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Espino R.,Hospital Universitario Nuestra Senora Of Valme
Anales de Pediatria | Year: 2012

An epidemiological study was conducted to assess the anthropometric development in children diagnosed with primary monosymptomatic nocturnal enuresis, depending on the treatment option selected. Patients and methods: A longitudinal series of cases including 548 children aged 5-10 years. Anthropometric parameters of children were assessed at diagnosis, and after one and two years of treatment. Results: Children with primary monosymptomatic nocturnal enuresis showed no anthropometric changes when their data were compared to the standard deviation score of height, weight, and body mass index (BMI). Overall, no changes were seen in the above mentioned parameters after two years of treatment for enuresis (except for a weight standard deviation score (SDS) decrease in boys). We only found a decrease in the size and weight in those children undergoing behavioral therapy with or without an alarm, findings that, given the limitations of the study, were not considered significant. The odds ratio for cure after one and two years of treatment was 1.41 (95% CI: 0.85-2.34) and 1.52 (95% CI: 0.86-2.70) for desmopressin (and watchful waiting) as compared to all other options. Conclusions: In this study, children had SDS values of height, weight, and BMI similar to healthy children of the same age and sex before and after treatment for primary monosymptomatic nocturnal enuresis. Desmopressin appeared to increase the probability of cure after one and two years of treatment, however these data should be corroborated in future randomized clinical trials. © 2011 Asociación Española de Pediatría. Source


Tocino A.,IVI Seville | Blasco V.,IVI Seville | Prados N.,IVI Seville | Prados N.,Pablo De Olavide University | And 6 more authors.
Fertility and Sterility | Year: 2015

Objective To describe a case of monozygotic twinning with asymmetric development following a single fresh embryo transfer as part of an intracytoplasmic sperm injection (ICSI) treatment. Secondarily, to report the incidence of monozygotic twinning at the IVI (Instituto Valenciano de Infertilidad) clinics. Design Case report. Setting Private fertility centers. Patient(s) A 33-year-old woman with a 2-year history of primary infertility. Intervention(s) Controlled ovarian hyperstimulation and ICSI treatment with single-embryo transfer. Main Outcome Measure(s) Incidence of monozygotic twinning at the IVI clinics. Result(s) We report a twin pregnancy after a single-embryo transfer. Twins were dichorionic and diamniotic. One fetus had a 6-day delay in its growth compared with the other when observed by ultrasound. Two female infants were delivered, and despite presenting congenital diseases, they were successfully treated and evolved correctly. A subsequent DNA analysis confirmed that the infants were monozygotic. Furthermore, we estimated a monozygotic twinning rate of 1.17% at the IVI clinics, taking into account those cases in which two or more embryos with heart beats were observed by ultrasound scanning after single-embryo transfers. Conclusion(s) Ultrasound scans performed during pregnancy suggested a possible dizygotic origin of the twins, but DNA analysis performed after birth established that they were monozygotic. Genetic analysis is the only valid tool to confirm if like-sex dichorionic twins are monozygotic or dizygotic. © 2015 American Society for Reproductive Medicine. Source


Socias Crespi L.,Servicio de Medicina Intensiva | Ceniceros Rozalen M.I.,Servicio de Emergencias del 061 Illes Balears | Rubio Roca P.,Servicio de Emergencias del 061 Illes Balears | Martinez Cuellar N.,Servicio de Emergencias del 061 Illes Balears | And 3 more authors.
Medicina Intensiva | Year: 2015

Objective: To describe the epidemiology of out-of-hospital cardiorespiratory arrest (OHCA) and identify factors associated with recovery of spontaneous circulation (ROSC). Design: Observational study of OHCA registered on a continuous basis in the Emergency Medical Services (EMS) database during 2009-2012. Setting: The islands of Mallorca, Ibiza, Menorca and Formentera (Balearic Islands, Spain). Patients: OHCA in patients ≥ 18 years of age.The main variables were: Patient sex, age, probable cause, place of arrest, bystander, witnessed, basic life support (BLS), shockable rhythm, intervention time, semi-automatic defibrillator (AED), duration of cardiopulmonary arrest (CA), and ROSC. Independent variables were defined according to the Utstein protocol, and the dependent variable was defined as ROSC. Results: The EMS treated 1170 OHCAs (28/100,000 persons-year). We included 1130 CA. The mean age was 61.4 years (73.4% males). Most CA (72.3%) were of cardiac etiology, and 84.7% were witnessed. A total of 840 (74.3%) received BLS and 400 (47.6%) did so before arrival of the EMS (45 by bystander relatives). AED was available in 330 cases CA (29.2%) (96 with shockable rhythm). The interval between emergency call and BLS and between emergency call and advanced life support was 8.4 and 15.8. min, respectively. Shockable rhythm was monitored in 257 CAs (22.7%). ROSC occurred in 261 (23.1%). Factors associated with ROSC were age, shockable rhythm, BLS before EMS arrival, and CA duration less than 30. min. Conclusion: The incidence rate of the OHCA is low. The proportion of patients receiving BLS from relatives was low. Age, shockable rhythm and BSL before EMS arrival were associated with ROSC. © 2013 Elsevier España, S.L.U. and SEMICYUC. Source


Navarro Valverde C.,Hospital Universitario Nuestra Senora Of Valme | Nunez Gil I.,Servicio de Cardiologia | Fernandez Ortiz A.,Servicio de Cardiologia
Medicina Clinica | Year: 2013

Obstructive coronary artery disease is not detected in up to 14% of patients who present with acute coronary syndrome (ACS). Diagnosis of the underlying cause is usually not made and there is much controversy regarding prognosis. Those patients who develop ACS while having normal or near normal coronary arteries are more frequently young women and have fewer cardiovascular risk factors (CVRF). Its prognosis has typically been excellent. However, different results published in recent years show that these conditions are not always so benign. This might be explained by the different degrees of coronary obstruction, varied clinical presentation, biomarkers' mobilization or CVRF. It is necessary to determine the cause of ACS and stratify the risk of these patients in order to establish the appropriate treatment. This is especially relevant in those cases of coronary disease not detected by angiography, in which the absence of specific treatment can lead to poorer prognosis. © 2012 Elsevier España, S.L. All rights reserved. Source


Afdhal N.,Beth Israel Deaconess Medical Center | Zeuzem S.,Goethe University Frankfurt | Kwo P.,Indiana University | Chojkier M.,University of California at San Diego | And 20 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: In phase 2 studies, treatment with the all-oral combination of the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor ledipasvir resulted in high rates of sustained virologic response among previously untreated patients with hepatitis C virus (HCV) genotype 1 infection. METHODS: We conducted a phase 3, open-label study involving previously untreated patients with chronic HCV genotype 1 infection. Patients were randomly assigned in a 1:1:1:1 ratio to receive ledipasvir and sofosbuvir in a fixed-dose combination tablet once daily for 12 weeks, ledipasvir-sofosbuvir plus ribavirin for 12 weeks, ledipasvir-sofosbuvir for 24 weeks, or ledipasvir-sofosbuvir plus ribavirin for 24 weeks. The primary end point was a sustained virologic response at 12 weeks after the end of therapy. RESULTS: Of the 865 patients who underwent randomization and were treated, 16% had cirrhosis, 12% were black, and 67% had HCV genotype 1a infection. The rates of sustained virologic response were 99% (95% confidence interval [CI], 96 to 100) in the group that received 12 weeks of ledipasvir-sofosbuvir; 97% (95% CI, 94 to 99) in the group that received 12 weeks of ledipasvir-sofosbuvir plus ribavirin; 98% (95% CI, 95 to 99) in the group that received 24 weeks of ledipasvir-sofosbuvir; and 99% (95% CI, 97 to 100) in the group that received 24 weeks of ledipasvir-sofosbuvir plus ribavirin. No patient in either 12-week group discontinued ledipasvir- sofosbuvir owing to an adverse event. The most common adverse events were fatigue, headache, insomnia, and nausea. CONCLUSIONS: Once-daily ledipasvir-sofosbuvir with or without ribavirin for 12 or 24 weeks was highly effective in previously untreated patients with HCV genotype 1 infection. (Funded by Gilead Sciences; ION-1 ClinicalTrials.gov number NCT01701401.) Copyright © 2014 Massachusetts Medical Society. Source

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