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INTRODUCTION AND OBJECTIVES: Clinical guidelines recommend specific drugs for type 2 diabetes (T2D), hypertension, and dyslipidemia in patients with non-alcoholic fatty liver disease (NAFLD) and/or non-alcoholic steatohepatitis (NASH). We aimed to investigate the differences in prescription trends of antidiabetic, antihypertensive, and lipid-lowering drugs among adult patients according to the presence of comorbid NAFLD and/or NASH. METHODS: We conducted a cross-sectional analysis using a large claims database from January 2013 to December 2020. RESULTS: Among 7,716,908 people, 47,157 patients with T2D, 180,050 with hypertension, and 191,348 with dyslipidemia were identified. A total of 8,897, 16,451, and 24,762 patients with NAFLD, as well as 435, 523, and 1033 patients with NASH, had T2D, hypertension, and dyslipidemia, respectively. Among antidiabetic drugs, sodium-glucose cotransporter-2 inhibitors (SGLT2is) and thiazolidine were more frequently prescribed to patients with NAFLD than to those without NAFLD (non-NAFLD) (thiazolidine: 1.4% and 2.8% and SGLT2is: 17.8% and 25.9% for non-NAFLD and NAFLD, respectively [2019-2020]). Among antihypertensive drugs, angiotensin II receptor antagonists exhibited a slightly higher prescription ratio in patients with NAFLD (33.6% vs. 39.0%). Regarding lipid-lowering drugs, fibrates were more frequently prescribed to patients with NAFLD (10.3% vs. 18.4%). CONCLUSIONS: Specific drugs tended to be prescribed to patients with NAFLD. However, the differences in prescription ratios were not considerable. Further investigation is required to confirm the effects of drugs on the prognosis of patients with NAFLD or NASH.
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Diabetes Mellitus Tipo 2 , Dislipidemias , Hipertensión , Enfermedad del Hígado Graso no Alcohólico , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Adulto , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Prescripciones de Medicamentos , Dislipidemias/diagnóstico , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipoglucemiantes/uso terapéutico , Hipolipemiantes/uso terapéutico , Lípidos , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Tiazolidinas/uso terapéuticoRESUMEN
OBJECTIVE: To describe the ambulatory proton pump inhibitor (PPI) prescription in French children, its trends, and the impact of French (2014) and international (2018) clinical guidelines. STUDY DESIGN: We described PPI prescription rates based on national dispensation data in French children (IQVIA's Xponent database, 2009-2019). Using a segmented linear regression, we assessed the impact of clinical guidelines on PPI prescription rates. Analyses were performed for the overall pediatric population and by age subgroups (infants <2 years old, children 2-11 years old, adolescents 12-17 years old). RESULTS: During the study period, 8 060 288 pediatric PPI prescriptions were filled, with a mean PPI prescription rate of 52.5 per 1000 inhabitants per year. Between 2009 and 2019, the PPI prescription rate increased by 41% in the overall pediatric population (+110% in infants). The PPI prescription rate showed seasonal patterns with peaks in winter. After the release of French guidelines, significant decreases in trends of prescription rates occurred overall (change in trend -0.28, 95% CI -0.34;-0.23) and across all age groups. In infants, this change in trend was not sufficient to reverse the PPI prescription rate that was still increasing over time. In children, the PPI prescription rate slightly decreased and in adolescents, it was stable. After the release of international guidelines, a significant decrease in trend occurred in adolescents only (change in trend -0.26, 95% CI -0.47; -0.04). CONCLUSIONS: The pediatric PPI prescription rate in France was high, displayed a major increase over the last decade, mainly among infants, and was modestly affected by clinical guidelines.
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Prescripciones , Inhibidores de la Bomba de Protones , Adolescente , Niño , Preescolar , Bases de Datos Factuales , Prescripciones de Medicamentos , Francia/epidemiología , Humanos , Lactante , Pautas de la Práctica en Medicina , Inhibidores de la Bomba de Protones/uso terapéutico , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.
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Ingle/cirugía , Adhesión a Directriz/estadística & datos numéricos , Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos , Adulto , Anestesia Local/estadística & datos numéricos , Costa Rica/epidemiología , Femenino , Herniorrafia/normas , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Encuestas y CuestionariosRESUMEN
Abstract Background: Evidence from previous studies has consistently revealed that patients develop target organ damage even with seemingly normal blood pressure thus informing the development of a new treatment guideline in 2017. The prevalence of hypertension in Nigeria ranges from 8-45%, however this is expected to change due to the new guideline. Thus, this study sought to estimate the prevalence of hypertension based on 2017 ACC/AHA clinical guidelines, and determine its associated factors. Methods: In this cross-sectional study a total of 296 participants were recruited with a simple random technique using a table of random numbers. Blood pressure, weight and height were measured and data was analysed with SPSS version 22. The primary outcome measures included proportion of respondents with hypertension based on AHA guideline and JNC 7 classifications, as well as the association between hypertension and BMI, age, sex and marital status. Results: The mean age of study participants was 38.71years, and male to female ratio was 2:3. Overall prevalence of hypertension was 63.5% and 22.6% based on the new guideline and JNC 7 classification respectively; higher risk of hypertension was significantly associated with the AHA guideline (p< 0.001). Association between body mass index, marital status (currently married/not married), sex, age group (≥40 vs. < 40years) and systolic as well as diastolic hypertension was significant (p< 0.001). Females were more than twice as likely to be hypertensive as males [OR: 2.51 (1.54 - 4.10)]. Age and weight were the only significant predictors of abnormal blood pressure, diastolic and systolic hypertension. Conclusion: Prevalence of hypertension based on the new guideline is staggeringly high and portends a huge public health problem. This conundrum requires immediate intervention in order to forestall the damaging effects of hypertension on vital body organs and for participants to lead a healthy life.
Resumen Antecedentes: La evidencia de los estudios previos ha revelado, consistentemente, que los pacientes desarrollan daños en los órganos diana aun cuando su presión arterial es aparentemente normal, lo cual ha impulsado el desarrollo de una nueva guía de tratamiento en 2017. La prevalencia de la hipertensión en Nigeria oscila del 8 al 45%, aunque está previsto que cambie, debido a esta nueva guía. En nuestro estudio calculamos la prevalencia de la hipertensión, basada en la guía clínica de ACC/AHA de 2017, y determinamos sus factores asociados. Métodos: En este estudio transversal reunimos a un total de 296 participantes mediante una técnica aleatoria simple, utilizando una tabla de números aleatorios. Medimos la presión arterial, el peso y la altura, y analizamos los datos con SPSS versión 22. Las medidas del resultado primario incluyeron la proporción de respondedores hipertensos, basándonos en la guía AHA y en la clasificación JNC 7, así como en la asociación entre hipertensión e IMC, edad, sexo y estado civil. Resultados: La edad media de los participantes del estudio fue de 38,71 años, siendo el ratio varón:mujer de 2:3. La prevalencia global de la hipertensión fue del 63,5% y del 22,6%, sobre la base de la nueva guía y la clasificación JNC 7, respectivamente. El mayor riesgo de hipertensión se asoció significativamente a la guía AHA (p< 0,001). La asociación entre índice de masa corporal, estado civil (actualmente casados/solteros), sexo, grupo de edad (≥40 vs. < 40 años), e hipertensión sistólica y diastólica fue significativa (p< 0,001). Las mujeres superaron en más del doble a los varones, en cuanto a la probabilidad de padecer hipertensión [OR: 2,51 (1,54 - 4,1)]. La edad y el peso constituyeron los únicos factores predictivos significativos de presión arterial anormal e hipertensión diastólica y sistólica. Conclusión: La prevalencia de la hipertensión basada en una nueva guía es asombrosamente elevada, presagiando un gran problema de salud pública. Este interrogante requiere una intervención inmediata, a fin de prevenir los efectos dañinos de la hipertensión en los órganos vitales, y animar a los participantes a llevar una vida sana.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Salud Pública , Hipertensión , Presión Sanguínea , Encuestas y Cuestionarios , Estilo de Vida Saludable , American Heart AssociationRESUMEN
Resumen La incorporación de terapias biológicas ha significado un gran avance en el manejo de diversas patologías de origen autoinmune, neoplásico u otros. Si bien su uso ha implicado mejoras significativas en el pronóstico de estas enfermedades, no está exento de complicaciones, entre éstas, las infecciosas. El objetivo de este consenso fue evaluar el perfil de seguridad, desde la mirada infectológica, de las terapias biológicas de uso más frecuente y dar recomendaciones para la prevención de infecciones en pacientes tratados con ellas, basándose en la evidencia de mayor calidad disponible para los biológicos seleccionados. El consenso cuenta de dos manuscritos. Esta segunda parte corresponde a la guía clínica que detalla estas recomendaciones mediante estrategias de cribado, terapias profilácticas e indicación de vacunas, según corresponde, para infecciones bacterianas, y por micobacterias en particular, virus, hongos y parásitos, tanto para adultos como para niños.
The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.
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Humanos , Femenino , Embarazo , Complicaciones Infecciosas del Embarazo/inducido químicamente , Terapia Biológica/efectos adversos , Enfermedades Transmisibles/inducido químicamente , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Consenso , Emigrantes e Inmigrantes , Complicaciones Infecciosas del Embarazo/prevención & control , Chile , Tamizaje Masivo , Factores de Riesgo , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Hepatitis B/inducido químicamente , Hepatitis B/prevención & controlRESUMEN
Resumen Existe gran variabilidad en la práctica clínica en cuanto al uso de estudios imagenológicos, específicamente de la tomografía de cráneo simple en los casos de trauma encefalocraneano leve, más aun en pacientes menores de 2 años. En la mayoría de estos pacientes existe bajo riesgo de injuria intracraneal, sin embargo, este grupo etario plantea mayores retos diagnósticos por las dificultades en su evaluación y las pocas manifestaciones clínicas que podrían presentar dado a sus características anatómicas. Resulta necesario acogerse a las guías de práctica clínica que contengan reglas de decisión clínicas, que incluyan los signos y/o síntomas con mayor valor predictivo para detectar injuria intracraneal, costo efectivas y redundando en el beneficio del paciente.
Summary There is great variability in clinical practice with the use of imaging studies, specifically head computed tomography in cases of minor head injuries, even more so in patients younger than 2 years old. Most of these patients have low risk of intracranial injury; however, this age group represents greater challenges in the diagnosis, because of the difficulties in their assessment and lack of clinical results that could be present due to their anatomical characteristics. It is necessary to make clinical practice guidelines that include some key points like clinical signs and/or symptoms with greater predictive value for detecting intracranial injury, cost-effective interventions resulting in benefits for the patients.
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Tomografía Computarizada por Rayos X , Guías de Práctica Clínica como Asunto , Lesiones Traumáticas del EncéfaloRESUMEN
El Lupus Eritematoso Sistémico (LES) es una enfermedad inflamatoria, sistémica, crónica, de patogenia autoinmune. Sus manifestaciones varían desde afecciones leves a graves o fatales. En más común en mujeres y su prevalencia varía entre 40 a 200 casos/100.000 habitantes. El diagnóstico y reconocimiento precoz de sus manifestaciones sistémicas son críticos para una adecuada derivación, tratamiento y pronóstico de los pacientes. A petición del MINSAL, la Sociedad Chilena de Reumatología designó un grupo de trabajo para la elaboración de una guía clínica de LES. Objetivos: Definir niveles de atención, criterios de derivación según gravedad y elaborar recomendaciones para el diagnóstico, tratamiento y seguimiento de los principales compromisos del LES siguiendo la metodología de realización de guías clínicas. Metodología: Se siguieron las indicaciones para realización de guías clínicas basadas en criterios de evaluación (AGREE) y una combinación de criterios de medicina basada en la evidencia y consenso de expertos. La pesquisa bibliográfica se centró en la búsqueda de respuesta para 13 preguntas seleccionadas, respecto a: niveles de atención y criterios de derivación; abordaje general; principales compromisos graves del LES y situaciones especiales. Para cada pregunta se hizo una recomendación. La evidencia se estableció usando una escala tradicional. Además, se midió el grado de acuerdo (GdA) con las recomendaciones efectuadas, mediante una escala de 0 a 10 puntos, por los reumatólogos integrantes del grupo de trabajo y por cinco pares independientes. Resultados: Se desarrollaron 13 recomendaciones respecto a: 1) Rol del médico no especialista y criterios de derivación. 2) Rol del reumatólogo. 3) Sospecha y diagnóstico precoz del LES. 4) Pronóstico y gravedad. 5) Evaluación de actividad y daño en el LES. 6) Patología asociada al LES. 7) Fármacos utilizados en el LES y su toxicidad. 8) Bases diagnósticas de nefropatía lúpica. 9) Tratamiento de nefropatía lúpica...
Systemic lupus erythematosus (SLE) is an inflammatory, systemic and chronic disease of autoimmune pathogenesis. Manifestations vary from mild to serious or fatal conditions. It is most common among women and its prevalence varies between 40 to 200 cases/100.000 inhabitants. Early diagnosis as well as identification of systemic manifestations are critical for adequate referral, treatment and prognosis. At the request of Chile's health ministry, the Chilean Society of Rheumatology designated a work group to elaborate clinical guidelines for SLE. Objectives: Define levels of attention, criteria for referral according to seriousness, and elaborate recommendations for diagnosis, treatment and follow-up of the main disorders of SLE following the clinical guideline execution methodology. Methodology: Indications for the creation of clinical guidelines based on the AGREE evaluation criteria and a combination of medical criteria based on expert evidence and consensus were followed. Bibliographical investigation was centered on responding 13 selected questions with respect to: level of attention and referral criteria; general approach; main critical SLE compromises, and special situations. A recommendation was given for each question. Evidence was established using a traditional scale. Moreover, the degree of agreement was measured (GdA) with the recommendations carried out, by means of a scale from 0 to 10 by the rheumatologists who made up the work group and by five independent peers. Results: 13 recommendations were developed with respect to: 1) Role played by non-specialized physicians and referral criteria; 2) Role played by rheumatologist; 3) Suspicion and early diagnosis of SLE; 4) Prognosis and seriousness; 5) evaluation of SLE activity and damage; 6) Pathology associated to SLE; 7) Drugs used for SLE and their toxicity; 8) Diagnostic basis for lupus nephritis; 9) Treatment for lupus nephritis; 10) Neuropsychiatric manifestations of SLE; 11) SLE and...