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Ipiales RP, Lelli G, Diaz E, Diaz-Portuondo E, Mohedano AF, de la Rubia MA. Study of two approaches for the process water management from hydrothermal carbonization of swine manure: Anaerobic treatment and nutrient recovery. Environ Res 2024; 246:118098. [PMID: 38184062 DOI: 10.1016/j.envres.2024.118098] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Hydrothermal carbonization (HTC) is a promising alternative to transform biomass waste into a solid carbonaceous material (hydrochar) and a process water with potential for material and energy recovery. In this study, two alternatives for process water treatment by conventional and acid-assisted HTC of swine manure are discussed. Process water from conventional HTC at 180 °C showed high biodegradability (55% COD removal) and methane production (∼290 mL STP CH4 g-1 CODadded) and the treatment in an upflow anaerobic sludge blanket reactor allowed obtaining a high methane production yield (1.3 L CH4 L-1 d-1) and COD removal (∼70%). The analysis of the microbiota showed a high concentration of Synergistota and Firmicutes phyla, with high degradation of organic nitrogen-containing organic compounds. Acid-assisted HTC proved to be a viable option for nutrient recovery (migration of 83% of the P to the process water), which allowed obtaining a solid salt by chemical precipitation with Mg(OH)2 (NPK of 4/4/0.4) and MgCl2 (NPK 8/17/0.5), with a negligible content of heavy metals. The characteristics of the precipitated solid complied with the requirements of European Regulation (2019)/1009 for fertilizers and amendments in agricultural soils, being a suitable alternative for the recycling of nutrients from wastes.
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Affiliation(s)
- R P Ipiales
- Chemical Engineering Department, Universidad Autonoma de Madrid, 28049, Madrid, Spain; Arquimea Agrotech, 28400, Collado Villalba, Madrid, Spain
| | - G Lelli
- Chemical Engineering Department, Universidad Autonoma de Madrid, 28049, Madrid, Spain
| | - E Diaz
- Chemical Engineering Department, Universidad Autonoma de Madrid, 28049, Madrid, Spain
| | | | - A F Mohedano
- Chemical Engineering Department, Universidad Autonoma de Madrid, 28049, Madrid, Spain
| | - M A de la Rubia
- Chemical Engineering Department, Universidad Autonoma de Madrid, 28049, Madrid, Spain.
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2
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Ipiales RP, Sarrion A, Diaz E, de la Rubia MA, Diaz-Portuondo E, Coronella CJ, Mohedano AF. Swine manure management by hydrothermal carbonization: Comparative study of batch and continuous operation. Environ Res 2024; 245:118062. [PMID: 38157959 DOI: 10.1016/j.envres.2023.118062] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Hydrothermal carbonization (HTC) is considered a promising technology for biomass waste management without pre-drying. This study explores the potential for swine manure management by comparing batch and continuous processes, emphasizing the benefits of the continuous mode, particularly for its potential full-scale application. The continuous process at low temperature (180 °C) resulted in a hydrochar with a lower degree of carbonization compared to the batch process, but similar characteristics were found in both hydrochars at higher operating temperatures (230-250 °C), such as C content (∼ 52 wt%), fixed carbon (∼ 24 wt%) and higher calorific value (21 MJ kg-1). Thermogravimetric and combustion analyses showed that hydrochars exhibited characteristics suitable as solid biofuels for industrial use. The process water showed a high content of organic matter as soluble chemical oxygen demand (7-22 g L-1) and total organic carbon (4-10 g L-1), although a high amount of refractory species such as N- and O-containing long aromatic compounds were detected in the process water from the batch process, while the process water from the continuous process presented more easily biodegradable compounds such as acids and alcohols, among others. The longer time required to reach operating temperature in the case of the batch system (longer heating time to reach operating temperature) resulted in lower H/C and O/C ratios compared to hydrochar from the continuous process. This indicates that the dehydration and decarboxylation reactions of the feedstock play a more important role in the batch process. This study shows the efficiency of the continuous process to obtain carbonaceous materials suitable for use as biofuel, providing a solution for swine manure management.
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Affiliation(s)
- R P Ipiales
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049, Madrid, Spain; Arquimea-Agrotech, 28400, Collado Villalba, Madrid, Spain
| | - A Sarrion
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049, Madrid, Spain
| | - E Diaz
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049, Madrid, Spain
| | - M A de la Rubia
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049, Madrid, Spain
| | | | - Charles J Coronella
- Department of Chemical and Materials Engineering, University of Nevada, Reno, Reno, 89557, Nevada, United States
| | - A F Mohedano
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049, Madrid, Spain.
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3
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Ipiales RP, Mohedano AF, Diaz-Portuondo E, Diaz E, de la Rubia MA. Co-hydrothermal carbonization of swine manure and lignocellulosic waste: A new strategy for the integral valorization of biomass wastes. Waste Manag 2023; 169:267-275. [PMID: 37481937 DOI: 10.1016/j.wasman.2023.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Co-hydrothermal carbonization (co-HTC) is a promising strategy to improve hydrothermal carbonization (HTC) of low-quality wastes. HTC of swine manure (SM), with high N (2.9 wt%), S (0.7 wt%) and ash (22.6 wt%) contents, as well as low C (35.6 wt%) and higher heating value (HHV; 14.3 MJ kg-1), resulted in a hydrochar with unsuitable characteristics as a solid fuel. Co-HTC of SM and garden and park waste (GPW) improved hydrochar properties (C content (43 - 48 wt%) and HHV (18 - 20 MJ kg-1), and decreased N (∼2 wt%), S (<0.3 wt%) and ash (<15 wt%) content. A high GPW ratio (>50 wt%) during co-HTC resulted in a hydrochar similar to that obtained from GPW. The co-HTC increased nutrient migration to the process water, which allowed the precipitation of salt with high P (7.8 wt%) and negligible heavy metal content. Anaerobic digestion of co-HTC process water allowed high organic matter removal (up to 65%), and methane production (315 - 325 mL CH4 g-1CODadded). Gross energy recovery by HTC and anaerobic digestion was 5 - 6-fold higher than anaerobic treatment of feedstocks. Therefore, co-HTC of SM and GPW with a ratio > 50% GPW proved to be a suitable approach to valorize and manage SM and obtain value-added products (hydrochar, mineral fertilizer and methane).
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Affiliation(s)
- R P Ipiales
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain; Arquimea-Agrotech, 28400 Collado Villalba, Madrid, Spain
| | - A F Mohedano
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
| | | | - E Diaz
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - M A de la Rubia
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Pariente MI, Segura Y, Álvarez-Torrellas S, Casas JA, de Pedro ZM, Diaz E, García J, López-Muñoz MJ, Marugán J, Mohedano AF, Molina R, Munoz M, Pablos C, Perdigón-Melón JA, Petre AL, Rodríguez JJ, Tobajas M, Martínez F. Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes. J Environ Manage 2022; 320:115769. [PMID: 35944316 DOI: 10.1016/j.jenvman.2022.115769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.
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Affiliation(s)
- M I Pariente
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain.
| | - Y Segura
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain
| | - S Álvarez-Torrellas
- Department of Chemical Engineering and Materials, Universidad Complutense de Madrid, Av/ Complutense s/n, 28040, Madrid, Spain
| | - J A Casas
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - Z M de Pedro
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - E Diaz
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - J García
- Department of Chemical Engineering and Materials, Universidad Complutense de Madrid, Av/ Complutense s/n, 28040, Madrid, Spain
| | - M J López-Muñoz
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain
| | - J Marugán
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain
| | - A F Mohedano
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - R Molina
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain
| | - M Munoz
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - C Pablos
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain
| | - J A Perdigón-Melón
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering. University of Alcalá, Ctra Madrid-Barcelona, 33,600, 28871, Alcalá de Henares, Madrid, Spain
| | - A L Petre
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering. University of Alcalá, Ctra Madrid-Barcelona, 33,600, 28871, Alcalá de Henares, Madrid, Spain
| | - J J Rodríguez
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - M Tobajas
- Department of Chemical Engineering, Faculty of Science, Universidad Autónoma de Madrid, Campus de Cantoblanco, C/ Francisco Tomás y, Valiente, 7, 28049, Madrid, Spain
| | - F Martínez
- Department of Chemical and Environmental Technology, ESCET, Rey Juan Carlos University, C/Tulipán s/n, 28933, Móstoles, Madrid, Spain
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Teixido Tura G, Martinez D, Calvo F, Garcia-Orta R, Sanchez R, Larranaga JM, Hernandiz A, Diaz E, Montanes E, Cabrera F, Sabate A, Nistal F, Forteza A, Evangelista A. Aortic and vascular involvement in Loeys-Dietz Syndrome. Results from the REPAG registry (Spanish network of genetic aortic diseases). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1946] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
LDS is a rare disease due to genetic variants in the TGFB pathway. Limited information is available regarding the overall aortic and vascular outcome of these patients
Purpose
To evaluate aortic and vascular complications of patients with mutations in the TGFB pathway.
Methods
Retrospective longitudinal study including patients with (likely) pathogenic (LP/P) variants in the TGFbeta pathway from 10 tertiary centers. Clinical and imaging data were reviewed and data on aortic and vascular outcome included.
Results
A total of 163 patients were included (47.9% women, 38.6% index cases), mean age at first evaluation 32.3±20.4 years, 27.0% with age <16 years. 70 TGFBR1, 43 TGFBR2, 29 SMAD3, 9 TGFB2 and 12 TGFB3 (Table1)
During a mean follow-up of 4.7±3.7 years, 54 (33.1%) patients had at least 1 aortic surgery (max 6). Mean age at first aortic surgery was 37.2±16.8 years (Range 1.2–72.9). First surgery was elective in 42 (77.8%), and included aortic root or ascending aorta in 40 (95.2%) and isolated descending aorta in 2 (4.8%). Emergent surgery included aortic root or ascending aorta in 11 (92.7%). Ascending aorta-root diameter previous to elective surgery was 48.9±4.9mm (range 41–65). 7 patients died during follow-up (2 intracranial bleeding, 1 SD, 2 aortic ruptures, 1post aortic surgery, 1 non-CV). Furthermore, 19 acute aortic syndromes (AAS) were reported (17 dissections, 2 haematomas) in 18 patients, 10 type A (52.6%). Mean age at first AAS was 42.3±11.1 years (min 19.7 years to 62.9 years)
Median survival free of intervention, dissection or death was 57.1 years, being worst for men than women (44.7 yrs vs 69.1 years, p<0.001) (Figure 1), these gender-difference only remained significant in the TGFBR1 and SMAD3 groups (p=0.005 and p=0.008) Regarding aortic branch and intracranial aneurysms, a total of 383 imaging studies of aortic branches and 223 cranial imaging studies were performed during the clinical follow-up. 21 cranial aneurysms and 73 aortic branch aneurisms were reported. 14 (11.5%) patients suffered 19 aneurysms-related events (3 dissections, 3 ruptures, 13 interventions).
Conclusions
In patients with Loeys-Dietz Syndrome, there's a high prevalence of aortic surgeries and acute aortic events, with high numbers of peripheral and intracranial aneurysms. A worst prognosis in men than in women is observed in TGFBR1 and SMAD3 variants. Thus, specialized clinical and imaging follow-up is crucial in the management of these patients
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Teixido Tura
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - D Martinez
- Puerta de Hierro Majadahonda University Hospital, Cardiac Surgery, Majadahonda , Madrid , Spain
| | - F Calvo
- Hospital Universitario Alvaro Cunqueiro, Cardiology , Vigo , Spain
| | - R Garcia-Orta
- Virgen de las Nieves University Hospital, Cardiology , Granada , Spain
| | - R Sanchez
- General University Hospital of Alicante , Alicante , Spain
| | - J M Larranaga
- Hospital General A Coruna, Cardiology , A Coruna , Spain
| | - A Hernandiz
- Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | - E Diaz
- Hospital Clinico Universitario, Cardiology , Salamanca , Spain
| | - E Montanes
- University Hospital 12 de Octubre , Madrid , Spain
| | - F Cabrera
- University Hospital Virgen de la Victoria, Cardiology , Malaga , Spain
| | - A Sabate
- University Hospital Vall d'Hebron, Pediatric Cardiology , Barcelona , Spain
| | - F Nistal
- University Hospital Marques de Valdecilla, Cardiac Surgery , Santander , Spain
| | - A Forteza
- Puerta de Hierro Majadahonda University Hospital, Cardiac Surgery, Majadahonda , Madrid , Spain
| | - A Evangelista
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
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Cybulski T, Klug Z, Nelson R, Sala M, Diaz E, Lu Z, Misharin A, Jain M. 427 Persistence of cell type–specific transcriptomic changes in the nasal epithelium of people with cystic fibrosis receiving cystic fibrosis transmembrane conductance regulator modulators. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01117-1] [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: 11/07/2022]
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Sanchis I, Diaz E, Pizarro A, Rodriguez J, Mohedano A. Nitrate reduction with bimetallic catalysts. A stability-addressed overview. Sep Purif Technol 2022. [DOI: 10.1016/j.seppur.2022.120750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Ipiales RP, Mohedano AF, Diaz E, de la Rubia MA. Energy recovery from garden and park waste by hydrothermal carbonisation and anaerobic digestion. Waste Manag 2022; 140:100-109. [PMID: 35078074 DOI: 10.1016/j.wasman.2022.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
Hydrothermal carbonisation (HTC) can transform wet lignocellulosic biomass, which is not considered an effective biofuel for energy production at the industrial level, into a carbonaceous product called hydrochar (HC) that is suitable for combustion and a process water (PW). PW is an interesting by-product that can be valorised for biogas production via anaerobic digestion (AD). This study presents a new approach for the valorisation of garden and park wastes (GPW) by integrating HTC to generate HC for energy production, while PW is subjected to AD for biogas production. The hydrothermal treatment was performed at 180, 210, and 230 °C, yielding HC with improved physicochemical properties, such as an elevated higher heating value (21-25 MJ kg-1); low ash (<5 wt.%), nitrogen (1.3 wt.%), and sulphur (0.2 wt.%) contents; better fuel ratio (0.4-0.6); and a broad comprehensive combustibility index (8.0×10-7 to 9.6×10-7 min-2 °C-3). AD of the generated PW was conducted under mesophilic conditions (35 °C), resulting in a methane production in the range of 253-326 mL g-1 CODadded and COD removal of up to 65%. The combination of HTC and AD allowed the recovery of 91% and 94% of the energy content feedstock, as calculated from the combustion of HC and methane, respectively.
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Affiliation(s)
- R P Ipiales
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain; Arquimea-Agrotech, 28400 Collado Villalba, Madrid, Spain
| | - A F Mohedano
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - E Diaz
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - M A de la Rubia
- Chemical Engineering Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
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Vallés J, Diaz E, Carles Oliva J, Martínez M, Navas A, Mesquida J, Gruartmoner G, de Haro C, Mestre J, Guía C, Rodriguez A, Ochagavía A. Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control. Med Intensiva 2021; 45:541-551. [PMID: 34839885 DOI: 10.1016/j.medine.2020.05.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). DESIGN A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). SETTING ICU at a University Hospital in Spain. PATIENTS All consecutive patients admitted to the ICU with CASS. INTERVENTIONS None. MAIN VARIABLES OF INTEREST CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. RESULTS During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. CONCLUSIONS The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.
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Affiliation(s)
- J Vallés
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain.
| | - E Diaz
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J Carles Oliva
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - M Martínez
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Navas
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J Mesquida
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - G Gruartmoner
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C de Haro
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J Mestre
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C Guía
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Rodriguez
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Ochagavía
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
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Vázquez ML, Vargas I, Oliver A, Espinel V, Ronda E, Sanz-Barbero B, Diaz E, Pujolar G. Access to health services for non-Covid-19 causes during the pandemic. A literature review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Negative effects of the Covid-19 pandemic on access to care for other diseases are currently at debate.
Aim
To review existing literature on care access for non-Covid-19 conditions since the pandemic onset.
Methods
Scoping review using various databases (Medline, VHL, Web of Science, 2020/21). Terms used: ‘access', ‘health services', ‘Covid-19'. Out of 4,060 identified articles, 37 were selected after reviewing and assessing titles, abstracts and full text. Aday and Andersen's framework guided the analysis.
Results
Of selected articles, 21 analyse impact on health services use; 8 on performance; 8 on access barriers. Most analyse specific services during early pandemic stages through register review, showing an initial decline in use with inconsistent results on recovery. Some indicate increased complexity of treated patients and treatment delays. Studies surveying professionals analyse the impact on services performance or clinical practice, reporting a decrease in consultations/interventions for diverse pathologies and response implementation (e.g. telemedicine), but not how they affected access. Few studies focus on social inequalities in use, showing a greater reduction in low-income or ethnic minority users. Studies on unmet needs, access or barriers based on user surveys or qualitative methods are scarce, focused on a pathology or clinical area. Particularly in Spain, studies analyse impact on use of emergency, primary care and cancer diagnosis, and on emergency and cardiology services functioning. Studies based on user surveys are lacking: only a qualitative study analysed access difficulties for chronic patients in confinement. Methodological weaknesses are identified.
Conclusions
Although currently emerging, studies analysing the pandemic impact on equal access to care for non-Covid-19 conditions are scarce, limited in focus and methodology, especially in Spain. Comprehensive medium/long-term impact assessments, including analysis of causes, are needed.
Key messages
Research is lacking on the impact of the COVID-19 pandemic on healthcare access, particularly for vulnerable groups. Further evidence is needed to improve health systems resilience in the future.
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Affiliation(s)
- ML Vázquez
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - I Vargas
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - A Oliver
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - V Espinel
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - E Ronda
- CIBERESP, Madrid, Spain
- University of Alicante, Alicante, Spain
| | | | - E Diaz
- University of Bergen, Bergen, Norway
| | - G Pujolar
- Health Policy and Health Services Research Group, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Abstract
Abstract
The growing body of migrant health research at all levels focuses around disease burden, risk factors/behaviours and on distal factors but research on policy issues remains limited. Internationally published declarations and recommendations to take the migrant health agenda forward address policy issues. However declarations at country are few and not systematically followed up.
The Bergen Declaration was endorsed at Norway's' First National Conference on Migration Health (2018) by the multi-disciplinary participants. The declaration reflects the ‘upstream' and ‘downstream' areas addressed and discussed at the conference and includes concrete recommendations for key areas. It was widely disseminated, including high-level policy makers. Prior to the second Migration Health Conference (2020), the progress of the recommendations were reviewed. Since 2018, Migrant Integration Policy Index (MIPEX) in Norway from 2015 was updated in 2019 and a Country Assessment as part of the WP7 of Joint Action on Health Equity Europe (JAHEE) was conducted providing the basis to review the recommendations of the Bergen Declaration. In addition, the 2020 Committee conducted a desk review and search to follow up the recommendations. The review revealed that among identified ‘upstream' areas most progress had been made with data collection and research and the least in policy and governance. Among the ‘downstream' areas some progress was observed regarding practise and access to health services. Education and Training had received some attention. The Bergen Declaration reflects the consensus regarding migrant health and recommendations to address these issues in Norway. Monitoring the progress made through data that included policy review revealed progress and gaps. Progress in research, education and practise was evident whereas policy change was not. Policy makers have not paid heed to the Bergen Declaration.
Key messages
The Bergen Declaration was a useful tool for initiating and monitoring progress in research, education and practice. Declarations do not support advancement of policies and other means are required to push the policies forward.
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Affiliation(s)
- B Kumar
- Unit for Migrant Health, Norwegian Institute of Public Health, Oslo, Norway
- Work Package 7, JAHEE, Oslo, Norway
| | - C Nordstrom
- Unit for Migrant Health, Norwegian Institute of Public Health, Oslo, Norway
- Work Package 7, JAHEE, Oslo, Norway
| | - E Diaz
- Pandemic Center, University of Bergen, Bergen, Norway
- Unit for Migrant Health, Norwegian Institute of Public Health, Oslo, Norway
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Diaz E, Ezzedine K, Ferkal S, Jannic A, Zehou O, Tran VT, Ravaud P, Wolkenstein P. ComPaRe NF : résultats à 6 mois des caractéristiques cliniques et de qualité de vie des patients atteints de neurofibromatose. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.345] [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: 10/22/2022]
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13
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Hasha W, Fadnes LT, Igland J, Strømme EM, Younes JH, Kumar B, Diaz E. Effect of group treatment on physical inactivity among Syrian refugees. Randomized controlled trial. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.825] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Refugees in Norway show low levels of physical activity, and have relatively high prevalence of pain disorders and post-traumatic symptoms. Physical inactivity can be both a cause of and a consequence of physical and mental symptoms. In CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), two group interventions, one based on physiotherapy and body awareness (PAAI) and the other on Teaching Recovery Techniques (TRT), were developed to treat patients with pain disorders and/or post-traumatic symptoms.
Objective
As a secondary outcome of study, we assessed the effect of these group interventions on physical inactivity.
Methods
We conducted a randomized controlled trial testing two group interventions. Syrian adults ≥16 years with pain and/or post-traumatic symptoms were randomized to either intervention group or control group. Effect of the intervention was measured after 8 (PAAI) and 6 (TRT) weeks, as relative risk (RR) with 95% confidence intervals for being inactive for intervention versus control groups, using log-binomial regression with adjustment for baseline inactivity and type of intervention (PAAI or TRT).
Results
177 Syrian refugees were recruited between July 2018-September 2019. 88 were randomized to the intervention group and 89 to the control group. Mean age was 35 years (SD 11) and 38% were women. Inactivity at recruitment was reported by 126 (71%) participants. The follow-up questionnaire was completed at 6/8 weeks by 116 (66%) participants. At that point, 39% in the intervention group were inactive as compared to 56% in the control group. RR for inactivity for the intervention group adjusted for inactivity at baseline was 0.68 (0.47-0.99) and remained 0.68 (0.48-0.99) when further adjusting for type of intervention (PAAI vs TRT).
Conclusions
PAAI and TRT group interventions reduced inactivity among refugees by 32%. Effect on physical inactivity was similar between PAAI and TRT interventions.
Key messages
Public health care should be aware of physical inactivity, especially in relation to pain disorders and post-traumatic symptoms among refugees. Group treatment interventions succeeded to encourage refugees to increase their physical activity.
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Affiliation(s)
- W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - L T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E M Strømme
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J H Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Haj-Younes J, Strømme E, Hasha W, Igland J, Abildsnes E, Kumar B, Diaz E. Access to healthcare and self-rated health among refugees in transit and after arrival in Norway. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.828] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lack of basic infrastructure and poor provision of health services in conflict settings and during flight can have a negative impact on health. The overall health status of refugees seems to improve after arrival at a safe destination. This may be related to a safer environment and better access to health care services, but prior studies on this topic are limited. This study aims to assess self-perceived access to healthcare and its relationship with self-rated health (SRH) among refugees in transit and when settled in a host country.
Methods
We used data from the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), which includes a cohort of 353 Syrian refugees who were contacted in 2017-2018 in Lebanon while waiting for relocation, and one year after their arrival to Norway. Information on self-perceived access to healthcare and its association with SRH was analyzed separately at each time-point. Data analysis was performed with STATA using logistic regression adjusting for age, gender, ethnicity and years of education and presented as adjusted odds ratios (AOR) with 95% CI.
Results
Fifteen percent reported good access to healthcare and 62% reported good SRH in Lebanon vs. 91% and 77% respectively, in Norway. Measures in Lebanon showed no association between access to healthcare and good SRH (AOR: 1.2 (0.6-2.2)), and men reported worse access to healthcare than women (AOR: 0.5 (0.3-1.0). In Norway, access to healthcare was strongly associated with good SRH (AOR: 4.7 (2.1-10.7) and was negatively associated with belonging to one specific minority group (AOR: 0.1 (0.0-0.3)).
Conclusions
Both SRH and perceived access to care improved from being in transit to being settled in Norway, the latter substantially more. There was a significant association between access to healthcare and good SRH after the refugees' arrival to a safe host country but not in transit.
Key messages
Refugee’s self-reported health and access to healthcare seem to improve shortly after arrival to a host country. To ensure that the UN’S Sustainable Development Goals concerning health equity are reached, refugees’ access to healthcare in transit and its impact on overall health needs to be addressed.
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Affiliation(s)
- J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E Strømme
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E Abildsnes
- Kristiansand Municipality, Kristiansand, Norway
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Strømme EM, Haj-Younes J, Hasha W, Fadnes LT, Kumar B, Diaz E. Non-communicable diseases and use of medication among Syrian refugees: a prospective cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1083] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Conflict-driven disruption in continuity of care for non-communicable diseases (NCDs) is likely to have adverse public health impact. Yet, data on the prevalence and treatment coverage of NCDs among refugees is scarce. In this study we aim to assess the changes in prevalence of NCDs and use of relevant medication among Syrian refugees from a near-conflict phase in Lebanon to a resettlement phase in Norway.
Methods
This is a prospective cohort study. Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were changes in NCDs as defined by the WHO and use of relevant medication. We calculated prevalence proportions with confidence intervals and assessed changes in prevalence over time using generalized estimating equations.
Results
Altogether 353 Syrians participated. The median age was 34 years and 51 percent were women. The overall prevalence of NCDs was 12 (9-16) percent at baseline and 9 (6-12) percent at follow-up. The odds ratio for reporting any NCD at follow-up compared to baseline was 0.68 (0.46, 1.00). Among those reporting NCDs, the prevalence of using either antithrombotic or cholesterol lowering medication, antihypertensives, antidiabetics, or drugs for asthma or chronic obstructive pulmonary disease was 55 (39-70) percent at baseline and 63 (44-80) percent at follow-up. The odds ratio for using relevant medication at follow-up compared to baseline was 1.01 (0.63, 2.05).
Conclusions
In our study around one tenth of the refugees reported at least one NCD. Nearly half of those reporting NCDs in a conflict-near setting did not seem to receive relevant medication, while the same was true for more than one third of respondents after resettlement. We call for innovative public health approaches and interventions to protect continuity of care for NCDs in settings of conflict-driven exodus.
Key messages
A high share of Syrian refugees reporting NCDs do not seem to receive relevant medication. The management of NCDs among refugees needs attention in order to avoid negative health effects.
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Affiliation(s)
- E M Strømme
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - L T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Strømme EM, Haj-Younes J, Hasha W, Fadnes LT, Kumar B, Igland J, Diaz E. Changes in health among Syrian refugees along their migration trajectories from Lebanon to Norway: a prospective cohort study. Public Health 2020; 186:240-245. [PMID: 32861924 DOI: 10.1016/j.puhe.2020.07.016] [Citation(s) in RCA: 4] [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: 05/30/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Conflict-driven displacement is an indisputable social determinant of health. Yet, data on changes in health along the migration trajectories of refugees are scarce. This study aims to assess the longitudinal changes in somatic and mental health and use of medication among Syrian refugees relocating from a conflict-near transit setting in the Middle East to a resettlement setting in Europe. Further, we examine different health status trajectories and factors that predict health in the early postmigration period. STUDY DESIGN This is a prospective cohort study. METHODS Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were non-communicable disease (NCD), chronic impairment, chronic pain, anxiety/depression, post-traumatic stress symptoms, and daily use of drugs. We estimated longitudinal changes in prevalence proportions using generalized estimating equations and evaluated effect modification of health outcomes. RESULTS Altogether, 353 Syrians participated. NCDs declined (12%-9%), while the prevalence of chronic impairment, chronic pain, and use of drugs remained nearly unchanged (29%-28%, 30%-28%, and 20%-18%) between baseline and follow-up. Conversely, mental health outcomes improved (anxiety/depression 33%-11%, post-traumatic stress disorder 5%-2%). Effect modifiers for improvement over time included younger age, short length of stay, and non-legal status in the transit country before resettlement in Europe. CONCLUSIONS We find that mental health outcomes improve from a conflict-near transit setting in Lebanon to an early resettlement setting in Norway, while somatic health outcomes remain stable. Temporal changes in health among moving populations warrant attention, and long-term changes need further scrutiny.
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Affiliation(s)
- E M Strømme
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - L T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway.
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway; Unit for Migration and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway.
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Vallés J, Diaz E, Carles Oliva J, Martínez M, Navas A, Mesquida J, Gruartmoner G, de Haro C, Mestre J, Guía C, Rodriguez A, Ochagavía A. Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control. Med Intensiva 2020; 45:S0210-5691(20)30175-3. [PMID: 32654923 DOI: 10.1016/j.medin.2020.05.008] [Citation(s) in RCA: 2] [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: 03/02/2020] [Revised: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). DESIGN A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). SETTING ICU at a University Hospital in Spain. PATIENTS All consecutive patients admitted to the ICU with CASS. INTERVENTIONS None. MAIN VARIABLES OF INTEREST CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. RESULTS During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. CONCLUSIONS The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.
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Affiliation(s)
- J Vallés
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain.
| | - E Diaz
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J Carles Oliva
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - M Martínez
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Navas
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J Mesquida
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - G Gruartmoner
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C de Haro
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J Mestre
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C Guía
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Rodriguez
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Ochagavía
- Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
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Canard C, Diaz E, Gusdorf L, Loget J, Durlach A, Graesslin O, Cadiot G, Viguier M. [Isolated Crohn's disease of the vulva with rapid clinical response to infliximab and azathioprine]. Ann Dermatol Venereol 2020; 147:569-571. [PMID: 32505375 DOI: 10.1016/j.annder.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/15/2020] [Accepted: 04/22/2020] [Indexed: 11/15/2022]
Affiliation(s)
- C Canard
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - E Diaz
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - L Gusdorf
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - J Loget
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Durlach
- Service de biopathologie, hôpital Maison-Blanche, 51092 Reims, France
| | - O Graesslin
- Service de gynécologie obstétrique, hôpital Maison-Blanche, 51092 Reims, France
| | - G Cadiot
- Service d'hépato-gastroentérologie et de cancérologie digestive, hôpital Robert-Debré, 51092 Reims, France
| | - M Viguier
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
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Mena IF, Diaz E, Palomar J, Rodriguez JJ, Mohedano AF. Cation and anion effect on the biodegradability and toxicity of imidazolium- and choline-based ionic liquids. Chemosphere 2020; 240:124947. [PMID: 31568943 DOI: 10.1016/j.chemosphere.2019.124947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/20/2019] [Accepted: 09/22/2019] [Indexed: 05/11/2023]
Abstract
This work studies the effect of the cation and anion on the biodegradability and inhibition of imidazolium- and choline-based ionic liquids (ILs) using activated sludge. Six commercial ILs, formed by combination of 1-Butyl-3-methylimidazolium (Bmim+) and N,N,N-trimethylethanolammonium (Choline+) cations and chloride (Cl-), acetate (Ac-) and bis(trifluoromethanesulfonyl)imide (NTf2-) anions were evaluated, all representative counter-ions with markedly different toxicity and biodegradability. Inherent and fast biodegradability tests were used to evaluate both the microorganism inhibition and the IL biodegradability. In addition, the ecotoxicological response (EC50) of the ILs was studied using activated sludge and Vibrio fischeri (Microtox® test). Bmim+ and NTf2- can be considered as non-biodegradable, whereas aerobic microorganisms easily degraded Choline+ and Ac-. The biodegradation pattern of each cation/anion is nearly unaffected by counter-ion nature. Moreover, concentrations of CholineNTf2 higher than 50 mg/L caused a partial inhibition on microbial activity, in good concordance with its low EC50 (54 mg/L) measured by respiration inhibition test, which alerts on the negative environmental impact of NTf2-containing ILs on the performance of sewage treatment plants.
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Affiliation(s)
- I F Mena
- Chemical Engineering Department, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain.
| | - E Diaz
- Chemical Engineering Department, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - J Palomar
- Chemical Engineering Department, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - J J Rodriguez
- Chemical Engineering Department, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - A F Mohedano
- Chemical Engineering Department, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
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Diaz E, Vanhaecke C, Sanchez J, Durlach A, Gusdorf L, Viguier M. Angiomatose dermique diffuse ulcérée multifocale. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.475] [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: 10/25/2022]
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Shourick J, Haddad C, Lebrun-Vignes B, Le Cleach L, Diaz E, Gaudin O, Wolkenstein P, Oro S, Sbidian E. Toxidermies et imputabilité médicamenteuse : création d’un outil d’aide à la décision. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.204] [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: 10/25/2022]
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Condamina M, Loget J, Le Berruyer PY, Vatin S, Durlach A, Vanhaecke C, Gusdorf L, Diaz E, Viguier MA. Calciphylaxie non urémique après chirurgie bariatrique. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.476] [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]
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Haj-Younes J, Strømme EM, Hasha W, Abildsnes E, Fadnes LT, Kumar B, Diaz E. Self Rated Health among Syrian refugees in Lebanon and Norway – a cross sectional study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.047] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Refugees are often exposed to various stressors before, during and after migration that can cause adverse health effects. Prior research indicates that the health status of refugees is a significant factor in determining their success in resettlement. This study aims to assess self-rated health (SRH) and factors associated with SRH among Syrian refugees in Lebanon and Norway.
Methods
The study uses a cross-sectional design with data from a self-administered survey among 827 adult Syrian asylum seekers of whom 506 were recruited in Lebanon, and 321 in Norway. Inclusion criteria were subjects who self-identified as Syrian nationals above the age of 16. The survey was conducted in 2017 and 2018 in collaboration with International Organization of Migration in Lebanon and through mandatory educational activities in Norway. Data analysis was performed for the main outcome self-rated health (SRH), a validated health status indicator, which was dichotomized into “good” and “poor” SRH. Odds Ratios for poor SRH were estimated adjusting for age, gender and country of residence.
Results
A total of 827 of 972 (85%) who were invited answered the questionnaire. The mean age was 33 years and 74% were men. Factors associated with good SRH were being Kurdish (AOR: 0.48 (0.23 to 0.97)) compared to Arabic ethnicity, being married (AOR 0.54 (0.29 to 0.99)) compared to being single, migrating alone (AOR 0.59 (0.37 to 0.96)) compared to co-migration and having low health literacy level (AOR: 0.64 (0.42 to 0.93)). In contrast, poor SRH was significantly increased with long time in transit country/ies (AOR 1.49 (1.07 to 2.06)) and with older age (age 30-34 AOR 3.2, age 35-39 AOR 2.2, age 40 + AOR 2.6) compared to age group 16-24.
Conclusions
Older refugees and those who stay long time in transit are at great risk of reporting poor SRH. Some of the factors associated with better health, like Kurdish ethnicity, low health literacy or migrating alone, deserve further research.
Key messages
Age and long stay in transit is associated with poor SRH among Syrian refugees. Demographic background and migrant related factors should be taken into account when planning refugee resettlement and healthcare provision.
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Affiliation(s)
- J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E M Strømme
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E Abildsnes
- Kristiansand Municipality, Kristiansand Municipality, Kristiansand, Norway
| | - L T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Strømme EM, Haj-Younes J, Hasha W, Fadnes LT, Kumar B, Diaz E. Chronic pain and migration-related factors among Syrian refugees: a cross-sectional study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Refugees display high rates of chronic pain. However, the relationship between refugee-related exposures introduced along their migration trajectories and the development of chronic pain remains unclear. The aim of this study was to assess the impact of stressors induced at various migration stages on chronic pain in Syrian refugees.
Methods
This is a cross-sectional survey among adult Syrian refugees in Lebanon and in Norway. We conducted logistic regression to study the associations between chronic pain and migration-related factors experienced prior to or during flight (trauma exposure, migrating alone and detainment) and after arrival in a new country (legal status, social relationships, living conditions and access to health care).
Results
Altogether 827 Syrians participated (response rate 85%). The mean age was 33 years and 41% were women. The overall prevalence of chronic pain was 30%. The mean WHO Quality of Life (WHOQOL) domain scores for both social relationships (13.4) and environment (10.2) were significantly lower among those reporting chronic pain, with low scores indicating less satisfaction. Regression analyses revealed an association between chronic pain and exposure to trauma (adjusted odds ratio (AOR) 2.5 (1.8; 3.4)), but no clear association between chronic pain and migrating alone or history of detention. Poor social relationships (AOR 1.9 (1.2; 3.1)), poor support from friends (AOR 1.5 (1.0; 2.1)) and poor living place (AOR 1.4 (1.0; 2.0)) were associated with reporting chronic pain, although associations reduced when adjusting for traumatic experiences. The associations between chronic pain and poor economy (AOR 1.6 (1.1; 2.5)) and poor access to health care (AOR 1.5 (1.0; 2.1)) persisted after trauma exposure adjustment.
Conclusions
We found a strong relationship between trauma exposure and chronic pain. Further, perceived poor economy and poor access to health care were associated with chronic pain regardless of trauma history.
Key messages
Trauma exposure, perceived poor economy and poor access to health care are associated with chronic pain among Syrian refugees. Public health care interventions should consider the combined impact of risk factors throughout the migration trajectory.
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Affiliation(s)
- E M Strømme
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - L T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Caruso R, Vicente E, Núñez-Alfonsel J, Ferri V, Diaz E, Fabra I, Malave L, Duran H, Isernia R, D'Ovidio A, Pinna E, Ielpo B, Quijano Y. Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-effectiveness analysis. J Robot Surg 2019; 14:627-632. [PMID: 31620970 DOI: 10.1007/s11701-019-01033-x] [Citation(s) in RCA: 4] [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: 08/07/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
In the last decade, there have clearly been important changes in the surgical approach of gastric cancer treatment due to an increased interest in the minimally invasive surgical approach (MIS). The higher cost of robotic surgery procedures remains an important issue of debate. The objective of the study is to compare the main operative and clinical outcomes and to assess the incremental cost-effectiveness ratios (ICERs) of the two techniques. This is a prospective cost-effectiveness and clinical study when comparing the robotic gastrectomy (RG) technique with open gastrectomy (OG) in gastric cancer. Outcome parameters included surgical and post-operative costs, quality-adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). The incremental utility was 0.038 QALYs and the estimated ICER for patients was dominated by robotic approach. The probability that the robotic approach was cost effective was 94.04% and 94.20%, respectively, at a WTP threshold of 20,000€ and 30,000€ per QALY gained. RG for gastric cancer represents a cost-effective procedure compared with the standard OG.
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Affiliation(s)
- Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain. .,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain.
| | - E Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - J Núñez-Alfonsel
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - V Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - E Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - I Fabra
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - L Malave
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - H Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - R Isernia
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - A D'Ovidio
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - E Pinna
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - B Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Y Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
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Affiliation(s)
- P Núñez
- Departamento de Biología Funcional, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | - C Perillan
- Departamento de Biología Funcional, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | - J Arguelles
- Departamento de Biología Funcional, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | - E Diaz
- Departamento de Biología Funcional, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
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Velasquez M, Emerson MG, Diaz E, Kennedy W, Rubesova E, Barth RA. The learning curve of contrast-enhanced 'microbubble' voiding urosonography-validation study. J Pediatr Urol 2019; 15:385.e1-385.e6. [PMID: 31133505 DOI: 10.1016/j.jpurol.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 10/25/2018] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) is a common pediatric urologic condition associated with urinary tract infection and pyelonephritis. It can be diagnosed via fluoroscopic voiding cystourethrogram (VCUG) and, more recently, contrast-enhanced voiding ultrasonography (ceVUS), which does not expose the patient to ionizing radiation. Voiding urosonography contrast agents used for the diagnosis of VUR have been widely available in Europe but were approved by the Food and Drug Administration for use in the United States only in 2016. OBJECTIVE The objective was to optimize a protocol and compare the diagnostic performance of ceVUS to fluoroscopic VCUG in an academic medical center naïve to previous use of contrast-enhanced voiding urosonography. STUDY DESIGN Thirty-nine patients referred for clinically indicated evaluation of VUR were enrolled between September 2016 and March 2017. Patients underwent contrast-enhanced ultrasonography with prediluted Lumason and under the same catheterization underwent fluoroscopic VCUG. Comparative grading was performed by pediatric radiologists on-site at the time of examination. RESULTS Reflux was observed in 16 of 39 patients (20 of 64 renal units) ranging from grades 1 through 5. VCUG and ceVUS were concordant for detecting reflux in 10 of 39 patients (14 of 84 renal units) and excluding reflux in 23 of 39 patients (64 of 84 renal units) (Fig. 1). Using contrast enhanced voiding urosonography, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that was not found on fluoroscopy. Using fluoroscopy, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that had not been found on ceVUS. Two of 20 renal units were upgraded from low-grade on ceVUS to high-grade on fluoroscopy. This corresponds to a Cohen's kappa of 0.72 (confidence interval [CI] 0.54-0.91) or 'moderate.' DISCUSSION During our investigation, we noted that there was a technical learning curve related to poor contrast mixing and the need to titrate the concentration of Lumason. However, over the course of the study, we were able to correct the technical aspects. Ultimately, our results showed good correlation between VCUG and Lumason ceVUS and only slightly less correlation than published studies by experienced centers. Future studies with voiding should allow for improved urethral visualization. CONCLUSION While there is a considerable learning curve to the implementation of ceVUS for the diagnosis of pediatric VUR, these technical aspects can be corrected. Even a center previously naïve to contrast-enhanced ultrasound technology can, over a short period of time, demonstrate good correlation between VCUG and ceVUS in the diagnosis of VUR. Translation of ceVUS into clinical practice is an alternative to VCUG for diagnosis of reflux, is feasible, and can eliminate the radiation exposure associated with a VCUG.
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Affiliation(s)
- M Velasquez
- Stanford Children's Health (Lucile Packard Children's Hospital), Department of Urology, Stanford University School of Medicine, 725 Welch Road - Room 1890, Stanford, CA 94304-5913, USA
| | - M G Emerson
- Radiology - Diagnostic, 677 N Wilmot Rd, Tucson, AZ 85711, USA
| | - E Diaz
- Stanford Children's Health (Lucile Packard Children's Hospital), Department of Urology, Stanford University School of Medicine, 725 Welch Road - Room 1890, Stanford, CA 94304-5913, USA
| | - W Kennedy
- Stanford Children's Health (Lucile Packard Children's Hospital), Department of Urology, Stanford University School of Medicine, 725 Welch Road - Room 1890, Stanford, CA 94304-5913, USA
| | - E Rubesova
- Stanford Children's Health (Lucile Packard Children's Hospital), Department of Radiology, Stanford University School of Medicine, 725 Welch Road - Room 1890, Stanford, CA 94304-5913, USA
| | - R A Barth
- Stanford Children's Health (Lucile Packard Children's Hospital), Department of Radiology, Stanford University School of Medicine, 725 Welch Road - Room 1890, Stanford, CA 94304-5913, USA.
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Vallès J, Fernández S, Cortés E, Morón A, Fondevilla E, Oliva JC, Diaz E. Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit. Med Intensiva 2019; 44:294-300. [PMID: 31378384 DOI: 10.1016/j.medin.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/27/2019] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the measurement of antimicrobial consumption by defined daily dose (DDD) versus by days of therapy (DOT). DESIGN Retrospective analysis of clinical and administrative data from patients admitted to a polyvalent ICU. SETTING ICU at a University Hospital in Spain. PATIENTS All patients admitted to the ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST For the DDD method, the World Health Organization (WHO)-assigned DDD was determined for the all the prescribed antimicrobials. For the DOT method, one DOT represented the administration of a single agent on a given day regardless of the number of doses administered. To express aggregate use, total DDDs and total DOTs were normalized to 100 patient-days. RESULTS During the study period, 2393 adult patients were admitted to the ICU. Total median antimicrobial drugs measured by DDDs was 535.3 (IQR 319.8-845.5) vs. 344.0 (IQR 117.2-544.5) when measured by DOTs, p<0.001. When antimicrobial consumption was normalized to 100 patient-days, median antimicrobial consumption was also higher when measured by DDDs [2.98/100 patient-days (IQR 1.76-5.25) vs. 1.89/100 patient-days (IQR 0.64-3.0) when measured by DOTs, p<0.001]. CONCLUSIONS For most antibacterial and antifungal drugs used in critically ill patients, estimates of aggregate antibiotic use by DDDs per 100 patient-days and DOTs per 100 patient-days are discordant because the administered dose is dissimilar from the WHO-assigned DDD. DOT methods should be recommended to avoid the overestimation that occurs with DDDs in adult critically ill patients.
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Affiliation(s)
- J Vallès
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain.
| | - S Fernández
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - E Cortés
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A Morón
- Department of Pharmacy, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - J C Oliva
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - E Diaz
- Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain
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Altamirano J, Contreras A, Cifuentes J, Yanine N, Cristi E, Diaz E, Pedregal P, Martinez F. Primary diffuse large b-cell lymphoma of the mandible, literature review and report of two cases. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.219] [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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Diaz E, Ditchi Y, Roux A, Senet P, Barbaud A, Francès C, Pacanowski J, Chasset F. [The value of healthy skin biopsy in the diagnosis of intravascular B-cell lymphoma: A case report and systematic literature review]. Ann Dermatol Venereol 2019; 146:297-302. [PMID: 30905386 DOI: 10.1016/j.annder.2019.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/01/2018] [Revised: 09/07/2018] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (ivLBCL) is a rare blood dyscrasia that is difficult to diagnose. Healthy skin biopsies may prove useful in diagnosis of the condition. Herein we report a case of ivLBCL diagnosed using this type of examination, and we provide a literature review to determine the sensitivity of such testing. PATIENTS AND METHODS A 67-year-old woman was hospitalised for unexplained prolonged fever (UPF) and impaired general well-being. Laboratory tests revealed inflammatory syndrome, elevated LDH>2000IU/L, hepatic cytolysis and decreased prothrombin time at 47 %. Analysis for infection and medical imaging ruled out both an infectious or inflammatory origin and solid tumour. A healthy skin biopsy enabled confirmation of the diagnosis of ivLBCL. DISCUSSION This clinical case illustrates the value of healthy skin biopsy in establishing a diagnosis of ivLBCL in patients hospitalised for UPF. Following a systematic literature review in PubMed/Medline, we included eight studies involving at least three patients designed to assess the value of healthy skin biopsy in the diagnosis of ivLBCL. The diagnostic sensitivity of this approach ranged from 67% to 100%, with a sensitivity of 100% being seen in four of the eight studies. Details of the biopsy sites were available in three studies and diagnostic sensitivity was similar overall between samples taken from the thigh, abdomen and arms. CONCLUSION Healthy skin biopsy sampling from at least two sites constitutes a sensitive and relatively non-invasive procedure for early diagnosis of ivLBCL.
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Affiliation(s)
- E Diaz
- Service de dermatologie et allergologie, faculté de médecine, Sorbonne Université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - Y Ditchi
- Service d'anatomopathologie, faculté de médecine, Sorbonne Université, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - A Roux
- Service de maladies infectieuses, et tropicales, faculté de médecine, Sorbonne Université, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - P Senet
- Service de dermatologie et allergologie, faculté de médecine, Sorbonne Université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Barbaud
- Service de dermatologie et allergologie, faculté de médecine, Sorbonne Université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Francès
- Service de dermatologie et allergologie, faculté de médecine, Sorbonne Université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Pacanowski
- Service de maladies infectieuses, et tropicales, faculté de médecine, Sorbonne Université, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - F Chasset
- Service de dermatologie et allergologie, faculté de médecine, Sorbonne Université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Calvo AG, Gomez R, Lopez A, Sanchez S, Villarejo P, Padilla D, Manzanedo I, Pereira F, Perez-Viejo E, Gonzalez L, Lopez-Tomassetti E, Hernandez J, Diaz E, Fabra I, Titos A, Pitarch M, Ochando F, Lacueva F. Morbimortality of patients undergoing cytoreduction + closed hipec with co2 agitation system: a multicentre study. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.493] [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: 10/27/2022] Open
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Salami B, Salma J, Hegadoren K, Meherali S, Kolawole T, Diaz E. Sense of community belonging among immigrants: perspective of immigrant service providers. Public Health 2019; 167:28-33. [DOI: 10.1016/j.puhe.2018.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/04/2018] [Accepted: 10/28/2018] [Indexed: 01/30/2023]
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Calvo AG, Gomez R, Lasa I, Sanchez S, Padilla D, Villarejo P, Manzanedo I, Pereira F, Perez-Viejo E, Gonzalez L, Lopez-Tomassetti E, Hernandez J, Fabra I, Diaz E, Titos A, Pitarch M, Marcello M, Lacueva F. Analysis of the survival of patients undergoing cytoreduction + closed hipec with co2 agitation system: multicenter study. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.494] [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: 11/29/2022] Open
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Diaz E, Monsalvo VM, Lopez J, Mena IF, Palomar J, Rodriguez JJ, Mohedano AF. Assessment the ecotoxicity and inhibition of imidazolium ionic liquids by respiration inhibition assays. Ecotoxicol Environ Saf 2018; 162:29-34. [PMID: 29960119 DOI: 10.1016/j.ecoenv.2018.06.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
The ecotoxicity and inhibition of 12 imidazolium ionic liquids (ILs) with alkyl chain from C4 to C10 and chloride (Cl-), tetrafluoroborate (BF4-) and bis(trifluoromethanesulfonyl)imide (NTf2-) anions have been studied by means of respiration inhibition assays using activated sludge collected from a wastewater treatment plant. This test represents an alternative easy, economic and quick way to evaluate the true impact of ILs on activated sludge-based wastewater treatment. For comparison purposes, the EC50 values were also determined by the Microtox test (Vibrio fischeri). It was observed that this widely used microbial test overestimates the effect of the ILs on biological wastewater treatment facilities, especially in the case of ILs with lower ecotoxicity. The results of the biological tests showed that the alkyl chain length plays a crucial role in the ecotoxicity of ILs. A significant increase of the toxicity with the length of the n-alkyl chain was found. Regarding to the impact of the anion, the ecotoxicity measured by respiration inhibition assays follows the order NTf2- > Cl- > BF4-, being the anion effect higher as decreasing the length of cation alkyl chain. According to the hazard substances ranking for aquatic organisms (Passino and Smith, 1987), imidazolium ILs with C4 alkyl chain can be classified as "practically harmless" compounds whereas those with alkyl chains C8 or C10 correspond to "highly toxic" species.
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Affiliation(s)
- E Diaz
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain.
| | - V M Monsalvo
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - J Lopez
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - I F Mena
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - J Palomar
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - J J Rodriguez
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
| | - A F Mohedano
- Chemical Engineering Section, University Autonoma de Madrid, C/ Francisco Tomás y Valiente 7, 28049, Madrid, Spain
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Terragni L, Beune E, Stronks K, Davidson E, Qureshi S, Kumar B, Diaz E. Developing culturally adapted lifestyle interventions for South Asian migrant populations: a qualitative study of the key success factors and main challenges. Public Health 2018; 161:50-58. [PMID: 29902781 DOI: 10.1016/j.puhe.2018.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/10/2017] [Revised: 03/15/2018] [Accepted: 04/13/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES South Asian migrant populations have a high risk of non-communicable diseases, such as type 2 diabetes (T2D). The aim of this study is to provide in-depth insight into key success factors and challenges in developing culturally adapted lifestyle interventions to prevent T2D within South Asian migrant populations. STUDY DESIGN The study has a qualitative research design. METHODS In-depth interviews, using a semi-structured interview guide, were conducted with eight researchers and project leaders from five studies of culturally adapted lifestyle interventions for South Asian migrant populations. Data were analysed using a grounded theory approach. RESULTS Four main themes emerged as key factors for success: 'approaching the community in the right way', 'the intervention as a space for social relations', 'support from public authorities' and 'being reflexive and flexible'. Two themes emerged as challenges: 'struggling with time' and 'overemphasising cultural differences'. CONCLUSIONS Our findings augment existing research by establishing the importance of cooperation at the organisational and institutional levels, of fostering the creation of social networks through interventions and of acknowledging the multiplicity of identities and resources among individuals of the same ethnic origin.
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Affiliation(s)
- L Terragni
- Norwegian Centre for Migration and Minority Health-The Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway; Institute of Nursing and Health Promotion, Department of Health, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - E Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - K Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - E Davidson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom.
| | - S Qureshi
- Norwegian Centre for Migration and Minority Health-The Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway.
| | - B Kumar
- Norwegian Centre for Migration and Minority Health-The Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway; Department of Community Medicine, Institute of Health and Society, University of Oslo, Postboks 4959 Nydalen, 0424, Oslo, Norway.
| | - E Diaz
- Norwegian Centre for Migration and Minority Health-The Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, PO. Box 7804 N-5020, Bergen, Norway.
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Møen K, Terragni L, Kumar B, Diaz E. 6.2-O8“I simply haven’t given it a thought before!” - health care providers’ experiences regarding cervical cancer screening among immigrant women in Norway- a qualitative study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.207] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Møen
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- The Norwegian Centre for Migration and Minority Health, Norway
| | - L Terragni
- The Norwegian Centre for Migration and Minority Health, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Norway
| | - B Kumar
- The Norwegian Centre for Migration and Minority Health, Norway
- Institute for Health and Society, University of Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- The Norwegian Centre for Migration and Minority Health, Norway
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Qureshi S, Gele A, Kour P, Ainul Moen K, Kumar B, Diaz E. 3.4-O6A qualitative intervention approach to increase the participation of Pakistani and Somali women in cervical cancer screening program in Norway. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.106] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Qureshi
- Norwegian Center for Migrant and Minority Health Research (NAKMI), Oslo, Norway
| | - A Gele
- Norwegian Center for Migrant and Minority Health Research (NAKMI), Oslo, Norway
- Department of Health, Institute of Nursing and Health Promotion, Oslo and Akershus University College, Norway
| | - P Kour
- Norwegian Center for Migrant and Minority Health Research (NAKMI), Oslo, Norway
| | - K Ainul Moen
- Norwegian Center for Migrant and Minority Health Research (NAKMI), Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - B Kumar
- Norwegian Center for Migrant and Minority Health Research (NAKMI), Oslo, Norway
| | - E Diaz
- Norwegian Center for Migrant and Minority Health Research (NAKMI), Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
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Stromme E, Haj-Younes J, Fadnes L, Kumar B, Diaz E. 4.3-O8Reported pain and use of painkillers among Syrian refugees at various stages in the migration process. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Stromme
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - L Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - B Kumar
- Department of Community Medicine and Global Health, University of Oslo, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Norway and Norwegian Center for Minority Health Research, Norway
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Beune E, van Valkengoed I, Muilwijk M, Kumar B, Diaz E, Gill J, Palaniappan L, Davidson E. 5.10-P15Development of an intervention for the prevention of type 2 diabetes addressing the specific needs of South Asian-origin population living in the Netherlands: a pilot study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.201] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Beune
- Academic Medical Centre - University of Amsterdam, The Netherlands
| | - I van Valkengoed
- Academic Medical Centre - University of Amsterdam, The Netherlands
| | - M Muilwijk
- Academic Medical Centre - University of Amsterdam, The Netherlands
| | - B Kumar
- The Norwegian Centre for Migration and Minority Health (NAKMI), Norway
| | - E Diaz
- The Norwegian Centre for Migration and Minority Health (NAKMI), Norway
| | - J Gill
- BHF Glasgow Cardiovascular Research Centre-University of Glasgow, United Kingdom
| | - L Palaniappan
- The Stanford University Medical Center, United States
| | - E Davidson
- Usher Institute of Population Health Sciences and Informatics, United Kingdom
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Haj-Younes J, Stromme E, Abildsnes E, Kumar B, Diaz E. 5.2-O8Access to healthcare and unmet health needs among Syrian asylum seekers in transit and at arrival in Norway. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.170] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - E Stromme
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | | | - B Kumar
- Institute for Health and Society, University of Oslo. Norwegian Center for Minority Health Research, Norway
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Norwegian Center for Minority Health Research, Norway
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Affiliation(s)
- E Diaz
- The Norwegian Centre for Migration And Minority Health (NAKMI), Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - R Spilker
- The Norwegian Centre for Migration And Minority Health (NAKMI), Oslo, Norway
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Padro T, Garcia-Arguinzonis M, Diaz E, Deya A, Badimon L. P563Relevance of C3-complement activation in atherosclerotic plaques and in the lipid-loaded smooth muscle cell phenotype. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.417] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Padro
- Cardiovascular Research Center (ICCC), IIB-SantPau, UAB, CiberCV, Barcelona, Spain
| | - M Garcia-Arguinzonis
- Cardiovascular Research Center (ICCC), IIB-SantPau, UAB, CiberCV, Barcelona, Spain
| | - E Diaz
- Cardiovascular Research Center (ICCC), IIB-SantPau, UAB, CiberCV, Barcelona, Spain
| | - A Deya
- Cardiovascular Research Center (ICCC), IIB-SantPau, UAB, CiberCV, Barcelona, Spain
| | - L Badimon
- Cardiovascular Research Center (ICCC), IIB-SantPau, UAB, CiberCV, Barcelona, Spain
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Nieves-Moreno M, Morales Fernández L, Domingo Gordo B, Maillo E, Diaz E, Gómez-de-Liaño R. Topical brinzolamide in congenital nystagmus: A retrospective study. Arch Soc Esp Oftalmol 2017; 92:571-576. [PMID: 28734565 DOI: 10.1016/j.oftal.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the effect of treatment with topical brinzolamide on visual acuity and nystagmus intensity in patients with congenital nystagmus. MATERIAL AND METHODS A retrospective study was designed in which the clinical records of 14 patients with congenital nystagmus were reviewed. All patients underwent a complete ophthalmological examination and a Perea video-oculography (VOG) before, and three days after, initiation of treatment with topical brinzolamide (Azopt). Five expert researchers evaluated the intensity of nystagmus by video before and after treatment. Finally, the subjective improvement of the patients was recorded. RESULTS Statistically significant differences were found in pre- and post-treatment binocular near visual acuity. A slight increase in the frequency of nystagmus was found, which was statistically significant with the horizontal gaze to the left and with the gaze downwards (P=.04, P=.03, respectively). The kappa index concordance between the researchers evaluating the intensity of nystagmus was 0.014. Only two of the patients noticed improvement in visual acuity, and one patient noticed improvement in the aesthetic aspect. CONCLUSIONS In spite of an improvement in nystagmus, it was slight, not cosmetically appreciable by patients in most cases, and was not related to a significant improvement in visual acuity or in patient quality of life. Further studies are needed to evaluate the effects of topical brinzolamide, and to establish potential therapeutic indications in nystagmus.
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Affiliation(s)
- M Nieves-Moreno
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España.
| | - L Morales Fernández
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - B Domingo Gordo
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - E Maillo
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - E Diaz
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
| | - R Gómez-de-Liaño
- Unidad de Estrabología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense, Madrid, España
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Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malavé L, Ferri V, Nuñez J, Ruiz-Ocaña A, Jorge E, Lazzaro S, Kalivaci D, Quijano Y, Vicente E. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs. Int J Colorectal Dis 2017; 32:1423-1429. [PMID: 28791457 DOI: 10.1007/s00384-017-2876-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Accepted: 07/25/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis. METHODS This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded. RESULTS A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection. CONCLUSION Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain.
| | - H Duran
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Diaz
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - I Fabra
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - R Caruso
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - L Malavé
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - V Ferri
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - J Nuñez
- (IVEC) Instituto de Validación de la Eficiencia Clínica, Fundación de Investigación HM Hospitales, Plaza del Conde de valle de Suchil 2, 28015, Madrid, Spain
| | - A Ruiz-Ocaña
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Jorge
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - S Lazzaro
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - D Kalivaci
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - Y Quijano
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
| | - E Vicente
- General Surgery Department, Sanchinarro Hospital HM, CEU San Pablo University of Madrid, Madrid, Spain
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Palacios N, Saura E, Fernández J, Elvira G, Diaz E. MON-P299: Vitamin D Levels and Deficiency Risks Analysis in Spanish Top Athletes. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30790-2] [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: 10/18/2022]
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Vicente E, Quijano Y, Duran H, Diaz E, Fabra I, Malavé L, Ferri V, Lazzaro S, Kalivaci D, Caruso R, Ielpo B. First case of complete full robotic surgical resection of leiomyosarcoma of the right renal vein. Surg Endosc 2017; 32:1072. [PMID: 28779244 DOI: 10.1007/s00464-017-5738-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Leiomyosarcomas present high postoperative morbidity and poor prognosis [1]. In the literature, only few cases of localized small leiomyosarcoma have been described [2, 3]. These cases might benefit from a minimally invasive approach. Robotic surgery has been claimed to have several advantages over laparoscopy such as enhanced vision and instruments movements which might make more feasible the execution of this type of surgery where partial renal resection is required. METHODS A 53-year-old female with a medical history of myeloid leukemia and with chronic renal failure (creatinine: 2.6) was referred to our hospital for an incidental finding of right perirenal tumor of almost 3 cm compatible with leiomyosarcoma arising from the right renal vein. RESULTS The operation was performed using a Da Vinci Robotic Surgical System model Si (Intuitive Surgical, Sunnyvale, CA, USA).Robotic ports were placed in a standard configuration for minimally invasive right nephrectomy. The dissection started with the partial mobilization of the right liver and Kocher maneuver. After the identification of the inferior vena cava the tumor was finally localized and dissected. Resection ended with a partial right vein resection and suture. Pathological final exam confirmed the diagnosis with margins free from tumor. CONCLUSIONS In selected cases, robotic resection of leiomyosarcoma might be a safe and feasible procedure in experienced hands.
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Affiliation(s)
- E Vicente
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - Y Quijano
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - H Duran
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - E Diaz
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - I Fabra
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - L Malavé
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - V Ferri
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - S Lazzaro
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - D Kalivaci
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - R Caruso
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain
| | - Benedetto Ielpo
- General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain.
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Affiliation(s)
- G. E. Lee
- General Atomics, P.O. Box 85608, San Diego, California 92186
| | - N. B. Alexander
- General Atomics, P.O. Box 85608, San Diego, California 92186
| | - E. Diaz
- General Atomics, P.O. Box 85608, San Diego, California 92186
| | - J. D. Sheliak
- General Atomics, P.O. Box 85608, San Diego, California 92186
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Goiriz B, Diaz E, Estevez R, Tejedor B, Cisneros R. Management in the diagnosis and treatment of Endo-Perio lesions. J Clin Exp Dent 2017. [DOI: 10.4317/medoral.176438661] [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: 11/05/2022] Open
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Rello J, Diaz E, Mañez R, Sole-Violan J, Valles J, Vidaur L, Zaragoza R, Gattarello S. Improved survival among ICU-hospitalized patients with community-acquired pneumonia by unidentified organisms: a multicenter case-control study. Eur J Clin Microbiol Infect Dis 2016; 36:123-130. [PMID: 27655267 DOI: 10.1007/s10096-016-2779-5] [Citation(s) in RCA: 5] [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] [Received: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
A retrospective analysis from prospectively collected data was conducted in intensive care units (ICUs) at 33 hospitals in Europe comparing the trend in ICU survival among adults with severe community-acquired pneumonia (CAP) due to unknown organisms from 2000 to 2015. The secondary objective was to establish whether changes in antibiotic policies were associated with different outcomes. ICU mortality decreased (p = 0.02) from 26.9 % in the first study period (2000-2002) to 15.7 % in the second period (2008-2015). Demographic data and clinical severity at admission were comparable between groups, except for age over 65 years and incidence of cardiomyopathy. Over time, patients received higher rates of combination therapy (94.3 vs. 77.2 %; p < 0.01) and early (<3 h) antibiotic delivery (72.9 vs. 50.3 %; p < 0.01); likewise, the 2008-2015 group was more likely to receive adequate antibiotic prescription [as defined by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines] than the 2000-2002 group (70.7 vs. 48.2 %; p < 0.01). Multivariate analysis showed an independent association between decreased ICU mortality and early (<3 h) antibiotic administration [odds ratio (OR) 3.48 [1.70-7.15], p < 0.01] or adequate antibiotic prescription according to guidelines (OR 2.22 [1.11-4.43], p = 0.02). In conclusion, our findings suggest that ICU mortality in severe CAP due to unidentified organisms has decreased in the last 15 years. Several changes in management and better compliance with guidelines over time were associated with increased survival.
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Affiliation(s)
- J Rello
- Universitat Autonoma de Barcelona, Barcelona, Spain. .,CIBERES, Barcelona, Spain.
| | - E Diaz
- CIBERES, Barcelona, Spain.,Hospital Joan XXIII, Tarragona, Spain
| | - R Mañez
- Hospital de Bellvitge, Barcelona, Spain
| | - J Sole-Violan
- CIBERES, Barcelona, Spain.,Hospital Negrin, Las Palmas de Gran Canaria, Spain
| | - J Valles
- CIBERES, Barcelona, Spain.,Hospital Parc Tauli, Sabadell, Spain
| | - L Vidaur
- CIBERES, Barcelona, Spain.,Hospital de Donostia, Donostia, Spain
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Garcia B, Sharma N, Johnson K, Diaz E, Wille K, Salgado J. Use of Oral Ribavirin for Respiratory Viral Infections in Lung Transplant Patients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.881] [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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