Hospital Universitario Arnau Of Vilanova

Hospital de Órbigo, Spain

Hospital Universitario Arnau Of Vilanova

Hospital de Órbigo, Spain
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Porcel J.M.,Hospital Universitario Arnau Of Vilanova
Revista Clinica Espanola | Year: 2017

In this narrative review we describe the main aetiologies, clinical characteristics and treatment for patients with benign pleural effusion that characteristically persists over time: chylothorax and cholesterol effusions, nonexpansible lung, rheumatoid pleural effusion, tuberculous empyema, benign asbestos pleural effusion and yellow nail syndrome. © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI).

Matute Crespo M.,Hospital Universitario Arnau Of Vilanova | Montero Matamala A.,Hospital Universitario Arnau Of Vilanova
Revista Espanola de Anestesiologia y Reanimacion | Year: 2017

The concept of multimodal analgesia is currently widespread in our clinical practice.The aim of multimodal analgesia is to reduce the side effects derived from the drugs or techniques used for the control of pain together with greater effectiveness (combination of multiple mechanisms of action) with the maximum efficiency, that is, to combine different pharmacodynamics (synergistic or additive effects) and pharmacokinetics, in the context of a predictable acute pain model, thus allowing a prior strategy such as the model of acute postoperative pain.Pain is a complex physiological phenomenon. Postoperative pain involves multiple pathways including nociceptive, inflammatory, and neuropathic sources. In the transmission of pain therefore, different molecules participate, which means that there are multiple pharmacological targets on which to act, and therefore a wide range of drugs to be used following the physiology of pain. © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.

Porcel J.M.,Hospital Universitario Arnau Of Vilanova
Revista Clinica Espanola | Year: 2017

In most cases, the etiological diagnosis of pleural exudates does not require a pleural biopsy. However, when it is considered necessary, the biopsy should seldom be conducted using invasive methods such as thoracoscopy. Two paradigmatic examples are pleural tuberculosis and malignant effusions. In many centres, pleural fluid adenosine deaminase measurement has replaced closed pleural biopsies in the diagnosis of tuberculosis. Similarly, pathological and molecular studies on pleural fluid cell blocks or alternatively, image-guided pleural biopsies have drastically reduced the need for thoracoscopy. © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI).

Bonsignore M.R.,University of Palermo | Esquinas C.,Hospital Santa Maria | Esquinas C.,Hospital Universitario Arnau Of Vilanova | Barcelo A.,Hospital Universitari Son Dureta | And 7 more authors.
European Respiratory Journal | Year: 2012

Themetabolic syndrome shows a variable prevalence in obstructive sleep apnoea (OSA), and its association with insulin resistance or excessive daytime sleepiness in OSA is unclear. This study assessed the following in consecutive patients with newly diagnosed OSA: 1) the prevalence of metabolic syndrome; and 2) its association with insulin resistance and daytime sleepiness. Metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel (NCEPATP) III criteria), insulin resistance (Homeostatic Model Assessment (HOMA) index, n=288) and daytime sleepiness (Epworth Sleepiness Scale) were assessed in 529 OSA patients. The prevalence of metabolic syndrome was 51.2%, which increased with OSA severity. Each metabolic syndrome component correlated with apnoea/hypopnoea index, but only blood pressure retained significance after correction for confounders. Both obesity and OSA contributed to metabolic abnormalities, with different sex-related patterns, since diagnosis of metabolic syndrome was significantly associated with neck circumference, age, body mass index and lowest arterial oxygen saturation in males, and with age and arousal index in females. The number of metabolic syndrome components increased with HOMA index (p<0.001). Prevalence of sleepiness was the same in patients with and without metabolic syndrome. The metabolic syndrome occurs in about half of "real-life" OSA patients, irrespective of daytime sleepiness, and is a reliable marker of insulin resistance. Copyright©ERS 2012.

Lopez-Pueyo M.J.,Hospital Universitario Of Burgos | Olaechea-Astigarraga P.,Hospital Of Galdakao Usansolo | Palomar-Martinez M.,Hospital Universitario Arnau Of Vilanova | Insausti-Ordenana J.,Hospital Of Navarra | Alvarez-Lerma F.,Service of Intensive Care Medicine
Journal of Hospital Infection | Year: 2013

Background: Data validation is an essential aspect for the accuracy of a nosocomial infection surveillance registry. Aim: To report the results of the first quality control programme in the national surveillance programme of intensive care unit (ICU)-acquired infection in Spain (ENVIN-HELICS registry). Method: During 2008, of 13,824 records included in the database, 1500 (10.8%) registries from 20 ICUs were reviewed. These ICUs were selected at random and stratified according to the number of cases included in the registry. The proportion of infected patients, which was 9.6% [95% confidence interval (CI) 8.09-11.16], was maintained during the selection of cases for review. Two physicians were trained for the purpose of the study and undertook the review. Results: Overall sensitivity, specificity and positive and negative predictive values of the ENVIN-HELICS registry for the identification of patients with any device-related infection acquired during their ICU stay were 86.0% (95% CI 80.0-92.0), 98.7% (95% CI 82.19-93.6), 87.9% (95% CI 82.19-93.6) and 98.5% (95% CI 97.8-99.2), respectively, with a kappa index of 0.85 (95% CI 0.79-0.92). Secondary bloodstream infection had the lowest sensitivity (59.3%), and intubation-associated pneumonia had the highest sensitivity (86.3%). Conclusion: There was good correlation between data reported by the registrars and data validated by auditors, confirming the reliability of the ENVIN-HELICS registry. © 2013 The Healthcare Infection Society.

Blanco I.,Biomedical Research Office OIB FICYT | Lara B.,Hospital Universitario Arnau Of Vilanova | De Serres F.,National Health Research Institute
Orphanet Journal of Rare Diseases | Year: 2011

Up to now alpha 1-antitrypsin (AAT) augmentation therapy has been approved only for commercial use in selected adults with severe AAT deficiency-related pulmonary emphysema (i.e. PI*ZZ genotypes as well as combinations of Z, rare and null alleles expressing AAT serum concentrations <11 μmol/L). However, the compassionate use of augmentation therapy in recent years has proven outstanding efficacy in small cohorts of patients suffering from uncommon AAT deficiency-related diseases other than pulmonary emphysema, such as fibromyalgia, systemic vasculitis, relapsing panniculitis and bronchial asthma. Moreover, a series of preclinical studies provide evidence of the efficacy of AAT augmentation therapy in several infectious diseases, diabetes mellitus and organ transplant rejection. These facts have generated an expanding number of medical applications and patents with claims for other indications of AAT besides pulmonary emphysema. The aim of the present study is to compile and analyze both clinical and histological features of the aforementioned published case studies and reports where AAT augmentation therapy was used for conditions other than pulmonary emphysema. Particularly, our research refers to ten case reports and two clinical trials on AAT augmentation therapy in patients with both AAT deficiency and, at least, one of the following diseases: fibromyalgia, vasculitis, panniculitis and bronchial asthma. In all the cases, AAT was successfully applied whereas previous maximal conventional therapies had failed. In conclusion, laboratory studies in animals and humans as well as larger clinical trials should be, thus, performed in order to determine both the strong clinical efficacy and security of AAT in the treatment of conditions other than pulmonary emphysema. © 2011 Blanco et al; licensee BioMed Central Ltd.

Porcel J.M.,Hospital Universitario Arnau Of Vilanova | Esquerda A.,Hospital Universitario Arnau Of Vilanova | Vives M.,Idcsalud Hospital Albacete | Bielsa S.,Hospital Universitario Arnau Of Vilanova
Archivos de Bronconeumologia | Year: 2014

Objective: To investigate the etiology of pleural effusions (PE) in adults and the accuracy of pleural fluid (PF) cytology and cultures in malignant and infectious PE, respectively. Patients and methods: Retrospective analysis of all consecutive patients with PE undergoing diagnostic thoracentesis during the last 19 years in a university hospital. Results: The leading causes of PE among the 3,077 patients were: cancer (27%), heart failure (21%), pneumonia (19%), tuberculosis (9%), abdominal surgery (4%), pericardial diseases (4%) and cirrhosis (3%). Tuberculosis was the most common etiology in patients <. 34 years of age (52%), whereas heart failure predominated in octogenarians (45%). The most common primary tumors in malignant PE were lung (37%) and breast (16%). The overall accuracy of PF cytology was 59%, although it was significantly lower in mesotheliomas (27%) and squamous cell lung cancer (25%). In infectious PE, only 30% of cultures yielded positive results, a percentage which increased two-fold (66%) in purulent fluids (empyemas). Viridans streptococci were the most commonly isolated pathogens (25.5%). The sensitivity of solid media cultures of PF for Mycobacterium tuberculosis was low (18.5%). Conclusions: Three-quarters of patients with PE in whom a diagnostic thoracentesis was indicated had cancer, heart failure, pneumonia or tuberculosis. PF cytology and cultures give false negative results in a significant number of cases. © 2013 SEPAR.

Serrano M.,Hospital Santa Maria Of Lleida | Barcenilla F.,Hospital Universitario Arnau Of Vilanova | Limon E.,Programa VINCat
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2014

The long-term care facilities (LTCF) are the health care level that integrates medical assistance and social services according to the requirements of its beneficiaries. There is a great variability depending on the users profile, the professional staff and accessibility to technical resources for diagnosis, treatment or rehabilitation. In LTCF different factors are shaping a challenge in the infection control. These factors are high prevalence of infection and colonization by multiresistant microorganisms (MROs), a high rate of, often inadequate, antibiotic prescriptions, the high transfer of hospital patients, and the lack of diagnostic resources. In infection studies in LTCF, one of the main problems is the lack of standard, and well defined, infection criteria. The special features of infections in the elderly population, together with the limited resources, make it necessary to establish standard and worldwide validated criteria in order achieve appropriate monitoring and control of infection. The most common infection is the respiratory, followed by the urinary, skin and soft tissue, gastro-intestinal tract, and eyes. The problematic microorganisms most frequently identified in LTCF are enterobacteriaceae extended spectrum beta lactamase, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). A successful infection control mainly depends on two actions. First, a high compliance of standard precautions and second, patient organization according to the risk of transmission of a particular MROs infection, especially MRSA. This risk classification may be a way to rationalize application measures, and the incorporation of ethical and legal issues. The level of stratification is established mainly according to the condition of being colonized or infected, the MROs anatomical location, and the degree of behavioral disorders suffered by the patient. Implementation of extensive screening programs or complex monitoring programs, as in acute care hospitals are not indicated. The epidemiological surveillance must adapt to clinical guidelines, with the registering of colonized and infected patients being mandatory, along with the coordination between health and social systems by applying global control programs. © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.

Porcel J.M.,Hospital Universitario Arnau Of Vilanova
Revista Clinica Espanola | Year: 2016

Pleural ultrasonography is useful for identifying and characterising pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety. © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI).

Lara B.,Hospital Universitario Arnau Of Vilanova
Archivos de Bronconeumologia | Year: 2010

Alpha-1-antitrypsin deficiency (AATD) is the main genetic factor related to the development of emphysema. This protein has numerous variants, some of which are clinically relevant because their anomalous conformation implies that they fail to reach the target organs as they are polymerized in the hepatocyte. The main abnormal variant is PiZ. In a small percentage of individuals, the accumulation of Z polymers in the liver leads to the development of liver disease. The lack of AATD in the lung favors the development of emphysema, since the proteolytic effect of elastases - the main biological function of AATD - is not counteracted. In Spain, approximately 400 persons are diagnosed with severe AATD deficiency, representing less than 10 % of those expected by epidemiological studies. The principal prognostic factor in these patients is forced expiratory volume in one second (FEV1), which is affected mainly by exposure to tobacco smoke. Thus, life expectancy in nonsmokers is similar to that in the general population while lung function decreases faster in smokers than in other patients with chronic obstructive pulmonary disease (COPD). The treatment of the lung disease is the same, although exogenous AATD augmentation is indicated when lung function deteriorates. © 2010 Sociedad Española de Neumología y Cirugía Torácica.

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