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Hospital de Órbigo, Spain

Ruiz J.C.,University of Cantabria | Sanchez-Fructuoso A.,San Carlos Hospital | Zarraga S.,Cruces Hospital
Transplantation Reviews | Year: 2012

Proteinuria is a marker of poor prognosis in kidney transplant recipients as well as in nontransplant patients with chronic kidney disease. It negatively influences the rate of deterioration of graft renal function, graft survival, and more importantly, patient survival. This review analyzes the current knowledge on the management of this crucial aspect in kidney transplantation.The reduction of proteinuria has demonstrated a beneficial effect on kidney function and also on patient survival in nontransplant patients with chronic kidney disease, but unfortunately, to date, it has not been possible to demonstrate the same benefit in the kidney transplant population (although it probably exists). Nevertheless, the appearance of proteinuria in a renal transplant patient must always be followed by an investigation on its etiology, and many times, it should include a graft biopsy to adequately categorize the underlying process responsible for the proteinuria and to establish a correct therapy. Furthermore, in spite of the cause of proteinuria, it should be treated to reduce to normal or near-normal levels with the objective to eliminate or reduce its negative effects on the graft and the cardiovascular system of the patient. The drugs that interfere with the renin-angiotensin-aldosterone system, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, are the cornerstone of the management of this complication, and recently, direct renin inhibitors have added to the armamentarium. Mono-, dual-, and triple-therapy modalities are discussed, as well as other therapies and nonpharmacologic measures. © 2012 Elsevier Inc.. Source

Garcia-Arumi J.,Institute Microcirugia Ocular | Boixadera A.,Vall dHebron Hospital | Martinez-Castillo V.,Vall dHebron Hospital | Zapata M.A.,Vall dHebron Hospital | And 2 more authors.
Retina | Year: 2011

Purpose: To review the surgical management and functional outcome of macular holes (MHs) developing after rhegmatogenous retinal detachment repair. Methods: Retrospective, interventional, noncomparative case series. Twenty patients with MH developing after rhegmatogenous retinal detachment repair were included. Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade was performed. Macular attachment status and number of best-corrected visual acuity lines of improvement after MH repair were evaluated. Results: The fovea had been detached in all eyes at the time of rhegmatogenous retinal detachment repair. Six MHs developed after scleral buckling surgery and 14 MHs after vitrectomy with an encircling band. In 5 of the 20 patients, ≥2 operations had been required to achieve retinal reapplication. The mean time to MH diagnosis was 38 weeks. Preoperative best-corrected visual acuity was ≤20/100 in all but one case. Single-operation MH closure rate was 100%, with a mean of 4 Early Treatment Diabetic Retinopathy Study lines of visual improvement (P < 0.001). Mean postoperative Snellen best-corrected visual acuity was 20/70 (±0.15) (P < 0.001). Conclusion: In this small retrospective study, standard surgical treatment for idiopathic MH was effective in achieving anatomical closure of these secondary MHs, but visual acuity gain was limited by the previous macula-involving rhegmatogenous retinal detachment status. Copyright © Opthalmic Communications Society. Inc. Source

Segarra R.,Research Center Biomedica En Red Of Salud Mental | Ojeda N.,Research Center Biomedica En Red Of Salud Mental | Ojeda N.,University of Deusto | Zabala A.,Research Center Biomedica En Red Of Salud Mental | And 4 more authors.
European Archives of Psychiatry and Clinical Neuroscience | Year: 2012

The aims of this study were to analyze the presence of gender differences in the phenotypic expression of schizophrenia at the onset of illness and to explore whether these differences determine clinical and functional outcome 2 years after the initiation of treatment. Data from 231 firstepisode-psychosis non-substance-dependent patients (156 men and 75 women) participating in a large-scale naturalistic open-label trial with risperidone were recorded at inclusion and months 1, 6, 12, and 24. Men presented a significant earlier age of onset (24.89 years vs. 29.01 years in women), poorer premorbid functioning, and a higher presence of prodromal and baseline negative symptoms. Women were more frequently married or lived with their partner and children and more frequently presented acute stress during the year previous to onset than men. No other significant clinical or functional differences were detected at baseline. The mean dose of antipsychotic treatment was similar for both genders during the study, and no significant differences in UKU scores were found. The number of hospitalizations was similar between groups, and adherence was more frequent among women. At the 2-year follow-up, both groups obtained significant improvements in outcome measures: PANSS, CGI severity, and GAF scores. Significant gender * time interactions were detected for negative and general PANSS subscales, with the improvement being more pronounced for men. However, no differences were detected for the mean scores obtained during the study in any outcome measure, and the final profile was similar for men and women. Our results suggest that although the initial presentation of schizophrenia can differ according to gender, these differences are not sufficient enough to determine differentiated outcome 2 years after the initiation of treatment in non-substance-dependent patients. The influence of gender on the early course of schizophrenia does not seem to be clinically or functionally decisive in this population. © 2011 Springer-Verlag. Source

Andia D.,University of the Basque Country | Mozo De Rosales F.,University of the Basque Country | Villasante A.,University of the Basque Country | Rivero B.,University of the Basque Country | And 2 more authors.
International Journal of Gynecology and Obstetrics | Year: 2011

Objective: To examine the causal contribution of conization to premature delivery. Methods: This was a retrospective, case-control, multicenter study of women who underwent conization in 5 hospitals in the Basque Country (Spain) from 1998 to 2007. Three study groups were established: group A, post-conization infant deliveries; control group B, pre-conization infant deliveries; and control group C, infant deliveries without conization. Results: Comparing group A with group C, there was a higher rate of preterm delivery before 35 weeks (5.3% versus 1.6%), a lower mean birth weight (3156.2 g versus 3328.5 g), and a greater prevalence of infants under 2500 g (10.6% versus 3.7%). There were no significant differences between group A and group B: preterm delivery before 35 weeks (5.3% versus 4.8%), mean birth weight (3156.2 g versus 3119.4 g), and prevalence of infants under 2500 g (10.6% versus 10.6%). Conclusion: Pregnancy in women post-conization was associated with a risk of preterm delivery. However, there were no significant differences between women who underwent conization before and those who underwent conization after delivery. Cervical conization does not necessarily increase the risk of preterm delivery in subsequent pregnancy. Conization should be considered an indicator of such risk because it is associated with pregnancy complications arising from socio-epidemiologic factors present in women requiring conization that are also present in women who have premature delivery. © 2010 International Federation of Gynecology and Obstetrics. Source

Pinar-Sueiro S.,Cruces Hospital | Pinar-Sueiro S.,University of the Basque Country | Urcola H.,University of the Basque Country | Agurtzane Rivas M.,University of the Basque Country | Vecino E.,University of the Basque Country
Clinical and Experimental Ophthalmology | Year: 2011

Background: The objective of this study was to evaluate the neuroprotective effect of brimonidine on retinal ganglion cells in rats with elevated intraocular pressure and to characterize the subpopulation of cells that can be rescued, as well as assess the effect of this drug on retinal ganglion cell soma size. Methods: Episcleral vein cauterization was used to increase intraocular pressure for 5weeks on left eyes, considering right eyes as intrinsic controls in all cases. All the animals were then given weekly intraperitoneal injections, the experimental group receiving brimonidine, and the control group were administered only phosphate-buffered saline. Surviving retinal ganglion cells were quantified and their area and distribution measured by retrograde labelling with fluorogold. Results: Brimonidine administered systemically has a neuroprotective effect on retinal ganglion cells, which is unrelated to its capacity to lower intraocular pressure. It prevents the increase of cell size that is associated with stages prior to cell death. This phenomenon is particularly evident in the zones of the retina most susceptible to the damage caused by glaucoma (middle and periphery). Conclusion: This effect of preventing retinal ganglion cell swelling can be considered as a new marker to study neuroprotection from antiglaucomatous drugs in the early stages of neurodegeneration in glaucoma. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists. Source

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