M Bruguera

Colegio Oficial de Médicos de Valencia, Valenza, Valencia, Spain

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Publications (356)1653.06 Total impact

  • Miguel Bruguera
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    ABSTRACT: La Asociación Española para el Estudio del Hígado se creó el año 1967 en Madrid por el empuje e iniciativa del catedrático de Medicina Don Manuel Díaz Rubio. Inicialmente denominada Asociación Española de Hepatología, fue una filial de la Sociedad Española de Patología Digestiva, de la que se ha ido independizando con el paso del tiempo. Los primeros congresos se celebraron en Madrid cada 2 años, y más tarde se inició una época de congresos itinerantes, hasta que en 1985 se acordó celebrarlos anualmente en Madrid. Uno de los hechos más destacados de los congresos ha sido su progresiva feminización, así como el incremento del número de trabajos cooperativos que se presentan.
    No preview · Article · Jan 2016
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    ABSTRACT: El especialista de cirugía ortopédica y traumatología, como cualquier facultativo, está sujeto en su ejercicio profesional a la normativa legal vigente y resulta imprescindible su formación en los aspectos médico-legales de obligado cumplimiento en la asistencia. Las reclamaciones contra los médicos son una realidad y la especialidad de cirugía ortopédica y traumatología ocupa el primer lugar en frecuencia de reclamaciones según los datos del Consejo General de Colegios de Médicos de Cataluña. Los profesionales deben conocer los aspectos fundamentales de la responsabilidad profesional médica, así como de la medicina defensiva y la seguridad clínica en su especialidad. La comprensión de estos aspectos médico-legales en la práctica clínica habitual puede ayudar a allanar el camino hacia una carrera profesional satisfactoria y segura. Con este trabajo de revisión queremos contribuir a esta formación en beneficio de profesionales y pacientes.
    Full-text · Article · Jan 2016
  • Miguel Bruguera
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    ABSTRACT: Liver diseases in the elderly have aroused less interest than diseases of other organs, since the liver plays a limited role in aging. There are no specific liver diseases of old age, but age-related anatomical and functional modifications of the liver cause changes in the frequency and clinical behavior of some liver diseases compared with those in younger patients. This review discusses the most important features of liver function in the healthy elderly population, as well as the features of the most prevalent liver diseases in this age group, especially the diagnostic approach to the most common liver problems in the elderly: asymptomatic elevation of serum transaminases and jaundice.
    No preview · Article · Nov 2014 · Gastroenterología y Hepatología
  • Miguel Bruguera
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    ABSTRACT: Liver diseases in the elderly have aroused less interest than diseases of other organs, since the liver plays a limited role in aging. There are no specific liver diseases of old age, but age-related anatomical and functional modifications of the liver cause changes in the frequency and clinical behavior of some liver diseases compared with those in younger patients. This review discusses the most important features of liver function in the healthy elderly population, as well as the features of the most prevalent liver diseases in this age group, especially the diagnostic approach to the most common liver problems in the elderly: asymptomatic elevation of serum transaminases and jaundice.
    No preview · Article · Jun 2014

  • No preview · Article · Apr 2014 · Journal of Hepatology
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    ABSTRACT: & Aims: Hy´s Law, which states that hepatocellular drug-induced liver injury (DILI) with jaundice indicates a serious reaction, is widely used to determine risk for acute liver failure (ALF). We aimed to optimize the definition of Hy´s Law and to develop a model for predicting ALF in patients with DILI. We collected data from 771 patients with DILI (805 episodes) from the Spanish DILI registry in Spain, from April 1994 through August 2012. We analyzed data collected at DILI recognition and at the time of peak levels of alanine aminotransferase (ALT) and total bilirubin (TBL). Of the 771 patients with DILI, 32 developed ALF. Hepatocellular injury, female sex, high levels of TBL, and a high ratio of aspartate aminotransferase (AST):ALT were independent risk factors for ALF. We compared 3 ways to use Hy's Law to predict which patients would develop ALF; all included TBL>2-fold the upper limit of normal (xULN) and either ALT>3xULN, an R value (ALT x ULN/ alkaline phosphatase x ULN) ≥5, or an nR value (ALT or AST, whichever produces the highest xULN/ alkaline phosphatase x ULN value) ≥5. At recognition of DILI, the R- and nR-based models identified patients who developed ALF with 67% and 63% specificity, respectively, whereas use of only ALT level identified them with 44% specificity. However, level of ALT and the nR model each identified patients who developed ALF with 90% sensitivity, whereas the R criteria identified them with 83% sensitivity. An equal number of patients who did and did not develop ALF had alkaline phosphatase levels >2xULN. An algorithm based on AST>17.3 x ULN, TBL >6.6 x ULN, and AST:ALT >1.5 identified patients who developed ALF with 82% specificity and 80% sensitivity. When applied at DILI recognition, the nR criteria for Hy's Law provides the best balance of sensitivity and specificity whereas our new composite algorithm provides additional specificity in predicting the ultimate development of ALF.
    Full-text · Article · Apr 2014 · Gastroenterology
  • L Caballería · G Pera · J Bernad · S Canut · E Navarro · M Bruguera
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    ABSTRACT: To evaluate which of the three studied strategies is the most effective to detect new cases of Hepatitis C virus (HCV) infections in primary care. This is an observational, prospective, and multicentre study evaluating three strategies. Strategy 1: provide an explanatory letter to adults assigned to two primary care teams (PCTs), inviting them to have a blood test. Strategy 2: place posters and leaflets in PCTs advertising the possibility of laboratory tests. Strategy 3: reexamine HCV antibody test results in patients with hypertransaminasemia diagnosed within the last two years through electronic records, and determine anti-HCV status in undiagnosed cases. There were a total 598 participants (51% female with an average age of 50.6±13 years). There were 238 people (4.1% of letters sent) in Strategy 1, 69 people (0.3% of potential participation) in Strategy 2, and 291 people (100% participation) from Strategy 3. One new case of HCV was found in both Strategy 1 and Strategy 2, representing a prevalence of 0.4 and 1.4%, respectively. Two new cases of HCV were found in Strategy 3, representing a prevalence of 0.7%. The three studied strategies for detecting new cases of HCV infection are ineffective, especially in regards to their cost and effort.
    No preview · Article · Mar 2014 · Revista Clínica Española
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    ABSTRACT: Antecedentes y objetivo Los premios a la excelencia del Colegio Oficial de Médicos de Barcelona (COMB) fueron instituidos en 2004 para reconocer la excelencia en el ejercicio profesional. Los premiados son elegidos anualmente por jurados nombrados por la junta de gobierno, cuyos miembros proponen médicos que en su opinión tienen un comportamiento profesional y humano ejemplar. Sujetos y métodos Hemos analizado el número de médicos y médicas que han obtenido este reconocimiento y la relación entre el número de varones y mujeres premiados con la distribución por géneros en los jurados. Asimismo se han comparado las edades de médicos y médicas premiados y la de colegiados y colegiadas de más de 45 años. Resultados La relación de varones y mujeres entre los premiados fue de 2,7/1 (rango: 1,2/1 para los premiados en Atención Primaria y 6/1 en el apartado Investigación), con una correlación directa no estadísticamente significativa entre la relación varones/mujeres premiados y jurados. La relación entre varones y mujeres colegiados con más de 45 años fue de 1,4/1, mientras que en los premiados fue de 2,7/1. En los últimos 4 años ha incrementado la proporción de mujeres en los jurados y de forma paralela ha aumentado el número de médicas premiadas. Conclusión El predomino de varones entre los premiados parece relacionarse con la mayor proporción de varones en la composición de los jurados.
    No preview · Article · Mar 2014
  • M Bruguera · P Arrizabalaga · M.C. Londoño · J Padrós
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    ABSTRACT: The awards for the excellence of the Official College of Physicians of Barcelona (COMB) were instituted in 2004 to recognize the excellence of the professional exercise. The winners are yearly chosen by juries appointed by the board of government, whose members propose for the award doctors who, in their opinion, have an exemplary professional and human behaviour. The number of male and female doctors who have obtained this recognition has been analysed in relation with the sex distribution in the juries. Likewise it has been compared the ratios men-to-women of those who have been rewarded and this ratio among physicians of more than 45 years. Between the awarded physicians the ratio men-to-women was of 2.7/1 (range, from 1.2/1 for awardees in primary care to 6/1 in research). The men-to-women ratio among those who were awarded was in parallel to the man-to-women ratios of the juries. The ratio between men and women among members of the COMB of more than 45 years was 1.4/1, whereas in those who were awarded it was of 2.7/1. The increase in the proportion of women in the juries in the last four years has been followed by an increase in the number of female physicians awarded. This data demonstrates that the predominance of male doctors among those who were awarded does not depend so much on the age factor, but basically on the proportion of male and female doctors in the juries.
    No preview · Article · Nov 2013 · Revista Clínica Española
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    Cristian Cerda · Miguel Bruguera · Albert Parés
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    ABSTRACT: Glucosamine and chondroitin sulfate are molecules involved in the formation of articular cartilage and are frequently used for symptom relief in patients with arthrosis. These molecules are well tolerated with scarce secondary effects. Very few cases of possible hepatotoxicity due to these substances have been described. The aim of this paper is to report the frequency of presumed glucosamine hepatotoxicity in patients with liver disease. A questionnaire was given to 151 consecutive patients with chronic liver disease of different etiology (mean age 59 years, 56.9% women) attended in an outpatient clinic with the aim of evaluating the frequency of consumption of these drugs and determine whether their use coincided with a worsening in liver function test results. Twenty-three patients (15.2%) recognized having taken products containing glucosamine or chondroitin sulfate previously or at the time of the questionnaire. Review of the clinical records and liver function tests identified 2 patients presenting an elevation in aminotransferase values temporarily associated with glucosamine treatment; one of the cases simultaneously presented a skin rash attributed to the drug. Review of these two patients and the cases described in the literature suggest toxicity of glucosamine and chondroitin sulfate. The clinical spectrum is variable, and the mechanism of toxicity is not clear but may involve reactions of hypersensitivity. The consumption of products containing glucosamine and/or chondroitin sulfate is frequent among patients with chronic liver diseases and should be taken into account on the appearance of alterations in liver function tests not explained by the underlying disease.
    Preview · Article · Aug 2013 · World Journal of Gastroenterology
  • Sabela Lens · María Leoz · Leyla Nazal · Miguel Bruguera · Albert Parés
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    ABSTRACT: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cirrhosis (PBC) but excellent response is not observed in all cases. Since potential favourable effects of fibrates have been reported in short series with inconclusive results, we have carried out a pilot study to analyse the effects of bezafibrate in patients with suboptimal response to UDCA. Thirty women (age 52.3 ± 2.3 years) treated with UDCA and abnormal alkaline phosphatase (AP) levels received bezafibrate (400 mg/d) for 1 year. Changes were measured every 3 months during the study period of 12 months, 3 months after discontinuation and 3 months after resuming bezafibrate. Two patients discontinued the treatment after few days, three at 6 and one at 9 months. Bezafibrate treatment resulted in a significant decrease in AP as early as 3 months. Normalization or decrease of AP below 1.5 times normal levels was observed in 13 and 4 patients respectively. There was also a significant decrease in γ-glutamyl transferase and alanine aminotransferase, cholesterol and triglyceride levels. Bezafibrate treatment resulted in significant improvement of pruritus. A rebound in liver biochemistries and pruritus occurred upon drug discontinuation, changes which improved again after resuming bezafibrate. Response to bezafibrate was associated with lower liver stiffness and severity of cholestasis. No severe adverse effects were observed. Combination treatment of bezafibrate and UDCA is associated with marked decrease or normalization of alkaline phosphatase as early as 3 months in patients with PBC. Better biochemical response was observed in patients with early disease and lower cholestasis.
    No preview · Article · Jul 2013 · Liver international: official journal of the International Association for the Study of the Liver
  • Miguel Bruguera · Juan G. Abraldes
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    ABSTRACT: Este trabajo tiene como objetivo dar respuesta a preguntas que con frecuencia se hacen médicos que atienden a pacientes con enfermedad de Wilson (EW) o pacientes en quienes se plantea la sospecha diagnóstica de que se trate de una EW. Tiene 2 partes, una con respuestas a preguntas relacionadas con el diagnóstico de la enfermedad y otra con respuestas a preguntas relacionadas con el tratamiento. Al final se incluye un breve apéndice con respuestas a preguntas que no se pueden incluir en las 2 anteriores categorías.
    No preview · Article · May 2013 · Gastroenterología y Hepatología

  • No preview · Article · Apr 2013 · Medicina Clínica
  • Miguel Bruguera · Juan G Abraldes
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    ABSTRACT: The present article aims to provide answers to questions frequently asked by physicians attending patients with Wilson's disease (WD) or those with a suspected diagnosis of WD. The article is divided into 2 parts: a first part with answers to questions relating to the diagnosis of this entity and a second with answers to questions concerning treatment. A brief appendix is included with responses to questions not falling into either of these 2 categories.
    No preview · Article · Apr 2013 · Gastroenterología y Hepatología
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    ABSTRACT: Precedents and aim The awards for the excellence of the Official College of Physicians of Barcelona (COMB) were instituted in 2004 to recognize the excellence of the professional exercise. The winners are yearly chosen by juries appointed by the board of government, whose members propose for the award doctors who, in their opinion, have an exemplary professional and human behaviour. Subjects and methods The number of male and female doctors who have obtained this recognition has been analysed in relation with the sex distribution in the juries. Likewise it has been compared the ratios men-to-women of those who have been rewarded and this ratio among physicians of more than 45 years. Results Between the awarded physicians the ratio men-to-women was of 2.7/1 (range, from 1.2/1 for awardees in primary care to 6/1 in research). The men-to-women ratio among those who were awarded was in parallel to the man-to-women ratios of the juries. The ratio between men and women among members of the COMB of more than 45 years was 1.4/1, whereas in those who were awarded it was of 2.7/1. The increase in the proportion of women in the juries in the last four years has been followed by an increase in the number of female physicians awarded. Conclusion This data demonstrates that the predominance of male doctors among those who were awarded does not depend so much on the age factor, but basically on the proportion of male and female doctors in the juries.
    No preview · Article · Jan 2013 · Revista Clínica Española
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    Full-text · Article · Jul 2012 · Annals of hepatology: official journal of the Mexican Association of Hepatology
  • M. Bruguera

    No preview · Article · Jun 2012 · Revista Clínica Española
  • M Bruguera

    No preview · Article · Jun 2012 · Revista Clínica Española
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    M. Bruguera

    Preview · Article · Jun 2012 · Revista Clínica Española
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    ABSTRACT: Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility.The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure.In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company.If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.
    No preview · Article · Apr 2012 · Revista Clínica Española

Publication Stats

5k Citations
1,653.06 Total Impact Points

Institutions

  • 2013-2014
    • Colegio Oficial de Médicos de Valencia
      Valenza, Valencia, Spain
  • 2009-2014
    • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
      Barcino, Catalonia, Spain
  • 1985-2014
    • Hospital Clínic de Barcelona
      • • Servicio de Hepatología
      • • Servicio de Hematología
      Barcino, Catalonia, Spain
  • 1971-2013
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 2011
    • University of Malaga
      • Facultad de Medicina
      Málaga, Andalusia, Spain
  • 2008
    • Hospital Universitario La Paz
      Madrid, Madrid, Spain
  • 1990-2008
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2006
    • Hospital Universitario San Cecilio
      Granata, Andalusia, Spain
  • 1998-2006
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 2000
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
  • 1999
    • University Hospital Vall d'Hebron
      • Department of Preventive Medicine and Epidemiology
      Barcino, Catalonia, Spain
    • La Fundacio Hospital de l' Esperit Sant
      Barcino, Catalonia, Spain
  • 1997
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
  • 1989-1994
    • Hospital Clínico, Maracaibo
      Maracaibo, Zulia, Venezuela
  • 1992
    • Navy Environmental & Preventive Medicine Unit Five
      San Diego, California, United States
  • 1991
    • Roche
      Bâle, Basel-City, Switzerland