RESUMO
OBJECTIVES: To present clinical experience with a regimen including abacavir/lamivudineâ+âdarunavir/ritonavir in a cohort of HIV-1-infected patients. METHODS: A retrospective, multicentre cohort study, including all consecutive adult HIV-1-infected patients who started abacavir/lamivudineâ+âdarunavir/ritonavir from April 2008 to December 2010 and had at least one follow-up visit. The primary endpoint was HIV-1 viral load (VL) <40 copies/mL at week 48. RESULTS: One hundred and eighty-three patients (42 naive and 141 experienced) from 19 hospitals in Spain were studied. The median follow-up was 26.7 (0.5-58.6) months, 79.8% were men, the median age was 47.1 (21.4-80.5) years, 26.2% had AIDS and 38.8% were positive for hepatitis C virus. At baseline, the median CD4 count was 246 cells/mm(3) in naive patients and 393 cells/mm(3) in experienced patients and the median VL was 4.80 and <1.59 log copies/mL, respectively. At week 48, 81.8% of naive patients and 84.2% of experienced patients receiving the regimen reached a VL <40 copies/mL, whereas at 96 weeks this occurred in 90.5% and 92.8%, respectively. CD4 cell count increases at 48 and 96 weeks were +176.5 and +283.5 cells/mm(3) in naive patients and +74.9 and +93 cells/mm(3) in experienced patients, respectively. Overall, 86 (47%) patients discontinued the study regimen, in many cases possibly related to non-medical reasons, such as drug switches to reduce cost or changes in address due to economic constraints. Three patients died of causes unrelated to therapy and 19 (10.4%) discontinued the regimen due to adverse events. CONCLUSIONS: In our cohort, abacavir/lamivudineâ+âdarunavir/ritonavir was safe, well tolerated and achieved high rates of virological suppression. In a proportion of patients, discontinuation of this effective regimen was possibly due to non-medical reasons.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Didesoxinucleosídeos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Lamivudina/uso terapêutico , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Estudos de Coortes , Darunavir , Didesoxinucleosídeos/efeitos adversos , Combinação de Medicamentos , Feminino , HIV-1/isolamento & purificação , Humanos , Lamivudina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ritonavir/efeitos adversos , Espanha , Sulfonamidas/efeitos adversos , Resultado do Tratamento , Carga Viral , Adulto JovemRESUMO
BACKGROUND: Smoking is the modifiable cardiovascular (CV) risk factor that contributes most to causing premature CV disease. Prevalence of smoking in patients with HIV infection is double that of the general population. OBJECTIVES: To determine the rate of patients succeeding in quitting smoking after 12 months, factors associated with this success, and the characteristics of tobacco consumption and nicotine dependence. METHODS: Longitudinal descriptive study. Three hundred and sixty-eight HIV-infected patients were interviewed. Smokers in Prochaska's stage of action began a programme to quit smoking. We registered the variables related to tobacco consumption and the level of success of cessation. RESULTS: 63.9% of the patients were active smokers and 14% of them began the cessation programme. Average motivation for cessation was 7.8 +/- 1.4 (Richmond) and nicotine dependence rate 5.5 +/- 3.0 (Fagerström). After 1 year, 25% had quit smoking. Those patients who stopped smoking presented a higher motivation level (8.8 +/- 1.3 vs. 7.5 +/- 1.5, P=0.048). Cessation significantly reduced their CV risk at 12 months [2.5 [interquartile range (IQR) 2.0-5.2] vs. 1.7 [IQR 1.0-3.5], P=0.026]. CONCLUSIONS: The prevalence of smokers in our population of HIV-infected patients was 63.9%. Only 14% began a smoking cessation programme. Twelve months after a programme to quit smoking, cessation rate was 25%; this was influenced mostly by the level of motivation of the patient.
Assuntos
Infecções por HIV/psicologia , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Motivação , Prevalência , Fatores de Risco , Fumar/efeitos adversos , Fumar/psicologia , Abandono do Hábito de Fumar/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: The study aims to define a method for the evaluation of the usage of systemic antifungal agents, and test it, in order to be able to develop larger studies. METHOD: Drug Use Study, pilot, observational, prescription- indication. We proposed a definition of antifungal type of treatment using as host factors the EORTC (European Organization for Research and Treatment of Cancer) criteria, the patient's clinical data as well as any evidence of fungal infection. Adequate use was evaluated by three standards of comparison: summary of product characteristics, hospital recommendations and an experts' committee. RESULTS: 60 antifungal prescriptions were recovered: fluconazole: 39; itraconazole: 6; liposomal amphotericin B: 5; caspofungin: 5; voriconazole: 5. Treatment was started as follows (N;%): microbiological (28;46.7), empirical (22;36.7) and prophylactic use (7;11.7). The indication for antifungal treatment was considered adequate in more than 90% of the cases for the three standards of comparison, whereas selection in 75-83% of the cases. CONCLUSIONS: The method is considered satisfactory for the evaluation of antifungal treatments and is proposed for being used in larger studies. For all the antifungal agents evaluated, a high degree of appropriateness of use was found, though some conditions are considered improvable.
Assuntos
Antifúngicos/uso terapêutico , Adulto , Idoso , Interpretação Estatística de Dados , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos , Feminino , Guias como Assunto , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Projetos Piloto , Projetos de Pesquisa , EspanhaRESUMO
SUMMARY: We report fusiform aneurysms in both internal carotid arteries in a 74-year-old man who presented with a nonpulsatile retropharyngeal mass. Both helical CT and MR imaging disclosed the nature of the lesions. Arteriography, required for therapeutic decisions, confirmed the diagnosis. Because of the rarity of this condition and the potential for misdiagnosis, we describe the findings on complementary radiologic examinations.
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Angiografia Digital , Doenças das Artérias Carótidas/diagnóstico , Artéria Carótida Interna , Aneurisma Intracraniano/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Faríngeas/diagnóstico , Tomografia Computadorizada por Raios X , Idoso , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
Spontaneous retropharyngeal hematoma is an uncommon entity that is difficult to diagnose and may progress rapidly to airway obstruction. We report a case of a 53-year-old man with acute onset of retropharyngeal pain, dysphonia, and dysphagia after vomiting. On CT, a nonspecific retropharyngeal collection was seen. MR imaging demonstrated blood products, suggesting a diagnosis of retropharyngeal hematoma, and the patient was managed conservatively. MR imaging allowed specific diagnosis of a rare condition that is otherwise difficult to diagnose without surgical intervention.
Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Hematoma/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Faríngeas/diagnóstico , Tomografia Computadorizada por Raios X , Obstrução das Vias Respiratórias/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/patologiaRESUMO
Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5-30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.
Assuntos
Carcinoma de Células Escamosas/complicações , Neoplasias de Cabeça e Pescoço/complicações , Trombose dos Seios Intracranianos/etiologia , Idoso , Carcinoma de Células Escamosas/secundário , Evolução Fatal , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Veias Jugulares/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Trombose dos Seios Intracranianos/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Trombose Venosa/complicações , Trombose Venosa/diagnósticoRESUMO
Schwannomas (neurilemmomas) are benign tumors of the nerve sheath arising from the Schwann cells in the neural sheath of cranial and spinal nerves. The most frequent sites are the peripheral nerves of the head and neck and the flexor surfaces of the upper extremities. Parapharyngeal schwannomas are rare, which makes them interesting for ear, nose and throat specialists. A new case of schwannoma of the parapharyngeal space is reported. Our experience with the clinical management and surgical treatment of cervical schwannomas is discussed and the literature is reviewed.
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Carcinoma/patologia , Neoplasias Laríngeas/patologia , Laringe/patologia , Neurilemoma/patologia , Carcinoma/cirurgia , Carcinoma/ultraestrutura , Humanos , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/ultraestrutura , Laringe/cirurgia , Laringe/ultraestrutura , Invasividade Neoplásica , Neurilemoma/cirurgia , Neurilemoma/ultraestruturaRESUMO
A case of benign, symmetrical lipomatosis is presented. The clinical aspects of this entity are discussed and points of interest in the head and neck are noted.
Assuntos
Lipomatose Simétrica Múltipla/diagnóstico , Humanos , Laringe/diagnóstico por imagem , Laringe/patologia , Laringe/cirurgia , Lipomatose Simétrica Múltipla/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Septic complications after coronary stenting are extremely rare. The occurrence of cardiac related sepsis after rapamycin eluting stent deployment has not been previously reported. The potential role of drug eluting stents in locally blunting the innate response to bacterial agents is discussed.
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Reestenose Coronária/terapia , Imunossupressores/efeitos adversos , Sirolimo/efeitos adversos , Infecções Estafilocócicas/induzido quimicamente , Staphylococcus aureus , Stents , Cateterismo/métodos , Implantes de Medicamento , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , RetratamentoRESUMO
No disponible
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Masculino , Adulto , Humanos , Síndrome da Imunodeficiência Adquirida/complicações , Fístula Arteriovenosa/complicações , Embolização Terapêutica , Varizes Esofágicas e Gástricas/complicaçõesRESUMO
No disponible
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Pessoa de Meia-Idade , Masculino , Humanos , Sacro , Infecções por HIV , Terapia Antirretroviral de Alta Atividade , Fraturas EspontâneasRESUMO
Introducción. El estudio propone definir una metodologíade evaluación del uso habitual de antifúngicos sistémicosy ponerla a prueba en un estudio piloto con el fin de facilitarel diseño de estudios de mayor tamaño.Método. Se diseñó en un Estudio de Utilización deMedicamentos, piloto, observacional, de prescripción-indicación.Se propuso una definición de tipo de tratamiento antifúngico(microbiológico, empírico y uso profiláctico) utilizandolos criterios de la EORTC (European Organization for Researchand Treatment of Cancer), la clínica del paciente y la evidenciamicrobiológica, conforme a las pautas de diagnóstico en lapráctica clínica habitual. La adecuación de los tratamientos sevaloró según tres patrones de comparación: ficha técnica, recomendacioneshospitalarias y comité de expertos.Resultados. Se recogieron 60 prescripciones de antifúngicos.39 casos fueron de fluconazol, 6 de itraconazol, 5 deanfotericina liposomal, 5 de caspofungina y 5 de voriconazol.El inicio del tratamiento se realizó en 28 casos como tratamientomicrobiológico (46,7%), en 22 casos como empírico(36,7%) y en 7 casos como uso profiláctico (11,7%). La indicaciónde tratamiento antifúngico se consideró adecuada enmás de un 90% de los casos para los tres patrones de comparación,mientras que adecuación de la selección osciló entreun 75 y un 83%.Conclusiones. El método propuesto para la definición deltipo de tratamiento antifúngico según criterios aplicables en lapráctica clínica se considera satisfactorio y se propone para suempleo en un estudio de mayor tamaño. Para todos los antifúngicosy patrones de comparación, la evaluación resultó conun alto grado de adecuación, sin embargo no resulta fácil sistematizarlas condiciones de utilización de los antifúngicos, debidoa la heterogeneidad de los pacientes e indicaciones (AU)
Introduction. The study aims to define a method forthe evaluation of the usage of systemic antifungal agents,and test it, in order to be able to develop larger studies.Method. Drug Use Study, pilot, observational, prescription-indication. We proposed a definition of antifungaltype of treatment using as host factors the EORTC(European Organization for Research and Treatment ofCancer) criteria, the patients clinical data as well as anyevidence of fungal infection. Adequate use was evaluatedby three standards of comparison: summary of productcharacteristics, hospital recommendations and an expertscommittee.Results. 60 antifungal prescriptions were recovered:fluconazole: 39; itraconazole: 6; liposomal amphotericinB: 5; caspofungin: 5; voriconazole: 5. Treatment wasstarted as follows (N;%): microbiological (28;46.7), empirical(22;36.7) and prophylactic use (7;11.7). The indicationfor antifungal treatment was considered adequatein more than 90% of the cases for the three standards ofcomparison, whereas selection in 75-83% of the cases.Conclusions. The method is considered satisfactoryfor the evaluation of antifungal treatments and is proposedfor being used in larger studies. For all the antifungalagents evaluated, a high degree of appropriateness of usewas found, though some conditions are considered improvable (AU)