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Los pacientes con tumores germinales no seminomatosos presentan metástasis encefálicas en 8% a 15% de los casos, generalmente en el contexto de una recaída sistémica. Si bien el primer gesto terapéutico ante un secundarismo único suele ser la cirugía, su particular quimiosensibilidad hace planteable la indicación de quimioterapia inicial seguida de radioterapia con o sin cirugía posterior. Al igual que en otros tumores sólidos los pacientes portadores de lesiones múltiples reciben tratamiento sistémico con o sin el agregado de radioterapia. Presentamos cinco pacientes de entre 20 y 43 años portadores de tumores germinales no seminomatosos con secundarismo encefálico que se presenta al momento del diagnóstico en dos casos y en el contexto de una progresión lesional en otros dos. En el caso restante se destaca su diagnóstico cuando se había objetivado una respuesta parcial mayor extraencefálica. El coriocarcinoma y el tumor del saco vitelino son las variedades histológicas más frecuentes en esta serie. Cuatro de los cinco pacientes pertenecían al grupo de alto riesgo y todos presentaban extenso compromiso pulmonar. En aquellos pacientes portadores de secundarismo único la cirugía constituyó el primer gesto terapéutico. Se destaca el beneficio de la combinación de los tratamientos sistémicos y radiante holocraneal en quienes presentaban múltiples lesiones encefálicas. El escaso número de pacientes impide obtener conclusiones con relación a la sobrevida, pero podemos destacar el mal pronóstico que implica el desarrollo de secundarismo encefálico en el contexto de refractariedad al tratamiento sistémico aun cuando sea único, y, por otra parte, la posibilidad de obtener remisiones completas duraderas en un grupo de pacientes seleccionados. Summary Patients with non seminomatous germinal tumors usually present encephalic metastasis in 8%-15% of the cases, generally in the context of a systemic fallen again. Although the first choice in these cases is surgery, its chemiosensitivity indicates initial chemotherapy followed by radiotherapy with or without surgery. As in patients with other solid tumors, carriers with multiple injuries receive systemic treatment with or without radiotherapy. Five patients aged from 20 and 43 years with encephalic non-seminomatous germinal tumors are analysed: two patients presented encephalic secondarism during diagnosis and two other patients during injury progress. Respecting the remaining case, its diagnosis was established during an extraencephalic parcial responce. Coriocarcinoma and yolk sac tumors are the most frequent histologic variaties in this series. Four patients were at high risk, with extended lung commitment. Surgery was the first therapeutic manoeuvre in patients with secondarism. Benefits of systemic and radio combined treatment are highlighted in those who presented multiple encephalic injuries. Conclusions about survival could not be obtained due to the sample, but prognosis is not optimistic when encephalic secondarism is systemic treatment refractary. Résumé Les patients avec des tumeurs germinales non seminoma-teuses, présentent des métastases encéphaliques à 8%-15% des cas, en général au cours d' une rechute systé-mique. Bien que le premier geste thérapeutique face à un secondarisme unique soit habituellement la chirurgie, sa particulière chimiosensibilité possibilite une indication de chimiothérapie initiale suivie de radiothérapie avec ou sans chirurgie postérieure. De même que dans d'autres tumeurs solides, les patients porteurs de lésions multiples reçoivent un traitement systémique avec ou sans radiothérapie. On fait le rapport de cinq patients âgés d'entre 20 et 30 ans porteurs de tumeurs germinales non seminomateuses avec secondarisme encéphalique qui se présente, en deux cas, au moment du diagnostic et dans le contexte d'une progression lésionnelle dans deux autres. Pour le cinquième, on a déterminé son diagnostic après avoir observé une réponse partielle extraencéphalique plus évidente. Le choriocarcinome et la tumeur du sac vitellin sont les variétés histologiques les plus fréquentes dans cette série. Quatre des cinq patients appartenaient au groupe de risque élevé et tous présentaient un grand compromis pulmonaire. Chez les patients porteurs de secondarisme unique la chirurgie a été le premier geste thérapeutique. On signale le bénéfice de combiner les traitements systémiques et radiant holocrànien chez ceux qui présentaient de multiples lésions encéphaliques. Le petit nombre de patients empêche de tirer des conclusions en ce qui concerne la survie, mais on peut signaler que le développement de secondarisme encéphalique comporte un mauvais pronostic, même s'il est unique. D'autre part, on signale la possibilité d'obtenir des rémissions complètes durables dans un groupe de patients choisis.

Introducción: Revisiones sistemáticas previas han apoyado la eficacia del consejo médico, como intervención breve, en el abordaje de bebedores excesivos detectados en la asistencia primaria. Sin embargo, estos resultados no pueden extrapolarse directamente a poblaciones que, como las mediterráneas, no están representadas en dichas revisiones. El objetivo de este estudio fue actualizar la evidencia sobre la eficacia de la intervención breve en consumidores excesivos de alcohol según estudios españoles. Métodos: Búsqueda de estudios en bases bibliográficas y consultas a expertos para localizar estudios no publicados. Se calcularon las estimaciones combinadas para dos variables de resultado, la reducción del consumo de alcohol y la disminución de la frecuencia de bebedores excesivos. Resultados: Dos de los 5 estudios localizados no estaban incluidos en una revisión previa. La eficacia de la intervención breve fue moderada para la disminución del consumo de alcohol (d = - 0,46; intervalo de confianza (IC) del 95%, - 0,29 a - 0,63; p < 0,0005; el grupo tratado mejoró un 22% más que el control) y pequeña para la disminución de la frecuencia de bebedores excesivos (OR = 1,55; IC del 95%, 1,06 a 2,26; p = 0,02; el grupo tratado mejoró un 11% más que el control). El análisis basado en el cumplimiento del protocolo sobrestimó 1,5 veces el tamaño del efecto respecto del análisis basado en la intención de tratamiento. Conclusiones: Los resultados del estudio señalan que, en nuestro país, la intervención breve en atención primaria sobre bebedores a riesgo es eficaz, aunque su efecto sea sólo moderado. Introduction: Former systematic reviews have backed the efficacy of medical counselling, a form of brief intervention, on the treatment of excessive drinkers detected in primary care settings. Nevertheless, these results cannot be applied without criticism to Mediterranean populations which, so far, have not been represented in the aforementioned studies. The aim of the present study was to update the results on the efficacy of brief interventions in primary care by pooling Spanish studies. Methods: Studies were searched for by using appropriate databases and also by consulting to experts in the field to retrieve grey literature. Pooled estimations of effect sizes were calculated for two outcomes, the reduction in the amount of alcohol consumption and the decrease in the number of excessive drinkers. Results: Two over the 5 retrieved studies were not included in a former review. The effect size regarding the decrease of alcohol consumption was medium (d = - 0.46; 95% CI, - 0.29 to - 0.63; p < 0.0005; the intervention group outperformed the control by a 22%) and small for the decrease in the frequency of excessive drinkers (OR = 1.55; 95% CI, 1.06 to 2.26; p = 0.02; the intervention group outperformed the control by a 11%). The analysis by complimented protocols at the end of the study showed an effect size 1.5 times larger than the analysis performed on intention-to-treat basis. Conclusions: The results of this meta-analysis support the efficacy of brief intervention for excessive drinkers in primary care settings in Spain.

Estudio clínico controlado aleatorizado doble ciego que se inició con sesenta y cuatro pacientes con diagnóstico de AR acorde a los criterios del Colegio Americano de Reumatología [ARA]; durante el estudio 32 pacientes recibieron terapia combinada con 10 mg de MTX semanales y 250 mg de CQ por día; y 32 pacientes con MTX 10 mg por semana y placebo una cápsula por día. La evolución de la enfermedad y efectos adversos fueron evaluados al inicio, al mes a los tres y seis meses. Completaron el estudio 59 pacientes. A los 6 meses de tratamiento los dos grupos tienen una mejoría clínica significativa en relación con el inicio del tratamiento. Comparando los dos grupos al final del estudio se observó diferencia estadística a favor de los pacientes que recibieron metotrexate más cloroquina en las siguientes variables: número de articulaciones tumefactas p: 0.05, PCR p: 0.03 y en valoración global del paciente: 0.01. Las otras variables como número de articulaciones dolorosas, escala análoga del dolor, valoración global del médico y VSG, no presentaron diferencia Magíster en Investigación de la Salud Cuenca

Se estudiaron 36 pacientes con diagnóstico de glaucoma primario de ángulo abierto (GPAA), sin tratamiento previo, a los que se les indicó durante 2 meses, timolol 0,5 % (1 gota 2 veces al día), y seguidamente, previo lavado de hipotensor, brimonidina 0,2 %; se evaluó la presión intraocular (PIO) y las reacciones adversas en la consulta inicial, 1ra semana, 1er mes y 2do mes de iniciado el tratamiento. Los resultados mostraron un descenso de la PIO media con respecto a la inicial (sin tratamiento) con ambos medicamentos durante los 2 meses de tratamiento; obteniéndose con el timolol una PIO media de 17,1 mm Hg y con la brimonidina de 16,1 mm Hg, lo que corresponde a un descenso de 7,7 mm Hg y de 6,9 mm Hg, respectivamente. Las reacciones adversas sistémicas más frecuentes con el uso de la brimonidina fueron: sequedad bucal y cefalea, mientras que las locales fueron: prurito ocular e hiperemia ocular. La intensidad de estos síntomas fue de leve a moderada. El estudio mostró que la brimonidina tiene una efectividad similar a la del timolol en la reducción de la presión intraocular, con buena tolerabilidad.36 patients with diagnosis of open-angle primary glaucoma (OAPG) without previous treatment were studied. They were indicated timolol 0.5 % (1 drop twice a day) and after that, previous lavage with hypotensor, brimonidine 0.2 %. The intraocular pressure (IOP) and the adverse reactions were evaluated on the initial visit and on the first week, the first month and the second month. The results showed a decrease of the mean IOP compared with the initial (without treatment) with both drugs during the 2 months of treatment. A mean IOP of 17.1 mm Hg was obtained with timolol and 16.1 mm Hg with brimonidine. It represents a reduction of 7.7 mm Hg and 6.9 mm Hg, respectively. The most frequent systemic adverse reactions with the administration of brimonidine were dry mouth and headache, whereas the local adverse reactions were ocular pruritus and ocular hyperemia. The intensity of these symptoms was from mild to moderate. The study demonstrated that brimonidine has an effectiveness similar to that of timolol as regards the reduction of intraocular pressure with a good tolerability.

OBJETIVO: Avaliar a efetividade da rizotomia facetária lombar por radiofreqüência no tratamento da dor lombar mecânica. MÉTODOS: Estudo prospectivo de 23 pacientes tratados com rizotomia por radiofrequência devido à dor lombar mecânica. O registro da intensidade da dor foi medido através de pontuação pela escala visual analógica (EVA) e o número de analgésicos administrado a cada paciente no pré-operatório e nos controles de 3, 6 e 12 meses de pós-operatórios. RESULTADOS: Foi observado um declínio significativo da intensidade da dor (p < 0,0001) nos pacientes estudados. CONCLUSÕES: Na série de pacientes avaliados, o tratamento foi efetivo no alívio sintomático da dor lombar mecânica e determinou menor uso de analgésicos após a realização do procedimento.OBJETIVO: Evaluar la efectividad de la rizotomía por radiofrecuencia facetaria lumbar en el tratamiento del lumbago mecánico. MÉTODOS: Estudio prospectivo de 23 pacientes tratados con rizotomía por radiofrecuencia en lumbago mecánico. El registro de la intensidad del dolor se midió por la puntuación de la escala analógica visual (VAS) y el número de analgésicos administrados a cada paciente antes de la operación, y 3, 6 y 12 meses después de la intervención. RESULTADOS: Se observó una disminución significativa en la intensidad del dolor (p OBJECTIVE: To evaluate the effectiveness of radiofrequency lumbar facet rhizotomy in the treatment of mechanical low back pain. METHODS: Prospective study of 23 patients treated with radiofrequency rhizotomy in mechanical low back pain. The pain intensity was measured by the visual analog scale (VAS) and the number of analgesics administered for each patient preoperatively and 3, 6 and 12 months postoperatively. RESULTS: We observed a significant decline in pain intensity (p

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Objetivo. Evaluar la eficacia y la eficiencia del tratamiento antituberculoso administrado por la Secretaría de Salud (SSA) en las jurisdicciones sanitarias de Cuernavaca y Cuautla, estado de Morelos, en el periodo 1992-1996. Material y métodos. Se hizo una revisión retrospectiva de las tarjetas de control de tratamiento en pacientes tuberculosos. Se utilizaron las definiciones contenidas en la Norma Oficial para el Control y Prevención de la Tuberculosis en la Atención Primaria a la Salud. La información fue vaciada en formatos estandarizados y se analizó mediante el programa SAS y Epi Info. Se visitaron las 149 unidades de atención primaria y los cuatro hospitales de la zona de estudio. Resultados. Se encontraron las tarjetas correspondientes a 288 pacientes, de los cuales 260 eran de casos nuevos. Estos pacientes recibieron en conjunto 311 tratamientos, de los cuales 85% fueron supervisados. Las tarjetas revisadas correspondieron al 60% de los casos notificados por la SSA en el mismo periodo. El grupo de pacientes tuberculosos tuvo mayor edad que la media poblacional y mayor probabilidad de pertenecer a los estratos socioeconómicos medio y bajo que la población general del área. Se analizaron 246 esquemas de tratamiento y se encontró que 32% presentó curación bacteriológica; 26%, curación probable; 18% abandonó el tratamiento; 1% fracasó en el tratamiento, y 3% murió durante el tratamiento. En 20% de los casos se desconoció el resultado del tratamiento. La frecuencia de urcuración fue mayor en los casos nuevos (61%) que en los retratamientos (38%) (p 0.01). Los pacientes en retratamiento lo abandonaron con mayor frecuencia (32%) que los casos nuevos (16%) (p 0.01). La eficacia del tratamiento fue de 71%, y la eficiencia, de 58%. Se encontró asociación estadísticamente significativa entre abandono de tratamiento y retratamiento (RM 3.3, IC95% 1.3-8.5, p= 0.01) o nivel socioeconómico bajo (RM 2.3, IC95% 1.0-4.9, p= 0.04). En los 34 esquemas de retratamiento, 11 lo iniciaron por abandono del tratamiento previo, y 11 por fracaso o recaída. Conclusiones. La proporción de pacientes que se curan es de solamente 58%, lo cual está por debajo del mínimo recomendado por la OMS, que es de 85%. Se discuten las implicaciones que tiene, para el Programa de Prevención y Control de la Tuberculosis, la tasa elevada de abandonos y la probabilidad de circulación de cepas de M. tuberculosis resistente. Se identificaron como necesidades urgentes: diseñar estrategias creativas para asegurar la adherencia al tratamiento, que consideren al paciente y no solamente a los servicios de salud; extender el uso de cultivos para conocer la farmacorresistencia, y evaluar la conveniencia de modificar los esquemas de retratamiento. La revisión de las tarjetas de control de tratamiento es una herramienta útil para la evaluación del programa.

Background: The aim of the study was to determine the most common pharmacological strategies used in the management of major depressive disorder (MDD) after an inadequate response to first-line antidepressant treatment in clinical practice. Methods: Multicenter, non-interventional study in adult outpatients with a DSM-IV-TR diagnosis of MDD and inadequate response to first-line antidepressant medication. Multiple logistic regression analyses were performed to identify independent factors associated with the adoption of a specific second-line strategy. Results: A total of 273 patients were analyzed (mean age: 46.8 years, 67.8% female). Baseline mean Montgomery-Asberg Depression Rating Scale total score was 32.1 (95% CI 31.2-32.9). The most common strategies were: switching antidepressant medication (39.6%), augmentation (18.8%), and combination therapy (17.9%). Atypical antipsychotic drugs were the most commonly used agent for augmenting antidepressant effect. The presence of psychotic symptoms and the number of previous major depressive episodes were associated with the adoption of augmenting strategy (OR = 3.2 and 1.2, respectively). Conclusion: The switch to another antidepressant agent was the most common second-line therapeutic approach. Psychiatrists chose augmentation based on a worse patients' clinical profile (number of previous episodes and presence of psychotic symptoms)., This study was sponsored by AstraZeneca Spain. EM and JM are employees of AstraZeneca Spain. JLG was an employee of AstraZeneca Spain when the study was designed and the data were collected. MAG is an employee of Quintiles Spain. MG-T has no conflict of interest to declare.

Case Reports; Journal Article; A 75-year-old man diagnosed with lower esophageal adenocarcinoma suffered from epirubicin extravasation during the second cycle of neoadjuvant chemotherapy with epirubicin and oxaliplatin. A full recovery was achieved after treatment with dexrazoxane (Cardioxane® ). This is the first time in our hospital that extravasation of an anthracycline has been treated with dexrazoxane. We used Cardioxane® , approved for the prevention of anthracycline-induced cardiotoxicity, while Savene® is indicated for the treatment of anthracycline extravasation. The treatment was effective, and the selection of Cardioxane® (seven-fold cheaper than Savene® ) yielded a cost saving. Consequently, Cardioxane® has been included in our guidelines for anthracycline extravasation. Yes

Introduction: The use of glutamine as a dietary supplement is associated with a reduced risk of infection. We hypothesized that the underlying mechanism could be an increase in the expression and/or functionality of Toll-like receptors (TLR), key receptors sensing infections. The objective of this study was to evaluate whether glutamine supplementation alters the expression and functionality of TLR2 and TLR4 in circulating monocytes of trauma patients admitted to the intensive care unit (ICU). Methods: We designed a prospective, randomized and single-blind study. Twenty-three patients received parenteral nutrition (TPN) with a daily glutamine supplement of 0.35 g/kg. The control group (20 patients) received an isocaloric-isonitrogenated TPN. Blood samples were extracted before treatment, at 6 and 14 days. Expression of TLR2 and TLR4 was determined by flow cytometry. Monocytes were stimulated with TLR specific agonists and cytokines were measured in cell culture supernatants. Phagocytic ability of monocytes was also determined. Results: Basal characteristics were similar in both groups. Monocytes from patients treated with glutamine expressed the same TLR2 levels as controls before treatment (4.9 +/- 3.5 rmfi vs. 4.3 +/- 1.9 rmfi, respectively; P = 0.9), at Day 6 (3.8 +/- 2.3 rmfi vs. 4.0 +/- 1.7 rmfi, respectively; P = 0.7) and at Day 14 (4.1 +/- 2.1 rfim vs. 4.6 +/- 1.9 rmfi, respectively; P = 0.08). TLR4 levels were not significantly different between the groups before treatment: (1.1 +/- 1 rmfi vs 0.9 +/- 0.1 rmfi respectively; P = 0.9), at Day 6 (1.1 +/- 1 rmfi vs. 0.7 +/- 0.4 rmfi respectively; P = 0.1) and at Day 14 (1.4 +/- 1.9 rmfi vs. 1.0 +/- 0.6 rmfi respectively; P = 0.8). No differences in cell responses to TLR agonists were found between groups. TLR functionality studied by phagocytosis did not vary between groups. Conclusions: In trauma patients in the intensive care unit, TPN supplemented with glutamine does not improve the expression or the functionality of TLRs in peripheral blood monocytes., The ESPEN Peter Furst Research Prize was funded by Nestle Nutrition Institute and by Fresenius Kabi.; This work was funded by a grant from the ESPEN Peter Furst Research Prize awarded to JPB. All other authors declare that they have no competing interests.

Journal Article; INTRODUCTION The objectives were to characterize alveolar fluid clearance (AFC) in pigs with normal lungs and to analyze the effect of immediate application of positive end-expiratory pressure (PEEP). METHODS Animals (n = 25) were mechanically ventilated and divided into four groups: small edema (SE) group, producing pulmonary edema (PE) by intratracheal instillation of 4 ml/kg of saline solution; small edema with PEEP (SE + PEEP) group, same as previous but applying PEEP of 10 cmH2O; large edema (LE) group, producing PE by instillation of 10 ml/kg of saline solution; and large edema with PEEP (LE + PEEP) group, same as LE group but applying PEEP of 10 cmH2O. AFC was estimated from differences in extravascular lung water values obtained by transpulmonary thermodilution method. RESULTS At one hour, AFC was 19.4% in SE group and 18.0% in LE group. In the SE + PEEP group, the AFC rate was higher at one hour than at subsequent time points and higher than in the SE group (45.4% vs. 19.4% at one hour, P < 0.05). The AFC rate was also significantly higher in the LE + PEEP than in the LE group at three hours and four hours. CONCLUSIONS In this pig model, the AFC rate is around 20% at one hour and around 50% at four hours, regardless of the amount of edema, and is increased by the application of PEEP. Yes

Introduction Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis -undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital -thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups. Trial Registration (Trial registration: US Clinical Trials registry NCT00622570.), This research was supported by a public grant from the Spanish government's Fondo de Investigacion Sanitaria (FIS PI020642), awarded to Dr J Perez Barcena. This public institution will not gain or lose financially from the publication of this manuscript in any way.

Policy Forum. Competing interests: ER has received research grants from Daiichi, Bayer, and Theravance and has served as a consultant to Pfizer, Theravance, Bayer, Wyeth, Rosetta, and BiondVax. Summary Points Brucellosis remains the commonest anthropozoonosis worldwide, and its treatment remains complex, requiring protracted administration of more than one antibiotic. In November 2006, a consensus meeting aimed at reaching a common specialist statement on the treatment of brucellosis was held in Ioannina, Greece under the auspices of the International Society of Chemotherapy and the Institute of Continuing Medical Education of Ioannina. The author panel suggests that the optimal treatment of uncomplicated brucellosis should be based on a six-week regimen of doxycycline combined either with streptomycin for 2–3 weeks, or rifampicin for six weeks. Gentamicin may be considered an acceptable alternative to streptomycin, while all other regimens/combinations should be considered second-line. The development of a common global therapeutic language for human brucellosis, and future, properly conducted clinical trials would definitely solve controversies regarding the disease. Yes

Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; INTRODUCTION Genetic variations may influence clinical outcomes in patients with sepsis. The present study was conducted to evaluate the impact on mortality of three polymorphisms after adjusting for confounding variables, and to assess the factors involved in progression of the inflammatory response in septic patients. METHOD The inception cohort study included all Caucasian adults admitted to the hospital with sepsis. Sepsis severity, microbiological information and clinical variables were recorded. Three polymorphisms were identified in all patients by PCR: the tumour necrosis factor (TNF)-alpha 308 promoter polymorphism; the polymorphism in the first intron of the TNF-beta gene; and the IL-10-1082 promoter polymorphism. Patients included in the study were followed up for 90 days after hospital admission. RESULTS A group of 224 patients was enrolled in the present study. We did not find a significant association among any of the three polymorphisms and mortality or worsening inflammatory response. By multivariate logistic regression analysis, only two factors were independently associated with mortality, namely Acute Physiology and Chronic Health Evaluation (APACHE) II score and delayed initiation of adequate antibiotic therapy. In septic shock patients (n = 114), the delay in initiation of adequate antibiotic therapy was the only independent predictor of mortality. Risk factors for impairment in inflammatory response were APACHE II score, positive blood culture and delayed initiation of adequate antibiotic therapy. CONCLUSION This study emphasizes that prompt and adequate antibiotic therapy is the cornerstone of therapy in sepsis. The three polymorphisms evaluated in the present study appear not to influence the outcome of patients admitted to the hospital with sepsis. Yes

Resumo OBJETIVO: avaliar a efetividade do tratamento coletivo para esquistossomose mansônica em duas localidades endêmicas do município de Jaboatão dos Guararapes-PE. MÉTODOS: foram descritas a prevalência de esquistossomose e a carga média parasitária antes e após tratamento coletivo, no período 2011-2013; foram utilizados dados do Sistema de Informações da Esquistossomose e de relatórios de conclusão dos inquéritos amostrais. RESULTADOS: observou-se redução no percentual de positividade de 8,9% para 2,3% em Barra de Jangada e de 15,7% para 3,5% em Novo Horizonte; ocorreu diminuição da carga média parasitária em Novo Horizonte (de 67,0 para 52,7 ovos/grama de fezes) e incremento em Barra de Jangada (de 23,8 para 91,7 ovos/grama de fezes). CONCLUSÃO: o tratamento coletivo contribuiu para a redução do percentual de positividade nas áreas endêmicas. Abstract OBJECTIVE: to evaluate the effectiveness of collective treatment for Schistosomiasis mansoni in two endemic localities in Jaboatão dos Guararapes-PE. METHODS: we described the prevalence of Schistosomiasis mansoni and the average parasite load before and after collective treatment in the period 2011-2013; data from the Schistosomiasis mansoni Information System and completion of sample surveys reports were used. RESULTS: there is a reduction in 8.9% positivity rate to 2.3% in Barra de Jangada and from 15.7% to 3.5% in Novo Horizonte; there was a decrease of the parasitic load average in Novo Horizonte (67.0 to 52.7 eggs/gram of feces) and increase in Barra de Jangada (23.8 to 91.7 eggs/gram of feces). CONCLUSION: the collective treatment contributed to reducing the rate of positivity in endemic areas. Resumen OBJETIVO: evaluar la efectividad del tratamiento colectivo para Esquistosomiasis mansónica en dos localidades endémicas del municipio de Jaboatão dos Guararapes-PE. MÉTODOS: describimos la prevalencia de Esquistosomiasis mansónica y la carga parasitaria antes y después del tratamiento colectivo en el período 2011-2013; se utilizaron los datos del Sistema de Información de la esquistosomiasis y la finalización de los informes de encuestas por muestreo. RESULTADOS: observamos una reducción de 8.9% para 2,3% en la tasa de positividad en Barra de Jangada y de 15,7% para 3,5% en Novo Horizonte; hubo una disminución del promedio de carga parasitaria en Nuevo Horizonte (de 67,0 para 52,7 huevos/gramo de heces) y un aumento en Barra de Jangada (de 23,8 a 91,7 huevos/gramo de heces). CONCLUSIÓN: el tratamiento colectivo ayudó a reducir la tasa de positividad en las zonas endémicas.

Objective To evaluate coronal alignment in patients with idiopathic adolescent scoliosis with structured lumbar curves submitted to surgical treatment by comparing coronal alignment in the group fusion up to L3 and the group fusion up to L4. Methods Retrospective cohort study. We evaluated patients submitted to surgical treatment with arthrodesis of the lumbar curve with high density of screws with at least 6 months of follow-up. Radiographically, coronal alignment, shoulder height and functional outcome were analyzed through SRS30 questionnaire. Results A total of 25 patients were analyzed, of which 23 were female and 2 were male, with a mean age of 15.2 years (12 to 29 years) at the time of surgery. The patients were divided into two groups. Group A, n = 15: Distal level of fusion in L3 and Group B, n = 10: distal level of fusion in L4. There was no statistically significant difference between Groups A and B when compared to coronal alignment (balanced vs. unbalanced). However, when compared with the coronal alignment (CA) values, lower values of CA were observed in Group A, with statistical significance. No difference was observed between Groups A and B with respect to the SRS30 questionnaire. Conclusions Patients with idiopathic adolescent scoliosis submitted to arthrodesis of the lumbar curve have a better coronal alignment when the distal fusion level is L3. Level of evidence III; Comparative Retrospective Study (based on prospectively collected data).

Journal Article; Localized rectal adenocarcinoma is a heterogeneous disease and current treatment recommendations are based on a preoperative multidisciplinary evaluation. High-resolution magnetic resonance imaging and endoscopic ultrasound are complementary to do a locoregional accurate staging. Surgery remains the mainstay of treatment and preoperative therapies with chemoradiation (CRT) or short-course radiation (SCRT) must be considered in more locally advanced cases. Novel strategies with induction chemotherapy alone or preceding or after CRT (SCRT) and surgery are in development. Yes

We conducted a phase II trial to investigate the safety and efficacy of alemtuzumab in treating steroid-refractory acute graft-versus-host disease (aGVHD) grade II or higher after stem cell transplantation. Ten adult patients (6 with aGVHD grade III and 4 with aGVHD grade IV) were included in the study. Nine patients had gastrointestinal tract involvement, 7 had skin involvement, and 5 had liver involvement. Five patients responded to treatment, 2 with complete response and 3 with partial response. Eight infectious events (4 of grade 3-4) and 7 cytomegalovirus (CMV) reactivations were observed. Six patients had grade 3-4 cytopenia. All 10 patients died (7 resulting from aGVHD progression, 2 from severe infection, and I from to leukemia relapse), at a median of 40 days (range, 4 to 88 days) after alemtuzumab treatment. Overall, our findings suggest that steroid-refractory aGVHD may be improved by treatment with alemtuzumab, but that this treatment does not overcome the dismal prognosis of patients with severe aGVHD, demonstrating the need for alternative therapies to treat this complication., This trial was supported by Bayer Schering Pharma.

Objective: This report compares various methods of bleeding control, and their influence on outcome and survival after decompression procedures for spinal metastasis of renal cell carcinoma (MRCC). Methods: A retrospective study. All patients underwent palliative decompression procedures. We compared 3 groups of patients stratified by methods of bleeding control. The first group (EMB) included 22 patients who underwent preoperative embolization of a tumor. The second group (HEM) consisted of 20 patients, treated surgically using intraoperative local hemostatic agents. In the third group (COMBI) 15 patients were treated with a combination of methods. Results: The average intraoperative blood loss for the EMB group was slightly less than the average for the HEM and COMBI groups, but without significant differences. The postoperative drainage loss in the HEM and COMBI groups was significantly less than in EMB group. The complication rate (infections, hematomas, neurological deficit) was practically equal in all groups. No statistically significant differences in local tumor recurrence and overall survival were found between groups. Conclusions: The overall results did not show that usage of different bleeding control methods can affect early or long-term outcomes. Level of Evidence III; retrospective study. RESUMO Objetivo: Este artigo compara vários métodos de controle de sangramento, sua influência no resultado e sobrevida após procedimentos de descompressão para metástases espinhais de carcinoma de células renais (MRCC). Métodos: Estudo retrospectivo. Todos os pacientes foram submetidos a procedimentos de descompressão paliativa. Comparamos três grupos de pacientes estratificados por métodos de controle de sangramento. O primeiro grupo (EMB) incluiu 22 pacientes submetidos à embolização pré-operatória de um tumor. O segundo grupo (HEM) consistiu em 20 pacientes tratados cirurgicamente usando agentes hemostáticos locais intra operatórios. No terceiro grupo (COMBI), 15 pacientes foram tratados com uma combinação de métodos. Resultados: A perda de sangue intra-operatória média para o grupo EMB foi ligeiramente inferior à média nos grupos HEM e COMBI ,sem diferenças significativas. A perda de drenagem pós-operatória nos grupos HEM e COMBI foi significativamente menor do que no grupo EMB. A taxa de complicações (infecções, hematomas, déficit neurológico) foi quase igual em todos os grupos. Não houve diferença estatisticamente significativa na recorrência local do tumor e a sobrevida global foi encontrada entre os grupos. Conclusões: Os resultados globais não mostraram que o uso de diferentes métodos de controle de sangramento pode afetar os resultados precoce e de longo prazo. Nível de Evidência III; Estudo retrospectivo. RESUMEN Objetivo: Este estudio compara varios métodos de control de sangrado, su influencia en el resultado y la supervivencia después de los procedimientos de descompresión de metástasis espinal de carcinoma de células renales (CCR). Métodos: Estudio retrospectivo en el que todos los pacientes fueron sometidos a procedimientos de descompresión paliativa. Comparamos 3 grupos de pacientes estratificados por métodos de control de sangrado. El primer grupo (EMB) incluyó a 22 pacientes sometidos a embolización preoperatoria de un tumor. El segundo grupo (HEM) consistió en 20 pacientes, tratados quirúrgicamente con agentes hemostáticos locales intraoperatorios. En el tercer grupo (COMBI) 15 pacientes fueron tratados con una combinación de métodos. Resultados: La pérdida de sangre intraoperatoria promedio en el grupo EMB fue ligeramente menor que el promedio en los grupos HEM y COMBI, pero sin diferencias significativas. La pérdida por drenaje posoperatorio en los grupos HEM y COMBI fue significativamente menor que en el grupo EMB. La tasa de complicaciones (infecciones, hematomas, déficit neurológico) fue prácticamente igual en todos los grupos. No se encontraron diferencias estadísticamente significativas en la recurrencia local del tumor y la supervivencia general entre los grupos. Conclusiones: Los resultados generales no mostraron que el uso de diferentes métodos de control de sangrado pueda afectar los resultados a corto o largo plazo. Nivel de Evidencia III; Estudio retrospectivo.

Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND Advanced heart failure (HF) is associated with high morbidity and mortality; it represents a major burden for the health system. Episodes of acute decompensation requiring frequent and prolonged hospitalizations account for most HF-related expenditure. Inotropic drugs are frequently used during hospitalization, but rarely in out-patients. The LAICA clinical trial aims to evaluate the effectiveness and safety of monthly levosimendan infusion in patients with advanced HF to reduce the incidence of hospital admissions for acute HF decompensation. METHODS The LAICA study is a multicenter, prospective, randomized, double-blind, placebo-controlled, parallel group trial. It aims to recruit 213 out-patients, randomized to receive either a 24-h infusion of levosimendan at 0.1 μg/kg/min dose, without a loading dose, every 30 days, or placebo. RESULTS The main objective is to assess the incidence of admission for acute HF worsening during 12 months. Secondarily, the trial will assess the effect of intermittent levosimendan on other variables, including the time in days from randomization to first admission for acute HF worsening, mortality and serious adverse events. CONCLUSIONS The LAICA trial results could allow confirmation of the usefulness of intermittent levosimendan infusion in reducing the rate of hospitalization for HF worsening in advanced HF outpatients. Yes

Objective: To know the clinical and radiographic results of patients with L4-L5 degenerative spondylolisthesis grade I, II, and III surgically treated with minimally invasive 360-degree arthrodesis. To determine the clinical and radiographic results according to the Oswestry Index 6 months after surgery and the percentage of postsurgical reduction in these patients. Methods: The present study was developed in the Department of Spinal Surgery of the Unidad Médica de Alta Especialidad Lomas Verdes, from October 2016 to August 2017. It is a prospective, cross-sectional, comparative observational study. We evaluated the reduction of the listhesis using pre and post-operative radiographs, as well as the Oswestry Disability Index. Results: The sample was composed of 12 patients, eight females and four males, showing a statistical significance in the Student’s t test, with p=0.05 for both variables. Conclusions: Degenerative spondylolisthesis of the 4th lumbar level is a very frequent pathology that affects groups of productive age and represents a burden not only for the patient, but also for the community. This surgical technique showed a high level of security and confidence for its resolution, showing results comparable to the literature. However, it requires certain technical resources and training to be performed. Evidence Level II; Prospective comparative study. RESUMO Objetivo: Conhecer os resultados clínicos e radiográficos de pacientes com espondilolistese degenerativa L4-L5 de grau I, II e III, tratados cirurgicamente com artrodese minimamente invasiva de 360 graus. Determinar os resultados clínicos e radiográficos segundo o Indice de Oswestry seis meses após a cirurgia e a porcentagem de redução pós-operatória nesses pacientes. Métodos: Este estudo se desenvolve na Unidade Médica de Alta Especialidade “Lomas Verdes”, Cirurgia de coluna, no período de outubro 2016 a agosto de 2017. É um estudo transversal prospectivo, observacional seccional. Avaliamos a lista de redução através de estudos radiográficos pré e pós-operatórios e escala de incapacidade Oswestry. Resultados: Observamos 12 pacientes, oito homens e quatro mulheres, mostrando significancia estatística pelo teste t de Student com p = 0,05, para ambas as variáveis. Conclusão: Espodilolistesis degenarativa de 4° nível lombar são muito frequentes, afetam grupos etários produtivos e afetam tanto o paciente quanto o seu ambiente social. Esta técnica cirúrgica mostra um alto nível de segurança e confiança para solução, mostrando resultados comparáveis com a literatura. No entanto, ele requer recursos técnicos e nível de formação para a sua execução. Nível de Evidência II; Estudo prospectivo comparativo. RESUMEN Objetivo: Conocer los resultados clínicos y radiográficos en pacientes con espondilolistesis degenerativa L4-L5 grado I, II y III operados con artrodesis 360 minimamente invasivo. Determinar los resultados clínico y radiográficos de pacientes con espondilolistesis degenerativa L4-L5 grado I, II y III con la escala de Oswestry después de 6 meses de operados. Determinar el porcentaje de reducción postquirúrgico de pacientes con espondilolistesis degenerativa L4-L5 grado I, II y III operados con artrodesis 360 minimamente invasivo.. Métodos: El presente estudio se desarrolló en la Unidad Médica de Alta Especialidad Lomas Verdes, módulo de Cirugía de Columna en el periodo de Octubre de 2016 a Agosto del 2017. Es un estudio prospectivo, observacional transversal y comparativo. Evaluamos la reducción de la listesis mediante estudios radiográficos pre y posoperatorios, así como la escala de discapacidad Oswestry. Resultados: La muestra fue de 12 pacientes, ocho del sexo femenino y cuatro del masculino, mostrando una significancia estadística mediante la prueba T de Student con una p=0,05 para ambas variables. Conclusiones: La espondilolistesis degenerativa en el cuarto nivel lumbar es una entidad patológica muy frecuente, que afecta grupos en edad productiva y representa una carga no solo para el paciente, sino también para la sociedad. Esta técnica quirúrgica mostró un alto nivel de seguridad y confianza para su resolución, mostrando resultados equiparables a la literatura. Sin embargo, requiere ciertos recursos técnicos y nivel de adiestramiento para su ejecución. Nivel de Evidencia II; Estudio prospectivo comparativo.

artículo (arbitrado) -- Universidad de Costa Rica. Instituto de Investigaciones en Salud (INISA), 1980 Este estudio fue realizado en niños desnutridos del Servicio de Medicina del Hospital Nacional de Niños (edad promedio de 7.5 meses, 55,2% del peso para edad y 4.3% del peso para talla). Los pacientes fueron tratados según una alimentación en el cual se introduce una fórmula hipercalórica a partir del séptimo día de hospitalización. Los niños mostraron una ganancia de peso promedio de 8.7 g/kg/día a partir de la primera. semana de hospitalización. Se encontró una fuerte correlación entre el consume calórico y la ganancia de peso (r=0.78). La ecuación Y —10.36 + 0.1X indica un requerimiento calórico adicional de 10 Ecal/kg/dia para una síntesis de tejido de 1 g/kg/dia. Los pacientes lograron una adecuación promedio del 90% de peso/talla y el paso de III a II grade de déficit ponderal según peso/edad en cuatro semanas de tratamiento. La implementación de dicho esquema de alimenticio ayudara a disminuir el costo de hospitalización, a mejorar la resistencia del niño contra la adquisición de infecciones, a disminuir is. frecuencia de readmisiones y a promover una mejor adaptación del niño a su ambiente natural. Universidad de Costa Rica Instituto de Investigaciones en Salud UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA)

Background: Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition. Methods/design: Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions). Discussion: Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons., This study was funded by the Ministry of Health, Carlos III Institute (grant PI12/01813). We also received support from the Health Promotion and Preventive Activities-Primary Health Care Network, sustained by the Ministry of Health, Carlos III Institute, Redes Tematicas de Investigacion Cooperativa en Salud (RETIC) award RD12/0005/0011, co-financed by the European Union European Regional Development Fund. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Background: To report results obtained by combining risk sharing tools with post-adoption surveillance mechanisms in order to control quality of care and implement a value-based reimbursement scheme for Neuroreflexotherapy (NRT), a non-pharmacological treatment proven effective for neck pain (NP), thoracic pain (TP) and low back pain (LBP). Methods: Pre-post prospective cohort study in routine clinical practice, carried out in primary care centers in the Spanish National Health Service in the Balearic Islands (Ib-Salut). Eight-hundred and seventy-one subacute and chronic NP, TP and LBP patients treated in Ib-Salut, who underwent NRT during 2011. A shared risk contract (SRC) was developed, where payments for NRT were linked to results on patients’ clinical evolution, reduction in medication and proportion of patients undergoing spinal surgery. Main outcome measures were local pain (NP, TP or LBP), referred pain, LBP-related disability and NP-related disability, measured using previously validated instruments at referral and 3 months later, use of medication assessed at referral and discharge, and rates of spinal surgery prescription after undergoing NRT. Results: Median improvements at discharge corresponded to 57.1% of baseline value for local pain, 75.0% for referred pain, 53.8% for LBP-related disability and 45.0% for NP-related disability. Patients taking medication at discharge represented 29.0% of those taking it at referral. The proportion of patients in whom spinal surgery was prescribed after undergoing NRT was 0%. These results were consistent with those from previous randomised controlled trials (RCTs) and studies in routine practice, and complied with the standards set in the SRC. Conclusions: It is feasible and effective to enhance post adoption surveillance methods with risk sharing tools to improve quality control and support value-based reimbursement decisions for NRT. The feasibility of generalising this approach to other settings and to other non-pharmacological treatments should be explored.

Objective To determine rates of retention, antiretroviral therapy (ART) use, and viral suppression in an adult cohort from a public tertiary referral hospital in the city of Buenos Aires, Argentina. Methods HIV-positive ART-naïve patients ≥ 18 years old starting care 2011-2013 contributed data until the end of 2014. Three outcomes were assessed in 2014: retention in care, ART use, and viral suppression. Patient characteristics associated with each outcome were assessed through logistic regression. Results A total of 1 031 patients were included. By the end of 2014, 1.5% had died and 14.8% were transferred to a different center. Of the remaining 859 patients, 563 (65.5%) were retained in 2014. Among those retained, 459 (81.5%) were on ART in 2014. Of those 459 on ART, 270 (58.8%) were virologically suppressed. Younger age was associated with lower retention (OR (odds ratio): 0.67; 95% CI (confidence interval): 0.44-0.92 for ≥ 35 vs. < 35 years), but unrelated with ART use or viral suppression. Low CD4 count at first visit was associated with ART use (OR: 35.72 for CD4 < 200, 7.13 for CD4 200-499 vs. ≥ 500, P < 0.001) and with virologic suppression (OR: 2.17 for CD4 < 200, 2.46 for CD4 200-499 vs. ≥ 500, P: 0.023). Conclusions Our hospital in Buenos Aires is still below the recommended 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for ART use and viral suppression. We found a major gap in retention in care. Identifying younger age as being associated with worse retention will help in the design of targeted interventions.

Presented in part at the 35th American Society of Clinical Oncology meeting. Atlanta (GA); 1999. Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; BACKGROUND Granulocyte colony-stimulating factors (G-CSFs) have been shown to help prevent febrile neutropenia in certain subgroups of cancer patients undergoing chemotherapy, but their role in treating febrile neutropenia is controversial. The purpose of our study was to evaluate-in a prospective multicenter randomized clinical trial-the efficacy of adding G-CSF to broad-spectrum antibiotic treatment of patients with solid tumors and high-risk febrile neutropenia. METHODS A total of 210 patients with solid tumors treated with conventional-dose chemotherapy who presented with fever and grade IV neutropenia were considered to be eligible for the trial. They met at least one of the following high-risk criteria: profound neutropenia (absolute neutrophil count

The aim of this study was to analyze the evolution of adherence to highly active antiretroviral therapy (HAART) in the Hospital General Universitario Gregorio Marañón (Madrid, Spain) over the last 8 years and determine the variables associated with the complexity of treatment and suboptimal adherence. An observational, retrospective method was used to measure adherence during the first 6 months of HAART in 3 cohorts: 2001 cohort (n = 90), 2005 cohort (n = 98), and 2008 cohort (n = 110). The adherence rate was determined using 2 methods: Pharmacy Department dispensation records and virologic response data. The evolution of the complexity of treatment and its influence on the adherence rate was analyzed by logistic regression. Adherence to HAART increased progressively from 45.6 % in 2001 to 56.1 % in 2005 and 77.3 % in 2008. Statistically significant differences were only observed between cohorts in 2005 and 2008. The average daily pill burden was 7, 4, and 4.5 tablets, respectively. The percentage of patients on twice-daily regimens decreased from 93.3 % in 2001 to 63.6 % in 2008, with a parallel increase in once-daily regimens. The proportion of patients with dietary restrictions decreased from 24.4 % to 3.6 %. A statistically significant association was found between the number of medication units per day and adherence and between frequency of administration and adherence. Adherence to HAART has improved significantly in the last 8 years. While the complexity of the treatment was significantly reduced in 2005, the largest increase in adherence occurred in the last cohort, which shows the influence of factors other than treatment simplification., Colegio de Farmacéuticos de la Provincia de Buenos Aires

Background: Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate. Methods/Design: Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragon and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953). At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients. Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out. Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables. Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed., This study has received a grant for each participating group from the Ministry of Science and Innovation, Carlos III Institute, Healthcare Research Fund; PS09/00663, PI09/01800, PS09/00954, PS09/01614 and PS09/01375. In addition, the study has received the support of the Health Promotion and Preventive Activities - Primary Healthcare Network, which is supported by other grants from the Ministry of Health ISCIII-RETCI G03/170 and RD06/0018.; The study is also partially supported by a XUGA grant (08CSA073916PR) and the Galician Network for Colorectal Cancer Research.

The ability to recognize facial emotional expression is essential for social interactions and adapting to the environment. Emotion recognition is impaired in people with Alzheimer's disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits.To assess the efficacy of a combined treatment of rehabilitation of emotion recognition (RER) and cognitive stimulation (CS) for people with AD, due to its potential implications for more effective psychosocial interventions.36 patients were assigned to one of three experimental conditions: an experimental group (EG) that received 20 sessions of RER and 20 sessions of CS; a control group (CG) that received 40 sessions of CS, and a treatment as usual group (TAU).32 patients completed the treatment (77.53 ± 5.43 years). Significant differences were found in MMSE30 (F = 5.10; p = 0.013), MMSE35 (F = 4.16; p = 0.026), affect recognition (Z = -2.81; p = 0.005) and basic activities of daily living (Z = -2.27; p = 0.018) favouring the efficacy of the combined treatment. The TAU group showed a decline in depression (Z = -1.99; p = 0.048), apathy (Z = -2.30; p = 0.022) and anosognosia (Z = -2.19; p = 0.028).The combined treatment of RER + CS was more effective than TAU and CS alone for the treatment of patients with AD. This is the first study about the rehabilitation of affect recognition in AD.Rehabilitacion del reconocimiento de emociones combinada con estimulacion cognitiva para personas con enfermedad de Alzheimer. Eficacia sobre aspectos cognitivos y funcionales.Introduccion. Se han encontrado deficits en el reconocimiento de emociones en personas con enfermedad de Alzheimer (EA), pero no se ha informado de ningun tratamiento rehabilitador de esta capacidad en esta poblacion. Objetivo. Evaluar la eficacia de un tratamiento combinado de rehabilitacion del reconocimiento de emociones (RRE) y estimulacion cognitiva (EsC) sobre las funciones cognitivas, el estado de animo, la anosognosia, la capacidad funcional y el reconocimiento de emociones de personas con EA. Sujetos y metodos. En un diseño cuasi experimental, 36 pacientes con EA fueron asignados a tres condiciones: un grupo experimental, que recibio 20 sesiones de RRE y 20 sesiones de EsC; un grupo control, que recibio 40 sesiones de EsC, y un grupo que recibio tratamiento usual (GTU). Resultados. Completaron el estudio 32 pacientes, con una edad media de 77,53 ± 5,43 años. Se observo mejoria en el Minimental State Examination en su version de 30 items (F = 5,10; p = 0,013) y en la de 35 (F = 4,16; p = 0,026), reconocimiento de afectos (Z = –2,81; p = 0,005) y actividades basicas de la vida diaria (Z = –2,27; p = 0,018) a favor del grupo experimental. El grupo que recibio tratamiento usual empeoro en depresion (Z = –1,99; p = 0,048), apatia (Z = –2,30; p = 0,022) y anosognosia (Z = –2,19; p = 0,028). Conclusiones. El tratamiento combinado de RRE y EsC fue mas eficaz que la EsC y que el tratamiento usual. Es la primera vez que se informa de un tratamiento rehabilitador del reconocimiento de emociones en personas con EA.

Background: Overactive bladder (OAB) is associated with high healthcare costs, which may be partially driven by drug treatment. There is little comparative data on antimuscarinic drugs with respect to resource use and costs. This study was conducted to address this gap and the growing need for naturalistic studies comparing health economics outcomes in adult patients with OAB syndrome initiating treatment with different antimuscarinic drugs in a primary care setting in Spain. Methods: Medical records from the databases of primary healthcare centres in three locations in Spain were assessed retrospectively. Men and women >= 18 years of age who initiated treatment with fesoterodine, tolterodine or solifenacin for OAB between 2008 and 2010 were followed for 52 weeks. Healthcare resource utilization and related costs in the Spanish National Health System were compared. Comparisons among drugs were made using multivariate general linear models adjusted for location, age, sex, time since diagnosis, Charlson comorbidity index, and medication possession ratio. Results: A total of 1,971 medical records of patients (58.3% women; mean age, 70.1 [SD: 10.6] years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952) or tolterodine (n = 717) were examined. Annual mean cost per patient was (sic)1798 (95% CI: (sic)1745; (sic)1848). Adjusted mean (95% bootstrap CI) healthcare costs were significantly lower in patients receiving fesoterodine ((sic)1639 [1542; 1725]) compared with solifenacin ((sic)1780 [(sic)1699; (sic)1854], P = 0.022) or tolterodine ((sic)1893 [(sic)1815; (sic)1969], P = 0.001). Cost differences occurred because of significantly fewer medical visits, and less use of absorbent products and OAB-related concomitant medication in the fesoterodine group. Conclusions: Compared with solifenacin and tolterodine, fesoterodine was a cost-saving therapy for treatment of OAB in the primary care setting in Spain., This study was sponsored by Pfizer Inc. Javier Rejas and Marion Kvasz are employees of Pfizer, S.L.U. and Pfizer PIO, respectively. Antoni Sicras was a paid consultant to Pfizer in connection with the development of this manuscript. Statistical analysis was performed by DataClinics and was funded by Pfizer Inc. All other authors declare that they have no competing interests. Editorial support was provided by Colin Mitchell, PhD, of Complete Healthcare Communications, Inc., and was funded by Pfizer Inc.

Objective To assess the implementation of HIV-related interventions for patients with tuberculosis (TB), as well as TB treatment outcomes in patients coinfected with HIV in Brazil in 2011. Methods This was a cross-sectional, operational research study of HIV-related interventions among TB cases and the sociodemographic and clinical characteristics of TB-HIV coinfected patients. It also used a retrospective cohort design to determine the association between antiretroviral therapy (ART) and favorable TB treatment outcomes. The source of data was a linkage of 2011 administrative health databases used by the National TB and HIV/AIDS Programs. Results Of 73 741 new cases of TB reported, 63.6% (46 865 patients) were tested for HIV; 10.3% were positive. Of patients with HIV, 45.9% or 3 502 were on ART. TB favorable outcome was achieved in 63.1% or 2 205 coinfected patients on ART and in only 35.4% or 1 459 of those not on ART. On multivariate analysis, the relative risk for the association between ART and TB treatment success was 1.72 (95% Confidence Interval = 1.64–1.81). Conclusions The linkage between national TB and HIV datasets has created a convenient baseline for ongoing monitoring of HIV testing, ART use, and TB treatment outcomes among coinfected patients. The low rates of HIV screening and ART use in 2011 need to be improved. The association between ART and treatment success adds to the evidence supporting timely initiation of ART for all patients with TB-HIV coinfection.

Osteoarthritis of the knee is a major cause of disability among adults. Electro-acupuncture is considered a potentially useful treatment for osteoarthritis. The purpose of this study is to assess the efficacy of electro-acupuncture on pain control, pain perception, plasma cortisol and beta-endorphin levels, patient-perceived quality of life, and pain medication use in patients with chronic knee pain. This study is a placebo-controlled, randomized, double-blind, parallel design trial. One hundred sixty out-patients who are more than 50 years old and who have osteoarthritis of the knee will be recruited from the island of Mallorca, Spain. Each participant will be randomly placed into one of two groups: (sham) electro-acupuncture non-insertion technique and real electro-acupuncture. Acupuncture treatments will be the Traditional Chinese Medicine type. The patients will be evaluated after a period of 1 month (with two weekly sessions), 3 months (with one monthly session), 6 months (with one session every 45 days), and 1 year later with follow-up sessions at the end of the study (with one session every 2 months). The primary outcomes will be based on the observed changes from the baseline of the visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain measured at 12 weeks after the end of treatment. Also to be included in the study are the possible changes in the secondary efficacy variables from baseline as assessed by the Short Form 36 version 2 health survey (patient-perceived quality of life), patient plasma cortisol and beta-endorphin levels at the different treatment stages, the Goldberg Anxiety and Depression Scale, pain medication use, functional capacity and stiffness (WOMAC subscales), and a VAS. These variables will be assessed at 1 month, 3 months, 6 months, and 1 year after study commencement. The findings from this study will help to determine whether electro-acupuncture is effective for chronic knee pain management in older people and whether electro-acupuncture can deliver results for the improvement of pain relief, stiffness, and disability. The study will therefore be a major step toward understanding the roles of the hypothalamic-pituitary-adrenal axis and the endogenous opioid system in the effectiveness of electro-acupuncture for chronic pain. ClinicalTrials.gov identifier NCT02299713 (11 Nov. 2014).

Background The objective of this research was to evaluate data from a randomized clinical trial that tested injectable diacetylmorphine (DAM) and oral methadone (MMT) for substitution treatment, using a multi-domain dichotomous index, with a Bayesian approach. Methods Sixty two long-term, socially-excluded heroin injectors, not benefiting from available treatments were randomized to receive either DAM or MMT for 9 months in Granada, Spain. Completers were 44 and data at the end of the study period was obtained for 50. Participants were determined to be responders or non responders using a multi-domain outcome index accounting for their physical and mental health and psychosocial integration, used in a previous trial. Data was analyzed with Bayesian methods, using information from a similar study conducted in The Netherlands to select a priori distributions. On adding the data from the present study to update the a priori information, the distribution of the difference in response rates were obtained and used to build credibility intervals and relevant probability computations. Results In the experimental group (n = 27), the rate of responders to treatment was 70.4% (95% CI 53.2-87.6), and in the control group (n = 23), it was 34.8% (95% CI 15.3-54.3). The probability of success in the experimental group using the a posteriori distributions was higher after a proper sensitivity analysis. Almost the whole distribution of the rates difference (the one for diacetylmorphine minus methadone) was located to the right of the zero, indicating the superiority of the experimental treatment. Conclusion The present analysis suggests a clinical superiority of injectable diacetylmorphine compared to oral methadone in the treatment of severely affected heroin injectors not benefiting sufficiently from the available treatments. Trial Registration Current Controlled Trials ISRCTN52023186

Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; BACKGROUND Left ventricular hypertrophy (LVH) is common in kidney transplant (KT) recipients. LVH is associated with a worse outcome, though m-TOR therapy may help to revert this complication. We therefore conducted a longitudinal study to assess morphological and functional echocardiographic changes after conversion from CNI to m-TOR inhibitor drugs in nondiabetic KT patients who had previously received RAS blockers during the follow-up. METHODS We undertook a 1-year nonrandomized controlled study in 30 non-diabetic KT patients who were converted from calcineurin inhibitor (CNI) to m-TOR therapy. A control group received immunosuppressive therapy based on CNIs. Two echocardiograms were done during the follow-up. RESULTS Nineteen patients were switched to SRL and 11 to EVL. The m-TOR group showed a significant reduction in LVMi after 1 year (from 62 ± 22 to 55 ± 20 g/m2.7; P=0.003, paired t-test). A higher proportion of patients showing LVMi reduction was observed in the m-TOR group (53.3 versus 29.3%, P=0.048) at the study end. In addition, only 56% of the m-TOR patients had LVH at the study end compared to 77% of the control group (P=0.047). A significant change from baseline in deceleration time in early diastole was observed in the m-TOR group compared with the control group (P=0.019). CONCLUSIONS Switching from CNI to m-TOR therapy in non-diabetic KT patients may regress LVH, independently of blood pressure changes and follow-up time. This suggests a direct non-hemodynamic effect of m-TOR drugs on cardiac mass. Yes

Introduction Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. Postoperative infection is the main non-cardiac complication after MHS and has been clearly related to increased morbidity, use of hospital resources and mortality. Our aim was to determine the incidence, aetiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients who have undergone MHS in Europe. Methods Our study was a prospective study of patients undergoing MHS in Europe who developed suspicion of VAP. During a one-month period, participating units submitted a protocol of all patients admitted to their units who had undergone MHS. Results Overall, 25 hospitals in eight different European countries participated in the study. The number of patients intervened for MHS was 986. Fifteen patients were excluded because of protocol violations. One or more nosocomial infections were detected in 43 (4.4%) patients. VAP was the most frequent nosocomial infection (2.1%; 13.9 episodes per 1000 days of mechanical ventilation). The microorganisms responsible for VAP in this study were: Enterobacteriaceae (45%), Pseudomonas aeruginosa (20%), methicillin-resistant Staphylococcus aureus (10%) and a range of other microorganisms. We identified the following significant independent risk factors for VAP: ascending aorta surgery (odds ratio (OR) = 6.22; 95% confidence interval (CI) = 1.69 to 22.89), number of blood units transfused (OR = 1.08 per unit transfused; 95% CI = 1.04 to 1.13) and need for re-intervention (OR = 6.65; 95% CI = 2.10 to 21.01). The median length of stay in the intensive care unit was significantly longer (P < 0.001) in patients with VAP than in patients without VAP (23 days versus 2 days). Death was significantly more frequent (P < 0.001) in patients with VAP (35% versus 2.3%). Conclusions Patients undergoing aortic surgery and those with complicated post-intervention courses, requiring multiple transfusions or re-intervention, constitute a high-risk group probably requiring more active preventive measures., The study was supported in part by Ciber de Enfermedades Respiratorias (CIBERES) and by the Rafael del Pino Foundation. We thank Lawrence JC Baron for his review of the English version of the manuscript and Cristina Fernandez for her contribution to the statistical analysis. We thank Dr M Desco and Dr J Pascau of the Medical Image Laboratory of Experimental Medicine for their support with the electronic retrieval of the data.

Background: To describe the long term outcome of patients who interrupted highly active antiretroviral therapy (HAART) once, identify the variables associated with earlier need to re-start HAART, and the response when therapy was resumed. A retrospective observational cohort of 66 adult patients with HIV-1 infection who interrupted HAART with a CD4+cell count ≥350 cells/μL and undetectable viral load (VL) was performed. The pre-established CD4+ cell count for restarting therapy was 300cells/μL. Cox regression was used to analyse the variables associated with earlier HAART reinitiation. Results: The median follow-up was 209 weeks (range, 64–395). Rates of HIV-related or possible HIV-related events were 0.37 (one case of acute retroviral syndrome) and 1.49 per 100 patient-years, respectively. Two patients died after re-starting therapy and having reached undetectable VL. Three patients suffered a sexually transmitted disease while off therapy. Fifty patients (76%) resumed therapy after a median of 97 weeks (range, 17–267). Age, a nadir of CD4+ 10,000 copies/ml were independent predictors for earlier re-start. The intention-to-treat success rate of the first HAART resumed regimen was 85.4%. There were no differences by regimen used, nor between regimens that were the same as or different from the one that had been interrupted. Conclusions: Our data suggest highly active antiretroviral therapy may be interrupted in selected patients because in these patients, when the HAART is restarted, the viral and clinical response may be achieved.