Background and ImportanceCeftazidime/avibactam is a combination antibiotic treatment considered to be of restricted use due to its novelty and low resistance. Its use is justified as a targeted ...therapy in the presence of multi-resistant gram-negative aerobic bacteria according to the antibiotic optimisation programme protocol.Aim and ObjectivesTo analyse the use and prescribing services of ceftazidime/avibactam in inpatients during 365 days.Material and MethodsA retrospective and descriptive observational study of the use of ceftazidime/avibactam during a 24-month period in the Hospital Universitario Torrecárdenas was carried out, analysing 46 patients. Data were extracted from the clinical database of the Andalusian Health System (Diraya), the database of the laboratories of Almeria (Modulab) and the location of the treatment was consulted in the Dominion – Unidosis database.ResultsThe group analysed consisted of 46 patients of whom 16 died, and of the total of 30 survivors, four were still in hospital at the time of the study.The group consisted of 26% women and 74% men. Mortality in females was 33% compared to 35% in males. Total mortality was 37%.Of the total, 48% received a targeted treatment for a multi-resistant bacterium, with 10% prescribed by the infectious disease service and 38% by other services. Only 28% were targeted treatments for multi-resistant gram- resistant bacteria.In contrast, 52% of the total received ceftazidime/avibactam as empirical treatment. In 37% of the empirical cases the bacteria were found to be non-resistant.Of the 48% of targeted treatments:20% of gram-positive 1 Staphylococcus petrasii5 Staphylococcus epidermidis MRSA2 Staphylococcus haemoliticum MRSA1 Staphylococcus aureus MRSA28% of gram-negative7 Pseudomona aeruginosa mR1 Escherichia coli OXA-481 Klebsiella pneumoniae BLEA1 Enterococcus faecium VanR3 Stenotrophomonas maltophilaConclusion and RelevanceThe data revealed by the study do not conform to the centre protocol highlighting its use as empirical and targeted treatment for gram-positives. Ceftazidime/avibactam is considered to be of extremely restricted use limited by antibiograms or sepsis codes in the presence of multidrug-resistant gram-positive bacteria.References and/or AcknowledgementsConflict of InterestNo conflict of interest.
Background and importanceMedication overdose headache (MOH) is a secondary headache disorder occurring on 15 or more days per month developing as a consequence of regular overdose of headache ...medication for more than 3 months.The prevalence of MOH is approximately 1–2% and is higher in women than in men. Many medications used to treat headaches have the potential for causing MOH. Currently, MOH secondary to triptans is increasing and leads to MOH sooner than with other medications. Anxiety and depression may be risk factors for the evolution of migraine into MOH.Aim and objectivesTo determine the prevalence of patients treated with triptans at risk of MOH (regular intake for ≥10 days/month for >3 months) and the profile in our health area; to identify and communicate to the prescribers those patients with overuse of triptans; and to inform all clinicians about MOH: aetiology, clinical features, diagnosis and treatment.Material and methodsWe analysed the dispensation records of all patients treated with triptans over 3 months (June 2019–September 2019). Data collected were sex, age, monthly intake frequency and co-medication. We alerted prescribers by email, including management and de-prescription recommendations for MOH. We posted content about MOH in our blog.ResultsThe prevalence of patients treated with triptans was 0.50%; 47 of 538 patients taking triptans (8.7%) were at risk of MOH. Their median age was 55 years and most were women (79%). Median monthly intake was 16 doses (10–48). Thirty patients (64%) had prescriptions for anxiety and/or depression and 13 patients (28%) had preventive therapy prescriptions for headache. Twenty-nine prescribers were notified by email. Dispensation record history, co-medication, MOH management guide and patient education leaflets were attached.Conclusion and relevanceMOH is a common problem in clinical practice that needs to be properly managed to increase the likelihood of successful chronic daily headache treatment. The results obtained in our population were similar to published studies, both in prevalence and in patient profile. However, the MOH rate was still lacking as it needs a clinician diagnosis. In 6 months we will collect information about the evolution of these patients, and we expect that our intervention will lead to treatment optimisation, better use of triptans and headache relief.References and/or acknowledgementsNo conflict of interest.
INTRODUCTIONThe influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation ...of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status. MATERIAL AND METHODSRetrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n=495); Subgroups: GA1 non-smoker (n=417), GA2 smoker (n=78). Group B (GB): Vaccine (n=360); Subgroups: GB1 non-smoker (n=263), GB2 smoker (n=97). VARIABLESAge, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire. RESULTSMean age 56.51 years (18-75), similar between groups (P=.2257). No difference in the number of pretreatment UTIs (P=.1329) or in the distribution of the bacterial spectrum (P=.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (P=.0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (P=.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin/clavulanic acid). In GB2 E. coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (P=.0144). CONCLUSIONSThe development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.
INTRODUCTION
Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm‐FINGERS) is the first non‐pharmacological multicenter randomized clinical trial (RCT) to prevent ...cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization.
METHODS
This 1‐year RCT (working on a 1‐year extension) investigates the feasibility of a multi‐domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries.
RESULTS
Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome).
DISCUSSION
LatAm‐FINGERS overcame a significant challenge to combine the region's diversity into a multi‐domain risk reduction intervention feasible across LA while preserving the original FINGER design.
The surface represents the two main thematic axes of the article. The left section portrays the harmonization processes among the members of LatAm FINGERS, and with other relevant initiatives, while the right section depicts the trial design, featuring two intervention branches (i.e., Systematic and Flexible) surrounded by their respective components. Additionally, the right column showcases the most relevant results, including the number of participants randomized per country, the percentage of individuals affected by metabolic syndrome, and the ethnic distribution of the sample.
Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with ...prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis.
Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included.
37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time.
Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.
La ansiedad específica del cáncer es la reacción psicológica más frecuentemente tras la prostatectomía radical (PR). Evaluamos la prevalencia de la patología psiquiátrica pretratamiento de cáncer de próstata mediante PR e identificamos la influencia de los diagnósticos psiquiátricos en la supervivencia y pronóstico en los pacientes.
Estudio retrospectivo multicéntrico observacional, 1.078 varones intervenidos mediante PR por cáncer de próstata órgano-confinado. Grupos: GP: pacientes con patología psiquiátrica previa a la PR; GNP: pacientes sin patología psiquiátrica previa a la PR, variables urológicas, oncológicas y psiquiátricas, estadística descriptiva y análisis multivariante.
El 37,94% presentó algún diagnóstico psiquiátrico. Fue necesario tratamiento adyuvante de radioterapia en 27,83% y hormonoterapia en 23,38%; más frecuentes en GP. La supervivencia cáncer-específica fue superior en GNP. La ansiedad, depresión, insomnio, tabaquismo, psicosis y alcoholismo fueron los más frecuentes. El bajo TNM y baja presencia de STUI e IUE aumentó la probabilidad de ausencia de patología psiquiátrica. En GP aumentó la fatiga, disfunción eréctil y deterioro cognitivo tras la PR junto con RT y/o HT. A mayor edad y mayor PSA al diagnóstico, aumentó el riesgo relativo de patología psiquiátrica y peor evolución. Los factores más relacionados fueron la PR, PSA, la edad y el tiempo de supervivencia.
La patología psiquiátrica está presente en pacientes tratados mediante prostatectomía radical debido a cáncer de próstata, teniendo alto impacto en los resultados de supervivencia y pronóstico.
Abstract
Background
In Latin America the experience in clinical practice with tofacitinib for moderate to severe Ulcerative Colitis (UC), in terms of both effectiveness and safety, is still limited. ...In Colombia, the incidence of UC as well as the availability of these new therapeutic options has been increasing, also, patients are frequently more refractory to treatments with higher rates of hospitalizations and surgeries. The aim of this study is to describe the real-life experience in Colombian patients with UC treated with Tofacitinib.
Methods
descriptive observational study, patients with moderate-severe UC as defined by the American College of Gastroenterology Ulcerative Colitis Activity Index (ACG score) treated with tofacitinib in induction phase (10mg every 12 hours) and maintenance (5mg every 12 hours), in different reference centers nationwide. Therapeutic response was evaluated in endoscopic (Mayo score), paraclinical (CRP, ESR, fecal calprotectin, hemoglobin) and clinical (absence of abdominal pain, diarrhea and rectorrhagia) terms. Additionally, the frequency of adverse events, steroid use and extraintestinal manifestations were measured.
Results
51 patients, 55% women, the average age was 37,14 years (range14-72). All patients had moderate to severe UC; 73% patients with pancolitis, and 21,6% with left colitis. The mean age at UC diagnosis was 29,77 (SD17,8) years (range 12.77-66,4). And the mean time between disease onset and tofacitininb initiation was 7,33 (SD17,1) years (range 0.001-22.72).
42/51(82,4%) patients had previously failed tumor necrosis factor inhibitors and 15/51(29,4%) had failed alpha4 beta7 integrin inhibitor (Vedolizumab). Six patients were naïve to any biologic drug. Ten patients had extraintestinal manifestations.
During the induction phase, 68,6% achieved clinical remission, 58,8% endoscopic remission, and 60,8% paraclinical remission. During maintenance phases, information was obtained from 18 patients during the first 6 months, 16 of whom reported clinical, paraclinical and endoscopic remission, while information was obtained from 7 patients at 12 months, 5 of whom showed clinical remission, and 6/7 endoscopic and paraclinical remission.
Four patients reported adverse events No thromboembolic or cardiovascular events were reported.
Conclusion
Tofacitinib is an effective and safe therapeutic alternative in the management of moderate-severe UC in our population. It is safe in patients with previous use of anti-TNF and anti-integrin, without presenting thrombotic or cardiovascular events. Also, it is a promising alternative in the bio-naïve patient. Its use in pediatric patients is off-label, the patients included presented clinical and paraclinical remission.
INTRODUCTIONProstate cancer (PCa) is the second most common male cancer in the world. Its incidence is estimated to grow to 1.7 million new cases and 499,000 new deaths by 2030. Treatment of OCPC can ...affect patients physically and mentally, as well as their close relationships and their job or career, which conditions health-related quality of life (QoL). OBJECTIVEEvaluate the impact on QoL attributable to the treatment for Organ Confined Prostate Cancer (OCPC). MATERIALS AND METHODSProspective multicenter observational study of 406 patients with OCPC treated from January 2015 to June 2018. The sample was divided into four study groups, according to the type of treatment: radical prostatectomy (RP) (GA), external radiotherapy (ERT) (GB), brachytherapy (BT) (GC) and other treatments different from monotherapy with RP, ERT or BT (GD). RESULTSThe age in GC was lower, the mean Prostate Specific Antigen (PSA) of all patients was 8.13 ng/ml, the group with the highest mean PSA was GB with a mean of 10.43 ng/dL, the mean Tumor Stage (TNM) was 3.82, and GD had the lowest post treatment quality of life. CONCLUSIONOCPC treatment affects QoL. Curative monotherapies, specifically RP and BT, have less effect on QoL than external radiotherapy or other therapeutic alternatives. Urinary incontinence and fistulas secondary to OCPC have the highest impact on QOL impairment. The internationally validated SF 36 questionnaire is a useful cross-sectional measure of QOL to compare the impact of OCPC treatment modalities.
The influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect ...of polyvalent bacterial vaccine on the prevention of RUTI and smoking status.
Retrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n = 495). Subgroups: GA1 non-smoker (n = 417), GA2 smoker (n = 78). Group B (GB): Vaccine (n = 360). Subgroups: GB1 non-smoker (n = 263), GB2 smoker (n = 97). Variables: Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire.
Mean age 56.51 years (18–75), similar between groups (p = 0.2257). No difference in the number of pretreatment UTIs (p = 0.1329) or in the distribution of the bacterial spectrum (p = 0.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (p = 0, 0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (p = 0.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin / clavulanic acid). In GB2 E.coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (p = 0,0144).
The development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.
Se analiza la influencia del tabaco en el espectro microbiológico, patrón de resistencia-sensibilidad y evolución en pacientes con infección de orina de repetición (ITUR). Evaluación del efecto de vacuna bacteriana polivalente en la prevención de las ITUR y el estado como fumador.
Estudio retrospectivo multicéntrico de 855 mujeres con ITUR tratadas con pauta antibiótica supresiva o vacuna bacteriana entre 2009 y 2013. Grupo A (GA): Antibiótico (n = 495). Subgrupos: GA1 no fumadora (n = 417), GA2 fumadora (n = 78).Grupo B (GB): Vacuna (n = 360). Subgrupos: GB1 no fumadora (n = 263), GB2 fumadora (n = 97).Variables: Edad, ITU pre-tratamiento, tiempo libre de enfermedad (TLE), especie microbiana, sensibilidad y resistencia. Seguimiento a 3, 6 y 12 meses con cultivo y cuestionario SF-36.
Edad media 56,51años (18–75), similar entre grupos (p = 0,2257). Sin diferencia en número de ITU pre-tratamiento (p = 0,1329) ni en distribución del espectro bacteriano (p = 0,7471). TLE fue superior en los subgrupos B respecto a los correspondientes A.Urocultivos en GA1: E. coli 62,71% con 8,10% resistencia (33% quinolonas; 33% cotrimoxazol; 33% quinolonas+cotrimoxazol); en GA2 E. coli 61,53% con 75% resistencia (16,66% quinolonas; 33,33% quinolonas + cotrimoxazol; 16,66% amoxi-clavulánico; 16,66% eritromicina+fosfomicina+clindamicina) (p = 0,0133). En GA, no hubo diferencias entre pacientes tratadas con cotrimoxazol y nitrofurantoina (p = 0,8724).Urocultivos en GB1: E. coli 47,36% con 22,22% resistencias (5,55% ciprofloxacino; 5,55% cotrimoxazol; 5,55% ciprofloxacino+cotrimoxazol; 5,55% amoxicilina/clavulánico). En GB2 E.Coli 70,02% con 61,90% resistencias (30,76% quinolonas; 30,76% cotrimoxazol; 30,76% quinolonas+cotrimoxazol; 17,69% amoxi-clavulánico) (p = 0,0144).
En mujeres con hábito tabáquico e infecciones urinarias de repetición es más frecuente la aparición bacterias resistentes, lo cual podría influir en una peor respuesta a los tratamientos preventivos, ya sea antibióticos o vacuna.
Previous studies have reported an association between a more pro-inflammatory diet profile and various chronic metabolic diseases. The Dietary Inflammatory Index (DII) was used to assess the ...inflammatory potential of nutrients and foods in the context of a dietary pattern. We prospectively examined the association between the DII and the incidence of cardiovascular disease (CVD: myocardial infarction, stroke or cardiovascular death) in the PREDIMED (Prevención con Dieta Mediterránea) study including 7216 high-risk participants. The DII was computed based on a validated 137-item food frequency questionnaire. Multivariate-adjusted hazard ratios (HR) and 95% confidence intervals of CVD risk were computed across quartiles of the DII where the lowest (most anti-inflammatory) quartile is the referent. Risk increased across the quartiles (i.e., with increasing inflammatory potential): HR(quartile2) = 1.42 (95%CI = 0.97-2.09); HR(quartile3) = 1.85 (1.27-2.71); and HR(quartile4) = 1.73 (1.15-2.60). When fit as continuous the multiple-adjusted hazard ratio for each additional standard deviation of the DII was 1.22 (1.06-1.40). Our results provide direct prospective evidence that a pro-inflammatory diet is associated with a higher risk of cardiovascular clinical events.
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