Complementary and alternative medicine in HIV care: frequency of consumption, risks and interactions with antiretroviral therapy.

OBJECTIVES: People living with HIV (PLWH) are common users of complementary and alternative medicine (CAM). The main objective of this study was to study the frequency and patterns of CAM natural products use in a large cohort of PLWH and to identify potential drug-drug interactions (DDIs) and the impact on their antiretroviral treatment (ART) adherence and efficacy. METHODS: This was a cross-sectional multicenter survey including 420 PLWH from different Spanish hospitals. Participants completed a face-to-face questionnaire on CAM consumption and different sociodemographic and clinical data were collected. DDIs between CAM and ART were identified and classified according to the Liverpool University Database and patient factors related to CAM consumption were assessed. RESULTS: 420 participants were included (82.6% male, mean age 47 years); 209 patients (49.8%) were taking at least one CAM. The most consumed CAM were green, black and red tea (n=146, 25.4%), ginger (n=26, 4.5%), fish oil (n=25, 4.4%) and cannabis (n=24, 4.2%). An ART based on integrase inhibitors was the only factor independently associated with CAM consumption (OR 1.54, 95% CI 1.04 to 2.26). 50 potential CAM-ART interactions in 43 (20.6%) patients taking CAM were identified, being clinically significant in 80% of the cases. CAM products most frequently involved with a potential significant DDI were supplements containing divalent cations (n=11) and garlic (n=7). No differences in ART efficacy and adherence were observed between patients with and without CAM consumption. CONCLUSIONS: Almost 50% of patients were taking at least one CAM product and its use was associated with an integrase inhibitor based ART. One out of every six patients was at risk of presenting with an interaction between a CAM and their ART, confirming the need to review continuously the use of CAM as part of the medication review process.

Factors associated with all-cause mortality at 90 days in hospitalized adult patients who received parenteral nutrition / Factores asociados a mortalidad a los 90 días en pacientes adultos hospitalizados que recibieron nutrición parenteral

Objective: this study aimed to assess the main factors related to mortality in a cohort of hospitalized adult patients who required parenteral nutrition (PN) considering their characteristics, type of admission, procedures, nutritional data, and adverse events. Methods: a retrospective study was performed in a 400-bed university hospital. All adult inpatients that had received ≥ 4 days as first course of PN within 24 months were included. Patients with long-term (> 90 days) or home PN were excluded. The main variable was all-cause mortality at 90 days after the end of PN. Initial independent variables were anthropometric and demographic data, admission characteristics, severity, comorbidity, surgical/medical procedures, baseline biochemical parameters, nutritional risk, and other nutritional data, medications, and adverse events during PN. A Cox proportional hazards regression model was planned to analyze time-to-event data. Results: a total of 634 patients entered the study and 140 (22.1 %) died. Patients were mainly: surgical 471 (74.3 %), male 393 (62.0 %), and age 69.0 (67.8-70.1) years old. The survival time for the entire cohort was 74.0 (95 % CI: 71.6-76.6) days. The final model included 14 variables, with severity and comorbidity being the main ones, but including also anastomotic suture dehiscence, sepsis during PN, days with hyperglycemic events, use of potent opioids, failed attempts at enteral nutrition, and, as a protective one, energy provided in PN. Conclusions: the factors related to mortality in hospitalized adult patients who required PN were mainly severity and comorbidities, but several other important factors were also relevant and could be modified to maximize outcomes in these patients (AU)

Objetivo: valorar los factores relacionados con la mortalidad en una cohorte de pacientes adultos hospitalizados que recibieron nutrición parenteral (NP) atendiendo a sus características, procedimientos, parámetros nutricionales y complicaciones. Métodos estudio retrospectivo realizado en un hospital universitario de 400 camas. Se incluyeron todos los pacientes adultos que recibieron ≥ 4 días de NP en un periodo de 24 meses. Se excluyeron los pacientes con NP de largo plazo (> 90 días) o NP domiciliaria. La variable principal fue la mortalidad por cualquier causa en los 90 días posteriores al fin de la NP. Las variables independientes iniciales fueron los datos antropométricos y demográficos, el tipo de ingreso, la gravedad, la comorbilidad, los procedimientos médicos/quirúrgicos, los parámetros bioquímicos, el riesgo nutricional, otros parámetros nutricionales, las medicaciones y los eventos adversos durante la NP. Se realizó un análisis de supervivencia por el modelo de los riesgos proporcionales de Cox. esultados en total, 634 pacientes entraron en el estudio, de los cuales 140 (22,1 %) murieron. Los pacientes fueron principalmente: quirúrgicos 471 (74,3 %), hombres 393 (62,0 %) y de 69,0 (67,8-70,1) años de edad. La supervivencia de toda la cohorte fue de 74,0 (IC 95 %: 71,6-76,6) días. El modelo final incluyó 14 variables. La gravedad y la comorbilidad fueron las principales, pero también resultaron incluidas la dehiscencia de la sutura, la sepsis, los días con hiperglucemia, los intentos fallidos de nutrición enteral, el uso de opiáceos potentes y, como protector, la energía administrada en la NP. Conclusión:los factores relacionados con la mortalidad en estos pacientes con NP fueron principalmente la gravedad y la comorbilidad, pero otros factores también fueron relevantes y podrían ser modificados para maximizar los resultados en salud (AU)

Estado actual de la reumatología en el sector sanitario público de Cataluña / Rheumatology Manpower in the Public System in Catalonia (Spain)

Objetivo: Determinar el estado actual de la reumatología en Cataluña, y actualizar la información respecto a los estudios previos. Material y métodos Diseño: Estudio observacional, descriptivo y transversal. Recogida de datos de enero a junio de 2017. Muestra: Reumatólogos que ejercen actividad asistencial pública en Cataluña. Se envió un cuestionario en línea recabando información tanto de forma individual como colectiva de los servicios de reumatología. Resultados: Se obtuvo información de 34 hospitales y de 109 reumatólogos: 39 varones y 70 mujeres; edad media: 47±9 años. El número de reumatólogos aumentó un 8% en los últimos 5 años. La obtención del título fue en 101 (92,7%) casos por vía MIR. Noventa y seis (88,1%) facultativos tenían dedicación completa. Un 50% de los reumatólogos ejercían además en el sector privado. La actividad asistencial suponía un 76% de la jornada laboral. Se constató que 24 (70%) servicios de reumatología dependían jerárquicamente de otra especialidad. En 6 hospitales de Cataluña no disponen de reumatólogo. Conclusiones: El número de reumatólogos aumentó respecto hace 5 años. La edad media de los reumatólogos es avanzada y existe un claro predominio femenino en la especialidad. Un gran número de unidades de reumatología dependen de otros servicios. La actividad reumatológica se centra en Barcelona.(AU)

Objective: To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies. Material and methods Design: Observational, descriptive and cross-sectional study. Data collection from January to June 2017. Sample: Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections. Results: Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist. Conclusions: The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.(AU)

Rheumatology manpower in the public system in Catalonia (Spain).

OBJECTIVE: To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies. MATERIAL AND METHODS DESIGN: Observational, descriptive and cross-sectional study. Data collection from January to June 2017. SAMPLE: Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections. RESULTS: Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist. CONCLUSIONS: The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.

Encuesta de satisfacción de tratamientos biológicos en un hospital comarcal / Survey of satisfaction of biological treatments in a regional hospital

No disponible

Rheumatology Manpower in the Public System in Catalonia (Spain). / Estado actual de la reumatología en el sector sanitario público de Cataluña.

OBJECTIVE: To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies. MATERIAL AND METHODS DESIGN: Observational, descriptive and cross-sectional study. Data collection from January to June 2017. SAMPLE: Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections. RESULTS: Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist. CONCLUSIONS: The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.

Severe thrombocytopenia caused by linezolid poisoning in an underweight critically ill patient with renal impairment treated with the recommended doses / Trombocitopenia severa causada por intoxicación de linezolid en paciente crítico con insuficiencia renal y bajo peso utilizando las dosis recomendadas

No disponible

Drug-drug interactions of telaprevir and boceprevir in HCV-monoinfected and HIV/HCV-coinfected patients can modify the adherence.

BACKGROUND & AIMS: The first generation protease inhibitors, boceprevir (BOC) and telaprevir (TVR), are both CYP3A4 inhibitors, which predispose drug-drug interactions (DDIs). The aim of this study was to evaluate the prevalence of potential DDIs, the management of outpatient medication and its impact on adherence and efficacy to antiviral treatment in hepatitis C virus (HCV)-monoinfected and human immunodeficiency virus (HIV)/HCV-coinfected patients receiving BOC and TVR. METHODS: The usual medication starting with BOC or TVR was screened by the pharmacist of the multidisciplinary support programme (MSP) for potential DDIs. Recommendations were made to avoid significant DDIs, and changes in the baseline medication were recorded. Adherence to antiviral treatment was considered as 80/80/95% of total doses. Sustained virological response was assessed at week 12 (SVR12). RESULTS: At least one potential DDI was found in 70 (64.8%) patients, 45 (54.2%) being HCV-monoinfected and 25 (100%) HIV/HCV-coinfected (P < 0.01). Baseline treatment modifications were required in 38 (35.2%) patients. Adherence and SVR12 were higher in patients without DDIs (86.8%) and (67.6%) compared to those with DDIs (62.8%) (P = 0.021) and (47.2%) (P = 0.097) respectively. CONCLUSIONS: More than half of the patients were at risk of presenting DDIs, leading to changes in the baseline medication in one-third of the patients. Drug interactions are frequent in patients with lower adherence.