Sofosbuvir-velpatasvir en pacientes mexicanos con hepatitis C: una revisión retrospectiva

Resumen: Introducción: La combinación de sofosbuvir-velpatasvir (SOF/VEL) es una terapia antiviral de acción directa que está autorizada y disponible en México. Esto hace que la evaluación de la respuesta virológica sostenida (RVS) 12 semanas después del tratamiento, por medio de la realización de una revisión multicentro en el mundo real, sea una tarea relevante. Métodos: Se efectuó una revisión retrospectiva de los registros de 241 casos de pacientes atendidos en 20 hospitales en México para evaluar el tratamiento contra la hepatitis C con la combinación SOF/VEL (n = 231) y sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) (n = 10). El objetivo de eficacia primario fue el porcentaje de pacientes que lograron la RVS 12 semanas posterior a la finalización del tratamiento. Resultados: En general, la RVS fue de 98.8% (IC 95% 97.35 a 100%). Solo tres pacientes no lograron la RVS, de los cuales dos padecían cirrosis y una tenía historia previa de tratamiento con interferón pegilado (peg-IFN). De los subgrupos analizados, todos los casos con infección de virus de la inmunodeficiencia humana (VIH), tres con genotipo 3 y aquellos tratados con la combinación SOF/VEL/RBV, lograron RVS. Los subgrupos con tasas menores de éxito fueron los pacientes que tenían experiencia con tratamiento (96.8%) y pacientes con fibrosis F1 (95.5%). Los eventos adversos más frecuentes fueron fatiga, cefalea e insomnio. No se reportaron eventos adversos graves. Conclusión: Los tratamientos con SOF/VEL y SOF/VEL/RBV fueron altamente seguros y efectivos y los resultados coinciden con los de otros estudios internacionales realizados en el mundo real. Abstract Introduction: The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. Methods: A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. Results: Overall SVR was 98.8% (95% CI 97.35-100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. Conclusion: Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies

Clinical practice guidelines for the attention of pregnant women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II

Background: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. Objectives: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). Methodology: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. Results: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. Conclusions: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions. © 2014 Elsevier España, S.L.U

Current threats faced by Neotropical parrot populations

Berkunsky I, Quillfeldt P, Brightsmith DJ, et al. Current threats faced by Neotropical parrot populations. Biological Conservation. 2017;214:278-287.Psittaciformes (parrots, cockatoos) are among the most endangered birds, with 31% of Neotropical species under threat. The drivers of this situation appear to be manifold and mainly of anthropogenic origin. However, this assessment is based on the last extensive consultation about the conservation situation of parrots carried out in the 1990s. Given the rapid development of anthropogenic threats, updated data are needed to strategize conservation actions. Using a population approach, we addressed this need through a wide-ranging consultation involving biologists, wildlife managers, government agencies and non-governmental conservation organizations. We gathered up-to-date information on threats affecting 192 populations of 96 Neotropical parrot species across 21 countries. Moreover, we investigated associations among current threats and population trends. Many populations were affected by multiple threats. Agriculture, Capture for the Pet Trade, Logging, each of them affected > 55% of the populations, suggesting a higher degree of risk than previously thought. In contrast to previous studies at the species level, our study showed that the threat most closely associated with decreasing population trends is now Capture for the local Pet Trade. Other threats associated with decreasing populations include Small-holder Farming, Rural Population Pressure, Nest Destruction by Poachers, Agro-industry Grazing, Small-holder Grazing, and Capture for the international Pet Trade. Conservation actions have been implemented on < 20% of populations. Our results highlight the importance of a population-level approach in revealing the extent of threats to wild populations. It is critical to increase the scope of conservation actions to reduce the capture of wild parrots for pets