ABSTRACT
OBJECTIVE: Dolutegravir plus lamivudine (2-DR) is suggested as an initial and switch option in HIV-1 treatment. The aim of this study was to analyze the effectiveness, durability, and safety of 2-DR compared to bictegravir/emtricitabine/tenofovir alafenamide (3-DR). PATIENTS AND METHODS: This was an observational, ambispective study that included all treatment-naïve (TN) and treatment-experienced (TE) people living with HIV/AIDS (PLWH), who started 2-DR or 3-DR between 01 July 2018, and 31 January 2022. The primary endpoint was non-inferiority, at 24 and 48 weeks, of 2-DR vs 3-DR regarding the percentage of PLWH with viral load (VL)<50 and 200 copies/mL in TN (12% margin) and VL≥50 and 200 copies/mL in TE (4% margin). Durability of response and safety were also measured. RESULTS: 292 PLWH were included (39 TN and 253 TE). In TN PLWH, non-inferiority was not achieved at 24 weeks (17; 95% CI -17 to 51 p = 0.348). By week 48, all PLWH on 3-DR maintained VL<50 copies/mL compared to 70% of PLWH on 2-DR although without reaching statistical significance (-33; 95% CI -60 to -10 p = 0.289). Non-inferiority was not achieved in TE PLWH either at 24 (0.4; 95% CI -9 to 10 p = 1) or at 48 weeks (4.5; 95% CI -0.5 to 9 p = 0.132). In TN, the risk of treatment discontinuation was similar between groups (HR: 0.31, p = 0.07); similar rates were also found in TE (HR: 1.3, p = 0.38). TE PLWH on 2-DR showed a better safety profile compared to 3-DR (p = 0.017). CONCLUSION: Our results did not show non-inferiority in terms of virological effectiveness. Additionally, durability and safety of 2-DR were confirmed to be similar to 3-DR.
Subject(s)
Anti-HIV Agents , HIV Infections , Humans , Adult , Emtricitabine/therapeutic use , Lamivudine/adverse effects , HIV Infections/drug therapy , Alanine/therapeutic use , Heterocyclic Compounds, 3-Ring/adverse effects , Pyridones/therapeutic use , Adenine/therapeutic use , Heterocyclic Compounds, 4 or More Rings/therapeutic use , Anti-HIV Agents/adverse effectsABSTRACT
BACKGROUND: Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training. METHODS: A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics. RESULTS: Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed. CONCLUSIONS: The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training. PRACTICAL IMPLICATIONS: Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.
Subject(s)
Dentists/standards , Education, Dental/standards , Medical Errors/statistics & numerical data , Clinical Competence , Female , Humans , Male , Patient Safety , Surveys and QuestionnairesABSTRACT
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Subject(s)
Humans , Male , Female , Adult , Middle Aged , AIDS-Related Opportunistic Infections/diagnostic imaging , AIDS-Related Opportunistic Infections/parasitology , Echinococcosis, Hepatic/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Echinococcosis, Hepatic/diagnostic imaging , HIV Infections/diagnosis , HIV Infections/microbiology , HIV Infections/parasitology , Administration, Oral , Adult , Albendazole/administration & dosage , Albendazole/therapeutic use , Animals , Antiprotozoal Agents/therapeutic use , Echinococcosis, Hepatic/blood , Echinococcosis, Hepatic/drug therapy , Echinococcosis, Hepatic/surgery , Echinococcus/isolation & purification , Elective Surgical Procedures , Female , HIV/immunology , HIV Infections/complications , Hepatomegaly/diagnosis , Hepatomegaly/etiology , Humans , Middle Aged , Serology/methods , Streptococcus oralis/isolation & purification , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
INTRODUCTION Over the last 40 years, high smoking prevalence has been reported throughout Cuba, including in Cienfuegos city in the central part of the island. OBJECTIVES Determine smoking prevalence and potential associated risk factors in Cienfuegos city for 2010-2011. METHODS A descriptive cross-sectional study was conducted in Cienfuegos city in the context of CARMEN (Collaborative Action for Risk Factor Prevention & Effective Management of Non-communicable Diseases), a PAHO multi-country initiative for a multidimensional approach to chronic non-communicable diseases. Participants totaled 2193 (aged 15-74 years), randomly selected through complex probabilistic three-stage sampling. Variables examined in relation to smoking included age, sex, skin color, civil status and educational level. RESULTS Approximately 25% of those surveyed were smokers (30.3% of men and 21.0% of women). For men, prevalence was highest in the groups aged 25-34 and 55-64 years; for women, in the group aged 45-54 years. Concerning skin color, smoking rates were higher among black and mestizo persons (29.5%); and concerning civil status, higher among those who were separated, widowed or divorced (30.0%). Smoking prevalence fell with higher educational level; in keeping with that trend, the university-educated group had the lowest prevalence (16.2%). CONCLUSIONS Although one in four Cienfuegos residents aged ≥15 years smoked in 2010-2011, prevalence there is lower than in previous surveys. Knowledge of differences observed in age, sex, skin color, civil status and educational level can be useful for planning future smoking prevention and control actions.
Subject(s)
Smoking/epidemiology , Urban Population , Adolescent , Adult , Aged , Cross-Sectional Studies , Cuba/epidemiology , Female , Health Surveys , Humans , Male , Middle Aged , Risk Factors , Young AdultABSTRACT
Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious.
Subject(s)
Acinetobacter Infections/epidemiology , Acinetobacter baumannii/enzymology , Cross Infection/epidemiology , Disease Outbreaks , beta-Lactamases/metabolism , Acinetobacter Infections/microbiology , Acinetobacter baumannii/isolation & purification , Aged , Aged, 80 and over , Cross Infection/microbiology , DNA Fingerprinting , Electrophoresis, Gel, Pulsed-Field , Genotype , Hospitals , Humans , Internal Medicine , Male , Multilocus Sequence TypingABSTRACT
BACKGROUND AND OBJECTIVE: The objective was to evaluate abnormalities in the quality of dreams after the use of efavirenz. PATIENTS AND METHOD: Ten HIV patients without neuropsychiatric diseases underwent a polisomnography (PSG) study before and after efavirenz treatment, [after 10.4 (SD 5.4) days]. Patients were awoke after REM phases to record their dreams. All patients had therapeutic efavirenz plasma levels. RESULTS: Dreams were recalled in 84% before efavirenz and 43% after efavirenz (p=0.024). There were no differences in the mean number of words per dream before and after efavirenz treatment (61.9 versus 47.5, p=0.115). The proportion of dreams with no neutral emotional content (either pleasant or unpleasant) was 37.5% in the first night and 66.7% in the second night (p=0.046). CONCLUSIONS: There were a higher proportion of dreams with no neutral emotional content after efavirenz treatment in this group of patients. However, no longer dreams and no more dreams with negative emotional content were noted. Dream recall was lower after efavirenz treatment.
Subject(s)
Benzoxazines/pharmacology , Dreams/drug effects , Reverse Transcriptase Inhibitors/pharmacology , Adolescent , Adult , Alkynes , Cyclopropanes , Female , Humans , Male , Pilot Projects , Young AdultABSTRACT
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Humans , Granulomatosis with Polyangiitis/diagnosis , Cocaine-Related Disorders/complications , Granulomatosis with Polyangiitis/etiology , Diagnosis, DifferentialABSTRACT
OBJECTIVES: Identifying methods to improve pharmacologic control of elevated blood pressure remains the most urgent challenge in clinical research on hypertension. The probability of having inadequate control varies widely in the population and better understanding of the factors responsible could help to focus treatment strategies. METHODS: A population-based community survey of 1475 persons aged 25-74 years, in Cienfuegos, Cuba, was used to identify these factors in a low-resource setting. RESULTS: While half of women with hypertension were controlled, only one-third of men were receiving successful treatment. Gender differences were not seen, however, among those currently taking medications. The largest burden of hypertension in absolute terms was concentrated in the age range 45-64, emphasizing the heavy burden of uncontrolled high blood pressure that falls on middle-aged men. Race-ethnicity was not a determinant of treatment and control status, nor was inability to obtain medication. CONCLUSIONS: These findings largely confirm the pattern observed in industrialized countries and demonstrate the near-universal challenge confronting primary-care systems in physician-based control of cardiovascular risk factors.
Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Hypertension/epidemiology , Urban Population/statistics & numerical data , Adult , Aged , Blood Pressure/drug effects , Cross-Sectional Studies , Cuba/epidemiology , Female , Health Services Accessibility/statistics & numerical data , Humans , Male , Middle Aged , Multivariate Analysis , Prevalence , Risk Factors , Surveys and Questionnaires , Treatment FailureABSTRACT
OBJETIVO: Con motivo de la aparición en la década de los ochenta de artículos científicos que evidenciaban el posible abordaje de las colecciones líquidas vaginales con anestesia local, revisamos nuestra experiencia en el manejo de esta patología. MÉTODO: Desde Enero de 1991 hasta Marzo de 2001 hemos tratado en nuestro servicio a 76 pacientes con hidrocele (6 bilaterales). El paciente es monitorizado en quirófano (EKG, tensión arterial y pulsioxímetro), se canaliza una vía sanguínea periférica. Se logra la sedación del paciente inyectando por vía intramuscular, 20 minutos antes de comenzar la intervención, Midazolam (5 mgrs.), Meperidina (50 mgrs.) y Atropina (0,5 mgrs.). Se infiltra Mepivacaina al 2 por ciento (10-20cc.) en el cordón espermático, así como la zona de pared escrotal a incidir. La técnica quirúrgica consistió en disección y excisión del saco vaginal. RESULTADOS: La tolerancia anestésica fue muy satisfactoria en 71 pacientes (93 por ciento) y no satisfactoria en cinco casos (7 por ciento). Las complicaciones registradas fueron: hematoma escrotal en 4 casos (5 por ciento), infección en 3 casos (4 por ciento), bradicardia e hipotensión en dos casos (3 por ciento). Sólo en cinco pacientes (7 por ciento) la estancia hospitalaria fue superior a 24 horas. CONCLUSIONES: El tratamiento quirúrgico del hidrocele se puede realizar con anestesia local evitando la morbilidad derivada de una técnica anestésica más agresiva. Este procedimiento terapéutico debe ser una opción a considerar en servicios pequeños con recursos limitados (AU)
Subject(s)
Middle Aged , Child , Adolescent , Adult , Aged, 80 and over , Aged , Male , Humans , Anesthesia, Local , Time Factors , Testicular HydroceleABSTRACT
Objetivo: Evaluar la cumplimentación, tolerancia y eficacia de una pauta corta de quimioprofilaxis para tuberculosis con isoniacida y rifampicina durante 3 meses frente a una pauta estándar de isoniacida durante 12 meses en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Pacientes y métodos: Ensayo clínico prospectivo, comparativo, aleatorizado y abierto realizado en cuatro hospitales generales y un centro penitenciario de Castilla-La Mancha. La profilaxis se administró en pacientes PPD positivos y pacientes anérgicos de acuerdo con las normas de los Centers for Diseases Control (CDC) de 1991. Los pacientes se distribuyeron de forma aleatoria en dos pautas: pauta de rifampicina a los que se les administraron 300 mg/día de isoniacida y 600 mg/día de rifampicina durante 3 meses, y pauta de isoniacida a los que se les administraron 300 mg/día de isoniacida durante 12 meses. Resultados: Se incluyeron 133 pacientes: 64 en la pauta isoniacida y 69 en la pauta rifampicina. Se toleró mejor la pauta de rifampicina, con un 28 por ciento de efectos adversos frente a un 55 por ciento en la pauta de isoniacida. La hepatotoxicidad fue más frecuente en la pauta de isoniacida, con un riesgo relativo (RR) de 2,2 (intervalo de confianza [IC] del 95 por ciento, 1,23-4,01). La hepatotoxicidad grave, que obligó a suspender el tratamiento, se relacionó con el tiempo de administración del fármaco, siendo más frecuente en la pauta de 12 meses. Se cumplimentó mejor la pauta corta, pero sin diferencias valorables. La incidencia de tuberculosis fue de 4,23 casos por 100 personas-año para la pauta de isoniacida y 2,08 para la pauta de rifampicina, con un riesgo relativo para desarrollar tuberculosis con la pauta de rifampicina de 0,51 (IC del 95 por ciento, 0,09-2,8) frente a la pauta de isoniacida, no estadísticamente significativo. La estancia en prisión se asoció con un riesgo significativo de tuberculosis, independientemente de la pauta de tratamiento (RR = 9,2; IC del 95 por ciento; 1,06-80,2). Conclusiones: En pacientes con infección por el VIH con PPD positivo o anérgicos, la pauta de rifampicina es al menos igual de eficaz para prevenir el desarrollo de tuberculosis que la pauta de isoniacida, y presenta menos efectos adversos (AU)
Subject(s)
Adult , Aged , Male , Female , Humans , Hospital Mortality , Rifampin , Spain , Subarachnoid Hemorrhage , Tuberculosis , Time Factors , Incidence , AIDS-Related Opportunistic Infections , Registries , Prospective Studies , Antibiotics, Antitubercular , Antitubercular Agents , Isoniazid , Liver , Tuberculin TestABSTRACT
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