ABSTRACT Local Anesthetics (LA) of the monoamide family have become the group of greatest demand during surgical procedures due to a lower incidence of adverse reactions in the metabolism of human beings. Bupivacaine belongs to this group. In Cuba, there is a new formulation of this drug register in CECMED at 2014, now with hyperbaric presentation, for which a prospective descriptive post commercialization study was carried out in the different surgical interventions performed at the Pedro Kourí Institute of Tropical Medicine (IPK) since July 2018 to February 2019. Hyperbaric bupivacaine administered via the spinal subarachnoid route was used as the anesthetic of choice in 21 of the interventions performed during this period. 71.4% of the operated patients presented some pathological history, the most frequent being arterial hypertension, bronchial asthma, diabetes mellitus and HIV infection, respectively. The 57.15% of the patients used one or two medications as their basic treatment, 9.5% more than two medications and 33% had no treatment at all. Anesthesia was effective in 20 of the interventions performed and it was not in only one patient, a result that could be related to failures in the administration technique (low volume of the drug and low speed of drug administration), but not with the quality intrinsic to the product. These results demonstrated that Cuban-made hyperbaric bupivacaine provided effective and safe surgical analgesia in studied patients.

RESUMEN Los Anestésicos Locales (AL) de la familia monoamidas se han convertido en el grupo de mayor demanda durante la realización de procedimientos quirúrgicos debido a una menor incidencia de reacciones adversas en el metabolismo del ser humano. Dentro de este grupo se encuentra la bupivacaína. En Cuba, existe una nueva formulación de este fármaco con registro CECMED en el 2014, ahora con presentación hiperbárica, por lo que se realizó un estudio de post comercialización de tipo observacional descriptivo prospectivo, en las diferentes intervenciones quirúrgicas realizadas en el Instituto de Medicina Tropical Pedro Kourí (IPK) desde julio 2018 a febrero de 2019. La bupivacaína hiperbárica administrada por vía espinal subaracnoidea, fue utilizada como anestésico de elección en 21 de las intervenciones realizadas durante este período. El 71,4 % de los pacientes operados presentaron algún antecedente patológico, siendo los más frecuentes la hipertensión arterial, asma bronquial, diabetes mellitus y la infección por VIH. El 57,15% de los pacientes llevaban como tratamiento de base uno o dos medicamentos, el 9,5 % más de dos medicamentos y el 33 % no llevaban tratamiento alguno. La anestesia fue efectiva en 20 de las intervenciones realizadas y solo en un paciente no lo fue, resultado que pudiera estar relacionado con fallos en la técnica de administración (bajo volumen del fármaco y baja velocidad de administración del mismo), pero no con la calidad intrínseca del producto. Estos resultados demostraron que la bupivacaína hiperbárica de fabricación cubana, proporcionó una efectiva y segura analgesia quirúrgica en los pacientes estudiados.

ABSTRACT It has been shown that patients with HIV / AIDS have chronic oxidative stress, with impaired antioxidant defense system. This influences aspects of the disease, including viral replication, inflammatory response, decreased lymphocyte proliferation, loss of immune function, chronic weight loss and increased sensitivity to drug toxicity. To assess the level of satisfaction of HIV patients with the rectal application of ozone therapy, observing the possible manifestations of adverse events and the performance of the nurses involved. Descriptive, cross-sectional study at the "Pedro Kourí" Institute of Tropical Medicine, from February to August 2019. A satisfaction survey was carried out on 20 patients with ozone therapy indicated for a 30-day cycle. Nursing activities were described during the procedure and the performance of the five nurses who applied ozone was evaluated through an observation guide. Regarding the level of satisfaction of the patients surveyed, 19 (99.5%) reported improving with treatment and 1 (0.5%) was not sure of their improvement. The emotional state of 14 (70%) patients was very good and in 6 (30%) of them it was good. Of the total of patients 15 (75%) reported that they were completely satisfied with the ozone therapy treatment, 3 (15%) felt very satisfied and 2 (10%) were quite satisfied. After rectal insufflation, the feeling of full stomach and hunger were referred by patients, in no case was treatment required. The evaluation of the practices showed that 4 (80%) nurses complied with the procedures and only 1 (20%) presented any breach. Compliance with good nursing practices in the application of ozone therapy influenced the satisfaction of the majority of patients in treatment.

RESUMEN Se ha demostrado que los pacientes con VIH/sida presentan estrés oxidativo crónico, con alteración del sistema de defensa antioxidante. Lo cual influye en aspectos de la enfermedad, incluida la replicación viral, la respuesta inflamatoria, la disminución de la proliferación linfocitaria, la pérdida de la función inmune, la pérdida crónica de peso y el incremento en la sensibilidad a la toxicidad de los medicamentos. Evaluar el nivel de satisfacción de los pacientes VIH con la aplicación rectal de la ozonoterapia, observando las posibles manifestaciones de eventos adversos y el desempeño de las enfermeras involucradas. Estudio descriptivo, de corte transversal en el Instituto de Medicina Tropical “Pedro Kourí”, de febrero a agosto de 2019. Se realizó encuesta de satisfacción a 20 pacientes con ozonoterapia indicada por un ciclo de 30 días. Se describió las actividades de enfermería durante el proceder y se evaluó la ejecución de las cinco enfermeras que aplican ozono a través de una guía de observación. En cuanto al nivel de satisfacción de los pacientes encuestados, 19 (99,5%) refirieron mejorar con el tratamiento y 1 (0.5%) no estuvo seguro de su mejoría. El estado emocional de 14 (70%) pacientes fue muy bueno y en 6 (30%) de ellos fue bueno. Del total de pacientes 15 (75%) refirieron que estaban completamente satisfechos con el tratamiento de ozonoterapia, 3 (15%) se sintieron muy satisfechos y 2 (10%) se encontraban bastantes satisfechos. Luego de la insuflación rectal, fue referida por los pacientes la sensación de estómago repleto y de hambre, en ningún caso se requirió tratamiento. La evaluación de las prácticas arrojó que 4 (80%) enfermeras cumplieron con los procedimientos y 1 (20%) presentó algún incumplimiento. El cumplimiento de buenas prácticas de enfermería en la aplicación de ozonoterapia influyó en la satisfacción de la mayoría de los pacientes en tratamiento.

INTRODUCTION Approximately 73% of persons with HIV who receive antiretroviral therapy in Cuba are in viral suppression. The non-response of the remaining 27% could be due to several factors including adverse drug reactions and HIV resistance to antiretroviral drugs, as well as social factors and idiosyncratic characteristics of each patient. Genetic information explains from 20% to 95% of a drug’s effects and variations in response. Considering optimization of therapeutic efficacy in our country, genetic factors of the host should be identified. OBJECTIVE Identify polymorphisms affecting genetic variability of responses to antiretroviral drugs. EVIDENCE ACQUISITION A literature review was conducted (of original articles, published theses, clinical reports and bibliographic review studies, from 2000 to 2018, in Spanish and English listed in MEDLINE/PubMed, SciELO, LILACS, PharmGKB and Google Scholar) with the following key words: pharmacogenetics, human immunodeficiency virus, anti-retroviral agents, genetic polymorphism, genetic techniques, pharmacogenomic variants. DEVELOPMENT The review identified 77 relevant publications meeting specific quality criteria. A summary table was built with data collected on antiretroviral drugs, genes and proteins involved in polymorphic variations, their associated effects and relevant scientific references. Information was included on polymorphisms related to 12 antiretroviral drugs used in HIV therapy. Polymorphisms determine variations in proteins involved in drug transport and metabolism and in elements of immunity. Relevant pharmacogenetic biomarkers recognized by drug regulatory agencies were identified. CONCLUSIONS The study identified genetic variations (single-nucleotide polymorphisms) associated with 12 antiretroviral drugs. In most cases, no statistically significant causal association was found. Identifying polymorphic variations is a medium- and long-term objective that requires statistical support and adoption of strategies to optimize antiretroviral therapy. An approach combining plasma-level monitoring and pharmacogenetic analysis is recommended to optimize therapy for HIV patients.