Off-label use of fixed-dose combination of tramadol and dexketoprofen in primary health care. Evidence-based or cause for concern?

Introduction: The use of the fixed-dose combination of tramadol/dexketoprofen in Spain and in other countries has increased considerably. The authorized therapeutic indication for this medicinal product is the short-term symptomatic treatment of moderate to severe acute pain in adult patients. The objective of this study was to describe the pattern of use of tramadol/dexketoprofen in the field of primary health care. Method: A cross-sectional, descriptive and multicenter study was carried out. The study population included all patients from a Primary Care Department (53 Primary Care teams) with an active prescription of tramadol/dexketoprofen on March 28, 2018. The target population was those patients who were prescribed tramadol/dexketoprofen. dexketoprofen for >20 days. Results: A total of 176 patients had an active prescription for tramadol/dexketoprofen. All patients (100%) had a duration of treatment greater than 5 days and 72.7% (N=128) greater than 20 days. The mean duration of treatment was 14±160.9 days in patients who had less than 20 days of treatment and 224±160.8 days in patients who had more than 20 days of treatment. 35.1% of the patients were treated with >2 pain medications and concomitantly with tramadol/dexketoprofen. The general practitioner initiated 65.6% of the prescriptions. Conclusions: The fixed-dose combination of tramadol/dexketoprofen was frequently used off-label, according to the product characteristics and the available scientific evidence. This study warns about the potential risks associated with the use of this drug in clinical practice, such as lack of effectiveness and/or the appearance of adverse effects

Off-label use of fixed-dose combination of tramadol and dexketoprofen in primary health care. Evidence-based or cause for concern?

Introduction: The use of the fixed-dose combination of tramadol/dexketoprofen in Spain and in other countries has increased considerably. The authorized therapeutic indication for this medicinal product is the short-term symptomatic treatment of moderate to severe acute pain in adult patients. The objective of this study was to describe the pattern of use of tramadol/dexketoprofen in the field of primary health care. Method: A cross-sectional, descriptive and multicenter study was carried out. The study population included all patients from a Primary Care Department (53 Primary Care teams) with an active prescription of tramadol/dexketoprofen on March 28, 2018. The target population was those patients who were prescribed tramadol/dexketoprofen. dexketoprofen for >20 days. Results: A total of 176 patients had an active prescription for tramadol/dexketoprofen. All patients (100%) had a duration of treatment greater than 5 days and 72.7% (N=128) greater than 20 days. The mean duration of treatment was 14±160.9 days in patients who had less than 20 days of treatment and 224±160.8 days in patients who had more than 20 days of treatment. 35.1% of the patients were treated with >2 pain medications and concomitantly with tramadol/dexketoprofen. The general practitioner initiated 65.6% of the prescriptions. Conclusions: The fixed-dose combination of tramadol/dexketoprofen was frequently used off-label, according to the product characteristics and the available scientific evidence. This study warns about the potential risks associated with the use of this drug in clinical practice, such as lack of effectiveness and/or the appearance of adverse effects

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Tapentadol and Oxycodone/Naloxone Prescribing Patterns in Primary Health Care in Catalonia, Spain: A Cross-Sectional Study

Objective: To characterize the use of tapentadol and the combination oxycodone/naloxone in primary health care. Data on their use and possible misuse will allow the identification of risk factors and to design protocols to reduce and prevent avoidable harm to patients being treated for pain. Design: A descriptive, cross-sectional and multicenter study was performed. Setting: Fifty-three primary health care teams, which provides healthcare for 1,300,000 inhabitants. Patients: A total of 1840 patients had active prescriptions of tapentadol and 985 of oxycodone/naloxone. Methods: Demographic (age, sex) and clinical (glomerular filtration rate; active liver disease; dosing and duration of treatment), prescribed daily dose (according to age, sex, length of treatment), concomitant analgesic treatment and diagnosis. Patient information was obtained from medical records. Results: Most of the patients were women (>74.0% in both cases), and the average age was 69.3 years (women: 70.1±13.2; men: 66.7±13.9 years) in the case of tapentadol and 70.6 years (women: 64.0±13.6; men: 72.6±14.3 years) in the case of oxycodone/naloxone. Only 12.2% of patients taking tapentadol and 12.1% taking oxycodone/naloxone had a normal renal function. In both cases, 4.1% of patients had active liver disease. The average length of treatment was 246.4 days in oxycodone/naloxone and 199.0 days in tapentadol. It was recorded that 85.1% of patients in the case of tapentadol and 89.0% in the oxycodone/ naloxone had at least another drug prescribed for pain. About 42.2% of patients treated with tapentadol and 34.4% of patients treated with oxycodone/naloxone had associated neuralgia as a diagnosis. Conclusion: The pattern of use and profile of patients with tapentadol and oxycodone/ naloxone had more similarities than differences, and suggested that prescribing practice, and monitoring should be assessed regularly to ensure patient safety and effective management of pain. Keywords: clinical practice pattern, chronic pain, opioids, oxycodone/naloxone, primary health care, culture, tapentad

Emergence of Streptococcus pneumoniae

Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008–2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008–2011, the prevalence was 4.4%, and during 2014–2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years

Estudio del mecanismo responsable de la superconductividad en los óxidos de cobre superconductores de itrio y lantano

IP 1101-05-402-93ARTICULO(S) EN REVISTA: Calculo de correlaciones entre TCy laspropiedades electronicas y fononicas en los;nuevos superconductores / Jairo Giraldo, R. Baquero - En:Revista Colombiana de Fisica No. 27 (1995); p.;595-598 - Thermoelectric power of (Bi-Pb)SrCaCuO superconductingthin films / J.E Rodriguez, A. Mariño, Jairo;Giraldo, H. Rodriguez - En: Revista Colombiana de Fisica Vol.28, no.2 (1996); p. 197-200 - Electron-phonon;enhancement of thermopower in si doped superconducting bicompounds / Jairo Giraldo, J. E Rodriguez, A. Mariño;- En: Revista Colombiana de Fisica No. 28 (1996); p. 189-1-92Optical andstructural properties of Cd1-iZniTe;for high Zn concentrations / J.J Perez Bueno, M. E Rodriguez,L.Baños, O.Zelaya-Angel, Jairo Giraldo - En:;Revista Colombiana de Fisica vol. 29 No. 2 (1997); p. 207-210-Incrementoen la interaccion e-ph en;compuestos superconductores de BSCCO dopados con Si y Ag /J.ERodriguez,A . Mariño, J. Giraldo - En: Revista;Colombiana de Fisica vol. 29 No. 2 (1997); p. 231-234 - Estudioelectronico del C60 con un modelo de ruptura;de la simetria esferica a la icosaedrica / F. Alonso, J. JGiraldo - En: Revista Colombiana de Fisica vol. 30;No 1 (1998); p. 173-176 - Some tracks to a conventional approachin the cuprates / Jairo Giraldo - En: Revista;Colombiana de Fisica vol. 30 No 1 (1998); p.177-180 - Breve historia de lasuperconductividad de alta;temperatura critica / Jairo Giraldo Gallo - En: Momento Revistadel departamento de Fisica Universidad;Nacional de Colombia No. 9 (abril : 1995); p. 52-63 - Algunosproblemas conceptuales y metodologicos en la;superconductividad de alta temperatura critica / Jairo GiraldoGallo - En:Momentos Revista del departamento;de Fisica Universidad Nacional de Colombia No 9 (abril : 1995);p. 64-78 -Calculated bonding, structural, and;vibrational properties of YBa2Cu3-xCoxO7 / U. Yxklinten, JairoGiraldo, K.Holmlund - En: Physica C. No 234;(1994); p. 295-299 - CAPITULO(S) EN LIBRO: Tight-binding calculation of the van hove singularity shift from;the fermi level as a function of x for La2-xBaxCuO4 / Jairo Giraldo, R. Baquero. - p. 135-142. -- En:;Manifestation of the E-Ph interaction - proceedings of the2 nd(CINVESTAV) superconductivity symposium -;Mexico : 1994. : il. ; 29 cm. - ISBN 9810215452 - ARTICULO(S)ENREVISTA:Lattice properties of YBa2Cu3-xCoxO7;: pilot calculation using effective medium theory / JairoGiraldo, U. Yxklinten - En: journal of;superconductivity vol. 8 No 1 (1995); p. 1-2 - Electron-phononcontribution to thermopower in si-doped;superconducting bi compounds / Jairo Giraldo, J. E Rodriguez,A.Mariño -En: Physical Review B. VOL. 56 No 5;(1997 : aug. 1); p. 2383-2386 - Transport and structural properties of YBa2Cu3O7-g thin films and bulk samples;as a function of oxygen content - En: Friday morning vol.43 No1 (1998);p. 964 - EMT Applied to complex;systems: lattice properties of YBa2Cu3-xCoxO7 / Jairo Giraldo,Uno Yxklinten - En: American institute of;Physics (1996); p. 461-465. - Termopower and lattice parametersof YBa2Cu3O7-g thin films as a function of;oxygen content / Jairo Giraldo, A. Pulzara, P. Prieto, M.Chacon'- en: Revista Mexicana de Fisica No 44 sup.;(1998 : dic); p. 202-207 - Electron-phonon enhancement ofthermopower in silver-doped superconducting bi;compounds / J. E. Rodriguez, A. Mariño, Jairo Giraldo - En: Physica C. 282-287 (1997); p. 1253-1254 - An;aproximation to the optical absorption spectra of the ternarycompound ZnSexTe1-x / J. C Salcedo, Jairo;Giraldo, A. Camacho - En: Revista Mexicana de Fisica No. 44 sup.(1998 : dic.); p. 119-121. - Electronic and;vibrational properties of the C60 molecule / F. Alonso Marroquin, Jairo Giraldo, A.Calles, J. J Castro - En:;Revista Mexicana de Fisica No 44 sup. (1998 : dic); p. 18-21