lite purpose oíthis stud\ vas tu assess the complianccwitlt tuberculostatic drugs Ireatment ¡u a pimhlic hospital [rom Córdoba City aud tu estahi ish the causes of noncont p lance. AH the patients lo xvii ich lrcatmcnt vith tubercu lostatic cirugs \vas indicated roni .lanuarv 1 99 1 np lo December 1994 \vcre includecl. 45 palienls were imtclucled: 1 8 lmales (40%) and 29 males.Sixteen (35.69/o) did not complete the tinte ol treatment indicatecl. N inc (56.3%) abandoned the treatment 2 ntonthsatter havine initiated it. In de group that did not complete tIte trealnient there 'vas a It igher percentage of flntalc patieiltS (62.5%) than ¡u lite group that did complete it (27.6%). p 0.02. Ihere ''ere not statisticallv signi l'icant di lerences ¡u age. percentages ol pulntonar aud extiaptilmuonar tuberculosis ancl monlhs oftrcatment md icatecl beteen 1)1)111 gronps. lh rtv-six percent otthe pat ¡en t s w tu aba ndor cd thc Ireatmen t re te rred having interrupted it doe lo their O\Vli neglieencv. Lnovingthe risl ofsuch heltavior 36f suffered side ef'fects and did not come backtohospital:2 1 °-referred havinuconsulted another physician skho md icateci lo intcrrupt the treatnient svithaut perliirmn ¡ng othcr rests aud 7% mtiisunderstood de indications. It isconc luded that in a general hospital from Córdoba City. ihe percentage uI palients vho abancloned tubereu lostatic lreatment is It iglt In ntusl cases the cause vas relaleci tu Oiiitmres ni tite condnct ot patients. phvsicians or hoth.

Surv Anesthesiol 2016;60(2):86–87 Chronic postsurgical pain (CPSP) is a frequent cause of persistent pain in the general population and has been linked to a diverse range of surgical settings, but its precise pathogenesis and standardized preventive strategies are widely debated. The authors hypothesized that genetic factors would identify individuals at risk for CPSP within patient populations sharing the same surgical contexts and clinical demographic risk for CPSP.

Background The development of FRAX ® has been useful to simplify the fracture risk assessment of patients, although several studies have shown that this tool underestimates the real risk of fracture in Spanish population. Objectives To develop an accurate model of fracture risk assessment based on FRAX ®, using a cohort of Spanish women followed over a 10 year period and to establish the best thresholds for indication of DXA and indication of treatment (high-risk patients). Methods Longitudinal multicenter study. Women between 40-90 years from FRIDEX cohort (35,000 people in the Barcelona with DXA and extensive questionnaire on risk factors for fracture at baseline), who had been followed during a 10 year period and who had not received any treatment for osteoporosis were selected. New self-reported osteoporotic fractures contrasted with electronic records or clinical reports were collected.The risk of major osteoporotic fracture for Spanish population based on FRAX was assessed in all women. We calculated the Area Under the ROC curve (AUC) for both DXA and 10-year risk of major fracture by FRAX. Results We selected 816 women, mean age 56.8±8.2 years. After 10 years, 76 women (9.3%) had suffered 95 osteoporotic fractures, of which 49 (6%) were major (15 hip, 4 vertebral, 13 humerus and 17 distal radio). Women who suffered a major osteoporotic fracture during the follow-up were significantly older (p<0.001), had more previous fractures (p<0.001), had suffered more falls (p=0.016), and had a higher prevalence of osteoporosis by DXA (60% vs 15%) (p<0.001). The AUC-ROC for predicting future fracture was better for FRAX ® major fracture without and with BMD (0.736 and 0.733 respectively) than for DXA using T-score of femoral neck (0.697). The FRIDEX model was created selecting the best cut-off point for the 10-year absolute risk of major fracture by FRAX without BMD (Table 1). This model classifies women as a low risk (10-year risk or major fracture <5%), intermediate risk (5-7.5%) and high risk (>7.5%). In women with intermediate risk the model reassess the probability of fracture including the T-score of femoral neck by DXA in the FRAX tool and classify these patients as low or high risk for fracture. The application of this model could save 82% of DXA scans and avoid up to 31% of unnecessary treatments. Conclusions The FRIDEX model, compared with DXA based model, has a better discriminative ability to detect women who will suffer osteoporotic fractures over a 10-year period. This model could save unnecessary DXA and osteoporotic treatments. Disclosure of Interest R. Azagra Grant/Research support from: Sponsored by FEDER, IS Carlos III Grant. Spanish Ministry of Science., E. Casado: None Declared, G. Encabo: None Declared, A. Aguyé: None Declared, J. Pujol-Salud: None Declared, J. C. Martín-Sánchez: None Declared, E. Gené: None Declared, M. Zwart: None Declared, M. Iglesias: None Declared, F. Lόpez-Expόsito: None Declared, G. Roca: None Declared, S. Güell: None Declared

Background: Although the role of vitamin D deficiency in causing osteomalacia is well recognised, there is limited evidence to suggest that vitamin D deficiency is associated with osteoporosis. One community based study has suggested a reduction in bone density in females with low vitamin D levels, while another has shown no effect of isolated vitamin D deficiency on population fracture rates. We aimed to assess bone density in a cohort of women with low vitamin D levels but no other identified risk factors for osteoporosis. We wished to see if there was any relationship between the two, in order to clarify whether measurement of vitamin D was justified in aiding selection of patients for DXA, and whether DXA was justified in patients found to have isolated vitamin D deficiency. Methods: We identified 70 women referred to an open access DXA scanning service by their GP with low vitamin D levels (under 48 nmol/l) as their only risk factor. We performed DXA of hip and spine and recorded the absolute bone density and Z scores for each patient, together with their vitamin D levels. We calculated the mean (SD) values for Z score at hip and spine, and compared these to a control group of women referred for baseline DXA prior to commencing aromatase inhibitors for breast cancer. We also compared the results with those obtained from the rest of the GP database for women referred up with a 10 year risk of osteoporotic fractures calculated at over 10% using FRAX. These statistical comparisons were made using unpaired Students t test. Mean values for Z scores at hip and spine were calculated and compared within the index group for those with vitamin D levels above and below 20 nmol/l using Students t test. Correlation coefficients between vitamin D levels and Z scores at hip and spine were also calculated for the index group. Results: Mean (SD) values for Z scores in the hip and spine for patients with isolated vitamin D deficiency were +0.30 (0.87) and +0.46 (0.92) respectively. These were not significantly different from controls whose corresponding values were +0.17 (0.34) and +0.49 (0.45). By contrast, patients with a 10 year risk of fracture of over 10% had lower values at hip −0.01 (0.07) and spine −0.13 (0.09) [p = 0.01]. Mean Z scores for those with very low vitamin D levels (under 20 nmol/l) were not significantly different at either site when compared to those with less severe deficiency (20-48 nmol/l) [p = 0.26]. There was no correlation between vitamin D levels and Z scores at hip or spine [r = 0.01] Conclusions: There was no overall decrease in bone density associated with low vitamin D levels in women in our study. There is no evidence to support the routine measurement of vitamin D to select patients for DXA scanning. There is no reason to perform DXA scans in those patients who have an isolated vitamin D deficiency in the absence of defined risk factors for osteoporosis. Disclosure statement: The authors have declared no conflicts of interest.

Background: To determine the efficacy and safety of intravitreal Avastin (bevacizumab) in the treatment of choroidal neovascularisation (CNV) secondary to pathological myopia (PM).Methods: This paper reports on a consecutive prospective study of patients with CNV secondary to PM who were treated with intravitreal bevacizumab (1.25 mg/0.05 ml). Patients underwent complete ophthalmic evaluation, which included best-corrected visual acuity testing measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography (OCT), and fluorescein angiography.Results: There were 17 eyes of 17 patients, and the mean age was 55.4 (SD 10.0) years. At the 6-month follow-up, the mean visual acuity improved by 8.4 letters (p = 0.04). Forty-one per cent of patients increased at least one line, and 17% increased more than six lines. There were no cases of moderate vision loss (>= 3 lines) or severe vision loss (>= 6 lines). The mean OCT foveal thickness decreased by 79.6 mm (p = 0.002). Favourable outcomes were obtained in all subgroups. Patients received an average of one injection. As a complication, there was a tear of the retinal pigment epithelium. No other ocular or systemic side effects were observed.Conclusion: In our study, intravitreal bevacizumab appeared to be safe and efficacious in eyes with CNV secondary to PM.

To study the prevalence of multiple neoplasms in patients affected by uveal melanoma in Spain and to relate these with survival.We carried out a longitudinal prospective study of the prevalence of multiple neoplasms in patients diagnosed to have a uveal melanoma during the years 1984-2005. The data has been analysed for the following variables: age, sex, date of diagnosis, affected eye, origin and tumoral size, classification according to COMS (Collaborative Ocular Melanoma Study), time of follow-up, presence of other neoplasms, current clinical state, date and cause of death.Three hundred and five patients affected by uveal melanoma have been studied in the Ocular Oncology Unit of our institution; 24 patients (7.9%) had evidence in their medical reports of one or more additional neoplasms. Excluding cutaneous neoplasms originating in basal cells, this number reduced to 22 patients (7.2%). We did not find any statistically significant differences among the presentation age, sex or localization of the melanoma (ciliary body or choroid) and the presence or absence of a second neoplasm. When we analysed the proportion of patients with metastatic disease (both alive and dead) who presented with a second neoplasm (40.9%), we found a statistically significant relationship between these variables (Chi-square test, p=0.004).We have observed a percentage of second neoplasms similar to that described in other international studies. We did not find a larger proportion with a second neoplasm according to the sex, age, or tumoral localization, nor did we observe a higher frequency of any particular second neoplasm. We have defined a relationship between metastasic uveal melanoma, and the development of a second neoplasm, which clearly indicates a need for increased systemic follow-up in such patients.

Purpose: To study the age distribution and survival in patients with uveal melanoma. Methods: A retrospective study was performed on 303 patients diagnosed with uveal melanoma. We analysed the clinical characteristics: age, gender, tumor size and origin, follow-up time, systemic state, survival time and cause of death. Results: The median age of the patients was 60.09 years. The 2-, 5-, and 10-year survival of patients less than 50 years of age at diagnosis was 91.41%, 81.83% and 61.45% respectively. The 2-, 5- and 10year survival of patients equal to or older than 50 years was 90.86%, 73.18% and 58.28% respectively. No significant difference was found between these two age groups. When we considered a possible relationship between the sex factor and survival, in patients equal to or older than 50 years of age, we found a higher survival in men than in women (logrank test; p=0.038). Conclusions: Uveal melanoma in Spain has a similar age distribution to that of other countries, and it is not an infrequent diagnosis in patients under 40 years of age. Survival rates are also similar to that

To study the age distribution and survival in patients with uveal melanoma.A retrospective study was performed on 303 patients diagnosed with uveal melanoma. We analysed the clinical characteristics: age, gender, tumor size and origin, follow-up time, systemic state, survival time and cause of death.The median age of the patients was 60.09 years. The 2-, 5-, and 10-year survival of patients less than 50 years of age at diagnosis was 91.41%, 81.83% and 61.45% respectively. The 2-, 5- and 10-year survival of patients equal to or older than 50 years was 90.86%, 73.18% and 58.28% respectively. No significant difference was found between these two age groups. When we considered a possible relationship between the sex factor and survival, in patients equal to or older than 50 years of age, we found a higher survival in men than in women (log-rank test; p=0.038).Uveal melanoma in Spain has a similar age distribution to that of other countries, and it is not an infrequent diagnosis in patients under 40 years of age. Survival rates are also similar to that of other series. We have not found any significant difference between the age of our patients and the survival, although if we analysed the subgroups, we found that the men equal to or over 50 years of age had a better survival than the women of the same age.

PURPOSE To study the prevalence of multiple neoplasms in patients affected by uveal melanoma in Spain and to relate these with survival. METHOD We carried out a longitudinal prospective study of the prevalence of multiple neoplasms in patients diagnosed to have a uveal melanoma during the years 1984-2005. The data has been analysed for the following variables: age, sex, date of diagnosis, affected eye, origin and tumoral size, classification according to COMS (Collaborative Ocular Melanoma Study), time of follow-up, presence of other neoplasms, current clinical state, date and cause of death. RESULTS Three hundred and five patients affected by uveal melanoma have been studied in the Ocular Oncology Unit of our institution; 24 patients (7.9%) had evidence in their medical reports of one or more additional neoplasms. Excluding cutaneous neoplasms originating in basal cells, this number reduced to 22 patients (7.2%). We did not find any statistically significant differences among the presentation age, sex or localization of the melanoma (ciliary body or choroid) and the presence or absence of a second neoplasm. When we analysed the proportion of patients with metastatic disease (both alive and dead) who presented with a second neoplasm (40.9%), we found a statistically significant relationship between these variables (Chi-square test, p=0.004). CONCLUSIONS We have observed a percentage of second neoplasms similar to that described in other international studies. We did not find a larger proportion with a second neoplasm according to the sex, age, or tumoral localization, nor did we observe a higher frequency of any particular second neoplasm. We have defined a relationship between metastasic uveal melanoma, and the development of a second neoplasm, which clearly indicates a need for increased systemic follow-up in such patients.

PURPOSE:To study the age distribution and survival in patients with uveal melanoma.METHODS:A retrospective study was performed on 303 patients diagnosed with uveal melanoma. We analysed the clinical characteristics: age, gender, tumor size and origin, follow-up time, systemic state, survival time and cause of death.RESULTS:The median age of the patients was 60.09 years. The 2-, 5-, and 10-year survival of patients less than 50 years of age at diagnosis was 91.41%, 81.83% and 61.45% respectively. The 2-, 5- and 10-year survival of patients equal to or older than 50 years was 90.86%, 73.18% and 58.28% respectively. No significant difference was found between these two age groups. When we considered a possible relationship between the sex factor and survival, in patients equal to or older than 50 years of age, we found a higher survival in men than in women (log-rank test; p=0.038).CONCLUSIONS:Uveal melanoma in Spain has a similar age distribution to that of other countries, and it is not an infrequent diagnosis in patients under 40 years of age. Survival rates are also similar to that of other series. We have not found any significant difference between the age of our patients and the survival, although if we analysed the subgroups, we found that the men equal to or over 50 years of age had a better survival than the women of the same age.

Transocular fine-needle aspiration biopsy (FNAB) with analysis of the aspirate is a diagnostic technique that can be helpful in selected cases of suspected intraocular tumors. In most cases, the improvement in clinical diagnostic imaging permits an accurate diagnosis, but in selected cases, histological confirmation is necessary to rule out other malignancies. The FNAB was introduced into ophthalmology by Schyberg in 1975 for the diagnosis of orbital neoplasm. In 1979, Jakobiec et al proposed the use of FNAB in the evaluation of intraocular tumors. Since then, this technique has been used in a large number of patients without any evidence of local or systemic spread. In this article, we report the first described case of a local epibulbar seeding at the scleral pars plana puncture site after a transvitreal FNAB.

Aim: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD).Methods: According to greatest linear dimension (GILD) of the entire lesion determined with fluorescein angiography (FA) patients were divided into two groups. In the first group GILD was <3000 μm and in the second one GLD was 3000-5000 μm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA).Results: 64 patients (mean (SD) age, 76.7 (7.7) years; range 58-95 years) were recruited to participate in the study. All participants in the study completed the follow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesions (n = 32) compared with 15 patients (46.8%) in the group of larger lesions of (n = 32) did not show significant leakage in FA at the end of follow up (p = 0.02). A GLD increase > 1000 mum was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p = 0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the group of larger lesions lost less than three lines of vision (p = 0.06). Relevant side effects related to verteporfin therapy were not recorded except for four patients (6.2%) with infusion related back pain.Conclusions: These results suggest that lesion size at baseline may be a prognosis factor in PDT in patients with subfoveal predominantly classic CNV secondary to AMD. There are no relevant side effects or safety concerns derived from verteporfin therapy.

ABSTRACT It is well established that the gp120 V3 loop of T-cell-line-adapted human immunodeficiency virus type 1 (HIV-1) binds both cell-associated and soluble polyanions. Virus infectivity is increased by interactions between HIV-1 and heparan sulfate proteoglycans on some cell types, and soluble polyanions such as heparin and dextran sulfate neutralize HIV-1 in vitro. However, the analysis of gp120-polyanion interactions has been limited to T-cell-line-adapted, CXCR4-using virus and virus-derived gp120, and the polyanion binding ability of gp120 regions other than the V3 loop has not been addressed. Here we demonstrate by monoclonal-antibody inhibition, labeled heparin binding, and surface plasmon resonance studies that a second site, most probably corresponding to the newly defined, highly conserved coreceptor binding region on gp120, forms part of the polyanion binding surface. Consistent with the binding of polyanions to the coreceptor binding surface, dextran sulfate interfered with the gp120-CXCR4 association while having no detectable effect on the gp120-CD4 interaction. The interaction between polyanions and X4 or R5X4 gp120 was readily detectable, whereas weak or undetectable binding was observed with R5 gp120. Analysis of mutated forms of X4 gp120 demonstrated that the V3 loop is the major determinant for polyanion binding whereas other regions, including the V1/V2 loop structure and the NH 2 and COOH termini, exert a more subtle influence. A molecular model of the electrostatic potential of the conserved coreceptor binding region confirmed that it is basic but that the overall charge on this surface is dominated by the V3 loop. These results demonstrate a selective interaction of gp120 with polyanions and suggest that the conserved coreceptor binding surface may present a novel and conserved target for therapeutic intervention.