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Martn-Rabadn P.,Hospital General Universitario Gregorio Maran | Martnez-Ruiz R.,Hospital Universitario Puerta Of Hierro Majadahonda | Cuadros J.,University of Huelva
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2010

Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis. © 2010 Elsevier España , S.L. Source

Annemans L.,Ghent University | Annemans L.,Vrije Universiteit Brussel | Wittrup-Jensen K.,Schering | Bueno H.,Hospital General Universitario Gregorio Maran
Journal of Medical Economics | Year: 2010

Purpose: The aim of this narrative review was to summarise the cost analyses and supporting trial data for aspirin prophylaxis in primary prevention. Methods: A PubMed search using the term 'aspirin and cost-effective and primary prevention' was performed. Professional meetings (2009) were also searched for any relevant abstracts contacting the terms 'aspirin' and 'cost effectiveness'. Where possible, outcomes were discussed in terms of cost implications (expressed as quality-adjusted life-year [QALY], disability-adjusted life-year or incremental cost-effectiveness ratio) in relation to the annual risk of cardiovascular disease. Aspirin was included in cost-effectiveness models that determined direct cost savings. Results: A total of 67 papers were identified using PubMed, and 17 cost-effectiveness studies, which assessed aspirin in primary prevention (largely based on the key primary prevention studies), and two abstracts were included in the review. These analyses showed that low-dose aspirin was cost effective in a variety of scenarios. In the UK, Germany, Spain, Italy and Japan, the mean 10-year direct cost saving (including follow-up costs and aspirin costs) per patient was €201, €281, €797, €427 and €889 with aspirin use in patients with an annual coronary heart disease risk of 1.5. Cost-effectiveness analyses were affected by age, risk level for stroke and myocardial infarction (MI), risk of bleeds and adherence to aspirin. Underutilisation is a major limiting factor, as the appropriate use of aspirin in an eligible population (n301,658) based on the NHANES database would prevent 1273 MIs, 2184 angina episodes and 565 ischaemic strokes in patients without previous events; this would result in a direct cost saving of $79.6million (€54.7million; 2010 values), which includes aspirin costs. Conclusions: Most analyses in primary prevention have shown that low-dose aspirin is a cost-effective option, and is likely to meet the willingness of a healthcare system to pay for any additional QALY gained in the majority of healthcare systems. © 2010 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted. Source

Bueno H.,Hospital General Universitario Gregorio Maran | Betriu A.,Hospital Clnic | Heras M.,Hospital Clnic | Alonso J.J.,Hospital de Fuenlabrada | And 5 more authors.
European Heart Journal | Year: 2011

Aims To compare primary percutaneous coronary intervention (pPCI) and fibrinolysis in very old patients with ST-segment elevation myocardial infarction (STEMI), in whom head-to-head comparisons between both strategies are scarce. Methods and resultsPatients <75 years old with STEMI <6 h were randomized to pPCI or fibrinolysis. The primary endpoint was a composite of all-cause mortality, re-infarction, or disabling stroke at 30 days. The trial was prematurely stopped due to slow recruitment after enroling 266 patients (134 allocated to pPCI and 132 to fibrinolysis). Both groups were well balanced in baseline characteristics. Mean age was 81 years. The primary endpoint was reached in 25 patients in the pPCI group (18.9) and 34 (25.4) in the fibrinolysis arm [odds ratio (OR), 0.69; 95 confidence interval (CI) 0.381.23; P 0.21]. Similarly, non-significant reductions were found in death (13.6 vs. 17.2, P 0.43), re-infarction (5.3 vs. 8.2, P 0.35), or disabling stroke (0.8 vs. 3.0, P 0.18). Recurrent ischaemia was less common in pPCI-treated patients (0.8 vs. 9.7, P< 0.001). No differences were found in major bleeds. A pooled analysis with the two previous reperfusion trials performed in older patients showed an advantage of pPCI over fibrinolysis in reducing death, re-infarction, or stroke at 30 days (OR, 0.64; 95 CI 0.450.91). Conclusion Primary PCI seems to be the best reperfusion therapy for STEMI even for the oldest patients. Early contemporary fibrinolytic therapy may be a safe alternative to pPCI in the elderly when this is not available.Clinicaltrials.gov NCT00257309. © 2010 The Author. Source

Garcia D.,University of Montreal | Del A.lamo J.C.,University of California at San Diego | Tanne. D.,Aix - Marseille University | Yotti R.,Hospital General Universitario Gregorio Maran | And 7 more authors.
IEEE Transactions on Medical Imaging | Year: 2010

Doppler echocardiography remains the most extended clinical modality for the evaluation of left ventricular (LV) function. Current Doppler ultrasound methods, however, are limited to the representation of a single flow velocity component. We thus developed a novel technique to construct 2D time-resolved (2D+t) LV velocity fields from conventional transthoracic clinical acquisitions. Combining color-Doppler velocities with LV wall positions, the cross-beam blood velocities were calculated using the continuity equation under a planar flow assumption. To validate the algorithm, 2D Doppler flow mapping and laser particle image velocimetry (PIV) measurements were carried out in an atrio-ventricular duplicator. Phase-contrast magnetic resonance (MR) acquisitions were used to measure in vivo the error due to the 2D flow assumption and to potential scan-plane misalignment. Finally, the applicability of the Doppler technique was tested in the clinical setting. In vitro experiments demonstrated that the new method yields an accurate quantitative description of the main vortex that forms during the cardiac cycle (mean error <25% for vortex radius, position and circulation). MR image analysis evidenced that the error due to the planar flow assumption is close to 15% and does not preclude the characterization of major vortex properties neither in the normal nor in the dilated LV. These results are yet to be confirmed by a head-to-head clinical validation study. Clinical Doppler studies showed that the method is readily applicable and that a single large anterograde vortex develops in the healthy ventricle while supplementary retrograde swirling structures may appear in the diseased heart. The proposed echocardiographic method based on the continuity equation is fast, clinically-compliant and does not require complex training. This technique will potentially enable investigators to study of additional quantitative aspects of intraventricular flow dynamics in the clinical setting by high-throughput processing conventional color-Doppler images. © 2006 IEEE. Source

Nso A.P.,Servicio de Pediatra | Larru B.,Hospital General Universitario Gregorio Maran | Bellon J.M.,Hospital General Universitario Gregorio Maran | Mellado M.J.,Hospital Universitario Carlos | And 5 more authors.
Journal of Adolescent Health | Year: 2011

The use of atazanavir (ATV) in adolescents infected with human immunodeficiency virus was analyzed in this study. ATV morning plasma concentrations were determined during regular visits to the outpatient department. Results showed that bilirubin levels were higher among patients with higher ATV plasma concentrations (p = .018). Monitoring plasma levels of ATV could avoid toxicity in these patients. © 2011 Society for Adolescent Health and Medicine. Source

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