Hospitales Universitarios Virgen del Rocio

Sevilla, Spain

Hospitales Universitarios Virgen del Rocio

Sevilla, Spain
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Martinez-Maestre M.A.,Hospitales Universitarios Virgen Del Rocio | Gonzalez-Cejudo C.,Hospitales Universitarios Virgen Del Rocio | MacHuca G.,University of Seville | Torrejon R.,Hospitales Universitarios Virgen Del Rocio | Castelo-Branco C.,University of Barcelona
Climacteric | Year: 2010

Background Osteoporosis and periodontitis are frequent disorders that affect aging populations. It has been hypothesized that both conditions may be related. Objective To determine whether dental osteoporosis is a local manifestation of systemic bone loss having similar etiology and risk factors, or whether it is an independent process depending primarily on factors that cause periodontitis. Methods A systematic review of clinical trials assessing the relationship between osteoporosis and periodontitis was carried out. An electronic search was made based on Internet search engines, MEDLINE (from 1966 to December 2009) and the Cochrane Controlled Clinical Trials Register. Results A total of 145 studies dealing with the relationship osteoporosisperiodontitis were identified. Of them, 35 were considered suitable for selection. Studies on maxillary and/or mandible radiological findings have a positive correlation in the majority of the cases (18 positive vs. three negative), whereas the findings on clinical periodontal examination are inconclusive (six positive vs. five negative). There were ten studies in which a diagnosis of osteoporosis was made, based on the existence of non-traumatic fracture, while there were nine studies using radiographs for diagnosis, of which six studies were found to have a positive correlation. There was only one study based on a clinical periodontal examination that found a positive correlation. Conclusions The majority of the studies suggested a relationship between osteoporosis and periodontitis. Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully give an early warning for osteoporosis risk. © 2010 International Menopause Society.

Martin-Gandul C.,University of Seville | Perez-Romero P.,University of Seville | Sanchez M.,University of Seville | Bernal G.,Hospitales Universitarios Virgen del Rocio | And 5 more authors.
Journal of Clinical Virology | Year: 2013

Background: Valganciclovir preemptive therapy guided by the viral load is the current strategy recommended for preventing CMV disease in CMV-seropositive Solid Organ Transplant Recipients (SOTR) at lower risk for developing CMV infection. However, universal viral load cut-off has not been established for initiating therapy. Objectives: Our goal was to define and validate a standardized cut-off determined in plasma by real-time PCR assay for initiating preemptive therapy in this population. Study design: A prospective cohort study of consecutive cases of CMV-seropositive SOTR was carried out. The cut-off value was determined in a derivation cohort and was validated in the validation cohort. Viral loads were determined using the Quant CMV LightCycler 2.0 real-time PCR System (Roche Applied Science) and results were standardized using the WHO International Standard for human CMV. Results: A viral load of 3983. IU/ml (2600. copies/ml) was established as the optimal cut-off for initiating preemptive therapy in a cohort of 141 patients with 982 tests and validated in a cohort of 252 recipients with a total of 2022 test. This cut-off had a 99.6% NPV indicating that the great majority of patients at lower risk will not develop CMV disease without specific antiviral therapy. The high sensitivity and specificity (89.9% and 88.9%, respectively) and the relatively small numbers of patients with CMV disease confirm that real-time PCR was optimal. Conclusions: We have established a cut-off viral load for starting preemptive therapy for CMV-seropositive SOT recipients. Our results emphasized the importance of a mandatory follow-up protocol for CMV-seropositive patients receiving preemptive treatment. © 2012 Elsevier B.V.

Morris IV J.P.,University of California at San Francisco | Cano D.A.,University of California at San Francisco | Cano D.A.,Hospitales Universitarios Virgen del Rocio | Sekine S.,University of California at San Francisco | And 3 more authors.
Journal of Clinical Investigation | Year: 2010

Cellular plasticity in adult organs is involved in both regeneration and carcinogenesis. WT mouse acinar cells rapidly regenerate following injury that mimics acute pancreatitis, a process characterized by transient reactivation of pathways involved in embryonic pancreatic development. In contrast, such injury promotes the development of pancreatic ductal adenocarcinoma (PDA) precursor lesions in mice expressing a constitutively active form of the GTPase, Kras, in the exocrine pancreas. The molecular environment that mediates acinar regeneration versus the development of PDA precursor lesions is poorly understood. Here, we used genetically engineered mice to demonstrate that mutant Kras promotes acinar-to-ductal metaplasia (ADM) and pancreatic cancer precursor lesion formation by blocking acinar regeneration following acute pancreatitis. Our results indicate that β-catenin is required for efficient acinar regeneration. In addition, canonical β-catenin signaling, a pathway known to regulate embryonic acinar development, is activated following acute pancreatitis. This regeneration-associated activation of β-catenin signaling was not observed during the initiation of Kras-induced acinar-to-ductal reprogramming. Furthermore, stabilized β-catenin signaling antagonized the ability of Kras to reprogram acini into PDA preneoplastic precursors. Therefore, these results suggest that β-catenin signaling is a critical determinant of acinar plasticity and that it is inhibited during Kras-induced fate decisions that specify PDA precursors, highlighting the importance of temporal regulation of embryonic signaling pathways in the development of neoplastic cell fates.

Eslam M.,Hospital Universitario Of Valme | Lopez-Cortes L.F.,Hospitales Universitarios Virgen del Rocio | Romero-Gomez M.,Hospital Universitario Of Valme
Current Opinion in HIV and AIDS | Year: 2011

Purpose of review: Insulin resistance, HIV, antiviral drugs and hepatitis C virus (HCV) infection contribute to a complex interaction involving the metabolic syndrome. The objective of this review was to explore the meaning of insulin resistance in HIV-HCV-coinfected patients and how it may impact on sustained virological response (SVR) and disease progression. Recent findings: In the HIV/HCV coinfection setting, insulin resistance seems to be associated with a reduction in rapid virological response and SVR to pegylated interferon and ribavirin, both in naive and treatment experienced patients. A recent meta-analysis demonstrated insulin resistance impairs SVR rate with an odds ratio 0.47 (95% confidence interval 0.31-0.71). However, many confounding factors may promote contradictory results. Prevalence of insulin resistance depends on surrogate markers of insulin resistance and the threshold for defining impaired insulin sensitivity. For example, homeostasis model for the assessment of insulin resistance may be influenced by both methods of insulin measurement and interpretation. Insulin sensitizers, lifestyle changes and improvement in the use of protease inhibitors should be evaluated in the management of coinfected patients. Summary: Insulin resistance is common finding in patients with HIV/HCV coinfection, with wide clinical consequences including progression of hepatic fibrosis and reduction in the response to antiviral treatment. Our understanding of this relationship continues to improve. More prospective studies are required to improve future management. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Mendoza C.S.,Polytechnic University of Valencia | Acha B.,Polytechnic University of Valencia | Serrano C.,Polytechnic University of Valencia | Gomez-Cia T.,Hospitales Universitarios Virgen Del Rocio
Machine Vision and Applications | Year: 2012

In this paper, we propose a self-assessed adaptive region growing segmentation algorithm. In the context of an experimental virtual-reality surgical planning software platform, our method successfully delineates main tissues relevant for reconstructive surgery, such as fat, muscle, and bone. We rely on a self-tuning approach to deal with a great variety of imaging conditions requiring limited user intervention (one seed). The detection of the optimal parameters is managed internally using a measure of the varying contrast of the growing region, and the stopping criterion is adapted to the noise level in the dataset thanks to the sampling strategy used for the assessment function. Sampling is referred to the statistics of a neighborhood around the seed(s), so that the sampling period becomes greater when images are noisier, resulting in the acquisition of a lower frequency version of the contrast function. Validation is provided for synthetic images, as well as real CT datasets. For the CT test images, validation is referred to manual delineations for 10 cases and to subjective assessment for another 35. High values of sensitivity and specificity, as well as Dice's coefficient and Jaccard's index on one hand, and satisfactory subjective evaluation on the other hand, prove the robustness of our contrast-based measure, even suggesting suitability for calibration of other region-based segmentation algorithms. © 2010 Springer-Verlag.

Aguilar Reina J.,Hospitales Universitarios Virgen del Rocio
Medicine (Spain) | Year: 2012

Hepatic encephalopathy is a neuropsychiatric complication of acute and chronic liver diseases with characteristics morphological changes in astrogial cells. Overt HE is a potencially reversible syndrome. Minimal hepatic encephalopathy is the mildest form of HE. Several scales facilitate monitoring and assessment of overt HE; neuropsychological and neurophysiological tests can establish the diagnosis of minimal HE. The general consensus is that these individuals are unable to remove toxic substances, especially ammonia, derived from the intestine. In patients with cirrhosis the accumulation of ammonia results mainly due to hepatocellular failure and portosystemic shunting. Current treatment is based on reduced intestinal ammonia load by antibiotics or disaccarides, nevertheless the actual efficacy of these treatment is to be thoroughly established.

Lopez-Campos J.L.,Hospitales Universitarios Virgen del Rocio
International journal of chronic obstructive pulmonary disease | Year: 2010

AIM: It has been recently shown that the original BODE index has a high degree of correlation with two modified BODE indexes using maximal oxygen uptake expressed either as mL/min/kg (mBODE) or as the percentage predicted (mBODE%). In this study we investigated the agreement between the two modified BODE indexes (mBODE and mBODE%) in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: A total of 169 patients with stable COPD were enrolled in this cross-sectional study. Differences between the two mBODE indexes were assessed using kappa coefficients and Bland-Altman plots. One out of every three patients underwent the six-minute walking test to investigate the agreement with the original BODE index. RESULTS: Correlations between the two mBODE indexes with each other (r = 0.96, P < 0.001) and with the original BODE index (mBODE r = 0.88, P < 0.001; mBODE% r = 0.93, P < 0.001) were excellent. However, the two mBODE indexes were significantly different from each other (mBODE 5.27 +/- 2.3 versus mBODE% 4.31 +/- 2.5; P < 0.001). The kappa coefficients were significantly lower (entire study group k = 0.5, P < 0.001) for every GOLD stage. The mean difference between the two mBODE indexes was 0.8 +/- 0.6 units. Differences with the original BODE were higher for the mBODE (1.8 +/- 0.9) than for the mBODE% (0.6 +/- 0.8). CONCLUSIONS: The new mBODE indexes are highly correlated but significantly different from each other. The differences between the novel indexes deserve further scrutiny.

Little information is available on the use of computerized systems in preanesthetic assessment. Our aim was to evaluate staff acceptance of a computerized system for the structured recording of preoperative assessment data in our hospital. The time taken to complete the assessment was compared to the time usually taken to record the information on paper. Observational, descriptive cross-sectional survey of user satisfaction 3 months after the system had been launched. We later carried out a prospective observational study of 796 preanesthetic assessment visits, comparing the mean time the users took to record information on paper to the time required to enter the data into the computer, analyzing differences between anesthesiologists and according to American Society of Anesthesiologists (ASA) classification and patient age. A total of 401 paper records and 395 electronic files were included. The users believed that the computerized system improved quality and accessibility of recorded data and clinical decision-making. The time required to enter data into the computer was believed to be the main drawback; the users took a mean (SD) 15.21 (5.41) minutes to enter the electronic data and 13.37 (5.08) minutes to record the information on paper (P < .001). There were also significant differences in the time taken to record data according to ASA classification and between anesthesiologists (P < .001). In spite of drawbacks such as extra time taken to record electronic data, the users perceived benefits, such as improved quality and accessibility of records. For this reason, the computerized system was well accepted.

To assess the utility of preoperative chest radiographic findings for predicting cardiopulmonary complications in smokers undergoing transurethral resection of urinary bladder tumors under spinal anesthesia. To analyze perioperative changes in attitude in this setting. Prospective study of 309 smokers with > or = 20 pack-years of cumulative smoking who were candidates for transurethral resection of urinary bladder tumors. The patients were classified in 2 groups according to radiographic findings. Between groups we compared the incidence of cardiopulmonary complications, perioperative changes in attitude to anesthesia and surgery, delays in completing the preanesthesia workup, and differences in the duration of surgery and hospital stay. Patients older than 65 years were 1.92 times more likely to have significant findings on the chest radiograph. Radiographic findings were associated with a higher incidence of perioperative complications (P=.02), need for further preoperative consultations (P<.01), longer delay in completing the preanesthesia study (P<.01), longer mean (SD) hospital stay (3.43 [3.17] days vs 2.50 [1.77] days, P<.001), and longer duration of surgery (P<.001). Attitudes did not change in relation to radiographic findings during or after surgery. Chest radiography correctly classified 3.54% of the patients with complications (predictive value). The predictive value of chest radiography for cardiopulmonary complications is low and findings do not influence intra- or postoperative attitudes. We therefore find no justification for performing chest x-rays in the population studied.

Aguilera I.,Hospitales Universitarios Virgen del Rocio | Sousa J.M.,Hospitales Universitarios Virgen del Rocio | Praena J.M.,Hospitales Universitarios Virgen del Rocio | Gomez-Bravo M.A.,Hospitales Universitarios Virgen del Rocio | Nunez-Roldan A.,Hospitales Universitarios Virgen del Rocio
Clinical Transplantation | Year: 2011

In 2004, we defined the genetic mismatch in the glutathione S-transferase T1 (GSTT1) gene positive donor/null recipient as a risk factor to develop de novo immune hepatitis (IH) after liver transplant (LT), which is always associated with production of donor-specific anti-GSTT1 antibodies. However, there are several unresolved questions, such as why some of these patients produce antibodies, why others do not and why not all of the patients with antibodies develop the disease. The aim of this study was to evaluate the influence of several variables in the production of anti-GSTT1 antibodies and/or de novo IH. The study group included 35 liver-transplanted patients. The number of patients not producing antibodies was significantly higher in the group treated with Tac-based immunosuppression compared with the CsA-based group (94.1% vs. 5.9%, p=0.001). Additionally, a protective effect of the Tac-based therapy vs. the CsA-based therapy was observed with regard to development of de novo IH (80.8% vs. 19.2%, p=0.003). In conclusion, the choice of calcineurin inhibitor may influence the development of de novo IH mediated by anti-GSTT1 antibodies. © 2010 John Wiley & Sons A/S.

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