Tabar A.I.,Hospital Virgen Del Camino |
Arroabarren E.,Hospital Universitario Donostia |
Echechipia S.,Hospital Virgen Del Camino |
Garcia B.E.,Hospital Virgen Del Camino |
And 2 more authors.
Journal of Allergy and Clinical Immunology | Year: 2011
Background: Specific immunotherapy (SIT) duration for respiratory allergy is currently based on individual decisions. Objective: To evaluate the differences in clinical efficacy of SIT as a result of the duration between the current recommended limits (3-5 years). Methods: A 5-year prospective, controlled clinical trial of SIT blind until the first year and randomization to a 3-year (IT3) or 5-year (IT5) course was conducted. Of the 239 patients with respiratory allergy caused by D pteronyssinus initially included, 142 completed 3 years of SIT with good compliance. Twenty-seven controls were included at the third year. Efficacy of SIT after 3 (T3) and 5 (T5) years was assessed by using clinical scores, visual analog scales (VASs), rhinitis (RQLQ) and asthma (AQLQ) quality of life questionnaires, skin tests, and serum immunoglobulins. Results: At T3, significant reductions were observed in rhinitis (44% in IT3 and 50% in IT5; P < .001), asthma (80.9 % in IT3 and 70.9% in IT5; P < .001) scores, VAS (P < .001 in both), RQLQ (P < .001 in both) and AQLQ (P < .001 in both). At T5, the clinical benefit was maintained in both groups, and IT5 patients presented additional decreases (19%; P = .019) in rhinitis scores. At Tf, specific IgG 4 measurements were lower in IT3 (P = .03) without detecting differences in IT5. An increase in asthma score of 133% was the only difference observed in controls. Conclusion: Clinical improvement is obtained with 3 years of D pteronyssinus SIT. Two additional years of SIT add clinical benefit in rhinitis only. © 2010 American Academy of Allergy, Asthma & Immunology.
Lopez J.I.,University of the Basque Country |
Guarch R.,Hospital Virgen del Camino |
Larrinaga G.,University of the Basque Country |
Corominas-Cishek A.,Hospital Universitario Cruces |
Orozco R.,Hospital San Juan Of Dios
APMIS | Year: 2013
The aim of this study was to define the histological spectrum, frequency and significance of nonconventional tumour cells in clear cell renal cell carcinomas (CCRCC). Fifty-one totally sampled CCRCC were studied histologically to evaluate the spectrum of cell morphology variability, its frequency and significance, and their correlation with tumour grade and stage, and other histological parameters of aggressive behaviour like necrosis. Aside from conventional clear/eosinophilic granular cells, three additional cellular types were identified and considered in this study: small clear cells, syncytial cells and rhabdoid cells. Small clear cells were detected in 11 cases (21.5%), syncytial cells in 8 (15.6%) and rhabdoid cells in 5 (9.8%). The presence of syncytial and rhabdoid cells statistically correlated with grade (p = 0.003 and p = 0.006) and stage (p = 0.049 and p = 0.05) in CCRCC. Necrosis correlated with stage (p = 0.018) and grade (p = 0.004), but not with syncytial, rhabdoid or small clear cells. The presence of syncytial and rhabdoid cells in CCRCC is a relatively frequent event that significantly correlates with high-grade tumours and high stage status. © 2013 APMIS.
Garcia-Mata S.,Hospital Virgen Del Camino
Journal of Pediatric Orthopaedics Part B | Year: 2013
Only four cases of avascular necrosis in the intermediate cuneiform bone have been described. A new case of avascular necrosis of the intermediate cuneiform bone as a very rare cause of limp is presented. A boy aged 4 years and 4 months came to the clinic with a 1-month history of pain in the left foot and on palpation of the base of the third metatarsal of the left foot. There were no signs of inflammation, bruising, erythema or fever. In the radiograph, a clear increase in the radiological density of the second cuneiform bone was seen. No treatment was prescribed. The symptoms remitted spontaneously after 2 weeks. The pain did not return and the patient was asymptomatic after 3 months. Five months later he presented a normal radiograph, continuing to be completely asymptomatic. One year later, he remained asymptomatic and carried out normal sports activities. A high index of suspicion is necessary with the aim of avoiding the performance of superfluous diagnostic tests (laboratory tests, MRIs or technetium-99 bone scans). The indication of treatments should be avoided, including conservative treatments such as shoe inserts or casts. Given its benign nature as well as the possibility of it presenting with no symptoms, we believe that it may be considered as a variant of normality. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Mayorga C.,Fundacion IMABIS Carlos Haya Hospital |
Sanz M.L.,University of Navarra |
Gamboa P.M.,Hospital Of Basurto |
Garcia B.E.,Hospital Virgen del Camino
Journal of Investigational Allergology and Clinical Immunology | Year: 2010
Evaluation of allergic reactions to drugs is difficult because of the poor sensitivity of in vivo tests, which makes controlled administration of the drug necessary to confirm the diagnosis. In vitro tests are important in order to avoid the risks of in vivo testing. In the present review, we describe the different methods for detecting immunoglobulin (Ig) E antibodies that are specific to drugs involved in the development of type I (immediate) reactions. The 2 main in vitro methods are immunoassays and the basophil activation test, both of which have sufficient sensitivity and specificity for the detection of specific IgE antibodies, although with a limited number of drugs, and they have proven complementary to in vivo methods. We show the importance of the allergological workup of the patient within less than 1 year from the occurrence of the allergic reaction in order to obtain positive results in both in vivo and in vitro tests. © 2010 Esmon Publicidad.
Martinon-Torres F.,Hospital Clinico Universitario Of Santiago |
Gimenez-Sanchez F.,Complejo Hospitalario Torrecardenas |
Bernaola-Iturbe E.,Hospital Virgen del Camino |
Diez-Domingo J.,Centro Superior Of Investigacion En Salud Publica Csisp |
And 3 more authors.
Vaccine | Year: 2014
Neisseria meningitidis serogroup B (MnB) is a major cause of invasive meningococcal disease in infants. A conserved, surface-exposed lipoprotein, LP2086 (a factor H-binding protein [fHBP]), is a promising MnB vaccine target. A bivalent, recombinant vaccine targeting the fHBP (rLP2086) of MnB was developed. Methods: This phase 1/2 clinical study was designed to assess the immunogenicity, safety, and tolerability of a 4-dose series of the rLP2086 vaccine at 20-, 60-, 120-, or 200-μg dose levels in vaccine-naive infants when given with routine childhood vaccines. The study was to consist of two phases: a single-blind sentinel phase and an open-label full enrollment phase. During the sentinel phase, randomization of subjects to the next higher dose was delayed pending a 14-day safety review of dose 1 of the preceding dose cohort. The full enrollment phase was to occur after completion of the sentinel phase. Results: Local reactions were generally mild and adverse events infrequent; however, after only 46 infants were randomized into the study, fever rates were 64% and 90% in subjects receiving one 20- or 60-μg rLP2086 dose, respectively. Most fevers were <39.0. °C. Only 2 subjects in the 20-μg group and 1 subject in the 60-μg group experienced fevers >39.0. °C; no fevers were >40.0. °C. Due to these high fever rates, the study was terminated early. No immunogenicity data were collected. This report discusses the safety and acceptability of rLP2086 in infants after one 20- or 60-μg dose. Conclusion: Due to the high fever rate experienced in the 20- and 60-μg groups, rLP2086 in the current formulation may not be acceptable for infants. © 2014.
Komorowski A.L.,Hospital Virgen Del Camino |
Rodil J.R.M.-H.,Hospital Virgen Del Camino
Journal of Emergencies, Trauma and Shock | Year: 2012
We report a case of a patient with an unrecognized colchicine overdose presenting to the emergency department with acute abdominal symptoms rapidly progressing to multiorgan failure. The patient died 16 h after a negative explorative laparotomy despite intensive supportive care. The problem of colchicine overdose is briefly discussed. We suggest that surgeons should be aware of the clinical presentation of colchicine overdose as it can mimic acute abdominal diseases.
Soler W.,Hospital Virgen del Camino
Anales del sistema sanitario de Navarra | Year: 2010
"Triage" is a process that enables us to manage clinical risk in order to safely and suitably handle patient flows when demand and clinical needs exceed resources. At present, triage systems that are employed are structured according to five levels of priority. Levels are allocated according to the concept that what is urgent is not always serious and that what is serious is not always urgent. This makes it possible to classify patients according to "degree of urgency", so that the more urgent patients will be attended to first and the rest will be re-evaluated until they are seen by the doctor. The Spanish triage system (SET) and the Manchester triage system (MTS) are the two standardised systems most implemented in our country. We also discuss the system of triage devised in Navarre--integrated in the computerised clinical history--and used in the hospital network of Navarre. All are multidisciplinary systems based on the reasons and urgency of consultation, but not on diagnoses, and are carried out by nursing staff with medical support when required. In addition, they all include monitoring of the quality of the accident and emergency service itself, and can be applied in the outpatient field.
Martin-Sanchez F.J.,Hospital Clinica San Carlos |
Fernandez Alonso C.,Hospital Clinica San Carlos |
Merino C.,Hospital Virgen del Camino
Anales del Sistema Sanitario de Navarra | Year: 2010
Demand in emergency care has been growing progressively in recent years and this increase is more pronounced in the elderly population. Taking into account that the elderly patient requires more complex evaluations with a greater requirement for complementary tests and consultations with other specialists, longer stays in the emergency ward and a greater percentage of admissions, the progressive ageing of the population might come to have a serious repercussion on hospital emergency departments. It is vital to detect high risk elderly patients before assigning them a definitive placement. For this purpose it is important to install a sieving process amongst elderly patients who attend the emergency department in order to select those that will benefit from a comprehensive geriatric assessment and thus be able to design a specific care plan. Emergency intervention in elderly patients should not be faced exclusively as a medical problem, but functional, mental or social aspects should be taken into account. This represents a challenge for emergency care. This article considers different aspects such as the detection and assessment of the geriatric patient, as well as establishing certain recommendations for emergency setting.
Solozabal-Campos C.,Hospital Virgen Del Camino
Dialisis y Trasplante | Year: 2010
Given the clinical characteristics of incident and prevalent patients in current hemodialysis programs, the successful use of internal arteriovenous fistulas (IAVF) to provide permanent vascular access is increasingly difficult. This difficulty seems to be the cause of the increase in the number of permanent catheters detected in almost all periodic hemodialysis programs. Compliance with the recommendations of the various "guidelines" does not seem to be feasible, indicating the need not only to reconsider our final objectives but also the indications for this technique. Thus, at the present moment, IAVF are no longer the first choice of vascular access for extracorporeal therapy in some patients. Furthermore, the ethical dilemma no longer lies in the choice between a fistula or a catheter but rather in whether to give the choice of access to the patient and/or the patient's relatives, individually tailoring the distinct types of access, but without forgetting the obligation to improve our results both in terms of the choice of materials and in placement of devices, as well as in terms of the care and maintenance of vascular access devices. Time is showing us that catheters are the best or only vascular access option for an increasing number of patients, obliging us to significantly improve the results currently reported in most publications. © 2010 SEDYT. Published by Elsevier España, S.L. All rights reserved.
Ortiz-Gomez R.,Hospital Virgen del Camino
Revista española de anestesiología y reanimación | Year: 2011
The economic evaluation of medications and health care technology has gained importance in recent years. Health care resources are limited and their use must be optimized so that we can take the greatest possible advantage. Pharmacoeconomics seeks to analyze the best therapeutic drug choices to obtain the desired outcome in specific cases or in populations. The 4 approaches used in pharmacoeconomics are cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis. This review examines the characteristics of each type of study using examples from anesthesiology, a field in which pharmacoeconomics is beginning to play a role.