Comparative evaluation of seven resistance interpretation algorithms and their derived genotypic inhibitory quotients for the prediction of 48 week virological response to darunavir-based salvage regimens.

BACKGROUND: the darunavir genotypic inhibitory quotient (gIQ) has been suggested as one of the predictors of virological response to darunavir-containing salvage regimens. Nevertheless, which resistance algorithm should be used to optimize the calculation of gIQ is still debated. The aim of our study was to compare seven different free-access resistance algorithms and their derived gIQs as predictors of 48 week virological response to darunavir-based salvage therapy in the clinical setting. METHODS: patients placed on two nucleoside reverse transcriptase inhibitors + 600/100 mg of darunavir/ritonavir twice daily  ±â€Š enfuvirtide were prospectively evaluated. Virological response was assessed at 48 weeks. Darunavir resistance interpretation was performed according to seven different algorithms, of which two were weighted algorithms. Analysis of other factors potentially associated with virological response at 48 weeks was performed. RESULTS: fifty-six treatment-experienced patients were included. Overall, 35 patients (62.5%) had a virological response at 48 weeks. Receiver operator characteristic curve analysis showed that De Meyer's weighted score (WS) and its derived gIQ (gIQ WS) were the most accurate parameters defining virological response, and related cut-offs showed the best sensitivity/specificity pattern. In univariate logistic regression analysis, baseline log viral load (P = 0.028), optimized background score ≥ 2 (P = 0.048), WS >5 (P = 0.001) and WS gIQ ≥ 600 (P < 0.0001) were independently associated with virological response. In multivariate analysis, only baseline log viral load (P = 0.008) and WS gIQ ≥ 600 (P < 0.0001) remained in the model. CONCLUSIONS: in our study, although different resistance interpretation algorithms and derived gIQs were associated with virological response, gIQ WS was the most accurate predictive model for achieving a successful virological response.

[Pain prevention in term neonates: randomized trial for three methods]. / Prevención del dolor en recién nacidos de término: estudio aleatorizado sobre tres métodos.

INTRODUCTION: Every newborn infant is screened for hypothyroidism and phenylketonuria by blood sampling, during the first week of life, but there is not a simple and efficient method to reduce pain during the procedure. OBJECTIVES: Prospective randomised trial, to assess if the administration of oral glucose, paracetamol or EMLA, given individually, can reduce the pain caused in newborns by heel prick, in an outpatient setting. METHODS: Double-blind study in which seventy six healthy newborns at term were randomly assigned to receive placebo, oral glucose, EMLA in the heel, or oral paracetamol. Heel prick was performed to get a blood sample, and pain was measured by two independent observers, using two scales (NIPS and PIPP). RESULTS: NIPS <4: placebo (9/19= 47%), glucose (16/19= 84%), paracetamol (8/19= 42%) and EMLA (12/19= 63%); PIPP <8: placebo (9/19= 47%), oral glucose (12/19= 63%), paracetamol (5/19= 26%) and EMLA (8/19= 42%). With the use of oral glucose we found RAR: 0.37 (IC 95% 0.09-0.64), RRR: 44% (IC 95% 6-67%), NNT: 2.7 (IC 95% 1.5-11). CONCLUSIONS: The best results were obtained with the use of oral glucose, being statistically significant with only one of the scales. The administration of paracetamol or EMLA did not reduce pain. Other complementary and/or combined methods, added to oral glucose, should be considered daily to diminish this painful experience in thousands of children.

Prevención del dolor en recién nacidos de término: estudio aleatorizado sobre tres métodos / Pain prevention in term neonates: randomised trial for three methods

Por norma legal, a todos los reciénnacidos se les debe extraer sangre durante los primerosdías de vida, para la pesquisa neonatal dehipotiroidismo congénito y fenilcetonuria. El procedimientode extracción supone cierto dolor parael neonato y aún no existe un método sencillo yeficaz para disminuirlo.Objetivos. Evaluar si la administración de glucosa,paracetamol o EMLA, disminuyen individualmenteel dolor en recién nacidos, provocado porpunción de talón, en un ambiente ambulatorio.Material y métodos. Estudio prospectivo y aleatorizado,a doble ciego, en el cual setenta y seis reciénnacidos de término y sanos fueron asignados arecibir placebo, glucosa por vía oral, EMLA en talóno paracetamol por vía oral. Se realizó punción detalón para extraer sangre y dos observadores independientesmidieron el dolor con dos escalas (NIPSy PIPP).La variable de resultado fue la cantidad de niñoscon valores de dolor por debajo de las cifras consideradasdolor moderado en cada grupo.Resultados. NIPS < 4: placebo (9/19= 47 por ciento), glucosa(16/19= 84 por ciento), paracetamol (8/19= 42%) y EMLA(12/19= 63%).PIPP < 8: placebo (9/19= 47 por ciento), glucosa (12/19=63 por ciento), paracetamol (5/19= 26 por ciento) y EMLA (8/19=42 por ciento).Con el uso de glucosa oral, encontramos: RAR: 0,37(IC 95 por ciento: 0,09-0,64), RRR: 44 por ciento (IC 95 por ciento: 6-67), NNT:2,7 (IC 95 por ciento 1,5-11).Conclusiones. Con el uso de la solución glucosadapor vía oral se obtuvieron los mejores resultados.Sólo con una de las escalas utilizadas fueron estadísticamentesignificativos.Con paracetamol y EMLA, no observamos disminucióndel dolor.Deberán considerarse otros métodos complementariosy combinados, junto con la glucosa, paraaliviar esta experiencia dolorosa a miles de niñosdiariamente