Control de HTA en pacientes bajo monoterapia / Control of HTN in patients on monotherapy

JUSTIFICACIÓN: desde 2018 se considera inadecuada la monoterapia para el tratamiento de la hiprtensión arterial (HTA), excepto en mayores de 80 años y casos de fragilidad. Sin embargo, la inercia terapéutica provoca que sigamos encontrando esta situación en muchos pacientesOBJETIVOS:Evaluar el control de HTA en pacientes suejtos a tratamiento antihipertensivo en monoterapiaMATERIAL Y MÉTODOS- Población diana: todos los pacientes con HTA y monoterapia antihipertensiva menores de 80 años que acudan a la farmacia- Tiempo: desde 1 febrero a 31 de marzo- Control de PA mediante MAFC (3 medidas separadas 1 minuto y la media de las dos últimas)- Registro en tabla excel y Sefac expertRESULTADOS: 16 pacientes, 10 hombres (71,2 ±14,0 años) y 6 mujeres (69,2 ±14,8 años) bajo tratamiento de antihipertensivo en monoterapia. La media de PA de los varones (PAS: 142,7 ±10,9, PAD: 86,3 ± 13,2) es más alta que en las mujeres (PAS: 135,0 ± 18,7, PAD: 86,2 ± 10,4) aunque estas tampoco cumplen con los parámetros objetivos y en general exceden los valores recomendados de objetivo de tratamiento (130/80) de la guía antihipertensivas.CONCLUSIONES: Si bien el número de pacientes es pequeño, se confirma el criterio publicado en la guia europea de hipertensión en la que se recomienda usar al menos dos principios activos en el tratamiento de la HTA. En este estudio además puede verse que la ineficiencia de la monoterapia parece más notable en varones. (AU)

Tratamiento de la epilepsia con perampanel: desde la terapia añadida a la conversión a monoterapia / Treatment of epilepsy with perampanel: conversion from add-on therapy to monotherapy

Introducción: El perampanel (PER) es un fármaco anticrisis epilépticas aprobado en Europa como terapia añadida para pacientes con crisis de inicio focal (con o sin crisis focal a bilateral tonicoclónica) desde los 4 años, y para las crisis tonicoclónicas generalizadas desde los 7 años. Objetivo: Revisar la evidencia existente sobre el tratamiento con PER en conversión a monoterapia. Desarrollo: Dos estudios multicéntricos retrospectivos en los que el PER se convirtió a monoterapia muestran que este fármaco en dosis bajas (6-8 mg/día) fue especialmente eficaz y bien tolerado en un subgrupo de pacientes con epilepsias menos graves que los pacientes que participaron en los ensayos clínicos en donde el PER se empleó como terapia añadida. En estos estudios, la tasa de retención superó el 90% a los tres meses y el 70% a los seis y a los 12 meses. La tasa de respondedores fue > 75% a los tres meses, y la tasa de pacientes libres de crisis llegó a superar el 50% a los tres y a los seis meses, y el 37% a los 12 meses. En comparación con otros estudios donde el PER se empleó como terapia añadida, no se observaron efectos adversos diferentes a los ya conocidos. Otros cuatro estudios que examinaron los efectos del PER en conversión a monoterapia en un número pequeño de pacientes apoyan estos resultados. Conclusiones: En la práctica clínica habitual, el PER es un tratamiento eficaz y bien tolerado cuando se usa en conversión a monoterapia, en dosis relativamente bajas, en pacientes con crisis focales y tonicoclónicas generalizadas.(AU)

Introduction: Perampanel (PER) is an antiepileptic drug approved in Europe as add-on therapy for patients with focal onset seizures (with or without secondary generalisation) from the age of 4 years, and for primary generalised tonic-clonic seizures from 7 years of age. Objective: Review current evidence on treatment with PER monotherapy after conversion from adjunctive therapy. Development: Two retrospective multicentre studies in which PER was used as monotherapy show that low doses (6-8 mg/day) of PER were effective and well tolerated in a subgroup of patients with less severe epilepsies than patients who participated in clinical trials (where PER was used as add-on therapy). In these studies, the retention rate exceeded 90% at 3 months, and 70% at 6, and 12 months. The responder rate was > 75% at 3 months, and the rate of seizure-free patients exceeded 50% at 3 and 6 months, and 37% at 12 months. Compared to other observational studies and clinical trials where PER was used as add-on therapy, no adverse effects other than those already known were observed. Four other studies examining the effects of conversion to PER monotherapy in a small number of patients support these results. Conclusions: In routine clinical practice, conversion to PER monotherapy, at relatively low doses, is an effective and well-tolerated treatment for patients with focal and generalised tonic-clonic seizures.(AU)

Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente / Alzemon: a prospective follow-up study of eslicarbazepine acetate monotherapy in patients with newly diagnosed epilepsy

Introducción: El acetato de eslicarbacepina es un nuevo bloqueante de los canales de sodio en el tratamiento de las crisis de inicio focal. Los estudios prospectivos sobre su efectividad en monoterapia en pacientes con epilepsia parcia l de reciente diagnóstico en la práctica clínica habitual son escasos.Objetivo: Evaluar la efectividad de la eslicarbacepina en monoterapia de inicio en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual.Pacientes y métodos: Estudio postautorización prospectivo y multicéntrico. Se incluyó a pacientes con epilepsia parcial de reciente diagnóstico de 18 años o más sin tratamiento previo. Las variables de eficacia fueron: porcentaje de pacientes libres de crisis, respondedores y reducción en la frecuencia mensual de crisis. Las variables de seguridad analizan la tasa de retención a los 12 meses y la aparición de efectos adversos.Resultados: Se incluyó a 53 pacientes. La tasa de retención fue del 77,4%. Al final del período de observación, el 83% de los pacientes se encontraba libre de crisis y el 92,5% había reducido en un 50% o más su frecuencia basal. El 68% de los pacientes notificó algún efecto adverso y el 7,5% de ellos abandonó el estudio por este motivo. El análisis de efectividad del subgrupo de 65 años o más no mostró diferencias respecto a la población global.Conclusión: La eslicarbacepina en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico, tanto en la población general como en la población de más de 65 años, es eficaz y segura en la práctica clínica habitual.(AU)

Introduction: Eslicarbazepine acetate is a novel sodium channel blocker for use in the treatment of focal onset seizures. Prospective studies on its effectiveness in monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice are scarce. Aim: To evaluate the effectiveness of eslicarbazepine as initial monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice. Patients and methods: A prospective, multicentre, post-authorisation study. Patients with newly diagnosed partial epilepsy aged 18 years or older without previous treatment were included. The efficacy variables were: percentage of seizure-free patients, responders and reduction in monthly frequency of seizures. The safety variables analyse the 12-month retention rate and the occurrence of adverse effects. Results: Fifty-three patients were included. The retention rate was 77.4%. At the end of the observation period, 83% of patients were seizure-free and 92.5% had reduced their baseline frequency by 50% or more. In addition, 68% of the patients reported some adverse effect and 7.5% of them dropped out of the study for this reason. The effectiveness analysis of the subgroup of patients aged 65 years or more showed no differences with respect to the overall population. Conclusion: Eslicarbazepine monotherapy in patients with newly diagnosed partial epilepsy, both in the general population and in the population over 65 years old, is effective and safe in routine clinical practice.(AU)

Monoterapia con sildenafilo en pacientes con hipertensión pulmonar grave / Sildenafil monotherapy in patients with severe pulmonary hypertension

Introducción: El tratamiento con inhibidores de la fosfodiesterasa 5 a pacientes con cardiopatías adquiridas y congénitas, con hipertensión pulmonar, puede mejorar la calidad y pronóstico de vida, tanto en cardiopatías quirúrgicas como no quirúrgicas, con hipertensión pulmonar grave. Objetivos: Analizar los resultados de la monoterapia con sildenafilo en pacientes quirúrgicos y no quirúrgicos, con cardiopatías congénitas y adquiridas e hipertensión pulmonar grave. Método: Estudio descriptivo en 60 pacientes que recibieron sildenafilo para hipertensión arterial pulmonar grave, secundaria a cardiopatías adquiridas izquierdas, congénitas. Se observó: dosis, duración del tratamiento, tolerancia, evolución clínica y ecocardiográfica, clase funcional y tratamiento quirúrgico según resultados del cateterismo cardiaco. Resultados: En el período entre diciembre de 2017 a diciembre de 2018 se operaron con hipertensión arterial pulmonar grave, 20 enfermos con trastornos valvulares cardíacos izquierdos, 8 congénitos y 3 tumores cardíacos primarios, con administración de sildenafilo en dosis de 100 a 150 miligramos diarios. Hubo otros 29 pacientes con cardiopatías, que aunque no eran quirúrgicos, mejoraron su calidad y pronóstico de vida. Conclusiones: Resultó útil la indicación de sildenafilo, para mejorar la calidad y el pronóstico de vida, tanto en pacientes quirúrgicos como no quirúrgicos con cardiopatías e hipertensión pulmonar grave(AU)

Introduction: Treatment with phosphodiesterase 5 inhibitors in patients with acquired and congenital heart disease, with pulmonary hypertension, can improve the quality and prognosis of life, both in surgical and non-surgical heart disease, with severe pulmonary hypertension. Objectives: To analyze the results of sildenafil monotherapy in surgical and non-surgical patients, with congenital and acquired heart disease and severe pulmonary hypertension. Method: Descriptive study in 60 patients who received sildenafil for severe pulmonary arterial hypertension, secondary to congenital left acquired heart disease. It was observed: dose, duration of treatment, tolerance, clinical and echocardiographic evolution, functional class and surgical treatment according to cardiac catheterization results. Results: In the period between December 2017 and December 2018, 20 patients with left heart valvular disorders, 8 congenital and 3 primary cardiac tumors, with sildenafil daily administration doses of 100 to 150 milligrams, were operated with severe pulmonary arterial hypertension. There were 29 other patients with heart disease, which although they were not surgical, improved their quality and prognosis of life. Conclusions: The prescription of sildenafil was useful to improve the quality and prognosis of life, both in surgical and non-surgical patients with heart disease and severe pulmonary hypertension(AU)

Effect of mono/dual antiretroviral therapy on suppression of HCV and HIV during treatment of HCV infection in HIV/HCV-coinfected patients.

OBJECTIVE: Data of hepatitis C treatment with direct-acting antivirals (DAAs) in HIV infected patients are limited to a few number of antiretroviral therapies (ART). The aim of this study was to assess the effectiveness and safety of non-conventional ART as monotherapy or dual therapy (MDT) when combined with DAA. METHODS: Retrospective review of HIV/HCV-coinfected patients treated with DAAs during one year in 3 centers. Sustained virologic response 12 weeks after therapy (SVR) and maintenance of HIV viral suppression were compared between patients receiving triple ART (TT) or MDT. RESULTS: Overall 485 patients were included (359 receiving TT and 126 MDT). HCV SVR was 93.4% (95%CI, 90.8% to 95.3%) in the intention-to-treat analysis without differences between groups: 92.8% on TT vs 95.2% on MDT (p=0.3). HCV virological failure was associated with lower CD4+cell count at baseline (for every 100-cell/µl increment: OR, 0.8; 95%CI, 0.7-0.9; p=0.01) and with liver stiffness (for every 10-unit increment: OR, 1.5; 95%CI 1.2-1.8; p<0.01). HIV-RNA during HCV treatment or 12 weeks after was detectable in 23 patients on TT (6.6%) and 9 (7.2%) patients on MDT (p=0.8). The median (IQR) change in CD4+cell count was not significantly different between the groups: 15 (-55 to 115) in TT vs -12 (-68 to 133) cells/µl in MDT (p=0.8). CONCLUSION: DAAs obtain high rates of SVR among HIV/HCV-coinfected patients independently of whether TT or non-conventional ART is used. Suppression of HIV was maintained in both groups.

Expert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary Disease. / Documento de expertos del uso de broncodilatadores inhalados en monoterapia en el tratamiento de la EPOC estable leve-moderada.

OBJECTIVE: To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). METHODS: Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from1 (total disagreement) to10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels. RESULTS: A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. CONCLUSIONS: These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD.

HIV-1 p24 and CD4+ T cell count during boosted protease-inhibitor monotherapy in HIV-infected patients.

BACKGROUND: Plasma HIV p24 is considered a significant predictor of CD4+ T cell decline and progression to AIDS in HIV-infected patients. We evaluated the p24 levels in patients on triple therapy and after switching to ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv), as well as the relationships with virological and immunological evolution. MATERIALS AND METHODS: Plasma samples from patients participating in two studies of simplification to mtPI/rtv were analysed for presence of p24, using a boosted enzyme-linked immunosorbent assay specific for mature p24. Only patients with available samples at baseline (on triple therapy) and during a follow-up of at least 12 months after switching to mtPI/rtv were included. RESULTS: A total of 233 samples from 51 patients were analysed. After switching to mtPI/rtv and a median follow-up of 24 months, 14 patients maintained continuous undetectable viraemia, and 37 patients experienced a total of 49 transient viraemic episodes. Unexpectedly, the evolutionary p24 patterns were uniform for most patients, both before and after switching to mtPI/rtv, independently of the virological behaviour, fitting into one of three categories: persistent undetectable p24 levels, positive p24, matching only with the viraemic episodes, and persistent detectable p24 levels. The last group showed lower CD4+ T cell counts and percentages, as well as lower CD4+/CD8+ T cell ratios after 12 and 24 months of follow up. CONCLUSION: Treatment simplification to mtPI/rtv does not influence the behaviour of p24 in plasma. Patients with continuous positive p24, despite undetectable viraemia, showed worse immunological evolution.

Switching from tenofovir containing regimens to boosted protease inhibitor monotherapy: Impact on renal function.

OBJECTIVE: To evaluate the effect on creatinine clearance (CG-CrCl, Cockcroft-Gault equation) of switching to boosted protease inhibitor (PI) monotherapy in patients receiving a triple drug antiretroviral regimen containing TDF. METHODS: All patients who had received a TDF-containing regimen for at least one year and had been switched to PI monotherapy were included. A rapid decrease in CG-CrCl during exposure to TDF was defined as a decrease in CG-CrCl at least five times higher than the expected due to age (0.4ml/min/year by the years of exposure to TDF). In this subgroup of patients, we considered improvement if the last value of CG-CrCl on PI monotherapy was 10% higher than the last value of CG-CrCl before switching to PI monotherapy. A multivariate logistic regression was constructed to identify factors associated to renal improvement after switching to bPI monotherapy. RESULTS: 64 patients included. The median (IQR) annual change in CG-CrCl during PI monotherapy was significantly lower than the median (IQR) annual change while exposed to TDF [-0.9 (-4.7 to +2.8) ml/min vs. -4 (-8 to -1) ml/min, p=0.001]. 44 patients experienced a rapid decline during TDF exposition. After switch to PI monotherapy, 15/44 (34%, 95% CI: 21-50%) had an improved CG-CrCl and 16/44 (36%, CI 23-52%) experienced a further decline in CG-CrCl. The only variable associated to CG-CrCl improvement was a more rapid CG-CrCl decline in the last year of exposure to TDF. CONCLUSION: Switching to PI monotherapy partially reversed CG-CrCl decrease associated to TDF use, especially in patients with a more rapid decline while receiving TDF.

Enfoque y manejo homeopático de los síndromes ansiosos / Homeopathic approach and management of anxious syndromes

La Homeopatía es un sistema médico alternativo holístico que tiene como objetivo primordial el conservar o restablecer el estado de salud del paciente (bienestar físico, mental y social) mediante la selección del medicamento especifico, para la necesidad terapéutica individual que posee cada individuo. Para lo cual se tienen en cuenta tanto los signos y síntomas del paciente , así como sus características mentales , emocionales , constitucionales , físicas y otros detalles que aparentemente para otros sistemas médicos carecen de importancia, pero que para la homeopatía son primordiales a la hora de hallar el medicamento especifico que permita el manejo integral de su particular forma de enfermar. Este remedio una vez administrado busca estimular procesos auto curativos (energía vital) que permitan una curación duradera, de la manera más rápida posible y causándole las menores molestias al paciente, durante su proceso curativo. La presente monografía se basa en la descripción del enfoque y tratamiento actuales , que tiene la Homeopatía Unicista, para el manejo de los Síndromes ansiosos, dada la alta tasa de incidencia y prevalencia que tienen en la población Colombiana, siendo por ende considerados como un problema actual de salud pública. Para lo cual se realizó una revisión bibliográfica de la literatura mundial a través de bases de datos reconocidas, con resultados corroborados por diversos estudios epidemiológicos ( Ver revisión de la literatura , página 64). Los resultados de la efectividad de la Homeopatía en el manejo de los síndromes ansiosos es promisoria , incluso plantea la posibilidad de tener una efectividad similar a la de los psicofármacos más usados, pero con la diferencia de que esta al contrario de los fármacos convencionales, tiene un bajo costo, no genera efectos secundarios , no causa letalidad en caso de sobredosis y no presenta interacciones graves con otros tratamientos, siendo segura su administración en niños , mujeres embarazadas y personas de la tercera edad. Sin embargo hace falta una mayor cantidad de estudios clínicos controlados, de mejor calidad en su realización, que corroboren lo evidenciado en la presente monografía. Así mismo se mostró como la Homeopatía puede ser utilizada como monoterapia o como coadyuvante de la terapéutica convencional para el manejo de los síndromes descritos.

Prescripción de antipsicóticos al egreso hospitalario durante el período abril-setiembre de 2012 en el Hospital Vilardebó de Montevideo, Uruguay / Prescribing antipsychotics to hospital discharge during the period April-September 2012 Vilardebó Hospital in Montevideo, Uruguay

Las guías clínicas recomiendan la monoterapia antipsicótica (mta). La polifarmacia antipsicótica (pfa, uso concomitante de dos o más antipsicóticos) es una práctica clínica frecuente. El objetivo del trabajo fue determinar el perfil de prescripción antipsicótica y su uso en mta o pfa, al egreso hospitalario durante el período abril setiembre de 2012 en el Hospital Vilardebó. Se realizó un estudio descriptivo, observacional y retrospectivo. Las variables estudiadas fueron sexo, edad, medicación y diagnóstico. Se definió mta para los que egresaron con un antipsicótico y pfa para aquellos que egresaron con dos o más antipsicóticos. El 52 % egresó con mta, de los cuales el 42% recibió un antipsicótico atípico y el 10%, uno típico. El 48 % restante egresó con dos o más antipsicóticos (pfa). El 19 % de los pacientes con pfa egresó con tres o más antipsicóticos. Es elevado el uso de pfa al egreso hospitalario.

[Lopinavir/ritonavir in new simplification strategies in antiretroviral therapy]. / Lopinavir/ritonavir en nuevas estrategias de simplificación del tratamiento antirretroviral.

Interest in simplification arises from the need to dispense with nucleoside analogs due to their long-term toxicity. Since the first trials analyzing the safety and effectiveness of the strategy with lopinavir/ritonavir (LPV/r) emerged more than 10 years ago, simplification continues to arouse scientific, clinical and economic interest. At present, there is no consensus on recommendations; interpretations of results are discordant: while some emphasize the greater risk of loss of virologic control, others indicate that the possible virological rebound with this strategy is unrelated to a loss of therapeutic options or to the emergence of resistance to ritonavir-boosted protease inhibitors. This scenario governs the recommendations that can be made in clinical practice; almost all groups agree that candidates should be selected for a simplification strategy with fewer drugs.

Adherence to migraine treatment does not depend on the number of prescribed medications / A adesão ao tratamento da migrânea não depende do número de medicações prescritas

To compare the adherence between monotherapy and politherapy in prophylactic migraine treatment. Five hundred consecutive patients with migraine from a tertiary center were retrospectively studied as to the number of preventive medications prescribed during the first visit. Adherence, defined as returning for the next consultation after 4 to 6 weeks and following the prescribed regimens, were also evaluated and compared between patients. 71.8% were women, and 6% of the patients did not receive any preventive medication, 11.4% received one drug, 22.2% two drugs, 41.4% three drugs, and 19% four drugs for the prevention of migraine. The overall adherence was 79.6%. Respectively, 73.7, 71.8, 82.6 and 86.3% of those who received the prescription of one, two, three and four drugs returned, complying with the treatment. There is no difference in adherence to monotherapy or politherapy (one to four drugs) for the prophylaxis of migraine. .

Comparar a adesão entre monoterapia e politerapia no tratamento profilático da migrânea. Foram analisados retrospec-tivamente 500 pacientes com migrânea de um centro terciário, com vistas ao número de medicações preventivas prescritas na primeira consulta e adesão ao tratamento após 4 a 6 semanas. 71,8% da amostra era composta de mulheres. Em relação ao tratamento preventivo da migrânea, 6% não receberam medicação preventiva; 11,4% receberam uma droga; 22,2% duas drogas; 41,4% três drogas e 19% quatro drogas. A adesão média foi de 79,6%. Em relação à prescrição de uma, duas, três ou quatro drogas, essa adesão foi respectiva-mente de 73,7, 71,8, 82,6 e 86,3%. Não houve diferenças na adesão à prescrição de medicações em monoterapia ou politerapia (uma a quatro drogas) para o tratamento preventivo da migrânea. .

Monoterapia biológica en pacientes con artritis reumatoidea en Argentina / Biological monotherapy in patients with rheumatoid arthritis in Argentina

Introducción: La utilización de agentes biológicos para el tratamiento de la Artritis Reumatoidea (AR) es habitualmente usada en aquellos pacientes con enfermedad activa que no hayan respondido al tratamiento con drogas modificadoras de la Artritis Reumatoidea convencionales (DMARD, por sus siglas en inglés) o que hayan presentado intolerancia a las mismas. Al estado actual de la evidencia, la terapia combinada de agentes biológicos más un DMARD convencional (principalmente metotrexato) constituye el estándar de tratamiento. Sin embargo existen algunos escenarios como la intolerancia, la falta de adherencia y la aparición de eventos adversos a las DMARDs convencionales donde la monoterapia biológica emerge como una opción terapéutica válida. Según los distintos registros a nivel internacional, la frecuencia de utilización de agentes biológicos en monoterapia oscila entre 12 a 39%. Debido a la ausencia de estos datos a nivel local decidimos realizar este estudio para conocer el porcentaje de pacientes que se encuentran en monoterapia biológica y analizar las causas que llevaron a este tipo de tratamiento. Materiales y métodos: Estudio de tipo corte transversal donde se invitó a participar a diferentes centros reumatológicos distribuidos a lo largo de Argentina. Cada centro revisó las historias clínicas de los últimos 30 a 50 pacientes consecutivos vistos con AR, mayores de 18 años, que habían presentado inadecuada respuesta al tratamiento con DMARDs y que estaban bajo tratamiento biológico. Se completaba una ficha por cada paciente incluido, registrando datos demográficos, de la enfermedad y tratamientos previos. Resultados: Se incluyeron 32 centros y se evaluaron 1148 historias clínicas de pacientes con AR durante el mes de octubre y noviembre del 2012. Un 21,4% (246) de los pacientes al momento del estudio se encontraba bajo tratamiento biológico en monoterapia...

Introduction: The use of biological agents for the treatment of rheumatoid arthritis (RA) is commonly used in patients with active disease who have not responded to treatment with conventional rheumatoid arthritis-modifying drugs (DMARDs) or Who have presented intolerance to them. At the present state of evidence, combined therapy of biological agents plus conventional DMARD (mainly methotrexate) is the standard of treatment. However, there are some scenarios such as intolerance, lack of adherence and the appearance of adverse events to conventional DMARDs where biological monotherapy emerges as a valid therapeutic option. According to different international registries, the frequency of use of biological agents in monotherapy ranges from 12 to 39%. Due to the absence of these data at the local level we decided to carry out this study to know the percentage of patients who are in biological monotherapy and to analyze the causes that led to this type of treatment. Materials and methods: A cross-sectional study where different rheumatologic centers throughout Argentina were invited to participate. Each center reviewed the medical records of the last 30 to 50 consecutive patients seen with RA, older than 18 years, who had inadequate response to treatment with DMARDs and who were under biological treatment. One card was completed for each patient included, recording demographic, disease and previous treatment data. Results: Thirty-two centers were included and 1148 clinical records of patients with RA were evaluated during October and November 2012. A total of 244 patients (246) at the time of the study were under monotherapy...

Papel de la monoterapia con nuevos fármacos antiepilépticos en el tratamiento de la epilepsia infantil / Role of monotherapy with new antiepileptic drugs in the treatment of childhood epilepsy

En este trabajo se revisa la información actual sobre el uso de los nuevos fármacos antiepilépticos (FAEs) en monoterapia en niños, resaltando nuestra experiencia personal. Específicamente, se incluyen los siguientes FAEs: lamotrigina (Lamictal®), topiramato (Topamax®), zonisamida (Zonegran®), levetiracetam (Keppra®), y oxcarbacepina (Trileptal®). Todos estos FAEs tienen un amplio espectro de acción en el tratamiento de crisis epilépticas parciales y generalizadas, excepto la oxcarbacepina, que es eficaz exclusivamente en crisis parciales. No está claro si la monoterapia con estos FAEs, en comparación con los FAEs clásicos (fenobarbital, fenitoína, carbamacepina, valproato sódico), proporciona una mayor eficacia y/o causa menos efectos secundarios y, si por lo tanto, mejora significativamente la calidad de vida de los niños con epilepsia. Se necesitan más estudios para poder contestar estas preguntas.

In this paper we review the current information regarding the use of new antiepileptic drugs (AEDs) used as monotherapy in children. We specifically include the following AEDs: lamotrigine (Lamictal®), topiramate (Topamax®), zonisamide (Zonegran®), levetiracetam (Keppra®), and oxcarbazepine (Trileptal®). All of these AEDs have a broad spectrum of action in the treatment of partial and generalized seizures, except Oxcarbazepine, which is effective only in partial seizures. It is unclear whether or not monotherapy with the new AEDs offers higher efficacy and/or lower side effects compared to classic AEDs (phenobarbital, phenytoin, carbamazepine, or valproate) thereby significantly improving the quality of life in children with epilepsy. More studies are needed to answer these questions.

Tratamento das epilepsias parciais / Partial epilepsies treatment

As epilepsias parciais constituem a forma mais comum de epilepsia nos indivíduos adultos. As drogas antiepilépticas (DAEs) permanecem como a principal forma de tratamento para os pacientes com epilepsia. Apesar da importância da medicação um número elevado de pacientes permanece sob um regime terapêutico inapropriado ou até mesmo sem qualquer medicação. Existem várias medicações disponíveis para o tratamento das epilepsias. A escolha de uma medicação específica ou a associação entre DAEs deve ser particularizada o máximo possível. Neste artigo revisamos alguns aspectos como classificação, início das crises, idade, sexo, comorbidades, custo e posologia das DAEs e história medicamentosa com a perspectiva de auxiliar nesta individualização do tratamento. Algumas características das principais DAEs disponíveis também são discutidas. Estes aspectos podem auxiliar na criação de um perfil ajudando assim na escolha do regime terapêutico mais apropriado para cada indivíduo. Aspectos práticos como o manuseio dos efeitos adversos, monoterapia e politerapia também são abordados.

Partial epilepsies are the most common form of epilepsy in adult individuals. Antiepileptic drugs (AEDs) continue as the main form of treatment for patients with epilepsy. Regardless of the importance of the medication a high number of patients are under inappropriate or not receiving AEDs. There are several medications available for the treatment of epilepsy. The choice of a particular medication or association among AEDs may be individualized as much as possible. In this article some aspects such as classification, onset of the seizures, age, sex, associated medical conditions, cost and posology of AEDs and medical drug history are reviewed. Details of the available AEDs are also discussed. These points may help to create a profile helping the decision for the appropriate AED. Some practical issues like adverse reaction management, monotherapy and politherapy are also discussed.

Cáncer de tiroides en SOLCA 1991-2000: estudio de resultados terapéuticos / Thyroid Cancer in SOLCA 1991-2000: study of therapeutic results

Tipo de estudio: Retrospectivo y comparativo en el hospital Dr. Juan Tanca Marengo ION SOLCA de la ciudad de Guayaquil, durante el período comprendido de enero de 1991 a diciembre del año 2000, sobre cáncer de tiroides.Objetivo: Comparar en dos grupos problema de 33 pacientes cada uno, variables referentes a sexo, edad, tipo histológico, y fundamentalmente el periodo de remisión tumoral entre dos terapéuticas que se presentaron durante estos diez años como parte del protocolo utilizado en la institución donde se llevó a cabo el estudio.Resultados: De 131 pacientes, 66 participaron en el estudio, pudiéndose constatar que es una patología con mayor incidencia en las mujeres relación mujer – hombre: 2.8–1, que si bien el tipo histológico fue contundentemente el carcinoma papilar, se observó una proporción idéntica entre el cáncer folicular y el cáncer anaplásico, dato que no se reporta normalmente en otros países. Finalmente y los más importante fue que pacientes que fueron solamente operados recidivaron en un 61% vs. un 15% en pacientes que posteriormente de la cirugía recibieron Yodo 131, concluyéndose que esta asociación es el tratamiento de elección para pacientes con cáncer diferenciado de tiroides sin importar edad y estadio de la enfermedad.Conclusiones: Mujeres menores de 40 años y económicamente activas fueron la mayor incidencia por lo que el factor hormonal y laboral esta relacionado en la etiología; la terapia combinada debe ser instaurada de forma sistemática a pacientes con Ca diferenciado de tiroides.

Type of study: Retrospective and comparative study at the Dr. Juan Tanca Marengo Hospital ION SOLCA in the city of Guayaquil, during the period of time between January of 1991 to December of the year 2000, in a group of patients with thyroid cancer.Objective: To compare two groups of 33 patients. The variables are: sex, age, histological type, and fundamentally the period of tumor remission between two therapeutic treatments that were presented during these ten years as part of the protocol used in the institution where the study was carried out.Results: Of 131 patients, 66 participated in the study, being able to verify that it is pathology with more incidences in the women. Where the ratio between woman - man: 2.8 - . Overwhelmingly the most frequent malignancy was the Papillary Carcinoma. An identical ratio was observed between follicular and anaplastic carcinoma a finding that is not usually reported in other countries. The most important finding was that patients that were solely operated recurred in 61% vs. only 15% in patients that after surgery they received Iodine 131. We conclude that this association of surgery and treatment with Iodine 131 is the goal treatment for patients with differentiated thyroid cancer without emphasis on age and stage of the illness.Conclusions: Women less than 40 years of age and economically active had a higher incidence due to the hormonal and labor factor which is associated with the etiology. Patients with Differentiated thyroid Cancer should receive the combined treatment.