Eficacia y seguridad de la combinación de fexofenadina con montelukast en el tratamiento de la rinitis alérgica / Efficacy and safety of combined therapy of fexofenadine and montelukast for the treatment of allergic rhinitis

El propósito de este trabajo fue revisar la literatura científica que evalúa la eficacia y seguridad de las monoterapias de fexofenadina y montelukast, la terapia combinada (fija o en asociación) de montelukast - fexofenadina, así como de montelukast con otros antihistamínicos de segunda generación en el tratamiento de la rinitis alérgica. Se realizó una estrategia de búsqueda bibliográfica de múltiples etapas, en donde se identificaron estudios basados en ensayos clínicos y estudios no aleatorizados (ensayo controlado no aleatorizado, controlado antes-después, de series de tiempo interrumpidas, con controles históricos, de cohorte, de casos y controles, estudio transversal, y series de casos) en pacientes con rinitis alérgica, en las bases de datos MEDLINE/ PubMed, Scopus, Web of Science, Biblioteca Cochrane, Redalyc y Colección BVS y debido a la cantidad de resultados obtenidos se incluyó la búsqueda en Hinari. Con base en esta revisión se concluye que las combinaciones de antihistamínicos de segunda generación y antagonistas de leucotrienos y, en particular, la combinación fija de fexofenadina ­ montelukast es eficaz, segura y favorece la adherencia al tratamiento, y a largo plazo también ayuda a alcanzar el objetivo terapéutico.

The purpose of this work was to review the scientific literature that evaluates the efficacy and safety of monotherapies of fexofenadine and montelukast, the combined therapy (fixed-dose or separate drug combinations) of montelukast-fexofenadine, as well as the use of montelukast together with other second-generation antihistamines in the treatment of allergic rhinitis. A multistage literature search strategy was designed, including clinical trials and non-randomized studies (non-randomized controlled trial, controlled before-after study, interrupted time series study, historical control study, cohort study, case-control study, crosssectional study, and case series) evaluating patients with allergic rhinitis. The databases MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, Redalyc, BVS Collection, and, due to the number of results obtained, Hinari were included. Based on this review, the conclusion is that the combinations of secondgeneration antihistamines with leukotriene antagonists and, in particular, the fixed combination of fexofenadine-montelukast are effective, safe and promote treatment adherence. In the long term, they also help achieve therapeutic goals.

Medición de la obsolescencia de la información en revistas de salud pública de México.

INTRODUCCIÓN: En el proceso de comunicación científica, la obsolescencia se define como el descenso de la validez o utilidad de la información en el tiempo. OBJETIVO: Determinar el grado de obsolescencia de la información publicada en tres revistas de salud pública en México y cuantificar su pérdida de utilidad anual en un lapso determinado. MÉTODO: Estudio bibliométrico multisincrónico de revistas indizadas, arbitradas y activas, con más de 30 años de antigüedad. Variables analizadas: año de publicación de los artículos fuente, año de las referencias, edad de estas últimas. De las referencias de los artículos originales publicados entre 2008 y 2013 se obtuvieron variables e indicadores conforme el modelo matemático de Brooks y el método de la vida media. RESULTADOS: Se obtuvieron medidas de obsolescencia y valores medios de las variables para cada revista. Los valores indicaron vida media de 7.5 años; promedio de actualidad de 39.76 %, factor de envejecimiento de 91.15 %, pérdida de utilidad de 8.85 % anual, lo que representa la obsolescencia de la literatura en este tema y el país. CONCLUSIÓN: Este estudio delinea un perfil de obsolescencia para cada revista: el factor de envejecimiento y la pérdida anual de utilidad son consistentes con los mostrados por las principales revistas de salud pública en América Latina y España. INTRODUCTION: In the process of scientific communication, obsolescence is defined as the decrease of information validity or usefulness over time. OBJECTIVE: To determine the degree of obsolescence of information published in three public health journals in Mexico and quantify their annual utility loss in a given period. METHOD: Multisynchronous bibliometric study of indexed, peer-reviewed and active journals, with more than 30 years of existence. Analyzed variables: source articles' year of publication, references' year, age of the latter. From the references of original articles published between 2008 and 2013, variables and indicators were obtained according to Brooks' mathematical model and the half-life method. RESULTS: Obsolescence measurements and variables' mean values were obtained for each journal. The values obtained indicate a half-life of 7.5 years; actuality average, 39.76%; aging factor, 91.15%; loss of usefulness, 8.85% per year, which represents obsolescence of literature on this subject and country. CONCLUSIONS: This study delineates an obsolescence profile for each journal: the aging factor and annual loss of usefulness are consistent with those shown by the leading public health journals in Latin America and Spain.

[Indicators of obsolescence of the medical literature in a mexican pediatric journal]. / Indicadores de obsolescencia de la literatura médica en una revista pediátrica mexicana.

INTRODUCTION: Obsolescence is the decrease of the validity of the information in time and is known as literature aging. OBJECTIVES: To analyze the obsolescence of the literature of original articles published in 10 years in a Mexican pediatric journal. MATERIAL AND METHODS: Articles published in the Clinical Bulletin of Sonora Children's Hospital (BCHIES) were analyzed. The variables were: year, volume, number, percentage of original articles, reference year, total of references per article, operational and file; articles citations and self-citations, Price Indices, Burton-Kebler and Brookes, half-life, and aging factor. RESULTS: The 87 original articles (37%) contained 1,726 references, and the average was 19.8 per article; operational references were 398 (23%) and the file references, 1,287 (74.5%). There were 30 (34.4%) citations to articles, and self-citations were 19 (21%), half-life, 13.2 years; the aging factor was 0.86, the annual loss of income was 14%. CONCLUSIONS: The percentage of original articles from the BCHIES is close to 40%, likely to improve, and in the literature archive, the aging factor reversed.

Validación de una escala clinimétrica para el diagnóstico de depresión en pacientes con diabetes mellitus tipo 2, en unidades de atención primaria / Validation of a clinimetric scale for the diagnosis of depression in patients with diabetes mellitus type 2, in primary healt care

Background. The prevalence of depression in patients with type 2 diabetes mellitus (DM2) is of up to 49.3% in primary care clinics. Nevertheless, medical doctors only recognize only 30% of these cases. Depression is associated with poor glycemic control, increase of diabetes complications, deterioration in patient's quality of life, and increase in demand and resources to provide care. The objective was to design and validate a clinimetric scale for the diagnosis of depression (CSDD in patients with DM2, in primary care units. Patients and methods. The study was conducted on 528 DM2 patients in Family Medicine Unit No. 10 of the Instituto Mexicano del Seguro Social (Mexican Social Security Institute), during 2003. A diagnostic test design was employed, with the golden standard consisting of the composite international diagnostic interview. Samples were constructed around consecutive cases. Depression and its degrees were the dependent variables. Absolute and relative frequencies were calculated, along with the Kappa index, sensibility, specificity, positive predictive values (PPV) and negative predictive values (NPV) and ROC curves. Results. The CSDD presented a concordance between observers of 0.7739. The best cut-off point in the ROC curves for diagnosis of depression was 6, which obtained a sensibility of 95.3%, a specificity of 96.8%, a PPV of 92.2%, and a NPV of 98.1%. Conclusions. The CSDD is a consistent and valid instrument and easy to use for the diagnosis of depression in patients with DM2 in primary care clinic.

Antecedentes. La prevalencia de depresión en pacientes con diabetes mellitus tipo 2 (DM2) es hasta de 49.3% en unidades de atención primaria. El médico reconoce únicamente 30% de los casos, lo que lleva al paciente a un pobre control glucémico, aumento en las complicaciones propias de la diabetes, deterioro de la calidad de vida, mayor número de consultas e importante consumo de recursos institucionales. El objetivo del estudio fue diseñar y validar una escala clinimétrica para el diagnóstico de depresión (ECDD) en pacientes con DM2, en unidades de atención primaria. Pacientes y métodos. El estudio se llevó a cabo en 528 pacientes con DM2, en la Unidad de Medicina Familiar No. 10, del Instituto Mexicano del Seguro Social, durante 2003. Se utilizó un diseño de prueba diagnóstica, el estándar de oro fue la Cédula Diagnóstica Internacional Compuesta. El muestreo fue por casos consecutivos. La variable dependiente fue depresión y sus grados. Se calcularon frecuencias absolutas y relativas, índice Kappa, sensibilidad, especificidad, valores predictivos positivo (VPP) y negativo (VPN) y curvas ROC. Resultados. La ECDD presentó una concordancia interobservador de 0.7739. El mejor punto de corte en las curvas ROC para diagnosticar depresión fue 6, con el cual se obtuvo una sensibilidad de 95.3%, especificidad 96.8%, VPP 92.2% y VPN 98.1%. Conclusiones. La ECDD aplicada en pacientes con DM2 es un instrumento consistente, válido y de fácil aplicación para diagnosticar depresión durante el acto de la consulta en atención primaria.

[Validation of a clinimetric scale for the diagnosis for depression in patients with diabetes mellitus type 2, in primary health care]. / Validación de una escala clinimétrica para el diagnóstico de depresión en pacientes con diabetes mellitus tipo 2, en unidades de atención primaria.

BACKGROUND: The prevalence of depression in patients with type 2 diabetes mellitus (DM2) is of up to 49.3% in primary care clinics. Nevertheless, medical doctors only recognize only 30% of these cases. Depression is associated with poor glycemic control, increase of diabetes complications, deterioration in patient's quality of life, and increase in demand and resources to provide care. The objective was to design and validate a clinimetric scale for the diagnosis of depression (CSDD in patients with DM2, in primary care units. PATIENTS AND METHODS: The study was conducted on 528 DM2 patients in Family Medicine Unit No. 10 of the Instituto Mexicano del Seguro Social (Mexican Social Security Institute), during 2003. A diagnostic test design was employed, with the golden standard consisting of the composite international diagnostic interview. Samples were constructed around consecutive cases. Depression and its degrees were the dependent variables. Absolute and relative frequencies were calculated, along with the Kappa index, sensibility, specificity, positive predictive values (PPV) and negative predictive values (NPV) and ROC curves. RESULTS: The CSDD presented a concordance between observers of 0.7739. The best cut-off point in the ROC curves for diagnosis of depression was 6, which obtained a sensibility of 95.3%, a specificity of 96.8%, a PPV of 92.2%, and a NPV of 98.1%. CONCLUSIONS: The CSDD is a consistent and valid instrument and easy to use for the diagnosis of depression in patients with DM2 in primary care clinic.