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Lanas A.,University of Zaragoza | Tornero J.,Hospital General Universitario Of Guadalajara | Zamorano J.L.,Servicio de Cardiologia
Annals of the Rheumatic Diseases

Background: Medical management of adults with osteoarthritis (OA) who require non-steroidal antiinfl ammatory drugs (NSAIDs) must be decided after assessing prevalent gastrointestinal (GI) and cardiovascular (CV) risks in the individual patient. Objective: To evaluate the GI and CV risk profile of patients with OA who require NSAIDs. Methods: A transversal, multicentre and observational study was conducted in consecutive patients with OA who were considered candidates for NSAID treatment and were visited by 374 unselected rheumatologists throughout the National Health System. Patients were classified into three risk groups (low, moderate and high) for their GI and CV characteristics. These were defined by considering the presence of a number of well-established GI risk factors or by application of the Systematic Coronary Risk Evaluation model for assessing the overall risk for CV disease, respectively. Results: Of 3293 consecutive patients, most (86.6%) were at increased GI risk and a considerable number, 22.3%, were at high GI risk. The CV risk was high in 44.2% of patients, moderate in 28.5% and low in 27.3%. Overall, 15.5% of patients presented a very high-risk profile, having high GI and CV risks. The type of NSAID prescription was similar regardless of the associated GI and CV risk profile. Conclusion: Most patients with OA requiring NSAIDs for pain control showed a high prevalence of GI and CV risk factors. Over half of the patients were at either high GI or CV risk, or both, such that the prescription of OA treatments should be very carefully considered. Source

Resano Barrio P.,Hospital General Universitario Of Guadalajara | Sanchez Hernandez I.M.,Servicio de Neumologia
Revista de Patologia Respiratoria

Lung cancer continues to be the first cause of death by cancer in developed countries. Because many patients with nonsmall cell lung cancer (NSCLC) are elderly or have multiple comorbid conditions, many are unfit to undergo definitive surgical resection. Stereotactic body radiation therapy (SBRT) is increasingly being used treat patients with medically inoperable stage I. Knowledge of molecular pathogenesis of NSCLC has increased remarkably and changed the principles of treatment during the past decade. This review will provide an overview of current therapies in NSCLC. Source

Rodriguez-Gonzalez N.,Hospital General Universitario Of Guadalajara | Perez-Rico C.,University of Alcala | Lopez-Para Gimenez R.,Hospital Universitario Principe Of Asturias | Arevalo-Serrano J.,Hospital Universitario Principe Of Asturias | And 4 more authors.
Archivos de la Sociedad Espanola de Oftalmologia

Objective: To evaluate the orbital structures and to establish correlations with disease activity and severity in patients with Graves' hyperthyroidism and orbitopathy (GO) using short-tau inversion-recovery (STIR) sequence magnetic resonance imaging (MRI). Methods: Observational, cross-sectional, case-control study. Twenty-eight patients with euthyroid status after treatment and GO (GO group) and 15 control subjects (control group) were included. Patients underwent a complete ophthalmologic examination and were then assessed according to the EUGOGO (European Group on Graves' Orbitopathy) recommendations. Muscle cross-sectional areas, orbital tissue volumes and the signal intensity ratio (SIR) from the most inflamed extraocular muscle were calculated using a STIR-T2 weighted sequence MRI. Correlations between clinical and MRI measurements were analyzed. Results: Enlargements in the cross-sectional areas and volumes were significant for most EOMs (P <.001), but not for the lateral rectus muscle cross-sectional area. A significant difference in SIR values between patients with GO and control subjects (P <.001) was found. No significant correlations were found between muscle cross-sectional areas, orbital tissue volumes, SIR values and the clinical activity parameters. Conclusions: Given the small sample size of our study, with the obvious need for larger clinical trials, we were unable to demonstrate that the STIR sequences in MRI are a sensitive tool in assessing patients with longstanding GO in order to detect inflammatory changes and activity follow-up, possibly because it is in inactive phase. Meanwhile, it is still necessary to continue performing a thorough clinical evaluation in the therapeutic management of GO. © 2010 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved. Source

Capel M.,Astrazeneca | Tornero J.,Hospital General Universitario Of Guadalajara | Zamorano J.L.,Servicio de Cardiologia | Oyaguez I.,Pharmacoeconomics and Outcomes Research Iberia | And 3 more authors.
Reumatologia Clinica

Objective: To assess, from the perspective of the National Healthcare System, the efficiency of a fixed-dose combination of naproxen and esomeprazole (naproxen/esomeprazole) in the treatment of osteoarthritis (OA) compared to other NSAID, alone or in combination with a proton pump inhibitor (PPI). Methods: A Markov model was used; it included different health states defined by gastrointestinal (GI) events: dyspepsia, symptomatic or complicated ulcer; or cardiovascular (CV) events: myocardial infarction, stroke or heart failure. The model is similar to the one used by NICE in its NSAID evaluation of OA published in 2008. The total costs (€, 2012), including drug and event-related costs, and the health outcomes expressed in quality-adjusted life years (QALY) were estimated in patients with increased GI risk, aged 65 or over, for a 1-year time horizon and a 6-month treatment with celecoxib (200. mg/day), celecoxib. +. PPI, diclofenac (150. mg/day). +. PPI, etoricoxib (60. mg/day), etoricoxib. +. PPI, ibuprofen (1,800. mg/day). +. PPI, naproxen (1,000. mg/day). +. PPI or naproxen/esomeprazole (naproxen 1,000. mg/esomeprazole 40. mg/day). The selected PPI was omeprazole (20. mg/day). Results: Naproxen/esomeprazole was a dominant strategy (more effective and less costly) compared to celecoxib, etoricoxib and diclofenac. +. PPI. Celecoxib. +. PPI and etoricoxib. +. PPI were more effective. Considering a cost-effectiveness threshold of €30,000 per additional QALY, naproxen/esomeprazole was cost-effective compared to ibuprofen. +. PPI and naproxen. +. PPI with incremental cost-effectiveness ratios (ICER) of €15,154 and €5,202 per additional QALY, respectively. Conclusions: A fixed-dose combination of naproxen and esomeprazole is a cost-effective, and even dominant, alternative compared to other options in OA patients with increased GI risk. © 2013 Elsevier España, S.L. Source

Aims: Try to establish a relationship between the presence or absence of lymphadenopathy in tumors of the larynx and the location of the tumor and discuss the treatment required in each case. Methods: Data collection sheets were designed for the 224 laryngeal cancer cases diagnosed in the province of Guadalajara between 1975 and 1998, among those data we included the presence or absence of lymph nodes at the time of diagnosis, as well as its location and treatment applied in each patient. Results: About in a half the cases studied had lymphadenopathy, being about in a half of the cases unilateral and about in a half of the cases bilaterals. The lymph nodes appeared more frequently in the supraglottic and hypopharyngeal tumors and less frequently in the glottic tumors. More extensive surgical interventions corresponded to supraglottic tumors and those affecting multiple levels of the larynx. Lymph node dissection was required in the 87% of supraglottic tumors and in 38.6% of the glottic tumors. Conclusions: The bigger size of the tumor correlated with more cases with lymphadenopathies and a more extensive treatment had to be applied. © 2012. Source

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