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Objective To carry out a systematic review of the literature to analyse the efficacy and safety of treatments available or under investigation for amyloidosis due to mutations in the transthyretin gene (ATTR). Methods A bibliographic search was carried out in the following electronic databases up to September 2017: PubMed, Cochrane Library and EMBASE. The inclusion criteria were: efficacy and/or safety studies conducted in humans, studies that included treatments, including treatments in the research phase, and studies that included 10 or more patients. Results A total of 21 articles were included; 16 were clinical trials, eight of them (50%) phase III trials, and five were observational studies. Of the total number of studies selected, 11 were on tafamidis, four on diflunisal, two on liver transplantation, two on patisiran and two on other therapeutic alternatives. Of the 11 studies related to the drug, the pivotal trial, the results of its two extension studies and an additional post hoc analysis were selected. In addition, two phase III trials were included in specific populations, two phase II studies, one safety study and two observational studies. Regarding the four included studies related to the drug, one was the pivotal trial that gave the indication to diflunisal, another a safety summary of the pivotal trial, and the other two trials were carried out in specific populations, one in a Japanese population and another phase I trial in cardiac amyloidosis in the USA. As far as other alternatives are concerned, of the six studies included in this section, two were related to liver transplantation, two to patisiran and two to different therapeutic alternatives. Conclusions Sufficient evidence has not been found that demonstrates superiority among the available oral alternatives, diflunisal or tafamidis, in the treatment of ATTR. Direct comparisons between both drugs and pharmacoeconomic studies would be necessary to select the most efficient treatment.

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical outcomes and reduce the risk of contagion. The purpose of this article is to describe and analyze the experience of HPSs with outpatient Telepharmacy during the COVID-19 pandemic and expose the lessons learned. Measures have been adopted in on-site outpatient pharmacy clinics to prevent exposure of patients and professionals to the virus. These measures are based on national and international recommendations on social distancing and hygiene. With regard to remote outpatient pharmacy services, teleconsultation with drug dispensing has been promoted based on five basic procedures, each with its advantages and limitations: home drug delivery from HPSs, with the advantage of universal access and the limitation of entailing a substantial investment in resources; HPS coordination with primary care pharmacists, which requires no investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which requires the patient to go to the pharmacy, without confidentiality being guaranteed for any patient; geolocation and hospital-based medication dispensing, which provides universal access and direct traceability, but entails investment in human resources; and HPS coordination with associations of patients, which does not entail any additional cost but limits the information available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of medication (with a high level of satisfaction among patients); and the need to foster Telepharmacy as a complementary tool through a mixed model of outpatient pharmacy consultation service that incorporates the advantages of each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.Los servicios de farmacia hospitalaria (SFH) en España se han visto afectados por la crisis sanitaria provocada por SARS-CoV-2 y han tenido que adoptar sus procedimientos de atención farmacéutica (AF) al paciente externo (PE) mediante estrategias de Telefarmacia, con los objetivos de maximizar los resultados en salud y reducir el riesgo de contagio. El objetivo de ese artículo es describir y analizar los procedimientos AFPE durante la pandemia SARS-CoV-2 y comunicar las lecciones aprendidas en los SFH. En relación con las consultas externas de AF presenciales, se han adoptado medidas para minimizar el contagio viral de pacientes y profesionales, siguiendo las recomendaciones nacionales e internacionales de referencia de distanciamiento temporal, espacial y recomendaciones higiénicas. En cuanto a las consultas externas de AF no presenciales, se han potenciado las teleconsultas con dispensación del tratamiento en base a cinco procedimientos básicos, cada uno de ellos con sus ventajas y limitaciones: dispensación domiciliaria desde SFH que presenta las ventajas de la universalidad de acceso, pero requiere una elevada inversión en recursos; coordinación del SHF con farmacéuticos de atención primaria, que conlleva una nula inversión en recursos, pero limita el acceso a determinadas zonas geográficas; coordinación del SFH con farmacéuticos comunitarios, que utiliza una amplia red de oficinas de farmacia, pero exige el desplazamiento del paciente sin garantías de confidencialidad para todos los casos; geolocalización y dispensación hospitalaria, que permite un acceso universal y trazabilidad directa, pero requiere un incremento en recursos humanos; y coordinación del SFH con asociaciones de pacientes, que no requiere inversión económica, pero limita el acceso a las patologías de los asociados. Destacamos finalmente tres lecciones aprendidas: la capacidad de AFPE de SFH españoles ante una crisis sanitaria; la utilidad de la Telefarmacia para el seguimiento clínico, la coordinación asistencial, información al PE, dispensación y entrega informada (con elevada satisfacción de los pacientes); y la necesidad de potenciar la Telefarmacia como herramienta complementaria, en un modelo mixto de AFPE que incorpore las ventajas de cada uno de los procedimientos adaptándose a las necesidades individuales de los pacientes en un entorno de humanización de la asistencia sanitaria.

Background and importance The combination of perphenazine, a typical antipsychotic, with propranolol, a beta adrenergic antagonist, increases the concentrations of both drugs by pharmacokinetic interaction.1 The main effect of the interaction is potentiation of the hypotensive effect. Typical antipsychotics have an anticholinergic and antihistamine effect that can cause drowsiness, but also have structural similarities with benzodiazepines. Aim and objectives To describe the clinical case of a patient with drug poisoning and the interaction between perphenazine and propranolol and its haemodynamic and CNS depressant effects. Material and methods The patient was a 64-year-old woman who was found at home by the emergency ambulance service with a Glasgow coma scale (GCS) score of 3. Anamnesis showed autolytic attempt. Home treatment was letrozole 2.5 mg every 24 hours orally, perphenazine 8 mg every 12 hours orally, losartan 50 mg/hydrochlorothiazide 12.5 mg every 24 hours orally, propranolol 10 mg every 6 hours orally and paracetamol 325 mg/tramadol 37.5 mg every 8 hours orally. During transfer to hospital, flumazenil 1 mg was administered intravenously (IV) and GCS changed to 9–10. The patient was admitted to the intensive care unit due to a decreased level of consciousness and haemodynamic instability. Drug tests (toxicology screens) on blood and urine were requested. Endotracheal intubation and gastric lavage were performed. Pinkish content came out and it was thought to be traces of propranolol tablets. For haemodynamic control, dobutamine was administered at 5 µg/kg/min IV perfusion and antidotes to possible pharmacological intoxication were given: glucagon was administered at 0.03 mg/kg/hour perfusion IV (beta blockers), flumazenil bolus 1 mg IV (benzodiazepines) and naloxone 0.4 mg bolus IV (opioids). Results Drug tests showed positive urine and blood levels of 84.1 g/L for benzodiazepines. In the anamnesis she did not take benzodiazepines. Dobutamine, glucagon and naloxone were stopped because of the test results and haemodynamic improvement. Flumazenil 1 mg bolus IV was administered again and an infusion of flumazenil was started at 0.5 mg/hour IV until the level of consciousness was regained and the patient answered verbal orders on what happened 4 hours later. Conclusion and relevance Perphenazine can produce possible false positives for benzodiazepines. The interaction between perphenazine and propranolol can trigger haemodynamic instability and CNS depression, which can be successfully managed with dobutamine, glucagon and flumazenil. References and/or acknowledgements 1. Lexicomp: Interactions. Perphenazine–propranolol. Available at: https://online.lexi.com/lco/action/interact No conflict of interest.

This study intended to determine the relationship between the level of depression and coping strategies in relatives of victims of forced disappearance in the city of Medellín, Colombia. The research involved 34 grown-up participants, of both genders (4 men and 30 women) ages between 18 and 71, who were relatives of victims of forced disappearance at 6-21 months from the event occurrence. They completed Beck depression inventory, validated and standardized for Mexican population (Jurado, 1998) as well as the Coping Styles Questionnaire (Sandin & Chorot, 2003). General population means were compared in terms of age groups, relative's disappearance time and the participants' previous attendance to psychotherapy. 79.4% of participants had relatives who had disappeared 6-12 months before, and 58.8% of participants had not received psychological support. Depression levels were in a minimum/free-of-symptom level in 29.4% of population, in 23.5% they were slight, in 41.2% they were moderate and they showed to be severe in 5.9% of participants. The relationship between depression and coping styles levels was not statistically significant, yet focusing on problem solving and religion appeared as protection factors against depression Se buscó determinar la relación entre el nivel de depresión y las estrategias de afrontamiento en familiares de personas víctimas de desaparición forzada de la ciudad de Medellín, Colombia. Los participantes fueron 34 personas adultas de ambos géneros (4 hombres y 30 mujeres) con un rango de edad 18 a 71 años de edad, familiares de víctimas de desaparición forzada de entre 6 y 21 meses de haber acontecido el evento, a quienes se les aplicó el cuestionario de depresión de Beck validado y estandarización en población mexicana (Jurado, 1998) y el cuestionario de estilos de afrontamiento (Sandin & Chorot, 2003). Se hicieron comparaciones con los promedios de la población general de acuerdo con los grupos de edad, tiempo de desaparición del familiar y asistencia previa a psicoterapia de los participantes. El 79,4% presentaban familiares desaparecidos entre 6 y 12 meses y el 58,8% no había recibido apoyo psicológico. Los niveles de depresión de la población se presentaron en 29,4% mínimo o sin síntomas, 23,5% leve, 41,2% moderada y 5,9% severa; aunque la relación entre el nivel de depresión y los estilos de afrontamiento no es estadísticamente significativa, la focalización en la solución de problemas y la religión parecen factores protectores del nivel de depresión.