Wolffenbuttel B.H.R.,University of Groningen |
Van Gaal L.,University of Antwerp |
Duran-Garcia S.,Hospital Universitario Virgen Of Valme |
Han J.,Pharmapace Inc
Diabetes, Obesity and Metabolism | Year: 2016
This post hoc analysis assessed the evidence behind common reimbursement practices by evaluating the relationship of body mass index (BMI) ranges (<30, 30–35 and >35 kg/m2) with treatment effects of exenatide twice daily among patients with type 2 diabetes. Patients received exenatide twice daily added to insulin glargine in two 30-week studies (exenatide twice daily vs insulin lispro, n = 627; exenatide twice daily vs placebo, n = 259). No association of baseline BMI with changes in efficacy variables was observed. Glycated haemoglobin (HbA1c) reductions were significant (p < 0.0001) and similar across BMI range groups in the lispro-comparator study and greater for exenatide versus placebo in the placebo-controlled study. Significant weight loss occurred with exenatide across BMI range groups (p < 0.0001), while weight increased with both comparators. Achievement of HbA1c <7.0% (<53 mmol/mol) without weight gain was greater for exenatide versus comparators. Systolic blood pressure decreased across BMI range groups with exenatide in the lispro-comparator study (p < 0.0001); changes in lipids were not clinically meaningful. Minor hypoglycaemia was less frequent for exenatide versus insulin lispro. These findings suggest that BMI alone should not limit clinical decision-making or patient access to medication. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Garcia S.D.,Hospital Universitario Virgen Of Valme |
Sanz S.D.,University of Seville |
Sanz A.D.,University of Seville
Medicina Clinica | Year: 2013
In this article, we review the results that can be expected after significant weight loss in patients with type 2 diabetes mellitus. We provide consensus-based documentation supported by the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation on the importance of physical exercise, metabolic-bariatric surgery, and drug therapy. Lastly, we report the results of studies published in the last few years on glucagon-like peptide-1 analogs and the new family of oral drugs known as gliflozins, specifically studies published on dapagliflozin. © 2013 Elsevier España, S.L. All rights reserved.
PubMed | Hospital Universitario Valdecilla, Hospital Universitario 12 Of Octubre, Hospital Universitario Of Mostoles, Autonomous University of Barcelona and 13 more.
Type: | Journal: Digestive diseases and sciences | Year: 2017
Long-term antiviral therapy has resulted in viral suppression and biochemical response in chronic hepatitis B, although the risk of hepatocellular carcinoma has not been abolished. The Page-B score could be useful to estimate the probability of HCC.To analyze the effectiveness and safety of entecavir or tenofovir for more than 4years and the usefulness of Page-B score in the real-world setting.Analysis of Caucasian chronic hepatitis B subjects treated with entecavir or tenofovir from the prospective, multicenter database CIBERHEP.A total of 611 patients were enrolled: 187 received entecavir and 424 tenofovir. Most were men, mean age 50years, 32% cirrhotic and 16.5% HBeAg-positive. Mean follow-up was 55 (entecavir) and 49 (tenofovir) months. >90% achieved HBV DNA <69IU/mL and biochemical normalization by months 12 and 36, respectively. Cumulative HBeAg loss and anti-HBe seroconversion were achieved by 33.7 and 23.8%. Four patients lost HBsAg; three HBeAg-positive. Renal function remained stable on long-term follow-up. Fourteen (2.29%) developed HCC during follow-up all of them with baseline Page-B 10. Nine were diagnosed within the first 5years of therapy. This contrasts with the 27 estimated by Page-B, a difference that highlights the importance of regular HCC surveillance even in patients with virological suppression.Entecavir and tenofovir achieved high biochemical and virological response. Renal function remained stable with both drugs. A Page-B cut-off 10 selected all patients at risk of HCC development.
Yebra G.,Hospital Ramon Y Cajal |
De Mulder M.,Hospital Ramon Y Cajal |
Martin L.,Hospital Ramon Y Cajal |
Rodriguez C.,Centro Sanitario Sandoval |
And 7 more authors.
Journal of Clinical Microbiology | Year: 2012
HIV-1 groupMis classified into 9 subtypes, as well as recombinants favored by coinfection and superinfection events with different variants. Although HIV-1 subtype B is predominant in Europe, intersubtype recombinants are increasing in prevalence and complexity. In this study, phylogenetic analyses of pol sequences were performed to detect the HIV-1 circulating and unique recombinant forms (CRFs and URFs, respectively) in a Spanish cohort of antiretroviral treatment-naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS). Bootscanning and other methods were used to define complex recombinants not assigned to any subtype or CRF. A total of 670 available HIV-1 pol sequences from different patients were collected, of which 588 (87.8%) were assigned to HIV-1 subtype B and 82 (12.2%) to HIV-1 non-B variants. Recombinants caused the majority (71.9%) of HIV-1 non-B infections and were found in 8.8% of CoRIS patients. Eleven URFs (accounting for 13.4% of HIV-1 non-B infections), presenting complex mosaic patterns, were detected. Among them, 10 harbored subtype B fragments. Four of the 11 URFs were found in Spanish natives. A cluster of three B/CRF02-AG recombinants was detected. We conclude that complex variants, including unique recombinant forms, are being introduced into Spain through both immigrants and natives. An increase in the frequency of mosaic viruses, reflecting the increasing heterogeneity of the HIV epidemic in our country, is expected. Copyright © 2012, American Society for Microbiology. All Rights Reserved.
Marenco J.L.,Hospital Universitario Virgen Of Valme |
Fernandez-Nebro A.,Hospital Regional Universitario Carlos Haya
Reumatologia Clinica | Year: 2010
Systemic lupus erythematosus is an autoimmune disease that may involve the function of organs and reduce the survival of patients. Advances in the diagnosis and treatment have improved the short-term prognosis. However, most therapeutic improvements come from progress in other areas of medicine and only in recent years is this trend changing. Unfortunately, the development of new drugs for lupus is facing specific difficulties and the development of rituximab in lupus has been stopped despite good results in the observational studies. This review examines some of the aspects that influence these difficulties from the perspective of the LESIMAB database. © 2010 Elsevier España, S.L.
Baena-Antequera F.,Hospital Universitario Virgen Of Valme |
Jurado-Garcia E.,Enfermeria Obstetrico Ginecologica Matrona
Enfermeria Clinica | Year: 2015
Within the assistance and support to coping with perinatal death, it must be considered that there is a group of women whose process has some features that give specific connotations. We talked about when the perinatal loss occurs due to a maternal decision to the presence of a fetal malformation. These cases today, thanks to advances in the techniques of control fetal development, are not uncommon. In their assistance, healthcare professionals should be aware that they often present a great sense of guilt and ambivalence between well-made decision and the hardness of having to come to it. A case of a pregnant woman undergoing a fetal fetolisis and care plan developed in her assistance for the induction of labor, delivery and immediate postpartum period is presented. This plan includes the problems of collaboration and the independent problems that are formulated according to the NANDA, NOC and NIC taxonomies. The implication for practice after studying this case leads to the duty to equally address the coping with a stillbirth, whether it was spontaneous or had it been determined by fetal malformation completion, giving parents the ability to view and contact with their child. © 2015 Elsevier España, S.L.U.
Gutierrez-Palomino L.,Hospital Universitario Virgen Of Valme |
Romo-De Los Reyes J.M.,Hospital Universitario Virgen Of Valme |
Pareja-Megia M.J.,Hospital Universitario Virgen Of Valme |
Garcia-Mejido J.A.,Hospital Universitario Virgen Of Valme
Cirugia y Cirujanos | Year: 2016
Background Synchronous multiple primary malignancies in the female genital tract are infrequent. From 50 to 70% of them corresponds to synchronous cancers of the endometrium and ovary. To our knowledge, this is only the third case report in the international literature of three concurrent gynaecological cancers of epithelial origin. A case is presented, as well as a literature review due to the infrequency of its diagnosis and the lack of information on the subject. Clinical case A 49-year-old woman, with previous gynaecological history of ovarian endometriosis. She underwent a hysterectomy and bilateral oophorectomy, as she had been diagnosed with endometrial hyperplasia with atypia. The final histopathology reported synchronous ovarian, Fallopian tube, and endometrial cancer. An extension study and complete surgical staging was performed, both being negative. She received adjuvant treatment of chemotherapy and radiotherapy. She is currently free of disease. Conclusions The aetiology is uncertain. There is controversy relating to increased susceptibility of synchronous neoplasms to pelvic endometriosis and inherited genetic syndromes. Its diagnosis needs to differentiate them from metastatic disease. Additionally, they are problematical from a clinical, diagnostic, therapeutic, and prognostic point of view. The presentation of more cases of triple synchronous cancers is necessary for a complete adjuvant and surgical treatment. © 2015 Academia Mexicana de Cirugía A.C.
Picon Heras R.,Hospital Universitario Virgen Of Valme
Cardiocore | Year: 2013
Brugada syndrome is still one of the most important channelopathies studied in the major experimental laboratories with the aim of finding a drug capable of eliminating secondary damages. The current indications for genetic testing, the limitations of provocative drug challenge testing, and intracardiac electrophysiology study and the therapeutics possibilities are reviewed in detail. © 2012 SAC.
Lozano De Leon-Naranjo F.,Hospital Universitario Virgen Of Valme
Medicine (Spain) | Year: 2014
The access to antiretroviral treatment has contributed to a global decrease in the number of new HIV infections, although the HIV pandemia continues to be a global challenge. In Spain, HIV transmission is mainly attributed to sexual relations among men. A 46 % of the new diagnoses has made lately. HIV infects CD4+ T lymphocytes, inducing an important reduction of the number of these cells, favoring the opportunistic and neoplastic entities defining AIDS. Likewise, HIV infection induces a persistent immune activation and a chronic inflammatory state, both implicated in the decrease of CD4+ T cells number, premature aging, multiorganic damage and non-AIDS defining neoplasias. The antiretroviral therapy has a limited activity against these immune and inflammatory activation-related diseases.
Cienfuegos A.,Hospital Universitario Virgen Of Valme |
Holgado M.I.,Hospital Universitario Virgen Of Valme |
Diaz del Rio J.M.,Hospital Universitario Virgen Of Valme |
Gonzalez Herranz J.,Hospital Universitario Virgen Of Valme |
Lara Bullon J.,Hospital Universitario Virgen Of Valme
Journal of Foot and Ankle Surgery | Year: 2013
Chronic ruptures of the Achilles tendon are more difficult to treat than acute tendon rupture. It has been shown that surgical treatment of chronic Achilles tendon rupture provides better functional results than nonoperative treatment. We present a case of neglected Achilles tendon rupture with a 12-cm defect that was repaired using an Achilles tendon allograft with interferential screws to fix the graft in the calcaneus. The patient recovered his ankle function to normal activities after rehabilitation. © 2013 American College of Foot and Ankle Surgeons.