PublicationPredictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.(2022) Estella, Á; Garcia Garmendia, J L; de la Fuente, C; Machado Casas, J F; Yuste, M E; Amaya Villar, R; Estecha, M A; Yaguez Mateos, L; Cantón Bulnes, M L; Loza, A; Mora, J; Fernández Ruiz, L; Díez Del Corral Fernández, B; Rojas Amezcua, M; Rodriguez Higueras, M I; Díaz Torres, I; Recuerda Núñez, M; Zaheri Beryanaki, M; Rivera Espinar, F; Matallana Zapata, D F; Moreno Cano, S G; Gimenez Beltrán, B; Muñoz, N; Sainz de Baranda Piñero, A; Bustelo Bueno, P; Moreno Barriga, E; Rios Toro, J J; Pérez Ruiz, M; Gómez González, C; Breval Flores, A; de San José Bermejo Gómez, A; Ruiz Cabello Jimenez, M A; Guerrero Marín, M; Ortega Ordiales, A; Tejero-Aranguren, J; Rodriguez Mejías, C; Gomez de Oña, J; de la Hoz, C; Ocaña Fernández, D; Ibañez Cuadros, S; Garnacho Montero, J; Work Group of Infectious Disease (GTEI) de la Sociedad Andaluza de Medicina Intensiva y Unidades coronarias SAMIUCThe objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Prospective descriptive multicenter cohort study. 26 Intensive care units (ICU) from Andalusian region in Spain. Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. None. Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor. Publication[Incidental finding of a right or mirror aortic arch].(2022-01-03) García-Borges, Nora; Ayllón-Gámez, Saray; García-Blanco, Victoria PublicationMultifocal Abdominal Pyomyositis From Subcutaneous Dissemination in an Immunocompetent Patient.(2022-04-02) Ropero-Luis, Guillermo; López-Núñez, Marina; Hidalgo-López, ClaraA 61-year-old woman presented to the emergency ward complaining of low back pain for a month. She had undergone several spinal surgeries and a right radical nephrectomy 30 years before. A few days earlier she was injected with an intramuscular painkiller in her right buttock. An abdominal CT scan revealed multiple abscesses in the psoas muscle and the right posterior abdominal wall, including cellulitis in the adjacent subcutaneous tissue and the injection site. A diagnosis of pyomyositis from subcutaneous dissemination was made, and intravenous cefazolin was initiated. After five days of favorable progress, treatment was switched to oral cefadroxil to complete four weeks, leading to full recovery. PublicationCOVID-19 Vaccines and Autoimmune Hematologic Disorders.(2022-06-16) Mingot-Castellano, María Eva; Butta, Nora; Canaro, Mariana; Gómez Del Castillo Solano, María Del Carmen; Sánchez-González, Blanca; Jiménez-Bárcenas, Reyes; Pascual-Izquierdo, Cristina; Caballero-Navarro, Gonzalo; Entrena Ureña, Laura; José González-López, Tomás; On Behalf Of The Gepti,Worldwide vaccination against SARS-CoV-2 has allowed the detection of hematologic autoimmune complications. Adverse events (AEs) of this nature had been previously observed in association with other vaccines. The underlying mechanisms are not totally understood, although mimicry between viral and self-antigens plays a relevant role. It is important to remark that, although the incidence of these AEs is extremely low, their evolution may lead to life-threatening scenarios if treatment is not readily initiated. Hematologic autoimmune AEs have been associated with both mRNA and adenoviral vector-based SARS-CoV-2 vaccines. The main reported entities are secondary immune thrombocytopenia, immune thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, Evans syndrome, and a newly described disorder, so-called vaccine-induced immune thrombotic thrombocytopenia (VITT). The hallmark of VITT is the presence of anti-platelet factor 4 autoantibodies able to trigger platelet activation. Patients with VITT present with thrombocytopenia and may develop thrombosis in unusual locations such as cerebral beds. The management of hematologic autoimmune AEs does not differ significantly from that of these disorders in a non-vaccine context, thus addressing autoantibody production and bleeding/thromboembolic risk. This means that clinicians must be aware of their distinctive signs in order to diagnose them and initiate treatment as soon as possible. PublicationNovel Therapies to Address Unmet Needs in ITP.(2022-06-23) Mingot-Castellano, María Eva; Bastida, José María; Caballero-Navarro, Gonzalo; Entrena Ureña, Laura; González-López, Tomás José; González-Porras, José Ramón; Butta, Nora; Canaro, Mariana; Jiménez-Bárcenas, Reyes; Gómez Del Castillo Solano, María Del Carmen; Sánchez-González, Blanca; Pascual-Izquierdo, Cristina; On Behalf Of The Gepti,Primary immune thrombocytopenia (ITP) is an autoimmune disorder that causes low platelet counts and subsequent bleeding risk. Although current corticosteroid-based ITP therapies are able to improve platelet counts, up to 70% of subjects with an ITP diagnosis do not achieve a sustained clinical response in the absence of treatment, thus requiring a second-line therapy option as well as additional care to prevent bleeding. Less than 40% of patients treated with thrombopoietin analogs, 60% of those treated with splenectomy, and 20% or fewer of those treated with rituximab or fostamatinib reach sustained remission in the absence of treatment. Therefore, optimizing therapeutic options for ITP management is mandatory. The pathophysiology of ITP is complex and involves several mechanisms that are apparently unrelated. These include the clearance of autoantibody-coated platelets by splenic macrophages or by the complement system, hepatic desialylated platelet destruction, and the inhibition of platelet production from megakaryocytes. The number of pathways involved may challenge treatment, but, at the same time, offer the possibility of unveiling a variety of new targets as the knowledge of the involved mechanisms progresses. The aim of this work, after revising the limitations of the current treatments, is to perform a thorough review of the mechanisms of action, pharmacokinetics/pharmacodynamics, efficacy, safety, and development stage of the novel ITP therapies under investigation. Hopefully, several of the options included herein may allow us to personalize ITP management according to the needs of each patient in the near future. PublicationClinical Characteristics and Prognostic Relevance of Different Types of Caregivers for Elderly Patients with Acute Heart Failure-Analysis from the RICA Registry.(2022-06-18) Méndez-Bailon, Manuel; Lorenzo-Villalba, Noel; Rubio-Garcia, Jorge; Moreno-García, María Carmen; Ropero-Luis, Guillermo; Martínez-Litago, Eduardo; Quirós-López, Raúl; Carrascosa-García, Sara; González-Franco, Alvaro; Andrès, Emmanuel; Casado-Cerrada, Jesús; Montero-Pérez-Barquero, ManuelBackground: Patients with heart failure encompass a heterogeneous group, but they are mostly elderly patients with a large burden of comorbid conditions. Objective: The aim of this study was to compare the clinical characteristics and the prognostic impact on hospital admissions and mortality in a population of patients with HF with different types of caregivers (family members, professionals, and the patient himself). Methods: We conducted an observational study from a prospective registry. Patients from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. Patients with heart failure were classified, according to the type of main caregiver, into four groups: the patient himself/herself, a partner, children, or a professional caregiver. A bivariable analysis was performed between the clinical, analytical, therapeutic, and prognostic characteristics of the different groups. The endpoints of the study were all-cause mortality at 1 year; mortality at 120 days; and the readmission rate for HF at 30 days, 120 days, and 1 year of follow-up. In all cases, the level of statistical significance was set at p PublicationClinical Impact of the Capacity-Motivation-Opportunity Pharmacist-Led Intervention in People Living with HIV in Spain, 2019-2020.(2022-05-24) Morillo-Verdugo, Ramón; Robustillo-Cortes, María de Las Aguas; Navarro-Ruiz, Andrés; Sánchez-Rubio Ferrandez, Javier; Fernández Espínola, Sergio; Fernández-Pacheco García-Valdecasas, María; Vélez-Diaz-Pallares, ManuelPeople living with HIV (PLWH) have significantly enhanced their life expectancy. Consequently, age-associated comorbidities and related health conditions are increasingly found in PLWH complicating their clinical management. To determine the effect of the capacity-motivation-opportunity (CMO) structured pharmaceutical care intervention for improving clinical health-care results frequently associated to PLWH. Multicenter, prospective, pre-post intervention study evaluating the CMO pharmacist-led program in adult PLWH was conducted between September 2019 and September 2020 with six months of follow-up. The primary objective of this study was to determine differences in clinical outcomes (total cholesterol, triglycerides, HDL, blood pressure and glycosylated hemoglobin) and variation in the patient's activation measure before and after the intervention. A total of 61 patients were included, 72% were men with a median age of 53 years. After the implementation of the pharmacist-driven program, the percentage of patients with high levels of total cholesterol decreased significantly (18% to 4.9%; p The CMO program resulted in significantly better health outcomes during the six months following the pharmacist-led intervention as well as improved activation in PLWH. PublicationMutational profile of primary breast diffuse large B-cell lymphoma(Impact journals llc, 2017-11-28) Franco, Fernando; Gonzalez-Rincon, Julia; Lavernia, Javier; Garcia, Juan F.; Martin, Paloma; Bellas, Carmen; Piris, Miguel A.; Pedrosa, Lucia; Miramon, Jose; Gomez-Codina, Jose; Rodriguez-Abreu, Delvys; Machado, Isidro; Illueca, Carmen; Alfaro, Jesus; Provencio, Mariano; Sanchez-Beato, Margarita; [Franco, Fernando] Hosp Univ Puerta Hierro, Med Oncol Dept, Madrid, Spain; [Provencio, Mariano] Hosp Univ Puerta Hierro, Med Oncol Dept, Madrid, Spain; [Franco, Fernando] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Lavernia, Javier] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Miramon, Jose] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Gomez-Codina, Jose] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Rodriguez-Abreu, Delvys] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Alfaro, Jesus] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Provencio, Mariano] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Sanchez-Beato, Margarita] GOTEL Spanish Lymphoma Oncol Grp, Madrid, Spain; [Gonzalez-Rincon, Julia] Inst Invest Sanitaria Puerta Hierro Segovia de Ar, Dept Med Oncol, Grp Res Lymphomas, Madrid, Spain; [Pedrosa, Lucia] Inst Invest Sanitaria Puerta Hierro Segovia de Ar, Dept Med Oncol, Grp Res Lymphomas, Madrid, Spain; [Sanchez-Beato, Margarita] Inst Invest Sanitaria Puerta Hierro Segovia de Ar, Dept Med Oncol, Grp Res Lymphomas, Madrid, Spain; [Gonzalez-Rincon, Julia] Ctr Invest Biomed Red Canc CIBERONC, Madrid, Spain; [Martin, Paloma] Ctr Invest Biomed Red Canc CIBERONC, Madrid, Spain; [Bellas, Carmen] Ctr Invest Biomed Red Canc CIBERONC, Madrid, Spain; [Piris, Miguel A.] Ctr Invest Biomed Red Canc CIBERONC, Madrid, Spain; [Lavernia, Javier] Inst Valenciano Oncol, Med Oncol Dept, Valencia, Spain; [Garcia, Juan F.] MD Anderson Canc Ctr, Pathol Dept, Madrid, Spain; [Martin, Paloma] Hosp Univ Puerta Hierro, Pathol Dept, Madrid, Spain; [Bellas, Carmen] Hosp Univ Puerta Hierro, Pathol Dept, Madrid, Spain; [Piris, Miguel A.] Hosp Univ Fdn Jimenez Diaz, Pathol Dept, Madrid, Spain; [Miramon, Jose] Hosp Serrania Ronda, Med Oncol Dept, Malaga, Spain; [Gomez-Codina, Jose] Hosp Univ & Politecn La Fe, Med Oncol Dept, Valencia, Spain; [Rodriguez-Abreu, Delvys] Hosp Univ Insular Gran Canaria, Med Oncol Dept, Las Palmas Gran Canaria, Spain; [Machado, Isidro] Inst Valenciano Oncol, Pathol Dept, Valencia, Spain; [Illueca, Carmen] Inst Valenciano Oncol, Pathol Dept, Valencia, Spain; [Alfaro, Jesus] Inst Oncol Kutxa, Med Oncol Dept, Donostia San Sebastian, Spain; Instituto de Salud Carlos III (ISCIII); AES-FEDER (Plan Estatal de I+D+I); ROCHE; iPFIS predoctoral fellowship; Juan Rodes contract from ISCIII-MINECO-AES-FEDER (Plan Estatal I+D+I); Miguel Servet contract from the ISCIII-MINECO-AES-FEDER (Plan Nacional I+D+I); Miguel Servet II contract from ISCIII-MINECO-AES-FEDER (Plan Estatal I+D+I), Spain; Fundacion de Investigacion Biomedica Puerta de Hierro; Spanish Ministry of Economy and Competence (MINECO)Primary breast lymphoma is a rare form of extra-nodal lymphoid neoplasm. The most common histological type is the diffuse large B-cell lymphoma, which represents 60-80% of all the cases. Our study analyzes the mutational profile of the primary lymphoma of the breast through targeted massive sequencing with a panel of 38 genes in a group of 17 patients with primary breast diffuse large B-cell lymphoma. Seventy-point-five percent of the patients presented with stage IE and 29.5% with stage IIE. 44% of the cases correspond to lymphomas with germinal center phenotype and 33.3% to activated B-cell. The genes with a higher mutational frequency include PIM1 (in 50% of the analyzed samples), MYD88 (39%), CD79B, PRDM1 and CARD11 (17%), KMT2D, TNFIAP3 and CREBBP (11%). The profile of mutant genes involves mostly the NF kappa B signaling pathway. The high frequency of mutations in PIM1 compared with other lymphomas may have implications in the clinical presentation and evolution of this type of lymphoma. PublicationPost-traumatic stress disorder after subsequent birth to a gestational loss: An observational study(Inst nac psiquiatria ramon fuente muniz, 2020-05-01) Fernandez Ordonez, Eloisa; Rengel Diaz, Cristobal; Morales Gil, Isabel Maria; Labajos Manzanares, Maria Teresa; [Fernandez Ordonez, Eloisa] Hosp Serrania Ronda, Malaga, Spain; [Rengel Diaz, Cristobal] Hosp Univ Virgen de la Victoria, Malaga, Spain; [Rengel Diaz, Cristobal] Univ Malaga, Dept Enfermeria, Malaga, Spain; [Morales Gil, Isabel Maria] Univ Malaga, Dept Enfermeria, Malaga, Spain; [Labajos Manzanares, Maria Teresa] Univ Malaga, Dept Fisioterapia, Malaga, SpainIntroduction. The loss of a pregnancy puts women at risk of suffering post-traumatic stress disorder. This circumstance can influence a subsequent pregnancy, and the link with the future baby. Objective. The main objective of this work was to identify the prevalence of post-traumatic stress disorder (PTSD) among post-partum women who give birth after having suffered a previous gestational loss and to identify possible relationships between PTSD and the variables studied. Method. An observational, descriptive, and cross-sectional study. A total of 115 puerperal women who had suffered a previous gestational loss completed questionnaires containing sociodemographic variables, obstetric history, and responses to the Davidson Trauma Scale. Results. A score of 40 was established as a cut-off point in the Davidson Trauma Scale for the identification of PTSD. 21.7% of the participants scored 40 or above. Significant differences were found related to age (p = .030), number of pregnancies (p = .033), and number of gestational losses (p = .001). The probability of PTSD increases significantly in relation to the number of losses. Respondents are 2.55 times (beta = .94 p = .027) more likely to suffer PTSD the higher the number of gestational losses suffered. Discussion and conclusion. There are significant differences in the presence of PTSD among puerperal women in terms of age, number of pregnancies, and number of gestational losses. Post-partum women are more likely to suffer PTSD after a gestational loss the higher the number of gestational losses suffered. PublicationPatients Admitted to Three Spanish Intensive Care Units for Poisoning: Type of Poisoning, Mortality, and Functioning of Prognostic Scores Commonly Used(Hindawi ltd, 2017-01-01) Esther Banderas-Bravo, Maria; Dolores Arias-Verdu, Maria; Macias-Guarasa, Ines; Aguilar-Alonso, Eduardo; Castillo-Lorente, Encarnacion; Perez-Costillas, Lucia; Gutierrez-Rodriguez, Raquel; Quesada-Garcia, Guillermo; Rivera-Fernandez, Ricardo; [Esther Banderas-Bravo, Maria] Reg Univ Hosp, Intens Care Unit, Malaga, Spain; [Dolores Arias-Verdu, Maria] Reg Univ Hosp, Intens Care Unit, Malaga, Spain; [Macias-Guarasa, Ines] Reg Univ Hosp, Intens Care Unit, Malaga, Spain; [Gutierrez-Rodriguez, Raquel] Reg Univ Hosp, Intens Care Unit, Malaga, Spain; [Quesada-Garcia, Guillermo] Reg Univ Hosp, Intens Care Unit, Malaga, Spain; [Aguilar-Alonso, Eduardo] Infanta Margarita Hosp, Intens Care Unit, Cordoba, Spain; [Castillo-Lorente, Encarnacion] Neurotraumatol Hosp, Intens Care Unit, Jaen, Spain; [Perez-Costillas, Lucia] Reg Univ Hosp, Dept Psychiat, Malaga, Spain; [Rivera-Fernandez, Ricardo] Serrania Hosp, Intens Care Unit, Malaga, Spain; Andalusian Public Foundation for Health and Biomedicine Research in MalagaObjectives. To evaluate the gravity and mortality of those patients admitted to the intensive care unit for poisoning. Also, the applicability and predicted capacity of prognostic scales most frequently used in ICU must be evaluated. Methods. Multicentre study between 2008 and 2013 on all patients admitted for poisoning. Results. The results are from 119 patients. The causes of poisoning were medication, 92 patients (77.3%), caustics, 11 (9.2%), and alcohol, 20 (16,8%). 78.3% attempted suicides. Mean age was 44.42 +/- 13.85 years. 72.5% had a Glasgow Coma Scale (GCS) PublicationPrimary Breast Lymphoma: Analysis of 55 Cases of the Spanish Lymphoma Oncology Group(Cig media group, lp, 2017-03-01) Franco Perez, Fernando; Lavernia, Javier; Aguiar-Bujanda, David; Miramon, Jose; Guma, Josep; Alvarez, Rut; Gomez-Codina, Jose; Garcia Arroyo, Francisco; Llanos, Marta; Marin, Miguel; Alfaro, Jesus; Quero, Cristina; Delgado, Mayte; Nogales, Esteban; Menarguez, Francisco; Martinez, Natividad; Torrente, Maria; Royuela, Ana; Abreu, Delvys; Provencio, Mariano; [Franco Perez, Fernando] Hosp Univ Puerta Hierro, Dept Med Oncol, Majadahonda, Spain; [Torrente, Maria] Hosp Univ Puerta Hierro, Dept Med Oncol, Majadahonda, Spain; [Provencio, Mariano] Hosp Univ Puerta Hierro, Dept Med Oncol, Majadahonda, Spain; [Lavernia, Javier] Inst Valenciano Oncolog, Dept Med Oncol, Valencia, Spain; [Aguiar-Bujanda, David] Hosp Univ Gran Canaria Doctor Negr, Dept Med Oncol, Las Palmas Gran Canaria, Spain; [Miramon, Jose] Hosp Serrania Ronda, Dept Med Oncol, Malaga, Spain; [Guma, Josep] Hosp Univ Sant Joan Reus, Dept Med Oncol, Reus, Spain; [Alvarez, Rut] Hosp Univ Virgen Salud, Dept Med Oncol, Toledo, Spain; [Gomez-Codina, Jose] Hosp Univ Politecn Le Fe, Dept Med Oncol, Valencia, Spain; [Garcia Arroyo, Francisco] Complejo Hospitalario Pontevedra, Dept Med Oncol, Pontevedra, Spain; [Llanos, Marta] Hosp Univ Canarias, Dept Med Oncol, San Cristobal la Laguna, Spain; [Marin, Miguel] Hosp Clinico Univ Virgen La Arrixaca, Dept Med Oncol, Murcia, Spain; [Alfaro, Jesus] Inst Oncol Kurxa, Dept Med Oncol, Donistia, Spain; [Quero, Cristina] Hosp Univ Virgen La Victoria, Dept Med Oncol, Malaga, Spain; [Delgado, Mayte] Hosp Univ San Cecilio, Dept Med Oncol, Granada, Spain; [Nogales, Esteban] Hosp Univ Virgen La Macarena, Dept Med Oncol, Seville, Spain; [Menarguez, Francisco] Hosp Gen Univ Elche, Dept Med Oncol, Alicante, Spain; [Martinez, Natividad] Hosp Gen Univ Elche, Dept Med Oncol, Alicante, Spain; [Royuela, Ana] Hosp Univ Puerta Hierro, Dept Biostat, Majadahonda, Spain; [Abreu, Delvys] Hosp Univ Insular Gran Canaria, Dept Med Oncol, Las Palmas Gran Canaria, SpainWe reviewed 55 patients diagnosed with primary breast lymphoma, stages IE and IIE, in 16 Spanish institutions. Of the 55 cases, 96.4% corresponded to non-Hodgkin lymphoma. Results of 5-year progression-free and overall survival were 73% and 76%, respectively. Current treatments achieve good control of the disease, with an overall survival of 5 years in 80% of the patients.Introduction: Primary breast lymphoma is a rare form of localized extranodal lymphoma, which affects the mammary glands unilaterally or bilaterally, and can also affect the regional lymph nodes. Materials and Methods: We reviewed 55 patients, with disease stages IE and IIE, diagnosed in 16 Spanish institutions between 1989 and 2016. A serial of clinical variables and treatment were collected, and overall survival (OS) and progression-free survival (PFS) were calculated. Results: Of the 55 patients, 96.4% were women with an average age of 69 years. A total of 53 patients corresponded to non-Hodgkin lymphoma (NHL), of whom 36.3% had lymph node involvement upon diagnosis. Of the patients, 58.2% were stage IE, and 41.8% were stage IIE. Treatments received included radiotherapy (36.3%), chemotherapy (85.5%), and rituximab (in 38 of the 45 patients with NHL treated with chemotherapy). In all, 82.2% of complete responses were achieved. OS and progression-free survival at 5 years in NHL patients was 76% and 73%, respectively. Conclusion: Current treatments (chemotherapy, immunotherapy, and radiotherapy) achieve good control of the disease, with an OS of 5 years in 80% of the patients, although there is no consensus in treatment, given the scarce incidence of these lymphomas. (C) 2016 The Authors. Published by Elsevier Inc. Publication[Reactivation of neurocysticercosis in patient under study on suspicion of dengue].(2021-02-22) Ruíz Márquez, M J; Cabra Rodríguez, R; Ruíz Márquez, D Publication[Study of the quality of life and adherence to treatment in patients from 2 to 16 years-old with type 1 diabetes mellitus in Andalusia, Spain].(2020-06-12) Álvarez Casaño, María; Alonso Montejo, María Del Mar; Leiva Gea, Isabel; Jiménez Hinojosa, José Manuel; Santos Mata, María Ángeles; Macías, Francisco; Romero Pérez, María Del Mar; de Toro, Marta; Martínez, Gabriela; Munguira, Pilar; Vivas, Gustavo; López Siguero, Juan PedroDiabetes mellitus 1 is the second most frequent chronic disease, and the most frequent endocrine-metabolic disorder in childhood. The estimated prevalence is between 1.1 and 1.4 / 1000 children under 15 years years-old. In Andalusia the prevalence is higher (1.7 per thousand). The objective of the study is to evaluate health-related quality of life (HRQoL) and adherence to treatment, specifically in the paediatric population of Andalusia. A multicentre cross-sectional observational analytical study was conducted on a sample of 178 patients from six hospitals with a Paediatric Endocrinology Unit. Each patient received two questionnaires; quality of life (PedsQL version 3.0) and adherence to the self-care recommendations (SCI-R) treatment. The demographic, clinical, metabolic control data, and possible complications were also collected. High levels were obtained in both adherence and health-related quality of life (HRQoL). Adherence was inversely related to age and HbA1c. The health-related quality of life (HRQoL) was associated with the use of a continuous real-time glucose monitoring system (MCG-TR) combined with continuous subcutaneous insulin infusion (CSII), as well as with a lower number of severe hypoglycaemia and renal complications. The mean HbA1c was 7.1%. 12,9% of patients used ISCI. 83.2% used capillary glycemia exclusively, while 16.8% used some interstitial glucose monitoring device. This is the first study in Andalusia that analyzes the health-related quality of life (HRQoL) of pediatric patients. The results show high levels of adherence and health-related quality of life (HRQoL), as well as good metabolic control. PublicationTowards the elimination of hepatitis C: implementation of reflex testing in Andalusia.(2020) Casas, María de la Paz; García, Fernando; Freyre-Carrillo, Carolina; Montiel, Natalia; de la Iglesia, Alberto; Viciana, Isabel; Domínguez, Ana; Guillot, Vicente; Muñoz, Aurora; Cantudo, Purificación; Franco-Álvarez, Francisco; Reguera, Juan Antonio; Romera, María Angustias; Cabezas, Teresa; Vargas, Julio; Ramírez-Arcos, Mercedes; Guerrero, Inmaculada; García-Navarrete, África; Pérez-Santos, María Jesús; Clavijo, Encarnación; Roldán, Carolina; Guzmán, Antonio; Palanca, Matilde; Torres, Eva; Serrano, María Del Carmen; Lozano, María Del Carmen; Becerril, Berta; Luzón, Pilar; Galán, María Ángeles; Alados, Juan Carlos; García, Federicoundiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain. PublicationValidation of the LESS-CHRON criteria: reliability study of a tool for deprescribing in patients with multimorbidity.(2018-05-30) Rodríguez-Pérez, Aitana; Alfaro-Lara, Eva Rocío; Sierra-Torres, María Isabel; Villalba-Moreno, Ángela; Nieto-Martin, María Dolores; Galván-Banqueri, Mercedes; Santos-Ramos, BernardoThe 'LESS-CHRON criteria' (List of Evidence-Based Deprescribing for Chronic Patients criteria) is a newly created tool with 27 criteria to guide deprescribing. It was developed using a Delphi methodology. Each criterion consists of drugs and their indications, conditions under which deprescribing would be considered, a health variable to be monitored after deprescribing and a follow-up period. The aim of our study was to evaluate the reliability of the LESS-CHRON criteria in a population of patients with multimorbidity to determine the possible usefulness of this tool in clinical practice. We selected chronic patients with multimorbidity from an internal medicine unit who were older than 80 years old and were alive at the time of the study. To determine interobserver reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intraobserver reliability, each health professional applied the tool at baseline and 2 months later. We measured interobserver and intraobserver reliability using the kappa coefficient. The proportion of overall agreement was also determined. We obtained a moderate overall kappa (ĸ=0.46, 95% CI 0.36 to 0.55) for interobserver reliability, and good (ĸ=0.65, 95% CI 0.57 to 0.78) and moderate (ĸ=0.59, 95% CI 0.49 to 0.74) values for intraobserver reliability for the internist and pharmacist, respectively. The proportion of overall agreement was very high: 92% (range: 62%-100%) for the interobserver, and 94% (80%-100%) and 93% (63%-100%) for the internist and pharmacist, respectively. The LESS-CHRON criteria shows early promise as a reliable method to help guide deprescribing in patients with multimorbidity. Further, more complete testing with a larger sample of prescribers is needed. PublicationAntituberculosis drug resistance in isolates of Mycobacterium tuberculosis complex in southeast Spain.(2019-08-14) Montiel Quezel-Guerraz, Natalia; Sánchez-Porto, Antonio; Ortega Torres, María; Pérez Santos, Mª Jesús; Acosta, Federico; Guzman, Antonio; Correa Ruiz, Ana; Bérmudez Ruiz, PilarThe aim of this study was to determine resistance to antituberculosis (anti-TB) drugs in Mycobacterium tuberculosis complex isolates from patients diagnosed with Tuberculosis (TB) in southeast Spain and to study related epidemiological factors. This retrospective study analysed 5-year data (2012-2016) obtained in southeast Spain for a total equivalent population of 1 735 608 inhabitants. Clinical samples were examined from 557 patients with suspected pulmonary TB (n=470; 84.4%) or extrapulmonary TB (n=87; 15.6%), taking into account patient age, sex, human immunodeficiency virus (HIV) infection, country of birth and prior anti-TB treatment. TB was found more frequently in men than in women (66.6% vs. 33.4%), and the age group with the most cases (43.7%) was 36-55 years. Among the first-line anti-TB drugs, 7.0% of patients harboured isolates resistant to isoniazid (INH) and 1.6% to rifampicin (RIF); moreover, 1.4% of isolates were multidrug-resistant TB (MDR-TB) and 0.7% were extensively drug-resistant TB. There was a statistically significant relationship (P=0.028) between MDR-TB isolates and non-Spanish-born patients, but not between the latter and INH resistance. Resistance to INH and RIF was observed at levels similar to those published nationwide, with rates of MDR-TB being somewhat lower. Rates of HIV/TB co-infection have decreased considerably between 2012 and 2016. PublicationValidation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain.(2018-08-13) Rodríguez-Fernández, Sonia; Castillo-Lorente, Encarnación; Guerrero-Lopez, Francisco; Rodríguez-Rubio, David; Aguilar-Alonso, Eduardo; Lafuente-Baraza, Jesús; Gómez-Jiménez, Francisco Javier; Mora-Ordóñez, Juan; Rivera-López, Ricardo; Arias-Verdú, María Dolores; Quesada-García, Guillermo; Arráez-Sánchez, Miguel Ángel; Rivera-Fernández, RicardoValidation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU). A multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated. A total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50-70) years. 21(15-26) points, GCS: 7 (4-11) points, ICH score: 2 (2-3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p ICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal. PublicationStroke treatment outcomes in hospitals with and without Stroke Units.(2017-11-01) Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I MOrganisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. PublicationMale breast cancer: correlation between immunohistochemical subtyping and PAM50 intrinsic subtypes, and the subsequent clinical outcomes.(2017-10-06) Sánchez-Muñoz, Alfonso; Vicioso, Luis; Santonja, Angela; Álvarez, Martina; Plata-Fernández, Yéssica; Miramón, José; Zarcos, Irene; Ramírez-Tortosa, César L; Montes-Torres, Julio; Jerez, José M; de Luque, Vanessa; Llácer, Casilda; Fernández-De Sousa, Cristina E; Pérez-Villa, Lidia; Alba, EmilioMale breast cancer is a rare disease that is still poorly understood. It is mainly classified by immunohistochemistry as a luminal disease. In this study, we assess for the first time the correlation between molecular subtypes based on a validated six-marker immunohistochemical panel and PAM50 signature in male breast cancer, and the subsequent clinical outcome of these different subtypes. We collected 67 surgical specimens of invasive male breast cancer from four different Spanish pathology laboratories. Immunohistochemical staining for the six-marker panel was performed on tissue microarrays. PAM50 subtypes were determined in a research-use-only nCounter Analysis System. We explored the association of immunohistochemical and PAM50 subtypes. Overall survival and disease-free survival were analyzed in the different subtypes of each classification. The distribution of tumor molecular subtypes according PAM50 was: 60% luminal B, 30% luminal A and 10% human epidermal growth factor receptor 2 (Her2) enriched. Only one Her2-enriched tumor was also positive by immunohistochemistry and was treated with trastuzumab. None of the tumors were basal-like. Using immunohistochemical surrogates, 51% of the tumors were luminal B, 44% luminal A, 4% triple-negative and 1% Her2-positive. The clinicopathological characteristics did not differ significantly between immunohistochemical and PAM50 subtypes. We found a significant worse overall survival in Her2-enriched compared with luminal tumors. Male breast cancer seems to be mainly a genomic luminal disease with a predominance of the luminal B subtype. In addition, we found a proportion of patients with Her2-negative by immunohistochemistry but Her2-enriched profile by PAM50 tumors with a worse outcome compared with luminal subtypes that may benefit from anti-Her2 therapies. PublicationRelationship between functional status prior to onset of critical illness and mortality: a prospective multicentre cohort study.(2017) Rivera-Lopez, R; Gutierrez-Rodriguez, R; Lopez-Caler, C; Aguilar-Alonso, E; Castillo-Lorente, E; Garcia-Delgado, M; Arias-Verdu, M D; Iglesias-Posadilla, D; Barrueco-Francioni, J E; Quesada-Garcia, G; Rivera-Fernandez, RThis prospective study aimed to assess the association between prior functional status and hospital mortality for patients admitted to four intensive care units in Spain between 2006 and 2012. Prior functional status was classified into three groups, using a modification of the Glasgow Outcome Scale (GOS), including group 1 with no limitations on activities of daily living; group 2 with some limitations but self-sufficient; and group 3 who were dependent on others for their activities of daily living. Of the 1,757 patients considered (mean Simplified Acute Physiology Score [SAPS] predicted mortality 14.8% and hospital mortality 13.7%), group 1 had the lowest observed hospital mortality (8.3%) compared to the SAPS 3 predicted mortality (11.6%). The observed mortality for group 2 (20.6%) and group 3 (27.4%) were both higher than predicted (19.2% and 21.2% respectively; odds ratio [OR] 1.97, 95% confidence interval [CI] 1.38-2.82 for group 2 and OR 2.90, 95% CI 1.78-4.72 for group 3 compared to group 1). Combining prior functional status and Sequential Organ Failure Assessment (SOFA) score with SAPS 3 further improved the ability of the SAPS 3 scores in predicting hospital mortality (area under the receiver operating characteristic curve 0.85 [95% CI 0.82-0.88] versus 0.84 [95% CI 0.81-0.87] respectively). In summary, patients with limited functional status prior to ICU admission had a higher risk of observed hospital mortality than predicted. Assessing prior functional status using a relatively simple questionnaire, such as a modified GOS, has the potential to improve the accuracy of existing prognostic models.