Factores de riesgo psicosocial asociados con la diabetes mellitus gestacional: revisión sistemática / Psychosocial risk factors associated with gestational diabetes mellitus: systematic review

La diabetes mellitus gestacional DMG es una enfermedad con consecuencias mortales, incapacitantes y costosas para las personas, las familias, las comunidades y los países. Con el fin de establecer de manera sistemática los factores de riesgo psicosocial asociados con la DMG que deberían ser monitoreados durante y después del embarazo se realizó una revisión sistemática en las bases de datos PubMed/Medline y Cochrane. Se encontraron 1188 artículos y se seleccionaron 41. Algunos temas principales fueron conflictos con prácticas culturales, estigma social, influencia de la etnia/raza, bajo nivel educativo, calidad del sueño, problemas con la lactancia materna, preocupación por la propia salud o la del bebé, baja percepción de riesgo de DMG o de diabetes mellitus tipo 2 en el futuro, estrés, ansiedad y depresión, conocimiento limitado, falta de apoyo de la pareja, de la familia o social y de los profesionales de la salud, bajos niveles de autocuidado/autoeficacia y dificultades con cambios en el estilo de vida. Estos factores deberían monitorearse en las embarazadas durante y después del parto. Los tratamientos deberían considerar el impacto psicológico y el riesgo de desarrollar diabetes mellitus tipo 2 después del parto, y deberían ser incluidos en las guías de práctica clínica. Las poblaciones multiétnicas y los grupos más vulnerables demográficamente y socioeconómicamente son más susceptibles de desarrollar DMG.

Gestational diabetes mellitus (GDM) is a disease with fatal, disabling, and costly consequences for individuals, families, communities and countries. To systematically establish the psychosocial risk factors associated with GDM that should be monitored during and after pregnancy. Systematic review in PubMed/Medline and Cochrane databases. 1188 articles were found and 41 were selected. Some main themes were conflicts with cultural practices, social stigma, ethnicity/race influence, low educational level, sleep quality, breastfeeding problems, concern for ones own health/baby, low perception of the risk of GDM/DM2 in the future, stress, anxiety and depression, limited knowledge, lack of support from the partner/family/social and health professionals, low levels of self-care/self-efficacy and difficulties with changes in the lifestyle. These factors should be monitored in pregnant women during and after delivery. Treatments should consider the psychological impact and the risk of developing DM2 after childbirth and should be included in clinical practice guidelines. Multi-ethnic populations and the most demographically and socioeconomically vulnerable groups are more susceptible to developing GDM.

Evaluating the Medial Longitudinal Arch of the Foot: Correlations, Reliability, and Accuracy in People With a Low Arch.

BACKGROUND: The medial longitudinal arch of the foot is a variable structure, and a decrease in its height could affect several functions and increase the risk of injuries in the lower limbs. There are many different techniques for evaluating it. OBJECTIVE: The objective of this study was to evaluate the correlations of the Navicular Drop Test, several footprint parameters, and the Foot Posture Index-6 in people with a low medial longitudinal arch. Intrarater reliability and interrater reliability were also estimated. DESIGN: This was a repeated-measures, observational descriptive study. METHODS: Seventy-one participants (53.5% women; mean age = 24.13 years; SD = 3.41) were included. All of the parameters were collected from the dominant foot. The correlation coefficients were calculated. The reliability was also calculated using the intraclass correlation coefficient, 95% CI, and kappa coefficient. RESULTS: Statistically significant correlations were obtained between the Navicular Drop Test and the footprint parameters, with r absolute values ranging from 0.722 to 0.788. The Navicular Drop Test and the Foot Posture Index-6 showed an excellent correlation (Spearman correlation coefficient = 0.8), and good correlations (Spearman correlation coefficient = |0.663-0.703|) were obtained between the footprint parameters and the Foot Posture Index-6. Excellent intrarater reliability and interrater reliability were obtained for all of the parameters. LIMITATIONS: Radiographic parameters, the gold standard for evaluating the medial longitudinal arch height, were not used. In addition, the results of this research cannot be generalized to people with normal and high medial longitudinal arches. CONCLUSIONS: In participants with a low medial longitudinal arch, the Navicular Drop Test showed significant correlations with footprint parameters; correlations were good for the arch angle and Chippaux-Smirnak Index, and excellent for the Staheli Index. The Foot Posture Index-6 showed an excellent correlation with the Navicular Drop Test and a good correlation with the footprint parameters evaluated. All of the parameters showed high reliability.

Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch.

OBJECTIVES: To evaluate the reliability of the used diagnostic criteria of latent trigger points (LTrPs) and pressure pain thresholds and to evaluate the prevalence of LTrPs in several muscles of the lower limb in subjects with a lower medial longitudinal arch (MLA) compared with controls. DESIGN: Cross-sectional study. SETTING: University campus. PARTICIPANTS: Subjects with a lower limb MLA (n=82) and controls (n=82) (N=164). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The navicular drop test was used to classify subjects with a lower MLA (≥10mm) and controls (5-9mm). The Simons et al recommended specific diagnostic criteria and pressure pain thresholds were used to evaluate the prevalence of LTrPs in several muscles of the lower limb, which was compared between the 2 groups. The reliability was evaluated using Cohen's kappa and intraclass correlation coefficient. The unpaired Student t test and chi-square test were used to evaluate the difference in the LTrP prevalence between the 2 groups. RESULTS: The intrarater reliability of the navicular drop test and the diagnosis of LTrPs was excellent, with the taut band and tender spot being the most reliable diagnostic criteria. In the lower MLA group, 60 subjects (73%) presented at least 1 LTrP whereas 57 controls (70%) presented at least 1 LTrP. The lower MLA group showed more LTrPs (4.46±4.10) than did controls (3.32±3.24) (P<.05). There were significantly (P<.05) more subjects with LTrPs in the flexor digitorum longus, tibialis anterior, and vastus medialis in the lower MLA group than in the control group. CONCLUSIONS: LTrPs are common in the lower limb muscles in both controls and subjects with a lower MLA. A lower MLA is associated with a higher prevalence of LTrPs, which are significant in the flexor digitorum longus, tibialis anterior, and vastus medialis.

Assessment of the anticonvulsant activity of pyrazolo[1,5-a][1,3,5]triazines obtained by synthesis / Evaluación de la actividad anticonvulsiva de pirazolo [1,5-a] [1,3,5] triazinas obtenidos por síntesis

Giving that the pyrazolo[1,5-a][1,3,5]triazine system is a potential source of pharmacological agents for treatment of central nervous system disorders this work was aimed to asses anticonvulsant and acute neurotoxic effects of six molecules obtained by synthesis, using experimental models in mice. A series of six pyrazolo[1,5-a][1,3,5]triazines (EAC-21, EAC-31, EAC-33, MH4a, MH4b1 and MH4c) obtained by one-step reaction from S,S-diethyl aroyl-/hetaroylimidodithiocarbonates and 5-aminopyrazoles were screened in vivo (300 mg/kg, v.o.) for their anticonvulsant activity in the maximal electroshock (MES) test in ICR mice and for acute toxicity in the rota-rod and wiring test. The structures of the obtained compounds were unambiguously established by IR, 1H and 13C-NMR spectroscopic techniques, COSY 1H-1H, HSQC and HMBC experiments, mass spectrometry and elemental analyses. Results shown that only MH4b1 showed protection against MES (p<0.05) and was devoid of gross neurotoxicity signs. Therefore, MH4b1 was chosen for additional anticonvulsant screening against MES, pentilenetetrazole, picrotoxin, strychnine and 6 Hz psychomotor seizure model, in a dose dependent manner (50, 150, 300 mg/kg, v.o.). MH4b1 also protected against 6 Hz seizure test (>150 mg/kg, v.o.). These data suggest that MH4b1 could be a source for anticonvulsant pyrazolo[1,5-a][1,3,5]triazine analogs potentially useful against tonic clonic and refractory seizures.

Dado el interés que el sistema pirazolo[1,5-a][1,3,5]triazina tiene como fuente potencial para la obtención de agentes farmacológicos para el tratamiento de trastornos del sistema nervioso central, en este trabajo se efectuó el cribado anticonvulsivante y el efecto neurotóxico agudo de seis moléculas derivadas de este sistema, en ratones ICR. La serie de compuestos denominados EAC-21, EAC-31, EAC-33, MH4a, MH4b1 y MH4c, obtenidas por la reacción de S,S-dietil aroil-/heteroilimidoditiocarbonatos y 5-aminopirazoles se evaluó in vivo (300 mg/kg, v.o.) en la prueba de convulsiones inducidas por electrochoque y en las pruebas de actividad neurotóxica aguda del eje rodante y del alambre. La estructura de estos compuestos se determinó por técnicas de infrarrojo, espectroscopia de 1H, 13C-NMR, COSY 1H-1H, experimentos de HSQC y HMBC, espectrometría de masas y análisis elemental. Los resultados mostraron que el compuesto MH4b1 confirió protección frente a las convulsiones inducidas por electrochoque (p<0.05) sin producir signos de neurotoxicidad aguda. Por consiguiente, MH4b1 se escogió para las siguientes pruebas de actividad anticonvulsivante, dosis - respuesta (50, 150, 300 mg/kg, v.o.): electrochoque, pentilenetetrazol, picrotoxin, estricnina y el modelo de convulsión psicomotora de 6 Hz. MH4b1 mostró efectos protectores en función de la dosis frente a las pruebas de convulsión por electrochoque (>150 mg/kg) y convulsión de 6 Hz (300 mg/kg, v.o.). Estos resultados sugieren que MH4b1 podría constituirse en fuente anticonvulsivante del sistema pirazolo[1,5-a][1,3,5]triazina eventualmente útil para el tratamiento de las crisis tónicas clónicas generalizadas y las crisis refractarias.

Plesiomonas shigelloides infection, Ecuador, 2004-2008.

Diarrheal risk associated with Plesiomonas shigelloides infection was assessed in rural communities in northwestern Ecuador during 2004-2008. We found little evidence that single infection with P. shigelloides is associated with diarrhea but stronger evidence that co-infection with rotavirus causes diarrhea.

Farmacovigilancia activa en pacientes afiliados al sistema general de seguridad social en salud / Active pharmacosurveillance of patients affiliated to the Colombian general social security/health system

Objetivos Determinar los posibles resultados negativos asociados a la medicación mediante la metodología de búsqueda activa de posibles interacciones medicamentosas en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos A partir de las bases de datos de dispensación de medicamentos de Audifarma S.A a unos 4 millones de usuarios del país, se hizo una revisión sistemática de estadísticas de una serie de medicamentos identificados por presentar interacciones de riesgo, dosis diferentes a las recomendadas o dispensación irregular. Los casos son socializados con las EPS responsables. Resultados Se encontró un caso de nefrotoxicidad por ácido zoledrónico; el 37,0 por ciento de los usuarios de clopidogrel recibían concomitantemente omeprazol, que reduce la efectividad del primero; el 29,9 por ciento de los pacientes que toman losartan están recibiendo dosis superiores a las recomendadas para su indicación; el 2,0 por ciento de los pacientes que toman metoprolol o verapamilo, los recibe simultáneamente, con riesgo de generar bradicardia sinusal, bloqueos auriculoventriculares o disfunción sistólica. Todos los casos fueron notificados a los responsables en la EPS que atienden estos pacientes. Discusión La farmacovigilancia activa permite optimizar recursos, prevenir eventos adversos que puedan potencialmente causar morbilidad importante o incluso letalidad o determinar problemas que podrían ser responsables del fracaso terapéutico. Este tipo de estrategia se anticipa a la aparición de posibles riesgos para el paciente por lo que se recomienda considerarla para reforzar los programas de vigilancia de uso de medicamentos en el país.

Objectives Determining negative results associated with medication through an active search of possible drug interactions in databases for patients affiliated to the Colombian general social security/health system. Methods Statistics related to Audifarma S.A. dispensation drug databases for about 4 million Colombian users were systematically reviewed for identifying drugs having known interactions involving risk, doses different from recommended ones or irregular dispensation. The pertinent health-care providing services were made aware of the above. Results There was one case of nephrotoxicity being caused by zoledronic acid. 37 percent of clopidogrel users concomitantly received omeprazole which reduces the former's effectiveness. 29.9 percent of patients who were taking losartan were receiving doses higher than the recommended ones. 2.0 percent of patients who were taking metoprolol or verapamil were simultaneously receiving them, at the risk of generating first-degree heart block, bradycardia, or systolic dysfunction. All these cases were notified to the pertinent health-care services. Conclusions Active pharmacosurveillance leads to resources being optimised, adverse events which can potentially cause morbidity or lethality being prevented or even determining problems which could be responsible for therapeutic failure. This type of strategy anticipates the appearance of possible risks for patients, meaning that drug use monitoring programmes in Colombia should be reinforced.

[Active pharmacosurveillance of patients affiliated to the Colombian general social security/health system]. / Farmacovigilancia activa en pacientes afiliados al sistema general de seguridad social en salud.

OBJECTIVES: Determining negative results associated with medication through an active search of possible drug interactions in databases for patients affiliated to the Colombian general social security/health system. METHODS: Statistics related to Audifarma S.A. dispensation drug databases for about 4 million Colombian users were systematically reviewed for identifying drugs having known interactions involving risk, doses different from recommended ones or irregular dispensation. The pertinent health-care providing services were made aware of the above. RESULTS: There was one case of nephrotoxicity being caused by zoledronic acid. 37 % of clopidogrel users concomitantly received omeprazole which reduces the former's effectiveness. 29.9 % of patients who were taking losartan were receiving doses higher than the recommended ones. 2.0 % of patients who were taking metoprolol or verapamil were simultaneously receiving them, at the risk of generating first-degree heart block, bradycardia, or systolic dysfunction. All these cases were notified to the pertinent health-care services. CONCLUSIONS: Active pharmacosurveillance leads to resources being optimised, adverse events which can potentially cause morbidity or lethality being prevented or even determining problems which could be responsible for therapeutic failure. This type of strategy anticipates the appearance of possible risks for patients, meaning that drug use monitoring programmes in Colombia should be reinforced.

Quality and effectiveness of diabetes care for a group of patients in Colombia / Calidad y eficacia de la atención a diabéticos en un grupo de pacientes de Colombia

OBJECTIVE: To assess quality and effectiveness of diabetes care in a sample of Colombian diabetes patients treated by the national social security health system (SGSSS). METHODS: A retrospective study was conducted among 19 704 type 2 diabetes patients >30 years old who were SGSSS members, on pharmacological therapy, and treated at least twice by the SGSSS diabetes control program in one of nine cities from 1 July 2006 to 30 June 2007. A random sample of 406 was obtained. Using subjects' clinical history, the following factors were assessed: use of antidiabetic drugs and prescribed daily doses; use of antithrombotic therapies; additional medications; level and control of glycosylated hemoglobin (HbA1c), blood pressure, and cholesterol; urine albumin level; retinal and foot condition; and changes in medical regimens at most recent clinic visit. RESULTS: Annual risk factor testing rates were high (81.5 percent, HbA1c; 100 percent, blood pressure; 76.8 percent, total cholesterol), and a large proportion of patients were at target levels for HbA1c (42.9 percent <7.0 percent), blood pressure (66.2 percent <130/80 mmHg), and serum lipids (44.9 percent total cholesterol <200 mg/dL). However, only 6.9 percent were within recommended levels for all three risk factors. At most recent clinic visit, pharmaceutical regimens were adjusted for 39.7 percent, 58.2 percent, and 42.5 percent of patients above HbA1c, blood pressure, and cholesterol target levels, respectively. CONCLUSION: Despite high testing rates, metabolic control was not effective. Low rates of medication adjustment among patients with measures outside target ranges suggest the need for changes in routine diabetes care to ensure therapeutic regimens are adjusted appropriately.

OBJETIVO: Evaluar la calidad y la eficacia de la atención de la diabetes en una muestra de diabéticos colombianos tratados en el Sistema General de Seguridad Social en Salud (SGSSS). MÉTODOS: Estudio retrospectivo en 19 704 pacientes del SGSSS con tratamiento farmacológico para la diabetes tipo 2, mayores de 30 años y atendidos por el Programa de Control de la Diabetes del SGSSS al menos dos veces entre el 1 de julio de 2006 y el 30 de junio de 2007 en alguna de nueve ciudades. Se obtuvo una muestra aleatoria de 406 pacientes. A partir de sus historias clínicas se evaluaron los factores: consumo de medicamentos antidiabéticos y dosis diaria prescrita; tratamiento antitrombótico; medicamentos adicionales; nivel y control de la glucohemoglobina (HbA1c), presión arterial y colesterol; albuminuria; estado de los pies y la retina; y cambio de régimen terapéutico en la última consulta. RESULTADOS: Las tasas anuales de análisis relacionados con los factores de riesgo fueron elevadas (HbA1c: 81,5 por ciento, tensión arterial: 100 por ciento y colesterol total: 76,8 por ciento) y una alta proporción de los pacientes alcanzaron los valores recomendados de HbA1c < 7,0 por ciento (42,9 por ciento), tensión arterial < 130/80 mm Hg (66,2 por ciento) y colesterol total < 200 mg/dL (44,9 por ciento). Sin embargo, solo 6,9 por ciento de los pacientes tenían los niveles recomendados en los tres factores de riesgo. En la última consulta, se ajustó el régimen farmacológico a 39,7 por ciento, 58,2 por ciento y 42,5 por ciento de los pacientes que presentaban valores alterados de HbA1c, tensión arterial y colesterol, respectivamente. CONCLUSIONES: A pesar de la alta tasa de análisis, el control metabólico no fue eficaz. La baja tasa de ajuste del tratamiento de los pacientes con resultados fuera del rango recomendado indica que es necesario cambiar el procedimiento habitual de atención de los pacientes diabéticos para garantizar el adecuado ajuste de los regímenes...

Quality and effectiveness of diabetes care for a group of patients in Colombia.

OBJECTIVE: To assess quality and effectiveness of diabetes care in a sample of Colombian diabetes patients treated by the national social security health system (SGSSS). METHODS: A retrospective study was conducted among 19 704 type 2 diabetes patients >30 years old who were SGSSS members, on pharmacological therapy, and treated at least twice by the SGSSS diabetes control program in one of nine cities from 1 July 2006 to 30 June 2007. A random sample of 406 was obtained. Using subjects' clinical history, the following factors were assessed: use of antidiabetic drugs and prescribed daily doses; use of antithrombotic therapies; additional medications; level and control of glycosylated hemoglobin (HbA1c), blood pressure, and cholesterol; urine albumin level; retinal and foot condition; and changes in medical regimens at most recent clinic visit. RESULTS: Annual risk factor testing rates were high (81.5%, HbA1c; 100%, blood pressure; 76.8%, total cholesterol), and a large proportion of patients were at target levels for HbA1c (42.9% < or = 7.0%), blood pressure (66.2% <130/80 mmHg), and serum lipids (44.9% total cholesterol <200 mg/dL). However, only 6.9% were within recommended levels for all three risk factors. At most recent clinic visit, pharmaceutical regimens were adjusted for 39.7%, 58.2%, and 42.5% of patients above HbA1c, blood pressure, and cholesterol target levels, respectively. CONCLUSION: Despite high testing rates, metabolic control was not effective. Low rates of medication adjustment among patients with measures outside target ranges suggest the need for changes in routine diabetes care to ensure therapeutic regimens are adjusted appropriately.

[Adverse drug reactions in patients attending in emergency service]. / Reacciones adversas medicamentosas en pacientes que consultaron a instituciones prestadoras de servicios en Pereira, Colombia.

OBJECTIVE: Describing adverse drug reactions (ADR) and analyzing the factors associated with their appearance in patients attending two hospitals' emergency services. METHODS: Descriptive, medicine-surveillance study of people consulting the emergency service at the Rosales hospital and the basic total health attention unit in Pereira, Colombia, between July and September 2005 for any symptom related to taking medicine. Naranjo's Adverse Drug Reaction probability scale was used. RESULTS: A total of 91 patients were found; 62,6 % were women having an average age of 36,3+/-22,4 (range 0-85). Antibiotics (24,2 %) NSAIDs (17,6 %), analgesics (9,9 %) and antidiabetic agents (8,8 %) were the most used drugs. 39,6 % of the patients only used one medicine; the average of drugs per patient was 2,4+/-1,5. Self-medication was present in 25,3 %. The most common ADRs arose from urticaria (31,9 %), hypoglycaemia (8,8 %), gastritis (6,6 %), angioedema (5,5 %) and anaphylaxis (4,4 %). 13,2 % of ADRs were serious and 54,9 % were avoidable. 14,3 % of ADRs were classified as being definite and 75,8 % probable. Only 14,3 % of patients had a past history of ADR. The average cost of being attended was US$ 78,1 dollars. Analgesic use was associated with anaphylaxis, antibiotics with urticaria whilst NSAIDs was associated with gastritis and gastrointestinal bleeding, antidiabetic agents with hypoglycaemia, antipsychotic and antidepressants agents with neurological symptoms and warfarin with bleeding. CONCLUSIONS: The most important ADR-associated risk factors in patients attending emergency services were determined. Special care must be paid to patients using NSAIDs, warfarin, metoclopramide, metamizole, antipsychotic and antidepressants agents, antidiabetic agents and antibiotics, having a past history of ADR, being more than 55 years old and presenting urticaria, digestive and/or neurological symptoms

Reacciones adversas medicamentosas en pacientes que consultaron a instituciones prestadoras de servicios en Pereira, Colombia / Adverse drug reactions in patients attending in emergency service

OBJETIVO: Describir las reacciones adversas medicamentosas (RAM) y analizar factores asociados con su aparición en pacientes consultantes en servicios de urgencias de dos clínicas. MÉTODOS: Estudio de farmacovigilancia, descriptivo, prospectivo, de personas que consultan en servicios de urgencias de Clínica los Rosales y Unidad Atención Básica Salud Total en Pereira, entre julio y septiembre de 2005, por cualquier síntoma relacionado con toma de medicamentos. RESULTADOS: Total 91 notificaciones. El 62,6 por ciento en mujeres, edad promedio 36,3 ± 22,4 años, rango: 0-85 años. Grupos farmacológicos más representativos: antibióticos (24,2 por ciento), AINES (17,6 por ciento), analgésicos (9,9 por ciento) y antidiabéticos (8,8 por ciento). El 39,6 por ciento de pacientes utilizaban solo un medicamento, promedio de fármacos por paciente fue 2,4 ± 1,5. El 25,3 por ciento se automedicó. Las RAM más frecuentes fueron urticaria alérgica (31,9 por ciento), hipoglicemia (8,8 por ciento), gastritis agudas (6,6 por ciento), edema angioneurótico (5,5 por ciento) y anafilaxia (4,4 por ciento). El 13,2 por ciento de las RAM fueron graves y el 54,9 por ciento fueron predecibles. Se clasificaron como definitivas el 14,3 por ciento y probables el 75,8 por ciento. El 14,3 por ciento de los pacientes tenían antecedentes de RAM. El costo promedio de atención fue US $ 78,1. El uso de analgésicos estuvo relacionado con anafilaxia; de antibióticos con urticaria alérgica; de AINES con gastritis y hemorragia digestiva; de antidiabéticos con hipoglicemia; de psicofármacos con síntomas neurológicos, y de warfarina con hemorragias. CONCLUSIONES: Se determinaron los factores asociados de manera más importante con RAM en pacientes que acudieron a servicios de urgencias. Se debe prestar especial atención al uso de AINES, warfarina, metoclopramida, dipirona, psicofármacos, hipoglicemiantes y antiinfecciosos, a la historia previa de RAM, la edad mayor de 55 años y presentar síntomas en piel, digestivos y neurológicos.