Abordaje de síntomas de diarrea y estreñimiento por el farmacéutico comunitario en periodo de pandemia por la COVID-19: estudio observacional, transversal y multicéntrico / Community pharmacist management of diarrhoea and constipation symptoms during a COVID-19 pandemic: an observational, cross-sectional, multicentre study

Introducción: el papel del farmacéutico comunitario ha adquirido mayor relevancia en el contexto de las restricciones derivadas por la pandemia de COVID-19. Objetivo del estudio: identificar el resultado de la indicación farmacéutica ante la consulta por diarrea o estreñimiento durante este período.Material y métodos: estudio observacional, transversal, multicéntrico y nacional. Se invitó a participar a los farmacéuticos comunitarios registrados en la base de datos Medynet. Los seleccionados se estratificaron por comunidades autónomas y población rural o urbana. La población de estudio fueron los pacientes que acudieron a las farmacias comunitarias desde enero a junio de 2021 por estreñimiento o diarrea. Resultados: un total de 121 farmacéuticos de un máximo establecido de 120 reclutaron a 849 pacientes (49,7 % consultaron por diarrea y un 50,3 % por estreñimiento). Un 83,5 % de farmacéuticos consideraba haber atendido un mayor número de consultas por síntomas digestivos, pero sin llegar a ser el doble que antes de la pandemia. En los pacientes con diarrea, dieta (76,9 %) y suero oral (64,2 %) fueron las indicaciones más frecuentes, mientras que en los pacientes con estreñimiento destacaron el aumento de la ingesta de agua (86,9 %), la dieta (84,1 %) y la indicación de algún medicamento de prescripción libre (68,1 %). 4 de cada 5 consultas farmacéuticas por diarrea o estreñimiento fueron resueltas en la farmacia comunitaria sin precisar derivación al médico.Conclusión: el presente estudio refuerza el papel destacado del farmacéutico comunitario como profesional de primera línea, realizando indicaciones farmacéuticas personalizadas a pacientes con diarrea o estreñimiento, contribuyendo de forma sustancial a la eficiencia y sostenibilidad del sistema sanitario durante la pandemia de COVID-19. (AU)

Patients' preference in the treatment of erectile dysfunction: a critical review of the literature.

The increase in the number of safe and effective ED treatments highlights the importance of patients' preference when choosing a therapeutic option. Several studies assessing these preferences are now available in published literature. This article aims to review and discuss the studies on patients' preference and the data concerning the reasons for preference for one PDE-5 inhibitor over another. A PubMed search was conducted for manuscripts published within the last 10 years containing the search items ED, preference, sildenafil, tadalafil or vardenafil. Selected articles were discerningly reviewed and summarized (design, limitations and relevance). The articles selected were peer reviewed publications on patients' preference and ED published in medical literature since 2000. Preference studies that include either two (tadalafil and sildenafil) or three PDE-5 inhibitors (tadalafil, sildenafil and vardenafil), showed that the majority of the patients preferred tadalafil versus either vardenafil or sildenafil. As the treatment of ED has evolved, patients' preference has become an important aspect of ED therapy, 52-65% of patients prefer tadalafil versus 12-20% vardenafil or 8-30% sildenafil. All founded studies have serious limitations, particularly in terms of dosing differences. Preference for tadalafil was mainly because of the longer duration of action that increases patients' freedom in sexual life. There is a consistency in patients' preference for tadalafil over sildenafil or vardenafil across the studies reviewed.

Factores predictivos del cumplimiento del tratamiento diario con Raloxifeno y Alendronato / Predictive factors of compliance with daily Raloxifene and Alendronate treatment

El cumplimiento del tratamiento prescrito para la osteoporosis a menudo es inadecuado en la práctica clínica. El objetivo de este análisis fue evaluar los factores predictivos asociados con el cumplimiento del tratamiento diario con raloxifeno y alendronato en la práctica clínica. La influencia de diferentes factores se evaluó como un objetivo secundario en un estudio comparativo, abierto, multicéntrico, con un período de seguimiento de 12 meses. Se incluyeron 902 mujeres posmenopáusicas. Únicamente dos de las variables analizadas se mostraron como predictivas del cumplimiento terapéutico: el tratamiento prescrito (68,7% en las pacientes tratadas con raloxifeno frente al 54,0% en las tra - tadas con alendronato; p < 0,00019) y el tipo de especialidad médica (66,7% de aquellas tratadas por reumatólogos frente al 57,5% en las tratadas por traumatólogos; p < 0,0059). La especialidad del médico y la elección del tratamiento constituyen probablemente el enfoque principal para el problema del cumplimiento terapéutico

Patient compliance to prescribed osteoporosis treatment is often poor in clinical practice and reasons for non-compliance are multifactorial. The aim of this analysis was to evaluate predictive factors associated with compliance to daily treatment with raloxifene and alendronate in clinical practice. The influence of different factors upon the degree of treatment compliance was evaluated as a secondary objective in a comparative, multicentre, open-label study with a 12- month follow-up period. Nine hundred and two postmenopausal women were included in the study. Only two of the variables were found to be predictive of treatment compliance: type of treatment (68,7% of patients administered raloxifene, versus 54,0% treated with alendronate; p < 0.00019) and the type of medical specialist attended (66,7% of the patients treated by rheumatologists, versus 57,5% treated by orthopaedic surgeons; p < 0.0059). The speciality of the physician and the selection of appropriate treatment for each patient are probably the primary approach to the issue of treatment compliance (AU)

Grado de conocimiento de la osteoporosis en mujeres posmenopáusicas / No disponible

En enfermedades asintomáticas como la osteoporosis es especialmente importante que las pacientes conozcan la enfermedad, sus tratamientos y las pautas de vidanecesarias para prevenir de ese modo las posibles fracturas y sus consecuencias. En un estudio observacional, prospectivo, multicéntrico, comparativo y abierto de 12 meses de duración para evaluar el cumplimiento, como objetivo secundario del estudio se analizó el grado de conocimiento de la enfermedad mediante la prueba de Batalla, modificada para la osteoporosis. Los resultaron mostraron que, globalmente, el 49,3% de las pacientes tenía un conocimientoaceptable de la enfermedad, el 14,3% medianamente aceptable y en un 36,5% era inaceptable. Por tanto, si bien el grado de conocimiento de la osteoporosisen mujeres posmenopáusicas españolas fue aceptable, el conocimiento de esta enfermedad es todavía deficiente en más del 50%, por lo que es necesario continuaraumentando el conocimiento de la enfermedad en esta población

In asymptomatic diseases such as osteoporosis, it is especially important for the patients to know about the disease, its treatment and the life guidelines necessaryto prevent this method of possible fractures and their consequences. In an observational, prospective, multicenter, comparative and open label 12 monthlong study to evaluate compliance, as a secondary objective of the study, grade of knowledge of the disease was evaluated to study compliance using theBatalla test, modified for osteoporosis. The results showed that, overall, 49.3% of the patients had acceptable knowledge about the disease, 14.3% somewhatacceptable and 36.5% unacceptable knowledge. Thus, although the grade of knowledge on osteoporosis in postmenopausal Spanish women was accepted,knowledge on osteoporosis is still deficient in more than 50%. Thus, it is necessary to continue to increase knowledge about the disease in this population

Raloxifeno no aumenta el riesgo de ictus en mujeres de alto riesgo / Raloxifene doesn’t increase the risk of stroke in high-risk women

No disponible

Effects of 17beta-estradiol, tamoxifen and raloxifene on the protein and mRNA expression of interleukin-6, transforming growth factor-beta1 and insulin-like growth factor-1 in primary human osteoblast cultures.

We investigated the effects of 17betaestradiol and two selective estrogen receptor modulators, tamoxifen and raloxifene, on the expression and release of constitutive and interleukin-1-stimulated interleukin (IL)-6, transforming growth factor-beta1 (TGF-beta1) and insulin-like growth factor-1 by osteoblasts in primary culture from trabecular bone of healthy post-menopausal women. After 24 h incubation with 10(-8) M concentration of these compounds, there was no decrease in: a) the constitutive or IL-1beta-induced levels of IL-6 protein released to culture medium; b) the constitutive IL-6 mRNA expression after incubation of osteoblasts with 10(-8) M 17betaestradiol or 10(-8) M tamoxifen for 1, 3, 6, 24 or 30 h. Although a decrease after 30 h of treatment with 10(-8) M, raloxifene was found in mRNA IL-6 expression, and this fact was not reflected by a decrease in the release of IL-6 protein to the culture medium after 48 h of incubation with 10(-8) M or 10(-7) M raloxifene. Tumoral growth factorTGF-betal expression was not influenced by incubation with these compounds. Gene expression of IGF-I increased following 24 or 30 h incubation with 10(-8) M 17beta-estradiol and 30 h incubation with raloxifene. Tamoxifen did not affect IGF-I expression. In conclusion, the effects of estradiol or tamoxifen on bone metabolism do not appear to be mediated through the regulation of osteoblast IL-6 release or synthesis, but raloxifene produces a decrease in mRNA IL-6 expression. The actions of estradiol, tamoxifen and raloxifene do not appear to be mediated by tumoral growth factor TGF-beta1. On the other hand, an increase in IGF-I synthesis induced by raloxifene and estradiol could mediate, in part, the effects of these compounds on bone.

Colonic volvulus and ulcerative jejunoileitis due to occult celiac sprue.

Colonic volvulus is a rare complication of celiac disease. A case is reported of a 46-year-old man with a long-standing history of diarrhea and abdominal distention with a diagnosis of irritable bowel syndrome. After an elective inguinal hernia repair, a cecal volvulus and an ulcerative jejunoileitis developed in the patient that required an extensive intestinal resection. Short bowel syndrome developed and was treated with total parenteral and enteral nutrition. The patient had a poor course after reinitiation of oral diet. Subsequently, celiac sprue was diagnosed and the patient improved with a gluten-free diet.