Clinica Quiron

Madrid, Spain

Clinica Quiron

Madrid, Spain
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PubMed | Clinica DIATROS, Clinica Ruber, Gabinete Medico Velazquez, Clinica Quiron and 9 more.
Type: | Journal: Maturitas | Year: 2016

To analyse the psychometric properties of the Cervantes scale short-form (SF) in the peri- and post-menopausal periods.Outpatients women 45-65 years with menstrual problems associated with the climacteric syndrome were analysed. Original and SF versions of the Cervantes scale were administered along with the EuroQol-5D (EQ-5D) and work productivity and activity impairment questionnaire (WPAI) scales. Conceptual model, burden of administration, feasibility, reliability, criteria validity and construct validity were assessed.317 women [55.75.3 years (meanstandard deviation)] were recruited: 75.4% were post- and 22.3% were peri-menopausal. The Cervantes-SF was completed in 2.51.6min, and 86% answered all items. Cronbachs was 0.820, and ranged from 0.510 (Aging) to 0.918 (Vasomotor Symptoms) for individual dimensions. The scale structure matched the structure of the original version, (2)/(degrees of freedom)=3.6, Comparative Fit Index=0.848, Tucker-Lewis Index=0.850, and root mean square error of approximation=0.099, although differences were found between sexual activity statuses. Criteria validity was good (r=0.890), concurrent validity was congruent with a priori hypothesis using either the EQ-5D or the WPAI scales. The scale discriminated significantly the severity of both vasomotor and genital climacteric associated symptoms.The Cervantes-SF has shown good psychometric properties for measuring Health related quality of life in peri- and post-menopausal women who regularly attended gynaecology clinics in Spain.


De Duenas E.M.,Hospital Provincial Of Castellon | Hernandez A.L.,Hospital Clinico Of Valencia | Zotano A.G.,Instituto Valenciano Of Oncologia | Carrion R.M.P.,Clinica Quiron | And 19 more authors.
Breast Cancer Research and Treatment | Year: 2014

The objective of this study was to determine the conversion rate of human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER) and progesterone receptor (PR) between primary tumors and metastatic lesions in advanced breast cancer. Patients with suspected diagnosis of locally recurrent or metastatic breast cancer, either at first relapse or after successive disease progressions, who had an appropriately preserved sample from a primary tumor and were scheduled for a biopsy of the recurrent lesion, were included. Blinded determinations of receptor status on paired samples were performed by immunohistochemistry and fluorescence in situ hybridization at a central laboratory and compared with those performed locally. Overall, 196 patients were included and 184 patients were considered evaluable. Reasons for non-evaluability included the inability to perform biopsy (n = 4) or biopsy results showing normal tissue (n = 3), benign disease (n = 3) or a second neoplasia (n = 2). Conversion rates determined at local level were higher than those determined centrally (HER2: 16 vs. 3 %, ER: 21 vs. 13 %, PR: 35 vs. 28 %, respectively). There was substantial agreement regarding the expression of HER2 in primary tumors and metastases, and ER at metastases, between local and central laboratories. PR at any site and ER at primary site showed moderate agreement. Oncologists altered their treatment plans in 31 % of patients whose tumor subtype had changed. These results reinforce the recommendation for performing confirmatory biopsies of metastases, not only to avoid misdiagnosis of breast cancer relapse, but also to optimize treatment (clinicaltrials.gov identifier: NCT01377363). © 2014 The Author(s).


Zeuzem S.,Goethe University Frankfurt | Andreone P.,University of Bologna | Pol S.,University of Paris Descartes | Lawitz E.,Alamo Medical Research | And 18 more authors.
New England Journal of Medicine | Year: 2011

BACKGROUND: Up to 60% of patients with hepatitis C virus (HCV) genotype 1 infection do not have a sustained virologic response to therapy with peginterferon alfa plus ribavirin. METHODS: In this randomized, phase 3 trial, we evaluated the addition of telaprevir to peginterferon alfa-2a plus ribavirin in patients with HCV genotype 1 infection who had no response or a partial response to previous therapy or who had a relapse after an initial response. A total of 663 patients were assigned to one of three groups: the T12PR48 group, which received telaprevir for 12 weeks and peginterferon plus ribavirin for a total of 48 weeks; the lead-in T12PR48 group, which received 4 weeks of peginterferon plus ribavirin followed by 12 weeks of telaprevir and peginterferon plus ribavirin for a total of 48 weeks; and the control group (PR48), which received peginterferon plus ribavirin for 48 weeks. The primary end point was the rate of sustained virologic response, which was defined as undetectable HCV RNA 24 weeks after the last planned dose of a study drug. RESULTS: Rates of sustained virologic response were significantly higher in the two telaprevir groups than in the control group among patients who had a previous relapse (83% in the T12PR48 group, 88% in the lead-in T12PR48 group, and 24% in the PR48 group), a partial response (59%, 54%, and 15%, respectively), and no response (29%, 33%, and 5%, respectively) (P<0.001 for all comparisons). Grade 3 adverse events (mainly anemia, neutropenia, and leukopenia) were more frequent in the telaprevir groups than in the control group (37% vs. 22%). CONCLUSIONS: Telaprevir combined with peginterferon plus ribavirin significantly improved rates of sustained virologic response in patients with previously treated HCV infection, regardless of whether there was a lead-in phase. (Funded by Tibotec and Vertex Pharmaceuticals; REALIZE ClinicalTrials.gov number, NCT00703118.) Copyright © 2011 Massachusetts Medical Society.


Subira D.,Flow Cytometry Section | Uriel M.,Clinica Quiron | Serrano C.,Unilabs Laboratory | Castanon S.,Flow Cytometry Section | And 4 more authors.
Cytometry Part B - Clinical Cytometry | Year: 2011

Background: Fetal erythrocytes cross the placenta during gestation, but invasive prenatal procedures might develop into fetomaternal hemorrhage (FMH). We examine whether flow cytometry immunophenotyping might be useful for measuring the volume of FMH after such procedures. Methods: Fetal erythrocytes (%) were determined in 153 pregnant women after amniocentesis (129) and chorionic villous sampling (24) using a monoclonal antibody against fetal hemoglobin. Fetal erythrocytes were identified for their high expression of fetal hemoglobin (HbF ++). Blood samples from two control groups, 53 healthy males and 21 pregnant women not submitted to invasive tests, were used to establish normal values of circulating HbF ++ erythrocytes in adults. Results: The highest percentage of HbF ++ erythrocytes in the control groups was 0.015%. The rate of HbF ++ erythrocytes in samples after invasive tests ranged between <0.01% and 0.15%. Seventy three women (47%) had ≤0.015% HbF ++ erythrocytes, and this rate was higher in 80. Nine women presented >1 ml of FMH (volume of packed cells corresponding to 0.054-0.15% HbF ++ erythrocytes), but only two had sonographic evidence of bleeding. Conclusions: Most women in our series had a very low volume of FMH after the invasive tests. Acute bleeding should be thoroughly investigated in women with either more than 1 ml of packed cells or more than 0.05% of HbF ++ erythrocytes. Intermediate values between >0.015% and <0.05%, should be carefully considered depending on the week of gestation. Data obtained before 15 weeks might reflect previous cell trafficking between fetus and mother instead of acute hemorrhage. © 2010 International Clinical Cytometry Society.


Modrego P.J.,Hospital Miguel Servet | Fayed N.,Clinica Quiron | Artal J.,Hospital Miguel Servet | Olmos S.,University of Zaragoza
Academic Radiology | Year: 2011

Rationale and Objectives: This work is aimed at determining whether magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) may correlate with disease severity in a series of Parkinson disease (PD) patients. Materials and Methods: We recruited a consecutive sample of 39 PD patients in several stages of the disease according to Hoehn and Yahr scale. There were 22 men, and the mean age was 74.5 years (SD 7.5). Disease severity was measured with the Unified Parkinson Disease Rating Scale (UPDRS). All of them underwent 1H MRS in basal ganglia and the anterior cingulate area, as well as DTI in bilateral substantia nigra. Correlation was made between radiological findings and UPDRS. Results: We found significant negative correlation between UPDRS scores and the Glx (glutamate+glutamine) levels in the right (r = -0.35; P = 03) and the left (r = -0.44; P = 006) lentiform nucleus; as well as with glutamate (r = -0.43; P = 008), the Glx/Cr ratio in the right (r = -0.41; P = 01), and in the left lentiform nucleus (r = -0.36; P = 02). We also found positive correlation between UPDRS scores and DTI in right rostral substantia nigra (r = 0.36; P = 02). Glx was increased in lentiform nucleus and fractional anisotropy was reduced in the rostral SN of subjects with PD in early stages. Conclusions: The results are consistent with the view that more than half the dopaminergic neurons in the nigrostriatal projection are lost before the onset of PD. © 2011 AUR.


Modrego P.J.,Hospital Miguel Servet | Fayed N.,Clinica Quiron | Errea J.M.,Hospital Of Barbastro | Rios C.,Hospital Of Barbastro | And 2 more authors.
European Journal of Neurology | Year: 2010

Background and purpose: To compare memantine with the most prescribed cholinesterase inhibitor (donepezil) from a clinical viewpoint when administered in early phases of Alzheimer disease (AD), and to find out whether memantine may produce changes in brain metabolite concentrations in comparison with donepezil. Methods: In this comparative rater-blinded parallel group randomized trial we recruited a consecutive sample of patients with probable mild to moderate AD. At baseline we carried out neuropsychological assessment with mini-mental, Clinical Dementia Rating Scale (CDR), Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale, cognitive part (ADAS-cog), neuropsychiatric inventory (NPI), and disability assessment for dementia (DAD), as well as 1H magnetic resonance spectroscopy (MRS) in several areas of the brain. Patients were randomized to receive either donepezil or memantine for 6 months. After this elapse of time we repeated the same procedures and observed the changes in clinical scales (ADAS-cog, NPI, DAD), as well as the changes in metabolite levels in every area of exploration (temporal, pre-frontal, posterior cingulated (PCG), and occipital), especially those of N-acetyl-aspartate (NAA) which is regarded as a surrogate marker of neuronal density. Results: A total of sixty-three patients completed the trial. We did not see significant differences in clinical scales and metabolite levels between those on donepezil (n = 32) and those on memantine (n = 31). In general, more patients worsened than improved on either of the drugs. The changes in the NAA/creatine ratio in the PCG correlated significantly with the changes in the ADAS-cog (P = 0.004). Conclusions: Donepezil and memantine have similar modest clinical and spectroscopic effect on mild to moderate AD. MRS could be useful to monitor progression of the disease. © 2009 EFNS.


PubMed | Clinica Quiron, Mayo Medical School, AZ Electronic and Mayo Clinic Hospital
Type: Evaluation Studies | Journal: Journal of minimally invasive gynecology | Year: 2015

To determine perioperative outcomes and factors impacting operating time, length of hospital stay, and complications of patients undergoing surgery for stage 3 or 4 endometriosis.Retrospective review of medical records (Canadian Task Force classification II-2).Mayo Clinic Hospital, Phoenix, Arizona.Women (n = 493) with endometriosis stage 3 and 4 undergoing surgical excision between March 15, 2005, and December 31,2011.Robotic-assisted (n = 331) or laparoscopic (n = 162) excision.Age, body mass index, comorbidities, number and type of procedures per patient, type of surgical approach, operating time, blood loss, intraoperative and postoperative complications (within 42 days), and length of hospital stay.The mean patient age was 39.5 years; body mass index, 25.9; number of procedures, 3.3; operating time, 130.4 minutes; blood loss, 88.5 mL; and hospital stay, 1.0 days. Major complications occurred in 5 patients (1.5%). Fifty-nine patients (12.0%) underwent modified radical hysterectomy, 90 (18.3%) underwent ureteral and/or intestinal resection, and 3 (0.6%) underwent diaphragm resection. Factors significantly associated with operating time included age (p = .008) and blood loss, number of procedures per patient, and robotics (all p < .001). Length of stay was affected by age, operating time, and blood loss (all p < .001). Operating time was the only significant factor associated with postoperative complications (p < .001).Operating time is an independent and significant factor for postoperative complications and hospital stay.


Magrina J.F.,Mayo Clinic Hospital | Espada M.,Clinica Quiron | Kho R.M.,Mayo Clinic Hospital | Cetta R.,Mayo Clinic Hospital | And 2 more authors.
Journal of Minimally Invasive Gynecology | Year: 2015

Objective: To determine perioperative outcomes and factors impacting operating time, length of hospital stay, and complications of patients undergoing surgery for stage 3 or 4 endometriosis. Design: Retrospective review of medical records (Canadian Task Force classification II-2). Setting: Mayo Clinic Hospital, Phoenix, Arizona. Patients: Women (n = 493) with endometriosis stage 3 and 4 undergoing surgical excision between March 15, 2005, and December 31, 2011. Interventions: Robotic-assisted (n = 331) or laparoscopic (n = 162) excision. Measurements: Age, body mass index, comorbidities, number and type of procedures per patient, type of surgical approach, operating time, blood loss, intraoperative and postoperative complications (within 42 days), and length of hospital stay. Main Results: The mean patient age was 39.5 years; body mass index, 25.9; number of procedures, 3.3; operating time, 130.4 minutes; blood loss, 88.5 mL; and hospital stay, 1.0 days. Major complications occurred in 5 patients (1.5%). Fifty-nine patients (12.0%) underwent modified radical hysterectomy, 90 (18.3%) underwent ureteral and/or intestinal resection, and 3 (0.6%) underwent diaphragm resection. Factors significantly associated with operating time included age (p =.008) and blood loss, number of procedures per patient, and robotics (all p <.001). Length of stay was affected by age, operating time, and blood loss (all p <.001). Operating time was the only significant factor associated with postoperative complications (p <.001). Conclusion: Operating time is an independent and significant factor for postoperative complications and hospital stay. © 2015 AAGL.


Dominguez-Luna A.,Hospital Universitario Of Fuenlabrada | Dominguez-Luna A.,Hospital General Universitario Gregorio Maranon | Fernandez-Miguez M.D.M.,Hospital General Universitario Gregorio Maranon | Dominguez-Luna S.C.,Clinica Quiron
Matronas Profesion | Year: 2012

This article describes the experiences of women with preterm premature rupture of amniotic membranes (PPROM) during bed rest in hospital and investigates their needs to improve clinical practice. Objetive: To investigate pregnant women's experience when they are resting in hospital in cases of preterm premature rupture of membranes. Methodology: This is a qualitative, descriptive, observational approach with a phenomenological focus. Data collection: Observation and individual interviews with pregnant women who are in the high risk obstetrics ward in "Gregorio Marañón" Hospital with PPROM. They will be between 24 and 31 weeks pregnant. Results: This study shows that in the non-interventional management of PPROM, which is based primarily on bed rest and admission into hospital, the mother can be emotionally charged showing high levels of anxiety and stress, worry and fear, in relation to fetal loss or perinatal health and sadness, emotional liability and uncertainty about the experience. It manifested in women the sense of loss of functional capacity, dependency and loss of control of her life, mainly by feeling worthless and having low self-esteem, experiencing a strong sense of guilt and grief. Conclusions: Bed rest in hospital for women with PPROM involves emotional crisis. Understanding the needs felt by women with high-risk pregnancies by healthcare professionals will improve the quality of care and can help reduce stress levels during this vulnerable period, and help them cope with motherhood. It is the responsibility of the healthcare professionals to care for women during this period and avoid the experience being traumatic. ©2012 Ediciones Mayo, S.A. All rights reserved.


PubMed | Clinica Quiron
Type: Journal Article | Journal: American journal of Alzheimer's disease and other dementias | Year: 2011

Glutamate (Glu) is the most abundant excitatory neurotransmitter in the central nervous system (CNS) and is involved in the pathophysiology of Alzheimers disease (AD) in which there is an increased excitotoxicity. Biochemical composition of living tissues including the levels of Glu was analyzed by magnetic resonance spectroscopy (MRS). Previous reports point to decreased levels of Glu in AD. As Glu plays an important role in memory, we hypothesize that Glu levels are decreased in patients with AD when compared with controls. A consecutive sample of 30 patients with mild-to-moderate AD underwent H-MRS with the voxel placed in the bilateral posterior cingulate gyrus. For comparison purposes, we carried out the same technique in 68 patients with mild cognitive impairment (MCI) and in 26 controls. The healthy controls had higher metabolite levels of N-acetyl-aspartate (NAA) than patients with MCI and AD. In turn, patients with MCI and the controls had higher levels of Glu than in patients with AD. The differences were significant in the analysis of variance (ANOVA) test model corrected for age. In the post hoc analysis, the most remarkable differences were seen between patients with AD and the rest (patients with MCI and the controls). In AD, the levels of Glu and NAA are decreased in comparison with MCI and normality, which reflects loss of neurons.

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