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Objetivo: determinar el efecto del cambio en la terapia antirretroviral sobre el control virológico en una cohorte de pacientes VIH positivos de una institución prestadora de servicios de salud en Medellín, Antioquia (Colombia) en el año 2017. Materiales y métodos: estudio observacional analítico transversal, comparativo entre pacientes que cambiaron y no cambiaron el esquema inicial de terapia antirretroviral. Se realizó en una cohorte de 1245 pacientes que conviven con el VIH. Resultados: un total de 322 pacientes fueron evaluados. El principal motivo de cambio fue la presencia de efectos adversos a la terapia antirretroviral, seguido de la falla virológica sin genotipo e intolerancia a la terapia antirretroviral. La falla virológica, RP 1,4 IC95% (1,2-1,6, p0,00), el tener genotipo, RP 1,2 IC95% (1,1-1,3, p 0,00) y el padecer una infección oportunista, RP 1,3 IC95% (1,0-1,6, p 0,03), se asociaron a mayor número de cambios a la TAR. La adherencia a la terapia antirretroviral, RP 0,18 IC95% (0,1-0,3, p 0,00) y la toma de otros medicamentos no relacionados al VIH (RP 0,6, IC95% 0,4-0,8, p 0,005) se asociaron a menor frecuencia de cambio de la terapia antirretroviral. El cambio de la terapia antirretroviral (OR ajustado 3,4, IC 95% (2,0-5,8), continúa siendo el factor pronóstico más importante para falla virológica. Conclusión: el cambio de la terapia antirretroviral, definida en este estudio como la principal variable de exposición, representa el principal factor de riesgo para falla virológica, incluso cuando fue ajustado por otras variables..Au
Objective: to determine the effect of the change in antiretroviral therapy on virological control in a cohort of HIV positive patients corresponding to a healthcare institution in Medellín, Antioquia (Colombia) in 2017. Materials and methods: cross-sectional,comparative analytical observational study. It was performed in a cohort of 1245 patients living with HIV. Results: a total of 322 patients were evaluated. The main reason for change was the presence of adverse effects to antiretroviral therapy, followed by virological failure without genotype and antiretroviral therapy intolerance. Virological failure, PR 1.4 95% CI (1.2-1.6, p 0,00), having genotype, PR 1.2 95% CI (1.1-1.3, p0,00 ) and suffering from an opportunistic infection, PR 1.3 95% CI (1.0-1.6, p 0,03),were associated with a greater number of changes to antiretroviral therapy. Adherence to antiretroviral therapy, PR 0.18 95% CI (0.1-0.3, p 0,00) and taking other non-HIVrelated medications (PR 0.6, 95% CI 0.4-0 , 8, p 0,005) were associated with a lower frequency of change of antiretroviral therapy. The change in antiretroviral therapy (adjusted OR 3.4, 95% CI (2.0-5.8)) remains the most important prognostic factor for virological failure. Conclusion: the change in antirretroviral therapy, defined in this study as the main exposure variable, represents the main risk factor for virological failure, even when was adjusted for other variables..Au
Subject(s)
HIV , Antiretroviral Therapy, Highly ActiveABSTRACT
AbstractIntroduction: Effects of medicine have many influential pharmaceutical and non-pharmaceutical factors. Term, “factors of medicine had been out because clinical research had proven that effect of medicine and reaction depends on medicine preparation technology, type of medicine, method to apply medicine. Prior to that, it was considered that quality of medicine depends on physical and chemistry conditions of medical ingredients, amount of active ingredients, etc. Bio digestion of medicine is an important criteria to take correct treatment, to reduce side effects in order to providing medical safety, to improve medicine quality, and to increase treatment impact. This study is about to prove that medical effect depends on medical factor particularly type of medicinePurpose: Aim is to study drug medical dissimilarity action in vivo enviromentMaterials and Methods: diuretics pharmacology tests 18-24gr 40 pieces weighting Balb /cshugamyn conducted on mice. Test "Monos" pharmacological sector in cooperation with the Institute for Research on drugs. Statistics by SPSS-20 software implementation and results of student criteria (p<0.05) was recognized and confirmed by one way ANOVA.Research is completedthe diuretics in the following the next sequence (Tryeindlinburg, 1980) 1. The research was conducted prior to the start of the test animals 0,3ml / 20gr doses of saline solution (NaCl 0.9%) treated with oral fluid pressure generated2. The research groups of injecting drug predicted doses experimental animals to drink5.3. Drinking the drug preparations 2.5 hours after the 30-minute intervals during the test animals urine test groups amount of urine of animals (p <0.05) compares.Result: Experimental animals, urine collected during the 30-minute interval of 2.5 hours, urine volume between the groups was compared with the control group.Administered medications, a comparative study of the Russian Federation " X1" acting industry furosemid make urinate "X2" Company "X3" LLC furosemid (p <0.05) compared to the control groups entails strong drugs furosemide make urinate consistent.Table form of furosemide drugs that acts comparative study of the Russian Federation "X1" acting industry furosemide make urinate "X4" Pharm Co Ltd furosemide (p <0.05) entails experimental groups with the control group furosemide make urinate strong comparison function (p <0.05)Conclusion:Medical activity that was different shows drug medical dissimilarity action, when comparing between types of pyroselid drug in various industries.Key words: Tablet form, active treatment, furosemide, injection, tablet, drug therapy acts as
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Background: Deaths in paediatric intensive care units (PICUs) are sometimes unavoidable. The decision to withdraw or withhold treatment is important especially in places where there are limited resources. Objective: To evaluate the modes of death and underlying diseases of patients’ deaths in a PICU. Method: We retrospectively reviewed the clinical features and management of consecutive non-survivors in the PICU at a tertiary care University Hospital in a developing country over a three-year period. Results: Of 1,389 admissions, 110 (8%) patients died. The median age of the deaths was 4.1 years. Most (86%) patients had underlying diseases including congenital heart diseases (27%) and malignancies (23%). Forty-seven patients died with active treatment (AT), 60 died with life support limitation (LSL), and 3 had brain death (BD). The median length of stay (LOS) in AT group was 3 days and this was not significantly different (p=0.056) from the median LOS in LSL group which was 5 days. LOS less than 3 days, postoperative cases and underlying diseases of the cardiovascular system were factors associated with the AT group. The three common complications leading to death were multi-organ failure, septicaemia with septic shock and respiratory failure. Conclusions: Congenital heart diseases and malignancies were the two common underlying diseases found in non-survivors. LSL was the common mode of death in PICU.
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Pruritus ani is an unpleasant cutaneous sensation that induces the desire to scratch the skin around the anal orifice. It may start insidiously and appears in 1% to 5% of the population. It is classified as primary (idiopathic) pruritus ani when no cause can be found. However, as 25% to 75% of cases have co-existing pathology, a detailed history and examination are necessary. The goal of treatment is asymptomatic, intact, dry, clean perianal skin with reversal of morphological changes. The management of pruritus ani is directed towards the underlying cause. If the diagnosis is idiopathic pruritus ani, the patients can still be managed with great success by eliminating of irritants and scratching, by giving general advice regarding hygiene and lifestyle modification and by using active treatment measures.
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Humans , Hygiene , Irritants , Life Style , Pruritus , Pruritus Ani , Sensation , SkinABSTRACT
Withdrawing medical treatment is quite common among patients with malignant tumors in present clinical practice in China,which is considered as a form of passive euthanasia and serious violation against social ethics and medical purposes.In this paper,the behaviors and reasons for withdrawing treatment of patients with malignant tumors are analyzed,and concerned solutions are explored as well.