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Manas A.,Hospital Universitario La Paz | Monroy J.L.,Hospital Universitario Of La Ribera | Ramos A.A.,Hospital Txagorritxu | Cano C.,Hospital Of Torrecardenas | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: Neuropathic pain (NP) in cancer patients severely impacts quality of life. Radiotherapy (RT) may cause NP, and at the same time, cancer patients visit RT units for pain relief. NP prevalence at these sites and current analgesic treatment should be assessed to improve management. Methods and Materials: This epidemiological, prospective, multicenter study was undertaken to assess NP prevalence, according to Douleur Neuropathique 4 questions questtionaire (DN4) test results, and analgesic management in cancer pain patients visiting RT oncologic units. Secondary analyses assessed NP etiology and pain intensity (using the Brief Pain Inventory - Short Form) and impact (using the Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study [MOS] for Sleep, and the Health Survey Short Form-12). Results: A total of 1,098 patients with any kind of pain were registered. NP prevalence was 31.1% (95% confidence interval, 28.4% - 33.9%); 291 NP patients (mean age, 62.2 ±12.5 years and 57.7% men) were eligible for study; 49% of patients were overweight. The most frequent tumors were those of breast and lung, and stage IIIB was the most common cancer stage. The tumors caused 75% of NP cases. Anxiety, sleepiness, and depression were common. At 8 weeks, pain intensity and interference with daily activities decreased significantly for 50.8% of responders. Depression and anxiety (p < 0.0001) scores on the Physical Component Summary and Mental Component Summary measures (p < 0.0001) and all MOS-Sleep subscales, except for snoring, improved significantly. The percentage of satisfied patients increased from 13.8% to 87.4% (p < 0.0001) with the current analgesic treatment, which meant a 1.2- and 6-fold increase (p < 0.0001) in narcotic analgesics and anticonvulsants, respectively, compared to previous treatment. Conclusions: NP is highly prevalent at RT oncology units, with sleepiness, anxiety, and depression as frequent comorbidities. There is a need to improve management of NP with increased use of more specific NP-targeting drugs. © 2011 Elsevier Inc.


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 | Qureshi M.M.,Kenyatta National Hospital | 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.


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.


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.


Tarazona-Santabalbina F.J.,Hospital Universitario Of La Ribera | Aguilella-Fernandez L.,Hospital Universitario Of La Ribera
Aging Clinical and Experimental Research | Year: 2013

Long-term treatment with biphosphonates has been related to atypical femoral fractures. We report the clinical case of a woman who suffered a proximal diaphyseal oblique fracture of the left femur after uninterrupted 13-year treatment with alendronate. Shortly after surgery, a painful lytic image in the external cortex of her right femur diaphysis was detected. Some papers have suggested surgical treatment to repair femur fractures after long-term treatment with bisphosphonates. Otherwise, two studies have shown healing acceleration of bone fractures with teriparatide. A lytic lesion was treated with teriparatide obtaining progressive disappearance of symptoms as well as bone healing. This outcome may suggest a way of prevention of complete fractures in symptomatic patients with long-term treatment with bisphosphonates. © 2013 Springer International Publishing Switzerland.


Ortega-Evangelio L.,Hospital Universitario Of La Ribera | Diago Sempere T.,Hospital Universitario Of La Ribera
Archivos de la Sociedad Espanola de Oftalmologia | Year: 2015

Abstract Objective To evaluate the efficacy of intravitreal dexamethasone implant on the treatment of pseudophakic macular edema (PME). Material and methods A retrospective, observational, descriptive study was conducted on 4 patients who received an intravitreal injection of dexamethasone implant due to PME in the period from 1st January 2013 to 31st December 2013 in the Hospital Universitario de La Ribera (Alzira, Valencia, Spain). A complete ophthalmic examination was performed on these patients. Best-corrected visual acuity (BCVA), macular thickness), and duration of the effect of the treatment were studied. Results At baseline, the mean MT was 414 μm. After dexamethasone implant, mean values of MT decreased to 330.25 μm at month one. The mean change from baseline MT was 83.75 μm. The baseline mean BCVA was 0.3 and improved to 0.575 at month one and 3. The mean duration of the effect of the treatment was 3.5 months. Conclusions Intravitreal dexamethasone implant is a possible treatment for Irvine-Gass syndrome as it improved visual acuity and reduced the macular thickness of these patients. © 2014 Sociedad Española de Oftalmología.


Gorriz Pintado S.,Hospital Universitario Of La Ribera | Estela Burriel P.L.,Hospital Universitario Of La Ribera
Endocrinologia y Nutricion | Year: 2014

Introduction: Serum 25-hydroxyvitamin D [25(OH)D] levels are the best indicator of vitamin D levels in the body. Precision, reproducibility, and lack of standardization are the main problems in such measurements. The aim of this study was to compare the 25(OH)D levels measured using Elecsys Vitamin D Total (Roche) and ADVIA Centaur Vitamin D Total (Siemens). Material and methods: 25(OH)D levels were tested in 166 patients using both methods. Patients were subsequently divided into two groups: a supplemented group consisting of patients receiving vitamin D supplements, and an untreated group consisting of the rest of patients. Results: 25(OH)D mean levels measured by the Roche and Siemens methods in the overall group were 33.6. ±. 16.0 and 19.8. ±. 12.4 ng/mL respectively. 54.2% of patients were receiving vitamin D supplements. In this group, mean 25(OH)D levels measured by the Roche and Siemens methods were 40.6. ±. 14.5 and 25.4. ±. 13.1 ng/mL respectively. In the untreated group, the respective values were 24.9. ±. 13.2 and 12.8. ±. 6.6 ng/mL. Prevalence of vitamin D deficiency (serum 25(OH)D levels less than 20 ng/mL) was higher in samples analyzed using the Siemens method (60.2%) as compared to those tested using the Roche method (23.5%). Conclusion: The assays evaluated are not comparable to each other. Laboratory specialists should inform clinicians of the features of the method used for measuring 25(OH)D because this will have a direct impact on interpretation of the results and medical decisions. © 2013 SEEN.


Gil-Tomas J.J.,Hospital Universitario Of La Ribera | Colomina-Rodriguez J.,Hospital Universitario Of La Ribera
Revista Iberoamericana de Micologia | Year: 2015

Background: Candida spp. represents a group of commensal yeasts that can act as pathogens and cause candidiasis in different anatomical locations. Aims: The aim of this study was to perform an epidemiological and comparative analysis between the isolates of Candida spp. in clinical specimens during a three year-period (2010-2012) from children (0-14 years) and adults (15-99 years) in the Valencian Community (RedMIVA). Methods: The microbiological surveillance network of Valencian Community was used as the information source. Results and conclusions: Candida was isolated in 52,436 patients (1,604 [3.1%] children and 50,832 [96.9%] adults). Candida albicans was significantly (p <. 0.05) the predominant species in both age groups, and in almost every type of clinical specimen. The distribution of other species varied depending on the sample type and age group. In blood specimens, Candida parapsilosis followed by C. albicans, Candida famata and Candida lusitaniae were the main species found in children, whereas C. albicans followed by C. parapsilosis, Candida glabrata and Candida tropicalis were the predominant species in adults. In sterile fluids, urine and lower respiratory tract samples, C. parapsilosis was the second most prevalent species in the children group, while C. glabrata and C. tropicalis were the main second species in adults. © 2015 Asociación Española de Micología.


Navarrete-Sanchis J.,Hospital Universitario Of La Ribera | Zarco-Bosquets J.,Hospital Universitario Of La Ribera | Tomas-Torrent J.M.,Hospital Universitario Of La Ribera | Diago T.,Hospital Universitario Of La Ribera | Ortega-Evangelio L.,Hospital Universitario Of La Ribera
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2015

Background: The aim of this study is to assess whether the outcome of pars plana vitrectomy for the treatment of cystoid non-tractional diabetic macular edema is stable and durable. Methods: A prospective longitudinal analysis of central macular thickness and visual acuity was performed, using repeated-measures ANOVA, in 22 subjects with cystoid diabetic macular edema. Results: Of the patients, 45.5 % met the criteria for surgical success at 6 months (achieving a reduction of central macular thickness of over 20 %, without associated loss of vision and central macular thickness less than 300 μm), of which 70 % remained stable at 1 year. A significant outcome of the intervention was found on central macular thickness (p < 0.01), but not on visual acuity (p = 0.159). This change occurred in the immediate postoperative period to remain stable thereafter. Conclusions: Vitreoretinal surgery can be an alternative treatment option in cases that do not respond to other types of treatment provided. Its expected benefit is observed in most cases in the immediate postoperative period, and is usually stable and sustained over 1-year follow-up. © 2014, Springer-Verlag Berlin Heidelberg.

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