39 research outputs found
Clinical trials and Haemophilia during the COVID-19 pandemic: Madrid's experience
This is the peer reviewed version of the following article: "Clinical trials and Haemophilia during the COVIDâ19 pandemic: Madrid's experience". Haemophilia (2020): 16 May, which has been published in final form at https://doi.org/10.1111/hae.14055. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Version
Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure
AIMS:
The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared.
METHODS:
LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6â
months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24â
months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2â
years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively).
CONCLUSIONS:
LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation
Study of platelet kinetics in immune thrombocytopenia to predict splenectomy response
Despite the efficacy of splenectomy for chronic immune thrombocytopenia (ITP), its considerable failure rate and its possible related complications prove the need for further research into potential predictors of response. The platelet sequestration site determined by 111In-labelled autologous platelet scintigraphy has been proposed to predict splenectomy outcome, but without standardisation in clinical practice. Here, we conducted a single-centre study by analysing a cohort of splenectomised patients with ITP in whom 111In-scintigraphy was performed at La Paz University Hospital in Madrid to evaluate the predictive value of the platelet kinetic studies. We also studied other factors that could impact the splenectomy outcome, such as patient and platelet characteristics. A total of 51 patients were splenectomised, and 82.3% responded. The splenic sequestration pattern predicted a higher rate of complete response up to 12 months after splenectomy (p = 0.005), with 90% sensitivity and 77% specificity. Neither age, comorbidities, therapy lines nor previous response to them showed any association with response. Results from the platelet characteristics analysis revealed a significant loss of sialic acid in platelets from the non-responding patients compared with those who maintained a response (p = 0.0017). Our findings highlight the value of splenic sequestration as an independent predictor of splenectomy respons
The importance of platelet glycoside residues in the haemostasis of patients with immune thrombocytopaenia
Loss of sialic acid from the carbohydrate side chains of platelet glycoproteins can affect platelet clearance, a proposed mechanism involved in the etiopathogenesis of immune thrombocy-topaenia (ITP). We aimed to assess whether changes in platelet glycosylation in patients with ITP affected platelet counts, function, and apoptosis. This observational, prospective, and transversal study included 82 patients with chronic primary ITP and 115 healthy controls. We measured platelet activation markers and assayed platelet glycosylation and caspase activity, analysing samples using flow cytometry. Platelets from patients with ITP with a platelet count <30 Ă 103/”L presented less sialic acid. Levels of α1,6-fucose (a glycan residue that can directly regulate antibody-dependent cellular cytotoxicity) and α-mannose (which can be recognised by mannose-binding-lectin and acti-vate the complement pathway) were increased in the platelets from these patients. Platelet surface exposure of other glycoside residues due to sialic acid loss inversely correlated with platelet count and the ability to be activated. Moreover, loss of sialic acid induced the ingestion of platelets by human hepatome HepG2 cells. Changes in glycoside composition of glycoproteins on the plateletsâ surface impaired their functional capacity and increased their apoptosis. These changes in platelet glycoside residues appeared to be related to ITP severity.This research was funded by FIS-Fondos FEDER PI19/00631, FIS-Fondos FEDER PI19/00772 and Platelet Disorder Support Associatio
Impact of Covid-19 pandemic on patients with immune thrombocytopaenia
Background and Objectives: The aim of this study was to determine the impact of the COVID-19 pandemic on the lives of patients with immune thrombocytopaenia (ITP) treated at our hospital. Materials and Methods: The study was conducted in the Community of Madrid, which has the highest number of COVID-19 cases in Spain. We included 143 adult patients with ITP (130 with chronic ITP, 8 with persistent ITP, and 5 with newly diagnosed ITP). We conducted a telephone survey to collect the data and created a registry. Materials and Methods: Overall, 24 patients presented symptoms suggestive of COVID-19, which was confirmed by RT-PCR in 8 cases. The cumulative incidence of confirmed SARS-CoV-2 infection was higher in the patients with ITP than in the Madrid population. There were no differences in the disease incidence or clinical course of infection in the patients treated with immunosuppressants. Almost all of the patients reported adherence to the prescribed treatment, although 49.2% of the hospital visits were either cancelled or postponed, 17.2% because of the patientsâ fear of coming to the centre. Nearly half of the cohort was considered vulnerable, and 17% had been granted a dependency or disability benefit. Conclusions: COVID-19 had a major impact on the psychosocial, occupational, and quality of care of patients with ITP.This study was supported by FIS-Fondos FEDER PI19/00631 and PI19/00772 and by the Platelet Disorder Support Associatio
2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla
La transfusiĂłn de sangre alogĂ©nica (TSA) no es inocua, y como consecuencia han surgido mĂșltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los mĂ©dicos que tratan a los pacientes, el grado de anemia, la polĂtica transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de AnestesiologĂa y ReanimaciĂłn (SEDAR), HematologĂa y Hemoterapia (SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias (SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones SanguĂneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6 sociedades ha llevado a cabo una revisiĂłn sistemĂĄtica de la literatura mĂ©dica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la TransfusiĂłn de Sangre AlogĂ©nica. Solo se contempla las ATSA dirigidas a disminuir la transfusiĂłn de concentrado de hematĂes. Se definen las ATSA como toda medida farmacolĂłgica y no farmacolĂłgica encaminada a disminuir la transfusiĂłn de concentrado de hematĂes, preservando siempre la seguridad del paciente. La cuestiĂłn principal que se plantea en cada Ătem se formula, en forma positiva o negativa, como: «La ATSA en cuestiĂłn reduce/no reduce la tasa transfusional». Para formular el grado de recomendaciĂłn se ha usado la metodologĂa Grades of Recommendation Assessment, Development and Evaluation (GRADE)
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Dietary αâLinolenic Acid, Marine Ïâ3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvenciĂłn con DIeta MEDiterrĂĄnea (PREDIMED) Study
Background: Epidemiological evidence suggests a cardioprotective role of αâlinolenic acid (ALA), a plantâderived Ïâ3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine Ïâ3 fatty acids (longâchain nâ3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to allâcause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for longâchain nâ3 polyunsaturated fatty acids (â„500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvenciĂłn con DIeta MEDiterrĂĄnea (PREDIMED) trial. Multivariableâadjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9ây followâup, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56â0.92) for allâcause mortality and 0.95 (95% CI 0.58â1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for longâchain nâ3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67â1.05) for allâcause mortality, 0.61 (95% CI 0.39â0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29â0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22â1.01) for sudden cardiac death. The highest reduction in allâcause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45â0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to allâcause mortality, whereas protection from cardiac mortality is limited to fishâderived longâchain nâ3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639
Phenology of Tempranillo and Cabernet-Sauvignon varieties cultivated in the Ribera del Duero DO: observed variability and predictions under climate change scenarios
Aim: This research examined relationships between grapevine phenology and climate in the Ribera del Duero DO
(Spain). The observed varieties included Tempranillo, the main variety planted in the region, and Cabernet-Sauvignon.
Methods and Results: Phenological events for stages C (budbreak), I (bloom), M (véraison) and N (maturity) were
analyzed for 2004-2015. Dormant period chilling and late winter heating requirements to initiate growth were evaluated
and accumulated temperature (growing degree days-GDD) prior to each phenological event and in between events were
examined for the role they play in influencing growth timing. The results were then used to examine future phenological
changes due to climate change using eight models integrated in the Coupled Model Intercomparison Project (CMIP5)
and for two Representative Concentration Pathways (RCP) scenarios â RCP4.5 and RCP8.5 â for 2030, 2050, and 2070.
Accumulated temperatures after March 20th become important for initiating phenology and are strongly correlated to all
growth events. The influence of water availability between budbreak and bloom and between bloom and véraison on
phenological timing was also confirmed.
Conclusions: The projections showed that for the RCP4.5 emission scenario, budbreak is predicted earlier by
approximately 2 days for 2030, 3 days for 2050 and 5 days for 2070, while bloom is predicted to be 3 to 8 days earlier
and véraison 6 to 19 days earlier for the same time periods. For the RCP8.5 emission scenario, budbreak is modeled to
take place about 3 days, 5 days and 9 days earlier, respectively for 2030, 2050 and 2070. Bloom is predicted to occur
about 5, 10 and 16 days earlier; véraison is predicted earlier by 10 days for 2030, 19 days for 2050, and 28 days for
2070. Maturity and the timing of harvest could be up to 23 days earlier under the RCP4.5 emission scenario and up to
35 days earlier under the RCP8.5 emission scenario. Compared to Cabernet-Sauvignon, Tempranillo exhibited greater
phenological sensitivity to temperature changes in the observed time period that is likely to continue into the future with
greater changes to earlier growth events projected. This sensitivity could be problematic for the region due to the
varietyâs historic importance and points to the need to examine adaptive measures that can help growers to respond to
projected changes in climate.
Significance and impact of the study: The projected climate changes in the future indicate the potential for significant
changes in the phenology of Tempranillo in the Ribera del Duero DO, Spain. Given that this variety has the largest
contribution and importance in this region, these changes could have impacts on wine quality, indicating the need of
establishing strategies to reduce or mitigate the impact from future changes in climate