Hospital Universitario Of Basurto

Hospital de Órbigo, Spain

Hospital Universitario Of Basurto

Hospital de Órbigo, Spain
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The main aim of the treatment of type 2 diabetes is overall control of cardiovascular risk factors. Almost 50% of patients with type 2 diabetes do not achieve glycaemic targets, and a much higher percentage do not achieve weight and blood pressure targets, despite the therapeutic arsenal that has appeared in the last decade for the treatment of this disease. In addition, antidiabetic secretatogues and insulin are associated with weight gain and an increased risk of hyperglycaemic episodes. Clinical practice guidelines recommend sodium-glucose cotransporter-2 inhibitors (SGLT2i) as an alternative in the same therapeutic step as the other options after initiation of metformin therapy. The present study reviews the most appropriate patient profile for SGLT2i therapy, based on their safety and efficacy demonstrated in controlled clinical trials. The article discusses which patients are at risk of experiencing the possible secondary effects due to the mechanism of action of this new therapeutic class, in whom SGLT2i should be used with caution. These considerations on the profile of patients suitable for SGLT2i therapy are contrasted with the results obtained in daily clinical practice, both in retrospective studies from other countries and from real-world experiences in Spain. This article presents a selection of studies performed in distinct centres with a minimum follow-up of 6 months and compares their results with those from clinical trials. SGLT2i are used in clinical practice in any therapeutic step and the efficacy results are very similar to those reported by controlled clinical trials, with a slightly higher proportion of genitourinary infections and a low dropout rate. Half the reported patients are diabetics receiving insulin therapy plus a gliflozin, showing the wide uptake of this therapeutic strategy by clinicians. SGLT2i are especially attractive due to their additional effectiveness in weight and blood pressure control and the possibility of using them in association with other antidiabetic agents or in monotherapy in patients at any stage of type 2 diabetes. © 2016 Elsevier España, S.L.U.

Quindos G.,University of the Basque Country | Eraso E.,University of the Basque Country | Lopez-Soria L.M.,Hospital Universitario Of Cruces | Ezpeleta G.,Hospital Universitario Of Basurto
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2012

Diagnosis of invasive mycoses is a difficult challenge due to the limitations and low sensitivity of traditional microbiology methods which lead to diagnostic and therapeutic delays. The aim of this review is to summarise the state of the art of the molecular diagnosis of invasive fungal disease and to clarify its current role in the clinical practice. Conventional microbiological methods could be complemented with molecular methods in the rapid and definitive identification of fungal isolates. Biomarkers (β-glucan, galactomannan) are very useful in immunocompromised patients and have been included as probable invasive mycoses by the EORTC/MSG. Nucleic acid detection is currently used as a complementary tool for diagnosis. However, PCR can be very useful in mould invasive mycoses. Finally, the combined detection using biomarkers can improve the diagnosis. However, their applicability in the microbiology laboratory is not so easy and further studies are required for the appropriate evaluation of its clinical usefulness. © 2011 Elsevier España, S.L. All rights reserved. © 2011 Elsevier España, S.L. All rights reserved.

Peinado R.,Hospital Universitario La Paz | Arribas F.,Hospital Universitario 12 Of Octubre | Ormaetxe J.M.,Hospital Universitario Of Basurto | Badia X.,IMS Health
Revista Espanola de Cardiologia | Year: 2010

Introduction and objectives: Atrial fibrillation (AF) is one of the most common arrhythmias. It is classified according to its presentation as either paroxysmal, persistent or permanent. The presence of this arrhythmia has been associated with a decrease in patients' healthrelated quality of life (HRQoL). The Atrial Fibrillation-Quality of Life (AF-QoL) questionnaire, which is specifically for use in patients with AF, has recently been developed and validated. The aim of this study was to use this questionnaire to investigate differences in HRQoL associated with different types of AF. Methods: This prospective observational multicenter study was performed in a regular clinical context in Spain. The AF-QoL questionnaire was administered to study patients, who were diagnosed as having one of the three types of AF. Results: The study involved 341 patients with AF, 43% of whom had persistent AF, while 37% had paroxysmal AF, and 20% had permanent AF. Although the type of AF had no significant effect on the overall AF-QoL score, patients with permanent AF had the highest scores on the psychological dimension (i.e. better HRQoL). In addition, an increased frequency of symptoms, more emergency department visits, and poorer functioning were also associated with significant differences in HRQoL in AF patients. Conclusions: Use of the AF-QoL questionnaire showed that the HRQoL of AF patients was influenced by the clinical characteristics of the disease but not, except on the psychological dimension, by the type of AF. © 2010 Sociedad Espaola de Cardiologa.

Villa G.,University of Oviedo | Fernandez-Ortiz L.,University of Oviedo | Cuervo J.,University of Oviedo | Rebollo P.,University of Oviedo | And 3 more authors.
Peritoneal Dialysis International | Year: 2012

Background: We undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios. Methods: A Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4). Results: The incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, -€83 150, -€354 977, and -€235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY. Conclusions: Scenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted. © 2012 International Society for Peritoneal Dialysis.

Medina-Quinones C.V.,Hospital Universitario Ramon y Cajal | Ramos-Merino L.,Complejo Hospitalario Universitario runa | Ruiz-Sada P.,Hospital Universitario Of Basurto | Isenberg D.,University College London
Arthritis Care and Research | Year: 2016

Objective: Systemic lupus erythematosus (SLE) is characterized by an unpredictable and fluctuating course. Although various methods have been developed to measure disease activity, there is still a lack of consensus about the optimal criteria for SLE remission. The principal aim of our study was to identify the number of lupus patients achieving a complete remission (implying that for 3 years there were no clinical or serologic features and no treatment with steroids and immunosuppressive drugs) in a single cohort of patients followed for a period of up to 32 years. In addition, we have identified patients in clinical but not serologic remission (known as serologically active, clinically quiescent disease [SACQ]) and vice versa. We were particularly interested to determine the factors associated with complete remission. Methods: Eligible patients were followed up in the University College Hospital Lupus cohort from January 1978 until December 2010 for a period of at least 3 years. Complete remission was defined as a period of at least 3 years with clinical inactivity (British Isles Lupus Assessment Group scores of C, D, or E only) and laboratory remission (no antibodies to double-stranded DNA and normal complement C3 levels), and being off-treatment with corticosteroids and immunosuppressants. Antimalarial and nonsteroidal antiinflammatory drugs were allowed. Results: Of 624 lupus patients at our hospital, a total of 532 patients met the strict inclusion criteria for the study. Of these 532 patients, 77 patients (14.5%) achieved complete remission for at least 3 years, and 23 (4.3%) achieved complete remission for a minimum period of 10 years. Ten of these 77 patients were subsequently lost to followup, and, interestingly, flares occurred subsequently in 15 of the 67 remaining patients (22.4%). Three patients relapsed after the tenth year of remission. Forty-five patients (8.5%) fulfilled the requirement for SACQ, and 66 patients (12.4%) achieved only serologic remission. Conclusion: Our study indicated that 14.5% of lupus patients achieved a complete remission for 3 years. However, flares may continue to occur beyond 10 years of remission. Long-term followup of SLE is therefore mandatory. © 2016, American College of Rheumatology

Gonzalez-Torres M.A.,Hospital Universitario Of Basurto
International Forum of Psychoanalysis | Year: 2014

An individual's identity is gradually built upon a lifelong process of maturation. Sexual life and how our desire is channeled and expressed represent a key area of that global identity. Also, the nation to which we feel we belong constitutes another cornerstone of that complex structure. The obvious attraction that nationalism awakens in many parts of the world might be related to the facilitation of a valuable identity acquired by just belonging to a idealized group instead of through a tiresome and continuous effort. In this process, "others" are chosen by us to establish comparisons with our tribe, helping us through a mirroring process to shape our own image. We project upon those "others" all kinds of undesirable traits. Those attributions tend to be very similar, regardless of which specific groups are involved. The "others" are always lazy, dishonest, untrustworthy, dirty. Interestingly, there are a specific set of "positive" attributions that are almost always present: the "others," and specifically the men in that group, are sexually more potent, attractive, or able. This contradictory image of the "other" can help us to understand the complex dynamics, at the individual and group levels, that are present in radical nationalist movements, and to open up new fields of inquiry and exploration in which psychoanalytic theory can offer guidance. © 2013 © 2013 The International Federation of Psychoanalytic Societies.

Murga N.,Hospital Universitario Of Basurto
Revista Espanola de Cardiologia Suplementos | Year: 2013

The management of chronic ischemic heart disease has advanced and mortality has decreased. However, despite improvements in diagnosis and therapy, angina may persist and have a serious effect on quality of life. The beneficial effects of the secondary prevention of cardiovascular disease on morbidity and mortality have been well established, but these benefits are frequently diminished by nonadherence, therapeutic inertia and social inequality. Patients with a history of ischemic heart disease are at an increased risk of a new coronary event, and systematic follow-up coupled to the use of risk markers that enable risk to be stratified could help us improve outcomes. Changing health-care needs, comorbidities and aging all increase costs in patients with chronic disease. In integrated-care models, the primary care team takes the leading role in monitoring and providing care for patients with stable disease, while the cardiologist acts as a consultant and deals with newly diagnosed conditions and with patients who need closer follow-up or special investigations. © 2013 Sociedad Española de Cardiología.

Alvarez Aldean J.,Hospital Costa del Sol | Aristegui J.,Hospital Universitario Of Basurto | Lopez-Belmonte J.L.,Sanofi S.A. | Pedros M.,IMS Health | Sicilia J.G.,Hospital Universitario La Paz
Vaccine | Year: 2014

Severe rotavirus gastroenteritis is common in children under 5 years of age. A literature review was performed to investigate the economic and psychosocial impact of rotavirus infection in children in this age group. We retrieved 56 articles on the economic burden of the disease in Europe, 18 of them reported data from Spain; 8 articles were retrieved analysing its psychosocial impact. In Spain, rotavirus is responsible for 14% to 30% of all cases of gastroenteritis, and a quarter of these require hospitalisation. It is also associated with high use of health care resources (emergency and primary care visits). Rotavirus gastroenteritis costs the Spanish national health system EUR 28 million a year and causes productivity loss in two-thirds of parents (mean of 4 days). Taking into account these costs, it was estimated that implementing universal vaccination could prevent 76% to 95% of hospital admissions due to rotavirus gastroenteritis, as well as reduce emergency and paediatric visits, nosocomial infections, and days missed from work (77% reduction). Rotavirus gastroenteritis also has a considerable psychosocial impact on the family, although it is difficult to compare results due to the diversity of study designs and the low specificity of the measurement tools used. It also causes high stress among parents, adding to their workload and adversely affecting their quality of life. © 2014 Elsevier Ltd.

Sada P.R.,Hospital Universitario Of Basurto | Sada P.R.,University College London | Isenberg D.,Hospital Universitario Of Basurto | Isenberg D.,University College London | And 2 more authors.
Rheumatology (Oxford, England) | Year: 2015

SS is a chronic systemic autoimmune disease characterized by decreased exocrine gland function. A variety of other disease manifestations may also be present, including general constitutional symptoms and extraglandular features. A multidisciplinary approach focused on both local and systemic medical therapies is needed as the disease has a wide clinical spectrum. The current treatment for SS is mainly symptomatic. However, there is evidence that systemic drugs are effective in controlling extraglandular manifestations of the disease. Overall evidence for the role of conventional immunosuppressive therapy is limited. A number of attempts to use biologic therapies have led to variable results. Biologic agents targeting B cells, such as rituximab, epratuzumab and belimumab, have shown promising results, but further studies are needed to validate the findings. Early-phase studies with abatacept and alefacept proved that T cell stimulation inhibition is another potentially effective target for SS treatment. Modulation or inhibition of other targets such as IFN, IL-6 and Toll-like receptor are also currently being investigated. We have summarized the available evidence regarding the efficacy of biologic treatments and discuss other potential therapies targeting pathways or molecules recognized as being involved in the pathogenesis of SS. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email:

Ynsaurriaga F.A.,Hospital 12 Of Octubre | Peinado R.P.,Hospital Universitario La Paz | Ormaetxe Merodio J.M.,Hospital Universitario Of Basurto
Future Cardiology | Year: 2014

Anticoagulation therapy is essential to reduce the risk of stroke in patients with atrial fibrillation. Traditionally, clinical trials have focused only on determining the efficacy and safety of anticoagulation but not on quality of life. In the last few years there has been a growing interest in determining the quality of life of patients treated with oral anticoagulation. In fact, specific tools that can evaluate quality of life related to atrial fibrillation and anticoagulation have been developed. Vitamin K antagonists have been shown to be effective in the prevention of thromboembolic complications. However, the use of vitamin K antagonists implies changes in behavior and lifestyle modifications that may have a negative impact on the quality of life. It has been suggested that self-monitoring of international normalized ratio could improve this impact. On the other hand, as new oral anticoagulants overcome these limitations, they may improve quality of life related with anticoagulant therapy. Unfortunately, although encouraging, the clinical experience with them is still quite limited. © 2014 Future Medicine Ltd.

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