Search

Einleitung: Das inzidentelle Prostatakarzinom tritt in ca. 10% der BPS-Operationen auf. Für das Festlegen einer individuellen Therapiestrategie ist eine Risikoeinschätzung des zugrundeliegenden Prostatakarzinoms entscheidend. Da keine Leitlinienempfehlung für dieses Scenario existiert, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Esclerosis múltiple; Brote; Resonancia magnética Esclerosi múltiple; Brot; Imatge per ressonància magnètica Multiple sclerosis; Outbreak; Magnetic resonance imaging Objective To study the clinico-radiological paradox in multiple sclerosis (MS) relapse by analyzing the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI before methylprednisolone (MP) treatment. Methods We analyzed brain MRI from 90 relapsed MS patients in two Phase IV multicenter double-blind randomized clinical trials that showed the noninferiority of different routes and doses of MP administration. A 1.5- or 3-T brain MRI was performed at baseline before MP treatment and within 15 days of symptom onset. The number and location of Gd+ lesions were analyzed. Associations were studied using univariate analysis. Results Sixty-two percent of patients had at least 1 Gd+ brain lesion; the median number was 1 (interquartile range 0–4), and 41% of patients had 2 or more lesions. The most frequent location of Gd+ lesions was subcortical (41.4%). Gd+ brain lesions were found in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms and 55.5% with optic neuritis (ON). Thirty percent of patients with brain symptoms did not have Gd+ lesions, and only 43.6% of patients had symptomatic Gd+ lesions. The univariate analysis showed a negative correlation between age and the number of Gd+ lesions (p = 0.002). Conclusion Most patients with relapse showed several Gd+ lesions on brain MRI, even when the clinical manifestation was outside of the brain. Our findings illustrate the clinico-radiological paradox in MS relapse and support the value of brain MRI in this scenario. Objetivo Estudiar la paradoja clínico-radiológica en el brote de la esclerosis múltiple (EM) mediante el análisis de lesiones captantes de gadolinio (Gd+) en la RM cerebral antes del tratamiento con metilprednisolona (MP). Métodos Analizamos la RM cerebral basal de 90 pacientes con EM en brote de 2 ensayos clínicos aleatorizados multicéntricos fase IV que demostraron la no inferioridad de diferentes vías y dosis de MP, realizadas antes del tratamiento con MP y en los 15 días siguientes a la aparición de los síntomas. Se analizaron el número y la localización de las lesiones Gd+. Se estudiaron las asociaciones mediante análisis univariado. Resultados El 62% de los pacientes tenía al menos una lesión Gd+ cerebral y el 41% de los pacientes tenía 2 o más lesiones. La localización más frecuente fue la subcortical (41,4%). Se encontraron lesiones Gd+ cerebrales en el 71,4% de los pacientes con síntomas de tronco cerebral o cerebelo, en el 57,1% con síntomas medulares y en el 55,5% con neuritis óptica. El 30% de los pacientes con síntomas cerebrales no tenían lesiones Gd+ y sólo el 4,.6% de los pacientes tenían lesiones Gd+ sintomáticas. El análisis univariante mostró una correlación negativa entre la edad y el número de lesiones Gd+ (p = 0,002). Conclusiones La mayoría de los pacientes en brote mostraron varias lesiones Gd+ en la RM cerebral, incluso cuando la manifestación clínica fue medular u óptica. Nuestros hallazgos ilustran la paradoja clínico-radiológica en el brote de la EM y apoyan el valor de la RM cerebral en este escenario. This work was supported in part by the Ministry of Health of Spain (grant numbers EC07/90278 and EC11/132) and personal grant Rio Hortega CM19/00042 to LMA.

The recent development of highly effective treatments for multiple sclerosis (MS) and the potential risk of infectious complications require the development of prevention and risk minimisation strategies. Vaccination is an essential element of the management of these patients. This consensus statement includes a series of recommendations and practical scenarios for the vaccination of adult patients with MS who are eligible for highly effective immunosuppressive treatments. A formal consensus procedure was followed. Having defined the scope of the statement, we conducted a literature search on recommendations for the vaccination of patients with MS and specific vaccination guidelines for immunosuppressed patients receiving biological therapy for other conditions. The modified nominal group technique methodology was used to formulate the recommendations. Vaccination in patients who are candidates for immunosuppressive therapy should be considered before starting immunosuppressive treatment providing the patient's clinical situation allows. Vaccines included in the routine adult vaccination schedule, as well as some specific ones, are recommended depending on the pre-existing immunity status. If immunosuppressive treatment is already established, live attenuated vaccines are contraindicated. For vaccines with a correlate of protection, it is recommended to monitor the serological response in an optimal interval of 1-2 months from the last dose.

BackgroundIn multiple sclerosis (MS), half of affected people are unemployed within 10years of diagnosis. The aim of this study was to assess the economic impact of MS in adult subjects with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS).MethodsA multicenter, non-interventional, cross-sectional study was conducted. The Expanded Disability Status Scale (EDSS) and the 23-item Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23) were used to assess disability and work performance, respectively. Only indirect costs were considered using the human capital method, including work costs. Professional support costs and informal caregivers' costs were also estimated.ResultsA total of 199 subjects were studied (mean age: 43.910.5years, 60.8% female, 86.4% with RRMS). Median EDSS score was 2.0 (interquartile range: 1.0-3.5) and median MSWDQ-23 total score was 31.5 (15.2, 50.0). The number of employed subjects decreased after MS diagnosis from 70.6 to 47.2%, and the number of retired people increased (23.6%). Mean age of retirement was 43.6 +/- 10.5years. Ten percent of the population had sick leaves (absenteeism was seen in 90.9% of the student population and 30.9% of the employed population). Professional support in their daily life activities was needed in 28.1% of subjects. Costs for sick leave, work absenteeism, premature retirement and premature work disability/pensioner were Euro416.6 +/- 2030.2, Euro763.4 +/- 3161.8, Euro5810.1 +/- 13,159.0 and Euro1816.8 +/- 9630.7, respectively. Costs for professional support and informal caregiving activities were Euro1026.93 +/- 4622.0 and Euro1328.72, respectively.Conclusions p id=Par4 MS is responsible for a substantial economic burden due to indirect and informal care costs, even in a population with low physical disability.

129 páginas. Maestría en Diseño. El presente trabajo analizará el cuadrante de Regina mediante instrumentos cuantitativos y cualitativos que permitan identificar los efectos relacionados con el auge en la creación de espacios artísticos y culturales, y se relacionarán con las categorías teóricas urbanas que fundamentan la investigación. Dichas categorías se definirán más adelante en función de las observaciones preliminares realizadas en la zona, y con el estudio de casos análogos alrededor del mundo. Para efectos de esta investigación, el área de estudio será delimitada por las calles de 16 de Septiembre al Norte, 20 de Noviembre al Oriente, Izazaga al Sur y Eje Central al Poniente. Se ha delimitado de esta manera el área de estudio ya que es en este cuadrante donde han proliferado la mayoría de espacios artísticos y culturales del Centro Histórico a raíz de su revitalización.

Background/aim - There are several reports that claim anticipation in complex or polygenic diseases such as multiple sclerosis (MS), Crohn disease or schizophrenia. The aim of the present study was to assess age at onset of MS during the last 60 years in the region of Costa de Ponent (Barcelona, Spain) showing how apparent changes in age at onset between generations can be an artefact of analysis based on cohorts that have not been followed enough time. Methods - The study comprised 1100 patients diagnosed of MS. The method used to correct for follow-up time bias involves constructing comparison cohorts that had been observed for the same amount of time. To ensure equal follow-up times, we restricted our analysis to patients whose onset was by 37 years of age (percentile 75) and were at least 37 years old. We analysed differences in age at onset using log-rank test to compare survival curves estimated by Kaplan-Meier method. Results - Age at onset decreases progressively from older to younger generations. However, when adjustment to equal follow-up time was done, anticipation in age at onset was not found. Conclusion - Anticipation of age at onset is undetectable when adjusted for follow-up time.

In a 6-month, placebo-controlled trial, oral fingolimod (FTY720) 1.25 or 5.0 mg, once daily, significantly reduced MRI inflammatory activity and annualized relapse rate compared with placebo in patients with relapsing multiple sclerosis (MS). The objectives were to monitor the 36-month, interim efficacy and safety results of the ongoing extension of this study. In the extension (months 7—36), placebo-treated patients were re-randomized to either dose of fingolimod; fingolimod-treated patients continued at the same dose. During months 15—24, all patients receiving fingolimod 5.0 mg switched to 1.25 mg. Of the 250 patients who entered the extension study, 173 (69%) continued to month 36. Most patients were free from gadolinium-enhanced lesions (88—89%) or new T2 lesions (70—78%) at month 36. Patients receiving continuous fingolimod treatment had sustained low annualized relapse rates of 0.20—0.21, and 68—73% remained relapse-free at month 36. Over 36 months, nasopharyngitis (34%), headache (30%), fatigue (19%) and influenza (18%) were the most commonly reported adverse events. Pulmonary function remained stable and blood pressure was stable after an initial increase (3—5 mmHg) during the first 6 months of fingolimod treatment; serious adverse events included infections and skin cancer. The low MRI and clinical disease activity at 6 months were maintained at 36 months with fingolimod, which was generally well tolerated by most patients. The efficacy and safety of oral fingolimod are being further evaluated in a large phase III MS study programme.

Objective:: To report the results of a 24-month extension of a phase II trial assessing the efficacy, safety, and tolerability of the once-daily oral sphingosine-1-phosphate receptor modulator, fingolimod (FTY720), in relapsing multiple sclerosis (MS). METHODS:: In the randomized, double-blind, placebo-controlled core study, 281 patients received placebo or FTY720, 1.25 or 5.0 mg/day, for 6 months. During the subsequent dose-blinded extension, patients assigned to placebo were re-randomized to either dose of FTY720; those originally assigned to FTY720 continued at the same dose. Patients receiving FTY720 5.0 mg were switched to 1.25 mg during the month 15 to month 24 study visits. RESULTS:: Of 281 patients randomized in the core study, 250 (89%) entered the extension phase, and 189 (75.6%) received treatment for 24 months. During the core study, FTY720 significantly reduced gadolinium-enhanced (Gd) lesions and annualized relapse rate (ARR) compared with placebo, with no differences between doses. During the extension phase, patients who switched from placebo to FTY720 showed clear reductions in ARR and lesion counts compared with the placebo phase; ARR and lesion counts remained low in patients who continued FTY720 treatment. After 24 months, 79 to 91% of patients were free from Gd lesions and up to 77% of patients remained relapse free. FTY720 was well tolerated; no new safety concerns emerged during months 7 to 24 compared with the 6-month core study. CONCLUSIONS:: Once-daily oral treatment with FTY720, 1.25 or 5.0 mg, for up to 2 years, was well tolerated and was associated with low relapse rates and lesion activity. © 2009 AAN Enterprises, Inc.

The objective of this study is to calculate direct, indirect and intangible costs of a relapse in multiple sclerosis (MS) in our cohort of patients.Data from patient questionnaires, hospital charts, Catalan Public Healthcare System tariffs and Catalan Statistics Institute. We employed a cost-of-illness method. The human capital approach was used to estimate indirect costs, and quality-of-life measurements were used to estimate intangible costs.148 MS patients monitored in our MS-Unit consecutively answered the questionnaire elaborated. We calculated 1,498.5-1,537.9 euros for direct costs (hospital admission and outpatient, respectively) and 1,530.6 euros for indirect costs. We estimated an average total cost of 3,048.8 euros per patient/relapse. We also calculated intangible costs, 539 euros per patient and relapse, which should be added to the previous figure.The total cost of a MS relapse in our population (3,048.8 euros) is lower than the cost reported in the literature. The economic impact of MS is due to its disabling progression rather than to relapses

S. aureus es un patógeno importante en el medio hospitalario y en la comunidad. Analizamos su comportamiento frente a los antimicrobianos. Clasificamos los antimicrobianos según su uso clínico y estructura farmacológica. Estudiamos 30.344 cepas de Staphylococcus aureus procedentes de los centros de salud del Grupo Venezolano de Vigilancia de la Resistencia Bacteriana a los Antimicrobianos (GVRB) realizando antibiogramas según las normas del NCCLS, y utilizando el análisis de series cronológicas, con los siguientes resultados. Antibióticos de primera línea: oxacilina, disminuyó; la variación porcentual fue del 64%, con respecto al primer valor de la serie. Vancomicina disminuyó el 100%. El descenso de la resistencia a oxacilina y vancomicina pareciera depender de las mejoras introducidas en las técnicas de determinación de la resistencia a estos antibióticos. b-lactámicos: ampicilina-sulbactam aumentó un 66,7%; aminoglucósidos: amikacina disminuyó 50% y gentamicina 63,20%. Quinolonas: ciprofloxacina aumentó un 300% y norfloxacina 50%. Otros: todos presentaron descenso. El uso de vancomicina debe reservarse para infecciones severas por cepas de S. aureus con comprobada resistencia a oxacilina. S. aureus is an important pathogen, both in hospitalized subjects and in the community. S. aureus’ antibiotic resistance was analyzed. We grouped the anti-microbial agents according to clinical use and pharmacological structure. We studied 30.344 isolates recuperated from hospital and community infections from 23 bacteriology laboratories registered in the data-base of the Surveillance Program of Bacterial Resistance to Antimicrobials in Venezuela (GVRB). Resistance being determined by the method of disc diffusion, following the NCCLS breakpoints. Results were as follows: first line antibiotics: oxacillin shows descent of 64% of variability according to the initial series value when applying the statistical tools for the Analysis of Chronological Series; vancomycin’s resistance descended 100%. Those descent are probably due to more careful procedures: ampicillin-sulbactam’s resistance raised 66,70%; aminoglycosides: amikacin lowered resistance in 50% and gentamicin in 63,20%; for the quinolones, cyprofloxacin raised values in 300% and norfloxacin in 50%. Among other antimicrobial tested, all of the group have reduced the resistance values. We consider that vancomycin should be reserved exclusively for patients with severe infections by S. aureus isolates where it has been demonstrated resistance to oxacillin.

Entre el 5 y el 10% de los pacientes que ingresan a hospitales de EE UU adquieren una o mas infecciones dentro del hospital. Una cuarta parte de esas infecciones nosocomiales están representadas por infecciones de la Unidad de Cuidados Intensivos (UCI). De estas últimas, el 70% son producidas por microorganismos resistentes a antimicrobianos; constituyendo este último, un problema de salud global por sí solo. El alto grado de resistencia por parte de estos microorganismos es una de las razones más relevantes que contribuyen a incrementar el número de muertes en los casos de infección nosocomial. Los bacilos Gram-negativos son los primeros responsables de infección nosocomial, y entre ellos P. aeruginosa es la primera en frecuencia. La división entre diferentes ecosistemas en el hospital refleja diferentes poblaciones con diferentes características. En este estudio presentamos comparaciones de los porcentajes de resistencia ante ß-lactámicos y aminoglicósidos en P. aeruginosa nosocomial (UCI y cirugía) y comunitaria (COM), en centros médicos de Venezuela, diferenciando los públicos (Hpu) de los privados (Hpri), para el año 2000. Se usó el método de difusión de disco, de acuerdo al NCCLS [National Committe for Clinical Laboratories Standards (Comité Nacional de Estándares para Laboratorios Clínicos)]. Se siguió el programa software WHONET (World Health Organization Net). Se incluyeron todas las cepas reportadas en los diferentes servicios. Se realizó la evaluación estadística por prueba Z (p≤ 0,05). 1. Se muestran diferencias significativas en la frecuencia de resistencia (fr) en P. aeruginosa nosocomial entre UCI/COM en Hpu (mayores diferencias: piperacilina, 44/8% y gentamicina, 39/10%), entre UCI/CI (la mayor ≠ piperac, 44/23% y la menor cefepime, 10/8%). 2. Hay diferencias significativas entre la frb de CI de Hpu/Hpri, siendo las mayores ≠ : piper, 23/15%; piper-tazob, 11/2%; tobra, 25/2%; netilm, 25/8%; genta, 37/22%. No se observaron diferencias significativas entre UCI de Hpu/Hpri. 3. No hubo diferencias en la frb ante Amg para P. aeruginosa entre UCI/Ci de Hpu, pero sí de Hpri (mayores ≠ : tobra, 40/1 y netilm, 40/9). 4. Tiene relevancia las diferencias observadas ante ß-L entre UCI/CI y entre éstos y la comunidad, tanto en Hpu como en Hpri. Estas observaciones ponen en evidencia la importancia del medio ambiente en la dinámica de la resistencia, y por tanto la necesidad de poner en práctica, y de rutina, medidas especiales de asepsia y antisepsia. Por otra parte, y debido a la gravedad y frecuencia tanto de las infecciones como de la resistencia producidas por P. aeruginosa en este medio ambiente, se impone el uso en estos pacientes de medidas farmacológicas especiales, para asegurar el éxito de la terapia antimicrobiana, tanto para curar la infección como para prevenir la aparición de cepas resistentes. Currently, between 5 and 10 percent of patients admitted to acute care hospitals acquire one or more infections in the hospital. A quarter of these nosocomial infections are originated in the intensive care unity (ICU), 20% of these are produced by antimicrobial agents resistant microorganisms; which is a global health problem by it self. This high degree of resistance is one of the reasons which contribute to increases the numbers of death by nosocomial infections. Gram-negative bacilli are the principals responsible of nosocomial infections, and among them, the first in frequency is P. aeruginosa. We compare the percentages of resistance to either ß-lactams or aminoglycosides in nosocomial (ICU and surgery=SU) and communitarian (Com) P. aeruginosa, at the Venezuelan Medical Centres, evaluating the differences between public (puC) and privates centres (priC) for the year 2000. It was used diffusion disk, according NCCLS. The software program WHONET was used. Statistical significance (p≤0,05-0,01) was determined by "Z". 1. We show significant differences in the frequency of resistance to ß-lactams (frb) in nosocomial P. aeruginosa from puC, between ICU/Com (major differences: piperacillin 44/ 8% and genta 39/ 10%), and between ICU/ Su (the major ≠ piperacillin 44/23%, and the minor ≠ cefepime 10/8%). 2. We observe a significant difference in frb, between puC and priC, in infections of patients from Su (majors ≠ : piper 23/15%, piper-tazob 11/2%, tobra 25/2%, netilm 25/8%, genta 37/22%, but not in those from ICU. 3. We did not found any difference in the P. aeruginosa resistant isolated to aminoglycosides between ICU and Su at the puC, but at the priC majors ≠ : tobra 40/1% and netilm 40/9%. 4. The differences in the fr to ß-lactams showed by P. aeruginosa infection are noteworthy between ICU and Su and between these and Com, either for puC or for priC. These observations support the implication of the environment, and specially the hospital environment in the dynamic of bacterial resistance, and then the necessity to take in account specials routine habit of asepsis and antisepsis measures. Moreover and due to the seriousness and high frequency, either for the infections or for the resistance produced by P. aeruginosa in this environment, demand the use in these patients, of specials pharmacological strategies; in order to ensure the success of the antimicrobial therapy, either to cure the infection or to prevent resistance