Person: Cano Valderrama, Óscar
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First Name
Óscar
Last Name
Cano Valderrama
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Department
Area
Cirugía
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Item Influence of the Human Development Index on the Maternal–Perinatal Morbidity and Mortality of Pregnant Women with SARS-CoV-2 Infection: Importance for Personalized Medical Care(Journal of Clinical Medicine, 2021) Cuñarro López, Yolanda; Garcia Tizon Larroca, Santiago; Pintado Recarte, Pilar; Hernández Martín, Concepción; Prats Rodríguez, Pilar; Cano Valderrama, Óscar; Cueto Hernandez, Ignacio; Ruiz Labarta, Javier; Muñóz Chápuli, María del Mar; Martínez Pérez, Óscar; Ortega, Miguel Angel; De León Luis, Juan AntonioCoronavirus disease-19 (COVID-19) is perhaps the most worrisome pandemic in the 21st century, having entailed devastating consequences for the whole society during the last year. Different studies have displayed an existing association between pregnancy and COVID-19 severity due to the various physiological changes that occur during gestation. Recent data identified maternal country of origin as an important determinant of COVID-19 presentation in pregnant women. However, the explanation of this fact remains to be fully elucidated. Therefore, the purpose of this work is to analyze the possible relationship between Human Development Index (HDI) of maternal country of origin with the morbimortality of pregnant women and their newborns. Here, we conducted a multicentric, ambispective, observational case-control study (1:1 ratio) and compare with the HDI of each country (group 1—very high HDI, group 2—high HDI, group 3—medium HDI, and group 4—low HDI). In total, 1347 pregnant women with confirmed SARV-CoV-2 infection (cases) were enrolled, and each was paired with one control to give a total number of 2694 participants from 81 tertiary care centers. Among the women with SARS-CoV-2 infection, more cases were produced of perinatal mortality, overall maternal morbidity, COVID-19 maternal morbidity, C-sections, hypertensive maternal morbidity, and perinatal morbidity. Our results described an inverse association between HDI and maternofetal morbidity and mortality. Moreover, the countries with an HDI lower than 1 showed higher rates of patients with maternal COVID-19-related morbidity (6.0% vs. 2.4%, p < 0.001), a need for oxygen therapy (4.7% vs. 1.8%, p < 0.001), and maternal ICU admission (2.6% vs. 1.0%, p = 0.007). Compared to other risk factors such as overweight, obesity, preexisting and obstetric comorbidities, HDI emerged as an independent risk factor explaining much of the increased maternal–perinatal morbidity and mortality detected in our group of cases. Further research is needed to establish to confirm the real impact of this factor and its components on pregnancy outcomes.Item The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature(Journal of Clinical Medicine, 2021) Cuñarro López, Yolanda; Pintado Recarte, Pilar; Cueto Hernandez, Ignacio; Hernández Martín, Concepción; Payá Martínez, María Pilar; Muñóz Chápuli, María del Mar; Cano Valderrama, Óscar; Bravo Arribas, Coral; Bujan, Julia; Álvarez Mon, Melchor; Ortega, Miguel A.; De León Luis, Juan AntonioSARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention.Item Obesity and telomere status in the prognosis of patients with colorectal cancer submitted to curative intention surgical treatment(Molecular and Clinical Onclogy, 2021) García Martínez, Sergio; González Gamo, Daniel; Fernández Marcelo, Tamara; Tesolato, Sofía; De La-Serna Esteban, Sofía Cristina; Domínguez Serrano, María Inmaculada; Cano Valderrama, Óscar; Barabash Bustelo, Ana; Juan Chocano, María Del Carmen De; Torres García, Antonio José; Iniesta Serrano, María PilarThe risk of colorectal cancer (CRC) development has been associated with telomere dysfunction and obesity. However, clinical relevance of these parameters in CRC prognosis is not clear. Therefore, the aim of the present study was to evaluate the impact of obesity and telomere status in the prognosis of patients affected by CRC and submitted to curative surgical treatment. According to published data, this is the first work in which obesity and telomere status are jointly considered in relation to CRC prognosis. A prospective study including 162 patients with CRC submitted to curative surgical treatment was performed. Subjects were classified according to their BMI. Telomere status was established through telomere length and telomerase activity evaluation. Statistical analyses were performed using the SPSS software package version 22. Telomere shortening was inversely associated with BMI in patients with CRC. Notably, among patients with CRC, subjects with obesity exhibited less shortening of tumor telomeres than non‑obese patients (P=0.047). Patients with shorter telomeres, both in the tumor (median telomere length <6.5 kb) and their non‑tumor paired tissues (median telomere length <7.1 kb), had the best clinical evolution, regardless of the Dukes' stage of cancers (P=0.025, for tumor samples; P=0.003, for non‑tumor samples). Additionally, subjects with a BMI >31.85 kg/m2 showed the worse clinical outcomes compared with subjects with other BMI values. Interestingly, the impact of BMI showed sex dependence, since only the group of men displayed significant differences in CRC prognosis in relation to obesity status (P=0.037). From the results of the present study, based on a multivariate prediction model to establish prognosis, it was concluded that telomere length is a useful biomarker to predict prognosis in patients with CRC. Regardless of BMI values, the improved clinical evolution was associated with shorter telomeres. The impact of BMI seems to be associated with other factors, such as sex.Item Comparación de los resultados ponderales, metabólicos y analíticos a largo plazo tras la realización de bypass gástrico, derivación biliopancreática de Larrad y cruce duodenal modificado en el tratamiento quirúrgico de la obesidad mórbida(2017) Cano Valderrama, Óscar; Torres García, Antonio José; Sánchez Pernaute, Andrés; Rubio Herrera, Miguel ÁngelLa obesidad es considerada la epidemia del siglo XXI1. Se espera que la prevalencia de esta enfermedad en Europa llegue a ser de un 20-30% en el año 20152. Este nivel ya ha sido superado en Estados Unidos, donde se registró una prevalencia del 35% en el período 2009-20103. De manera paralela al aumento de la obesidad en nuestra sociedad, se ha observado durante los últimos años un aumento en el número de cirugías bariátricas que se realizan. Mientras que en el año 2003 se llevaron a cabo menos de 150.000 procedimientos de cirugía bariátrica, en los años 2008 y 2011 esta cifra superó los 340.000 pacientes intervenidos4-6. La cirugía bariátrica es el único tratamiento que ha demostrado ser capaz de producir una pérdida de peso significativa a largo plazo en los enfermos que padecen obesidad mórbida7. Además, existe suficiente evidencia para decir que la cirugía bariátrica mejora el pronóstico a largo plazo de estos pacientes, consiguiendo una menor mortalidad que en los pacientes tratados de manera conservadora8, 9. Por ejemplo, en el estudio SOS realizado en Suecia la mortalidad tras 11 años de seguimiento fue de un 5% en los pacientes intervenidos y un 6,3% en los pacientes tratados de manera conservadora...Item Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic(Journal of Personalized Medicine, 2021) Cuñarro López, Yolanda; Pintado Recarte, Pilar; Hernández Martín, Concepción; Payá Martínez, Pilar; López Pérez, Rocío; Cueto Hernandez, Ignacio; Ruiz Labarta, Javier; Cano Valderrama, Óscar; Martínez Pérez, Óscar; Bravo Arribas, Coral; Ortega, Miguel A.; De León Luis, Juan AntonioDuring 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We conducted an observational, analytical, ambispective cohort study with longitudinal follow-up of mothers with confirmed SARV-CoV-2 infection from different hospitals in our country between March–November 2020. We recruited 1295 pregnant women with SARS-CoV2 infection from 78 hospitals, 846 (65.3%) of whom were diagnosed during the first wave and 449 (34.7%) during the second wave. Our results show that patients developing COVID-19 during the first wave had more symptoms at triage, early in pregnancy with greater rates of COVID-19-related maternal morbidity; caesarean section and preterm birth in the first wave. We register two cases of maternal mortality and only during the first wave. Maternal morbidity events showed a strong link to perinatal mortality events in the first wave compared to the second wave, in which maternal morbidity was more associated with pneumonia. Likewise, maternal morbidity showed a strong correlation with perinatal morbidity events in both waves. We describe the differences between the patients’ profiles and management between the two waves and related to maternal and perinatal outcomes. Differences were also observed in the management of pregnant women with COVID-19. Thus, there were fewer caesarean sections, and maternal and perinatal morbidity events were reduced in the second wave, while the impacts of respiratory symptoms and their severity, including a greater need for maternal treatment, were greater in this last period. Identifying the impact that changes in the profile as well as in the treatment have on maternal–perinatal morbidity and mortality will help improve the well-being of our patients and their newborns.Item Workshop for Basic Gynaecological Examinations: Improving Medical Student Learning through Clinical Simulation(2023) Cuñarro-López, Yolanda et al; De León-Luis, Juan; Cueto Hernández, Ignacio; Pintado Recarte, María Del Pilar; Cano Valderrama, Óscar; Pérez Lucas, Raquel; León Luis, Juan AntonioIntroduction: This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical–practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations. Materials and Methods: This was a quasi-experimental pre–post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Marañón Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020–2021 and 2021–2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives. Results: Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020–2021 academic year and 80.6% of students in the 2021–2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical–practical knowledge (improvement mean = 1.38 and 1.21 in 2020–2021 and 2021–2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points. Conclusions: Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.