Similar risk of renal events among patients treated with tenofovir or entecavir for chronic hepatitis B.

BACKGROUND & AIMS: Tenofovir is a nucleotide reverse-transcriptase inhibitor approved for treatment of human immunodeficiency virus infection, as well as chronic hepatitis B (CHB). We evaluated nephrotoxicity among patients with CHB treated with tenofovir. METHODS: We performed a community-based, retrospective cohort study of 80 patients with CHB who received tenofovir, alone or in a combination regimen; they were matched for age and sex with 80 CHB patients who received only entecavir. Incidences of serum creatinine (SCr) increase ≥0.2 mg/dL and new SCr levels of 1.5, 2.0, or 2.5 mg/dL were assessed. Patients with an estimated glomerular filtration rate (eGFR) <60 mL/min, calculated using the Modification of Diet in Renal Disease or Cockcroft-Gault formula, or who had ≥20% decrease in eGFR were also recorded. RESULTS: More patients given entecavir had increases in SCr ≥2.5 mg/dL (1 vs 6; P = .053), whereas more patients given tenofovir had a new Cockcroft-Gault eGFR of <60 mL/min (15 vs 6; P = .022) and at least 1 dose adjustment (13 vs 4; P = .021). By multivariate analysis, the only significant factors associated with an increase in SCr were a history of organ transplantation (adjusted odds ratio, 6.740; 95% confidence interval, 1.799-28.250; P = .005) and pre-existing renal insufficiency (adjusted odds ratio, 10.960; 95% confidence interval, 2.419-48.850; P = .002). No factors, including therapy assignment, were associated with a new eGFR <60 mL/min. CONCLUSIONS: Markers of renal function indicated that patients who received tenofovir were no more likely to have changes in renal function than patients treated with entecavir. History of transplant and pre-existing renal insufficiency were the only factors independently associated with increases in SCr.

Expandiendo la reforma en la capacitacion de docentes en Guatemala: el rol de los procesos de pensamiento de los maestros / Expanding the reform of teacher's training in Guatemala: the role of teachers's thought processes

El gobierno de Guatemala se ha embarcado en un ambicioso proyecto de reforma educativa que incluye la descentralización del sistema educativo y la adecuación curricular. El análisis de dicha reforma, en particular la relacionada con la capacitación de docentes, indica que la definición y roles del docente deben ampliar su foco conceptual y ubicarse dentro de un marco constructivista y evolutivo. Para ilustrar nuestra tesis, presentamos una revisión de la literatura en el área de procesos de pensamiento en maestros. Estudios realizados en paises desarrollados y en Guatemala se presentan para ilustrar esta literatura. Finalmen-te, concluimos que la adopción de un modelo cognoscitivo sobre la labor del docente permitira a los reformistas el tomar en cuenta una crítica dimensión frecuentemente obviada: las creencias, teorias, decisiones y valores de los el cargados de implementar tales reformas, que son los docentes guatemaltecos.