Hospital Universitario Ramon jal

Madrid, Spain

Hospital Universitario Ramon jal

Madrid, Spain

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Mateos-Nozal J.,Hospital Universitario Ramon jal | Cruz-Jentoft A.J.,Hospital Universitario Ramon jal | Ribera Casado J.M.,Complutense University of Madrid
European Geriatric Medicine | Year: 2014

Background: Due to population aging, different international organizations recommend that all medical students should receive training in geriatric knowledge and skills. Methods: A systematic review of national and international surveys on the provision of geriatric education to undergraduate medical students was done for articles published from 2000 to July 2013. The analysis included all studies on the presence and characteristics of geriatric teaching in medical schools. Eighteen surveys were identified: 13 in single countries, 3 European-wide, 1 in two countries, and 1 global. Results: Most surveys were based on the answers of geriatricians and academic staff. Average answer rate was 83%. Forty-one percent of the countries report some geriatric contents in the curricula of their medical schools. Mean national prevalence of geriatric teaching was 81% of medical schools (range 15 to 100%, with wide differences between aged and aging countries); courses were mandatory in only 62%. The main topics taught are geriatric syndromes and geriatric assessment. Between 21% and 65% of the persons responsible for this teaching are geriatricians. An increase in the number of geriatric departments has been observed in Europe and in the USA. Human and financial resources are the main limitations to the inclusion of Geriatrics in the curricula. Conclusion: Geriatric training has been evaluated mainly in North American and European countries. Geriatric contents in the medical curricula, academic structures and qualified teachers are not systematically available in most countries. In a rapidly ageing world, many physicians are not receiving formal education on geriatrics at medical schools. © 2014 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.


Capdevila J.,Autonomous University of Barcelona | Iglesias L.,Hospital Universitario 12 Of Octubre | Halperin I.,University of Barcelona | Segura A.,University of Valencia | And 6 more authors.
Endocrine-Related Cancer | Year: 2012

Although thyroid cancer usually has an excellent prognosis, few therapeutic options are available in the refractory setting. Based on the recent results of phase II studies with tyrosine kinase inhibitors, we designed a retrospective analysis of patients with metastatic thyroid cancer treated with sorafenib in seven Spanish referral centers. Consecutive patients with progressive metastatic thyroid cancer (papillary, follicular, medullary, and anaplastic) not suitable for curative surgery, radioactive-iodine therapy, or radiotherapy were treated with sorafenib 400 mg twice a day. The primary end point was objective response rate (RR). Secondary end points included toxicity, median progression-free survival (mPFS), median overall survival (mOS), and correlation between tumor marker levels (thyroglobulin, calcitonin, and carcinoembryonic antigen) and efficacy. Between June 2006 and January 2010, 34 patients were included in the study. Sixteen patients presented differentiated thyroid carcinomas (DTC) of which seven (21%) were papillary, nine (26%) follicular, 15 (44%) medullary (MTC), and three (9%) were anaplastic (ATC). Eleven (32%) patients achieved partial response and 14 (41%) had stable disease beyond 6 months. Regarding histological subtype, RRs were 47% (seven of 15) for MTC, 19% (three of 16) for DTC, and 33% (one of three) for ATC. With a median follow-up of 11.5 months, mPFS were 13.5, 10.5, and 4.4 months for DTC, MTC, and ATC respectively. Tumor markers were evaluated in 22 patients, and a statistically significant association was observed between RR and decrease in tumor marker levels >50% (P=0.033). In this retrospective trial, sorafenib showed antitumor efficacy in all histological subtypes of thyroid cancer, warranting further development in this setting. © 2012 Society for Endocrinology Printed in Great Britain.


Figueroa M.S.,Hospital Universitario Ramon jal | Contreras I.,Hospital Universitario Ramon jal | Noval S.,Retina and Vitreous Section | Noval S.,Hospital Universitario La Paz | And 2 more authors.
British Journal of Ophthalmology | Year: 2010

Background: The purpose of this study is to evaluate the efficacy of intravitreal bevacizumab as the primary treatment of macular oedema due to retinal vein occlusions. Methods: Patients diagnosed as having central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) with visual acuity of less than 20/40 and macular oedema with more than 300 mm central retinal thickness were recruited. Patients that had received any prior treatment were excluded. After an initial intravitreal injection of bevacizumab, re-treatment was performed if intraretinal or subretinal fluid with distortion of the foveal depression was found in optical coherence tomography. Results: 18 eyes with CRVO and 28 eyes with BRVO were included. During a 6-month period, the mean number of injections per patient was 3.7 (BRVO group) and 4.6 (CRVO group). In the BRVO group, mean baseline logMAR visual acuity was 0.80 (SD 0.38) and macular thickness was 486.9 μm (SD 138.5 μm). After 6 months, mean logMAR visual acuity improved significantly to 0.44 (SD 0.34), p<0.001. Mean macular thickness decreased significantly to 268.2 μm (SD 62.5 μm), p<0.001. In the CRVO group, mean baseline logMAR visual acuity was 1.13 (SD 0.21) and macular thickness was 536.4 μm (SD 107.1 μm). Mean final logMAR visual acuity improved significantly to 0.83 (SD 0.45), p<0.001. Mean macular thickness decreased significantly to 326.17 μm (SD 96.70 μm), p<0.001. Conclusions: Intravitreal bevacizumab seems to be an effective primary treatment option for macular oedema due to retinal occlusions. Its main drawback is that multiple injections are necessary to maintain visual and anatomic improvements.


An otherwise healthy 63-year-old man who had undergone emergency laparoscopic cholecystectomy for acute calculous cholecystitis 6 weeks earlier developed daily fever for more than 3 weeks, malaise, weight loss, and elevated erythrocyte sedimentation rate. Initial imaging procedures (abdominal ultrasound and chest radiograph) were normal. The diagnosis of fever of unknown origin was established, and a whole-body FDG PET/CT scan was performed. PET/CT showed inflammatory changes corresponding to spilled intraperitoneal gallstones. We have described the PET/CT findings of spilled intraperitoneal gallstones, a relatively common complication of laparoscopic cholecystectomy. © 2012 Lippincott Williams & Wilkins, Inc.


Novais A.,University of Porto | Pires J.,University of Porto | Ferreira H.,University of Porto | Costa L.,University of Porto | And 5 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2012

The characterization of a broad representative sample of ST131 Escherichia coli isolates from different origins and settings (1991 to 2010) revealed that this clonal group has likely diversified recently and that the expansion of particular variants has probably been favored by the capture of diverse, multidrug-resistant IncFII plasmids (pC15-1a, pEK499, pKF3-140-like). The low ability to adhere and to grow as biofilm that was detected in this study suggests unknown mechanisms for the persistence of this clonal group which need to be further explored. Copyright © 2012, American Society for Microbiology. All Rights Reserved.


Trefz F.K.,Klinik fur Kinder und Jungendmedizin | Belanger-Quintana A.,Hospital Universitario Ramon jal
Drugs of Today | Year: 2010

Phenylketonuria (PKU) is characterized by persistent hyperphenylalaninemia, due to mutations in the gene coding for phenylalanine hydroxylase (PAH). If untreated, patients develop profound mental retardation. The principal treatment for PKU is lifelong dietary phenylalanine restriction, requiring the administration of special phenylalanine-free protein supplements. Adhering to the diet is burdensome, and poor compliance and control of blood phenylalanine are common, especially in adolescents and adults. A subset of patients, particularly those with milder forms of PKU, shows a clinically significant reduction in blood phenylalanine when treated with pharmacological doses of tetrahydrobiopterin, the cofactor of PAH. A tablet formulation of sapropterin dihydrochloride is approved for therapeutic use in Europe and the USA. Clinical trials have demonstrated durable reductions in blood phenylalanine, and/or increased dietary phenylalanine tolerance, in some patients with hyperphenylalaninemia due to PKU. Although further data are needed, especially with regard to long-term neuropsychological outcomes or possible use in pregnancy, sapropterin appears to represent a useful addition to the management of PKU. Copyright © 2010 Prous Science, S.A.U. or its licensors. All rights reserved.


Rios A.M.,Lifecenter Hospital | Rosenberg Z.S.,New York University | Bencardino J.T.,New York University | Rodrigo S.P.,Hospital Universitario Ramon jal | Theran S.G.,Hospital Universitario Mayor
American Journal of Roentgenology | Year: 2011

OBJECTIVE. Many disorders produce similar or overlapping patterns of bone marrow edema in the ankle. Bone marrow edema may present in a few hindfoot bones simultaneously or in a single bone. The purpose of this pictorial essay is to provide guidelines based on clinical history and specific MRI patterns and locations to accurately identify the cause of ankle bone marrow edema. We will first focus on bone marrow edema in general disease categories involving multiple bones, such as reactive processes, trauma, neuroarthropathy, and arthritides. A discussion of bone marrow edema in individual bones of the ankle and hindfoot including the tibia, fibula, talus, and calcaneus will follow. Helpful hints for arriving at the correct diagnosis will be provided in each section. CONCLUSION. After review of this article, radiologists should be able to use their knowledge of clinical history and specific MRI patterns and locations to accurately distinguish between the various causes of bone marrow edema in the ankle and hindfoot. © American Roentgen Ray Society.


Grande E.,Hospital Universitario Ramon jal | Carrato A.,Hospital Universitario Ramon jal
Cancer and Chemotherapy Reviews | Year: 2011

Purpose: To review the current status of biosimilars in oncology and regulatory aspects of biosimilar approval, and to examine the future prospects and impact of these types of drugs in oncology. Methods: Data were primarily obtained by searches of PubMed, including the "related articles" function, and the bibliographies of those publications identified as relevant. The European Medicines Agency website was used as a source of information on the regulatory aspects of biosimilars. Results: Patents on several biopharmaceuticals used in cancer therapy have recently expired or are due to expire. This has provided opportunities for pharmaceutical companies to develop and produce biosimilars. The European Medicines Agency defines biosimilars as medicines that are similar to a biological drug that has already been approved. In the European Union, biosimilars are subject to a thorough comparability exercise with the reference product, which includes a comparison of quality attributes and comparative nonclinical studies; biosimilars are also required to undergo testing in clinical studies to ensure similar efficacy and safety to the reference product. In the oncology setting, biosimilar versions of recombinant human erythropoietin and recombinant human granulocyte colony-stimulating factor have been approved to date, and the number of biosimilar medicines available for use in oncology is likely to increase rapidly, with the focus likely to shift from agents used in the supportive care setting to medicines that offer potentially life-saving or life-extending benefits, including monoclonal antibodies. As with all biopharmaceuticals, the primary safety concern with biosimilars is immunogenicity, and the European Medicines Agency mandates implementation of a risk-management plan as a condition of marketing approval. The availability of biosimilar medicines has the potential to save costs and potentially increase access to treatments. Emerging data with biosimilars currently available for use in oncology in Europe indicate the cost-effectiveness benefits of these agents. Conclusions: Biosimilars are medicines that are similar to a biological drug that has already been approved. They are required to undergo testing in clinical studies to ensure similar efficacy and safety to the reference product. The cost of new cancer drugs alongside the inevitable increase in cancer prevalence as our populations age mean that the current rate of increase in cancer drug budgets is irreversible. Biosimilars may provide one means of bringing cancer drug spending under control. These agents have the potential to provide cost savings and greater accessibility to anticancer and supportive care medicines. As more biosimilars become available for use in oncology, the potential benefits to be achieved by adopting these agents will increase further.


Vergara A.,University of Barcelona | Zboromyrska Y.,University of Barcelona | Mosqueda N.,CRESIB Hospital Clinic | Morosini M.,Hospital Universitario Ramon jal | And 6 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2014

Carbapenem-resistant Acinetobacter baumannii is a major source of nosocomial infections worldwide and is mainly associated with the acquisition of OXA-type carbapenemases, to a lesser extent, metalloβ-lactamases (MBLs). In this study, 82 nonepidemiologically related Acinetobacter strains carrying different types of OXA or MBL enzymes were tested using the Eazyplex system, a loop-mediated isothermal amplification (LAMP)-based method to rapidly detect carbapenemase carriage. The presence/ absence of carbapenem-hydrolyzing enzymes was correctly determined for all isolates in <30 min. © 2014 American Society for Microbiology. All Rights Reserved.


Alonso-Gordoa T.,Ramon jal University Hospital | Diez J.J.,Ramon jal University Hospital | Duran M.,Rey Juan Carlos University | Grande E.,Hospital Universitario Ramon jal
Therapeutic Advances in Medical Oncology | Year: 2015

Advanced thyroid carcinoma is an infrequent tumor entity with limited treatment possibilities until recently. The extraordinary improvement in the comprehension of genetic and molecular alterations involving the RAS/RAF/mitogen-activated protein kinase and phosphatidylinositide 3-kinase/Akt/mammalian target of rapamycin signaling and interacting pathways that are involved in tumor survival, proliferation, differentiation, motility and angiogenesis have been the rationale for the development of new effective targeted therapies. Data coming from phase II clinical trials have confirmed the efficacy of those targeted agents against receptors in cell membrane and cytoplasmic molecules. Moreover, four of those investigational drugs, vandetanib, cabozantinib, sorafenib and lenvatinib, have reached a phase III clinical trial with favorable results in progression-free survival and overall survival in medullary thyroid carcinoma and differentiated thyroid carcinoma. Further analysis for an optimal approach has been conducted according to mutational profile and tumor subtypes. However, consistent results are still awaited and the research for adequate prognostic and predictive biomarkers is ongoing. The following report offers a comprehensive review from the rationale to the basis of targeted agents in the treatment of thyroid carcinoma. In addition, current and future therapeutic developments by the inhibition of further molecular targets are discussed in this setting. © The Author(s), 2014.

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