La infección por Helicobacter pylori se asocia con disminución del riesgo de esofagitis eosinofílica en pacientes mexicanos / Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients

Objetivos La incidencia de la esofagitis eosinofílica (EEo) está aumentando en algunas regiones del mundo. Estudios retrospectivos han encontrado asociación inversa con la infección por Helicobacter pylori (H. pylori). Un estudio prospectivo reciente ha cuestionado esta relación. Por lo que buscamos evaluar esta relación en pacientes mexicanos. Pacientes y métodos Evaluamos pacientes adultos sin erradicación previa de la infección por H. pylori. Los casos se definieron por la presencia de síntomas esofágicos y > 15 eosinófilos/campo de alto poder (CAP) en biopsias de esófago. Los controles, por la presencia de < 15 eosinófilos/CAP. La infección por H. pylori se estableció por histología. Los pacientes fueron pareados por edad y género, asignando cuatro controles por caso. Resultados Se incluyeron 190 pacientes: 38 casos y 152 controles. Los casos tuvieron mayor frecuencia de atopia, disfagia, impactación alimentaria, eosinofilia periférica y anormalidades endoscópicas de EEo. La prevalencia de la infección por H. pylori fue de 63,6%. Los casos tuvieron prevalencia significativamente menor que los controles (36,8 vs. 70,4%, odds ratio (OR) 0,21, intervalo de confianza (IC) 95% 0,08-0,69, p = 0,001). Los pacientes atópicos tuvieron menor prevalencia en comparación con aquellos sin atopia: 13,1 vs. 50,5% (OR 0,20, IC 95% 0,06-0,69, p < 0,001), particularmente con rinitis alérgica y alergia alimentaria. Conclusiones Observamos una relación inversa entre la infección por H. pylori y EEo así como con atopia. Se necesitan estudios en modelos experimentales de EEo que clarifiquen el papel del H. pylori en esta interacción, así como estudios robustos que incluyan otros factores que puedan influir en esta relación (socioeconómicos, culturales, microbiota, etc.) (AU)

Background The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. Patients and methods We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. Results We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08–0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06–0.69, p < 0.001), particularly allergic rhinitis and food allergy. Conclusions We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship (AU)

Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients. / La infección por Helicobacter pylori se asocia con disminución del riesgo de esofagitis eosinofílica en pacientes mexicanos.

BACKGROUND: The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. PATIENTS AND METHODS: We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. RESULTS: We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08-0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06-0.69, p < 0.001), particularly allergic rhinitis and food allergy. CONCLUSIONS: We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

Implications of the prevalence of Ascaris sp. in the funerary context of a Late Antique population (5th-7th c.) in Granada (Spain).

OBJECTIVE: To evaluate the prevalence of gastro-intestinal parasites in human remains from Late Antiquity (5th - 7th c.) Granada (Spain). MATERIALS: The study included pelvic and cranial control samples from 17 skeletons from the archaeological sites of Los Mondragones (n = 13) and Rafael Guillén (n = 4). METHODS: In the paleoparasitological study, soil samples from pelvic area and cranium were analyzed using the rehydration, homogenization, and micro-sieving method and visualization under brightfield microscopy. RESULTS: Ascaris sp. eggs were detected in pelvic samples from seven individuals. CONCLUSIONS: These findings may indicate that this parasite was endemic. Its detection frequency is one of the highest reported at group level in an osteological series from Late Antiquity. SIGNIFICANCE: The prevalence of Ascaris sp. associated with skeletal remains has implications for assessing the lifestyle and health of populations in southern Spain during the Late Antique period. LIMITATIONS: The number of individuals is small and taphonomic processes could have limited paleoparasitological findings SUGGESTIONS FOR FURTHER RESEARCH: Future interdisciplinary studies of this type are warranted in larger osteological series to improve knowledge of parasitosis in the past.

Body weight loss and glycemic control on the outcomes of patients with NAFLD. The role of new antidiabetic agents.

Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease worldwide affecting a third of adults and 12% of children in Western countries. In around 50-60%% of cases, NAFLD and type 2 diabetes mellitus (T2DM) coexist and act synergistically to increase the risk of adverse hepatic and extra-hepatic outcomes. T2DM is a strong risk factor for rapid progression of NAFLD to nonalcoholic steatohepatitis (NASH), cirrhosis or hepatocellular carcinoma (HCC), which have become frequent indications of liver transplantation. The pathophysiology of NAFLD is complex and its relationship with T2DM is bidirectional, where lipotoxicity and insulin resistance (IR), act as the strongest pillars. To date, no pharmacological treatment has been approved for NAFLD. However, there is an intense research with numerous drugs focused on reversing inflammation and liver fibrosis through modulation of molecular targets without good results. It has been known for some time that weight reduction >10% is associated to histological improvement of NAFLD. Recently, glycemic control has been shown to induce similar results. Diet and physical exercise for weight reduction have limitations, so alternative methods (pharmacologic, endoscopic or surgical) may be required. Currently, new antidiabetic drugs inducing weight loss, have been recently approved for the treatment of obesity. Nevertheless, their therapeutic effects on NAFLD have not been extensively studied. We will review here, recently published data on the effects of weight loss and glycemic control on the histological and metabolic parameters of NAFLD and recent published data on therapeutic studies of NAFLD with new antidiabetic drugs.

Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.

Diabetes mellitus (DM) is common in liver cirrhosis (LC). The pathophysiological association is bidirectional. DM is a risk factor of LC and LC is a diabetogenic condition. In the recent years, research on different aspects of the association DM and LC has been intensified. Nevertheless, it has been insufficient and still exist many gaps. The aims of this review are: (1) To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis; (2) To evaluate the impact of DM on outcomes of LC patients; and (3) To select the most adequate management benefiting the two conditions. Literature searches were conducted using PubMed, Ovid and Scopus engines for DM and LC, diagnosis, outcomes and management. The authors also provided insight from their own published experience. Based on the published studies, two types of DM associated with LC have emerged: Type 2 DM (T2DM) and hepatogenous diabetes (HD). High-quality evidences have determined that T2DM or HD significantly increase complications and death pre and post-liver transplantation. HD has been poorly studied and has not been recognized as a complication of LC. The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure. In conclusion, the clinical impact of DM in outcomes of LC patients has been the most studied item recently. Nevertheless many gaps still exist particularly in the management. These most important gaps were highlighted in order to propose future lines for research.

Evaluation and Validation of a New Score to Measure the Severity of Small Bowel Angiodysplasia on Video Capsule Endoscopy.

INTRODUCTION: Angiodysplasias are responsible of 50% of small bowel bleeding. An endoscopic method that allows measuring its severity is not available. AIMS: The aim of the study was to validate a new endoscopic score with VCE to measure the severity of small bowel angiodysplasias (SBAD). METHODS: Four endoscopists independently reviewed VCE videos of 22 patients with SBAD. The score graded 3 variables: A - extent of lesions: E1, located in one half of the intestine and E2, in both halves; B - number of lesions: N1, <5; N2, 5-10; and N3, >10 lesions; C - probability of bleeding: P1, pale red spots; P2, bright red spots; P3, bleeding stigmata; and P4, active bleeding. Capsule Endoscopy Small Bowel Angiodysplasia Activity Index (CESBAI) was calculated as follows: E × 1 + N × 2 + P × 3. Interobserver variability was analyzed by Spearman's correlation and agreement Kappa statistic tests. RESULTS: The mean CESBAI scores by observers were O1= 11.6 ± 4.1; O2 = 11.3 ± 4.8; O3 = 11.1 ± 4.9; and O4 = 11.8 ± 4.2 (p > 0.05). Spearman's correlation values of CESBAI between every 2 observers were from 0.61 to 0.94 (p < 0.001) with a global correlation of 0.73 among all observers. Kappa values of CESBAI between every 2 observers ranged from 0.42 to 0.87 (p < 0.001) with a global agreement of 0.57 among all observers. All evaluators stated that the method was easy to use. CONCLUSIONS: CESBAI is a reliable and reproducible score. Nevertheless, these results must be validated in other studies with larger population before assessing its power for predicting bleeding recurrence.

Clinical, endoscopic and histological characteristics of Mexican adult patients with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) has high prevalence/incidence in Western Europe, Canada, United States of America and Australia where it has significantly increased over the past three decades to the extent that some consider it an epidemic.

Intervención educativa para el mejoramiento humano desde la cultura en los estudiantes de ciencias médicas / Educational intervention for human improvement from culture in medical science students

RESUMEN Fundamento: es necesario fortalecer la cultura general en los educandos a través del vínculo de las artes, la historia y la medicina para la formación de un profesional integral y culto. Objetivo: elaborar un programa de intervención educativa desde la cultura general para el mejoramiento del comportamiento humano de los estudiantes de la carrera de Medicina. Métodos: se realizó una investigación de desarrollo en la Facultad de Ciencias Médicas "Julio Trigo López" en el primer semestre de 2019. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo y sistémico estructural; y empíricos: revisión documental del plan de estudio D de la carrera de Medicina y el documento base para el diseño del plan de estudio E del Ministerio de Educación Superior, y un cuestionario de conocimientos a los alumnos antes y después de la aplicación del producto, el cual validado según postulados de Moriyama. Resultados: el análisis documental permitió establecer la ausencia de contenidos de cultura general vinculados a los programas de la carrera, mientras el cuestionario demostró inconsistencia en conocimientos asociados a elementos de la historia, el arte y la medicina, por lo que se elaboró un programa de intervención educativa para los estudiantes compuesto por cuatro temas y ocho actividades lectivas impartidas en cuatro conferencias y cuatro talleres. Conclusiones: fue valorada por criterios de expertos como adecuada. Una vez aplicada demostró su efectividad al ampliar o modificar los conocimientos de los alumnos sobre los temas impartidos.

ABSTRACT Background: it is necessary to strengthen the general culture in students through the link of arts, history and medicine for the formation of a comprehensive and cultured professional. Objective: to elaborate an educational intervention program from the general culture for the improvement of the human behavior of the students of the Medicine degree. Methods: a development investigation was carried out at "Julio Trigo López" Faculty of Medical Sciences in the first semester of 2019. Theoretical methods were used: analysis-synthesis, inductive-deductive and structural systemic; and empirical ones: documentary review of study plan D of the Medicine degree and the base document for the design of study plan E of the Ministry of Higher Education, and a knowledge questionnaire to students before and after the implementation of the product, validated according to Moriyama's postulates. Results: the documentary analysis allowed to establish the absence of contents of general culture linked to the programs of the degree, while the questionnaire showed inconsistency in knowledge associated with elements of history, art and medicine, so a program of educational intervention was elaborated for students consisting of four topics and eight teaching activities given in four conferences and four workshops. Conclusions: it was assessed by expert´s criteria as adequate. Once applied, it demonstrated its effectiveness by expanding or modifying students' knowledge of the subjects taught.

Vulnerabilidad de la Covid-19 por estratificación epidemiológica en policlínicos de Arroyo Naranjo, La Habana / Covid-19 vulnerability due to epidemiological stratification at community clinics in Arroyo Naranjo, Havana

Introducción: El SARS-CoV-2 es un coronavirus nuevo poco conocido, su puerta de entrada es la respiratoria. La vulnerabilidad espacial establece grados de riesgos para contraer la enfermedad, esto permite aplicar intervenciones radicales y diferentes, necesarias para enfrentar la pandemia. Objetivo: Determinar la vulnerabilidad espacial de la Covid-19 en policlínicos de Arroyo Naranjo, La Habana. Método: Se realizó un estudio descriptivo y transversal. Las siete áreas de salud del municipio Arroyo Naranjo. Con una población territorial. Se estudiaron adultos de 60 años y más, casos positivos y mortalidad por Covid-19, con infección respiratoria aguda, sintomatología y vulnerabilidad espacial. Los policlínicos se estratificaron en contextos vulnerables, medianamente vulnerables y menos vulnerables. La estratificación epidemiológica se realizó mediante el método de indicadores con ponderación fija, establecidos según criterios de expertos. Los datos se obtuvieron del departamento de estadística de los policlínicos y de la pesquisa diaria. Resultados: Los policlínicos estratificados como de contexto menos vulnerable fueron Capri, Managua y Eléctrico; mientras que como contexto medianamente vulnerable fueron Los Pinos, Mantilla y Grimau y de contexto vulnerable resultó el policlínico Párraga. Conclusiones: Existieron contextos vulnerables en el territorio, con una influencia negativa de los indicadores no bien controlados que favorecen la aparición de la Covid-19, lo que expresa el peligro de contraer la enfermedad o de un rebrote(AU)

Introduction: SARS-CoV-2 is a little-known new coronavirus, its entry point is the respiratory way. The spatial vulnerability establishes degrees of risks to contract the disease, this allows the application of radical and different interventions, necessary to face the pandemic. Objective: To determine Covid-19 spatial vulnerability at polyclinics in Arroyo Naranjo, Havana. Method: A descriptive and cross-sectional study was carried out in the seven health areas at Arroyo Naranjo municipality, with territorial population. We studied adults aged 60 years and over, positive cases and mortality from Covid-19, with acute respiratory infection, symptoms and spatial vulnerability. The community clinics were stratified into vulnerable, moderately vulnerable and lesser vulnerable contexts. Epidemiological stratification was carried out using the method of indicators with fixed weights, established according to expert criteria. Data were obtained from the statistics department of the clinics and from the daily survey. Results: The community clinics stratified as having less vulnerable context were Capri, Managua and Eléctrico; while Los Pinos, Mantilla and Grimau were a moderately vulnerable context and Párraga clinic resulted as a vulnerable context. Conclusions: There were vulnerable contexts in the territory, with a negative influence of poorly controlled indicators that favor the appearance of Covid-19, which expresses the danger of contracting the disease or a regrowth(AU)

Utilización de plantas medicinales por tutores de residentes de Medicina General Integral municipio Arroyo Naranjo / Use of medicinal plants by tutors of residents of General Comprehensive Medicine Arroyo Naranjo municipality

Introducción: La utilización de las plantas medicinales por los tutores de residentes de Medicin General Integral es un aspecto a tener presente en la formación del futuro especialista Objetivo: Determinar la utilización y conocimientos sobre los fitofármacos por los tutores de residentes de Medicina General Integral municipio Arroyo Naranjo La Habana 2020. Método: Se realizó una investigación observacional descriptiva transversal, sobre la utilización, de las plantas medicinales Universo: 74 tutores de residentes en la atención primaria de salud Muestra 43 tutores seleccionados por muestreo no probabilístico por factibilidad que se encontraban en los consultorios de médicos de familia. Se aplicó una entrevista semiestructurada con las variables siguientes: fitoterapia, vía de información, formas de uso, afecciones por aparatos donde se prescribe, síntomas y reacciones adversas Resultados: Se obtuvo información sobre plantas medicinales las cuales se identificaron y clasificaron. La forma de preparación preferida fue la decocción 41.8%, la parte de la planta más utilizada, las hojas 46.6 % , Los cursos de la Facultad de Ciencias Médicas fue la primera forma de adquirir el conocimiento 100,0%, seguida del Fitomed 76.7% Se recomendó en más de 20 síntomas y enfermedades, el uso en múltiples afecciones, alcanza >60% Se reporta más de 40 especies con fines curativos. Conclusiones, son insuficientes los conocimiento sobre la cantidad a preparar, las contraindicaciones y las reacciones adversas que pueden producir el uso inadecuado de las mismas. La información que tienen los tutores de los residentes de MGI, no siempre cuenta con un sustento científico

Prevalence of liver fibrosis in an unselected general population with high prevalence of obesity and diabetes mellitus. Time for screening?

INTRODUCTION: Cirrhosis and liver cancer are currently common causes of death worldwide. The global epidemic of obesity has increased the incidence of nonalcoholic fatty liver disease (NAFLD) and cirrhosis in recent years. Advanced fibrosis increases the morbimortality rate in NAFLD. The Mexican population has one of the highest prevalence of obesity and diabetes mellitus (DM) worldwide. AIM: To determine the prevalence of advanced liver fibrosis in Mexican general population. METHODS: Adult individuals, without a history of liver disease nor heavy alcohol consumption were randomly sampled from 20,919 participants of a health and nutrition survey applied to the general population. Clinical and laboratory evaluations were performed to calculate the NAFLD fibrosis score (NFS) (an extensively validated non-invasive method). Two cut-off points were used. Advanced fibrosis was defined as a result >0.676. RESULTS: In total 695 individuals were included. The mean age was 47.8±16.4. The majority were between 20 and 50 years (59%), 70.2% were female, 35.5% showed obesity and 15.8% DM. The 93% had normal serum ALT. Based on the NFS results, 56 individuals (8.1%) had a high probability of fibrosis. Most patients from this subgroup showed normal serum ALT (92.9%), 89.3% were >45yr. old, 52% were obese and 27% suffered from DM. CONCLUSIONS: Based on these results, 8.1% of Mexican general population without a history of liver disease is at high risk of having advanced liver fibrosis and complications and death derived from cardiovascular disease and cirrhosis. Most of them showed normal ALT serum levels.

Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points.

Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes; nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient's quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.

Pseudomyocardial Infarction in a Patient with Severe Diabetic Ketoacidosis and Mild Hyperkalemia.

A 48-year-old male with a prior diagnosis of diabetes mellitus presented to the emergency department with malaise and nausea. On work-up, he was found with hyperglycemia and high anion gap metabolic acidosis, with a blood pH < 6.94. A diagnosis of severe diabetic ketoacidosis was established; serum electrolyte analysis showed mild hyperkalemia. On work-up, a 12-lead electrocardiogram was obtained, and it showed an ST-segment elevation on anterior leads that completely resolved with diabetic ketoacidosis treatment. ST-segment elevation myocardial infarction can be a precipitant factor for diabetic ketoacidosis, and evaluation of diabetic patients with suspected myocardial infarction can be challenging since they can present with atypical or little symptoms. Hyperkalemia, which usually accompanies diabetic ketoacidosis, can cause electrocardiographic alterations that are well described, but ST-segment elevation is uncommon. A pseudomyocardial infarction pattern has been described in patients with diabetic ketoacidosis; of note, most of these patients presented severe hyperkalemia. We believe this is of great importance for clinicians because they must be able to recognize those patients that present with electrocardiographic abnormalities secondary to the metabolic alterations and those that can be experiencing actual ongoing ischemia, in order to establish an appropriate and prompt treatment.

Meckel's diverticulum diagnosis by video capsule endoscopy: A case report and review of literature.

BACKGROUND: Meckel's diverticulum (MD) occurs predominantly in children and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is difficult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy (VCE) in the diagnosis of MD is unknown, and the endoscopic patterns are not defined. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics. CASE SUMMARY: We present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding (OGIB). They had a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglobin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retained in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases. CONCLUSION: VCE is useful for the diagnosis of MD. However, endoscopic characteristics must be recognized in order to establish preoperative diagnosis.

Reacciones adversas por medicamentos en embarazadas cubanas / Adverse Drug Reactions in Cuban Pregnant Women from 2003 to 2013

Introducción: La vigilancia poscomercialización de la seguridad de los medicamentos en las gestantes es esencial para prevenir los efectos perjudiciales de los fármacos. Objetivos: Caracterizar las reacciones adversas medicamentosas en embarazadas reportadas al Sistema de Farmacovigilancia e identificar nuevos efectos adversos. Método: La primera etapa del estudio fue descriptiva y transversal y la segunda fue analítica. El estudio se realizó desde 2003 hasta 2013. La fuente de información fue la base de datos nacional de Farmacovigilancia. Para detectar las señales, se calculó el riesgo relativo proporcional (RRP). Los pares medicamento-reacción adversa con RRP> 2 (p ≤ 0,05), se sometieron a evaluación cualitativa por expertos. Resultados: La tasa de notificación reacciones adversas fue de 1 536,6 / 105 embarazadas. El grupo de 40 y más años (2 357,8 / 10 5) resultó ser el más afectado. Las reacciones adversas medicamentosas predominantes fueron vómito (22,8 por ciento), leves (52,8 por ciento), probables (64,9 por ciento) y frecuentes (65,9 por ciento), producidas más por antivirales (21,1 por ciento) y oseltamivir (21,9 por ciento). Los licenciados en farmacia (37,2 por ciento) reportaron más desde la atención secundaria de salud (60,9 por ciento). Se detectaron 7 avisos y una señal. Conclusiones: Las reacciones adversas medicamentosas en embarazadas detectadas en una década mostraron características diferentes a lo reportado a nivel internacional y nacional. Se generó la señal de una nueva reacción adversa por un antiviral que estaba en vigilancia intensiva(AU)

Introduction: There is no knowledge of the characteristics of adverse drug reactions in Cuban pregnant women or the signs of new adverse reactions during a decade of notification. Objectives: To characterize adverse drug reactions in pregnant women reported to the Pharmacovigilance System from 2003 to 2013. To identify signs of new adverse reactions. Method: This study had two stages. The first stage was descriptive and transversal, the second was analytical. The source of information was the national pharmacovigilance database. We calculated the relative proportional risk (RRP) to detect signals. Experts subjected the drug-adverse reaction pairs with RRP > 2 (p ? 0, 05) to qualitative evaluation. Results: The reporting rate of adverse reactions was 1 536, 6 / 105 pregnant. The age group of 40 and older (2 357, 8 / 105) was the most affected. The predominant adverse drug reactions were vomiting (22, 8 percent), mild (52, 8 percent), probable (64, 9 percent) and frequent (65, 9 percent) produced more by antiviral drugs (21,1 percent) and oseltamivir (21,9 percent). Graduates in pharmacy (37, 2 percent) reported more from secondary health care (60,9 percent). Seven warnings and a signal were detected. Conclusions: Adverse drug reactions in pregnant women detected in a decade showed different characteristics than those reported at the international and national levels. The signal of a new adverse reaction was generated by an antiviral that was under intensive surveillance(AU)

Levocarnitine Decreases Intradialytic Hypotension Episodes: A Randomized Controlled Trial.

Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo-controlled quadruple-blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively. During the trial, 33 patients received 1188 hemodialysis sessions. We identified 239 (21.3%) intradialytic hypotension episodes. The intradialytic hypotension episodes were less frequent in the levocarnitine group (9.3%, 60 IH events) (P < 0.001). Hemodialysis is frequently perplexed by intradialytic hypotension episodes. Levocarnitine supplementation before each hemodialysis session efficiently diminishes the intradialytic hypotension episodes. This is a new application method that must be considered and explored.

Reacciones adversas por medicamentos en ancianos cubanos (2003-2013) / Adverse drug reactions reported in the Cuban elderly in the 2003-2013 period

Introducción: Las peculiaridades de las reacciones adversas medicamentosas en ancianos no están bien establecidas en Cuba. Objetivo: Determinar las reacciones adversas medicamentosas en ancianos reportadas al Sistema Cubano de Farmacovigilancia. Métodos: Investigación descriptiva y transversal. El universo, constituido por 26 489 reportes de reacciones adversaspor fármacos del Cuadro Básico de Medicamentos enpacientes de 60 años y más, registradas enla base de datos nacional de farmacovigilancia del 2003 al 2013. Las variables examinadas fueron edad, sexo, reacción adversa, sistema de órgano, medicamento, grupo farmacológico, imputabilidad, gravedad, frecuencia, notificador y nivel de atención de salud. Las medidas de resumen fueron frecuenciaabsoluta, porcentaje y tasas. Resultados: La tasa de notificación fue de 1 479, 4 × 105 ancianos. Las mujeres (1 885,1 × 105) y el grupo de 60 a 69 años (1 559,8 × 105) resultaron los más afectados. Las reacciones adversas medicamentosas predominantes fueron erupción cutánea (148,3 × 105), las leves (741,1 × 105), probables (1097,5 × 105) y las frecuentes (828,8 × 105), producidas más por antibacterianos (341,5 × 105) y captopril (167,7 × 105). Reportaron más los médicos (68,8 por ciento) desde la atención primaria de salud (85,8 por ciento). Conclusiones: Las reacciones adversas medicamentosas en ancianos constituyeron una pequeña proporción de todos los efectos indeseados notificados al Sistema Cubano de Farmacovigilancia del 2003 al 2013; sus características son similares a las reportadas a nivel internacional, excepto el grupo de edad afectado, el tipo de efecto indeseado y los medicamento simplicados(AU)

Introduction: The characteristics of the adverse drug reactions in the elderly are not clearly identified in Cuba.Objective: To determine adverse drug reactions in the elderly reported to the Cuban Pharmacovigilance System.Methods: Descriptive cross-sectional research work. The universe of study was 26 489 adverse reaction reports to drugs from the Basic Drug Group in 60 years-old and over patients, registered in the national pharmacovigilance database from 2003 to 2013. The studied variables were age, sex, kind of adverse reactions, affected organ system, drug, pharmacological group, imputability, severity, frequency, notifying person and health care level. The summary measures were absolute frequencies, percentages and rates.Results: The adverse drug reactions reporting rate was 1 479.4 x 105 elders. Women (1 885.1 × 105) and the 60-69 y old group (1 559.8 × 10 5) were the most affected ones. The predominating adverse drug reactions were skin rash (148.3 × 105), slight (741.1 × 105), probable (1 097.5 × 105) and frequent (828.8 × 10 5) caused mainly by antibacterial drugs (341.5 × 105) and captopril (167.7 × 105). Adverse reactions were mostly reported physicians (68.8 prcent) at the primary health care (85.8 percent).Conclusions: The adverse drug reactions reported in the elderly represent a small proportion of all undesirable effects notified to the Cuban pharmacovigilance System from 2003 to 2013; the main feature of adverse reactions were similar to that reported at international level, except for the affected age group, the kind of undesirable effect and the involved drugs(AU)