Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
AIDS ; 32(7): 913-920, 2018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29424785

RESUMO

OBJECIVE: Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to assess bone health in HIV patients. DXA measures the amount of mineral, but not other key aspects of bone strength such as bone microarchitecture or bone quality. Trabecular bone score (TBS) and in-vivo microindentation directly measure trabecular microarchitecture and bone tissue quality, respectively. The aim of this study is to measure bone strength properties using these techniques. RESULTS: Forty naive HIV patients who were going to start antiretroviral therapy (ART), a single pill treatment with elvitegravir/cobicistat, tenofovir disoproxil fumarate (TDF), emtricitavine (FTC) were included. A significant reduction in BMD at spine (-3.25%, P < 0.001) and in femoral neck (-3.82%, P = 0.016) between baseline and 48 weeks of treatment were found. Bone microarchitecture score at the spine, as measured by TBS, also significantly decreased from 1.357 (0.09) to 1.322 (0.09) (-2.5%, P = 0.011) between baseline to 48 weeks of treatment. Microindentation (BMSi) values were significantly higher than at baseline [89.04 (4.2) versus 86.07 (6.1); 3.49%, P < 0.001] after 48 weeks of TDF-based ART treatment, indicating improved bone material properties CONCLUSION:: A significant decrease in BMD and TBS were observed after 1 year of TDF therapy. However, tissue quality significantly improved after 1 year of treatment, suggesting a recovery of bone material properties following the control of the infection despite the significant reduction of BMD. These techniques provide additional and necessary information to DXA about bone health in treated HIV patients, and because of its convenience and feasibility they could be routinely apply to assess bone in clinical practice.

2.
J Acquir Immune Defic Syndr ; 75(3): 322-327, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28418990

RESUMO

OBJECTIVES: HIV infection has been associated with reduced bone mineral density (BMD). Antiretroviral therapy (ART) has a deleterious effect on BMD, but its effect on bone fragility is not clear. The objective of this study is to analyze the BMD, microarchitecture, and tissue quality of bone in patients receiving long-term tenofovir- or abacavir-based ART. DESIGN: We conducted a cross-sectional study in patients with HIV undergoing tenofovir or abacavir ART for more than 5 years. METHODS: We measured BMD using dual X-ray absorptiometry ,bone michroarchitecture using trabecular bone score (TBS), and bone tissue quality using microindentation. TBS is a dual X-ray absorptiometry-based software that is more highly correlated with bone fragility than BMD. Microindentation (BMSi) directly assesses bone quality at the tissue level. RESULTS: A total of 63 patients were included in this study, with 36 belonging to the TDF-FTC group and 27 to the ABC-3TC group. Patients receiving TDF-FTC treatment showed lower BMD values than those in the ABC-3TC group. We found no differences in TBS or microindentation between the 2 groups. However, after adjusting for sex, age, body mass index, and 25[OH]vitD we found lower BMSi and thus poorer bone properties in the TDF-FTC group than in the ABC-3TC group [beta coefficient -3.594 (confidence interval: 95% -0.12 to -7.61); P = 0.043]. CONCLUSIONS: Long-term treatment with TDF-FTC leads to impaired bone health, not only in terms of BMD but also in terms of bone quality, another determinant of overall bone strength. To complement BMD-based predictions, these other techniques may also be used to identify patients with excess fracture risk.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Didesoxinucleosídeos/efeitos adversos , Emtricitabina/efeitos adversos , Infecções por HIV/fisiopatologia , Lamivudina/efeitos adversos , Tenofovir/efeitos adversos , Absorciometria de Fóton , Fármacos Anti-HIV/administração & dosagem , Remodelação Óssea , Estudos Transversais , Didesoxinucleosídeos/administração & dosagem , Combinação de Medicamentos , Emtricitabina/administração & dosagem , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lamivudina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Espanha , Tenofovir/administração & dosagem
3.
Rev. esp. quimioter ; 29(3): 119-121, jun. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-153085

RESUMO

We report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy (AU)


Presentamos un estudio cuasi-experimental de la aplicación de un programa de uso de terapia antimicrobiana en dos salas quirúrgicas, con un período de pre-intervención en que se realizó evaluación de la prescripción y un período de intervención con una auditoría prospectiva sobre la prescripción antibiótica siguiendo un modelo de recomendación. Hubo una reducción significativa de la estancia media y del total de días de tratamiento antibiótico. No hubo diferencias en la mortalidad entre los grupos. El programa de uso de terapia antimicrobiana condujo a la detección precoz de tratamiento antibiótico empírico inadecuado y se asoció con una reducción significativa de la estancia media y la duración total de la terapia antimicrobiana (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Salas Cirúrgicas , Antibacterianos/uso terapêutico , Estudos Prospectivos , Diagnóstico Precoce , Tempo de Internação/economia , Tempo de Internação/legislação & jurisprudência , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Cefotaxima/uso terapêutico , Ciprofloxacino/uso terapêutico , Piperacilina/uso terapêutico
4.
J Acquir Immune Defic Syndr ; 72(3): 314-8, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-26910501

RESUMO

Low bone mineral density (BMD) in HIV-infected individuals has been documented in an increasing number of studies. However, it is not clear whether it is the infection itself or the treatment that causes bone impairment. Microindentation measures bone material strength (Bone Material Strength index) directly. We recruited 85 patients, 50 infected with HIV and 35 controls. Median Bone Material Strength index was 84.5 (interquartile range 83-87) in HIV-infected patients and 90 (88.5-93) in controls (P < 0.001). No significant differences in BMD between cases and controls at any of the sites examined (total hip, femoral neck, and lumbar spine). HIV infection is associated with bone damage, independently of BMD.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Colo do Fêmur/patologia , Infecções por HIV/complicações , Vértebras Lombares/patologia , Osteoporose/patologia , Absorciometria de Fóton , Adulto , Fármacos Anti-HIV/efeitos adversos , Densidade Óssea , Estudos Transversais , Feminino , Colo do Fêmur/virologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Vértebras Lombares/virologia , Masculino , Pessoa de Meia-Idade , Osteoporose/virologia , Medição de Risco , Espanha
5.
Aten. prim. (Barc., Ed. impr.) ; 44(2): 97-106, feb. 2012.
Artigo em Espanhol | IBECS | ID: ibc-97937

RESUMO

Objetivo: Probar la eficacia y aceptabilidad de intervenciones cortas tipo ensayo-formación en el manejo de urgencias o emergencias sanitarias (EMS). Diseño: Combinado: serie de casos y estudio controlado de antes y después de una intervención formativa. Emplazamiento: Centro de salud (CS). Participantes: Equipo de guardia, 2 monitores-dinamizadores, un maniquí. Mediciones principales: Variables: tiempos de respuesta, actuación del personal, uso de recursos y opinión. Estructuración: escenarios y mensajes clave. Elaboración de instrumentos: 1) encuesta inicial/final; 2) tiempos y sucesos esenciales/no esenciales; y 3) encuesta-opinión post-ensayo. Realización de 6 ensayos consecutivos quincenales de 15’ (incluyendo correcciones) y encuesta tras cada ensayo. Al mes, repetición en orden aleatorizado y similares condiciones. Análisis: medidas repetidas. Resultados: Cumplimentaron la encuesta inicial 93 (2/3) trabajadores; 74 la final. Cuarenta y seis intervinientes (25 médicos, 7 enfermeras, 21 no sanitarios) completaron 95 intervenciones directas. Coincidencia de participantes > 80% entre series. Se evidenció una reducción del intervalo detección colapso-primera desfibrilación (de 10 a 4min); mejoraron por 2-3 los tiempos de sucesos EMS y la «sensación de seguridad durante una EMS real» (de 23 a 71% entre los participantes). La gran mayoría de participantes declararon «útiles las correcciones realizadas por el dinamizador». Se incrementó moderadamente la proporción de quienes «verían bien la implementación de ensayos» y de quienes «necesitaban reciclarse en EMS» (67,4 vs. 85% en sanitarios). No se modificó: «se atrevían a hacer SVB». Conclusiones: A pesar de ser reducido en número y duración, este modelo de intervención ha mostrado tendencias positivas en términos de aprovechamiento y aceptabilidad para su implementación en el CS(AU)


Objective: Test effectiveness and acceptability of interventions short essay-type training in health emergency management (EM). Design: Combined case series and controlled study before and after training sessions. Location: Health Center (HC). Participants: Team on duty, two monitors-facilitators, and a mannequin. Main measures: Variables: response times, staff performance, resource usage and opinion. Structure: scenarios and key messages. Instrument development: 1. Initial/final questionnaire and events. 2. Essential/non-essential times; 3. Post-test opinion questionnaire. Performance of six consecutive 15 min tests fortnightly (including corrections) and poll after each test. A month later, repeat in random order and under similar conditions. Analysis: repeated measures. Results: A total of 93 (2/3) workers completed the initial survey, and 74 the final, with 46 participants (25 doctors, 7 nurses, 21 non-health completed 95 direct interventions. Matching participants > 80% between series. A reduction was seen in the “detection of collapse to first defibrillation” interval (10 to 4min). EM events improved 2-3 fold and “sense of security during a real EM” increased from 23% to 71% among participants. The vast majority of participants said “useful corrections made by the facilitator.” The proportions of those who “would like to see tests introduced” and those who said “re-training was needed in EM” were moderately increased (67.4% vs 85% in health care workers). The “would like to attempt basic life support” was unchanged. Conclusion: Despite being reduced in number and duration, this model of intervention has shown positive trends in terms of use and acceptability for implementation in the HC(AU)


Assuntos
Humanos , Masculino , Feminino , Emergências , Atenção Primária à Saúde/ética , Atenção Primária à Saúde/legislação & jurisprudência , Resultado do Tratamento , Emergências/economia , Emergências/epidemiologia , Emergências/psicologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos
6.
Aten Primaria ; 44(2): 97-106, 2012 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-21632154

RESUMO

OBJECTIVE: Test effectiveness and acceptability of interventions short essay-type training in health emergency management (EM). DESIGN: Combined case series and controlled study before and after training sessions. LOCATION: Health Center (HC). PARTICIPANTS: Team on duty, two monitors-facilitators, and a mannequin. VARIABLES: response times, staff performance, resource usage and opinion. Structure: scenarios and key messages. Instrument development: 1. Initial/final questionnaire and events. 2. Essential/non-essential times; 3. Post-test opinion questionnaire. Performance of six consecutive 15 min tests fortnightly (including corrections) and poll after each test. A month later, repeat in random order and under similar conditions. ANALYSIS: repeated measures. RESULTS: A total of 93 (2/3) workers completed the initial survey, and 74 the final, with 46 participants (25 doctors, 7 nurses, 21 non-health completed 95 direct interventions. Matching participants > 80% between series. A reduction was seen in the "detection of collapse to first defibrillation" interval (10 to 4 min). EM events improved 2-3 fold and "sense of security during a real EM" increased from 23% to 71% among participants. The vast majority of participants said "useful corrections made by the facilitator." The proportions of those who "would like to see tests introduced" and those who said "re-training was needed in EM" were moderately increased (67.4% vs 85% in health care workers). The "would like to attempt basic life support" was unchanged. CONCLUSION: Despite being reduced in number and duration, this model of intervention has shown positive trends in terms of use and acceptability for implementation in the HC.


Assuntos
Medicina de Emergência/educação , Tratamento de Emergência/normas , Humanos , Estudos Longitudinais , Projetos Piloto , Melhoria de Qualidade , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA