[Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain]. / Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.

AIM: To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. PATIENTS AND METHODS: Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. RESULTS: 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. CONCLUSIONS: Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high.

TITLE: Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.Objetivo. Determinar el perfil clinico, el manejo del tratamiento anticoagulante y la satisfaccion relacionada con la anticoagulacion en pacientes con fibrilacion auricular no valvular atendidos en consultas de neurologia o medicina interna de España. Pacientes y metodos. Estudio prospectivo, transversal y multicentrico en el que se incluyo a 1.337 pacientes, que completaron los cuestionarios Anti-Clot Treatment Scale, Self-Assessment of Treatment Questionnaire y EuroQol-5 dimensions. Resultados. 865 pacientes (64,7%) provenian de consultas de neurologia, y 472 (35,3%), de medicina interna. Los atendidos en medicina interna eran mayores, tenian mas hipertension, diabetes, insuficiencia cardiaca, insuficiencia renal y arteriopatia periferica. Los pacientes atendidos en neurologia tenian mas antecedentes de ictus. Globalmente, la escala CHADS2 fue 3,2 ± 1,3; CHA2DS2Vasc, 4,8 ± 1,5, y HAS-BLED, 2,0 ± 0,9, y las puntuaciones mas altas fueron en neurologia. El 56,1% tomaba antagonistas de la vitamina K, lo que era mas comun en medicina interna. El porcentaje de tiempo en rango terapeutico adecuado fue del 47% (Rosendaal), sin diferencias entre los grupos. La satisfaccion con el tratamiento anticoagulante oral fue elevada en ambos grupos, aunque mayor en los sujetos atendidos en neurologia, y mayor con los anticoagulantes orales de accion directa que con los antagonistas de la vitamina K. Conclusiones. Aunque existieron ciertas diferencias en el perfil clinico de los pacientes con fibrilacion auricular atendidos en neurologia o medicina interna, todos presentaban multiples comorbilidades y un riesgo tromboembolico elevado. A pesar de que el control del indice internacional normalizado fue pobre, el anticoagulante oral mas empleado fueron los antagonistas de la vitamina K. La satisfaccion con el tratamiento anticoagulante oral fue alta.

[Nosocomial respiratory viral infection]. / Infección viral respiratoria nosocomial.

Nosocomial viral infections have not been well studied. In this context, the aim of this work is to review epidemiological and therapeutic data published on the main viral agents that can produce nosocomial respiratory infection. The study thus aims to expand knowledge of behaviour of these agents in nosocomial infections and provide information to improve the implementation of preventive measures. The concepts of mimivirus, herpes simplex virus, varicella-zoster virus, cytomegalovirus, respiratory syncytial virus, parainfluenza virus, influenza virus, adenovirus, metapneumovirus and measles viruses are discussed in detail.

Efficacy of intravenous thrombolysis according to stroke subtypes: the Madrid Stroke Network data.

OBJECTIVES: To identify possible differences in the early response to intravenous thrombolysis (IVT) or in stroke outcome at 3 months, based on stroke subtype in patients with acute ischaemic stroke (IS). METHODS: Multicentre stroke registry data were used, with prospective inclusion of consecutive patients with acute IVT-treated IS in five acute stroke units. We compared clinical improvement (National Institutes of Health Stroke Scale, NIHSS) at 24 h and at day 7 as well as functional outcome at 3 months (Modified Rankin Scale, mRS) amongst the different stroke subtypes (ICD-10). RESULTS: In total, 1479 patients were included; 178 (12%) had large vessel disease (LVD) with carotid stenosis ≥ 50%, 175 (11.8%) had other LVD, 638 (43%) had cardioembolism, 60 (4.1%) had lacunar infarction, 72 (4.9%) were patients with IS of other/unusual cause and 356 (24.1%) had unknown/multiple causes. Patients with lacunar infarction had lower stroke severity (median NIHSS 6) whilst cardioembolic IS was the most severe (median NIHSS 14) (P < 0.001). No differences in NIHSS improvement were found at 24 h. LVD patients with carotid stenosis (odds ratio 0.544; 95% CI 0.383-0.772; P = 0.001) were less likely to improve at day 7 after adjustment for age, gender, vascular risk factors and stroke severity. However, adjusted multivariate analysis showed no influence of stroke subtype on stroke outcome (mRS) at 3 months. Age, systolic blood pressure on admission and stroke severity were independently associated with mRS > 2 at 3 months. CONCLUSION: Although LVD patients with arterial stenosis ≥ 50% improve less than the other aetiologies at day 7, stroke aetiological subtype does not determine differences in IS outcome at 3 months after IVT.

[Glomerulopathies associated to HIV infection: a Spanish perspective]. / Glomerulopatías asociadas a la infección por VIH una perspectiva española.

UNLABELLED: HIV nephropathy (HIVAN) is the most frequent cause of chronic renal failure in HIV-infected black patients. However, the prevalence of other glomerulopathies mediated by immunocomplexes has increased in the last years. We report on the glomerular diseases observed in HIV patients in our Hospital. METHODS: A retrospective study of all patients with HIV infection and glomerular diseases diagnosed by renal biopsy. RESULTS: We found 27 patients with the following glomerular diseases: membranoproliferative glomerulonephritis (MPGN) in 8 patients, non-collapsing focal segmental glomerulosclerosis (FSGS) in 7, IgA nephropaty (IgA N) in 6, collapsing glomerulosclerosis in 4 (HIVAN, and membranous nephropaty (MN) in 2. Most of patients were young white men. A high prevalence of coinfection with hepatitis C virus (HCV) (77.8%) and hepatitis B virus (HBV) (37%) was found. At diagnosis, most of patients (90%) had proteinuria, with nephrotic syndrome in 52% of them; 59% presented with acute renal failure. Nine patients (33%) showed malignant hypertension at diagnosis: this complication was particularly common among IgA N patients (4/6, 66%). CONCLUSION: In our Hospital, immunocomplex-mediated glomerulonephritis were more frequent than HIVAN among HIV-infected patients. HCV-associated MPGN was the most frequently detected glomerular disease. A high prevalence of malignant hypertension was observed at diagnosis, particularly among patients with IgAN.

Glomerulopatías asociadas a la infección por VIH una perspectiva española / Glomerulopathies associated to HIV infection: a spanish perspective

La nefropatía asociada al VIH (HIVAN) es la causa más común de insuficiencia renal crónica en los pacientes VIH de raza negra. Sin embargo, en los últimos años la prevalencia de otras glomerulopatías asociadas a inmunocomplejos ha ido en aumento. Nuestro estudio describe la patología glomerular en los pacientes VIH de nuestro centro. Material y métodos: estudio retrospectivo de pacientes VIH con afectación glomerular confirmada mediante biopsia renal. Resultados: Se detectaron 27 pacientes en los que se habían diagnosticado las siguientes glomerulopatías: glomerulonefritis membranoproliferativa (GNMP) en 8, glomeruloesclerosis focal y segmentaria no colapsante (GSF) en 7, nefropatía mesangial IgA (GNIgA) en 6, glomeruloesclerosis colapsante (HIVAN) en 4 y glomerulonefritis membranosa (GNM) en 2. La mayoría de los casos eran varones jóvenes de raza blanca. Destaca una alta coinfección con el virus de la hepatitis C (VHC) (77,8%) y con el virus de la hepatitis B (VHB) (37%). En el momento del diagnóstico la mayoría de los pacientes presentaba proteinuria (96%), con síndrome nefrótico en el 52% de los casos, y un 59% presentaba un deterioro agudo de la función renal. Nueve pacientes (33%) presentaron HTA maligna al diagnóstico, siendo particularmente frecuente esta complicación entre los pacientes con GNIgA (4/6, 66%). Conclusiones: las glomerulopatías más frecuentes en nuestra población VIH son las asociadas a inmunocomplejos, sobre todo la GNMP asociada a la infección por el VHC. La HTA maligna tiene una alta incidencia en los pacientes VIH, más marcada en los pacientes con nefropatía mesangial IgA

HIV nephropathy (HIVAN) is the most frequent cause of chronic renal failure in HIV-infected black patients. However, the prevalence of other glomerulopathies mediated by immunocomplexes has increased in the last years. We report on the glomerular diseases observed in HIV patients in our Hospital. Methods: A retrospective study of all patients with HIV infection and glomerular diseases diagnosed by renal biopsy. Results: We found 27 patients with the following glomerular diseases: membranoproliferative glomerulonephritis (MPGN) in 8 patients, non-collapsing focal segmental glomerulosclerosis (FSGS) in 7, IgA nephropaty (IgA N) in 6, collapsing glomerulosclerosis in 4 (HIVAN, and membranous nephropaty (MN) in 2. Most of patients were young white men. A high prevalence of coinfection with hepatitis C virus (HCV) (77.8%) and hepatitis B virus (HBV) (37%) was found. At diagnosis, most of patients (90%) had proteinuria, with nephrotic syndrome in 52% of them; 59% presented with acute renal failure. Nine patients (33%) showed malignant hypertension at diagnosis: this complication was particularly common among IgA N patients (4/6, 66%).Conclusion: In our Hospital, immunocomplex-mediated glomerulonephritis were more frequent than HIVAN among HIV-infected patients. HCV-associated MPGN was the most frequently detected glomerular disease. A high prevalence of malignant hypertension was observed at diagnosis, particularly among patients with IgAN

Anti-CD25 monoclonal antibody sequential immunosuppressive induction therapy in renal transplants with high risk of delayed graft function.

There is little experience on the use of monoclonal antibodies that block the high-affinity interleukin-2 receptor (basiliximab and daclizumab) in sequential therapy in renal transplants with risk of delayed graft function. This study sougth to test the efficacy and safety of the substitution of anticalcineurins with two doses of basiliximab or daclizumab in the immediate posttransplant period for recipients at risk of delayed renal graft function. Immunosuppression consisted of steroids, mycophenolate mofetil, and two doses of basiliximab (20 mg/day) on days 0 and 4 posttransplant or daclizumab (1 mg/kg per day) on days 0 and 15 posttransplant. Anticalcineurins were not administered until the beginning of graft function. Among 49 recipients (mean age 63.5 +/- 10.5 years), 40 received a kidney from a donor over 60 years of age, three from a non-heart-beating donor, and six from donors with an acute elevation of serum creatinine to 2.4 +/- 0.86 (1.7-3.7). At a mean follow-up of 14.2 +/- 8.4 months, five patients experienced acute rejection episodes. Only 15 patients needed posttransplant dialysis (2.7 +/- 1.6). In 11 patients, cyclosporine (CsA) was introduced at 6 +/- 2.9 days posttransplant and in 37, tacrolimus on 8.6 +/- 3.6 days posttransplant. The incidence of kidney graft loss was 16.3%. Patient survival was 96%. Thirty-nine recipients are alive with functioning grafts, with mean serum creatinine of 1.4 mg/dL. In conclusion, substitution for anticalcineurins with interleukin-2-receptor blockade in the immediate posttransplant period for patients at risk of delayed graft function minimizes nephrotoxicity and reduces tubular necrosis, without increasing the risk of an acute rejection episode.