Effectiveness and Safety of Entecavir or Tenofovir in a Spanish Cohort of Chronic Hepatitis B Patients: Validation of the Page-B Score to Predict Hepatocellular Carcinoma.

BACKGROUND: Long-term antiviral therapy has resulted in viral suppression and biochemical response in chronic hepatitis B, although the risk of hepatocellular carcinoma has not been abolished. The Page-B score could be useful to estimate the probability of HCC. AIMS: To analyze the effectiveness and safety of entecavir or tenofovir for more than 4 years and the usefulness of Page-B score in the real-world setting. METHODS: Analysis of Caucasian chronic hepatitis B subjects treated with entecavir or tenofovir from the prospective, multicenter database CIBERHEP. RESULTS: A total of 611 patients were enrolled: 187 received entecavir and 424 tenofovir. Most were men, mean age 50 years, 32% cirrhotic and 16.5% HBeAg-positive. Mean follow-up was 55 (entecavir) and 49 (tenofovir) months. >90% achieved HBV DNA <69 IU/mL and biochemical normalization by months 12 and 36, respectively. Cumulative HBeAg loss and anti-HBe seroconversion were achieved by 33.7 and 23.8%. Four patients lost HBsAg; three HBeAg-positive. Renal function remained stable on long-term follow-up. Fourteen (2.29%) developed HCC during follow-up all of them with baseline Page-B ≥10. Nine were diagnosed within the first 5 years of therapy. This contrasts with the 27 estimated by Page-B, a difference that highlights the importance of regular HCC surveillance even in patients with virological suppression. CONCLUSIONS: Entecavir and tenofovir achieved high biochemical and virological response. Renal function remained stable with both drugs. A Page-B cut-off ≥10 selected all patients at risk of HCC development.

[Low molecular weight heparin versus unfractionated heparin in the treatment of deep vein thrombosis]. / Heparinas de bajo peso molecular frente a heparinas no fraccionadas en el tratamiento de la trombosis venosa profunda.

BACKGROUND: Low-molecular-weight heparin (LMWH) are replacing unfractionated heparin (UH) in treatment of deep vein thrombosis (DVP), showing their security and effectiveness. METHODS: To demonstrate their security and effectiveness a randomized prospective study was realised. It compared UH with LMWH in DP treatment, clinically diagnosed and confirmed with eco-Doppler. The study included 32 patients (21 males and 11 females); 15 received UH in continuos i.v. infusion and 17 sodic dalteparine, with dicumarinic afterwards in every case. The patients were followed for one year. RESULTS: There were no differences between the two groups of treatment in clinical/radiological effectiveness either in short term nor one year follow up. There were no significative differences in side effects. CONCLUSION: LMWH are as effective and safe as UH for DVT treatment. They also have a more comfortable dosage for the patient, avoiding the i.v. infusion and the coagulation test, which allows treatment at home.

Heparinas de bajo peso molecular frente a heparinas no fraccionadas en el tratamiento de la trombosis venosa profunda / Low-molecular-weight heparin versus unfractiona ted heparin in the treatment of deep vein thrombosis

Antecedentes: Las heparinas de bajo peso molecular están sustituyendo de forma progresiva a las heparinas no fraccionadas en el tratamiento de la enfermedad tromboembólica, porque parecen haber demostrado ser seguras y eficaces.Métodos: Para analizar su eficacia y seguridad en nuestro medio, se realizó un estudio prospectivo aleatorizado en el que se comparaba la heparina sódica con una heparina de bajo peso molecular en el tratamiento de las trombosis venosas profundas, diagnosticadas clínicamente y confirmadas por eco-Doppler. Se incluyeron 32 pacientes (21 varones y 11 mujeres) de los cuales 15 recibieron heparina sódica en perfusión continua y 17 dalteparina sódica, seguida posteriormente de dicumarínicos en todos los casos. Se realizó un seguimiento de un año.Resultados: No hubo diferencias entre ambos grupos de tratamiento en eficacia clínica/radiológica a corto plazo ni en el año de seguimiento. Asimismo tampoco hubo diferencias significativas en cuanto a efectos secundarios.Conclusión: En nuestro medio, las heparinas de bajo peso molecular resultan tan eficaces y seguras como la heparina sódica para el tratamiento de la trombosis venosa profunda, presentando una posología más cómoda para el paciente, evitando el uso de bombas de infusión y la práctica de controles analíticos, y posibilitando el tratamiento domiciliario. (AU)

[The use of cefotaxime on patients admitted to the internal medicine service of a general hospital. An analysis from the viewpoint of health economics]. / Empleo de la cefotaxima en pacientes ingresados en el Servicio de Medicina Interna de un hospital general. Un análisis desde el punto de vista de la economía de la salud.

Cefotaxime is a widely employed antibiotic in hospital practice, leading to an important economical cost. We analyse the adequacy of the indications of cefotaxime in our Internal Medicine Unit along a two month period. The records of the 54 patients treated with cefotaxime along a two month period were retrospectively reviewed to establish the adequacy of the prescriptions by checking them with a list of indications based on widely used bibliographical sources. Cefotaxime prescription was considered inadequate because of its inefficiency in 15 out of the 54 patients studied (28%). They were all patients admitted because of bronchitic relapses of chronic obstructive lung disease ("COLD") without radiological evidence of pneumonic consolidation. We calculate that using a more efficient antibiotic alternative could lead to a decrease of a 3.6 to 7.53% in the total pharmaceutical expenses of our unit along the study period. We conclude that the unnecessary routine use of cefotaxime may lead to an avoidable important increase in sanitary costs.