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BACKGROUND—Pigeon breeder's disease is an extrinsic allergic alveolitis in the lungs of sensitised people, caused by hypersensitivity reactions to inhaled pigeon antigens. Antigens from different sources of the animal are used for diagnostic purposes, with serum being the most widely used. Bloom is rarely used; very little is known of its antigenicity and diagnostic performance, particularly when used with the enzyme linked immunosorbent assay (ELISA) method, which is the most popular test as it permits measurement of the antibody response. METHODS—To (a) standardise an ELISA for the measurement of specific IgG against pigeon serum and pigeon bloom extract; (b) to establish reference values for specific IgG in 73 non-exposed controls, (c) to show the presence of specific IgG against pigeon serum and bloom in serum samples of 17 patients with bird fancier's lung and 11 asymptomatic fanciers, and (d) to study the similarity of the two antigen sources by cross reactivity experiments. RESULTS—Reference values of specific IgG were defined with the 97.5 percentile (367.9 U/ml for pigeon serum and 953.7 U/ml for pigeon bloom extract). Of symptomatic patients 100% had values higher than the cut off for both antigens. In asymptomatic fanciers values were higher than the cut off for pigeon serum in 45% and bloom extract in 54%. Cross reactivity experiments showed that the two antigens differed in antigenic content although some components may be common to both. CONCLUSION—The ELISA methods used proved to be useful tools for evaluating specific IgG antibody responses against both antigens. The diagnostic performance of both ELISA methods performed with these antigen sources was similar, showing very high sensitivity but moderate specificity. Although some antigenic similarity was found between pigeon serum and bloom extract, cross reactivity studies showed that various antigens seemed to be specific to the bloom extract. However, the antigens responsible for pigeon breeder's disease seem to be present in both antigenic sources. Keywords: antibodies; pigeons; ELISA

Background: Patients affected during the asthma outbreaks caused by soybean dust inhalation in Barcelona presented with sudden onset of severe asthma followed by the rapid relief of symptoms after treatment. Two years after the epidemics ended, a case-control study was conducted in which the clinical, functional, and immunological characteristics of these asthma patients (a randomised sample of asthmatic patients admitted as emergency cases on epidemic days, n = 213) were compared with those of a control group (a random sample of asthmatic patients admitted as emergency cases for attacks of asthma on non-epidemic days, n = 170). METHODS--The study included the administration of the ATS-DLD78 standardised respiratory questionnaire, the measurement of atopy, and performance of spirometric tests and a methacholine inhalation test. Results: Patients with epidemic asthma reported fewer symptoms of asthma, had attended emergency departments less frequently during the previous year for acute attacks of asthma, were taking fewer inhaled corticosteroids at the time of the study, and attended medical follow up less frequently than did the patients with non-epidemic asthma. However, the cases and controls showed no differences in ventilatory capacity or reactivity to the methacholine bronchoprovocation test. Conclusions: Two years after the end of the soybean epidemics, people affected by epidemic asthma had a favourable prognosis. This finding contrasts with a higher risk of life threatening asthma and death during the epidemics. This paradox could be the result of a complex interaction between host and conditions of exposure.

Background Severe deficiency in human fibrinogen is a cause of massive haemorrhage whose management in emergency situations is the subject of debate. Purpose A prospective, observational study to ascertain how human fibrinogen is used in patients with life-threatening haemorrhagic disorders (trauma and surgery), especially in patients with underlying disease states that limit fibrinogen synthesis. Moreover, it aims to assess the adherence to the European guideline recommendations. Materials and methods In a third-level hospital, patients with a documented life-threatening haemorrhage who received a human fibrinogen prescription were included in the protocol, over a period of 12 months. Demographic data, treatment indication, prothrombin time, plasma fibrinogen, haemoglobin and haematocrit before and after treatment; admission diagnosis, fibrinogen dose and concomitant blood product treatment were collected. Results 46 patients were treated with human fibrinogen and included in the analysis. Patients’ mean age was 55.23 (18–85) years, 30.43% were women and 69.57% men. The average dose was 2.39 g, the global survival after seven days was 86.96% and 34.78% had concomitant treatment with prothrombin complex concentrates (PCC). 80.43% of patients underwent surgery and 82.61% suffered an active haemorrhage. The mean initial fibrinogen level was 1.77 g/L, and post-administration the mean level increased to 2.43 g/L. The fibrinogen biological recovery was 105%. 58.63% of patients had initial fibrinogen levels beneath 2 g/L, while the other 41.38% didn’t meet the clinical guideline recommendations. Quick time (s) (% t/ INR): –Before administration: 21.73s (68.88%, 1.62) –After administration: 19.20s, (75.96%, 1.38) –After three days: 18.38s (79.96%, 1.36) –After seven days: 17.35s (84.71%, 1.29) Haemoglobin (g/dL) and haematocrit (%) levels: –Before administration: 9.37g/dL/27.46% –After administration: 9.63 g/dL/28.02% –After three days: 9.77 g/dL/28.44% Regarding to the European Clinical Guidelines, 41.38% of the treatments did not follow their recommendations as the initial fibrinogen levels were superior to 2 g/L. Conclusions Following fibrinogen administration a great improvement in the coagulation parameters was observed, as well as in the haemoglobin and haematocrit levels. Finally, the European Clinical Guidelines were not followed in a significant percentage as fibrinogen was administered in spite of initial fibrinogen levels greater than 2 g/L. No conflict of interest.

Background Severe deficiency in blood clotting factors is a cause of massive haemorrhage whose management in emergency situations is the subject of debate. Purpose A prospective, observational study, to ascertain how prothrombin complex concentrates (PCC) are used and their efficacy in patients with life-threatening haemorrhagic disorders (trauma and surgery), especially in patients with underlying disease states that limit the synthesis of blood clotting factors. To assess the adherence to the European guideline recommendations. Materials and methods In a third-level hospital, patients with a documented life-threatening haemorrhage who received a PCC prescription were included in the protocol, over a period of 12 months. Demographic data, treatment indication, prothrombin time, haemoglobin and haematocrit before and after treatment; diagnosis on admission, PCC dose, current oral anticoagulant treatment (OAT) and treatment administering vitamin K, and FFP or other blood products were recorded. Results 45 patients were treated with PCC and included in the analysis. Mean patient age was 59.64 years, 42.2% were women and 57.77% men. The average dose was 1604 IU, the global survival after seven days was 73.33% and 35.55% had concomitant treatment with fibrinogen. 11.11% of the patients had been treated with oral anticoagulants (OAT) prior to the emergency bleeding, 48.89% had polytraumatic wounds, 4.44% had thrombocytopenia secondary to hepatopathy, 0% had haemophilia, 75.55% had an active haemorrhage, 68.89% underwent surgery, when the PCC was administered. Quick time (s) (% // INR): Before Administration: 25.36s (70.49%, 2.02) After Administration: 19.47s (81.97%, 1.57) After Three Days: 17.53s (84.03%, 1.26) After Seven Days: 19.01s (81.64%, 1.38) Haemoglobin (g/dL) and haematocrit levels (%): Before Administration: 10.5 g/dL/31.09% After Administration: 10.33 g/dL/30.18% After Three Days: 10.28 g/dL/31.09% Conclusions Following PCC administration the coagulation parameters improved dramatically. However, according to the European Guidelines, there aren’t enough studies to support PCC use other than in haemophilia or for the rapid reversal of the effect of oral vitamin K antagonists. No conflict of interest.

Background The different methods that currently exist to estimate renal function take into account different parameters, which may affect the dose of some drugs, such as dexketoprofen. The recommended dose of IV dexketoprofen is 50 mg every 8 hours if eGFR is >80 mL/min/1.73 m², 25 mg every 12 hours if eGFR is between 50–80 mL/min/1.73 m² and it is contraindicated if eGFR is Purpose To determine the differences in the estimates of renal function, using CKD-EPI, MDRD4-IDMS and Cockcroft-Gault (CG) to estimate the glomerular filtration rate (eGFR) and to assess their effect on the functional characterization of patients and the dose of IV dexketoprofen. Materials and Methods Retrospective observational study performed in adults admitted to surgical units – general, trauma and obstetric – treated with dexketoprofen IV in a tertiary hospital from January to September 2011 (9 months). The eGFR was calculated by CKD-EPI, MDRD4-IDMS and Cockcroft-Gault. Patients with serum creatinine below 0.4 mg/dl were excluded. CKD-EPI was used as a reference formula to assess the concordance between the different methods of estimating, classifying patients in 3 eGFR groups according to the IV dexketoprofen SmPC: 80 mL/min/ 1.73 m². Results The study included 1946 patients – 54.3% men, 45.7% women – from a total population of 2052 admissions; mean age of 59.8 years (range 17–103). The mean serum creatinine concentration was 0.84 mg/dL ± 0.43 and mean eGFR, according to CKD-EPI, 83.05 ± 26.17 mL/min/1.73 m². The following results of non-concordance were found by comparing these formulas to estimate renal function: CKD-EPI vs. MDRD4-IDMS: 4.3% in eGFR 80 mL/min/1.73 m². CKD-EPI vs. CG: 2.8% in eGFR 80 mL/min/1.73 m². MDRD4-IDMS vs. CG: 4.5% in the group of eGFR 80 ml/min. Conclusions A great difference was found in the estimates of renal function between the three methods used – CKD-EPI, MDRD4-IDMS and CG – in the three eGFR functional categories − 80 mL/min/1.73 m² – ranging between 2.8% and 23.2%. These results are relevant in clinical practise because the functional category determines the non-use or limited dose of dexketoprofen IV for each patient. No conflict of interest.

Background Acute renal failure is a side effect of NSAIDs. Purpose To assess the appropriateness of the intravenous prescription of dexketoprofen according to the dosage specifications depending on renal function following the recommendations of the Summary of Product Characteristics. Materials and Methods An observational, retrospective study that analysed dexketoprofen prescriptions in surgical patients admitted to a tertiary hospital from January-September 2011. The estimated glomerular filtration rate (eGF) was calculated by the CKD-EPI formula, of reference in the hospital. The Summary of Product Characteristics advises using the following posology for dexketoprofen: 150 mg maximum daily dose for a maximum duration of 48 hours. In patients with renal impairment: GF GF 50–80 mL/min: 25 mg/12 h. Maximum: 50 mg daily. GF > 80 mL/min: No dosage adjustment required. Results Prescriptions from 1946 patients were analysed. Of the patients, 54.3% were male and 45.7% female, with a mean age of 59.8 years (17–103). The mean serum creatinine levels were 0.84 mg/dL ± 0.43 and the mean eGF from the CKD-EPI calculation was 83.05 ± 26.17 mL/min/1.73m2. In 58% of the admissions the drug was not prescribed correctly. Of these: 270 patients were prescribed dexketoprofen when the eFG was less than 50 mL/min/1.73m 2 ; 550 of them had an unadjusted prescription with an eFG 50–80 mL/min/1.73m 2 . 370 patients with an eGF > 80 mL/min/1.73 m 2 were prescribed NSAIDs for longer than 48 h. Conclusions 58% of the intravenous NSAID prescriptions did not conform to the SPC recommendations. Due to this fact and in order to prevent renal toxicity it is recommended: To establish protocols for pain management during hospitalisation to limit the duration of these drugs to 48 hours and adjust the dose to the patient’s renal function. To enhance the proactive role of the pharmacist in individualised patient monitoring. No conflict of interest.

Background Multiple sclerosis (MS) is a disabling disease that affects the central nervous system. Switching of first-line drugs (interferon β, glatiramer acetate) or initiation of a second-line treatment (natalizumab, mitoxantrone, cyclophosphamide, rituximab) should be considered if suboptimal response is observed with first-line drugs. Purpose To analyse the treatment pattern and the main reasons for changing MS treatment. Materials and methods Cross-sectional, retrospective descriptive study in MS patients, in a reference unit, in a tertiary hospital. A sample of 100 patients was analysed (10% of complete MS population) who picked up medicines from the outpatient pharmacy unit, following a database that included demographic and clinical information. Results 30% of patients had switched treatment once and 7% at least twice (23.3% of the MS population that had changed previously). The main reasons for changing treatment, from initial to second and second to third treatment were: lack of efficacy: 65.4% and 20% respectively; drug withdrawal: 15.4% and 20%; pregnancy: 15.4% and 0%; drug intolerance: 3.8% and 0%; adverse reaction: 0% and 20%; maximum tolerated dose: 0% and 10%. By drugs, main reasons for changing MS treatment, from the initial to second treatment were: Avonex: lack of efficacy (75%) and pregnancy (25%); Betaferon: lack of efficacy (20%) and drug withdrawal (80%); Rebif 22 mcg lack of efficacy (75%) and pregnancy (25%); Rebif 44 mcg: lack of efficacy (100%); Copaxone: lack of efficacy (50%), intolerance (25%) and pregnancy (25%). The treatment mean time was 51±43 months prior to the first change, which decreased to 23.5±21.9 months for the second change of treatment. The mean Expanded Disability Status Scale (EDSS) score increased from 2.5±1.4 at the beginning to 3.9±1.9 in second-line treatment and 5.7±1.8 in third-line treatment. Conclusions 30% of patients with MS had changed treatment. The main reason was progression of the disease.