Posibilidad de predecir el riesgo de una vitreorretinopatía proliferante mediante el análisis de factores clínicos de los desprendimientos de retina regmatógenos / Risk of developing proliferative vitreoretinopathy (PVR) in patients with regmatogenous retinal detachments: clinical assessment

Objetivo: Investigar la posibilidad de clasificar, en diferentes grupos de riesgo, a los pacientes con DR según su probabilidad de desarrollar VRP. Métodos: Se revisaron retrospectivamente las historias de 298 pacientes intervenidos de DR, sin VRP o con VRP de grado B o menor. Se evaluaron factores de riesgo pre, intra y postquirúrgicos mediante un análisis multivariante de regresión logística para obtener los factores de riesgo de VRP. Según estos resultados del análisis de regresión se asignó una puntuación a cada factor de riesgo. La suma de cada una de estas puntuaciones proporcionó una puntuación final para cada paciente, la cual fue utilizada para dividir a los pacientes en tres grupos de riesgo de VRP. Resultados: Se identificaron los siguientes factores de riesgo de VRP: VRP preoperatoria grado A o B, DR afectando a 4 cuadrantes, cirugía intraocular previa, aplicación de endoláser e inyección intraocular de gas. Se obtuvieron tres factores protectores: DR en el ojo contralateral, hipertensión ocular postquirúrgica y replicación a las 24 horas de la cirugía. Los pacientes fueron divididos en tres grupos según su probabilidad de desarrollar VRP: riesgo bajo (192 pacientes) el 11,5 por ciento desarrolló una VRP, riesgo moderado (70 pacientes) 50 por ciento de VRP, riesgo alto (36 pacientes) 80 por ciento de VRP. Conclusiones: Es posible clasificar a los pacientes en grupos de riesgo de desarrollar VRP, sin embargo es necesario un estudio prospectivo para confirmar estos resultados y obtener nuevos indicadores de riesgo (AU)

Efficacy of fenfluramine and dexfenfluramine in the treatment of obesity: a meta-analysis.

A meta-analysis was conducted to estimate the difference of weight loss among patients treated with placebo and with fenfluramine or dexfenfluramine after 1, 2, 3, 6, and 12 months of treatment. Placebo-controlled, double-blind, randomized clinical trials, whose results were presented as weight loss by the placebo group and the drug-treated patient group, were selected for the analysis. For the pooled estimations, the method of the weighted means by the inverse of the variance was used. The association between the difference of means and several predictive variables was studied by means of weighted linear regression. Patients treated with fenfluramine or dexfenfluramine achieved a higher weight loss than those receiving placebo in all the periods studied. The greatest efficacy was observed after 3 months of treatment. Beyond this time, there is a decline in the effectiveness. Based on the efficacy data, treatments longer than 3 months would not be justified.

Is metronidazole teratogenic? A meta-analysis.

AIM: In order to assess whether the use of metronidazole during pregnancy is associated with a higher risk of congenital malformations, a meta-analysis was conducted. METHODS: All epidemiological studies (cohort and case-control) which estimate risk of congenital malformations after exposure to metronidazole during early pregnancy were included in the meta-analysis. To obtain a summary odds ratio, the Mantel-Haenszel method was used. A test to verify absence of heterogeneity was also performed. RESULTS: One unpublished case-control and four published cohort studies fulfilled the inclusion criteria and were not statistically heterogeneous. A summary odds ratio was calculated for metronidazole exposure during the first trimester: OR = 1.08, 95% CI: 0.90-1.29, heterogeneity test chi2 = 4.72, P = 0.32. CONCLUSIONS: This meta-analysis did not find any relationship between metronidazole exposure during the first trimester of pregnancy and birth defects.

[Changes in the pattern of opioid analgesic consumption in Spain]. / Cambios en el patrón de consumo de analgésicos opioides en España.

BACKGROUND: Data from different sources have proved an infrautilization of opioid analgesics in Spain. A descriptive study has been conducted in order to know the utilization of these drugs and changes in the pattern of use in the last few years. MATERIAL AND METHOD: To know the consume of narcotic analgesic drugs, N02A group of the Anatomic Therapeutic Classification, a search was developed in the ECOM database from the Spanish Ministry of Health. This database contains information of drug preparations prescribed throughout the National Health Care System. RESULTS: The consumption of opioid analgesics in Spain has been multiplied by 5.2 during this period. It has increased from 94.7 defined daily dose per 1,000,000 inhabitants in 1985 to 489.4 in 1994. The most consumed drug in 1994 was dihydrocodeine, followed by tramadol. The number of defined daily dose per inhabitant and day of parenteral administration have decreased during the last years. CONCLUSIONS: Availability of new analgesic opioid drugs with better pharmacokinetic profiles has contributed to an increase of their consume in Spain.

[DTP vaccine and infant sudden death syndrome. Meta-analysis]. / Vacuna DTP y síndrome de muerte súbita del lactante. Un metaanálisis.

BACKGROUND: At the beginning of 1994, five cases of sudden infant death syndrome after DTP immunization appeared in Spain. In order to study a causal relationship a meta-analysis of the different studies that assess this possibility has been conducted. METHODS: The selection criteria was epidemiological study, case-control or cohort, assessing risk of sudden infant death syndrome in immunized versus non-immunized infants or risk of sudden infant death syndrome in recently immunized infants versus immunized infants beyond 30 days. Pooled risk ratios were calculated from adjusted risk ratios, when available, of the different studies, by a meta-analysis according the method described by Greenland. RESULTS: One cohort and four case-control studies were selected. Pooled risk ratio for immunized versus non-immunized infants was 0.67 (95% CI = 0.60-0.75). When comparing risk of sudden death syndrome in up to 30 days immunized infants versus more than 30 days immunized infants, the pooled risk ratio was 1.00 (95% CI = 0.84-1.20). CONCLUSIONS: DTP-immunization does not seem to increase the risk of sudden infant death syndrome. The risk of sudden infant death syndrome is not greater in the first thirty days following immunization. These data indicate a lack of association between DTP immunization and sudden infant death syndrome.