Publications by authors named "Joaquín Gómez"

39 Publications

Growth Hormone and the Auditory Pathway: Neuromodulation and Neuroregeneration.

Int J Mol Sci 2021 Mar 11;22(6). Epub 2021 Mar 11.

Scientific Direction, Medical Center Foltra, 15886 Teo, Spain.

Growth hormone (GH) plays an important role in auditory development during the embryonic stage. Exogenous agents such as sound, noise, drugs or trauma, can induce the release of this hormone to perform a protective function and stimulate other mediators that protect the auditory pathway. In addition, GH deficiency conditions hearing loss or central auditory processing disorders. There are promising animal studies that reflect a possible regenerative role when exogenous GH is used in hearing impairments, demonstrated in in vivo and in vitro studies, and also, even a few studies show beneficial effects in humans presented and substantiated in the main text, although they should not exaggerate the main conclusions.
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http://dx.doi.org/10.3390/ijms22062829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998811PMC
March 2021

Current and Future Role of Tyrosine Kinases Inhibition in Thyroid Cancer: From Biology to Therapy.

Int J Mol Sci 2020 Jul 13;21(14). Epub 2020 Jul 13.

Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain.

Thyroid cancer represents a heterogenous disease whose incidence has increased in the last decades. Although three main different subtypes have been described, molecular characterization is progressively being included in the diagnostic and therapeutic algorithm of these patients. In fact, thyroid cancer is a landmark in the oncological approach to solid tumors as it harbors key genetic alterations driving tumor progression that have been demonstrated to be potential actionable targets. Within this promising and rapid changing scenario, current efforts are directed to improve tumor characterization for an accurate guidance in the therapeutic management. In this sense, it is strongly recommended to perform tissue genotyping to patients that are going to be considered for systemic therapy in order to select the adequate treatment, according to recent clinical trials data. Overall, the aim of this article is to provide a comprehensive review on the molecular biology of thyroid cancer focusing on the key role of tyrosine kinases. Additionally, from a clinical point of view, we provide a thorough perspective, current and future, in the treatment landscape of this tumor.
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http://dx.doi.org/10.3390/ijms21144951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403957PMC
July 2020

RELINF: prospective epidemiological registry of lymphoid neoplasms in Spain. A project from the GELTAMO group.

Ann Hematol 2020 Apr 20;99(4):799-808. Epub 2020 Feb 20.

Haematology Department, Hospital Clinic of Barcelona, Barcelona, Cataluña, Spain.

Lymphomas are a large, heterogeneous group of neoplasms with well-defined characteristics, and this heterogeneity highlights the importance of epidemiological data. Knowledge of local epidemiology is essential to optimise resources, design clinical trials, and identify minority entities. Given there are few published epidemiological data on lymphoma in Spain, the Spanish Lymphoma and Autologous Bone Marrow Transplant Group created the RELINF project. The aim of this project is to determine the frequencies and distribution of lymphoid neoplasms in Spain and to analyse survival. We developed an online platform for the prospective collection of data on newly diagnosed cases of lymphoma in Spain between January 2014 and July 2018; 11,400 patients were registered. Diffuse large B cell lymphoma (DLBCL) and follicular lymphoma (FL) were the most frequent lymphomas in our series. Marginal B cell lymphoma frequency was higher than that reported in other studies, representing more than 11% of mature B cell lymphomas. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) was the most common subtype of T cell lymphoma, and NK/T cell lymphomas were more frequent than expected (5.4% of total). Hodgkin's lymphoma accounted for 12% of lymphoproliferative syndromes. Overall survival was greater than 90% at 2 years for indolent B cell lymphomas, and approximately 60% for DLBCL, somewhat lower than that previously reported. Survival was poor for PTCL-NOS and angioimmunoblastic T cell lymphoma, as expected; however, it was somewhat better than that in other studies for anaplastic large cell anaplastic lymphoma kinase lymphomas. This is the first prospective registry to report the frequencies, distribution, and survival of lymphomas in Spain. The frequencies and survival data we report here are globally consistent with that reported in other Western countries. These updated frequencies and survival statistics are necessary for developing appropriate management strategies for neoplasias in the Spanish population.
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http://dx.doi.org/10.1007/s00277-020-03918-6DOI Listing
April 2020

A nomogram to predict the likelihood of permanent hypoparathyroidism after total thyroidectomy based on delayed serum calcium and iPTH measurements.

Gland Surg 2017 Dec;6(Suppl 1):S11-S19

Endocrine Surgery Unit, University Hospital del Mar, Barcelona, Spain.

Background: Retrospective studies have shown that delayed high-normal serum calcium and detectable iPTH are independent variables positively influencing outcome of prolonged parathyroid failure after total thyroidectomy (TT). The aim of the present study was to examine prospectively the ability of these two variables to predict permanent hypoparathyroidism in patients under replacement therapy for postoperative hypocalcemia.

Methods: Prospective observational multicenter study of patients undergoing TT followed by postoperative parathyroid failure (serum calcium <8 mg/dL within 24 h and PTH <15 pg/mL 4 h after surgery). Serum calcium, vitamin D and iPTH were determined before thyroidectomy, 24 h after surgery, at 1 month and then periodically until recovery of the parathyroid function or permanent hypoparathyroidism was diagnosed after at least 1 year follow-up.

Results: Some 145 patients with postoperative hypocalcemia were investigated [s-Ca 7.5 (0.5) mg/dL]. Hypocalcemia recovered within 30 days in 91 (63%) patients and 54 (37%) developed protracted hypoparathyroidism {iPTH 5.8 [4] pg/mL at 1 month}, of whom 32 recovered within 1 year and 22 developed permanent hypoparathyroidism. Protracted hypoparathyroidism was related to few parathyroid glands remaining in situ (PGRIS). Serum calcium concentration (mg/dL) at 1 postoperative month correlated positively with the rate of recovery (percent) from protracted hypoparathyroidism: <8.5 (20%); 8.5-9 (29%); 9.1-9.5 (70%); 9.6-10 (89%); >10 (83%) (P=0.013). Serum iPTH at 1 month was also higher (7.3 . 3.7 pg/mL; P=0.002) in recovered protracted hypoparathyroidism. The combination of both variables predicts the likelihood of recovery of the parathyroid function with >90% accuracy.

Conclusions: High-normal serum calcium and low but detectable iPTH concentrations at 1 month after TT were associated with better outcome of protracted hypoparathyroidism. A nomogram combining both variables may guide medical treatment and monitoring of post-thyroidectomy prolonged hypoparathyroidism.
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http://dx.doi.org/10.21037/gs.2017.10.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756757PMC
December 2017

[Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011].

Cad Saude Publica 2016 Nov 1;32(11):e00080215. Epub 2016 Nov 1.

Asociación Colombiana de la Salud, Bogotá, Colombia.

The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.
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http://dx.doi.org/10.1590/0102-311X00080215DOI Listing
November 2016

A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome.

Asian J Neurosurg 2015 Apr-Jun;10(2):75-82

Department of Neurosurgery, Narayana Medical College and Hospital, Chintareddy Palem, Nellore, India.

Background: The spine surgeons have been combining anterior and posterolateral fusion (circumferential fusion) as the final solution to treat spinal disorders and many have been using it to treat failed back surgery syndrome (FBSS). In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral B-Twin system for FBSS with a follow-up period of 10 years after the surgery.

Materials And Methods: This study was a retrospective case study performed on 55 patients with FBSS. Clinical and radiological changes were compared between the two groups of patients on the basis of improvement of back pain, radicular pain, and work capacity. Outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year from before surgery until 2012. We analyzed the evolution of 55 cases of FBSS those underwent segmental circumferential posterior fusions from June 2001 to February 2003, operated by a single surgeon and followed up during 10 years until February 2012. The patients were divided into 2 groups: In 25 patients, posterolateral fusions with Legacy™ (Medtronic, Inc. NYSE: MDT) screws and intersomatic autogenous posterior iliac crest bone graft was performed, and, in 30 patients, posterolateral fusions with the same screws and intersomatic fusion B-Twin (Biomet Spain Orthopaedics, S.L.) system was performed. In all cases, we used posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) approach for intervertebral graft, and the artrodesis was supplemented at intertransverse level with Autologus Growth Factor (AGF-MBA INCORPORADO, S.A.). The outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year and compared from before surgery to the final follow-up visit. Preoperative and postoperative scores were available for all patients.

Results: The average age of these patients was comparable in both groups (mean age 42.6 versus 50.2 years). The average follow-up period was 200.6 months in the first group (screws and intersomatic bone) and 184.4 months in the second group (screws and B-Twin). In the autologus bone graft group, the CT scan and Rx study revealed loss of height of intervertebral space between 25% and 45% of 24 h postoperative height of intervertebral operated disc, and the patients continued to lose the height until 20 months after the surgery. In the B Twin group, the CT scan and Rx study revealed a loss of height of the intervertebral level of 8-12% over a period of 9 months follow-up, followed by stability. A total of 31 patients (55%) had improved Oswestry Low Back Pain Disability Index >40% of the total possible points, although this did not reflect in PSI or return to work rate.

Conclusions: The patients with rigid fixation do well in terms of correction of lumbar lordosis, but they do not do well in terms of recurrence of pain. Furthermore, they need some kind of intervention to control pain after the first year after surgery. In patients in whom bone graft is used, although they do not maintain and sustain the lumbar lordosis in the long term, they have less recurrence of pain with less chances of intervention for pain control.
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http://dx.doi.org/10.4103/1793-5482.145120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421972PMC
May 2015

Bacteremia in adult cancer patients with apparently stable febrile neutropenia: data from a cohort of 692 consecutive episodes from a single institution.

J Community Support Oncol 2014 Sep;12(9):312-20

Departments of Hematology and Medical Oncology, Hospital Morales Meseguer, Murcia, Spain.

Background: Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment.

Objective: To assess the risk factors and the impact of bacteremia in ASPs.

Methods: We retrospectively analyzed 861 consecutive episodes of FN that were classifed according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting.

Results: We classifed 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specifcity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward.

Limitations: A single-center, retrospective analysis, and the absence of a validation set to test the model's discriminatory ability.

Conclusions: Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identifed several variables that could improve the prognostic classifcation of clinically stable FN.
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http://dx.doi.org/10.12788/jcso.0071DOI Listing
September 2014

One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy.

Asian J Neurosurg 2015 Jan-Mar;10(1):21-5

Department of Surgery Datta Meghe Institute of Medical Sciences, Sawangi, Meghe, Wardha, India.

Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.

Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed.

Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105-130 months) with a mean age was 52 years (range 26-74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3-4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.

Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.
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http://dx.doi.org/10.4103/1793-5482.151504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352623PMC
March 2015

[Betalactams in clinical practice].

Rev Esp Quimioter 2015 Feb;28(1):1-9

Joaquín Gómez, Servicio Medicina Interna-Infecciosas Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina. Universidad de Murcia, Ctra. Madrid-Cartagena, 30120 El Palmar (Murcia), Spain.

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February 2015

Long term preservation of motion with artificial cervical disc implants: A comparison between cervical disc replacement and rigid fusion with cage.

Asian J Neurosurg 2014 Oct-Dec;9(4):213-7

Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andra Pradesh, India.

Background: With the advancement of technologies there is more interest in the maintenance of the spine's biomechanical properties focusing on the preservation of the functional motion segment. In present article we describe our experience with 25 cases managed with artificial cervical discs with 28 Solis cage following cervical discectomy with a mean follow-up period of 7.5 year.

Materials And Methods: All surgeries were performed by single surgeon from March 2004 to June 2005 with a follow-up till date. Patients with symptomatic single or multiple level diseases that had no prior cervical surgery were candidates for the study. Cohort demographics were comparable. Standardized clinical outcome measures and radiographic examinations were used at prescribed post-operative intervals to compare the treatment groups. Relief in radicular pain, cervical spine motion, and degenerative changes at follow-up were noted.

Results: In a total 53 cases, the mean age in prosthesis group was 47 years (age range: 30-63 years) and mean age in cage group was 44 years (32-62 years). Mean hospital stay was 2.7 days in both the groups. At 4 weeks complete cervical movements could be achieved in 19 cases in artificial disc group. Maintenance of movement after 7.5 years was in 76% of these patients. Lordosis was maintained in all cases till date. There was no mortality or wound infection in our series.

Conclusions: We conclude that artificial cervical disc could be an alternative to fixed spinal fusion as it represents the most physiological substitute of disc. However, there is need for further studies to support the use of artificial cervical disc prosthesis.
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http://dx.doi.org/10.4103/1793-5482.146608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323965PMC
February 2015

[Analysis of mortality caused by tuberculosis in Medellín, Colombia, 2012].

Biomedica 2014 Jul-Sep;34(3):425-32

Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Introduction: Tuberculosis is a relevant global public health problem. Although reports of the World Health Organization show decrease in overall mortality rates, Colombia and Medellin show no significant decline.

Objective: To describe the sociodemographic, clinical, diagnosis, and treatment characteristics of patients who died due to tuberculosis in Medellin, Colombia, during 2012.

Materials And Methods: A descriptive study of tuberculosis deaths reported in the city.

Results: 93 deaths were identified, of which 32 were confirmed as directly caused by tuberculosis (34.4%); in 23 deaths (24.7%) tuberculosis was an associated cause. Co-morbidities were found in 34 patients (61.7%), HIV being the most common with 18 cases important(32.7%). Social risk factors such as being homeless, drug addiction or having no fixed address were found in 32 cases (58.1%); and there were deficiencies in the healthcare system in 26 cases (47.2%). No meaningful delay in the onset of anti-tuberculosis treatment was found after the microbiological diagnosis; however, 64% of patients did not adhere to treatment.

Conclusion: Mortality caused by tuberculosis in Medellin is a relevant problem associated with delays in diagnosis of the disease and lack of adherence to treatment.
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http://dx.doi.org/10.1590/S0120-41572014000300012DOI Listing
August 2015

[Study of a cohort of patients with Enterococcus spp. Bacteraemia. Risk factors associated to high-level resistance to aminoglycosides].

Rev Esp Quimioter 2013 Sep;26(3):203-13

Elisa García-Vázquez, Servicio Medicina Interna-Infecciosas. Hospital Universitario Virgen de la Arrixaca. Murcia, Ctra. Madrid-Cartagena. 30120 El Palmar (Murcia), Spain.

Objectives: To analyze a cohort of patients with Enterococcus sp. bacteraemia.

Patients And Methods: Retrospective and observational study of a cohort of non-pediatric in-patients with Enterococcus spp. bacteraemia (June 2007-September 2009). Data collection from clinical records was done according to a standard protocol. We analyzed epidemiological, clinical and microbiological data. Treatment with glycopeptides in non allergic patients or in case of betalactam susceptibility (ampicillin) was considered "optimizable".

Results: Three were 106 cases of bacteraemia (2.2/1000 admitted patients; 84% E. faecalis); 83% had an underlying condition; 88% nosocomial or health related cases. Urinary infection was present in 20% and primary bacteraemia in 47%. High level resistance to gentamicin (HLRG) was present in 60%; there was no vancomycin or linezolid resistance. Most frequent empiric treatments were penicillin-betalactamase inhibitor (25%) and glycopeptides (22%). Most frequent definitive treatment was glycopeptides (34%), being "optimized" 21% and 44% of empiric and definitive treatments, respectively. Mortality was 23% (related, 14%). In the multivariate analysis, risk factors associated with HLRG were nosocomial acquired infection (OR 6.083; 95CI% 1.428-25.915) and no-abdominal origin (OR 6.006; 95CI%1.398-25.805). In multivariate analysis, independent risk factors for mortality were: Pitt > 3 (OR 14.405; 95CI%2.236-92.808) and active empiric treatment (OR 8.849; 95CI% 1.101-71.429). Incidence in previous cohort was similar but HLRG rate has increased.

Conclusions: Risk factors associated with HLRG were nosocomial acquired infection and no-abdominal origin. Risk factors for mortality were initial clinical severity and having received active empiric treatment. HLRG rate has increased.
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September 2013

When is coagulase-negative Staphylococcus bacteraemia clinically significant?

Scand J Infect Dis 2013 Sep 1;45(9):664-71. Epub 2013 Jul 1.

Servicio de MI-Infecciosas, Hospital Clínico Universitario Virgen de la Arrixaca, Madrid-Cartagena, El Palmar, Murcia, Spain.

Background: Coagulase-negative staphylococci (CoNS) are common contaminants in blood cultures (BC). A prospective study of patients with ≥ 2 blood culture sets and at least 1 positive CoNS BC was performed to develop an algorithm to assist in determining the clinical significance of CoNS bacteraemia.

Methods: A single reviewer examined the medical records of patients with CoNS bacteraemia (January-June 2010). The determination of clinical significance was made according to CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network) criteria. To explore risk factors associated with clinical significance, a multivariate analysis was performed. The performances of various algorithms were then compared. An algorithm to assist in determining clinical significance was developed.

Results: Two hundred and sixty-nine cases were included; 97 (36%) were considered clinically significant bacteraemia (CSB). Predictors of CSB in the multivariate analysis were: time to positivity < 16 h (odds ratio (OR) 4.540, 95% confidence interval (CI) 1.734-11.884), identification of Staphylococcus epidermidis (OR 4.273, 95% CI 2.124-5.593), central venous catheter (OR 4.932, 95% CI 2.467-9.858), > 2 CoNS-positive bottles from different BC sets (OR 1.957, 95% CI 1.401-2.733), and Charlson score ≥ 3 (OR 2.102, 95% CI 1.078-4.099). The algorithm with best sensitivity (62%) and specificity (93%) for determining clinical significance of CoNS included Charlson score ≥ 3, Pitt score ≥ 1, neutropenic patients, presence of central venous catheter, identification of S. epidermidis, and time to positivity < 16 h. The positive predictive value was 83% and the negative predictive value was 81% (likelihood ratio 8.87).

Conclusion: The use of this algorithm could potentially reduce the misclassification of nosocomial bloodstream infections and inappropriate antibiotic treatment in patients for whom a positive CoNS does not represent a CSB.
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http://dx.doi.org/10.3109/00365548.2013.797599DOI Listing
September 2013

What is the impact of a rapid diagnostic E-test in the treatment of patients with Gram-negative bacteraemia?

Scand J Infect Dis 2013 Aug 18;45(8):623-8. Epub 2013 Apr 18.

From the Infectious Diseases - Internal Medicine Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.

Objective: To evaluate the influence of a rapid diagnostic test (RDT) in antibiotic therapeutic decisions in non-paediatric patients with Gram-negative bacteraemia (GNB).

Patients And Methods: A RDT consisting of a direct antibiogram was used on blood isolates of GNB. GNB were also identified and sensitivity tests were performed according to standard criteria. Information on empirical treatment was registered (T1), as well as the antibiotic administered once the results of the RDT were available (T2). Finally, we noted the ideal antibiotic that the infectious diseases specialist (IDS) would have prescribed (T3). The decision regarding T2 was always taken by the patient's physician or the physician on duty.

Results: A RDT was performed for 248 patients. The most frequently isolated bacterium was Escherichia coli (13% producing extended-spectrum beta-lactamase). T1 was considered appropriate in 74% and appropriate but optimizable in 43%. T2 was considered appropriate in 95%, appropriate but optimizable in 36%, and inappropriate in 5%. The cost of the optimizable treatment (T2) was € 2210, while the cost of the ideal treatment would have been € 416; the saving in antibiotic cost of 1 day of treatment would have been € 1694.

Conclusions: Treatment prescribed by a non-IDS after a RDT was inappropriate in 5% and optimizable in 36%. It is our recommendation that information provided by a RDT should be interpreted by an IDS to make the information more beneficial both economically and 'ecologically'.
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http://dx.doi.org/10.3109/00365548.2013.782102DOI Listing
August 2013

Lack of Association between Recurrent Pregnancy Loss and Inherited Thrombophilia in a Group of Colombian Patients.

Thrombosis 2012 11;2012:367823. Epub 2012 Apr 11.

Grupo Reproducción, Universidad de Antioquia, Medellín, Colombia.

Studies have shown an association between recurrent pregnancy loss and inherited thrombophilia in Caucasian populations, but there is insufficient knowledge concerning triethnic populations such as the Colombian. The aim of this study was to evaluate whether inherited thrombophilia is associated with recurrent pregnancy loss. Methods. We conducted a case-control study of 93 patients with recurrent pregnancy loss (cases) and 206 healthy multiparous women (controls) in a Colombian subpopulation. Three single nucleotide polymorphisms (SNPs) markers of the inherited thrombophilias factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T were genotyped by PCR-RFLP. Activated protein C resistance and plasma levels of antithrombin, protein C, and protein S were also measured. Results. The frequency of thrombophilia-associated SNPs, activated protein C resistance, and anticoagulant protein deficiencies, was low overall, except for the methylenetetrahydrofolate reductase C677T SNP. The differences between patients and controls had no statistical significance. Conclusion. Our study confirms the low prevalence of inherited thrombophilias in non-Caucasian populations and it is unlikely that the tested thrombophilias play a role in the pathogenesis of recurrent pregnancy loss in this Colombian population.
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http://dx.doi.org/10.1155/2012/367823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345256PMC
August 2012

Recommendations for the treatment of invasive fungal infection caused by filamentous fungi in the hematological patient.

Rev Esp Quimioter 2011 Dec;24(4):263-70

Servicio de Enfermedades Infecciosas, Hospital Central de la Defensa Gómez Ulla, E-28047 Madrid, Spain.

Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results.
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December 2011

Multidrug and carbapenem-resistant Acinetobacter baumannii infections: Factors associated with mortality.

Med Clin (Barc) 2012 May 16;138(15):650-5. Epub 2011 Nov 16.

Services of Internal Medicine-Infectious Diseases, University Hospital Virgen de la Arrixaca, Spain.

Background And Objective: To analyse factors related to mortality and influence of antibiotic treatment on outcome in patients with nosocomial infection due to multidrug and carbapenem-resistant Acinetobacter baumannii (MDR-C AB).

Patients And Methods: Observational and prospective study of a cohort of adult patients with MDR-C AB infection. Data collection from clinical records was done according to a standard protocol (January 2007 through June 2008). Patients with MDR-C AB infection were identified by review of results of microbiology cultures from the hospital microbiology laboratory. Epidemiological and clinical variables and predictors of mortality were analysed.

Results: 24 out of 101 cases were considered colonizations and 77 infections (27 bacteraemia); global mortality in infected patients was 49% (18 cases with bacteraemia and 20 with no bacteraemia). In the multivariate analysis, including the 77 cases of infection, the prognosis factors associated with mortality were age (OR 1.09; 95% CI 1.02-1.2), McCabe 1 (OR 33.98; 95% CI 4.33-266.85), bacteraemia (OR 9.89; 95% CI 1.13-86.13), inadequate empiric treatment (OR 16.7; 95% CI 2.15-129.79), and inadequate definitive treatment (OR 26.29; 95% CI 1.45-478.19). In the multivariate analysis including the 57 cases of infection with adequate definitive treatment, the prognosis factors associated with mortality were McCabe 1 (OR 24.08; 95% CI 3.67-157.96) and monotherapy versus combined treatment (OR 7.11; 95% CI 1.63-30.99).

Conclusions: Our cohort of patients with MDR-C AB infection is characterised by a very high mortality (49%); the severity of patients and inadequate treatment or monotherapy are statistically associated with mortality.
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http://dx.doi.org/10.1016/j.medcli.2011.06.024DOI Listing
May 2012

H1N1 influenza pandemic and maternal mortality in Antioquia, Colombia.

Int J Gynaecol Obstet 2011 Nov 26;115(2):144-7. Epub 2011 Aug 26.

Department of Obstetrics and Gynecology, University of Antioquia School of Medicine, Center Nacer in Sexual and Reproductive Health, Medellín, Colombia.

Objective: To evaluate the impact of the H1N1 influenza pandemic on maternal mortality in the province of Antioquia, Colombia, in 2009.

Methods: The present study was a descriptive, retrospective, cross-sectional study of maternal deaths in Antioquia in 2009 caused by H1N1-related pneumonia. The study formed part of the epidemiologic surveillance process undertaken by the Health and Social Protection Directorate of Antioquia and the particular healthcare institutions involved in the cases.

Results: In 2009, there were 42 maternal deaths in Antioquia, corresponding to a maternal mortality ratio of 46 per 100 000 live births. Ten deaths were due to pneumonia, 9 of which occurred after the H1N1 outbreak was first reported in early 2009. In 3 cases, the women were confirmed to have H1N1 virus infection, and the remainder fulfilled probable case criteria. The main factors contributing to the deaths were underestimation of H1N1 symptoms, and delays in administration of antiviral medication and in hospitalization.

Conclusion: For the population subgroup of pregnant women in Antioquia, it is crucial to remain alert regarding H1N1 virus infection, guaranteeing patients adequate monitoring and/or timely administration of immunization, medication, and hospitalization.
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http://dx.doi.org/10.1016/j.ijgo.2011.05.022DOI Listing
November 2011

[Bacteraemia due to Escherichia coli producing extended-spectrum beta-lactamases (ESBL): clinical relevance and today's insights].

Rev Esp Quimioter 2011 Jun;24(2):57-66

Servicios de MI-Infecciosas, Hospital Universitario Virgen de Arrixaca.

Antibiotic resistance is an old problem with new face as the rate of infections due to multidrug resistant bacteria is higher everyday and the number of new antibiotics to overwhelm the problem is becoming smaller. E. coli is the most frequent agent causing nosocomial or community-acquired bacteraemia being in our country 10% of them extended-spectrum beta-lactamases (ESBL) producing E. coli isolates. Nowadays the number of community- acquired or health-related infections caused by these ESBL producing E. coli is increasing. CTX-M has also become the most frequent ESBL compared to other enzymes. The role of these enzymes as a virulence factor increasing mortality in patients with bacteraemia due to E. coli is not well defined. The relevance of ESBL-E. coli seems to be related with the higher frequency of inadequate treatment and therefore the importance of identifying factors or features that might predict that the patient's infection is due to one of these isolates. In terms of prevention and control of infection measures, the role of patient's isolation is not clear but a proper prescription of antibiotics and antibiotic control policies are probably important to reduce the problem.
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June 2011

[Carbapenem and multidrug-resistant Acinetobacter baumannii colonisation/infection: epidemiology and factors associated with infection].

Med Clin (Barc) 2010 Sep 11;135(9):389-96. Epub 2010 Jun 11.

Servicios de Medicina Interna-Infecciosas, Hospital Universitario Virgen de la Arrixaca, and Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain.

Background And Objective: To study an outbreak of nosocomial colonisation/infection due to multidrug and carbapenem resistant A. baumannii (ABMDR-C).

Patients And Methods: Prospective study of patients with ABMDR-C colonisation/infection (January 2007-June 2008). Epidemiological and clinical variables and predictors of infection versus colonization were analysed.

Results: 24 out of 101 cases were considered colonisations and 77 infections (27 bacteraemia); global mortality (colonisations and infections) was 42% (4 colonisations and 38 infections -18 bacteraemia). All together, the incidence was 3.2/1000 admissions/day; 29% had been previously admitted and 79% had received previous antibiotic treatment (29% carbapenem; 34% piperacillin-tazobactam; 12.5% both); 78% had an underlying condition; 81% were UCI patients; 90% had gone through invasive procedures; 65% had another microorganism isolated. In multivariate analysis, infection predictor factors were isolation of ABMDR-C in respiratory samples (OR 5.406; 95% CI 1.419-20.599); male patients (OR 8.842; 95% CI 1.988-39.325); previous hospitalization (OR 9.720; 95% CI 1.383-68.291) and initial clinical severity (OR 30.897; 95% CI 5.533-172.543).

Conclusions: Our cohort of patients with ABMDR-C colonisation/infection is characterised by their underlying comorbidity, the high rate of previous invasive procedures, previous hospitalisation and previous broad-spectrum betalactam treatments (especially carbapenem). Initial severity and respiratory samples with ABMDR-C isolates were predictors of infection versus colonisation.
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http://dx.doi.org/10.1016/j.medcli.2010.01.033DOI Listing
September 2010

Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002-2005).

Med Clin (Barc) 2010 Jan 12;134(1):1-5. Epub 2009 Nov 12.

Internal Medicine-Infectious Diseases Department, University Hospital Virgen de la Arrixaca, Murcia, España.

Objectives: To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC).

Patients And Methods: Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002-5).

Results: In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age >65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5-500) being early and adequate treatment (OR 11.8; CI 1.7-81.2) and early (<48h) removing of central venous catheter (OR 12.2; CI 1.9-74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment.

Conclusions: Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure.
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http://dx.doi.org/10.1016/j.medcli.2009.06.066DOI Listing
January 2010

Nosocomial candidemia at a general hospital: the change of epidemiological and clinical characteristics. A comparative study of 2 cohorts (1993-1998 versus 2002-2005).

Rev Iberoam Micol 2009 Sep 18;26(3):184-8. Epub 2009 Jul 18.

Internal Medicine-Infectious Diseases Department, University Hospital Virgen de Arrixaca, Murcia, Spain.

Background: Nosocomial candidemia (NC) is associated with high mortality, increased hospital stay and greater economical cost.

Aims: To evaluate epidemiological and clinical aspects of 2 different cohorts of non-paediatric patients with NC.

Methods: A retrospective observational and comparative study of patients with NC. Patients were identified by review of results of blood cultures from the hospital microbiology laboratory. We analysed epidemiological, clinical, microbiological and laboratory data and changes in the 2 cohorts: 1993-1998 (P1) and from 2002 to 2005 (P2).

Results: Eighty patients were studied during P1 and 107 during P2; incidence was 9/10,000 in P1 and 15.8/10,000 admitted patients in P2 (p<0.05). Mean age was 52 years in P1 and 61 years in P2 (p<0.05); 66% and 49% NC were due to Candida albicans in P1 and P2, respectively (p<0.05); diabetes was present in 12% in P1 and in 25% in P2 (p<0.05). All of the patients had previously received at least one course of broad-spectrum antibiotics. A statistically significant difference (p<0.05) in predisposing conditions was identified in central intravenous line rate (100% in P1 and 91% in P2) and previous surgery (43% in P1 and 78% in P2). Acute severity of illness at onset and complications were more frequent in P2 (p<0.05). Mortality rate was similar in P1 and P2 (51% and 49.5%, respectively).

Conclusions: Frequency of NC has increased and non-albicans Candida is now more frequent than C. albicans. Although acute severity of illness at onset and complications are now more frequent, mortality remains the same.
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http://dx.doi.org/10.1016/j.riam.2009.02.003DOI Listing
September 2009

[Low mortality rate in an outbreak of Legionnaires' disease: correlation with the cytopathogenity study].

Med Clin (Barc) 2009 Sep;133(9):325-9

Servicio de Enfermedades Infecciosas, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain.

Background: In 2001 an outbreak of Legionnaires' diseases occurred in Murcia, Spain, with one of the lowest known rates of associated mortality. We describe the clinical data of a subgroup of patients, and present the results from molecular and virulence studies to correlate the lower mortality of the overall series with the strain virulence.

Patients And Methods: A subgroup of 86 patients from the outbreak of Legionnaires'disease was prospectively included. Demographic, risk factors and clinical evolution data were obtained. Moreover, we performed a pulsed field gel electrophoresis and cytopathogenicity assay of the Murcia outbreak that were compared with other unrelated Legionella isolates.

Results: Sixty-nine (77.9%) patients were males. The mean age of the patients was 58.2 years (range: 32-87). Smoking was the most frequent risk factor in 62 patients (71.7%) and 61 patients (70.2%) had underlying diseases. Clinical, laboratory and radiological manifestations were compatible with the atypical pneumonia syndrome. The mortality rate was 3.2%. All the clinical L. pneumophila isolates analyzed by PFGE showed the same subtype. When analyzing theses strains together with other Legionella strains, they were included in the group with lower virulence in the cytopathogenicity study.

Conclusions: The most outstanding data in this subgroup of patients were: male-sex, smoking, atypical clinical manifestations and low mortality. The low virulence of this molecular genotype of L. pneumophila may be responsible, in part, for the low mortality observed in the outbreak in Murcia.
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http://dx.doi.org/10.1016/j.medcli.2009.05.016DOI Listing
September 2009

(125)I episcleral plaque brachytherapy in the treatment of choroidal melanoma: a single-institution experience in Spain.

Brachytherapy 2009 Jul-Sep;8(3):290-6. Epub 2009 May 9.

Department of Radiation Oncology, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.

Purpose: To analyze the results of episcleral plaque brachytherapy from the Catalan Institute of Oncology in Spain.

Materials And Methods: From September 1996 through December 2004, 120 patients with choroidal melanoma (median age, 59 years) were treated with iodine-125 seeds at our institution. Patients were classified according to the criteria developed by the Collaborative Ocular Melanoma Study (COMS) group, as follows-COMS-I: 3 patients; COMS-II: 87 patients; COMS-III: 24 patients; and indeterminate COMS: 9 patients. Followup ranged from 1 year to 8.4 years.

Results: Overall survival at 5 and 8 years was 83.9% and 73.3%, respectively. The 5- and 8-year specific survival rate was 85.7%. Local control was 88.2% and 72.7% at 5 and 8 years, respectively. The most common treatment-related toxicity was cataract formation (31.6% of cases), followed by radiation retinopathy (7.5%) and retinal detachment (4.1%).

Conclusion: The results of this institutional retrospective study confirm that the use of iodine-125 episcleral plaques to treat choroidal melanoma offers the potential for conserving a functioning eyeball. The toxicity profile is favorable and disease control is similar to other techniques.
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http://dx.doi.org/10.1016/j.brachy.2009.03.189DOI Listing
November 2009

[Clinical and economic analysis of an internal medicine-infectious disease department at a university general hospital (2005-2006)].

Enferm Infecc Microbiol Clin 2009 Feb 9;27(2):70-4. Epub 2009 Jan 9.

Servicio de Medicina Interna-Infecciosas, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.

Objectives: Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness.

Patients And Methods: Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed.

Results: 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (p<0.05). The readmission rate was similar in the 2 groups (5.5% and 6.5%, respectively). The results per each DRG group were similar to the overall results.

Conclusions: For a similar case mix, hospitalization in IMID departments had a positive influence on the variables analyzed as compared to hospitalization in other departments, with a shorter mean stay, lower mortality, and lower mean DRG-based economic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.
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http://dx.doi.org/10.1016/j.eimc.2008.05.001DOI Listing
February 2009

[Pharmacoeconomic results of introducing antimicrobial prophylaxis in surgery at a university hospital].

Cir Esp 2008 Dec;84(6):333-6

Servicio de MI-Infecciosas, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.

Objectives: The introduction of antimicrobial prophylaxis in surgery was designed and pre-intervention (controls) and post-intervention (cases) evaluations were carried out at a university tertiary hospital.

Patients And Method: Prospective recording of information on prophylaxis in all patients undergoing non-emergency abdominal surgery was analysed during a 3-week period before and after implementing an antimicrobial prophylaxis program. Adequacy of prophylaxis was defined as prescription of antibiotics (type, dose and duration of treatment) according to the Guidelines.

Results: In the pre-intervention study: included 36 patients; prophylaxis was inadequate in all patients (long-term in 22 cases; antibiotic class and long-term in 2 cases; antibiotic class, dose and long-term in 12 cases); mean duration of prophylaxis was 6 days (range 1 to 10 days); mean antibiotic cost per patient was 77 euro (range 9 to 412 euro); overall antibiotic cost for the 36 patients was 2770 euro. In the post-intervention study: included 37 patients: prophylaxis was inadequate in 11 patients (long-term in 10 cases; antibiotic class and long-term in 1 case); mean duration of prophylaxis was 2 days (range 1 to 9 days); mean antibiotic cost per patient was 16 euro (range 2 to 78 euro); overall antibiotic cost for the 37 patients was 593 euro. In the pre-intervention period antibiotic cost was 38 times higher than expected. In the post-intervention period it was 1.6 times higher than expected.

Conclusions: The most common reason of prophylaxis inadequacy is prolonged antibiotic treatment. A multidisciplinary intervention that comprises infectious diseases, surgical and pharmacy departments improves prophylaxis prescribing practice and avoids erroneous prescribing of antibiotics with both microbiological and economical cost savings.
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http://dx.doi.org/10.1016/s0009-739x(08)75045-0DOI Listing
December 2008

Simple criteria to assess mortality in patients with community-acquired pneumonia.

Med Clin (Barc) 2008 Jul;131(6):201-4

Departamento de Medicina Interna-Enfermedades Infecciosas, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.

Background And Objectives: The Pneumonia Patient Outcomes Research Team (PORT) developed a prediction rule to identify patients with community-acquired pneumonia (CAP) who are at risk for death and other adverse outcomes. Simpler criteria are needed to evaluate risk of mortality in CAP.

Patients And Methods: Observational study of patients with CAP admitted to a tertiary care university hospital. Epidemiological, clinical, radiological and laboratory data associated with mortality were analysed.

Results: A cohort of 211 patients with CAP was studied. Severity distribution according to PORT score was 12.3%, 15.6%, 19%, 35.5% and 17.5% in groups I, II, III, IV and V, respectively; mean age was 63 years (range, 13 to 100 years); in 43.6% age was < 65 years; 61.5% patients had > or = 1 underlying disease (congestive heart failure in 33.6% and chronic lung disease in 29.9%). Mortality rate was 0% in groups I-II, 2.5% in group III, 5.3% in group IV and 27% in group V. All variables considered in PORT-score were included in a mortality predicting model; factors significantly associated with death were: altered mental status, respiratory rate > or = 30/min, pH < 7.35, glucose > or = 250 mg/dl and age > 65 years; 99% of patients who had none of these abnormalities survived.

Conclusions: Simpler criteria to assess mortality in CAP were identified. Non-existence of altered mental status, respiratory rate > or = 30/min, pH < 7.35, glucose > or = 250 mg/dl and age > 65 years predicted a non-fatal outcome in 99% of patients. These clinical or laboratory findings should be considered as mortality predictors, can be used as severity adjustment measure and may help physicians make more rational decisions about hospitalization in CAP.
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http://dx.doi.org/10.1157/13124630DOI Listing
July 2008

[Brain abscess. The experience of 30 years].

Med Clin (Barc) 2008 May;130(19):736-9

Servicio de Medicina Interna-Infecciosas. Hospital Universitario Virgen de la Arrixaca. El Palmar. Murcia. España.

Background And Objective: The aim of this study was to evaluate epidemiological and clinical aspects of brain abscess (BA) and changes in clinical patterns during the last 30 years.

Patients And Method: Observational study of a cohort of non-pediatric patients with BA admitted at a 944-bed hospital. Data collection from clinical records was done according to a standard protocol. We analysed epidemiological, clinical and microbiological data and localization as well as changes during a 30 year period divided in 2 equal length phases: 1976-1989 (P1), and 1990-2005 (P2).

Results: 108 patients with BA were included (mean age: 45 years; range: 12-86; > 40 years in 42.4% P1, and 71.4% in P2, p < 0.05); 66 patients were treated in P1 and 42 in P2 (annual incidence: 4-5 cases and 2-3 cases per 10(6) population in P1 and P2, respectively). A predisposing condition was identified in 86% cases with statistically significant differences (p < 0.05) in: otitis media (18.2% vs 2.4%); dental infection (3% vs 16.7%); penetrating cranial trauma (16.7% vs 0%); post-neurosurgery (15.1% vs 21.4%), in P1 and P2, respectively; microbiologic diagnosis was made in 76% (no statistical differences P1/P2). Clinical aspects statistically different in P1/P2: severely altered mental status (10.6% vs 0%); vomiting (37.9% vs 21.4%); focal neurological deficits (37.9% vs 71.4%). No statistically significant differences were found in other epidemiological, clinical, radiological, microbiological or outcome characteristics in P1/P2.

Conclusions: In spite of a lower incidence in P2 and certain epidemiological and clinical differences in P1/P2, mortality and relapses rates have not significantly changed in a 30 year period.
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http://dx.doi.org/10.1157/13121077DOI Listing
May 2008

[Amyloid goiter].

Cir Esp 2008 Apr;83(4):217-8

Servicio de Cirugía General y Aparato Digestivo, Sección de Cirugía Endocrina, Hospital Universitario de La Princesa, Madrid, España.

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http://dx.doi.org/10.1016/s0009-739x(08)70555-4DOI Listing
April 2008