Hospital Universitario Valle Of Hebron

Hospital de Órbigo, Spain

Hospital Universitario Valle Of Hebron

Hospital de Órbigo, Spain
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Gudiol F.,Hospital Universitario Of Bellvitge | Aguado J.M.,Hospital Universitario 12 Of Octubre | Almirante B.,Hospital Universitario Valle Of Hebron | Bouza E.,Hospital Universitario Gregorio Maranon | And 16 more authors.
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2015

Bacteremia and infective endocarditis caused by Staphylococcus aureus are common and severe diseases. Optimization of treatment is fundamental in the prognosis of these infections. The high rates of treatment failure and the increasing interest in the influence of vancomycin susceptibility in the outcome of infections caused by both methicillin-susceptible and -resistant isolates have led to research on novel therapeutic schemes. The interest in the new antimicrobials with activity against methicillin-resistant staphylococci has been extended to susceptible strains, which still carry the most important burden of infection. New combinations of antimicrobials have been investigated in experimental and clinical studies, but their role is still being debated. Also, the appropriateness of the initial empirical therapy has acquired relevance in recent years. The aim of this guideline is to update the 2009 guidelines and to provide an ensemble of recommendations in order to improve the treatment of staphylococcal bacteremia and infective endocarditis, in accordance with the latest published evidence. © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.

Mogollon M.V.,Hospital Universitario Virgen Del Rocio | Anguita M.P.,Hospital Universitario Reina Sofia | Aguado J.M.,Hospital 1O Of Octubre | Tornos P.,Hospital Universitario Valle Of Hebron | And 13 more authors.
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2011

Objectives: To describe the clinical presentation of a large number of Q fever endocarditis (QFE) and its management considering the role of serology. Patients and methods: Eighty-three patients with definite QFE (56 native and 27 prosthetic valve) with a long-term follow-up after stopping treatment (median: 48 months) were included. Final outcome (cure or relapse) was compared according with the serological titre at the end of therapy: less than 1:400 of phase I Ig G antibodies by indirect immunofluorescence (group 1, N = 23) or more than 1:400 (group 2, N = 30). Results: Eleven patients (13.2%) died from QFE and other 8 died for other reasons not related to endocarditis during follow-up. Surgery was performed in 61 (73.5%) patients and combined antimicrobial treatment was long (median: 23 months, IQR: 12 - 36). Seven relapses were observed, but five of them had received an initial incomplete antibiotic regimen. In patients who completed the programmed treatment (range: 12 - 89 months), serological titres at the end of therapy were not useful for predicting the final outcome: one relapse in each group. Conclusions: QFE requires a prolonged antimicrobial treatment, but serological titres are not useful for determining its duration. © 2011 Elsevier España, S.L.

Zeuzem S.,Goethe University Frankfurt | Mantry P.,Liver Institute | Soriano V.,Hospital Carlos III | Buynak R.J.,Northwest Indiana Center for Clinical Research | And 10 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2016

Background SOUND-C3 was a multicentre, open-label, phase 2b study exploring the safety and efficacy of the interferon-free combination of faldaprevir (an NS3/A4 protease inhibitor), deleobuvir (BI 207127, a non-nucleoside polymerase inhibitor) and ribavirin in treatment-naive patients with chronic hepatitis C virus (HCV) genotype-1 infection. Results in patients with HCV genotype-1b and in IL28B CC genotype patients with HCV genotype-1a have been described previously. This report describes the results in IL28B non-CC genotype patients with HCV genotype-1a. Methods Patients were randomized to receive faldaprevir 120 mg once daily with deleobuvir at either 800 mg twice daily (b.i.d.; N=26) or 600 mg three times daily (t.i.d.; N=25), and weight-based ribavirin for 24 weeks. The primary endpoint was sustained virological response 12 weeks after treatment (SVR12). Results In each group, five patients completed 24 weeks of treatment. SVR12 rates were 19% (5/26) and 8% (2/25) in the b.i.d. and t.i.d. groups, respectively. On-treatment breakthrough [50% (13/26) and 68% (17/25) in the b.i.d. and t.i.d. groups, respectively] was the most frequent reason for not achieving SVR12. Adverse events led to premature treatment discontinuation in six (23%) patients in the b.i.d. group and in two patients (8%) in the t.i.d. group. The majority of adverse events were mild or moderate; the most frequently reported were nausea (67%), fatigue (35%) and diarrhoea (35%). Conclusion In this small study, the interferon-free regimen of faldaprevir, deleobuvir and ribavirin resulted in high rates of virological breakthrough and low rates of SVR12 in IL28B non-CC genotype patients infected with genotype-1a HCV ( NCT01132313). © 2016 Wolters Kluwer Health, Inc.

PubMed | Programa Integrado de Investigacion en Tuberculosis PII TB de la Sociedad Espanola de Neumologia y Cirugia Toracica SEPAR, Complejo Hospitalario Of Caceres, Hospital Universitario Valle Of Hebron and Hospital Gregorio Maranon
Type: | Journal: BMC infectious diseases | Year: 2016

To determine the prevalence of smoking and analyze associated factors in a cohort of patients diagnosed with tuberculosis (TB) in Spain between 2006 and 2013.Multicenter, cross-sectional, descriptive, observational study using a national database of TB patients, using logistic regression to calculate odds ratios (OR) and confidence intervals (CI).We analyzed 5,846 cases (62% men, mean age 39years, 33% foreigners). 23.4% were alcohol abuser, 1.3% were injected drug users (IDU), 4.6% were co-infected with HIV, and 7.5% had a history of TB treatment. 6.6% and 0.8% showed resistance to one and multiple drugs, respectively. The predominant clinical presentation was pulmonary (71%) with a cavitary radiological pattern in 32.8% of cases. 82% of cases were confirmed microbiologically, and 54% were smear-positive microscopy. 2,300 (39.3%) patients were smokers. The following factors were associated with smoking: male sex (OR=2.26;CI:1.97;2.60), Spanish origin (OR=2.79;CI:2.40-3.24), alcoholism (OR=2.85;CI:2.46;3.31), IDU (OR=2.78;CI:1.48;5.52), homelessness (OR=1.99;CI:1.14-3.57), pulmonary TB (OR=1.61;CI:1.16;2.24), cavitary radiological pattern (OR=1.99;CI:1.43;2.79) and a smear-positive microscopy at the time of diagnosis (OR=1.39;CI:1.14;1.17).The prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and microbiological profile to non-smokers.

PubMed | Red Cross, Semmelweis University, University of Calgary, Hospital Sant Joan Of Deu and 47 more.
Type: | Journal: Pediatric rheumatology online journal | Year: 2015

Rheumatic diseases in children are associated with significant morbidity and poor health-related quality of life (HRQOL). There is no health-related quality of life (HRQOL) scale available specifically for children with less common rheumatic diseases. These diseases share several features with systemic lupus erythematosus (SLE) such as their chronic episodic nature, multi-systemic involvement, and the need for immunosuppressive medications. HRQOL scale developed for pediatric SLE will likely be applicable to children with systemic inflammatory diseases.We adapted Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY) to Simple Measure of Impact of Illness in Youngsters (SMILY-Illness) and had it reviewed by pediatric rheumatologists for its appropriateness and cultural suitability. We tested SMILY-Illness in patients with inflammatory rheumatic diseases and then translated it into 28 languages. Nineteen children (79% female, n=15) and 17 parents participated. The mean age was 124 years, with median disease duration of 21 months (1-172 months). We translated SMILY-Illness into the following 28 languages: Danish, Dutch, French (France), English (UK), German (Germany), German (Austria), German (Switzerland), Hebrew, Italian, Portuguese (Brazil), Slovene, Spanish (USA and Puerto Rico), Spanish (Spain), Spanish (Argentina), Spanish (Mexico), Spanish (Venezuela), Turkish, Afrikaans, Arabic (Saudi Arabia), Arabic (Egypt), Czech, Greek, Hindi, Hungarian, Japanese, Romanian, Serbian and Xhosa.SMILY-Illness is a brief, easy to administer and score HRQOL scale for children with systemic rheumatic diseases. It is suitable for use across different age groups and literacy levels. SMILY-Illness with its available translations may be used as useful adjuncts to clinical practice and research.

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.

Masjuan J.,Hospital Universitario Ramon y Cajal | Alvarez-Sabin J.,Hospital Universitario Valle Of Hebron | Arenillas J.,Hospital Universitario Clinico Of Valladolid | Calleja S.,Hospital Universitario Central Of Asturias | And 15 more authors.
Neurologia | Year: 2011

Introduction: The Spanish Stroke Group published the "Plan for stroke healthcare delivery" in 2006 with the aim that all stroke patients could receive the same degree of specialised healthcare according to the stage of their disease, independently of where they live, their age, gender or ethnicity. This Plan needs to be updated in order to introduce new developments in acute stroke. Methods: A committee of 19 neurologists specialised in neurovascular diseases representing different regions of Spain evaluated previous experience with this Plan and the available scientific evidence according to published literature. Background: The new organised healthcare system must place emphasis on the characteristics of the different care levels with promotion of Reference Stroke Hospitals, set up less restrictive Stroke Code activation criteria that include new therapeutic options, establish new standard measures for endovascular treatment and develop tele-medicine stroke networks. © 2010 Sociedad Española de Neurología.

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