Diagnosis and treatment of dyspepsia associated with pancreatic tumors / 临床肝胆病杂志

Dyspepsia is the one of the most common clinical manifestations of digestive system diseases and has various and complex causes， among which pancreatic tumor is a relatively uncommon cause and is easily neglected in clinical practice. The dual factors of tumor and dyspepsia may cause a significant reduction in the quality of life of patients. At present， there is still a lack of standardized diagnosis and treatment strategies for dyspepsia associated with pancreatic tumors， and this article reviews the diagnosis and treatment of this disease.

Medicamentos genéricos ¿buenos y usables? La percepción de los estudiantes de medicina en un estado mexicano

Introducción: el conocimiento y la percepción hacia los medicamentos genéricos son temas que surgen como un factor importante a explorar en los estudiantes de medicina. Objetivo: determinar las diferencias entre los estudiantes de medicina de universidades públicas y privadas sobre la percepción y el uso de las Especialidades Farmacéuticas Genéricas (EFG). Materiales y métodos: se realizó un estudio cuantitativo de tipo observacional, transversal, analítico y comparativo en un universo de 858 estudiantes matriculados durante 2019-2020 en cinco escuelas de medicina del estado mexicano de Tabasco. A través de Google Forms se recolectaron los datos de un formulario auto aplicado con base a un cuestionario previamente validado. Se emplearon estadísticas descriptivas para evaluar las percepciones de los estudiantes y pruebas no paramétricas a través de un modelo de análisis de diferencia de medias para comparar el resultado entre las universidades. Resultados: la percepción de las dimensiones de calidad (8= 12,51) y eficacia (8=6,06) muestran una postura indecisa en general. En la fiabilidad (8=6,99), los alumnos estuvieron de acuerdo. Las dimensiones de preferencia-experiencia (8=10,649) y la de accesibilidad (X=7,01), colocan a los alumnos en el grupo de indecisos. En la comparación de medias de la escala de percepción de EFG (prueba t de estudent), la universidad pública presentó una media baja (8=24,72), mientras que en el grupo de universidades privadas fue mayor (8=26,06). En cuanto al uso de EFG, la universidad pública presentó una media 8=38,22, mientras que el grupo de universidades privadas fue menor (8=36,70). Conclusiones: se requiere incluir en los contenidos curriculares de los futuros profesionales de la medicina, mayor información sobre calidad, seguridad y eficacia de las EFG, lo que contribuirá a elevar el nivel de confianza en su prescripción.

Introduction: Knowledge and perception towards generic drugs are topics that emerge as an important factor to explore in medica students. Objective: To determine the differences between medical students from public and private universities on the perception and use of Generic Pharmaceutical Specialties (GFE). Materials and methods: A quantitative observational, cross-sectional, analytica and comparative study was conducted in a universe of 858 students enrolled during 2019-2020 in five medical schools in the Mexican state of Tabasco. Through Google Forms, data were collected from a self-applied form based on a previously validated questionnaire Descriptive statistics were used to assess student perceptions, and nonparametric tests through an analysis model for difference of means to compare the result between universities. Results: The perception of the dimensions of quality (8= 12,51) and efficacy (8=6,06) shows an indecisive position in general. On reliability (8=6,99), students agreed. The dimensions of preference-experience (8=10.649) and accessibility (8=7,01), place students in the group of undecideds. In the comparison of means of the GFE perception scale (student's t test), the public university presented a low mean (8=24,72), while in the group of private universities it was higher (8=26,06). Regarding the use of GFE, the public university presented a mean 8=38,22, while the group of private universities was lower (8=36,70). Conclusions: It is necessary to include in the curricular contents of future medical professionals more information on quality, safety and efficacy of GFE, which will contribute to raising the level of confidence in their prescription.

Percepción y uso de medicamentos genéricos en médicos en formación de una universidad mexicana / Perception and use of generic drugs in medical students at a Mexican university

INTRODUCCIÓN: la formación que reciben los médicos es fundamental para su futuro como profesionales; ideas erróneas sobre los medicamentos genéricos pueden influir negativamente en su prescripción. OBJETIVO: identificar la percepción y el uso de medicamentos genéricos de médicos en formación. MÉTODOS: estudio cuantitativo, descriptivo y transversal, realizado en estudiantes de medicina de una Universidad Pública del Sureste de México. La población de estudio se conformó por una muestra depurada de 522 estudiantes matriculados durante el periodo escolar febrero-junio de 2020, quienes mediante convocatoria abierta llenaron un formulario (Google Forms) tipo escala de Likert. RESULTADOS: la apreciación de los estudiantes hacia un medicamento de patente es superior, tendiendo a una mayor fiabilidad en casos de gravedad. Los medicamentos genéricos son vistos como de mala calidad y se tiene la creencia de que los existentes en el mercado son piratas o copias ilegales. CONCLUSIÓN: los resultados sugieren que los médicos en formación tienen una percepción negativa hacia las Especialidades Farmacéuticas Genéricas, las consideran menos eficaces y de calidad dudosa. Pese a esta consideración, los genéricos suelen ser usados en padecimientos leves y refieren obtener buenos resultados.

INTRODUCTION: the medical education receive is critical to their professional future. Misconceptions about generic drugs can negatively influence your prescription. OBJECTIVE: identify the perception and use of generic drugs in trained physicians. METHODS: quantitative, descriptive and cross-sectional study carry out in medical students at a public university in southeastern Mexico. The study population consisted of a purified sample of 522 students enrolled during the February-June 2020 school year, who by open call filled out a Likert scale form (Google Forms). Results: Students' appreciation of a patent drug is superior, taking into account greater reliability in cases of seriousness. Generic drugs are seen as of poor quality and it is believed that those on the market are pirates or illegal copies. CONCLUSIONS: the results suggest that trained physicians have a negative perception of Generic Pharmaceutical Specialties, considering them less effective and of dubious quality. Despite this consideration, generics are often used in mild conditions and refer good results.

Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease: the switching from clopidogrel to ticagrelor (SHIFT-CACS) study / 中华医学杂志(英文版)

Background@#The dose and time point for switching from clopidogrel to ticagrelor remain controversial, especially for Chinese acute coronary syndrome (ACS) patients with complicated coronary artery disease (CAD). Hence, the purpose of this study was to further explore the optimal dose and time point for the switching strategy to balance the increase in platelet inhibition and the decrease in adverse events in Chinese ACS patients with complicated CAD managed by percutaneous coronary intervention (PCI).@*Methods@#From July 2017 to December 2017, the prospective, randomized, open-label study (the SwitcHIng from clopidogrel to ticagrelor study) assigned the eligible Chinese ACS patients with complicated CAD managed by PCI (n = 102) for 90 mg of ticagrelor at 12 h (T-90 mg-12 h), 90 mg of ticagrelor at 24 h (T-90 mg-24h) or 180 mg ticagrelor at 24 h (T-180 mg-24 h) after the last dose of clopidogrel. The primary endpoint was the comparison of maximal platelet aggregation (MPA) values at 2 h after switching strategies among the three groups. In addition, the MPA values at baseline, 8 h and before discharge and the rates of high ontreatment platelet reactivity were evaluated, the incidences of bleeding episodes and dyspnea during hospitalization and at 30-day follow-up in our study were also recorded. The MPA was measured by light transmittance aggregometry in our study. A repeatedmeasures analysis of variance (ANOVA) model and one-way ANOVA were used to compare data for the primary endpoint.@*Results@#The MPA values were significantly decreased in the T-180 mg-24 h group compared with the T-90 mg-12 h group (P = 0.017) and decreased numerically compared with the T-90 mg-24 h group (P = 0.072) at 2 h. In particular, the MPA values were markedly reduced in the T-90 mg-24 h group compared with the T-90 mg-12 h group at 8 h after switching treatment (P = 0.002). There was no significant difference among the three groups in all bleedings and dyspnea events.@*Conclusions@#The optimal treatment strategy recommended in this study for Chinese ACS patients with complicated CAD managed by PCI is 180 or 90 mg of ticagrelor at 24 h after the last dose of clopidogrel. In addition, a negative interaction was detected in this study between the overlap for clopidogrel and ticagrelor at 12 h after the last dose of clopidogrel.@*Trial Registration@#ClinicalTrials.gov, NCT03577652; http://clinicaltrials.gov/ct2/show/NCT03577652.

Percepção, conhecimento e uso de medicamentos genéricos no Sul do Brasil: o que mudou entre 2002 e 2012? / Perception, knowledge, and use of generic drugs in southern Brazil: what changed from 2002 to 2012? / Percepción, conocimiento y uso de medicamentos genéricos en el Sur de Brasil: ¿qué ha cambiado entre 2002 y 2012?

Resumo: Este estudo compara a percepção, conhecimento e uso de medicamentos genéricos em adultos de Pelotas, Rio Grande do Sul, Brasil, por meio de dois estudos transversais de base populacional realizados em 2002 e 2012. Os desfechos estudados foram: (a) prevalência de utilização de medicamentos genéricos; (b) proporção de uso de medicamentos genéricos entre os demais medicamentos; (c) percepção dos usuários sobre preço e qualidade dos medicamentos genéricos; (d) conhecimento dos usuários sobre medicamentos genéricos; e (e) estratégias de aquisição de medicamentos. A prevalência de uso de medicamentos genéricos aumentou de 3,6% (IC95%: 3,0-4,3) para 26,1% (IC95%: 24,5-27,7) no período de dez anos. A percepção sobre preço e qualidade dos medicamentos genéricos se manteve estável, a identificação das características que diferenciam os medicamentos genéricos dos demais medicamentos melhorou (p < 0,001) e o erro de classificação de medicamento diminuiu (p < 0,001). Houve um aumento significativo na estratégia de aquisição de medicamentos pela substituição do medicamento prescrito pelo medicamento genérico. Entre 2002 e 2012, aumentou o conhecimento e uso de medicamentos genéricos, enquanto a percepção quanto ao menor preço e qualidade equivalente mantiveram-se elevadas.

Abstract: This study compared the perception, knowledge, and use of generic drugs by adults in Pelotas, Rio Grande do Sul State, Brazil, using two cross-sectional population-based studies from 2002 and 2012. Study outcomes were: (a) prevalence of use of generics; (b) generics as a proportion of all medication; (c) users' perceptions of prices and quality; (d) users' knowledge of generics; and (e) strategies for acquisition of medicines. Prevalence of generics use increased from 3.6% (95%CI: 3.0-4.3) to 26.1% (95%CI: 24.5-27.7) in the 10-year period. Perceptions of prices and quality of generics remained stable, identification of characteristics that distinguish generics from other drugs improved (p < 0.001), and drug classification errors decreased (p < 0.001). There was a significant increase in acquiring medication by replacing prescribed drugs with generics. Between 2002 and 2012 there was an increase in knowledge and use of generics, while perception of lower prices and equivalent quality remained high.

Resumen: Este estudio compara la percepción, conocimiento y uso de medicamentos genéricos en adultos de Pelotas, Río Grande do Sul, Brasil, a través de dos estudios transversales de base poblacional, realizados en 2002 y 2012. Los resultados estudiados fueron: (a) prevalencia de utilización de medicamentos genéricos; (b) proporción de uso de medicamentos genéricos entre los demás medicamentos; (c) percepción de los usuarios sobre el precio y calidad de los medicamentos genéricos; (d) conocimiento de los usuarios sobre medicamentos genéricos y (e) estrategias de adquisición de medicamentos. La prevalencia de uso de medicamentos genéricos aumentó de 3,6% (IC95%: 3,0-4,3) a 26,1% (IC95%: 24,5-27,7) en un período de 10 años. La percepción sobre el precio y calidad de los medicamentos genéricos se mantuvo estable, la identificación de las características que diferencian los medicamentos genéricos de los demás medicamentos mejoró (p < 0,001) y el error de clasificación de medicamentos disminuyó (p < 0,001). Hubo un aumento significativo en la estrategia de adquisición de medicamentos, a través de la sustitución del medicamento prescrito por el medicamento genérico. Entre 2002 y 2012 aumentó el conocimiento y uso de medicamentos genéricos, mientras que la percepción en lo referente al menor precio y calidad equivalente, se mantuvieron elevadas.

Management of cephalosporin resistance in Neisseria gonorrhoeae / 中华皮肤科杂志

Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae,and substantially harms human health and socioeconomic development.Due to inappropriate treatment and the presence of drug resistance genes in patients,antibiotic resistance has emerged in Neisseria gonorrhoeae,such as resistance to penicillin,tetracycline,ciprofloxacin,or other antibiotics.Currently,extended-spectrum cephalosporins (ESCs) are the first-line treatment of gonococcal infection.With the wide use of ESCs,the sensitivity of Neisseria gonorrhoeae to ESCs has been decreasing gradually,and there have been reports on cases of treatment failure in clinical practice.In order to control gonorrhea and deal with drug resistance in Neisseria gonorrhoeae,combined therapy,alternative therapy and new drugs have been developed in clinic.

Comparative in vitro dissolution of commercially available sustained release nifedipine tablet brands in the Kumasi Metropolis, Ghana.

The aim of this study was to assess the dissolution properties of twelve sustained release (SR) nifedipine tablet brands, including 20 mg and 30 mg innovator brands, for possible generic substitution. The tablet brands were purchased from retail pharmacies in the Kumasi Metropolis, Ghana. The weight uniformity, drug content and in vitro dissolution of the tablets in phosphate buffer pH 6.8 were evaluated. The dissolution data were compared using the similarity (f2) and difference (f1) factors, and the USP acceptance criteria for SR tablets. The kinetics of drug release from the tablets was also evaluated. All the brands passed the weight uniformity test. Nine brands (75 %) passed the drug content test while three brands (25 %) failed. The two innovator nifedipine SR brands passed all the tests undertaken. Comparison of the dissolution data using f1 and f2 showed that all three 30 mg nifedipine SR brands were dissimilar to the innovator brand. Also, two 20 mg nifedipine SR brands (28.6 %) were similar or bioequivalent with the innovator 20 mg brand while five brands (71. 4 %) were dissimilar. Three (75 %) 30 mg and four (50 %) 20 mg nifedipine SR brands exhibited appropriate drug release profiles based on the USP acceptance criteria. Drug release from the twelve tablet brands mostly followed the Higuchi kinetic model (58.3 %) followed by the Hixson-Crowell model (16.7 %). Only one brand (N7) exhibited constant drug release kinetics. Results from the study have shown that switching or substituting brands of SR nifedipine for patients should be guided by a critical assessment of the dissolution data using appropriate evaluation techniques.

Percepcion del uso de genéricos en usuarios de farmácias privadas en un distrito de Lima / Perception of the use of generics in private pharmacies users in a district of Lima

Objetivos: Determinar la percepción de riesgo del uso de los medicamentos genéricos en usuarios de farmacias privadas en un distrito de Lima-Perú.Metodología: Se realizó un estudio observacional de tipo transversal. El muestreo fue por conveniencia. Se entrevistaron 36 usuarios de farmacias privadas a la salida del establecimiento, que atendían a los criterios de selección previamente definidos. Se empleó como instrumento un cuestionario aplicado a través de una entrevista como técnica de recolección de datos. El concepto de percepción de riesgo fue evaluado en cinco dimensiones: funcional, física, financiera, social y psicológica, considerando una puntuación en 7 grados usando escala de Likert. (...) En el riesgo global del uso del medicamentos genéricos, se observó que el 97.2 por cento de los participantes tuvieron una percepción buena a regular del uso de los medicamentos genéricos.Conclusiones: La mayoría de los usuarios de farmacias privadas tuvieron una percepción buena a regular del riesgo del uso de los medicamentos genéricos y a nivel de las dimensiones, la percepción fue buena a regular en los dominios financiero, social, psicológico, y un poco menor en el dominio funcional y físico...

Objectives: To determine the risk perception of the use of generic drugs in private pharmacies users in a district of Lima-Perú.Methodology: A cross-sectional observational study was performed. The convenience sample. 36 users were interviewed private pharmacies outside the property, which catered to the previously defined selection criteria. Questionnaire was used as a tool and applied through the interview as a technique for data collection. The concept of perceived risk was evaluated in five dimensions: functional, physical, financier, social and psychological. (...) In the overall risk of the use of generic drugs, we observed that 97.2% of participants had a good perception to regulate the use of generic drugs.Conclusions: The majority of users of private pharmacies had a good perception to regulate the risk of using generic drugs and dimensional level, the perception was good to fair in the financial, social, psychological domains, and a little lower in the functional and physical domain...

Evolución del consumo de medicamentos de alto costo en Colombia / Evolution of consumption of high-cost drugs in Colombia

Objective. Determine the patterns of consumption of high-cost drugs (HCD) during the 2005–2010 period in a population of Colombian patients enrolled in the General System of Social Security in Health. Methods. An observational descriptive study was conducted. The prescription dataof formulas of any drug considered to be high-cost dispensed to all users (1 674 517) in 20 cities of Colombia between 2005 and 2010 were analyzed. The anatomical therapeutic classification was considered, and the number of patients as well as monthly invoicing for each drug, the daily dose defined, and the cost per 1 000 inhabitants/day were defined. Results. Over the entire study period, the amount invoiced for HCDs increased by 847.4%. Antineoplastic and immunomodulator drugs accounted for 46.3% of the totalinvoicing. The other drugs were anti-infectives (15.2%), systemic hormonal preparations (9.5%), and drugs for the nervous system (9.1%). Most of these drugs were prescribed at the daily doses defined as recommended by the World Health Organization, but with high costs per 1 000 inhabitants/day. Conclusions. In Colombia a crisis has occurred in recent years due to the high spending generated by the most expensive drugs. The progressive growth of pharmaceutical spending is greater than the increased coverage by the country’s health system. The Colombian health system should evaluate how much it is willing to pay for the most expensive drugs for some diseases and what strategies should be implemented to cover these expenses and thus guarantee access to the insured.

Objetivo. Determinar el comportamiento del consumo de medicamentos de alto costo (MAC) durante 2005–2010 en una población de pacientes colombianos afiliados al Sistema General de Seguridad Social en Salud. Métodos. Estudio descriptivo observacional; se analizaron datos de prescripción de fórmulas dispensadas desde 2005 a 2010 a todos los usuarios (1 674 517) de algún medicamento considerado de alto costo en 20 ciudades de Colombia. Se consideró la clasificación anatómicaterapéutica y el número de pacientes, así como la facturación mensual por cada medicamento, la dosis diaria definida y el costo por 1 000 habitantes/día. Resultados. En todo el período de estudio, el valor facturado por MAC creció 847,4%. Losantineoplásicos e inmunomoduladores constituyeron 46,3% del total facturado, antinfecciosos 15,2%, preparaciones hormonales sistémicas 9,5% y fármacos para el sistema nervioso 9,1%. La mayoría de estos medicamentos fueron prescritos a las dosis diarias definidas recomendadaspor la Organización Mundial de Salud, pero con altos costos por 1 000 habitantes y día. Conclusiones. En Colombia durante los últimos años se ha presentado una crisis debida al elevado gasto generado por los medicamentos más costosos. El crecimiento progresivo del gasto farmacéutico es mayor que el aumento de la cobertura del sistema sanitario del país. El sistema sanitario colombiano debe evaluar cuánto está dispuesto a pagar por los medicamentosmás costosos para algunas morbilidades y qué estrategias debe implementar para sufragar estos gastos y así garantizar el acceso a los asegurados.

Cyperus rotundus, a substitute for Aconitum heterophyllum: Studies on the Ayurvedic concept of Abhava Pratinidhi Dravya (drug substitution).

In the absence of a desired first choice medicinal herb, classical Ayurveda recommends use of a functionally similar substitute. Post 16th century Ayurvedic texts and lexicons give specific examples of possible substitutes. Here we report a preliminary study of one such Ayurvedic substitution pair: Musta (Cyperus rotundus L., Cyperaceae), a common weed, for the rare Himalayan species, Ativisha (Aconitum heterophyllum Wall. ex Royle; Ranunculaceae). The study’s strategy was to use modern phytochemical and pharmacological methods to test the two herbs for biochemical and metabolic similarities and differences, and literary studies to compare their Ayurvedic properties, a novel trans-disciplinary approach. No previous scientific paper has compared the two herbs’ bioactivities or chemical profiles. Despite being taxonomically unrelated, the first choice, but relatively unavailable (Abhava) plant, A. heterophyllum, and its substitute (Pratinidhi) C. rotundus, are not only similar in Ayurvedic pharmacology (Dravyaguna) profile, but also in phytochemical and anti-diarrheal properties. These observations indicate that Ayurveda may attach more importance to pharmacological properties of raw drugs than to their botanical classification. Further research into the nature of raw drugs named could open up new areas of medicinal plant classification, linking chemistry and bioactivity. Understanding the logic behind the Ayurvedic concept of Abhava Pratinidhi Dravya (drug substitution) could lead to new methods of identifying legitimate drug alternatives, and help solve industry’s problems of crude drug shortage.