ABSTRACT
BACKGROUND: Evidence regarding the implementation of medium-term strategies in advanced hybrid closed-loop (AHCL) system users is limited. Therefore, this study aimed to describe the efficacy and safety of the AHCL system in patients with type 1 diabetes (T1D) on a six-month follow-up in a virtual diabetes clinic (VDC). METHOD: A prospective cohort of adult patients with T1D treated using the AHCL system (Mini Med 780G; Medtronic, Northridge, California) in a VDC follow-up. Standardized training and follow-up were conducted virtually. Clinical data and metabolic control outcomes were reported at baseline, and at three and six months. RESULTS: Sixty-four patients (mean age = 42 ± 14.6 years, 65% men, 54% with graduate education) were included. Percentage time in range (%TIR) increased significantly regardless of prior therapy with intermittently scanned continuous glucose monitoring + multiple daily injections and sensor-augmented pump therapy with predictive low-glucose management after starting AHCL and persisted during the follow-up period with no hypoglycemic events. The %TIR 70 to 180 mg/dL according to socioeconomic strata was 73.4% ± 5.3%, 78.1% ± 8.1%, and 84.2% ± 7.5% for the lower, middle, and upper strata, respectively. The sensor was used more frequently in the population with a higher education level. Adherence to sensor use and SmartGuard retention were higher in patients who underwent the VDC follow-up. CONCLUSIONS: Medium-term follow-up of users of AHCL systems in a VDC contributes to safely achieving %TIR goals. Virtual diabetes clinic follow-up favored adherence to sensor use and continuous SmartGuard use. Socioeconomic strata were associated with a better glycemic profile and education level was associated with better adherence to sensor use.
ABSTRACT
Outstanding health care institutions around the world lead, in effect, by setting an example and keeping hospital-acquired infections to a minimum. Behind the apparent simplicity of an indicator hides an enormous complexity. We believe that the difficulty in achieving seemingly simple benchmarks stems from the necessity to perform optimally at different levels of the organization consistently. This challenge can be summarized in a word: alignment. Institutional alignment starts with the mission and must be ubiquitous. Achieving the benchmark illustrates the elusive trait of institutional coherence. We will describe the dimensions and levels at our institution that influence our ability to strive for better indicators in the prevention of nosocomial infections, examine some of the difficulties and provide a few examples of success.
Subject(s)
Cross Infection/prevention & control , Hospital Administration , Safety Management/organization & administration , Benchmarking , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Cross Infection/epidemiology , Humans , Organizational Objectives , Planning Techniques , Pneumonia, Ventilator-Associated/epidemiologyABSTRACT
Raltegravir as initial HIV therapy was examined in a double-blind study; 160 patients were randomized to raltegravir (400 mg bid after dose-ranging), 38 to efavirenz, both with tenofovir/lamivudine. At week 240, HIV-RNA remained <50 copies per milliliter in 68.8% (raltegravir) versus 63.2% (efavirenz), and CD4 increases were 302 versus 276 cells per microliter, respectively. Early HIV-RNA decline predicted later CD4 increases in both groups. Raltegravir resistance was observed in 3 of 10 raltegravir recipients with virologic failure. Few drug-related adverse events were reported after week 48. Raltegravir had minimal effect on laboratory values, including lipids. Raltegravir with tenofovir/lamivudine showed durable efficacy and good tolerability over 5 years.
Subject(s)
Anti-Retroviral Agents/administration & dosage , Anti-Retroviral Agents/adverse effects , HIV Infections/drug therapy , HIV-1/isolation & purification , Pyrrolidinones/administration & dosage , Pyrrolidinones/adverse effects , Adult , Aged , Antiretroviral Therapy, Highly Active/adverse effects , Antiretroviral Therapy, Highly Active/methods , CD4 Lymphocyte Count , Double-Blind Method , Drug-Related Side Effects and Adverse Reactions/epidemiology , Female , HIV Infections/virology , Humans , Male , Middle Aged , RNA, Viral/blood , Raltegravir Potassium , Treatment Outcome , Viral LoadABSTRACT
OBJECTIVES: The purpose of this study was to evaluate the safety and efficacy of raltegravir vs efavirenz-based antiretroviral therapy after 96 weeks in treatment-naive patients with HIV-1 infection. METHODS: Multicenter, double-blind, randomized study of raltegravir (100, 200, 400, or 600 mg twice a day) vs efavirenz (600 mg every day), both with tenofovir/lamivudine (TDF/3TC), for 48 weeks, after which raltegravir arms were combined and all dosed at 400 mg twice a day. Eligible patients had HIV-1 RNA > or =5000 copies per milliliter and CD4 T cells > or =100 cells per microliter. RESULTS: One hundred ninety-eight patients were randomized and treated; 160 received raltegravir and 38 received efavirenz. At week 96, 84% of patients in both groups achieved HIV-1 RNA <400 copies per milliliter; 83% in the raltegravir group and 84% in the efavirenz group achieved <50 copies per milliliter (noncompleter = failure). Both groups showed similar increases in CD4 T cells (221 vs 232 cells/uL, respectively). An additional 2 patients (1 in each group) met the protocol definition of virologic failure between weeks 48 and 96; no known resistance mutations were observed in the raltegravir recipient; the efavirenz recipient had nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor resistance mutations. Investigator reported drug-related clinical adverse events (AEs) were less frequent with raltegravir (51%) than efavirenz (74%). Drug-related AEs occurring in >10% of patients in either group were nausea in both groups and dizziness and headache in the efavirenz group. Laboratory AEs remained infrequent. Raltegravir had no adverse effect on total or low-density lipoprotein cholesterol or on triglycerides. Neuropsychiatric AEs remained less frequent with raltegravir (34%) than efavirenz (58%). There were no drug-related serious AEs in patients receiving raltegravir. CONCLUSIONS: In antiretroviral therapy-naive patients, raltegravir with TDF/3TC had potent antiretroviral activity, which was similar to efavirenz/TDF/3TC and was sustained to week 96. Raltegravir was generally well tolerated; drug-related AEs were less frequent in patients treated with raltegravir compared with efavirenz.
Subject(s)
Anti-HIV Agents/administration & dosage , Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV-1 , Pyrrolidinones/administration & dosage , Pyrrolidinones/therapeutic use , Alkynes , Anti-HIV Agents/adverse effects , Benzoxazines/administration & dosage , Benzoxazines/adverse effects , Benzoxazines/therapeutic use , Cyclopropanes , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Humans , Pyrrolidinones/adverse effects , Raltegravir PotassiumABSTRACT
Introducción: la tigeciclina, el primer representante el grupo de las glicilciclinas, nueva clase de antibióticos, ha sido recientemente introducida en Colombia y no se disponen aún de datos en el país de su actividad in vitro. Objetivo: evaluar la actividad in vitro de la tigeciclina contra aislamientos clínicos de pacientes hospitalizados en tres hospitales colombianos de tercer nivel. Materiales y métodos: los aislamientos de bacterias aerobias y anaerobias facultativas de pacientes hospitalizados de tres centros de alta complejidad fueron remitidos a un laboratorio de referencia para la determinación de la concentración inhibitoria mínima (CIM) por el método de microdilución en caldo para la tigeciclina y otros antibióticos. Para los puntos de corte se utilizaron los criterios de interpretación de la CLSI 2006 y para la tigeciclina sugeridos por la FDA. Resultados: la susceptibilidad a la tigeciclina de las cepas evaluadas y sus respectivas CIM50-90 fueron las siguientes: Staphylococcus aureus (n=78), 100 por ciento, 0,12 y 0,12 mg/L; Streptococcus pneumoniae (n=24)100 por ciento, 0,015 y 0,5 mg/L; Streptococcus agalactiae (n=10), 100 por ciento, 0,03 y 0,06 mg/L; Enterococcus spp. (n=43) 100 por ciento, 0,06 y 0,12 mg/L; Klebsiella pneumoniae (n=56), 96,4 por ciento, 0,5 y 1 mg/L; Klebsiella oxytoca (n=15), 93,3 por ciento, 0,25 y 2 mg/L; Escherichia coli (n=89) 100 por ciento, 0,12 y 0,5 mg/L; Enterobacter cloacae (n=48), 100 por ciento, 0,5 y 2 mg/L; Serratia marscescens (n=42) 96,2 por ciento, 0,5 y 2 mg/L. ParaHaemophilus influenza (n=15) y Acinetobacter baumannii (n=36), que no tienen puntos de corte definidos, las CIM50-90 fueron 0,06 y 0,12 y 0,5 y 2 mg/L, respectivamente. El 100 por ciento de los aislamientos productores de beta-lactamasas de espectro extendido de Escherichia coli (n=18) y el 94,4 por ciento de los de Klebsiella pneumoniae (n=18) fueron susceptibles a tigeciclina. Las CIM50-90 para Pseudomonas aeruginosa (n=63) fueron 8 y 16 mg/L...
Subject(s)
Humans , Bacteria, Aerobic/isolation & purification , Bacteria, Aerobic , Bacteria, Anaerobic/isolation & purification , Bacteria, Anaerobic , Glycylglycine/therapeutic use , In Vitro Techniques , PatientsABSTRACT
BACKGROUND: Raltegravir is an HIV-1 integrase strand-transfer inhibitor with potent in vitro activity. This study explored the antiretroviral activity and safety of raltegravir in treatment-naive patients with plasma HIV-1 RNA levels > or = 5000 copies/mL and CD4 T-cell counts > or = 100 cells/mm. METHODS: Multicenter, double-blind, randomized, controlled study of raltegravir at doses of 100, 200, 400, and 600 mg twice daily versus efavirenz at a dose of 600 mg/d, all in combination with tenofovir at a dose of 300 mg/d and lamivudine at a dose of 300 mg/d (clinicaltrials.gov identifier: NCT00100048). RESULTS: In the 198 patients treated (160 on raltegravir and 38 on efavirenz), the mean HIV-1 RNA level ranged from 4.6 to 4.8 log10 copies/mL at baseline. At weeks 2, 4, and 8, the proportion of patients achieving an HIV-1 RNA level <50 copies/mL was greater in each of the raltegravir treatment groups than in the efavirenz group. By week 24, all treatment groups appeared similar, with plasma HIV-1 RNA levels <400 copies/mL in 85% to 98% of patients and <50 copies/mL in 85% to 95% of patients. These reductions were maintained through week 48 in 85% to 98% of patients and in 83% to 88% of patients, respectively. Five (3%) patients on raltegravir and 1 (3%) on efavirenz experienced virologic failure before week 48. Drug-related clinical adverse events were less common with raltegravir than with efavirenz. After 24 and 48 weeks of treatment, raltegravir did not result in increased serum levels of total cholesterol, low-density lipoprotein cholesterol, or triglycerides. CONCLUSIONS: Raltegravir at all doses studied was generally well tolerated in combination with tenofovir and lamivudine. Raltegravir exhibited potent and durable antiretroviral activity similar to that of efavirenz at 24 and 48 weeks but achieved HIV-1 RNA levels below detection at a more rapid rate.
Subject(s)
HIV Infections/drug therapy , HIV Integrase Inhibitors/therapeutic use , HIV-1 , Organic Chemicals/therapeutic use , Adenine/analogs & derivatives , Adenine/therapeutic use , Adolescent , Adult , Aged , Australia , Canada , Double-Blind Method , Drug Administration Schedule , Drug Therapy, Combination , Female , HIV Infections/virology , HIV Integrase Inhibitors/administration & dosage , HIV-1/genetics , HIV-1/isolation & purification , Humans , Lamivudine/therapeutic use , Latin America , Male , Middle Aged , Organophosphonates/therapeutic use , Pyrrolidinones , RNA, Viral/blood , Raltegravir Potassium , Tenofovir , Thailand , Time Factors , Treatment Outcome , United StatesABSTRACT
Se presenta un caso de enfermedad de Caroli, que se ha complicado con colangitis a repetición y bacteremia. Se plantea la posibilidad del drenaje repetido de la via biliar por medio de la endoscopia retrógrada como una alternativa para reducir los episodios de colangitis, y mitigar por ende el daño hepático progresivo. Se revisa la literatura pertinente de una enfermedad poco común, cuyo diagnóstico se hace a veces demasiado tarde y se presta a confusión con otras anomalías estructurales hepáticas y del árbol biliar.
Subject(s)
Humans , Male , Caroli Disease/diagnosis , Caroli Disease/etiology , Liver Cirrhosis, Biliary , Cholangiopancreatography, Endoscopic Retrograde , Biliary Tract Diseases/diagnosisABSTRACT
Sir William Osler decía que los pacientesusualmente fallecen de las complicaciones de suenfermedad, antes que de la enfermedad misma.Nada mejor que esta frasese acomoda al síndromede respuesta inflamatoria aguda sistémica (SRIS) ya su consecuencia, la falla orgánica múltiple (FOM).Las dos son causantes actualmente de la mayoríade las muertes de las unidades de cuidado intensivono coronarias, con tasas de mortalidad superioresal 50% (1 -4). El deterioro progresivo de la funciónorgánica aparece con frecuencia en los pacientesque están críticamente enfermos, politraumatizadoso infectados y constituye un problema muy complejocuyos intricados cambios fisiopatológicos apenascomienzan a establecerse con certeza.
Subject(s)
Systemic Inflammatory Response Syndrome , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/metabolismABSTRACT
Presentamos tres casos de endocarditis por Streptococcus pneumoniae,entidad poco frecuente pero de comportamiento agresivo pues el germen destruye rápidamente el sistema valvular ocasionando deterioro hemodimánico y sepsis progresiva. Llama la atención los antecedentes de trauma tegumentario,tratamiento dental ó esplenectomía en los pacientes que desarrolla infección valvular por neumococo.
Subject(s)
Humans , Endocarditis, Bacterial/classification , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/epidemiology , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/mortality , Endocarditis, Bacterial/pathology , Endocarditis, Bacterial/physiopathology , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/therapy , Endocarditis, Bacterial/transmission , Streptococcus pneumoniae/pathogenicityABSTRACT
Se revisaron las historias clínicas de todos los pacientes vistos en la Fundación Santa Fe de Bogotá, con el diagnóstico de infección por el virus de inmunodeficiencia humana tipo 1 (VIH-1), entre enero 1 de 1984 y marzo 31 de 1992. Se estudió un total de 244 pacientes; de ellos 235 (96.3 por ciento) eran hombres, de los cuales 79.6 por ciento eran homosexuales y 1.7 por ciento hemofílicos. El total de la nueve mujeres adquirió la infección por contacto sexual, mientras que dos de los hombres eran drogadictos endovenosos (un homosexual y un heterosexual). La edad promedio de los pacientes era 34 años (7-83 años). Se encontró significativa la estrecha relación entre el conteó de células CD4 y la presencia de varias infecciones (P. carinii, C. albicans y T. gondii). De otra parte, el sarcoma de Kaposi, que era el tumor maligno más común, y la dermatitis seborréica presentaron un recuento de células CD4 superior a 500. Se discuten estos y otros hallazgos
Subject(s)
Humans , HIV-1/isolation & purification , HIV-1/pathogenicityABSTRACT
Se presenta una revisión del "Estado del Arte" en profilaxis antibíotica en cirugía cardivascular con circulación extracorporea. Se analizaron varios regimenes antibíoticos y se concluye que lo mejor es el uso de antibíoticos del espectro reducido y por tiempo limitado