Recibido para evaluación: 28 de julio del 2016 Aceptado para publicación: 13 de octubre del 2016 Resumen Introducción. La automedicación es un problema de salud pública frecuente en población estudiantil, el cual se da sobre todo en estudiantes de medicina, dado su mayor conocimiento en farmacología. Por tratarse de los futuros prescriptores, es importante establecer la magnitud del problema en esta población. Materiales y métodos. Se realizó un estudio de corte transversal mediante una encuesta aplicada a 276 estudiantes de medicina, en el que se indagaron datos demográficos, antecedentes patológicos, hábitos, frecuencia de automedicación, medicamentos automedicados, porcentaje de automedicación responsable, razones para automedicarse y conocimiento sobre esta conducta. Resultados. De las 276 encuestas realizadas, se analizaron 270. La prevalencia de automedicación fue del 79,3%. El único factor con asociación estadística fue pertenecer a un semestre clínico (p = 0,020). Los medicamentos automedicados con mayor frecuencia son acetaminofén (10,8%), e ibuprofeno (3,9%).Artículo de investigación clínica / http://dx.

Background: Epilepsy is a serious health problem worldwide. Despite the introduction of new antiepileptic drugs (AEDs) almost 30% of these patients have drug-resistant forms of the disease (DRE), with a significant increase in morbi-mortality. Objective: Our objective was to assess the impact of some genetic factors and its possible association with treatment response and adverse drug reactions (ADRs) to phenytoin in 67 adult Colombian patients with epilepsy. Methods: We conducted an analytical, observational, prospective cohort study to screen four polymorphisms in pharmacogenes: CYP2C9*2-c.430C>T (rs1799853), CYP2C9*3c.1075A>C (rs1057910), ABCB1-c.3435T>C (rs1045642), and SCN1A-IVS5-91G>A (rs3812718), and their association with treatment response. Patients were followed for 1 year to confirm the existence of DRE (non-response) and ADRs using an active pharmacovigilance approach, followed by a consensus in order to classify ADRs according to causality, preventability, intensity and their relation with phenytoin dose, the duration of treatment, and susceptibility factors (DoTS methodology). Results: A little more than half of evaluated subjects (52.2%) were non-responding to phenytoin. Regarding the genotype-phenotype correlation there was no association between polymorphisms of SCN1A and ABCB1 and DRE (non-response) (p = 0.34), and neither with CYP2C9 polymorphisms and the occurrence of ADRs (p = 0.42). We only found an association between polymorphic alleles of CYP2C9 and vestibular-cerebellar ADRs (dizziness, ataxia, diplopia, and dysarthria) (p = 0.001). Alleles CYP2C9*2-c.430C>T and CYP2C9*3-c.1075A>C were identified as susceptibility factors to ADRs in 24% of patients. Conclusions: Decreased function alleles of CYP2C9 were highly predictive of vestibularcerebellar ADRs to phenytoin in our study (p = 0.001). However, the genetic variants

To estimate the cost-effectiveness of sunitinib as first-line treatment for metastatic renal-cell carcinoma (mRCC) from the Colombian health system perspective. MethOds: A Markov model was developed to compare the quality-adjusted life-years (QALYs) of three strategies as first-line treatment for (mRCC): sunitinib (50 mg per day for 4 weeks followed by 2 weeks off-treatment), bevacizumab (10 mg/kg every 2 weeks) combined with interferon alfa-2a (9 MIU subcutaneously three times a week), and pazopanib (800 mg once daily). The efficacy, safety and utility data were taken from published studies. Bayesian mixed treatment comparison method was applied for the indirect comparison among treatments related to efficacy and safety. We used 5 years as time horizon. An annual discounted rate of 5% was applied. All currency units are in USD$ (1 USD$ = COP 2,640). Costs of drug treatment, disease progression and best supportive care were estimated using official tariffs and databases from Colombia. We used as threshold three times the GDP per capita (USD$ 17,043). Results were tested using deterministic and probabilistic sensitivity analyses. Results: The total expected costs per patient were: bevacizumab combined with interferon alfa-2a

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En años recientes han sido introducidos nuevos antianginosos al mercado con mecanismos de acción novedosos, complementarios a los del arsenal farmacoterapéutico existente. Aunque el tratamiento de primera línea continúan siendo los betabloqueadores, antagonistas de canales de calcio y nitratos, el descubrimientos de nuevos aspectos fisiopatológicos de la enfermedad permitieron el desarrollo de blancos terapéuticos innovadores a nivel celular y molecular. El nicorandil, la trimetazidina, la ivabradina y la ranolazina se consideran nuevos fármacos antianginosos y constituyen la segunda línea de tratamiento de la angina de pecho estable; están indicados en pacientes que persisten sintomáticos a pesar del manejo de primera línea o en aquellos que presentan intolerancia o contraindicación a los betabloqueadores o antagonistas de canales de calcio. La trimetazidina, a través de su mecanismo de acción metabólico, mejora la tolerancia al ejercicio y puede ser útil en pacientes con falla cardíaca y contraindicación al uso de digitales; la ivabradina tiene un efecto cronotrópico negativo sin afectar el inotropismo ni la tensión arterial por lo que se puede usar en pacientes con taquiarritmias o falla cardíaca concomitante; en contraste, la ranolazina no afecta el cronotropismo por lo que se usa en pacientes con bradiarritmias aunque puede generar prolongación del intervalo QTc. La elección de alguno de estos medicamentos antianginosos de primera o segunda línea debe ser individualizado para cada paciente y se basa en las comorbilidades, contraindicaciones y preferencias del paciente. MÉD.UIS. 2016;29(3):79-93.

using the narrative analysis approach. Results: 17 publications met the inclusion criteria (8 randomized controlled trials, 1 case-controlled trial, 6 qualitative and 2 economic evaluation studies of moderate to high quality), which represented 10 studies. Disease activity was the most common measure of effectiveness with NLC being superior (n= 3) or equal (n= 3) to comparator. Acceptability was assessed in 6 studies; patients were more (n= 4) or equally (n= 1) satisfied with NLC compared to single-provider care and less satisfied compared to team care (n= 1). NLC was found to be safe (n= 2), with no difference in blood tests and disease activity. With regard to efficiency, mixed data on cost of NLC was reported with NLC being equivalent or less costly than traditional models (n= 3). Quantitative measures of accessibility and appropriateness were not found. Although in qualitative studies patients found NLC provided improved continuity of care (n= 3) and education and support (n= 4). ConClusions: NLC for RA patients is effective, acceptable, and safe. More information regarding accessibility, appropriateness and efficiency of this model, including its cost-effectiveness and the impact on patient flow, is needed.

A43was to assess the association of the depression as a risk factor for coronary heart disease (CHD) based on prospective studies included in published systematic reviews. Methods: A systematic review to identify systematic reviews was conducted in MEDLINE, Cochrane library and Embase databases, with no limit on the start date until December 2015, using keywords for depression, coronary events and risk factors. The selection of the reviews that included prospective studies was realized by two researchers independently; primary data from prospective studies analyzing the relationship of depression and CHD were extracted. The Hazard Ratios (HRs) were pooled using random effects model. The subgroup analysis was carried out considering fatal CHD, myocardial infarction, gender, and follow-up duration. Results: It was selected twenty one systematic reviews comprising thirty five prospective studies that were extracted. The number of people included in the studies was 900,226. The main differences among the studies were the age, gender, measurement of depression, length of follow-up and CHD fatality. The meta-analysis found that the depression behavior is a risk factor for CHD, although the heterogeneity is substantial. The analysis by subgroup found low heterogeneity for myocardial infarction and fatal CHD. The analysis suggested that depression increases the risk for fatal CHD AND myocardial infarction (HR 1.13 95%CI: 1.06-1.20 and HR 1.29 95%CI: 1.19-1.39, respectively). In the subgroup analysis by length of follow-up, the HR of CHD was 1.24 (95%CI 1.01-1.47) for the studies with less than 15 years of follow-up and 1.18 (95%CI 1.12-1.24) for those with more than 15 years of followup. ConClusions: The results of meta-analysis suggest that depression increases the risk of CHD significantly, although the evidence has substantial heterogeneity. PCV24CardioVasCular risks of ExogEnous TEsTosTEronE usE among mEn: a sysTEmaTiC rEViEw and mETa-analysis