Publicacions cientifiques CSDM 2018

Publicacions Científiques CSDM 2018

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Publicacions científiques 2018 Consorci Sanitari del Maresme.

Publicacions de l’any 2018 Biblioteca.

Direcció Acadèmica, Recerca i Innovació Consorci Sanitari del Maresme.

Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Publicacions Científiques CSDM 2018

Presentació.

Aquest document recull i presenta els articles científics del Consorci Sanitari del Maresme (amb almenys un autor amb filiació CSDM) indexats al llarg de l’any 2018 en almenys alguna de les següents bases de dades: MEDLINE/PubMed/Web of Science (WOS)/Journal Citation Reports (JCR).

Els indicadors bibliomètrics adjudicats a cada article i per Serveis (Factor d’Impacte, Factor d’Impacte Mig, Quartil, i Posició de la revista) corresponen al Journal Citation Reports 2016, per la qual cosa s’ha de tenir en compte quesón valors aproximats, els valors definitius del JCR 2018 estaran disponibles el proper mes de juliol de 2019.

En aquest document s’inclouent els articles amb etiqueta ahead of print de PubMed encara que siguin posteriorment indexats a MEDLINE durant l’any 2019. Per tant, no s’han inclòs els articles ahead of print del 2017 de PubMed que han estat indexats definitivament a MEDLINE durant el 2018 i que ja es van incloure a la llista de l’any passat, evitant, d’aquesta manera, duplicitats.

No s’han considerat aquells articles que els autors CSDM consten dins de grups d’investigació (col.laboradors).

I tampoc s’han considerat aquells articles indexats però que corresponen a resums/abstracts de congresos.

El document recull també aquells articles no indexats a cap de les BDD anteriors, així com altres documents (capítols de llibres…) publicats durant l’any 2018.

Aquest document recull els articles publicats en el període que va del dia 21 de desembre de 2017 a 21 desembre 2018.

Foto : Dani Olea. Comunicació

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Publicacions Científiques CSDM 2018

Índex PRESENTACIÓ…………………………………………………………………………………………………………………………..……………………..

2

Neurologia – Neurology ……………………………………………………………………………………………….……………..……..…………..

4

Medicina Interna – Internal Medicine ……………………………………………………………………….………………………………..….

8

Oncologia – Oncology …………………………………………………………………………………………………………………………..………..

17

Cirurgia General – General Surgery …………………………………………………………………………….…………………………………..

21

Cirurgia Vascular – Vascular Surgery …………………………………………………………………………….…………………………………

22

Motilitat Digestiva – Gastrointestinal Motility ……………………………………………………………………………………..…………

23

Infermeria – Nursing ………………………….……………………………………..………………………………………………………..…………..

27

Medicina Física y Rehabilitació – Physical Medicine & Rehabilitation…………….……………………………………..………… .

28

Psiquiatria - Psychiatry …………………………………………………………………………………………….………………………………………

33

Medicina Intensiva – Intensive Care Medicine ……………………………………………………………………………………………….. .

34

Digestiu – Gastroenterology ………………………..…………………………………………………………….…………………………………….

42

Geriatria - Geriatrics ………………………………………….……………………………………………………………….…………………………….

43

Atenció Primària – Primary Care ………………………….……………………………………………………………………………………………

44

Unitat de Recerca – Research Unit ……………………...…….…………………………………………………………………………………… ..

44

Farmàcia – Pharmacy ……………………...…….…………………………..…………………………………………………………………………….

46

Hematologia– Hematology ….……………………….……………………………………………..………………….………………………………..

49

Urgències – Emergency Medicine ….……………………….……………………………………………..………………….………………………

50

Dermatologia – Dermatology………………………..…………………………………………………………….…………………………………….

51

Pediatria – Pediatrics……………………...…….…………………………..………………………………………………………………………………

52

Urologia – Urology….……………………….………………………………………………………………………………………………………………….

53

Neumologia – Pneumology….……………………….………………………………………………………………………………………………… ….

53

Medicina Preventiva – Preventive Medicine….……………………….………………………………………………………………………. ….

54

Cirurgia Ortopèdica i Traumatologia – Orthopaedic Surgery……………………………………………………………….………………..

55

Ginecologia –Obstetricia……..….……………………….……………………………………………..………………….…………………….……..

55

Anestesiologia– Anesthesiology….……………………….……………………………………………..………………….…………………….……..

56

INDICADORS BIBLIOMÈTRICS GLOBALS………………………….……………………………………………………………………………………..

57

Identificació del tipus de publicació : Article Indexat a: MEDLINE/PubMed/ Web of Science (WOS)/Journal Citation Reports (JRC).

Article no indexat a cap de les anteriors BDD. Llibre o Capítol de llibre.

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NEUROLOGIA - NEUROLOGY Nº Articles indexats: 6

Factor Impacte total: 26.618

Factor d’impacte mig per article: 4.436

Garcia-Ruiz PJ, Sanz-Cartagena P, Martinez-Castrillo JC, Ares-Pensado B, Aviles-Olmos I, Blazquez-Estrada M, Fanjul-Arbos S, Garcia-Caldentey J, Gazulla J, Gutierrez-Garcia J, Huete-Anton B, Lucas-Rodenas C, Luquin MR, Martinez-Torres I, Medialdea-Natera P, Mendoza-Rodriguez A, Mir-Rivera P, Posada IJ, Ruiz-Martinez J, SanchezAlonso P, Trejo-Gabriel Y Galan JM, Vela L, Pena-Segura JL. [Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia].

Rev Neurol. 2018 Mar 1;66(5):163-172. Spanish. PubMed PMID: 29480513 Abstract INTRODUCTION: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity.

AIM: To analyze and summarize different questions about the use of BTA in our clinical practice.

DEVELOPMENT: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt.

The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc.

CONCLUSION: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 0.601 Quartil: 4

Categoria: Clinical Neurology

Posició: 191/197

Quirant-Sánchez B, Hervás-García JV, Teniente-Serra A, Brieva L, Moral-Torres E, Cano A, Munteis E, Mansilla MJ, Presas-Rodriguez S, Navarro-Barriuso J, Ramo-Tello C, Martínez-Cáceres EM. Predicting therapeutic response to fingolimod treatment in multiple sclerosis patients.

CNS Neurosci Ther. 2018 Dec;24(12):1175-1184. doi: 10.1111/cns.12851. Epub 2018 Apr 15. PubMed PMID: 29656444.

Abstract AIMS: Fingolimod, an orally active immunomodulatory drug for relapsing-remitting multiple sclerosis (RRMS), sequesters T cells in lymph nodes through functional antagonism of the sphingosine-1-phosphate receptor, reducing the number of potential autoreactive cells that migrate to the central nervous system. However, not all RRMS patients respond to this therapy. Our aim was to test the hypothesis that by immune-monitoring RRMS patient's leukocyte subpopulations it is possible to find biomarkers associated with clinical response to fingolimod.

METHODS: Prospective study. Analysis of peripheral blood mononuclear cell subpopulations by multiparametric flow cytometry, at baseline and +1, +3, +6, +12 months of follow-up in 40 RRMS patients starting fingolimod therapy.

RESULTS: Fingolimod treatment induced a severe lymphopenia affecting mainly T and B cells. A relative increase in Treg (memory Treg : 3.8 ± 1.0% baseline vs 8.8 ± 4.4% month +1; activated Treg : 1.5 ± 0.7% baseline vs 3.7 ± Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Publicacions Científiques CSDM 2018

2.1% month +1, P < 0.001) as well as transitional B cells (10.5 ± 12.3% baseline vs 18.7 ± 14.6% month +1, P < 0.001) was observed. Interestingly, lymphocyte subpopulations were already at baseline significantly different in responder patients. The percentage of recent thymic emigrants (RTE) used to stratify fingolimod responder, and no responder patients was the best biomarker (4.0 ± 1.4% vs 7.4 ± 1.9%, respectively [P < 0.001]).

CONCLUSION: The results support that immune-monitoring of lymphocyte subpopulations in peripheral blood is a promising tool to select RRMS candidate for fingolimod treatment.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.495 Quartil: 1

Categoria: Pharmacology & Pharmacy

Posició: 65/261

Hervás-García JV, Ramió-Torrentà L, Brieva-Ruiz L, Batllé-Nadal J, Moral E, Blanco Y, Cano-Orgaz A, PresasRodríguez S, Torres F, Capellades J, Ramo-Tello C. Comparison of two high doses of oral methylprednisolone for multiple sclerosis relapses: a pilot, multicentre, randomized, double-blind, non-inferiority trial.

Eur J Neurol. 2018 Oct 23. doi: 10.1111/ene.13851. [Epub ahead of print] PubMed PMID: 30351511.

Abstract BACKGROUND AND PURPOSE: Oral or intravenous methylprednisolone (≥500 mg/day for 5 days) is recommended for multiple sclerosis (MS) relapses. Nonetheless, the optimal dose remains uncertain. We compared clinical and radiological effectiveness, safety and quality of life (QoL) of oral methylprednisolone [1250 mg/day (standard high dose)] versus 625 mg/day (lesser high dose), both for 3 days] in MS relapses.

METHODS: A total of 49 patients with moderate to severe MS relapse within the previous 15 days were randomized in a pilot, double-blind, multicentre, non-inferiority trial (ClinicalTrial.gov, NCT01986998). The primary endpoint was non-inferiority of the lesser high dose by Expanded Disability Status Scale (EDSS) score improvement on day 30 (non-inferiority margin, 1 point). The secondary endpoints were EDSS score change on days 7 and 90, changes in T1 gadolinium-enhanced and new/enlarged T2 lesions on days 7 and 30, and safety and QoL results.

RESULTS: The primary outcome was achieved [mean (95% confidence interval) EDSS score difference, -0.26 (-0.7 to 0.18) at 30 days (P = 0.246)]. The standard high dose yielded a superior EDSS score improvement on day 7 (P = 0.028). No differences were observed in EDSS score on day 90 (P = 0.352) or in the number of T1 gadoliniumenhanced or new/enlarged T2 lesions on day 7 (P = 0.401, 0.347) or day 30 (P = 0.349, 0.529). Safety and QoL were good at both doses.

CONCLUSIONS: A lesser high-dose oral methylprednisolone regimen may not be inferior to the standard high dose in terms of clinical and radiological response.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 4.621 Quartil: 1

Categoria: Clinical Neurology

Posició: 34/197

Corral-Juan M, Serrano-Munuera C, Rábano A, Cota-González D, Segarra-Roca A, Ispierto L, Cano-Orgaz A, Adarmes AD, Méndez-Del-Barrio C, Jesús S, Mir P, Volpini V, Alvarez-Ramo R, Sánchez I, Matilla-Dueñas A. Clinical, genetic and neuropathological characterization of spinocerebellar ataxia type 37.

Brain. 2018 Jul 1;141(7):1981-1997. doi: 10.1093/brain/awy137. PubMed PMID: 29939198.

Abstract The autosomal dominant spinocerebellar ataxias (SCAs) consist of a highly heterogeneous group of rare movement disorders characterized by progressive cerebellar ataxia variably associated with ophthalmoplegia, Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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pyramidal and extrapyramidal signs, dementia, pigmentary retinopathy, seizures, lower motor neuron signs, or peripheral neuropathy. Over 41 different SCA subtypes have been described evidencing the high clinical and genetic heterogeneity. We previously reported a novel spinocerebellar ataxia type subtype, SCA37, linked to an 11-Mb genomic region on 1p32, in a large Spanish ataxia pedigree characterized by ataxia and a pure cerebellar syndrome distinctively presenting with early-altered vertical eye movements. Here we demonstrate the segregation of an unstable intronic ATTTC pentanucleotide repeat mutation within the 1p32 5' non-coding regulatory region of the gene encoding the reelin adaptor protein DAB1, implicated in neuronal migration, as the causative genetic defect of the disease in four Spanish SCA37 families. We describe the clinical-genetic correlation and the first SCA37 neuropathological findings caused by dysregulation of cerebellar DAB1 expression. Post-mortem neuropathology of two patients with SCA37 revealed severe loss of Purkinje cells with abundant astrogliosis, empty baskets, occasional axonal spheroids, and hypertrophic fibres by phosphorylated neurofilament immunostaining in the cerebellar cortex. The remaining cerebellar Purkinje neurons showed loss of calbindin immunoreactivity, aberrant dendrite arborization, nuclear pathology including lobulation, irregularity, and hyperchromatism, and multiple ubiquitinated perisomatic granules immunostained for DAB1. A subpopulation of Purkinje cells was found ectopically mispositioned within the cerebellar cortex. No significant neuropathological alterations were identified in other brain regions in agreement with a pure cerebellar syndrome. Importantly, we found that the ATTTC repeat mutation dysregulated DAB1 expression and induced an RNA switch resulting in the upregulation of reelin-DAB1 and PI3K/AKT signalling in the SCA37 cerebellum.

This study reveals the unstable ATTTC repeat mutation within the DAB1 gene as the underlying genetic cause and provides evidence of reelin-DAB1 signalling dysregulation in the spinocerebellar ataxia type 37.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 10.848 Quartil/Decil: 1

Categoria: Clinical Neurology

Posició: 6/197

Martí-Fàbregas J, Medrano-Martorell S, Merino E, Prats-Sánchez L, Marín R, Delgado-Mederos R, Camps-Renom P, Martínez-Domeño A, Gómez-Choco M, Lara L, Casado-Naranjo I, Cánovas D, Torres MJ, Freijo M, Calleja A, Bravo Y, Cocho D, Rodríguez-Campello A, Zandio B, Fuentes B, de Felipe A, Llull L, Maestre J, Hernández M, Garcés M, De Arce-Borda AM, Palomeras E, Rodríguez-Yáñez M, Díaz-Maroto I, Serrano M, FernándezDomínguez J, Sanahuja J, Purroy F, Zedde M, Delgado-Mengual J, Gich I. Statins do not increase Markers of Cerebral Angiopathies in patients with Cardioembolic Stroke.

Sci Rep. 2018 Jan24;8(1):1492. doi: 10.1038/s41598-018-20055-3. PubMed PMID: 29367736 Abstract We investigated whether pre-treatment with statins is associated with surrogate markers of amyloid and hypertensive angiopathies in patients who need to start long-term oral anticoagulation therapy. A prospective multicenter study of patients naive for oral anticoagulants, who had an acute cardioembolic stroke. MRI was performed at admission to evaluate microbleeds, leukoaraiosis and superficial siderosis. We collected data on the specific statin compound, the dose and the statin intensity. We performed bivariate analyses and a logistic regression to investigate variables associated with microbleeds. We studied 470 patients (age 77.5 ± 6.4 years, 43.7% were men), and 193 (41.1%) of them received prior treatment with a statin. Microbleeds were detected in 140 (29.8%), leukoaraiosis in 388 (82.5%) and superficial siderosis in 20 (4.3%) patients. The presence of microbleeds, leukoaraiosis or superficial siderosis was not related to pre-treatment with statins. Microbleeds were more frequent in patients with prior intracerebral hemorrhage (OR 9.7, 95% CI 1.06-90.9) and in those pretreated antiplatelets (OR 1.66, 95% CI 1.09-2.53). Prior treatment with statins was not associated with markers of bleeding-prone cerebral angiopathies in patients with cardioembolic stroke. Therefore, previous statin treatment should not influence the decision to initiate or withhold oral anticoagulation if these neuroimaging markers are detected.

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Indexat a: MEDLINE/WOS/JCR Factor Impacte: 4.122 Quartil: 1

Categoria: Multidiscilinary Sciences

Posició: 12/64

López-Cancio E, Ribó M, Cardona P, Serena J, Purroy F, Palomeras E, Aragonès JM, Cocho D, Garcés M, Puiggròs E, Soteras I, Cabanelas A, Villagrasa D, Catena E, Sanjurjo E, López Claverol N, Carrión D, López M, Abilleira S, Dávalos A, Pérez de la Ossa N; Catalan Stroke Code and Reperfusion Consortium (Cat-SCR).

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers.

Cerebrovasc Dis. 2018;46(1-2):66-71. doi: 10.1159/000492124. Epub 2018 Aug 22. PubMed PMID: 30134222.

Abstract OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study.

METHODS: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC).

After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry.

RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages.

CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.931 Quartil: 2

Categoria: Clinical Neurology

Posició: 81/197

López-de-Ipiña K, Martinez-de-Lizarduy U, CalvoB. Beitia PM, García-Melero J, Fernández E, Ecay-Torres E, Faundez-Zanuy M, Sanz P On the analysis of speech and disfluencies for automatic detection of Mild Cognitive Impairment.

Neural Comput Appl. 2018;101:60-63 Abstract Alzheimer’s disease is characterized by a progressive and irreversible cognitive deterioration. In a previous stage, the so-called Mild Cognitive Impairment or cognitive loss appears. Nevertheless, this previous stage does not seem sufficiently severe to interfere in independent abilities of daily life, so it is usually diagnosed inappropriately. Thus, its detection is a crucial challenge to be addressed by medical specialists. This paper presents a novel proposal for such early diagnosis based on automatic analysis of speech and disfluencies, and Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Deep Learning methodologies. The proposed tools could be useful for supporting Mild Cognitive Impairment diagnosis. The Deep Learning approach includes Convolutional Neural Networks and nonlinear multifeature modeling. Additionally, an automatic hybrid methodology is used in order to select the most relevant features by means of nonparametric Mann–Whitney U test and Support Vector Machine Attribute evaluation.

MEDICINA INTERNA–INTERNAL MEDICINE Nº Articles indexats: 15

Factor Impacte total: 35.768

Factor d’impacte mig per article: 2.554

Weinberg I, Giri J, Kolluri R, Arcelus JI, Falgá C, Soler S, Braester A, Bascuñana J, Gutiérrez-Guisado J, Monreal M; RIETE Investigators.

Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry.

J Thromb Thrombolysis. 2018 Nov;46(4):551-558. doi: 10.1007/s11239-018-1736-9. PubMed PMID: 30196344.

Abstract: Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of postarthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed postarthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.620 Quartil: 2

Categoria: Hematology

Posició: 35/71

Fernandez-Sierra MA, Rueda-Domingo MT, Rodriguez-Del-Aguila MM, Perez-Lozano MJ, Force L, Fernandez-Villa T, Astray J, Egurrola M, Castilla J, Sanz F, Toledo D, Dominguez A; Workgroup Project PI12/02079.

Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia.

Epidemiol Infect. 2018 Oct;146(14):1870-1877. doi: 10.1017/S0950268818002121. Epub 2018 Aug 2. PubMed PMID: 30070190 Abstract: Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.044 Quartil: 2

Categoria: Public, Enviromental & OH

Posició: 76/181

Troya J, Montejano R, Ryan P, Gómez C, Matarranz M, Cabello A, Vera F, Sepúlveda MA, Santos I, Samperiz G, Bachiller P, Boix V, Barrufet P, Cervero M, Sanz J, Solís J, Yllescas M, Valencia E; GESIDA-8715 Study Group.

Raltegravir plus abacavir/lamivudine in virologically suppressed HIV-1-infected patients: 48-week results of the KIRAL study.

PLoS One. 2018 Jun 14;13(6):e0198768. doi: 10.1371/journal.pone.0198768. eCollection 2018. PubMed PMID: 29902204 Abstract BACKGROUND: Long-term combination antiretroviral therapy often results in toxicity/tolerability problems, which are one of the main reasons for switching treatment. Despite the favorable profile of raltegravir (RAL), data on its combination with abacavir/lamivudine (ABC/3TC) are scarce. Based on clinical data, we evaluated this regimen as a switching strategy.

DESIGN: Multicenter, non-controlled, retrospective study including all virologically suppressed HIV-1-infected patients who had switched to RAL+ABC/3TC. METHODS: We evaluated effectiveness (defined as maintenance of HIV-1-RNA <50 copies/mL at 48 weeks) safety, tolerability, laboratory data, and CD4+ count at week 48 of this switching strategy.

RESULTS: The study population comprised 467 patients. Median age was 49 years (IQR: 45-53). Males accounted for 75.4%. Median CD4+ count at baseline was 580 cells/μL (IQR, 409). The main reasons for switching were toxicity/tolerability problems (197; 42.2%) and physician's criteria (133; 28.5%). At week 48, HIV-1 RNA remained at <50 copies/mL in 371/380 (97.6%; 95%CI: 96.4-99.0) when non-virological failure was censured.

Virological failure was recorded in 1.9% patients and treatment failure in 20.5% of patients (96/467 [95%CI, 16.9-24.2]). The main reasons for treatment failure included switch to fixed-dose combination regimens (31; 6.6%), toxicity/poor tolerability (27; 5.8%), and physician's decision (17; 3.6%). A total of 73 adverse events were detected in 64 patients (13.7%). These resolved in 43 patients (67.2%). Of the 33 cases related or likely related to treatment, 30 were Grade-1 (90.9%). CD4+ count and renal, hepatic, and lipid profiles remained clinically stable over the 48 weeks.

CONCLUSIONS: Our findings suggest that RAL+ABC/3TC could be an effective, safe/tolerable, and low-toxicity option for virologically suppressed HIV-1-infected patients.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.766 Quartil: 1

Categoria: Multidisciplinary Sciences

Posició: 15/64

Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Bouza E; in behalf of the NUVE Study Group.

Impact of a training program on adherence to recommendations for care of venous lines in internal medicine departments in Spain.

Eur J Clin Microbiol Infect Dis. 2018 Jun;37(6):1163-1168. doi: 10.1007/s10096-018-3236-4. Epub 2018 Mar 22.

PubMed PMID: 29569044 Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Abstract: A high percentage of venous lines (VLs) are placed in non-ICU patients, particularly those treated in the internal medicine department (IMD). We assessed adherence to VL care after a training program aimed at nurses and clinicians attending patients admitted to Spanish IMDs. We performed a multicenter prospective observational point prevalence study in 14 Spanish IMDs in 2013 and 2016. We included all adult patients (> 18 years) admitted to IMDs on the study day and reviewed nursing records for patients with VL in place before and after a 1-year training program during 2015. Answers from an interview with head nurses of the IMDs regarding commonly used practices in the daily management of VLs were also compared. A total of 638 and 693 patients were seen during each period, respectively, and 530 and 598 patients had ≥ 1 VL implanted (83.1 vs. 86.3%).

Catheters were considered unnecessary in 12.8 and 15.0% of cases (p = 0.28). Daily recording of the need for catheter use increased from 43.8 to 71.8% (p < 0.001). Furthermore, daily monitoring of the insertion site remained very frequent (94.4 vs. 92.2%; p = 0.16). The date of insertion was recorded in 86.3 and 85.5% of cases (p = 0.73), and no combination of closed connectors with open caps increased from 74.8 to 90.3% (p < 0.001).

Overall, head nurses' knowledge improved in 4 out of 14 recommendations assessed (28.6%). A simple and easy program for training on management of VLs in Spanish IMDs was associated with improved quality of care.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.537 Quartil: 2

Categoria: Microbiology

Posició: 63/126

Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC).

Med Intensiva. 2018 Jan - Feb;42(1):5-36. doi: 10.1016/j.medin.2017.09.012. English, Spanish. PubMed PMID: 29406956 Abstract Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded.

Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.755 Quartil: 4

Categoria: Critical Care Medicine

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Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). Enferm Infecc Microbiol Clin. 2018 Feb;36(2):112119. doi: 10.1016/j.eimc.2017.10.019. English, Spanish. PubMed PMID: 294128957 Abstract Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded.

Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible.

Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.707 Quartil: 3

Categoria: Microbiology

Posició: 94/126

Artero A, Inglada L, Gómez-Belda A, Capdevila JA, Diez LF, Arca A, Romero JM, Domínguez-Gil M, Serra-Centelles C, de la Fuente J. The clinical impact of bacteremia on outcomes in elderly patients with pyelonephritis or urinary sepsis: A prospective multicenter study.

PLoS One. 2018 Jan 24;13(1):e0191066. doi: 10.1371/journal.pone.0191066. eCollection 2018. PubMed PMID: 29364923; PubMed Central PMCID: PMC5783370 Abstract BACKGROUND: Bacteremia is common in severe urinary infections, but its influence on the outcomes is not well established. The aim of this study was to assess the association of bacteremia with outcomes in elderly patients admitted to hospital with pyelonephritis or urinary sepsis.

METHODS: This prospective muticenter observational study was conducted at 5 Spanish hospitals. All patients aged >65 years with pyelonephritis or urinary sepsis admitted to the departments of internal medicine and with urine and blood cultures obtained at admission to hospital were eligible. Transfer to ICU, length of hospital stay, hospital mortality and all cause 30-day mortality in bacteremic and non-bacteremic groups were compared. Risk factors for all cause 30-day mortality was also estimated.

RESULTS: Of the 424 patients included in the study 181 (42.7%) had bacteremia. Neither transfer to ICU (4.4% vs. 2.9%, p = 0.400), nor length of hospital stay (9.7±4.6 days vs. 9.0±7.3 days, p = 0.252), nor hospital mortality (3.3% vs. 6.2%, p = 0.187), nor all cause 30-day mortality (9.4% vs. 13.2%, p = 0.223) were different between Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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bacteremic and non-bacteremic groups. By multivariate analysis, risk factors for all cause 30-day mortality were age (OR 1.05, 95% CI 1.00-1.10), McCabe index ≥2 (OR 10.47, 95% CI 2.96-37.04) and septic shock (OR 8.56, 95% CI 2.86-25.61); whereas, bacteremia was inversely associated with all cause 30-day mortality (OR 0.33, 95% CI 0.15-0.71).

CONCLUSIONS: In this cohort, bacteremia was not associated with a worse prognosis in elderly patients with pyelonephritis or urinary sepsis.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.766 Quartil: 1

Categoria: Multidisciplinary Sciences

Posició: 15/64

Jara-Palomares L, Otero R, Jimenez D, Praena-Fernandez JM, Font C, Falga C, Soler S, Riesco D, Verhamme P, Monreal M; RIETE Registry.

Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism.

PLoS One. 2018 Mar 20;13(3):e0194673. doi: 10.1371/journal.pone.0194673. eCollection 2018. PubMed PMID: 29558509 Abstract The usefulness of a diagnostic workup for occult cancer in patients with venous thromboembolism (VTE) is controversial. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to perform a nested case-control study to validate a prognostic score that identifies patients with unprovoked VTE at increased risk for cancer. We dichotomized patients as having low- (≤2 points) or high (≥3 points) risk for cancer, and tried to validate the score at 12 and 24 months. From January 2014 to October 2016, 11,695 VTE patients were recruited. Of these, 1,360 with unprovoked VTE (11.6%) were eligible for the study. At 12 months, 52 patients (3.8%; 95%CI: 2.9-5%) were diagnosed with cancer. Among 905 patients (67%) scoring ≤2 points, 22 (2.4%) had cancer. Among 455 scoring ≥3 points, 30 (6.6%) had cancer (hazard ratio 2.8; 95%CI 1.6-5; p<0.01). Cstatistic was 0.63 (95%CI 0.55-0.71). At 24 months, 58 patients (4.3%; 95%CI: 3.3-5.5%) were diagnosed with cancer. Among 905 patients scoring ≤2 points, 26 (2.9%) had cancer. Among 455 patients scoring ≥3 points, 32 (7%) had cancer (hazard ratio 2.6; 95%CI 1.5-4.3; p<0.01). C-statistic was 0.61 (95%CI, 0.54-0.69). We validated our prognostic score at 12 and 24 months, although prospective cohort validation is needed. This may help to identify patients for whom more extensive screening workup may be required.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.766 Quartil: 1

Categoria: Multidisciplinary Sciences

Posició: 15/64

Bikdeli B, Sharif-Kashani B, Bikdeli B, Valle R, Falga C, Riera-Mestre A, Mazzolai L, Verhamme P, Wells PS, Torrero JFSM, Lopez-Jiménez L, Monreal M; RIETE Investigators.

Impact of Thrombus Sidedness on Presentation and Outcomes of Patients with Proximal Lower Extremity Deep Vein Thrombosis.

Semin Thromb Hemost. 2018 Jun;44(4):341-347. doi: 10.1055/s-0037-1621716. Epub 2018 Jan 12. PubMed PMID: 293294722 Abstract Small studies have suggested differences in demographics and outcomes between left- and right-sided deep vein thrombosis (DVT), and also unilateral versus bilateral DVT. We investigated the clinical presentation and outcomes of patients with DVT based on thrombus sidedness. The authors used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) database (2001-2016) to identify patients with symptomatic proximal lower-extremity DVT. Main outcomes included cumulative 90-day symptomatic Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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pulmonary embolism (PE) and 1-year mortality. Overall, 30,445 patients were included. The majority of DVTs occurred in the left leg (16,421 left-sided, 12,643 right-sided, and 1,390 bilateral; p < 0.001 for chi-squared test comparing all three groups). Comorbidities were relatively similar in those with left-sided and right-sided DVT. Compared with those with left-sided DVT, patients with right-sided DVT had higher relative frequency of PE (26% versus 23%, p < 0.001) and 1-year mortality (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00-1.18).

This difference in mortality did not persist after multivariable adjustment (OR: 1.01; 95% CI: 0.93-1.1). Patients with bilateral DVT had a greater burden of comorbidities such as heart failure, and recent surgery compared with those with unilateral DVT (p < 0.001), and higher relative frequency of PE (48%), and 1-year mortality (24.1%). Worse outcomes in patients with bilateral DVT were attenuated but persisted after multivariable adjustment for demographics and risk factors (OR: 1.64; 95% CI: 1.43-1.87). Patients with bilateral DVT had worse outcomes during and after discontinuation of anticoagulation. There is a left-sided preponderance for proximal lower-extremity DVT. Compared with those with left-sided DVT, patients with right-sided DVT have slightly higher rates of PE. Bilateral DVT is associated with markedly worse short-term and 1-year outcomes.

Indexat a: Medline/WOS/JCR Factor Impacte: 3.345 Quartil: 2

Categoria: Hematology

Posició: 23/71

Weinberg I, Giri J, Kolluri R, Arcelus JI, Falgá C, Soler S, Braester A, Bascuñana J, Gutiérrez-Guisado J, Monreal M; RIETE Investigators.

Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry.

J Thromb Thrombolysis. 2018 Nov;46(4):551-558. doi: 10.1007/s11239-018-1736-9. PubMed PMID: 301963446 Abstract Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed postarthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.620 Quartil: 2

Categoria: Hematology

Posició: 35/71

Reyes-Urueña JM, Campbell CNJ, Vives N, Esteve A, Ambrosioni J, Tural C, Ferrer E, Navarro G, Force L, García I, Masabeu À, Vilaró JM, García de Olalla P, Caylà JA, Miró JM, Casabona J; PISCIS investigators.

Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population.

BMJ Open. 2018 Feb 28;8(2):e018533. doi: 10.1136/bmjopen-2017-018533. PubMed PMID: 29490955 Abstract OBJECTIVE: Undiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.

METHODS: To estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.

RESULTS: The total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).

CONCLUSIONS: By the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.413 Quartil: 2

Categoria: Medicine, General & Internal

Posició: 43/155

Sanz F, Morales-Suárez-Varela M, Fernández E, Force L, Pérez-Lozano MJ, Martín V, Egurrola M, Castilla J, Astray J, Toledo D, Domínguez Á; Project PI12/02079 Working Group.

A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients.

J Gen Intern Med. 2018 Apr;33(4):437-444. doi: 10.1007/s11606-017-4267-8. Epub 2018 Jan 4. PubMed PMID: 293272125 Abstract BACKGROUND: The baseline health status may be a determinant of interest in the evolution of pneumonia.

OBJECTIVE: Our objective was to assess the predictive ability of community-acquired pneumonia (CAP) mortality by combining the Barthel Index (BI) and Pneumonia Severity Index (PSI) in patients aged ≥ 65 years.

DESIGN, PATIENTS AND MAIN MEASURES: In this prospective, observational, multicenter analysis of comorbidities, the clinical data, additional examinations and severity of CAP were measured by the PSI and functional status by the BI. Two multivariable models were generated: Model 1 including the PSI and BI and model 2 with PSI plus BI stratified categorically.

KEY RESULTS: The total population was 1919 patients, of whom 61% had severe pneumonia (PSI IV-V) and 40.4% had some degree of dependence (BI ≤ 90 points). Mortality in the PSI V-IV group was 12.5%. Some degree of dependence was associated with increased mortality in both the mild (7.2% vs. 3.2%; p = 0.016) and severe (14% vs. 3.3%; p < 0.001) pneumonia groups. The combination of PSI IV-V and BI ≤ 90 was the greatest risk factor for mortality (aOR 4.17; 95% CI 2.48 to 7.02) in our series.

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CONCLUSIONS: The use of a bimodal model to assess CAP mortality (PSI + BI) provides more accurate prognostic information than the use of each index separately.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 4.005 Quartil: 1

Categoria: Medicine, General & Internal

Posició: 22/155

Fernández-Codina A, Fernández-Fernández J, Fernández-Pantiga A; en nombre del grupo vii de trabajo de final de máster en Manejo Clínico de Enfermedades Autoinmunes Sistémicas de la Sociedad Española de Medicina Interna.

Use of tocilizumab in systemic sclerosis: A brief literature review.

Rev Clin Esp. 2018 Aug - Sep;218(6):298-304. doi: 10.1016/j.rce.2018.02.011. Epub 2018 Mar 27. English, Spanish. PubMed PMID: 29602447 Abstract The available treatments for systemic sclerosis (SS) have limited effectiveness. Treatment with tocilizumab (TCZ), a biological drug that inhibits interleukin 6 (IL-6), has recently been proposed. In this study, we conducted a literature review to assess the safety and efficacy of TCZ in SS. We found 52 articles, 10 of which we selected after evaluating the articles. In a randomised clinical trial, TCZ showed a nonsignificant improvement in the degree of skin induration, while another observational study showed neutral results. In this same clinical trial, the functional respiratory parameters showed a certain degree of stabilization. The safety profile of TCZ is acceptable; however, the current evidence regarding treatment of SS with TCZ is highly limited, although the drug could have a beneficial effect in skin disorder. New clinical trials are needed to determine the usefulness of TCZ in SS. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.184 Quartil: 3

Categoria: Medicine, General & Internal

Posició:92/155

Berenguer J, Jarrín I, Pérez-Latorre L, Hontañón V, Vivancos MJ, Navarro J, Téllez MJ, Guardiola JM, Iribarren JA, Rivero-Juárez A, Márquez M, Artero A, Morano L, Santos I, Moreno J, Fariñas MC, Galindo MJ, Hernando MA, Montero M, Cifuentes C, Domingo P, Sanz J, Domíngez L, Ferrero OL, De la Fuente B, Rodríguez C, Reus S, Hernández-Quero J, Gaspar G, Pérez-Martínez L, García C, Force L, Veloso S, Losa JE, Vilaró J, Bernal E, Arponen S, Ortí AJ, Chocarro Á, Teira R, Alonso G, Silvariño R, Vegas A, Geijo P, Bisbe J, Esteban H, González-García J; GeSIDA 8514 Study Group.

Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant.

Open Forum Infect Dis. 2018 Jan 12;5(1):ofx258. doi: 10.1093/ofid/ofx258. eCollection 2018 Jan. PubMed PMID: 29354658 Abstract BACKGROUND: Effective two-drug regimens could decrease long-term drug exposure and toxicity with HIV-1 antiretroviral therapy (ART). We therefore aimed to evaluate the efficacy and safety of a two-drug regimen compared with a three-drug region for the treatment of HIV-1 infection in ART-naive adults METHODS: We conducted two identically designed, multicentre, double-blind, randomised, non-inferiority, phase 3 trials: GEMINI-1 and GEMINI-2. Both studies were done at 192 centres in 21 countries. We included participants (≥18 years) with HIV-1 infection and a screening HIV-1 RNA of 500 000 copies per mL or less, and who were naive to ART. We randomly assigned participants (1:1) to receive a once-daily two-drug regimen of dolutegravir (50 mg) plus lamivudine (300 mg) or a once-daily three-drug regimen of dolutegravir (50 mg) plus tenofovir disoproxil Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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fumarate (300 mg) and emtricitabine (200 mg). Both regimen drugs were administered orally. We masked participants and investigators to treatment assignment: dolutegravir was administered as single-entity tablets (similar to its commercial formulation, except with a different film colour), and lamivudine tablets and tenofovir disoproxil fumarate and emtricitabine tablets were over-encapsulated to visually match each other. Primary endpoint was the proportion of participants with HIV-1 RNA of less than 50 copies per mL at week 48 in the intention-to-treat-exposed population, using the Snapshot algorithm and a non-inferiority margin of -10%.

Safety analyses were done on the safety population. GEMINI-1 and GEMINI-2 are registered with ClinicalTrials.gov, numbers NCT02831673 and NCT02831764, respectively.

FINDINGS: Between July 18, 2016, and March 31, 2017, 1441 participants across both studies were randomly assigned to receive either the two-drug regimen (n=719) or three-drug regimen (n=722). At week 48 in the GEMINI-1 intention-to-treat-exposed population, 320 (90%) of 356 participants receiving the two-drug regimen and 332 (93%) of 358 receiving the three-drug regimen achieved plasma HIV-1 RNA of less than 50 copies per mL (adjusted treatment difference -2·6%, 95% CI -6·7 to 1·5); in GEMINI-2, 335 (93%) of 360 in the two-drug regimen and 337 (94%) of 359 in the three-drug regimen achieved HIV-1 RNA of less than 50 copies per mL (adjusted treatment difference -0·7%, 95% CI -4·3 to 2·9), showing non-inferiority at a -10% margin in both studies (pooled analysis: 655 [91%] of 716 in the two-drug regimen vs 669 [93%] of 717 in the three-drug regimen; adjusted treatment difference -1·7%, 95% CI -4·4 to 1·1). Numerically, more drug-related adverse events occurred with the three-drug regimen than with the two-drug regimen (169 [24%] of 717 vs 126 [18%] of 716); few participants discontinued because of adverse events (16 [2%] in the three-drug regimen and 15 [2%] in the two-drug regimen). Two deaths were reported in the two-drug regimen group of GEMINI-2, but neither was considered to be related to the study medication.

INTERPRETATION: The non-inferior efficacy and similar tolerability profile of dolutegravir plus lamivudine to a guideline-recommended three-drug regimen at 48 weeks in ART-naive adults supports its use as initial therapy for patients with HIV-1 infection.

FUNDING: ViiV Healthcare.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.240 Quartil: 2

Categoria: Infectious Diseases

Posició: 31/88

Badia JM, Abad A, Barrufet P, Díes C, Guirao X, Navarro L, López-Contreras J, Ortiz D, Píriz M, torner P, Rams N, Davins J, Gudiol F, Pujol M Programa de prevenció de les infeccions quirúrgiques a Catalunya: PREVINQ-CAT. Annals Med 2018;101:60-63 Abstract La infecció de localització quirúrgica (ILQ) és la infecció relacionada amb l’assistència sanitària més freqüent. La ILQ té un impacte molt important en el pacient, comporta una prolongació de l’estada hospitalària variable en funció del procediment quirúrgic i de la gravetat de la infecció, és una causa freqüent de reingrés hospitalari i s’associa a una mortalitat atribuïble significativa. A més, ocasiona en els pacients i familiars un sofriment notable i una pèrdua de confiança en l’equip quirúrgic i en el sistema sanitari. Les conseqüències per al sistema sanitari són també molt rellevants. La ILQ té un cost econòmic directe molt elevat, relacionat amb l’assistència del pacient, i comporta un cost indirecte relacionat amb la pèrdua de productivitat i de qualitat i d’anys de vida.

Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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ONCOLOGIA–ONCOLOGY Nº Articles indexats: 6

Factor Impacte total: 24.788

Factor d’impacte mig per article: 4.131

Martin-Castillo B, Pernas S, Dorca J, Álvarez I, Martínez S, Pérez-Garcia JM, Batista-López N, Rodríguez-Sánchez CA, Amillano K, Domínguez S, Luque M, Stradella A, Morilla I, Viñas G, Cortés J, Cuyàs E, Verdura S, FernándezOchoa Á, Fernández-Arroyo S, Segura-Carretero A, Joven J, Pérez E, Bosch N, Garcia M, López-Bonet E, Saidani S, Buxó M, Menendez JA. A phase 2 trial of neoadjuvant metformin in combination with trastuzumab and chemotherapy in women with early HER2-positive breast cancer: the METTEN study.

Oncotarget. 2018 Nov 2;9(86):35687-35704. doi: 10.18632/oncotarget.26286. eCollection 2018 Nov 2.

PubMed PMID: 30479698 Abstract The METTEN study assessed the efficacy, tolerability, and safety of adding metformin to neoadjuvant chemotherapy plus trastuzumab in early HER2-positive breast cancer (BC). Women with primary, non-metastatic HER2-positive BC were randomized (1:1) to receive metformin (850 mg twice-daily) for 24 weeks concurrently with 12 cycles of weekly paclitaxel plus trastuzumab, followed by four cycles of 3-weekly FE75C plus trastuzumab (arm A), or equivalent regimen without metformin (arm B), followed by surgery. Primary endpoint was the rate of pathological complete response (pCR) in the per-protocol efficacy population. pCR rate was numerically higher in the metformin-containing arm A (19 of 29 patients [65.5%, 95% CI: 47.3-80.1]) than in arm B (17 of 29 patients [58.6%, 95% CI: 40.7-74.5]; OR 1.34 [95% CI: 0.46-3.89], P = 0.589). The rate of breastconserving surgery was 79.3% and 58.6% in arm A and B (P = 0.089), respectively. Blood metformin concentrations (6.2 μmol/L, 95% CI: 3.6-8.8) were within the therapeutic range. Seventy-six percent of patients completed the metformin-containing regimen; 13% of patients in arm A dropped out because of metforminrelated gastrointestinal symptoms. The most common adverse events (AEs) of grade ≥3 were neutropenia in both arms and diarrhea in arm A. None of the serious AEs was deemed to be metformin-related. Addition of anti-diabetic doses of metformin to a complex neoadjuvant regimen was well tolerated and safe. Because the study was underpowered relative to its primary endpoint, the efficacy data should be interpreted with caution.

Indexat a: MEDLINE/WOS

Garrido P, Viñolas N, Isla D, Provencio M, Majem M, Artal A, Carcereny E, Garcia Campelo R, Lianes P, De La Peñas R, Felip E Lung cancer in Spanish women: The WORLD07 project.

Eur J Cancer Care (Engl). 2018 Oct 2:e12941. doi: 10.1111/ecc.12941. [Epub ahead of print] PubMed PMID: 30277293 Abstract The WORLD07 study was a female-specific database, to prospectively characterise the clinical, histological, molecular and treatment-related features in Spanish women with lung cancer. Data were collected from patients' medical records and patient interviews from October 2007 to December 2012. A total of 2,060 women were analysed: median age, 61.3 years; white, 98.6%; postmenopausal, 80.2%; and no smokers, 55% including never smokers and ex-smokers. A family history of cancer was found in 42.5% of patients, 12.0% of patients had had a previous history of cancer (breast cancer, 39.7%). Most patients (85.8%) were diagnosed of non-small-cell lung cancer (NSCLC), most commonly reported with adenocarcinoma (71.4%), which was stage IV at diagnosis in 57.6%. Median overall survival (OS) for the entire population was 24.0 months, with a 1- and 2-year survival rate of 70.7% and 50.0% respectively. Median OS in patients with small-cell lung cancer was 18.8 months versus 25.0 months in patients with NSCLC (p = 0.011). Lung cancer appears to be a biologically different disease in women.

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By collecting prospective information about characteristics of women with lung cancer attending university hospitals in Spain, we hope to highlight the need to develop strategies based on gender differences and influence future healthcare policy.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.409 Quartil: 3

Categoria: Rehabilitation

Posició: 14/65

Alonso V, Escudero P, Fernández-Martos C, Salud A, Méndez M, Gallego J, Rodriguez JR, Martín-Richard M, Fernández-Plana J, Manzano H, Méndez JC, Zanui M, Falcó E, Gil-Raga M, Rojo F, Cuatrecasas M, Feliu J, GarcíaAlbéniz X, Maurel J. Coexpression of p-IGF-1R and MMP-7 Modulates Panitumumab and Cetuximab Efficacy in RAS Wild-Type Metastatic Colorectal Cancer Patients.

Neoplasia. 2018 Jul;20(7):678-686. doi: 10.1016/j.neo.2018.05.004. Epub 2018 May 26. PubMed PMID: 29842993 INTRODUCTION: The coexpression of pIGF-1R and MMP-7 (double-positive phenotype, DP) correlates with poor overall survival (OS) in KRAS wild-type (WT) (exon 2) metastatic colorectal cancer (mCRC) patients treated with irinotecan-cetuximab in second/third line.

METHODS: We analyzed two prospective biomarker design trials of newly diagnosed RAS-WT mCRC patients treated with panitumumab-FOLFOX6 (PULSE trial; NCT01288339) or cetuximab plus either FOLFOX6/FOLFIRI (POSIBA trial; NCT01276379). The main exposure was DP phenotype (DP/non-DP), as assessed by two independent pathologists. DP cases were defined by immunohistochemistry as >70% expression of moderate or strong intensity for both MMP-7 and pIGF-1R. Primary endpoint: progression-free survival (PFS); secondary endpoints: OS and response rate. PFS and OS were adjusted by baseline characteristics using multivariate Cox models.

RESULTS: We analyzed 67 patients (30 non-DP, 37 DP) in the PULSE trial and 181 patients in the POSIBA trial (158 non-DP, 23 DP). Response rates and PFS were similar between groups in both studies. DP was associated with prolonged OS in PULSE (adjusted HR: 0.23; 95%CI: 0.11-0.52; P=.0004) and with shorter OS in POSIBA (adjusted HR: 1.67; 95%CI: 0.96-2.90; P=.07).

CONCLUSION: A differential effect of anti-EGFRs on survival by DP phenotype was observed. Panitumumab might be more beneficial for RAS-WT mCRC patients with DP phenotype, whereas cetuximab might improve OS in non-DP. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 4.994 Quartil: 1

Categoria: Oncology

Posició: 50/223

Esteban I, Vilaró M, Adrover E, Angulo A, Carrasco E, Gadea N, Sánchez A, Ocaña T, Llort G, Jover R, Cubiella J, Servitja S, Herráiz M, Cid L, Martínez S, Oruezábal-Moreno MJ, Garau I, Khorrami S, Herreros-de-Tejada A, Morales R, Cano JM, Serrano R, López-Ceballos MH, González-Santiago S, Juan-Fita MJ, Alonso-Cerezo C, Casas A, Graña B, Teulé A, Alba E, Antón A, Guillén-Ponce C, Sánchez-Heras AB, Alés-Martínez JE, Brunet J, Balaguer F, Balmaña J. Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain.

Psychooncology. 2018 Jun;27(6):1530-1537. doi: 10.1002/pon.4686. Epub 2018 Mar 26. PubMed PMID: 29498768.

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Abstract OBJECTIVE: Patients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model.

METHODS: One hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1 week, 3 months, and 12 months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty.

RESULTS: A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value = .87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results.

CONCLUSIONS: Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.455 Quartil: 1

Categoria: Social Sciences, Biomedical

Posició: 3/42

Abad A, Martínez-Balibrea E, Viéitez JM, Alonso-Orduña V, García Alfonso P, Manzano JL, Massutí B, Benavides M, Carrato A, Zanui M, Gallego J, Grávalos C, Conde V, Provencio M, Valladares-Ayerbes M, Salazar R, Sastre J, Montagut C, Rivera F, Aranda E. Genotype-based selection of treatment of patients with advanced colorectal cancer (SETICC): a pharmacogenetic-based randomized phase II trial.

Ann Oncol. 2018 Feb 1;29(2):439-444. doi: 10.1093/annonc/mdx737. PubMed PMID: 29145602 Abstract BACKGROUND: There has been little progress toward personalized therapy for patients with metastatic colorectal cancer (mCRC). TYMS-3' untranslated region (UTR) 6 bp ins/del and ERCC1-118C/T polymorphisms were previously reported to facilitate selecting patients for fluoropyrimidine-based treatment in combination with oxaliplatin as first-line therapy. We assessed the utility of these markers in selecting therapy for patients with mCRC. PATIENTS AND METHODS: This randomized, open-label phase II trial compared bevacizumab plus XELOX (control) versus treatment tailored according to TYMS-3'UTR 6 bp ins/del and ERCC1-118C/T polymorphisms.

Patients randomized to the experimental treatment received bevacizumab plus FUOX, FUIRI, XELIRI, or XELOX depending on their combination of favorable polymorphisms for FUOX treatment (TYMS-3'UTR ins/del or del/del; ERCC1-118T/T). Progression-free survival (PFS) was the primary end point.

RESULTS: Overall, 195 patients were randomized (control n = 65; experimental n = 130). The primary objective was not met: median PFS was 9.4 months in the control group and 10.1 months in the experimental group (P = 0.745). Median overall survival was similar in both groups (16.5 versus 19.1 months, respectively; P = 0.797).

Patients in the experimental group had a significantly higher overall response rate (ORR; 65% versus 47% in the control group; P = 0.042) and R0 resection rate (86% versus 44%, respectively; P = 0.018). Neuropathy, hand-foot syndrome, thrombocytopenia, and dysesthesia were significantly less common in the experimental group.

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CONCLUSIONS: This study did not show survival benefits after treatment personalization based on polymorphisms in mCRC. However, the improved ORR and R0 resection rate and fewer disabling toxicities suggest that tailoring therapy by TYMS-3'UTR and ERCC1-118 polymorphisms warrants further investigation in patients with mCRC. CLINICALTRIALS.GOV:NCT01071655.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 13.930 Quartil/Decil: 1

Categoria: Oncology

Posició: 9/223

Morales-Barrera R, González M, Suárez C, Carles J. Detection of circulating tumor DNA for advanced bladder cancer: where are we going?

Transl Androl Urol. 2018 Mar;7(Suppl 1):S101-S103. doi: 10.21037/tau.2018.01.01. PubMed PMID: 29644172 Abstract Bladder cancer (BC) is the ninth most common malignant disease and the thirteenth most common cause of cancer death worldwide. In 2012, 429,793 cases of BC were diagnosed and nearly 165,000 deaths were recorded globally (1). Urothelial carcinoma (UC) is the most common histologic subtype of BC, and represents nearly 90% of all cases (2). Around thirty percent of cases are diagnosed as muscle-invasive urothelial carcinoma (MIUC) and radical cystectomy (RC) remains the cornerstone of therapy (3). However, cancer-specific survival (CSS) after RC is relatively low, ranging from 72% at 5 years for patients with organ-confined disease, to 48–25% at 5 years in patients with extravesical extension or lymph node metastases. Around 50% of patients with clinical stages T2b–T4a will develop metastatic disease after two years of RC (4). This supports the use of neoadjuvant cisplatin-based chemotherapy (NAC) to achieve a better control disease and increase overall survival. NAC has demonstrated a 5% increase in 5-year cancer specific survival in MUIC compared to surgery alone (5). Interestingly, the 5-year CSS for patients who achieved pathological response (<ypT2) is 90%, in contrast to the 30–40% CSS for those who does not reach this degree of response (4,5).

To date, there are no biomarkers to predict these responses to NAC and most of the methods that we use to evaluate responses are based on clinical data and imaging procedures. Additionally, some patients will suffer toxicity, without any benefit. Therefore, the identification of reliable biomarkers to identify patients who will benefit from NAC is needed.

Indexat a: PubMed/WOS

Javier de Castro Carpeño, José Luís Fírvida Pérez, Pilar Lianes Barragán, Manuel Ángel Cobo Dols, Juan Miguel Gil Gil, Alfredo Carrato Mena, Ángeles Fernández Puentes, Andrés García Palomo7, Montserrat Muñoz Mateu, Mª Josep Carreras Soler, Mª Àngels Peñuelas Saiz, Javier Parrondo García, Carme Pinyol i Villena Cuantificando el beneficio de la sustitución por vinorelbina oral en los pacientes susceptibles de tratamiento con vinorelbina. Estudio del retorno social de la inversión Rev Esp Econ Salud. 2018;13(2):336-353 Abstract OBJETIVOS: El uso de quimioterápicos orales para el tratamiento del cáncer de mama avanzado y del cáncer de pulmón no microcítico estadio III o IV presenta la misma eficacia que sus equivalentes intravenosos y ofrece ventajas socioeconómicas. El objetivo de este estudio fue cuantificar el valor generado por la sustitución de

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vinorelbina oral en lugar de intravenosa en los tratamientos quimioterápicos de estos pacientes, para determinar si la sustitución es asumible por el sistema nacional de salud.

MÉTODOS: Se ha utilizado la metodología del retorno social de la inversión mediante la identificación los grupos de interés involucrados y los indicadores, proxys financieros y duraciones que permiten la cuantificación económica del impacto en cada uno de estos grupos. Para ello se realizaron tres paneles de expertos (oncólogos, farmacéuticos hospitalarios y personal de enfermería).

RESULTADOS: La sustitución del tratamiento de vinorelbina intravenosa por vinorelbina oral produce un retorno social de 3,97€ por cada euro invertido. Este beneficio es consistente con el obtenido en los escenarios mínimo y máximo donde el retorno es de 2,97€ y 4,65€ por euro invertido.

CONCLUSIONES: La sustitución de tratamiento intravenoso por oral en pacientes susceptibles de recibir vinorelbina ofrece un retorno social de la inversión cuatro veces superior a la inversión necesaria para su implementación, haciendo la asignación de estos recursos más eficiente tanto para la Sociedad como para el Sistema Nacional de Salud.

CIRURGIA GENERAL – GENERAL SURGERY Nº Articles indexats: 1

Factor Impacte total: 0.841

Factor d’impacte mig per article: 0.841

Osorio J, Jericó C, Miranda C, Garsot E, Luna A, Miró M, Santamaría M, Artigau E, Rodríguez-Santiago J, Castro S, Feliu J, Aldeano A, Olona C, Momblan D, Ruiz D, Galofré G, Pros I, García-Albéniz X, Lozano M, Pera M. Perioperative transfusion management in gastric cancer surgery: Analysis of the Spanish subset of the EURECCA oesophago-gastric cancer registry.

Cir Esp. 2018 Nov;96(9):546-554. doi: 10.1016/j.ciresp.2018.03.010. English, Spanish. PubMed PMID: 29773261 Abstract INTRODUCTION: This study evaluated allogenic packed red blood cell (aPRBC) transfusion rates in patients undergoing resection for gastric cancer and the implementation of blood-saving protocols (BSP).

METHODS: Retrospective study of all gastric cancer patients operated on with curative intent in Catalonia and Navarra (2011-2013) and included in the Spanish subset of the EURECCA Oesophago-Gastric Cancer Registry.

Hospitals with BSP were defined as those with a preoperative haemoglobin (Hb) optimisation circuit associated with restrictive transfusion strategies. Predictors of aPRBC transfusion were identified by multinomial logistic regression analysis.

RESULTS: A total of 652 patients were included, 274 (42.0%) of which received aPRBC transfusion. Six of the 19 participating hospitals had BSP and treated 145 (22.2%) patients. Low Hb level at diagnosis (10 vs 12.4g/dL), ASA score III/IV, pT3-4, open surgery, associated visceral resection, and having being operated on in a hospital without BSP were predictors of aPRBC transfusion, while low Hb level, associated visceral resection, and nonBSP hospital remained predictors in the multivariate analysis. In case of comparable risk factors for aPRBC transfusion, there was a higher use of preoperative intravenous iron treatment (26.2% vs 13.2%) and a lower percentage of transfusions (31.7% vs 45%) in hospitals with BSP. CONCLUSIONS: The perioperative transfusion rate in gastric cancer was 42%. Hospitals with BSP showed a significant reduction of blood transfusions but treated only 22% of patients. Main predictors of aPRBC were low Hb level, associated visceral resection, and undergoing surgery at a hospital without BSP. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 0.841 Quartil: 4

Categoria: Surgery

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CIRURGIA VASCULAR – VASCULAR SURGERY Nº Articles indexats: 1

Factor Impacte total: 3.046

Factor d’impacte mig per article: 3.046

Davins Riu M, Borràs Pérez X, Artigas Raventós V, Palomera Fanegas E, Serra-Prat M, Alós Villacrosa J. Use of Telehealth as a New Model for Following Intermittent Claudication and Promoting Patient Expertise.

Telemed J E Health. 2018 Oct;24(10):773-781. doi: 10.1089/tmj.2017.0226. Epub 2018 Jan 11. PubMed PMID: 29323628 Abstract BACKGROUND: A change in healthcare systems is needed, due to the increased prevalence of chronic diseases.

Patient empowerment improves results in terms of patient quality of life (QoL) and satisfaction.

INTRODUCTION: We have developed a telehealth program Control Telehealth Claudication Intermittent (CONTECI) for patients with peripheral arterial disease (PAD), aimed at enhancing patient satisfaction and QoL, while improving health system efficiency.

MATERIALS AND METHODS: We conducted a randomized clinical trial of patients with PAD, at the intermittent claudication stage. Study subjects were randomized into either (1) an intervention arm (IA), which utilized our CONTECI program for promoting patient self-management, or (2) a control arm (CA), utilizing the familiar system of in-person patient visits. All patients were followed up at 1 year.

RESULTS: The trial included 150 patients, 75 in each arm. Complications were diagnosed more quickly in the IA (7.85 days standard deviation (SD) 9.95 vs. 53.89 days SD 41.56; p = 0.016) compared with the CA. Rest pain decreased (1.4% vs. 8.4%; p = 0.05) in the IA group, as did the number of scheduled visits-decreased by 95.95%and the number of emergency visits (p = 0.017). QoL scores in IA patients improved from baseline (67.87 vs.

72.25; p = 0.047), as did patient satisfaction (67.36 vs. 76.78; p = 0.03).

DISCUSSION: Telemedicine can improve health results and aid communication and visit scheduling. Our eHealth programs are financially viable.

CONCLUSIONS: Self-management using the CONTECI telehealth program is feasible for patients with PAD. The program promotes patient expertise, encourages proactivity, increases QoL and satisfaction with disease control, and improves health resource use, with no evidence of clinical inferiority to conventional practices.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.046 Quartil: 1

Categoria: Helath Care Sciences & Services

Posició: 19/94

Marinello J, Serra-Prat M, Albuxeich C, Carreño P, Lopez-Palencia J, Palomera E, Alós J Safety and Efficacy of Amniotic Membrane Implant in Venous Leg Ulcers.

J Vasc Med Surg. 2018: 6: 373. DOI: 10.4172/2329-6925.1000373.

Abstract OBJECTIVE: To assess the safety and efficacy of amniotic membrane (AM) application in venous leg ulcers (VLU).

METHODOLOGY: Design: non-controlled pre-post clinical trial. A unique AM fragment was placed on the ulcer in strict sterility conditions. Main outcome measures: total healing rate, percentage of ulcer area reduction and diurnal and nocturnal pain assessment. Control visits: at baseline and 1, 2, 3, 4 and 8 weeks after treatment.

Results: Ten patients were recruited (79.6 years). 3 weeks after AM implant, pain had completely disappeared and ulcer area had reduced to nearly halved and, 8 weeks after AM implant, ulcer area was reduced in more than 80% and in two thirds of patients the ulcer was completely healed. No relevant side effects were observed.

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CONCLUSIONS: The present study brings new evidence reinforcing the idea that AM dressing is a safety and effective alternative to heal VLU. Marinel.lo Roure J, Verdú Soriano J (Coord).

Conferencia nacional de consenso sobre las úlceras de la extremidad inferior (C.O.N.U.E.I). Documento de Consenso 2018. 2ª Ed. Madrid: Ergon;2018.

Introducción: Este Documento de Consenso se estructura en cinco secciones, en función de las diferentes etiologías de la Úlcera en la Extremidad Inferior (UEEII). En cada uno de los “ítems” se sigue la exposición de forma idéntica y estructurada en cinco apartados: Preámbulo, Recomendación, Evidencias bibliográficas que argumentan la recomendación, Nivel de evidencia y Grado de recomendación. El objetivo del Preámbulo es exponer, con brevedad, cuáles son los criterios actuales sobre el ítem de referencia (“estado de la cuestión”) y la Recomendación se ha establecido siguiendo el “Sistema Grade”.

MOTILITAT DIGESTIVA – GASTROINTESTINAL MOTILITY Nº Articles indexats: 7

Factor Impacte total: 27.085

Factor d’impacte mig per article: 3.869

Alvarez-Berdugo D, Rofes L, Casamitjana JF, Enrique A, Chamizo J, Viña C, Pollán CM, Clavé P. TRPM8, ASIC1, and ASIC3 localization and expression in the human oropharynx.

Neurogastroenterol Motil. 2018 Nov;30(11):e13398. doi: 10.1111/nmo.13398. Epub 2018 Jul 4. PubMed PMID: 29971861.

Abstract BACKGROUND: Oropharyngeal dysphagia (OD) is a prevalent disease with poor prognosis among older people and has no pharmacological treatment. Polymodal sensory receptors like the TRP or ASIC family receptors are potential targets to treat OD. TRPM8 agonists and acidic solutions can improve the swallow response in patients with OD, but little is known about the expression of TRPM8, ASIC1, and ASIC3 in the human oropharynx. The aim of this study was to assess the expression and localization of TRPM8, ASIC1, and ASIC3 in human samples of the oropharynx to lay the basis for new pharmacological treatments for OD. METHODS: Pathology-free samples from oropharyngeal regions innervated by cranial nerves V, IX, and X were obtained during major ENT surgery and processed to obtain mRNA (20 patients) or to be used in immunohistochemical assays (12 patients). TRPM8, ASIC1, and ASIC3 expression and localization were studied with RT-qPCR and fluorescent immunohistochemistry.

KEY RESULTS: ASIC3 was expressed in the 3 regions studied with similar levels and was localized on sensory fibers innervating the mucosa below the basal lamina of all studied regions. TRPM8 was also co-localized on the sensory fibers innervating the mucosa below the basal lamina of all studied regions. In contrast, ASIC1 was only found in the nerves innervating the tongue muscular fibers.

CONCLUSIONS & INFERENCES: TRPM8 and ASIC3 are found on submucosal sensory nerves in the human oropharynx. Our study lays the basis to use oropharyngeal TRPM8 and ASIC3 receptors as therapeutic targets to develop new active pharmacological treatments for OD patients.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.842 Quartil: 1

Categoria: Clinical Neurology

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Cordier R, Speyer R, Schindler A, Michou E, Heijnen BJ, Baijens L, Karaduman A, Swan K, Clavé P, Joosten AV. Using Rasch Analysis to Evaluate the Reliability and Validity of the Swallowing Quality of Life Questionnaire: An Item Response Theory Approach.

Dysphagia. 2018 Aug;33(4):441-456. doi: 10.1007/s00455-017-9873-4. Epub 2018 Feb 1. PubMed PMID: 29392474 Abstract The Swallowing Quality of Life questionnaire (SWAL-QOL) is widely used clinically and in research to evaluate quality of life related to swallowing difficulties. It has been described as a valid and reliable tool, but was developed and tested using classic test theory. This study describes the reliability and validity of the SWAL-QOL using item response theory (IRT; Rasch analysis). SWAL-QOL data were gathered from 507 participants at risk of oropharyngeal dysphagia (OD) across four European countries. OD was confirmed in 75.7% of participants via videofluoroscopy and/or fiberoptic endoscopic evaluation, or a clinical diagnosis based on meeting selected criteria. Patients with esophageal dysphagia were excluded. Data were analysed using Rasch analysis. Item and person reliability was good for all the items combined. However, person reliability was poor for 8 subscales and item reliability was poor for one subscale. Eight subscales exhibited poor person separation and two exhibited poor item separation. Overall item and person fit statistics were acceptable. However, at an individual item fit level results indicated unpredictable item responses for 28 items, and item redundancy for 10 items. The itemperson dimensionality map confirmed these findings. Results from the overall Rasch model fit and Principal Component Analysis were suggestive of a second dimension. For all the items combined, none of the item categories were 'category', 'threshold' or 'step' disordered; however, all subscales demonstrated category disordered functioning. Findings suggest an urgent need to further investigate the underlying structure of the SWAL-QOL and its psychometric characteristics using IRT. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.531 Quartil: 1

Categoria: Otorhinolaryngology

Posició: 8/41

Molina L, Santos-Ruiz S, Clavé P, González de Paz L, Cabrera E. Nursing interventions in adult patients with oropharyngeal dysphagia: a systematic review.

Eur Geriatr Med. 2018;9(1):5-21. doi: 10.1007/s41999-017-0009-z Abstract Background Oropharyngeal dysphagia is a geriatric syndrome of high prevalence. It requires screening, diagnosis and specific care to avoid possible complications. The objective of this study is to perform a systematic review of the literature to know what interventions are performed by nursing professionals in the care of adult patients with OD. Methods A systematic literature review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guideline. Included are observational and analytical scientific studies on the interventions nurses made in the assessment and screening of OD secondary to age and/or neurodegenerative diseases, as well as nursing interventions in patient's care and diagnosis in the electronic databases of Medline, SCOPUS and CINALH. Results A total of 51 articles were included: 10 observational studies, 29 experimental studies and 12 systematic reviews. 66.7% studies talked about the interventions to patients with OD secondary to ICTUS. 82.05% was performed in a hospital setting. In 49.01% of the articles, nurses are mentioned as participants in the interventions.

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Conclusion Screening and clinical assessment of OD for an early diagnosis are the interventions performed by the most prevalent nursing professionals found in the literature, mainly in the OD, due to ICTUS and in the hospital setting. Further research on interventions by nursing professionals is needed in this area.

Indexat a: WOS/JCR Factor Impacte: 1.169

Quartil: 4

Categoria: Geriatrics & Gerontology

Posició: 45/53

Martín A, Ortega O, Roca M, Arús M, Clavé P. Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

J Nutr Health Aging. 2018;22(6):739-747. doi: 10.1007/s12603-018-1043-3. PubMed PMID: 29806864 Abstract BACKGROUND: Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population.

OBJECTIVE: Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD. DESIGN AND PARTICIPANTS: An open label trial was performed on 186 hospitalized older patients (>70y) with OD; 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls.

INTERVENTION: The MMI consisted of: a) fluid thickening and texture-modified foods, b) caloric and protein supplementation; and c) oral health and hygiene recommendations during hospitalization and following discharge. The control group followed the standard clinical practice without MMI. MEASUREMENTS: Main study outcomes were hospital readmissions, respiratory infections, nutritional status and survival after 6 months follow up.

RESULTS: Both groups had similar advanced age (84.87±6.02MMI and 84.42±5.31 years), poor functionality (Barthel 59.51±26.76 MMI and 58.84±26.87), and high comorbidities (Charlson 3.00±1.60 MMI and 3.06±1.45).

Main results showed that MMI improved nutritional status (MNA 9.84±2.05 pre-MMI vs. 11.31±2.21 post-MMI; p=0.0038) and functionality (Barthel 62.34±25.43 pre-MMI vs. 73.44±25.19 post-MMI; p=0.007). In addition MMI decreased hospital readmissions (68.8 readmissions/100 persons-year (28.1-109.38) MMI vs. 190.8 (156.0225.7); p=0.001), respiratory infections (12.50 readmissions/100 persons-year (0-29.82) MMI vs. 74.68 (52.8696.50); p=0.002), and increased 6-month survival (84.13% MMI vs. 70.96%; p=0.044).

CONCLUSIONS: Our results suggest that a MMI in hospitalized older patients with OD improves nutritional status and functionality and reduces hospital readmissions, respiratory infections and mortality. MMI might become a new simple and cost-effective strategy to avoid OD complications in the geriatric population admitted with an acute disease to a general hospital.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.868 Quartil: 2

Categoria: Gesriatrics & Gerontology

Posició: 26/53

Martín A, Ortega O, Roca M, Arús M, Clavé P. Respond to Letter to the editor: Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

J Nutr Health Aging. 2018;22(8):1019-1020. doi: /10.1007/s12603-018-1091-8. PubMed PMID: 30272109

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Abstract: We have read with interest the letter from Hansen T et al. In response to our article and we want to make some comments. First, our intervention is not complex, it is very simple and is designed to be applied massively. To the specific question whether the results of the study by Martín et al would change the conclusions of the systematic review by Beck et al, our consensus answer is yes because of 3 reasons: 1) The findings of the systematic review by Beck et al concludes with “a weak recommendation against the use of texture modified liquids and good clinical practice pointing for the use of texture modified foods in patients with OD were made” but this is based on the analysis of only two RCTs with patients over 50 years of age with dementia and Parkinson’s disease, published in 2008. We believe this generalization is not acceptable. 2) Our intervention in older patients with OD admitted to a general hospital is not complex and it is based on our multiple studies on the diagnosis, pathophysiology, complications, and the effect of thickening agents in elderly patients with OD, the same phenotype as the patients included in the present study. 3) Regarding treatment, several studies have proved the separate therapeutic effect of the three elements of the Minimal-Massive Intervention (fluid viscosity, nutritional intervention, and oral health); the nutritional treatment is supported by a resolution by the European Council, the improvement of oral hygiene in older people is supported by the WHO, and the use of fluid thickening agents is supported by the European Society for Swallowing Disorders (ESSD) white paper on fluid thickening. In its whitepaper, the ESSD concluded that there is evidence for increasingviscosity to reduce the risk of airway invasion and that it is a valid management strategy for OD. In addition, our strategy is supported by the European Union Geriatric Medicine Society and the ESSD in their white paper on OD as a geriatric syndrome.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.868 Quartil: 2

Categoria: Gesriatrics & Gerontology

Posició: 26/53

Rofes L, Muriana D, Palomeras E, Vilardell N, Palomera E, Alvarez-Berdugo D, Casado V, Clavé P. Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: A cohort study.

Neurogastroenterol Motil. 2018 Mar 23:e13338. doi: 10.1111/nmo.13338. [Epub ahead of print] PubMed PMID: 29573064 Abstract BACKGROUND: Oropharyngeal dysphagia (OD) is a prevalent poststroke condition with severe complications and increased mortality. Poststroke OD prevalence varies among studies and there is little evidence of its related risk factors and associated complications.

OBJECTIVE: to evaluate the prevalence of OD after stroke and the risk factors and associated complications.

METHODS: We performed a prospective longitudinal study of stroke patients consecutively admitted to a general hospital. OD was diagnosed with the volume-viscosity swallow test (V-VST). Demographic, functional status and topographical and clinical variables of stroke were collected to assess risk factors for OD. We evaluated functional status, mortality, respiratory infections, and readmissions 3 and 12 months after stroke. A multivariate regression analysis determined associated risk factors for OD and for each outcome variable.

KEY RESULTS: We included 395 stroke patients with a 45.06% prevalence of OD on admission. OD was independently associated with age (OR = 1.05; CI = 1.02-1.08), previous stroke (OR = 2.40; CI = 1.00-5.79), severity using the National Institute of Health Stroke Scale (OR = 3.52; CI = 1.57-7.87) and volume of the lesion (OR = 1.02; CI = 1.01-1.03). OD after stroke was an independent risk factor for prolonged hospital stay (P = .049; β = 0.938) and institutionalization after discharge (OR = 0.47; CI = 0.24-0.92); OD was an independent risk factor for poorer functional capacity (OR = 3.00; CI = 1.58-5.68) and increased mortality (HR = 6.90; CI = 1.57-30.34) 3 months after stroke.

CONCLUSIONS & INFERENCES: Poststroke OD is prevalent and associated with poor short and long term prognosis. Stroke severity and patient status before stroke were more relevant to OD than lesion location.

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Systematic screening programs and early OD management could significantly improve poststroke patient outcome.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.852 Quartil: 1

Categoria: Clinical Neurology

Posició: 45/197

Marin S, Serra-Prat M, Ortega O, Clavé P. Cost of oropharyngeal dysphagia after stroke: protocol for a systematic review.

BMJ Open. 2018 Dec 14;8(12):e022775. doi: 10.1136/bmjopen-2018-022775. PubMed PMID: 305522554 Abstract INTRODUCTION: Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute inhospital costs from OD complications, there are other costs related to poststroke OD such as direct nonhealthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients.

METHODS AND ANALYSIS: nA systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured.

ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER: CRD42018099977.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.413 Quartil: 2

Categoria: Medicine, General & Internal

Posició: 43/1

INFERMERIA– NURSING Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Agustín C, Bringue J, Gargallo E, Jiménez M, Ortiz I, Planella M, Pujol M, Ruiz-Arevalo MC, Sagrera C, Tapia V, Troyano MJ Prevenció i actuació davant el risc de caigudes en pediatria en l’àmbit hospitalari Annals Med 2018;101:118-120 Abstract:

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El Departament de Salut desenvolupa i impulsa accions que contribueixin a millorar la seguretat dels pacients amb l’objectiu de garantir la màxima qualitat dels serveis sanitaris i una pràctica assistencial més segura.

L’estratègia en seguretat dels pacients del Departament de Salut només es pot desplegar i fer efectiva si els centres sanitaris dissenyen i desenvolupen la seva pròpia estratègia i polítiques associades de manera alineada, establint plans de seguretat dels pacients i objectius clarament establerts i apropiats. També és necessari establir mecanismes de comparació transparents dels resultats d’aquests objectius amb la finalitat de compartir el coneixement i incorporar mecanismes d’aprenentatge entre els centres.

Les caigudes accidentals intrahospitalàries es troben definides dins dels estàndards de qualitat per la seguretat dels pacients del Sistema Nacional de Salut (SNS) en el projecte SENECA, on es recomana l’elaboració d’un protocol de prevenció de caigudes com un indicador de qualitat en les cures infermeres. El terme ‘caiguda’ es troba definit de maneres diferents i no hi ha un criteri comú dins la bibliografia consultada.

L’Organització Mundial de la Salut (OMS) l’any 2012 defineix la caiguda com un “esdeveniment involuntari que fa perdre l’equilibri i fa que el cos topi amb el terra o una altra superfície ferma que el detingui” i segons la taxonomia NANDA 2009-2013, es descriu el risc de caiguda com “la situació vulnerable a un augment de la susceptibilitat a les caigudes que pot causar un dany físic i comprometre la salut”.

Cabrera E, Limón E, Font S, Palacios M, Mulet C, Bartolomé M. Necesidades formativas percibidas al envejecer. Cómo afrontar un envejecimiento saludable.

Index de Enfermeria. 2018; 27(3):138-142 Abstract OBJETIVO: Explorar necesidades formativas percibidas por las personas mayores de 60 años al envejecer y conocer los beneficios o barreras de participar en cursos de formación dirigidos a ellos.

METODOLOGIA: Estudio cualitativo con grupos focaleS realizado en áreas básicas de salud y un centro social de Mataró (Barcelona). Se estudiaron 29 sujetos divididos en: personas mayores de 60 años que acudían a un centro de atención primaria y personas mayores de 60 de una asociación de persones mayores. Se organizaron 4 grupos focales estratificados por segmentos. Se transcribieron las grabaciones elaborando categorías, codificaron y analizaron.

RESULTADOS: Los participantes tenían vidas plenas, apoyos emocionales y vínculos positivos con su comunidad y familia. Manifestaron que es importante planificar el envejecimiento y actividades para realizar al jubilarse.

CONCLUSION: Es necesario recibir formación al envejecer. Principales barreras: obligación de cuidar, falta de tiempo y coste económico

REHABILITACIÓ - PHYSICAL MEDICINE & REHABILITATION Nº Articles indexats: 8

Factor Impacte total: 18.087

Factor d’impacte mig per article: 2.260

Pleguezuelos E, Gimeno-Santos E, Hernández C, Mata MDC, Palacios L, Piñera P, Molina J, Chiner E, Miravitlles M. Recommendations on non-Pharmacological Treatment in Chronic Obstructive Pulmonary Disease From the Spanish COPD Guidelines (GesEPOC 2017).

Arch Bronconeumol. 2018 Nov;54(11):568-575. doi: 10.1016/j.arbres.2018.06.001. Epub 2018 Sep 18. English, Spanish. PubMed PMID: 30241689 Abstract: Non-pharmacological treatment is essential in patients with chronic obstructive pulmonary disease (COPD), but this treatment is sometimes not given the importance it deserves. Patients diagnosed with COPD should benefit from comprehensive care services. These services comprise a protocolized set of actions aimed at covering the

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health needs of the patient, taking into account their environment and circumstances. Pulmonary rehabilitation is one of the essential components of non-pharmacological treatment in comprehensive COPD care services. In the Spanish COPD Guidelines (GesEPOC) 2017, we provided a systematic report of the scientific evidence for pulmonary rehabilitation programs in acute and stable phase disease. Another important issue in the nonpharmacological treatment of COPD is physical activity, and the most essential considerations regarding prescription are described in the GesEPOC guidelines, along with a review of the most effective strategies to ensure adherence. GesEPOC 2017 aims to underline the importance of non-pharmacological treatment as a coadjuvant to pharmacological treatment.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.633 Quartil: 2

Categoria: Respiratory System

Posició: 29/60

Garnacho-Castaño MV, Albesa-Albiol L, Serra-Payá N, Gomis Bataller M, Pleguezuelos Cobo E, Guirao Cano L, Guodemar-Pérez J, Carbonell T, Domínguez R, Maté-Muñoz JL. Oxygen Uptake Slow Component and the Efficiency of Resistance Exercises.

J Strength Cond Res. 2018 Oct 17. doi: 10.1519/JSC.0000000000002905. [Epub ahead of print] PubMed PMID: 30335719 Abstract: This study aimed to evaluate oxygen uptake slow component (V[Combining Dot Above]O2sc) and mechanical economy/efficiency in half squat (HS) exercise during constant-load tests conducted at lactate threshold (LT) intensity. Nineteen healthy young men completed 3 HS exercise tests separated by 48-hour rest periods: 1 repetition maximum (1RM), incremental-load HS test to establish the %1RM corresponding to the LT, and constant-load HS test at the LT. During the last test, cardiorespiratory, lactate, and mechanical responses were monitored. Fatigue in the lower limbs was assessed before and after the constant-load test using a countermovement jump test. A slight and sustained increase of the V[Combining Dot Above]O2sc and energy expended (EE) was observed (p < 0.001). In blood lactate, no differences were observed between set 3 to set 21 (p > 0.05). A slight and sustained decrease of half squat efficiency and gross mechanical efficiency (GME) was detected (p < 0.001). Significant inverse correlations were observed between V[Combining Dot Above]O2 and GME (r = -0.93, p < 0.001). Inverse correlations were detected between EE and GME (r = -0.94, p < 0.001).

Significant losses were observed in jump height ability and in mean power output (p < 0.001) in response to the constant-load HS test. In conclusion, V[Combining Dot Above]O2sc and EE tended to rise slowly during constantload HS exercise testing. This slight increase was associated with lowered efficiency throughout constant-load test and a decrease in jump capacity after testing. These findings would allow to elucidate the underlying fatigue mechanisms produced by resistance exercises in a constant-load test at LT intensity.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.325 Quartil: 2

Categoria: Sport Sciences

Posició: 29/81

Guirao L, Samitier B, Tibau R, Alós J, Monago M, Morales-Suarez-Varela M, Pleguezuelos E. Distance and speed of walking in individuals with trans-femoral amputation fitted with a distal weightbearing implant.

Orthop Traumatol Surg Res. 2018 Oct;104(6):929-933. doi: 10.1016/j.otsr.2018.04.011. Epub 2018 Jun 1.

PubMed PMID: 29864519 Abstract

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INTRODUCTION: Preservation of femoral condyles in patients with knee disarticulation amputation (KDA) facilitates distal support inside the socket, compared to trans-femoral amputation (TFA), and allows the direct transfer of weight-bearing loads toward residual limbs.

HYPOTHESIS: The hypothesis was that the gait distance and speed of TFA patients after a surgical femoral implant that allowed the distal support of the residuum would improve.

MATERIAL AND METHODS: Twenty-three TFA patients received a titanium implant that allowed the distal weight bearing of the residuum inside the socket. The post-intervention follow-up period lasted 14 months. Gait distance and speed were assessed with the 2-minute walk test (2MWT).

RESULTS:The amputation etiology was trauma in 11 patients (48%), peripheral vascular disease in nine (39%) and oncologic disease in three (13%). The mean 2MWT distance was 103.6±34.7m prior to femoral implant and 128±38.9m at 14 months, which implies an improvement of 24% (p<0.001). The mean gait speed was 0.86±0.29m/s prior to femoral implant and 1.06±0.32m/s at 14 months (p<0.001).

DISCUSSION: After implant placement, distance covered increased by 24%. This value is higher than those described by other groups, such as Rau (12.6%) and Darter (19.2%), who assessed improvement in distance covered with the 2MWT in a younger population and after completing different physiotherapy programs. Our results showed improved distance walked and gait speed as well as in the physical functioning score in TFA patients 14 months after receiving a femoral implant that permitted distal residuum loading.

TYPE OF STUDY: An experimental prospective study.

LEVEL OF PROOF: III, case-control study.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.413 Quartil: 3

Categoria: Orthopedics

Posició: 48/77

Pleguezuelos E, Guirao L, Moreno E, Samitier B, Ortega P, Vila X, Garnacho-Castaño MV, Majó M, Ovejero L, Miravitlles M. Ischiocrural Strength May Be a Better Prognostic Marker Than Quadriceps Strength in COPD. Lung. 2018 Dec;196(6):665-668. doi: 10.1007/s00408-018-0164-0. Epub 2018 Sep 21. PubMed PMID: 30242510 Abstract: It is well known that chronic obstructive pulmonary disease (COPD) patients present with muscle dysfunction that may not correlate with the degree of severity of airflow obstruction. Historically, the strength deficit of the knee extensor musculature (quadriceps) has been described as an independent factor of mortality in COPD. We present the results of a retrospective study with longitudinal follow-up of 60 patients with severe COPD followed for 7 years. During follow-up 22 patients died, mainly of respiratory cause. We have observed that the strength of knee flexor muscles (ischiocrural) and dominant handgrip were independent predictors of mortality in severe COPD patients. However, knee extensor strength (quadriceps) was not an independent predictor of mortality. This is the first study which highlights the importance of knee flexor musculature as a prognostic factor in COPD. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.101 Quartil: 3

Categoria: Respiratory System

Posició: 41/60

Guirao Cano L, Samitier Pastor B, Maldonado Garrido D, Rodriguez-Piñero Duran M, Exposito Tirado J, PeraitaCosta I, Morales-Suarez-Varela M. Effect of a distal weight-bearing implant on visual analog scale scores in 23 transfemoral amputees.

Int J Rehabil Res. 2018 Sep;41(3):258-261. doi: 10.1097/MRR.0000000000000294. PubMed PMID: 29864034

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Abstract: The objective of this interrupted time series clinical trial was to evaluate the effect of a distal weight-bearing implant on well-being in patients with transfemoral amputations using the visual analog scale (VAS). A total of 29 patients from five hospitals with previous transfemoral amputations were surgically implanted with an osseoanchored implant with a distal spacer that allows a direct load on the residuum over the distal surface of the socket. Patients were followed for a 14-month period and assessed presurgically and postsurgically using the VAS. The Wilcoxon test was used to evaluate the differences between variables. VAS mean scores improved significantly after intervention. Significant and clinically meaningful improvements in the VAS score suggest overall improvement in well-being for patients after receiving a distal weight-bearing implant.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.432 Quartil: 3

Categoria: Rehabilitation

Posició: 41/65

Soler-Cataluña JJ, Puente Maestu L, Román-Rodríguez M, Esteban C, Gea J, Bernabeu Mora R, Pleguezuelos Cobo E, Ancochea J, Monteagudo Ruiz G, Garcia Rio F. Creation of the SAQ-COPD Questionnaire to Determine Physical Activity in COPD Patients in Clinical Practice.

Arch Bronconeumol. 2018 Sep;54(9):467-475. doi: 10.1016/j.arbres.2018.01.016. Epub 2018 Mar 13. English, Spanish. PubMed PMID: 29548802 Abstract INTRODUCTION: Physical activity (PA) is a significant clinical dimension in COPD, but no useful tools are available to determine this variable in routine clinical practice.

OBJECTIVE: To create a simple, easy-to-use, specific questionnaire to detect PA deficits.

METHOD: A multidisciplinary panel of COPD experts was formed to review PA, its determinants, and measuring methods. The methodology for selecting specific dimensions and items was agreed in rounds, and the aspects to be included in the preliminary version were determined. The questionnaire structure was defined according to applicability of these aspects in clinical practice. Agreements were reached by consensus of the members.

RESULTS: A total of 148 items were reviewed, of which only 3 were directly selected. It was decided that the questionnaire should evaluate the intensity (low, moderate, or intense), amount, and frequency of PA, and inactivity or sedentary lifestyles. It also gathers information on the profile of inactive patients, and includes a measure of impact, defined as the patient's perception of their expectations regarding activity, their personal experience, characteristics of their environment, and their personality. The questionnaire is divided into 2blocks, one aimed at quantifying PA, and the other at collecting data for defining the profile and impact in patients with low PA only.

CONCLUSION: The SAQ-COPD is a simple, short, specific questionnaire, designed to evaluate PA in COPD patients in clinical practice.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.633 Quartil: 2

Categoria: Respiratory System

Posició: 29/60

Pleguezuelos E, Casarramona P, Guirao L, Samitier B, Ortega P, Vila X, Carmen AD, Ovejero L, Moreno E, Serra N, Gomís M, Garnacho-Castaño MV, Miravitlles M. How whole-body vibration can help our COPD patients. Physiological changes at different vibration frequencies.

Int J Chron Obstruct Pulmon Dis. 2018 Oct 18;13:3373-3380. doi: 10.2147/COPD.S165058. eCollection 2018.

PubMed PMID: 30425467 Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Abstract OBJECTIVE: Evaluate cardiac, metabolic, and ventilatory changes during a training session with whole-body vibration training (WBVT) with 3 different frequencies in patients with chronic obstructive pulmonary disease (COPD).

METHODS: This was a prospective, interventional trial in outpatients with severe COPD. Participants performed 3 vertical WBVT sessions once a week using frequencies of 35, 25 Hz and no vibration in squatting position (isometric). Cardiac, metabolic, and ventilator parameters were monitored during the sessions using an ergospirometer. Changes in oxygen pulse response (VO2/HR) at the different frequencies were the primary outcome of the study.

RESULTS: Thirty-two male patients with a mean forced expiratory volume in 1 second of 39.7% completed the study. Compared to the reference of 35 Hz, VO2/HR at no vibration was 10.7% lower (P=0.005); however, no statistically significant differences were observed on comparing the frequencies of 35 and 25 Hz. The median oxygen uptake (VO2) at 25 Hz and no vibration was 9.43% and 13.9% lower, respectively, compared to that obtained at 35 Hz (both comparisons P<0.0001). The median expiratory volume without vibration was 9.43% lower than the VO2 at the end of the assessment at 35 Hz vibration (P=0.002).

CONCLUSION: Vertical WBVT training sessions show greater cardiac, metabolic, and respiratory responses compared with the squat position. On comparing the 2 frequencies used, we observed that the frequency of 35 Hz provides higher cardiorespiratory adaptation.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.917 Quartil: 2

Categoria: Respiratory System

Posició: 26/60

Pleguezuelos E, Guirao L, Moreno E, Samitier B, Ortega P, Vila X, Majó M, González MV, Ovejero L, Juanola J, Gómez A, Miravitlles M. Safety of Rehabilitation Program for COPD Patients.

Arch Bronconeumol. 2018 Feb;54(2):111-112. doi: 10.1016/j.arbres.2017.06.012. Epub 2017 Aug 5. English, Spanish. PubMed PMID: 28789812 Abstract: Pulmonary rehabilitation (PR) is a comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of patients with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviors. Physical exercise prescription is the cornerstone of rehabilitation in COPD patients, but performance of physical exercise is not without complications. Studies analyzing the complications of cardiac rehabilitation (CR) have demonstrated a low incidence of fatal and nonfatal complications. However, the incidence of complications of PR in COPD patients has not been analyzed. The objective of this retrospective analysis with longitudinal follow-up was to identify the incidence of complications in COPD patients who performed PR in two hospitals from January 2013 to September 2016.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.633 Quartil: 2

Categoria: Respiratory System

Posició: 29/60

Guirao L, Samitier B, Maldonado D, Rodriguez-Piñero M, Exposito J, Peraita-Costa I, Morales-Suarez-Varela M Evaluation of Functional Health and Well-Being in 23 Transfemoral Amputees After Distal Weight-Bearing Implant.

J Orthop Ther: JORT-192. 2018; DOI: 10.29011/2575-8241. 000092 Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Abstract PURPOSE: Functional health in patients with transfemoral amputations can be compromised when using standard socket prostheses due to problems associated with the skin-socket interface, lack of distal support and inability to transfer load to the residual limb. Osseoanchored implants that allow distal weight-bearing of the residuum can be an alternative for prosthetic attachment in these individuals. The objective of this study was to evaluate the effect of a distal weight-bearing implant on function, health, and well-being in patients with transfemoral amputations using the SF-36 Health Survey.

METHODS: Interrupted time series clinical trial where 29 patients with previous transfemoral amputations were recruited under the same protocol from 5 hospitals and received an osseoanchored distal weight-bearing implant. Patients were followed for a 14-month period and assessed pre-and post-surgically using SF-36. The Wilcoxon test was used to evaluate the differences between variables and the minimally important difference threshold to assess clinical significance.

RESULTS: All the Individual Health Domain scores of the SF-36 improved after intervention. The overall mean change is 3.94 ± 9.22 for the summary Physical Component and 1.14 ± 8.07 for the summary Mental Health Component. For both, improvement is greater in female patients, patients ≤ 50 years old and patients with traumatic amputations.

CONCLUSIONS: Significant and clinically meaningful improvements on the Physical Component Score and several individual domains suggest overall improvement in health-related functioning for patients after receiving a distal weight bearing implant.

PSIQUIATRIA - PSYCHIATRY Nº Articles indexats: 2

Factor Impacte total: 4.612

Factor d’impacte mig per article: 2.306

Varela Casal P, Lorena Esposito F, Morata Martínez I, Capdevila A, Solé Puig M, de la Osa N, Ezpeleta L, Perera I Lluna A, Faraone SV, Ramos-Quiroga JA, Supèr H, Cañete J. Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children.

J Atten Disord. 2018 Jan 1:1087054717749931. doi: 10.1177/1087054717749931. [Epub ahead of print] PubMed PMID: 29357741 Abstract OBJECTIVE: ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children.

METHOD: To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30).

RESULTS: We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90).

CONCLUSION: In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.668 Quartil:2

Categoria: Psychiatry

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Publicacions Científiques CSDM 2018

Frías A. Positive psychotic symptoms in patients with borderline personality disorder: a valuable but still not completely understood clinical marker of the illness.

Australas Psychiatry. 2018 Jun;26(3):327. doi: 10.1177/1039856217749656. PubMed PMID: 29873564 The presence of positive psychotic symptoms (PSSs) in patients primarily diagnosed with borderline personality disorder (BPD) ranges from 13% to 60%. Heterogeneity in their prevalence is due to divergences on their assessment instruments as well as targeted symptoms since half of studies have been focused on auditory verbal hallucinations.

Current data reveals that the contents of PSSs in BPD are not easily differentiated from those encountered in schizophrenia spectrum disorders (SSDs). Also, prior assumption indicating that PSSs in BPD were transient reactions has not been fully observed in recent studies. Because of these, clinicians should pay attention to the presence of other psychotic symptoms in order to determine differential diagnosis. However, significant diagnostic uncertainty may appear because not all patients with SSDs have negative symptoms or disorganized thinking. In addition, people with SSDs can also have BPD. Taking these facts into account, further research should compare three groups (schizophrenia vs BPD vs schizophrenia + BPD) in order to delineate distinctive cognitive/neurobiological endophenotypes.

Concerning aetiological pathways, PSSs in BPD are related to childhood trauma. Preliminary findings indicate that dissociation may explain this link. Notwithstanding, there is a lack of advanced methodology to corroborate this result. Moreover, the role of post-traumatic stress disorder comorbidity is still unsolved...

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 0.944 Quartil:4

Categoria: Psychiatry

Posició: 120/142

Vilches Jiménez MJ, Román Casenave M. Les addiccions comportamentals: addiccions tecnològiques i paral·lelisme and les addiccions a substàncies.

Ann Sagrat Cor 2018; 25(2): 69-70.

Abstract: El creixent avenç de les tecnologies i la seva incorporació a la societat de manera tan ràpida, fan que la persona estigui en procés d’adaptació respecte a aquesta nova forma de relacionar-se. Aquest canvi deriva en l’aparició de “noves patologies” relacionades amb aquest ús. Segons Zygmunt Baumann “les xarxes socials són molt útils, donen serveis molt plaents, però són una trampa” La dicotomia del segle xxi és discernir quan es realitza un ús adequat i quan es produeix un abús, problemàtic o addictiu de la tecnologia que tenim a l’abast. Les addiccions comportamentals més conegudes són el joc patològic, l’addicció a les compres, el sexe i les noves tecnologies. Segons Rodríguez de “Cap de les addiccions a la tecnologia són reconegudes oficialment però als darrers anys s’estan obrint noves línies d’investigació pel seu tractament i prevenció”. El problema identificat es mostra com a potencial dins de l’àmbit de la salut i l’àmbit socioeconòmic.

MEDICINA INTENSIVA – INTENSIVE MEDICINE Nº Articles indexats: 10

Factor Impacte total: 60.099

Factor d’impacte mig per article: 7.512

Escudero-Acha P, Palomo Navarro M, Leizaola Irigoyen O, Vidal Tegedor B, González Romero D, Misis Del Campo M, Recena Pérez P, Pavía Pesquera MC, Freita Ramos S, Miró Andreu G, de Pablo Hermida AM, Barceló Castelló

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M, Blasco Cortes ML, Ballesteros Ortega D, Lázaro Martín N, Díaz Díaz D, Pérez Ruiz M, Poyo-Guerrero R, Cordero Vallejo M, Acune O, Duerto Alvarez J, Garcia Torrejon MC, Gómez Gómez EM, Claverías Cabreras L, Gomez Acebo I, Gonzalez-Castro A; Grupo de Trabajo de Bioética de la SEMICYUC. Preliminary results of the ADENI-ICU trial: Analysis of decisions of refuse admission in intensive care units as a limitation of life support treatments; multi-center, prospective, observational study.

Med Intensiva. 2018 Nov 26. pii: S0210-5691(18)30283-3. doi: 10.1016/j.medin.2018.10.001. [Epub ahead of print] English, Spanish. PubMed PMID: 30497853 Abstract: La falta de análisis de los factores relacionados con los procesos de denegación de ingreso en las unidades de cuidados intensivos (UCI) ha sido una demanda tradicional. En el mes de febrero de 2018 comenzó el reclutamiento de enfermos del estudio ADENI-UCI, con el objetivo de analizar las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital de nuestro entorno.

El presente análisis es parte del estudio ADENI-UCI, un estudio prospectivo, observacional, multicéntrico, llevado a cabo en España, que comenzó el reclutamiento en el mes de febrero de 2018. La fecha de corte se efectuó a los 120 días de comenzado el reclutamiento, con la finalidad de valorar la capacidad de reclutamiento de los centros implicados (8 de junio de 2018). Se invitó a participar a todos los servicios de medicina intensiva (SMI) a través del Grupo de Trabajo de Bioética de la SEMICYUC. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.755 Quartil: 4

Categoria: Critical Care Medicine

Posició: 28/33

Blazquez V, Rodríguez A, Sandiumenge A, Oliver E, Cancio B, Ibañez M, Miró G, Navas E, Badía M, Bosque MD, Jurado MT, López M, Llauradó M, Masnou N, Pont T, Bodí M. Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study.

Med Intensiva. 2018 May 7. pii: S0210-5691(18)30124-4. doi: 10.1016/j.medin.2018.03.010. [Epub ahead of print] English, Spanish. PubMed PMID: 29747939 Abstract OBJECTIVE: To determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission.

STUDY DESIGN: Prospective multicenter study.

SETTING: Eleven ICUs. PATIENTS: All patients who died and/or had limitations on life support after ICU admission during a four-month period.

VARIABLES: Patient characteristics, hospital characteristics, characteristics of limitations on life support. Timeto-first-limitation was classified as early (<48h of admission) or late (≥48h). We performed univariate, multivariate analyses and CHAID (chi-square automatic interaction detection) analysis of variables associated with limitation of life support within 48h of ICU admission.

RESULTS: 3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%-84.2%). The median (p25-p75) time from admission to initial limitation was 2 (0-7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR=2.5; 95% CI: 1.5-4.4) and lung disease was the variable most strongly associated with early limitations (OR=12.29; 95% CI: 1.63-255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR=2.4; 95% CI: 1.15.5).

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CONCLUSION: Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48h of admission.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.755 Quartil: 4

Categoria: Critical Care Medicine

Posició: 28/33

Moreno G, Rodríguez A, Reyes LF, Gomez J, Sole-Violan J, Díaz E, Bodí M, Trefler S, Guardiola J, Yébenes JC, Soriano A, Garnacho-Montero J, Socias L, Del Valle Ortíz M, Correig E, Marín-Corral J, Vallverdú-Vidal M, Restrepo MI, Torres A, Martín-Loeches I; GETGAG Study Group.

Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study.

Intensive Care Med. 2018 Sep;44(9):1470-1482. doi: 10.1007/s00134-018-5332-4. Epub 2018 Aug 3. PubMed PMID: 30074052 Abstract BACKGROUND: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis.

METHODS: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not.

RESULTS: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08).

A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043⁻1.268).

CONCLUSIONS: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially nonhypotensive patients. The time of door-to-antibiotic administration was related to mortality.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 15.008 Quartil/Decil: 1

Categoria: Critical Care Medicine

Posició: 3/33

Welte T, Dellinger RP, Ebelt H, Ferrer M, Opal SM, Singer M, Vincent JL, Werdan K, Martin-Loeches I, Almirall J, Artigas A, Ignacio Ayestarán J, Nuding S, Ferrer R, Sirgo Rodríguez G, Shankar-Hari M, Álvarez-Lerma F, Riessen R, Sirvent JM, Kluge S, Zacharowski K, Bonastre Mora J, Lapp H, Wöbker G, Achtzehn U, Brealey D, Kempa A, Sánchez García M, Brederlau J, Kochanek M, Reschreiter HP, Wise MP, Belohradsky BH, Bobenhausen I, Dälken B, Dubovy P, Langohr P, Mayer M, Schüttrumpf J, Wartenberg-Demand A, Wippermann U, Wolf D, Torres A. Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study).

Intensive Care Med. 2018 Apr;44(4):438-448. doi: 10.1007/s00134-018-5143-7. Epub 2018 Apr 9. PubMed PMID: 29632995 Abstract PURPOSE: The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP).

METHODS: In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L).

RESULTS: Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58-78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline.

CONCLUSIONS: No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 15.008 Quartil/Decil: 1

Categoria: Critical Care Medicine

Posició: 3/33

Rubio O, Arnau A, Cano S, Subirà C, Balerdi B, Perea ME, Fernández-Vivas M, Barber M, Llamas N, Altaba S, Prieto A, Gómez V, Martin M, Paz M, Quesada B, Español V, Montejo JC, Gomez JM, Miro G, Xirgú J, Ortega A, Rascado P, Sánchez JM, Marcos A, Tizon A, Monedero P, Zabala E, Murcia C, Torrejon I, Planas K, Añon JM, Hernandez G, Fernandez MD, Guía C, Arauzo V, Perez JM, Catalan R, Gonzalez J, Poyo R, Tomas R, Saralegui I, Mancebo J, Sprung C, Fernández R. Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study.

J Intensive Care. 2018 Apr 13;6:24. doi: 10.1186/s40560-018-0283-y. eCollection 2018. PubMed PMID: 29686878 Abstract PURPOSE: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission.

METHODS: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models.

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RESULTS: We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0-8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59-2.96]) and identified the following patientrelated variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.744.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission.

CONCLUSIONS: The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days.

Indexat a: PubMed/WOS

Bermejo-Martin JF, Almansa R, Yebenes JC. New Organ Failure as an Alternative Endpoint to Develop Diagnostic Criteria for Sepsis.

Chest. 2018 May;153(5):1278. doi: 10.1016/j.chest.2017.11.046. PubMed PMID: 29731039 In a recent editorial published in CHEST (January 2018), Dr Simpson expressed his concern about the potential lack of sensitivity of the new definition proposed by the Sepsis-3 consensus for the detection of sepsis in its early moments. This lack of sensitivity could be explained by the endpoint considered to develop the new definition: in-hospital mortality. Sepsis-3 proposes the use of the Sequential Organ Failure Assessment score to identify sepsis patients and discourages using the Systemic Inflammatory Response syndrome (SIRS) criteria because they showed a lower predictive validity for mortality than Sequential Organ Failure Assessment. As a result, Sepsis-3 preserves the term “sepsis” only for the most severe form of an infection, defined by the increased risk of developing a fatal outcome. The new definition did pay not enough attention to those patients who are in transition from a noncomplicated infection to a complicated one, a situation we have recently called “presepsis.” A delayed identification of patients in this scenario could in turn delay antibiotic treatment and omplicate their hemodynamic management.

In the sepsis timeline, organ failure precedes mortality. As a result, using “risk of developing new organ failure” as an endpoint to build a definition for sepsis instead of using “mortality” could translate into the development of a more sensible definition for detecting sepsis earlier. In this sense, SIRS could be a good candidate to predict organ failure. As demonstrated by Kaukonen et al. and highlighted by Simpson, SIRS is able to detect 88% of the patients with infections causing new organ failure. In our view, the challenge in the near future should be to improve the SIRS criteria to detect 100% of these patients, probably by modifying or combining these criteria with other biomarkers, which could help to gain not only sensitivity but also specificity. New prospective studies recruiting either critical or noncritical patients with infection (in the community, nursing homes, in the ED, or hospitalized in the ward) are needed to address this challenge. As a result, we propose considering “new organ failure” as a more adequate endpoint than “mortality” to develop diagnostic criteria to be able to detect sepsis in its earliest moments.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 7.652 Quartil: 1

Categoria: Critical Care Medicine

Posició: 4/33

Zampieri FG, Póvoa P, Salluh JI, Rodriguez A, Valade S, Andrade Gomes J, Reignier J, Molinos E, Almirall J, Boussekey N, Socias L, Ramirez P, Viana WN, Rouzé A, Nseir S, Martin-Loeches I; TAVeM study group.

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Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome.

J Intensive Care Med. 2018 Jan 1:885066618772498. doi: 10.1177/0885066618772498. [Epub ahead of print] PubMed PMID: 29699468 Abstract OBJECTIVE: To assess whether ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with mortality in critically ill patients with acute respiratory distress syndrome (ARDS).

MATERIALS AND METHODS: Post hoc analysis of prospective cohort study including mechanically ventilated patients from a multicenter prospective observational study (TAVeM study); VA-LRTI was defined as either ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP) based on clinical criteria and microbiological confirmation. Association between intensive care unit (ICU) mortality in patients having ARDS with and without VA-LRTI was assessed through logistic regression controlling for relevant confounders.

Association between VA-LRTI and duration of mechanical ventilation and ICU stay was assessed through competing risk analysis. Contribution of VA-LRTI to a mortality model over time was assessed through sequential random forest models.

RESULTS: The cohort included 2960 patients of which 524 fulfilled criteria for ARDS; 21% had VA-LRTI (VAT = 10.3% and VAP = 10.7%). After controlling for illness severity and baseline health status, we could not find an association between VA-LRTI and ICU mortality (odds ratio: 1.07; 95% confidence interval: 0.62-1.83; P = .796); VA-LRTI was also not associated with prolonged ICU length of stay or duration of mechanical ventilation. The relative contribution of VA-LRTI to the random forest mortality model remained constant during time. The attributable VA-LRTI mortality for ARDS was higher than the attributable mortality for VA-LRTI alone.

CONCLUSION: After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.514 Quartil: 3

Categoria: Critical Care Medicine

Posició: 18/33

Ballester L, Martínez R, Méndez J, Miró G, Solsona M, Palomera E, Capdevila JA, Rodriguez A, Yébenes JC. Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-toAntibiotic Time Impact on Sepsis Survival.

Med Sci (Basel). 2018 Oct 10;6(4). pii: E91. doi: 10.3390/medsci6040091. PubMed PMID: 30309044 Abstract BACKGROUND: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis.

METHODS: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not.

RESULTS: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the

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emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08).

A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043⁻1.268).

CONCLUSIONS: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially nonhypotensive patients. The time of door-to-antibiotic administration was related to mortality.

Indexat a: PubMed/WOS

Vendrell Torra E, Force Sanmartín L, Sauca Subias G, Palomera Fànegas E, Barrufet Barqué P, Capdevila Morell JA. Factors for persistence of MRSA carriage a year after initial detection in individuals from various healthcare institutions.

Med Clin (Barc). 2018 May 17. pii: S0025-7753(18)30256-2. doi: 10.1016/j.medcli.2018.03.035. [Epub ahead of print] English, Spanish. PubMed PMID: 29779567 Abstract INTRODUCTION AND OBJECTIVE: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence.

MATERIAL AND METHODS: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin.

RESULTS: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization.

CONCLUSION: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.168 Quartil: 3

Categoria: Medicine, General & Internal

Posició: 94/155

Méndez R, Menéndez R, Cillóniz C, Amara-Elori I, Amaro R, González P, Posadas T, Gimeno A, España PP, Almirall J, Torres A. Initial Inflammatory Profile in Community-acquired Pneumonia Depends on Time since Onset of Symptoms.

Am J Respir Crit Care Med. 2018 Aug 1;198(3):370-378. doi: 10.1164/rccm.201709-1908OC. PubMed PMID: 29509439

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Abstract RATIONALE: Assessment of the inflammatory response can help the decision-making process when diagnosing community-acquired pneumonia (CAP), but there is a lack of information about the influence of time since onset of symptoms.

OBJECTIVES: We studied the impact of the number of days since onset of symptoms on inflammatory cytokines and biomarker concentrations at CAP diagnosis in hospitalized patients.

METHODS: We performed a secondary analysis in two prospective cohorts including 541 patients in the derivation cohort and 422 in the validation cohort. The time since onset of symptoms was self-reported, and patients were classified as early presenters (<3 d) and nonearly presenters. Biomarkers (C-reactive protein [CRP] and procalcitonin [PCT] in both cohorts) and cytokines in the derivation cohort (IL-1, - 6, -8, -10, and tumor necrosis factor-α) were measured within 24 hours of hospital admission.

MEASUREMENTS AND MAIN RESULTS: In early presenters, CRP was significantly lower, whereas PCT, IL-6, and IL-8 were higher. Nonearly presenters showed significantly lower PCT, IL-6, and IL-8 levels. In the validation cohort, CRP and PCT exhibited identical patterns: CRP levels were 36.4% greater in patients with 3 or more days since onset of symptoms than in those with less than 3 days since symptom onset in the derivation cohort and 38.2% in the validation cohort. PCT levels were 40% lower in patients with 3 or more days since onset of symptoms in the derivation cohort and 56% in the validation cohort.

CONCLUSIONS: Time since symptom onset modifies the systemic inflammatory profile at CAP diagnosis. This information has relevant clinical implications for management, and it should be taken into account in the design of future clinical trials.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 15.239 Quartil/Decil: 1

Categoria: Respiratory System

Posició: 2/60

Yébenes JC, Martínez de la Gran I, Campins Ll. Adecuación en el aporte calórico-proteico en nutrición parenteral en el paciente crítico: Cuando más no es mejor y menos es malo. Chapter 19, 2018 Libro del año. La Nutrición en Medicina Intensiva. Madrid: 2018;p.209-215 Introducción: Aunque en los últimos tiempos se ha observado un descenso en la utilización de la Nutrición Parenteral en los pacientes críticos, la nutrición parenteral (NP) sigue siendo el recurso más valioso para los pacientes en los que no es posible el soporte nutricional enteral. A pesar de ello, mucho se sigue debatiendo sobre el papel de la NP y sobre como diseñar la mejor estrategia tanto en relación al momento de inicio, como a la cantidad y calidad de nutrientes a administrar.A diferencia del soporte nutricional enteral en el que pueden existir importantes diferencias entre la nutrición pautada y la administrada, en la NP el total de recursos energéticos y proteicos pautados se administraran completamente y de forma directa al torrente sanguíneo, lo que enfatiza la importancia del diseño de la fórmula utilizada. Será el medio interno el que haya de gestionar déficits o excesos en la administración de substratos, lo que puede conllevar efectos nocivos para el paciente. La NPTha de tener la misma consideración que cualquier otro tratamiento (fármacos, ventilación mecánica, técnicas de depuración extracorpórea,…), por lo que sus indicaciones, dosis máximas y criterios de retirada se han de revisar y respetar escrupulosamente. Enfatizar los efectos nocivos de la NP no tiene mayor discusión que revisar sus indicaciones en tiempo, cantidad, calidad y duración. Es obvio que la nutrición parenteral no va a aportar los beneficios fisiológicos que aporta la nutrición enteral, especialmente en el ámbito de la inmunoregulación. El aparato digestivo es el mayor órgano absortivo pero también inmunológico del cuerpo humano.Está cada vez mejor documentado el efecto de la nutrición enteral sobre el sistema inmunitario, tanto a nivel de regulación de la respuesta humoral, celular, microbiota,… Si el intestino es funcionante, siempre intentaremos el soporte

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nutricional enteral, ya sea a través de la vía oral, gástrica o postpilórica. Sin embargo, la búsqueda del beneficio inmunoregulador no puede hacer rechazar la NPT como recurso terapéutico en aquellos pacientes en los que no se puede conseguir la necesaria administración de nutrientes por vía enteral. Por tanto, la primera cuestión seria cuanto margen tiene el paciente para seguir intentando el soporte nutricional enteral sin iniciar nutrición parenteral.

DIGESTIU – GASTROENTEROLOGY Nº Articles indexats: 2

Factor Impacte total: 15.157

Factor d’impacte mig per article: 7.578

Sánchez Delgado J, García-Iglesias P, Titó L, Puig I, Planella M, Gené E, Saló J, Martínez-Cerezo F, Molina-Infante J, Gisbert JP, Calvet X. Update on the management of Helicobacter pylori infection. Position paper from the Catalan Society of Digestology.

Gastroenterol Hepatol. 2018 Apr;41(4):272-280. doi: 10.1016/j.gastrohep.2017.12.009. Epub 2018 Feb 6.

English, Spanish. PubMed PMID: 29426621 Abstract: More than 30 years after its discovery, Helicobacter pylori (H. pylori) infection remains the most common cause of gastric and duodenal diseases. H. pylori is the leading cause of chronic gastritis, peptic ulcer, gastric MALT lymphoma and gastric adenocarcinoma. Several consensuses have recently been published on the management of H. pylori infection. The general guidelines of the Spanish consensus, the Toronto Consensus and the Maastricht V Consensus of 2016 are similar but concrete recommendations can vary significantly. In addition, the recommendations of some of these consensuses are decidedly complex. This position paper from the Catalan Society of Digestology is an update of evidence-based recommendations on the management and treatment of H. pylori infection. The aim of this document is to review this information in order to make recommendations for routine clinical practice that are simple, specific and easily applied to our setting.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.078 Quartil: 4

Categoria: Gastroenterology & Hepatology

Posició: 75/80

Ardevol A, Ibañez-Sanz G, Profitos J, Aracil C, Castellvi JM, Alvarado E, Cachero A, Horta D, Miñana J, GomezPastrana B, Pavel O, Dueñas E, Casas M, Planella M, Castellote J, Villanueva C. Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first-line therapies.

Hepatology. 2018 Apr;67(4):1458-1471. doi: 10.1002/hep.29370. Epub 2018 Feb 18. PubMed PMID: 28714072 Abstract: The presence of cirrhosis increases the mortality of patients with peptic ulcer bleeding (PUB). Both acute variceal bleeding (AVB) and PUB are associated with substantial mortality in cirrhosis. This multicenter cohort study was performed to assess whether the mortality of patients with cirrhosis with PUB is different from that of those with AVB. Patients with cirrhosis and acute gastrointestinal bleeding were consecutively included and treated with somatostatin and proton pump inhibitor infusion from admission and with antibiotic prophylaxis. Emergency endoscopy with endoscopic therapy was performed within the first 6 hours. 646 patients with AVB and 144 with PUB were included. There were baseline differences between groups, such as use of gastroerosive drugs or β-blockers. Child-Pugh and Model for End-Stage Liver Disease MELD scores were

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similar. Further bleeding was more frequent in the AVB group than those in the PUB group (18% vs. 10%; odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.29-0.88). However, mortality risk at 45 days was similar in both groups (19% in the AVB group vs. 17% in the PUB group; OR = 0.85; 95% CI = 0.55-1.33; P = 0.48). Different parameters, such as Child-Pugh score, acute kidney injury, acute on chronic liver failure, or presence of shock or bacterial infection, but not the cause of bleeding, were related to the risk of death. Only 2% of the PUB group versus 3% of the AVB group died with uncontrolled bleeding (P = 0.39), whereas the majority of patients in either group died from liver failure or attributed to other comorbidities.

CONCLUSION: Using current first-line therapy, patients with cirrhosis and acute peptic ulcer bleeding have a similar survival than those with variceal bleeding. The risk of further bleeding is higher in patients with variceal hemorrhage. However, few patients in both groups died from uncontrolled bleeding, rather the cause of death was usually related to liver failure or comorbidities. (Hepatology 2018;67:1458-1471).

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 14.079 Quartil/Decil: 1

Categoria: Gastroenterology & Hepatology

Posició: 5/80

GERIATRIA – GERIATRIC MEDICINE Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Moreta-Lora F Asociación entre el tipo de sintomatología neuropsiquiátrica percibida según el tipo de cuidador principal en pacientes con demencia evolucionada Inf Psiquiatr. 2018; 232:113-129 Abstract OBJECTIVO: Los síntomas neuropsiquiátricos de los pacientes con demencia deterioran la calidad de vida tanto del cuidador como del paciente e incrementan los problemas mentales (depresión y ansiedad principalmente) en los cuidadores, con disminución de la esperanza de vida para ambos. El presente estudio intenta encontrar una asociación entre el tipo de sintomatología neuropsiquiátrica percibida según el tipo de cuidador principal en pacientes con demencia evolucionada, y la dificultad de estos cuidadores para asumir los cuidados en el domicilio, para beneficiar tanto a pacientes como a los cuidadores de estos.

METODO: Se incluyeron cuidadores de pacientes que ingresaron por cualquier causa en una Unidad de media estancia de Psicogeriatría y que padeciesen una demencia de cualquier etiología, en una fase moderada a severa y se valoraban la carga sintomática de los pacientes dementes mediante la escala de Cornell de depresión en demencia y el NPI-Q en su versión en castellano, y las características de los cuidadores.

RESULTADOS: Se analizaron los datos de 34 pacientes y sus familiares. No se encontró diferencias ni estadísticamente significativas ni objetivas entre el grupo de los pacientes que tenían un cuidador particular ni en los que tenían un cuidador familiar. La mayor parte de los pacientes presentaban sintomatología depresiva mayor asociada a la demencia según la escala cornell y el NPI-Q. Ambos grupos tenían unos valores elevados de NPI-Q, escala de cornell y un deterioro funcional muy importante.El síntoma más frecuente fue la apatía. El síntoma menos frecuente fue la euforia.

CONCLUSION: No se encontró asociación estadísticamente significativa entre el tipo de cuidador y la gravedad de los SCPD percibidos.

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ATENCIÓ PRIMARIA – PRIMARY CARE Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Molina-Moya M; Sais G, Admella C Paniculitis Lúpica FMC. Form Med Cont Aten Prim; 2018; 25(2):134-135. doi:10.1016/j.fmc.2016.09.016 Abstract: Se caracteriza por la aparición de lesiones nodulares subcutáneas profundas o placas induradas, localizadas con mayor frecuencia en región facial, tronco, glúteos y región proximal de extremidades, que pueden presentarse de forma aislada o asociada a lupus eritematoso sistémico, lupus discoide y lupus cutáneo subagudo.

Puede presentarse de forma atípica como edema periorbitario o mastitis. El diagnóstico se establece por la histología de la lesión, que se caracteriza por ser una paniculitis linfocítica lobular, con mayor o menor afectación de los septos. La inmunofluorescencia directa puede ayudar a confirmar el diagnóstico, apreciándose depósitos de IgG, IgM y C3 en el 70-80% de los casos con histopatología compatible con paniculitis lúpica. Las lesiones pueden evolucionar de forma dolorosa o indolente y presentar ulceraciones.

Limón E, Bullich I, Fontecha B, Rusiñol M, Burdoy J El model d’atenció a la cronicitat avançada.

Butll Soc Catalana Med Fam Comunitaria; 2018; 36(14):1-6. doi:10.1016/j.fmc.2016.09.016 Abstract: Totes les societats estan encarant l’envelliment com un repte de salut pública per afrontar les necessitats creixents de la població en termes de salut i de dependència. I, a mesura que les persones envelleixen, el seu risc d’emmalaltir també ho fa. Una clara majoria d’elles moriran després d’haver viscut durant anys amb condicions com fragilitat, multimorbiditat, demència, insuficiència avançada d’òrgan i, proporcionalment menys, ho faran per càncer. Més encara, hi ha càncers que es comporten cada vegada més com una malaltia crònica i estem assistint a un canvi de paradigma en el comportament d’aquests tumors (mama, pròstata, colon) amb pronòstics d’anys amb una qualitat de vida acceptable.

Per això, molts recursos adreçats a persones amb malalties avançades o pronòstic de vida limitat encara s’ofereixen prioritàriament als pacients oncològics, fruit d’una tradició clínica que emfatitza el càncer com a paradigma de malaltia mortal.

La trajectòria del declivi de les malalties cròniques és molt més incerta que la del càncer, i el temps de supervivència acostuma també a ser més llarg. Identificar anticipadament aquestes condicions i planificar el final de la vida esdevé tot un repte per als professionals sanitaris, que són interpel·lats a oferir atenció pal·liativa a tots els àmbits d’atenció, i especialment, a l’atenció primària de salut, referent assistencial de la majoria de problemes de salut no oncològics.

UNITAT DE RECERCA – RESEARCH UNIT Nº Articles indexats: 2

Factor Impacte total: 4.345

Factor d’impacte mig per article: 2.172

Doria M, Viadé J, Palomera E, Pérez R, Lladó M, Costa E, Huguet T, Reverter JL, Serra-Prat M, Franch-Nadal J, Mauricio D. Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain.

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Endocrinol Diabetes Nutr. 2018 Nov;65(9):479-485. doi: 10.1016/j.endinu.2018.06.004. Epub 2018 Aug 11.

English, Spanish. PubMed PMID: 30108031 Abstract INTRODUCTION: Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute inhospital costs from OD complications, there are other costs related to poststroke OD such as direct nonhealthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients.

METHODS AND ANALYSIS: A systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured.

ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER: CRD42018099977.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.268 Quartil: 4

Categoria: Endocrinology & Metabolism

Posició: 127/142

Hernández M, López C, Soldevila B, Cecenarro L, Martínez-Barahona M, Palomera E, Rius F, Lecube A, Pelegay MJ, García J, Mauricio D, Puig Domingo M. Impact of TSH during the first trimester of pregnancy on obstetric and foetal complications: Usefulness of 2.5 mIU/L cut-off value.

Clin Endocrinol (Oxf). 2018 May;88(5):728-734. doi: 10.1111/cen.13575. Epub 2018 Mar 9. PubMed PMID: 294537921 Abstract BACKGROUND: Frailty is a highly prevalent geriatric syndrome and a major public health problem. Designing effective preventive measures requires an understanding of frailty mechanisms and risk factors.

OBJECTIVE: To estimate the incidence of frailty and identify the main risk factors for frailty in community dwelling elderly individuals.

DESIGN: Cohort study followed up over 2 years.

PARTICIPANTS: Non-frail community-dwelling individuals aged 75 years and older.

MEASUREMENTS: Socio-demographic variables, co-morbidities, lifestyle, nutritional status, anabolic hormones, inflammatory markers, physical exercise and body composition. Frailty, assessed annually, was defined according to Fried criteria.

RESULTS: 278 subjects were recruited (mean age 79.9 years; 42.8% women). Frailty incidence was estimated as 6.8 new cases/100 person-years. Risk factors for frailty were being female, arthrosis, depression, dyspepsia Biblioteca. Direcció Acadèmica, Recerca i Innovació.

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number of medications, being unable to stand on 1 foot for 5 seconds, a positive Timed Up-and-Go test, Barthel Index score <90, a high waist-hip ratio, high cholesterol and interleukin-6 levels and low glomerular filtration Physical exercise was a protective factor for frailty. Risk factors for frailty in men were number of comorbidities, tricipital skinfold and previous handgrip, and in women, insulin resistance and cortisol levels.

Conclusion: The fact that certain modifiable risk factors for frailty were identified would suggest that better control of underlying diseases and inflammatory processes, a review of prescribed medications, physical exercise and correction of obesity and hypercholesterolaemia could be effective interventions to reduce frailty in communitydwelling elderly subjects. However, the effectiveness of such interventions needs to be demonstrated by welldesigned clinical trials.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.077 Quartil: 2

Categoria: Endocrinology & Metabolism

Posició: 69/142

FARMÀCIA - PHARMACY Nº Articles indexats: 5

Factor Impacte total: 13.567

Factor d’impacte mig per article: 2.713

Miarons M, Tomsen N, Nascimento W, Espín A, López-Faixó D, Clavé P, Rofes L. Increased levels of substance P in patients taking beta-blockers are linked with a protective effect on oropharyngeal dysphagia.

Neurogastroenterol Motil. 2018 Sep;30(9):e13397. doi: 10.1111/nmo.13397. Epub 2018 Jul 24. PubMed PMID: 300435380 Abstract BACKGROUND: We have recently found a potential protective effect of beta-blockers on oropharyngeal dysphagia (OD). The action mechanism by which beta-blockers could wield this protective effect is unknown, but the neurotransmitter substance P (SP) could play a key role. The aim of this study was to analyze serum and saliva SP levels in patients taking beta-blockers (TBB), and to explore its relationship with OD. METHODS: Adult (>50 year) patients TBB were randomly recruited from the primary care setting and 1:1 matched by age, sex, and Barthel Index (BI) with patients not taking beta-blockers (NTBB). Serum and saliva samples were taken and analyzed for their SP levels using an enzyme-linked immunosorbent assay (ELISA).

Socio-demographic and clinical variables were collected. Dysphagia was evaluated in all patients using the clinical volume-viscosity swallow test (V-VST).

KEY RESULTS: We studied 28 patients TBB (64.96 ± 7.31 years, 57.1% women, BI 99.6 ± 1.31, carvedilolequivalent dose 24.11 ± 18.12 mg) and 28 patients NTBB (65.61 ± 6.43 years, 57.1% women, BI 99.6 ± 1.31). SP serum levels were significantly higher in patients TBB (260.68 ± 144.27 vs 175.46 ± 108.36 pg/mL, P = .009) as were SP saliva levels (170.34 ± 146.48 vs 102.73 ± 52.28 pg/mL, P < .001) compared with patients NTBB. The prevalence of OD was 32.1% in patients TBB and 67.9% in patients NTBB (P = .015). Moreover, patients with OD had significantly lower SP saliva levels in comparison with patients without clinical signs of OD (98.39 ± 43.25 vs 174.69 ± 147.21 pg/mL) P < .001.

CONCLUSIONS & INFERENCES: We have found that serum and saliva SP levels are greater in patients TBB. This increase in SP levels could be the action mechanism by which beta-blockers protect patients from OD. Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.842 Quartil: 1

Categoria: Clinical Neurology

Posició: 45/197

Miarons M, Clavé P, Wijngaard R, Ortega O, Arreola V, Nascimento W, Rofes L.

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Pathophysiology of Oropharyngeal Dysphagia Assessed by Videofluoroscopy in Patients with Dementia Taking Antipsychotics.

J Am Med Dir Assoc. 2018 Sep;19(9):812.e1-812.e10. doi: 10.1016/j.jamda.2018.04.016. PubMed PMID: 30149844 Abstract OBJECTIVES: The objective of this study was to assess the pathophysiology of oropharyngeal dysphagia (OD) in patients with dementia, specifically in those taking antipsychotics (APs).

DESIGN: A cross-sectional study was performed from January 2011 to May 2017 in a general hospital.

SETTING AND PARTICIPANTS: We included 114 patients with dementia, of which 39 (34.2%) were taking APs (82.5 ± 7.8 years, Barthel Index 52.28 ± 30.42) and 29 patients without dementia (82.4 ± 6.7 years, Barthel Index 77.71 ± 24.7) and OD confirmed by a videofluoroscopy.

MEASURES: Demographical and clinical factors as well as swallowing function of patients with dementia with OD were compared with older patients without dementia with OD. We also compared patients with dementia taking and not taking APs. Impaired efficacy during videofluoroscopy was defined as the presence of oral and/or pharyngeal residue, and impaired safety (unsafe swallow) was defined as aspiration or penetration. Receiver operating characteristic curves were drawn for laryngeal vestibule closure (LVC) time to predict unsafe swallow.

RESULTS: 87.7% of patients with dementia presented impaired efficacy of swallow and 74.6% impaired safety [penetration-aspiration scale (PAS) 3.94 ± 1.94]. 86.2% of patients without dementia presented impaired efficacy and 44.8% impaired safety (PAS 2.21 ± 1.92). Time to LVC was significantly delayed in patients with dementia taking APs in comparison with patients without dementia (LVC 0.377 ± 0.093 vs 0.305 ± 0.026, P = .003). In contrast, there were no differences in the PAS and LVC time in patients with dementia taking and not taking APs (PAS 3.96 ± 0.26 vs 3.88 ± 0.22, LVC 0.398 ± 0.117 vs 0.376 ± 0.115, NS). LVC time ≥0.340 seconds predicted unsafe swallow in patients with dementia with an accuracy of 0.71.

CONCLUSIONS/IMPLICATIONS: Patients with dementia presented high prevalence and severity of videofluoroscopy signs of impaired efficacy and safety of swallow and a more severe impairment in airway protection mechanisms (higher PAS and LVC delay). Clinical practice should implement specific protocols to prevent OD and its complications in these patients. AP treatment did not significantly worsen swallowing impairments.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 5.325 Quartil/Decil: 1

Categoria: Geriatrics & Gerontology

Posició: 4/53

Miarons M, Rofes L. Systematic review of case reports of oropharyngeal dysphagia following the use of antipsychotics.

Gastroenterol Hepatol. 2018 Nov 20. pii: S0210-5705(18)30288-7. doi: 10.1016/j.gastrohep.2018.09.010. [Epub ahead of print] English, Spanish. PubMed PMID: 30470564 Abstract OBJECTIVE: The purpose of this systematic review was to examine the effect of antipsychotic medication on dysphagia based on clinical case reports.

PATIENTS AND METHODS: Literature searches were performed using the electronic databases PubMed and Embase. In PubMed, we used the MeSH terms "antipsychotic agents" OR "tranquilizing agents" combined with "deglutition disorders" OR "deglutition". In Embase, we used the Emtree terms "neuroleptic agents" combined with "swallowing" OR "dysphagia". Two reviewers assessed the eligibility of each case independently.

RESULTS: A total of 1043 abstracts were retrieved, of which 36 cases met the inclusion criteria; 14 cases were related to typical antipsychotics and 22 to atypical antipsychotics. Dysphagia occurred together with

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extrapyramidal symptoms in half of the cases and was the only prominent symptom in the other half. The most common strategy against dysphagia was changing to another antipsychotic (n=13, 36.1%).

CONCLUSIONS: The data from this review indicate that antipsychotics can increase the prevalence of dysphagia.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.078 Quartil: 1

Categoria: Gastroenterology & Hepatology

Posició: 75/80

Marin S, Querol R, Campins L, Miarons M, Font A, Lianes P. Long-termabiraterone withdrawal syndrome.

J Clin Pharm Ther. 2018 Oct;43(5):714-716. doi: 10.1111/jcpt.12693. Epub 2018 May 2. PubMed PMID: 29722038 Abstract: WHAT IS KNOWN AND OBJECTIVE: Abiraterone acetate (AA) is an androgen receptor axis inhibitor, indicated together with prednisone, for metastatic castration-resistant prostate cancer. Withdrawal syndrome for classical antiandrogen treatments is well known, but not so known for AA. Abiraterone withdrawal syndrome (AWS) could be related to simultaneous prednisone discontinuation or to an androgenic effect of AA metabolites.

CASE DESCRIPTION: A case is described of a patient with long-term AWS without prednisone discontinuation.

The clinical and prostate-specific antigen (PSA) response allowed an 8-month delay in docetaxel treatment.

WHAT IS NEW AND CONCLUSION: Prednisone did not play a role in AWS in this case. The long-term response allowed a delay in future treatment.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.661 Quartil: 4

Categoria: Pharmacology & Pharmacy

Posició: 202/261

Marin S, Campins L, Miarons M, Pérez-Cordón L, Reina-Aguilar C, Solsona M. Successful desensitization to cloxacillin in a patient with sepsis, with infective endocarditis and clinical suspicion of hypersensitivity to penicillins, a case report.

J Clin Pharm Ther. 2018 Dec;43(6):921-924. doi: 10.1111/jcpt.12751. Epub 2018 Jul 21. PubMed PMID: 30030968 Abstract WHAT IS KNOWN AND OBJECTIVE: Beta-lactam antibiotic (BLA) therapy is frequently needed to treat infective endocarditis (IE). Hypersensitive reactions to BLA restrict BLA therapy in allergic patients. In the current case, we aim to describe the utility of desensitization (DS) in this context. Although the evidence is limited, DS is recommended.

CASE DESCRIPTION: This case report deals with a 79-year-old woman with a clinical suspicion of allergy to BLA and a methicillin-sensitive Staphylococcus aureus (MSSA) IE. A cloxacillin DS protocol was developed to enable treatment with cloxacillin.

WHAT IS NEW AND CONCLUSION: Alternative antibiotic treatments may be less effective or not available in MSSA IE. In this case report, DS allowed optimal cloxacillin treatment.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.661 Quartil: 4

Categoria: Pharmacology & Pharmacy

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HEMATOLOGIA – HEMATOLOGY Nº Articles indexats: 3

Factor Impacte total: 40.447

Factor d’impacte mig per article: 13.484

Sorigue M, Lopez-Viaplana L, Sancho JM. Predictive gene-expression score for follicular lymphoma.

Lancet Oncol. 2018 Jun;19(6):e279. doi: 10.1016/S1470-2045(18)30262-6. Epub 2018 Jun 1. PubMed PMID: 29893254 In a recent article, Sarah Huet andcolleagues analysed the prognostic value of the expression of a large set of genes in patients with follicular lymphoma. After a careful and rigorous process of curation and selection (on the basis of the correlation between the expression of each gene and progression-free survival), the authors developed a geneexpression signature score based on the expression of 23 genes. This study provided invaluable data regarding the biology of malignant cells and the role of the microenvironment in follicular lymphoma in the immunochemotherapy era.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 36.421 Quartil/Decil: 1

Categoria: Oncology

Posició: 3/223

Sorigue M, Nieto J, Santos-Gomez M, Sarrate E, Jiménez MJ, Morales-Indiano C, Lopez-Viaplana L, Orna E, Navarro JT, Ribera JM, Xicoy B. Indications and use of, and incidence of major bleeding with, antithrombotic agents in myelodysplastic syndrome.

Leuk Res. 2018 Oct;73:24-28. doi: 10.1016/j.leukres.2018.08.017. Epub 2018 Aug 31. PubMed PMID: 30193204 Abstract: Myelodysplastic syndrome (MDS) and antithrombotic medication both increase the risk of bleeding. We set out to analyze the prevalence of use, indications and bleeding risk of antithrombotic therapy in patients with MDS in a retrospective, single-center study including all patients with MDS with >20 × 109/L platelets. 193 patients (59% male, median age 75 years) were included; 122 did not receive antithrombotic treatment, 51 received antiplatelet agents and 20 received anticoagulants. The cumulative incidence of major bleeding was higher in both the antiplatelet group (11.8% at 4 years, 95% confidence interval [95%CI]: 4.7-22.3%) and the anticoagulation group (21.2% at 4 years, 95%CI 6-42.5%) than in the control group (2.8% at 4 years 95%CI: 0.77.3%). The prevalence of use of antithrombotic medication in this cohort of patients with MDS was high and bleeding risk was increased in these patients.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 2.319 Quartil: 3

Categoria: Hematology

Posició: 41/71

Argente M, Miró E, Martí C, Vilamala A, Alonso-Tarrés C, Ballester F, Calderón A, Gallés C, Gasós A, Mirelis B, Morta M, Olsina M, Sauca G, Sierra M, Rivera A, Navarro F. Molecular characterization of OXA-48 carbapenemase-producing Klebsiella pneumoniae strains after a carbapenem resistance increase in Catalonia.

Enferm Infecc Microbiol Clin. 2018 Apr 6. pii: S0213-005X(18)30052-1. doi: 10.1016/j.eimc.2018.02.003. [Epub ahead of print] English, Spanish. PubMed PMID: 29631930

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Abstract INTRODUCTION: To characterize OXA-48 carbapenemase-producing Klebsiella pneumoniae strains isolated after an increase in carbapenem resistance in Catalonia.

METHODOLOGY: K. pneumoniae identification, antimicrobial susceptibility studies, the Modified Hodge Test method, amplification of antimicrobial resistance genes (against β-lactamases, quinolones and aminoglycosides), molecular typing (by PFGE and MLST), conjugation assays, plasmid characterization (PBRT-PCR and Southern blot), a description of mobile genetic elements and statistical analysis were done.

RESULTS: OXA-48 was the only carbapenemase detected, with a prevalence of 1.9%. The blaOXA-48 gene was located in an IncL conjugative plasmid of 62kb and integrated into the transposons Tn1999.2 (91.7%) or Tn1999.1. Five PFGE profiles (A to E) were found, which exactly matched the MLST: ST101, ST17, ST1233, ST14 and ST405, respectively. ST1233 is described here for the first time. K. pneumoniae OXA-48-producing strains were also CTX-M-15 carriers, some producing OXA-1 and TEM-1 penicillinases. The acquired qnrB66 and qnrB1 and aac(3')-IIa, aac(6')-Ib genes were also identified.

CONCLUSION: The K. pneumoniae ST405 clone has played an important role in the growing prevalence of OXA48 in Catalonia. All clones described preserved the blaOXA-48 genetic environment and mobile genetic elements (Tn1999). Notably, the three strains with minor sequence types in this study are not multiresistant strains. These strains are expanding in elderly patients (average age of 76 years) with serious underlying diseases, mainly women (61.2%).

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.707 Quartil: 3

Categoria: Microbiology

Posició: 94/126

URGÈNCIES – EMERGENCY MEDICINE Nº Articles indexats: 2

Factor Impacte total: 2.377

Factor d’impacte mig per article: 1.188

Jacob J, Zorrilla J, Gené E, Alonso G, Rimbau P, Casarramona F, Netto C, Sánchez P, Hernández R, Escalada X, Miró Ò.

Non-invasive ventilation in emergency departments in public hospitals in Catalonia. The VENUR-CAT study.

Med Intensiva. 2018 Apr;42(3):141-150. doi: 10.1016/j.medin.2017.05.002. Epub 2017 Jun 16. English, Spanish. PubMed PMID: 286253397 Abstract OBJECTIVES: To know the implementation and characteristics of non-invasive ventilation (NIV) in the Emergency Departments (EDs) of public hospitals in Catalonia (Spain) and analyze possible differences based on the typology, degree of activity and the availability of an Intensive Care Unit (ICU) in the hospital.

DESIGN: A non-interventional, descriptive study was carried out, using a structured questionnaire divided into 3sections: 1) professional experience and training; 2) devices used; and 3) clinical scenarios and the use of NIV. SETTING: Persons responsible for public EDs in Catalonia.

RESULTS: Fifty-two of the 54 public EDs in Catalonia responded (96.3%). Fifty-one perform NIV, which is mainly initiated by emergency care physicians (78.5%); 66.7% maintain the patient in the ED until discharge; and in 43.1% of the cases the length of stay is>24h. Of the EDs, 39.2% have their own protocol, 35.3% of which are established by consensus with other departments (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.014]), while 25.5% have no protocol, and 43.1% register the activity. Training represents the greatest difficulty for the implementation of NIV, but 19.6% do not provide specific training. When support is needed, the main physician of reference is the intensivist (35.3%) (more frequently in non-county hospitals [P=.012], and centers with an ICU [P=.002]).

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CONCLUSIONS: In most EDs in Catalonia, NIV is performed by emergency care physicians. Areas needing improvement include drainage of patients once NIV has been started, the promotion of protocols, registry of activity, and training of the healthcare professionals.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.755 Quartil:4

Categoria: Critical Care Medicine

Posició: 148/157

Jacob J, Zorrilla J, Gené E, Alonso G, Rimbau P, Casarramona F, Netto C, Sánchez P, Hernández R, Escalada X, Miró O. [Analysis of the use of point-of-care ultrasonography in Emergency Departments in public hospitals in Catalonia. ECURCAT Study].

An Sist Sanit Navar. 2018 Aug 29;41(2):161-169. doi: 10.23938/ASSN.0300. Spanish. PubMed PMID: 29943757 Abstract BACKGROUND: The aim of this study was to determine the degree of implantation, the characteristics and the formation of point-of-care ultrasonography, performed by emergency physicians in the public hospital emergency department (ED) of Catalonia.

METHODS: Descriptive study based on a survey conducted with those responsible for the public ED in Catalonia and structured in three blocks: difficulty of implementing the technique and perceived reasons for this difficulty, equipment available in the emergency room and its use, and training of emergency physicians.

RESULTS: The survey was answered by 96.3% of public ED; in 63.5% of them the emergency physicians performed point-of-care ultrasonography. Implementing ultrasonography was considered to have a high degree of difficulty in 86.5%, and 78.8% had their own ultrasound. The most frequent use is abdominal (87.9%), thoracic (72.7%) and peripheral vascular (69.7%). The presence of protocols and registers of the activity is scarce. The training is not uniform between staff doctors and those on call. No significant differences were found according to the type of hospital, the degree of activity or the presence of a radiologist 24 hours a day, the exception being the FAST protocol, which was more used in regional hospitals (89.5% vs. 42.9%; p=0.007).

CONCLUSIONS: Point-of-care ultrasonography done by emergency physicians is used in more than half of the Catalan public ED. There is a need for extending the use of ultrasound in the ED, it should be more regulated, appropriately registered and involve all physicians working in the emergency department.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 0.622 Quartil:4

Categoria: Public, Environmental & Ocup Health

Posició: 148/157

DERMATOLOGIA – DERMATOLOGY Nº Articles indexats: 1

Factor Impacte total: 1.541

Factor d’impacte mig per article: 1.541

Matas-Nadal C, Malvehy J, Ferreres JR, Boada A, Bodet D, Segura S, Salleras M, Azon A, Bel-Pla S, Bigata X, Campoy A, Curcó N, Dalmau J, Formigon M, Gonzalez A, Just M, Llistosella E, Nogues ME, Pedragosa R, Pujol JA, Sabat M, Smandia JA, Zaballos P, Puig S, Martí RM. Increasing incidence of lentigo maligna and lentigo maligna melanoma in Catalonia.

Int J Dermatol. 2018 Dec 13. doi: 10.1111/ijd.14334. [Epub ahead of print] PubMed PMID: 30548854 Abstract

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BACKGROUND: Recent epidemiological studies suggest that past data where superficial spreading melanoma was by far the most common subtype of melanoma may not reflect current patterns of sun exposure or other risk factors more involved in other subtypes of melanoma as lentigo maligna (LM) or lentigo maligna melanoma (LMM).

METHODS: In order to measure the current situation in our country, all cases of LM and LMM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007, were recorded.

RESULTS: Although for the global period LM/LMM represented only 8.4% of cases, an increasing trend in this percentage was observed throughout the study period (from 6.9% [27 cases] in 2000 to 13.1% [94 cases] in 2007). Also, an increasing incidence of LM/LMM was observed, especially in chronically sun-exposed areas (85.5% involving the head and neck region). During the 8 years of the registry, the mean Breslow thickness of LMM remained stable. However, the increase in the number of LM (in situ) cases was significantly higher than the increase of the invasive ones.

CONCLUSIONS: An important observation from this data is that aging of population and current sun exposure patterns could keep increasing the incidence of LM/LMM, which may become an important public healthcare problem, over the other histological subtypes. In order to establish primary or secondary preventive measures to the LM/LMM risk-population, it is imperative to highlight the importance of chronic sun damage as a melanoma risk factor, and not only sunburn, most commonly addressed in melanoma prevention campaigns.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.541 Quartil:3

Categoria: Dermatology & Venereal Diseases

Posició: 39/64

PEDIATRIA– PEDIATRICS Nº Articles indexats: 1

Factor Impacte total: 3.607

Factor d’impacte mig per article: 3.607

Marti-Sanchez L, Ortigoza-Escobar JD, Darling A, Villaronga M, Baide H, Molero-Luis M, Batllori M, Vanegas MI, Muchart J, Aquino L, Artuch R, Macaya A, Kurian MA, Dueñas P. Hypermanganesemia due to mutations in SLC39A14: further insights into Mn deposition in the central nervous system.

Orphanet J Rare Dis. 2018 Jan 30;13(1):28. doi: 10.1186/s13023-018-0758-x. PubMed PMID: 29382362 Abstract BACKGROUND: BThe SLC39A14, SLC30A10 and SLC39A8 are considered to be key genes involved in manganese (Mn) homeostasis in humans. Mn levels in plasma and urine are useful tools for early recognition of these disorders. We aimed to explore further biomarkers of Mn deposition in the central nervous system in two siblings presenting with acute dystonia and hypermanganesemia due to mutations in SLC39A14. These biomarkers may help clinicians to establish faster and accurate diagnosis and to monitor disease progression after chelation therapy is administered.

RESULTS: A customized gene panel for movement disorders revealed a novel missense variant (c.311G > T; p.Ser104Ile) in SLC39A14 gene in two siblings presenting at the age of 10 months with acute dystonia and motor regression. Mn concentrations were analyzed using inductively coupled mass spectrometry in plasma and cerebrospinal fluid, disclosing elevated Mn levels in the index case compared to control patients. Surprisingly, Mn values were 3-fold higher in CSF than in plasma. We quantified the pallidal index, defined as the ratio between the signal intensity in the globus pallidus and the subcortical frontal white matter in axial T1-weighted MRI, and found significantly higher values in the SLC39A14 patient than in controls. These values increased over a period of 10 years, suggesting the relentless pallidal accumulation of Mn. Following genetic confirmation, a trial with the Mn chelator Na2CaEDTA led to a reduction in plasma Mn, zinc and selenium levels. However,

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parents reported worsening of cervical dystonia, irritability and sleep difficulties and chelation therapy was discontinued.

CONCLUSIONS: Our study expands the very few descriptions of patients with SLC39A14 mutations. We report for the first time the elevation of Mn in CSF of SLC39A14 mutated patients, supporting the hypothesis that brain is an important organ of Mn deposition in SLC39A14-related disease. The pallidal index is an indirect and noninvasive method that can be used to rate disease progression on follow-up MRIs. Finally, we propose that patients with inherited defects of manganese transport should be initially treated with low doses of Na2CaEDTA followed by gradual dose escalation, together with a close monitoring of blood trace elements in order to avoid side effects.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 3.607 Quartil: 2

Categoria: Medicine, Research & Experimental

Posició: 45/133

UROLOGIA– UROLOGY Nº Articles indexats: 1

Factor Impacte total: 1.508

Factor d’impacte mig per article: 1.508

Ramírez Sevilla C, Admella-Salvador C, Romero-Martin JA, Llopis-Manzanera J, Barranco-Sanz MA. Bladder Leiomyosarcoma 25 Years after Treatment with Cyclophosphamide in Patient with History of Retinoblastoma.

Urol Int. 2018;100(1):119-121. doi: 10.1159/000437442. Epub 2015 Dec 17. PubMed PMID: 26675030 Abstract: The objective of this case report is to present a rare bladder tumour in a young patient 25 years after the treatment with cyclophosphamide because of a neuroblastoma of the right eye. The first symptom of the tumour was macroscopic haematuria with dysuria and pollakiuria. The final diagnosis was dictaminated by the pathologist and the best treatment option was radical cystoprostatectomy. Leiomyosarcoma was presented in a 26-year-old patient like the third different tumour, the second was an esphenoidal meningioma. At the 8th year of follow-up after the radical surgery, the patient is free of bladder disease. Bladder leiomyosarcoma is a rare tumour of the bladder and its early diagnosis and treatment are mandatory for best prognosis.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 1.508 Quartil: 3

Categoria: Medicine, Urology & Nephrology

Posició: 54/76

NEUMOLOGIA– PNEUMOLOGY Nº Articles indexats: 1

Factor Impacte total: 12.244

Factor d’impacte mig per article: 12.244

Arbillaga-Etxarri A, Gimeno-Santos E, Barberan-Garcia A, Balcells E, Benet M, Borrell E, Celorrio N, Delgado A, Jané C, Marin A, Martín-Cantera C, Monteagudo M, Montellà N, Muñoz L, Ortega P, Rodríguez DA, RodríguezRoisin R, Simonet P, Torán-Monserrat P, Torrent-Pallicer J, Vall-Casas P, Vilaró J, Garcia-Aymerich J. Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial.

Eur Respir J. 2018 Oct 18;52(4). pii: 1800063. doi: 10.1183/13993003.00063-2018. Print 2018 Oct. PubMed PMID: 30166322

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Abstract: There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease (COPD). We assessed 12-month efficacy and effectiveness of the Urban Training intervention on physical activity in COPD patients.This randomised controlled trial (NCT01897298) allocated 407 COPD patients from primary and hospital settings 1:1 to usual care (n=205) or Urban Training (n=202). Urban Training consisted of a baseline motivational interview, advice to walk on urban trails designed for COPD patients in outdoor public spaces and other optional components for feedback, motivation, information and support (pedometer, calendar, physical activity brochure, website, phone text messages, walking groups and a phone number). The primary outcome was 12-month change in steps·day-1 measured by accelerometer.Efficacy analysis (with per-protocol analysis set, n=233 classified as adherent to the assigned intervention) showed adjusted (95% CI) 12-month difference +957 (184-1731) steps·day-1 between Urban Training and usual care. Effectiveness analysis (with intention-totreat analysis set, n=280 patients completing the study at 12 months including unwilling and self-reported nonadherent patients) showed no differences between groups. Leg muscle pain during walks was more frequently reported in Urban Training than usual care, without differences in any of the other adverse events.Urban Training, combining behavioural strategies with unsupervised outdoor walking, was efficacious in increasing physical activity after 12 months in COPD patients, with few safety concerns. However, it was ineffective in the full population including unwilling and self-reported non-adherent patients.

Indexat a: MEDLINE/WOS/JCR Factor Impacte: 12.244 Quartil/Decil: 1

Categoria: Respiratory System

Posició: 3/60

MEDICINA PREVENTIVA – PREVENTIVE MEDICINE Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Molina Aragonés JM, Bausà Peris R, Carreras Valls R, Carrillo Castillo A, Fiblà Nicolau F, Gaynés Palou E, Guerrero Monge J, Inglés torruella J, López Muños JA, Martinez Carrasco E, Matlló Aguilar J, Medina Lavela JA, Mestre Prat MT, Peña Garcia P, Rodriguez Vallecillos S, Tapias Oller G, Vilardell Ynaraja M. Toxicidad del formaldehido en trabajadores profesionales expuestos. Revisión bibliográfica.

Arch Prev Riesgos Labor 2018; 21(3):128-157 Abstract La presencia del formaldehido en el ámbito laboral sigue siendo importante. La exposición produce irritación local de mucosas oculares, nasales y del tracto respiratorio superior, y crónicamente se ha asociado con mayor riesgo de desarrollar cáncer a nivel de senos paranasales, naso-orofaringe y pulmón. Esta revisión tiene por objetivo actualizar la bibliografía y categorizar la evidencia científica más actualizada de los efectos que el formaldehido produce sobre el organismo humano. Búsqueda bibliográfica en la base de datos electrónica Medline/PubMed, limitada a los últimos 10 años mediante combinación de lenguaje libre y controlado. Se revisaron 185 artículos con inclusión final de 54 tras descartar por duplicidad, idioma y criterios de inclusión. Se observa un elevado grado de evidencia respecto a la genotoxicidad, evidencia contradictoria, inconsistente o limitada respecto a patologías neoplásicas de origen hematopoyético, laringe, naso-sinusales o de pulmón y falta de evidencia sobre la relación con el asma bronquial. Es preciso efectuar nuevos estudios, especialmente con carácter longitudinal y mayor potencia epidemiológica, para generar nuevo conocimiento sobre el comportamiento de este tóxico.

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TRAUMATOLOGIA – ORTHOPAEDIC SURGERY Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Ballester M, Lucar G, Marcello P, Babot E Tratamiento de la rotura crónica del tibial anterior con plastia tendinosa Rev Pie Tobillo. 2018;32(2):122-6 Abstract: La rotura crónica del tibial anterior tiene una incidencia baja y en muchas ocasiones pasa desapercibida. Se asocia a una importante retracción tendinosa que dificulta en la gran mayoría de los casos su inserción primaria.

Se recomienda el tratamiento mediante plastia tendinosa con auto- o aloinjerto a través de una fijación transósea. Se describe la técnica quirúrgica.

OBSTETRICIA I GINECOLOGIA – OBSTETRICS & GINECOLOGY Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Valldeperas Abad L, Altés Planas A, Cobos Melià M, Furriols Raulí B, Solé Suau J, Genover Llimona E Rate of cesarean delivery according to the Robson classification at Hospital de Mataró.

Prog Obstet Ginecol 2018;61(2):139-143 Abstract: Objective: To determine the obstetric profile of women undergoing cesarean delivery.

Material and methods: We performed a retrospective observational study of deliveries at Hospital de Mataró during 2000-2015 in which we compared the rate of cesarean delivery in 2 periods (2000-2008 and 2009-2015), overall, and stratified by the mother’s obstetric characteristics according to the Robson method.

Results: The overall rate of cesarean delivery increased by 2.81% between the 2 periods studied (p < 0.001). The contribution of groups 2, 3, and 4 to this increase was statistically significant. Groups 1 and 6 reduced the rate.

When each group was analyzed separately, the rate increased for groups 1, 2, 3, and 8.

Conclusion: The Robson classification is easy and useful and shows which groups of women contribute most to the increase in the cesarean delivery rate. We are therefore able to propose appropriate obstetric measures to reduce the rate without repercussions on maternal and fetal morbidity and mortality.

Cobos Melià M, Celades Filella M, Ballestar Mas E, Fantova Cosculluela MJ, Carabias Meseguer P, Genover Llimona E .

Virilización en mujer menopáusica: limitaciones de la ecografía ginecológica en la detección de tumores ováricos.

Prog Obstet Ginecol. 2018;61(5):502-507 Abstract: Presentamos un caso de una mujer menopáusica de 56 años con clínica de hirsutismo progresivo severo de 7 meses de evolución. Entre otras pruebas, se realizó una ecografía transvaginal en el que se observaron unos anejos estrictamente normales. Ante la sospecha de patología ovárica debido a la ausencia de patología suprarrenal y test de frenación con análogos de la GnRh positivo, se solicitó una RMN pélvica que identificó una

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pequeña tumoración sugestiva de tumor del estroma ovárico. Se realizó una ooforectomia bilateral laparoscópica. El estudio anatomopatológico informó de tumor de células esteroideas (Tumor de células de Leydig). La clínica de virilización mejoró progresivamente después de la intervención.

ANESTESIOLOGIA – ANESTHESIOLOGY Nº Articles indexats: 0

Factor Impacte total: 0

Factor d’impacte mig per article: 0

Pérez Herranz D, Villamizar Avendaño MA, Ferre Forcadell TD, Villanova Baraza M, Yuste Graupera M. Radiofrecuencia de nervios pudendos para el control del dolor en el carcinoma escamoso de vulva.

Dolor. Investigación Clínica & Terapéutica 2018;33(2): 81-84 Abstract: Radiofrequency has proven to be an effective technique in the control of pain caused by neuropathy of the pudendal nerve. Likewise, the use of this procedure can be extrapolated to chronic pain caused by invasive organic lesions that affect the sensory territory of this nerve. We present the case of a 70-year-old woman with a diagnosis of moderately differentiated vulvar squamous carcinoma. In a therapeutic way, lumpectomy and lymphadenectomy were performed, subsequently associating radiotherapy. Five months later, a local relapse of the disease was observed, having to enter due to difficult pain control, requiring morphine perfusion, fentanyl patches, and multiple adjuvants (antidepressants, benzodiazepines and antiepileptics) without achieving optimal pain control and associating multiple secondary effects. Being tributary of palliative treatment, the pain clinic is contacted, which proposes a blockade of pudendal nerves as possible effective option. A transperineal block of the right pudendal nerve is performed by ultrasound support, with clear clinical improvement of the symptoms. The possibility of performing radiofrequency for long-term pain control is proposed, which is accepted and performed in the hospital of third level of reference, guided by CT, with very good response and relief of symptoms. Conclusion: Radiofrequency is not only useful in the neuralgia of the pudendal nerve, but it can be a very good therapeutic alternative in the case of organic pathology affecting the genital or perineal area, with difficult pain control by conventional treatment.

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INDICADORS BIBLIOMÈTRICS GLOBALS CSDM 2018

89

73

Articles Publicats Articles Publicats

Articles Indexats Articles Indexats

2

Llibres/Capítols Llibres/Capítols

MEDLINE/PubMed/WOS/JCR

Total articles indexats per Servei:

Factor d’Impacte* Total per Servei i FI mig(segons nº articles indexats a JCR*)

Medicina Interna

14

Medicina Intensiva 60.099

(7.512)

Medicina Intensiva

10

Hematologia

40.447

(13.484)

Rehabilitació

8

Medicina Interna

35.768

(2.554)

Motilitat Digestiva

7

Motilitat digestiva

27.085

(3.869)

Neurologia

6

Neurologia

26.618

(4.436)

Oncologia

6

Oncologia

24.788

(4.131)

Farmàcia

5

Rehabilitació

18.087

(2.260)

Hematologia

3

Digestiu

15.157

(7.578)

Digestiu

2

Farmàcia

13.567

(2.713)

Psiquiatria

2

Neumologia

12.244

(12.244)

Unitat de Recerca

2

Psiquiatria

4.612

(2.306)

Urgències

2

Unitat de Recerca

4.345

(2.172)

Dermatologia

1

Pediatria

3.607

(3.607)

Cirurgia General

1

Cirurgia Vascular

3.046

(3.046)

Cirurgia Vascular

1

Urgències

2.377

(1.188)

Neumologia

1

Dermatologia

1.541

(1.541)

Pediatria

1

Urologia

1.508

(1.508)

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Urologia

1

Cirurgia General

0.841

(0.841)

* Font: Journal Citation Reports, JCR: 2017

10 Articles en el 1r Decil* * Font: Journal Citation Reports, JCR: 2017

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