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González-Gómez Á, Caro-Teller JM, González-Barrios I, Castro-Frontiñán A, Rodríguez-Quesada PP, Ferrari-Piquero JM. Safety profile of nirmatrelvir-ritonavir: Evidence of adverse events due to drug-drug interactions. Farm Hosp 2024; 48:70-74. [PMID: 37714801 DOI: 10.1016/j.farma.2023.08.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the safety profile of nirmatrelvir-ritonavir (NMV-r) in real clinical practice and to analyze the clinical relevance of drug-drug interactions in the development of adverse events. METHODS Observational, retrospective study in which safety data of patients treated with NMV-r between April and July 2022 in an outpatient setting were evaluated. The duration of follow-up was 28 days and the number of adverse reactions reported, as well as whether they were managed on an outpatient basis or required health care, and the presence of renal and hepatic function impairment were assessed. Concomitant treatment was reviewed, identifying theoretical drug-drug interactions (TDDIs) whose severity was defined using the Lexi-interact classification. RESULTS The study included 146 patients, 82 (56,16%) were women, whose median age was 65 years (22-95). The number of TDDIs detected and maintained during treatment with NMV-r was 164, with the percentage of patients with at least one interaction being 62,33%. The median number of TDDIs per patient was 1 (0-5). At least 1 adverse event (AE) was reported in 18 patients (11,84%). Eleven AEs were potentially related to any TDDI. Seven patients required contact with hospital assistance for AE management. Eight patients had impaired renal function and 2 had impaired liver function at 28 days. The main groups of drugs implicated in the occurrence of an AE were oral anticoagulants and calcium antagonists. CONCLUSIONS Our results show a high number of TDDIs detected were detected between NMV-r and other drugs. This study provides greater knowledge of the drugs involved in such interactions and their potential relationship with the occurrence of adverse events.
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Wang Z, Bi H, Wang YD, Liu Q, Shao B, Li CQ, Fu C, Fu S, Shan GY, Chen A, Lv CC, Zeng Y. Tislelizumab, a novel PD-1 monoclonal antibody in urothelial cancer: A real-world study. Actas Urol Esp 2023:S2173-5786(23)00142-7. [PMID: 38160794 DOI: 10.1016/j.acuroe.2023.12.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Tislelizumab, a monoclonal antibody against programed death protein-1 (PD-1), has shown encouraging antitumor activity in urothelial cancer. This study was designed to assess the efficacy and safety of tislelizumab in urotelial cancer in a real-world setting. METHODS The study was a real-world retrospective study undertaken at Liaoning Cancer Hospital & Institute, China. Eligible patients were ≥18 years. Patients received 200-mg tislelizumab monotherapy intravenously every 3 weeks until the disease progressed to intolerable toxicity. Outcomes included an objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety. RESULTS Between March 2020 and December 2022, 33 patients were enrolled. The median follow-up was 10.17 (IQR 5.73-12.47) months. Of all 33 patients, ORR and DCR were 30.30% (95% CI 15.6%-48.7%) and 42.42% (95% CI 25.48%-60.78%), respectively. The median PFS was 5.73 (95% CI 3.27-13.00) months, with a 12-month PFS rate of 31.90% (95% CI 19.20%-53.00%). The median OS was 17.7 (95% CI 12.80-not reach) months, with a 12-month OS rate of 67.50% (95% CI 52.70%-86.40%). Eleven (33.33%) and 8 (24.24%) experienced ≥grade 3 treatment-related adverse events (TRAEs) and immune-related Aes, respectively. No treatment-related deaths occurred. CONCLUSION The excellent efficacy and controllable safety of tislelizumab in locally advanced or metastatic urothelial cancer suggest that it may be a promising therapeutic option for this population.
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Affiliation(s)
- Z Wang
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - H Bi
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Y D Wang
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Q Liu
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - B Shao
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - C Q Li
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - C Fu
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - S Fu
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - G Y Shan
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - A Chen
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - C C Lv
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Y Zeng
- Servicio de Urología, Hospital Oncológico de la Universidad Medica de China, Liaoning Cancer Hospital & Institute, Shenyang, China.
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Membrive-Jiménez C, Sánchez-Piedra C, Martínez-González O, García-González J, Expósito-Pérez L, Bohórquez-Heras C, Campos-Fernández C, Sanchez-Alonso F, Cáliz-Cáliz R, Castrejón-Fernández I. Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry. Reumatol Clin (Engl Ed) 2023; 19:500-506. [PMID: 37945183 DOI: 10.1016/j.reumae.2023.02.005] [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: 11/07/2022] [Accepted: 02/01/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients. METHOD This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups. RESULT Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation. CONCLUSION Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.
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Affiliation(s)
| | - Carlos Sánchez-Piedra
- Health Technology Assessment Agency (AETS), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | - Rafael Cáliz-Cáliz
- Rheumatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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León-Salas B, Hernández-Yumar A, Infante-Ventura D, de Armas Castellano A, González Hernández Y, Linertová R, Téllez Santana T, de Pablos-Velasco P, Trujillo-Martín MM. Percutaneous ethanol injection in thyroid nodular pathology and metastatic cervical adenopathies: A systematic review, meta-analysis and economic evaluation. ENDOCRINOL DIAB NUTR 2023; 70:572-583. [PMID: 37996202 DOI: 10.1016/j.endien.2023.08.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/08/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Percutaneous ethanol injection (PEI) has been shown to be a valuable treatment for thyroid nodular pathology and metastatic cervical adenopathies. OBJECTIVE To evaluate the effectiveness, safety, and cost-effectiveness of PEI in thyroid nodular pathology and metastatic cervical adenopathies. METHODS A systematic review (SR) using meta-analysis was conducted on the effectiveness and safety of PEI. A SR on cost-effectiveness was also performed. The SRs were conducted according to the methodology developed by the Cochrane Collaboration with reporting in accordance with the PRISMA statement. A cost-minimization analysis was carried out using a decision tree model. Assuming equal effectiveness between two minimally invasive techniques (PEI and radiofrequency ablation (RFA)), the model compared the costs of the alternatives with a horizon of six months and from the perspective of the Spanish National Health System. RESULTS The search identified three RCTs (n=157) that evaluated PEI versus RFA in patients diagnosed with benign thyroid nodules: ninety-six patients with predominantly cystic nodules and sixty-one patients with solid nodules. No evidence was found on other techniques or thyroid nodular pathology. No statistically significant differences were observed between PEI and RFA in volume reduction (%), symptom score, cosmetic score, therapeutic success and major complications. No economic evaluations were identified. The cost-minimization analysis estimated the cost per patient of the PEI procedure at €326 compared to €4781 for RFA, which means an incremental difference of -€4455. CONCLUSIONS There are no differences between PEI and RFA regarding their safety and effectiveness, but the economic evaluation determined that the former option is cheaper.
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Affiliation(s)
- Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain; Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, Spain.
| | - Aránzazu Hernández-Yumar
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain
| | - Aythami de Armas Castellano
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain
| | - Yadira González Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain
| | - Renata Linertová
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain; Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, Spain
| | - Teresa Téllez Santana
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, Spain; Malaga University, Malaga, Spain
| | | | - María M Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain; Spanish Network of Agencies for Health Technology Assessment for the National Health Service (RedETS), Spain; Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute (Instituto de Salud Carlos III), Madrid, Spain
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Nieto Royo R, Durán Barata D, Barrios Barreto D, Briceño Franquiz W, Máiz Carro L. [Safety and effectiveness of treatment with elexacaftor, tezacaftor and ivacaftor in adults with cystic fibrosis]. Med Clin (Barc) 2023; 161:338-341. [PMID: 37474394 DOI: 10.1016/j.medcli.2023.06.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a disease caused by mutations in the gene located on chromosome 7 that encodes the CF transmembrane conductance regulator protein. Several trials have demonstrated the efficacy and safety of the ELE/TEZ/IVA combination in patients who have at least one F508del mutation. The main objective of the study was to evaluate the safety at 3 and 6 months of treatment with ELE/TEZ/IVA in adult patients with CF. METHODS This is a real-life, prospective, single-center, cross-sectional study that included adult patients from the CF multidisciplinary unit. The demographic and clinical characteristics of all patients were recorded. During the time of the study, 3 visits were carried out (baseline, at 3 and at 6 months). Side effects were recorded during the follow-up time. RESULTS 3 months after the start of treatment, a statistically significant improvement was observed. of lung function, BMI, pulmonary exacerbations and energy level, as well as in all the categories of the CFQ-R questionnaire except in the digestive domain. This improvement was maintained, but not increased at 6 months in all variables, except BMI, where differences were observed between 3 and 6 months of treatment. CONCLUSIONS In the cohort studied, treatment with ELE/TEZ/IVA has a good safety profile. and produces an early improvement in lung function, BMI, quality of life and the "energy level" of adult patients with CF, which is maintained at 6 months of treatment.
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Affiliation(s)
- Rosa Nieto Royo
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España.
| | - Diego Durán Barata
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
| | - Deisy Barrios Barreto
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
| | - Winnifer Briceño Franquiz
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
| | - Luis Máiz Carro
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Universidad de Alcalá, Madrid, España
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Escobedo-Sánchez PE, de la Cruz-Hernández I, Ramos-García M, Sánchez-Yedra I, García-Vázquez C, Guzmán-Priego CG, García-Vidrios MV, Olvera-Hernández V, Mendoza-García Y, Ble-Castillo JL. [Efficacy and safety of convalescent plasma administration in patients with COVID-19 infection]. Med Clin (Barc) 2023; 161:323-329. [PMID: 37423879 PMCID: PMC10277849 DOI: 10.1016/j.medcli.2023.05.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, several strategies were suggested for the management of the disease, including pharmacological and non-pharmacological treatments such as convalescent plasma (CP). The use of CP was suggested due to the beneficial results shown in treating other viral diseases. OBJECTIVE To determine the efficacy and safety of CP obtained from whole blood in patients with COVID-19. METHODS Pilot clinical trial in patients with COVID-19 from a general hospital. The subjects were separated into three groups that received the transfusion of 400ml of CP (n=23) or 400ml of standard plasma (SP) (n=19) and a non-transfused group (NT) (n=37). Patients also received the standard available medical treatment for COVID-19. Subjects were followed up daily from admission to day 21. RESULTS The CP did not improve the survival curve in moderate and severe variants of COVID-19, nor did it reduce the degree of severity of the disease evaluated with the COVID-19 WHO and SOFA clinical progression scale. No patient had a severe post-transfusion reaction to CP. CONCLUSIONS Treatment with CP does not reduce the mortality of patients even when its administration has a high degree of safety.
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Affiliation(s)
- Priscila Edith Escobedo-Sánchez
- División Académica de Ciencias de la Salud (DACS), Universidad Juárez Autónoma de Tabasco (UJAT), Villahermosa, Tabasco, México
| | - Ibis de la Cruz-Hernández
- Hospital General de Zona No. 46, Instituto Mexicano del Seguro Social (IMSS), Villahermosa, Tabasco, México
| | - Meztli Ramos-García
- División Académica de Ciencias de la Salud (DACS), Universidad Juárez Autónoma de Tabasco (UJAT), Villahermosa, Tabasco, México
| | - Iván Sánchez-Yedra
- Hospital General de Zona No. 46, Instituto Mexicano del Seguro Social (IMSS), Villahermosa, Tabasco, México
| | - Carlos García-Vázquez
- División Académica de Ciencias de la Salud (DACS), Universidad Juárez Autónoma de Tabasco (UJAT), Villahermosa, Tabasco, México
| | | | | | - Viridiana Olvera-Hernández
- División Académica de Ciencias de la Salud (DACS), Universidad Juárez Autónoma de Tabasco (UJAT), Villahermosa, Tabasco, México
| | - Yolanda Mendoza-García
- Hospital General de Zona No. 46, Instituto Mexicano del Seguro Social (IMSS), Villahermosa, Tabasco, México
| | - Jorge Luis Ble-Castillo
- División Académica de Ciencias de la Salud (DACS), Universidad Juárez Autónoma de Tabasco (UJAT), Villahermosa, Tabasco, México.
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Villegas-Quintero VE, Rivas-Ruíz R, García-Rivero AA, Rivera-Lara P, González-Tovar NB. [Efficacy and safety of atorvastatin in major cardiovascular events: Meta-analysis]. Rev Med Inst Mex Seguro Soc 2023; 61:S407-S415. [PMID: 37934798 PMCID: PMC10735271 DOI: 10.5281/zenodo.8319748] [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] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/01/2023] [Indexed: 11/09/2023]
Abstract
Introduction Atorvastatin has been used in the management of dyslipidemia and little is known about the efficacy and safety of high-dose atorvastatin administration for secondary prevention of Major Cardiovascular Events (MACE). Objective To evaluate the impact of high-dose atorvastatin on secondary prevention of MACE and adverse events. Material and methods A systematic review and meta-analysis of Pubmed, Embase, Bireme and Cochrane Library Plus databases was performed, with a time scope from 1990 to July 2022. Six randomized clinical trials were included with a total of 29,333 patients who were treated with 80 mg, 10 mg or placebo doses of Atorvastatin where the main outcomes evaluated were Major Cardiovascular Events (MACE), mortality and treatment safety. Results In the comparative study between the use of Atorvastatin 80 mg and other therapies, a relative risk (RR) of 0.8 (95%CI 0.69-0.92) was found, representing a 20% reduction in risk (RRR) and a number needed to treat (NNT) of 30-55. In the analysis of adverse effects, an RR of 2.37 (95% CI 0.86-6.53) and a number needed to harm (NNH) of 14-19 were observed. The use of 80 mg atorvastatin is associated with similar adverse events at lower doses. Conclusions The use of atorvastatin 80 mg is effective in the secondary prevention of Major Cardiovascular Event (MACE). The drug has adverse events that should be taken into account in secondary prevention.
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Affiliation(s)
- Víctor Eder Villegas-Quintero
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro de Adiestramiento en investigación Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Rodolfo Rivas-Ruíz
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro de Adiestramiento en investigación Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alexis Alejandro García-Rivero
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro de Adiestramiento en investigación Clínica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Pedro Rivera-Lara
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Cardiología, Servicio de Urgencias. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Nelly Berenice González-Tovar
- Instituto Mexicano del Seguro Social, Centro Médico la Raza, Hospital de Especialidades, Servicio de Urgencias. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Corbella-Bagot L, Riquelme-McLoughlin C, Morgado-Carrasco D. Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders. Actas Dermosifiliogr 2023; 114:T784-T801. [PMID: 37543140 DOI: 10.1016/j.ad.2023.08.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023] Open
Abstract
JAK inhibitors target specific inflammatory cytokines involved in various inflammatory diseases. Four molecules have been approved for dermatological use: upadacitinib, baricitinib, abrocitinib and topical ruxolitinib. Off-label prescriptions for other dermatological conditions have been reported. We conducted a narrative review of the literature to assess the long-term safety profile of currently approved JAK inhibitors in dermatology, and their off-label use in skin disorders. We performed literature searches with PubMed and Google Scholar from January 2000 to January 2023, using the keywords "Janus kinase inhibitors", "JAK inhibitors","off-label", "dermatology", "safety", "adverse events", "ruxolitinib", "upadacitinib","abrocitinib" and "baricitinib". Our search yielded a total of 37 dermatological disorders with studies supporting the use of these JAK inhibitors. Preliminary studies indicate that JAK inhibitors generally have a favorable safety profile and can be considered as an option in many dermatological disorders.
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Affiliation(s)
- L Corbella-Bagot
- Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - C Riquelme-McLoughlin
- Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Departamento de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Departamento de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, España.
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Corbella-Bagot L, Riquelme-McLoughlin C, Morgado-Carrasco D. Long-Term Safety Profile and Off-Label Use of JAK Inhibitors in Dermatological Disorders. Actas Dermosifiliogr 2023; 114:784-801. [PMID: 37331618 DOI: 10.1016/j.ad.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
JAK inhibitors target specific inflammatory cytokines involved in various inflammatory diseases. Four molecules have been approved for dermatological use: upadacitinib, baricitinib, abrocitinib and topical ruxolitinib. Off-label prescriptions for other dermatological conditions have been reported. We conducted a narrative review of the literature to assess the long-term safety profile of currently approved JAK inhibitors in dermatology, and their off-label use in skin disorders. We performed literature searches with Pubmed and Google Scholar from January 2000 to January 2023, using the keywords "Janus kinase inhibitors", "JAK inhibitors", "off-label", "dermatology", "safety", "adverse events", "ruxolitinib", "upadacitinib", "abrocitinib" and "baricitinib". Our search yielded a total of 37 dermatological disorders with studies supporting the use of these JAK inhibitors. Preliminary studies indicate that JAK inhibitors generally have a favorable safety profile and can be considered as an option in many dermatological disorders.
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Affiliation(s)
- L Corbella-Bagot
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - C Riquelme-McLoughlin
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Department of Dermatology, Hospital de Figueres, Fundació Salut Empordà, Figueres, Spain.
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Martín-García P, Alonso-Arroyo A, Catalá-López F. Tumour necrosis factor (TNF) antagonist therapy for paediatric inflammatory bowel disease: A systematic review. Med Clin (Barc) 2023; 160:501-516. [PMID: 36967304 DOI: 10.1016/j.medcli.2023.02.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 06/07/2023]
Abstract
Inflammatory bowel disease includes two chronic inflammatory diseases, ulcerative colitis and Crohn's disease. The burden of disease is increasing worldwide. A few reviews evaluating the paediatric use of tumour necrosis factor (TNF) antagonists have been published, although these mostly include observational studies and do not consider economic evaluations. This systematic review evaluated the available evidence regarding the efficacy, safety, and cost-effectiveness of TNF antagonist therapy for paediatric inflammatory bowel disease. We searched PubMed/MEDLINE, Embase, and Cochrane Central (up to May 2022). Nine randomized clinical trials and four economic evaluations that examined any anti-TNF drugs (e.g., infliximab, adalimumab, golimumab, and certolizumab) against different alternatives were included. In studies evaluating the efficacy of anti-TNF drugs in Crohn's disease, most assessed the efficacy of maintenance regimen in patients who had previously responded to induction (response=28%-63%, and clinical remission=17%-83% depending on dose, drug, and follow-up). In ulcerative colitis, maintenance treatment with anti-TNF drugs reported clinical remission rates between 17% and 44%. Nine studies reported information on adverse events. No clinical trials comparing different anti-TNF drugs were found. The findings from this review suggest that maintenance treatment with anti-TNF drugs (such as infliximab and adalimumab) in paediatric inflammatory bowel disease is probably effective and safe. However, the economic evaluations reported contradictory results of the cost-effectiveness ratios. Protocol registry: Open Science Framework: https://osf.io/wjmvf.
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Affiliation(s)
- Paula Martín-García
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Adolfo Alonso-Arroyo
- Departamento de Historia de la Ciencia y Documentación, Universidad de Valencia, Valencia, España
| | - Ferrán Catalá-López
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Universidad de Valencia/Instituto de Investigación Sanitaria INCLIVA y CIBERSAM, Valencia, España; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canadá
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. Radiologia (Engl Ed) 2023; 65:269-284. [PMID: 37268369 DOI: 10.1016/j.rxeng.2022.09.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 06/04/2023]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- M Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - B Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - D Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J L Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - T Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - E Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - A M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - S Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - R J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - C Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J M Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J A Hidalgo Pérez
- Servicio de Radiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - V Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - H Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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12
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. Rev Esp Cardiol (Engl Ed) 2023; 76:183-196. [PMID: 36539182 DOI: 10.1016/j.rec.2022.12.002] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/23/2022]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- Manuel Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Beatriz Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - David Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Luis Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomás Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Eliseo Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - Alicia M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Susanna Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - Rosario J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - Gorka Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marcelo Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - Covadonga Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - José F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José María Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Esther Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Vicente Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Hug Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Río END, Lugo-Baruqui A, Prieto-Aldape R, Oseguera-Vizcaíno C, Covarrubias-Velasco MA. Seguridad y calidad de vida de los donadores renales. Comparación entre dos técnicas. CIR CIR 2023; 91:58-63. [PMID: 36787620 DOI: 10.24875/ciru.21000699] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Currently there are no studies that determine the safety and quality of life of kidney donors in Mexico. OBJECTIVE To determine the safety of being a kidney donor and the quality of life, comparing the open approach with hand-assisted laparoscopic technique. METHOD Observational, cross-sectional, analytical study of the kidney donors in our hospital from January 2015 to December 2018, in two groups: open technique and hand-assisted laparoscopic. To determine safety, the Clavien-Dindo scale and transoperative bleeding were used, and the SF-36 health-related quality of life questionnaire was applied. RESULTS There are no reports of peri-operative complications in any type of approach. All the patients obtained a grade I in the Clavien-Dindo scale. When the difference in the score of the SF-36 health-related quality of life questionnaire in kidney donor patients with hand-assisted laparoscopic surgical approach versus open approach was compared, a difference between both means of 14.05 was obtained, with p < 0.0001 in favor of the hand-assisted approach. CONCLUSIONS Being a kidney donor is safe and the approach that we recommend is hand-assisted laparoscopic nephrectomy.
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Affiliation(s)
| | | | - Rodrigo Prieto-Aldape
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara. Jalisco, Guadalajara, México
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Butragueño-Laiseca L, Torres L, O'Campo E, de la Mata Navazo S, Toledano J, López-Herce J, Mencía S. Evaluation of tracheal intubations in a paediatric intensive care unit. An Pediatr (Barc) 2023; 98:109-118. [PMID: 36740510 DOI: 10.1016/j.anpede.2023.01.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Tracheal intubation is a frequent procedure in paediatric intensive care units (PICUs) that carries a risk of complications that can increase morbidity and mortality. PATIENTS AND METHODS Prospective, longitudinal, observational study in patients intubated in a level III PICU between January and December 2020. We analysed the risk factors associated with failed intubation and adverse events. RESULTS The analysis included 48 intubations. The most frequent indication for intubation was hypoxaemic respiratory failure (25%). The first attempt was successful in 60.4% of intubations, without differences between procedures performed by staff physicians and resident physicians (62.5% vs 56.3%; P = .759). Difficulty in bag-mask ventilation was associated with failed intubation in the first attempt (P = .028). Adverse events occurred in 12.5% of intubations, and severe events in 8.3%, including 1 case of cardiac arrest, 2 cases of severe hypotension and 1 of oesophageal intubation with delayed recognition. None of the patients died. Making multiple attempts was significantly associated with adverse events (P < .002). Systematic preparation of the procedure with cognitive aids and role allocation was independently associated with a lower incidence of adverse events. CONCLUSIONS In critically ill children, first-attempt intubation failure is common and associated with difficulty in bag-mask ventilation. A significant percentage of intubations may result in serious adverse events. The implementation of intubation protocols could decrease the incidence of adverse events.
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Affiliation(s)
- Laura Butragueño-Laiseca
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | - Laura Torres
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Elena O'Campo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Sara de la Mata Navazo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), Madrid, Spain
| | - Javier Toledano
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Santiago Mencía
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Pérez Alonso L, Cervera Calero R, Campos Fernández de Sevilla MÁ, Moreno Palanco MÁ, Gómez Cerezo JF. Evolocumab as treatment in lorlatinib-related hyperlipidemia. Clin Investig Arterioscler 2023:S0214-9168(22)00138-3. [PMID: 36641361 DOI: 10.1016/j.arteri.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
Anti-PCSK9 monoclonal antibodies have reduced the risk of cardiovascular events in patients with atheroesclerosis cardiovascular disease. However, its use has not been described in hyperlipidemia associated with lorlatinib, a third-generation ALK tyrosin kinasa inhibitor approved as treatment for ALK-positive non-small cell lung cancer.
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Echeverría Gorriti A, Alzueta Istúriz N, García González P, Fernández González J, Sanz Álvarez L, Garjón Parra J. [Off-label use of gabapentinoid drugs: is it necessary a deprescription strategy?]. Gac Sanit 2022; 37:102283. [PMID: 36565565 DOI: 10.1016/j.gaceta.2022.102283] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate gabapentin and pregabalin treatment adequacy to label indications, to analyze off-label use and to identify patients at high risk of respiratory depression. METHOD An observational, retrospective study was performed. It included patients treated with pregabalin and gabapentin during 2020 in Navarre. RESULTS A total of 9778 patients were treated with gabapentin or pregabalin during the first two months of 2020. In 56% of the cases, gabapentinoids were prescribed for off-label uses. Sixty percent of patients were taking at least one central nervous system (CNS) depressant drug concomitantly, 33% of them opioids, 20% of them combined opioids with CNS depressants and 4% of them at least one systemic antihistamine. In addition, 11% of the patients had a diagnosis of asthma or COPD. Prevalences remained constant along the year. CONCLUSIONS It is necessary to implement a gabapentinoid deprescription strategy to improve its use and reduce safety problems.
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Affiliation(s)
- Amaya Echeverría Gorriti
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España.
| | - Natalia Alzueta Istúriz
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Patricia García González
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Julen Fernández González
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Lorea Sanz Álvarez
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | - Javier Garjón Parra
- Subdirección de Farmacia y Prestaciones, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
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Ortiz-Movilla R, Funes-Moñux RM, Domingo-Comeche LD, Beato-Merino M, Martínez-Bernat L, Royuela-Vicente A, Román-Riechmann E, Marín-Gabriel MÁ. Combined application of various quality assessment tools in neonatal resuscitation. An Pediatr (Barc) 2022; 97:405-14. [PMID: 36257893 DOI: 10.1016/j.anpede.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates. MATERIAL AND METHODS Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods. RESULTS Total of 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P < .001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period. CONCLUSIONS The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparation.
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Alonso Castillo R, Martínez Castrillo JC. Neurological manifestations associated with COVID-19 vaccine. Neurologia 2022:S2173-5808(22)00141-9. [PMID: 36288776 PMCID: PMC9595420 DOI: 10.1016/j.nrleng.2022.09.007] [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: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has spread rapidly, giving rise to a pandemic, causing significant morbidity and mortality. In this context, many vaccines have emerged to try to deal with this disease. OBJECTIVE To review the reported cases of neurological manifestations after the application of COVID-19 vaccines, describing clinical, analytical and neuroimaging findings and health outcomes. METHODS We carried out a review through bibliographic searches in PubMed. RESULTS We found 86 articles, including 13 809 patients with a wide spectrum of neurological manifestations temporally associated with COVID-19 vaccination. Most occurred in women (63.89%), with a median age of 50 years. The most frequently reported adverse events were Bell's palsy 4936/13 809 (35.7%), headache (4067/13 809), cerebrovascular events 2412/13 809 (17.47%), Guillain-Barré syndrome 868/13 809 (6.28%), central nervous system demyelination 258/13 809 (1.86%) and functional neurological disorder 398/13 809 (2.88%). Most of the published cases occurred in temporal association with the Pfizer vaccine (BNT162b2), followed by the AstraZeneca vaccine (ChAdOX1-S). CONCLUSIONS It is not possible to establish a causal relationship between these adverse events and COVID-19 vaccines with the currently existing data, nor to calculate the frequency of appearance of these disorders. However, it is necessary for health professionals to be familiar with these events, facilitating their early diagnosis and treatment. Large controlled epidemiological studies are necessary to establish a possible causal relationship between vaccination against COVID-19 and neurological adverse events.
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Affiliation(s)
- R Alonso Castillo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - J C Martínez Castrillo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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Meca-Lallana JE, Fernández-Prada M, García Vázquez E, Moreno Guillén S, Otero Romero S, Rus Hidalgo M, Villar Guimerans LM, Eichau Madueño S, Fernández Fernández Ó, Izquierdo Ayuso G, Álvarez Cermeño JC, Arnal García C, Arroyo González R, Brieva Ruiz L, Calles Hernández C, García Merino A, González Platas M, Hernández Pérez MÁ, Moral Torres E, Olascoaga Urtaza J, Oliva-Nacarino P, Oreja-Guevara C, Ortiz Castillo R, Oterino A, Prieto González JM, Ramió-Torrentá L, Rodríguez-Antigüedad A, Saiz A, Tintoré M, Montalbán Gairin X. Consensus statement on the use of alemtuzumab in daily clinical practice in Spain. Neurologia 2022; 37:615-630. [PMID: 31987648 DOI: 10.1016/j.nrl.2019.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.
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Affiliation(s)
- J E Meca-Lallana
- CSUR Esclerosis Múltiple. Servicio de Neurología. Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-ARRIXACA), Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM. Universidad Católica San Antonio, Murcia, España.
| | - M Fernández-Prada
- Servicio de Medicina Preventiva y Salud Pública, Hospital Vital Álvarez-Buylla, Mieres (Asturias), España
| | - E García Vázquez
- Servicio de MI-Infecciosas. Hospital Clínico Universitario Virgen de la Arrixaca, Departamento de Medicina. Facultad de Medicina. Universidad de Murcia. IMIB-Arrixaca, Murcia, España
| | - S Moreno Guillén
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - S Otero Romero
- Centro de Esclerosis Múltiple de Cataluña (Cemcat), Servicio de Neurología/Neuroinmunología, Hospital Universitario Vall de Hebrón, Barcelona, España
| | - M Rus Hidalgo
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - L M Villar Guimerans
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - S Eichau Madueño
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - Ó Fernández Fernández
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, España
| | - G Izquierdo Ayuso
- Unidad de Investigación y Tratamiento de Esclerosis Múltiple, Hospital Vithas Nisa, Castilleja de la Cuesta (Sevilla), España
| | - J C Álvarez Cermeño
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Arnal García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Hospital General, Granada, España
| | - R Arroyo González
- Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón (Madrid), España
| | - L Brieva Ruiz
- Servicio de Neurología, Hospital Arnau de Vilanova, IRBLLEIDA, Lérida, España
| | | | - A García Merino
- Servicio de Neurología, Unidad de Neuroinmunología, Hospital Universitario Puerta de Hierro, Majadahonda (Madrid), España
| | - M González Platas
- Hospital Universitario de Canarias, La Cuesta (Santa Cruz de Tenerife), España
| | - M Á Hernández Pérez
- Servicio de Neurología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - E Moral Torres
- Servicio de Neurología, Hospital Moisés Broggi y Hospital General de ĺHospitaletí, Sant Joan Despí (Barcelona), España
| | - J Olascoaga Urtaza
- Unidad de EM Hospital Universitario Donostia-Instituto de Investigación BIODONOSTIA, San Sebastián (Guipúzcoa), España
| | - P Oliva-Nacarino
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - C Oreja-Guevara
- Neurología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | | | - A Oterino
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Prieto González
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, Santiago de Compostela (La Coruña), España
| | - L Ramió-Torrentá
- Unidad de Neuroinmunología y Esclerosis Múltiple Territorial de Gerona, Servicio de Neurología. Hospital Universitario Doctor Josep Trueta, Grupo Neurodegeneración y Neuroinflamación. IDIBGI, Facultad de Medicina. Universidad de Gerona, Gerona, España
| | | | - A Saiz
- Servicio de Neurología, Hospital Clínico, Universidad de Barcelona, Barcelona, España
| | - M Tintoré
- Centro de Esclerosis Múltiple de Cataluña (Cemcat), Servicio de Neurología/Neuroinmunología, Hospital Universitario Vall de Hebrón, Barcelona, España
| | - X Montalbán Gairin
- Centro de Esclerosis Múltiple de Cataluña (Cemcat), Servicio de Neurología/Neuroinmunología, Hospital Universitario Vall de Hebrón, Barcelona, España
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Bajo MA, Ríos-Moreno F, Arenas MD, Devesa-Such RJ, Molina-Higueras MJ, Delgado M, Molina P, García-Fernández N, Martin-Malo A, Peiró-Jordán R, Cannata-Andia J, Martín-De Francisco ÁL. Safety and effectiveness of sucroferric oxyhydroxide in Spanish patients on dialysis: sub-analysis of the VERIFIE study. Nefrologia 2022; 42:594-606. [PMID: 36739246 DOI: 10.1016/j.nefroe.2021.04.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND AND AIMS In this study, we show the results of the subset of Spanish patients of the VERIFIE study, the first post-marketing study assessing the long-term safety and effectiveness of sucroferric oxyhydroxide (SFOH) in patients with hyperphosphatemia undergoing dialysis during clinical practice. PATIENTS AND METHODS Patients undergoing hemodialysis and peritoneal dialysis with indication of SFOH treatment were included. Follow-up duration was 12-36 months after SFOH initiation. Primary safety variables were the incidence of adverse drug reactions (ADRs), medical events of special interest (MESIs), and variations in iron-related parameters. SFOH effectiveness was evaluated by the change in serum phosphorus levels. RESULTS A total of 286 patients were recruited and data from 282 were analyzed. Among those 282 patients, 161 (57.1%) withdrew the study prematurely and 52.5% received concomitant treatment with other phosphate binders. ADRs were observed in 35.1% of patients, the most common of which were gastrointestinal disorders (77.1%) and mild/moderate in severity (83.7%). MESIs were reported in 14.2% of patients, and 93.7% were mild/moderate. An increase in ferritin (386.66ng/mL vs 447.55ng/mL; p=0.0013) and transferrin saturation (28.07% vs 30.34%; p=0.043) was observed from baseline to the last visit (p=0.0013). Serum phosphorus levels progressively decreased from 5.69mg/dL at baseline to 4.84mg/dL at the last visit (p<0.0001), increasing by 32.2% the proportion of patients who achieved serum phosphorus levels ≤5.5mg/dL, with a mean daily SFOH dose of 1.98 pills/day. CONCLUSIONS SFOH showed a favorable effectiveness profile, a similar safety profile to that observed in the international study with most adverse events of mild/moderate severity, and a low daily pill burden in Spanish patients in dialysis.
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Affiliation(s)
- María Auxiliadora Bajo
- Hospital Universitario La Paz, Madrid, Instituto de Investigación Sanitaria del HULP (IdiPAZ), Madrid, Spain; Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) del Instituto de Salud Carlos III, Universidad Autónoma Madrid, Madrid, Spain.
| | | | - Maria Dolores Arenas
- Hospital Vithas Perpetuo Socorro, Alicante, Spain; Hospital del Mar, Barcelona, Spain
| | - Ramón Jesús Devesa-Such
- FMC Valencia, Valencia Spain; Servicio de Nefrología, Hospital Universitari y Politècnic La Fe, Valencia, Spain
| | | | | | - Pablo Molina
- Hospital Doctor Peset, Valencia, FISABIO, Valencia, Spain; Departamento de Medicina de la Universitat de València, Valencia, Spain
| | - Nuria García-Fernández
- Departamento de Nefrología, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Alejandro Martin-Malo
- Hospital Universitario Reina Sofía, IMIBIC, REDinREN, Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
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Sánchez Tocino ML, López González A, Villoria González S, González Sánchez MI, García Macías M, González Horna A, Puente González AS, Handel Blanc M, Furaz Czereak K, Sánchez Tocino H. Validation of the inverse method for the determination of the access flow with thermodilution. Nefrologia 2022; 42:56-64. [PMID: 36153900 DOI: 10.1016/j.nefroe.2022.03.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 01/17/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Thermodiluction is a widely used method for measuring vascular access flow (QA). Among the possibilities of TD, the reverse method (MI) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique. METHOD Transversal study of 117 arteriovenous fistulas (AVF). Two QA measurements were taken with the method described by the manufacturer (MR) and another with MI. MI is bases in the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used. RESULTS Very good concordance between MR and MI was evidenced for QA below 700 ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and MI (inter-method variability), which was 2% (-14, 12) (P = 0.287). The degree of agreement between the two to identify AVFs susceptible to intervention was very good (K = 0.834). The time spent using the MI was significantly shorter (P = 0.000) without evidence of variations in the Kt of the measurement sessions (P = 0.201). CONCLUSIONS The thermodiluction MI is valid to determine the flow of the vascular access, especially in Qa lower than 700 ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and MI is similar to that of MR. The concordance between methods in identifying potentially pathological AVFs is very good.
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22
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Villegas-Echeverri JD, López-Isanoa JD, Piedrahita-Gutiérrez DL, Bastidas-Guarín C, Cuello-Salcedo AM, López-Jaramillo JD. Ten steps towards a safe and feasible total laparoscopic hysterectomy. CIR CIR 2021; 89:624-631. [PMID: 34665167 DOI: 10.24875/ciru.20000845] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To contribute to the training of specialists by describing in a systematic and detailed way the ten steps to perform a safe and feasible Total Laparoscopic Hysterectomy (HTL). METHOD The detailed description of the steps of the HTL intends that this procedure can be safely and effectively reproduced. RESULTS By clearly knowing the steps of HTL, it is possible to favor minimally invasive routes so that patients benefit from its multiple proven benefits. CONCLUSIONS The benefits of minimally invasive routes for performing a hysterectomy have already been demonstrated in the literature. It is particularly important that specialists are familiar with these techniques and that groups standardize the procedure so that more patients can safely undergo and benefit from the laparoscopic approach.
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Affiliation(s)
- Juan D Villegas-Echeverri
- Unidad de Laparoscopia Ginecológica Avanzada y Dolor Pélvico, ALGIA, Clínica Comfamiliar, Pereira, Colombia
| | - Jorge D López-Isanoa
- Unidad de Laparoscopia Ginecológica Avanzada y Dolor Pélvico, ALGIA, Clínica Comfamiliar, Pereira, Colombia
| | | | - Claudia Bastidas-Guarín
- Unidad de Laparoscopia Ginecológica Avanzada y Dolor Pélvico, ALGIA, Clínica Comfamiliar, Pereira, Colombia
| | - Angélica M Cuello-Salcedo
- Unidad de Laparoscopia Ginecológica Avanzada y Dolor Pélvico, ALGIA, Clínica Comfamiliar, Pereira, Colombia
| | - José D López-Jaramillo
- Unidad de Laparoscopia Ginecológica Avanzada y Dolor Pélvico, ALGIA, Clínica Comfamiliar, Pereira, Colombia
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Sánchez Tocino ML, López González A, Villoria González S, González Sánchez MI, García Macías M, González Horna A, Puente González AS, Handel Blanc M, Furaz Czereak K, Sánchez Tocino H. Validation of the inverse method for the determination of the access flow with thermodilution. Nefrologia 2021; 42:S0211-6995(21)00089-8. [PMID: 34148666 DOI: 10.1016/j.nefro.2021.01.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 01/17/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Thermodilution is a widely used method for measuring vascular access flow (QA). Among the possibilities of thermodilution, the reverse method (RM) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique. METHOD Transversal study of 117 arteriovenous fistulas. Two QA measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used. RESULTS Very good concordance between MR and RM was evidenced for QA below 700ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (-14,12) (P=.287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa=0.834). The time spent using the RM was significantly shorter (P=.000) without evidence of variations in the Kt of the measurement sessions (P=.201). CONCLUSIONS The thermodilution RM is valid to determine the flow of the vascular access, especially in QA lower than 700ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good.
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Rodríguez Escobedo R, González Martínez S, Díaz Naya L, Suárez Gutiérrez L, Fernández Morera JL, Riestra Fernández M, Martínez Faedo C, Villazón González F, Menéndez Torre EL. [Real-life efficacy and safety of PCSK9 inhibitors treatment: Experience in three hospitals in Asturias]. Semergen 2021; 47:369-375. [PMID: 34112592 DOI: 10.1016/j.semerg.2021.03.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inhibitors of proprotein convertase subtilisin/kexin type9 (PCSK9 inhibitors) are a treatment option for those patients with familial hypercholesterolemia or in secondary prevention who do not reach the LDL-C target with other therapeutic measures. The aim of this study is to assess the effectiveness and safety of these drugs. METHODS Retrospective, multicentric, descriptive study. We collected data from all patients that have started PCSK9 inhibitors treatment in three hospitals in Asturias since the beginning of its use in 2016. We analysed changes in lipid profile with PCSK9 inhibitors and its side effects. RESULTS We registered 98 patients, 75 of them affected by familial hypercholesterolemia (FH) and 23 unaffected. Two months after the beginning of PCSK9 inhibitors treatment, a 61% reduction rate in LDL-C in patients with FH and 52% in those without this condition was observed. This statistically significant reduction remained stable during follow-up. A significant decrease in total cholesterol was observed, without significant changes in HDL-C and triglycerides. 96% of patients had no complications. CONCLUSIONS PCSK9 inhibitors are safe drugs that rapidly achieve significant reductions in LDL-C after the beginning of treatment, which are maintained over time. Hence, the use of PCSK9 inhibitors is an alternative for the control of LDL-C in those patients in which the LDL-C target is not reached with other therapeutic measures.
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Affiliation(s)
- R Rodríguez Escobedo
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA).
| | - S González Martínez
- Hospital Vital Álvarez Buylla, Mieres, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
| | - L Díaz Naya
- Hospital Universitario de Cabueñes, Gijón, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
| | - L Suárez Gutiérrez
- Hospital Universitario San Agustín, Avilés, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
| | | | - M Riestra Fernández
- Hospital Universitario de Cabueñes, Gijón, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
| | - C Martínez Faedo
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
| | - F Villazón González
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
| | - E L Menéndez Torre
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad. Instituto de Investigación del Principado de Asturias (ISPA)
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Vaquerizo Alonso C, Bordejé Laguna L, Fernández-Ortega JF. Recommendations for specialized nutritional-metabolic management of the critical patient: introduction, methodology and list of recommendations. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2021; 44 Suppl 1:1-14. [PMID: 32532404 DOI: 10.1016/j.medin.2020.02.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
The Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) has reviewed and updated the recommendations for specialized nutritional and metabolic support in critically ill patients published by the Group in 2011, with the primary aim of helping decision making in daily clinical practice. The recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically ill patients, and were drafted between March 2016 and February 2019. A level of evidence has been provided for each of the recommendations, based on the GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation Working Group). A grade of recommendation has also been produced, taking into account the clinical impact of the recommendation, regardless of the level of evidence established by the GRADE scale.
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Rosado-Urteaga M, Prera Á, Muñoz J, Domínguez A, Ferran A, González J, García D, Prats J. Live surgery: Safety study after 17 editions of retroperitoneoscopic surgery. Actas Urol Esp 2021; 45:281-288. [PMID: 33602592 DOI: 10.1016/j.acuro.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Live surgery has become an excellent tool for medical training. Despite this, there is controversy about the safety of the patients involved. OBJECTIVE To analyze the results of live surgeries performed in 17 consecutive retroperitoneoscopy courses organized in our center. Procedures performed were partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU). MATERIAL AND METHODS Review from January 2010 to October 2017 of all live surgeries carried out by an expert surgical team in the retroperitoneoscopy courses, compared with a control group of surgeries performed in standard conditions. A matching (1:1 for each RN and 1:2 for each PN and NU) according to age, body mass index and comorbidities was performed. RESULTS Twenty-one live surgeries were analyzed (eight PN, seven RN and six NU) with a global median follow-up of 38 months. No significant differences were observed between both groups in terms of perioperative variables (operative time, operative bleeding and intraoperative complications) or of postoperative complications and length of hospital stay. Likewise, there were no differences between recurrence rates (PN: 0% vs. 6.3%, p = 0.47, NU: 33.3% vs. 66.7%, p = 0.180, RN: 0% vs. 28.6%, p = 0,127). CONCLUSIONS Live surgery in the hands of expert surgeons in a suitable environment and with well-selected patients does not increase the risk of complications and allows maintaining the same oncological outcomes.
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Ruiz Guerrero E, Ledo Cepero MJ, Ojeda Claro AV, Soto Delgado M, Álvarez-Ossorio Fernández JL. Renal angiomyolipoma and tuberous sclerosis complex: long-term safety and efficacy outcomes of Everolimus therapy. Actas Urol Esp 2021; 45:264-272. [PMID: 33637375 DOI: 10.1016/j.acuro.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/25/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy. MATERIAL AND METHODS Descriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause. RESULTS We confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment. CONCLUSION Everolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up.
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Affiliation(s)
- E Ruiz Guerrero
- Unidad de Uro-Oncología, Servicio Urología, Hospital Universitario Puerta del Mar, INIBICA (Instituto de Investigación e Innovación Biomédica), Cádiz, España.
| | - M J Ledo Cepero
- Unidad de Uro-Oncología, Servicio Urología, Hospital Universitario Puerta del Mar, INIBICA (Instituto de Investigación e Innovación Biomédica), Cádiz, España
| | - A V Ojeda Claro
- Unidad de Uro-Oncología, Servicio Urología, Hospital Universitario Puerta del Mar, INIBICA (Instituto de Investigación e Innovación Biomédica), Cádiz, España
| | - M Soto Delgado
- Unidad de Uro-Oncología, Servicio Urología, Hospital Universitario Puerta del Mar, INIBICA (Instituto de Investigación e Innovación Biomédica), Cádiz, España
| | - J L Álvarez-Ossorio Fernández
- Unidad de Uro-Oncología, Servicio Urología, Hospital Universitario Puerta del Mar, INIBICA (Instituto de Investigación e Innovación Biomédica), Cádiz, España
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Sedigh O, Dalmasso E, Barale M, Pizzuto G, Agosti S, Dadone C, Maugeri O, Giammo A, Manassero A, Gontero P. UVENTA urethral stents: Are we taking a step forward? The first clinical series. ARCH ESP UROL 2021; 74:435-440. [PMID: 33942736] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe first clinical results in term of safety, complications and short term efficacy of temporary placement of UVENTA urethral stent in the treatment of urethral and bladder neck strictures. METHODS UVENTA urethral stent (Taewoong Medical) is a temporary self expandable covered metallic stent. Anti-migration system and different radial force distribution are the two main innovations. This is a retrospective evaluation of UVENTA stent temporary placements for urethral diseases in two urological Centers. RESULTS 15 patients underwent UVENTA stent placement between 2016 and 2018. Stent placement was easy and quick in all cases. Considering indwelling period: one patient reported urethral pain related to the stent in the first month, three patients had urinary infection treated with antibiotics; temporary stress incontinence was noted in 21% of bulbar-membranous stents; stent migrations was noted in 3 out of 4 bladder neck cases whereas no bulbar-membranous stents migrated. At removal no significant incrustation, stone or tissue ingrowth were noted, as well as new proximal or distal strictures. Stent removal was uncomplicated in all cases. Median follow up is 9.5 months (6-24). Considering strictures overall success rate is 73% (11/15): 82% for bulbar urethra (9/11) and 50% for bladder neck (2/4). CONCLUSIONS UVENTA urethral stent showed a satisfying safety profile with few and low grade complications. Absence of migration and damage on healthy mucosa are main achievements. Further cases are needed to confirm these results and to really explore its efficacy.
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Affiliation(s)
- Omid Sedigh
- Division of Urology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
| | - Ettore Dalmasso
- Division of Urology. Santa Croce e Carle Hospital. Cuneo. Italy
| | - Maurizio Barale
- Division of Urology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
| | - Giuseppe Pizzuto
- Division of Urology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
| | - Simone Agosti
- Division of Urology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
| | - Claudio Dadone
- Division of Urology. Santa Croce e Carle Hospital. Cuneo. Italy
| | - Orazio Maugeri
- Division of Urology. Santa Croce e Carle Hospital. Cuneo. Italy
| | - Alessandro Giammo
- Division of Neurourology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
| | - Alberto Manassero
- Division of Neurourology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
| | - Paolo Gontero
- Division of Urology. Città della Salute e della Scienza di Torino. University of Turin. Turin. Italy
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Morales-García D, Docobo-Durantez F, Capitán Vallvey JM, Suarez-Grau JM, Campo-Cimarras ME, González-Vinagre S, Hidalgo-Grau LA, Puigcercos-Fusté JM, Zaragoza-Fernández C, Valera-Sánchez Z, Vega-Ruiz V. Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic. Cir Esp 2021; 100:115-124. [PMID: 33994557 PMCID: PMC8075840 DOI: 10.1016/j.ciresp.2021.04.012] [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: 02/09/2021] [Accepted: 04/17/2021] [Indexed: 11/27/2022]
Abstract
La situación actual de la pandemia por SARS-CoV-2 tiene paralizada la cirugía no urgente y/u oncológica en muchos hospitales de nuestro país con lo que esto conlleva para la salud de los ciudadanos que están pendientes de una intervención quirúrgica. La cirugía mayor ambulatoria puede abarcar en su cartera de servicios más del 85% de los procedimientos quirúrgicos que se realizan en un servicio de cirugía y se presenta como una alternativa factible y segura en el momento actual ya que no requiere camas de ingreso y disminuye claramente el riesgo de infección. Además, es la herramienta que debería generalizarse para solucionar la acumulación de pacientes en lista de espera que la pandemia está generando, por lo que parece oportuno que desde la sección de Cirugía Mayor Ambulatoria de la Asociación Española de Cirujanos se presente una serie de recomendaciones para la implementación de la misma en estas circunstancias excepcionales que nos toca vivir.
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Affiliation(s)
- Dieter Morales-García
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Universitario «Marqués de Valdecilla», Instituto de Investigación IDIVAL, Santander, España.
| | - Fernando Docobo-Durantez
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Comité Científico, Asociación Andaluza de Cirujanos, Andalucía, España
| | - J M Capitán Vallvey
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Universitario de Jaén, Jaén, España
| | - Juan Manuel Suarez-Grau
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Riotinto, Huelva, España
| | - María Eugenia Campo-Cimarras
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Txagorritxu, Vitoria, España
| | - Salustiano González-Vinagre
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Universitario de Santiago, Santiago de Compostela, España
| | - Luis Antonio Hidalgo-Grau
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital de Mataró, Barcelona, España
| | - J M Puigcercos-Fusté
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Dos de Mayo, Barcelona, España
| | - Cristóbal Zaragoza-Fernández
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital General Universitario de Valencia, Valencia, España
| | - Zoraida Valera-Sánchez
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Universitario Virgen Macarena, Sevilla, España
| | - Vicente Vega-Ruiz
- Sección de Cirugía Mayor Ambulatoria, Asociación Española de Cirujanos, Madrid, España; Hospital Universitario Puerto Real, Cádiz, España
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Jahangiri M, Malakoutikhah M, Choobineh A, Zare A. Nurses' uncertainty about medical gloves safety during the COVID-19 pandemic. J Healthc Qual Res 2021; 36:294-300. [PMID: 33975815 PMCID: PMC8075845 DOI: 10.1016/j.jhqr.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/27/2021] [Accepted: 03/27/2021] [Indexed: 12/24/2022]
Abstract
Background Nurses, as the largest group of health professionals, are at the frontline of the healthcare system in response to COVID-19 epidemic. This study aimed to evaluate the nurses’ certainty and satisfaction with medical gloves when exposed to coronavirus in Fars province, south of Iran. Methods Using convenience sampling, 400 hospital nurses during the COVID-19 outbreak were selected from eight hospitals of Shiraz University of Medical Sciences (SUMS). A questionnaire about glove reliability, including protection in tasks, durability, integrity and tear resistance, feeling fearful, and focusing on duties, and the nurses’ anxiety regarding their infection with coronavirus was distributed to the selected nurses to complete. 375 questionnaires were completed (response rate of 93.75%). Among the participants, 180 (48%) were in the corona section and 195 (52%) were hardly possible to have contact with coronavirus pneumonia patients. Results The mean score (SD) of anxiety about infection with COVID-19 for nurses in the COVID-19 section and those in the non-COVID-19 section were 6.08 (2.8) and 4.56 (2.58), respectively (p < 0.05). The mean duration of gloves usage in a day was almost similar in the two groups (about 5 h), but the number of glove replacements was significantly higher among the nurses in the corona section (6 times) compared to those in the non-corona section (3 times). The two groups were also significantly different regarding glove protection in daily tasks and glove durability. Conclusion The nurses in the corona section had more concerns about medical gloves as a type of personal protective equipment. In addition to health education on controlling and preventing the spread of diseases, raising awareness about the reliability of personal protective equipment can improve nurses’ performance.
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Affiliation(s)
- M Jahangiri
- Research Center for Health Sciences, Institute of Health, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Malakoutikhah
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Zare
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Adánez Martínez MG, Leal Costa C, García López JA, Torres Ganfornina M, Ramos Morcillo AJ, Hernández Ruipérez T, García Palenciano C, Díaz Agea JL. Perception of level of knowledge, skills, and safety before and after training to perform videolaryngoscopy with the Intubox barrier system for airway management in patients with COVID-19. Emergencias 2021; 33:93-99. [PMID: 33750049] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The main objective was to describe physicians’ perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation. MATERIAL AND METHODS Single-arm clinical simulation trial. The participants were physicians who received training in both a lowfidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually. RESULTS Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place. CONCLUSION After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation.
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Affiliation(s)
- María Gracia Adánez Martínez
- Servicio de Urgencias Hospitalarias, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, España
| | | | - José Antonio García López
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | - Máximo Torres Ganfornina
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | | | - Tomás Hernández Ruipérez
- Servicio de Urgencias Hospitalarias, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad Católica de Murcia (UCAM), Murcia, España
| | - Carlos García Palenciano
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, España
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Garcia Del Campo C, Murcia Soler M, Martinez-Mir I, Palop Larrea V. [Adequacy of the safety of metamizole and agranulocytosis]. Aten Primaria 2021; 53:102047. [PMID: 33823317 PMCID: PMC8047160 DOI: 10.1016/j.aprim.2021.102047] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
Objetivo Analizar si la nota informativa de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), de 30 de octubre del 2018, sobre agranulocitosis y metamizol contiene la información precisa y necesaria para proteger a los pacientes de la aparición de esta reacción adversa (RA) y si la documentación oficial de los medicamentos con metamizol para médicos, farmacéuticos y población general está adaptada a las directrices de la AEMPS para disminuir el riesgo. Emplazamiento y participantes Nota informativa, búsqueda bibliográfica, información sobre los medicamentos con metamizol comercializados en España en la Agencia Europea del Medicamento, fichas técnicas, prospectos, base de datos de información sanitaria Bot PLUS y Catálogo de Especialidades Farmacéuticas. Notificación de 4 casos de agranulocitosis por metamizol posteriores a la fecha de la nota informativa. Intervenciones y mediciones principales Comparación de los puntos clave de la nota informativa y de los documentos oficiales sobre metamizol con la bibliografía. Descripción de 4 casos de agranulocitosis por metamizol y aplicación del algoritmo de causalidad y gravedad. Resultados La nota informativa presenta ausencias y dudas respecto a la bibliografía y al uso de metamizol en la práctica asistencial. Los documentos oficiales presentan faltas de actualización, indicaciones no aprobadas y dosis superiores a las recomendadas. La nota informativa no ha frenado la presentación de casos de agranulocitosis por metamizol. Conclusiones La nota informativa de la AEMPS es mejorable y es necesario actualizar los documentos oficiales de información sobre el metamizol para profesionales sanitarios y pacientes para disminuir el riesgo de agranulocitosis.
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Affiliation(s)
- Cristina Garcia Del Campo
- Traductora médica y jurídica, presidenta de la Asociación de Afectados por Fármacos (ADAF), Jávea, Alicante, España
| | - Miguel Murcia Soler
- Farmacéutico de Atención Primaria, Departamento de Salud de La Ribera, Conselleria de Sanitat Universal i Salut Pública, Valencia, España
| | - Inocencia Martinez-Mir
- Técnica superior de Investigación, Dirección Gerencia Consorcio Hospital General Universitario de Valencia, Fundación IHGU, Valencia, España
| | - Vicente Palop Larrea
- Médico especialista en Medicina Familiar y Comunitaria, consulta de Fibromialgia, Unidad de Aparato Locomotor, Hospital de Denia, Alicante. Grupo de Fármacos de semFYC, Grupo de Investigación en Humanidades Histex, España.
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Prado-Mel E, Mejías Trueba M, Reyes González I, Gallego Espina MA, Martín Márquez MT, Alfaro Lara ER. [Failure mode effect analysis for safety improvement in the automatic drug dispensing systems]. J Healthc Qual Res 2021; 36:81-90. [PMID: 33495116 DOI: 10.1016/j.jhqr.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/15/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the risks in automated dispensing cabinet use in order to improve routine procedure safety. METHODS We used the Failure Mode Effect Analysis (FMEA) methodology. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. We assessed the impact associated with each failure mode with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for failure modes with RPN>100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated. RESULTS The process was divided into five sub-processes: automatic delivery of order replacement, to prepare order in a pyramidal cart, transport of the pyramidal cart from the pharmacy service to the automated dispensing cabinet, replacement of the automated dispensing cabinet by the pharmacy technician and dispensing/returning by nursing staff. Twenty-two failure modes, with 25 cases and with varying effects (severity 2-8) were evaluated. The sub-process with more failure modes with NPR>100 was dispensing/returning by nursing staff. CONCLUSIONS The FMEA methodology was a useful tool when applied to automated dispensing cabinet system use. The implementation of improvement actions significantly reduced the risk.
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Guilabert Giménez A, Guilabert Mora M. [Safe surgery and COVID-19: A narrative review]. J Healthc Qual Res 2021; 36:160-7. [PMID: 33589399 DOI: 10.1016/j.jhqr.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/02/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Fundamentos La interrupción de la actividad asistencial quirúrgica en España provocada por la pandemia debe finalizar. La recuperación de esta actividad ha de realizarse de forma electiva y en convivencia con posibles casos de COVID-19. El objetivo de esta revisión fue la incorporación de criterios de buenas prácticas relacionados con la COVID-19 al contexto de cirugía segura, que permitiesen desarrollar una propuesta de lista de verificación de seguridad quirúrgica adaptada a pacientes con esta enfermedad. Métodos Revisión bibliográfica narrativa, siguiendo el protocolo PRISMA, en los repertorios Medline y Cochrane, utilizando los términos MeSH (coronavirus, infections, safety, surgical procedures, operative, checklist) y el operador booleano AND. Además, se revisaron recomendaciones de organismos y sociedades científicas (literatura gris). Resultados Se incluyeron 33 estudios finales con recomendaciones para la cirugía segura y lista de verificación de seguridad quirúrgica adaptada para COVID-19, siendo los más frecuentes los aspectos relacionados con el tratamiento (41,3%) y medidas de prevención y control (27,6%). Conclusiones La existencia de un amplio consenso en buenas prácticas recomendadas a pacientes COVID quirúrgicos permite realizar una propuesta de lista de verificación de seguridad quirúrgica a estos enfermos.
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Moreiras-Plaza M, Nieto-Baltar B, Hernansanz-Pérez M, Carames-Feijoo C, Martínez-Corona E, Lorenzo-García G. Magnetic resonance imaging in patients with self-locating peritoneal catheters: Is it safe? Nefrologia 2021; 41:41-44. [PMID: 36165360 DOI: 10.1016/j.nefroe.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2019] [Accepted: 05/04/2020] [Indexed: 06/16/2023] Open
Abstract
The fact that self-locating catheters have a piece of metal at the tip leads to doubt and uncertainty around performing magnetic resonance imaging (MRI) in patients with this type of catheter. We simulated a peritoneum with a weighted catheter to ascertain how the catheter behaved during MRI scans in 1.5 T and 3 T machines. We also reviewed cases in which MRI had been performed in patients with this type of catheter. In the simulation, the tip of the self-locating peritoneal catheter caused a magnetic susceptibility artefact that made it difficult to see nearby areas, but it proved to be a safe device for MRI. 14 MRI scans were performed in patients with self-locating catheters, none in the abdominal area. There were no complications in the patients or the technique after performing MRI.
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Affiliation(s)
- Mercedes Moreiras-Plaza
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
| | - Beatriz Nieto-Baltar
- Servicio de Radiodiagnóstico, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - María Hernansanz-Pérez
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Cintia Carames-Feijoo
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Evelio Martínez-Corona
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Graciela Lorenzo-García
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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Sánchez Santos R, Garcia Ruiz de Gordejuela A, Breton Lesmes I, Lecube Torelló A, Moizé Arcone V, Arroyo Martin JJ, Fernandez Alsina E, Martín Antona E, Rubio Herrera MÁ, Sabench Pereferrer F, Sánchez Pernaute A, Vilallonga Puy R. Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. Cir Esp 2021; 99:4-10. [PMID: 32921419 PMCID: PMC7301111 DOI: 10.1016/j.ciresp.2020.06.005] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Abstract
The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.
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Illán Ramos M, Mazariegos Orellana D, Prieto Tato LM, Navarro Gómez ML, Muñoz Gálligo E, Ramos Amador JT. Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort. Med Clin (Barc) 2020; 155:441-4. [PMID: 32473739 DOI: 10.1016/j.medcli.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The risk of HIV-1 mother-to-child transmission (MTCT) is associated mainly with gestational age at which antiretroviral therapy begins and the HIV-1 RNA plasma viral load at delivery. Regimens with integrase inhibitors (INI) are increasing in high-risk pregnant women. The objective was to review the experience with INI in a Madrid Cohort of mother-infant pairs. PATIENTS AND METHODS Retrospective, multicentric, observational study, of HIV-infected pregnant women exposed to INI. Patients of 9 hospitals were included (2000-2017). RESULTS Sixty-seven pregnant women exposed to INI (cohort: 1,423) and 68 children (17.6% premature babies, 34.3% with combined postexposure prophylaxis). There were no cases of MTCT. Of 24 women with no previous antiretroviral therapy, 20 were diagnosed in current pregnancy. Of 43 women with antiretroviral therapy before pregnancy, 65% received INI before conception. Raltegravir was the most used (80.5%). There was a statistically significant increase (p = 0,02) of mothers with undetectable viral load at delivery. INI were well tolerated. In 11.7% of exposed children minor congenital anomalies were detected. CONCLUSIONS INI seem safe and effective in the prevention of MTCT. Our findings support their use as intensification regimens in pregnant women with high risk of MTCT.
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Saiz Ladera GM, Pejenaute Labari ME, García Pascual JN. [Updating in prescription of proton pump inhibitors. What to do and what not to do]. Semergen 2020; 47:267-279. [PMID: 33223372 DOI: 10.1016/j.semerg.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/07/2020] [Revised: 08/22/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) are the most prescribed pharmacological subgroup of the National Health System and their use has been related to possible potentially serious adverse effects. OBJECTIVE To review the current indications for treatment with PPIs as well as the data related to their safety, in order to promote their adecuate use. MATERIAL AND METHODS A review of the literature focused on the following topics has been carried out: a) molecules and mechanism of action; b) current indications for treatment and adherence to them; c) adverse effects related to its use; d) drug interactions; e) alternatives in deprescription. RESULTS The current indications have not changed substantially in recent years and are well established, however, there is a high percentage of inappropriate prescription, mainly in individuals with low or no risk. CONCLUSIONS PPIs are safe drugs and generally well tolerated and their benefits are higher than possible adverse effects. Adhering to evidence-based recommendations represents the only rational approach to safe and effective therapy.
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Affiliation(s)
- G M Saiz Ladera
- Medicina de Familia, Centro de Salud Panaderas, Fuenlabrada (Madrid), España.
| | | | - J N García Pascual
- Medicina de Familia, Centro de Salud Arganda del Rey, Arganda del Rey (Madrid), España
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Moreiras-Plaza M, Nieto-Baltar B, Hernansanz-Pérez M, Carames-Feijoo C, Martínez-Corona E, Lorenzo-García G. Magnetic resonance imaging in patients with self-locating peritoneal catheters: Is it safe? Nefrologia 2020; 41:41-44. [PMID: 32980183 DOI: 10.1016/j.nefro.2020.05.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022] Open
Abstract
The fact that self-locating catheters have a piece of metal at the tip leads to doubt and uncertainty around performing magnetic resonance imaging (MRI) in patients with this type of catheter. We simulated a peritoneum with a weighted catheter to ascertain how the catheter behaved during MRI scans in 1.5T and 3T machines. We also reviewed cases in which MRI had been performed in patients with this type of catheter. In the simulation, the tip of the self-locating peritoneal catheter caused a magnetic susceptibility artefact that made it difficult to see nearby areas, but it proved to be a safe device for MRI. 14 MRI scans were performed in patients with self-locating catheters, none in the abdominal area. There were no complications in the patients or the technique after performing MRI.
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Affiliation(s)
- Mercedes Moreiras-Plaza
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, España.
| | - Beatriz Nieto-Baltar
- Servicio de Radiodiagnóstico, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - María Hernansanz-Pérez
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - Cintia Carames-Feijoo
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - Evelio Martínez-Corona
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - Graciela Lorenzo-García
- Servicio de Nefrología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Vigo, España
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Jarabo JR, Martínez N, Cabañero A, Call S, Campo-Cañaveral JL, Cilleruelo Á, Caballero U, Obeso A, Recuero JL, Sevilla S, Hernando F. Recommendations for acting in elective and urgent thoracic surgery during SARS-CoV-2 pandemic. Spanish Society of Thoracic Surgery. Cir Esp 2020; 98:574-581. [PMID: 33040975 PMCID: PMC7470699 DOI: 10.1016/j.ciresp.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/24/2020] [Revised: 07/02/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
La expansión de la pandemia producida por el nuevo coronavirus SARS-CoV-2 ha obligado a focalizar casi toda la asistencia sanitaria en pacientes con enfermedad COVID-19, obligando a suspender la mayoría de intervenciones quirúrgicas electivas programadas. La cirugía torácica es eminentemente oncológica, por lo que resulta obligada una adecuada priorización de los pacientes para ser intervenidos lo antes posible y en condiciones de máxima seguridad. Por otra parte, la afectación pulmonar grave COVID-19 presenta complicaciones que con frecuencia requieren procedimientos quirúrgicos torácicos urgentes en un contexto nuevo. La Sociedad Española de Cirugía Torácica (SECT) ha desarrollado este documento para establecer unas recomendaciones básicas para mantener la actividad quirúrgica electiva imprescindible y para orientar a los cirujanos que deban afrontar urgencias torácicas en este nuevo y desconocido entorno.
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Affiliation(s)
- José R Jarabo
- Servicio de Cirugía Torácica, Hospital Clínico San Carlos, Madrid, España.
| | - Néstor Martínez
- Servicio de Cirugía Torácica, Hospital de la Ribera, Alzira, Valencia, España
| | - Alberto Cabañero
- Servicio de Cirugía Torácica, Hospital Ramón y Cajal, Madrid, España
| | - Sergi Call
- Servicio de Cirugía Torácica, Hospital Mútua de Terrassa, Terrassa, Barcelona, España
| | - José L Campo-Cañaveral
- Servicio de Cirugía Torácica, Hospital Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Ángel Cilleruelo
- Servicio de Cirugía Torácica, Hospital Clínico Universitario, Valladolid, España
| | - Usue Caballero
- Servicio de Cirugía Torácica, Hospital Ramón y Cajal, Madrid, España
| | - Andrés Obeso
- Servicio de Cirugía Torácica, Hospital Clínico Universitario, Santiago de Compostela, La Coruña, España
| | - José L Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Sebastián Sevilla
- Servicio de Cirugía Torácica, Complejo Hospitalario de Jaén, Jaén, España
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López-Sanromán A, Esplugues JV, Domènech E. Pharmacology and safety of tofacitinib in ulcerative colitis. Gastroenterol Hepatol 2020; 44:39-48. [PMID: 32829958 DOI: 10.1016/j.gastrohep.2020.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
The use of Janus kinase (JAK) inhibitors is a new approach in the therapy of inflammatory diseases with immune base. Tofacitinib is one of these inhibitors targeting JAK1 and JAK3, and its efficacy has been demonstrated in the treatment of moderate to severe ulcerative colitis (UC). It is a small synthetic molecule administered orally, with a fast bioavailability and elimination rate, predictable pharmacokinetics and lack of immunogenicity, which are convenient characteristics for both efficacy and safety. This article reviews the pharmacological characteristics of tofacitinib and its safety profile.
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Affiliation(s)
- Antonio López-Sanromán
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Juan V Esplugues
- Unidad de Farmacología Digestiva e Inflamatoria, Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - Eugeni Domènech
- Servicio de Gastroenterología y Hepatología, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas, Madrid, España.
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Sánchez-Redondo MD, Cernada M, Boix H, Espinosa Fernández MG, González-Pacheco N, Martín A, Pérez-Muñuzuri A, Couce ML. [Home births: A growing phenomenon with potential risks]. An Pediatr (Barc) 2020; 93:266.e1-266.e6. [PMID: 32800721 DOI: 10.1016/j.anpedi.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 01/27/2023] Open
Abstract
Home birth is a controversial issue that raises safety concerns for paediatricians and obstetricians. Hospital birth was the cornerstone to reduce maternal and neonatal mortality. This reduction in mortality has resulted in considering pregnancy and childbirth as a safe procedure, which, together with a greater social awareness of the need for the humanisation of these processes, have led to an increase in the demand for home birth. Studies from countries such as Australia, the Netherlands, and United Kingdom show that home birth can provide advantages to the mother and the newborn. It needs to be provided with sufficient material means, and should be attended by trained and accredited professionals, and needs to be perfectly coordinated with the hospital obstetrics and neonatology units, in order to guarantee its safety. Therefore, in our environment, there are no safety data or sufficient scientific evidence to support home births at present.
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Affiliation(s)
| | - María Cernada
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Hector Boix
- Servicio de Neonatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | | | | | - Ana Martín
- Servicio de Neonatología, Hospital Sant Joan de Déu, Barcelona, España
| | - Alejandro Pérez-Muñuzuri
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | - María L Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago de Compostela, Santiago de Compostela, España.
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Díaz-Pérez A, Vega-Ochoa A, Dominguez-Lozano B, Carrillo-González S, González-Puertas J. Factors attributable to the cancellation of programmed surgeries. CIR CIR 2020; 88:489-499. [PMID: 32567596 DOI: 10.24875/ciru.20001008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To analyze the factors attributable to the cancellation of surgeries of a third level health institution in the city of Valledupar, Cesar / Colombia (2017-2018). Material and methods Descriptive, retrospective, cross-sectional study. Data from the hospital surgical unit adverse case file were collected for 6 surgical specialties. Results They showed that in 2017 there was a surgical suspension of 4% of the total of scheduled surgeries that were (3339), for 2018 the rate was 3% with a total of scheduled surgeries (1733). The reason for the suspension for both periods was the factor related to the patient's adverse conditions with 45.9 and 38.5% respectively. The specialty most affected for these cases was the specialty of general surgery with the same percentage value in both periods of 4%. Conclusion The results give us an idea of the factors present for the cancellation of scheduled surgeries and the need to apply measures to guarantee patient safety.
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Affiliation(s)
- Anderson Díaz-Pérez
- Departamento de Ciencias Sociales y Humanas, Universidad Simón Bolívar, Barranquilla. Colombia.,Facultad de Química y Farmacia, Universidad del Atlántico, Barranquilla. Colombia
| | - Arley Vega-Ochoa
- Facultad de Ciencias de la Salud Universidad Popular del Cesar, Valledupar. Colombia
| | - Brayan Dominguez-Lozano
- Departamento de Ciencias Sociales y Humanas, Universidad Simón Bolívar, Barranquilla. Colombia
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Balibrea JM, Badia JM, Rubio Pérez I, Martín Antona E, Álvarez Peña E, García Botella S, Álvarez Gallego M, Martín Pérez E, Martínez Cortijo S, Pascual Miguelañez I, Pérez Díaz L, Ramos Rodriguez JL, Espin Basany E, Sánchez Santos R, Soria Aledo V, López Barrachina R, Morales-Conde S. Surgical Management of Patients With COVID-19 Infection. Recommendations of the Spanish Association of Surgeons. Cir Esp 2020; 98:251-259. [PMID: 32252979 PMCID: PMC7270428 DOI: 10.1016/j.ciresp.2020.03.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required.
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Affiliation(s)
- Jose Mose Balibrea
- Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Josep Mose Badia
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, España.
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Esteban-Fernández A, Díez-Villanueva P, Vicent L, Bover R, Gómez-Bueno M, De Juan J, Iniesta ÁM, García-Aguado M, Martínez-Sellés M. Sacubitril/Valsartan is useful and safe in elderly people with heart failure and reduced ejection fraction. Data from a real-word cohort. Rev Esp Geriatr Gerontol 2020; 55:65-69. [PMID: 31892433 DOI: 10.1016/j.regg.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND HF elderly patients are underrepresented in Sacubitril/Valsartan HF trials, and the effect of S/V in real-life patients with advanced age is unknown. The aim of this study was to evaluate the use and safety of S/V in a real-word cohort of elderly patients. METHODS We performed a prospective registry of patients who started S/V in clinical practice. We compared baseline characteristics, adverse events during follow-up and causes of S/V withdrawal according to age. RESULTS A total of 427 patients started treatment with S/V: 222 (52.0%)<70 years old, 140 (32.8%) between 70 and 79 and 65 (15.2%)≥80. During a mean follow-up of 7.0±0.1months S/V was well tolerated, with no age-related differences in adverse events (26.8%, 25.9%, 23.1% respectively; p=0.83). Symptomatic hypotension tended to be more frequent in the elderly (19.8%, 25.6%, 33.3% respectively; p=0.17). The withdrawal of S/V was more frequent in younger patients (14.4%, 10.0%, 4.6% respectively; p=0.05) and related to poor prognosis (HR 13.51, 95% CI 3.22-56.13, p<0.001). CONCLUSIONS Sacubitril/Valsartan is useful and safe in elderly people with HF-rEF in real-life clinical practice, and withdrawal is associated to poor prognosis. The doses achieved are lower in elderly people.
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Affiliation(s)
- Alberto Esteban-Fernández
- Servicio de Cardiología, Hospital Universitario de Móstoles, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain.
| | | | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Ramón Bover
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Manuel Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier De Juan
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense, Universidad Europea, Madrid, Spain
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Fernández Oliveira C, Martínez Roca C, Ávila Álvarez A, Balboa Barreiro V, Giménez Arufe V, Yáñez Gómez P, Hermida Bouzas MC, Martín Herranz I. [Impact of introducing assisted electronic prescription on paediatric patient safety]. An Pediatr (Barc) 2020; 93:103-110. [PMID: 32061530 DOI: 10.1016/j.anpedi.2019.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/01/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE There have been very few studies on the effect of assisted electronic prescription on paediatric patient safety. The objective of this study is to compare medication errors that occurred before and after its introduction in a tertiary hospital. MATERIAL AND METHODS A quasi-experimental comparative study of medication errors detected before and after assisted electronic prescription introduction. All treatment lines were analysed in order to detect the point in the chain where the medication error occurred, as well as its type and cause. A Delphi study was conducted on the importance of each medication error involving doctors, nurses, and pharmacists. RESULTS The study included 166 patients (83 at each stage). At least one medication error was detected in 92% in the pre-introduction phase patients (2.8±2.1 errors/patient) and 7.2% of post-introduction phase patients (0.1±0.4 errors/patient). The assisted electronic prescription led to an absolute risk reduction of 40% (95% confidence interval=35.6-44.4%). The main cause of error was lapses and carelessness in both stages. Medication errors were considered serious in 9.5% of cases in the pre-introduction phase, while all of them were mild or moderate in the post-introduction phase. CONCLUSIONS The assisted electronic prescription implementation with prescription, validation and medication administration assistance systems significantly reduces medication errors and eliminates serious errors.
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Affiliation(s)
- Carla Fernández Oliveira
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España.
| | - Cristina Martínez Roca
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Alejandro Ávila Álvarez
- Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Vanesa Balboa Barreiro
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Víctor Giménez Arufe
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Pedro Yáñez Gómez
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - María Carmen Hermida Bouzas
- Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Isabel Martín Herranz
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
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Cordero-Alfaro M, León-Céspedes C, Ramos-Esquivel A. Effectiveness of intravenous tocilizumab in routine clinical practice in a cohort of Costa Rican patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2020; 17:329-334. [PMID: 32057667 DOI: 10.1016/j.reuma.2019.11.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/19/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the effectiveness and the incidence of severe adverse events in a cohort of Costa Rican patients with Rheumatoid Arthritis (RA) treated with intravenous (IV) tocilizumab (TCZ). PATIENTS AND METHODS A retrospective analysis was carried out in 45 patients that were unresponsive to disease-modifying antirheumatic drugs (DMARDs). The study included patients who received IV TCZ every 4 weeks (4mg/kg) along with methotrexate or leflunomide. Effectiveness was measured through the incidence of clinical remission according to a disease activity score - erythrocyte sedimentation rate (DAS28-ESR) less than 2.6. Safety was assessed by the incidence rate of serious adverse events. An univariate and multivariate logistic regression analysis was performed to assess the association of potential variables with the probability of achieving remission during the first 3 months of TCZ therapy. RESULTS During the 3rd month of TCZ therapy, a total of 22 patients (48.9%; 95% Confidence Interval (CI) 34.3-63.5%) achieved remission. The cumulative incidence of patients with remission at month 12 was 75.0% (n=34) (95% CI: 62.3-87.6%). A total of 18 patients (40%; 95% CI: 25.7-54.3%) were switched to a 8mg/kg dose due to the absence of remission. The incidence rate of serious adverse events was .98 per 100 patients/year, all of them due to infectious diseases with no fatal events reported. Only basal DAS28-ESR was associated with the probability of achieving remission at month 3. CONCLUSIONS IV TCZ (4mg/kg) is an effective and safe treatment for RA patients in a clinical setting in Costa Rica.
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Parra Salinas I, Recasens Flores V, Montañés MÁ, García-Erce JA. Therapeutic erythroapheresis: Experience in patients with polycythemia vera and secondary erythrocytosis. Med Clin (Barc) 2020; 154:16-19. [PMID: 30795904 DOI: 10.1016/j.medcli.2018.12.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Therapeutic erythrocytapheresis (TE) is a more efficient strategy compared to phlebotomy to deplete levels of haematocrit in primary and secondary erythrocytosis. OBJECTIVE To analyse response rate and safety profile of TE in polycythemia vera (PV) and secondary erythrocytosis (SE). PATIENTS AND METHOD Retrospective review of all patients with PV or SE treated with TE, due to phlebotomy failure, or comorbidities that prevented changes of blood volumen. RESULTS 217 TE sessions (48 PV and 79 SE) corresponding to 20 patients (12 ES and 8 PV). Response were achieved in 87.5% of PV patients and in 50% of SE patients. Adverse effects related to TE performance occurred in 7.08%. CONCLUSION Despite our small sample size and the heterogeneous nature of the patients included, we can postulate that TE is a secure strategy that can achieve haematocrit depletion in a shorter time than phlebotomy, specifically in PV patients and in selected cases of SE with expected haemodynamic intolerance to phlebotomies or in patients who fail to respond to phlebotomies.
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Affiliation(s)
| | | | | | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común», España.
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Heili-Frades S, Carballosa de Miguel MDP, Naya Prieto A, Galdeano Lozano M, Mate García X, Mahillo Fernández I, Fernández Ormaechea I, Álvarez Suárez L, Ezzine de Blas F, Checa Venegas MJ, González Mangado N, Peces Barba G. Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe? Arch Bronconeumol 2019; 55:634-641. [PMID: 31587917 DOI: 10.1016/j.arbres.2019.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/13/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Historically, it has been assumed that Intermediate Respiratory Care Units (IRCU) were efficient, because they saved costs by reducing the number of admissions to intensive care units (ICU), and effective, because they specialized in respiratory diseases. METHODS The number of IRCU admissions and mortality rate, historically and in 2016, were evaluated. For 2016, the grouped Related Diagnostic Groups (DRGs) were also described, and the savings achieved under all budgetary headings by avoiding UCI stays were calculated. A multivariate analysis was performed to associate costs with mean weights and complexity, and multiple logistic regression was performed on all patients admitted from 2004 to 2017 to describe the variables associated with mortality in our unit. RESULTS An IRCU generates savings of €500,000/year by reducing length of ICU stay. Analysis of the 2016 cohort shows that costs correlate with mean weight and mortality, and consequently complexity. The multivariate logistic regression analysis of the 2004-2017 cohort found respiratory frequency, leukopenia, anemia, hyperkalemia, and acidosis to be the variables best associated with mortality. The area under the curve for the logistic model was 0.75. CONCLUSION The IRCU analyzed in our study was efficient in terms of 'avoided costs' and savings associated with complexity. Our results suggest that IRCUs have a lower mortality rate than other similar units, and are therefore a safe environment for patients.
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Affiliation(s)
- Sarah Heili-Frades
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España.
| | - María Del Pilar Carballosa de Miguel
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Alba Naya Prieto
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Marina Galdeano Lozano
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, Hospital Universitario Sagrat Cor, Grupo Quirón Salud. Universitat de Barcelona, REVA (Réseau Européen de Ventilation Artificielle), Barcelona, España
| | - Xavier Mate García
- Dirección General y Gerencia, Hospital Universitario Sagrat Cor, Grupo Quirón Salud, Barcelona, España
| | | | - Itziar Fernández Ormaechea
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Laura Álvarez Suárez
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Farah Ezzine de Blas
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - María José Checa Venegas
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Nicolás González Mangado
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
| | - Germán Peces Barba
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud. UAM, Ciberes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), REVA (Réseau Européen de Ventilation Artificielle), Madrid, España
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Sobradillo Ecenarro P, García-Rivero JL, López Caro JC. [Bronchodilator therapy in the prevention of COPD exacerbations]. Semergen 2019; 45:479-488. [PMID: 31540819 DOI: 10.1016/j.semerg.2019.03.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/26/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
The natural course of chronic obstructive pulmonary disease usually includes exacerbations. chronic obstructive pulmonary disease patients suffer from 1-4 exacerbations per year on average. These are associated with worsening quality of life and increased mortality. Reducing and controlling the number of exacerbations is one of the main goals of chronic obstructive pulmonary disease treatment. Among current treatments, tiotropium is the active substance with the strongest evidence in the reduction of moderate/severe exacerbations, together with a good safety and tolerability profile. The addition of olodaterol to tiotropium offers well-tolerated and effective double bronchodilation for improving lung function, quality of life, and decreased dyspnoea compared to its single components. This also reduces the annual rate of moderate/severe exacerbations vs. tiotropium by 7%, although not reaching the pre-specified statistical significance level of P<.01.
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Affiliation(s)
- P Sobradillo Ecenarro
- Servicio de Neumología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
| | - J L García-Rivero
- Servicio de Neumología, Hospital de Laredo, Laredo, Cantabria, España
| | - J C López Caro
- Médicina de familia, Centro de Salud Cotolino, Castro Urdiales, Cantabria, España
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