Publications by authors named "Jesús María González-Martín"

18 Publications

  • Page 1 of 1

Gamma-glutamyl transferase and cardiovascular events in patients with congenital heart disease.

Eur J Clin Invest 2021 Nov 24:e13720. Epub 2021 Nov 24.

Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.

Introduction: Serum gamma-glutamyltransferase activity (GGT) seems to predict cardiovascular events in different populations. However, no data exist on patients with congenital heart disease (CHD).

Methods: Observational, analytic, prospective cohort study design involving CHD patients and a control population to determine the effect of GGT levels on survival.

Results: 589 CHD patients (58% males, 29 ± 14 years old) and 2745 matched control patients were followed up. 69 (12%) CHD patients had a major acute cardiovascular event (MACE) during the follow up time [6.1 (0.7-10.4) years]. Patients with CHD and a GGT > 60 U/L were significantly older, more hypertensive and dyslipedemic, had a worse NYHA functional class and a greater anatomical complexity than CHD patients with a GGT ≤ 60 U/L. The binary logistic regression analysis showed that age, a great CHD anatomical complexity, and having atrial fibrillation/flutter were predictive factors of higher GGT levels (> 60 U/L). The Kaplan-Meier analysis showed that patients with CHD and a GGT concentration above 60 UL showed the lowest probability of survival compared to CHD with GGT ≤ 60 U/L and controls irrespective of their GGT concentrations (p<0.001). Similarly, the multivariable Cox regression analysis found an independent association between higher GGT levels (> 60 U/L) and a worse prognosis [HR 2.44 (1.34-4.44), p=0.003] among patients with CHD.

Conclusion: Patients with CHD showed significant higher GGT levels than patients in the control group having those with higher GGT concentrations (> 60 U/L) the worst survival.
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http://dx.doi.org/10.1111/eci.13720DOI Listing
November 2021

Outpatient Management of Persistent Air Leak.

Arch Bronconeumol (Engl Ed) 2021 Apr 26. Epub 2021 Apr 26.

Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España.

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http://dx.doi.org/10.1016/j.arbres.2021.04.019DOI Listing
April 2021

Rotational forceps: a retrospective study evaluating anatomical and functional consequences for the pelvic floor.

Int Urogynecol J 2021 07 15;32(7):1857-1865. Epub 2021 May 15.

Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular-Materno Infantil, Avenida Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Spain.

Introduction And Hypothesis: The use of Kielland's rotational forceps is considered to involve greater technical difficulty and may be associated with a higher rate of pelvic floor trauma. Our main objective was to evaluate the association between avulsion of the levator muscle and rotational and non-rotational forceps.

Methods: This was an observational study carried out at a tertiary hospital that recruited singleton cephalic vaginally primiparous women with previous Kielland's forceps delivery between March 2012 and May 2017. Patients were retrieved from a local database, contacted consecutively and blinded to all clinical data. Power calculations determined a sample of n = 160 patients. All women underwent a urogynecological interview, clinical examination and 4D translabial ultrasound (TLUS). The 4D TLUS volumes were stored and analyzed offline by an experienced ultrasound examiner who was blinded to all clinical data.

Results: A total of 165 patients were available for analysis. Rotational forceps accounted for 27.3% (45 out of 165) of the study sample. Avulsion was present in 41.8% (69 out of 165) of all forceps deliveries. On multivariate analysis, rotational forceps was associated with avulsion, with an adjusted odds ratio (OR) of 2.57 (CI 95% 1.20-5.62, p = 0.016). Body mass index at the beginning of gestation was found to be a protective factor, with an adjusted OR of 0.918 (CI 95% 0.847-0.986, p = 0.025).

Conclusion: Rotational forceps is associated with a higher avulsion rate than non-rotational forceps, with an adjusted OR of over 2.5. Obstetricians need to consider the potential long-term consequences of performing a rotational forceps for mothers.
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http://dx.doi.org/10.1007/s00192-021-04814-xDOI Listing
July 2021

The effect of physical activity on quality of life and serum glucose and cholesterol levels in patients with congenital heart disease.

Am J Cardiovasc Dis 2021 15;11(1):53-64. Epub 2021 Feb 15.

Research Unit. Complejo Hospitalario Universitario Insular-Materno Infantil Las Palmas de Gran Canaria 35016, Spain.

As physical activity contributes to quality of life and health, we evaluated its association, as measured by the Global physical activity (GPAQ) questionnaire, on the quality of life (QoL) and serum glucose and cholesterol levels of patients with congenital heart disease (CHD). This cross-sectional study was carried out in 200 adult patients with CHD (17 to 58 years old), of whom 45 had simple defects, 122 moderate defects and 33 great anatomical complexity defects. Physiological complexity was defined as stage A in 74 patients, stage B in 29, stage C in 86 and stage D in 11. The energy expenditure was below 600 Metabolic Equivalent of Task (MET)-minutes per week in 56 (28%) patients, while 144 (72%) were above 600 MET-minutes per week. Physically inactive patients with CHD were significantly more dyslipidemic than active ones, but no significant differences in serum glucose and cholesterol levels were observed. Logistic regression analysis showed that physical activity was associated with a better QoL rating [0.28 (0.10-0.17), P=0.014] and health satisfaction [0.24 (0.09-0.62), P=0.003]. Physically active patients with CHD scored 7.7 and 8.9 points higher, on a 100-point scale, in the physical and social relationships domains respectively, than physically inactive ones. No significant differences were seen in the psychological and the environment domains associated with physical activity. Additionally, a worse New York Heart Association (NYHA) functional class (≥ 2) was identified as a risk factor for dissatisfaction with health [OR 7.48, 95% CI (1.55-47.14), P=0.020], having a significantly negative impact of 8.5 and 7.6, on a 100-point scale, in the physical and psychological domains respectively. In conclusion, physically active patients with CHD had a better QoL assessment, were more satisfied with their health and scored higher in the physical and social relationships domains.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012286PMC
February 2021

The incidence of skin melanoma in Gran Canaria (Canary Islands, Spain) is lower than expected in Southern Europe despite high-risk environmental conditions: an island-wide cross-sectional study.

Cancer Causes Control 2021 May 1;32(5):525-535. Epub 2021 Mar 1.

Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.

Background: The Canary Islands are a leading European touristic destination. The ultraviolet index (UVI) in the region is the highest in Spain, and similar to indexes registered in Australia and New Zealand, which hold the highest incidence of skin melanoma worldwide. Yet according to cancer registry data, the incidence in the Canary Islands in the late 1990s was the lowest in Spain (among the lowest in Europe) and about six times lower than in New Zealand.

Purpose: To analyze the incidence rates of skin melanoma in Gran Canaria island between 2007 and 2018.

Methods: The study was based in the two centres of the Canary Islands' Healthcare Service centralizing melanoma care in Gran Canaria. We analyzed crude and age-standardized (ASR) incidence rates of invasive cutaneous melanoma for the period 2007-2018 following the inclusion criteria of the International Agency for Research on Cancer (IARC). Clinical and histological characteristics of melanoma patients were assessed.

Results: A total of 1058 patients were included. The incidence rates obtained matched the latest available Canary Islands' cancer registry data, confirming its reliability (ASR, Segi-Doll world standard population: 6.4 cases per 100,000 habitants for 2008-2012). The incidence was also below the latest IARC predictions for Southern Europe (GLOBOCAN 2018). Histological characteristics of patients were similar to other Southern European series.

Conclusions: The incidence of skin melanoma in Gran Canaria is unexpectedly low for a Southern European population exposed to such a high UVI. Further research in the Canary Islands could provide insight into a better understanding of melanoma pathogenesis.
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http://dx.doi.org/10.1007/s10552-021-01403-7DOI Listing
May 2021

[Commitment and responsibility of health professionals in a region of Spain during the Covid-19 pandemic].

Salud Publica Mex 2020 Nov-Dec;62(6):868-869

Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria.Las Palmas de Gran Canaria, España.

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http://dx.doi.org/10.21149/11726DOI Listing
March 2021

Expression at Post-Induction and Complete Remission Impact Outcome in Acute Myeloid Leukemia.

Diagnostics (Basel) 2020 Dec 4;10(12). Epub 2020 Dec 4.

Molecular Biology Group, Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain.

Advances in acute myeloid leukemia (AML) genomics and targeted therapies include the recently approved BCL2 inhibitor venetoclax. The association between expression and patient outcome was analyzed in a series of 176 consecutive AML patients at diagnosis (Dx), post-induction (PI), complete remission (CR) and relapse (RL). Levels increased significantly at relapse (mean 1.07 PI/0.96 CR vs. 2.17 RL, = 0.05/ = 0.03). In multivariate analysis, high -Dx were marginally associated with worse progression-free survival, while high PI levels or at CR had an independent negative impact on outcome (PI: HR 1.58, = 0.014; CR: HR 1.96, = 0.008). This behavior of high PI or CR levels and increased risk was maintained in a homogeneous patient subgroup of age <70 and intermediate cytogenetic risk (PI: HR 2.44, = 0.037; CR: HR 2.71, = 0.049). Finally, for this subgroup, high at relapse indicated worse overall survival (OS, HR 1.15, = 0.05). In conclusion, high levels PI or at CR had an independent negative impact on patient outcome. Therefore, expression is a dynamic marker that may be useful during AML patient follow up, and levels at PI and/or CR may influence response to anti-BCL2 therapy.
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http://dx.doi.org/10.3390/diagnostics10121048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762084PMC
December 2020

The risk of thrombosis in essential thrombocythemia is associated with the type of CALR mutation: A multicentre collaborative study.

Eur J Haematol 2021 Mar 30;106(3):371-379. Epub 2020 Dec 30.

Hematology Department, Hospital Universitario de Gran Canaria Dr.Negrín, Las Palmas de Gran Canaria, Spain.

Objectives: In patients with essential thrombocythemia (ET), after the JAK2V617F driver mutation, mutations in CALR are common (classified as type 1, 52-bp deletion or type 2, 5-bp insertion). CALR mutations have generally been associated with a lower risk of thrombosis. This study aimed to confirm the impact of CALR mutation type on thrombotic risk.

Methods: We retrospectively investigated 983 ET patients diagnosed in Spanish and Polish hospitals.

Results: With 7.5 years of median follow-up from diagnosis, 155 patients (15.8%) had one or more thrombotic event. The 5-year thrombosis-free survival (TFS) rate was 83.8%, 91.6% and 93.9% for the JAK2V617F, CALR-type 1 and CALR-type 2 groups, respectively (P = .002). Comparing CALR-type 1 and CALR-type 2 groups, TFS for venous thrombosis was lower in CALR-type 1 (P = .046), with no difference in TFS for arterial thrombosis observed. The cumulative incidence of thrombosis was significantly different comparing JAK2V617F vs CALR-type 2 groups but not JAK2V617F vs CALR-type 1 groups. Moreover, CALR-type 2 mutation was a statistically significant protective factor for thrombosis with respect to JAK2V617F in multivariate logistic regression (OR: 0.45, P = .04) adjusted by age.

Conclusions: Our results suggest that CALR mutation type has prognostic value for the stratification of thrombotic risk in ET patients.
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http://dx.doi.org/10.1111/ejh.13561DOI Listing
March 2021

Malnutrition is independently associated with an increased risk of major cardiovascular events in adult patients with congenital heart disease.

Nutr Metab Cardiovasc Dis 2021 02 28;31(2):481-488. Epub 2020 Sep 28.

Research Unit, Complejo Hospitalario Universitario Insular- Materno Infantil, Las Palmas de Gran Canaria, Spain.

Background And Aims: Malnutrition is found frequently during chronic diseases, and its prevalence and relation to disease outcome in adult patients with congenital heart disease (CHD) remains unknown.

Methods And Results: A cohort of 393 consecutive stable congenital heart disease (CHD) patients was followed up in a single dedicated clinical unit. Demographic, clinical and laboratory parameters, along with a nutritional risk index (NRI), were studied, as well as major acute cardiovascular events (MACE), defined as arterial thrombotic events, heart failure requiring hospitalization or cardiovascular and non-cardiovascular mortality. The median age of the patients was 23 years (17-35) and 225 (57%) were males. Median plasma albumin concentration was 4.5 (4.2-4.7) g/dL, the body mass index was 23 (21-27) kg/m, the NRI was 112 (106-118), and 33 (8%) patients showed malnutrition (NIR<100). A worse NYHA functional class (II and III), total cholesterol and serum glucose levels were significant risk factors associated with malnutrition (NRI<100) in CHD patients. During a median follow-up of 8 (5-10) years, 39 (10%) CHD patients suffered a MACE. Multivariable Cox regression analysis showed that older patients (years) [HR 1.06 (1.04-1.09), p < 0.001], CHD patients with great anatomical complexity [HR 4.24 (2.17-8.27), p < 0.001] and those with a lower NRI [HR 0.95 (0.93-0.98), p = 0.001] had a significant worse MACE-free survival, being the NRI a better predictor of MACE than albumin concentration.

Conclusions: A low NRI is independently associated with a significant increased risk of MACE in CHD patients.
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http://dx.doi.org/10.1016/j.numecd.2020.09.026DOI Listing
February 2021

Relationship between perimetric increase and fluoroscopic pattern type in secondary upper limb lymphedema observed by Indocyanine green lymphography.

Medicine (Baltimore) 2020 Jun;99(24):e20432

Department of Physiotherapy, University of Seville, Spain.

To ascertain the relationship between the perimetric differences obtained between the limbs and the type of fluoroscopic pattern observed by Indocyanine green (ICG) lymphography in patients with upper limb lymphedema.A correlational descriptive study was carried out in 19 patients with upper limb lymphedema secondary to breast cancer. The perimetric increase was recorded in 11 anatomical regions after ICG injection, fluoroscopic patterns were identified using an infrared camera. The ICG patterns were categorized into worse (stardust, diffuse) or better (linear, splash) patterns.The pattern coincidence between the anterior and posterior regions of the edematous extremities was 45%. At the wrist level, a difference of 2 cm was associated with the presence of a worse fluoroscopic pattern, whereas perimeter differences of 4.25 cm in the elbow and 2.25 cm in the arm (12 cm from the epicondyle) were associated with the presence of a better fluoroscopic pattern.The perimetric differences observed between the healthy and affected upper limbs in 4 specific anatomical areas allowed us to predict the type of fluoroscopic pattern. ICG lymphography has facilitated the study of the posterior regions of edema, which are difficult to visualize using other imaging techniques.
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http://dx.doi.org/10.1097/MD.0000000000020432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302654PMC
June 2020

Thrombotic Risk Detection in Patients with Polycythemia Vera: The Predictive Role of Mutations.

Cancers (Basel) 2020 Apr 10;12(4). Epub 2020 Apr 10.

Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, 35019 Las Palmas de Gran Canaria, Spain.

The development of thrombotic events is common among patients with polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). We studied the influence of pathogenic mutations frequently associated with myeloid malignancies on thrombotic events using next-generation sequencing (NGS) in an initial cohort of 68 patients with myeloproliferative neoplasms (MPN). As expected, the presence of mutations in and (DTA genes) was positively associated with age for the whole cohort ( = 0.025, OR: 1.047, 95% CI: 1.006-1.090). Also, while not related with events in the whole cohort, DTA mutations were strongly associated with the development of vascular events in PV patients ( = 0.028). To confirm the possible association between the presence of DTA mutation and thrombotic events, we performed a case-control study on 55 age-matched patients with PV (including 12 PV patients from the initial cohort, 25 with event vs. 30 no event). In the age-matched case-control PV cohort, the presence of ≥1 DTA mutation significantly increased the risk of a thrombotic event (OR: 6.333, = 0.0024). Specifically, mutations in were associated with thrombotic events in the PV case-control cohort (OR: 3.56, 95% CI: 1.15-11.83, = 0.031). Our results suggest that pathogenic DTA mutations, and particularly mutations, may be an independent risk factor for thrombosis in patients with PV. However, the predictive value of and DTA mutations in ET and PMF was inconclusive and should be determined in a larger cohort.
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http://dx.doi.org/10.3390/cancers12040934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226609PMC
April 2020

Low educational attainment is still associated with late melanoma diagnosis: A cross-sectional study from a European setting with universal healthcare.

Cancer Epidemiol 2019 10 14;62:101576. Epub 2019 Aug 14.

Dermatology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain.

Background: An early diagnosis of cutaneous melanoma remains determinant for improved survival. Low educational attainment has been associated with a late-stage diagnosis in settings where access to healthcare is restricted. Little evidence is available from regions with universal healthcare. We aimed at analysing whether educational attainment was associated with Breslow thickness at diagnosis in a peripheral European region with universal healthcare (in the Canary Islands, Spain).

Methods: We conducted a cross-sectional study with prospectively collected data (2010-2017). Patients were recruited at diagnosis, and information about Breslow thickness, age at diagnosis, gender, highest educational attainment and site of melanoma were registered. Univariate and multivariate linear regression analyses were performed.

Results: Low educational attainment was associated with thicker tumours at diagnosis. The association remained true after adjustment for age, gender and site of melanoma. In the multivariate analysis, tumours diagnosed in patients with low educational attainment were on average 1.08 mm thicker (95% confidence interval: 0.36-1.81; p = 0.003) than those diagnosed in patients with high educational attainment.

Conclusion: Public health strategies targeting this vulnerable group are currently needed in the Canary Islands (Spain).
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http://dx.doi.org/10.1016/j.canep.2019.101576DOI Listing
October 2019

Effect of femtosecond laser-assisted lens surgery on the optic nerve head and the macula.

Int J Ophthalmol 2019 18;12(6):961-966. Epub 2019 Jun 18.

Universidad Internacional de Cataluña (UIC), Barcelona 08195, Spain.

Aim: To evaluate the effect of femtosecond laser-assisted lens surgery (FLALS; cataract surgery or refractive lens exchange) on the structure of the optic nerve head and the macula.

Methods: This prospective longitudinal study included healthy eyes undergoing FLALS. Eyes with glaucoma or any other ocular disease that could alter optical coherence tomography results were excluded. Retinal nerve fiber layer (RNFL), Bruch's membrane opening-minimum rim width (BMO-MRW) and macular thickness (MT) were measured preoperatively, 1 and 6mo after surgery using spectral-domain optical coherence tomography (SD-OCT). Changes between preoperative and postoperative values were evaluated.

Results: A total of 87 eyes of 46 patients were included in this study. Preoperative RNFL, BMO-MRW and MT in microns (µm) were 100.77±10.39, 330.31±49.99 and 276.30±33.39, respectively. Postoperative RNFL, BMO-MRW and MT were 104.74±11.55, 348.32±54.05 and 279.83±22.65 1mo after surgery and 102.93±11.17, 343.11±53.4 and 278.90±22.19 6mo after surgery, respectively; which equals an increase of 3.93%, 5.45% and 1.27%, respectively, 1mo after surgery, and 2.14%, 3.87% and 0.94% 6mo after surgery. The differences between the preoperative and the postoperative RNFL and BMO-MRW values were statistically significant (<0.001). Regarding MT values, there were not statistically significant differences (=0.26).

Conclusion: Our study suggests that FLALS does not have a negative impact on the structural status of the optic nerve head in healthy eyes, assessed by SD-OCT. There is a slight increase in the values of RNFL, BMO-MRW and MT 1mo and 6mo after surgery.
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http://dx.doi.org/10.18240/ijo.2019.06.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580205PMC
June 2019

First-trimester cystic posterior fossa: reference ranges, associated findings, and pregnancy outcomes.

J Matern Fetal Neonatal Med 2021 Mar 4;34(6):933-942. Epub 2019 Jun 4.

Fetal Imaging Unit, FETALMED - Maternal-Fetal Diagnostic Center, Santiago, Chile.

Objective: To report reference ranges for fetal cerebral posterior fossa measurements and to describe the sonographic findings, karyotype results, and pregnancy outcomes in fetuses presenting with cystic posterior fossa (CPF) in the first trimester of pregnancy.

Methods: Two groups of patients undergoing first-trimester sonographic screening at 11-13 weeks' gestation were studied. The first (control group) consisted of 253 consecutive fetuses with normal posterior fossa, in which the brainstem (BS), fourth ventricle, cisterna magna, and BS-occipital bone (BS-OB) diameter were prospectively measured and the BS/BS-OB diameter ratio was calculated. The second (study group) consisted of 14 fetuses in which a CPF was detected. Information on sonographic findings, prenatal karyotype results, and pregnancy outcomes was obtained by reviewing ultrasound reports and medical records. The results from the two groups were then compared.

Results: In the control group, the size of all posterior fossa structures increased and the BS/BS-OB diameter ratio slightly decreased as the pregnancy progressed. In the study group, the BS diameter did not differ significantly from the measurements obtained in the control group. However, the BS-OB diameter and the fourth ventricle were significantly larger ( < .05 and  < .001, respectively) in the study group than in the control group. Additionally, the cisterna magna was not identified in 13 of the 14 fetuses (93%) in the study group, in comparison to zero out of the 253 fetuses in the control group ( < .001). Finally, the BS/BS-OB diameter ratio was significantly smaller in the study group when compared with the control group ( < .05). Regarding pregnancy outcomes, 12 of the 14 (86%) affected pregnancies underwent elective termination ( = 11) or ended in an early intrauterine demise ( = 1) due to the associated chromosomal abnormalities or structural defects. The two fetuses with isolated CPF had a normal second-trimester scan and resulted in the delivery of healthy newborn infants.

Conclusions: The detection of a CPF in the first trimester is associated with a high rate of chromosomal and structural defects. By using normative data, early sonographic screening and detection of mildly and moderately abnormal cases is possible. Fetuses with isolated CPF require further study with a detailed second-trimester scan. This is essential in order to differentiate cases with poor and good perinatal outcomes. Finally, our data also demonstrate that the main sonographic tool when screening for CPF in the first trimester is the assessment of the fourth ventricle, which is significantly larger in abnormal cases as the result of the wide communication between the fourth ventricle and the cisterna magna.
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http://dx.doi.org/10.1080/14767058.2019.1622673DOI Listing
March 2021

[Optimization of the prediction of financial problems in Spanish private health companies using genetic algorithms].

Gac Sanit 2019 Sep - Oct;33(5):462-467. Epub 2018 Aug 22.

Instituto para el Desarrollo Tecnológico y la Innovación en Comunicaciones (IDeTIC), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.

Objective: This paper presents a methodology to optimize, using Altman's Z-Score for private companies, the prediction of private companies of the Spanish health sector entering a situation of bankruptcy.

Method: The proposed method consists of the application of genetic algorithms (GA) to find the coefficients of the formula of the chain of ratios proposed by Altman in the version of the score for private companies which optimize the prediction for Spanish private health companies, maximizing sensitivity and specificity, and thereby reducing type I and type II errors. For this purpose, a sample of 5,903 companies from the Spanish private health sector obtained from the database of the Iberian Balance Analysis System (SABI) between 2007 and 2015 was used.

Results: The results show that the predictive model obtained with the AG presents greater accuracy, sensitivity and specificity than that proposed by Altman for private companies with both test data and all sample data.

Conclusions: The most important finding of this study was to establish a methodology that can identify the optimized coefficients for the Altman Z-Score, which allows a more accurate prediction of bankruptcy in Spanish private healthcare companies.
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http://dx.doi.org/10.1016/j.gaceta.2018.01.001DOI Listing
February 2020

Nuclear cataract as an early predictive factor for recalcitrant juvenile idiopathic arthritis-associated uveitis.

J AAPOS 2016 06 6;20(3):232-238.e1. Epub 2016 May 6.

Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Purpose: To analyze factors predictive of having treatment-resistant uveitis in patients with juvenile idiopathic arthritis (JIA)-associated uveitis.

Methods: The medical records of patients diagnosed with JIA-associated uveitis treated at a single tertiary referral center from October 2005 to March 2013 were reviewed retrospectively. The main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies.

Results: A total of 96 patients (175 eyes) were included. Of these, 58 patients (108 eyes) required biologic disease-modifying antirheumatic drugs or alkylating agents for their uveitis during follow-up (recalcitrant group), and 38 patients (67 eyes) did not (nonrecalcitrant group). Eyes of the recalcitrant group tended to have a higher incidence of cataract at baseline (49%; P < 0.0001). In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%). The mean number of flares in the recalcitrant group was significantly reduced from 3.7/eye/year prior to cataract surgery to 1.6/eye/year after (P < 0.0001). Nuclear cataract was found to be an independent predictor for a severe course of JIA-associated uveitis. Any other type of cataract, posterior synechiae, male sex, or active uveitis at baseline were not found to be independently associated with recalcitrant uveitis.

Conclusions: Nuclear cataract at baseline evaluation is a risk factor for poor response to first-line therapies in JIA-associated uveitis patients.
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http://dx.doi.org/10.1016/j.jaapos.2016.02.010DOI Listing
June 2016

Analysis of a novel protocol of pulsed intravenous cyclophosphamide for recalcitrant or severe ocular inflammatory disease.

Ophthalmology 2013 Jun 16;120(6):1201-9. Epub 2013 Apr 16.

Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA.

Purpose: To analyze the success rate of pulsed intravenous (IV) cyclophosphamide (CyP) for noninfectious ocular inflammatory disease and to identify risk factors for failure of therapy.

Design: Retrospective, interventional, noncomparative cohort study.

Participants: One hundred ten eyes of 65 patients.

Methods: Through a computer search of the Massachusetts Eye Research and Surgery Institution's database, we identified patients who were treated with IV CyP between May 2005 and April 2012. We obtained demographic and clinical information through review of the electronic health record of each patient.

Main Outcomes Measures: Clinical response, corticosteroid-sparing effect, recurrence rate, calculated "risk factors" for failure, visual acuity, and adverse reactions.

Results: Pulsed IV CyP achieved complete remission of inflammation (for ≥ 2 visits) in 54 patients (84.4%). Sustained remission of inflammation occurred in 70% of patients within 3 months, 86.6% of patients within 6 months, and 91.7% within 9 months. The mean time to achieving quiescence was 3.5 months. The success rate in reducing corticosteroid to prednisone ≤ 10 mg/d within 6 months, while maintaining control of ocular inflammation, was 89.7% (95% confidence interval [CI], 81.1-93.5%). The mean duration of clinical remission for those patients who had a positive response to CyP was 32.67 months (95% CI, 25.91-39.43). Relapse of vasculitis was observed in 1 patient (1.5%) after completing the course of therapy. Early initiation of therapy during the course of the disease was correlated with a lesser rate of recurrence (P = 0.028). The most common adverse effects were nausea (29%) and transient lymphopenia (26%). The mean best-corrected visual acuity (BCVA) improved from 0.59 ± 0.66 at baseline to 0.30 ± 0.54 at 6 months of follow-up (P<0.001). The mean follow-up period was 31.61 ± 20.47 months.

Conclusions: Pulsed IV CyP employing our protocol results in an extremely high rate of sustained complete remission in patients with recalcitrant and fulminant, vision-threatening ocular inflammatory disorders, with an excellent safety profile in the hands of physicians trained and skilled in the art of this therapy. It also allows tapering and discontinuing corticosteroids in most patients. Early initiation of therapy may decrease the risk of relapses.

Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
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http://dx.doi.org/10.1016/j.ophtha.2013.01.031DOI Listing
June 2013
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