Comparación del efecto de omeprazol como monoterapia y su combinación con bicarbonato de sodio en el tratamiento de la pirosis moderada a severa: ensayo clínico controlado, aleatorizado y doble ciego / Comparison of the effect of omeprazole monotherapy and its combination with sodium bicarbonate in the treatment of moderate to severe heartburn: a double-blind, randomized controlled clinical trial

Heartburn occurs in 75% of patients with digestive discomfort of any origin and is one of the main symptoms of gastroesophageal reflux disease. Treatment focuses on lifestyle modification and symptomatology management with various drugs; when heartburn is moderate to severe, a proton pump inhibitor is more suitable. Omeprazole (OMZ) combined with sodium bicarbonate (BC) has demonstrated significant and sustained suppression of acid secretion. The objective was to compare the effect of sequential OMZ/BC therapy compared to OMZ monotherapy for the improvement of heartburn in Mexican individuals. The study was a double-blind, randomized, controlled, multicenter clinical study including 277 subjects with moderate to severe heartburn. Patients received 7 days of OMZ/BC and 7 days of OMZ (OMZ/BC7) or 14 days of OMZ (OMZ14). The primary endpoint was defined as the change in the number of days a week that the patient has heartburn, it was evaluated at 14 days. Both treatments reduced time (days) with heartburn by less than 4 days (OMZ14 3.9 vs. 4.2 days OMZ/BC7), as well as duration, number of events and intensity of heartburn. The treatments improved the quality of life, and the control of the symptoms. The proportion of adverse events was lower with OMZ/BC. The non-inferiority of OMZ/BC7 with respect to OMZ14 was verified.

La pirosis se presenta en el 75% de los pacientes con molestias digestivas de cualquier origen y es uno de los principales síntomas de la enfermedad por reflujo gastroesofágico. El tratamiento se enfoca en la modificación del estilo de vida y el manejo de la sintomatología con diversos fármacos; cuando la pirosis es moderada a severa, un inhibidor de la bomba de protones es más adecuado. El omeprazol (OMZ) combinado con bicarbonato de sodio (BC) ha demostrado supresión significativa y sostenida de la secreción ácida. El objetivo fue comparar el efecto de la terapia secuencial de OMZ/BC en comparación con el tratamiento continuo de OMZ para la mejoría de la pirosis en individuos mexicanos. Estudio clínico multicéntrico, doble ciego, controlado, aleatorizado que incluyó 277 sujetos con pirosis moderada a severa. Los pacientes recibieron 7 días de OMZ/BC y 7 días de OMZ (OMZ/BC7) o 14 días de OMZ (OMZ14). La variable primaria fue definida como el cambio del número de días a la semana que el paciente presenta pirosis, se evaluó a los 14 días. Ambos tratamientos redujeron los días con pirosis en menos 4 días (OMZ14 3,9 vs. 4,2 días OMZ/BC7), así como la duración, el número de eventos e intensidad de la pirosis. Los tratamientos mejoraron los indicadores de calidad de vida, y el control del padecimiento. La proporción de eventos adversos fue menor con OMZ/BC. Se comprobó la no-inferioridad de OMZ/BC7 respecto OMZ14.

Reversal of itraconazole resistance in Sporothrix brasiliensis and Sporothrix schenckii by nonsteroidal anti-inflammatory drugs / Reversión de la resistencia a itraconazol en Sporothrix brasiliensis y Sporothrix schenckii con antiinflamatorios no esteroideos

Background: The emergence of resistant isolates has brought challenges to the treatment of sporotrichosis, prompting the search for new therapeutic strategies. Previous studies reported that nonsteroidal anti-inflammatory drugs (NSAIDs) show in vitro activity against several pathogenic fungi, including species of Candida, Cryptococcus, and Trichosporon.AimsThis study aimed to investigate the in vitro efficacy of three NSAIDs (acetylsalicylic acid, diclofenac sodium, and ibuprofen), alone and in combination with itraconazole, against eleven clinical isolates of Sporothrix brasiliensis and Sporothrix schenckii.MethodsMinimal inhibitory concentrations were determined by the broth microdilution method. Drug interactions and the fractional inhibitory concentration index of NSAIDs and itraconazole were assessed by the checkerboard method.ResultsWhen used alone, ibuprofen was the most active NSAID, followed by acetylsalicylic acid. Combinations of NSAIDs with itraconazole showed synergistic antifungal activity against nine isolates. It was also found that itraconazole combined with acetylsalicylic acid, diclofenac sodium, or ibuprofen, led to resistance reversal in two, three, and five of the six drug-resistant isolates, respectively. (AU)

Antecedentes: La aparición de cepas resistentes a los antifúngicos convencionales ha supuesto un nuevo desafío en el tratamiento de la esporotricosis y ha impulsado la búsqueda de nuevas estrategias terapéuticas. Estudios anteriores han descrito que los antiinflamatorios no esteroideos (AINE) tienen actividad in vitro contra diversos hongos patógenos, incluidas especies de Candida, Cryptococcus y Trichosporon.ObjetivosEste estudio tuvo como objetivo investigar la eficacia in vitro de tres AINE (ácido acetilsalicílico, diclofenaco sódico e ibuprofeno), aisladamente y en combinación con itraconazol, contra once aislamientos clínicos de Sporothrix brasiliensis y Sporothrix schenckii.MétodosLas concentraciones inhibitorias mínimas fueron determinadas según el método de microdilución en caldo. Las interacciones farmacológicas y el índice de concentración inhibitoria fraccional de los AINE y de itraconazol fueran evaluadas mediante el método del tablero de ajedrez.ResultadosComo molécula única, el ibuprofeno fue el AINE más activo, seguido del ácido acetilsalicílico. Las combinaciones de los AINE con itraconazol exhibieron actividades antifúngicas sinérgicas frente a nueve aislamientos. También se observó que la combinación de itraconazol con ácido acetilsalicílico, diclofenaco sódico o ibuprofeno provocó la reversión de la resistencia en dos, tres y cinco de los seis aislamientos resistentes a los fármacos, respectivamente. (AU)

Reversal of itraconazole resistance in Sporothrix brasiliensis and Sporothrix schenckii by nonsteroidal anti-inflammatory drugs.

BACKGROUND: The emergence of resistant isolates has brought challenges to the treatment of sporotrichosis, prompting the search for new therapeutic strategies. Previous studies reported that nonsteroidal anti-inflammatory drugs (NSAIDs) show in vitro activity against several pathogenic fungi, including species of Candida, Cryptococcus, and Trichosporon. AIMS: This study aimed to investigate the in vitro efficacy of three NSAIDs (acetylsalicylic acid, diclofenac sodium, and ibuprofen), alone and in combination with itraconazole, against eleven clinical isolates of Sporothrix brasiliensis and Sporothrix schenckii. METHODS: Minimal inhibitory concentrations were determined by the broth microdilution method. Drug interactions and the fractional inhibitory concentration index of NSAIDs and itraconazole were assessed by the checkerboard method. RESULTS: When used alone, ibuprofen was the most active NSAID, followed by acetylsalicylic acid. Combinations of NSAIDs with itraconazole showed synergistic antifungal activity against nine isolates. It was also found that itraconazole combined with acetylsalicylic acid, diclofenac sodium, or ibuprofen, led to resistance reversal in two, three, and five of the six drug-resistant isolates, respectively. CONCLUSIONS: The results indicate that the combination of itraconazole and the evaluated NSAIDs are a promising strategy for the treatment of sporotrichosis.

COVID-19: Some unresolved issues / COVID-19: Algunos asuntos no resueltos

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia. (AU)

Cuando han transcurrido ya dos años de la pandemia de COVID-19 persisten muchas incertidumbres sobre el agente causal, la enfermedad y su futuro. El presente documento contiene la reflexión del grupo de trabajo sobre COVID-19 del Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) en relación a algunas preguntas que nos parecen sin resolver. El documento incluye reflexiones sobre el origen del virus, la indicación actual de pruebas diagnósticas, el valor de los “scores” de gravedad en el comienzo de la enfermedad y el riesgo añadido que supone la hipertensión o la demencia. Se discute también, la posibilidad de deducir del examen de la estructura del genoma viral completo el comportamiento viral, el futuro de algunas asociaciones de fármacos y el papel actual de recursos terapéuticos como los corticoides o la oxigenación extracorpórea (ECMO). Revisamos la escasa información existente sobre la realidad de la COVID-19 en África, las incertidumbres sobre el futuro de la pandemia y la situación de las vacunas y los datos e incertidumbres sobre las secuelas pulmonares a largo plazo de los que padecieron neumonía grave. (AU)

Seasonal malaria chemoprevention in an area of extended seasonal transmission in Ashanti, Ghana: an individually randomised clinical trial.

OBJECTIVE: To investigate the effectiveness of seasonal malaria chemoprevention (SMC) and community case management with long-acting artemisinin-based combination therapies (ACTs) for the control of malaria in areas of extended seasonal malaria transmission. METHOD: Individually randomised, placebo-controlled trial in the Ashanti Region of Ghana. A total of 2400 children aged 3-59 months received either: (i) a short-acting ACT for case management of malaria (artemether-lumefantrine, AL) plus placebo SMC, or (ii) a long-acting ACT (dihydroartemisinin-piperaquine, DP) for case management plus placebo SMC or (iii) AL for case management plus active SMC with sulphadoxine-pyrimethamine and amodiaquine. SMC or placebo was delivered on five occasions during the rainy season. Malaria cases were managed by community health workers, who used rapid diagnostic tests to confirm infection prior to treatment. RESULTS: The incidence of malaria was lower in children given SMC during the rainy season. Compared to those given placebo SMC and AL for case management, the adjusted hazard ratio (aHR) was 0.62 (95% CI: 0.41, 0.93), P = 0.020 by intention to treat and 0.53 (95% CI: 0.29, 0.95), P = 0.033 among children given five SMC courses. There were no major differences between groups given different ACTs for case management (aHR DP vs. AL 1.18 (95% CI 0.83, 1.67), P = 0.356). CONCLUSION: SMC may have an important public health impact in areas with a longer transmission season, but further optimisation of SMC schedules is needed to maximise its impact in such settings.

Valoración del tratamiento para el control de la hipertensión arterial en una comunidad urbana / Assessment of the treatment for the control of high blood pressure in an urban community

Se efectuó un estudio descriptivo y transversal de 117 pacientes con hipertensión arterial, pertenecientes al Policlínico Universitario 30 de Noviembre de Santiago de Cuba, en el período comprendido de octubre a diciembre de 2007, con vista a valorar cómo se administraba la terapéutica antihipertensiva. La enfermedad prevalecía en ancianos, sobre todo del sexo masculino. Más de un tercio de los pacientes con tratamiento regular eran fumadores y aproximadamente una quinta parte consumían bebidas alcohólicas. En la serie, un elevado número de sus integrantes combinaban los medicamentos hipotensores con otros fármacos

A descriptive and cross-sectional study of 117 patients with high blood pressure that belong to the University Polyclinic 30 de Noviembre was carried out, in the period between October to December 2007, in order to evaluate the control of hypertensive therapy. The disease prevailed in elderly, male gender fundamentally. More than one third of the patients with standard treatment were smokers and approximately one fifth of them consumed alcohol. In the case series, a high number of its participants mixed these hypotensive drugs with other drugs

Valoración del tratamiento para el control de la hipertensión arterial en una comunidad urbana / Assessment of the treatment for the control of high blood pressure in an urban community

Se efectuó un estudio descriptivo y transversal de 117 pacientes con hipertensión arterial, pertenecientes al Policlínico Universitario 30 de Noviembre de Santiago de Cuba, en el período comprendido de octubre a diciembre de 2007, con vista a valorar cómo se administraba la terapéutica antihipertensiva. La enfermedad prevalecía en ancianos, sobre todo del sexo masculino. Más de un tercio de los pacientes con tratamiento regular eran fumadores y aproximadamente una quinta parte consumían bebidas alcohólicas. En la serie, un elevado número de sus integrantes combinaban los medicamentos hipotensores con otros fármacos(AU)

A descriptive and cross-sectional study of 117 patients with high blood pressure that belong to the University Polyclinic 30 de Noviembre was carried out, in the period between October to December 2007, in order to evaluate the control of hypertensive therapy. The disease prevailed in elderly, male gender fundamentally. More than one third of the patients with standard treatment were smokers and approximately one fifth of them consumed alcohol. In the case series, a high number of its participants mixed these hypotensive drugs with other drugs(AU)