11 research outputs found
Contribution of Cytochrome P450 and ABCB1 Genetic Variability on Methadone Pharmacokinetics, Dose Requirements, and Response
Although the efficacy of methadone maintenance treatment (MMT) in opioid dependence disorder has been well established, the influence of methadone pharmacokinetics in dose requirement and clinical outcome remains controversial. The aim of this study is to analyze methadone dosage in responder and nonresponder patients considering pharmacogenetic and pharmacokinetic factors that may contribute to dosage adequacy. Opioid dependence patients (meeting Diagnostic and Statistical Manual of Mental Disorders, [4th Edition] criteria) from a MMT community program were recruited. Patients were clinically assessed and blood samples were obtained to determine plasma concentrations of (R,S)-, (R) and (S)- methadone and to study allelic variants of genes encoding CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19, and P-glycoprotein. Responders and nonresponders were defined by illicit opioid consumption detected in random urinalysis. The final sample consisted in 105 opioid dependent patients of Caucasian origin. Responder patients received higher doses of methadone and have been included into treatment for a longer period. No differences were found in terms of genotype frequencies between groups. Only CYP2D6 metabolizing phenotype differences were found in outcome status, methadone dose requirements, and plasma concentrations, being higher in the ultrarapid metabolizers. No other differences were found between phenotype and responder status, methadone dose requirements, neither in methadone plasma concentrations. Pharmacokinetic factors could explain some but not all differences in MMT outcome and methadone dose requirements
Cómo diseñar talleres para promover la salud en grupos comunitarios
Una de las estrategias de promoción de la salud es el desarrollo de habilidades para la vida considerando a las propias personas como principal recurso para la salud. Un taller ha de conseguir que sus participantes se conviertan en «activos» para tomar decisiones y generar salud, centråndose en el desarrollo y adquisición de habilidades en grupo de una manera motivadora y con la finalidad de alcanzar unos objetivos. Los conceptos que fundamentan el diseño de un taller y que han de plantearse como etapa 0 son: planificación participativa, capacitar, aprendizaje significativo, aprender en grupo y técnicas participativas.
Las etapas que se deben seguir para diseñar un taller y facilitar su aplicación son: etapa 0 de fundamentación, etapa inicial, de acogida y de evaluación inicial; etapa central o de construcción del aprendizaje basado en la adquisición de conocimientos, actitudes y habilidades, y etapa final o de evaluación
Quiste adventicial de arteria poplĂtea y su relaciĂłn con la articulaciĂłn de la rodilla. HistologĂa y resonancia magnĂ©tica
El quiste adventicial de arteria poplĂtea es una causa poco frecuente de sĂntomas isquĂ©micos de extremidades inferiores. No obstante, es importante considerarlo en el diagnĂłstico diferencial de individuos jĂłvenes afectos de claudicaciĂłn intermitente gemelar. Pese a que la etiologĂa y patogenia de esta entidad permanece todavĂa incierta, un correcto diagnĂłstico permite al especialista restaurar el flujo sanguĂneo normal de la extremidad. Caso clĂnico. Paciente de 57 años con claudicaciĂłn intermitente y portador de un quiste adventicial de arteria poplĂtea, en el que su comunicaciĂłn con la articulaciĂłn de la rodilla puede demostrarse por resonancia magnĂ©tica y confirmarse por cirugĂa. ConclusiĂłn. La resonancia magnĂ©tica es una prueba diagnĂłstica que pudo mostrar claramente esta patologĂa y reforzar la hipĂłtesis sinovial
Aneurismas poplĂteos. EvoluciĂłn y factores pronĂłsticos en la trombosis del saco
Objetivos. Conocer la evoluciĂłn de aneurismas poplĂteos tratados quirĂșrgicamente y evaluar factores pronĂłsticos en la trombosis del saco. Pacientes y mĂ©todos. Desde mayo de 1993 hasta junio del año 2005, 43 pacientes presentaron 64 aneurismas poplĂteos (diĂĄmetro medio: 2,8 cm; intervalo: 1,2-8 cm); de ellos, 19 (29%) han recibido tratamiento mĂ©dico (compensaciĂłn tras trombosis), dos (3%) aneurismectomĂa mĂĄs injerto terminoterminal vĂa posterior, 22 (34%) exclusiĂłn por ligadura mĂĄs bypass poplĂteo-poplĂteo y, por Ășltimo, 21 (32%) exclusiĂłn y bypass femoropoplĂteo. Hemos realizado un estudio descriptivo transversal en los 43 aneurismas tratados mediante exclusiĂłn y bypass (67%). Mediante eco-Doppler de control se evaluĂł: diĂĄmetro, presencia de flujo o trombosis del aneurisma y permeabilidad del bypass. Se analizĂł, mediante regresiĂłn de Cox, si existĂa asociaciĂłn estadĂsticamente significativa entre la trombosis postoperatoria del saco aneurismĂĄtico y los siguientes factores: diĂĄmetro preoperatorio del aneurisma, edad, factores de riesgo cardiovascular, comorbilidad, tipo de tratamiento, run-off, permeabilidad del bypass y presencia de aneurisma contralateral o de aorta. Resultados. De 43 aneurismas intervenidos, se pudieron evaluar 25 (56%). Se detectĂł flujo Doppler intraaneurismĂĄtico en cuatro casos (16%); de Ă©stos, hubo crecimiento del saco en tres (12%), y en uno (4%) disminuyĂł. De los 21 casos (84%) con trombosis completa del saco, se detectĂł su crecimiento en dos (8%), y en los 19 restantes (76%) disminuyĂł. El control clĂnico medio fue de 65 meses (intervalo: 1-128 meses). No se detectaron roturas ni sĂntomas compresivos. El tipo de cirugĂa resultĂł ser el Ășnico factor estadĂsticamente significativo (p = 0,04). Conclusiones. La reparaciĂłn quirĂșrgica no garantiza la trombosis del aneurisma. El bypass poplĂteo-poplĂteo muestra mayores garantĂas en la trombosis del saco aneurismĂĄtico
Phlegmasia Cerulea Dolens of the Lower Extremities Secondary to Thrombosis of an Inferior Vena Caval Aneurysm
AnĂĄlisis prospectivo de una serie de artroscopias de hombro en el tratamiento de la patologĂa del manguito rotador
Assessment of radiolucent lines in cemented shoulder hemi-arthroplasties: study of concordance and reproducibility
We report on the concordance and reproducibility of the evaluation of radiolucent lines in the humeral component of shoulder arthroplasty. Thirty-two shoulder prostheses were assessed independently, on two occasions, by five observers. The level of inter- and intra-observer agreement was calculated using the kappa statistic. Intra-observer agreement: the overall kappa values ranged from 0 to 0.6, meaning poor, fair and moderate agreement levels. Inter-observer agreement: when the anteroposterior (AP) views were analysed, the values obtained for the boneâcement interface ranged from 0.290 to 0.539, meaning a poor-to-moderate agreement. For the cementâimplant interface, the values ranged from 0.064 to 0.684, meaning a poor-to-good agreement. When radiolucent lines of the humeral component were analysed, inter-observer agreement proved to be as low as that obtained when total hip or knee components were analysed. Intra-observer agreement showed better results
Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial
Meeting abstract FRAB0101LB from 21st International AIDS Conference 18â22 July 2016, Durban, South Africa.
Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIVâinfected adults and children with advanced disease in subâSaharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown.
Methods:
The REALITY 2Ă2Ă2 factorial openâlabel trial (ISRCTN43622374) randomized ARTânaĂŻve HIVâinfected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (antiâtuberculosis) and fluconazole (antiâcryptococcal/candida), 5 days azithromycin (antiâbacterial/protozoal) and singleâdose albendazole (antiâhelminth)), versus standardâofâcare cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixedâdose combination. Two other randomizations investigated 12âweek adjunctive raltegravir or supplementary food. The primary endpoint was 24âweek mortality.
Results:
1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% lossâtoâfollowâup). Median baseline CD4 was 36 cells/mm3 (IQR: 16â62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54â0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58â0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2).
Conclusions:
Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIVâinfected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this lowâcost broad infection prevention package which could save 3.3 lives for every 100 individuals treated