650 results on '"resultado del tratamiento"'
Search Results
602. Secundarismo encefálico de tumores germinales no seminomatosos. Revisión a propósito de cinco casos clínicos
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Roldán, Gloria, Rodríguez, Robinson, and Musé, Miguel
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GERMINOMA ,NEOPLASMAS CEREBRALES ,NEOPLASMAS TESTICULARES ,TERAPIA COMBINADA ,RESULTADO DEL TRATAMIENTO ,NEOPLASMAS PULMONARES - Abstract
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.
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- 2004
603. Efecto de la lecitina de soya como coadyuvante a la otorvastatina en el tratamiento de pacientes hiperlipemicos de los Centros de Salud de el Tambo, y Cañar.
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Pesántez Palacios, César Rubén, Cárdenas Herrera, Oswaldo José, Avila Gavilanez, Edwin Fernando, Pesántez Palacios, César Rubén, Cárdenas Herrera, Oswaldo José, and Avila Gavilanez, Edwin Fernando
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- 2007
604. Eficacia del consejo médico para la reducción del consumo excesivo de alcohol: Metaanálisis de estudios españoles en atención primaria
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Ballesteros, J., Ariño, J., González-Pinto, A., and Querejeta, I.
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Counseling ,Atención primaria de salud ,Treatment efficacy ,Eficacia ,Consejo médico ,Intervención breve ,Alcohol drinking ,Resultado del tratamiento ,Treatment outcome ,Consumo de bebidas alcohólicas ,Brief intervention ,Primary health care - Abstract
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.
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- 2003
605. Tratamiento de la artritis reumatoide con cloroquina y metotrexate vs metotrexate más placebo en pacientes de los Hospitales Vicente Corral M. y José Carrasco A. Cuenca 2003
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Guevara Pacheco, Sergio Vicente, Castro Calle, Fernando Eugenio, and Bustamante Medina, José Leonardo
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Hospitales Publicos ,Resultado Del Tratamiento ,Cloroquina ,Ecuador ,Artritis Reumatoidea ,Cuenca ,Mototexato - Abstract
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
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- 2003
606. En recién nacidos prematuros menores de 29 semanas de edad gestacional la ventilación de alta frecuencia como modalidad inicial electiva, comparada con la ventilación convencional no mejoró el desarrollo psicomotor ni los síntomas respiratorios a los dos años de edad
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Bernaola Aponte, Guillermo, Aparicio Sánchez, Julio, Bernaola Aponte, Guillermo, and Aparicio Sánchez, Julio
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- 2006
607. Estudio de la eficacia clínica de la brimonidina vs. timolol en el tratamiento del glaucoma primario de ángulo abierto Study of the clinical efficiency of briomonidine vs. timolol in the treatment of open-angle primary glaucoma
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Ibis Sedeño Cruz, Jaime Alemañy González, Fariel Camacho Ruaigip, and Frank García González
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INTRAOCULAR PRESSURE ,lcsh:Ophthalmology ,HIPERTENSION OCULAR ,GLAUCOMA ,lcsh:RE1-994 ,ADRENERGIC AGONISTS ,TIMOLOL ,OPEN-ANGLE ,GLAUCOMA DE ANGULO ABIERTO ,AGONISTAS ADRENERGICOS ,RESULTADO DEL TRATAMIENTO ,TREATMENT OUTCOME - Abstract
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.
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- 2002
608. Efetividade da rizotomia facetária por radiofrequência na lombalgia mecânica crônica Efectividad de la rizotomía facetaria en lumbago mecánico Effectiveness of radiofrequency facet rhizotomy in the treatment of mechanical back pain
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Lourimar Octaviano de Tolêdo, Sebastião Maurício Macedo, and Tarciso Fávaro
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Rizotomía ,lcsh:Diseases of the musculoskeletal system ,Rizotomia ,Dolor en la región lumbar ,Zygapophyseal joint ,Articulación cigapofisaria ,Rhizotomy ,Articulação zigoapofisária ,lcsh:RD701-811 ,lcsh:Orthopedic surgery ,Resultado de tratamento ,Low back pain ,Dor lombar ,Resultado del tratamiento ,Treatment outcome ,lcsh:RC925-935 - Abstract
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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- 2011
609. Lichenoid Dermatosis Induced by Alendronate: An Unusual Skin Drug Reaction
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José Aneiros-Fernández, Husein Husein-ElAhmed, Ramón Naranjo-Sintes, Jose Aneiros-Cachaza, Salvador Arias-Santiago, [Husein-Elahmed,H, Arias-Santiago S, Naranjo-Sintes R] Departamento de Dermatología, Hospital Universitario San Cecilio, Granada, Spain. [Aneiros-Fernandez J, and Aneiros-Cachaza,J] Departamento de Anatomía Patológica, Hospital Universitario San Cecilio, Granada, Spain
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medicine.medical_specialty ,Vértebras Lumbares ,Resultado del Tratamiento ,edad ,Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Dermatology ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Glucocorticoids [Medical Subject Headings] ,Anatomy::Musculoskeletal System::Skeleton::Bone and Bones::Spine::Lumbar Vertebrae [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Biopsy [Medical Subject Headings] ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Bone Density Conservation Agents [Medical Subject Headings] ,Agentes Conservadores da Densidade Óssea ,Medicine ,Drug reaction ,Glucocorticoides ,Fracturas de la Columna Vertebral ,Humano ,Masculino ,Chemicals and Drugs::Organic Chemicals::Organophosphorus Compounds::Diphosphonates::Alendronate [Medical Subject Headings] ,ComputingMilieux_THECOMPUTINGPROFESSION ,Diseases::Wounds and Injuries::Back Injuries::Spinal Injuries::Spinal Fractures [Medical Subject Headings] ,business.industry ,Anatomy::Urogenital System::Genitalia::Genitalia, Male [Medical Subject Headings] ,General Medicine ,Diseases::Skin and Connective Tissue Diseases::Skin Diseases::Skin Diseases, Papulosquamous::Lichenoid Eruptions [Medical Subject Headings] ,Anatomy::Integumentary System::Skin [Medical Subject Headings] ,Biopsia ,Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienediols::Prednisone [Medical Subject Headings] ,TheoryofComputation_MATHEMATICALLOGICANDFORMALLANGUAGES ,Prednisona ,Osteoporosis ,Alendronato ,Diseases::Musculoskeletal Diseases::Bone Diseases::Bone Diseases, Metabolic::Osteoporosis::Osteoporosis, Postmenopausal [Medical Subject Headings] ,Erupciones Liquenoides ,Health Care::Health Services Administration::Quality of Health Care::Outcome and Process Assessment (Health Care)::Outcome Assessment (Health Care)::Treatment Outcome [Medical Subject Headings] ,business ,Piel - Abstract
Yes
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- 2010
610. Tratamiento de la artritis reumatoide con cloroquina y metotrexate vs metotrexate más placebo en pacientes de los Hospitales Vicente Corral M. y José Carrasco A. Cuenca 2003
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Bustamante Medina, José Leonardo, Guevara Pacheco, Sergio Vicente, Castro Calle, Fernando Eugenio, Bustamante Medina, José Leonardo, Guevara Pacheco, Sergio Vicente, and Castro Calle, Fernando Eugenio
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- 2003
611. Efficacy of amodiaquine and sulfadoxine/pyrimethamine in the treatment of malaria not complicated by Plasmodium falciparum in Nariño, Colombia, 1999-2002.
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González, Iveth J., Padilla, Julio O., Giraldo, Luis E., Saravia, Nancy G., González, Iveth J., Padilla, Julio O., Giraldo, Luis E., and Saravia, Nancy G.
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The resurgence and spread of antimalarial drug resistance is one of the causes of the worldwide increase of malaria. In Colombia, uncomplicated Plasmodium falciparum malaria has been treated with a combination of amodiaquine (AQ) and sulfadoxine/pyrimethamine (SP) since 2000. The efficacy of these two antimalarials was evaluated after the implementation of the new malaria treatment scheme. In the municipalities of El Charco and Tumaco (Nariño) on the Pacific Coast region, the standard PAHO protocol was used to evaluate antimalarial efficacy in areas of low to moderate malaria transmission. Patients were randomly allocated to treatment regime in two cities of Nariño, El Charco (n = 48) and Tumaco (n = 50). After 14 days none of El Charco patients presented therapeutic failure to either antimalarial. However, in Tumaco after 28 days, 12 of 24 (95% CI: 30.6-69.4) patients presented AQ treatment failure while 4 of 26 (95% CI: 5.1-33.1) patients had SP treatment failure. The high level of AQ treatment failure in Tumaco was unexpected because it had been introduced only recently as an antimalarial treatment in Colombia. The results suggest that the use of the current dose of AQ in combination with SP will be therapeutically useful for less time than expected. Use of combined therapies is a key strategy to delay antimalarial resistance. Unfortunately, its success depends on the efficacy of antimalarial drugs individually., La resistencia a los antimaláricos es una de las causas del aumento de casos de malaria en el mundo. Desde el año 2000, el tratamiento de malaria no complicada por Plasmodium falciparum en Colombia ha sido la combinación de amodiaquina (AQ) y sulfadoxina/pirimetamina (SP). La eficacia de estos dos medicamentos se evaluó después de la implementación del nuevo esquema. El estudio se realizó en los municipios de El Charco y Tumaco (Nariño) en la Costa Pacífica. Se utilizó el protocolo estándar de la OPS para la evaluación de la eficacia de antimaláricos en áreas de baja a moderada transmisión. Los pacientes incluidos fueron asignados al azar a los dos medicamentos de estudio y seguidos hasta el día 14 en El Charco y hasta el día 28 en Tumaco. Ninguno de los 48 pacientes en El Charco presentó falla terapéutica a los medicamentos en estudio. En Tumaco, por el contrario, 12 de 24 pacientes (IC95%: 30,6 a 69,4) presentaron falla a la AQ y 4 de 26 (IC95%:5,1-33,1) presentaron falla a SP. Los altos niveles de falla a AQ en Tumaco fueron inesperados por su reciente introducción oficial al tratamiento de malaria, mientras que los niveles de falla a SP aumentaron respecto a lo encontrado en estudios anteriores. Estos hallazgos sugieren que el uso de AQ a las dosis actuales en combinación con SP tendrá un tiempo de vida útil más corto que el esperado. El uso combinado de antimaláricos como estrategia para retardar la aparición de resistencia será efectivo en la medida en que las monoterapias sean eficaces.
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- 2003
612. Eficacia y eficiencia del tratamiento antituberculoso en jurisdicciones sanitarias de Morelos
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Carlos Alvarez-García, José Luis Valdespino-Gómez, Manuel Palacios-Martínez, Ma. de Lourdes García-García, Leticia Ferreyra-Reyes, and Ma. Eugenia Mayar-Maya
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Anti tuberculosis ,business.industry ,Environmental health ,resultado del tratamiento ,México ,Public Health, Environmental and Occupational Health ,Medicine ,Salud ,tuberculosis/terapia ,business - Abstract
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.
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- 1998
613. Relationship between multimorbidity and the outcome of the treatment for pulmonary tuberculosis
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Luciana Nunes Soares, Lílian Moura de Lima Spagnolo, Jéssica Oliveira Tomberg, Christian Loret de Mola Zanatti, and Roxana Isabel Cardozo-Gonzales
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tuberculosis ,multimorbilidad ,comorbilidad ,resultado del tratamiento ,monitoreo epidemiológico ,Nursing ,RT1-120 - Abstract
ABSTRACT Objective: To analyze the influence of multimorbidity on the treatment outcome of new cases of pulmonary tuberculosis. Method: A population-based analytical study, using secondary data, collected from the database of the Notification Disease Information System, of new cases of pulmonary tuberculosis in the state of Rio Grande do Sul between 2013 and 2016. The relationship between multimorbidity and the outcome was analyzed with Multinomial Logistic Regression. Results: Multimorbidity was present in 37.0% of the cases. Of these, the Relative Risk (RR) was 1.7 for treatment abandonment and 2.9 for death. HIV had an RR of 2.1 for dropout and of 3.9 for death. The higher the number of comorbidities, the higher the RR for unfavorable outcomes. Conclusion: Multimorbidity influences on unfavorable outcomes of the treatment for tuberculosis.
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614. Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment
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Jaime Galan, J. Maurino, E. Medina, M.A. Gonzalez, and Mauro García-Toro
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Adult ,Male ,medicine.medical_specialty ,Combination therapy ,lcsh:RC435-571 ,medicine.drug_class ,humanos ,Atypical antipsychotic ,Major depressive disorder ,Augmentation ,Logistic regression ,sinergismo farmacológico ,Antidepressant treatment ,Pharmacotherapy ,Drug Therapy ,Rating scale ,trastorno depresivo ,lcsh:Psychiatry ,Internal medicine ,medicine ,Humans ,Psychiatry ,Depression (differential diagnoses) ,mediana edad ,Psychiatric Status Rating Scales ,Depressive Disorder ,Depressive Disorder, Major ,antidepresivos ,resultado del tratamiento ,farmacoterapia ,Response ,Disease Management ,Drug Synergism ,adulto ,Middle Aged ,medicine.disease ,Antidepressive Agents ,Psychiatry and Mental health ,escalas de valoración psiquiátrica ,Treatment Outcome ,Switching ,Combination ,Antidepressant ,Drug Therapy, Combination ,Female ,Psychology ,Research Article - Abstract
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.
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- 2012
615. Good clinical and cost outcomes using dexrazoxane to treat accidental epirubicin extravasation
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Maria Amalia Fernandez Feijoo, Ruth Ubago Pérez, Miguel Angel Calleja Hernández, Patricia Araque Arroyo, [Araque Arroyo,P, Ubago Perez,R, Fernandez Feijoo,MA, and Calleja Hernandez,MA] Department of Pharmacy, Virgen de las Nieves University Hospital, Granada, Spain.
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Male ,Cost-Benefit Analysis ,medicine.medical_treatment ,Desraxozane ,Esophageal adenocarcinoma ,Anthracycline ,Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Piperazines::Diketopiperazines::Razoxane [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,cost ,Masculino ,Razoxano ,General Medicine ,Epirrubicina ,Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Extravasation of Diagnostic and Therapeutic Materials [Medical Subject Headings] ,Extravasation ,Humanos ,Extravasación de Materiales Terapéuticos y Diagnósticos ,Treatment Outcome ,Oncology ,Análisis Costo-Beneficio ,Razoxane ,medicine.drug ,Epirubicin ,medicine.medical_specialty ,Resultado del Tratamiento ,Anciano ,Check Tags::Male [Medical Subject Headings] ,Antineoplastic Agents ,Health Care::Health Care Economics and Organizations::Economics::Costs and Cost Analysis::Cost-Benefit Analysis [Medical Subject Headings] ,Chemicals and Drugs::Organic Chemicals::Hydrocarbons::Hydrocarbons, Cyclic::Hydrocarbons, Aromatic::Polycyclic Hydrocarbons, Aromatic::Naphthacenes::Anthracyclines::Daunorubicin::Doxorubicin::Epirubicin [Medical Subject Headings] ,medicine ,Chemotherapy ,Humans ,Radiology, Nuclear Medicine and imaging ,Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Aged ,Cardiotoxicity ,business.industry ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antineoplastic Agents [Medical Subject Headings] ,Antineoplásicos ,Oxaliplatin ,Surgery ,Dexrazoxane ,business ,extravasation ,Extravasation of Diagnostic and Therapeutic Materials - Abstract
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
- Published
- 2010
616. Lack of effect of glutamine administration to boost the innate immune system response in trauma patients in the intensive care unit
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Verónica Regueiro, José A. Bengoechea, Jon Pérez-Bárcena, Abelardo García de Lorenzo-Mateos, Pedro Marsé, Jordi Ibáñez, Catalina Crespí, and Joan Maria Raurich
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método simple ciego ,Adult ,Male ,medicine.medical_specialty ,Glutamine ,humanos ,unidades de cuidados intensivos ,Critical Care and Intensive Care Medicine ,law.invention ,Young Adult ,Basal (phylogenetics) ,law ,estudios prospectivos ,Internal medicine ,medicine ,Humans ,Single-Blind Method ,Prospective Studies ,Receptor ,Prospective cohort study ,mediana edad ,business.industry ,resultado del tratamiento ,inmunidad ,Research ,Immunity ,adulto ,Middle Aged ,receptor 4 similar a toll ,Intensive care unit ,Immunity, Innate ,adulto joven ,Toll-Like Receptor 4 ,Intensive Care Units ,TLR2 ,heridas y traumatismos ,Treatment Outcome ,Parenteral nutrition ,Endocrinology ,glutamina ,Immunology ,TLR4 ,Wounds and Injuries ,Female ,business - Abstract
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.
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- 2010
617. Alveolar fluid clearance in healthy pigs and influence of positive end-expiratory pressure
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Eduardo Aguilar-Alonso, Enrique Fernández-Mondéjar, Antonio Ruiz-Aguilar, Virginia Chamorro-Marín, Manuel García-Delgado, Ángel Touma-Fernández, [García-Delgado,M, Ruiz-Aguilar,A, Aguilar-Alonso,E, and Fernández-Mondéjar,E] Department of Intensive Care Medicine, Virgen de las Nieves University Hospital, Granada, Spain. [Touma-Fernández,A] Department of Anesthesiology, Virgen de las Nieves University Hospital, Granada, Spain.[Chamorro-Marín,V] Experimental Surgery Laboratory, Virgen de las Nieves University Hospital, Granada, Spain.
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Swine ,Intratracheal instillation ,Resultado del Tratamiento ,medicine.medical_treatment ,Respiración con Presión Positiva ,Hemodynamics ,Pulmonary Edema ,Critical Care and Intensive Care Medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Models, Animal [Medical Subject Headings] ,Positive-Pressure Respiration ,Edema ,Organisms::Eukaryota::Animals [Medical Subject Headings] ,Diseases::Respiratory Tract Diseases::Lung Diseases::Pulmonary Edema [Medical Subject Headings] ,Animals ,Medicine ,Hemodinámica ,Saline ,Positive end-expiratory pressure ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Airway Management::Respiration, Artificial::Positive-Pressure Respiration [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,business.industry ,Research ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Artiodactyla::Swine [Medical Subject Headings] ,Pig model ,respiratory system ,Agua Pulmonar Extravascular ,Pulmonary edema ,medicine.disease ,Porcinos ,Modelos Animales ,respiratory tract diseases ,Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Hemodynamics [Medical Subject Headings] ,Treatment Outcome ,Lung water ,Edema Pulmonar ,Anatomy::Fluids and Secretions::Body Fluids::Extracellular Fluid::Extravascular Lung Water [Medical Subject Headings] ,Anesthesia ,Animales ,Extravascular Lung Water ,Models, Animal ,medicine.symptom ,business ,therapeutics ,circulatory and respiratory physiology - Abstract
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
- Published
- 2010
618. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial
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J.M. Abadal, Jordi Ibáñez, Jon Pérez-Bárcena, Joan Maria Raurich, Guillem Frontera, Juan Antonio Llompart-Pou, Marta Brell, Javier Ibáñez, and Javier Homar
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Adult ,hipertensión intracraneal ,Pentobarbital ,Resuscitation ,Adolescent ,Traumatic brain injury ,humanos ,traumatismos cerebrales ,adolescente ,Critical Care and Intensive Care Medicine ,law.invention ,Cohort Studies ,Young Adult ,tiopental ,Randomized controlled trial ,law ,estudios prospectivos ,Medicine ,Humans ,Prospective Studies ,Thiopental ,Prospective cohort study ,estudios de cohortes ,mediana edad ,Intracranial pressure ,Aged ,anciano ,business.industry ,resultado del tratamiento ,Research ,Glasgow Coma Scale ,Middle Aged ,adulto ,medicine.disease ,adulto joven ,Treatment Outcome ,Anesthesia ,Brain Injuries ,Intracranial Hypertension ,business ,medicine.drug ,Cohort study - Abstract
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.
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- 2008
619. Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations
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Javier Ariza, Mile Bosilkovski, Antonio Cascio, Juan D Colmenero, Michael J Corbel, Matthew E Falagas, Ziad A Memish, Mohammad Reza Hasanjani Roushan, Ethan Rubinstein, Nikolaos V Sipsas, Javier Solera, Edward J Young, Georgios Pappas, International Society of Chemotherapy, Institute of Continuing Medical Education of Ioannina, Universitat de Barcelona, ARIZA J, BOSILKOVSKI M, CASCIO A., COLMENERO JD, CORBEL MJ, FALAGAS ME, MEMISH, ZA, ROUSHAN MR, RUBINSTEIN E, SIPSAS NV, SOLERA J, YOUNG EJ, PAPPAS G, and [Ariza, J] Servicio de Enfermedades Infecciosas, Hospital de Bellvitge, Universidad de Barcelona, Barcelona, Spain. [Bosilkovski, M] Clinic for Infectious Diseases and Febrile Conditions, Clinical Center, Skopje, Former YugoslavRepublic of Macedonia. [Cascio, A] Scuola di Specializzazione in Malattie Infettive, Dipartimento di Patologia Umana, Universitadi Messina, Messina, Italy. [Colmenero, JD] Infectious Diseases Service, Carlos Haya University Hospital, Malaga, Spain. [Corbel, MJ] Division of Bacteriology, National Institute for Biological Standards and Control, Hertfordshire, United Kingdom. [Falagas, ME] Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. [Falagas, ME] Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America. [Memish, ZA] Department of Infection Prevention and Control, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. [Roushan, MRH] Department of Infectious Diseases, Yahyanejad Hospital, Babol Medical University, Babol, Iran. [Rubinstein, E] Section of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada. [Sipsas, NV] Pathophysiology Department, Laikon General Hospital, University of Athens, Athens,Greece. [Sipsas, NV] Medical School, National and Kapodistrian University of Athens, Athens, Greece. [Solera, J] Servicio de Medicina Interna, Hospital General Universitario, Albacete, Spain. [Young, EJ] Medical Services,Veterans Affairs Medical Center, Houston,Texas,United States of America. [Pappas, G] Institute of Continuing Medical Education of Ioannina, Ioannina, Greece. [Pappas, G] Working Group on Zoonoses, International Society of Chemotherapy, London, United Kingdom.
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Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Recurrence [Medical Subject Headings] ,Veterinary medicine ,Chemicals and Drugs::Carbohydrates::Glycosides::Aminoglycosides::Streptomycin [Medical Subject Headings] ,Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial [Medical Subject Headings] ,Disease ,Global Health ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Health Care::Population Characteristics::Health::World Health [Medical Subject Headings] ,Terminología como Asunto ,Brucellosi ,Organisms::Eukaryota::Animals [Medical Subject Headings] ,Health Care::Health Care Economics and Organizations::Organizations::International Agencies::United Nations::World Health Organization [Medical Subject Headings] ,Policy Forum ,Medicine in Developing Countries ,Gentamicinas ,Drug Resistance, Microbial ,Brucelosis ,Adhesión a Directriz ,General Medicine ,Humanos ,Drug Combinations ,Antibacterianos ,Doxycycline ,Streptomycin ,Estreptomicina ,Medicine ,Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds with 4 or More Rings::Rifamycins::Rifampin [Medical Subject Headings] ,Drug Therapy, Combination ,Guideline Adherence ,Rifampin ,Fluoroquinolones ,Salud Mundial ,medicine.medical_specialty ,Efficacy ,Resultado del Tratamiento ,Investigación Biomédica ,Recurrencia ,Therapeutics ,World Health Organization ,Microbiology ,Antibiotic resistance ,Terminology as Topic ,Disciplines and Occupations::Social Sciences::Internationality::International Cooperation::Developing Countries [Medical Subject Headings] ,Humans ,Medical journal ,Intensive care medicine ,Developing Countries ,Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Pyrimidines::Trimethoprim::Trimethoprim-Sulfamethoxazole Combination [Medical Subject Headings] ,medicine.disease ,Cotrimoxazole ,Animales ,Quimioterapia ,Humanities::Humanities::History::History, Modern 1601-::History, 21st Century [Medical Subject Headings] ,Gentamicins ,Brucel·losi ,Biomedical Research ,Communicable diseases ,Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 2-Ring::Quinolines::Quinolones::Fluoroquinolones [Medical Subject Headings] ,Human disease ,Recurrence ,Chemicals and Drugs::Pharmaceutical Preparations::Drug Combinations [Medical Subject Headings] ,Information Science::Information Science::Communication::Language::Linguistics::Terminology as Topic [Medical Subject Headings] ,biology ,Iraqi patients ,Metaanalysis ,Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Brucellosis [Medical Subject Headings] ,Historia del Siglo XXI ,Anti-Bacterial Agents ,Combinación Trimetoprim-Sulfametoxazol ,Treatment Outcome ,Infectious Diseases ,Disciplines and Occupations::Natural Science Disciplines::Science::Research::Biomedical Research [Medical Subject Headings] ,Chemicals and Drugs::Organic Chemicals::Hydrocarbons::Hydrocarbons, Cyclic::Hydrocarbons, Aromatic::Polycyclic Hydrocarbons, Aromatic::Naphthacenes::Tetracyclines::Doxycycline [Medical Subject Headings] ,Fluoroquinolonas ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings] ,Chemicals and Drugs::Carbohydrates::Glycosides::Aminoglycosides::Gentamicins [Medical Subject Headings] ,Países en Desarrollo ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Therapy, Combination [Medical Subject Headings] ,Brucella ,History, 21st Century ,Brucellosis ,World health ,Trimethoprim, Sulfamethoxazole Drug Combination ,medicine ,Animals ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Resistencia a Medicamentos ,business.industry ,Organización Mundial de la Salud ,Malalties infeccioses ,Terapèutica ,biology.organism_classification ,Combinación de Medicamentos ,Doxiciclina ,Therapy ,business ,Brucella melitensis - Abstract
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
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- 2007
620. Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis
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Garnacho-Montero, Jose, Aldabo-Pallas, Teresa, Garnacho-Montero, Carmen, Cayuela, Aurelio, Jiménez, Rocio, Barroso, Sonia, Ortiz-Leyba, Carlos, [Garnacho-Montero,J, Aldabo-Pallas,T, Jiménez,R, Barroso,S, Ortiz-Leyba,C] Intensive Care Unit, Hospital Universitatrio Virgen del Rocio, Seviilla, Spain. [Garnacho-Montero,C] Institute for Environmental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. [Cayuela,A] Supportive Research Unit, Hospital Universitario Virgen del Rocio, Sevialla, Spain., and This research was supported by the Grant (35/01) of the Regional Government of Andalucia.
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Time Factors ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings] ,Mortalidad Hospitalaria ,Resultado del Tratamiento ,Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings] ,Polimorfismo Genético ,Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Linfotoxina-alfa ,Drug Administration Schedule ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Cohort Studies ,Sepsis ,Humans ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Tumor Necrosis Factors [Medical Subject Headings] ,Hospital Mortality ,Prospective Studies ,Factor de Necrosis Tumoral alfa ,Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Diseases::Bacterial Infections and Mycoses::Infection::Sepsis [Medical Subject Headings] ,Lymphotoxin-alpha ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Aged ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Schedule [Medical Subject Headings] ,Polymorphism, Genetic ,Tumor Necrosis Factor-alpha ,Esquema de Medicación ,Research ,Phenomena and Processes::Genetic Phenomena::Genetic Variation::Polymorphism, Genetic [Medical Subject Headings] ,Middle Aged ,Anti-Bacterial Agents ,Interleukin-10 ,Treatment Outcome ,Antibacterianos ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings] ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-10 [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Hospital Mortality [Medical Subject Headings] ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Lymphokines::Lymphotoxin-alpha [Medical Subject Headings] ,Interleucina-10 ,Factores de Tiempo ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings] - Abstract
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
- Published
- 2006
621. Multidimensional Family Therapy: Evidence Base for Transdiagnostic Treatment Outcomes, Change Mechanisms, and Implementation in Community Settings.
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Liddle HA
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- Adolescent, Antisocial Personality Disorder psychology, Child, Delivery of Health Care, Evidence-Based Practice methods, Family Therapy methods, Female, Health Plan Implementation, Humans, Male, Patient Acceptance of Health Care, Substance-Related Disorders psychology, Treatment Outcome, Antisocial Personality Disorder therapy, Evidence-Based Practice trends, Family Therapy trends, Substance-Related Disorders therapy
- Abstract
This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with standard services as well as active treatments. The diverse and continuing MDFT research, the favorable, multi-source independent evaluations, combined with the documented receptivity of youth, parents, community-based clinicians and administrators, and national and international MDFT training programs (U.S.-based organization is MDFT International, www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potential for continued transfer of MDFT to real-world clinical settings., (© 2016 Family Process Institute.)
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- 2016
- Full Text
- View/download PDF
622. Prescription patterns and treatment outcomes of MDR-TB patients treated within and outside the National Tuberculosis Programme in Pham Ngoc Thach hospital, Viet Nam.
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Hoa NB, Khanh PH, Chinh NV, and Hennig CM
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- Adult, Drug Therapy, Combination, Extensively Drug-Resistant Tuberculosis drug therapy, Extensively Drug-Resistant Tuberculosis microbiology, Female, Health Services Accessibility, Humans, Male, Middle Aged, Mycobacterium tuberculosis, Retrospective Studies, Treatment Outcome, Tuberculosis, Multidrug-Resistant microbiology, Vietnam, Young Adult, Antitubercular Agents therapeutic use, Drug Prescriptions, Hospitals, Program Evaluation, Tuberculosis, Multidrug-Resistant drug therapy
- Abstract
Objective: To describe and analyse the prescription patterns and treatment outcomes of MDR-TB patients managed within Green Light Committee (GLC) and outside (non-GLC) the National TB programme in Viet Nam., Methods: Retrospective cohort study with two elements: (i) in-depth interviews and focus group discussions with clinical doctors, hospital pharmacists, and the non-GLC patients with MDR-TB; (ii) review of treatment cards and patients' charts of all GLC and non-GLC patients with MDR-TB put on treatment during 2010., Results: Of 282 patients with MDR-TB, comprising 79 (28%) GLC patients MDR-TB and 203 (72%) non-GLC patients with MDR-TB, were enrolled in the study. Treatment delay was significantly higher in the GLC group (12.8 days) than the non-GLC group (2.3 days), (P = 0.004). The success rate was significantly better in GLC patients (84.8%) than in non-GLC patients (53.7%) (P < 0.001). The default rate was significantly higher in non-GLC patients than in GLC patients (25.6% vs. 6.3%), (P < 0.001). The risk of unsuccessful outcome was higher in non-GLC patients (Hazard ratio = 4.6, 95% CI: 1.8-11.8)., Conclusions: The treatment outcomes of patients with MDR-TB in the GLC group were significantly better than in the non-GLC group. Reasons for the high default rate in non-GLC patients with MDR-TB must be further investigated., (© 2014 John Wiley & Sons Ltd.)
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- 2014
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623. Noninvasive mechanical ventilation in chronic obstructive pulmonary disease and in acute cardiogenic pulmonary edema.
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Rialp Cervera G, del Castillo Blanco A, Pérez Aizcorreta O, and Parra Morais L
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- Acute Disease, Decision Trees, Heart Diseases complications, Humans, Pulmonary Edema etiology, Noninvasive Ventilation, Pulmonary Disease, Chronic Obstructive therapy, Pulmonary Edema therapy
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Noninvasive ventilation (NIV) with conventional therapy improves the outcome of patients with acute respiratory failure due to hypercapnic decompensation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPE). This review summarizes the main effects of NIV in these pathologies. In COPD, NIV improves gas exchange and symptoms, reducing the need for endotracheal intubation, hospital mortality and hospital stay compared with conventional oxygen therapy. NIV may also avoid reintubation and may decrease the length of invasive mechanical ventilation. In ACPE, NIV accelerates the remission of symptoms and the normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a trend towards lesser mortality, without increasing the incidence of myocardial infarction. The ventilation modality used in ACPE does not affect the patient prognosis., (Copyright © 2012 Elsevier España, S.L. y SEMICYUC. All rights reserved.)
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- 2014
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624. [Factors Associated With the Temporary Abandonment of Treatment for Disorders Due to Substance Abuse in an Institution in Medellin, Colombia].
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Valencia JG and Méndez Villanueva MP
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Objective: To determine the frequency and factors associated withtreatment drop-out in patients from a Substance User Treatment Center in Medellín, Colombia., Methods: A case-control study was conducted, with patients with an early treatment dropout as cases, and patients who completed the treatment as controls. Demographic data, substance use pattern, concomitant diseases, and the decision to initiate treatment were compared between cases and controls., Results: The frequency of early drop-out was 59%, but a high proportion of this drop-out (47.5%) occurred in the transition period between the program stages. The variables associated with drop-out were: psychotic disorder (OR=0.32; 95% CI, 0.11-0.91), bipolar disorder (OR=0.31; 95% CI, 0.12-0.77), heroin as the principal substance compared to alcohol (OR=6.68; 95% CI, 1.52-29.4), decision to initiate the treatment by the family compared to personal decision (OR=3.02; 95% CI, 1.28-7.17), and previous treatments (OR=1.87; 95% CI, 1.02-3.44)., Conclusions: The drop-out frequency is similar to those reported in other studies. Associated factors were found, which could be considered in order to plan strategies to improve the program results., (Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)
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- 2014
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625. Prevalência e carga parasitária da esquistossomose mansônica antes e depois do tratamento coletivo em Jaboatão dos Guararapes, Pernambuco
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Ana Clarissa Luna Gomes, Natália Nunes de Lima, Éllyda Vanessa Gomes da Silva, and Jadson Mendonça Galindo
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Veterinary medicine ,Esquistossomose mansoni ,Resultado del Tratamiento ,030231 tropical medicine ,Esquistossomose ,Esquistosomiasis ,lcsh:Medicine ,Schistosomiasis ,Effectiveness ,Biology ,Parasite load ,Esquistosomiasis mansoni ,03 medical and health sciences ,0302 clinical medicine ,parasitic diseases ,Efectividad ,medicine ,Parasite Egg Count ,Feces ,030505 public health ,lcsh:Public aspects of medicine ,lcsh:R ,Efetividade ,lcsh:RA1-1270 ,General Medicine ,medicine.disease ,biology.organism_classification ,Infant newborn ,Schistosomiasis mansoni ,Treatment Outcome ,Age distribution ,Schistosoma mansoni ,Endemic diseases ,0305 other medical science ,Resultado do Tratamento - Abstract
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.
626. WHAT IS THE BEST DISTAL LEVEL OF ARTHRODESIS IN LUMBAR FUSION IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: L3 OR L4?
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Sérgio Daher, Brenda Cristina Ribeiro Araújo, Pedro Felisbino Jr, Marcelo Fouad Rabahi, Vinício Nunes Nascimento, Murilo Tavares Daher, and Nilo Carrijo Melo
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lcsh:Diseases of the musculoskeletal system ,Fusión Vertebral ,Arthrodesis ,medicine.medical_treatment ,Resultado del Tratamiento ,Idiopathic scoliosis ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,lcsh:Orthopedic surgery ,Statistical significance ,Medicine ,Orthopedics and Sports Medicine ,In patient ,Orthodontics ,030222 orthopedics ,business.industry ,Retrospective cohort study ,Lumbar Curve ,lcsh:RD701-811 ,Treatment Outcome ,Spinal Fusion ,Scoliosis ,Coronal plane ,Quality of Life ,Surgery ,Neurology (clinical) ,Escoliosis ,Calidad de Vida ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery - Abstract
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).
627. SEOM Clinical Guideline of localized rectal cancer (2016)
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Ruth Vera, Jorge Aparicio, Susana Roselló, M. T. Cano, Ferran Losa, Maria Jose Safont, Encarnación González-Flores, Carlos Fernández-Martos, Carles Pericay, E. Polo, [Gonzalez-Flores, E.] Complejo Hosp Granada, Granada, Spain, [Losa, F.] Hosp St Joan Despi Moises Broggi, ICO Hospitalet, Barcelona, Spain, [Pericay, C.] Hosp Parc Tauli Sabadell, Barcelona, Spain, [Polo, E.] Hosp Miguel Servet, Zaragossa, Spain, [Rosello, S.] Hosp Clin Univ Valencia, Valencia, Spain, [Safont, M. J.] Hosp Gen Valencia, Valencia, Spain, [Vera, R.] Complejo Hosp Navarra, Pamplona, Spain, [Aparicio, J.] Hosp Univ La Fe Valencia, Valencia, Spain, [Cano, M. T.] Hosp Reina Sofia Cordoba, Cordoba, Spain, [Fernandez-Martos, C.] Fdn Inst Valenciano Oncol, C Prof Beltran Baguena 8, Valencia 46009, Spain, and [González-Flores,E] Complejo Hospitalario de Granada, Granada, Spain. [Losa,F] Hospital Sant Joan Despí-Moises Broggi-ICO Hospitalet, Barcelona, Spain. [Pericay,C] Hospital Parc Taulí de Sabadell, Barcelona, Spain. [Polo,E] Hospital Miguel Servet, Zaragossa, Spain. [Roselló,S] Hospital Clínico Universitario de Valencia, Valencia, Spain. [Safont,MJ] Hospital General de Valencia, Valencia, Spain. [Vera,R] Complejo Hospitalario de Navarra, Pamplona, Spain. [Aparicio,J] Hospital Universitario La Fe de Valencia, Valencia, Spain. [Cano,MT] Hospital Reina Sofía de Córdoba, Córdoba, Spain. [Fernández-Martos,C] Fundación Instituto Valenciano de Oncología, Valencia, Spain.
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Endoscopic ultrasound ,Cancer Research ,Colorectal cancer ,España ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,0302 clinical medicine ,Rectal Adenocarcinoma ,Diseases::Neoplasms::Neoplasms by Histologic Type::Neoplasms, Glandular and Epithelial::Carcinoma::Adenocarcinoma [Medical Subject Headings] ,Open-label ,Diseases::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Gastrointestinal Neoplasms::Intestinal Neoplasms::Colorectal Neoplasms::Rectal Neoplasms [Medical Subject Headings] ,Rectal cancer ,Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings] ,medicine.diagnostic_test ,Follow-up ,General Medicine ,Humanos ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Induction chemotherapy ,Transanal endoscopic microsurgery ,030211 gastroenterology & hepatology ,medicine.medical_specialty ,Locally advanced ,Clinical Guides in Oncology ,Adenocarcinoma ,Guidelines ,Neoadjuvant chemotherapy ,Health Care::Health Services Administration::Quality of Health Care::Quality Assurance, Health Care::Guidelines as Topic::Practice Guidelines as Topic [Medical Subject Headings] ,Randomized phase-iii ,03 medical and health sciences ,medicine ,Humans ,Diagnostic ,Short-course radiotherapy ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Rectal Neoplasms ,business.industry ,Magnetic resonance imaging ,Guideline ,medicine.disease ,Surgery ,Adjuvant chemotherapy ,Treatment ,Spain ,Resultado del tratamiento ,business ,Preoperative radiotherapy ,Guías de práctica clínica como asunto ,Total mesorectal excision - Abstract
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
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628. Alemtuzumab as Treatment of Steroid-Refractory Acute Graft-versus-Host Disease: Results of a Phase II Study
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Martinez, Carmen, Solano, Carlos, Ferra, Christelle, Sampol, Antonio, Valcarcel, David, Antonio Perez-Simon, Jose, and Spanish Grp Stem Cell Transplantat
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Male ,trasplante de células madre hematopoyéticas ,Antibodies, Neoplasm ,Gastrointestinal Diseases ,humanos ,Salvage therapy ,Phases of clinical research ,Graft vs Host Disease ,Gastroenterology ,enfermedad aguda ,Cause of Death ,hemic and lymphatic diseases ,Medicine ,antineoplásicos ,Alemtuzumab ,mediana edad ,infecciones oportunistas ,anciano ,integumentary system ,Liver Diseases ,resultado del tratamiento ,enfermedades gastrointestinales ,Hematopoietic Stem Cell Transplantation ,Antibodies, Monoclonal ,Hematology ,Middle Aged ,adulto ,Survival Rate ,adulto joven ,Treatment Outcome ,surgical procedures, operative ,Acute Disease ,Female ,Steroids ,medicine.drug ,Adult ,medicine.medical_specialty ,esteroides ,Antineoplastic Agents ,Opportunistic Infections ,Antibodies, Monoclonal, Humanized ,Skin Diseases ,Antibodies ,Young Adult ,enfermedades de la piel ,causas de muerte ,Internal medicine ,Humans ,tasa de supervivencia ,Survival rate ,Aged ,Salvage Therapy ,enfermedades hepáticas ,Transplantation ,Cytopenia ,Acute graft-versus-host disease ,business.industry ,medicine.disease ,tratamiento de última línea ,Surgery ,Allogeneic stem cell transplantation ,Clinical trial ,anticuerpos ,enfermedad injerto contra huésped ,business ,Complication - Abstract
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.
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629. METÁSTASIS ESPINAL DE CARCINOMA DE CÉLULAS RENALES: MÉTODOS DE CONTROL DE SANGRADO
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Nikita Zaborovskii, Dmitrii Mikaylov, Dmitrii Ptashnikov, Oleg Smekalenkov, and Sergei Masevnin
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medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Decompression ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,Metastasis ,Embolization ,03 medical and health sciences ,0302 clinical medicine ,Bleeding control ,Blood loss ,lcsh:Orthopedic surgery ,Renal cell carcinoma ,Hemostasia ,medicine ,Orthopedics and Sports Medicine ,Treatment outcome ,Hemostasis ,business.industry ,Carcinoma de células renales ,Retrospective cohort study ,medicine.disease ,Surgery ,Carcinoma de células renais ,lcsh:RD701-811 ,Resultado do tratamento ,Embolização ,Neurology (clinical) ,Resultado del tratamiento ,lcsh:RC925-935 ,business ,Embolización ,030217 neurology & neurosurgery - Abstract
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.
630. Rationale and Design of a Randomized, Double-Blind, Placebo Controlled Multicenter Trial to Study Efficacy, Security, and Long Term Effects of Intermittent Repeated Levosimendan Administration in Patients with Advanced Heart Failure: LAICA study
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M. del Mar García-Saiz, Marco Cordero, Francisco Marrero-Rodríguez, Martín J. García-González, Manuel de Mora-Martín, Silvia López-Fernández, Ana Aldea-Perona, Manuel Martínez-Sellés, Javier López-Díaz, José Romero-García, Antonio Lara-Padrón, The LAICA study investigators, [García-González,MJ] Department of Cardiology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Sta. Cruz de Tenerife, Spain. [Mora-Martín,M de] Department of Cardiology, Hospital Regional Carlos Haya, Málaga, Spain. [López-Fernandez,S] Department of Cardiology, Hospital Virgen de la Nieves, Granada, Spain. [López-Díaz,J] Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. [Martínez-Sellés,M] Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Europea, Madrid, Spain. [Romero-García,J] Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain. [García-Saiz,M del M] Department of Clinical Pharmacology, Hospital Universitario de Canarias, La Laguna, Sta. Cruz de Tenerife, Spain. [Aldea-Perona,A] Clinical Trials Unit, Biomedical Research Unit, Fundación Rafael Clavijo para la Investigación Biomédica, Hospital Universitario de Canarias, La Laguna, Sta. Cruz de Tenerife, Spain., and Department of Pharmacy and Health Products. Ministry of Health, Social Services and Equality, Government of Spain 2009. (TRA-058). Department of Health. Canary Islands Government. Fundación Canaria de Investigación y Salud (FUNCIS) 2010. Additional research unrestricted grant from ORION PHARMA Laboratory
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Inotrope ,Levosimendan ,Advanced heart failure ,Enfermedad cardiovascular ,Hospitalización ,law.invention ,Tratamiento médico ,Randomized controlled trial ,law ,Outpatients ,Estudios multicéntricos como asunto ,Estudios prospectivos ,Medicine ,Pharmacology (medical) ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Controlled Clinical Trials as Topic::Randomized Controlled Trials as Topic::Pragmatic Clinical Trials as Topic [Medical Subject Headings] ,Cardiotónicos ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Schedule [Medical Subject Headings] ,Ensayos clínicos controlados como asunto ,Insuficiencia cardíaca ,General Medicine ,Morbilidad ,Hospitalization ,Pyridazines ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Hospitalization [Medical Subject Headings] ,Pacientes Ambulatorios ,Original Article ,Safety ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,Cardiotonic Agents ,Efficacy ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings] ,Repeated administration ,Named Groups::Persons::Patients::Outpatients [Medical Subject Headings] ,Placebo ,Drug Administration Schedule ,Double-Blind Method ,Multicenter trial ,Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Outcome and Process Assessment (Health Care)::Outcome Assessment (Health Care)::Treatment Outcome [Medical Subject Headings] ,Humans ,Decompensation ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity [Medical Subject Headings] ,Intensive care medicine ,Simendan ,Heart Failure ,Pharmacology ,business.industry ,Hydrazones ,Pauta de administración medicamentosa ,Diseases::Cardiovascular Diseases::Heart Diseases::Heart Failure [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality [Medical Subject Headings] ,medicine.disease ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents::Cardiotonic Agents [Medical Subject Headings] ,Clinical trial ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Multicenter Studies as Topic [Medical Subject Headings] ,Heart failure ,Mortalidad ,Resultado del tratamiento ,business - Abstract
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
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631. ARTRODESIS CIRCUNFERENCIAL MINIMAMENTE INVASIVA DEL CUARTO NIVEL LUMBAR PARA TRATAMIENTO DE ESPONDILOLISTESIS
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Juvenal Ordaz Vega, Jose Enrique Salcedo Oviedo, Luis Muñiz Luna, Hugo Vilchis Sámano, Marco Antonio Marbán Heredia, Mario Alonso Cienega Valerio, Yadira Bahena Salgado, and Luis Ivan Herrera Alcaraz
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medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Radiography ,Arthrodesis ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Minimally invasive surgical procedures ,lcsh:Orthopedic surgery ,Cirugía ,Statistical significance ,Estudios prospectivos ,medicine ,Procedimentos cirúrgicos minimamente invasivos ,Orthopedics and Sports Medicine ,Procedimientos quirúrgicos mínimamente invasivos ,Treatment outcome ,Coluna vertebral ,Prospective cohort study ,030222 orthopedics ,Cirurgia ,business.industry ,Estudos prospectivos ,medicine.disease ,Spondylolisthesis ,Spine ,Surgery ,Oswestry Disability Index ,Columna vertebral ,lcsh:RD701-811 ,Resultado do tratamento ,Observational study ,Neurology (clinical) ,Resultado del tratamiento ,lcsh:RC925-935 ,business ,Prospective studies ,030217 neurology & neurosurgery - Abstract
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.
632. Factores asociados con remisión o baja actividad de la enfermedad en personas con artritis reumatoide en el aseguramiento en Colombia
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Trujillo Cáceres, Silvia Juliana, Bernal Macías, Santiago, Fernández Ávila, Daniel Gerardo, Barrios Taborda, Onaldo, Trujillo Cáceres, Silvia Juliana, Bernal Macías, Santiago, Fernández Ávila, Daniel Gerardo, and Barrios Taborda, Onaldo
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Objetivo: identificar los factores asociados con la remisión o baja actividad en las personas con AR en Colombia. Materiales y métodos: estudio longitudinal retrospectivo basado en información del registro administrativo de AR en Colombia. Se utilizó un modelo de supervivencia paramétrico flexible de Royston Parmar para evaluar el tiempo al evento, definido como la diferencia entre el diagnóstico de AR y el logro de la primera remisión o baja actividad medida con el índice DAS28. Resultados: Se analizaron 24.914 casos incidentes de AR. La mayoría de los casos mujeres, con una mediana de edad al diagnóstico de 54 años. Al momento del diagnóstico, 35,9 % presentaba una actividad moderada a alta de la enfermedad medida por DAS28. En el primer año, la probabilidad de alcanzar la remisión o baja actividad fue del 25 %, aumentando aproximadamente hasta 50 % a los 5 años. Las personas mayores de 60 años presentaron una probabilidad de remisión o baja actividad un 19 % mayor en comparación con los más jóvenes (p = 0,001). Conclusiones: este estudio identificó factores demográficos y clínicos relacionados con la remisión o baja actividad en AR. La edad al diagnóstico, el tratamiento, la oportunidad de la atención y la seropositividad de marcadores fueron aspectos relevantes. Estos hallazgos podrían contribuir a la identificación de pacientes con mayor riesgo de recaída y al diseño de estrategias de tratamiento personalizadas para mejorar los resultados terapéuticos.
633. Análisis de los parámetros de fotobiomodulación del láser de baja potencia (LLLT) en la aceleración del movimiento dental en población humana Revisión sistemática de la literatura
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Sanchez Vallejo, Gustavo Adolfo, Martinez Rodriguez, Maria Angelica, Charry Anzola, Sandra Ximena, Valenzuela Peña, Patricia, Montoya, Diana, Araqur Salamanca, Lazo Saizarbitoria, Lazo Saizarbitoria, Ignacio Alejandro, Sanchez Vallejo, Gustavo Adolfo, Martinez Rodriguez, Maria Angelica, Charry Anzola, Sandra Ximena, Valenzuela Peña, Patricia, Montoya, Diana, Araqur Salamanca, Lazo Saizarbitoria, and Lazo Saizarbitoria, Ignacio Alejandro
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Antecedentes: La terapia láser de baja potencia, en ortodoncia, se presenta como una opción no invasiva para mejorar la eficacia de los tratamientos ortodónticos y la experiencia de los pacientes, aunque no reemplaza completamente los enfoques tradicionales. Objetivo: Identificar los parámetros del láser de baja potencia para lograr mayor efectividad en aceleración del movimiento dental ortodóntico, en términos de tasa de movimiento dental y reducción en el tiempo de tratamiento a partir de una revisión sistemática de la literatura. Método: Se llevó a cabo una búsqueda exhaustiva de estudios primarios, publicados en el periodo comprendido entre el 1 de Enero de 2004 al 30 de Agosto de 2022, incluidos en las bases de datos PubMed, ScienceDirect, Elsevier, Cochrane, Embase, Medline y Ebscohost. Se emplearon términos de búsqueda en lenguaje controlado y los operadores lógicos (AND, OR, NOT) para construir las estrategias de búsqueda. El proceso se sistematizó siguiendo las pautas de PRISMA Resultados: El filtro final incluyó 12 artículos cuyo diseño de estudio se relacionó con ensayos clínicos controlados aleatorizados. La revisión de la literatura destaca el potencial de la terapia láser de baja frecuencia para acelerar el movimiento dental ortodóntico, con un aumento en la velocidad y una reducción en el tiempo de tratamiento. La longitud de onda (800-940 nm) y la densidad de energía (25,56-0,16 J/cm²) son parámetros críticos. Se encontró una disminución del 26% en el tiempo de tratamiento con LLLT, y la tasa de movimiento dental varió de 1,29 mm a 4,45 mm. Hubo mejoras significativas en alineación, nivelación y retracción canina con el uso del láser; no obstante, se observó heterogeneidad en los protocolos y parámetros reportados en los estudios. Conclusión: Los resultados del presente estudio confirman la efectividad de la terapia láser de baja potencia para acelerar el movimiento dental; no obstante, dada la heterogeneidad de las publicaciones incluidas en el filt
634. Evaluación de la calidad de la finalización de los tratamientos de ortodoncia, posterior a la implementación del protocolo de finalización FTO1, en las clínicas correctivas de posgrado de ortodoncia de la Pontificia Universidad Javeriana
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Valenzuela Peña, Patricia, Martinez Leon, Rafael Hernando, Suarez Castillo, Angela, Carreño Rojas, Juan Carlos, Ariza Gonzalez, Claudia Helena, Castaño Montoya, Marcela, López Ramírez, Lida Esperanza, Valenzuela Peña, Patricia, Martinez Leon, Rafael Hernando, Suarez Castillo, Angela, Carreño Rojas, Juan Carlos, Ariza Gonzalez, Claudia Helena, Castaño Montoya, Marcela, and López Ramírez, Lida Esperanza
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Antecedentes: Diferentes Instituciones académicas han empleado el OGS como índice de medida en los tratamientos ortodóncicos terminados, para evaluar la calidad de la finalización; Yang L et al. (2002) y Pinskaya et al. (2004) informaron que sólo el 19,6% y el 39,7% respectivamente de los pacientes terminados en ortodoncia obtienen puntuaciones ABO inferiores a 30 puntos; lo que demuestra un porcentaje relativamente alto de casos finalizados como fallidos. En la PUJ, Cardier F. et al. (2017), y Cacua et al. (2018), evaluaron los resultados del OGS, encontrando en una muestra de 95 pacientes, que el 13.68% se encontraba en el rango fallido. Teniendo en cuenta la problemática mencionada, diferentes universidades han intentado implementar protocolos para mejorar los resultados logrados en la finalización de los tratamientos. Objetivo: Determinar el resultado del índice OGS de los tratamientos finalizados en las clínicas correctivas de ortodoncia, de la PUJ, al aplicar el protocolo de finalización FTO1, durante el periodo entre septiembre de 2021 y mayo 2022. Método: El diseño de estudio fue observacional descriptivo de corte transversal. La muestra total estuvo conformada por 59 casos en fase de finalización, cuya unidad de observación fueron modelos de estudio y radiografías panorámicas. Se evaluaron los registros previo y posterior a la aplicación de protocolo. Resultados: El promedio del OGS previo a la aplicación del protocolo FTO1 fue de 29,2 puntos, considerado dentro de la categoría indeterminado; mientras que el promedio del OGS posterior al protocolo fue de 14.7, considerado dentro de la categoría aceptable. Conclusión: Se requirió agregar ajustes al formato FTO1 una puntuación a cada parámetro en particular y se obtuvo uno total por cada paciente, el cual da un indicador cuantitativo de la calidad del resultado obtenido en la finalización. No se encontraron diferencias significativas en las variables del OGS pre y post implementación del protocolo de finaliza
635. Análisis del estado final de alineación dental y oclusión de los tratamientos ortodóncicos realizados en la Pontificia Universidad Javeriana evaluado mediante el sistema de Calificación Objetiva
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Valenzuela Peña, Patricia, Martínez León, Rafael, Cardier Gonzalez, Francis Beatriz, Santacoloma Jimenez, Stephanie, Valenzuela Peña, Patricia, Martínez León, Rafael, Cardier Gonzalez, Francis Beatriz, and Santacoloma Jimenez, Stephanie
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Determinar el estado final de alineación dental y oclusión de los tratamientos ortodóncicos realizados en la Pontificia Universidad Javeriana, evaluados mediante el Sistema de Calificación Objetiva (índice OGS), en el periodo 2015 a 2016. Método: El estudio se desarrolló a través del diseño observacional descriptivo de corte transversal. Se analizaron 95 registros finales de acuerdo con los ocho parámetros considerados por el índice OGS: alineación, rebordes marginales, inclinación vestíbulo-lingual, relación oclusal, contactos oclusales, sobremordida horizontal, contactos proximales y angulación radicular. Se identificó el diente y el parámetro que presentó mayor dificultad en la finalización del tratamiento, y se determinó la relación entre el tiempo total de tratamiento y el número de controles ortodóncicos realizados con el OGS. Se empleó estadística descriptiva y ANOVA de dos vías con una corrección post-hoc mediante la prueba de Bonferroni. Resultados: El OGS promedio para los casos seleccionados fue de 19.4 ± 10.2, es decir, aceptables en su tratamiento de acuerdo con lo establecido por el ABO. La duración de tratamiento promedio fue de 33.9 ± 18.93 meses, con un número de controles promedio de 22.3 ± 8.6. Los dientes que más puntos aportaron al OGS fueron los segundos premolares (6.7%) y los segundos molares (6.4%). Los parámetros que presentaron mayor dificultad se relacionaron con la inclinación vestíbulo-lingual (19.4%) y los contactos oclusales (13.1%). Conclusiones: De los 95 registros evaluados, el 65.26% (n=62) obtuvo un OGS aceptable en su tratamiento. Una mejor finalización del caso no se relaciona estadísticamente con una mayor duración de tratamiento. No se debe considerar la angulación radicular como único método para indicar la remoción de los aparatos, se recomienda la evaluación minuciosa de los modelos de estudio.
636. Recuperación del desnutrido severo en Costa Rica, mediante alimentacion hipercalórica
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Murillo González, Sandra, Waterlow, John, Vargas, William, and Mata Jiménez, Leonardo
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Trastornos de la Nutrición del Niño ,Resultado del Tratamiento ,Niño ,Malnutrition ,Recuperación Nutricional - Abstract
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)
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637. Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial
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Rullan, Manuel, Bulilete, Oana, Leiva, Alfonso, Soler Mieras, Aina, Roca, Antonia, Jose Gonzalez-Bals, Maria, Lorente, Patricia, Llobera Cànaves, Joan, and PHN Grp
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Male ,sueño ,Time Factors ,antivíricos ,Cyclohexanecarboxylic Acids ,humanos ,Herpes zoster ,Acyclovir ,Neuralgia, Postherpetic ,Medicine (miscellaneous) ,neuralgia ,Study Protocol ,0302 clinical medicine ,Clinical Protocols ,analgésicos ,ácido gamma-aminobutírico ,Surveys and Questionnaires ,valina ,Pharmacology (medical) ,030212 general & internal medicine ,Amines ,mediana edad ,gamma-Aminobutyric Acid ,Primary health care ,Pain Measurement ,Analgesics ,Dysesthesia ,resultado del tratamiento ,Valine ,ácidos ciclohexanocarboxílicos ,Middle Aged ,Allodynia ,medida del dolor ,Treatment Outcome ,Research Design ,Anesthesia ,Valacyclovir ,Hyperalgesia ,Neuropathic pain ,Postherpetic neuralgia ,Female ,medicine.symptom ,Gabapentin ,medicine.drug ,aminas ,Visual analogue scale ,Analgesic ,Antiviral Agents ,03 medical and health sciences ,factores de tiempo ,Double-Blind Method ,medicine ,Humans ,método con doble ocultación ,protocolos clínicos ,business.industry ,Prevention ,medicine.disease ,aciclovir ,Spain ,calidad de vida ,Quality of Life ,business ,Sleep ,030217 neurology & neurosurgery ,diseño de la investigación - Abstract
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.
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638. The use of risk sharing tools for post adoption surveillance of a non pharmacological technology in routine practice: results after one year
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Carlos Campillo-Artero and Francisco M. Kovacs
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Male ,medicine.medical_specialty ,Referral ,National Health Programs ,humanos ,Pain ,Disability Evaluation ,reflexoterapia ,estudios prospectivos ,valoración de discapacidades ,alta de pacientes ,Medicine ,dolor ,Humans ,Prospective Studies ,Medical prescription ,Prospective cohort study ,Referral and Consultation ,Reimbursement ,mediana edad ,Aged ,Pain Measurement ,Quality of Health Care ,Neck pain ,anciano ,Referred pain ,business.industry ,resultado del tratamiento ,Health Policy ,Middle Aged ,Low back pain ,Patient Discharge ,Neuroreflexotherapy ,medida del dolor ,Outcome and Process Assessment, Health Care ,Treatment Outcome ,Spain ,Physical therapy ,Female ,medicine.symptom ,business ,Reflexotherapy ,Research Article - Abstract
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.
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639. The HIV care cascade in Buenos Aires, Argentina: Results in a tertiary referral hospital
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Cesar, C., Blugerman, G., Valiente, J. A., Peter Rebeiro, Sued, O., Fink, V., Soto, M. R., Cillis, R., Yamamoto, C., Falistocco, C., Cahn, P., and Pérez, H.
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Adult ,lcsh:Arctic medicine. Tropical medicine ,Anti-HIV Agents ,lcsh:RC955-962 ,resultado del tratamiento ,lcsh:Public aspects of medicine ,lcsh:R ,Argentina ,VIH ,lcsh:Medicine ,HIV Infections ,terapia antirretroviral altamente activa ,lcsh:RA1-1270 ,Viral Load ,Article ,CD4 Lymphocyte Count ,Tertiary Care Centers ,continuidad de la atención al paciente ,Humans ,Patient Compliance ,Regression Analysis - Abstract
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.
640. Granulocyte colony-stimulating factor in the treatment of high-risk febrile neutropenia: A multicenter randomized trial
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Luis Paz-Ares, Antonio Rueda, Carlos Lage Gómez, Carlos Lumbreras, Jose Luis Perez-Gracia, Hernán Cortés-Funes, A. Yubero, María Victoria Tornamira, Marta López-Brea, Alberto Arcediano, Rocio Garcia-Carbonero, Vicente Guillem, Alejandro Tres, Javier Hornedo, Fernando Ribera, Jose I. Mayordomo, [García-Carbonero,R, Tornamira,MV, Arcediano,A, Gómez,C, Pérez-Gracia,JL, Hornedo,J, Cortés-Funes,H, Paz-Ares,L] Division of Medical Oncology, Hospital Universitario Doce de Octubre, Madrid, Spain. [Mayordomo,JI, Yubero,A, Trés,A] Division of Medical Oncology, Hospital Clínico, Zaragoza, Spain. [López-Brea,M, and Rivera,F] Division of Medical Oncology, Hospital M. Valdecilla, Santander, Spain. [Rueda Domínguez,A] Division of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Guillém,V] Division of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain. [Lumbreras,C] Division of Infectious Diseases, Hospital Universitario Doce de Octubre, Madrid, Spain.
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Male ,Cancer Research ,Time Factors ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Proportional Hazards Models [Medical Subject Headings] ,Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings] ,Cost-Benefit Analysis ,España ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Hematopoietic Cell Growth Factors::Colony-Stimulating Factors::Granulocyte Colony-Stimulating Factor [Medical Subject Headings] ,Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Diseases::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Temperature Changes::Fever [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,Granulocyte Colony-Stimulating Factor ,Medicine ,Prospective Studies ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Clinical Protocols::Antineoplastic Protocols::Antineoplastic Combined Chemotherapy Protocols [Medical Subject Headings] ,Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Schedule [Medical Subject Headings] ,Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Survival Analysis [Medical Subject Headings] ,Leukopenia ,Diseases::Neoplasms [Medical Subject Headings] ,Middle Aged ,Chemotherapy regimen ,Neoplasias ,Granulocyte colony-stimulating factor ,Anti-Bacterial Agents ,Treatment Outcome ,Antibacterianos ,Oncology ,Amikacin ,Absolute neutrophil count ,Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Leukocyte Disorders::Leukopenia::Agranulocytosis::Neutropenia [Medical Subject Headings] ,Female ,medicine.symptom ,Análisis Costo-Beneficio ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings] ,medicine.drug ,Protocolos de Quimioterapia Combinada Antineoplásica ,medicine.medical_specialty ,Neutropenia ,Fever ,Análisis de Supervivencia ,Resultado del Tratamiento ,Check Tags::Male [Medical Subject Headings] ,Drug Administration Schedule ,Health Care::Health Care Economics and Organizations::Economics::Costs and Cost Analysis::Cost-Benefit Analysis [Medical Subject Headings] ,Internal medicine ,Humans ,Health Care::Health Care Facilities, Manpower, and Services::Health Services::Patient Care::Hospitalization::Length of Stay [Medical Subject Headings] ,Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Aged ,Proportional Hazards Models ,Performance status ,business.industry ,Esquema de Medicación ,Length of Stay ,medicine.disease ,Survival Analysis ,Surgery ,Factor Estimulante de Colonias de Granulocitos ,Check Tags::Female [Medical Subject Headings] ,Spain ,Health Care::Health Services Administration::Quality of Health Care::Outcome and Process Assessment (Health Care)::Outcome Assessment (Health Care)::Treatment Outcome [Medical Subject Headings] ,Modelos de Riesgos Proporcionales ,business ,Fiebre ,Factores de Tiempo ,Febrile neutropenia ,Tiempo de Internación - Abstract
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
641. Evolution of adherence to antiretroviral treatment in a spanish hospital during 2001, 2005 and 2008
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Echarri Martínez, L., Rodríguez González, C. G., Castillo Romera, I., Trovato López, A. N., Ais Larisgoitia, A., José María Bellón Cano, and Sanjurjo Sáez, M.
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Resultado del Tratamiento ,adherence antiretroviral therapy ,HAART ,predictive factors ,Farmacia ,Terapia Antirretroviral Altamente Activa ,Hospitales - Abstract
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
642. Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol
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Paloma González Santamaría, Elena Cabeza Irigoyen, Montserrat Casmitjana Abella, Marta Maia Boscá Watts, Cristiane Murta Nascimento, Hermini Manzano, Francisco Arnal Monreal, Ana Costa Alcaraz, Josep María Segura Noguera, Olga Pueyo, Alejandro Espí Macías, Sonia Pértega Díaz, Teresa Seoane Pillado, Concepción García Aranda, Catalina Vadell, Marina Pinilla, María Martín Rabadán, Alejandro Pazos, Maria de Lluc Bennasar, Manuel Valladares Ayerbes, María Antonia Sánchez Calavera, Luis González Luján, Margarita Reboredo López, Isabel Monreal Aliaga, E. Falcó, Salvador Pita Fernández, Maite Novella, Magdalena Esteva, Andrea Burón Pust, Beatriz López Calviño, Amador Ruiz Torrejón, Luis González Saez, Francesc Macià, María Ramos Montserrat, and Sergio Lafita Mainz
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Oncology ,Male ,medicine.medical_specialty ,Cancer Research ,neoplasias colorrectales ,Time Factors ,Colorectal cancer ,humanos ,oncología médica ,Medical Oncology ,lcsh:RC254-282 ,invasividad neoplásica ,Colorectal neoplasms ,Disease-Free Survival ,Study Protocol ,factores de tiempo ,Surgical oncology ,Recurrence ,estudios prospectivos ,Internal medicine ,medicine ,Genetics ,Humans ,In patient ,Neoplasm Invasiveness ,supervivencia sin enfermedad ,tasa de supervivencia ,Prospective Studies ,Neoplasm Metastasis ,Prospective cohort study ,Survival rate ,metástasis neoplásica ,business.industry ,resultado del tratamiento ,Diagnosis delay ,Treatment delay ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Prognosis ,Survival Rate ,pronóstico ,Treatment Outcome ,Spain ,Female ,business ,Colorectal Neoplasms ,recurrencia ,After treatment - Abstract
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.
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643. [Emotion recognition rehabilitation combined with cognitive stimulation for people with Alzheimer's disease. Efficacy for cognition and functional aspects]
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J. Antonio García-Casal, Goni-Imizcoz M, Mv, Perea-Bartolome, Garcia-Moja C, Calvo-Simal S, Cardelle-Garcia F, and Franco-Martin M
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Male ,anciano ,Cognición ,Cognitive Behavioral Therapy ,emociones ,resultado del tratamiento ,6104.01 Procesos Cognitivos ,Emotions ,humanos ,enfermedad de Alzheimer ,tratamiento combinado ,Combined Modality Therapy ,Treatment Outcome ,Cognition ,Rehabilitación ,Alzheimer Disease ,Demencia ,Humans ,Female ,Alzheimer, Enfermedad de ,3205.07 Neurología ,Afectos ,Aged - Abstract
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.
644. Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain
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A. Ruiz-Torrejón, Jordi Ibáñez-Nolla, Marion Kvasz, Ruth Navarro-Artieda, Antoni Sicras-Mainar, Alba Aguado-Jodar, and Javier Rejas
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Male ,Quinuclidines ,compuestos de bencidrilo ,Cost-Benefit Analysis ,Phenylpropanolamine ,humanos ,síndrome ,Cholinergic Agents ,costos de la atención de salud ,colinérgicos ,Cresols ,Antimuscarinics ,Tetrahydroisoquinolines ,Health care ,Prevalence ,anciano ,Medical record ,resultado del tratamiento ,prevalencia ,General Medicine ,Solifenacin Succinate ,Syndrome ,Health Care Costs ,fármacos urológicos ,Treatment Outcome ,Overactive bladder ,Urological Agents ,Female ,Tolterodine ,medicine.drug ,Research Article ,medicine.medical_specialty ,quinuclidinas ,Tolterodine Tartrate ,Urology ,Urinary Bladder ,stomatognathic system ,fenilpropanolamina ,Internal medicine ,vejiga urinaria ,medicine ,Fesoterodine ,Humans ,Benzhydryl Compounds ,cresoles ,Aged ,Retrospective Studies ,Health economics ,Solifenacin ,Primary Health Care ,business.industry ,Urinary Bladder, Overactive ,estudios retrospectivos ,Retrospective cohort study ,Health resources ,medicine.disease ,Costs ,Primary care setting ,Reproductive Medicine ,Spain ,business ,tetrahidroisoquinolinas - Abstract
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.
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645. HIV testing, antiretroviral therapy, and treatment outcomes in new cases of tuberculosis in Brazil, 2011
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Torrens, Ana, Bartholomay, Patricia, Silva, Silvano, Khogali, Mohammed, Kristien Verdonck, and Bissell, Karen
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terapia antirretroviral ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,resultado del tratamiento ,Brasil ,lcsh:Public aspects of medicine ,lcsh:R ,Tuberculosis ,VIH ,lcsh:Medicine ,lcsh:RA1-1270 ,coinfección, VIH, TB ,investigación operativa - Abstract
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.
646. Electro-acupuncture for treatment of knee pain from osteoarthritis and the possible endocrinology changes: a study protocol for a randomized controlled trial
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Jose Luis Aguilar, Pedro Valentí, Regina Fortuny, Patricia Hernández, Pilar Sanchis, Sandra Cabrera, J. Mata, and Serafin Lirola
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Male ,Time Factors ,Knee Joint ,Hydrocortisone ,Electroacupuncture ,medicine.medical_treatment ,humanos ,Medicine (miscellaneous) ,Chronic pain ,Osteoarthritis ,Cortisol ,law.invention ,Study Protocol ,Disability Evaluation ,Randomized controlled trial ,Clinical Protocols ,law ,Surveys and Questionnaires ,Electro-acupuncture ,Pharmacology (medical) ,mediana edad ,Endogenous opioid ,Pain Measurement ,resultado del tratamiento ,beta-Endorphin ,recuperación de la función ,fenómenos biomecánicos ,Osteoarthritis, Knee ,Middle Aged ,Arthralgia ,Biomechanical Phenomena ,artralgia ,Treatment Outcome ,medida del dolor ,Research Design ,electroacupuntura ,Female ,Knee osteoarthritis ,medicine.symptom ,medicine.medical_specialty ,WOMAC ,Visual analogue scale ,Non-puncturing needle ,factores de tiempo ,Double-Blind Method ,articulación de la rodilla ,medicine ,valoración de discapacidades ,Humans ,método con doble ocultación ,hidrocortisona ,protocolos clínicos ,business.industry ,Recovery of Function ,beta-endorfina ,medicine.disease ,dolor crónico ,osteoartritis ,Knee pain ,Spain ,calidad de vida ,Physical therapy ,Quality of Life ,business ,Biomarkers ,diseño de la investigación - Abstract
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).
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647. Efficacy of prescribed injectable diacetylmorphine in the Andalusian trial: Bayesian analysis of responders and non-responders according to a multi domain outcome index
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Francisco González Saiz, Luis Carlos Silva Ayçaguer, Alina Danet Danet, Emilio Perea-Milla, Manuel Romero Vallecillo, Eugenia Oviedo-Joekes, Joan Carles March Cerdá, Francisco Rivas-Ruiz, [Perea-Milla, E, Rivas-Ruiz,F] Research Support Unit, Hospital Costa del Sol, Marbella, Spain. [Perea-Milla,E, March Cerdà,JC, Rivas-Ruiz,F, Danet,A, Romero Vallecillo,M] CIBER Epidemiología y Salud Pública (CIBERESP), Spain. [Silva Ayçaguer,LC] National Center for Medical Science Information (INFOMED), vedado, Ciudad de la Habana,Cuba. [March Cerdà,JC, Romero Vallecillo,M] Andalusian School of Public Health, Campus Universitario de Cartuja, Granada, Spain. [González Saiz,F] Andalusian Foundation for Drug Abuse Attendance (FADA), Seville, Spain. [Oviedo-Joekes,E] School of Population and Public Health, University of British Columbia & Centre for Health Evaluations and Outcomes, Providence Health Care, Vancouver,Canada., and Funded by the Drug Commission, Council for Equality and Social Welfare, Andalusian Government.
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Narcotics ,medicine.medical_specialty ,Bayesian probability ,dependencia de heroína ,Administration, Oral ,Medicine (miscellaneous) ,law.invention ,Heroin ,Injections ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Bayes' theorem ,Diseases::Substance-Related Disorders::Opioid-Related Disorders::Heroin Dependence [Medical Subject Headings] ,Randomized controlled trial ,law ,Internal medicine ,Metadona ,Statistics ,medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Bayes Theorem [Medical Subject Headings] ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Central Nervous System Depressants::Narcotics [Medical Subject Headings] ,Chemicals and Drugs::Organic Chemicals::Ketones::Methadone [Medical Subject Headings] ,Humans ,Pharmacology (medical) ,Chemicals and Drugs::Heterocyclic Compounds::Alkaloids::Opiate Alkaloids::Morphinans::Morphine::Morphine Derivatives::Heroin [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,lcsh:R5-920 ,Inyecciones ,business.industry ,Heroin Dependence ,Research ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Routes::Administration, Oral [Medical Subject Headings] ,Narcoticos ,Diacetylmorphine ,Bayes Theorem ,Andalucía ,Outcome (probability) ,Administración oral ,Treatment Outcome ,Teorema de bayes ,Heroína ,Resultado del tratamiento ,business ,lcsh:Medicine (General) ,Psychosocial ,Methadone ,medicine.drug - Abstract
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
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648. Regression of cardiac growth in kidney transplant recipients using anti-m-TOR drugs plus RAS blockers: a controlled longitudinal study
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Eva Briceño, Domingo Hernández, Mercedes Cabello, Manuel De Mora, Eulalia Palma, Dolores Burgos, Auxiliadora Mazuecos, Daniel Gaitán, Rocío Collantes, Pedro Ruiz-Esteban, M. Gonzalez-Molina, [Hernández,D, Ruiz-Esteban,P, Burgos,D, Palma,E, Cabello,M, González-Molina,M] Department of Nephrology, Carlos Haya University Hospital and IBIMA, Malaga, Spain. [Gaitán,D, De Mora,M] Department of Cardiology and Radiology, Carlos Haya University Hospital and IBIMA, Malaga, Spain. [Briceño,E] Department of Radiology, Carlos Haya University Hospital and IBIMA, Malaga, Spain. [Mazuecos,A, Collantes,R] Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain., and This study was supported by grant PI-0499/2009 from the Consejería de Salud del Gobierno de Andalucía and, in part, by the Spanish Ministry of Science and Innovation (MICINN) (Grant no. PI10/01020) from the Instituto de Salud Carlos III, RETIC, REDinREN RD12/0021/0015.
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Male ,Nephrology ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Protein Kinase Inhibitors [Medical Subject Headings] ,Angiotensin-Converting Enzyme Inhibitors ,Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Left ventricular hypertrophy ,Kidney transplantation ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Trasplante de riñón ,Inhibidores de proteínas cinasas ,Longitudinal Studies ,TOR Serine-Threonine Kinases ,TOR serina-treonina cinasas ,Middle Aged ,Treatment Outcome ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Transplantation::Organ Transplantation::Kidney Transplantation [Medical Subject Headings] ,Cardiology ,Drug Therapy, Combination ,Female ,Hypertrophy, Left Ventricular ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Angiotensin Receptor Antagonists [Medical Subject Headings] ,Inhibidores de la enzima convertidora de angiotensina ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive Agents [Medical Subject Headings] ,Immunosuppressive Agents ,Research Article ,medicine.medical_specialty ,Diastole ,Hipertrofia ventricular izquierda ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Therapy, Combination [Medical Subject Headings] ,Check Tags::Male [Medical Subject Headings] ,Antagonistas de receptores de angiotensina ,Angiotensin Receptor Antagonists ,Pharmacotherapy ,Internal medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies [Medical Subject Headings] ,medicine ,Humans ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Intracellular Signaling Peptides and Proteins::TOR Serine-Threonine Kinases [Medical Subject Headings] ,Everolimus ,Protein Kinase Inhibitors ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Sirolimus ,business.industry ,medicine.disease ,Inmunosupresores ,Kidney Transplantation ,Renin-angiotensin blockers ,Calcineurin ,Left ventricular hupertrophy ,Endocrinology ,Blood pressure ,Diseases::Pathological Conditions, Signs and Symptoms::Pathological Conditions, Anatomical::Hypertrophy::Cardiomegaly::Hypertrophy, Left Ventricular [Medical Subject Headings] ,Farmacoterapia combinada ,Check Tags::Female [Medical Subject Headings] ,Resultado del tratamiento ,Complication ,business ,Renin-angiotensis blockers ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Protease Inhibitors::Angiotensin-Converting Enzyme Inhibitors [Medical Subject Headings] - Abstract
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
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649. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe
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Hortal, Javier, Munoz, Patricia, Cuerpo, Gregorio, Litvan, Hector, Rosseel, Peter M., Bouza, Emilio, European Study Grp Nosocomial Infe, and European Workgrp Cardiothoracic In
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,humanos ,Critical Care and Intensive Care Medicine ,incidencia ,law.invention ,Risk Factors ,law ,estudios prospectivos ,medicine ,factores de riesgo ,Humans ,análisis multifactorial ,Prospective Studies ,Cardiac Surgical Procedures ,Antibiotic prophylaxis ,procedimientos quirúrgicos cardíacos ,Prospective cohort study ,mediana edad ,Mechanical ventilation ,business.industry ,resultado del tratamiento ,Incidence ,Research ,Incidence (epidemiology) ,profilaxis antibiótica ,Ventilator-associated pneumonia ,Pneumonia, Ventilator-Associated ,neumonía ,Pneumonia ,Odds ratio ,Antibiotic Prophylaxis ,Middle Aged ,medicine.disease ,Intensive care unit ,Surgery ,Europe ,Treatment Outcome ,Multivariate Analysis ,Female ,business - Abstract
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.
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650. Long-term outcome of patients after a single interruption of antiretroviral therapy: a cohort study
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Virginia Palomo, Carmen Machado, Felipe Fernández-Cuenca, Ángel Domínguez-Castellano, María J. Ríos-Villegas, Juan Gálvez-Acebal, Miguel A. Muniain, Jesús Rodríguez-Baño, [Machado,C, Ríos-Villegas,MJ, Gálvez-Acebal,J, Domínguez-Castellano,A, Fernández-Cuenca,F, Palomo,V, Muniain,MA, Rodríguez-Baño,J] Infectious Diseases Unit, Hospital Universitario Virgen Macarena. Seville, Spain. [Ríos-Villegas,MJ, Rodríguez-Baño,J] Departament of Medicine, University of Seville, Seville, Spain., The Andalusian Public Foundation for the management of Research in Health of Seville (FISEVI). The Ministry of Science and Innovation, Institute Carlos III of Health - co-financed by European Development Regional Fund 'A way to achieve Europe' ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008)., and Universidad de Sevilla. Departamento de Medicina
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Sexually transmitted disease ,Male ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies [Medical Subject Headings] ,lcsh:Medicine ,HIV Infections ,Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Diseases::Virus Diseases::RNA Virus Infections::Retroviridae Infections::Lentivirus Infections::HIV Infections [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Antiretroviral Therapy, Highly Active ,lcsh:QH301-705.5 ,Outcome ,Medicine(all) ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Schedule [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Therapy, Combination::Antiretroviral Therapy, Highly Active [Medical Subject Headings] ,General Medicine ,Middle Aged ,Tratamiento antirretrovírico de gran actividad ,Antiretroviral therapy ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiviral Agents::Anti-Retroviral Agents::Anti-HIV Agents [Medical Subject Headings] ,Treatment Outcome ,Cohort ,Female ,Cohort study ,Viral load ,Research Article ,Adult ,medicine.medical_specialty ,Anti-HIV Agents ,Check Tags::Male [Medical Subject Headings] ,Treatment interruption ,General Biochemistry, Genetics and Molecular Biology ,Drug Administration Schedule ,Estudios retrospectivos ,Internal medicine ,medicine ,Named Groups::Persons::Age Groups::Adult [Medical Subject Headings] ,Humans ,lcsh:Science (General) ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Retrospective Studies ,business.industry ,Proportional hazards model ,Biochemistry, Genetics and Molecular Biology(all) ,lcsh:R ,Pauta de administración medicamentosa ,Infecciones por VIH ,Surgery ,Acute Retroviral Syndrome ,Regimen ,Fármacos anti-VIH ,Check Tags::Female [Medical Subject Headings] ,lcsh:Biology (General) ,HIV-1 ,Resultado del tratamiento ,business ,lcsh:Q1-390 - Abstract
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.
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