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Sogbe M, Arraiza M, Pastrana M, Alegre F, Fernández-Ros N, Sunsundegui P, Quiroga J, Lucena J. Segmental arterial mediolysis and pheochromocytoma. A case report. J Vasc Interv Radiol 2022; 34:314-317. [PMID: 37190973 DOI: 10.1016/j.jvir.2022.10.036] [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] [Received: 04/29/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
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2
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Fernández Ros N, Alegre F, Rodríguez Rodriguez J, Landecho MF, Sunsundegui P, Gúrpide A, Lecumberri R, Sanz E, García N, Quiroga J, Lucena JF. Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit. J Clin Med 2022; 11:jcm11123472. [PMID: 35743544 PMCID: PMC9225024 DOI: 10.3390/jcm11123472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75−391.25) days (patients with DNR orders 46 days (19.5−92.25), patients without DNR orders 162 days (39.5−632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3−4 vs. 0−2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.
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Affiliation(s)
- Nerea Fernández Ros
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Correspondence: ; Tel.: +34-948-296635; Fax: +34-948-296500
| | - Félix Alegre
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
| | | | - Manuel F. Landecho
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Patricia Sunsundegui
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
| | - Alfonso Gúrpide
- Department of Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.R.R.); (A.G.)
| | - Ramón Lecumberri
- Hematology Service, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Eva Sanz
- Faculty of Medicine, European University of Madrid, 28670 Madrid, Spain;
| | - Nicolás García
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Jorge Quiroga
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 28801 Madrid, Spain
| | - Juan Felipe Lucena
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
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3
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Senent Y, Inogés S, López-Díaz de Cerio A, Blanco A, Campo A, Carmona-Torre F, Sunsundegui P, González-Martín A, Ajona D, Okrój M, Prósper F, Pio R, Yuste JR, Tavira B. Persistence of High Levels of Serum Complement C5a in Severe COVID-19 Cases After Hospital Discharge. Front Immunol 2021; 12:767376. [PMID: 34868021 PMCID: PMC8636747 DOI: 10.3389/fimmu.2021.767376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
Evidence supports a role of complement anaphylatoxin C5a in the pathophysiology of COVID-19. However, information about the evolution and impact of C5a levels after hospital discharge is lacking. We analyzed the association between circulating C5a levels and the clinical evolution of hospitalized patients infected with SARS-CoV-2. Serum C5a levels were determined in 32 hospitalized and 17 non-hospitalized patients from Clinica Universidad de Navarra. One hundred and eighty eight serial samples were collected during the hospitalization stay and up to three months during the follow-up. Median C5a levels were 27.71 ng/ml (25th to 75th percentile: 19.35-34.96) for samples collected during hospitalization, versus 16.76 ng/ml (12.90-25.08) for samples collected during the follow-up (p<0.001). There was a negative correlation between serum C5a levels and the number of days from symptom onset (p<0.001). C5a levels also correlated with a previously validated clinical risk score (p<0.001), and was associated with the severity of the disease (p<0.001). An overall reduction of C5a levels was observed after hospital discharge. However, elevated C5a levels persisted in those patients with high COVID-19 severity (i.e. those with a longest stay in the hospital), even after months from hospital discharge (p=0.020). Moreover, high C5a levels appeared to be associated with the presence of long-term respiratory symptoms (p=0.004). In conclusion, serum C5a levels remain high in severe cases of COVID-19, and are associated with the presence of respiratory symptoms after hospital discharge. These results may suggest a role for C5a in the long-term effects of COVID-19 infection.
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Affiliation(s)
- Yaiza Senent
- Program in Solid Tumors, Translational Oncology Group, Cima-University of Navarra, Pamplona, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain.,Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain
| | - Susana Inogés
- Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Department of Immunology and Immunotherapy, Clinica Universidad de Navarra, Pamplona, Spain.,Area of Cell Therapy and Department of Hematology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ascensión López-Díaz de Cerio
- Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Department of Immunology and Immunotherapy, Clinica Universidad de Navarra, Pamplona, Spain.,Area of Cell Therapy and Department of Hematology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Andres Blanco
- Department of Internal Medicine, Clinica Universidad de Navarra, Pamplona, Spain
| | - Arantxa Campo
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Francisco Carmona-Torre
- Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Department of Internal Medicine, Clinica Universidad de Navarra, Pamplona, Spain.,Division of Infectious Diseases, Clinica Universidad de Navarra, Pamplona, Spain
| | - Patricia Sunsundegui
- Department of Internal Medicine, Clinica Universidad de Navarra, Pamplona, Spain
| | - Antonio González-Martín
- Program in Solid Tumors, Translational Oncology Group, Cima-University of Navarra, Pamplona, Spain.,Department of Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Daniel Ajona
- Program in Solid Tumors, Translational Oncology Group, Cima-University of Navarra, Pamplona, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain.,Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Program in Respiratory Tract Tumors, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Marcin Okrój
- Department of Cell Biology and Immunology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Felipe Prósper
- Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Department of Immunology and Immunotherapy, Clinica Universidad de Navarra, Pamplona, Spain.,Program in Respiratory Tract Tumors, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Program of Regenerative Medicine, Cima-University of Navarra, Pamplona, Spain
| | - Ruben Pio
- Program in Solid Tumors, Translational Oncology Group, Cima-University of Navarra, Pamplona, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain.,Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Program in Respiratory Tract Tumors, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - José Ramón Yuste
- Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Department of Internal Medicine, Clinica Universidad de Navarra, Pamplona, Spain.,Division of Infectious Diseases, Clinica Universidad de Navarra, Pamplona, Spain
| | - Beatriz Tavira
- Program in Solid Tumors, Translational Oncology Group, Cima-University of Navarra, Pamplona, Spain.,Respiratory Tract Cancer Group, Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain
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4
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Ballester MP, Lluch P, Tosca J, Capilla M, Gómez C, Moreno O, Jordán-Iborra C, Sunsundegui P, Argemi J, Guijarro J, Mínguez M. Serum cholesterol predicts transplant-free survival in cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt. Dig Liver Dis 2021; 53:1596-1602. [PMID: 34052179 DOI: 10.1016/j.dld.2021.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malnutrition is frequent in patients with cirrhosis and has been associated with poor prognosis. The Model for End-stage Liver Disease (MELD) score was created to predict survival after Transjugular Intrahepatic Porto-systemic Shunt (TIPS) but lacks a nutritional parameter. AIMS To evaluate the prognostic value of serum cholesterol in patients with cirrhosis undergoing TIPS and to develop a prognostic score to predict survival. METHODS An explorative cross-sectional study was conducted of cirrhotic patients undergoing TIPS from 2008 until 2019. Exclusion criteria were liver transplantation or hepatocellular carcinoma before TIPS. Risk analysis was used to compare survival according to clinical and analytical data. The diagnostic performance of serum cholesterol added to MELD was evaluated and confirmed in an external validation cohort. RESULTS The final cohort of 100 patients had a mean MELD score of 14±5 and cholesterol of 122±51 mg/dL. MELD (p < 0,05) and both cholesterol (p < 0,05) and low-density lipoprotein levels (LDL-C) (p < 0,05) were independent predictors of post-TIPS transplant-free survival with an optimal cut-off of 106 mg/dL for serum cholesterol. The combined MELD-cholesterol risk score improved diagnostic accuracy of each parameter separately, and this was confirmed in the external cohort. CONCLUSION Serum cholesterol and LDL-C are independent predictors of transplant-free survival in cirrhotic patients undergoing TIPS. The MELD-cholesterol score slightly improved prognostic accuracy. LAY SUMMARY As an objective and easily measured indicator of both nutritional status and hepatic function, serum cholesterol could be useful to predict transplant-free survival in patients with cirrhosis undergoing TIPS. It can enable health care providers to identify high-risk patients and to optimize nutritional status before TIPS.
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Affiliation(s)
- Maria Pilar Ballester
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain.
| | - Paloma Lluch
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Joan Tosca
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Maria Capilla
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Concepción Gómez
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Oswaldo Moreno
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Carlota Jordán-Iborra
- Internal Medicine Department and Liver Unit. Clinic University Hospital of Navarra, Navarra, Spain
| | - Patricia Sunsundegui
- Internal Medicine Department and Liver Unit. Clinic University Hospital of Navarra, Navarra, Spain
| | - Josepmaria Argemi
- Internal Medicine Department and Liver Unit. Clinic University Hospital of Navarra, Navarra, Spain
| | - Jorge Guijarro
- Interventional Radiology Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Miguel Mínguez
- Digestive Disease Department, Clinic University Hospital of Valencia, Valencia, Spain
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5
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Fernández Ros N, Lucena F, Iñarrairaegui M, Landecho MF, Sunsundegui P, Jordán-Iborra C, Pineda I, Quiroga J, Herrero JI. Web-based formative assessment through clinical cases: role in pathophysiology teaching. BMC Med Educ 2021; 21:249. [PMID: 33931038 PMCID: PMC8088046 DOI: 10.1186/s12909-021-02691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Active learning strategies such as formative assessment through clinical cases may help to get a deeper learning. We have studied the effect of this kind of online formative assessment in pathophysiology teaching. METHODS Seven brief clinical cases were used to give formative assessment in the first semester of a pathophysiology course. To evaluate its effect on learning, we analyzed the proportion of students that passed the end of semester exam with a score above 60 over 100. We also analyzed the effect of the intervention according to the students' previous academic performance. RESULTS Ninety-six students participated in the study and sat the exam. Sixty-five of them passed it. Students that passed the exam had a higher previous academic performance and had done a higher number of exercises of formative assessment, both in univariate and multivariate analysis. The participants were divided in three groups, according to their previous academic performance. In the intermediate group, the number of cases done by the students who passed the exam was significantly higher than in those who did not pass it (median: 4 versus 0; P = 0.009). CONCLUSION Formative assessment through web-based clinical cases was followed by an improvement of the academic results in pathophysiology, mainly in students with intermediate performance.
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Affiliation(s)
- Nerea Fernández Ros
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Felipe Lucena
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Mercedes Iñarrairaegui
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Liver Unit (Department of Internal Medicine), Clínica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red de enfermedades hepaticas y digestivas (CIBERehd), Madrid, Spain
| | - Manuel F Landecho
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Patricia Sunsundegui
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Iñigo Pineda
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge Quiroga
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de enfermedades hepaticas y digestivas (CIBERehd), Madrid, Spain
| | - Jose Ignacio Herrero
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
- Liver Unit (Department of Internal Medicine), Clínica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Navarra, Spain.
- Centro de Investigación Biomédica en Red de enfermedades hepaticas y digestivas (CIBERehd), Madrid, Spain.
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6
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Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, García-Layana A. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med 2021; 289:116-120. [PMID: 32729633 DOI: 10.1111/joim.13156] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Abstract
IMPORTANCE COVID-19 is caused by SARS-CoV-2, a betacoronavirus that uses the angiotensin-converting enzyme-related carboxypeptidase (ACE2) receptor to gain entry into cells. ACE2 receptor is widely expressed in multiple organs, including the retina, an extension of the central nervous system. The ACE2 receptor is involved in the diabetic and hypertensive retinopathy. Additionally, coronaviruses cause ocular infections in animals, including retinitis, and optic neuritis. OBJECTIVE To assess whether there is any retinal disease associated with COVID-19. DESIGN We have evaluated 27 asymptomatic subjects, with retinal fundoscopic, optical coherence tomography (OCT) and OCT angiography fourteen days after hospital discharge due to COVID-19 bilateral pneumonia. RESULTS Cotton wool exudates were evident in six out of 27 patients evaluated, a 22%. Cotton wool exudates are a marker vascular disease severity in other medical context, that is diabetes and hypertension, and are associated with increased risk for acute vascular events. Whether antiaggregation therapy may play a role on fundoscopic-selected patients with COVID-19 requires prospective trials.
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Affiliation(s)
- M F Landecho
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J R Yuste
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Microbiology and Infectious Diseases Division, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - E Gándara
- Ophtalmology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - P Sunsundegui
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J Quiroga
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBEREHD
| | - A B Alcaide
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Pulmonary Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - A García-Layana
- Ophtalmology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
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7
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Landecho MF, Colina I, Sunsundegui P, Camarero B, Núñez-Córdoba JM, Beloqui Ó. Comparison of correlations of equation-derived body fat percentage and body mass index with carotid intima-media thickness. Acta Diabetol 2019; 56:373-375. [PMID: 30467729 DOI: 10.1007/s00592-018-1255-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Manuel Fortún Landecho
- General Health Check-up Unit, Internal Medicine Department, Clínica Universidad de Navarra, Avenida Pío XII, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Inmaculada Colina
- General Health Check-up Unit, Internal Medicine Department, Clínica Universidad de Navarra, Avenida Pío XII, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Patricia Sunsundegui
- General Health Check-up Unit, Internal Medicine Department, Clínica Universidad de Navarra, Avenida Pío XII, 31008, Pamplona, Spain
| | - Bruno Camarero
- General Surgery and Digestive System Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jorge M Núñez-Córdoba
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
- Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Spain.
| | - Óscar Beloqui
- General Health Check-up Unit, Internal Medicine Department, Clínica Universidad de Navarra, Avenida Pío XII, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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