R Galván

Critical Care (2003)

Leonardo Lorente María Lecuona Carolina García R Galván ML Mora

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported.To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period.All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge.Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH).Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively.Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH.TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH.Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels.Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH.Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency.These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common.Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity.

10.1186/cc2037

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Citations (0)

Critical Care (2010)

Leonardo Lorente S Palmero Cayetano Naranjo Juan J. Jiménez J Iribarren

In previous guidelines of the Centers for Disease Control and Prevention (CDC) [1] and in the recently published Guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) [2] it is recommended to avoid the femoral access to reduce the risk of catheter-related bacteremia (CRB). However, in these guidelines there are no recommendations for the catheter site regarding the presence of tracheostomy, and we have not found data about the incidence of CRB comparing a central jugular site with tracheostomy and a femoral site. The objective of this study was to determine whether a jugular site with tracheostomy may have a higher risk of CRB than a femoral site.

Bacteremia

10.1186/cc8618

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Citations (2)

Critical Care (2003)

Leonardo Lorente R Galván MM Martín Carolina García S Huidobro

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported.To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period.All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge.Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH).Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively.Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH.TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH.Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels.Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH.Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency.These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common.Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity.

10.1186/cc2027

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Citations (0)

[Uptake of technetium-99m pyrophosphate in cardiac amyloidosis].

PubMed (1985)

José Antonio García Montes Leonardo Ferrero López Francisco Martín Pinedo Ji R Galván

Technetium-99m

Cardiac Amyloidosis

Source

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Citations (1)

Influence of tracheostomy on the incidence of central venous catheter-related bacteremia

European Journal of Clinical Microbiology & Infectious Diseases (2009)

Leonardo Lorente Alejandro Jiménez María M. Martín J Castedo R Galván

Bacteremia

Central venous catheter

Medical microbiology

10.1007/s10096-009-0742-4

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Citations (39)

Dioxido de cloro como agente antimicrobiano para uso hospitalario. Valoracion microbiologica

Bioquimia (1989)

R Galván

Source

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Left ventricular TEI index: comparison between flow and tissue Doppler analyses and its association with postoperative atrial fibrillation in cardiopulmonary bypass surgery

Critical Care (2008)

J Iribarren Cayetano Naranjo M. Mora R Galván R Pérez

The TEI index (myocardial performance index), an indicator of combined ventricular systolic and diastolic function, is defined as the ratio of the sum of the isovolumic relaxation time and the isovolumic contraction time. The TEI index is independent of ventricular geometry, and is not significantly affected by heart rate or blood pressure. We sought to determine whether there was association with postoperative atrial fibrillation (AF) after cardiopulmonary bypass surgery.

10.1186/cc6467

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Preoperative tissue Doppler imaging and diastolic filling patterns on postoperative new-onset atrial fibrillation in cardiopulmonary bypass surgery

Critical Care (2008)

J Iribarren Juan José Jiménez Ignacio Laynez Antonio Barragán Juan Lacalzada‐Almeida

Postoperative atrial fibrillation is one of the most frequent complications after cardiopulmonary bypass (CPB) surgery. We evaluated the value of preoperative transthoracic echocardiography and tissue Doppler imaging (TDI) analysis of the mitral annulus and the incidence of postoperative new-onset atrial fibrillation (NOAF) in CPB surgery.

Doppler imaging

10.1186/cc6472

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Buprenorphine, Pain, and Opioid Use in Patients Taking High-Dose Long-Term Opioids

JAMA Internal Medicine (2025)

William C. Becker Karen H. Seal David Nelson Beth DeRonne Allyson M. Kats

Importance Guidelines recommend dose reduction or discontinuation of long-term opioid therapy when harm outweighs benefit, but strategies to help patients do so are limited. Objective To test optionally switching to buprenorphine as a strategy for improving pain and reducing opioids among patients prescribed high-dose, full agonist long-term opioid therapy. Design, Setting, and Participants In this pragmatic, multisite, 12-month randomized clinical trial with masked outcome assessment, patients treated at Veterans Affairs primary care clinics were recruited from October 2017 to March 2021, with follow-up completed June 2022. Eligible patients had moderate to severe chronic pain despite high-dose opioid therapy (≥70 mg/d for at least 3 months). Patients were randomized to having the option to switch to buprenorphine or not having the option to switch. Interventions The buprenorphine option was discussed with eligible patients as part of a larger trial of collaborative pain care interventions. Those who switched had structured follow-up to optimize dosing and address adverse effects. Main Outcomes and Measures The primary outcome was Brief Pain Inventory total score at 12 months. The main secondary outcome was opioid dose in morphine milligram equivalents at 12 months. Results Of 207 included participants, 185 (89.4%) were male, and the mean (SD) age was 60.9 (10.2) years. A total of 104 were randomized to the buprenorphine option and 103 to the no buprenorphine option. In the buprenorphine option arm, 27 participants (26.0%) switched. Over 12 months, the mean (SD) Brief Pain Inventory score improved from 6.8 (1.5) to 6.1 (1.9; adjusted mean difference [AMD], −0.59; 95% CI, −0.89 to −0.29) in the buprenorphine option arm and from 6.8 (1.6) to 6.3 (1.7; AMD, −0.50; 95% CI, −0.81 to 0.20) in the no option arm (between-group AMD, −0.09; 95% CI, −0.52 to 0.34). Over 12 months, mean (SD) opioid dosage decreased from 157 (75) mg/d to 94 (98) mg/d in the buprenorphine option arm (AMD, −61.0 mg/d; 95% CI, −74.1 to −47.9) and from 165 (88) mg/d to 107 (89) mg/d (AMD, −58.5 mg/d; 95% CI, −71.6 to −45.4) in the no option arm (between-group AMD, −2.5 mg/d; 95% CI, −21.1 to 16.0). Conclusions and Relevance In this trial, outcomes did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage, but the proportion of participants who switched to buprenorphine was low. Trial Registration ClinicalTrials.gov Identifier: NCT03026790

Discontinuation

10.1001/jamainternmed.2024.8361

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Incidence of nosocomial infection in patients with nontraumatic or traumatic coma

Critical Care (2008)

L Ramos J Castedo R Galván Carolina García J Iribarren

IntroductionIn order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project.Methods This study was conducted within the framework of MPVM student research projects by means of collaboration between

Coma (optics)

10.1186/cc6233

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Citations (2)

Papers

Citation

H-Index

i-10 index

Papers

Citation

H-Index

i-10 index