Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

publishersversionPeer reviewe

Prognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children

Background Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution. Methods Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit. Results 146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5-6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000-1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003-0.720). Conclusions CD4/CD8 > 1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1)

Hidatidosis hepática: Cirugía radical vs. no radical: 22 años de experiencia Hepatic hydatidosis: Radical vs. conservative surgery: 22 years of experience

Introducción: la incidencia de la hidatidosis hepática ha disminuido notablemente en los últimos años gracias a las medidas de prevención adoptadas para interrumpir la transmisión del parásito. Con todo, la cirugía continúa siendo el tratamiento de elección, si bien su modalidad es todavía motivo de controversia. Objetivos: el objetivo de este trabajo es evaluar los resultados obtenidos en el tratamiento de esta patología a lo largo de más de dos décadas, atendiendo a la modalidad quirúrgica empleada ya fuese cirugía radical o no radical. Material y métodos: se analizaron un total de 372 pacientes intervenidos por quiste hepático hidatídico (QHH) entre 1983-2005 en el Hospital Ramón y Cajal. En 162 se efectúa una cirugía radical (43,5%) y en 210 una no radical (56,5%). Resultados: tanto la estancia media hospitalaria (8,65 días vs. 14,9 días) como la morbilidad (13,3 vs. 31,4 %, p Objectives: the incidence of hepatic hydatidosis has remarkably decreased in the last years due to the preventive measures adopted to stop the transmission of the parasite. However, surgery carries on being the treatment of choice, although the surgical procedure is still a matter of controversy. The aim of the study was to evaluate the results obtained with the treatment of this condition after two decades according to surgical procedure type. Material and methods: from 1983 to 2005, 372 patients were operated on for hepatic hydatidic cyst in Hospital Ramón y Cajal. Radical surgery was performed for 162 (43.5%) and conservative surgery for 210 (56.5%). Results: average postoperative hospital stay (8.65 vs. 14.9 days), morbidity (13.3 vs. 31.4%, p < 0.001), and mortality (0 vs. 3.8%, p < 0.01) were lower in the radical surgery group. Recurrence rate was 1.85% after radical surgery versus 11.9% in the conservative surgery group (p < 0.0001). Conclusion: radical surgery is associated with lower morbidity, mortality, postoperative hospital stay, and recurrence rates, and represents the treatment of choice for hepatic hydatidosis. However, its indication must depend on the patient characteristics, cyst anatomy, and surgical team experience

Repercusión nutricional de la cirugía bariátrica según técnica de Scopinaro: análisis de 40 casos Nutritional effect of bariatric surgery with Scopinaro operation: analysis of 40 cases

Objetivos: Analizar la repercusión de la cirugía bariátrica sobre los valores de antropometría absoluta y relativa, parámetros bioquímicos y niveles vitamínicos tras un año de seguimiento y estudiar la posible influencia del sexo, la longitud del canal común y el grado de esteatorrea en estos pacientes. Material y métodos: Se estudiaron retrospectivamente 40 pacientes (28 mujeres y 12 varones) de edad media de 38 ± 12 años (18-62) a los que se les practicó derivación biliopancreática según técnica de Scopinaro dejando 70- 120 cm de canal común y seguidos durante el año posterior a la realización de esta cirugía. Se procedió a control de parámetros antropométricos: índice de masa corporal (IMC), cincunferencia cintura cadera (CC); parámetros bioquímicos: glucosa, ácido úrico, lípidos plasmáticos, proteínas de vida media corta, transaminasas y hemograma; niveles de vitaminas A, E, D, B12, C y ácido fólico y el grado de esteatorrea, que se realizaron antes y un año después de la cirugía. Resultados: Se logró una pérdida de peso del 29,7% ± 2,9 sin diferencia entre ambos sexos. En cuanto a los parámetros bioquímicos se constató una reducción estadísticamente significativa en las cifras de colesterol total, triglicéridos, ácido úrico y transaminasas (p Objectives: To analyze the influence of bariatric surgery over nutritional status in patients with morbid obesity after 1 year of following. To know the influence of specific factors as age, sex and common channel´s length. Design: Retrospective study from 1998-2001. Subject: All patients suffering from morbid obesity that had been operated during this period of time, 40 subjects: 28 women and 12 men with a mean age of 38 ± 12 years old. Were studied. Methods: We analyzed the variations of weight and other anthropometric measures, biochemical parameters and the micronutrient (vitamins A, D, E, B12, folate, C, zinc, Calcium, Magnesium) status during 1 year of following after surgery. Results: Percentage weight loss was 29.7 ± 2.9% without sex differences. A significant (p < 0.005) descent of serum cholesterol, triglycerides, and uric acid level as well as liver function markers was observed. All the hyperglycemic disturbances were reverted. 97% and 48% of the patients developped hypovitaminosis A and D respectively, that was correlated to steatorrhea. Vitamin E deficiency was found in 72% of the patients, and zinc deficiency in 68% Conclusions: Our expected weight loss 1 year after bariatric surgery is 30%, irrespective of sex and age. This loss is accompanied by a significant improvement in metabolic parameters, but the high prevalence of micronutrients deficiency that was found makes an early supplementation and close follow-in of these patients very advisable