Control glucémico en pacientes diabéticos tipo 2 de edad avanzada. Intervención para evitar riesgos / Blood-glucose control in eldely patients with type 2 diabetes. Interventions to avoid risks

OBJETIVO: Evaluar el control glucémico de pacientes de edad avanzada, con diabetes mellitus tipo 2 (DM2), en tratamiento con varios antidiabéticos, y analizar el efecto de una intervención. MATERIAL Y MÉTODOS: Estudio descriptivo transversal y observacional de prevalencia que incluyó a pacientes ≥75 años con DM2, en tratamiento con 2 o más hipoglucemiantes. Se analizó la adecuación de los tratamientos siguiendo las recomendaciones actuales para este grupo poblacional, la prevalencia de complicaciones macro y microvasculares, demencia e hipoglucemias, los tratamientos empleados y la adherencia. Se realizó una intervención para optimizar la prescripción. RESULTADOS: Se incluyeron 215 pacientes. El 54,4% fueron mujeres, con edad media de 82,0±4,1 años, el 77,2% tenía complicaciones macro y/o microvasculares y el 7,4% demencia. En el 67,9% se detectó inadecuación por control glucémico demasiado intensivo (55,6% HbA1c<7,5%) o no estar ajustada la posología a su filtrado glomerular (51,0%). El 81,4% estaba en tratamiento con fármacos con riesgo de producir hipoglucemias; el 2,3% tenía algún episodio registrado. La HbA1c media fue mayor en los no adherentes (8,1±1,6% vs. 7,5±1,3%, p < 0,05). Tras la intervención disminuyó la intensidad del tratamiento hipoglucemiante en el 36,2% de los pacientes, y se adecuó la posología en el 23,1% de los fármacos que precisaban ajuste. El porcentaje de sobretratamiento se redujo al 40,0% (p < 0,01). CONCLUSIONES: Más de la mitad de los pacientes mayores, con DM2 e importantes comorbilidades, tenía un control glucémico demasiado estricto. La puesta en marcha de un programa de intervención ha permitido mejorar la seguridad y la adecuación de los tratamientos

OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments

[Blood-glucose control in eldely patients with type 2 diabetes. Interventions to avoid risks]. / Control glucémico en pacientes diabéticos tipo 2 de edad avanzada. Intervención para evitar riesgos.

OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments.

Análisis de la utilización de inhibidores de la bomba de protones en Atención Primaria / Analysis of the use of proton pump inhibitors in primary health care

Objetivo: El incremento en el consumo de antiulcerosos se acompaña de una elevada tasa de utilización incorrecta. Los objetivos del estudio fueron analizar la adecuación de la prescripción crónica de inhibidores de la bomba de protones (IBP) en un centro de salud, así como la eficacia de una intervención de mejora. Material y métodos: Estudio descriptivo transversal y observacional de prevalencia que incluyó a pacientes de un centro de salud en tratamiento con IBP durante, al menos, 3meses consecutivos (de noviembre de 2016 a enero de 2017). Se analizó la indicación, posología y duración de tratamiento del IBP, interacciones farmacológicas y posibles riesgos que pudieran relacionarse con el uso continuado de IBP. Se realizó una intervención para optimizar la prescripción racional y eficiente de estos fármacos. Resultados: Se incluyó a 703 pacientes, lo que supone el 5,4% sobre el total de los pacientes mayores de edad adscritos al centro. De ellos, 436 (62,0%) no presentaban criterios de adecuación; el 52,5% eran mujeres, el 70,0% mayores de 65 años y llevaban una media de 2,7 ± 1,9 años en tratamiento. El 48,1% presentaban interacciones y el 29,0%, algún factor de riesgo. Tras la intervención se corrigió la prescripción inadecuada a 112 pacientes (25,7%), que se redujo al 46,1% (p < 0,001). Conclusiones: Existe una elevada prevalencia de prescripción e inadecuación de IBP a largo plazo, por lo que resulta necesario mejorar la formación de los profesionales para potenciar su uso racional y reducir los riesgos. La puesta en marcha de un programa de intervención ha permitido revisar y optimizar los tratamientos

Objective: The increase in the consumption of anti-ulcer drugs is accompanied by a high rate of incorrect use. The objectives of this study were to analyse the adequacy of repeat prescriptions of proton pump inhibitors (PPIs) in a Medical Centre, and to evaluate the efficacy of an improvement intervention. Material and method: A cross-sectional, descriptive and observational study of prevalence was conducted on patients in a medical centre under treatment with PPIs for at least 3consecutive months (November 2016-January 2017). An analysis was performed that included the indication, dosage and time of treatment with PPIs, drug interactions, and possible risks that could be related with their use. An intervention was carried out to optimise rational and efficient prescribing of these medicines. Results: A total of 703 patients were included in the study, which is 5.4% of the total adult patients that are assigned to the centre. Adequacy criteria were not met by 436 (62.0%). Of these, 52.5% were women, 70.0% were over 65 years old, and had been on treatment for a mean of 2.7 ± 1.9 years. Interactions were observed in 48.1%, and 29.0% had some risk factors. After the intervention, the inadequate prescribing was corrected in 112 (25.7%) patients, which was a reduction of 46.1% (P<.001). Conclusions: There is a high prevalence of prescription and inadequacy of PPIs in the long term. This suggests that it is necessary to improve training of professionals to strengthen rational use and to reduce risks. The launch of an intervention programme has led to the revision and optimisation of treatments

[Analysis of the use of proton pump inhibitors in primary health care]. / Análisis de la utilización de inhibidores de la bomba de protones en Atención Primaria.

OBJECTIVE: The increase in the consumption of anti-ulcer drugs is accompanied by a high rate of incorrect use. The objectives of this study were to analyse the adequacy of repeat prescriptions of proton pump inhibitors (PPIs) in a Medical Centre, and to evaluate the efficacy of an improvement intervention. MATERIAL AND METHOD: A cross-sectional, descriptive and observational study of prevalence was conducted on patients in a medical centre under treatment with PPIs for at least 3consecutive months (November 2016-January 2017). An analysis was performed that included the indication, dosage and time of treatment with PPIs, drug interactions, and possible risks that could be related with their use. An intervention was carried out to optimise rational and efficient prescribing of these medicines. RESULTS: A total of 703 patients were included in the study, which is 5.4% of the total adult patients that are assigned to the centre. Adequacy criteria were not met by 436 (62.0%). Of these, 52.5% were women, 70.0% were over 65 years old, and had been on treatment for a mean of 2.7 ± 1.9 years. Interactions were observed in 48.1%, and 29.0% had some risk factors. After the intervention, the inadequate prescribing was corrected in 112 (25.7%) patients, which was a reduction of 46.1% (P<.001). CONCLUSIONS: There is a high prevalence of prescription and inadequacy of PPIs in the long term. This suggests that it is necessary to improve training of professionals to strengthen rational use and to reduce risks. The launch of an intervention programme has led to the revision and optimisation of treatments.

Evolución del consumo de opioides en Castilla y León desde el año 2000 al 2006 / No disponible

Objetivo: analizar la evolución del consumo de opioides en Castilla y León desde el año 2000 al 2006. Métodos: estudio retrospectivo y descriptivo. A partir del sistema de información de farmacia de Castilla-León (CONCYLIA), se obtuvo el consumo de fármacos del grupo terapéutico N02A (analgésicos narcóticos), a través de receta del Sistema Nacional de Salud, en el periodo 2000-2006, expresándolo en dosis por 1.000 habitantes día (DHD). Resultados: el consumo de opioides se duplicó desde el 2000 (2,1DHD) al 2006 (4,6 DHD), con un incremento progresivo y constante. Ávila presentó el crecimiento más acusado, seguido de Soria y León, mientras que Burgos y Valladolid se mantuvieron por debajo de la media. Tramadol fue el fármaco más utilizado durante todo el periodo. En el 2006 el 95% del consumo lo representaron: tramadol (1,78 DHD), fentanilo (0,89DHD), tramadol en asociación (0,82 DHD), codeína en asociación (0,53DHD) y buprenorfina (0,34 DHD). La morfina pasó de 0,18 a 0,17 DHD en el año 2006 (3,7% sobre el total). La vía de administración más utilizada en el 2006 fue la oral (73,1%), seguido de la transdérmica (25,9%). Conclusiones: se evidencia un cambio en la prescripción de opioides debido a la comercialización de nuevos fármacos (oxicodona y tramadol en asociación) y nuevas vías de administración (transdérmica y oral transmucosa), que favorecen el aumento progresivo de la utilización de estos fármacos y un incremento en el gasto farmacéutico (AU)

Objective: to analyze the evolution of opioid consumption in Castile & Leon (Spain) from year 2000 to 2006. Methods: a retrospective, descriptive study. The use of drugs in therapeutic group N02A (narcotic analgesics) was obtained from pharmacy information systems in Castile & Leon (CONCYLIA) regarding prescriptions made by the National Health System in 2000-2006 (expressed in doses per 1,000 inhabitants per day (DHD). Results: opioid consumption has doubled from 2000 (2.1 DHD) to 2006 (4.6 DHD), with a progressive and constant increase. Ávila grew most, followed by Soria and León, whereas Burgos and Valladolid remained below average. Tramadol was the most commonly used drug during the whole period. In 2006 95% of consumption was: tramadol (1.78 DHD), fentanyl (0.89 DHD), tramadol in association (0.82 DHD), codeine in association (0.53 DHD), and buprenorphine (0.34 DHD). Morphine increased from 0.18 to 0.17 DHD in 2006 (3.7% of total). The most commonly used route of administration in 2006 was oral (73.1%), followed by transdermal (25.9%). Conclusions: a change in the prescription of opioids is observed due to the marketing of new medications (oxycodone and tramadol in association) and new routes of administration (transdermic and oral transmucosal), which favor a progressive increase in the use of these drugs and anincrease in pharmaceutical expense (AU)

[Estimate of the prevalence of hypothyroidism in Castilla y Leon and its trends from 1992 to 2000 based on the use of thyroid hormones]. / Estimación de la prevalencia del hipotiroidismo en Castilla y León y su evolución desde 1992 al 2000 a través del consumo de hormonas tiroideas.

BACKGROUND: The significance of hypothyroidism from an epidemiological viewpoint and the difficulty of obtaining updated information have led us to undertake this study, the objective of which is to ascertain the level of consumption of thyroid hormones in the general population within the scope of the Social Security health care system in the Community of Castilla y León, by provinces, together with its progress from 1992 to 2000, as an estimative indicator of the prevalence of hypothyroidism. METHODS: With the ECOM data base of the Ministry of Health and Consumer Affairs as our starting point, we obtained the amounts of thyroid hormones dispensed with prescriptions issued by the Social Security health care services in the provinces of Castilla y León during the period between 1992-2000, estimating the prevalence by means of the Daily Defined Doses (DDD) per 100,000 inhabitants. RESULTS: The prevalence of hypothyroidism in Castilla-León is estimated at 185 cases per 100,000 inhabitants in 1992, increasing to 489 in 2000, reflecting a percentage rise of 164%. This result represents between 4,559-4,827 patients in 1992, and between 11,929-12,360 in 2000. The increase in prevalence was observed in all of the provinces. The provinces with the highest prevalence are León, Soria and Avila, while Palencia, Salamanca and Burgos have the least incidence. CONCLUSIONS: The specificity of the treatment has enabled us to establish a relationship between the consumption of thyroid hormones and the prevalence of hypothyroidism, as well as its progress from 1992 to 2000, thus providing us with a close estimate of the current situation of this pathology in Castilla-León.

[Changes in antidepressants consumption in the health area of Zamora from 1996 to 1999]. / Evolución del consumo de antidepresivos en el área de Zamora desde 1996 a 1999.

OBJECTIVE: To describe the evolution of antidepressants outside hospital consumption (therapeutic subgroup N06A) in the health area of Zamora since 1996 to 1999, and also to rate the impact of the most recently marketed drugs introduction. DESIGN: Retrospective observational study. SETTING: Primary care. METHODOLOGY: All antidepressants containers dispensed in Zamora with prescription of the Seguridad Social in the 1996-1999 period are obtained from SIFAR (Pharmacy Management Informatic System), computing defined daily doses per 1000 inhabitants day (DHD) for each drug. RESULTS: An increase of 47% in antidepressants whole consumption is observed, progressively since 1996 to 1999: 18.91 DHD (1996); 22.09 DHD (1997); 24.67 DHD (1998); 27.85 DHD (1999).ISRS (88%) and heterocyclics (56%) increase in this period, whereas IMAO (71%) and tricyclic antidepressants (14%) decrease. CONCLUSION: Antidepressant whole consumption experiments an outstanding increase in the area of Zamora. Recently marketed drugs utilisation increases as well, superseding classical antidepressants. The five most used drugs in 1999 were, in decreasing order, paroxetine, fluoxetine, sertraline, citalopram and venlafaxine. These last three ones got the most outstanding rise in the reviewed period.

Evolución del consumo de antidepresivos en el área de Zamora desde 1996 a 1999 / Evolution of antidepressants consumption in the health area of Zamora in the 1996-1999 period

Objetivo. Describir la evolución del consumo extrahospitalario de antidepresivos (subgrupo terapéutico N06A) en el área de Zamora, desde 1996 a 1999, así como valorar el impacto de la introducción de los fármacos más recientemente comercializados. Diseño. Estudio observacional, retrospectivo. Emplazamiento. Atención primaria. Material y métodos. A partir del Sistema Informático de Gestión de Farmacia (SIFAR), se obtienen todos los envases de antidepresivos dispensados en Zamora con receta de la Seguridad Social en el período 1996-1999, calculando para cada principio activo sus dosis diarias definidas por 1.000 habitantes día (DHD). Resultados. Aumenta el consumo total de antidepresivos en un 47 por ciento, siendo este incremento progresivo desde el año 1996 a 1999: 18,91 DHD (1996); 22,09 DHD (1997); 24,67 DHD (1998) y 27,85 DHD (1999). En este período aumentan los ISRS en un 88 por ciento y los heterocíclicos un 56 por ciento, disminuyendo los IMAO un 71 por ciento y los antidepresivos tricíclicos un 14 por ciento. Conclusiones. El consumo total de antidepresivos experimenta un notable incremento en el área de Zamora, aumentando la utilización de fármacos de más reciente comercialización, que van desplazando a los antidepresivos más clásicos. En 1999, los 5 principios activos más consumidos en orden descendente fueron: paroxetina, fluoxetina, sertralina, citalopram y venlafaxina, siendo el incremento de estos tres últimos el más importante en el período estudiado (AU)

Coma metabólico secundario a sertralina / Sertraline-induced metabolic coma

La sertralina es un fármaco inhibidor de la recaptación de serotonina en el sistema nervioso central que se utiliza como antidepresivo. Entre sus efectos secundarios se ha descrito la presentación de síndrome de secreción inadecuada de ADH, especialmente en individuos de edad avanzada. En la mayoría de los pacientes afectados, los síntomas revistieron escasa gravedad y pudieron ser rápidamente revertidos. Presentamos los casos de 2 mujeres de mediana edad que desarrollaron SSIADH e hiponatremia severa después de haber seguido tratamiento con sertralina. Ambas ingresaron en nuestra unidad de cuidados intensivos en estado de coma inferior o igual a 8 puntos en la escala de Glasgow y necesitaron ventilación mecánica invasiva (AU)

[Prescription of generic drugs in the health area of Zamora. Benefits for the users and the National Health Service]. / Prescripción de genéricos en el Area de Salud de Zamora. Beneficios para el usuario y el Sistema Nacional de Salud.

OBJECTIVE: To know the highest possible saving in pharmaceutical expenditures for the active user and for the National Health System (NHS), by replacing trademark specialties of Social Security prescriptions in 1995 by other generic medicines. DESIGN: Economic evaluation study for minimizing cost. SETTING: Health Area of Zamora, 1995. MEASURES AND MAIN RESULTS: 32 active components were selected (58 presentations and 24 therapeutic groups) marketed under generic denomination that were equivalent to specialties with identical composition-presentation and more expensive. For all those medicines that include the 32 active components, the following data were obtained from the pharmacy Management Computer System (SIFAR in Spanish): number of containers, amount and percentage prescribed to pensioners and active population, breaking down the amount of actives for the Health System and for the user. Out of the 153,885 dispensed containers analyzed in the study, 2.83% belong to those dispensed under generic denomination. The estimated possible saving could have been about 56,991,515 PTAs corresponding to 85.5% of pensioners and 14.5 of the active population. The saving for active users could have reached 4,387,523 PTAs. CONCLUSIONS: The prescription of generic medicines allows us to improve the efficiency of the NHS because the saving generated may positively have an effect on the system itself without loosing quality or freedom in the prescription.

Histoplasmosis in northwestern Argentina. Epidemiological survey of Chuscha and La Higuera in the province of Tucumán.

The present work was undertaken to obtain epidemiological data on the extent and distribution of Histoplasma capsulatum infections in the Chuscha and La Higuera areas. Skin test surveys of the human population with histoplasmin and paracoccidioidin were carried out in 40% of the permanent population of both localities, between 3 and 88 years old. It was found that 53.57% of the population were histoplasmin reactors and 1.86% of the population were paracoccidioidin reactors.