Influence of antiviral therapy in the long-term outcome of recurrent hepatitis C virus infection following liver transplantation.

INTRODUCTION: Severity of recurrent hepatitis C virus (HCV) infection in liver transplant recipients (LTR) is variable and the influence of different factors, including the administration of antiviral therapy in the long-term outcome is controversial. METHODS: We analyzed the outcome of a cohort of HCV-infected LTR who were transplanted in our institution. Patients were divided into 2 groups (severe and non-severe HCV disease) depending on the presence of a fibrosis score of F ≥ 2 in the Scheuer index and/or fibrosing cholestasic hepatitis (FCH) in a graft biopsy. Risk factors were studied using logistic regression analysis. Survival of patients was estimated using Kaplan-Meier plots. A total of 146 patients were followed for a mean of 58 months. RESULTS: Fifty-six (34%) patients developed severe HCV disease and showed shorter survival (P < 0.024). Donor age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02-1.06) and pre-transplant viral load (VL) >10(6) UI/mL (OR: 3.5; 95% CI: 1.42-10.61) were the only factors associated with severe HCV infection. Over-immunosuppression (OR: 2.3; 95% CI: 1.2-4.41) was specifically associated with the development of FCH. Overall, patient survival in recipients who received a full course of anti-HCV therapy was higher than in patients who did not complete antiviral therapy (P = 0.004) or received no treatment (P = 0.007). Patients with non-severe HCV infection have a higher probability of receiving a full course of antiviral therapy (P = 0.033). CONCLUSION: In conclusion, donor age, pre-transplant VL, and over-immunosuppression were associated with the long-term development of severe HCV recurrence in liver grafts. Administration of a full course of antiviral therapy was associated with better survival.

Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Nosocomial infection in a neonatal intensive care unit and its prevention with selective intestinal decolonization. A multivariant evaluation of infection reduction.

A prospective cohort study in a neonatal intensive care unit (ICU) was carried out to evaluate whether the incidence of infection in neonates receiving intestinal decolonization was reduced in comparison to those who did not. This study was performed after controling possible confounding infection risk factors. A total of 536 babies were screened in our ICU during the 27-month study period. Neonates were admitted to the ICU for different reasons: low weight, respiratory distress syndrome, acute fetal suffering, surgery, etc. The doctor in charge decided whether the baby should be decolonized or not, so this experimental study was non-random. Thus more of the babies with a greater risk of infection were decolonized more often than the other babies who were not so much at risk. In this study, babies were classified by type of decolonization given: a well-performed Selective Intestinal Decolonization (SID) was done (early and with three oral drugs: E polymyxin, tobramycin and nystatin): 10.8% of the babies; Incorrect SID (was begun late and/or less than three drugs were used): 16.7% of the babies; and Without SID (72.9%). Total nosocomial infection (NI) was 11.2%, catheter-associated sepsis was 42% of the total NI. When the NI incidence was directly compared among groups, it was lower in the group without SID, but infants with decolonization initially had more infection risk factor than the first group. For this reason, multiple logistic regression was used in order to stratify factors by infection probability, and correcting the existing bias.(ABSTRACT TRUNCATED AT 250 WORDS)

[Nosocomial infection and its impact on the stay in a neonatal intensive care unit (1988-1991)]. / Infección nosocomial y su repercusión en la estancia de una unidad de cuidados intensivos neonatales (1988-1991).

BACKGROUND: Neonatal intensive care units show one of the highest frequencies of nosocomial infections (NI), specially in teaching hospitals. METHODS: The cumulative incidence and distribution of NI in a neonatal intensive care unit of a teaching hospital during three years and three months (536 children) is studied, evaluating the relation between NI and its risk factors with X2 and variance analysis and, finally, estimating the excess stays with a multiple linear regression. RESULTS: The global cumulative incidence of NI was 11% (or an incidence density of 30.7 per 100 children/month); the prevailing etiological agents were negative coagulase Staphylococcus and fungi of Candida Sp. When analyzing, according to the kind of infection, sepsis associated to catheter, stands out. The relation between the different intrinsic or extrinsic risk factors and the NI was studied as well, and it stood out that infected children suffer manipulations as: Central catheter, assisted respiration, parenteral feeding et cetera, with a greater frequency (twice as much) that of non infected children. CONCLUSIONS: The cumulative incidence of NI is moderate-low; but is is necessary to continue insisting and increasing the current control measures and on the other hand, is is necessary to calculate the excess stays, due to NI, with multivariate methods because the direct estimation produces an overestimation of that one.