Abstract
Background
The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in ...the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH.
Methods
We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS).
Discussion
The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented.
Trial registration
ClinicalTrials.gov
NCT04735445. Registered on 25 June 2019
4CPS-236 Loss to follow-up factors of people living with HIV Vélez-Díaz-Pallarés, M; Montero Llorente, B; Parro Martín, MÁ ...
European journal of hospital pharmacy. Science and practice,
03/2023, Letnik:
30, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Background and ImportanceLoss of adherence to antiretroviral treatment (ART) is one of the leading causes of virological failure in people living with HIV (PLWHIV). Lack of adherence is associated ...with a loss of follow-up by the health system, particularly in the Pharmacy Department.Aim and ObjectivesTo identify factors in PLWHIV which cause their follow-up to fail by the Pharmacy Department.Material and MethodsCase-control study conducted in a tertiary hospital which attends 3,000 PLWHIV. Patients who had run out of medication for more than one month, according to pharmacy registrations between September 2020 and September 2021, were identified and named after cases if the reason to not come to the Pharmacy were not justified (death, hospital transfer, inclusion in a clinical trial, etc.). We conducted a case-control study (1:4), and cases were matched according to age ( 5 years) and date of the last dispensation.Statistical analysis was performed using the STATA 17.0 program (StataCorp LLC). All models were performed univariately, and a p<0.05 was considered significant.Variables studied were: gender, age, region of birth, studies, stable housing, route of HIV transmission, CD4 nadir, years after diagnostic, type of ART, years on ART, stage, adverse effects to ART, number of lines of treatment, pharmacy registrations of adherence, alcohol use, drug use, and psychiatric problems. Data were obtained from the clinical databaseResultsSixty-one cases were identified and matched with 244 controls. Statistical differences were found in gender, where cis-man have an OR=4.5 (CI95% 1.0−19.6,p=0.047) and trans-man have an OR=23.9 (CI 95% 2.9−195.8,p=0.003) in comparison with women, and region where Latin-American have an OR=2.7 (CI 95% 1.3−5.6, p=0.008). Patients who fail to adhere to treatment according to the records in Pharmacy have an OR=0.04 (CI 95% 0.01−0.11, p=0.000) and patients who are alcoholics or drug abusers, have an OR=3.24 (CI 95% 1.30−8.04, p=0.011) and an OR=2.01 (CI 95% 1.03-3.93, p=0.039), respectively.Conclusion and RelevanceClinicians should pay special attention to cis or trans-men, Latin Americans, historic bad adherence registrations by pharmacists and alcoholic or drug abusers who are more prone to losing follow-up in their treatments. This enhances the importance of multidisciplinary team approach to these patients. Clinical, pharmacist and nurse interventions and information registration are crucial to identify these patients.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Abstract
Background
Recent data suggest that in pulmonary regurgitation (PR) after repair of Tetralogy of Fallot (rToF) sex may influence right ventricular (RV) size, mass and function. We ...hypothesized that women with rToF and PR constitute a patient population with different preoperative clinical characteristics and different postoperative outcomes compared with men.
Methods
We collected retrospectively demographic data, clinical variables, imaging and functional variables in a cohort of 166 rToF patients (50% males; median age 35; IQR 26–41 years) with at least moderate PR. A transannular patch was used in 73 and 79% of men and women, respectively. The most recent data preceding death and pulmonary valve replacement (PVR) were requested. Variables were compared between men and women.
Results
Over follow-up, none of the patients died but 35 (42.7%) men and 23 (27.4%) women underwent PVR (p=0.05) at a median age of 32.5 (IQR 23.7–42.7 years). Women are more likely to undergo surgery after developing symptoms, while the criterion for surgery in men was ventricular size. At surgery, women were nearly twice as likely to have class III or IV symptoms preoperatively as men. Although PR fraction was similar between the two groups, indexed ventricular volumes were substantially higher and RV function was lower in males, compared to females. 20% of women had a RVEDVi ≥160ml and a RVESVi ≥80ml, compared with 35 and 32% of men, respectively (p=0.06), and only 6% of woman had an RVEDVi >180ml, compared with 18% of men (p=0.01). Fibrosis detected on late gadolinium was observed in 100% of men but only in 20% of women (p=0.009).
Conclusions
Under comparable loading conditions, a striking difference was noted in the condition leading to the surgical indication. These results suggest that the generalization of the RV dimension surgical criteria results in criteria almost never reached by women. Recommendations need more focus on sex differences.
Funding Acknowledgement
Type of funding sources: None.
Although, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role.
To evaluate the satisfaction with anticoagulant treatment in ...patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain.
Patients from two different cross-sectional studies were combined. To measure the satisfaction with anticoagulant treatment, the Anti-Clot-Treatment Scale (ACTS) questionnaire was completed by every patient. A multivariate analysis was performed to determine the variables associated with satisfaction of patients receiving oral anticoagulants.
A total of 1,309 patients (mean age 78.5±8.4 years; 49.3% men; CHA
DS
VASC 4.9±1.5; HAS-BLED 2.0±0.9) were included in the study, of whom 902 (68.9%) were taking vitamin K antagonists (VKA) and 407 (31.1%) direct oral anticoagulants (DOACs). Overall, satisfaction with oral anticoagulation was high (ACTS Burdens scale 49.69±9.45; ACTS Benefits scale 11.35±2.61). The perceived burdens with anticoagulant treatment were lower in men, as well as in patients with no dependency, normal renal function, who were not polymedicated, or who had moderate bleeding risk. Among patients taking VKA, those subjects with a lower number of International Normalized Ratio (INR) determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden. Patients taking DOACs (vs VKA) showed a lower perceived burden with anticoagulation. Benefits with anti-coagulation were higher in men, younger patients, those with no dependency, or low bleeding risk. Perceived benefits were higher in patients taking DOACs (vs VKA).
Satisfaction with oral anticoagulation was high in patients with nonvalvular atrial fibrillation, who were attending internal medicine departments daily in Spain. Among patients taking VKA, those subjects with a lower number of INR determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden with anticoagulant therapy. Patients taking DOACs (vs VKA) showed lower perceived burdens and higher perceived benefits with anticoagulation.
To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment.
A review and analysis of the existing literature. Recommendations are given based on the ...level of evidence for each study reviewed.
The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm.
SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
4CPS-097 Cobicistat interactions with chronic treatments Vélez-Díaz-Pallarés, M; Gramage Caro, T; Rodríguez Sagrado, Má ...
European journal of hospital pharmacy. Science and practice,
03/2019, Letnik:
26, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
BackgroundCobicistat is used in clinical practice as a pharmacokinetic enhancer of protease and/or integrase inhibitors. Nevertheless, the mechanism by which this occurs (metabolism inhibition) makes ...cobicistat-containing HIV regimens very prone to interact with chronic treatments, which triggers toxicity.PurposeTo reconcile HIV treatments containing cobicistat and to analyse the interactions with the chronic treatment.Material and methodsPatients attending the outpatient pharmacy clinic between January and September 2018 with a regimen containing cobicistat were included. During the dispensation of their HIV medication, patients’ treatment was reconciliated by two methods: pharmacy interview and consultation of the prescribed medication in the primary records. The interaction between the cobicistat and the patients’ chronic treatment was checked in drugs.com. In this website interactions are classified as major, moderate, minor and non-interaction.ResultsEight-hundred and forty-two treatments were reconciliated (patients: 47.9±11.5 years old; 82.4% male). Twenty-eight different HIV regimens were identified, the most frequent being the one containing Genvoya (cobicistat, elvitegravir, emtricitabine, tenofovir alafenamide) (68.4%).Two-hundred and forty different chronic drugs were prescribed (2.2±2.4 drugs per patient). Twenty-one drugs were classified to have a major interaction with cobicistat, 40 a moderate interaction, five minor, 147 did not have any interaction registered in drugs.com and 27 drugs did not appear in this web. Pharmacists made 87 interventions with 35 different drugs. The most frequent were inhaled budesonide (12) and nasal fluticasone (11). Forty-four (51%) of the pharmaceutical interventions did not need the physician’s approval (17 to interrupt chronic treatments, 13 to change treatments, 12 to monitor and one to change dose). The rest (43) required physician approval and these consisted of more varied actions, highlighting six changes in the HIV regimen to eliminate cobicistat. We registered possible/probable toxicities related to the inhibition of metabolism due to cobicistat in eight patients.ConclusionPharmacist reconciliation detects numerous potential interactions. Pharmacist intervention helped to modify several treatments and make treatments safer.References and/or acknowledgementsNone.No conflict of interest.
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