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Díez JJ, Anda E, Alcazar V, Isidro ML, Familiar C, Paja M, Martín Rojas-Marcos P, Pérez-Corral B, Navarro E, Romero-Lluch AR, Oleaga A, Pamplona MJ, Fernández-García JC, Megía A, Manjón-Miguélez L, Sánchez-Ragnarsson C, Iglesias P, Sastre J. Consumption of health resources in older people with differentiated thyroid carcinoma: a multicenter analysis. Endocrine 2023; 81:521-531. [PMID: 37103683 DOI: 10.1007/s12020-023-03369-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE There is hardly any information on the consumption of healthcare resources by older people with differentiated thyroid cancer (DTC). We analyzed these consumptions in older patients with DTC and compared patients 75 years and older with subjects aged 60-74 years. METHODS A multicenter, retrospective analysis was designed. We recorded three groups of health resources consumption (visits, diagnostic procedures, and therapeutic procedures) and identified a subgroup of patients with high consumption of resources. We compared patients aged between 60-74 years (group 1) with patients aged 75 and over (group 2). RESULTS We included 1654 patients (women, 74.4%), of whom 1388 (83.9%) belonged to group 1 and 266 (16.1%) to group 2. In group 2, we found a higher proportion of patients requiring emergency department visits (7.9 vs. 4.3%, P = 0.019) and imaging studies (24.1 vs. 17.3%; P = 0.012) compared to group 1. However, we did not find any significant difference between both groups in the consumption of other visits, diagnostic procedures, or therapeutic procedures. Overall, 340 patients (20.6%) were identified as high consumers of health resources, 270 (19.5%) in group 1 and 70 (26.3%) in group 2 (P = 0.013). Multivariate logistic regression analysis showed that the risk of recurrence and mortality, radioiodine treatment, tumor size, and vascular invasion were significantly related to the high global consumption of resources. However, the age was not significantly related to it. CONCLUSION In patients with DTC over 60 years of age, advanced age is not an independent determining factor in the consumption of health resources.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Emma Anda
- Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain
| | - María L Isidro
- Department of Endocrinology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Cristina Familiar
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Bilbao, Spain
| | | | - Begoña Pérez-Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Elena Navarro
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Bilbao, Spain
| | - María J Pamplona
- Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain
| | - José C Fernández-García
- Department of Endocrinology, Hospital Regional Universitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Ana Megía
- Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain
| | - Laura Manjón-Miguélez
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Cecilia Sánchez-Ragnarsson
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
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Díez JJ, Anda E, Alcazar V, Isidro ML, Familiar C, Paja M, Rojas Marcos P, Pérez-Corral B, Navarro E, Romero-Lluch AR, Oleaga A, Pamplona MJ, Fernández-García JC, Megía A, Manjón L, Sánchez-Ragnarsson C, Iglesias P, Sastre J. Differentiated thyroid carcinoma in the elderly: influence of age on disease-free and overall survival. Endocrine 2022; 77:121-133. [PMID: 35585463 DOI: 10.1007/s12020-022-03059-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients. METHODS A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years). RESULTS The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not. CONCLUSION Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Emma Anda
- Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain
| | - María L Isidro
- Department of Endocrinology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Cristina Familiar
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Leioa, Spain
| | | | - Begoña Pérez-Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Elena Navarro
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
- Department of Medicine, Universidad del País Vasco, Leioa, Spain
| | - María J Pamplona
- Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain
| | - José C Fernández-García
- Department of Endocrinology, Hospital Regional Universitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Ana Megía
- Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain
| | - Laura Manjón
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Cecilia Sánchez-Ragnarsson
- Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
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Sánchez Santos E, Garrido-González JJ, Fuentes de Arriba AL, Rodríguez-Sahagún L, Habib A, Sanz F, Martin del Valle E, Rodriguez Moran J, Alcazar V. Tryptophan association in water driven by charge-transfer interactions with electron-deficient aromatic haptens. Org Biomol Chem 2022; 20:7972-7980. [DOI: 10.1039/d2ob01650h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The ability of a series of electron-deficient aromatic compounds to form charge-transfer complexes with tryptophan in water has been evaluated by X-ray diffraction studies, UV-vis spectra and NMR. As dinitrophenyl...
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Garrido González JJ, Boya Del Teso I, Fuentes de Arriba AL, Sanz F, Martín Del Valle EM, Morán JR, Alcazar V. An Adjustable Cleft Based on an 8-sulfonamide-2-naphthoic Acid with Oxyanion Hole Geometry. Chemistry 2021; 27:14605-14609. [PMID: 34396599 DOI: 10.1002/chem.202102137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/15/2021] [Indexed: 11/11/2022]
Abstract
Cleft type receptors showing the oxyanion hole motif have been prepared in a straightforward synthesis starting from the commercial 3,7-dihidroxy-2-naphthoic acid. The double H-bond donor pattern is achieved by the introduction of a sulfonamide group in the C-8 position of naphthalene and a carboxamide at the C-2 position. This cleft, whose geometry resembles that of an oxyanion hole, is able to adjust to different guests, as shown by the analysis of the X- ray crystal structures of associates with methanol or acetic acid. Combination of hydrogen bonds and charge-transfer interactions led to further stabilization of the complexes, in which the electron-rich aromatic ring of the receptor was close in space to the electron-deficient dinitroaromatic guests. Modelling studies and bidimensional NMR experiments have been carried out to provide additional information.
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Affiliation(s)
| | - Irene Boya Del Teso
- Universidad de Salamanca, Organic Chemistry, Plaza de los Caídos, 37008, España, 37008, Salamanca, SPAIN
| | | | - Francisca Sanz
- Universidad de Salamanca, Servicio de Rayos X, Plaza de los Caídos, 37008, España, 37008, Salamanca, SPAIN
| | - Eva María Martín Del Valle
- Universidad de Salamanca, Chemical Engineering, Plaza de los Caídos, 37008, España, 37008, Salamanca, SPAIN
| | - Joaquín R Morán
- Universidad de Salamanca, Organic Chemistry, Plaza de los Caídos, 37008, España, 37008, Salamanca, SPAIN
| | - Victoria Alcazar
- Polytechnic University of Madrid: Universidad Politecnica de Madrid, Department of Chemical and Environmental Engineering, José Gutiérrez Abascal 2, E-28006, Madrid, SPAIN
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Imbernon-Moya A, Ortiz-de Frutos FJ, Sanjuan-Alvarez M, Portero-Sanchez I, Merinero-Palomares R, Alcazar V. Treatment of chronic venous ulcers with topical sevoflurane: a retrospective clinical study. Br J Anaesth 2019; 119:846-847. [PMID: 29121303 DOI: 10.1093/bja/aex269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
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Imbernon‐Moya A, Ortiz‐de Frutos FJ, Sanjuan‐Alvarez M, Portero‐Sanchez I, Merinero‐Palomares R, Alcazar V. Healing of chronic venous ulcer with topical sevoflurane. Int Wound J 2017; 14:1323-1326. [PMID: 28834293 PMCID: PMC7950126 DOI: 10.1111/iwj.12806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/06/2017] [Revised: 07/15/2017] [Accepted: 07/19/2017] [Indexed: 01/09/2023] Open
Abstract
The present study assesses the efficacy and safety of topical sevoflurane in chronic venous ulcers and its impact on analgesia and healing. This retrospective study included 30 patients older than 65 years with painful refractory chronic venous ulcers. Patients were treated with topical sevoflurane prior to the usual ulcer cleaning every 2 days for a period of 1 month. Treatment was initiated with a saline solution, followed by direct irrigation of 1 ml of liquid sevoflurane over the wound size, which was measured as cm2 . Sevoflurane had a fast, intense and long-lasting analgesic effect. Latency time ranged from 2 to 7 minutes (3·9 ± 1·5 minutes), and duration varied from 8 to 18 hours (12 ± 2·9). The mean ulcer size was 8·4 ± 9·7 cm2 . There was a progressive decrease in size in all patients, with a mean size of 4·2 ± 5·4 cm2 at the end of the study. There were no adverse systemic effects. Local adverse effects were mild and transient, including pruritus, erythema and heat. Topical sevoflurane is a new, efficient and safe therapeutic alternative in painful chronic venous ulcers, refractory to usual analgesic treatment. It can improve the ulcer-healing process that shortens the cicatrisation period.
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Imbernon-Moya A, Ortiz-de Frutos FJ, Sanjuan-Alvarez M, Portero-Sanchez I, Merinero-Palomares R, Alcazar V. Pain, Quality of Life, and Functional Capacity With Topical Sevoflurane Application for Chronic Venous Ulcers: A Retrospective Clinical Study. EJVES Short Rep 2017; 36:9-12. [PMID: 29296683 PMCID: PMC5626915 DOI: 10.1016/j.ejvssr.2017.08.001] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Chronic venous ulcers (CVU) commonly have poorly controlled pain. Report Thirty patients older than 65 years of age with painful CVU were reviewed. At the initial visit, cleaning without sevoflurane was performed. Cleaning visits with sevoflurane every 2 days for 1 month were scheduled. The results of subsequent treatment with sevoflurane at the first, second, seventh, and twelfth cleanings were analysed. Pain was measured using a visual analog scale (VAS), quality of life by the Charing Cross Venous Leg Ulcer Questionnaire, and functional capacity by the Barthel Index. Discussion Initial VAS was 8.8 ± 1.3 points and at the twelfth cleaning VAS was 0.8 ± 1 points (p = .001). Latency time ranged between 2 and 7 m and duration ranged between 8 and 18 h. It improved quality of life (83 ± 14 points before treatment vs. 50 ± 14 at the twelfth cleaning) and functional capacity (82 ± 13.3 before treatment vs. 91 ± 11.6 points at the twelfth cleaning) (p = .001). The safety profile was favourable with mild and self limited local cutaneous adverse effects, including pruritus, erythema, and heat. No systemic toxicity was detected. Topical sevoflurane may be a therapeutic alternative for painful CVU with a fast, intense, and long-lasting analgesic effect.
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Affiliation(s)
- Adrian Imbernon-Moya
- Department of Dermatology, Hospital Severo Ochoa, Avenida de Orellana, Leganés, Madrid 28911, Spain
| | | | - Monica Sanjuan-Alvarez
- Department of Anesthetics, Hospital Severo Ochoa, Avenida de Orellana, Leganés, Madrid 28911, Spain
| | | | - Raul Merinero-Palomares
- Department of Crystallography and Mineralogy, Complutense University of Madrid, Madrid, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Avenida de Orellana, Leganés, Madrid 28911, Spain
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Imbernón-Moya A, Ortiz-de Frutos FJ, Sanjuan-Alvarez M, Portero-Sanchez I, Merinero-Palomares R, Alcazar V. Topical sevoflurane for chronic venous ulcers infected by multi-drug-resistant organisms. Int Wound J 2017; 14:1388-1390. [PMID: 28736974 DOI: 10.1111/iwj.12794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022] Open
Abstract
Several anaesthetic drugs have demonstrated antibacterial properties in vitro. Anaesthetics can primarily affect the cell wall of both susceptible and multi-resistant bacteria. They may also have a synergistic effect with conventional antibiotics through an unknown mechanism. We present three cases of a chronic venous ulcer infected by multi-resistant bacteria refractory to conventional systemic antibiotics, including Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). Treatment with topical sevoflurane was performed for 1 month without systemic antibiotics. Patients with an MRSA infection showed progressive improvement with negative culture at the end of the treatment. Multi-drug-resistant P. aeruginosa infection persisted at the end of treatment with positive culture. The local adverse events were mild and transient, including heat, pruritus and erythema. Topical sevoflurane may have an antibacterial effect on sensitive and multi-resistant strains. It can allow more complete surgical cleaning, leaving a cleaner wound with less fibrin and necrotic tissue. This decreases the bacterial colonisation and therefore the infectious risk, the bad smell and the exudation. The simultaneous use of conventional antibiotics and topical sevoflurane can have a synergistic antimicrobial effect.
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Affiliation(s)
| | | | | | | | - Raúl Merinero-Palomares
- Department of Crystallography and Mineralogy, Complutense University of Madrid, Madrid, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Madrid, Spain
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López Del Val T, Del Olmo D, Diago J, Alcazar V, Hernández E, Vázquez C. [Acute water intoxication as complication of intravenous urography]. An Med Interna 2001; 18:265-8. [PMID: 11496563] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Physiologically, two complementary mechanisms regulate plasma osmolality: antduretic hormone ADH) and thirst. ADH release s supressed, thirst s inhbted and renal water loss occurs when plasma osmolality below a threshold level. The rise in plasma osmolalty causes ADH release, stimulation of thirst and water intake. Acute water intoxication is exceptional in patients without a chronic psychiatric disease. Herein, we describe a case of acute water intoxication in a previously healthy patient, after making an intravenous urography. The excessive water intake and the impossibility of renal water loss because of streee-induced ADH release originated t. Only nine cases have been previously described; almost they all were women preparing for diagnostic procedures.
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Affiliation(s)
- T López Del Val
- Sección de Endocrinología y Nutrición, Hospital Severo Ochoa, Avenida de Orellana, s/n. 28911 Leganés, Madrid
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Alcazar V, Diederich F. Enantioselective Complexation of Chiral Dicarboxylic Acids in Clefts of Functionalized 9,9′-Spirobifluorenes. ACTA ACUST UNITED AC 1992. [DOI: 10.1002/anie.199215211] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alcazar V, Diederich F. Enantioselektive Komplexierung chiraler Dicarbonsäuren in funktionalisierten spaltenförmigen 9,9′-Spirobifluorenen. Angew Chem Int Ed Engl 1992. [DOI: 10.1002/ange.19921041115] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tapia I, Alcazar V, Moran JR, Caballero C, Grande M. Pyruvic Acid Dimethylhydrazone. A Synthetic Equivalent of the Pyruvic Acid Dianion. CHEM LETT 1990. [DOI: 10.1246/cl.1990.697] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Barrientos A, Alcazar V, Ruilope L, Jarillo D, Rodicio JL. Indomethacin and beta-blockers in hypertension. Lancet 1978; 1:277. [PMID: 74701 DOI: 10.1016/s0140-6736(78)90525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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