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Fenix-Caballero S.,Puerto Real Universitary Hospital | Alegre-Del Rey E.J.,Puerto Real Universitary Hospital | Castano-Lara R.,Ceuta Universitary Hospital | Puigventos-Latorre F.,Son Espases Universitary Hospital | And 2 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2013

What is known and Objective Psoriatic arthritis is an autoimmune disease characterized by chronic inflammation of the skin and joints. Anti-TNF drugs reduce the severity of the disease in the long term. This study compares the efficacy and safety of adalimumab, etanercept, infliximab and golimumab in patients with psoriatic arthritis. Methods Direct comparison was based on a literature search of drug comparison studies, whereas indirect treatment comparison was based on phase III clinical trials with biological agents, involving similar populations and durations, and with the same outcome. ACR50 was taken as primary outcome for comparison, whereas ACR20 and ACR70 were used as secondary outcomes. Indirect comparisons were made using infliximab as the reference drug and the Bucher method. In calculating δ (the maximum acceptable difference as a clinical criterion of equivalence), use was made of half of the absolute risk reduction obtained in the meta-analysis of the clinical trials included in the indirect comparison (ARR 32%; δ: 16%). The four anti-TNF drugs were also compared in relation to the secondary outcomes and adverse effects. Results and Discussion Reported direct and indirect comparisons of the four drugs did not include golimumab, and did not yield conclusive results. Four clinical trials - one for each drug studied - were identified. The estimated differences for the primary outcome, ACR50, between infliximab and the other drugs were adalimumab (ARR 4%, 95% CI -9·5 to 17·5), etanercept (ARR 4%, 95% CI -10·5 to 18·5) and golimumab (ARR 9%, 95% CI -5·4 to 23·4). Likewise, there were no relevant differences between the drugs in relation to the secondary efficacy outcomes, except for etanercept, which was less effective in ACR70 response. For adverse reactions, there were also no significant differences except for injection site, reactions which were more frequent with etanercept, with a mean difference of 26% relative to infliximab. What is new and Conclusion No significant differences were found in ACR50 responses to the four drugs after 24 weeks. Injection-site reactions were more common with etanercept, but this was insufficient to invalidate the inference that clinically the four drugs can be regarded as clinically equivalent for the treatment of psoriatic arthritis. © 2013 John Wiley & Sons Ltd. Source


Di Minno G.,Regional Reference Center for Coagulation Disorders | Canaro M.,Son Espases Universitary Hospital | Ironside J.,University of Edinburgh | Navarro D.,University of Valencia | And 3 more authors.
Seminars in Thrombosis and Hemostasis | Year: 2013

Substantial improvements in the safety of blood and plasma products for the management of bleeding disorders have been achieved in recent decades. This has led some clinicians to believe that the infectious threat is over and that inhibitor formation is the foremost complication of hemophilia therapy. On the contrary, elimination of all microbes from blood is difficult, potentially impossible, and there are always threats from emerging pathogens. The risk of infection transmission is also increasing due to greater exposure to products, increasing prophylaxis and high-dose regimens for immune tolerance, and longevity of hemophilia patients. Current products can be considered "reasonably safe,o" but pathogen testing is not all-inclusive, and manufacturing and purification techniques are often not standardized. Although safer nonplasma-derived products are widely used, they are not available for all bleeding disorders, and so there is an ongoing need for plasma-derived products. This review will discuss the evolving risk from emerging pathogens in the context of the issues described. Reducing the risk from emerging infections requires global collaboration to devise ways to monitor and continue to improve blood safety. © 2013 by Thieme Medical Publishers, Inc. Source


Masa J.F.,San Pedro de Alcantara Hospital | Masa J.F.,CIBER ISCIII | Duran-Cantolla J.,Alava University Hospital | Duran-Cantolla J.,University of the Basque Country | And 51 more authors.
Sleep | Year: 2015

Conclusion: Automatic home single-channel nasal pressure scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary.Introduction: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored.Objectives: To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables.Methods: Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points.Results: Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP. Source


Grases F.,University of the Balearic Islands | Saez-Torres C.,University of the Balearic Islands | Rodriguez A.,University of the Balearic Islands | Costa-Bauza A.,University of the Balearic Islands | And 4 more authors.
Journal of Renal Nutrition | Year: 2014

Objective: Although the incidence of urolithiasis is lower in children than in adults, the number of children with urolithiasis is increasing. Phytate, a naturally occurring compound present in legumes, nuts, and whole meals, has antilithiasic activity. The aim of this study was to assess, for the first time, the urinary levels of phytate in children and to correlate these levels with other urinary parameters related to crystallization risk and to general dietary habits. Design and Methods: This was a cohort study conducted from April 2012 to March 2013 in the Laboratory of Investigation in Renal Lithiasis and at Son Espases Universitary Hospital in Palma de Majorca, Spain. Subjects: Subjects included 165 healthy schoolchildren aged 5 to 12years. Intervention: All subjects followed their habitual diet. Information on the main dietary habits of the study subjects was obtained by asking each child's parents to fill out a dietary questionnaire. Main Outcome Measure: Phytate and citrate concentration and excretion were measured in 2 urine samples (a spot sample and a 12-hour overnight sample) for each child. Furthermore, common urinary biochemical indicators of stone risk were measured in each sample. Results: The urinary phytate concentrations were low in this child population because of low consumption of dietary phytate. The urinary concentrations of phytate and citrate were low in 27.5% of these children. Conclusion: Because both substances are important inhibitors of crystallization, these finding suggests that these children are at risk of crystallization. Moreover, their diets consisted of foods rich in animal protein, with insufficient consumption of vegetables, legumes, and fruits. © 2014 National Kidney Foundation, Inc. Source


Saez-Torres C.,University of the Balearic Islands | Grases F.,University of the Balearic Islands | Rodrigo D.,Son Espases Universitary Hospital | Garcia-Raja A.M.,Son Espases Universitary Hospital | And 2 more authors.
Pediatric Nephrology | Year: 2013

Background: The prevalence of lithiasis is increasing at all ages. This study aimed to assess the crystallization risk in urine from healthy school children and to determine urinary parameters that are most associated with it. Methods: Urine samples were obtained from 184 children aged 5-12 years: a spot sample collected in the afternoon, and a 12-h overnight sample. Information was obtained regarding family histories of lithiasis. Urine volume, pH, and biochemical parameters of stone risk were measured. Crystallization risk was defined by the presence of specific urine conditions that had previously been associated with stone formation in vitro. Results: Crystallization risk was observed in 15 % of spot urine samples and 54 % of 12-h samples. Metabolic abnormalities and a low urinary volume were more frequently detected in children with crystallization risk. Calcium excretion and calcium/citrate ratio were higher in children with a family history of lithiasis. Conclusions: We observed a high prevalence of crystallization risk in urine, especially in children with a family history of the disease. Low urinary volume was the factor most associated with increased risk. Adequate fluid intake at an early age may be a simple and effective measure to reduce the incidence of nephrolithiasis. © 2012 IPNA. Source

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