Hospital Universitario Of Cruces

Hospital de Órbigo, Spain

Hospital Universitario Of Cruces

Hospital de Órbigo, Spain

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The Spanish Society of Critical Care Medicine (SEMICYUC) has recently published an updated version of Quality Indicators in Critical Care. Daily sedative interruption is included among them. As this practice is controversial, research studies are revised and guidelines for its implementation are proposed. © 2011 Elsevier España, S.L. y SEMICYUC.


Montejo M.,Hospital Universitario Of Cruces
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2012

In diabetic patients, there is a high prevalence of skin or nasal carriage of Staphylococcus aureus, which is associated with an increased risk of local or systemic infections and consequently with greater morbidity and mortality. The microorganisms causing most infections in diabetic ulcers and diabetic foot are S. aureus and Streptococcus pyogenes, although chronic diabetic foot infections are generally polymicrobial, including Pseudomonas aeruginosa and enterobacteria. The present article describes experience with daptomycin in the treatment of the most frequent infectious complications in diabetic patients. The Cubicin Outcomes Registry and Experience (CORE) registry contains information on 60 patients with skin and soft tissue infections treated with daptomycin, with a success rate of 83%. Other recent studies comparing daptomycin with vancomycin or semi-synthetic penicillins have also shown the efficacy and safety of daptomycin with cure rates of between 70% and 80%. In the European version of the CORE registry, the EUROCORE, diabetic patients who developed bacteremia or endocarditis due to Gram-positive pathogens and who received daptomycin showed success rates of 76.8% and 72%, respectively. No significant differences were found in a study comparing daptomycin or standard therapy with vancomycin in methicillin-resistant S. aureus (MRSA) or antistaphylococcal penicillin in methicillin-susceptible S. aureus (MSSA) in diabetic patients with bacteremia or endocarditis. Because of its rapid bactericidal action and scarce adverse effects, daptomycin is an attractive antimicrobial agent in the treatment of Gram-positive infections in diabetic patients, whether in monotherapy or in association with other agents. © 2011 Elsevier España, S.L. All rights reserved.


Garcia L.I.R.,University of Navarra | Garcia L.I.R.,Hospital Universitario Of Cruces | Azorin J.F.P.,Hospital Universitario Of Cruces
Medical Physics | Year: 2013

Purpose: To compare how the inclusion of the uncertainties in dose and optical density affects the results of the calibration of Gafchromic ® EBT3 radiochromic films. Methods: Five methods of least square minimization were compared for calibration of radiochromic films. These differed in the way in which the uncertainties of dose and optical density are taken into account. The comparison was made by simulating the calibration fit at an increasing number of points measured in the calibration table and in the gamma analysis of ten real IMRT verifications. Results: According to the results of the simulations, the methods that take into account all the variability in dose and optical density are superior to those that do not use them. The improvements are reflected in lower bias of the parameters, lower variability and faster convergence when the number of the points increases in the calibration table. When these methods are employed in the gamma analysis comparison, the statistical significance of the results depends on how restrictive the parameters are that define this comparison. Conclusions: Methods that take into account all the variability both in dose and in optical density should be used in the calibration process. © 2013 American Association of Physicists in Medicine.


Ruiz Aja E.,Hospital Universitario Of Cruces
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2012

Hirschsprung disease (HSCR) is caused by the absence of ganglion cells in the intestine due to defects in the migration of enteric nervous system cells during embryologic development. The incidence is one in every 5000 births, more common in men than women. There are two main phenotypes according to the aganglionic segment length: Short (S-HSCR, (80% of patients) and Long (L-HSCR, 20%). Variations have been detected in the coding sequence of the RET proto-oncogene in patients with HSCR, suggesting a genetic predisposition to the disease. Our aim is to find and analyze polymorphisms (SNPs) associated with the disease. We are interested also in stablish an association between sex and type of aganglionic segment. We analyzed the RET promoter as well a polymorphism in exon 13 strongly associated to the disease. The populations for the study were a group of 56 patients with sporadic HSCR and 178 healthy controls. The results obtained show that the disease is more common in men than in women (3:1). The RET genotype shows that alleles A and G of the promoter (c.-200A > G and c.-196C > A) and G of exon 13 (c.2307T > G) are associated with the affected population. Our data suggest neither association between the disease phenotype and the distribution of the polymorphisms analyzed nor with the sex of the patients. The presence of certain polymorphisms in the RET sequence indicates a genetic predisposition (combined with other genetic or environmental factors) to the disease.


Combination antiretroviral therapy (ART) has increased patient survival, which is currently similar to that of the general population in western countries. However, ART is unable to completely restore normal health, given the persistence of chronic immune activation. Human immunodeficiency virus (HIV) infection has become a chronic disease and 50% of patients will soon be older than 50 years. Currently, there is a debate on the possibility of accelerated aging in the HIV-infected population. An overlap has been observed between chronic inflammation, age-related comorbidities, lifestyle, and the long-term toxicity of ART. ART-related toxicity can encourage the development of comorbidities, especially cardiovascular and renal complications, while toxicity-especially that of thymidine analogs-can also contribute to inflammation and aging. Evidence is available on simplification strategies with boosted protease inhibitor monotherapy aiming to avoid or reduce potential or demonstrated toxicity. Currently, studies are underway of dual therapy strategies with lopinavir/ritonavir (LPV/r) with distinct antiretroviral agents. The studies with the largest samples are those with raltegravir and lamivudine. The GARDEL trial has demonstrated that dual therapy with LPV/r plus a generic drug such as lamivudine is non-inferior to triple therapy in treatment-naïve patients. All of the above indicates the response to the challenge posed to LPV/r by the chronic phase of the disease and by the need to reduce costs. © 2014 Elsevier España, S.L. All rights reserved.


De Las Heras J.,Hospital Universitario Of Cruces | De Las Heras J.,University of Pittsburgh | Rajakumar K.,Childrens Hospital of Pittsburgh of UPMC | Lee S.,University of Pittsburgh | And 5 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-To 1) determine if plasma 25-hydroxyvitamin D (25[OH]D) concentrations differ among obese youth with normal glucose tolerance (NGT) versus prediabetes versus type 2 diabetes and 2) assess the relationships between 25(OH)D and in vivo insulin sensitivity and β-cell function in this cohort. RESEARCH DESIGN AND METHODS-Plasma 25(OH)D concentrations were examined in banked specimens in 9- to 20-year-old obese youth (n = 175; male 42.3%, black 46.3%) (NGT, n = 105; impaired glucose tolerance [IGT], n = 43; type 2 diabetes, n = 27)who had in vivo insulin sensitivity and secretion measured by hyperinsulinemic-euglycemic and hyperglycemic clamp techniques and had an assessment of total body composition and abdominal adiposity. RESULTS-The mean age and BMI of the subjectswere 14.3±2.1 years and 35.7 ±5.6 kg/m2, respectively. BMI, plasma 25(OH)D, and the proportion of vitamin D-deficient and -insufficient children did not differ across the three groups. Furthermore, there was no association between 25(OH)D and in vivo insulin sensitivity or β-cell function relative to insulin sensitivity (disposition index) in all groups combined or in each group separately. CONCLUSIONS-Our data in obese youth show 1) no differences in plasma 25(OH)D concentrations across the glucose tolerance groups and 2) no relationship between 25(OH)D and in vivo insulin sensitivity and β-cell function relative to insulin sensitivity in any of the groups. It remains uncertain if enhancement of the vitamin D status could improve pathophysiological mechanisms of prediabetes and type 2 diabetes in obese youth. © 2013 by the American Diabetes Association.


Objective: To analyze changes in the epidemiology of poisonings attended in Spanish pediatric emergency departments in the last decade. Methods: Comparative study with historical control group. The characteristics of poisoning cases were extracted from the records of hospital emergency departments participating in the working group on poisonings of the Spanish Society of Pediatric Emergency Medicine (GTI-SEUP). We studied 2 groups comprised of cases from 2 periods: January 2001 to December2002 (data from the paper records of 17 departments) and October 2008 to September 2010 (data from the computerized records of 38 departments). Results: The frequency of poisoning among all emergencies attended was higher in the second period (0.33%) than in the first (0.28%) (P=.0076). In both periods around 75% of poisonings occurred in children aged 6 years or under (78.3% in the first period and 73.8% in the second). Medicines were the substances most often involved (54.7% and 51.6% in the first and second periods, respectively). The individual substances most often ingested were paracetamol in 2001-2002 and ethanol in 2008-2010. Ethanol poisonings increased from 7.5% of all cases in the first period to 16% in the second (P<.00001); abuse of illegal drugs (mainly cannabis) was associated with alcohol poisoning in nearly 9% of the cases. A third of the patients were discharged after initial evaluation and treatment. Conclusions: Involuntary ingestion of a medicine by a child under the age of 6 years continues to be the main cause of acute poisoning in Spanish pediatrics, although poisoning due to recreational use of alcohol has increased significantly. Ethanol is now the main single toxic substance implicated in cases of acute poisonings attended by Spanish pediatric emergency departments.


Perez Azorin J.F.,Hospital Universitario Of Cruces | Ramos Garcia L.I.,University of Pamplona | Marti-Climent J.M.,University of Pamplona
Medical Physics | Year: 2014

Purpose: An improved method for multichannel dosimetry is presented. This method explicitly takes into account the information provided by the unexposed image of the film. Methods: The method calculates the dose by applying a couple of perturbations to the scanned dose, one dependent and the other independent on the color channel. The method has been compared with previous multichannel and two single channel methods (red and green) against measurements using two different tests: first, five percentage depth dose profiles covering a wide range of doses; second, the dose map perpendicular to the beam axis for a 15 × 15cm2 square field. Finally, the results of 30 IMRT quality assurances tests are presented. All tests have been evaluated using the gamma analysis. Results: The coefficient of variation was found to be similar for all methods in a wide range of doses. The results of the proposed method are more in agreement with the experimental measurements and with the treatment planning system. Furthermore, the differences in the mean gamma pass rates are statistically significant. Conclusions: The improved multichannel dosimetric method is able to remove many of the common disturbances usually present in radiochromic films and improves the gamma analysis results compared with the other three methods. © 2014 American Association of Physicists in Medicine.


Gastaca M.,Hospital Universitario Of Cruces
Transplantation Proceedings | Year: 2012

Biliary complications (BCs) are a common source of morbidity after liver transplantation, leading to long-term and repeated therapies. The incidence of BCs currently ranges from 5% and 25%. Biliary strictures and leaks are the most common complications after deceased donor liver transplantation (DDLT), occurring in 9%-12% and 5%-10% of cases, respectively. Hepatic artery complications are recognized as the major risk factor for BCs; however, other circumstances such as advanced donor age, prolonged cold and warm ischemia times, grafts from donors after cardiac death, occurrence of a previous bile leak, T-tube use, cytomegalovirus infection, or graft steatosis have also been reported to be potential risk factors. Use of various preservation solutions has not significantly improved the biliary complication rate after DDLT. Technical modifications in biliary reconstruction have been proposed to improve outcomes after DDLT; the use of a T-tube for biliary reconstruction continues to be controversial. Non anastomotic strictures (NAS) are recognized to be different from anastomotic strictures. Although they have been associated with ischemic or immunological mechanisms, bile salt toxicity has recently been recognized as a potential factor for NAS. Donation after cardiac death is a significant source of organs that has been associated with decreased graft survival due to the increased BCs. © 2012 Elsevier Inc. All rights reserved.


Miranda-Zapico I.,University of the Basque Country | Eraso E.,University of the Basque Country | Hernandez-Almaraz J.L.,Hospital Universitario Of Cruces | Lopez-Soria L.M.,Hospital Universitario Of Cruces | And 3 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2011

Objectives: There is scarce information on the clinical relevance and antifungal susceptibility of Candida bracarensis, Candida nivariensis, Candida orthopsilosis and Candida metapsilosis. The objective of this study was to assess the prevalence and in vitro antifungal susceptibility of these cryptic species among 173 blood isolates previously identified as Candida glabrata or Candida parapsilosis at the Hospital of Cruces (Barakaldo, Spain). The survey was extended to 518 clinical isolates from the culture collection of the Universidad del Pai{dotless}́s Vasco-Euskal Herriko Unibertsitatea (UPV-EHU; Bilbao, Spain). Methods: In vitro susceptibilities to 5-fluorocytosine, amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, micafungin, posaconazole and voriconazole were tested. Results: All isolates of C. glabrata were identified as C. glabrata sensu stricto. Inside the C. parapsilosis complex, 2.4% of isolates from the Hospital of Cruces and 5.8% from the UPV-EHU were C. metapsilosis or C. orthopsilosis. Of 457 isolates, 435 (95.19%) were C. parapsilosis sensu stricto, 11 (2.41%) C. metapsilosis and 11 (2.41%) C. orthopsilosis. Only seven blood isolates were C. metapsilosis (0.44%) or C. orthopsilosis (1.09%). These cryptic species were also isolated from other relevant clinical specimens. Four C. parapsilosis sensu stricto (5.6%) were susceptible dose-dependent, and one was resistant to both fluconazole and voriconazole (1.4%). Moreover, 19 isolates of C. parapsilosis sensu stricto (26.4%) were intermediately susceptible to itraconazole and higher concentrations of echinocandins were needed to inhibit this species. Most C. orthopsilosis and C. metapsilosis were susceptible to all antifungal agents tested, but one otic isolate of C. metapsilosis was resistant to fluconazole and 5-fluorocytosine. Conclusions: C. metapsilosis and C. orthopsilosis are associated with human disease and show a different antifungal susceptibility profile compared with C. parapsilosis sensu stricto. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

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