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Martn-Rabadn P.,Hospital General Universitario Gregorio Maran | Martnez-Ruiz R.,Hospital Universitario Puerta Of Hierro Majadahonda | Cuadros J.,Campus Universitario
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.


Garcia D.,University of Montréal | 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.


Cal-Gonzalez J.,Complutense University of Madrid | Herraiz J.L.,Complutense University of Madrid | Espana S.,Harvard University | Desco M.,Hospital General Universitario Gregorio Maran | And 2 more authors.
IEEE Nuclear Science Symposium Conference Record | Year: 2010

Positron range depends on the materials in which positron propagates and on positron emitter isotope. As positron range limits the spatial resolution of PET images, good quantitative estimates of it should be included in any realistic simulation of PET acquisitions. In this work we compare positron range estimates obtained with PeneloPET to previous available simulations and experimental data. PeneloPET was used to simulate the positron range of 18F, 11C, 13N, 15O, 68Ga and 82Rb in the following tissues: cortical bone, soft bone, skin, muscle, brain, water, adipose tissue and lung. The 3D and 1D annihilation Point Spread Functions (aPSF) were calculated for each isotope-material combination. We have studied with more detail the 3D aPSF (radial distributions) and the cumulative fraction of annihilation events. These aPSF distributions were also studied for non-uniform media. Results obtained were consistent with other results previously reported in the literature as well as with experimentally measured data. © 2010 IEEE.


Bueno H.,Hospital General Universitario Gregorio Maran | Betriu A.,Hospital Clnic | Heras M.,Hospital Clnic | Alonso J.J.,Hospital Of 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.


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.


Nso A.P.,Hospital Infantil la Paz | 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.


Rodriguez Ferrero M.,Hospital General Universitario Gregorio Maran | Rincon A.,University of Madrid | Bucalo L.,Hospital General Universitario Gregorio Maran | Rementeria A.,Hospital General Universitario Gregorio Maran | Anaya F.,Hospital General Universitario Gregorio Maran
Transplantation Proceedings | Year: 2010

Introduction Acute antibody-mediated rejection (AMR) leads to graft loss. The combination of plasmapheresis (PP), intravenous immunoglobulin (IVIG), and rituximab (RTX) has been reported to be effective therapy. Patients and methods Between October 2005 and September 2009, 8 (4.7%) kidney transplant recipients developed AMR, diagnosed by severe acute rejection and extensive C4d staining in peritubular capillaries. Results All patients were treated with two to six sessions of PP with IVIG added after the last PP. In two patients, RTX was prescribed after PP and IVIG. Baseline immunosuppression was based on steroids, mycophenolate mofetil or azathioprine, and tacrolimus or cyclosporine or everolimus. The presence of subsequent significant decrease in anti-HLA class I antibodies was demonstrated in a highly sensitized patient before and after transplantation with PP treatment. An increase was observed before the diagnosis of AMR. After a mean follow-up of 10 months (range = 123), patient and graft survivals were 100% and 50%, respectively. Three patients lost their transplants to AMR refractory to treatment and one patient, due to interstitial fibrosis and tubular atrophy at 23 months after AMR. Finally, four patients recovered renal function, showing a mean serum creatinine of 2.2 ± 0.45 mg/dL. Conclusions Early diagnosis and treatment with PP, IVIG, and RTX may resolve AMR. PP before and after transplantation in high-risk patients may result in anti-HLA class I and class II antibody removal from plasma and prevention of AMR. © 2010 Elsevier Inc.


Lledo-Garcia E.,Hospital General Universitario Gregorio Maran | Subira-Rios D.,Hospital General Universitario Gregorio Maran | Ogaya-Pinies G.,Hospital General Universitario Gregorio Maran | Tejedor-Jorge A.,Hospital General Universitario Gregorio Maran | And 2 more authors.
Journal of Urology | Year: 2011

Purpose: We designed an experimental model of renal ischemia-reperfusion to evaluate the preemptive effect of intravenous sildenafil according to the dose administered (0.7 vs 1.4 mg/kg) and the time of administration (30 minutes before ischemia or during ischemia). Materials and Methods: A total of 20 minipigs were divided into groups of 4 each, including group 1control, group 2sildenafil 0.7 mg/kg intravenously 30 minutes before vascular clamping, group 3sildenafil 0.7 mg/kg intravenously during warm ischemia, group 4sildenafil 1.4 mg/kg intravenously 30 minutes before vascular clamping and group 5sildenafil 1.4 mg/kg intravenously during warm ischemia. The ischemia-reperfusion model was applied using laparotomy and right kidney vascular clamping for 30 minutes, followed by unclamping and reperfusion for 45 minutes. Renal vascular flow and systemic mean arterial pressure were recorded for 45 minutes after unclamping. Mean values were compared using Student t test with significance considered at p <0.05. Results: Sildenafil led to a decrease in arterial pressure compared to that in controls, especially at the dose of 1.4 vs 0.7 mg/kg, including 113.77, 109.76, 106.12, 97.41 and 82.85 mm Hg in groups 1 to 5, respectively. Renal vascular flow was significantly higher in groups 2 and 3 than in groups 1, 4 and 5 (112.82 and 111.33 vs 88.25, 87.91 and 84.37 ml per minute, respectively, p = 0.000). Conclusions: The effect of intravenous sildenafil as a preemptive drug against the hemodynamic effects of renal ischemia-reperfusion is dose dependent. The 0.7 mg/kg dose significantly increased reperfusion renal vascular flow with a small decrease in arterial pressure compared to the 1.4 mg/kg dose. © 2011 American Urological Association Education and Research, Inc.


Gonzalez-Haba E.,Hospital General Universitario Gregorio Maran | Garcia M.I.,Hospital General Universitario Gregorio Maran | Cortejoso L.,Hospital General Universitario Gregorio Maran | Lopez-Lillo C.,Hospital General Universitario Gregorio Maran | And 8 more authors.
Pharmacogenomics | Year: 2010

Aim: To find out whether SNPs in the transporter gene ATP-binding casette B1 (ABCB1) were related to adverse effects in colorectal cancer patients treated with 5-fluorouracil (5-FU) or capecitabine. Materials & methods: Patients treated with a 5-FU-based therapy (n = 67) or a capecitabine-based therapy (n = 74) were recruited and genotyped for the ABCB1 SNPs rs1128503 (C1236T), rs2032592 (G2677T/A) and rs1045642 (C3435T). Clinical data and adverse reactions were recorded. ABCB1 genotypes of patients were statistically analyzed for association with the most frequent adverse reactions. Results: Statistical associations were observed, suggesting a lower risk of neutropenia (p = 0.013) and hand-foot syndrome (HFS; p = 0.027) for the carriers of T variation for rs1128503 in capecitabine-treated patients, carriers of T variation for rs1045642 treated with capecitabine had a lower risk of HFS (p = 0.033), while those treated with 5-FU had a higher risk of diarrhea (p = 0.035), and carriers of T variation for rs2032592 treated with capecitabine were at less risk of developing HFS (p = 0.033). Conclusion: This is the first time evidence has been found of differing pharmacogenetic markers for capecitabine and 5-FU treatments. Genotyping of SNPs in the ABCB1 gene prior to chemotherapy administration could help reduce adverse reactions in colorectal cancer patients. © 2010 Future Medicine Ltd.


Perez-David E.,Hospital General Universitario Gregorio Maran | Arenal A.,Hospital General Universitario Gregorio Maran | Rubio-Guivernau J.L.,Technical University of Madrid | Del Castillo R.,Hospital General Universitario Gregorio Maran | And 11 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives We performed noninvasive identification of post-infarction sustained monomorphic ventricular tachycardia (SMVT)related slow conduction channels (CC) by contrast-enhanced magnetic resonance imaging (ceMRI). Background Conduction channels identified by voltage mapping are the critical isthmuses of most SMVT. We hypothesized that CC are formed by heterogeneous tissue (HT) within the scar that can be detected by ceMRI. Methods We studied 18 consecutive VT patients (SMVT group) and 18 patients matched for age, sex, infarct location, and left ventricular ejection fraction (control group). We used ceMRI to quantify the infarct size and differentiate it into scar core and HT based on signal-intensity (SI) thresholds (>3 SD and 2 to 3 SD greater than remote normal myocardium, respectively). Consecutive left ventricle slices were analyzed to determine the presence of continuous corridors of HT (channels) in the scar. In the SMVT group, color-coded shells displaying ceMRI subendocardial SI were generated (3-dimensional SI mapping) and compared with endocardial voltage maps. Results No differences were observed between the 2 groups in myocardial, necrotic, or heterogeneous mass. The HT channels were more frequently observed in the SMVT group (88%) than in the control group (33%, p < 0.001). In the SMVT group, voltage mapping identified 26 CC in 17 of 18 patients. All CC corresponded, in location and orientation, to a similar channel detected by 3-dimensional SI mapping; 15 CC were related to 15 VT critical isthmuses. Conclusions SMVT substrate can be identified by ceMRI scar heterogeneity analysis. This information could help identify patients at risk of VT and facilitate VT ablation. © 2011 American College of Cardiology Foundation.

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