BackgroundPegylated Interferon-alpha-2b (pegIFNα2b) is an effective agent for the treatment of haematological malignancies. As it does not inhibit DNA synthesis, this agent may be safe for use during pregnancy.PurposeTo describe 2 cases of successful pregnancies in patients with haematological disorders treated with pegIFNα2b.Material and methodsMedical record review and literature search.ResultsPatient 1: 30-year-old woman diagnosed with polycythaemia vera at age 13, well-controlled with hydroxyurea. Chemotherapy was interrupted due to the patient’s desire for a second pregnancy and treatment with pegIFNα2b 50mcg/week subcutaneously was initiated. (During the first pregnancy she received non-pegylated-IFNα2b with good progression but low tolerance due to influenza-like symptoms). 5 months later, she became pregnant, but was hospitalised due to headaches which caused a dose reduction to 30 mcg/week of pegIFNα2b. Finally, the patient delivered a healthy male infant. 15 days later, pegIFNα2b treatment was interrupted to recommence the usual treatment with hydroxyurea.Patient 2: 27-year-old woman with Philadelphia chromosome-positive chronic myeloid leukaemia diagnosed at age 22, well-controlled with imatinib. The patient interrupted antineoplastic treatment due to her desire to conceive a child and subcutaneous treatment with pegIFNα2b at 50 mcg/week was initiated. She became pregnant after 4 months and pegIFNα2b dose was increased to 80 mcg/week and developed hypothyroidism which was treated with levothyroxine. Finally, the patient delivered a healthy male infant and 1 month later, she discontinued pegIFNα2b and levothyroxine treatment to recommence her usual treatment with imatinib.Both were normal full-term deliveries. Infant growth and development have been normal to date (follow-up time of 2 and 3 years). Blood tests were normal during pregnancies. Only mild anaemia and slight neutrophilia were detected in the first patient, but did not require treatment interruption.ConclusionPegIFNα2b was well tolerated, safe and effective, and caused no complications during the pregnancies. Since chemotherapy agents involve teratogenic effects, pegIFNα2b might be a safe treatment option during pregnancy, although further teratogenic studies are necessary.References and/or acknowledgementsNo conflict of interest.

Background In July 2013, the Spanish Medicines Agency published an informative note (IN) limiting the use of metoclopramide to prevent and treat nausea and vomiting caused by chemotherapy, radiotherapy or surgery and suggesting a maximum duration of treatment of 5 days. Purpose To evaluate the impact of the metoclopramide IN on a general hospital. Materials and methods Prospective quasi-experimental study in different Clinical Units (CU) using the Unitary Dose Drug Dispensing System (UDDDS): Digestive/General Surgery (DGS), Vascular Surgery, Digestive, Obstetrics/Gynaecology, Haematology, Internal Medicine (IM), Nephrology, Neurology, Traumatology and Urology. During August 2013, following the IN guidance, hospital pharmacists directed a pharmaceutical intervention (PI) at physicians prescribing metoclopramide. An alarm system was created in the UDDDS module of Farmatools-Dominion to detect metoclopramide treatments in excess of 5 days. Daily, every metoclopramide prescription was reviewed by a pharmacist and physicians were alerted in accordance with the IN. Data collection: age, gender, CU, PI (reason for PI and degree of acceptance). Results 553 patients were hospitalised during the study: 96 treated with metoclopramide, mainly in DGS (59) and IM (17). 41 PIs were made. The majority of patients were female (63%) and the mean age was 64 years. 34 of the 41 PIs were made because metoclopramide was not recommended for use, while 7 were due to excessive length of treatment (surgery patients). The degree of acceptance of the PIs was 61% (19 drug interruptions and 6 changes from daily administration to only when presenting nausea or vomiting). Obstetrics/Gynaecology and Neurology were the CU with the highest degree of acceptance (100%), while IM (41%) and Surgery (20%) represented the highest number of PIs. Conclusions The degree of acceptance confirms both the importance of the involvement of pharmacists in the patient’s pharmacotherapy, as well as the importance of cooperation with physicians to optimise pharmaceutical care. Furthermore, PIs were successful and considered useful to improve the use of metoclopramide, not only improving safety but also efficacy. No conflict of interest.

BackgroundAutomated dispensing cabinets (ADC) allow medications to be stored and dispensed near the point of care, improving efficiency in drug distribution. Nevertheless, new technologies are not exempt from errors.PurposeTo analyse if there are stock discrepancies (SD) in drugs included in ADC.Material and methodsA descriptive observational prospective study was conducted during October 2014. Medicines contained in three ADC were inventoried. ADC were placed in internal medicine/haematology departments, digestive/oncology/cardiology departments and urgency service.We evaluated: global rate of SD; global rate of SD by drawer type; rate of SD per ADC; and rate of SD by drawer type per ADC.Three drawer types were defined: multiple drug access drawers (MDAD), single drug access drawers (SDAD) and single dose dispensing pockets (SDDP).Results1082 drugs were inventoried. 395 presented SD (36.5%): 279 (25.8%) in MDAD, 115 (10.6%) in SDAD and only 1 (0.1%) in SDDP. SD distribution by ADC is shown in table 1.Abstract DD-022 Table 1Total No of drugs by ADCTotal SD by ADC (%)Multiple drug access drawers SD (%)Single drug access drawers SD (%)Single dose dispensing pockets SD (%)Internal medicine/haematology departments393146 (37.2%)115 (29.3%) (261 drugs)31 (7.9%) (116 drugs)0 (0%) (16 drugs)Digestive/oncology/cardiology departments416169 (40.6%)103 (24.7%) (209 drugs)66 (15.9%) (166 drugs)0 (0%) (41 drugs)Urgency service27380 (29.3%)61 (22.3%) (178 drugs)18 (6.6%) (78 drugs)1 (0.4%) (17 drugs)ConclusionThe more drug storage is in an ADC, the more SD are found. Discrepancies were more common with MDAD because users could remove more doses and different drugs than requested. Therefore, although new technologies are designed to improve both safety and efficiency in medicine management in  hospitals, the use of ADC should include an evaluation of possible error opportunities, to implement strategies focused on preventing or minimising these errors. taking more care with those drawers where you can access the whole medication. Appropriate ADC handling is crucial to guarantee fast and safe access to medications in clinical units.No conflict of interest.

The social significance of public health and current scientific practice poses new responsibilities that drive scientific-medical societies to assume a public commitment, freely adopted and voluntary responsibility expressed through a Code of Good Practices [1],

BackgroundPrimary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin lymphoma which starts in the brain or spinal cord. PCNSL is more common in adults, typically in patients in their 50s and 60s, and its incidence has been increasing.PurposeTo analyse the neurological, radiological and clinical manifestations, and treatment and evolution of a series of patients diagnosed with PCNSL.Material and methodsRetrospective observational study of patients diagnosed with PCNSL from 2008 to 2014 in a second level hospital. All medical records were reviewed as well as all medical information from reference centres where some patients were transferred to receive their treatments.Data collected: sex, age, lactate dehydrogenase level, CSF protein levels and global survival.Results10 patients were included in the study, the majority were male (70%) and mean age was 69.5 years. Initial clinical manifestations: dizziness and instability (40%), disorders of consciousness (20%), changes of behaviour (20%), cephalea (10%) and partial (focal) epilepsy seizure (10%).All patients were immunocompromised. 4 patients presented elevated lactate dehydrogenase levels (500-1600 U/L) and another 4 presented high CSF protein levels (45-133 mg/dL) with normal cytological study. Neuroimaging studies showed unique tumoral lesions in 8 patients, with multicentric lesions in 2 cases. Tumoral biopsies were performed in 6 patients, spinal cord biopsy in 4 and extension study in 7 patients.Principal treatments were: corticosteroids (dexamethasone, oral and intravenous administration; 100%), surgical intervention (20%), cytostatic treatment (high dose methotrexate, intravenous regimen, high dose methotrexate intravenous plus cytarabine regimen, and high dose methotrexate intravenous plus cytarabine plus carmustine regimen; 80%), radiotherapy (30%) and spinal cord transplantation (10%). 7 patients died during the study. Mean global survival was 9.1 months and survival of patients after surgical intervention was 22.5 months.ConclusionPCNSL continues to be a malignancy with a poor prognosis in our work environment. Because the mainstay of treatment for many patients is high dose methotrexate intravenously, they must be educated carefully about the drugs to be avoided in the week prior to chemotherapy and about the fluid and intensive monitoring requirements of their inpatient stay.No conflict of interest.