Avatrombopag plus fostamatinib combination as treatment in patients with multirefractory immune thrombocytopenia.

Immune thrombocytopenia (ITP) refractory to multiple therapies may require a combination of drugs targeting different mechanisms and targets. In this retrospective, multicentre, international study, we report the safety and effectiveness of avatrombopag and fostamatininb in combination administered to 18 patients with multirefractory ITP. Overall, the combination response was achieved in 15 patients (83.3%), with a median time from combination start to best response of 15 days (IQR: 8-35 days). After a median follow-up of 256 days (IQR: 142.8-319), 5 patients relapsed (26.7%), all during tapering or stopping one drug. Adverse events were described in 6 of 18 patients (33%).

Combined or Sequential Treatment with Immune Checkpoint Inhibitors and Car-T Cell Therapies for the Management of Haematological Malignancies: A Systematic Review.

The aim of this paper was to review the available evidence on the efficacy and safety of combined or sequential use of PD-1/PD-L1 immune checkpoint inhibitors (ICI) and CAR-T cell therapies in relapsed/refractory (R/R) haematological malignancies. A systematic literature review was performed until 21 November 2022. Inclusion criteria: cohort studies/clinical trials aimed at evaluating the efficacy and/or safety of the combination of CAR-T cell therapy with PD-1/PD-L1 inhibitors in R/R haematological malignancies, which had reported results. Those focusing only on ICI or CAR-T separately or evaluating the combination in other non-hematological solid tumours were excluded. We used a specific checklist for quality assessment of the studies, and then we extracted data on efficacy or efficiency and safety. A total of 1867 articles were identified, and 9 articles were finally included (early phase studies, with small samples of patients and acceptable quality). The main pathologies were B-cell acute lymphoblastic leukaemia (B-ALL) and B-cell non-Hodgkin's lymphoma (B-NHL). The most studied combination was tisagenlecleucel with pembrolizumab. In terms of efficacy, there is great variability: the combination could be a promising option in B-ALL, with modest data, and in B-NHL, although hopeful responses were received, the combination does not appear better than CAR-T cell monotherapy. The safety profile could be considered comparable to that described for CAR-T cell monotherapy.

Subgroup analyses in venous thromboembolism trials reporting pharmacological interventions: A systematic review.

INTRODUCTION: Randomized controlled trials (RCTs) that conduct subgroup analyses have the potential to provide information on treatment decisions in specific groups of patients from heterogeneous populations. Although we understand several factors can modify the incidence of venous thromboembolism (VTE) and the benefit/risk ratio of anticoagulation treatments, further evidence is warranted to show the heterogeneity of treatment effects in different subgroups of patients. AIMS: The primary purpose was to evaluate the appropriateness and interpretation of subgroup analysis performed on VTE RCTs reporting pharmacological interventions. MATERIALS AND METHODS: A systematic review of RCTs published between January 2017 and January 2022 was conducted. Claims of subgroup effects were evaluated with predefined criteria. High-quality claims of subgroup effect were further analyzed and discussed. RESULTS: Overall, 28 RCTs with a generally low bias risk were included. The purposes of the treatments included pharmacologic thromboprophylaxis (17), therapeutic dose anticoagulation (9), and catheter-directed pharmacologic thrombolysis (2). The evaluated subgroup analyses generally presented: a high number of subgroup analyses reported, a lack of prespecification, and a lack of usage of statistical tests for interaction. The authors reported 13 claims of subgroup effect; only two were considered potentially reliable to represent heterogeneity in the direction or magnitude of treatment effect. CONCLUSIONS: Subgroup analyses of VTE RCTs reporting pharmacologic interventions are generally methodologically poor. Most claims of subgroup effect did not meet critical criteria and lacked credibility. Clinicians in this field may proceed with scepticism when assessing claims of subgroup effects due to methodological concerns and misleading interpretations.

Correction: Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content.

[This corrects the article DOI: 10.2196/35851.].

Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content.

BACKGROUND: Hematological malignancies (HMs) are a heterogeneous group of cancers representing a significant cause of morbidity and mortality. The chronification of HMs and the increasing use of smartphones may lead patients to seek their current unmet needs through mobile health apps. OBJECTIVE: The goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs. METHODS: A systematic search of apps that were aimed at patients diagnosed with HMs, accessed from a Spain IP address, and were available on the iOS (App Store) and Android (Google Play) platforms was conducted in November 2021. The search terms used were "hematology," "blood cancer," "leukemia," "lymphoma," and "myeloma" apps in English, Spanish, or both languages. The identified apps were downloaded and analyzed independently by 2 reviewers. Information about general app characteristics was collected. The Mobile Application Rating Scale (MARS) was used to assess quality. The resulting parameter of the analyses, the mean score of the apps, was compared by Student t test. RESULTS: Overall, 18 apps were identified; 7 were available on Android, 5 were available on iOS, and 6 were available on both platforms. All included apps were free; 3 were published in 2021, and among the apps published before 2021, only 6 were updated in 2021. Most (16/18, 89%) of the apps were aimed at patients with leukemia or lymphoma (16). The primary purposes of the apps were to provide general information about the condition (16/18, 89%) and monitor symptoms and clinical parameters (11/18, 61%). Health care professionals contributed to the development of 50% (9/18) of apps; 6 were owned and supported by scientific societies, and 3 were developed with the participation of health care professionals. The mean MARS score for the overall quality of the apps was 3.1 (SD 1.0). The engagement and aesthetics subscales were the lowest rated subscales, with only 44% (8/18) and 67% (12/18), respectively, of the apps obtaining acceptable scores. None of the included apps proved clinical efficacy through clinical trials in patients with HMs. Statistically significant differences were found in the MARS scores between operating systems (+1.0, P=.003) in favor of iOS apps. The participation of health care professionals in the development of the apps did not have a statistically significant impact on the MARS scores. CONCLUSIONS: This systematic search and evaluation identified few acceptable quality mobile apps for patients with HMs. Current and future apps for patients with HMs should provide evidence-based valuable information, improve user engagement, incorporate functions according to patient preferences, and generate evidence regarding the efficacy of app use by patients with HMs.

Factors associated with mortality in patients hospitalized for COVID-19 in Spain. Data from the RERFAR registry.

OBJECTIVE: To determine the baseline characteristics associated with higher  mortality at 42 days in patients hospitalized for COVID-19 in Spain. METHOD: The study analyzed a prospective cohort of hospitalized COVID-19  patients. The dependent variable was 42-day mortality. Data on the subjects'  demographic and clinical characteristics, comorbidities, usual therapy and  supportive interventions and treatments was collected within 48 hours from  admission. To determine the potential association of the data with mortality, a  multivariate analysis was performed using logistic regression. RESULTS: 15,628 patients were included, 18.2% of whom (n = 2,806) died  during the study period. According to the multivariate analysis, the variables  that were significantly associated (p < 0.05) with mortality upon admission  were: being referred from a nursing home (OR 1.9); having a high respiratory  rate (OR 1,5); having moderate (OR 1.7) or severe (OR 2.9) pneumonia  (CURB-65); aspartate aminotransferase transaminase ≥ 100 IU/l (OR 2.1);  lactate dehydrogenase ≥ 360 IU/L (OR 1.6); procalcitonin > 0.5 ng/mL (OR  1.8); creatine kinase ≥ 294 U/L (OR 1.5); D-dimer > 3,000 ng/mL (OR 1.5);  hemoglobin < 11.6 g/dL (OR 1.4) and C-reactive protein > 120 mg/L (OR 1.2;  requiring respiratory support within the first 48 hours (oxygen therapy [OR  2.0], non-invasive ventilation [OR 2.8], and mechanical ventilation [OR 3.5]);  and being treated with interferon-beta (OR 1.5). On the contrary, being under  80 years of age was associated with lower mortality. CONCLUSIONS: The analysis, based on the data in the RERFAR registry, showed that the factors associated with poorer prognosis were older age,  assessed using the CURB-65 scale, level of respiratory support required,  severe pneumonia (CURB-65), hypertransaminasemia, elevated creatine  kinase, lactate dehydrogenase, and D-dimer levels, anemia, and elevated  respiratory rate.

OBJETIVO: Determinar las características basales que se asocian a una mayor  mortalidad a los 42 días en aquellos pacientes hospitalizados por COVID-19 en  España.Método: Cohorte prospectiva de pacientes COVID-19 hospitalizados. La  variable dependiente fue la mortalidad a los 42 días. Además, se recogieron  características demográficas, clínicas, comorbilidades, tratamiento habitual,  intervenciones de soporte y tratamientos en las primeras 48 horas del ingreso.  Para determinar la asociación con la mortalidad, se realizó un análisis  multivariante mediante regresión logística. Resultados: Se incluyeron 15.628 pacientes, de ellos falleció el 18,2% (n =  2.806). El análisis multivariante mostró que las variables asociadas significativamente (p < 0,05) con la mortalidad al ingreso fueron:  proceder de un centro sociosanitario (odds ratio OR 1,9), frecuencia  respiratoria (odds ratio 1,5), gravedad de neumonía (CURB-65) moderada  (odds ratio 1,7) o alta (odds ratio 2,9), transaminasa aspartato  aminotransferasa ≥ 100 UI/l (odds ratio 2,1), lactato-deshidrogenasa ≥ 360  UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina- quinasa ≥ 294 U/l (odds ratio 1,5), dímero D > 3.000 ng/ml (odds ratio 1,5),  hemoglobina < 11,6 g/dl (odds ratio 1,4) y proteína C reactiva > 120 mg/l  (odds ratio 1,2), necesidad de soporte respiratorio en las primeras 48 horas  (odds ratio 2,0 de oxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilación mecánica) y tratamiento con interferón-beta (odds ratio  1,5). Por el contrario, ser menor de 80 años se asoció a una menor mortalidad. Conclusiones: El análisis del Registro Español de Resultados de  farmacoterapia frente a COVID-19 muestra que los factores asociados a peor pronóstico son: mayor edad, valoración mediante la escala CURB­65, el nivel de requerimiento de soporte respiratorio, neumonía grave (CURB­65), hipertransaminasemia, elevación de creatina-quinasa, lactato- deshidrogenasa, y dímero-D, anemia y elevación de la frecuencia respiratoria.

Factores asociados a la mortalidad en pacienteshospitalizados por COVID-19 en España. Datos del Registro Español de Resultadosde Farmacoterapia frente a COVID-19 (RERFAR) / Factors associated with mortality in patients hospitalized for COVID-19 in Spain. Data from the RERFAR registry

Objetivo: Determinar las características basales que se asocian a unamayor mortalidad a los 42 días en aquellos pacientes hospitalizados porCOVID-19 en España.Método: Cohorte prospectiva de pacientes COVID-19 hospitalizados.La variable dependiente fue la mortalidad a los 42 días. Además, serecogieron características demográficas, clínicas, comorbilidades, tratamientohabitual, intervenciones de soporte y tratamientos en las primeras48 horas del ingreso. Para determinar la asociación con la mortalidad, serealizó un análisis multivariante mediante regresión logística.Resultados: Se incluyeron 15.628 pacientes, de ellos falleció el 18,2%(n = 2.806). El análisis multivariante mostró que las variables asociadassignificativamente (p < 0,05) con la mortalidad al ingreso fueron: procederde un centro sociosanitario (odds ratio OR 1,9), frecuencia respiratoria (oddsratio 1,5), gravedad de neumonía (CURB-65) moderada (odds ratio 1,7) oalta (odds ratio 2,9), transaminasa aspartato aminotransferasa ≥ 100 UI/l(odds ratio 2,1), lactato-deshidrogenasa ≥ 360 UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina-quinasa ≥ 294 U/l (odds ratio1,5), dímero D > 3.000 ng/ml (odds ratio 1,5), hemoglobina < 11,6 g/dl(odds ratio 1,4) y proteína C reactiva > 120 mg/l (odds ratio 1,2), necesidadde soporte respiratorio en las primeras 48 horas (odds ratio 2,0 deoxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilaciónmecánica) y tratamiento con interferón-beta (odds ratio 1,5). Por elcontrario, ser menor de 80 años se asoció a una menor mortalidad. Conclusiones: El análisis del Registro Español de Resultados de Farmacoterapiafrente a COVID-19 muestra que los factores asociados a peorpronóstico son: mayor edad, valoración mediante la escala CURB‑65, elnivel de requerimiento de soporte respiratorio, neumonía grave (CURB‑65),hipertransaminasemia, elevación de creatina-quinasa, lactato-deshidrogenasa,

Objective: To determine the baseline characteristics associated withhigher mortality at 42 days in patients hospitalized for COVID-19 inSpain.Method: The study analyzed a prospective cohort of hospitalizedCOVID-19 patients. The dependent variable was 42-day mortality. Dataon the subjects’ demographic and clinical characteristics, comorbidities,usual therapy and supportive interventions and treatments was collectedwithin 48 hours from admission. To determine the potential associationof the data with mortality, a multivariate analysis was performed usinglogistic regression.Results: 15,628 patients were included, 18.2% of whom (n = 2,806)died during the study period. According to the multivariate analysis, thevariables that were significantly associated (p < 0.05) with mortality uponadmission were: being referred from a nursing home (OR 1.9); havinga high respiratory rate (OR 1,5); having moderate (OR 1.7) or severe(OR 2.9) pneumonia (CURB-65); aspartate aminotransferase transaminase ≥ 100 IU/l (OR 2.1); lactate dehydrogenase ≥ 360 IU/L (OR 1.6);procalcitonin > 0.5 ng/mL (OR 1.8); creatine kinase ≥ 294 U/L (OR 1.5);D-dimer > 3,000 ng/mL (OR 1.5); hemoglobin< 11.6 g/dL (OR 1.4) andC-reactive protein > 120 mg/L (OR 1.2; requiring respiratory support withinthe first 48 hours (oxygen therapy [OR 2.0], non-invasive ventilation [OR 2.8],and mechanical ventilation [OR 3.5]); and being treated with interferon-beta(OR 1.5). On the contrary, being under 80 years of age was associated withlower mortality. Conclusions: The analysis, based on the data in the RERFAR registry, showedthat the factors associated with poorer prognosis were older age, assessedusing the CURB-65 scale, level of respiratory support required, severe pneumonia(CURB-65), hypertransaminasemia, elevated creatine kinase, lactatedehydrogenase, and D-dimer levels, anemia, and elevated respiratory rate.

Venetoclax combination therapy with hypomethylating agents in young adults with relapsed/refractory acute myeloid leukaemia.

In recent years, one of the most successful advances in treating acute myeloid leukaemia (AML) has been the combination of the B-cell lymphoma 2 (BCL-2) inhibitor venetoclax with hypomethylating agents (decitabine or azacytidine). This combination treatment has an accelerated approval by the Food and Drug Administration for newly diagnosed AML adults who are 75 years of age or older or who have comorbidities and are not eligible to receive intensive induction chemotherapy. AML is the most common form of acute leukaemia in adults, with a median age at diagnosis of 68 years. Consequently, most of the patients included in the studies are elderly. Traditionally, young patients achieve higher remission rates compared with the elderly AML population. Although venetoclax combination therapy could become a treatment option for treating young patients with relapsed/refractory AML, this regimen has not been systematically tested in this setting. In this study, we summarize the currently available evidence on the treatment of venetoclax in combination with hypomethylating agents for the treatment of young relapsed/refractory AML patients, in addition to our experience in clinical practice with two case reports. Venetoclax, combined with hypomethylating agents, seems to be an effective option for young relapsed/refractory AML patients. However, due to the poor quality of the evidence, additional well-designed studies with greater numbers of patients are needed to confirm the effectiveness and safety of venetoclax combination regimens for this population.

Subgroup analysis in haematologic malignancies phase III clinical trials: A systematic review.

AIMS: To assess the appropriateness of the use and interpretation of subgroup analysis in haematology randomized clinical trials (RCTs). METHOD: A systematic review of Medline, including haematology phase III RCTs published between January 2013 and October 2019, was carried out to identify reported subgroup analysis. Information related to trial characteristics, subgroup analysis and claims of subgroup difference were collected. RESULTS: The initial search identified 1622 studies. A total of 98 studies reporting subgroup analyses were identified. Of those, 24 RCT reported 46 claims of subgroup difference. Among them, 44 were claims for the primary outcome, of which 25 were considered strong claims and 17 were considered suggestions of a possible effect. Authors included subgroup variables for the primary outcome measured at baseline for 38 claims (n = 86.36%), used a subgroup variable as a stratification factor at randomization for 15 (34.09%), clearly prespecified their hypothesis for 11 (25%), the subgroup effect was one of a small number of hypothesised effects tested (≤ 5) for 17 (38.64%), carried out a test of interaction that provide statistically significant for 18 (40.91%), documented replication of a subgroup effect with previously related studies for 11 (25%), identified the consistency of a subgroup effect across related outcome for 10 (22.72%) and provided a biological rationale for the effect for 8 (18.18%). Of the 44 claims for the primary outcome, 34 (77.27%) met four or fewer of the 10 credibility criteria. CONCLUSION: The subgroup claims reported in haematology RCTs lack credibility, even when the claims are strong. Information about subgroup difference should be interpreted cautiously.

Plataformas online y redes sociales para la creación de perfiles de investigación / Online platforms and social networks for the creation of research profiles

Hoy en día, la comunicación científica se está viendo enriquecida debido a la utilización de nuevos modos de almacenamiento, publicación y difusión de los resultados. Entre ellos se encuentran las denominadas plataformas de perfiles académicos, dentro de las cuales se encuadrarían Scopus author ID, ORCID, Publons y Kudos y, por otro lado, las redes sociales de investigación, entre las que se incluirían ResearchGate, Academia.edu y Google Scholar citations. Estas herramientas tienen como principal objetivo aumentar la visibilidad e impacto de los contenidos y publicaciones. Son páginas web multidisciplinares que contienen perfiles investigadores individuales con hipervínculos en red a revistas, bases de datos y otras fuentes. En algunos casos incluyen indicadores bibliométricos, que permiten medir el impacto causado por un trabajo a partir de la literatura. En este artículo se comparan las principales plataformas online, así como algunas de las redes sociales de investigación que existen hoy día para la creación de perfiles de investigación

Nowadays, scientific communication is enriched by the use of new ways of storing, publishing and disseminating research findings. Said new ways of scientific communication are known as the so-called academic profile platforms, which include Scopus author ID, ORCID, Publons and Kudos and on the other hand-social research networks, including ResearchGate, Academia.edu and Google Scholar citations. These tools have a main objective: enhancing both visibility and impact of contents and publications. They are multidisciplinary web pages that contain individual research profiles with network hyperlinks to magazines, databases and other sources. In some cases, bibliometric indicators are included, which allow measuring the impact caused by studies based on literature. This study compares the main online platforms, as well as some of the social research networks that currently exist for the creation of research profiles

Online platforms and social networks for the creation of research profiles.

Nowadays, scientific communication is enriched by the use of new ways of storing, publishing and disseminating research findings. Said new ways of  scientific communication are known as the so-called academic  profile platforms, which include Scopus author ID, ORCID, Publons and  Kudos and -on the other hand- social research networks, including  Research-Gate, Academia.edu and Google Scholar citations. These tools  have a main objective: enhancing both visibility and impact of contents  and publications. They are multidisciplinary web pages that contain  individual research profiles with network hyperlinks to magazines,  databases and other sources. In some cases, bibliometric indicators are  included, which allow measuring the impact caused by studies based on  literature. This study compares the main online platforms, as well as  some of the social research networks that currently exist for the  creation of research profiles.

Hoy en día, la comunicación científica se está viendo enriquecida debido a la utilización de nuevos modos de almacenamiento, publicación y difusión de los resultados. Entre ellos se encuentran las  denominadas plataformas de perfiles académicos, dentro de las cuales  se encuadrarían Scopus author ID, ORCID, Publons y Kudos y, por otro  lado, las redes sociales de investigación, entre las que se incluirían  ResearchGate, Academia. edu y Google Scholar citations. Estas  herramientas tienen como principal objetivo aumentar la visibilidad e  impacto de los contenidos y publicaciones. Son páginas web  multidisciplinares que contienen perfiles investigadores individuales con  hipervínculos en red a revistas, bases de datos y otras fuentes. En  algunos casos incluyen indicadores bibliométricos, que permiten medir  el impacto causado por un trabajo a partir de la literatura. En este  artículo se comparan las principales plataformas online, así como  algunas de las redes sociales de investigación que existen hoy día para  la creación de perfiles de investigación.

Checklist for clinical applicability of subgroup analysis.

WHAT IS KNOWN AND OBJECTIVE: Subgroup analysis plays an important role in clinical decision-making. Correct management of subgroup analysis is necessary to optimize effectiveness, safety and efficiency of treatments. No homogeneous criteria have been developed for interpretation of subgroup analysis. In this study, the researcher develops a checklist to evaluate the reliability and applicability of the results of subset analyses. METHODS: With a review of previous literature, three main criteria were included in the checklist: statistical association, biological plausibility and consistency among studies. Statistical association considered interaction probability, prespecification of analysis, number of subgroups analysed, sample size and positive/negative result in global analysis. Each item was given an indicative score. Total score was related to a level of applicability for the results in clinical practice. Checklist validation included interinvestigator concordance and assessment about utility. Three drug examples were used to validate the tool. RESULTS AND DISCUSSION: Twenty-six evaluators showed adequate interinvestigator concordance (kappa 0.79, 1 and 0.83 for each drug example regarding applicability). Kappa values increased to 0.94, 1 and 1 after group discussion. Checklist utility score was greater than 4.7/5 in three drug examples. In pre-analysis, inter-researcher agreement on global applicability recommendation of subgroup results to practice was 92.3% (ramucirumab), 96% (nivolumab) and 100% (mepolizumab). In post-analysis, inter-researcher agreement on applicability recommendation of subgroup results was 100%, 94.45% and 100%, respectively. The checklist validation shows a high interindividual agreement of the results, both with respect to the evaluation of the applicability of subgroup analysis and concerning clinical decision-making. WHAT IS NEW AND CONCLUSION: We have developed the first validated tool for interpretation of subgroup analyses. The checklist contributes to the adoption of homogeneous criteria for subgroup analyses, thereby allowing discussion and evaluation of the effects of a health intervention.

Determination of a cutoff value for medication regimen complexity index to predict polypharmacy in HIV+ older patient / Determinación del valor umbral del índice de complejidad de la farmacoterapia para predecir polifarmacia en pacientes VIH+

INTRODUCTION: HIV+ patients have increased their life expectancy with a parallel increase in age-associated co-morbidities and pharmacotherapeutic complexity. The aim of this study was to determine an optimal cutoff value for Medication regimen complexity index (MRCI) to predict polypharmacy in HIV+ older patients. PATIENTS AND METHODS: A transversal observational single cohort study was conducted at a tertiary Hospital in Spain, between January 1st up to December 31st, 2014. Patients included were HIV patients over 50 years of age on active antiretroviral treatment. Prevalence of polypharmacy and it pattern were analyzed. The pharmacotherapy complexity value was calculated through the MRCI. Receiver operating characteristic curve analyses were used to calculate the area under the curve (AUC) for the MRCI value medications to determine the best cutoff value for identifying outcomes including polypharmacy. Sensitivity and specificity were also calculated. RESULTS: A total of 223 patients were included. A 56.1% of patients had polypharmacy, being extreme polypharmacy in 9.4% of cases. Regarding the pattern of polypharmacy, 78.0% had a cardio-metabolic pattern, 12.0% depressive-psychogeriatric, 8.0% mixed and 2.0% mechanical-thyroidal. The ROC curve demonstrated that a value of medication complexity index of 11.25 point was the best cutoff for predict polypharmacy (AUC=0.931; sensitivity= 77.6%; specificity=91.8%). CONCLUSIONS: A cut-off value of 11.25 for MRCI is proposed to determine if a patient reaches the criterion of polypharmacy. In conclusion, the concept of polypharmacy should include not only the number of prescribed drugs but also the complexity of them

INTRODUCCIÓN: La esperanza de vida de los pacientes VIH+ se ha incrementado. De forma paralela han aumentado las comorbilidades asociadas a la edad y la complejidad farmacoterapéutica. El objetivo del estudio es estimar el valor umbral del índice de complejidad de la farmacoterapia (MRCI) para la determinación del criterio de polifarmacia en pacientes VIH+ mayores de 50 años. MÉTODOS: Estudio observacional, trasversal, unicéntrico. Se incluyeron todos los pacientes VIH+ mayores de 50 años, en tratamiento antirretroviral activo entre el 1 enero y 31 diciembre-2015. Se determinó la presencia de polifarmacia y los patrones asociados. La complejidad del tratamiento se calculó con la herramienta MRCI (Universidad de Colorado). Se analizó el índice de complejidad total como marcador cuantitativo de polifarmacia mediante la realización de una curva ROC y el cálculo de su área bajo la curva. Se calculó la sensibilidad y la especificidad de la misma. RESULTADOS: Se incluyeron 223 pacientes. El 56,1% presentó polifarmacia, siendo extrema en el 9,4% de los casos. En relación con el patrón de polifarmacia, el 78,0% presentaron un patrón cardio-metabólico, el 12,0% psico geriátrico-depresivo, el 8,0% mixto y el 2,0% mecánico tiroideo . Se determinó un valor de área bajo la curva ROC de 0,931 con límites entre (0,901-0,962) y p< 0,001. El valor 11,25 de índice de complejidad total de la farmacoterapia proporcionó un valor de especificidad del 92% y una sensibilidad del 78%. CONCLUSIÓN: El valor de 11,25 de índice de complejidad es un buen indicador para conocer los pacientes con polifarmacia. El concepto de polifarmacia no solo debe incluir el número de fármacos que toma el paciente sino incluir también la complejidad del tratamiento

El reto del envejecimiento y la complejidad farmacoterapéutica en el paciente VIH + / The challenge of aging and pharmacoterapeutic complexity in the HIV + patient

Objetivo:Describir el conocimiento actual y el manejo del envejecimiento y la complejidad farmacoterapéutica en pacientes VIH +. Método: Se realizó una revisión bibliográfica, incluyéndose artículos, originales o revisiones, publicados en lengua inglesa o española, desde 2007 al 2017, que analizaron el envejecimiento y la complejidad farmacoterapéutica en pacientes VIH + . Se combinaron los términos: "Polypharmacy"/"Polifarmacia", "Aging"/"Envejecimiento", "Frailty"/"Fragilidad", "Complejidad Farmacoterapéutica"/"Medication Regimen Complexity" y "HIV"/"VIH". La revisión se realizó de forma independiente por dos autores. Se analizó el grado de concordancia según el índice Kappa. Resultados: Se analizaron 208 referencias bibliográficas, incluyéndose finalmente 68. Se ha identificado un envejecimiento de la población y un incremento de las comorbilidades asociadas, especialmente a partir de los 50 años. Se han descrito cambios inmunológicos similares a los que se generan en la población anciana no infectada. Esto condiciona, según estudios identificados, la prescripción del tratamiento antirretroviral. Paralelamente, el concepto de polifarmacia está cada vez más presente, definiéndose exclusivamente por el uso concomitante de cinco fármacos. La complejidad farmacoterapéutica, a través del Medication Regimen Complexity Index, se ha empezado a analizar y a relacionar con resultados en salud. Se ha evidenciado una necesidad de profundizar y aplicar conceptos ya conocidos en la población no VIH envejecida, como desprescripción, medicación potencialmente inapropiada, riesgo colinérgico, etc., aunque existen pocos resultados disponibles. Conclusiones: Existe un interés creciente en profundizar en la relación VIH y envejecimiento. La complejidad farmacoterapéutica está empezando a utilizarse como criterio de seguimiento farmacoterapéutico por su influencia en los resultados en salud. Es necesario manejar e incorporar nuevos conceptos que ayuden a la optimización farmacoterapéutica en esta población

Objective:To describe the current knowledge and management of aging and pharmacotherapeutic complexity in HIV + patients. Method: A review of literature was carried out, including articles, originals or reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms «Polypharmacy»/«Polifarmacia», «Aging»/«Envejecimiento», «Frailty»/«Fragilidad», «Complejidad Farmacoterapéutica»/«Medication Regimen Complexity» and «HIV»/«VIH» were combined. The review was carried out independently by two authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An aging of the population and an increase in associated comorbidities have been identified, especially over 50 years-old. Immunological changes similar to those that are generated in a non-infected elderly population have been described. These conditions influencing the prescription of antiretroviral treatment, according to studies identified. In parallel, polypharmacy is increasingly present, being defined exclusively by the concomitant use of five drugs. Pharmacotherapeutic complexity, through the Medication Regimen Complexity Index, has begun to analyse and relate to health outcomes. There has been a need to know and apply concepts already known in non-HIV-aged population, such as deprescription, potentially inappropriate medication, cholinergic risk, although few results are available. Conclusions: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new concepts that help pharmacotherapeutic optimization in this population

The challenge of aging and pharmacoterapeutic complexity in the HIV + patient.

OBJECTIVE: To describe the current knowledge and management of aging and  pharmacotherapeutic complexity in HIV + patients. METHOD: A review of literature was carried out, including articles, originals or  reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms  «Polypharmacy¼/¼Polypharmacy¼, «Aging¼/¼Aging¼, «Frailty¼/¼Fragility¼,  «Pharmacotherapeutic Complexity¼/¼Medication Regimen Complexity¼ and  «HIV¼/"HIV¼ were combined. The review was carried out independently by two  authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An  aging of the population and an increase in associated comorbidities have been  identified, especially over 50 years-old. Immunological changes similar to those  that are generated in a non-infected elderly population have been described.  These conditions influencing the prescription of antiretroviral treatment,  according to studies identified. In parallel, polypharmacy is increasingly present,  being defined exclusively by the concomitant use of five drugs.  Pharmacotherapeutic complexity, through the Medication Regimen Complexity  Index, has begun to analyse and relate to health outcomes. There has been a  need to know and apply concepts already known in non-HIV-aged population,  such as de-prescription, potentially inappropriate medication, cholinergic risk, although few results are available. CONCLUSIONS: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is  beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new  concepts that help pharmacotherapeutic optimization in this population.

Objetivo: Describir el conocimiento actual y el manejo del envejecimiento y la  complejidad farmacoterapéutica en pacientes VIH ≥ .Método: Se realizó una revisión bibliográfica, incluyéndose artículos, originales o revisiones, publicados en lengua inglesa o española, desde 2007 al 2017, que analizaron el envejecimiento y la complejidad farmacoterapéutica  en pacientes VIH ≥ . Se combinaron los términos:  "Polypharmacy"/"Polifarmacia", "Aging"/"Envejecimiento", "Frailty"/"Fragilidad",  "Complejidad Farmacoterapéutica"/"Medication Regimen Complexity" y  "HIV"/"VIH". La revisión se realizó de forma independiente por dos autores. Se  analizó el grado de concordancia según el índice Kappa.Resultados: Se analizaron 208 referencias bibliográficas, incluyéndose finalmente 68. Se ha identificado un envejecimiento de la  población y un incremento de las comorbilidades asociadas, especialmente a  partir de los 50 años. Se han descrito cambios inmunológicos similares a los que  se generan en la población anciana no infectada. Esto condiciona, según estudios identificados, la prescripción del tratamiento antirretroviral. Paralelamente, el concepto de polifarmacia está cada vez más  presente, definiéndose exclusivamente por el uso concomitante de cinco  fármacos. La complejidad farmacoterapéutica, a través del Medication Regimen Complexity Index, se ha empezado a analizar y a relacionar con  resultados en salud. Se ha evidenciado una necesidad de profundizar y aplicar conceptos ya conocidos en la población no VIH envejecida, como  desprescripción, medicación potencialmente inapropiada, riesgo colinérgico, etc., aunque existen pocos resultados disponibles.Conclusiones: Existe un interés creciente en profundizar en la relación VIH y  envejecimiento. La complejidad farmacoterapéutica está empezando a utilizarse  como criterio de seguimiento farmacoterapéutico por su influencia en los  resultados en salud. Es necesario manejar e incorporar nuevos conceptos que  ayuden a la optimización farmacoterapéutica en esta población.

Preferencias por los tratamientos anticoagulantes orales para la prevención a medio y largo plazo del ictus en la fibrilación auricular no valvular / Preferences for oral anticoagulant treatment in the medium and long term prevention of stroke in non valvular atrial fibrillation

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Salud oral de los escolares de Ceuta. Influencias de la edad, el género, la etnia y el nivel socioeconómico / Oral health of schoolchildren in Ceuta. Influences of age, sex, ethnic background and socioeconomic level

Fundamento: La caries dental tiene una etiología multifactorial en la que intervienen características del huésped (saliva y esmalte dental), de la flora bucal (placa bacteriana) y del substrato sobre el que ésta se desarrolla (higiene oral y dieta). El objetivo de este trabajo es medir la prevalencia de caries, enfermedad periodontal y maloclusión en la población escolar de Ceuta, y su distribución según edad, género, etnia y nivel socioeconómico (NSE) -medido a través de la ocupación paterna-.Métodos: Se realizó una exploración física de la cavidad bucal a una muestra de escolares de 7, 12 y 14 años (n=347) del distrito sanitario de Ceuta con el fin de calcular los índices cao -dentición temporal-, CAO -dentición definitiva-, CPITN y de maloclusión. La selección de la muestra se realizó de forma aleatoria, estratificada polietápica. Se valoró la significación estadística de las diferencias encontradas aplicando las pruebas de Chi-cuadrado, T de Student. y F de Snedecor. Se calcularon las razones de ventaja (Odds Ratio), según sexo, etnia y NSE, de un índice CAO superior a la mediana de la distribución en escolares de 12 y 14 años.Resultados: El índice cao (piezas cariadas, ausentes y obturadas en dentición temporal) es 3,02 a los 7 años y el índice CAO (piezas cariadas, ausentes y obturadas en dentición definitiva) es 3,91 a los 12 años y 4,46 a los 14 años. Las razones de ventaja (OR) de un índice CAO> 4 a los 12-14 años y sus intervalos de confianza (IC) son los siguientes: 2,26 según género (IC95 por ciento= 1,27-4,05), 2,17 según etnia (IC95 por ciento=1,18-3,99) y 1,80 según NSE (IC95 por ciento=0,85-3,81). En el estrato de bajo NSE la OR por etnia es 1,38 (IC95 por ciento= 0,28-7,0). No se observan diferencias significativas en la distribución de maloclusión ni de enfermedad periodontal -excepto por edad-.Conclusiones: Los valores del índice CAO en escolares de Ceuta son más elevados que el promedio nacional y superiores al objetivo marcado por la OMS para el año 2000. El riesgo de índice CAO superior a la mediana es en niñas 2,3 veces mayor que en niños, en musulmanes 2,17 veces mayor que en no musulmanes y en escolares con bajo nivel socioeconómico -padres desempleados- 1,8 veces mayor que en escolares con padres activos. El aumento de riesgo asociado a etnia está influenciado por el nivel socioeconómico (AU)

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