1
|
Manceñido Marcos N, Novella Arribas B, Mora Navarro G, Rodríguez Salvanés F, Loeches Belinchón P, Gisbert JP. Efficacy and safety of proactive drug monitoring in inflammatory bowel disease treated with anti-TNF agents: A systematic review and meta-analysis. Dig Liver Dis 2024; 56:421-428. [PMID: 37422409 DOI: 10.1016/j.dld.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND AIMS A systematic review and a meta-analysis of the literature was conducted to assess efficacy and safety of proactive therapeutic drug monitoring (TDM) versus conventional management during maintenance treatment with anti-tumour necrosis factor (anti-TNFα) in patients with inflammatory bowel disease (IBD). METHODS A search was conducted up to January 2022 (MEDLINE, EMBASE, and the Cochrane Library). The primary outcome was the ability to maintain clinical remission at 12 months. The certainty of evidence was determined using the GRADE approach. RESULTS Nine studies were identified: one systematic review, six randomised clinical trials, and two cohort studies. No superior efficacy of proactive TDM [relative risk 1.16; 95% confidence interval (CI): 0.98-1.37, n=528; I2=55%] was shown. Proactive TDM could improve the durability of anti-TNFα treatment [odds ratio (OR) 0.12; 95%CI: 0.05-0.27; n=390; I2=45%), prevent acute infusion reactions (OR 0.21; 95%CI: 0.05-0.82; n=390; I2=0%), decrease adverse events (OR 0.38; 95%CI: 0.15-0.98; n=390; I2=14%), and reduce the probability of surgery, at lower economical expenditure. CONCLUSIONS The analysed evidence did not confirm the superiority of proactive TDM of anti-TNFα treatment over conventional management in patients with IBD, so proactive TDM should not currently be recommended.
Collapse
Affiliation(s)
- Noemí Manceñido Marcos
- Gastroenterology Department, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid (UEM), San Sebastián de los Reyes, Spain.
| | | | | | | | | | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| |
Collapse
|
2
|
Pizarro Portillo A, Del Arco Galán C, de Los Santos Gil I, Rodríguez Salvanés F, Negro Rua M, Del Rey Ubago A. [Prevalence of undiagnosed human immunodeficiency virus infection in an emergency department and the characteristics of newly diagnosed patients]. Emergencias 2016; 28:313-319. [PMID: 29106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To estimate the prevalence of undiagnosed human immunodeficiency virus (HIV) infection detected by routine testing of patients seeking care in an emergency department and to describe the characteristics associated with new HIV-infection diagnosis. MATERIAL AND METHODS Walk-in patients between the ages of 15 and 75 years who required a blood test were included. Routine fourth-generation enzyme-linked immunoassays were performed to detect HIV infection in all samples extracted. Patients with positive results were referred to the infectious diseases department for monitoring and treatment. RESULTS Blood samples for 1722 patients were analyzed. Twenty-one patients (1.2%) refused to allow their samples to be tested; 19 more samples (1.1%) could not be tested. The prevalence of undiagnosed HIV infection among the remaining 1682 remaining patients was 0.6% (95% CI, 0.23%-0.96%). The prevalence tended to be nonsignificantly higher among patients born outside Spain (0.97% [95% CI, 0.3%-2.20%]) and in 36-50-year-olds (1.46% [95% CI, 0.4%-2.5%]). Characteristics associated with undiagnosed HIV infection were male sex (odds ratio [OR], 5.78 [95% CI, 1.0-31.4]), presenting with a chief complaint that suggested infection (OR, 8.14 [95% CI, 1.6-41.4]), and a history of hepatitis (OR, 5.53 [95% CI, 1.1-27.7]). CONCLUSION The prevalence of undiagnosed HIV infection in our emergency department was high at 0.6%. The rate of patient acceptance of routine HIV testing was high. Strategies that target improving the detection of undiagnosed HIV infection are advisable.
Collapse
Affiliation(s)
| | | | | | - Francisco Rodríguez Salvanés
- Unidad de Apoyo Metodológico. Instituto de Investigación Sanitaria Princesa. Hospital Universitario de La Princesa, Madrid, España
| | - Mónica Negro Rua
- Servicio de Urgencias, Hospital Universitario de La Princesa, Madrid, España
| | - Ana Del Rey Ubago
- Servicio de Urgencias, Hospital Universitario de La Princesa, Madrid, España
| |
Collapse
|
3
|
Tineo Drove T, Santos Ampuero MÁ, Díaz López A, Rodríguez Salvanés F, Vega Piris L, Gómez Puyuelo M. [ESTIMATE OF THE INTRINSIC ERROR OF THE MEASURING INSTRUMENT OF THE LABORATORY FOR ANALYTICAL DETERMINATIONS OF THE CRITICAL PATIENT]. Rev Enferm 2016; 39:26-31. [PMID: 27405144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient.
Collapse
|
4
|
de Ulíbarri Pérez JI, Fernández G, Rodríguez Salvanés F, Díaz López AM. Nutritional screening; control of clinical undernutrition with analytical parameters. NUTR HOSP 2014; 29:797-811. [PMID: 24679020 DOI: 10.3305/nh.2014.29.4.7275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To update the system for nutritional screening. The high prevalence of nutritional unstability that causes the Clinical Undernutrition (CU), especially within the hospitals and assisted residencies, makes it necessary to use screening tools for the constant control of undernutrition to combat it during its development. CU is not so much due to a nutritional deficiency but to the illness and its treatments. However, the screening systems currently used are aimed at detecting an already established undernutrition rather than at detecting any nutritional risk that may be present. The metabolic changes of the nutritional status that have a trophopathic effect, can be easily and automatically detected in plasma, which allows to make the necessary changes in treatments that might be too aggressive, as well as to apply nutritional support according to each case. The manual screening systems can detect those somatic changes typical of undernutrition only after many days or weeks, which might be too late. Plasma albumin is a very reliable parameter for nutritional control. A lowered amount of it, due to whatever reason, is a clear sign of a possible deficit as well as of a nutritional risk suffered by the cell way before the somatic signs of undernutrition will become apparent. A fast detection of nutritional risk, anticipating undernutrition, offers prognostic abilities, which makes screening tools based on analytic parameters the most useful, ergonomic, reliable and efficient system for nutritional screening and prognosis in the clinical practice. CONCLUSION It is necessary to update some concepts, to leave behind old myths and to choose modern screening systems that have proven to be efficient. This is the only way achieving the dream of controlling CU among ill and vulnerable patients.
Collapse
Affiliation(s)
| | - Guillermo Fernández
- Unit of Clinical and Assistance Information Admissions and Clinical Documentation Service. University Hospital La Princesa. Madrid..
| | | | - Ana María Díaz López
- Head of Clinical Analysis Service. University Hospital La Princesa. Madrid. Spain..
| |
Collapse
|
5
|
|
6
|
Ortiz Lobo A, González González R, Rodríguez Salvanés F. [Mental health referrals of patients without diagnosable psychiatric pathology]. Aten Primaria 2007; 38:563-9. [PMID: 17198609 PMCID: PMC7669137 DOI: 10.1157/13095928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the characteristics of referral from primary health care to mental health of patients with no diagnosable mental disorder. METHODS Consecutively and without exemptions, all persons attending for first-time consultation a mental health centre in the course of a year were clinically examined. We measured the incidence of conditions not attributable to a mental disorder using ICD-10 (Z codes). Information was collected on whose idea it was that they attended, and who, how and with what treatment they were referred. In addition, data about their social, demographic and clinical characteristics were collected. RESULTS Of the 1004 persons examined, 244 (24.4%) (95% CI, 21.6-27) did not meet the ICD-10 diagnosis criteria for mental disorders. They themselves or their family tended to request the Z codes (54.5%) (95% CI, 48.3-60.8]. Mental health referral was almost always through the PC doctor (95.5%) (95% CI, 92.1-97.7). Half the patients were already receiving drug therapy under their general practitioner before their visit and 20.9% (95% CI, 15.8-26) were referred as priority patients. CONCLUSIONS Our study found that a large number of patients with no diagnosable mental disorder at the mental health centre, many of them with drug treatment prescribed, were referred. This places a question-mark over the function of primary care as a filter for these patients. The population s indiscriminate health care demand and the steady increase in treating mental health with drugs partially explain this phenomenon.
Collapse
|
7
|
Trapero-Marugán M, García-Buey L, Muñoz C, Quintana NE, Moreno-Monteagudo JA, Borque MJ, Fernández MJ, Salvanés FR, Medina J, Moreno-Otero R. Sustained virological response to peginterferon plus ribavirin in chronic hepatitis C genotype 1 patients is associated with a persistent Th1 immune response. Aliment Pharmacol Ther 2006; 24:117-28. [PMID: 16803610 DOI: 10.1111/j.1365-2036.2006.02954.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND An impairment of cellular immune response may contribute to the persistency of hepatitis C virus infection. AIM To analyse the Th1/Th2 cytokine profile in peripheral blood CD4(+) and CD8(+) T cells from patients with chronic hepatitis C (CHC) during treatment with pegylated interferon-alpha2a plus ribavirin and to correlate the Th1/Th2 balance with virological response (SVR). METHODS Prospective longitudinal study: 44 naïve genotype 1 CHC patients received PEG-IFNalpha2a plus ribavirin for 48 weeks: 26 (59.1%) achieved a SVR, 13 relapsed (29.5%) and 5 (11.4%) were non-responders. Sixteen healthy controls were analysed. The production of IL-4, IFNgamma and TNFalpha by CD4(+) and CD8(+) T cells was measured using flow cytometry, both in resting and phorbol-ester-stimulated cells. RESULTS First three months of treatment: the synthesis of TNFalpha by phorbol-ester-stimulated-CD4(+) T cells was higher in patients with SVR (P < 0.01). At the end of treatment, SVR was associated with higher intracellular expression of IFNgamma by stimulated-CD4(+) and CD8(+) T cells (P < 0.05). At the end of follow-up, a higher intracellular expression of IFNgamma by CD4(+) T cells was associated with a SVR. CONCLUSIONS A Th1-type immune response was associated with achievement of a SVR, as indicated by the persistent elevation of intracellular IFNgamma and TNFalpha.
Collapse
Affiliation(s)
- M Trapero-Marugán
- Gastroenterology and Hepatology Service, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Girón RM, Sánchez Moliní P, García Vadillo A, Quintana ML, Rodríguez Salvanés F, Jiménez I, Mancha A, Cisneros C, Ancochea J. Efectividad en la aplicación de tres protocolos de prevención y tratamiento de la osteoporosis en pacientes adultos con fibrosis quística. Med Clin (Barc) 2005; 125:325-8. [PMID: 16185631 DOI: 10.1157/13078772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Reduction of bone mineral density (BMD) is a complication of cystic fibrosis (CF) which is observed in parallel to the increment of life expectancy in these patients. The aim of this study was to analyze the evolution of BMD following the application of a protocol for the prevention and treatment of osteoporosis. PATIENTS AND METHOD We performed a multidisciplinary prospective study in 21 adult patients with CF with a mean age of 24.3 (r: 19-44) years. We evaluated BMD results depending on the treatment schedule, and the annual relative change of BMD percentage was correlated with changes observed in respiratory function, corporal mass index (CMI), Brasfield radiologic score and Shwachman clinical score for a 3 years follow up period. Three regimens of treatment were applied: general measurements, supplementation of calcium and vitamin D, and 10 daily mg of alendronate plus calcium and vitamin D supplements. RESULTS Basal assessment showed that 14.2% of CF patients had a marked diminution of bone mass with respect to an age and sex matched control population, with a Z score of < -2 DE in lumbar vertebral and/or total femur. Another 38% showed a lessening of Z score between -1 and -2.5 DE. We observed a progressive annual reduction of BMD in all the anatomic areas analyzed: -0.52% (1.87) in lumbar spine, -1.17% (1.91) in total femur and -2.16% (2.65) in neck femur. The hip BMD annual decrement was related to that observed in FEV1. Only patients treated with alendronate did not suffer progressive BMD lose. Treatment with a combination of calcium, vitamin D and alendronate was more efficient in hip BMD than calcium plus vitamin D alone (p < 0.05). Also, this combination was better than no treatment at hip and femoral neck levels (p < 0.05). CONCLUSIONS Our work confirms that Spanish young adults patients with CF show low control matched BMD, and that it even worsens at follow-up. This decrement is not adequately halted with preventive treatment with supplements of calcium and vitamin D, and only patients treated with alendronate show increments of their BMD.
Collapse
Affiliation(s)
- Rosa María Girón
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Girón RM, Sánchez Moliní P, Almonacid C, Jiménez I, Rodríguez Salvanés F, García Vadillo A, Quintana ML, Hurtado J, Ancochea J. Estudio de la densidad mineral ósea en pacientes adultos con fibrosis quística. Med Clin (Barc) 2004; 123:81-4. [PMID: 15225470 DOI: 10.1016/s0025-7753(04)74420-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Due to recent medical advances, patients with cystic fibrosis (CF) can expect longer survival rates and, as a result, face previously unreported complications such as osteoporosis. Our goal was to determine the mineral bone density in young adult patients with CF attended in the adult CF Unit, and correlate these findings with other clinical variables of interest in this patient population. PATIENTS AND METHOD We carried out a transversal study from 1999 to 2002 of 34 patients with CF (19 males and 15 females. Mean age 23 years). Upon enrollment in the study, patient gender and age were recorded along with Schwachman and Brasfield scores, pulmonary function test results (spirometry) and sputum analysis, phosphorus and calcium balance, vitamin D intake, and dual energy X-ray absorptiometry (DEXA) findings of the spinal column (L2-L4) and femur. RESULTS 54.5% of all study patients were found to have an abnormal mineral bone density. Fifteen patients met criteria for osteopenia and 3 for osteoporosis. Age, treatment with inhaled corticosteroids, and pulmonary function test results correlated with bone density. CONCLUSIONS DEXA scans should be performed in young adults with CF at least once during the course of their illness on the basis of the high prevalence of mineral bone density abnormalities in this population.
Collapse
Affiliation(s)
- Rosa María Girón
- Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Aspa J, Rajas O, Rodríguez de Castro F, Blanquer J, Zalacain R, Fenoll A, de Celis R, Vargas A, Rodríguez Salvanés F, España PP, Rello J, Torres A. Drug‐Resistant Pneumococcal Pneumonia: Clinical Relevance and Related Factors. Clin Infect Dis 2004; 38:787-98. [PMID: 14999620 DOI: 10.1086/381886] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Accepted: 11/03/2003] [Indexed: 11/03/2022] Open
Abstract
A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of > or =0.12 microg/mL (3 isolates had an MIC of 4 microg/mL), 23.8% had an MIC of erythromycin of 128 microg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC > or =0.12 microg/mL (OR, 15.85) were related to erythromycin resistance (MIC, > or =1 microg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of > or =0.12 microg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta -lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.
Collapse
Affiliation(s)
- Javier Aspa
- Servicio de Neumologia, Hospital de la Princesa, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|