J M Salmerón

Institut Marqués, Spain, Barcelona, Barcino, Catalonia, Spain

Are you J M Salmerón?

Claim your profile

Publications (70)532.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to assess the effects of albumin dialysis on hepatic encephalopathy and circulating levels of amino acids in severe alcoholic hepatitis. The study was carried out in nine patients with severe alcoholic hepatitis and four with primary biliary cirrhosis treated with the molecular adsorbent recirculating system. Besides standard liver function tests, circulating levels of ammonia, total, branched chain and aromatic amino acids, the presence and severity of hepatic encephalopathy, and number connection test were measured before and after each treatment. There were eight episodes of encephalopathy in patients with alcoholic hepatitis. Albumin dialysis was associated with significant improvement in encephalopathy (p = 0.02), and a decrease in total amino acid levels (2490 +/- 152 microM to 2229 +/- 114 microM, p < 0.001). Moreover, the Fischer's ratio, which was significantly lower in patients with alcoholic hepatitis (1.32 +/- 0.08) than in controls (3.20 +/- 0.16), increased by 17% after albumin dialysis (p < 0.02) because of a significant decrease in phenolic aromatic amino acids (193 +/- 17 microM to 165 +/- 9 microM, p = 0.04). No differences were observed in circulating ammonia. Changes in phenolic aromatic amino acids and the Fischer's ratio were more prominent in patients with encephalopathy and higher bilirubin removal. Albumin dialysis did not significantly affect the amino acid profile in the controls. Albumin dialysis results in a significant decrease in circulating phenolic aromatic amino acids and improvement of hepatic encephalopathy in patients with severe liver failure.
    Critical care (London, England) 02/2009; 13(1):R8. · 5.04 Impact Factor
    This article is viewable in ResearchGate's enriched format
  • Medicina Clínica 04/2008; 130(10):393-8. · 1.25 Impact Factor
  • Medicina Clínica 03/2008; 130(10):393-398. · 1.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The cause of acute liver failure (ALF) is a major determinant of its outcome. Acetaminophen (paracetamol) overdose is a leading cause of ALF in some developed countries, whereas in others, such as Spain, it is extremely rare. To analyze the etiology, characteristics, and outcome of ALF in Spain, we performed a retrospective analysis of 267 patients whom we observed from 1992 to 2000. Seventeen tertiary-care hospitals with active liver transplantation (LT) programs contributed data. Causes of ALF were viral hepatitis in 98 (37%; hepatitis B virus in 75 patients), unknown in 86 (32%), drug or toxic reactions in 52 (19.5%; acetaminophen overdose in 6), and miscellaneous in 31 (11.6%). Overall survival was 58%. LT was performed in 150 patients, with a survival of 69%. Despite fulfilling criteria, 51 patients were not transplanted because of contraindications; their survival was only 7.8%. Forty-seven (85.5%) of 55 patients without transplant criteria survived. Hepatitis B virus is the most common cause of ALF in Spain, although the origin of 30% of cases remains undetermined. Acetaminophen overdose represents a very rare cause of ALF. LT was performed in >50% of cases. Patients without transplant criteria had a very good prognosis; those who fulfilled these criteria but who had contraindications for transplantation had a high mortality rate.
    Liver Transplantation 11/2007; 13(10):1389-95. · 3.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and objective To determine the effect that the lack of inhospital beds exerts on emergency department performance. Material and method Two different time periods with comparable daily census, but significantly different bed availability. Variables assessed were general emergency department performance markers, emergency department effectiveness markers and objective and subjective quality markers. Results All variables got worse within lower bed availability period, and reached a change magnitude between 0% and 300% when compared with control period. However, a statistical difference was only achieved in emergency department occupation rate (+14%; p < 0.001), rate of patients waiting to be admitted (+100%; p < 0.001), patients waiting to be seen (+60%; p < 0.01), waiting time to be seen (+83%; p < 0.001), time to employed for first medical assessment and treatment (+44%; p < 0.01), and patients left without being seen (+90%; p < 0.05). Conclusions The lack of inhospital beds for patients admitted from the emergency department leads to a remarkable worsening in its function and performance.
    Medicina Clínica 05/2006; 126(19):736-739. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the effect that the lack of inhospital beds exerts on emergency department performance. Two different time periods with comparable daily census, but significantly different bed availability. Variables assessed were general emergency department performance markers, emergency department effectiveness markers and objective and subjective quality markers. All variables got worse within lower bed availability period, and reached a change magnitude between 0% and 300% when compared with control period. However, a statistical difference was only achieved in emergency department occupation rate (+14%; p < 0.001), rate of patients waiting to be admitted (+100%; p < 0.001), patients waiting to be seen (+60%; p < 0.01), waiting time to be seen (+83%; p < 0.001), time to employed for first medical assessment and treatment (+44%; p < 0.01), and patients left without being seen (+90%; p < 0.05). The lack of inhospital beds for patients admitted from the emergency department leads to a remarkable worsening in its function and performance.
    Medicina Clínica 05/2006; 126(19):736-9. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: After triage assessment, some hospitals refer emergency department (ED) patients with minor chief complaints to off-site clinics. The potential for 2 different referral models introduced in 2 urban hospitals was assessed, as well as the suitability of this measure. After triage assessment, patients with minor complaints were identified. ED from Hospital Clínic of Barcelona (HCB) proposed that these patients should be referred to a hospital affiliated off-site clinic, whereas ED from Hospital Mútua de Terrassa (HMT) tried to refer such patients to their primary care setting. Within a year, we assessed on both ED the following items: number of arrivals, percentage of proposed referrals (PR), percentage of accepted referrals (AR), percentage of carried-out referrals (CR: patients who, once discharged, really attended the other setting), and percentage of returned referrals (RR) to the ED, as well as return reasons, and the percentage of returned patients finally admitted. The degree of patient satisfaction was evaluated by means of a telephone survey. From both ED, 44,764 arrivals and 7,297 (16.3%) PR were registered. The percentage of AR and CR was 94.3% and 75.3%, respectively. The percentage of PR from HMT was higher (18.7% vs 13.1%; p < 0.001), yet HCB obtained a greater percentage of AR (98.9% vs 92%, p < 0.001) and CR (93.7% vs 65%; p < 0.001). The percentage of RR from both ED was 1.5% (2.8% vs 0.4%; p < 0.001). Among returned patients, 12 of them (0.17% respect to AR) were finally admitted. Only 41% of patients who were found to be eligible for direct discharge would have agreed with being referred to another clinical setting, but after the experience, up to 93% of them said they would go through it again. HMT gave referral information to patients faster than HCB (p < 0.05), but HCB got a better model evaluation (p < 0.01), a greater medical complaint solution (p < 0.05), and generated a smaller number of subsequent consultations (p < 0.05). After a rapid triage assessment, a percentage of patients arriving on EDs may be directly and safely discharged and referred to other clinical settings. This is achieved by both proposed models without additional risks for patients. However, patients feel more satisfied with an hospital-affiliated off-site clinic instead of their primary care setting.
    Medicina Clínica 01/2006; 126(3):88-93. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and objective After triage assessment, some hospitals refer emergency department (ED) patients with minor chief complaints to off-site clinics. The potential for 2 different referral models introduced in 2 urban hospitals was assessed, as well as the suitability of this measure. Patients and method After triage assessment, patients with minor complaints were identified. ED from Hospital Clínic of Barcelona (HCB) proposed that these patients should be referred to a hospital affiliated off-site clinic, whereas ED from Hospital Mútua de Terrassa (HMT) tried to refer such patients to their primary care setting. Within a year, we assessed on both ED the following items: number of arrivals, percentage of proposed referrals (PR), percentage of accepted referrals (AR), percentage of carried-out referrals (CR: patients who, once discharged, really attended the other setting), and percentage of returned referrals (RR) to the ED, as well as return reasons, and the percentage of returned patients finally admitted. The degree of patient satisfaction was evaluated by means of a telephone survey. Results From both ED, 44,764 arrivals and 7,297 (16.3%) PR were registered. The percentage of AR and CR was 94.3% and 75.3%, respectively. The percentage of PR from HMT was higher (18.7% vs 13.1%; p < 0.001), yet HCB obtained a greater percentage of AR (98.9% vs 92%, p < 0.001) and CR (93.7% vs 65%; p < 0.001). The percentage of RR from both ED was 1.5% (2.8% vs 0.4%; p < 0.001). Among returned patients, 12 of them (0.17% respect to AR) were finally admitted. Only 41% of patients who were found to be eligible for direct discharge would have agreed with being referred to another clinical setting, but after the experience, up to 93% of them said they would go through it again. HMT gave referral information to patients faster than HCB (p < 0.05), but HCB got a better model evaluation (p < 0.01), a greater medical complaint solution (p < 0.05), and generated a smaller number of subsequent consultations (p < 0.05). Conclusions After a rapid triage assessment, a percentage of patients arriving on EDs may be directly and safely discharged and referred to other clinical settings. This is achieved by both proposed models without additional risks for patients. However, patients feel more satisfied with an hospital-affiliated off-site clinic instead of their primary care setting.
    Medicina Clínica 01/2006; 126(3):88-93. · 1.25 Impact Factor
  • Medicina Clínica 07/2005; 125(6):205-209. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several thousands deaths were attributed to a heatwave during the summer of 2003 in Europe. The aim of this study was to analyze its consequences in an emergency department. We performed a descriptive observational study of the patients admitted to our emergency unit between 15 July and 31 August, 2003. We also carried out a comparative study of these patients with those admitted during the same period of 2002. A total of 5197 patients were admitted in our unit during the summer of 2003, in comparison with 4672 in the same interval in 2002. An increase in rates of total fever (17% versus 12%; p < 0.001), non-infectious fever (29% versus 26%; p < 0.001), decompensation of a chronic cardiovascular or respiratory disease (14% versus 11%; p < 0.001), admission (28% versus 22%; p < 0.001), and mortality (2% versus 1%; p < 0.001) were registered during the summer of 2003, in comparison with the previous year. A multivariate study showed a higher risk of death in patients older than 70 years (p < 0.01), in fragile dependent people (p < 0.05), and upon the presence of abnormal blood levels of creatinine (p < 0.05) on arrival at the emergency department. We also found an association between daily maxim temperature and number of daily emergency visits (R2 = 0.15; p < 0.001), total percentage of patients with fever (R2 = 0.26; p < 0.001), percentage of patients with non-infectious fever (R2 = 0.07; p = 0.01), percentage of decreases (R2 = 0.04; p < 0.05), and percentage of hospital admissions (R2 = 0.15; p < 0.001). The summer 2003 heatwave resulted in an elevation of the total number of emergency visits and hospital admissions, and higher mortality and morbidity rates, especially in old people. In the future, preventive measures must be taken to limit the health consequences of any heatwaves to come.
    Medicina Clínica 07/2005; 125(6):205-9. · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pruritus is a distressing symptom in patients with primary biliary cirrhosis, and when uncontrollable it is an indication for liver transplantation. Since pruritus can result from unknown substances that accumulate systemically as a consequence of impaired biliary secretion, we have assessed whether a new extracorporeal albumin dialysis (ECAD) procedure, the molecular-adsorbing recirculating system-MARS, has any effect on pruritus of cholestasis. Four patients with primary biliary cirrhosis and resistant pruritus were treated with two 7-h ECAD sessions 1 day apart. Pruritus was recorded from 15 days before the first session, before and after each session, and during the follow-up using a visual analogue scale (VAS). Standard liver tests as well as serum bile acid levels were also measured. There was a clear association between ECAD treatment and relief of itching, which promptly disappeared in two patients, or decreased markedly in the other two. One patient was free of pruritus for 18 months except for short periods with mild pruritus. The second patient experienced amelioration of itching, which almost disappeared completely and recurred mildly 4 months later. In the other two patients pruritus was alleviated markedly after ECAD but gradually recurred. These two patients were treated again 9 and 7 months later with favorable effects on pruritus. The scratching skin lesions improved or disappeared in parallel with the alleviation of itching. The albumin dialysis procedure did not result in liver test changes, except for circulating bile acids, which decreased in all the patients. No significant adverse effects were observed. The ECAD procedure seems to be an effective alternative for the treatment of patients with pruritus of cholestasis who do not respond to other therapeutic methods.
    The American Journal of Gastroenterology 07/2004; 99(6):1105-10. · 9.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the incidence, clinical course, predictive factors, and prognosis of renal failure in patients with cirrhosis and gastrointestinal bleeding, 175 consecutive episodes of gastrointestinal bleeding in 161 patients were analyzed. Renal failure occurred in 20 (11%) episodes and was transient in 8 episodes and nontransient in 12. Renal failure was more common in patients with cirrhosis than in a control population of bleeding patients without cirrhosis matched by age and severity of the bleeding episode. Among 39 clinical and laboratory variables obtained at admission or during hospitalization related with the bleeding episode or with liver and renal function, the presence of hypovolemic shock, number of packed red blood cells transfused, Child-Pugh class at admission, and baseline platelet count were independent predictors of renal failure. The development of renal failure and hypovolemic shock was the only independent predictors of in-hospital mortality. Mortality rate among the 20 episodes with renal failure was 55% (11 deaths) as compared with only 3% (5 deaths) in the 155 episodes without renal failure (P < .01). The development of nontransient renal failure entailed a much greater mortality as compared with transient renal failure (10 of 12 [83%] vs. 1 of 8 [12%]; P < .01). In conclusion, renal failure is a common event in patients with cirrhosis and gastrointestinal bleeding, the occurrence of which is mainly related to the severity of bleeding and baseline liver function. Renal failure is a strong predictor of mortality in patients with cirrhosis and gastrointestinal bleeding.
    Hepatology 12/2003; 34(4):671 - 676. · 11.19 Impact Factor
  • Intensive Care Medicine 09/2003; 29}, Meeting Abstract = {750:S195. · 5.54 Impact Factor
  • Liver Transplantation 06/2003; 9(6}, Meeting Abstract = {53):C14. · 3.79 Impact Factor
  • Liver Transplantation 06/2003; 9(6}, Meeting Abstract = {52):C13. · 3.79 Impact Factor
  • Journal of Hepatology 04/2003; 38(2}, Meeting Abstract = {213):67. · 10.40 Impact Factor
  • Journal of Hepatology 04/2003; 38(2}, Meeting Abstract = {214):67. · 10.40 Impact Factor
  • Hepatology 10/2002; 36(4, Part 2, S}, Meeting Abstract = {2069):680A. · 11.19 Impact Factor
  • Intensive Care Medicine 09/2002; 28(1}, Meeting Abstract = {691):S177. · 5.54 Impact Factor
  • Journal of Hepatology 04/2002; 36(1}, Meeting Abstract = {541):150. · 10.40 Impact Factor

Publication Stats

2k Citations
532.09 Total Impact Points

Institutions

  • 2001
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 1993–2001
    • University of Barcelona
      • Departament de Medicina
      Barcelona, Catalonia, Spain
  • 1999–2000
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1990–2000
    • Hospital Clínic de Barcelona
      • Servicio de Hepatología
      Barcelona, Catalonia, Spain
    • Hospital Universitari Germans Trias i Pujol
      Badalona, Catalonia, Spain