Institution
Hospital Universitario La Paz
Healthcare•Madrid, Spain•
About: Hospital Universitario La Paz is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Medicine. The organization has 8960 authors who have published 11499 publications receiving 191509 citations.
Topics: Population, Medicine, Cancer, Transplantation, Haemophilia
Papers published on a yearly basis
Papers
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TL;DR: Dabigatran was associated with a higher incidence of major bleeding, a higher risk of gastrointestinal bleeding, but a lower risk of intracranial hemorrhage, and should be prescribed with caution, especially among high-risk patients.
Abstract: Importance It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. Objective To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. Design, Setting, and Participants In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having atrial fibrillation from October 1, 2010, through October 31, 2011, and who initiated dabigatran or warfarin treatment within 60 days of initial diagnosis. We followed up patients until discontinued use or switch of anticoagulants, death, or December 31, 2011. Exposures Dabigatran users (n = 1302) and warfarin users (n = 8102). Main Outcomes and Measures We identified any bleeding events and categorized them as major and minor bleeding by anatomical site. Major bleeding events included intracranial hemorrhage, hemoperitoneum, and inpatient or emergency department stays for hematuria, gastrointestinal, or other hemorrhage. We used a propensity score weighting mechanism to balance patient characteristics between 2 groups and Cox proportional hazards regression models to evaluate the risk of bleeding. We further examined the risk of bleeding for 4 subgroups of high-risk patients: those 75 years or older, African Americans, those with chronic kidney disease, and those with more than 7 concomitant comorbidities. Results Dabigatran was associated with a higher risk of bleeding relative to warfarin, with hazard ratios of 1.30 (95% CI, 1.20-1.41) for any bleeding event, 1.58 (95% CI, 1.36-1.83) for major bleeding, and 1.85 (95% CI, 1.64-2.07) for gastrointestinal bleeding. The risk of intracranial hemorrhage was higher among warfarin users, with a hazard ratio of 0.32 (95% CI, 0.20-0.50) for dabigatran compared with warfarin. Dabigatran was consistently associated with an increased risk of major bleeding and gastrointestinal hemorrhage for all subgroups analyzed. The risk of major bleeding among dabigatran users was especially high for African Americans and patients with chronic kidney disease. Conclusions and Relevance Dabigatran was associated with a higher incidence of major bleeding (regardless of the anatomical site), a higher risk of gastrointestinal bleeding, but a lower risk of intracranial hemorrhage. Thus, dabigatran should be prescribed with caution, especially among high-risk patients.
257 citations
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TL;DR: The genotype of infants at family risk of developing CD, carrying the HLA-DQ2 haplotypes, influences the early gut microbiota composition, suggesting that a specific disease-biased host genotype may also select for the first gut colonisers and could contribute to determining disease risk.
Abstract: Objective Intestinal dysbiosis has been associated with coeliac disease (CD), but whether the alterations are cause or consequence of the disease is unknown. This study investigated whether the human leukocyte antigen (HLA)-DQ2 genotype is an independent factor influencing the early gut microbiota composition of healthy infants at family risk of CD. Design As part of a larger prospective study, a subset (n=22) of exclusively breastfed and vaginally delivered infants with either high genetic risk (HLA-DQ2 carriers) or low genetic risk (non-HLA-DQ2/8 carriers) of developing CD were selected from a cohort of healthy infants with at least one first-degree relative with CD. Infant faecal microbiota was analysed by 16S rRNA gene pyrosequencing and real time quantitative PCR. Results Infants with a high genetic risk had significantly higher proportions of Firmicutes and Proteobacteria and lower proportions of Actinobacteria compared with low-risk infants. At genus level, high-risk infants had significantly less Bifidobacterium and unclassified Bifidobacteriaceae proportions and more Corynebacterium, Gemella, Clostridium sensu stricto, unclassified Clostridiaceae, unclassified Enterobacteriaceae and Raoultella proportions. Quantitative real time PCR also revealed lower numbers of Bifidobacterium species in infants with high genetic risk than in those with low genetic risk. In high-risk infants negative correlations were identified between Bifidobacterium species and several genera of Proteobacteria (Escherichia/Shigella) and Firmicutes (Clostridium). Conclusions The genotype of infants at family risk of developing CD, carrying the HLA-DQ2 haplotypes, influences the early gut microbiota composition. This finding suggests that a specific disease-biased host genotype may also select for the first gut colonisers and could contribute to determining disease risk.
256 citations
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TL;DR: A homozygous single base pair deletion in SP7/Osterix (OSX) in an Egyptian child with recessive osteogenesis imperfecta is identified, adding another locus to the spectrum of genes associated with osteogenesisperfecta and reveals that SP 7/OSX also plays a key role in human bone development.
Abstract: Osteogenesis imperfecta, or "brittle bone disease," is a type I collagen-related condition associated with osteoporosis and increased risk of bone fractures. Using a combination of homozygosity mapping and candidate gene approach, we have identified a homozygous single base pair deletion (c.1052delA) in SP7/Osterix (OSX) in an Egyptian child with recessive osteogenesis imperfecta. The clinical findings from this patient include recurrent fractures, mild bone deformities, delayed tooth eruption, normal hearing, and white sclera. OSX encodes a transcription factor containing three Cys2-His2 zinc-finger DNA-binding domains at its C terminus, which, in mice, has been shown to be essential for bone formation. The frameshift caused by the c.1052delA deletion removes the last 81 amino acids of the protein, including the third zinc-finger motif. This finding adds another locus to the spectrum of genes associated with osteogenesis imperfecta and reveals that SP7/OSX also plays a key role in human bone development.
255 citations
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TL;DR: In Spanish hospitals, almost one in four patients is malnourished, and this condition is associated with increased length of hospital stay and associated costs, especially in patients developing malnutrition during hospitalization.
Abstract: Background and aims: The main objective of the
PREDyCES® study was twofold. First, to analyse the
prevalence of hospital malnutrition in Spain, both at
admission and at discharge, and second, to estimate the
hospital costs associated with disease-related malnutrition.
Methods: The study was a nationwide, cross-sectional,
observational, multicentre study in routine clinical practice,
which assessed the prevalence of hospital malnutrition
both at patient admission and discharge using NRS-
2002®. A study extension analysed the incidence of
complications associated with malnutrition, excess
hospital stay and healthcare costs associated with hospital
malnutrition.
Results: Malnutrition was observed in 23.7% of
patients according to NRS-2002®. Multivariate analysis
revealed that age, gender, presence of malignant disease,
diabetes mellitus, dysphagia and polymedication were the
main factors associated with the presence of malnutrition.
Malnutrition was associated with an increase in
length of hospital stay, especially in patients admitted
without malnutrition but who presented malnutrition at
discharge (15.2 vs. 8.0 days, p < 0.001), with an associated
additional cost of €5,829 per patient.
Conclusion: In Spanish hospitals, almost one in four
patients is malnourished. This condition is associated
with increased length of hospital stay and associated
costs, especially in patients developing malnutrition
during hospitalization. Systematic screening for malnutrition
should be generalised in order to implement nutritional
interventions with well-known effectiveness.
254 citations
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TL;DR: Considering the beneficial effects and the absence of detrimental ones, the use of diets enriched with pharmaconutrients-enriched diets could be recommended in ICU patients requiring enteral feeding.
252 citations
Authors
Showing all 9020 results
Name | H-index | Papers | Citations |
---|---|---|---|
Jaakko Tuomilehto | 115 | 1285 | 210682 |
Vincent Soriano | 87 | 762 | 34084 |
Lina Badimon | 86 | 682 | 35774 |
Francisco J. Blanco | 84 | 789 | 33319 |
Michael A. Gatzoulis | 82 | 478 | 32562 |
Jose Lopez-Sendon | 81 | 460 | 41809 |
Victor Moreno | 80 | 635 | 31511 |
Joaquín Dopazo | 75 | 396 | 24790 |
Fernando Rodríguez-Artalejo | 74 | 512 | 23296 |
José R. Banegas | 74 | 421 | 28249 |
Michael Becker | 72 | 317 | 18189 |
Gianfranco Ferraccioli | 70 | 402 | 26515 |
Maria-Victoria Mateos | 66 | 480 | 24278 |
Manuel Romero-Gómez | 64 | 420 | 19006 |
Eulogio García | 63 | 270 | 15354 |