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Marin-Iranzo R.,Centro Medico Of Asturias | Riesgo-Garcia A.,Hospital Valle del Nalon | Garcia-Casas J.B.,Servicio de Medicina Preventiva y Salud Publica
Nefrologia | Year: 2012

Objectives: To determine the prevalence of kidney failure in people older than 49 years old with peripheral arterial disease and to analyse its relationship with risk factors and cardiovascular disease. Material and method: Prospective epidemiological study 3 years in duration with selection by simple random sampling in the general population aged over 49 years. Data on demographic, clinical, prevalence of risk factors and cardiovascular disease were registered. We defined peripheral arterial disease (PAD) by ankle-brachial index (ABI) ≤0.9 and chronic kidney disease (CKD) according to estimated glomerular filtration rates by the MDRD <60 ml/min/1.73m 2. Baseline data are presented. Results: 511 people were included. The mean age was 66.6 (9.7) years (SD), 37% were men. The prevalence of PAD was 12.4% (N=63) of the sample, average age 72.6 years, 46% men. The presence of CKD stages 3-5 was 39.7%. Patients with PAD and CKD compared with those with normal renal function were older (75.6 vs. 70.6, p=0.08), predominantly women (64% vs 47.4%, p=ns), and showed higher values for systolic and diastolic blood pressure (159.2 vs 146.1, p=ns and 85.7 vs 80.3 mmHg, p=0.09), CRP (1.23 vs 0.38 mg/dl, p=0.05) and albumin creatinine ratio (90.2 vs 26.4 mg/g, p=ns). In this group, the prevalence of cardiovascular risk factors and associated cardiovascular disease, were significantly higher without reaching statistical significance. Conclusions: Kidney failure is present in 39.7% of patients with PAD and it defines a subgroup of patients with high cardiovascular risk. © 2012 Revista Nefrología.


Mateos V.,Centro Medico Of Asturias | Guerrero-Peral A.L.,Hospital Clinico Universitario | Garcia M.,Adknoma Health Research
Revista de Neurologia | Year: 2012

Introduction. Patients with migraine often report factors or circumstances that precipitate or trigger their attacks. Yet few studies have been conducted to examine this matter. Aim. To explore the factors that precipitate migraine in our setting, as well is their possible relation with the intensity of the attacks or the overall repercussion of migraine. Patients and methods. An epidemiological, cross-sectional, multi-centre study was conducted in neurology consultation services. Sociodemographic and clinical data were collected and the precipitating factors were identified from a closed list. The specific migraine disability questionnaire -Headache Impact Test (HIT-6)- and the measurement of the number of lost workday equivalents were used in the study. Results. Altogether 817 patients were recruited (72.5% females, mean age: 34.6 ± 10.3 years). A total of 70.5% of the patients had severe disability according to the HIT-6. The mean monthly number of lost workday equivalents was 2.1 ± 2.5. A total of 96.6% of the patients identified some precipitating factor for the attacks, the most commonly reported being hormonal (75.2%), stress (70.9%) and those related with disorders affecting sleep patterns (68.4%). Conclusions. The FACTOR study confirms that most patients with migraine identify some circumstance that precipitates their attacks. Controlling or avoiding these factors, whenever possible, must be part of the programme of education received by patients suffering from migraine. © 2012 Revista de Neuroloǵa.


Pascual J.,Hospital Universitario Central Of Asturias | Sanchez Del Rio M.,Hospital Ruber Internacional | Dolores Jimenez M.,Hospital Universitario Virgen del Rocio | Lainez-Andres J.M.,Hospital Clinico | And 4 more authors.
Revista de Neurologia | Year: 2010

Introduction. Data on the reality of chronic migraine in our clinics are scarce. Aim. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. Subjects and methods. A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. Results. A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. Conclusions. Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feedback with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology. © 2010 Revista de Neurología.


Mateos V.,Centro Medico Of Asturias | Porta-Etessam J.,Hospital Clinico San Carlos | Armengol-Bertolin S.,Almirall S.A. | Larios C.,Biometria Clinica | Garcia M.,Adknoma Health Research
Revista de Neurologia | Year: 2012

Introduction. Despite the high degree of disability it entails, many patients with migraine have never visited their doctor for this reason. It is necessary to conduct a study to examine the characteristics of first-time visits as a step that must be carried out prior to establishing specific intervention measures for this group of patients. Aim. To determine the profile of the patients with migraine who visit a neurology service for the first time, together with the diagnostic and therapeutic attitudes that neurologists display towards them. Patients and methods. We conducted a cross-sectional, multi-centre study of neurology services across the country. The research included 168 neurologists who recruited 851 patients (74.6% females; mean age: 34.0 ± 10.7 years). Disability was assessed by means of the specific migraine questionnaire (Headache Impact Test) and the generic disability questionnaire (Sheehan Disability Scale). Results. A third (66.5%) of the patients went for consultation following their doctor's advice, while the remaining 33.5% went on their own accord. Only 55.9% had been previously diagnosed with migraine. The main reasons for visiting were ineffective symptomatic treatment (25%) and an increase in the frequency or intensity of the attacks (23.4%). Although 70.3% of the patients had high disability scores on the Headache Impact Test, only 17.4% used specific treatment and only 13.3% were on preventive treatment. Conclusions. The PRIMERA study confirms, once again, that migraine is an under-diagnosed and under-treated condition in our setting, which means that specific educational interventions and training are still required for this pathology. © 2012 Revista de Neurología.


Cabanillas R.,Institute Medicina Oncologica Y Molecular Of Asturias | Cadinanos J.,Institute Medicina Oncologica Y Molecular Of Asturias | Villameytide J.A.,Centro Medico Of Asturias | Perez M.,Centro Medico Of Asturias | And 7 more authors.
American Journal of Medical Genetics, Part A | Year: 2011

Progeria syndromes are rare disorders that involve premature aging. Mutations in BANF1 have been recently reported to cause a new hereditary progeroid syndrome that we now propose to call the Néstor-Guillermo progeria syndrome (NGPS). We describe herein the clinical features of the first two NGPS patients, who phenocopy features of classic progerias (i.e., Hutchinson-Gilford progeria syndrome or mandibuloacral dysplasia), such as aged appearance, growth retardation, decreased subcutaneous fat, thin limbs, and stiff joints. However, these NGPS patients have a distinctive phenotype. In their early adulthood (32 and 24 years of age), they have no signs of cardiovascular impairment, diabetes mellitus, or hypertriglyceridemia. In contrast, they suffer profound skeletal abnormalities that affect their quality of life. The observed differences are of utmost importance to patients and their families and palliation of osseous manifestations is a priority, given their relatively long lifespan. We define NGPS as a chronic progeria because of its slow clinical course and relatively long survival, despite its early onset. Understanding the differences between progeria syndromes might contribute to the development of treatment strategies for common skeletal conditions, as well as aging itself. © 2011 Wiley Periodicals, Inc.


Marcos Mateos V.,Centro Medico Of Asturias | Garcia-Monco J.C.,Hospital Of Galdakao | Gomez-Beldarrain M.,Hospital Of Galdakao | Armengol-Bertolin S.,Almirall S.A. | Larios C.,Biometria Clinica CRO
Revista de Neurologia | Year: 2011

Introduction. Migraine has recently been associated to certain personality profiles and styles of coping. Aim. To explore the association between personality factors, disability and the therapeutic management of migraine. Patients and methods. We conducted an epidemiological, cross-sectional, multi-centre study with patients with migraine visiting a neurology unit for the first time. Socio-demographic and clinical data were collected about the patients. The NEO-FFI (Neuroticism-Extraversion-Openness Five-Factor Inventory) was used to evaluate personality factors; the degree of disability was evaluated using the Headache Impact Test (HIT-6) and the number of lost workday equivalents (LWDE) was measured. Bivariate logistic regression analyses were also performed. Results. A total of 736 patients were recruited, of whom 700 were suitable for inclusion in the analysis (75.6% females; mean age: 35.5 ± 11.5 years). In all, 68.9% presented migraine without aura, 1-4 seizures/month (66.7%) and of moderate intensity (58.1%). A total of 76.1% of patients had severe disability according to the HIT-6. Of the 554 active patients, the mean number of lost workday equivalents in the previous three months was 6.8 ± 8.2. Patients showed greater emotional instability than the general population and they scored lower on extraversion, openness, agreeableness and conscientiousness. All the patients were being treated for their migraine: 47.3% by means of stepped treatment between seizures; 39.9% intra-seizures, and stratified in only 12.9%. Conclusions. This study confirms the impact of migraine in terms of disability and in terms of loss of labour output, together with its association with personality factors. © 2011 Revista de Neurología.


Ernste F.C.,Mayo Medical School | Sanchez-Menendez M.,Centro Medico Of Asturias | Wilton K.M.,Mayo Medical School | Crowson C.S.,Mayo Medical School | And 2 more authors.
Arthritis Care and Research | Year: 2015

Objective The role of cardiovascular disease (CVD) risk factors in psoriatic arthritis (PsA) is poorly understood. We examined the prevalence of CVD risk factors at initial onset of PsA and compared the observed incidence of CVD events with that predicted by the Framingham Risk Score (FRS) to determine its applicability in this patient population. Methods A population-based incidence cohort of 158 patients with PsA who fulfilled Classification of Psoriatic Arthritis criteria for PsA in 1989-2008 was assembled. Medical records were reviewed to ascertain CVD risk factors and CVD events. Future risk of CVD was estimated using the FRS algorithm. Results Mean age was 43.4 years (range 19-74 years), 61% were men, and 44% were obese (body mass index ≥30 kg/m2). Fifty-four patients (34%) presented with ≥2 CVD risk factors at PsA incidence. Among 126 patients ages ≥30 years at PsA incidence with no prior history of CVD, 33% had an FRS ≥10%, with 11% having an FRS ≥20%, and 18 experienced a CVD event in the first 10 years of disease duration. The 10-year cumulative incidence of CVD events was 17% (95% confidence interval [95% CI] 10%-24%), almost twice as high as the predicted incidence based on the FRS (standardized incidence ratio 1.80, 95% CI 1.14-2.86; P-=-0.012). Conclusion The majority of newly diagnosed PsA patients have a >10% risk of CVD within 10 years of PsA incidence. The CVD risk in these patients is higher than expected and underestimated by the FRS. © 2015, American College of Rheumatology.


Vilar-Gonzalez S.,Centro Medico Of Asturias | Perez-Rozos A.,Centro Medico Of Asturias | Torres-Campa J.M.,Centro Medico Of Asturias | Mateos V.,Centro Medico Of Asturias
Revista de Neurologia | Year: 2013

Spinal cord compression must be considered a top-priority neuro-oncological emergency. Hence, a multidisciplinary approach and swiftness in establishing appropriate therapeutic measures are crucial to optimise the functional (and perhaps vital) prognosis of these patients. The nihilistic attitudes that have prevailed up until now in some professional sectors, possibly stemming from the perception of a poor short-term prognosis, must be completely eradicated. The overall improvement in survival rates among cancer patients in general, the availability of new neurosurgical techniques in the vast majority of our hospitals and the obvious improvements in radiotherapy equipment and techniques all this pathology to be addressed with greater chances of success. This greater likelihood of accomplishing a better outcome refers not only to the control of the development of the tumour itself, but also to pain control, maintenance of the functioning of the spinal cord and the overall survival of the patient. In this context, we consider it essential for all hospitals to have specific protocols on how to proceed in cases of acute spinal cord compression. The fact that this kind of protocol has been introduced in the Centro Médico de Asturias has prompted us to conduct a review of the current state-of-the-art in this field, with special emphasis on the evidence available for each of the modes of therapy that are discussed. © 2013 Revista de Neurología.


Fernandez-Dominguez J.,Centro Medico Of Asturias | Garcia-Rodriguez R.,Centro Medico Of Asturias | Mateos V.,Centro Medico Of Asturias
Revista de Neurologia | Year: 2012

Introduction. Demielinating diseases are a group of heterogenic diseases in whom mieline is attacked. The optic nerve (ON) is one of the most commonly affected. Subjects and methods. An observational prospective case-control study with ON orbital echography was developed. The case group was formed by 31 demielinating diseases patients and the control group was formed by 24 healthy people. Mean age of cases: 48.3 ± 11.8 years old, controls 48.7 ± 9.9 years old. 46% of controls and 35% of cases were males. Results. We found statistical significance differences between cases and controls regarding the diameter of right (controls 3.64 ± 0.58 mm vs patients 2.84 ± 0.56 mm; p < 0.001) and left ON (controls 3.95 ± 0.84 mm vs patients 2.74 ± 0.54 mm; p < 0.001). We found no differences between maximum systolic and median velocities regarding ophthalmic arteries in both groups, neither for previous acute optical neuritis history or visual evocated potentials. Conclusions. ON evaluation with transorbital echography is an easy, feasible, non invasive, useful and costless technique for the evaluation of the ON atrophy. As for visual evocated potentials are abnormal in a huge number of patients without previous optical neuritis evidence, the diameter of ON measured by transorbital Doppler could be a consistent paraclinic marker of these diseases.


Cartin-Ceba R.,Mayo Medical School | Golbin J.M.,Mayo Medical School | Golbin J.M.,Long Island Lung Center | Keogh K.A.,Mayo Medical School | And 5 more authors.
Arthritis and Rheumatism | Year: 2012

Objective This study was conducted to evaluate the efficacy and safety of repeated and prolonged B cell depletion with rituximab (RTX) for the maintenance of long-term remission in patients with chronic relapsing granulomatosis with polyangiitis (Wegener's) (GPA). Methods We conducted a single-center observational study of all patients with chronic relapsing GPA treated with at least 2 courses of RTX between January 1, 2000 and May 31, 2010. Participants in the Rituximab in ANCA-Associated Vasculitis (RAVE) trial were excluded from this analysis. Data were abstracted from electronic medical records. Results Fifty-three patients with refractory GPA (median age 46 years [interquartile range (IQR) 30-61 years]; 53% women) received at least 2 courses of RTX to treat GPA relapses or to maintain remission. All but 1 patient had antineutrophil cytoplasmic antibodies (ANCA) against proteinase 3 (PR3). These patients received a median of 4 courses of RTX (IQR 3-5); all had depletion of B cells, and the median time to return of B cells was 8.5 months (IQR 6-11 months). All observed relapses occurred after reconstitution of B cells and were accompanied or preceded by an increase in ANCA levels, except for the 1 ANCA-negative patient. Infusion-related adverse events occurred in 16 patients. During the period of B cell depletion, 30 infections requiring antimicrobial therapy were recorded. Conclusion RTX appeared to be effective and safe for the induction and maintenance of remission in patients with chronic relapsing GPA. Repeated depletion of B lymphocytes seems to be associated with a low risk of infections. Preemptive re-treatment decisions can be individualized based on serial B lymphocyte and PR3 ANCA monitoring. The use of RTX for the maintenance of long-term remission merits further formal investigation. Copyright © 2012 by the American College of Rheumatology.

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