Fourteen cases are presented of preoperative portal vein thrombosis complicating orthotopic liver transplantation from an experience of 195 transplants carried out between April 1986 and April 1991. In four patients who suffered rethrombosis of the portal vein, the mortality rate was 100 per cent from various causes. Overall there were six deaths; two of those who died had a patent portal vein at death. Three patients underwent retransplantation: one for primary non-function, two for rejection. It is concluded that: (1) portal vein thrombosis should not represent an absolute contraindication to liver transplantation; (2) preoperative screening of prospective transplant recipients for portal thrombosis should be routine; (3) postoperative anticoagulation therapy and periodic Doppler ultrasonographic assessment of portal vein flow are important elements of post-transplant management; and (4) with thrombectomy and portal vein resection an end-to-end portal anastomosis may be performed with good results.
BackgroundThe safety of biologic agents for the treatment of psoriasis has been studied in long term clinical trials with up to 5 years of follow-up. However, observational studies provide the potential to identify safety signals in a real world setting.PurposeTo evaluate the safety and use of adalimumab, etanercept and ustekinumab in several lines of treatment in patients with psoriasis from a tertiary hospital.Material and methodsRetrospective observational longitudinal study of psoriasis patients followed from 1 January 2008 to 30 June 2015; there were no exit points. Variables included were: demographic (sex and age), pharmacological (biological drug used up to thirdline of treatment) and clinical (side effects reported).Clinical databases used were PRISMA (prescribing electronic software) for patient selection and collection of pharmacological variables, and DIRAYA for collection of clinical variables.Results88 patients were included (mean age 66 years; 60% males).40% of patients started treatment with adalimumab (35/88), 31% with etanercept (27/88) and 29% with ustekinumab (26/88).42% of patients required a second biological drug (37/88). 9 patients received adalimumab (9/37; 24%), 6 patients received etanercept (6/37; 16%) and 22 patients received ustekinumab (22/37; 60%).16% of patients required a third biological drug (14/88). 8 patients received adalimumab (8/14; 57%), 4 patients received etanercept (4/14; 29%) and 2 patients received ustekinumab (2/14; 14%).Regarding safety, 4% of patients receiving adalimumab (2/53) experienced adverse effects (one patient presented fatigue and headaches and other increased transaminases).14% of patients treated with etanercept (5/37) experienced side effects: 4 patients showed increased transaminases (1 with concomitant anxious depression and tonsillitis, and other with concomitant discomfort in the area of injection), and 1 patient showed herpes simplex reactivation.6% of patients treated with ustekinumab experienced increased transaminases (3/50).ConclusionThe most used biological drug for psoriasis in our hospital was adalimumab (60%), followed by ustekinumab (56%) and etanercept (42%).Adalimumab was the drug most commonly used in first and thirdline treatment, whereas ustekinumab was the most commonly used secondline drug.The highest percentage of adverse effects was found in etanercept patients, whereas adalimumab treatment presented a lower occurrence of adverse events. The most common adverse effect was increased transaminases for any biological therapy.No conflict of interest.
Background Advances in antiretroviral therapy have resulted in more potent and safe drugs, with higher success rates due to improved adherence and better control of the HIV infection. Efforts to improve the control of HIV infection should be reflected in increased quality of life. Purpose To analyse the health-related quality of life (HRQL) of HIV-infected patients over the age of 50 on antiretroviral treatment. Materials and methods Cross sectional study. We included patients on antiretroviral treatment aged over 50 years. Study variables were collected at interview, in the clinical history and pharmacy records. Variables were: sex, age, CD4 count, viral load, antiretroviral treatment, adherence, comorbidities and quality of life. The HRQL was assessed through the ‘Medical Outcomes Study HIV Health Survey’ (MOS-HIV) questionnaire. The adherence was estimated using the SMAQ questionnaire. Results The study included 70 patients, 81% were men, average age of 57 years old. Most of them presented CD4 >500 cells/mm3 and undetectable viral load. The most prescribed antiretrovirals were darunavir and tenofovir and 50% of patients were adherent. The most frequent comorbidities were: metabolic syndrome (36%), hypertension (30%) and hypercholesterolemia (37%). Concerning quality of life, social functioning obtained the highest score (mean 86) and general health perception the lowest score (mean 48). The average dimensions of HRQL in patients older than 60 years were higher than in patients aged 50–59, except in the physical functioning dimension, and the difference was significant in the dimensions pain, energy and health distress. Lower scores were observed in the patients using a protease inhibitor, with a significant difference in the dimensions general health perception (p = 0.024) and pain (p = 0.01). Conclusions The general perception of health was the dimension with the worst score and social function the best. Patients aged over 60 have a better perceived quality of life than patients aged 50–59 years. The use of protease inhibitors was associated with worse quality of life. No conflict of interest.
BackgroundFacial angiofibromas (FA) are the most visible of the cutaneous manifestations of tuberous sclerosis. Current treatments include laser and other invasive techniques. Topical rapamycin is a recent and unauthorised option to treat FA (off-label use) but a commercially available compound has not yet been developed.PurposeTo evaluate the efficacy and safety of a pharmaceutical compound of topical rapamycin in a child with FA.Material and methodsA retrospective review of the literature was conducted to select the vehicle, concentration and posology of the topical formulation. Topical 0.1% rapamycin in petrolatum using the powder from the manufacturer was the pharmaceutical compound selected. This concentration was proposed because it is an effective, efficient and safe therapy in pretreated children. The vehicle selected to prepare this topical preparation was petrolatum because treatment with topical rapamycin solution has reportedly caused local adverse side effects, such as irritation. The treatment was authorised by the hospital management, and the child´s parents were informed and provided informed consent. The authors evaluated efficacy through improvement of lesions and safety was evaluated by adverse effects at 3 months.ResultsA 6-year-old patient with FA was selected for treatment with topical 0.1% rapamycin in petrolatum twice daily to the affected areas on the face. In this patient there was an improvement and clearance of the lesions. No local irritation or serious adverse events were described. Rapamycin blood levels at 3 months were 1.02 ng/mL, far below the therapeutic range (5–15 ng/mL) needed for immunosuppression. The posology was reduced to three times a week instead of daily for maintenance.ConclusionTopical 0.1% rapamycin in petrolatum was an effective treatment for FA in this patient. The preparation formulated in petrolatum was well tolerated with no adverse effects. This pharmaceutical compound could be used as an effective option for treatment of FA in paediatric patients without serious adverse effects. It is necessary to establish how long treatment must be continued.References and/or AcknowledgementsBalestri R, Neri I, Patrizi A, et al. Analysis of current data on the use of topical rapamycin in the treatment of FA. J Eur Acad Dermatol Venereol 2015;29:14-20No conflict of interest.
Background The introduction of highly-active antiretroviral treatment (HAART) has decreased mortality related to HIV infection. The number of patients over the age of 50 is increasing. This population suffers multiple comorbidities related to ageing, chronic HIV infection and antiretroviral treatment. Purpose To analyse antiretroviral therapy, associated treatments and clinical outcomes in patients older than 50 years. Materials and methods Cross sectional study. We included patients on antiretroviral treatment over the age of 50. Study variables were collected at interview, in the clinical history and pharmacy records. Variables were: sex, age, CD4 count, viral load, antiretroviral treatment, adherence, comorbidities, associated treatments and clinical parameters. Results The study included 70 patients, 81% were men, average age of 57. Most of them presented CD4 >500 cells/mm3 and undetectable viral load. Mean of 13 years on antiretroviral treatment. The most prescribed antiretrovirals were darunavir and tenofovir and 36% of patients had been prescribed an alternative regimen. The most frequent comorbidities were: metabolic syndrome (36%), hypertension (30%) and hypercholesterolemia (37%). Lipid-lowering drugs were prescribed to 33% of patients, antihypertensives to 30% and central nervous system agents to 24%. The mean values of systolic blood pressure were: 128 mmHg (non-hypertensive patients) and 143 mmHg (hypertensive patients). The mean values of total cholesterol (201 mg/dl versus 188 mg/dl), LDL-c (114 mg/dl versus 112 mg/dl) and triglycerides (206 mg/dl versus 139 mg/dl) were higher in patients with lipid-lowering treatment compared to patients without it. Mean blood glucose was higher in patients with diabetes than in the remaining patients (137 mg/dl versus 97 mg/dl). Conclusions The patients in this study were experienced in antiretroviral treatment and had a satisfactory control of HIV infection. Despite the use of antihypertensive, lipid-lowering and hypoglycaemic treatment, clinical outcomes were not within desirable levels, so improvements in pharmacotherapy follow-up are required in this population. No conflict of interest.
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