This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave.
Material and methodsThis is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed.
ResultsOf the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy.
ConclusionsPatients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.
Comparar las características, evolución y pronóstico de los pacientes con EPOC hospitalizados por COVID-19 en España en la primera ola con los de la segunda ola.
Material y métodosEstudio observacional de los pacientes hospitalizados en territorio español con diagnóstico de EPOC incluidos en el registro SEMI-COVID-19.
Se compararon los antecedentes, la clínica, resultados analíticos y radiológicos, tratamiento y evolución de los pacientes con EPOC hospitalizados en la primera ola (desde marzo hasta junio 2020) frente a los hospitalizados en la segunda ola (desde julio hasta diciembre 2020). Se analizaron los factores de mal pronóstico, definidos como mortalidad por todas las causas y un evento combinado que incluía mortalidad, oxigenoterapia con alto flujo, ventilación mecánica e ingreso en UCI.
ResultadosDe 21,642 pacientes del Registro SEMI COVID-19, están diagnosticados de EPOC el 6,9%, 1128 (6,8%) en la OLA1 y 374 (7,7%) en la OLA2 (p = 0,04). Los pacientes de la OLA2 presentan menos tos seca, fiebre y disnea, hipoxemia (43% vs 36%, p < 0,05) y condensación radiológica (46% vs 31%, p < 0,05) que los de la OLA1. La mortalidad es menor en la OLA2 (35% vs 28,6%, p = 0,01). En el global de pacientes la mortalidad y la variable combinada de mal pronóstico fue menor entre los pacientes que recibieron tratamiento inhalador.
ConclusionesLos pacientes con EPOC con ingreso hospitalario por COVID-19 en la segunda ola presentan menos insuficiencia respiratoria y menos afectación radiológica, con mejor pronóstico. Estos pacientes deben recibir tratamiento broncodilatador si no hay contraindicación para el mismo.
SARS-CoV-2 infection started in China at the end of 2019 and then spread to the rest of the world, with a progressive increase in the number of cases reported. The peak of infections in Europe occurred in April 2020, with a decline until June. This is referred to as the first wave because in July 2020, another progressive increase in cases started, giving rise to the second wave.1
It was expected that a significant part of patients hospitalized due to COVID-19 in the first wave would have been patients with COPD. However, it was observed that there were fewer than expected, as different registries have shown. A total of 7.7% of patients in the SEMI-COVID-19 registry2 had COPD compared to 5.4% in a series from the New York area.3
In the works published on the first wave, patients with COPD hospitalized due to COVID-19 had more severe disease, a worse prognosis, and a mortality rate of up to 40%.4–6
After the experience and large amount of scientific research generated after the first wave, it is to be expected that the management and prognosis of patients with COPD and COVID-19 would improve in the second wave.
This work aims to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in the first and second waves.
Materials and methodsObservational studyData were collected from patients included in the SEMI-COVID-19 registry, a retrospective cohort which included consecutive patients hospitalized in Spain from March 2020 with confirmed SARS-CoV-2 infection who were discharged after hospitalization or who died. The registry inclusion criteria were: a) patient age ≥18 years; b) confirmed COVID-19 diagnosis; c) index hospitalization in a Spanish hospital participating in the registry; d) hospital discharge or in-hospital death. COVID-19 disease was confirmed through a positive result on a real-time polymerase chain reaction (RT-PCR) test of a nasopharyngeal or sputum sample or a positive result on serological tests and a clinically compatible presentation. The description, characteristics, and baseline results of the SEMI-COVID-19 registry can be consulted in the work published by Casas-Rojo et al.2
Patients diagnosed with COPD were selected from the SEMI-COVID-19 registry without needing to have a confirmatory spirometry. Patients hospitalized from March to June 2020 were considered to belong to the first wave (WAVE1) and those hospitalized from July to December 2020 were considered to belong to the second wave (WAVE2).
The variables selected for the analysis were demographic variables; medical history; comorbidities; chronic treatment; signs and symptoms of patients upon admission; analytical data; radiological findings; treatment received upon admission; radiological progress; ventilatory support: high-flow nasal cannula (HFNC) oxygen therapy, noninvasive mechanical ventilation (NIMV), or invasive mechanical ventilation (IMV); admission to the ICU; and death.
The medical history, symptoms, analytical and radiological results, treatment, and clinical progress of patients with COPD hospitalized in the first wave were compared to those hospitalized in the second wave. Factors associated with poor prognosis, defined as all-cause mortality and a composite variable that included mortality; need for HFNC oxygen therapy, NIMV, or IMV; or ICU admission were analyzed.
The calculations for the descriptive analysis were performed using the EXCEL computer program using the dynamic tables tool and the advanced data analysis feature. Qualitative variables were expressed as absolute frequency (n) and percentage (%). Quantitative variables were expressed as medians, interquartile range, and range with a 95% confidence interval. The Student’s t-test was used. Statistical significance was defined as p < 0.05. A logistic regression analysis was performed using the R statistical program to control for confounding bias. To do so, WAVE1 was treated as the cause or independent variable, mortality and the composite variable as the dependent variable, and respiratory failure and radiological involvement as possible confounding factors because they were found to be associated with mortality. The regression coefficients obtained on two different models were compared and when the magnitude of the change in OR was close to or greater than 10%, it was considered that there was confounding bias.
Ethical considerationsPersonal data were processed in strict compliance with Law 14/2007, of July 3, on Biomedical Research; Regulation (EU) 2016/679 of the European Parliament and of the Council, of 27 April 2016, on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation); and Organic Law 3/2018, of December 5, on the Protection of Personal Data and Guarantee of Digital Rights. The SEMI-COVID-19 Registry was approved for the first time by the Provincial Research Ethics Committee of Málaga (Spain), following the recommendation of the Spanish Agency of Medicines and Health Products (AEMPS, for its initials in Spanish). Informed consent was requested from all patients. When it was not possible to obtain it in writing due to biosafety issues or because the patient was already discharged from the hospital, verbal informed consent was requested and recorded on the medical record.
ResultsOf a total of 21,642 patients in the SEMI-COVID-19 Registry, 1502 patients (6.9%) had been diagnosed with COPD. Of them, 1128 (6.8%) corresponded to WAVE1 and 374 (7.7%) to WAVE2. The proportion of patients with COPD hospitalized due to COVID-19 was significantly greater in WAVE2 (p < 0.05).
Eighty-two percent of patients in the first wave and 88% of patients in the second wave were men. Thirty-six percent of patients in WAVE1 and 46% of patients in WAVE2 were older than 80 years (Table 1).
Characteristics of patients with COPD hospitalized due to COVID-19. Comparison between WAVE1 and WAVE2.
| Total (1502) | WAVE1 (1128) | WAVE2 (374) | p WAVE1 vs WAVE2 | |
|---|---|---|---|---|
| Men | 84% | 82% | 88% | p < 0.01 |
| >80 years | 39% | 36% | 46% | |
| HT | 70% | 69% | 72% | NS |
| Dyslipidemia | 54% | 54% | 54% | NS |
| AF | 23% | 24% | 22% | NS |
| Obesity | 28% | 28% | 30% | NS |
| Dry cough | 45% | 48% | 36% | p < 0.05 |
| Fever | 50% | 52% | 44% | p < 0.05 |
| Dyspnea | 72% | 74% | 66% | p < 0.05 |
| SatO2 < 92% | 41% | 43% | 36% | p < 0.05 |
| Kidney failure | 44% | 42% | 50% | p < 0.05 |
| Radiological condensation | 43% | 46% | 31% | p < 0.05 |
| Prone positioning | 11% | 12% | 6% | NS |
| HFNC oxygen therapy | 13% | 12% | 14% | NS |
| NIMV | 11% | 11% | 10% | NS |
| IMV | 6% | 6% | 7% | NS |
| ICU | 8% | 8% | 10% | NS |
| Mortality | 33.4% | 35% | 28.6% | p < 0.05 |
HT: hypertension. AF: atrial fibrillation. SatO2: pulse oxymetry oxygen saturation. Renal failure: creatinine >1.2 mg/dL. HFNC: high-flow nasal cannula oxygen therapy. NIMV: non-invasive mechanical ventilation. IMV: invasive mechanical ventilation. ICU: intensive care unit.
The clinical presentation of patients with COPD continued to mainly be dyspnea, fever, and dry cough, but in the second wave, patients presented with significantly less dry cough, fever, and dyspnea (p < 0.05). Differences were found in hypoxemia, with 43% of patients in WAVE1 and 36% of patients in WAVE2 presenting with SatO2 <92% (p < 0.05). Patients in WAVE2 presented with more kidney failure (42% vs 50%, p < 0.05) and less radiological condensation (46% vs 31%, p < 0.05) than those in WAVE1 (Table 1). Symptoms differed somewhat in women, who presented with more nonspecific symptoms such as arthromyalgia (27% vs 21%, p < 0.05), headache (13% vs 5%, p < 0.05), and absence of fever or low-grade fever (59% vs 47%, p < 0.05).
There were differences in the treatments used in both waves. In WAVE2, lopinavir/ritonavir, hydroxychloroquine, and chloroquine were not used; 15% of patients received remdesivir (1% in WAVE1); and 88% of patients received treatment with systemic glucocorticoids, compared to 51% in the first wave. Fewer antibiotics were used (82% vs 91%) and a lower rate of polypharmacy was observed in patients in WAVE2.
The overall mortality rate in patients with COPD was 33.4%: 35% in WAVE1 and 28.6% in WAVE2. Mortality declined in the second wave, with the decline being greater than what occurred in the total population of patients with COVID-19 (Fig. 1). Mortality was greater in men with COPD than in women (35.2% vs 24.5%, p < 0.001) and declined in WAVE2, with the decline being greater in women: 26.1% vs 17.4%.
The probability of death in those older than 80 years is significantly greater than in the rest of patients (p < 0.05). Nearly all comorbidities increased mortality, but only HT (WAVE1: 38.4% vs WAVE2: 29.3%, p = 0.005) and obesity (40.4% vs 27.9%, p = 0.018) significantly increased mortality between waves.
In all patients with COPD, the presence of dyspnea is an indicator of poor prognosis (49% vs 30%, p < 0.05) and mortality (37.3% vs 23.2%, p < 0.05). On the contrary, patients who had anosmia (mortality 11.5% vs 34.2%, p < 0.05), ageusia (mortality 14.8% vs 34%, p < 0.05), or arthromyalgias (mortality 27% vs 35.2%, p < 0.05) had a better prognosis.
Patients with SatO2 < 92%, creatinine >1.2 mg/dL, or bilateral lung lesions on radiologic tests had greater mortality and a worse prognosis (Table 2). No differences were found between waves in levels of procalcitonin or D-dimer.
Indicators of a poor prognosis in patients with COPD hospitalized due to COVID-19.
| Total mortality | Mortality WAVE1 | Mortality WAVE2 | p WAVE1 vs WAVE2 | Poor overall prognosis | Poor prognosis WAVE1 | Poor prognosis WAVE2 | p WAVE1 vs WAVE2 | |
|---|---|---|---|---|---|---|---|---|
| 33% | 35% | 28.6% | 44% | 46% | 38% | |||
| Confusion | 52% | 54% | 47% | p<0.05 | 62% | 64% | 57% | p < 0.05 |
| Tachypnea | 46% | 47% | 40% | p<0.05 | 59% | 60% | 53% | p < 0.05 |
| Sat02* <92% | 45% | 46% | 43% | p<0.05 | 59% | 60% | 55% | p < 0.05 |
| Creatinine >1.2 mg/dL | 44% | 46% | 39% | p<0.05 | 53% | 56% | 47% | p < 0.05 |
| Bilateral condensation on X-ray** | 44% | 46% | 36% | p<0.05 | 54% | 57% | 42% | p < 0.05 |
| Bilateral interstitial pattern on X-ray** | 39% | 40% | 34% | p < 0.05 | 52% | 54% | 48% | p < 0.05 |
No differences in mortality were found among patients with chronic habitual use of inhaled corticosteroids, inhaled beta-adrenergics, and inhaled anticholinergics compared to patients who did not use them. Patients treated with systemic glucocorticoids had greater overall mortality (47.1% vs 32.2%, p < 0.001) and a worse prognosis on the combined variable (57% vs 43%, p < 0.001) than those who did not use them.
Among all patients, those who received inhaled therapy had lower mortality (35.8% vs 27.3%, p < 0.05) and a lower percentage on the composite poor prognosis variable (46% vs 39%, p < 0.05). Patients who received beta-adrenergics had lower mortality (23% vs 33%, p < 0.05). Those who received ipratropium (30% vs 44%, p < 0.05; 35% vs 44%, p < 0.05, respectively) had a better prognosis on the combined variable (Fig. 2).
Patients who did not receive any antibiotics had a lower mortality rate (25% vs 33%, p < 0.05) and a better prognosis (35% vs 44%, p < 0.05) than the mean. Comparing other treatments received during hospitalization (angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), statins, acetylsalicylic acid (ASA), low-molecular-weight heparin (LMWH)), there were no differences in mortality or the composite poor prognosis variable except for LMWH at full anticoagulation doses, which was associated with a poor prognosis (55% vs 44%, p < 0.05).
On the regression analysis, WAVE1 was treated as the main independent variable and mortality and the composite poor prognosis variable as the dependent variable. Respiratory failure and radiological involvement were treated as possible confounding factors. If respiratory failure and radiological involvement are analyzed separately, there is no sufficiently strong statistical evidence that these factors are responsible for the differences in mortality and poor prognosis between waves. On the contrary, when the two factors are analyzed jointly, there are differences (Table 3).
Characteristics of patients with COPD hospitalized due to COVID-19. Logistic regression study.
| Results for mortality | |||
|---|---|---|---|
| Crude OR (95% CI) | Adjusted OR (95% CI) | Magnitude difference | |
| SatO2* <92% | 1.34 (1.04–1.74) | 1.28 (0.99–1.86) | 4.80% |
| Bilateral condensation on X-ray** | 1.34 (1.04–1.74) | 1.26 (0.98–1.64) | 6.10% |
| SatO2* <92% + Bilateral condensation on X-ray** | 1.34 (1.04–1.74) | 1.21 (0.93–1.58) | 9.80% |
| Results for the composite poor prognosis variable | |||
|---|---|---|---|
| Crude OR (95% CI) | Adjusted OR (95% CI) | Magnitude difference | |
| SatO2* <92% | 1.39 (1.1–1.78) | 1.33 (1.04–1.7) | 4.80% |
| Bilateral condensation on X-ray** | 1.39 (1.1–1.78) | 1.33 (1.04–1.69) | 5.10% |
| SatO2* <92% + Bilateral condensation on X-ray** | 1.39 (1.1–1.78) | 1.28 (0.99–1.64) | 8.70% |
OR: odds ratio.
According to other published works, the percentage of patients with COPD hospitalized due to COVID-19 is lower than the overall prevalence of the disease in the population. In the previously reported SEMI-COVID-19 registry, the prevalence of COPD in the first wave was 7.6% and the prevalence in this study is 6.9%, a variation that may be due to the inclusion of more cases following publication of the initial study. However, in this series, the proportion of patients with COPD increased significantly in the second wave compared to the first.2–4
Previous works have described that patients with COPD who are hospitalized due to SARS-CoV-2 infection are predominantly men; are older adults; have high comorbidity; have symptoms which consist of an increase in dyspnea and expectoration with fever or low-grade fever; and present with hypoxemia, tachypnea, and confusional syndrome upon admission.4
This work found that patients in the second wave continued to mainly be older men. These patients in the second wave presented with fewer symptoms, less respiratory failure, and less condensation on radiological tests. This suggests that patients in WAVE2 arrived to the hospital earlier, with less advanced disease, and in better condition than in WAVE1. This could have been influenced by the general population’s better knowledge on the disease and its symptoms and consequently, patients may have consulted sooner; an improvement in diagnostics, with an earlier diagnosis and a diagnosis in milder phases; less collapse of the healthcare system; and a change in virologic pattern given that in the second wave, the mean viral load value was lower and the highest levels were detected among younger patients, which could be explained by a lower level of viral inoculation as a consequence of the use of masks, social distancing, and restrictions on gatherings.1–9
As previous publications have described, age continues to be one of the main prognostic factors in SARS-CoV-2 infection in patients with COPD.
Although mortality decreased in the second wave, the mortality rate in patients with COPD is nearly double that of the population without COPD. In addition to this, the older age of patients with COPD than the rest of the hospitalized population and the high comorbidity of patients with COPD, especially cardiovascular disease, diabetes, and obesity, are clear factors of a poor prognosis in COVID-19. In this work, the comorbidity of patients with COPD continues to be very high, with no differences between the two waves, as has been reported in other publications.4,10,11
The better prognosis in women is notable, with a greater decline in mortality in the second wave than in men with COPD. One of the hypotheses that could explain this difference due to sex is based on the role of sex in the genetic and hormonal regulation of immune responses and in the different ACE2 activity between men and women; men with hypertension and heart failure tend to have a higher level of ACE2 serum activity compared to women.12,13
There was a lower mortality and better prognosis in WAVE2. In a work comparing mortality in the two waves in Japan, mortality was also lower in the second wave, even when stratified by age and severity upon admission. The authors linked this to a shorter period of time between disease onset and admission and that the patients had milder disease upon admission.14 After the regression analysis in this series, it was also observed that the patients’ better clinical situation—reflected in the combination of lesser respiratory failure and lesser radiologic involvement—would be behind the lower mortality rate and better prognosis observed in WAVE2. Other works have suggested that the pattern of inflammation in the second wave—measured through biomarkers such as LDH, ferritin, CRP, IL-6, and D-dimer—was lower. This was not able to be confirmed in this series, in which no differences were found in the lymphocytes or d-dimer figures between the waves.15
Contou et al. described less of a need for invasive mechanical ventilation in the second wave of patients hospitalized in the ICU, but did not find any differences in mortality. Other authors have also reported greater use of non-invasive mechanical ventilation in the second wave. In this study, no differences were found between waves in the need for high-flow oxygen therapy, non-invasive or invasive mechanical ventilation, or ICU admission.16
One of the factors that contributed to the improvement in patients’ prognosis in the second wave is undoubtedly the fact that Spain’s healthcare system was better prepared than in the first wave; more diagnostic tests were performed and performed earlier; and there was more experience with and scientific evidence on treatment. In the second wave, drugs such as lopinavir/ritonavir or hydroxychloroquine were no longer used whereas remdesivir, tocilizumab were used; most patients (88% in this series) received systemic glucocorticoids. There was less polypharmacy in the second wave and lesser use of antibiotics, which was also described by Brehm, who additionally reported fewer nosocomial infections.17
In this work, 46% of patients were in treatment with inhaled glucocorticoids and, as in the work by Mancia, it was not found to influence the prognosis of patients with COPD.18 No differences were found in patients who were in chronic inhalation therapy with beta-adrenergics, tiotropium, or other long-acting anticholinergics either. The protective and prognostic role in COVID-19 of habitual inhalation therapy in patients with COPD is continuously under review. Indeed, there are works that do suggest benefits of tiotropium as a protective factor against SARS-CoV-2 infection19 and others in which inhalatory treatment with steroids and tiotropium are a protective factor against mortality.20
The improvement in the prognosis of patients who received treatment with inhaled bronchodilators was notable. In patients with exacerbated COPD, beta-adrenergics and short-acting muscarinic antagonists are the basis of treatment. The fact that there were patients who did not receive bronchodilator treatment during hospitalization may be due to the high rates of contagion among healthcare personnel attributed to the use of nebulizers during the first wave. In patients with COPD hospitalized due to COVID-19, bronchodilator treatment must be administered unless it is contraindicated. It is recommended to avoid nebulizations and instead provide treatment with pressurized, dry powder, or soft mist inhalers with or without a spacer device.
ConclusionsPatients with COPD hospitalized due to COVID-19 are mainly men; older adults; have high comorbidity; and present with dyspnea, cough, fever or low-grade fever, and respiratory failure. In the second wave, patients presented with less respiratory failure and less radiological involvement. This better clinical condition, together with lesser healthcare overload and strain on hospitals and the updating of treatment protocols, may have been behind the lower mortality and better prognosis observed in the second wave.
Patients with COPD hospitalized due to COVID-19 must receive bronchodilator treatment unless it is contraindicated.
FundingThis research has not received specific grants from agencies in the public, commercial, or non-profit sectors.
Conflicts of interestThe authors confirm there are no conflicts of interest in the conduct of this work.
We would like to thank the invaluable, generous help of María Ángeles Bacete Silva in the creation of this work.
Coordinator of the SEMI-COVID-19 Registry: José Manuel Casas Rojo.
SEMI-COVID-19 Scientific Committee Members: José Manuel Casas Rojo, José Manuel Ramos Rincón, Carlos Lumbreras Bermejo, Jesús Millán Núñez-Cortés, Juan Miguel Antón Santos, Ricardo Gómez Huelgas.
Members of the SEMI-COVID-19 Group
H. Univ. de Bellvitge. L'Hospitalet de Llobregat (Barcelona)
Xavier Corbella, Francesc Formiga Pérez, Narcís Homs, Abelardo Montero, Jose María Mora-Luján, Manuel Rubio-Rivas
H. Costa del Sol. Marbella (Málaga)
Victoria Augustín Bandera, Javier García Alegría, Nicolás Jiménez-García, Jairo Luque del Pino, María Dolores Martín Escalante, Francisco Navarro Romero, Victoria Nuñez Rodriguez, Julián Olalla Sierra
H. U. 12 de Octubre. Madrid
Paloma Agudo de Blas, Coral Arévalo Cañas, Blanca Ayuso, José Bascuñana Morejón, Samara Campos Escudero, María Carnevali Frías, Santiago Cossio Tejido, Borja de Miguel Campo, Carmen Díaz Pedroche, Raquel Diaz Simon, Ana García Reyne, Laura Ibarra Veganzones, Lucia Jorge Huerta, Antonio Lalueza Blanco, Jaime Laureiro Gonzalo, Jaime Lora-Tamayo, Carlos Lumbreras Bermejo, Guillermo Maestro de la Calle, Rodrigo Miranda Godoy, Barbara Otero Perpiña, Diana Paredes Ruiz, Marcos Sánchez Fernández, Javier Tejada Montes
H. U. S. Juan de Alicante (Alicante)
Marisa Asensio Tomás, David Balaz, David Bonet Tur, Ruth Cañizares Navarro, Paloma Chazarra Pérez, Jesús Corbacho Redondo, Eliana Damonte White, María Escamilla Espínola, Leticia Espinosa Del Barrio, Pedro Jesús Esteve Atiénzar, Carles García Cervera, David Francisco García Núñez, Francisco Garrido Navarro, Vicente Giner Galvañ, Angie Gómez Uranga, Javier Guzmán Martínez, Isidro Hernández Isasi, Lourdes Lajara Villar, Verónica Martínez Sempere, Juan Manuel Núñez Cruz, Sergio Palacios Fernández, Juan Jorge Peris García, Rafael Piñol Pleguezuelos, Andrea Riaño Pérez, José Miguel Seguí Ripoll, Azucena Sempere Mira, Philip Wikman-Jorgensen
H. de Cabueñes. Gijón (Asturias)
Ana María Álvarez Suárez, Carlos Delgado Vergés, Rosa Fernandez-Madera Martínez, Eva Mª Fonseca Aizpuru, Alejandro Gómez Carrasco, Cristina Helguera Amezua, Juan Francisco López Caleya, Diego López Martínez, María del Mar Martínez López, Aleida Martínez Zapico, Carmen Olabuenaga Iscar, Lucía Pérez Casado, María Luisa Taboada Martínez, Lara María Tamargo Chamorro
H. U. Gregorio Marañon. Madrid
Laura Abarca Casas, Álvaro Alejandre de Oña, Rubén Alonso Beato, Leyre Alonso Gonzalo, Jaime Alonso Muñoz, Crhistian Mario Amodeo Oblitas, Cristina Ausín García, Marta Bacete Cebrián, Jesús Baltasar Corral, Maria Barrientos Guerrero, Alejandro D. Bendala Estrada, María Calderón Moreno, Paula Carrascosa Fernández, Raquel Carrillo, Sabela Castañeda Pérez, Eva Cervilla Muñoz, Agustín Diego Chacón Moreno, Maria Carmen Cuenca Carvajal, Sergio de Santos, Andrés Enríquez Gómez, Eduardo Fernández Carracedo, María Mercedes Ferreiro-Mazón Jenaro, Francisco Galeano Valle, Alejandra Garcia, Irene Garcia Fernandez-Bravo, María Eugenia García Leoni, María Gómez Antúnez, Candela González San Narciso, Anthony Alexander Gurjian, Lorena Jiménez Ibáñez, Cristina Lavilla Olleros, Cristina Llamazares Mendo, Sara Luis García, Víctor Mato Jimeno, Clara Millán Nohales, Jesús Millán Núñez-Cortés, Sergio Moragón Ledesma, Antonio Muiño Míguez, Cecilia Muñoz Delgado, Lucía Ordieres Ortega, Susana Pardo Sánchez, Alejandro Parra Virto, María Teresa Pérez Sanz, Blanca Pinilla Llorente, Sandra Piqueras Ruiz, Guillermo Soria Fernández-Llamazares, María Toledano Macías, Neera Toledo Samaniego, Ana Torres do Rego, Maria Victoria Villalba Garcia, Gracia Villarreal, María Zurita Etayo
C. H. U. de Badajoz
Rafael Aragon Lara, Inmaculada Cimadevilla Fernandez, Juan Carlos Cira García, Gema Maria García García, Julia Gonzalez Granados, Beatriz Guerrero Sánchez, Francisco Javier Monreal Periáñez, Maria Josefa Pascual Perez
C. H. U. de Albacete
Jose Luis Beato Pérez, Maria Lourdes Sáez Méndez
H. Royo Villanova. Zaragoza
Nicolás Alcalá Rivera, Anxela Crestelo Vieitez, Esther del Corral Beamonte, Jesús Díez Manglano, Isabel Fiteni Mera, Maria del Mar Garcia Andreu, Martin Gericó Aseguinolaza, Cristina Gallego Lezaun, Claudia Josa Laorden, Raul Martínez Murgui, Marta Teresa Matía Sanz
H. Reg. Univ. de Málaga
Mª Mar Ayala-Gutiérrez, Rosa Bernal López, José Bueno Fonseca, Verónica Andrea Buonaiuto, Luis Francisco Caballero Martínez, Lidia Cobos Palacios, Clara Costo Muriel, Francis de Windt, Ana Teresa Fernandez-Truchaud Christophel, Paula García Ocaña, Ricardo Gómez Huelgas, Javier Gorospe García, José Antonio Hurtado Oliver, Sergio Jansen-Chaparro, Maria Dolores López-Carmona, Pablo López Quirantes, Almudena López Sampalo, Elizabeth Lorenzo-Hernández, Juan José Mancebo Sevilla, Jesica Martín Carmona, Luis Miguel Pérez-Belmonte, Iván Pérez de Pedro, Araceli Pineda-Cantero, Carlos Romero Gómez, Michele Ricci, Jaime Sanz Cánovas
H. U. La Paz. Madrid
Jorge Álvarez Troncoso, Francisco Arnalich Fernández, Francisco Blanco Quintana, Carmen Busca Arenzana, Sergio Carrasco Molina, Aranzazu Castellano Candalija, Germán Daroca Bengoa, Alejandro de Gea Grela, Alicia de Lorenzo Hernández, Alejandro Díez Vidal, Carmen Fernández Capitán, Maria Francisca García Iglesias, Borja González Muñoz, Carmen Rosario Herrero Gil, Juan María Herrero Martínez, Víctor Hontañón, Maria Jesús Jaras Hernández, Carlos Lahoz, Cristina Marcelo Calvo, Juan Carlos Martín Gutiérrez, Monica Martinez Prieto, Elena Martínez Robles, Araceli Menéndez Saldaña, Alberto Moreno Fernández, Jose Maria Mostaza Prieto, Ana Noblejas Mozo, Carlos Manuel Oñoro López, Esmeralda Palmier Peláez, Marina Palomar Pampyn, Maria Angustias Quesada Simón, Juan Carlos Ramos Ramos, Luis Ramos Ruperto, Aquilino Sánchez Purificación, Teresa Sancho Bueso, Raquel Sorriguieta Torre, Clara Itziar Soto Abanedes, Yeray Untoria Tabares, Marta Varas Mayoral, Julia Vásquez Manau
H. Clínico de Santiago de Compostela (A Coruña)
Maria del Carmen Beceiro Abad, Maria Aurora Freire Romero, Sonia Molinos Castro, Emilio Manuel Paez Guillan, María Pazo Nuñez, Paula Maria Pesqueira Fontan
H. U. Reina Sofía. Córdoba
Antonio Pablo Arenas de Larriva, Pilar Calero Espinal, Javier Delgado Lista, Francisco Fuentes-Jiménez, María del Carmen Guerrero Martínez, María Jesús Gómez Vázquez, Jose Jiménez Torres, Laura Limia Pérez, José López-Miranda, Laura Martín Piedra, Marta Millán Orge, Javier Pascual Vinagre, Pablo Pérez-Martinez, María Elena Revelles Vílchez, Angela Rodrigo Martínez, Juan Luis Romero Cabrera, José David Torres-Peña.
C. A. U. de Salamanca
Gloria María Alonso Claudio, Víctor Barreales Rodríguez, Cristina Carbonell Muñoz, Adela Carpio Pérez, María Victoria Coral Orbes, Daniel Encinas Sánchez, Sandra Inés Revuelta, Miguel Marcos Martín, José Ignacio Martín González, José Ángel Martín Oterino, Leticia Moralejo Alonso, Sonia Peña Balbuena, María Luisa Pérez García, Ana Ramon Prados, Beatriz Rodríguez-Alonso, Ángela Romero Alegría, Maria Sanchez Ledesma, Rosa Juana Tejera Pérez
H. Universitario Dr. Peset. Valencia
Juan Alberto Aguilera Ayllón, Arturo Artero, María del Mar Carmona Martín, María José Fabiá Valls, Maria de Mar Fernández Garcés, Ana Belén Gómez Belda, Ian López Cruz, Manuel Madrazo López, Elisabeth Mateo Sanchis, Jaume Micó Gandia, Laura Piles Roger, Adela Maria Pina Belmonte, Alba Viana García
H. U. Puerta de Hierro. Madrid
Ane Andrés Eisenhofer, Ana Arias Milla, Isolina Baños Pérez, Laura Benítez Gutiérrez, Javier Bilbao Garay, Jorge Calderón Parra, Alejandro Callejas Díaz, Erika Camacho Da Silva, M ª Cruz Carreño Hernández, Raquel Castejón Díaz, María Jesús Citores Sánchez, Carmen Cubero Gozalo, Valentín Cuervas-Mons Martínez, Laura Dorado Doblado, Sara de la Fuente Moral, Alberto Díaz de Santiago, Itziar Diego Yagüe, Ignacio Donate Velasco, Ana María Duca, Pedro Durán del Campo, Gabriela Escudero López, Esther Expósito Palomo, Ana Fernández Cruz, Amy Galán Gómez, Sonia García Prieto, Beatriz García Revilla, Miguel Ángel García Viejo, Javier Gómez Irusta, Patricia González Merino, Edith Vanessa Gutiérrez Abreu, Isabel Gutiérrez Martín, Ángela Gutiérrez Rojas, Andrea Gutiérrez Villanueva, Jesús Herráiz Jiménez, Fátima Ibáñez Estéllez, Pedro Laguna del Estal, Mª Carmen Máinez Sáiz, Carmen de Mendoza Fernández, María Martínez Urbistondo, Fernando Martínez Vera, María Mateos Seirul-lo, Susana Mellor Pita, Patricia A. Mills Sánchez, Esther Montero Hernández, Alberto Mora Vargas, Victor Moreno-Torres Concha, Ignacio Morrás De La Torre, Elena Múñez Rubio, Rosa Muñoz de Benito, Alejandro Muñoz Serrano, Pablo Navarro Palomo, Ilduara Pintos Pascual, Arturo José Ramos Martín-Vegue, Antonio Ramos Martínez, Celia Rodríguez Olleros, Alberto Roldán Montaud, Yolanda Romero Pizarro, Silvia Rosado García, Diana Ruiz de Domingo, David Sánchez Ortiz, Enrique Sánchez Chica, Irene Solano Almena, Elena Suanzes Martin, Yale Tung Chen, Pablo Tutor de Ureta, Ángela Valencia Alijo, Jose Manuel Vázquez Comendador, Juan Antonio Vargas Núñez.
H. Clínico San Carlos. Madrid
Inés Armenteros Yeguas, Javier Azaña Gómez, Julia Barrado Cuchillo, Irene Burruezo López, Noemí Cabello Clotet, Alberto E. Calvo Elías, Elpidio Calvo Manuel, Carmen María Cano de Luque, Cynthia Chocron Benbunan, Laura Dans Vilan, Claudia Dorta Hernández, Ester Emilia Dubon Peralta, Vicente Estrada Pérez, Santiago Fernandez-Castelao, Marcos Oliver Fragiel Saavedra, José Luis García Klepzig, Maria del Rosario Iguarán Bermúdez, Esther Jaén Ferrer, Alejandro Maceín Rodríguez, Alejandro Marcelles de Pedro, Rubén Ángel Martín Sánchez, Manuel Méndez Bailón, Sara Miguel Álvarez, Maria José Nuñez Orantos, Carolina Olmos Mata, Eva Orviz García, David Oteo Mata, Cristina Outon González, Juncal Perez-Somarriba, Pablo Pérez Mateos, Maria Esther Ramos Muñoz, Xabier Rivas Regaira, Laura Mª Rodríguez Gallardo, Iñigo Sagastagoitia Fornie, Alejandro Salinas Botrán, Miguel Suárez Robles, Maddalena Elena Urbano, Andrea María Vellisca González, Miguel Villar Martínez
H. G. U. de Elda (Alicante)
Carmen Cortés Saavedra, Jennifer Fernández Gómez, Borja González López, María Soledad Hernández Garrido, Ana Isabel López Amorós, Santiago López Gil, Maria de los Reyes Pascual Pérez, Nuria Ramírez Perea, Andrea Torregrosa García
Complejo Asistencial de Segovia
Daniel Monge Monge, Eva María Ferreira Pasos, Alba Varela García
H. Miguel Servet. Zaragoza
Luis Sáez Comet, Laura Letona Giménez, Uxua Asín Samper, Gonzalo Acebes Repiso, José Miguel García Bruñén, Mónica Llorente Barrio, María Aranzazu Caudevilla Martínez, Jesús Javier González Igual, Rosa García Fenoll
H. U. La Princesa. Madrid
María Aguilera García, Ester Alonso Monge, Jesús Álvarez Rodríguez, Claudia Alvarez Varela, Miquel Berniz Gòdia, Marta Briega Molina, Marta Bustamante Vega, Jose Curbelo, Alicia de las Heras Moreno, Ignacio Descalzo Godoy, Alexia Constanza Espiño Alvarez, Ignacio Fernández Martín-Caro, Alejandra Franquet López-Mosteiro, Gonzalo Galvez Marquez, María José García Blanco, Yaiza García del Álamo Hernández, Clara García-Rayo Encina, Noemí Gilabert González, Carolina Guillamo Rodríguez, Nicolás Labrador San Martín, Manuel Molina Báez, Carmen Muñoz Delgado, Pedro Parra Caballero, Javier Pérez Serrano, Laura Rabes Rodríguez, Pablo Rodríguez Cortés, Carlos Rodriguez Franco, Emilia Roy-Vallejo, Monica Rueda Vega, Aresio Sancha Lloret, Beatriz Sánchez Moreno, Marta Sanz Alba, Jorge Serrano Ballesteros, Alba Somovilla, Carmen Suarez Fernández, Macarena Vargas Tirado, Almudena Villa Marti
H. Infanta Sofía. SS de los Reyes (Madrid)
José Francisco Pascual Pareja, Isabel Perales Fraile, Arturo Muñoz Blanco, Rafael del Castillo Cantero, José Luis Valle López, Isabel Rábago Lorite, Rebeca Fuerte Martínez, Inés Suárez García, Llanos Soler Rangel
H. U. de A Coruña
Alicia Alonso Álvarez, Olaya Alonso Juarros, Ariadna Arévalo López, Carmen Casariego Castiñeira, Ana Cerezales Calviño, Marta Contreras Sánchez, Ramón Fernández Varela, Santiago J. Freire Castro, Ana Padín Trigo, Rafael Prieto Jarel, Fátima Raad Varea, Ignacio Ramil Freán, Laura Ramos Alonso, Francisco Javier Sanmartín Pensado, David Vieito Porto
H. Moisès Broggi. Sant Joan Despí (Barcelona)
Judit Aranda Lobo, Lucía Feria Casanovas, Jose Loureiro Amigo, Miguel Martín Fernández, Isabel Oriol Bermúdez, Melani Pestaña Fernández, Nicolas Rhyman, Nuria Vázquez Piqueras
H. de Pozoblanco (Córdoba)
José Nicolás Alcalá Pedrajas, Antonia Márquez García, Inés Vargas
H. U. Río Hortega. Valladolid
Irene Arroyo Jiménez, Marina Cazorla González, Marta Cobos-Siles, Luis Corral-Gudino, Pablo Cubero-Morais, María González Fernández, José Pablo Miramontes González, Marina Prieto Dehesa, Pablo Sanz Espinosa
H. Nuestra Señora del Prado. Talavera de la Reina (Toledo)
Sonia Casallo Blanco, Jeffrey Oskar Magallanes Gamboa, Cristina Salazar Mosteiro, Andrea Silva Asiain
H. U. Infanta Cristina. Parla (Madrid)
Juan Miguel Antón Santos, Ana Belén Barbero Barrera, Blanca Beamonte Vela, Coralia Bueno Muiño, Charo Burón Fernández, Ruth Calderón Hernáiz, Irene Casado López, José Manuel Casas Rojo, Andrés Cortés Troncoso, Pilar Cubo Romano, Francesco Deodati, Alejandro Estrada Santiago, Gonzalo García Casasola Sánchez, Elena García Guijarro, Francisco Javier García Sánchez, Pilar García de la Torre, Mayte de Guzmán García-Monge, Davide Luordo, María Mateos González, José A. Melero Bermejo, Cruz Pastor Valverde, José Luis Pérez Quero, Fernando Roque Rojas, Lorea Roteta García, Elena Sierra Gonzalo, Francisco Javier Teigell Muñoz, Juan Vicente de la Sota, Javier Villanueva Martínez
H. de Urduliz Alfredo Espinosa (Vizcaya)
Miriam García Gómez, Pablo Ramírez Sánchez, Gorka Arroita Gonzalez, Alazne Lartategi Iraurgi, Asier Aranguren Arostegui, Paula Arriola Martínez, Isabel María Portales Fernández, Esther Martinez Becerro, Amalur Iza Jiménez, Cristian Vidal Núñez, María Aparicio López, Eduardo García López, Mª Soledad Azcona Losada, Beatriz Ruiz Estévez
H. Virgen de la Salud. Toledo
Ana Maria Alguacil Muñoz, Marta Blanco Fernández, Veronica Cano, Ricardo Crespo Moreno, Fernando Cuadra Garcia-Tenorio, Blanca Díaz-Tendero Nájera, Raquel Estévez González, María Paz García Butenegro, Alberto Gato Díez, Verónica Gómez Caverzaschi, Piedad María Gómez Pedraza, Julio González Moraleja, Raúl Hidalgo Carvajal, Patricia Jiménez Aranda, Raquel Labra González, Áxel Legua Caparachini, Pilar Lopez Castañeyra, Agustín Lozano Ancin, Jose Domingo Martin Garcia, Cristina Morata Romero, María Jesús Moya Saiz, Helena Moza Moríñigo, Gemma Muñiz Nicolás, Enriqueta Muñoz Platon, Filomena Oliveri, Elena Ortiz Ortiz, Raúl Perea Rafael, Pilar Redondo Galán, María Antonia Sepulveda Berrocal, Vicente Serrano Romero de Ávila, Pilar Toledano Sierra, Yamilex Urbano Aranda, Jesús Vázquez Clemente, Carmen Yera Bergua
H. U. Son Llàtzer. Palma de Mallorca
Andrés de la Peña Fernández, Almudena Hernández Milián
H. Santa Marina. Bilbao
María Areses Manrique, Ainara Coduras Erdozain, Ane Labirua-Iturburu Ruiz
H. Juan Ramón Jiménez. Huelva
Francisco Javier Bejarano Luque, Francisco-Javier Carrasco-Sánchez, Mercedes de-Sousa-Baena, Jaime Díaz Leal, Aurora Espinar Rubio, Maria Franco Huertas, Juan Antonio García Bravo, Andrés Gonzalez Macías, Encarnación Gutiérrez Jiménez, Alicia Hidalgo Jiménez, Constantino Lozano Quintero, Carmen Mancilla Reguera, Francisco Javier Martínez Marcos, Francisco Muñoz Beamud, Maria Pérez-Aguilar, Alícia Pérez Jiménez, Virginia Rodríguez Castaño, Alvaro Sánchez de Alcazar del Río, Leire Toscano Ruiz
H. San Pedro. Logroño (La Rioja)
Diana Alegre González, Irene Ariño Pérez de Zabalza, Sergio Arnedo Hernández, Jorge Collado Sáenz, Beatriz Dendariena, Marta Gómez del Mazo, Iratxe Martínez de Narvajas Urra, Sara Martínez Hernández, Estela Menendez Fernández, Jose Luís Peña Somovilla, Elisa Rabadán Pejenaute
H. del Henares. Coslada (Madrid)
Jesús Ballano Rodríguez-Solís, Luis Cabeza Osorio, María del Pilar Fidalgo Montero, Mª Isabel Fuentes Soriano, Erika Esperanza Lozano Rincón, Ana Martín Hermida, Jesús Martínez Carrilero, José Ángel Pestaña Santiago, Manuel Sánchez Robledo, Patricia Sanz Rojas, Nahum Jacobo Torres Yebes, Vanessa Vento
H. U. Ramón y Cajal. Madrid
Luis Fernando Abrego Vaca, Ana Andréu Arnanz, Octavio Arce García, Marta Bajo González, Pablo Borque Sanz, Alberto Cozar Llisto, Sonia de Pedro Baena, Beatriz Del Hoyo Cuenda, Martin Fabregate-Fuente, María Alejandra Gamboa Osorio, Isabel García Sánchez, Andrés González García, Oscar Alberto López Cisneros, Luis Manzano, Miguel Martínez-Lacalzada, Borja Merino Ortiz, Jimena Rey-García, Elisa Riera González, Cristina Sánchez Díaz, Grisell Starita Fajardo, Cecilia Suárez Carantoña, Adrian Viteri-Noël, Svetlana Zhilina Zhilina
H. U. Torrevieja (Alicante)
Julio César Blázquez Encinar
H. HLA Moncloa. Madrid
Carmen Martínez Cilleros, Isabel Jiménez Martínez, Teresa García Delange
C. H. U. Ourense
Raquel Fernández González, Amara Gonzalez Noya, Carlos Hernández Ceron, Isabel Izuzquiza Avanzini, Ana Latorre Diez, Pablo López Mato, Ana María Lorenzo Vizcaya, Daniel Peña Benítez, Milagros María Peña Zemsch, Lucía Pérez Expósito, Marta Pose Bar, Lara Rey González, Laura Rodrigo Lara
H. U. La Fe. Valencia
Dafne Cabañero, María Calabuig Ballester, Pascual Císcar Fernández, Ricardo Gil Sánchez, Marta Jiménez Escrig, Cristina Marín Amela, Laura Parra Gómez, Carlos Puig Navarro, José Antonio Todolí Parra
C. Asistencial de Zamora
Carlota Tuñón de Almeida, María Esther Fraile Villarejo, Victoria Palomar Calvo, Sara Pintos Otero, Beatriz García López, Carlos Aldasoro Frías, Víctor Madrid Romero, Luis Arribas Pérez, Emilia Martínez Velado
H. de Mataró. Barcelona
Raquel Aranega González, Ramon Boixeda, Javier Fernández Fernández, Carlos Lopera Mármol, Marta Parra Navarro, Ainhoa Rex Guzmán, Aleix Serrallonga Fustier
H. Público de Monforte de Lemos (Lugo)
José López Castro, Manuel Lorenzo López Reboiro, Cristina Sardiña González
H. de Sagunto (Valencia)
Enrique Rodilla Sala, Jose María Pascual Izuel, Zineb Karroud Zamrani
C. H. U. de Ferrol (A Coruña)
Hortensia Alvarez Diaz, Tamara Dalama Lopez, Estefania Martul Pego, Carmen Mella Pérez, Ana Pazos Ferro, Sabela Sánchez Trigo, Dolores Suarez Sambade, Maria Trigas Ferrin, Maria del Carmen Vázquez Friol, Laura Vilariño Maneiro
H. Alto Guadalquivir. Andújar (Jaén)
Begoña Cortés Rodríguez
H. Infanta Margarita. Cabra (Córdoba)
María Esther Guisado Espartero, Lorena Montero Rivas, Maria de la Sierra Navas Alcántara, Raimundo Tirado-Miranda
H. U. San Agustin. Avilés (Asturias)
Marta Nataya Solís Marquínez, Víctor Arenas García, Demelsa Blanco Suárez, Natalia García Arenas, Paula Martínez García, David Castrodá Copa, Andrea Álvarez García, Jaime Casal Álvarez, María Jose Menéndez Calderón, Raquel García Noriega, María Caño Rubia, Joaquin Llorente García, Luis Trapiella Martínez, José Ferreiro Celeiro, Diego Eduardo Olivo Aguilar, Irene Maderuelo Riesco, Juan Valdés Bécares, Alba Barragán Mateos, Andrés Astur Treceño García
H. Univ. Ntra. Sra. Candelaria. Sta. Cruz de Tenerife
Joaquín Delgado Casamayor, Diego García Silvera, Andrea Afonso Díaz, Carolina Hernández Carballo, Alicia Tejera, María José Monedero Prieto, María Blanca Monereo Muñoz, José Manuel Del Arco Delgado, Daniel Rodríguez Díaz, Marta Bethencourt Feria, Francisco Javier Herrera Herrera, María de la Luz Padilla Salazar, Rubén Hernández Luis, Eduardo Mauricio Calderón Ledezma, María del Mar López Gámez, Laura Torres Hernández, Sara Castaño Pérez, Selena Gala Aguilera García, Guillermo Castro Gainett, Alba Gómez Hidalgo, Julia Marfil Daza, Marcelino Hayek Peraza
H. U. Virgen del Rocío. Sevilla
Reyes Aparicio Santos, Máximo Bernabeu-Wittel, Santiago Rodríguez Suárez, María Nieto, Luis Giménez Miranda, Rosa María Gámez Mancera, Fátima Espinosa Torre, Carlos Hernandez Quiles, Concepción Conde Guzmán, Juan Delgado de la Cuesta, Jara Eloisa Ternero Vega, María del Carmen López Ríos, Pablo Díaz Jiménez, Bosco Baron Franco, Carlos Jiménez de Juan, Sonia Gutiérrez Rivero, Julia Lanseros Tenllado, Verónica Alfaro Lara, Aurora González Estrada
H. Marina Baixa. Villajoyosa (Alicante)
Javier Ena, José Enrique Gómez Segado
H. San Juan de la Cruz. Úbeda (Jaén)
Marcos Guzmán García, Francisco Javier Vicente Hernández
H. del Tajo. Aranjuez (Madrid)
Ruth Gonzalez Ferrer, Virginia Gracia Lorenzo, Raquel Monsalvo Arroyo
C. Asist. Univ. de León
Ángel Luis Martínez González, Beatriz Vicente Montes, Rosario María García Die, Alberto Muela Molinero, Manuel Martín Regidor, Raquel Rodríguez Díez
H. Torrecárdenas. Almería
Bárbara Hernández Sierra, Luis Felipe Díez García, Iris El Attar Acedo, Carmen Mar Sánchez Cano
H. Dr. José Molina Orosa. Arrecife (Lanzarote)
Virginia Herrero García, Berta Román Bernal
H. Clinic Barcelona
Júlia Calvo Jiménez, Emmanuel Coloma Bazán, Aina Capdevila Reniu, Joan Ribot Grabalosa, Joaquim Fernández Solà, Irene Carbonell De Boulle, Cristina Gabara Xancó, Olga Rodríguez Núñez
H. Insular de Gran Canaria. Las Palmas G. C.
Carlos Jorge Ripper
H. U. Marqués de Valdecilla. Santander
Marta Fernández-Ayala Novo, José Javier Napal Lecumberri, Nuria Puente Ruiz, Jose Riancho, Isabel Sampedro García
H. General Defensa. Zaragoza
Anyuli Gracia Gutiérrez, Leticia Esther Royo Trallero
H. U. Virgen de las Nieves. Granada
Pablo Conde Baena, Joaquín Escobar Sevilla, Laura Gallo Padilla, Patricia Gómez Ronquillo, Pablo González Bustos, María Navío Botías, Jessica Ramírez Taboada, Mar Rivero Rodríguez
H. U. C. de Asturias. Oviedo
Víctor Asensi Alvarez, Noelia Morán Suárez, Sara Rodríguez Suárez, Silvia Suárez Díaz, Lucia Suárez Pérez, Maria Folgueras Gómez, Claudia Moran Castaño, Lucía Meijide Rodríguez, Carlos Vázquez, Itxasne Cabezón Estévanez, Carmen Yllera Gutiérrez, Maria Martinez Sela
H. Valle del Nalón. Riaño-Langreo (Asturias)
Sara Fuente Cosío, César Manuel Gallo Álvaro, Julia Lobo García, Antía Pérez Piñeiro
H. U. Severo Ochoa. Leganés (Madrid)
Yolanda Casillas Viera, Lucía Cayuela Rodríguez, Carmen de Juan Alvarez, Gema Flox Benitez, Laura García Escudero, Juan Martin Torres, Patricia Moreira Escriche, Susana Plaza Canteli, M Carmen Romero Pérez
H. G. U. de Castellón
Jorge Andrés Soler, Marián Bennasar Remolar, Alejandro Cardenal Álvarez, Daniela Díaz Carlotti, María José Esteve Gimeno, Sergio Fabra Juana, Paula García López, María Teresa Guinot Soler, Daniela Palomo de la Sota, Guillem Pascual Castellanos, Ignacio Pérez Catalán, Celia Roig Martí, Paula Rubert Monzó, Javier Ruiz Padilla, Nuria Tornador Gaya, Jorge Usó Blasco
H. Francesc de Borja. Gandía (Valencia)
M Angeles Martinez Pascual, Leyre Jorquer Vidal
H. de Palamós (Girona)
Ana Alberich Conesa, Mari Cruz Almendros Rivas, Miquel Hortos Alsina, José Marchena Romero, Anabel Martin-Urda Diez-Canseco
H. Germans Trias i Pujol. Badalona (Barcelona)
H. U. del Vinalopó. Elche (Alicante)
Francisco Amorós Martínez, Erika Ascuña Vásquez, José Carlos Escribano Stablé, Adriana Hernández Belmonte, Ana Maestre Peiró, Raquel Martínez Goñi, M. Carmen Pacheco Castellanos, Bernardino Soldan Belda, David Vicente Navarro
H. Platón. Barcelona
Ana Suárez Lombraña
H. U. del Sureste. Arganda del Rey (Madrid)
Jon Cabrejas Ugartondo, Ana Belén Mancebo Plaza, Arturo Noguerado Asensio, Bethania Pérez Alves, Natalia Vicente López
H. Parc Tauli. Sabadell (Barcelona)
Francisco Epelde, Isabel Torrente
H. U. Quironsalud Madrid
Pablo Guisado Vasco, Ana Roda Santacruz, Ana Valverde Muñoz
H. Santa Bárbara. Soria
Marta León Téllez
H. Virgen de los Lirios. Alcoy (Alicante)
Mª José Esteban Giner
H. San Pedro de Alcántara. Cáceres
Eva García Sardón, Javier Galán González, Luis Gámez Salazar, Angela Agea Garcia, Itziar Montero Días, Alvaro Santaella Gomez, Marta Correa Matos, Selene Núñez Gaspar, Antonio González Nieto
H. Asepeyo Coslada (Madrid)
Alejo Erice Calvo-Sotelo
H. U. Lucus Augusti. Lugo
Raquel Gómez Méndez, Ana Rodríguez Álvarez
H. U. de Canarias. Sta. Cruz de Tenerife
Onán Pérez Hernández, Alina Pérez Ramírez, María Candelaria Martín González, Miguel Nicolas Navarrete Lorite, Lourdes González Navarrete, Julio Cesar Alvisa Negrin, José Fernando Armas González, Iballa Jiménez, Paula Ortega Toledo, Esther Martin Ponce
H. Clínico Universitario de Valladolid
Xjoylin Teresita Egües Torres, Sara Gutiérrez González, Cristina Novoa Fernández, Pablo Tellería Gómez
H. Comarcal de Blanes (Girona)
Oriol Alonso Gisbert, Mercé Blázquez Llistosella, Pere Comas Casanova, Angels Garcia Flores, Anna Garcia Hinojo, Ana Inés Méndez Martínez, Maria del Carmen Nogales Nieves, Agnés Rivera Austrui, Alberto Zamora Cervantes
H. do Salnes. Vilagarcía de Arousa (Pontevedra)
Vanesa Alende Castro, Ana María Baz Lomba, Ruth Brea Aparicio, Marta Fernández Morales, Jesús Manuel Fernández Villar, María Teresa López Monteagudo, Cristina Pérez García, Lorena Rodríguez Ferreira, Diana Sande Llovo, Maria Begoña Valle Feijoo
H. U. HM Montepríncipe
José F. Varona Arche
H. Virgen del Mar. Madrid
Thamar Capel Astrua, Paola Tatiana Garcia Giraldo, Maria Jesús González Juárez, Victoria Marquez Fernandez, Ada Viviana Romero Echevarry
H. de Poniente. El Ejido (Almería)
Juan Antonio Montes Romero, Jose Luis Serrano Carrillo de Albornoz, Manuel Jesus Soriano Pérez, Encarna Sánchez Martín
H. Sierrallana. Torrelavega (Cantabria)
Reina Valle Bernad, Cristina Limia, Cristina Amado Fernández, Andrea Tejero Fernández, Lucia Paz Fajardo, Tomás de Vega Santos
H. de Montilla (Córdoba)
Adrián Montaño Martínez
H. Infanta Elena. Huelva
María Gloria Rojano Rivero
H. de la Axarquía. Vélez-Málaga (Málaga)
Antonio López Ruiz
H. Quironsalud A Coruña
Hector Meijide Míguez
