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Oishi N.,Consorci Hospital General Universitari Of Valencia | Oishi N.,University of Valencia | Bagan J.V.,Consorci Hospital General Universitari Of Valencia | Javier K.,Consorci Hospital General Universitari Of Valencia | Zapater E.,Consorci Hospital General Universitari Of Valencia
International Archives of Otorhinolaryngology | Year: 2016

Introduction Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis Although Hodgkin's lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposi's sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection. Copyright © 2016, Georg Thieme Verlag. All rights reserved.


PubMed | University of Barcelona, Hospital Of Mataro, CIBER ISCIII, j Servicio de Vigilancia and 6 more.
Type: Journal Article | Journal: Expert review of vaccines | Year: 2016

This study aimed to assess whether influenza vaccination reduces the risk of severe and fatal outcomes in influenza inpatients aged 65years.During the 2013-2014 influenza season persons aged 65years hospitalized with laboratory-confirmed influenza were selected in 19 Spanish hospitals. A severe influenza case was defined as admission to the intensive care unit, death in hospital or within 30 days after admission. Logistic regression was used to compare the influenza vaccination status between severe and non-severe influenza inpatients.Of 433 influenza confirmed patients, 81 (19%) were severe cases. Vaccination reduced the risk of severe illness (odds ratio: 0.57; 95%CI: 0.33-0.98). The cumulative number of influenza vaccine doses received since the 2010-2011 season was associated with a lower risk of severe influenza (odds ratio: 0.78; 95% CI 0.66-0.91).Adherence to seasonal influenza vaccination in the elderly may reduce the risk of severe influenza outcomes.


Sanz F.,Consorci Hospital General Universitari Of Valencia | Dean N.,University of Utah | Dickerson J.,University of Utah | Jones B.,University of Utah | And 7 more authors.
Respirology | Year: 2015

Background and objective Assessment of oxygenation in patients with community-acquired pneumonia is critical for treatment. The accuracy of percutaneous oxygen saturation (SpO2) determined by pulse oximetry is uncertain, and it has limited value in patients receiving supplemental oxygen. We hypothesized that calculation of partial arterial oxygen concentration/inspired oxygen faction (PaO2/FiO2) from SpO2 by the Ellis or Rice equations might adequately correlate with PaO2/FiO2 measured by arterial blood gases. Methods We studied 1004 patients with pneumonia in the emergency department with simultaneous measurement of SpO2 and PaO2 from two cohorts from Valencia, Spain and Utah, USA. We compared SpO2 with measured SaO2, compared the equations' accuracy in calculating PaO2/FiO2 and determined how often patients would be misclassified at clinically important thresholds. We compared estimated PaO2/FiO2 to measured PaO2/FiO2 using the Spearman correlation. Results Pairwise correlation of SpO2 with SaO2 was moderate (rho-=-0.66; P-<-0.01). Both equations performed similarly among patients with lower PaO2/FiO2 ratios. The Ellis equation estimated PaO2/FiO2 from SpO2 more accurately than the Rice equation in patients with PaO2/FiO2 ≥200. Simple agreement between calculated and measured P/F was 91% and 92%, respectively. Conclusions The Ellis equation was more accurate than the Rice equation for estimating PaO2/FiO2, especially at higher levels of P/F ratio. Estimation of PaO2/FiO2 from SpO2 is accurate enough for initial oxygenation assessment. Ellis and Rice equations could misclassify 20% and 30% of patients, respectively, at higher levels of PaO2/FiO2. For patients with abnormal oxygenation falling near thresholds for clinical decision making, arterial blood gas measurement preferably on room air is more accurate. Different equations for PaO2/FiO2 calculation have been described for patients with acute respiratory distress syndrome; we publish data to validate these in emergency room patients with pneumonia. The use of PaO2/FiO2 calculated from non-invasive techniques (SpO2) is accurate in the assessment of oxygenation in emergency room patients with community-acquired pneumonia. © 2015 Asian Pacific Society of Respirology.


Sanz-Herrero F.,Consorci Hospital General Universitari Of Valencia | Gimeno-Cardona C.,Consorci Hospital General Universitari Of Valencia | Gimeno-Cardona C.,University of Valencia | Tormo-Palop N.,Consorci Hospital General Universitari Of Valencia | And 4 more authors.
Vaccine | Year: 2016

Introduction: Pneumococcal 13-valent vaccine (PCV-13) has a potential role in preventing bacteraemic pneumococcal pneumonia and its complications, but little is known about its ability to specifically prevent respiratory complications. Our aim were to analyse the pneumococcal serotypes associated with the development of respiratory complications and the potential role of PCV-13 in preventing respiratory complications in bacteraemic pneumococcal pneumonia. Material and methods: We analysed demographic characteristics, comorbidities, antibiotic resistances and the outcomes of a cohort of 65 vaccine-naïve bacteraemic pneumococcal pneumonias, stratified by the pneumococcal serotypes included in PCV13 vs. those not included. Complications were clustered as follows: respiratory complications (hypoxemic respiratory failure; mechanical ventilation), systemic complications (septic shock; multiorgan failure), suppurative complications (empyema; pleural effusion; lung abscess). Results: From a population of 65 CAP-SP, 47.7% of the isolates belonged to PCV-13 serotypes group. No differences in comorbidities or clinical manifestations were found between groups. With regard to biochemical parameters, we found more profound hypoxemia levels in PCV-13 serotypes group comparing to non-vaccine group [PaO2/FiO2 209 (63) vs. 268 (57); p =0.007]. Global complications were identified in 69.2% (45 patients), and the most frequent were respiratory complications, found in 47.7%. Respiratory complications were detected more frequently in PCV-13 groups compared to non-vaccine groups (61.3% vs. 35.3%; p =0.036). Overall 30-day mortality was 30.8%. Mortality was similar between both groups (25.8% vs. 35.3%; p =0.408). Conclusions: Pneumococcal 13-valent conjugate vaccine includes the serotypes which cause more respiratory complications in our series; these serotypes were not associated with higher mortality in our series. PCV-13 may have a potential role in preventing respiratory complications due to bacteraemic pneumonoccal pneumonia. © 2016 Elsevier Ltd.


PubMed | Hospital Clinic Universitari Of Valencia, University of Valencia, Hospital Clinic Universitari Of Valencia 17 and Consorci Hospital General Universitari Of Valencia
Type: Journal Article | Journal: Vaccine | Year: 2016

Pneumococcal 13-valent vaccine (PCV-13) has a potential role in preventing bacteraemic pneumococcal pneumonia and its complications, but little is known about its ability to specifically prevent respiratory complications. Our aim were to analyse the pneumococcal serotypes associated with the development of respiratory complications and the potential role of PCV-13 in preventing respiratory complications in bacteraemic pneumococcal pneumonia.We analysed demographic characteristics, comorbidities, antibiotic resistances and the outcomes of a cohort of 65 vaccine-nave bacteraemic pneumococcal pneumonias, stratified by the pneumococcal serotypes included in PCV13 vs. those not included. Complications were clustered as follows: respiratory complications (hypoxemic respiratory failure; mechanical ventilation), systemic complications (septic shock; multiorgan failure), suppurative complications (empyema; pleural effusion; lung abscess).From a population of 65 CAP-SP, 47.7% of the isolates belonged to PCV-13 serotypes group. No differences in comorbidities or clinical manifestations were found between groups. With regard to biochemical parameters, we found more profound hypoxemia levels in PCV-13 serotypes group comparing to non-vaccine group [PaO2/FiO2 209 (63) vs. 268 (57); p=0.007]. Global complications were identified in 69.2% (45 patients), and the most frequent were respiratory complications, found in 47.7%. Respiratory complications were detected more frequently in PCV-13 groups compared to non-vaccine groups (61.3% vs. 35.3%; p=0.036). Overall 30-day mortality was 30.8%. Mortality was similar between both groups (25.8% vs. 35.3%; p=0.408).Pneumococcal 13-valent conjugate vaccine includes the serotypes which cause more respiratory complications in our series; these serotypes were not associated with higher mortality in our series. PCV-13 may have a potential role in preventing respiratory complications due to bacteraemic pneumonoccal pneumonia.


Sanz Herrero F.,Consorci Hospital General Universitari Of Valencia | Perez T.L.,Consorci Hospital General Universitari Of Valencia | Olivas J.B.,Hospital Clinic Universitari Of Valencia
Current Respiratory Medicine Reviews | Year: 2010

Invasive pneumococcal disease is a major cause of morbimortality worldwide. The presence of bacteremia in pneumococcal pneumonia constitutes an additional factor of worse prognosis, although the highest virulence of invasive pneumococcal infection is clustered in certain serotypes. Antibiotic resistances are a challenge for the clinician when choosing the most appropriate antibiotic treatment. However, the influence of these in the evolution of the disease is a controversial issue, and it is clinically irrelevant if the MIC is lower than 4 g/ml. The control of antibiotic pressure on Streptococcus pneumoniae has proved the most effective tool for monitoring resistances. Prevention strategies through pneumococcal vaccination have been shown to reduce the incidence of invasive pneumococcal disease in vaccinated children and the unvaccinated adult population. However, a phenomenon of increased infections by serotypes not included in the vaccine has been described. The development of antibiotics and vaccination have achieved great progress in the control of this disease, although Streptococcus pneumoniae continues to develop mechanisms of survival and adaptation. © 2010 Bentham Science Publishers Ltd.


Novella Sanchez L.,Consorci Hospital General Universitari Of Valencia | Sanz Herrero F.,Consorci Hospital General Universitari Of Valencia | Berraondo Fraile J.,Consorci Hospital General Universitari Of Valencia | Fernandez Fabrellas E.,Consorci Hospital General Universitari Of Valencia
Archivos de Bronconeumologia | Year: 2013

Superior vena cava syndrome is a clear sign for clinicians of infiltrative mediastinal involvement, usually caused by neoplasms in this location, and it is an indicator of poor prognosis. However, other diseases of benign origin can also cause these alterations. We present the case of a 34-year-old patient who debuted with symptoms of superior vena cava syndrome due to idiopathic mediastinal fibrosis, which presented a torpid evolution and few therapeutic alternatives. © 2012 SEPAR.


Pitarch G.,Hospital General Of Castello | Perez-Ferriols A.,Consorci Hospital General Universitari Of Valencia | Millan F.,Hospital Arnau Of Vilanova
Actas Dermo-Sifiliograficas | Year: 2012

The appearance of multiple satellite lesions is a rare complication of the treatment of a primary pyogenic granuloma lesion. We report 5 cases of recurrent pyogenic granuloma in patients aged between 4 and 31 years. The lesions resolved spontaneously after 1 to 9 months. Although the diagnosis and treatment of recurrent pyogenic granuloma can be problematic, this condition is benign and frequently self-limiting. © 2011 Elsevier España, S.L. and AEDV. All rights reserved.


Sanz Herrero F.,Consorci Hospital General Universitari Of Valencia | Malanda N.M.,Hospital Of Cruces | Veiga B.M.,Hospital Universitario La Paz | Sanjuan Lopez M.P.,Complexo Hospitalario Universitario
Archivos de Bronconeumologia | Year: 2010

Community-acquired pneumonia is a major cause of morbidity and mortality. Severity assessment is a fundamental tool in the management of pneumonia that allows patients to be stratified according to risk of death and the most appropriate treatment intensity to be provided. The most widely used scales are the PSI/Fine and CURB-65 scales, which have been widely validated and are easy to calculate in clinical practice. Biomarkers can additionally be used to increase accuracy in predicting complications and mortality. Etiologic diagnosis of pneumonia continues to pose a challenge to clinicians. With the experience acquired in the 2009 AH1/N1 influenza pandemic, virological diagnosis of pneumonia by rapid polymerase chain reaction techniques has recently begun to be used. Experience has also been gained in antiviral treatment and complications, especially bacterial superinfection as the main unfavorable event in viral pneumonias. Just as the use of antibiotics to treat infections radically changed their prognosis and treatment, reports in the literature have progressively began to appear of the immunomodulatory effect of drugs that were not initially designed for the treatment of pneumonia, leading to hope for the potential modification of outcome in these patients. © 2010 Sociedad Española de Neumología y Cirugía Torácica.


PubMed | Consorci Hospital General Universitari Of Valencia
Type: Journal Article | Journal: Respirology (Carlton, Vic.) | Year: 2014

Severity assessment is made at the time of the initial clinical presentation in patients with community-acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP.This was a prospective, multicentre study of CAP in Spain. The primary outcomes were the clinical factors associated with POS defined as days from symptoms onset to pneumonia diagnosis >7 days. The secondary outcomes were intensive care unit (ICU) admission, the presence of suppurative complications, septic shock and 30-day mortality.We enrolled 1038 patients diagnosed of CAP: 152 (14.6%) patients had a POS. In multivariate analysis, the presence of prior corticosteroid therapy, alcohol abuse, prior antibiotic therapy, and confusion, urea, respiratory rate, blood pressure and age 65 years or older score 0-1 was independently associated with POS. Patients with POS had a higher incidence of suppurative complications, but not of 30-day mortality when compared with a shorter onset of symptoms.Approximately 15% of patients diagnosed with CAP had POS. Risk factors associated with POS were previous corticosteroids and antibiotic therapy, alcoholism and less severe pneumonia. POS was associated with a higher rate of suppurative complications and less need for ICU admission.

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