Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria / Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice

OBJETIVO: Describir en el entorno de la práctica clínica diaria, el perfil del paciente con vejiga hiperactiva (VH) tratado con dosis flexible de antimuscarícos. MÉTODOS: Estudio observacional, retrospectivo y multicéntrico llevado a cabo en 88 Hospitales públicos y privados. Se incluyeron pacientes adultos, diagnosticados de VH que iniciaron tratamiento con algún antimuscarínico a dosis flexible. Se recogió tipo de antimuscarínico, dosis, tratamientos concomitantes, beneficio aportado y cumplimiento terapéutico. RESULTADOS: Población constituida por 846 pacientes mayores de 60 años, pluripatológica (83,5%) y polimedicada (73,4%), formada mayoritariamente por mujeres (74,5%) y con más de un año de evolución de la VH. Principales antimuscarínicos inicialmente prescritos: fesoterodina (66,9%) y solifenacina (31,0%). El 68,2% de los pacientes iniciaron el tratamiento con la dosis baja. En la visita de seguimiento, el 47,0% modificó dosis (84,2% aumentaron la dosis, 15,8% disminuyeron la dosis). Los grupos que tuvieron que modificar dosis presentaron significativamente mayor morbilidad, peor sintomatología, mayor empleo de recursos sanitarios y peor cumplimiento terapéutico que el grupo de pacientes tratados siempre a dosis alta. CONCLUSIÓN: En determinados pacientes, el empleo desde el inicio del tratamiento antimuscarínico de dosis- flexible a la dosis más alta, podría proporcionar mayor beneficio terapéutico, adherencia y menor empleo de recursos sanitarios que el escalado de dosis

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5%) and polymedicated (73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose

Radiotherapy dose escalation with concurrent chemotherapy in locally advanced cervix cancer is feasible

Background. To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity. Methods. Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment. Results. Mean age was 46 (30-63) and 47 years (33-67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I-II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I-III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity. Conclusion. VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT "Box". We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT (AU)

No disponible

Ejercicio terapéutico para epicondilalgia lateral: revisión sistemática / Exercise therapy for lateral epicondylalgia: systematic review

La epicondilalgia lateral es una de las lesiones más comunes del brazo, siendo el músculo extensor radial corto del carpo (ERCB) la estructura más afectada, por movimientos repetitivos, rápidos y monótonos, principalmente afecta entre 1-3% de la población general, siendo más común en mujeres. El ejercicio terapéutico, es uno de los elementos claves en los programas diseñados para el manejo de esta condición. Se realizará una búsqueda de la evidencia a través de una revisión sistemática de ensayos clínicos aleatorizados que hayan determinado la efectividad del ejercicio terapéutico para el manejo de estos pacientes. El objetivo de esta Revisión es determinar si existe evidencia científica que avale la efectividad clínica del ejercicio terapéutico sólo o dentro de un programa de tratamiento en pacientes adultos con epicondilalgia lateral. La estrategia de búsqueda incluyó ensayos clínicos aleatorizados (ECA) y ensayos clínicos controlados (ECC); las bases de datos usadas fueron: Medline, Cinahl, PEDro, Central, Lilacs. Los resultados obtenidos fueron de treinta y seis artículos que cumplían con nuestros criterios de elegibilidad. Se concluye que existe evidencia moderada que el ejercicio terapéutico comparado con una intervención única, disminuye el dolor, mejora la funcionalidad y aumenta la fuerza libre de dolor en corto, medio y largo plazo. Existe evidencia de que el ejercicio terapéutico disminuye el dolor, y aumenta la fuerza sin dolor a corto plazo. Existe evidencia fuerte de que el ejercicio terapéutico disminuye el dolor, aumenta la fuerza y mejora la funcionalidad a corto, medio y largo plazo (AU)

The lateral epicondylalgia is one of the most common injuries of the arm; with the muscle extensor carpi radialis brevis (ERCB) affected the structure, repetitive motion, rapids and monotonous, mainly affects between 1-3% of the general population, being more common in women. Therapeutic exercise is one of the key elements in programs designed for the management of this condition. There will be a synthesis of evidence through a systematic review of randomized clinical trials that established the effectiveness of exercise therapy in the management of these patients. The aim of this review is to determine whether there is scientific evidence to support the clinical effectiveness of exercise therapy alone or in a treatment program for adult patients with LE. The search strategy included randomized clinical trials (RCTs) and controlled clinical trials (CCTs) databases were used: Medline, CINAHL, PEDro, Central, Lilacs. The results obtained were thirty-six articles that met our eligibility criteria. We conclude that there is moderate evidence shows that therapeutic exercise alone compared with a single intervention, decreases pain, improves function and increases strength pain free in short, medium and long term. There is strong evidence that exercise therapy reduces pain, increases strength and free from short-term pain. There is strong evidence that exercise therapy reduces pain, increases strength and improves functionality in the short, medium and long term (AU)

Errores de prescripción como barrera para la Atención Farmacéutica en establecimientos de salud públicos: Experiencia Perú / Prescription errors as a barrier to pharmaceutical care in public health facilities: Experience Peru

Objetivos: Evaluar la calidad de llenado de las recetas médicas en los establecimientos públicos de salud del distrito de Independencia, departamento de Lima como barrera para brindar atención farmacéutica a los pacientes. Material y métodos: Estudio de diseño transversal, se emplearon recetas atendidas en las farmacias ambulatorias de todos los establecimientos de salud del distrito de Independencia (11). En el mes de noviembre 2013 se seleccionaron aleatoriamente, de cada uno de los 11 establecimientos, 384 recetas atendidas en el mes de octubre de 2013. Resultados: Se tomó de modo aleatorizado 384 recetas de cada uno de los 11 establecimientos de salud, haciendo un total de 4224 recetas. El 24% de recetas consignaban el dato del peso del paciente (IC: 22,76%-25,30%); el 34,2% mencionaba el diagnóstico (IC: 32,80%-35,62%); el 93,7% tenían descrito los medicamentos expresados en DCI (IC: 93,00-94,41%). Asimismo, solo el 11,3% consignaban la vía de administración (IC: 10,40%-12,28%) y el 41,4% señalaban la frecuencia (IC: 39,94%- 42,88%). La duración del tratamiento estuvo ausente en 32% de las recetas evaluadas (IC: 66,62%-69,41%) y solo el 5,7% tuvieron la fecha de vencimiento (IC: 5,00%-6,41%). Estos errores son barreras para la atención farmacéutica ya que dificulta la detección de problemas relacionados con medicamentos y asimismo limita la información que se pueda brindar al paciente sobre el uso de sus medicamentos. Conclusión: Se necesita de estrategias innovadoras para mejorar la prescripción de modo que no sea una barrera para poder detectar, resolver y prevenir la aparición de problemas relacionados a los medicamentos

Objectives: to evaluate the quality of prescriptions' filling in Independencia’s District public health facilities in the department of Lima as a barrier to provide pharmaceutical care to patients. Materials and methods: It was carried out a cross-sectional study with prescriptions from the outpatients pharmacies of all the Independencia’s District health facilities (11). During the month of November 2013, 384 prescriptions that have been assisted in October were randomly selected of each of the health facilities. Results: 384 prescriptions were randomly selected of each of the 11 health facilities which represented a whole of 4224 prescriptions. 24% of the prescriptions recorded the patient’s weight (IC: 22,76%-25,30%); 34,2% included the diagnosis (IC: 32,80%- 35,62%); 93,7% included drugs expressed in INN (IC: 93,00-94,41%). Furthermore, only 11,3 mentioned the route of administration (IC: 10,40%-12,28%) and 41,4 pointed out the frequency (IC: 39,94%-42,88%). The length of treatment was missing in 32% of the evaluated prescriptions (IC: 66,62%-69,41%) and only 5,7 included the expiration date (IC: 5,00%-6,41%). These errors are barriers for the pharmaceutical care due to the fact that they make difficult the detection of problems related to drugs; on the other hand, they limit the information that can be given to a patient about the use of his/her drugs. Conclusion: Innovative strategies are needed in order to improve prescriptions so that they are not a barrier any more for the detection, solution and prevention of problems related to drugs

Formulation and evaluation of CFC free inhalers for beclomethasone dipropionate

Beclomethasone dipropionate CFC free inhalation formulations were developed with a view to treat asthma prophylactically. Dry powder inhalers (DPI) for beclomethasone dipropionate were prepared with different grades of lactose monohydrate. The influence of carrier and overages on performance of DPI was studied. Metered dose inhalers (MDI) with HFA based propellants were formulated with various doses, overages and different concentrations of alcohol. Formulated DPI and MDI were evaluated for various official and unofficial quality control tests. The influence of over doses on valve delivery, effect of overages on emitted dose and influence of alcohol on spray pattern from MDI were studied. The better fine particle fraction and emitted dose were obtained from the DPI formulated with 10:90 ratio of fine lactose: coarse lactose and with 20% w/w overages. The studies on MDI revealed that the 15% of overdoses are required for effective valve delivery and 20% overages are required for 100% drug delivery. 5-10%v/v alcohol was found to be preferable to get optimum emitted dose and fine particle fraction.

Desenvolveram-se formulações por inalação de dipropionato de beclometasona, livres de CFC, com o objetivo de tratar a asma profilaticamente. Prepararam-se inaladores de pó seco (DPI) para o dipropionato de beclometasona com diferentes gradações de lactose monoidratada. Estudou-se a influência do transportador e dos excessos de fármaco em relação ao rotulado no desempenho do DPI. Inaladores de dose calibrada (MDI) com propelentes à base de hidrofluoralcanos (HFA) foram formulados com várias doses, excessos de fármaco em relação ao rotulado e diferentes concentrações de álcool. Avaliaram-se as DPI e MDI formuladas por vários métodos oficiais e não oficiais de controle de qualidade. Estudaram-se a influência da superdosagem na liberação da válvula, o efeito dos excessos na dose emitida e a influência do álcool no padrão do spray do MDI. Obtiveram-se a melhor partícula fina e a dose emitida do DPI formulado com proporção de 10:90 de lactose fina:lactose grossa e 20% p/p de excesso. Os estudos em MDI revelaram que 15% de sobredose são requeridos para a liberação efetiva da válvula e 20% de excessos, para a liberação de 100% dos fármacos. Álcool a 5-10% v/v permitiu alcançar ótima dose emitida e fração de partícula fina.

Myostatin: genetic variants, therapy and gene doping

Since its discovery, myostatin (MSTN) has been at the forefront of muscle therapy research because intrinsic mutations or inhibition of this protein, by either pharmacological or genetic means, result in muscle hypertrophy and hyperplasia. In addition to muscle growth, MSTN inhibition potentially disturbs connective tissue, leads to strength modulation, facilitates myoblast transplantation, promotes tissue regeneration, induces adipose tissue thermogenesis and increases muscle oxidative phenotype. It is also known that current advances in gene therapy have an impact on sports because of the illicit use of such methods. However, the adverse effects of these methods, their impact on athletic performance in humans and the means of detecting gene doping are as yet unknown. The aim of the present review is to discuss biosynthesis, genetic variants, pharmacological/genetic manipulation, doping and athletic performance in relation to the MSTN pathway. As will be concluded from the manuscript, MSTN emerges as a promising molecule for combating muscle wasting diseases and for triggering wide-ranging discussion in view of its possible use in gene doping.

Desde sua descoberta, a miostatina (MSTN) entrou na linha de frente em pesquisas relacionadas às terapias musculares porque mutações intrínsecas ou inibição desta proteína tanto por abordagens farmacológicas como genéticas resultam em hipertrofia muscular e hiperplasia. Além do aumento da massa muscular, a inibição de MSTN potencialmente prejudica o tecido conectivo, modula a força muscular, facilita o transplante de mioblastos, promove regeneração tecidual, induz termogênese no tecido adiposo e aumenta a oxidação na musculatura esquelética. É também sabido que os atuais avanços em terapia gênica têm uma relação com o esporte devido ao uso ilícito de tal método. Os efeitos adversos de tal abordagem, seus efeitos no desempenho de atletas e métodos para detectar doping genético são, contudo, desconhecidos. O objetivo da presente revisão de literatura foi discutir biossíntese, variantes genéticas, manipulação genética e farmacológica, e doping relacionado à via da MSTN. Como será concluído do manuscrito, a MSTN emerge como uma molécula promissora para combater doenças atróficas musculares e para gerar muitas discussões devido à sua possível utilização em doping genético.