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Monteagudo C, Porcar-Saura S, Navarro S, Burgués O, González JF, Ferrández A, Forner MJ. Acquired aggressive multisystemic disseminated lobular capillary haemangioma: a life threatening disorder. Pathology 2023; 55:729-732. [PMID: 36894353 DOI: 10.1016/j.pathol.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Carlos Monteagudo
- Department of Pathology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Avenida Blasco Ibáñez, Valencia, Spain; Department of Pathology, University of Valencia, Avenida Blasco Ibáñez, Valencia, Spain.
| | - Saray Porcar-Saura
- Dermatology Department, Hospital Clínico Universitario, Avenida Blasco Ibáñez, Valencia, Spain
| | - Samuel Navarro
- Department of Pathology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Avenida Blasco Ibáñez, Valencia, Spain; Department of Pathology, University of Valencia, Avenida Blasco Ibáñez, Valencia, Spain
| | - Octavio Burgués
- Department of Pathology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Avenida Blasco Ibáñez, Valencia, Spain; Department of Pathology, University of Valencia, Avenida Blasco Ibáñez, Valencia, Spain
| | - José F González
- Department of Pathology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Avenida Blasco Ibáñez, Valencia, Spain
| | - Antonio Ferrández
- Department of Pathology, Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Avenida Blasco Ibáñez, Valencia, Spain; Department of Pathology, University of Valencia, Avenida Blasco Ibáñez, Valencia, Spain
| | - María José Forner
- Internal Medicine Department, Hospital Clínico Universitario, Avenida Blasco Ibáñez, Valencia, Spain; Department of Medicine, University of Valencia, Avenida Blasco Ibáñez, Valencia, Spain
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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Iraola D, Marcos-Garcés V, García Blas S, Sanchis J, Bahamonde JÁ, Gracia JM, Forner MJ, Rojo N, Chorro FJ, López FJ. Immunoglobulin G4-related aortitis and severe aortic valve stenosis treated with transcatheter aortic valve replacement and immunosuppression. Can J Cardiol 2021; 37:1873-1876. [PMID: 34333027 DOI: 10.1016/j.cjca.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
IgG4-related disease is an immune-mediated fibro-inflammatory disorder with multisystemic involvement. Aortitis and periaortitis are the most common cardiovascular manifestations of the disease. We present the case of a 65-year-old male with symptomatic severe aortic stenosis and concomitant IgG4 aortitis. The diagnosis was confirmed by IgG4 serum levels, positive PET-TC, and pathology from mediastinal dissection. Surgical aortic valve replacement (SAVR) was unfeasible due to extensive mediastinal fibrosis, and transcatheter aortic valve replacement (TAVR) was successfully performed. Since ascending aorta access for SAVR in IgG4 aortitis with long-run fibrosis entails a high mortality risk, TAVR could be considered in certain suitable patients.
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Affiliation(s)
- Diego Iraola
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain.
| | - Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Sergio García Blas
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Juan Sanchis
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - José Ángel Bahamonde
- Department of Cardiac Surgery, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Juan Manuel Gracia
- Department of Cardiac Surgery, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - María José Forner
- INCLIVA Biomedical Research Institute, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain; Department of Internal Medicine, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Natalia Rojo
- Department of Pathology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Francisco Javier Chorro
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Francisco Jesús López
- Department of Cardiology, Hospital Clinico Universaitario de Valencia, Valencia, Spain
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Martínez MT, Montón-Bueno J, Simon S, Ortega B, Moragon S, Roselló S, Insa A, Navarro J, Sanmartín A, Julve A, Buch E, Peña A, Franco J, Martínez-Jabaloyas J, Marco J, Forner MJ, Cano A, Silvestre A, Teruel A, Lluch A, Cervantes A, Chirivella Gonzalez I. Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation. ESMO Open 2021; 6:100148. [PMID: 33989988 PMCID: PMC8136438 DOI: 10.1016/j.esmoop.2021.100148] [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: 03/05/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/07/2022] Open
Abstract
Background Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation. Patients and methods Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process. Results A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis. Conclusions The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting. Our CFP easily connects GPs and hospital specialists. Our CFP shortens assessment time in patients with suspected cancer, adding to quality care. Our CFP decreases emotional stress in patients without cancer.
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Affiliation(s)
- M T Martínez
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J Montón-Bueno
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - S Simon
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - B Ortega
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - S Moragon
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - S Roselló
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain
| | - A Insa
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J Navarro
- Management Department, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; CIBERESP (CIBER de Epidemiología y Salud Pública), Centro Nacional de Epidemiología del Instituto de Salud Carlos III, Madrid, Spain
| | - A Sanmartín
- Management Department, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Julve
- Department of Radiodiagnosis, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - E Buch
- Department of Surgery, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Peña
- Department of Medicine Digestive, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J Franco
- Department of Pneumology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J Martínez-Jabaloyas
- Department of Urology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - J Marco
- Department of Otolaryngology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - M J Forner
- Department of Internal Medicine, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Cano
- Department of Gynecology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Silvestre
- Department of Traumatology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Teruel
- Department of Hematology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Lluch
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - A Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Instituto de Salud Carlos III, CIBERONC, Madrid, Spain.
| | - I Chirivella Gonzalez
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
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Giménez E, Albert E, Torres I, Remigia MJ, Alcaraz MJ, Galindo MJ, Blasco ML, Solano C, Forner MJ, Redón J, Signes-Costa J, Navarro D. SARS-CoV-2-reactive interferon-γ-producing CD8+ T cells in patients hospitalized with coronavirus disease 2019. J Med Virol 2020; 93:375-382. [PMID: 32579268 PMCID: PMC7361624 DOI: 10.1002/jmv.26213] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 06/05/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023]
Abstract
There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) T‐cell immune responses in patients with coronavirus disease 2019 (COVID‐19). Both CD4+ and CD8+ T cells may be instrumental in resolution of and protection from SARS‐CoV‐2 infection. Here, we tested 25 hospitalized patients either with microbiologically documented COVID‐19 (n = 19) or highly suspected of having the disease (n = 6) for presence of SARS‐CoV‐2‐reactive CD69+ expressing interferon‐γ (IFN‐γ) producing CD8+ T cells using flow‐cytometry for intracellular cytokine staining assay. Two sets of overlapping peptides encompassing the SARS‐CoV‐2 Spike glycoprotein N‐terminal 1 to 643 amino acid sequence and the entire sequence of SARS‐CoV‐2 M protein were used simultaneously as antigenic stimulus. Ten patients (40%) had detectable responses, displaying frequencies ranging from 0.15 to 2.7% (median of 0.57 cells/µL; range, 0.43‐9.98 cells/µL). The detection rate of SARS‐CoV‐2‐reactive IFN‐γ CD8+ T cells in patients admitted to intensive care was comparable (P = .28) to the rate in patients hospitalized in other medical wards. No correlation was found between SARS‐CoV‐2‐reactive IFN‐γ CD8+ T‐cell counts and SARS‐CoV‐2 S‐specific antibody levels. Likewise, no correlation was observed between either SARS‐CoV‐2‐reactive IFN‐γ CD8+ T cells or S‐specific immunoglobulin G‐antibody titers and blood cell count or levels of inflammatory biomarkers. In summary, in this descriptive, preliminary study we showed that SARS‐CoV‐2‐reactive IFN‐γ CD8+ T cells can be detected in a non‐negligible percentage of patients with moderate to severe forms of COVID‐19. Further studies are warranted to determine whether quantitation of these T‐cell subsets may provide prognostic information on the clinical course of COVID‐19. SARS‐CoV‐2 specific CD8+ T cells can be detected in 40% of COVID‐19 patients. No correlation was found between SARS‐CoV‐2‐reactive IFN‐γ CD8+ T‐cell countsand SARS‐CoV‐2 S‐specific antibody levels. No correlation was observed between SARS‐CoV‐2‐reactive IFN‐γ CD8+ T cells and levels of inflammatory biomarkers.
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Affiliation(s)
- Estela Giménez
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Ignacio Torres
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - María José Remigia
- Hematology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - María Jesús Alcaraz
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - María José Galindo
- Internal Medicine Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - María Luisa Blasco
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Carlos Solano
- Hematology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - María José Forner
- Internal Medicine Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Josep Redón
- Internal Medicine Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Signes-Costa
- Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
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Blasco ML, Buesa J, Colomina J, Forner MJ, Galindo MJ, Navarro J, Noceda J, Redón J, Signes-Costa J, Navarro D. Co-detection of respiratory pathogens in patients hospitalized with Coronavirus viral disease-2019 pneumonia. J Med Virol 2020; 92:1799-1801. [PMID: 32320082 DOI: 10.1002/jmv.25922] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
- María Luisa Blasco
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Javier Buesa
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Javier Colomina
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - María José Forner
- Internal Medicine Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - María José Galindo
- Internal Medicine Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jorge Navarro
- Medical Directory, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - José Noceda
- Emergency Medical Service, Clinic University Hospital, Valencia, Spain
| | - Josep Redón
- Internal Medicine Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Signes-Costa
- Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
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Brito-Zerón P, Kostov B, Moral-Moral P, Martínez-Zapico A, Díaz-Pedroche C, Fraile G, Pérez-Guerrero P, Fonseca E, Robles A, Vaquero-Herrero MP, Calvo MA, Forner MJ, Morcillo C, Larrañaga J, Rodriguez-Carballeira M, Ruiz-Muñoz M, Hurtado-García R, Prieto-González S, Aguilar AA, Caminal-Montero L, Hernández-Jiménez P, Fernández-Viagas CR, Castro P, Massó VM, Flores-Chavez A, Ramos-Casals M. Prognostic Factors of Death in 151 Adults With Hemophagocytic Syndrome: Etiopathogenically Driven Analysis. Mayo Clin Proc Innov Qual Outcomes 2018; 2:267-276. [PMID: 30225460 PMCID: PMC6132215 DOI: 10.1016/j.mayocpiqo.2018.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 06/03/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To characterize the etiologies and clinical features at diagnosis of patients with hemophagocytic lymphohistiocytosis (HLH) and correlate these baseline features with survival using an etiopathogenically guided multivariable model. Patients and Methods The Spanish Group of Autoimmune Diseases HLH Study Group, formed in 2013, is aimed at collecting adult patients with HLH diagnosed in internal medicine departments between January 3, 2013, and October 28, 2017. Results The cohort consisted of 151 patients (91 men; mean age, 51.4 years). After a mean follow-up of 17 months (range, 1-142 months), 80 patients died. Time-to-event analyses for death identified a worse survival curve for patients with neoplasia (P<.001), mixed microbiological infections (P=.02), and more than 1 infection (P=.01) and glucocorticoid monotherapy (P=.02). According to univariate analyses, platelets of less than 100,000/mm3 (hazard ratio [HR], 3.39; 95% CI, 1.37-8.40), leukopenia (HR, 1.81; 95% CI, 1.01-3.23), severe hyponatremia (HR, 1.61; 95% CI, 1.02-2.54), disseminated intravascular coagulation (HR, 1.87; 95% CI, 1.05-3.34), bacterial infection (HR, 1.99; 95% CI, 1.09-3.63), mixed microbiological infections (HR, 3.42; 95% CI, 1.38-8.46), and 2 or more infectious triggers (HR, 2.95; 95% CI, 1.43-6.08) were significantly associated with death. In contrast, peripheral adenopathies (HR, 0.63; 95% CI, 0.40-0.98) and the immunosuppressive drug/intravenous immunoglobulin/biological therapies (HR, 0.44; 95% CI, 0.20-0.96) were protective against all-cause mortality. Multivariable Cox proportional hazards regression analysis identified 2 or more infectious triggers (HR, 3.14; 95% CI, 1.28-7.68) as the only variable independently associated with death. Conclusion The mortality rate of adult patients diagnosed with HLH exceeds 50%. Infection with more than 1 microbiological agent was the only independent variable associated with mortality irrespective of the underlying disease, epidemiological profile, clinical presentation, and therapeutic management.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
| | - Belchin Kostov
- Laboratory of Autoimmune Diseases Josep Font, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Primary Healthcare Transversal Research Group, IDIBAPS, Barcelona, Spain
| | - Pedro Moral-Moral
- Immunopathology Section, Department of Internal Medicine, Hospital Universitari i Politècnic La Fe, Departament de Salut Valencia La Fe, Valencia, Spain
| | - Aleida Martínez-Zapico
- Autoimmune Diseases Unit, UGC Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen Díaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Guadalupe Fraile
- Department of Internal Medicine, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Eva Fonseca
- Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain
| | - Angel Robles
- Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - María P Vaquero-Herrero
- Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - María Andrés Calvo
- Department of Internal Medicine, Hospital Rio Hortega Valladolid, Valladolid, Spain
| | - María José Forner
- Department of Internal Medicine, Hospital Clínico de Valencia, Valencia, Spain
| | - Cesar Morcillo
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
| | - José Larrañaga
- Department of Internal Medicine, Hospital Xeral, Vigo, Spain
| | | | - Manuel Ruiz-Muñoz
- Department of Internal Medicine, Hospital Universitario Fundacion Alcorcón, Alcorcón, Spain
| | | | | | - Asun Aljibe Aguilar
- Immunopathology Section, Department of Internal Medicine, Hospital Universitari i Politècnic La Fe, Departament de Salut Valencia La Fe, Valencia, Spain
| | - Luis Caminal-Montero
- Autoimmune Diseases Unit, UGC Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Pedro Castro
- Medical Intensive Care Unit, Department of Medicine, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Victoria Morell Massó
- Immunopathology Section, Department of Internal Medicine, Hospital Universitari i Politècnic La Fe, Departament de Salut Valencia La Fe, Valencia, Spain
| | - Alejandra Flores-Chavez
- Laboratory of Autoimmune Diseases Josep Font, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Biomedical Research Unit 02, Clinical Epidemiology Research Unit, UMAE, Specialties Hospital, Western Medical Center, Mexican Institute for Social Security (IMSS), Guadalajara, Mexico.,Postgraduate Program of Medical Science, University Center for Biomedical Research (CUIB), University of Colima, Colima, Mexico
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
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López V, Molina I, Martín JM, Santonja N, Forner MJ, Jordá E. Eruptive Nevi in a Patient Receiving Cyclosporine A for Psoriasis Treatment. ACTA ACUST UNITED AC 2010; 146:802-4. [DOI: 10.1001/archdermatol.2010.145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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9
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Ruano M, Oltra R, Martínez F, Oliver V, Forner MJ, García-Fuster MJ. Síndrome antifosfolipídico catastrófico y adenocarcinoma de páncreas. Rev esp enferm dig 2007; 99:54-5. [PMID: 17371136 DOI: 10.4321/s1130-01082007000100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Oltra MR, Vicente A, Vicente Lozano J, Forner MJ, Fabià MJ, Abdilla N, Redón J. [Factors related to the differences in blood pressure values assessed by auscultatory or oscillometric methods]. Med Clin (Barc) 2006; 127:688-91. [PMID: 17169294 DOI: 10.1157/13095096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Measurement of blood pressure by using the auscultatory method coupled with mercury sphygmomanometer is rapidly being replaced for monitor using the oscillometric one. Discrepancies between the two methods and the factors related to them were analyzed in a large subset of adults. MATERIAL AND METHOD Blood pressure values were obtained sequentially in the same arm by using a mercury sphygmomanometer and a Spacelabs monitor devices. The relationship between both kinds of measurements was assessed by the Pearson's correlation coefficients and the concordance by using the Bland and Altman method. Differences between the two methods were calculated and the factors related to the differences were sought by multiple regression models. RESULTS A total of 1,742 adult subjects were analyzed. Pearson's correlation coefficients were 0.927, 0.922, 0.886, 0.962 for SBP, DBP, MBP and PR, respectively. Oscillometric method overestimate and infraestimate SBP values in the two extreme of SBP values, the lowest SBP the highest the values and vice versa. A similar trend was observed for DBP although the differences were minor. Pulse wave amplitude explains the 24% of the variance observed for SBP and arm circumference the 8% for DBP. CONCLUSIONS Blood pressure values measured by oscillometric methods are influenced for pulse wave amplitude and by the arm circumference. These need to be taken in account when blood pressure assessment is obtained by using this method.
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Affiliation(s)
- María Rosa Oltra
- Unidad de Hipertensión Arterial, Servicio de Medicina Interna, Hospital Clínic Universitari, Universitat de València, Valencia, Spain
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11
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Martínez F, Forner MJ, Ruano M, Abdilla N, Oltra R, García-Fuster MJ. Factores relacionados con el riesgo de trombosis en pacientes con lupus y positividad para anticuerpos antifosfolipídicos. Med Clin (Barc) 2006; 127:405-8. [PMID: 17020683 DOI: 10.1157/13092765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Antiphospholipid antibodies (aPL) are frequently associated with eritematosus systemic lupus (SLE) and increases the risk of thrombosis. The aim of the study was to analize risk factors of thrombosis and its temporal profile in subjects with SLE. PATIENTS AND METHOD One hundred and two SLE patients -mean age: 37.5 years (range: 8-85); 90 women; mean of follow-up: 72 months (range: 9-324); 41 (40.2%) with aPL positive- were included in the study. Actuarial Kaplan-Meier curves were used to assess the thrombosis risk and Cox proportional hazard model was used to evaluate factors associated with the risk. RESULTS 13 thrombotic events occurred in the group with aPL positive (mean of follow up: 83.5 months) and 5 events in aPL negative group (mean of follow up: 72 months). The event-rates were 3.93 and 0.96/100 patients/year for each group, respectively. Survival curves showed a significantly higher risk of thrombotic events in the patients with positive aPL as compared to the aPL negative group, and the risk still present throughout the observational time. Activated partial thromboplastine time up to 37 s was significantly associated with thrombosis risk (p = 0.003). Furthermore, positivity of lupus anticoagulant and proteinuria > 2.5 g/day tended to increase thrombotic risk, although they did not achieve statistical significance. CONCLUSIONS In patients with SLE and aPL, risk of first thrombosis remains over the years, and a large activated partial thromboplastine time was the most important risk factor.
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Affiliation(s)
- Fernando Martínez
- Servicio de Medicina Interna, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
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12
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Giner V, Esteban MJ, Fernández C, Galindo MJ, Oltra MR, Oliver V, Rodríguez JC, Forner MJ, Alcácer F, Guix J, Redón J, Monteagudo C. [Renal involvement in the human immunodeficiency virus infection]. Med Clin (Barc) 2004; 122:601-4. [PMID: 15142506 DOI: 10.1016/s0025-7753(04)74325-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Although renal pathologies are becoming an emergent problem in the population infected by the human immunodeficiency virus (HIV), there is very scarce information about the natural course of this problem. The objective of the present study is to describe renal lesions in an autopsy series of HIV-infected patients never treated with antiretroviral therapies. PATIENTS AND METHOD Autopsy information has been retrospectively retrieved from 61 HIV-infected subjects (mean age, 36,9 [8,4] years; 58,6% drug abusers, 84% males) died in our hospital between 1984 and 1997. None of the patients received antiretroviral therapy. All autopsy and clinical reports were considered, as well as basic analytical parameters about renal function. Renal autopsy samples were specifically reviewed. RESULTS At the time of the last admission, 9.8% of patients had renal insufficiency, who made up 44.3% of patients having renal insufficiency anytime. Infections were the main cause of death (76%). The majority of patients (93.4%) showed histopathological renal abnormalities, which were highly heterogeneous. Renal lesions were mainly located on the tubules (96.7%) and the interstitium (60.7%). Moreover, glomeruli were affected in 55.7% of patients. Most frequent histopathological diagnosis was acute tubular necrosis (16.4%) and septic nephritic abscesses (16.4%), followed by tubulointerstitial nephritis (9%). HIV-associated nephropathy was present in two patients (3.3%). There were no significant differences when considering the existent of renal failure. CONCLUSIONS Renal histological abnormalities are frequent in the natural evolution of HIV infection. There is an important heterogeneity of lesions, mainly involving tubules, interstitium and mesangium. The cause of renal lesions is predominantly septic, according to the chief systemic process. It does not exist any relationship between renal analytical parameters and the presence of renal damage.
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Affiliation(s)
- Vicente Giner
- Servicio de Medicina Interna, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España.
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García-Fuster MJ, Fernández C, Forner MJ, Vayá A. Estudio prospectivo de los factores de riesgo y las características clínicas de la enfermedad tromboembólica en pacientes jóvenes. Med Clin (Barc) 2004; 123:217-9. [PMID: 15282075 DOI: 10.1016/s0025-7753(04)74464-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE We aimed to determine the risk factors of thromboembolic disease in young patients and to study the clinical characteristics according to the etiology. PATIENTS AND METHOD A prospective study of 100 patients under 50 years who were not affected by neoplasias or chronic diseases and who required hospitalization due to thromboembolic disease. The morphological diagnosis was performed by eco-Doppler, flebography, lung gammagraphy or CT scan. Risk factors assessed were antithrombin, protein C and S deficiency, presence of factor V Leiden, prothrombin G20210A, hyperhomocisteinemia, increased PAI-I, increased factor VIII, and presence of antiphospholipid antibodies (APAs). Acquired factors were also evaluated. RESULTS In 87% of patients, a venous thrombosis was observed in lower limbs. 37% of patients had congenital risk factors and 19% had APAs, whereas in the remaining patients only acquired factors were demonstrated. Most frequent congenital factors were factor V Leiden, pothrombin G20210A, and protein C and S deficiency. Most patients presented several risk factors. A family thrombotic history was significantly more frequent in the group with congenital risk factors. CONCLUSIONS In 56% of young patients with thromboembolic disease, a congenital etiology or APAs are identified. In these patients the number of acquired factors needed to trigger thrombosis is fewer than in patients in whom a cause is not identified.
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García MJ, Ruano M, Forner MJ. Estómago en cavidad torácica. Neumonías secundarias a aspiración. Med Clin (Barc) 2004. [DOI: 10.1157/13058394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vayá A, Forner MJ, Estellés A, Villa P, Mira Y, Ferrando F, García Fuster JM, Oliver V, Aznar J. Intracardiac thrombosis in a case of Behcet's disease associated with the prothrombin 20210G-A mutation. Haematologica 2000; 85:425-8. [PMID: 10756370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Thrombosis occurs in 20 to 30% of patients with Behçet's disease (BD), but the precise pathogenic mechanism underlying the thrombotic tendency in these patients is not well known. Venous thromboses are commonly located in the lower extremities, but right intracardiac thrombi are extremely rare. We report for the first time on a young patient with BD associated the 20210G-A prothrombin gene mutation and right intracardiac thrombosis. We suggest that the association of BD with this newly recognized prothrombotic genetic mutation may have contributed to the development of the thrombotic event in this patient.
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Affiliation(s)
- A Vayá
- Thrombosis and Hemostasis Unit, Dept. of Clinical Pathology, La Fe University Hospital, Avda. Campanar 21, 46009 Valencia, Spain
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