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Castellino G.,Hospital Luis Lagomaggiore | Maggi S.C.,Hospital Italiano Of Buenos Aires | Piquioni P.,Hospital Of San Pedro | Ponce De Leon M.,Sanatorio Dupuytren | And 4 more authors.
Neurologia Argentina | Year: 2012

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid,often frightening dreams associated with simple or complex motor behavior during REM sleep. Patients appear to "act out their dreams", in which the exhibited behaviors mirror the content of the dreams, and the dream content often involves a chasing or attacking theme. The polysomnographic features of RBD include increased electromyographic tone ± dream enactment behavior during REM sleep. In this review, the terminology, clinical and polysomnographic features, epidemiologic features, diagnostic criteria, differential diagnosis, and management strategies are discussed. Recent data on the suspected pathophysiologic mechanisms of RBD are also reviewed. Several issues relating to evolving concepts, controversies, and future directions are then reviewed, with an emphasis on idiopathic RBD representing an early feature of a neurodegenerative disease and particularly an evolving synucleinopathy. © 2012 Sociedad Neurológica Argentina. Published by Elsevier España, S.L. All rights reserve.


Lopez-Cortes L.E.,Hospital Universitario Virgen Macarena | Del Toro M.D.,Hospital Universitario Virgen Macarena | Del Toro M.D.,Institute Salud Carlos III | Galvez-Acebal J.,Hospital Universitario Virgen Macarena | And 30 more authors.
Clinical Infectious Diseases | Year: 2013

Background. Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Several aspects of clinical management have been shown to have significant impact on prognosis. The objective of the study was to identify evidence-based quality-of-care indicators (QCIs) for the management of SAB, and to evaluate the impact of a QCI-based bundle on the management and prognosis of SAB.Methods. A systematic review of the literature to identify QCIs in the management of SAB was performed. Then, the impact of a bundle including selected QCIs was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The main and secondary outcome variables were adherence to QCIs and mortality. Specific structured individualized written recommendations on 6 selected evidence-based QCIs for the management of SAB were provided.Results. A total of 287 and 221 patients were included in the preintervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to follow-up blood cultures (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.78-4.49), early source control (OR, 4.56; 95% CI, 2.12-9.79), early intravenous cloxacillin for methicillin-susceptible isolates (OR, 1.79; 95% CI, 1.15-2.78), and appropriate duration of therapy (OR, 2.13; 95% CI, 1.24-3.64). The intervention was independently associated with a decrease in 14-day and 30-day mortality (OR, 0.47; 95% CI,. 26-.85 and OR, 0.56; 95% CI,. 34-.93, respectively).Conclusions. A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality. © 2013 The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.


PubMed | Hospital Universitario La Paz, Hospital Marina Baixa, Hospital Universitario Miguel Servert, Hospital Reina Sofia Of Navarra and 10 more.
Type: Journal Article | Journal: Journal of the International AIDS Society | Year: 2014

Switching therapy studies are usually designed as second-line antiretroviral treatment (ART) in patients without previous virologic failures. Combined ART (cART) with DRV/r and ETR has a good pharmacokinetic profile, high genetic barrier and has been proved as rescue therapy. The aim of our study was to analyze efficacy and safety of therapy with DRV/r plus ETR in treatment experienced HIV-patients with previous therapeutic failures that need to switch ART. We present results at first 24 weeks.Multicentre retrospective observational study.adult HIV-patients on ART with HIV-VL <1000 cop/mL who started their ART with DRV/r (600/100 bid or 800/100 qd)+ETR by adverse events, non-adherence, tolerability or prevention of future complications. Patients with acute AIDS events, HBV, pregnancy, drug addiction or previous selected mutations to DRV or ETR were excluded.Ninety-nine patients were included, mean age: 47 years (r: 22-79); 70% men, 40.4% previous AIDS event and 39.3% HCV. Ninety-one patients had received 3 cART regimens and 455, 75 patients had HIV-VL <50 cop/mL and 24 low-level viremia (LLV): 297.5261.4 cop/mL, CD4+ 568279 cells/L. ART before switching: NRTI+PI/r (33%), NNRTI (17%), PI/r+NNRTI (23%), PI/r+INI (13%), other (14%). Main reason to switching was: toxicity/intolerance 50 patients (renal 32%, gastrointestinal: 14%, hyperlipidaemia 10%; osteopenia/osteoporosis: 6%); improving adherence 26 patients; prevention of complications 19 patients. Nine subjects withdrew ART during follow-up because: intolerance or new toxicity three; non-adherence two; simplification to DRV/r monotherapy two; persistence of previous toxicity one; virologic failure one. At week 24, among patients who continued with DRV/r+ETR (n=90): 81 (89%) had VL<50 cop/mL, in those with with HIV-VL<50 at baseline (67/90), 94% persisted with <50 cop., and in those with LLV (24/90), 61% (n=14) achieved a VL<50 cop. We didnt observe any significant difference in lab parameters between baseline and week 24. Estimated glomerular filtrate rate increased from 83.424.7 to 88.556.8 mL/min, p=NS. Regarding reason to switching, it improved in 42 cases, no changes: 20 cases; worsened: 4 cases, and non-applicable or unknown: 24 cases.Switching to dual therapy with DRV/r+ETR is an effective strategy in selected heavily experienced ART patients, even in those with LLV (<1000 cop/mL). This cART is safe and well tolerated, can reduce number of pills and improve adherence.


PubMed | Hospital General Of Valencia, Hospital Lucus Augusti, Servicio de Oncologia Medica, Hospital General Universitario Santa Lucia and 16 more.
Type: Journal Article | Journal: PloS one | Year: 2015

Familial history of melanoma is a well-known risk factor for the disease, and 7% melanoma patients were reported to have a family history of melanoma. Data relating to the frequency and clinical and pathological characteristics of both familial and non-familial melanoma in Spain have been published, but these only include patients from specific areas of Spain and do not represent the data for the whole of Spain.An observational study conducted by the Spanish Group of Melanoma (GEM) analyzed the family history of patients diagnosed with melanoma between 2011 and 2013 in the dermatology and oncology departments.In all, 1047 patients were analyzed, and 69 (6.6%) fulfilled criteria for classical familial melanoma (two or more first-degree relatives diagnosed with melanoma). Taking into account other risk factors for familial melanoma, such as multiple melanoma, pancreatic cancer in the family or second-degree relatives with melanoma, the number of patients fulfilling the criteria increased to 165 (15.8%). Using a univariate analysis, we determined that a Breslow index of less than 1 mm, negative mitosis, multiple melanoma, and a history of sunburns in childhood were more frequent in familial melanoma patients, but a multivariate analysis revealed no differences in any pathological or clinical factor between the two groups.Similar to that observed in other countries, familial melanoma accounts for 6.6% of melanoma diagnoses in Spain. Although no differences in the multivariate analysis were found, some better prognosis factors, such as Breslow index, seem more frequent in familial melanoma, which reflect a better early detection marker and/or a different biological behavior.


Castro B.,Histocell | Palomares T.,University of the Basque Country | Azcoitia I.,Histocell | Bastida F.,ArtinVet | And 3 more authors.
Histology and Histopathology | Year: 2015

We describe a novel wound dressing (HR006) with two components: a lyophilized matrix of the galactomannan from locust bean gum (LBG) and an antioxidant hydration solution (AHsol) containing curcumin and N-acetyl-L-cysteine (NAC). Physicostructural analyses of the LBG matrix revealed homogeneous interconnected pores with high absorbing capacity showing excellent properties for moist wound care (MWC). In an in vitro oxidative stress fibroblast injury model, the AHsol showed relevant protective effects reducing intracellular reactive oxygen species (ROS) production, rescuing cell viability, and regulating expression of inflammation-related genes (COX-2, TNF-α, IL-1α, IL-1β). The new dressing showed good biocompatibility profile as demonstrated by cytotoxicity, hemocompatibility, and skin irritation tests. Moreover, in an in vivo skin wound model in pigs, this dressing enhanced the production of healthy and organized granulation tissue and re-epithelization. In summary, HR006 exhibits significant antioxidant activity, good biocompatibility, and excellent repair capabilities improving tissue remodeling and the healing of wounds. © 2015, Histology and Histopathology. All rights reserved.


Lezcano E.J.,Hospital Of San Pedro | Inigo P.,Hospital Clinico Universitario Lozano Blesa | Larraga A.M.,Hospital Clinico Universitario Lozano Blesa | Barranquero C.,University of Zaragoza | And 4 more authors.
Diabetology and Metabolic Syndrome | Year: 2014

Background: The obese Zücker diabetic fatty male rat (ZDF:Gmi™-fa) is an animal model of type II diabetes associated with obesity and related metabolic disturbances like dyslipidaemia and diabetic nephropathy. In addition, diabetic dyslipidaemia has been linked to vascular and glomerular damage too. Dietary fat restriction is a current strategy to tackle obesity and, telmisartan, as a renoprotective agent, may mediate cholesterol efflux by activating PPARγ. To test the hypothesis that both therapeutical alternatives may influence dyslipidaemia and nephropathy in the ZDF rat, we studied their effect on development of diabetes. Methods. Male Zücker Diabetic Fatty (ZDF) rats received a low-calorie diet, vehicle or telmisartan for 9 weeks. Blood samples were obtained for analyses of lipids and lipoproteins, LDL-oxidisability, HDL structural and functional properties. Urinalysis was carried out to estimate albumin loss. At the end of the experimental period, rats were sacrificed, liver extracted and APOA1 mRNA quantified. Results: Results indicated that low-calorie diet and telmisartan can slower the onset of overt hyperglycaemia and renal damage assessed as albuminuria. Both interventions decreased the oxidative susceptibility of LDL and hepatic APOA1 mRNA expression but only dietary restriction lowered hyperlipidaemia. Conclusion: Either a dietary or pharmacologic interventions with telmisartan have important beneficial effects in terms of LDL oxidative susceptibility and progression of albuminuria in obesity related type II diabetes. © 2014 Lezcano et al.; licensee BioMed Central Ltd.


Oraa Tabernero N.,AECC Junta Provincial La Rioja | Sanchez Fuentes M.,Fundacion Rioja Salud | Ossola Lentati G.,Hospital Of San Pedro | Velez E.,Hospital Of San Pedro | And 2 more authors.
Psicooncologia | Year: 2013

The aim of this paper is to show the effective psychological treatments in prostate cancer performed to date. To understand these treatments is important to know the medical facilities carried out in order to treat or palliate the disease and its effects, both, reversible and irreversible ones, since the biopsychological state play an important role in the quality of life of individuals, as well as in their physical and psychological health. Even though prostate cancer is the most common in men in our country and is diagnosed at early stages in many cases, increasing the percentage of cure, there are only a few studies about psychological treatments to face with this tumor, both national and international ones. It is important to improve the research in this field, mainly in which is focused in evaluate psychological treatments effectiveness.

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