Se evaluaron 43 pacientes adultos con leucemia mieloide crónica, Philadelphia positivo, que recibieron tratamiento con mesilato de imatinib como droga de segunda línea por resistencia o intolerancia ...al interferón alfa recombinante. La manifestación más frecuente al inicio de la enfermedad fue la esplenomegalia. El tratamiento con mesilato de imatinib se inició por resistencia (33; 76,7 %) o intolerancia grado 3 o 4 (10; 23,3 %). El mayor porcentaje de respuesta citogenética mayor (22; 91,7 %) y completa (11; 61,1 %) se alcanzó a los 18 y 24 meses de evolución. El 74,3 % no mostró respuesta molecular y el 5,1 % ya presentaba respuesta molecular antes del tratamiento; 9 (26,5 %) mostraron pérdida de la remisión hematológica completa, de ellos, 7 fallecieron por progresión de la enfermedad. La sobrevida global fue de 90,7 %, 83,3 %, 82,6 % y 78,9 % a los 5, 6, 7 y 8 años de evolución, respectivamente. La sobrevida global y libre de eventos a los 3 años de iniciado el mesilato de imatinib fue de 92,3 % y 81,8 %, respectivamente. Se encontró diferencia significativa entre la sobrevida libre de eventos y el índice pronóstico de Sokal. Las reacciones clínicas secundarias más frecuentes fueron dolores óseos, musculares o ambos; y las hematológicas: anemia hemolítica autoinmune y trombocitopenia.Forty three patients presenting with chronic positive-Philadelphia myeloid leukemia were assessed treated with Imatinib Mesilate as a second line drug by resistance or intolerance to recombinant alpha Interferon. At onset, the more frequent manifestation of this condition was the splenomegalia. Imatinib Mesilate treatment was started by resistance (33; 7.6 %) or 3 or 4 degree intolerance (10; 23.3 %). The greater percentage of cytogenetic response (22; 91.7 %) and complete (11; 61.1 %) was achieved at 18 and 24 course months. The 74.3 % hadn't "molecular response and the 5.1 % yet had it before treatment; 9 (26.5 %) showed a loss of complete hematologic remission, from them, 7 deceased from disease progression. Global survival was of 90.7 %, 83.3 %, 82.6 % and 78.9 % at 5, 6, 7 and 8 course years, respectively. Global survival and free of events at three years of Imatinib Mesilate appearance was of 92.3 % and 81.8 %, respectively. There was a significant difference between survival free of events and the Sokal prognostic rate. The more frequent secondary clinical reactions were the bone and/or muscular pain and the hematologic ones were the autoimmune hemolytic anemia and the thrombocytopenia.
Se evaluaron 43 pacientes adultos con leucemia mieloide crónica, Philadelphia positivo, que recibieron tratamiento con mesilato de imatinib como droga de segunda línea por resistencia o intolerancia ...al interferón alfa recombinante. La manifestación más frecuente al inicio de la enfermedad fue la esplenomegalia. El tratamiento con mesilato de imatinib se inició por resistencia (33; 76,7 %) o intolerancia grado 3 o 4 (10; 23,3 %). El mayor porcentaje de respuesta citogenética mayor (22; 91,7 %) y completa (11; 61,1 %) se alcanzó a los 18 y 24 meses de evolución. El 74,3 % no mostró respuesta molecular y el 5,1 % ya presentaba respuesta molecular antes del tratamiento; 9 (26,5 %) mostraron pérdida de la remisión hematológica completa, de ellos, 7 fallecieron por progresión de la enfermedad. La sobrevida global fue de 90,7 %, 83,3 %, 82,6 % y 78,9 % a los 5, 6, 7 y 8 años de evolución, respectivamente. La sobrevida global y libre de eventos a los 3 años de iniciado el mesilato de imatinib fue de 92,3 % y 81,8 %, respectivamente. Se encontró diferencia significativa entre la sobrevida libre de eventos y el índice pronóstico de Sokal. Las reacciones clínicas secundarias más frecuentes fueron dolores óseos, musculares o ambos; y las hematológicas: anemia hemolítica autoinmune y trombocitopenia.
Recently, a novel simple classification called MNCD, based on 4 axes (Motor; Non-motor; Cognition; Dependency) and 5 stages, has been proposed to classify Parkinson's disease (PD).
Our aim was to ...apply the MNCD classification in a cohort of PD patients for the first time and also to analyze the correlation with quality of life (QoL) and disease severity.
Data from the baseline visit of PD patients recruited from 35 centers in Spain from the COPPADIS cohort fromJanuary 2016 to November 2017 were used to apply the MNCD classification. Three instruments were used to assess QoL:1) the 39-item Parkinson's disease Questionnaire PDQ-39); PQ-10; the EUROHIS-QOL 8-item index (EUROHIS-QOL8).
Four hundred and thirty-nine PD patients (62.05±7.84 years old; 59% males) were included. MNCD stage was:stage 1, 8.4% (N = 37); stage 2, 62% (N = 272); stage 3, 28.2% (N = 124); stage 4-5, 1.4% (N = 6). A more advancedMNCD stage was associated with a higher score on the PDQ39SI (p < 0.0001) and a lower score on the PQ-10 (p< 0.0001) and EUROHIS-QOL8 (p< 0.0001). In many other aspects of the disease, such as disease duration, levodopa equivalent daily dose, motor symptoms, non-motor symptoms, and autonomy for activities of daily living, an association between the stage and severity was observed, with data indicating a progressive worsening related to disease progression throughout the proposed stages.
Staging PD according to the MNCD classification correlated with QoL and disease severity. The MNCD could be a proper tool to monitor the progression of PD.
The profile of patients with heart failure varies according to the healthcare setting and specialty. A national survey was carried out by the Working Group on Heart Failure of the Spanish Society of ...Internal Medicine in order to define the profile of patients with heart failure hospitalized in Spanish Internal Medicine Departments.
National registry including 51 hospitals all over Spain and 2145 patients suffering from this pathology.
Patients' median age was 77.2 years, 57.3% women and 42.7% men. There was a high percentage of illiteracy and low cultural level among patients (58.9%). In addition, many patients were found to have impaired physical and/or cognitive functions (67.4%). There was also a high incidence of related illnesses. Hypertension was the most frequent cause of heart failure. Echocardiography was performed in less than a quarter of patients and left ventricular ejection fraction was greater than 45% in more than a half (53.7%). At discharge, diuretics were the mostly prescribed drugs (92.5%). Angiotensin-converting enzyme inhibitors were prescribed in 66.1% patients (73.4% in patients with known systolic dysfunction) and beta-blockers in 9.8% (12.3% in patients with known systolic dysfunction).
In Spain, patients hospitalized for heart failure in Internal Medicine Departments use to be elderly women with preserved left ventricular systolic function, low cultural level and physically handicapped. This profile is pretty different from that reported in published clinical trials.Therefore, we should consider the most appropriate management of these patients with regard to treatment, hospitalization and follow-up.
