Cristina Masuet-Aumatell

One-year results of a flexible regimen with ranibizumab therapy in macular degeneration: relationship with the number of injections.

Purpose: To evaluate the efficacy and safety of a flexible regimen with intravitreal injections of ranibizumab in patients with naive choroidal neovascularization secondary to age-related macular degeneration and to determine whether the final outcome is related to the number of injections. Methods: Prospective, noncomparative, consecutive case series study. We included 90 eyes of 88 patients that were initially treated with 3 consecutive monthly intravitreal injections of ranibizumab, and thereafter, follow-up visits were progressively spread out to a maximum of 8 weeks apart in the absence of visual acuity loss and signs of lesion activity. The primary end points were changes in visual acuity (Early Treatment Diabetic Retinopathy Study letters), foveal thickness measured by spectral-domain optical coherence tomography, and lesion size (LS) measured by fluorescein angiography. Results: The median visual acuity improved from 53 letters at baseline to 60 letters at Month 1 (P < 0.0001), 63 letters at Month 3 (P < 0.0001), and 60 letters at Month 12 (P < 0.0001). A significant reduction was also observed in foveal thickness and LS (P < 0.0001). The mean number of injections was 4.4, and the mean number of visits was 8.0. Treatment consisted of 3 injections for 40% of patients, and 60% of patients received more than 3 injections. No significant association was observed between the visual acuity improvement and the number of injections. No relevant side effects were observed. Conclusion: A flexible regimen with ranibizumab therapy is efficacious and safe in patients with neovascular age-related macular degeneration, reducing both the burden of injections and follow-up visits. The visual acuity improvement was independent of the number of injections.

Combining varenicline and nicotine patches: a randomized controlled trial study in smoking cessation

BackgroundSome smokers may benefit from a therapy that combines different nicotine replacement therapies (NRT) or drugs with different mechanisms of action.The aim of this study was to determine the efficacy of the combined therapy of varenicline and nicotine patches versus varenicline monotherapy.MethodsThree hundred forty-one smokers who smoked 20 or more cigarettes per day were recruited from a smoking cessation clinic between February 2012 and June 2013. The participants were randomized to receive a varenicline plus nicotine patch of 21 mg every 24 hours (170) or varenicline plus a placebo patch (171). All of the smokers received a standard 12-week course of varenicline and an 11-week course of either the placebo patch or the active patch after the target quit day. Both groups received behavioral support. The primary outcome was continuous abstinence for weeks 2 through 12 confirmed by exhaled levels of carbon monoxide. Post hoc subgroup analyses were performed to evaluate the treatment effects for a specific endpoint in subgroups of smokers.ResultsThe combination of the nicotine patch with varenicline was not associated with higher rates of continuous abstinence at 12 weeks (39.1% versus 31.8%; odds ratio (OR) 1.24; 95% confidence interval (CI) 0.8 to 2.6) and 24 weeks (32.8% versus 28.2%; OR 1.17; 95% CI 0.4 to 1.9). When participants were analyzed by subgroups according to cigarette consumption, the abstinence rates among smokers who smoked more than 29 cigarettes per day at 12 weeks (OR 1.39; 95% CI 1.2 to 2.5) and 24 weeks (OR 1.46; 95% CI 1.2 to 2.8) were significantly higher in the combination group. Other post hoc analyses based on level of dependence and previous quit attempts did not show subgroup differences. No differences between the groups for the reported adverse events were observed (χ2 value 0.07; P 0.79).ConclusionsThe combination of varenicline with the nicotine patch does not improve abstinence rates at 12 and 24 weeks compared with varenicline used as monotherapy when all smokers were analyzed as a whole, independent of consumption level.Trial registrationThis study is registered at clinicaltrial.gov (NCT01538394).

Endoresection Versus Iodine-125 Plaque Brachytherapy for the Treatment of Choroidal Melanoma

PURPOSE To compare the effectiveness of pars plana vitrectomy endoresection with iodine-125 brachytherapy in the treatment of choroidal melanoma. DESIGN A nested case-control study (1:2) from a surgical cohort. METHODS The study comprised 81 choroidal melanoma patients treated with either endoresection or iodine-125 brachytherapy. Twenty-seven patients who had undergone endoresection were matched according to tumor height and postequatorial tumor location with 54 cases treated with iodine-125 brachytherapy. Metastatic disease, overall survival, local tumor recurrence, visual acuity, and secondary enucleation rates were analyzed and compared between groups. RESULTS Metastatic spread was observed in 11 patients in the iodine-125 brachytherapy group vs only 1 patient in the endoresection group (20.4% and 3.7%, respectively, P = .053). Fourteen patients died during follow-up: 11 in the brachytherapy arm vs 3 in the endoresection arm (20.4% and 11.1%, respectively, P = .238). For the iodine-125 brachytherapy and endoresection groups, respectively, the 5-year Kaplan-Meier estimates were as follows: overall survival, 81.5% vs 89.2% (log-rank test, P = .429;); relapse-free survival, 96.6% vs 92.4% (P = .2); visual acuity retention equal or superior to 20/200, 66.4% vs 59.9% (P = .083), and eye retention, 85.7% vs 87.8% (P = .942). CONCLUSIONS Endoresection for choroidal melanoma is an effective treatment modality in selected cases of posterior choroidal melanomas, with outcomes similar to those obtained with iodine-125 brachytherapy.

A multicentre randomized trial of combined individual and telephone counselling for smoking cessation

OBJECTIVE The present study assessed the effectiveness of smoking cessation programs combining individual and telephone counselling, compared to individual or telephone counselling alone. METHOD A randomized, multicentre, open-label trial was performed between January 2009 and July 2011 at six smoking cessation clinics in Spain. Of 772 smokers assessed for eligibility, 600 (77%) met inclusion criteria and were randomized. Smokers were randomized to receive individual counselling, combined telephone and individual counselling, or telephone counselling. The primary outcome was biochemically validated continuous abstinence at 52 weeks. RESULTS The 52-week abstinence rate was significantly lower in the telephone group compared to the combined group (20.1% vs. 29.0%; OR, 1.32; 95% CI, 1.1-2.7) and to the individual counselling group (20.1% vs. 27.9%; OR, 1.37; 95% CI, 1.0-2.8). The 52-week abstinence rates were not significantly higher in the combined group than the individual group (OR, 0.97; 95% CI, 0.7-1.4). CONCLUSION Individual counselling and combined individual and telephone counselling were associated with higher 52-week abstinence rates than telephone counselling alone. A combined approach may be highly useful in the clinical treatment of smokers, as it involves less clinic visits than individual counselling alone, thus reducing the program cost, and it increases patient compliance compared to telephone counselling alone.

Awareness of Meningococcal Disease among Travelers from the United Kingdom to the Meningitis Belt in Africa

Meningococcal disease causes considerable morbidity and has a high case-fatality rate. In the United Kingdom, the meningococcal quadrivalent vaccine is recommended for travelers visiting the meningitis belt of Africa. We analyzed 302 responses to a cross-sectional study conducted in 2010 of travelers who had visited the meningitis belt recently or were shortly due to travel there. Using the results of an online questionnaire, we assessed knowledge and understanding of meningococcal disease and likelihood of uptake of meningococcal immunization before travel. Meningococcal vaccine uptake was 30.1%. Although global scores in the questionnaire did not correlate with vaccine uptake, knowledge of the meningitis belt and knowledge of certain key symptoms or signs were statistically associated with high vaccine uptake. We conclude that improved education of travelers may improve vaccine uptake before travel to the meningitis belt in Africa.

Measles in Bolivia: A ‘honeymoon period’

BACKGROUND Although measles is a highly infectious disease, the live measles vaccine provides protection for over 20 years, and immunity may be lifelong. This study assessed measles seroprevalence in schoolchildren in the Cochabamba region of Bolivia. METHODS A seroepidemiological survey of measles immunity in 5-16-year-old schoolchildren (n=441) living in the Cochabamba region of Bolivia was performed in March and April of 2010. Representative regional samples of school children from 14 schools were obtained. A parent-administered questionnaire collected sociodemographic and socio-economic status, and serum samples were tested for measles antibodies using an enzyme-linked fluorescent antibody test. The measles prevalence and corresponding 95% confidence intervals (CI) were calculated. A descriptive and bivariate analysis was performed using the ANOVA or the Kruskal-Wallis test according to whether the data were distributed normally (Kolmogorov-Smirnov test p-value<0.05) plus the chi-square test or Fishers exact test as needed. RESULTS The global seroprevalence of measles was 69.61% (95% CI 65.32-73.90) and was higher in adolescents (84.16%, 95% CI 77.04-91.28) and Spanish speakers (74.74%, 95% CI 68.56-80.92). The seroprevalence did not differ according to socio-economic status, living area, or number of family members in the household. CONCLUSIONS This study found a high prevalence of measles susceptibility in Bolivian children. Thus, herd immunity may not have been established, and some outbreak could occur. Authorities should redress this situation before endemic measles transmission occurs nationally and regionally, and there is an urgent need to conduct more seroprevalence studies in the region.

Seroprevalence of varicella-zoster virus infection in children from Cochabamba: tropical or temperate pattern?

To determine the seroprevalence of varicella‐zoster viral (VZV) infections in schoolchildren from the Cochabamba region (Bolivia), and its association with socio‐demographic variables, socio‐economic status and geographical location.

Prevention of influenza among travellers attending at a UK travel clinic: beliefs and perceptions. A cross-sectional study.

Please cite this paper as: Masuet‐Aumatell et al. (2012) Prevention of influenza among travellers attending at a UK travel clinic: beliefs and perceptions. A cross‐sectional study. Influenza and Other Respiratory Viruses 7(4), 574–583.

Prevalence of hepatitis A antibodies in Eastern Bolivia: a population-based study.

The seroprevalence of hepatitis A virus (HAV) is changing from high to intermediate endemicity in several Latin American countries, but the pattern in the Andean Latin American countries is unknown. A seroepidemiological survey (n = 436) of HAV in schoolchildren living in the Cochabamba region of Bolivia was conducted in 2010. A questionnaire was completed by parents to obtain demographic, socio‐economic, and housing data, and blood samples were collected. The overall prevalence of HAV IgG was 95.4% (95% CI 93.5–97.4). The prevalence was higher in children aged 5–10 years (97%) and pre‐adolescents aged 10–13 years (97.9%). The prevalence was also higher in subjects whose parents had a low level of education (99.4–99.5%), who lived in rural areas (98.7%), lived in municipalities with low urban development (99.1–100%), had water delivered at home from a tanker (99.4%), and spoke Quechua at home (99.5%). The descriptive and bivariate analysis suggested that no change in HAV epidemiology has occurred in Cochabamba. J Med. Virol. 85:1692–1697, 2013.

Quadrivalent meningococcal conjugated vaccine: A routine or selective vaccine in Europe?

At present, two quadrivalent A, C, Y, W135 meningococcal conjugate vaccines are licensed, one in Europe and two in the United States of America and Canada, both of which can be administered from 2 to 55 years of age, or even since 9 months of age in children at increased risk for invasive meningococcal disease, and can be used interchangeably because of their similar efficacy and safety profiles. This editorial reviews the public health approach to the elimination of meningococcal disease which varies from country to country by applying either a strategy of national routine or selective immunisation. Meningococcal disease remains a major public health problem worldwide, being mainly endemic and hyperendemic in developing countries. The incidence rates are highest in the ‘meningitis belt’ of sub-Saharan Africa reaching 25 cases per 100,000 population for endemic disease and 1000 cases per 100,000 population during epidemics. Meningococcal ACYW135 vaccine is recommended for people who travel to or reside in countries where Neisseria meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged. The quadrivalent meningococcal vaccination is a mandatory vaccination for pilgrims going on Hajj or Umrah where due to the overcrowded conditions, the risk of meningococcal disease is significant. The prevention of international outbreaks of meningococcal disease as a consequence of travel underpin the requirement of meningococcal vaccination and indeed, a meningococcal vaccination programme. Although meningococcal polysaccharide vaccine protects against invasive disease, it does not prevent acquisition and carriage and may not prevent transmission from returning travellers to unvaccinated household and other close contacts. Travellers to the SubSaharan meningitis belt where large outbreaks of serogroup A orW135 occur are recommended to receive selective quadrivalent vaccine rather than the bivalent vaccine, where available, because of the additional protection against serogroups W135 and Y. The conjugate quadrivalent meningococcal vaccine is advantageous in inducing immunological memory, overcoming hyporesponsiveness induced by the polysaccharide vaccine as well as reducing acquisition of nasopharyngeal carriage.