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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 Cronbach's alpha (internal consistency) and test-retest by using Spearman's 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 (Cronbach's α ), with only two domains (family roles and personality) having lower internal consistency values. The results displayed high test-retest reliability: all domains had Spearman's 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.

Objective 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. Methods This cost–utility analysis was done in the context of a clinical trial with a follow-up period of 3 months. In the clinical trial, dapsone efficacy versus placebo was measured in patients who presented with an AIS that also were receiving conventional therapy. Efficacy was also obtained from a published article that used dapsone to treat patients with AIS. A meta-analysis was conducted in order to obtain dapsone efficacy with a 95% confidence interval. The economic medical and nonmedical costs were calculated. The utility was evaluated using the Stroke Specific Quality of Life questionnaire, Spanish version. A Markov model was used. Key findings Twenty-nine patients with AIS were included, with an average age of 62.2 years (interval 23–90 years), and 62.1% were women. Dapsone cost–utility ratio was US$14612.79/quality-adjusted life year (QALY) versus placebo US$18631.84/QALY. The incremental cost-effectiveness ratio was US$49 700.05/QALY gained with dapsone. The sensitivity analysis of results was not sensitive to the variation of costs and/or QALYs. Conclusions The use of dapsone in AIS patients is a favourable option regarding cost–utility in comparison with placebo.

Background: 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.

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 patient's 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.

After spinal cord injury (SCI), a complex cascade of pathophysiological processes rapidly damages the nervous tissue. The initial damage spreads to the surrounding tissue by different mechanisms, including oxidative stress. We have recently reported that the induction of metallothionein (MT) protein is an endogenous rapid-response mechanism after SCI. Since the participation of MT in neuroprotective processes after SCI is still unknown, the aim of the present study was to evaluate the possible neuroprotective effect of exogenously administered MT-II during the acute phase after SCI in rats. Female Wistar rats weighing 200-250g were submitted to spinal cord contusion by means of a computer-controlled device (NYU impactor). Rats received several doses of MT-II (3.2, 10 and 100μg) at 2 and 8h after SCI. Results of the BBB scale were statistically analysed using an ANOVA of repeated-measures, followed by Tukey's test. Among the three doses tested, only 10 and 100μg were able to significantly increase (p

Christian Díaz de León-Castañeda, Marina Altagracia-Martínez, Jaime Kravzov-Jinich, Ma del Rosario Cárdenas-Elizalde, Consuelo Moreno-Bonett, Juan Manuel Martínez-NúñezDepartment of Biological Systems and Health Care, Biological and Health Sciences Division, Universidad Autónoma Metropolitana-Xochimilco, Mexico DF, MexicoIntroduction: 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$272.63/QALY (glibenclamide), US$296.48/QALY (metformin), and US$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.Keywords: cost-effectiveness, hypoglycemic, outpatients, type 2 diabetes

Objective To evaluate the cost-effectiveness (CE) ratio of clomiphene citrate versus anastrozole in the induction of ovulation in infertile adult women attending a Mexican public hospital. Methods A CE study was conducted from a hospital perspective. A clinical pilot study was carried out at the La Raza hospital. Thirty patients with infertility due to anovulation were recruited and grouped as follows: group A was treated with clomiphene citrate and group B with anastrozole. Efficacy data and adverse events of both drugs were obtained from the above-described clinical pilot study with Mexican women patients and through a systematic review of published medical literature. Efficacy data were analysed using meta-analysis; direct and indirect costs were gathered and calculated by the micro-costing technique, and a 1-year time horizon was considered. The Monte Carlo Markov model was used, and quality-adjusted life years (QALYs) were used as the unit of effectiveness. Incremental and sensitivity analyses were performed and we investigated the effect of a 5% discount rate. Key findings The odds ratios from the meta-analysis were 0.86 for ovulation induction and 1.46 for pregnancy. The most cost-effective therapy was clomiphene citrate at US$405/QALY in comparison to US$457/QALY for anastrozole. The incremental cost was US$52/QALY. The result of the discount rate for the most cost-effective therapy projected for 5 years was US$1288. The sensitivity analysis did not show changes for the most cost-effective therapy when the effectiveness probabilities or the treatment costs were modified. Conclusion Conventional treatment with clomiphene citrate therapy has the highest cost-effectiveness for the population studied.

Beatriz Espinosa Franco1, Marina Altagracia Martínez2, Martha A Sánchez Rodríguez1, Albert I Wertheimer31Facultad de Estudios Superiores Zaragoza (UNAM), Mexico; 2Universidad Autónoma Metropolitana Unidad Xochimilco, Mexico; 3Temple University, Philadelphia, Pennsylvania, USABackground: The use of antibiotic drugs triggers a complex interaction involving many biological, sociological, and psychological determinants. Resistance to antibiotics is a serious worldwide problem which is increasing and has implications for morbidity, mortality, and health care both in hospitals and in the community.Objectives: To analyze current research on the determinants of antibiotic resistance and comprehensively review the main factors in the process of resistance in order to aid our understanding and assessment of this problem.Methods: We conducted a MedLine search using the key words “determinants”, “antibiotic”,and “antibiotic resistance” to identify publications between 1995 and 2007 on the determinants of antibiotic resistance. Publications that did not address the determinants of antibiotic resistance were excluded.Results: The process and determinants of antibiotic resistance are described, beginning with the development of antibiotics, resistance and the mechanisms of resistance, sociocultural determinants of resistance, the consequences of antibiotic resistance, and alternative measures proposed to combat antibiotic resistance.Conclusions: Analysis of the published literature identified the main determinants of antibiotic resistance as irrational use of antibiotics in humans and animal species, insufficient patient education when antibiotics are prescribed, lack of guidelines for treatment and control of infections, lack of scientific information for physicians on the rational use of antibiotics, and lack of official government policy on the rational use of antibiotics in public and private hospitals.Keywords: antibiotic drug resistance, determinants, social-biological

Jacobo Alejandro Gómez-Rico1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Juan Carlos Hinojosa-Cruz2, Consuelo Rubio-Poo31Departments of Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS), Universidad Autónoma Metropolitana–Xochimilco (UAM-X), Xochimilco, Mexico; 2La Raza Hospital of the Mexican Social Security Institute (IMSS), Mexico City, Mexico; 3Universidad Nacional Autónoma de México (UNAM), Faculty of Professional Studies, Zaragoza (FES-Zaragoza), MexicoAbstract: Breast cancer (BC) is the second leading cause of death among Mexican women over 40 years of age. This study aimed to identify and examine the effects of cancer stage and surgical treatment on the quality of life (QOL) of Mexican women with early stage breast cancer (ESBC) treated with either modified radical mastectomy (MRM) or breast conservative surgery (BCS), plus adjuvant chemotherapy. The QLQ-C30 and QLQ BR-23 questionnaires were used to assess QOL. Sociodemographic characteristics and clinical factors of 102 women with early BC were also evaluated; analysis of variance (ANOVA) was performed and a statistical significance of p < 0.05 was assumed. Most women were of reproductive age. Meaningful differences in QOL as a result of surgical treatment, in women receiving BCS compared with those receiving MRM, were limited to body image. We conclude that MRM and BCS are essentially equivalent choices in terms of QOL, with the exception of the impact on body image. In general, women who received BCS had a better perceived QOL.Keywords: quality of life, breast cancer, Mexican women

Background Little is known about hypertension medication consumption and costs in Mexico. Hypertension control is a pharmacological challenge and a public health issue. Objective ( a ) To compare drug sales, number of written prescriptions, and monthly treatment costs among 5 classes of antihypertensive drugs and ( b ) to analyze diuretic drug sales and prescriptions to determine whether these antihypertensive agents represent an established technological trajectory. Methods A retrospective time series data study from 1999 to 2003. Data sources used were International Marketing Services of Mexico drug sales and the Mexico Prescription Audit databases. The 5 different classes of antihypertensive drugs were accommodated into 4 main technological trajectories according to their main biological mechanisms of action. Each technological trajectory was assessed using consumption and prescription data. Daily defined dose was used to calculate drug treatment costs. Results The market for cardiovascular agents is one of the largest, and in 2003 accounted for a value market share of US $59 billion and a unit share of 40.7 million. Among cardiovascular agents, antihypertensive drugs made up a large percentage of market shares. Calcium channel blockers and angiotensin-converting enzyme inhibitors I had the biggest share value of the total cardiovascular market. Amlodipine had the highest share among calcium channel blockers, and enalapril and captopril had the largest share among angiotensin-converting enzyme inhibitors I. The top-selling diuretic drug was furosemide. The trend in number of prescriptions was parallel to that in sales. The diuretic spinorolactone was the most expensive drug treatment (US $59). Treatment with spinorolactone might represent 47% of the income of a Mexican family if their household income was close to minimum wage (US $124). Conclusions The most effective and least expensive drugs—diuretics—had the smallest market share of all antihypertensive agents in Mexico. Nevertheless, diuretic agents are still in use and kept over time a steady market share both in value and in units.

Background. In a previous study we reported that 4,4′diaminodiphenylsulfone (dapsone) has anticonvulsant activity using kainic acid (KA) model. This work shows the behavioral and electrophysiologic changes caused by systemic application of several dapsone derivatives. These derivatives include disodium salt of 4,4′-diaminodifenylsulfone N,N′-diformaldehyde sulfoxylate (I), 4,4′-diaminodiphenylsulfone N,N′-didextrose sulfonate (II), sodium dibisulfite 4,4′-biscinamilidenamindiphenyl sulfone (III), and N,N′-dimethyl-4,4′-dimethylphenylsulfone (IV), which were synthesized and purified in our laboratory. Methods. A KA model was used to provoke limbic seizures. Limbic seizures were provoked by injection, KA, and electrophysiologic recorder at the following concentrations: 6.25 and 12.50 mg/kg of III and 6.25 and 12.50 mg/kg of IV. Results. Compounds III and IV caused decrease of postdischarges; we found percentage of protection of 55.60 and 70.78%, respectively. This showed possible anticonvulsant activity of these compounds (III and IV), while I and II showed no significant changes. We also studied whether there was a dose-dependence relationship, and different doses of compound IV were evaluated (25.00, 12.50, 6.25, 3.12, and 1.62 mg/kg). We found that greatest anticonvulsant effect occurred using doses of 3.12 and 6.25 mg/kg (two of the three lowest doses). Conclusions. We concluded that IV at doses of 3.25 and 6.25 mg/kg has anticonvulsant effect because it diminished duration of the first limbic seizure induced by KA; latency of first limbic seizure crisis was also increased. Both facts demonstrated possible therapeutic application of compound IV as anticonvulsant.

"El objetivo del estudio fue determinar la carga económica de la osteoporosis vertebral desde la perspectiva de la sociedad mexicana utilizando datos del mundo real en pacientes atendidos en el Centro Médico Nacional “20 de Noviembre”. Se realizó un estudio transversal y observacional. Se incluyeron 186 pacientes. Los costos se estimaron mediante el proceso de microcosteo, la aplicación de un cuestionario específico de 25 ítems y la revisión de expedientes médicos. La carga económica anual por paciente fue de $12,595 a $72,898 dependiendo del tipo de tratamiento antirresortivo administrado. La carga económica anual extrapolada a todos los pacientes con osteoporosis vertebral atendidos en el ISSSTE fue de $484.3 millones. La carga económica de la osteoporosis vertebral en la población estudiada fue alta."

"El proceso de limpieza es muy importante a todos niveles desde experimental hasta industrial ya que de ello depende la calidad de los resultados, productos elaborados y es indispensable para que el trabajo que se desarrolla en las diferentes áreas en que se involucra la salud sea confiable, se requiere la certeza de que existe una bioseguridad que no pone en riesgo la salud de los trabajadores y/o pacientes a través de los programas de limpieza de las áreas, equipos e instalaciones, apegándose a los procedimientos operacionales estandarizados de limpieza y sanitización."

"México cuenta con una ancestral tradición en el uso de tratamientos naturales, como parte del repunte de la medicina tradicional herbolaria; se revisaron las características etnobotánicas de la Lavandula officinalis (Lavanda) y se diseñó una metodología para obtener e identificar varios de los diferentes agentes bioactivos y valorar su posible efecto sedante."

"México es uno de los países de Latino América con un alto consumo de alcohol. Cuarenta y ocho bebidas alcohólicas (BA) comercializadas en México fueron analizadas por métodos establecidos físico-químicos para la determinación de etanol y metanol; la espectroscopia de absorción atómica se utilizó para detectar la presencia en cantidades trazas de Cu, Pb y Cd. Las muestras BA analizadas para la determinación de metanol y para la detección de la presencia de los metales pesados tóxicos (cobre, plomo y cadmio) en cantidades trazas estuvieron dentro de los límites establecidos en las normas oficiales mexicanas correspondientes. El consumo excesivo de BA aumenta el riesgo de muerte porque, potencialmente, pueden exacerbar la presencia de las enfermedades crónicas y(o) por accidente."

"La presencia de principios activos farmacéuticos en el medio ambiente es cada vez más preocupante. Muchos fármacos son liberados al medio ambiente, lo que los convierte en agentes contaminantes, a través de desechos y subproductos industriales, excreciones humanas y animales, basura doméstica, etc. Se han observado diversos efectos nocivos de varios grupos terapéuticos tales como los agentes citotóxicos, los antibióticos, los medicamentos hormonales, los AINES (diclofenaco) y los antidepresivos sobre la reproducción, fallo renal, muerte, resistencia a antibióticos y desórdenes endócrinos en diferentes especies animales. Aunque no hay evidencia suficiente, dichos efectos nocivos pueden, sin duda, extrapolarse a la salud humana. La presente revisión pretende mostrar los efectos nocivos que los medicamentos de receta y sus metabolitos pueden tener sobre el ambiente, la flora, la fauna y los humanos."

"Las enfermedades tropicales olvidadas (ETO) son un grupo de enfermedades infecciosas y no infecciosas que empobrecen a las poblaciones que las padecen. Dentro de las principales causas de dichas enfermedades la más común es la extrema pobreza de muchos pobladores que viven en países en desarrollo. Su control y eliminación es reconocido como una prioridad a alcanzar en las metas de desarrollo del milenio de las Naciones Unidas. Los objetivos de la presente revisión son describir la situación de las enfermedades olvidadas de diferentes orígenes en las Américas, contribuir a construir redes para trabajar en el desarrollo o mejora de los tratamientos medicamentosos y vacunas para el control de dichas enfermedades y estimular la participación del sector farmacéutico y de sus profesionales en este importante problema."

"El objetivo del presente estudio fue determinar los costos totales de la infertilidad femenina por anovulación en pacientes atendidas en el Hospital de Gineco–Obstetricia “La Raza”. Se realizó un estudio transversal y observacional. Se incluyeron 30 mujeres mayores de 18 años con infertilidad por anovulación tratadas con citrato de clomifeno o anastrozol. Los costos se estimaron mediante el proceso de micro-costeo, la aplicación de un cuestionario de 20 items y la revisión de expedientes médicos. El costo total por un periodo de seis meses para las 25 pacientes tratadas con citrato de clomifeno fue $733,658.35 y para las cinco pacientes tratadas con anastrozol fue $282,278.05. La carga económica de la infertilidad femenina por anovulación en la población estudiada fue alta."

DL-penicillamine (DL-P) and Prussian blue (PB) given alone or in combination were tested as possible treatments against acute thallium toxicity. Rats were intoxicated by i.p. injection of thallium (I) acetate at LD(50) (32 mg/kg). A day later, pharmacological treatment was administered until day 4 as follows: (1) vehicles, (2) PB 50mg/kg, by oral route, twice a day, (3) DL-P 25mg/kg i.p. route, twice daily and (4) PB+DL-P. The Estimated Probability Survival (EPS) was recorded during the experiment for each treatment. DL-P alone did not show a significant effect on survival. However, when it was used in combination with PB, it increased the survival significantly (EPS=0.8, P0.05) as compared to the control group (EPS=0.4). In a different experiment, using 16 mg/kg of Thallium I acetate, the metal levels were analyzed in blood, body organs and brain regions after treatments. DL-P given alone decreased slightly the thallium content in blood, organs and brain. Meanwhile, its administration in combination with PB diminished the thallium levels significantly (P0.05) in the majority of tissues, at levels lower than those achieved in the PB group. Those results indicate that DL-P administered alone did not prevent the mortality nor accumulation of the metal in body tissues. Its combination with PB could be considered an alternative antidotal treatment in thallium toxicity, because this chelating agent given alone did not cause thallium redistribution to the brain. When given in combination with PB it has an additive effect in the treatment of acute thallotoxicosis.

José Antonio Corona-Rojo1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Laura Vázquez-Cervantes1, Edilberto Pérez-Montoya2, Consuelo Rubio-Poo31Division of Biological Sciences and Health, Metropolitan Autonomous University, Campus Xochimilco (UAM-X), Xochimilco, México; 2National Polytechnical Institute (IPN), México DF; 3Faculty of Higher Studies – Zaragoza (FES-Zaragoza), National Autonomous University of México (UNAM), México City, MéxicoIntroduction: Six out of every 10 elderly persons live in developing countries.Objective: To analyze and assess the drug prescription patterns and errors in elderly outpatients attending public health care centers in Mexico City, Mexico.Materials and methods: A descriptive and retrospective study was conducted in 2007. Fourteen hundred prescriptions were analyzed. Prescriptions of ambulatory adults aged >70 years who were residents of Mexico City for at least two years were included. Prescription errors were divided into two groups: (1) administrative and legal, and (2) pharmacotherapeutic. In group 2, we analyzed drug dose strength, administration route, frequency of drug administration, treatment length, potential drug–drug interactions, and contraindications. Variables were classified as correct or incorrect based on clinical literature. Variables for each drug were dichotomized as correct (0) or incorrect (1). A Prescription Index (PI) was calculated by considering each drug on the prescription. SPSS statistical software was used to process the collected data (95% confidence interval; p < 0.05).Results: The drug prescription pattern in elderly outpatients shows that 12 drugs account for 70.72% (2880) of prescribed drugs. The most prescribed drugs presented potential pharmacotherapeutic errors (as defined in the present study). Acetylsalicylic acid–captopril was the most common potential interaction (not clinically assessed). Potential prescription error was high (53% of total prescriptions). Most of the prescription errors were due to omissions of dosage, administration route, and length of treatment and may potentially cause harm to the elderly outpatients.Conclusions: A high number of potential prescription errors were found, mainly due to omissions. The drug prescription pattern of the study population is mainly constituted by 12 drugs. The results indicate that prescription quality depends on the number of prescribed drugs per prescription (p < 0.000).Keywords: elderly, prescription, pattern, error, outpatients, Mexico

la diabetes mellitus (DM) es un grave problema de salud pública. El objetivo del presente trabajo fue analizar el uso de los medicamentos hipoglucemiantes en México. Este estudio utilizó como método la evaluación farmacoeconómica parcial. Los resultados indican que los agentes hipoglucemiantes incrementaron sus ventas de US$58.4 a US$140.8 millones de dólares de 1999 al 2003. La mayor participación en el mercado fue una combinación de sulfonilureas/biguanidas. Las tiazolidinedionas muestran la mayor participación en el mercado con un crecimiento en 5 años de 8.61% del total del mercado de hipoglucemiantes. Los medicamentos más vendidos fueron: glimepirida (sulfonilurea), metformina (biguanida) y la pioglitazona (tiazolidenodiona). El costo mensual del tratamiento farmacológico para la DM oscila entre $54.00 (glibenclamida) y $2,373.86 pesos (pioglitazona). En conclusión, los agentes hipoglucemiantes más nuevos (pioglitazona) muestran una creciente tendencia en las ventas (8.61%), a pesar de su alto costo de tratamiento mensual.

In a previous study we reported that 4,4'diaminodiphenylsulfone (dapsone) has anticonvulsant activity using kainic acid (KA) model. This work shows the behavioral and electrophysiologic changes caused by systemic application of several dapsone derivatives. These derivatives include disodium salt of 4,4'-diaminodifenylsulfone N,N'-diformaldehyde sulfoxylate (I), 4,4'-diaminodiphenylsulfone N,N'-didextrose sulfonate (II), sodium dibisulfite 4,4'-biscinamilidenamindiphenyl sulfone (III), and N,N'-dimethyl-4,4'-dimethylphenylsulfone (IV), which were synthesized and purified in our laboratory.A KA model was used to provoke limbic seizures. Limbic seizures were provoked by injection, KA, and electrophysiologic recorder at the following concentrations: 6.25 and 12.50 mg/kg of III and 6.25 and 12.50 mg/kg of IV.Compounds III and IV caused decrease of postdischarges; we found percentage of protection of 55.60 and 70.78%, respectively. This showed possible anticonvulsant activity of these compounds (III and IV), while I and II showed no significant changes. We also studied whether there was a dose-dependence relationship, and different doses of compound IV were evaluated (25.00, 12.50, 6.25, 3.12, and 1.62 mg/kg). We found that greatest anticonvulsant effect occurred using doses of 3.12 and 6.25 mg/kg (two of the three lowest doses).We concluded that IV at doses of 3.25 and 6.25 mg/kg has anticonvulsant effect because it diminished duration of the first limbic seizure induced by KA; latency of first limbic seizure crisis was also increased. Both facts demonstrated possible therapeutic application of compound IV as anticonvulsant.

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.

Jacobo Alejandro Gómez-Rico1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Consuelo Rubio-Poo21Universidad Autónoma Metropolitano–Xochimilco (UAM-X), Departments: Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS); 2Universidad Nacional Autónoma de México (UNAM), Faculty of Professional Studies-Zaragoza (FES-Zaragoza)Abstract: Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.Keywords: breast cancer, Mexican women, direct and indirect costs