Clinical pathways in acute pancreatitis: Recommendations for early multidisciplinary management [Hoja de ruta de los cuidados clínicos para la pancreatitis aguda: Recomendaciones para el manejo anticipado multidisciplinar (clinical pathways)]
Maravi Poma E.,Complejo Hospitalario Of Navarra Antiguo H Virgen Del Camino |
Laplaza Santos C.,Complejo Hospitalario Of Navarra Antiguo H Virgen Del Camino |
Gorraiz Lopez B.,Complejo Hospitalario Of Navarra Antiguo H Virgen Del Camino |
Albeniz Arbizu E.,Complejo Hospitalario Of Navarra Antiguo H Virgen Del Camino |
And 10 more authors.
Medicina Intensiva | Year: 2012
There is a growing body of evidence that early management of patients with acute pancreatitis may alter the natural course of disease and improve outcomes of patients.The aim of this paper is to optimize the management of patients with acute pancreatitis during the first 72. h after hospital admission by proposing several clinical care pathways. The proposed pathways are based on the SEMICYUC 2005 Recommendations with incorporation of the latest developments in the field, particularly the determinants-based classification of acute pancreatitis severity. The pathways also incorporate the " alarm signs" , the use of therapeutic modalities known as PANCREAS, and the " call to ICU" criteria.Further studies will need to assess whether the adoption of these pathway reduces mortality and morbidity in patients with acute pancreatitis.The previous SEMICYUC guidelines on management of patients with acute pancreatitis in Intensive Care will need to be revised to reflect the recent developments in the field. © 2011 Elsevier España, S.L. and SEMICYUC.
Ruiz-Hernandez R.,Fundacio irsiCaixa HIVACAT |
Jou A.,Hospital Universitari Germans Trias i Pujol |
Cabrera C.,Fundacio irsiCaixa HIVACAT |
Noukwe F.,Fundacio irsiCaixa HIVACAT |
And 7 more authors.
Open Immunology Journal | Year: 2010
CD31+ is a marker for recent thymic emigrants. Nevertheless it is present in a proportion of memory cells. We looked at the distribution of CD31 on CD4 T-cell subpopulations. In cord blood, CD31 was present in the majority of the CD45RAhigh and 60% of the CD45RAlow cells, and in adults over 70% of "true" naïve and in 5-10% of all memory subpopulations (central memory, effector memory, follicular helper and T regulatory cells). No major differences were seen in the distribution of chemokine receptors between CD31+ and CD31- populations within the naïve cells nor the memory populations except for CCR3 and CCR9, which were preferentially expressed in the CD31+ memory cells. The CD31 distribution and cytokine receptors was similar between HIV negative and positive individuals, and between adult blood and tonsils. There was a correlation between the levels of TRECs and the percentages of CD31 in all samples studied. © Ruiz-Hernandez et al.
PubMed | Hospital Universitario La Paz, Hospital Infantil Universitario Nino Jesus, Hospital El Bierzo, Hospital Universitario Of Canarias and 9 more.
Type: | Journal: Allergy | Year: 2016
Despite the socioeconomic importance of allergic rhinitis (AR), very few prospective studies have been performed under conditions of routine clinical practice and with a sufficiently long observation period outside the clinical trial scenario. We prospectively estimated the direct and indirect costs of AR in patients attending specialized clinics in Spain.Patients were recruited at random from allergy outpatient clinics in 101 health centers throughout Spain over 12 months. We performed a multicenter, observational, prospective study under conditions of routine clinical practice. We analyzed direct costs from a funder perspective (health care costs) and from a societal perspective (health care and non-health care costs). Indirect costs (absenteeism and presenteeism [productivity lost in the workplace]) were also calculated. The cost of treating conjunctivitis was evaluated alongside that of AR.The total mean cost of AR per patient-year (n=498) was 2,326.70 (direct, 553.80; indirect, 1,772.90). Direct costs were significantly higher in women (600.34 vs. 484.46, P=0.02). Total costs for intermittent AR were significantly lower than for persistent AR (1,484.98vs 2,655.86, P<0.001). Total indirect costs reached 1,772.90 (presenteeism, 1,682.71; absenteeism, 90.19). The direct costs of AR in patients with intermittent asthma (507.35) were lower than in patients with mild-persistent asthma (719.07) and moderate-persistent asthma (798.71) (P=0.006).The total cost of AR for society is considerable. Greater frequency of symptoms and more severe AR are associated with higher costs. Indirect costs are almost 3-fold direct costs, especially in presenteeism. A reduction in presenteeism would generate considerable savings for society. This article is protected by copyright. All rights reserved.
Salazar M.R.,Hospital Universitario Gral San Martin |
Salazar M.R.,Hospital Municipal |
Espeche W.G.,Hospital Universitario Gral San Martin |
Espeche W.G.,Hospital Municipal |
And 10 more authors.
Metabolic Syndrome and Related Disorders | Year: 2012
Background: Identifying insulin-resistant (IR) individuals is an issue of particular interest in the assessment of cardiometabolic risk, but there is no simple way to accomplish this task. Our aims were to determine the relationship between uric acid and insulin resistance and to define the optimal uric acid cutoff to identify insulin resistance in women. Methods: A population-based sample of 588 women without cardiovascular diseases, diabetes, or low glomerular filtration rate (GFR) was divided according to uric acid tertiles. Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), TG/HDL-C ratio, insulin [fasting plasma insulin (FPI)], and homeostasis model assessment of insulin resistance (HOMA-IR) were compared between the mentioned tertiles. Receiver operating characteristic (ROC) curves were constructed to determinate the optimal cutoff of uric acid and identify IR individuals defined by the top tertile of FPI and HOMA-IR. The same variables were compared using the top tertile of uric acid and the maximum Youden index as cutoffs. The P values were adjusted by age, GFR, and body mass index (BMI) using analysis of covariance (ANCOVA). Results: FPI, HOMA-IR, and all of the cardiometabolic risk factors increased through uric acid tertiles. Both cutoffs of uric acid, estimated by the top tertile and by ROC, were identical (4.0 mg/dL). FPI, HOMA-IR, SBP, DBP, TG, TG/HDL-C ratio, and fasting glucose were higher, whereas HDL-C was lower in women who had uric acid levels >4.0 mg/dL. All of the differences remained significant after the adjustment by age and GFR. Conclusion: In healthy women, uric acid levels >4.0 mg/dL were associated with all the markers of IR. © 2012, Mary Ann Liebert, Inc.
Ferreira G.F.,University of Vale do Rio Doce |
Moraes C.,University of Vale do Rio Doce |
Moraes C.,Hospital Municipal |
da Silveira A.M.S.,University of Vale do Rio Doce |
And 8 more authors.
Memorias do Instituto Oswaldo Cruz | Year: 2012
We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6 production during early and late episodes.
PubMed | Hospital Universitario Gral San Martin, Hospital Municipal and National University of La Plata
Type: Journal Article | Journal: Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina) | Year: 2016
Hypertension is a recognized strong risk factor for cardiovascular disease. However, no data was available in our country to quantify the relationship between blood pressure and cardiovascular event.to quantify the risk of cardiovascular events according to blood pressure categories.A prospective epidemiological study was conducted in 1526 inhabitants from Rauch City, (Buenos Aires, Argentina) between 1997 and 2012. Subjects were classified into one of these blood-pressure categories: 1-optimal, 2-normal, 3-high-normal, 4-grade 1 hypertension, 5-grade 2 hypertension and 6-grade 3 hypertension. The first CVD event, including unstable angina pectoris, fatal and non-fatal myocardial infarction, myocardial revascularization, and fatal or non-fatal stroke, was defined as the primary endpoint. Multivariable Cox proportional-hazards regression models were used to estimate the relative risk (HR) of CVD according to base-line blood-pressure categories.In 2012, 1124 individuals (73.7% of the baseline sample), 719 women and 405 men (in 1997, aged 4516 and 4616 respectively) or their relatives in case of death, could be surveyed again in order to obtain information concerning incident CVD events. Cardiovascular event rates and HR values increased in a stepwise manner across the blood pressure categories (p for trend across categories <0.001 in both sex); however, in subjects aged 55 years a j-curve phenomenon was observed, showing the lowest incidence in the high-normal category. In all categories CVD events rates were higher for men.This study quantified relationships between BP and CVD starting from high-normal blood pressure in Argentina.
Trujillo-Santos J.,Hospital Universitario Santa Maria Of Rosell |
Casa J.M.,Hospital Infanta Cristina |
Casado I.,Hospital Universitario Virgen Of Las Nieves |
Samperiz A.L.,Hospital Reina Sofia |
And 3 more authors.
Thrombosis Research | Year: 2011
The influence of the site of cancer on outcome in cancer women with venous thromboembolism (VTE) is poorly understood. Reliable information on its influence might facilitate better use of prevention strategies. We assessed the 30-day outcome in all women with active cancer in the RIETE Registry, trying to identify if differences exist according to the tumor site. Up to May 2010, 2474 women with cancer and acute VTE had been enrolled. The most common sites were the breast (26%), colon (13%), uterus (9.3%), and haematologic (8.6%) cancers. During the 30-day study period, 329 (13%) patients died. Of them, 71 (2.9%) died of pulmonary embolism (PE), 22 (0.9%) died of bleeding. Fatal PE was more common in women with breast, colorectal, lung or pancreatic cancer (59% of the fatal PEs). Fatal bleeding was more frequent in women with colorectal, haematologic, ovarian cancer or carcinoma of unknown origin (55% of fatal bleedings). © 2011 Elsevier Ltd.
Salazar M.R.,Hospital Universitario San Martin |
Espeche W.G.,Hospital Universitario San Martin |
Aizpurua M.,Hospital Municipal |
Sisnieguez B.C.L.,Hospital Universitario San Martin |
And 3 more authors.
American Journal of Hypertension | Year: 2014
Background The significance in terms of the cardiovascular outcome of different patterns of blood pressure (BP) response to community-based activities has not been previously studied. The aim of our study was to evaluate the relationship between changes of BP observed during a community- based program and long-term rate of cardiovascular disease (CVD) events. methods A program focused on the prevention of CVDs was implemented in a small city in Argentina over a 6-year period (1997-2003). The program was evaluated using a cohort of 1,526 randomly selected individuals. The population's mean systolic BP (SBP) decreased approximately 5 mm Hg, but BP changes were heterogeneous. Eight years after the intervention had stopped, 1,124 individuals of the cohort were surveyed to evaluate incident CVD events. The sample was divided into 3 SBP change categories during the intervention: decrease (< -5 mm Hg), no change (-5 to 5 mm Hg) and increase (> 5 mm Hg). Cox models were used to estimate the hazard ratio (HR) of CVD events for each category adjusted for age, sex, and baseline BP. results At the end of the intervention, individuals who had increased their SBP showed an adjusted HR for CVD that was double those whose SBP levels decreased or did not change. An inverse relationship between baseline SBP and ΔSBP was observed: individuals with an increase in BP during the intervention had lower SBP at the beginning of the study. conclusions BP increase during the community-based program was an independent predictor of CVD events. © American Journal of Hypertension, Ltd 2014.
PubMed | Hospital Municipal and Hospital Universitario San Martin
Type: Journal Article | Journal: American journal of hypertension | Year: 2014
The significance in terms of the cardiovascular outcome of different patterns of blood pressure (BP) response to community-based activities has not been previously studied. The aim of our study was to evaluate the relationship between changes of BP observed during a community-based program and long-term rate of cardiovascular disease (CVD) events.A program focused on the prevention of CVDs was implemented in a small city in Argentina over a 6-year period (1997-2003). The program was evaluated using a cohort of 1,526 randomly selected individuals. The populations mean systolic BP (SBP) decreased approximately 5mm Hg, but BP changes were heterogeneous. Eight years after the intervention had stopped, 1,124 individuals of the cohort were surveyed to evaluate incident CVD events. The sample was divided into 3 SBP change categories during the intervention: decrease (< -5mm Hg), no change (-5 to 5mm Hg) and increase (> 5mm Hg). Cox models were used to estimate the hazard ratio (HR) of CVD events for each category adjusted for age, sex, and baseline BP.At the end of the intervention, individuals who had increased their SBP showed an adjusted HR for CVD that was double those whose SBP levels decreased or did not change. An inverse relationship between baseline SBP and SBP was observed: individuals with an increase in BP during the intervention had lower SBP at the beginning of the study.BP increase during the community-based program was an independent predictor of CVD events.
PubMed | Hospital San Martin, Hospital Municipal and National University of La Plata
Type: Journal Article | Journal: Journal of human hypertension | Year: 2015
We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1SBP). SBP decreased through sequential readings, 3-1SBP was -5.5 9.7 mm Hg (P<0.001), -5.1 10.4 mm Hg (P<0.001) and -6.1 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1SBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.