Practical aspects of factor concentrate use in patients with von Willebrand disease undergoing invasive procedures: a European survey.

INTRODUCTION: The bleeding propensity in von Willebrand disease (VWD) is usually moderate or mild and patients with VWD do not need continuous treatment, but do require extra increased haemostatic cover when undergoing dental or surgical procedures. Desmopressin can be effective in certain patient groups and this has been considered in a previous publication. AIM: This paper now seeks to evaluate current knowledge and practice in the use of factor concentrate in the management of VWD patients undergoing invasive procedures. METHODS: A literature search was performed on the use of factor concentrates to cover invasive procedures and a survey of current practice in a number of specialist haematology centres across Europe represented by the European Haemophilia Strategy Board was conducted. RESULTS: Our review of the literature and the results of the survey showed considerable heterogeneity in treatment regimens, and a lack of consistency in reporting of the variables that determine factor concentrate dosing and monitoring. CONCLUSION: By analysing the literature, examining guidelines and using consensus deliberation, this survey allowed the group to develop recommendations for management of VWD patients undergoing invasive procedures.

Practical aspects of DDAVP use in patients with von Willebrand Disease undergoing invasive procedures: a European survey.

INTRODUCTION: Desamino D-arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored. AIM: The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWD patients. METHODS: We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWD patients. RESULTS: DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWD patients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use. CONCLUSIONS: DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWD patients.

Prevalencia de la agregación de factores de riesgo cardiovascular en un Área de Atención Primaria en Madrid. Estudio SIRVA2 / No disponible

OBJETIVO: El objetivo del estudio es medir la prevalencia de agregación de tres de los principales factores de riesgo cardiovascular: hipertensión, hipercolesterolemia y diabetes mellitusen la población mayor o igual a 14 años atendida en las consultas de Atención Primaria de un Área Sanitaria de Madrid y estudiar su distribución por sexo y edades. MÉTODOS: Se realizó un estudio transversal. Mediante un muestreo aleatorio proporcional al número de pacientes adscritos por tarjeta sanitaria a los Centros de Salud del Área 2 de Madrid, se seleccionaron 1.733 historias de pacientes mayores o iguales a 14 años. Se midieron los datos de registro de hipertensión arterial, diabetes e hipercolesterolemia, de forma individual y agregada. RESULTADOS: La prevalencia de hipertensión e hipercolesterolemia fue mayor en mujeres que en hombres. La proporción de pacientes con hipertensión y diabetes fue de 1,9% sin diferencias por sexos. La proporción de pacientes con hipercolesterolemia y diabetes fue más frecuente en hombres que en mujeres. La asociación de los tres factores de riesgo cardiovascular estudiados fue más frecuente en mujeres y más alta en el grupo de edad de mayor o igual a 76 años. CONCLUSIONES: La prevalencia de asociación de dos o más factores deriesgo cardiovascular en nuestra población es importante, siendo la asociación más frecuente la hipertensión e hipercolesterolemia, seguida de hipertensión y diabetes

OBJECTIVE: To measure the prevalence of aggregation of three major cardiovascular risk factors: hypertension, hypercholesterolemia and diabetes mellitus in a population greater than or equal to 14 years in a Health Area of Madrid and study their distribution by sex and age. METHODS: We conducted a cross-sectional study by random sampling proportional to the number of patients assigned by health card to the Health Centers in the Area 2 of Madrid. 1733 records of patients greater than or equal to 14 years were finally selected. Were measured data of hypertension, diabetes and hypercholesterolemia, individually and aggregated. RESULTS: The prevalence of hypertension and hypercholesterolemiawas higher in women than in men. The proportion of patients with hypertension and diabetes mellitus was 1.9% with no differences by sex. The proportion of patients with hypercholesterolemia and diabetes mellitus was more frequent in men than in women. The combination of the three cardiovascular risk factors studied was more frequent in women and highest in the age group greater than or equal to 76 years CONCLUSIONS: The prevalence of association of two or more cardiovascular risk factors in our population is important, being the most frequent the association of hypertension and hypercholesterolemia, followed by hypertension and diabetes mellitus

La investigación toxicológica en países iberoamericanos / The toxicological r esear ch in iberoamerican countries

Se hace una exposición de los datos obtenidos en la encuesta realizada desde la Red iberoamericana de Toxicología y Seguridad Química desde 2009 a 2010. Se presentan los datos en forma de tablas ateniendo a los siguientes epígrafes: a) Distribución de publicaciones científicas que utilizan la palabra clave toxicology, según país de origen, en la base de datos isi web of knowledge; b) País de origen de los toxicólogos que respondieron la encuesta; c) Tipo de institución donde desarrolla la actividad toxicológica; d) Área en la cual se desarrolla la actividad toxicológica; e) Líneas de desarrollo de la investigación; f) Tipo de difusión de resultados; y g) Financiamiento para investigación. Se señala que la falta de toxicólogos probablemente se deba a una pobre demanda y unas oportunidades de formación insuficientes, lo cual lleva a una autoformación que no necesariamente permite la experiencia suficiente para desarrollar investigación en instituciones académicas o trabajar en agencias gubernamentales (AU)

An exhibition of the information obtained in the survey realized by the Iberoamerican Network of Toxicology and Chemical Safety from 2009-2010 is proposed. The information in the shape of tables abiding to the following epigraphs is presented: a) Distribution of scientific publications which use the word toxicology as a key word, according to native country of origin, in the database isi web of knowledge; b) Native land/country of origin of the toxicologists who answered the survey; c) Type of institution where the toxicological activity is developed; d) Area in which the toxicological activity is developed; e) Lines of the research's development; f) Type of results' diffusion; and g) Financing for research. It highlights that the lack of toxicologists should be due to a poor demand and insufficient opportunities of formation, which leads to an autoformation which does not necessarily allow enough experience to develop research in academic institutions or to be employed in governmental agencies (AU)

Efectos del VIH y otras variables sobre el resultado del tratamiento antituberculoso en España / Effects of HIV status and other variables on the outcome of tuberculosis treatment in Spain

Objetivo: Analizar el efecto del virus de la inmunodeficiencia humana (VIH) y otras variables sobre el resultado del tratamiento antituberculoso en España. Pacientes y métodos: Estudio multicéntrico de cohorte retrospectivo en 6 comunidades autónomas (de mayo de 1996 a abril de 1997). Se recogió información sobre el resultado del tratamiento en casos nuevos de tuberculosis siguiendo la normativa europea. Se realizó seguimiento de los casos hasta 3 meses después de la fecha prevista de finalización del tratamiento. Resultados: De los 4.899 pacientes incluidos, se observó un resultado satisfactorio en 3.417 (69,7%), 438 (8,9%) murieron antes o durante el tratamiento y 1.044 (21,4%) tuvieron un resultado potencialmente insatisfactorio. Estratificando por el estado de la infección por el VIH, las cifras fueron, respectivamente: para los que la presentaban, del 43,4, el 21,5 y el 35,1%; para los seronegativos, del 71, el 6,2 y el 22,8%, y para aquellos en quienes no constaba, del 74,3, el 7,5 y el 18,2%. El VIH modificaba el efecto de diversas variables sobre el resultado del tratamiento, por lo que se ajustaron modelos de regresión logística separados para cada categoría VIH. Entre los seropositivos, la mortalidad aumentó en enfermos con neoplasias y en usuarios de drogas por vías distintas de la parenteral, mientras que los resultados potencialmente insatisfactorios aumentaron en usuarios de drogas por vía intravenosa y en las mujeres. Conclusiones: En España, el resultado del tratamiento antituberculoso es mucho peor en enfermos infectados por el VIH. El uso de drogas y el hecho de padecer neoplasias tienen un papel importante sobre la mortalidad

Objective: To analyze the effect of human immunodeficiency virus (HIV) status and other variables on the outcome of tuberculosis treatment in Spain. Patients and Methods: Multicenter retrospective cohort study in 6 autonomous communities of Spain (from May 1996 to April 1997). Data on treatment outcome were collected for new cases of tuberculosis in accordance with European guidelines. Follow up of patients continued for 3 months after scheduled end of treatment. Results: Of the 4899 patients included, 3417 (69.7%) had a satisfactory outcome, 438 (8.9%) died before or during treatment, and 1044 (21.4%) had a potentially unsatisfactory outcome. On stratification by HIV status, satisfactory outcome, mortality, and potentially unsatisfactory outcome were reported for 43.4%, 21.5%, and 35.1%, respectively, of HIV-positive patients; 71%, 6.2%, and 22.8%, respectively, of HIV-negative patients; and 74.3%, 7.5%, and 18.2%, respectively, of patients with no HIV status available. HIV modified the effect of several variables on the outcome of treatment, and so separate logistic regression models for each HIV category were constructed. Among HIV-positive patients, mortality increased in patients with neoplastic disease and in users of drugs by nonintravenous routes of administration, whereas potentially unsatisfactory outcomes increased in intravenous drug users and in women. Conclusions: In Spain, the outcome of tuberculosis treatment is much worse in HIV-positive patients. Drug use and presence of neoplastic disease substantially affect mortality