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INTRODUCTION: The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. METHODS: A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (nâ¯=â¯231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (nâ¯=â¯10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. RESULTS: Overall SVR was 98.8% (95% CI 97.35-100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. CONCLUSION: Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.
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Hepatite C Crônica , Hepatite C , Antivirais/efeitos adversos , Carbamatos , Genótipo , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis , Humanos , México , Estudos Retrospectivos , Sofosbuvir/efeitos adversosRESUMO
INTRODUCTION: The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking. METHODS: A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment. RESULTS: Overall SVR was 98.8% (95% CI 97.35-100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported. CONCLUSION: Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.
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BACKGROUND: hepatitis C virus (HCV) infection is a global health problem. Chronic infection induces the development of fibrosis and cirrhosis together with all the related complications. The use of direct-acting antiviral (DAA) drugs has proven highly effective. Telemedicine is a present-day resource that brings treatment closer to distant areas and may result in cost savings. OBJECTIVE: to implement a microelimination program for HCV using DAAs with the support of a telemedicine program to minimize expenses. PATIENTS AND METHODS: the program was developed at the Medical Services department of Petróleos Mexicanos (SMPM) with a national coverage; patients diagnosed with chronic hepatitis C were included. These were classified into locals and outsiders. Treatment for foreign patients was indicated, monitored and completed via telemedicine. Thus, avoiding their travel to the country's capital city, in order to save on transportation costs and travel allowances. RESULTS: a total of 136 patients, 74 locals and 62 outsiders, participated in the study. Transfer was avoided for 62 patients (45.5 %), which meant that telemedicine resulted in savings of 3,176.20 USD per patient, with overall savings of 196,924.40 USD from cost minimization. A total of 30 patients remained untreated due to lack of medication, hence the coverage amounted to 86 %. Sustained virological response (SVR) was achieved in 99 % of cases. Only two patients had treatment failure. Adverse events included headache and fatigue in 5 % of the cohort. CONCLUSIONS: with the aid of a telemedicine approach, significant savings were achieved by minimizing costs, since nearly half of patients were outsiders. Coverage reached 86 % and treatment with DAAs was successful for 99 % of our cases.
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Hepatite C Crônica , Hepatite C , Telemedicina , Antivirais/uso terapêutico , Hepacivirus , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Resposta Viral SustentadaRESUMO
INDRODUCTION: Trigger finger is very common in the population, with a life-threatening risk of developing the disease of 2.6% in the general population and increasing to 4 to 10% in diabetics. Since there is no standard gold of surgical treatment and there is still controversy in this, it is important to evaluate the results of the different surgical techniques. The objective of this study is to evaluate postoperative results of both surgical techniques in patients with follow-up of 1 to 12 months postoperative. MATERIAL AND METHODS: It is a prospective, longitudinal, descriptive and observational study carried out in a period from January 2015 to December 2017. Postoperative open (group 1) and percutaneous needle (group 2) patients were included. All patients were reviewed and surveyed by telephone. The comparison results of both techniques were analyzed using 2 for parametric results and by the Fisher test for nonparametric results. RESULTS: It was found that patients in group 2 expressed greater satisfaction, where 21.8% (n = 12) were fully satisfied with the percutaneous procedure, unlike those in group 1 where total satisfaction was only manifested at 3.8% (n = 2). CONCLUSIONS: In this study we can conclude that both techniques are effective for the treatment of trigger finger, with percutaneous needle release offering the highest degree of satisfaction in patients.
INTRODUCCIÓN: El dedo en gatillo es muy frecuente en la población, con un riesgo de vida de padecer la enfermedad de 2.6% en la población general y con un aumento de 4 a 10% en diabéticos. Dado que no hay un estándar de oro de tratamiento quirúrgico y aún hay controversia en ello, es importante evaluar los resultados de las distintas técnicas quirúrgicas. El objetivo de este estudio es evaluar resultados postoperatorios de ambas técnicas quirúrgicas en pacientes con seguimiento de uno a 12 meses de postoperatorio. MATERIAL Y MÉTODOS: Se trata de un estudio prospectivo, longitudinal, descriptivo y observacional realizado en un período de Enero de 2015 a Diciembre de 2017. Se incluyeron pacientes postoperados de liberación con técnica abierta (grupo 1) y percutánea con aguja (grupo 2). Se llevó a cabo la revisión de expedientes de todos los pacientes y se les hizo una encuesta mediante vía telefónica. Los resultados de la comparación de ambas técnicas se analizaron mediante 2 para resultados paramétricos y mediante la prueba de Fisher para los no paramétricos. RESULTADOS: Se encontró que los pacientes del grupo 2 manifestaron mayor satisfacción, de los cuales 21.8% (n = 12) estuvieron totalmente satisfechos con el procedimiento percutáneo, a diferencia de los del grupo 1 quienes manifestaron satisfacción total sólo en 3.8% (n = 2). CONCLUSIONES: En este estudio podemos concluir que ambas técnicas son efectivas para el tratamiento de dedo en gatillo, siendo la liberación percutánea con aguja la que ofrece mayor grado de satisfacción en los pacientes.
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Procedimentos Ortopédicos , Dedo em Gatilho/cirurgia , Humanos , Período Pós-Operatório , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions.
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Síndrome Antifosfolipídica/terapia , Artrite Reumatoide/terapia , Lúpus Eritematoso Sistêmico/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Assistência ao Convalescente/métodos , Síndrome Antifosfolipídica/diagnóstico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , México , Gravidez , Complicações na Gravidez/diagnósticoRESUMO
BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions.
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Síndrome Antifosfolipídica/terapia , Artrite Reumatoide/terapia , Lúpus Eritematoso Sistêmico/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Assistência ao Convalescente/métodos , Síndrome Antifosfolipídica/diagnóstico , Artrite Reumatoide/diagnóstico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , México , Gravidez , Complicações na Gravidez/diagnósticoRESUMO
Obesity and overweight are established risk factors for the development of breast cancer. They are also associated with poor prognosis for higher risk of disease recurrence and lower overall survival (OS). The aim of this study was to evaluate the influence of overweight and obesity in OS in patients with locally advanced breast cancer (LABC) treated with neoadjuvant chemotherapy. This is a retrospective analysis that included 819 patients diagnosed with LABC between January 2004 and December 2008. The patients were treated with neoadjuvant chemotherapy (NAT) based on anthracyclines, taxanes, or both, followed by surgery. For comparison, patients were divided into the normal weight (NW) group or the overweight/obesity (OW/OB) group. The prevalence of overweight/obesity was 74 %. General characteristics of the patients, including age, tumor size, clinical stage, nuclear grade, hormone receptors, and HER2 expression, were similar between both groups. At a median follow-up of 28 months, we found a statistically significant difference in OS between the two groups, achieving a 91.5 % in NW patients versus 85.9 % in the OW/OB group (P = 0.050). Cox multivariate analysis demonstrated that obesity was an independent factor for poor prognosis, with a hazard ratio of 1.79 (95 % CI (Confidence Interval) 1.09-2.96; P = 0.022). This is the first Mexican study that confirms the role of OW/OB as a risk factor for poor outcome among patients with LABC. Obesity in our country is a public health problem and requires strong preventive intervention strategies for its control, especially among patients diagnosed with breast cancer.
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Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Sobrepeso/epidemiologia , Adulto , Biomarcadores Tumorais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Obesidade/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de SobrevidaRESUMO
Eight patients with refractory lupus nephritis received rituximab after failing standard sequential therapy and were followed for 104 weeks after the infusion. One patient died secondary to a complicated pregnancy but had stable renal function. Three patients received a re-infusion of rituximab approximately 12 months apart due to a renal flare; during the second year of follow-up, those patients progressed toward ESRD. The four remaining patients demonstrated improvements in SLEDAI score, CrCl, and proteinuria with maintenance of their standard immunosuppressive therapy and did not require a re-infusion of rituximab. Although rituximab as induction therapy for refractory lupus nephritis has been shown to have a good response, its efficacy in long-term assessments demonstrates disappointing results.
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Anticorpos Monoclonais Murinos/administração & dosagem , Antígenos CD20/imunologia , Fatores Imunológicos/administração & dosagem , Nefrite Lúpica/tratamento farmacológico , Adulto , Biomarcadores/sangue , Creatinina/sangue , Progressão da Doença , Esquema de Medicação , Resistência a Medicamentos , Substituição de Medicamentos , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Infusões Intravenosas , Falência Renal Crônica/etiologia , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Nefrite Lúpica/imunologia , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Proteinúria/tratamento farmacológico , Proteinúria/etiologia , Recidiva , Rituximab , Índice de Gravidade de Doença , Fatores de Tempo , Falha de Tratamento , Adulto JovemRESUMO
INTRODUCTION: Bacterial resistance to antibiotics is associated with morbidity, mortality, and an increase in cost. Our objective was to assess bacterial resistance from cultures of patients with non-complicated urinary tract infection (UTI). METHODS: We analyzed antibiotic resistance using the VITEK-II system among patients attending the internal medicine unit with non-complicated UTI. RESULTS: 1,479 urine cultures were performed; we excluded: 98 due to contamination, 924 had no bacterial growth, and 57 had missing data. Among the 404 samples that were positive, 240 were found among out patients and 164 among hospitalized patients. E coli were the most frequent pathogen, followed by Enterococcus, and K pneumonia, in out patients; E coli, P aeruginosa, and fungal infections (23% of cases) in hospitalized patients. Samples with E coli among out patients displayed resistance of 50% to fluoroquinolones and 55% to sulfas. Among hospitalized patients, resistance was observed in 71 and 66% respectively. Resistance to P aeruginosa was 38% for amynoglucosides and carbapenems and 100% for piperacillin; Enterococcus had 50% for fluoroquinolones. CONCLUSION: E. coli is the most common pathogen among UTI patients. We must adapt guidelines to recommend antibiotics and design a comprehensive control program to reduce the high levels of bacterial antibiotic resistance among our population.
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Infecções Urinárias/microbiologia , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Infecções Urinárias/tratamento farmacológicoRESUMO
There are no reports in the literature of an association between soft tissue filler (STF) injection and fat embolism syndrome (FES). The authors present the case of a 26-year-old woman who was injected in the gluteal area with approximately 200 cc of STF on each side for aesthetic purposes. After this procedure, she presented with the triad of hypoxemia, neurological impairment, and petechiae consistent with the diagnosis of FES. After advanced support measures, she recovered completely. This article reviews the presence of FES after a cosmetic procedure with STF.
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Técnicas Cosméticas/efeitos adversos , Embolia Gordurosa/etiologia , Reação a Corpo Estranho/etiologia , Adulto , Nádegas , Feminino , HumanosRESUMO
This case involved a 75-year-old woman with systemic lupus erythematosus. Two months previously, she had a flare that was treated successfully by increasing the dosages of prednisone and azathioprine. A sudden onset of ocular pain, diplopia, and loss of vision suggestive of optical neuritis or vascular involvement confused the issue, and rhinocerebral zygomycosis was demonstrated later. We review the presentations of this fungal infection in patients with systemic lupus erythematosus with emphasis on its initial features.
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Infecções Fúngicas do Sistema Nervoso Central/etiologia , Lúpus Eritematoso Sistêmico/complicações , Mucormicose/etiologia , Idoso , Azatioprina/uso terapêutico , Infecções Fúngicas do Sistema Nervoso Central/patologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Mucormicose/parasitologia , Prednisona/uso terapêuticoRESUMO
Only a few cases of complete atrioventricular block (AVB) in adult lupus patients have been previously described, but only one as the initial manifestation. A 19-year-old woman who presented with seizures and loss of consciousness, was diagnosed with complete ABV and underwent pacemaker placement. Over the next weeks she developed serositis, joint, cutaneous, and renal involvement; positive antinuclear antibodies and high anti-SSA/Ro titers. This is the second case with AVB as a feature of SLE at onset. A review of previous complete AVB cases of adult SLE patients is presented.
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Bloqueio Atrioventricular/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Feminino , Humanos , Adulto JovemRESUMO
BACKGROUND: Obstructive jaundice in patients with previous cholecystectomy requires a precise diagnosis. In the diagnostic algorithm, biliary ultrasound (BUS) and magnetic resonance cholangiogram (MRC) are used, although the accuracy of each method is unknown in our setting. No previous comparison of US and MRC in subjects with cholecystectomy has been made. AIM: To determine diagnostic accuracy of BUS and MRC in patients with recurrent biliary obstruction. PATIENTS AND METHODS: Patients with endoscopic retrograde cholangiopacreatography (ERCP) demonstrating recurrent biliary obstruction by stones were included. All patients underwent BUS and MRC. We determined the diagnostic performance of each image study compared with ERCP. RESULTS: Twenty-seven patients with a mean age of 62.9 +/- 17.3 years-old were included. Sensitivity and specificity of BUS were 0.12 and 0.58, respectively. Figures for MRC were 0.88 and 0.82. Diagnostic agreement between ERCP and MRC was k= 0.66 whereas BUS had a k of only 0.26. DISCUSSION: MRC had good diagnostic performance for recurrent choledocolithiasis. BUS demonstrated lower accuracy compared with previous reports, so should not be considered in the initial approach of recurrent choledocus obstruction.
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Colangiografia/métodos , Colestase/diagnóstico por imagem , Imageamento por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , UltrassonografiaRESUMO
INTRODUCTION: Microalbuminuria is a well known risk factor for renal damage and for cardiovascular disease in type-2 diabetic patients. OBJECTIVE: To evaluate anthropometric, laboratory, and diet factors related to the presence of microalbuminuria in non-hypertensive type 2 diabetic subjects. MATERIAL AND METHODS: We carry-out an assessment of a group of non-hypertensive diabetic patients with or without microalbuminuria. Some anthropometric measures, physical fitness, tobacco and alcohol consumption, creatinine clearance, HbA1c, lipid profile, the mean fast serum glucose levels in last two years, 24 h urine protein, and caloric intake were all measured. RESULTS: From 86 included patients, 19 had microalbuminuria; it was related with the length of diabetes mellitus duration (114 +/- 55 vs. 84 +/- 67 months; p = 0.03), higher HbA1c level (8.9 vs. 7.1%; p = 0.001), and lower HDL-cholesterol levels (37.7 +/- 11 vs. 42.9 +/- 12 mg/dL; p = 0.03). In the multivariate analysis HbA1c level, and mean fast glucose remained significant. CONCLUSIONS: In non-hypertensive diabetic subjects, poor glucose control, and longer disease duration were both related with microalbuminuria. Moreover, caloric intake, exercise, tobacco or alcohol consumption, or BMI did not show association with microalbuminuria.
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Albuminúria/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Para prevenir el rechazo agudo en el trasplante renal de alto riesgo se emplea el anticuerpo monoclonal quimérico anti-CD25 (basiliximab). Estudiamos los receptores de trasplante renal de alto riesgo, de Julio de 1999 a Abril de 2001. Un grupo recibió 2 dosis de basiliximab y el esquema inmunosupresor habitual (grupo B) y el otro grupo sólo triple inmunosupresión (grupo C). Se compararon: número de episodios de rechazo agudo, función renal, sobrevida del paciente y del injerto, hemoglobina y eventos de toxicidad. Se incluyeron 13 pacientes del grupo B y 11 en el grupo C. No se encontraron episodios de rechazo en ningún grupo; en el grupo C hubo un fallecimiento con función renal normal y se perdió 1 injerto. La depuración de creatinina al final del estudio fue de 77.4ñ22.3 ml/min en grupo B y 65.6ñ28.5 ml/min en el grupo C y la hemoglobina de 14ñ2.2 g/dl y 12.3ñ2.8 g/dl, respectivamente. El caso de muerte en el grupo C fue atribuido a efectos colaterales de la ciclosporina (microangiopatía trombótica) y no hubieron eventos de toxicidad en el grupo B. El basiliximab es adecuadamente tolerado y permite el mantenimiento de la función renal en pacientes de alto riesgo, comparado con el esquema habitual de inmunosupresión.
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Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Anticorpos Monoclonais , Rejeição de Enxerto , Terapia de Imunossupressão , Transplante de Rim/efeitos adversos , Evolução Clínica , Rim/fisiologiaRESUMO
We describe a 72-year-old man with prostate enlargement, prostate-specific antigen level of 35 ng/dl, mild polyarthritis, and constitutional symptoms. Prostatic ultrasonography suggested neoplasm; however, transrectal biopsy revealed findings consistent with polyarteritis nodosa (PAN). The patient went on to develop leg paresthesia and dysesthesia, increased serum creatinine, and systemic hypertension. Steroids and intravenous cyclophosphamide were administered, followed by improvement. Our case emphasizes the protean onset of PAN, and provides a new differential diagnosis of prostatic diseases related to elevated prostate-specific antigen.
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Adenocarcinoma/diagnóstico , Poliarterite Nodosa/diagnóstico , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Creatinina/sangue , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Humanos , Hipertensão/etiologia , Imunossupressores/uso terapêutico , Masculino , Poliarterite Nodosa/tratamento farmacológico , Prednisona/uso terapêutico , Pregnenodionas/uso terapêutico , Próstata/diagnóstico por imagem , UltrassonografiaRESUMO
En el presente estudio se reporta el caso de una mujer de 30 años de edad que desarrolló lupus eritematoso generalizado (LEG) y tromboembolia pulmonar (TEP) durante el embarazo. Después de una punción de la vena subclavia, presentó un hematoma mediastinal que generó un desplazamiento de las estructuras vecinas y síndrome de Horner, los cuales se resolvieron sin abordaje quirúrgico, hecho poco común para este tipo de lesiones. El tratamiento consistió en esteroides e inmunosupresores. Se discuten la evolución y el abordaje de estos hematomas y la posible participación del tratamiento en la evolución de este caso