Rubio-Terres C.,Health Value Health Economics and Research of Outcomes |
Garau J.,Hospital Mutua Of Terrasa Infectious Diseases |
Grau S.,Hospital del Mar Pharmacy |
Martinez-Martinez L.,Santander University
Clinical Microbiology and Infection | Year: 2010
The aim of this study was to determine the impact on healthcare resource utilization and associated costs of bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA) vs. methicillin-susceptible S. aureus (MSSA) strains in Spain. An observational, retrospective, cohort multicentre study was conducted during 2005. The target population comprised Spanish patients with S. aureus bacteraemia (five and ten cases per hospital for resistant and susceptible strains, respectively). The resources used were obtained from the hospital patient records. The unit costs were obtained from the participating hospitals and from Spanish databases; the costs of a bacteraemic episode were estimated from resource utilization results and expressed in euros (€). Univariate sensitivity analyses were performed. The clinical records of 366 valid patients with S. aureus bacteraemia (121 MRSA and 245 MSSA) from 27 Spanish hospitals were reviewed. Resource use per bacteraemic episode was higher for MRSA cases than for MSSA cases, with longer antibiotic treatment (3.1 additional days) and greater length of hospital stay (LOS) (2.2 additional days), more diagnostic tests, and higher rates of admission to the intensive-care unit (ICU) (7.6%). As a consequence, a higher cost per episode was incurred, with an additional €1205 in episodes of MRSA infections (1.12-fold increase). The main drivers of the cost difference were the higher rates of ICU admission and hospital re-admission and increased LOS. The analysis confirmed that there were additional costs due to resistant strains, ranging from €293 to €5188. Overall, MRSA was associated with higher costs in bacteraemic patients, and this was attributable mainly to the greater rate of ICU admissions and increased LOS. © 2009 Hospital Universitari Mútua de Terrassa. Journal Compilation.
Gutierrez J.D.,Santander University
ASME 2015 International Pipeline Geotechnical Conference, IPG 2015 | Year: 2015
Extreme meteorological events associated with climate change are a real issue and have important impact over the economy of infrastructure sector, including highways, hydrocarbon transport by pipelines, mines, etc., because saturation of soils by water can produce landslides and it could produce the fracture of pipelines or other kind of tangible assets. For example, an assessment of historical geotechnical failures in Ecopetrol (Colombian Oil Company) vs. extreme meteorological events shows that during La Niña (extreme rainfall period) geotechnical failures are three times greater. This work shows a method to identify places of risk by extreme meteorological events, mainly La Niña phenomenon, with focus in most probably alteration of rainfall. Our results illustrate the hot spots where there is a high probability of slight excess (120-160% of average rainfall) and high excess (>160%) of average rainfall. The results were intersected in a GIS with pipelines and mass movement risk maps to identify the places of high risk along Santander region. © Copyright 2015 by ASME.
Gonzalez-Vilchez F.,Santander University |
Vazquez de Prada J.A.,Santander University
Drugs | Year: 2014
Renal dysfunction after heart transplantation is a frequently observed complication, in some cases resulting in significant limitation of quality of life and reduced survival. Since the pathophysiology of renal failure (RF) is multifactorial, the current etiologic paradigm for chronic kidney disease after heart transplantation relies on the concept of calcineurin inhibitor (CNI)-related nephrotoxicity acting on a predisposed recipient. Until recently, the management of RF has been restricted to the minimization of CNI dosage and general avoidance of classic nephrotoxic risk factors, with somewhat limited success. The recent introduction of proliferation signal inhibitors (PSIs) (sirolimus and everolimus), a new class of immunosuppressive drugs lacking intrinsic nephrotoxicity, has provided a completely new alternative in this clinical setting. As clinical experience with these new drugs increases, new renal-sparing strategies are becoming available. PSIs can be used in combination with reduced doses of CNIs and even in complete CNI-free protocols. Different strategies have been devised, including de novo use to avoid acute renal toxicity in high-risk patients immediately after transplantation, or more delayed introduction in those patients developing chronic RF after prolonged CNI exposure. In this review, the main information on the clinical relevance and pathophysiology of RF after heart transplantation, as well as the currently available experience with renal-sparing immunosuppressive regimens, particularly focused on the use of PSIs, is reviewed and summarized, including the key practical points for their appropriate clinical usage. © 2014 Springer International Publishing Switzerland.
Rodrigo E.,Santander University
Transplantation | Year: 2015
BACKGROUND: Lack of adherence to immunosuppressive drugs is a risk factor for development of de novo donor-specific antibodies (dnDSA) and can contribute to antibody-mediated rejection and graft loss. Moreover, nonadherence is the main determinant of immunosuppressive drug level variability. High intrapatient variability of tacrolimus relates to a worse outcome in transplant recipients through unknown mechanisms. We hypothesized that a high within-patient variability of tacrolimus could increase the rate of dnDSA development and contribute to further death-censored graft loss (DCGL). METHODS: We included 310 adult renal transplants receiving twice-daily tacrolimus throughout their first posttransplant year, with (1) at least 3 blood trough levels available to calculate coefficient of variation (CV) from month 4 to 12, (2) graft survival longer than 1 year, and (3) absence of pretransplant DSA. The dnDSA were analyzed in sera at 1, 3, and 5 years and around 6 month before the last follow-up visit or graft loss by single-antigen beads. RESULTS: During the follow-up, 53 patients lost their graft excluding death. A total of 116 patients (37.4%) had a CV greater than 30% and 39 (12.6%) developed dnDSA. Coefficient of variation greater than 30% (hazards ratio, 2.613; 95% confidence interval, 1.361-5.016; P = 0.004) independently related to DCGL. Acute rejection, re-transplant and CV greater than 30% (hazards ratio, 2.925; 95% confidence interval, 1.473-5.807; P = 0.002) were the only variables related to dnDSA development by Cox regression analysis. CONCLUSIONS: Tacrolimus level variability is a strong risk factor for dnDSA development and DCGL. Variability must be added to the current monitoring of kidney transplant recipients due to its relationship with adherence and to graft outcome. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Lopez-Jaramillo P.,Santander University
Journal of Nutrition | Year: 2016
Adiponectin is an adipocyte-derived hormone abundantly present in plasma that exerts its effects through the activation of 3 receptors. Its concentrations are negatively regulated by the accumulation of visceral fat, and clinical studies implicate hypoadiponectinemia in the pathogenesis of diabetes mellitus type 2, coronary artery disease, hypertension, and left ventricular hypertrophy. In contrast, high concentrations of adiponectin are associated with a decreased risk of coronary artery disease, with an improvement in the differentiation of preadipocytes into adipocytes, and with increased endothelial nitric oxide production. Therefore, adiponectin appears to be an important molecule involved in limiting the pathogenesis of obesity-linked disorders, and it may have potential benefits in the treatment and prevention of cardiovascular disease. Caloric restriction, moderate alcohol consumption, and consuming a Mediterranean diet increase adiponectin concentrations, and current evidence suggests a positive, dose-dependent relation between ω-3 (n-3) fatty acid intake and circulating concentrations of adiponectin. Recently, it was reported that the administration of aged garlic extract and a single food intervention with pistachios can increase adiponectin concentrations in individuals with metabolic syndrome. Moreover, the Mediterranean diet is associated with higher adiponectin concentrations. Additional studies are needed to evaluate the potential benefits of increasing adiponectin by nutritional interventions in the treatment and prevention of cardiometabolic diseases. © 2016 American Society for Nutrition.
Oterino A.,Santander University |
Ramon C.,University of Oviedo |
Pascual J.,University of Oviedo
Journal of Headache and Pain | Year: 2011
The objective of this study is to analyse our experience in the treatment of refractory chronic migraine (CM) with onabotulinumtoxinA (BTA) and specifically in its effects over disabling attacks. Patients with CM and inadequate response or intolerance to oral preventatives were treated with pericranial injections of 100 U of TBA every 3 months. The dose was increased up to 200 U in case of no response. The patients kept a headache diary. In addition, we specifically asked on the effect of BTA on the frequency of disabling attacks, consumption of triptans and visits to Emergency for the treatment of severe attacks. This series comprises a total of 35 patients (3 males), aged 24-68 years. All except three met IHS criteria for analgesic overuse. The number of sessions with BTA ranged from 2 to 15 (median 4) and nine (26%) responded (reduction of >50% in headache days). However, the frequency of severe attacks was reduced to an average of 46%. Oral triptan consumption (29 patients) was reduced by 50% (from an average of 22 to 11 tablets/month). Those six patients who used subcutaneous sumatriptan reduced its consumption to a mean of 69% (from 4.5 to 1.5 injections per month). Emergency visits went from an average of 3 to 0.4 per trimester (-83%). Six patients complained of mild adverse events, transient local cervical pain being the most common. Although our data must be taken with caution as this is an open trial, in clinical practice treatment of refractory CM with BTA reduces the frequency of disabling attacks, the consumption of triptans and the need of visits to Emergency, which makes this treatment a profitable option both clinically and pharmacoeconomically. © The Author(s) 2011.
Berciano J.,Santander University
Journal of Neurology | Year: 2013
Herein, I review the main papers in neurogenetic research published in the Journal of Neurology over the last year. © 2012 Springer-Verlag Berlin Heidelberg.
Vargas M.N.,Santander University |
Lloria M.B.,University of Valencia
Industrial Management and Data Systems | Year: 2014
Purpose - The main aim of this research is to relate intellectual capital (IC) and organizational performance through intermediate variables, enablers and learning flows. To this end, the paper defines a new theoretical model of relations and presents an empirical study to contrast the model. Design/methodology/approach - The proposed theoretical model is contrasted by means of a quantitative study of Spanish firms from the biotechnology sector. The statistical analysis applies a method based on variance using partial least squares. Findings - The theoretical model proposes a total of 15 relations, 13 of which are statistically significant, which demonstrates the close relationship between IC and performance using enablers and learning flows as intermediate variables. Originality/value - From the theoretical model proposed and its subsequent empirical contrast, the research shows the close relations that exist between areas of knowledge that traditionally appear separately in the literature. The proposed model thus allows us to explain and predict the dynamization of the components of IC due to enablers and learning flows, and the effect of these elements on organizational performance. Copyright © 2014 Emerald Group Publishing Limited. All rights reserved.
Gallardo E.,Santander University |
Gallardo E.,University of Cantabria |
Noto Y.-I.,Kyoto Prefectural University of Medicine |
Simon N.G.,University of New South Wales |
Simon N.G.,University of Sydney
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2015
Peripheral nerve ultrasound (US) has emerged as a promising technique for the diagnosis of peripheral nerve disorders. While most experience with US has been reported in the context of nerve entrapment syndromes, the role of US in the diagnosis of peripheral neuropathy (PN) has recently been explored. Distinctive US findings have been reported in patients with hereditary, immune-mediated, infectious and axonal PN; US may add complementary information to neurophysiological studies in the diagnostic work-up of PN. This review describes the characteristic US findings in PN reported to date and a classification of abnormal nerve US patterns in PN is proposed. Closer scrutiny of nerve abnormalities beyond assessment of nerve calibre may allow for more accurate diagnostic classification of PN, as well as contribute to the understanding of the intersection of structure and function in PN.
Quintanar Lartundo J.A.,Santander University
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis | Year: 2011
Peritonitis, the major complication of peritoneal dialysis (PD), is associated with high morbidity and mortality. It is a major cause of hospitalization and transfer to hemodialysis. In the present study, we aimed to identify predictors of hospitalization in PD-related peritonitis and to examine its microbiology profile over time in our unit to determine the best therapeutic approach. We studied all peritonitis episodes that occurred in a 6-year period (January 1, 2004, to December 31, 2009), evaluating whether adequate treatment could be delivered on an outpatient basis. During the study period, 411 patients were on PD, and 229 peritonitis episodes were recorded in 91 patients. Peritonitis were treated according to unit protocol. The average hospital stay was 11.6 +/- 6.6 days. We observed an increase of Streptococcus (to 19.4% from 7.7%) and a stabilization of coagulase-negative Staphylococcus, S. epidermidis, and S. aureus (from 9.5%, 22.6%, and 3.2% to 7.7%, 30.8%, and 3.8% respectively) peritonitis episodes. The main risk factors for hospitalization were fungal infection, poor 72-hour outcome, inability to perform self-care, and age greater than 80 years. We observed a decline in the incidence of peritonitis, and despite changes in its microbiology profile, no loss of sensitivity to antibiotics used was observed.