Comparación de la eficacia de la fototerapia convencional con tubos de luz azul vs. LEDs / Comparison of the efficacy of conventional phototherapy with blue light tubes vs LEDs

Introducción: La hiperbilirrubinemia (HB) es la principal causa de ingreso en unidades neonatales de bajo riesgo. Nuevos dispositivos de fototerapia (FT) permiten el uso de irradiación a dosis alta. Objetivo: Comparar la eficacia de la FT aplicada con equipos de tubos de luz azul (30 µW/cm2/nm) y FT con tecnología LED’s a dos niveles de irradiancia (30 y 40 µW/ cm2/nm) en términos de duración del tratamiento. Material y métodos: Estudio prospectivo, controlado y randomizado. Los recién nacidos de término o cercanos al término que necesitaban tratamiento con luminoterapia fueron aleatorizados a tres grupos: 1) luz azul a 30 µW/cm2/nm (LC), 2) LED a 30 µW/cm2/nm (L30), y 3) LED a 40 µW/cm2/nm (L40). Resultados: Se incluyeron 165 pacientes, 54 en LC, 56 en L30 y 55 en el grupo L40. El peso al nacer, edad gestacional, horas a la aleatorización y los valores BST al ingreso a FT (18,9 ± 2 mg/dl en BL, 18,9 ± 2,2 en L30 y 19 ± 1,6 en L40) fueron similares. El tiempo total (horas) de FT fue: 54,4 ± 6,9 en LC, 53,4 ± 10,7 en L30 y 41,7 ± 6 en L40 (p <0,001). Los niveles de BST en la interrupción de FT (10,1 ± 1,7 mg/dl, 9,9 ± 1 y 8,9 ± 1,8, p = 0,002) y 24 horas después (9,6 ± 1,3 mg/dl, 9,8 ± 1,4 y 9 ± 1,8, p = 0,04) fueron menor en el grupo L40. Conclusiones: El tratamiento con LEDs a 40 µW/cm2/nm reduce en 12 horas la duración del tratamiento en comparación con LEDs o luz azul a 30 µW/cm2/nm.

Introduction: Hyperbilirubinemia (HB) is the main cause of admission to low risk neonatal units. New phototherapy devices (PT) allow the use of high dose of irradiance. Objective: To compare the efficacy of PT in terms of hours of treatment between blue light tubes and LEDs equipments with two levels of irradiance. Material and methods: Prospective controlled trial. Term or near-term infants with need of PT treatment according to AAP recommendations were randomized into three groups: blue lights PT with 30 µW/cm2/nm (BL) or LEDs PT with 30 µW/cm2/nm (L30) or 40 µW/cm2/nm (L40) at skin level. Results: 165 patients were included, 54 in the BL group, 56 in L30 and 55 in L40 group. Birth weight, gestational age, postnatal hours at randomization and total serum bilirubin (TSB) level at entry (18.9 ± 2 mg/dl in BL, 18.9 ± 2.2 in L30 and 19 ± 1.6 in L40) were similar between groups. Total time of PT were 54.4 ± 6.9 hours in BL, 53.4 ± 10.7 in L30 and 41.7 ± 6 in L40 (p <0.001). TSB levels at PT discontinuation (10.1 ± 1.7 mg/dl, 9.9 ± 1 and 8.9 ± 1.8, p = 0.002) and 24 hours later (9.6 ± 1.3 mg/dl, 9.8 ± 1.4 and 9 ± 1.8, p = 0.04) were lower in L40 group.Conclusions: PT treatment with LEDs at µW/cm2/nm reduced the duration of treatment in 12 hours compared with BL or LEDs at 30 µW/cm2/nm.

Evaluation of genotype resistance testing for salvage antiretroviral therapy at AIDS care centers from Ribeirão Preto, São Paulo, Brazil

The availability of HIV-1 genotype resistance testing (GRT) to clinicians has been insufficiently studied outside randomized clinical trials. The present study evaluated the outcome of salvage antiretroviral therapy (ART) recommended by an expert physician based on GRT in a non-clinical trial setting in Ribeirão Preto, Brazil. A prospective, open, nonrandomized study evaluating easy access to GRT at six Brazilian AIDS Clinics was carried out. This cooperative study analyzed the efficacy of treatment recommended to patients whose salvage ART was guided by GRT with that of treatment with ART based only on previous ART history. A total of 112 patients with ART failure were included in the study, and 77 of them were submitted to GRT. The median CD4 cell count and viral load for these 77 patients at baseline were (mean ± SD) 252.1 ± 157.4 cells/µL and 4.60 ± 0.5 log10 HIV RNA copies/mL, respectively. The access time, i.e., the time elapsed between ordering the GRT and receiving the result was, on average, 71.9 ± 37.3 days. The study results demonstrated that access to GRT followed by expert recommendations did not improve the time to persistent treatment failure when compared to conventional salvage ART. Access to GRT in this Brazilian community health care setting did not improve the long-term virologic outcomes of HIV-infected patients experiencing treatment failure. This result is probably related to the long time required to implement ART guided by GRT.