Adherence to interferon β-1b treatment in patients with multiple sclerosis in Spain

BACKGROUND Adherence to interferon β-1b (INFβ-1b) therapy is essential to maximize the beneficial effects of treatment in multiple sclerosis (MS). For that reason, the main objectives of this study are to assess adherence to INFβ-1b in patients suffering from MS in Spain, and to identify the factors responsible for adherence in routine clinical practice. METHODOLOGY/PRINCIPAL FINDINGS This was an observational, retrospective, cross-sectional study including 120 Spanish patients with MS under INFβ-1b treatment. Therapeutic adherence was assessed with Morisky-Green test and with the percentage of doses received. The proportion of adherent patients assessed by Morisky-Green test was 68.3%, being indicative of poor adherence. Nevertheless, the percentage of doses received, which was based on the number of injected medication, was 94.3%. The main reason for missing INFβ-1b injections was forgetting some of the administrations (64%). Therefore, interventions that diminish forgetfulness might have a positive effect in the proportion of adherent patients and in the percentage of doses received. In addition, age and comorbidities had a significant effect in the number of doses injected per month, and should be considered in the management of adherence in MS patients. CONCLUSION/SIGNIFICANCE Among all the available methods for assessing adherence, the overall consumption of the intended dose has to be considered when addressing adherence.

Horae ad usum Bituricensem.

F. 1 Calendrier avec saints parisiens (en français). F. 13 Extraits des IV Évangiles. F. 19v Prières à la Vierge : « Obsecro te... », etc. F. 26 Passion selon saint Jean. F. 37v Prières diverses. F. 42 Matines et laudes de la Vierge. F. 73 et 74v Matines de la Croix et du Saint-Esprit. F. 76 Petites heures, vêpres et complies de la Vierge (usage de Bourges), de la Croix et du Saint-Esprit. F. 117 Psaumes de la pénitence. F. 129 Litanies. F. 135 Suffrages de s. Ursin. F. 136 Office des morts (usage de Bourges). F. 182v Suffrages. F. 207 Prières avant et après la communion, etc. (rubriques en français).

Andalucía reduce a la mitad la mortalidad por accidentes de tráfico en carretera en el período 2001-2010

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Basic life support teaching in the second year pregraduate medical curriculum: quality of acquisition after 6 months

Purpose of the study: Basic life support (BLS) and automated externaldefibrillation (AED) represent important skills to be acquired duringpregraduate medical training. Since 3 years, our medical school hasintroduced a BLS-AED course (with certification) for all second yearmedical students. Few reports about quality and persistence over timeof BLS-AED learning are available to date in the medical literature.Comprehensive evaluation of students' acquired skills was performedat the end of the 2008 academic year, 6 month after certification.Materials and methods: The students (N = 142) were evaluated duringa 9 minutes «objective structured clinical examination» (OSCE) station.Out of a standardized scenario, they had to recognize a cardiac arrestsituation and start a resuscitation process. Their performance wererecorded on a PC using an Ambuman(TM) mannequin and the AmbuCPR software kit(TM) during a minimum of 8 cycles (30 compressions:2 ventilations each). BLS parameters were systematically checked. Nostudent-rater interactions were allowed during the whole evaluation.Results: Response of the victim was checked by 99% of the students(N = 140), 96% (N = 136) called for an ambulance and/or an AED. Openthe airway and check breathing were done by 96% (N = 137), 92% (N =132) gave 2 rescue breaths. Pulse was checked by 95% (N=135), 100%(N = 142) begun chest compression, 96% (N = 136) within 1 minute.Chest compression rate was 101 ± 18 per minute (mean ± SD), depthcompression 43 ± 8 mm, 97% (N = 138) respected a compressionventilationratio of 30:2.Conclusions: Quality of BLS skills acquisition is maintained during a6-month period after a BLS-AED certification. Main targets of 2005 AHAguidelines were well respected. This analysis represents one of thelargest evaluations of specific BLS teaching efficiency reported. Furtherfollow-up is needed to control the persistence of these skills during alonger time period and noteworthy at the end of the pregraduatemedical curriculum.

Genotyping of gastroenteric viruses in hospitalised children: first report of norovirus GII.21 in Brazil

This retrospective study (April-September 2003) was designed to investigate the roles of the main viruses responsible for cases of acute infantile gastroenteritis in hospitalised children up to two years of age. The viruses were identified in 64.7% (88/136) of the cases and the detection rates of rotavirus A (RVA), norovirus (NoV) and astrovirus were 41.9% (57/136), 30.3% (24/79) and 12.7% (7/55), respectively. RVA and NoV were detected in 20 of the 24 reported nosocomial infection cases. This study identified the first circulation of the genotype NoV GII.21 in Brazil and highlights the need to establish differential diagnoses through active laboratorial surveillance.

Incidència de l'aplicació d'un programa de control de la conducta violenta en joves infractors

En aquest estudi es pretén avaluar l'impacte de la intervenció de tres programes aplicats en centres educatius tancats de la Direcció General de Justícia juvenil per ajudar al jove al control de la seva conducta violenta. Aquest mateix programa s'ha aplicat a joves en medi obert que complien mesures imposades pel jutge de llibertat vigilada. La recerca intenta avaluar els resultats de l'aplicació i la seva perdurabilitat en el temps, un cop han passat uns anys des que van ser aplicats en els joves. El programa es plantejava el control de la conducta violenta dels joves a partir d'un plantejament cognitivo-conductual on les activitats proposades i desenvolupades amb els joves anaven encaminades al canvi i modificació d'aquests comportament. Per avaluar l'efectivitat d'aquests programes la recerca segueix a 31 joves que van fer el programa entre el 2002 i el 2004 i analitza el seu grau de satisfacció respecte la situació actual així com la taxa actual de reincidència. L'estudi aprofita per donar dades respecte el perfil socio-familiar, personal i criminològic dels joves que participen en les diferents aplicacions dels programes.

Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population.

BACKGROUND: Intravenous recombinant tissular plasminogen activator (rt-PA) is the only approved pharmacological treatment for acute ischaemic stroke. The authors aimed to analyse potential causes of the variable effect on early course and late outcome. METHODS AND RESULTS: 136 patients (42% women, 58% men) treated with intravenous rt-PA within 3 h of stroke onset in an acute stroke unit over a 3-year period, were included. Early clinical profiles of evolution at 48 h were divided into clinical improvement (CI) (decrease >4 points in the National Institute of Health Stroke Scale (NIHSS)); clinical worsening (CW) (increase >4 points NIHSS); clinical worsening after initial improvement (CWFI) (variations of >4 points in the NIHSS). Patients with clinical stability (no NIHSS modification or <4 points) were excluded. The patients showed in 66.9% CI, 13.2% CW 8.1 % CWFI and 11.8% remained stable. Female sex, no hyperlipaemia and peripheral arterial disease were associated with CW. Male sex and smoking were associated with CI. Absence of arterial occlusion on admission (28.4%) and arterial recanalisation at 24 h were associated with CI. Main causes of clinical deterioration included symptomatic intracranial haemorrhage (sICH), persistent occlusion and cerebral oedema. 23.5% developed ICH, 6.6% of which had sICH. At 3 months, 15.5% had died. Mortality was increased in CW, mainly related to sICH and cerebral oedema. The outcome of CWFI was intermediate between CW and CI. CONCLUSIONS: Early clinical profiles of evolution in thrombolysed patients vary considerably. Even with CI, it is critical to maintain vessel permeability to avoid subsequent CW.

Sandflies (Diptera: Psychodidae) in rural and urban environments in an endemic area of cutaneous leishmaniasis in southern Brazil

The high proportion of cases of cutaneous leishmaniasis reported amongst residents in the city of Bandeirantes, in the state of Paraná, Brazil, led the authors to investigate the phlebotomine fauna in both urban and rural environments. The sandflies were captured with automatic light traps from 07:00 pm-07:00 am fortnightly in 11 urban peridomiciles from April 2008-March 2009 and monthly in three ecotopes within four rural localities from April 2009-March 2010. In one of these latter localities, sandfly capture was conducted with white/black Shannon traps during each of three seasons: spring, summer and fall. A total of 5,729 sandflies of 17 species were captured. Nyssomyia neivai (46.7%) and Nyssomyia whitmani (35.3%) were the predominant species. In this study, 3,865 specimens were captured with automatic light traps: 22 (0.083 sandflies/trap) in the urban areas and 3,843 (26.69 sandflies/trap) in the rural areas. Ny. neivai was predominant in urban (68.2%) and rural (42.8%) areas. A total of 1,864 specimens were captured with the white/black Shannon traps and Ny. neivai (54.5%) and Ny. whitmani (31.4%) were the predominant species captured. The small numbers of sandflies captured in the urban areas suggest that the transmission of Leishmania has occurred in the rural area due to Ny. neivai and Ny. whitmani as the probable vectors.

The STOP the Bleeding Campaign.

According to the World Health Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 years.

Progression of auditory discrimination based on neural decoding predicts awakening from coma.

Auditory evoked potentials are informative of intact cortical functions of comatose patients. The integrity of auditory functions evaluated using mismatch negativity paradigms has been associated with their chances of survival. However, because auditory discrimination is assessed at various delays after coma onset, it is still unclear whether this impairment depends on the time of the recording. We hypothesized that impairment in auditory discrimination capabilities is indicative of coma progression, rather than of the comatose state itself and that rudimentary auditory discrimination remains intact during acute stages of coma. We studied 30 post-anoxic comatose patients resuscitated from cardiac arrest and five healthy, age-matched controls. Using a mismatch negativity paradigm, we performed two electroencephalography recordings with a standard 19-channel clinical montage: the first within 24 h after coma onset and under mild therapeutic hypothermia, and the second after 1 day and under normothermic conditions. We analysed electroencephalography responses based on a multivariate decoding algorithm that automatically quantifies neural discrimination at the single patient level. Results showed high average decoding accuracy in discriminating sounds both for control subjects and comatose patients. Importantly, accurate decoding was largely independent of patients' chance of survival. However, the progression of auditory discrimination between the first and second recordings was informative of a patient's chance of survival. A deterioration of auditory discrimination was observed in all non-survivors (equivalent to 100% positive predictive value for survivors). We show, for the first time, evidence of intact auditory processing even in comatose patients who do not survive and that progression of sound discrimination over time is informative of a patient's chance of survival. Tracking auditory discrimination in comatose patients could provide new insight to the chance of awakening in a quantitative and automatic fashion during early stages of coma.

Tratamiento ambulatorio de la diverticulitis aguda no complicada: impacto sobre los costes sanitarios

OBJETIVOS: Se ha demostrado previamente que el tratamiento ambulatorio de la diverticulitis aguda no complicada es seguro, eficaz y aplicable en la mayoría de los pacientes que toleran la dieta oral y que tienen un adecuado apoyo familiar. El objetivo de este estudio es cuantificar el impacto que el tratamiento ambulatorio tiene en la reducción de costes sanitarios. MATERIAL Y MÉTODOS: Estudio comparativo retrospectivo realizado sobre una base de datos mantenida de forma prospectiva. Periodo de estudio: enero del 2005 hasta junio del 2011. Grupo de estudio: pacientes diagnosticados de diverticulitis aguda no complicada tratados con antibióticos vía oral de forma ambulatoria (7-10 días). Grupo control: pacientes diagnosticados de diverticulitis aguda no complicada que cumplían criterios de tratamiento ambulatorio pero que fueron ingresados con tratamiento antibiótico endovenoso (7-10 días). El diagnóstico se confirmó mediante TC abdominal. Se han analizado las características de los pacientes y los motivos del ingreso así como el resultado del tratamiento. El análisis de costes se ha realizado mediante el sistema “full costing”, sumación de todos los costes variables (costes directos) más el conjunto de costes generales repartidos por actividad (costes indirectos) y que incluye los gastos en urgencias, unidad de hospitalización, laboratorio, radiología y farmacia. Se ha añadido el coste del tratamiento ambulatorio tanto en el grupo de estudio (tratamiento completo) como en el grupo control, cuando completaron el tratamiento una vez dados de alta. Se ha realizado el análisis comparativo según intención de tratamiento. RESULTADOS: Se incluyeron 136 pacientes, 90 en el grupo de estudio y 46 en el grupo control. No hubo diferencias en la edad, sexo, número de episodios anteriores, fiebre o leucocitosis entre los dos grupos. Los motivos de tratamiento hospitalario más frecuentes fueron: ingreso en la fase inicial del protocolo, decisión del médico de guardia o negativa del paciente al tratamiento ambulatorio. Cinco de los 90 pacientes del grupo de estudio precisaron ingreso por persistencia del dolor o vómitos mientras que 2 de los pacientes del grupo control reingresaron por recurrencia de la sintomatología (5,5% vs. 4,3%; p=0,7). Ninguno de estos pacientes precisó cirugía urgente. El coste global por episodio fue de 882±462 euros en el grupo de estudio frente a 2376±830 euros en el grupo control (p=0,0001). CONCLUSION El tratamiento ambulatorio de la diverticulitis agua no sólo es seguro y eficaz sino que también reduce más de un 50% los costes sanitarios. Palabras clave: Diverticulitis aguda. Tratamiento ambulatorio. Impacto sobre coste sanitario

Interrogation of related clinical pan-azole-resistant Aspergillus fumigatus strains: G138C, Y431C, and G434C single nucleotide polymorphisms in cyp51A, upregulation of cyp51A, and integration and activation of transposon Atf1 in the cyp51A promoter.

Multiple Aspergillus fumigatus isolates from a patient with two aspergillomas complicating chronic pulmonary aspergillosis were pan-azole resistant. Microsatellite typing was identical for all isolates despite major phenotypic and some growth rate differences. Three different cyp51A mutations were found (G138C, Y431C, and G434C), of which the first two were demonstrated by heterologous expression in a hypersusceptible Saccharomyces cerevisiae strain to be at least partly responsible for elevated MICs. cyp51A and cyp51B gene duplication was excluded, but increased expression of cyp51A was demonstrated in three isolates selected for additional study (7-to 13-fold increases). In the isolate with the greatest cyp51A expression, an Aft1 transposon was found inserted 370 bp upstream of the start codon of the cyp51A gene, an integration location never previously demonstrated in Aspergillus. Two transcription start sites were identified at 49 and 136 bp upstream of the start codon. The role of the Aft1 transposon, if any, in modulating cyp51A expression remains to be established. Increased mRNA expression of the transporters AfuMDR1 and AfuMDR4 also was demonstrated in some isolates, which could contribute to azole resistance or simply represent a stress response. The diversity of confirmed and possible azole resistance mechanisms demonstrated in a single series of isogenic isolates is remarkable, indicating the ability of A. fumigatus to adapt in the clinical setting.