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PURPOSE: This study addresses the growing concern of Dry Eye Disease (DED), which has become increasingly prevalent due to modern lifestyles characterized by prolonged screen usage, global warming, polypharmacy, and extended life expectancy. METHODS: Grounded in the Dry Eye Workshop II (DEWSII) diagnosis framework, the study focuses on DED as a multifactorial condition affecting the ocular surface's tear film homeostasis. The study evaluates the short-term impact of 5 commercially available ocular lubricants on disrupting the hyperosmolar environment and determine whether these lubricants can offer potential treatment benefits for DED. RESULTS: Conducted on 300 eyes (from 150 patients) with 5 preservative-free lubricants compared to a control group, the study reveals that all lubricants effectively reduced tear film osmolarity within 15 minutes of application. Notably, the control group exhibited an increase in average osmolarity (+0.98 mOsm/L) without lubricant use. Siccafluid demonstrated the most substantial osmolarity reduction after 15 minutes, with an average decrease of 11.54 mOsm/L. Statistical significance was observed for Siccafluid, Optive Fusion unique dose (UD), and Systane Ultra UD, while Hyabak and Freegen preservative free (PF) showed lower significance. CONCLUSIONS: Emphasizing the importance of disrupting the hyperosmolar environment to break the cycle of inflammation, the study concludes that ocular lubricants, at least as an immediate post-application effect, can interrupt this cycle and improve the hyperosmolar environment of the ocular surface.

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Unsaturated polyester resin (UPR) is one of the first commercialized polymer matrices for composites reinforced with glass fibers, but has remained popular to this day. To reduce their environmental impact, natural fibers have been used as reinforcements. Researchers all over the world are still interested in these composites, and numerous papers have been published in the last four decades. Using bibliometric analysis, this work provides compiled, structured, and relevant information about the evolution and current state of these materials. This first study on UPR biocomposites based on bibliometric analysis examined 531 published papers identified in the Scopus database from 1982 to July 2022. An analysis of the most active states, leading institutions, and leading authors is followed by the identification of key areas such as the most common natural fibers used as reinforcements, fiber treatments, and composite design parameters such as processing techniques; recently, composite testing; and technological applications. The findings emphasize the importance of staying active in this global field and provide information on novel promising topics for future research.

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Soybean is a key crop in many countries, being used from human food to the animal industry due to its nutritional properties. Financially, the grain chain moves large sums of money into the economy of producing countries. However, like other agricultural commodities around the world, it can have its final yield seriously compromised by abiotic environmental stressors, like drought. As flowers imply in pods and in grains inside it to minimize damages caused by water restriction, researchers have focused on understanding flowering-process related genes and their interactions. Here a review dedicated to the soybean flowering process and gene network involved in it is presented, describing gene interactions and how genes act in this complex mechanism, also ruled by environmental triggers such as day-light and circadian cycle. The objective was to gather information and insights on the soybean flowering process, aiming to provide knowledge useful to assist in the development of drought-tolerant soybean lines, minimizing losses due to delays or anticipation of flowering and, consequently, restraining financial and productivity losses.

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OBJETIVE: To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS: A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS: We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS: Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.

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ABSTRACT OBJETIVE To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.

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BACKGROUND: The pharmacokinetics of anti-retrovirals (ARVs) can be modified by other concomitant medicinal products. It is timely to update the interactions between new ARVs and drugs of chronic use to maintain therapeutic success. AIM: To update information about drug interactions in patients with HIV/AIDS on antiretroviral therapy. METHODS: Comprehensive literature review in MEDLINE/PubMed database from January of 2015 to June of 2017, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into levels according to seriously and probability of occurrence. RESULTS: 466 articles were identified; full text was accessed in 444. Of these, 164 provided interactions, which allowed the identification of a total of 534 pairs of drug interactions. The interactions that presented a higher risk of generating safety and effectiveness problems were 308 (57.7%) of level 2 and 35 (6.6%) of level 1. CONCLUSIONS: We identify 534 new pairs of drug interactions, of which 308 (64.2%) are the most clinically relevant.

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Resumen Introducción: La farmacocinética de los anti-retrovirales (ARVs) puede ser modificada por otros medicamentos de uso concomitante. Es oportuno actualizar las interacciones entre nuevos ARVs y fármacos de uso crónico para mantener un éxito terapéutico. Objetivo: Actualizar información sobre interacciones medicamentosas en pacientes con infección por VIH/SIDA en terapia antiretroviral. Método: Revisión estructurada en MEDLINE/ PubMed utilizando los términos Mesh: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions, entre enero de 2015 y junio de 2017. Fueron seleccionadas publicaciones sobre interacciones medicamentosas en humanos, en inglés o español y con acceso a texto completo. Además, se incluyeron referencias de artículos considerados relevantes. La inclusión de los artículos fue evaluada por tres investigadores independientes y, en caso de requerirlo, por consenso entre ellos. La relevancia clínica se estableció, acorde con la gravedad y probabilidad de ocurrencia de la interacción. Resultados: Se identificaron 466 artículos, se accedió a texto completo a 444. De éstos, 164 aportaron interacciones, lo que permitió identificar un total de 534 parejas de interacciones medicamentosas. Las interacciones que presentaron un mayor riesgo de generar problemas de seguridad y efectividad fueron 308 (57,7%) de nivel 2 y 35 (6,6%) de nivel 1. Conclusiones: Se identifican 534 parejas nuevas de interacciones medicamentosas, de ellas 308 (64,2%) de mayor relevancia clínica.

Background: The pharmacokinetics of anti-retrovirals (ARVs) can be modified by other concomitant medicinal products. It is timely to update the interactions between new ARVs and drugs of chronic use to maintain therapeutic success. Aim: To update information about drug interactions in patients with HIV/AIDS on antiretroviral therapy. Methods: Comprehensive literature review in MEDLINE/PubMed database from January of 2015 to June of 2017, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into levels according to seriously and probability of occurrence. Results: 466 articles were identified; full text was accessed in 444. Of these, 164 provided interactions, which allowed the identification of a total of 534 pairs of drug interactions. The interactions that presented a higher risk of generating safety and effectiveness problems were 308 (57.7%) of level 2 and 35 (6.6%) of level 1. Conclusions: We identify 534 new pairs of drug interactions, of which 308 (64.2%) are the most clinically relevant.

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Resumen Objetivo: establecer y evaluar la relevancia clínica de las interacciones medicamentosas en el tratamiento de pacientes con hepatitis C. Método: se realizó una búsqueda en PubMed/MedLine de artículos publicados en inglés y en español, desde el 1 de enero de 2015 hasta el 30 de marzo de 2017, utilizando los términos Mesh: Hepatitis C AND drug interactions OR herb-drug interactions OR food-drug interactions, de estudios realizados en humanos. La relevancia clínica de las interacciones medicamentosas se estableció y evaluó con base en la probabilidad de ocurrencia y la gravedad de la interacción. Resultados: se identificaron 184 artículos, de los cuales 92 se seleccionaron por el título y resumen para revisión completa, a 2 de ellos no fue posible acceder al texto completo. De estos, 57 aportaban interacciones, lo que permitió identificar 155 parejas de interacciones medicamentosas, de las cuales 154 (99,4 %) fueron farmacocinéticas y 1 (0,6 %) farmacodinámica. Por su parte, de las 155 parejas, 34 (21,9 %) se valoraron de nivel 1; 73 (47,1 %) de nivel 2; 48 (31,0 %) de nivel 3; y 0 (0,0 %) de nivel 4. Además, se identificaron 29 parejas agrupadas como interacciones con evidencia de ausencia de relevancia clínica. Conclusiones: más de 99 % de las interacciones medicamentosas de relevancia clínica son farmacocinéticas, asociadas con cambios en el metabolismo y el transporte de fármacos; el simeprevir y la terapia 3D (Paritaprevir/Ritonavir+ Ombitasvir+Dasabuvir) fueron los medicamentos con mayor número de interacciones.

Abstract Objective: This study-s objective is to establish and evaluate the clinical relevance of drug interactions during treatment of patients with hepatitis C. Method: A PubMed/MedLine search was conducted for articles published in English and Spanish from January 1, 2015 to March 30, 2017 using the terms Mesh: Hepatitis C AND drug interactions OR herb-drug interactions OR food-drug interactions, from studies conducted in humans. The clinical relevance of drug interactions was established and evaluated based on probability of occurrence and severity of interactions. Results: Of the 184 four articles identified, 92 were selected by title and abstract for full review. The full texts of two articles could not be accessed. Of the remaining articles, 57 describ ed relevant interactions. Of the 155 pairs of drugs that interact that were identified, 154 (99.4%) were pharmacokinetic, and one (0.6%) was pharmacodynamic. Thirty-four of the 155 pairs (21.9%) were assessed at level 1; 73 (47.1%) were assessed at level 2; 48 (31.0%) were assessed at level 3, none were assessed at level 4. In addition, 29 pairs of interacting drugs had no evidence of clinical relevance. Conclusions: More than 99% of clinically relevant drug interactions are pharmacokinetics and are associated with changes in metabolism and transport of drugs. Simeprevir and 3D (Paritaprevir/Ritonavir+ Ombitasvir+Dasabuvir) therapy had the greatest number of interactions.

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Resumen Introducción: Durante el proceso de uso de los medicamentos es complejo establecer un esquema terapéutico eficaz y seguro, especialmente en los pacientes geriátricos, debido a la polimedicación. En este sentido, a medida que aumenta el número de medicamentos también aumenta la probabilidad de aparición de una interacción medicamentosa que podría tener consecuencias clínicas importantes. El objetivo de este estudio fue establecer y evaluar la relevancia clínica de las interacciones de antibióticos relacionadas con cambios en la absorción. Métodos: Búsqueda en PubMed/Medline y Embase de artículos en inglés y español, acceso a texto completo, sin fecha límite, en humanos. La relevancia clínica se estableció con base a la probabilidad y la gravedad. Se identificaron 85 artículos, 46 informaron interacciones de antibióticos relacionadas con cambios en la absorción. Los resultados se orientaron en los antibióticos comercializados en Colombia, acorde con la base de datos del Instituto Nacional de Vigilancia de Medicamentos y Alimentos. Resultados: Se identificaron 74 parejas de interacciones medicamentosas de medicamentos comercializados en Colombia, 63 fueron clínicamente relevantes y 11 con evidencia de ausencia de interacción. Conclusiones: La absorción de los antibióticos puede modificarse por factores como el uso simultaneo de medicamentos o alimentos; igualmente, los antibióticos pueden afectar la biodisponibilidad de algunos medicamentos, principalmente por modificaciones en la microbiota y generando interacciones clínicamente relevantes. El 67 % de las interacciones identificadas son de riesgo alto.

Abstract Introduction: During the process of drug use, it is demanding to establish an effective and safe therapeutic scheme, especially in elderly patients, because they are polymedicated. In this sense, while the number of medications increases also increases the likelihood of the appearance of an interaction drug, which could have significant clinical consequences. The objective of this study was toestablish and evaluate the clinical relevance of drug interactions whit antibiotics related to changes in the absorption. Methods: A search in PubMed / MedLine and Embase was made for articles in English and Spanish, full-text access, without a cut-off date, in humans. The clinical relevance was established based on the probability of occurrence and the severity of the interaction. The results were oriented in the antibiotics commercialized in Colombia, according to the database of Invima. Results: 74 pairs of drug interactions of drugs marketed in Colombia were identified, 63 were clinically relevant and 11 with evidence of absence of interaction. Conclusion: The absorption of antibiotics can be modified by factors such as the simultaneous use of drugs or food; equally, antibiotics can affect the bioavailability of some drugs, mainly by modifications in the microbiota and generating clinically relevant interactions. 67% of the identified interactions are high risk.

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Resumen Introducción: La planta Cannabis sativa (marihuana) contiene un número aproximado de 60 cannabinoides, de los cuales, el delta-9-tetrahidrocannabinol es el componente más estudiado para ser utilizado con fines medicinales. El conocimiento adecuado por parte de los ciudadanos de esta estrategia terapéutica es un proceso clave para garantizar la aceptación y la buena adherencia al tratamiento. Objetivo: Establecer la percepción que tienen los estudiantes de pregrado de Química Farmacéutica, Tecnología en Regencia de Farmacia y Medicina de la Universidad de Antioquia, en cuanto al uso de los productos de extractos de cannabis como tratamiento medicinal. Método: Estudio observacional de corte transversal, a partir de encuestas a estudiantes a través de un formulario en línea. Resultados: Se aplicaron 374 encuestas, 232 (62%) estudiantes de pregrado de Química Farmacéutica y Tecnología en Regencia de Farmacia y 142 (38%) de Medicina. De los estudiantes, 222 (59,4%) eran del sexo femenino, con una edad promedio de 22,5 años, y 348 (94%) viven en estrato socioeconómico bajo y medio. El 60,2% de los estudiantes dicen tener un conocimiento inadecuado sobre la utilización de la marihuana medicinal, la utilización de cannabinoides medicinales, la reglamentación y la seguridad. Relacionado con la opinión sobre la utilización medicinal, 356 (95,2%) de los encuestados estuvieron de acuerdo. Conclusiones: La mayoría de los estudiantes manifestaron un conocimiento inadecuado sobre la utilización de los cannabinoides terapéuticos. Además, gran parte de los estudiantes están de acuerdo con la utilización de la marihuana medicinal.

Abstract Introduction: Cannabis sativa (marijuana) contains approximately 60 cannabinoids, of which, delta-9-tetrahydrocannabinol is the most studied component to be used for medicinal purposes. Adequate knowledge by citizens of this therapeutic strategy is a key process to guarantee the acceptance and the good adherence to the treatment. Objective: To establish the perception of undergraduate students of Pharmaceutical Chemistry, Technology in Regency of pharmacy and medicine of the University of Antioquia, as regards to the use of cannabis extracts products as medicinal treatment. Method: Observational cross-sectional study, based on surveys to students through an online form. Results: 374 surveys were obtained, 232 (62%) from students of Pharmaceutical Chemistry and Technology in Regency of Pharmacy, and 142 (38%) from Medicine. 222 (59.4%) of the students that were female, with a mean age of 22.5 years, and 348 (94%) live in low and middle socioeconomic strata. 60.2% of students claim to have inadequate knowledge regarding the use of medical marijuana, the use of medicinal cannabinoids, regulation and safety. Related to the opinion of the medicinal use, 356 (95.2%) respondents agreed. Conclusions: Most of the students expressed inadequate knowledge about the use of therapeutic cannabinoids. In addition, the vast majority of students agree with the use of medical marijuana.

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Resumen Objetivo: Identificar la contribución del reporte de reacciones adversas a medicamentos por pacientes, así como las barreras y facilitadores asociados con esta estrategia. Metodología: Revisión estructurada en PubMed/MedLine de artículos en inglés y/o español, hasta el 30/05/2017, con los términos: Pharmacovigilance reporting AND patient report. Resultados: Se obtuvieron 16 artículos con información relacionada con el objeto de estudio y se incluyeron tres artículos más considerados como relevantes. Se identificaron las principales barreras y facilitadores del paciente para reportar la sospecha de reacciones adversas a medicamentos, los efectos del reporte y las características del mismo. De igual forma, se describieron las diferencias y similitudes entre el reporte por profesionales de la salud y pacientes. Conclusiones: La implementación del informe por pacientes disminuye el sub-reporte en farmacovigilancia. Además, permite la participación activa y la integración de las experiencias del paciente con las reacciones adversas a los medicamentos.

Abstract Objective: To identify the contribution of the report of suspected adverse drug reactions by patients, as well as the barriers and facilitators associated with this strategy. Methodology: Structured review based on PubMed / MedLine articles in English and Spanish, until 05/30/2017, using the keywords: Pharmacovigilance reporting AND patient report. Results: 16 articles were identified with information related to the object of study and three more were included taking into account their relevance. Main barriers and facilitators of patients for reporting suspected adverse drug reactions, the effects of the report and its characteristics, were identified. Besides, similarities and disparities between reports from health professionals and patients were described. Conclusions: The implementation of the report by patients decreases sub-reporting in pharmacovigilance. In addition, it allows the active participation and integration of patients' experiences about adverse drug reactions.

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Objective: To update information about drug interactions in patients with HIV/AIDS. Methods: Comprehensive literature review in MEDLINE/PubMed database from May of 2009 to December of 2014, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into four levels according to seriously and probability of occurrence. Results: Global, 546 different references were retrieved and 243 were selected. In addition 11 further manuscripts were identified in the references of the included articles. Overall, 935 pairs of drug interactions were identified, 95.7% pharmacokinetic (823 by enzyme induction or inhibition and 67 by changes in bioavailability). Of the 935 pairs of drug interactions, 402(43%) were classified as levels 1 or 2. Conclusions: The most clinically relevant antiretroviral drug interactions are due to pharmacokinetic mechanism, mainly induction or enzyme inhibition, according to previous reviews, the protease inhibitors remain as the antiretrovirals with the highest number of clinical relevant interactions.

Objetivo: Actualizar información sobre interacciones medicamentosas en pacientes con VIH/SIDA. Métodos: Revisión estructurada en MEDLINE/PubMed utilizando los términos Mesh: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions, entre mayo de 2009 y diciembre de 2014. Publicaciones sobre interacciones medicamentosas, en humanos, en inglés o español y con acceso a texto completo fueron seleccionadas. Además, se incluyeron referencias de artículos considerados relevantes. La inclusión de los artículos fue evaluada por tres investigadores independientes y, en caso de requerirlo, por consenso entre ellos. La relevancia clínica se estableció en cuatro niveles, acorde con la gravedad y probabilidad de ocurrencia de la interacción. Resultados: Se identificaron 546 artículos, de los cuales se seleccionaron 273; además, se incluyeron 11 referencias relevantes. Se identificaron 935 parejas de interacciones medicamentosas, 95,7% farmacocinéticas. De este grupo, 823 mediadas por inducción o inhibición enzimática y 67 por cambios en la biodisponibilidad. De las 935 parejas de interacciones, 402 (43%) fueron relevantes clínicamente (niveles 1 o 2). Conclusiones: Las interacciones medicamentosas con anti-retrovirales de mayor relevancia clínica se deben a mecanismos farmacocinéticos, principalmente inducción o inhibición enzimática. Acorde con revisiones previas, los inhibidores de proteasa continúan siendo los anti-retrovirales con mayor número de interacciones relevantes.

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Introducción: La obtención de información precisa y oportuna relacionada con las reacciones adversas medicamentosas resulta clave; utiliza estrategia como notificación voluntaria o por un profesional sanitario, ante la autoridad competente. Objetivo: Diseñar una propuesta de formato de reporte de reacciones adversas medicamentosas (RAM) por pacientes ambulatorios en Colombia, basado en recomendaciones de otros países y en requerimientos mínimos definidos para este tipo de formatos. Metodología: Revisión estructurada en PUBMED/MEDLINE de artículos publicados en inglés o español, utilizando los términos Pharmacovigilance AND Patients; y Pharmacovigilance reporting AND patient report. Se incluyeron artículos con información sobre reporte de RAM por pacientes. Con el soporte de la información de la revisión, al igual que con los requerimientos establecidos en las Guías del International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) E2A y E2B (R3), se construyó una lista de chequeo, la cual fue confrontada con la revisión de los formatos para el reporte por pacientes de 50 países pertenecientes al Uppsala Monitoring Center. Finalmente, se definieron los ítems a incluir en la propuesta de formato. Resultados: Se identificaron 104 artículos, de los cuales 5 cumplieron con los criterios de inclusión. Se elaboró una lista de chequeo con 34 ítems, la cual fue confrontada con 33 formatos, de los 50 países a los que se pudo acceder y, con ello, se definió el contenido del formato de reporte de RAM por pacientes. Conclusiones: Se diseña y presenta una propuesta de formato de reporte de RAM por pacientes ambulatorios en Colombia, con la información identificada como clave. El formato requiere de un proceso de validación y valoración de su funcionalidad en la contribución al logro de los objetivos de la farmacovigilancia.

Introduction: Obtaining accurate and timely information related to adverse drug reactions is key; uses strategy as voluntary reporting by health professionals or to the competent authority. Objective: To design a proposal of format for reporting adverse drug reactions (ADRs) by outpatients in Colombia based on recommendations from other countries and definite minimum requirements for this type of format. Methodology: We completed a structured review in PubMed/MEDLINE database of articles published in English or Spanish, using the terms Pharmacovigilance AND Patients, and Pharmacovigilance reporting and patient report. Articles with information about patients reporting ADR where included. With the support of the information from the review, as with the requirements established in the guidelines from the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) E2A and E2B (R3). We developed a checklist, and then we contrasted the items with the information registered in the format for reporting by patients from 50 countries belonging to the Uppsala Monitoring Center with. Finally, we defined the items to be included in the proposed format. Results: From structured review, we identified 104 articles, of which five met the inclusion criteria. We developed a checklist with 34 items, and then we confronted the 34 items with information registered in 33 of the 50 formats of the countries that we may accessed. We defined the contents of the ADR report format by patients. Conclusions: We design and develop a proposal of ADR reporting format by outpatient in Colombia, which has the information identified as key. The format requires a process of validation and evaluation of its functionality in contributing to achieving the objectives of pharmacovigilance.

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Objetivo: establecer y evaluarla relevancia clínica de interacciones medicamentosas en el tratamiento de pacientes con hepatitis C genotipo 1. Método: se realizó una búsqueda en PubMed/MedLine de artículos publicados en inglés y en español, desde el diciembre de 2004 a diciembre de 2014, utilizando los términos Mesh: Hepatitis C AND drug interactions OR herb-drug interactions OR food-drug interactions, de estudios realizados en humanos. Además, la búsqueda se complementó con la revisión, en el mismo período, sobre interacciones de antiretrovirales y hepatitis C en humanos, utilizando los términos Mesh: (Anti-retroviral agents AND Hepatitis C AND drug interactions OR herb-drug interactions OR food-drug interactions). La relevancia clínica de las interacciones medicamentosas se definió y evaluó con base a la probabilidad de ocurrencia y la gravedad de la interacción. Resultados: se identificaron 228 artículos, de los que se pudo acceder al texto completo en 212. De estos, 62 aportaban interacciones, lo que permitió identificar 128 parejas de IM, de las cuales 120 (93,7%) fueron farmacocinéticas y 8 (6,3%) farmacodinámicas. Por su parte, de estas 128 parejas, 2 (1,6%) fueron valoradas de nivel 1: 110 (53,7%) de nivel 2; 16 (7,8%) de nivel 3; y 0 (0%) de nivel 4. Además, se identificaron 78 parejas agrupadas como interacciones con evidencia de ausencia de relevancia clínica. Conclusiones: más del 90% de las interacciones medicamentosas de relevancia clínica son farmacocinéticas asociadas a cambios del metabolismo hepático, el telaprevir fue el medicamento con mayor número de interacciones.

Objective: Our objective was to establish and evaluate the clinical relevance of drug interactions in the treatment of patients with hepatitis C genotype 1. Method: We searched for articles published in English and Spanish from December 2004 to December 2014 in PubMed/MedLine. We used the following Medical Subject Headings (MESH): Hepatitis C and drug interactions OR herb-drug interactions OR food-drug interactions studies performed in humans. We conducted an additional complementary search for articles published in the same period about interactions of anti-retroviral and hepatitis C in humans using the following MESH: (Anti-retroviral agents AND Hepatitis C and drug interactions OR herb-drug interactions OR food -drug interactions). The clinical relevance of drug interactions was defined and evaluated based on the probability of occurrence and severity of interaction. Results: We identified 228 articles. Of these, it was possible to read the full text of 212. Of these, 62 contributed interactions which allowed us to identify 128 pairs of drug interactions, of which 120 (93.7%) were pharmacokinetic and 8 (6.3%) pharmacodynamic. Of these 128 pairs, two (1.6%) were rated Level 1: 110 (53.7%) were Level 2, 16 (7.8%) were Level 3, and 0 (0%) were Level 4. In addition, 78 pairs were identified that were grouped as interactions with evidence of absence of clinical significance. Conclusions: More than 90% of clinically relevant drug interactions are pharmacokinetic interactions associated with hepatic metabolism. Telaprevir has the greatest number of interactions.

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OBJECTIVE: To update information about drug interactions in patients with HIV/AIDS. METHODS: Comprehensive literature review in MEDLINE/PubMed database from May of 2009 to December of 2014, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into four levels according to seriously and probability of occurrence. RESULTS: Global, 546 different references were retrieved and 243 were selected. In addition 11 further manuscripts were identified in the references of the included articles. Overall, 935 pairs of drug interactions were identified, 95.7% pharmacokinetic (823 by enzyme induction or inhibition and 67 by changes in bioavailability). Of the 935 pairs of drug interactions, 402(43%) were classified as levels 1 or 2. CONCLUSIONS: The most clinically relevant antiretroviral drug interactions are due to pharmacokinetic mechanism, mainly induction or enzyme inhibition, according to previous reviews, the protease inhibitors remain as the antiretrovirals with the highest number of clinical relevant interactions.

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El síndrome de hipoventilación central congénito idiopático, también conocido como síndrome de Ondina, es una enfermedad poco común, caracterizada por la ausencia congénita del control central de la respiración y disfunción del sistema nervioso autónomo. Su incidencia se estima en aproximadamente 1 de cada 200 000 nacimientos al año. Es una enfermedad de transmisión autosómica dominante, derivada de una mutación heterocigótica del gen PHOX2B, presente en 90 % de los pacientes, pero su causa fisiopatológica aún no está claramente dilucidada. Presenta una elevada tasa de mortalidad, y una dependencia a la ventilación mecánica durante el sueño de por vida; sin embargo, gracias a una atención multidisciplinar y coordinada, con estrecha vigilancia y apoyo, podría esperarse que los pacientes con ella puedan llevar una vida relativamente normal. Se realiza el reporte de un caso diagnosticado en el departamento de Antioquia (Colombia), lugar con importantes barreras socioeconómicas que limitan el estudio complejo de este tipo de enfermedades de baja prevalencia global.

Idiopathic congenital central hypoventilation syndrome, also known as Ondine´s curse, is a rare disease characterized by congenital absence of the central control of breathing and autonomic nervous system dysfunction. Its incidence is estimated to be one per 200,000 births a year. It is an autosomal dominant disease derived from a heterozygous PHOX2B gene mutation, present in 90 % of patients, but its pathophysiological cause has not been elucidated yet. It has a high mortality rate and a lifelong dependency on a life-support device during sleep. However, it could be expected that a coordinated multidisciplinary care, with close monitoring and support, could help this kind of patients to have a relatively normal life. This is the report of a case diagnosed with this disease in Antioquia, Colombia, a place with significant socio-economic limitations that hinder a complete study of this type of low overall prevalence disease.

RESUMO

Antecedentes: el trígono retromolar es el sector de mucosa bucal situado detrás de los arcos dentarios superior e inferior. Los resultados de su tratamiento y las tasas de supervivencia han sido esporádicamente publicados solo en series retrospectivas. Objetivo: determinar los factores que afectaron la supervivencia y el intervalo libre de enfermedad de una serie de pacientes tratados con un protocolo preestablecido. Material y métodos: estudio retrospectivo, con revisión de historias clínicas e informes de anatomía patológica. Resultados: la extensión de la cirugía en 90 pacientes operados de inicio fue resección simple en 11, asociada a resección marginal de mandíbula en 23, segmentaria de mandíbula en 40, de las cuales se reconstruyeron solo 7, y parcial de maxilar superior en 21. En el 12,2% (11/90) se agregó un vaciamiento supraomohioideo y en 87,8% (79/90) vaciamiento de los 5 niveles. El 80,5% (83/103) recibieron radioterapia posoperatoria. Solo en el 12,6% (13/103) de los pacientes se aplicó un tratamiento de preservación con quimioterapia/radioterapia secuencial. La morbilidad resultó 81,1% y la mortalidad 5,5%.El 64% de los pacientes desarrolló recurrencias, con una media del 58,3% a los 5 años. En el análisis multivariado solo los márgenes de resección tuvieron significación estadística. La supervivencia global a 5 años fue del 46,7% y libre de enfermedad del 39,1%. En el análisis mul-tivariado solo la invasión perineural, los márgenes insuficientes y las adenopatas positivas fueron estadísticamente significativos. Conclusiones: el alto número de enfermos no pasibles de un tratamiento con intención curativa, que tenen infltración ósea, invasión perineural y extensión al cuello, hacen del trígono retromolar un temible subsito del cáncer bucal.

Background: the retromolar trigone is an area of the oral mouth located behind the superior and inferior dental archs. Results of its treatment and overall survival has been sporadically published in retrospective series. Objective: to discover factors which afect survival and free of disease interval in a series of patents under a preset protocol. Methods: retrospective study, review of medical records and pathologic reports. Results: The type of surgery in 90 patents included was: simple resecton, 11; combined with marginal resecton of mandible, 23; segmentary resecton, 40 (7 of them reconstructed with fbula); and partal maxillectomy, 21. A supraomohyoid neck dissecton was addedin 11/90 (12.2%) and a complete neck dissecton of fve levels, in 79/90 (97.8%). In 80.5% of the cases (83/103) received postoperative radiotherapy. In only 12.6% of the patents (13/103), preservaton treatment with sequental chemo/radiotherapy was applied. Morbidity was 81.1 % and mortality 5.5%. Sixty four per cent of patents relapsed, with a 5 years average of 58.3%. In the multivariate analysis for recurrence, only margin resecton was statstically significant. Five years overall survival was 46.7% and free of disease 39.1%. In multivariate analysis for survival, perineural invasion, margin resecton and node metastases were statstically significant. Conclusions: The high number of patents not suitable por curative surgery usually afected by bone infltraton, perineural invasion or extension to the neck suggests that the retromolar trigone is a dreadful subsite for oral cancer.

RESUMO

Actualmente, la causa específica del cáncer de mama es desconocida, pero han sido identificados una gran variedad de genes implicados en su desarrollo. Uno de estos es el HER2, cuya sobre expresión, y por ende la de sus receptores, está presente en cerca del 20 al 30 porciento de los cánceres de mama como resultado de la amplificación de la región cromosómica 17q12-21, y está asociado con subtipos agresivos y con sobrevidas bajas. La expresión de receptores proporciona información fundamental para el diagnóstico, pronóstico y el tratamiento en pacientes con cáncer de mama. Un diagnóstico preciso del estado de HER2 es fundamental debido a su relación al tratamiento con Trastuzumab y otros medicamentos que mejoran la sobrevida de estos pacientes. Para el diagnóstico se han diseñado varias técnicas, las cuales determinan el estado de HER2 en tejidos tumorales, tales como Inmunohistoquímica (IHQ) e Hibridización In situ (ISH). Algunos de los resultados obtenidos por IHQ son catalogados como no concluyentes, por ello se ha planteado la IHQ como prueba de detección primaria seguida por una prueba ISH confirmatoria.

Currently, the specific cause of breast cancer is unknown, but have been identified a variety of genes involved in its development. One of these is the HER2, whose overexpression, and hence their receptors, is present in about 20 to 30% of breast cancers as a result of amplification of the chromosomal region 17q12-21, and is associated with aggressive subtypes and with low survival. Receptor expression provides critical information for the diagnosis, prognosis and treatment in patients with breast cancer. Accurate diagnosis of HER2 status is essential because of its relationship to treatment with Trastuzumab and other drugs that improve survival in these patients For diagnosis have been designed several techniques, which determine HER2 status in tumor, such as immunohistochemistry (IHC) and in situ hybridization (ISH). Some of the results obtained by IHC are classified as inconclusive, so the IHC has emerged as a primary screening test followed by an ISH confirmatory test.

Assuntos

RESUMO

Antecedentes: los paragangliomas cervicales son tumores poco frecuentes, que reciben diferentes denominaciones según su ubicación. Los que asientan en la bifurcación carotdea son llamados ca-rotdeos; en el oído medio, tmpánicos; en el bulbo yugular, yugulares y en el nervio vagal, vagales. Lugar de aplicación: hospital público de atención terciaria de tumores. Población: veintséis pacientes, 22 de ellos operados. La edad media fue 48,6 años, el 77% del sexo femenino. Método: revisión de historias clínicas e informes de anatomía patológica. Resultados: doce eran izquierdos, 11 derechos, 2 bilaterales y 1 múltple. Se llegó al diagnóstico por la semiología, por angiorresonancia y por tomografa computarizada. Fueron divididos según la clasificación de Shamblin en grado 1-2 en 16 y grado 3 en 10. La extensión de la cirugía demandó en todos la resección del tumor que implicó en 2 la reparación vascular, en 2 la resección de los pares craneales XI y XII y en los 4 restantes por ser asintomáticos solo la observación. La morbilidad fue del 22,7%, las secuelas del 31,8% y la mortalidad del 4,5% distnta a la presentada en la serie histórica de 44,4%, 55,5% y 5,4%, respectvamente. Conclusiones: 1) Los tumores del cuerpo carotdeo son infrecuentes, benignos en su mayoría y de crecimiento lento. 2) Los recursos diagnósticos más utlizados fueron: el ecodoppler, la tomografa computarizada con contraste y la angiorresonancia, con resultados positvos en el 100% de los casos, a diferencia de la serie histórica donde se utlizó la angiografa con éxito en el diagnóstico en el 70%. 3) Los pacientes con tumores I, II y III sintomáticos de la clasificación de Shamblin son quirúrgicos con un porcentaje de secuelas del 31,8 % a diferencia de la serie histórica del 55,5 %. 4) En los tumores tpo III asintomáticos la selección de los pacientes debe ser cuidadosamente considerada para recomendar una cirugía agresiva y con alta morbilidad. Esta conclusión difere de la presentada en la serie histórica, donde todos los pacientes fueron intervenidos quirúrgicamente.

Background: cervical paragangliomas are very rare tumours and receive diferent names according to the site of origin. Carotd for those localized in the carotd bifurcaton, tympanic for those in the middle ear, yugular for those in the yugular bulb and vagal for those in the vagal nerve. Setng: tertary care oncologic public hospita. Populaton: 26 patents, 22 of them surgically treated. Mean age was 48.6 years, 77% female. Methods: review of clinical records and pathologic reports. Results: twelve were at the lef side, 11 at the right, 2 bilateral and 1 multple. Diagnosis was done by semiology, magnetic resonance and computed tomography. The tumors were classifed according to Shamblin classificaton in 1, 2 grades in 16 patents and 3 in 10. Surgery included tumor resecton with vascular graf in 2, XI and XII craneal nerve also in 2, while 4 patents remained in observaton because they were asymptomatic. Morbidity was 22.7%, sequels 31.8% and mortality 4.5%, diferent to the historic series with 44.4%, 55.5% and 5.4% respectvely. Conclusions: tumors of carotd body are infrequent, benign and of slow growth. Diagnostic techniques frequently used were ecodopler, CT scan and MRI, with positve results in about 100% of cases. It was diferent to historic series in which angiographic studies had positve results in only 70% of them. Symptomatic Shamblin 1, 2 and 3 were surgically treated with 31.8% of sequels, diferent to historic sample with 55.5%, but in asymptomatic grade 3, careful selecton of patents must be taken into ac-count for avoiding an aggressive surgery with high morbidity. This conclusion is diferent of the historic series in which all patents were surgically treated.