Uso de medicina alternativa y complementaria en pacientes oncológicos sometidos a tratamiento quimioterápico intravenoso

Introducción: La popularidad de la medicina alternativa y complementaria (MAC) entre los pacientes enfermos de cáncer ha ido en aumento, pero son pocos los datos que disponemos acerca de la prevalencia de MAC en España. El objetivo de este estudio fue analizar el uso de MAC en pacientes adultos oncológicos sometidos a tratamiento antineoplásico intravenoso en un centro autonómico español de referencia. Material y Métodos: Durante dos semanas consecutivas de marzo de 2015 acudimos al Hospital de Día del centro a reclutar a los pacientes mientras recibían tratamiento. Se les solicitó cumplimentar un cuestionario y posteriormente se recogieron datos clínicos de la historia clínica. Se trata de un estudio observacional, descriptivo, transversal. Resultados: Un total de 316 pacientes participaron en el estudio; el 32.3% estaba usando algún tipo de MAC en ese momento, y el 89% de los pacientes que la empleaban lo hacían a base de una ingesta oral de sustancias. Las hierbas y productos naturales fueron los más consumidos. El 81% de los pacientes se inició en el ámbito de la MAC a raíz del diagnóstico, con una mediana de tiempo de empleo de 4.5 meses. Las fuentes de información principales fueron familiares/amigos. El 65% de los pacientes refirió sentir mejoría con la MAC, principalmente en el bienestar físico y psíquico. El uso de MAC se relacionó de manera significativa con el sexo (P=0.027), la edad (P=0.000) y el nivel educativo (P=0.003). Conclusión: Cerca de un tercio de los pacientes que estaban recibiendo tratamiento intravenoso para el cáncer usaban simultáneamente MAC, y ésta consistía en su mayor parte en una ingesta oral de preparados. Precisamente es ésta práctica de MAC la que entraña riesgo de interaccionar con la quimioterapia. De ahí la importancia de la formación de los profesionales sanitarios en éste ámbito, para poder aconsejar a los pacientes acerca de los potenciales beneficios y riesgos que entraña la MAC.Background: Complementary and alternative medicine (CAM) use has grown considerably, although there is little research about its prevalence in Spain. The aim of this study was to explore the use of CAM in adult cancer patients at the same time as they were receiving conventional intravenous treatment, in a Spanish referral cancer center. Methods: Researchers went to the Ambulatory Treatment Unit of a Spanish hospital during two consecutive weeks on March 2015. Patients were invited to participate and complete a descriptive questionnaire. Clinical data was extracted from medical records and databases. This is an observational, descriptive and cross-sectional study. Results: 316 adult cancer patients were included in the study. 32.3% of the patients reported CAM use at that moment and 89% of those who were using it were ingesting products. Herbs and natural products were the most commonly used. 81% of patients started to use CAM after diagnosis, with a median of 4.5 months using it. The source of information was mainly from family/friends. 65% of the patients seemed to have benefits from using CAM, especially improvements in both their physical and psychological well-being. Independent predictors of CAM use were sex (P=0.027), age (P=0.000) and education level (P=0.003). Conclusion: Nearly one third of the patients receiving conventional intravenous treatments for cancer also used CAM; it mainly consisted of a product intake. Precisely, it is this practice of CAM the one at risk of interacting with chemotherapy. It is important for health-professionals to keep abreast of research on CAM, in order to provide advice and counseling for patients.Máster Universitario en Investigación en Ciencias de la SaludUnibertsitate Masterra Osasun Zientzietako Ikerketa

Effectiveness of palivizumab in preventing respiratory syncytial virus infection in high-risk children

To date, there is no consensus regarding palivizumab prophylaxis for respiratory syncytial virus infection. The purpose of this study is to assess the effectiveness of palivizumab prophylaxis to prevent respiratory syncytial virus-related infection consultations and hospitalizations in high-risk children <2 y. We studied children <2 y of age with risk factors who had indication of palivizumab prophylaxis over eight epidemic seasons (2011–2012 to 2018–2019) in Navarra, Spain. Children positives for respiratory syncytial virus by reverse-transcription polymerase chain reaction were compared to negative testers. Palivizumab was indicated in 1,214 children <2 y of age with risk factors during 2011–2012 to 2018–2019 seasons. A total of 142 high-risk children tested for respiratory syncytial virus were included in the study. From the 35 respiratory syncytial virus-positive confirmed cases, 20 (57%) had received palivizumab versus 82 (77%) from the 107 negative controls. The effectiveness of prophylactic palivizumab was 70% (95% CI, 19%-90%) in preventing confirmed clinical infection and 82% (95% CI, 29%-96%) in preventing hospitalized cases. Our results show that palivizumab is notably effective for preventing laboratory-confirmed cases of respiratory syncytial virus and hospitalization in high-risk children <2 y of age. For children who have received palivizumab, the risk of getting sick remains high; thus, other preventive measures are necessary

Clinical course of patients with severe COVID-19 pneumonia treated with remdesivir: A real-life study.

BackgroundThere is currently much uncertainty regarding the most optimal treatment for COVID-19. This study analyze the change in the clinical condition of patients hospitalized for severe COVID-19 pneumonia and treated with remdesivir in a real-life setting, based on the WHO Ordinal Scale. Clinical complications, treatment safety, and impact of other associated drugs were also analyzed.MethodsWe conducted an observational, retrospective study including patients treated with remdesivir. The need for admission to the ICU, the length of ICU and hospital stay, and the need for ventilatory support were analyzed. The laboratory parameters, drugs administered concomitantly, and difference in the length of hospital stay according to the concomitant treatment received were also evaluated. A univariate and multivariate Cox regression analysis was performed to analyze associated factors.ResultsA total of 92 patients were included. The mean length of hospital stay was 15 days, and 90% of the patients had been discharged from the hospital 28 days after starting treatment with remdesivir. The likelihood of hospital discharge among patients not presenting with hypertension as a comorbidity was significantly higher than that of those with this condition (HR = 3.19, P = 0.008). Nineteen patients had to be admitted to the ICU (mean of 18 days). Approximately 11% required invasive mechanical ventilation (mean of 22 days). Almost 37% of the patients received high-flow oxygen therapy and 14% non-invasive mechanical ventilation. Four deaths were recorded within the first week. Main adverse events were increases in transaminase and creatinine levels. Nosocomial infections were more frequent when remdesivir was combined with immunosuppressive drugs.ConclusionsPatients with severe COVID-19 pneumonia and treated with remdesivir require relatively prolonged hospital stays, many with a need for ventilatory support and, in a considerable proportion of cases, admission to the ICU. However, the observed survival rate is high, and the drug is well tolerated

Impact of successful treatment with direct-acting antiviral agents on health-related quality of life in chronic hepatitis C patients.

BACKGROUND:Direct-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in health-related quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation. METHODS:In a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR. RESULTS:Median baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45-64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score. CONCLUSIONS:The cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed

Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain.

BackgroundThe World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain.MethodsUsing electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period.ResultsAt the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950-1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels.ConclusionsThe prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary

Progress in the elimination of hepatitis C virus infection in Spain: a population-based cohort study

Background: The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain. Methods: Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period. Results: At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950-1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels. Conclusions: The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary