Safety and efficacy of treatment with pegylated interferon alpha-2a with ribavirin in chronic hepatitis C genotype 4.

The hepatitis C virus (HCV) genotype is an important predictive outcome parameter for pegylated interferon plus ribavirin therapy. Most published therapeutic trials to date have enrolled mainly patients with HCV genotypes 1, 2 and 3. Limited studies have focused on genotype 4 patients, who have had a poor representation in pivotal trials. Our aim was to evaluate the efficacy and safety of treatment with standard dose pegylated interferon alfa-2a in combination with weight-based ribavirin in patients with chronic hepatitis C genotype 4. In this prospective observational study, 198 patients with HCV-4 were included in this study from February 2004 to August 2005,188 patients who received at least 1 dose of drugs were included in the ITT analysis and they were treated with pegylated interferon alfa-2a and ribavirin for 48 weeks. Baseline and demographic characteristics, response to treatment at weeks 12, 48 and 72, and the nature and frequency of adverse effects were analyzed. Virological response at week 12 was achieved in 144 patients (76.6%). Virological response at the end of treatment was present in 110 patients (58.5%). At week 72, 99 patients presented SVR (52.7%). The reported adverse events were similar to those found in the literature for treatments of similar dose and duration. In conclusion, combined treatment with pegylated interferon alfa-2a and ribavirin was well tolerated and effective in chronic hepatitis C genotype 4, yielding response rates between those reported for genotype 1 and those of genotypes 2-3.

Asistencia urgente a los pacientes con hemorragia digestiva alta en los hospitales comarcales catalanes / Emergency care of patients with upper gastrointestinal bleeding in regional hospitals in Catalonia

Objetivo Valorar los recursos disponibles en los hospitales comarcales catalanes para la asistencia urgente de la hemorragia digestiva alta. Método Se analiza una encuesta enviada a 32 hospitales, sobre la existencia, composición y recursos del turno de guardia (TDG) de endoscopia, referida al año 2009.ResultadosRespondieron 24 centros, que cubrían la asistencia de 3.954.000 habitantes. Tenían TDG 12 hospitales. No disponían de TDG en su centro de referencia 1.483.000 habitantes. Los centros con TDG tenían más camas y cubrían más población. Los TDG estaban formados por 4,5 endoscopistas (rango 2-11), que cubrían 82,1 (33,2-182,5) guardias/año. Diecisiete centros reportaban 1.571 episodios (51 por centro, rango 3-280, 39,68/100.000 hab.). Los centros con TDG reportaban más casos (76 vs. 43, p=0,047). Los que no disponen de TDG derivaron más pacientes (147 vs. 17, p= 0,001). Los pacientes en urgencias estaban a cargo de medicina interna en 4 centros, de cirugía en 14 y repartidos entre ambos servicios en 6. Si ingresaban, quedaron a cargo de Digestivo solo en 6 hospitales. Los recursos más utilizados eran la ligadura en la hemorragia varicosa y las terapias de inyección en la no varicosa. Un 21% de centros no realizaban tratamiento combinado. Conclusiones Una proporción significativa de la población no dispone de endoscopista de guardia en su centro de referencia. La constitución de TDG en hospitales comarcales supone importantes cargas asistenciales. La coordinación entre profesionales y centros permitiría la aplicación eficiente de los recursos terapéuticos y el establecimiento de TDG en centros que no tienen (AU)

Objective To evaluate the resources available in Catalan regional hospitals for the emergency care of upper gastrointestinal hemorrhage. Methods We analyzed a survey sent to 32 hospitals on the availability, composition and resources of a duty endoscopy service for the year 2009.ResultsResponses were obtained from 24 centers, covering 3,954,000 inhabitants. Duty endoscopists were available in 12 hospitals. A total of 1,483,000 inhabitants were unable to access a duty endoscopist in the referral center. Centers with duty endoscopists had more beds and had a larger catchment area. Duty services were composed of 4.5 endoscopists (range 2-11), covering 82.1 (33.2-182.5) duty shifts/year. Seventeen centers reported 1,571 episodes (51%, range: 3-280, 39.68/100,000 inhabitants). Centers with a duty service reported a greater number of cases (76 vs. 43, p=0.047). Centers without this service referred a greater number of patients (147 vs. 17, p=0.001). Patients in the emergency department were under the care of the internal medicine department in four centers, the surgery department in 14 centers and under the care of both departments in six. Admitted patients were under the care of the gastroenterology department in only six hospitals. The most widely used procedures were ligation of varicose bleeding and injection therapies in non-varicose bleeding. Twenty-one percent of centers did not perform combined treatment. Conclusions A significant proportion of the population does not have access to a duty endoscopist in referral centers. Duty shifts represent significant workload in regional hospitals. Coordination among health professionals and centers would allow the efficient application of therapeutic resources and a duty endoscopy service to be established in centers lacking this resource (AU)

[Emergency care of patients with upper gastrointestinal bleeding in regional hospitals in Catalonia]. / Asistencia urgente a los pacientes con hemorragia digestiva alta en los hospitales comarcales catalanes.

OBJECTIVE: To evaluate the resources available in Catalan regional hospitals for the emergency care of upper gastrointestinal hemorrhage. METHODS: We analyzed a survey sent to 32 hospitals on the availability, composition and resources of a duty endoscopy service for the year 2009. RESULTS: Responses were obtained from 24 centers, covering 3,954,000 inhabitants. Duty endoscopists were available in 12 hospitals. A total of 1,483,000 inhabitants were unable to access a duty endoscopist in the referral center. Centers with duty endoscopists had more beds and had a larger catchment area. Duty services were composed of 4.5 endoscopists (range 2-11), covering 82.1 (33.2-182.5) duty shifts/year. Seventeen centers reported 1,571 episodes (51%, range: 3-280, 39.68/100,000 inhabitants). Centers with a duty service reported a greater number of cases (76 vs. 43, p=0.047). Centers without this service referred a greater number of patients (147 vs. 17, p=0.001). Patients in the emergency department were under the care of the internal medicine department in four centers, the surgery department in 14 centers and under the care of both departments in six. Admitted patients were under the care of the gastroenterology department in only six hospitals. The most widely used procedures were ligation of varicose bleeding and injection therapies in non-varicose bleeding. Twenty-one percent of centers did not perform combined treatment. CONCLUSIONS: A significant proportion of the population does not have access to a duty endoscopist in referral centers. Duty shifts represent significant workload in regional hospitals. Coordination among health professionals and centers would allow the efficient application of therapeutic resources and a duty endoscopy service to be established in centers lacking this resource.

The importance of the length of the first metatarsal and the proximal phalanx of hallux in the etiopathogeny of the hallux rigidus.

The purpose of this study was to determine if the relative length of the first metatarsal and the proximal phalanx of the hallux, in respect to the total foot length, were associated with the incidence of hallux rigidus. For this retrospective study, lateral radiographs from 132 cases with hallux rigidus and a control group of 132 normal feet were reviewed. We measured the following parameters: the index between the foot length and first metatarsal length, the proximal phalanx of the hallux length, and the sum of the first metatarsal length and the proximal phalanx of the hallux length. We found a statistically significant difference (p: 0.002) between the two groups in the Foot L/1st Mtt L index, and no statistical difference in the Foot L/Phalanx L index. We think that a greater length of first metatarsal is involved in the etiopathogeny of hallux rigidus.

[Individual and ecological factors related to the geographical variability of psychological distress among small areas: a multilevel analysis in Catalonia, Spain]. / Factores individuales y del entorno asociados a la variabilidad geográfica de los trastornos psicológicos entre areas pequeñas: un análisis multinivel.

BACKGROUND: To know the geographic distribution of the prevalence of psychological distress is important for mental health services planning. This study is aimed at identifying the individual factors and those related to the area of residence which may explain the geographic variability of psychological distress (by healthcare districts) in Catalonia. METHODS: The data was taken from the 1994 Catalonian Health Survey and from the 1996 Catalonia population statistics. The prevalence of psychological distress is estimated by age and sex and by healthcare district. In a two-level logic regression model, a study is made of the relationship between the individual variables (first level: health survey n = 12,455) and those of the area of residence (second level: the healthcare district, n = 46) to the geographic distribution of the prevalence of psychological distress. RESULTS: The significant variables at individual level are in men: age (45-64 years OR: 0.63 y > 64 years OR: 0.22), working status (no work OR: 1.60), number of chronic diseases (CD) (CD = 1 OR: 1.75 CD = 2 OR: 2.06 CD = 3-5 OR: 3.36 and CD > 5 OR: 8.9). In women: age (25-44 years OR: 0.63 45-64 years OR: 0.45 and > 64 years OR: 0.32), working status (no work OR: 1.30), number of chronic diseases (CD = 1 OR: 1.75 CD = 2 OR: 2.44 CD = 3-5 OR: 4.09 and CD > 5 OR: 11.14), and also the kind of parental household in women (single-parental OR: 1.42). The variables at the level of the area of residence are in migration (men OR: 1.55 and women OR: 1.68) and unemployment (men OR: 1.07 and women OR: 1.06). CONCLUSIONS: The individual factors do not suffice to explain the geographical variability of the prevalence of psychological distress, but the characteristics of the area of residence are also important.

[Differences between public and private hospital care in Spain: the realities of health care or a numerical fallacy?]. / Diferencias entre público y privado en la asistencia hospitalaria en España: 'realidad asistencial o falacia numérica?

OBJECTIVE: To give an example of the misleading interpretations of the concepts "public and private" when dealing with simple data from hospital resources and activities in Spain. MATERIAL AND METHODS: Data comes from the survey of hospitals (EESCRI) for the year 2002 in Catalonia. Using the figures corresponding to resources (number of centers and beds) and activities (discharges, stays, mean stay, occupancy, and rotation) comparisons are made among different variables (managing authority and funding source) reclassified, according to the concepts of public and private. RESULTS: The figures on resources and activities offer a very different portrait about the public or private nature of the care provided, according to the variables being used for classification. CONCLUSIONS: It is necessary to specify the concepts and variables to be used when analyzing the performance of health services and to improve the information sources in order to adapt them to the new management forms of the health services.

Factores individuales y del entorno asociados a la variabilidad geográfica de los trastornos psicológicos entre áreas pequeñas: un análisis multinivel / Individual and ecological factors related to the geographical variability of psychological distress among small areas: a multilevel analysis in Catalonia, Spain

Fundamento: Para planificar las necesidades de servicios sanitarioses fundamental conocer la distribución de la morbilidad portrastornos psicológicos en el territorio así como los factores que ladeterminan. El objetivo es identificar los factores que pueden explicarla variabilidad geográfica de estos trastornos en Cataluña.Métodos: Los datos proceden de la Encuesta de Salud de l994 yde la estadística de población de l996 para Cataluña. Se estima la prevalenciade trastornos psicológicos por edad y sexo y por sector sanitario.En un modelo de regresión logística a dos niveles se estudia laasociación entre las variables individuales (primer nivel: Encuestade Salud n=12.455) y las de la zona de residencia (segundo nivel: elsector sanitario, n= 46) con la prevalencia de trastornos psicológicos.Resultados: Las variables individuales que influyen en las diferenciasentre sectores son: la edad (45-64 años OR:0,63 y >64 años:OR:0,22), la situación laboral (no trabaja OR:1,60) y el número detrastornos crónicos (TC) (TC=1 OR: 1,75 TC=2 OR: 2,06 TC=3-5OR:3,36 y TC>5 OR: 8,9) en hombres. En las mujeres, además deestas variables (edad 25-44 años OR: 0,63 45-64 años OR:0,45 y >64años OR: 0,32 la situación laboral no trabaja OR:1,30 y el número detrastornos crónicos (TC) TC=1 OR: 1,75 TC=2 OR: 2,44 TC=3-5OR:4,09 y TC>5 OR: 11,14), influye el tipo de hogar (monoparentalOR: 1,42). Las variables a nivel de la zona de residencia son la proporciónde inmigración (hombres OR:1,55 y mujeres OR:1,68) y dedesempleo (hombres OR:1,07 y mujeres OR:1,06).Conclusiones: Los factores individuales no son suficientes paraexplicar la variabilidad geográfica de la prevalencia de los trastornospsicológicos, ya que también influyen las características de la zonade residencia

Background: To know the geographic distribution of the prevalenceof psychological distress is important for mental healthservices planning. This study is aimed at identifying the individualfactors and those related to the area of residence which may explainthe geographic variability of psychological distress (by healthcaredistricts) in Catalonia.Methods: The data was taken from the 1994 Catalonian HealthSurvey and from the 1996 Catalonia population statistics. The prevalenceof psychological distress is estimated by age and sex and byhealthcare district. In a two-level logic regression model, a study ismade of the relationship between the individual variables (first level:health survey n=12,455) and those of the area of residence (secondlevel: the healthcare district, n=46) to the geographic distribution ofthe prevalence of psychological distress.Results: The significant variables at individual level are in men:age (45-64 years OR:0,63 y >64 years OR: 0,22), working status (nowork OR:1,60) , number of chronic diseases (CD) (CD=1 OR: 1,75CD=2 OR: 2,06 CD=3-5 OR:3,36 and CD>5 OR: 8,9). In women:age (25-44 years OR: 0,63 45-64 years OR:0,45 and >64 years OR:0,32), working status (no work OR:1,30), number of chronic diseases(CD=1 OR: 1,75 CD=2 OR: 2,44 CD=3-5 OR:4,09 and CD>5OR: 11,14), and also the kind of parental household in women (single-parental OR: 1,42). The variables at the level of the area of residenceare inmigration (men OR:1,55 and women OR:1,68) andunemployment (men OR:1,07 and women OR:1,06).Conclusions: The individual factors do not suffice to explain thegeographical variability of the prevalence of psychological distress,but the characteristics of the area of residence are also important

Diferencias entre público y privado en la asistencia hospitalaria en España: ¿realidad asistencial o falacia numérica? / Differences between public and private hospital care in Spain: the realities of health care or a numerical fallacy?

Objetivo: Mostrar un ejemplo de la interpretación engañosa del concepto «público» y «privado» con datos sencillos sobre la dotación y la actividad hospitalaria en España. Material y métodos: Se utilizan datos de la Encuesta de Establecimientos Sanitarios con Régimen de Internado (EESCRI) del año 2002 para Cataluña y se comparan los resultados de dotación (hospitales y camas) y de actividad (altas, estancias, estancia media, índice de ocupación e índice de rotación) como resultado de recategorizar las variables (dependencia funcional y financiación), en función del concepto público y privado. Resultados: La dotación, actividad y los índices hospitalarios básicos dan una imagen muy diferente sobre la asistencia pública o privada según cuál sea la variable de clasificación utilizada. Conclusiones: Es necesario precisar mejor los conceptos y las variables utilizadas en el estudio del sistema sanitario y mejorar las fuentes de información para adaptarlas a las nuevas realidades de gestión de los servicios existentes

Objective: To give an example of the misleading interpretations of the concepts «public and private» when dealing with simple data from hospital resources and activities in Spain. Material and methods: Data comes from the survey of hospitals (EESCRI) for the year 2002 in Catalonia. Using the figures corresponding to resources (number of centers and beds) and activities (discharges, stays, mean stay, occupancy, and rotation) comparisons are made among different variables (managing authority and funding source) reclassified, according to the concepts of public and private. Results: The figures on resources and activities offer a very different portrait about the public or private nature of the care provided, according to the variables being used for classification. Conclusions: It is necessary to specify the concepts and variables to be used when analyzing the performance of health services and to improve the information sources in order to adapt them to the new management forms of the health services

Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features.

To evaluate and compare the diagnostic utility of multiple quantitative parameters as measured on knee magnetic resonance (MR) examinations of patients suffering objective patellar instability (OPI). We performed a retrospective evaluation of knee MR examinations in a group of 46 patients (59 knees) with clinically proven OPI, and in a control group of 69 patients (71 knees). Multiple quantitative parameters in both groups were statistically evaluated and compared for their association with OPI. OPI patients tend to present shallower trochlear groove (<5 mm), larger Insall-Salvati index (>1.2), shorter patellar nose (<9 mm), smaller morphology ratio (<1.2), and larger patellar tilt (>11 degrees ) than control patients. The best sensitivities were those of the lateral patellar tilt (92.7%), the trochlear groove depth at the roman arch level (85.7%) and the Insall-Salvati index (78%). The best specificities were those of the morphology ratio (86.9%), the patellar nose (84.5%) and the patellar tendon length (84.5%). Shallow trochlear groove may be confidently identified at the roman arch view in OPI patients. Patella alta may be more reliably detected by the Insall-Salvati index in OPI patients. Patellar nose and morphology ratio are very specific indicators of OPI. A short patellar nose (that is to say, a patellar nose ratio of <0.25) has a high association with OPI. Lateral patellar tilt remains the single feature with the highest sensitivity and specificity for identifying OPI patients.

Localized pigmented villonodular synovitis in an unusual location in the knee.

PURPOSE: Localized pigmented villonodular synovitis (LPVNS) is a rare lesion that can affect any joint, although it is most frequently found in the knee. Clinically, it is difficult to diagnose. Radiographs are usually within normal limits. TYPE OF STUDY: Case series. METHODS: We present a series of 9 cases of LPVNS of the knee in 9 patients with an average age of 36 years. In 7 of the 9 cases, the lesions were in an an unusual location, 4 in the fat pad and 3 in the posterior compartment of the knee. The other 2 cases were located in the meniscocapsular junction and the intercondylar notch, respectively. The mean time from the onset of symptoms to diagnosis was 2.26 years. Magnetic resonance image (MRI) provided a characteristic image that helped with diagnosis and localizing the lesion in all cases. RESULTS: Complete resection of the lesion using arthrotomy was performed in 4 cases and resection assisted using arthroscopy was performed in 5. All cases had an excellent result. There were no signs of clinical or MRI recurrence after a mean follow-up of 36 months. CONCLUSIONS: LPVNS of the knee is a rare lesion. MRI provides the basis for diagnosis. Complete resection using arthrotomy or arthroscopy is the treatment.