ObjectiveThe aim of the study was to estimate human papillomavirus (HPV) vaccination efficacy in reducing recurrence risk within 4 years after conization for high-grade cervical neoplasia.Materials and MethodsFrom January 2012 to June 2015, we performed a longitudinal, observational study (case-series study) on patients diagnosed with cervical intraepithelial neoplasia 2–3 neoplasia. Efficacy was estimated by a 95% CI of the relative risk, relative risk reduction, attributable risk, and number needed to treat. Parametric and nonparametric tests were used as appropriate to compare 160 vaccinated with 171 nonvaccinated patients. To estimate the hazard ratio of the vaccinated status, patients were subjected to multivariable analyses based on the Cox proportional hazard model. To compare recurrence-free survival, a Kaplan-Meier model and a log-rank test were applied.ResultsThe overall recurrence was 9.4% in the nonvaccinated and 2.5% in the vaccinated group (p = .009). Vaccination was associated with a significant decrease in the relative risk (73.5%, 95% CI = 21.8%–90.9%) with a mean number needed to treat of 14 patients per relapse prevented. Although positive conization margins were related to the highest recurrence risk, not being vaccinated independently increased this risk 3.5-fold in a 4-year follow-up (p = .025). Cumulative recurrence-free rates differed significantly between both groups (log-rank test: p = .009).ConclusionsOur study corroborates the benefits of HPV vaccination, recommends a closer and longer follow-up in nonvaccinated women, and offers a 4-year prognosis for patients undergoing conization for high-grade cervical lesions.
BackgroundSeven angiotensin receptor blocker(ARB) have been marketed, making it a therapeutic group capable of therapeutic exchange at the hospital. Losartan,irbesartan,candesartan and valsartan are available in the ’Hospital’s Pharmacotherapeutic Guide(HPG) of our centre. Losartan is the ARB of choice for therapeutic exchanges based on efficiency criteria.PurposeThe aim of this study is to analyse the effectiveness of ARB in hospitalised patients as a function of the ARB prescribed at admission.Material and methodsA cross-sectional study was conducted in September 2017. All patients admitted to units with pharmaceutical validation were selected for treatment with any ARB available in the HPG and retrospectively. ARB home prescriptions were assessed, at admission, systolic blood pressure(SBP) and diastolic blood pressure (DBP) throughout the stay if it was <10 days or for a maximum of 10 days if it was higher and prescribed diet. It was defined as hypertension if SBP >139 if the age was <80 years or >149 if the age >80 years and/or if DBP >89. It was defined as hypotension if SBP <90 and/or if the DSP<60.ResultsWe selected 48 patients, 18% of all patients admitted. Eight patients had no ARB prescribed at home. Twenty per cent (n=8) were >80 years: 10% (n=4) were diagnosed on entry of cardiovascular and ischaemic pathologies. The median stay was 12. 5±13. 5 days. The diet was 67% unsalted. A mean of blood pressure records was obtained of 14. 5±7. 4 (2/patient/day). The efficacy data are shown in the following table:Abstract 1ISG-002 Table 1ConclusionThe most frequent alteration was hyperSBP. In the group of patients that maintained the same treatment prior to admission, there was a tendency to hyperSBP and hyperDBP, whereas hypotension was more frequent in the group where treatment was modified.These data suggest that therapeutic exchanges have no impact on the effectiveness of ARB.No conflict of interest
Four patients presented haematologic toxicity, grade 3 neutropenia, requiring G-CSF, treatment delay was only required in one of them.Other AE: grade 2 anaemia treated with erythropoietin (n=1), grade 2 thrombocytopenia (n=1), respiratory infections (n=2; one patient with hypogammaglobulinaemia previous to treatment required hospital admission and treatment suspension).By the time the study was finished, effectiveness was evaluated in four up to six patients that finished treatment: complete response (n=3) and partial response (n=1). Conclusion In our experience, the obinuzumab-chlorambucil scheme presented a good safety profile in patients with comorbidities. The main AE were IRRs: limited to first administration that did not require treatment suspension; and neutropaenia, which was the most frequent haematologic toxicity.Regarding response, a continuous monitoring is necessary to confirm long-term effectiveness.
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