"Sigma Volvere" acerca del vólvulo de sigmoides, diagnóstico y manejo quirúrgico, reporte de serie de casos / "Sigma Volvere" About Sigmoid Volvulus, Diagnosis and Surgical Management. Case Series Report

Resumen Presentar la experiencia en el diagnóstico clínico-radiológico y tratamiento de vólvulo sigmoideo. Se incluyeron casos con clínica sugestiva de obstrucción intestinal secundaria a vólvulo de sigmoides. Los factores de riesgo fueron: sexo masculino, mayor estancia hospitalaria, edad mayor a 70 años y la tríada clásica. Los estudios de imagen resultaron concluyentes, siendo la radiografía de abdomen y la tomografía simple de abdomen, los de elección para el abordaje diagnóstico. El vólvulo de sigmoides tiene un patrón clínico-radiológico predecible, un examen físico minucioso y estudios de gabinete de primera línea pueden ser concluyentes. La opción terapéutica para estos pacientes fue la cirugía.

Abstract To present the experience in clinical/radiological diagnosis and treatment of sigmoid volvulus. Cases with symptoms suggestive of intestinal obstruction secondary to sigmoid volvulus were included. The risk factors were: male sex, longer hospital stay, age over 70 years and the classic triad. Imaging studies were conclusive, with abdominal radiography and simple abdominal tomography being the tests of choice for the diagnostic approach. Sigmoid volvulus has a predictable clinical-radiological pattern, a thorough physical examination and first-line cabinet studies can be conclusive. The therapeutic option for these patients was surgery.

[Costs and cost-efficacy analysis of the preferred treatments by GESIDA/National Plan for AIDS for the initial antiretroviral therapy in adult human immunodeficiency virus (HIV) infected patients in 2012]. / Análisis de costes y de coste/eficacia de las pautas preferentes de GESIDA/Plan Nacional sobre el Sida en 2012 para el tratamiento antirretroviral inicial en adultos infectados por el virus de la inmunodeficiencia humana (VIH).

INTRODUCTION: The GESIDA and National AIDS Plan panel of experts propose «preferred regimens¼ of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2012. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these «preferred regimens¼. METHODS: Economic assessment of costs and efficiency (cost/efficacy) using decision tree analysis model. Efficacy was defined as the probability of having a viral load <50 copies/ml at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and all its consequences (adverse effects, changes of ART regime, and drug resistance analyses) during the first 48 weeks. The perspective of the analysis is that of the National Health System, considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance and determination of HLA B 5701. The setting is Spain and the costs are those of 2012. A sensitivity deterministic analysis was conducted, building three scenarios for each regime: baseline, most favourable, and most unfavourable cases. RESULTS: In the baseline case scenario, the cost of initiating treatment ranges from 6,895 euros for TDF/FTC+NVP to 12,067 euros for TDF/FTC+RAL. The efficacy ranges between 0.66 for ABC/3TC+LPV/r and 0.87 for TDF/FTC+RAL. Efficiency, in terms of cost/efficacy, varies between 9,387 and 13,823 euros per responder at 48 weeks, for TDF/FTC/EFV and TDF/FTC+RAL, respectively. In the most unfavourable scenario, the most efficient regime is TDF/FTC+NVP (9,742 per responder). CONCLUSION: Considering the official prices of ART, the most efficient regimens are TDF/FTC/EFV (baseline case and most favourable scenarios), and TDF/FTC+NVP (most unfavourable scenario).

[Secondary effects associated with raltegravir]. / Efectos secundarios asociados al raltegravir.

Integrase inhibitors are a new therapeutic modality against HIV. Raltegravir is the first integrase inhibitor to have been approved by the health authorities for human use. This drug acts by inhibiting the HIV enzyme that catalyzes integration of the virus inside the genome of the host cell. In the host cell, there is no homologue to viral integrase and consequently the potential toxicity of this drug is probably low. The results of safety studies in animal models have shown that the recommended dose in humans is lower than the dose below which no secondary effects are observed. Studies of genotoxicity and carcinogenicity, as well as of fertility and embryo development, have been negative to date. During clinical trials, raltegravir has been shown to have a very good safety profile, with few adverse effects, which were mild-to-moderate and similar to those of the comparator. The most notable were diarrhea, nausea and headache. The lipid profile of raltegravir was better than that of efavirenz. In view of the above, the risk-benefit ratio for raltegravir is positive.