Hospital General Universitario Rafael Mendez

Lorca, Spain

Hospital General Universitario Rafael Mendez

Lorca, Spain
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Mezquita-Raya P.,Complejo Hospitalario Torrecardenas | Reyes-Garcia R.,Servicio de Endocrinologia | Reyes-Garcia R.,Hospital General Universitario Rafael Mendez | Moreno-Perez O.,University Miguel Hernández | And 3 more authors.
Diabetes Therapy | Year: 2015

Introduction: A limitation with randomized controlled trials is that, while they provide unbiased evidence of the efficacy of interventions, they do so under unreal conditions and in a very limited and highly selected patient population. Our aim was to provide data about the effectiveness of liraglutide treatment in a real-world and clinical practice setting. Methods: In a retrospective and observational study, data from 753 patients with type 2 diabetes were recorded through an online tool (eDiabetes-Monitor). Results: Mean baseline glycated hemoglobin (HbA1c) was 8.4 ± 1.4% and mean body mass index (BMI) was 38.6 ± 5.4 kg/m2. After 3–6 months of treatment with liraglutide, we observed a change in HbA1c of −1.1 ± 1.2%, −4.6 ± 5.3 kg in weight and −1.7 ± 2.0 kg/m2 in BMI (p < 0.001 for all). Compared to baseline, there was a significant reduction in systolic blood pressure (−5.9 mmHg, p < 0.001), diastolic blood pressure (−3.2 mmHg, p < 0.001), LDL cholesterol (−0.189 mmol/l, p < 0.001) and triglycerides (−0.09 mmol/l, p = 0.021). In patients switched from DPP-4 inhibitors, liraglutide induced a decrease of −1.0% in HbA1c (p < 0.001) and a reduction in weight (−4.5 kg, p < 0.001). In patients treated with liraglutide as an add-on therapy to insulin a decrease of −1.08% in HbA1c (p < 0.001) and a weight reduction of −4.15 kg (p < 0.001) were observed. Conclusion: Our study confirms the effectiveness of liraglutide in a real-life and clinical practice setting. Funding: Spanish Society of Endocrinology and Nutrition. © 2015, The Author(s).


PubMed | Hospital General Universitario Rafael Mendez, Hospital Universitario San Cecilio, Complejo Asistencial Universitario Of Leon, Hospital Of Sant Pau I Santa Tecla and 5 more.
Type: Journal Article | Journal: Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion | Year: 2015

To update previous recommendations developed by the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition for the evaluation and treatment of osteoporosis associated to different endocrine and nutritional diseases.Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition.Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each condition: AND osteoporosis, fractures, bone mineral density, and treatment. Papers in English with publication date between 18 October 2011 and 30 October 2014 were included. The recommendations were discussed and approved by all members of the Working Group.This update summarizes the new data regarding evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions.


PubMed | Hospital General Universitario Rafael Mendez, Hospital Universitario San Cecilio, Hospital Of La Santa Creu I Sant Pau, Hospital Clinico San Carlos and 6 more.
Type: Consensus Development Conference | Journal: Enfermedades infecciosas y microbiologia clinica | Year: 2014

To provide practical recommendations for the evaluation and treatment of metabolic bone disease in human immunodeficiency virus (HIV) patients.Members of scientific societies related to bone metabolism and HIV: Grupo de Estudio de Sida (GeSIDA), Sociedad Espaola de Endocrinologa y Nutricin (SEEN), Sociedad Espaola de Investigacin sea y del Metabolismo Mineral (SEIOMM), and Sociedad Espaola de Fractura Osteoportica (SEFRAOS).A systematic search was carried out in PubMed, and papers in English and Spanish with a publication date before 28 May 2013 were included. Recommendations were formulated according to GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) setting both their strength and the quality of supporting evidence. Working groups were established for each major part, and the final resulting document was later discussed in a face-to-face meeting. All the authors reviewed the final written document and agreed with its content.The document provides evidence-based practical recommendations on the detection and treatment of bone disease in HIV-infected patients.


Llamoza-Torres C.J.,Hospital General Universitario Rafael Mendez | Fuentes-Pardo M.,Family and Community Medicine | Alvarez-Higueras F.J.,Hospital Clinico Universitario Virgen Of La Arrixaca | Alberca-De-Las-Parras F.,Hospital Clinico Universitario Virgen Of La Arrixaca | And 3 more authors.
Revista Espanola de Enfermedades Digestivas | Year: 2016

Objective: To determine the accuracy of the acoustic radiation force impulse (ARFI) technique for the diagnosis of chronic pancreatitis. Materials and methods: We present an observational, single-center study that included patients with suspected chronic pancreatitis in the period between October 2012 and September 2015 who underwent endoscopic ultrasound (EUS) and were classified according to the standard and Rosemont criteria. The same group of patients was assessed by the ARfitechnology using ACUSON S2000™ equipment with Virtual Touch™ Quantification software for the assessment of pancreatic stiffness by obtaining the shear wave velocity (SWV) in the head, body and tail of the pancreas. Data were analyzed using ANOVA and nonparametric correlation methods. Diagnostic accuracy was obtained by analyzing receiver operating characteristic (ROC) curve. Results: A total of thirty-three patients were studied (45.5% women); mean age was 58.3 ± 11.8 years. Seventeen with a diagnosis of chronic pancreatitis and sixteen classified as normal according to standard criteria. A significant difference was detected between the means of SWV in pancreatic body of patients without (SWV: 1.27 m/s) and with chronic pancreatitis (SWV 1.57 m/s), p = 0.037. The area under the ROC curve was 71.3% (95% CI 0.532-0.895) and the accuracy of ARfifor diagnosing chronic pancreatitis was 69.7% for a SWV of 1.4 m/s in the pancreatic body. The SWV means in head (r = 0.421, p < 0.05) and body (r = 0.455, p < 0.05) of the pancreas showed a significant correlation with the number of EUS criteria for chronic pancreatitis. Conclusion: Quantification of pancreatic stiffness with ARfielastography technique has proven to be useful for the non-invasive diagnosis of chronic pancreatitis. © 2016. SEPD y © ARÁN EDICIONES, S.L.


Garcia-Martin A.,Hospital Universitario San Cecilio | Garcia-Martin A.,Hospital Comarcal Del Noroeste | Reyes-Garcia R.,Hospital Universitario San Cecilio | Reyes-Garcia R.,Hospital General Universitario Rafael Mendez | And 2 more authors.
Revista Clinica Espanola | Year: 2013

A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850 mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5 mg and atorvastatin 40 mg. Her weight was 92 kg and height 162 cm (BMI, 35.1 kg/m2). The last analysis showed fasting glucose 168 mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated? © 2012 Elsevier España, S.L.


Fonolla-Joya J.,Hospital General Universitario Rafael Mendez | Reyes-Garcia R.,Hospital General Universitario Rafael Mendez | Reyes-Garcia R.,Hospital Universitario San Cecilio | Garcia-Martin A.,Hospital Comarcal del Noroeste | And 3 more authors.
Journal of the American College of Nutrition | Year: 2016

Objective: Nutritional strategies can be effective for the prevention of menopause-related diseases, such as osteoporosis and cardiovascular disease. Our aim was to evaluate the effects of a dairy product enriched in polyunsaturated fatty acids, calcium, oleic acid, and vitamins on cardiovascular markers and bone metabolism in postmenopausal women with moderate cardiovascular risk. Methods: One hundred seventeen healthy postmenopausal women (aged 45 ± 7.7 years) were allocated to 2 groups: the intervention group (IG; n = 63), who consumed 0.5 L/day of a low-lactose skimmed milk enriched with 40 mg/100 mL of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), 0.54 g/100 mL oleic acid, and vitamins, and the control group (CG; n = 54), who consumed 0.5 L/day of semiskimmed milk 0.5 L/day enriched with vitamins A and D. Results: After 12 months, in the IG there was an improvement in lipid profile: a −5.78% decrease in total cholesterol (p = 0.010), −9.79% (p = 0.004) in low-density lipoprotein (LDL) cholesterol, −9.56% (p < 0.001) in total cholesterol (TC)/high-density lipoprotein (HDL) ratio, and −3.38% in LDL/HDL ratio (p < 0.001). No changes were observed in the CG. In the IG we observed a decrease of −28.20% in high-sensitivity C-reactive protein (hs-CRP; p = 0.012). There was no effect on bone turnover markers or serum osteoprotegerin (OPG) in either of the study groups. In the IG, receptor activator of nuclear factor κB ligand (RANKL) was reduced −17.64% (p = 0.003), with no effect in the CG. Conclusion: In postmenopausal women with moderate cardiovascular risk, dietary supplementation with a dairy drink enriched with fatty acids (EPA+DHA), oleic acid, minerals, and vitamins induces a positive effect on cardiovascular risk and parameters of bone metabolism. Its regular consumption may be a useful nutritional support for postmenopausal women. © 2016, © American College of Nutrition Published by Taylor & Francis Group, LLC.


PubMed | Hospital General Universitario Rafael Mendez, Hospital Universitario San Cecilio, Hospital Comarcal del Noroeste and CSIC - Experimental Station of El Zaidín
Type: Journal Article | Journal: Journal of the American College of Nutrition | Year: 2016

Nutritional strategies can be effective for the prevention of menopause-related diseases, such as osteoporosis and cardiovascular disease. Our aim was to evaluate the effects of a dairy product enriched in polyunsaturated fatty acids, calcium, oleic acid, and vitamins on cardiovascular markers and bone metabolism in postmenopausal women with moderate cardiovascular risk.One hundred seventeen healthy postmenopausal women (aged 45 7.7years) were allocated to 2 groups: the intervention group (IG; n = 63), who consumed 0.5 L/day of a low-lactose skimmed milk enriched with 40mg/100mL of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), 0.54g/100mL oleic acid, and vitamins, and the control group (CG; n = 54), who consumed 0.5 L/day of semiskimmed milk 0.5 L/day enriched with vitamins A and D.After 12 months, in the IG there was an improvement in lipid profile: a -5.78% decrease in total cholesterol (p = 0.010), -9.79% (p = 0.004) in low-density lipoprotein (LDL) cholesterol, -9.56% (p < 0.001) in total cholesterol (TC)/high-density lipoprotein (HDL) ratio, and -3.38% in LDL/HDL ratio (p < 0.001). No changes were observed in the CG. In the IG we observed a decrease of -28.20% in high-sensitivity C-reactive protein (hs-CRP; p = 0.012). There was no effect on bone turnover markers or serum osteoprotegerin (OPG) in either of the study groups. In the IG, receptor activator of nuclear factor B ligand (RANKL) was reduced -17.64% (p = 0.003), with no effect in the CG.In postmenopausal women with moderate cardiovascular risk, dietary supplementation with a dairy drink enriched with fatty acids (EPA+DHA), oleic acid, minerals, and vitamins induces a positive effect on cardiovascular risk and parameters of bone metabolism. Its regular consumption may be a useful nutritional support for postmenopausal women.


Martinez Diaz-Guerra G.,Hospital Doce Of Octubre | Jodar Gimeno E.,Hospital Universitario Quiron Madrid | Reyes Garcia R.,Hospital General Universitario Rafael Mendez | Gomez Saez J.M.,Hospital Universitario Of Bellvitge | Munoz-Torres M.,Hospital Universitario San Cecilio
Endocrinologia y Nutricion | Year: 2013

Objective: To provide practical recommendations for evaluation and follow-up of patients with normocalcemic primary hyperparathyroidism. Participants: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. Methods: A systematic search was made in MEDLINE (PubMed), using the terms normocalcemic primary hyperparathyroidism and primary hyperparathyroidism, for articles in English published before 22 November 2012. Literature was reviewed by 2 members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, and after development of recommendations, the manuscript was reviewed by all other members of the Group, and their suggestions were incorporated. Conclusions: The document provides practical recommendations for evaluation and follow-up of patients with normocalcemic primary hyperparathyroidism. There is however little evidence available about different aspects of this disease, mainly progression rate and clinical impact. More data are therefore needed before definite recommendations may be made. © 2012 SEEN.


Reyes Garcia R.,Hospital General Universitario Rafael Mendez | Mezquita Raya P.,Complejo Hospitalario Torrecardenas
Revista Clinica Espanola | Year: 2014

A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m2. She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA 1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated? © 2013 Elsevier España, S.L.


PubMed | Hospital General Universitario Rafael Mendez and España University
Type: Journal Article | Journal: Medicina intensiva | Year: 2015

The integration of the ventricular function is essential when making decisions over a patient subjected to cardiac electrostimulation in order to understand the structure followed in the new cardiac stimulation and resynchronising therapy guides. To support the importance of ventricular function in cardiac electrostimulation it is important to know: (i)the deleterious effect of stimulation on the right ventricle apex; (ii)the effect over the left ventricular function produced by complete blockage of the left branch, and (iii)left ventricular disfunction as arrythmogenic substrate. When it comes to decide what type of cardiac electrostimualtion to apply we will know: the percentage of ventricular stimulation needed and its ventricular function. A normal ventricular function will enable electrostimulation from the right ventricle apex or alternative site. On the contrary, if this value is lower than 50% the most recommended electrostimulation is cardiac resynchronisation (CRT-P), which will be accompanied by defibrillation (CRT-D) if FEVI is lower than 35%.

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