Hospital General Universitario Gregorio Marañón

About: Hospital General Universitario Gregorio Marañón is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Transplantation. The organization has 11975 authors who have published 12386 publications receiving 244847 citations.

Manejo quirúrgico de pacientes con infección por COVID-19. Recomendaciones de la Asociación Española de Cirujanos

Abstract: Resumen Debido a la actual pandemia de enfermedad respiratoria denominada enfermedad por coronavirus 2019 (COVID-19) causada por el virus denominado SARS-CoV-2, numerosos pacientes con confirmacion o sospecha de COVID-19 precisaran tratamiento quirurgico electivo inaplazable o urgente. Estas situaciones requieren la adopcion de medidas especiales da cara a minimizar la posibilidad de contagio entre pacientes, la exposicion del personal sanitario y el desarrollo de complicaciones postoperatorias. En el presente documento se explican las principales medidas a tener en cuenta en caso de atencion a pacientes COVID-19 o sospecha tanto durante su evaluacion como en caso de requerir tratamiento quirurgico.

Discontinuation of Maintenance Therapy for Cryptococcal Meningitis in Patients with AIDS Treated with Highly Active Antiretroviral Therapy: An International Observational Study

Abstract: We conducted a retrospective, multicenter study evaluating the safety of discontinuing maintenance therapy for cryptococcal meningitis after immune reconstitution. Inclusion criteria were a previous definitive diagnosis of cryptococcal meningitis, a CD4 cell count of >100 cells/microL while receiving highly active antiretroviral therapy (HAART), and the subsequent discontinuation of maintenance therapy for cryptococcal meningitis. The primary end point was relapse of cryptococcal disease. As of July 2002, 100 patients were enrolled. When maintenance therapy was discontinued, the median CD4 cell count was 259 cells/microL and the median plasma virus load was 100 cells/microL and a positive serum cryptococcal antigen test result during the recurrent episode. In conclusion, discontinuation of maintenance therapy for cryptococcal meningitis is safe if the CD4 cell count increases to >100 cells/microL while receiving HAART. Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy.

Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases

Abstract: Objective To assess the prevalence of major geriatric syndromes (MGSs)―frailty, cognitive impairment, severe dependence and depression―and their influence on outcomes in unselected patients with acute cardiac diseases. Design Observational prospective study with 12-month clinical and functional follow-up. Setting Clinical cardiology unit of a university hospital in Madrid, Spain. Patients Consecutive patients ≥75 years old urgently admitted to the cardiology unit. Intervention Systematic comprehensive geriatric assessment. Main outcome measures 12-month rates of mortality, readmission, functional decline and need for new social help. Results Among the 211 patients studied, 127 (60.2%) presented at least one MGS on admission: 86 frailty (40.8%), 67 cognitive impairment (31.8%), 31 severe dependency (14.7%) and 9 depression (4.3%). Patients with MGSs were slightly older (82±5 vs 81±4 years, p=0.02) but did not show greater disease severity or comorbidity. The presence of MGSs was associated with a higher incidence of functional decline during hospitalisation (35.7% vs 8.6%, p=0.002) and higher 12-month age-, comorbidity- and diagnosis-adjusted risks of readmission (OR, 2.1.92; 95% CI 0.98 to 3.7), functional decline (OR, 2.86; 95% CI 1.41 to 5.79) and need for new social help (OR, 3.10; 95% CI 1.45 to 6.60). MGSs were also associated with a higher 12-month mortality rate, which was only obvious in patients hospitalised for heart failure but not for other reasons. Conclusions A majority of older patients hospitalised for acute cardiac conditions in a cardiology department show at least one MGS on admission. MGSs are associated with poorer inhospital and postdischarge functional and clinical outcomes, particularly in patients with heart failure.