Adverse drug reactions impact on patient health, effectiveness of pharmacological therapy and increased health care costs. This investigation intended to detect the most critical drug-drug interactions in hospitalized elderly patients, weighting clinical risk. We conducted a cross-sectional study between January and April 2014; all patients 70 years or older, hospitalized for >24 hr and prescribed at least one medication were included in the study. Drug-drug interactions were estimated by combining Stockley's, Hansten and Tatro drug interactions. Drug-drug interactions were weighted using a risk-analysis method based on failure modes, effects and criticality analysis. We calculated a criticality index for each drug involved in the drug-drug interactions based on the severity of the interaction mechanism, the frequency the drug was involved in drug-drug interactions and the risk of drug-drug interactions in patients with impaired renal function. The average number of drugs consumed in the hospital was 6 AE 2.69, involving 160 active ingredients. The most frequent were as follows: Furosemide, followed by Enalapril. Of drug-drug interactions, 2% were classified as contraindicated, 14% advised against and 83% advised caution during the hospital stay. Thirty-four drug-drug interactions were assessed, of which 23 were pharmacodynamic drug-drug interactions and 12 were pharmacokinetic drug-drug interactions (1 was both). The clinical risk calculated for each drug-drug interaction included heparins + non-steroidal anti-inflammatory drugs (NSAIDs) or Digoxin + Calcium Gluconate, cases which are pharmacodynamic drug-drug interactions with agonist effect and clinical risk of bleeding, one of the most common clinical risks in the hospital. An index of clinical risk for drug-drug interactions can be calculated based on severity by the interaction mechanism, the frequency that the drug is involved in drug-drug interactions and the risk of drug-drug interactions in an elderly patient with impaired renal function.Drug-related problems (DRP) are a very important public health concern that cause adverse drug reactions (ADR), which impact on patient health, effectiveness of pharmacological therapy and increased healthcare costs [1]. Drug-drug interactions have been reported to account for 5.6% to 63% of medication-related problems (MRPs), particularly in elderly patients, where the prevalence of at least one drug-drug interaction is about 46% [2]. The conditions of elderly patients, such as a decline in the functional capacity of most organs and systems, comorbidity and, in turn, polypharmacy (more than five drugs), make this population more susceptible to drug-drug interactions, resulting in a long hospital stay or death [3,4].There are many studies that report the prevalence of drugdrug interactions, while focusing on identifying the implicated drugs and the type of clinical effect on the patient [5,6]. Currently, research has focused on knowing the DDI action mechanisms, which allows assessment of their relevance and ...

Background: Dementia is a priority public health issue due to its high prevalence worldwide and its economic, social, and health impact. However, there are few reports in Mexico based on formal tests and with a clinical approach based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Objective: This study estimates the prevalence of the main types of dementia among elderly people living in the community in Mexico City. Methods: A population-based, two-step study was conducted, including 6,204 elderly individuals aged 60 or above with in-home assessment. All participants were screened for cognitive impairment; those who presented some cognitive problem underwent a standardized neurological examination. Each diagnosis was based on the criteria for dementia in the DSM-5, and the final consensus diagnosis of dementia was determined by an expert panel. Results: The global estimated prevalence of dementia in the Mexican population was 7.8% met the criteria for Alzheimer’s disease, 4.3% for vascular dementia, and 2.1% for mixed dementia. The prevalence of dementia was higher in women than in men (15.3% versus 12.5%, respectively). Conclusion: These results provide evidence to propose strategies for Latin American countries where dementia represents a challenge due to the heterogeneity of the populations and socioeconomic disparities, requiring early diagnosis and at the first levels of care.

Bacteriophages are the most abundant biological entity on the planet, having pivotal roles in bacterial ecology, animal and plant health, and in the biogeochemical cycles. Although, in principle, phages are simple entities that replicate at the expense of their bacterial hosts, due the importance of bacteria in all aspects of nature, they have the potential to influence and modify diverse processes, either in subtle or profound ways. Traditionally, the main application of bacteriophages is phage therapy, which is their utilization to combat and help to clear bacterial infections, from enteric diseases, to skin infections, chronic infections, sepsis, etc. Nevertheless, phages can also be potentially used for several other tasks, including food preservation, disinfection of surfaces, treatment of several dysbioses, and modulation of microbiomes. Phages may also be used as tools for the treatment of non-bacterial infections and pest control in agriculture; moreover, they can be used to decrease bacterial virulence and antibiotic resistance and even to combat global warming. In this review manuscript we discuss these possible applications and promote their implementation.

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Context:The performance of a prognostic score must be evaluated prior to being used. The aim of the present study was to evaluate the predictive ability of hospital mortality of Simplified Acute Physiology Score 3 (SAPS 3) score in elderly patients admitted to Intensive Care Units (ICUs).Aims:The aim of the present study was to evaluate the SAPS 3 score predictive ability of hospital mortality in elderly patients admitted to ICU.Settings and Design:This study was conducted as a prospective cohort, in two mixed ICUs.Patients and Methods:Two hundred and eleven elderly patients were included.Interventions:None. We compared the predictive accuracy of SAPS 3 measured at the first hour at ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) measured with the worst values in the first 24 h at ICU. The patients were followed until hospital discharge.Statistical Analysis Used:Evaluation of discrimination through area under curve receiver operating characteristic (aROC) and calibration by Hosmer-Lemeshow (HL) test.Results:The median age was 68 years. The hospital mortality rate was 35.54%. The mean value of SAPS 3 was 62.54 ± 12.51 and APACHE II was 17.46 ± 6.77. The mortality predicted by APACHE II was 24.98 ± 19.96 and for standard SAPS 3 equation 41.18 ± 22.34. The discrimination for SAPS 3 model was aROC = 0.68 (0.62–0.75) and to APACHE II aROC = 0.70 (0.63–0.78). Calibration: APACHE II with HL 10.127 P = 0.26, and standard SAPS 3 equation HL 7.204 P = 0.51.Conclusions:In this study, the prognostic model of SAPS 3 was not found to be accurate in predicting mortality in geriatric patients requiring ICU admission.

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Background/Aim Medication prescription is a fundamental component in the care of the elderly. Several characteristics of aging and geriatric medicine affect prescriptions for these people and make the selection of drug therapy a difficult and complex process. The objective of this study is to develop a geriatric portal for asynchronous online counseling (AGAlink) for use by physicians specializing in family medicine to reduce medication problems among older adult patients in the first level of care. Method A qualitative study was carried out in the first level of care at the Mexican Institute of Social Security (IMSS), 31 family doctors were interviewed to identify attitudes, preferences about the use of the AGAlink geriatric portal, as well as their recommendations for the implementation of this tool in their daily practice. For the analysis of the data obtained, a qualitative thematic content analysis was used. Results 90% of the physicians used the geriatric portal outside office hours without the need for the patient to be present. The perception of the physician towards the use of the AGAlink geriatric portal was favorable, provided relevant information and had several positive effects on the process of care for medical prescription. The barriers identified to accept the change in medication were not having the proposed therapeutic option, lack of any laboratory analysis, continuing to consider their experience for the prescription of the medication. Conclusions The AGAlink geriatric portal was a tool that was well received by physicians who expressed a positive attitude, considered an investment of a short time that allowed them to update and learn about strategies to reduce the prescription problems presented among the elderly population. However, the main barrier was the use of technology, especially in the doctors with more seniority in the service.

Resumen. Este trabajo propone una serie de argumentos filosóficos y epistémicos que incentiven la participación ciudadana fundamentada en las prácticas epistémicas y en el modelo argumentativo planteado por Stephen Toulmin. En la primera parte se dilucida la noción de conocimiento y la manera en que se fundamenta a través de las razones objetivamente suficientes desde las comunidades epistémicas. Posteriormente se desarrolla el concepto de práctica como argumento epistémico para fortalecer la participación ciudadana. Finalmente, apoyándonos en el contexto de la pandemia por SARS-CoV-2 y la enfermedad COVID-19, retomamos elementos del modelo argumentativo de Toulmin para evidenciar que es fundamental una base epistemológica y filosófica para establecer una legítima participación ciudadana para el desarrollo de sociedades basadas en el conocimiento.