Becerra J.L.,Hospital Germans Trias i Pujol |
Ojeda J.,Hospital Universitario Infanta Sofia |
Corredera E.,Hospital Clinico Universitario Of Santiago Of Compostela |
Gimenez J.R.,Hospital Virgen Of Las Nieves
CNS Drugs | Year: 2012
Epilepsy is one of the most common serious neurological conditions worldwide, with an age-adjusted incidence of approximately 50 per 100 000 persons per year in developed countries. Antiepileptic therapy can result in long-term remission in 60-70% of patients, but many patients will require combination treatment to achieve optimal seizure control, as monotherapy is ineffective at controlling seizures in 30-53% of patients. Despite the increase in available treatment options, patient outcomes have not improved significantly and there is still a need for more effective therapies. Drugs used in the treatment of focal-onset seizures are a diverse range of compounds, and in most cases their mechanism of action is unknown or poorly defined. This review discusses the efficacy and safety of the newer adjuvant antiepileptic therapies that may improve outcomes in patients unresponsive to monotherapy, including clobazam, vigabatrin, lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam, oxcarbazepine, pregabalin, zonisamide and eslicarbazepine, with focus on lacosamide. Lacosamide has been shown to exert its anticonvulsant effects predominantly by enhancement of the slow inactivation of voltage-gated sodium channels. Lacosamide is indicated for use as adjuvant treatment of focal-onset seizures in patients with epilepsy, and there is some evidence that it may also be of use in patients with status epilepticus and cancer patients with epilepsy. The efficacy of lacosamide has been assessed in three randomized, double-blind, placebo-controlled clinical trials, all of which have shown lacosamide to be effective at reducing seizure frequency and increasing 50% responder rates in patients with focal-onset seizures. Long-term lacosamide treatment is generally well tolerated and is not associated with significant drug interactions; the availability of an intravenous form of the drug also makes it particularly useful for a broad range of patients. © 2011 Adis Data Information BV. All rights reserved.
Cobo-Ibanez T.,Hospital Universitario Infanta Sofia |
Loza-Santamaria E.,Institute for Musculoskeletal Health |
Pego-Reigosa J.M.,Institute Investigacion Biomedica Of Vigo Ibiv |
Marques A.O.,Hospital Universitario Germans Trias i Pujol |
And 5 more authors.
Seminars in Arthritis and Rheumatism | Year: 2015
Objective: To analyse the efficacy and safety of rituximab in the treatment of non-renal systemic lupus erythematosus (SLE). Methods: We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials up to June 2013. The following were the selection criteria: (1) adult patients with SLE, (2) rituximab treatment, (3) placebo or active comparator, (4) outcome measures assessing efficacy and/or (5) safety. Meta-analysis, systematic literature reviews, randomised control trials (RCT), open clinical trials and cohort studies were included.Independent extraction of articles by 2 authors using predefined data fields was performed. The quality of each study was graded using the Oxford Levels of Evidence and Jadad's scale. Results: A total of 26 articles met our inclusion criteria: one RCT and its exploratory analysis, 2 open studies and 22 cohort studies, which analysed 1,231 patients. Overall, patients had active disease refractory to steroids and/or immunosuppressant drugs. Acceptable evidence suggested improvements in disease activity, arthritis, thrombocytopaenia, complement and anti-dsDNA, with a steroid-sparing effect. But relapses of disease were demonstrated too. Weak evidence suggested a response in anaemia, cutaneous and neuropsychiatric manifestations. Available evidence revealed few major adverse events. Studies had medium methodological quality and in general were applicable to current practice. Conclusion: Rituximab has been shown to be safe and effective in the treatment of non-renal SLE, especially in terms of disease activity, immunologic parameters and steroid-sparing effect. However, it can only be recommended for organ-specific manifestations such as arthritis and thrombocytopaenia. High-quality studies are needed in order to consider the long-term effects of re-treatment on different organ-specific manifestations. © 2014 Elsevier Inc.
Silva-Fernandez L.,Hospital Universitario Of Guadalajara |
Loza E.,Institute for Musculoskeletal Health |
Martinez-Taboada V.M.,University of Cantabria |
Blanco R.,University of Cantabria |
And 3 more authors.
Seminars in Arthritis and Rheumatism | Year: 2014
Objective: Relapses and failure are frequent in systemic vasculitis (SV) patients. Biological agents have been prescribed as rescue therapies. The aim of this systematic review is to analyze the current evidence on the therapeutic use of biological agents for SV. Methods: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to the end of April 2013. Systematic reviews and meta-analysis, clinical trials, cohort studies, and case series with >3 patients were included. Independent article review and study quality assessment was done by 2 investigators with consensus resolution of discrepancies. Results: Of 3447 citations, abstracts, and hand-searched studies screened, 90 were included. Most of the studies included ANCA-associated vasculitis (AAV) patients and only a few included large vessel vasculitis (LVV) patients. Rituximab was the most used agent, having demonstrated efficacy for remission induction in patients with AAV. A number of studies used different anti-TNFα agents with contrasting results. A few uncontrolled studies on the use of abatacept, alemtuzumab, mepolizumab, and tocilizumab were found. Conclusion: Current evidence on the use of biological therapies for SV is mainly based on uncontrolled, observational data. Rituximab is not inferior to cyclophosphamide for remission induction in AAV and might be superior in relapsing disease. Infliximab and adalimumab are effective as steroid-sparing agents. Etanercept is not effective to maintain remission in patients with granulomatosis with polyangiitis, and serious adverse events have been reported. For LVV, both infliximab and etanercept had a role as steroid-sparing agents, and tocilizumab might be effective also for remission induction in LVV. © 2014 Elsevier Inc.
Roupret M.,University Pierre and Marie Curie |
Morgan T.M.,University of Michigan |
Bostrom P.J.,University of Turku |
Cooperberg M.R.,University of California at San Francisco |
And 10 more authors.
European Urology | Year: 2014
Social media use is becoming common in medical practice. Although primarily used in this context to connect physicians, social media allows users share information, to create an online profile, to learn and keep knowledge up to date, to facilitate virtual attendance at medical conferences, and to measure impact within a field. However, shared content should be considered permanent and beyond the control of its author, and typical boundaries, such as the patient-physician interaction, become blurred, putting both parties at risk. The European Association of Urology brought together a committee of stakeholders to create guidance on the good practice and standards of use of social media. These encompass guidance about defining an online profile; managing accounts; protecting the reputations of yourself and your organization; protecting patient confidentiality; and creating honest, responsible content that reflects your standing as a physician and your membership within this profession. © 2014 European Association of Urology.
Lopez-Gomez M.,Hospital Universitario Infanta Sofia |
Malmierca E.,Hospital Universitario Infanta Sofia |
de Gorgolas M.,Foundation Medicine |
Casado E.,Hospital Universitario Infanta Sofia
Critical Reviews in Oncology/Hematology | Year: 2013
Cancer is a global problem that accounts for almost 13% of deaths worldwide, a number similar to the 7 million deaths each year from HIV/AIDS, TB and malaria combined According to Globocan it is estimated that by 2020, there will be between 15 and 17 million new cases of cancer every year, 60% of which will be in developing countries. Moreover, the survival rates in these regions are often half those of developed countries. However, cancer is potentially the most preventable disease; with current resources, one-third of tumors could be preventable, and another one-third of newly diagnosed cancer patients could experience increased survival or early-stage detection. There have been proposed several strategies and programs to ameliorate cancer prevention and treatment in less developed countries. If all these proposed strategies are taken into consideration, worldwide cancer care, control and survival in low-income countries may improve in the years to come. © 2013 Elsevier Ireland Ltd.
Diaz-Diaz R.M.,Hospital Universitario Infanta Sofia
Actas Dermo-Sifiliograficas | Year: 2014
We review advertisements published in the journal . Actas Dermosifiliográficas between 1909 and 1939. Treatments for sexually transmitted diseases were advertised with particular frequency, and they offer a case in point that exemplifies the close relationship between the pharmaceutical industry and medical journals. Aportamos algunos datos acerca de los anuncios publicados en la revista . Actas Dermosifiliográficas durante el periodo 1909-1939. Destacan los anuncios relacionados con el tratamiento de las enfermedades de transmisión sexual. Son un ejemplo de la estrecha relación existente entre la industria farmacéutica y las revistas médicas. © 2012 Elsevier España, S.L. and AEDV.
Rodriguez Jimenez M.J.,Hospital Universitario Infanta Sofia
Medicine (Spain) | Year: 2014
The possibility of contracting a sexually transmitted infections (STIs) is higher in adolescents than in adults, favoured by the early onset of sexual relations, the high number of different sexual partners or the lack of use of preventive methods such as the condom. Ignorance of STIs can be also considered a risk factor for them. From the biological point of view, adolescents are more susceptible to infection and, although the clinical features of STIs are similar to the adults, are at increased risk of morbidity and long-term sequelae. The complications of STIs, when not detected early and treated properly, can cause significant impact on the health of the individual from the neoplastic transformation induced by human papillomavirus (HPV) virus to infertility chlamydial or gonococcal infections upper genital tract involvement.
Gutierrez-Gutierrez G.,Hospital Universitario Infanta Sofia
Medicine (Spain) | Year: 2015
Polyneuropathies (PNP) affect 2-8% of the population, have numerous causes and not all can be treated. When studying a PNP, it is advisable to start by classifying the PNP into patterns, each with a reduced differential diagnosis. To this end, we must properly define the PNP through the assessment of a series of clinical characteristics that can be determined through a proper review of the case history and a careful examination. Neurophysiological studies are also essential for classifying the PNP into demyelinating or axonal and determining the predominant type of affected fibers. Lastly, certain additional tests (from blood tests to genetic studies) will provide the definitive diagnosis.
Diaz-Diaz R.M.,Hospital Universitario Infanta Sofia
Actas Dermo-Sifiliograficas | Year: 2014
We review advertisements published in the journal Actas Dermosifiliográficas between 1909 and 1939. Treatments for sexually transmitted diseases were advertised with particular frequency, and they offer a case in point that exemplifies the close relationship between the pharmaceutical industry and medical journals. © 2012 Elsevier España, S.L. and AEDV. All rights reserved.
Moreno-Zabaleta R.,Hospital Universitario Infanta Sofia
Revista de Patologia Respiratoria | Year: 2015
Acute pulmonary edema (APE), fundamentally of cardiogenic origin, entails a significant care load in the hospital emergencyservices and is an important cause of death. Together with optimal medical treatment, many guidelines recommend the useof continuous positive airway pressure (CPAP) or non-invasive mechanical ventilation. Although the meta-analyses publishedup to date show sufficient evidence to recommend the use of ventilatory devices in acute pulmonary edema, there is a clinicaltrial including approximately 1000 patients in which no clear advantage of the CPAP or non-invasive mechanical ventilationover oxygen therapy in the treatment of these patients was demonstrated. This has generated some controversy regarding themanagement of acute pulmonary edema with ventilatory therapies. As an alternative, there are other non-mechanical devicessuch as Boussignac CPAP or high flow humidified oxygen therapy whose results seem to be similar to CPAP or non-invasivemechanical ventilation in the initial studies.