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Capdevila O, Mitjavila F, Espinosa G, Caminal-Montero L, Marín-Ballvè A, González León R, Castro A, Canora J, Pinilla B, Fonseca E, Ruiz-Irastorza G. Predictive Factors of the Use of Rituximab and Belimumab in Spanish Lupus Patients. Medicina (Kaunas) 2023; 59:1362. [PMID: 37629652 PMCID: PMC10456702 DOI: 10.3390/medicina59081362] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
Objectives: To analyze the characteristics and the predictive factors of the use of rituximab and belimumab in daily practice in patients from the inception cohort Registro Español de Lupus (RELES). Material and methods: The study included 518 patients. We considered patients treated with biologics who received at least one dose of rituximab or belimumab, and possible indications of those manifestations registered at the same time or in the previous 2 months of the start of the therapy. Results: In our cohort, 37 (7%) patients received at least one biological treatment. Rituximab was prescribed in 26 patients and belimumab in 11. Rituximab was mainly prescribed for hemolytic anemia or thrombocytopenia (11 patients, 42%), lupus nephritis and neuropsychiatric lupus (5 patients each, 19%). Belimumab was mostly used for arthritis (8 patients, 73%). In the univariate analysis, the predictive factors at diagnosis for the use of biologic therapy were younger age (p = 0.022), a higher SLEDAI (p = 0.001) and the presence of psychosis (p = 0.011), organic mental syndrome (SOCA) (p = 0.006), hemolytic anemia (p = 0.001), or thrombocytopenia (p = 0.01). In the multivariant model, only younger age, psychosis, and hemolytic anemia were independent predictors of the use of biologics. Conclusions: Rituximab is usually given to patients with hematological, neuropsychiatric and renal involvement and belimumab for arthritis. Psychosis, hemolytic anemia and age at the diagnosis of lupus were independent predictive factors of the use of biological agents. Their global effects are beneficial, with a significant reduction in SLE activity and a low rate of side effects.
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Affiliation(s)
- O. Capdevila
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - F. Mitjavila
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - G. Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, 08036 Barcelona, Spain;
| | - L. Caminal-Montero
- Group of Basic and Translational Research in Inflammatory Diseases, Departament of Internal Medicine, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - A. Marín-Ballvè
- Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - R. González León
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - A. Castro
- Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - J. Canora
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - B. Pinilla
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - E. Fonseca
- Department of Internal Medicine, Hospital de Cabueñes, 33394 Gijón, Spain;
| | - G. Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, 48903 Barakaldo, Spain
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Candel FJ, Barreiro P, San-Román J, Sanz-Moreno JC, Carretero MM, Martínez-Peromingo FJ, Barba R, Lastra A, Vázquez J, Prados F, Canora J, Zapatero A. Approach to COVID-19 pandemic management in Madrid. Chronic of a year. Rev Esp Quimioter 2021; 34 Suppl 1:76-80. [PMID: 34598434 PMCID: PMC8683010 DOI: 10.37201/req/s01.22.2021] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
After more than a year of pandemic, the international medical community has changed the perception of fear to one of respect for SARS-COV-2. This has been the consequence of the integral study of all the dimensions of the disease, from viral recombinant capacity to transmissibility, diagnosis, care and prevention. This document summarizes the main strategic lines of study and approach to the pandemic in Madrid.
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Affiliation(s)
- F J Candel
- Francisco Javier Candel, Public Health Laboratory. Community of Madrid.
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Candel FJ, Barreiro P, San Román J, Carretero MM, Sanz JC, Perez-Abeledo M, Ramos B, Viñuela-Prieto JM, Canora J, Martínez-Peromingo FJ, Barba R, Zapatero A. The demography and characteristics of SARS-CoV-2 seropositive residents and staff of nursing homes for older adults in the Community of Madrid: the SeroSOS study. Age Ageing 2021; 50:1038-1047. [PMID: 33945607 PMCID: PMC8135991 DOI: 10.1093/ageing/afab096] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Nursing homes for older adults have concentrated large numbers of severe cases and deaths for COVID-19. Methods: Point seroprevalence study of nursing homes to describe the demography and characteristic of SARS-CoV-2 IgG-positive residents and staff. Results: Clinical information and blood samples were available for 9,332 residents (mean age 86.7 ± 8.1 years, 76.4% women) and 10,614 staff (mean age 45.6 ± 11.5, 86.2% women). Up to 84.4% of residents had frailty, 84.9% co-morbidity and 69.3% cognitive impairment; 65.2% of workers were health-aides. COVID-19 seroprevalence was 55.4% (95% CI, 54.4–56.4) for older adults and 31.5% (30.6–32.4) for staff. In multivariable analysis frailty of residents was related with seropositivity (OR: 1.19, p = 0.02). In the case of staff, age > 50 years (2.10, p < 0.001), obesity (1.19, p = 0.01), being a health-aide (1.94, p < 0.001), working in a center with high seroprevalence in residents (3.49, p < 0.001), and contact with external cases of COVID-19 (1.52, p < 0.001) were factors associated with seropositivity. Past symptoms of COVID-19 were good predictors of seropositivity for residents (5.41, p < 0.001) and staff (2.52, p < 0.001). Conclusions: Level of dependency influences risk of COVID-19 among residents. Individual and work factors, and contacts outside the nursing home are associated with COVID-19 exposure in staff members. It is key to strengthen control measures to prevent the introduction of COVID-19 into care facilities from the community.
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Affiliation(s)
- F J Candel
- Clinical Microbiology and Infectious Diseases, IdISSC and IML Health Institutes, Hospital Universitario San Carlos, Madrid
- Regional Public Health Laboratory, Community of Madrid
| | - P Barreiro
- Address correspondence to: Pablo Barreiro, MD PhD, Infectious Diseases. Internal Medicine. Hospital General Universitario La Paz. Madrid. Spain, E-mail:
| | - J San Román
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid
- Regional Public Health Laboratory, Community of Madrid
| | - M M Carretero
- Regional Public Health Laboratory, Community of Madrid
| | - J C Sanz
- Regional Public Health Laboratory, Community of Madrid
| | | | - B Ramos
- Regional Public Health Laboratory, Community of Madrid
| | - J M Viñuela-Prieto
- Department of Neurosurgery, Hospital General Universitario La Paz, Madrid
| | - J Canora
- Assistant to the Vice-counselor of Public Health, Community of Madrid
| | | | - R Barba
- Medical Manager, Hospital Universitario Rey Juan Carlos, Madrid
| | - A Zapatero
- Vice-counselor of Public Health, Community of Madrid
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Candel FJ, Canora J, Zapatero A, Barba R, González Del Castillo J, García-Casasola G, Gil-Prieto R, Barreiro P, Fragiel M, Prados F, Busca P, Vázquez-Castro J, Marco J. Temporary hospitals in times of the COVID pandemic. An example and a practical view. Rev Esp Quimioter 2021; 34:280-288. [PMID: 33752321 PMCID: PMC8329569 DOI: 10.37201/req/041.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe the most widely used temporary hospital in Europe during the first pandemic wave, its structure, function, and achievements. Other models of care developed during the pandemic around the world were reviewed including their capacity, total bed/ICU bed ratio and time of use. We particularly analyzed the common and differential characteristics of this type of facilities. IFEMA Exhibition Center was transformed into a temporary 1,300-bed hospital, which was in continuous operation for 42 days. A total of 3,817 people were treated, generally patients with mild to moderate COVID-19, 91% of whom had pneumonia. The average length of stay was 5 to 36 days. The most frequent comorbidities were hypertension (16.5%), diabetes mellitus (9.1%), COPD (6%), asthma (4.6%), obesity (2.9%) and dementia (1.6%). A total of 113 patients (3%) were transferred to another centers for aggravation, 19 (0.5%) were admitted to ICU and 16 patients (0.4%) died. An element of great help to reducing the overload of care in large hospitals during peaks of health emergencies could be these flexible structures capable of absorbing the excess of patients. These must be safe, breaking domestic transmission and guarantee social and emotional needs of patients. The success of these structures depends on delimitation in admission criteria taking into account the proportion of patients who may require, during admission, assistance in the critical care area.
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Affiliation(s)
- F J Candel
- Francisco Javier Candel,Clinical Microbiology and Infectious Diseases. Hospital Clínico Universitario San Carlos. Madrid. Spain.
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Candel FJ, Barreiro P, San Román J, Abanades JC, Barba R, Barberán J, Bibiano C, Canora J, Cantón R, Calvo C, Carretero M, Cava F, Delgado R, García-Rodríguez J, González Del Castillo J, González de Villaumbrosia C, Hernández M, Losa JE, Martínez-Peromingo FJ, Molero JM, Muñoz P, Onecha E, Onoda M, Rodríguez J, Sánchez-Celaya M, Serra JA, Zapatero A. Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings. Rev Esp Quimioter 2020; 33:466-484. [PMID: 33070578 PMCID: PMC7712344 DOI: 10.37201/req/120.2020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 01/10/2023]
Abstract
The high transmissibility of SARS-CoV-2 before and shortly after the onset of symptoms suggests that only diagnosing and isolating symptomatic patients may not be sufficient to interrupt the spread of infection; therefore, public health measures such as personal distancing are also necessary. Additionally, it will be important to detect the newly infected individuals who remain asymptomatic, which may account for 50% or more of the cases. Molecular techniques are the "gold standard" for the diagnosis of SARS-CoV-2 infection. However, the massive use of these techniques has generated some problems. On the one hand, the scarcity of resources (analyzers, fungibles and reagents), and on the other the delay in the notification of results. These two facts translate into a lag in the application of isolation measures among cases and contacts, which favors the spread of the infection. Antigen detection tests are also direct diagnostic methods, with the advantage of obtaining the result in a few minutes and at the very "pointof-care". Furthermore, the simplicity and low cost of these tests allow them to be repeated on successive days in certain clinical settings. The sensitivity of antigen tests is generally lower than that of nucleic acid tests, although their specificity is comparable. Antigenic tests have been shown to be more valid in the days around the onset of symptoms, when the viral load in the nasopharynx is higher. Having a rapid and real-time viral detection assay such as the antigen test has been shown to be more useful to control the spread of the infection than more sensitive tests, but with greater cost and response time, such as in case of molecular tests. The main health institutions such as the WHO, the CDC and the Ministry of Health of the Government of Spain propose the use of antigenic tests in a wide variety of strategies to respond to the pandemic. This document aims to support physicians involved in the care of patients with suspected SC2 infection, in the context of a growing incidence in Spain since September 2020, which already represents the second pandemic wave of COVID-19.
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Affiliation(s)
- F J Candel
- Dr. Francisco Javier Candel. Enfermedades Infecciosas y Microbiología Clínica. Hospital Clínico San Carlos. Institutos IdISSC e IML. Profesor Asociado. Facultad de Medicina. UCM. Madrid. Spain.
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Marco J, Méndez M, Cruz-Jentoft A, García Klepzig J, Calvo E, Canora J, Zapatero A, Barba R. Clinical characteristics and prognosis for delirium in Spanish internal medicine departments: An analysis from a large clinical-administrative database. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barba R, Gonzalvez-Gasch A, Joya Seijo D, Marco J, Canora J, Plaza S, Angelina García M, Zapatero A. Venous thromboembolism in patients with liver diseases. J Thromb Haemost 2018; 16:2003-2007. [PMID: 30066476 DOI: 10.1111/jth.14255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 11/30/2022]
Abstract
Essentials Emerging evidence shows that patients with liver disease are not protected from thrombotic events. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. The presence of VTE resulted in an increase in mortality for patients with liver disease. Hospitalized patients with moderate-severe liver disease had low risk of VTE during admission. SUMMARY Background and Aims Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. Methods Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate-severe or no liver disease, and the impact on in-hospital mortality and length of stay was calculated. Results The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate-severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in-hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate-severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14-1.18) and moderate-severe liver disease (OR, 1.63; CI 95%, 1.42-1.88). Conclusions Patients with moderate-severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in-hospital mortality.
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Affiliation(s)
- R Barba
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | - D Joya Seijo
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - J Marco
- Department of Internal Medicine, Hospital Clínico de San Carlos, San Carlos, Madrid, Spain
| | - J Canora
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - S Plaza
- Department of Internal Medicine, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - M Angelina García
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - A Zapatero
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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Canora J, García M, Mitjavila F, Espinosa G, Suárez S, González-León R, Sopeña B, Boldova R, Castro A, Ruiz-Irastorza G. Características clínicas al diagnóstico de una cohorte prospectiva de pacientes con lupus eritematoso sistémico atendidos en servicios de Medicina Interna españoles: estudio RELES. Rev Clin Esp 2017; 217:7-14. [DOI: 10.1016/j.rce.2016.09.006] [Citation(s) in RCA: 2] [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] [Received: 04/07/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
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Canora J, García M, Mitjavila F, Espinosa G, Suárez S, González-León R, Sopeña B, Boldova R, Castro A, Ruiz-Irastorza G. Clinical characteristics during diagnosis of a prospective cohort of patients with systemic lupus erythematosus treated in Spanish Departments of Internal Medicine: The RELES study. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.09.003] [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: 12/01/2022]
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Ruiz-Irastorza G, Garcia M, Espinosa G, Caminal L, Mitjavila F, González-León R, Sopeña B, Canora J, Villalba MV, Rodríguez-Carballeira M, López-Dupla JM, Callejas JL, Castro A, Tolosa C, Sánchez-García ME, Pérez-Conesa M, Navarrete-Navarrete N, Rodríguez AP, Herranz MT, Pallarés L. First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort. Lupus Sci Med 2016; 3:e000153. [PMID: 27547439 PMCID: PMC4985804 DOI: 10.1136/lupus-2016-000153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/22/2016] [Accepted: 07/02/2016] [Indexed: 11/13/2022]
Abstract
Aim To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2–12). Methods 223 patients from the Registro Español de Lupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2–12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2–12 doses was tested. We analysed whether the four-level prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2–12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI). Results Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2–12 dose categories (p<0.001). The cumulative prednisone-1 dose was directly associated with the cumulative prednisone-2–12 dose (p<0.001). Compared with patients on no prednisone, patients taking medium (adjusted OR 5.27, 95% CI 2.18 to 12.73) or high-dose prednisone-1 (adjusted OR 10.5, 95% CI 3.8 to 29.17) were more likely to receive prednisone-2–12 doses of >7.5 mg/day, while patients receiving low-dose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of ≥6, the model did not change. Conclusion The dose of prednisone during the first month after the diagnosis of SLE is an independent predictor of prednisone burden during the following 11 months.
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Affiliation(s)
- G Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine , BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country , Barakaldo, Bizkaia , Spain
| | - M Garcia
- Autoimmune Diseases Research Unit, Department of Internal Medicine , BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country , Barakaldo, Bizkaia , Spain
| | - G Espinosa
- Department of Autoimmune Diseases , Hospital Clinic , Barcelona , Spain
| | - L Caminal
- Department of Internal Medicine , Hospital Universitario Central de Asturias , Oviedo, Asturias , Spain
| | - F Mitjavila
- Autoimmune Diseases Unit, Department of Internal Medicine . Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Spain
| | - R González-León
- Department of Internal Medicine , Hospital Universitario Virgen del Rocío , Sevilla , Spain
| | - B Sopeña
- Department of Internal Medicine , Complejo Hospitalario Universitario de Vigo , Pontevedra, Vigo , Spain
| | - J Canora
- Department of Internal Medicine , Hospital Universitario Fuenlabrada , Fuenlabrada, Madrid , Spain
| | - M V Villalba
- Department of Internal Medicine , Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - M Rodríguez-Carballeira
- Department of Internal Medicine , Hospital Universitario Mutua de Terrasa , Barcelona , Spain
| | - J M López-Dupla
- Department of Internal Medicine , Hospital Universitario Joan XXIII , Tarragona , Spain
| | - J L Callejas
- Department of Internal Medicine , Hospital Universitario San Cecilio , Granada , Spain
| | - A Castro
- Department of Internal Medicine , Hospital Universitario Sant Joan de Reus , Reus, Tarragona , Spain
| | - C Tolosa
- Department of Internal Medicine , Corporació Sanitària Parc Taulí , Sabadell, Barcelona , Spain
| | - M E Sánchez-García
- Department of Internal Medicine, Autoimmune Diseases Unit , Hospital Universitario Reina Sofía , Córdoba , Spain
| | - M Pérez-Conesa
- Department of Internal Medicine , Hospital Universitario Miguel Servet , Zaragoza , Spain
| | - N Navarrete-Navarrete
- Department of Internal Medicine , Hospital Universitario Virgen de las Nieves , Granada , Spain
| | - A P Rodríguez
- Department of Internal Medicine , Complejo Hospitalario Universitario de Ourense , Orense , Spain
| | - M T Herranz
- Department of Internal Medicine , Hospital J.M. Morales Meseguer , Murcia , Spain
| | - L Pallarés
- Department of Internal Medicine , Hospital Universitario Son Espases, Palma de Mallorca , Islas Baleares , Spain
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Ramos-Casals M, Brito-Zeron P, Solans R, Camps MT, Casanovas A, Sopena B, Diaz-Lopez B, Rascon FJ, Qanneta R, Fraile G, Perez-Alvarez R, Callejas JL, Ripoll M, Pinilla B, Akasbi M, Fonseca E, Canora J, Nadal ME, Red GDL, Fernandez-Regal I, Jimenez-Heredia I, Bosch JA, Ayala MDM, Morera-Morales L, Maure B, Mera A, Ramentol M, Retamozo S, Kostov B. Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology (Oxford) 2013; 53:321-31. [DOI: 10.1093/rheumatology/ket349] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Marco J, Barba R, Lázaro M, Matía P, Plaza S, Canora J, Zapatero A. Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to Internal Medicine Departments. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.01.004] [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: 10/26/2022]
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13
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Zapatero A, Barba R, Ruiz J, Losa JE, Plaza S, Canora J, Marco J. Malnutrition and obesity: influence in mortality and readmissions in chronic obstructive pulmonary disease patients. J Hum Nutr Diet 2013; 26 Suppl 1:16-22. [DOI: 10.1111/jhn.12088] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- A. Zapatero
- Servicio de Medicina Interna; Hospital Universitario de Fuenlabrada; Madrid Spain
| | - R. Barba
- Servicio de Medicina Interna; Hospital Rey Juan Carlos; Madrid Spain
| | - J. Ruiz
- Servicio de Medicina Interna; Hospital Universitario de Fuenlabrada; Madrid Spain
| | - J. E. Losa
- Servicio de Medicina Interna; Hospital Universitario Fundación Alcorcón; Madrid Spain
| | - S. Plaza
- Servicio de Medicina Interna; Hospital Severo Ochoa; Madrid Spain
| | - J. Canora
- Servicio de Medicina Interna; Hospital Universitario de Fuenlabrada; Madrid Spain
| | - J. Marco
- Servicio de Medicina Interna; Hospital Clínico de San Carlos; Madrid Spain
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14
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Marco J, Barba R, Lázaro M, Matía P, Plaza S, Canora J, Zapatero A. Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to internal medicine departments. Rev Clin Esp 2013; 213:223-8. [PMID: 23566479 DOI: 10.1016/j.rce.2013.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Enteral nutrition using feeding devices such as nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) is an effective feeding method subject that may give rise to complications. We have studied the relationship between enteral nutrition feeding devices in patients admitted to the Internal Medicine Departments and the development of pulmonary complications (bronchial aspiration and aspiration pneumonia). PATIENTS AND METHODS All of the patients discharge between 2005 and 2009 from the Internal Medicine (IM) Departments of the public hospitals of the National Health System in Spain were analyzed. The data of patients with bronchial aspiration or aspiration pneumonia who also were carriers of NG tubes or PEG, were obtained from the Minimum Basic Data Set (MBDS). RESULTS From a total of 2,767,259 discharges, 26,066 (0.92%) patients with nasogastric tube (NG tube) or percutaneous gastrostomy (PEG) were identified. A total of 21.5% of patients with NG tube and 25.9% of patients with PEG had coding for a bronchopulmonary aspiration on their discharge report versus 1.2% of patients without an enteral feeding tube. In the multivariate analysis, the likelihood of suffering bronchoaspiration was 9 times greater in patients with SNG (OR: 9.1; 95% CI: 8.7-9.4) and 15 greater in subjects with PEG (OR: 15.2; 95% CI: 14.5-15.9) than in subjects without SNG or PEG. Mean stay (9.2 and 12.7 more days), diagnostic complexity and costs were much higher in patients with SNG or PEG compared to patients in hospital who did not require these devices. CONCLUSIONS An association was found between SNG and PEG for enteral feeding and pulmonary complications. Mean stay, diagnostic complexity and cost per admission of these patients was higher in patients who did not require enteral nutrition.
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Affiliation(s)
- J Marco
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain.
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15
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Plaza S, Barba R, Zapatero A, Losa JE, Canora J, Marco J. [Invasive procedures in patients hospitalized in Spanish internal medicine departments]. Rev Clin Esp 2012; 212:513-9. [PMID: 22836024 DOI: 10.1016/j.rce.2012.05.014] [Citation(s) in RCA: 7] [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: 02/03/2012] [Revised: 05/19/2012] [Accepted: 05/28/2012] [Indexed: 11/30/2022]
Abstract
AIMS Invasive procedures (IP) have become routine techniques that benefit an important number of patients on improving their quality of life or avoiding more aggressive treatments. We have conducted a study on the IPs performed in Spanish Internal Medicine (IM) Departments between 2005 and 2009. PATIENTS AND METHODS IP performed to patients admitted to Spanish Internal Medicine departments were analyzed based on the information obtained from the Minimum Basis Data Set (CMBD). IP was defined as the following: filter placement in the inferior vena cava, chest tube placement, biliary, esophageal and colon prosthesis placement, pleurodesis, nephrostomy, external biliary drain placement, gastrostomy tube placement, thoracocentesis and peritoneal catheter placement. RESULTS During the study period, a total of 75,853 invasive procedures on 70,239 admittances were performed in 2,766,673 patients (2.5%). IP subjects were younger (68.1 vs 71.4; P<.001), predominantly male (61.9 vs 53.2%; P<.001), with higher mortality (14.6 vs 9.9%; P<.001) and longer stay (18.4 vs 9.6 days; P<0.001). Cost of admittance was clearly higher than the rest of the patients (5,600€ vs 3,835€; P<.001). CONCLUSIONS IPs are performed on a low percentage of IM Department hospitalized patients. They are costly, entail high mortality and a longer stay period compared to the mean population admitted to IM. A considerable proportion of the patients receiving IP suffer from neoplastic diseases, frequently in advances stages, which justifies the high inhospital mortality of this population.
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Affiliation(s)
- S Plaza
- Servicio de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, España
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16
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Abstract
Differences in hospital staffing may influence outcomes for patients with acute conditions, including acute exacerbations of chronic obstructive pulmonary disease (COPD), depending on which day of the week the patients are admitted. This study was conducted to determine whether weekend admission increases the risk of dying in hospital. We analysed the clinical data of 289,077 adults with acute exacerbations of COPD admitted to the hospital at any public centre in Spain, during 2006 and 2007. We analysed the following factors for their association with death rate: day of admission, demographics, medical history and comorbidity. During the study period, there were 35,544 (12.4%) deaths during admission in COPD patients. Weekend admissions were associated with a significantly higher in-hospital mortality (12.9%) than weekday admissions (12.1%) among COPD patients (OR 1.07 (95% CI 1.04-1.10)). The differences in mortality persisted after adjustment for age, sex and coexisting disorders (OR 1.05 (95% CI 1.02-1.08)). Analyses of deaths within 2 days after admission showed larger relative differences in mortality between the weekend and weekday admissions (OR 1.17 (95% CI 1.11-1.23)). We conclude that patients with acute exacerbations of COPD are more likely to die in the hospital if they are admitted on a weekend compared with a weekday.
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Affiliation(s)
- R Barba
- Depts of Internal Medicine, Hospital Infanta Cristina, Avda 9 Junio no. 2, 28981, Parla, Madrid, Spain.
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Losa J, Zapatero A, Barba R, Marco J, Plaza S, Canora J. Encuesta SEMI sobre la oferta asistencial de los internistas en los hospitales del Sistema Público de Salud. Rev Clin Esp 2011; 211:223-32. [DOI: 10.1016/j.rce.2011.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/05/2011] [Accepted: 01/24/2011] [Indexed: 10/16/2022]
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Peces R, Canora J, Venegas JL. [Chronic renal failure secondary to uterine prolapse]. Nefrologia 2005; 25:191-4. [PMID: 15912657] [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: 05/02/2023] Open
Abstract
Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs.
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Affiliation(s)
- R Peces
- Sección de Nefrología, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real.
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Rodríguez-Cuartero A, Pérez-Blanco F, Riera M, Canora J, Roldán J. Spurious serum hyperkalemia in essential thrombocytemia. Clin Nephrol 2004; 61:229-30. [PMID: 15077878 DOI: 10.5414/cnp61229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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