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1.
Artigo em Inglês | MEDLINE | ID: mdl-30929024

RESUMO

Data for a total of 57 patients vertically coinfected with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) and 365 HIV-monoinfected patients were compared until their transition to adult care. No differences regarding the dynamics of CD4 and/or CD8 T-cell counts during childhood were found. The coexistence of HCV does not increase the risk of disease progression in vertically HIV-infected patients.

4.
Med. clín (Ed. impr.) ; 134(5): 189-193, feb. 2010. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-82726

RESUMO

Fundamento y objetivo: Conocer el riesgo de fractura estimado con el aplicativo FRAX® en pacientes tratados y no tratados según la práctica clínica habitual. Pacientes y método: De una base de datos sobre factores de riesgo de osteoporosis y fractura, que incluye determinaciones densitométricas, se seleccionó a todos los pacientes que cumplían los siguientes criterios: 1) edad entre 40 y 90 años; 2) disponer del peso y la talla; 3) tener el primer estudio densitométrico por densitometría ósea de rayos X de doble energía después de septiembre de 2005; 4) conocer la intervención terapéutica realizada después de la densitometría ósea, y 5) no haber realizado tratamiento previo a la primera densitometría. El cálculo del riesgo de fractura se realizó con la aplicación disponible en la web durante el mes de junio de 2008. Resultados: Se incluyó a 192 personas (45 varones), de las que 81 recibieron tratamiento después de la densitometría. Los pacientes tratados tenían mayor número de factores de riesgo (media [DE] de 1,06 [0,97] e intervalo de confianza [IC] del 95%: 0,88–1,24 frente a 1,49 [1,03] e IC del 95%: 1,27–1,71; p=0,003). El riesgo de fractura fue superior en los pacientes tratados en todos los grupos (fractura mayor y fractura del fémur, con y sin densitometría). En todos los casos, el riesgo de fractura fue mayor cuando no se utilizó el valor densitométrico. En pacientes menores de 65 años, el riesgo de fractura fue significativamente inferior al de los pacientes de más de 64 años en todos los casos (AU)


Background and objective: To estimate the fracture risk with the FRAX® in patients treated and not treated in clinical practice. Material and methods: From a database of risk factors for osteoporosis and fracture, that included absorptiometry measurements, we selected all patients who met the following criteria: 1) Age between 40 and 90 years, 2) to have the weight and size, 3) To have the first study by DXA scan after September 2005, 4) To know the therapeutic intervention made after bone densitometry, and 5) Not have done any treatment before the first densitometry. The calculation of the fracture risk was achieved with the application available on the Web during June 2008. Results: One hundred and ninety two people (45 men) were included, 81 of which received treatment after densitometry. Treated patients had more risk factors (1,06±0,97 [IC 95% 0,88–1,24] vs. 1,49±1,03 [IC 95% 1,27–1,71], p=0,003). Fracture risk was higher in treated patients in all groups (major osteoporotic fracture and hip fracture, with and without bone absorptiometry). In all cases, fracture risk was lower when using the densitometric value. In patients younger than 65 years, the fracture risk was significantly lower than in patients over 64 years in all cases. Conclusions: The risk of fracture measured by the FRAX® is higher in patients receiving treatment, although there is a significant overlap between the two groups (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoporose/complicações , Fraturas Ósseas/epidemiologia , Osteoporose/tratamento farmacológico , Fraturas Ósseas/etiologia , Densidade Óssea , Estudos Transversais , Densitometria , Algoritmos
5.
Med Clin (Barc) ; 134(5): 189-93, 2010 Feb 20.
Artigo em Espanhol | MEDLINE | ID: mdl-19931877

RESUMO

BACKGROUND AND OBJECTIVE: To estimate the fracture risk with the FRAX in patients treated and not treated in clinical practice. MATERIAL AND METHODS: From a database of risk factors for osteoporosis and fracture, that included absorptiometry measurements, we selected all patients who met the following criteria: 1) Age between 40 and 90 years, 2) to have the weight and size, 3) To have the first study by DXA scan after September 2005, 4) To know the therapeutic intervention made after bone densitometry, and 5) Not have done any treatment before the first densitometry. The calculation of the fracture risk was achieved with the application available on the Web during June 2008. RESULTS: One hundred and ninety two people (45 men) were included, 81 of which received treatment after densitometry. Treated patients had more risk factors (1,06 + or - 0,97 [IC 95% 0,88-1,24] vs. 1,49 + or - 1,03 [IC 95% 1,27-1,71], p=0,003). Fracture risk was higher in treated patients in all groups (major osteoporotic fracture and hip fracture, with and without bone absorptiometry). In all cases, fracture risk was lower when using the densitometric value. In patients younger than 65 years, the fracture risk was significantly lower than in patients over 64 years in all cases. CONCLUSIONS: The risk of fracture measured by the FRAX is higher in patients receiving treatment, although there is a significant overlap between the two groups.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Osteoporose/complicações , Algoritmos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Medição de Risco/métodos
7.
J Gastrointestin Liver Dis ; 18(1): 99-101, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19337644

RESUMO

Epithelioid cell granulomas are more commonly seen in Hodgkin's disease and T cell lymphomas. Rarely florid granulomatous reaction with necrosis may be a prominent feature in lymphoma. To the best of our knowledge, a total of 11 cases of Burkitt's lymphoma with florid necrotizing granulomas have been reported in the English literature. None of these cases have previously had the stomach involved. Here we report a gastric Burkitt's lymphoma with florid granulomatous reaction diagnosed following a partial gastrectomy. The initial gastric biopsy showed granulomatous gastritis but the radiological and endoscopic appearance was that of a gastric stromal tumour. We conclude that in the presence of a mass lesion, the finding of epithelioid granulomas should warrant re-biopsy to establish an accurate diagnosis and exclude a concurrent malignant process. Hence, major surgery and postoperative complications can be avoided and appropriate treatment regimen can be initiated.


Assuntos
Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/terapia , Células Epitelioides/patologia , Granuloma/diagnóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Quimioterapia Adjuvante , Criança , Erros de Diagnóstico/prevenção & controle , Células Epitelioides/diagnóstico por imagem , Feminino , Gastrectomia , Tumores do Estroma Gastrointestinal/diagnóstico , Granuloma/cirurgia , Humanos , Necrose , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Reumatol. clín. (Barc.) ; 4(3): 96-99, mayo-jun. 2008. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-78033

RESUMO

Objetivo: Evaluar el efecto de la coexistencia de fibromialgia y artritis reumatoide en el valor del índice DAS28 en mujeres. Pacientes y método: Se incluyó a 53 mujeres con artritis reumatoide (9 con fibromialgia y 44 sin fibromialgia) visitadas de forma consecutiva en una consulta extrahospitalaria de reumatología. Se recogieron la velocidad de sedimentación globular (VSG), la PCR, el número de articulaciones dolorosas y tumefactas, la valoración general de las pacientes mediante escala visual analógica y otros parámetros referentes a la enfermedad articular y el estado funcional y emocional de las pacientes. Resultados: No se encontraron diferencias significativas en la edad de las pacientes, la duración de la artritis, el número de articulaciones tumefactas, la VSG y la PCR; por el contrario, hubo diferencias en el número de articulaciones dolorosas, la evaluación global de la enfermedad por las pacientes y en aspectos funcionales y emocionales. El DAS28 fue mayor en las mujeres que tenían fibromialgia asociada (5,55 ± 0,78 frente a 3,39 ± 1,15; p = 0,000). Conclusiones: La coexistencia de fibromialgia en mujeres con artritis reumatoide se asocia a un mayor valor del DAS28 (AU)


Objective: To compare the effect of coexisting fibromyalgia in DAS28 in RA female patients. Patients and method: Fifty-three RA women seen consecutively in an outpatient rheumatology clinic were included and classified according to the presence (9 women) or absence (44 women) of fibromyalgia. ESR, number of tender and swollen joints, and global assessment by the patient through a visual analogue scale were recorded, as well as other functional and emotional variables. Results: There were no differences in age, time since onset of the arthritis, number of swollen joints, ESR, and CRP. Number of tender joints, global assessment by the patient, and functional and emotional aspects were worse in patients with fibromyalgia. DAS28 was higher when fibromyalgia was associated to RA (5.55±0.78 vs 3.39± 1.15; P=.000). Conclusions: Coexistence of fibromyalgia increases DAS28 in women with RA (AU)


Assuntos
Humanos , Feminino , Artrite Reumatoide/complicações , Fibromialgia/complicações , Índice de Gravidade de Doença , Distribuição por Idade , Estudos Transversais , Comorbidade , Antirreumáticos/uso terapêutico
9.
Reumatol Clin ; 4(3): 96-9, 2008 May.
Artigo em Espanhol | MEDLINE | ID: mdl-21794508

RESUMO

OBJECTIVE: To compare the effect of coexisting fibromyalgia in DAS28 in RA female patients. PATIENTS AND METHOD: Fifty-three RA women seen consecutively in an outpatient rheumatology clinic were included and classified according to the presence (9 women) or absence (44 women) of fibromyalgia. ESR, number of tender and swollen joints, and global assessment by the patient through a visual analogue scale were recorded, as well as other functional and emotional variables. RESULTS: There were no differences in age, time since onset of the arthritis, number of swollen joints, ESR, and CRP. Number of tender joints, global assessment by the patient, and functional and emotional aspects were worse in patients with fibromyalgia. DAS28 was higher when fibromyalgia was associated to RA (5.55 ± 0.78 vs 3.39 ± 1.15; P = .000). CONCLUSIONS: Coexistence of fibromyalgia increases DAS28 in women with RA.

10.
J Card Fail ; 12(8): 621-7, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17045181

RESUMO

BACKGROUND: This study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure. METHODS AND RESULTS: Prospective study conducted with 371 patients, age 65 and older, admitted for heart failure-related emergencies at 4 Spanish hospitals. Social network was measured at baseline with a 4-item questionnaire that ascertained whether subjects were married, lived with another person(s), saw or had telephone contact with family members daily or almost daily, and were at home alone for less than 2 hours per day. Social network was deemed "high" where all 4 items were present, "moderate" where 3 were present, and "low" where 2 or fewer were present. Analyses were performed using Cox models, and adjusted for the main confounders. A total of 55% of patients had high or moderate social networks. During a median follow-up of 6.5 months, 135 (36.4%) patients underwent a first emergency rehospitalization and 68 (18.3%) died. Compared with patients with high social network, hospital readmission was more frequent among those who had moderate (hazard ratio [HR] 1.87; 95% confidence interval [CI] 1.06-3.29; P < .05) and low social networks (HR 1.98; 95% CI 1.07-3.68; P < .05). This relationship showed a positive dose-response (p for linear trend 0.042). The magnitude of this association was comparable to that of other important predictors of readmission, such as previous hospitalization. No relationship was observed between social network and death. CONCLUSION: A very simple questionnaire measuring social network can identify patients with a higher short-term risk of hospital readmission.


Assuntos
Baixo Débito Cardíaco/mortalidade , Readmissão do Paciente , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco/métodos , Inquéritos e Questionários
11.
Rev Esp Cardiol ; 59(8): 770-8, 2006 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-16938225

RESUMO

INTRODUCTION AND OBJECTIVES: This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. METHODS: The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. RESULTS: In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). CONCLUSIONS: Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.


Assuntos
Depressão/epidemiologia , Depressão/etiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Prevalência , Espanha/epidemiologia
12.
Rev. esp. cardiol. (Ed. impr.) ; 59(8): 770-778, ago. 2006. tab
Artigo em Espanhol | IBECS | ID: ibc-136482

RESUMO

Introducción y objetivos. En este trabajo se estima la prevalencia de depresión y se identifican los factores biomédicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en España. Métodos. Se estudió a 433 pacientes ≥ 65 años ingresados de urgencia en 4 hospitales españoles desde enero de 2000 hasta junio de 2001, con diagnóstico principal o secundario de insuficiencia cardiaca. Se consideró que había depresión ante la presencia de 3 síntomas en la Escala de Depresión Geriátrica de 10 ítems. Resultados. Del total de pacientes estudiados, 210 (48,5%) presentaron depresión. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresión fue más frecuente en los pacientes con las siguientes características: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuación en los aspectos físicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades básicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o más ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitación en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28- 3,79); hospitalización previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa más de 2 h al día (ORa = 3,24; IC del 95%, 1,93- 5,45); menor satisfacción con el médico de atención primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones. La depresión es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomédicos y psicosociales. Esta elevada frecuencia, el peor pronóstico de la insuficiencia cardiaca en presencia de síntomas depresivos y la existencia de instrumentos diagnósticos sencillos y un tratamiento eficaz apoyan el cribado sistemático de la depresión en estos pacientes (AU)


Introduction and objectives. This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. Methods. The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. Results. In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for ≥3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). Conclusions. Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Depressão/epidemiologia , Depressão/etiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/psicologia , Hospitalização , Insuficiência Cardíaca/terapia , Prevalência , Espanha/epidemiologia
13.
Pediatr Infect Dis J ; 24(10): 867-73, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16220083

RESUMO

INTRODUCTION: Many human immunodeficiency virus type 1 (HIV-1)-infected children have already failed treatment with 2 or even 3 classes of antiretrovirals. Coformulation of lopinavir with low dose ritonavir exhibits a potent antiretroviral effect. However, the data in heavily pretreated children are still scarce. This study evaluated the safety and effectiveness of combination therapy including lopinavir/ritonavir in children with prior exposure to all classes of oral antiretrovirals. METHODS: This was an open label multicenter observational study, in which data were reviewed according to a standardized protocol. The study population included all HIV-1-infected children with virologic failure (HIV-1 RNA >5000 copies/mL) followed in 12 Spanish hospitals for >12 months, experienced with the 3 classes of oral antiretrovirals, in whom a lopinavir/ritonavir-containing regimen was started. RESULTS: By March 2003, 45 patients had been treated with lopinavir/ritonavir for a median of 18 months (range, 3-28). The median age at baseline was 9.7 years (range, 4.3-17.1). The median times of prior treatment were 88 months (range, 31-145) with nucleoside reverse transcription inhibitors and 42 months (range, 19-63) with protease inhibitors. Twenty-five patients were classified as Centers for Disease Control and Prevention clinical category C. Median values for absolute and percentage CD4 at baseline were 501 (range, 6-1512) and 19% (range, 0.5-49), respectively, and plasma HIV-RNA was 5.0 log10 copies/mL (range, 4.1-6.1). During follow-up, 11 (24%) children switched from liquid to solid formulation. At 48 weeks, the median values for absolute and percentage CD4 increased by 199 cells/microL and 3%, respectively, and median plasma viral load declined 1.75 log10 copies/mL. Forty-two percent of children achieved a plasma RNA of <400 copies/mL (intent to treat analysis). Baseline genotypic resistance was available in 40 children. Nonresponders had 7.0 +/- 1.6 protease inhibitor-associated mutations at baseline compared with 4.8 +/- 1.7 in children achieving virologic suppression (P = 0.06). Adverse events were described in 18 children. Three children permanently discontinued and 4 transiently withdrew lopinavir/ritonavir. At 12 months, there were mild but not significant increases in plasma cholesterol and triglycerides. CONCLUSIONS: Lopinavir/ritonavir when given as part of salvage regimen is well-tolerated, although switching to pills is frequently required. The regimen has a potent and durable antiretroviral activity in most heavily pretreated children, despite the presence of multiple mutations to all classes of oral antiretrovirals.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Pirimidinonas/efeitos adversos , Inibidores da Transcriptase Reversa/uso terapêutico , Ritonavir/efeitos adversos , Adolescente , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Infecções por HIV/virologia , Humanos , Lopinavir , Masculino , Pirimidinonas/uso terapêutico , RNA Viral/sangue , Ritonavir/uso terapêutico , Terapia de Salvação , Resultado do Tratamento
14.
Arch Intern Med ; 165(11): 1274-9, 2005 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-15956007

RESUMO

BACKGROUND: We sought to examine the relationship between health-related quality of life (HRQL) and a first emergency rehospitalization and mortality in patients with heart failure (HF) having a wide variation in ventricular ejection fraction and functional status. METHODS: Prospective study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals. Baseline HRQL was measured with a generic questionnaire, the Medical Outcomes Study 36-item Short Form Survey (SF-36), and with an HF-specific instrument, the Minnesota Living With Heart Failure (MLWHF) questionnaire. Cox proportional hazards models were used to calculate hazard ratios (HRs) for hospitalization and death on the basis of HRQL scores. RESULTS: During a median follow-up of approximately 6 months, 138 patients (35.0%) underwent a first emergency rehospitalization and 70 (17.8%) died. After adjustment for biomedical, psychosocial, and health care variables, the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning (HR, 1.65; 95% confidence interval [CI], 1.11-2.44; P = .01), general health (HR, 1.73; 95% CI, 1.19-2.52; P = .003), and mental health (HR, 1.65; 95% CI, 1.10-2.47; P = .02) subscales. Results were similar for the mortality end point. For the MLWHF questionnaire, worse overall and worse physical and emotional summary scores were associated with higher mortality. CONCLUSIONS: Worse HRQL is associated with hospital readmission and death in patients with HF. The magnitude of this association, for both physical and mental HRQL components, is comparable to that for other well-known predictors of hospital readmission and death, such as personal history of diabetes, previous hospitalizations, and treatment with angiotensin-converting enzyme inhibitors.


Assuntos
Insuficiência Cardíaca/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Indicadores Básicos de Saúde , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Espanha/epidemiologia
15.
Enferm Infecc Microbiol Clin ; 23(5): 279-312, 2005 May.
Artigo em Espanhol | MEDLINE | ID: mdl-15899180

RESUMO

OBJECTIVE: To update antiretroviral recommendations in antiretroviral therapy (ART) in HIV-infected children and adolescents. METHODS: Theses guidelines have been formulated by a panel of members of the Plan Nacional sobre el SIDA (PNS) and the Asociacion Espanola de Pediatria (AEP) by reviewing the current available evidence of efficacy, safety, and pharmacokinetics in pediatric studies. Three levels of evidence have been defined according to the source of data: Level A: randomized and controlled studies; Level B: Cohort and case-control studies; Level C: Descriptive studies and experts' opinion. RESULTS: When to start ART should be made on an individual basis, discussed with the family, considering the risk of progression according to age, CD4 and viral load, the ART-related complications and adherence. The ART goal is to reach a maximum and durable viral suppression. This is not always possible, even with clinical and immunologic improvement. The difficulties of permanent adherence and side-effects are resulting in a more conservative trend to initiate ART, and to less toxic and simpler strategies. Currently, combinations of at least three drugs are of first choice both in acute and chronic infection. They must include 2 NA 1 1 NN or 2 NA 1 1 PI. ART is recommended in all symptomatic patients and, with few exceptions, in all infants in the first year of life. Older asymptomatic children should start ART according to CD4 count, especially CD4 percentage, that vary with age. Despite potent salvage therapies, it is common not to reach viral undetectability. Therapeutical options when ART fails are scarce due to cross-resistance. The cause of failure must be identified. Occasionally, there exists clinical and/or immunological progression, and a change of therapy with at least two new drugs still active for the patient, is warranted with the aim of increasing the CD4 count to a lower level of risk. Toxicity and adherence must be regularly monitored. Some aspects about post exposure prophylaxis and coinfection with HCV or HBV are discussed. CONCLUSIONS: A higher level of evidence with regard to ART effectiveness and toxicity in pediatrics is currently available, leading to a more conservative and individualized approach. Clinical symptoms and CD4 count are the main determinants to start and change ART.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , HIV-1 , Adolescente , Terapia Antirretroviral de Alta Atividade/métodos , Terapia Antirretroviral de Alta Atividade/normas , Criança , Ensaios Clínicos como Assunto , Humanos , Espanha
16.
Rev. Asoc. Esp. Neuropsiquiatr ; 21(79): 91-99, jul. 2001. tab
Artigo em Espanhol | IBECS | ID: ibc-112288

RESUMO

Este trabajo se propone investigar como está distribuida la asunción de tareas asistenciales entre los profesionales de salud mental de la Comunidad de madrid, fundamentalmente psiquiatras y psicólogos. A la luz de estos datos, analiza hasta donde se refrenda y potencia el modelo comunitario de atención, supuestamente basado en la interdisciplinariedad y las responsabilidades compartidas(AU)


The objective of this article is to research how the clinical work (diagnosis, treatments, etc) is distributed among the mental health professionals of the Community of Madrid, mainly between psychiatrist and psychologists. the community mental health based ont he interdisciplinary team is also analyzed(AU)


Assuntos
Humanos , Masculino , Feminino , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente , Estudos Interdisciplinares/tendências , Psicologia Clínica/métodos , Psicologia Clínica/normas , Psicologia Clínica/tendências , Psiquiatria Comunitária/métodos , Psiquiatria Comunitária/tendências , Psicoterapia/métodos , Psicoterapia/tendências , Equipe de Assistência ao Paciente , Estudos Interdisciplinares/normas , Saúde Mental/normas , Saúde Mental/tendências , Serviços de Saúde Comunitária/normas , /organização & administração , Inquéritos e Questionários
17.
Medicina [B.Aires] ; 56(4): 423-8, 1996.
Artigo em Espanhol | BINACIS | ID: bin-21401

RESUMO

En el tratamiento del cáncer colorrectal la cirurgía es, sin lugar a dudas, la modalidad "standard" en aquellos pacientes potencialmente curables. El concepto de quimioterapia precaucional, utilizada en tumores de otras localizaciones, ha impulsado ensayos clínicos que demonstraron efectividad y mejoría de la sobrevida. En este artículo analizamos la utilización de dos modalidades (quimioterapia y radioterapia) junto con la cirurgía como parte de un tratamiento multidisciplinario en pacientes portadores de cáncer colorrectal. (AU)


Assuntos
Humanos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/radioterapia , Neoplasias Retais/cirurgia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Prognóstico
18.
Medicina (B.Aires) ; 56(4): 423-8, 1996.
Artigo em Espanhol | LILACS | ID: lil-186266

RESUMO

En el tratamiento del cáncer colorrectal la cirurgía es, sin lugar a dudas, la modalidad "standard" en aquellos pacientes potencialmente curables. El concepto de quimioterapia precaucional, utilizada en tumores de otras localizaciones, ha impulsado ensayos clínicos que demonstraron efectividad y mejoría de la sobrevida. En este artículo analizamos la utilización de dos modalidades (quimioterapia y radioterapia) junto con la cirurgía como parte de un tratamiento multidisciplinario en pacientes portadores de cáncer colorrectal.


Assuntos
Humanos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/radioterapia , Prognóstico , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia
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