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10. Impact of ABVD chemotherapy on ovarian reserve after fertility preservation in reproductive-aged women with Hodgkin lymphoma

Author

Policiano C, Subirá J, Aguilar A, Monzó S, Iniesta I, and Rubio Rubio JM

Subjects
endocrine system, endocrine system diseases, Ovarian reserve, ABVD, Anti-Mullerian hormone, Fertility preservation, Hodgkin lymphoma
Abstract

Research question How is ovarian reserve affected by chemotherapy in patients with Hodgkin lymphoma (HL) who undergo fertility preservation (FP)? Methods A retrospective study was conducted by reviewing medical records of 105 HL patients referred to the FP unit before starting adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. Ovarian reserve was evaluated before chemotherapy and at the last follow-up using anti-Mullerian hormone (AMH) and antral follicle count (AFC) measurements. The decrease in AMH was compared with that expected from normograms. AMH was compared between patients who underwent cryopreservation of ovarian tissue and those who underwent cryopreservation of mature oocytes. Results After ABVD, 15% of patients required hematopoietic stem cell transplantation. At a median follow-up of 33 months, the median decrease in AMH was 0.88 ng/mL, which was significantly greater than that of the general population of this age group (p < 0.001). Of the 82 women who only had ABVD, 38 underwent FP by cryopreservation of mature oocytes and 44 underwent cryopreservation of the ovarian cortex. There was no significant difference in AMH or AFC at the last follow-up between FP techniques. Conclusion Although ABVD is considered to be of low gonadotoxic risk, the decrease in AMH was greater than expected for patients' age, and 15% of patients needed more aggressive therapy during follow-up. Type of FP was not associated with decline in ovarian reserve. Reproductive-aged women with HL should have the opportunity for FP counseling before starting treatment.

Published
2020

13. EpiNet as a way of involving more physicians and patients in epilepsy research: Validation study and accreditation process

Author

Bergin, P. S., Beghi, E., Sadleir, L. G., Brockington, A., Tripathi, M., Richardson, M. P., Bianchi, E., Srivastava, K., Jayabal, J., Legros, B., Ossemann, M., Mcgrath, N., Verrotti, A., Tan, H. J., Beretta, S., Frith, R., Iniesta, I., Whitham, E., Wanigasinghe, J., Ezeala-Adikaibe, B., Striano, P., Rosemergy, I., Walker, E. B., Alkhidze, M., Rodriguez-Leyva, I., Ramirez Gonzalez, J. A., D'Souza, W. J., Calle, A., Palacios, C., Cairns, A., Carney, P., Craig, D., Gill, D., Gupta, S., Lander, C., Laue-Gizzi, H., Hitchens, N., Kiley, M., Lawn, N., Reyneke, E., Riney, K., Tan, M., Thieban, M., Wong, C., van Rijckevorsel, G., Ferrari Strang, A. G., Gifoni, A., Helio, L., Monnerat, B., Brna, P., Donner, E., Jacques, S., Jette, N., Mclachlan, R., Mohamed, I., Tran, T. P. Y., Bo, X., Fan, S., Guang, Y., Li, M., Wang, K., Zhang, S., Ladino, L., Christensen, J., Kӧlmel, M. S., Nikanorova, M., Uusitalo, A., Vieira, P., Auvin, S., Ediberidze, T., Gogatishvili, N., Jishkariani, T., Dennig, D., Grimmer, A., Michaelis, R., Schubert-Bast, S., Stephani, C., Stodieck, S., Vollbrandt, M., Zellner, A., Zafeiriou, D., Fogarasi, A., Halasz, P., Chaurasia, R. N., Jain, S., Nair, R., Passi, P., Rajadhyaksha, S., Sattaluri, S. J., Shah, H., Udani, V., Costello, D., Aguglia, U., Bartocci, A., Benna, P., Ferlazzo, E., Laino, D., Spalice, A., Zanchi, C., Ali, A., Lim, K. S., Ramirez, A., Anderson, N., Barber, A., Cariga, P., Cleland, J., Child, N., Davis, S., Dayal, V., Dickson, C., Doran, J., Duncan, R., Giri, P., Herd, M., Hutchinson, D., Jones, B., Kao, J., Kilfoyle, D., Mottershead, J., Muir, C., Nolan, M., Pereira, J., Ranta, A., Sadani, S., Simpson, M., Spooner, C., Timmings, P., Walker, E., Wei, D., Willoughby, E., Wong, E., Wu, T., Olusola, T., Mahmud, H., Mogul, Z., Espinoza, J., Vizarreta, J. H., Baeta, E. M., Teotonio, R., Jocic-Jakubi, B., Lukic, S., Korosec, M., Zgur, T., Eguilaz, M. G., Asztely, F., Sithinamsuwan, P., Anderson, J., Auce, P., Desurkar, A., Hamandi, K., Kelso, A., Sanchez, V., Sidra, A., Smith, P., Wehner, T., Winston, G., Andrade, E., Bensalem-Owen, M., Boudreau, M., Caller, T., Chapman, K., Chari, G., Davis, K., Droker, B., El-Hagrassy, M., Eliashiv, D., Eze, C., Heck, C., Kabir, A., Kolesnik, D., Lam, A., Lopez, J., Maamoon, T., Cohen, J. M., Maganti, R., Nwankwo, C., Park, K., Proteasa, S., Sandok, E., Seinfield, S., Toub, J., Wirrell, E., Arbildi, M., Thien, T. T., UCL - SSS/IONS/NEUR - Clinical Neuroscience, and UCL - (MGD) Service de neurologie

Subjects
0301 basic medicine, medicine.medical_specialty, Validation study, education, Alternative medicine, Multicenter collaboration, Diagnostic accuracy, Accreditation, 03 medical and health sciences, Epilepsy, Clinical trials, 0302 clinical medicine, Clinical Trials, Multicentre Collaboration, medicine, health care economics and organizations, Kappa value, business.industry, medicine.disease, Invited Original Research, Clinical trial, 030104 developmental biology, Neurology, Family medicine, Etiology, Neurology (clinical), business, 030217 neurology & neurosurgery, Cohort study, Biomedical engineering
Abstract

Objective\ud \ud EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator‐led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet‐First trials.\ud Methods\ud \ud Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet‐First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false‐positive errors and could make only one error regarding seizure classification.\ud Results\ud \ud Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet‐First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70.\ud Significance\ud \ud We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet‐accredited and to participate in these investigator‐led clinical trials.

Published
2017
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14. Oocyte vitrification versus ovarian cortex transplantation in fertility preservation for adult women undergoing gonadotoxic treatments: a prospective cohort study

Author

Diaz-Garcia C, Domingo J, Garcia-Velasco J, Herraiz S, Mirabet V, Iniesta I, Cobo A, Remohi J, and Pellicer A

Subjects
fertility preservation, Oocyte vitrification, ovarian cortex cryopreservation and transplantation
Abstract

Objective: To compare the efficacy of oocyte vitrification (OV) with that of ovarian cortex cryopreservation and transplantation (OCT) in women undergoing gonadotoxic treatments. Design: Prospective observational cohort study. Setting: Not applicable. Patient(s): Candidates for chemo-/radiotherapy who joined our fertility preservation (FP) program were included in this study between 2005 and 2015. One cohort included 1,024 patients undergoing OV; the other cohort included 800 patients undergoing OCT. Intervention(s): OV using the cryotop device and OCT using a slow freezing protocol. Main Outcome Measure(s): Live-birth rate (LBR) and clinical pregnancy rate (CPR). Result(s): Basal antimullerian hormone levels of the patients revealed no differences in ovarian reserve before FP (OV, 11.6 pM [5.4-24.7]; OCT, 11.8 pM [6.4-21.9]). In the OV cohort, 49 patients used the vitrified oocytes after a mean storage time of 3.9 years. In the OCT cohort, 44 sought pregnancy after a mean storage time of 5.5 years. A trend toward higher CPR and LBR (per patient) was observed in the OV group (risk ratio [RRCPR], 1.31 [95% confidence interval, 0.90-1.92]; RRLBR 1.39 [95% confidence interval, 0.95-2.03]), although differences were not statistically significant. In the OCT group, 46.7% of pregnancies occurred spontaneously and no pregnancy was achieved when the tissue was harvested beyond the age of 36 years. All patients except three undergoing OCT resumed or improved endocrine ovarian function. Conclusion(s): Although we observed a trend toward higher LBR after OV, OCT is a very effective method to preserve fertility, allows for natural pregnancy, and restores ovarian function. In clinical scenarios where OV is not feasible, OCT remains the FP technique of choice and should no longer be considered experimental. (C) 2017 by American Society for Reproductive Medicine.

Published
2018

17. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Author

Bath, Philip M, primary, Woodhouse, Lisa J, additional, Appleton, Jason P, additional, Beridze, Maia, additional, Christensen, Hanne, additional, Dineen, Robert A, additional, Duley, Lelia, additional, England, Timothy J, additional, Flaherty, Katie, additional, Havard, Diane, additional, Heptinstall, Stan, additional, James, Marilyn, additional, Krishnan, Kailash, additional, Markus, Hugh S, additional, Montgomery, Alan A, additional, Pocock, Stuart J, additional, Randall, Marc, additional, Ranta, Annemarei, additional, Robinson, Thompson G, additional, Scutt, Polly, additional, Venables, Graham S, additional, Sprigg, Nikola, additional, Christensen, L M, additional, Bentsen, L, additional, Krarup Hansen, C, additional, Thomsen, T T, additional, Kruuse, C, additional, Jensen, H H, additional, Hansen, S S, additional, Petrovic, V, additional, Beridze, N, additional, Kakabadze, N, additional, Kherkheulidze, T, additional, Kakabadze, D, additional, Toidze, I, additional, Lobjanidze, N, additional, Akiashvili, N, additional, Tevdoradze, A, additional, Khizanishvili, N, additional, Tsanava, T, additional, Taylor, R, additional, Iniesta, I, additional, Kok, J, additional, Duignan, J, additional, Funnell, M, additional, Cariga, P, additional, Rodriguez, M, additional, Watson, I J, additional, Tennant, S, additional, Macleod, M, additional, Furnace, J, additional, Gow, H, additional, Irvine, J, additional, Joyson, A, additional, Nelson, S, additional, Taylor, V, additional, Smith, M, additional, Bellfield, R, additional, Hairsine, B, additional, Davies, R, additional, Dodd, A, additional, Corrigan, J, additional, Doherty, M, additional, Ahmed, A, additional, Denniss, C, additional, Johnson-Holland, S, additional, Kay, K A, additional, Palau, R Icart, additional, Auld, G, additional, Daboo, P, additional, Erande, R, additional, Grimwood, G, additional, Hove, D, additional, Howaniec, L, additional, Redjep, O, additional, Rangasamay, R, additional, Butt, G, additional, Sandler, D, additional, Reddan, J, additional, Stafford, S, additional, McIlmoyle, J, additional, Maguire, S, additional, Murphy, P, additional, Chambers, J, additional, Guthrie, L, additional, Osborn, M, additional, Steele, A, additional, Burn, M, additional, Benford, A, additional, Misra, A, additional, Hilton, D, additional, O'Brien, E, additional, Amis, E, additional, Finlay, S, additional, Mitchell, J, additional, Geraghty, O, additional, Harvey, K, additional, Hazel, B, additional, Mashate, S, additional, Wilding, P, additional, Sajid, M, additional, Ball, M, additional, Gascoyne, R, additional, Sivakumar, R, additional, Wright, A, additional, Chatterjee, K, additional, Booth, S, additional, Eccleson, H, additional, Kelly, C, additional, Leason, S, additional, Perkins, C, additional, Bruce, D, additional, Brown, E, additional, Clayton, S, additional, Garside, M, additional, Rogers, G, additional, Lawrence, E, additional, Mahmood, S, additional, Watchurst, C, additional, Chadha, D, additional, Glover, L, additional, Holford, L, additional, Smith, K, additional, Walstow, D, additional, Williams, R, additional, O'Shea, L, additional, Goodsell, J, additional, Athulathmudali, C, additional, Barbon, E, additional, Namushi, R, additional, Jacob, P, additional, Johnson, L, additional, Morse, D, additional, McGhee, C, additional, Speirs, O, additional, Atkinson, S, additional, Peacocke, A, additional, Langhorne, P, additional, Graham, R, additional, Wright, F, additional, McAlpine, C, additional, Ravindrane, A, additional, Bajoriene, M, additional, Matter, L, additional, Windebank, S, additional, Giallombardo, E, additional, Dellafera, D, additional, Eglinton, C, additional, Wilson, J, additional, Broughton, D, additional, Chapman, K, additional, Dixon, L, additional, Zaidi, M, additional, Ayes, K, additional, Kessell, J, additional, Manawadu, D, additional, Adegbaju, O, additional, Aeron-Thomas, J, additional, Anderson, K, additional, Brigden, A, additional, Cattermole, E, additional, Good, J, additional, Hassan, S, additional, Khoromana, E, additional, Lee-Carbon, L, additional, Marks, K, additional, Mckenzie, E, additional, Sikondari, N, additional, Cooper, M, additional, Whysall, K, additional, Wynter, I, additional, Bamford, J, additional, Hassan, A, additional, Wanklyn, P, additional, Kambafwile, M, additional, Makawa, L, additional, Waugh, D, additional, Veraque, E, additional, Soliman, MGG, additional, Arif, S, additional, Brown, R, additional, Butler, S, additional, Hewitt, C, additional, Hindle, J, additional, Pusalkar, A, additional, Beadle, H, additional, Chan, K, additional, Siddiqui, M, additional, Dangri, P, additional, Buddha, S, additional, Asokanathan, A, additional, Mistri, A, additional, Eveson, D, additional, Musarrat, K, additional, Manning, L, additional, Anand, S, additional, Christian, P, additional, Khan, S, additional, Patel, C, additional, Sein, M, additional, Banns, J, additional, Gibson, E, additional, Gordon, T, additional, Gruenbeck, Y, additional, Wong, S, additional, Datta, P, additional, Bateman, G, additional, Jackson, L, additional, Needle, A, additional, Duodu, Y, additional, Oliver, R, additional, Padilla-Harris, C, additional, Barber, M, additional, Esson, D, additional, Brodie, F, additional, McInnes, C, additional, Fotherby, K, additional, Butler, D, additional, Morgan, D, additional, Preece, K, additional, Willberry, A, additional, Dent, M, additional, Hammonds, F, additional, Hunt, J, additional, Vernon, C, additional, O'Kane, D, additional, Faola, F, additional, Lai, P, additional, O'Callaghan, J, additional, Smith, C, additional, Price, C, additional, Lakey, R, additional, Riddell, V, additional, Smith, A, additional, Storey, G, additional, Munshi, S, additional, Buck, A, additional, Clarke, J, additional, Gilzeane, N, additional, Godfrey, M, additional, Keshvara, R, additional, Richardson, C, additional, Roffe, J, additional, Ryan, L, additional, Shelton, F, additional, Sunman, W, additional, Tittle, A, additional, Tomlinson, J, additional, Whittamore, K, additional, Wilkes, G, additional, Owusu-Agyei, P, additional, Temple, N, additional, Mangion, D, additional, Hardwick, A, additional, Netherton, K, additional, Nor, A Mohd, additional, Hyams, B, additional, Norman, S, additional, Persad, N, additional, Ragab, S, additional, Dickson, C, additional, Dube, J, additional, Jinks, E, additional, Knops, K, additional, Wadams, B, additional, Ali, K, additional, Gaylard, J, additional, Spurling, G, additional, Sztriha, L, additional, Ajao, T, additional, Alao, M, additional, Chan, F K, additional, Webster, P, additional, Howard, P, additional, Dobson, T J, additional, Hyatt, L, additional, Sims, D, additional, Cunningham, J, additional, Esisi, B, additional, Cassidy, T, additional, Bokhari, M, additional, McClelland, B, additional, Mokoena, B, additional, Gunathilagan, G, additional, Jones, S, additional, Reader, M, additional, Thomas, G, additional, Tilby, S, additional, Findlay, P, additional, Barrett, F, additional, Leslie, F, additional, Ross, S, additional, Shread, I, additional, Okwera, J, additional, Howe, J, additional, Harrington, F, additional, Courtauld, G, additional, Schofield, C, additional, Donnelly, R, additional, Maddula, M, additional, Scott, J, additional, Beavan, J, additional, Muhidden, K, additional, Memon, I, additional, Clarke, M, additional, Hedstrom, A, additional, Mills, L, additional, Hemsley, A, additional, Bowring, A, additional, Boxall, L, additional, Kingwell, H, additional, Keenan, S, additional, Roughan, C, additional, Manoj, A, additional, Cox, P, additional, Fletcher, G, additional, Lopez, P, additional, Emsley, H, additional, Gregary, B, additional, McLoughlin, A, additional, Raj, S, additional, Roffe, C, additional, Abano, N, additional, Barry, A, additional, Butler, A, additional, Carpio, R, additional, Castro, K, additional, Finney, K, additional, Gomm, S, additional, Hiden, J, additional, Grocott, J, additional, Lyjko, S, additional, Maguire, H, additional, Remegoso, A, additional, Sanyal, R, additional, Stevens, S, additional, Natarajan, I, additional, Chembala, J, additional, Muddegowda, G, additional, Warusevitane, A, additional, Blight, A, additional, Balazikova, O, additional, Lawlor, C, additional, Shaw, L, additional, Button, D, additional, Howcroft, D, additional, Lucas, S, additional, Madigan, B, additional, McCann, S, additional, Dixit, A, additional, Barkat, A, additional, Davis, J, additional, Fawcett, M, additional, Finlay, L, additional, Guy, H, additional, Hays, C, additional, Hogg, V, additional, Horsley, E, additional, Hubbuck, C, additional, Pringle, C, additional, Stevenson, C, additional, Storey, K, additional, Thompson, T, additional, Woodward, S, additional, Banerjee, A, additional, Allcock, C, additional, Merotra, S, additional, Douglass, C, additional, Campbell, E, additional, Jarapa, R, additional, Johnes, M, additional, Keaveney, C, additional, Marsden, T, additional, Naing, Z, additional, Perez, J, additional, Shaw, K, additional, Black, T, additional, Anthony, A, additional, Clarke, C, additional, Paterson, J, additional, Deighton, K, additional, Temlett, E, additional, Blank, C, additional, Doyle, C, additional, Duty, S, additional, Gill, K, additional, Harkness, K, additional, Kamara, C, additional, Richards, E, additional, Elfandi, K, additional, Guyler, P, additional, Harman, P, additional, Khuoge, C, additional, Kunhunny, S, additional, Tysoe, S, additional, Moynihan, B, additional, Adedoyin, T, additional, Chopra, N, additional, Dayal, N, additional, Ghatala, R, additional, Jeyaraj, N, additional, Jones, I, additional, Kennedy, F, additional, Kerin, L, additional, Khanom, N, additional, Lewis, S, additional, Maheswaran, S, additional, Montague, L, additional, Niemierko, M, additional, O'Reilly, J, additional, Trippier, S, additional, Watson, F, additional, Wilkinson, P, additional, Young, E, additional, Dizayee, K, additional, Cochrane, H, additional, O'Connell, J, additional, Mokoena, L, additional, Osborne, E, additional, Nair, A, additional, Greig, J, additional, Jenkins, C, additional, Powell, J, additional, Price, F, additional, Chowdhury, M, additional, Brixey, S, additional, Hunt, L, additional, Rands, N, additional, Rose, G, additional, Stoddart, S, additional, Srinivasan, M, additional, Motherwell, N, additional, Shekhar, R, additional, Fuller, T, additional, Lankester, A, additional, Lingwood, P, additional, Rankin, C, additional, Webb, H, additional, Jupp, B, additional, Bell, J, additional, Hann, G, additional, Longland, B, additional, Ovington, C, additional, Bhaskaran, B, additional, Ayres, G, additional, Bailey, C, additional, Bearne, H, additional, Buxton, J, additional, Fitzell, P, additional, Hilaire, C, additional, Kelly, D, additional, Szabo, S, additional, Tomlin, D, additional, Gamble, E, additional, Charles, B, additional, Kumar, R, additional, Fluskey, T, additional, Mellor, Z, additional, Peters, J, additional, Sutton, V, additional, Kenton, A, additional, Martin, I, additional, Nyabadza, S, additional, Ghosh, S, additional, Henry, M, additional, Kumar, B, additional, Ambulo, C, additional, Crawford, S, additional, Nozedar, T, additional, Platton, M, additional, Cvoro, V, additional, Couser, M, additional, McCormick, K, additional, Wilkinson, D, additional, Javaid, K, additional, Hurdowar, S, additional, Attygalle, T, additional, Sundayi, S, additional, Orugun, O, additional, Crowther, H, additional, Jolly, R, additional, Poultney, U, additional, Azim, A, additional, Krasinska-Chavez, M, additional, White, J, additional, Sengupta, N, additional, Margalef, J, additional, Metiu, M G, additional, Meenakshisundaram, S, additional, Dealing, S, additional, Hargroves, D, additional, Beranova, E, additional, Cowie, L, additional, Rudenko, H, additional, Thomson, A, additional, Verrion, A, additional, Rashed, K, additional, Board, S, additional, Buckley, C, additional, Hayward, D, additional, Jenkins, K, additional, Keeling, E, additional, Rowland-Axe, R, additional, Vickers, C, additional, Wood, D, additional, Lehman, A, additional, Patel, M, additional, Russell, H, additional, Rehman, H, additional, Forrest, D, additional, and Farren, P, additional

Published
2018
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18. EpiNet as a way of involving more physicians and patients in epilepsy research: Validation study and accreditation process.

Author

Bergin, PS, Beghi, E, Sadleir, LG, Brockington, A, Tripathi, M, Richardson, MP, Bianchi, E, Srivastava, K, Jayabal, J, Legros, B, Ossemann, M, McGrath, N, Verrotti, A, Tan, HJ, Beretta, S, Frith, R, Iniesta, I, Whitham, E, Wanigasinghe, J, Ezeala-Adikaibe, B, Striano, P, Rosemergy, I, Walker, EB, Alkhidze, M, Rodriguez-Leyva, I, Ramírez González, JA, D'Souza, WJ, EpiNet Study Group, Bergin, PS, Beghi, E, Sadleir, LG, Brockington, A, Tripathi, M, Richardson, MP, Bianchi, E, Srivastava, K, Jayabal, J, Legros, B, Ossemann, M, McGrath, N, Verrotti, A, Tan, HJ, Beretta, S, Frith, R, Iniesta, I, Whitham, E, Wanigasinghe, J, Ezeala-Adikaibe, B, Striano, P, Rosemergy, I, Walker, EB, Alkhidze, M, Rodriguez-Leyva, I, Ramírez González, JA, D'Souza, WJ, and EpiNet Study Group

Abstract

OBJECTIVE: EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator-led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet-First trials. METHODS: Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet-First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false-positive errors and could make only one error regarding seizure classification. RESULTS: Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet-First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70. SIGNIFICANCE: We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet-accredited and to partici

Published
2017

19. Assessment of the implantation of day-2 human embryos by morphometric nonsubjective parameters

Author

Molina I, Martínez JV, Pertusa JF, Balasch S, Iniesta I, and Pellicer A

Subjects
morphological and morphometric embryo variables, animal structures, urogenital system, embryonic structures, embryo score, images analysis, Embryo selection, embryo implantation, embryo grading systems, reproductive and urinary physiology
Abstract

Objective: To demonstrate the usefulness of image analysis in designing objective embryonic morphometric variables. Design: Retrospective study of 214 top-quality day-2 embryo photographs from 50 double-embryo transfers resulting in no pregnancy (group 0) and 57 resulting in twin pregnancy (group 1). Setting: Human reproduction unit. Patient(s): Study of 107 in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles in women age

Published
2014

33. Neuroferritinopathy Missense mutation in FTLcausing early-onset bilateral pallidal involvement

Author

Maciel, P, Cruz, V T., Constante, M, Iniesta, I, Costa, M C., Gallati, S, Sousa, N, Sequeiros, J, Coutinho, P, and Santos, M M.

Abstract

The authors identified a missense mutation in the FTLgene (474G>A; A96T) in a 19-year-old man with parkinsonism, ataxia, corticospinal signs, mild nonprogressive cognitive deficit, and episodic psychosis. This mutation was also present in his asymptomatic mother and younger brother, who had abnormally low levels of ferritin in the serum. The patient and his mother displayed bilateral involvement of the pallidum.

Published
2005
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36. Pandemics in ancient Greek and Roman coinage: medical memories at the service of hope.

Author

Iniesta I

Subjects
Greece epidemiology, Humans, Pandemics, Physicians
Abstract

Medical goddesses and gods invoked in the Hippocratic Oath were called on in times of pandemics along with Greek physicians such as Galen of Pergamum. Ancient Greek and Roman coinage provide insights into the coexisting religious and rational approaches to medicine rooted in Classical Antiquity, portraying medical symbols and gestures akin to contemporary medicine., (© 2020 Royal Australasian College of Physicians.)

Published
2020
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37. Impact and implementation of a sustainable regional telestroke network.

Author

Ranta A, Lanford J, Busch S, Providence C, Iniesta I, Rosemergy I, Wilson A, Cariga P, Richmond V, and Gommans J

Subjects
Fibrinolytic Agents administration & dosage, Humans, Pilot Projects, Prospective Studies, Stroke diagnosis, Telemedicine methods, Thrombolytic Therapy methods, Time-to-Treatment trends, Stroke therapy, Telemedicine standards, Thrombolytic Therapy standards, Time-to-Treatment standards, Videoconferencing standards
Abstract

Background: Telestroke uses videoconferencing technology to allow off-site experts to provide stroke thrombolysis decision support to less experienced front line clinicians., Aim: To assess the impact of a new telestroke service on thrombolysis rates and door-to-needle times in participating provincial hospitals and service resources to aid transition to a sustainable telestroke service., Methods: This is a sequential comparison of 'pre' (December 2015 to May 2016) and 'post' (June 2016 to December 2016) implementation outcomes. The main outcomes were thrombolysis rate and door-to-needle time. All patient data were captured prospectively in a central database. Data captured and analysed also included technical problems, consumer and clinician feedback, and additional service resources required., Results: Over the study period, 164 telestroke assessments were completed, including the 'hub' hospital. Among the participating provincial hospitals, 21 of 343 patients (6.1%) were thrombolysed in the 6-months prior to June 2016 and 50 of 318 patients (15.7%) during the 6-month following implementation of telestroke; odds ratio 2.86 (95% confidence interval 1.68-4.89); P = 0.0001. Overall, mean (standard deviation) regional hospital door-to-needle time reduced from 79.6 (31.4) to 62.7 (23.3) min (P = 0.015). Videoconferencing failure occurred in 4.8% of cases. Consumer and clinician feedback was positive. The main resource challenge was doubling of out-of-hours neurologist workload., Conclusion: Telestroke was associated with a significant increase in thrombolysis rate and reduction in door-to-needle time in provincial hospitals indicating improved patient care. Quantification of the extra neurologist workload allowed for a seamless transition to 'business as usual' using a novel annual subscription funding and service model., (© 2017 Royal Australasian College of Physicians.)

Published
2017
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38. Radiological findings of a symptomatic carotid pseudocclusion: «Guadiana river sign».

Author

Iniesta I, Lamballe A, Rodríguez M, Duignan J, Zaman S, Watson I, Cariga P, and Ranta A

Subjects
Angiography methods, Carotid Arteries pathology, Carotid Stenosis pathology, Cerebrovascular Circulation, Cerebrovascular Disorders pathology, Humans, Male, Middle Aged, Carotid Arteries diagnostic imaging, Carotid Stenosis diagnostic imaging, Cerebrovascular Disorders diagnostic imaging
Published
2017
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40. International Telestroke: The First Five Cases.

Author

Ranta A, Whitehead M, Gunawardana C, Cariga P, Iniesta I, Watson I, and Reoch A

Subjects
Aged, Aged, 80 and over, Female, Humans, Male, International Cooperation, Stroke therapy, Telemedicine methods, Thrombolytic Therapy methods
Abstract

Telestroke services can improve access to stroke thrombolysis. To address challenges of night time coverage we explored the feasibility of an international telestroke service between Scotland and New Zealand taking advantage of international time zone differences. After addressing medico-legal, governance, and technical issues we tested this international service model and here we present the first 5 cases. Based on our initial experience this new model of care appears feasible and has the potential to improve patient care through reduced doctor fatigue and improved access to expert care in regions where stroke specialist input is limited., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Published
2016
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41. Effects of pediatric cancer and its treatment on nutritional status: a systematic review.

Author

Iniesta RR, Paciarotti I, Brougham MF, McKenzie JM, and Wilson DC

Subjects
Anthropometry, Body Mass Index, Child, Humans, Malnutrition etiology, Overnutrition etiology, Prevalence, Skinfold Thickness, Malnutrition epidemiology, Neoplasms complications, Neoplasms therapy, Nutritional Status, Overnutrition epidemiology
Abstract

Context: Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear., Objective: The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status., Data Sources: Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013)., Study Selection: Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported and included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer., Data Extraction: Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles., Data Synthesis: A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies., Conclusion: The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, population-based, longitudinal studies using standard criteria to identify malnutrition., (© The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Published
2015
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42. On the origin of Ammon's horn.

Author

Iniesta I

Subjects
Egypt, Greek World history, History, 18th Century, History, 20th Century, History, 21st Century, History, Ancient, Humans, Neuroanatomy history, Roman World history, Hippocampus anatomy & histology, Mythology, Numismatics history, Temporal Lobe anatomy & histology
Abstract

Introduction: Greek and Roman worship of their gods and myths go back to Ancient Egyptian times. Images engraved in Greco-Roman coinage range from references to the assassination of Caesar and legendary stories like the arrival of a snake shaped demi-god Aesculapius to save the Romans from the plague, to invocations of major deities including Apollo the physician or Ammon the protector., Development: Depicted with the horns of a ram, Ammon was adopted by the Greeks as an epithet of Zeus and later incorporated by the Romans as Jupiter. References to the cult of Ammon appear on tetradrachms minted for Alexander The Great and on provincial Roman coins struck under Claudius. It is thrilling to hold a coin depicting Marcus Aurelius with Salus on the reverse and think that it could have been handed to Galen in payment for his services. However, it is rare to find figures other than rulers on coins and the physician of Pergamum is no exception. Inspired by the Renaissance school of Padua, French anatomists in the Enlightenment (Garengeot in 1742 and Flurant in 1752) continued reviving ancient myths and named the curve-shaped-inner portion of the temporal lobe Ammon's horn. Outstanding scholars who studied this primitive structure of the brain included Lorente de Nó and his mentor Cajal, whose portrait appeared on fifty-pesetas notes issued in 1935., Conclusions: As primary sources of great archaeological and artistic value, Greco-Roman coins provide information about the origins of the myths and gods of classical antiquity and continue to inspire the arts and sciences to this day., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Published
2014
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43. Epilepsy in the process of artistic creation of Dostoevsky.

Author

Iniesta I

Subjects
History, 19th Century, History, 20th Century, Humans, Male, Epilepsy history, Famous Persons, Literature, Modern history, Medicine in Literature
Abstract

Introduction: Fyodor M. Dostoevsky (Moscow, 1821-Saint Petersburg, 1881) suffered epilepsy throughout his full literary career. The aim here is to understand his condition in light of his novels, correspondence and his contemporaries' accounts as well as by later generations of neurologists., Development: From Murin and Ordynov (The landlady, 1847) to Smerdyakov (The brothers Karamazov, 1879-1880), Dostoevsky portrayed up to six characters with epilepsy in his literature. Apart from making an intelligent use of the disease by incorporating it into his novels, his seminal idea -that a moment of happiness is worth a lifetime- was probably inspired by his epileptic aura. Through epilepsy, Dostoevsky also found a way to freedom from perpetual military servitude. The first symptoms of the epilepsy presented in early adulthood (late 1830s to early 1840s), but he was only diagnosed a decade later. In 1863 he went abroad seeking expert advice from Romberg and Trousseau. In the first retrospective study of Dostoevsky's literary epilepsy, Stephenson and Isotoff noticed the influence of Carus' Psyche (1848) in the preparation of his characters, whilst his epilepsy has inspired later generations of epileptologists., Conclusions: Dostoevsky offers an insight into the natural history of an epilepsy, which in contemporary scientific terms would be classified as cryptogenic localization-related of probable temporal lobe origin. Above all, Dostoevsky's case illustrates the good use of a common neurological disorder by a remarkable writer who transformed suffering into art and a disadvantage into an advantage., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Published
2014
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44. Neurology and literature 2.

Author

Iniesta I

Subjects
Humans, Narration, Nervous System Diseases, Patients, Physicians, Medicine in Literature, Neurology
Abstract

Introduction: Good literary fiction has the potential to move us, extend our sense of life, transform our prospective views and help us in the face of adversity. A neurological disorder is likely to be the most challenging experience a human being may have to confront in a lifetime. As such, literary recreations of illnesses have a doubly powerful effect., Objectives: Study the synergies between neurology and fictional literature with particular reference to narrative based medicine (NBM)., Development: Doctors establish boundaries between the normal and the abnormal. Taking a clinical history is an act of interpretation in which the doctor integrates the science of objective signs and measurable quantities with the art of subjective clinical judgment. The more discrepancy there is between the patient's experience with the illness and the doctor's interpretation of that disease, the less likely the doctor-patient interaction is to succeed. NBM contributes to a better discernment of the meanings, thus considering disease as a biographical event rather than just a natural fact. Drawing from their own experience with disease, writers of fiction provide universal insights through their narratives, whilst neuroscientists, like Cajal, have occasionally devoted their scientific knowledge to literary narratives. Furthermore, neurologists from Alzheimer to Oliver Sacks remind us of the essential value of NBM in the clinic., Conclusions: Integrating NBM (the narrative of patients) and the classic holistic approach to patients with our current paradigm of evidence based medicine represents a challenge as relevant to neurologists as keeping up with technological and scientific advances., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Published
2014
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47. Tomas Tranströmer's stroke of genius: language but no words.

Author

Iniesta I

Subjects
Agraphia etiology, Agraphia history, Aphasia etiology, History, 20th Century, History, 21st Century, Humans, Male, Stroke complications, Sweden, Aphasia history, Famous Persons, Poetry as Topic history, Stroke history
Abstract

In 1990, the widely acclaimed Swedish poet Tomas Tranströmer lost his speech and the ability to use his right hand as a result of a stroke. As if anticipating his own fate, in 1974, he referred in his longest poem Baltics the story of the Russian composer Vissarion Shebalin who suffered the same symptoms as Tranströmer following a brain bleed: "Then, cerebral hemorrhage: paralysis on the right side with aphasia." An amateur pianist himself, Tranströmer carried on playing left-handed piano pieces after the stroke. In spite of a severe nonfluent dysphasia with dysgraphia, Tranströmer kept producing a poetic language of the highest caliber in accordance with his 1979 no less prophetic verse "language but no words." And through music and poetry, overcame the great communication barriers imposed by a large dominant hemispheric stroke. A nonprolific writer before the stroke, after it Tranströmer became disproportionately brief compared to his prestroke production, confining most of his poetry to the agrammatical and telegraphic haiku style., (© 2013 Elsevier B.V. All rights reserved.)

Published
2013
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48. Epilepsy in Dostoevsky.

Author

Iniesta I

Subjects
History, 19th Century, Epilepsy history, Famous Persons, Medicine in Literature
Abstract

Fyodor M. Dostoevsky (Moscow, 1821-Saint Petersburg, 1881) suffered epilepsy throughout his whole literary career. The aim here is to understand his condition in light of his novels, correspondence, and his contemporaries' accounts as well as through the eyes of later generations of neurologists. From Murin (The landlady, 1847) to Smerdyakov (The brothers Karamazov, 1880), Dostoevsky portrayed up to six characters with epilepsy in his literature. The first symptoms of the disease presented in early adulthood, but he was only diagnosed with epilepsy a decade later. In 1863 he went abroad seeking expert advice from the famous neurologists Romberg and Trousseau. Dostoevsky made an intelligent use of epilepsy in his literature (of his experiential auras or dreamy states particularly) and through it found a way to freedom from perpetual military servitude. His case offers an insight into the natural history of epilepsy (a cryptogenic localization related one of either fronto-medial or temporal lobe origin using contemporary medical terms), thus inspiring later generations of writers and neurologists. Furthermore, it illustrates the good use of an ordinary neurological disorder by an extraordinary writer who transformed adversity into opportunity., (© 2013 Elsevier B.V. All rights reserved.)

Published
2013
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