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Pérez-Pérez M, Agostino A, de Sola-Llamas CG, Ruvolo M, Vilches-Arenas A, Relimpio-López MI, Espejo-Arjona F, Macías-García L, De Miguel-Rodríguez M, García-Escudero A, Idoate MA, Ríos-Martín JJ. Next-generation sequencing of uveal melanoma with clinical and histological correlations: Prognostic value of new mutations in the PI3K/AKT/mTOR pathway. Clin Exp Ophthalmol 2023; 51:822-834. [PMID: 37803816 DOI: 10.1111/ceo.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Uveal melanoma (UM) is the eye's most common primary malignancy and there are no effective therapies for disseminated disease. It is important to try to know the patient's prognosis. The aim of this study was to reflect genetic variants, studied using NGS, of a series of 69 cases of UM and its correlation with histopathology and clinical progression. METHODS We performed targeted NGS using a 519-gene panel. RESULTS There were selected 28 different mutated genes, showing a total of 231 genetic variants that affected the function of the protein. The most common secondary mutations occurred in SF3B1 (in 26%), followed by BAP1 (in 23%), LRP1B (22%) and FGFR4 (20%). BAP1 mutation was associated with a greater likelihood of metastases and with greater presence of epithelioid cells. LRP1B was also associated with presence of epithelioid cells SF3B1 mutation was significantly associated with a spindle morphology. We found variants in the RAD51B, TOP2A, PTPRD, TSC2, DHX9, PDK1 and MTOR that have not been previously reported in consulted databases. The presence of a mutation in: CHEK2, DHX9 and PDK1 was associated with metastases. CONCLUSIONS BAP1 is the most solid biomarker of a poor prognosis in UM and mutations can be detected using NGS. SF3B1 is associated with the spindle cell subtype of UM, which gives it probably a favourable prognostic value. Our study suggests that mutations in DHX9 and PDK1 can have prognostic value. These potential biomarkers are related to the PI3K/AKT/mTOR pathway and makes them candidates for developing new directed therapies.
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Affiliation(s)
- Manuel Pérez-Pérez
- Department of Anatomic Pathology, Virgen Macarena University Hospital, Seville, Spain
| | - Alessandro Agostino
- Diagnostics and Genomics Division, Agilent Technologies Italia S.p.A. Cernusco sul Naviglio, Milan, Italy
| | | | - Michael Ruvolo
- Diagnostics and Genomics Division, Agilent Technologies, Inc., Santa Clara, California, USA
| | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Seville, Spain
| | | | | | - Laura Macías-García
- Department of Normal and Pathological Histology and Cytology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Manuel De Miguel-Rodríguez
- Department of Normal and Pathological Histology and Cytology, Faculty of Medicine, University of Seville, Seville, Spain
| | | | - Miguel A Idoate
- Department of Anatomic Pathology, Virgen Macarena University Hospital, Seville, Spain
- Department of Normal and Pathological Histology and Cytology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Juan J Ríos-Martín
- Department of Anatomic Pathology, Virgen Macarena University Hospital, Seville, Spain
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Alonso-Tuñón O, Bertomeu-Cornejo M, Castillo-Cantero I, Borrego-Domínguez JM, García-Cabrera E, Bejar-Prado L, Vilches-Arenas A. Development of a Novel Prediction Model for Red Blood Cell Transfusion Risk in Cardiac Surgery. J Clin Med 2023; 12:5345. [PMID: 37629386 PMCID: PMC10456036 DOI: 10.3390/jcm12165345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Cardiac surgery is a complex and invasive procedure that often requires blood transfusions to replace the blood lost during surgery. Blood products are a scarce and expensive resource. Therefore, it is essential to develop a standardized approach to determine the need for blood transfusions in cardiac surgery. The main objective of our study is to develop a simple prediction model for determining the risk of red blood cell transfusion in cardiac surgery. METHODS Retrospective cohorts of adult patients who underwent cardiac surgery between 2017 and 2019 were studied to identify hypothetical predictors of blood transfusion. Finally, a multivariable logistic regression model was developed to predict the risk of transfusion in cardiac surgery using the AUC and the Hosmer-Lemeshow goodness-of-fit test. RESULTS We included 1234 patients who underwent cardiac surgery. Of the entire cohort, 875 patients underwent a cardiac procedure 69.4% [CI 95% (66.8%; 72.0%)]; 119 patients 9.6% [CI 95% (8.1%; 11.4%)] underwent a combined procedure, and 258 patients 20.9% [CI 95% (18.7; 23.2)] underwent other cardiac procedures. The median perioperative hemoglobin was 13.0 mg/dL IQR (11.7; 14.2). The factors associated with the risk of transfusion were age > 60 years OR 1.37 CI 95% (1.02; 1.83); sex female OR 1.67 CI 95% (1.24; 2.24); BMI > 30 OR 1.46 (1.10; 1.93); perioperative hemoglobin < 14 OR 2.11 to 51.41 and combined surgery OR 3.97 CI 95% (2.19; 7.17). The final model shows an AUC of 80.9% for the transfusion risk prediction [IC 95% (78.5-83.3%)]; p < 0.001]. CONCLUSIONS We have developed a model with good discriminatory ability, which is more parsimonious and efficient than other models.
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Affiliation(s)
- Ordoño Alonso-Tuñón
- Department of Anesthesia and Reanimation, Virgen del Rocio University Hospital, 41013 Seville, Spain; (O.A.-T.)
| | - Manuel Bertomeu-Cornejo
- Department of Anesthesia and Reanimation, Virgen del Rocio University Hospital, 41013 Seville, Spain; (O.A.-T.)
| | - Isabel Castillo-Cantero
- Department of Obstetric and Gynecology, Maternity and Children Hospital, Virgen del Rocio University Hospital, 41013 Seville, Spain
| | | | - Emilio García-Cabrera
- Department of Preventive Medicine and Public Health, University of Seville, 41004 Seville, Spain; (L.B.-P.)
| | - Luis Bejar-Prado
- Department of Preventive Medicine and Public Health, University of Seville, 41004 Seville, Spain; (L.B.-P.)
| | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, University of Seville, 41004 Seville, Spain; (L.B.-P.)
- Department of Preventive Medicine and Public Health, Virgen Macarena University Hospital, 41009 Seville, Spain
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Fernández-Alvarez P, Guerra-Veloz MF, Vilches-Arenas A, Cordero-Ruíz P, Bellido-Muñoz F, Caunedo-Alvarez A, Carmona-Soria I. Dynamic Changes in Non-Invasive Markers of Liver Fibrosis Are Predictors of Liver Events after SVR in HCV Patients. Viruses 2023; 15:1251. [PMID: 37376551 DOI: 10.3390/v15061251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives: The course of progressive liver damage after achieving sustained virological response (SVR) with direct-acting antivirals (DAAs) remains undetermined. We aimed to determine risk factors associated with the development of liver-related events (LREs) after SVR, focusing on the utility of non-invasive markers. Methods: An observational, retrospective study that included patients with advanced chronic liver disease (ACLD) caused by hepatitis C virus (HCV), who achieved SVR with DAAs between 2014 and 2017. Patients were followed-up until December 2020. LREs were defined as the development of portal hypertension decompensation and the occurrence of hepatocellular carcinoma (HCC). Serological markers of fibrosis were calculated before treatment and one and two years after SVR. Results: The study included 321 patients, with a median follow-up of 48 months. LREs occurred in 13.7% of patients (10% portal hypertension decompensation and 3.7% HCC). Child-Pugh [HR 4.13 (CI 95% 1.74; 9.81)], baseline FIB-4 [HR 1.12 (CI 95% 1.03; 1.21)], FIB-4 one year post-SVR [HR 1.31 (CI 95% 1.15; 1.48)] and FIB-4 two years post-SVR [HR 1.42 (CI 95% 1.23; 1.64)] were associated with portal hypertension decompensation. Older age, genotype 3, diabetes mellitus and FIB-4 before and after SVR were associated with the development of HCC. FIB-4 cut-off values one and two years post-SVR to predict portal hypertension decompensation were 2.03 and 2.21, respectively, and to predict HCC were 2.42 and 2.70, respectively. Conclusions: HCV patients with ACLD remain at risk of developing liver complications after having achieved SVR. FIB-4 evaluation before and after SVR may help to predict this risk, selecting patients who will benefit from surveillance.
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Affiliation(s)
- Paula Fernández-Alvarez
- Department of Gastroenterology and Hepatology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | | | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, 41009 Seville, Spain
| | - Patricia Cordero-Ruíz
- Department of Gastroenterology and Hepatology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Francisco Bellido-Muñoz
- Department of Gastroenterology and Hepatology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Angel Caunedo-Alvarez
- Department of Gastroenterology and Hepatology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Isabel Carmona-Soria
- Department of Gastroenterology and Hepatology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
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Muñoz-Terol JM, Rocha JL, Castro-de la Nuez P, Egea-Guerrero JJ, Gil-Sacaluga L, García-Cabrera E, Vilches-Arenas A. Prognosis Factors of Patients Undergoing Renal Replacement Therapy. J Pers Med 2023; 13:jpm13040605. [PMID: 37108991 PMCID: PMC10141530 DOI: 10.3390/jpm13040605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Survival in patients with end-stage kidney disease (ESKD) on renal replacement therapy (RRT) is less than that of the general population of the same age, and depends on patient factors, the medical care received, and the type of RRT used. The objective of this study is to analyze the factors associated with survival in patients undergoing RRT. METHODS We conducted a retrospective observational study of adult patients with an incident of ESKD on RRT in Andalusia from 1 January 2008 to 31 December 2018. Patient characteristics, nephrological care received, and survival from the beginning of RRT were evaluated. A survival model for the patient was developed according to the variables studied. RESULTS A total of 11,551 patients were included. Median survival was 6.8 years (95% CI (6.6; 7.0)). After starting RRT, survival at one year and five years was 88.7% (95% CI (88.1; 89.3)) and 59.4% (95% CI (58.4; 60.4)), respectively. Age, initial comorbidity, diabetic nephropathy, and a venous catheter were independent risk factors. However, non-urgent initiation of RRT and follow-up in consultations for more than six months had a protective effect. It was identified that renal transplantation (RT) was the most influential independent factor in patient survival, with a risk ratio of 0.13 (95% CI (0.11; 0.14)). CONCLUSIONS The receiving of a kidney transplant was the most beneficial modifiable factor in the survival of incident patients on RRT. We consider that the mortality of the renal replacement treatment should be adjusted, taking into account both modifiable and nonmodifiable factors to achieve a more precise and comparable interpretation.
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Affiliation(s)
- José Manuel Muñoz-Terol
- Department of Nephrology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Department of Medicine, University of Seville, 41009 Seville, Spain
| | - José L Rocha
- Department of Nephrology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Department of Medicine, University of Seville, 41009 Seville, Spain
| | - Pablo Castro-de la Nuez
- Information System of the Autonomic Transplant Coordination of Andalusia (SICATA), 41013 Seville, Spain
| | - Juan José Egea-Guerrero
- Neurocritical Care Unit, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Institute of Biomedicine of Seville (IBiS)/Consejo Superior de Investigaciones Científicas (CSIC), University of Seville, 41013 Seville, Spain
| | - Luis Gil-Sacaluga
- Department of Nephrology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Emilio García-Cabrera
- Preventive Medicine and Public Health Department, University of Seville, 41009 Seville, Spain
| | - Angel Vilches-Arenas
- Preventive Medicine and Public Health Department, University of Seville, 41009 Seville, Spain
- Department of Preventive Medicine, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
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Martin-Villen L, Egea-Guerrero JJ, Mendoza-Prieto M, de Azua-López ZR, Ruiz-Matas JH, Vilches-Arenas A. Effectiveness Factors of Organ Donation in Andalusia. Transplant Proc 2021; 54:4-6. [PMID: 34895898 DOI: 10.1016/j.transproceed.2021.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Donation effectiveness is one of the most important factors for the sustainability of the donation transplant process. The aim of this study was to characterize and identify hypothetical factors associated with effective donation (at least one organ transplanted) in the Andalusian population. METHOD Cross-sectional descriptive observational study of a sample of 4144 potential organ donors registered in the Andalusian Information System of Transplant from January 2006 to December 2018. Donors were categorized according to the result of the donation and analyzed depending their effectiveness. RESULTS The Andalusian donors were mainly men (60%) and were between 55 and 75 years of age (47.6%). The majority died of brain death (87.45%) caused by a cerebrovascular accident (63.5%). They had cardiovascular risk factors such as hypertension (38.3%), diabetes mellitus (14.8%), dyslipidemia (11.1%), smoking (20.4%), and overweight with a median body mass index of 27.1 kg/m2 (IQR, 24.6-29.4). Effective donor rate was 84.5%. Increasing age, diabetes mellitus, increasing body mass index, and the presence of antibodies against hepatitis C virus were hypothetical predictors of an ineffective donation. CONCLUSIONS In view of our results, we can say that the Andalusian donor population has a high effectiveness rate, presenting hypothetical factors that could allow one to predict the outcome of an effective donation.
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Affiliation(s)
- Luis Martin-Villen
- Intensive and Critical Care Service, Virgen del Rocio University Hospital, Seville, Spain.
| | | | - Maria Mendoza-Prieto
- Intensive and Critical Care Service, Virgen del Rocio University Hospital, Seville, Spain
| | | | | | - Angel Vilches-Arenas
- Public Health and Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Seville, Spain
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6
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Pérez Sánchez S, Eichau Madueño S, Rus Hidalgo M, Domínguez Mayoral A, Vilches-Arenas A, Navarro Mascarell G, Izquierdo G. Usefulness of optic nerve ultrasound to predict clinical progression in multiple sclerosis. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7
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Varo Muñoz A, Molinero Delgado L, Marcos Alonso C, Gabaldón-Rodríguez I, Vilches-Arenas A, Ortega-Calvo M. Comparación de biomarcadores de primer trimestre en gestantes normotensas según su grado de obesidad en el tercer trimestre. Clínica e Investigación en Ginecología y Obstetricia 2021. [DOI: 10.1016/j.gine.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Rodriguez-Rodriguez A, Boyero L, Sempere L, Vilches-Arenas A. Animal models for neurotoxicity assessment in cardiac arrest. Med Intensiva 2018; 43:450. [PMID: 30528953 DOI: 10.1016/j.medin.2018.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
Affiliation(s)
- A Rodriguez-Rodriguez
- Laboratorio de Neurocríticos, U.G.C. Cuidados Críticos, H.U. Virgen del Rocío-IbiS, Spain
| | - L Boyero
- Laboratorio de Neurocríticos, U.G.C. Cuidados Críticos, H.U. Virgen del Rocío-IbiS, Spain.
| | - L Sempere
- Laboratorio de Neurocríticos, U.G.C. Cuidados Críticos, H.U. Virgen del Rocío-IbiS, Spain
| | - A Vilches-Arenas
- Unidad Medicina Preventiva y Salud Pública. H.U.V. Macarena-Universidad de Sevilla, Spain
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Rocchetti NS, Egea-Guerrero JJ, Ruiz de Azua-Lopez Z, Martin-Villen L, Rodriguez-Rodriguez A, Vilches-Arenas A, Correa-Chamorro E, Settecase CJ, Bagilet DH. [APACHE II and SAPS II as predictors of brain death development in neurocritical care patients]. Rev Neurol 2018; 67:121-128. [PMID: 30039839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To assess the prognostic value of APACHE II and SAPS II scales to predict brain death evolution of neurocritical care patients. PATIENTS AND METHODS Retrospective observational study performed in a tertiary hospital. Include 508 patients over 16 years old, hospitalized in ICU for at least 24 hours. The variables of interest were: demographic data, risk factors, APACHE II, SAPS II and outcome. RESULTS Median age: 41 years old (IR: 25-57). Males: 76.2%. Most frequent reason for admission: trauma (55.3%). Medians: Glasgow Coma Scale (GCS), 10 points; APACHE II, 13 points; SAPS II, 31 points; and ICU stay, 5 days. Mortality in the ICU was 28.5% (n = 145) of whom 44 (8.7%) evolved to brain death. Univariate logistic regression analysis showed that GCS, APACHE II and SAPS II scores, as well as ICU stay days behaved as predictors of brain death evolution. However, the multivariate analysis performed including APACHE II and SAPS II scores showed that only APACHE II maintained statistical significance, despite the good discrimination of both scores. CONCLUSION Transplant coordinators might use the APACHE II score as a tool to detect patients at risk of progression to brain death, minimizing the loss of potential donors.
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Affiliation(s)
| | - J J Egea-Guerrero
- Universidad de Sevilla, Sevilla, Espana
- Hospital Universitario Virgen del Rocio, Sevilla, Espana
| | | | | | | | | | | | | | - D H Bagilet
- Hospital Eva Peron, Granadero Baigorria, Argentina
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10
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Gili-Miner M, López-Méndez J, Vilches-Arenas A, Ramírez-Ramírez G, Franco-Fernández D, Sala-Turrens J, Béjar-Prado L. Multiple sclerosis and alcohol use disorders: in-hospital mortality, extended hospital stays, and overexpenditures. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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González-Montelongo MDC, Egea-Guerrero JJ, Murillo-Cabezas F, González-Montelongo R, Ruiz de Azúa-López Z, Rodríguez-Rodríguez A, Vilches-Arenas A, Castellano A, Ureña J. Relation of RhoA in Peripheral Blood Mononuclear Cells With Severity of Aneurysmal Subarachnoid Hemorrhage and Vasospasm. Stroke 2018; 49:1507-1510. [DOI: 10.1161/strokeaha.117.020311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | - Angel Vilches-Arenas
- Dpto. de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena (A.V.-A.), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Antonio Castellano
- From the Dpto. de Fisiología Médica y Biofísica (M.d.C.G.-M., R.G.-M., A.C., J.U.)
| | - Juan Ureña
- From the Dpto. de Fisiología Médica y Biofísica (M.d.C.G.-M., R.G.-M., A.C., J.U.)
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12
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Pérez Sánchez S, Eichau Madueño S, Rus Hidalgo M, Domínguez Mayoral AM, Vilches-Arenas A, Navarro Mascarell G, Izquierdo G. Usefulness of optic nerve ultrasound to predict clinical progression in multiple sclerosis. Neurologia 2018; 36:209-214. [PMID: 29573900 DOI: 10.1016/j.nrl.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/17/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Progressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time. MATERIAL AND METHODS We conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the 'as low as reasonably achievable' (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0. RESULTS Disease progression was significantly correlated with ultrasound findings (P=.041 for the right eye and P=.037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P=.07 for the right eye and P=.043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables. DISCUSSION Ultrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS).
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Affiliation(s)
- S Pérez Sánchez
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - S Eichau Madueño
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Rus Hidalgo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - A Vilches-Arenas
- Servicio de Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Navarro Mascarell
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Izquierdo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
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Fernandez-Maza L, Egea-Guerrero JJ, Balcerzyk M, Civantos-Jubera G, Gordillo-Escobar E, Vilches-Arenas A, Fernandez-Gomez I, Parrado-Gallego A, Murillo-Cabezas F. Rapid and simplified synthesis of [ 18 F]Fluoromisonidazole and its use in PET imaging in an experimental model of subarachnoid hemorrhage. Appl Radiat Isot 2018; 132:79-84. [DOI: 10.1016/j.apradiso.2017.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/28/2017] [Accepted: 09/22/2017] [Indexed: 01/08/2023]
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14
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Montero-Balosa MC, Fernández-Urrusuno R, Vilches-Arenas A. The Effect of Monthly Medication on Mortality After a Coronary Event. J Cardiovasc Pharmacol Ther 2017; 23:192-199. [PMID: 28978235 DOI: 10.1177/1074248417732833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to analyze how the consumption of medication over time affects the survival rate in patients with a coronary event and whether there is a gender difference. METHODS The study included 804 patients admitted to 4 hospitals with a coronary event during 2007. Monitoring after coronary event was carried out during 2007 and every 6 months in the subsequent 2 years (2008 and 2009) throughout the review of the clinical history of the patient. The main outcome was the analysis of mortality after the coronary event. Kaplan-Meier survival curves were plotted to calculate the time to death, comparing women versus men for 4 medication groups: aspirin, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs). A Cox regression model was used for the final mortality analysis. RESULTS During the follow-up time, 172 deaths were assessed. Each month of treatment with aspirin, statins, β-blockers, or ACEI/ARB was associated with a decrease in mortality between 13.0% and 0.5% (univariate analysis). The Kaplan-Meier method revealed a significant reduction in mortality after the coronary event for each month of treatment with aspirin (men), statins (men), and β-blockers (both men and women). No significant effect in survival was observed in either gender with ACEI/ARB treatment. The final multivariable model (Cox regression) showed that the taking of aspirin, statins, β-blockers, or ACEI/ARB is able to reduce mortality rates up to 7.0% (aspirin) throughout each month of treatment after a coronary event without any influence of gender. CONCLUSION Aspirin, statins, β-blockers, and ACEI/ARB revealed a protective character with each month of treatment throughout the follow-up period, in terms of risk reduction of death. Aspirin and statins showed the maximum benefit, followed by ACEI/ARB and β-blockers.
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Affiliation(s)
- María C Montero-Balosa
- 1 Primary Care Pharmacy Service, Aljarafe-Sevilla Norte Primary Care District, Andalusian Health Service, Seville, Spain
| | - Rocío Fernández-Urrusuno
- 1 Primary Care Pharmacy Service, Aljarafe-Sevilla Norte Primary Care District, Andalusian Health Service, Seville, Spain
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15
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Argüelles-Arias F, Guerra Veloz MF, Perea Amarillo R, Vilches-Arenas A, Castro Laria L, Maldonado Pérez B, Chaaro D, Benítez Roldán A, Merino V, Ramírez G, Caunedo Álvarez A, Romero Gómez M. Erratum to: Effectiveness and Safety of CT-P13 (Biosimilar Infliximab) in Patients with Inflammatory Bowel Disease in Real Life at 6 Months. Dig Dis Sci 2017; 62:2203. [PMID: 28660487 PMCID: PMC6828546 DOI: 10.1007/s10620-017-4657-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- F. Argüelles-Arias
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - M. F. Guerra Veloz
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - R. Perea Amarillo
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - A. Vilches-Arenas
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - L. Castro Laria
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - B. Maldonado Pérez
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - D. Chaaro
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - A. Benítez Roldán
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - V. Merino
- Unidad de Farmacia, Hospital Universitario Virgen Macarena (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - G. Ramírez
- Unidad de Farmacia, Hospital Universitario Virgen Macarena (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - A. Caunedo Álvarez
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain
| | - M. Romero Gómez
- UGC Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Rocío (Sevilla), Avda Dr. Fedriani 3, 41007 Seville, Spain ,Dirección Gerencia, Hospital Universitario Virgen Rocío (Sevilla), Avda Manuel Siurot, s/n, 41013 Seville, Spain
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16
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Gili-Miner M, López-Méndez J, Vilches-Arenas A, Ramírez-Ramírez G, Franco-Fernández D, Sala-Turrens J, Béjar-Prado L. Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures. Neurologia 2016; 33:S0213-4853(16)30173-6. [PMID: 27780613 DOI: 10.1016/j.nrl.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/30/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.
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Affiliation(s)
- M Gili-Miner
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J López-Méndez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - A Vilches-Arenas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Ramírez-Ramírez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España
| | - D Franco-Fernández
- Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, España; Servicio de Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J Sala-Turrens
- Unidad de Documentación Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - L Béjar-Prado
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España
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17
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Egea-Guerrero JJ, Martínez-Fernández C, Rodríguez-Rodríguez A, Bohórquez-López A, Vilches-Arenas A, Pacheco-Sánchez M, Guerrero JM, Murillo-Cabezas F. The utility of C-reactive protein and procalcitonin for sepsis diagnosis in critically burned patients: A preliminary study. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the utility of C-reactive protein (CRP) and procalcitonin (PCT) as biomarkers of infection in patients with severe burn injury. Methods The present study included severe burn injury patients consecutively admitted to the Virgen del Rocío University Hospital (Andalucia, Spain) intensive care unit during a 12-month period. The variables of interest were: age, sex, mechanism of injury, percentage of burned body surface area, the Abbreviated Burn Severity Index (ABSI) and the absence/presence of sepsis. The authors analyzed serum levels of CRP and PCT at admission and every 48 h thereafter until intensive care unit discharge or death. Each determination was considered to be a sample or unit of analysis. Results A total of 157 determinations were analyzed from 17 severe burn injury patients. Fifty-four samples were considered to be septic, 25 of which corresponded to the first day of a new onset of sepsis. The mean duration of these symptoms was four days (interquartile range two to five days). Significant differences were found in the distributions of CRP and PCT values between sepsis and no-sepsis samples. Analysis of the changes in these biomarkers over time showed that PCT increase (ΔPCT) differentiated these diagnoses, whereas CRP increase (ΔCRP) did not. ROC curve analysis revealed that ΔPCT could predict positive sepsis samples (area under the curve 0.75 [95% CI 0.58 to 0.90]; P=0.003). Conclusion These preliminary results showed that PCT had a better discriminatory capacity than CRP for identifying infectious processes in patients with severe burn injury. A larger sample size would be needed to confirm these results.
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Affiliation(s)
- Juan J Egea-Guerrero
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
| | | | | | | | - Angel Vilches-Arenas
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
| | - María Pacheco-Sánchez
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
| | - Juan M Guerrero
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
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18
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Egea-Guerrero J, Ferrete-Araujo A, Vilches-Arenas A, Freire-Aragón M, Rivera-Rubiales G, Quintana-Díaz M, Godoy D, Murillo-Cabezas F. Severe Supratentorial Intracerebral Hemorrhage: Factors Related to Brain Death Development. Transplant Proc 2015; 47:2564-6. [DOI: 10.1016/j.transproceed.2015.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
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19
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Herrera-Melero MC, Egea-Guerrero JJ, Vilches-Arenas A, Rincón-Ferrari MD, Flores-Cordero JM, León-Carrión J, Murillo-Cabezas F. Acute predictors for mortality after severe TBI in Spain: Gender differences and clinical data. Brain Inj 2015; 29:1439-44. [DOI: 10.3109/02699052.2015.1071428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Leon-Justel A, Noval-Padillo JA, Alvarez-Rios AI, Mellado P, Gomez-Bravo MA, Álamo JM, Porras M, Barrero L, Hinojosa R, Carmona M, Vilches-Arenas A, Guerrero JM. Point-of-care haemostasis monitoring during liver transplantation reduces transfusion requirements and improves patient outcome. Clin Chim Acta 2015; 446:277-83. [PMID: 25916692 DOI: 10.1016/j.cca.2015.04.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 04/11/2015] [Accepted: 04/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optimal haemostasis management can improve patient outcomes and reduce blood loss and transfusion volume in orthotopic-liver-transplant (OLT). METHODS We performed a prospective study including 200 consecutive OLTs. The first 100 patients were treated according to the clinic's standards and the next 100 patients were treated using the new point-of-care (POC)-based haemostasis management strategy. Transfusion parameters and other outcomes were compared between groups. RESULTS Transfusion requirements were reduced in the POC group. The median and IQR of red-blood-cells (RBC) transfusion units were reduced from 5 [2-8] to 3 [0-5] (p < 0.001), plasma from 2 [0-4] to 0 (p < 0.001), and platelets from 1 [0-4] to 0 [0-1] (p < 0.001), into the POC group only four patients received tranexamic acid and fibrinogen transfusion rate was 1.13 ± 1.44 g (p = 0.001). We also improved the incidence of transfusion avoidance, 5% vs. 24% (p < 0.001) and reduced the incidence of massive transfusion (defined as the transfusion of more than 10 RBC units), 13% vs. 2% (p = 0.005). We also observed a relationship between RBC transfusion requirements and preoperative haemoglobin, and between platelet transfusion and preoperative fibrinogen levels. The incidence of postoperative complications, such as, reoperation for bleeding, acute-kidney-failure or haemodynamic instability was significantly lower (13.0% vs. 5%, p = 0.048, 17% vs. 2%, p < 0.001, and 29% vs. 16%, p = 0.028). Overall, blood product transfusion was associated with increased risk of postoperative complications. CONCLUSIONS A haemostatic therapy algorithm based on POC monitoring reduced transfusion and improved outcome in OLT.
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Affiliation(s)
- Antonio Leon-Justel
- Laboratory Medicine Department, Huelva University Hospital (Institute of Biomedicine of Seville, Seville University), Spain.
| | - Jose A Noval-Padillo
- Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain
| | - Ana I Alvarez-Rios
- Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain
| | - Patricia Mellado
- Department of Anaesthesiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Miguel A Gomez-Bravo
- Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Jose M Álamo
- Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Manuel Porras
- Department of Intensive Care Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Lydia Barrero
- Department of Hepatobiliary Surgery, Virgen del Rocío University Hospital, Seville, Spain
| | - Rafael Hinojosa
- Department of Intensive Care Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Magdalena Carmona
- Department of Haematology and Haemotherapy, Virgen del Rocío University Hospital, Seville, Spain
| | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, University of Seville, Spain
| | - Juan M Guerrero
- Laboratory Medicine Department, Virgen del Rocío University Hospital, Seville (Institute of Biomedicine of Seville, Seville University), Spain
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21
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Egea-Guerrero JJ, Martínez-Fernández C, Rodríguez-Rodríguez A, Bohórquez-López A, Vilches-Arenas A, Pacheco-Sánchez M, Guerrero JM, Murillo-Cabezas F. The utility of C-reactive protein and procalcitonin for sepsis diagnosis in critically burned patients: A preliminary study. Plast Surg (Oakv) 2015; 23:239-243. [PMID: 26665138 PMCID: PMC4664138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To assess the utility of C-reactive protein (CRP) and procalcitonin (PCT) as biomarkers of infection in patients with severe burn injury. METHODS The present study included severe burn injury patients consecutively admitted to the Virgen del Rocío University Hospital (Andalucia, Spain) intensive care unit during a 12-month period. The variables of interest were: age, sex, mechanism of injury, percentage of burned body surface area, the Abbreviated Burn Severity Index (ABSI) and the absence/presence of sepsis. The authors analyzed serum levels of CRP and PCT at admission and every 48 h thereafter until intensive care unit discharge or death. Each determination was considered to be a sample or unit of analysis. RESULTS A total of 157 determinations were analyzed from 17 severe burn injury patients. Fifty-four samples were considered to be septic, 25 of which corresponded to the first day of a new onset of sepsis. The mean duration of these symptoms was four days (interquartile range two to five days). Significant differences were found in the distributions of CRP and PCT values between sepsis and no-sepsis samples. Analysis of the changes in these biomarkers over time showed that PCT increase (ΔPCT) differentiated these diagnoses, whereas CRP increase (ΔCRP) did not. ROC curve analysis revealed that ΔPCT could predict positive sepsis samples (area under the curve 0.75 [95% CI 0.58 to 0.90]; P=0.003). CONCLUSION These preliminary results showed that PCT had a better discriminatory capacity than CRP for identifying infectious processes in patients with severe burn injury. A larger sample size would be needed to confirm these results.
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Affiliation(s)
- Juan J Egea-Guerrero
- Correspondence: Dr Juan J Egea-Guerrero, Intensive Care Unit, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, Sevilla, Andalucia, Spain 41013. Telephone 34686638646, e-mail
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22
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Egea-Guerrero JJ, Revuelto-Rey J, Gordillo-Escobar E, Rodríguez-Rodríguez A, Enamorado-Enamorado J, Ruiz de Azúa López Z, Aldabó-Pallás T, León-Justel A, Murillo-Cabezas F, Vilches-Arenas A. Serologic behavior of S100B protein in patients who are brain dead: preliminary results. Transplant Proc 2014; 45:3569-72. [PMID: 24314961 DOI: 10.1016/j.transproceed.2013.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study is to assess the S100B protein serum concentrations from brain dead (BD) donors to understand whether its level could provide clinical information during BD diagnosis as a potential confirmatory test. METHODS During 12 months, 26 patients declared BD were prospectively included in this study. Once the diagnosis of BD was achieved, serum S100B protein levels were measured using an electrochemiluminescence assay. For analytical purposes, we selected the maximum S100B serum value reached during the first 5 days of evolution from a historical cohort of 124 survived patients after a severe brain injury (SBI), as well as from 18 healthy donors (HD) and a subgroup of patients who had severe traumatic brain injuries (TBIs) without extracranial injuries. RESULTS Mean age was 53.48 years (SD, 18.91 years). The BD group had significantly higher S100B serum levels (1.44 μg/L; interquartile ratio [IR], 0.63-3.68) than the SBI (0.34 μg/L; IR, 0.21-0.60) and HD groups (0.06 μg/L; IR, 0.03-0.07; P < .001). Analysis of S100B levels depending on the main cause responsible for BD development showed significant differences between subgroups (P = .012). S100B serum levels were higher in the isolated TBI BD group (P = .004). The S100B value showed an odds ratio for BD diagnosis of 8.38 (95% confidence interval [CI], 1.16-60.45; P = .035). Reciever operating characteristic analysis revealed an area under the curve of 0.92 (95% CI, 0.79-1.00; P = .007). We set a cut-off value of 2 μg/L in S100B serum concentrations. At this level, the diagnostic properties of S100B would reach 100% of specificity and positive predictive value (PPV), and sensitivity and negative predictive value (NPV) of 60% and 86.7%, respectively. CONCLUSION This preliminary analysis shows for the very first time that BD is associated with higher S100B serum levels, compared with other neurocritical care patients. We also found that the cause of BD development must be considered. Specifically, S100B serum levels in severe isolated TBI patients-with clinical exploration compatible with BD-could be used in a future as confirmatory test.
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Affiliation(s)
- J J Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Spain.
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23
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Egea-Guerrero JJ, Murillo-Cabezas F, Gordillo-Escobar E, Rodríguez-Rodríguez A, Enamorado-Enamorado J, Revuelto-Rey J, Pacheco-Sánchez M, León-Justel A, Domínguez-Roldán JM, Vilches-Arenas A. S100B protein may detect brain death development after severe traumatic brain injury. J Neurotrauma 2013; 30:1762-9. [PMID: 23710646 PMCID: PMC3796324 DOI: 10.1089/neu.2012.2606] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI. The objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for BD after severe TBI. This prospective study included patients with severe TBI (Glasgow Coma Scale score [GCS] ≤ 8) admitted to our Neurocritical Care Unit over a 30 month period. We collected the following clinical variables: age, gender, GCS score, pupillary alterations at admission, hypotension and pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24 h post-admission, and a final diagnosis regarding BD. Of the 140 patients studied, 11.4% developed BD and showed significantly higher S100B concentrations (p<0.001). Multivariate analysis showed that bilateral unresponsive mydriasis at admission and serum S100B at 24 h post-admission had odds ratios (ORs) of 21.35 (p=0.005) and 4.9 (p=0.010), respectively. The same analysis on patients with photomotor reflex in one pupil at admission left only the 24 h S100B sample in the model (OR=15.5; p=0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p=0.001) for 24 h S100B determinations. The cut off was set at 0.372 μg/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV]=18.7% and negative predictive value [NPV]=98.9%). This study shows that pupillary responsiveness at admission, as well as 24 h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI.
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Affiliation(s)
- Juan J. Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Francisco Murillo-Cabezas
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Elena Gordillo-Escobar
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Ana Rodríguez-Rodríguez
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Judy Enamorado-Enamorado
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Jaume Revuelto-Rey
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - María Pacheco-Sánchez
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Antonio León-Justel
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Jose M. Domínguez-Roldán
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain
| | - Angel Vilches-Arenas
- Department of Preventive Medicine and Public Health, IBIS/CSIC/University of Seville, Seville, Spain
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24
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Fernández-Urrusuno R, Flores-Dorado M, Vilches-Arenas A, Serrano-Martino C, Corral-Baena S, Montero-Balosa MC. [Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study]. Enferm Infecc Microbiol Clin 2013; 32:285-92. [PMID: 23867142 DOI: 10.1016/j.eimc.2013.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/07/2013] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. METHODS DESIGN Cross-sectional study of prescription-indication. SETTING A primary health care area in Andalusia. SUBJECTS Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (±1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness.
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Affiliation(s)
| | | | | | - Carmen Serrano-Martino
- Laboratorio de Microbiología, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - Susana Corral-Baena
- Servicio de Farmacia, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
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Egea-Guerrero JJ, Murillo-Cabezas F, Rodríguez-Rodríguez A, Gordillo-Escobar E, Revuelto-Rey J, Muñoz-Sánchez MA, León-Justel A, Vilches-Arenas A. [An experimental model of mass-type brain damage in the rat: expression of brain damage based on neurospecific enolase and protein S100B]. Med Intensiva 2013; 38:218-25. [PMID: 23786666 DOI: 10.1016/j.medin.2013.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/14/2013] [Accepted: 03/31/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN An experimental study with a control group. SETTING Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS Fourteen adult Wistar rats. INTERVENTIONS Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 μl/20 sec, followed by 4 blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. PRIMARY STUDY VARIABLES Weight, early mortality, serum NSE and S100B concentration. RESULTS Differences in NSE and S100B concentration were observed over time within the MTBD group (P<.001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE and S100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r=0.765; P=.001 and r=0.628; P=.001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat.
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Affiliation(s)
- J J Egea-Guerrero
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España.
| | - F Murillo-Cabezas
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - A Rodríguez-Rodríguez
- Departamento de Bioquímica Clínica, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - E Gordillo-Escobar
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - J Revuelto-Rey
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - M A Muñoz-Sánchez
- Unidad de Neurocríticos, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - A León-Justel
- Departamento de Bioquímica Clínica, H.U. Virgen del Rocío, IBiS/CSIC Universidad de Sevilla, Sevilla, España
| | - A Vilches-Arenas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, IBiS/CSIC Universidad de Sevilla, Sevilla, España
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Egea-Guerrero JJ, Gordillo-Escobar E, Revuelto-Rey J, Enamorado-Enamorado J, Vilches-Arenas A, Pacheco-Sánchez M, Domínguez-Roldán JM, Murillo-Cabezas F. Clinical variables and neuromonitoring information (intracranial pressure and brain tissue oxygenation) as predictors of brain-death development after severe traumatic brain injury. Transplant Proc 2013; 44:2050-2. [PMID: 22974906 DOI: 10.1016/j.transproceed.2012.07.070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to ascertain the role of clinical variables and neuromonitoring data as predictors of brain death (BD) after severe traumatic brain injury (TBI). PATIENTS AND METHODS This prospective observational study involved severe TBI patients admitted to the intensive care unit between October 2009 and May 2011. The following variables were recorded: gender, age, reference Glasgow Coma Scale after resuscitation, pupillary reactivity, prehospital hypotension and desaturation, injury severity score, computed tomography (CT) findings, intracranial hypertension, and low brain tissue oxygenation (Pti02) levels (<16 mm Hg), as well as the final result of BD. RESULTS Among 61 patients (86.9% males) who met the inclusion criteria, the average age was 37.69 ± 16.44 years. Traffic accidents were the main cause of TBI (62.3%). The patients at risk of progressing to BD (14.8% of the entire cohort) were those with a mass lesion on CT (odds ratio [OR] 33.6; 95% confidence interval [CI]: 3.75-300.30; P = .002), altered pupillary reaction at admission (OR 25.5; 95% CI: 2.27-285.65; P = .009), as well low Pti02 levels on admission (OR 20.41; 95% CI: 3.52-118.33; P < .001) and during the first 24 hours of neuromonitoring (OR 20; 95% CI: 2.90-137.83; P < .001). Multivariate logistic regression showed that a low Pti02 level on admission was the best independent predictor for BD (OR 20.41; 95% CI: 3.53-118.33; P = .001). CONCLUSIONS Clinical variables and neuromonitoring information may identify TBI patients at risk of deterioration to BD.
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Affiliation(s)
- J J Egea-Guerrero
- NeuroCritical Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
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Egea-Guerrero J, Murillo-Cabezas F, Maira-Gonzalez I, Montero-Romero E, Palacios-Gómez C, Vilches-Arenas A. Supervivencia de la parada cardiorrespiratoria en relación con el área hospitalaria donde se detecta. Med Intensiva 2012; 36:448-50. [DOI: 10.1016/j.medin.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/02/2011] [Accepted: 11/06/2011] [Indexed: 10/14/2022]
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Egea-Guerrero JJ, Revuelto-Rey J, Murillo-Cabezas F, Muñoz-Sánchez MA, Vilches-Arenas A, Sánchez-Linares P, Domínguez-Roldán JM, León-Carrión J. Accuracy of the S100βprotein as a marker of brain damage in traumatic brain injury. Brain Inj 2011; 26:76-82. [DOI: 10.3109/02699052.2011.635360] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Egea-Guerrero J, Maira-Gonzalez I, Palacios-Gómez C, Vilches-Arenas A, Montero-Romero E, Murillo-Cabezas F. Detection of high risk mortality areas after in-hospital cardiac arrest. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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