Assessing Adherence by Combining the Test of Adherence to Inhalers With Pharmacy Refill Records

BACKGROUND: The Global Initiative for Asthma (GINA) recommends the concurrent use of self-report and pharmacy refill data to assess treatment adherence. However, clinical evidence to support this combined approach is limited. OBJECTIVE: To determine nonadherence to inhaler medication based on a validated questionnaire (Test of Adherence to Inhalers; TAI) and prescription refill data in a community sample of patients with chronic obstructive pulmonary disease (COPD) or asthma. Secondarily, we sought to determine the degree of concordance between these two measures. METHODS: Cross-sectional, observational multicenter study in patients with asthma or COPD. Sociodemographic and clinical data were obtained from clinical records. Refill data were retrieved from electronic pharmacy databases. Participants completed the 12-item TAI during a single visit as part of routine care. Nonadherence was defined as TAI <50 or <80% pharmacy refill rate (PRR) in the previous 6 months. RESULTS: A total of 816 patients (mean age, 60) were included. Nonadherence rates were 58.1% (TAI) and 28.6% (PRR) compared with 64.6% for the combined data (P<.0001). Concordance between the 2 measures was weak (=0.205). CONCLUSIONS: These findings confirm the GINA recommendations, indicating that concomitant use of the TAI and pharmacy refill data identifies a higher percentage of nonadherent asthma or COPD patients than either instrument alone

ANTECEDENTES: La Global Initiative for Asthma (GINA) recomienda el uso combinado de cuestionarios autocumplimentados y el registro de la retirada de la medicación mediante la receta electrónica (RERFF) para determinar el nivel de adhesión terapéutica. Sin embargo, la evidencia para apoyar esta recomendación es limitada. OBJETIVOS: El objetivo del presente estudio fue determinar el nivel de adhesión a los inhaladores utilizando la información proporcionada mediante el Test de Adhesión a los Inhaladores (TAI-12), junto al RERFF, en un grupo de pacientes con asma o con Enfermedad Pulmonar Obstructiva Crónica (EPOC). Un objetivo secundario fue determinar el grado de concordancia entre ambos métodos. MÉTODOS: Estudio observacional, transversal y multicéntrico en pacientes diagnosticados con asma o EPOC. Se recogieron las características demográficas y clínicas de los registros clínicos. Los datos de retirada de inhaladores se recogieron en el RERFF. Los participantes cumplimentaron el TAI-12 durante una sola visita en el contexto de la atención clínica rutinaria. Se definió "baja adherencia" como TAI <50 o RERFF <80% en los 6 meses previos. RESULTADOS: Se incluyeron 816 pacientes (edad media, 60 años). Las tasas de baja adherencia fueron 58,1% (TAI) y 28,6% (RERFF) versus 64,6% para la combinación de los dos instrumentos (TAI+RERFF; p < 0,0001). La concordancia entre las dos medidas fue débil (kappa de Cohen = 0,205). CONCLUSIONES: Estos resultados confirman las recomendaciones de GINA, indicando que el uso de la combinación del TAI y la RERFF incrementa la capacidad para identificar la baja adherencia terapéutica, comparada con la del TAI o RERFF por separado

A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM)

Purpose. To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. Methods. A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. Results. Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. Conclusions. High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches (AU)

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Value of microarray allergen assay in the management of eosinophilic oesophagitis

BACKGROUND: Eosinophilic oesophagitis (EoE) is a disorder characterised by oesophageal dysfunction and, histologically, by eosinophilic inflammation. Although treatment, which includes dilatations, oral corticosteroids and restrictive diets, is often effective, choosing the foods to be eliminated from the diet is difficult. OBJECTIVE: Component resolved diagnostic by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process. METHODS: We studied 67 patients with EoE, diagnosed clinically and histologically by endoscopic biopsy. CRD analysis with microarray technology was carried out in the 67 EoE patients, 50 patients with pollen allergy without digestive symptoms, and 50 healthy controls. RESULTS: Allergies were not detected by microarray in only seven of the 67 patients with EoE. Controls with pollen allergy showed sensitisation to different groups of pollen proteins without significant differences. In EoE patients with response to some allergens, the predominant allergens were grasses group 1 and, in particular, nCyn d 1 (Cynodon dactylon) or Bermuda grass pollen in 59.5%, followed by lipid transfer proteins (LTP) of peach (19.40%), hazelnut (17.91%) and Artemisia (19.40%)

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Manifestaciones cutáneas originadas por la oruga procesionaria del pino ( Thaumetopoea pityocampa) / Skin Reactions on Exposure to the Pine Processionary Caterpillar ( Thaumetopoea pityocampa)

La oruga procesionaria del pino es la forma larvaria del lepidóptero nocturno Thaumetopoea pityocampa (TP). Supone una plaga forestal en los países mediterráneos y se está expandiendo hacia el norte de Europa por el calentamiento global. Durante sus tres últimos estadios larvarios presenta unos pelos urticantes de pequeño tamaño, que se desprenden con facilidad y pueden ser transportados por el viento. Estos pelos pueden producir distintas patologías, entre las que destaca la afectación cutánea que se manifiesta fundamentalmente como urticaria de contacto y dermatitis papulosa. También son capaces de clavarse e irritar la mucosa conjuntival y de penetrar en la vía respiratoria produciendo manifestaciones a este nivel. En los últimos años se han descrito varios casos de reacciones anafilácticas por este insecto. Los mecanismos patogénicos implicados incluyen el mecánico o irritativo y el alérgico por hipersensibilidad mediada por IgE, donde las reacciones son inmediatas, repetidas y progresivamente más graves (AU)

The pine processionary caterpillar is the larval form of the Thaumetopoea pityocampa moth. Mediterranean forests regularly suffer plagues of this insect, which has been moving north as a result of global warming. When the small urticating hairs that develop during the last 3 larval stages are shed and can become airborne. If they come in contact with skin, they can cause a variety of reactions, notably contact urticaria and papular rashes. Irritation can also occur if the hairs lodge in the mucosa of the conjunctiva or in the respiratory tract. Several cases of anaphylactic reactions have been reported in recent years. Mechanical (irritative) mechanisms may be involved in the pathogenesis of lesions, or immunoglobulin E-mediated allergic hypersensitivity reactions may be implicated when the process is rapid, recurrent, and progressively more severe (AU)

Phase I/II docetaxel plus concurrent hyperfractionated radiotherapy in locally advanced unresectable head and neck cancer (TAX. ES1. 102 study)

INTRODUCTION: Concurrent chemotherapy and radiotherapy is recommended for the treatment of locally advanced unresectable head and neck (H&N) cancer. OBJECTIVE: The primary purpose of the Phase I part of the study was to determine the maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended dose (RD) of docetaxel with hyperfractionation radiotherapy. The primary objective of the Phase II part was to determine the response rate to the RD of treatment and, secondarily, to assess the toxicity of the schedule, time to progression, duration of response and overall survival (OS). MATERIALS AND METHODS: Patients (n=9 in Phase I; n=19 in Phase II) had unresectable H&N cancer. The starting docetaxel dose was 20 mg/m(2) plus hyperfractionated radiotherapy. Ramping of docetaxel was 5 mg/m(2) if MTD was not reached. RESULTS: MTD of docetaxel was 20 mg/m(2). Limiting toxicities were grade 4 pneumonia and grade 4 mucositis. The RD was 15 mg/m(2). Phase II initial response was 76% (CR=18%; PR=9%); updated response was 89% (CR=59%; PR=29%). The median progression-free survival was 7.8 months (95%CI: 0-22.3) and the median OS was 15.1 months (95%CI: 0-35.9). Grade 3-4 toxicities included mucositis (91%), pneumonia (27%) and fatigue (27%). There were 5 toxic deaths (2 from intestinal perforation, 3 from pneumonia). CONCLUSIONS: Weekly docetaxel+hyperfractionation radiotherapy is active but with high toxicity rates and, hence, this treatment regimen would be difficult to justify (AU)

Efecto estrogénico proligerativo in vitro del bisfenil-a sobre las célucas hipofisarias productoras de prolactina en la rata macho / No disponible

El bisgenol-a forma parte de la molécula de BIS-GMA que se utiliza en la composición (..) (AU)

Bisphernol-a is part of the BIS-GMA molecule that is used (..) (AU)

Anestesia epidural para cesárea a una paciente con síndrome de Pierre Marie-Sainton / Epidural anesthesia for the cesarean section of a patient with Pierre Marie-Sainton syndrome

No disponible (AU)

Aumento de la alergenicidad de la oruga procesionaria del pino durante su desarrollo larvario / Increase in allergenicity of the processionary caterpillar (Cnethocampa processionesa) in the course of its larval development

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Angioedema resistente al tratamiento habitual / Angioedema refractory to standard therapy

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Riesgo laboral y residencial por exposición a campos electromagnéticos / Labour and residential risk due to electromagnetic fields exposition

En los últimos años hemos asistido a un incremento, por su número y diversidad, de las fuentes de campos eléctricos y magnéticos (CEM) utilizadas con fines individuales, industriales y comerciales. Al mismo tiempo, diversos estudios científicos han sugerido que la exposición a CEM emitidos por esos aparatos podría tener efectos perjudiciales para la salud. El presente trabajo realiza una revisión acerca de la relación o influencia de los CEM (centrándonos en los campos de frecuencia industrial) sobre el sistema reproductor, alteraciones psicológicas y desarrollo de cáncer. Hasta la actualidad, la comunidad científica no ha establecido una relación causal entre exposición residencial y laboral a campos de frecuencia industrial y riesgo para la salud humana (AU)

Is Lolium pollen from an urban environment more allergenic than rural pollen?

Background: Allergy to grass pollen is a highly prevalent allergic disease. Hay fever is more predominant in urban than in rural areas, despite the increasingly smaller areas of surrounding grassland. The effect of vehicle exhaust pollutants, mainly diesel particles, and other industrial sources of atmospheric pollution leading to plant damage has been implicated in this phenomenon. Objective: This study compared the in vivo and in vitro allergenicity of pooled samples of Lolium perenne grass pollen harvested from 10 different urban areas with that of samples of the same pollen from 10 neighboring rural areas. Methods: Lolium perenne pollen from different parts of a city and from a nearby rural area was harvested in 1999 and 2000 during the peak pollination period. Protein composition was compared by SDS-PAGE and in vivo and in vitro IgE-binding capacity was compared by skin-prick tests, RAST-inhibition and measurement of the major allergen, Lol p 5. Results: In the two years under study, urban samples contained approximately twice the protein content of the rural samples. Biological activity and Lol p 5 content was higher in urban pollen than in rural pollen and showed differences in the two years under study. Conclusions: The protein content and allergenicity of Lolium perenne pollen was higher in urban areas than in rural areas. These differences might explain why allergy to grass pollen is more prevalent in urban areas. This finding should be taken into account in diagnosis, preventive measures and specific immunotherapy (AU)

Antecedentes: Los pólenes son una causa muy importante de enfermedades alérgicas. La polinosis es mas prevalente en zonas urbanas que en rurales, a pesar de que cada vez hay menos zonas verdes en las ciudades. Se ha valorado el efecto de las partículas diesel y otras fuentes de contaminantes urbanos sobre los pólenes para tratar de explicar este fenómeno. Objetivo: Este estudio compara la alergenicidad de muestras de Lolium perenne recolectado en diferentes zonas de la ciudad de Valladolid con pólenes de la misma especie recogidos en zonas rurales vecinas. Métodos: Se recolectaron pólenes de Lolium perenne de diferentes partes de la ciudad y de zonas rurales circundantes durante su pico de polinización en los años 1999 y 2000. Se mide su reactividad "in vivo" mediante prick tests e "in vitro" por SDS-PAGE, RAST inhibición y medición de su alérgeno principal Lol p 5, y se comparan los resultados obtenidos por todas la técnicas. Resultados: Demostramos una mayor concentración proteica y alergenicidad de los pólenes de Lolium perenne de zonas urbanas comparadas con las rurales cercanas. Conclusión: Sugerimos que esta diferencia en concentración proteica y actividad biológica del polen según el lugar de procedencia debería ser tenida en cuenta para el diagnóstico, medidas de prevención e inmunoterapia específica (AU)

Dermatitis to captopril

Background: reports on delated cutaneous reactions to captopril have been seldom reported. Captopril is an angiotensin-converting enzyme (ACE) inhibitor and their cutaneous side-effects are documented, but little has been published concerning the usefulness of patch test when they occur. We presented the case of a patient who developed a cutaneous reaction induced by captopril with positive patch test. Methods and results: patch testing was performed with captopril, other ACE (enalapril, lisinopril ramipril), and European standard series. Following, we performed a double-blind oral challenge test with drugs who results was negastive. Positive reaction were obtained to captopril at 4 days and the others test being negative. The same test were negative in five control patients. The patient tolerated enalapril, and lisinopril without problems. Conclusion: the allergological studies confirmed sensitisation to captopril and tolerance to lisinopril, and enalapril. When patch test are performed with several drugs of the same family, results seem to indicate an absence of cross-sensitivity, but in several patients, oral provocation test were needed because patch test gave no conclusive information (AU)

Antecedentes: pocos casos de reacciones cutáneas tardías por captopril han sido descritas. El captopril es un fármaco inhibidor del enzima conversor de la angiotensina (IECA), y sus efectos cutáneos secundarios han sido documentados, pero poco ha sido publicado respecto el uso de las pruebas epicutáneas cuando eso ocurre. Presentamos el caso de un paciente que desarrolla una reacción cutánea inducida por captopril, con test del parche positivo. Métodos y resultados: las pruebas epicutáneas fueron realizadas con captopril, otros IECAs, y batería estándar europea. Posteriormente, realizamos estudio de provocación oral con los fármacos con resultado negativo. Las pruebas fueron positivas para captopril a los 4 días, y negativas para los otros fármacos. El mismo test fue negativo en cinco controles. El paciente toleró enalapril y lisinopril sin problemas. Conclusión: el estudio alergológico confirma la sensibilización a captopril y la tolerancia a lisinopril y enalapril. Cuando las pruebas epicutáneas se realizan con varios fármacos de la misma familia, los resultados indican una ausencia de reactividad cruzada, pero en muchos pacientes el test de provocación oral es necesario porque las pruebas epicutáneas no proporcionan una información concluyente. (AU)

Reacción de hipersensibilidad retardada por enoxaparina con sensibilización a otras heparinas de bajo peso molecular y no fraccionadas: tolerancia de una hirudina recombinante / Delayed hypersensitivity reaction to enoxaparin with sensitisation to other low molecular weight and unfractionated heparins: tolerance to a recombinant hirudin

La administración de heparinas no fraccionadas (HNF) o de heparinas de bajo peso molecular (HBPM) pueden ocasionar una reacción eccematosa no necrótica en el lugar de la inyección, mediada por un mecanismo de hipersensibilidad retardada. Se describe el caso de una mujer de 38 años que tras sufrir dos episodios de erupción cutánea abdominal relacionados con la administración de enoxaparina, presentó una prueba de provocación subcutánea con desirudina, una nueva hirudina recombinante, negativa. En aquellos pacientes que presenten sensibilización a heparinas, sobre todo cuando es múltiple, a HNF y a HBPM, caso de precisar coagulación urgente y a la espera de las pruebas alérgicas, las hirudinas recombinantes pueden constituir una alternativa segura (AU)

Purification and characterization of NAD-isocitrate dehydrogenase from chlamydomonas reinhardtii

NAD-isocitrate dehydrogenase (NAD-IDH) from the eukaryotic microalga Chlamydomonas reinhardtii was purified to electrophoretic homogeneity by successive chromatography steps on Phenyl-Sepharose, Blue-Sepharose, diethylaminoethyl-Sephacel, and Sephacryl S-300 (all Pharmacia Biotech). The 320-kD enzyme was found to be an octamer composed of 45-kD subunits. The presence of isocitrate plus Mn2+ protected the enzyme against thermal inactivation or inhibition by specific reagents for arginine or lysine. NADH was a competitive inhibitor (Ki, 0.14 mM) and NADPH was a noncompetitive inhibitor (Ki, 0.42 mM) with respect to NAD+. Citrate and adenine nucleotides at concentrations less than 1 mM had no effect on the activity, but 10 mM citrate, ATP, or ADP had an inhibitory effect. In addition, NAD-IDH was inhibited by inorganic monovalent anions, but L-amino acids and intermediates of glycolysis and the tricarboxylic acid cycle had no significant effect. These data support the idea that NAD-IDH from photosynthetic organisms may be a key regulatory enzyme within the tricarboxylic acid cycle.