Isabel Maria Vera - Academia.edu (original) (raw)

Papers by Isabel Maria Vera

PloS one, 2018

Zika virus has created a major epidemic in Central and South America, especially in Brazil, durin... more Zika virus has created a major epidemic in Central and South America, especially in Brazil, during 2015-16. The infection is strongly associated with fetal malformations, mainly microcephaly, and neurological symptoms in adults. During the preparation of the Rio de Janeiro Olympic Games in 2016, members of Olympic Delegations worldwide expressed their concern about the health consequences of being infected with Zika virus. A major risk highlighted by the scientific community was the impact on the spreading of the virus into new territories immediately after the Games. To detect real-time incidence of symptoms compatible with arboviral diseases and other tropical imported diseases among the Spanish Olympic Delegation (SOD) attending the Rio Olympic Games in 2016. We developed a surveillance platform based on a mobile application installed in participant's smartphones that monitored the health status of the SOD through a daily interactive check of the user health status including ...

Alimentary pharmacology & therapeutics, 2018

Effectiveness of vedolizumab in real world clinical practice is unknown. To evaluate the short an... more Effectiveness of vedolizumab in real world clinical practice is unknown. To evaluate the short and long-term effectiveness of vedolizumab in patients with inflammatory bowel disease (IBD). Patients who received at least 1 induction dose of vedolizumab were included. Effectiveness was defined based on Harvey-Bradshaw index (HBI) in Crohn's disease (CD) and Partial Mayo Score (PMS) in ulcerative colitis (UC). Short-term response was assessed at week 14. Variables associated with short-term remission were identified by logistic regression analysis. The Kaplan-Meier method was used to evaluate the long-term durability of vedolizumab treatment. Cox model was used to identify factors associated with discontinuation of treatment and loss of response. 521 patients were included (median follow-up 10 months [interquartile range 5-18 months]). At week 14, 46.8% had remission and 15.7% clinical response. CD (vs UC), previous surgery, higher CRP concentration and disease severity at baseline...

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 2018

To reach a situation diagnosis on the status of patient management at digestive care units (DCUs)... more To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain. A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014). Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% ...

Drug Design, Development and Therapy, 2017

Eluxadoline is a novel drug approved for the management of diarrhea predominant irritable bowel s... more Eluxadoline is a novel drug approved for the management of diarrhea predominant irritable bowel syndrome (IBS-D). It has unique pharmacology and works on three different opioid receptors. Several Phase II and III clinical trials have demonstrated eluxadoline's efficacy in reducing symptoms related to IBS-D. Clinical trial results and postmarketing reports show a risk of pancreatitis in patients without a gallbladder or those abusing alcohol. This review article will include information on clinical trial results related to IBS-D management as well as eluxadoline's limitations.

Gastroenterología y Hepatología, 2017

a,b , on behalf of the Helicobacter pylori Study Group of the Asociación Española de Gastroentero... more a,b , on behalf of the Helicobacter pylori Study Group of the Asociación Española de Gastroenterología (AEG)

Digestive and Liver Disease, 2016

Background: Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did ... more Background: Anti-TNF treatment is effective for Crohn's disease (CD); however, some patients did not achieve remission with these drugs. Aims: To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability. Methods: Patients who did not achieve remission with their first anti-TNF were included. The shortterm response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy.

Journal of Crohn's and Colitis, 2015

Background and Aims: Patients with ulcerative colitis (UC) are at increased risk of developing co... more Background and Aims: Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer (CRC), but recent studies suggest a lower risk than previously reported. The aim was to evaluate the incidence of dysplasia, CRC and related risk factors in UC patients from a Spanish nationwide database. Methods: All UC patients were identified and retrospectively reviewed. Clinical-epidemiological data and the finding of dysplasia and/or CRC were collected. Results: A total of 831 UC patients were included. Twenty-six cases of CRC in 26 patients and 29 cases of high-grade dysplasia (HGD) in 24 patients were found, accounting for 55 diagnoses of advanced neoplasia (AN = CRC and/or HGD) in 45 patients (33% of them within the first 8 years after UC diagnosis). The cumulative risk of AN was 2, 5.3 and 14.7% at 10, 20 and 30 years, respectively. Concomitant primary sclerosing cholangitis (odds ratio [OR] 10.90; 95% confidence interval [CI] 3.75-31.76, p < 0.001), extensive UC (OR 2.10, 95% CI 1.01-4.38, p = 0.048), UC diagnosis at an older age (OR 2.23, 95% CI 1.03-4.83, p = 0.043) and appendectomy prior to UC diagnosis (OR 2.66, 95% CI 1.06-6.71, p = 0.038) were independent risk factors for AN. Use of thiopurines (OR 0.21, 95% CI 0.06-0.74, p = 0.015) and being in a surveillance colonoscopy programme (OR 0.33; 95% CI 0.16-0.67; p = 0.002) were independent protective factors for AN.

Journal of Crohn's and Colitis Supplements, 2008

quent adverse events were infussional reactions and the most critical were infections. Toxicity w... more quent adverse events were infussional reactions and the most critical were infections. Toxicity was associated with older age in diagnosis and smoking habit.

Gastroenterología y Hepatología, 2009

La morbilidad en la colitis ulcerosa (CU) y el tratamiento medico elegido para su control se rela... more La morbilidad en la colitis ulcerosa (CU) y el tratamiento medico elegido para su control se relaciona directamente con la necesidad de cirugía en el curso de la enfermedad.

Revista Española de Enfermedades Digestivas, 2013

Background: patient satisfaction with healthcare services provided for inflammatory bowel disease... more Background: patient satisfaction with healthcare services provided for inflammatory bowel diseases (IBD) is essential due to high resources use. Objectives: the study aimed to describe patient satisfaction with healthcare services using the CACHE questionnaire and to assess gastroenterologist and nurse perception on patients' satisfaction. Methods: observational multicentric prospective study in 35 Spanish hospitals. Patients included had Crohn's disease or ulcerative colitis. The study was approved by the Hospital Universitari Vall d´Hebron Ethics Committee. Scheduled study visits: baseline (patient sociodemographics and clinical data were collected), 2-4 and 6-months. Patient satisfaction with healthcare was assessed by CACHE questionnaire at each visit; it scores from 0-least satisfaction to 100-highest satisfaction. Gastroenterologists and nurses answered once an adapted questionnaire. Results: participating 290 patients (54.2 % males, 41.3 years old), 62 gastroenterologists and 47 nurses. At baseline mean (SD) CACHE score was 81.7 (10.9); satisfaction with clinician care was the highest, patient information the lowest. Scores did not change across study. Gastroenterologist global score was 72.5 (9.8); Staff Care satisfaction was the highest, patient information the lowest. All scores were significantly lower than patients´. Nurses´ global score was 82.2 (8.5), clinician care satisfaction was the highest, centre facilities the lowest. Scores on satisfaction with clinician care, centre facilities, and patient information scored statistically lower than patients´. No relationship was found between patients´ satisfaction and patients characteristics. Conclusions: IBD patients are satisfied with healthcare services provided, even though the information may be improved. Nurses' perception is similar to that of patients, physicians have a lower perception.

Gastroenterología y Hepatología, 2008

BACKGROUND: Efficacy of infliximab in Crohn's disease (CD) showed by randomized controlled trials... more BACKGROUND: Efficacy of infliximab in Crohn's disease (CD) showed by randomized controlled trials must be confirmed in clinical practice. We aimed to evaluate efficacy and safety of infliximab in CD patients of the Madrid area, looking for clinical predictors of response. METHODS: Multicenter retrospective survey of all CD patients treated with infliximab in 8 University hospitals of the Madrid area (Spain) with a minimum follow up of 14wks. RESULTS: 169 patients included (48%males, mean age 39 ± 12 yrs). 64% of them had perianal disease. 82% were under immunosuppressants. 1355 infliximab infusions administered (mean 8, range 1-30). 90% response rate and 4 8 % remission rate were obtained with induction therapy. 73% followed maintenance treatment, and 78% of them maintained or improved the response after a mean follow up of 28 months (range 3.5-86). 24 patients lost response during the follow up, after a mean of 41wks (range 6-248). Only the prescription of maintenance therapy was predictive factor for favourable response (p < 0.01). 17 infusion reactions were reported (10% of the patients, 1.2% of the infusions; only one case was severe) and were the cause of treatment withdrawal in 7 patients. Co-treatment with immunosuppressive drugs and maintenance infliximab therapy were protective factors for infusion reactions (p < 0.05). Other adverse events occurred in 26% of the patients, and were cause of treatment withdrawal in 7 patients. CONCLUSIONS: Infliximab is effective and safe for CD management but concomitant immunosuppressive drugs and maintenance treatment should be prescribed to obtain the best outcome. That confirms in a real life clinical setting the favourable results obtained in randomized clinical trials. ENFERMEDAD DE CROHN E INFLIXIMAB: ESTUDIO RETROSPECTIVO Y MULTICÉNTRICO SOBRE SU EFICACIA, SEGURIDAD Y FACTORES PREDICTIVOS DE RESPUESTA A LARGO PLAZO OBJETIVO: La eficacia de infliximab en la enfermedad de Crohn (EC), demostrada por los diferentes ensayos clínicos, ha de ser confirmada en la práctica clínica. Nuestro objetivo fue evaluar la eficacia y la seguridad del infliximab en pacientes con EC del área de Madrid, buscando predictores de respuesta. MÉTODOS: Estudio retrospectivo y multicéntrico que incluye los pacientes con EC tratados con infliximab en 8 hospitales de la Comunidad de Madrid, con un seguimiento mínimo de 14 semanas. RESULTADOS: Se incluyó a un total de 169 pacientes (un 48% varones, con una edad de 39 ± 12 años), un 64% con enfermedad perianal y un 82% bajo tratamiento inmunosupresor. Se administraron un total de 1.355 perfusiones de infliximab (media, 8; rango, 1-30): un 90% de los pacientes respondió, un 48% alcanzó la remisión clínica, un 73% siguió tratamiento de mantenimiento, y un 78% mantuvo o mejoró su respuesta tras un seguimiento medio de 28 meses (rango, 3,5-86). Se perdió la respuesta durante el seguimiento de 24 pacientes, tras una media de 41

Gastroenterología y Hepatología, 2015

Methotrexate is an immunosuppressant that may be useful in several clinical scenarios in inflamma... more Methotrexate is an immunosuppressant that may be useful in several clinical scenarios in inflammatory bowel disease. In this article, we review the available evidence in Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and ulcerative colitis and establish general recommendations for its use in clinical practice. Although the available data are limited, it is very likely that methotrexate is underused because its effectiveness is underestimated and its toxicity is overestimated. Both in induction therapy and in maintenance of remission, methotrexate is useful in Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. When prescribed in combination with biologic agents, immunogenicity is less frequent and consequently long-term response could potentially be improved. There are few published studies, but several data suggest that methotrexate could also be useful in ulcerative colitis. Although myelotoxicity and liver toxicity are well known risks, methotrexate is a drug that is well tolerated in many patients, even in the long term.

Vaccine, 2011

To evaluate possible persistence of 17D yellow fever vaccine, we tested urine samples from 44 hea... more To evaluate possible persistence of 17D yellow fever vaccine, we tested urine samples from 44 healthy recipients of yellow fever vaccine at varying times up to one year after vaccination. Urine samples from two vaccine recipients had detectable yellow fever virus RNA. The time since vaccination was reported as 21 days for one sample and 198 days for the other sample. These results suggest that yellow fever vaccine virus might persist for at least 6 months after vaccination in some people.

Journal of Crohn's and Colitis, 2009

Presentations have pseudopolyposis in 20/146 pts (13%) (c 2 test=1.02; p value NS). In the group ... more Presentations have pseudopolyposis in 20/146 pts (13%) (c 2 test=1.02; p value NS). In the group of UC pts there are 31with left-sided disease and 61 with pancolitis. In the left sided group indidence of pseudopolyposis is 29% (9/29), and in pancolitis 11% (10/61) (c 2 test 0.75, p value NS). Conclusion: There is no difference in prevalence of pseudopolyposis in patients with ulcerative colitis and Crohn colitis in our cohort, also no difference in incidence regarding the initial extension of the disease in UC. We can conclude that phenotype (UC:CC) isn't relevant for the development of colonic pseudopolyposis.

Journal of Crohn's and Colitis, 2013

Background and aims: The aim of the present study was to analyze the satisfaction of health care ... more Background and aims: The aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction. Methods: Cross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care. Results: A total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p b 0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of

Inflammatory Bowel Diseases, 2009

The diagnosis of inflammatory bowel disease (IBD), as well as the evaluation of disease activity,... more The diagnosis of inflammatory bowel disease (IBD), as well as the evaluation of disease activity, can be challenging. The aim of the study was to evaluate the significance of onestep card tests for fecal calprotectin (FC) and fecal lactoferrin (FL) in patients with IBD. Material and methods: We have examined fecal samples for FC and FL obtained from 29 patients with IBD (15 with ulcerative colitis-UC and 14 with Crohn's disease-CD) and 12 healthy individuals. A qualitative one-step card test was used for each marker. Results: We obtained a sensitivity of 72.4% and 44.8%, for FC and FL, respectively, and positive predictive value (PPV) of 100% for both tests, and negative predictive value (NPV) 60% and 42%, respectively. We found a correlation between the disease activity of CD patients and FC level (p = 0.024, r = 0.583) with Likelihood Ratio (LR) 4.31 (p = 0.038). FC demonstrated also association with platelet count (p = 0.007), serum iron (p = 0.031) and disease duration (p = 0.027), whereas FL showed association with platelet count (p = 0.001), CRP (p = 0.023) and presence of complications (p = 0.017). Conclusion: The one-step card test for fecal markers is useful in the diagnosis of IBD, although FC showed better performance than FL. However, both markers are useful in clinical practice where FC can assess the severity of CD, while FL is elevated in complicated IBD.

Gastroenterology, 2010

No abstract is available. To read the body of this article, please view the PDF online. ... © 201... more No abstract is available. To read the body of this article, please view the PDF online. ... © 2010 AGA. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site do not constitute a ...