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Hospital de Órbigo, Spain

Fernandez-Nebro A.,University of Malaga | Marenco J.L.,Hospital Virgen de Valme | Lopez-Longo F.,Hospital General Universitario Gregorio Maranon | Galindo M.,Hospital Universitario 12 Of Octubre | And 12 more authors.
Lupus | Year: 2014

Introduction: Patients with systemic lupus erythematosus (SLE) have increased cardiovascular risk related to lipid changes induced by inflammatory activity, proteinuria and treatments. Our objective was to analyse lipid changes in a cohort of patients with SLE resistant to standard treatments who were treated with rituximab. Methods: The study population comprised a retrospective multicentre, national cohort of patients with SLE resistant to standard treatments who were treated with rituximab. The basic lipid profile, concomitant treatment and disease activity were analysed at the start of the treatment, 24 weeks later, and at the end of the follow-up period. The effects of the main lupus variables and therapy on the lipid changes were analysed. Results: Seventy-nine patients with active lupus treated with rituximab were assessed during 149.3 patient-years. Prior to the treatment, 69% had dyslipidaemia. The most frequent abnormalities were a low-density lipoprotein (LDL) level of ≥100 mg/dl (34%) and a high-density lipoprotein (HDL) level of <50 mg/dl (27%). Baseline total cholesterol (TC) and LDL levels correlated with the degree of proteinuria, while the concentration of triglycerides (TGs) correlated with the SLE Disease Activity Index (SLEDAI). TGs were reduced at short- and long-term follow-up after rituximab treatment. A multiple linear regression analysis identified that the reduction of the lupus inflammatory activity, particularly changes in proteinuria, was the only independent variable that was positively associated with the reduction in TGs after 24 weeks (p=0.001) and with TC (p=0.005) and TGs (p<0.001) at the end of the follow-up period. Conclusion: Our results suggest that rituximab may improve the long-term lipid profile of patients with SLE refractory to standard treatment, mainly by reducing inflammatory activity. © The Author(s), 2014. Source

Salguero-Cabalgante R.,Agencia de Calidad Sanitaria de Andalucia | Fernandez-Martinez M.A.A.,Hospital Virgen de Valme | Alarcon-Martinez M.A.L.,Fundacion Progreso Y Salud
Matronas Profesion | Year: 2015

The current student system for Spanish midwives pretend to evaluate the progress in learning through a variety of tools to assess the clinical competences. Furthermore, this system is implemented with the intention of identifying areas to achieve objectives in the training program. A structured objective clinical evaluation for midwifery students was designed by a group of midwives from the Andalusian Association of Midwives. The activity included 9 clinical situations to demonstrate the professional competences in specific areas of knowledge. With this objective, the method included simulated patients and computer simulations. This application was voluntary and it had a training objective. The main findings was provided to the participants which included upgradable clinical competences and detected strengths. Participation was wide and the general assessment was positive. From an individual point of view, the results permit to identify knowledge areas to enhance and to adapt the learning methods. ©2015 Ediciones Mayo, S.A. All rights reserved. Source

Pascasio J.M.,Hospital Virgen del Rocio | Grilo I.,Hospital de Alta Resolucion de Ecija | Lopez-Pardo F.J.,Hospital Virgen del Rocio | Ortega-Ruiz F.,Hospital Virgen del Rocio | And 7 more authors.
American Journal of Transplantation | Year: 2014

The prevalence of hepatopulmonary syndrome (HPS) and its influence on survival before and after liver transplantation (LT) remain controversial. Additionally, the chronology of post-LT reversibility is unclear. This study prospectively analyzed 316 patients with cirrhosis who were evaluated for LT in 2002-2007; 177 underwent LT at a single reference hospital. HPS was defined by a partial pressure of arterial oxygen (PaO2) <70 mmHg and/or an alveolar-arterial oxygen gradient (A-a PO2) ≥20 mmHg in the supine position and positive contrast echocardiography. The prevalence of HPS was 25.6% (81/316 patients), and most patients (92.6%) had mild or moderate HPS. High Child-Pugh scores and the presence of ascites were independently associated with HPS. Patients with and without HPS did not significantly differ in LT waiting list survival (mean 34.6 months vs. 41.6 months, respectively; log-rank, p = 0.13) or post-LT survival (mean 45 months vs. 47.6 months, respectively; log-rank, p = 0.62). HPS was reversed in all cases within 1 year after LT. One-fourth of the patients with cirrhosis who were evaluated for LT had HPS (mostly mild to moderate); the presence of HPS did not affect LT waiting list survival. HPS was always reversed after LT, and patient prognosis did not worsen. This prospective study investigates hepatopulmonary syndrome in cirrhotic patients evaluated for liver transplantation, finding a 25% prevalence, mostly mild or moderate, without any influence on the waiting list and posttransplantation survival and with reversibility in all cases after transplant. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons. Source

Silva-Fernandez L.,Complexo Hospitalario Universitario Of Ferrol | Perez-Vicente S.,Research Unit | Martin-Martinez M.A.,Research Unit | Lopez-Gonzalez R.,Complejo Hospitalario de Zamora | And 105 more authors.
Seminars in Arthritis and Rheumatism | Year: 2015

Objective: To describe the variability in the prescription of non-biologic disease-modifying antirheumatic drugs (nbDMARDs) for the treatment of spondyloarthritis (SpA) in Spain and to explore which factors relating to the disease, patient, physician, and/or center contribute to these variations. Methods: A retrospective medical record review was performed using a probabilistic sample of 1168 patients with SpA from 45 centers distributed in 15/19 regions in Spain. The sociodemographic and clinical features and the use of drugs were recorded following a standardized protocol. Logistic regression, with nbDMARDs prescriptions as the dependent variable, was used for bivariable analysis. A multilevel logistic regression model was used to study variability. Results: The probability of receiving an nbDMARD was higher in female patients [OR = 1.548; 95% confidence interval (CI): 1.208-1.984], in those with elevated C-reactive protein (OR = 1.039; 95% CI: 1.012-1.066) and erythrocyte sedimentation rate (OR = 1.012; 95% CI: 1.003-1.021), in those with a higher number of affected peripheral joints (OR = 12.921; 95% CI: 2.911-57.347), and in patients with extra-articular manifestations like dactylitis (OR = 2.997; 95% CI: 1.868-4.809), psoriasis (OR = 2.601; 95% CI: 1.870-3.617), and enthesitis (OR = 1.717; 95% CI: 1.224-2.410). There was a marked variability in the prescription of nbDMARDs for SpA patients, depending on the center (14.3%; variance 0.549; standard error 0.161; median odds ratio 2.366; p < 0.001). After adjusting for patient and center variables, this variability fell to 3.8%. Conclusion: A number of factors affecting variability in clinical practice, and which are independent of disease characteristics, are associated with the probability of SpA patients receiving nbDMARDs in Spain. © 2015 Elsevier Inc. Source

Gamez-Pozo A.,Hospital Universitario La Paz | Carrion R.M.P.,Hospital Quiron | Manso L.,Hospital 12 de Octubre | Crespo C.,Hospital Ramon y Cajal | And 19 more authors.
PLoS ONE | Year: 2014

Background: Trastuzumab improves survival outcomes in patients with HER2+ metastatic breast cancer. The Long-Her study was designed to identify clinical and molecular markers that could differentiate long-term survivors from patients having early progression after trastuzumab treatment.Methods: Data were collected from women with HER2-positive metastatic breast cancer treated with trastuzumab that experienced a response or stable disease during at least 3 years. Patients having a progression in the first year of therapy with trastuzumab were used as a control. Genes related with trastuzumab resistance were identified and investigated for network and gene functional interrelation. Models predicting poor response to trastuzumab were constructed and evaluated. Finally, a mutational status analysis of selected genes was performed in HER2 positive breast cancer samples.Results: 103 patients were registered in the Long-HER study, of whom 71 had obtained a durable complete response. Median age was 58 years. Metastatic disease was diagnosed after a median of 24.7 months since primary diagnosis. Metastases were present in the liver (25%), lungs (25%), bones (23%) and soft tissues (23%), with 20% of patients having multiple locations of metastases. Median duration of response was 55 months. The molecular analysis included 35 patients from the group with complete response and 18 patients in a control poor-response group. Absence of trastuzumab as part of adjuvant therapy was the only clinical factor associated with long-term survival. Gene ontology analysis demonstrated that PI3K pathway was associated with poor response to trastuzumab-based therapy: tumours in the control group usually had four or five alterations in this pathway, whereas tumours in the Long-HER group had two alterations at most.Conclusions: Trastuzumab may provide a substantial long-term survival benefit in a selected group of patients. Whole genome expression analysis comparing long-term survivors vs. a control group predicted early progression after trastuzumab-based therapy. Multiple alterations in genes related to the PI3K-mTOR pathway seem to be required to confer resistance to this therapy. © 2014 Gámez-Pozo et al. Source

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