[Prescription of acetylcholinesterase inhibitors and memantine in the Canary Islands, comparison with the Spanish population.] / Prescripción de inhibidores de acetilcolinesterasa y memantina en Canarias: comparación con la población española.

OBJECTIVE: In the Canary Islands the prescriptions billed to the National Health System are registered in a database (FarmaCanarias). The main objective was to estimate the consumption of Acetylcholinesterase inhibitors (IACE) and Memantine in Canary Islands and to compare with a Spanish sample from Pharmacoepidemiological Research Base in Primary Care (PRBPC) which is national in scope. As secondary we determined the percentage in treatment in the Spanish sample. METHODS: The prescriptions of IACE and / or memantine in 2017 were calculated as Defined Daily Doses per 100 habitants (DHD) in FarmaCanarias and PRBPC. The prescriptions in FarmaCanarias were disclosed by island and age groups were also compared. The percentage of cases in treatment was calculated in PRBPC from records with diagnosis of "dementia". All the comparations were made by Pearson's χ2. RESULTS: The prescription of IACE and Memantine was: 3.042% (95% CI; 3.039-3.045) and 1.584% (95% CI; 1.582-1.587) in The Canary islands, respectively and 2.545% (95% CI; 2.518-2.572) and 0.922% (95% CI; 0.906-0.938), in PRBPC (p<0.001). DHDs between islands were different, except in two (p<0.001) The distribution by age group between FarmaCanarias and PRBPC was hetereogeneous (p<0.001). The percentage of dementia cases in treatment in PRBPC was 45.51% (95% CI; 45.186-45.838). CONCLUSIONS: The prescription of IACE and Memantine was higher in the Canary Islands, which added to the difference by age group, suggests epidemiological differences in dementia compared to the mainland. There is heterogeneity between islands that could be due to epidemiological factors, provider or the Public Health Service.

OBJETIVO: En Canarias las recetas facturadas al Sistema Nacional de Salud están registradas en una base de datos (FarmaCanarias). El objetivo principal de este estudio fue calcular el consumo de inhibidores de la acetilcolinesterasa (IACE) y memantina en Canarias y compararlo con una muestra representativa de la población española procedente de la Base de Investigación Farmacoepidemiológica en Atención Primaria (BIFAP). Como objetivo secundario determinamos el porcentaje de casos tratados en la muestra española. METODOS: Las prescripciones de IACE y/o memantina se calcularon como Dosis Diarias Definidas por 100 habitantes (DHD) en FarmaCanarias y en BIFAP. Se calcularon los resultados por isla y también se compararon por grupos de edad. Los casos tratados se calcularon como porcentaje sobre los casos con demencia totales en BIFAP. Todas las comparaciones fueron efectuadas con la χ2 de Pearson. RESULTADOS: El consumo de IACE y Memantina fue de 3,042% (IC 95%; 3,039-3,045) y 1,584% (IC 95%; 1,582-1,587) en Canarias, respectivamente y de 2,545% (IC 95%; 2,518-2,572) y 0,922% (IC 95%; 0,906-0,938), en BIFAP (p<0,001). Las DHD entre islas fueron diferentes, salvo en dos (p<0,001). La distribución por grupos de edad entre FarmaCanarias y BIFAP fue heterogénea (p<0,001). El porcentaje de casos tratados en BIFAP fue: 45,51% (IC 95%; 45,186-45,838). CONCLUSIONES: La prescripción de IACE y Memantina fue mayor en Canarias lo que, añadido a la diferencia por grupos de edad, sugiere diferencias epidemiológicas en demencia frente al resto de España. Existe heterogeneidad entre islas que podría deberse a factores epidemiológicos, de proveedor o del Servicio Público de Salud.

COVID-19 y diabetes mellitus: una relación bidireccional / COVID-19 and diabetes: A bidirectional relationship

El coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es el agente causal de la enfermedad por coronavirus 2019 (COVID-19). La diabetes es una de las comorbilidades más frecuentes en personas con COVID-19, con una prevalencia que varía según los estudios entre el 7 y el 30%. Los diabéticos infectados con SARS-CoV-2 tienen una tasa más alta de admisión hospitalaria, neumonía severa y mayor mortalidad en comparación con sujetos no diabéticos. La hiperglucemia crónica puede comprometer la inmunidad innata y la inmunidad humoral. Además, la diabetes se asocia con un estado inflamatorio crónico de bajo grado que favorece el desarrollo de una respuesta inflamatoria exagerada y, por tanto, la aparición del síndrome de distrés respiratorio agudo. Evidencia reciente ha demostrado que el SARS-CoV-2 también es capaz de producir un daño directo al páncreas, que podría empeorar la hiperglucemia e incluso inducir la aparición de diabetes en sujetos previamente no diabéticos. Las estrategias terapéuticas deben dirigirse a facilitar el acceso de los pacientes al sistema sanitario. El control de la glucemia y de las comorbilidades debe ser individualizado a fin de reducir la incidencia de complicaciones y disminuir la carga en los sistemas de salud. En este artículo revisaremos los mecanismos fisiopatológicos que explican la relación bidireccional entre COVID-19 y diabetes mellitus, su implicación en el pronóstico y el manejo de la hiperglucemia en este grupo de pacientes.(AU)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Diabetes is one of the most frequent comorbidities in people with COVID-19 with a prevalence that varies between 7 and 30%. Diabetics infected with SARS-CoV-2 have a higher rate of hospital admission, severe pneumonia, and higher mortality compared to non-diabetic subjects. Chronic hyperglycemia can compromise innate and humoral immunity. Furthermore, diabetes is associated with a low-grade chronic inflammatory state that favors the development of an exaggerated inflammatory response and therefore the appearance of acute respiratory distress syndrome. Recent evidence has shown that SARS-CoV-2 is also capable of causing direct damage to the pancreas that could worsen hyperglycemia and even induce the onset of diabetes in previously non-diabetic subjects. Therapeutic strategies should be aimed at facilitating patient access to the healthcare system. Control of blood glucose and comorbidities must be individualized in order to reduce the incidence of complications and decrease the burden on health systems. In this article we will review the pathophysiological mechanisms that explain the bidirectional relationship between COVID-19 and diabetes mellitus, its implication in the prognosis and management of hyperglycemia in this group of patients.(AU)

COVID-19 and diabetes: A bidirectional relationship. / COVID-19 y diabetes mellitus: una relación bidireccional.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of coronavirus disease 2019 (COVID-19). Diabetes is one of the most frequent comorbidities in people with COVID-19 with a prevalence that varies between 7 and 30%. Diabetics infected with SARS-CoV-2 have a higher rate of hospital admission, severe pneumonia, and higher mortality compared to non-diabetic subjects. Chronic hyperglycemia can compromise innate and humoral immunity. Furthermore, diabetes is associated with a low-grade chronic inflammatory state that favors the development of an exaggerated inflammatory response and therefore the appearance of acute respiratory distress syndrome. Recent evidence has shown that SARS-CoV-2 is also capable of causing direct damage to the pancreas that could worsen hyperglycemia and even induce the onset of diabetes in previously non-diabetic subjects. Therapeutic strategies should be aimed at facilitating patient access to the healthcare system. Control of blood glucose and comorbidities must be individualized in order to reduce the incidence of complications and decrease the burden on health systems. In this article we will review the pathophysiological mechanisms that explain the bidirectional relationship between COVID-19 and diabetes mellitus, its implication in the prognosis and management of hyperglycemia in this group of patients.

Utilidad de la ficha técnica de los medicamentos como herramienta para mejorar la prescripción en pacientes mayores / Usefulness of the summary of product characteristics as a tool to improve prescription in elderly patients

ANTECEDENTES Y OBJETIVO: La ficha técnica debe contribuir a un uso seguro y efectivo de medicamentos en las personas de edad avanzada, proporcionando información precisa sobre la prescripción, sobre los posibles beneficios o riesgos de los medicamentos, o en su defecto comunicando la falta de información sobre su uso en este grupo. Nuestro objetivo fue cuantificar la información específica para personas mayores de 65 años contenida en las fichas técnicas de los fármacos comercializados en España, y que permite una adecuada prescripción en dicha población. MATERIALES Y MÉTODOS: Un grupo multidisciplinar revisó todas las fichas técnicas de los medicamentos autorizados por la Agencia Española de Medicamentos y Productos Sanitarios. Se clasificó la calidad de la información en 4 categorías: información referida específicamente a la población de más de 65 años, información referida específicamente a la población de más de 80 años, recomendaciones no específicas para los ancianos e información específica para los ancianos. RESULTADOS: Se revisaron un total de 1.462 fichas técnicas, de las cuales el 48% tenía información relativa a la prescripción en ancianos. La información sobre el uso en mayores de 80 años estaba presente en el 1,23% de las fichas. Solo 6,83% del total de las fichas revisadas incluía recomendaciones específicas para el anciano. CONCLUSIONES: Hay poca información específica para la adecuada prescripción en personas de edad avanzada, en las fichas técnicas de los fármacos comercializados en España. Para mejorar el conocimiento en este campo debemos incluir datos en las fichas basados en la literatura científica, de ensayos clínicos dirigidos a personas mayores o de estudios de farmacovigilancia centrados en esta población

BACKGROUND AND OBJECTIVE: The Drug Technical Data Sheet should contribute to a safe and effective use of medications in the elderly, providing accurate information on the prescription, on the possible benefits or risks of the medications, or failing that, communicating the lack of information on their use in this group. The aim of this article was to quantify the specific information for people over 65 years of age included in the data sheets of the drugs available in Spain, and enables an adequate prescription in this population. MATERIALS AND METHODS: A multidisciplinary group reviewed all the Technical Data Sheets of drugs approved by the Spanish Agency for Medicines and Health Devices (AEMPS). The quality of the information was classified into 4 categories: information specifically referring to the population over 65 years old; information specifically referring to the population over 80 years old; recommendations not specific to the elderly; and specific information for the elderly. RESULTS: A total of 1,462 Technical Sheets were reviewed, of which 48% had information regarding prescription in the elderly. Information on the use in patients over 80 years old was present in 1.23% of the sheets. Only 6.83% of all the sheets reviewed included specific recommendations for the elderly. CONCLUSIONS: There is little specific information regarding prescription in the elderly in the technical data sheets of drugs prescribed/sold in Spain. To improve knowledge in this field, data must be provided in the sheets that are based on the scientific literature, clinical trials for the elderly, or pharmacovigilance studies focused on this population

[Usefulness of the summary of product characteristics as a tool to improve prescription in elderly patients]. / Utilidad de la ficha técnica de los medicamentos como herramienta para mejorar la prescripción en pacientes mayores.

BACKGROUND AND OBJECTIVE: The Drug Technical Data Sheet should contribute to a safe and effective use of medications in the elderly, providing accurate information on the prescription, on the possible benefits or risks of the medications, or failing that, communicating the lack of information on their use in this group. The aim of this article was to quantify the specific information for people over 65 years of age included in the data sheets of the drugs available in Spain, and enables an adequate prescription in this population. MATERIALS AND METHODS: A multidisciplinary group reviewed all the Technical Data Sheets of drugs approved by the Spanish Agency for Medicines and Health Devices (AEMPS). The quality of the information was classified into 4 categories: information specifically referring to the population over 65 years old; information specifically referring to the population over 80 years old; recommendations not specific to the elderly; and specific information for the elderly. RESULTS: A total of 1,462 Technical Sheets were reviewed, of which 48% had information regarding prescription in the elderly. Information on the use in patients over 80 years old was present in 1.23% of the sheets. Only 6.83% of all the sheets reviewed included specific recommendations for the elderly. CONCLUSIONS: There is little specific information regarding prescription in the elderly in the technical data sheets of drugs prescribed/sold in Spain. To improve knowledge in this field, data must be provided in the sheets that are based on the scientific literature, clinical trials for the elderly, or pharmacovigilance studies focused on this population.

WITHDRAWN: Pulmonary Hemorrhage in a Patient With ST-segment Elevation Acute Myocardial Infarction Treated With Ticagrelor: A Case Report.

This article has been withdrawn at the request of the Editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Determinants of organochlorine levels detectable in the amniotic fluid of women from Tenerife Island (Canary Islands, Spain).

Organochlorines (OCs) tend to accumulate in human tissues and can be measured in amniotic fluid (AF). The detection of OCs in AF samples reflects intrauterine exposure of human beings to these persistent organic pollutants. The present study was performed to evaluate the level of contamination of AF by OCs in 100 pregnant women from Tenerife Island (Canary Islands, Spain). Gas chromatography/mass spectrometry (GC/MS) was used to identify and quantify the analytes, including 7 polychlorobiphenyl (PCB) congeners and 18 OC pesticides and metabolites. The majority of the AF samples (67%) showed some detectable OC-residue, hexachlorobenzene (HCB) being the most frequently detected compound (66% of the samples) and at the highest concentration (median 0.023 ng/ml). Lindane was also detected in 28% of the samples. Inverse associations were found between previous lactation and hexachlorocyclohexane isomers (HCH) and cyclodienes in the group of younger women (p = 0.037 and p = 0.027, respectively). Unexpectedly, serum values of HCB (r = -0.414; p = 0.04), gamma-HCH (r = -0.294; p = 0.035), and SigmaOCs (r = -0.350; p = 0.014) were negatively related to age. Even more, women with detectable levels of HCH isomers were younger (33.9 +/- 4.9 years) than women with undetectable levels of them (36.1 +/- 4.9 years; p = 0.035). We conclude that approximately one in two fetuses in the Canary Islands is exposed to OCs in utero, and that, therefore, the exposure of young women from these Islands to some HCH isomers persists nowadays. Because prenatal exposure to these chemicals may be a causative factor in adverse health trends, further studies are required to enhance preventive measures.

Net efficacy adjusted for risk (NEAR): a simple procedure for measuring risk:benefit balance.

BACKGROUND: Although several mathematical models have been proposed to assess the risk:benefit of drugs in one measure, their use in practice has been rather limited. Our objective was to design a simple, easily applicable model. In this respect, measuring the proportion of patients who respond favorably to treatment without being affected by adverse drug reactions (ADR) could be a suitable endpoint. However, remarkably few published clinical trials report the data required to calculate this proportion. As an approach to the problem, we calculated the expected proportion of this type of patients. METHODOLOGY/PRINCIPAL FINDINGS: Theoretically, responders without ADR may be obtained by multiplying the total number of responders by the total number of subjects that did not suffer ADR, and dividing the product by the total number of subjects studied. When two drugs are studied, the same calculation may be repeated for the second drug. Then, by constructing a 2 x 2 table with the expected frequencies of responders with and without ADR, and non-responders with and without ADR, the odds ratio and relative risk with their confidence intervals may be easily calculated and graphically represented on a logarithmic scale. Such measures represent "net efficacy adjusted for risk" (NEAR). We assayed the model with results extracted from several published clinical trials or meta-analyses. On comparing our results with those originally reported by the authors, marked differences were found in some cases, with ADR arising as a relevant factor to balance the clinical benefit obtained. The particular features of the adverse reaction that must be weighed against benefit is discussed in the paper. CONCLUSION: NEAR representing overall risk-benefit may contribute to improving knowledge of drug clinical usefulness. As most published clinical trials tend to overestimate benefits and underestimate toxicity, our measure represents an effort to change this trend.

Influencia del comportamiento del niño en el hogar, en la consulta odontológica / Correlation between child's behavior at home and about odontological consultation

Un estudio observacional descriptivo de correlación fue realizado para demostrar la relación existente entre la conducta del niño en el hogar con respecto a la consulta odontológica.Para este estudio se tomó como universo la Clínica Odontológica Santa Mónica de la E.C.M donde se recolectó una muestra de 100 niños por disponibilidad,en edades comprendidas entre los 5-12 años sin discriminar su sexo.Los datos fueron obtenidos por medio de una encuesta y observación durante la consulta.Se utilizó para probar significacncia el coeficiente de contingencia,el cual se establece por medio de la prueba Chi2 se realizaron ciertas relaciones para determinar la verdadera asociación de las variables.Los resultados muestran una gran relación entre la conducta del niño en el hogar y la conducta del niño en la consulta,a medida que la edad del infante aumenta.