Influence of the number of daily pills and doses on adherence to antiretroviral treatment: a 7-year study

[EN] What is known and objective: Antiretroviral treatment (ART) is hampered by complicated regimens, high pill burden, drug–drug interactions, and frequent short- and long-term adverse effects, leading to decreased adherence. Over recent years, considerable effort has been directed at developing regimens that are less burdening. We undertook a 7-year retrospective study of the records of 264 HIV-infected subjects enrolled in a pharmaceutical care programme to document the progress made and to study the influence of the number of ART pills and doses on the level of treatment adherence. Methods: Antiretroviral dispensing records were analysed for the number of pills and doses administered and the ART adherence rate estimated. Results and discussion: In 2005, the patients took a mean of 6 2 pills daily (CI 95%: 5 9–6 6), and 92 9% of them were on a twice-a-day (BID) dosage regimen. By 2012, the mean number of pills was reduced to 4 1 (CI 95%: 3 8–4 4), and only 50 9% were on a BID regimen. No statistically significant relation was observed between number of daily pills and doses and ART adherence reached by the patients in any of the analyses performed. What is new and conclusions: There has been a continuous reduction in the number of pills and doses of antiretrovirals taken by individual patients over the last 7 years due largely to the introduction of improved treatments and regimens. More daily pills or doses was not associated with worse ART adherence in our pharmaceutical care programme

Intervención farmacéutica en el seguimiento de la terapia antirretroviral

The elevated cost of antiretroviral treatment demands close follow-up to achieve the effectiveness and efficacy of the treatments implemented, the role of pharmacists in achieving such goals is crucial in the sense that they are mainly involved in directing antiretroviral treatments aimed at generating maximum benefit with the available resources. The aim of the present study was to achieve an appropriate clinical control of HIV+ patients through the correct use of the antiretroviral drugs prescribed. The study was carried out for external HIV-patients with antiretroviral treatment in a university hospital. One and a half years after implementing a Pharmaceutical Care Program, a total of 853 interviews were obtained from 386 HIV+ patients (79.6% of the total), achieving a 9% increase in optimal adherence. In turn, we observed 1060 adverse drugs events and 513 drug related problems. In consequence, we performed 1401 interventions in 365 patients. The degree of patient acceptance of the program had a mean score of 3.7 (scale 0-4). The number of patients whose antiretroviral plasma concentrations were monitored was 381, with a total of 849 determinations. Only 39% of them were within the therapeutic range established for these drugs. Based on pharmacokinetic information, the clinicians performed a dosage adjustment in 16 patients. The experience gained since the implementation of the HIV+ patient follow-up program has proved to be useful for the optimisation of treatments using antiretroviral drugs.La eficacia y el alto coste de la terapia antirretroviral exigen un estrecho seguimiento para lograr su máxima efectividad y eficiencia, siendo fundamental el papel del farmacéutico para alcanzarla mediante la individualización de los tratamientos. El objetivo de este estudio ha sido conseguir un adecuado control clínico del paciente VIH+ a través del uso correcto de los medicamentos antirretrovirales prescritos. Para ello se ha puesto en marcha un Programa de Atención Farmacéutica para los pacientes externos VIH+ en tratamiento antirretroviral en un hospital universitario. Después de un año y medio de iniciarlo se han realizado un total de 853 entrevistas en 386 pacientes VIH+ (79,6% del total), consiguiéndose un aumento del 9% en la proporción de pacientes con adherencia óptima. A su vez, se han detectado 1.060 acontecimientos adversos por medicamentos y 513 problemas relacionados con la medicación. En función de ello, se han realizado 1.401 intervenciones en 365 pacientes. El grado de aceptación de los pacientes al servicio de atención farmacéutica ha alcanzado una puntuación media de 3,27 (escala 0-4). El número de pacientes cuyas concentraciones plasmáticas de fármacos antirretrovirales se han monitorizado es de 381, con un total de 849 determinaciones. Sólo el 39% de ellas se encontraba dentro de los márgenes terapéuticos aceptados para estos fármacos. Basándose en la información farmacocinética, los clínicos han realizado el ajuste posológico en 16 pacientes. La experiencia obtenida desde la implantación del programa de seguimiento ha puesto de manifiesto su utilidad para la optimización de los tratamientos con fármacos antirretrovirales

Impacto científico y temático de la Rev. Cuerpo Méd. HNAAA: un análisis bibliométrico, 2011-2020

Introduction: Peru has several journals about biomedical areas, but a few serial publications are visible and indexing in different global indexing media. Objective: To analyze the main publication characteristics from Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo (Chiclayo) based on bibliometric methods. Methods: Descriptive study that analyzes 587 articles published by the journal from 2011 to 2020, based on bibliometric methods and indicators: citations, scientific impact and co-word analysis. Results: Original articles were the highest types of document published (60%; X̅=66). Published research articles on general medicine received more impact in previous years than the recents. Most frequent terms analyzed were studies about patients from hospitals in Chiclayo city (Lambayeque) with covid-19 clinical cases.  Conclusion: Revista del Cuerpo Médico HNAAA is emerging as an important scholarly publication to do visible local, national, and international production due to health subject coverage into medical specialties.Introducción: El Perú posee un gran número revistas de áreas biomédicas, pero solo algunas han logrado visibilizar e indizar sus publicaciones en diferentes medios de indización de alcance global. Objetivo: Analizar las características de publicación de la Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo (Chiclayo) a partir de indicadores bibliométricos. Métodos: Estudio descriptivo que analiza 587 registros bibliográficos de los artículos publicados en la revista durante 2011-2020, a partir de indicadores de impacto científico y análisis de términos. Resultados: La mayor producción de artículos corresponde a originales (60%; X̅=66). Los artículos publicados sobre medicina general obtuvieron más impacto en años anteriores. Los temas más frecuentes fueron estudios sobre pacientes de hospitales de Chiclayo, Lambayeque con casos de covid-19. Conclusiones: La Revista del Cuerpo Médico HNAAA se perfila como una publicación seriada de importancia para visibilizar la producción nacional y local por la cobertura temática en especialidades médicas de relevancia regional que publica

Estudio comparativo en el manejo médico del aborto terapéutico entre el uso de Mifepristone más Misoprostol y el uso de Misoprostol solo

Tuvo como objetivo evaluar las diferencias en el manejo médico del aborto terapéutico usando Mifepristone más Misoprostol comparado con el uso de Misoprostol solo. Se realizó un estudio observacional, de cohorte retrospectiva y multicéntrica (Instituto Nacional Materno Perinatal [INMP], Hospital Regional de Pucallpa, Hospital Santa Rosa de Piura y Hospital Regional de Loreto), en gestantes con indicación de aborto terapéutico, según lo establecido en la RM N° 486-2014-MINSA. Las pacientes enroladas en el INMP, al ingreso recibieron 200 mg de Mifepristona y a las 24 horas Misoprostol 800 μg colocado en fondo de saco vaginal posterior al cérvix, seguido de 400 μg vía sublingual, cada 3 horas hasta la expulsión del feto y placenta, siendo el tope 5 dosis por día; las pacientes de los tres hospitales restantes se les administro solo Misoprostol bajo el mismo esquema. El tiempo de expulsión del feto se consideró desde la administración de la primera dosis del misoprostol hasta las 24 horas; en el grupo de Mifepristona mas Misoprostol fue del 100% y en el grupo de Misoprostol solo fue del 83% (p = 0.05). La expulsión de la placenta en grupo que uso Mifepristona fue del 96% y en el grupo de Misoprostol solo fue del 83% (p = 0.20). Se presentaron restos endouterinos en el 10% del grupo de mifepristona versus 33% del grupo de solo misoprostol (p = 0.03). El tiempo de expulsión del producto de la concepción fue menor en el grupo de mifepristona con una diferencia de sus medianas de 2.8 horas (p =0.001). El estudio concluye que existen diferencias en el manejo médico del aborto terapéutico a favor del uso de Mifepristone más Misoprostol versus el uso de Misoprostol solo, en términos de tasa de éxito, tiempo de inducción al aborto y reacciones adversas o complicacione

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified