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1.
J. investig. allergol. clin. immunol ; 33(2): 109-118, 2023. ilus, tab, graf
Artículo en Inglés | IBECS | ID: ibc-219413

RESUMEN

Objective: To determine the relationship between short-acting ß-adrenergic agonist (SABA) overuse and health care resource use and costs in asthma patients in routine clinical practice. Methods: A longitudinal retrospective study was conducted in Spanish primary and specialized care centers using the BIG-PAC medical records database. The study population comprised asthma patients ≥12 years of age who attended ≥2 consultations during 2017 and had 1-year follow-up data available. The main outcomes were demographics, comorbidities, medication, and clinical and health care resource use and costs. The relationship between SABA overuse and health care costs and between asthma severity and health care costs was determined. Results: The SABA use IN Asthma (SABINA) study included 39 555 patients, with a mean (SD) age of 49.8 (20.7) years (64.2% female). The Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥3 canisters/y) was 28.7% (95%CI, 27.7-29.7), with a mean of 3.3 (3.6) canisters/y. Overall, 5.1% of patients were prescribed ≥12 canisters/y. SABA overuse was correlated with health care costs (ρ=0.621; P<.001). The adjusted mean annual cost/patient according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity was €2231, €2345, €2735, €3473, and €4243 for steps 1-5, respectively (P<.001). Regardless of asthma severity, SABA overuse yielded asignificant increase in health care costs per patient and year (€5702 vs €1917, P<.001) compared with recommended use (<2 canisters/y). Conclusion: SABA overuse yields high costs for the Spanish National Health System. Costs increased with severity of asthma (AU)


Objetivo: Determinar la relación entre la sobreutilización de agonistas beta adrenérgicos de acción corta (SABA) en pacientes con asma y el uso y coste de recursos sanitarios en la práctica clínica rutinaria. Métodos: Se realizó un estudio longitudinal retrospectivo en atención primaria y especializada en España, en el que se utilizó la base de datos de registros médicos BIG-PAC®. Se incluyeron pacientes con asma ≥12 años que asistieron a ≥2 consultas durante 2017 y con datos disponibles del seguimiento durante 1 año. Los principales resultados analizados fueron características demográficas, comorbilidades, medicaciones, y el uso y coste de recursos clínicos y sanitarios. Se determinó la relación de los costes sanitarios tanto con la sobreutilización de SABA como con la severidad del asma. Resultados: Este estudio sobre el uso de SABA en asma (SABINA, del inglés “SABA use IN Asthma”) incluyó a 39.555 pacientes, con una edad media (DE, desviación estándar) de 49,8 años (20,7); 64.2% fueron mujeres. La media del índice de comorbilidad Charlson fue 0,7 (1,0). La sobreutilización de SABA (≥3 envases/año) fue del 28,7% (IC95%: 27,7–29,7), con una media global de 3,3 envases (3,6) /año. En total, el 5,1% de los pacientes fueron prescritos con ≥12 envases/año. La sobreutilización de SABA correlacionó con los costes sanitarios (ρ = 0,621; p < 0,001). El coste medio anual/paciente según la clasificación de severidad del asma de la Global Initiative for Asthma (GINA 2019) fue de 2.231 €, 2.345 €, 2.735 €, 3.473 €, y 4.243 €, para los pasos 1-5, respectivamente (p < 0,001) (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Asma/tratamiento farmacológico , Asma/epidemiología , Antiasmáticos/uso terapéutico , Agonistas Adrenérgicos/uso terapéutico , Estudios Longitudinales , Estudios Retrospectivos , Comorbilidad , España/epidemiología
2.
J Investig Allergol Clin Immunol ; 33(2): 109-118, 2023 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-34825651

RESUMEN

BACKGROUND AND OBJECTIVE: To determine the relationship between short-acting ß-adrenergic agonist (SABA) overuse and health care resource use and costs in asthma patients in routine clinical practice. METHODS: A longitudinal retrospective study was conducted in Spanish primary and specialized care centers using the BIG-PAC medical records database. The study population comprised asthma patients ≥12 years of age who attended ≥2 consultations during 2017 and had 1-year follow-up data available. The main outcomes were demographics, comorbidities, medication, and clinical and health care resource use and costs. The relationship between SABA overuse and health care costs and between asthma severity and health care costs was determined. RESULTS: The SABA use IN Asthma (SABINA) study included 39 555 patients, with a mean (SD) age of 49.8 (20.7) years (64.2% female). The Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥3 canisters/y) was 28.7% (95%CI, 27.7-29.7), with a mean of 3.3 (3.6) canisters/y. Overall, 5.1% of patients were prescribed ≥12 canisters/y. SABA overuse was correlated with health care costs (ρ=0.621; P<.001). The adjusted mean annual cost/patient according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity was €2231, €2345, €2735, €3473, and €4243 for steps 1-5, respectively (P<.001). Regardless of asthma severity, SABA overuse yielded a significant increase in health care costs per patient and year (€5702 vs €1917, P<.001) compared with recommended use (<2 canisters/y). CONCLUSION: SABA overuse yields high costs for the Spanish National Health System. Costs increased with severity of asthma.


Asunto(s)
Antiasmáticos , Asma , Humanos , Femenino , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , España/epidemiología , Asma/tratamiento farmacológico , Asma/epidemiología , Comorbilidad , Agonistas Adrenérgicos/uso terapéutico , Antiasmáticos/uso terapéutico , Administración por Inhalación
3.
Rev. neurol. (Ed. impr.) ; 73(5): 165-173, Sep 1, 2021. ilus, graf, tab
Artículo en Español | IBECS | ID: ibc-227994

RESUMEN

Introducción: La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos: El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos: Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados: Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p < 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031)...(AU)


Introduction: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. Objectives: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. Patients and methods: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. Results: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031)...(AU)


Asunto(s)
Humanos , Masculino , Femenino , Hemorragia Cerebral/mortalidad , Inhibidores del Factor Xa , Anticoagulantes/efectos adversos , Protocolos Clínicos , Resultado del Tratamiento , Estudios Prospectivos , Neurología , Enfermedades del Sistema Nervioso , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/tratamiento farmacológico
4.
Rev Neurol ; 73(5): 165-173, 2021 Sep 01.
Artículo en Español | MEDLINE | ID: mdl-34328205

RESUMEN

INTRODUCTION: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. OBJECTIVES: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. PATIENTS AND METHODS: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. RESULTS: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031). CONCLUSIONS: ICH-OAC has a high mortality rate, related to the use of acenocoumarol and regardless of the initial clinical situation. A lower rate of early mortality was found among patients who received ART.


TITLE: Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO).Introducción. La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos. El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos. Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados. Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p lower than 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031). Conclusiones. La HIC-ACO presenta una elevada mortalidad, relacionada con la toma de acenocumarol y de forma independiente con la situación clínica inicial. Se comprobó una menor tasa de mortalidad precoz entre pacientes que recibieron TRA.


Asunto(s)
Anticoagulantes/efectos adversos , Reversión de la Anticoagulación , Antídotos/uso terapéutico , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/tratamiento farmacológico , Hemorragia Cerebral/mortalidad , Protocolos Clínicos , Inhibidores del Factor Xa/efectos adversos , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neuroimagen , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria/estadística & datos numéricos , Tromboembolia/epidemiología , Tromboembolia/prevención & control , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vitamina K/antagonistas & inhibidores
6.
Rev Neurol ; 69(3): 109-112, 2019 Aug 01.
Artículo en Español | MEDLINE | ID: mdl-31310000

RESUMEN

INTRODUCTION: An arterial gas embolism is defined as the presence of air in the arterial circulation. This is an extremely rare cause of stroke that has been described in a multitude of clinical scenarios, generally related to iatrogenic processes. A clinical case is reported in which the arterial gas embolism occurred after a traumatic brain injury, and the most relevant aspects of diagnosis and aetiopathogenesis are reviewed. CASE REPORT: We report the case of a 52-year-old woman with an open craniofacial wound resulting from an attack with an axe. The initial CT scan found fractures in the left zygomatic, sphenoidal and maxillary arches, as well as pneumocephalus in the cavernous sinuses and the right carotid canal. One hour later, the patient showed a neurological deficit in the right hemisphere, and so a new cranial computed tomography scan with multimodal vascular study was urgently requested, which revealed the mobilisation of the pneumocephalus and ruled out a large vessel arterial occlusion. A shunt study using transcranial Doppler and echocardiography showed the presence of a patent foramen ovale to be the cause of arteriovenous communication that justified an arterial gas embolism. The follow-up CT scan at 48 hours confirmed the appearance of a right parietal ischaemic lesion. CONCLUSION: This case reflects the simultaneous presence of air in the arterial and venous circulation of the brain, as well as the peripheral communication through a patent foramen ovale. This production mechanism is poorly documented in the literature.


TITLE: Embolismo arterial gaseoso paradojico tras una herida incisa craneal directa.Introduccion. El embolismo arterial gaseoso se define como la presencia de aire en la circulacion arterial. Se trata de una causa extremadamente rara de ictus que se ha descrito en multitud de escenarios clinicos, generalmente relacionados con procesos yatrogenos. Se aporta un caso clinico en el que el embolismo arterial gaseoso sucedio tras un traumatismo craneoencefalico, y se revisan los aspectos mas relevantes del diagnostico y la etiopatogenia. Caso clinico. Mujer de 52 años que presentaba herida incisa craneofacial tras una agresion con un hacha. La tomografia computarizada inicial objetivo fractura en los arcos cigomatico, esfenoidal y maxilar izquierdos, asi como neumoencefalo en los senos cavernosos y el canal carotideo derecho. Una hora mas tarde, la paciente mostro un deficit neurologico hemisferico derecho, por lo que se solicito de forma urgente una nueva tomografia computarizada craneal con estudio vascular multimodal, que objetivo la movilizacion del neumoencefalo y descarto una oclusion arterial de gran vaso. Un estudio de shunt mediante Doppler transcraneal y ecocardiografia comprobo la presencia de un foramen oval permeable como causa de comunicacion arteriovenosa que justificaba un embolismo arterial gaseoso. La tomografia computarizada de control a las 48 horas confirmo la aparicion de una lesion isquemica parietal derecha. Conclusion. En este caso queda reflejada la presencia simultanea de aire en la circulacion cerebral arterial y venosa y la comunicacion periferica a traves de un foramen oval permeable. Este mecanismo de produccion esta escasamente documentado en la bibliografia.


Asunto(s)
Embolia Aérea/etiología , Embolia Paradójica/etiología , Fracturas Maxilares/complicaciones , Fracturas Craneales/complicaciones , Hueso Esfenoides/lesiones , Heridas Penetrantes/complicaciones , Fracturas Cigomáticas/complicaciones , Seno Cavernoso/diagnóstico por imagen , Disartria/etiología , Ecocardiografía Doppler en Color , Parálisis Facial/etiología , Femenino , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Mano/fisiopatología , Humanos , Imagenología Tridimensional , Fracturas Maxilares/diagnóstico por imagen , Persona de Mediana Edad , Espasticidad Muscular/etiología , Paresia/etiología , Abuso Físico , Fracturas Craneales/diagnóstico por imagen , Hueso Esfenoides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Heridas Penetrantes/diagnóstico por imagen , Fracturas Cigomáticas/diagnóstico por imagen
7.
West Indian Med J ; 65(2): 260-262, 2015 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-26716804

RESUMEN

OBJECTIVE: This study aimed to evaluate the levels of the adipokines, resistin and adiponectin in normotensive and high normal blood pressure patients. METHODS: Circulating levels of the adipokines, resistin and adiponectin were measured by enzyme-linked immunosorbent assay (ELISA; R'D Systems, Minneapolis) in 20 high normal blood pressure patients and in 20 age-matched normotensive non-diabetic subjects. Statistical analysis was performed with analysis of variance (ANOVA). RESULTS: The control group showed non-significantly decreased levels of resistin when compared with patients with high normal blood pressure [systolic 130-139 mmHg; diastolic 85-89 mmHg] (12.25 vs 14.38 pg/mL, p = 0.40). There were significantly higher levels of adiponectin in the control group when compared with high normal blood pressure patients (11.3 vs 7.51 µg/mL, p = 0.028). CONCLUSIONS: High normal blood pressure patients have increased levels of resistin and lower values of adiponectin when compared with age-matched non-diabetic normotensive subjects. This may explain why those patients showed more progression to hypertension, atherosclerosis and cardiovascular risk than normotensive subjects.

8.
Aliment Pharmacol Ther ; 37(10): 1005-10, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23557078

RESUMEN

BACKGROUND: In gastro-oesophageal reflux disease (GERD), heartburn responds well to acid suppression, but regurgitation is a common cause of incomplete treatment response. AIM: To assess the prevalence and burden of persistent, frequent regurgitation in primary care patients with GERD treated with acid suppression. METHODS: We analysed observational data from 134 sites across six European countries in patients diagnosed with GERD. Within 3 months of the index visit, symptoms were assessed using the Reflux Disease Questionnaire, and their impact on sleep and work productivity with the Quality of Life in Reflux and Dyspepsia questionnaire and the Work Productivity and Activity Impairment Questionnaire, respectively. Patients provided information on concomitant over-the-counter (OTC) GERD medication use. RESULTS: Persistent, frequent (3-7 days/week) regurgitation was reported by 13.2% (153/1156) of GERD patients with no heartburn on acid suppression; the prevalence was very similar for patients with up to 2 days/week of ongoing mild heartburn. Among patients without heartburn, sleep disturbance of any type was reported by 50.7-60.1% with persistent, frequent regurgitation, compared with 38.1-51.1% and 14.4-19.2% of those with less frequent or no regurgitation respectively. Persistent, frequent regurgitation was associated with increased use of OTC medication and more hours of work missed, whether mild, infrequent heartburn was present or not. CONCLUSIONS: Frequent regurgitation, which persisted in 12-13% of patients with no or infrequent, mild heartburn on acid suppression, negatively affected sleep and work productivity, and increased use of OTC medication. Persistent, frequent regurgitation is problematic for primary care patients with GERD.


Asunto(s)
Reflujo Gastroesofágico/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Pirosis/tratamiento farmacológico , Reflujo Laringofaríngeo/psicología , Calidad de Vida/psicología , Adulto , Anciano , Estudios Transversales , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/psicología , Estado de Salud , Pirosis/etiología , Pirosis/psicología , Humanos , Concentración de Iones de Hidrógeno , Reflujo Laringofaríngeo/etiología , Persona de Mediana Edad , Atención Primaria de Salud , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/etiología , Encuestas y Cuestionarios
9.
Int J Clin Pract ; 66(9): 897-905, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22805293

RESUMEN

BACKGROUND: Response to treatment among primary care patients with gastro-oesophageal disease (GERD) is variable. AIM: The GERD Management Project (GMP) evaluated the effectiveness of a structured management approach to GERD vs. standard treatment (usual care). METHODS: Data from five cluster-randomised clinical trials in adult primary care patients with symptoms of GERD were pooled. The structured pathway was based on the self-administered GERD Questionnaire (GerdQ) and was compared with standard treatment. RESULTS: 1734 patients were enrolled (structured treatment, n=834; standard treatment, n=900). The difference in the mean GerdQ score change from baseline favoured the structured pathway (-0.61; 95% CI: -0.88, -0.34; p<0.001). The odds ratio for an indication for treatment revision at the end of follow-up (structured vs. standard treatment) was 0.39 (95% CI: 0.29, 0.52; p=0.001). CONCLUSIONS: Management of primary care patients with GERD can be improved by systematic stratification of patients using a patient management tool such as the GerdQ.


Asunto(s)
Reflujo Gastroesofágico/terapia , Análisis por Conglomerados , Vías Clínicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Encuestas y Cuestionarios
10.
Aliment Pharmacol Ther ; 33(11): 1225-33, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21480935

RESUMEN

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with substantial morbidity and mortality. Despite advances in endoscopic and pharmacological treatment during the past two decades, the incidence of mortality associated with NVUGIB has remained relatively constant. AIM: To report outcomes and predictive factors for bleeding continuation/re-bleeding and mortality of NVUGIB in clinical practice in different European countries. METHODS: This observational, retrospective cohort study (NCT00797641; ENERGIB) was conducted in Belgium, Greece, Italy, Norway, Portugal, Spain and Turkey. Eligible patients were hospitalised (new admissions or inpatients), presenting with overt NVUGIB with endoscopy from 1 October to 30 November, 2008. Patients were managed according to routine care, and data regarding bleeding continuation/re-bleeding, pharmacological treatment, surgery and mortality during 30-days after the initial bleed were collected. A multivariate analysis of clinical factors predictive of poor outcomes was conducted. RESULTS: Overall, 2660 patients (64.7% men; mean age 67.7 years) were evaluable. Significant differences across countries in bleeding continuation/re-bleeding (range: 9-15.8%) or death (2.5-8%) at 30 days were explained by clinical factors (number of comorbidities, age > 65 years, history of bleeding ulcers, in-hospital bleeding, type of lesion or type of concomitant medication). Other factors (country, size of hospital, profile of team managing the event, or endoscopic/pharmacological therapy received) did not affect these outcomes. Similar predictors were observed in patients with high-risk stigmata. CONCLUSION: Differences in the outcomes of nonvariceal upper gastrointestinal bleeding in clinical practice across some European countries are explained mainly by patient-related factors, and not by management factors.


Asunto(s)
Endoscopía Gastrointestinal/métodos , Hemorragia Gastrointestinal/fisiopatología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Europa (Continente)/epidemiología , Femenino , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
11.
Science ; 330(6005): 800-4, 2010 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-21051633

RESUMEN

Gravitational lensing is a powerful astrophysical and cosmological probe and is particularly valuable at submillimeter wavelengths for the study of the statistical and individual properties of dusty star-forming galaxies. However, the identification of gravitational lenses is often time-intensive, involving the sifting of large volumes of imaging or spectroscopic data to find few candidates. We used early data from the Herschel Astrophysical Terahertz Large Area Survey to demonstrate that wide-area submillimeter surveys can simply and easily detect strong gravitational lensing events, with close to 100% efficiency.

12.
Radiologia ; 50(4): 327-30, 2008.
Artículo en Español | MEDLINE | ID: mdl-18783655

RESUMEN

Primary lymphoma of the esophagus is very rare; it affects less than 1% of all patients with gastrointestinal lymphoma. We present a case of mucosa-associated lymphoid tissue (MALT)-type primary lymphoma of the esophagus that manifested as a large ulcerated submucosal mass. We describe the radiological findings on the esophagram, endoscopic ultrasonography, and helical computed tomography. To our knowledge, only 10 cases of MALT-type primary lymphoma of the esophagus have been published to date.


Asunto(s)
Neoplasias Esofágicas/diagnóstico por imagen , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Humanos , Masculino
13.
Radiología (Madr., Ed. impr.) ; 50(4): 327-330, jul. 2008. ilus
Artículo en Es | IBECS | ID: ibc-68889

RESUMEN

El linfoma primario del esófago es una entidad muy rara que afecta a menos de un 1% de los pacientes con linfoma gastrointestinal. Presentamos un caso de linfoma primario tipo MALT (mucosa-associated lymphoid tissue) de esófago que se manifestó como una masa submucosa ulcerada de gran tamaño. Describimos los hallazgos radiológicos en el esofagograma, la ultrasonografía endoscópica y la tomografía computarizada helicoidal. En nuestro conocimiento, tan solo 10 casos de linfoma MALT primario del esófago han sido publicados hasta el momento


Primary lymphoma of the esophagus is very rare; it affects less than 1% of all patients with gastrointestinal lymphoma. We present a case of mucosa-associated lymphoid tissue (MALT)-type primary lymphoma of the esophagus that manifested as a large ulcerated submucosal mass. We describe the radiological findings on the esophagram, endoscopic ultrasonography, and helical computed tomography. To our knowledge, only 10 cases of MALT-type primary lymphoma of the esophagus have been published to date (AU)


Asunto(s)
Humanos , Masculino , Anciano , Linfoma de Células B de la Zona Marginal/diagnóstico , Neoplasias Esofágicas/diagnóstico , Ultrasonografía/métodos , Diagnóstico Diferencial
14.
Rev Esp Enferm Dig ; 96(6): 385-90; 390-4, 2004 Jun.
Artículo en Inglés, Español | MEDLINE | ID: mdl-15230668

RESUMEN

OBJECTIVE: To analyze the epidemiology, associated risk factors, clinical presentation, diagnostic methods, treatment, and evolution of patients diagnosed with superior mesenteric venous thrombosis (SMVT) at an university hospital in Madrid. EXPERIMENTAL DESIGN: Retrospective and descriptive study. We review the medical records of patients with this diagnosis in our hospital from January 1998 to December 2002. Data were processed by using the SPSS vs. 11 software. PATIENTS: All thirteen subjects diagnosed with SMVT in that period were included. RESULTS: Associated risk factors included tumoral conditions (5 patients), acute abdominal pathology (2), polyglobulia (1), prothrombin gene mutation (1), and anticardiolipin antibodies (1). No predisposing factor was found in 3 patients. Clinical presentation for all patients was abdominal pain, with nausea and vomiting being the second symptom in frequency (7). The diagnosis was reached by abdominal CT (9), arteriography (2), ultrasounds (1), and histology after intestinal resection (1). Treatment with only anticoagulation was initiated in 4 patients, whereas anticoagulation and surgery were performed in 5 cases. In 4 subjects no specific treatment was prescribed and only palliative measures were established due to a baseline end-stage condition. Five patients died, and four of them had a neoplasic condition as associated risk factor. Mortality in our series was 38.5%. CONCLUSIONS: SMVT is a very rare disease that is often associated with neoplasic pathology, which influences its high mortality. Due to non specific symptoms, imaging is essential for the diagnosis and the detection of associated risk factors. In our series, computed tomography imaging was the most profitable test.


Asunto(s)
Oclusión Vascular Mesentérica/patología , Trombosis de la Vena/patología , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Femenino , Humanos , Masculino , Oclusión Vascular Mesentérica/tratamiento farmacológico , Oclusión Vascular Mesentérica/cirugía , Venas Mesentéricas/patología , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/cirugía
15.
Scand J Gastroenterol ; 38(7): 693-700, 2003 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12889553

RESUMEN

BACKGROUND: There is very little information available on the incidence of complications and on the best prevention therapy in high-risk patients taking non-steroidal anti-inflammatory drugs (NSAIDs) and/or aspirin. Randomized-controlled trials in such patients are rare for ethical reasons. We studied the incidence of gastrointestinal complications in high-risk patients taking long-term low-dose aspirin or non-aspirin-NSAIDs combined with omeprazole in a real-life clinical setting. METHODS: This was a multicentre, prospective and observational study including 247 consecutive high-risk patients who had a clinical indication for long-term treatment with either low-dose aspirin or non-aspirin NSAIDs and omeprazole therapy. The occurrence of gastrointestinal complications was measured. RESULTS: In addition to a recent history of peptic ulcer bleeding, all patients had at least 1 other risk factor and 112 (45.3%) had 3 or more risk factors; 78.9% were taking low-dose aspirin and the remainder non-aspirin NSAIDs. Mean follow-up was 14.6 +/- 10.38 months. Three patients taking low-dose aspirin developed upper gastrointestinal bleeding (1.2%; 95% CI 0.3-3.5; 1.0 event/100 patients/year). This was similar to the rate observed in studies involving non-high-risk patients taking low-dose aspirin and higher than that observed in patients not taking low-dose aspirin. Two additional patients developed a lower gastrointestinal bleeding event (0.81% (0.04%-3.12%); 0.67 events/100 patients/year), which was within the range expected in NSAID users. CONCLUSIONS: The use of omeprazole in the high-risk patient taking low-dose aspirin or NSAIDs seems to be a safe therapeutic approach in this population and is associated with a low frequency of upper gastrointestinal complications.


Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Antiulcerosos/uso terapéutico , Aspirina/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Omeprazol/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/administración & dosificación , Antiulcerosos/administración & dosificación , Aspirina/administración & dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Femenino , Enfermedades Gastrointestinales/epidemiología , Hemorragia Gastrointestinal/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/administración & dosificación , Úlcera Péptica/tratamiento farmacológico , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
18.
Infection ; 30(2): 98-100, 2002 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12018478

RESUMEN

A 69-year-old female was admitted to our hospital because of asthenia, anorexia and 20 kg weight loss. An ultrasound study and computerized tomography (CT) imaging revealed a mesenteric mass and laparotomy was performed. The diagnosis was mesenteric tuberculosis with jejunal involvement. This represents an atypical onset of tuberculosis in a non-immunosuppressed patient.


Asunto(s)
Yeyuno , Linfadenitis Mesentérica/diagnóstico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Gastrointestinal/diagnóstico , Tuberculosis Ganglionar/diagnóstico , Anciano , Femenino , Humanos , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/microbiología , Linfadenitis Mesentérica/microbiología , Tuberculosis Gastrointestinal/microbiología , Tuberculosis Ganglionar/microbiología
19.
Rev Esp Cardiol ; 54(4): 529-31, 2001 Apr.
Artículo en Español | MEDLINE | ID: mdl-11282062

RESUMEN

Ventricular diverticulum are small outpouchings, in the cardiac wall, which are mostly described as a part of malformation syndromes. This finding is infrequent in asymptomatic patients with no pathology in the thoraco abdominal line. The case we present shows a diverticulum in the cardiac apex in a male patient with no cardiological clinic manifestations and with an abnormal electrocardiogram. At present, magnetic resonance is the best diagnostic test, for this kind of malformation, and is also the most reliable in the follow-up of these patients.


Asunto(s)
Divertículo/diagnóstico , Ventrículos Cardíacos , Cardiomiopatías/diagnóstico , Humanos , Masculino , Persona de Mediana Edad
20.
Angiology ; 52(2): 131-5, 2001 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11228086

RESUMEN

Sixty patients with a hypertensive emergency (mean arterial pressure >130 mm Hg and evidence of target organ damage) were randomly divided into two groups of 30 patients each. Group A received 1.25 mg of isosorbide dinitrate aerosol upon arrival and a second dose 15 minutes later when the mean arterial pressure reduction was < 15%. Group B received a single 5 mg tablet of sublingual isosorbide dinitrate. Electrocardiography was performed in both groups prior to and 30 minutes after the medication. Blood pressure was monitored for 6 hours. Blood pressure in Group A patients decreased in an average time of 10 minutes from 191 +/- 12/122.3 +/- 5 to 151.5 +/- 9.2/93 +/- 4 mm Hg, p < 0.005. Mean arterial pressure decreased by 22.8%: 145 +/- 7 to 112 +/- 7.5 mm Hg, p < 0.005. No adverse effects occurred. Five patients in Group B did not respond; in the rest of the group blood pressure decreased 45 minutes after receiving the medication from 194 +/- 8/125 +/- 5.5 to 160 +/- 11/98 +/- 6 mm Hg; p < 0.005. Mean arterial pressure decreased by 20.1%: 148.3 +/- 12 to 118.6 +/- 9 mm Hg, p < 0.002; ten patients suffered headache. Three patients in Group A had a subepicardial lesion in the first electrocardiograph, which disappeared with the use of the aerosol. In Group B, electrocardiography results were normal. These results seem to indicate that isosorbide dinitrate aerosol is better than tablets for the treatment of patients with a hypertensive emergencies.


Asunto(s)
Aerosoles , Hipertensión/tratamiento farmacológico , Dinitrato de Isosorbide/administración & dosificación , Vasodilatadores/administración & dosificación , Administración por Inhalación , Administración Oral , Presión Sanguínea/efectos de los fármacos , Electrocardiografía , Urgencias Médicas , Femenino , Humanos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Persona de Mediana Edad , Vasodilatadores/uso terapéutico
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