Optimización en el abordaje multidisciplinar del paciente con hepatitis C en la era de los antivirales de acción directa

The advents of current direct-acting antiviral treatments has revolutionised the therapeutic approach to hepatitis C, increasing cure rates to above 90% and substantially simplifying treatment, which translates into benefits for patients, clinicians and the health system. These new drugs allow cure to be achieved, irrespective of the patient’s characteristics, with tolerability similar to that of placebo and few drug reactions with concomitant medication. This in turn improves patients’ quality of life and wellbeing. Moreover, these drugs allow multidisciplinary optimisation of the approach to patients with hepatitis C, thus reducing both short- and long-term costs. All these factors facilitate treatment universality, with treatments that are less influenced by specific factors and that allow better results to be obtained in a larger number of patients. Elimination of hepatitis C is now a real possibility.Supplement information: This article is part of a supplement entitled “The value of simplicity in hepatitis C treatment”, which is sponsored by Gilead.© 2019 Elsevier España, S.L.U. All rights reserved.     

Cambio de CLSI a EUCAST en la interpretación de la sensibilidad a antimicrobianos: ¿cómo influye en nuestro medio?

Introduction

Implementation of the breakpoints established in the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines in comparison with those of the Clinical and Laboratory Standards Institute (CLSI) means that the criteria for interpreting the susceptibility of some antimicrobials have been modified, resulting in changes in the reports of accumulated antibiotic susceptibility.

Validación de una versión en español del Health Assessment Questionnaire-II para la evaluación de la capacidad funcional en pacientes mexicanos con artritis reumatoide

ObjectiveTo evaluate the validity, reliability, and performance of the Health Assessment Questionnaire-II(HAQ-II) Spanish version questionnaire to measure physical function.MethodsA cross-sectional study of 496 patients with rheumatoid arthritis, distributed in 2 samples. The construct validity was evaluated employing the confirmatory factor analysis and the validity based on the relationship with other variables. Cronbach's alpha (α) and McDonald's omega (ω) coefficient were used to determine reliability. Item performance was analysed by fitting different models of item response theory.ResultsThe one-factor model presented a poor fit in the confirmatory factor analysis; an exploratory factor analysis was carried out, which suggested a 2-factor structure. The confirmatory factor analysis in the second sample confirmed that the second-order model had a good fit to the data. The general factor explained more than 70% of the variance. The reliability indices showed adequate internal consistency (α = .92-.95; ω = .88-.93). Ninety-three percent of the contrasting hypotheses about the relationship of the HAQ-II scores with other variables were confirmed, demonstrating their convergent, divergent, and known group validity. The multidimensional graduated response model was the one that best predicted person's interaction with the items.ConclusionThe Spanish version of the HAQ-II presents adequate validity and reliability for measuring Mexican patients’ physical function with rheumatoid arthritis.     

Valor de la ecografía con Doppler de poder en pacientes con artritis reumatoide en remisión clínica: ¿reclasificación de la actividad de la enfermedad?

Objectives

The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients.

Factores de riesgo cardiovascular dependientes del paciente en población con infección por VIH

The pathogenesis of arteriosclerosis in HIV-infected patients is complex. Both patient-related cardiovascular risk factors (CVRF) established for the general population and those related to highly-active antiretroviral therapy (HAART) and HIV infection per se are involved. Some traditional CVRF are more frequent in HIVinfected patients than in the general population. In developed countries, HIV infection is more frequent among men and, due to HAART, their life expectancy has significantly increased. The prevalence of smoking (37-72%) is higher than in the general population, as is that of diabetes mellitus (17%), insulin resistance (17-51%), dyslipidemia (22-49%) and hypertriglyceridemia (34%). The higher prevalence in these patients is probably due to lifestyle and length of exposure to HAART, especially to certain antiretroviral drugs. Although overall cardiovascular risk in patients with HIV remains low, CVRF established for the general population become more important with increasing age. Longitudinal cohort studies indicate the magnitude of the association of these risk factors with cardiovascular disease in patients with HIV infection. In view of all the factors that intervene in HIV infection, specific mathematical models should be designed for this population that would allow individual cardiovascular risk to be calculated in each patient and measures for cardiovascular prevention to be established.     

Impacto económico de la optimización de los recursos asistenciales en el abordaje del paciente con hepatitis C

TThe incorporation of direct-acting antiviral agents to the treatment of chronic hepatitis C infection has simplified diagnosis and follow-up, allowing optimisation of health resources (consultations and tests) dedicated to the management of the disease. The aim of this study was to estimate the economic impact of this simplification. Health resource optimisation was estimated through the Delphi method, based on a panel of 36 experts, consisting of Spanish clinicians, and on clinical practice guidelines. The unit costs (€ in 2017) of the health resources included were obtained from Spanish sources. Simplification of the process, as well as liaison between the medical specialist, nurses and the pharmacy service, would generate savings of €591.17 per patient. Likewise, the mean length of consultations would be shorter with regimens of only 1 tablet daily compared with regimens of more than 1 tablet daily.Supplement information: This article is part of a supplement entitled “The value of simplicity in hepatitis C treatment”, which is sponsored by Gilead.© 2019 Elsevier España, S.L.U. All rights reserved.     

¿Podemos predecir la gravedad de la hipertensión arterial pulmonar en pacientes con esclerodermia?

ObjectivesTo describe the clinical-biological characteristics of patients with scleroderma (SSc) and pulmonary artery hypertension (PAH).To establish the relationship between pulmonary functional tests (PFT), Doppler echocardiography (ECHO) and the severity of the PAH.Material and methodsRetrospective study of patients with scleroderma treated at a tertiary center. All participants received a protocol study, which included a complete analysis and additional tests: Doppler Echocardiography and pulmonary functional tests (PFT) with carbon monoxide diffusing capacity (DLCO).ResultsOverall, 331 patients were treated, including 68 (20.5%) with PAH. The limited subtype of Scleroderma was the most prevalent. The Person‘s correlation coefficient was used for the following variables: FVC-sPAP, FVC/DLCO-sPAP, DLCO-sPAP and TRV-sPAP, showed a significant moderate linear association in the relationship DLCO-sPAP and TRV-sPAP.29 deaths occurred, with 12 of them related to PAH. The median time between the PAH diagnosis and death was 1.8 years.ConclusionsThe decrease in DLCO and the increase in TRV are negative predictor factor of PAH which, at the same time, means a worsening prognosis for patients with Scleroderma.     

Enfermedad de Crohn en paciente con artritis idiopática juvenil de inicio sistémico: ¿asociación o complicación asociada al tratamiento?

The progression of systemic-onset juvenile idiopathic arthritis (JIAs) to the different forms of presentation of inflammatory bowel disease is extremely rare. We present the first report of a patient with SJIA that progressed to Crohn's disease in which mutations have been detected in genes responsible for the adequate regulation of the innate immune system.