Time filter

Source Type

Lopez-A Lvarez S.,Complexo Hospitalario Universitario | Mayo-Moldes M.,Complexo Hospitalario Universitario Of Vigo | Zaballos M.,Hospital Universitario Gregorio Maranon | Zaballos M.,Complutense University of Madrid | And 2 more authors.
Canadian Journal of Anesthesia | Year: 2012

Purpose Controversy surrounds the optimal technique to moderate pain after laparoscopic cholecystectomy (LC). Opioid analgesics, sympatholytic drugs, and adjuvants, such as ketamine, have all been used. We compared esmolol with a combination of remifentanil plus ketamine in patients undergoing LC to determine the impact of these drugs on morphine requirements and pain control. Methods Sixty American Society of Anesthesiologists physical status I-II patients undergoing LC and anesthetized with sevoflurane were randomized to one of two groups. Group E patients received a bolus of esmolol 0.5 mgμkg -1 iv at induction followed by an infusion of 5-15 lgμkg -1 min -1, and Group R-K patients received a bolus of ketamine 0.5 mgμkg -1 iv and remifentanil 0.5 lgμkg -1 iv at induction followed by a remifentanil infusion titrated over a range of 0.1-0.5 lgμkg -1 min -1. All patients received paracetamol, dexketoprofen, and levobupivacaine via infiltration of laparoscopic port sites. After surgery, a predetermined bolus of morphine was administered according to a verbal numerical rating scale (VNRS) for pain intensity. The primary outcome of interest was postoperative morphine requirement. Results Median consumption of morphine was higher in Group R-K than in Group E (5 mg [4-6] vs 0 mg [0-2], respectively; P<0.001). In the postanesthesia care unit, patients in Group R-K had higher pain scores than patients in Group E (difference in maximum VNRS, -11; 95% confidence interval (CI), -19 to -3). The concentration of sevoflurane to maintain a bispectral index40 was higher in Group E than in Group R-K (between-group difference 0.3%; 95% CI, 0.15 to 0.40). The incidence of postoperative nausea and vomiting was similar between the two groups. Conclusion Intraoperative esmolol infusion reduces morphine requirements and provides more effective analgesia compared with a combination of remifentanil-ketamine given by infusion in patients undergoing LC.© 2012 Canadian Anesthesiologists' Society. Source

Miravitlles M.,CIBER ISCIII | Huerta A.,Glaxosmithkline | Fernandez-Villar J.A.,Complexo Hospitalario Universitario Of Vigo | Alcazar B.,Hospital de Alta Resolucion de Loja | And 6 more authors.
Health and Quality of Life Outcomes | Year: 2014

Background: To determine generic utilities for Spanish chronic obstructive pulmonary disease (COPD) patients stratified by different classifications: GOLD 2007, GOLD 2013, GesEPOC 2012 and BODEx index. Methods: Multicentre, observational, cross-sectional study. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from EQ-5D-3 L. Means, standard deviations (SD), medians and interquartile ranges (IQR) were computed based on the different classifications. Differences in median utilities between groups were assessed by non-parametric tests. Results: 346 patients were included, of which 85.5% were male with a mean age of 67.9 (SD = 9.7) years and a mean duration of COPD of 7.6 (SD = 5.8) years; 80.3% were ex-smokers and the mean smoking history was 54.2 (SD = 33.2) pack-years. Median utilities (IQR) by GOLD 2007 were 0.87 (0.22) for moderate; 0.80 (0.26) for severe and 0.67 (0.42) for very-severe patients (p < 0.001 for all comparisons). Median utilities by GOLD 2013 were group A: 1.0 (0.09); group B: 0.87 (0.13); group C: 1.0 (0.16); group D: 0.74 (0.29); comparisons were statistically significant (p < 0.001) except A vs C. Median utilities by GesEPOC phenotypes were 0.84 (0.33) for non exacerbator 0.80 (0.26) for COPD-asthma overlap 0.71 (0.62) for exacerbator with emphysema; 0.72 (0.57) for exacerbator with chronic bronchitis (p < 0.001). Comparisons between patients with or without exacerbations and between patients with COPD-asthma overlap and exacerbator with chronic bronchitis were statistically-significant (p < 0.001). Median utilities by BODEx index were: group 0-2: 0.89 (0.20); group 3-4: 0.80 (0.27); group 5-6: 0.67 (0.29); group 7-9: 0.41 (0.31). All comparisons were significant (p < 0.001) except between groups 3-4 and 5-6.Conclusion: Irrespective of the classification used utilities were associated to disease severity. Some clinical phenotypes were associated with worse utilities, probably related to a higher frequency of exacerbations. GOLD 2007 guidelines and BODEx index better discriminated patients with a worse health status than GOLD 2013 guidelines, while GOLD 2013 guidelines were better able to identify a smaller group of patients with the best health. © 2014 Miravitlles et al.; licensee BioMed Central Ltd. Source

Barros-Tizon J.C.,Complexo Hospitalario Universitario Of Vigo | Torres M.L.,Complexo Hospitalario Universitario Of Vigo | Blanco I.,Hospital Valle del Nalon | Martinez M.T.,Hospital Universitario Doce Of Octubre
Therapeutic Advances in Respiratory Disease | Year: 2012

Objective: Severe exacerbations in alpha-1-antitrypsin (AAT)-deficient patients with chronic obstructive pulmonary disease (COPD) and/or emphysema are a major cause of hospitalization. A multicentre, observational, retrospective study was undertaken to evaluate the effect of continuous AAT augmentation therapy in reducing the incidence of exacerbations in these patients.Methods: Patients treated with Trypsone® or Prolastin® for at least 18 months were recruited if their medical records for 18 months before starting augmentation therapy were available. The number of mild and severe exacerbations in the two periods was compared and hospitalization-related costs were analysed.Results: A total of 127 patients were recruited; 75 of them experienced at least one exacerbation in the period prior to augmentation. In the treatment period, the mean number of exacerbations per patient was reduced in both the total population and the population with exacerbations (mean ± SD: 1.2 ± 1.6 versus 1.0 ± 2.2 and 2.0 ± 1.6 versus 1.4 ± 2.7, respectively; p < 0.01). The percentage of patients experiencing exacerbations was reduced in the total population (59.1% versus 44.1%; p < 0.05). In the patient subgroup of the total population who experienced a change in their number of exacerbations between the two periods, 43.7% had a reduction and 21.4% had an increase (p < 0.01). The number of severe exacerbations diminished in 42.9% of this subgroup and increased in 12.0% (p < 0.001). Most adverse events were nonserious or not related to treatment. Hospitalization costs savings per patient associated with treatment ranged from approximately €400 to €900 (p < 0.05).Conclusions: Augmentation therapy with AAT concentrates was associated with a reduction in the incidence and severity of exacerbations in AAT-deficient patients, which resulted in lower hospitalization expenditures. © The Author(s), 2012. Source

Bernardino J.I.,Hospital Universitario La Paz | Pulido F.,Hospital Universitario 12 Of Octubre I12 | Martinez E.,University of Barcelona | Arrizabalaga J.,Hospital Donostia | And 6 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2013

Discontinuation of thymidine nucleoside reverse transcriptase inhibitors (tNRTIs) is the only proven strategy for improving lipoatrophy. It is unclear whether switching to NRTI-sparing or to non-thymidine NRTIcontaining therapy has differential effects on body fat recovery. Methods: This was a 96 week, open-label, randomized study in suppressed patients with moderate/severe lipoatrophy and no prior virological failure while receiving a protease inhibitor and who had their triple NRTI regimen (zidovudine/lamivudine/abacavir) switched to lopinavir/ritonavir plus abacavir/lamivudine for a 1 month run-in period and then randomized to lopinavir/ritonavir plus abacavir/lamivudine versus lopinavir/ritonavir monotherapy. The KRETA trial is registered with ClinicalTrials.gov (number NCT00865007). Results: Of 95 patients included, 88 were randomized to lopinavir/ritonavir plus abacavir/lamivudine (n=44) or lopinavir/ritonavir monotherapy (n=44). Median (IQR) baseline limb fat was 2.5 (1.6-3.7) kg in the lopinavir/ ritonavir plus abacavir/lamivudine group and 2.5 (2.0-5.4) kg in the lopinavir/ritonavir monotherapy group. Six patients in the triple therapy group and 13 in the monotherapy group had discontinued study drugs by week 96. Although there were limb fat gains in each group at weeks 48/96 (+324/+358 g in lopinavir/ritonavir plus abacavir/lamivudine, P=0.09/0.07, versus +215/+416 g in the lopinavir/ritonavir monotherapy group, P=0.28/0.16), differences between groups were not significant [difference +109 g (95% CI 2442, +660)/257 g (95% CI 2740, +625)]. Conclusions: In lipoatrophic patients treated with zidovudine/lamivudine/abacavir, switching to lopinavir/ ritonavir monotherapy had no additional benefit in limb fat recovery relative to switching to lopinavir/ritonavir with abacavir/lamivudine. These data suggest that non-thymidine nucleosides such as abacavir/lamivudine are not an obstacle to limb fat recovery. ©The Author 2013. Source

Spuch C.,Complexo Hospitalario Universitario Of Vigo | Navarro C.,Complexo Hospitalario Universitario Of Vigo
Recent Patents on Endocrine, Metabolic and Immune Drug Discovery | Year: 2010

The central nervous system (CNS) barriers are composed of blood-brain barrier (BBB) and blood-cerebrospinal fluid barrier (B-CSFB). The BBB and B-CSFB are a highly specialized brain endothelial and epithelial structure of the fully differentiated neurovascular system. These barriers separate components of the circulating blood from neurons. Moreover, the BBB and B-CSFB maintain the chemical composition of the neuronal milieu, which is required for the proper functioning of neuronal circuits, synaptic transmission, synaptic remodelling, angiogenesis, and neurogenesis in the adult brain. Hematoencephalic barrier breakdown, due to disruption of the tight junctions, alters transport of molecules between blood and brain and vice versa, causes an aberrant angiogenesis, vessel regression, and inflammatory responses. Megalin is a multi-ligand endocytic receptor expressed in the choroid plexus epithelium and in the brain-endothelial cells, playing a central role in the clearance/entrance of many proteins from the brain or cerebrospinal fluid (CSF). Megalin cooperates with various membrane molecules and interacts with many adaptor proteins for endocytic trafficking. It has already been implicated in amyloid-clearance and amyloidosis through the BBB and B-CSFB. Also, it is a promiscuous receptor involved in the endocytic uptake of many ligands, including many of the known carriers of amyloid-, insulin, IGF-I, leptin, transthyretin, transferrin, ApoE and others. The knowledge of B-CSFB and its transporters in healthy and pathological situations supports the development of new therapeutic approaches for chronic diseases such as Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, multiple sclerosis, brain cancer, diabetes and others. This article outlines recent patents on artificial carriers for transport of substances across of the CNS barriers, different models for the drug delivery research and future therapies for the treatment of Alzheimer's disease. © 2010 Bentham Science Publishers Ltd. Source

Discover hidden collaborations