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1.
J Orthop Surg (Hong Kong) ; 27(3): 2309499019867580, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31470759

RESUMO

PURPOSE: To compare the healing and clinical outcomes of anterior cruciate ligament (ACL) reconstruction between patients with or without intraoperative administration of adipose-derived regenerative stem cells (ADRC). METHODS: Between 2013 and 2014, the outcomes of 20 soccer players undergoing ACL reconstruction using bone-patellar tendon-bone autograft infiltrated with ADRC at the end of the procedure were compared to a historical, matched cohort of 19 soccer players undergoing the same procedure without ADRC. Outcomes were obtained at baseline, and 6 and 12 months postop for IKDC (International Knee Documentation Committee), Lysholm, and Lequesne, and at 2, 4, 6, and 12 months postop for VAS (visual analogue scale) for pain and graft maturation to evaluate the ligamentization process (magnetic resonance imaging (MRI)-based). RESULTS: Both groups significantly improved the IKDC (p < 0.001 in both groups), Lysholm (p < 0.001 in both groups), Lequesne index (p < 0.001 in both groups), VAS for pain (p = 0.002 for the ADRC and p < 0.001 for the control group), and MRI scores (p < 0.001 in both groups) in the 12 months postop compared to baseline scores. However, there were no significant differences in the improvement of the outcomes between groups across time (p > 0.05). All patients returned to sports after surgery, but 8 (40%) patients in the ADRC and 13 (68.4%) patients in the control group had lower Tegner activity score at 12 months postop. CONCLUSIONS: Patients receiving ADRC at the time of ACL reconstruction significantly improved knee function and healing/maturation of the graft at 12 months. However, this improvement was not statistically significant compared to a control group undergoing ACL reconstruction alone.

2.
Nat Commun ; 10(1): 3705, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420544

RESUMO

The identification of exclusive markers to target HIV-reservoir cells will represent a significant advance in the search for therapies to cure HIV. Here, we identify the B lymphocyte antigen CD20 as a marker for HIV-infected cells in vitro and in vivo. The CD20 molecule is dimly expressed in a subpopulation of CD4-positive (CD4+) T lymphocytes from blood, with high levels of cell activation and heterogeneous memory phenotypes. In lymph node samples from infected patients, CD20 is present in productively HIV-infected cells, and ex vivo viral infection selectively upregulates the expression of CD20 during early infection. In samples from patients on antiretroviral therapy (ART) this subpopulation is significantly enriched in HIV transcripts, and the anti-CD20 monoclonal antibody Rituximab induces cell killing, which reduces the pool of HIV-expressing cells when combined with latency reversal agents. We provide a tool for targeting this active HIV-reservoir after viral reactivation in patients while on ART.

3.
PLoS Pathog ; 15(8): e1007991, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31425551

RESUMO

Latency reversal agents (LRAs) have proven to induce HIV-1 transcription in vivo but are ineffective at decreasing the size of the latent reservoir in antiretroviral treated patients. The capacity of the LRAs to perturb the viral reservoir present in distinct subpopulations of cells is currently unknown. Here, using a new RNA FISH/flow ex vivo viral reactivation assay, we performed a comprehensive assessment of the viral reactivation capacity of different families of LRAs, and their combinations, in different CD4+ T cell subsets. We observed that a median of 16.28% of the whole HIV-reservoir induced HIV-1 transcripts after viral reactivation, but only 10.10% of these HIV-1 RNA+ cells produced the viral protein p24. Moreover, none of the LRAs were powerful enough to reactivate HIV-1 transcription in all CD4+ T cell subpopulations. For instance, the combination of Romidepsin and Ingenol was identified as the best combination of drugs at increasing the proportion of HIV-1 RNA+ cells, in most, but not all, CD4+ T cell subsets. Importantly, memory stem cells were identified as highly resistant to HIV-1 reactivation, and only the combination of Panobinostat and Bryostatin-1 significantly increased the number of cells transcribing HIV within this subset. Overall, our results validate the use of the RNA FISH/flow technique to assess the potency of LRAs among different CD4+ T cell subsets, manifest the intrinsic differences between cells that encompass the latent HIV reservoir, and highlight the difficulty to significantly impact the latent infection with the currently available drugs. Thus, our results have important implications for the rational design of therapies aimed at reversing HIV latency from diverse cellular reservoirs.

4.
Med Clin (Barc) ; 2019 May 25.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31138444

RESUMO

BACKGROUND AND AIM: To assess emotional distress and complexity of patients referred to the Psychosocial Committee. MATERIAL AND METHODS: A pre-post single group study was performed in a sample of oncological patients. From the 144 patients referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later. RESULTS: After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%. CONCLUSIONS: The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases.

5.
Pharmacotherapy ; 39(4): 501-507, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30723941

RESUMO

STUDY OBJECTIVE: Dual therapy with once/day dolutegravir (DTG) plus boosted darunavir (DRV/b) may be a suitable and effective strategy with a high genetic barrier to resistance in patients infected with human immunodeficiency virus (HIV). Our aim was to evaluate the effectiveness of DTG plus DRV/b (DTG+DRV/b) as a switch strategy in HIV-infected patients, irrespective of their history of virologic failure (VF). DESIGN: Multicenter retrospective cohort study. SETTING: Human immunodeficiency outpatient treatment clinics at three university hospitals in Spain. PATIENTS: Fifty HIV-infected adults who had a stable antiretroviral treatment (ART) regimen and an undetectable viral load for at least 6 months, and whose ART was switched to once/day DTG+DRV/b between January 2015 and January 2018 were included in the analysis. Historical genotype at the time of VF was available in 44 patients. MEASUREMENTS AND MAIN RESULTS: Patients were followed until VF or treatment discontinuation for any reason. The primary outcome was the percentage of patients with a viral load of 50 copies/mL or lower at the last follow-up visit. Secondary outcomes included changes in CD4+ cell count, lipid profile, and renal function. Of the 50 patients included, median time of viral suppression was 52 months (interquartile range [IQR] 18-103 mo) and nadir CD4+ 89 cells/mm3 (IQR 37-241 cells/mm3 ). Patients had a history of a median of 8 ART combinations (IQR 4-11 combinations) and 3 VFs (IQR 2-8 VFs). The historical genotypes from 44 patients showed 41 patients (93.2%) with nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) resistance-associated mutations (RAMs), 32 (72.7%) with nonnucleoside reverse transcriptase inhibitor (NNRTI) RAMs, and 12 (27.3%) with primary protease inhibitor (PI) RAMs; 7 (15.9%) had darunavir RAMs, and no patients had baseline integrase strand transfer inhibitor RAMs. Thirty-seven patients (84.1%) had resistance to at least two antiretroviral classes. After a median of 25 months (IQR 17-28 mo) of follow-up, 49 patients (98%) maintained a viral load of 50 copies/mL or lower, and 1 patient (2%) had VF. No new RAMs emerged at VF. At week 4, serum creatinine concentration increased a median of 0.12 mg/dl (0.03-0.23 mg/dl). At last visit, total cholesterol and low-density lipoprotein cholesterol levels increased by a median of 9 mg/dl (IQR -18 to 40 mg/dl) and 16 mg/dl (IQR -9 to 40 mg/dl), respectively, whereas CD4+ cell count remained stable (median +13 cell/mm3 ). CONCLUSION: In this cohort of heavily treated HIV-infected patients with virologic suppression, switching to the combination of DTG+DRV/b was a convenient regimen that was highly effective and had good tolerability.

6.
Enferm Infecc Microbiol Clin ; 36 Suppl 2: 10-16, 2018 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30545466

RESUMO

Symtuza® is the first and only treatment for HIV-1 that combines 2 nucleos(t)ide analogues (emtricitabine and tenofovir alafenamide) together with a boosted protease inhibitor (darunavir/cobicistat) in a once-daily single tablet regimen (STR). This combination is active against a wide variety of HIV strains and, in turn, avoids bone and renal toxicity associated with the use of tenofovir disoproxil fumarate, combining efficacy, convenience, tolerability and high genetic barrier. Pharmacokinetic studies of its components show a favourable profile, allowing its use in a wide variety of patients and clinical situations. Although, as in any boosted combination, possible interactions with concomitant medication should be borne in mind, cobici-stat inhibits cytochrome P-450 more selectively and has no inducing effect, so it has a more predictable interaction profile than ritonavir. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen.


Assuntos
Fármacos Anti-HIV/farmacologia , Darunavir/farmacologia , Tenofovir/farmacologia , Fármacos Anti-HIV/farmacocinética , Darunavir/farmacocinética , Combinação de Medicamentos , Interações de Medicamentos , Humanos , Tenofovir/farmacocinética
7.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(supl.2): 10-16, dic. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-177042

RESUMO

Symtuza(R) es el primer y único tratamiento del VIH-1 que combina 2 análogos de nucleós(t)idos (emtricita-bina y tenofovir alafenamida) junto con un inhibidor de la proteasa potenciado (darunavir/cobicistat) en un solo comprimido una vez al día. Esta combinación es activa frente a una gran variedad de cepas del VIH y, a su vez, evita la toxicidad renal y ósea asociada con el uso de tenofovir disoproxil fumarato, y aúna eficacia, conveniencia, tolerabilidad y elevada barrera genética. Los estudios farmacocinéticos de sus componentes demuestran un perfil favorable que permite su uso en una gran variedad de pacientes y situaciones clínicas. Aunque, como en toda combinación potenciada, es necesario considerar posibles interacciones con medicación concomitante, el potenciador cobicistat inhibe más selectivamente el citocromo P-450 y no posee ningún efecto inductor, por lo que su perfil de interacciones es más predecible que el de ritonavir. Información sobre el suplemento: este artículo forma parte del suplemento titulado "Darunavir, cobicistat, emtricitabina y tenofovir alafenamida coformulados en el tratamiento de la infección por el VIH", que ha sido patrocinado por Janssen


Symtuza(R) is the first and only treatment for HIV-1 that combines 2 nucleos(t)ide analogues (emtricitabine and tenofovir alafenamide) together with a boosted protease inhibitor (darunavir/cobicistat) in a once-daily single tablet regimen (STR). This combination is active against a wide variety of HIV strains and, in turn, avoids bone and renal toxicity associated with the use of tenofovir disoproxil fumarate, combining efficacy, convenience, tolerability and high genetic barrier. Pharmacokinetic studies of its components show a favourable profile, allowing its use in a wide variety of patients and clinical situations. Although, as in any boosted combination, possible interactions with concomitant medication should be borne in mind, cobici-stat inhibits cytochrome P-450 more selectively and has no inducing effect, so it has a more predictable interaction profile than ritonavir. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen


Assuntos
Humanos , Darunavir/administração & dosagem , Cobicistat/administração & dosagem , Emtricitabina/administração & dosagem , Tenofovir/administração & dosagem , Quimioterapia Combinada , Infecções por HIV/tratamento farmacológico
8.
Clin Infect Dis ; 2018 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-30590412

RESUMO

Background: Optimization of combination antiretroviral therapy (cART) can impact the HIV reservoir. We evaluated the effect on the HIV reservoir in peripheral blood and ileum biopsies of switching from boosted protease inhibitor (PI)-based therapy to dolutegravir (DTG)-based therapy. Methods: INDOOR is a phase IV open-label clinical trial that randomly included 42 HIV-1-infected individuals on effective cART: 20 who switched from boosted PI-based to DTG-based cART (switch group), and 22 who remained in boosted PI-based regimens (control group). We analyzed blood and ileum biopsies to quantify episomal, total, and integrated HIV-DNA, cell-associated HIV-RNA, residual plasma viremia, T-cell subsets, cell activation, and inflammation markers. Results: There were no related adverse events or treatment discontinuations due to drug intolerance. The HIV reservoir was consistently larger in ileal than in peripheral CD4 + T cells in both groups (p<0.01). Residual viremia in plasma decreased in the switch group (p=0.03). However, we did not observe significant longitudinal changes in low-level viral replication, total and integrated HIV reservoir, HIV transcription, T-cell maturation subsets, immunoactivation markers, inflammatory soluble proteins, or cellular markers of latently infected cells. Conclusions: The INDOOR study is the first evaluation of changes in HIV reservoir size in ileum biopsies and in peripheral blood in individuals switched from boosted PI- to DTG-based cART. Although this switch was safe and well tolerated, it had no impact on a large array of immunological and inflammatory markers or on HIV reservoir markers in peripheral or in ileal CD4 + T cells. Clinical Trials Registration: EudraCT no. 2014-004331-39.

9.
Data Brief ; 19: 1498-1503, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30229022

RESUMO

The present data article offers a dataset about the use, knowledge, attitudes, and perceptions of the Internet in the entire of Spanish territory (16-65+). The data is achieved through biennial surveys in 2011 and 2013. This allows observing the evolution of assessments, the perception of use and penetration that different digital services have in the Spanish society. The paper includes some descriptive data that shows characteristic of internet access and Internet consumption among internet users and non-users over 16 years old.

10.
Mucosal Immunol ; 2018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30171206

RESUMO

Human immunodeficiency virus (HIV)-1 infection causes severe gut and systemic immune damage, but its effects on the gut microbiome remain unclear. Previous shotgun metagenomic studies in HIV-negative subjects linked low-microbial gene counts (LGC) to gut dysbiosis in diseases featuring intestinal inflammation. Using a similar approach in 156 subjects with different HIV-1 phenotypes, we found a strong, independent, dose-effect association between nadir CD4+ T-cell counts and LGC. As in other diseases involving intestinal inflammation, the gut microbiomes of subjects with LGC were enriched in gram-negative Bacteroides, acetogenic bacteria and Proteobacteria, which are able to metabolize reactive oxygen and nitrogen species; and were depleted in oxygen-sensitive methanogenic archaea and sulfate-reducing bacteria. Interestingly, subjects with LGC also showed increased butyrate levels in direct fecal measurements, consistent with enrichment in Roseburia intestinalis despite reductions in other butyrate producers. The microbiomes of subjects with LGC were also enriched in bacterial virulence factors, as well as in genes associated with beta-lactam, lincosamide, tetracycline, and macrolide resistance. Thus, low nadir CD4+ T-cell counts, rather than HIV-1 serostatus per se, predict the presence of gut dysbiosis in HIV-1 infected subjects. Such dysbiosis does not display obvious HIV-specific features; instead, it shares many similarities with other diseases featuring gut inflammation.

11.
J Acquir Immune Defic Syndr ; 79(5): 612-616, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30179983

RESUMO

BACKGROUND: Trichloroacetic acid (TCA) and electrocautery ablation (ECA) are 2 of the main treatment options for anal high-grade squamous intraepithelial lesion (HSIL). Our aim was to compare the efficacy and tolerance of TCA vs. ECA for HSIL. METHODS: Retrospective uncontrolled study of HIV-infected men who have sex with men who had an anal HSIL treated with TCA or ECA. On-treatment effectiveness was evaluated at 6-8 weeks after treatment. A complete response was defined as resolution of HSIL, a partial response as regression to low-grade lesion, and recurrence as biopsy-proven HSIL during follow-up. A propensity-score analysis was used to adjust efficacy to potential confounding. RESULTS: From May 2009 to March 2018, 182 and 56 cases of anal HSIL were treated with ECA and TCA, respectively. Comparing ECA with TCA, a complete response was observed in 33.5% (95% confidence interval: 25.8 to 41.6) vs. 60.7% (50.0 to 74.8) and a partial response in 28.0% (20.3 to 36.0) vs. 23.2% (12.5 to 37.3), respectively (P < 0.001). These differences were maintained in the propensity-score analyses. Side effects were common in both treatment, but tolerance was reported as good in 80.6% (74.2 to 89.2) and 82.6% (73.9 to 93.9) of cases treated with ECA and TCA, respectively, and no serious events were described. Recurrence cumulative incidence for the first 12 months was 14.6% (9.1 to 23.1) for ECA episodes and 27.6% (11.5 to 57.7) for TCA (P = 0.183). CONCLUSIONS: Our study showed a higher efficacy of TCA than ECA with similar rates of side effects. In our opinion, considering the benefits of TCA, it should be considered as a first-line therapy for most anal HSIL management.

12.
Arthrosc Tech ; 7(2): e131-e137, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29552479

RESUMO

Posterior cruciate ligament reconstruction using the transtibial technique provides successful clinical outcomes. However, a bone-patellar tendon-bone (BTB) autograft with the transtibial technique has not been used by some surgeons because of concerns with graft passage from the tibial to the femoral tunnels (sharp turn) that can damage graft fibers. In the present surgical technique, an arthroscopic, transtibial, single-bundle technique for posterior cruciate ligament reconstruction using the BTB autograft with an easy and effective technical tip to facilitate graft passage is presented. Once the BTB is harvested, the femoral bone block is divided into 2 equal-sized blocks providing an articulated structure while preserving the tendon component. This facilitates the passage of the BTB tendon once it is entered in the posterior tibia and the graft has to make a sharp turn to reach the femoral tunnel. This easy and effective technique tip may avoid graft damage during the sharp turn, while maintaining all the advantages of a BTB autograft (bone-to-bone healing, own tissue with fast incorporation, and strong fixation and stability).

13.
Open Forum Infect Dis ; 5(1): ofx258, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29354658

RESUMO

Background: We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. Methods: The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. Results: The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Conclusions: Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.

14.
AIDS ; 32(2): 149-160, 2018 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-29112067

RESUMO

OBJECTIVE: To characterize the effect of the HIV-1 infection and antiretroviral treatment (ART) in the human memory B (MEB)-cell compartment. DESIGN: A cross-sectional study was designed to analyze MEB cells of HIV-1 ART treated and ART-naive study participants, and uninfected individuals. METHODS: Frequency and absolute counts of MEB cell subsets in blood were determined by multicolor flow cytometry. Spontaneous cell death and B-cell proliferative capacity was evaluated in vitro by cell culture and flow cytometry. Splenic function was determined by pitted erythrocytes quantification in HIV-1 ART-treated study participants. RESULTS: HIV-1 ART-treated individuals did not show functional hyposplenism despite the lack of recovery IgMIgDCD27 marginal zone-like B cells. Moreover, two germinal center-dependent MEB cells subsets were also dysregulated in HIV-1 individuals: IgMIgDCD27 (IgM only) cells were increased, whereas the switched subset (IgMIgD) was reduced in viremic individuals. Althought ART restored the numbers of these populations; the switched MEB cells were enriched in CD27 cells, which showed the highest susceptibility to spontaneous cell death ex vivo. In addition, B cells from viremic individuals showed a poor response to B-cell receptor and toll-like receptor 9 stimulation that was circumvented when both stimuli were used simultaneously. CONCLUSION: B cells from HIV-1 study participants show a poor stimulation capacity, that may be bypassed by the proper combination of stimuli, and a dysregulated MEB cell pool that suggest an affectation of the germinal center reaction, only partially normalized by ART. Interestingly, hyposplenism does not explain the lack of recovery of the marginal zone-like B cells in ART-treated HIV-1 individuals.


Assuntos
Linfócitos B/imunologia , Infecções por HIV/patologia , Memória Imunológica , Ativação Linfocitária , Subpopulações de Linfócitos/imunologia , Adulto , Antirretrovirais/uso terapêutico , Técnicas de Cultura de Células , Morte Celular , Proliferação de Células , Estudos Transversais , Feminino , Citometria de Fluxo , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Baço/imunologia
15.
Palliat Med ; 32(1): 79-105, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29130387

RESUMO

BACKGROUND: Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. AIM: To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. DESIGN: Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240). DATA SOURCES: PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies. RESULTS: The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as 'miscellany'. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking. CONCLUSION: Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.

16.
Med. paliat ; 24(4): 188-195, oct.-dic. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-167608

RESUMO

Objetivo: Describir la experiencia tras el primer año de funcionamiento de una consulta integrativa de cuidados paliativos en pacientes con mieloma múltiple. Materiales y métodos: Se revisaron las historias clínicas de los pacientes visitados por primera vez en la consulta de cuidados paliativos en pacientes con mieloma múltiple. Durante la primera y las 3 siguientes visitas se evaluaron: dolor, anorexia, estreñimiento, insomnio, náuseas y vómitos, disnea, ansiedad y tristeza; mediante una escala visual numérica [0-10]. Se calculó la carga sintomática de los síntomas físicos y emocionales mediante el sumatorio de las puntuaciones de sus escalas visuales numéricas. La intensidad del dolor y su interferencia se evaluó mediante la versión española del Brief Pain Inventory modificada ad hoc. Resultados: De febrero a diciembre 2013, se visitaron 67 pacientes (mediana desde el diagnóstico 355 días), y tras 3 visitas de seguimiento (mediana 60 días) la proporción de pacientes con dolor moderado-severo (escala visual numérica≥5) se redujo para el «dolor máximo» (57 vs. 18%; p<0,0001) y el «dolor promedio» (24 vs. 2%; p<0,0001). La proporción de pacientes sin interferencia por el dolor mejoró: actividad general (52 vs. 82%; p=0,0001), sueño (73 vs. 91%; p=0,01), estado de ánimo (52 vs. 87,5%; p=0,0001). La carga sintomática física y emocional, y la proporción de pacientes deprimidos (13 vs. 5%; p=0,001) mejoraron. Conclusiones: La integración de los cuidados paliativos en la atención de los pacientes con mieloma múltiple no solo es posible, sino que mejora de forma significativa los síntomas emocionales y físicos (AU)


Aim: To describe the experience after the first year of operation of an integrative palliative care clinic for patients with multiple myeloma. Materials and methods: The medical records were reviewed of patients seen for the first time in the integrative palliative care clinic for patients with multiple myeloma. During the first, and the next 3 visits, pain, anorexia, constipation, insomnia, nausea and vomiting, dyspnoea, anxiety, and sadness were evaluated using a visual numeric scale [0-10]. The symptomatic burden of physical and emotional symptoms was calculated by summing the scores of their visual numeric scale. The pain intensity and its interference were assessed using the Spanish version of the Brief Pain Inventory modified ad hoc. Results: From February to December 2013, 67 patients (median 355 days from diagnosis) were seen, and after 3 follow up visits (median 60 days from the first visit) the proportion of patients with moderate-severe pain (visual numeric scale≥5) was reduced for 'worst pain' (57% vs. 18%; P<.0001) and 'average pain' (24% vs. 2%; P<.0001). The proportion of patients without interference from pain improved in, general activity (52% vs. 82%; P=.0001), sleep (73% vs. 91%; P=.01), and mood (52% vs. 87.5%; P=.0001). There was also improvement in the physical and emotional symptom burden, and the proportion of depressed patients (13% vs. 5%; P=.001). Conclusions: The integration of palliative care in the care of patients with multiple myeloma is not only possible, but also significantly improves the emotional and physical symptoms (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Mieloma Múltiplo/epidemiologia , Cuidados Paliativos na Terminalidade da Vida/métodos , Manejo da Dor/métodos , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Sintomas Afetivos/terapia , Avaliação de Sintomas/métodos
17.
PLoS One ; 12(11): e0187893, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29135988

RESUMO

The aims of this study were to describe the evolution of acute hepatitis C virus (HCV) infections since 2004 and to determine its associated factors. Acute HCV infections diagnosed in Barcelona from 2004 to 2015 were included. Incidence ratios (IR) were then estimated for sex and age groups. Cases were grouped between 2004-2005, 2006-2011 and 2012-2015, and their incidence rate ratios (IRR) were calculated. In addition, risk factors for acute HCV infection were identified using multinomial logistic regression for complete, available and multiple imputed data. 204 new HCV cases were identified. Two peaks of higher IR of acute HCV infection in 2005 and 2013 were observed. Men and those aged 35-54 had higher IR. IRR for men was 2.9 times greater than in women (95% confidence intervals (CI): 1.8 ‒ 4.7). Factors related to the period 2012-2015 (versus 2006-2011) were: a) sexual risk factor for transmission versus nosocomial (relative-risk ratio (RRR): 13.0; 95% CI: 2.3 ‒ 72.1), b) higher educated versus lower (RRR: 5.4; 95% CI: 1.6 ‒ 18.7), and c) HIV co-infected versus not HIV-infected (RRR: 53.1; 95% CI: 5.7 ‒ 492.6). This is one of the few studies showing IR and RRRs of acute HCV infections and the first focused on a large city in Spain. Sexual risk for transmission between men, higher educational level and HIV co-infection are important factors for understanding current HCV epidemic. There has been a partial shift in the pattern of the risk factor for transmission from nosocomial to sexual.


Assuntos
Hepatite C/epidemiologia , Adulto , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha/epidemiologia
18.
J Antimicrob Chemother ; 72(10): 2850-2856, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29091196

RESUMO

Background: New direct-acting antiviral agents (DAAs) have shown great efficacy and tolerability in clinical trials and real-life cohorts. However, data are scarce regarding efficacy and safety in cirrhotic HCV/HIV-coinfected patients. Methods: A multicentre prospective analysis was performed in 13 Spanish hospitals, including all cirrhotic HCV/HIV-coinfected patients starting DAA combinations from January to December 2015. Sustained virological response 12 weeks after treatment (SVR12) was analysed. Withdrawal due to toxicity and/or hepatic decompensation and change in liver stiffness measurement (LSM) after HCV treatment were evaluated. Results: Patients (n = 170) were mostly male (n = 125; 74.3%) with the following HCV genotype (Gt) distribution: Gt-1a, 68 (40%); Gt-1b, 21 (12.4%); Gt-4, 47 (27.6%); and Gt-3, 26 (15.3%). Baseline median LSM was 20.6 kPa (IQR 16.1-33.7) and log10 HCV-RNA 6.1 IU/mL (IQR 5.7-6.5). Most patients had a Child-Pugh class A score (n = 127; 74.7%) and 28 (16.5%) had prior hepatic decompensation. There were 89 (52.4%) pretreated patients with 40.4% (n = 36) of null responders. Preferred regimens were as follows: sofosbuvir/ledipasvir + ribavirin, 43 (25.3%) patients; sofosbuvir + simeprevir + ribavirin, 34 (20%); sofosbuvir/ledipasvir, 26 (15.3%) and sofosbuvir + daclatasvir + ribavirin, 25 (14.7%). Overall SVR12 was 92.9% (158/170), without differences between genotypes. Pretreated patients had lower SVR12 rates compared with naive (88.8% versus 97.5%; P = 0.026). Treatment failures were as follows: 7 (4.1%) relapses; 2 (1.2%) lost to follow-up; 1 (0.6%) toxicity-related discontinuation; 1 (0.6%) hepatic decompensation; and 1 (0.6%) viral breakthrough. On-treatment hepatic decompensation was recorded in four (2.4%) patients (encephalopathy and ascites, two each). Paired LSM in 33 patients showed a decrease of 5.6 kPa (95% CI 1.8-9.2; P = 0.004). Conclusions: In our cohort of cirrhotic HCV/HIV-coinfected patients, DAAs were highly safe and efficacious. Viral eradication was associated with a significant decrease in liver stiffness.


Assuntos
Antivirais/uso terapêutico , Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Cirrose Hepática/complicações , RNA Viral/efeitos dos fármacos , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Benzimidazóis/administração & dosagem , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico , Estudos de Coortes , Coinfecção/virologia , Quimioterapia Combinada/efeitos adversos , Feminino , Fluorenos/administração & dosagem , Fluorenos/efeitos adversos , Fluorenos/uso terapêutico , Genótipo , HIV/efeitos dos fármacos , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/complicações , Hepatite C Crônica/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ribavirina/administração & dosagem , Ribavirina/efeitos adversos , Ribavirina/uso terapêutico , Simeprevir/administração & dosagem , Simeprevir/efeitos adversos , Simeprevir/uso terapêutico , Espanha/epidemiologia , Resposta Viral Sustentada , Resultado do Tratamento , Uridina Monofosfato/administração & dosagem , Uridina Monofosfato/efeitos adversos , Uridina Monofosfato/análogos & derivados , Uridina Monofosfato/uso terapêutico
19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(8): 493-498, oct. 2017. tab, graf
Artigo em Inglês | IBECS | ID: ibc-167836

RESUMO

Introduction: Limited data is available regarding the hepatic safety of maraviroc in patients co-infected with HIV and HCV and/or HBV. Our objective was to compare the hepatic safety profile and fibrosis progression in HIV-mono-infected patients and co-infected with HCV and/or HBV treated with maraviroc. Methods: Retrospective multicentre cohort study of HIV-infected patients receiving treatment with a maraviroc-containing regimen in 27 hospitals in Spain. Results: A total of 667 patients were analyzed, of whom 313 were co-infected with HCV (n=282), HBV (n=14), or both (n=17). Maraviroc main indications were salvage therapy (52%) and drug toxicity (20%). Grade 3-4 hypertransaminasaemia (AST/ALT >5 times ULN) per 100 patient-years of maraviroc exposure, was 5.84 (95% CI, 4.04-8.16) and 1.23 (95% CI, 0.56-2.33) in co-infected and HIV-mono-infected patients, respectively (incidence rate ratio, 4.77; 95% CI, 2.35-10.5). However, the degree of aminotransferase abnormalities remained stable throughout the study in both groups, and no significant between-group differences were seen in the cumulative proportion of patients showing an increase in AST/ALT levels greater than 3.5 times baseline levels. No between-group differences were seen in liver fibrosis over time. With a maraviroc median exposure of 20 months (IQR, 12-41), two patients (0.3%) discontinued maraviroc because of grade 4 hepatitis, and other 2 died due to complications associated to end-stage-liver disease. Conclusions: Maraviroc-containing regimens showed a low incidence of hepatitis in a large Spanish cohort of HIV-infected patients, including more than 300 patients co-infected with HCV and/or HBV. Co-infection did not influence the maximum liver enzyme level or the fibrosis progression throughout the study (AU)


Introducción: La seguridad hepática del maraviroc en pacientes coinfectados por VIH y VHC y/o VHB es poco conocida. Nuestro objetivo es comparar el riesgo de hepatitis y la progresión de la fibrosis hepática en pacientes monoinfectados por VIH y coinfectados por VHC y/o VHB, tratados con maraviroc. Métodos: Estudio de cohortes, retrospectivo, en pacientes infectados por VIH, tratados con maraviroc en 27 hospitales españoles. Resultados: Analizamos 667 pacientes, 313 coinfectados por VHC (n=282), VHB (n=14) o ambos (n=17). El rescate (52%), y la toxicidad farmacológica (20%) fueron las principales indicaciones de tratamiento con maraviroc. La incidencia de hipertransaminasemia de grado 3-4 (AST o ALT >5 veces el LSN), por 100 paciente-años de exposición a maraviroc, fue 5,84 (IC 95%, 4,04-8,16) y 1,23 (IC 95%, 0,56-2,33) en coinfectados y monoinfectados por VIH, respectivamente (razón de tasas, 4,77; IC95%, 2,35-10,5). No se observaron diferencias en la proporción acumulada de pacientes con elevación de AST o ALT mayor de 3,5 veces respecto al valor basal, ni en la progresión de la fibrosis hepática entre ambos grupos. Tras una mediana de tratamiento de 20 meses (AIC, 12-41), dos pacientes (0,3%) discontinuaron el maraviroc por hepatitis de grado 4, y dos pacientes fallecieron por enfermedad hepática. Conclusiones: En una cohorte española de pacientes infectados por VIH que incluye más de 300 pacientes coinfectados por VHC y/o VHB, maraviroc mostró una baja incidencia de hepatitis. La coinfección no afectó al grado de elevación de las transaminasas ni a la progresión de la fibrosis hepática (AU)


Assuntos
Humanos , Masculino , Adulto , Coinfecção/microbiologia , Infecções por HIV/complicações , Hepatite C/complicações , Hepatite B/complicações , Cirrose Hepática/microbiologia , Estudos de Coortes , Estudos Retrospectivos , Hepatopatias/complicações , Hepatopatias/mortalidade , Transaminases/análise , Cirrose Hepática/prevenção & controle
20.
Case Rep Orthop ; 2017: 8284548, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28798878

RESUMO

Knee cartilage or osteochondral lesions are common and challenging injuries. To date, most symptomatic lesions warrant surgical treatment. We present two cases of patients with knee osteochondral defects treated with a one-step surgical procedure consisting of an autologous-based matrix composed of healthy hyaline cartilage chips, mixed plasma poor-rich in platelets clot, and plasma rich in growth factors (PRGF). Both patients returned to playing soccer at the preinjury activity level and demonstrated excellent defect filling in both magnetic resonance imaging and second-look arthroscopy (in one of them). The use of a clot of autologous plasma poor in platelets with healthy hyaline cartilage chips and intra-articular injection of plasma rich in platelets is an effective, easy, and cheap option to treat knee cartilage injuries in young and athletic patients.

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