Prevalence of sexually risky behaviors among Mexican medical students.

University students are at high risk of sexually transmitted infections due to the lack of adequate sexual education, as well as multiple associated factors, which lead to risky sexual practices. It is important to update data about sexual behaviors to identify the main factors associated with sexually risky behaviors. The present study aimed to evaluate the current prevalence of sexually risky practices in medical students. A cross-sectional study was conducted among medical students through an anonymous self-administered online questionnaire including demographic characteristics and sexual behaviors. We used descriptive statistics and multivariable regression to analyze the data collected. A total of 1520 undergraduate medical students aged between 18 and 28 years old were included in the study. Sixty percent of the students were sexually active with a higher proportion in men (70%), likewise, they had an earlier sexual debut (16.5 vs 16.9 years old), and a greater number of lifetime sexual partners than women (3.8 vs 2.2). The main sexual activity in both groups was vaginal sex with high use of condoms (75%), however, most of them (67%) reported having unprotected oral sex. Logistic regression analysis showed that condomless sex was associated with having oral sex, anal sex, and being female. The findings of this study showed that medical university students are involved in risky sexual behaviors, the major risk factor was unprotected oral sex. Based on these results, we recommended designing interventions to improve sexual education and preventive approaches from early stages such as in middle school students to mitigate sexually transmitted infections among medical university students.

Clinical Experience on the Use of a Single-day, Two-injection Start Initiation Regimen of Aripiprazole Once Monthly in Patients With Schizophrenia in Spain: SaTISfy Study.

OBJECTIVE: The two-injection start (TIS) initiation regimen was recently approved for aripiprazole once monthly 400 mg (AOM400), with potential benefits in adherence. The SaTISfy study described in this article analyzed Spanish psychiatrists' perspectives on hospitalization lengths of stay, schizophrenia management, and the use of AOM400-TIS. METHODS: The authors describe an ecological study of aggregated data collected using a 41-question survey. Fifty psychiatrists were asked to provide their perceptions of their patients with schizophrenia and treatment with AOM400. RESULTS: The psychiatrists reported that lack of treatment adherence was the main reason for hospitalization for 58.3% of their patients diagnosed with schizophrenia. Aripiprazole, in any formulation, was the most commonly prescribed therapeutic option, being prescribed for a mean (SD) of 2.5 (0.9) out of 5 patients, while 98% of psychiatrists chose AOM400-TIS for patients who failed to adhere to previous treatments. Patients with schizophrenia, regardless of their treatment, were hospitalized for an average of 17.7 (3.93) days versus patients with schizophrenia treated with AOM400-TIS, who were hospitalized for an average of 14.2 (4.18) days, a reduction of 3.5 (3.86) days. Patients treated with AOM400-TIS showed a reduction of 5 (4.18) days compared with the mean national duration of hospitalization for acute patients in psychiatry units in Spain (19.18 d). The surveyed psychiatrists reported that AOM400-TIS improved safety and tolerability. Most of the psychiatrists were satisfied with the administration and results of AOM400-TIS. Most of the psychiatrists (90%) also reported that fewer health care resources were consumed with AOM400-TIS, mainly due to a reduction in hospitalization days and in the use of concomitant medications. CONCLUSIONS: AOM400-TIS was considered to have a positive impact on the duration of hospitalization and thus on the use of health care resources. There was a positive perception of adherence, safety, and tolerability with the use of AOM400-TIS in patients with schizophrenia.

Identification of Compound Heterozygous EVC2 Gene Variants in Two Mexican Families with Ellis-van Creveld Syndrome.

BACKGROUND: Ellis-van Creveld syndrome (EvCS) is an autosomal recessive ciliopathy with a disproportionate short stature, polydactyly, dystrophic nails, oral defects, and cardiac anomalies. It is caused by pathogenic variants in the EVC or EVC2 genes. To obtain further insight into the genetics of EvCS, we identified the genetic defect for the EVC2 gene in two Mexican patients. METHODS: Two Mexican families were enrolled in this study. Exome sequencing was applied in the probands to screen potential genetic variant(s), and then Sanger sequencing was used to identify the variant in the parents. Finally, a prediction of the three-dimensional structure of the mutant proteins was made. RESULTS: One patient has a compound heterozygous EVC2 mutation: a novel heterozygous variant c.519_519 + 1delinsT inherited from her mother, and a heterozygous variant c.2161delC (p.L721fs) inherited from her father. The second patient has a previously reported compound heterozygous EVC2 mutation: nonsense mutation c.645G > A (p.W215*) in exon 5 inherited from her mother, and c.273dup (p.K92fs) in exon 2 inherited from her father. In both cases, the diagnostic was Ellis-van Creveld syndrome. Three-dimensional modeling of the EVC2 protein showed that truncated proteins are produced in both patients due to the generation of premature stop codons. CONCLUSION: The identified novel heterozygous EVC2 variants, c.2161delC and c.519_519 + 1delinsT, were responsible for the Ellis-van Creveld syndrome in one of the Mexican patients. In the second Mexican patient, we identified a compound heterozygous variant, c.645G > A and c.273dup, responsible for EvCS. The findings in this study extend the EVC2 mutation spectrum and may provide new insights into the EVC2 causation and diagnosis with implications for genetic counseling and clinical management.

Antifungal Activity of Mexican Propolis on Clinical Isolates of Candida Species.

Infections caused by micro-organisms of the genus Candida are becoming a growing health problem worldwide. These fungi are opportunistic commensals that can produce infections-clinically known as candidiasis-in immunocompromised individuals. The indiscriminate use of different anti-fungal treatments has triggered the resistance of Candida species to currently used therapies. In this sense, propolis has been shown to have potent antimicrobial properties and thus can be used as an approach for the inhibition of Candida species. Therefore, this work aims to evaluate the anti-Candida effects of a propolis extract obtained from the north of Mexico on clinical isolates of Candida species. Candida species were specifically identified from oral lesions, and both the qualitative and quantitative anti-Candida effects of the Mexican propolis were evaluated, as well as its inhibitory effect on C. albicans isolate's germ tube growth and chemical composition. Three Candida species were identified, and our results indicated that the inhibition halos of the propolis ranged from 7.6 to 21.43 mm, while that of the MFC and FC50 ranged from 0.312 to 1.25 and 0.014 to 0.244 mg/mL, respectively. Moreover, the propolis was found to inhibit germ tube formation (IC50 ranging from 0.030 to 1.291 mg/mL). Chemical composition analysis indicated the presence of flavonoids, including pinocembrin, baicalein, pinobanksin chalcone, rhamnetin, and biochanin A, in the Mexican propolis extract. In summary, our work shows that Mexican propolis presents significant anti-Candida effects related to its chemical composition, and also inhibits germ tube growth. Other Candida species virulence factors should be investigated in future research in order to determine the mechanisms associated with antifungal effects against them.

Human papillomavirus infection and seroprevalence among female university students in Mexico.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases, and the main etiology of cervical cancer. This study was aimed to assess type-specific cervical HPV prevalence and their association with HPV-specific antibodies in a cohort of female university students. HPV genotyping was performed by amplifying and sequencing a fragment of the L1 protein. A BLAST search was performed to identify HPV types. HPV-specific IgG antibodies were measured by ELISA in serum samples. A total of 129 women participated, with an average age of 21.75 years. The prevalence of vaginal HPV infection was 74.42%. The most predominant high-risk HPV types were 18 (13.95%), 31 (10.85%), and 16 (9.3%). We found that early age at coitarche and a higher number of sexual partners were significantly associated with a high prevalence of HPV infection. In addition to sexual behavior, we observed that the presence of serum-specific IgG antibodies against HPV can impact the prevalence of the virus. Seropositivity to HPV-16 and HPV-18 was associated with a lower prevalence of HPV-16, but not for other HPV types. Of note, there was a lower proportion of HPV-specific seropositivity in women who had the presence of the same HPV type in a cervical specimen, suggesting an immunoregulatory mechanism associated with the viral infection. In conclusion, the prevalence of HPV in university women was higher than expected and it was associated with early age of sexual debut, an increasing number of sexual partners, and a low proportion of HPV seropositivity.

Hypophysitis secondary to pembrolizumab: a case report and review of the literature.

Pembrolizumab is a mAb against the programmed cell death protein-1 (PD-1). It has been approved for the treatment of advanced melanoma (unresectable or metastatic) in adults. Side effects associated with the use of anti-PD-1 are usually considered well tolerated; nevertheless, there are immune-related adverse events that may require treatment discontinuation. A 79-year-old man diagnosed with stage IV right scapular melanoma experienced unspecific symptoms and alterations of the hypothalamus-hypophysis axis after six cycles with pembrolizumab. The case was compatible with immune-related hypophysitis. Autoimmune thyroiditis and primary hypophysitis were excluded and toxicity due to pembrolizumab was considered the cause of hypophysitis. Pembrolizumab was discontinued and toxicity was managed with corticosteroids and hormonal replacement therapy (HRT). After 7 months of follow-up, symptoms were controlled with HRT but thyrotropin and corticotropin hormones had not recovered. It was decided not to reintroduce immunotherapy. Although endocrine disorders are common with the use of anti-PD-1, hypophysitis is very rare. However, clinical signs and symptoms can be nonspecific, therefore, it has probably been underdiagnosed. Monitoring hormones before and during the treatment is important for an early diagnosis and also to replace the alterations with HRT to control the symptoms. Hormonal function does not always recover, but it does not mean immunotherapy cannot be restarted and it should be evaluated in every case.

Flavonoids Present in Propolis in the Battle against Photoaging and Psoriasis.

The skin is the main external organ. It protects against different types of potentially harmful agents, such as pathogens, or physical factors, such as radiation. Skin disorders are very diverse, and some of them lack adequate and accessible treatment. The photoaging of the skin is a problem of great relevance since it is related to the development of cancer, while psoriasis is a chronic inflammatory disease that causes scaly skin lesions and deterioration of the lifestyle of people affected. These diseases affect the patient's health and quality of life, so alternatives have been sought that improve the treatment for these diseases. This review focuses on describing the properties and benefits of flavonoids from propolis against these diseases. The information collected shows that the antioxidant and anti-inflammatory properties of flavonoids play a crucial role in the control and regulation of the cellular and biochemical alterations caused by these diseases; moreover, flavones, flavonols, flavanones, flavan-3-ols, and isoflavones contained in different worldwide propolis samples are the types of flavonoids usually evaluated in both diseases. Therefore, the research carried out in the area of dermatology with bioactive compounds of different origins is of great relevance to developing preventive and therapeutic approaches.

Effect on the adherence to concomitant medications after initiation of treatment with direct-acting antiviral agents against hepatitis C virus.

INTRODUCTION: Many patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications. PATIENTS AND METHODS: HCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication. RESULTS: Data from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p=0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p=0.006 and 84.7%, p<0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09-0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48-13.92). DISCUSSION: Adherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence.

Hypohidrotic ectodermal dysplasia: clinical and molecular review.

Hypohidrotic Ectodermal Dysplasia (HED) is a genetic human disorder which affects structures of ectodermal origin. Although there are autosomal recessive and dominant forms, X-linked (XL) is the most frequent form of the disease. This XL-HED phenotype is associated with mutations in the gene encoding the transmembrane protein ectodysplasin-1 (EDA1), a member of the TNFα-related signaling pathway. The proteins from this pathway are involved in signal transduction from ectoderm to mesenchyme leading to the development of ectoderm-derived structures in the fetus such as hair, teeth, skin, nails, and eccrine sweat glands. The aim of this review was to update the main clinical characteristics of HED regarding to recent molecular advances in the comprehension of all the possible genes involved in this group of disorders since it is known that Eda-A1-Edar signaling has multiple roles in ectodermal organ development, regulating their initiation, morphogenesis, and differentiation steps. The knowledge of the biological mechanisms that generate HED is needed for both a better detection of possible cases and for the design of efficient prevention and treatment approaches.

Infratrochlear neuralgia: A prospective series of seven patients treated with infratrochlear nerve blocks.

Background Infratrochlear neuralgia is a recently described painful cranial neuropathy that causes pain in the internal angle of the orbit and the medial upper eyelid, the upper bridge of the nose and/or the lacrimal caruncle. We aim to present seven new cases of infratrochlear neuralgia treated with anaesthetic nerve blocks. Methods Over an 18-month period, we prospectively identified seven cases of infratrochlear neuralgia among the patients attending the Headache Unit in a tertiary hospital. Anaesthetic blocks were performed by injecting 0.5 cc of bupivacaine 0.5% at the emergence of the nerve above the internal canthus. Results All patients were women, and the mean age was 49.1 years (standard deviation, 17.9). The pain appeared at the internal angle of the orbit and/or the medial upper eyelid in six cases, and the whole territory of the infratrochlear nerve in one case. Six patients had continuous pain and one had episodes lasting 8-24 hours. All patients showed sensory disturbances within the painful area and tenderness upon palpation of the infratrochlear nerve. Nerve blocks resulted in complete and long-lasting relief in four patients and short-lasting relief in the other three patients. Conclusions Infratrochlear neuralgia should be considered among the neuralgic causes of orbital and periorbital pain. Anaesthetic blocks may assist clinicians in the diagnosis and may also be an effective therapy.

Adequancy of treatment with canaglifozin alter alerts pharmacovigilance in the health management area.

OBJECTIVE: To analyze the impact of a strategy on the suitability of canaglizozin, and its level of acceptance, after issuing recommendations based on drug surveillance alerts issued by the Spanish Medicines and Medical Devices Agency (AEMPS). DESIGN: A prospective intervention from may 2016 to october 2016. Location: South Seville Health Management Area. Participants: Patients with active canagliflozin prescription. Interventions: The study was conducted in three phases, the first one linked to the issuance of the safety information note on the canaglifozin by the AEMPS, the obtaining of the patient lists and the recommendations of the adequacy in the sending of letters. A second phase where the medical professional performed the actions and a final phase in which the degree of acceptance of the recommendations made by the Pharmacy Service is evaluated. MAIN MEASUREMENTS: Suitability of canaglizozin treatment and the level of acceptance by physicians. RESULTS: A total of 61 patients at baseline were included in treatment canagliflozin. Of the total number of patients referred to, some type of intervention was performed by the family and community medicine doctor after the pharmaceutical intervention (PI), by means of letters (n = 30), 56.7% were monitored, 33.3% were discontinued and 10.0% were closely monitoredConclusions: Interventions aimed at reviewing patients on canagliptin, based on pharmacovigilance alerts, have been effective, with a high degree of acceptance by the family and community medicine practitioner.

Objetivo: Analizar el impacto de una estrategia de adecuación de canaglifozina tras la emisión de recomendaciones en base a las notas de farmacovigilancia emitidas por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), así como el grado de aceptación.Diseño: Estudio prospectivo de intervención desde mayo de 2016 a octubre de 2016.Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de canaglifozina. Intervenciones: Se realizó en tres fases: la primera ligada a la emisión de una nota informativa de seguridad sobre canaglifozina por la AEMPS, la obtención de listados de pacientes y las recomendaciones de adecuación mediante cartas, una segunda fase en la que el médico realizaba las actuaciones y una última fase en la cual se evalúo el grado de aceptación de las recomendaciones.Variables principales: Adecuación del tratamiento con canaglifozina y grado de aceptación de las recomendaciones por los facultativos médicos.Resultados: Se incluyeron un total de 61 pacientes en nuestro estudio en tratamiento con canaglifozina. Del total de los pacientes a los que se les realizó algún tipo de intervención por el médico de atención primaria tras la intervención farmacéutica (IF), realizada mediante el envío de cartas (n=30), al 56,7% se les monitorizó, al 33,3% se le suspendió el tratamiento y al 10,0% se les vigiló estrechamente.Conclusiones: Las intervenciones dirigidas a la revisión de pacientes en tratamiento con canaglizozin, en base a las alertas de farmacovigilancia, han sido efectivas, con un alto grado de aceptación por el especialista en medicina familiar y comunitaria.

Suplementação com amêndoa de bacuri na composição corporal de ratos submetidos ao exercício / Supplementation with bacuri almond in the body composition of rats submitted to the exercise / Suplementación de almendra del bacuri en la composición corporal de ratas sometidas a ejercicio

RESUMO Introdução: A proteína da amêndoa do bacuri (Attalea phalerata Mart. Ex Spreng) e da whey protein (WP) têm quantidades relevantes de aminoácidos essenciais e são de boa digestibilidade, características que têm sido buscadas por atletas para auxílio para melhorar a composição corporal, particularmente quando associadas a exercícios. Objetivo: Avaliar o efeito de dietas com teor proteico vegetal e animal sobre a composição corporal de ratos Wistar submetidos ao exercício resistido em escada. Métodos: Quarenta ratos machos recém-desmamados foram submetidos a um período de adaptação com dieta comercial (4 semanas) e treinamento resistido durante oito semanas (três vezes por semana), recebendo dietas com farinha de bacuri e whey protein. Foram distribuídos randomicamente em seis grupos: G1 (bacuri sedentário), G2 (bacuri exercitado), G3 (WP sedentário), G4 (WP exercitado), G5 (controle sedentário) e G6 (controle exercitado). Avaliou-se consumo da dieta, peso corporal, comprimento, circunferências torácica e abdominal para calcular o índice de Lee e o índice de massa corporal; os sítios com gordura foram retirados após eutanásia. A análise estatística foi realizada por ANOVA e Teste de Tukey, considerando 5% de significância. Resultados: O peso final do G3 (372 ± 8,86 g) foi superior ao do G2 (326,83 ± 15,03 g) e do G6 (316,75 ± 5,90 g); os grupos que receberam dieta com farinha de bacuri consumiram quantidade superior de dieta, porém, tiveram menor peso final; não diferiram no índice de Lee e no IMC, sítios com gordura e índice de adiposidade com relação aos grupos tratados com WP, apresentando valores inferiores das circunferências torácica e abdominal. Com relação às gorduras e índice de adiposidade, não houve diferença entre os grupos sedentários e exercitados. Conclusão: A proteína da amêndoa de bacuri mostrou-se de boa qualidade quando comparada com a whey protein, havendo possibilidade de recomendação de seu uso na elaboração de suplementos nutricionais, como fonte vegetal alternativa e de baixo custo.

ABSTRACT Introduction: The bacuri almond protein (Attalea phalerata Mart. Ex Spreng) and whey protein (WP) have significant amounts of essential amino acids and are of good digestibility, characteristics that have been sought by athletes to aid in improving body composition, particularly when associated with exercises. Objective: To evaluate the effect of diets with vegetable and animal protein content on the body composition of Wistar rats submitted to resisted ladder exercise. Methods: Forty male newly weaned rats were exposed to a period of adaptation to a commercial diet (4 weeks) and resistance training for eight weeks (three times a week), receiving diets with bacuri flour and whey protein. They were randomly assigned to 6 groups: G1 (sedentary bacuri), G2 (exercised bacuri), G3 (sedentary WP), G4 (exercised WP), G5 (sedentary control) and G6 (exercised control). Dietary intake, body weight, length, thoracic and abdominal circumferences were evaluated to calculate Lee index and body mass index; the fat sites were removed after euthanasia. Statistical analysis was performed by ANOVA and Tukey's test, considering a 5% significance level. Results: The final weight of G3 (372±8.86 g) was higher than those of G2 (326.83±15.03 g) and G6 (316.75±5.90 g); the groups that received diet with bacuri flour consumed higher amount of food, however, they had lower final weight, did not differ in the Lee index and BMI, fat sites and adiposity index in relation to the groups treated with WP, presenting lower values in the thoracic and abdominal circumferences. Regarding fat and adiposity index, there was no difference between the sedentary and exercised groups. Conclusion: The bacuri almond protein showed good quality when compared to whey protein, and it is possible to recommend its use in the preparation of nutritional supplements as an alternative and low cost vegetable protein source.

RESUMEN Introducción: La proteína de la almendra del bacuri (Attalea phalerata Mart ex Spreng) y proteína del suero de la leche (whey protein - WP) tienen cantidades significativas de aminoácidos esenciales y son de buena digestibilidad, características que han sido buscadas por atletas para ayudar a mejorar de la composición corporal, especialmente cuando se asocian a ejercicios. Objetivo: Evaluar el efecto de dietas con contenido proteico vegetal y animal sobre la composición corporal de ratas Wistar sometidas al ejercicio resistido en escalera. Métodos: Cuarenta ratas machos recién destetadas se sometieron a un periodo de adaptación con dieta comercial (4 semanas) y entrenamiento de resistencia durante ocho semanas (tres veces por semana), recibiendo dietas con harina de bacuri y proteína del suero de la leche. Se distribuyeron aleatoriamente en 6 grupos: G1 (bacuri sedentario), G2 (bacuri ejercitado), G3 (WP sedentario), G4 (WP ejercitado), G5 (control sedentario) y G6 (control ejercitado). Se evaluó consumo de la dieta, peso corporal, longitud, circunferencias torácica y abdominal para calcular el índice de Lee y el índice de masa corporal; los sitios con grasa se retiraron después de la eutanasia. El análisis estadístico se realizó por ANOVA y prueba de Tukey, considerando el 5% de significación. Resultados: El peso final del G3 (372 ± 8,86 g) fue superior al del G2 (326,83 ± 15,03 g) y del G6 (316,75 ± 5,90 g); los grupos que recibieron dieta con harina de bacuri consumieron una cantidad mayor de alimentos, sin embargo, tuvieron menor peso final; no difirieron en el índice de Lee y en el IMC, sitios con grasa y índice de adiposidad con relación a los grupos tratados con WP, presentando valores inferiores en las circunferencias torácica y abdominal. Con respecto a las grasas e índice de adiposidad, no hubo diferencia entre los grupos sedentarios y ejercitados. Conclusión: a proteína de la almendra del bacuri se mostró de buena calidad en comparación con la proteína del suero de la leche, y existe la posibilidad de recomendar su uso en la preparación de suplementos nutricionales, como fuente de proteína vegetal alternativa e de bajo costo.

Prevalence of drug interactions in elderly patients with multimorbidity in primary care.

Background Drug interactions (DIs) are a significant cause of medication-related problems. The aging population, high chronic diseases prevalence and polypharmacy are closely associated factors. Aim of the review To study the prevalence, types and associated factors of DIs in multimorbidity patients of over 65 years of age in primary care. Methods Relevant studies on DI prevalence in this population were reviewed in PubMed, Cochrane Library and EMBASE (January 2000-December 2015). Independent variables (duration, target population, age, sex, mean of drugs and diseases, geographical localization, DI databases used and study designs) and dependent variables (prevalence, number of DIs per 100 patients and per patient, number of clinically-relevant DIs per 100 patients, most common DI and associated factors) were classified for each article. Results The search generated 749 articles and 46 duplicates were discarded. After reviewing, 10 articles were included. Seven studies were observational and 3 were quasi-experimental. Seven out of 10 used interaction databases. Only 2 studies described both actual and potential DIs. The prevalence of multimorbidity patients with DI ranged from 25.1 to 100% and the number of DIs per 100 patients was from 30 to 388.3. All the lower values correspond to the study conducted at the nursing home. This could be due to special care offered in these centres, where the medication is more controlled. The most frequent DIs were reported in five articles. However, these results could not be correlated since they were ranked using different methodologies. ACEIs, diuretics and NSAID were the most common therapeutic groups. Finally, 5 studies identified factors associated with the presence of potential DIs. The number of drugs and age were the most significant factors. Conclusions There is little evidence of prevalence of actual and potential DIs in elderly patients with multimorbidity in outpatient settings, showing widely heterogeneous results.

Suitability of teriparatide and level of acceptance of pharmacotherapeutic recommendations in a healthcare management area.

OBJECTIVE: To analyse the suitability of teriparatide prescriptions for osteoporosis treatment in a health management area, as well as the level of acceptance of pharmacotherapeutic recommendations made to physicians. DESIGN: A prospective interventional study conducted from february 2015 to june 2015. SETTING: South Seville Health Management Area. PARTICIPANTS: Patients receiving teriparatide. MAIN MEASUREMENTS: Suitability of teriparatide prescriptions according to Clinical Practice Guidelines and level of acceptance of pharmacotherapeutic recommendations. RESULTS: Teriparatide prescriptions were unsuitable in 45 patients (68.2%); 11 due to no indication, 17 patients did not have previous treatments with first-line drugs, 6 due to contraindications and 9 patients were treated for more than 24 months with the drug. Besides, 4 prescriptions were unsuitable because of combination with other therapies. The acceptance of pharmacotherapeutic recommendations was 64.4%, leading to teriparatide discontinuation in 21 patients (72.4%), and a switch to alendronate or ibandronate in another 8 patients. CONCLUSIONS: A high percentage of teriparatide prescriptions is unsuitable in our health care management area, but it has decreased after pharmacist intervention.

Objetivo: Analizar la adecuación de la prescripción de teriparatida en el tratamiento de la osteoporosis en un área de gestión sanitaria, así como el grado de aceptación por el médico de las recomendaciones de intervención realizadas. Diseño: Estudio prospectivo de intervención desde febrero de 2015 a junio de 2015. Emplazamiento: Área de Gestión Sanitaria Sur de Sevilla. Participantes: Pacientes con prescripción activa de teriparatida. Mediciones principales: Adecuación de la prescripción de teriparatida y grado de aceptación por el médico de las recomendaciones farmacoterapéuticas. Resultados: La prescripción de teriparatida fue inadecuada en 45 pacientes (68,2%). Once pacientes no cumplían los criterios de tratamiento, mientras que 17 no habían tenido prescrito previamente otro medicamento para la prevención de fracturas. Seis pacientes presentaban alguna contraindicación. En 9 pacientes la duración de la terapia fue superior a los 24 meses recomendados. Cuatro de ellas (dos ya inadecuadas) por combinación inadecuada con otros medicamentos. El grado de aceptación de las recomendaciones farmacoterapéuticas realizadas por farmacia fue del 64,4%, produciéndose en 21 pacientes (72,4%) la suspensión de teriparatida y en 8, el cambio a otro medicamento de primera línea: ibandrónico, en tres de ellos, y alendrónico, en el resto. Conclusiones: El número de pacientes con prescripciones inadecuadas de teriparatida es elevado en nuestra área, pero ha disminuido tras realizar intervenciones con recomendaciones farmacoterapéuticas de adecuación del tratamiento.

Novel missense mutation in the EDA1 gene identified in a family with hypohidrotic ectodermal dysplasia.

BACKGROUND: Hypohidrotic ectodermal dysplasia (HED) is a human genetic disorder that affects structures of ectodermal origin such as hair, teeth, and sweat glands. Although there are autosomal recessive and dominant forms, X-linked (XL) is the most frequent form of the disease. This XL-HED phenotype is associated with mutations in the gene encoding the transmembrane protein ectodysplasin-1 (EDA1). We report the clinical and molecular analysis of a novel mutation in exon 1 affecting the transmembrane domain of the protein. METHODS: We have screened 20 members of a family from Yucatán, México, nine men and 11 women, searching clinical and histopathological signs of HED. We searched mutations in EDA1 gene from patients with XL-HED, carriers, and controls. RESULTS: We identified seven men with clinical characteristics of HED showing short toes and plantar hyperkeratosis not reported previously in patients with HED. A mutational study of the EDA1 gene showed that all seven patients with HED carry a novel missense mutation of the nucleotide 409 (c.409T>C) in exon 1, which changes p.Leu56-Pro in the protein amino acid sequence; five women are heterozygous compatible with carrier status. CONCLUSIONS: We found a novel missense mutation in exon 1 of the EDA1 gene in a putative Mayan family from México with XL-HED. We identified in this population some novel clinical signs of HED.

[Importance of health CRM in pandemics and health alerts]. / Importancia de los Customer Relationship Management (CRM) sanitarios en las pandemias y alertas sanitarias.

OBJECTIVE: The aim of this article is to demonstrate the importance of the role a health CRM can play in a pandemic or health alert. During the influenza-A pandemic, Salud Responde played a very important role. Its main objective was to establish protocols and citizens advice lines that would avoid patients with mild influenza-A symptoms going to health centre. DESIGN: A triage system was developed around the Siebel CRM (software tool) to achieve this objective. This allowed the Salud Responde staff to establish the severity of the patient depending on the symptoms and the risk factors of the patient, as well as being able to inform, give health advice or refer the patient to medical centres if necessary. SETTING: All patients (a total of 56,497) who were attended by Salud Responde within its influenza-A service portfolio have been included. PARTICIPANTS: Patients who were attended by Salud Responde. MAIN MEASUREMENTS: The data have been extracted from the Salud Responde data base. RESULTS: Salud Responde attended to 56,497 patients during the influenza-A pandemic, of whom 48,287 patients did not require health care. CONCLUSIONS: Salud Responde attended to 56,497 patients, of whom 48,287 patients did not require health care. Apart from any financial savings that this could entail, it contributed to minimising the pandemic, avoiding the patient having to go to a health centre to receive medical care or information, and prevented, to a great extent, the flooding of casualty departments.

Crecimiento y nutrición en la infancia y riesgo para enfermedad cardiovascular en la adultez / Growth and nutrition in children and cardiovascular disease risk in adulthood

Las Enfermedades Cardiovasculares (ECV) son la principal causa de mortalidad a nivel mundial y nacional. La persistente prevalencia global de la mortalidad por ECV y su incremento exponencial en poblaciones con crecientes índices de pobreza, han conducido al diseño e implementación de estrategias de prevención, con base en la historia natural de la aterosclerosis, la cual está presente desde la vida fetal. La presencia de factores de riesgo para ECV en la infancia con persistencia hasta la adultez soporta la hipótesis de programación fetal cardiometabólica para explicar el impacto de la nutrición sobre el desarrollo de ECV, desde el inicio de la vida. Con el objeto de establecer los lineamientos nutricionales para niños venezolanos de 0 a 9 años de edad, en el Segundo Consenso Venezolano Pediátrico de Nutrición: nutrición temprana y salud a corto y largo plazo, se evaluó la evidencia epidemiológica publicada a nivel nacional y global sobre factores metabólicos y conductuales para riesgo de ECV relacionados con la nutrición presentes en niños. Se presentan las conclusiones y recomendaciones del grupo de trabajo: crecimiento y nutrición en la infancia y riesgo para enfermedad cardiovascular en la adultez. El análisis de la evidencia revisada permite afirmar que la alimentación del niño de 0 a 9 años tiene impacto en la presencia de factores de riesgo para ECV en el adulto. Se sugieren estrategias para la nutrición del niño con el fin de garantizar un crecimiento y desarrollo adecuado con un estado de salud cardiovascular óptima.

Cardiovascular diseases (CVD) remains the leading cause of death globally and nationally. The global persistent mortality prevalence of CVD and its exponential increase in countries with poverty index increasing have led to design of prevention strategies, based on the natural history of atherosclerosis, which is present from the fetal life. The presence of CVD risk factors in childhood with persistence into adulthood supports cardiometabolic fetal programming hypothesis to explain the impact of dietary habits on the development of CVD, from the beginning of life. In order to establish nutritional guidelines for Venezuelan children of 0-9 years old, in the Second Venezuelan Pediatric Nutrition Consensus: early nutrition and health in the short and long term, the national and global epidemiological evidence published for metabolic and behavioral risk factors for CVD related to nutrition present in children was evaluated. Growth and nutrition in childhood and risk for cardiovascular disease in adulthood working group: findings and recommendations of the working group are presented. The evidence analysis suggest that the nutrition of children from 0 to 9 years has an impact on the presence of risk factors for CVD in adults. Strategies for child nutrition are suggested in order to ensure proper growth and development with a state of optimal cardiovascular health.

Estudio retrospectivo del efecto del furoato de mometasona al 0.1% en el tratamiento no quirúrgico de fimosis y adherencias prepuciales en niños mexicanos / A retrospective study of the effect of mometasone furoate 0.1% in the nonsurgical treatment of phimosis and preputial adhesions in Mexican children

Introducción. El término fimosis abarca distintas condiciones que van desde la presencia de un anillo fibroso hasta un prepucio asintomático pero no retráctil. Hasta hace algunos años, la circuncisión era la única opción disponible para el manejo de la fimosis. Sin embargo, diversos estudios y ensayos clínicos han evaluado el uso de esteroides tópicos para la liberación del prepucio fimótico. En el presente trabajo se evaluó el efecto del furoato de mometasona al 0.1% como tratamiento en la liberación de adherencias prepuciales y fimosis en niños mexicanos. Métodos. Se realizó un estudio retrospectivo y descriptivo en el que se incluyeron a 129 pacientes de 1 a 8 años de edad, a quienes se les aplicó furoato de mometasona al 0.1% en el prepucio y el glande una vez al día por 4 semanas y se les realizó una sinequiotomía al término del tratamiento. Resultados. Al realizar la sinequiotomía, se logró la retracción total del prepucio en 98% de los casos; de estos, 20% presentó recaída. En términos generales, la eficacia a largo plazo fue de 81% (IC 95% 73-89). Conclusiones. La aplicación tópica de furoato de mometasona al 0.1% fue eficaz para manejar la fimosis y liberar adherencias en el prepucio de niños mexicanos.

Background. In this study we evaluated the effect of mometasone furoate (0.1%) as a nonsurgical treatment of phimosis in Mexican children. Methods. We carried out a retrospective and descriptive study including 129 patients between 1 and 8 years old who were treated with the topical administration of 0.1% mometasone furoate on the prepuce and glans once daily for 4 weeks followed by sinechiotomy at the end of treatment. Results. After sinequiotomy, the foreskin was able to be fully retracted over the glans in 98% of the patients; however, in 20% of patients it returned to the original condition. Overall long-term efficacy was 81% (95% CI: 73-89). Conclusions. Topical administration of mometasone furoate (0.1%) was effective in the detachment of the foreskin of the prepuce from the glans, making it an effective, nonsurgical treatment for phimosis.