J Ris

Hospital de la Santa Creu i Sant Pau, Barcino, Catalonia, Spain

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Publications (38)368.96 Total impact

  • Transplantation 10/2013; 96(8):e63-4. · 3.78 Impact Factor
  • Transplantation 04/2013; 95(7):e47-8. · 3.78 Impact Factor
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    ABSTRACT: rain-dead donors (BDD) are the single largest source of transplantable organs. Families’ informed consent to donate family members’ organs is always requested and is a determining factor in the success of organ transplantation. The interview between the transplant coordinator (TC) and the family of possible organ donors requires specific planning and methodology. The transplant coordination department at the Hospital Sant Creu and Sant Pau (HSCSP) of Barcelona (Spain) has developed a Family Interview Guide (FIG) for requesting informed consent to organ donation for transplantation from BDD. For the internal evaluation of the guidelines presented in this paper the AGREE II (Appraisal of Guidelines Research & Evaluation) instrument was used. We present our FIG to request organ donation and its assessment with the AGREE II instrument by four medical specialists. The FIG describes the process and content of the conversations surrounding the donation request. FIG was implemented in 2011 and consists of the following 13 sections: planning, recommendations, professionals conducting the interview, requestor’s attitude towards families, interview setting, timing of the interview, duration of the interview, requesting informed consent, details of the donation process to the donor’s family, formalizing the agreement, donor documentation, funeral arrangements administration procedures and psychological support for donor families. The main purpose of this guide is to increase organ donation rates. From January 2011 to August 2012, 40 consecutive family interviews from 40 BDD were conducted using FIG. For the evaluation of this FIG the AGREE II instrument was used. This is a generic tool designed primarily to assist designers and users of clinical guidelines in the assessment of their methodological quality. The rate of family consent to organ donation for transplantation in the HSCSP after implementation of this FIG in 40 consecutive family interviews was 100%. The assessment of this clinical guideline with the AGREE II instrument scored 71%. The application of our guideline in face-to-face interviews with the families of potential brain-dead organ donors was a success. The evaluation of our guide with the AGREE II instrument recommended its use in general clinical practice
    Cells Tissues Organs 11/2012; 16:163-169. · 1.96 Impact Factor
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    ABSTRACT: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Prospective observational study. Emergency department and geriatric medical day hospital of a university teaching hospital. Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94-0.98 and OR=0.97, 95% CI=0.95-0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01-1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16-2.57; P<.01). Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account.
    Journal of the American Geriatrics Society 11/2004; 52(10):1603-9. · 3.98 Impact Factor
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    ABSTRACT: Initiation of combination antiretroviral therapy may be followed by inflammatory reactions. We studied the epidemiology of herpes zoster infection among patients with human immunodeficiency virus (HIV) infection who were treated with combination antiretroviral therapy. Of 316 patients who initiated combination antiretroviral therapy, 24 (8%) were treated for herpes zoster within 17 weeks of starting therapy. The characteristics of these cases were compared with those of a control group of 96 HIV-1-infected patients, who were matched by age, sex, plasma HIV-1 RNA concentration and CD4 cell counts, and length of follow-up. The incidence of herpes zoster associated with combination antiretroviral therapy was 9 episodes per 100 patient-years. There were no significant differences between cases and controls in age, sex, years of HIV infection, history of herpes zoster, previous acquired immune deficiency syndrome, or baseline mean CD4 and CD8 cell counts before beginning combination antiretroviral therapy. However, patients who developed herpes zoster had a significantly greater mean (+/- SD) increase in the number of CD8 cells than did controls (347 +/- 269 vs. 54 +/- 331 cells/mL, P = 0.0006). In a multivariate analysis, the only factor that was associated with the development of herpes zoster was the increase in CD8 cells from before initiation of combination antiretroviral therapy to 1 month before development of herpes zoster (odds ratio 1.3 per percentage increase; 95% confidence interval: 1.1 to 1.5; P = 0.0002). The initiation of combination antiretroviral therapy in HIV-1-infected patients was often associated with the development of herpes zoster, especially in those in whom the number of CD8 cells increased after therapy.
    The American Journal of Medicine 07/2001; 110(8):605-9. · 5.30 Impact Factor
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    ABSTRACT: Of the 316 patients who initiated combination antiretroviral therapy, 24 were treated for herpes zoster within 17 weeks of starting therapy. The characteristics of these cases were compared with those of a control group of 96 human immunodeficiency virus type-1 (HIV-1) infected patients, who were matched by age, sex, plasma, HIV-1 RNA concentration and CD4 cell counts, and length of follow-up. The incidence of herpes zoster associated with combination antiretroviral therapy was 9 episodes per 100 patient years. There were no significant differences between cases and controls in age, sex, years of HIV infection, history of herpes zoster, previous acquired immune deficiency syndrome, or baseline mean CD4 and CD8 cell counts before beginning combination antiretroviral therapy. However, patients who developed herpes zoster had a significantly greater mean increase in the number of CD8 cells than did controls. Conclude that the initiation of combination antiretroviral therapy in HIV-1 infected patients was often associated with the development of herpes zoster especially in those whom the number of CD8 cells increased after therapy.
    Pain Practice 01/2001; 1(4):381-381. · 2.61 Impact Factor
  • Acta Neurologica Scandinavica 12/2000; 102(5):340-1. · 2.47 Impact Factor
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    ABSTRACT: The objective was to determine whether the use of intermediate echo times (135 ms) in proton magnetic resonance spectroscopy (1H-MRS) detects a homogenous pattern in progressive multifocal leukoencephalopathy (PML) in HIV-1 infected people, and to confirm the results of previous studies. Six patients infected with HIV-1, with PML established by biopsy, and six healthy age and sex matched volunteers were evaluated to define their spectroscopic pattern. 1H-MRS spectra performed at 1.5 T were obtained with the STEAM sequence: TE/TM/TR, 20 ms/13.7 ms/2000 ms; 2500 Hz, size 2048 points, 256 acquisitions (STEAM-20) and with the PRESS sequence; TE/TR, 135 ms/2000 ms; 2500 Hz, size 2048 points, 256 acquisitions (PRESS-135). A single voxel was placed on the lesions and on the parieto-occipital white matter of controls. The peaks of N-acetylaspartate (NAA), choline (Cho), myoinositol (mI), lactate, and lipids were considered, and the results were expressed using creatine as reference. Spectra of PML lesions were characterised by significantly reduced NAA, lactate presence, and by significantly increased Cho and lipids compared with control group values. These results indicate that 1H-MRS detects a homogenous pattern in PML lesions. Recent studies, together with this, suggest that 1H-MRS may help in the diagnostic approach to patients with suspected PML lesions associated with AIDS.
    Journal of Neurology Neurosurgery &amp Psychiatry 05/1999; 66(4):520-3. · 4.92 Impact Factor
  • AIDS 04/1999; 13(4):530-2. · 6.41 Impact Factor
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    ABSTRACT: The aim of this study was to delineate the clinical and therapeutic characteristics of Pseudomonas aeruginosa bronchopulmonary infection in acquired immunodeficiency syndrome (AIDS) patients. Eighteen AIDS patients had 39 episodes of P. aeruginosa bronchopulmonary infection. Their mean CD4 cell count was 0.012+/-0.011 cells x 10(9) x L(-1) and two episodes (5.1%) occurred in neutropenic patients. Ten patients (55.5%) had 21 outbreaks of pseudomonal infection. Relapses were more frequent in patients with chronic bronchitis (80 versus 0%, p=0.03) and in those who received initial oral antibiotic therapy (100 versus 55.6%, p=0.25). Three patients died, but death was directly related to pseudomonal infection in only one patient. In a case-control study, patients with bronchopulmonary P. aeruginosa infection had a survival comparable to patients in the control group. Immunoglobulin prophylaxis was administered to three patients with relapses, without success. The two patients who had P. aeruginosa eradicated were those who began triple antiretroviral therapy and had a CD4 cell increase >0.150 cells x 10(9) x L(-1). Relapsing Pseudomonas aeruginosa bronchopulmonary infection affects patients with advanced human immunodeficiency virus infection, prior underlying lung disease, chronic bronchitis and initial oral antibiotic therapy. Immune reconstitution through triple antiretroviral therapy succeeded in eradicating Pseudomonas aeruginosa respiratory infection in two patients.
    European Respiratory Journal 07/1998; 12(1):107-12. · 6.36 Impact Factor
  • Archives of Internal Medicine 05/1998; 158(8):929-30. · 11.46 Impact Factor
  • AIDS 03/1998; 12(5):529-30. · 6.41 Impact Factor
  • American Journal of Hypertension - AMER J HYPERTENS. 01/1998; 11(4).
  • AIDS 11/1996; 10(12):1449-50. · 6.41 Impact Factor
  • Annals of internal medicine 06/1996; 124(10):928; author reply 928-9. · 13.98 Impact Factor
  • Archives of Internal Medicine 06/1996; 156(10):1114. · 11.46 Impact Factor
  • AIDS 02/1996; 10(1):106-7. · 6.41 Impact Factor
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    ABSTRACT: We have retrospectively reviewed 63 cases of encephalic toxoplasmosis (ET) in HIV-infected patients in order to determine clinical and radiological characteristics, the diagnostic value of serologic determinations, and the response to antioxoplasmic therapy. ET was the AIDS-defining condition in 44% of the patients. Eighty of the patients had a CD4 cell count < 100/microliters when ET was diagnosed. Only 4.8% of the patients had been taking anti-Pneumocytis carinii prophylaxis with cotrimoxazol. The most frequent clinical presentation was focal neurologic signs in 80.9% of the patients, with headache and fever in 53.3% and 42.4%, respectively. The most frequent cerebral CT finding was hipodense lesions (92%) with ring enhancement (68.9%). They were most frequently had a hemisferic location. Seroconversion was detected in two patients (6%), whereas 55 patients had serologic evidence of latent infection by Toxoplasma gondii (87.3%). Ninety eight percent of the patients were treated with sulphadiazine plus pyrimethamine. However, such therapy should be discontinued in 22% of them and switched to clindamycin plus pyrimethamine. The overall mortality rate during the acute phase of the disease was 7.9%, but 41.4% of the survivors exhibited neurologic sequelae. Relapsing ET was detected in 33.3% of the patients, and it was usually due to discontinuation of treatment. The mean survival time after the diagnosis of ET was 11.5 months. ET is the most common opportunistic infection of the central nervous system among our AIDS patients. Primary prophylaxis for toxoplasmic infection seems advisable in our epidemiologic environment, when CD4 cell count is less than 200/microliters and there is serologic evidence of latent infection. Acute ET usually has a good response to therapy, and the acute mortality rate is low. However, most of the survivors will remain with neurologic sequelae. The high frequency of adverse effects to sulphamide therapy with clindamycin make the need of alternative treatment strategies urgent.
    Anales de medicina interna (Madrid, Spain: 1984) 01/1996; 13(1):4-8.
  • Clinical Infectious Diseases 06/1995; 20(5):1435-7. · 9.37 Impact Factor
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    ABSTRACT: Eosinophilic pustulous foliculitis (EPF) is a rare dermatosis which has been reported in association with the human immunodeficiency virus infection. Six patients infected with HIV are reported with advanced disease in whom the diagnosis of EPF was made. All patients has a highly pruritic follicular papular rash. In all cases the pathology study revealed a mixed inflammatory infiltrate with predominance of eosinophils at the infundibulum of the pilous folliculi. Two patients had eosinophilia in peripheral blood. Therapy with antihistaminic agents and topical corticosteroids was ineffective in all cases. A favourable therapeutic response was achieved with phototherapy associated with the topic application of disodium cromoglycate 4%.
    Revista Clínica Española 03/1995; 195(2):92-6. · 2.01 Impact Factor