Very low level viraemia and risk of virological failure in treated HIV-1-infected patients.

OBJECTIVES: The aim of the study was to investigate whether very low level viraemia (VLLV) (20-50 HIV-1 RNA copies/mL) was associated with increased risk of virological failure (VF) as compared with persistent full suppression (< 20 copies/mL). METHODS: From the VACH Cohort database, we selected those patients who started antiretroviral therapy (ART) after January 1997 and who achieved effective viral suppression [two consecutive viral loads (VLs) < 50 copies/mL] followed by full suppression (at least one VL <20 copies/mL). We carried out survival analyses to investigate whether the occurrence of VLLV rather than maintaining full suppression at < 20 copies/mL was associated with virological failure (two consecutive VLs > 200 copies/mL or one VL > 200 copies/mL followed by a change of ART regimen, administrative censoring or loss to follow-up), adjusted for nadir CD4 cell count, sex, age, ethnicity, transmission group, type of ART and time on effective suppression at < 50 copies/mL. RESULTS: Of 21 480 patients who started ART, 13 674 (63.7%) achieved effective suppression at < 50 copies/mL, of whom 4289 (31.4%) further achieved full suppression at < 20 copies/mL after May 2009. A total of 2623 patients (61.1%) remained fully suppressed thereafter, while 1666 had one or more episodes of VL detection > 20 copies/mL (excluding virological failure). A total of 824 patients had VLLV after suppression at < 20 copies/mL. VLLV was not associated with virological failure as compared with persistent full suppression [hazard ratio (HR) 0.67; 95% confidence interval (CI) 0.44-1.00], independently of the number of blips recorded (from one to 18). CONCLUSIONS: In our population of HIV-infected patients on ART who achieved viral suppression at < 20 copies/mL, the risk of virological failure was no different for patients who remained fully suppressed compared with those who experienced subsequent episodes of VLLV.

The relationship between antiretroviral prescription patterns and treatment guidelines in treatment-naïve HIV-1-infected patients.

BACKGROUND: Reports have shown that the publication of practice guidelines does not guarantee their use in clinical practice. The objective of this study was to evaluate the agreement between antiretroviral treatments (ARTs) prescribed in clinical practice and the recommendations in published guidelines. METHODS: A retrospective cohort study was carried out in ART-naïve adults of the Spanish Asociacion Medica Vach de Estudios Multicentricos (VACH) Cohort for the period from 2003 to 2006. RESULTS: A total of 945 patients initiated ART. Of these patients, 12.3% had a CD4 cell count above 350 cells/microL. A 'nonrecommended' antiretroviral regimen was prescribed to 5.3, 5.1 and 7.8% of patients with CD4 counts <200, 200-350 and >350 cells/microL, respectively. Multivariate analyses demonstrated that only a higher viral load was associated with the selection of a combination treatment that was recommended by the guidelines. CONCLUSIONS: Most patients were prescribed initial treatments in agreement with the recommendations. Appropriate routine data collection in databases can be used to evaluate the level of antiretroviral guideline compliance. We propose that routine evaluations of the guidelines must be part of quality assessment to improve medical care.

Effect of cigarette smoking on periodontal status of healthy young adults.

BACKGROUND: It has been shown that tobacco is a significant risk factor for periodontal disease; however, there have been few studies on young populations where problems of general health can be discounted. The purpose of this study was to examine the influence of tobacco consumption on the periodontal condition of a young, healthy population. METHODS: The study population consisted of 304 young Caucasian males (average age 19.38 +/- 0.72 years) entering the Armed Forces. All the subjects completed a self-administered questionnaire on age, oral hygiene habits, previous dental examinations, and quantity and length of tobacco use. The periodontal examination consisted of the plaque index (PI); periodontal bleeding index (PBI); probing depth (PD); and clinical attachment level (CAL). One- and 2-way ANOVA was used to compare data recorded between smokers and non-smokers. RESULTS: Forty-six percent of subjects reported that they brushed their teeth at least once a day, but only 13% visited a dentist at least once a year. Over half (53%) were habitual smokers, 43% smoking between 5 and 20 cigarettes per day; 39% of the smokers had been smoking for less than 5 years. Mean PI was 31.24 +/- 14.88 (27.19 +/- 15.93 for smokers and 35.78 +/- 12.17 for non-smokers), with significant differences between non-smokers and those who smoked 5 to 20 cigarettes per day (26.85 +/- 16.11, P<0.0001). Mean PBI was 42.29 +/- 8.43 (non-smokers 44.67 +/- 6.53 and smokers 40.17 +/- 9.46). Significant differences were found between the PBI of the non-smokers and of those who smoked 5 to 20 cigarettes per day (39.90 +/- 9.64, P <0.0001). There were also differences in the PBI between those who brushed their teeth once (40.53 +/- 9.61) and twice (44.86 +/- 5.9) a day (P<0.0001). Mean PD was 1.62 +/- 0.43 mm (non-smokers 1.56 +/- 0.36 and smokers 1.68 +/- 0.49). Deeper probing depths were recorded among smokers than among non-smokers, with statistically significant differences (P<0.049); statistically significant differences were also found between those who attended (1.49 +/- 0.50) and those who did not attend (1.65 +/- 0.42) regular dental check-ups (P<0.031). Mean CAL 1.75 +/- 0.41 (non-smokers 1.64 +/- 0.32 and smokers 1.82 +/- 0.44). CONCLUSIONS: It may be concluded that, even at such an early age, tobacco consumption affects the periodontal health. It is necessary to inform young smokers of the risk of tobacco use regarding periodontal health.

The influence of general health and socio-cultural variables on the periodontal condition of pregnant women.

BACKGROUND: There has been speculation as to whether hormonal changes during pregnancy or pre-existing conditions of general, oral, and dental health and socio-cultural background have a greater impact on the development of periodontal disease during pregnancy. METHODS: This study evaluates the periodontal status of 130 pregnant women (plaque index, bleeding index, probing depth, and clinical attachment level) and its relationship to demographic (age, professional level, education, and urban or rural residence) and clinical variables (gestation period, previous pregnancy, health status, previous live births, previous periodontal maintenance). The hospital in which the study was conducted was selected during a prior pilot study. All records were compiled by the same trained examiner with a calibrated manual probe. Statistical tests used were ANOVA and ANCOVA. RESULTS: Results showed a mean plaque index of 58.7+/-2.79%, which increased with statistical significance when the professional level was lower (P <0.014), education was lower (P <0.01), previous periodontal maintenance was less frequent (P <0.00001) and patients lived in rural areas (P <0.0003). The mean bleeding index was 68.8+/-2.44% and was significant in relation to lower professional level (P <0.025), less frequent previous periodontal maintenance (P <0.029), and an urban residence (P <0.0011). A mean clinical attachment level of 0.84+/-0.65 mm was observed and was related significantly with age (26 to 30 years) (P <0.001) and the third trimester of gestation period (P <0.0025). The mean probing depth was 1.71+/-0.3 mm, which related significantly with age (36 to 42 years) (P <0.0002), lower professional level (P <0.0013), rural residence (P <0.0025), 2 or more previous live births (P <0.0001), and non-attendance for previous periodontal maintenance (P <0.0023). Using ANCOVA testing and adjusting by age, the differences relating to previous live births disappeared. CONCLUSIONS: Gingivitis due to accumulation of plaque was the most characteristic periodontal condition in this sample and was related to professional level, level of education, and previous periodontal maintenance. These results illustrate the importance of establishing periodontal preventive measures for pregnant women, even though their demographic and clinical characteristics do not differ from those of the general population.

[The identification and description of clinical trials published in Spanish journals of general and internal medicine during the period of 1971-1995]. / Identificación y descripción de los ensayos clínicos publicados en revistas españolas de medicina general e interna durante el período 1971-1995.

BACKGROUND: When faced with a therapeutic issue, the practice of evidence-based medicine requires efficient access to information derived from controlled clinical trials. The objectives of the study were to locate, with the greatest possible exhaustivity, all controlled clinical trials published in Spanish journals of general medicine, between 1971 and 1995 (25 years), to characterize them, and to incorporate them into the worldwide database of clinical trials maintained by the Cochrane Collaboration. METHODS: The controlled clinical trials have been identified by a systematic, manual review of all the Spanish journals of general and internal medicine. The results obtained have been compared with an exclusive electronic search in MEDLINE. A descriptive analysis of the characteristics of the localized controlled clinical trials was done. RESULTS: 68 journals of general and internal medicine have been identified, only 6 being indexed in MEDLINE. A search carried out exclusively using MEDLINE would imply the loss of one third of all controlled clinical trials. About 16 controlled clinical trials per year have been published in Spain in the area of general and internal medicine, most of them with important missing information. CONCLUSIONS: The limitations of searching only in MEDLINE have been shown once again. There are few controlled clinical trials published in Spain in the area of general and internal medicine, and in order to improve their quality and their diffusion is recommended that authors and editors adhered to the international consensus initiatives that are under way.

A clinical assessment of the effectiveness of a mouthwash based on triclosan and on Zea mays L used as supplements to brushing.

The effectiveness of a mouthwash based on triclosan in combatting plaque and gingivitis was compared with a mouthwash based on nonsaponifiable maize germ (Zea mays L). Both were used to supplement conventional mechanical oral hygiene. The study was carried out under double-blind conditions with a negative control (a placebo) and a positive control (a mouthwash based on chlorhexidine). After a period of 14 days to allow the Plaque Index and Gingival Index to standardize, the 43 subjects who formed the sample were examined weekly for 3 weeks. During the study, five subjects were excluded because they did not meet the criteria for selection for the study. Although the mouthwash based on triclosan reduced the Plaque Index by 7.3% in comparison with the placebo negative control (a less marked effect than that of chlorhexidine, which achieved an 8.43% reduction), it had scarcely any effect on the Gingival Index. The mouthwash based on Zea mays L had no beneficial action on the Plaque Index, which increased slightly, but it led to an improvement in the Gingival Index (7.17% in comparison with the placebo).

Evaluation of gingival and periodontal conditions following causal periodontal treatment in patients treated with nifedipine and diltiazem.

It is established that phenytoin, cyclosporin and some calcium antagonists produce gingival overgrowth, but it is not known how this condition may respond to causal periodontal treatment. In order to find out, a longitudinal study was carried out, over a year, comparing a group of patients who were given nifedipine (NG, n = 18) and another group who were given diltiazem (DG, n = 13) with 2 others: one comprised cardiopathic patients who took no calcium antagonists (CG, n = 12) and the other contained patients who were medically healthy, with moderate periodontitis (HG, n = 12). On their basal visit, they were examined and instructed in oral hygiene, and then given causal periodontal treatment, being seen again at 4 and 8 months, when hygiene instructions were reinforced. They were seen for the last time at 12 months, when they were again examined. Groups NG and DG, on their basal visit, showed larger gum size than groups HG and CG, which was statistically significant; on their final visit, these differences remained only at the interproximal level. The number of patients with gingival overgrowth-taking the average of group HG as a minimal value-was much higher in groups CG (92%), DG (100%) and NG (89%) on the basal visit; on the final visit, the differences remained only in groups DG (85%) and NG (83%). The probing pocket depth reduction was much greater in groups HG and CG than in DG and NG, basically due to a greater gaining on clinical attachment level. The % of sites in which the pocket depth improved by more than 2 mm was 39.8% in HG, 54.5% in CG, 23.7% in DG and 28.7% in NG. The % of sites where the attachment gain by more than 2 mm was 46.2% in HG, 55.5% in CG, 22.8% in DG and 21.4% in NG. The amount of plaque and bleeding on probing, which was similar in all groups on the basal visit, decreased throughout the study, especially between the basal and 2nd visit in groups HG and CG. We have demonstrated that patients that take nifedipine and diltiazem show a larger gum size and their response to causal periodontal treatment is poorer than in the healthy and the cardiac groups.

Clinical assessment of gingival size among patients treated with diltiazem.

Gingival overgrowth induced by nifedipine has been extensively reported. This finding, however, does not apply to gingival size changes caused by other calcium antagonists such as diltiazem. We studied the gingiva of 13 subjects with ischemic cardiopathy who had been treated with diltiazem and established two control groups: (1) a healthy group of 12 patients and (2) a group of 10 patients with ischemic cardiopathy and concomitant treatment similar to that applied to the diltiazem group except that they had not been administered any type of calcium antagonists. The size of the gingiva around the six anterior teeth was measured on plaster models of the upper and lower jaws. Significantly higher scores of the size of the gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) and also when interproximal (p < 0.05) and vestibular (p < 0.05) sites were considered. We did not observe any significant difference in the plaque index of each group (p < 0.05); only bleeding after probing was found statistically different between the diltiazem and the nondiltiazem groups.

Clinical assessment of gingival hyperplasia in patients treated with nifedipine.

Gingival hyperplasia caused by the use of nifedipine has been extensively reported. In this paper, the gingiva of 18 patients suffering from cardiopathy and treated with nifedipine were compared with those of 10 patients with cardiac disorders who had not been treated with calcium antagonists and with a no-treatment group of 12 patients. Nifedipine produced gingival hyperplasia, although patients who had not been treated with calcium antagonists also had mild hyperplasia. Hyperplasia first appeared in the interproximal areas, an observation which may be important for early detection. There was a direct correlation between the degree of hyperplasia and the bacterial plaque score. When we studied the influence of administration time and dose of nifedipine with the degree of hyperplasia, no statistically significant differences were found.

[Detection of alcohol-related problems in primary care]. / Detección de problemas relacionados con el alcohol en atención primaria.

The results of a survey of primary health care physicians in order to know which factors are associated with the efficacy in the detection and treatment of patients with alcohol-related problems are analyzed in this article. The number of diagnosed patients is related with previous formal education on alcohol-related problems of primary health care physicians. Primary health care physicians are very interested in this issue, but they don't feel satisfied nor gratified with their work with this type of patients. Gratifying feelings are directly related to previous formal education, and those who feel gratified diagnose more patients. Needs for formal education must be accompanied by profound organizational changes in the coordination of actions between primary health care, specialized services and social care.

Analysis of cohort mortality from prostatic cancer in Spain, 1951-1983.

Prostatic cancer mortality rates in Spain were analysed for the period 1951-1983 by age groups. Five year interval age cohort trends were also studied. A rising trend was seen over this period of time, although there has been some stabilisation during the recent past. Age cohort analysis shows a generation effect in those cohorts born before 1896, consistent with an increased exposure to environmental and/or occupational factors.

Patterns of consumption of alcohol in Seville, Spain. Results of a general population survey.

The results of a general population survey of the patterns of consumption of alcohol in a representative sample of the province of Seville, Spain, are analysed in this article. The proportions of drinkers and abstainers and distribution by age, by sex and by urban-rural residency are discussed. Frequency of consumption declines as age increases in both sexes but the negative slope is more marked in females. Analysis of the results on quantity of alcohol consumed during the week prior to the interview shows that men drink more heavily than women in all age-groups and young people drink more heavily than other age-groups. The combination of data on frequency of consumption and maximum quantity of alcohol reportedly consumed on the highest drinking occasion shows that the majority of men belong to the High Frequency-Low Quantity typology, followed by High Frequency-Medium Quantity, but in women nearly 60% belong to the Low Frequency-Low Quantity typology, followed by High Frequency-Low Quantity. The highest proportions of both abstainers and heavy drinkers are found in the group of people with the lowest income.