Hospital de Órbigo, Spain
Hospital de Órbigo, Spain

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Gisbert J.P.,Hospital Universitario Of La Princesa | Chaparro M.,Hospital Universitario Of La Princesa | Esteve M.,Hospital Universitari Mutua Of Terrassa
Alimentary Pharmacology and Therapeutics | Year: 2011

Aliment Pharmacol Ther 2011; 33: 619-633 Summary Background Viral hepatitis is a very common infection. Aim To review the prevention and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in inflammatory bowel disease (IBD). Methods Bibliographical searches were performed in MEDLINE up to September 2010. Results The prevalence of both HBV and HCV infection in IBD patients is now similar to that of the general population. All IBD patients should be screened for HBV markers at diagnosis. Liver dysfunction in IBD patients treated with immunosuppressants is more frequent and severe in HBV than in HCV carriers and is associated with combined immunosuppression. In patients receiving anti-TNF drugs, HBV reactivation is common unless anti-viral prophylaxis is administered. HBsAg-positive patients should receive anti-viral prophylaxis before starting immunosuppressants. As interferon might worsen underlying IBD, nucleoside/nucleotide analogues are preferred for anti-viral prophylaxis in patients with HBV (tenofovir/entecavir are preferred to lamivudine). IBD patients should be vaccinated against HBV at diagnosis. The response rate to HBV vaccination is low, mainly in those receiving anti-TNF therapy. The serological response to HBV vaccine should be confirmed, and patients with an inadequate response should receive a second full series of vaccine. Peginterferon (plusmn;ribavirin) for HCV infection is as effective and safe as in non-IBD patients. Conclusions The present manuscript poses a series of questions on the prevention and management of HBV/HCV infection in IBD, and attempts to answer them using scientific evidence in order to provide practical conclusions for the clinician. © 2011 Blackwell Publishing Ltd.


Blasi F.,University of Milan | Garau J.,Hospital Universitari Mutua Of Terrassa | Medina J.,Astrazeneca | Avila M.,Astrazeneca | And 2 more authors.
Respiratory Research | Year: 2013

Background: Data describing real-life management and treatment of community-acquired pneumonia (CAP) in Europe are limited. REACH (http://NCT01293435) was a retrospective, observational study collecting data on the management of EU patients hospitalized with CAP.The purpose of this study was to understand patient and disease characteristics in patients hospitalized with CAP and to review current clinical practices and outcomes.Methods: Patients were aged ≥18 years, hospitalized with CAP between March 2010 and February 2011, and requiring in-hospital treatment with intravenous antibiotics. An electronic Case Report Form was used to collect patient, disease and treatment variables, including type of CAP, medical history, treatment setting, antibiotics administered and clinical outcomes.Results: Patients (N = 2,039) were recruited from 128 centres in ten EU countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Turkey, UK). The majority of patients were aged ≥65 years (56.4%) and had CAP only (78.8%). Initial antibiotic treatment modification occurred in 28.9% of patients and was more likely in certain groups (patients with comorbidities; more severely ill patients; patients with healthcare-associated pneumonia, immunosuppression or recurrent episodes of CAP). Streamlining (de-escalation) of therapy occurred in 5.1% of patients. Mean length of hospital stay was 12.6 days and overall mortality was 7.2%.Conclusion: These data provide a current overview of clinical practice in patients with CAP in EU hospitals, revealing high rates of initial antibiotic treatment modification. The findings may precipitate reassessment of optimal management regimens for hospitalized CAP patients. © 2013 Blasi et al.; licensee BioMed Central Ltd.


Gould I.M.,Royal Infirmary | David M.Z.,University of Chicago | Esposito S.,The Second University of Naples | Garau J.,Hospital Universitari Mutua Of Terrassa | And 2 more authors.
International Journal of Antimicrobial Agents | Year: 2012

Meticillin-resistant Staphylococcus aureus (MRSA) remains one of the principal multiply resistant bacterial pathogens causing serious healthcare-associated and community-onset infections. This paper reviews recent studies that have elucidated the virulence strategies employed by MRSA, key clinical trials of agents used to treat serious MRSA infections, and accumulating data regarding the implications of antibacterial resistance in MRSA for clinical success during therapy. Recent pre-clinical data support a species-specific role for Panton-Valentine leukocidin in the development of acute severe S. aureus infections and have elucidated other virulence mechanisms, including novel modes of internalisation, varying post-invasion strategies (featuring both upregulation and downregulation of virulence factors) and phenotypic switching. Recent double-blind, randomised, phase III/IV clinical trials have demonstrated the efficacy of linezolid and telavancin in hospital-acquired pneumonia (HAP) and complicated skin and skin-structure infections (cSSSIs) caused by MRSA. Tigecycline was non-inferior to imipenem/cilastatin in non-ventilator-associated HAP but was inferior in ventilator-associated pneumonia and has shown a higher rate of death than comparators on meta-analysis. Ceftaroline was clinically and microbiologically non-inferior to vancomycin/aztreonam in the treatment of MRSA cSSSI. Key resistance issues include a rise in vancomycin minimum inhibitory concentrations in MRSA, reports of clonal isolates with linezolid resistance mediated by acquisition of the chloramphenicol/florfenicol resistance gene, and case reports of daptomycin resistance resulting in clinical failure. Novel antimicrobial targets must be identified with some regularity or we will face the risk of untreatable S. aureus infections. © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.


Garau J.,Hospital Universitari Mutua Of Terrassa | Ostermann H.,Ludwig Maximilians University of Munich | Medina J.,Astrazeneca | Avila M.,Astrazeneca | And 2 more authors.
Clinical Microbiology and Infection | Year: 2013

Complicated skin and soft tissue infections (cSSTI) are common and frequently require treatment in hospital. Comprehensive current data on management practices in patients hospitalized with cSSTI are limited. REACH was a retrospective, observational cohort study designed to provide data on current clinical management of moderate to severe cSSTI in European hospitals. Data were collected via an electronic case report form from 129 sites in ten European countries. The study population comprised patients ≥18 years, hospitalized between March 2010 and February 2011 with cSSTI who received intravenous antibiotic treatment. Presented here is an analysis of the disease characteristics, treatment patterns during hospitalization and clinical outcomes identified by the study. The total population included 1995 patients (mean age 60.6 years; 57.7% male). Initial antibiotic treatment modification was reported in 39.6% (n = 791) of patients; it was more common in patients with co-morbidities (42.6%), those requiring surgical intervention (43.4%), those with more severe infections such as bacteraemia (51.6%) or with fascia affected (49.0%), those admitted to the intensive care unit (56.2%) and those with lesions > 50 cm2 (44.3%). A switch to narrower-spectrum antibiotic treatment (streamlining) occurred in 5.6% of patients. Mean length of hospital stay was 18.5 days (±19.9; median 12.0) and the total mortality rate was 3.4%. The data collected in REACH give a comprehensive and current view of real-life clinical management of cSSTI in European hospitals and provide evidence of a high rate of initial antibiotic treatment modification. ©2013 European Society of Clinical Microbiology and Infectious Diseases.


Angels Font M.,Fundacio IDIBELL | Arboix A.,Hospital Universitari Sagrat Cor | Krupinski J.,Hospital Universitari Mutua Of Terrassa
Current Cardiology Reviews | Year: 2010

Only very little is know about the neurovascular niche after cardioembolic stroke. Three processes implicated in neurorepair: angiogenesis, neurogenesis and synaptic plasticity, would be naturally produced in adult brains, but also could be stimulated through endogen neurorepair phenomena. Angiogenesis stimulation generates new vessels with the aim to increase collateral circulation. Neurogenesis is controlled by intrinsic genetic mechanisms and growth factors but also ambiental factors are important. The leading process of the migrating neural progenitor cells (NPCs) is closely associated with blood vessels, suggesting that this interaction provides directional guidance to the NPCs. These findings suggest that blood vessels play an important role as a scaffold for NPCs migration toward the damaged brain region. DNA microarray technology and blood genomic profiling in human stroke provided tools to investigate the expression of thousands of genes. Critical comparison of gene expression profiles after stroke in humans with those in animal models should lead to a better understanding of the pathophysiology of brain ischaemia. Probably the most important part of early recovery after stroke is limited capacity of penumbra/infarct neurones to recover. It became more clear in the last years, that penumbra is not just passively dying over time but it is also actively recovering. This initial plasticity in majority contributes towards later neurogenesis, angiogenesis and final recovery. Penumbra is a principal target in acute phase of stroke. Thus, the origin of newly formed vessels and the pathogenic role of neovascularization and neurogenesis are important unresolved issues in our understanding of the mechanisms after stroke. Biomaterials for promoting brain protection, repair and regeneration are new hot target. Recently developed biomaterials can enable and increase the target delivery of drugs or therapeutic proteins to the brain, allow cell or tissue transplants to be effectively delivered to the brain and help to rebuild damaged circuits. These new approaches are gaining clear importance because nanotechnology allows better control over material-cell interactions that induce specific developmental processes and cellular responses including differentiation, migration and outgrowth. © 2010 Bentham Science Publishers Ltd.


Calbo E.,Hospital Universitari Mutua Of Terrassa | Calbo E.,Autonomous University of Barcelona | Garau J.,Hospital Universitari Mutua Of Terrassa
International Journal of Antimicrobial Agents | Year: 2010

Pneumococcal pneumonia is characterised by an intense inflammatory response induced mainly by cell wall components of the bacterium. Recognition of cell wall components by Toll-like receptors (TLRs) induces intracellular signalling pathways that culminate in the activation of pro-inflammatory genes through nuclear factor κB (NF-κB). Tumour necrosis factor-alpha (TNFα) is one of the earliest mediators produced and induces a second wave of pro- and anti-inflammatory cytokines that orchestrate the immune response. The magnitude of this response in patients with pneumococcal pneumonia is a complex network and many factors must be considered in the analysis of the cytokine production pattern. First, bacterial growth and the inflammatory response are dynamic processes, produced initially as a local phenomenon with a late systemic extension. Second, host characteristics, such as different cytokine gene polymorphisms, can cause a distinct immune response. Finally, other microorganism determinants and even the immunomodulatory effect of antimicrobials may play a role in cytokine production. Recent data on innate immunity against Streptococcus pneumoniae gathered from the murine model of pneumonia, from studies of human genetic polymorphisms associated with increased susceptibility to pneumococcal infection, and from human clinical trials are discussed. Special emphasis has been placed on the description of the chronology of the complex network of innate immunity triggered by pneumococcal infection. © 2009 Elsevier B.V. and the International Society of Chemotherapy.


Calbo E.,Hospital Universitari Mutua Of Terrassa | Calbo E.,International University of Catalonia | Garau J.,Hospital Universitari Mutua Of Terrassa
Current Opinion in Infectious Diseases | Year: 2011

Purpose of review: Streptococcus pneumoniae continues to be responsible for significant mortality and morbidity worldwide. A better understanding of the inflammatory response generated by the interaction of this microorganism with the host and antimicrobial therapy will improve the management of patients with pneumococcal infection. Recent findings: On the side of the microorganism, recent studies have identified virulence factors such as capsular polysaccharides, surface protein, pili and pneumolysin, among others, that are able to trigger a complex inflammatory network. A misbalance in this network will precipitate a specific response that generates the systemic inflammatory response syndrome. Some of these virulence factors could be used as antigens for the production of vaccines with a broader spectrum than the currently used ones. On the host side, many single-nucleotide polymorphisms in genes controlling the immune response have been associated with specific clinical presentations. Finally, some antimicrobials or adjunctive therapies have recently been evaluated as inmunomodulatory agents. Summary: Systemic inflammatory response syndrome is the result of an anomalous activation of the inflammatory network triggered by S. pneumoniae. Pneumococcal virulence factors, host comorbidities, the genetic background and the concomitant activity of antimicrobials and adjuvant therapies modulate the magnitude of this response. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Garrido I.,Hospital Universitari Mutua Of Terrassa | Garrido I.,Autonomous University of Barcelona | Subira S.,Autonomous University of Barcelona
Psychiatry Research | Year: 2013

Impairment in decision-making can be related to some pathological behaviors in eating disorders. This ability was assessed in 71 eating disorder patients (27 restricting type patients and 44 binge/purging type patients) and compared with 38 healthy controls using the Iowa Gambling Task. This task simulates real-life decision-making by assessing the ability to sacrifice immediate rewards in favor of long term gains. Furthermore, some studies have demonstrated a relationship between impulsivity and decision-making, so in our study the Barratt Impulsiveness Scale was also used. Eating disorder patients, both the restricting and the binge/purging groups, performed poorly in the Iowa Gambling Task compared to controls, confirming a deficit in decision-making in these patients. The restricting group showed poorer IGT performance than the binge/purging group. Interestingly, impulsivity was negatively correlated with decision-making, but only in the binge/purging group. In conclusion, our results confirm a specific deficit in eating disorder patients which may be related to their pathological eating behavior, and suggest that this impairment might be explained by different mechanisms in restricting and binge/purging disorders. © 2012 Elsevier Ireland Ltd.


Calbo E.,Hospital Universitari Mutua Of Terrassa | Calbo E.,International University of Catalonia | Garau J.,Hospital Universitari Mutua Of Terrassa
Future Microbiology | Year: 2015

Klebsiella pneumoniae is responsible for a large number of hospital outbreaks. In the 1990s, there were clonal epidemics, affecting mostly intensive care patients, which carried SHV and TEM enzyme types. With the advent of CTX-M-15 enzymes in the 2000, plasmids encoding multiple extended-spectrum β-lactamase (ESBL) types were described and, frequently, nosocomial outbreaks reported polyclonal dissemination and involved multiple Enterobacteriaceae. Worryingly, the interface between community and hospital is becoming blurred, and there is increasing evidence for the presence of ESBL-producing K. pneumoniae in the community. Furthermore, carbapenem resistance is increasingly reported in ESBL-producing K. pneumoniae strains. Infection control measures and stewardship programs are vital weapons in controlling the pandemic evolution of multidrug-resistant K. pneumoniae. © 2015 Future Medicine Ltd.


The 7th edition of the UICC/AJCC TNM, and a new revision of the Japanese Classification for Gastric Cancer and Treatment Guidelines (Japanese Gastric Cancer Association) have been available since the beginning of 2010. One of the most important changes consists on the redefining and simplification of type D1/D2 lymphadenectomy depending on the type of gastrectomy performed (previously it depended on the location of the primary tumour), and the adoption of numeric criteria of TNM-7th Edition to evaluate the level of lymph node involvement (before, according to the anatomical location of the groups as regards the primary tumour). These changes attempt to make therapeutic management easier and a more uniform comparison of results between countries. The importance of these modifications in both systems justifies this exhaustive analysis and update of the new concepts for a correct management of gastric cancer. © 2010 AEC.

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