Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification.

BACKGROUND: Polypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects associated to the use of psych drugs and to estimate the risk in specific groups. METHODS: We carried out a longitudinal, retrospective study that included the analysis of all discharged patients (n = 140) in the first trimester of the year in a psychiatric hospital in Mexico. The information was classified into 7 sections: sociodemographic, diagnosis, clinical follow-up information, prescribed drugs, adverse reactions, substance abuse, laboratory and complementary results. Risk estimation was obtained with Odds Ratios, to correlate continuous variables Pearson's correlation was used. Student's T and Mann Whitney's U were used to compare 2 independent samples; multiple and linear regressions were carried out. RESULTS: The mean number of drugs used during hospitalization was 7.8 drugs per patient. The mean prescribed psych drugs was 4.07. The mean antipsychotic dose was the risperidone equivalent of 5.08 mg. 29.2% of patients had at least one secondary effect associated to the use of drugs, 17.8% presented extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days. CONCLUSIONS: Despite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence of polypharmacy in patients hospitalized in psychiatric institutions. In the present study 4 out of 5 patients received polypharmacy decreasing tolerability, treatment adherence and increasing the risk and costs secondary to an increased hospital stay.

Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Changes in the costs of antihypertensive medications in a developing country: a study in Mexico comparing 1990 and 1996.

In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.

Association of adiposity assessed by means of near-infrared interactance with the beta-cell function, insulin resistance and leptin concentrations in non-obese subjects. Exploratory study.

The objective was to identify the association of adiposity with the beta-cell function, insulin resistance and leptin concentrations in non-obese subjects. Twenty-eight healthy, non-obese volunteers were recruited, 14 male and 14 female. Body mass index (BMI) and waist hip ratio (WHR) were calculated. Blood pressure was measured. Adiposity was estimated by means of near-infrared (NIR) interactance method predicting the percentage of body fat (% BF). All subjects were divided into adipose and non-adipose individuals. Serum glucose, insulin and leptin levels were measured. Formulas of the homeostasis model analysis were used to assess the insulin resistance and the beta-cell function. Clinical characteristics and laboratory profile were similar between both groups. There were no significant differences between both groups in beta-cell function, insulin resistance and leptin concentrations. There was a positive significant correlation of % BF with BMI in women (r= .82, P< .001) and in men (r= .85, P< .001). Adiposity was not associated with the beta-cell function, insulin resistance and leptin concentrations in non-obese subjects, and only percent body fat was positive correlated with BMI.

Reproducibility and cost of blood pressure self-measurement using the 'Loaned Self-measurement Equipment Model'.

OBJECTIVE: To determine the reproducibility and the cost of the Loaned Self-measurement Equipment Model for blood pressure. SUBJECTS: Seventy-five subjects with non-complicated essential hypertension, having an average age of 56.2 +/- 11 years, were evaluated. METHODS: The Loaned Self-measurement Equipment Model consists of a set of sphygmomanometers belonging to the clinic, loaned to patients for 3-day periods for them to carry out 27 readings, and then returned. Using a mercury sphygmomanometer, a nurse carried out office blood pressure readings during two visits. A month later, the same procedure was repeated under the same clinical conditions. The agreement between studies was assessed by correlation coefficients, coefficients of variation and standard deviation of the differences (SDD). RESULTS: The office blood pressure was 147 +/- 17/89 +/- 12 mmHg during visit A, and 145 +/- 16/88 +/- 11 mmHg during visit B. The self-measurement blood pressure was 139 +/- 16/84 +/- 10 mmHg during the first visit, and 136 +/- 15/84 +/- 11 mmHg during the second visit. In neither of the cases were the differences statistically significant. The correlation coefficients for the office and self-measurement systolic blood pressure were statistically significant (P = 0.018), while those for the diastolic blood pressure were not statistically significant. The SDD for self-measurement systolic blood pressure was 10.7, compared to 15.0 for the office blood pressure (P < 0.01). The comparison in the case of diastolic blood pressure was not significant. The cost of each loan was $5.85 (US dollars). CONCLUSIONS: The Loaned Self-measurement Equipment Model has a good short-term reproducibility, and the cost is reasonable.

[Excretion of uric aid, sodium, and potassium in preeclampsia patients and its behavior in acute hyperglycemia-hyperinsulinemia]. / Excreción de ácido úrico, sodio y potasio en la paciente con preeclampsia y su comportamiento ante un estado agudo de hiperglucemia-hiperinsulinemia.

The aim of the present research was to compare the uric acid, sodium and potassium excretions among patients with mild preeclampsia and normotensive pregnancy and to determine their behavior towards an acute physiologic state of hyperglycemia-hyperinsulinemia. It was carried out a cuasi-experimental study with parallel group in 25 patients with mild preeclampsia and in 25 patients with normotensive pregnancy all of them in the third trimester of gestation. The intervention consisted in administering an oral load of 50 grams of glucose in order to achieve a physiologic state of hyperglycemia-hyperinsulinemia. The seric levels of glucose, insulin, creatine, uric acid, sodium and potassium were measured, as well as the last four in urine before the oral load (with at least 6 hours fasting) and 60 minutes after the load, besides that, the urinary excretions of solutes were calculated with standard formulas. The urinary excretions of uric acid, sodium and potassium in fasting, and so after the oral glucose load were lower in the group of preeclampsia patients than in the normotensive gestation group. Upon analyzing the influence of a physiologic state of hyperglycemia-hyperinsulinemia, after the oral glucose load on determined solutes and their urinary excretion, we found that there was a significant decrease in the seric potassium level, without modifying its urinary excretion, as much as in the preeclampsia group as in the normotensive group. The seric uric acid and sodium levels diminished in the preeclampsia group and in normotensive group respectively, without modifying their urinary excretion. In conclusion, in the current study the urinary excretion of sodium, potassium and uric acid were lower in the preeclampsia patients than the women with normotensive pregnancy and a physiologic state of hyperglycemia-hyperinsulinemia didn't modify these excretions.

[Effect of hormone replacement therapy including a progestin on insulin sensitivity and lipid profile in postmenopausal women]. / Efecto de la terapia hormonal de reemplazo, que incluye un progestágeno, sobre la sensibilidad a la insulina y el perfil de lípidos en la mujer en etapa de posmenopausia.

BACKGROUND: The cardiovascular protective properties of hormone replacement therapy can be hampered when a progestin is used. AIM: To assess the effects of hormone replacement therapy with progestins on insulin sensitivity and lipid profile. PATIENTS AND METHODS: Twelve healthy postmenopausal women aged 45 to 55 years old were studied. Blood lipids and insulin sensitivity, determined using the insulin tolerance test, were measured at baseline and after three months of hormone replacement therapy using conjugated estrogens, 0.625 mg/day and medroxyprogesterone acetate, 5 mg/day. RESULTS: The glucose disappearance constant was higher after the treatment period than at baseline (5.3 +/- 0.8 and 4.7 +/- 0.8%/min respectively, p = 0.005). Serum LDL cholesterol was also lower at the end of treatment period (124.5 +/- 30.2 and 140 +/- 25.4 mg/dl respectively, p = 0.019). CONCLUSIONS: In this group of postmenopausal women, a period of three months of hormone replacement therapy with a progestin improved insulin sensitivity and lowered LDL cholesterol levels.

Serum complement C3c concentration in non-obese young insulin-resistant Mexicans.

The aim of this study was to compare the serum complement C3 concentration between non-obese young insulin-sensitive and insulin-resistant Mexicans. A cross-sectional study was carried out in 28 healthy, non-obese [Body mass index (BMI) < 26 kg/m2] young (age 19-25 yr), male volunteers to measure the serum C3 concentration. In accordance with the constant for rate serum glucose disappearance (KITT) obtained from the insulin tolerance test, the subjects were divided into quartiles, considering as insulin-resistant individuals those in quartile 1, and insulin-sensitive subjects those in quartile 4. Serum C3c concentration was measured by a nephelometric method. Other biochemical characteristics were measured, like lipid profile and uric acid using enzymatic techniques. The serum C3 concentrations were similar (p = 0.949) between insulin-resistant and insulin-sensitive groups respectively (1.4 +/- 0.2 vs 1.3 +/- 0.1 g/l). There were no significant correlations between serum C3 concentrations and serum glucose, insulin levels, KITT and lipid profile. In conclusion, the serum complement C3c concentrations were similar between non-obese young insulin-sensitive and insulin-resistant Mexicans.

Renal handling of uric acid assessed by means of pharmacological tests in obese women.

The aim of this study was to compare the renal handling of uric acid by means of pyrazinamide and probenecid tests between obese and non-obese women. A cross-sectional study was carried out in 8 obese women and in 8 non-obese women as control group. Metabolic profile and renal handling of uric acid including clearance, fractional excretion and excretion rates, were assessed. Due to technical problems, pyrazinamide and probenecid tests were performed only in 5 women of each group to evaluate presecretory reabsorption, secretion and post-secretory reabsorption of uric acid. Uric acid clearance had a tendency to be lower in the obese women than in the control group. There were no significant differences between the groups in fractional excretion and excretion uric acid rates. Pre- and post-secretory reabsorptions of uric acid did not differ between the obese and the non-obese women. Tubular secretion of uric acid was significantly lower in the obese women compared with the control group (6.4 vs 13.6%; p=0.02). Tubular secretion of uric acid negatively correlated with body mass index (r=-0.73; p<0.05). In conclusion, tubular secretion of uric acid possibly plays an important role in uric acid homeostasis in obese women.