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Rodríguez-Baño J, Pérez-Moreno MA, Peñalva G, Garnacho-Montero J, Pinto C, Salcedo I, Fernández-Urrusuno R, Neth O, Gil-Navarro MV, Pérez-Milena A, Sierra R, Estella Á, Lupión C, Irastorza A, Márquez JL, Pascual Á, Rojo-Martín MD, Pérez-Lozano MJ, Valencia-Martín R, Cisneros JM. Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis. Clin Microbiol Infect 2019; 26:358-365. [PMID: 31323260 DOI: 10.1016/j.cmi.2019.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.
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Affiliation(s)
- J Rodríguez-Baño
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain
| | - M A Pérez-Moreno
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Seville, Spain
| | - G Peñalva
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, CSIC, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain
| | - J Garnacho-Montero
- Department of Critical Care, University Hospital Virgen Macarena, University of Seville, Seville, Spain
| | - C Pinto
- Department of Pharmacy, Guadix-Loja Hospital, Granada, Spain
| | - I Salcedo
- Department of Preventive Medicine and Public Health, University Hospital Reina Sofia, Cordoba, Spain
| | - R Fernández-Urrusuno
- Pharmacy Service, Primary Healthcare District Aljarafe-Sevilla Norte, Mairena del Aljarafe, Seville, Spain
| | - O Neth
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - M V Gil-Navarro
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Seville, Spain
| | | | - R Sierra
- Intensive Care Unit, University Hospital Puerta del Mar, University of Cadiz, Cadiz, Spain
| | - Á Estella
- Intensive Care Unit, Jerez de la Frontera Hospital, Jerez de la Frontera, Cadiz, Spain
| | - C Lupión
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain
| | - A Irastorza
- Department of Comprehensive Health Plans, Supporting Services of the Andalusian Healthcare Service, Seville, Spain
| | - J L Márquez
- Department of Comprehensive Health Plans, Supporting Services of the Andalusian Healthcare Service, Seville, Spain
| | - Á Pascual
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain
| | - M D Rojo-Martín
- Department of Microbiology, Regional University Hospital of Malaga, Spain
| | - M J Pérez-Lozano
- Clinical Unit of Prevention, Promotion and Health Surveillance, University Hospital Virgen de Valme, Seville, Spain
| | - R Valencia-Martín
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Seville, Spain
| | - J M Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, CSIC, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain.
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Márquez JL, Benito G, Saez JC, Navarro N, Alvarez A, Quiñones J. The Influence of Radon (Gas and Progeny) and Weather Conditions on Ambient Dose Equivalent Rate. Radiat Prot Dosimetry 2017; 174:423-430. [PMID: 27522045 DOI: 10.1093/rpd/ncw219] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study is to identify the influence of radon (gas and progeny) on the ambient dose equivalent rate measured at the reference station ESMERALDA, where continuous measurements of the ambient dose equivalent rate (every 10 min) combined with activity concentration measurements of radon gas and radon progeny as well as meteorological parameters have been collected. This study has been performed using a correlation study based on a principal components analysis and the Spearman's rank correlation coefficient.
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Affiliation(s)
- J L Márquez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - G Benito
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - J C Saez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - N Navarro
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - A Alvarez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - J Quiñones
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
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Ontanilla G, Herrera JM, Alcívar JM, Martín-Gutiérrez G, Márquez C, Márquez JL. Liver abscess due to Klebsiella pneumoniae and its relation to colon lesions. Rev Esp Enferm Dig 2015; 107:51-52. [PMID: 25603336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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4
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Méndez-Villafañe R, Guerrero JE, Embid M, Fernández R, Grandio R, Pérez-Cejuela P, Márquez JL, Alvarez F, Ortego P. Design and verification of the shielding around the new Neutron Standards Laboratory (LPN) at CIEMAT. Radiat Prot Dosimetry 2014; 161:393-397. [PMID: 24478306 DOI: 10.1093/rpd/nct348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The construction of the new Neutron Standards Laboratory at CIEMAT (Laboratorio de Patrones Neutrónicos) has been finalised and is ready to provide service. The facility is an ∼8 m×8 m×8 m irradiation vault, following the International Organization for Standardization 8529 recommendations. It relies on several neutron sources: a 5-GBq (5.8× 10(8) s(-1)) (252)Cf source and two (241)Am-Be neutron sources (185 and 11.1 GBq). The irradiation point is located 4 m over the ground level and in the geometrical centre of the room. Each neutron source can be moved remotely from its storage position inside a water pool to the irradiation point. Prior to this, an important task to design the neutron shielding and to choose the most appropriate materials has been developed by the Radiological Security Unit and the Ionizing Radiations Metrology Laboratory. MCNPX was chosen to simulate the irradiation facility. With this information the walls were built with a thickness of 125 cm. Special attention was put on the weak points (main door, air conditioning system, etc.) so that the ambient dose outside the facility was below the regulatory limits. Finally, the Radiation Protection Unit carried out a set of measurements in specific points around the installation with an LB6411 neutron monitor and a Reuter-Stokes high-pressure ion chamber to verify experimentally the results of the simulation.
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Affiliation(s)
- R Méndez-Villafañe
- Ionizing Radiations Metrology Laboratory (LMRI), CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - J E Guerrero
- Ionizing Radiations Metrology Laboratory (LMRI), CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - M Embid
- Ionizing Radiations Metrology Laboratory (LMRI), CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - R Fernández
- Licensing and Radiological Safety Unit, CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - R Grandio
- Licensing and Radiological Safety Unit, CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - P Pérez-Cejuela
- Radiation Protection Unit, CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - J L Márquez
- Radiation Protection Unit, CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - F Alvarez
- Nuclear Innovation Unit, CIEMAT, Av. Complutense 40, E-28040, Madrid, España
| | - P Ortego
- SEA Ingeniería, Las Rozas, 28290 Madrid, España
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Abad C, González-Escribano MF, Diaz-Gallo LM, Lucena-Soto JM, Márquez JL, Leo E, Crivell C, Gómez-García M, Martín J, Núñez-Roldán A, García-Lozano JR. Association of Toll-like receptor 10 and susceptibility to Crohn's disease independent of NOD2. Genes Immun 2011; 12:635-42. [PMID: 21716313 DOI: 10.1038/gene.2011.41] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Impaired innate inflammatory response has a key role in the Crohn's disease (CD) pathogenesis. The aim of this study was to investigate the possible role of the TLR10-TLR1-TLR6 gene cluster in CD susceptibility. A total of 508 CD patients (284, cohort 1 and 224, cohort 2) and 576 controls were included. TLR10-TLR1-TLR6 cluster single-nucleotide polymorphisms genotyping, NOD2 mutations and TLR10 mRNA quantification were performed using TaqMan assays. Nucleotide-binding oligomerization domain containing 2 (NOD2) and Toll-like receptor (TLR) loci interaction was analyzed by logistic regression and multifactor-dimensionality reduction (MDR). Entropy-based analysis was used to interpret combination effects. One TLR10 haplotype (TLR10(GGGG)) was found associated with CD susceptibility in both cohorts, individuals with two copies had approximately twofold more risk of CD susceptibility than individuals having no copies (odds ratio=1.89, P-value=0.0002). No differences in the mRNA levels were observed among the genotypes. The strongest model for predicting CD risk according to the MDR analysis was a two-locus model including NOD2 mutations and TLR10(GGGG) haplotype (P(c)<0.0001). The interaction gain attributed to the combination of both genes was negative (IG=-2.36%), indicating redundancy or independent effects. Our results support association of the TLR10 gene with CD susceptibility. The effect of TLR10 would be independent of NOD2, suggesting different signaling pathways for both genes.
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Affiliation(s)
- C Abad
- Servicio de Inmunología, Instituto de Biomedicina, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Garrido A, Giráldez A, Pareja F, Márquez JL. [Topical formalin treatment of radiation-induced hemorrhagic proctitis]. Rev Esp Enferm Dig 2009; 101:735-736. [PMID: 19899945 DOI: 10.4321/s1130-01082009001000013] [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: 05/28/2023]
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Cuevas A, Márquez JL, Jaramillo P, Caamaño J, Saavedra N, Lanas F, Lanas C, Salazar LA. D 012 Capn10 Ucsnp-43 Gene Polymorphism in Chilean Individuals with Coronary Artery Disease and Controls. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71706-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bello A, Dorantes S, Márquez JL, Jaimes ML. Physical and biochemical characteristics of platelets in severely malnourished children with purpura. Scand J Haematol 2009; 8:321-7. [PMID: 5134832 DOI: 10.1111/j.1600-0609.1971.tb00881.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Garrido A, Giráldez A, Trigo C, Leo E, Guil A, Márquez JL. [Intravenous proton-pump inhibitor for acute peptic ulcer bleeding--is profound acid suppression beneficial to reduce the risk of rebleeding?]. Rev Esp Enferm Dig 2009; 100:466-9. [PMID: 18942898 DOI: 10.4321/s1130-01082008000800004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare two regimens of pantoprazole administered intravenously in patients with ulcerative gastrointestinal bleeding (UGB), and a high risk of presenting with persitent or recurrent hemorrhage. MATERIAL AND METHOD Patients were randomized into two groups: group 0--treatment with a 80 mg bolus of pantoprazole administered intravenously, followed by continuous infusion of 8 mg/h for 72 hours; group 1--treatment with 40 mg of pantoprazole administered intravenously on a daily basis. The percentage of hemorrhagic persistence/recurrence in both groups was analyzed, as were transfusion requirements, need for surgery, and mortality resulting from the hemorrhagic episode. RESULTS There were 20 patients in group 0 and 21 in group 1. No differences were found between groups in terms of gender, age, smoking habits, use of NSAIDs, presence of hemodynamic instability or stigmata in ulcer crater (Forrest Ia: 5 vs. 14.3%, p = 0.322; Forrest Ib: 30 vs. 33.3%, p = 0.819; Forrest IIa: 60 vs. 50.1%, p = 0.753). In group 0, 90% of patients received endoscopic treatment, versus 100% in group 1, p = 0.232. In group 0, 50% of patients had a transfusion, as compared to 52.4% in group 1, p = 0.879. In group 0, 2 patients (10.5%) presented with recurrent hemorrhage, versus 3 patients (14.3%) in group 1. Surgery was required by 1 person from each group, and 1 patient in group 0 died. CONCLUSIONS Maximum acid inhibition with a bolus and then a continuous infusion of pantoprazole does not yield better results than treatment with conventional doses in acute hemorrhagic episodes.
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Affiliation(s)
- A Garrido
- Servicio de Aparato Digestivo, Hospital Virgen del Rocío, Seville.
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10
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Sobrino S, Garrido A, López T, Santa-Cruz T, Belda O, Márquez JL. [Upper esophageal hemangioma successfully treated by laser]. Rev Esp Enferm Dig 2007; 99:552-553. [PMID: 18052652 DOI: 10.4321/s1130-01082007000900013] [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: 05/25/2023]
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11
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Garrido A, Márquez JL, Guerrero FJ, Leo E, Pizarro MA, Trigo C. [Changes in the etiology, outcome, and characteristics of patients with acute gastrointestinal bleeding between 1999 and 2005]. Rev Esp Enferm Dig 2007; 99:275-9. [PMID: 17650937 DOI: 10.4321/s1130-01082007000500006] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To analyze the evolution of the following variables in patients admitted to a Blood Unit for gastrointestinal bleeding throughout 1999-2005: etiology, comorbid diseases, use of NSAIDs/anticoagulants, and mortality. MATERIAL AND METHODS We analyzed the evolution of the following causes of GIB that required admission to the Blood Unit from 1999 to 2005: duodenal ulcer (DU), gastric ulcer (GU), portal hypertension (PHT), and others. We also analyzed changes in the percentage of patients admitted with comorbid disease, use of NSAIDs/anticoagulants, and mortality. RESULTS 1,611 Patients with a mean age of 60.45 years (59.7-61.2) were included in this study; 76.41% were males (74.3-78.5). DU was the cause of bleeding in 22.20% of cases (20.2-24.3), GU in 18.40% of cases (16.6-20.4), and PHT in 33.60% of cases (31.3-36.0). In all, 34.5% (32.6-37.3) of patients were taking NSAIDs, 7.1% (6.0-8.6) were receiving anticoagulant therapy, 72.6% (70.4-74.8) presented with comorbid disease, and overall mortality was 6.27% (5.16-7.59). Throughout the 1999-2005 period there was an increase in the number of patients with comorbid diseases (p < 0.02), and a decrease in cases of DU (p < 0.04), without significant differences in the remaining variables. CONCLUSIONS DU, GU and PHT account for three quarters of admissions to our Blood Unit. Over the last seven years, there has been a decrease in cases due to DU, and an increase in patients with comorbid disease; overall mortality rates have remained stable.
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Affiliation(s)
- A Garrido
- Unidad de Sangrantes, Hospital Virgen del Rocío, Sevilla.
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Garrido A, Márquez JL, Guerrero FJ, Pizarro MA, Leo E, Giráldez A. Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital. Rev Esp Enferm Dig 2007; 98:760-9. [PMID: 17094725 DOI: 10.4321/s1130-01082006001000006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES 1. To study transfusion requirements in the Department of Gastroenterology of a Tertiary Referral Hospital, and their evolution over the last seven years. 2. To analyze risk factors associated with greater erythrocyte transfusion requirements. PATIENTS AND METHODS erythrocyte transfusion requirements were compared for patients admitted to the Department of Gastroenterology at Hospital Virgen del Rocío, Seville, from 1999 to 2005. Clinical data of interest have been analyzed in order to determine factors associated with greater transfusion requirements. RESULTS 1,611 patients with a mean age of 60.45 years (59.7-61.2) were included in this study; 76.41% were males. Gastric ulcers were the cause of bleeding in 18.4% of cases (with 69% requiring transfusions); duodenal ulcers caused 22.2% of cases (with 52.9% requiring transfusions), and portal hypertension caused 33.6% of cases (with 90.2% requiring transfusions). Upper and lower gastrointestinal bleeding of unknown origin requires transfusions in 88.9 and 96.2% of cases, respectively.A multivariate logistic regression analysis showed that clinical presentations such as hematemesis (odds ratio = 3.12), hematochezia (odds ratio = 33.17), gastrointestinal hemorrhage of unknown origin (odds ratio = 6.57), and hemorrhage as a result of portal hypertension (odds ratio = 3.43) were associated with greater transfusion requirements for erythrocyte concentrates. No significant differences were observed between the percentages of patients who received transfusions from 1999 to 2005. CONCLUSIONS 1. No differences have been observed between the percentages of patients who received transfusions over the last seven years at our Department of Gastroenterology. 2. Patients presenting with hematemesis or hematochezia, in addition to those with bleeding of unknown origin or from portal hypertension, are prone to have greater transfusion requirements.
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Affiliation(s)
- A Garrido
- Gastrointestinal Bleeding Unit, Hospital Virgen del Rocío, Seville, Spain.
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Garrido A, Márquez JL, Iglesias A, Peiró J, Grilo I, Garzón M. Hemorragia por varices ectópicas periostomales: una rara complicación de la hipertensión portal. Gastroenterología y Hepatología 2006; 29:320-1. [PMID: 16733040 DOI: 10.1157/13087474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rivera M, Lucero J, Guerrero A, Márquez JL, Montes R, Suñer M, Ruiz A, Valdivia MA, Mateos J. [Octreotide in the treatment of angiodysplasia in patients with advanced chronic renal failure]. Nefrologia 2005; 25:332-5. [PMID: 16053016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Angiodysplasia is an important cause of gastrointestinal bleeding in patients with chronic renal failure. Octreotide, a long-acting synthetic somatostatin analogue that reduces splachnic blood flow have been used to treat esophageal varicose hemorrhage, but its efficacy for bleeding vascular ecstasies is awaiting support. We present three patients with chronic renal failure (two with diabetic nephropaty and the third with mesangiocapilar glomerulonephritis and hepatic cirrosis), seric creatinine 3-4,5 mg/dl, and recurrent gastrointestinal bleeding due to diffuse angiodysplasia and vascular ecstasies, diagnosed by oral endoscopy, colonoscopy and video capsule. They all were treated with octreotide, administered subcutanesly 0.1 mg twice a day for six months, with significantly decreased blood requirements in all of them, as well as the occurrence of bleeding episodes. It was well tolerated and none side-effects occurred in any subject. In our experience, octreotide is an effective and safe drug in bleeding angiodysplasia and ecstasies vascular of the gastrointestinal tract in patients with chronic renal failure, and it may be a good option especially in patients who are not candidates for surgery or endoscopic treatment due to inaccessible sites, spread of the lesion, old age and/or concomitant disorders.
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Affiliation(s)
- M Rivera
- Servicio de Nefrología, Hospital Universitario Virgen del Rocío, Sevilla.
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15
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Lanas A, Rodrigo L, Márquez JL, Bajador E, Pérez-Roldan F, Cabrol J, Quintero E, Montoro M, Gomollón F, Santolaria S, Lorente S, Cucala M, Nuevo J. Low frequency of upper gastrointestinal complications in a cohort of high-risk patients taking low-dose aspirin or NSAIDS and omeprazole. Scand J Gastroenterol 2003; 38:693-700. [PMID: 12889553 DOI: 10.1080/00365520310003967] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- A Lanas
- Service of Digestive Diseases, University Hospital Lozano Blesa, Zaragoza, Spain.
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Reyes C, Márquez JL, Reina FR, García FJ, Jiménez FM, Giráldez A, Lucero JA, Trigo C. [Intracanalicular metastasis of biliary tract from colorectal carcinoma as cause of obstructive jaundice]. Rev Esp Enferm Dig 2003; 95:365-6. [PMID: 12828525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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17
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Márquez JL, Mota R, Herrera JM, Narváez I, Sáenz de Santamaría J. [Immunoproliferative disease of the small intestine. Report of a case]. Rev Esp Enferm Dig 1993; 83:381-3. [PMID: 8318283] [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: 01/29/2023]
Abstract
We report one case of immunoproliferative small intestinal disease with two rare characteristics. Firstly, the detection of monoclonal IgA-Kappa in serum and in the intestinal infiltrate and secondly, the advanced age of the patient at diagnosis. We checked up on Spanish literature and found an important number of patients that were diagnosed at such an age. We suggest that this disease may appear in elderly people in developed countries.
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Affiliation(s)
- J L Márquez
- Servicio de Aparato Digestivo, Hospital Regional Universitario Infanta Cristina, Badajoz
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18
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Márquez JL, Herrera JM, Herrera J, Caballero M, Narváez I, Pascasio JM, Pimentel JJ, Pabón M, Vega P, Soria A. [Gastric metastasis of renal cell adenocarcinoma]. Rev Esp Enferm Dig 1992; 81:129-30. [PMID: 1567704] [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: 12/27/2022]
Abstract
Gastric metastases are rare, usually discovered at autopsy. The most frequent ones are breast and bronchial cancer, as well as malignant melanoma. The case of a patient with upper gastroenterological hemorrhage due to an ulcerated metastasis from a renal cell carcinoma is presented.
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Affiliation(s)
- J L Márquez
- Sección de Aparato Digestivo, Hospital Universitario Infanta Cristina, Badajoz
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19
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Herrera JM, Sáenz de Santa María J, Pascasio JM, Márquez JL, Pabón M, Vega P, Caravaca F, Soria A. [Amyloid colitis]. Rev Esp Enferm Dig 1991; 80:120-2. [PMID: 1790076] [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: 12/28/2022]
Abstract
A patient is reported who had urolithiasis and pyonephrosis of the right kidney. In the terminal phase of his disease he developed chronic diarrhea and hematochezia. Sigmoidoscopy showed changes in the colo-rectal mucosa compatible with ulcerative colitis with moderate activity. Histology demonstrated large amyloid deposits of the AA type in the lamina propia around the vessels and with atrophy and ulceration if the epithelium.
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Affiliation(s)
- J M Herrera
- Sección de Aparato Digestivo, Hospital Infanta Cristina, Badajoz
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20
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Castro M, Márquez JL, Guerrero P, Castilla L, Guillén P. [Double esophageal membrane in a patient with Plummer-Vinson syndrome]. Rev Esp Enferm Apar Dig 1989; 75:597-8. [PMID: 2762643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case is presented of a 27-year-old patient with Plummer-Vinson syndrome. Radiological and endoscopic study detected a double membrane in the cervical esophagus. After esophageal dilation, dysphagia remitted and the patient remains asymptomatic.
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21
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Márquez JL, Jordá MM, Andrada ME, Nogueira J, Ayerza MA, Caballero J, Villar JL, Muñoz E, Mendoza E, Reina FR. [Immunoproliferative disease of the small intestine with development to B cell immunoblastic sarcoma. Presentation of a case]. Rev Esp Enferm Apar Dig 1987; 72:373-6. [PMID: 3500490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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Enrique Ochoa J, Vinageras E, Márquez JL. [Chronic ischemic ulcer secondary to African anemia. Presentation of a case]. Bol Med Hosp Infant Mex 1987; 44:278-82. [PMID: 3606789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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23
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Dorantes-Alvarez S, Dorantes-Mesa S, Márquez JL, Nussbaumer C. [Local administration of epsilon-aminocaproic acid in the prevention of post-exodontic hemorrhage in children with hemophilia]. Bol Med Hosp Infant Mex 1987; 44:143-7. [PMID: 3580097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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24
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Nogueira J, Sayago M, Márquez JL, Caballero J, Muñoz E, Trujillo L, de la Santa J. [The CREST syndrome. Apropos of a case]. Rev Esp Enferm Apar Dig 1986; 70:355-9. [PMID: 3786917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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25
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Dorantes-Mesa S, Márquez JL, Valencia-Mayoral P. [Iron overload in hereditary atransferrinemia]. Bol Med Hosp Infant Mex 1986; 43:99-101. [PMID: 3964403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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26
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Bello-González A, Dorantes S, Ruiz-Reyes G, Márquez JL, Escanero A, Loperena L. [Congenital absolute afibrinogenemia]. Bol Med Hosp Infant Mex 1983; 40:325-9. [PMID: 6615624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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27
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Bello A, Dorantes S, Loperena L, Márquez JL, Fernández E. [Iatrogenic disease in hemophilia and Von Willebrand's disease]. Bol Med Hosp Infant Mex 1982; 39:23-8. [PMID: 6978721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
From a group of 115 children with hereditary haemorrhagic disease, nine suffered avoidable accidents or incidents during their treatment, these nine patients represent 8.6% of the cases. The observed complications included a giant cervical hematoma and hemomediastinum after a puncture of the internal jugular vein; an encephalic lesion associated with descompressive craneotomy; a hemophilic pseudo cyst associated with inappropriate treatment of a tibial fracture; acute bleeding and shock after surgery for tonsillectomy and circumcision; subdural hygroma after a subdural puncture; giant hematoma and acute anemia secondary to a venous dissection; permanent dyslexia after inappropriate puncture; giant hematoma and acute anemia secondary to a venous dissection; permanent dyslexia after inappropriate management of intracranial bleeding; bleeding and acute anemia after surgical drainage of a prepucial hematoma and a joint hematoma of the left knee after synovectomy and application of a prosthesis.
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Loperena L, Dorantes S, Medrano E, Berrón R, Vega L, Cuarón A, Rodríguez C, Márquez JL. [Hereditary atransferrinemia]. Bol Med Hosp Infant Mex 1974; 31:519-35. [PMID: 4215439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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29
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Dorantes S, Bello A, De Márquez ML, Márquez JL. [Infant nutrition. IV. Viscosity metamorphosis and blood platelet adhesiveness in children with severe malnutrion]. GAC MED MEX 1967; 97:1554-7. [PMID: 5629349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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