Multimorbidity patterns and trajectories in young and middle-aged adults: a large-scale population-based cohort study.

Introduction: The presence of multiple chronic conditions, also referred to as multimorbidity, is a common finding in adults. Epidemiologic research can help identify groups of individuals with similar clinical profiles who could benefit from similar interventions. Many cross-sectional studies have revealed the existence of different multimorbidity patterns. Most of these studies were focused on the older population. However, multimorbidity patterns begin to form at a young age and can evolve over time following distinct multimorbidity trajectories with different impact on health. In this study, we aimed to identify multimorbidity patterns and trajectories in adults 18-65 years old. Methods: We conducted a retrospective longitudinal epidemiologic study in the EpiChron Cohort, which includes all inhabitants of Aragón (Spain) registered as users of the Spanish National Health System, linking, at the patient level, information from electronic health records from both primary and specialised care. We included all 293,923 patients 18-65 years old with multimorbidity in 2011. We used cluster analysis at baseline (2011) and in 2015 and 2019 to identify multimorbidity patterns at four and eight years of follow-up, and we then created alluvial plots to visualise multimorbidity trajectories. We performed age- and sex-adjusted logistic regression analysis to study the association of each pattern with four- and eight-year mortality. Results: We identified three multimorbidity patterns at baseline, named dyslipidaemia & endocrine-metabolic, hypertension & obesity, and unspecific. The hypertension & obesity pattern, found in one out of every four patients was associated with a higher likelihood of four- and eight-year mortality (age- and sex-adjusted odds ratio 1.11 and 1.16, respectively) compared to the unspecific pattern. Baseline patterns evolved into different patterns during the follow-up. Discussion: Well-known preventable cardiovascular risk factors were key elements in most patterns, highlighting the role of hypertension and obesity as risk factors for higher mortality. Two out of every three patients had a cardiovascular profile with chronic conditions like diabetes and obesity that are linked to low-grade systemic chronic inflammation. More studies are encouraged to better characterise the relatively large portion of the population with an unspecific disease pattern and to help design and implement effective and comprehensive strategies towards healthier ageing.

Genetic polymorphisms of CYP2C19 in ecuadorian population: An interethnic approach.

Introduction: CYP2C19 is a highly polymorphic gene responsible for metabolizing commonly used drugs. CYP2C19*2,*3 (loss of activity alleles) and *17 (increased activity allele) are the principal alleles included in clinical guidelines, however their prevalence varies among different ethnicities. Ecuadorian population is formed by Mestizos, Afrodescendants and Native Americans and frequency of CYP2C19 alleles could be different among them. The objective of this study was to establish the frequency of these variants in the different populations of Ecuador and to compare them with other populations. Materials and methods: DNA from 105 Afrodescendants, 75 Native Americans of the Kichwa ethnicity, and 33 Mestizos Ecuadorians was analyzed by nested-PCR to identify CYP2C19*17 carriers. CYP2C19*2 allele was analyzed in DNA from 78 Afrodescendants, 29 Native Americans of the Kichwa, and 16 Mestizos by TaqMan Allelic Discrimination Assay. CYP2C19*3 was analyzed in 33 Afrodescendants by nested-PCR. Results: The global frequencies of the alternate alleles were 14.22% (CYP2C19*2) and 2.10% (CYP2C19*17). No differences (p > 0.05) were observed among the subgroups. No CYP2C19*3 carrier was identified. CYP2C19*2 frequencies in Ecuador were similar to the ones reported in Europe, Africa and Middle East countries and to some American populations. Low CYP2C19*17 frequencies, like the ones in our population, were also observed in East and South Asia and in Native American groups. Discussion: Absence of differences in the ethnic groups in Ecuador for CYP2C19*2 and *17 could be due to either a bias in sample selection (ethnic group was assed by self-identification) or to a high interethnic admixture in the Ecuadorian population that would had diluted genetic differences. In addition, CYP2C19*2, *3, and *17 alleles frequencies in our study suggest that Ecuadorians ancestry is mostly of Native American origin.

[Deshabituación al consumo de tabaco desde las oficinas de farmacia mediante planes multidisciplinares.] / Smoking cessation from pharmacies through multidisciplinary plans.

OBJECTIVE: Tobacco is the most consumed drug in the world and each year it causes the death of more than eight million people. The pharmacist is the healthcare professional most accessible to smokers, therefore they are essential in the treatment and prevention of smoking. The study´s aim was to implement a multidisciplinary anti-smoking program in a pharmacy and evaluate the effect of pharmaceutical care on smoking cessation. METHODS: The study was carried out in two army pharmacies located in Spain and Lebanon in which a smoking cessation plan was developed in 2020 and 2021. As the requirements for participants selection, all those patients in the area of influence of pharmacies that agreed to participate in the program were accepted, with a sample size of thirty-eight people. The patients underwent an addiction, motivation and smoking habit test, and a descriptive analysis of the data provided was carried out, using the chi-square test for the comparison of values. Only those with a probability value less than 0.05 are considered statistically significant. RESULTS: The multidisciplinary work allowed treatment with prescription drugs. The study shows that 63% of patients managed to quit smoking. CONCLUSIONS: Pharmacies can implement and lead smoking cessation programs that facilitate cessation and adherence to treatments. The classification of patients according to their history of smoking is key to carrying out an adequate and personalized treatment.

OBJETIVO: El tabaco es la droga más consumida en el mundo y cada año provoca la muerte de más de ocho millones de personas. El farmacéutico es el profesional de la salud más accesible a los fumadores, por lo que es fundamental en el tratamiento y prevención del tabaquismo. El objetivo de este estudio fue implantar un programa antitabaco multidisciplinar en una oficina de farmacia y evaluar el efecto de la atención farmacéutica en la cesación del consumo de tabaco. METODOS: El estudio se realizó en dos farmacias del Ejército de Tierra situadas en España y Líbano en las que se desarrolló un plan de deshabituación al consumo de tabaco durante los años 2020 y 2021. Como criterio de selección de participantes se aceptó a todos aquellos pacientes del área de influencia de las farmacias que aceptasen participar en el programa, siendo el tamaño muestral de treinta y ocho personas. Los pacientes se sometieron a test de adicción, motivación y hábito de consumo de tabaco, y se realizó un análisis descriptivo de los datos aportados, usando el test de chi-cuadrado para la comparación de valores, considerándose estadísticamente significativos solo aquellos con un valor de probabilidad inferior a 0,05. RESULTADOS: El trabajo multidisciplinar permitió el tratamiento con medicamentos mediante prescripción médica. El 63% de los pacientes del estudio consiguieron dejar de fumar. CONCLUSIONES: Las oficinas de farmacia pueden implantar y liderar programas de deshabituación al consumo de tabaco que faciliten la cesación y la adhesión a los tratamientos. La clasificación de los pacientes según su historial de tabaquismo resulta clave para realizar un tratamiento adecuado y personalizado.

The Efficacy and Safety of Biologic Drugs in the Treatment of Moderate-Severe Crohn's Disease: A Systematic Review.

Conventional therapy is the most commonly used treatment for Crohn's disease (CD), but it does not always achieve disease control, which is why the use of biologic drugs is increasing. The aim of this study was to analyze the efficacy and safety of biologic drugs in adult patients diagnosed with moderate-severe CD. An intensive search was performed in PubMed, Web of Science and Medline to collect phase 2 or 3 clinical trials published between 2018 and 2023 that were randomized, placebo-controlled and double-blind trials analyzing the efficacy and safety of biologic drugs in adult patients diagnosed with CD. This systematic review was conducted according to the PRISMA statement. Thirteen clinical trials evaluating eight biologic drugs were included. Upadacitinib, vedolizumab, adalimumab, guselkumab, mirikizumab, ustekinumab and risankizumab showed statistically significant efficacy across different clinical, endoscopic, histological, genetic, biomarker or quality-of-life parameters. However, PF-00547659 only showed statistically significant results for the CDAI-70 at week 12. In terms of safety, the incidence and severity of adverse effects were analyzed, with all drugs being well tolerated and presenting a good safety profile since most adverse effects were mild. Biologic drugs can be considered an effective and safe option for the treatment of moderate-severe CD in adult patients with an inadequate response or intolerance to conventional therapy.

Reports of Symptoms Associated with Supraventricular Arrhythmias as a Serious Adverse Drug Reaction in the Spanish Pharmacovigilance Database.

This study aimed to determine the type of drugs reported as suspected of causing severe supraventricular arrhythmias from the Spanish Human Pharmacovigilance System database. A total of 1053 reports were analysed, of which 526 (50%) were on men and 516 (49%) were on women. The most affected age group was the over-65s, with 593 reports (56%). Of the 1613 drugs, those belonging to the cardiovascular system (ATC Group C) were the most numerous (414 reports, 26%), with digoxin being the most frequent drug (49 reports, 12%). Other common groups were antiinfectives for systemic use (ATC Group J; 306 reports, 19%), antineoplastic and immunomodulating agents (ATC Group L; 198 reports, 12%), and nervous system drugs (ATC Group N; 185 reports, 11%). The most common supraventricular arrhythmia was atrial fibrillation (561 reports, 51%). Regarding outcomes, 730 (66%) patients recovered, 76 (7%) did not recover, 25 (3%) recovered but with sequelae, and 23 (2%) resulted in death. This study revealed that certain drugs have reported to be associated more frequently to supraventricular arrhythmias as serious adverse reactions, especially in the older population. Proper clinical management and effective strategies to ensure medication appropriateness should always be considered to improve patient safety when prescribing drugs.

Drug Repurposing in Oncology: A Systematic Review of Randomized Controlled Clinical Trials.

Quality pharmacological treatment can improve survival in many types of cancer. Drug repurposing offers advantages in comparison with traditional drug development procedures, reducing time and risk. This systematic review identified the most recent randomized controlled clinical trials that focus on drug repurposing in oncology. We found that only a few clinical trials were placebo-controlled or standard-of-care-alone-controlled. Metformin has been studied for potential use in various types of cancer, including prostate, lung, and pancreatic cancer. Other studies assessed the possible use of the antiparasitic agent mebendazole in colorectal cancer and of propranolol in multiple myeloma or, when combined with etodolac, in breast cancer. We were able to identify trials that study the potential use of known antineoplastics in other non-oncological conditions, such as imatinib for severe coronavirus disease in 2019 or a study protocol aiming to assess the possible repurposing of leuprolide for Alzheimer's disease. Major limitations of these clinical trials were the small sample size, the high clinical heterogeneity of the participants regarding the stage of the neoplastic disease, and the lack of accounting for multimorbidity and other baseline clinical characteristics. Drug repurposing possibilities in oncology must be carefully examined with well-designed trials, considering factors that could influence prognosis.

Prescribed Drugs and Self-Directed Violence: A Descriptive Study in the Spanish Pharmacovigilance Database.

Self-inflicted violence is a major and growing public health problem and its prediction and prevention is challenging for healthcare systems worldwide. Our aim was to identify prescribed drugs associated with self-directed violent behaviors in Spain. A descriptive, longitudinal and retrospective study of spontaneous reports of adverse drug reactions corresponding to self-directed violence was recorded in the Spanish Pharmacovigilance Database (FEDRA®) from 1984 to 31 March 2021. A total of 710 cases were reported in the study period. The mean age was 45.52 years (range 1-94). There were no gender differences except in children, where most reports were of male children. The main therapeutic groups that were involved included drugs for the nervous system (64.5%) and anti-infectives for systemic use (13.2%). The most commonly reported drugs were varenicline, fluoxetine, lorazepam, escitalopram, venlafaxine, veralipride, pregabalin, roflumilast and bupropion. There were reports of montelukast, hydroxychloroquine, isotretinoin, methylphenidate, infliximab, natalizumab, ribavirin and efavirenz, which were less known to be involved in self-directed violence. This study shows that self-directed violence is a rare adverse drug reaction, and can be related to the use of some medicines. It is important for healthcare professionals to consider this risk in their clinical praxis, implementing person-centred approaches. Further studies are needed, considering comorbidities and potential interactions.

Musculoeskeletal injuries and illnesses in the Spanish team the month prior to the WMTRC 2022

Introduction: The recent professionalization of trail running has focussed the interest in this sport. The aim is to describe the epidemiology of musculoskeletal injuries and illnesses among professional Spanish trail runners team during the month of training prior to the World Mountain and Trail Running Championship 2022.Material and Methods33 professional athletes from Spanish National Team that competed in the World Championship participated in the study. They completed a pre-participation health questionnaire based on the specific questionnaire "Oslo Sport Trauma Research Center - Health 2″.Results55% of the athletes suffered a musculoeskeletal injury or health problem during the last month. 12% had to modify their performance in a moderate or severe way. By anatomic location the foot was the most affected with 33% of the cases, followed by the ankle in 25%. Among the diagnoses, chronic overuse musculoskeletal injuries represented 80% with tendinopathy being the most frequent. Regarding the symptons 53% affected upper respiratory tract and 23% gastrointestinal problems.ConclusionsThere is a high risk for the professional trail runners who carry out a continued practice of trail running to suffer an injury or health problem, although most of such injuries or health problems have little impact on their sports performance. The foot and the upper respiratory system are the most affected. (AU)