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Pujol M.,Hospital Universitario Of Bellvitge | Pujol M.,at Coordinating Center | Limon E.,at Coordinating Center | Lopez-Contreras J.,Hospital Universitario Of La Santa Creu nt Pau | And 4 more authors.
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2012

The VINCat Program is a standardized surveillance program of healthcare infections in Catalonia, Spain. This program includes monitoring of surgical site infections (SSI) of elective colorectal surgery. The aim of this study was to define SSI rates in colorectal surgery among VINCat hospitals over a period of 4 years. We included consecutive elective colorectal interventions performed in VINCat hospitals from 2007 to 2010. Follow-up visits were performed 30 days after surgery. Prospective monitoring of SSI in colorectal surgery was performed according to standardized VINCat methodology. SSI was defined according to the Centers for Disease Control (CDC) and surgical risk factors according to the National Healthcare Safety Network (NHSN) classification. From 2007 to 2010, 49 centers performed 10,104 surgical procedures. The cumulative incidence of SSI was 20.8% (95% CI: 20.03-21.63). The annual cumulative SSI incidence rate did not vary significantly over the study period; however, there were significant differences among hospital infection rates. The relative frequency of organ-space infection increased from 25% in 2007 to 40% in 2010 (p < 0.001). Laparoscopic surgery also increased (28% in 2007 to 42% in 2010, p < 0.001). However, no changes were observed in mean surgery duration, ASA score and degree of surgical contamination. The VINCat Program incorporated a large number of Catalan hospitals that participated in standardized monitoring of colorectal surgery. The cumulative incidence rate of SSI for colorectal surgery was 20.8%, although there were large variations between hospitals. © 2012 Elsevier España S.L. All rights reserved. Source


Gonzalez-Vilchez F.,Registro Espanol de Trasplante Cardiaco | Gonzalez-Vilchez F.,Hospital Universitario Marques Of Valdecilla | Gomez-Bueno M.,Servicio de Cardiologia | Almenar L.,Polytechnic University of Valencia | And 7 more authors.
Revista Espanola de Cardiologia | Year: 2013

Introduction and objectives The present article reports the characteristics and results of heart transplantation in Spain since this therapeutic modality was first used in May 1984. Methods We summarize the main features of recipients, donors, and surgical procedures, as well as the results of all heart transplantations performed in Spain until December 31, 2012. Results A total of 247 heart transplantations were performed in 2012. The whole series consisted of 6775 procedures. Recent years have seen a progressive worsening in the clinical characteristics of recipients (34% aged over 60 years, 22% with severe kidney failure, 17% with insulin-dependent diabetes, 29% with previous heart surgery, 16% under mechanical ventilation) and donors (38% aged over 45 years, 26% with recipient: donor weight mismatch>20%), and in surgical conditions (29% of procedures at >4 h ischemia and 36% as emergency transplantations). The probability of survival at 1, 5, 10, and 15 years of follow-up was 78%, 67%, 53%, and 38%, respectively. These results have remained stable since 1995. Conclusions In recent years, the number of heart transplantations/year in Spain has remained stable at around 250. Despite the worsening of recipient and donor clinical characteristics and of time-to-surgery, the results in terms of mortality have remained stable and compare favorably with those of other countries. © 2013 Sociedad Espanola de Cardiologa. Published by Elsevier Espana, S.L. All rights reserved. Source


Gonzalez-Vilchez F.,Registro Espanol de Trasplante Cardiaco | Gonzalez-Vilchez F.,Hospital Universitario Marques Of Valdecilla | Gomez-Bueno M.,Servicio de Cardiologia | Almenar L.,Polytechnic University of Valencia | And 7 more authors.
Revista Espanola de Cardiologia | Year: 2014

Introduction and objectives The present article reports the characteristics and outcome of heart transplantation in Spain since it was first performed in May 1984. Methods We provide a descriptive analysis of the characteristics of the recipients, the donors, the surgical procedure, and results of the heart transplantations performed in Spain until 31 December 2013. Results During 2013, a total of 248 transplantation procedures were carried out, bringing the time series to a total of 7023 transplantations. The temporal analysis confirms a significant deterioration in the clinical profile of the recipients (higher percentage of older patients, severe renal failure, insulin-dependent diabetes mellitus, previous heart surgery, mechanical ventilation), of the donors (higher proportion of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations which, in 2013, reached 49%, and with ischemia times > 240 min). There was a marked increase in the use of circulatory assist devices prior to transplantation which, in 2013, were employed in 25.2% of all the patients. The survivals at 1, 5, 10, and 15 years were 76%, 65%, 52%, and 37%, respectively, and have remained stable since 1995. Conclusions Heart transplantation activity in Spain remains stable in recent years, with around 250 procedures a year. Despite the clear deterioration in the clinical characteristics of the donors and recipients, and lengthening of the operative times, the results in terms of mortality continue to be comparable to those reported in our neighboring countries, and a growing use of circulatory assist devices prior to transplantation is confirmed. Full English text available from: www.revespcardiol.org/en © 2014 Sociedad Española de Cardiología. Source


Macias J.,Hospital Universitario Of Valme | Neukam K.,Hospital Universitario Of Valme | Mallolas J.,Unit of Infectious Diseases | Lopez-Cortes L.F.,Hospitales Universitarios Virgen Rocio | And 11 more authors.
HIV Clinical Trials | Year: 2012

Objective: To evaluate the incidence and risk factors for grade 3 or 4 ALT or AST elevations (TE) and grade 4 total bilirubin elevations (TBE) among HIV/HCV- coinfected treatment-naïve patients with an initial regimen including 2 nucleoside analogs plus efavirenz (EFV), nevirapine (NVP), or a ritonavir-boosted protease inhibitor (PI/r).Patients and Methods: This was a retrospective multicenter observational cohort study that recruited 745 HIV-infected drug-naïve patients with detectable plasma HCV RNA who started a regimen including EFV, NVP, or PI/r.Results: EFV was prescribed in 323 (43%), NVP in 126 (17%), and a PI/r in 296 (40%) patients. Grade 3 or 4 TE were observed in 19 (5.9%) individuals receiving EFV compared with 14 (11%) on NVP (P = .056) and 31 (10.5%) on PI/r (P = .036). Grade 4 TBE were identified in 7 (2.2%) patients on EFV, 1 (0.8%) on NVP, and 11 (3.7%) on PI/r (P = .19). Therapy was discontinued due to liver toxicity in 13 (4%) patients on EFV, 16 (13%) on NVP, and 17 (6%) on PI/r (P = .003).Conclusions: Regimens including EFV, NVP, or PI/r are generally safe in treatment-naïve HIV/HCV-coinfected patients. Grade 3-4 TE are less commonly seen with EFV than with PI/r. Discontinuations due to hepatotoxicity were less frequent for patients receiving EFV than for those treated with NVP. © 2012 Thomas Land Publishers, Inc. Source


Marin F.,Hospital Clinico Universitario Virgen Of La Arrixaca | Diaz-Castro O.,Complejo Hospitalario Universitario Of Pontevedra | Ruiz-Nodar J.M.,Hospital General Universitario Of Alicante | De La Villa B.G.,Servicio de Cardiologia | And 4 more authors.
Revista Espanola de Cardiologia | Year: 2014

This article summarizes the main developments reported in 2013 on ischemic heart disease, together with the most important innovations in the management of acute cardiac patients. © 2013 Sociedad Española de Cardiología. Source

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