CYP2D6 and CYP2C19 Genes Associated with Tricontinental and Latin American Ancestry of Pe-ruvians.

Precision medicine seeks to individualize the dose from the beginning of phar-macological therapy based on the characteristics of each patient, genes involved in the metabolic phenotype, ethnicity or miscegenation, with the purpose to minimize adverse effects and optimize drug efficacy. The objective was to re-view studies that describe the association of the CYP2D6 and CYP2C19 genes with the tricontinental and Latin American ancestry of Peruvians. A biblio-graphic search was carried out in PubMed/Medline and SciELO, with various descriptors in Spanish and English. The results of this review confirm that the ethnic origin of Peruvians is triconti-nental due to European (mainly Spanish), African and Asian migration, in addi-tion to Latin American migration, being 60.2% mixed, 25.8% Amerindian, 5.9% white, 3.6% African descent, 1.2% Chinese and Japanese descent, and 3.3% unspecified. Studies on CYP2C19*3, CYP2D6*2, *3 and *6 have been reported in Peruvians, and the frequency is similar to that studied in Ecuadori-ans and Colombians. The CYP2C19*3, CYP2D6*3, and CYP2D6*6 alleles found in Peruvians are common in Europeans, Africans, and Asians; while CYP2D6*4 in Africans and CYP2D6*2 related to Asians. In some studies, the ethnic/gene association has not been demonstrated; while others have shown a significant association, which is why further investigation is warranted. It is concluded that the studies on CYP2D6 and CYP2C19 genes associated with the tricontinental and Latin American ancestry of Peruvians are little, and ac-cording to what has been investigated, the CYP2C19*3, CYP2D6*2, *3, *4 and *6 alleles have more related to their ancestry.

Estudio del índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida / Study of the level/dose index of phenytoin in volunteer epileptic patients from Mérida

INTRODUCCIÓN La fenitoína es usada con mucha frecuencia en nuestro medio, por lo que se requiere hacer estudios de monitorización terapéutica, que contribuya a minimizar los efectos adversos y optimizar la terapia farmacológica. En ese contexto, nuestro objetivo ha sido determinar el índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida. MÉTODOS Se realizó un estudio descriptivo, observacional y por reclutamiento consecutivo concurrente, conformado por 30 pacientes voluntarios con diagnóstico de epilepsia. Las muestras de suero se obtuvieron en niveles mínimos de pacientes que estaban en tratamiento con fenitoína durante 1 mes. Los niveles del fármaco se cuantificaron por el método de Inmunoensayo de enzima donante clonada en el equipo Indiko Thermo Scientific. RESULTADOS El índice nivel/dosis fue de 1,4 y 1,6, la concentración plasmática de 4,8mg/l y 8,0mg/l, la capacidad metabólica de 388,4 y 462,9mg/día, respectivamente en mujeres y hombres. Mientras que el nivel de la concentración plasmática en el estado estacionario fue de 6,5mg/l y 5,5mg/l, la dosis de carga máxima de 237,3mg y de 395,6mg, respectivamente en mujeres y hombres con epilepsia de la ciudad de Mérida. CONCLUSIONES Nuestros resultados sugieren que se debe individualizar la dosis en base al índice nivel/dosis de cada paciente, ya que no se puede extrapolar para todos los pacientes con epilepsia, debido a diversos factores como al fenotipo metabólico y al uso de fármacos inductores e inhibidores enzimáticos.

INTRODUCTION Phenytoin is used very frequently in our environment, so it is necessary to do studies of therapeutic monitoring, which helps to minimize adverse drug reaction and optimize pharmacological therapy. In this context, our objective was to determine the level/dose index of phenytoin in volunteer epileptic patients from Mérida. METHODS A descriptive, observational and consecutive concurrent recruitment study was carried out, consisting of 30 volunteer patients with a diagnosis of epilepsy. The serum samples were obtained in minimum levels from patients who were in treatment with phenytoin for 1 month. The levels of the drug were quantified by the method of donor enzyme immunoassay cloned in the Indiko Thermo Scientific equipment. RESULTS The level/dose index was 1,4 and 1,6, the plasma concentration of 4,8mg/l and 8,0mg/l, the metabolic capacity of 388,4 and 462,9mg/day, respectively in women and men. While the level of plasma concentration at steady state was 6,5mg/l and 5,5mg/l, the maximum loading dose of 237,3mg and 395,6mg, respectively in women and men with epilepsy of the city of Mérida. CONCLUSIONS Our results suggest that the dose should be individualized based on the level/dose index of each patient, since it can not be extrapolated for all patients with epilepsy, due to various factors such as the metabolic phenotype and the use of enzyme-inducing drugs and inhibitors.

Quality of an ambulatory monitoring technique for diagnosing obstructive sleep apnea under conditions of limited resources.

OBJECTIVES: To: 1) evaluate the quality of an ambulatory monitoring technique for diagnosing Obstructive Sleep Apnea Syndrome (OSAS) while patients move through the city; and 2) identify factors that lead to data loss. METHODS: Clinical histories were reviewed and ambulatory portable monitorings of adults with high pretest probability for OSAS were included, the signals monitored were pulse oximetry, heart rate, nasal pressure, snoring, chest band and body position. The equipment was connected from 14:00-20:00 h and then patients moved through the city turning it off and on at home. Results were analyzed visually to record all the minutes lost. A good-quality study was defined as recording time 240 min and signal loss <20%. A cost/benefit analysis was performed using Golpe et al.'s methodology. RESULTS: A total of 70 recordings were analyzed. Most subjects were obese men with severe OSAS. Signal quality was determined to be good with a median signal loss of 4.9 min (0-405) that represented 1% (0-99) of total recording time. The signal lost most often was pulse oximetry at 1.8 min (0-403, p=0.0001). Of the 70 studies performed, 57 (81%) met the definition of good quality, while 13 (19%) had to be repeated. Men lost the pulse oximetry signal more often than women. This technique could represent savings of 65-75%. CONCLUSIONS: Placing a portable OSAS monitor during the day while patients move around the city turning it on and off at home does not affect the quality of the study results obtained and is a cost-effective method.

Aplicación de las escalas Epworth, Berlín y SACS en el diagnóstico del Síndrome de Apnea Obstructiva del Sueño en el personal de salud del Servicio de Neumología del Centro Médico Naval 2014 / Application of Epworth, Berlin and SACS scales in the diagnosis Obstructive Sleep Apnea Syndrome in the health personnel of the Pneumology Service at the Naval Medical Center 2014

Objetivo: Determinar la prevalencia de Síndrome de Apnea Obstructiva del Sueño aplicando las escalas de Epworth, Berlín y SACS, en el profesional de salud del Servicio de Neumología del Centro Médico Naval 2014. Metodología: Estudio observacional, descriptivo, transversal. Se estudió a 30 personales de salud que laboran en el Servicio de Neumología del Centro Médico Naval "Cirujano Mayor Santiago Távara", durante el período Julio 2014. Para describir variables cualitativas se usó frecuencias absolutas y relativas, mientras que para describir las variables cuantitativas se estimaron medidas de dispersión y tendencia central. Resultados: La edad promedio del personal de salud fue de 49±10.7 años, comprendida entre 28 a 66 años, en su mayoría fueron: Mujeres (80 por ciento), procedentes de Lima Cercado (33.3 por ciento), de ocupación técnica enfermería (43.3 por ciento) y casados/as (26.7 por ciento). En las evaluaciones del diagnóstico de SAOS se observa según la escala de Berlín que el 30 por ciento presentó alto riesgo, mediante la escala de Epworth el 20 por ciento del personal presentó alta probabilidad para quedarse dormido y los resultados de la escala SACS evidenciaron que solo el 10 por ciento del personal de salud presentó probabilidad intermedia de padecer SAOS. Las características generales del personal de salud como la edad, sexo, lugar de nacimiento, profesión y estado civil no presentaron asociación significativa (p>0.005) con los niveles de riesgo de la escala de Berlín en el diagnóstico del Síndrome de Apnea Obstructiva del Sueño. Respecto a la escala de Berlín se observó que 20 de los personales de salud estudiados refirieron que "roncan", 10 lo hacen con una respiración fuerte, 11 lo hacen con una frecuencia de 3 a 4 veces por semana, 12 reconocen molestar a otras personas con sus ronquidos y en 2 de ellos han notado que hacen pausas en la respiración mientras duerme entre 3 a 4 veces por semana. De acuerdo a la escala de Epworth, 10 de los...

Objective: To determine the prevalence of Obstructive Sleep Apnea Syndrome using Epworth, Berlin and SACS scales in the health professional Pneumology Department of Naval Medical Center 2014. Methodology: Observational, descriptive and cross-sectional study. The sample was 30 health professional working in Pneumology Department of "Cirujano Mayor Santiago Távara" Naval Medical Center, during the period July 2014. To describe qualitative variables absolute and relative frequencies were used, whereas to describe quantitative variables was estimated measures of central tendency and dispersion. Results: The average age of health professional was 49±10.7 years, ranging from 28 to 66 years old; most of them were women (80 per cent), from Lima Cercado (33.3 per cent), technical nurses occupation (43.3 per cent) and married (26.7 per cent). Evaluations of diagnosis of OSA is observed according to Berlin scale that 30 per cent had a high risk, EpW0l1h scale 20 per cent of staff presented high probability to fall asleep and SACS-scale showed that only 10 per cent of health professional presented intermediate probability of having OSA. The general characteristics of health professional such as age, sex, place of birth, occupation and marital status showed no significant association (p>0.005) with the risk levels of the Berlin scale in the diagnosis of obstructive sleep apnea syndrome. Regarding the Berlin scale was observed that 20 of the studied health professional reported "snore", 10 do so with a heavy breathing, 11 do so with a frequency of 3-4 times per week, 12 recognized disturb others with their snoring and 2 of them have noted pauses in breathing during sleep between 3-4 times a week. According to Epworth scale, 10 health professional in study rarely fall asleep while read sitting, 14 of them rarely fall asleep watching television, 7 rarely do sleep in public places and 9 rarely do so as passenger in a car or bus traveling for more than an hour. In relation to...

Efecto de la terapia láser de baja potencia sobre el hueso alveolar dañado / The low level laser therapy effect on alveolar bone damaged

La terapia con láser de baja potencia ha demostrado tener propiedades analgésicas antiinflamatorias, bioestimulantes y promotoras de la respuesta tisular al daño. El propósito de este estudio fue determinar el efecto que el láser de baja potencia tiene sobre el hueso alveolar dañado. Se utilizaros 13 ratas Sprage Dawley, en las cuales se realizó una lesión estandarizada del hueso alveolar, posterior a lo cual una muestra aleatoria de 7 ratas fue sometida a un protocolo de irradiación de 6 J/cm2, tres veces por semana durante cuatro semanas. Las muestras obtenidas del sitio lesionado en ratas expuestas y no expuestas a la terapia fueron procesadas para hematoxilina eosina, contabilizándose el número de osteonas al microscopio óptico con aumento de 40x. Los resultados muestran un aumento en el número de osteonas en el grupo irradiado, diferencia que resultó estadísticamente significativa (p<0,01), con una alta fuerza de asociación estadística (O.R=5,6 ). Estos resultados sugieren que la terapia láser de baja potencia favorece la respuesta del hueso alveolar dañado.

The Low Level Laser Therapy (LLLT) has demostrated to have analgesic, antiinflamatory, bioestimulant and promoters from the tissues responses properties to the damage. The purpose of this study was determinate the Low Level Laser Therapy effect in the damaged alveolar bone. Thirteen Sprage Dawley rats were used. Total number of animals alveolar bones a standarized lesion was made, later an aleatory sample of seven rats was subjected to the irradiation protocol 6 J/cm², three times per week during four weeks. The obtained samples of the injured area, of exposed and not exposed rats to the laser therapy were processed for hematoxilin & eosin, being the osteon number count by optic microscope with increase of 40x. The result show an increase in the osteon number in the irradiated group, this differentiated was statistically significant (p<0.01), whit a high strength of statistical association (OR=5.6). These result suggest that the therapy laser of low power favors the answer of the damaged alveolar bone.