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Hospital de Órbigo, Spain

Jarque I.,University of Valencia | Tormo M.,Hospital Clinico Universitario | Bello J.L.,Complejo Hospitalario Universitario | Rovira M.,Hospital Clinic | And 10 more authors.
Medical Mycology | Year: 2013

Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). This multicenter, prospective, non-comparative, observational ProCAS study was aimed to assess the effectiveness and safety of caspofungin in adult hematological patients with IC or IA under everyday clinical conditions. Favorable outcomes included complete and partial responses on the last day of caspofungin therapy. Safety was assessed up to 14 days post-caspofungin. A total of 115 patients (69 male) with a median age of 52 years (range, 23-78 years) were analyzed. Underlying disease was acute myeloid leukemia in 45 patients (39%), and 21 (18%) were allogeneic stem cell transplant recipients. Thirty-four (29.5%) patients had a diagnosis of IA and 26 (22.6%) had IC (candidemia). The median duration of caspofungin therapy was 14 days (range, 1-100). The overall favorable response rate was 77% (20/26) for patients with IC (69% first-line) and 79% (27/34) for those with IA. Antifungal therapy with caspofungin was generally well tolerated, only two (1.7%) patients having a non-serious drug-related adverse reaction. These results suggest that caspofungin, either alone or in combination, should be considered an effective and safe option for the treatment of invasive mycoses in patients with severe hematological disorders. © 2013 ISHAM.

Marin-Jimenez I.,Hospital General Universitario Gregorio Maranon | Nos P.,Polytechnic University of Valencia | Domenech E.,Hospital Universitari Germans Trias i Pujol Badalona | Riestra S.,University of Oviedo | And 18 more authors.
American Journal of Gastroenterology | Year: 2016

OBJECTIVES:New e-health technologies can improve patient-physician communication and contribute to optimal patient care. We compared the diagnostic performance of the Simple Clinical Colitis Activity Index (SCCAI) self-administered by patients with ulcerative colitis (UC) at home (through a website) with the in-clinic gastroenterologist-assessed SCCAI.METHODS:Patients were followed-up over 6 months. At months 3 and 6, patients completed the SCCAI online at home; within 48 h, gastroenterologists (blinded to patients' scores) completed the in-clinic SCCAI (reference). SCCAI scores were dichotomized to remission or active disease, and SCCAI changes in disease activity from month 3 to 6 were classed as worsening, stability, or improvement.RESULTS:A total of 199 patients (median age: 38 years; 56% female) contributed with 340 pairs of questionnaires. Correlation of SCCAI scores by patients and physicians was good (Spearman's ρ=0.79), with 85% agreement for remission or activity (95% CI: 80.8-88.6, κ=0.66). The negative predictive value for active disease was 94.5% (91.4-96.6); the positive predictive value was 68.0% (58.8-69.2). Agreement between patient and physician was higher in the 168 month 6 pairs than in the 172 month 3 pairs of questionnaires (89.3% (83.6-93.1) vs. 80.8% (74.2-86.0), P=0.027).CONCLUSIONS:In patients with UC, SCCAI self-administration via an online tool resulted in a high percentage of agreement with evaluation by gastroenterologists, with a remarkably high negative predictive value for disease activity. Remote monitoring of UC patients is possible and might reduce hospital visits.

Sanchez-Ortiga R.,Massachusetts General Hospital | Sanchez-Ortiga R.,Hospital General Universitario Alicante | Klibanski A.,Massachusetts General Hospital | Klibanski A.,Harvard University | And 2 more authors.
Clinical Endocrinology | Year: 2012

Objective: Prader-Willi syndrome (PWS) is associated with GH deficiency, deleterious changes in body composition and function. As the effects of recombinant human GH (rhGH) in PWS adults have not been well established, we sought to conduct a meta-analysis of pertinent studies. Design: Meta-analysis of studies examining the effects of rhGH therapy in PWS adults. Patients: One hundred and thirty four PWS adults (75 men, 59 women). Measurements: Literature searches, including publications (PubMed, EMBASE and the Cochrane Register), and abstracts presented at meetings through July 2011 describing studies of rhGH therapy in PWS adults; 8/1194 articles, describing unique cohorts, were included. Two authors independently extracted data and examined study quality. Results: rhGH therapy for 12 months led to [weighted mean difference (95% CI)] decreased body fat [-2.91% (-3.90, -1.91)], visceral [-32.97 cm 2 (-55.67, -10.26)] and subcutaneous adiposity [-55.24 cm 2 (-89.05, -21.44)], and increased lean body mass (LBM) [2.41 Kg (1.32, 3.49)]. Similar changes in body fat [-2.89% (-4.69, -1.07)] and LBM [2.82 Kg (1.31, 4.33)] were found in longer studies. There were no changes in body mass index (BMI) or lipids. There was a small increase in fasting glucose [0.27 mmol/l (0.05, 0.49)] and trends towards higher fasting insulin [20.24 pmol/l (-0.55, 41.02)] and insulin resistance [HOMA: 0.60 (-0.04, 1.24)] after rhGH therapy for 12 months. Conclusions: In PWS adults, rhGH therapy led to decreased body adiposity and increased LBM without changes in BMI or lipids. There was a small increase in fasting glucose and trends towards higher insulin and insulin resistance. © 2012 Blackwell Publishing Ltd.

Villanueva V.,Polytechnic University of Valencia | Lopez F.J.,Complejo Hospitalario Universitario Santiago | Serratosa J.M.,Hospital Universitario Fundacion Jimenez Diaz | Gonzalez-Giraldez B.,Hospital Universitario Fundacion Jimenez Diaz | And 13 more authors.
Epilepsy and Behavior | Year: 2013

Lacosamide is approved as adjunctive therapy for focal epilepsies. The number of antiepileptic drugs (AEDs) tried is associated with prognosis. This multicenter, retrospective, observational study (LACO-EXP) in Spain in 500 adult patients with focal epilepsies examined the efficacy and tolerability of add-on lacosamide. Factors associated with better efficacy/tolerability were analyzed. After 12. months, the responder rate (≥. 50% reduction in seizure frequency) was 57.1%, and the seizure-free rate was 14.9%. Efficacy was better when lacosamide was the first or second add-on AED, although there was a small chance to be seizure-free even for patients who had received ≤. 10 prior AEDs. The mechanism of action of concomitant AEDs is important in all the stages, but differences are smaller in the early stages. Lacosamide was generally well tolerated. A slower dosage-titration schedule was associated with a lower adverse event rate. Further investigation of the timing of initiation of lacosamide add-on therapy and ideal combinations of AEDs is required. © 2013 Elsevier Inc.

Gomez-Hurtado I.,Hospital General Universitario Alicante | Such J.,Hospital General Universitario Alicante | Sanz Y.,CSIC - Institute of Agricultural Chemistry and Food Technology | Frances R.,Hospital General Universitario Alicante
World Journal of Gastroenterology | Year: 2014

Gut microbiota plays an important role in cirrhosis. The liver is constantly challenged with commensal bacteria and their products arriving through the portal vein in the so-called gut-liver axis. Bacterial translocation from the intestinal lumen through the intestinal wall and to mesenteric lymph nodes is facilitated by intestinal bacterial overgrowth, impairment in the permeability of the intestinal mucosal barrier, and deficiencies in local host immune defences. Deranged clearance of endogenous bacteria from portal and systemic circulation turns the gut into the major source of bacterialrelated complications. Liver function may therefore be affected by alterations in the composition of the intestinal microbiota and a role for commensal flora has been evidenced in the pathogenesis of several complications arising in end-stage liver disease such as hepatic encephalopathy, splanchnic arterial vasodilatation and spontaneous bacterial peritonitis. The use of antibiotics is the main therapeutic pipeline in the management of these bacteria-related complications. However, other strategies aimed at preserving intestinal homeostasis through the use of pre-, pro- or symbiotic formulations are being studied in the last years. In this review, the role of intestinal microbiota in the development of the most frequent complications arising in cirrhosis and the different clinical and experimental studies conducted to prevent or improve these complications by modifying the gut microbiota composition are summarized. © 2014 Baishideng Publishing Group Inc. All rights reserved.

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