Impacto de las alertas de seguridad en la prescripción de terapia hormonal sustitutiva / Impact of safety alerts on prescription of hormone replacement therapy

Objetivo: Evaluar el impacto de evidencias científicas y alertas farmacéuticas (período 2002-2004) sobre la prescripción de la terapia hormonal sustitutiva (THS). Material y método: Estudio observacional retrospectivo donde se han analizado las variaciones en la prescripción de la hormonoterapia realizada por facultativos del servicio de atención primaria (292.000 habitantes). Se ha evaluado la prescripción de la THS según los períodos de las alertas farmacéuticas y se ha estratificado el cambio en la prescripción según períodos preestablecidos. La unidad de medida utilizada fue la dosis diaria definida por 1.000 habitantes/día, en nuestro estudio referida a la población de mujeres (DHDmujeres). Resultados: Se observó una disminución inmediata del 5,5% en la prescripción de THS tras la publicación de la alerta 2002 que llegó al 29,6% al año de su difusión. La nota informativa 2004 produjo una reducción inicial del 29,8%, que llegó al 56,9% al año. En los ginecólogos, observamos una respuesta más tardía y menos intensa a la alerta 2002 (reducción del 6,6% al año), con una respuesta inicial a la alerta 2004 del 39,4 y del 64,3% al año. Conclusiones: La respuesta a las alertas de seguridad en la prescripción de THS fue variable según el período estudiado y el colectivo profesional

Aim: To evaluate the impact of scientific evidence and pharmaceutical safety alerts on prescription of hormone replacement therapy (HRT) from 2002 to 2004. Material and method: An observational retrospective study of prescription of HRT was carried out by physicians from a primary care service (292,000 inhabitants). Variations in HRT prescription were evaluated according to publication of safety alerts between 2002 and 2004 and changes in prescription were stratified by pre-established periods. The unit of measure employed was the defined daily dose per 1,000 inhabitants per day (DID). In this study, the DID referred to the female population (DIDwomen). Results: After the publication of the 2002 alert, HRT prescription immediately decreased by 5.5%. A year after the alert was issued, prescriptions had fallen by 29.6%. After the 2004 safety alert, HRT prescription fell by 29.8 %, reaching a 56.9% decrease after 1 year. Gynecologists showed a later and less intense response to the 2002 alert (6.6% decrease at 1 year) than to the 2004 alert, which produced an initial decrease in prescription of 39.4%, which fell further to 64.3% 1 year later. Conclusions: Response to the publication of safety alerts on HRT prescription was erratic, depending on the period and the professional group studied

In vitro antiprotozoal activity from the roots of Geranium mexicanum and its constituents on Entamoeba histolytica and Giardia lamblia.

This paper examines the antiprotozoal activity of the dichloromethane-MeOH extract, fractions and pure compounds from the roots of Geranium mexicanum on Entamoeba histolytica and Giardia lamblia. The result indicated that the extract, organic fraction and a pure flavonoid were active against both protozoa with IC50 values ranging from 1.9 to 79.2 microg/ml for Entamoeba histolytica and from 1.6 to 100.4 microg/ml in the case of Giardia lamblia. The main active compound was the flavan-3-ol, (-)-epicatechin. In addition, the moderate active compounds (+)-catechin, tyramine and beta-sitosterol 3-O-beta-D-glucopyranoside, also were isolated. These results support the anecdotal reports for the traditional use of Geranium mexicanum roots in the management of diarrhoea and dysentery, illnesses caused in some cases by enteric protozoa.

Intelligence quotient and iodine intake: a cross-sectional study in children.

The association between iodine deficiency and poor mental and psychomotor development is known. However, most studies were undertaken in areas of very low iodine intake. We investigated whether a similar association is found in schoolchildren from southern Europe with a median urinary iodine output of 90 microg/liter. Urinary iodine levels were measured in 1221 children who also completed a questionnaire about their usual dietary habits. Intelligence quotient (IQ) was measured by Cattell's g factor test. IQ was significantly higher in children with urinary iodine levels above 100 microg/liter. The risk of having an IQ below the 25th percentile was significantly related to the intake of noniodized salt and drinking milk less than once a day. As expected, the risk of having an IQ below 70 was greater in children with urinary iodine levels less than 100 microg/liter. In conclusion, this study demonstrates that the IQ of schoolchildren in a developed country can be influenced by iodine intake. The results support the possibility of improving the IQ of many children from areas with mild iodine deficiency by ensuring an iodine intake sufficient to achieve a urinary iodine concentration greater than 100 microg/liter.

Blood cultures for women with uncomplicated acute pyelonephritis: are they necessary?

To assess the utility of blood cultures in the management of uncomplicated pyelonephritis in women, we prospectively collected data from 583 cases. Discordant cases were defined as those for which the pathogens isolated from urine and from blood were different. We found that 97.6% of cases were nondiscordant. Clinical and microbiological evolution of infection did not differ between the 2 groups, and no changes of antibiotic therapy were required on the basis of blood culture results. Blood culture may not be routinely required for the evaluation of uncomplicated pyelonephritis in women.

Estudio de supervivencia de tres sistemas de ataches extracoronarios utilizados en prótesis mixta / Survival study of three systems of extracoronary attachments used in mixed prostheses

Introducción: El objetivo es determinar el comportamiento clínico y la supervivencia de tres sistemas de ataches extracoronarios: Roach, MiniDalbo y MiniSG. Material y método: Se realizó un estudio retrospectivo, de las historias clínicas de pacientes a los que como mínimo hacía 48 meses se habían colocado prótesis mixta con los citados ataches. Se registraron los aspectos clínicos que podían influir en la supervivencia: número de pilares ferulizados, extremo libre, maxilar y tipo de dentición del antagonista. El tamaño muestral incluyó 163 ataches. Se consideró evento terminal la fractura del atache, del pilar o el despegamiento de la corona. El estudio fue a tiempo completo. Resultados: La supervivencia media fue de 46 meses (IC 95 por ciento 44,9-47,3 ). Se presentaron 24 complicaciones en 21 ataches. El atache MiniSG presenta el menor número de complicaciones 9 por ciento (IC 95 por ciento 0-18,12 ). Ni el Test de Breslow, ni la regresión de Cox mostraron valores significativos cuando se contrastaron las curvas de supervivencia de las distintas variables estudiadas, incluido el tipo de atache. Conclusion: El atache MiniSG presenta mejor comportamiento clínico que el Roach y el MiniDalbo pero las diferencias no son estadísticamente significativas (AU)