RESUMEN
BACKGROUND: Vitamin D insufficiency contributes to muscle weakness and a higher risk of falls in older adults. OBJECTIVES: This study explored the impact of vitamin D supplementation on self-reported falls and physical function in older adults with low vitamin D levels and a recent fall history. MATERIALS AND METHODS: Twenty-five older adults ≥ 70 years with two or more falls during the past year, low vitamin D blood levels (≥10 ng/ml and < 30 ng/mL), and slow gait speed (1.2 m/s) participated in a 6-month vitamin D supplementation (800 IU/day) study. A modified version of the Morse Fall Scale questionnaire was used to assess frequency of falls over one-year prior to study enrollment. Functional outcomes (short physical performance battery, handgrip strength, gait Timed Up and Go, and six-minute walk), and vitamin D levels were assessed at baseline and 6-month follow-up. RESULTS: Based on diaries and pill counts, participants were generally adherent to the intervention (6 of 7 days per week). Supplementation with 800 IU/day of vitamin D for 6 months increased blood vitamin D levels from 23.25±4.8 ng/ml to 29.13±6.9 ng/ml (p<0.001). Self-reported number of falls decreased from an average of 3.76 ± 2.2 falls in one-year to 0.76 plusmn; 1.4 falls (p <0.0001) over the 6-month intervention. No changes in functional outcome measures were observed. CONCLUSIONS: Vitamin D supplementation at the currently recommended dose of 800 IU/day increased blood vitamin D levels and reduced frequency of falls in older adults with low vitamin D levels and a recent fall history.
Asunto(s)
Accidentes por Caídas , Deficiencia de Vitamina D , Accidentes por Caídas/prevención & control , Anciano , Suplementos Dietéticos , Estudios de Factibilidad , Fuerza de la Mano , Humanos , Autoinforme , Vitamina D , Vitaminas/uso terapéuticoRESUMEN
OBJETIVO: Realizar una revisión estructurada sobre interacciones medicamentosas de los hipolipemiantes y valorar su relevancia clínica. MÉTODO: Revisión estructurada de interacciones medicamentosas con hipolipemiantes en humanos, en PubMed/Medline de artículos publicados sin restricción de idioma, con acceso a texto completo hasta junio 30 de 2012. La búsqueda se realizó con los siguientes terminos Mesh: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). La información se complementó con artículos considerados importantes. Por último, se utilizó un método para evaluar la relevancia clínica de la interacción, basado en la probabilidad de ocurrencia y en la gravedad del efecto de la interacción. RESULTADOS: Se obtuvieron 849 publicaciones, de las cuales se seleccionaron 243 referencias, en las los que se identificaron 189 interacciones. De ellas 33 fueron valoradas como de riesgo muy alto (nivel 1) y 42 de riesgo alto (nivel 2), asociadas fundamentalmente al aumento del riesgo de rabdomiólisis. La inhibición enzimática de la CYP450 fue el mecanismo más común de las interacciones. CONCLUSIONES: En los pacientes en tratamiento con hipolipemiantes, de las interacciones identificadas 60,3% (128/189) son clínicamente relevantes (riesgo muy alto o alto), asociadas principalmente a la aparición de rabdomiólisis. La mayoría de dichas interacciones son atribuidas al uso simultáneo de reconocidos inhibidores de la CYP3A4. Por ello, las estatinas metabolizadas por la CYP3A4 (simvastatina, lovastatina y atorvastatina) son las que más interacciones de relevancia clínica presentan
OBJECTIVE: To carry out a structures review of drug interactions of hypolipidemic drugs and to assess their clinical relevance. METHOD: Structured review of drug interactions of hypolipidemic drugs in humans through PubMed/Medline of published articles, without language restrictions and with full text access until June 30th of 2012. The following Mesh terms were used: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). The information was completed with those articles considered to be relevant. Finally, a method was used to assess the clinical relevance of the interaction, based on the likelihood of occurrence and the severity of the effect of the interaction. RESULTS: 849 publications were gathered, of which 243 references were selected, among which 189 interactions were identified. Thirty-three of them were considered of very high risk (level 1) and 42 of high risk (level 2), basically associated to increased risk for rhabdomyolisis. Enzymatic inhibition of CYP450 was the most common mechanism for these interactions. CONCLUSIONS: Of the interactions identified in patients on hypolipidemic drugs, 60.3% (128/189) are clinically relevant (very high or high risk), mainly associated to the occurrence of rhabdomyolisis. Most of these interactions are attributed to simultaneous use of CYP3A4 inhibitors. Therefore, statins metabolized through CYP3A4 (simvastatin, lovastatin and atorvastatin) are the ones with the highest number of clinically relevant interactions
Asunto(s)
Humanos , Hipolipemiantes/efectos adversos , Interacciones Farmacológicas , Rabdomiólisis/etiología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Citocromo P-450 CYP3A/antagonistas & inhibidores , Factores de Riesgo , Seguridad del Paciente/normas , Servicio de Farmacia en Hospital/organización & administraciónRESUMEN
OBJECTIVE: To carry out a structures review of drug interactions of hypolipidemic drugs and to assess their clinical relevance. METHOD: Structured review of drug interactions of hypolipidemic drugs in humans through PubMed/Medline of published articles, without language restrictions and with full text access until June 30th of 2012. The following Mesh terms were used: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). The information was completed with those articles considered to be relevant. Finally, a method was used to assess the clinical relevance of the interaction, based on the likelihood of occurrence and the severity of the effect of the interaction. RESULTS: 849 publications were gathered, of which 243 references were selected, among which 189 interactions were identified. Thirty-three of them were considered of very high risk (level 1) and 42 of high risk (level 2), basically associated to increased risk for rhabdomyolisis. Enzymatic inhibition of CYP450 was the most common mechanism for these interactions. CONCLUSIONS: Of the interactions identified in patients on hypolipidemic drugs, 60.3% (128/189) are clinically relevant (very high or high risk), mainly associated to the occurrence of rhabdomyolisis. Most of these interactions are attributed to simultaneous use of CYP3A4 inhibitors. Therefore, statins metabolized through CYP3A4 (simvastatin, lovastatin and atorvastatin) are the ones with the highest number of clinically relevant interactions.
Objetivo: Realizar una revisión estructurada sobre interacciones medicamentosas de los hipolipemiantes y valorar su relevancia clínica. Método: Revisión estructurada de interacciones medicamentosas con hipolipemiantes en humanos, en PubMed/Medline de artículos publicados sin restricción de idioma, con acceso a texto completo hasta junio 30 de 2012. La búsqueda se realizó con los siguientes terminos Mesh: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). La información se complementó con artículos considerados importantes. Por último, se utilizó un método para evaluar la relevancia clínica de la interacción, basado en la probabilidad de ocurrencia y en la gravedad del efecto de la interacción. Resultados: Se obtuvieron 849 publicaciones, de las cuales se seleccionaron 243 referencias, en las los que se identificaron 189 interacciones. De ellas 33 fueron valoradas como de riesgo muy alto (nivel 1) y 42 de riesgo alto (nivel 2), asociadas fundamentalmente al aumento del riesgo de rabdomiólisis. La inhibición enzimática de la CYP450 fue el mecanismo más común de las interacciones. Conclusiones. En los pacientes en tratamiento con hipolipemiantes, de las interacciones identificadas 60,3% (128/189) son clínicamente relevantes (riesgo muy alto o alto), asociadas principalmente a la aparición de rabdomiólisis. La mayoría de dichas interacciones son atribuidas al uso simultáneo de reconocidos inhibidores de la CYP3A4. Por ello, las estatinas metabolizadas por la CYP3A4 (simvastatina, lovastatina y atorvastatina) son las que más interacciones de relevancia clínica presentan.
Asunto(s)
Hipolipemiantes/efectos adversos , Inhibidores Enzimáticos del Citocromo P-450 , Interacciones Farmacológicas , Ácidos Fíbricos/efectos adversos , Interacciones Alimento-Droga , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Rabdomiólisis/inducido químicamenteRESUMEN
O comportamento de constituintes bioquímicos sanguíneos (glicose, fibrinogênio, creatina fosfoquinase e gama-glutamiltransferase) foi monitorado, in vivo, em 12 equinos mestiços (seis machos e seis fêmeas), com idade entre 4 e 20 anos, submetidos à ozonioterapia. O tratamento foi realizado mediante administração de 500 ou 1000mL da mistura de oxigênio-ozônio (O2-O3) por via intravenosa, a cada três dias, durante 24 dias. Os equinos foram distribuídos em quatro grupos: MT500 constituído por três machos tratados com 500mL; MT1000 por três machos tratados com 1000mL; FT500, por três fêmeas tratadas com 500mL e FT1000, por três fêmeas tratadas com 1000mL. A ozonioterapia por via intravenosa não ocasionou alterações clínicas nos equinos. Os valores médios mínimos e máximos de glicose, fibrinogênio, creatina fosfoquinase e gama-glutamiltransferase mantiveram-se dentro dos limites de referência para a espécie equina. Houve diminuição nas concentrações da glicose e gama-glutamiltransferase ao longo dos períodos de aplicação e aumento nos valores do fibrinogênio. A creatina fosfoquinase não sofreu efeito do tratamento.
The profile of blood biochemistry variables (glucose, fibrinogen, creatine phosphokinase, and gamma glutamyltransferase) was in vivo monitored in 12 crossbred horses (six males and six females), aging from four to 20-years-old treated with ozone therapy. Treatments were carried out by applying 500 or 1000mL of the mixture oxygen-ozone (O2-O3) via intravenous route, every three days, during 24 days. Horses were assigned to four groups: MT500 (three males given 500mL), MT1000 (three males given 1000mL), FT500 (three females given 500mL) and FT1000 (three females given 1000mL). Ozone therapy by intravenous route caused no clinical changes in the horses. Minimum and maximum mean values of glucose, fibrinogen, creatine phosphokinase, and gamma glutamyltransferase were within the range considered as normal reference for the equine species. There was decrease in glucose and gamma glutamyltransferase concentrations over the period of application, whereas fibrinogen increased and creatine phosphokinase was not affected by the treatment.