Simplificación del tratamiento antirretroviral: una buena alternativa para nuestros pacientes y para la sostenibilidad de nuestro sistema sanitario / Simplification of Antiretroviral Therapy: A Good Choice for Our Patients and the Sustainability of Our Health Care System

Objetivo Describir la efectividad, seguridad, adherencia y ahorro económico de la monoterapia basada en lopinavir/ritonavir. Método Estudio observacional, descriptivo y retrospectivo que evaluó la monoterapia. La adherencia se calculó utilizando un método objetivo. Se estimaron los costes directos derivados de la no dispensación de la triple terapia. Resultados Identificamos 17 pacientes. La adherencia por intervalos fue: >95%, 9 pacientes; 90-95%, 2 pacientes; 90-85%, 2 pacientes; inferior al 85%, 4 pacientes. La carga viral fue indetectable durante las semanas 12, 24, 36 y 48 excepto en 2 pacientes. Las cifras de CD4 se mantuvieron en la mayor parte de las analíticas >350 cél./μl, y solo un paciente tuvo una cifra inferior. El ahorro medio fue 4.819 euros/paciente/año (rango 1.116 - 8.700).Conclusiones En pacientes seleccionados la monoterapia puede ser una opción terapéutica coste-efectiva(AU)

Objective To describe the efficacy, safety, compliance and cost savings of lopinavir/ritonavir monotherapy. Method Observational, descriptive and retrospective study evaluating monotherapy. Adherence was calculated using an objective method. We estimated the direct costs of dispensing non-triple therapy. Results We identified 17 patients. Interval adherence was >95% in 9 patients, 90%–95% in 2 patients, 90%–85% in 2 patients, and less than 85% in 4 patients. Viral load was undetectable during weeks 12, 24, 36, and 48, except in 2 patients. The CD4 count in most analytical tests remained at >350cells/ml, only 1 patient had a lower figure. The average savings was 4819 Euros/patient/year (range 1116–8700).Conclusions In selected patients, monotherapy can be a cost-effective treatment option (AU)

Simplification of antiretroviral therapy: a good choice for our patients and the sustainability of our health care system.

OBJECTIVE: To describe the efficacy, safety, compliance and cost savings of lopinavir/ritonavir monotherapy. METHOD: Observational, descriptive and retrospective study evaluating monotherapy. Adherence was calculated using an objective method. We estimated the direct costs of dispensing non-triple therapy. RESULTS: We identified 17 patients. Interval adherence was > 95% in 9 patients, 90-95% in 2 patients, 90-85% in 2 patients, and less than 85% in 4 patients. Viral load was undetectable during weeks 12, 24, 36 and 48, except in 2 patients. The CD4 count in most analytical tests remained at > 350 cells/ml, only 1 patient had a lower figure. The average savings was 4819 Euros/patient/year (range 1116 to 8700). CONCLUSIONS: In selected patients, monotherapy can be a cost-effective treatment option.

Importancia pronóstica de la hipertensión pulmonar en insuficiencia cardiaca con fracción de eyección preservada / Prognostic importance of pulmonary hypertension in heart failure with preserved ejection fraction

Objetivos. La hipertensión pulmonar (HP) es una complicación frecuente en insuficiencia cardiaca (IC). Sin embargo, su impacto no está bien establecido en insuficiencia cardiaca con fracción de eyección preservada (ICFEP). El objetivo principal del estudio es conocer el valor pronóstico de la HP en pacientes hospitalizados por ICFEP. Pacientes y métodos. Estudio observacional y prospectivo de pacientes hospitalizados por ICFEP (fracción de eyección del ventrículo izquierdo [FEVI] >45%). Se definió HP por una presión arterial sistólica pulmonar (PASP) >35mmHg medido por el gradiente de regurgitación tricuspidea añadido a la presión auricular. La variable resultado fue un evento compuesto de mortalidad total y/o ingreso hospitalario por IC durante un seguimiento de 1 año. Para valorar diferencias en el seguimiento se realizó una curva de Kaplan-Meier y posteriormente se estimó riesgo ajustado mediante una regresión de Cox. Resultados. Un total de 218 pacientes completaron el periodo de seguimiento, de los que 56 (26,7%) tenían una PASP>35mmHg. La incidencia del evento combinado fue en 126 pacientes (57,8%) y la mortalidad en 70 pacientes (32,1%). El estudio de supervivencia mostró diferencias pronósticas en el grupo de HP tanto para la variable resultado combinada (Log Rank <0,001) como para la mortalidad total (log Rank 0,019). El riesgo ajustado para los pacientes con HP fue de 2,03 (IC 95%: 1,39–2,96; p<0,001) para el evento combinado y de 1,84 (IC 95%: 1,11–3,03; p=0,017) para la mortalidad total. Conclusiones. La hipertensión pulmonar (PASP >35mmHg) medida por métodos no invasivos es un marcador robusto e independiente de mal pronóstico en pacientes hospitalizados por IC con fracción eyección preservada o ligeramente deprimida(AU)

Objectives. Pulmonary hypertension (PH) is a frequent complication in heart failure (HF). However, its impact factor in heart failure with preserved ejection fraction (HFPEF) is not well-known. This study has aimed to identify the prognostic value of PH in hospitalized patients with HFPEF. Material and Methods. An observational and prospective trial of patients admitted due to HFPEF (LVEF >45%). Pulmonary hypertension was defined by Pulmonary artery systolic pressure (PASP) >35mm Hg measured by the tricuspid regurgitation velocity plus atrial pressure. The primary endpoint was all-cause mortality and/or readmissions during 1-year follow-up. Kaplan-Meier survival curves and Cox regression were performed to identify adjusted hazard ratios (HR). Results. A total of 218 patients completed the follow-up period, 56 patients (32.2%) had PASP >35mm Hg. Primary endpoint was observed in 126 patients (57.8%) and 70 patients (32.2%) died. Kaplan-Meier survival curves showed increased significantly all-cause mortality and/or readmission in patients with PH (Log Rank <0.001) and mortality (Log Rank 0.019). Patients with PH were an increased adjusted risk for primary endpoint, HR 2.03 (CI 95%: 1.39–2.96; p<0.001) and all-cause mortality, HR 1.84 (CI 95%: 1.11–3.03; p=0.017). Conclusions. Pulmonary hypertension (PASP >35mm Hg) measured by non-invasive methods is a strong and independent predictor of an unfavorable outcome in patients hospitalized due to heart failure and normal or only mildly reduced ejection fraction(AU)

[Prognostic importance of pulmonary hypertension in heart failure with preserved ejection fraction]. / Importancia pronóstica de la hipertensión pulmonar en insuficiencia cardiaca con fracción de eyección preservada.

OBJECTIVES: Pulmonary hypertension (PH) is a frequent complication in heart failure (HF). However, its impact factor in heart failure with preserved ejection fraction (HFPEF) is not well-known. This study has aimed to identify the prognostic value of PH in hospitalized patients with HFPEF. MATERIAL AND METHODS: An observational and prospective trial of patients admitted due to HFPEF (LVEF >45%). Pulmonary hypertension was defined by Pulmonary artery systolic pressure (PASP) >35mm Hg measured by the tricuspid regurgitation velocity plus atrial pressure. The primary endpoint was all-cause mortality and/or readmissions during 1-year follow-up. Kaplan-Meier survival curves and Cox regression were performed to identify adjusted hazard ratios (HR). RESULTS: A total of 218 patients completed the follow-up period, 56 patients (32.2%) had PASP >35mm Hg. Primary endpoint was observed in 126 patients (57.8%) and 70 patients (32.2%) died. Kaplan-Meier survival curves showed increased significantly all-cause mortality and/or readmission in patients with PH (Log Rank <0.001) and mortality (Log Rank 0.019). Patients with PH were an increased adjusted risk for primary endpoint, HR 2.03 (CI 95%: 1.39-2.96; p<0.001) and all-cause mortality, HR 1.84 (CI 95%: 1.11-3.03; p=0.017). CONCLUSIONS: Pulmonary hypertension (PASP >35mm Hg) measured by non-invasive methods is a strong and independent predictor of an unfavorable outcome in patients hospitalized due to heart failure and normal or only mildly reduced ejection fraction.

Endometriosis como causa de invaginación intestinal / Endometriosis as cause of intestinal invagination

No disponible

[Medication errors and non-compliance in polymedicated elderly patients]. / Errores de medicación e incumplimiento terapéutico en ancianos polimedicados.

OBJECTIVE: To detect and describe medication errors and adherence to therapy in polymedicated (> 5 drugs) elderly patients (> 65 years). METHOD: A descriptive, observational study using a phone survey to polymedicated elderly outpatients. Sociodemographic, clinical, and pharmacotherapeutic data were collected, as well as information on their functional and mental capability. The number, type and severity of medication errors were measured, as was non-adherence. RESULTS: Errors were detected in 42.5% of 73 responders, with a total of 55 errors, and a mean 1.77 errors per patient. Most commonly found errors included inappropriate administration frequency and therapeutic duplicity. Regarding adherence, 43.8% were non-compliants, being sporadic in 68.8% and sequential in 31.2% of the cases. A positive relationship between error number and drug number or adherence was found. CONCLUSIONS: Actions are required from a multidisciplinary standpoint to reduce this high percentage of errors.

Estudio de utilización de Tenofovir DF en el tratamiento antirretroviral de gran actividad / Use study of tenofovir DF in higly active anti-retroviral therapy

Objetivo: Describir la eficacia y seguridad de tenofovir. Métodos: Estudio descriptivo, observacional. Análisis por intención de tratar. La variable principal fue la proporción de pacientes con supresión de la carga viral plasmática del VIH hasta indetectable. Las variables secundarias fueron la respuesta inmunológica, proporción de pacientes con variación positiva del número de CD4+ y la seguridad (eventos adversos clínicos y valores bioquímicos y hematológicos). Se midió la causalidad por el algoritmo de Naranjo. Resultados: Se seleccionaron 154 pacientes, 12 fueron excluidos de todos los análisis. Las variables de eficacia fueron: La proporción de pacientes que disminuyeron la carga viral a 50 copias/ml o menos fue 28,16%, la media de descenso fue -1,29 ± 0,97 log10 copias/ml. La media de aumento de CD4 fue de 40,27 ± 141,50 cel/mm3 La seguridad fue similar a la ficha técnica, destacando tres casos de Síndrome de Fanconi. Conclusión: Tenofovir supone un antirretroviral de gran efectividad en el hospital con un perfil de seguridad óptimo

Objective: Describe the efficacy and safety of tenofovir. Methods: Observational, descriptive study. Data were analyzed for the intention-to-treat sample. The primary efficacy end-point included the proportion of patients with HIV-1 RNA level of 50 copies/ml or less. Secondary efficacy end points was the increase of the CD4 cell count at week 48. The primary safety end-point was the number of patients with abnormalities (clinical adverse events and laboratory toxicities). The causality of the adverse effects was measured by the Naranjo algorithm Results: 154 subjects were enrolled; 12 were excluded from all analyses. Efficacy end points: Plasma HIV-1 RNA response: -1.29 ± 0.97 log10 copies/ml; Patients with HIV-1 RNA levels of 50 copies/ml or less: 28.16%; CD4 cell count response: 40.27 ± 141.50 cel/mm3. Safety profile was similar to showed at prescribing information, 3 Fanconi Syndrome were detected. Conclusion: Tenofovir supposes an antiretroviral of high effectiveness in our hospital, with an optimum safety profile

[Cerebral calcifications: a clue for a diagnostic process in a nonspecific clinical case]. / Calcificaciones cerebrales típicas como orientación de cuadro clínico inespecífico.

Coeliac disease is a gluten sensitive enteropathy, autoimmune in origin, which has been traditionally regarded as a gastrointestinal disease. Years later it has been reported an extraintestinal affection. A huge number of neurological syndromes of unknown cause had been initially described in association with coeliac disease, with total or partial response to a gluten free-diet. A specific kind of occipital cerebral calcifications in relation to coeliac disease has been also described, and sometimes it means the existence of a syndrome called "Gobby's Syndrome". We show a patient with a mild unknown coeliac disease, a woman who had occipital cerebral calcifications in a TAC cerebral, which was made because of her intractable migraines and that it lead to the diagnosis. The migraine disappeared after a gluten free-diet, like similar cases reported by literature. The fact of existing neurological symptoms associated to coeliac diseases opens a therapeutic window of opportunity because they would respond to a gluten free-diet.

Errores de medicación e incumplimiento terapéutico en ancianos polimedicados / No disponible

Objetivo: Detectar y describir los errores de medicación y laadherencia al tratamiento en ancianos (> 65 años) y polimedicados(> 5 fármacos).Método: Estudio observacional, descriptivo, llevado a cabomediante cuestionario telefónico a una muestra de pacientesancianos y polimedicados no ingresados. Se recogieron datossociodemográficos y la capacidad funcional y mental, datos clínicosy farmacoterapéuticos. Se midió el número, tipo y gravedadde los errores de medicación y la adherencia.Resultados: Se detectó algún error en el 42,5% de los 73pacientes entrevistados, con un total de 55 errores, media de1,77 errores por paciente. Los errores más frecuentes fueron losde frecuencia de administración incorrecta y duplicidad terapéutica.En cuanto a la adherencia se detectó un 43,8% de incumplimiento,siendo esporádico en un 68,8% y secuencial en un31,2%. Se encontró una relación positiva entre el número deerrores y el número de medicamentos o la adherencia.Conclusiones: Es necesario, desde un punto de vista multidisciplinar,realizar actuaciones encaminadas a disminuir este altoporcentaje de errores

Objective: To detect and describe medication errors andadherence to therapy in polymedicated (> 5 drugs) elderly patients(> 65 years).Method: A descriptive, observational study using a phone surveyto polymedicated elderly outpatients. Sociodemographic, clinical,and pharmacotherapeutic data were collected, as well asinformation on their functional and mental capability. The number,type and severity of medication errors were measured, as wasnon-adherence.Results: Errors were detected in 42.5% of 73 responders, witha total of 55 errors, and a mean 1.77 errors per patient. Mostcommonly found errors included inappropriate administration frequencyand therapeutic duplicity. Regarding adherence, 43.8%were non-compliants, being sporadic in 68.8% and sequential in31.2% of the cases. A positive relationship between error numberand drug number or adherence was found.Conclusions: Actions are required from a multidisciplinarystandpoint to reduce this high percentage of errors

Seudomixoma peritoneal: utilidad de la quimiohipertermia intraabdominal tras la cirugía / Peritoneal pseudomyxoma. Utility of intraperitoneal chemohyperthermia after surgery

No disponible

Calcificaciones cerebrales típicas como orientación de cuadro clínico inespecífico / Cerebral calcifications: a clue for a diagnostic process in a inespecific clinical case

La enfermedad celíaca es una enteropatía por sensibilidad al gluten de origen autoinmune, considerada clásicamente como enfermedad exclusivamente gastrointestinal. Posteriormente se han puesto de manifiesto manifestaciones extraintestinales. Un número importante de síndromes neurológicos catalogados de idiopáticos al inicio, han sido descritos en el contexto de enfermedad celiaca, presentando respuesta total o parcial tras dieta sin gluten. Se ha descrito asociado a enfermedad celiaca un tipo muy característico de calcificaciones cerebrales occipitales, que a veces forma parte de un síndrome específico llamado síndrome de Gobby. Presentamos una paciente con enfermedad celiaca oligosintomática, que presentaba las peculiares calcificaciones cerebrales que fueron halladas tras realización de una prueba de imagen al presentar migraña rebelde a tratamiento, y que orientaron hacia su diagnóstico. La migraña mejoró sustancialmente tras realizar dieta sin gluten, como en otros casos descritos en la literatura. El hecho de que existan manifestaciones neurológicas asociadas a enfermedad celiaca hace posible la reversibilidad de las mismas tras dieta exenta de gluten

Coeliac disease is a gluten sensitive enteropathy, autoimmune in origin, which has been traditionally regarded as a gastrointestinal disease. Years later it has been reported an extraintestinal affection. A huge number of neurological syndromes of unknown cause had been initially described in association with coeliac disease, with total or parcial response to a gluten free-diet. A specific kind of occipital cerebral calcifications in relation to coeliac disease has been also described, and sometimes it means the existence of a syndrom called “Gobby´s Syndrom”. We show a patient with a mild unknown coeliac disease, a woman who had occipital cerebral calcifications in a TAC cerebral, which was made because of her wild migraine and that it leaded the diagnosis. The migraine disappeared after a gluten free-diet, like similar cases reported by literature. The fact of existing neurological symtoms associated to coeliac diseases opens a therapeutc window of opportunity because they would repond to a gluten free-diet

[Use study of tenofovir DF in highly active anti-retroviral therapy]. / Estudio de utilización de Tenofovir DF en el tratamiento antirretroviral de gran actividad.

OBJECTIVE: Describe the efficacy and safety of tenofovir. METHODS: Observational, descriptive study. Data were analyzed for the intention-to-treat sample. The primary efficacy end-point included the proportion of patients with HIV-1 RNA level of 50 copies/ml or less. Secondary efficacy end points was the increase of the CD4 cell count at week 48. The primary safety end-point was the number of patients with abnormalities (clinical adverse events and laboratory toxicities). The causality of the adverse effects was measured by the Naranjo algorithm. RESULTS: 154 subjects were enrolled; 12 were excluded from all analyses. Efficacy end points: Plasma HIV-1 RNA response: -1.29 +/- 0.97 log10 copies/ml; Patients with HIV-1 RNA levels of 50 copies/ml or less: 28.16%; CD4 cell count response: 40.27 +/- 141.50 cel/mm3. Safety profile was similar to showed at prescribing information, 3 Fanconi Syndrome were detected. CONCLUSION: Tenofovir supposes an antiretroviral of high effectiveness in our hospital, with an optimum safety profile.

Distonía aguda tras picadura de avispa / Acute dystonia following a wasp sting

No disponible

No disponible

[Cost-effectiveness analysis of tenofovir versus zidovudine in combination therapy with efavirenz and lamivudine for the treatment of HIV in naive patients]. / Análisis coste-eficacia de tenofovir versus zidovudina en terapia combinada con efavirenz y lamivudina para el tratamiento de VIH en pacientes no pretratados.

OBJECTIVES: To assess tenofovir + lamivudine + efavirenz versus zidovudine + lamivudine + efavirenz in treatment-naive patients using a cost-effectiveness analysis. METHODS: A decision tree was designed. Effectiveness was estimated from clinical trials. Viral load and CD4 cells count were chosen as endpoints for health outcome. Both healthcare and treatment costs were considered, and univariate sensitivity tests were performed. RESULTS: The regimen including tenofovir would have a yearly cost of 10,116.61 Euros when effective, and of 12,140.40 Euros in case of therapeutic failure. The regimen including zidovudine would have a yearly cost of 7,470.36 Euros when effective, and of 8,964.90 Euros in case of therapeutic failure. The cost of switching to the regimen with tenofovir represents 14,765.86 Euros per year per additional patient with non-detectable viral load. After 3 years, the expected yearly cost is 8,765.83 Euros for the regimen including tenofovir versus 8,894.36 Euros for the regimen including zidovudine. CONCLUSION: The regimen including zidovudine is less costly in the short run when compared to the regimen including tenofovir. Both regimens become financially similar when extending the study horizon.

[Cystinosis: an infrequent cause of distal myopathy]. / Cistinosis: una causa infrecuente de miopatía distal.

INTRODUCTION: Cystinosis is a hereditary disease with clinical symptoms that are caused by the accumulation of cystine crystals in different tissues. Distal vacuolar myopathy has been reported as one of its later complications. CASE REPORT: Here, we present the case of a 20-year-old male diagnosed with cystinosis at the age of 2 years, with severe renal involvement that required a transplant. The patient gradually developed weakness and atrophy of the muscles in his hands. Neurophysiological and histological studies enabled a diagnosis of distal vacuolar myopathy to be established, and electron microscopy revealed deposits of cystine crystals. CONCLUSIONS: Cystinosis must be included within the differential diagnosis of distal myopathies. Timely treatment with cysteamine could prevent the development of this complication.

Análisis coste-eficacia de tenofovir versus zidovudina en terapia combinada con efavirenz y lamivudina para el tratamiento de VIH en pacientes no pretratados / Cost-effectiveness analysis of tenofovir versus zidovudine in combination therapy with efavirenz and lamivudine for the treatment of HIV in naive patients

Objetivos: Evaluar los regímenes en pacientes no pretratados de tenofovir + lamivudina + efavirenz versus zidovudina + lamivudina + efavirenz mediante un estudio coste-eficacia. Métodos: Se diseñó un árbol de decisiones. Se estimó la eficaciaa través de ensayos clínicos. Para valorar la medida sobre los resultados de la salud se consideró la carga viral y los CD4. Se consideraron costes asistenciales y de tratamiento, y se realizó un análisis de sensibilidad univariante. Resultados: El régimen con tenofovir tendría un coste anual, en caso de ser efectivo, de 10.116,61 €, mientras que si existefallo terapéutico el coste sería de 12.140,40 €. El régimen que incluye zidovudina tendría un coste anual de 7.470,36 € en caso de ser efectivo, y un coste de 8.964,90 €, en caso de fallo terapéutico.El coste de pasar al régimen que incluye tenofovir supone 14.765,86 € al año por paciente adicional con carga viral indetectable. En 3 años, el coste anual esperado es de 8.765,83 € para el régimen que incluye tenofovir frente a 8.894,36 € del régimen que incluye zidovudina. Conclusión: El régimen que incluye zidovudina es menos costoso a corto plazo que el que incluye tenofovir. Si ampliamos el horizonte del estudio, los dos regímenes se equiparan económicamente

Objectives: To assess tenofovir + lamivudine + efavirenz versus zidovudine + lamivudine + efavirenz in treatment-naive patients using a cost-effectiveness analysis. Methods: A decision tree was designed. Effectiveness was estimated from clinical trials. Viral load and CD4 cells count were chosen as end points for health outcome. Both healthcare and treatment costs were considered, and univariate sensitivity tests were performed. Results: The regimen including tenofovir would have a yearly cost of € 10,116.61 when effective, and of € 12,140.40 in case of therapeutic failure. The regimen including zidovudine would have a yearly cost of € 7,470.36 when effective, and of € 8,964.90 incase of therapeutic failure. The cost of switching to the regimen with tenofovir represents € 14,765.86 per year per additional patient with non-detectable viral load. After 3 years, the expected yearly cost is € 8,765.83 for the regimen including tenofovir versus € 8,894.36 for the regimen including zidovudine. Conclusion: The regimen including zidovudine is less costly in the short run when compared to the regimen including tenofovir. Both regimens become financially similar when extending the study horizon