Biomodulina T: una nueva opción terapéutica contra la COVID-19 / Biomodulin T: a new therapeutic option against COVID-19

RESUMEN Para potenciar la inmunidad en personas con deterioro gradual del sistema inmune, causado por el envejecimiento o por padecer diferentes comorbilidades, el Grupo de las Industrias Biotecnológica y Farmacéutica de Cuba (BioCubaFarma) ha introducido el producto Biomodulina T. Este se ha utilizado, además, como parte del protocolo de prevención y para el tratamiento de pacientes positivos al SARS-CoV-2. La inmunidad dependiente del timo, incluida la inmunidad de células T y la producción de anticuerpos, disminuye con el tamaño del órgano en los adultos, lo que se conoce como "inmunosenescencia". La Biomodulina T es un extracto diafiltrado de timo de ternera; tiene una acción citorrestauradora e inmunomoduladora, que ha demostrado su eficacia en diferentes grupos de riesgo, dentro de los cuales los ancianos ocupan un lugar especial. En la actual situación epidemiológica nacional e internacional su inclusión en los protocolos de actuación es clave. El uso de este medicamento en un grupo vulnerable, como los ancianos, representa un horizonte esperanzador en tanto se avanza en la producción de vacunas nacionales que sean seguras y eficaces (AU).

ABSTRACT To boost immunity in people with gradual deterioration of the immune system, caused by aging or suffering from different comorbidities, the Group of the Biotechnology and Pharmaceutical Industries of Cuba (Biotechnology Farma) has introduced the product Biomodulin T. This has also been used as part of the prevention protocol and for the treatment of patients positive to SARS-CoV-2. Thymus-dependent immunity, including T-cell immunity and antibody production, decreases with organ size in adults, which is known as "immunosenescence." Biomodulin T is a diafiltered extract of veal thymus; it has a cytorestaurative and immunomodulatory action, which has demonstrated its effectiveness in different risk groups, within which elder people occupy a special place. In the current national and international epidemiological situation its inclusion in the protocols of action is significant. The use of this medication in a vulnerable group, such as elder people, represents a hopeful horizon as progress is made in the production of safe and effective national vaccines (AU).

Insuficiencia cardíaca con función preservada. Revisión del tema y comunicación de la experiencia española / Heart failure with preserved function. Review of the topic and communication of the spanish experience

En la presente revisión los autores abordan en forma pormenorizada la definición, los aspectos epidemiológicos, la fisiopatología, los pilares diagnósticos y el tratamiento de esta entidad que está adquiriendo cada vez mayor importancia en el campo de la cardiología. Los escasos ensayos clínicos realizados no han logrado aportar evidencias satisfactorias, por lo que especialmente su tratamiento constituye un reto intelectual y científico. Como muy interesante aporte se exponen las bases fundamentales del programa de las Unidades de Manejo Integral de Pacientes con Insuficiencia Cardíaca (UMIPIC) en España. Este programa tiene como principal objetivo ofrecer una asistencia sanitaria de calidad y sostenible por el sistema público y comprende la atención global de todas las enfermedades de los pacientes mayores, la educación, el uso eficiente de los recursos económicos y la motivación profesional. Se describen el plan general de trabajo y los resultados de los primeros 258 pacientes que completaron un año de seguimiento.

In the present review, the authors analyze in detail, the definition, the epidemiological aspects, the physiopathology, the diagnostic bases, and the treatment of this entity which es becoming increasingly important in the field of cardiology. The few clinical trials made so far, have not managed to satisfactory evidence, so especially the treatment, constitutes an intelectual and scientific challenge. As a very interesting contribution, the bases of the spanish Program for Integral Management of Heart Failure Units (UMIPIC), are analyzed. This program`s main objective is to offer quality health care and sustainable by the public system. It includes all diseases of elderly patients global attention, education, efficient use of economic resources and the professional motivation. The general work plan and the results of the first 258 patients who completed one year of follow- up are described.

Agentes reversores para os anticoagulantes orais de ação direta nas hemorragias e cirurgias de emergência / Reversal agents for direct acting oral anticoagulants in hemorrhages and emergency surgery

Em indivíduos com fibrilação atrial, os grandes estudos clínicos randomizados mostraram que os inibidores diretos da trombina e do fator Xa são mais seguros que a varfarina e têm menor risco de hemorragias graves, entre elas o sangramento intracraniano e o acidente vascular cerebral hemorrágico. Além disso, o uso de agentes dessas classes, conhecidos como anticoagulantes orais de ação direta (DOAC) não dependentes da vitamina K, permite a utilização em doses fixas e não requer monitoramento laboratorial. O início rápido e a suspensão da ação anticoagulante oferecem vantagens para os DOAC sobre a varfarina em vários contextos clínicos. Contudo, ainda que sejam mais seguros que a varfarina, as questões relacionadas com o sangramento constituem o principal problema desses fármacos. O manejo do sangramento em pacientes expostos aos anticoagulantes é estratégia fundamental na prática clínica, a fim de evitar situações catastróficas que levem o paciente à morte. O desenvolvimento de agentes reversores do efeito desses fármacos, visando a redução de complicações hemorrágicas em situações de urgência é mais um passo para o aumento da segurança da utilização dos anticoagulantes de ação direta

In individuals with atrial fibrillation, large randomized controlled trials have shown that direct thrombin and factor Xa inhibitors are safer than warfarin, with a lower risk of serious bleeding, including intracranial bleeding and hemorrhagic stroke. In addition, the use of agents of these classes, known as non-vitamin K-dependent direct acting oral anticoagulants (DOACs), allows their use in fixed doses and does not require laboratory monitoring. The rapid onset and termination of the anticoagulant action offer advantages for DOACs over warfarin in various clinical settings. However, although safer than warfarin issues related to bleeding are the main problem of these drugs. Bleeding management of patients exposed to DOACs is a fundamental strategy in clinical practice, in order to avoid catastrophic situations leading to the patient's death. The development of reversal agents of the effect of these drugs, seeking to reduce hemorrhagic complications in emergency situations, is yet another step in increasing the safety of the use of direct action anticoagulants

Breast cancer: news in diagnosis and treatment / Câncer de mama: novidades no diagnóstico e no tratamento

SUMMARY The authors discuss the main innovations in the diagnosis and treatment of breast cancer, particularly in diagnostic imaging and screening, and in locoregional and systemic therapies.

RESUMO Os autores discutem as principais novidades no diagnóstico e no tratamento do câncer de mama, particularmente no diagnóstico por imagem, no rastreamento e nas terapêuticas locorregional e sistêmica.

Supervivencia libre de enucleación de pacientes con diagnóstico de retinoblastoma tratados con quimioterapia intraarterial en el Hospital Universitario de San Vicente Fundación / Enucleation free survival of patients with retinoblastoma diagnosis treated with intraarterial chemotherapy at University-Based San Vicente Fundacion Hospital

Objetivo: describir la supervivencia libre de enucleación, respuesta al tratamiento y complicaciones de los pacientes sometidos a tratamiento con quimioterapia intraarterial (QIA) para el control del retinoblastoma en el Hospital Universitario de San Vicente Fundación (HUSVF). Tipo de estudio: estudio de cohortes. Materiales y Métodos: se incluyeron todos los pacientes con diagnóstico de retinoblastoma tratados en el husvf con qia supraselectiva de la arteria oftálmica entre agosto del 2011 y agosto de 2013. Resultados: se realizó tratamiento a 21 pacientes, 24 ojos, en un periodo de 23.5 meses. La edad media al momento de inicio de la QIA fué 19 meses (rango 5-60 meses) con un seguimiento promedio de 9.3 meses (rango 3 semanas a 23.5 meses). Se realizaron 78 cateterizaciones, siendo 9 de ellas bilaterales. El salvamento ocular se alcanzó en el 100% de los Grupo A (n1), 100% B (n=2), 100% C (n=5) y 87.5% D (n=16), según la Clasificación Internacional para Retinoblastoma (CIRB). Sólo se reportaron dos eventos adversos importantes, una hemiparesia transitoria y una reacción alérgica severa. Ninguno de los pacientes ha fallecido, ha tenido compromiso metastásico o necesidad de radioterapia externa. Sólo se realizaron dos enucleaciones. La media de supervivencia de los 24 globos oculares tratados es de 10.4 meses ± 1.6. La media de supervivencia de los 21 pacientes tratados es de 10.4 meses ±1.7. Conclusiones: los resultados muestran una respuesta satisfactoria, constituyéndose la QIA como procedimiento seguro y con baja tasa de complicaciones en el tratamiento del retinoblastoma.

Purpose: to describe globe salvage, treatment response and complications of patients following intra-arterial chemotherapy (IAC) for retinoblastoma at Hospital Universitario de San Vicente Fundacion (HUSVF). Type of study: Cohort Study. Materials and methods: We included all patients diagnosed with retinoblastoma and treated with IAC between from August 2011 to August 2013. Results: A total of 21 patients, with a total of 24 eyes, were treated with IAC over a period of 23.5 months. The mean age of patients at time of treatment was 19 months (range 5-60 months) with a mean follow-up time of 9.3 months (range 3 weeks to 23.5 months). 78 catheterizations were performed, nine of them being bilateral. Ocular salvage rate was achieved in 100% of the Group A (n1), 100% in group B (n = 2), 100% in group C (n = 5) and 87.5% in group D (n = 16), according to the International Classification for Retinoblastoma. Only two major adverse events were reported, a transient hemiparesis and a severe allergic reaction. No deaths, metastatic involvement or need for external beam radiotherapy were reported. Two eyes, from group D, required enucleation. The mean survival rate of 24 eyes treated was 10.4 months ± 1.6. The mean survival rate of the 21 patients treated was 10.4 ± 1.7 months. Conclusions: The results show a satisfactory response, becoming the IAC a safe procedure with a low complication rate in retinoblastoma treatment.

Aspectos clínicos y farmacoterapéuticos de la infección del tracto urinario Revisión estructurada / Clinical and therapeutic aspects in the treatment of urinary tract infection Structured review

Objetivo: las infecciones del tracto urinario, después de las respiratorias, son las enfermedades infecciosas más frecuentes. Por ello es necesario disponer de información sistematizada y actualizada que contribuya a mejorar los resultados de la farmacoterapia y a disminuir la morbimortalidad asociada a esta infección. El objetivo de este trabajo fue realizar una revisión estructurada de los aspectos clínicos y farmacoterapéuticos de las infecciones del tracto urinario.Método: se realizó una revisión estructurada sobre lainfección del tracto urinario en humanos, en PubMed/MedLine, de artículos publicados en inglés y en español,entre el 2007 y el 2010, con acceso a texto completo, buscando, en el título o en el resumen los términos:“Urinary tract infections” y (classification, epidemiology,complications, physiology, physiopathology o drug therapy). La información se complementó conuna búsqueda específica de la base de datos Scielo Colombia,utilizando los términos: infecciones urinarias y urinary tract infection, al igual que con las referenciasde artículos considerados relevantes. La información se estructuró en los siguientes apartados: clasificación, indicadores epidemiológicos, factores de riesgo, etiología, presentación clínica, diagnóstico, farmacoterapia, profilaxis y resistencia. Resultados: se presentan aspectos relevantes y actuales de la infección del tracto urinario (ITU) relacionados consu clasificación, epidemiología, factores de riesgo, etiología,presentación clínica, diagnóstico, farmacoterapia, profilaxis y resistencia a antibióticos. Conclusiones: la revisión de problemas de salud frecuentesen la población, como las infecciones del tracto urinario, ofrece la posibilidad de actualizar y esbozar un enfoque farmacoterapéutico basado en el uso adecuado de los medicamentos, con el propósito de disminuir la probabilidadde fallo terapéutico y la resistencia de los microorganismos.

Objective: The urinary tract infections (UTI) are more frequent infection after respiratory infectiousdiseases. It is therefore considered necessary to have systematic and updated informationto help improve drug therapy outcomes and reduce morbidity and mortality associated with this infection. The aim of this study was to performa structured review of clinical and pharmacotherapeuticaspects of urinary tract infections.Methods: We conducted a structured review of urinary tract infection in PubMed/MedLine ofarticles published in English and Spanish, between2007and 2010, in humans, with accessto full text. Search terms were: “Urinary tract infections” AND (classification OR epidemiologyOR complications OR physiology OR physiopathology OR drug therapy) in title/abstract field. The information was complemented bothby a specific search of Colombia Scielo database,using the terms: urinary tract infections and urinary tract Infection, and by review of referencescited in relevant articles. The information is organized into the following sections: Classification,epidemiological, risk factors, etiology,clinical presentation, diagnosis, drug therapy, prophylaxis and resistance. Relevant aspectsare presented and current urinary tract infection (UTI) related to its classification, epidemiology,risk factors, etiology, clinical presentation, diagnosis, drug therapy, prophylaxis and antibioticresistance. Results: We present some relevant and currentaspects of the urinary tract infection related to its classification, epidemiology, risk factors, etiology,clinical presentation, diagnosis, drug therapy, prophylaxis, and antibiotic resistance.

La combinación de quimioterapia intravenosa e intraperitoneal mejora la supervivencia en el cáncer de ovario / The combination of intravenous and intraperitoneal chemotherapy improves survival for women ovarian cancer

Existen pruebas convincentes provenientes de diversos estudios aleatorizados y controlados de que la combinación de quimioterapia intravenosa (IV) e intraperitoneal(IP), administradas luego de una citorreducción quirúrgica óptima, mejora significativamente la supervivencia de las mujeres con cáncer epitelial de ovario en estadio III de la clasificación de la FIGO. En base a este concepto, el National Cancer Institute de Estados Unidos (US-NCI) emitió un anuncio clínico en enero de 2006 en el que recomendaba que las mujeres y sus médicos tratantes tuvieran en cuenta dicha quimioterapia IV/IP en los casos adecuados. Pese a los actuales esfuerzos en la enseñanza, los esquemas IV/IP no se han convertido en el tratamiento estándar en diversos hospitales. Las investigaciones clínicas actualmente en marcha buscan reducir la toxicidad asociada con la quimioterapia IP sin perder la eficacia e incorporando nuevos abordajes biológicos al tratamiento.

Atenção farmacêutica e práticas integrativas e complementares no SUS: conhecimento e aceitação por parte da população sãojoanense / Pharmaceutical care and complementary and alternative medicine in the SUS: knowledge and acceptance on the part of the population from the city of São João da Mata, Minas Gerais state, Brazil

Em 2006, o Ministério da Saúde criou a Política Nacional de Terapias Integrativas e Complementares no SUS. O objetivo do estudo foi investigar o conhecimento e a aceitação das terapias integrativas e complementares e atenção farmacêutica por parte dos usuários do SUS. O estudo foi realizado na farmácia da Unidade Básica de Saúde da cidade de São João da Mata, Minas Gerais, Brasil. Um estudo transversal descritivo qualitativo e quantitativo foi realizado com três médicos e 35 usuários do serviço. Destes, 100 por cento não conheciam as terapias integrativas e complementares. Após explicação clara e simples pelo pesquisador, 31,42 por cento disseram que aceitariam o uso de fitoterapia, 51,42 por cento aceitariam a acupuntura, 37,14 por cento aceitariam a homeopatia e nenhum utilizaria a crenoterapia. Quando questionados sobre a atenção farmacêutica, 45,71 por cento disseram já ter ouvido falar neste assunto, 22,85 por cento sabem do que se trata e 31,42 por cento nunca tinham ouvido falar em atenção farmacêutica. Quando os três médicos que atendem na unidade de saúde foram questionados, observou-se indiferença, não-aceitação e aceitação, respectivamente. Em conclusão, este estudo demonstrou que a grande maioria dos pesquisados aceitaria as terapias integrativas e complementares se estas fossem oferecidas pela unidade de saúde. Além disso, os usuários acham importante uma maior atuação do farmacêutico. É necessária a implantação de programas de divulgação para os pacientes e principalmente para os médicos prescritores de práticas integrativas e complementares.

In 2006, the Ministry of Health created the National Policy on Integrative and Complementary Therapies in the Unified Health System. This study aimed to investigate the knowledge and acceptance of complementary and integrative therapies and pharmaceutical care by SUS users. The study was conducted in the pharmacy of a primary healthcare unit in São João da Mata city , Minas Gerais state, Brazil. A cross sectional study was performed qualitatively and quantitatively with three doctors and 35 service users. Of these, 100 percent did not know the complementary and integrative therapies. After clear and simple explanation by the researcher, 31.42 percent said they would accept the use of herbal medicine, 51.42 percent accepted acupuncture, 37.14 percent would use homeopathy and none would use crenotherapy. When asked about the pharmaceutical care, 45.71 percent said they had heard of this matter, 22.85 percent know what it is and 31.42 percent had never heard of it. When the three doctors who at the clinic were questioned, there was indifference, non-acceptance and acceptance, respectively. In conclusion, this study showed that the vast majority of respondents would accept the complementary and integrative therapies if they were offered by the health unit. In addition, users find important a greater role of the pharmacist. One need to implement outreach programs for patients and especially for prescribers of complementary and integrative practices.

Synergy: an old wisdom, a new paradigm for pharmacotherapy / Sinergia: uma sabedoria antiga, um novo paradigma para a farmacoterapia

Synergy is one of the governing principles of the natural world, and is one of the reasons for the increasing complexity of the evolutionary process. Broadly speaking, it relates to the cooperative effects produced by the interaction between various forces, elements, parts or individuals in a given context. Since the last century, some clinical studies have described the increased efficiency of a combination of drugs. To study the effects of the drug interactions, the most commonly cited model is that of Loewe, and the classical graphical representation is the iso-effect curve (isobologram). Plants contain an enormous diversity of specialized micromolecules, therefore there is a high likelihood of interactions between them. Through recent synergy studies, various synergistic interactions have been demonstrated among extracts of different plants, and between components of the same extract.

Sinergia é um dos princípios que rege o mundo natural, apontado como uma das razões para a crescente complexidade do processo evolutivo. De uma forma ampla, ela se refere aos efeitos cooperativos produzidos pela interação entre diversas forças, elementos, partes ou indivíduos em um dado contexto. Desde o ultimo século, alguns estudos clínicos tem descrito a eficiência ampliada da combinação de fármacos. Para estudar os efeitos da interação de fármacos, o modelo mais citado é o da aditividade de Loewe, e também a representação clássica é o isobolograma, ou curva iso-efeito. As plantas contem uma diversidade enorme de micromoléculas especializadas, e consequentemente, alta probabilidade de interações entre elas. Através de estudos recentes dos efeitos sinérgicos, varias interações sinérgicas estão sendo demonstradas entre extratos de diferentes plantas e também entre componentes de um mesmo extrato.

Cómo medicalizar la vida diaria: la creación de enfermedades o disease mongering / Medicalizing people´s daily life, creating disease or disease mongering

En esta editorial se describe el problema de la medicalización de la vida diaria de las personas con fines económicos o de marketing, por medio de la creación de enfermedades o la exageración de situaciones fisiológicas, asociándolas con posibles sufrimientos o patologías ("disease mongering"). Se citan ejemplos como la calvicie, la timidez y ataques de pánico, el colon irritable y las disfunciones sexuales. Además, se analiza el rol de los médicos, los médicos de comunicación y la industria farmacéutica en esta problemática.

Role of chelates in treatment of cancer.

Chelates are used in cancer as cytotoxic agent, as radioactive agent in imaging studies and in radioimmunotherapy. Various chelates based on ruthenium, copper, zinc organocobalt, gold, platinum, palladium, cobalt, nickel and iron are reported as cytotoxic agent. Monoclonal antibodies labeled with radioactive metals such as yttrium-90, indium-111 and iodine-131 are used in radioimmunotherapy. This review is an attempt to compile the use of chelates as cytotoxic drugs and in radioimmunotherapy.

Diabetes tipo 2: nuevo algoritmo terapéutico basado en viejas drogas / Type 2 diabetes: new therapeutic algorithm based on old drugs

Este artículo resume la evidencia disponible sobre la eficacia de las sulfonilureas, la metformina, las ôglitazonasõ y la insulina para el tratamiento de los pacientes con diabetes tipo 2 y destaca el nuevo algoritmo consensuado por la Asociación Americana de Diabetes y la Asociación Europea para el Estudio de la Diabetes. Se sugiere que los profesionales que trabajan en el ámbito de la Atención Primaria se familiaricen con el uso de las glitazonas y la insulina.

Peroxisome proliferator-activated receptors as molecular targets for drug therapy.

Peroxisome proliferator-activated receptors (PPAR) are a family of nuclear receptors that regulate lipid and carbohydrate metabolism in response to extracellular fatty acids and their metabolites. They are crucial in the regulation of fat storage, besides having a potential role in insulin resistance syndrome. They have clinical relevance in understanding the cause and in development of drugs in common clinical conditions such as type 2 diabetes mellitus, cellular growth and neoplasia. Three types of receptors were identified: PPAR alpha, gamma and delta. Fibrate group of lipid lowering agents bind to the alpha isoform and glitazone group of insulin sensitizers to gamma isoform. Further advances can result in new drugs for atherosclerosis, malignancies and diabetes mellitus.

Human genome project: pharmacogenomics and drug development.

Now that all 30,000 or so genes that make up the human genome have been deciphered, pharmaceutical industries are emerging to capitalize the custom based drug treatment. Understanding human genetic variation promises to have a great impact on our ability to uncover the cause of individual variation in response to therapeutics. The study of association between genetics and drug response is called pharmacogenomics. The potential implication of genomics and pharmacogenomics in clinical research and clinical medicine is that disease could be treated according to the interindividual differences in drug disposition and effects, thereby enhancing the drug discovery and providing a stronger scientific basis of each patient's genetic constitution. Sequence information derived from the genomes of many individuals is leading to the rapid discovery of single nucleotide polymorphisms or SNPs. Detection of these human polymorphisms will fuel the discipline of pharmacogenomics by developing more personalized drug therapies. A greater understanding of the way in which individuals with a particular genotype respond to a drug allows manufacturers to identify population subgroups that will benefit most from a particular drug. The increasing emphasis on pharmacogenomics is likely to raise ethical and legal questions regarding, among other things, the design of research studies, the construction of clinical trials and the pricing of drugs.

Análise crítica das formas de tratamento na cardiomiopatia hipertrófica / Critical analysis of the therapeutic options in hypertrophic cardiomyopathy

O manuseio do portador de cardiomiopatia hipertrófica segue sendo objeto de dúvidas e controvérsias. Pacientes assinomáticos devem submeter-se a estratificação de risco, e os de baixo risco devem ficar sob acompanhamento e sem uso de medicação...