PubMed | University of Victoria, University of La Coruña, University Hospital of Araba, Infanta Cristina University Hospital and 4 more.
Type: Journal Article | Journal: Journal of cardiovascular electrophysiology | Year: 2016
The Sprint Fidelis defibrillator lead (Medtronic) was recalled in 2007 due to an increased risk of failure. The generator exchange (GE) procedure has been associated with the development of Fidelis lead dysfunction. The aim of this study was to compare the rate of dysfunction between Sprint Fidelis and other defibrillator leads during the first year after GE.A multicenter retrospective study involving patients from the UMBRELLA database who underwent GE with previous normal lead function and minimum follow-up of 1 year after the procedure was performed. The incidence of lead dysfunction was determined via remote monitoring and defined as pacing impedance > 1,500 ohm, high-voltage impedance > 100 ohm, R wave sensing under 2 mV, or the presence of VT/VF episodes classified as noise.A total of 531 patients were included (114 Fidelis). In the first year after GE, the total incidence of lead dysfunction was 3.6%. No significant differences were found between Fidelis and the others in survival analysis (3.5% vs. 3.6%, respectively, log-rank 0.002, P = 0.962).According to our results, the preventive removal/replacement of the Sprint Fidelis leads with normal function until GE is not a recommended practice since the rate of dysfunction after the procedure in this subgroup is no different compared with other defibrillator leads.
Arrebola J.P.,Virgen Of Las Nieves University Hospital |
Arrebola J.P.,University of Granada |
Arrebola J.P.,CIBER ISCIII |
Gonzalez-Jimenez A.,San Cecilio University Hospital |
And 8 more authors.
Environmental Research | Year: 2015
The aim of the present study was to assess the relationship between serum concentrations of several persistent organic pollutants and insulin resistance markers in a cohort of women with a history of gestational diabetes mellitus. ∑POPs was computed as the sum of individual serum POP concentrations. No statistically significant associations were found between levels of any POP and fasting glucose. However, polychlorinated biphenyl (PCB) congeners 138 and 180 were positively associated with 2-h glucose levels and PCB 180 also with fasting immunoreactive insulin (IRI). We also found a positive association of p,p'. - dichlorodiphenyldichloroethylene (p,p'. - DDE), PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs with 2-h IRI. Serum concentrations of PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs were also positively associated with homeostasis model assessment (HOMA2-IR) levels. Moreover, p,p'- DDE, PCBs (138, 153 and 180), hexachlorobenzene, and ∑POPs were negatively associated with Insulin Sensitivity Index (ISI-gly) levels. No significant association was found between glycated hemoglobin and the concentrations of any POP. The removal of women under blood glucose lowering treatment from the models strengthened most of the associations previously found for the whole population. Our findings suggest that exposure to certain POPs is a modifiable risk factor contributing to insulin resistance. © 2014 Elsevier Inc.
PubMed | Complutense University of Madrid, Gregorio Maranon University Hospital and Virgen Of Las Nieves University Hospital
Type: Journal Article | Journal: International journal of technology assessment in health care | Year: 2014
The aim of this study was to identify risk points in the different stages of the smart infusion pump implementation process to prioritize improvement measures.Failure modes and effects analysis (FMEA) in the pediatric intensive care unit (PICU) of a General and Teaching Hospital. A multidisciplinary team was comprised of two intensive care pediatricians, two clinical pharmacists and the PICU nurse manager. FMEA was carried out before implementing CareFusion infusion smart pumps and eighteen months after to identify risk points during three different stages of the implementation process: creating a drug library; using the technology during clinical practice and analyzing the data stored using Guardrails CQI v4.1 Event Reporter software.Several actions for improvement were taken. These included carrying out periodical reviews of the drug library, developing support documents, and including a training profile in the system so that alarms set off by real programming errors could be distinguished from those caused by incorrect use of the system. Eighteen months after the implementation, these measures had helped to reduce the likelihood of each risk point occurring and increase the likelihood of their detection.Carrying out an FMEA made it possible to detect risk points in the use of smart pumps, take action to improve the tool, and adapt it to the PICU. Providing user training and support tools and continuously monitoring results helped to improve the usefulness of the drug library, increased users compliance with the drug library, and decreased the number of unnecessary alarms.
Matas-Cobos A.M.,Virgen Of Las Nieves University Hospital |
Redondo-Cerezo E.,Virgen Of Las Nieves University Hospital |
Alegria-Motte C.,Virgen Of Las Nieves University Hospital |
Martinez-Chamorro A.,Virgen Of Las Nieves University Hospital |
And 6 more authors.
Pancreas | Year: 2015
Objectives: Toll-like receptors (TLRs) are damage-associated molecular patterns receptors, which are essential in the activation of the inflammasome cascade, required for the initiation of inflammation. We hypothesized that changes in the function of these receptors caused by genetic polymorphisms in their encoding genes could determine acute pancreatitis (AP) incidence or severity. Methods: Two hundred sixty-nine patients and 269 controls were included. Acute pancreatitis diagnosis criteria were abdominal pain, increased serum amylase levels, and positive findings on abdominal imaging. The patients were observed until discharge. Blood samples were obtained, determining the following TLRs: TLR1 rs5743611, TLR2 rs5743704, TLR3 rs3775291, TLR3 rs5743305, TLR4 rs4986790, TLR4 rs4986791, TLR5 rs5744174, TLR6 rs5743795, TLR7 rs2302267, TLR9 rs352140, and TLR10 rs4129009. Results: No TLR polymorphism was related to AP incidence. Regarding severity, CC genotype patients in TLR3 rs3775291 had an increased risk for severe pancreatitis (CC odds ratio [OR], 2.426; P = 0.015). In addition, TLR6 rs5743795 GG genotype patients had a lower risk for severe AP (GG OR, 0.909; P < 0.05). Intensive care unit admission was related to TLR5 rs5744174 homozygote TT carriers (TT OR, 3.367; P = 0.036). Conclusions: Our article points to genetic polymorphisms in TLR3 and TLR6 as having a plausible role in the occurrence of severe AP.
Effectiveness of cognitive-behavioral therapy in morbidity obese candidates for bariatric surgery with and without binge eating disorder [Efectividad de la terapia cognitivo-conductual en obesos mórbidos candidatos a cirugía bariátrica con o sin trastorno por atracón]
Abiles V.,Costa del Sol Hospital |
Rodriguez-Ruiz S.,University of Granada |
Abiles J.,Costa del Sol Hospital |
Obispo A.,Costa del Sol Hospital |
And 3 more authors.
Nutricion Hospitalaria | Year: 2013
Aims: To analyze changes in the general and specific psychopathology of morbidly obese bariatric surgery (BS) candidates after cognitive behavioral therapy (CBT) and assess differences between patients with and without binge eating disorder (BED) and between patients with obesity grades III and IV, studying their influence on weight loss. Methods: 110 consecutive morbidly obese BS candidates [77 females; aged 41 ± 9 yrs; body mass index 49.1 ± 9.0 kg/m2] entered a three-month CBT program (12 two-hour sessions) before BS. Participants were assessed with general and specific psychopathology tests pre-and post-CBT. Data were analyzed according to the degree of obesity and presence/absence of BED. Results: At baseline, BED patients were more anxious and depressive with lower self-esteem and quality of life versus non-BED patients (p < 0.05) and were more concerned with food, weight and figure, felt greater hunger, fear and guilt, and were more influenced by contextual cues (p < 0.005). Post-CBT, these differences in self-esteem, depression, and eating disorders disappeared due to significant improvements in BED patients. No difference between OIII and OIV groups was found in any psychopathology test pre- or post-CBT. Multivariate analysis demonstrated that CBT was effective to treat psychological comorbidity regardless of the presence/ absence of BED or degree of obesity. At 1 yr post-CBT, weight loss versus baseline (before CTT) was > 10% in 61%, with no intergroup differences. Conclusions: CBT is effective to treat psychological comorbidity in BS candidates, regardless of the presence of BED and degree of obesity.
Morales-Garcia C.,Virgen Of Las Nieves University Hospital |
Parra-Ruiz J.,San Cecilio University Hospital |
Sanchez-Martinez J.A.,Santa Ana Hospital |
Delgado-Martin A.E.,Santa Ana Hospital |
And 2 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2015
SETTING: South Granada Health Area (SGHA), Spain. OBJECTIVE : To describe the characteristics of concomitant tuberculosis (TB) and lung cancer cases. DESIGN: A total of 319 TB cases diagnosed between January 2003 and December 2010 were evaluated and identified using a prospective database. During this period, samples of bronchial secretions were obtained from all patients who underwent fibreoptic bronchoscopy (FBS) as part of a TB screening programme. A descriptive study was conducted. RESULTS : Concomitant TB and lung cancer were diagnosed in 15 cases (4.7% of total TB cases). The most common radiographic finding was atelectasis (53.3%), and the most common histological type was epidermoid carcinoma (60%). Lung cancer stage was advanced (III-IV) in 60% of the cases. CONCLUSION: The association between TB and lung cancer found in the SGHA after implementing a TB screening programme was higher than in other studies. This suggests that it would be advisable to perform acidfast bacilli smear and mycobacterial culture of bronchial aspirates in all patients with presumed lung cancer, particularly in high TB prevalence areas. © 2015 The Union.
Orgaz-Molina J.,University of Granada |
Cotugno M.,University of Granada |
Giron-Prieto M.S.,PinosPuente Health Care Center |
Arrabal-Polo M.A.,University of Granada |
And 3 more authors.
Actas Dermo-Sifiliograficas | Year: 2015
Background The use of the Internet to search for medical information is considered by some physicians as an invasion of their medical domain and a reflection of a lack of trust in their advice and recommendations. Objective The main objective of this study was to estimate the amount of medical information gathered from the Internet and to establish whether these online searches reflect a lower degree of patient satisfaction. Patients and methods A survey was conducted among 175 patients seen at the melanoma and psoriasis units of San Cecilio University Hospital in Granada, Spain between May 2010 and December 2011. Results Online searches for medical information were performed by 44.4% of patients who returned correctly completed questionnaires. The main reasons given for these searches were to complement appropriate information provided by the physician (67.3%) and to gather information before consultation with the physician (36.5%). Variables associated with the search for medical information on the Internet in the multivariate analysis were a higher educational level, a higher score on two items in the Need for Cognition Scale, and consultation of mass media other than the Internet. Limitations Studies with larger numbers of patients and other diseases, however, are required to confirm these results. Conclusions The search for medical information is a widespread reality among patients with psoriasis and melanoma and it is not associated with a poor relationship with the physician. Dermatologists can play a beneficial role by recommending trustworthy Internet sites during the patient's visit and by promoting the development of pages by scientific societies to provide high-quality information. © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.
Martinez M.P.,University of Granada |
Miro E.,University of Granada |
Sanchez A.I.,University of Granada |
Diaz-Piedra C.,University of Granada |
And 3 more authors.
Journal of Behavioral Medicine | Year: 2014
Sleep disturbances play an important role in the exacerbation of pain and other troubling symptoms reported by patients with fibromyalgia (FM). The objective of this trial was to analyze the efficacy of a cognitive-behavioral therapy for insomnia (CBT-I) versus a sleep hygiene (SH) education program at improving sleep and other clinical manifestations in FM. Sixty-four FM women with insomnia were randomly assigned to the CBT-I or the SH groups, and 59 completed the treatments (30 in the CBT-I group and 29 in the SH group). Participants completed several self-report questionnaires at pre-, post-treatment and follow-ups. The CBT-I group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM. © 2013 Springer Science+Business Media New York.
PubMed | PinosPuente Health Care Center, University of Granada and Virgen Of Las Nieves University Hospital
Type: Journal Article | Journal: Actas dermo-sifiliograficas | Year: 2015
The use of the Internet to search for medical information is considered by some physicians as an invasion of their medical domain and a reflection of a lack of trust in their advice and recommendations.The main objective of this study was to estimate the amount of medical information gathered from the Internet and to establish whether these online searches reflect a lower degree of patient satisfaction.A survey was conducted among 175 patients seen at the melanoma and psoriasis units of San Cecilio University Hospital in Granada, Spain between May 2010 and December 2011.Online searches for medical information were performed by 44.4% of patients who returned correctly completed questionnaires. The main reasons given for these searches were to complement appropriate information provided by the physician (67.3%) and to gather information before consultation with the physician (36.5%). Variables associated with the search for medical information on the Internet in the multivariate analysis were a higher educational level, a higher score on two items in the Need for Cognition Scale, and consultation of mass media other than the Internet.Studies with larger numbers of patients and other diseases, however, are required to confirm these results.The search for medical information is a widespread reality among patients with psoriasis and melanoma and it is not associated with a poor relationship with the physician. Dermatologists can play a beneficial role by recommending trustworthy Internet sites during the patients visit and by promoting the development of pages by scientific societies to provide high-quality information.
Vargas-Hitos J.A.,systemIC |
Sabio J.M.,systemIC |
Tercedor J.,Virgen Of Las Nieves University Hospital |
Navarrete-Navarrete N.,systemIC |
Indian Journal of Dermatology | Year: 2013
A 65-year-old woman with bullous pemphigoid presented with fever and several red-purple nodular subcutaneous lesions on both lower legs 1 week after starting treatment with azathioprine (AZA). Biopsy of a skin nodule was compatible with erythema nodosum (EN) and hypersensitivity reaction to AZA was suspected. AZA was subsequently discontinued, observing complete remission of fever and EN within 2 weeks. This case highlights the importance of recognizing EN as a possible manifestation of hypersensitivity reaction to AZA.