Sixty nosocomial infections caused by Pseudomonas aeruginosa and Acinetobacter baumannii resistant to aminoglycosides, cephalosporins, quinolones, penicillins, monobactams, and imipenem were treated with colistin (one patient had two infections that are included as two different cases). The infections were pneumonia (33% of patients), urinary tract infection (20%), primary bloodstream infection (15%), central nervous system infection (8%), peritonitis (7%), catheter-related infection (7%), and otitis media (2%). A good outcome occurred for 35 patients (58%), and three patients died within the first 48 hours of treatment. The poorest results were observed in cases of pneumonia: only five (25%) of 20 had a good outcome. A good outcome occurred for four of five patients with central nervous system infections, although no intrathecal treatment was given. The main adverse effect of treatment was renal failure; 27% of patients with initially normal renal function had renal failure, and renal function worsened in 58% of patients with abnormal baseline creatinine levels. Colistin may be a good therapeutic option for the treatment of severe infections caused by multidrug-resistant P. aeruginosa and A. baumannii.

Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.

IntroductionThe literature concerning possible cardio-toxic effects of lithium therapy in man is reviewed.MethodologyA review was conducted to clarify the mechanisms associated with the occurrence of conducting abnormalities when using lithium and investigating (if so) whether these alterations depend on the dose. The literature search was conducted in PubMed data reviewing articles between 1982 and 2015.Results(1) Related to pathopsychiology/risk factors: reports indicate T wave morphology changes with lithium therapy. Of particular concern are cases of sinus mode dysfunction or sinoatrial block and the appearance or aggravation of ventricular irritability. The incidence of cardiac complications, in general terms, may increase with age. Recent findings (a retrospective study of bipolar patients) of lithium-associated hypocalcaemia showed that hypocalcaemia resulting from medical diseases and bipolar patients with lithium-associated hypocalcaemia had significantly higher frequencies of conduction defects. (2) Related/unrelated to dose: therapeutic and toxic levels of lithium have infrequently been associated with serious cardiac dysfunction. Several case reports demonstrate two important points about Brugada syndrome unmasking: electrocardiograph abnormality severity may correspond to lithium levels and unmasking may occur in the therapeutic range of lithium. Other report shows a case of lithium induced sinus-node dysfunction in a patient with serum lithium levels in therapeutic range.ConclusionsLithium abnormalities are rare and mostly not related to dose. Conducting heart anomalies may occur, especially when several factors are present (such as age or co-morbid illnesses that affect calcium serum levels).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction: Rheumatoid arthritis is an autoimmune, chronic and inflammatory disease that mainly the synovial membrane of the joints. Clinical features are pain, inflammation, heat and stiffness of the joints. Objective: Identification of the problems related to the use of biotechnological medicines and the negative results associated with them. Results: 78 patients (91.02% women and 9.8% men) were included where the most commonly used biological medicines were Etanercept (52.5%) Adalimumab (14.10) and Tocilizumab (15.3) and Tofacitinib (3.8%) Rituximab, Golimumab (5.12%) abatacept (3.84%) and certolizumab (1.84%). 96 NCO were identified in 49 patients of which 11 are problems of need, 28 effectiveness problems and 57 safety problems. Conclusion: The identification of medication-related problems and the resolution and prevention of negative results associated with medication allows us to obtain better results in the pharmacotherapy of the patient, improving their quality of life.