«Correct Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease»: A Consensus Document [Documento de consenso «Uso adecuado de los corticoides inhalados en la enfermedad pulmonar obstructiva crónica»]
Alcazar Navarrete B.,Hospital Of Alta Resolucion Of Loja |
Casanova C.,Hospital Universitario Nuestra Senora Of La Candelaria |
Miravitlles M.,Hospital Universitari Vall dHebron |
de Lucas P.,Hospital General Universitario Gregorio Maranon |
And 2 more authors.
Archivos de Bronconeumologia | Year: 2015
Introduction: Indications for inhaled corticosteroids (IC) in combination with long-acting bronchodilators (LABD) are well defined in clinical practice guidelines. However, there are some doubts about their efficacy and safety. The aim of this document is to establish an expert consensus to clarify these issues. Method: A coordinator group was formed, which systematically reviewed the scientific evidence with the aim of identifying areas of uncertainty about the efficacy of ICs, the adverse effects associated with their use and criteria for withdrawal. Their proposals were submitted to a panel of experts and the Delphi technique was used to test the level of consensus. Results: Twenty-five experts participated in the panel, and consensus was reached on the use of IC in the mixed chronic obstructive pulmonary disease (COPD)-asthma phenotype and in frequent exacerbators, and on not using IC in association with LABD for improving lung function in COPD. There was no general consensus on restricting the use of IC to prevent adverse effects. The panel did agree that IC withdrawal is feasible but should be undertaken gradually, and patients who have discontinued must be evaluated in the short term. Conclusions: Consensus was reached regarding the indication of IC in mixed COPD-asthma and frequent exacerbator phenotypes. The potential for adverse effects must be taken into consideration, but there is no consensus on whether limiting use is justified. The withdrawal of ICs was uniformly agreed to be feasible. © 2014 SEPAR.
Marin J.M.,Hospital Universitario Miguel Servet |
Marin J.M.,Hospital Miguel Servet |
Cote C.G.,Bay Pines VA Health Care System |
Diaz O.,University of Chile |
And 8 more authors.
Respiratory Medicine | Year: 2011
Rationale: COPD is a debilitating disease with increasing mortality worldwide. The BODE index evaluates disease severity and the St George's Respiratory Questionnaire (SGRQ) measures health status. Objective: To identify the relationship between BODE index and the SGRQ and to test the predictive value of both tools against survival. Methods: Open cohort study of 1398 COPD patients (85% male) followed for up to 10 years. Measurements and main results: At the time of the inclusion, clinical data, forced spirometry and 6 min walking distance were determined and BODE index and SGRQ were calculated. Vital status and cause of death were documented at the end of follow-up. Results: The cohort's mean of FEV1% predicted was 46 ± 18%, BODE index was 3.6 ± 2.5, and SGRQ% total score was 49 ± 20. The SGRQ scores increased progressively as severity of COPD increased by BODE quartiles. The correlation between SGRQ and BODE index was good (r = 0.58, p < 0.0001). Both tests correlated with COPD survival (BODE = -0.4 vs. SGRQ = -0.20, p < 0.0001). The area under the curve (AUC) for the BODE index was 0.77 vs. 0.66 for the SGRQ % total score (p < 0.001). Conclusions: Health status as measured by SGRQ worsens with disease severity evaluated by the BODE index. Both tools predict mortality and provide complimentary information in the evaluation of patients with COPD. © 2010 Elsevier Ltd. All rights reserved.
Quevedo O.,Hospital Universitario Nuestra Senora Of La Candelaria |
Quevedo O.,Copenhagen University |
Ramos-Perez C.,Hospital Universitario Nuestra Senora Of La Candelaria |
Petes T.D.,Duke University |
Machin F.,Hospital Universitario Nuestra Senora Of La Candelaria
Genetics | Year: 2015
Genomic instability is a common feature found in cancer cells . Accordingly, many tumor suppressor genes identified in familiar cancer syndromes are involved in the maintenance of the stability of the genome during every cell division and are commonly referred to as caretakers. Inactivating mutations and epigenetic silencing of caretakers are thought to be the most important mechanisms that explain cancer-related genome instability. However, little is known of whether transient inactivation of caretaker proteins could trigger genome instability and, if so, what types of instability would occur. In this work, we show that a brief and reversible inactivation, during just one cell cycle, of the key phosphatase Cdc14 in the model organism Saccharomyces cerevisiae is enough to result in diploid cells with multiple gross chromosomal rearrangements and changes in ploidy. Interestingly, we observed that such transient loss yields a characteristic fingerprint whereby trisomies are often found in small-sized chromosomes, and gross chromosome rearrangements, often associated with concomitant loss of heterozygosity, are detected mainly on the ribosomal DNA-bearing chromosome XII. Taking into account the key role of Cdc14 in preventing anaphase bridges, resetting replication origins, and controlling spindle dynamics in a well-defined window within anaphase, we speculate that the transient loss of Cdc14 activity causes cells to go through a single mitotic catastrophe with irreversible consequences for the genome stability of the progeny. © 2015 by the Genetics Society of America.
Perez-Etchepare E.,Hospital Universitario Nuestra Senora Of La Candelaria
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2012
Pericardial tamponade is a rare medical emergency in children. We describe a 16 years old patient, who presented with pneumonia localized in upper left lobe complicated with lung abscess and ipsilateral pleural effusion, associated with pericardial effusion. The initial treatment was: broad-spectrum antibiotics, left thoracic drenage and pericardiocentesis After 24 hours postoperative, developed circulatory collapse with significant increase in pericardial effusion. The preoperative studies were thoracic CT-scann and echocardiography, showing an increase of pericardial effusion with no major changes in lung pathology. We performed a pericardial window by right thoracoscopic. After this, quickly improved clinically and the echocardiography 24 hours postoperatively was normal. The thoracoscopic approach in cases of pericardial tamponade is an useful alternative, benefiting the patient of minimally invasive approaches.
Sanchez-Quintana A.,Hospital Universitario Nuestra Senora Of La Candelaria
BMJ case reports | Year: 2013
We describe a case of progressive multifocal leucoencephalopathy (PML) in a 39-year-old patient diagnosed with chronic lymphocytic leukaemia (CLL) who underwent two allogenic matched-sibling stem cell transplantations. PML was confirmed just after the first transplantation with cerebral MRI and by PCR in the cerebrospinal fluid. After immunosuppression withdrawal and cidofovir treatment, he achieved a reversal of clinical symptoms, John Cunningham (JC) virus positivity and MRI lesions regression. He remained asymptomatic for 5 years with no signs of infection activity, even though he received three new chemotherapy regimens due to a CLL relapse. However, after the second stem cell transplantation, new neurological symptoms began and a reactivation of the JC virus infection was detected. This time, treatment with mefloquine was started, but he experienced a progressive neurological deterioration and died 1 month after the symptoms began.
Perez-Etchepare E.,Hospital Universitario Nuestra Senora Of La Candelaria
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2013
Costal osteochondromas are benign, uncommon and usually asymptomatic tumors, but may be associated with severe intrathoracic complications such as pneumothorax, hemothorax, nerve or vascular injury and fractures. We report a 12 year old patient, who presented a right spontaneous pneumothorax, which did not improve with standard treatment. Thoracic CT showed a costal exostosis of 2.5 cm in length. Excision was performed by videothoracoscopy (VATS), with good postoperative course. We consider the thoracoscopic approach as the most appropriate initial way in this type of tumors.
Normal macular thickness and volume using spectral domain optical coherence tomography in a reference population [Espesor y volumen macular normal, mediante tomografía de coherencia óptica de dominio espectral, en nuestra población de referencia]
Sole Gonzalez L.,Hospital Universitario Nuestra Senora Of La Candelaria |
Abreu Gonzalez R.,Hospital Universitario Nuestra Senora Of La Candelaria |
Alonso Plasencia M.,Hospital Universitario Nuestra Senora Of La Candelaria |
Abreu Reyes P.,Hospital Universitario Nuestra Senora Of La Candelaria
Archivos de la Sociedad Espanola de Oftalmologia | Year: 2013
Objective: To establish normal values of macular thickness and volume obtained by the Cirrus SD-OCT (Carl ZeissMeditec, Dublin, CA, U.S.A.). Secondly, to assess the association between macular thickness and volume, sex and age. Material and methods: A prospective study was conducted on patients who were seen in a hospital Retina Unit, and who only had retinal disease in one eye. All the Macular Cube 512 × 128 scan protocols were performed by the same operator. Only the healthy eye was scanned in each patient. Results: A total of 100 eyes of 100 patients were analysed. The mean central foveal thickness was 261.31 ± 17.67 microns, and was significantly (P<.05) higher in males (267.74 ± 16.98 microns) than in females (255.60 ± 16.40 microns). The mean obtained for the volume of the cube was 10.09 ± 0.37 mm 3, and the mean thickness of 280.33 ± 10.34 cube um, with no statistically significant differences between gender being found (P<.05). The mean macular thickness is less at central level, increases in the inner perifoveal ring, and then decreases in the outer perifoveal ring. Furthermore, of all quadrants the greatest thickness was the nasal (328.27 ± 12.96 microns), followed by the upper (326.27 ± 11.89 microns), lower (322.53 ± 12.37 mm) sectors, with the temporal sector being the thinnest (313.35 ± 14.20 microns). The mean age of the patients was 60.86 ± 14 years. Conclusion: The mean central foveal thickness and the thickness of the inner perifoveal ring are significantly higher in men than in women. Both the mean volume and thickness of the cube, as well as nasal and inner superior sectors decrease with age, being significantly only in women. © 2012 Sociedad Española de Of talmología. Published by Elsevier España, S.L. All rights reserved.
Alvarez-Acosta L.,Hospital Universitario Nuestra Senora Of La Candelaria
BMJ case reports | Year: 2013
A 14-year-old asymptomatic girl without relevant medical history was referred to our department for heart murmur evaluation. The echocardiogram showed cardiac chambers with normal size and function. Noteworthy was the presence of an apparently fibrous tissue joining the ventricular surfaces of the aortic non-coronary and right coronary leaflets with the anterior mitral leaflet. Both valves were slightly thickened and there was a mild anterior mitral valve 'billowing' causing an eccentric mild-to-moderate regurgitant jet. During systole, tethering of this tissue caused the incomplete opening of both mentioned aortic leaflets, causing a turbulent flow with no significant gradient across the valve. During diastole, moderate eccentric aortic regurgitation jet was noted, probably related to incomplete coaptation at the insertion point of this anomalous tissue. We speculate that this finding may represent the remnant of some tissue during heart development that abnormally persisted in this young lady.
Sanchez Quintana A.,Hospital Universitario Nuestra Senora Of La Candelaria |
Rull P.R.,Hospital Universitario Nuestra Senora Of La Candelaria |
Atienza J.B.,Hospital Universitario Nuestra Senora Of La Candelaria |
McDonnell C.N.,Hospital Universitario Nuestra Senora Of La Candelaria
Nephrology | Year: 2013
Plasma cell dyscrasias (PCD) are a spectrum of diseases characterized by clonal proliferation of plasma cells secreting a monoclonal immunoglobulin. Although considered an incurable disease, a combination of autologous stem cell transplant with novel therapies, including lenalidomide, has improved the overall and progression-free survival of these patients. Renal impairment is an important complication of the disease that, in some cases, progresses to end-stage renal disease. Due to the characteristics of PCD, traditionally these patients have not been candidates for renal transplantation. However, treatment improvement allows a reconsideration of this perception, especially in younger patients with good performance status and treatment response. We report two cases of patients diagnosed with PCD undergoing renal transplantation after autologous stem cell transplantation, both cases under treatment with lenalidomide. We also report their perioperative management and their outcome. © 2013 The Authors. Nephrology © 2013 Asian Pacific Society of Nephrology.
PubMed | Hospital Universitario Nuestra Senora Of La Candelaria
Type: | Journal: BMJ case reports | Year: 2017
A 68-year-old man with alcoholic liver cirrhosis and portal hypertension was admitted due to ascites. Bilateral severe hepatic hydrothorax did not resolve despite sodium restriction, and diuretic treatment, requiring repeated thoracentesis for relief of dyspnoea. Curative options, as transjugular intrahepatic portosystemic shunt and liver transplantation were both contraindicated. An attempt of pleurodesis was ineffective. Bilateral insertion of tunnelled pleural catheter allowed symptom control and home discharge. After 6months, bilateral stable pleurodesis has been achieved and patient is still free from dyspnoea.