Gutiérrez Guisado, Javier

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Gutiérrez Guisado






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    Obesity in Spanish Schoolchildren: Relationship with Lipid Profile and Insulin Resistance.
    (Obesity, 2012) Garcés, Carmen; Gutiérrez Guisado, Javier; Benavente, Mercedes; Cano, Beatriz; Viturro, Enrique; Ortega, Henar; De Oya, Manuel
    This article reports cross-sectional data from a total of 1048 children, 6 to 8 years of age, categorized by presence or absence of obesity, who participated in a voluntary survey of cardiovascular risk factors in Spain over the period of 1998 to 2000, to establish the relationship between obesity and its metabolic consequences at this age. The prevalence of obesity and overweight were 9.4% and 15.7%, respectively, in boys and 10.5% and 18.0%, respectively, in girls. We observed that, in both sexes, obese children had higher triglycerides and lower high-density lipoprotein-cholesterol levels than non-obese children. No differences were found in plasma glucose or low-density lipoprotein-cholesterol levels between normal and obese children. However, we observed that insulin levels and the homeostasis model assessment for insulin resistance were significantly (p < 0.001) higher in obese children of both sexes but that free fatty acid levels were lower in obese children than in nonobese children, with a statistical significance in girls (0.72 ± 0.30 vs. 0.61 ± 0.16 mEq/liter). In summary, our survey found some metabolic consequences of obesity similar to those found in adults (elevated triglycerides, insulin, and the homeostasis model assessment for insulin resistance, and lower high-density lipoprotein-cholesterol). However, other features (glucose, total cholesterol, low-density lipoprotein-cholesterol, and free fatty acid levels) were found to behave differently, indicating that the association of obesity with risk factors seems to change as the children age and may depend on the chronology of sexual maturation.
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    Characteristics, Treatment Patterns and Outcomes of Patients Presenting with Venous Thromboembolic Events After Knee Arthroscopy in the RIETE Registry.
    (Journal of Thrombosis and Thrombolysis, 2018) Weinberg, Ido; Giri, Jay; Kolluri, Raghu; Arcelus, Juan Ignacio; Falga, Conxita; Soler, Silvia; Braester, Andrei; Bascunana, Jose; Gutiérrez Guisado, Javier; Monreal, Manuel
    Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.
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    Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE Registry.
    (Thrombosis and Haemostasis, 2008) Arcelus, Juan Ignacio; Monreal, Manuel; Caprini, Joseph A.; Gutiérrez Guisado, Javier; Soto, Mª José; Núñez, Manuel Jesús; Alvárez, Juan Carlos
    There is little literature about the clinical presentation and timecourse of postoperative venous thromboembolism (VTE) in different surgical procedures. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic acuteVTE.In this analysis,we analysed the baseline characteristics, thromboprophylaxis and therapeutic patterns, timecourse, and three-month outcome of all patients with postoperative VTE. As of January 2006, there were 1,602 patients with postoperativeVTE in RIETE: 393 (25%) after major orthopaedic surgery (145 elective hip arthroplasty, 126 knee arthroplasty, 122 hip fracture); 207 (13%) after cancer surgery; 1,002 (63%) after other procedures. The percentage of patients presenting with clinically overt pulmonary embolism (PE) (48%, 48%, and 50% respectively), the average time elapsed from surgery toVTE (22 ± 16, 24 ± 16, and 21 ± 15 days, respectively), and the three- month incidence of fatal PE (1.3%, 1.4%, and 0.8%, respectively), fatal bleeding (0.8%, 1.0%, and 0.2%, respectively), or major bleeding (2.3%, 2.9%, and 2.8%, respectively) were similar in the three groups. However, the percentage of patients who had received thromboprophylaxis (96%, 76% and 52%, respectively), the duration of prophylaxis (17 ± 9.6, 13 ± 8.9, and 12 ± 11 days, respectively) and the mean daily doses of low-molecular-weight heparin (4,252 ± 1,016, 3,260 ± 1,141, and 3,769 ± 1,650 IU, respectively), were significantly lower in those undergoing cancer surgery or other procedures. In conclusion, the clinical presentation, time-course, and three-month outcome ofVTE was similar among the different subgroups of patients,but the use of prophylaxis in patients undergoing cancer surgery or other procedures was suboptimal.
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    Insulin and HOMA in Spanish prepubertal children: Relationship with lipid profile.
    (Clinical Biochemistry, 2005) Garcés, Carmen; Cano, Beatriz; Granizo, Juan J; Benavente, Mercedes; Viturro, Enrique; Gutiérrez Guisado, Javier; De Oya, Iria; Lasunción, Miguel A; De Oya, Manuel
    Objective: The effects of insulin or insulin resistance on the lipid profile seem to change with age. The aim of this study was to analyze insulin levels and an insulin resistance index and to investigate the relationship between these and the lipid profile in a population-based sample of Spanish prepubertal children. Methods: 1048 (524 boys and 524 girls) randomly selected prepubertal children were studied. Children were 6 to 8 years old with a mean age of 6.7. Plasma lipid, FFA and insulin levels were measured. The homeostatic model assessment (HOMA) was calculated as an indicator of insulin resistance. Results: When analyzing percentile values of insulin, HOMA and FFA by sex, we observed that girls had significantly higher insulin concentrations than boys (except at the 10th percentile) and significantly higher FFA (except at the 90th percentile) with no significant differences between sexes for HOMA. Multivariate regression analyses showed that insulin was positively associated with glucose, triglycerides and apoB in boys but not in girls, and negatively associated with FFA in both genders. Conclusions: We report here data about the distribution of insulin in the Spanish prepubertal population. The higher levels of insulin in prepubertal girls could indicate that girls start to be more insulin resistant than boys at this age, although other manifestations of insulin resistance are not yet detectable.
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    Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis.
    (Revista Clínica Española, 2018) Gutiérrez Guisado, Javier; Trujillo Santos, J.; Arcelus, J. I.; Bertoletti, L.; Fernández Capitán, C.; Valle, R.; Hernández Hermoso, J.A.; Erice Calvo Sotelo, A.; Nieto, J. A.; Monreal, M.
    BACKGROUND: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. METHODS: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. RESULTS: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). CONCLUSIONS: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures.
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    Occam can be wrong: a young man with lumbar pain and acute weakness of the legs.
    (The Lancet, 2006) Neira, M. Inmaculada; Sánchez, Javier; Moreno, Isabel; Chiaraviglio, Ana; Rayo, Alfonso; Gutiérrez Guisado, Javier; Erice, Alejo
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    Profilaxis tromboembólica en cirugía ortopédica y traumatología.
    (Revista Clínica Española, 2020) Gutiérrez Guisado, Javier
    La profilaxis tromboembólica en cirugía ortopédica está muy bien establecida en la cirugía ortopédica mayor (artroplastia de cadera y rodilla y cirugía de fractura de cadera) y habitualmente el agente elegido son las Heparinas de Bajo Peso Molecular (HBPM), si bien en los últimos años los Anticoagulantes de Acción Directa (ACODs), están ganando terreno y pueden utilizarse en este escenario (salvo en la cirugía de fractura de cadera) ; incluso en EEUU la aspirina podría tener su indicación en pacientes de bajo riesgo que se intervengan de artroplastia de cadera o rodilla. En el resto de cirugía ortopédica (cirugía de extremidad inferior por debajo de la rodilla, tobillo y pie; artroscopia de rodilla, cirugía de extremidad superior y cirugía de columna), dado que el riesgo de Enfermedad Tromboembólica es menor, exige una individualización de la profilaxis tromboembólica, según los factores de riesgo del paciente y las características de la cirugía. En este grupo de pacientes el agente elegido son las HBPM, dado que los ACODs no están aprobados en estos tipos de cirugía.