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Background: Research on medicines access and use is heterogeneous and can be challenging for decision-makers to interpret. Pharmaceutical policy is an additional component for study and is the foundation for the promotion of access and use of medicines. This systematic review summarizes findings from the literature on medicines policy, access and use over the past two decades in Mexico and identifies research gaps that should be addressed. Methods: A systematic review of the literature published between 2000 and 2022 was conducted to identify publications on medicines policy, access and use in Mexico. The study followed PRISMA Statement guidelines 2020. A narrative review including content analysis was conducted. Results: A total of 5057 articles were reviewed, of which 77 fit the inclusion criteria. Studies described the lack of an explicit national policy, a misalignment between the legal framework and reinforcement incentives, deficient policy documentation at the national level, and the absence of necessary medicines regulation and transparency. In terms of access to medicines, challenges related to supply, selection, acquisition, distribution and expenditure were noted. Regarding medicine use, key study findings included a lack of adherence to standard treatment guidelines, dispensing, lack of reliable information on medicines, lack of treatment adherence and harmful self-medication. Conclusion: The appropriate use of medicines and adequate access to them are priority topics for the formulation of Mexican pharmaceutical policy. It is critical that further research includes longitudinal studies of medicine access and use, and the consideration of studying the private sector as well as new methodological approaches. Many reported challenges related to access to and use of medicines have persisted across decades, suggesting a lack of effective research-to-practice knowledge transfer and policy implementation.This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/.

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Background: Pharmacy practice (PP) research is a new discipline that studies the scope of interventions and health services performed by pharmacists. Information on PP in Latin America is available; however, to date, it has not been methodically analysed. It is critical to understand the current level of evolution of pharmaceutical activities to support evidence-based decision-making. Methods: We performed a review of PP literature published in five databases, of which two were international and three were focused on Latin America. The data obtained were qualitative, such that the strategies used for data search and collection were structured by PRISMA guidelines, and data synthesis and analysis were conducted through a narrative review. Results: Of the 1863 articles found in the initial search, 108 were included in the final analysis. The majority of these were conducted in Brazil (n=73, 74%) and Colombia (n=14, 13%). The interventions and services most frequently reported were dispensing (n=24, 22%), clinical pharmacy services (n=21, 19%) and pharmaceutical care (n=21, 19%). Most studies focused on only one key strategic area (n=94, 87%), specifically on health services provision. Conclusion: PP in Latin America follows worldwide trends to some extent with regard to the inclusion of clinical pharmacy and pharmaceutical care. However, the region also demonstrates particularities, including the heterogenous level of development amongst its countries. It is vital for Latin American pharmacists to publish their activities, interventions and services in order to generate a solid evidence base to evaluate practice and support informed decision-making.

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Introduction: Morphotypes of native catfish of the genus Ictalurus (Siluriformes: Ictaluridae) are known to occur in allopatry in the northern Sierra Madre Occidental of Mexico, with only the Yaqui catfish (Ictalurus pricei) taxonomically described. Recent genetic analysis of these morphotypes has revealed the monophyly of the I. pricei complex, which indicates Ictalurus sp. from the Culiacán River and San Lorenzo River basins as its nearest genetic relative and recognizes as an evolutionarily significant unit the Culiacán River and San Lorenzo River morphotypes. Objective: To compare the meristic and morphometric characteristics of the catfish of the Culiacán River basin with its nearest genetic relative, the Yaqui catfish, in order to determine the presence of distinctive morphological characters that support genetic evidence previously reported for these morphotypes. Methods: Catfish specimens were collected during various field expeditions (1990-2012) to remote sites of the Sierra Madre Occidental and conducted in the Yaqui River and Culiacán River basins with the purpose of morphological comparison. Forty-five morphological characters (40 morphometric and five meristic) were examined in 76 adult specimens - 52 Ictalurus sp. and 24 Ictalurus pricei. Three groups were subject to a discriminant function analysis (DFA), including two Ictalurus sp. groups from the Humaya River and Tamazula River sub-basins, representing the Culiacán River basin, and one I. pricei group representing the Yaqui River basin. The standardized measurements and meristic data of the catfish morphotypes were compared by means of DFA. Results: The DFA revealed 12 characters to be significantly different (P< 0.01) among the groups compared. The morphological characters separating the Ictalurus sp. (Culiacán River basin) from the Yaqui catfish were associated with lower anal, pelvic and pectoral fin ray numbers, shorter head and predorsal lengths, shorter longest lateral barbel and longest dorsal ray lengths and a narrower premaxilar dentary plate; and finally longer distances in Ictalurus sp. for dorsal-fin origin to last anal-fin ray base and dorsal-fin origin to posterior end of the adipose fin base. The standardized coefficients for canonical variables 1 and 2 accounted for 85.6 % and 14.4 % of the total variation, respectively. Conclusions: The distinctive morphological characters of the Ictalurus sp. found in the Culiacán River basin, combined with the known mitochondrial evidence for this morphotype, identify it as an evolutionarily significant unit that requires description as a new species based on taxonomical protocols.

Introducción: Morfotipos de bagres nativos del género Ictalurus (Siluriformes: Ictaluridae) se distribuyen de manera alopátrica en el norte de la Sierra Madre Occidental, de los cuales solo el bagre Yaqui (Ictalurus pricei) ha sido taxonómicamente descrito. Análisis genéticos recientes de esos morfotipos han revelado la monofilia del complejo I. pricei, que incluyó a Ictalurus sp. de las cuencas de los ríos Culiacán y San Lorenzo como su pariente genético más cercano, además del reconocimiento de los morfotipos de los ríos Culiacán and San Lorenzo como una unidad evolutivamente significativa. Objetivo: Comparar características merísticas y morfométricas del bagre de la cuenca del río Culiacán con su pariente genético más cercano, el bagre Yaqui, con el propósito de determinar la presencia de caracteres morfológicos distintivos en apoyo a evidencia genética previamente reportada para esos morfotipos. Métodos: Especímenes de bagres fueron recolectados durante varias expediciones de campo (1990-2012) en sitios remotos de la Sierra Madre Occidental en las cuencas de los ríos Yaqui y Culiacán para comparación morfológica. Cuarenta y cinco caracteres morfológicos (40 morfométricos y cinco merísticos) fueron examinados en 76 especímenes adultos (52 de Ictalurus sp. y 24 de Ictalurus pricei). Medidas corporales estandarizadas y datos merísticos de los morfotipos de bagres estudiados fueron comparados por medio de un análisis de función discriminante (AFD). Resultados: El AFD arrojó 12 caracteres significativamente diferentes (P< 0.01) entre los grupos comparados. Los caracteres morfológicos que distinguen al bagre del río Culiacán del bagre Yaqui, estuvieron asociados con un menor número de radios anales, pélvicos y pectorales, así como dimensiones más pequeñas para la longitud de la cabeza, longitud predorsal, longitud de la barbilla lateral más larga, longitud del radio dorsal más largo y una menor anchura de la placa dentaria premaxilar; y finalmente, dimensiones mayores en Ictalurus sp. (cuenca del río Culiacán) para distancias como origen de aleta dorsal a la base del último radio anal y origen de aleta dorsal a conexión posterior de aleta adiposa. Los coeficientes estandarizados para las variables canónicas 1 y 2 explicaron el 85.6 y 14.4 % de la variación total, respectivamente. Conclusiones: Los caracteres morfológicos distintivos de Ictalurus sp. de la cuenca del río Culiacán, en combinación con la evidencia mitocondrial conocida para este mismo morfotipo, permite reconocerlo como una unidad evolutivamente significativa y que requiere ser descrita como una especie nueva bajo los protocolos taxonómicos.

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HIGHLIGHTS Short-term incubation with insulin increases the L-arginine transport in HUVECs.Short-term incubation with insulin increases the NO synthesis in HUVECs.Insulin induces relaxation in human placental vascular bed.Insulin attenuates the constriction induced by hydrogen peroxide in human placenta.The relaxation induced by insulin is dependent on BKCa channels activity in human placenta. Insulin induces relaxation in umbilical veins, increasing the expression of human amino acid transporter 1 (hCAT-1) and nitric oxide synthesis (NO) in human umbilical vein endothelial cells (HUVECs). Short-term effects of insulin on vasculature have been reported in healthy subjects and cell cultures; however, its mechanisms remain unknown. The aim of this study was to characterize the effect of acute incubation with insulin on the regulation of vascular tone of placental vasculature. HUVECs and chorionic vein rings were isolated from normal pregnancies. The effect of insulin on NO synthesis, L-arginine transport, and hCAT-1 abundance was measured in HUVECs. Isometric tension induced by U46619 (thromboxane A2 analog) or hydrogen peroxide (H2O2) were measured in vessels previously incubated 30 min with insulin and/or the following pharmacological inhibitors: tetraethylammonium (KCa channels), iberiotoxin (BKCa channels), genistein (tyrosine kinases), and wortmannin (phosphatidylinositol 3-kinase). Insulin increases L-arginine transport and NO synthesis in HUVECs. In the placenta, this hormone caused relaxation of the chorionic vein, and reduced perfusion pressure in placental cotyledons. In vessels pre-incubated with insulin, the constriction evoked by H2O2 and U46619 was attenuated and the effect on H2O2-induced constriction was blocked with tetraethylammonium and iberiotoxin, but not with genistein, or wortmannin. Insulin rapidly dilates the placental vasculature through a mechanism involving activity of BKCa channels and L-arginine/NO pathway in endothelial cells. This phenomenon is related to quick increases of hCAT-1 abundance and higher capacity of endothelial cells to take up L-arginine and generate NO.

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Impairment of insulin signaling on diabetes mellitus has been related to cardiovascular dysfunction, heart failure, and sudden death. In human endothelium, cationic amino acid transporter 1 (hCAT-1) is related to the synthesis of nitric oxide (NO) and insulin has a vascular effect in endothelial cells through a signaling pathway that involves increases in hCAT-1 expression and L-arginine transport. This mechanism is disrupted in diabetes, a phenomenon potentiated by excessive accumulation of reactive oxygen species (ROS), which contribute to lower availability of NO and endothelial dysfunction. On the other hand, electrical remodeling in cardiomyocytes is considered a key factor in heart failure progression associated to diabetes mellitus. This generates a challenge to understand the specific role of insulin and the pathways involved in cardiac function. Studies on isolated mammalian cardiomyocytes have shown prolongated action potential in ventricular repolarization phase that produces a long QT interval, which is well explained by attenuation in the repolarizing potassium currents in cardiac ventricles. Impaired insulin signaling causes specific changes in these currents, such a decrease amplitude of the transient outward K(+) (Ito) and the ultra-rapid delayed rectifier (IKur) currents where, together, a reduction of mRNA and protein expression levels of α-subunits (Ito, fast; Kv 4.2 and IKs; Kv 1.5) or ß-subunits (KChIP2 and MiRP) of K(+) channels involved in these currents in a MAPK mediated pathway process have been described. These results support the hypothesis that lack of insulin signaling can produce an abnormal repolarization in cardiomyocytes. Furthermore, the arrhythmogenic potential due to reduced Ito current can contribute to an increase in the incidence of sudden death in heart failure. This review aims to show, based on pathophysiological models, the regulatory function that would have insulin in vascular system and in cardiac electrophysiology.