Primary care pharmacist-led medication review in older adult patients in coordination with general practitioners: an observational retrospective cohorts study.

Background: Polypharmacy and risk of potentially inappropriate prescribing (PIP) in older adult are being continuously increased. Including a primary care pharmacist (PCP) in the healthcare team is associated with lower rates of medication-related problems (MRPs). Objectives: To determine the impact (in terms of variation of PIP, MRPs and polymedication) of treatment reviews (TR) carried out by the PCP by comparing two cohorts: standard TR vs coordinated TR with prescribing General Practitioners (GP). To assess possible health outcomes in both groups 6 months post-TR. Methods: This is an observational study of two retrospective cohorts (2018 to 2020). All patients who met the inclusion/exclusion criteria were analyzed. Patients ≥65 years, who underwent complete TR by the PCP were included. Patients in a situation of exitus at the time of TR and those who underwent a partial TR were excluded. Control group cohort consisted of patients who underwent standard TR, and intervention group cohort consisted of those who underwent TR coordinated with GP. Sociodemographic, clinical and pharmacological variables were analyzed. Results: 181 patients were enrolled. Mean age 84.4 ± 7.2 years, 78.5% women. Variables (GP-coordinated vs standard TRs) pre-post: decrease in drugs/patient 1.9 (95%CI: 1.4-2.4) vs 0.6 (95%CI: 0.2-1.3), p < 0.05; decrease in MRPs/patient 3.1 (95%CI: 2.8-3.4) vs 1.0 (95%CI: 0.6-1.4), p < 0.05; decrease in PIP/patient 2.0 (95% CI: 1.6-2.2) vs 0.6 (95% CI: 0.2-0.9), p < 0.05. Health outcomes: there was significant difference in average primary-care visits/patient 1.3 ± 0.5 vs 2.2 ± 1.8, p < 0.05. Conclusions: Multidisciplinary interventions between PCP and GP, together with a systematic approach to TR can improve the quality of pharmacotherapy in the elderly. Prospective large follow-up studies are needed to demonstrate a positive trend in health outcomes.

Exploratory dietary patterns and cognitive function in the "Seguimiento Universidad de Navarra" (SUN) Prospective Cohort.

BACKGROUND: Dementia is projected to affect 135 million by 2050. Diet is a pertinent target for primary prevention, but firm recommendations for dementia prevention are not available yet. Our aim was to address the association between exploratory (empirically derived) dietary patterns (DP) and changes in the Spanish Telephone Interview for Cognitive Status (STICS-m, maximum score = 41 points) over 6 years. METHOD: Information on diet was collected with a validated 136-item food-frequency questionnaire from 803 participants in the Mediterranean cohort "Seguimiento Universidad de Navarra." We used principal component analysis to derive exploratory DP. The derived DP were associated with change in STICS-m scores over 6 years, through adjusted multiple linear regression models. RESULTS: Two main DP were identified. The first DP resembled a Western dietary pattern (WDP)-high in sugar, fat, processed foods, and red meat-and the second DP resembled a Mediterranean dietary pattern (MDP)-high in vegetables, fruits, nuts, fish, and olive oil. Adherence to the WDP (tertile 3 vs tertile 1) was significantly associated with negative STICS-m changes after 6 years (between-tertile difference in changes: -0.80 points; 95% confidence interval [CI] -1.51, -0.08, p value = 0.03). Meanwhile, the MDP showed a positive +0.71 point (95% CI 0.15, 1.26, p value = 0.01) between-tertile difference in changes in the STICS-m score. CONCLUSIONS: A healthy, prudent, MDP was associated with less decline in cognitive function and, thus, could help to lower dementia incidence. Western-type diets were associated with a greater decline in cognitive performance and could increase dementia incidence.

Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review.

PURPOSE: To identify the evidence that supports the effect of interventions made by hospital pharmacists, individually or in collaboration with a multidisciplinary team, in terms of healthcare outcomes, a more effective utilization of resources and lower costs in older polymedicated inpatients. METHODS: We searched the following databases: MEDLINE, EMBASE and the Cochrane Library. We also conducted a hand search by checking the references cited in the primary studies and studies included in reviews identified during the process of research. Four review authors working by pairs searched for studies, extracted data, and drew up the results tables. RESULTS: Twenty-six studies were included in the review. In 13 of them pharmacists carried out their intervention exclusively while the patients were in hospital, whereas in 13 interventions were delivered during admission and after hospital discharge. Outcomes identified were mortality, length of stay, visits to the emergency department, readmissions and reported quality of life, among others. Pharmacist interventions were found to be beneficial in fifteen studies, specifically on hospital readmissions, visits to the emergency department and healthcare costs. CONCLUSION: There is no hard evidence demonstrating the effectiveness of hospital pharmacist interventions in older polymedicated patients. Mortality does not show as a relevant outcome. Other health care outcomes, such as hospital readmissions, visits to the emergency department and healthcare costs, seem to be more relevant and amenable to change. Interventions that include pharmacists in multidisciplinary geriatric teams seem to be more promising that isolated pharmacist interventions. Interventions prolonged after hospital discharge seem to be more appropriate that interventions delivered only during hospital admission. Better-designed studies should be conducted in the future to provide further insight into the effect of hospital pharmacist interventions.

Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks.

BACKGROUND: Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHOD: A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of "clean" and "contaminated" areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS: Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, 83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR = 15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR = 28 [5-160]). All outbreaks were controlled in 39 [37-42] days. CONCLUSIONS: A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.

Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks.

Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75-0.87])) and PROFUND (AUC-ROC = 0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.

Oral versus transdermal oestrogen delivery for endometrial preparation before embryo transfer: a prospective, comparative, randomized clinical trial.

RESEARCH QUESTION: To determine whether the transdermal route is equal or superior to the oral route, when preparing the endometrium with oestrogens for embryo transfer. DESIGN: Prospective, randomized controlled trial; 140 patients randomized; the pills group followed a protocol with oestradiol valerate pills and the patches group followed a protocol with oestradiol hemihydrate patches. The primary variable was endometrial thickness on day 10 ± 1 of treatment. Secondary variables were endometrial thickness on day 15 ± 1 of treatment, patient satisfaction, plasma levels of oestradiol, rates of pregnancy, miscarriage and delivery. Endometrial thickness was measured on day 10 ± 1 of the cycle, if the lining was 7 mm or less in thickness, another measurement was made on day 15 ± 1. Blood oestradiol levels were analysed on the day the endometrial lining was greater than 7 mm (day 10 ± 1 or day 15 ± 1). Patients completed a survey to evaluate comfort and side-effects. RESULTS: The patches group achieved significantly thicker endometrium by the first check-up on day 10 ± 1 (7.6 mm versus 7.0 mm; P = 0.026), with lower blood levels of oestradiol (159.2 pg/ml versus 237.1 pg/ml; P < 0.001) when the endometrial thickness was over 7mm. The pills group considered the treatment more comfortable, with less side-effects. No significant differences in the rates of pregnancy, miscarriage or live birth were found. CONCLUSIONS: Transdermal oestrogen treatment allows patients to reach a higher endometrial thickness after 10 days of treatment, with lower plasma levels of oestradiol, although it is not tolerated as well.

Pharmacist comprehensive review of treatment compared with STOPP-START criteria to detect potentially inappropriate prescription in older complex patients.

OBJECTIVES: To compare potentially inappropriate prescribing (PIP) according to the clinical judgement of the pharmacist with PIP according to explicit STOPP-START criteria in institutionalised and hospitalised patients with multiple pathologies. To describe and compare the main pharmacological groups involved and determine the factors associated with the detection of PIP in these patients. METHOD: A prospective multicentre observational study of institutionalised and hospitalised multipathology patients aged >65 years. A specialised pharmacist used his best clinical judgement to detect PIP based on a comprehensive review of the complete chronic treatment of patients, which is an essential activity in interdisciplinary care. STOPP-START criteria were used as an aid tool to detect PIP. The main variable was the number of PIP incidents detected. RESULTS: Detected PIP incidents were analysed in 338 patients. Clinical judgement detected more PIP incidents (35%) than did STOPP-START criteria. More PIP incidents unrelated to these criteria were detected in institutionalised patients than in hospitalised patients. Clinical judgement mainly detected PIP incidents related to incorrect doses and drug interactions (p<0.001); however, STOPP-START criteria mainly detected PIP incidents related to drug duplication and insufficiently treated diagnosis or symptoms (p=0.001 and p<0.001). In total, 93.8% of the PIP incidents were detected in polypharmacy patients (≥5 drugs). Institutionalised and high-level polypharmacy (≥10 drugs) patients were at the highest risk of PIP. CONCLUSIONS: A large number of PIP incidents were detected in institutionalised and hospitalised patients with multiple pathologies. The inclusion of a pharmacist in the multidisciplinary team facilitated the detection of PIP incidents, particularly in the institutionalised population and patients treated with high-level polypharmacy which were not detected by explicit STOPP-START criteria.

Mejorando la prescripción de medicamentos en las personas mayores: una nueva edición de los criterios STOPP-START / Improving drug prescribing in the elderly: A new edition of STOPP/START criteria

La utilización inapropiada de los medicamentos en los pacientes mayores tiene graves consecuencias en su salud —aumento del riesgo de sufrir reacciones adversas o síndromes geriátricos, mayor morbimortalidad— y en el sistema sanitario —aumento de costes, estancias hospitalarias excesivas. Para detectar y prevenir la utilización inadecuada de fármacos se está imponiendo progresivamente el uso de criterios explícitos, que pueden usarse dentro de la evaluación geriátrica exhaustiva o como parte de la actuación de diversos equipos multidisciplinares geriátricos. Los criterios STOPP-START, publicados por vez primera en 2008 (y en español en 2009), se están imponiendo como criterios de referencia en el ámbito europeo. Se presenta aquí la versión en español de la nueva edición (2014) de estos criterios, recientemente publicados en inglés. Además, se revisan en este artículo las publicaciones que han usado la versión inicial de los criterios STOPP-START en España desde su aparición, con la intención de fomentar su utilización e investigación en los distintos niveles asistenciales (AU)

Inappropriate use of drugs in older patients may have an adverse impact on several individual health outcomes, such as increasing the prevalence of adverse drug reactions, morbidity and mortality, and geriatric syndromes, as well as on health care systems, such as increased costs and longer hospital stays. Explicit criteria of drug appropriateness are increasingly used to detect and prevent inappropriate use of drugs, either within a comprehensive geriatric assessment or as tool used by different multidisciplinary geriatric teams. STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition (recently published in English) of the STOPP-START criteria is presented here. A review of all the papers published in Spain using the former version of these criteria is also presented, with the intention of promoting their use and for research in different health care levels (AU)

[Improving drug prescribing in the elderly: a new edition of STOPP/START criteria]. / Mejorando la prescripción de medicamentos en las personas mayores: una nueva edición de los criterios STOPP-START.

Inappropriate use of drugs in older patients may have an adverse impact on several individual health outcomes, such as increasing the prevalence of adverse drug reactions, morbidity and mortality, and geriatric syndromes, as well as on health care systems, such as increased costs and longer hospital stays. Explicit criteria of drug appropriateness are increasingly used to detect and prevent inappropriate use of drugs, either within a comprehensive geriatric assessment or as tool used by different multidisciplinary geriatric teams. STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition (recently published in English) of the STOPP-START criteria is presented here. A review of all the papers published in Spain using the former version of these criteria is also presented, with the intention of promoting their use and for research in different health care levels.

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain.

BACKGROUND: The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. METHOD: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). RESULTS: Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. CONCLUSIONS: The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

[Advances in the knowledge of the use of micronutrients in artificial nutrition]. / Avances en el conocimiento del uso de micronutrientes en nutrición artificial.

Micronutrients are defined as those compounds necessary for the adequate physiological status of the organism and that may be administered through the daily diet either enteral or parenteral. The term micronutrient encompasses the vitamins and oligoelements, also termed trace elements. Vitamins cannot be synthesized by the organism and are categorized in two groups: water-soluble vitamins (the vitamin B group, C, folic acid, and biotin) and lipid-soluble vitamins (A, D, E, and K). Oligoelements are found in small amounts in the human body, and copper, cobalt, chrome, iron, iodine, manganese, molybdenum, nickel, selenium, and zinc are considered to be essential. The important role of micronutrients in critically-ill patients has been demonstrated, and their influence on the immune system, cancer, burnt, septic, and poly-traumatized patients has extensively been put in evidence. It is important to establish the micronutrients demands for each individual in order to achieve an adequate intake. However, there is little evidence on the necessary intake to achieve proper physiological functioning under different pathologies; therefore, studies bringing light to this situation are needed. The aim of this review is to update the current state of knowledge on micronutrients supplementation in the adult population with pathologies such as cancer, coronary and cardiovascular disease, bowel inflammatory disease, short-bowel syndrome, cystic fibrosis, liver disease, renal failure, respiratory failure, the surgical patient, big-burnt patient, pancreatitis, poly-traumatized patients, sepsis and HIV. After the bibliographical search, we describe the current state of knowledge regarding micronutrients intake in artificial nutrition under the above-mentioned pathologies.

Avances en el conocimiento del uso de micronutrientes en nutrición artificial / Advances in the knowledge of the use of micronutrients in artificial nutrition

Los micronutrientes se definen como compuestos necesarios para un adecuado estado fisiológico del organismo que pueden ser administrados vía oral en la dieta diaria, enteral o parenteral. El término micronutriente engloba las vitaminas y los oligoelementos, también llamados elementos traza. Las vitaminas no pueden ser sintetizadas por el organismo y se dividen en dos grupos: vitaminas hidrosolubles (grupo vitamina B, C, ácido fólico y biotina) y vitaminas liposolubles (A, D, E y K). Los oligoelementos se encuentran en pequeñas cantidades en el cuerpo humano, se consideran esenciales el cobre, cobalto, cromo, hierro, yodo, manganeso, molibdeno, níquel, selenio y zinc. La importancia del papel de los micronutrientes en los pacientes críticos es un hecho constatado, al igual que su influencia en la respuesta inmune en el cáncer, quemados, sepsis y politraumatizados está ampliamente evidenciada. Es importante establecer los requerimientos y necesidades de micronutrientes en cada individuo para que el aporte de los mismos sea adecuado. No obstante, existe poca evidencia sobre el aporte necesario para conseguir un adecuado funcionamiento fisiológico en las distintas patologías, por lo que se hace necesario desarrollar estudios que aclaren esta situación El objetivo de esta revisión es actualizar el estado del conocimiento de la suplementación de micronutrientes en patologías como el cáncer, la enfermedad coronaria y cardiovascular, enfermedad inflamatoria intestinal, síndrome de intestino corto, fibrosis quística, enfermedad hepática, insuficiencia renal, insuficiencia respiratoria, paciente quirúrgico, grandes quemados, pancreatitis, politraumatizados, sepsis y VIH, en pacientes adultos. Tras los resultados de la búsqueda bibliográfica detallamos el estado actual del conocimiento relativo al aporte de micronutrientes en nutrición artificial en las patologías anteriormente mencionadas (AU)

Micronutrients are defined as those compounds necessary for the adequate physiological status of the organism and that may be administered through the daily diet either enteral or parenteral. The term micronutrient encompasses the vitamins and oligoelements, also termed trace elements. Vitamins cannot be synthesized by the organism and are categorized in two groups: water-soluble vitamins (the vitamin B group, C, folic acid, and biotin) and lipid-soluble vitamins (A, D, E, and K). Oligoelements are found in small amounts in the human body, and copper, cobalt, chrome, iron, iodine, manganese, molybdenum, nickel, selenium, and zinc are considered to be essential. The important role of micronutrients in critically-ill patients has been demonstrated, and their influence on the immune system, cancer, burnt, septic, and poly-traumatized patients has extensively been put in evidence. It is important to establish the micronutrients demands for each individual in order to achieve an adequate intake. However, there is little evidence on the necessary intake to achieve proper physiological functioning under different pathologies; therefore, studies bringing light to this situation are needed. The aim of this review is to update the current state of knowledge on micronutrients supplementation in the adult population with pathologies such as cancer, coronary and cardiovascular disease, bowel inflammatory disease, short-bowel syndrome, cystic fibrosis, liver disease, renal failure, respiratory failure, the surgical patient, big-burnt patient, pancreatitis, poly-traumatized patients, sepsis and HIV. After the bibliographical search, we describe the current state of knowledge regarding micronutrients intake in artificial nutrition under the above-mentioned pathologies (AU)

[Survey on parenteral nutrition preparation variability in pediatrics]. / Encuesta sobre la variabilidad en la elaboración de la nutrición parenteral en pediatría.

UNLABELLED: The prescription and preparation of paediatric parenteral nutrition in Spain are subject to great variability. AIM: To identify how paediatric parenteral nutrition is prescribed and prepared in Spain. MATERIAL AND METHODS: During the first quarter of 2001, a telephone survey was carried out among most of the hospitals in which parenteral nutrition is habitually prepared. The survey included questions on who was in charge of the prescription, the use of different solutions, addition of supplements (carnitine, heparin and glutamine), as well as information on the shelf-life of the mixtures. Subsequently, the results of the survey were compared with the following guidance documents: "Enteral and parenteral nutrition in paediatrics", drafted under the auspices of the Spanish Association for Paediatric Gastroenterology, Hepatology and Nutrition (2000) and the "Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients"/"Nutrition support practice manual" from the American Society for Parenteral and Enteral Nutrition (1998). RESULTS: Of the 48 hospitals surveyed, paediatric parenteral nutrition was not prepared in 12 of them. the number of food bags prepared daily correlated directly with the size of the hospital. In all cases, the paediatricians were responsible for prescription. In 87% of the centres, this prescription was customized (i.e. solutions adapted to each individual patient). All of the hospitals used dextrose as the source of carbohydrates and specific amino acid solutions for paediatric medicine. Basically, lipid emulsions with long chain triglycerides were used in 65% of cases and another 19% used physical mixtures of MCT and LCT. Only half of the hospitals routinely used all-in-one mixtures. Inorganic phosphate continued to be used in most cases (78%) versus sodium glycerol phosphate. Vitamins and trace elements were added daily in 65% of the hospitals, with alternate administration in the remainder. In half of the centres, heparin was added to the mixture and carnitine in 27%. For 40% of the centres responding to the survey, the solution had to be used within 24 hours of its preparation; 11% did not indicate the shelf-life. CONCLUSIONS: Although parenteral nutrition is prescribed by the paediatricians on all occasions, the preparation protocols differ significantly between hospitals. Standardization is exceptional. It is noteworthy that all-in-one mixtures are only used in half of the hospitals surveyed. We suggest the creation of a multidisciplinary working party (pharmacists, paediatricians, neonatologists) in order to draw up protocols for the preparation of paediatric parenteral nutrition.

Efavirenz en dosis única diaria: su influencia en la adherencia al tratamineto antirretroviral / Efavirenz in single daily dose: influence on antiretroviral therapy compliance

El objetivo del estudio es analizar la influencia de efavirenz, en dosis única diaria, en la adherencia al tratamiento antirretroviral y las consecuencias clínicas derivadas de la misma. Para ello se realizó un estudio observacional prospectivo en un total de 52 pacientes a los que se incorporó efavirenz como parte del tratamiento antirretroviral activo. Se analizó la adherencia antes y después del cambio de tratamiento, así como la evolución clínica de los pacientes en función de la respuesta virológica. Los resultados muestran que el 65,3 per cent de los pacientes mejoraron su adherencia y un total de 16 pacientes (30,8 per cent) vieron mejorado el cumplimiento por encima del 95 per cent. Esta mejora de la adherencia se tradujo a nivel clínico en un 85,3 per cent de pacientes que presentaron respuesta virológica (completa o parcial). De forma global, se ha pasado de 9 pacientes (17,3 per cent) con una adherencia > 95 per cent a 20 pacientes (38,5 per cent) con una adherencia > 95 per cent. Los resultados señalan la importancia de la dosis única diaria como factor facilitador de la adherencia al tratamiento antirretroviral y por tanto, con capacidad para incrementar la efectividad clínica del mismo (AU)

Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico.

A study to evaluate the efficacy and safety of nitazoxanide as a single agent for the treatment of a broad spectrum of mixed parasitic infections, both protozoa and helminths, was conducted at a primary school in San Pedro Tolimán, Querétaro, Mexico. Three faecal samples from 1824 adults and children were screened for the presence of oocysts, cysts, trophozoites, eggs or larvae of intestinal protozoa or helminths. Two hundred and forty-six adults and children infected with at least one protozoan and 2 helminths were given 7.5 mg/kg of nitazoxanide (500 mg to adults and 200 mg to children less than 12 years old) every 12 h for 3 consecutive days. Faecal samples were examined on days 6, 7, 8, 13, 14 and 15 (+/- 1) following initiation of treatment, using formalin-ether concentration and Kato-Katz egg counting. Treatment with nitazoxanide was 71-100% effective in eliminating evidence of infection with Entamoeba histolytica/E. dispar, Giardia duodenalis, Blastocystis hominis, Isospora belli, Enterobius vermicularis, Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana. Haematology and clinical chemistry values obtained before and after treatment remained unaffected by nitazoxanide. The drug was well tolerated, with only 15 patients (6.1%) reporting mild abdominal pain that lasted less than 24 h.

[The clinico-microbiological diagnosis of encephalitis due to herpes zoster in an elderly patient: apropos a case]. / Diagnóstico clínico-microbiológico de la encefalitis por herpes zoster en el anciano: a propósito de un caso.

Varicella-zoster infection consists of well-recognized cutaneous manifestations. However, in several cases it is complicated with central nervous system disorders. We present a 79-year-old diabetic woman with zoster ophthalmicus, who developed an acute confusional syndrome. EEG, cranial computed tomographic, biochemical and haematologic and liquoral studies were performed. An increased in the CSF-IgG index was founded, and it was related with Varicella-Zoster Herpes antibodies. She was treated with intravenous acyclovir, and her encephalopathy was resolved.