Merchante N.,Hospital Universitario Of Valme |
Merino E.,Hospital General Universitario Of Alicante |
Rodriguez-Arrondo F.,Hospital Universitario Donostia |
Tural C.,Autonomous University of Barcelona |
And 10 more authors.
AIDS | Year: 2014
Objective: To describe the frequency and the characteristics of hepatocellular carcinoma (HCC) cases that appeared in HIV/hepatitis C virus (HCV)-coinfected patients with previous sustained virological response (SVR) and to compare these cases to those diagnosed in patients without SVR. Methods: All HIV/HCV-coinfected patients diagnosed with HCC in 26 hospitals in Spain before 31 December 2012 were analyzed. Comparisons between cases diagnosed in patients with and without previous SVR were made. Results: One hundred and sixty-seven HIV/HCV-coinfected patients were diagnosed with HCC in the participant hospitals. Sixty-five (39%) of them had been previously treated against HCV. In 13 cases, HCC was diagnosed after achieving consecution of SVR, accounting for 7.8% of the overall cases. The median (Q1-Q3) elapsed time from SVR to diagnosis of HCC was 28 (20-39) months. HCC was multicentric and was complicated with portal thrombosis in nine and six patients, respectively. Comparisons with HCC cases diagnosed in patients without previous SVR only yielded a significantly higher proportion of genotype 3 infection [10 (83%) out of 13 cases versus 34 (32%) out of 107; P1/40.001)]. The median (Q1-Q3) survival of HCC was 3 (1-39) months among cases developed in patients with previous SVR, whereas it was 6 (2-20) months in the remaining individuals (P1/40.7). Conclusion: HIV/HCV-coinfected patients with previous SVR may develop HCC in the mid term and long term. These cases account for a significant proportion of the total cases of HCC in this setting. Our findings reinforce the need to continue surveillance of HCC with ultrasound examinations in patients with cirrhosis who respond to anti-HCV therapy. © 2013 Wolters Kluwer Health.
PubMed | Hospital Universitario San Cecilio, Hospital Universitario Virgen Of Las Nieves, Complejo Hospitalario Juan Ramon Jimenez, Hospital Universitario Virgen Of La Victoria and 6 more.
Type: Journal Article | Journal: PloS one | Year: 2016
Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv) as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure (VF) while on protease inhibitor (PI) -based regimens. We have evaluated the effectiveness of two mtPI/rtv regimens in an actual clinical practice setting, including patients that had experienced previous VF with PI-based regimens.This retrospective study analyzed 1060 HIV-infected patients with undetectable viremia that were switched to lopinavir/ritonavir or darunavir/ritonavir monotherapy. In cases in which the patient had previously experienced VF while on a PI-based regimen, the lack of major HIV protease resistance mutations to lopinavir or darunavir, respectively, was mandatory. The primary endpoint of this study was the percentage of participants with virological suppression after 96 weeks according to intention-to-treat analysis (non-complete/missing = failure).A total of 1060 patients were analyzed, including 205 with previous VF while on PI-based regimens, 90 of whom were on complex therapies due to extensive resistance. The rates of treatment effectiveness (intention-to-treat analysis) and virological efficacy (on-treatment analysis) at week 96 were 79.3% (CI95, 76.8-81.8) and 91.5% (CI95, 89.6-93.4), respectively. No relationships were found between VF and earlier VF while on PI-based regimens, the presence of major or minor protease resistance mutations, the previous time on viral suppression, CD4+ T-cell nadir, and HCV-coinfection. Genotypic resistance tests were available in 49 out of the 74 patients with VFs and only four patients presented new major protease resistance mutations.Switching to mtPI/rtv achieves sustained virological control in most patients, even in those with previous VF on PI-based regimens as long as no major resistance mutations are present for the administered drug.
Grau T.,Hospital Universitario Doce Of Octubre |
Bonet A.,Hospital Universitario Of Girona |
Minambres E.,Hospital Universitario Marques Of Valdecilla |
Pineiro L.,Hospital Universitario Of Girona |
And 8 more authors.
Critical Care Medicine | Year: 2011
Objective: The aim of this study was to assess the clinical efficacy of alanine-glutamine dipeptide-supplemented total parenteral nutrition defined by the occurrence of nosocomial infections. Secondary parameters included Sequential Organ Failure Assessment score, hyperglycemia and insulin needs, intensive care unit and hospital length of stay, and 6-month mortality. Design: Multicenter, prospective, double-blind, randomized trial. Setting: Twelve intensive care units at Spanish hospitals. Patients: One hundred twenty-seven patients with Acute Physiology and Chronic Health Evaluation II score >12 and requiring parenteral nutrition for 5-9 days. Intervention: Patients were randomized to receive an isonitrogenous and isocaloric total parenteral nutrition or alanine-glutamine dipeptide-supplemented total parenteral nutrition. Nutritional needs were calculated: 0.25 g N/kg-1/d -1 and 25 kcal/kg/d. The study group received 0.5 g/kg/d of glutamine dipeptide and the control total parenteral nutrition group a similar amount of amino acids. Hyperglycemia was controlled applying an intensive insulin protocol with a target glycemia of 140 mg/dL. Measurements and Main Results: The two groups did not differ at inclusion for the type and severity of injury or the presence of sepsis or septic shock. Caloric intake was similar in both groups. Preprotocol analysis showed that treated patients with alanine-glutamine dipeptide-supplemented total parenteral nutrition had lesser nosocomial pneumonia, 8.04 vs. 29.25 episodes-‰ days of mechanical ventilation (p = .02), and urinary tract infections, 2.5 vs. 16.7 episodes-‰ days of urinary catheter (p = .04). Intensive care unit, hospital, and 6-month survival were not different. Mean plasmatic glycemia was 149 ± 46 mg/dL in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group and 155 ± 51 mg/dL in the control total parenteral nutrition group (p < .04), and mean hourly insulin dose was 4.3 ± 3.3 IU in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group and 4.7 ± 3.7 IU in control total parenteral nutrition group (p < .001). Multivariate analysis showed a 54% reduction of the amount of insulin for the same levels of glycemia in the alanine-glutamine dipeptide-supplemented total parenteral nutrition group. Conclusions: Total parenteral nutrition supplemented with alanine-glutamine in intensive care unit patients is associated with a reduced rate of infectious complications and better glycemic control. Copyright © 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
PubMed | Institute Investigacion Biomedica Of Malaga Ibima, Hospital Universitario Ciudad Of Jaen, Hospital Of Poniente, Hospital Torrecardenas and 4 more.
Type: Journal Article | Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology | Year: 2016
We analysed the efficacy and safety of switching from a regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTI) or integrase inhibitors (INI) to ABC/3TC+RPV in virologically suppressed HIV-infected patients. This multicentre, retrospective study comprised asymptomatic HIV-infected patients who switched from 2 NRTI+NNRTI or 2 NRTI+INI to ABC/3TC+RPV between February 2013 and December 2013; all had undetectable HIV viral load prior to switching. Efficacy and safety, and changes in lipids and cardiovascular risk (CVR) were analysed at 48 weeks. Of 85 patients (74.1 % men, mean age 49.5 years), 83 (97.6 %) switched from a regimen based on NNRTI (EFV 74, RPV 5, ETV 2, NVP 2), and 45 (53 %) switched from TDF/FTC to ABC/3TC. The main reasons for switching were toxicity (58.8 %) and convenience (29.4 %). At 48 weeks, 78 (91.8 %) patients continued taking the same regimen; efficacy was 88 % by intention to treat, and 96 % by per protocol. Two patients were lost to follow-up and five ceased the new regimen (4 due to adverse effects and 1 virologic failure). Mean CD4 cell counts increased (744 vs. 885 cells/L; p=0.0001), and there were mean decreases in fasting total cholesterol (-15.9 mg/dL; p<0.0001) and LDL-cholesterol (-11.0 mg/dL; p<0.004), with no changes in HDL-cholesterol, triglycerides, total cholesterol:HDL-cholesterol ratio, and CVR. ABC/3TC+RPV is effective and safe in virologically-suppressed patients on antiretroviral therapy (ART). Forty-eight weeks after switching the lipid profile improved with decreases in total and LDL cholesterol.
PubMed | Hospital Arnau Of Vilanova, Hospital General Universitario Of Alicante, Hospital del Mar, Hospital Vall dHebron and Hospital Universitario Of Puerto Real
Type: Journal Article | Journal: European journal of dermatology : EJD | Year: 2016
Chronic spontaneous urticaria (CSU) is a skin disease characterised by wheal appearance, swelling, itching, and painful skin. Omalizumab has been used for CSU treatment demonstrating good efficacy. To investigate the efficacy and safety of omalizumab treatment in CSU patients in real-life practice. A retrospective analysis was performed on 38 patients suffering from CSU who received 300mg of omalizumab every four weeks. After omalizumab treatment, 68.4% of patients showed a complete response (UAS7=0). All the patients were able to stop treatment with corticosteroids, cyclosporine, and anti-leukotrienes, and only 39.5% of patients remained on anti-histamines. Omalizumab treatment led to a 96% and 65% decrease in emergency room and primary health care visits, respectively, as well as a reduction in the direct costs associated with the disease. No omalizumab-related adverse events were reported. Omalizumab exhibits good efficacy in alleviating the symptoms of CSU, leads to a decrease in concomitant medication use, restores patients quality of life, and has economic benefits by reducing disease-related health care costs.
Roca-Rodriguez M.D.M.,Hospital Universitario Puerta del Mar |
Carral-San Laureano F.,Hospital Universitario Virgen Of La Victoria |
Baena-Nieto G.,Hospital Universitario Of Puerto Real |
Aguilar-Diosdado M.,Hospital Universitario Of Puerto Real
Endocrinologia y Nutricion | Year: 2010
Objective: To evaluate the extent to which metabolic targets in type 2 diabetes (DM-2) are achieved in the Endocrinology and Clinical Nutrition Unit of the Hospital Puerta del Mar in Cadiz (Spain) from 2005 to 2008. Method: The database included in the computer application HP-Doctor used for all patients attended in our unit (admissions, consultations and peripheral centers) was analyzed. All patients with a principal or secondary diagnosis of DM-2 were included. Clinical characteristics, chronic complications, drug treatment and the percentage of patients who achieved annual mean targets of glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDLc) were analyzed. Results: From 2005 to 2008, the number of DM-2 patients with computerized records increased by 108.7%. In 2008, 1,177 patients were evaluated. A total of 10.8% were active smokers, 53% had hypertension, and 51.2% and 12.6% presented with retinopathy and cardiovascular disease, respectively. During the study period, the percentage of patients with a mean HbA1c <7% was similar (2005: 31.7% 2008: 30.4%), those with LDLc <100. mg/dl increased from 19.2% to 25.6% and only 9.2% of patients achieved both targets, HbA1c <7% and LDLc <100. mg/dl. Conclusions: In 2008, only 30% of DM-2 patients achieved a mean HbA1c < 7% and only 25% had LDLc < 100 mg/dl. Metabolic control in DM-2 patients should be improved. © 2010 SEEN.
Chinchilla N.,University of Cádiz |
Carrera C.,University of Cádiz |
Duran A.G.,University of Cádiz |
Macias M.,Hospital Universitario Of Puerto Real |
And 2 more authors.
Phytochemistry Reviews | Year: 2013
Aloe barbadensis Miller is a plant that is native to North and East Africa and has accompanied man for over 5,000 years. The aloe vera plant has been endowed with digestive, dermatological, culinary and cosmetic virtues. On this basis, aloe provides a range of possibilities for fascinating studies from several points of view, including the analysis of chemical composition, the biochemistry involved in various activities and its application in pharmacology, as well as from horticultural and economic standpoints. The use of aloe vera as a medicinal plant is mentioned in numerous ancient texts such as the Bible. This multitude of medicinal uses has been described and discussed for centuries, thus transforming this miracle plant into reality. A summary of the historical uses, chemical composition and biological activities of this species is presented in this review. The latest clinical studies involved in vivo and in vitro assays conducted with aloe vera gel or its metabolites and the results of these studies are reviewed. © Springer Science+Business Media 2013.
Gonzalez E.,Hospital Universitario Of Puerto Real |
Elorza J.,Hospital Universitario Of Puerto Real |
Failde I.,University of Cádiz
Actas Espanolas de Psiquiatria | Year: 2010
Patients with fibromyalgia (FM) often have associated mental disorders. As well as being very prevalent, the two conditions also have sociodemographic and clinical similarities. If both of these clinical conditions lead independently to a limitation of the health-related quality of life (HRQL) of the patients, it may be thought that their conjunction could have a greater adverse effect on this parameter. Equally, it could be assumed that the factors that worsen the HRQL of patients with FM or with mental illness could have a more serious effect on the HRQL of those in whom the two clinical conditions coexist. Although this conclusion seems evident, as far as we know there have been no studies to assess how much or in what way psychiatric comorbidity affects the HRQL of patients with FM, or any studies to analyze the particular factors that may affect their HRQL. This study approaches the importance of psychiatric comorbidity in patients with fibromyalgia and analyzes the combined effect that these two conditions have on the overall HRQL of these patients.
Perez-Alonso A.,Hospital Universitario Of Puerto Real |
Cordoba-Dona J.A.,Servicio de Salud Publica |
Cordoba-Dona J.A.,Umeå University |
Millares-Lorenzo J.L.,Servicio Of Epidemiologia Y Salud Laboral |
And 3 more authors.
International Journal of Occupational and Environmental Health | Year: 2014
Objectives: To describe the epidemiological and clinical characteristics of an outbreak of occupational silicosis and the associated working conditions. Methods: Cases were defined as men working in the stone cutting, shaping, and finishing industry in the province of Cádiz, diagnosed with silicosis between July 2009 and May 2012, and were identified and diagnosed by the department of pulmonology of the University Hospital of Puerto Real (Cádiz). A census of workplaces using quartz conglomerates was carried out to determine total numbers of potentially exposed workers. A patient telephone survey on occupational exposures and a review of medical records for all participants were conducted. Results: Silicosis was diagnosed in 46 men with a median age of 33 years and a median of 11 years working in the manufacturing of countertops. Of these cases, 91·3% were diagnosed with simple chronic silicosis, with an abnormal high-resolution computerized tomography (HRCT) scan. One patient died during the study period. Employer non-compliance in prevention and control measures was frequently reported, as were environmental and individual protection failures. Conclusions: The use of new construction materials such as quartz conglomerates has increased silicosis incidence due to intensive occupational exposures, in the context of high demand fuelled by the housing boom. This widespread exposure poses a risk if appropriate preventive measures are not undertaken. © W. S. Maney & Son Ltd 2014.
[Study of the prevalence of severe mental disorder in the penitentiaries Puerto I, II and III of Puerto de Santa María (Cádiz): new strategies of psychiatric care in prison]. [Estudio de la prevalencia de trastorno mental grave (TMG) en los centros penitenciarios de Puerto I, II y III del Puerto de Santa María (Cádiz): nuevas estrategias en la asistencia psiquiátrica en las prisiones.]
Marin-Basallote N.,Hospital Universitario Of Puerto Real
Revista española de sanidad penitenciaria | Year: 2012
In recent years it has been observed that there is a high level of severe mental disorder within the Spanish prison system. A one year descriptive and transversal study of the psychiatric health care demand in the prisons Puerto I, II and III of Puerto de Santa Maria (Cádiz). Of the 128 patients studied, the psychiatric diagnostics with highest prevalence were personality disorders (F60-69) at 35.16%, the next group was psychosis (F20-29) at 25.78%, and in third place mental and behaviour disorders due to use of psychotropic substances (F10-19) at 16.41%. 46.09% suffered conditions which are categorised as severe mental disorders. This study confirms the high levels of severe mental disorder in prisons located in the area of the Puerto Real Hospital. We are making efforts to improve on psychiatric health care provided to these patients by working closely with the Prison system.