Hospital Universitario Rio Hortega

Valladolid, Spain

Hospital Universitario Rio Hortega

Valladolid, Spain
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Miguel-Hernandez A.S.,Hospital Universitario Rio Hortega
Gaceta Medica de Bilbao | Year: 2015

Infection by the Chikungunya virus causes an illness with an acute febrile phase lasting two to five days, followed by a longer period of joint pains in the extremities. The disease is transmitted by Aedes albopictus and Aedes aegypti. The A. albopictus or Asian tiger mosquito is more widespread and is the most aggressive. It is known that monkeys, bats and rodents act as a reservoir for the virus. The best means of prevention is overall mosquito control and the avoidance of bites by any infected mosquitoes. No specific treatment is known, but drugs can be used to reduce symptoms. Rest and fluids may also be useful. © 2015 Academia de Ciencias Médicas de Bilbao. All rights reserved.


Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a disease of humans and other primates caused by one type of ebolavirus, family Filoviridae: Zaire, Sudan, Bundibugyo Côte d'Ivoire (Taï Forest virus) and Reston virus. The disease has a high risk of death, killing between 25% and 90% of the patients. During 2014, to October 8, 8,033 suspected cases and 3,865 deaths had been reported. So far, the disease is not under control. The virus may be acquired upon contact with blood or other body fluids of an infected human or other animal and with surfaces and materials contaminated with these fluids. Symptoms start 2 days to 21 days after contracting the virus, with a fever, sore throat, muscle pain, and headaches. Typically, vomiting, diarrhea, and rash follow, along with decreased function of the liver and kidneys. Around this time, affected people may begin to bleed both within the body and externally. Outbreak control requires community engagement, case management, surveillance and contact tracing, appropriate laboratory service, and proper disposal of remains through cremation or burial. No specific treatment for the disease is yet available. In laboratories where virus culture is carried out, biosafety level 4-equivalent containment is required. Quarantine (also known as enforced isolation) and contact tracing are regarded as important to contain an outbreak. © 2014 Academia de Ciencias Médicas de Bilbao. All rights reserved.


Arrese I.,Hospital Universitario Rio Hortega | Sarabia R.,Hospital Universitario Rio Hortega | Pintado R.,Hospital Universitario Rio Hortega | Delgado-Rodriguez M.,University of Jaén
Neurosurgery | Year: 2013

Background: Although the introduction of flow-diverter devices (FDDs) has aroused great enthusiasm, the level of evidence supporting their use has not been systematically evaluated. Objective: To report a systematic review of medical literature up to May 2012 on FDDs to assess the morbidity, case fatality rate, and efficacy of FDDs for intracranial aneurysms. Methods: The literature was searched by using Medline, Embase, and all Evidence-Based Medicine in the OVID database. Eligibility criteria were studies including at least 10 patients, reporting duration of follow-up and number of patients lost to follow-up, and documenting the rate of aneurysm occlusion and death and neurological complications. The endpoints were angiographic success, early and late mortality, and neurological morbidity. Results: Fifteen studies were analyzed consisting of 897 patients with 1018 aneurysms. The mean value of methodological quality score was 14.4 using the STROBE score. The early mortality rate was 2.8% (95% confidence interval [CI]: 1.7-3.8; I2 = 93.4%) and the late mortality rate was 1.3% (95% CI: 0.2-2.3; I2 = 36.9%). The early neurological morbidity rate was 7.3% (95% CI: 5.7-9; I2 = 91.8%) and the late morbidity rate was 2.6% (95% CI: 1.1-4; I2 = 81.3%). The Egger test for early and late morbidity and aneurysm occlusion was,0.001. Conclusion: With the available data from the studies, both heterogeneity and publication biases imply that the current clinical use of FDDs is not supported by highquality evidence. In the absence of reliable evidence, the use of FDDs in patients eligible for more conventional treatments should be restricted to controlled clinical trials. Copyright © 2013 by the Congress of Neurological Surgeons.


The current definition and severity stages of chronic obstructive pulmonary disease (COPD) focus excessively on spirometric criteria alone. Measurement of chronic airflow obstruction and its degree of reversibility is complex. The etiology of this disease cannot be fully explained in relation to smoking and the heterogeneity of this systemic disease septiemthat affects mainly the lung cannot be expressed through forced expiratory volume in 1 second (FEV 1) alone. This simplification was useful for a period but the loss of clinical subtlety in large studies hampers interpretation of their results and their conclusions lose external validity. Accepting the complexity of COPD requires substituting the analytic focus centered on FEV1 for a multifaceted approach that integrates other aspects in the analysis of real COPD patients. Identifying and classifying clinically significant subgroups or "COPD phenotypes" may help to guide treatment more efficiently. In patients with COPD, mortality due to cardiovascular diseases or malignancies occurs earlier than that due to respiratory causes; that is, deaths from COPD occur in patients not succumbing to cardiovascular diseases or cancer. To prolong survival in these patients, comorbidity should be evaluated and treated. COPD treatment based on severity measured by lung function can no longer be recommended. The various therapeutic options should be individualized according to the patient's other characteristics. © 2011 Elsevier España, S.L. All rights reserved.


Perez-Miranda M.,Hospital Universitario Rio Hortega | De La Serna-Higuera C.,Hospital Universitario Rio Hortega
Current Gastroenterology Reports | Year: 2013

EUS-guided biliary access procedures can target the gallbladder or the bile duct for drainage in selected cases. EUS-guided gallbladder drainage offers comparable results to percutaneous cholecystostomy in high-surgical risk patients with acute cholecystitis refractory to medical treatment. The procedure is not yet widely available. Novel lumen-apposing stents may improve long-term outcomes, resulting in rapid dissemination. EUS access to the bile duct is coupled with ERCP techniques into a hybrid procedure, endosono- cholangiopancreatography (ESCP). ESCP admits six variant approaches to bile duct drainage based on the combination of two access routes (intrahepatic and extrahepatic) with three drainage routes: transmural, retrograde transpapillary and antegrade transpapillary. A thousand ESCP cases have been reported to date with good outcomes. When the expertise is available, ESCP is increasingly replacing percutaneous transhepatic biliary drainage to provide biliary drainage in patients in whom ERCP is not feasible, predominantly in the setting of palliation, but not limited to it. © 2013 Springer Science+Business Media New York.


Martin-Escudero J.C.,Hospital Universitario Rio Hortega
Revista Clinica Espanola | Year: 2010

A 60-year old male patient with obesity and type 2 diabetes mellitus consulted due to high blood pressure, fearful of suffering ischemic heart disease. He also had a background of smoking 20 cigarettes/day for the last 30 years, but this did not concern him. In the questioning, he reported, although he did not consider it important, that he had cough and dyspnea on moderate exertions for some years. It is very unlikely that any internal medicine physician would doubt about whether to evaluate and treat his type 2 diabetes mellitus or high blood pressure, calculate his cardiovascular risk or if he has a metabolic syndrome, attempt to reduce his obesity and to make him stop smoking. However, should we label him as having chronic bronchitis or COPD? Should we perform a spirometry and bronchodilater test, treat his probable COPD? All his current symptoms are probably only due to COPD. © 2009 Elsevier España, S.L. All rights reserved.


Penas-Herrero I.,Hospital Universitario Rio Hortega | De La Serna-Higuera C.,Hospital Universitario Rio Hortega | Perez-Miranda M.,Hospital Universitario Rio Hortega
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2015

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been introduced as an alternative to percutaneous transhepatic gallbladder drainage for the treatment of acute cholecystitis in non-surgical candidates. A systematic review of the English language literature through PubMed search until June 2014 was conducted. One hundred and fifty-five patients with acute cholecystitis treated with EUS-GBD in eight studies and 12 case reports, and two patients with EUS-GBD for other causes were identified. Overall, technical success was obtained in 153 patients (97.45%) and clinical success in 150 (99.34%) patients with acute cholecystitis. Adverse events developed in less than 8% of patients, all of them managed conservatively. EUS-GBD has been performed with plastic stents, nasobiliary drainage tubes, standard or modified tubular self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS) by different authors with apparently similar outcomes. No comparison studies between stent types for EUS-GBD have been reported. EUS-GBD is a promising novel alternative intervention for the treatment of acute cholecystitis in high surgical risk patients. Feasibility, safety and efficacy in published studies from expert centers are very high compared to currently available alternatives. Further studies are needed to establish the safety and long-term outcomes of this procedure in other practice settings before EUS-GBD can be widely disseminated. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.


Perez-Miranda M.,Hospital Universitario Rio Hortega
Current gastroenterology reports | Year: 2013

EUS-guided biliary access procedures can target the gallbladder or the bile duct for drainage in selected cases. EUS-guided gallbladder drainage offers comparable results to percutaneous cholecystostomy in high-surgical risk patients with acute cholecystitis refractory to medical treatment. The procedure is not yet widely available. Novel lumen-apposing stents may improve long-term outcomes, resulting in rapid dissemination. EUS access to the bile duct is coupled with ERCP techniques into a hybrid procedure, endosono-cholangiopancreatography (ESCP). ESCP admits six variant approaches to bile duct drainage based on the combination of two access routes (intrahepatic and extrahepatic) with three drainage routes: transmural, retrograde transpapillary and antegrade transpapillary. A thousand ESCP cases have been reported to date with good outcomes. When the expertise is available, ESCP is increasingly replacing percutaneous transhepatic biliary drainage to provide biliary drainage in patients in whom ERCP is not feasible, predominantly in the setting of palliation, but not limited to it.


San Roman J.A.,Hospital Clinico Universitario | Vilacosta I.,Hospital Clinico San Carlos | Lopez J.,Hospital Clinico Universitario | Revilla A.,Hospital Clinico Universitario | And 3 more authors.
Journal of the American Society of Echocardiography | Year: 2012

The added value of transesophageal echocardiography (TEE) over transthoracic echocardiography in the assessment of left-sided infective endocarditis has been extensively validated in the literature. Little research has dealt with the role of echocardiography in right-sided infective endocarditis (RSE), however. In this review, the differences between RSE and left-sided endocarditis and the different types of RSE according to the types of patients who have the disease are described. Both issues have important implications for echocardiographic workup. Moreover, a systematic echocardiographic protocol to avoid missing right-sided vegetations and several specific morphologic aspects of RSE are reviewed. Normal right-sided structures, which may mimic vegetations, particularly when the clinical picture is compatible, are described. Finally, the value of transthoracic echocardiography and TEE in RSE is reviewed according to the publications available. The diagnostic yield of transthoracic echocardiography is comparable with that of TEE in intravenous drug users. On the contrary, TEE is mandatory in patients with cardiac devices. A Bayesian-based diagnostic approach is proposed for a third poorly characterized group of patients with RSE who are not drug addicts, have no cardiac devices, and have no left-sided endocarditis (the "three no's" endocarditis group). © 2012 American Society of Echocardiography.


Vega J.,Hospital Universitario Rio Hortega | Vega J.M.,Hospital Universitario Rio Hortega | Moneo I.,Institute Salud Carlos III
Actas Dermo-Sifiliograficas | Year: 2011

The pine processionary caterpillar is the larval form of the Thaumetopoea pityocampa moth. Mediterranean forests regularly suffer plagues of this insect, which has been moving north as a result of global warming. When the small urticating hairs that develop during the last 3 larval stages are shed and can become airborne. If they come in contact with skin, they can cause a variety of reactions, notably contact urticaria and papular rashes. Irritation can also occur if the hairs lodge in the mucosa of the conjunctiva or in the respiratory tract. Several cases of anaphylactic reactions have been reported in recent years. Mechanical (irritative) mechanisms may be involved in the pathogenesis of lesions, or immunoglobulin E-mediated allergic hypersensitivity reactions may be implicated when the process is rapid, recurrent, and progressively more severe. © 2010 Elsevier España, S.L. and AEDV. All rights reserved.

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