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Serena J.,Hospital Universitario Dr Josep Trueta | Segura T.,Complejo Hospitalario Universitario Of Albacete | Roquer J.,Hospital Universitari Del Mar | Garcia-Gil M.,Institute dInvestigacio en Atencio Primaria IDIAP Jordi Gol | Castillo J.,University of Santiago de Compostela
BMC Neurology | Year: 2015

About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers. Methods: The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events. Results: Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI <0.9 and significant ICA stenosis (>50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. Conclusions: Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either symptomatic or asymptomatic PAD. Neither asymptomatic PAD alone nor isolated ICA stenosis >50% were associated with an increased risk of recurrence in this particularly high-risk group of non-cardioembolic stroke. © Serena et al.; licensee BioMed Central.

Oliveras A.,Hospital Universitari Del Mar | Schmieder R.E.,University Hospital
Journal of Hypertension | Year: 2013

There is no doubt that patients with high blood pressure (BP) are at higher cardiovascular and death risk than those subjects whose BP levels are below the admitted normal threshold. However, most of the epidemiological surveys show that BP is uncontrolled in more than fifty percent of hypertensive subjects. There are several reasons that can justify this lack of hypertension control, some of them depending on the patient, such as therapeutic adherence, or some related to the doctor, due to therapeutic inertia or reluctance to increment the number and doses of antihypertensive drugs. Sometimes the efficacy or adverse effects related to the antihypertensive drugs underlie the uncontrolled hypertension. And, finally, there are some clinical conditions that are associated with difficult-to-control hypertension. Among them, comorbidities such as diabetes, obesity, obstructive sleep apnoea syndrome or chronic kidney disease, but also drug-related hypertension or resistant hypertension. In this article we review the epidemiology and the conditions which are related to poorly controlled hypertension and that can explain why hypertension may become difficult-to-treat. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Conde-Estevez D.,Hospital Universitari Del Mar | Conde-Estevez D.,Hospital del Mar Medical Research Institute IMIM
Clinical and Translational Oncology | Year: 2016

Targeted therapy drugs, mainly those within the signal transduction inhibitors, are used more chronically than cytotoxic drugs and are metabolised by cytochrome P450 isozymes so patients are at high risk of having drug–drug interactions (DDI). Not only this, as the majority of them are given orally, new drug–drug interactions concerning gastrointestinal absorption can occur (e.g., with proton pump inhibitors). DDI can lead to changed systemic exposure, resulting in variations in drug response of the co-administered. In addition, concomitant ingestion of dietary supplements could also alter systemic exposure of drugs, thus leading to adverse drug reactions or loss of efficacy. In this review, we give an overview of the current existing data of known or suspected DDI between targeted therapy and other medicines. A review of package inserts was performed to identify drug–drug interactions for all targeted antineoplastic agents. Tertiary databases such as Lexicomp®, Drugs, Martindale, Facts and Comparisons®, and AHFS Drug Information were also referenced. This study covered 40 targeted antineoplastic agents (28 signal transduction inhibitors, 9 monoclonal antibodies and 3 other drugs, 2 monoclonal antibody conjugates and 1 fusion protein). Most of targeted therapy drugs are major CYP3A4 substrates with P-gp playing an important role in disposition too. Thus, there is a very common thread here that these agents will likely be sensitive victims to strong CYP3A4/P-gp inhibitors and inducers. It is essential that health care providers monitor patients for potential DDI to avoid a loss in efficacy or risk of greater toxicity from targeted therapy. © 2016 Federación de Sociedades Españolas de Oncología (FESEO)

Oliveras A.,Hospital Universitari Del Mar | Armario P.,Hypertension and Vascular Risk Unit | Martell-Claros N.,Hypertension Unit | Ruilope L.M.,Hypertension Unit | De La Sierra A.,Hospital Mutua de Terrassa
Hypertension | Year: 2011

Microalbuminuria is a known marker of subclinical organ damage. Its prevalence is higher in patients with resistant hypertension than in subjects with blood pressure at goal. On the other hand, some patients with apparently well-controlled hypertension still have microalbuminuria. The current study aimed to determine the relationship between microalbuminuria and both office and 24-hour ambulatory blood pressure. A cohort of 356 patients (mean age 64±11 years; 40.2% females) with resistant hypertension (blood pressure 140 and/or 90 mm Hg despite treatment with 3 drugs, diuretic included) were selected from Spanish hypertension units. Patients with estimated glomerular filtration rate <30 mL/min/1.73 m were excluded. All patients underwent clinical and demographic evaluation, complete laboratory analyses, and good technical-quality 24-hour ambulatory blood pressure monitoring. Urinary albumin/creatinine ratio was averaged from 3 first-morning void urine samples. Microalbuminuria (urinary albumin/creatinine ratio 2.5 mg/mmol in males or 3.5 mg/mmol in females) was detected in 46.6%, and impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m) was detected in 26.8%. Bivariate analyses showed significant associations of microalbuminuria with older age, reduced estimated glomerular filtration rate, increased nighttime systolic blood pressure, and elevated daytime, nighttime, and 24-hour diastolic blood pressure. In a logistic regression analysis, after age and sex adjustment, elevated nighttime systolic blood pressure (multivariate odds ratio, 1.014 [95% CI, 1.001 to 1.026]; P=0.029) and reduced estimated glomerular filtration rate (multivariate odds ratio, 2.79 [95% CI, 1.57 to 4.96]; P=0.0005) were independently associated with the presence of microalbuminuria. We conclude that microalbuminuria is better associated with increased nighttime systolic blood pressure than with any other office and 24-hour ambulatory blood pressure monitoring parameters. © 2011 American Heart Association, Inc.

Sancho J.J.,Autonomous University of Barcelona | Sancho J.J.,Hospital Universitari Del Mar | Lennard T.W.J.,Northumbria University | Paunovic I.,University of Belgrade | And 2 more authors.
Langenbeck's Archives of Surgery | Year: 2014

Background: There remains still no clear answer as to whether or not prophylactic central compartment neck dissection (pCCND) is indicated for the treatment of patients with papillary thyroid cancer. Methods: The published studies, including single cohort, comparative studies and meta-analysis, were critically appraised. Aspects beyond postoperative complications and loco-regional recurrence rates in the analysis, as the impact of pre- and post-ablation thyroglobuline levels, multifocality, bilaterality and additional risk factors for recurrence, were also considered. Results: Thirty studies and five meta-analyses were assessed. The lack of randomized clinical trials on the subject and the heterogeneity of study populations are the main limiting factors to draw clear conclusions, and a comprehensive list of bias sources has been identified. Recent comparative studies and systematic reviews all associate the pCCND with higher proportions of temporary postoperative hypocalcemia but not with significantly higher permanent hypoparathyroidism, recurrent laryngeal nerve injury or permanent vocal cord paralysis. The risk of recurrence appears to be reduced after pCCND, and the number of patients needed to treat to avoid a recurrence is between 20 and 31. Conclusions: It is suggested that routine level 6 prophylactic dissections should be risk-stratified. Larger tumours (T3, T4), patients aged 45 years and older or 15 years and younger, male patients, patients with bilateral or multifocal tumours, and patients with known involved lateral lymph nodes could all be candidates for routine unilateral level 6 dissection. The operation should be limited to surgeons who have the available expertise and experience © 2013 Springer-Verlag.

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