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Barberan J.,Hospital Central Of La Defensa Gomez Ulla | Sanz F.,Hospital General Universitario Of Valencia | Hernandez J.-L.,Hospital Universitario Marques Of Valdecilla | Merlos S.,Hospital Virgen Of Las Nieves | And 8 more authors.
Journal of Infection | Year: 2012

Objective: To explore clinical features of invasive pulmonary aspergillosis (IPA) vs. colonization among hospitalized COPD patients. Methods: Records of COPD patients with two respiratory cultures yielding Aspergillus were retrospectively reviewed. Cases categorized as proven/probable IPA or colonization was analyzed. Results: 118 patients were identified: 70 (59.3%) colonized, 48 (40.7%) with IPA (42 probable, 6 proven). Higher percentage of IPA patients (vs. colonized) presented GOLD III + IV (77.1% vs. 57.1%, p = 0.025). IPA patients presented higher Charlson index (3.5 ± 2.5 vs. 2.6 ± 2.2, p = 0.027), higher rate of ICU admission (27.1% vs. 4.3%, p = 0.001) and worse prognosis (McCabe rapidly fatal category: 31.3% vs. 7.1%, p = 0.001). GOLD-I IPA patients presented risk factors other than COPD. Before hospitalization, 66.7% IPA and 28.6% colonized patients were taking steroids (p < 0.001). Antifungals were administered to 83.3% IPA and 21.4% colonized patients (p < 0.001). Mortality was higher among IPA vs. colonized patients, both in global (58.3% vs. 10.0%, p < 0.001), GOLD-I (75.0% vs. 10.0%, p = 0.041), GOLD-II (42.9% vs. 5.0%, p = 0.042) and GOLD-III patients (54.2% vs. 0.0%, p < 0.001), but not in GOLD-IV patients (69.2% vs. 31.3%, p = 0.066). Conclusions: IPA should be suspected not only in GOLD-III and GOLD-IV COPD patients, with higher mortality in IPA vs. colonized patients for GOLD-II and -III COPD patients. © 2012 The British Infection Association.


Fernandez-Ruiz M.,Institute Investigacion Hospital 12 Of Octubre I12 | Silva J.T.,Complejo Hospitalario Universitario Of Badajoz | San-Juan R.,Institute Investigacion Hospital 12 Of Octubre I12 | De Dios B.,Institute Investigacion Hospital 12 Of Octubre I12 | And 4 more authors.
Medicine (United States) | Year: 2012

Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor. Copyright © 2012 by Lippincott Williams &Wilkins.


Gutierrez-Casares J.R.,Complejo Hospitalario Universitario Of Badajoz | Canas F.,Hospital Rodriguez Lafora | Rodriguez-Morales A.,Group Medical Affairs Manager of Psychiatry and Dermatology | Hidalgo-Borrajo R.,Medical Affairs Manager of Psychiatry | Alonso-Escolano D.,Medical Education Manager of Psychiatry
CNS Spectrums | Year: 2010

Aim: To assess the degree of compliance and adherence to treatment during the follow-up of schizophrenic outpatients after a new therapeutic strategy had been initiated. Methods: A multicenter, retrospective, prospective, observational study of 1,848 outpatients with schizophrenia or schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) was conducted. Patients were treated either with oral or injectable conventional or second generation antipsychotics, and were followed up for 3 months at mental health centers. Patient compliance with the pharmacological treatment was assessed by the use of questionnaires, scales, medication accountability, and the Medication Event Monitoring System. Patients were considered compliant if they reported a high compliance rate (≥80%). Results: At baseline only 29% of patients on oral medication were compliant compared with 79% of patients on injectable medication (injection counting) (OR= 9.11; 95% CI 6.02-13.77; P<.0001). At the 3 month visit, 84% of patients had changed their treatment and in these, the compliance rate of those on injectable medication was 94% versus 87% of patients taking oral medication (OR= 2.47; 95% CI 1.21-5.05; P=.022). Conclusion: The use of long-acting injectable antipsychotics, which improves compliance rates and patient follow-up, should facilitate the management of Spanish patients with schizophrenia in mental health centers. © MBL Communications Inc.


Inchausti F.,Complejo Hospitalario Universitario Of Badajoz | Prieto G.,University of Salamanca | Delgado A.R.,University of Salamanca
Revista de Psiquiatria y Salud Mental | Year: 2014

Introduction The clinical use of mindfulness has increased recently, and the Mindful Attention Awareness Scale (MAAS) has become one of the most used tools to measure it. The aim of this study was to test the effectiveness of mindfulness training and analyzing the psychometric properties of the MAAS scores in a clinical sample using the Rasch Model. Methods One hundred and ninety-nine participants with mood-anxiety clinical symptoms were recruited. The experimental group (n = 103) received mindfulness training, and the control group (n = 96) a conventional outpatient treatment for the same duration. The pre-post MAAS scores were analyzed to test the effectiveness of training, the psychometric properties of the scores, and differential item functioning (DIF) using the Rating Scale Model (RSM). Results Misfit in items 9 and 12, DIF in item 9, and Spanish translation problems in the items 5, 9 and 12 were observed. The repetition of the analysis without these items was decided. Appropriate dimensionality, fit and reliability values were obtained with the short version, MAAS-12. Conclusions Contrary to previous studies, the MAAS was sensitive to treatment-associated change. However, the commonly used MAAS has some translation and metric problems, and should be revised. MAAS-12 is a better scale than MAAS but suffers from construct under-representation. Constructing tools from a coherent theoretical perspective is suggested, so that all mindfulness facets are represented. © 2012 SEP y SEPB. Publicado por Elsevier Espana, S.L. Todos los derechos reservados.


Placido Paias R.,Hospital Of Merida | Marquez Armenteros A.M.,Complejo Hospitalario Universitario Of Badajoz
Pediatria Integral | Year: 2015

When we detect a splenomegaly, we must rule out many entities like oncohaematological, autoimmune, metabolic, infectious, pharmacological or genetics diseases. We present the clinical case of a 13-yearsold girl, previously healthy, who is referred to our department to study a massive splenomegaly and a leukothrombocytopenia as the only manifestations of an uncommon disease. © 2011 Sociedad Española de PEDIATRÍA Extrahospitalaria y Atención Primaria (SEPEAP).


Carrasco Cubero C.,Complejo Hospitalario Universitario Of Badajoz | Chamizo Carmona E.,Hospital Of Merida
Reumatologia Clinica | Year: 2016

Systemic mastocytosis (SM) is a clonal disease of mast cell progenitors from the bone marrow. The clinical picture varies from asymptomatic forms (indolent) to a highly aggressive form with a very short (mast cell leukemia) survival. Between 28-34% of patients with SM are related to bone condition at the time of diagnosis and 16% have symptomatic fractures. The presentation of SM as clinical vertebral fractures in young men is rare. Here, we describe a case of established osteoporosis as the only manifestation of SM. © 2016 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología.


Ngeles Fernandez-Gil M.,Complejo Hospitalario Universitario Of Badajoz | Palacios-Bote R.,Complejo Hospitalario Universitario Of Badajoz | Leo-Barahona M.,Complejo Hospitalario Universitario Of Badajoz | Mora-Encinas J.P.,Complejo Hospitalario Universitario Of Badajoz
Seminars in Ultrasound, CT and MRI | Year: 2010

The brainstem has an ectodermal origin and is composed of 4 parts: the diencephalon, mesencephalon, pons, and medulla oblongata. It serves as the connection between the cerebral hemispheres with the medulla and the cerebellum and is responsible for basic vital functions, such as breathing, heartbeat blood pressure, control of consciousness, and sleep. The brainstem contains both white and gray matter. The gray matter of the brainstem (neuronal cell bodies) is found in clumps and clusters throughout the brainstem to form the cranial nerve nuclei, the reticular formation, and pontine nuclei. The white matter consists of fiber tracts (axons of neuronal cells) passing down from the cerebral cortex-important for voluntary motor function-and up from peripheral nerves and the spinal cord-where somatosensory pathways travel-to the highest parts of the brain. The internal structure of brainstem, although complex, presents a systematical arrangement and is organized in 3 laminae (tectum, tegmentum, and basis), which extend its entire length. The motor pathway runs down through the basis, which is located at the most anterior part. The cranial nerve nuclei are settled into the middle layer (the tegmentum), just in front of the 4th ventricle and are placed, from medial to lateral, on the basis of their function: somatic motor, visceral motor, visceral sensory, and somatic sensory. All the somatosensory tracts run upward to the thalamus crossing the tegmentum in front of the cranial nerve nuclei. The tectum, formed by the quadrigeminal plate and the medullary velum, contains no cranial nuclei, no tracts and no reticular formation. The knowledge of precise anatomical localization of a lesion affecting the brainstem is crucial in neurological diagnosis and, on this basis, is essential to be familiar with the location of the mayor tracts and nuclei appropriately. Nowadays, current magnetic resonance imaging techniques, although still macroscopic, allow the fine internal structure of the brainstem to be viewed directly and make it possible to locate the main intrinsic structures that justify the symptoms of the patient. In this article we discuss the anatomy of the brainstem and highlight the features and landmarks that are important in interpreting magnetic resonance imaging. © 2010 Elsevier Inc.


Querol-Pascual M.R.,Complejo Hospitalario Universitario Of Badajoz
Seminars in Ultrasound, CT and MRI | Year: 2010

The brainstem consists of the midbrain, pons, and medulla. The cerebellum is attached to the dorsal surface of the pons and upper medulla. The brainstem contains 9 of the 12 cranial nerves and is crossed by ascending, descending, and cerebellar pathways and their nuclei as well as the reticular formation. Numerous and rare crossed brainstem syndromes have been described in recent years, many of them without clinical significance. The aim of this article is to provide a brief clinical description of some conditions affecting the brainstem. © 2010 Elsevier Inc.


Introduction: Nowadays, the masculine factor is the person in charge of form isolated of 40 % of the cases of infertility of pair, sharing this protagonism of additional form in 20 % close to the feminine factor, for what of joint form, it represents 50 % of all the cases. In spite of the lack of scientific evidence, the empirical treatment has been in use widely and continues being done at present, basically to expense of compound of vitamins and other trace elements, which due to his antirust power, it would allow to improve seminal parameters as mobility or morphology. Objetive: To study the changes in seminal parameters in a group of patients with idiophatic oligoastenoteratozoospermia, to whom they treatment was ruled by the antirust complex. Material and methods: 40 patients with idiophatic oligoastenoteratozoospermia were treated by the complex antirust Androferti (Laboratory Q-Pharma). Conclusions: The study demonstrated improvement of the seminal parameters concentration, progressive mobility and morphology to 3 and 6 months of treatment, presenting statistical significance the analysis of the information, which, given the improvement on the inventory of mobile sperms (REM), allows to these patients to come to technologies of assisted reproduction (TRA) as in vitro fertilization (FIV) or injection intracitoplasmática of sperms (ICSI) with major guarantee, or even, pairs who due to the initial REM necessarily had to resort to the above mentioned technology of reproduction, they can resort finally to artificial insemination (IAC) before the experienced improvement. © 2011 Sociedad Española de Andrología.


To assess the safety and efficacy of using the Anesthetic Conserving Device (AnaConDa) when maintaining sedation after cardiac surgery. Descriptive study of 46 consecutive patients in the postoperative recovery unit after cardiac surgery between January and April 2009. The patients were under sevoflurane sedation administered with the AnaConDa placed in the inhalation tube. No exclusion criteria were established before enrollment. The sevoflurane dose was set using the manufacturer's normogram and was later adjusted to give an end-tidal concentration of sevoflurane between 0.5% and 0.7% on the basis of data from a gas analyzer. Remifentanil was administered to all patients; a fast-track extubation protocol was used. The only criterion for excluding a patient's data from analysis was prolonged sedation (> 5 hours). The mean (SD) time patients were under sedation with the AnaConDa in place was 2588 (12.32) minutes. The end-tidal concentration of sevoflurane never exceeded 1%. Scores on the Richmond agitation-sedation scale were -5 at 60 minutes in all cases; there was some score variability at 120 minutes. Deeper sedation was desired for the first 60 minutes to avoid awakening related to rewarming. The mean time until awakening was 6.17 minutes (range, 1-30 minutes). The mean time until extubation was 43 (6.69) minutes. The most common adverse effect was arterial hypotension (12 cases). Hypotension was related to bleeding in 3 patients and to low cardiac output in 4 patients. Administering sevoflurane through the AnaConDa can be a safe, valid, and reliable method for sedating patients after cardiac surgery. With this device, it is possible to monitor the concentration administered.

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