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Introduction
Skills and Expertise
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November 1994 - present
Publications
Publications (336)
Background
Obstructive sleep apnea (OSA) is associated with a recurrent cardiovascular event (CVE) risk in patients with a first acute coronary syndrome (ACS). However, the pathological pathways by which OSA promotes this deleterious role are unknown. We aim to explore the proteomic profile associated with OSA that promote the recurrent CVE risk in...
Introduction
Obstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acu...
Rationale:
Obstructive sleep apnea (OSA) is prevalent in acute coronary syndrome (ACS) patients and is a cause of secondary hypertension.
Objective:
To explore the long-term effects of OSA and CPAP treatment on blood pressure (BP) in ACS patients.
Methods:
Post-hoc analysis of the ISAACC study included 1803 patients admitted for ACS (NCT013350...
In addition to recommendations for pharmacological treatment stratified for risk and phenotype, the new 2021 edition of the Spanish COPD Guidelines (GesEPOC 2021) proposes a personalized approach to treatable traits, defined as a characteristic (clinical, physiological, or biological) that can be identified by diagnostic tests or biomarkers, for wh...
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 speciali...
Background:
Cutaneous metastasis (CM), while uncommon, is usually an indicator of poor prognosis. With cancer patients living longer, the incidence of CM has increased, which justifies its analysis.
Objectives:
The objective of this study was to carry out a descriptive study of CM diagnosed for 18 years in a dermatology department of a tertiary...
Study Objective. There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old.
Methods. Post-hoc pooled analysis of 2 open-label, multicenter clinical trials aimed to...
Introduction
Little is known about adult asthma patients’ perspective of their disease burden. This study aimed to obtain a comprehensive picture of patient needs, evaluate their knowledge, source of information and perception of the severity of their asthma, and compare these variables between severe (SA) and non-severe (NSA) asthma patients.
Met...
Study objectives:
Pulmonary hypertension (PH) is prevalent in obesity hypoventilation syndrome (OHS). However, there is a paucity of data assessing pathogenic factors associated with PH. Our objective is to assess risk factors that may be involved in the pathogenesis of PH in untreated OHS.
Methods:
In a post-hoc analysis of the Pickwick trial,...
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.arbres.2021.05.029. The duplicate article has therefore been withdrawn.
The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 speciali...
We aimed to (1) evaluate the incidence of tuberculous pleural effusion (TPE) over 25 years in our centre; (2) measure the yield of different diagnostic techniques; (3) compare TPE features between immigrant and native patients. Retrospective study of patients who underwent diagnostic thoracentesis and pleural biopsy in our hospital between 1995 and...
Resumen
Los modelos de atención sanitaria actuales descritos en GesEPOC indican la mejor manera de hacer un diagnóstico correcto, la categorización de los pacientes, la adecuada selección de la estrategia terapéutica y el manejo y la prevención de las agudizaciones. Además, en la EPOC concurren diversos aspectos que resultan cruciales en una aproxi...
Resumen
La nueva edición de 2021 de la Guía Española de la EPOC (GesEPOC 2021) propone, junto al tratamiento farmacológico ajustado por estratificación de riesgo y fenotipo, el abordaje personalizado de los rasgos tratables, definidos como una característica (clínica, fisiológica o biológica) que se puede identificar mediante pruebas diagnósticas o...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with thrombotic phenomena in the early stages of the disease, but also, less frequently, with major bleeding between the second and third week after onset, particularly in patients treated with therapeutic anticoagulation. This article describes four cases of...
Some solid cancers (such as lung, breast, and esophageal cancer, and melanoma) can lead to pericardial effusion by metastatic spread, potentially provoking hemodynamic instability. Detection by echocardiography is therefore essential. Pericardiocentesis can help restore cardiac function and provide fluid for establishing an etiology through cytolog...
RESUMEN Se trata de una forma infrecuente de infección por Ochrobactrum anthropi, de la que existen muy pocos casos comunicados en pacientes con bronquiectasias no debidas a fibrosis quística. En nuestro conocimiento, este sería el primer caso de bronquiectasias no debidas a fibrosis quística, asociadas a hipogammaglobulinemia, en el que se comunic...
Rationale: Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severit...
El objetivo principal de este Documento Internacional de Consenso (DIC) sobre Apnea Obstructiva del Sueño es proporcionar unas directrices que permitan a los profesionales sanitarios tomar las mejores decisiones en la asistencia de los pacientes adultos con esta enfermedad según un resumen crítico de la literatura más actualizada. El grupo de traba...
Background. Some studies suggest a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. However, no studies have examined the relationship between T2DM and aggressiveness of cutaneous melanoma at diagnosis.
Objetives. To explore potential associations between T2DM, glycemic control and metformin treatment, with...
In conclusion, we found for the first time a positive relationship between a long duration of sleep and some markers of melanoma aggressiveness. Future studies are needed to investigate the main pathophysiological mechanisms that could explain this association and the prognostic relevance of this finding.
Consignas útiles para pacientes, convivientes, cuidadores, profesionales y empresas de Terapias Respiratorias Domiciliarias Recomendaciones del uso de la CPAP para tratar la apnea del sueño en tiempos de COVID-19
Unos 1.000 millones de personas tienen apnea obstructiva del sueño o AOS y unos 425 millones necesitarían tratarse con CPAP para poder c...
nLa aerosolterapia domiciliaria constituye el 10-14% de las terapias respiratorias domiciliarias. Permiteadministrar sustancias por vía inhalada mediante nebulizadores, alcanzando concentraciones superioresen el árbol bronquial, aunque con una gran variabilidad inter- e intraindividual, dependientes del tama˜node las partículas, la edad, el patrón...
Rationale Obstructive sleep apnea (OSA) is associated with increased cardiovascular disease (CVD) risk. Conversely, OSA has not been shown to increase recurrent cardiovascular events in acute coronary syndrome (ACS) patients. This lack of homogeneity could suggest that the deleterious effect of OSA and its contribution to CVD could depend on specif...
The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric d...
Foreign body aspiration is relatively infrequent in adults. Airway foreign bodies (AFBs) can be removed by flexible bronchoscopy (FB) or rigid bronchoscopy (RB). We performed a retrospective analysis of FBs performed in our centre over a 25 year period, focusing on the procedures that revealed an AFB during the examination stage. We recorded demogr...
Resumen
La aerosolterapia domiciliaria constituye 10-14% de las Terapias Respiratorias Domiciliarias. Permite administrar sustancias por vía inhalada mediante nebulizadores, alcanzando concentraciones superiores en el árbol bronquial, aunque con una gran variabilidad inter e intraindividual, dependientes del tamaño de las partículas, la edad, el pa...
Resumen
La problemática de la Apnea Obstructiva del Sueño (AOS), tiene un innegable impacto en la calidad de vida de las personas que lo sufren y es un potencial factor de riesgo que puede empeorar problemas de salud, pero en España apenas un 25% de los pacientes reciben tratamiento.
Se ha demostrado que los costes de salud de los pacientes que no...
RESUMEN
La ventilación mecánica a domicilio (VMD), presenta un objetivo claro; el tratamiento de la insuficiencia respiratoria crónica de pacientes en Fracaso ventilatorio crónico, impactando este tratamiento tanto en la calidad de vida como en la supervivencia de los pacientes. La idea motriz que en su día impulsó la habilitación de la VM en el do...
Background
Noninvasive ventilation (NIV) is an effective form of treatment in obesity hypoventilation syndrome (OHS) with severe obstructive sleep apnea (OSA). However, there is paucity of evidence in OHS patients without severe OSA phenotype.
Research questions
Is NIV effective in OHS without severe OSA phenotype?
Study design and methods
In thi...
We describe the case of a 93-year-old patient who was diagnosed with lymphoepithelial-type pleural mesothelioma, attributed to indirect exposure to asbestos fibers from washing her husband’s clothes, with a long latency period, reviewing occupational exposure to asbestos and its low incidence in women, more frequent in these cases due to indirect o...
Background
Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.
Objectives
We performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiv...
Background
Large variation in diagnostic procedures and treatment recommendations may hinder the management of obstructive sleep apnea (OSA) and also compromise correct interpretation of the results of multicenter clinical trials, especially in subjects with non-severe OSA. The aim of this study was to analyze the therapeutic decision-making betwee...
Background:
Despite the improvement in the prognosis of acute coronary syndrome (ACS), substantial morbidity and mortality remain. We aimed to evaluate the effect of obstructive sleep apnoea (OSA) and its treatment with continuous positive airway pressure (CPAP) on the clinical evolution of patients with ACS.
Methods:
We designed a multicentre,...
Rationale:
Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomized trials have assessed the impact of long-term noninvasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography.
Objectives:
We performed a pre-specified secondary analysis of the la...
The efficacy of continuous positive airway pressure (CPAP) treatment in elderly
patients with non-severe obstructive sleep apnea (OSA) is controversial.
The objective of this study was to assess the effect of CPAP treatment in elderly
patients with moderate OSA on clinical, quality of life and neurocognitive
spheres.
Open-label, randomized, multice...
Anti-IL-5 therapy agents are an option of treatment for patients with severe eosinophilic asthma.
The objectives of this study were to describe the characteristics of patients on Mepolizumab therapy and to evaluate changes at 6 months of treatment on asthma control and changes on lung function.
Obstructive sleep apnoea (OSA) upregulates the programmed cell death-1 receptor and its ligand (PD-L1) pathway, potentially compromising immunosurveillance. We compared circulating levels of soluble PD-L1 (sPD-L1) in patients with cutaneous melanoma according to the presence and severity of OSA, and evaluated relationships with tumour aggressivenes...
Epidemiological associations linking between obstructive sleep apnea and poorer solid malignant tumor outcomes have recently emerged. Putative pathways proposed to explain that these associations have included enhanced hypoxia inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) cell expression in the tumor and altered immune fun...
Aim:
We analysed the effectiveness and safety of outpatient parenteral antibiotic therapy (OPAT) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in patients admitted to home hospitalisation units (HHU).
Methods:
Retrospective multicentre study of patients with AECOPD included in the Spanish OPAT Registry during 2 years pe...
Melanoma is a highly prevalent cancer that is associated with substantial mortality. Although clinical staging procedures can serve as relatively robust prognostic indicators, we aimed to determine whether assessments of the abundance of hypoxia inducible factor-1α (HIF-1α) or vascular endothelial growth factor (VEGF) in postexcisional melanoma tum...
Recent decades have seen the publication of numerous studies on the association between excessive sleep disordered breathing (SDB), particularly sleep apnoea, and an increase in cardiovascular morbidity and mortality. These studies have used a wide range of methodologies and criteria for patient inclusion. The results have been diverse, depending o...
Objectives
To analyze the reliability and validity of the Spanish version of the OSA-18 quality of life questionnaire in children with apnea-hypopnea syndrome (SAHS).
Method
Children with suspected SAHS were studied with polysomnography (PSG) before and after adenotonsillectomy (AA). Age, gender, clinical data, PSG, anthropometric data, and Mallam...
Rationale: Supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is paucity of data regarding its efficacy and safety.
Objectives: To assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS.
Methods: In this post-h...
Background: Obesity hypoventilation syndrome (OHS) is associated with a high burden of cardiovascular morbidity (CVM) and mortality. The majority of OHS patients have concomitant obstructive sleep apnea (OSA), but there is a paucity of data on the association between CVM and OSA severity in patients with OHS. The objective of our study was to asses...
Background:Guidelines do not state a specific advantage regarding the addition of macrolides or quinolones to beta-lactams in empirical combined antibiotic therapy. But little is known if there exists a survival benefit of the different regimes.
We aim to evaluate the impact in mortality of two different guidelines-recommended combined antibiotic t...
Objective. To analyze the relationship between sleep-disordered breathing (SDB) and markers of aggressiveness of malignant cutaneous melanoma (MCM).
Methods. 476 patients from 24 Spanish centers were screening. Thirty-three were exclude, and 402 patients had complete data. Inclusion criteria:>18 yr and proven MCM. Exclusion criteria: “in situ”melan...
Rationale: Noninvasive ventilation (NIV) is an effective treatment in patients with obesity hypoventilation syndrome (OHS) who have severe obstructive sleep apnea (OSA). However, there is paucity of evidence on the efficacy of NIV in OHS patients without severe OSA.
Objective: We performed a multicenter randomized clinical trial to determine the e...
Rationale:
Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety.
Objectives:
To assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS.
Methods:...
Background
Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial t...