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Escobar A, García Pérez L, Herrera-Espiñeira C, Aizpuru F, Sarasqueta C, Gonzalez Sáenz de Tejada M, Quintana JM, Bilbao A. Total knee replacement: Are there any baseline factors that have influence in patient reported outcomes? J Eval Clin Pract 2017; 23:1232-1239. [PMID: 28548313 DOI: 10.1111/jep.12765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is conflicting evidence about what factors influence outcomes after total knee replacement (TKR). The objective is to identify baseline factors that differentiate patients who achieve both, minimal clinically important difference (MCID) and a patient acceptable symptom state (PASS) in pain and function, measured by WOMAC, after TKR from those who do not attain scores above the cutoff in either of these dimensions. METHODS One-year prospective multicentre study. Patients completed WOMAC, SF-12, EQ-5D, expectations, other joint problems and sociodemographic data while in the waiting list, and 1-year post-TKR. Dependent variable was a combination of MCID and PASS in both dimensions (yes/no). Univariate analysis was performed to identify variables associated. Exploratory factor analysis (EFA) was performed to study how these variables grouped into different factors. RESULTS Total sample comprised 492 patients. Mean (SD) age was 71.3 (6.9), and there were a 69.7% of women. Of the total, 106 patients did not attain either MCID or PASS in either dimension, and 230 exceeded both thresholds in both dimensions. In the univariate analysis, 13 variables were associated with belonging to one group or another. These 13 variables were included in EFA; 3 factors were extracted: expectations, mental health, and other joints problems. The percentage of variance explained by the 3 factors was 80.4%. CONCLUSION We have found 2 modifiable baseline factors, expectations and mental health, that should be properly managed by different specialist. Indication of TKR should take into account these modifiable factors for improving outcomes after TKR.
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Antonioli M, Carvalho J, Bustamante C, Mendonça L, Bergamasco P, Escobar A, Marques L, Canola P. Atresia anal com fístula retovaginal em ovino: relato de caso. ARQ BRAS MED VET ZOO 2017. [DOI: 10.1590/1678-4162-9379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A atresia anal com fístula retovaginal, é considerada uma afecção congênita rara nos ovinos. Em virtude disso, buscou-se descrever o reparo cirúrgico e cuidados pós-operatórios em uma borrega que apresentava essa afecção. Nesse sentido, uma borrega, sem raça definida, de 25 dias de idade e pesando 7,2kg, apresentou sinais de distensão abdominal e defecação pela vulva. A afecção foi diagnosticada por meio do exame clínico e confirmada radiograficamente, constatando-se atresia anal do tipo III em associação com a fístula.
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Cohen LC, Dahlen G, Escobar A, Fejerskov O, Johnson NW, Manji F. Dentistry in crisis: time to change. La Cascada Declaration. Aust Dent J 2017; 62:258-260. [DOI: 10.1111/adj.12546] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schettino B, Vega S, Gutiérrez R, Escobar A, Romero J, Domínguez E, González-Ronquillo M. Fatty acid profile of goat milk in diets supplemented with chia seed (Salvia hispanica L.). J Dairy Sci 2017; 100:6256-6265. [DOI: 10.3168/jds.2017-12785] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/09/2017] [Indexed: 11/19/2022]
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Sánchez-López C, Perestelo-Pérez L, Escobar A, López-Bastida J, Serrano-Aguilar P. Health-related quality of life in patients with spinocerebellar ataxia. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gonzalez-Saenz de Tejada M, Bilbao A, Baré M, Briones E, Sarasqueta C, Quintana J, Escobar A. Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients. Psychooncology 2016; 26:1263-1269. [DOI: 10.1002/pon.4303] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 01/09/2023]
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Cabo Fustaret M, Escobar A, Novo F, Illia R, Rivas C, Uranga Imaz M, Lobenstein G. PM321 NT-Pro-BNP Relevance in the Clinical Monitoring of Pregnant Patients. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gonzalez-Saenz de Tejada M, Bilbao A, Baré M, Briones E, Sarasqueta C, Quintana JM, Escobar A. Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer. Psychooncology 2015; 25:891-7. [PMID: 26582649 DOI: 10.1002/pon.4022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim of this study was to explore the association of social support received, and functional and psychological status of colorectal cancer patients before surgery with changes in health-related quality of life (HRQoL) outcomes measured by EORTC QLQ-C30 at 1-year post-intervention. METHODS Consecutive patients that were because of undergo therapeutic surgery for the first time for colon or rectum cancer in nine hospitals in Spain were eligible for the study. Patients completed questionnaires before surgery and 12 months afterwards: one HRQoL instrument, the EORTC QLQ-C30; a social network and social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Hospital Anxiety and Depression Scale, to assess anxiety and depression; and the Barthel Index, to assess functional status; as well as questions about sociodemographic information. General linear models were built to explore the association of social support, functional status, and psychological variables with changes in HRQoL 12 months after intervention. RESULTS A total of 972 patients with colorectal cancer took part in the study. Patients' functional status, social support, and anxiety and depression were associated with changes in at least one HRQoL domain. The higher functional status, and the higher social support, the more they improved in HRQoL domains. Regarding anxiety and depression, the more anxiety and depression patients have at baseline, less they improve in HRQoL domains. CONCLUSIONS Patients with colorectal cancer who have more social support and no psychological distress may have better results in HRQoL domains at 1 year after surgery. Copyright © 2015 John Wiley & Sons, Ltd.
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Sánchez-López CR, Perestelo-Pérez L, Escobar A, López-Bastida J, Serrano-Aguilar P. Health-related quality of life in patients with spinocerebellar ataxia. Neurologia 2015; 32:143-151. [PMID: 26541695 DOI: 10.1016/j.nrl.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The progressive deterioration of patients with spinocerebellar ataxia (SCA) has a major impact on their health-related quality of life (HRQOL). This study evaluates HRQOL in a sample of patients diagnosed with SCA and aims to estimate the predictive ability of a set of sociodemographic variables for the different dimensions of the General Health Questionnaire. METHODS A total of 80 patients diagnosed with SCA were assessed using a sociodemographic questionnaire and the SF-36 General Health Questionnaire. The sociodemographic variables studied were sex, age, presence of a carer, employment status, and time elapsed from diagnosis of the disease. RESULTS The 8 subscales of the SF-36 show positive and significant correlations to one another. Mean scores obtained on each SF-36 subscale differ between women and men, although this difference is significant only on the general health subscale, with men scoring higher than women. We found significant age differences on the vitality and social function subscales, with higher scores among younger patients (< 34 years). The variable 'presence of a carer' accounts for most of the total variance of the questionnaire. CONCLUSIONS The SF-36 is a valid and useful instrument for evaluating HRQOL in patients diagnosed with SCA. Presence of a carer seems to be a determinant of self-perceived quality of life in these patients.
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Palmer SC, Ruospo M, Wong G, Craig JC, Petruzzi M, De Benedittis M, Ford P, Johnson DW, Tonelli M, Natale P, Saglimbene V, Pellegrini F, Celia E, Gelfman R, Leal MR, Torok M, Stroumza P, Bednarek-Skublewska A, Dulawa J, Frantzen L, Ferrari JN, del Castillo D, Bernat AG, Hegbrant J, Wollheim C, Gargano L, Bots CP, Strippoli GF, Raña S, Serrano M, Claros S, Arias M, Petracci L, Arana M, De Rosa P, Gutierrez A, Simon M, Vergara V, Tosi M, Cernadas M, Vilamajó I, Gravac D, Paulón M, Penayo L, Carrizo G, Ghiani M, Perez G, Da Cruz O, Galarce D, Gravielle M, Vescovo E, Paparone R, Mato Mira C, Mojico E, Hermida O, Florio D, Yucoswky M, Labonia W, Rubio D, Di Napoli G, Fernandez A, Altman H, Rodriguez J, Serrano S, Valle G, Lobos M, Acosta V, Corpacci G, Jofre M, Gianoni L, Chiesura G, Capdevila M, Montenegro J, Bequi J, Dayer J, Gómez A, Calderón C, Abrego E, Cechín C, García J, Corral J, Natiello M, Coronel A, Muñiz M, Muñiz V, Bonelli A, Sanchez F, Maestre S, Olivera S, Camargo M, Avalos V, Geandet E, Canteli M, Escobar A, Sena E, Tirado S, Peñalba A, Neme G, Cisneros M, Oliszewski R, Nascar V, Daud M, Mansilla S, Paredes Álvarez A, Gamín L, Arijón M, Coombes M, Zapata M, Boriceanu C, Frantzen-Trendel S, Albert K, Csaszar I, Kiss E, Kosa D, Orosz A, Redl J, Kovacs L, Varga E, Szabo M, Magyar K, Kriza G, Zajko E, Bereczki A, Csikos J, Kuti A, Mike A, Steiner K, Nemeth E, Tolnai K, Toth A, Vinczene J, Szummer S, Tanyi E, Toth R, Szilvia M, Dambrosio N, Paparella G, Sambati M, Donatelli C, Pedone F, Cagnazzo V, Antinoro R, Torsello F, Saturno C, Giannoccaro G, Maldera S, Boccia E, Mantuano M, Di Toro Mammarella R, Meconizzi M, Steri P, Riccardi C, Flammini A, Moscardelli L, Murgo M, San Filippo N, Pagano S, Marino G, Montalto G, Cantarella S, Salamone B, Randazzo G, Rallo D, Maniscalco A, Fici M, Lupo A, Pellegrino P, Fichera R, D’Angelo A, Falsitta N, Bochenska-Nowacka E, Jaroszynski A, Drabik J, Birecka M, Daniewska D, Drobisz M, Doskocz K, Wyrwicz G, Inchaustegui L, Outerelo C, Sousa Mendes D, Mendes A, Lopes J, Barbas J, Madeira C, Fortes A, Vizinho R, Cortesão A, Almeida E, Bernat A, De la Torre B, Lopez A, Martín J, Cuesta G, Rodriguez R, Ros F, Garcia M, Orero E, Ros E, Caetano A, MacGregor K, Santos M, Silva Pinheiro S, Martins L, Leitão D, Izidoro C, Bava G, Bora A, Gorena H, Calderón T, Dupuy R, Alonso N, Siciliano V, Frantzen-Trendel S, Nagy K, Bajusz Ö, Pinke I, Decsi G, Gyergyoi L, Jobba Z, Zalai Z, Zsedenyi Á, Kiss G, Pinter M, Kereszturi M, Petruzzi M, De Benedittis M, Szkutnik J, Sieczkarek J, Capelo A, Garcia Gallart M, Mendieta C. Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study. Am J Kidney Dis 2015; 66:666-76. [DOI: 10.1053/j.ajkd.2015.04.051] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/29/2015] [Indexed: 01/28/2023]
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Quintana JM, Aguirre U, González NM, Lazaro S, Sarasqueta C, Escobar A, Baré M, Fernández de Larrea N, Redondo M. Parameters Related to Death at One year in Colorectal Cancer Patients. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Melgar-Rodríguez S, Díaz-Zúñiga J, Alvarez C, Rojas L, Monasterio G, Carvajal P, Escobar A, Sanz M, Vernal R. Serotype b of Aggregatibacter actinomycetemcomitans increases osteoclast and memory T-lymphocyte activation. Mol Oral Microbiol 2015; 31:162-74. [PMID: 26172400 DOI: 10.1111/omi.12112] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/21/2023]
Abstract
During periodontitis, alveolar bone resorption is associated with activation of T helper type 17 (Th17) lymphocytes and receptor activator of nuclear factor-κB ligand (RANKL) -induced osteoclasts. We previously reported that serotype b of Aggregatibacter actinomycetemcomitans has a higher capacity to trigger Th17-type differentiation and function in activated T lymphocytes and its lipopolysaccharide is a more potent immunogen compared with the other serotypes. This study aimed to investigate whether serotype b of A. actinomycetemcomitans induces higher Th17-associated RANKL production, RANKL-induced osteoclast activation, and antigen-specific memory T lymphocyte proliferation. On naive CD4(+) T lymphocytes stimulated with autologous dendritic cells primed with different A. actinomycetemcomitans serotypes, RANKL production, T-bet, GATA-3, RORC2 and Foxp3 expression, RORC2/RANKL intracellular double-expression, TRAP(+) osteoclast activation, and bone resorption were quantified. The frequency of proliferating memory T lymphocytes in response to A. actinomycetemcomitans serotypes was determined in periodontitis and healthy subjects. Naive CD4(+) T lymphocytes stimulated by serotype b-primed dendritic cells elicited higher levels of RANKL, RORC2, TRAP(+) osteoclasts, and bone resorption than the same cells stimulated with the other serotypes. RANKL positively correlated and co-expressed with RORC2. Memory T lymphocytes responding to serotype b were more frequently detected in periodontitis patients than healthy subjects. These results indicate that serotype b of A. actinomycetemcomitans is associated with higher production of RANKL and these increased levels are associated with Th17 lymphocyte induction, osteoclast activation, and bone resorption.
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Orive M, Barrio I, Orive VM, Matellanes B, Padierna JA, Cabriada J, Orive A, Escobar A, Quintana JM. A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia. J Psychosom Res 2015; 78:563-8. [PMID: 25791668 DOI: 10.1016/j.jpsychores.2015.03.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Epidemiological evidence suggests an association between psychological factors and functional dyspepsia (FD). Yet few randomized controlled trials (RCTs) of psychological interventions have been conducted for FD. We conducted an RCT to evaluate the efficacy of psychotherapy among chronic FD. METHODS One hundred fifty-eight consecutive patients with FD were randomized to medical therapy plus psychotherapy consisted in 8 group and 2 individual sessions focused on teaching techniques for coping with FD (intensive treatment (IT); n=76) or medical therapy alone (conventional treatment (CT); n=82). Patients completed validated self-reported questionnaires before and after the 10-week treatment and 6 months later. Linear mixed-effects models were used, in intention-to-treat analysis. RESULTS At the end of treatment period, statistically significant improvements were observed for IT compared with CT for dyspepsia-related quality of life (DRQoL). DRQoL mean changes of 6.09 and 3.54 were obtained in IT and CT patients, respectively (p=<0.0001); and SS mean changes of 11.55 and 4.57 were obtained in IT and CT patients, respectively (p=0.0013). Those improvements, measured by minimum clinically important difference (MCID), were clinically significant (DRQoL: 77% of the IT patients exceeded the MCID vs. the 45% of the CT; SS: 75% vs. 48%). Six months after treatment, those statistically significant improvements persisted for DRQoL (p=0.0067) and for SS (p=0.0405). Clinical improvements persisted for SS (63% vs. 41%). CONCLUSIONS These findings suggest that adding psychotherapy to standard medical therapy improves short-term outcomes in patients with FD and may have long-term effects as well. The cost-effectiveness of intensive therapy needs to be evaluated. Registration number and name of trial registry: NCT01802710.
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Díaz-Zúñiga J, Melgar-Rodríguez S, Alvarez C, Monasterio G, Benítez A, Ciuchi P, Díaz C, Mardones J, Escobar A, Sanz M, Vernal R. T-lymphocyte phenotype and function triggered by Aggregatibacter actinomycetemcomitans is serotype-dependent. J Periodontal Res 2015; 50:824-35. [PMID: 25824938 DOI: 10.1111/jre.12270] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Based on lipopolysaccharide (LPS) antigenicity, different Aggregatibacter actinomycetemcomitans serotypes have been described. Serotype b strains have demonstrated a stronger capacity to trigger cytokine production on dendritic cells (DCs). As DCs regulate the development of T-lymphocyte lineages, the objective of this investigation was to study the response of T lymphocytes after being stimulated with autologous DCs primed with different bacterial strains belonging to the most prevalent serotypes of A. actinomycetemcomitans in humans: a-c. MATERIAL AND METHODS Human DCs were primed with increasing multiplicity of infection (10(-1) -10(2) ) or the purified LPS (10-50 ng/mL) of A. actinomycetemcomitans serotypes a-c and then used to stimulate autologous naïve CD4(+) T lymphocytes. The T-helper (Th) type 1, Th2, Th17 and T-regulatory transcription factors T-bet, GATA-3, RORC2 and Foxp3, which are the master-switch genes implied in their specific differentiation, as well as T-cell phenotype-specific cytokine patterns were quantified by real-time reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay. In addition, the intracellular expression of T-bet/interferon-γ, GATA-3/interleukin-4, RORC2/interleukin-17A and Foxp3/transforming growth factor-β1 was analysed by double staining and flow cytometry. RESULTS All the A. actinomycetemcomitans serotypes led to T-lymphocyte activation; however, when T lymphocytes were stimulated with DCs primed with the A. actinomycetemcomitans serotype b strain or their purified LPS, higher levels of Th1- and Th17-associated transcription factors and cytokines were detected compared with similar experiments with the other serotypes. CONCLUSION These results demonstrate that serotype b of A. actinomycetemcomitans has a higher capacity of trigger Th1 and Th17 phenotype and function and it was demonstrated that their LPS is a more potent immunogen compared with the other serotypes.
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Peter WF, Loos M, de Vet HCW, Boers M, Harlaar J, Roorda LD, Poolman RW, Scholtes VAB, Boogaard J, Buitelaar H, Steultjens M, Roos EM, Guillemin F, Rat AC, Benedetti MG, Escobar A, Østerås N, Terwee CB. Development and Preliminary Testing of a Computerized Animated Activity Questionnaire in Patients With Hip and Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2014; 67:32-9. [DOI: 10.1002/acr.22386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/17/2014] [Indexed: 12/27/2022]
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Escobar A, Trancho Z, Gonzale-Saenz DTM, Quiros R, Garcia PL, Navarro G, Bilbao A. Health Related Quality Of Life At One Year Post Discharge In Patients With Heart Failure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A495. [PMID: 27201484 DOI: 10.1016/j.jval.2014.08.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Poblete-Echeverría C, Ortega-Farías S, Lobos G, Romero S, Ahumada L, Escobar A, Fuentes S. NON-INVASIVE METHOD TO MONITOR PLANT WATER POTENTIAL OF AN OLIVE ORCHARD USING VISIBLE AND NEAR INFRARED SPECTROSCOPY ANALYSIS. ACTA ACUST UNITED AC 2014. [DOI: 10.17660/actahortic.2014.1057.43] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Escobar A, Riddle DL. Concordance between important change and acceptable symptom state following knee arthroplasty: the role of baseline scores. Osteoarthritis Cartilage 2014; 22:1107-10. [PMID: 24971868 DOI: 10.1016/j.joca.2014.06.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/27/2014] [Accepted: 06/10/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the influence of baseline score on concordance between the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) estimates obtained on persons following total knee arthroplasty (TKA). DESIGN Patients scheduled for TKA in 15 hospitals in Spain were recruited and provided pre-operative and 1-year postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function scores. 1 year following surgery, patients completed questionnaires that determined the importance of any changes in status since surgery as well as the extent of satisfaction with the 1-year outcome. Kappa (κ) was used to determine the extent of concordance between MCID and PASS measures for the entire sample and after splitting the sample based on quartiles of the baseline WOMAC scores. RESULTS A total of 923 patients participated in the study. The extent of concordance between MCID and PASS without regard to baseline score was κ = 0.41 (95% Confidence Interval (CI) = 0.36, 0.47) for WOMAC Function and after stratifying baseline scores into quartiles, κ = 0.72 (95%CI = 0.68, 0.77). Similar estimates were obtained for WOMAC Pain. CONCLUSIONS Baseline score has substantial influence on the extent of concordance between MCID and PASS for patients undergoing TKA. Clinicians should account for baseline score when interpreting either MCID or PASS and the extent to which these measures agree. These findings have potential to influence the interpretation of outcome following TKA.
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Hernandez-Suarez G, Pineros M, Vargas JC, Orjuela L, Hernandez F, Peroza C, Torres D, Escobar A, Perez G. Human papillomavirus genotypes in genital warts in Latin America: a cross-sectional study in Bogota, Colombia. Int J STD AIDS 2013; 24:567-72. [PMID: 23970773 DOI: 10.1177/0956462412474538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological studies on benign lesions related to human papillomavirus (HPV) infection are scarce in Latin America. We enrolled 342 consecutive patients with lesions suspected of being genital warts (GW). All patients underwent confirmatory biopsy and GP5+/GP6+/- Reverse Line Blot HPV testing on frozen tissue. In 261 (81%) cases, the diagnosis was confirmed by histopathology and HPV was detected in 90.6% of men and 87.7% of women. HPV 6 was by far the most common type in both women (62%) and men (56%), followed by HPV 11 (∼20%). Co-infection with these two types occurred in 7% and 12% of women and men, respectively. HPV16 ranked third in prevalence, with 16% of patients testing positive. Twenty-five percent of cases tested positive for multiple HPV genotypes. Although HPV 6 and HPV 11 were the main types detected and no differences between men and women were observed, we found HPV 11 contributed more to GW aetiology compared with previous reports, showing a variability of HPV type distribution in GW across populations. This information is valuable baseline data in Latin America for future estimations of the burden of GW in men and women and shows the potential benefit obtainable by prophylactic vaccination against HPV types 6 and 11.
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Quintana JM, Garcia S, Aguirre U, Gonzalez N, Arteta E, Escobar A, Bare M, Blasco JA, Martínez-Tapias J. Relationship of sociodemographic variables with outcomes after cataract surgery. Eye (Lond) 2013; 27:698-707; quiz 708. [PMID: 23703627 DOI: 10.1038/eye.2013.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The objective of this study is to analyse the relationship between sociodemographic characteristics of patients undergoing cataract extraction and their outcomes. METHODS The method comprised a prospective cohort study of patients recruited from 17 hospitals of different areas of Spain. Data gathered before surgery included sociodemographic variables, visual acuity, and visual function (using the Visual Function Index-14). After surgery, we assessed visual acuity and visual function at 6 weeks and at 3 months, respectively. Multivariate multilevel analysis was performed to assess the relationship of sociodemographic variables with changes in visual acuity and function, analysing whether improvements surpassed the minimal clinically important differences (MCIDs). RESULTS Multivariate analysis showed that for visual acuity, (i) older men had a lower odds ratio (OR) of surpassing the MCID (OR: 65-75 years, 0.64; >75 years, 0.51); (ii) those with primary (1.65) or secondary (1.41) education had higher ORs than those with no formal education; and (iii) those living in a residential home had a lower OR than men living alone (0.36). In women, we found that the higher the educational level, the greater the improvement in visual acuity (primary, 1.41; secondary, 1.76), whereas socially dependent women (0.70) were less likely to exceed the MCID. With regards to predictors related to achievement of an MCID in visual function, only dependency was associated with more improvement in men (OR: 1.39), whereas in women the educational level was the only predictor (primary: 0.72; secondary: 0.61). CONCLUSIONS This study found that patients with certain sociodemographic characteristics were less likely to experience an MCID in visual acuity or visual function after cataract surgery.
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Rashidian A, Claes D, Escobar A, Sriprasart T, Mueller C, Tyner T, Vempilly JJ. RV/TLC Ratio Is a Better Criterion for Diagnosing Obstructive Ventilatory Defect in Asthma. Chest 2012. [DOI: 10.1378/chest.1388905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Escobar A, Gonzalez M, Quintana JM, Vrotsou K, Bilbao A, Herrera-Espiñeira C, Garcia-Perez L, Aizpuru F, Sarasqueta C. Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values. Osteoarthritis Cartilage 2012; 20:87-92. [PMID: 22155074 DOI: 10.1016/j.joca.2011.11.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/08/2011] [Accepted: 11/14/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify new cut-off values beyond which patients can be considered as satisfied or as responders through patient acceptable symptom state (PASS) and OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) set of responder criteria in total joint replacement. METHODS Secondary analysis of a 1-year prospective multicenter study of 861 patients, 510 with total knee replacement (TKR) and 351 with total hip prosthesis (THR). Pain and function data were collected by the reverse scoring option of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). PASS values were identified with the 25th centile estimation using an anchoring question about satisfaction with actual symptoms. OMERACT-OARSI set of responder criteria was based on a combination of absolute and relative change of pain, function and global patient's assessment. Receiver operating characteristic (ROC) analysis was used as a complementary approach. RESULTS The values for PASS were about 80 and 69 for pain and function in THR, while these values were 80 and 68 when using OMERACT-OARSI criteria. Regarding TKR, PASS values were about 75 and 67 in pain and function with both criteria. ROC values were slightly lower in all cases. PASS and OMERACT-OARSI values varied moderately across tertiles of baseline severity. CONCLUSION With the provided data we can establish when a patient can be considered as satisfied/responder in joint replacement. The scores achieved at 1 year were very similar according to both criteria.
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Flores-Cruz GM, Escobar A. [Ontogenesis of the neurotransmitter systems]. Rev Neurol 2012; 54:41-48. [PMID: 22187211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The study of the ontogenesis of neurotransmitter systems is relevant not only to understand the development of the central nervous system. The new horizons that have appeared in research into the use of stem cells in the repair of damaged neurons are allowing attempts to be made to imitate the differentiation and maintenance of the type of affected neuron. To achieve this, it is necessary to understand which signals direct the differentiation and the molecules that guide their maturation, their survival and the maintenance of their functionality. Furthermore, the early emergence of these systems during ontogenesis has led us to question their participation in the regulation of the development of the central nervous system. AIMS To describe the most significant events in the development of the neurotransmitter systems and to discuss some of the processes that take part in the ontogenesis of the nervous system. DEVELOPMENT The study will offer a chronological review of the sequence of molecular events in the main neurotransmitter systems that allow the phenotype to be established and the appearance of receptors and transporters. Likewise, the role they play in events like neurogenesis, proliferation, differentiation and neuronal migration will also be outlined. CONCLUSIONS The neurotransmitter systems regulate events that range from neurogenesis to both radial and tangential cortical migration, as well as intervening in the correct maturation of their own system.
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Gómez Palacios A, Barrios B, Gutiérrez MT, Expósito A, Gómez Zabala J, Roca B, Pérez de Villarreal P, Ruiz S, Escobar A, Iturburu I, Méndez J. [Morbidity and costs in complete thyroidectomies. Improvement in Value of the Process by a change in the management]. ACTA ACUST UNITED AC 2011; 27:161-8. [PMID: 22137200 DOI: 10.1016/j.cali.2011.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/30/2011] [Accepted: 09/30/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES 1) To present the postoperative morbidity of complete thyroidectomies and the results of their clinical management and costs obtained after surgery. 2) To compare the results obtained for the morbidity and costs in the complete thyroidectomy Process, after the management changes introduced by the Endocrine Surgical Unit (ESU). 3) To define whether these changes improve the Value (benefit/cost ratio) of the Process. MATERIAL AND METHODS Prospective study of cohorts conducted on 529 complete thyroidectomies performed between 1998 and 2011. We present their clinical-pathological characteristics and we compare the clinical and management results obtained after surgery in 2 time periods: 1998-2006 without ESU (group 1, 205 patients) and 2007-2011 with ESU (group 2, 324 patients). The clinical results and the possible benefits are assessed by studying the morbimortality (recurrent lesions, hypocalcaemia [<8 mg/dl], suffocative haematomas and bleeding), and those of management, for the evaluation of the use of operating room time, the average stay and the total cost of the Process. The statistical comparison study was made using Student t test, for the comparison of means and the Chi(2) to compare percentages, accepting P<.05 as significant. RESULTS The global percentage of transient recurrent dysfunctions (TRD) was 6%, and for definitive recurrent paralysis (DRP) it was 1.5%. Hypocalcaemia, at 24 hours was 54.6%, at one month 7%, at six months 6.2% and that of definitive hypoparathyroidism 1.3%. There were 2.8% of suffocative haematomas and 2% adverse effects. The mean surgical time was 98 minutes, and the average stay was 3.66 days. In the comparison of results of the groups, the ESU improved the TRD index by nearly 7 points (10.2 vs. 3.4%, P=.002), that of DRP by 1.5 (2.4 vs. 0.4%; P=.3) until reaching under 1%. The figures on bleeding at 24 hours (53 vs. 44 cc; P=.002) and 48 hours (23 to 17 cc; P<.001), the rate of haematomas by another 6 points (6.3 vs. 0.6%; P<.001), and that of hypocalcaemia at 24 hours (P=.01). The average stay also improved (4.79 vs. 2.94 days; P<.001), the use of operating room time (reduced by 20 minutes/operation; P<.001), the total cost of the Process, decreasing by more than € 2,000/Process (P<.001), and produced a total savings for the hospital in the period of study of € 665,820. CONCLUSIONS 1) The global results (post-operative morbidity) of our total thyroidectomies are within the quality standards. 2) The surgical specialisation and the changes introduced by the ESU improved the clinical results (greater benefit) and those of management, cutting down the average stay and the operating room usage time and decreasing costs. 3) The change in management increased the Value of the Process.
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Garcia-Gutierrez S, Quintana JM, Aguirre U, Esteban C, Bilbao A, Escobar A, Vidal S, Bare M, Aizpuru F, Blasco JA. Explicit criteria for hospital admission in exacerbations of chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2011; 15:680-6. [PMID: 21756522 DOI: 10.5588/ijtld.10.0408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To develop detailed, explicit criteria for determining the appropriateness of admission for patients with exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN Using a modified Delphi process, a panel of seven pneumologists and five emergency department (ED) physicians was assembled to establish the appropriateness of hospital admission for 896 distinct theoretical scenarios. To assess the reliability of the criteria, a second national panel of five pneumologists and five ED physicians was assembled. We examined the influence of all variables on the first panel score using linear regression models. The explicit criteria developed were summarised by classification and regression tree analysis. RESULTS The appropriateness of the hospitalisation scenarios increased with the severity of COPD. The kappa of agreement between the two panels was 0.79. Predictors of appropriate hospitalisation were severity of current COPD exacerbation, response to previous treatment and expected adherence to treatment. The panel results were synthesised and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel's original ratings, was 6.1%. CONCLUSIONS These explicit criteria can be used to help determine the appropriateness of admission for patients with exacerbations of COPD.
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