Tenofovir vs lamivudine plus adefovir in chronic hepatitis B: TENOSIMP-B study

AIM To demonstrate the non-inferiority (15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate (TDF) vs the combination of lamivudine (LAM) plus adefovir dipivoxil (ADV) in the maintenance of virologic response in patients with chronic hepatitis B (CHB) and prior failure with LAM. METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups (TDF and LAM+ADV) of adult patients with hepatitis B e antigen (HBeAg)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed. RESULTS Forty-six patients were evaluated [median age: 55.4 years (30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA (HBV-DNA) remained undetectable, all patients remained HBeAg negative, and hepatitis B surface antigen (HBsAg) positive. Alanine aminotransferase (ALT) values at the end of the study were similar in the 2 groups (25.1 ± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects (AEs) (53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively (P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment (€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001). CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs

Correlation between clinical parameters characterising peri-implant and periodontal health : a practice-based research in Spain in a series of patients with implants installed 4-5 years ago

Objectives: To explore peri-implant health (and relation with periodontal status) 4-5 years after implant insertion. Study D esign: A practice-based dental research network multicentre study was performed in 11 Spanish centres. The first patient/month with implant insertion in 2004 was considered. Per patient four teeth (one per quadrant) showing the highest bone loss in the 2004 panoramic X-ray were selected for periodontal status assessment. Bone losses in implants were calculated as the differences between 2004 and 2009 bone levels in radiographs. Results: A total of 117 patients were included. Of the 408 teeth considered, 73 (17.9%) were lost in 2009 (losing risk: >50% for bone losses ?7mm). A total of 295 implants were reviewed. Eight of 117 (6.8%) patients had lost implants (13 of 295 implants installed; 4.4%). Implant loss rate (quadrant status) was 1.4% (edentulous), 3.6% (preserved teeth), and 11.1% (lost teeth) (p=0.037). The percentage of implant loss significantly (p<0.001) increased when the medial/distal bone loss was ?3 mm. The highest (p?0.001) pocket depths were found in teeth with ?5mm and implants with ?3mm bone losses, with similar mean values (?4mm), associated with higher rates of plaque index and bleeding by probing. Conclusions: The significant bi-directional relation between plaque and bone loss, and between each of these two parameters/signs and pocket depths or bleeding (both in teeth and implants, and between them) together with the higher percentage of implants lost when the bone loss of the associated teeth was ?3 mm suggest that the patient?s periodontal status is a critical issue in predicting implant health/lesion

Un siglo de luz : Historia empresarial de Iberdrola

El libro se divide en épocas y, dentro de cada una de ellas, se analizan los avatares de las tres empresas fundadoras de Iberdrola. La parte I tiene carácter de introducción y sus dos capítulos responden al deseo de integrar la historia de Iberdrola, tanto en el sector eléctrico espafíol como en el de otros países de Europa. La parte II abarca hasta el afío 1944, fecha de la fusión entre Saltos del Duero e Hidroeléctrica Ibérica. La parte III comprende los afíos 1944-1973, con la crisis energética como límite diferenciador. La parte IV comprende desde el comienzo de la crisis hasta la fusión de Iberduero e Hidrola, en 1991. La última parte del libro, en la que se hace la historia reciente de la empresa, ha sido escrita por sus principales protagonistas, lo cual afíade un interés muy especial a los capítulos catorce, quince y dieciséis, con los que termina la obra

Primary and Secondary Immunodeficiency Diseases in Oncohaematology: Warning Signs, Diagnosis, and Management

Background: Immunodeficiencies (ID), in particular primary immunodeficiencies (PID), are often associated with haematological manifestations, such as peripheral cytopenias or lymphoproliferative syndromes. Early diagnosis and management have significant prognostic implications. Secondary immunodeficiencies (SID) may also be induced by oncohaematological diseases and their treatments. Haematologists and oncologists must therefore be aware of the association between blood disorders and cancer and ID, and be prepared to offer their patients appropriate treatment without delay. Our aim was to define the warning signs of primary and secondary IDs in paediatric and adult patients with oncohaematological manifestations.Methods: A multidisciplinary group of six experts (2 haematologists, 2 immunologists, and 2 paediatricians specializing in ID) conducted a literature review and prepared a document based on agreements reached an in-person meeting. An external group of 44 IDs specialists from all over Spain assessed the document and were consulted regarding their level of agreement.Results: This document identifies the haematological and extra-haematological diseases that should prompt a suspicion of PIDs in adults and children, in both primary care and haematology and oncology departments. Cytopenia and certain lymphoproliferative disorders are key diagnostic pointers. The diagnosis must be based on a detailed clinical history, physical exploration, complete blood count and standard laboratory tests. The immunological and haematological tests included in the diagnostic process will depend on the care level. Patients who are candidates for immunoglobulin replacement therapy must be carefully selected, and treatment should be offered as soon as possible to avoid the development of complications. Finally, this document recommends procedures for monitoring these patients.Conclusions: This document combines scientific evidence with the opinion of a broad panel of experts, and emphasizes the importance of an early diagnosis and treatment to avoid complications. The resulting document is a useful tool for primary care physicians and specialists who see both adult and paediatric patients with oncohaematological diseases

Herramienta de edición de diagramas de clases con generación de código

Realizado en la Escuela Politécnica Superior, por 7 profesores del centro. El objetivo era construir una herramienta software que asista al alumno de Ingeniería Técnica en Informática de Gestión e Ingeniería Informática en la elaboración del diseño de diagramas de clases y posterior implementación de sistemas software a través de un mapeo en lenguaje Java. El proyecto se ha desarrollado en 10 fases: 1. Fijación de objetivos y plan detallado; 2. Especificación del proyecto; 3. Análisis; 4. Diseño; 5. Implementación y pruebas unitarias en fases iterativas, con realimentación al diseño; 6. Pruebas de integración; 7. Liberación del prototipo de la aplicación; 8. Revisión y correcciones al prototipo; 9. Explotación de la aplicación; 10. Publicación de memoria y conclusiones. Junto a la memoria con los conocimientos técnicos se adjunta un CD-ROM con el software. Se ha conseguido una herramienta práctica y efectiva en base al objetivo propuesto y el mejor resultado es el de la generación del código.Junta de Castilla y León. Consejería de Educación y CulturaCastilla y LeónJunta de Castilla y León. Consejería de Educación y Cultura; Monasterio de Nuestra Señora de Prado. Autovía Puente Colgante, s. n.; 47071 Valladolid; Tel. +34983411881; Fax +34983411939; [email protected]

Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH)

The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the re sources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of microelimination strategies in vulner able populations; 2) Simplification of HCV diagnosis (one step diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and improvement of care circuits; 4) Health policy measures, and, finally, 5) Es tablishment of HCV elimination indicators