Uso de antipsicóticos en los pacientes con demencia en España: comparación con la prescripción de los inhibidores de la acetilcolinesterasa y de la memantina, y análisis de las asociaciones / Use of antipsychotics in patients with dementia in Spain: Comparison with prescription of acetylcholinesterase inhibitors and memantine and analysis of associations

Objetivo: Se ha analizado la prevalencia de antipsicóticos, inhibidores de la acetilcolinesterasa (IACE) y memantina en pacientes con demencia en España y la influencia de estas asociaciones en su prescripción. Método: Estudio descriptivo, retrospectivo y transversal de la base BIFAP de 2017 en los mayores de 65 años con demencia. Se recogieron las prescripciones de antipsicóticos, los IACE y la memantina. Para los antipsicóticos también se recogieron, la duración del tratamiento y el tiempo desde el diagnóstico de demencia, al de prescripción. Resultados: Se recuperaron 1.327.792 sujetos, 89.464 (6,73%) con demencia. El 31,76% tuvieron prescritos antipsicóticos; los más frecuentes: quetiapina (58,47%), risperidona (21%) y haloperidol (19,34%). Las prescripciones de IACE y memantina fueron más frecuentes en los menores de 84 años y las de antipsicóticos en los mayores de 85 años (p<0,001). Los antipsicóticos se mantuvieron una media de 1.174,5 días. En el 26,4% de los casos se prescribieron aislados, OR: 0,61 (IC 95%: 0,59-0,62), en el 35,85% asociados a IACE, OR: 1,26 (IC 95%: 1,22-1,30) y en el 42,4% a memantina, OR: 1,69 (IC 95%: 1,62-1,78); p<0,000). Desde el diagnóstico de demencia transcurrieron de 461 días (±1.576,5) cuando se prescribieron aislados; 651 días (±1.574,25) asociados a IACE y 1.224 (±1.779) a memantina. Conclusiones: Una tercera parte de los pacientes con demencia tuvieron prescritos antipsicóticos, mayoritariamente atípicos, más frecuentemente en los mayores de 85 años y durante periodos prolongados. La prescripción de IACE y memantina se asoció al incremento del riesgo de uso de antipsicóticos, pero paradójicamente, a la prolongación del tiempo hasta su prescripción.(AU)

ObjectiveWe have analyzed the prevalence of antipsychotics in patients with dementia in Spain, their age distribution and the influence of treatment with IACEs and memantine on their prescription. Method: Descriptive, retrospective and cross-sectional study of the 2017 BIFAP database in over 65 years of age with dementia. Prescriptions of antipsychotics, IACEs and memantine were collected. For antipsychotics were also collected, the duration of treatment and time from dementia diagnosis to prescription. Results: A total of 1,327,792 subjects were retrieved, 89,464 (6.73%) with dementia. Antipsychotics were prescribed in 31.76%; by frequency: quetiapine (58.47%), risperidone (21%) and haloperidol (19.34%). Prescriptions of IACEs and memantine were clustered in those younger than 84 years and antipsychotics in those older than 85 (P<.001). Antipsychotics were maintained for a mean of 1174.5 days. In 26.4% of cases they were prescribed alone, OR 0.61 (95% CI: 0.59-0.62), in 35.85% associated with IACEs, OR 1.26 (95% CI: 1.22-1.30) and in 42.4% with memantine, OR 1.69 (95% CI: 1.62-1.78) (P<.000). From the diagnosis of dementia, 461 days (±1576.5) elapsed when isolated drugs were prescribed; 651 days (±1574.25) associated with IACEs and 1224 (±1779) with memantine. Conclusions: One third of patients with dementia were prescribed antipsychotics, mostly atypical, more frequently in those older than 85 years and for prolonged periods. IACEs and memantine were associated with the risk of antipsychotic prescription, but paradoxically, with prolonged time to onset.(AU)

[Use of antipsychotics in patients with dementia in Spain: Comparison with prescription of acetylcholinesterase inhibitors and memantine and analysis of associations]. / Uso de antipsicóticos en los pacientes con demencia en España: comparación con la prescripción de los inhibidores de la acetilcolinesterasa y de la memantina, y análisis de las asociaciones.

OBJECTIVE: We have analyzed the prevalence of antipsychotics in patients with dementia in Spain, their age distribution and the influence of treatment with IACEs and memantine on their prescription. METHOD: Descriptive, retrospective and cross-sectional study of the 2017 BIFAP database in over 65 years of age with dementia. Prescriptions of antipsychotics, IACEs and memantine were collected. For antipsychotics were also collected, the duration of treatment and time from dementia diagnosis to prescription. RESULTS: A total of 1,327,792 subjects were retrieved, 89,464 (6.73%) with dementia. Antipsychotics were prescribed in 31.76%; by frequency: quetiapine (58.47%), risperidone (21%) and haloperidol (19.34%). Prescriptions of IACEs and memantine were clustered in those younger than 84 years and antipsychotics in those older than 85 (P<.001). Antipsychotics were maintained for a mean of 1174.5 days. In 26.4% of cases they were prescribed alone, OR 0.61 (95% CI: 0.59-0.62), in 35.85% associated with IACEs, OR 1.26 (95% CI: 1.22-1.30) and in 42.4% with memantine, OR 1.69 (95% CI: 1.62-1.78) (P<.000). From the diagnosis of dementia, 461 days (±1576.5) elapsed when isolated drugs were prescribed; 651 days (±1574.25) associated with IACEs and 1224 (±1779) with memantine. CONCLUSIONS: One third of patients with dementia were prescribed antipsychotics, mostly atypical, more frequently in those older than 85 years and for prolonged periods. IACEs and memantine were associated with the risk of antipsychotic prescription, but paradoxically, with prolonged time to onset.

Niveles de colinesterasa sérica en agricultores de San Pablo de Borbur, Boyacá, expuestos a organofosforados

Introducción: Las colinesterasas son enzimas que se encargan de hidrolizar la acetilcolina en ácido acético y colina, poniéndole fin a la transmisión nerviosa a lo largo de la sinapsis de las uniones neuromusculares. La medición de la actividad de la colinesterasa sérica constituye un indicador del efecto causado por la exposición prolongada a los organofosforados. Objetivo: Determinar los niveles de colinesterasa sérica y factores relacionados con la exposición a organofosforados en agricultores de la vereda de Páramo Lagunas de San Pablo de Borbur, Boyacá, Colombia. Metodología: Estudio prospectivo, de corte transversal, con una muestra de 57 trabajadores. A cada individuo se le aplicó una encuesta de datos sociodemográficos y factores laborales, posteriormente se les tomó una muestra de sangre venosa en ayuno de 8-12 horas; con el fin de determinar las concentraciones de colinesterasa sérica (kit Colinesterasa Butiriltiocolina Biosystems®) con el equipo automatizado de química clínica A-15 de Biosystems®. Resultados: El rango de edad de los participantes estuvo entre los 22 y 64 aflos, el 72 % de los individuos pertenecía al sexo masculino. El 3,5 % (2 varones) presentó valores inferiores al intervalo biológico de referencia (IBR), el 88 % de las personas afirmó realizar tareas con plaguicidas y el 54 % afirmó no utilizar los elementos de protección personal (EPP) al trabajar con estas sustancias. Conclusiones: Se evidenció la falta de escolaridad y la ausencia del acompaflamiento técnico en esta zona, lo que induce a que estos agricultores realicen procesos agrícolas relacionados con la aplicación de plaguicidas sin el adecuado conocimiento y sin la utilización adecuada de EPP.

Introduction: Cholinesterases are enzymes responsible for hydrolyzing acetylcholine in acetic acid and choline, which ends nerve transmission along the synapse of neuromuscular junctions. Measurement of serum cholinesterase activity acts as an indicator of the effect caused by prolonged exposure to organophosphates and carbamates Objective: To determine serum cholinesterase levels and factors related to exposure to organophosphates in farmers from the county of Páramo Lagunas in San Pablo de Borbur, Boyacá, Colombia. Methodology: Prospective, cross-sectional study, with a sample of 57 agricultural workers, a survey of sociodemographic data and labor factors was applied to each individual and a venous blood sample was taken in an 8-12 hour fasting, Serum cholinesterase concentrations were determined (Biosystems® Butyrylthiocholine Cholinesterase kit), by means of the Biosystems® A-15 automated clinical chemistry kit. Results: The age range of the participants was between 22 and 64 years old, 72% of the individuals belonged to the male sex. 3.5% (2 male individuals) presented values lower than the biological reference interval (BRI); 88% of the people affirmed to carry out tasks with pesticides and 54% of them affirmed not to use personal protective equipment (PPE) when working with these substances. Conclusions: The lack of schooling was evidenced in most of the farmers, as well as the absence of technical support to this area, which induces these farmers to carry out agricultural processes such as pesticide application, without adequate knowledge and without the proper use of PPE.

Antioxidant and Acetylcholinesterase Inhibitor Potentials of the Stem Extract of Pternandra galeata / Potenciales antioxidantes e inhibidores de la acetilcolinesterasa del extracto de tallo de Pternandra galeata

Background: Pternandra galeata belongs to the family Melastomataceae. It is a native flowering plant in Borneo Island that serve as food for monkey habitat. There has been limited study on the medicinal and chemical properties of this plant. Objectives: We investigated the acetylcholinesterase inhibitory activity and evaluated the antioxidant activity of the ethanolic extract of Pternandra galeata stem. The total phenolic content in the sample was also determined. Methods: The acetylcholinesterase inhibitory assays were performed using Ellman's method. Two different methods were used to evaluate the antioxidant activity of the extract by 2,2-diphenyl-1-picryl hydrazyl (DPPH) and 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays. The total phenolic content was determined by the Folin-Ciocalteu method by employing gallic acid as a reference. Results: The ethanolic extract of the P. galeata stems inhibited the AChE enzyme with an IC50 value of 74.62 ± 0.89 µg/mL.The sample exhibited antioxidant activity in the DPPH assay with an IC50 value of 20.21 ± 0.08 µg/mL and 7.68 ± 0.09 µg/mL in the ABTS scavenging assay. The total phenolic content was 164.71 ± 3.33 mg GAE/g extract. Conclusion: The ethanolic extract of the P. galeata stem can be a promising cholinesterase inhibitor and antioxidant for treating Alzheimer's disease

Antecedentes: Pternandra galeata pertenece a la familia Melastomataceae. Se trata de una planta con flores nativa de la isla de Borneo que sirve de alimento para el hábitat de los monos. Se han realizado pocos estudios sobre las propiedades medicinales y químicas de esta planta. Objetivos: Se investigó la actividad inhibidora de la acetilcolinesterasa y se evaluó la actividad antioxidante del extracto etanólico del tallo de Pternandra galeata. También se determinó el contenido fenólico total de la muestra. Métodos: Los ensayos de inhibición de la acetilcolinesterasa (AChE) se realizaron mediante el método de Ellman. Se utilizaron dos métodos diferentes para evaluar la actividad antioxidante de los ensayos de 2,2-difenil-1-picril hidrazilo (DPPH) y 2,2'-azinobis-(ácido 3-etilbenzotiazolina-6-sulfónico) (ABTS). El contenido fenólico total se determinó por el método de Folin-Ciocalteu empleando el ácido gálico como referencia. Resultados: El extracto etanólico de los tallos de P. galeata inhibió la enzima AChE con un valor IC50 de 74.62 ± 0.89 µg/mL. La muestra mostró actividad antioxidante en el ensayo DPPH con un valor IC50 de 20.21 ± 0.08 µg/mL y 7.68 ± 0.09 µg/mL en el ensayo de barrido ABTS. El contenido fenólico total fue de 164.71 ± 3.33 mg GAE/g de extracto. Conclusión: El extracto etanólico del tallo de P. galeata puede ser un prometedor inhibidor de la colinesterasa y antioxidante para el tratamiento de la enfermedad de Alzheimer.

Chemical characterization, antioxidant activity, -amylase and acetylcholinesterase inhibitory potential of Angelica pancicii Vandas ex Velen / Caracterización química, actividad antioxidante, potencial inhibidor de -amilasa y acetilcolinesterasa de Angelica pancicii Vandas ex Velen

Abstract: Comparative study GC - FID /M S of essential oils of fruits, leaves and roots of the endemic plant Angelica pancicii Vandas ex Velen. revealed a significant difference in their chemical composition. The enantiomeric purity of the main component in the fruit oil (+) - ß - phellandrene was a lso confirmed. In addition, imperatorin, isoimperatorin, oxypeucedanin, oxypeucedanin hydrate, angeloylpangelin and umbelliprenin were isolated from the fruit hexane extract. The content of these coumarins in the hexane extracts from different plant parts was further determined by HPLC. The essential oils and hexane extracts were assessed for their antioxidant potential and inhibitory effect towards  - amylase and acetylcholinesterase enzymes. The fruit and leaf essential oils (> 80%) as well as the fruit he xane extract (> 62%) significantly inhibited acetylcholinesterase enzyme. Distinguish free radical scavenging properties were detected for the leaf (Inh. 95.0 ± 2.2 %) and the root (Inh. 66.0 ± 2.4 %) extracts.

Resumen: Estudio comparativo GC - FID / MS de aceites esenciales de frutas, hojas y raíces de la planta endémica Angelica pancicii Vandas ex Velen revelaron una dife rencia significativa en su composición química. También se confirmó la pureza enantiomérica del componente principal del aceite de fruta (+) - ß - felandreno. Además, se aislaron imperatorina, isoimperatorina, oxipeucedanina, hidrato de oxipeucedanina, angeloi lpangelina y umbeliprenina del extracto de hexano del fruto. El contenido de estas cumarinas en los extractos de hexano de diferentes partes de la planta se determinó adicionalmente mediante HPLC. Los aceites esenciales y extractos de hexano se evaluaron p or su potencial antioxidante efecto inhibidor de las enzimas -  - amilasa y acetilcolinesterasa. Los aceites esenciales de frutas y hojas (> 80%), así como el extracto de hexano de frutas (> 62%) inhibieron significativamente la enzima acetilcolinesterasa. Se detectaron propiedades de captación de radicales libres diferenciadas para los extractos de hoja (Inh. 95,0 ± 2,2%) y de raíz (Inh. 66,0 ± 2,4%).

Pharmacogenetic studies in Alzheimer disease.

INTRODUCTION: Alzheimer disease (AD) is the most common cause of dementia and is considered one of the main causes of disability and dependence affecting quality of life in elderly people and their families. Current pharmacological treatment includes acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine; however, only one-third of patients respond to treatment. Genetic factors have been shown to play a role in this inter-individual variability in drug response. DEVELOPMENT: We review pharmacogenetic reports of AD-modifying drugs, the pharmacogenetic biomarkers included, and the phenotypes evaluated. We also discuss relevant methodological considerations for the design of pharmacogenetic studies into AD. A total of 33 pharmacogenetic reports were found; the majority of these focused on the variability in response to and metabolism of donepezil. Most of the patients included were from Caucasian populations, although some studies also include Korean, Indian, and Brazilian patients. CYP2D6 and APOE are the most frequently studied biomarkers. The associations proposed are controversial. CONCLUSIONS: Potential pharmacogenetic biomarkers for AD have been identified; however, it is still necessary to conduct further research into other populations and to identify new biomarkers. This information could assist in predicting patient response to these drugs and contribute to better treatment decision-making in a context as complex as ageing.

Comportamiento de las colinesterasas tras condiciones de fatiga en corredores de fondo / Behaviour of cholinesterases after fatigue conditions in endurance runners

El objetivo del presente estudio fue evaluar el efecto de un entrenamiento intenso en atletas de resistencia sobre el comportamiento de las colinesterasas (ChE) tras condiciones de fatiga y su relación con otros marcadores de carga interna. Participaron 18 atletas de sexo masculino especialistas en pruebas de resistencia. Se evaluó las ChE y dos índices de variabilidad de la frecuencia cardiaca en tres momentos diferentes, previo al protocolo (BASAL), 15 minutos posterior al protocolo (FINAL) y 24 horas después del entrenamiento (24H). Un ANOVA de una vía con post-hoc de Tukey HSD se utilizó para comparar las medias. Se encontraron cambios significativos en las variables analizadas (p < .001) con tamaños de efecto muy grandes (d > 0.9) en los diferentes momentos y correlaciones moderadas entre variables (p < .001). El comportamiento de las ChE muestra un cambio significativo (p < .001) posterior al ejercicio y una relación con otros indicadores de carga interna. Nuestros resultados indican que las ChE tienen relación con la fatiga en el caso de los deportistas estudiados, pudiendo ser una medida para determinar la carga de entrenamiento. (AU)

The objective of the present study was to evaluate the effect of intense training in endurance athletes on the behaviour of cholinesterases (ChE) after fatigue conditions and its relationships with other internal load markers. 18 male athletes specializing in endurance events participated. ChEs and two index of heart rate variability were evaluated at three different moments, before the study protocol (BASAL), 15 minutes after (FINAL) and the day after finishing the training (24H). A one-way ANOVA with post-hoc Tukey HSD was used to compare means. Significant differences were found in the variables analysed (p < .001), with very large effect sizes (d > 0.9) between BASAL, FINAL and 24H and moderate correlations between ChE and LnRMSSD and SS (p < .001). The behaviour of the ChEs showed a significant change (p < .001) after exercise and relationship with other internal training load indicators. Our results indicate that ChEs are related with fatigue in the studied athletes and may be a measure for training load determination. (AU)

Determination of insecticides' lethal concentrations and metabolic enzyme levels in Triatoma dimidiata / Determinación de concentraciones letales y niveles de enzimas metabólicas de insecticidas en Triatoma dimidiata

Abstract: Objective: The feasibility of the use of WHO impregnated paper and biochemical assays to determine lethal concentrations (LC50 and LC99) and insecticide metabolic enzyme levels of Triatoma dimidiata. Materials and methods: LC50 and LC99 were calculated with WHO papers impregnated at different concentrations of malathion, propoxur and deltamethrin; the percentage of insensitive acetylcholinesterase (iAChE); and the levels of esterases, glutathione S-transferases, and monooxygenases in laboratory nymphs of the first stage (5 to 7 days), were undertaken using the WHO biochemical assays. Results: Respectively the LC50 and LC99 µg/cm2 obtained for malathion were 43.83 and 114.38, propoxur 4.71 and 19.29, and deltamethrin 5.80 and 40.46. A 30% of the population had an iAChE, and only a few individuals had high P450 and β-eterase levels. Conclusion: Impregnated papers and biochemical tests developed by WHO for other insects, proved to be feasible methods in monitoring insecticide resistance and metabolic enzymes involved in T. dimidiata.

Resumen: Objetivo: La factibilidad de usar los papeles impregnados y ensayos bioquímicos según la OMS para determinar concentraciones letales (CL50 y CL99) y niveles enzimáticos en la resistencia a insecticidas en Triatoma dimidiata. Material y métodos: Se calcularon la CL50 y CL99 con papeles impregnados según la OMS a diferentes concentraciones de malatión, propoxur y deltametrina; el porcentaje de acetilcolinesterasa insensible (iAChE); y los niveles de esterasas, glutatión S-transferasas, y monooxigenasas en ninfas de laboratorio del estadio I (5-7 días) se determinaron usando los ensayos bioquímicos según la OMS. Resultados: Se obtuvieron las CL50 y CL99 µg / cm2 respectivamente para malatión 43.83 y 114.38, propoxur 4.71 y 19.29, y deltametrina 5.80 y 40.46. Un 30% de las chinches tuvo iAChE, y sólo pocos individuos tuvieron niveles superiores de P450 y β-eterasas. Conclusión: Los papeles impregnados y ensayos bioquímicos que describe la OMS para otros insectos demostraron ser métodos factibles para monitorear la resistencia a insecticidas y las enzimas metabólicas involucradas en T. dimidiata.

Phenolic profile and antioxidant, acetylcholinesterase, and tyrosinase inhibitor activities of Jurinea tzar-ferdinandii Davidov, an endemic plant of the Balkans / Perfil fenólico y actividad antioxidante, acetilcolinesterasa e inhibidora de tirosinasa de Jurinea tzar-ferdinandii Davidov, planta endémica de los Balcanes

The methanol extract of the Balkan endemic species Jurinea tzar-ferdinandii Davidov demonstrated weak antioxidant activity against DPPH• and ABTS+• and low inhibitory potential against acetylcholinesterase (8.3% Inh.) and tyrosinase (IC50 = 208 ± 8 µg/mL) enzymes. Phytochemical investigation of the extract led to isolation and identification of apigenin, luteolin, apigenin-7-O-glucoside, apigenin-4'-O-glucoside, apigenin-7-O-gentiobioside, luteolin-4'-O-glucoside, rutin, narcissin, chlorogenic and 1,5-dicaffeoylquinic acid. With exception of apigenin and rutin, all isolated compounds are reported for the first time in the representatives of genus Jurinea. The distribution of flavonoids was discussed from chemotaxonomic point of view.

El extracto de metanol de la especie endémica de los Balcanes Jurinea tzar-ferdinandii Davidov demostró una actividad antioxidante débil contra DPPH• y ABTS+• y un bajo potencial inhibidor contra las enzimas acetilcolinesterasa (8.3% Inh.) tirosinasa (IC50 = 208 ± 8 µg/mL). La investigación fitoquímica del extracto condujo al aislamiento e identificación de apigenina, luteolina, apigenina-7-Oglucósido, apigenina-4'-O-glucósido, apigenina-7-O-gentiobiósido, luteolina-4'-O-glucósido, rutina, narcissin, clorogénico y ácido 1,5- dicafeoilquinico. Con excepción de la apigenina y la rutina, todos los compuestos aislados se informan por primera vez en el género Jurinea. La distribución de flavonoides se discute desde el punto de vista quimiotaxonómico.

Aporphine alkaloids from Piper erecticaule and acetylcholinesterase inhibitory activity / Alcaloides de aporfina obtenida de Piper erecticaule y actividad inhibitoria de la acetilcolinesterasa

Chemical constituents and biological activities of the aerial parts of Piper erecticaule C.DC. have been studied for the first time. Fractionation and purification of the extracts afforded aristolactam AII (1), aristolactam BII (2), piperolactam A (3), piperolactam C (4), piperolactam D (5), together with terpenoids of ß-sitosterol, ß-sitostenone, taraxerol, and lupeol. The structures of these compounds were obtained by analysis of their spectroscopic data, as well as the comparison with that of reported data. Acetylcholinesterase inhibitory activity revealed that compounds 1 and 3 showed strong AChE inhibitory effects with the percentage inhibition of 75.8% and 74.8%, respectively.

Se estudiaron por primera vez los constituyentes químicos y actividad biológica de las partes aéreas de Piper erecticaule C.DC. El fraccionamiento y la purificación de los extractos proporcionaron aristolactama AII (1), aristolactama BII (2), piperolactama A (3), piperolactama C (4), piperolactama D (5), junto con terpenoides de ß-sitosterol, ß-sitostenona, taraxerol, y el lupeol. Las estructuras de estos compuestos se obtuvieron mediante el análisis de sus datos espectroscópicos, así como mediante la comparación con datos ya informados. La actividad inhibidora de la acetilcolinesterasa reveló que los compuestos 1 y 3 mostraron un potente efecto inhibidor de la AChE con un porcentaje de inhibición del 75.8% y 74.8%, respectivamente.

Uso de pralidoxima en la intoxicación con metomilo en pastor collie en Medellín (Colombia). Reporte de caso / Use of pralidoxime in methomyl intoxication in a Collie Shepherd in Medellín (Colombia). Case report

RESUMEN Se describe el uso de la pralidoxima en el tratamiento de una intoxicación con metomilo en un canino en la ciudad de Medellín (Colombia). Un macho de raza pastor collie sufrió intoxicación accidental con metomilo, presentó cuadro colinérgico, con miosis, sialorrea, delirio, excitación y emesis, fue sometido a descontaminación con carbón activado y terapia con atropina (0,04 mg/kg IM) cada 30 minutos hasta atropinizar, difenhidramina (2 mg/kg EV) y pralidoxima (10 mg/kg EV) cada 8 horas y pentobarbital (12 mg/kg EV) por 24 horas, además de terapia de sostén. Se realizaron pruebas hematológicas, creatinina, alanino aminotrasferasa, tiempo de protrombina y tiempo parcial tromboplastina que resultaron normales para la especie. Después de una terapia de 7 días el paciente presentó mejoría total de los signos nerviosos y se dio de alta en condición normal. El uso de pralidoxima como activador de la acetilcolinesterasa es una opción en el tratamiento de la intoxicación grave por metomilo en la especie canina que muestra sensibilidad a los carbamatos.

ABSTRACT The use of pralidoxime in the treatment of intoxication by methomyl in a canine of the city of Medellín (Colombia) is described. A male of the Collie Shepherd breed who accidentally intoxicated itself with methomyl and presented cholinergic profile with myosis, sialorrhea, delirium, excitement and emesis, was subjected to decontamination with activated charcoal and therapy with atropine (0.04 mg/kg IM) every 30 minutes until atropinization; diphenhydramine (2 mg/kg IV) every 8 hours, pralidoxime (10 mg/kg IV) every 8 hours; and pentobarbital (12 mg/kg IV) for 24 hours, in addition to supportive therapy. Hematological, creatinine, alanine aminotransferase, prothrombin time and partial thromboplastint time tests were performed and resulted normal for the species. After a 7-day therapy, the patient presented complete improvement of its nervous signs and was discharged in normal condition. The use of pralidoxime as activator of acetylcholinesterase is an option in the treatment of severe intoxication with methomyl in canine species that exhibit sensitivity to carbamates.

Intoxicación por organofosforados / Organophospate poisoning

Resumen La intoxicación por organofosforados es de gran importancia en el campo de la medicina, debido a su uso frecuente en la actividad agrícola, las intoxicaciones producidas por estos agentes pueden ser ocupacionales, accidentales, y con mayor frecuencia por ingesta voluntaria. Una de las mayores repercusiones de los organofosforados es la inhibición del acetil colinesterasa, enzima encargada de hidrolizar el acetil colina. Las manifestaciones clínicas de la intoxicación aguda se deben a la estimulación de receptores muscarínicos y nicotínicos, entre ellas broncorrea, salivación, lagrimeo, broncoespasmo, defecación, emesis, miosis, entre otros. El diagnóstico se realiza mediante la historia clínica y examen físico, de manera adicional con la detección de los niveles en sangre eritrocitaria de acetil colinesterasa o de los metabolitos de los organofosforados. El manejo incluye la descontaminación del agente, la revisión del estado respiratorio y el acceso al soporte ventilatorio, posteriormente se procede con el tratamiento farmacológico que incluye el uso de la atropina, pralidoxima y diazepam. El presente artículo constituye una revisión bibliográfica sobre la intoxicación por organofosforados, sus manifestaciones clínicas, diagnóstico y tratamiento.

Abstract Organophosphorus poisoning is of great importance in the field of medicine due to its frequent use in agriculture, the poisoning by exposure to these agents can be occupational, accidental, and frequently due to voluntary intake. Organophosphorus' intake most notable effects are produced by the inhibition of the acetyl cholinesterase, responsible for hydrolyzing acetyl choline. Clinical manifestations of acute intoxication typically include bronchorrhea, salivation, lacrimation, bronchospasm, defecation, emesis, miosis, among others and they occur due to the stimulation of muscarinic and nicotinic receptors. Diagnosis is made through the interrogation and physical examination, in addition to the detection of acetyl cholinesterase levels or the organophosphates' metabolites in blood testing. Management includes decontamination of the agent, review of respiratory status and access to ventilatory support, followed by pharmacological treatment that includes the use of atropine, pralidoxime and diazepam. The present article constitutes a bibliographic review about the organopho sphorus intoxication, its clinical manifestations, diagnosis and treatment.

Los niveles de acetilcolinesterasa en pacientes con inestabilidad hemodinámica descartan sepsis como causa de choque / The levels of acetylcholinesterase in patients with hemodynamic instability discard sepsis as a cause of shock / Níveis de acetilcolinesterase em pacientes com instabilidade hemodinâmica descartam sepse como causa de choque

Resumen: Introducción: La detección temprana de sepsis es fundamental para disminuir la mortalidad de este padecimiento. Hasta el momento, ninguna escala clínica ni biomarcador ha sido útil en su diagnóstico y detección precoz. Los niveles de actividad de la acetilcolinesterasa se han propuesto como un biomarcador muy prometedor para la detección de sepsis y choque séptico. Objetivo: Estudiar la utilidad de los niveles de acetilcolinesterasa en el diagnóstico de sepsis. Material y métodos: Estudio observacional y prospectivo, en pacientes de la Unidad de Cuidados Intensivos del Hospital San Ángel Inn Universidad con diagnóstico de inestabilidad hemodinámica, clasificados con presencia o no de sepsis, tomándose niveles de acetilcolinesterasa al ingreso. Resultados: Se evaluaron 44 pacientes, 27% con sepsis. Los valores de acetilcolinesterasa tuvieron validez diagnóstica para predecir sepsis (AUC: 0.852 IC 95%: 0.726-0.977, p < 0.001), con un punto de corte de 3,956 U/L, sensibilidad = 81%, especificidad = 75%. El valor de neutrófilos con corte < 74% también tuvo valor predictor de sepsis (AUC: 0,710 IC 95%: 0,512-0,907, p = 0.034) sensibilidad = 75%, especificidad = 75%. Conclusiones: En pacientes con inestabilidad hemodinámica con niveles de acetilcolinesterasa mayores de 4,000 U/L se descarta sepsis como causa de choque.

Abstract: Introduction: Early detection of sepsis is essential to reduce mortality from this condition. So far, no clinical scale or biomarker has been useful in its diagnosis and early detection. Levels of acetylcholinesterase activity have been proposed as a very promising biomarker for the detection of sepsis and septic shock. Objective: To study the usefulness of acetylcholinesterase levels in the diagnosis of sepsis. Material and methods: Observational and prospective study in patients of the Intensive Care Unit of the Hospital San Ángel Inn Universidad with diagnosis of hemodynamic instability, classified with or without sepsis, taking acetylcholinesterase levels at admission. Results: 44 patients were evaluated, 27% with sepsis. The acetylcholinesterase values ​​presented a normal distribution and had diagnostic validity to predict sepsis (AUC: 0.852 95% CI: 0.726-0.977, p < 0.001), with a cut-off value of < 3,956 U/L, sensitivity = 81%, specificity = 75%. The value of neutrophils with a cut < 74% also had a predictive value of sepsis (AUC: 0.710 95% CI: 0.512-0.907, p = 0.034) sensitivity = 75%, specificity = 75%. Conclusions: In patients with hemodynamic instability with acetylcholinesterase levels greater than 4,000 U/L, sepsis is ruled out as the cause of shock.

Resumo: Introdução: A detecção precoce da sepse é fundamental para reduzir a mortalidade desta doença. Até agora nenhuma escala clínica ou biomarcador tem sido útil em seu diagnóstico e detecção precoce. Os níveis de atividade da acetilcolinesterase têm sido propostos como um biomarcador muito promissor para a detecção de sepse e choque séptico. Objetivo: Estudar a utilidade dos níveis de acetilcolinesterase no diagnóstico da sepse. Material e métodos: Estudo observacional e prospectivo, realizado em pacientes da unidade de terapia intensiva do Hospital Universitário San Ángel Inn, com diagnóstico de instabilidade hemodinâmica, classificados com ou sem a presença de sepse, obtendo os níveis de acetilcolinesterase na admissão. Resultados: Foram avaliados 44 pacientes, 27% com sepse. Os valores de acetilcolinesterase apresentaram validade diagnóstica para predizer sepse (AUC: 0.852 IC 95%: 0.726-0.977, p < 0.001), com valor de corte 3956 U/L, sensibilidade = 81%, especificidade = 75%. O valor de neutrófilos com um corte < 74% também teve um valor preditivo de sepsis (AUC: 0.710 IC 95%: 0.512-0.907, p = 0.034) sensibilidade = 75%, especificidade = 75%. Conclusões: Em pacientes com instabilidade hemodinâmica com níveis de acetilcolinesterase superiores a 4,000 U/L a sepse é descartada como causa de choque.

Pharmacogenetic studies in Alzheimer disease. / Estudios farmacogenéticos en la enfermedad de Alzheimer.

INTRODUCTION: Alzheimer disease (AD) is the most common cause of dementia and is considered one of the main causes of disability and dependence affecting quality of life in elderly people and their families. Current pharmacological treatment includes acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine; however, only one-third of patients respond to treatment. Genetic factors have been shown to play a role in this inter-individual variability in drug response. DEVELOPMENT: We review pharmacogenetic reports of AD-modifying drugs, the pharmacogenetic biomarkers included, and the phenotypes evaluated. We also discuss relevant methodological considerations for the design of pharmacogenetic studies into AD. A total of 33 pharmacogenetic reports were found; the majority of these focused on the variability in response to and metabolism of donepezil. Most of the patients included were from Caucasian populations, although some studies also include Korean, Indian, and Brazilian patients. CYP2D6 and APOE are the most frequently studied biomarkers. The associations proposed are controversial. CONCLUSIONS: Potential pharmacogenetic biomarkers for AD have been identified; however, it is still necessary to conduct further research into other populations and to identify new biomarkers. This information could assist in predicting patient response to these drugs and contribute to better treatment decision-making in a context as complex as aging.

Assessment of hematological parameters in workers exposed to organophosphorus pesticides, carbamates and pyrethroids in Cundinamarca 2016-2017 / Evaluación de parámetros hematológicos en trabajadores expuestos a pesticidas organofosforados, carbamatos y piretroides, Cundinamarca 2016-2017

ABSTRACT Objective To establish hematotoxic alterations through clinical and paraclinical exploration in workers who are exposed to organophosphorus pesticides, carbamates and pyrethroids (OPCP) due to their work in production, packaging, distribution and fumigation processes in Cundinamarca-Colombia between 2016 and 2017. Materials and Methods A cross-sectional descriptive epidemiological study was carried out on a sample of 92 workers from six companies, mostly aged between 18 and 30 years, of which 61 % were males and 39 % females, and 71 % were workers in the operational area and 29 % in the administrative area. Univariate, bivariate and multivariate analyses were performed. Results Clinical exploration reported findings in 17 % of the sample group, of which only 2 % presented with erythrocyte cholinesterase outside the reference range. The values of hematological parameters such as peripheral blood smear (PBS) and complete blood count (CBC) were outside the range in 15 % and 47 % of the sample, respectively. Discussion The results suggest that there are hematological alterations in this group that could possibly be associated with chronic exposure to OPCP.

RESUMEN Objetivo Determinar las alteraciones hematotóxicas a través de una exploración clínica y paraclínica, en trabajadores que por su oficio se exponen a pesticidas organofosforados, carbamatos y piretroides (POCP), en procesos de producción, envase, distribución y fumigación, en el departamento de Cundinamarca Colombia. Metodología Se realizó un estudio epidemiológico descriptivo de corte transversal. Se realizó un análisis univariado, bivariado y multivariado. La muestra se conforma por 92 trabajadores de seis empresas, la mayoría entre los 18 y 30 años, de los cuales el 61 % son hombres y el 39 % mujeres, 71 % se desempeñan en el área operativa y 29 % en el área administrativa. Resultados Es de resaltar que se tienen hallazgos en la exploración clínica en el 17 % del grupo participante, solo el 2 % presenta la colinesterasa eritrocitaria por fuera del rango de referencia. Los parámetros hematológicos como el frotis de sangre periférica (FSP) presentan valores por fuera de los rangos en el 15 % y el cuadro hemático (CH) tiene valores por fuera de los rangos en el 47 % de las personas. Discusión Los resultados sugieren que existen alteraciones hematológicas en este grupo y que posiblemente podrían estar asociadas con la exposición crónica a POCP.

Caracterización fitoquímica y evaluación de actividad inhibitoria sobre acetilcolinesterasa de hojas de Piper pesaresanum C. DC / Phytochemical characterization and evaluation of the inhibitory activity of Piper pesaresanum C. DC leaves against acetylcholinesterase

Introducción: el género Piper perteneciente a la familia Piperaceae es de gran importancia económica debido a sus aplicaciones a nivel alimenticio, industrial y medicinal. Especies de este género son conocidas popularmente como cordoncillos y se caracterizan porque presentan un amplio espectro de actividades biológicas, entre las que se encuentra el efecto neuroprotector, que está asociado al tratamiento de enfermedades neurodegenerativas como el Alzheimer. En Colombia existen muchas especies a las cuales no se les han desarrollado estudios investigativos, tal es el caso de Piper pesaresanum C. DC. Objetivo: caracterizar química y biológicamente el extracto etanólico de hojas de P. pesaresanum mediante un estudio fitoquímico biodirigido y evaluar la actividad inhibitoria sobre acetilcolinesterasa. Métodos: a partir del extracto etanólico de hojas maduras de P. pesarenasum se realizó un estudio químico biodirigido para aislar e identificar las sustancias responsables de la actividad inhibitoria sobre acetilcolinesterasa. La evaluación de la actividad inhibitoria sobre acetilcolinesterasa se realizó por autografía directa empleando el método de Ellman. Adicionalmente se realizó un tamizaje fitoquímico preliminar mediante pruebas de...(AU)

Introduction: The genus Piper, from the Piperaceae family, has great economic importance, due to its uses on a nutritional, industrial and medicinal level. The species in this genus are commonly known as peppers, and are characterized by a broad range of biological activities, including a neuroprotective effect associated with the treatment of neurodegenerative conditions such as Alzheimer's disease. Many of the species growing in Colombia have not been studied. Such is the case with Piper pesaresanum C. DC. Objective: Carry out a chemical and biological characterization of the ethanolic extract of P. pesaresanum leaves by means of a bioguided phytochemical study and evaluate inhibitory activity on acetylcholinesterase. Methods: A bioguided chemical study was conducted of the ethanolic extract of P. pesarenasum mature leaves to isolate and identify the substances responsible for inhibitory activity on acetylcholinesterase. Evaluation of inhibitory activity on acetylcholinesterase was based on direct autography using the Ellman method. Preliminary phytochemical screening was also performed by means of wet color and precipitation tests, and thin-layer chromatography. Results: Preliminary phytochemical analysis suggests the presence of terpenes, steroids, phenols and coumarins. Evaluation of inhibitory activity on acetylcholinesterase revealed clear-cut inhibition areas in petroleum ether (PE) and chloroform (CHCl3) fractions. The bioguided phytochemical study led to isolation and identification of 4-methoxy-3.5-di(3'-methyl-2'-butenyl) benzoic acid for the first time in the study species. Conclusions: Chemical study and evaluation of the biological activity of the species P. pesaresanum led to identification of 4-methoxy-3.5-di(3'-methyl-2'-butenyl) benzoic acid as one of the compounds responsible for inhibitory activity on acetylcholinesterase(AU)

Caracterización fitoquímica y evaluación de actividad inhibitoria sobre acetilcolinesterasa de hojas de Piper pesaresanum C. DC / Phytochemical characterization and evaluation of the inhibitory activity of Piper pesaresanum C. DC leaves against acetylcholinesterase

Introducción: el género Piper perteneciente a la familia Piperaceae es de gran importancia económica debido a sus aplicaciones a nivel alimenticio, industrial y medicinal. Especies de este género son conocidas popularmente como cordoncillos y se caracterizan porque presentan un amplio espectro de actividades biológicas, entre las que se encuentra el efecto neuroprotector, que está asociado al tratamiento de enfermedades neurodegenerativas como el Alzheimer. En Colombia existen muchas especies a las cuales no se les han desarrollado estudios investigativos, tal es el caso de Piper pesaresanum C. DC. Objetivo: caracterizar química y biológicamente el extracto etanólico de hojas de P. pesaresanum mediante un estudio fitoquímico biodirigido y evaluar la actividad inhibitoria sobre acetilcolinesterasa. Métodos: a partir del extracto etanólico de hojas maduras de P. pesarenasum se realizó un estudio químico biodirigido para aislar e identificar las sustancias responsables de la actividad inhibitoria sobre acetilcolinesterasa. La evaluación de la actividad inhibitoria sobre acetilcolinesterasa se realizó por autografía directa empleando el método de Ellman. Adicionalmente se realizó un tamizaje fitoquímico preliminar mediante pruebas de coloración y precipitación llevadas a cabo en vía húmeda y cromatografía en capa delgada. Resultados: el análisis fitoquímico preliminar sugiere la presencia de terpenos, esteroides, fenoles y cumarinas. La evaluación de la actividad inhibitoria sobre acetilcolinesterasa permitió evidenciar zonas claras de inhibición en las fracciones de éter de petróleo (EP) y cloroformo (CHCl3). El estudio fitoquímico biodirigido condujo al aislamiento e identificación por primera vez para la especie del ácido 4-metoxi-3,5-di(3'-metil-2'-butenil) benzoico. Conclusiones: el estudio químico y de actividad biológica llevado a cabo en la especie P. pesaresanum permitió identificar al ácido 4-metoxi-3,5-di(3'-metil-2'-butenil) benzoico como uno de los compuestos responsables de la actividad inhibitoria sobre acetilcolinesteras(AU)

Introduction: The genus Piper, from the Piperaceae family, has great economic importance, due to its uses on a nutritional, industrial and medicinal level. The species in this genus are commonly known as peppers, and are characterized by a broad range of biological activities, including a neuroprotective effect associated with the treatment of neurodegenerative conditions such as Alzheimer's disease. Many of the species growing in Colombia have not been studied. Such is the case with Piper pesaresanum C. DC. Objective: Carry out a chemical and biological characterization of the ethanolic extract of P. pesaresanum leaves by means of a bioguided phytochemical study and evaluate inhibitory activity on acetylcholinesterase. Methods: A bioguided chemical study was conducted of the ethanolic extract of P. pesarenasum mature leaves to isolate and identify the substances responsible for inhibitory activity on acetylcholinesterase. Evaluation of inhibitory activity on acetylcholinesterase was based on direct autography using the Ellman method. Preliminary phytochemical screening was also performed by means of wet color and precipitation tests, and thin-layer chromatography. Results: Preliminary phytochemical analysis suggests the presence of terpenes, steroids, phenols and coumarins. Evaluation of inhibitory activity on acetylcholinesterase revealed clear-cut inhibition areas in petroleum ether (PE) and chloroform (CHCl3) fractions. The bioguided phytochemical study led to isolation and identification of 4-methoxy-3.5-di(3'-methyl-2'-butenyl) benzoic acid for the first time in the study species. Conclusions: Chemical study and evaluation of the biological activity of the species P. pesaresanum led to identification of 4-methoxy-3.5-di(3'-methyl-2'-butenyl) benzoic acid as one of the compounds responsible for inhibitory activity on acetylcholinesterase(AU)

[Pharmacological treatment]. / Terapias farmacológicas.

Alzheimer's disease (AD) is a chronic degenerative and inflammatory process leading to synapticdysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made.

Diagnóstico diferencial de cetoacidosis hiperglicémica: Intoxicación por plaguicidas. Caso clínico / Differential diagnosis from hyperglycemic ketoacidosis: Pesticide poisoning. Clinical case

La cetoacidosis diabética en niños puede ser una causa de morbilidad grave y mortalidad, especialmente si no se reconoce en el momento del primer diagnóstico. Sin embargo, existen otras patologías que pueden aparentar una alteración metabólica de este tipo y pasarse por alto si no se tiene sospecha clínica. A continuación, se describe un caso clínico que presenta cetoacidosis hiperglicémica debido al contacto con organofosforado, en el cual fue necesario el uso de insulina en infusión continua para el control del trastorno metabólico, sin repercusiones después del alta.

Diabetic ketoacidosis in children causes serious morbidity and mortality, especially if it is not recognized on time in the initial diagnosis. However, there are other diseases that can appear to be a metabolic disorder of this kind and be ignored if it is not suspected. We present a clinical case with hyperglycemic ketoacidosis due to the contact with organophosphate; we had to use a continuous infusion of insulin to control the metabolic disorder without repercussions after the girl came home.

[Risk/benefit assessment in the treatment of Alzheimer's disease. Drug interactions]. / Valoración del riesgo/beneficio en el tratamiento de la enfermedad de Alzheimer. A propósito de una interacción.

INTRODUCTION: Anticholinergic drugs reduce the efficacy of acetylcholinesterase inhibitors (AChEI) and are inappropriate in elderly patients. The aim of this study is to determine the prevalence rate of prescription AChEI drugs and anticholinergics in a Healthcare Area, to identify the affected patients, and to inform the attending physicians, in order to evaluate the suitability of treatments. MATERIAL AND METHODS: A descriptive cross-sectional observational study of prevalence. Patients on treatment with AChEI and any anticholinergic drug in the first quarter of 2015 were selected. The review of Duran et al. was used as reference to identify anticholinergics, assigning a score to each drug according to its anticholinergic potency. Physicians were provided with a report about the interaction, the list of affected patients, and recommendations. RESULTS: A total of 486 patients were included in the study, representing 59.0% of total patients with Alzheimer's disease in the Area. There were 66.0% women, and 86.8% of the patients were older than 75 years, and with a mean of 9.2 drugs per patient. The mean number of anticholinergic drugs was 1.6, and 38.3% of patients were prescribed various anticholinergic drugs, with 23.9% on high potency anticholinergic drugs. A statistically significant association was found between taking an anticholinergic and AChEI concomitantly (P=.000; OR: 3.9). CONCLUSIONS: The prevalence of interactions between AChEI and anticholinergic drugs is relevant, considering that it affects vulnerable members of the population. Providing physicians with information about the interaction could help them make clinical decisions, and could improve patient safety, as well as health outcomes.