Valores pretratamiento e inducidos por el tratamiento de enolasa específica de neurona en pacientes con cáncer de pulmón microcítico: estudio prospectivo,abierto

Background

Neuron-specific enolase (NSE) is the most sensitive tumor marker for small-cell lung carcinoma (SCLC) at the time of diagnosis. The main purpose of this study was to review the usefulness of serum NSE level as a prognostic factor in patients with SCLC and to determine the correlation between the NSE level and the stage of disease and response to chemotherapy.

Methods

In this prospective study, patients with SCLC were evaluated for response to chemotherapy, survival without disease progression, and overall survival. The end point was designated at patient death due to SCLC. NSE assays were performed before and after completion of chemotherapy.

Results

Sixty-five patients were included in study. NSE levels were significantly higher in patients who died of SCLC. The pre-treatment NSE levels in patients who responded to treatment were significantly lower. The post-treatment NSE levels were not significantly correlated with response to chemotherapy, progression-free survival, overall survival, and prognosis of patients. Change in the NSE level between the pre- and post-treatment periods was not significantly correlated with response to treatment, progression-free survival, and overall survival.

Conclusions

NSE levels might not be related with the stage of the disease. However, a low pre-treatment NSE level might be used in predicting good response to chemotherapy in patients with SCLC. The post-treatment serum NSE levels and the rate of change between pre- and post-treatment serum levels of NSE were not related with response to chemotherapy, progression-free survival, and overall survival.     

Socioeconomic differences in diabetes prevalence, awareness, and treatment in rural southwest China

Objective To examine how socioeconomic differences are related to the prevalence, awareness and treatment of diabetes in rural Yunnan province, a relatively undeveloped province in southwest China. Methods A cross‐sectional survey was conducted from 2008 to 2010; 10 007 consenting individuals aged ≥18 years were selected to participate in the study using a stratified, multistage sampling technique. Information about participants’ demographic characteristics, smoking habits, drinking habits, awareness and treatment of diabetes, and family history of diabetes were obtained using a standard questionnaire. Height, weight, waist circumference, hip circumference, fasting blood sugar level and blood pressure were also measured for each individual. Data were analysed using multivariate logistic regression. Results The age‐standardised presence of diabetes was 6.8% in the study population. In diabetic subjects, 28.7% were aware that they had diabetes, and 22.6% had received treatment. After controlling for age, sex, smoking behaviour, drinking behaviour, hypertension, being overweight, central obesity and family history of diabetes, individual educational level was negatively associated with the prevalence of diabetes and positively associated with the awareness and treatment of diabetes. The awareness and treatment of diabetes showed a negative relationship with ethnic minority status and a positive relationship with individual household income. Conclusions There are low levels of awareness and treatment among individuals living with diabetes in rural southwest China. Strategies that can enhance public awareness of diabetes and increase access to affordable medications are urgently needed, especially for poor, less educated individuals who belong to ethnic minorities.     

Análisis de la frecuentación de Urgencias en consulta ERCA (enfermedad renal crónica avanzada): enseñanzas para optimizar el inicio programado en tratamiento renal sustitutivo

The decision to initiate renal replacement therapy (RRT) implies a wide margin of uncertainty. Glomerular filtration rate (GFR) tells us the magnitude of renal damage. Proteinuria indicates the speed of progression. However, nowadays more than 50% of patients are still initiating RRT hastily, and it is life threatening.

Impacto del tratamiento antiviral en la historia natural del virus de la hepatitis C

Chronic hepatitis C virus infection affects around 150 million persons, and 350,000 persons worldwide die of this disease each year. Although the data on its natural history are incomplete, after the acute infection, most patients develop chronic forms of hepatitis C with variable stages of fibrosis. In these patients, continual inflammatory activity can cause significant fibrosis, cirrhosis, decompensation of the liver disease, or hepatocarcinoma. In the next few years, it is expected that hepatitis C virus infection and its complications will significantly increase, as will the incidence of hepatocarcinoma in Spain. This review presents the data on the natural history of hepatitis C virus infection and discusses the potential impact of antiviral therapy on the distinct stages of the disease.     

The effects of a pre-season treatment with effective antimalarials on subsequent malaria morbidity in under five-year-old children living in high and seasonal malaria transmission area of Burkina Faso

Objectives To evaluate the effects of pre‐season treatment with single dose of sulfadoxine‐pyrimethamine (SP) or artemether‐lumefantrine (AL) on subsequent malaria morbidity in under‐fives. Methods A cohort of 156 children was enrolled for longitudinal follow‐up. Children received curative therapy with SP or AL, and a third group received no treatment. Participants were home‐visited twice a week with blood smears taken from children with fever (axillary T°≥37.5 °C) or history of fever. To assess the time to re‐infection, a blood film was also systematically obtained from pre‐treated children every 2 weeks. Results The mean time to the first malaria infection was 36 days in the SP arm and 26 days in the AL arm (P = 0.006). The incidence density of malaria infection was similar in both groups (86.5%vs. 92.3%, P = 0.52). The mean time to the first malaria episode was 47 days in the SP arm and 32 days in the AL arm (P < 0.001). The incidence of malaria episodes was significantly higher in the group pre‐treated with AL (45.7 per 1000 child days‐at‐risk CI 95% [35–56]) than in the control group (10.7 per 1000 child days‐at‐risk CI 95% [7–15]); P < 0.001). Conclusions Our findings suggest that the radical clearance of parasitemia with AL may increase susceptibility to malaria infection and clinical malaria episodes.     

Evaluación del retiro progresivo y/o la suspensión de la terapia anti-TNF-α en la enfermedad inflamatoria intestinal

Anti-tumour necrosis factor α therapy in inflammatory bowel disease has been shown to be effective in clinical practice.After more than a decade using these therapies the question arises about whether there is an appropriate time to suspend these therapies, and how this should be done. This review aims to evaluate the current evidence on these topics concerning anti-tumour necrosis factor α therapies, and eventually identify conditions and subgroups of patients that could potentially be candidates for withdrawal.     

Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon

Objective To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin‐based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated. Methods A cross‐sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers. Results Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial. Conclusions Malaria case management could be improved. Symptomatic diagnosis is inefficient because two‐thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results.     

La EPOC: un paradigma para el uso de directivas previas y la planificación anticipada de decisiones

Decision-making in COPD is complicated by the lack of clear prognostic factors. In this clinical situation it is also necessary to include the desires, values and choices of patients. The problem is more complex in the critical episodes, where the patients are incapable to make decisions. The instruments that allow incapable patients to represent themselves, the kind of patients who could benefit from its use, and the Spanish legislation on the matter, are presented in the first part of the work. The paper goes on to explain how to apply advance directives to the case of COPD. The article concludes that the appropriate use of advance directives and advanced care planning increases the quality of decisions at the end of the life of the patients with COPD."     

Monitoring drug effectiveness in kala-azar in Bihar, India: cost and feasibility of periodic random surveys vs. a health service-based reporting system

Objective In 2009, a random survey was conducted in Muzaffarpur district to document the clinical outcomes of visceral leishmaniasis patients (VL) treated by the public health care system in 2008, to assess the effectiveness of miltefosine against VL. We analysed the operational feasibility and cost of such periodic random surveys as compared with health facility‐based routine monitoring. Methods A random sample of 150 patients was drawn from registers kept at Primary Health Care centres. Patient records were examined, and the patients were located at their residence. Patients and physicians were interviewed with the help of two specifically designed questionnaires by a team of one supervisor, one physician and one field worker. Costs incurred during this survey were properly documented, and vehicle log books maintained for analysis. Results Hundred and 39 (76.7%) of the patients could be located. Eleven patients were not traceable. Per patient, follow‐up cost was US$ 15.51 and on average 2.27 patients could be visited per team‐day. Human resource involvement constituted 75% of the total cost whereas involvement of physician costs 51% of the total cost. Conclusion A random survey to document clinical outcomes is costly and labour intensive but gives probably the most accurate information on drug effectiveness. A health service‐based retrospective cohort reporting system modelled on the monitoring system developed by tuberculosis programmes could be a better alternative. Involvement of community health workers in such monitoring would offer the additional advantage of treatment supervision and support.     

Unstructured treatment interruption of antiretroviral therapy in clinical practice: a systematic review

Objective To characterize the frequency, reasons, risk factors, and consequences of unstructured anti‐retroviral treatment interruptions. Method Systematic review. Results Seventy studies were included. The median proportion of patients interrupting treatment was 23% for a median duration of 150 days. The most frequently reported reasons for interruptions were drug toxicity, adverse events, and side‐effects; studies from developing countries additionally cited treatment costs and pharmacy stock‐outs as concerns. Younger age and injecting drug use was a frequently reported risk factor. Other risk factors included CD4 count, socioeconomic variables, and pharmacy stock outs. Treatment interruptions increased the risk of death, opportunistic infections, virologic failure, resistance development, and poor immunological recovery. Proposed interventions to minimize interruptions included counseling, mental health services, services for women, men, and ethnic minorities. One intervention study found that the use of short message service reminders decrease the prevalence of treatment interruption from 19% to 10%. Finally, several studies from Africa stressed the importance of reliable and free access to medication. Conclusion Treatment interruptions are common and contribute to worsening patient outcomes. HIV/AIDS programmes should consider assessing their causes and frequency as part of routine monitoring. Future research should focus on evaluating interventions to address the most frequently reported reasons for interruptions.     

Non-invasive functional evaluation of the reserve in fatigue and the diaphragm structure using transthoracic echography in B and M modes

The diaphragm is the principal respiratory muscle. Its special characteristics have made it difficult to design instruments capable of performing a non-invasive evaluation of its structure and function in humans. The present study was designed to evaluate the potential use of echography as a non-invasive method to fulfil these objectives.     

Relationship between C-reactive protein level and early recurrence of atrial fibrillation after electrical cardioversion

INTRODUCTION AND OBJECTIVES: Atrial remodeling is responsible for the early recurrence of atrial fibrillation (AF) after cardioversion. Recently, it has been shown that the C-reactive protein (CRP) level is elevated in patients with AF, indicating that inflammation may play a role in the pathogenesis of this arrhythmia. We postulated that a high CRP level would predict early recurrence of AF after electrical cardioversion. PATIENTS AND METHOD: Forty-two patients with persistent AF, but without known heart disease, who underwent elective electrical cardioversion were investigated. The CRP level was measured immediately before cardioversion. The study population comprised the 37 patients in whom sinus rhythm was restored. RESULTS: After a follow-up period of 30 days, 16 patients (43%) had recurrence of AF; the other 21 (57%) remained in sinus rhythm. The mean CRP level was significantly higher in patients with AF recurrence (6.3 [3.3] mg/L vs 2.4 [2.1] mg/L, P=.0001). On dividing patients according to whether their CRP level was < or =3 mg/L or >3 mg/L, it was observed that only 33% of those in sinus rhythm had a level >3 mg/L compared with 81% of those with AF recurrence (P=.004). Patients with a CRP level >3 mg/L had a significant increase in the 1-month risk of AF recurrence (RR=3.7; 95% CI, 1.3-10.8). There was no association between CRP level and left atrial diameter (P =.50) or AF duration (P=.458). CONCLUSIONS: A high CRP level is associated with early recurrence of AF after electrical cardioversion, suggesting that inflammation could play a role in atrial remodeling.     

Modifications in ventricular fibrillation and capture capacity induced by a linear radiofrequency lesion

Introduction and objectives

An analysis was made of the effects of a radiofrequency-induced linear lesion during ventricular fibrillation and the capacity to capture myocardium through high-frequency pacing.

Methods

Using multiple epicardial electrodes, ventricular fibrillation was recorded in 22 isolated perfused rabbit hearts, analyzing the activation maps upon applying trains of stimuli at 3 different frequencies close to that of the arrhythmia: a) at baseline; b) after radio-frequency ablation to induce a lesion of the left ventricular free wall (length=10 [1] mm), and c) after lengthening the lesion (length=23 [2] mm).

Results

Following lesion induction, the regularity of the recorded signals decreased and significant variations in the direction of the activation fronts were observed. On lengthening the lesion, there was a slight increase in the episodes with at least 3 consecutive captures when pacing at cycles 10% longer than the arrhythmia (baseline: 0.6 [0.7]; initial lesion: 1 [1], no significant differences; lengthened lesion: 3 [2.8]; P<.001), while a decrease was observed in those obtained upon pacing at cycles 10% shorter than the arrhythmia.

Conclusions

The radio-frequency -induced lesion increases the heterogeneity of myocardial activation during ventricular fibrillation and modifies arrival of the activation fronts in the adjacent zones. High-frequency pacing during ventricular fibrillation produces occasional captures during at least 3 consecutive stimuli. The lengthened lesion in turn slightly increases capture capacity when using cycles slightly longer than the arrhythmia.Full English text available from:www.revespcardiol.org     

Prevention and treatment of hepatic veno-occlusive disease

Hematopoietic stem cell transplantation is currently the main cause of hepatic veno-occlusive disease, which is the early complication of this procedure with the highest short-term morbidity and mortality.Given that mortality from severe hepatic veno-occlusive disease can be nearly 100%, the search for measures to prevent of treat this complication is essential.Several risk factors for this complication have been identified and the triggering event that leads to sinusoidal obstruction has been shown to be sinusoidal endothelial cell injury.The present review analyzes measures to avoid or modify the casual risk factors for this complication, as well as the pharmacological agents that can prevent or modify the initial endothelial dysfunction or the resulting sinusoidal occlusion.