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Rodríguez-Molinero A, Carot-Sans G, Escrig R, Tebé C, Arce J, Pérez-López C, Ballesta S, Verdejo G, Cedeño Á, Riera-Pagespetit M, Vivas-Angeles S, Alarcon JL, Navarro I, Toro S, Mateo L, Torres AJ, Delmás G, Camell H, Chamero A, Gasol M, Piera-Jiménez J. Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study. Trials 2023; 24:797. [PMID: 38066614 PMCID: PMC10704815 DOI: 10.1186/s13063-023-07679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting. METHODS Multicenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024. DISCUSSION The scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript. TRIAL REGISTRATION NCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021.
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Affiliation(s)
- Alejandro Rodríguez-Molinero
- Àrea de Recerca, Consorci Sanitari de L'Alt Penedès I GarrafEspirall, Vilafranca del Penedès, 61 08720, Barcelona, Spain.
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Roser Escrig
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jacobo Arce
- Urology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Carlos Pérez-López
- Àrea de Recerca, Consorci Sanitari de L'Alt Penedès I GarrafEspirall, Vilafranca del Penedès, 61 08720, Barcelona, Spain
| | - Silvia Ballesta
- Endocrinology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Guillermo Verdejo
- Department of Internal Medicine, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Ángel Cedeño
- Gastroenterology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Mar Riera-Pagespetit
- Geriatrics Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Sofia Vivas-Angeles
- Department of Surgery, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Jose L Alarcon
- Department of Surgery, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Itziar Navarro
- Nefrology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Silvia Toro
- Endocrinology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Llorenç Mateo
- Musculoskeletal Area, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Ana J Torres
- Maternal-Child Area, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Gerard Delmás
- Innovation Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Helena Camell
- Department of Internal Medicine, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Antonio Chamero
- Anesthesiology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Montse Gasol
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Department of Pharmacology, Therapeutics, and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
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Scévola S, Niubó J, Domingo P, Verdejo G, Curran A, Diaz-Brito V, Peñafiel J, Tiraboschi J, Morenilla S, Garcia B, Soriano I, Podzamczer D, Imaz A. Decay of HIV RNA in Seminal Plasma and Rectal Fluid in Treatment-Naive Adults Starting Antiretroviral Therapy With Dolutegravir Plus Lamivudine or Bictegravir/Emtricitabine/Tenofovir Alafenamide. J Infect Dis 2023; 228:919-925. [PMID: 37526315 DOI: 10.1093/infdis/jiad304] [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: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Decay of HIV in seminal plasma (SP) and rectal fluid (RF) has not yet been described for the antiretroviral combination of dolutegravir (DTG) + lamivudine (3TC). METHODS In this randomized multicenter pilot trial, males who were antiretroviral naive were randomized (2:1) to DTG + 3TC or bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). HIV-1 RNA was measured in blood plasma (BP), SP, and RF at baseline; days 3, 7, 14, and 28; and weeks 12 and 24. RESULTS Of 25 individuals enrolled, 24 completed the study (DTG + 3TC, n = 16; BIC/FTC/TAF, n = 8). No significant differences were observed between groups for median decline in HIV-1 RNA from baseline at each time point or median time to achieve HIV-1 RNA <20 copies/mL in BP and SP and <20 copies/swab in RF. HIV-1 RNA decay patterns were compared in individuals receiving DTG + 3TC. Despite significantly higher percentages for changes from baseline in BP, median (IQR) times to HIV-1 RNA suppression were shorter in SP (7 days; 0-8.75) and RF (10.5 days; 3-17.5) than in BP (28 days; 14-84; P < .001). CONCLUSIONS Comparable HIV-1 RNA decay in BP, SP, and RF was observed between DTG + 3TC and BIC/FTC/TAF. As shown with triple-drug integrase inhibitor-based regimens, rapid HIV-1 RNA suppression in SP and RF is achieved with DTG + 3TC, despite decay patterns differing from those of BP. CLINICAL TRIALS REGISTRATION EudraCT 2019-004109-28.
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Affiliation(s)
- Sofía Scévola
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Niubó
- Department of Microbiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Domingo
- HIV Unit, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Guillermo Verdejo
- Department of Internal Medicine, Sant Camil Hospital, Sant Pere de Ribes, Barcelona, Spain
| | - Adrian Curran
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Judith Peñafiel
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - Juan Tiraboschi
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra Morenilla
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Benito Garcia
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Irene Soriano
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Podzamczer
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Rombauts A, Abelenda-Alonso G, Simonetti AF, Verdejo G, Meije Y, Ortega L, Clemente M, Niubó J, Ruiz Y, Gudiol C, Tebé C, Videla S, Carratalà J. Effect of albumin administration on outcomes in hypoalbuminemic patients hospitalized with community-acquired pneumonia (ALBUCAP): a prospective, randomized, phase III clinical controlled trial-a trial protocol. Trials 2020; 21:727. [PMID: 32819439 PMCID: PMC7438978 DOI: 10.1186/s13063-020-04627-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) remains a leading cause of death worldwide, and hypoalbuminemia is associated with worse outcomes. However, it remains uncertain whether albumin administration could have any beneficial effects. We aim to assess whether the administration of albumin in hypoalbuminemic patients with CAP increases the proportion of clinically stable patients at day 5 compared with the standard of care alone. Methods This is a trial protocol for a superiority, non-blinded, multicenter, randomized, phase 3, interventional controlled clinical trial. The primary endpoint will be the proportion of clinical stable patients at day 5 (intention to treat), defined as those with stable vital signs for at least 24 h. The secondary endpoints will be time to clinical stability, duration of intravenous and total antibiotic treatment, length of hospital stay, intensive care unit admission, duration of mechanical ventilation and vasopressor treatment, adverse events, readmission within 30 days, and all-cause mortality. The trial has been approved by the Spanish Medicines and Healthcare Products Regulatory Agency. The investigators commit to publish the data in peer-reviewed journals within a year of the study completion date. Subjects will be recruited from three Spanish hospitals over a planned enrolment period of 2 years. A follow-up visit will be performed 1 month after discharge. We have estimated the need for a sample size of 360 patients at a two-sided 5% alpha-level with a power of 80% based on intention to treat. Eligible participants must be hospitalized, hypoalbuminemic (≤ 30 g/L), non-immunosuppressed, adults, and diagnosed with CAP. They will be randomly assigned (1:1) to receive standard care plus albumin (20 g in 100 mL) every 12 h for 4 days or standard care alone. Discussion If this randomized trial confirms the hypothesis, it should lead to a change in current clinical practice for the management of hypoalbuminemic patients with CAP. Trial registration European Clinical Trials Database (EudraCT) 2018-003117-18. Registered on 12 April 2019. ClinicalTrials.gov NCT04071041. Registered on 27 August 2019
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Affiliation(s)
- Alexander Rombauts
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Gabriela Abelenda-Alonso
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Antonella Francesca Simonetti
- Department of Internal Medicine, Hospital Residència Sant Camil-Consorci Sanitari del Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Guillermo Verdejo
- Department of Internal Medicine, Hospital Residència Sant Camil-Consorci Sanitari del Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Yolanda Meije
- Infectious Diseases Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Lucia Ortega
- Infectious Diseases Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Mercedes Clemente
- Infectious Diseases Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Jordi Niubó
- Department of Microbiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Ruiz
- Department of Pneumology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Gudiol
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Sebastian Videla
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, Hospital de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Disease, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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4
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Pasquau J, de Jesus SE, Arazo P, Crusells MJ, Ríos MJ, Lozano F, de la Torre J, Galindo MJ, Carmena J, Santos J, Tornero C, Verdejo G, Samperiz G, Palacios Z, Hidalgo-Tenorio C. Effectiveness and safety of dual therapy with rilpivirine and boosted darunavir in treatment-experienced patients with advanced HIV infection: a preliminary 24 week analysis (RIDAR study). BMC Infect Dis 2019; 19:207. [PMID: 30819101 PMCID: PMC6396540 DOI: 10.1186/s12879-019-3817-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background The objective was to analyze the effectiveness and safety of dual therapy with rilpivirine plus boosted-darunavir (RPV + bDRV) in real-life patients. Methods Observational, retrospective, multi-center study in HIV+ patients who had received RPV + bDRV for 24 weeks to optimize/simplify their previous antiretroviral treatment. We determined the percentage of patients without virologic failure (2 consecutive viral loads > 50 copies/mL) at 24 weeks of treatment. Results The study included 161 patients from 15 hospitals with median age of 49 years; 29.3% had previous AIDS stage and median CD4+ lymphocyte nadir of 170 cells/uL. They had been diagnosed with HIV for a median of 17 years and had received 14 years of ART, with five previous treatment combinations, and 36.6% had a history of virological failure. The reasons for the switch were simplification/optimization (49.7%), toxicity/intolerance (17.4%), or inadequate effectiveness of previous ART (10.6%). Baseline VL of 50–1000 copies/mL was recorded in 25.5% of the patients. In the“intention-to-treat” analysis at 24 weeks, 87.6% of 161 patients continued the study treatment without virologic failure criteria. In the “on treatment” analysis (excluding patients who discontinued treatment with dual therapy for any reason other than virologic failure) the efficacy was 94.6% (141/149 patients). Conclusions Dual therapy with RPV + DRVb proved to be effective and safe in patients with advanced HIV infection, long exposure to ART, low CD4 nadir, previous virologic failure, and/or history of ineffective ART.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | | | | | | | | | | | | | - Jorge Carmena
- Hospital Universitario Doctor Peset, Valencia, Spain
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Rubio-Rivas M, Corbella X, Pestaña-Fernández M, Tolosa-Vilella C, Guillen-Del Castillo A, Colunga-Argüelles D, Trapiella-Martínez L, Iniesta-Arandia N, Castillo-Palma MJ, Sáez-Comet L, Egurbide-Arberas MV, Ortego-Centeno N, Freire M, Vargas-Hitos JA, Ríos-Blanco JJ, Todolí-Parra JA, Rodríguez-Carballeira M, Marín-Ballvé A, Segovia-Alonso P, Pla-Salas X, Madroñero-Vuelta AB, Ruiz-Muñoz M, Fonollosa-Pla V, Simeón-Aznar CP, Callejas Moraga E, Calvo E, Carbonell C, Castillo MJ, Chamorro AJ, Colunga D, Corbella X, Egurbide MV, Espinosa G, Fonollosa V, Freire M, García Hernández FJ, González León R, Guillén Del Castillo A, Iniesta N, Lorenzo R, Madroñero AB, Marí B, Marín A, Ortego-Centeno N, Pérez Conesa M, Pestaña M, Pla X, Ríos Blanco JJ, Rodríguez Carballeira M, Rubio Rivas M, Ruiz Muñoz M, Sáez Comet L, Segovia P, Simeón CP, Soto A, Tarí E, Todolí JA, Tolosa C, Trapiella L, Vargas Hitos JA, Verdejo G. First clinical symptom as a prognostic factor in systemic sclerosis: results of a retrospective nationwide cohort study. Clin Rheumatol 2017; 37:999-1009. [PMID: 29214548 DOI: 10.1007/s10067-017-3936-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 07/14/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Xavier Corbella
- Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Melany Pestaña-Fernández
- Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Tolosa-Vilella
- Department of Internal Medicine, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Dolores Colunga-Argüelles
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Nerea Iniesta-Arandia
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatología, Hospital Clínic, Barcelona, Spain
| | - María Jesús Castillo-Palma
- Collagenosis and Pulmonary Hypertension Unit, Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis Sáez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Mayka Freire
- Thrombosis and Vasculitis Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | | | - Adela Marín-Ballvé
- Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Pablo Segovia-Alonso
- Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Xavier Pla-Salas
- Department of Internal Medicine, Consorci Hospitalari de Vic, Barcelona, Spain
| | | | - Manuel Ruiz-Muñoz
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Vicent Fonollosa-Pla
- Autoimmune Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Pilar Simeón-Aznar
- Autoimmune Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Verdejo G, Bortman M. Argentina: health situation analysis and trends, 1986-1995. Epidemiol Bull 2000; 21:7-10. [PMID: 10815315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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7
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Villar RG, Shapiro RL, Busto S, Riva-Posse C, Verdejo G, Farace MI, Rosetti F, San Juan JA, Julia CM, Becher J, Maslanka SE, Swerdlow DL. Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina. JAMA 1999; 281:1334-8, 1340. [PMID: 10208152 DOI: 10.1001/jama.281.14.1334] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires. OBJECTIVES To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina. DESIGN, SETTING, AND PARTICIPANTS Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires. MAIN OUTCOME MEASURE Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak. RESULTS Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78 degrees C to 80 degrees C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established. CONCLUSIONS Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.
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Affiliation(s)
- R G Villar
- Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Nogueira JM, Belda R, Rodríguez-Arias C, Peláez G, Esteban J, Verdejo G, Abad A, Osorio M. [Leiomyosarcoma of the duodenal bulb. Presentation of a case with digestive hemorrhage and abdominal mass]. Rev Esp Enferm Dig 1991; 80:143-4. [PMID: 1790083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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9
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Carrasco R, González J, Cumsille F, Concha M, de la Fuente M, Spencer P, Verdejo G. [Nontraumatic deaths associated with a natural catastrophe. The experience of the earthquake in Chile 1985]. Rev Med Chil 1990; 118:84-91. [PMID: 2152707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We analyzed causes of death before and after the March 1985 earthquake in Valparaíso, Chile. Causes of death were obtained from death certificates. Apart from death directly due to trauma during the earthquake, a significant increase was observed in deaths due to accidents (+51), cardiovascular disease (+38), malnutrition (+13) and psychiatric disorders (+13). Retired males over age 65 were most affected.
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Affiliation(s)
- R Carrasco
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago
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