1
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Stewart S, Gómez López de Las Huertas A, Jiménez-González M, Carcas AJ, Borobia AM, Ramírez E. ALDRESS: A Retrospective Pilot Study to Develop a Pharmacological Causality Algorithm for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). J Clin Med 2024; 13:2622. [PMID: 38731156 DOI: 10.3390/jcm13092622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/18/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome represents a severe form of drug hypersensitivity reaction characterized by significant morbidity, mortality, and long-term sequelae, coupled with limited therapeutic avenues. Accurate identification of the causative drug(s) is paramount for acute management, exploration of safe therapeutic alternatives, and prevention of future occurrences. However, the absence of a standardized diagnostic test and a specific causality algorithm tailored to DRESS poses a significant challenge in its clinical management. Methods: We conducted a retrospective case-control study involving 37 DRESS patients to validate a novel causality algorithm, the ALDRESS, designed explicitly for this syndrome, comparing it against the current standard algorithm, SEFV. Results: The ALDRESS algorithm showcased superior performance, exhibiting an 85.7% sensitivity and 93% specificity with comparable negative predictive values (80.6% vs. 97%). Notably, the ALDRESS algorithm yielded a substantially higher positive predictive value (75%) compared to SEFV (51.40%), achieving an overall accuracy rate of 92%. Conclusions: Our findings underscore the efficacy of the ALDRESS algorithm in accurately attributing causality to drugs implicated in DRESS syndrome. However, further validation studies involving larger, diverse cohorts are warranted to consolidate its clinical utility and broaden its applicability. This study lays the groundwork for a refined causality assessment tool, promising advancements in the diagnosis and management of DRESS syndrome.
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Affiliation(s)
- Stefan Stewart
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Arturo Gómez López de Las Huertas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | | | - Antonio J Carcas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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2
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Elizalde MU, Eguinoa FJG, de Las Huertas AGL, Jiménez-González M, Ramírez E. Myocarditis and pericarditis risk with mRNA COVID-19 vaccination compared to unvaccinated individuals: A retrospective cohort study in a Spanish Tertiary Hospital. Biomed Pharmacother 2024; 171:116181. [PMID: 38262150 DOI: 10.1016/j.biopha.2024.116181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/31/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This study compared the incidence of pericarditis and myocarditis in patients exposed to mRNA COVID-19 vaccines to the incidence in those who were not vaccinated, considering the incidence of these conditions resulting from COVID-19 infection. METHODS This was a retrospective cohort study of individuals assigned to health area of La Paz University Hospital in Spain. The exposure factor was vaccination with mRNA COVID-19 vaccines between December 27th, 2020 and January 9th, 2022 with a minimum follow-up of one month. The outcome was the incidence of pericarditis or myocarditis in these individuals. RESULTS The incidence of pericarditis and myocarditis in the total population exposed to at least one dose of mRNA COVID-19 vaccines was 5/100,000 (CI95%:3 to 8 per 100,000), compared to 70/100,000 (CI95%: 66 to 92 per 100,000) in those who were not vaccinated. In the adolescent population (aged 12-17), the incidence was 10/100,000 in vaccinated population (CI95%: 5 to 45 per 100,000) compared to 20/100,000 in unvaccinated (CI95%: 6 to 79 per 100,000). The incidence of pericarditis or myocarditis in patients with COVID-19 infection was 200/100,000 people (CI95%: 114 to 306 per 100,000). The most common cause of pericarditis and myocarditis in the cohort was idiopathic/infectious (74 cases). Cases of myocarditis attributed to COVID-19 infection were more severe and had higher mortality rates compared to cases with other causes. CONCLUSION The incidence of pericarditis and myocarditis in patients exposed to mRNA COVID-19 vaccines was lower than in those who were not vaccinated, especially in adults.The most common cause of pericarditis and myocarditis was idiopathic/infectious, but the most frequent cause in adolescent patients was mRNA COVID-19 vaccination. Cases of myocarditis due to COVID-19 infection were more severe and had greater mortality.
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Affiliation(s)
- Mikel Urroz Elizalde
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain.
| | - Francisco Javier Guijarro Eguinoa
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Arturo Gómez López de Las Huertas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - María Jiménez-González
- Clinical Trial Unit, La Paz University Hospital-IdiPAZ, Spain; Infectious Disease Unit, La Paz University Hospital-IdiPAZ, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain.
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3
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Rogozina O, Ruiz-Fernández C, Martín-López S, Akatbach-Bousaid I, González-Muñoz M, Ramírez E. Organ-specific immune-mediated reactions to polyethylene glycol and polysorbate excipients: three case reports. Front Pharmacol 2024; 14:1293294. [PMID: 38235115 PMCID: PMC10792031 DOI: 10.3389/fphar.2023.1293294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
Drug-related acute pancreatitis (AP), acute interstitial nephritis (AIN) and drug-induced liver injury (DILI) are rare but serious adverse drug reactions (ADRs) that can have life-threatening consequences. Although the diagnosis of these ADRs can be challenging, causality algorithms and the lymphocyte transformation test (LTT) can be employed to help with the diagnosis. In this report, we present 3 cases of drug-related AP, AIN and DILI. The first case involved a patient with AP to lacosamide and to the excipient polysorbate 80 in pantoprazole. The second case involved a patient with DILI secondary to polyethylene glycol (PEG) excipients and amoxicillin-clavulanate. In case 3, AIN was considered to be the result of sensitization to excipients. Diagnoses were made using causality algorithms and the LTT. The LTT is a useful tool for helping diagnose drug-related AP and DILI, and it can be used to identify the specific drug or excipient causing the ADR. These cases highlight the importance of considering PEG and polysorbate excipients in the causality diagnosis of ADRs.
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Affiliation(s)
- Olga Rogozina
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | - Susana Martín-López
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
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4
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Muruzábal JC, Veiga N, Aguirre S, Guelbenzu JJ, Ramírez E. Video assisted thoracoscopic surgery and its applicability in patients with advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:1658-1659. [PMID: 37146995 DOI: 10.1136/ijgc-2023-004359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Affiliation(s)
| | - Nadia Veiga
- Ginecología Oncológica, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Sara Aguirre
- Ginecología Oncológica, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Juan José Guelbenzu
- Cirugía Torácica, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Elena Ramírez
- Cirugía Torácica, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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5
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Ruiz-Fernández C, Cuesta R, Martín-López S, Guijarro J, López Gómez de Las Huertas A, Urroz M, Miguel-Berenguel L, González-Muñoz M, Ramírez E. Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study. Pharmaceuticals (Basel) 2023; 16:ph16050720. [PMID: 37242502 DOI: 10.3390/ph16050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 caused the global COVID-19 pandemic and public health crisis, and it led to the rapid development of COVID-19 vaccines, which can cause rare and typically mild hypersensitivity reactions (HRs). Delayed HRs to COVID-19 vaccines have been reported, and the excipients polyethylene glycol (PEG)2000 and polysorbate 80 (P80) are the suspected culprits. Skin patch tests do not help in diagnosing delayed reactions. We aimed to perform lymphocyte transformation tests (LTT) with PEG2000 and P80 in 23 patients with suspected delayed HRs. Neurological reactions (n = 10) and myopericarditis reactions (n = 6) were the most frequent complications. Seventy-eight percent (18/23) of the study patients were admitted to a hospital ward, and the median time to discharge was 5.5 (IQR, 3-8) days. Some 73.9% of the patients returned to baseline condition after 25 (IQR, 3-80) days. LTT was positive in 8/23 patients (5/10 neurological reactions, 2/4 hepatitis reactions and 1/2 rheumatologic reactions). All myopericarditis cases had a negative LTT. These preliminary results indicate that LTT with PEGs and polysorbates is a useful tool for identifying excipients as causal agents in HRs to COVID-19 vaccines and can play an important role in risk stratification in patients with HRs.
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Affiliation(s)
| | - Ricardo Cuesta
- Immunology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain
| | - Susana Martín-López
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Javier Guijarro
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Arturo López Gómez de Las Huertas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Mikel Urroz
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | | | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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6
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Ramírez E, González-Muñoz M, Kulkarni C, De Abajo FJ. Editorial: Reducing the harm of medication–recent trends in pharmacovigilance (volume II). Front Pharmacol 2023; 14:1175039. [PMID: 37089940 PMCID: PMC10114211 DOI: 10.3389/fphar.2023.1175039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- *Correspondence: Elena Ramírez,
| | | | | | - Francisco J. De Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
- Department of Biomedical Sciences (Pharmacology Section), University of Alcalá (IRYCIS), Madrid, Spain
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7
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Nin-Valencia A, Domínguez-Ortega J, Cabañas R, Sánchez H, Fiandor A, Lluch M, Ramírez E, Gómez-Traseira C, Rodríguez A, González-Muñoz M. The Lymphocyte Transformation Test in Delayed Hypersensitivity Reactions Induced by Ibuprofen and/or Metamizole. J Investig Allergol Clin Immunol 2023; 33:52-53. [PMID: 35416155 DOI: 10.18176/jiaci.0814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Nin-Valencia
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
| | - J Domínguez-Ortega
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium
| | - R Cabañas
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium
| | - H Sánchez
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
| | - A Fiandor
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium
| | - M Lluch
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - E Ramírez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium.,Department of Clinical Pharmacology, University Hospital La Paz, Madrid, Spain
| | - C Gómez-Traseira
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium
| | - A Rodríguez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Clinical Pharmacology, University Hospital La Paz, Madrid, Spain
| | - M González-Muñoz
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Immunology, Hospital Universitario La Paz, Madrid, Spain
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8
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Bellón T, Lerma V, Guijarro J, Ramírez E, Martínez C, Escudero C, Fiandor AM, Barranco R, de Barrio M, de Abajo F, Cabañas R. LTT and HLA testing as diagnostic tools in Spanish vancomycin-induced DRESS cases: A case-control study. Front Pharmacol 2022; 13:959321. [PMID: 36339612 PMCID: PMC9631441 DOI: 10.3389/fphar.2022.959321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/03/2022] [Indexed: 11/23/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe T-cell-mediated off-target adverse reaction. DRESS cases caused by vancomycin have often been reported. The HLA-A*32:01 allele has been associated with genetic susceptibility to vancomycin-induced DRESS in US citizens of European descent. We have analyzed the association of the HLA-A*32:01 allele in 14 Spanish DRESS cases in which vancomycin was suspected as the culprit drug, and the lymphocyte transformation test (LTT) as an in vitro assay to evaluate vancomycin sensitization. The results were compared to vancomycin-tolerant control donors. LTT was performed in 12 DRESS cases with PBMCs from resolution samples available and in a group of 12 tolerant donors. ROC curves determined that LTT is a suitable tool to identify patients sensitized to vancomycin (AUC = 0.9646; p < 0.0001). When a stimulation index >3 was regarded as a positive result, contingency tables determined 91% sensitivity, 91.67% specificity, 91% positive predictive value, and 91.67% negative predictive value (p = 0.0001, Fisher’s exact test). The HLA A*32:01 allele was determined by an allele-specific PCR assay in 14 cases and 25 tolerant controls. Among the DRESS cases, five carriers were identified (35.7%), while it was detected in only one (4%) of the tolerant donors, [odds ratio (OR) = 13.33; 95% CI: 1.364–130.3; p = 0.016]. The strength of the association increased when only cases with positive LTT to vancomycin were considered (OR = 24.0; 95% CI: 2.28–252.6; p = 4.0 × 10−3). Our results confirm the association of the risk allele HLA-A*32:01 with vancomycin-induced DRESS in Spanish cases, and support LTT as a reliable tool to determine vancomycin sensitization.
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Affiliation(s)
- Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz (IdiPaz), Madrid, Spain
- *Correspondence: Teresa Bellón,
| | - Victoria Lerma
- Clinical Pharmacology Unit, Hospital Universitario Príncipe de Asturias, Madrid, Spain
- Department of Biomedical Sciences, University of Alcalá (IRYCIS), Madrid, Spain
| | - Javier Guijarro
- Clinical Pharmacology Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Celia Martínez
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - Carmelo Escudero
- Allergy Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Ana M. Fiandor
- Allergy Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Ruth Barranco
- Allergy Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Francisco de Abajo
- Clinical Pharmacology Unit, Hospital Universitario Príncipe de Asturias, Madrid, Spain
- Department of Biomedical Sciences, University of Alcalá (IRYCIS), Madrid, Spain
| | - Rosario Cabañas
- Allergy Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
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9
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Ramírez E, González-Munoz M, Kulkarni C, de Abajo FJ. Editorial: Reducing the Harm of Medication–Recent Trends in Pharmacovigilance. Front Pharmacol 2022; 13:964125. [PMID: 36110529 PMCID: PMC9469192 DOI: 10.3389/fphar.2022.964125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- *Correspondence: Elena Ramírez,
| | | | - Chanda Kulkarni
- Free Lancer-Clinical Pharmacologist, Rajeev Gandhi University of Health Sceinces Bangalore, Bangalore, India
| | - Francisco J. de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
- Department of Biomedical Sciences (Pharmacology Section), University of Alcalá (IRYCIS), Madrid, Spain
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10
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Rodríguez A, García-García I, Martínez de Soto L, Gómez López De Las Huertas A, Borobia AM, González-Torbay A, Akatbach-Bousaid I, González-Muñoz M, Ramírez E. Utility of Lymphocyte Transformation Test for Assisting Updated Roussel Uclaf Causality Assessment Method in Drug-Induced Liver Injury: A Case-Control Study. Front Pharmacol 2022; 13:819589. [PMID: 35370653 PMCID: PMC8965575 DOI: 10.3389/fphar.2022.819589] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The Roussel Uclaf Causality Assessment Method (RUCAM) is a validated tool for assessing causality in cases of suspected drug-induced liver injury (DILI). However, RUCAM cannot discriminate between concomitant hepatotoxic drugs with the same temporal sequence. Objective: To analyse the utility of the lymphocyte transformation test (LTT) for assisting updated RUCAM in 45 patients and 40 controls with a clinical diagnosis of DILI. Methods: Suspected DILI cases were detected through the Prospective Pharmacovigilance Program from Laboratory Signals in Hospital (PPLSH) or by consultations. The controls completed the drug therapy with no adverse reactions during the study period. A receiver operating characteristics (ROC) curve analysis was performed to calculate the optimal cut-off value for the stimulation index (SI), corresponding to the largest sum for the specificity and sensitivity values of LTT for true DILI cases. Results: Out of 45 patients diagnosed with DILI, 42 cases were detected by the PPLSH, two cases by consultation and one case by both methods. Most DILI cases (64.4%) arose during hospitalization. According to the biochemical parameters, 24 cases (53.3%) had the hepatocellular phenotype, 14 (31.1%) had the cholestatic phenotype, and 7 cases (15.6%) had the mixed phenotype. Considering the severity criteria, 7 (15.5%) cases were classified as moderate DILI, and 4 (8.9%) were severe DILI; there were no fatal cases. A total of 149 drugs (median/case, 3; IQR, 2–5) were suspected to be involved in the DILI cases (RUCAM score ≥3). In 8 cases, only one drug was suspected, and polypharmacy (≥5 drugs) was identified in 29% of the cases. Of all DILI cases, 46 (30.9%) of the 149 suspected drugs produced positive LTT results, and the LTT was positive in 34 (75.5%) of the 45 patients. No exposed controls produced positive LTT results. The optimal cut-off of 1.95 for the SI was obtained with a sensitivity of 77% and specificity of 100% (area under the curve, 0.91; 95% asymptotic confidence interval 0.84–0.97; p < 0.001). The sensitivity of the hepatocellular phenotype was 92%. Conclusion: Our results demonstrate that LTT is an add on strengthening causality in cases of suspected idiosyncratic DILI, especially for patients with several suspected drugs and a hepatocellular phenotype.
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Affiliation(s)
- Amelia Rodríguez
- Clinical Pharmacology Department, Faculty of Medicine, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Irene García-García
- Clinical Pharmacology Department, Faculty of Medicine, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lucía Martínez de Soto
- Clinical Pharmacology Department, Faculty of Medicine, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Arturo Gómez López De Las Huertas
- Clinical Pharmacology Department, Faculty of Medicine, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto M. Borobia
- Clinical Pharmacology Department, Faculty of Medicine, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Miguel González-Muñoz
- Immunology Department, La Paz University Hospital-IdiPAZ, Madrid, Spain
- *Correspondence: Miguel González-Muñoz, ; Elena Ramírez,
| | - Elena Ramírez
- Clinical Pharmacology Department, Faculty of Medicine, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
- *Correspondence: Miguel González-Muñoz, ; Elena Ramírez,
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11
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Vílchez-Sánchez F, Busto Leis JM, Sendagorta E, Ramírez E, Fiandor A, Bellón T, De Soto Álvarez T, Sánchez Ocando H, Heredia Revuelto R, Cabañas R. Allopurinol induced - DRESS and neo-sensitization to thalidomide: complex management and diagnosis in a patient with multiple myeloma. J Investig Allergol Clin Immunol 2022; 32:406-407. [PMID: 35029153 DOI: 10.18176/jiaci.0776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F Vílchez-Sánchez
- Institute for Health Research (IdiPAZ), Madrid, Spain.,Allergy Department, La Paz University Hospital, Madrid, Spain
| | - J M Busto Leis
- Dermatology Department, La Paz University Hospital, Madrid, Spain
| | - E Sendagorta
- Dermatology Department, La Paz University Hospital, Madrid, Spain.,PIELenRed Consortium
| | - E Ramírez
- Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium.,Pharmacology Department La Paz University Hospital, Madrid, Spain
| | - A Fiandor
- Institute for Health Research (IdiPAZ), Madrid, Spain.,Allergy Department, La Paz University Hospital, Madrid, Spain.,PIELenRed Consortium
| | - T Bellón
- Institute for Health Research (IdiPAZ), Madrid, Spain.,PIELenRed Consortium.,Drug Hypersensitivity Laboratory, IdiPAZ, Madrid, Spain
| | | | | | | | - R Cabañas
- Institute for Health Research (IdiPAZ), Madrid, Spain.,Allergy Department, La Paz University Hospital, Madrid, Spain.,PIELenRed Consortium.,Centro de Investigación en Red de Enfermedades Raras (CIBERER, U754)
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12
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Monserrat Villatoro J, Mejía-Abril G, Díaz García L, Zubiaur P, Jiménez González M, Fernandez Jimenez G, Cancio I, Arribas JR, Suarez Fernández C, Mingorance J, García Rodríguez J, Villagrasa Ferrer JR, Carcas AJ, Frías J, Abad-Santos F, Borobia AM, Ramírez E. A Case-Control of Patients with COVID-19 to Explore the Association of Previous Hospitalisation Use of Medication on the Mortality of COVID-19 Disease: A Propensity Score Matching Analysis. Pharmaceuticals (Basel) 2022; 15:ph15010078. [PMID: 35056135 PMCID: PMC8780256 DOI: 10.3390/ph15010078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
Data from several cohorts of coronavirus disease 2019 (COVID-19) suggest that the most common comorbidities for severe COVID-19 disease are the elderly, high blood pressure, and diabetes; however, it is not currently known whether the previous use of certain drugs help or hinder recovery. This study aims to explore the association of previous hospitalisation use of medication on the mortality of COVID-19 disease. A retrospective case-control from two hospitals in Madrid, Spain, included all patients aged 18 years or above hospitalised with a diagnosis of COVID-19. A Propensity Score matching (PSM) analysis was performed. Confounding variables were considered to be age, sex, and the number of comorbidities. Finally, 3712 patients were included. Of these, 687 (18.5%) patients died (cases). The 22,446 medicine trademarks used previous to admission were classified according to the ATC, obtaining 689 final drugs; all of them were included in PSM analysis. Eleven drugs displayed a reduction in mortality: azithromycin, bemiparine, budesonide-formoterol fumarate, cefuroxime, colchicine, enoxaparin, ipratropium bromide, loratadine, mepyramine theophylline acetate, oral rehydration salts, and salbutamol sulphate. Eight final drugs displayed an increase in mortality: acetylsalicylic acid, digoxin, folic acid, mirtazapine, linagliptin, enalapril, atorvastatin, and allopurinol. Medication associated with survival (anticoagulants, antihistamines, azithromycin, bronchodilators, cefuroxime, colchicine, and inhaled corticosteroids) may be candidates for future clinical trials. Drugs associated with mortality show an interaction with the underlying conditions.
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Affiliation(s)
- Jaime Monserrat Villatoro
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.M.V.); (L.D.G.); (A.J.C.); (J.F.)
| | - Gina Mejía-Abril
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (G.M.-A.); (P.Z.)
| | - Lucía Díaz García
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.M.V.); (L.D.G.); (A.J.C.); (J.F.)
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (G.M.-A.); (P.Z.)
| | | | - Guillermo Fernandez Jimenez
- Medical Information Unit, Instituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, 28006 Madrid, Spain; (G.F.J.); (I.C.)
| | - Inés Cancio
- Medical Information Unit, Instituto de Investigación Sanitaria La Princesa (IP), Hospital Universitario de La Princesa, 28006 Madrid, Spain; (G.F.J.); (I.C.)
| | - José Ramón Arribas
- Internal Medicine Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain;
| | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain;
| | - Jesús Mingorance
- Microbiology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.M.); (J.G.R.)
| | - Julio García Rodríguez
- Microbiology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain; (J.M.); (J.G.R.)
| | - José Ramón Villagrasa Ferrer
- Preventive Medicine Department, Hospital Universitario de La Princesa, Faculty of Medicine, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain;
| | - Antonio J. Carcas
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.M.V.); (L.D.G.); (A.J.C.); (J.F.)
| | - Jesús Frías
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.M.V.); (L.D.G.); (A.J.C.); (J.F.)
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), 28006 Madrid, Spain; (G.M.-A.); (P.Z.)
- Correspondence: (F.A.-S.); (A.M.B.); (E.R.); Tel.: +34-915-202200 (F.A.-S.); +34-917-277000 (A.M.B. & E.R.)
| | - Alberto M. Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.M.V.); (L.D.G.); (A.J.C.); (J.F.)
- Correspondence: (F.A.-S.); (A.M.B.); (E.R.); Tel.: +34-915-202200 (F.A.-S.); +34-917-277000 (A.M.B. & E.R.)
| | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.M.V.); (L.D.G.); (A.J.C.); (J.F.)
- Correspondence: (F.A.-S.); (A.M.B.); (E.R.); Tel.: +34-915-202200 (F.A.-S.); +34-917-277000 (A.M.B. & E.R.)
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Flores B, Ramírez E, Moncada A, Salinas N, Fischer R, Hernández C, Mora-Sánchez B, Sheleby-Elías J, Jirón W, Balcázar JL. Antimicrobial effect of Moringa oleifera seed powder against Vibrio cholerae isolated from the rearing water of shrimp (Penaeus vannamei) postlarvae. Lett Appl Microbiol 2021; 74:238-246. [PMID: 34806784 DOI: 10.1111/lam.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/01/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Shrimp farming has experienced rising costs as a result of disease outbreaks associated with Vibrio spp. Suitable strategies for disease prevention and control are therefore urgently needed. This study aimed to evaluate the antimicrobial effect of Moringa oleifera seed powder against Vibrio cholerae in the rearing water of Pacific white shrimp (Penaeus vannamei) postlarvae. In vitro assays included the determination of minimum inhibitory concentration (MIC) of M. oleifera seed powder against V. cholerae, whereas in vivo assays included the effect of M. oleifera seed powder on bacterial load and water quality parameters in the rearing tanks, as well as its effect on shrimp postlarvae survival. M. oleifera seed powder inhibited the growth of V. cholerae with MIC values of 62·5 µg ml-1 . Moreover, seawater pH of treated tanks (8·66) was significantly lower (P < 0·01) than pH of the control tanks (9·02), whereas the visibility of treated tanks (37·08 cm) was significantly higher (P < 0·01) as compared to control tanks (35·37 cm). Likewise, V. cholerae load was significantly reduced (P < 0·01) from 4·7 × 104 to 3·1 × 103 CFU per ml in tanks treated with M. oleifera seed powder. Altogether, this study demonstrates the antimicrobial activity of M. oleifera against V. cholerae in shrimp culture.
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Affiliation(s)
- B Flores
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - E Ramírez
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - A Moncada
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - N Salinas
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - R Fischer
- Department of Epidemiology and Biostatistics, Texas A & M University Health Science Center, College Station, TX, USA
| | - C Hernández
- Departamento Acuícola, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - B Mora-Sánchez
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua.,Department of Animal Pathology, Faculty of Veterinary Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - J Sheleby-Elías
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - W Jirón
- Centro Veterinario de Diagnóstico e Investigación (CEVEDI), Departamento de Veterinaria y Zootecnia, Escuela de Ciencias Agrarias y Veterinarias, Universidad Nacional Autónoma de Nicaragua-León (UNAN-León), León, Nicaragua
| | - J L Balcázar
- Catalan Institute for Water Research (ICRA), Girona, Spain
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Delgado A, Stewart S, Urroz M, Rodríguez A, Borobia AM, Akatbach-Bousaid I, González-Muñoz M, Ramírez E. Characterisation of Drug-Induced Liver Injury in Patients with COVID-19 Detected by a Proactive Pharmacovigilance Program from Laboratory Signals. J Clin Med 2021; 10:jcm10194432. [PMID: 34640458 PMCID: PMC8509270 DOI: 10.3390/jcm10194432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has a wide spectrum of clinical manifestations. An elevation of liver damage markers has been observed in numerous cases, which could be related to the empirical use of potentially hepatotoxic drugs. The aim of this study was to describe the clinical and analytical characteristics and perform a causality analysis from laboratory signals available of drug-induced liver injury (DILI) detected by a proactive pharmacovigilance program in patients hospitalised for COVID-19 at La Paz University Hospital in Madrid (Spain) from 1 March 2020 to 31 December 2020. The updated Roussel Uclaf Causality Assessment Method (RUCAM) was employed to assess DILI causality. A lymphocyte transformation test (LTT) was performed on 10 patients. Ultimately, 160 patients were included. The incidence of DILI (alanine aminotransferase >5, upper limit of normal) was 4.9%; of these, 60% had previous COVID-19 hepatitis, the stay was 8.1 days longer and 98.1% were being treated with more than 5 drugs. The most frequent mechanism was hepatocellular (57.5%), with mild severity (87.5%) and subsequent recovery (88.1%). The most commonly associated drugs were hydroxychloroquine, azithromycin, tocilizumab and ceftriaxone. The highest incidence rate of DILI per 10,000 defined daily doses (DDD) was with remdesivir (992.7/10,000 DDD). Some 80% of the LTTs performed were positive, with a RUCAM score of ≥4. The presence of DILI after COVID-19 was associated with longer hospital stays. An immune mechanism has been demonstrated in a small subset of DILI cases.
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Affiliation(s)
- Ana Delgado
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Stefan Stewart
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Mikel Urroz
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Amelia Rodríguez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Alberto M. Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | | | - Miguel González-Muñoz
- Immunology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain;
- Correspondence: (M.G.-M.); (E.R.); Tel./Fax: +34-917-277-558 (M.G.-M.); +34-917-277-559 (E.R.)
| | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
- Correspondence: (M.G.-M.); (E.R.); Tel./Fax: +34-917-277-558 (M.G.-M.); +34-917-277-559 (E.R.)
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15
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Ramírez E, Vives Lara E, A V, Rodríguez-Gómez F. Proposal for technological adaptation of small-sized green olives to Spanish-STYLE processing. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Pedraza L, Laosa O, Rodríguez-Mañas L, Gutiérrez-Romero DF, Frías J, Carnicero JA, Ramírez E. Drug Induced Liver Injury in Geriatric Patients Detected by a Two-Hospital Prospective Pharmacovigilance Program: A Comprehensive Analysis Using the Roussel Uclaf Causality Assessment Method. Front Pharmacol 2021; 11:600255. [PMID: 33613279 PMCID: PMC7892439 DOI: 10.3389/fphar.2020.600255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background/aim: A prospective evaluation of drug-induced liver injury (DILI) in two tertiary hospitals was conducted through a pharmacovigilance program from laboratory signals at hospital (PPLSH) to determine the principal characteristics of DILI in patients older than 65 years, a growing age group worldwide, which is underrepresented in the literature on DILI. Methods: All DILI in patients older than 65 years detected by PPLSH in two hospitals were followed up for 8 years in the La Paz Hospital and 2 years in the Getafe Hospital. A descriptive analysis was conducted that determined the causality of DILI and suspected drugs, the incidence of DILI morbidities, DILI characteristics, laboratory patterns, evolution and outcomes. Results: 458 DILI cases in 441 patients were identified, 31.0% resulting in hospitalisation and 69.0% developing during hospitalisation. The mean age was 76.61 years old (SD, 7.9), and 54.4% were women. The DILI incidence was 76.33/10,000 admissions (95%CI 60.78–95.13). Polypharmacy (taking >4 drugs) was present in 86.84% of patients, 39.68% of whom took >10 drugs. The hepatocellular phenotype was the most frequent type of DILI (53.29%), a higher proportion (65%) had a mild severity index, and, in 55.2% of the evaluated drugs the RUCAM indicated that the causal relationship was highly probable. The most frequently employed drugs were paracetamol (50-cases), amoxicillin-clavulanate (42-cases) and atorvastatin (37-cases). The incidence rate of in-hospital DILI per 10,000 DDDs was highest for piperacillin-tazobactam (66.96/10,000 DDDs). A higher risk of in-hospital DILI was associated with the therapeutic chemical group-J (antiinfectives for systemic use) (OR, 2.65; 95%CI 1.58–4.46) and group-N (central nervous system drugs) (OR, 2.33; 95%CI 1.26–4.31). The patients taking >4 medications presented higher maximum creatinine level (OR, 2.01; 95%CI 1.28–3.15), and the patients taking >10 medications had a higher use of group J drugs (OR, 2.08; 95%IC 1.31–3.32). Conclusion: The incidence rate of DILI in the patients older than 65 years was higher than expected. DILI in elderly patients is mild, has a good outcome, has a hepatocellular pattern, develops during hospitalisation, and prolongs the hospital stay. Knowing the DILI incidence and explanatory factors will help improve the therapy of the elderly population.
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Affiliation(s)
- Laura Pedraza
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, Getafe, Spain
| | - Olga Laosa
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, Getafe, Spain.,Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III., Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III., Madrid, Spain.,Division of Geriatrics, University Hospital of Getafe, Getafe, Spain
| | | | - Jesús Frías
- Clinical Pharmacology departments, La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - José Antonio Carnicero
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, Getafe, Spain.,Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III., Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology departments, La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain.,Clinical pharmacology department, University Hospital La Paz, La Paz, Spain
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Ramírez E, Urroz M, Rodríguez A, González-Muñoz M, Martín-Vega A, Villán Y, Seco E, Monserrat J, Frías J, Carcas AJ, Borobia AM. Incidence of Suspected Serious Adverse Drug Reactions in Corona Virus Disease-19 Patients Detected by a Pharmacovigilance Program by Laboratory Signals in a Tertiary Hospital in Spain: Cautionary Data. Front Pharmacol 2020; 11:602841. [PMID: 33343374 PMCID: PMC7744878 DOI: 10.3389/fphar.2020.602841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND: From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious adverse drug reactions (SADRs) in COVID-19 patients vs. non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019. METHODS: All ALSs that reflected potential SADRs including neutropenia, pancytopenia, thrombocytopenia, anemia, eosinophilia, leukocytes in cerebrospinal fluid, hepatitis, pancreatitis, acute kidney injury, rhabdomyolysis, and hyponatremia were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients. RESULTS: The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89-816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients, 95% CI 137.09-186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53-154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%). CONCLUSIONS: The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.
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Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Mikel Urroz
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Amelia Rodríguez
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | | | - Yuri Villán
- Safety and Quality Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Enrique Seco
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Jaime Monserrat
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Antonio J Carcas
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Alberto M Borobia
- Department of Clinical Pharmacology, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
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Vílchez‐Sánchez F, Loli‐Ausejo D, Rodriguez‐Mariblanca A, Montserrat‐Villatoro J, Ramírez E, Domínguez‐Ortega J, González‐Muñoz M. Lymphocyte transformation test can be useful for the diagnosis of delayed adverse reactions to sulfonamides. Allergy 2020; 75:3267-3272. [PMID: 32506576 DOI: 10.1111/all.14437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | | | - Elena Ramírez
- Pharmacology Department La Paz University Hospital Madrid Spain
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19
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González‐Muñoz M, Monserrat Villatoro J, Marín‐Serrano E, Stewart S, Bardón Rivera B, Marín J, Martínez de Soto L, Seco Meseguer E, Ramírez E. A case report of a drug-induced liver injury (DILI) caused by multiple antidepressants with causality established by the updated Roussel Uclaf causality assessment method (RUCAM) and in vitro testing. Clin Case Rep 2020; 8:3105-3109. [PMID: 33363890 PMCID: PMC7752543 DOI: 10.1002/ccr3.3348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/17/2020] [Accepted: 08/22/2020] [Indexed: 12/13/2022] Open
Abstract
A 56-year-old female patient was hospitalized because of a lack of response and poor tolerance to multiple antidepressants, which included an episode of DILI. During hospitalization, the patient suffered another episode of DILI. Causality was assessed both by RUCAM and Lymphocyte Transformation Test, allowing to identify a safer medication.
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Affiliation(s)
- Miguel González‐Muñoz
- Immunology DepartmentLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazMadridEspaña
| | - Jaime Monserrat Villatoro
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Eva Marín‐Serrano
- Gastroenterology and Hepatology DepartmentLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazMadridEspaña
| | - Stefan Stewart
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Belén Bardón Rivera
- Psiquiatry DepartmentLa Paz‐Cantoblanco‐Carlos III University Hospital, IdiPazMadridEspaña
| | - Jesús Marín
- Psiquiatry DepartmentLa Paz‐Cantoblanco‐Carlos III University Hospital, IdiPazMadridEspaña
| | - Lucía Martínez de Soto
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Enrique Seco Meseguer
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
| | - Elena Ramírez
- Clinical Pharmacology DepartmentFacultad de MedicinaLa Paz‐Cantoblanco‐Carlos III University HospitalIdiPazUniversidad Autónoma de MadridMadridEspaña
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Garcia Urbán J, Gurrado K, Brea Rivas PC, Abou Elrous D, Zubimendi Machain M, Romero Gómez M, García Rodríguez J, Vicandi Plaza B, Yébenes Gregorio L, García Fernández E, Jiménez Martín C, López Oliva MO, González García E, Ledesma Sánchez G, Carreño Cornejo G, Selgas Gutiérrez R, Zarauza Santoveña A, Melgosa Hijosa M, Fernández Camblor C, Mozo Del Castillo Y, Sisinni L, Bueno Sánchez D, Pérez-Martínez A, Sánchez Zapardiel E, López Granados E, Monserrat Villatoro J, Hernández Zabala R, Borobia AM, Frías J, Ramírez E. A case-control study to assess the role of polyomavirus in transplant complications: Where do we stand? Transpl Infect Dis 2020; 22:e13432. [PMID: 32738811 DOI: 10.1111/tid.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia. METHODS Case-control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matched 1:1 with controls. Control group consists of the patient who received a transplant immediately before or after each identified case and did have nil viremia. FINDING Ultimately, 120 cases of BK polyomavirus (BKPyV) were detected and matched with 130 controls. Of these, 54 were adult kidney transplant recipients (KTRs), 43 were pediatric KTRs, and 23 were undergoing hemato-oncologic therapy, of which 20 were undergoing hematopoietic stem cell transplantation. The odds ratio (OR) for overall risk of poorer outcomes in cases versus controls was 16.07 (95% CI: 5.55-46.54). The unfavorable outcome of switching the immunosuppressive drug (ISD) (14/40,35%) was no different from that of those treated with reduced ISD doses (31/71, 43.6%, P = .250). Acute rejection or graft-versus-host disease, previous transplant, and intensity of immunosuppression (4 ISDs plus induction or conditioning) were risk factors for BKPyV-DNAemia (OR: 13.96, 95% CI: 11.25-15.18, P < .001; OR: 6.14, 95% CI: 3.91-8.80, P < .001; OR: 5.53, 95% CI: 3.37-7.30, P < .001, respectively). CONCLUSIONS Despite viremia screening, dose reduction, and change in therapeutic protocol, patients with positive BKPyV-DNAemia present poorer outcomes and unfavorable results.
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Affiliation(s)
- Julia Garcia Urbán
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Katia Gurrado
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Paola C Brea Rivas
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Dina Abou Elrous
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Mónica Zubimendi Machain
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - María Romero Gómez
- Microbiology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Julio García Rodríguez
- Microbiology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Blanca Vicandi Plaza
- Pathological Anatomy Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Laura Yébenes Gregorio
- Pathological Anatomy Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Eugenia García Fernández
- Pathological Anatomy Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Carlos Jiménez Martín
- Nephrology Department, REDinREN, IRSIN, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - María-Ovidia López Oliva
- Nephrology Department, REDinREN, IRSIN, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Elena González García
- Nephrology Department, REDinREN, IRSIN, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Gabriel Ledesma Sánchez
- Nephrology Department, REDinREN, IRSIN, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Gilda Carreño Cornejo
- Nephrology Department, REDinREN, IRSIN, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Rafael Selgas Gutiérrez
- Nephrology Department, REDinREN, IRSIN, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | | | - Marta Melgosa Hijosa
- Pediatric Nephrology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Carlota Fernández Camblor
- Pediatric Nephrology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Yasmina Mozo Del Castillo
- Pediatric Hematology Oncology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Luisa Sisinni
- Pediatric Hematology Oncology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - David Bueno Sánchez
- Pediatric Hematology Oncology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Antonio Pérez-Martínez
- Pediatric Hematology Oncology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Elena Sánchez Zapardiel
- Immunology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Eduardo López Granados
- Immunology Department, IdiPaz, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Jaime Monserrat Villatoro
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Rafael Hernández Zabala
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, IdiPaz, School of Medicine, La Paz-Cantoblanco-Carlos III University Hospital, Autonomous University of Madrid, Madrid, Spain
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Cabañas R, Ramírez E, Sendagorta E, Alamar R, Barranco R, Blanca-López N, Doña I, Fernández J, Garcia-Nunez I, García-Samaniego J, Lopez-Rico R, Marín-Serrano E, Mérida C, Moya M, Ortega-Rodríguez NR, Rivas Becerra B, Rojas-Perez-Ezquerra P, Sánchez- González MJ, Vega-Cabrera C, Vila-Albelda C, Bellón T. Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome. J Investig Allergol Clin Immunol 2020; 30:229-253. [DOI: 10.18176/jiaci.0480] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Eichau S, López Ruiz R, Castón Osorio J, Ramírez E, Domínguez-Mayoral A, Izquierdo G. Primary cytomegalovirus infection in a patient with relapsing-remitting multiple sclerosis under treatment with alemtuzumab. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2018.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Balas A, Ramírez E, Trigo E, Cabañas R, Fiandor A, Arsuaga M, Lerma V, Sanz B, LuisVicario J, Herranz P, de Abajo F, Bellón T. HLA-A∗68, -A∗11:01, and -A∗29:02 alleles are strongly associated with benznidazole-induced maculopapular exanthema (MPE)/DRESS. J Allergy Clin Immunol Pract 2020; 8:3198-3200.e3. [PMID: 32417447 DOI: 10.1016/j.jaip.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Balas
- Histocompatibility, Centro de Transfusión de Madrid, Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Elena Trigo
- Tropical Medicine and Travel Health Unit, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Rosario Cabañas
- Allergy Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Ana Fiandor
- Allergy Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Marta Arsuaga
- Tropical Medicine and Travel Health Unit, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Beatriz Sanz
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - José LuisVicario
- Histocompatibility, Centro de Transfusión de Madrid, Madrid, Spain
| | - Pedro Herranz
- Dermatology Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - Francisco de Abajo
- Clinical Pharmacology Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; Department of Biomedical Sciences, University of Alcalá (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research Hospital Universitario La Paz (IdiPaz), Madrid, Spain.
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de la Fuente V, Rufo L, Rodríguez N, Ramírez E, Sánchez-Gavilán I, Amils R. Differential iron management in monocotyledon and dicotyledon plants from the Río Tinto basin. Protoplasma 2020; 257:889-900. [PMID: 31909435 DOI: 10.1007/s00709-019-01476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
The study of plants adapted to an extreme environment with a high concentration of iron such as Río Tinto allowed the study of important elements for the development and control of plant growth including their localization, management, and storage. The absorption, transport, and accumulation of iron were studied in different species of dicotyledons (Sarcocornia pruinosa, Salicornia patula, Arthrocnemum macrostachyum, and Halogeton sativus of the Chenopodiaceae family) and monocotyledons (Imperata cylindrica, Cynodon dactylon, and Panicum repens from the Poaceae family), all obtained from the Río Tinto banks in different sample collection campaigns. The results clearly show that phytoferritin is not observed in the chloroplast of monocotyledons, an important difference from what is observed in dicotyledons. The presence of plastids with a high concentration of iron in the sieve tubes of monocotyledons strongly suggests their possible role in the transport and accumulation of iron in these plants.
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Affiliation(s)
- V de la Fuente
- Departamento de Biología, Facultad de Ciencias, Universidad Autónoma de Madrid, Cantoblanco, E28049, Madrid, Spain.
| | - L Rufo
- Instituto de Investigaciones Biosanitarias, Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - N Rodríguez
- Centro de Astrobiología, INTA-CSIC, Torrejón de Ardoz, Madrid, Spain
| | - E Ramírez
- Departamento de Biología, Facultad de Ciencias, Universidad Autónoma de Madrid, Cantoblanco, E28049, Madrid, Spain
| | - I Sánchez-Gavilán
- Departamento de Biología, Facultad de Ciencias, Universidad Autónoma de Madrid, Cantoblanco, E28049, Madrid, Spain
| | - R Amils
- Centro de Biología Molecular Severo Ochoa (UAM-CSIC), Universidad Autónoma de Madrid, Cantoblanco, Madrid, Spain
- Centro de Astrobiología, INTA-CSIC, Torrejón de Ardoz, Madrid, Spain
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Bellón T, Rodríguez‐Martín S, Cabañas R, Ramírez E, Lerma V, González‐Herrada C, González O, Sendagorta E, Fiandor A, Abajo FJ. Assessment of drug causality in Stevens-Johnson syndrome/toxic epidermal necrolysis: Concordance between lymphocyte transformation test and ALDEN. Allergy 2020; 75:956-959. [PMID: 31557316 DOI: 10.1111/all.14062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Teresa Bellón
- Drug Hypersensitivity Group Hospital La Paz Institute for Health Research (IdiPAZ) Madrid Spain
| | - Sara Rodríguez‐Martín
- Clinical Pharmacology Unit Principe de Asturias University Hospital University of Alcalá (IRYCIS) Alcalá de Henares Spain
| | - Rosario Cabañas
- Allergy Department La Paz University Hospital IdiPAZ Madrid Madrid Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER, U754) Spain
| | - Elena Ramírez
- Clinical Pharmacology Department La Paz University Hospital IdiPAZ Madrid Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit Principe de Asturias University Hospital University of Alcalá (IRYCIS) Alcalá de Henares Spain
| | | | - Olga González
- Dermatology Department University Hospital of Getafe Getafe Spain
| | - Elena Sendagorta
- Dermatology Department La Paz University Hospital IdiPAZ Madrid Spain
| | - Ana Fiandor
- Allergy Department La Paz University Hospital IdiPAZ Madrid Madrid Spain
| | - Francisco J Abajo
- Clinical Pharmacology Unit Principe de Asturias University Hospital University of Alcalá (IRYCIS) Alcalá de Henares Spain
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González-Ramos J, Lamas C, Bellón T, Ruiz-Bravo E, Ramírez E, Lerma V, Lecumberri B. Oseltamivir-induced toxic epidermal necrolysis in a patient with Cushing's disease. Indian J Dermatol Venereol Leprol 2020; 86:515-518. [DOI: 10.4103/ijdvl.ijdvl_53_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Biondo S, Gálvez A, Ramírez E, Frago R, Kreisler E. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol 2019; 23:1141-1161. [DOI: 10.1007/s10151-019-02110-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/02/2019] [Indexed: 02/07/2023]
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Chaparro M, Garre A, Guerra Veloz MF, Vázquez Morón JM, De Castro ML, Leo E, Rodriguez E, Carbajo AY, Riestra S, Jiménez I, Calvet X, Bujanda L, Rivero M, Gomollón F, Benítez JM, Bermejo F, Alcaide N, Gutiérrez A, Mañosa M, Iborra M, Lorente R, Rojas-Feria M, Barreiro-de Acosta M, Kolle L, Van Domselaar M, Amo V, Argüelles F, Ramírez E, Morell A, Bernardo D, Gisbert JP. Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:1380-1386. [PMID: 30976785 DOI: 10.1093/ecco-jcc/jjz070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®. RESULTS A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - A Garre
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - M F Guerra Veloz
- Gastroenterology Units from Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J M Vázquez Morón
- Gastroenterology Units from Hospital Juan Ramón Jiménez, Huelva, Spain
| | - M L De Castro
- Gastroenterology Units from Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - E Leo
- Gastroenterology Units from Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Rodriguez
- Gastroenterology Units from Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - A Y Carbajo
- Gastroenterology Units from Hospital Universitario Río Hortega, Valladolid, Spain
| | - S Riestra
- Gastroenterology Units from Hospital Universitario Central de Asturias and ISPA, Asturias, Spain
| | - I Jiménez
- Gastroenterology Units from Hospital de Galdakao-Usansolo, Vizcaya, Spain
| | - X Calvet
- Gastroenterology Units from Consorcí Corporació Sanitària Parc Tauli de Sabadell and CIBERehd, Barcelona, Spain
| | - L Bujanda
- Gastroenterology Units from Instituto Biodonostia, Universidad del País Vasco [UPV/EHU] and CIBERehd, San Sebastián, Spain
| | - M Rivero
- Gastroenterology Units from Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - F Gomollón
- Gastroenterology Units from Hospital Clínico Universitario Lozano Blesa, IIS Aragón and CIBERehd, Zaragoza, Spain
| | - J M Benítez
- Gastroenterology Units from Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Bermejo
- Gastroenterology Units from Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - N Alcaide
- Gastroenterology Units from Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Gutiérrez
- Gastroenterology Units from Hospital General Universitario de Alicante and CIBERehd, Alicante, Spain
| | - M Mañosa
- Gastroenterology Units from Hospital Germans Trials i Pujol and CIBERehd, Barcelona, Spain
| | - M Iborra
- Gastroenterology Units from Hospital Universitario y Politécnico de La Fe and CIBERehd, Valencia, Spain
| | - R Lorente
- Gastroenterology Units from Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - M Rojas-Feria
- Gastroenterology Units from Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain
| | - M Barreiro-de Acosta
- Gastroenterology Units from Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - L Kolle
- Gastroenterology Units from Hospital General de La Palma, La Palma, Spain
| | - M Van Domselaar
- Gastroenterology Units from Hospital Universitario de Torrejón, Madrid, Spain
| | - V Amo
- Gastroenterology Units from Hospital Regional Universitario de Málaga, Málaga, Spain
| | - F Argüelles
- Gastroenterology Units from Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - E Ramírez
- Gastroenterology Units from Pharmacy Unit, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - A Morell
- Gastroenterology Units from Pharmacy Unit, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - D Bernardo
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - J P Gisbert
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
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Ramírez E, Rodríguez A, Queiruga J, García I, Díaz L, Martínez L, Muñoz R, Muñoz M, Tong HY, Martínez JC, Borobia AM, Carcas AJ, Frías J. Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program. Clin Pharmacol Ther 2019; 106:1362-1379. [DOI: 10.1002/cpt.1562] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/08/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Amelia Rodríguez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Javier Queiruga
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Irene García
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Lucía Díaz
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Lucía Martínez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Raúl Muñoz
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Mario Muñoz
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Hoi Y. Tong
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - José Carlos Martínez
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Alberto M. Borobia
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Antonio J. Carcas
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
| | - Jesús Frías
- Department of Clinical Pharmacology La Paz University Hospital‐Carlos III IdiPAZ School of Medicine Autonomous University of Madrid Madrid Spain
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Marques-Mejías MA, Cabañas R, Ramírez E, Domínguez-Ortega J, Fiandor A, Trigo E, Quirce S, Bellón T. Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach. Front Pharmacol 2019; 10:469. [PMID: 31164819 PMCID: PMC6536588 DOI: 10.3389/fphar.2019.00469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Benznidazole (Bzn) from the nitroimidazole family and nifurtimox from nitrofurans family, are drugs used as first and second line treatment for acute and chronic phases of Chagas disease (CD). Even though skin reactions are frequent, confirmed allergy to Bzn is rare, and there are few cases reported in the literature. Since CD treatment is very restrained, the possibility of cross-reactivity between members of the same and other pharmacological families highlights the importance of an adequate diagnosis that allows alternative treatments in CD and other diseases. We report a series of 31 patients (69% women) referred to our Allergy unit with suspected hypersensitivity to Bzn, twenty three of them with mild reactions and eight of them with severe reactions. LTT with Bzn was performed in 31 patients and in 8 negative controls. LTT was also performed in 25 and 20 of these patients with nifurtimox and Mtn, respectively. Twenty-one out of thirty-one patients were Bzn prick tested, and all were negative. We obtained 2/19 positive results on patch tests to Bzn. LTT with Bzn was positive in 22/31 patients (Sensitivity 75.9% and specificity 100%). The test was considered positive with a stimulation index ≥2. There was a positive result in 7/25 patients for nifurtimox and in 7/20 patients with Mtn. After negative LTT and skin tests, oral provocation was performed in 4/9 patients, all negative. LTT is a safe test that seems to be more useful than skin tests (prick and patch test), particularly in severe reactions, in confirming delayed hypersensitivity to Bzn and detecting cross reactivity with other imidazoles such as Mtn and reactivity to other drugs like nifurtimox. Tests for these drugs need to be included in the workup of patients with hypersensitivity to Bzn in case they are needed as an alternative treatment for CD or to treat other frequent infectious diseases.
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Affiliation(s)
| | - Rosario Cabañas
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,PIELenRed Consortium, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Elena Ramírez
- PIELenRed Consortium, Madrid, Spain.,Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Ana Fiandor
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Elena Trigo
- PIELenRed Consortium, Madrid, Spain.,Tropical Medicine and Travel Health Unit, Department of Internal Medicine, University Hospital La Paz, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Teresa Bellón
- PIELenRed Consortium, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
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Rodríguez-Martín S, Martín-Merino E, Lerma V, Rodríguez-Miguel A, González O, González-Herrada C, Ramírez E, Bellón T, de Abajo FJ. Incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis among new users of different individual drugs in a European population: a case-population study. Eur J Clin Pharmacol 2018; 75:237-246. [PMID: 30298362 DOI: 10.1007/s00228-018-2569-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/27/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To estimate the specific incidences of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) among new users of drugs frequently reported to be associated with this serious event. METHODS We performed a case-population approach, which combined data from a registry of SJS/TEN cases from the Madrid region (numerator) during the study period 2005-2015 and a primary healthcare database from the same catchment population. The proportion of new users of drugs estimated in the primary healthcare database was stratified by calendar year, sex and age (5-year bands), and then applied to the same strata of Madrid's population census to compute the number of new users (denominator). Incidences were re-estimated using only cases in which the concerned drug had a probable or very probable causal relationship. RESULTS A total of 44 SJS/TEN cases aged > 14 years were registered during the study period. The highest SJS/TEN incidence was found for phenytoin with 68.9 per 100,000 new users (95% CI 27.7-141.9), followed by dexamethasone (5.48; 1.49-14.03), allopurinol (3.29; 1.07-7.67) and cotrimoxazole (3.19; 0.87-8.16). Considering only probable and very probable cases, the incidences hardly changed, except for dexamethasone, which was left without cases. Pantoprazole, levofloxacin and lorazepam showed incidences between 1 per 100,000 and 1 per 1,000,000 new users. Ibuprofen, amoxicillin-clavulanic acid, metamizole, amoxicillin, paracetamol and omeprazole showed incidences around 1 per one million new users. CONCLUSIONS Phenytoin was the drug with the highest incidence of SJS/TEN, followed by allopurinol and cotrimoxazole. For the rest of the drugs, the estimated incidences were below 1 in 100,000 new users.
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Affiliation(s)
- Sara Rodríguez-Martín
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Ctra. Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Elisa Martín-Merino
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Ctra. Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Olga González
- Dermatology Department, University Hospital of Getafe, Getafe, Madrid, Spain
| | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain. .,Department of Biomedical Sciences, University of Alcalá, Ctra. Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain. .,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain.
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32
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Ramírez E, Martín A, Villán Y, Lorente M, Ojeda J, Moro M, Vara C, Avenza M, Domingo MJ, Alonso P, Asensio MJ, Blázquez JA, Hernández R, Frías J, Frank A. Effectiveness and limitations of an incident-reporting system analyzed by local clinical safety leaders in a tertiary hospital: Prospective evaluation through real-time observations of patient safety incidents. Medicine (Baltimore) 2018; 97:e12509. [PMID: 30235764 PMCID: PMC6160204 DOI: 10.1097/md.0000000000012509] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The effectiveness of a hospital incident-reporting system (IRS) on improve patient safety is unclear. This study objective was to assess which implemented improvement actions after the analysis of the incidents reported were effective in reduce near-misses or adverse events.Patient safety incidents (PSIs), near misses and adverse events, notified to the IRS were analyzed by local clinical safety leaders (CSLs) who propose and implement improvement actions. The local CSLs received training workshops in patient safety and analysis tools. Following the notification of a PSI in the IRS, prospective real-time observations with external staff were planned to record and rated the frequency of that PSI. This methodology was repeated after the implementation of the improvement actions.Ultimately, 1983 PSIs were identified. Surgery theaters, emergency departments, intensive care units, and general adult care units comprised 82% of all PSIs. The PSI rate increased from 0.39 to 3.4 per 1000 stays in 42 months. A significant correlation was found between the reporting rate per month and the number of workshop-trained local CSLs (Spearman coefficient = 0.874; P = .003). A total of 24,836 real-time observations showed a statistically significant reduction in PSIs observed in 63.15% (categories: medication P = .044; communication P = .037; technology P = .009) of the implemented improvements actions, but not in the organization category (P = .094). In the multivariate analyses, the following factors were associated with the reduction in near misses or adverse events after the implementation of the improvement actions: "adverse event" type of PSI (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.93-5.74), "disussion group" type of analysis (OR, 2.45; 95% CI, 1.52-3.76), and root cause type of analysis (OR, 2.32; 95% CI: 1.17-3.90).The implementation of a hospital IRS, together with the systematization of the method and analysis of PSIs by workshop-trained local CSLs led to an important reduction in the frequency of PSIs.
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Affiliation(s)
- Elena Ramírez
- Functional Risk Management Unit
- Department of Clinical Pharmacology, School of Medicine, Autonomous University of Madrid
| | - Alberto Martín
- Functional Risk Management Unit
- Department of Management Control
| | - Yuri Villán
- Functional Risk Management Unit
- Quality Medical Unit
| | | | - Jonay Ojeda
- Functional Risk Management Unit
- Quality Medical Unit
| | - Marta Moro
- Functional Risk Management Unit
- Department of Hospital Pharmacy
| | - Carmen Vara
- Functional Risk Management Unit
- Quality Nurse Unit
| | - Miguel Avenza
- Functional Risk Management Unit
- Physiotherapy, Rehabilitation Department
| | | | - Pablo Alonso
- Functional Risk Management Unit
- Department of Neurology
| | | | - José A. Blázquez
- Functional Risk Management Unit
- Department of Cardiac Surgery, University Hospital La Paz-Cantoblanco-Carlos III, IdiPAZ, Madrid, Spain
| | - Rafael Hernández
- Department of Clinical Pharmacology, School of Medicine, Autonomous University of Madrid
| | - Jesús Frías
- Department of Clinical Pharmacology, School of Medicine, Autonomous University of Madrid
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Rodríguez-Martín S, Martín-Merino E, Lerma V, Rodríguez-Miguel A, González O, González-Herrada C, Ramírez E, Bellón T, de Abajo FJ. Active surveillance of severe cutaneous adverse reactions: A case-population approach using a registry and a health care database. Pharmacoepidemiol Drug Saf 2018; 27:1042-1050. [PMID: 30051945 DOI: 10.1002/pds.4622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The "case-population" design has been proposed for the surveillance of rare events like Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), wherein a registry of cases is combined with sales data from the source population in order to estimate crude odds ratios (ORs). A major drawback of this method is the inability to distinguish between new and non-new users of drugs, which for the study of hypersensitivity reactions is of utmost importance. METHODS We have explored an approach in which the exposure to the drugs of interest in the source population is inferred from a primary health care database (BIFAP), which helped us to identify drug initiators among all users and additionally adjust for potential confounders. A total of 44 SJS/TEN cases from the Registry and 44 000 controls randomly sampled from BIFAP and matched with cases for index date were included. We estimated the adjusted ORs (AORs) and 95% confidence intervals (CI) of SJS/TEN associated with the new use of 13 drugs (for which we had at least two exposed cases) through a conditional logistic regression model. RESULTS AORs (95% CI) were estimated for phenytoin, 4618 (434-49112); cotrimoxazole, 1142 (163-8015); allopurinol, 160 (36-709); dexamethasone, 38 (1.33-1077); ibuprofen, 33 (8.6-124); lorazepam, 27 (5.8-124); paracetamol, 13 (2.8-62); levofloxacine, 12 (1.24-120); amoxicillin, 6.9 (1.39-35); pantoprazole, 6.5 (0.10-420); metamizole, 6.3 (0.69-57); amoxicillin clavulanic acid, 4.2 (0.53-34); and omeprazole, 1.34 (0.06-31). The inclusion of non-new users dramatically decreased the AORs for all drugs. CONCLUSIONS The case-population approach using a registry of cases and a primary health care database proved feasible and efficient for the active surveillance of SJS/TEN.
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Affiliation(s)
- Sara Rodríguez-Martín
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Elisa Martín-Merino
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Olga González
- Dermatology Department, University Hospital of Getafe, Madrid, Spain
| | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
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34
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Eichau S, López Ruiz R, Castón Osorio JJ, Ramírez E, Domínguez-Mayoral A, Izquierdo G. Primary cytomegalovirus infection in a patient with relapsing-remitting multiple sclerosis under treatment with alemtuzumab. Neurologia 2018; 35:440-443. [PMID: 29907474 DOI: 10.1016/j.nrl.2018.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/28/2018] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Eichau
- Servicio de Neurología, Unidad de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España
| | - R López Ruiz
- Servicio de Neurología, Unidad de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - J J Castón Osorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, España
| | - E Ramírez
- Servicio de Microbiología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Domínguez-Mayoral
- Servicio de Neurología, Unidad de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Izquierdo
- Servicio de Neurología, Unidad de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Sevilla, España
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35
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Borobia AM, Dapia I, Tong HY, Arias P, Muñoz M, Tenorio J, Hernández R, García García I, Gordo G, Ramírez E, Frías J, Lapunzina P, Carcas AJ. Clinical Implementation of Pharmacogenetic Testing in a Hospital of the Spanish National Health System: Strategy and Experience Over 3 Years. Clin Transl Sci 2018; 11:189-199. [PMID: 29193749 PMCID: PMC5866958 DOI: 10.1111/cts.12526] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/27/2017] [Indexed: 01/31/2023] Open
Abstract
In 2014, we established a pharmacogenetics unit with the intention of facilitating the integration of pharmacogenetic testing into clinical practice. This unit was centered around two main ideas: i) individualization of clinical recommendations, and ii) preemptive genotyping in risk populations. Our unit is based on the design and validation of a single nucleotide polymorphism (SNP) microarray, which has allowed testing of 180 SNPs associated with drug response (PharmArray), and clinical consultation regarding the results. Herein, we report our experience in integrating pharmacogenetic testing into our hospital and we present the results of the 2,539 pharmacogenetic consultation requests received over the past 3 years in our unit. The results demonstrate the feasibility of implementing pharmacogenetic testing in clinical practice within a national health system.
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Affiliation(s)
- Alberto M. Borobia
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Irene Dapia
- Medical and Molecular Genetics Institute (INGEMM)La Paz University HospitalMadridSpain
- Center for Biomedical Network Research on Rare Diseases (CIBERER)ISCIIIMadridSpain
| | - Hoi Y. Tong
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Pedro Arias
- Medical and Molecular Genetics Institute (INGEMM)La Paz University HospitalMadridSpain
- Center for Biomedical Network Research on Rare Diseases (CIBERER)ISCIIIMadridSpain
| | - Mario Muñoz
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Jair Tenorio
- Medical and Molecular Genetics Institute (INGEMM)La Paz University HospitalMadridSpain
- Center for Biomedical Network Research on Rare Diseases (CIBERER)ISCIIIMadridSpain
| | - Rafael Hernández
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Irene García García
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Gema Gordo
- Medical and Molecular Genetics Institute (INGEMM)La Paz University HospitalMadridSpain
- Center for Biomedical Network Research on Rare Diseases (CIBERER)ISCIIIMadridSpain
| | - Elena Ramírez
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Jesús Frías
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
| | - Pablo Lapunzina
- Medical and Molecular Genetics Institute (INGEMM)La Paz University HospitalMadridSpain
- Center for Biomedical Network Research on Rare Diseases (CIBERER)ISCIIIMadridSpain
| | - Antonio J. Carcas
- Clinical Pharmacology DepartmentIdiPAZ, La Paz University Hospital, School of MedicineAutonomous University of MadridMadridSpain
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36
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Ramírez E. Laboratorio: Reconocimiento de los elementos del embrión de pollo y su empleo en virología. Actual Biol 2018. [DOI: 10.17533/udea.acbi.330497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
El embrión de pollo es uno de los medios de cultivo más favorables para el aislamiento de algunos virus. Los huevos embrionados pueden ser inoculados por varias vías y su elección depende del virus que se quiera estudiar.
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37
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Cabañas R, Calderón O, Ramírez E, Fiandor A, Caballero T, Heredia R, Herranz P, Madero R, Quirce S, Bellón T. Sensitivity and specificity of the lymphocyte transformation test in drug reaction with eosinophilia and systemic symptoms causality assessment. Clin Exp Allergy 2018; 48:325-333. [DOI: 10.1111/cea.13076] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 12/17/2022]
Affiliation(s)
- R. Cabañas
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
- PIELenRed Consortium; Madrid Spain
| | - O. Calderón
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - E. Ramírez
- PIELenRed Consortium; Madrid Spain
- Department of Clinical Pharmacology; School of Medicine; La Paz University Hospital Health Research Institute (IdiPAZ); Autonomous University of Madrid; Madrid Spain
| | - A. Fiandor
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
- PIELenRed Consortium; Madrid Spain
| | - T. Caballero
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - R. Heredia
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - P. Herranz
- PIELenRed Consortium; Madrid Spain
- Department of Dermatology; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - R. Madero
- Department of Statistics; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - S. Quirce
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - T. Bellón
- PIELenRed Consortium; Madrid Spain
- La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
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Ramírez E, Picatoste B, González-Bris A, Oteo M, Cruz F, Caro-Vadillo A, Egido J, Tuñón J, Morcillo MA, Lorenzo Ó. Sitagliptin improved glucose assimilation in detriment of fatty-acid utilization in experimental type-II diabetes: role of GLP-1 isoforms in Glut4 receptor trafficking. Cardiovasc Diabetol 2018; 17:12. [PMID: 29325553 PMCID: PMC5765634 DOI: 10.1186/s12933-017-0643-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The distribution of glucose and fatty-acid transporters in the heart is crucial for energy consecution and myocardial function. In this sense, the glucagon-like peptide-1 (GLP-1) enhancer, sitagliptin, improves glucose homeostasis but it could also trigger direct cardioprotective actions, including regulation of energy substrate utilization. METHODS Type-II diabetic GK (Goto-Kakizaki), sitagliptin-treated GK (10 mg/kg/day) and wistar rats (n = 10, each) underwent echocardiographic evaluation, and positron emission tomography scanning for [18F]-2-fluoro-2-deoxy-D-glucose (18FDG). Hearts and plasma were isolated for biochemical approaches. Cultured cardiomyocytes were examined for receptor distribution after incretin stimulation in high fatty acid or high glucose media. RESULTS Untreated GK rats exhibited hyperglycemia, hyperlipidemia, insulin resistance, and plasma GLP-1 reduction. Moreover, GK myocardium decreased 18FDG assimilation and diastolic dysfunction. However, sitagliptin improved hyperglycemia, insulin resistance, and GLP-1 levels, and additionally, enhanced 18FDG uptake and diastolic function. Sitagliptin also stimulated the sarcolemmal translocation of the glucose transporter-4 (Glut4), in detriment of the fatty acyl translocase (FAT)/CD36. In fact, Glut4 mRNA expression and sarcolemmal translocation were also increased after GLP-1 stimulation in high-fatty acid incubated cardiomyocytes. PI3K/Akt and AMPKα were involved in this response. Intriguingly, the GLP-1 degradation metabolite, GLP-1(9-36), showed similar effects. CONCLUSIONS Besides of its anti-hyperglycemic effect, sitagliptin-enhanced GLP-1 may ameliorate diastolic dysfunction in type-II diabetes by shifting fatty acid to glucose utilization in the cardiomyocyte, and thus, improving cardiac efficiency and reducing lipolysis.
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Affiliation(s)
- E Ramírez
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - B Picatoste
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - A González-Bris
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - M Oteo
- Biomedical Applications of Radioisotopes and Pharmacokinetics, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - F Cruz
- Biomedical Applications of Radioisotopes and Pharmacokinetics, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - A Caro-Vadillo
- Veterinary School, Universidad Complutense, Madrid, Spain
| | - J Egido
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain
| | - J Tuñón
- Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M A Morcillo
- Biomedical Applications of Radioisotopes and Pharmacokinetics, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Ó Lorenzo
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain. .,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain.
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Delibes-Mateos M, Castro F, Piorno V, Ramírez E, Blanco-Aguiar JA, Aparicio F, Mínguez LE, Ferreira CC, Rouco C, Ríos-Saldaña CA, Recuerda P, Villafuerte R. First assessment of the potential introduction by hunters of eastern cottontail rabbits (Sylvilagus floridanus) in Spain. Wildl Res 2018. [DOI: 10.1071/wr17185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context
Humans have introduced lagomorph species in areas outside their native ranges for their meat, fur or value as game species. Assessing the rate of success of lagomorph introductions is vital to address the ecological damage they may cause. Cases of failed lagomorph introductions in apparently suitable areas may also shed light on mechanisms that may deter invasion, which are useful in developing strategies for population control. In Spain, it has been suggested that hunters introduced the non-native eastern cottontail (Sylvilagus floridanus) to compensate for the recent drastic declines of the native European rabbit (Oryctolagus cuniculus).
Aims
Our main goals were to investigate (1) whether Sylvilagus rabbits have indeed been introduced by hunters across Spain, and (2) whether the species has become established in Spanish ecosystems.
Methods
We interviewed 311 hunters or naturalists across Spain. The questionnaires inquired about the characteristics of game management in each locality, including the frequency of rabbit restocking, and particularly whether Sylvilagus rabbits had been released in the surveyed localities. In addition, we sampled 192 rabbit populations (n=3974 individuals) across Spain by using molecular analysis to determine whether Sylvilagus rabbits were present in these areas.
Key results
Our interview results suggest that Sylvilagus rabbits may have been released in 6% of the 311 localities surveyed. However, molecular analyses failed to confirm their persistence, because all samples belonged to O. cuniculus.
Conclusions
We infer that Sylvilagus rabbits failed to establish themselves in Spain, although interviewees reported their introduction. Several reasons may explain the unsuccessful establishment of this species, such as a low propagule pressure, competition with native species, predation, inability to cope with local pathogens and unsuitable climatic conditions.
Implications
The risk of future introductions of non-native game species can be reduced through the implementation of stricter regulations of animal releases into the wild. Long-term monitoring networks should be developed to help identify non-native game species before they become established and spread to neighbouring areas, thereby preventing any ecological or economic impacts these species may cause.
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Soto R, Fité C, Ramírez E, Iborra M, Tejero J. Catalytic activity dependence on morphological properties of acidic ion-exchange resins for the simultaneous ETBE and TAEE liquid-phase synthesis. REACT CHEM ENG 2018. [DOI: 10.1039/c7re00177k] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Resin acid capacity and specific volume of the swollen polymer are the key properties that determine its catalytic activity.
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Affiliation(s)
- R. Soto
- Faculty of Chemistry
- Chemical Engineering and Analytical Chemistry Department
- University of Barcelona
- 08028-Barcelona
- Spain
| | - C. Fité
- Faculty of Chemistry
- Chemical Engineering and Analytical Chemistry Department
- University of Barcelona
- 08028-Barcelona
- Spain
| | - E. Ramírez
- Faculty of Chemistry
- Chemical Engineering and Analytical Chemistry Department
- University of Barcelona
- 08028-Barcelona
- Spain
| | - M. Iborra
- Faculty of Chemistry
- Chemical Engineering and Analytical Chemistry Department
- University of Barcelona
- 08028-Barcelona
- Spain
| | - J. Tejero
- Faculty of Chemistry
- Chemical Engineering and Analytical Chemistry Department
- University of Barcelona
- 08028-Barcelona
- Spain
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González-Herrada C, Rodríguez-Martín S, Cachafeiro L, Lerma V, González O, Lorente JA, Rodríguez-Miguel A, González-Ramos J, Roustan G, Ramírez E, Bellón T, de Abajo FJ. Cyclosporine Use in Epidermal Necrolysis Is Associated with an Important Mortality Reduction: Evidence from Three Different Approaches. J Invest Dermatol 2017. [PMID: 28634032 DOI: 10.1016/j.jid.2017.05.022] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Several immunomodulatory agents are used in the treatment of epidermal necrolysis, but evidence of their efficacy is limited. The Autonomous Community of Madrid has two reference burn units to which all patients with epidermal necrolysis are referred. One burn unit has mostly used cyclosporine (CsA), and the other has used non-CsA therapies (mainly high-dose intravenous immunoglobulin). The allocation of patients to one or the other burn unit was mainly based on proximity, resembling a random assignment. Thus, we took advantage of this "natural experiment" to estimate the mortality risk ratio (MRR) of CsA (n = 26) compared with non-CsA (n = 16) treatment using hospital as an instrumental variable over the period from 2001 to 2015. We also computed the observed versus expected (O/E) MRR in a case series of 49 CsA-treated patients (including 23 patients from other regions treated in Madrid), and using the Score for Toxic Epidermal Necrolysis (i.e., SCORTEN) scale to estimate the expected values. The instrumental variable-based MRR of CsA versus non-CsA was 0.09 (95% confidence interval = 0.00-0.49). The O/E analysis also showed a reduction in mortality risk (MRROE = 0.42; 95% confidence interval = 0.14-0.99). We identified five other case series of CsA-treated patients providing MRROE and meta-analyzed their results. The pooled MRROE (including from this study) was 0.41 (95% confidence interval = 0.21-0.80). All three approaches consistently show that CsA reduces the mortality in epidermal necrolysis patients.
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Affiliation(s)
| | - Sara Rodríguez-Martín
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, Institute for Health Research IRYCIS, Alcalá de Henares, Madrid, Spain
| | - Lucía Cachafeiro
- Burn Unit, Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, Institute for Health Research IRYCIS, Alcalá de Henares, Madrid, Spain
| | - Olga González
- Dermatology Department, University Hospital of Getafe, Getafe, Madrid, Spain
| | - José A Lorente
- Burn Unit, Intensive Care Unit, University Hospital of Getafe, Getafe, Madrid, Spain; Respiratory Diseases Networking Biomedical Research Centre (CibeRes), Madrid, Spain; European University of Madrid, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, Institute for Health Research IRYCIS, Alcalá de Henares, Madrid, Spain
| | | | - Gaston Roustan
- Dermatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, Institute for Health Research IRYCIS, Alcalá de Henares, Madrid, Spain.
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Tong HY, Borobia AM, Martínez Ávila JC, Lubomirov R, Muñoz M, Blanco Bañares MJ, Hernández R, Fernández Capitán C, Ramírez E, Frías J, Carcas AJ. Influence of two variants of CYP450 oxidoreductase on the stable dose of acenocoumarol in a Spanish population. Pharmacogenomics 2017; 18:797-805. [PMID: 28592191 DOI: 10.2217/pgs-2017-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIM To evaluate the influence of two variants of P450 oxidoreductase (POR), rs2868177 and POR*28, on the stable dosage of acenocoumarol. PATIENTS & METHODS For this observational, cross-sectional study, patients were undergone stable anticoagulant treatment with acenocoumarol. Univariate and multiple regression analyses were performed to assess the influence of POR polymorphisms. RESULTS About 340 patients were enrolled. Multiple regression had a coefficient of determination (R2) of 51.5% and an Akaike information criterion of 234.22. The inclusion of POR*28 polymorphisms increased the R2 to 52.0% and reduced the Akaike information criteria to 230.58. The POR*28 heterozygote showed statistical significance in the algorithm. CONCLUSION The POR*28 heterozygote appears to be associated with the stable dose of acenocoumarol, but its clinical contribution to the prediction of the dosing of this drug is minimal.
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Affiliation(s)
- Hoi Y Tong
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain.,Pharmacology Department, School of Medicine, Autonomous University of Madrid, IdiPAZ, Madrid, Spain
| | | | - Rubin Lubomirov
- Pharmacology Department, School of Medicine, Autonomous University of Madrid, IdiPAZ, Madrid, Spain
| | - Mario Muñoz
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | | | - Rafael Hernández
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain.,Pharmacology Department, School of Medicine, Autonomous University of Madrid, IdiPAZ, Madrid, Spain
| | - Jesús Frías
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain.,Pharmacology Department, School of Medicine, Autonomous University of Madrid, IdiPAZ, Madrid, Spain
| | - Antonio J Carcas
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain.,Pharmacology Department, School of Medicine, Autonomous University of Madrid, IdiPAZ, Madrid, Spain
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Tong HY, Medrano N, Borobia AM, Ruiz JA, Martínez AM, Martín J, Quintana M, García S, Carcas AJ, Ramírez E. Hepatotoxicity induced by acute and chronic paracetamol overdose in children: Where do we stand? World J Pediatr 2017; 13:76-83. [PMID: 27457792 DOI: 10.1007/s12519-016-0046-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are few data on hepatotoxicity induced by acute or chronic paracetamol poisoning in the pediatric population. Paracetamol poisoning data can reveal the weaknesses of paracetamol poisoning management guidelines. METHODS We retrospectively studied the patients of less than 18 years old with measurable paracetamol levels, who were brought to the emergency department (ED) of La Paz University Hospital, Madrid, Spain, for suspected paracetamol overdoses between 2005 and 2010. RESULTS Ninety-two patients with suspected paracetamol poisoning were identified. In 2007, the incidence of paracetamol poisoning in the pediatric population was 0.8 [Poisson-95% confidence interval (CI): 0.03-3.69] per 10 000 inhabitants aged less than 18 years. The incidence in the same year was 1.53 (Poisson-95% CI: 0.24-5.57) per 10 000 patients in the pediatric ED. The most common cause of poisoning was attempted suicide (47.8%) in teenagers with a median age of 15 years, followed by accidental poisoning (42.2%) in babies with a median age of 2.65 years. Difference was seen in the frequency of hepatotoxicity between acute and chronic poisoning cases. Only 1 of 49 patients with acute poisoning showed hepatotoxicity [acute liver failure (ALF)], whereas 7 of 8 patients with chronic poisoning showed hepatotoxicity (3 cases of ALF). The average time to medical care was 6.83 hours for acute poisoning and 52.3 hours for chronic poisoning (P<0.001). CONCLUSIONS Chronic paracetamol poisoning is a potential risk factor for hepatotoxicity and acute liver failure. Delays in seeking medical help might be a contributing factor. Clinicians should have a higher index of clinical suspicion for this entity.
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Affiliation(s)
- Hoi Yan Tong
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nicolás Medrano
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Manuel Borobia
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Antonio Ruiz
- Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Ana María Martínez
- General Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Julia Martín
- Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Manuel Quintana
- General Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Santos García
- Pediatric Emergency Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Antonio José Carcas
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Ramírez
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Madrid, Paseo de la Castellana, 261, 28046, Spain.
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Gil MM, Brik M, Casanova C, Martin-Alonso R, Verdejo M, Ramírez E, Santacruz B. Screening for trisomies 21 and 18 in a Spanish public hospital: from the combined test to the cell-free DNA test. J Matern Fetal Neonatal Med 2016; 30:2476-2482. [PMID: 27806655 DOI: 10.1080/14767058.2016.1253062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe our experience in first-trimester screening for trisomies 21 and 18 firstly by the combined test alone and secondly by cell-free (cf) DNA testing contingent on the results from a previously performed combined test. METHODS Women with singleton pregnancies attending Torrejon University Hospital in Madrid, Spain, from November 2011 to January 2016, were screened for trisomy (T)21 and T18 by the combined test at 11-13 weeks. Before the introduction of cfDNA testing, women at high risk (>1 in 250) were offered invasive testing (IT) and from January 2015 they were offered cfDNA test as well as IT. RESULTS Combined test was performed in 6011 pregnancies. The risk was high in 202 (3.4%) cases. There was complete follow-up for 5507 (91.6%) pregnancies. Detection rate (DR) for T21 was 83.3% (15/18) and 100% (4/4) for T18. Additionally, 2/2 (100%) cases of T13 and 2/2 (100%) cases of triploidy were also detected. False positive rate (FPR) was 3.2% (174/5488). The introduction of this contingent model was followed by a 73% reduction on the IT rate in the high-risk group, from 76.3% to 20.8%. CONCLUSION Contingent screening for trisomies 21 and 18 by cfDNA testing at 11-13 weeks is feasible and has a lower IT rate than combined testing alone.
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Affiliation(s)
- M M Gil
- a Department of Obstetrics and Gynecology , Torrejon University Hospital , Torrejon de Ardoz , Madrid , Spain and
| | - M Brik
- a Department of Obstetrics and Gynecology , Torrejon University Hospital , Torrejon de Ardoz , Madrid , Spain and
| | - C Casanova
- a Department of Obstetrics and Gynecology , Torrejon University Hospital , Torrejon de Ardoz , Madrid , Spain and
| | - R Martin-Alonso
- a Department of Obstetrics and Gynecology , Torrejon University Hospital , Torrejon de Ardoz , Madrid , Spain and
| | - M Verdejo
- a Department of Obstetrics and Gynecology , Torrejon University Hospital , Torrejon de Ardoz , Madrid , Spain and
| | - E Ramírez
- b Clinical Analysis Laboratory of Torrejon University Hospital, Unilabs® , Madrid , Spain
| | - B Santacruz
- a Department of Obstetrics and Gynecology , Torrejon University Hospital , Torrejon de Ardoz , Madrid , Spain and
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Ramírez E, Bellón T, Tong HY, Borobia AM, de Abajo FJ, Lerma V, Moreno Hidalgo MA, Castañer JL, Cabañas R, Fiandor A, González-Ramos J, Herranz P, Cachafeiro L, González-Herrada C, González O, Aramburu JA, Laosa O, Hernández R, Carcas AJ, Frías J. Significant HLA class I type associations with aromatic antiepileptic drug (AED)-induced SJS/TEN are different from those found for the same AED-induced DRESS in the Spanish population. Pharmacol Res 2016; 115:168-178. [PMID: 27888155 DOI: 10.1016/j.phrs.2016.11.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
Aromatic antiepileptic drugs (AEDs) are among the drugs most frequently involved in severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms (DRESS). This study investigated the associations between the genetic polymorphisms of HLA class-I and AED-induced SCARs in the Spanish population. HLA class-I genotypes were determined in AED (phenytoin[PHT],lamotrigine[LTG],carbamazepine[CBZ],phenobarbital[PB])-induced SJS/TEN (n=15) or DRESS (n=12) cases included in the Spanish SCAR registry, PIELenRed. There were 3 control groups: (A)tolerant to a single AED, (B)tolerant to any AED, and (C)Spanish population controls. For SJS/TEN, concomitant HLA-A*02:01/Cw15:02 alleles were significantly associated with PHT-cases compared to control groups B and C [(B)odds ratio(OR):14.75, p=0.009;(C)OR:27.50, p<0.001], and were close to significance with respect to control group A (p=0.060). The genotype frequency of the HLA-B*38:01 was significantly associated with PHT-LTG-cases compared with the 3 groups of controls [(A)OR:12.86, p=0.012;(B)OR:13.81; p=0.002;(C)OR:14.35, p<0.001], and with LTG-cases [(A)OR:147.00, p=0.001;(B)OR:115.00, p<0.001;(C)OR:124.70, p<0.001]. We found the HLA-B*15:02 allele in a Spanish Romani patient with a CBZ-case. The HLA-A*11:01 was significantly associated with CBZ-cases [(A)OR:63.89, p=0.002;(B)OR:36.33, p=0.005;(C)OR:28.29, p=0.007]. For DRESS, the HLA-A*24:02 genotype frequency was statistically significant in the PHT-LTG-cases [(A)OR:22.56, p=0.003;(B)OR:23.50. p=0.001; (C)OR:33.25, p<0.001], and in the LTG-cases [(A),OR:49.00, p=0.015;(B)OR:27.77, p=0.005; (C)OR:34.53, p=0.002]. HLA-A*31:01 was significantly associated with the CBZ-cases [(A)OR:22.00, p=0.047;(B)OR:29.50, p=0.033;(C)OR:35.14, p=0.006]. In conclusion, we identified several significant genetic risk factors for the first time in the Spanish Caucasian population: HLA-A*02:01/Cw*15:02 combination as a risk factor for PHT-induced SJS/TEN, HLA-B*38:01 for LTG- and PHT- induced SJS/TEN, HLA-A*11:01 for CBZ-induced SJS/TEN, and HLA-A*24:02 for LTG- and PHT- induced DRESS. The strong association between HLA*31:01 and CBZ-DRESS in Europeans was confirmed in this study.
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Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain.
| | - Teresa Bellón
- Institute for Health Research, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Hoi Y Tong
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Alberto M Borobia
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences (Pharmacology), University of Alcalá, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences (Pharmacology), University of Alcalá, Madrid, Spain
| | | | - José L Castañer
- Immunology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Rosario Cabañas
- Allergy Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Ana Fiandor
- Allergy Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | | | - Pedro Herranz
- Dermatology Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Lucía Cachafeiro
- Intensive Care Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | | | - Olga González
- Dermatology Department, Getafe University Hospital, Madrid, Spain
| | - José A Aramburu
- Pathological Anatomy Department, Getafe University Hospital, Madrid, Spain
| | - Olga Laosa
- Clinical Pharmacology Unit, Geriatric Department, Getafe University Hospital, Madrid, Spain
| | - Rafael Hernández
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Antonio J Carcas
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain.
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Ramírez E, Medrano-Casique N, Tong HY, Bellón T, Cabañas R, Fiandor A, González-Ramos J, Herranz P, Trigo E, Muñoz M, Borobia AM, Carcas AJ, Frías J. Eosinophilic drug reactions detected by a prospective pharmacovigilance programme in a tertiary hospital. Br J Clin Pharmacol 2016; 83:400-415. [PMID: 27543764 DOI: 10.1111/bcp.13096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/31/2016] [Accepted: 08/14/2016] [Indexed: 11/27/2022] Open
Abstract
AIM We conducted a prospective evaluation of all eosinophilic drug reactions (EDRs) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital to find out the incidence and distribution of these entities in our hospital, their causative drugs, and predictors. METHODS All peripheral eosinophilia >700 × 106 cells l-1 detected at admission or during hospitalisation, were prospectively monitored over 42 months. The spectrum of the localised or systemic manifestation of EDR, the incidence, the distribution of causative drugs, and the predictors were analysed. RESULTS The incidence of EDR was 16.67 (95% Poisson confidence interval [CI]: 9.90-25.98) per 10 000 admissions. Of 274 cases of EDR, 154 (56.2%) cases in 148 patients were asymptomatic hypereosinophilia. In the remaining 120 (43.8%) cases, there was other involvement. Skin and soft tissue reactions were detected in 36 (13.1%) cases; visceral EDRs in 19(7.0%) cases; and drug-induced eosinophilic cutaneous and visceral manifestations were detected in the remaining 65 (23.7%) cases, 64 of which were potential drug reaction with eosinophilia and systemic symptoms (DRESS). After adjusting for age, sex, and hospitalisation wards, predictors of symptomatic eosinophilia were earlier onset of eosinophilia (hazard ratio [HR], 10.49; 95%CI: 3.13-35.16) higher eosinophil count (HR, 8.51; 95%CI: 3.28-22.08), and a delayed onset of corticosteroids (HR, 1.34; 95%CI: 1.01-1.73). A higher eosinophil count in patients with DRESS was significantly associated with greater impairment of liver function, prolonged hospitalisation, higher cumulative doses of corticosteroids, and if hypogammaglobinaemia was detected, a reactivation of human-herpesvirus 6 was subsequently detected. CONCLUSIONS Half (53.3%, 64/120 cases) of symptomatic EDRs were potential DRESS. The main predictor of severity of EDR was an early severe eosinophilia.
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Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Nicolás Medrano-Casique
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Hoi Y Tong
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Teresa Bellón
- Institute for Health Research, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Rosario Cabañas
- Allergy Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Ana Fiandor
- Allergy Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | | | - Pedro Herranz
- Dermatology Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Elena Trigo
- Tropical Medicine and Travel Health Unit, Internal Medicine Department, La Paz University Hospital-Carlos III, IdiPAZ, Madrid, Spain
| | - Mario Muñoz
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Alberto M Borobia
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Antonio J Carcas
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Department of Clinical Pharmacology, La Paz University Hospital-Carlos III, IdiPAZ, School of Medicine, Autonomous University of Madrid, Madrid, Spain
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Medrano-Casique N, Tong HY, Borobia AM, Carcas AJ, Frías J, Ramírez E. Nonchemotherapy drug-induced agranulocytosis in children detected by a prospective pharmacovigilance program. Pediatr Hematol Oncol 2016; 33:441-456. [PMID: 27922762 DOI: 10.1080/08880018.2016.1234523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES A prospective evaluation of nonchemotherapy drug-induced agranulocytosis (DIA) cases, which are infrequent in the pediatric population. We characterize agranulocytosis cases and assess lab test differences between drug- and nondrug-induced agranulocytosis. METHODS Through our Prospective Pharmacovigilance Program from Laboratory Signals at Hospital we detected pediatric agranulocytosis cases from July 2007 to December 2010. This program estimates the incidence, drug causality, clinical features, outcomes of DIA pediatric cases, and assesses laboratory differences with respect to non-DIA. RESULTS We detected 662 agranulocytosis in 308 pediatric patients, of which 14 were caused by nonchemotherapy drugs. The incidence rate of DIA for 10,000 pediatric patients was 3.92 (Poisson 95% confidence interval 1.09-8.77); 78.6% of DIA cases occurred in patients younger than 3 years. The final outcome was recovery without sequela in all cases. The pharmacologic group most frequently implicated was antimicrobial drugs (11 drugs), 7 of which were beta-lactams. The drugs most frequently suspected were cefotaxime and vancomycin (3 cases each). We found 3 drugs (cloperastine, codeine, and enoxaparin) not previously described to induce DIA. Automatic linear modeling (n = 56, R2 = 45.2%) showed a significant inverse association with platelets (R2 = 17.5%), hemoglobin, and alanine transaminase, and a direct association with red cell distribution (R2 = 16.2%). A generalized linear model (Type III, n = 1188; DIA, n = 86; likelihood ratio chi-squared = 156.16) retained eosinophils (p <.001), platelets (p <.001), total serum proteins (p <.001), and hemoglobin (p =.039). CONCLUSIONS We found a higher incidence of DIA in children than previously described. Our findings also suggest an immune-mediated destruction or myeloid toxicity, possibly facilitated by an increase in drug exposure.
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Affiliation(s)
- Nicolás Medrano-Casique
- a Department of Clinical Pharmacology , La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid , Madrid , Spain
| | - Hoi Y Tong
- a Department of Clinical Pharmacology , La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid , Madrid , Spain
| | - Alberto M Borobia
- a Department of Clinical Pharmacology , La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid , Madrid , Spain
| | - Antonio J Carcas
- a Department of Clinical Pharmacology , La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid , Madrid , Spain
| | - Jesús Frías
- a Department of Clinical Pharmacology , La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid , Madrid , Spain
| | - Elena Ramírez
- a Department of Clinical Pharmacology , La Paz University Hospital, IdiPAZ, School of Medicine, Autonomous University of Madrid , Madrid , Spain
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Carr DF, Chung WH, Jenkiins RE, Chaponda M, Nwikue G, Cornejo Castro EM, Antoine DJ, Pirmohamed M, Wuillemin N, Dina D, Eriksson KK, Yerly D, Pavlos R, Mckinnin E, Ostrov D, Peters B, Buus S, Koelle D, Chopra A, Rive C, Redwood A, Restrepo S, Bracey A, Yuan J, Gaudieri S, Carrington M, Haas D, Mallal S, Phillips E, De Boer D, Menheere P, Nieuwhof C, Bons J, Jonsson F, De Chaisemartin L, Granger V, Gillis C, Gouel A, Neukirch C, Dib F, Nicaise PR, Longrois D, Tubach F, Martin S, Bruhns P, Chen KL, Liao SL, Sheen YS, Cho YT, Yang CW, Liau JY, Chu CY, Aguiar R, Lopes A, Fernandes N, Viegas L, Pereira-Barbosa MA, Bünter A, Gupta N, Petkovic TP, Wirth N, Pichler WJ, Hausmann O, Yazicioglu M, Ozdemir PG, Ciplak G, Kaya O, Cooke PJ, Mota I, Gaspar Â, Benito-Garcia F, Chambel M, Morais-Almeida M, Marques L, Alcoceba E, Lara S, Carneiro-Leão L, Botelho C, Dias-Castro E, Cernadas JR, Nicholls K, Lay W, Smith O, Collins C, Unglik G, Spriggs K, Auyeung P, McComish J, Douglass JA, Peter JG, Potter P, Carolino F, De Castro ED, Moreira AS, Abreu C, Gomes E, Cardoso BK, Tomaz E, Correia S, Inácio F, Arnold A, Bear N, Rueter K, Gong G, O’Sullivan M, Muthusamy S, Noble V, Lucas M, Buterleviciute N, Rudzeviciene O, Abreu C, May S, Pongdee T, Park M, Griguola L, Vinikovas A, Kašinskaite S, Kvedariene V, Aktas A, Rahman S, Elbi H, Ozyurt BC, Cavkaytar O, Karaatmaca B, Cetinkaya PG, Esenboga S, Sahiner UM, Sekerel BE, Soyer O, Zubrinich C, Tong B, Patel M, Giles M, O’Hehir R, Puy R, Amaral L, Demir S, Gelincik A, Olgac M, Caskun R, Unal D, Colakoglu B, Buyukozturk S, Matute OV, Bernad A, Gastaminza G, Madamba R, Lacasa C, Goikoetxea MJ, D’Amelio C, Rifón J, Martínez N, Ferrer M, Ribeiro C, Faria E, Frutuoso C, Barros A, Lebre R, Pego A, Bom AT, Ensina LF, Aranda C, Nunes IC, Martins AM, Solé D, Bavbek S, Kendirlinan R, Çerçi P, Tutluer S, Soyyigit S, Sözener ZÇ, Aydin Ö, Gümüsburun R, Almeida M, Sai K, Imatoh T, Nakamura R, Fukazawa C, Hinomura Y, Saito Y, Sousa-Pinto B, Correia C, Gomes L, Gil-Mata S, Araújo L, Delgado L, Sai K, Okamoto-Uchida Y, Kajinami K, Matsunaga K, Aihara M, Wang CW, Su SC, Hung SI, Ho HC, Yang CH, Paulmann M, Dunant A, Mockenhaupt M, Sekula P, Schumacher M, Kardaun S, Naldi L, Bellón T, Creamer D, Haddad C, Sassolas B, Lebrun-Vignes B, Valeyrie-Allanore L, Roujeau JC, Paulmann M, Kremmler C, Mockenhaupt M, Dodiuk-Gad RP, Olteanu C, Feinstein A, Hashimoto R, Alhusayen R, Whyte-Croasdaile S, Finkelstein Y, Burnett M, Sade S, Cartotto R, Jeschke M, Shear NH, Takamura N, Yamane Y, Matsukura S, Nakamura K, Watanabe Y, Yamaguchi Y, Kambara T, Ikezawa Z, Aihara M, Hashimoto R, Chew H, Burnett M, Jeschke M, Knezevic B, Ionmhain UN, Barraclough A, Anstey M, Usui T, Meng X, Farrell J, Whitaker P, Watson J, French N, Park K, Naisbitt D, Neves AC, Cadinha S, Moreira A, Da Silva JPM, Drvar DL, Gulin SJ, Hadzavdic SL, Ceovic R, De Francisco AM, De Vicente Jiménez T, Luque AG, David NR, Galván JMM, Darlenski R, Gulin D, Sikic J, Habek JC, Galic E, Specht P, Staab D, Mayer B, Roehmel J, Solovan C, Chiriac A, Djurinec P, Kostovic K, Bradamante M, Almeida JP, Caiado J, Pedro E, Da Silva PC, Barbosa MP, Bogas G, Blanca-López N, Pérez-Alzate D, Doña I, Agúndez JA, García-Martín E, Cornejo-García JA, Mayorga C, Torres MJ, Canto MG, Blanca M, Aksakal S, Sin AZ, Koç ZP, Günsen FD, Ardeniz Ö, Gökmen ENM, Gülbahar O, Kokuludag A, Pérez-Sánchez N, Salas M, Salas M, Gomez F, Barrionuevo E, Andreu I, Miranda MÁ, Didžiokaite G, Gaidej O, Kašinskaite S, Garcimartin MI, Somoza ML, Bojas G, Cornejo-Garcia JA, Perez FJR, Miranda MA, Jerschow E, Pelletier T, Ren Z, Hudes G, Sanak M, Morales E, Schuster V, Spivack SD, Rosenstreich D, Erzen R, Silar M, Bajrovic N, Rijavec M, Zidarn M, Korosec P, Castro E, Al-Ahmad M, Rodriguez T, Azevedo JP, Tavares B, Regateiro F, Todo-Bom A, Miranda PA, De La Cruz Hoyos B, Abuzeid W, Akbar N, Gibber M, Fried M, Han W, Keskin T, Tamayev R, Spivack SD, Rosenstreich D, Jerschow E, Boni E, Russello M, Mauro M, Neto MF, Brosseron L, Malheiro D, Barreira P, Sprigg D, Trevenen M, Seet J, Trubiano J, Smith W, Jeelall Y, Vale S, Loh R, Mclean-Tooke A, Müller S, Amstutz U, Jörg L, Yawalkar N, Krähenbühl S, Leblanc A, Ribeiro L, Vega A, Rivas RG, Alonso A, Beitia JM, Mateo B, Cárdenas R, Garcia-Dominguez JJ, Pavlos R, Strautins K, James I, Mallal S, Redwood A, Aguiar R, Lopes A, Neves A, Do Céu Machado M, Dalgiç CT, Gökmen ENM, Bulut G, Ardeniz FÖ, Gülbahar O, Sin AZ, Hsu SH, Yang CW, Ye YM, Hur GY, Park HS, Kim SH, Ali S, Hollingsworth PN, Mclean-Tooke APC, Chadly Z, Fredj NB, Aouam K, Romdhane HB, Boughattas NA, Chaabane A, Salazar ML, Pola B, Fiandor A, Ramírez E, Ortega JD, Quirce S, Cabañas R, Baynova K, Labella M, Prados M, Ramonaite A, Bajoriuniene I, Sitkauskiene B, Sakalauskas R, Kwon JW, Park S, Silva D, Leão LC, Castro E, Garcimartin M, De La Torre MV, Pérez FJR, Haroun E, Diez GC, Ónodi-Nagy K, Kinyó Á, Kemény L, Bata-Csörgo Z, Pita JS, Fernandes RA, Moura A, Sousa N, Loureiro C, Pfützner W, Marrouche N, Grattan C, Chen YE, Chen CB, Hsiao YP, Garcimartin MI, Ruano FJ. 7th drug hypersensitivity meeting: part one. Clin Transl Allergy 2016. [PMCID: PMC5009634 DOI: 10.1186/s13601-016-0121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Oral Abstracts O1 Functionally distinct HMGB1 isoforms correlate with physiological processes in drug-induced SJS/TEN Daniel F. Carr, Wen-Hung Chung, Rosalind E. Jenkiins, Mas Chaponda, Gospel Nwikue, Elena M. Cornejo Castro, Daniel J. Antoine, Munir Pirmohamed O2 Hypersensitivity reactions to beta-lactams, does the t cell recognition pattern influence the clinical picture? Natascha Wuillemin, Dolores Dina, Klara K. Eriksson, Daniel Yerly O3 Specific binding characteristics of HLA alleles associated with nevirapine hypersensitivity Rebecca Pavlos, Elizabeth Mckinnin, David Ostrov, Bjoern Peters, Soren Buus, David Koelle, Abha Chopra, Craig Rive, Alec Redwood, Susana Restrepo, Austin Bracey, Jing Yuan, Silvana Gaudieri, Mary Carrington, David Haas, Simon Mallal, Elizabeth Phillips O4 Do we need to measure total ige for the interpretation of analytical results of ImmunoCAP dnd 3gAllergy specific IgE? Douwe De Boer, Paul Menheere, Chris Nieuwhof, Judith Bons O5 Neutrophil activation in systemic anaphylaxis: results from the multicentric NASA study Friederike Jonsson, Luc De Chaisemartin, Vanessa Granger, Caitlin Gillis, Aurelie Gouel, Catherine Neukirch, Fadia Dib, Pascale Roland Nicaise, Dan Longrois, Florence Tubach, Sylvie Martin, Pierre Bruhns, NASA Study Group O6 Purpuric drug eruptions due to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for non-small-cell lung cancer (NSCLC): a clinic-pathological study of 32 cases Kai-Lung Chen, Shu-Ling Liao, Yi-Shuan Sheen, Yung-Tsu Cho, Che-Wen Yang, Jau-Yu Liau, Chia-Yu Chu Poster presentations: Poster Walk 1—Anaphylaxis (P01–P09) P1 Anaphylactic reactions during anaesthesia and the perioperative period Rita Aguiar, Anabela Lopes, Natália Fernandes, Leonor Viegas, M. A. Pereira-Barbosa P2 Anaphylaxis to chlorhexidine: is there a cross-reactivity to alexidine? Antonia Bünter, Nisha Gupta, Tatjana Pecaric Petkovic, Nicole Wirth, Werner J. Pichler, Oliver Hausmann P3 Cefotaxime-induced severe anaphylaxis in a neonate Mehtap Yazicioglu, Pinar G. Ozdemir, Gokce Ciplak, Ozkan Kaya P4 Clinical features and diagnosis of anaphylaxis resulting from exposure to chlorhexidine Peter John Cooke P5 Drug-induced anaphylaxis: five-year single-center survey Inês Mota, Ângela Gaspar, Filipe Benito-Garcia, Marta Chambel, Mário Morais-Almeida P6 Intraoperative severe anaphylactic reaction due to patent blue v dye Luis Marques, Eva Alcoceba, Silvia Lara P7 Kounis syndrome in the setting of anaphylaxis to diclofenac Leonor Carneiro-Leão, Carmen Botelho, Eunice Dias-Castro, Josefina Cernadas P8 Perioperative anaphylaxis audit: Royal Melbourne Hospital Katherine Nicholls, William Lay, Olivia Smith, Christine Collins, Gary Unglik, Kymble Spriggs, Priscilla Auyeung, Jeremy McComish, Jo A. Douglass P9 Recurrent peri-operative anaphylaxis: a perfect storm Jonny G. Peter, Paul Potter Poster Walk 2: DH regions and patient groups (P10–P19) P10 A rare presentation of amoxicillin allergy in a young child Fabrícia Carolino, Eunice Dias De Castro, Josefina R. Cernadas P11 Adverse drug reactions in children: antibiotics or virus? Ana Sofia Moreira, Carmo Abreu, Eva Gomes P12 Allergic reactions in invasive medical procedures Bárbara Kong Cardoso, Elza Tomaz, Sara Correia, Filipe Inácio P13 Antibiotic allergy in children: room for improvement Annabelle Arnold, Natasha Bear, Kristina Rueter, Grace Gong, Michael O’Sullivan, Saravanan Muthusamy, Valerie Noble, Michaela Lucas P14 Drug hypersensitivity reactions in children and results of diagnostic evaluation Neringa Buterleviciute, Odilija Rudzeviciene P15 Nonimmediate cutaneous drug reactions in children: are skin tests required? Ana Sofia Moreira, Carmo Abreu, Eva Gomes P16 Pediatric patients with a history of penicillin allergy and a positive penicillin skin test may not be at an increased risk for multiple drug allergies Sara May, Thanai Pongdee, Miguel Park P17 Proved hypersensitivity to drugs according data of Vilnius University Hospital Santariskiu Klinikos Linas Griguola, Arturas Vinikovas, Simona Kašinskaite, Violeta Kvedariene P18 Self-reported prevalence of drug hypersensitivity reactions among students in Celal Bayar University, Turkey Ayse Aktas, Suheyla Rahman, Huseyin Elbi, Beyhan Cengiz Ozyurt P19 Severe drug hypersensitivity reactions in pediatric age Ozlem Cavkaytar, Betul Karaatmaca, Pinar Gur Cetinkaya, Saliha Esenboga, Umit M. Sahiner, Bulent E. Sekerel, Ozge Soyer Poster Walk 3: Desensitisation (P20–P28) P20 A protocol for desensitisation to valaciclovir Celia Zubrinich, Bianca Tong, Mittal Patel, Michelle Giles, Robyn O’Hehir, Robert Puy P21 A rare case of desensitization to modafinil Josefina Cernadas, Luís Amaral, Fabrícia Carolino P22 A sixteen-day desensitization protocol in delayed type hypersensitivity reactions to oral drugs Semra Demir, Asli Gelincik, Muge Olgac, Raif Caskun, Derya Unal, Bahauddin Colakoglu, Suna Buyukozturk P23 Desensitization to intravenous etoposide using a 12 and a 13-step protocol. Two cases report Olga Vega Matute, Amalia Bernad, Gabriel Gastaminza, Roselle Madamba, Carlos Lacasa, M. J. Goikoetxea, Carmen D’Amelio, Jose Rifón, Nicolas Martínez, Marta Ferrer P24 Drug desensitisation in oncology: the experience of an immunoallergology department for 5 years Carmelita Ribeiro, Emília Faria, Cristina Frutuoso, Anabela Barros, Rosário Lebre, Alice Pego, Ana Todo Bom P25 Filgrastim anaphylaxis: a successful desensitization protocol Luis Amaral, Josefina Cernadas P26 Galsulfase hypersensitivity and desensitization of a mucopolysaccharidosis VI patient Luis Felipe Ensina, Carolina Aranda, Ines Camelo Nunes, Ana Maria Martins, Dirceu Solé P27 Rapid drug desensitization with biologicals: one-center experience with four biologicals Sevim Bavbek, Resat Kendirlinan, Pamir Çerçi, Seda Tutluer, Sadan Soyyigit, Zeynep Çelebi Sözener, Ömür Aydin, Reyhan Gümüsburun P28 Successful desensitization to a high dose of methotrexate in a delayed type hypersensitivity reaction Josefina Cernadas, Leonor Carneiro-Leão, Fabrícia Carolino, Marta Almeida Poster Walk 4: SJS (P29–P38) P29 Assessment of impact of infection on drug-induced severe cutaneous adverse reactions and rhabdomyolysis using the Japanese adverse drug event report database Kimie Sai, Takuya Imatoh, Ryosuke Nakamura, Chisato Fukazawa, Yasushi Hinomura, Yoshiro Saito P30 Characterization of erythema multiforme and severe cutaneous adverse reactions hospitalizations Bernardo Sousa-Pinto, Cláudia Correia, Lídia Gomes, Sara Gil-Mata, Luís Araújo, Luís Delgado P31 Effects of infection on incidence/severity of SJS/TEN and myopathy in Japanese cases analyzed by voluntary case reports Ryosuke Nakamura, Kimie Sai, Takuya Imatoh, Yoshimi Okamoto-Uchida, Koji Kajinami, Kayoko Matsunaga, Michiko Aihara, Yoshiro Saito P32 Efficacy of tumor necrosis factor—a antagonists in Stevens–Johnson syndrome and toxic epidermal necrolysis: a randomized controlled trial and immunosuppressive effects evaluation Chuang-Wei Wang, Shih-Chi Su, Shuen-Iu Hung, Hsin-Chun Ho, Chih-Hsun Yang, Wen-Hung Chung P33 Evolution of drug causality in Stevens–Johnson syndrome and toxic epidermal necrolysis in Europe: analysis of 10 years RegiSCAR-Study Maren Paulmann, Ariane Dunant, Maja Mockenhaupt, Peggy Sekula, Martin Schumacher, Sylvia Kardaun, Luigi Naldi, Teresa Bellón, Daniel Creamer, Cynthia Haddad, Bruno Sassolas, Bénédicte Lebrun-Vignes, Laurence Valeyrie-Allanore, Jean-Claude Roujeau P34 Long-term sequelae in patients with Stevens–Johnson syndrome and toxic epidermal necrolysis: a 5-year analysis Maren Paulmann, Carmen Kremmler, Peggy Sekula, Laurence Valeyrie-Allanore, Luigi Naldi, Sylvia Kardaun, Maja Mockenhaupt P35 Major emotional complications and decreased health related quality of life among survivors of Stevens–Johnson syndrome and toxic epidermal necrolysis Roni P. Dodiuk-Gad, Cristina Olteanu, Anthony Feinstein, Rena Hashimoto, Raed Alhusayen, Sonia Whyte-Croasdaile, Yaron Finkelstein, Marjorie Burnett, Shachar Sade, Robert Cartotto, Marc Jeschke, Neil H. Shear P36 Retrospective analysis of Stevens–Johnson syndrome and toxic epidermal necrolysis in Japanese patients: treatment and outcome Naoko Takamura, Yumiko Yamane, Setsuko Matsukura, Kazuko Nakamura, Yuko Watanabe, Yukie Yamaguchi, Takeshi Kambara, Zenro Ikezawa, Michiko Aihara P37 Severe physical complications among survivors of Stevens–Johnson syndrome and toxic epidermal necrolysis Roni P. Dodiuk-Gad, Cristina Olteanu, Rena Hashimoto, Hall Chew, Raed Alhusayen, Sonia Whyte-Croasdaile, Yaron Finkelstein, Marjorie Burnett, Shachar Sade, Robert Cartotto, Marc Jeschke, Neil H. Shear P38 Stevens–Johnson syndrome/toxic epidermal necrolysis combined with haemophagocytic lymphohistiocytosis: a case report Brittany Knezevic, Una Nic Ionmhain, Allison Barraclough, Michaela Lucas, Matthew Anstey Poster Walk 5: Other organs/unexpected immune reactions (P39–P47) P39 A case report of patient with anti-tuberculosis drug-related severe liver failure Toru Usui, Xiaoli Meng, John Farrell, Paul Whitaker, John Watson, Neil French, Kevin Park, Dean Naisbitt P40 Acute interstitial nephritis induced by ibuprofen Ana Castro Neves, Susana Cadinha, Ana Moreira, J. P. Moreira Da Silva P41 Cetuximab induced acneiform rash—two case reports Daniela Ledic Drvar, Sandra Jerkovic Gulin, Suzana Ljubojevic Hadzavdic, Romana Ceovic P42 Enteropathy associated with losartan Ana Montoro De Francisco, Talía De Vicente Jiménez, Amelia García Luque, Natalia Rosado David, José Mª Mateos Galván P43 Granuloma annulare after therapy with canakinumab Razvigor Darlenski P44 Hypersensitivity eosinophilic myocarditis or acute coronary syndrome? Case report Dario Gulin, Jozica Sikic, Jasna Cerkez Habek, Sandra Jerkovic Gulin, Edvard Galic P45 Piperacillin-induced immune haemolytic anaemia: a severe and frequent complication of antibiotic treatment in patients with cystic fibrosis Philip Specht, Doris Staab, Beate Mayer, Jobst Roehmel P46 Progesterone triggered pemphigus foliaceus: case report Sandra Jerkovic Gulin, Caius Solovan, Anca Chiriac P47 Ramipril: triggered generalized pustular psoriasis Paola Djurinec, Kresimir Kostovic, Mirna Bradamante, Sandra Jerkovic Gulin, Romana Ceovic Poster Walk 6: NSAIDs (P48–P56) P48 Aspirin desensitization in cardiovascular disease—Portuguese experience Jose Pedro Almeida, Joana Caiado, Elisa Pedro, Pedro Canas Da Silva, Manuel Pereira Barbosa P49 Asthma and/or rhinitis to NSAIDs with good tolerance to ASA Gador Bogas, Natalia Blanca-López, Diana Pérez-Alzate, Inmaculada Doña, José Augusto Agúndez, Elena García-Martín, José Antonio Cornejo-García, Cristobalina Mayorga, María José Torres, Gabriela Canto, Miguel Blanca P50 Clinical characteristics of 196 patients with non-steroidal anti-inflammatory drug (NSAIDs) hypersensitivity Sengül Aksakal, Aytül Zerrin Sin, Zeynep Peker Koç, Fatma Düsünür Günsen, Ömür Ardeniz, Emine Nihal Mete Gökmen, Okan Gülbahar, Ali Kokuludag P51 Development of immediate hypersensitivity to several NSAIDs maintaining good tolerance to ASA Natalia Pérez-Sánchez, Natalia Blanca-López, Diana Pérez-Alzate, Gador Bogas, Inmaculada Doña, María Salas, María José Torres, Miguel Blanca, Gabriela Canto P52 Diagnosis of hypersensitivity reactions to paracetamol in a large series of cases Inmaculada Doña, Maria Salas, Francisca Gomez, Natalia Blanca-Lopez, Diana Perez-Alzate, Gador Bogas, Esther Barrionuevo, Maria Jose Torres, Inmaculada Andreu, Miguel Ángel Miranda, Gabriela Canto, Miguel Blanca P53 Hypersensitivity to paracetamol according to the new classification of hypersensitivity to NSAIDs Gabija Didžiokaite, Olesia Gaidej, Simona Kašinskaite, Violeta Kvedariene P54 Ibuprofen and other aryl propionic derivates can induce immediate selective hypersensitivity responses Diana Perez-Alzate, Natalia Blanca-López, Maria Isabel Garcimartin, Inmaculada Doña, Maria Luisa Somoza, Cristobalina Mayorga, Maria Jose Torres, Gador Bojas, Jose Antonio Cornejo-Garcia, Maria Gabriela Canto, Miguel Blanca P55 Subjects developing immediate responses to several NSAIDs can be selective with good tolerance to ASA Natalia Blanca-Lopez, Diana Pérez-Alzate, Francisco Javier Ruano Perez, Inmaculada Doña, Maria Luisa Somoza, Inmaculada Andreu, Miguel Angel Miranda, Cristobalina Mayorga, Maria Jose Torres, Jose Antonio Cornejo-Garcia, Miguel Blanca, Maria Gabriela Canto P56 Utility of low-dose oral aspirin challenges for diagnosis of aspirin exacerbated respiratory disease Elina Jerschow, Teresa Pelletier, Zhen Ren, Golda Hudes, Marek Sanak, Esperanza Morales, Victor Schuster, Simon D. Spivack, David Rosenstreich Poster Walk 7: NSAID 2 (P57–P65) P57 Alternate regulation of cyclooxygenase-2 (COX-2) MRNA expression may predispose patients to aspirin-induced exacerbations Renato Erzen, Mira Silar, Nissera Bajrovic, Matija Rijavec, Mihaela Zidarn, Peter Korosec P58 Anaphylaxis to diclofenac: what about the underlying mechanism? Leonor Carneiro-Leão, Fabrícia Carolino, Luís Amaral, Carmen Botelho, Eunice Dias-Castro, Josefina Cernadas P59 COX-2 inhibitors: are they always a safe alternative in hypersensitivity to nonsteroidal anti-inflammatory drugs? Luis Amaral, Fabricia Carolino, Eunice Castro, Josefina Cernadas P60 Management of patients with history of NSAIDs reactions prior to coronary angioplasty Mona Al-Ahmad, Tito Rodriguez P61 Oral drug challenge with non-steroidal anti-inflammatory drug under spirometric control: clinical series of 110 patients João Pedro Azevedo, Emília Faria, Beatriz Tavares, Frederico Regateiro, Ana Todo-Bom P62 Prevalence and incidence of analgesic hypersensitivity reactions in Colombia Pablo Andrés Miranda, Bautista De La Cruz Hoyos P63 Recent endoscopic sinus surgery lessens reactions during aspirin challenge in patients with aspirin exacerbated respiratory disease Teresa Pelletier, Waleed Abuzeid, Nadeem Akbar, Marc Gibber, Marvin Fried, Weiguo Han, Taha Keskin, Robert Tamayev, Golda Hudes, Simon D. Spivack, David Rosenstreich, Elina Jerschow P64 Safe use of imidazole salycilate in a case of multiple NSAIDs induced urticaria-angioedema Elisa Boni, Marina Russello, Marina Mauro P65 Selective hypersensitivity reactions to ibuprofen—seven years experience Marta Ferreira Neto Poster Walk 8: Epidemiological methods (P66–P72) P66 Allopurinol hypersensitivity: a 7-year review Lise Brosseron, Daniela Malheiro, Susana Cadinha, Patrícia Barreira, J. P. Moreira Da Silva P67 Antibiotic allergy labelling is associated with increased hospital readmission rates in Australia Brittany Knezevic, Dustin Sprigg, Michelle Trevenen, Jason Seet, Jason Trubiano, William Smith, Yogesh Jeelall, Sandra Vale, Richard Loh, Andrew Mclean-Tooke, Michaela Lucas P68 Experts’ opinions on severe cutaneous adverse drug reactions-report of a survey from the 9th international congress on cutaneous adverse drug reactions 2015 Roni P. Dodiuk-Gad, Cristina Olteanu, Wen-Hung Chung, Neil H. Shear P69 HLA-A*31-positive AGEP with carbamazepine use and other severe cutaneous adverse drug reactions (SCARs) detected by electronic medical records screening Sabine Müller, Ursula Amstutz, Lukas Jörg, Nikhil Yawalkar, Stephan Krähenbühl P70 Patients with suspected drug allergy: a specific psychological profile? Eunice Dias-Castro, Ana Leblanc, Laura Ribeiro, Josefina R. Cernadas P71 Use of an electronic device and a computerized mathematic algorithm to detect the allergic drug reactions through the analysis of heart rate variability Arantza Vega, Raquel Gutierrez Rivas, Ana Alonso, Juan Maria Beitia, Belén Mateo, Remedios Cárdenas, Juan Jesus Garcia-Dominguez P72 Variation in ERAP influences risk for HLA-B*57:01 positive abacavir hypersensitivity Rebecca Pavlos, Kaija Strautins, Ian James, Simon Mallal, Alec Redwood, Elizabeth Phillips Poster Walk 9: DRESS/AGEP (P73–P81) P73 A clinical case of DRESS syndrome in a child after administration of amoxicillin-clavulanic acid Rita Aguiar, Anabela Lopes, Ana Neves, Maria Do Céu Machado, M. A. Pereira-Barbosa P74 Acute generalized exanthematous pustulosis (AGEP) induced by mesalazine, reliable and oftenly used drug to treat inflammatory bowel disease Ceyda Tunakan Dalgiç, Emine Nihal Mete Gökmen, Fatma Düsünür Günsen, Gökten Bulut, Fatma Ömür Ardeniz, Okan Gülbahar, Ali Kokuludag, Aytül Zerrin Sin P75 Changes of blood plasmacytoid dendritic cells, myeloid dendritic cells, and basophils during the acute stage of drug reaction with eosinophilia and systemic symptoms (DRESS) and other drug eruptions Shao-Hsuan Hsu, Yung-Tsu Cho, Che-Wen Yang, Kai-Lung Chen, Chia-Yu Chu P76 Characterization of isoniazid/rifampicin-specific t-cell responses in patients with DRESS syndrome Young-Min Ye, Gyu-Young Hur, Hae-Sim Park, Seung-Hyun Kim P77 DRESS syndrome secondary to sulfasalazine with delayed TEN: a case presentation Syed Ali, Michaela Lucas, Peter N. Hollingsworth, Andrew P. C. Mclean-Tooke P78 Drug rash with eosinophilia and systemic symptoms (DRESS) features according to the culprit drug Zohra Chadly, Nadia Ben Fredj, Karim Aouam, Haifa Ben Romdhane, Naceur A. Boughattas, Amel Chaabane P79 Drug reaction with eosinophilia and systemic symptoms induced by allopurinol: not always easy to diagnose Marina Lluncor Salazar, Beatriz Pola, Ana Fiandor, Teresa Bellón, Elena Ramírez, Javier Domínguez Ortega, Santiago Quirce, Rosario Cabañas P80 Drug reaction with eosinophilia and systemic symptoms syndrome induced by two drugs simultaneously: a case report Krasimira Baynova, Marina Labella, Manuel Prados P81 The drug reaction with eosinophilia and systemic symptoms (DRESS) induced by the second-line antituberculosis drugs and Epstein–Barr virus infection Agne Ramonaite, Ieva Bajoriuniene, Brigita Sitkauskiene, Raimundas Sakalauskas Poster Walk 10: Miscellaneous drug hypersensitivity (P82–P91) P82 A case of cycloserine-induced lichenoid drug eruption confirmed with a lymphocatye transformation test Jae-Woo Kwon, Shinyoung Park P83 Allergic reaction to topical eye drops: 5 years’ retrospective study in a drug allergy unit Diana Silva, Leonor Carneiro Leão, Fabricia Carolino, Eunice Castro, Josefina Cernadas P84 Allergy to heparins Diana Perez-Alzate, Natalia Blanca-López, Maria Luisa Somoza Alvarez, Maria Garcimartin, Maria Vazquez De La Torre, Francisco Javier Ruano Pérez, Elisa Haroun, Gabriela Canto Diez P85 Allopurinol-induced adverse drug reactions Katinka Ónodi-Nagy, Ágnes Kinyó, Lajos Kemény, Zsuzsanna Bata-Csörgo P86 Analysis of a population with immediate hypersensitivity to corticosteroids: an 11 year review Joana Sofia Pita, Emília Faria, Rosa Anita Fernandes, Ana Moura, Nuno Sousa, Carmelita Ribeiro, Carlos Loureiro, Ana Todo Bom P87 Anaphylaxis against mivacurium in a 12-months old boy at first-time exposure Wolfgang Pfützner P88 Antihistamine-exacerbated chronic spontaneous urticaria: a paradox? Nadine Marrouche, Clive Grattan P89 Anti-osteoporotic agents-induced cutaneous adverse drug reactions in Asians Yu-En Chen, Chun-Bing Chen, Wen-Hung Chung, Yu-Ping Hsiao, Chia-Yu Chu P90 Diagnosis of allergic reactions to eye drops Maria Vazquez De La Torre, Natalia Blanca-Lopez, Diana Perez-Alzate, Maria Isabel Garcimartin, Francisco Javier Ruano, Maria Luisa Somoza, Elisa Haroun, Gabriela Canto P91 Diagnostic approach in suspected hypersensitivity reactions to corticosteroids Fabrícia Carolino, Eunice Dias De Castro, Josefina R. Cernadas
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González-Ramos J, Noguera-Morel L, Tong HY, Ramírez E, Ruiz-Bravo E, Bellón T, Cabañas R, Cachafeiro L, Herranz-Pinto P. Two cases of overlap severe cutaneous adverse reactions to benznidazole treatment for asymptomatic Chagas disease in a nonendemic country. Br J Dermatol 2016; 175:604-7. [PMID: 26851874 DOI: 10.1111/bjd.14451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 01/17/2023]
Abstract
Chagas disease is a parasitosis endemic to South America. It is normally treated with benznidazole as first choice, which has been associated with numerous cutaneous reactions. However, very few benznidazole-associated severe cutaneous adverse reactions have been reported to date. The rise of Chagas disease in nonendemic countries represents a growing public health challenge. We report two patients who met the criteria for drug reaction with eosinophilia and systemic symptoms syndrome and Stevens-Johnson syndrome/toxic epidermal necrolysis according to the RegiSCAR scoring systems. They were thus deemed overlapping cases, with a lymphocyte transformation test positive for benznidazole. Both required intensive care unit admission and both survived. Considering the rising application of this drug for trypanosomiasis in immigrant populations, clinicians should be aware of this newly reported, potentially life-threatening risk.
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Affiliation(s)
- J González-Ramos
- Department of Dermatology, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain.
| | - L Noguera-Morel
- Department of Dermatology, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - H Y Tong
- Department of Clinical Pharmacology, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - E Ramírez
- Department of Clinical Pharmacology, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - E Ruiz-Bravo
- Department of Dermatopathology, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - T Bellón
- Research Department, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - R Cabañas
- Department of Allergy, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - L Cachafeiro
- Department of Intensive Care Unit, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
| | - P Herranz-Pinto
- Department of Dermatology, La Paz University Hospital, Researching Consortium PIELenRed, Paseo La Castellana 261, CP 28046, Madrid, Spain
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Bellón T, Ramírez E, Borobia AM, Lerma V, Moreno-Hidalgo MA, Laosa O, Aramburu JA, González-Herrada C, de Abajo FJ. The HLA-B*15:02 allele in a Spanish Romani patient with carbamazepine-induced Stevens-Johnson syndrome. Pharmacogenomics 2016; 17:541-5. [PMID: 27020614 DOI: 10.2217/pgs.16.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The HLA-B*15:02 allele is a risk factor for carbamazepine (CBZ)-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in populations where the allele is prevalent. Han Chinese and Thai patients are advised to take a genetic test before introducing CBZ. Such testing is not recommended for patients of European descent. We report the case of a Spanish Romani patient who developed Stevens-Johnson syndrome upon treatment with CBZ. In vitro assays confirmed CBZ as the culprit drug. HLA typing showed that the patient carried the HLA-B*15:02 allele. A public database search revealed that 2% of Spanish Romani people likely carry the risk variant HLA-B*15:02 and therefore may be included in the population to be tested prior to beginning treatment with CBZ.
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Affiliation(s)
- Teresa Bellón
- Institute for Health Research, University Hospital La Paz - IdiPAZ, Madrid, Spain
| | - Elena Ramírez
- Clinical Pharmacology Department, University Hospital La Paz, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, University Hospital La Paz, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - Olga Laosa
- Foundation for Biomedical Research, University Hospital de Getafe, Getafe, Madrid, Spain
| | - José A Aramburu
- Pathology Department, University Hospital de Getafe, Getafe, Madrid, Spain
| | | | - Francisco J de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.,Department of Biomedical Sciences (Pharmacology), University of Alcalá, Alcalá de Henares, Madrid, Spain
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