SAS - Hospital Universitario Juan Ramón Jiménez

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[Effect of the first wave of COVID-19 on the implementation of Enhanced Recovery After Surgery (ERAS) protocols based on perceptions of healthcare professionals].
(2021-10-09) Lorente, J V; Ripollés-Melchor, J; Aldecoa, C; Abad-Motos, A
Executive summary on the treatment of type 2 diabetes mellitus in elderly or frail individuals. 2022 update of the 2018 consensus document "Treatment of type 2 diabetes mellitus in the elderly".
(2022-06-24) Gómez-Peralta, F; Carrasco-Sánchez, F J; Pérez, A; Escalada, J; Álvarez-Guisasola, F; Miranda-Fernández-Santos, C; Mediavilla-Bravo, J J; Gómez-Huelgas, R
The population with type 2 DM (DM2) is highly heterogeneous, representing an important challenge for healthcare professionals. The therapeutic choice should be individualized, considering the functional status, frailty, the occurrence of comorbidities, and the preferences of patients and their caregivers. New evidence on the cardiovascular and renal protection of specific therapeutic groups and on the usefulness of new technologies for DM2 management, among other aspects, warrant an update of the consensus document on the DM2 in the elderly that was published in 2018.
Preliminary analysis of a shortened picture version of the Free and Cued Selective Reminding Test.
(2019-03-27) Rodrigo-Herrero, S; Mendez-Barrio, C; Bernal Sánchez-Arjona, M; de Miguel-Tristancho, M; Graciani-Cantisán, E; Carnero-Pardo, C; Franco-Macías, E
A picture version of the Free and Cued Selective Reminding Test (FCSRT) would assist in the assessment of memory function in patients with low levels of schooling. A shortened version would improve the test's applicability. To analyse the diagnostic usefulness of a shortened picture version of the FCSRT for distinguishing patients with amnestic mild cognitive impairment (aMCI) from controls, without excluding participants with a low level of schooling. Phase I study of a diagnostic evaluation (convenience sampling; pre-test prevalence 50%). A blinded researcher independently administered the FCSRT to 30 patients with aMCI and 30 controls matched for age, sex, level of schooling and literacy, using images and omitting the usual 30-minute delayed recall item. Three variables were recorded: free recall, total recall, and cue efficiency. Diagnostic accuracy was calculated using receiver operating characteristic curves and the area under the curve. The Youden index was used to identify optimal cut-off points. Of all participants, 41.7% had not completed primary education. There were no differences between groups as regards sociodemographic variables. Area under the curve was excellent for free recall (0.99), total recall (0.95), and cue efficiecy (0.93). The optimal cut-off points were 21/22, 43/44, and This preliminary analysis shows that a shortened picture version of the FCSRT may be useful and applicable for the diagnosis of aMCI without excluding individuals with a low level of schooling.
Story of two sisters with kidney disease: genetics command.
(2020-12-19) Barral-Juez, Mikel; García-Rabaneda, Carmen; Poyatos-Andújar, Antonio Miguel; Martínez-Atienza, Margarita; Morales-García, Ana Isabel; Morales-Santana, Sonia; Bellido-Díaz, María Luz; Bravo-Soto, Juan Antonio; Esteban-de la Rosa, Rafael José
Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis.
(2022-05-10) Castro-Mejía, Alex F; Amat-Santos, Ignacio; Ortega-Armas, Maria E; Baz, Jose A; Moreno, Raúl; Diaz, Jose F; Travieso, Alejandro; Jimenez-Quevedo, Pilar; Santos-Martínez, Sandra; McInerney, Angela; Galeote, Guillermo; Díaz, Victor Alfonso Jimenez; Garrido, Jessica Roa; Tirado-Conte, Gabriela; Barrero, Alejandro; Marroquin, Luis; Nuñez-Gil, Ivan; Gonzalo, Nieves; Fernandez-Ortiz, Antonio; Escaned, Javier; Nombela-Franco, Luis
High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR. Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.
[Executive Summary from Expert consensus on effectiveness and safety of iDPP-4 in the treatment of patients with diabetes and COVID-19].
(2021-11-06) Carrasco-Sánchez, Francisco Javier; Carretero-Anibarro, Enrique; Gargallo, Manuel Ángel; Gómez-Huelgas, Ricardo; Merino-Torres, Juan Francisco; Orozco-Beltrán, Domingo; Pines Corrales, Pedro José; Ruiz Quintero, Manuel Antonio
This consensus aims to clarify the role of Dipeptidyl Peptidase-4 inhibitors (iDPP-4) in managing patients with diabetes during the COVID-19 pandemic. A PubMed bibliographic search was carried out (December 2019-February 2021). Oxford methodology was used for the evaluation of evidence and possible recommendations were established by consensus. Diabetes appears to be an independent factor in COVID-19 disease (evidence 2b). No increased risk of contagion with iDPP-4 is demonstrated (evidence 2b), and its use has been shown to be safe (evidence 2b). The use of this drug may present a specific benefit in reducing mortality, particularly in in-hospital use (evidence 2a), reducing admission to intensive care units (evidence 2b) and the need for mechanical ventilation (evidence 2b). The use of iDPP-4 appears to be safe in patients with COVID-19, and quality studies are needed to clarify their possible advantages further.
Validation of the aberrant salience inventory in a general and clinical Spanish population.
(2022-08-19) Rodríguez-Testal, J F; Fuentes-Márquez, S; Senín-Calderón, C; Fernández-León, S; Ceballos Munuera, C; Perona-Garcelán, S; Fonseca-Pedrero, E
The concept of aberrant salience is related to the onset of psychosis. Its study is important for early identification and possible intervention in processes activating later positive symptoms. This study validated the Spanish Aberrant Salience Inventory (ASI) for adult and clinical populations. The sample consisted of 6178 participants, of whom 4523 were adolescents, 1292 were general population adults and 363 were patients with a psychopathology. The evidence provided validates the instrument's structure. Invariance of measurement suggests that both men and women, patients and nonclinical population (adults and adolescents) interpreted the items on the ASI similarly. The distribution of scores by age also suggests stabilization of the trend at about 19 years of age, showing a developmental change in motivational response. The hypothesis that patients, and in particular, those diagnosed with schizophrenia and other psychotic disorders and bipolar disorders would have the highest average scores in aberrant salience was met. This is a valuable instrument for evaluating a complex process related to abnormal motivation in the development of schizophrenia.
Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study
(Elsevier science inc, 2023-01-26) Ripolles-Melchor, Javier; Aldecoa, Cesar; Fernandez-Garcia, Raquel; Varela-Duran, Marina; Aracil-Escoda, Norma; Garcia-Rodriguez, Daniel; Cabezudo-de-la-Muela, Lucia; Hormaechea-Bolado, Lucia; Nacarino-Alcorta, Beatriz; Hoffmann, Rolf; Lorente, Juan, V; Ramirez-Rodriguez, Jose M.; Abad-Motos, Ane; Spanish Perioperative Audit Res; [Ripolles-Melchor, Javier] Infanta Leonor Univ Hosp, Dept Anesthesia & Perioperat Med, Madrid, Spain; [Aracil-Escoda, Norma] Infanta Leonor Univ Hosp, Dept Anesthesia & Perioperat Med, Madrid, Spain; [Abad-Motos, Ane] Infanta Leonor Univ Hosp, Dept Anesthesia & Perioperat Med, Madrid, Spain; [Ripolles-Melchor, Javier] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain; [Aldecoa, Cesar] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain; [Ramirez-Rodriguez, Jose M.] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain; [Abad-Motos, Ane] Spanish Perioperat Audit & Res Network REDGERM, Zaragoza, Spain; [Ripolles-Melchor, Javier] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Aldecoa, Cesar] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Fernandez-Garcia, Raquel] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Varela-Duran, Marina] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Aracil-Escoda, Norma] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Garcia-Rodriguez, Daniel] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Cabezudo-de-la-Muela, Lucia] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Hormaechea-Bolado, Lucia] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Nacarino-Alcorta, Beatriz] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Hoffmann, Rolf] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Lorente, Juan, V] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Ramirez-Rodriguez, Jose M.] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Abad-Motos, Ane] Grp Espanol Rehabil Multimodal GERM, Zaragoza, Spain; [Ripolles-Melchor, Javier] Rio Hortega Univ Hosp, Dept Anesthesia & Crit Care, Valladolid, Spain; [Aldecoa, Cesar] Rio Hortega Univ Hosp, Dept Anesthesia & Crit Care, Valladolid, Spain; [Abad-Motos, Ane] Rio Hortega Univ Hosp, Dept Anesthesia & Crit Care, Valladolid, Spain; [Fernandez-Garcia, Raquel] Mostoles Univ Hosp, Dept Anesthesia & Crit Care, Mostoles, Spain; [Nacarino-Alcorta, Beatriz] Mostoles Univ Hosp, Dept Anesthesia & Crit Care, Mostoles, Spain; [Varela-Duran, Marina] Complexo Hosp Montecelo, Dept Anesthesia & Crit Care, Pontevedra, Spain; [Garcia-Rodriguez, Daniel] Hosp La Cruz Roja, Dept Anesthesia & Perioperat Med, Gijon, Spain; [Cabezudo-de-la-Muela, Lucia] La Fe Univ Hosp, Dept Anesthesia & Perioperat Med, Valencia, Spain; [Hormaechea-Bolado, Lucia] Puerta de Hierro Univ Hosp, Dept Anesthesia & Perioperat Med, Majadahonda, Spain; [Hoffmann, Rolf] Hosp Santa Creu & Sant Pau, Dept Anesthesia & Perioperat Med, Barcelona, Spain; [Lorente, Juan, V] Juan Ramon Jimenez Univ Hosp, Dept Anesthesia & Perioperat Med, Huelva, Spain; [Ramirez-Rodriguez, Jose M.] Lozano Blesa Univ Hosp, Dept Surg, Zaragoza, Spain
Background: Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization.Methods: This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery.Results: A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16-30]. 4,222 (69.3%) patients moved in
Prone Position in COVID-19 Patients With Severe Acute Respiratory Distress Syndrome Receiving Conventional Oxygen Therapy: A Retrospective Study.
(2021-06-06) Loureiro-Amigo, Jose; Suárez-Carantoña, Cecilia; Oriol, Isabel; Sánchez-Díaz, Cristina; Coloma-Conde, Ana; Manzano-Espinosa, Luis; Rubio-Rivas, Manuel; Otero-Perpiñá, Barbara; Ferreiro-Mazón Jenaro, María Mercedes; Coduras-Erdozain, Ainara; Garcia-Klepzig, José Luis; Vargas-Parra, Derly; Pesqueira-Fontán, Paula M; Fiteni-Mera, Isabel; García-García, Gema María; Jiménez-Torres, José; Rodríguez-Cortés, Pablo; Costo-Muriel, Clara; Arnalich-Fernández, Francisco; Artero, Arturo; Carrasco-Sánchez, Francisco Javier; Escobar-Sevilla, Joaquín; Alcalá-Pedrajas, José Nicolás; Gómez-Huelgas, Ricardo; Ramos-Rincón, José-Manuel; SEMI-COVID-19 Network
Experiences of suffering among nursing professionals during the COVID-19 pandemic: A descriptive qualitative study.
(2022-06-24) Sánchez-Romero, Sheila; Ruiz-Fernández, María Dolores; Fernández-Medina, Isabel María; Del Mar Jiménez-Lasserrotte, María; Del Rocío Ramos-Márquez, María; Ortega-Galán, Ángela María
Healthcare professionals have played a fundamental role in managing and controlling the COVID-19 health crisis. They are exposed to high levels of suffering, trauma, uncertainty, and powerlessness in the workplace. The objective of this study was to explore and understand experiences of suffering among primary care and hospital care nurses during the COVID-19 health crisis. This is a descriptive qualitative study. Between March and April 2021, 19 in-depth interviews were carried out with nurses at health and social care facilities and hospitals in southern Spain. ATLAS.ti 9.0 software was used for discourse analysis. Nurses reported that they had experienced suffering during their work in the pandemic. The main causes suggested were direct contact with patients' suffering and organisational difficulties. The repercussions are in emotional dimension and physical deterioration and social isolation. Given the circumstances, programmes to promote healthy, compassion-based behaviours and changes to the way in which professionals' suffering is handled must be implemented by healthcare facility managers. Nursing leaders should consider the management of suffering as a matter of the first order, both from the ethical point of view and the business profitability and make compassionate leadership.
[Gestational and pregestational diabetes: Perinatal characteristics and neonatal morbidity].
(2021-05-06) Santos Martín, María Teresa; Gómez Santos, Elisabeth; Torres Del Pino, Marta; Toledo Muñoz-Cobo, Gloria; Pérez Hernández, Ana
[Use of the subcutaneous route in a second level hospital. A review of current use and new proposals].
(2020-10-25) Baquero Gómez, Concepción; de Los Santos Martín, María Teresa; Croche Santander, Borja; Gómez Pérez, Sara; Díaz Suárez, Manuela
Comparison between five PCR techniques for the diagnosis of SARS-CoV-2.
(2022-06-20) Tenorio-Abreu, A; Ruiz-Castillo, A; Guzmán-González, A F; Peña-Monje, A; Saavedra-Martín, J M; Franco-Álvarez De Luna, F
Since the first cases of SARS-CoV-2 appeared, there have been numerous techniques that have been developed for the diagnosis or monitoring of infection, both direct and serological techniques. Choosing a good diagnostic tool is essential for epidemiological control. The objective was to compare five commercialized RT-PCR techniques in real time, in sensitivity, specificity and agreement for the detection of SARS-CoV-2. Five commercial RT-PCR kits for the detection of SARS-CoV-2 were compared. Eight known positive samples were taken and subjected to seven different dilutions or concentrations, and another 135 negative samples were used to determine sensitivity, specificity, and agreement values. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the Palex, Roche and GeneXpert techniques with respect to Seegene were identical, corresponding to 98.21%, 100%, 100% and 99.26% respectively. For Becton Dickinson the sensitivity was 89.28%, the specificity of 100%, the PPV of 100% and the NPV of 95.74%. The agreement using the Kappa index for Palex, Roche and GeneXpert was 0.9892, while the agreement for Becton Dickinson was with a Kappa index of 0.9215. All commercial RT-PCR kits had high sensitivities and specificities, as well as PPV, NPV, and concordance.
[Osteomyelitis of the cuboid due to Mycobacterium smegmatis].
(2022-07-18) Ruiz-Castillo, A; Tenorio-Abreu, A; Hidalgo-Jiménez, A; Saavedra-Martín, J M
Subclavian angioplasty during coronary interventions using radial approach.
(2022-06-20) El Amrawy, Ahmed Mahmoud; Camacho-Freire, Santiago; Gomez-Menchero, Antonio; Cardenal-Piris, Rosa; Diaz-Fernandez, Jose Francisco
In the past years, the percentage of percutaneous coronary angiography and coronary interventions using radial access had significantly increased due to its higher safety, lower risk of major bleeding, and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion. To evaluate the feasibility and safety of performing subclavian angioplasty via radial access during complex coronary interventions using the forearm approach. A series of patients with complex radial approach due to subclavian stenosis received subclavian angioplasty during the procedure. We included 48 patients out of 22 500 procedures performed from February 2009 to February 2020. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion, which makes femoral access crossover difficult; also the contralateral radial/ulnar artery was very faint or not detectable at all). Mean age was 72 (10) years and 67% of patients were males. Subclavian angioplasty was successfully done in all patients via ipsilateral radial access; 44 patients (91.7%) required subclavian stenting, and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly achieved through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated. It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approach.
Analysis of blood markers for early colorectal cancer diagnosis.
(2022) Bayo Calero, Juan; Castaño López, Miguel Angel; Casado Monge, Pedro Germán; Díaz Portillo, Jacobo; Bejarano García, Ana; Navarro Roldán, Francisco
Colorectal cancer (CRC) is a very common tumor worldwide. Its mortality can be limited by early diagnosis through screening programs. These programs are based on fecal occult blood testing and colonoscopy. Our objective was to find a model based on the determination of blood biomarkers that was efficacious enough to become part of the early diagnosis of CRC. In a total of 221 patients who underwent a colonoscopy, two types of markers were identified (I) classic: carcinoembryonic antigen (CEA), CA19.9, α-fetoprotein, CA125, CA72.4, and ferritin; and (II) experimental: neutrophil gelatinase-associated lipocalin (NGAL), estimated glomerular filtration rate (EGFR), 8-hydroxydeoxyguanosine (8OHdG), calprotectin, and cysteine-rich 61 (Cyr61). We divided the patients into four groups according to colonoscopy results: a control group (n=83) with normal colonoscopy, a polyp group (n=56), a CRC group (n=45), and an inflammatory disease group (n=37). We built an algorithm based on multivariate logistic regression analysis. A total of 51.6% were males, and the median age was 63 years. We designed an algorithm based on the combination of several markers that discriminated CRC patients from the rest of the patients with a performance of 94%, a sensitivity of 95.6%, and a specificity of 80.6%. Discriminating by sex also resulted in two powerful algorithms, although it performed better in males (97% vs. 91%). Our study has devised a predictive model with high efficacy based on the determination of several biomarkers. We think that it could be incorporated into the set of methods used in CRC screening.
Efficacy and safety of tofacitinib in the treatment of ulcerative colitis: real-life experience in Andalusia.
(2022) Hernández Martínez, Alvaro; Navajas Hernández, Pilar; Martín Rodríguez, María Del Mar; Lázaro Sáez, Marta; Olmedo Martín, Raúl; Núñez Ortiz, Andrea; Argüelles Arias, Federico; Fernández Cano, María Carmen; Gallardo Sánchez, Francisco; Marín Pedrosa, Sandra; González García, Javier; Vázquez Morón, Juan María
tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). This study aimed to evaluate its efficacy in a real-life setting. a retrospective and multicenter observational study was performed with UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety were analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. seventy-four patients were included, 98.3 % had received prior biological treatment, 55.4 % with three or more biologicals and up to 64.9% with two or three different mechanisms of action. Clinical remission and response rates were 37.8 % and 77 % at eight weeks, and 41.8 % and 70.1 % at 16 weeks. With regard to non-responders at eight weeks, 37.5 % achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95 % CI: 16-22), with a treatment survival of 56 % at 28 months, and remission and response rates at 24 months of 53.8 % and 61.5 %. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only four were severe and led to treatment discontinuation. tofacitinib has a demonstrated efficacy in clinical practice to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
Ustekinumab in Crohn's disease: real-world outcomes and predictors of response.
(2022) Lorenzo González, Laura; Valdés Delgado, Teresa; Vázquez Morón, Juan María; Castro Laria, Luisa; Leo Carnerero, Eduardo; Maldonado Pérez, María Belén; Sánchez Capilla, Damián; Pallarés Manrique, Héctor; Sáez Díaz, Antonia; Argüelles Arias, Federico; Grupo de Enfermedad Inflamatoria de Andalucía
ustekinumab is a monoclonal antibody that inhibits interleukins IL-12 and IL-23, and is approved for the treatment of Crohn's disease (CD) and, more recently, also ulcerative colitis (UC). The aim of this study was to evaluate the effectiveness and safety of ustekinumab, as well as to identify possible predictive factors of response in a real-life setting. an observational, retrospective, multicenter study was carried out in 4 hospitals in Andalusia. Adult patients with a confirmed diagnosis of CD treated with ustekinumab from 2017 to 2019 were included. Clinical response was analyzed at 3, 6 and 12 months of treatment. Clinical disease activity was assessed with the Harvey-Bradshaw index (HBI) and the Crohn's Disease Activity Index (CDAI); biochemical response was assessed with lab parameters such as CRP and ESR. One-year ustekinumab drug-survival was analyzed. a total of 98 patients were analyzed (mean age, 43 years; 52 % were male); 56 % had failed with ≥ 2 previous biologicals therapies. At 3 months, 69 % of the patients were in response and 40.8 % in remission. At 6 months, 56 % were in clinical remission. At 12 months, 73.7 % were in clinical response and 60.5 % in remission. Corticosteroid-free remission was 32.4 %, 44 %, and 47.4 % at 3, 6, and 12 months, respectively. Cumulative survival after one year of treatment with ustekinumab was 85.3 %. Biochemical parameters such as CRP and ESR showed a statistically significant decrease between baseline and control levels at 3, 6, and 12 months. A lower HBI at baseline and female sex were predictors of corticosteroid-free clinical remission in a univariate analysis. In the multivariate analysis no variables were found as predictors of corticosteroid-free clinical remission. ustekinumab therapy is safe and useful, inducing clinical response in more than 50 % of patients, including patients who failed with other biological therapies.
Thrombotic Left Main Coronary Artery Occlusion Treated With Bioresorbable Scaffold.
(2022) Camacho Freire, Santiago Jesús; Gómez Menchero, Antonio Enrique; Garrido, Jessica Roa; Rojas, Marcos López; Piris, Rosa Cardenal; Díaz Fernández, José Francisco
Shorter Time to Discontinuation Due to Treatment Failure in People Living with HIV Switched to Dolutegravir Plus Either Rilpivirine or Lamivudine Compared with Integrase Inhibitor-Based Triple Therapy in a Large Spanish Cohort.
(2022-04-11) Teira, Ramón; Diaz-Cuervo, Helena; Aragão, Filipa; Castaño, Manuel; Romero, Alberto; Roca, Bernardino; Montero, Marta; Galindo, Maria José; Muñoz-Sánchez, Maria Jose; Espinosa, Nuria; Peraire, Joaquim; Martínez, Elisa; de la Fuente, Belén; Domingo, Pere; Deig, Elisabeth; Merino, María Dolores; Geijo, Paloma; Estrada, Vicente; Sepúlveda, María Antonia; García, Josefina; Berenguer, Juan; Currán, Adriá
Standard therapy for HIV treatment has consisted of two nucleoside analogue reverse transcriptase inhibitors (NRTI) paired with a third agent. Use of two-drug regimens (2DR) has been considered for selected patients in part to avoid toxicities associated with the use of NRTIs. This study aimed to compare the real-world outcomes of integrase inhibitor (INSTI)-based three-drug regimens (3DR) versus 2DR of dolutegravir (DTG) + rilpivirine (RPV) or DTG + lamivudine (3TC). All patients in the Spanish VACH cohort switching to INSTI-based 3DR or a 2DR consisting of DTG + RPV or DTG + 3TC between May 2, 2016 and May 15, 2019 were included. Kaplan-Meier curves and Cox proportional hazard models were used to assess time to/risk of discontinuation due to treatment failure (TF) (defined as virologic failure [VF], immunologic failure, or disease progression) and adverse events (AEs). Three secondary analyses were performed: (1) in restricting the analysis to patients who were virologically suppressed (HIV RNA Overall, 5047 3DR and 617 2DR patients were analyzed. Baseline characteristics differed between groups; 2DR patients were older, more treatment experienced, and more likely to be virologically suppressed at switch. Time to discontinuation due to TF was significantly shorter for 2DR (P = 0.002). The hazard ratio (HR) for discontinuation due to TF on 2DR vs 3DR was 2.33 (P = 0.003). No difference was observed for time to discontinuation (P = 0.908) or risk of discontinuation due to AEs (HR = 0.80; P = 0.488). Results were qualitatively similar in virologically suppressed patients, matched analysis, and for VF. In the real world, the risks of discontinuation due to TF and VF were more than two times higher in patients switching to DTG-based 2DR than INSTI-based 3DR, with no difference in discontinuation due to AEs.

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