Citomegalovirus asociado a úlcera gástrica: caso clínico y revisión de la literatura / Cytomegalovirus associated with gastric ulcer: case report and literature review

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Enteropatía sprue-like en ancianos tratados con olmesartán / Sprue-like enteropathy in the elderly treated with olmesartan

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Abscesos hepáticos y cuerpo extraño en el antro gástrico / Liver abscesses and a foreign body in the antrum of the stomach

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Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.

AIM: To determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units. METHODS: A cross-sectional multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index was<60 or Pfeiffer questionnaire ≥ 3 errors. RESULTS: 471 polypathological patients, 337 from internal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p=.01), digestive (8.3% vs 3.0%; p=.04) and oncohematological diseases (30.2% vs 18.8%; p=.01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; p<.001) and locomotive ones (39.1% vs 20.4%; p<.001) in geriatrics inpatients. Charlson index was higher for internal medicine inpatients [4.0(2.1) vs 3.5(2.1); p=.04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); p<.001], and lower in Barthel [38.8(32.5) vs 61.2(34.3); p=.001] and Lawton-Brody indexes [0.9(1.6) vs 3.0(2.9); p<.001], and more frequently needed a caregiver (87.8% vs 53.6%; p<.001) and had it. CONCLUSIONS: There are differences in disease profile and functional and cognitive situation between polypathological patients of internal medicine and geriatrics departments.

Darunavir en pacientes avanzados con multirresistencias. Estudios POWER, DUET y BENCHMRK / Darunavir in patients with advanced HIV and multiresistance. The POWER, DUET and BENCHMRK studies

Darunavir (DRV) es un nuevo inhibidor de proteasa (IP)muy activo frente a cepas del virus de la inmunodeficienciahumana (VIH) salvajes y multirresistentes, que se unefirmemente a la proteasa del VIH-1, presenta una potenteafinidad por la proteasa, y potenciado con una dosissubterapéutica de ritonavir tiene un perfil de resistenciasfavorable y no coincidente con los IP actuales.En los ensayos clínicos en fase IIb (estudios POWER 1 y 2),tras determinar la dosis óptima, se observó su graneficacia virológica e inmunológica muy superior a la de losIP con los que se comparó. Los resultados del estudio enfase III (POWER 3) ratifican de nuevo la eficacia y seguridadde DRV, y los 3 estudios POWER demuestran su elevadabarrera genética frente a las mutaciones que confierenresistencias a otros IP, aunque la sensibilidad basal de DRVy las mutaciones específicas a este IP influyen en surespuesta virológica.Se ha demostrado que cuando hay 2 o másantirretrovirales activos frente al VIH conmultirresistencias se obtienen mejores respuestasterapéuticas. En los estudios en fase III (DUET 1 y DUET 2)en los que se administra junto con un nuevo inhibidor de latranscriptasa inversa, la etravirina, se observa que si seadministran estos 2 fármacos en pacientes con altaexperiencia en el tratamiento antirretroviral puedeconseguirse, en una elevada proporción de casos, lasupresión de la viremia plasmática y la recuperacióninmunológica. Estos datos se ratifican con los resultadosde los estudios BENCHMRK, en los que el DRV estabaincluido en el tratamiento optimizado en un importantenúmero de pacientes. En estos ensayos se observó quecuando se administraba con el inhibidor de la integrasa, elraltegravir, la indetectabilidad tanto en la rama delraltegravir como en la del control mejoraba de formaimportante respecto a los resultados globales de la rama control(AU)

Darunavir is a new protease inhibitor. This drug is highlyactive against wild-type and multiresistant HIV strains, bindsstrongly to the HIV-1 protease, has extremely high affinityfor the protease and, when enhanced by subtherapeuticdoses of ritonavir, has a favorable resistance profile differingfrom that of current protease inhibitors (PIs).After determining the optimal dose, phase IIb clinical trials(POWER studies 1 and 2) observed much higher virologicaland immunological efficacy with darunavir than with thecomparator PIs. The results of a phase III clinical trial(POWER 3) provide further support for the safety andefficacy of darunavir, and the three POWER studiesdemonstrate the high genetic barrier of this drug againstmutations conferring resistance to other PIs, although thebaseline sensitivity of darunavir and the specific mutationsto this PI influence the virological response.Better therapeutic responses have been obtained whenthere are two or more antiretroviral drugs active againstmultiresistant HIV strains. The phase III trials (DUET 1 and2), in which darunavir was administered with the new nonnucleosidereverse transcriptase inhibitor, etravirine, foundthat if these two drugs were administered in highlytreatment-experienced patients, a large percentageshowed suppression of plasma viremia and immunologicalrecovery. These data have been supported by the resultsof the BENCHMARK studies, in which darunavir wasincluded in an optimized regimen in a substantial numberof patients. In these trials, when darunavir wasadministered with the integrase inhibitor, raltegravir,undetectable viral loads both in the raltegravir arm and inthe control group were substantially improved withrespect to the overall results obtained in the control group(AU)

Darunavir en pacientes avanzados con multirresistencias. Estudios POWER, DUET y BENCHMRK / Darunavir in patients with advanced HIV and multiresistance. The POWER, DUET and BENCHMRK studies

Darunavir (DRV) es un nuevo inhibidor de proteasa (IP)muy activo frente a cepas del virus de la inmunodeficiencia humana (VIH) salvajes y multirre-sistentes, que se une firmemente a la proteasa del VIH-1, presenta una potente afinidad por la proteasa, y potenciado con una dosis subterapéutica de ritonavir tiene un perfil de resistencias favorable y no coincidente con los IP actuales. En los ensayos clínicos en fase IIb (estudios POWER 1 y 2), tras determinar la dosis óptima, se observó su gran eficacia virológica e inmunológica muy superior a la de los IP con los que se comparó. Los resultados del estudio en fase III (POWER 3) ratifican de nuevo la eficacia y seguridadde DRV, y los 3 estudios POWER demuestran su elevadabarrera genética frente a las mutaciones que confierenresistencias a otros IP, aunque la sensibilidad basal de DRV y las mutaciones específicas a este IP influyen en surespuesta virológica.Se ha demostrado que cuando hay 2 o másantirretrovirales activos frente al VIH conmultirresistencias se obtienen mejores respuestasterapéuticas. En los estudios en fase III (DUET 1 y DUET 2) en los que se administra junto con un nuevo inhibidor de la transcriptasa inversa, la etravirina, se observa que si se administran estos 2 fármacos en pacientes con alta experiencia en el tratamiento antirretroviral puedeconseguirse, en una elevada proporción de casos, lasupresión de la viremia plasmática y la recuperacióninmunológica. Estos datos se ratifican con los resultadosde los estudios BENCHMRK, en los que el DRV estabaincluido en el tratamiento optimizado en un importantenúmero de pacientes. En estos ensayos se observó quecuando se administraba con el inhibidor de la integrasa, el raltegravir, la indetectabilidad tanto en la rama delraltegravir como en la del control mejoraba de formaimportante respecto a los resultados globales de la ramacontrol

Darunavir is a new protease inhibitor. This drug is highly active against wild-type and multiresistant HIV strains, binds strongly to the HIV-1 protease, has extremely high affinity for the protease and, when enhanced by subtherapeutic doses of ritonavir, has a favorable resistance profile differing from that of current protease inhibitors (PIs). After determining the optimal dose, phase IIb clinical trials (POWER studies 1 and 2) observed much higher virological and immunological efficacy with darunavir than with thecomparator PIs. The results of a phase III clinical trial (POWER 3) provide further support for the safety and efficacy of darunavir, and the three POWER studiesdemonstrate the high genetic barrier of this drug againstmutations conferring resistance to other PIs, although the baseline sensitivity of darunavir and the specific mutations to this PI influence the virological response.Better therapeutic responses have been obtained whenthere are two or more antiretroviral drugs active againstmultiresistant HIV strains. The phase III trials (DUET 1 and 2), in which darunavir was administered with the new nonnucleoside reverse transcriptase inhibitor, etravirine, found that if these two drugs were administered in highly treatment-experienced patients, a large percentage showed suppression of plasma viremia and immunological recovery. These data have been supported by the results of the BENCHMARK studies, in which darunavir was included in an optimized regimen in a substantial number of patients. In these trials, when darunavir was administered with the integrase inhibitor, raltegravir, undetectable viral loads both in the raltegravir arm and in the control group were substantially improved with respect to the overall results obtained in the control group

[Darunavir in patients with advanced HIV and multiresistance. The POWER, DUET and BENCHMRK studies]. / Darunavir en pacientes avanzados con multirresistencias. Estudios POWER, DUET y BENCHMRK.

Darunavir is a new protease inhibitor. This drug is highly active against wild-type and multiresistant HIV strains, binds strongly to the HIV-1 protease, has extremely high affinity for the protease and, when enhanced by subtherapeutic doses of ritonavir, has a favorable resistance profile differing from that of current protease inhibitors (PIs). After determining the optimal dose, phase IIb clinical trials (POWER studies 1 and 2) observed much higher virological and immunological efficacy with darunavir than with the comparator PIs. The results of a phase III clinical trial (POWER 3) provide further support for the safety and efficacy of darunavir, and the three POWER studies demonstrate the high genetic barrier of this drug against mutations conferring resistance to other PIs, although the baseline sensitivity of darunavir and the specific mutations to this PI influence the virological response. Better therapeutic responses have been obtained when there are two or more antiretroviral drugs active against multiresistant HIV strains. The phase III trials (DUET 1 and 2), in which darunavir was administered with the new nonnucleoside reverse transcriptase inhibitor, etravirine, found that if these two drugs were administered in highly treatment-experienced patients, a large percentage showed suppression of plasma viremia and immunological recovery. These data have been supported by the results of the BENCHMARK studies, in which darunavir was included in an optimized regimen in a substantial number of patients. In these trials, when darunavir was administered with the integrase inhibitor, raltegravir, undetectable viral loads both in the raltegravir arm and in the control group were substantially improved with respect to the overall results obtained in the control group.

Peritonitis bacteriana espontánea por Streptococcus constellatus / Spontaneous bacterial peritonitis due to Streptococcus constellatus

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