Can the genetic variability of Blastocystis sp. be associated with the climatic region of its human carriers?

Blastocystis sp. is a widespread microorganism that colonizes the intestinal tract of several animals, including human beings, while its pathogenic role in humans is still under debate. The objective of the present study was to describe the frequency of Blastocystis sp. subtypes (STs) and their genetic variation within and among samples recovered from scholars inhabiting two rural villages with tropical climates and compare this information with previously documented data from arid and temperate zones in Mexico. Blastocystis sp. positive samples and ST identification were achieved by coprological analysis screening and Polymerase Chain Reaction-sequencing, respectively. Classical population genetics indexes (nucleotide diversity (π), haplotype polymorphism (θ), gene flow (Nm), genetic differentiation (ST), and Tajima's D) were calculated by comparing the sequences here obtained (n = 42) and those from previous studies from the arid (n = 80) and temperate (n = 61) climates from Mexico. Although Blastocystis sp. was the parasite most frequently found between 33% and 26% in both communities, only STs 1-3 were found. Haplotype network inference of Blastocystis sp. STs showed different haplotype profiles among STs vs. climate zones, although no specific haplotypes were identified for any particular climatic zone. Population genetics indexes showed different values within STs and climate zones (π and θ values ranged from 0.004 to 0.147; Nm > 4 and ST from 0.006 to 0.12). Our results show that Blastocystis sp. subtypes exhibit a different genetic variability profile according to the climate zone, suggesting a balancing process between the genetic variability within the Blastocystis sp. subtype and the number of haplotypes identified in each climate.

Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study.

BACKGROUND: The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS: Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS: A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS: PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.

Risk factors for anastomotic leakage following total or subtotal colectomy

Introduction: A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. Themain aimof the present studywas to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods: We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results: Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of ALwas 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p=0.038), in the electivelaparoscopic approach subgroup (p=0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p=0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion: A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgerymay improve short-term outcomes. (AU)

Estadificación axilar post-neoadyuvancia en pacientes con cáncer de mama con metástasis ganglionares al diagnóstico. Nuestra experiencia preliminar con biopsia selectiva de ganglio centinela y disección axilar dirigida guiada con semilla de iodo-125 / Post-neoadjuvant axillary staging in node-positive breast cancer patients. Preliminary experience with sentinel lymph node biopsy and targeted axillary dissection with iodine-125 seed

La expansión de la quimioterapia neoadyuvante en cáncer de mama ha dado lugar a nuevos dilemas clínicos en el manejo de pacientes con axila metastásica al diagnóstico. La linfadenectomía axilar es el estándar en su estadificación y tratamiento, pese a tasas de respuesta axilar completa de 40-60%. Estudios prospectivos recientes han demostrado una buena precisión de los métodos mínimamente invasivos de estadificación axilar, por lo que su práctica se está extendiendo entre grupos de expertos. Presentamos nuestros primeros resultados en la evaluación axilar postneoadyuvancia de pacientes con metástasis ganglionares al diagnóstico (cN1) mediante biopsia selectiva de ganglio centinela (BSGC) y disección axilar dirigida guiada con semilla de iodo-125

The expansion of neoadjuvant chemotherapy (NACT) in breast cancer has led to new clinical dilemmas in the management of node-positive cancers at diagnosis. Axillary lymphadenectomy is the standard approach for the staging and treatment, despite complete axillary response rates up to 40-60%. Recent prospective studies have shown good accuracy of non-invasive methods for axillary staging in cN1 patients post-NACT, and have led to the spreading of this practice among expert groups. The first results are presented with post-neoadjuvant axillary re-evaluation of cN1 patients using Sentinel Lymph node biopsy (SLNB) and targeted axillary dissection with iodine-125 seed

Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study.

AIM: The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groups - primary perineal closure and reconstruction with a biological mesh. METHOD: One hundred and forty-seven consecutive patients who underwent ELAPE for primary rectal cancer between January 2007 and December 2018 in two tertiary referral centres were retrospectively identified from prospective databases. Perineal closure was carried out via primary closure or with a biological mesh (porcine dermal collagen mesh). Outcome measures were perineal hernia and perineal wound morbidity (infection, dehiscence, persistent sinus and chronic pain). RESULTS: A total of 139 patients were included in the study. A prophylactic mesh was used in 80 (57.5%) and primary closure was practised in 59 (42.4%) patients. The median follow-up was 30 (interquartile range 46.88) months. Thirty patients (21.6%) developed perineal hernia. No significant differences were found between prophylactic mesh and primary closure (16.3% vs 23.3%, P = 0.07). The median period between surgery and hernia diagnosis was 8 months in the primary closure group and 24 months in the mesh group (P < 0.01). Perineal wound morbidity was significantly higher in the prophylactic mesh group (55% vs 33.9%, P < 0.01). CONCLUSION: In our study, the use of a biological mesh did not reduce the rate of perineal hernia, although it did delay its appearance. Perineal closure using a biological mesh may increase perineal morbidity, both acute and chronic.

Comanejo de la fractura de cadera del anciano en un hospital de tercer nivel: un estudio de cohortes / Hip fracture co-management in the elderly in a tertiary referral hospital: a cohorts study

INTRODUCCIÓN: La fractura de cadera del anciano es de los diagnósticos más prevalentes en los servicios de Traumatología, con gran impacto en términos clínicos, económicos y sociales. Nuestro objetivo es analizar el impacto clínico de un modelo de comanejo entre Traumatología y Medicina Interna para pacientes ancianos ingresados por fractura de cadera en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Cohortes retrospectivas de pacientes mayores de 65 años ingresados por fractura de cadera entre enero de 2005 y agosto de 2006 (cohorte HIST) sin modelo de comanejo, y entre enero de 2008 y agosto de 2010 (cohorte COFRAC) con dicho modelo. Se analizaron características demográficas, clínicas y quirúrgicas, incidencia de complicaciones, mortalidad y reingreso a los 30 días. RESULTADOS: Se incluyó a 701 pacientes (471 HIST, 230 COFRAC). No hubo diferencias en edad, género, demora quirúrgica, tiempo y tipo de cirugía e intervención, estancia, deambulación al alta, consulta en urgencias ni reingreso o mortalidad a 30 días. Hubo diferencias en identificación de pluripatológicos (16,8 vs. 24,4%; p = 0,02), osteoporosis (3,9 vs. 7,6%; p = 0,03) o déficit motor (3,5 vs. 8,8%; p = 0,03), fármacos del tratamiento (3,7+/-2,5 vs. 4,3+/-3,2; p < 0,01), aparición de delirium (15,6 vs. 20,9%, p = 0,048) e hipomotilidad intestinal (80,3 vs. 74,7%; p < 0,001), seguimiento de anemia (83,3 vs. 97,1%; p > 0,01) y de función renal (44,5 vs. 97,3%; p < 0,01) y mortalidad intrahospitalaria (4,6 vs. 1,3%; p = 0,02). CONCLUSIONES: El comanejo de pacientes ancianos ingresados por fractura de cadera permite mejorar la documentación de los problemas crónicos previos y el control de complicaciones hospitalarias y disminuye la mortalidad intrahospitalaria

INTRODUCTION: Hip fracture in the elderly is one of the most prevalent diagnoses in Orthopedic Surgery Departments. It has a great impact in medical, economic and social terms. Our objective is to analyze clinical impact of a co-management care model between orthopedic surgery and internal medicine departments for elderly patients admitted with hip fracture in a tertiary referral hospital. MATERIAL AND METHODS: Retrospective cohort study of patients older than 65 years old admitted with hip fracture between January 2005-August 2006 (HIST cohort) without a co-management care model, and between January 2008-August 2010 (COFRAC cohort) with a co-manEdadment care model. Analysis of demographic, clinical and surgery characteristics, complications incidence and mortality and re-admissions at 30 days was made. RESULTS: A total of 701 patients were included (471 HIST, 230 COFRAC). There were no differences in sex, gender, time to surgery, type of anesthesia and surgery, length of stay, ambulation at discharge and 30-days emergency room consultation, readmissions or mortality at 30 days. There were differences in identification of polypatological patients (16.8 vs. 24.4%, P=0.02), presence of osteoporosis (3.9 vs. 7.6%, P=0.03), motor deficit (3.5 vs. 8.8%, P=0.03), number of chronic drugs (3.7+/-2.5 vs. 4.3+/-3.2, P<0.01), diagnosis of delirium (15.6 vs. 20.9%, P=0.048), constipation (80.3 vs. 74.7%, p < 0.001), monitoring of anemia (83.3 vs. 97.1%, P>0.01) and renal failure at discharge (44.5 vs. 97.3%, P<0.01) and hospital mortality (4.6 vs. 1.3%, P=0.02). CONCLUSIONS: Co-management for elderly patients admitted with hip fracture provides a better information about previously chronic conditions, a higher control of hospital complications and decreases hospital mortality

Hip fracture co-management in the elderly in a tertiary referral hospital: A cohorts study. / Comanejo de la fractura de cadera del anciano en un hospital de tercer nivel: un estudio de cohortes.

INTRODUCTION: Hip fracture in the elderly is one of the most prevalent diagnoses in Orthopedic Surgery Departments. It has a great impact in medical, economic and social terms. Our objective is to analyze clinical impact of a co-management care model between orthopedic surgery and internal medicine departments for elderly patients admitted with hip fracture in a tertiary referral hospital. MATERIAL AND METHODS: Retrospective cohort study of patients older than 65 years old admitted with hip fracture between January 2005-August 2006 (HIST cohort) without a co-management care model, and between January 2008-August 2010 (COFRAC cohort) with a co-manEdadment care model. Analysis of demographic, clinical and surgery characteristics, complications incidence and mortality and re-admissions at 30 days was made. RESULTS: A total of 701 patients were included (471 HIST, 230 COFRAC). There were no differences in sex, gender, time to surgery, type of anesthesia and surgery, length of stay, ambulation at discharge and 30-days emergency room consultation, readmissions or mortality at 30 days. There were differences in identification of polypatological patients (16.8 vs. 24.4%, P=0.02), presence of osteoporosis (3.9 vs. 7.6%, P=0.03), motor deficit (3.5 vs. 8.8%, P=0.03), number of chronic drugs (3.7±2.5 vs. 4.3±3.2, P<0.01), diagnosis of delirium (15.6 vs. 20.9%, P=0.048), constipation (80.3 vs. 74.7%, p<0.001), monitoring of anemia (83.3 vs. 97.1%, P>0.01) and renal failure at discharge (44.5 vs. 97.3%, P<0.01) and hospital mortality (4.6 vs. 1.3%, P=0.02). CONCLUSIONS: Co-management for elderly patients admitted with hip fracture provides a better information about previously chronic conditions, a higher control of hospital complications and decreases hospital mortality.

Medicina interna y cuidados paliativos: ciencia y humanismo / Internal medicine and palliative care: science and humanism

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Chemical analysis on laser processed Ultrahydrophobic Ti-6Al-4V surface by high vacuum Process.

A technique has been developed for fabrication of ultrahydrophobic Ti-6Al-4V surface by vacuum process. This report has the data related to the article "Hybrid laser and vacuum process for rapid ultrahydrophobic Ti-6Al-4 V surface formation" on the fabrication of ultrahydrophobic Ti-6Al-4V by Vacuum process (Jagdheesh et al., 2019). The present data consist of X-ray photo electron spectroscopy spectrums recorded for the laser patterned ultrahydrophobic samples, droplet image and surface chemical composition of laser patterned Ti-6Al-4V samples before vacuum process(b. v. p.) and after vacuum process (a. v. p.) for 120 min. The presented data give a clear idea about the chemical modification evolved during the vacuum process.

Rabies in a Dog Imported from Egypt - Connecticut, 2017.

In 2007, the United States successfully eliminated canine rabies virus variant. Globally, however, dogs remain the principal source of human rabies infections. Since 2007, three cases of canine rabies virus variant were reported in dogs imported into the United States, one each from India (2007), Iraq (2008), and Egypt (2015) (1-3). On December 20, 2017, a dog imported into the United States from Egypt was identified with rabies, representing the second case from Egypt in 3 years. An Egyptian-based animal rescue organization delivered four dogs from Cairo, Egypt, to a flight parent (a person solicited through social media, often not affiliated with the rescue organization, and usually compensated with an airline ticket), who transported the dogs to the United States. The flight parent arrived at John F. Kennedy International Airport (JFK) in New York City and, via transporters (persons who shuttle dogs from one state to another), transferred the dogs to foster families; the dogs ultimately were adopted in three states. The Connecticut Department of Public Health Laboratory (CDPHL) confirmed the presence of a canine rabies virus variant in one of the dogs, a male aged 6 months that was adopted by a Connecticut family. An investigation revealed the possibility of falsified rabies vaccination documentation presented on entry at JFK, allowing the unvaccinated dog entry to the United States. This report highlights the continuing risk posed by the importation of dogs inadequately vaccinated against rabies from high-risk countries and the difficulties in verifying any imported dog's health status and rabies vaccination history.

On the fatigue behavior of medical Ti6Al4V roughened by grit blasting and abrasiveless waterjet peening.

Flat fatigue specimens of biomedical Ti6Al4V ELI alloy were surface-processed by high pressure waterjet peening (WJP) without abrasive particles using moderate to severe conditions that yield roughness values in the range of those obtained by commercial grit blasting (BL) with alumina particles. Fatigue behavior of WJP and BL specimens was characterized under cyclical uniaxial tension tests (R=0.1). The emphasis was put on a comparative analysis of the surface and subsurface induced effects and in their relevance on fatigue behavior. Within the experimental setup of this investigation it resulted that blasting with alumina particles was less harmful for fatigue resistance than abrasiveless WJP. BL specimens resulted in higher subsurface hardening and compressive residual stresses. Specimens treated with more severe WJP parameters presented much higher mass loss and lower compressive residual stresses. From the analysis performed in this work, it follows that, in addition to roughness, waviness emerges as another important topographic parameter to be taken into account to try to predict fatigue behavior. It is envisaged that optimization of WJP parameters with the aim of reducing waviness and mass loss should lead to an improvement of fatigue resistance.

Knowledge, attitudes, and practices among border crossers during temporary enforcement of a formal entry requirement for Mexican-style soft cheeses, 2009.

Mexican-style soft cheese known as queso fresco (QF), which is often unpasteurized, has been implicated in outbreaks of foodborne illness in the United States. The U.S. Food and Drug Administration (FDA) exercises discretion in enforcement of noncommercial importation of cheese. To test control measures aimed at decreasing unlawful QF importation, in 2009 the FDA temporarily enforced a requirement for formal commercial entry for all cheeses over 5 lb (2.3 kg) at the San Diego-Tijuana border. Enforcement was combined with educational outreach. Border crossers importing cheese and those not importing cheese were surveyed at the beginning and end of the temporary enforcement period. Data collected included participant demographic information, knowledge of QF-associated health risks, and attitudes and practices regarding QF consumption and importation. We surveyed 306 importers and 381 nonimporters. Compared with nonimporters, importers had a lower level of knowledge regarding QF-associated health risks (P < 0.0001). Border crossers carrying cheese were more likely to have less education, be U.S. or dual residents, consume QF more frequently, and cross the border less often. Importation and consumption of unpasteurized QF remained prevalent among border crossers during the temporary enforcement period, and the level of knowledge regarding QF-associated risks remained low among these crossers. More vigorous, sustained messaging targeted at high-risk groups is needed to change behaviors. Definition and consistent enforcement of limits will likely be needed to reduce QF importation and the risk of QF-associated diseases along the U.S.-Mexico border; however, public health benefits will need to be balanced against the cost of enforcement.

Clinical usefulness of lanthanum carbonate for serum phosphate control in difficult patients.

BACKGROUND: The adequate control of phosphataemia is of major importance in end-stage renal disease patients on maintenance dialysis. Recently, lanthanum carbonate (LC) has been added to the phosphate binder armamentarium. To our knowledge, no studies have yet evaluated the usefulness of this drug in uncontrolled hyperphosphataemic patients. METHODS: This was a 6-month prospective observational study. Patients on chronic hemodialysis who had previously failed to achieve serum phosphate control were enrolled. Thirty-four patients (i.e. 11% out of 305 from three dialysis units) met the inclusion criteria. Lanthanum carbonate was introduced and titrated to achieve serum phosphate control, according to the KDOQI guidelines. Clinical targets, gastrointestinal symptoms, and patients' satisfaction with therapy were assessed at baseline and after 6 months. RESULTS: Eight patients (23.5%) were withdrawn from the study due to side effects. In the remaining patients, serum phosphate level significantly decreased from 5.8 to 4.4 mg/dl and calcium-phosphate product also decreased significantly from 55.6 to 41.8 mg(2)/dl(2). The average number of all phosphate binder tablets taken per day was reduced from 6.7 to 4.7. Evaluation scores of dyspeptic symptoms and of patient's satisfaction with therapy also improved: from 7.5 to 5.3 and from 6.6 to 8.1, respectively. CONCLUSIONS: The introduction of LC improved serum phosphate control in over 70% of these "difficult patients". A lower pill burden was also obtained, which might help to simplify treatment and increase patients' compliance. Dyspeptic symptoms and overall satisfaction with treatment also improved.

[Approach to quality objectives in incidents of patients in peritoneal dialysis]. / Cumplimiento de objetivos de calidad y evolución de los pacientes incidentes en diálisis peritoneal.

INTRODUCTION: In 2007 the Scientific Quality-technical and Improvement of Quality in Peritoneal Dialysis was edited. It includes several quality indicators. As far as we know, only some groups of work had evaluated these indicators, with inconclusive results. AIM: To study the evolution and impact of guidelines in Peritoneal Dialysis. METHODS: Prospective cohort study of each incident of patients in Peritoneal Dialysis, in a regional public health care system (2003-2006). We prospectively collected baseline clinical and analytical data, technical efficacy, cardiovascular risk, events and deaths, hospital admissions and also prescription data was collected every 6 months. RESULTS: Over a period of 3 years, 490 patients (53.58 years of age; 61.6% males.) Causes of ERC: glomerular 25.5%, diabetes 16%, vascular 12.4%, and interstitial 13.3%. 26.48% were on the list for transplant. Dialysis efficacy: Of the first available results, the residual renal function was 6.37 ml/min, achieving 67.6% of all the objectives K/DOQI. 38.6% remained within the range during the entire first year. Anaemia: 79.3% received erythropoietic stimulating agents and maintained an average Hb of 12.1 g/dl. The percentage of patients in the range (Hb: 11-13 g/dl) improved after a year (58.4% vs 56.3% keeping in the range during this time of 25.6%). Evolution: it has been estimated that per patient-year the risk of: 1) mortality is 0.06 IC 95% [0.04-0.08]; 2) admissions 0.65 [0.58-0.72]; 3) peritoneal infections 0.5 [0.44-0.56]. CONCLUSION: Diabetes Mellitus patients had a higher cardiovascular risk and prevalence of events. The degrees of control during the follow-up in many topics of peritoneal dialysis improve each year; however they are far from the recommended guidelines, especially if they are evaluated throughout the whole study.

Interacciones medicamentosas en pacientes pluripatológicos / Drug-drug interactions in a multicentre polypathological polymedicated patients

ObjetivosDeterminar la prevalencia de interacciones medicamentosas en pacientes pluripatológicos polimedicados y los factores asociados. Como objetivo secundario determinamos la aceptación de un programa de notificación de interacciones medicamentosas con recomendaciones dirigido a los facultativos prescriptores.Sujetos y métodosEstudio transversal en 3 centros de salud del área sanitaria de un hospital universitario. Se incluyeron todos los pacientes pluripatológicos a quienes se les había recomendado 5 o más fármacos diferentes de forma simultánea. Las interacciones medicamentosas se detectaron mediante el programa Drug-Reax System® (Micromedex), Bot del Consejo General de Colegios Oficiales de Farmacéuticos de España, o mediante búsqueda bibliográfica. Fueron seleccionadas como relevantes aquellas interacciones medicamentosas consideradas por los investigadores farmacéuticos como susceptibles de intervención. La aceptación del programa de notificación de interacciones medicamentosas se evaluó mediante una encuesta dirigida a los facultativos de atención primaria («aceptable», recomendación oportuna que potencialmente puede modificar el tratamiento).ResultadosFueron incluidos 283 pacientes pluripatológicos polimedicados, con una edad media de 74,5 años (rango 43–100 años). La media de condiciones patológicas por paciente fue de 2,5 y de prescripciones de 9,7. De un total de 2.748 prescripciones medicamentosas se identificaron 1.053 interacciones medicamentosas que afectaron a 250 enfermos (96,5%). Se consideraron interacciones relevantes el 45%. La presencia de cardiopatía isquémica, haber estado ingresado en 2 o más ocasiones y recibir 7 o más prescripciones se asoció con la presencia de interacciones medicamentosas. Desde el servicio de farmacia se emitieron 177 notificaciones para otros tantos facultativos responsables de cada paciente que contenían 473 recomendaciones sobre las interacciones detectadas...AU)

ObjectiveTo determine the prevalence of relevant drug-drug interactions (DDIs) and associated predictor factors in a sample of patients with multiple complex chronic diseases (polypathological patients) receiving multiple drug therapy. Our secondary objective was to determine the acceptance of a drug interaction reporting program with recommendations addressed to the prescribing physicians.Subjects and methodsA cross-sectional study performed in three primary care centres assigned to a teaching hospital. All patients with 2 or more chronic diseases and treated simultaneously with 5 or more drugs were recruited in the study. DDIs were detected by using Drug-Reax System® (Micromedex) program, the Drug Data Base (Bot) Spanish General Council of Official Colleges of Pharmacists or literature search when needed. Those DDIs which, according to the opinion of the pharmacist investigators, required any intervention were considered relevant. Acceptance of the reported DDI recommendations was evaluated by means of a survey addressed by primary care physicians ("acceptable," pertinent recommendation to modify treatment).ResultsA total of 283 polypathological polymedicated patients were included. Mean age was 74.5 years (range 43–100 years). Mean number of diseases per patient was 2.5 and prescriptions 9.7). Out of a total of 2748 drug prescriptions, 1053 DDIs in 250 patients (96.5%) were identified. Of these, 45% were filtered as relevant DDIs. The presence of ischemic heart disease, two or more hospital admissions and having received 7 or more prescriptions were associated with the presence of DDIs. 177 informs containing 473 recommendations about DDIs were sent to primary care physicians from our Pharmacy Department. 339 recommendations were answered by primary care physicians, and 84% were favourably accepted...(AU)

[Drug-drug interactions in multicentre polypathological polymedicated patients]. / Interacciones medicamentosas en pacientes pluripatológicos.

OBJECTIVE: To determine the prevalence of relevant drug-drug interactions (DDIs) and associated predictor factors in a sample of patients with multiple complex chronic diseases (polypathological patients) receiving multiple drug therapy. Our secondary objective was to determine the acceptance of a drug interaction reporting program with recommendations addressed to the prescribing physicians. SUBJECTS AND METHODS: A cross-sectional study performed in three primary care centres assigned to a teaching hospital. All patients with 2 or more chronic diseases and treated simultaneously with 5 or more drugs were recruited in the study. DDIs were detected by using Drug-Reax System((R)) (Micromedex) program, the Drug Data Base (Bot) Spanish General Council of Official Colleges of Pharmacists or literature search when needed. Those DDIs which, according to the opinion of the pharmacist investigators, required any intervention were considered relevant. Acceptance of the reported DDI recommendations was evaluated by means of a survey addressed by primary care physicians ("acceptable," pertinent recommendation to modify treatment). RESULTS: A total of 283 polypathological polymedicated patients were included. Mean age was 74.5 years (range 43-100 years). Mean number of diseases per patient was 2.5 and prescriptions 9.7). Out of a total of 2748 drug prescriptions, 1053 DDIs in 250 patients (96.5%) were identified. Of these, 45% were filtered as relevant DDIs. The presence of ischemic heart disease, two or more hospital admissions and having received 7 or more prescriptions were associated with the presence of DDIs. 177 informs containing 473 recommendations about DDIs were sent to primary care physicians from our Pharmacy Department. 339 recommendations were answered by primary care physicians, and 84% were favourably accepted. CONCLUSIONS: Almost every polypathological polymedicated patient is exposed to at least one DDI and about a 60% would require any intervention. Appropriate filtering and personalising recommendations in a collaborative way may represent an adequate manner to improve the risk-benefit ratio of the drug prescriptions.