Vall Dhebron University Hospital

Vall de Ebo, Spain

Vall Dhebron University Hospital

Vall de Ebo, Spain
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Otero-Romero S.,Hospital Universitari Vall dHebron | Otero-Romero S.,Vall dHebron University Hospital | Roura P.,Hospital General Of Vic | Sola J.,Hospital General Of Vic | And 6 more authors.
Multiple Sclerosis Journal | Year: 2013

The prevalence of multiple sclerosis in the south of Europe seems to be higher than previously considered. This study aimed to probe a possible increase in the prevalence of multiple sclerosis (MS) in Osona over the past 17 years. This was a cross-sectional study including MS-confirmed cases from several sources of information. Crude and adjusted prevalence rates were obtained. One hundred and twenty patients fulfilled the study criteria. The crude prevalence of MS was 79.9 (95% CI: 66.3-95.6) per 100,000 inhabitants and 91.2 (95% CI: 75.5-109.2) per 100,000 among Spanish born individuals. The prevalence of multiple sclerosis cases in Osona has increased over the past 17 years to being one of the highest reported in Spain. © The Author(s) 2012.

Alijotas-Reig J.,systemIC | Alijotas-Reig J.,Vall dHebron University Hospital | Alijotas-Reig J.,Autonomous University of Madrid | Garcia-Gimenez V.,Europa Medical Center | And 4 more authors.
Lupus | Year: 2012

Background: Systemic autoimmune/granulomatous adverse reactions related to biomaterials other than silicone have rarely been reported. Aim: The aim of this paper is to communicate the cases of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in a study of Spanish patients suffering from inflammatory disorders related to biomaterial injections other than silicone, principally hyaluronic acid, acrylamides or methacrylate compounds. Methods: The authors performed a retrospective analysis of the clinical, laboratory, histopathology and follow-up of a cohort of 250 cases of patients suffering from inflammatory/autoimmune disorders related to bioimplant injections. Results: Of these 250 cases, patients with adverse reactions related to silicone injections (n=65) were excluded. Of the remaining 185, 15 cases (8%) had systemic or distant and multiple complaints that could be categorized as ASIA. In all but four patients, inflammatory features at the implantation site preceded distant or systemic manifestations. Abnormal blood tests were common. Eleven cases (73.3%) with inflammatory localized nodules and panniculitis evolved into a variety of disorders, namely, primary biliary cirrhosis, Sjögren's syndrome, sarcoidosis, human adjuvant disease and inflammatory polyradiculopathy. Four cases presented primarily with systemic autoimmune disorders. Conclusions: Infrequently, biomaterials other than silicone can provoke local inflammatory adverse reactions that may evolve into systemic autoimmune and/or granulomatous disorders. Whether or not these biomaterials act as an adjuvant, they could be included in the ASIA category. © The Author(s), 2012. Reprints and permissions: journalsPermissions.nav.

Roberts J.A.,University of Queensland | Roberts J.A.,Royal Brisbane and Womens Hospital | Ulldemolins M.,University of Queensland | Ulldemolins M.,Vall dHebron University Hospital | And 8 more authors.
International Journal of Antimicrobial Agents | Year: 2010

The extreme pharmacokinetic behaviour of drugs sometimes observed in critically ill patients poses a significant threat to the achievement of optimal antibiotic treatment outcomes. Scant information on β-lactam antibiotic therapeutic drug monitoring (TDM) is available. The objective of this prospective study was to evaluate the practicality and utility of a β-lactam TDM programme in critically ill patients. TDM was performed twice weekly on all eligible patients at a 30-bed tertiary referral critical care unit. Blood concentrations were determined by fast-throughput high-performance liquid chromatography (HPLC) assays and were available within 12. h of sampling. Dose adjustment was instituted if the trough or steady-state blood concentration was below 4-5× the minimum inhibitory concentration (MIC) or above 10× MIC. A total of 236 patients were subject to TDM over an 11-month period. The mean ± standard deviation age was 53.5 ± 18.3 years. Dose adjustment was required in 175 (74.2%) of the patients, with 119 of these patients (50.4%) requiring dose increases after the first TDM. For outcome of therapy, 206 (87.3%) courses resulted in a positive treatment outcome and there were 30 (12.7%) treatment failures observed including 14 deaths and 15 courses requiring escalation to broader-spectrum agents; 1 course was ceased due to an adverse drug reaction. Using binomial logistic regression, only an elevated Acute Physiology and Chronic Health Evaluation (APACHE) II score (P<0.01) and elevated plasma creatinine concentration (P=0.05) were found to be predictive of mortality. In conclusion, further research is required to determine definitively whether achievement of optimal β-lactam pharmacodynamic targets improves clinical outcomes. © 2010 Elsevier B.V. and the International Society of Chemotherapy.

Walden A.P.,Royal Berkshire hospital | Clarke G.M.,University of Oxford | McKechnie S.,John Radcliffe hospital | Hutton P.,John Radcliffe hospital | And 6 more authors.
Critical Care | Year: 2014

Introduction: Community acquired pneumonia (CAP) is the most common infectious reason for admission to the Intensive Care Unit (ICU). The GenOSept study was designed to determine genetic influences on sepsis outcome. Phenotypic data was recorded using a robust clinical database allowing a contemporary analysis of the clinical characteristics, microbiology, outcomes and independent risk factors in patients with severe CAP admitted to ICUs across Europe.Methods: Kaplan-Meier analysis was used to determine mortality rates. A Cox Proportional Hazards (PH) model was used to identify variables independently associated with 28-day and six-month mortality.Results: Data from 1166 patients admitted to 102 centres across 17 countries was extracted. Median age was 64 years, 62% were male. Mortality rate at 28 days was 17%, rising to 27% at six months. Streptococcus pneumoniae was the commonest organism isolated (28% of cases) with no organism identified in 36%. Independent risk factors associated with an increased risk of death at six months included APACHE II score (hazard ratio, HR, 1.03; confidence interval, CI, 1.01-1.05), bilateral pulmonary infiltrates (HR1.44; CI 1.11-1.87) and ventilator support (HR 3.04; CI 1.64-5.62). Haematocrit, pH and urine volume on day one were all associated with a worse outcome.Conclusions: The mortality rate in patients with severe CAP admitted to European ICUs was 27% at six months. Streptococcus pneumoniae was the commonest organism isolated. In many cases the infecting organism was not identified. Ventilator support, the presence of diffuse pulmonary infiltrates, lower haematocrit, urine volume and pH on admission were independent predictors of a worse outcome. © 2014 Walden et al.; licensee BioMed Central Ltd.

Miller D.H.,University College London | Fazekas F.,Medical University of Graz | Montalban X.,Vall dHebron University Hospital | Reingold S.C.,Scientific and Clinical Review Associates | Trojano M.,University of Bari
Multiple Sclerosis Journal | Year: 2014

Background: Multiple sclerosis (MS) is influenced by pregnancy, sex and hormonal factors.Objectives: A comprehensive understanding of the role of pregnancy, sex and hormonal factors can provide insights into disease mechanisms, and new therapeutic developments and can provide improved patient care and treatment. Methods: Based on an international conference of experts and a comprehensive PubMed search for publications on these areas in MS, we provide a review of what is known about the impact of these factors on disease demographics, etiology, pathophysiology and clinical course and outcomes. Results and conclusions: Recommendations are provided for counseling and management of people with MS before conception, during pregnancy and after delivery. The use of disease-modifying and symptomatic therapies in pregnancy is problematic and such treatments are normally discontinued. Available knowledge about the impact of treatment on the mother, fetus and newborn is discussed. Recommendations for future research to fill knowledge gaps and clarify inconsistencies in available data are made. © The Author(s) 2013.

Martinez de Salazar P.,University of Barcelona | Martinez de Salazar P.,Global and the Barcelona Center for International Health Research | Suy A.,Vall dHebron University Hospital | Sanchez-Montalva A.,University of Barcelona | And 3 more authors.
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2016

Zika fever is an arboviral systemic disease that has recently become a public health challenge of global concern after its spread through the Americas. This review highlights the current understanding on Zika virus epidemiology, its routes of transmission, clinical manifestations, diagnostic tests, and the current management, prevention and control strategies. It also delves the association between zika infection and complications, such as microencephaly or Guillem-Barré syndrome. © 2016 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.

PubMed | University of Barcelona and Vall dHebron University Hospital
Type: Journal Article | Journal: Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology | Year: 2016

Brain-derived neurotrophic factor (BDNF) is linked to numerous brain functions. In addition, BDNF alterations contribute to neurological, mental, and addictive disorders. Cocaine dependence has received much attention recently due to its prevalence and psychological effects. Symptoms of psychosis are one of the most serious adverse events precipitated by cocaine use. It is particularly important to identify patients at risk of developing cocaine-induced psychosis (CIP). We described two cases of patients with cocaine dependence who presented with CIP and had changes in their BDNF levels during the psychotic episode. BDNF levels were initially low in both patients, and then decreased by more than 50% in association with CIP. The relationship between BDNF and psychosis is described in the literature. These cases revealed that BDNF levels decreased during a CIP episode and, thus, it is necessary to investigate BDNF and its relationship with CIP further.

Rodon J.,Vall dHebron University Hospital | Saura C.,Vall dHebron University Hospital | Dienstmann R.,Vall dHebron University Hospital | Vivancos A.,Vall dHebron Institute of Oncology | And 3 more authors.
Nature Reviews Clinical Oncology | Year: 2012

The efficacy of targeted therapies in patient populations selected for treatment on the basis of the molecular features of their tumours is shifting the current focus of treatment to biomarker-driven clinical trials. Phase I trials provide an arena for early hypothesis testing, examining not only safety and toxicity, but also target engagement, biologically effective dosages, and the appropriate patient population. In this Perspectives article, we describe this new trend in early drug development, establishing the different approaches for building a pre-screening programme in an academic institution that is involved in early drug development. Our experience establishing the phase I programme at Vall d'Hebrón serves as an example of how these approaches can be integrated in ongoing trials, and we believe these considerations will help others to implement similar programmes in their institutions. © 2012 Macmillan Publishers Limited. All rights reserved.

Ramirez-Estrada S.,Vall Dhebron University Hospital | Borgatta B.,Vall Dhebron University Hospital | Borgatta B.,Vall Dhebron Institute Of Research Vhir | Rello J.,Autonomous University of Barcelona | Rello J.,Research Center Biomedica en Red enfermedad Respiratoria eReS
Infection and Drug Resistance | Year: 2016

Ventilator-associated pneumonia is the most common infection in intensive care unit patients associated with high morbidity rates and elevated economic costs; Pseudomonas aeruginosa is one of the most frequent bacteria linked with this entity, with a high attributable mortality despite adequate treatment that is increased in the presence of multiresistant strains, a situation that is becoming more common in intensive care units. In this manuscript, we review the current management of ventilator-associated pneumonia due to P. aeruginosa, the most recent antipseudomonal agents, and new adjunctive therapies that are shifting the way we treat these infections. We support early initiation of broad-spectrum antipseudomonal antibiotics in present, followed by culture-guided monotherapy de-escalation when susceptibilities are available. Future management should be directed at blocking virulence; the role of alternative strategies such as new antibiotics, nebulized treatments, and vaccines is promising. © 2016 Ramírez-Estrada et al.

Braquehais M.D.,Vall dHebron University Hospital | Sher L.,Columbia University
Journal of Affective Disorders | Year: 2010

Introduction: Trauma is a universal phenomenon. Violence is a type of trauma and war is one of the ways in which violence is expressed. The "Neuroevolutionary Time-depth Principle" of innate fears, based on prevalence data, suggests that high rates of posttraumatic stress disorder (PTSD) after combat exposure can be due to the fact that this fear-stress response appeared as a reaction to inter-group male-to-male and intra-group killings after the rising of population densities in the Neolithic period. Material and methods: Studies of PTSD prevalence available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts and Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed. Results: Prevalence data of PTSD deeply vary from one country to another, even in groups exposed to similar stressors. Moreover, war is not a uniform and unchanged phenomenon and not all war stressors are similar because some of them are known to lead to PTSD more than others. Discussion: We argue that psychosocial narratives deeply influence our biological response to trauma and violence, shaping the genotypical response to trauma. Great differences in prevalence may be in part due to this fact. We also suggest that personal preconceptions and socio-cultural interests may also be playing a critical role in the theories developed to explain the nature of our response to violence. Conclusion: A comprehensive model for war-related PTSD should integrate both genotypical and phenotypical findings. © © 2010 Elsevier B.V. All rights reserved.

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