Educational interventions in pharmacovigilance to improve the knowledge, attitude and the report of adverse drug reactions in healthcare professionals: Systematic Review and Meta-analysis.

OBJECTIVES: Underreporting of adverse drug reactions (ADRs) limits and delays the detection of signs. The aim of this systematic review with meta-analyses was to synthesize the evidence of educational interventions (EIs) efficacy in health professionals to increase ADR reporting, attitudes, and knowledge of pharmacovigilance. EVIDENCE ACQUISITION: A systematic literature review was carried out to identify randomized clinical trials evaluating the efficacy of EI in pharmacovigilance in health professionals to improve ADR reports, knowledge, and attitude toward pharmacovigilance. ADR reports were pooled by calculating Odds Ratio (OR) with a 95% confidence interval (95%CI), while pharmacovigilance knowledge and attitude were pooled by calculating a mean difference (MD) with 95%CI. In addition, the subanalysis was performed by EI type. Meta-analysis was performed with RevMan 5.4 software. PROSPERO registry CRD42021254270. RESULTS: Eight hundred seventy-five articles were identified as potentially relevant, and 11 were included in the systematic review. Metanalysis showed that EI increased ADR reporting in comparison with control group (OR = 4.74, [95%CI, 2.46 to 9.12], I2 = 93%, 5 studies). In subgroup analysis, the workshops (OR = 6.26, [95%CI, 4.03 to 9.73], I2 = 57%, 3 studies) increased ADR reporting more than telephone-based interventions (OR = 2.59, [95%CI, 0.77 to 8.73], I2 = 29%, 2 studies) or combined interventions (OR = 5.14, [95%CI, 0.97 to 27.26], I2 = 93%, 3 studies). No difference was observed in pharmacovigilance knowledge. However, the subanalysis revealed that workshops increase pharmacovigilance knowledge (SMD = 1.85 [95%CI, 1.44 to 2.27], 1 study). Only one study evaluated ADR reporting attitude among participants and showed a positive effect after the intervention. CONCLUSION: EI improves ADR reports and increases pharmacovigilance knowledge. Workshops are the most effective EI to increase ADR reporting.

Effect of a light-darkness cycle on the body weight gain of preterm infants admitted to the neonatal intensive care unit.

The Continuous bright light conditions to which premature infants are subjected while hospitalized in Neonatal Intensive Care Units (NICU) can have deleterious effects in terms of growth and development. This study evaluates the benefits of a light/darkness cycle (LDC) in weight and early hospital discharge from the NICU. Subjects were recruited from three participating institutions in Mexico. Eligible patients (n = 294) were premature infants who were hospitalized in the low-risk and high-risk neonatal units classified as stable. The subjects randomized to the experimental group (n = 150) were allocated to LDC conditions are as follows: light from 07:00 to 19:00 and darkness (25 lx) from 19:00 to 07:00. The control group (n = 144) was kept under normal room light conditions (CBL) 24 h a day. Main outcome was weight gain and the effect of reducing the intensity of nocturnal light in development of premature infants. Infants to the LDC gained weight earlier, compared with those randomized to CBL, and had a significant reduction in length of hospital stay. These results highlight those premature infants subjected to a LDC exhibit improvements in physiological development, favoring earlier weight gain and consequently a decrease in hospital stays. ClinicalTrials.gov; 02/09/2020 ID: NCT05230706.

Midazolam reduction with pre-operative melatonin in abdominal hysterectomy: double-blind randomized clinical trial.

INTRODUCTION: Midazolam is a benzodiazepine used for sedation, however, can cause respiratory depression and increases morbidity in patients. Melatonin is an effective alternative to manage anxiety in the perioperative period and could help to reduce the use of benzodiazepines during surgery. The aim of this clinical trial was to determine the efficacy of pre-operative sedation with a single-dose melatonin to reduce intraoperative use of midazolam in women under total abdominal hysterectomy (TAH). MATERIALS AND METHODS: This is a double-blind randomized clinical trial conducted in women over 25 years, scheduled for TAH, with American Society of Anesthesiologists Grade I or II. Each patient was randomly assigned to receive 5 mg of melatonin prolonged-release oral capsules or placebo. Midazolam use for anesthetic management was the decision of the treating anesthesiologist and sedation status was determined using the observer's assessment of alertness/sedation scale. RESULTS: In patients receiving melatonin, the use of midazolam during surgery was less than in patients receiving placebo. In addition, melatonin produces sedation 30 min after administration, the sedative effect was maintained at 60- and 90-min. Furthermore, hospital stay was shorter in patients who received melatonin (p = 0.006). CONCLUSION: Melatonin is effective for reduces intraoperative midazolam consumption and hospital stay in women undergoing TAH.

INTRODUCCIÓN: El midazolam es una benzodiazepina utilizada para la sedación, sin embargo, puede causar depresión respiratoria y aumentar la morbilidad en los pacientes. La melatonina es una alternativa eficaz para controlar la ansiedad en el período perioperatorio y podría ayudar a reducir el uso de benzodiazepinas durante la cirugía. El objetivo de este ensayo clínico fue determinar la eficacia de la sedación preoperatoria con una dosis única de melatonina para reducir el uso intraoperatorio de midazolam en mujeres sometidas a histerectomía abdominal total (HTA). MATERIAL Y MÉTODOS: Se trata de un ensayo clínico aleatorizado doble ciego realizado en mujeres mayores de 25 años, programadas para TAH, con American Society of Anesthesiologists Grado I o II. Cada paciente fue asignado al azar para recibir 5 mg de cápsulas orales de liberación prolongada de melatonina o placebo. El uso de midazolam para el manejo anestésico fue decisión del anestesiólogo tratante y el estado de sedación se determinó mediante la escala OAA/S. RESULTADOS: En las pacientes que recibieron melatonina, el uso de midazolam durante la cirugía fue menor que en las pacientes que recibieron placebo. Además, la melatonina produce sedación 30 min después de la administración, el efecto sedante se mantuvo a los 60 y 90 min. Además, la estancia hospitalaria fue más corta en los pacientes que recibieron melatonina (p = 0.006). CONCLUSIÓN: La melatonina es eficaz para reducir el consumo de midazolam intraoperatorio y la estancia hospitalaria en mujeres sometidas a HTA.

Characterization of hypotensive and vasorelaxant effects of PHAR-DBH-Me a new cannabinoid receptor agonist.

The effect of PHAR-DBH-Me, a cannabinoid receptor agonist, on different cardiovascular responses in adult male rats was analyzed. The blood pressure was measured directly and indirectly. The coronary flow was measured by Langendorff preparation, and vasomotor responses induced by PHAR-DBH-Me in aortic rings precontracted with phenylephrine (PHEN) were analyzed. The intravenous injection of the compound PHAR-DBH-Me (0.018-185 µg/kg) resulted in decreased blood pressure; maximum effect was observed at the dose of 1,850 µg/kg. A concentration-dependent increase in the coronary flow was observed in a Langendorff preparation. In the aortic rings, with and without endothelium, pre-contracted with PHEN (10-6 M), the addition of PHAR-DBH-Me to the superfusion solution (10-12-10-5 M), produced a vasodilator response, which depends on the concentration and presence of the endothelium. L-NAME inhibited these effects. Addition of CB1 receptor antagonist (AM 251) did not modify the response, while CB2 receptor antagonist (AM630) decreased the potency of relaxation elicited by PHAR-DBH-Me. Indomethacin shifted the curve concentration-response to the left and produced an increase in the magnitude of the maximum endothelium dependent response to this compound. The maximum effect of PHAR-DBH-Me was observed with the concentration of 10-5 M. These results show that PHAR-DBH-Me has a concentration-dependent and endothelium-dependent vasodilator effect through CB2 receptor. This vasodilation is probably mediated by the synthesis/release of NO. On the other hand, it is suggested that PHAR-DBH-Me also induces the release of a vasoconstrictor prostanoid.

Enfermedad pulmonar obstructiva crónica (EPOC). Bases para el médico general / Chronic Obstructive Pulmonary Disease (COPD). Bases for the General Practitioner

Resumen La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad crónico-degenerativa frecuente, prevenible y tratable, caracterizada por persistentes síntomas respiratorios y limitación del flujo aéreo. En 2016, el Instituto Nacional de Enfermedades Respiratorias (INER) la ubicó en el cuarto lugar en la tabla de morbi-mortalidad anual en México. Su prevalencia está directamente relacionada con la del tabaquismo; sin embargo, su desarrollo es multifactorial. Para el estudio de la EPOC es importante conocer los antecedentes de exposición a factores de riesgo y la presencia de los principales síntomas; es esencial una historia clínica bien detallada, donde se recabe la mayor cantidad de datos de todo nuevo paciente en el que se conozca o se sospeche de la enfermedad, así como una espirometría para establecer el diagnóstico. Debido a la gran variabilidad que existe entre los pacientes con EPOC, es necesario establecer tratamiento farmacológico individualizado. Los fármacos utilizados en su tratamiento reducen los síntomas, la frecuencia y la gravedad de las exacerbaciones; sin embargo, no hay ningún medicamento que modifique el deterioro a largo plazo de la función pulmonar. Por lo tanto, el conocimiento básico de este padecimiento por el médico de primer contacto es esencial para la sospecha en una etapa inicial, y así ofrecer al paciente una intervención médica inmediata. El presente trabajo tiene la finalidad de acercar al médico general una visión básica de la EPOC.

Abstract Chronic obstructive pulmonary disease (COPD) is a chronic degenerative disease. It is a frequent, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. The National Institute of Respiratory Diseases (INER), ranked COPD in 2016 in fourth place in the table of annual morbidity and mortality in Mexico. The prevalence of COPD is directly related to smoking; however, its development is multifactorial. For its study it is important to know of any prior exposure to risk factors and of any manifestation of the main symptoms. To make a diagnosis, a detailed clinical history, where the largest amount of data is collected from every new possible COPD patient, and a spirometry are essential. Individual pharmacological treatment is necessary due to the great variability among COPD patients. The drugs used in the treatment of COPD reduce the symptoms, the frequency and severity of exacerbations; however, there is no medication that modifies the long-term deterioration of the lung function. Therefore, a basic knowledge of this condition by the medical doctor first contacted, is essential for the suspicion of COPD in its initial stage and thus, offer the patient immediate medical intervention. The objective of the present work is to provide a basic overview of COPD to the general practitioner.

Clasificación del tubérculo suprameatal y análisis morfométrico con enfoque quirúrgico del hueso temporal / Classification of the suprameatal tubercle and morphometric analysis with a surgical approach to the temporal bone

Introducción: El hueso temporal es una estructura valiosa en el abordaje de patologías intracraneales a la fosa media y posterior, requiriendo en ocasiones la realización de petrosectomías anteriores, posteriores o abordajes combinados para la resección de tumores en dichas regiones. El propósito del presente estudio es realizar análisis morfométrico con enfoque quirúrgico del hueso temporal, en cráneos adultos, con énfasis en el tubérculo suprameatal (TSM) teniendo en consideración sus relaciones anatómicas. Material y métodos: El presente estudio se realizó en las instalaciones de la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM). Se analizaron 200 huesos temporales de 100 cráneos humanos adultos. Se dio énfasis al TSM de acuerdo a su ubicación y tamaño, clasificándolo en: anterior medio o posterior y en tipo I (0-1 mm), tipo II (2-3 mm) y tipo III (>3 mm). Además, se realizaron mediciones con enfoque quirúrgico de la porción petrosa del hueso temporal y de la cresta supramastoidea. Resultados: El TSM se observó en 171 especímenes estudiados (85.5%). Entre ellos, la posición posterior fue la más frecuente 85 de 171 (49.70%), seguida de la posición media 43 (25.14%) y por último la posición anterior 43 (25.14%). En cuanto al tamaño, se encontró con mayor frecuencia el tipo II en 99 de los especímenes (49.5%), el tipo I en 82 especímenes (41%) y tipo III en 19 (9.5%). El asterion se reflejó dentro de la impresión de los senos en la mayoría 48.5%, la unión de la cresta supramastoidea con sutura escamosa se reflejaba en 98.5% de los casos a la fosa media. Discusión: En nuestra búsqueda de información no se cuenta con datos para realizar comparación con la obtenida en este estudio del tubérculo suprameatal, el hallazgo encontrado parece indicar que se encuentra una relación directa con la presencia de la impresión del surco del seno petroso superior. La distribución de acuerdo a su posición reviste importancia cuando se encuentra en grado III puesto que plantea una dificultad técnica, en abordajes como en petrosectomías, o bien, al cavum de Meckel desde un abordaje retrosigmoideo. Conclusión: La observación anatómica y clasificación que realizamos del tubérculo suprameatal, una estructura muy poco evaluada, nos da una consideración preoperatoria y transoperatoria cuando realizamos abordaje que involucra la cara posterior de la porción petrosa del hueso temporal

Introduction: The temporal bone is a valuable structure in the approach of intracranial pathologies to the middle and posterior fossa. Sometimes requiring the performance of petrosectomies or combined approaches for the resection of tumors in these regions. The purpose of this study is to perform morphometric analysis in adult skulls with a surgical approach to the temporal bone, with emphasis on the suprameatal tubercle (SMT) taking into account their anatomical relationships. Material and methods: The present study was carried out in the facilities of the Faculty of Medicine of the National Autonomous University of Mexico (UNAM). 200 temporal bones from 100 adult human skulls were analyzed. The SMT was emphasized according to its location and size, classifying it as: anterior, middle, or posterior and type I (0-1 mm), type II (2-3 mm) and type III (> 3mm). In addition, measurements were made with a surgical approach of the petrosal portion of the temporal bone and the supramastoid crest. Results: The SMT was observed in 171 specimens studied (85.5%). Among them, the posterior position was the most frequent 85 of 171 (49.70%), followed by the middle position in 43 (25.14%) and finally the anterior position in 43 (25.14%). In terms of size, type II was more frequently found in 99 of the specimens (49.5%), type I in 82 specimens (41%) and type III were found in 19 (9.5%). The asterion was reflected within the impression of the sinuses in the majority 48.5%, the union of the supramastoid crest with squamous suture was reflected in 98.5% of the cases to the middle fossa.Discussion: In our search for information, there is no data to make a comparison with that obtained in this study of the suprameatal tubercle. The findings seems to indicate that there is a direct relationship with the presence of the impression of the groove of the upper petrosal sinus. The distribution according to its position is important when it is in grade III since it poses a technical difficulty, in approaches such as petrosectomies, or approach to Meckel's cave from a retrosigmoid approach. Conclusion: The anatomical observation and classification that we perform of the suprameatal tubercle, a very poorly evaluated structure, gives us a preoperative and transoperative consideration when we perform an approach that involves the posterior aspect of the petrosal portion of the temporal bone

Síndrome de jet lag o cambio de zonas de tiempo / The jet lag syndrome or time-zone changes

Resumen Nuestro planeta, así como la vida que en él se desarrolla, se encuentra en constante movimiento. Los ritmos geofísicos influyen en la actividad de los organismos, de tal manera que los seres vivos han desarrollado mecanismos adaptativos para poder responder a las variaciones diarias del medio ambiente. El sistema circadiano es el responsable de responder a estas variaciones cíclicas ambientales. Cuando se modifican las señales ambientales, como en un viaje que implica atravesar varias zonas horarias, se ocasionan cambios fisiológicos que han llevado a buscar estrategias para contrarrestar los síntomas que se presentan; estas estrategias incluyen el ejercicio programado, la exposición a la luz brillante, la melatonina y la alimentación programada.

Abstract Our planet and the life that develops in it are in constant movement, therefore, the geophysical rhythms influence the activity of organisms, in such a way that living beings have developed adaptative mechanims in order to respond to the daily variations of the environment. The circadian system is responsible for responding to these cyclical environmental variations. When the environmental signals are modified, like for instance, on a trip that involves crossing several time zones, physiological changes occur. This results in searching for possible strategies to counteract the symptomatology. These strategies include scheduled exercise, exposure to a bright light, melatonin and scheduled meals.

Loss of melatonin daily rhythmicity is asociated with delirium development in hospitalized older adults.

Delirium is associated with circadian rhythm disruption. In this study we have explored whether circadian variation of melatonin is an indicator for delirium. Melatonin levels were determined from the first day of hospitalization and up to three days after the onset of delirium. Patients who did not developed delirium exhibited a daily melatonin rhythm, while in patients that developed delirium, the melatonin rhythm was lost and mean melatonin levels were found decreased as early as three days before the diagnosis of delirium, indicating that on arrival to the hospital circadian melatonin disruption can be used as an indicator of delirium.

Trastornos temporomandibulares: Complejo clínico que el médico general debe conocer y saber manejar. Cátedra especial "Dr. Ignacio Chávez" / Temporomandibular disorders: Clinical complex that the general practitioner must recognize and know how to treat. Special professorship "Dr. Ignacio Chávez"

Los trastornos temporomandibulares (TTM), abarcan un conjunto de problemas clínicos que comprometen diferentes estructuras anatómicas como son: músculos de la masticación, la articulación temporomandibular y estructuras asociadas. Se consideran como una subclasificación de desórdenes musculoesqueléticos y han sido identificados como una causa importante de dolor en la región facial de origen no dentario. Los trastornos temporomandibulares se caracterizan clínicamente por dolor en músculos de la masticación, área preauricular o directamente en la articulación (usualmente agravado por la manipulación y alteración de los movimientos mandibulares principalmente debido a limitación del movimiento), presencia de ruidos articulares como crepitación y chasquidos (clicking). Epidemiológicamente la prevalencia va del 20 al 70% en la población general, motivo por el que creemos que es importante que el médico general tenga el conocimiento básico sobre estos trastornos que generalmente los desconoce y los delega al médico odontólogo. El tratamiento de los TTM va desde fomentar el autocuidado, tratamiento conservador y, de ser necesario, tratamiento quirúrgico.

Temporomandibular disorders (TMDs) are a set of clinical problems that involve different anatomical structures such as masticatory muscles, the temporomandibular joint and related anatomical structures. They are considered a subclass of musculoskeletal disorders and have been identified as a major cause of non-dental facial pain. TMDs are characterized by pain in the masticatory muscles, either in the pre-auricular area or directly in the joint (usually worsened by manipulation or altered movement of the jaw, mainly due to movement limitation) and the presence of clicking sounds during movement. Epidemiologically, TMDs have a prevalence ranging from 20% to 70% in the general population, that is why we believe it is important for the general practitioner to have the basic knowledge about these disorders, often unknown to the general practitioner who leaves the to the odontologist. Treatment includes fostering self-care measures, conservative treatment, or surgical treatment when necessary.

Fisura facial nasoorbitaria, Tessier número 3 / Naso-orbital cleft, Tessier Number 3

Las fisuras oblicuas faciales son anormalidades poco frecuentes, aunque la incidencia exacta es desconocida, se reporta una incidencia de 1.5 a 5 por 100,000 nacimientos. Tessier en 1976 propuso una clasificación de las fisuras faciales, craneofaciales y laterofaciales. Morian describió la fisura oral nasoorbitaria (fisura número 3), que representa una de las malformaciones más difíciles de corregir para el cirujano plástico y reconstructivo. Reportamos un caso de fisura craneofacial Tessier número 3 así como la técnica de corrección quirúrgica empleada. Los autores enfatizan en el análisis de la embriología facial.

The oblique facial clefts are extremely rare facial anomalies, although the exact incidence of these facial clefts is unknown, is reported an incidence de 1.5 to 5 per 100,000 births. Tessier in 1976 proposed an anatomic classification of the facial, craniofacial, and laterofacial clefts. Number 3 clefts o oral-nasal-ocular cleft was described by Morian and represents one of the most difficult malformations to correct for the reconstructive surgeon. We report a case of unilateral Tessier No 3 craniofacial cleft and our approach to surgical correction. The authors emphasize in the analysis of the facial embryology.