Complejo Hospitalario Universitario Of Granada

La Guardia de Jaén, Spain

Complejo Hospitalario Universitario Of Granada

La Guardia de Jaén, Spain
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Exposito-Ruiz M.,Complejo Hospitalario Universitario Of Granada | Sanchez-Lopez J.,Complejo Hospitalario Universitario Of Granada | Ruiz-Bailen M.,Complejo Hospitalario Of Jaen | Rodriguez-del Aguila M.M.,Complejo Hospitalario Universitario Of Granada
Emergencias | Year: 2017

Objectives. To determine the frequency of use of Spanish pediatric emergency services, and to describe user profiles and geographic variations. Methods. Descriptive study based on data from the Spanish National Health Survey. We calculated descriptive statistics and analyzed crude and adjusted odds ratios (ORs). Results. Thirty-five percent of the 5495 respondents had come to an emergency department in the past year, and 88.1% of them had used the services of a Spanish national health service hospital. Factors associated with higher use of emergency services were male sex of the patient, (OR, 1.202; 95% CI, 1.047-1.381), a higher educational level of parents (OR, 1.255; 95% CI, 0.983-1.603), and younger age of the child (OR, 0.909; 95% CI, 0.894-0.924). Emergency department use varied widely from one Spanish community to another. There was a positive correlation between use and the presence of a foreign-born population (ρ=0.495, P=.031). Conclusions. The rate of emergency department use is high in Spain. Variability between geographic areas is considerable, and some variation is explained by population characteristics. © 2017, Grupo Saned. All rights reserved.


Linares-Pineda T.M.,Complejo Hospitalario Universitario Of Granada | Canadas-Garre M.,Complejo Hospitalario Universitario Of Granada | Sanchez-Pozo A.,University of Granada | Calleja-Hernandez M.A.,Complejo Hospitalario Universitario Of Granada
Pharmacological Research | Year: 2016

Psoriasis is a chronic inflammatory autoimmune skin disease, characterized by the formation of erythematous scaly plaques on the skin and joints. The therapies for psoriasis are mainly symptomatic and sometimes with poor response. Response among patients is very variable, especially with biological drugs (adalimumab, etarnecept, infliximab and ustekimumab). This variability may be partly explained by the effect of different genetic backgrounds. This has prompted the investigation of many genes, such as FCGR3A, HLA, IL17F, IL23R, PDE3A-SLCO1C1, TNFα and other associated genes, as potential candidates to predict response to the different biological drugs used for the treatment of psoriasis. In this article, we will review the influence of gene polymorphisms investigated to date on response to biological drugs in psoriasis patients. © 2016 Elsevier Ltd


Madrid-Paredes A.,Complejo Hospitalario Universitario Of Granada | Canadas-Garre M.,Complejo Hospitalario Universitario Of Granada | Sanchez-Pozo A.,University of Granada | Segura-Perez A.M.,Complejo Hospitalario Universitario Of Granada | And 4 more authors.
Pharmacological Research | Year: 2016

HER2-positive breast cancer patients treated with trastuzumab schemes have good initial clinical outcomes. Despite this beneficial effect, many patients experiment resistance to these drugs. Several gene polymorphisms in ABCB1, HER2, and CCND1 have been proposed as potential predictors of clinical outcomes of trastuzumab schemes. The aim of this study was to evaluate the association between 4 gene polymorphisms potentially responsible for bad prognosis (HER2-Ile655Val, CCND1-A870G and ABCB1C1236T, C3435T) and clinical outcomes in HER2-positive BC patients. A retrospective cohorts study was performed. Eighty-four HER2-positive BC patients treated with trastuzumab schemes were included. The four gene polymorphisms were analyzed by PCR Real-Time with Taqman® probes. Genotypes were investigated for their association with tumor response, survival and resistance. Patients with CC genotype of ABCB1-C3435T presented higher risk of resistance to chemotherapy/trastuzumab schemes, compared to those carrying the T-allele (RR: 2.71; CI95%:1.29-5.68; p = 0.013888), progression (RR: 1.89; p = 0.017964); and exitus (RR: 2.09; p = 0.03276). Multivariate logistic regression analysis considering clinical variables and ABCB1-C3435T revealed that the only independent factor associated to resistance to therapy was ABCB1-C3435T gene polymorphism (ORCT/CC: 0.25; p = 0.0123; ORTT/CC: 0.09; p = 0.0348. The protective effect of ABCB1-C3435T T-allele was confirmed in the multivariate Cox regression analysis for PFS (HRCT/CC: 0.41; p = 0.00806; HRTT/CC: 0.22; p = 0.01982) and OS (HRCT/CC: 0.49; p = 0.0555; HRTT/CC: 0.12; p = 0.0398). ABCB1-C1236T, CCND1-A870 G and HER2-Ile655Val polymorphisms were not associated to resistance, PFS or OS (p > 0.05). The A-allele for CCND1-rs9344 was associated with higher response rates (RR: 3.44; uncorrected p-value: 0.03816) in the bivariate analysis, but no statically association was found after Bonferroni correction (p = 0.15264). ABCB1-C3435T, ABCB1-C1236T and HER2-Ile655Val gene polymorphisms were not associated with response. Although this study demonstrates a prognostic value of ABCB1-C3435T gene polymorphism to predict clinical outcomes, further studies with a larger sample will be necessary to validate this result. © 2016 Elsevier Ltd. All rights reserved.


Almazan-Fernandez F.M.,Complejo Hospitalario Universitario Of Granada | Fernandez-Crehuet Serrano P.,Alto Guadalquivir Hospital andujar
Dermatology Online Journal | Year: 2017

Trichomycosis axillaris is a common but underdiagnosed condition of the skin. The dermoscopic image of this disease is not previously described in the scientific literature. We believe that dermoscopy is a convenient and interesting diagnostic method that may aid in the diagnosis. © 2017 by the article author(s).


Almansa J.F.,Complejo Hospitalario Universitario Of Granada | Guerrero R.,Complejo Hospitalario Universitario Of Granada | Torres J.,Hospital General Universitario Of Ciudad Real | Lallena A.M.,University of Granada
Brachytherapy | Year: 2017

Purpose: 60Co sources have been commercialized as an alternative to 192Ir sources for high-dose-rate (HDR) brachytherapy. One of them is the Flexisource Co-60 HDR source manufactured by Elekta. The only available dosimetric characterization of this source is that of Vijande et al. [J Contemp Brachytherapy 2012; 4:34-44], whose results were not included in the AAPM/ESTRO consensus document. In that work, the dosimetric quantities were calculated as averages of the results obtained with the Geant4 and PENELOPE Monte Carlo (MC) codes, though for other sources, significant differences have been quoted between the values obtained with these two codes. The aim of this work is to perform the dosimetric characterization of the Flexisource Co-60 HDR source using PENELOPE. Methods and Materials: The MC simulation code PENELOPE (v. 2014) has been used. Following the recommendations of the AAPM/ESTRO report, the radial dose function, the anisotropy function, the air-kerma strength, the dose rate constant, and the absorbed dose rate in water have been calculated. Results: The results we have obtained exceed those of Vijande et al. In particular, the absorbed dose rate constant is ∼0.85% larger. A similar difference is also found in the other dosimetric quantities. The effect of the electrons emitted in the decay of 60Co, usually neglected in this kind of simulations, is significant up to the distances of 0.25 cm from the source. Conclusions: The systematic and significant differences we have found between PENELOPE results and the average values found by Vijande et al. point out that the dosimetric characterizations carried out with the various MC codes should be provided independently. © 2017 American Brachytherapy Society.


Perez-Ramirez C.,Complejo Hospitalario Universitario Of Granada | Perez-Ramirez C.,University of Granada | Canadas-Garre M.,Complejo Hospitalario Universitario Of Granada | Alnatsha A.,University of Tübingen | And 5 more authors.
Pharmacological Research | Year: 2016

Platinum-based chemotherapy is the standard treatment for NSCLC patients with EGFR wild-type, and as alternative to failure to EGFR inhibitors. However, this treatment is aggressive and most patients experience grade 3–4 toxicities. ERCC1, ERCC2, ERCC5, XRCC1, MDM2, ABCB1, MTHFR, MTR, SLC19A1, IL6 and IL16 gene polymorphisms may contribute to individual variation in toxicity to chemotherapy. The aim of this study was to evaluate the effect of these polymorphisms on platinum-based chemotherapy in NSCLC patients. A prospective cohorts study was conducted, including 141 NSCLC patients. Polymorphisms were analyzed by PCR Real-Time with Taqman® probes and sequencing. Patients with ERCC1 C118T-T allele (p = 0.00345; RR = 26.05; CI95% = 4.33, 515.77) and ERCC2 rs50872-CC genotype (p = 0.00291; RR = 4.06; CI95% = 1.66, 10.65) had higher risk of general toxicity for platinum-based chemotherapy. ERCC2 Asp312Asn G-alelle, ABCB1 C1236T-TT and the IL1B rs12621220-CT/TT genotypes conferred a higher risk to present multiple adverse events. The subtype toxicity analysis also revealed that ERCC2 rs50872-CC genotype (p = 0.01562; OR = 3.23; CI95% = 1.29, 8.82) and IL16 rs7170924-T allele (p = 0.01007; OR = 3.19; CI95% = 1.35, 7.97) were associated with grade 3–4 hematological toxicity. We did not found the influence of ERCC1 C8092A, ERCC2 Lys751Gln, ERCC2 Asp312Asn, ERCC5 Asp1104His, XRCC1 Arg194Trp, MDM2 rs1690924, ABCB1 C3435T, ABCB1 Ala893Ser/Thr, MTHFR A1298C, MTHFR C677T, IL1B rs1143623, IL1B rs16944, and IL1B rs1143627 on platinum-based chemotherapy toxicity. In conclusion, ERCC1 C118T, ERCC2 rs50872, ERCC2 Asp312Asn, ABCB1 C1236T, IL1B rs12621220 and IL16 rs7170924 polymorphisms may substantially act as prognostic factors in NSCLC patients treated with platinum-based chemotherapy. © 2016 Elsevier Ltd


Salmeron Febres L.M.,Complejo Hospitalario Universitario Of Granada | Cuenca Manteca J.,Complejo Hospitalario Universitario Of Granada
Annals of Vascular Surgery | Year: 2016

Background: Anticoagulation is the treatment of choice in the management of venous thromboembolic disease. This approach is applied to reduce mortality and the risk of recurrences and associated complications. Standard therapy for non-oncologic patients has traditionally been based on parenteral anticoagulation followed by vitamin K antagonists. However, this approach has many limitations. Methods: The aim of this manuscript was to critically review current evidence on the use of direct oral anticoagulants in the treatment of venous thromboembolic disease by analyzing the specific characteristics of each drug. Results: Direct oral anticoagulants have many advantages over standard therapy. While they are equally effective as standard therapy for reducing the possibility of recurrence of venous thromboembolic disease, they carry a lower risk of major bleeding. Conclusions: Direct oral anticoagulants are an attractive alternative to standard therapy for the treatment of venous thromboembolism. © 2017 Elsevier Inc.


Torres Sanchez M.J.,Complejo Hospitalario Universitario Of Granada | Barranco E.A.,Complejo Hospitalario Universitario Of Granada
Revista de Nefrologia, Dialisis y Trasplante | Year: 2016

Introduction: Vaccination against hepatitis B virus (HBV) is more effective in pre-dialysis, but sometimes the patient has to start treatment in an unscheduled way, without full immunization coverage. We try to establish the immune response rate against HBV in hemodialysis with different vaccination schemes. Methods: We studied 30 patients in hemodialysis program with 2 different vaccination schemes against HBV. One group performed a 3-doses scheme (0, 1 and 6 months) (PATTERN 3) and the other group performed a 4-doses scheme (0, 1, 2 and 6 months) (PATTERN 4). Results: 56.7% performed pattern 3, with immune response of 26.7%. 43.3% performed pattern 4, with immune response of 23.3%, without significant differences between them (p=0.06). Anti-hepatitis B surface antibodies (anti-HBs) rate after vaccination was significantly higher with pattern 4 (p<0.05) as well as the antibodies counts maintained within 1 year. After 2 years, anti-HBs rates were not significantly different between both patterns. In other statical analysis, vaccination carried out in patients who have been for a long time in hemodialysis treatment, was more responsive with pattern 4 (p<0.05) although anti-HBs levels were similar in patients that had response with each pattern. Conclusions: There are no differences in immune response between 3-doses scheme and 4-doses scheme in HBV vaccination for hemodialysis patients. There is greater response with 4-doses scheme in hemodialysis patients who have not been vaccinated previously. © 2016, Asociacion Regional de Dialisi y Transplantes Renales. All rights reserved.


Villares J.M.P.,Complejo Hospitalario Universitario Of Granada
Cuadernos de Medicina Forense | Year: 2015

Donation after cardiac death, or donation from persons whose death has been diagnosed by cardiocirculatory and respiratory criteria, has been identified as one of the areas with the greatest room for improvement in Spain. Uncontrolled donation after cardio-circulatory death or type II classification donation modified Maastricht Madrid is one that comes from people who have suffered an unexpected cardio-respiratory arrest, after application of cardiopulmonary resuscitation without success. Controlled donation after cardio-circulatory death or type III modified the classification of Madrid Maastricht donation refers to the donation of organs that occurs from people dying from circulatory and respiratory criteria following a limitation of life-sustaining treatment. © 2015 Asociacion Andaluza de Medicos Forenses. All rights reserved.


Molina Lerma M.J.,Complejo Hospitalario Universitario Of Granada | Alvarez M.,Complejo Hospitalario Universitario Of Granada | Tercedor L.,Complejo Hospitalario Universitario Of Granada
Cardiocore | Year: 2016

Implantable cardioverter defibrillator has been shown to improve survival in patients with structural heart disease, but it is not without risk, so patients selection and device programming are essential to maximize profit and minimize risk. © 2016 SAC.

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