Juan Manuel Martínez-Núñez

Prussian blue as an antidote for radioactive thallium and cesium poisoning

Correspondence: Marina AltagraciaMartinez Calle la Joya, 17 Casa 5, Colonia San Juan Tepepan, Mexico DF, Mexico CP 16020 Tel +52 55 5676 4276 Fax +52 55 5606 0535 Email marina.altagraciamartnez3@gmail. com Background: Following the attacks on the US on September 11, 2001, potentially millions of people might experience contamination from radioactive metals. However, before the specter of such accidents arose, Prussian blue was known only as an investigational agent for accidental thallium and cesium poisoning. The purpose of this review is to update the state of the art concerning use of Prussian blue as an effective and safe drug against possible bioterrorism attacks and to disseminate medical information in order to contribute to the production of Prussian blue as a biodefense drug. Methods: We compiled articles from a systematic review conducted from January 1, 1960 to March 30, 2011. The electronic databases consulted were Medline, PubMed, the Cochrane Library, and Scopus. Results: Prussian blue is effective and safe for use against radioactive intoxications involving cesium-137 and thallium. The US Food and Drug Administration has approved Prussian blue as a drug, but there is only one manufacturer providing Prussian blue to the US. Based on the evidence, Prussian blue is effective for use against radioactive intoxications involving cesium-137 and thallium, but additional clinical research on and production of Prussian blue are needed.

Cost-effectiveness study of oral hypoglycemic agents in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City

Introduction Worldwide, diabetes mellitus presents a high burden for individuals and society. In Latin America, many people with diabetes have limited access to health care, which means that indirect costs may exceed direct health care cost. Diabetes is Mexico’s leading cause of death. Purpose To evaluate the cost-effectiveness ratios of the most used oral hypoglycemic agents (OHA) in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City. Design A cross-sectional and analytic study was conducted in Mexico City. Methodology Twenty-seven adult outpatients with type 2 diabetes who were treated either with metformin or glibenclamide were included. Acarbose was used as an alternative strategy. The study was carried out from the perspective of Mexican society. Direct medical and nonmedical costs as well as indirect costs were evaluated using a structured questionnaire. Efficacies of all drug treatments were evaluated retrospectively. A systematic search was conducted to select published randomized clinical trials based on predetermined inclusion criteria, and treatment success was defined as glycosylated hemoglobin factor ≤ 7%. Efficacy data of each drug and/or combination were analyzed using meta-analysis. The Monte Carlo Markov model was used. Quality-adjusted life-years (QALY) were used as the unit of effectiveness; incremental and sensitive analyses were performed and a 5% discount rate was calculated. A hypothetical cohort of 10,000 patients was modeled. Results The odds ratios of the success of each drug treatment were obtained from the meta-analyses, and were the following: 5.82 (glibenclamide), 3.86 (metformin), 3.5 (acarbose), and 6.76 (metformin–glibenclamide). The cost-effectiveness ratios found were US

Evaluation of Completeness of Suspected Adverse Drug Reaction Reports Submitted to the Mexican National Pharmacovigilance Centre

272.63/QALY (glibenclamide), US

Evaluation of the Stroke-Specific Quality-of-Life (SSQOL) Scale in Mexico: A Preliminary Approach

296.48/QALY (metformin), and US

Cost–utility analysis in acute ischemic stroke survivors treated with dapsone in a public hospital in Mexico City

409.86/QALY (acarbose). Sensitivity analysis did not show changes for the most cost-effective therapy when the effectiveness probabilities or treatment costs were modified. Conclusion Glibenclamide is the most cost-effective treatment for the present study outpatient population diagnosed with type 2 diabetes in the early stages.

Health-Related Quality of Life in Patients Poststroke: Dapsone versus Placebo

AbstractBackground: The Mexican National Centre of Pharmacovigilance (CNFV) receives suspected adverse drug reaction (ADR) reports from the pharmaceutical industry, Federal States Centre of Pharmacovigilance (CEFV) and Healthcare Institution Centres of Pharmacovigilance (CIFV). The completeness of these suspected ADR reports is particularly important for the proper evaluation of drug safety. Objective: The aim of the study was to evaluate the completeness of the information reported in a representative sample of suspected ADR reports submitted to the CNFV during 2007 and 2008, to evaluate the completeness of the suspected ADR reports submitted to the CNFV from different sources during these 2 years and to identify the therapeutic subgroups with the highest number of suspected ADR reports during the study years. Methods: A cross-sectional period-prevalence study was conducted at the CNFV. Only reports of suspected ADRs submitted by the CEFV, pharmaceutical industry and CIFV during 2007 and 2008 were included in the present study (reports related to vaccines were excluded). The sample sizes to be used for each year were determined using the formula for population rate at 95% significance level. The samples for each year were randomly selected from the reports related to synthetic drugs submitted that year. The suspected ADR reports were classified according to the standing Mexican Official Norm (Norma Oficial Mexicana [NOM]) guidelines, which were used to divide the reports into four categories (0, 1, 2 and 3) based on their completeness. The seriousness of the suspected ADRs reported was also evaluated; a suspected ADR was classified as ‘non-serious’ when signs and symptoms are likely to be tolerated, ‘moderate’ when ADR is not life threatening and needs pharmacological treatment, ‘erious’ when ADR is life threatening and leads to hospitalization and ‘fatal’ when ADR contributes directly or indirectly to the patient’s death. Results: A total sample size of 370 and 371suspected ADR reports from 2007 and 2008, respectively, were examined. Our analysis revealed that the pharmaceutical industry sent the highest number of suspected ADR reports for both years (58% and 63%, respectively). Results of the information completeness analysis by using the NOM categories showed that, in both study years, among the total suspected ADR reports about 32% (119) and 40% (148), respectively, were categorized as grade 0 (information insufficient to generate risk signals). Analyses of the seriousness of all suspected ADR reports revealed that 2% of reports were classified as fatal each year, whereas 6% and 5% were classified as serious and 25% and 29% were classified as moderate in 2007 and 2008, respectively. The therapeutic subgroups, according to the Anatomical Therapeutic Chemical classification, with the highest frequencies of suspected ADR reports in both study years were sex hormones and modulators of the genital system, antibacterial for systemic use, antiepileptics and psychoanaleptics, and antihypertensives. Conclusions: The completeness of the information provided in the suspected ADR reports submitted during the sample study years was incomplete and, in general, did not fulfil the requirements established by the NOM guidelines. Among the pharmaceutical industry, CEFV and CIFV, the suspected ADR reports were mainly provided by the pharmaceutical industry. It is necessary to improve the pharmacovigilance system in Mexico to achieve a high level of completeness of suspected ADR reports that totally fulfil the standing regulations.

Evaluation of completeness of suspected adverse drug reaction reports submitted to the mexican national pharmacovigilance centre: a cross-sectional period-prevalence study.

OBJECTIVES The prevalence of stroke survivors with incomplete recovery in society has been estimated at 460/100,000 people, and one third of them require help in at least one daily activity. Two thirds of all deaths related to stroke in the world occur in low- and middle-income countries. The objective of the present work was to assess the reliability and validity of the previously translated Spanish Stroke-Specific Quality-of-Life (SSQOL) version 2.0 scales in Mexican stroke survivors. METHODS An observational and cross-sectional pilot study was conducted. Thirty-one patients who suffered stroke up to 1 year prior to the present study were included. Patients were interviewed twice in a 7-day period; other indexes and scales were applied. The reliability was assessed by using Cronbachs alpha (internal consistency) and test-retest by using Spearmans rho scores; the acceptability was evaluated by the floor and ceiling effects. RESULTS Ceiling and floor effects were observed for fewer than 20% of the patients. The overall internal consistency of the questionnaire was greater than 0.7 (Cronbachs α), with only two domains (family roles and personality) having lower internal consistency values. The results displayed high test-retest reliability: all domains had Spearmans rho scores of over 0.8. The questionnaire has adequate construct validity. CONCLUSIONS Our preliminary results showed that the psychometric properties (acceptability and reliability) of the Spanish SSQOL questionnaire are good, encouraging, and comparable to those of other similar studies. This study is the first approach to validate the Spanish version of the SSQOL questionnaire in Mexican stroke survivors.

Las enfermedades "olvidadas" de América Latina y el Caribe: un problema de salud pública global

Stroke is the leading cause of disability and death in the world. Each year, 15 million people worldwide suffer strokes. This study aims to analyze the relationship between the economic consequences and the units of utility in Mexican acute ischemic stroke (AIS) survivors who attended the National Institute of Neurology and Neurosurgery in Mexico City and who were treated with dapsone (a neuroprotective drug) versus placebo in addition to conventional treatment.

Rx synthetic medicines and their environmental impact

Background: Stroke is the second leading cause of death in the world and the main cause of long-term disability in Western countries. Evaluating health-related quality of life (HRQOL) in patients who have survived a stroke provides a more complete picture of the effects of different interventions in a patients condition. Dapsone has been shown to have neuroprotective effects during the acute phase of stroke. Objective: To evaluate HRQOL in patients who received dapsone versus placebo after stroke. Methods: This was an observational pilot study of 21 patients who randomly received dapsone or placebo during the acute phase of a stroke. HRQOL was evaluated with the Stroke-Specific Quality of Life (SSQOL) questionnaire 6 months after the stroke. Results: There was no significant difference in the total SSQOL score 6 months after a stroke between patients who received dapsone or placebo (3.41 vs 3.19; p = 0.434). Patients who received dapsone had higher mean values for 9 of the 12 domains of the SSQOL than patients who received placebo. However, the difference was not statistically significant. The highest score for the patients who received dapsone was in the self-care domain. Overall SSQOL scores were lower in women than in men (p < 0.01). Conclusion: SSQOL was slightly better for patients who received dapsone, showing a possible improvement in their functional level. More prospective, randomized, and placebo-controlled studies with a larger number of patients are needed to confirm these results.