Influència de l'ètnia en el comportament farmacocinètic dels antibiòtics

Un estudi retrospectiu realitzat a l'Hospital del Mar ha investigat la relació entre l'antibiòtic amikacina i l'ètnia dels pacients tractats amb ell entre gener de 2003 i desembre de 2010. Els resultats mostren una menor concentració en sang i una major eliminació del medicament en pacients magribins respecte d'altres pacients. Seria doncs recomanable monitoritzar les concentracions de l'antibiòtic en sang en pacients d'aquesta població per tal d'evitar el risc d'un tractament subòptim.Un estudio retrospectivo realizado en el Hospital del Mar ha investigado la relación entre el antibiótico amikacina y la etnia de los pacientes tratados con él entre enero de 2003 y diciembre de 2010. Los resultados muestran una menor concentración en sangre y una mayor eliminación del medicamento en pacientes magrebíes respecto a otros pacientes. Sería pues recomendable monitorizar las concentraciones del antibiótico en sangre en pacientes de esta población con el fin de evitar el riesgo de un tratamiento subóptimo

Cost-Effectiveness Analysis of Bezlotoxumab Added to Standard of Care Versus Standard of Care Alone for the Prevention of Recurrent Clostridium difficile Infection in High-Risk Patients in Spain

Introduction Clostridium difficile infection (CDI) is the major cause of infectious nosocomial diarrhoea and is associated with considerable morbidity, mortality and economic impact. Bezlotoxumab administered in combination with standard of care (SoC) antibiotic therapy prevents recurrent CDI. This study assessed the cost-effectiveness of bezlotoxumab added to SoC, compared to SoC alone, to prevent the recurrence of CDI in high-risk patients from the Spanish National Health System perspective. Methods A Markov model was used to simulate the natural history of CDI over a lifetime horizon in five populations of patients at high risk of CDI recurrence according to MODIFY trials: (1) ≥ 65 years old; (2) severe CDI; (3) immunocompromised; (4) ≥ 1 CDI episode in the previous 6 months; and (5) ≥ 65 years old and with ≥ 1 CDI episode in the previous 6 months. The incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained was calculated. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed. Results In all patient populations (from 1 to 5), bezlotoxumab added to SoC reduced CDI recurrence compared to SoC alone by 26.4, 19.5, 21.2, 26.6 and 39.7%, respectively. The resulting ICERs for the respective subgroups were €12,724, €17,495, €9545, €7386, and €4378. The model parameters with highest impact on the ICER were recurrence rate (first), mortality, and utility values. The probability that bezlotoxumab was cost-effective at a willingness-to-pay threshold of €21,000/QALY was 85.5%, 54.1%, 86.0%, 94.5%, 99.6%, respectively. Conclusion The results suggest that bezlotoxumab added to SoC compared to SoC alone is a cost-effective treatment to prevent the recurrence of CDI in high-risk patients. The influence of changes in model parameters on DSA results was higher in patients  ≥ 65 years old, with severe CDI and immunocompromised. Additionally, PSA estimated that the probability of cost-effectiveness exceeded 85% in most subgroups

Predicting current and future global distribution of invasive Ligustrum lucidum (W.T. Aiton) : assessing emerging risks to biodiversity hotspots

ACKNOWLEDGEMENTS We thank the Argentine National Council of Scientific and Technological Research (CONICET) and Rufford Small Grand (8204-2) for supporting the fieldwork and Project CONTAIN funded under the Latin American Biodiversity Programme, as part of the Newton Fund (NE/S011641/1) that constructed an international network among authors. S.J.E.V. thanks the postdoctoral fellowships supported by the National Science Foundation (Award 1853697) and the CONICET received during the time of this project. We are grateful to M. Ayup, PAPD of Jiangsu higher education, Nanjing Forestry University (China), and particularly to Professor Ruan Honghua, Zou Xiaoming and Qi Weilong to help with data collection and useful information. To P. Garcia-Diaz to improve the first version of this work. Particularly, we thank to three anonymous Reviewers and the Editor of DDI Dr Zhang, for their very useful suggestions and detailed revision.Peer reviewedPublisher PD

Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain

Anidulafungina; Cost-efectivitat; Aspergil·losi invasivaAnidulafungina; Coste-efectividad; Aspergilosis invasivaAnidulafungin, Cost-effectiveness; Invasive aspergillosisObjective: According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System. Methods: An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables. Results: According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763–16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively. Conclusion: According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy

La gamificación como recurso telemático en la comunicación empresarial en tiempos de pandemia

Este trabajo tiene como objetivo conocer, desde el punto de vista de los directivos de las empresas pequeñas y medianas con amplia utilización de las tecnologías digitales, si el alejamiento físico de las personas como consecuencia del teletrabajo (en rápido crecimiento por efectos de la pandemia de COVID-19) dificulta las relaciones interpersonales y el conocimiento de los objetivos y valores estratégicos de la empresa, y si ese mismo equipo directivo conoce y en qué grado utiliza la gamificación como posible herramienta para mejorar la comunicación interna con el fin de paliar o solucionar dicha situación. Para este estudio exploratorio se ha adoptado una perspectiva metodológica cualitativa, basada en una revisión de la bibliografía sobre el papel de la gamificación en la comunicación interna de las empresas y utilizando entrevistas en profundidad, semiestructuradas con preguntas abiertas y cerradas a los directivos de un grupo de pequeñas y medianas empresas que están en el ámbito de este análisis.The aim of this paper is to find out, from the point of view of managers of small and medium-sized enterprises that make extensive use of digital technologies, whether the physical remoteness of people as a result of teleworking (which is growing rapidly due to the effects of the COVID-19 pandemic) hinders interpersonal relations and knowledge of the company's strategic objectives and values, and whether this same management team is aware of and to what extent it uses gamification as a possible tool for improving internal communication to alleviate or solve this situation. For this exploratory study, a qualitative methodological perspective was adopted, based on a review of the literature on the role of gamification in the internal communication of companies and using in-depth, semistructured interviews with open and closed questions to the managers of a group of small and medium-sized companies within the scope of the study

Impact of changes in the WHO's 2019 update of DDDs on the measurement of adult hospital antibacterial consumption in Catalonia (Spain), 2008-18

In 2019 the WHO fully adopted new DDD values. The objective of this study is to analyse their impact on the measurement of consumption of antibacterials in hospitals participating in the Catalan Infection Control and Antimicrobial Stewardship National Program (VINCat-PROA) in Catalonia (Spain) between 2008 and 2018. The anatomical therapeutic chemical/DDD system was used to monitor adult hospital antibacterial consumption expressed in DDD/100 bed-days. Consumption from 2008 to 2018 was calculated using both pre- and post-update DDD values. Differences were calculated as the percentage variation in DDD/100 bed-days and analysed with Student's t -test. Simple linear regressions were performed to evaluate the trends in adult antimicrobial consumption over the study period. The overall consumption according to post-update DDD values decreased by 12.2% (P < 0.001) compared with the pre-update DDD values. Penicillins (−19.6.%; P < 0.001) and carbapenems (−19.0%; P = 0.023) showed the greatest reduction, followed by cephalosporins (−7.7%; P = 0.021) and quinolone antibacterials (−7.7%; P = 0.017). ICU services showed the greatest overall reduction (−13.1%; P < 0.001). From 2008 to 2018 there was a statistically significant decrease in consumption of penicillins and quinolone antibacterials and a statistically significant increase in cephalosporin and carbapenem consumption with both pre- and post-update DDD values. There were no variations in the ranking of consumption between the pre- and post-update DDD values. The WHO's updates of DDDs have had a significant impact on the measurement of antibacterial consumption. In our region, they have corrected an overestimation of penicillin and carbapenem consumption amounting to 19%. It is essential to bear these findings in mind for an accurate assessment of temporal trends and benchmarking

Splenogonadal fusion: An important differential diagnosis for testicular masses

Splenogonadal fusion is a rare cause of scrotal swelling. We present a case of a 9-year-old boy with a left testicular mass and phocomelia who was found to have splenogonadal fusion upon scrotal exploration. We discuss the etiology, pathophysiology and management of splenogonadal fusion

Potential role of tedizolid phosphate in the treatment of acute bacterial skin infections

Tedizolid phosphate (TR-701), a prodrug of tedizolid (TR-700), is a next-generation oxazolidinone that has shown favorable results in the treatment of acute bacterial skin and skin-structure infections in its first Phase III clinical trial. Tedizolid has high bioavailability, penetration, and tissue distribution when administered orally or intravenously. The activity of tedizolid was greater than linezolid against strains of Staphylococcus spp., Streptococcus spp., and Enterococcus spp. in vitro studies, including strains resistant to linezolid and those not susceptible to vancomycin or daptomycin. Its pharmacokinetic characteristics allow for a once-daily administration that leads to a more predictable efficacy and safety profile than those of linezolid. No hematological adverse effects have been reported associated with tedizolid when used at the therapeutic dose of 200 mg in Phase I, II, or III clinical trials of up to 3 weeks of tedizolid administration. Given that the clinical and microbiological efficacy are similar for the 200, 300, and 400 mg doses, the lowest effective dose of 200 mg once daily for 6 days was selected for Phase III studies in acute bacterial skin and skin-structure infections, providing a safe dosing regimen with low potential for development of myelosuppression. Unlike linezolid, tedizolid does not inhibit monoamine oxidase in vivo, therefore interactions with adrenergic, dopaminergic, and serotonergic drugs are not to be expected. In conclusion, tedizolid is a novel antibiotic with potent activity against Gram-positive microorganisms responsible for skin and soft tissue infections, including strains resistant to vancomycin, linezolid, and daptomycin, thus answers a growing therapeutic need

Recent advances in thermosensitive hydrogels as drug delivery systems: A review

Polymers that exhibit physicochemical responses to stimuli have been widely explored as potential drug delivery systems. Different kind of stimuli investigated to date includes, for example, chemical substances and changes in temperature, pH and electric fields. Polymers that exhibit dramatic changes in their behavior in an aqueous solution at temperatures close to the body temperature are of particular interest in drug delivery and biomedical applications. Thermosensitive polymers have a wide range of applications, specially, the thermosensitive triblock copolymers because they exhibit unique aqueous solution properties, biodegradability and biocompatibility. These copolymers can be designed to be used as potential drug delivery systems for therapeutic protein drugs or poorly water soluble drugs. This article reviews the applications of polymer solutions with the ability to form in situ implants under temperature changes, in areas of interest to biomedical, pharmacist and engineer scientists. Recent advantages on thermosensitive and biodegradable polymers are discussed to give a wide overview of the available strategies to modify them in order to make them suitable for potential applications in health products.Fil: Bermudez, Jose Maria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Quinteros, Daniela Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; ArgentinaFil: Grau, Ricardo José Antonio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Allemandi, Daniel Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; ArgentinaFil: Palma, Santiago Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; Argentin