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Barrios V, Pintó X, Escobar C, Varona JF, Gámez JM. Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study. J Clin Med 2023; 12:3187. [PMID: 37176627 PMCID: PMC10179558 DOI: 10.3390/jcm12093187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin ± ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin ± ezetimibe was the LLT in 52.2% of patients, and atorvastatin ± ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Alcalá University, 28034 Madrid, Spain
| | - Xavier Pintó
- Lipid and Vascular Risk Unit, Department of Internal Medicine, University Hospital of Bellvitge-Idibell-UB-CiberObn, 08907 L’Hospitalet de Llobregat, Spain;
| | - Carlos Escobar
- Department of Cardiology, University Hospital La Paz, 28046 Madrid, Spain;
| | - Jose F. Varona
- Department of Internal Medicine, University Hospital HM Monteprincipe, HM Hospitales, 28660 Madrid, Spain;
| | - José M. Gámez
- Department of Cardiology, University Hospital Son Llàtzer, 07198 Palma, Spain;
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN CB 12/03/30038), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Varona JF, Landete P, Paredes R, Vates R, Torralba M, Guisado-Vasco P, Porras L, Muñoz P, Gijon P, Ancochea J, Saiz E, Meira F, Jimeno J, Lopez-Martin J, Estrada V. Plitidepsin in adult patients with COVID-19 requiring hospital admission: A long-term follow-up analysis. Front Cell Infect Microbiol 2023; 13:1097809. [PMID: 36909731 PMCID: PMC9992643 DOI: 10.3389/fcimb.2023.1097809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The APLICOV-PC study assessed the safety and preliminary efficacy of plitidepsin in hospitalized adult patients with COVID-19. In this follow-up study (E-APLICOV), the incidence of post-COVID-19 morbidity was evaluated and any long-term complications were characterized. Methods Between January 18 and March 16, 2022, 34 of the 45 adult patients who received therapy with plitidepsin in the APLICOV-PC study were enrolled in E-APLICOV (median time from plitidepsin first dose to E-APLICOV enrollment, 16.8 months [range, 15.2-19.5 months]). All patients were functionally autonomous with regard to daily living (Barthel index: 100) and had normal physical examinations. Results From the APLICOV-PC date of discharge to the date of the extension visit, neither Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5) grade 3-4 complications nor QT prolongation or significant electrocardiogram (EKG) abnormalities were reported. Five (14.7%) patients had another COVID-19 episode after initial discharge from APLICOV-PC, and in 2 patients (5.9%), previously unreported chest X-ray findings were documented. Spirometry and lung-diffusion tests were normal in 29 (85.3%) and 27 (79.4%) patients, respectively, and 3 patients needed additional oxygen supplementation after initial hospital discharge. None of these patients required subsequent hospital readmission for disease-related complications. Discussion In conclusion, plitidepsin has demonstrated a favorable long-term safety profile in adult patients hospitalized for COVID-19. With the constraints of a low sample size and a lack of control, the rate of post-COVID-19 complications after treatment with plitidepsin is in the low range of published reports. (ClinicalTrials.gov Identifier: NCT05121740; https://clinicaltrials.gov/ct2/show/NCT05121740).
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Affiliation(s)
- Jose F. Varona
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
- Facultad de Medicina, Universidad San Pablo-Centro de Estudios Universitarios (CEU), Madrid, Spain
- *Correspondence: Jose F. Varona,
| | - Pedro Landete
- Departamento de Neumología, Hospital Universitario La Princesa, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roger Paredes
- Infectious Diseases Department, IrsiCaixa Acquired Immunodeficiency Syndrome (AIDS) Research Institute, Barcelona, Spain
- Servicio de Enfermedades Infecciosas Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Roberto Vates
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Miguel Torralba
- Medicine Department, Health Sciences Faculty, University of Alcalá, Madrid, Spain
- Internal Medicine Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Pablo Guisado-Vasco
- Internal Medicine Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
| | - Lourdes Porras
- Internal Medicine, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paloma Gijon
- Clinical Microbiology and Infectious Diseases Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julio Ancochea
- Departamento de Neumología, Hospital Universitario La Princesa, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Saiz
- Virology Unit, PharmaMar, SA, Madrid, Spain
| | | | | | | | - Vicente Estrada
- Departamento de Medicina Interna Hospital Clínico San Carlos, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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3
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Varona JF, Muñiz J, Balboa-Barreiro V, Peñalver F, Abarca E, Almirall C, Castellano JM. Persistence and Waning of Natural SARS-CoV-2 Antibodies Over 18 Months: Long-Term Durability of IgG Humoral Response in Healthcare Workers. J Gen Intern Med 2022; 37:2614-2616. [PMID: 35581448 PMCID: PMC9113620 DOI: 10.1007/s11606-022-07652-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jose F Varona
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain. .,Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.
| | - Javier Muñiz
- Fundación de Investigación, HM Hospitales, Madrid, Spain.,Grupo de Investigación Cardiovascular, Departamento de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de La Coruña, A Coruña, Spain
| | - Vanesa Balboa-Barreiro
- Unidad de Apoyo a la Investigación, Complexo Hospitalario Universitario A Coruña (CHUAC)-Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain
| | - Francisco Peñalver
- Departamento de Seguridad, Salud y Bienestar de HM Hospitales, Madrid, Spain
| | - Elena Abarca
- Servicio de Laboratorio, HM Hospitales, Madrid, Spain
| | | | - Jose María Castellano
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.,Fundación de Investigación, HM Hospitales, Madrid, Spain.,Departamento de Cardiología, Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Monteprincipe, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain
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Varona JF, Núñez E, Fernández Félix BM, Castellano Vázquez JM, Cubillo A. Efficacy and safety of therapeutic vs. prophylactic bemiparin in noncritically ill patients with COVID-19 pneumonia. Eur J Intern Med 2022; 99:106-108. [PMID: 35094895 PMCID: PMC10007736 DOI: 10.1016/j.ejim.2022.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/03/2021] [Accepted: 01/19/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Jose F Varona
- Servicio de Medicina Interna, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain; Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, Spain.
| | - Elena Núñez
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario HM Sur, HM Hospitales, Madrid, Spain
| | - Borja M Fernández Félix
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Madrid. Spain; CIBER Epidemiology and Public Health, CIBERESP, Spain
| | - Jose María Castellano Vázquez
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, Spain; Fundación de Investigación HM Hospitales, Madrid, Spain; Departamento de Cardiología, Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Monteprincipe, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Cubillo
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, Spain; Servicio de Oncología Médica, Centro Oncológico Clara Campal (CIOCC), Hospital Universitario HM San Chinarro, HM Hospitales, Madrid, Spain
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5
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Varona JF, Landete P, Lopez-Martin JA, Estrada V, Paredes R, Guisado-Vasco P, Fernandez de Orueta L, Torralba M, Fortun J, Vates R, Barberan J, Clotet B, Ancochea J, Carnevali D, Cabello N, Porras L, Gijon P, Monereo A, Abad D, Zuñiga S, Sola I, Rodon J, Vergara-Alert J, Izquierdo-Useros N, Fudio S, Pontes MJ, de Rivas B, Giron de Velasco P, Nieto A, Gomez J, Aviles P, Lubomirov R, Belgrano A, Sopesen B, White KM, Rosales R, Yildiz S, Reuschl AK, Thorne LG, Jolly C, Towers GJ, Zuliani-Alvarez L, Bouhaddou M, Obernier K, McGovern BL, Rodriguez ML, Enjuanes L, Fernandez-Sousa JM, Krogan NJ, Jimeno JM, Garcia-Sastre A. Preclinical and randomized phase I studies of plitidepsin in adults hospitalized with COVID-19. Life Sci Alliance 2022; 5:e202101200. [PMID: 35012962 PMCID: PMC8761492 DOI: 10.26508/lsa.202101200] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022] Open
Abstract
Plitidepsin, a marine-derived cyclic-peptide, inhibits SARS-CoV-2 replication at nanomolar concentrations by targeting the host protein eukaryotic translation elongation factor 1A. Here, we show that plitidepsin distributes preferentially to lung over plasma, with similar potency against across several SARS-CoV-2 variants in preclinical studies. Simultaneously, in this randomized, parallel, open-label, proof-of-concept study (NCT04382066) conducted in 10 Spanish hospitals between May and November 2020, 46 adult hospitalized patients with confirmed SARS-CoV-2 infection received either 1.5 mg (n = 15), 2.0 mg (n = 16), or 2.5 mg (n = 15) plitidepsin once daily for 3 d. The primary objective was safety; viral load kinetics, mortality, need for increased respiratory support, and dose selection were secondary end points. One patient withdrew consent before starting procedures; 45 initiated treatment; one withdrew because of hypersensitivity. Two Grade 3 treatment-related adverse events were observed (hypersensitivity and diarrhea). Treatment-related adverse events affecting more than 5% of patients were nausea (42.2%), vomiting (15.6%), and diarrhea (6.7%). Mean viral load reductions from baseline were 1.35, 2.35, 3.25, and 3.85 log10 at days 4, 7, 15, and 31. Nonmechanical invasive ventilation was required in 8 of 44 evaluable patients (16.0%); six patients required intensive care support (13.6%), and three patients (6.7%) died (COVID-19-related). Plitidepsin has a favorable safety profile in patients with COVID-19.
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Affiliation(s)
- Jose F Varona
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
- Facultad de Medicina, Universidad San Pablo-CEU, Madrid, Spain
| | - Pedro Landete
- Hospital Universitario La Princesa, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Vicente Estrada
- Hospital Clínico San Carlos, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Roger Paredes
- Infectious Diseases Department, IrsiCaixa AIDS Research Institute, Barcelona, Spain
- Hospital Germans Trias I Pujol, Barcelona, Spain
| | - Pablo Guisado-Vasco
- Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Universidad Europea, Madrid, Spain
| | - Lucia Fernandez de Orueta
- Universidad Europea, Madrid, Spain
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Miguel Torralba
- Health Sciences Faculty, University of Alcalá, Madrid, Spain
- Guadalajara University Hospital, Guadalajara, Spain
| | - Jesus Fortun
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Roberto Vates
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Jose Barberan
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
- Facultad de Medicina, Universidad San Pablo-CEU, Madrid, Spain
| | - Bonaventura Clotet
- Infectious Diseases Department, IrsiCaixa AIDS Research Institute, Barcelona, Spain
- Hospital Germans Trias I Pujol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic, Universitat Central de Catalunya, Barcelona, Spain
| | - Julio Ancochea
- Hospital Universitario La Princesa, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Daniel Carnevali
- Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Universidad Europea, Madrid, Spain
| | - Noemi Cabello
- Infectious Diseases Department, Clinico San Carlos University Hospital, Madrid, Spain
| | - Lourdes Porras
- Internal Medicine, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Paloma Gijon
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Alfonso Monereo
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Daniel Abad
- Universidad Europea, Madrid, Spain
- Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Sonia Zuñiga
- Department of Molecular and Cell Biology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain
| | - Isabel Sola
- Department of Molecular and Cell Biology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain
| | - Jordi Rodon
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la UAB, Bellaterra, Spain
| | - Julia Vergara-Alert
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la UAB, Bellaterra, Spain
| | - Nuria Izquierdo-Useros
- IrsiCaixa AIDS Research Institute, Barcelona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Badalona, Spain
| | | | | | | | | | | | | | | | | | | | - Belen Sopesen
- Virology and Inflammation Unit, PharmaMar, SA, Madrid, Spain
- Sylentis, SAU, Madrid, Spain
- Biocross, SL, Valladolid, Spain
| | - Kris M White
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romel Rosales
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Soner Yildiz
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Lucy G Thorne
- Division of Infection and Immunity, University College London, London, UK
| | - Clare Jolly
- Division of Infection and Immunity, University College London, London, UK
| | - Greg J Towers
- Division of Infection and Immunity, University College London, London, UK
| | - Lorena Zuliani-Alvarez
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J David Gladstone Institutes, San Francisco, CA, USA
- QBI, Coronavirus Research Group (QCRG), San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, USA
| | - Mehdi Bouhaddou
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J David Gladstone Institutes, San Francisco, CA, USA
- QBI, Coronavirus Research Group (QCRG), San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, USA
| | - Kirsten Obernier
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J David Gladstone Institutes, San Francisco, CA, USA
- QBI, Coronavirus Research Group (QCRG), San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, USA
| | - Briana L McGovern
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Luis Rodriguez
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luis Enjuanes
- Department of Molecular and Cell Biology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain
| | | | - Nevan J Krogan
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA, USA
- J David Gladstone Institutes, San Francisco, CA, USA
- QBI, Coronavirus Research Group (QCRG), San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, USA
| | - Jose M Jimeno
- Virology and Inflammation Unit, PharmaMar, SA, Madrid, Spain
| | - Adolfo Garcia-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tish Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ruiz-Cabello Subiela J, Martinez-Sepulveda T, Medina J, Varona JF, Zorita B, Fuertes B, Pastor A, Osende J, Palomo J, Castellano JM, Parra Jimenez FJ, Fernandez-Friera L, Lopez-Melgar B. Usefulness of carotid and femoral plaque burden quantification by 3-dimensional vascular ultrasound for cardiovascular risk assessment in the cardiovascular disease prevention unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2532] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Subclinical atherosclerosis improves cardiovascular risk assessment and is considered a risk modifier in individuals at borderline-to-intermediate estimated risk by clinical risk scores.
Purpose
We seek to propose a new decision algorithm for statin allocation based on the quantification of carotid and/or femoral atherosclerosis burden by novel 3-dimensional vascular ultrasound (3DVUS) and to explore its potential additive value when used in combination with conventional risk evaluation.
Methods
We conducted an observational study in all outpatients without previous history of cardiovascular events assessed in the Cardiovascular Disease Prevention Unit during 2017–2020. Cardiovascular risk was assessed with the ACC/AHA 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm to establish the indication for initiating statin therapy following current clinical guidelines. All patients underwent 3DVUS evaluation for carotid plaque burden (CPB) calculated as the sum of all plaque volumes present in bilateral carotid arteries. Femoral 3DVUS evaluation was included later in the study protocol. Global plaque burden (GPB) was calculated in patients with both carotid and femoral 3DVUS as the sum of all plaque volumes present in bilateral carotid and femoral arteries. Carotid and global plaque burden was classified as high, moderate and low if a patient presented a percentile (p) >75, p50–75 and p<50, respectively, based on the age and sex-adjusted reference values reported by PESA study (1). We determined the percentage of patients reclassified for considering (p>75) or discouraging (p<50) statin therapy over clinical recommendation.
Results
One hundred sixty-three patients (age 51±8 years; 72,4% men; 10y-ASCVD 5,9%±4,8%) were included, being the most frequent reason for referral the presence of metabolic syndrome (37%), followed by intermediate or indeterminate estimated CV risk (33%), one markedly elevated single risk factor (15%) and family history of early CVD (13%). 10y-ASCVD score classified 80 (49%) patients as low-risk without recommendation for initiating statins, 18 (11%) as high-risk indicating statin therapy and 65 (40%) patients that needed clinical-patient risk discussion. Among patients under risk discussion, the CPB percentile re-stratified 51 (78%) of them, recommending statins in 26 (40%) and discouraging statins in 25 (38%). In addition, CPB re-stratified 24 (30%) low-risk patients to recommend statins. A sub-group of 114 patients additionally underwent femoral 3DVUS, and calculated GPB led to similar results of patient re-stratification (Figure).
Conclusions
Quantification of 3D atherosclerosis burden and its percentile would re-stratify a significant number of patients with intermediate risk, becoming a potentially useful tool for clinical decision making. In addition, it possibly improves the detection of low-risk patients who would benefit from statin therapy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dr. Lόpez-Melgar has received a grant from the Spanish Society of Cardiology “Proyecto de investigaciόn traslacional en Cardiología 2020” Patient re-stratification with CPB/GPB
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Affiliation(s)
| | | | - J Medina
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J F Varona
- University Hospital HM Montepríncipe, Internal Medicine Department, Boadilla del Monte, Spain
| | - B Zorita
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - B Fuertes
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - A Pastor
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J Osende
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J Palomo
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J M Castellano
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - F J Parra Jimenez
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - L Fernandez-Friera
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiovascular Imaging Unit, Madrid, Spain
| | - B Lopez-Melgar
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
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7
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Varona JF, García-Isidro M, Moeinvaziri M, Ramos-López M, Fernández-Domínguez M. Primary adrenal insufficiency associated with Oxford-AstraZeneca ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia (VITT). Eur J Intern Med 2021; 91:90-92. [PMID: 34256983 PMCID: PMC8271354 DOI: 10.1016/j.ejim.2021.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Jose F Varona
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain; Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.
| | - Millán García-Isidro
- Departamento de Radiodiagnóstico, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
| | - Mojdeh Moeinvaziri
- Departamento de Radiodiagnóstico, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
| | - María Ramos-López
- Departamento de Radiodiagnóstico, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
| | - Manuel Fernández-Domínguez
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain; Departamento de Cirugía, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
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Cardinal-Fernández P, Garcia Cuesta E, Barberán J, Varona JF, Estirado A, Moreno A, Villanueva J, Villareal M, Baez-Pravia O, Menéndez J, Villares P, López Escobar A, Rodríguez-Pascual J, Almirall C, Domínguez E, Pey C, Ferreiro A, Revilla Amores M, Sánchez N, Ruiz de Aguiar S, Castellano JM. Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort. Rev Esp Quimioter 2021; 34:342-352. [PMID: 34008930 PMCID: PMC8329575 DOI: 10.37201/req/050.2021] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. METHODS This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. RESULTS One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. CONCLUSIONS Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.
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Affiliation(s)
- P Cardinal-Fernández
- Pablo Cardinal-Fernández, Intensive care unit coordinator, HM Torrelodones University Hospital, Av. Castillo Olivares, s/n, CP 28250, Torrelodones, Madrid, Spain.
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9
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Varona JF, Madurga R, Peñalver F, Abarca E, Almirall C, Cruz M, Ramos E, Castellano-Vazquez JM. kinetics of anti-SARS-CoV-2 antibodies over time. Results of 10 month follow up in over 300 seropositive Health Care Workers. Eur J Intern Med 2021; 89:97-103. [PMID: 34090748 PMCID: PMC8148432 DOI: 10.1016/j.ejim.2021.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The kinetics of the antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) needs to be evaluated since long-term duration of antibody remains largely unknown, particularly in infected healthcare workers (HCW). METHODS Prospective study, evaluating the longitudinal profile of anti-SARS-CoV-2 antibody titers in a random sample of 331 seropositive healthcare workers (HCW) of Spanish Hospitals Group. Serial measurements of serum IgG-anti-SARS-CoV-2 were obtained at baseline (April-May,2020), and in 2 follow-up visits. Linear mixed models were used to investigate antibody kinetics and associated factors. RESULTS A total of 306 seropositive subjects (median age: 44.7years;69.9% female) were included in the final analysis. After a median follow-up of 274 days between baseline and final measurement, 235(76.8%) maintained seropositivity. Antibody titers decreased in 82.0%, while remained stable in 13.1%. Factors associated with stability of antibodies over time included age≥45 years, higher baseline titers, severe/moderate infection and high-grade exposure to COVID-19 patients. In declining profile, estimated mean antibody half-life was 146.3 days(95%CI:138.6-154.9) from baseline. Multivariate models show independent longer durability of antibodies in HCW with high-risk exposure to COVID-19 patients (+14.1 days;95%CI:0.6-40.2) and with symptomatic COVID-19 (+14.1 days;95%CI:0.9-43.0). The estimated mean time to loss antibodies was 375(95% CI:342-408) days from baseline. CONCLUSIONS We present the first study measuring the kinetics of antibody response against SARS-CoV-2 in HCW beyond 6 months. Most participants remained seropositive after 9 months but presented a significant decline in antibody-titers. Two distinct antibody dynamic profiles were observed (declining vs. stable). Independent factors associated with longer durability of antibodies were symptomatic infection and higher exposure to COVID-19 patients.
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Affiliation(s)
- Jose F Varona
- Departamento de Medicina Interna, Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain; Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.
| | - Rodrigo Madurga
- Fundación de Investigación, HM Hospitales, Madrid, Spain; Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - Francisco Peñalver
- Departamento de Seguridad, Salud y Bienestar de HM Hospitales, Madrid, Spain
| | - Elena Abarca
- Servicio de Laboratorio, HM Hospitales, Madrid, Spain
| | | | - Marta Cruz
- Servicio de Laboratorio, HM Hospitales, Madrid, Spain
| | - Enrique Ramos
- Servicio de Laboratorio, HM Hospitales, Madrid, Spain
| | - Jose María Castellano-Vazquez
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain; Fundación de Investigación, HM Hospitales, Madrid, Spain; Departamento de Cardiología, Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario HM Monteprincipe, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Madrid, Spain
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10
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Varona JF, Madurga R, Peñalver F, Abarca E, Almirall C, Cruz M, Ramos E, Castellano Vázquez JM. Seroprevalence of SARS-CoV-2 antibodies in over 6000 healthcare workers in Spain. Int J Epidemiol 2021; 50:400-409. [PMID: 33434269 PMCID: PMC7928898 DOI: 10.1093/ije/dyaa277] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 10/17/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023] Open
Abstract
Background: Spain has one of the highest incidences of coronavirus disease 2019 (COVID-19) worldwide, so Spanish health care workers (HCW) are at high risk of exposure. Our objective was to determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seroprevalence amongst HCW and factors associated with seropositivity. Methods: A cross-sectional study evaluating 6190 workers (97.8% of the total workforce of a healthcare-system of 17 hospitals across four regions in Spain) was carried out between April and June 2020, by measuring immunoglobulin G (IgG)-SARS-CoV-2 antibody titres and related clinical data. Exposure risk was categorized as high (clinical environment; prolonged/direct contact with patients), moderate (clinical environment; non-intense/no patient contact) and low (non-clinical environment). Results: A total of 6038 employees (mean age 43.8 years; 71% female) were included in the final analysis. A total of 662 (11.0%) were seropositive for IgG against SARS-CoV-2 (39.4% asymptomatic). Adding available PCR-testing, 713 (11.8%) employees showed evidence of previous SARS-CoV-2 infection. However, before antibody testing, 482 of them (67%) had no previous diagnosis of SARS-CoV-2-infection. Seroprevalence was higher in high- and moderate-risk exposure (12.1 and 11.4%, respectively) compared with low-grade risk subjects (7.2%), and in Madrid (13.8%) compared with Barcelona (7.6%) and Coruña (2.0%). High-risk [odds ratio (OR): 2.06; 95% confidence interval (CI): 1.63–2.62] and moderate-risk (OR: 1.77; 95% CI: 1.32–2.37) exposures were associated with positive IgG-SARS-CoV-2 antibodies after adjusting for region, age and sex. Higher antibody titres were observed in moderate–severe disease (median antibody-titre: 13.7 AU/mL) compared with mild (6.4 AU/mL) and asymptomatic (5.1 AU/mL) infection, and also in older (>60 years: 11.8 AU/mL) compared with younger (<30 years: 4.2 AU/mL) people. Conclusions: Seroprevalence of IgG-SARS-CoV-2 antibodies in HCW is a little higher than in the general population and varies depending on regional COVID-19 incidence. The high rates of subclinical and previously undiagnosed infection observed in this study reinforce the utility of antibody screening. An occupational risk for SARS-CoV-2 infection related to working in a clinical environment was demonstrated in this HCW cohort.
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Affiliation(s)
- Jose F Varona
- Departamento de Medicina Interna, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain.,Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Rodrigo Madurga
- Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, Spain.,Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - Francisco Peñalver
- Departamento de Seguridad, Salud y Bienestar, HM Hospitales, Madrid, Spain
| | - Elena Abarca
- Departamento de Laboratorio, HM Hospitales, Madrid, Spain
| | | | - Marta Cruz
- Departamento de Laboratorio, HM Hospitales, Madrid, Spain
| | - Enrique Ramos
- Departamento de Laboratorio, HM Hospitales, Madrid, Spain
| | - Jose María Castellano Vázquez
- Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.,Fundación de Investigación HM Hospitales, HM Hospitales, Madrid, Spain
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11
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Álvarez-Mon M, Ortega MA, Gasulla Ó, Fortuny-Profitós J, Mazaira-Font FA, Saurina P, Monserrat J, Plana MN, Troncoso D, Moreno JS, Muñoz B, Arranz A, Varona JF, Lopez-Escobar A, Barco AAD. A Predictive Model and Risk Factors for Case Fatality of COVID-19. J Pers Med 2021; 11:36. [PMID: 33430129 PMCID: PMC7827846 DOI: 10.3390/jpm11010036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February-June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Príncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (<5%), medium-risk level (5-20%), and high-risk level (>20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU-death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19.
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Affiliation(s)
- Melchor Álvarez-Mon
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
| | - Óscar Gasulla
- Hospital Universitari de Bellvitge–Universitat de Barcelona, 08907 L´Hospitalet de Llobregat, Spain;
| | | | - Ferran A. Mazaira-Font
- Departament d’Econometria, Estadística I Economia Aplicada–Universitat de Barcelona, 08007 Barcelona, Spain;
| | - Pablo Saurina
- Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - María N. Plana
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Daniel Troncoso
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
| | - José Sanz Moreno
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (J.M.); (D.T.)
| | - Benjamin Muñoz
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
| | - Alberto Arranz
- Service of Internal Medicine and Immune System Diseases-Rheumatology, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain; (M.N.P.); (J.S.M.); (B.M.); (A.A.)
| | - Jose F. Varona
- Service of Internal Medicine, Hospital Universitario HM Montepríncipe, HM Hospitales, 28660 Boadilla del Monte, Spain;
- Faculty of Medicine, Universidad San Pablo-CEU, CEU Universities, Fundación de Investigación HM Hospitales, 28003 Madrid, Spain;
| | - Alejandro Lopez-Escobar
- Faculty of Medicine, Universidad San Pablo-CEU, CEU Universities, Fundación de Investigación HM Hospitales, 28003 Madrid, Spain;
- Service of Pediatrics, Hospital Universitario HM Puerta del Sur, 28938 Móstoles, Spain
| | - Angel Asúnsolo-del Barco
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, University of New York, New York, NY 10027, USA
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12
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Varona JF, Ortiz-Regalón R, Sánchez-Vera I, López-Melgar B, García-Durango C, Castellano Vázquez JM, Solís J, Fernández-Friera L, Vidal-Vanaclocha F. Soluble ICAM 1 and VCAM 1 Blood Levels Alert on Subclinical Atherosclerosis in Non Smokers with Asymptomatic Metabolic Syndrome. Arch Med Res 2019; 50:20-28. [DOI: 10.1016/j.arcmed.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/25/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
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Abstract
There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The present paper reviews the most relevant published information concerning long-term prognosis and predictors of unfavorable outcomes of ischemic stroke affecting young adults. As a summary, we can conclude that, in the long term, stroke in the young adult increases slightly the risk of mortality, implies higher risk of future cardiovascular events, and determines functional limitations in a significant percentage of patients. Nevertheless, in every individual case the prognosis has to be considered depending on several factors (stroke subtype, initial severity, cardiovascular risk factors) that determine the long-term outcomes.
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Affiliation(s)
- Jose F Varona
- Department of Internal Medicine, University Hospital "Madrid Montepríncipe", CEU-San Pablo University School of Medicine and Institute of Applied Molecular Medicine (IMMA), Avenida Montepríncipe 25, Boadilla del Monte, 28660 Madrid, Spain
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14
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Varona JF. [Neurological manifestations as presentation of infectious endocarditis]. ACTA ACUST UNITED AC 2008; 24:439-41. [PMID: 18198953 DOI: 10.4321/s0212-71992007000900007] [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: 11/11/2022]
Abstract
Neurologic complications of infective endocarditis (IE) are frequent. In many cases, they are the initial feature and considerably impair the prognosis of the disease. The most common neurologic manifestation is embolic stroke, but other many neurologic events have been described, ranged from cerebral hemorrhage due to rupture of mycotic aneurysm to the exceptional aseptic meningitis with acellular cerebrospinal fluid. We describe 3 cases that represent this wide spectrum of presentation. Ischemic stroke in the first patient and cerebral hemorrhage in the second were respectively documented several days before the diagnosis of IE. In the third case, acellular meningitis was the unusual clinical debut of aortic IE. Cerebral infarct or hemorrhage are exceptionally caused by an underlying IE, so a high level of suspicious is needed to recognize these complications. The best management to improve the prognosis has to be based on a rapid diagnosis and onset of antibiotic treatment, considering valve replacement in the adequate timing.
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Affiliation(s)
- J F Varona
- Departamento de Medicina Interna, Hospital El Escorial, San Lorenzo de El Escorial, Madrid.
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15
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Varona JF, Zafra E, Viguer JM, Hernández G, Román J. [Abdominal pain, jaundice and mesenteric mass]. Rev Clin Esp 2007; 207:45-7. [PMID: 17306154 DOI: 10.1016/s0014-2565(07)73301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J F Varona
- Servicios de Medicina Interna, Clínica La Luz, Madrid, España
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16
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Varona JF, Díaz-Corandi R, Valle M, Muñoz F, Bufalá MA. [Acute abdomen due to massive abdominal wall hematoma]. Rev Esp Enferm Dig 2007; 99:120-1. [PMID: 17417929 DOI: 10.4321/s1130-01082007000200015] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Varona JF, Guerra JM, Bermejo F, Molina JA, Gomez de la Cámara A. Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol 2007; 57:212-8. [PMID: 17268202 DOI: 10.1159/000099161] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 11/26/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Causes of ischemic stroke in young adults (15-45 years) are diverse, but undetermined etiology is common in a majority of studies. AIMS The present series study aims to evaluate causes and changes in the etiological diagnosis of ischemic stroke in young adult patients admitted to a tertiary medical center over a period of 27 years. METHODS We retrospectively reviewed the records of patients with a first-ever stroke in the age range of 15-45 years who were admitted to the '12 de Octubre' University Hospital between 1974 and 2002. RESULTS 272 young adults with ischemic stroke were identified. The etiological diagnoses were: undetermined in 36% of patients, large-artery atherosclerosis in 21%, cardioembolism in 17%, non-atherosclerotic vasculopathy in 17%, and other specific etiologies in 9%. While in the first study period (1974-1988) 45% of patients were diagnosed with uncertain etiology, in the last period (1989-2002) only 26% were diagnosed with cryptogenic stroke (45% with two or more potential etiologies identified; 45% with no identified cause despite complete evaluation, and 10% with incomplete evaluation). CONCLUSIONS The etiological diagnosis of stroke in young adults has changed over time as a result of improvements in diagnostic workup. While cryptogenic stroke was the most frequent diagnosis in the past, today specific causes (non-atherosclerotic vasculopathy, large-artery atherosclerosis, cardioembolism and hematological disorder) are identified in the majority of patients.
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Affiliation(s)
- J F Varona
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain.
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18
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Varona JF, Montero FJ, Bufalá MA. [Herpes simplex encephalitis in a 30-year-old male]. An Med Interna 2006; 23:449-50. [PMID: 17096611 DOI: 10.4321/s0212-71992006000900012] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Affiliation(s)
- J F Varona
- Servicios de Medicina Interna, Clínica La Luz, Madrid, España
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Varona JF, Guerra Vales JM, Grande M, Rodríguez-Peralto JL, Pérez-Rojo R. Varón de 27 años con infiltrados pulmonares bilaterales y parotiditis aguda bilateral. Rev Clin Esp 2005; 205:507-8. [PMID: 16238963 DOI: 10.1157/13079767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- J F Varona
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid
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Varona JF, Guerra JM, Salamanca J, Colina F, Lopez G, Morales M. Pseudomyxoma peritonei: a clinicopathologic analysis and follow-up of 21 patients. Hepatogastroenterology 2005; 52:812-6. [PMID: 15966210] [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: 05/03/2023]
Abstract
BACKGROUND/AIMS Pseudomyxoma peritonei is an uncommon disease characterized by the presence of mucinous peritoneal implants associated with an abdominal neoplasm. Our objective is to consider the characteristics of this entity in our western Mediterranean urban population. METHODOLOGY All cases diagnosed with pseudomyxoma peritonei by our hospital during a period of 16 years were reviewed. Data from their clinical records and the biopsy samples were analyzed. RESULTS We found 21 cases of pseudomyxoma peritonei with a male/female ratio of 10/11 and a mean age of 59 years. The predominant presentation symptom was abdominal pain (17 cases, 6 of them with acute abdomen). The most frequent primary site of origin of the pseudomyxoma was the appendix (10 cases). The histologic diagnosis was malignant (associated with carcinoma) in 17 cases and indeterminate behavior in 4. The follow-up was available for 15 patients (mean follow-up of 41 months), while six patients have been lost. Nine patients have died during the follow-up and the other 6 patients are still alive after follow-up. CONCLUSIONS Laparotomy is the main tool for diagnosing pseudomyxoma peritonei. The appendix is the most frequent primary site of origin of pseudomyxoma peritonei, followed by bowel; the latter being more important than previously described. In most cases the histology is malignant. The prognosis is bad with a mortality greater than 60% at 5 years.
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Affiliation(s)
- J F Varona
- Department of Internal Medicine, 12 de Octubre University Hospital of Madrid, Spain.
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Varona JF, Bermejo F, Guerra JM, Molina JA. Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol 2005; 251:1507-14. [PMID: 15645352 DOI: 10.1007/s00415-004-0583-0] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Revised: 06/08/2004] [Accepted: 06/14/2004] [Indexed: 12/11/2022]
Abstract
BACKGROUND There have been few studies of the long-term prognosis of young adults with ischemic stroke. The present study aimed to evaluate the long-term clinical outcome in a large series of young adults with ischemic stroke admitted to a tertiary medical center over the last 27 years, and to identify possible predictors for mortality, stroke recurrence and poor functional recovery. METHODS We retrospectively reviewed 272 young adults (15-45 years) with a first-ever ischemic stroke admitted to the Neurology Department of University Hospital "12 de Octubre" between 1974 and 2001. Follow-up assessments were performed by review of medical records and telephone interviews. RESULTS Nine patients (3%) died as the result of their initial stroke and follow-up information about the status of 23 (8%) patients was not available. The remaining 240 patients (89%) were followed. Two hundred and ten of them (88%) were alive with a mean follow-up of 12.3 years and 30 (12%) died during follow-up. The average annual mortality rate was 1.4%, being notably higher during the first (4.9%) than in the subsequent years (0.9%) after the initial stroke. Ninety per cent of the followed patients were independent and 53% returned to work, although adjustments were necessary for 23% of them. The annual stroke recurrence rate during the first year was 3.6% dropping to 1.7% in subsequent years. Age over 35 years, male gender, the presence of cardiovascular risk factors and large-artery atherosclerosis in the carotid territory were predictors of negative long-term outcome after the initial stroke. CONCLUSIONS The long-term prognosis for the ischemic stroke in the young is better than in the elderly, but the risk of mortality in young adults with ischemic stroke is much higher than in the general population of the same age. A bad prognosis is associated with an atherosclerotic risk profile, with a higher mortality and recurrent stroke rates and poorer functional recovery. The main functional limitation in the young survivors of their initial ischemic stroke occurs in work activity, since most patients are independent but almost half of them do not return to work.
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Affiliation(s)
- J F Varona
- Department of Internal Medicine, University Hospital 12 de Octubre, Avda. Andalucía, km 5.4, 28041-Madrid, Spain.
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Varona JF, Guerra JM, Guillén V, Guillén S, Menassa A, Palenque E. Isolated cervical lymphadenopathy as unique manifestation of Brucellosis. Scand J Infect Dis 2003; 34:538-40. [PMID: 12195883 DOI: 10.1080/003655402320208802] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a 42-y-old male with an isolated cervical lymphadenopathy due to Brucella melitensis. The diagnosis was established by isolation of B. melitensis in a lymphatic specimen obtained by fine-needle aspiration and confirmed by serological test results showing high levels of Brucella agglutinins. Mycobacteria-specific cultures were negative. Treatment with streptomycin and doxycycline resulted in complete healing. Exceptionally, and only if the epidemiologic context supports it, brucellosis should be considered in the differential diagnosis of lymphadenopathy.
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Affiliation(s)
- J F Varona
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain.
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