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Forner Giner J.,Servicio de Radiologia | Sanz-Requena R.,Servicio de Radiologia | Florez N.,Santo Tomas University of Colombia | Alberich-Bayarri A.,Servicio de Radiologia | And 5 more authors.
Neurologia | Year: 2014

Objectives: The aim of this study is to evaluate the use of phase-contrast MR imaging to diagnose normal pressure hydrocephalus (NPH) and differentiate it from other neurological disorders with similar clinical symptoms. Methods: The study included 108 subjects, of whom 61 were healthy controls and 47, patients; in the patient group, 19 had cerebrovascular disease (CVD) and 28 had NPH. All patients underwent a phase-contrast MRI study and several CSF flow and velocity parameters were measured at the aqueduct of Sylvius. Discriminant analyses were performed to evaluate the classification capacity of both individual parameters and the combination of different parameters. Results: Maximum diastolic velocity, mean flow, and stroke volume showed statistically significant differences that could be used to distinguish between NPH and CVD patients (P<.001). Stroke volume and mean flow showed no false positive results and successful classification rates of 86% and 79%, respectively. No other parameters or combination produced better results. Conclusions: Phase-contrast MR imaging is a useful tool for the early diagnosis of patients with NPH. CSF flow quantitative parameters, along with morphological features in a conventional MR study, enable us to differentiate between NPH and CVD patients. © 2012 Sociedad Española de Neurología.

Sanz F.,Universitari Of Valencia | Restrepo M.I.,University of Texas Health Science Center at San Antonio | Fernandez E.,Veterans Evidence Based Research Dissemination and Implementation Center | Fernandez E.,Hospital Universitario Doctor Peset Of Valencia | And 5 more authors.
Respiratory Care | Year: 2011

BACKGROUND: Hypoxemia may influence the prognosis of patients with mild pneumonia, regardless of the initial CURB-65 score (confusion, blood urea nitrogen > 20 mg/dL, respiratory rate > 30 breaths/min, blood pressure < 90/60 mm Hg, and age ≥ 65 y). OBJECTIVE: To determine the risk factors associated with hypoxemia and the influence of hypoxemia on clinical outcomes in hospitalized patients with mild pneumonia. METHODS: We performed a multicenter prospective cohort study of 585 consecutive hospitalized patients with mild pneumonia (CURB-65 groups 0 and 1). We stratified the patients according to the presence of hypoxemia, defined as a PaO2/FIO2 < 300 mm Hg on admission. We assessed the risk factors associated with hypoxemia, hypoxemia's influence on the course of pneumonia, and clinical outcomes (mortality, hospital stay, and need for intensive care unit admission), with multivariable regression. RESULTS: Fifty percent of the patients (294 cases) had hypoxemia on admission. The risk factors independently associated with hypoxemia were: bilateral radiological involvement (odds ratio 2.8, 95% CI 1.1-7.5), history of COPD (odds ratio 2.5, 95% CI 1.4-4.3), and hypoalbuminemia (odds ratio 2.0, 95% CI.1-3.5). The hypoxemic patients had longer hospital stay, higher intensive care unit admission rate, higher rate of severe sepsis, and higher mortality than the non-hypoxemic patients. CONCLUSIONS: Hypoxemia in patients with mild pneumonia is independently associated with several adverse clinical and radiological variables, and the hypoxemic patients had worse clinical outcomes than the non-hypoxemic patients. Therefore, additional attention should be paid to the presence of hypoxemia, regardless of a low CURB-65 score. © 2011 Daedalus Enterprises.

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.

Badenes R.,Hospital Clinic Universitari Of Valencia | Bilotta F.,University of Rome La Sapienza
British Journal of Anaesthesia | Year: 2015

Intracerebral haemorrhage (ICH) is associated with significant early mortality (up to 50% at 30 days) and long-term morbidity (with permanent neurological deficits in 75-80% of patients) and represents a serious health issue worldwide. The past decade has seen a dramatic increase in clinical research on ICH diagnosis and treatment that has led to revision of the guidelines for the diagnosis and management of ICH from the American Heart Association and American Stroke Association in 2013. This systematic review reports recent clinical evidence (original studies published between September 2013 and July 2015) related to neurocritical care and intensive care unit management of patients with ICH. All but one publication included in this review report original studies related to managment of patients with intracerebral or subarachnoid haemorrhage. These include insights on risk stratification and neurocritical care or intensive care unit treatment, management of haemodynamic variables and mechanical ventilation (goal-directed fluid therapy, advanced haemodynamic monitoring, and avoidance of hyperoxia and hyperventilation), and pharmacological neuroprotection. © 2015 The Author.

Lopez-Labrador F.X.,University of Valencia | Lopez-Labrador F.X.,CIBER ISCIII | Berenguer M.,University of Valencia | Berenguer M.,CIBER ISCIII | And 2 more authors.
Future Microbiology | Year: 2015

Although vaccination has provided as a very efficient preventive tool, antiviral therapy is still needed to control viral infections not avoidable by prophylaxis with vaccines; those caused by viruses for which a vaccine is available, but vaccination is not universally implemented or does not result in complete, long-term protection; and in immunocompromised individuals with reduced immune control of viral replication. After more than 50 years of the first licensing for an antiherpetic drug, novel compounds for herpes-simplex viruses and human cytomegalovirus will open new strategies for better control and management of these two recurrent viral infections. Besides, the development and use of antiviral drugs for hepatitis viruses causing chronic liver disease has evolved from the unavailability of compounds targeting virus-specific pathways, to the generalization of different treatment regimes based on specific antiviral drugs, both for hepatitis B and C viruses. However, due to the nature of the viral genomes and their replication, in the face of the selective pressure imposed by antiviral drugs viral-resistant variants inevitably emerge, and specific strategies are needed to avoid, or reduce, their clinical and public health impact. © 2015 Future Medicine Ltd.

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