Las Palmas de Gran Canaria, Spain
Las Palmas de Gran Canaria, Spain

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Abasolo I.,University of La Laguna | Barber P.,University of Las Palmas de Gran Canaria | Gonzalez Lopez-Valcarcel B.,University of Las Palmas de Gran Canaria | Jimenez O.,Hospital Universitario Of Gran Canaria Doctor Negrin
Gaceta Sanitaria | Year: 2014

Objectives: In Spain, official information on waiting times for surgery is based on the interval between the indication for surgery and its performance. We aimed to estimate total waiting times for surgical procedures, including outpatient visits and diagnostic tests prior to surgery. In addition, we propose an alternative system to manage total waiting times that reduces variability and maximum waiting times without increasing the use of health care resources. This system is illustrated by three surgical procedures: cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair. Methods: Using data from two Autonomous Communities, we adjusted, through simulation, a theoretical distribution of the total waiting time assuming independence of the waiting times of each stage of the clinical procedure. We show an alternative system in which the waiting time for the second consultation is established according to the time previously waited for the first consultation. Results: Average total waiting times for cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair were 331, 355 and 137 days, respectively (official data are 83, 68 and 73 days, respectively). Using different negative correlations between waiting times for subsequent consultations would reduce maximum waiting times by between 2% and 15% and substantially reduce heterogeneity among patients, without generating higher resource use. Conclusion: Total waiting times are between two and five times higher than those officially published. The relationship between the waiting times at each stage of the medical procedure may be used to decrease variability and maximum waiting times. © 2013 SESPAS.


Rua-Figueroa I.,Hospital Universitario Of Gran Canaria Doctor Negrin | Arencibia-Mireles O.,Canarias Government | Elvira M.,Hospital Universitario Of Gran Canaria Doctor Negrin | Erausquin C.,Hospital Universitario Of Gran Canaria Doctor Negrin | And 7 more authors.
Annals of the Rheumatic Diseases | Year: 2010

Objectives: To assess the changes in carotid intima-media thickness (IMT) and the associated risks factors in patients with low severity systemic lupus erythematosus (SLE). Methods: Common carotid IMT measurements were obtained by ultrasound from 101 patients with SLE at an interval of 2 years. Cardiovascular risk factors, disease activity, accumulated damage, severity (Katz index) and biochemical parameters (including high sensitivity C-reactive protein, interleukin 6, C3a, C4a, C5a and homocysteine) were also assessed. Multiple linear regression was used to assess the effect of these variables on the end IMT measurement (eIMT) adjusted to the baseline measurement (bIMT). Results: The cohort comprised 94.1% women, with a mean age at entry of 41.5 years and a mean disease duration of 12.1 years. An increase of 0.078 mm in IMT was detected over 2 years, from a mean bIMT of 0.37 mm to a mean eIMT of 0.44 mm (p<0.001). When adjusted for the bIMT, multiple linear regression identifi ed bIMT, age at diagnosis, homocysteine, C3 and C5a as risk factors for IMT progression. Conclusions: IMT signifi cantly increases over 2 years in patients with SLE. Age, baseline IMT, C3, C5a anaphylatoxin and homocysteine are all associated risk factors, supporting a role for complement and homocysteine in the early stages of premature SLE-associated atherosclerosis.


Rua-Figueroa I.,Hospital Universitario Of Gran Canaria Doctor Negrin | Gil-Aguado A.,Hospital Universitario La Paz | Sabio J.M.,Complejo Hospitalario Virgen Of Las Nieves | Pallares L.,Servicio de Medicina Interna | And 2 more authors.
Revista Clinica Espanola | Year: 2013

Background and objective: The cost of control and management of Systemic Lupus Erythematosus (SLE) in Spain is unknown. This study has aimed to describe the healthcare resources associated to control and treatment of LES and its flares and to estimate the associated direct costs. Patients and methods: This was a European, multicentric, retrospective study (2008-2010) carried out with the participation of 5 hospitals in Spain with experience in SLE. Adult SLE patients (ACR criteria), with positive auto-antibodies (ANA and/or anti-ds-DNA) and active disease were included. Patients were stratified into severe and non-severe SLE. Direct healthcare costs were estimated with resources used and their unit costs. Results: Seventy-five out of 79 SLE patients were analyzed. Of these, 52% had severe disease, 91.9% were females and 90.7% were Caucasian. Mean (SD) age was 41.0 (14.5) years. Annual direct cost per patient related to SLE management was 05,968 (7,038) and 03,604 (5,159) for severe and non-severe patients, respectively (P =.002). Costs related to hospitalizations, pharmacological treatment, visits to specialists, and laboratory tests were higher for patients with severe disease. At least one flare during the observation period was present in 90.7% of patients. Severe flares were a significant predictor of increase in cost. Conclusions: The cost associated with SLE control and treatment is higher for severe SLE patients. Insufficient control of the disease activity results in an increase in flares. Its presence is related to an increase in costs, hospitalization being the major component. © 2012 Elsevier España, S.L. Todos los derechos reservados.


Objectives To evaluate the impact of urinary symptoms of Painful Bladder/Pelvic Pain Syndrome and Radiation Cystitis (PBCPPS) on the Quality of Life, and self-esteem of the patient. Material and methods An observational, multicenter, epidemiological and cross-sectional study was performed on patients with Painful Bladder/Chronic Pelvic Pain Syndrome and Radiation Cystitis. Data was recorded on severity of urinary symptoms and QoL impairment using the PUF Score. The patients evaluated the QoL deterioration grade through the King's Health Questionnaire (KHQ), and the level of their anxiety and self-esteem with the Goldberg's Anxiety Scale (GAS) and Rosenberg's Self-Esteem Scale (RSES), respectively. Post-hoc comparisons were performed between the results of the KHQ of this study and a sample of patients with urinary incontinence (UI). Results on RSES were analyzed with data from the general population and from patients with erectile dysfunction. Results A total of 530 cases, mostly female patients, who had been diagnosed with PBCPPS, were analyzed. High levels of deterioration in QoL were described: KHQ scores were significantly higher when compared with patients with UI (P <.01). Involvement of self-esteem was higher in patients with RC and men, who obtained scores similar to those of patients with erectile dysfunction. Conclusions Patients with Painful Bladder Syndrome/Chronic Pelvic Pain Syndrome and Radiation Cystitis present high levels of anxiety, and significant reductions in both quality of life and self-esteem. Especially for men, this affectation is similar to that caused by erectile dysfunction. © 2013 AEU. Published by Elsevier Espana, S.L. All rights reserved.


Gonzalez-Rodriguez E.,Hospital Universitario Of Gran Canaria Doctor Negrin | Rodriguez-Abreu D.,Hospital Universitario Insular Of Gran Canaria
Oncologist | Year: 2016

In recent years, immune checkpoint inhibitors have emerged as effective therapies for advanced neoplasias. As new checkpoint target blockers become available and additional tumor locations tested, their use is expected to increase within a short time. Immune-related adverse events (irAEs) affecting the endocrine system are among the most frequent and complex toxicities. Some may be life-threatening if not recognized; hence, appropriate guidance for oncologists is needed. Despite their high incidence, endocrine irAEs have not been fully described for all immunotherapy agents available. This article is a narrative review of endocrinopathies associated with cytotoxic T lymphocyte-associated antigen-4, blockade of programmed death receptor 1 and its ligand inhibitors, and their combination. Thyroid dysfunction is the most frequent irAE reported, and hypophysitis is characteristic of ipilimumab. Incidence, timing patterns, and clinical presentation are discussed, and practical recommendations for clinical management are suggested. Heterogeneous terminology and lack of appropriate resolution criteria in clinical trials make adequate evaluation of endocrine AEs difficult. It is necessary to standardize definitions to contrast incidences and characterize toxicity patterns. To provide optimal care, a multidisciplinary team that includes endocrinology specialists is recommended. © AlphaMed Press 2016.


Zaballos P.,Hospital Of Sant Pau I Santa Tecla | Banuls J.,Hospital Universitario Of Alicante | Medina C.,Hospital Universitario Of Gran Canaria Doctor Negrin | Salsench E.,Hospital Of Sant Pau I Santa Tecla | And 2 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2014

Background The dermoscopic morphology of apocrine hidrocystomas remains to be elucidated. Objective To evaluate the morphological findings of apocrine hidrocystomas under dermoscopic observation. Methods Dermoscopic examination of 22 cases of apocrine hidrocystomas was performed to evaluate specific dermoscopic criteria and patterns. Results The most frequently occurring dermoscopic features were found to be: (i) A translucent to opaque, homogeneous area which occupies the whole lesion in all apocrine hidrocystomas (100%). The colour of this homogeneous area was skin-colored in 31.8% of our cases; yellow, in 31.8% and blue, in 22.7% of apocrine hidrocystomas. (ii) Vascular structures were identified in 81.8% of our cases; arborizing vessels, in 68.2% and linear-irregular vessels in 9.1% of our cases; and (iii) Whitish structures were identified in 22.7% of the lesions. The results of our study reveal that the presence of a homogeneous area that occupies the whole lesion and arborizing vessels is the most common dermoscopic pattern in apocrine hidrocystomas (68.2%). Conclusion Apocrine hidrocystomas, above all in its pigmented variant, may represent a dermoscopic pitfall, being difficult to differentiate clinically and dermoscopically from basal cell carcinomas. © 2012 European Academy of Dermatology and Venereology.


Gilarranz R.,Hospital Universitario Of Gran Canaria Doctor Negrin | Juan C.,Hospital Universitari Son Espases | Castillo-Vera J.,Hospital Universitari Son Espases | Chamizo F.J.,Hospital Universitario Of Gran Canaria Doctor Negrin | And 3 more authors.
Clinical Microbiology and Infection | Year: 2013

In a prospective study (2009-2011) in healthcare institutions from the Canary Islands (Spain), 6 out of 298 carbapenem non-susceptible Pseudomonas aeruginosa isolates produced a metallo-β-lactamase: four IMP-15, two VIM-2 (including one IMP-15-positive isolate) and one VIM-1. Multilocus sequence typing identified the single VIM-1-producing isolate as clone ST111 and two IMP-15-producing isolates as ST606, but, strikingly, bacterial re-identification revealed that the other three isolates (producing IMP-15 and/or VIM-2) were actually Pseudomonas putida. Further retrospective analysis revealed a very high prevalence (close to 50%) of carbapenem resistance in this environmental species. Hence, we report the simultaneous emergence in hospitals on the Canary Islands of P. putida and P. aeruginosa strains producing IMP-15, a metallo-β-lactamase not previously detected in Europe, and suggest an underestimated role of P. putida as a nosocomial reservoir of worrying transferable resistance determinants. ©2013 European Society of Clinical Microbiology and Infectious Diseases.


Ruiz-Santana S.,Hospital Universitario Of Gran Canaria Doctor Negrin
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral | Year: 2011

Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation.


Suarez-Ortega S.,Hospital Universitario Of Gran Canaria Doctor Negrin
Revista médica del Instituto Mexicano del Seguro Social | Year: 2013

Fatigue, anorexia and involuntary weight loss have been included under the term constitutional syndrome. These manifestations accompany many diseases in which the diagnosis is made by specific symptoms and signs. However, these events are generally the main reason for consultation and the patient does not report other specific data. This forces us to rigorously investigate the possible causes of the disorder. Usually, three manifestations coexist: asthenia, anorexia and weight loss, but sometimes the patient has only one or two of them. The causes of constitutional symptoms are varied and can be divided into three groups: psychiatric diseases, neoplasms and non-neoplastic diseases. The etiological identification is usually done with a simple protocol, which rules out malignancy; the rest of the cases of uncertain etiology are subject to evolution. The constitutional syndrome correlates well with good prognosis or medical functional processes. Although no clinical guidelines have been developed, score scales may help for the etiological assessment. Given the myriad of different causes of the constitutional syndrome, the treatment of this illness depends primarily on the etiology.


The ethiology and phisiopathology of the Thoracic Outlet Syndrome is presented describing the oseous, muscular, ligamentous and functional causes. The Thoracic Outlet Syndrome is divided in Neurologic, Arterial and Venous Syndrome. Clinical, diagnostic and the therapeutic basic aspects of these three Syndromes are exposed with special reference in the surgical treatment.

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