PubMed | Hospital Universitario San Cecilio, Hospital General Of Castello, Hospital Reina Sofia, Polytechnic University of Catalonia and 14 more.
Type: | Journal: HIV medicine | Year: 2016
Maraviroc (MVC) is a suitable drug for aviraemic subjects on antiretroviral treatment (ART) developing toxicity. Its prescription requires prior tropism testing. It is unknown if proviral DNA genotypic tropism testing is reliable for guiding MVC initiation in aviraemic subjects, so this study was carried out to address this issue.PROTEST was a phase 4, prospective, single-arm clinical trial carried out in 24 HIV care centres in Spain. MVC-nave HIV-1-infected patients with HIV-1 RNA < 50 copies/mL on stable ART during the previous 6 months who required an ART change because of toxicity and who had R5 HIV, as determined by proviral DNA genotypic tropism testing, initiated MVC with two nucleoside reverse transcriptase inhibitors (NRTIs) and were followed for 48 weeks. Virological failure was defined as two consecutive viral load measurements > 50 copies/mL.Tropism results were available for 141 of 175 (80.6%) subjects screened: 60% had R5 and 85% of these (n = 74) were finally included in the study. Previous ART included protease inhibitors (PIs) in 62% of subjects, nonnucleoside reverse transcriptase inhibitors (NNRTIs) in 36%, and integrase inhibitors (INIs) in 2%. Main reasons for treatment change were dyslipidaemia (42%), gastrointestinal symptoms (22%) and liver toxicity (15%). MVC was given alongside tenofovir (TDF)/emtricitabine (FTC) (54%) and abacavir (ABC)/lamivudine (3TC) (40%) in most patients. Eighty-four per cent of patients maintained a viral load < 50 copies/mL to week 48, whereas 16% discontinued treatment: two withdrew informed consent, one had an R5 to X4 shift between screening and baseline, one was lost to follow-up, one developed an adverse event (rash), two died from non-study-related causes, and five developed protocol-defined virological failure.Initiation of MVC plus two NRTIs in aviraemic subjects based on genotypic tropism testing of proviral HIV-1 DNA is associated with low rates of virological failure for up to 1 year.
PubMed | Hospital Rafael Mendez, Hematology Service, Hospital General Universitario Santa Lucia, Hospital Clinico Universitario Virgen Of La Arrixaca Hcuva and Pediatric oncology Service
Type: Journal Article | Journal: Oncoimmunology | Year: 2016
Missing self recognition makes cancer sensitive to natural killer cell (NKc) reactivity. However, this model disregards the NKc licensing effect, which highly increases NKc reactivity through interactions of inhibitory killer cell immunoglobulin-like receptors (iKIR) with their cognate HLA-I ligands. The influence of iKIR/HLA-ligand (HLA-C1/C2) licensing interactions on the susceptibility to and progression of plasma cell (PC) dyscrasias was evaluated in 164 Caucasian patients and 286 controls. Compared to controls, myeloma accumulates KIR2DL1
PubMed | Hospital Universitario La Paz, Hospital Virgen Of La Luz Of Cuenca, Hospital Universitario Miguel Servet, Hospital General Universitario Of Valencia and 24 more.
Type: Journal Article | Journal: British journal of cancer | Year: 2016
We sought to develop and externally validate a nomogram and web-based calculator to individually predict the development of serious complications in seemingly stable adult patients with solid tumours and episodes of febrile neutropenia (FN).The data from the FINITE study (n=1133) and University of Salamanca Hospital (USH) FN registry (n=296) were used to develop and validate this tool. The main eligibility criterion was the presence of apparent clinical stability, defined as events without acute organ dysfunction, abnormal vital signs, or major infections. Discriminatory ability was measured as the concordance index and stratification into risk groups.The rate of infection-related complications in the FINITE and USH series was 13.4% and 18.6%, respectively. The nomogram used the following covariates: Eastern Cooperative Group (ECOG) Performance Status 2, chronic obstructive pulmonary disease, chronic cardiovascular disease, mucositis of grade 2 (National Cancer Institute Common Toxicity Criteria), monocytes <200/mm(3), and stress-induced hyperglycaemia. The nomogram predictions appeared to be well calibrated in both data sets (Hosmer-Lemeshow test, P>0.1). The concordance index was 0.855 and 0.831 in each series. Risk group stratification revealed a significant distinction in the proportion of complications. With a 116-point cutoff, the nomogram yielded the following prognostic indices in the USH registry validation series: 66% sensitivity, 83% specificity, 3.88 positive likelihood ratio, 48% positive predictive value, and 91% negative predictive value.We have developed and externally validated a nomogram and web calculator to predict serious complications that can potentially impact decision-making in patients with seemingly stable FN.
Romero-Arenas S.,San Antonio de Murcia Catholic University |
Martinez-Pascual M.,Hospital General Universitario Santa Lucia |
Alcaraz P.E.,San Antonio de Murcia Catholic University
Aging and Disease | Year: 2013
Declines in maximal aerobic power and skeletal muscle force production with advancing age are examples of functional declines with aging, which can severely limit physical performance and independence, and are negatively correlated with all cause mortality. It is well known that both endurance exercise and resistance training can substantially improve physical fitness and health-related factors in older individuals. Circuit-based resistance training, where loads are lifted with minimal rest, may be a very effective strategy for increasing oxygen consumption, pulmonary ventilation, strength, and functional capacity while improving body composition. In addition, circuit training is a time-efficient exercise modality that can elicit demonstrable improvements in health and physical fitness. Hence, it seems reasonable to identify the most effective combination of intensity, volume, work to rest ratio, weekly frequency and exercise sequence to promote neuromuscular, cardiorespiratory and body composition adaptations in the elderly. Thus, the purpose of this review was to summarize and update knowledge about the effects of circuit weight training in older adults and elderly population, as a starting point for developing future interventions that maintain a higher quality of life in people throughout their lifetime.
PubMed | Hopital Saint Louis, Hospital Universitario La Paz, Hospital Clinico San Carlos, Hospital General Universitario Santa Lucia and 4 more.
Type: Journal Article | Journal: Heliyon | Year: 2017
In cancer patients with symptomatic venous thromboembolism (VTE) (deep-vein thrombosis (DVT) and/or pulmonary embolism (PE)), clinical factors that influence the benefit-risk balance of anticoagulation need to be identified so treatment intensity and duration can be optimally adjusted for the individual patient.Using clinical data for cancer patients with VTE obtained from the RIETE registry, we compared how rates of fatal PE and fatal bleeding during and after anticoagulation vary depending on patients clinical characteristics.Data were analysed from the 10,962 cancer patients with VTE (5,740 with PE with or without DVT; 5,222 with DVT alone) in RIETE registry as of March 2016. Fatal PE occurred in 2.18% of patients, while fatal bleedings occurred in 1.55%. During the 12 months from initial VTE, fatal PE was the most common cause of death, after disseminating cancer, and bleeding the fourth most common. In patients initially presenting with PE, fatal PE during anticoagulation was 4-fold more frequent than fatal bleeding (204 vs 51 deaths) and occurred mostly during the first month of treatment (196/223, 88%). In patients initially presenting with DVT, fatal PE was 3-fold lower than fatal bleeding during (25 vs 85 deaths) and after anticoagulation treatment (8 vs 37 deaths). During the 12-month follow-up, other characteristics of cancer patients with VTE were identified as more common in fatal cases of PE and/or bleeding than in surviving cases.Baseline clinical characteristics may determine anticoagulation outcomes in cancer patients with VTE and should be further investigated as possible factors for guiding changes in current practices of anticoagulation, such as adjusting anticoagulation intensity and duration in selected patients.
Villanueva E.F.,Hospital General Universitario Santa Lucia |
Bautista R.G.,Hospital General Universitario Santa Lucia |
Marchal A.C.,Hospital General Universitario Santa Lucia
Nutricion Hospitalaria | Year: 2015
Introduction: Hirschsprung’s disease (HD) or aganglionic megacolon is a congenital disorder characterized by the absence of ganglion intramural cells of the submucosal myenteric plexus (namely Auerbach and Meissner, respectively) in distal sections of the intestine. This is due to a failure in the migration of the precursors of these cells from the neural chalk during the embryonic development and also due to other abnormalities associated (18 % of cases), in some cases involving specific polymalformation syndromes. Objectives: The aim of the work is to present the clinical and nutritional evolution of a 14 months aged pediatric patient who was diagnosed with HD since was born associated with Mowat- Wilson syndrome (MWS). In addition, it is also targeted to evaluate the clinical results from this patient. Methods: Reviewing the medical history of the patient, the evolution of the anthropometric data (weight and height) as well as the analytical parameters for further studies were carried out. In addition, the upcoming issues associated with nutritional support and therapeutic strategies in the multidisciplinary context were evaluated. Results: A male, 14 months aged patient, son of not consanguineous healthy immigrants parents from Colombia went to the emergency department of our hospital suffering abdominal distension and vomiting with no spontaneous bowels. A detailed description of the composition of parenteral nutrition administered within the period of 28 days of hospital admission. Conclusion: As observed in this patient, the association of HD and MWS can lead to the need of prolonged parenteral nutrition and frequently present diverting stoma leading to a greater number of postoperative complications in this population. © 2015, Grupo Aula Medica S.A. All rights reserved.
Santos A.J.T.,Hospital General Universitario Santa Lucia
Medicina Clinica | Year: 2012
Venous thromboembolism is a frequent complication in cancer patients and affects their morbidity and mortality. The risk of this event differs according to the characteristics of the tumor, the patient's circumstances, and the treatments provided. Although the benefits of thromboprophylaxis in certain subgroups of patients with cancer have been demonstrated, currently generic prescription is not recommended unless other risk factors are present, or the patient has multiple myeloma and has been treated with thalidomide or lenalidomide. The insertion of a central venous catheter in these patients does not imply prescription of thromboprophylaxis, although the risk factors for catheter thrombosis are known. Finally, a risk scoring model for the prediction of venous thromboembolism has been defined in outpatients with cancer starting chemotherapy, which has been externally validated and supplemented with the addition of two biomarkers. © 2012 Elsevier España, S.L. All rights reserved.
Santos J.T.,Hospital General Universitario Santa Lucia
Angiologia | Year: 2014
The iliofemoral location of a deep vein thrombosis (DVT) is particularly serious, as it affects the single drainage stem of the lower limb. Treatment with anticoagulatants alone is often insufficient in preventing severe post-thrombotic syndrome, due to frequent incomplete thrombus resolution. While new thrombectomy techniques are capable of achieving patency of the iliofemoral venous system in a higher percentage of cases than previous techniques, they have not been compared with the current standard of treatment, which is the catheter-directed thrombolysis. This catheter-directed thrombolysis also can be combined with mechanical thrombolysis, increasing its effectiveness. A clinical trial is currently in the recruiting phase and it will assess the most efficient dose of alteplase in catheter-directed thrombolysis in patients with iliofemoral DVT, and the possibility of increasing its effectiveness with mechanical methods. © 2014 SEACV. Published by Elsevier España, S.L.U. All rights reserved.
PubMed | Hospital Reina Sofia and Hospital General Universitario Santa Lucia
Type: | Journal: International journal of surgery case reports | Year: 2016
Shoulder surgery is often performed with the patient in the so called beach-chair position with elevation of the upper part of the body. The anesthetic procedure can be general anesthesia and/or regional block, usually interscalenic brachial plexus block. We present a case of brachial plexus palsy with a possible mechanism of traction based on the electromyographic and clinical findings, although a possible contribution of nerve block cannot be excluded.We present a case of a 62 year-old female, that suffered from shoulder fracture-dislocation. Open reduction and internal fixation were performed in the so-called beach-chair position, under combined general-regional anesthesia. In the postoperative period complete motor brachial plexus palsy appeared, with neuropathic pain. Conservative treatment included analgesic drugs, neuromodulators, B-vitamin complex and physiotherapy. Spontaneous recovery appeared at 11 months. DISCUSION: in shoulder surgery, there may be complications related to both anesthetic technique and patient positioning/surgical maneuvers. Regional block often acts as a confusing factor when neurologic damage appears after surgery. Intraoperative maneuvers may cause eventual traction of the brachial plexus, and may be favored by the fixed position of the head using the accessory of the operating table in the beach-chair position.When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus.
PubMed | Hospital General Universitario Santa Lucia, University of Murcia and University of Navarra
Type: | Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society | Year: 2016
Regulatory T cells (Tregs) play a potential role in operational tolerance in liver transplant patients, and microRNAs (miRNAs) are known to be involved in immunological responses and tolerance. Thus, we analyzed the implication of different peripheral blood Treg subsets and miRNAs on liver transplantation tolerance in 24 tolerant (Tol) and 23 non-tolerant (non-Tol) liver transplant recipients by cellular, genetic and epigenetic approximation. Non-Tol patients had a lower demethylation rate of the FOXP3 Treg-specific demethylated region (TSDR) than Tol patients that correlated with the frequency of circulating Tregs. Tol patients presented a different signature of Treg subset markers compared with non-Tol patients with increased expression of HELIOS and FOXP3 and a higher proportion of LAPThese data suggest that activated effector-memory Tregs and a TSDR-demethylation state of Tregs may play a role in the complex system of regulation of liver transplantation tolerance. In addition, we describe a set of miRNAs differentially expressed in human liver transplant tolerant patients providing suggestive evidence that miRNAs are implied in the preservation of self-tolerance as mediated by Tregs. This article is protected by copyright. All rights reserved.