Análisis de la utilización de antiulcerosos inhibidores de la bomba de protones en el área de atención primaria de la comarca Araba

OBJETIVO: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacologicos mas prescritos en atencion primaria. El objetivo del trabajo fue conocer la prescripcion de IBP en el Area de Atencion Primaria de la Comarca Araba de Osakidetza para sensibilizar a los medicos de familia sobre su correcta utilizacion, asi como fomentar la prescripcion de los IBP mas eficientes.METODOS: Estudio descriptivo de la prescripcion de IBP de 200 medicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los anos 2009-2014. Se analizo el importe del consumo y las Dosis por 1000 habitantes/dia (DHD) de IBP, asi como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapeutico. El analisis estadistico se realizo mediante el programa IBM SPSS v23.RESULTADOS: La prescripcion de IBP se incremento un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilizacion muy superior a la de otros paises europeos. En el mismo periodo, el porcentaje de prescripcion relativa de omeprazol frente al resto de IBP disminuyo un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol paso del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyo un 17,60%.CONCLUSIONES: Existe un incremento global en el numero de prescripciones de IBP, aunque ha disminuido el gasto por la reduccion de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripcion de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevencion de gastropatias aumenta el riesgo de prescripciones inadecuadas. El antiulceroso mas recomendado continua siendo el omeprAbstract OBJECTIVE: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. METHODS: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23 statistic software. RESULTS: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. CONCLUSIONS: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole

Análisis de la utilización de antiulcerosos inhibidores de la bomba de protones en el área de atención primaria de la comarca Araba

OBJETIVO: Los antiulcerosos inhibidores de la bomba de protones (IBP) son uno de los grupos farmacologicos mas prescritos en atencion primaria. El objetivo del trabajo fue conocer la prescripcion de IBP en el Area de Atencion Primaria de la Comarca Araba de Osakidetza para sensibilizar a los medicos de familia sobre su correcta utilizacion, asi como fomentar la prescripcion de los IBP mas eficientes.METODOS: Estudio descriptivo de la prescripcion de IBP de 200 medicos de familia de la Comarca Araba de Osakidetza a partir de las recetas facturadas por las oficinas de farmacia durante los anos 2009-2014. Se analizo el importe del consumo y las Dosis por 1000 habitantes/dia (DHD) de IBP, asi como el consumo relativo de omeprazol respecto al resto de principios activos de este subgrupo terapeutico. El analisis estadistico se realizo mediante el programa IBM SPSS v23.RESULTADOS: La prescripcion de IBP se incremento un 23,75% (de 78,14 DHD en 2009 hasta 96,70 DHD en 2014), siendo su utilizacion muy superior a la de otros paises europeos. En el mismo periodo, el porcentaje de prescripcion relativa de omeprazol frente al resto de IBP disminuyo un 4,56% (el porcentaje de Dosis diaria definida (DDD) de omeprazol paso del 74,67% en 2009 al 70,11% en 2014). El gasto global de estos medicamentos disminuyo un 17,60%.CONCLUSIONES: Existe un incremento global en el numero de prescripciones de IBP, aunque ha disminuido el gasto por la reduccion de precios. Asimismo hay un descenso del consumo relativo de omeprazol, aunque no se han modificado las indicaciones aprobadas. La prescripcion de IBP debe realizarse con prudencia, ya que su elevado uso de forma injustificada en la prevencion de gastropatias aumenta el riesgo de prescripciones inadecuadas. El antiulceroso mas recomendado continua siendo el omeprAbstract OBJECTIVE: The proton pump inhibitors (PPI) anti-ulcer drugs are one of the most prescribed pharmacological groups in primary care. The objective of the work was to know the prescription of PPI in a Primary Care Area, the Araba district of the Basque Health Service, to advise family doctors about its correct use, and encourage the prescription of the most efficient PPIs. METHODS: Descriptive study of 200 family doctors PPI prescription at the Araba district of the Basque Health Service. Data were obtained from prescriptions billed by pharmacies between 2009 and 2014. We analyzed the expenses and DHD (DDD per 1000 inhabitants/day) of PPIs dispensed and the omeprazole relative uptake compared to other PPIs. Statistical analysis was performed with IBM SPSS v23 statistic software. RESULTS: IBP prescription increased by 23.75% (from 78.14 DHD in 2009 to 96.70 DHD in 2014). Their use was much higher than that of other European countries. In the same period, omeprazole relative prescription compared to other PPIs decreased by 4.56% (omeprazole % Defined daily dose (DDD) went from 74.67% in 2009 to 70.11% in 2014). The overall expenditure of these medicines decreased by 17.60%. CONCLUSIONS: There is an overall increase in the prescription of PPIs, although the expenses have decreased due to price drop. Likewise there is a decrease in the relative consumption of omeprazole, although the indications approved had not changed. PPIs prescription should be done with caution since their unjustified high use in the prevention of gastropathy increases the risk of inappropriate prescriptions. The most recommended PPI continues to be omeprazole

Kanabinoideoak: onuragarriak ala kaltegarriak?

Kanabinoideoak konposatu psikoaktiboen talde bat da; munduan gehien kontsumitzen diren drogen artean daude eta beraien kontsumoa areagotuz doa gaur eguneko gizartean. Konposatuok hainbat funtzio biologikoren erregulazioan garrantzitsuak direla ikusi da; adibidez, ikasketa- eta oroimen-prozesuetan parte hartzen dute. Jatorri kanabinoideoa duten konposatuak funtzio biologiko horiekin harremanetan dauden patologien tratamendurako erabilgarriak izan daitezkeela uste da, hala nola, minaren, Parkisonaren, Huntingtonen gaixotasunaren, esklerosi anizkoitzaren, tumoreen eta abarren tratamendurako. Hori guztia dela eta, kanabinoideoen gaitasun terapeutikoa ikertzen ari da egun.Hala ere, aipatzekoa da kanabinoideoek albo-ondorio garrantzitsuak ere eragin ditzaketela, adibidez, immunitate-sistemaren ahalmena murrizten dute eta jasankortasuna eta menpekotasuna sortzen dute..

Kanabinoideoak: onuragarriak ala kaltegarriak?

Kanabinoideoak konposatu psikoaktiboen talde bat da; munduan gehien kontsumitzen diren drogen artean daude eta beraien kontsumoa areagotuz doa gaur eguneko gizartean. Konposatuok hainbat funtzio biologikoren erregulazioan garrantzitsuak direla ikusi da; adibidez, ikasketa- eta oroimen-prozesuetan parte hartzen dute. Jatorri kanabinoideoa duten konposatuak funtzio biologiko horiekin harremanetan dauden patologien tratamendurako erabilgarriak izan daitezkeela uste da, hala nola, minaren, Parkisonaren, Huntingtonen gaixotasunaren, esklerosi anizkoitzaren, tumoreen eta abarren tratamendurako. Hori guztia dela eta, kanabinoideoen gaitasun terapeutikoa ikertzen ari da egun.Hala ere, aipatzekoa da kanabinoideoek albo-ondorio garrantzitsuak ere eragin ditzaketela, adibidez, immunitate-sistemaren ahalmena murrizten dute eta jasankortasuna eta menpekotasuna sortzen dute..

Dysautonomia Differentially Influences the Effect of Affective Pain Perception on Quality of Life in Parkinson’s Disease Patients

[EN] Background. Our aim was to evaluate the real effect of dysautonomic symptoms on the influence of affective pain perception on quality of life in PD patients. Methods. An observational cross-sectional study was carried out using 105 Parkinson's disease (PD) patients of the Movement Disorders Unit, Hospital de Cruces (Bilbao, Spain) [men 59 (56.2%), women 46 (43.85%)]. Statistical analysis was made in order to evaluate the possible association of pain with life quality. Results. Quality of life measured by PDQ-39 (Parkinson's Disease Questionnaire for quality of life) was statistically associated with affective dimension of pain (PRIA, affective pain rating index). However, the influence of this dimension on PDQ-39 was different in the specific case of PD patients that experimented a high score (>12) in SCOPA-AUT (Scale for Outcomes in PD-Autonomic scale). Conclusions. These results confirm the effect of affective perception of pain in life quality of PD patients, indicating the critical role of autonomic symptoms in the modulation of the influence of pain on quality of life and showing the possible utility of dysautonomia as clinical prognostic indicator of quality of life in PD patients affected by painS

Sex differences in the aging pattern of renin–angiotensin system serum peptidases

Background: Serum peptidases, such as angiotensin-converting enzyme (ACE), angiotensin-converting enzyme-2 (ACE2), neutral endopeptidase (NEP), aminopeptidase N (APN), and aminopeptidase A (APA), are important elements of the renin-angiotensin system (RAS). Dysregulation of these enzymes has been associated with hypertension and cardiovascular risk. In the present study, serum activities of RAS peptidases were analyzed to evaluate the existence of sexual differences, with a possible different pattern in pre- and post-andropausal/post-menopausal participants. Methods: One hundred and eighteen healthy men and women between 41 and 70 years of age (58 women and 60 men) were recruited to participate in the study. Serum RAS-regulating enzymes were measured by spectrofluorimetry. Enzymatic activity was recorded as units of enzyme per milliliter of serum (U/mL). Results: Significantly lower serum APA activity was observed in men with respect to women; no sex differences were detected for ACE, ACE2, NEP, or APN. Significantly lower APA and ACE serum activity were observed in older men compared to older women. In contrast, younger (<55 years) men had significantly higher values of NEP serum activity than younger women. Significantly lower ACE serum activity was detected in older men compared to younger men. In women, significantly higher ACE2 serum activity was observed in older women compared to younger women. Conclusions: These results suggest a differential effect of aging on the activity of RAS enzymes in men and women, especially with respect to the breakpoint of andropausia/menopausia, on the critical serum enzymatic activities of the RAS, which could correlate with sexual differences in cardiovascular risk.This work was supported by a grant from the Basque Government (IT8-11/13), the University of the Basque Country UPV/EHU (UFI 11/44), and the Gangoiti-Barrera Foundation

Clinical Implications of (Pro)renin Receptor (PRR) Expression in Renal Tumours

(1) Background: Renal cancer is one of the most frequent malignancies in Western countries, with an unpredictable clinical outcome, partly due to its high heterogeneity and the scarcity of reliable biomarkers of tumour progression. (Pro)renin receptor (PRR) is a novel receptor of the renin–angiotensin system (RAS) that has been associated with the development and progression of some solid tumours by RAS-dependent and -independent mechanisms. (2) Methods: In this study, we analysed the immunohistochemical expression of PRR at the centre and border in a series of 83 clear-cell renal cell (CCRCCs), 19 papillary (PRCC) and 7 chromophobe (ChRCC) renal cell carcinomas, and the benign tumour renal oncocytoma (RO, n = 11). (3) Results: PRR is expressed in all the tumour subtypes, with higher mean staining intensity in ChRCCs and ROs. A high expression of PRR at the tumour centre and at the infiltrative front of CCRCC tissues is significantly associated with high grade, tumour diameter, local invasion and stage, and with high mortality risk by UCLA integrated staging system (UISS) scale. (4) Conclusions: These findings indicate that PRR is associated with the development and progression of renal tumours. Its potential as a novel biomarker for RCC diagnosis/prognosis and as a promising therapeutic target should be taken into account in the future.The work was funded by the Basque Government (ELKARTEK KK2018-00090 and KK-2020/00069)

Altered expression of fibroblast activation protein-α (FAP) in colorectal adenoma-carcinoma sequence and in lymph node and liver metastases

Colorectal cancer (CRC) is a major health problem in elderly people because of its high incidence and high mortality rate. Despite early screening programs, more than half of CRC patients are diagnosed at advanced stages. Fibroblast activation protein-alpha (FAP) expression in cancer-associated fibroblasts (CAFs) has been associated with a higher risk of metastases and poor survival. Here, we have analyzed the immunohistochemical expression of FAP in 41 adenoma-carcinoma sequences. In addition, FAP expression was analyzed individually and in combination with beta-catenin (BCAT), CD44 and Cyclin-D1 expression in primary tumors and in their corresponding lymph node and liver metastases (n=294). Finally, soluble FAP (sFAP) levels in plasma from CRC patients (n=127) were also analyzed by ELISA. FAP was expressed only in CRC tissue and its expression level was found to be higher in tumors exhibiting deeper local invasion and poorer cancer cell differentiation. FAP and concomitant nuclear BCAT expression in cancer cells at the infiltrating front of primary tumors and in lymph node metastases was independently associated with 5- and 10-year cancer specific and disease-free survival. Moreover, lower sFAP levels correlated with poorer survival. These findings support the potential importance of FAP as a biomarker of CRC development and progression.This work was partially funded by the ELKARTEK 18/10 grant from the Basque Government

Soluble PD-L1 Is an Independent Prognostic Factor in Clear Cell Renal Cell Carcinoma

(1). Background: Immunohistochemical (IHC) evaluation of programmed death-1 (PD-1) and its ligand (PD-L1) is being used to evaluate advanced malignancies with potential response to immune checkpoint inhibitors. We evaluated both plasma and tissue expression of PD-1 and PD-L1 in the same cohort of patients, including non-metastatic and metastatic clear cell renal cell carcinoma (CCRCC). Concomitant plasma and tissue expression of PD-1 and PD-L1 was evaluated with emphasis on diagnostic and prognostic implications. (2) Methods: we analyzed PD-1 and PD-L1 IHC expression in tumor tissues and soluble forms (sPD-1 and sPD-L1) in plasma from 89 patients with CCRCC, of which 23 were metastatic and 16 received systemic therapy. The primary endpoint was evaluation of overall survival using Kaplan-Meier analysis and the Cox regression model. Plasma samples from healthy volunteers were also evaluated. (3) Results: Interestingly, sPD-1 and sPD-L1 levels were lower in cancer patients than in controls. sPD-1 and sPD-L1 levels and their counterpart tissue expression both at the tumor center and infiltrating front were not associated. Higher expression of both PD-1 and PD-L1 were associated with tumor grade, necrosis and tumor size. PD-1 was associated to tumor stage (pT) and PD-L1 to metastases. sPD-1 and sPD-L1 were not associated with clinico-pathological parameters, although both were higher in patients with synchronous metastases compared to metachronous ones and sPD-L1 was also higher for metastatic patients compared to non-metastatic patients. sPD-1 was also associated with the International Metastatic Renal Cell Cancer Database Consortium (IMDC) prognostic groups in metastatic CCRCC and also to the Morphology, Attenuation, Size and Structure (MASS) response criteria in metastatic patients treated with systemic therapy, mainly tyrosine-kinase inhibitors. Regarding prognosis, PD-L1 immunostaining at the tumor center with and without the tumor front was associated with worse survival, and so was sPD-L1 at a cut-off >793 ng/mL. Combination of positivity at both the tissue and plasma level increased the level of significance to predict prognosis. (4) Conclusions: Our findings corroborate the role of PD-L1 IHC to evaluate prognosis in CCRCC and present novel data on the usefulness of plasma sPD-L1 as a promising biomarker of survival in this neoplasia.The work was funded by the Basque Government (ELKARTEK KK2018-00090 and KK-2020/00069)

Factores influyentes en la calidad de la prescripción en atención primaria y relación con el gasto farmacéutico

Background: The high pharmaceutical consumption requires establishing improvement measures with the collaboration of all the agents involved. The objective of the study was to analyze the pharmaceutical expenditure generated by prescriptions made by physicians working in a primary care area and assess its relationship with the quality indicators of the prescription. Methods: The prescriptions of 200 family physicians of the Basque Health Service Araba Countyand dispensed by the community pharmacies between 2009 and 2016 were studied. The variables evaluated retrospectively corresponded to the quality indicators of the pharmaceutical prescription included in the Contract-Program of the Basque Department Health of 2016. Prediction models were developed using linear regression and binary logistic regression analysis. Results: The main factors which increased the pharmaceutical expenditure per person were: the use of novel drugs which do not offer therapeutic improvements, the proportion of pensioners, the use of statins and the use of antiulcer the proton pump inhibitors (PPI). On the contrary, the factors that reduced this expense were: the seniority in the medical position, the physician job stability and the prescription quality index. The profile of the doctor who generated the greatest expense of pharmaceutical prescription was mainly that of a professional who was responsible for a high percentage of pensioners, prescribed a high amount of inhibitors of the enzyme angiotensin converting enzyme inhibitors (ACEI), prescribed a high amount of first level non-steroidal anti-inflammatory drugs (NSAIDs) and also showed high use of antiulcer PPI. Conclusions: There is a statistically significant correlation between physicians who generate lower pharmaceutical expenditure and have a higher quality of prescription. The most influencing factors in the pharmaceutical expenditure are a high percentage of pensioners in the medical quota, the use of novel drugs that do not provide therapeutic improvements and the prescription of statins and anti-ulcer PPI drugs.Fundamentos: El elevado consumo farmacéutico requiere establecer medidas de mejora con la colaboración de todos los agentes implicados. El objetivo del estudio fue analizar el gasto farmacéutico generado por las recetas prescritas por los médicos que trabajan en un área de atención primaria y evaluar su relación con los indicadores de calidad de la prescripción. Métodos: Se estudiaron las prescripciones de 200 médicos de familia de la Comarca Araba de Osakidetza y dispensadas por las oficinas de farmacia entre los años 2009 y 2016. Las variables evaluadas retrospectivamente correspondieron a los indicadores de calidad de la prescripción farmacéutica recogidos en el Contrato-Programa del Departamento de Salud del 2016. Se elaboraron modelos de predicción mediante técnicas de regresión lineal y logística binaria. Resultados: Los principales factores que aumentaron el gasto farmacéutico por persona fueron: el uso de medicamentos novedosos que no ofrecen mejoras terapéuticas, la proporción de pensionistas, el uso de estatinas y el uso de antiulcerosos inhibidores de la bomba de protones (IBP). Por el contrario, los factores que redujeron este gasto fueron: la antigüedad en la plaza médica, la estabilidad laboral e el índice de calidad de prescripción. El perfil del médico que generó mayor gasto de prescripción farmacéutica fue principalmente el de un profesional que tenía a su cargo un elevado porcentaje de pensionistas, recetaba una cantidad elevada de inhibidores del enzima convertidor de angiotensina (IECA), prescribía una elevada cantidad de antiinflamatorios no esteroideos (AINE) de primer nivel e igualmente tenía un elevado uso de antiulcerosos IBP. Conclusiones: Existe una correlación estadísticamente significativa entre los médicos que generan un menor gasto farmacéutico y presentan mayor calidad de la prescripción. Los factores que más influyen en el gasto farmacéutico son un elevado porcentaje de pensionistas en el cupo médico, el uso de medicamentos novedosos que no aportan mejoras terapéuticas y la prescripción de estatinas y de antiulcerosos IBP