Cefalea por abuso de medicamentos y sus marcadores clínicos / Medication overuse headache and its specific clinical markers

Resumen Introducción: Los marcadores clínicos de la cefalea por uso excesivo de medicación (CMA) se basan en la clasificación de las cefaleas desarrollada por la Sociedad Internacional de Cefaleas (IHS). Esta clasificación incluye sólo dos criterios: la frecuencia de los días de cefalea debe ser de 15 o más días al mes durante al menos tres o más meses; - y el número de días de uso excesivo de la medicación debe ser de 10 o 15 días al mes dependiendo del tipo de medicación. Sin embargo, los pacientes suelen tener otros marcadores clínicos asociados distintos, que la mayoría de los médicos pasan por alto durante la evaluación inicial. Metodología: Este estudio es un estudio prospectivo, longitudinal y observacional de 76 pacientes ingresados en la Unidad de Cefaleas del hospital DIPRECA. Todos ellos fueron diagnosticados de HMO según los criterios establecidos por su ICHD III beta.(1) Los pacientes recibieron un tratamiento estándar que incluía desintoxicación y medicación preventiva y fueron seguidos durante 6 meses. Se registraron los síntomas de interés en cada visita de seguimiento clínico y se administraron escalas de evaluación como Zung, MIDAS, HIT-6. Resultados: Los medicamentos sobreutilizados incluyeron antiinflamatorios no esteroideos (AINE), triptanes y cornezuelos. Los síntomas clínicos más significativos asociados fueron: despertar por la mañana con dolor de cabeza, despertar al paciente al amanecer por dolor de cabeza, dificultades de atención, depresión, dolor cervical y síndrome de dolor miofascial. Todos los síntomas mejoraron significativamente al iniciar el tratamiento, al igual que la calidad de vida medida por las escalas MIDAS y HIT-6. Discusión: Al evaluar a los pacientes con HMO, hay que tener en cuenta tanto los criterios diagnósticos de la ICHD III beta como los síntomas comunes y específicos que se observan en la mayoría de los casos de HMO.

Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: frequency of headache days must be 15 or more days per month for at least three or more months; - and the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often have others distinct associated clinical markers, which are overlooked by most physicians during the initial evaluation. Methodology: This study is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with, MOH according to the criteria established by the his ICHD III beta.(1) Patients were given standard treatment including detoxification and preventive medications and followed for 6 months. Symptoms of interest were recorded in at each clinical monitoring visit and assessment scales such as Zung, MIDAS, HIT-6 were administered. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant clinical symptoms associated were: awaking in the morning with headache, awaking the patient at dawn by headache, attention difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms significantly improved when treatment began, as did quality of life as measured by MIDAS and HIT-6 scales. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Efeitos adversos associados a uso de contraceptivos orais em discentes / Adverse effects associated with students' use of oral contraceptives

Objetivos: Investigar o número de mulheres, as causas que levam a fazer o uso e descrever os efeitos adversos mais comuns associados ao uso de contraceptivos orais de forma contínua. Métodos: Trata-se de estudo observacional, transversal ou de prevalência e quantitativo. A pesquisa teve população de 832 alunas do curso de Direito dos turnos matutino, vespertino e noturno, no período de agosto a setembro, tendo como amostra 248 participantes para esse estudo. O questionário versou sobre o uso de anticoncepcionais, o perfil das usuárias e os possíveis efeitos adversos observados ao longo do uso. Resultados: A prevalência de uso dos contraceptivos orais foi de 42,3%, justificada principalmente pelo desejo de evitar a concepção (42,9%), regular os níveis hormonais (25,7%) e tratar acne (15,2%). Cerca de 63,8% relataram que já sentiram algum desconforto associado ao uso destes medicamentos, sendo os mais frequentes aumento de peso corporal (32,4%), alterações de humor (24,3%), dor nas mamas (13,5%), cefaleia (4,1%), dor abdominal (2,7%). Conclusão: A prevalência de efeitos adversos decorrentes do uso contínuo de contraceptivos orais é alta, evidenciando-se a necessidade de conscientizar as usuárias a buscarem profissionais habilitados, para que elas façam uso do anticoncepcional mais adequado, minimizando o desconforto advindo dos efeitos adversos.

Objectives: To investigate the number of women, the causes that lead to making use, and to describe the most common adverse effects associated with oral contraceptive continuous use. Methods: This is an observational, cross-sectional, or prevalence and quantitative study. The research had a population of 832 students of the law course of the morning, afternoon and evening shifts, from August to September, with a sample of 248 participants for this study. The questionnaire was about contraceptive use, users' profile, and possible adverse effects observed during use. Results: The prevalence of oral contraceptive use was 42.3%, mainly explained by the desire to avoid conception (42.9%), regulate hormone levels (25.7%), and to treat acne (15.2%). About 63.8% reported already having some discomfort associated with the use of these medications, with the most frequent being body weight gain (32.4%), mood swings (24.3%), breast pain (13.5%), headache (4.1%), abdominal pain (2.7%). Conclusion: The prevalence of adverse effects resulting from the continued use of oral contraceptives is high, so there is a need to guide users to seek qualified professionals so that they make use of the most appropriate contraceptive, minimizing the discomfort arising from adverse effects.

Características demográficas, clínicas y reacciones adversas de personas con sobrepeso y obesidad: consumidores de orlistat atendidos por centro de atención telefónica (2009 ­ 2017) / Demographic and clinical characteristics, and adverse reactions of people with overweight and obesity consumers of orlistat, attended by a call center (2009 ­ 2017)

Resumen Introducción Las enfermedades crónicas van en ascenso y están asociadas al incremento ponderal. Se requieren estrategias multidisciplinarias para su control. Métodos El diseño es descriptivo, observacional y retrospectivo. Los objetivos de esta comunicación son describir las características demográficas, clínicas y reacciones adversas de personas con sobrepeso y obesidad consumidores de orlistat, atendidos por un centro de atención telefónica durante el periodo 2009 a 2017; e identificar al profesional de la salud más consultado por ellos. La información se obtuvo desde una base de datos existente de un programa de atención a personas con sobrepeso u obesidad, interesadas en usar orlistat (prospectos) o usuarios (pacientes). El estudio se llevó a cabo en México y duró siete años. Las variables estudiadas fueron demográficas, clínicas y reacciones adversas. Resultados Se reunieron 311 913 solicitudes de 126 607 sujetos (104 711 prospectos interesados en consumir orlistat y 21 896 pacientes que ya lo tomaban). Las principales actividades fueron llamadas al sujeto (35,9%). Hubo 104 711 solicitudes: 82 810 (79,1%) prospectos y 21 896 (20,9%) pacientes. El 79,9% fue de sexo femenino. El intervalo de edad predominante fue de 32 a 45 años. Se detectaron 43 reacciones adversas (0,02%); las más comunes fueron dolor abdominal (0,05%) y cefalea (0,03%). Conclusiones La población más interesada en el control ponderal en este estudio es la femenina (79,9%) y el grupo etario de 32 a 45 años. El profesional más consultado fue el nutriólogo. Solo se obtuvo el índice de masa corporal (29,2 kilogramos por metro cuadrado) de los sujetos que desarrollaron 43 reacciones adversas, las más comunes fueron dolor abdominal y cefalea.

Introduction Chronic diseases are on the rise and are associated with weight gain. Multidisciplinary strategies are required for its control. Methods The design was descriptive, observational and retrospective. The objectives of this communication were to describe the demographic and clinical characteristics and adverse reactions of overweight and obese people who were consumers of orlistat, attended by a call center during the period 2009 to 2017; and to identify the healthcare professional most consulted by them. The information was obtained from an existing database of a program of attention to people with overweight or obesity, interested in using orlistat (prospects) or users (patients). The study was carried out in Mexico and lasted seven years. The variables studied were demographic, clinical and adverse reactions. Results A total of 311,913 requests were collected from 126 607 subjects (104 711 prospects interested in consuming orlistat and 21 896 patients who already took it). The main activities were phone calls to the subject (35.9%). There were 104 711 requests: 82 810 (79.1%) prospects and 21 896 (20.9%) patients. 79.9% of all were female. The predominant age interval was 32 to 45 years. 43 adverse reactions (0.02%) were detected; the most common were abdominal pain (0.05%) and headache (0.03%). Conclusions The population most interested in weight control in this study was the female population (79.9%) and the age group from 32 to 45 years. The most consulted healthcare professional was the nutritionist. Only the body mass index (29.2 kilograms per square meter) of the subjects who developed 43 adverse reactions was obtained. There were 43 adverse reactions, the most common being abdominal pain and headache.

Eszopiclone versus zopiclone in the treatment of insomnia

OBJECTIVE: To determine the therapeutic effects of two selective GABA-A agonists, zopiclone and eszopiclone, in the treatment of insomnia. METHODS: This study comprised a phase III, single-center, randomized, double-blind, double-dummy, parallel-group, non-inferiority trial. Patients were randomized to receive zopiclone 7.5 mg or eszopiclone 3 mg, both orally, for four weeks. In total, 199 patients were evaluated during two visits and then followed for at least six weeks. The primary endpoint was the Insomnia Severity Index after four weeks of treatment. Secondary endpoints were obtained through polysomnography data, including total sleep time, sleep latency and sleep efficiency. The frequency of adverse events was also analyzed. ClinicalTrials.gov: NCT01100164. RESULTS: The primary efficacy analysis demonstrated the non-inferiority of eszopiclone over zopiclone. Analysis of objective parameters assessed by polysomnography showed that eszopiclone increased total sleep time and also improved sleep efficiency. The safety profile of both study treatments was similar and the most common events reported in both groups were dysgeusia, headache, dizziness, irritability and nausea. Adverse events were observed in 223 patients, 109 (85.2%) in the eszopiclone group and 114 (87.7%) in the zopiclone group. CONCLUSION: Based on the Insomnia Severity Index at the end of four weeks of treatment, eszopiclone demonstrated efficacy comparable to that of zopiclone in the treatment of insomnia, increasing total sleep time as well as sleep efficiency according to polysomnography.

Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

BACKGROUND/AIMS: This integrated analysis aimed to identify the factors associated with the most frequently reported treatment-emergent adverse events (TEAEs) in Asian and non-Asian patients with chronic constipation (CC) who receive prucalopride or placebo over 12 weeks. METHODS: Pooled data from four randomized, double-blind, placebo-controlled, multicenter, phase III studies (NCT00488137, NCT00483886, NCT00485940, and NCT01116206) on patients treated with prucalopride 2 mg or placebo were analyzed. The associations between predictors and TEAEs were evaluated based on a logistic regression model. RESULTS: Overall, 1,821 patients (Asian, 26.1%; non-Asian, 73.9%) were analyzed. Prucalopride treatment was significantly associated with diarrhea, headache, and nausea (p<0.001), but not with abdominal pain, compared with placebo. Differences in the prevalence of TEAEs between prucalopride and placebo decreased greatly after the first day of treatment. Compared with non-Asians, Asians were more likely to experience diarrhea and less likely to develop abdominal pain, headache, and nausea. Prior laxative use, CC duration, and body weight were not predictive of any of these TEAEs. CONCLUSIONS: Prucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non-Asians.

Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

BACKGROUND/AIMS: This integrated analysis aimed to identify the factors associated with the most frequently reported treatment-emergent adverse events (TEAEs) in Asian and non-Asian patients with chronic constipation (CC) who receive prucalopride or placebo over 12 weeks. METHODS: Pooled data from four randomized, double-blind, placebo-controlled, multicenter, phase III studies (NCT00488137, NCT00483886, NCT00485940, and NCT01116206) on patients treated with prucalopride 2 mg or placebo were analyzed. The associations between predictors and TEAEs were evaluated based on a logistic regression model. RESULTS: Overall, 1,821 patients (Asian, 26.1%; non-Asian, 73.9%) were analyzed. Prucalopride treatment was significantly associated with diarrhea, headache, and nausea (p<0.001), but not with abdominal pain, compared with placebo. Differences in the prevalence of TEAEs between prucalopride and placebo decreased greatly after the first day of treatment. Compared with non-Asians, Asians were more likely to experience diarrhea and less likely to develop abdominal pain, headache, and nausea. Prior laxative use, CC duration, and body weight were not predictive of any of these TEAEs. CONCLUSIONS: Prucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non-Asians.

Seguridad e interacciones de los IBP / Security and interactions of PPIs

Los IBP han demostrado ser fármacos relativamente seguros después de muchos años de una amplia utilización. Las reacciones adversas con las que más frecuentemente se han asociado son leves y con escasa repercusión clínica. Inducen hipergastrinemia pero esta no se ha relacionado con una capacidad para inducir lesiones malignas Parece que pueden facilitar determinadas infecciones bacterianas a nivel digestivo y del aparato respiratorio, aunque este hecho no limita su prescripción dada la facilidad de su tratamiento. Desde el punto de vista farmacocinético se han descrito la posibilidad de interacciones con otros fármacos a nivel del citocromo P450, pero ello no parece tener mayor trascendencia clínica y terapéutica en general. Sin embargo, recientemente se está incidiendo por las agencias reguladoras en la hipotética interacción de los IBP (sobre todo omeprazol) con el clopidogrel generando una reducción en su efecto antiagregante. Aunque se debe seguir esta recomendación, necesitaria ser evaluado de forma específica para poder determinar su realidad clínica y las posibles alternativas existentes en los pacientes con riesgo de sangrado gastrointestinal. En último lugar se revisa su administración en situaciones especiales, objeto de discusión, como en la mujer embarazada o durante la lactancia materna...

Kawasaki disease: are we missing the diagnosis?

We report 6 cases of Kawasaki disease (KD) diagnosed over a period of one year and review of all the cases reported from India. The diagnosis of KD was based on clinical criteria The mean age of patients was 6.83 years and mean duration of symptoms before diagnosis was 7.5 days. Apart from classical clinical features, elevated transaminases and blood urea along with free fluid in abdomen was present in one case each. Two patients had dilated coronaries that returned to normal on follow up. One patient developed headache and neck stiffness following treatment with intravenous gamma globulins. The outcome was excellent in all the cases.

Randomized control trial of quinine and artesunate in complicated malaria.

OBJECTIVE: To study the comparative efficacy of the quinine and artesunate in complicated malaria in children. METHODS: All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P. falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests. RESULTS: 80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 +/- 31.49 hrs; 43.55 +/- 20.12 hrs, and 41.67 +/- 16.78 hrs respectively) as compared to the quinine group (70.15 +/- 17.56 hrs, 62.23 +/- 16.99 hrs, and 52.24 +/- 12.69 hrs respectively) ( p<0.05) No side effects were observed in the artesunate treated group. CONCLUSION: Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution, fever clearance, parasite clearance and better tolerability.

Exposicion ocupacional y efectos a la salud del mercurio metalico entre odontologos y asistentes dentales: un estudio preliminar: Valencia, Venezuela; 1998 / Occupational exposure and health effects of metallic mercury among dentists and dental assistants: a preliminary study, Valencia, Venezuela; 1998

Esta investigación pretendió establecer los efectos del Hg sobre la salud de odontólogos y asistentes dentales, su relación con condiciones de exposición, y el posible daño renal debido al Hg. La población fue de 66 personas, la muestra, 37 (56 por ciento), 22 odontólogos (59,5 por ciento, 19 hombres, 3 mujeres) y 15 asistentes dentales mujeres (40,5 por ciento). Se realizaron: encuesta opcional, Hg en orina (Hg-O) y actividad de N-Acetil-beta-D-glucosaminidasa en orina (BAG-O), como biomarcador precoz de daño renal. Los valores de HgO para los odontólogos fueron 22.4 más o menos 6,4 micra g/g creatinina, para los asistentes, 22,2 más o menos 6,1 mu g/g creatinina (p>0.05), y los de BAG-O, de 2,9 más o menos 3 U/L y de 5,2 más o menos 8,1 U/L, respectivamente, no existiento diferencias estadísticamente significativas (p0,05). No se detectó correlación entre el námero de amalgamas preparadas y de horas trabajadas con Hg-O y NAG-O. Los síntomas más frecuentes referidos por los odontólogos fueron irritabilidad, 54,5 por ciento, cefalea, 45,4 por ciento y artralgias, 40,9 por ciento. Por los asistentes, artralgia, 53,5 por ciento, irritabilidad, 46,7 por ciento, y cefalea, 46,7 por ciento, no existiendo riesgo significativo de sufrirlo para ningún grupo. Se requieren nuevas investigaciones que incluyan monitoreo ambiental del Hg, evaluación médica y pruebas neuroconductuales para detectar efectos precoces, asá como la aplicación de medidas de control en pro de la salud del personal.

Albendazole treatment for Giardia intestinalis infections in school children.

A randomized controlled trial, 113 school children with Giardia intestinalis infection were treated with albendazole or tinidazole. Albendazole 400 mg once a day x 3 days and tinidazole 50 mg/kg single dose were given orally to 62 and 51 children, respectively. Parasitological cure was documented when there were > or = 2 times negative stool examination for G. intestinalis at 1-2 weeks after therapy. Thirty-one of 62 (50%) children treated with albendazole and 49 of 51 (96.1%) children treated with tinidazole had parasitological cure (p < 0.001). No major side effects were observed except one case in tinidazole group had severe headache for 30 hours. Albendazole appears to be safe and produced a moderate cure rate for G. intestinalis infection when a 3 day anthelmintic regimen is given.

Prednisona na fase inicial de tratamento das cefaléias diárias induzidas por analgégicos / Predinisone during the initial tretament phase of analgesic inducided daily headache

As cefaléias diárias acometem 5 a 6 por cento de toda a populaçäo adulta mundial. Em clínicas específicas para a atendimento a sofredores crônicos de cefaléia, os pacientes com cefaléias diárias chegam representar mais de 35 por cento de todos os pacientes que procuram tratamento. Embora estas cefaléias possam ser tipos paroxísticos como por exemplo as cefaléias em salvas, a maioria dos pacientes apresentam migrâneas ou enxaquecas transformadas em diárias ao longo do tempo, pelo uso frequente e abusivo de analgésicos e/ou derivados da ergotamina ou cafeína. O tratamento destas cefaléias obrigatoriamente demanda a suspensäo por pelo menos três a quatro semanas destas substâncias, o que acarreta sintomas bastante desconfortáveis ao paciente, pelo rebote que se observa principalmente nos primeiros sete a dez dias de abstinência dos analgésicos e/ou derivados da ergonomina. O uso de prednisona, em um único ciclo de seis dias com doses decrescentes, em 400 pacientes, diminuiu de forma significativa a frequência e intensidade da dor de cabeça. A duraçäo dos episódios foi igual ou maior que antes do tratamento. Estudos controlados comparando pacientes que näo utilizam a prednisona neste período com aqueles fizeram uso da mesma säo necessários para confirmar estas observaçöes

Some consequences of ozone exposure on health

The reaction of ozone with polyunsaturated fatty acids from the surfactant factor and pulmonary epithelial cells produces different reaction products which can cross the alveolar-capillary barrier and reach distant structures. Although only a few papers claim extrapulmonary changes in animals exposed to this gas, some neurological deficits, such as complaints of fatigue, lethargy, headache in humans, as well as significant disarrangements in the sleep pattern related to biochemical changes int he brain have referred to in animals exposed to ozone. In the present review, the molecular configuration and the reaction of ozone at different lung levels are related to impairment at the respiratory and blood systems, in order to elucidate the mechanisms by which this gas or its reaction products, such as free radicals, prostaglandins and others can cross the alveolar-capillary and hemato-encephalic barriers, and to explain those neurological effects