Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study.

BACKGROUND: Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically. METHODS: A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy. RESULTS: The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems. CONCLUSIONS: Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.

Candida species and other yeasts in the oral cavities of type 2 diabetic patients in Cali, Colombia.

OBJECTIVE: To determine the prevalence of Candida species and to study factors associated to oral cavity colonization in patients with type 2 diabetes mellitus. METHODS: A total of 107 diabetics were classified into controlled and uncontrolled according to glycosylated hemoglobin values. Each patient was assessed for stimulated salivary flow rates, pH, and an oral rinse to search for yeast. The study also determined the state of oral health via Klein and Palmer CPO indexes for permanent dentition, dental plaque by O'Leary, and a periodontal chart. RESULTS: We found yeasts in 74.8% of the patients. A total of 36 of the 52 subjects with controlled diabetes presented yeasts and 44 in the uncontrolled; no significant differences (p = 0.2) were noted among the presence of yeasts and the control of blood glucose. The largest number of isolates corresponded to C. albicans, followed by C. parapsilosis. Uncontrolled individuals presented a significantly higher percentage of yeast different from C. albicans (p = 0.049). CONCLUSIONS: We found a high percentage of Candida colonization and uncontrolled individuals had greater diversity of species. The wide range of CFU/mL found both in patients with oral candidiasis, as well as in those without it did not permit distinguishing between colonization and disease. We only found association between isolation of yeasts and the low rate of salivary flow.

OBJETIVOS: Determinar la prevalencia de las especies de Candida y estudiar factores asociados a la colonización de la cavidad oral en pacientes con diabetes mellitus tipo 2. MÉTODOS: 107 diabéticos se clasificaron en controlados y no controlados, de acuerdo con los valores de hemoglobina glucosilada. A cada paciente se le tomó una muestra de saliva estimulada y un enjuague oral, la primera se utilizó para determinar el pH y la tasa de flujo salival, la segunda para buscar levaduras. Además, se determinó el estado de salud oral mediante los índices CPO-D de Klein y Palmer para dentición permanente, el de placa bacteriana de O Leary y un periodontograma. RESULTADOS: Se hallaron levaduras en el 74,8% de los pacientes. Un total de 36 de 52 sujetos con diabetes controlada presentaron levaduras y 44 en los no controlados; sin diferencias significativas (p = 0.2) entre la presencia de levaduras y el control de la glucemia. El mayor número de aislamientos correspondió a C. albicans, seguido de C. parapsilosis. Los individuos no controlados presentaron de manera significante un porcentaje más alto de levaduras diferentes a C. albicans (p = 0.049). Sólo se encontró asociación entre el aislamiento de levaduras y la baja tasa de flujo salival. CONCLUSIÓN: Se encontró un alto porcentaje de colonización por Candida, y en los individuos no controlados hubo mayor diversidad de especies. El amplio rango de UFC/mL hallada tanto en pacientes con candidiasis oral como sin ella no permitió establecer colonización y enfermedad.

Isolation of Candida dubliniensis for the first time in Cali, Colombia, and its identification with phenotyping methods.

Candida dubliniensis is an emerging pathogenic yeast isolated mainly from the oral cavity of HIV-infected patients. The close phenotypic and genotypic relationship between C. albicans and C. dubliniensis has led to incorrectly identifying isolates of C. dubliniensis as C. albicans. The oral cavities of 107 diabetic patients were studied in Cali, Colombia, and 72 colonies of Candida, with shades of green on CHROMagar Candida culture media, were obtained. Various phenotypic tests were carried out, which included germ tube formation and production of chlamydospores on corn meal Agar. Additionally, growth studies were carried out at 42 degrees C and 45 degrees C and on Sabouraud agar with 6.5%, sodium chloride. Identification of C. dubliniensis with these tests was confirmed with API 20C Aux. We identified 65 and 7 colonies of C. albicans and C. dubliniensis, respectively. This is the first time that C. dubliniensis is identified with phenotypic methods in Colombia.

Candida species and other yeasts in the oral cavities of type 2 diabeticpatients in Cali, Colombia / Especies de candida y otras levaduras en la cavidad oral de pacientes diabéticos tipo 2 en Cali, Colombia

Objective:To determine the prevalence ofCandidaspeciesand to study factors associated to oral cavity colonization inpatients with type 2 diabetes mellitus.Methods:A total of 107 diabetics were classified into contro-lled and uncontrolled according to glycosylated hemoglobinvalues. Each patient was assessed for stimulated salivary flowrates, pH, and an oral rinse to search for yeast. The study alsodetermined the state of oral health via Klein and Palmer CPOindexes for permanent dentition, dental plaque by O’Leary,and a periodontal chart.Results:We found yeasts in 74.8 percent of the patients. A total of 36of the 52 subjects with controlled diabetes presented yeasts and44 in the uncontrolled; no significant differences (p = 0.2) werenoted among the presence of yeasts and the control of bloodglucose. The largest number of isolates corresponded toC. al-bicans, followed byC. parapsilosis.Uncontrolled individualspresented a significantly higher percentage of yeast differentfromC. albicans(p = 0.049).Conclusions:We found a high percentage of Candida colo-nization and uncontrolled individuals had greater diversityof species. The wide range of CFU/ml found both in patientswith oral candidiasis, as well as in those without it did not per-mit distinguishing between colonization and disease. We onlyfound association between isolation of yeasts and the low rateof salivary flow.

Utilidad de la biopsia de médula ósea en estadificación de pacientes con cáncer de mama / Usefulness of bone marrows biopsy in the breast cancer patients staging

El objetivo del presente estudio es determinar la utilidad de la biopsia de médula ósea en la estadificación de pacientes con cáncer de mama. Estudio prospectivo, descriptivo y con diseño transversal. La población estuvo representada por los nuevos casos diagnosticados como cáncer de mama en la consulta de cirugía oncológica y patología mamaria, la muestra quedó conformada por 18 casos. Los datos obtenidos se clasificaron y procesaron en una matriz de datos, se analizaron mediante técnica de estadística simple descriptiva o “tabulación simple porcentual” apoyadas en medias de dispersión (frecuencias relativas). La mayoría de los casos se estadificaron en etapas clínicas IIA y IIB. La totalidad de los casos incluidos en esta investigación resultaron negativos para micrometástasis en médula ósea, lo cual podría predecir que se tratan de pacientes con buen pronóstico. Ante la falla como factor pronóstico del estado ganglionar se especula que la detección de células tumorales tempranas puede predecir el curso de la enfermedad mejor que el estado de los ganglios axilares. Actualmente la determinación genética ha tenido un impacto mayor como factor pronóstico que los estudios de estadificación convencionales. Ahora bien la determinación de células tumorales en la médula podría establecerse como parte del protocolo de estadificación en los diversos centros de referencia oncológico, y convertirse al igual que la determinación del perfil genético, como un factor pronóstico y predictivo importante en las pacientes con cáncer de mama y etapa clínicas tempranas.

The objective of the present study is to determine the usefulness and importance of bone marrows biopsy in the breast cancer patients staging. To such end, a cross sectional, prospective, and descriptive study was performed. The population was represented by new diagnosed cases of breast cancer view and evaluated in the consult of surgery oncology y mammalian pathology of our institution, formed the sample by 18 cases. The data obtained were processed and classified in an adequate data matrix; the results once separated were analyzed by the simple descriptive statistic technique or percentile simple tabulation, supported by the dispersion measures (the relative frequencies). Most of the cases were classified in IIA and IIB clinical stages. All included cases in this research were negative to bone marrow´s micro metastases, and which can predict good prognosis in these patients. At lymph node staging failure as a prognostic factor we can be speculate that the early tumor cell detection can predict the course of the disease better than the staging of axillaries lymph nodes. Actually the genetic determination has a better impact as a prognostic factor that the conventional staging studies. The determination of bone marrow´s tumor cell can be establish as a very important part of the staging protocol in the different especial oncologic reference centers, and became as same as genetic profile determination in an important prognostic and predictive factor in breast cancer patients at early stages.