SAS - Hospital Universitario Juan Ramón Jiménez

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Surgical treatment for infective endocarditis in elderly patients
(Elsevier, 2011-06-06) Ramirez-Duque, N.; García-Cabrera, Emilio; Ivanova-Georgieva, R.; Noureddine, Mariam; Lomas, J. M.; Hidalgo-Tenorio, Carmen; Plata, A.; Gálvez-Acebal, Juan; Ruiz-Morales, J.; de la Torre-Lima, J.; Reguera-Iglesias, José María; Martinez-Marcos, F. J.; de Alarcón, Arístides; [Ramirez-Duque,N; Garcia-Cabrera,E; Alarcon,A] Hospital Virgen del Rocio, Sevilla, Spain.; [Ivanova-Georgieva,R; Ruiz-Morales;J;] Hospital Virgen de la Victoria, Málaga, Spain.; [Noureddine,M; de la Torre-Lima,J;] Hospital Costa del Sol, Marbella, Spain.; [Lomas,JM; Martinez-Marcos,FJ] Hospital Juan Ramón Jiménez, Huelva, Spain.; [Hidalgo-Tenorio,C] Hospital Virgen de las Nieves, Granada, Spain.; [Plata,A; Reguera,JM] Hospital Carlos Haya, Malaga, Spain.; Ministerio de Sanidad y Consumo; Instituto de Salud Carlos III; Spanish Network for the Research in Infectious Diseases; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)
Objectives: We evaluate the clinical, echographic and prognostic characteristics of infective endocarditis (IE) in a large population of elderly patients, and the results of surgical approach.Methods: Multicentric, prospective, observational cohort study with 961 consecutive left-sided IE: ;356 patients aged >= 65 years were compared with 605 younger. Indications for cardiac surgery, potential surgical risk, time and outcome, were compared.Results: Hospital-acquired endocarditis, comorbidity, renal failure and septic shock were more frequent in elderly, but embolisms were less. Intracardiac destruction and ventricular failure were similar in both groups, but significantly fewer elderly patients underwent cardiac surgery (36% vs 51%; p < 0.01), and this group showed a worse outcome (43.2% of mortality vs 27% in younger; p < 0.01), resulting age as an independent predictor of mortality (OR: 1.02 CI95%: 1.01-1.03). Compared with medical treatment, surgery showed lower percentages ofmortality compared with medical treatment (23.3% vs 31.3%; p = 0.03) in younger group, but a high mortality was observed with both procedures (47.6% vs 40.3%; p = 0.1) in the elderly.Conclusions: Although similar percentages of heart failure and intracardiac complications, increasing age is associated with higher mortality in IE. Lower rates of surgical treatment and a worse outcome after operation are common features in elderly patients.
COVID-19: age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study.
(2020-08-14) Jurado, Aurora; Martín, María C; Abad-Molina, Cristina; Orduña, Antonio; Martínez, Alba; Ocaña, Esther; Yarce, Oscar; Navas, Ana M; Trujillo, Antonio; Fernández, Luis; Vergara, Esther; Rodríguez, Beatriz; Quirant, Bibiana; Martínez-Cáceres, Eva; Hernández, Manuel; Perurena-Prieto, Janire; Gil, Juana; Cantenys, Sergi; González-Martínez, Gema; Martínez-Saavedra, María T; Rojo, Ricardo; Marco, Francisco M; Mora, Sergio; Ontañón, Jesús; López-Hoyos, Marcos; Ocejo-Vinyals, Gonzalo; Melero, Josefa; Aguilar, Marta; Almeida, Delia; Medina, Silvia; Vegas, María C; Jiménez, Yesenia; Prada, Álvaro; Monzón, David; Boix, Francisco; Cunill, Vanesa; Molina, Juan
The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor. In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course. Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease.
The age again in the eye of the COVID-19 storm: evidence-based decision making.
(2021-05-20) Martín, María C; Jurado, Aurora; Abad-Molina, Cristina; Orduña, Antonio; Yarce, Oscar; Navas, Ana M; Cunill, Vanesa; Escobar, Danilo; Boix, Francisco; Burillo-Sanz, Sergio; Vegas-Sánchez, María C; Jiménez-de Las Pozas, Yesenia; Melero, Josefa; Aguilar, Marta; Sobieschi, Oana Irina; López-Hoyos, Marcos; Ocejo-Vinyals, Gonzalo; San Segundo, David; Almeida, Delia; Medina, Silvia; Fernández, Luis; Vergara, Esther; Quirant, Bibiana; Martínez-Cáceres, Eva; Boiges, Marc; Alonso, Marta; Esparcia-Pinedo, Laura; López-Sanz, Celia; Muñoz-Vico, Javier; López-Palmero, Serafín; Trujillo, Antonio; Álvarez, Paula; Prada, Álvaro; Monzón, David; Ontañón, Jesús; Marco, Francisco M; Mora, Sergio; Rojo, Ricardo; González-Martínez, Gema; Martínez-Saavedra, María T; Gil-Herrera, Juana; Cantenys-Molina, Sergi; Hernández, Manuel; Perurena-Prieto, Janire; Rodríguez-Bayona, Beatriz; Martínez, Alba; Ocaña, Esther; Molina, Juan
One hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data. Concerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/μL, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve. Age and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results.
Sandwich-Type Electrochemical Paper-Based Immunosensor for Claudin 7 and CD81 Dual Determination on Extracellular Vesicles from Breast Cancer Patients.
(2020-12-10) Ortega, Francisco G; Regiart, Matías D; Rodríguez-Martínez, Alba; de Miguel-Pérez, Diego; Serrano, María J; Lorente, José A; Tortella, Gonzalo; Rubilar, Olga; Sapag, Karim; Bertotti, Mauro; Fernández-Baldo, Martín A
This study is focused on identifying novel epithelial markers in circulating extracellular vesicles (EVs) through the development of a dual sandwich-type electrochemical paper-based immunosensor for Claudin 7 and CD81 determination, as well as its validation in breast cancer (BC) patients. This immunosensor allows for rapid, sensitive, and label-free detection of these two relevant BC biomarkers. Under optimum conditions, the limit of detection for Claudin 7 was 0.4 pg mL-1, with a wide linear range of 2 to 1000 pg mL-1, while for CD81, the limit of detection was 3 pg mL-1, with a wide linear range of 0.01 to 10 ng mL-1. Finally, we validated Claudin 7 and CD81 determination in EVs from 60 BC patients and 20 healthy volunteers, reporting higher diagnostic accuracy than the one observed with classical diagnostic markers. This analysis provides a low-cost, specific, versatile, and user-friendly strategy as a robust and reliable tool for early BC diagnosis.
Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke.
(2020-05-31) Pérez-Sánchez, Soledad; Barragán-Prieto, Ana; Ortega-Quintanilla, Joaquín; Domínguez-Mayoral, Ana; Gamero-García, Miguel Ángel; Zapata-Arriaza, Elena; Torres-Chacón, Reyes de; de Albóniga-Chindurza, Asier; Zapata-Hidalgo, Montserrat; Moniche, Francisco; Escudero-Martínez, Irene; Baena, Pablo; Cabezas, Juan Antonio; Oropesa-Ruiz, Juan Miguel; Sanz-Fernández, Gema; González, Alejandro; Montaner, Joan
Pregnancy after bariatric surgery: improving outcomes for mother and child.
(2016-12-14) González, Irene; Lecube, Albert; Rubio, Miguel Ángel; García-Luna, Pedro Pablo
The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS). These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy.
[Systematic Review of the Reduction of Negative Emotional Effects in Emergency and Disaster Response Workers Through Catharsis Techniques].
Prieto-Callejero, Blanca; Gómez-Salgado, Juan; Alvarado-Gómez, Francisco; Dias, Adriano; García-Iglesias, Juan Jesús; Ruiz-Frutos, Carlos
To analyze catharsis techniques used with professionals assisting victims of emergencies and disasters. Systematic review carried out in seven bibliographic databases: MEDLINE-Pubmed, Web of Science, Cochrane Library, CINAHL, Scopus, PsycINFO, and other secondary sources, for articles published between 2008 and 2017, with the terms "catharsis", "emergencies", "debriefing" y "post-traumatic stress". Publication and selection biases were taken into account. Five reviews met the study inclusion criteria. Distress and traumatic experiences following an emergency or disaster are very common among health professionals, with adverse repercussions at the physical, psychological and cognitive levels. Some authors find that debriefing offers an opportunity for emotional release and toreduce the impact of stress on the lives of emergency responders, acting as a support network where they can reconstruct their experiences, express their thoughts and feelings, and reduce the impact on their lives. For other authors, however, this technique is not always effective for all professionals and may lead to negative consequences. Debriefing is a common intervention that promotes catharsis. However, there is considerable controversy over its implementation and effectiveness. This study identified a diversity of catharsis techniques applied to staff responding to emergencies and disasters.
Different Pathological Complete Response Rates According to PAM50 Subtype in HER2+ Breast Cancer Patients Treated With Neoadjuvant Pertuzumab/Trastuzumab vs. Trastuzumab Plus Standard Chemotherapy: An Analysis of Real-World Data.
(2019-11-05) Díaz-Redondo, Tamara; Lavado-Valenzuela, Rocio; Jimenez, Begoña; Pascual, Tomas; Gálvez, Fernando; Falcón, Alejandro; Alamo, Maria Del Carmen; Morales, Cristina; Amerigo, Marta; Pascual, Javier; Sanchez-Muñoz, Alfonso; González-Guerrero, Macarena; Vicioso, Luis; Laborda, Aurora; Ortega, Maria Victoria; Perez, Lidia; Fernandez-Martinez, Aranzazu; Chic, Nuria; Jerez, Jose Manuel; Alvarez, Martina; Prat, Aleix; Ribelles, Nuria; Alba, Emilio
Background: Double blockade with pertuzumab and trastuzumab combined with chemotherapy is the standard neoadjuvant treatment for HER2-positive early breast cancer. Data derived from clinical trials indicates that the response rates differ among intrinsic subtypes of breast cancer. The aim of this study is to determine if these results are valid in real-world patients. Methods: A total of 259 patients treated in eight Spanish hospitals were included and divided into two cohorts: Cohort A (132 patients) received trastuzumab plus standard neoadjuvant chemotherapy (NAC), and Cohort B received pertuzumab and trastuzumab plus NAC (122 patients). Pathological complete response (pCR) was defined as the complete disappearance of invasive tumor cells. Assignment of the intrinsic subtype was realized using the research-based PAM50 signature. Results: There were more HER2-enriched tumors in Cohort A (70 vs. 56%) and more basal-like tumors in Cohort B (12 vs. 2%), with similar luminal cases in both cohorts (luminal A 12 vs. 14%; luminal B 14 vs. 18%). The overall pCR rate was 39% in Cohort A and 61% in Cohort B. Better pCR rates with pertuzumab plus trastuzumab than with trastuzumab alone were also observed in all intrinsic subtypes (luminal PAM50 41 vs. 11.4% and HER2-enriched subtype 73.5 vs. 50%) but not in basal-like tumors (53.3 vs. 50%). In multivariate analysis the only significant variables related to pCR in both luminal PAM50 and HER2-enriched subtypes were treatment with pertuzumab plus trastuzumab (Cohort B) and histological grade 3. Conclusions: With data obtained from patients treated in clinical practice, it has been possible to verify that the addition of pertuzumab to trastuzumab and neoadjuvant chemotherapy substantially increases the rate of pCR, especially in the HER2-enriched subtype but also in luminal subtypes, with no apparent benefit in basal-like tumors.
Oxidative Stress, Telomere Shortening, and Apoptosis Associated to Sarcopenia and Frailty in Patients with Multimorbidity.
(2020-08-18) Bernabeu-Wittel, Máximo; Gómez-Díaz, Raquel; González-Molina, Álvaro; Vidal-Serrano, Sofía; Díez-Manglano, Jesús; Salgado, Fernando; Soto-Martín, María; Ollero-Baturone, Manuel; On Behalf Of The Proteo Researchers,
The presence of oxidative stress, telomere shortening, and apoptosis in polypathological patients (PP) with sarcopenia and frailty remains unknown. Multicentric prospective observational study in order to assess oxidative stress markers (catalase, glutathione reductase (GR), total antioxidant capacity to reactive oxygen species (TAC-ROS), and superoxide dismutase (SOD)), absolute telomere length (aTL), and apoptosis (DNA fragmentation) in peripheral blood samples of a hospital-based population of PP. Associations of these biomarkers to sarcopenia, frailty, functional status, and 12-month mortality were analyzed. Of the 444 recruited patients, 97 (21.8%), 278 (62.6%), and 80 (18%) were sarcopenic, frail, or both, respectively. Oxidative stress markers (lower TAC-ROS and higher SOD) were significantly enhanced and aTL significantly shortened in patients with sarcopenia, frailty or both syndromes. No evidence of apoptosis was detected in blood leukocytes of any of the patients. Both oxidative stress markers (GR, p = 0.04) and telomere shortening (p = 0.001) were associated to death risk and to less survival days. Oxidative stress markers and telomere length were enhanced and shortened, respectively, in blood samples of polypathological patients with sarcopenia and/or frailty. Both were associated to decreased survival. They could be useful in the clinical practice to assess vulnerable populations with multimorbidity and of potential interest as therapeutic targets.
Impact of Sarcopenia and Frailty in a Multicenter Cohort of Polypathological Patients.
(MDPI, 2019-04-18) Bernabeu-Wittel, Maximo; Gonzalez-Molina, Alvaro; Fernandez-Ojeda, Rocio; Diez-Manglano, Jesus; Salgado, Fernando; Soto-Martin, Maria; Muniesa, Marta; Ollero-Baturone, Manuel; Gomez-Salgado, Juan
The prevalence, relationships and outcomes of sarcopenia and frailty in polypathological patients remain unknown. We performed a multicenter prospective observational study in six hospitals in order to assess prevalence, clinical features, outcome and associated risk factors of sarcopenia and frailty in a hospital-based population of polypathological patients. The cohort was recruited by performing prevalence surveys every 14 days during the inclusion period (March 2012-June 2016). Sarcopenia was assessed by means of EWGSOP criteria and frailty by means of Fried's criteria. Skeletal muscle mass was measured by tetrapolar bioimpedanciometry. All patients were followed for 12 months. Factors associated with sarcopenia, frailty and mortality were analyzed by multivariate logistic regression, and Kaplan-Meier curves. A total of 444 patients (77.3 ± 8.4 years, 55% males) were included. Sarcopenia was present in 97 patients (21.8%), this being moderate in 54 (12.2%), and severe in 43 (9.6%); frailty was present in 278 patients (62.6%), and 140 (31.6%) were pre-frail; combined sarcopenia and frailty were present in the same patient in 80 (18%) patients. Factors independently associated to the presence of both, sarcopenia and frailty were female gender, older age, different chronic conditions, poor functional status, low body mass index, asthenia and depressive disorders, and low leucocytes and lymphocytes count. Mortality in the 12-months follow-up period was 40%. Patients with sarcopenia, frailty or both survived significantly less than those without these conditions. Sarcopenia and frailty are frequent and interrelated conditions in polypathological patients, shadowing their survival. Their early recognition and management could improve health-related outcomes in this population.
A three-dimensional printed customized bolus: adapting to the shape of the outer ear.
(2021-04-14) Gomez, Gorka; Baeza, Montserrat; Mateos, Juan Carlos; Rivas, Jose Antonio; Simon, Florencio Javier Luis; Ortega, Diego Mesta; de Los Ángeles Flores Carrión, María; Del Campo, Eleonor Rivin; Gómez-Cía, Tomas; Guerra, Jose Luis Lopez
The skin-sparing effect of megavoltage-photon beams in radiotherapy (RT) reduces the target coverage of superficial tumours. Consequently, a bolus is widely used to enhance the target coverage for superficial targets. This study evaluates a three-dimensional (3D)-printed customized bolus for a very irregular surface, the outer ear. We fabricated a bolus using a computed tomography (CT) scanner and evaluated its efficacy. The head of an Alderson Rando phantom was scanned with a CT scanner. Two 3D boluses of 5- and 10-mm thickness were designed to fit on the surface of the ear. They were printed by the Stratasys Objet260 Connex3 using the malleable "rubber-like" photopolymer Agilus. CT simulations of the Rando phantom with and without the 3D and commercial high density boluses were performed to evaluate the dosimetric properties of the 3D bolus. The prescription dose to the outer ear was 50 Gy at 2 Gy/fraction. We observed that the target coverage was slightly better with the 3D bolus of 10mm compared with the commercial one (D98% 98.2% vs. 97.6%).The maximum dose was reduced by 6.6% with the 3D bolus and the minimum dose increased by 5.2% when comparing with the commercial bolus. In addition, the homogeneity index was better for the 3D bolus (0.041 vs. 0.073). We successfully fabricated a customized 3D bolus for a very irregular surface. The target coverage and dosimetric parameters were at least comparable with a commercial bolus. Thus, the use of malleable materials can be considered for the fabrication of customized boluses in cases with complex anatomy.
The impact of rituximab infusion protocol on the long-term outcome in anti-MuSK myasthenia gravis.
(2018-04-14) Cortés-Vicente, Elena; Rojas-Garcia, Ricard; Díaz-Manera, Jordi; Querol, Luis; Casasnovas, Carlos; Guerrero-Sola, Antonio; Muñoz-Blanco, José Luis; Bárcena-Llona, José Eulalio; Márquez-Infante, Celedonio; Pardo, Julio; Martínez-Fernández, Eva María; Usón, Mercedes; Oliva-Nacarino, Pedro; Sevilla, Teresa; Illa, Isabel
To evaluate whether the clinical benefit and relapse rates in anti-muscle-specific kinase (MuSK) myasthenia gravis (MG) differ depending on the protocol of rituximab followed. This retrospective multicentre study in patients with MuSK MG compared three rituximab protocols in terms of clinical status, relapse, changes in treatment, and adverse side effects. The primary effectiveness endpoint was clinical relapse requiring a further infusion of rituximab. Survival curves were estimated using Kaplan-Meier methods and survival analyses were undertaken using Cox proportional-hazards models. Twenty-five patients were included: 11 treated with protocol 4 + 2 (375 mg/m2/4 weeks, then monthly for 2 months), five treated with protocol 1 + 1 (two 1 g doses 2 weeks apart), and nine treated with protocol 4 (375 mg/m2/4 weeks). Mean follow-up was 5.0 years (SD 3.3). Relapse occurred in 18.2%, 80%, and 33.3%, and mean time to relapse was 3.5 (SD 1.5), 1.1 (SD 0.4), and 2.5 (SD 1.4) years, respectively. Based on Kaplan-Meier estimates, patients treated with protocol 4 + 2 had fewer and later relapses than patients treated with the other two protocols (log-rank test P = 0.0001). Patients treated with protocol 1 + 1 had a higher risk of relapse than patients treated with protocol 4 + 2 (HR 112.8, 95% CI, 5.7-2250.4, P = 0.002). Patients treated with protocol 4 showed a trend to a higher risk of relapse than those treated with protocol 4 + 2 (HR 9.2, 95% CI 0.9-91.8, P = 0.059). This study provides class IV evidence that the 4 + 2 rituximab protocol has a lower clinical relapse rate and produces a more durable response than the 1 + 1 and 4 protocols in patients with MuSK MG.
Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings.
(2021-04-25) Rodríguez-Capitán, Jorge; Sánchez-Pérez, Andrés; Ballesteros-Pradas, Sara; Millán-Gómez, Mercedes; Cardenal-Piris, Rosa; Oneto-Fernández, Manuel; Gutiérrez-Alonso, Lola; Rivera-López, Ricardo; Guisado-Rasco, Agustín; Cano-García, Macarena; Gutiérrez-Bedmar, Mario; Jiménez-Navarro, Manuel
The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion 70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23-2.39; p for trend
A Genome-Wide Association Study on Liver Stiffness Changes during Hepatitis C Virus Infection Cure.
(2021-08-20) Corma-Gómez, Anaïs; Macías, Juan; Rivero, Antonio; Rivero-Juarez, Antonio; de Los Santos, Ignacio; Reus-Bañuls, Sergio; Morano, Luis; Merino, Dolores; Palacios, Rosario; Galera, Carlos; Fernández-Fuertes, Marta; González-Serna, Alejandro; de Rojas, Itziar; Ruiz, Agustín; Sáez, María E; Real, Luis M; Pineda, Juan A
Liver stiffness (LS) at sustained virological response (SVR) after direct-acting antivirals (DAA)-based therapy is a predictor of liver events in hepatitis C virus (HCV)-infected patients. The study aim was to identify genetic factors associated with LS changes from the moment of starting anti-HCV therapy to SVR. This prospective study included HCV-infected patients from the GEHEP-011 cohort who achieved SVR with DAA-based therapy, with LS pre-treatment ≥ 9.5 kPa and LS measurement available at SVR. Plink and Magma software were used to carry out genome-wide single-nucleotide polymorphism (SNP)-based and gene-based association analyses, respectively. The ShinyGO application was used for exploring enrichment in Gene Ontology (GO) categories for biological processes. Overall, 242 patients were included. Median (quartile 1, quartile 3) LS values at pre-treatment and at SVR were 16.8 (12, 28) kPa and 12.0 (8.5, 19.3) kPa, respectively. Thirty-five SNPs and three genes reached suggestive association with LS changes from the moment of starting anti-HCV therapy to SVR. GO categories related to DNA packaging complex, DNA conformation change, chromosome organization and chromatin organization were significantly enriched. Our study reports possible genetic factors associated with LS changes during HCV-infection cure. In addition, our results suggest that processes related to DNA conformation are also involved in these changes.
Clinical Characteristics and Risk Factors of Respiratory Failure in a Cohort of Young Patients Requiring Hospital Admission with SARS-CoV2 Infection in Spain: Results of the Multicenter SEMI-COVID-19 Registry.
(2021-08-11) Díaz-Simón, Raquel; Lalueza, Antonio; Lora-Tamayo, Jaime; Rubio-Rivas, Manuel; Mendo, Cristina Llamazares; Martínez, María Luisa Taboada; Méndez, Cristina Asencio; Pesqueira Fontán, Paula M; Cruz, Ana Fernández; Cabrera, Juan Luis Romero; Rodríguez, Begoña Cortés; Rubio, Aurora Espinar; de Ávila, Vicente Serrano Romero; García, Gema Maria García; Osorio, Luis Cabeza; González-Fernández, María; Noya, Amara González; Wittel, Máximo Bernabeu; Fernandez, Francisco Arnalich; Sempere, Verónica Martínez; Artero, Arturo; Loureiro-Amigo, Jose; Huelgas, Ricardo Gómez; Santos, Juan Miguel Antón; Lumbreras, Carlos; SEMI-COVID-19 Network
Age is a risk factor for COVID severity. Most studies performed in hospitalized patients with SARS-CoV2 infection have shown an over-representation of older patients and consequently few have properly defined COVID-19 in younger patients who require hospital admission. The aim of the present study was to analyze the clinical characteristics and risk factors for the development of respiratory failure among young (18 to 50 years) hospitalized patients with COVID-19. This retrospective nationwide cohort study included hospitalized patients from 18 to 50 years old with confirmed COVID-19 between March 1, 2020, and July 2, 2020. All patient data were obtained from the SEMI-COVID Registry. Respiratory failure was defined as the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) ≤200 mmHg or the need for mechanical ventilation and/or high-flow nasal cannula or the presence of acute respiratory distress syndrome. During the recruitment period, 15,034 patients were included in the SEMI-COVID-19 Registry, of whom 2327 (15.4%) were younger than 50 years. Respiratory failure developed in 343 (14.7%), while mortality occurred in 2.3%. Patients with respiratory failure showed a higher incidence of major adverse cardiac events (44 (13%) vs 14 (0.8%), p320 U/I (OR, 1.69; 95% CI, 1.18 to 2.42; p=0.0039), AST >35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium 35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium 8 mg/dL (OR, 2.42; 95% CI, 1.72 to 3.41; p Young patients with COVID-19 requiring hospital admission showed a notable incidence of respiratory failure. Obesity, SAHS, alcohol abuse, and certain laboratory parameters were independently associated with the development of this complication. Patients who suffered respiratory failure had a higher mortality and a higher incidence of major cardiac events, venous thrombosis, and hospital stay.
Novel mutations associated with inherited human calcium-sensing receptor disorders: A clinical genetic study.
(2019) García-Castaño, Alejandro; Madariaga, Leire; Pérez de Nanclares, Gustavo; Ariceta, Gema; Gaztambide, Sonia; Castaño, Luis
Objective Molecular diagnosis is a useful diagnostic tool in calcium metabolism disorders. The calcium-sensing receptor (CaSR) is known to play a central role in the regulation of extracellular calcium homeostasis. We performed clinical, biochemical and genetic characterization of sequence anomalies in this receptor in a cohort of 130 individuals from 82 families with suspected alterations in the CASR gene, one of the largest series described. Methods The CASR gene was screened for mutations by polymerase chain reaction followed by direct Sanger sequencing. Results Presumed CaSR-inactivating mutations were found in 65 patients from 26 families. These patients had hypercalcemia (median: 11.3 mg/dL) but normal or abnormally high parathyroid hormone (PTH) levels (median: 52 pg/mL). On the other hand, presumed CaSR-activating mutations were detected in 17 patients from eight families. These patients had a median serum calcium level of 7.4 mg/dL and hypoparathyroidism (median: PTH 13 pg/mL). Further, common polymorphisms previously associated with high blood ionized calcium levels were found in 27 patients (median calcium: 10.6 mg/dL; median PTH: 65 pg/mL) with no other alterations in CASR. Overall, we found 30 different mutations, of which, 14 have not been previously reported (p.Ala26Ser, p.Cys60Arg, p.Lys119Ile, p.Leu123Met, p.Glu133Val, p.Gly222Glu, p.Phe351Ile, p.Cys542Tyr, p.Cys546Gly, p.Cys677Tyr, p.Ile816Val, p.Ala887Asp, p.Glu934*, p.Pro935_Gln945dup). Conclusions Patients with CASR mutations may not fit the classic clinical pictures of hypercalcemia with hypocalciuria or hypocalcemia with hypercalciuria. Molecular studies are important for confirming the diagnosis and distinguishing it from other entities. Our genetic analysis confirmed CaSR disorders in 82 patients in the study cohort.
Short-Term Effectiveness and Safety of Biologics and Small Molecule Drugs for Moderate to Severe Atopic Dermatitis: A Systematic Review and Network Meta-Analysis.
(2021-09-06) Pereyra-Rodriguez, Jose Juan; Alcantara-Luna, Sara; Domínguez-Cruz, Javier; Galán-Gutiérrez, Manuel; Ruiz-Villaverde, Ricardo; Vilar-Palomo, Samuel; Armario-Hita, Jose-Carlos
Some Network Meta-analysis (NMA) has been published regarding atopic dermatitis (AD). These studies have considered drugs under investigation both in monotheraphy or in combination with topical corticosteroids, as well as systemic immunosuppressant therapies. The objective of this study is to evaluate the efficacy and safety of biological agents and small molecules in AD. A systematic review and NMA of biologics agents and small molecules in AD was performed. A literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for clinical trials and systematic reviews between January 2000 and 19 December 2020. Only randomized clinical trials (RCTs) were included. It was limited to English language and adult human subjects. Two networks were evaluated: monotherapy and combination with TCS. The two primary outcomes were Eczema Area and Severity Index (EASI) 75 and EASI 90 change from baseline to week 12-16, depending on source study cut-off. The Cochrane's Risk of Bias tool 2011 update was used to analyze the risk of bias, focused on the primary objectives. 30 RCTs (included in 26 publications) were included in the systematic review. Finally, 23 RCTs were included in the quantitative analysis (14 RCTs including 3582 patients in monotherapy; and 9 RCTs including 3686 patients with TCS). In monotherapy, a higher percentage of patients achieving EASI-75 was obtained with Upadacitinib 30 mg [OR: 18.90 (13.94; 25.62)] followed by Abrocitinib 200 mg [OR = 11.26 (7.02; 18.05)] and Upadacitinib 15 mg [OR: 10.89 (8.13; 14.59)]. These results were also observed in studies where the use of topical corticosteroid (TCS) was allowed (OR Upadacitinib 30 mg = 9.43; OR Abrocitinib 200 mg = 6.12; OR Upadacitinib 15 mg = 5.20). Regarding IGA, the percentage of patients achieving IGA0/1 was higher with both doses of Upadacitinib 30 mg [OR: 19.13 (13.14; 27.85)] and 15 mg [OR = 10.95 (7.52; 15.94). In studies where the use of TCS were allowed, however, the dose of Abrocitinib 200 mg [OR = 6.10 (3.94; 9.44)] showed higher efficacy than Upadacitinib 15 mg [OR = 5.47 (3.57; 8.41)]. Regarding safety, the drugs with the highest probability of presenting adverse effects were the Janus kinases (JAK) inhibitors, Upadacitinib and Abrocitinib in monotherapy and Baricitinib in combination with TCS. Some risks of bias have been found, which must be taken into account when interpreting the results. The funnel plot shows a possible publication bias that may underestimate the efficacy of drugs. Upadacitinib and Abrocitinib are the drugs with the highest efficacy, both in monotherapy and in association with TCS. However, they were also those associated with the highest risk of adverse effects, showing monoclonal antibodies better safety profile. We have included molecules still in the development phase as well studies completed and presented at conferences and with data available in Trialsgov® but not published yet. Several molecules' development had included a small number of patients from 12 to 17 years of age, without being able to differentiate the results from the adult population. Other: Founding: None. PROSPERO database registration number CRD42021225793.
Duration of the acute hepatic encephalopathy episode determines survival in cirrhotic patients.
(2017-11-26) Ventura-Cots, Meritxell; Carmona, Isabel; Moreno, Carolina; Ampuero, Javier; Simón-Talero, Macarena; Sanpedro, Francesc; Les, Iñigo; Romero-Gómez, Manuel; Genescà, Joan
Episodes of hepatic encephalopathy (HE) have been related to low survival rate. However, the relation between its clinical evolution and mortality has not been assessed. A retrospective analysis of 245 cirrhotic patients admitted for an acute episode of HE (⩾grade 2) or who developed an HE episode after an upper gastrointestinal bleeding (UGIB) event was performed to assess the relation between time in HE and transplant-free survival. Median (IQR25-75) time in HE was 48 h (24-96 h) in the whole cohort. Patients who presented a longer time in HE (>48 h; n = 89) exhibited a lower transplant-free survival at 28 days (67.2% versus 88.9%, p 48 h; n = 89) exhibited a lower transplant-free survival at 28 days (67.2% versus 88.9%, p 48 h, when comparing patients according to baseline HE grade (2 versus ⩾3) or model for end-stage liver disease (MELD) function (⩽15 versus >15). Time in HE was also an independent risk factor for mortality at each time point, hazard ratio (HR) (95 CI%) 28 days 2.59 (1.39-4.84); 90 days 1.98 (1.28-3.1) and 365 days 1.5 (1.08-2.19). The duration of the acute HE episode determines survival in cirrhotic patients independently of liver function and baseline HE grade.
Preliminary Validation of the Triana Test: A New Story Recall Test Based on Emotional Material.
(2021) Luque-Tirado, Andrea; Rodrigo-Herrero, Silvia; Sánchez-Arjona, María Bernal; Franco-Macías, Emilio
To first validate the diagnostic accuracy of the "Triana Test," a new story recall test based on emotional material. A phase I study of validation. We included 55 patients with amnestic Mild Cognitive Impairment and 69 healthy controls, diagnosed according to the "Memory Associative Test of the district of Seine-Saint-Denis" (TMA-93), and matched by age, gender, and educational level. The Triana Test's diagnostic accuracy was calculated by ROC curve analysis and Spearman correlations estimated its convergent validity with a hippocampal memory test, the Free and Cued Selective Reminding Test with Immediate Recall (FCSRT+IR). The "Triana Test" immediate and delayed recalls showed adequate diagnostic accuracy (AUC ≥ 0,74). The delayed free recall showed the highest diagnostic accuracy (AUC = 0.86). Correlations with the FCSRT+IR were moderate to strong. The "Triana Test" demonstrated accuracy for discriminating amnestic Mild Cognitive Impairment patients from healthy controls and convergent validity with the FCSRT+IR.
Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy
(Bmc, 2021-11-08) Bendala Estrada, Alejandro David; Calderon Parra, Jorge; Fernandez Carracedo, Eduardo; Muino Miguez, Antonio; Ramos Martinez, Antonio; Munez Rubio, Elena; Rubio-Rivas, Manuel; Agudo, Paloma; Arnalich Fernandez, Francisco; Estrada Perez, Vicente; Taboada Martinez, Maria Luisa; Crestelo Vieitez, Anxela; Pesqueira Fontan, Paula Maria; Bustamante, Marta; Freire, Santiago J.; Oriol-Bermudez, Isabel; Artero, Arturo; Olalla Sierra, Julian; Areses Manrique, Maria; Javier Carrasco-Sanchez, H. Francisco; Carolina Vento, Vanessa; Garcia Garcia, Gema Maria; Cubero-Morais, Pablo; Casas-Rojo, Jose-Manuel; Millan Nunez-Cortes, Jesus; [Bendala Estrada, Alejandro David] Gregorio Maranon Gen Univ Hosp, Internal Med Dept, Madrid, Spain; [Fernandez Carracedo, Eduardo] Gregorio Maranon Gen Univ Hosp, Internal Med Dept, Madrid, Spain; [Muino Miguez, Antonio] Gregorio Maranon Gen Univ Hosp, Internal Med Dept, Madrid, Spain; [Millan Nunez-Cortes, Jesus] Gregorio Maranon Gen Univ Hosp, Internal Med Dept, Madrid, Spain; [Calderon Parra, Jorge] Puerta Hierro Majadahonda Univ Hosp, Internal Med Dept, Madrid, Spain; [Ramos Martinez, Antonio] Puerta Hierro Majadahonda Univ Hosp, Internal Med Dept, Madrid, Spain; [Munez Rubio, Elena] Puerta Hierro Majadahonda Univ Hosp, Internal Med Dept, Madrid, Spain; [Rubio-Rivas, Manuel] Bellvitge Univ Hosp IDIBELL, Internal Med Dept, Barcelona, Spain; [Agudo, Paloma] 12 Octubre Univ Hosp, Internal Med Dept, Madrid, Spain; [Arnalich Fernandez, Francisco] La Paz Univ Hosp, Internal Med Dept, Madrid, Spain; [Estrada Perez, Vicente] San Carlos Clin Hosp, Internal Med Dept, Madrid, Spain; [Taboada Martinez, Maria Luisa] Cabuenes Univ Hosp, Internal Med Dept, Gijon, Asturias, Spain; [Crestelo Vieitez, Anxela] Royo Villanova Hosp, Internal Med Dept, Zaragoza, Spain; [Pesqueira Fontan, Paula Maria] Santiago Clin Hosp, Internal Med Dept, Santiago De Compostela, A Coruna, Spain; [Bustamante, Marta] La Princesa Univ Hosp, Internal Med Dept, Madrid, Spain; [Freire, Santiago J.] A Coruna Univ Hosp, Internal Med Dept, La Coruna, Spain; [Oriol-Bermudez, Isabel] Moises Broggi Hosp, Internal Med Dept, Infect Dis, Barcelona, Spain; [Artero, Arturo] Dr Peset Univ Hosp, Internal Med Dept, Valencia, Spain; [Olalla Sierra, Julian] Costa del Sol Hosp, Internal Med Dept, Malaga, Spain; [Areses Manrique, Maria] Santa Marina Hosp, Internal Med Dept, Bilbao, Spain; [Javier Carrasco-Sanchez, H. Francisco] Juan Ramon Jimenez Univ Hosp, Internal Med Dept, Huelva, Spain; [Carolina Vento, Vanessa] Henares Hosp, Internal Med Dept, Madrid, Spain; [Garcia Garcia, Gema Maria] Badajoz Univ Hosp Complex, Internal Med Dept, Badajoz, Spain; [Cubero-Morais, Pablo] Rio Hortega Univ Hosp, Internal Med Dept, Reg Hlth Management Castilla & Leon SACYL, Valladolid, Spain; [Casas-Rojo, Jose-Manuel] Infanta Cristina Univ Hosp, Internal Med Dept, Madrid, Spain
Background Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. Methods This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. Results Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21-1.62; p

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