Influence of the number of daily pills and doses on adherence to antiretroviral treatment: a 7-year study.

WHAT IS KNOWN AND OBJECTIVE: Antiretroviral treatment (ART) is hampered by complicated regimens, high pill burden, drug-drug interactions, and frequent short- and long-term adverse effects, leading to decreased adherence. Over recent years, considerable effort has been directed at developing regimens that are less burdening. We undertook a 7-year retrospective study of the records of 264 HIV-infected subjects enrolled in a pharmaceutical care programme to document the progress made and to study the influence of the number of ART pills and doses on the level of treatment adherence. METHODS: Antiretroviral dispensing records were analysed for the number of pills and doses administered and the ART adherence rate estimated. RESULTS AND DISCUSSION: In 2005, the patients took a mean of 6·2 pills daily (CI 95%: 5·9-6·6), and 92·9% of them were on a twice-a-day (BID) dosage regimen. By 2012, the mean number of pills was reduced to 4·1 (CI 95%: 3·8-4·4), and only 50·9% were on a BID regimen. No statistically significant relation was observed between number of daily pills and doses and ART adherence reached by the patients in any of the analyses performed. WHAT IS NEW AND CONCLUSIONS: There has been a continuous reduction in the number of pills and doses of antiretrovirals taken by individual patients over the last 7 years due largely to the introduction of improved treatments and regimens. More daily pills or doses was not associated with worse ART adherence in our pharmaceutical care programme.

[Incidence of Cryptosporidium sp in patients treated in a general hospital. Technics for the identification of oocysts in feces]. / Incidencia de Cryptosporidium sp en pacientes asistidos en un hospital general. Técnicas para la identificación de ooquistes en heces.

In feces referred for parasite investigation from 1973 patients of the Hospital Clinico Universitario in Salamanca, 27 instances of infestation by Cryptosporidium sp (1.5% of all investigated patients) were detected in 19 children (1.4%) and 8 adults (2.2%). The incidence in patients with antibodies against the human immunodeficiency virus (HIV) was 12.5%, in contrast with 1.25% in patients without anti-HIV antibodies. 55.5% of the instances of Cryptosporidium sp infestation were found in children less than 4 years old. The higher incidence was in winter and spring. The association with other enteropathogens was found in 14.8%. Diarrhea and abdominal pain were the most common clinical features of cryptosporidial disease. Chronic diarrhea was found in two adult patients with acquired immunodeficiency syndrome. In immunocompromised children and adults asymptomatic carriers were found. The sensitivity and specificity of immunofluorescence testing with monoclonal antibodies as compared with Ziehl-Neelsen stain for the detection of Cryptosporidium sp oocysts were 100%.

[Advances in the diagnosis of pulmonary complications in patients infected with the human immunodeficiency virus]. / Avances en el diagnóstico de las complicaciones pulmonares en pacientes infectados por el virus de la inmunodeficiencia humana.

Lung complications are the main cause of morbi-mortality in patients infected with HIV. In this review, we develop an algorithm with respect to the attitude to be taken when faced with an HIV-positive patient with respiratory affliction. The diagnosis value of non-invasive techniques are evaluated, as well as the right moment to be employed, and other future possibilities. Subsequently, the invasive studies are analysed (fiberoptic bronchoscopy, transbronchial biopsy, bronchial lavage samples). We dedicate a special section to bronchoalveolar lavage and to the test that must be carried out on the samples. Finally, the biological parameters which lead to the prognosis and/or control the treatment evolution of these patients are reviewed.

[Septic shock and multiple organ failure caused by Mycobacterium tuberculosis]. / Shock séptico y fallo multiorgánico por Mycobacterium tuberculosis.

We report a case of death from septic shock with multiorganic failure of tuberculosis origin. We described, the pathogenic mechanism of the sepsis and respiratory distress due to Mycobacterium tuberculosis. Another aspect of interest was the hemodynamic demonstration of septic shock due to M. tuberculosis.

[The urban population of Spain, 1860-1930]. / La poblacion urbana en Espana, 1860-1930.

PIP: Estimates of the urban population of Spain are provided for selected years from 1860-1930. The data are presented by province and are from official sources.^ieng

[Urban development in Spain, 1860-1930]. / El desarrollo urbano en Espana, 1860-1930.

PIP: Trends in urbanization in Spain between 1860 and 1930 are analyzed. Data are from the Geographical and Tax Institute and concern selected census years. Consideration is given to trends in rural-urban migration and to regional differences in the rate of urbanization over time.^ieng

[Sarcoidosis. Retrospective study of 30 cases in Salamanca and comparison with other national series]. / Sarcoidosis. Estudio retrospectivo de 30 casos en Salamanca y comparación con otras series nacionales.

Sarcoidosis is a disease which presents important clinical differences according to its geographical distribution. Thus, the objective of this study was to evaluate the epidemiologic, clinical, radiologic, and diagnostic characteristics in a series of 30 sarcoidosis patients in the province of Salamanca (representing the Castilla-Leon region). The most relevant results are the following: a) in our region, sarcoidosis predominates in females and furthermore, the presenting age in females is greater than in males; b) there is a clear predominance of the disease in the rural area; c) the prevalence of smoking habit in these patients is low (10%); d) the clinical manifestations are similar to other Spanish series with the exception, however of a high incidence of hypercalciuria; e) there is no correlation between the increase in sedimentation rate and the degree of sarcoidosis activity; f) there is a predominance of the radiologic type 11 of the disease and there is a high number of atypic radiologic patterns. The results obtained are with regard to the pathogeny are discussed as well as the differences and similarities of this series with other preceding from other regions.