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Javier Garcia-Fernandez F.,Hospital Universitario Of Burgos | Almendral J.,University of San Pablo - CEU | Marta Pachon,University of San Pablo - CEU | Gonzalez-Torrecilla E.,Hospital General Universitario Gregorio Maranon | And 2 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2013

Resetting Response to Differentiate SVT Background The usefulness of ventricular entrainment to differentiate AV nodal reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) by substracting the corrected postpacing interval (cPPI) from the tachycardia cycle length (TCL) or the ventriculoatrial interval during stimulation (SA) from that during tachycardia (VA) have been widely validated. However, some tachycardias are interrupted by pacing trains but may not be so by ventricular extrastimuli resulting in resetting. Objectives To validate prospectively the diagnostic yield of cPPI-TCL and SA-VA measurements after resetting and to determine the proportion of AVNRT and ORT that can be entrained and/or reset from the right ventricular apex (RVA). Methods 223 consecutive patients with inducible AVNRT or ORT underwent pacing trains and single extrastimulus (also double extrastimuli if singles did not reset tachycardia) at the RVA. We calculated cPPI-TCL and SA-VA during entrainment and resetting. Results Entrainment could not be achieved in 15.2% of tachycardias because of consistent tachycardia interruption by pacing; resetting was observed in 99.5%. Values of cPPI-TCL and SA-VA > 110 milliseconds after resetting identified AVNRT as accurately as after entrainment. Values for cPPI-TCL/ SA-VA were: sensitivity: 98/100%; specificity: 96/98%; positive predictive value: 98/99%; negative predictive value: 98/100%. Conclusions Determinations of cPPI-TCL and SA-VA after resetting with single or double RVA extrastimuli are useful maneuvers to differentiate AVNRT from ORT and can be used for nearly every inducible AVNRT or ORT, even if they are interrupted by ventricular trains. © 2012 Wiley Periodicals, Inc.


Sanchis J.,University of Barcelona | Corrigan C.,King's College London | Levy M.L.,University of Edinburgh | Viejo J.L.,Hospital Universitario Of Burgos
Respiratory Medicine | Year: 2013

This brief overview of the factors determining lung deposition of aerosols provides background information required by health care providers when instructing patients to use their prescribed inhalers. We discuss differences in the optimal inhalation manoeuvres for each type of aerosol generator and the difficulties patients face. Provision of short, clear instructions with demonstration of critical steps and checking technique during later clinical visits are necessary if these aerosolised medications are to be fully beneficial.© 2012 Elsevier Ltd. All rights reserved.


Alonso-Alvarez M.L.,Hospital Universitario Of Burgos | Alonso-Alvarez M.L.,CIBER ISCIII | Teran-Santos J.,Hospital Universitario Of Burgos | Teran-Santos J.,CIBER ISCIII | And 5 more authors.
Chest | Year: 2015

OBJECTIVE: The objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS: A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date , same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. The apneahypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coefficients, Bland-Altman plots, and receiver operator curves (ROCs). RESULTS: Twenty-seven boys and 23 girls, with a mean age of 5.3 ± 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defined obstructive respiratory disturbance index ≥ 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defined OSAS criterion was established as ≥ 5.6/h The latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specificity of 94.1% (95% CI, 80%-100%). CONCLUSIONS: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children. © 2015 American College of Chest Physicians.


Delgado-Lopez P.D.,Hospital Universitario Of Burgos | Corrales-Garcia E.M.,Hospital Universitario Of Burgos
Clinical and Translational Oncology | Year: 2016

Glioblastoma (GBM) is the most common and lethal tumor of the central nervous system. The natural history of treated GBM remains very poor with 5-year survival rates of 5 %. Survival has not significantly improved over the last decades. Currently, the best that can be offered is a modest 14-month overall median survival in patients undergoing maximum safe resection plus adjuvant chemoradiotherapy. Prognostic factors involved in survival include age, performance status, grade, specific markers (MGMT methylation, mutation of IDH1, IDH2 or TERT, 1p19q codeletion, overexpression of EGFR, etc.) and, likely, the extent of resection. Certain adjuncts to surgery, especially cortical mapping and 5-ALA fluorescence, favor higher rates of gross total resection with apparent positive impact on survival. Recurrent tumors can be offered re-intervention, participation in clinical trials, anti-angiogenic agent or local electric field therapy, without an evident impact on survival. Molecular-targeted therapies, immunotherapy and gene therapy are promising tools currently under research. © 2016 Federación de Sociedades Españolas de Oncología (FESEO)


Alvarez-Lario B.,Hospital Universitario Of Burgos | Prieto-Tejedo R.,Hospital Universitario Of Burgos | Colazo-Burlato M.,Hospital Universitario Of Burgos | Macarron-Vicente J.,Hospital Universitario Of Burgos
Clinical Rheumatology | Year: 2013

The adverse effects of anti-tumour necrosis factor alpha (TNFα) drugs include an increase in the risk of infections, congestive heart failure, lupus-like syndrome, and the onset or worsening of various demyelinating diseases such as, multiple sclerosis, optic neuritis, and Guillain-Barrè syndrome (GBS), among others. We describe the case of a patient who developed GBS while she was on treatment with adalimumab. A 50-year-old woman with rheumatoid arthritis (RA) was admitted to the hospital due to progressive severe bilateral symmetric weakness of the legs, which quickly extended to the upper limbs and to the respiratory muscles. Adalimumab was started 13 months before. GBS was diagnosed and the anti-TNFα therapy discontinued. The serological test for Campylobacter jejuni was positive. She required invasive mechanical ventilatory support for 9 months. Twelve months later, the patient was using a wheelchair following a rehabilitation programme, and at 24 months she was walking a few steps with assistive devices. The relevant literature on the relationship between GBS and anti-TNFα is reviewed. Twenty three cases of GBS occurring during anti-TNFα therapy have been reported so far in the literature. In several cases, there was no clear temporal association, more than half had a possible previous infection, and in two cases the drug was reintroduced without recurrence of GBS. Our case, which is best explained by C. jejuni infection, as well as some of the cases described are probably not a direct result of anti-TNFα treatment, but an accidental coincidence. We also discuss the potential therapeutic options after anti-TNFα discontinuation. © 2013 Clinical Rheumatology.


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.


Gonzalez-Quijada S.,Hospital Universitario Of Burgos | Mora-Simon M.J.,Hospital Universitario Of Burgos | Martin-Ezquerro A.,Hospital Universitario Of Burgos
Clinical Microbiology and Infection | Year: 2014

Q fever, caused by Coxiella burnetii, may cause vascular complications, but the role that this infection may play in the development of atherosclerotic cardiovascular disease remains unknown. This study examined the association between Q fever serology and cardiovascular disease in a region where Q fever is endemic. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and June 2012. A total of 513 samples were tested, from 454 hospitalized patients ≥65 years old, of whom 164 were cases (patients with prevalent or incident coronary heart, cerebrovascular or peripheral artery, disease) and 290 controls (patients without cardiovascular disease). Serum IgG antibody phase II titres against Q fever were determined by immunofluorescence assay. Seropositivity (titres ≥1:256) was detected in 84/164 (51.2%) cases and in 109/290 (37.6%) controls (p = 0.005; OR, 1.7; 95% CI, 1.1-2.5). This ratio increases when adjusted for sex, hypertension, dyslipidaemia, smoking, diabetes and atrial fibrillation (OR, 2.6; 95% CI, 1.5-4.7). The geometric mean titre (GMT) for C. burnetii phase II assay was higher in cases than in controls (p = 0.004). We found no significant relationship between cardiovascular disease and C. pneumoniae, and Cytomegalovirus seropositivity (both determined by the IgG ELISA method). In conclusion, serological evidence of past Q fever is associated with atherosclerotic cardiovascular disease in elderly patients in an endemic region. © 2014 The Authors.


Frasson M.,Polytechnic University of Valencia | Flor-Lorente B.,Polytechnic University of Valencia | Rodriguez J.L.R.,Hospital Universitario Of Getafe | Granero-Castro P.,Polytechnic University of Valencia | And 5 more authors.
Annals of Surgery | Year: 2015

Objective: To determine pre-/intraoperative risk factors for anastomotic leak after colon resection for cancer and to create a practical instrument for predicting anastomotic leak risk. Background: Anastomotic leak is still the most dreaded complication in colorectal surgery. Many risk factors have been identified to date, but multicentric prospective studies on anastomotic leak after colon resection are lacking. Methods: Fifty-two hospitals participated in this prospective, observational study. Data of 3193 patients, operated for colon cancer with primary anastomosis without stoma, were included in a prospective online database (September 2011-September 2012). Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak (60-day follow-up). A nomogram was created to easily predict the risk of anastomotic leak for a given patient. Results: The anastomotic leak rate was 8.7%, and widely varied between hospitals (variance of 0.24 on the logit scale). Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P < 0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001). In the multivariate analysis, the following variables were independent risk factors for anastomotic leak: obesity [P = 0.003, odds ratio (OR) = 2.7], preoperative serum total proteins (P = 0.03, OR = 0.7 per g/dL), male sex (P = 0.03, OR = 1.6), ongoing anticoagulant treatment (P = 0.05, OR = 1.8), intraoperative complication (P = 0.03, OR = 2.2), and number of hospital beds (P = 0.04, OR = 0.95 per 100 beds). Conclusions: Anastomotic leak after colon resection for cancer is a frequent, relevant complication. Patients, surgical technique, and hospital are all important determining factors of anastomotic leak risk. © 2015 Wolters Kluwer Health, Inc.


Objective: To determine the requirements to become a wet nurse for the rich class, mainly at the Court, from the 17th century to the 19 th century; the social consideration of maternal breastfeeding and wet nurse breastfeeding; the wet nurse social relevance and the reasons to hire them, as well as the knowledge about the female reproductive cycle and physiology of lactation. Material and methods: A bibliographical investigation of printed documents, royal decrees, orphanage documentation, and medical, historical, gynecology, hygiene and ways of life books of the centuries mentioned. Results: There was a huge demand of wet nurses on the society due to medical and socioeconomical reasons. The wet nurses were very important so they received great number of praises, but were also strongly criticized; in fact, from the 17th century, a medical current that proclaims the advantages of maternal breastfeeding begins, and considers wet nurses as the worst of the society. The requirements to become a wet nurse in the high class, and especially at the Court, were very strict. The origin, the physical and moral characteristic, the social conditions and the milk quality and amount were considered. Conclusions: The knowledge about physiological changes of the female body and the child social class determinate the wet nurse characteristics. The perfect nurse had good morality, medium constitution and medium breasts, was healthy, blond or dark-haired, and proceeded from a little town. This work gives us the chance to continue researching in this way. ©2013 Ediciones Mayo, S.A. All rights reserved.


Alvarez-Lario B.,Hospital Universitario Of Burgos | Alonso-Valdivielso J.L.,Hospital Universitario Of Burgos
Nutricion Hospitalaria | Year: 2014

From ancient times, gout has been related with excessive eating and drinking; however, it has not been until the last decade that a broader knowledge on dietary factors associated with hyperuricemia and gout has been achieved. Obesity, excessive intake of red meats and alcoholic beverages were already recognized as causal factors from Antiquity. Legumes and purine rich vegetables have been exculpated after the studies. New risk factors, not previously recognized, have been described such as fructose and sweetened beverages. Finally, protective factors have also been described, such as skimmed dairy products. Gout is characterized not only by an increase in uric acid, eventual episodes of arthritis, and chronic joint damage, but also by association with several comorbidities and increased cardiovascular risk. The adoption of more healthier dietary habits may contribute to better management of uricemia and also to a reduction of associated disea ses. The most common practice recommendations according to current knowledge and the main treatment guidelines are reviewed. Additional studies are needed on the actual efficacy in clinical practice of the adoption of specific dietary measures on the management and clinical course of patients with hyperuricemia and gout.

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