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Tarazona-Santabalbina F.J.,Hospital Universitario Of La Ribera | Tarazona-Santabalbina F.J.,University of Valencia | Gomez-Cabrera M.C.,University of Valencia | Perez-Ros P.,University of Valencia | And 6 more authors.
Journal of the American Medical Directors Association | Year: 2016

Background: Frailty can be an important clinical target to reduce rates of disability. Objective: To ascertain if a supervised-facility multicomponent exercise program (MEP) when performed by frail older persons can reverse frailty and improve functionality; cognitive, emotional, and social networking; as well as biological biomarkers of frailty, when compared with a controlled population that received no training. Design: This is an interventional, controlled, simple randomized study. Researchers responsible for data gathering were blinded for this study. Setting: Participants from 2 primary rural care centers (Sollana and Carcaixent) of the same health department in Spain were enrolled in the study between December 2013 and September 2014. Patients: We randomized a volunteer sample of 100 men and women who were sedentary, with a gait speed lower than 0.8 meters per second and frail (met at least 3 of the frailty phenotype criteria). Interventions: Participants were randomized to a supervised-facility MEP (n = 51, age = 79.5, SD 3.9) that included proprioception, aerobic, strength, and stretching exercises for 65 minutes, 5 days per week, 24 weeks, or to a control group (n = 49, age = 80.3, SD 3.7). The intervention was performed by 8 experienced physiotherapists or nurses. Protein-calorie and vitamin D supplementation were controlled in both groups. Results: Our MEP reverses frailty (number needed to treat to recover robustness in subjects with attendance to ≥50% of the training sessions was 3.2) and improves functional measurements: Barthel (trained group 91.6 SD 8.0 vs 82.0 SD 11.0 control group), Lawton and Brody (trained group 6.9 SD 0.9 vs 5.7 SD 2.0 control group), Tinetti (trained group 24.5 SD 4.4 vs 21.7 SD 4.5 control group), Short Physical Performance Battery (trained group 9.5 SD 1.8 vs 7.1 SD 2.8 control group), and physical performance test (trained group 23.5 SD 5.9 vs 16.5 SD 5.1 control group) as well as cognitive, emotional, and social networking determinations: Mini-Mental State Examination (trained group 28.9 SD 3.9 vs 25.9 SD 7.3 control group), geriatric depression scale from Yesavage (trained group 2.3 SD 2.2 vs 3.2 SD 2.0 control group), EuroQol quality-of-life scale (trained group 8.2 SD 1.6 vs 7.6 SD 1.3 control group), and Duke social support (trained group 48.5 SD 9.3 vs 41.2 SD 8.5 control group). This program is unique in that it leads to a decrease in the number of visits to primary care physician (trained group 1.3 SD 1.4 vs 2.4 SD 2.9 control group) and to a significant improvement in frailty biomarkers. Conclusions: We have designed a multicomponent exercise intervention that reverses frailty and improves cognition, emotional, and social networking in a controlled population of community-dwelling frail older adults. Trial Registration: ClinicalTrials.gov. Identifier: NCT02331459. © 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.


Qureshi M.M.,Aga Khan University | Piquer J.,Hospital Universitario Of La Ribera | Young P.H.,Washington University in St. Louis
World Neurosurgery | Year: 2013

Background Hydrocephalus, largely a disease of poverty in many developing regions such as Sub-Saharan Africa, becomes even more challenging to treat because of lack of trained neurosurgical personnel, inadequately equipped public health care facilities, meager resource allocation, high rates of neonatal infection, difficulty of access to tertiary care hospitals able to treat hydrocephalus, and high complication rates in patients who are able to access and receive shunting procedures. Furthermore, conventional methods of training of neurosurgeons and nursing staff to become proficient in neuroendoscopic procedures involve a lengthy period of training, often at specialized centers in Western or local Western-style institutions. Methods The novel approach promoted by volunteer neurosurgical teams from Neurosurgery Education Development Foundation is described, and its potential role in successfully providing neuroendoscopic ventriculostomy at hospitals in regional sites away from main referral tertiary hospitals is outlined. The impact on the training of local neurosurgical specialists and residents in training as well as nursing staff is highlighted. Results With the use of a single portable neuroendoscopy system and a versatile free-hand, single-operator neuroendoscope, this outreach, mobile, and readily portable model has been successfully used to perform more than 250 procedures in 21 different hospital sites around seven different countries in two continents. The local courses have imparted hands-on training to 62 neurosurgeons and trainee residents and a further 110 operating room nurses at these 21 institutions. Conclusions Neuroendoscopy is not only a priority surgical tool for East Africa. It offers a medical philosophy as an application that serves as an art and a science dedicated to the development of a complex surgical specialty: neurosurgery. © 2013 Elsevier Inc. All rights reserved.


Perez-Jorge E.V.,Hospital Universitario Of La Ribera | Burdette S.D.,Wright State University
Molecular Diagnosis and Therapy | Year: 2010

This case report describes the differential diagnosis of cutaneous ulcerations and the utility of the interferon-γ release assays as a tool to aid in the diagnosis. These new assays can be used to identify mycobacterial infections (specifically Mycobacterium marinum) as the etiologic agents. © 2010 Adis Data Information BV. All rights reserved.


Rodriguez-Bano J.,Hospital Universitario Virgen Macarena | Picon E.,Hospital Universitario Virgen Macarena | Gijon P.,Hospital Universitario Gregorio Maranon | Hernandez J.R.,Hospital Universitario Virgen Macarena | And 12 more authors.
Clinical Infectious Diseases | Year: 2010

Background. There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality. Methods. Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study. Results. We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with β-lactam/β-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production. Conclusions. ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors. © 2009 by the Infectious Diseases Society of America. All rights reserved.


Aguilella L.,Hospital Universitario Of La Ribera | Aguilella L.,Institute Kaplan | Garcia-Elias M.,Hospital Universitario Of La Ribera | Garcia-Elias M.,Institute Kaplan
Journal of Hand Surgery | Year: 2012

As a source of corticocancellous grafts for treating scaphoid nonunions, the anterolateral corner of the distal radial metaphysis has several advantages over other alternatives: it provides good-quality corticocancellous bone, it allows one to harvest the graft and treat the scaphoid through the same incision, it does not require general anesthesia, and it has less morbidity than occurs when obtaining the graft from the iliac crest. © 2012 ASSH Published by Elsevier, Inc. All rights reserved.

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