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
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TL;DR: Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients.
Abstract: In critically ill patients sudden changes in glomerular filtration rate (GFR) are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to analyze the utility of serum cystatin C as a marker of renal function in these patients. Serum creatinine, serum cystatin C and 24-hour creatinine clearance (CCr) were determined in 50 critically ill patients (age 21–86 years; mean Acute Physiology and Chronic Health Evaluation II score 20 ± 9). They did not have chronic renal failure but were at risk for developing renal dysfunction. Serum cystatin C was measured using particle enhanced immunonephelometry. Twenty-four-hour body surface adjusted CCr was used as a control because it is the 'gold standard' for determining GFR. Serum creatinine, serum cystatin C and CCr (mean ± standard deviation [range]) were 1.00 ± 0.85 mg/dl (0.40–5.61 mg/dl), 1.19 ± 0.79 mg/l (0.49–4.70 mg/l), and 92.74 ± 52.74 ml/min per 1.73 m2 (8.17–233.21 ml/min per 1.73 m2), respectively. Our data showed that serum cystatin C correlated better with GFR than did creatinine (1/cystatin C versus CCr: r = 0.832, P < 0.001; 1/creatinine versus CCr: r = 0.426, P = 0.002). Cystatin C was diagnostically superior to creatinine (area under the curve [AUC] for cystatin C 0.927, 95% confidence interval 86.1–99.4; AUC for creatinine 0.694, 95% confidence interval 54.1–84.6). Half of the patients had acute renal dysfunction. Only five (20%) of these 25 patients had elevated serum creatinine, whereas 76% had elevated serum cystatin C levels (P = 0.032). Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients.
251 citations
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Copenhagen University Hospital1, Hospital Universitario La Paz2, Utrecht University3, Cambridge University Hospitals NHS Foundation Trust4, King's College London5, University College Cork6, Boston Children's Hospital7, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico8, University of Zurich9, Medical University of Graz10, Technical University of Madrid11
TL;DR: Cerebral oxygenation was stabilised in extremely preterm infants using a dedicated treatment guideline in combination with cerebral NIRS monitoring and no severe adverse reactions were associated with the device.
Abstract: Objective To determine if it is possible to stabilise the cerebral oxygenation of extremely preterm infants monitored by cerebral near infrared spectroscopy (NIRS) oximetry. Design Phase II randomised, single blinded, parallel clinical trial. Setting Eight tertiary neonatal intensive care units in eight European countries. Participants 166 extremely preterm infants born before 28 weeks of gestation: 86 were randomised to cerebral NIRS monitoring and 80 to blinded NIRS monitoring. The only exclusion criterion was a decision not to provide life support. Interventions Monitoring of cerebral oxygenation using NIRS in combination with a dedicated treatment guideline during the first 72 hours of life (experimental) compared with blinded NIRS oxygenation monitoring with standard care (control). Main outcome measures The primary outcome measure was the time spent outside the target range of 55-85% for cerebral oxygenation multiplied by the mean absolute deviation, expressed in %hours (burden of hypoxia and hyperoxia). One hour with an oxygenation of 50% gives 5%hours of hypoxia. Secondary outcomes were all cause mortality at term equivalent age and a brain injury score assessed by cerebral ultrasonography. Randomisation Allocation sequence 1:1 with block sizes 4 and 6 in random order concealed for the investigators. The allocation was stratified for gestational age ( Blinding Cerebral oxygenation measurements were blinded in the control group. All outcome assessors were blinded to group allocation. Results The 86 infants randomised to the NIRS group had a median burden of hypoxia and hyperoxia of 36.1%hours (interquartile range 9.2-79.5%hours) compared with 81.3 (38.5-181.3) %hours in the control group, a reduction of 58% (95% confidence interval 35% to 73%, P Conclusions Cerebral oxygenation was stabilised in extremely preterm infants using a dedicated treatment guideline in combination with cerebral NIRS monitoring. Trial registration ClinicalTrial.gov NCT01590316.
248 citations
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Hospital Universitario La Paz1, University of Guadalajara2, University of Hamburg3, George Washington University4, University of Lausanne5, University of Toronto6, Queen Mary University of London7, University of North Carolina at Chapel Hill8, Henry Ford Health System9, Mercer University10, University of Paris11, Ruth M. Rothstein CORE Center12
TL;DR: Switching to a tenofovir alafenamide-containing regimen from one containing ten ofovir disoproxil fumarate was non-inferior for maintenance of viral suppression and led to improved bone mineral density and renal function.
Abstract: Summary Background Antiretroviral regimens containing tenofovir disoproxil fumarate have been associated with renal toxicity and reduced bone mineral density. Tenofovir alafenamide is a novel tenofovir prodrug that reduces tenofovir plasma concentrations by 90%, thereby decreasing off-target side-effects. We aimed to assess whether efficacy, safety, and tolerability were non-inferior in patients switched to a regimen containing tenofovir alafenamide versus in those remaining on one containing tenofovir disoproxil fumarate. Methods In this randomised, actively controlled, multicentre, open-label, non-inferiority trial, we recruited HIV-1-infected adults from Gilead clinical studies at 168 sites in 19 countries. Patients were virologically suppressed (HIV-1 RNA Findings Between April 12, 2013 and April 3, 2014, we enrolled 1443 patients. 959 patients were randomly assigned to the tenofovir alafenamide group and 477 to the tenofovir disoproxil fumarate group. Viral suppression at week 48 was noted in 932 (97%) patients assigned to the tenofovir alafenamide group and in 444 (93%) assigned to the tenofovir disoproxil fumarate group (adjusted difference 4·1%, 95% CI 1·6–6·7), with virological failure noted in ten and six patients, respectively. The number of adverse events was similar between the two groups, but study drug-related adverse events were more common in the tenofovir alafenamide group (204 patients [21%] vs 76 [16%]). Hip and spine bone mineral density and glomerular filtration were each significantly improved in patients in the tenofovir alafenamide group compared with those in the tenofovir disoproxil fumarate group. Interpretation Switching to a tenofovir alafenamide-containing regimen from one containing tenofovir disoproxil fumarate was non-inferior for maintenance of viral suppression and led to improved bone mineral density and renal function. Longer term follow-up is needed to better understand the clinical impact of these changes. Funding Gilead Sciences.
248 citations
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TL;DR: Methods developed for testing filamentous fungi (molds) include standardized broth microdilution methods and disk diffusion methods and the link between resistance molecular mechanisms, elevated MICs, and clinical treatment failure has been documented.
Abstract: Methods developed for testing filamentous fungi (molds) include standardized broth microdilution (Clinical and Laboratory Standards Institute [CLSI] and European Committee for Antimicrobial Susceptibility Testing [AFST-EUCAST]) methods and disk diffusion (CLSI) methods. Quality control limits also are available from CLSI for MIC (minimal inhibitory concentration), MEC (minimal effective concentration), and zone diameters. Although clinical breakpoints based on correlations of in vitro results with clinical outcome have not been established, epidemiologic cutoff values have been defined for six Aspergillus species and the triazoles, caspofungin, and amphotericin B. The link between resistance molecular mechanisms, elevated MICs, and clinical treatment failure has also been documented, especially for Aspergillus and the triazoles. Other insights into the potential clinical value of high MICs have also been reported. Various commercial methods (e.g., YeastOne, Etest, and Neo-Sensitabs) have been evaluated in comparison with reference methods. This review summarizes and discusses these developments.
248 citations
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University of Rennes1, University of California, Los Angeles2, University of Montpellier3, Université de Montréal4, university of lille5, University of Toulouse6, National and Kapodistrian University of Athens7, University of Bordeaux8, Laval University9, University of Nantes10, University of Rouen11, University of Clermont-Ferrand12, Katholieke Universiteit Leuven13, University of Strasbourg14, Hospital Universitario La Paz15, University Hospital Bonn16
TL;DR: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival.
247 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 |