Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database.

BACKGROUND: Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. METHODS: Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009-2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). RESULTS: Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. CONCLUSIONS: Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients.

[Factors determining antibiotic prescription in primary care]. / Determinantes de la prescripción de antibióticos en atención primaria.

INTRODUCTION: To determine patient and physician-related factors associated with variability in antibiotic prescription. MATERIAL AND METHODS: Observational study of the prevalence of antibacterial medication prescription >14 years old. DATA SOURCE: official prescriptions, clinical histories and individual health cards. Patient-related variables were: age, sex, number of medical visits-year, comorbidity, antibacterials dispensed with prescription. Physician-related variables were age, sex, number of patients assigned, place of work and rurality. Variables associated with prescription were studied by estimating the odds ratio (OR) from the fit of the multilevel logistic regression models. RESULTS: The rate of antibiotic prescription-year in the population was 31.4%. Factors associated with prescription were high rate of visits (users with more than 5 annual visits multiply the probability of receiving antibiotics, compared to those who madeno visits: OR=10.8), age (non-linearly, with a greater likelihood in the young and the elderly) and sex, with a higher rate in women (OR=1.5). No association was found between prescription and age and sex of the physician, but an association was found with workload: the higher the physician's workload, the higher the likelihood of antibiotic prescription. CONCLUSIONS: The most important factor associated with the increase in prescription rate was the frequency of visits. In addition, women, the young and the elderly receive more antibiotics. A multi-factor intervention focusing on demand, patients, and physicians should be carried out to reduce prescription rates.

[High exposure to antibiotics in the population and differences by sex and age]. / Alta exposición a antibióticos en la población y sus diferencias por género y edad.

PURPOSE: To determine antibiotic use and its distribution by age and gender, as well as the most prescribed therapeutic group. DESIGN: Observational descriptive with retrospective data. SETTINGS AND PARTICIPANTS: Population from the Lleida (Spain) Health Region receiving antibiotic prescriptions from 2002 to 2007. MEASUREMENTS: Daily Dose Per Inhabitant (DID) was calculated, as well as the number of patients under treatment. The study variables were: age, gender, number of patients under antibiotic treatment and pharmacological group. RESULTS: Mean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and 40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had received antibiotics once a year. The antibiotic consumption prevalence has a "V" shape with higher values among children and old people. There is an annual exposure to antibiotics in 58.8% of the 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic. CONCLUSIONS: We observe a high antibiotic prescription rate among children and older people, the high consumption in childhood being of note. There is also a higher use of antibiotics among women and changing of prescription towards broad spectrum antibiotics.

Impact of rifampicin addition to clarithromycin in Legionella pneumophila pneumonia.

We evaluated the effectiveness and safety of rifampicin addition to clarithromycin in the treatment of Legionnaires' disease. An observational cohort study was conducted on patients assigned to a Legionnaires' disease outbreak. Of 32 patients with confirmed Legionella pneumonia, 11 received clarithromycin monotherapy and 21 received combination therapy of clarithromycin with rifampicin. Both groups had similar baseline characteristics and all patients were cured. Patients who received rifampicin had a 50% longer length of stay (P=0.035) and a trend towards higher bilirubin levels (P=0.053). Length of stay was directly correlated with the duration of rifampicin treatment (P=0.001). Combination therapy of clarithromycin and rifampicin had no additional benefit compared with clarithromycin monotherapy and could prolong the length of stay owing to possible negative drug interactions that could also affect other antibiotics.

[Paraoxonase 1 gene 192 polymorphism, physical activity and lipoprotein in women]. / Polimorfismo 192 del gen de la paraoxonasa 1, actividad física y lipoproteínas de alta densidad en la mujer.

BACKGROUND AND OBJECTIVE: Regular physical activity is associated with an increase in high-density lipoprotein cholesterol (HDL-C), whose antioxidant and protective effect for coronary artery disease is well known. Paraoxonase-1 (PON1) is an enzyme related with the antioxidant activity of HDL. The PON1 gene has several genetic polymorphisms; one of them locates in codon 192, whose alleles Q and R are associated with low and high PON1-activity, respectively. The objective of this study was to determine whether physical activity has different effects on the lipid profile in women depending on the PON1-192 genotype. PATIENTS AND METHOD: Six hundred and fifty-one women from a cross-sectional risk-factor study were included in this retrospective cohort study. We analyzed anthropometrical characteristics, serum lipids and lipoproteins, blood pressure, PON1-192 genotypes and menopause. We used the Minnesota Leisure Time Physical Activity Questionnaire to assess the daily physical activity in the previous year. RESULTS: Women included in the study were classified into three categories by tertiles of daily physical activity. Although no differences in the lipidic parameters were found, we observed an increasing trend in HDL-C concentration and a decreasing trend in log-triglyceride-to-HDL-cholesterol ratio with increasing physical activity in RR homozygous women. In subgroup analyses, we observed that the association of high physical activity and increased HDL-C concentration or decreased log-triglyceride-to-HDL-cholesterol ratio were exclusive for RR homozygous non-menopausal women. CONCLUSIONS: The results of this study suggest that PON1-192 polymorphism could modulate the effect of physical activity on HDL-C concentration and on triglyceride-rich lipoprotein catabolism in non-menopausal women.

Comparative effects of olive oil-based and soyabean oil-based emulsions on infection rate and leucocyte count in critically ill patients receiving parenteral nutrition.

Soyabean oil-based emulsions high in linoleic acid used in parenteral nutrition (PN) could interfere with immune function and may increase the risk of septic complications. Olive oil-based emulsions, high in oleic acid, could have fewer immune effects. We compared the effects of a soyabean oil-based emulsion v. an olive oil-based emulsion on infection rate, appearance of new infection episodes, leucocyte count (peak and evolution), acute-phase proteins, and major health outcomes in intensive care unit (ICU) adult patients receiving PN. The study was designed as an observational, retrospective, single-centre, cohort study in a general ICU. Patients in the SOYA cohort (n 16) received a soyabean oil-based emulsion and patients in the OLIVE cohort (n 23), an olive oil-based emulsion. Both cohorts had similar basal characteristics and received a similar energy load. The SOYA cohort received an oleic acid:linoleic acid ratio of 0.43 and the OLIVE cohort 2.99 (P < 0.001). No differences were observed in infection rate and appearance, acute-phase proteins, and major health outcomes. At the end of PN, blood leucocyte count decreased by 3.25 x 109 cells/l in the SOYA cohort and increased by 4.51 x 109 cells/l in the OLIVE cohort from baseline values (P = 0.036). Peak leucocyte count presented a trend for a higher value in the OLIVE cohort v. the SOYA cohort (18.86 v. 15.28 x 109 cells/l; P = 0.078). The use of an olive oil-based emulsion in PN had no effect on infection, acute-phase proteins, major health outcomes, and presented higher leucocyte count at the end of PN and a trend to higher peak leucocyte count when compared with soyabean oil-based emulsion in ICU patients.

Alta exposición a antibióticos en la población y sus diferencias por género y edad / High exposure to antibiotics in the population and differences by sex and age

Objetivo: Determinar la prevalencia de consumo de antibióticos y su distribución por edad ysexo, así como el grupo terapéutico más prescrito.Diseño: Estudio observacional descriptivo con datos retrospectivos.Emplazamiento: Región Sanitaria de Lleida.Participantes: Personas que reciben prescripción de antibacterianos entre los años 2002 y 2007.Mediciones principales: Se calcula la dosis habitante día (DHD) y los pacientes expuestos atratamiento. Las variables de estudio son: edad, sexo, número de pacientes con tratamientoantibacteriano y grupo farmacológico.Resultados: La prevalencia de pacientes expuestos a tratamiento con antibacterianos en un añoes del 37% con un 33,5% en hombres y un 40,4% en mujeres. La DHD de Lleida durante el año 2007fue de 23,52. Un 56% han recibido antibiótico una sola vez durante el año. La prevalencia deconsumo tiene una forma de V en relación a la edad con cifras superiores en los grupos extremos(niños y ancianos). En el grupo de edad de 0 a 4 años un 58,8% de niños se encuentra expuestoa antibiótico al año. El principio activo más prescrito es la amoxicilina/ácido clavulánico.Conclusiones: Observamos una elevada prescripción de antibióticos con un mayor consumo enlas edades extremas de la vida, siendo llamativa la elevada prevalencia en la infancia, así comoun mayor consumo de antibióticos en mujeres de 5 a 74 años y en hombre mayores de 74 años.También se constata una desviación de las prescripciones hacia moléculas de amplio espectro(AU)

Purpose: To determine antibiotic use and its distribution by age and gender, as well as the mostprescribed therapeutic group.Design: Observational descriptive with retrospective data.Settings and participants: Population from the Lleida (Spain) Health Region receiving antibioticprescriptions from 2002 to 2007.Measurements: Daily Dose Per Inhabitant (DID) was calculated, as well as the number of patientsunder treatment. The study variables were: age, gender, number of patients under antibiotictreatment and pharmacological group.Results: Mean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had receivedantibiotics once a year. The antibiotic consumption prevalence has a ‘‘V’’ shape with highervalues among children and old people. There is an annual exposure to antibiotics in 58.8% ofthe 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic.Conclusions: We observe a high antibiotic prescription rate among children and older people,the high consumption in childhood being of note. There is also a higher use of antibiotics amongwomen and changing of prescription towards broad spectrum antibiotics(AU)

Determinantes de la prescripción de antibióticos en atención primaria / Factors determining antibiotic prescription in primary care

Introducción Determinar los factores del paciente y el médico asociados a la variabilidad en la prescripción de antibióticos. Material y métodos Estudio observacional de prevalencia de las dispensaciones de medicamentos antibacterianos en población mayor de 14 años. Fuente de datos: receta oficial, historia clínica y tarjeta sanitaria individual. Las variables del usuario fueron: edad, sexo, número de consultas al médico durante el año, presencia de comorbilidad, envase antibacteriano dispensado con prescripción, y las variables del médico: edad, sexo, número de usuarios asignados, centro de trabajo y ruralidad. Las variables asociadas a la prescripción se estudiaron mediante la estimación de la odds ratio (OR) a partir del ajuste de modelos de regresión logística multinivel. Resultados La tasa de prescripción de antibióticos durante un año en la población es de un 31,4%. Los factores asociados a la prescripción fueron la mayor frecuentación (usuarios con más de 5 visitas-año multiplican la probabilidad de recibir antibiótico respecto los no visitados: OR=10,8), la edad con más prescripción en jóvenes y mayores y el sexo con más prescripciones en mujeres (OR=1,5). Ni la edad ni el sexo del profesional presentaron asociación con la prescripción. Los médicos con alta carga asistencial tienen una mayor probabilidad de prescripción de antibióticos. Conclusiones El principal factor asociado al aumento de prescripciones es la frecuentación en consulta. También reciben más antibióticos las mujeres, los jóvenes y los mayores. Los médicos con más carga asistencial prescriben más antibióticos. Se debe realizar una intervención multifactorial (sobre demanda, pacientes y médicos) para reducir la prescripción (AU)

Introduction: To determine patient and physician-related factors associated with variability in antibioticprescription. Material and methods: Observational study of the prevalence of antibacterial medication prescription>14 years old. Data source: official prescriptions, clinical histories and individual health cards. Patien trelated variables were: age, sex, number of medical visits-year, comorbidity, antibacterials dispensed with prescription. Physician-related variables were age, sex, number of patients assigned, place of work and rurality. Variables associated with prescription were studied by estimating the odds ratio (OR) from the fit of the multilevel logistic regression models. Results: The rate of antibiotic prescription-year in the population was 31.4%. Factors associated with prescription were high rate of visits (users with more than 5 annual visits multiply the probability of receiving antibiotics, compared to those who made no visits: OR= 10.8), age (non-linearly, with a greater likelihood in the young and the elderly) and sex, with a higher rate in women (OR = 1.5). No association was found between prescription and age and sex of the physician, but an association was found with workload: the higher the physician’s workload, the higher the likelihood of antibiotic prescription Conclusions: The most important factor associated with the increase in prescription rate was the frequency of visits. In addition, women, the young and the elderly receive more antibiotics. A multi-factor intervention focusing on demand, patients, and physicians should be carried out to reduce prescription rates (AU)

Mortalidad temprana en pacientes con bacteriemia extrahospitalaria / Early mortality in patients with extrahospitalary bacteremia

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