Ortega F.,Hospital Central Universitario Of Asturias |
Otero A.,Hospital Universitario runa |
Crespo J.F.,Hospital Doctor Peset |
Delgado J.F.,Hospital Doce de Octubre |
And 2 more authors.
Journal of Nephrology | Year: 2013
Background: The aim of this study was to analyze patient satisfaction and adherence in a sample of renal transplant patients living with a working allograft. Methods: An epidemiological cross-sectional multicenter study was carried out with renal recipients who had received a transplant 6-24 months before and were undergoing immunosuppressant therapy (IT). Sociodemographic and clinical variables registered were dosage, allograft functioning, number of medications, health-related quality of life (HRQoL by SF-6D), patients' satisfaction (SAT-Q) and adherence to medication (abnormal levels of immunosuppressant in blood tests [ALIBT] and clinical impression). Relationships between those parameters were contrasted (chi-square test, Spearman correlation coefficient and Mann-Whitney U-test). Multivariate regression models (linear and logistic) were computed to analyze the factors related to patients' satisfaction and adherence to medication, respectively. Results: Data from 206 patients were collected (61.2% males with a mean age of 53.35 years). Nonadherence rates (29.1% and 31.1%) were found according to clinical impression and ALIBT, respectively (chi-square = 31.810, p<0.001). Overall, global patients' satisfaction (74.000 ± 1.251) and HRQoL (0.765 ± 0.011) levels were high. Low-moderate significant associations between satisfaction and adherence to IT and HRQoL were found (p<0.01). Finally, age, vitality, allograft functioning and dosage were correlated with patient satisfaction (R2=0.174; F(1,185)=4.134; p<0.043). Number of medications (odds ratio [OR] = 0.890; 95% confidence interval [95% CI], 0.812-0.975; p=0.012), convenience domain (OR=1.037; 95% CI, 1.005-1.070; p=0.021) and clinical criteria (OR=6.135; 95% CI, 2.945-12.782; p<0.001) were associated with adherence. Conclusions: In renal transplant patients, satisfaction with IT is related to the levels of HRQoL and compliance. © 2012 Società Italiana di Nefrologia.
Molina V.,Hospital Universitario Of Salamanca |
Galindo G.,Hospital Universitario Of Salamanca |
Cortes B.,Hospital Universitario Of Salamanca |
De Herrera A.G.S.,Rey Juan Carlos University |
And 4 more authors.
European Archives of Psychiatry and Clinical Neuroscience | Year: 2011
Gray matter (GM) volume deficits have been described in patients with schizophrenia (Sz) and bipolar disorder (BD), but to date, few studies have directly compared GM volumes between these syndromes with methods allowing for whole-brain comparisons. We have used structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to compare GM volumes between 38 Sz and 19 BD chronic patients. We also included 24 healthy controls. The results revealed a widespread cortical (dorsolateral and medial prefrontal and precentral) and cerebellar deficit as well as GM deficits in putamen and thalamus in Sz when compared to BD patients. Besides, a subcortical GM deficit was shown by Sz and BD groups when compared to the healthy controls, although a putaminal reduction was only evident in the Sz patients. In this comparison, the BD patients showed a limited cortical and subcortical GM deficit. These results support a partly different pattern of GM deficits associated to chronic Sz and chronic BD, with some degree of overlapping. © 2010 Springer-Verlag.
Isasi C.,Hospital Puerta de Hierro |
Colmenero I.,Hospital Infantil Nino Jesus |
Casco F.,Hospital Infantil Nino Jesus |
Tejerina E.,Hospital Puerta de Hierro |
And 4 more authors.
Rheumatology International | Year: 2014
Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5–31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome. © 2014, The Author(s).
Iglesias P.,Hospital Ramon y Cajal |
Bernal C.,Hospital Doce de Octubre |
Villabona C.,Hospital Bellvitge |
Castro J.C.,Hospital General |
And 2 more authors.
Clinical Endocrinology | Year: 2012
Aims To assess treatment outcome in male patients with micro- and macroprolactinomas. Design Multicentre and retrospective study. Patients Eighty-eight male patients (15 micro- and 73 macroprolactinomas), aged 40.3 ± 14.7 years, were studied. Time of follow-up ranged from 3 to 244 months. Methods Clinical, hormonal and radiological data were registered at diagnosis and follow-up. Treatment outcome was evaluated in relation to the modality of therapy (dopamine agonists, surgery and radiation therapy). Results Dopamine agonists normalized prolactin levels in 73.3% and 65.2% of patients with micro- and macroprolactinomas, respectively. Disappearance of tumour was reached in 53.3% and 28.3% of subjects with micro- and macroprolactinomas, respectively. Tumour absence at last visit was achieved in 7 of 14 patients with macroprolactinoma and treated by means of dual therapy (dopamine agonists and neurosurgery) and in 9 of 13 patients with macroprolactinoma managed with triple therapy (dopamine agonists, neurosurgery and radiation therapy). Normalization of prolactin levels at last visit was present in 68.9%, 79.6% and 69.2% of patients treated by medical therapy, dual therapy and triple therapy, respectively (differences not significant). Multivariate logistic regression analysis showed that the time on therapy was the only significant variable related to tumour disappearance. Conclusion We conclude that medical therapy normalizes prolactin and reduces tumour size in the majority of men with prolactinomas. The addition of pituitary surgery with or without radiation therapy does not offer significant advantages over medical therapy with dopamine agonists in male patients with macroprolactinomas. © 2012 Blackwell Publishing Ltd.
Atienza F.,Hospital General Universitario Gregorio Maranon |
Almendral J.,Hospital Universitario Monteprincipe |
Ormaetxe J.M.,Hospital de Basurto |
Moya A.,Hospital Vall DHebron |
And 13 more authors.
Journal of the American College of Cardiology | Year: 2014
Background Empiric circumferential pulmonary vein isolation (CPVI) has become the therapy of choice for drugrefractory atrial fibrillation (AF). Although results are suboptimal, it is unknown whether mechanistically-based strategies targeting AF drivers are superior. Objectives This study sought to determine the efficacy and safety of localized high-frequency source ablation (HFSA) compared with CPVI in patients with drug-refractory AF. Methods This prospective, multicenter, single-blinded study of 232 patients (age 53 ± 10 years, 186 males) randomized those with paroxysmal AF (n = 115) to CPVI or HFSA-only (noninferiority design) and those with persistent AF (n = 117) to CPVI or a combined ablation approach (CPVI + HFSA, superiority design). The primary endpoint was freedom from AF at 6 months post-first ablation procedure. Secondary endpoints included freedom from atrial tachyarrhythmias (AT) at 6 and 12 months, periprocedural complications, overall adverse events, and quality of life. RESULTS In paroxysmal AF, HFSA failed to achieve noninferiority at 6 months after a single procedure but, after redo procedures, was noninferior to CPVI at 12 months for freedom from AF and AF/AT. Serious adverse events were significantly reduced in the HFSA group versus CPVI patients (p = 0.02). In persistent AF, there were no significant differences between treatment groups for primary and secondary endpoints, but CPVI + HFSA trended toward more serious adverse events. Conclusions In paroxysmal AF, HFSA failed to achieve noninferiority at 6 months but was noninferior to CPVI at 1 year in achieving freedom of AF/AT and a lower incidence of severe adverse events. In persistent AF, CPVI + HFSA offered no incremental value. © 2014 by the American College of Cardiology Foundation.