Tuberculosis respiratoria: repercusión del retraso diagnóstico sobre la salud laboral / Respiratory tuberculosis: impact of diagnostic delay on occupational health

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Influence of combinations of drugs that act on the CYP2D6 metabolic pathway in the treatment of major depressive disorder: a population-based study.

OBJECTIVE: To describe the frequency of drug combinations (substrate-substrate or substrate-inhibitor) with the potential to interfere with the CYP2D6 metabolic pathway in patients receiving antidepressant medication for major depressive disorder. METHODS: We carried out an observational study using outpatient medical records. We included adult subjects who initiated antidepressant medication during 2008-2010. Patients were assigned to three study groups: no combination, substrate-substrate, and substrate-inhibitor. Follow-up period was 12 months. MAIN MEASURES: demographics, comorbidity and medication persistence. Statistical analysis included a logistic regression model, P<0.05. RESULTS: Five thousand six hundred and thirty patients were recruited (61.9 years, 76.9% female), 24.4% (CI: 23.8 - 26.0%) received some kind of drug combination (substrate-substrate: 15.4%, substrate-inhibitor: 9.0%). Variables significantly associated with drugs combinations that may act on the CYP2D6 metabolic pathway were: dementia (OR=4.2), neuropathy (OR=4.2) and stroke (OR=1.9), P<0.001. Medication persistence at 12 months was longer in patients with no combination (55.3%) than in patients receiving substrate-substrate (50.5%) or substrate-inhibitor (45.0%) combinations, P<0.001. CONCLUSIONS: Twenty-five percent of major depressive disorder patients received a combination of drugs with the potential to interfere with CYP2D6 metabolic pathway. These combinations increased with comorbidity and resulted in shorter medication persistence of antidepressant treatment.

Adverse events in hospitals: the patient's point of view.

BACKGROUND: The publication of the report "To err is human: building a safer system" by the Institute of Medicine incited a profuse research addressing improvements in healthcare safety. However, there is still little acknowledgement of the key role of the patient in preventing adverse events of medical care. The aim of this review is to analyse and compare studies about patient's perception and opinion about care safety in hospitals. METHODS: We searched 10 databases (EMBASE, MEDLINE, PsychINFO, SCOPUS, Science Citation Index Expanded, Social Science Citation, IME, Sociological Abstracts, LILACS and The Cochrane Library) to identify articles and reports on patient's safety perception published between 1989 and 2006. RESULTS: From the 699 articles, 18 were selected: eight determined the frequency of experiences related to adverse events and the safety perception reported by patients, seven focused on the impact of the adverse events regarding the communication to the patient, and three included patient's opinions about the management and disclosure of adverse events and proposals to prevent them. CONCLUSIONS: The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patient's concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patient's perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs.

Prevalencia del síndrome metabólico en la población general de la provincia de Cáceres (Estudio SIMCA) / No disponible

FUNDAMENTO Y OBJETIVO. Conocer la prevalencia del síndrome metabólico (SM) en la población de la provincia de Cáceres. PACIENTES Y MÉTODO. Estudio descriptivo transversal realizado durante 2006-2007 en una muestra aleatoria y representativa de 1.314 individuos mayores de 24 años. A todos se les realizó anamnesis sobre antecedentes familiares y personales de patología cardiovascular, determinación de tensión arterial, peso, talla, perímetro abdominal, glucemia basal, triglicéridos y colesterol HDL. Se utilizaron las tres definiciones más recientes de SM: a) tercer informe del panel de expertos en el control de la hiperlipemia del programa nacional de educación sobre el colesterol de Estados Unidos (NCEP/ATPIII2001); b) la actualización de ésta realizada por la Asociación Americana del Corazón (AHA/NHLBI 2005) y c) Federación Internacional de Diabetes (IDF 2005).RESULTADOS. La prevalencia de SM fue 18,6% (IC 95%:16,5-20,8) según ATP-III 2001, 21,8% (IC 95%: 19,6-24,1)según AHA/NHLBI 2005 y 26,6% (IC 95%: 24,2-28,9) según IDF 2005. No se encontraron diferencias significativas entre sexos. La prevalencia de SM aumentó con la edad. En los varones de más de 80 años se encontró una disminución en la presencia de SM respecto a los grupos de edad previos en todas las clasificaciones. CONCLUSIONES. La prevalencia estimada de SM es elevada con cualquier definición en la población cacereña pero sobre todo con la de la IDF. No obstante, es menor que la encontrada en la mayoría de los estudios realizados en España, Europa y Estados Unidos (AU)

BACKGROUND AND OBJECTIVE. To know the prevalence of metabolic syndrome (MS) in the Caceres province population. PATIENTS AND METHODS. A descriptive, cross-sectional study conducted during 2006-2007 in a random and representative sample of 1314 subjects over 24 years of age. A clinical history was obtained for all of them on family and personal backgrounds regarding cardiovascular disease, measurement of blood pressure, weight, height, abdominal circumference, baseline glycemia, triglycerides and HDL cholesterol. The three most recent definitions of MS were used: a) third report of the expert’s panel in the control of hyperlipidemia from the national cholesterol education program of the United States (NCEP/ATP-III 2001); b) its update which is being done by the American Heart Association(AHA / NHLBI 2005) and c) International Diabetes Federation(IDF 2005).RESULTS. Prevalence of MS was 18.6% (95% CI: 16.5-20.8) according to the ATP-III 2001, 21.8% (95% CI: 19.6-24.1) according to AHA/NHLBI 2005 and 26.6% (95% CI:24.2-28.9) according to IDF 2005. No significant differences were found between genders. MS prevalence increased with age. In male over 80 years, a decrease was found in the presence of MS compared to the previous age groups in all the classifications. CONCLUSIONS. Estimated prevalence of MS is elevated with any definition in the Caceres population but above all with that of the IDF. However, it is less than that found in most of the studies performed in Spain, Europe and the United States (AU)

Age-dependent effects of secreted Semaphorins 3A, 3F, and 3E on developing hippocampal axons: in vitro effects and phenotype of Semaphorin 3A (-/-) mice.

We studied the role of Semaphorins in the formation of hippocampal connections at embryonic and early postnatal stages. We show that the embryonic entorhinal cortex has a repulsive effect on embryonic hippocampal axons that disappears gradually at postnatal stages. Such chemorepulsion is blocked by Neuropilin-1 and -2 blocking antibodies. However, at perinatal stages, the inner layers of the entorhinal cortex attract CA1 axons. At these stages, Sema3A and Sema3F bind commissural and entorhinal axons. Sema3A and Sema3F repel hippocampal axons at E14-P2, but not at E13. A similar spatiotemporal pattern of chemorepulsion is observed for Sema3A on entorhinal axons, in contrast to Sema3F, which repels these axons only at postnatal ages. Sema3E also repels hippocampal axons but exclusively at E14. We show that Sema3A and Sema3F can induce the collapse of hippocampal growth cones and that membrane-bound Sema3A and Sema3F can guide hippocampal axons in the stripe assay. In sema3A (-/-) mice, the entorhinohippocampal projection is largely normal although single axons innervate aberrantly the stratum radiatum and the hilus. Thus, the chemorepulsion evoked by Sema3A, Sema3E, and Sema3F is dynamically regulated in the developing hippocampal formation.

Oral oleoyl-estrone induces the rapid loss of body fat in Zucker lean rats fed a hyperlipidic diet.

OBJECTIVE: To test whether oleoyl-estrone affects body weight when given orally, which may help curtail the secondary growth-boosting effects of derived estrone. DESIGN: The rats were fed for 15 days with a powdered hyperlipidic diet (16.97 MJ/kg metabolizable energy) in which 46.6% was lipid-derived and 16.1% protein-derived energy (HL group), containing 1.23+/-0.39micromol/kg of fatty-acyl esters of estrone. This diet was supplemented with additional oleoyl-estrone to produce diets with 2.5 micromol/kg (diet OE2.5), 4.4 micromol/kg (diet OE4.4), and 33.3 micromol/kg content in fatty-acyl estrone (diet OE33). SUBJECTS: Twelve-week old female Zucker lean (Fa/?) rats initially weighing 200-235g. MEASUREMENTS: Food intake and body weight changes; urine and droppings production and nitrogen content. Body composition (water, lipid, protein) and total energy. Energy and nitrogen balances. Plasma chemistry including free amino acids. RESULTS: Oral administration of oleoyl-estrone in a hyperlipidic diet resulted in significant losses of fat, energy and, ultimately, weight, which were dependent on the dose of oleoyl-estrone ingested. Treatment induced the maintenance of energy expenditure combined with lower food intake, creating an energy gap that was filled with internal fat stores whilst preserving body protein. The decrease in food intake was not a consequence of food aversion but of diminished appetite. Energy expenditure was practically constant for all groups except for the OE33, which showed values about 25% lower than the controls. In most of the groups studied, there was a net protein deposition in spite of severe lipid and energy drainage. Amino acid levels agreed with this N-sparing shift. In spite of lowered energy intake, the N balance was positive or near zero in all groups, with a sizeable N-gap in controls and in lower-dose groups that disappeared in the OE33 group. CONCLUSION: Treatment of rats with a hyperlipidic diet containing added oleoyl-estrone resulted in the dose-related loss of fat reserves with scant modification of other metabolic parameters and preservation of body protein. The results agree with the postulated role of oleoyl-estrone as a ponderostat signal and open the way for its development as anti-obesity drug.