Systematic literature review and expert meeting report on health-related quality of life in chronic venous disease.

INTRODUCTION: Chronic venous disease (CVD) can lead to considerable morbidity and impact health-related quality of life (HRQoL). The aim of this review was twofold: (i) to provide a deeper understanding of how CVD affects HRQoL (physical, psychological and social functioning), and (ii) to review the impact of evidence-based veno-active drugs (VADs) on HRQoL. EVIDENCE ACQUISITION: For the effect of CVD on HRQoL, information was gathered during an Expert Consensus Meeting, during which data were presented from both the patient and physician perspective assessed with validated quality-of-life measures. For the impact of VADs on HRQoL, a systematic literature review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for real world evidence or randomized-controlled trials (RCT) vs. placebo, reporting data on the influence of VADs on HRQoL in patients with CVD. EVIDENCE SYNTHESIS: CVD can negatively affect daily life in a number of areas related to pain, physical function and social activities. The impact of CVD on HRQoL begins early in the disease and for patients the emotional burden of the disease is as high as the physical burden. In contrast, physicians tend to overestimate the physical impact. The database search yielded 184 unique records, of which 19 studies reporting on VADs and HRQoL in patients with CVD met the inclusion criteria (13 observational and 6 RCTs). Micronized purified flavonoid fraction (MPFF) was the most represented agent, associated with 12/19 studies (2 RCTs and 10 observational). Of the 6 RCTs, only MPFF, aminaphthone and low-dose diosmin provided statistically significant evidence for improvement on HRQoL compared with placebo; for the other VADs improvements in HRQoL were not statistically different from placebo. MPFF was also associated with improvements in HRQoL in the observational studies, across all CEAP clinical classes, as monotherapy or in combination with other conservative therapy, and for all aspects of HRQoL: physical, psychological, and social. Real-world data for the other VADs were scarce. Ruscus extract, sulodexide and a semi-synthetic diosmin were each represented by a single observational study and these limited data were associated with statistically significant improvements compared with baseline in overall and subdomain scores across the range of CEAP clinical classes. CONCLUSIONS: CVD can impair patients' HRQoL significantly at all stages of the disease. MPFF has the greatest evidence base of clinical use in both RCT and real-world observational studies for effectiveness on HRQoL and is recognized by international guidelines. The complete video presentation of the work is available online at www.minervamedica.it (Supplementary Digital Material 1: Supplementary Video 1, 5 min, 194 MB).

Características demográficas, quimioprofilaxis antimalárica e inmunoprofilaxis en 6.783 viajeros internacionales atendidos en una unidad monográfica / Demographic characteristics, malaria chemoprophylaxis and vaccination in 6,783 international travelers attended in a specialized unit

Introduccion. El objetivo fue conocer las características demográficas y la evolución temporal de los viajeros internacionales atendidos en la Unidad de Enfermedades Infecciosas y Medicina Tropical con el fin de mejorar las precauciones previas al viaje y disminuir la aparición de dichas enfermedades. Métodos. Se realizó un estudio descriptivo retrospectivo de todos los viajeros internacionales atendidos en la UEIMT (Las Palmas de Gran Canaria) durante el periodo 1998 - 2013. Se analizaron las siguientes variables que fueron recogidas mediante un protocolo estandarizado: edad, género, fecha de la consulta, tipo de viajero, país/es de destino y medidas preventivas realizadas (quimioprofilaxis antipalúdica y vacunas). El análisis estadístico se realizó usando el paquete SPSS versión 19.0. Resultados. Se analizaron un total de 6.783 viajeros internacionales de los cuales 52% fueron mujeres. La media de edad fue de 36 años (DT 13). El continente de destino más frecuente fue África (39%) seguido de Asia (36%) y América Latina (23%). El país de destino más habitual fue la India 13% (882), seguido de Senegal 7,5% (509) y Tailandia 6,3% (429). Las vacunas más frecuentemente recomendadas fueron, fiebre tifoidea (82,9%) y hepatitis A (66,9%). En cuanto a la profilaxis antipalúdica, los fármacos indicados fueron atovacuonaproguanil (56,5%), mefloquina (36,7 %), En lo que respecta a los viajeros que regresan para visitar a amigos y familiares un 26,81% eran niños (0-9 años). Conclusiones. El perfil general del viajero es un joven que con motivo vacacional elige como destino África seguido de Asia y Latinoamérica. Más del 50% de los viajeros recibieron vacunación frente a la fiebre tifoidea y a la hepatitis A. La quimioprofilaxis antipalúdica más utilizada fue atovacuona/ proguanil seguida de mefloquina (AU)

Background. The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases. Methods. A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines). Results. A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years). Conclusions. The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine (AU)

Poliserositis en paciente con hepatitis C en tratamiento con los nuevos antivirales / Poliserositis in a patient with hepatitis C under treatment with new antivirals

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