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Ferrandiz C.,Autonomous University of Barcelona | Fonseca-Capdevila E.,Complejo Hospitalario Universitario Of runa | Garcia-Diez A.,Hospital Universitario Of La Princesa | Guillen-Barona C.,Instituto Valenciano Of Oncologia | And 3 more authors.
Actas dermo-sifiliográficas | Year: 2014

Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

PubMed | Hospital U Reina Sofia, Fundacio Puig Vert. Barcelona., Hospital Universitari Arnau Of Villanova Of Lleida, Hospital Universitario Reina Sofia Of Cordoba and 10 more.
Type: | Journal: American journal of physiology. Renal physiology | Year: 2017

Patients with stage 5 chronic kidney disease who are on hemodialysis (HD) remain in a chronic inflammatory state, characterized by the accumulation of uremic toxins that induce endothelial damage and cardiovascular disease (CVD). Our aim was to examine microvesicles (MVs), monocyte subpopulations, and angiopoietins to identify prognostic markers in HD patients with or without diabetes mellitus (DM). A total of 160 prevalent HD patients from 10 centers across Spain were obtained from the Biobank of the Nephrology Renal Network (REDinREN, Madrid): 80 patients with diabetes mellitus (DM) and 80 patients without DM who were matched for clinical and demographic criteria. MVs from plasma and several monocyte subpopulations (CD14++/CD16+, CD14+/CD16++) were analyzed by flow cytometry, and the plasma concentrations of angiopoietin (Ang)1 and Ang2 were quantified by ELISA. Data on cardiovascular disease were gathered over the 5.5 years after these samples were obtained. MV level, monocyte subpopulations (CD14+/CD16++ and CD14++/CD16+), and Ang2/Ang1 ratios increased in HD patients with DM compared with non-DM patients. Moreover, MV level above the median (264 MVs/l) were associated independently with greater mortality. MVs, monocyte subpopulations, and Ang2/Ang1 ratio can be used as predictors for CVD. In addition, MV level have potential predictive value in the prevention of CVD in HD patients. These parameters undergo more extensive changes in patients with DM.

Tunez I.,University of Cordoba, Spain | Sanchez-Lopez F.,Hospital Universitario Reina Sofia Of Cordoba | Aguera E.,Hospital Universitario Reina Sofia Of Cordoba | Fernandez-Bolanos R.,Hospital Universitario Nuestra Senora Of Valme | And 2 more authors.
Journal of Medicinal Chemistry | Year: 2011

This study examined global oxidative stress (GOS) and antioxidant system and their correlation with disease stage in 19 patients with HD. The results revealed an increase in oxidative stress biomarkers and a reduction in antioxidant systems in HD patients. The effects were more intense in HD1 than in HD2 patients. Additionally, carbonylated proteins and GOS were correlated with disease stage. These findings suggest that oxidative stress plays an important role in the pathogenesis of HD. © 2011 American Chemical Society.

Valenzuela-Salas B.,Hospital Universitario Reina Sofia Of Cordoba | Dean-Ferrer A.,University of Cordoba, Spain | Alamillos-Granados F.-J.,University of Cordoba, Spain
Medicina Oral, Patologia Oral y Cirugia Bucal | Year: 2010

Burkitt's lymphoma (BL) is a neoplasm which, despite its very aggressive behaviour is potentially curable. It typically affects the paediatric population. BL belongs to the non-Hodgkin lymphomas group, and is the first human tumour undoubtedly related to a viral origin (Epstein-Barr virus). Two main clinical subtypes are recognized: endemic or African type, and sporadic type; HIV associated BL constitutes a third type. Although common in endemic BL, maxillary involvement is rare in sporadic cases. This, together with the clinical lack of specificity associated to this location, makes diagnosis difficult. New chemotherapeutic protocols achieve a high survival rate. Most important prognostic factors are location and tumour stage. We report a paediatric case of BL presenting in the maxilla, with a review and a description of the characteristics of the disease. © Medicina Oral S. L.

Vicente A.,Hospital Virgen Of La Salud | Lecumberri B.,Hospital Universitario La Paz | Galvez M.T.,Hospital Universitario Reina Sofia Of Cordoba
Endocrinologia y Nutricion | Year: 2013

Classic pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland. PA is considered a neuroendocrinological emergency. However, there is no consensus about the best options for PA diagnosis and management. Objective: To develop a clinical practice guideline with a number of recommendations for diagnosis and treatment of patients with PA based on the medical evidence available, in order to help clinicians involved in their care. Methods: The clinical guideline for diagnosis and treatment of pituitary apoplexy issued in 2006 by the Neuroendocrinology Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and the British Clinical Practice Guideline published in 2011 were taken as the basis. The text has been adapted to the format used in most international medical journals. For this, after updated medical literature, the quality of evidence and the strength of the recommendations were evaluated using the system proposed by the Agency for Health Care Policy and Research (AHCPR). Conclusions: Diagnosis of pituitary apoplexy should be considered in all patients with acute severe headache with or without neuro-ophthalmic signs. Patients with PA must undergo a complete history and physical examination. All patients with suspected pituitary apoplexy should have urgent blood samples drawn to test electrolytes, renal function, liver function, coagulation screen, complete blood count, and basal levels of pituitary and peripheral hormones, and to rule out adrenocorticotropic hormone (ACTH) deficiency. Formal visual field assessment should be performed when the patient is clinically stable. Magnetic resonance imaging (MRI) is the imaging test of choice to confirm diagnosis. Indications for empirical urgent corticosteroid therapy in patients with PA include hemodynamic instability, impaired consciousness, reduced visual acuity, and severe visual field defects. In patients with these severe neuro-ophthalmic signs, surgery should be considered. Surgery should preferably be performed within seven days of the onset of symptoms. Patients with mild and stable signs may be managed conservatively with careful monitoring. Treatment and long-term follow-up of patients with PA should be conducted by a multidisciplinary team consisting, amongst others, of an experienced pituitary neurosurgeon, an ophthalmologist, and an endocrinologist. © 2012 SEEN.

Rivero-Juarez A.,Hospital Universitario Reina Sofia Of Cordoba | Camacho A.,Hospital Universitario Reina Sofia Of Cordoba | Rivero A.,Hospital Universitario Reina Sofia Of Cordoba
Expert Opinion on Drug Metabolism and Toxicology | Year: 2015

Introduction: Telaprevir is one of the first direct-acting antiviral drugs approved for the treatment of the hepatitis C virus (HCV) genotype 1. Following its approval in 2011, new data regarding the pharmacokinetics and pharmacodynamics were reported, leading to important clinical applications.Areas covered: This article reviews the pharmacokinetic and pharmacodynamic properties of telaprevir for the treatment of the HCV. The areas covered include data regarding the drug's absorption, distribution, metabolism and excretion, in addition to the antiviral activity strategy such as the clinical dose selection and treatment duration.Expert opinion: Telaprevir presents several pharmacological properties that could limit its administration such a high-fat, high-calorie meal; the need to be administrated with pegylated IFN plus ribavirin; and the drug-drug interaction profile. As a consequence and considering the new therapeutic arsenal against the HCV, the use of telaprevir as part of HCV therapy will be limited. © Informa UK, Ltd.

PubMed | Hospital Universitario Reina Sofia Of Cordoba
Type: Journal Article | Journal: Revista espanola de cirugia ortopedica y traumatologia | Year: 2016

Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty.A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft.The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1.Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution.

Delgado I.Z.,Hospital Universitario Reina Sofia Of Cordoba | Villarraso M.T.C.,Hospital Universitario Reina Sofia Of Cordoba | Garcia M.R.,Hospital Universitario Reina Sofia Of Cordoba
Revista de la Sociedad Espanola de Enfermeria Nefrologica | Year: 2014

Introduction: Poor adherence to treatment in chronic diseases such as hypertension currently remains a latent problem in our country. Although the Health Education is been used in different levels of health care to improve adherence to drug therapy and acquisition of healthy lifestyles, there is little evidence of their effectiveness, especially in hypertensive patients, refractory to change their hygienic-dietary habits. Objective: This study was realized with the aim of learning personal motivations involved in changing habits, adherence and knowledge of the disease in a group of hypertensive patients. Method: Phenomenological study in the hospital setting, using semi- structured interviews. The sample was made of eighteen patients with uncontrolled levels of blood pressure associated with metabolic syndrome and / or obesity (BMI>30). These patients are been visited by the health care team of Nephrology UGC/Hypertension, in the Hospital Universitario Reina Sofía of Córdoba, since last January. Results: Three thematic categories with which to answer our study objectives, have been found: Raising awareness about cardiovascular risk to which they are exposed and knowledge of the disease itself, justifying the reasons which motivate or retract the hypertensive patient to adhere to treatment, and relationship between compliance pharmacological and non-pharmacological treatment. Conclusion: The lack of adherence to treatment is showed up by unwillingness among hypertensive patients refractory, rather than an information problem. For this reason, a nursing intervention focused on solving the problem, is necessary. © 2014, Sociedad Espanola de Enfermeria Nefrologica. All rights reserved.

PubMed | Hospital Universitario Reina Sofia Of Cordoba
Type: Journal Article | Journal: Anales del sistema sanitario de Navarra | Year: 2016

Intestinal obstruction is one of the most frequent surgical emergencies. Its diagnosis is essentially based on clinical history, physical exploration and image tests. The aim of this study was to analyze the diagnostic value of acute phase reactants in patients with benign versus malign intestinal obstruction.Historical cohort study of 53 patients who underwent surgery because of intestinal obstruction and/or non-obstructive colorectal cancer. The patients were placed in three groups: group 1 (colorectal cancer with intestinal obstruction) (n=23), group 2 (benign intestinal obstruction)(n=10) and group 3 (non-obstructive cancer of the colon)(n=20). We determined the initial plasma values of the C-reactive protein (CRP) and the lactate dehydrogenase (LDH)enzyme.CRP was quantitatively higher in patients with benign intestinal obstruction (group 2) (p=0.001), while LDH was quantitatively higher in group 1 (patients with obstructive cancer). The plasma levels of LDH were significantly greater in the groups with intestinal obstruction (groups 1 and 2) than in patients without obstruction (p<0.001). Plasma levels of CRP above 11 mg/l and of LDH above 317 U/L showed an acceptable diagnostic value for differentiating patients with intestinal obstruction, with areas under the ROC curve of 80% (CI 95% = 68-92%) and 86% (CI 95%= 75-96%)respectively. Their diagnostic value for differentiating benign or malign origin is lower, with areas under the ROC curve of 56% for levels of CRP > 24 ng/l (CI 95% = 30-82%) and 52% (CI 95% = 29-74%) for levels of LDH > 359 U/L.Determination of plasma concentrations of CRP can help in the diagnosis of intestinal obstruction and indicate its benign or malign origin in emergency services.

PubMed | Hospital Universitario Of Gran Canaria Dr Negrin and Hospital Universitario Reina Sofia Of Cordoba
Type: Journal Article | Journal: Revista espanola de cardiologia (English ed.) | Year: 2016

The treatment of coronary lesions with a bioresorbable vascular scaffold has been shown to be effective. However there is little information about its use in bifurcations. The aim of this study was to analyze the safety and efficacy of the bioresorbable scaffold in the treatment of coronary bifurcation lesions.From January 2012 to January 2015, we used a bioresorbable vascular scaffold to treat 194 patients with 230 bifurcation lesions. The scaffold geometry was examined by intracoronary imaging techniques in 145 bifurcations (65%). In all, 78% of the bifurcations were evaluated angiographically during follow-up (computed tomography angiography in 138 and coronary angiography in 41).The most common clinical presentation was acute coronary syndrome (81%). The most frequent type of bifurcation was 1,1,1 (34%). A simple approach was the chosen strategy in 221 bifurcations (96%). In 90 of these lesions, the side branch was postdilated through the cells of the platform and, in 3 cases, strut fractures were observed in optical coherence tomography. Procedural success was achieved in all patients. There was 1 case of subacute thrombosis and 1 sudden cardiac death during the first month. The duration of angiographic follow-up was 7.31.6 months and that of clinical follow-up, 146 months. Twelve (5%) restenoses were documented and revascularized. During follow-up, 2 patients (1%) had an infarction in another territory and another 2 patients (1%) died; the remaining patients had a symptom-free follow-up. The incidence of thrombosis was 1.3%.Treatment of bifurcation coronary lesions using a provisional approach is feasible and safe, with a low rate of adverse events.

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