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Artero A, Sáez Ramírez T, Muresan BT, Ruiz-Berjaga Y, Jiménez-Portilla A, Sánchez-Juan CJ. The Effect of Fasting on Body Composition Assessment in Hospitalized Cancer Patients. Nutr Cancer 2023; 75:1610-1618. [PMID: 37350672 DOI: 10.1080/01635581.2023.2218039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
Guidelines for bioelectrical impedance analysis (BIA) recommend fasting before measurements, but how it affects the outcomes is unclear. This descriptive, before-and-after study examines the effect of fasting on BIA results and its impact on the diagnosis of malnutrition in hospitalized cancer patients. Fifty-three oncology patients (admitted in January-March 2020) were consecutively enrolled regardless of their nutritional status. Patients were assessed by the same dietician 24-48 h after admission, following the usual clinical practice. The measurements were taken after 12-h fasting (fasting state) and 60-90 min after breakfast (non-fasting state). Bioimpedance parameters (resistance [R], reactance [Xc], phase angle [PA]) and body composition indices (free-fat mass index [FFMI] and appendicular skeletal muscle index [ASMI]) were calculated. On average, R values did not significantly differ between fasting and non-fasting states (mean difference: +1.82 Ω; p = 0.64). The non-fasting Xc and PA were reduced (mean differences: -1.55 Ω, p = 0.93 and 0.09°, p = 0.82, respectively). Fasting and non-fasting FFMI and ASMI were similar (mean differences: -0.13 kg/m2 (p = 0.5) and -0.10 kg/m2 (p not calculated)). These results suggest that BIA does not require fasting, facilitating its routine use in hospitalized cancer patients.
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Affiliation(s)
- Ana Artero
- Departamento de Medicina, Universitat de Valencia, Valencia, Spain
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Muresan B, Artero A, Portilla AJ, Berjaga YR, Arribas BV, Juan CS. Prevalence of malnutrition according to the glim criteria in hospitalized cancer patients. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Muresan BT, Sánchez Juan C, Artero A, Montoro A, Garcia Miragll E, Ruiz Y, Soriano del Castillo JM, Ríos Ríos J, Hervás D, López-Torrecilla J. Tomografía computarizada a nivel de C3 y dinamometría como técnicas de diagnóstico de sarcopenia en pacientes con cáncer de cabeza y cuello. Rev Esp Nutr Hum Diet 2020. [DOI: 10.14306/renhyd.24.2.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introducción: Estudio piloto que determina el diagnóstico de sarcopenia mediante tomografía computarizada (TC) a nivel de la tercera vértebra cervical (C3) y dinamometría en pacientes con cáncer de cabeza y cuello. Comparación de la masa magra (MM) determinada mediante TC con técnicas clásicas de antropometría y dinamometría.Material y métodos: Se analizó la MM y el tejido adiposo mediante TC a nivel de C3 en 37 pacientes oncológicos mediante Unidades Hounsfield (UH). Posteriormente, se calculó el índice musculoesquelético (IME) y se determinó la fuerza prensora de mano para la determinación de sarcopenia. Por último, se comparó el IME mediante técnicas de valoración antropométrica clásica y dinamometría. Resultados: El 59,46% de los pacientes presentaron un IME (cm2/m2) disminuido, el 64,86% dinapenia, el 54,05% sarcopenia, el 32,43% sarcopenia dentro del sobrepeso y obesidad. Por otro lado, la media de la masa grasa intermuscular fue 6,69 (3,8) cm2, y la masa grasa intramuscular 2,06 (1,11) cm2. Además, se encontró una asociación estadísticamente significativa entre la fuerza tanto en la mano fuerte (estimado = 0,412, IC95% [0,219; 0,605], p-valor <0,001) como en la mano débil (estimado =0,289, IC95% [0,123; 0,454], p-valor <0,001) y el IME cm2/m2. Respecto a la circunferencia muscular braquial), no alcanzamos a mostrar correlación positiva.Conclusiones: Nuestro estudio muestra que en el paciente con cáncer de cabeza y cuello la prevalencia de sarcopenia es elevada. Además, la depleción muscular evaluada mediante TC a nivel de C3 y dinamometría presenta cierta correlación, por lo que, aquellos pacientes con mayor depleción muscular a nivel de C3 presentan menor funcionalidad.
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Collazos J, de la Fuente B, de la Fuente J, García A, Gómez H, Menéndez C, Enríquez H, Sánchez P, Alonso M, López-Cruz I, Martín-Regidor M, Martínez-Alonso A, Guerra J, Artero A, Blanes M, Asensi V. Factors associated with sepsis development in 606 Spanish adult patients with cellulitis. BMC Infect Dis 2020; 20:211. [PMID: 32164590 PMCID: PMC7066725 DOI: 10.1186/s12879-020-4915-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background Cellulitis, a frequent cause of admission of adult patients to medical wards, occasionally evolves to sepsis. In this study we analyze the factors related to sepsis development. Methods Prospective and observational study of 606 adult patients with cellulitis admitted to several Spanish hospitals. Comorbidities, microbiological, clinical, lab, diagnostic, and treatment data were analyzed. Sepsis was diagnosed according to the criteria of the 2016 International Sepsis Definitions Conference. Multiple logistic regression modelling was performed to determine the variables independently associated with sepsis development. Results Mean age was 63.4 years and 51.8% were men. Overall 65 (10.7%) patients developed sepsis, 7 (10.8%) of whom died, but only 4 (6.2%) due to cellulitis. Drawing of blood (P < 0.0001) or any (P < 0.0001) culture, and identification of the agent (P = 0.005) were more likely among patients with sepsis. These patients had also a longer duration of symptoms (P = 0.04), higher temperature (P = 0.03), more extensive cellulitis (P = 0.02), higher leukocyte (P < 0.0001) and neutrophil (P < 0.0001) counts, serum creatinine (P = 0.001), and CRP (P = 0.008) than patients without sepsis. Regarding therapy, patients with sepsis were more likely to undergo changes in the initial antimicrobial regimen (P < 0.0001), received more antimicrobials (P < 0.0001), received longer intravenous treatment (P = 0.03), and underwent surgery more commonly (P = 0.01) than patients without sepsis. Leukocyte counts (P = 0.002), serum creatinine (P = 0.003), drawing of blood cultures (P = 0.004), change of the initial antimicrobial regimen (P = 0.007) and length of cellulitis (P = 0.009) were independently associated with sepsis development in the multivariate analysis. Conclusions Increased blood leukocytes and serum creatinine, blood culture drawn, modification of the initial antimicrobial regimen, and maximum length of cellulitis were associated with sepsis in these patients.
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Affiliation(s)
- J Collazos
- Infectious Diseases Unit, Hospital de Galdácano, Vizcaya, Spain
| | - B de la Fuente
- Infectious Diseases Unit, Hospital de Cabueñes, Gijón, Spain
| | - J de la Fuente
- Internal Medicine Service, Hospital de Povisa, Vigo, Spain
| | - A García
- Infectious Diseases Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - H Gómez
- Infectious Diseases Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - C Menéndez
- Infectious Diseases Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - H Enríquez
- Internal Medicine Service, Hospital de Povisa, Vigo, Spain
| | - P Sánchez
- Internal Medicine Service, Hospital de Povisa, Vigo, Spain
| | - M Alonso
- Internal Medicine Service, Hospital de Povisa, Vigo, Spain
| | - I López-Cruz
- Internal Medicine Service, Hospital Dr Peset, Valencia, Spain
| | - M Martín-Regidor
- Internal Medicine Service, Complejo Hospitalario de León, León, Spain
| | - A Martínez-Alonso
- Internal Medicine Service, Complejo Hospitalario de León, León, Spain
| | - J Guerra
- Internal Medicine Service, Complejo Hospitalario de León, León, Spain
| | - A Artero
- Internal Medicine Service, Hospital Dr Peset, Valencia, Spain
| | - M Blanes
- Infectious Diseases Unit, Hospital La Fe, Valencia, Spain
| | - V Asensi
- Infectious Diseases Unit, Hospital Universitario Central de Asturias, Oviedo, Spain. .,Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
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Muresan BT, Sánchez Juan C, Artero A, Montoro A, Hernández Machancoses A, Ruiz Berjaga Y, Ríos Ríos J, Soriano del Castillo JM, Sebastià Fabregat N, Prieto Colodrero N, López - Torrecilla J. Estudio transversal de medición de la composición corporal en pacientes con cáncer mediante antropometría y técnicas de imagen médica. Rev Esp Nutr Hum Diet 2020. [DOI: 10.14306/renhyd.23.3.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introducción: Analizar la composición corporal tanto mediante técnicas antropométricas y parámetros bioquímicos clásicos, como mediante técnicas modernas utilizando tomografía computarizada (TC), en pacientes oncológicos antes de iniciar el tratamiento con radioterapia.Metodología: Se analizaron de forma retrospectiva 22 pacientes con diversos tumores del aparato digestivo, que fueron sometidos al TC de planificación antes de iniciar el tratamiento con radioterapia, y que disponían de un corte axial en la tercera vértebra lumbar. Para analizar la composición corporal, se determinaron tanto parámetros antropométricos y bioquímicos clásicos, como la determinación de la masa muscular mediante Unidades Hounsfield (UH).Resultados: En cuanto a las características antropométricas clásicas, el peso medio fue 65,19 (±12,72) Kg, IMC 23,74 (± 5,03) kg/m2, %pp 15,84 (±10,87) %, PT 9,73 (± 5,08) mm y CMB 22,81 (± 2,95) cm. En cuanto a los parámetros bioquímicos, la hipoalbuminemia estuvo presente en el 63,45% de los casos. Por otro lado, la medición de composición corporal mediante técnicas modernas, determinó un promedio de circunferencia de cintura de 99,06 (±13,38) cm, MM de 119,41 (±35,54) cm2, y la media del IME fue de 71,50 (±20.57) cm2/m2; estando por debajo de la normalidad en el 13,64% de los pacientes.Conclusiones: Las nuevas técnicas por imagen basadas en cortes TC, pueden incluirse en la rutina diaria del paciente oncológico como información adicional a los parámetros antropométricos y bioquímicos más clásicos, por ser una técnica sencilla de realizar, con bajo coste, reproducible y muy fiable en cuanto a determinación de composición corporal.
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Muresan B, Sánchez Juan C, Artero A, Montoro A, Sanchz Jordá G, López Torrecilla J. Measuring skeletal muscle mass using C3 cross-sectional computed tomography images. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poveda E, Hernández-Quero J, Pérez-Elías MJ, Ribas MA, Martínez-Madrid OJ, Flores J, Navarro J, Gutiérrez F, García-Deltoro M, Imaz A, Ocampo A, Artero A, Blanco F, Bernal E, Pasquau J, Mínguez-Gallego C, Pérez N, Aiestaran A, García F, Paredes R. Genotypic tropism testing of proviral DNA to guide maraviroc initiation in aviraemic subjects: 48-week analysis of results from the PROTEST study. HIV Med 2016; 18:482-489. [PMID: 28035758 DOI: 10.1111/hiv.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Maraviroc (MVC) is a suitable drug for aviraemic subjects on antiretroviral treatment (ART) developing toxicity. Its prescription requires prior tropism testing. It is unknown if proviral DNA genotypic tropism testing is reliable for guiding MVC initiation in aviraemic subjects, so this study was carried out to address this issue. METHODS PROTEST was a phase 4, prospective, single-arm clinical trial carried out in 24 HIV care centres in Spain. MVC-naïve HIV-1-infected patients with HIV-1 RNA < 50 copies/mL on stable ART during the previous 6 months who required an ART change because of toxicity and who had R5 HIV, as determined by proviral DNA genotypic tropism testing, initiated MVC with two nucleoside reverse transcriptase inhibitors (NRTIs) and were followed for 48 weeks. Virological failure was defined as two consecutive viral load measurements > 50 copies/mL. RESULTS Tropism results were available for 141 of 175 (80.6%) subjects screened: 60% had R5 and 85% of these (n = 74) were finally included in the study. Previous ART included protease inhibitors (PIs) in 62% of subjects, nonnucleoside reverse transcriptase inhibitors (NNRTIs) in 36%, and integrase inhibitors (INIs) in 2%. Main reasons for treatment change were dyslipidaemia (42%), gastrointestinal symptoms (22%) and liver toxicity (15%). MVC was given alongside tenofovir (TDF)/emtricitabine (FTC) (54%) and abacavir (ABC)/lamivudine (3TC) (40%) in most patients. Eighty-four per cent of patients maintained a viral load < 50 copies/mL to week 48, whereas 16% discontinued treatment: two withdrew informed consent, one had an R5 to X4 shift between screening and baseline, one was lost to follow-up, one developed an adverse event (rash), two died from non-study-related causes, and five developed protocol-defined virological failure. CONCLUSIONS Initiation of MVC plus two NRTIs in aviraemic subjects based on genotypic tropism testing of proviral HIV-1 DNA is associated with low rates of virological failure for up to 1 year.
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Affiliation(s)
- E Poveda
- Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | | | - M A Ribas
- Hospital Son Espases, Palma de Mallorca, Spain
| | | | - J Flores
- Hospital Arnau de Vilanova, Valencia, Spain
| | - J Navarro
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - F Gutiérrez
- Hospital Universitario de Elche, Elche, Spain
| | | | - A Imaz
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Ocampo
- Hospital Xeral de Vigo, Vigo, Spain
| | - A Artero
- Hospital Universitario Dr. Peset, Valencia
| | - F Blanco
- Hospital Carlos III, Madrid, Spain
| | - E Bernal
- Hospital Reina Sofía, Murcia, Spain
| | - J Pasquau
- Hospital Virgen de la Nieves, Granada, Spain
| | | | - N Pérez
- Universitat Politécnica de Catalunya, Barcelona, Spain
| | - A Aiestaran
- Universitat Politécnica de Catalunya, Barcelona, Spain
| | - F García
- Hospital Universitario San Cecilio, Granada, Spain
| | - R Paredes
- HIV Unit and irsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Martinez-Hervas S, Navarro I, Real JT, Artero A, Peiro M, Gonzalez-Navarro H, Carmena R, Ascaso JF. Unsaturated Oral Fat Load Test Improves Glycemia, Insulinemia and Oxidative Stress Status in Nondiabetic Subjects with Abdominal Obesity. PLoS One 2016; 11:e0161400. [PMID: 27537847 PMCID: PMC4990252 DOI: 10.1371/journal.pone.0161400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/04/2016] [Indexed: 12/14/2022] Open
Abstract
Aims To evaluate the changes in glycemia, insulinemia, and oxidative stress markers during an oral fat load test in nondiabetic subjects with abdominal obesity and to analyze the association between postprandial oxidative stress markers and postprandial glucose and insulin responses. Methods We included 20 subjects with abdominal obesity (waist circumference > 102 cm for men and > 88 cm for women) and 20 healthy lean controls (waist circumference < 102 cm for men and < 88 cm for women). After 12 hours of fasting we performed a standardized fat load test (0–8 hours) with supracal® (50 g/m2). We determined metabolic parameters, oxidized and reduced glutathione, and malondialdehyde. Results In both groups, insulin, HOMA, oxidized/reduced glutathione ratio, and malondialdehyde significantly decreased in the postprandial state after the OFLT. All these parameters were significantly higher in the abdominal obesity group at baseline and during all the postprandial points, but the reduction from the baseline levels was significantly higher in the abdominal obesity group. Conclusion Unsaturated fat improves insulin resistance and oxidative stress status. It is possible that a consumption of unsaturated fat could be beneficial even in subjects with abdominal obesity in postprandial state.
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Affiliation(s)
- Sergio Martinez-Hervas
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, Madrid, Spain
| | - Inmaculada Navarro
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Valencia, Valencia, Spain
| | - Jose T. Real
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, Madrid, Spain
- * E-mail:
| | - Ana Artero
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Valencia, Valencia, Spain
| | - Marta Peiro
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, Madrid, Spain
- Hospital Clínico Research Foundation (INCLIVA), Valencia, Spain
| | - Herminia Gonzalez-Navarro
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, Madrid, Spain
- Hospital Clínico Research Foundation (INCLIVA), Valencia, Spain
| | - Rafael Carmena
- Department of Medicine, University of Valencia, Valencia, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, Madrid, Spain
- Hospital Clínico Research Foundation (INCLIVA), Valencia, Spain
| | - Juan F. Ascaso
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), ISCIII, Madrid, Spain
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Martinez-Hervas S, Artero A, Martinez-Ibañez J, Tormos MC, Gonzalez-Navarro H, Priego A, Martinez-Valls JF, Saez GT, Real JT, Carmena R, Ascaso JF. Increased thioredoxin levels are related to insulin resistance in familial combined hyperlipidaemia. Eur J Clin Invest 2016; 46:636-42. [PMID: 27208733 DOI: 10.1111/eci.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/18/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Thioredoxins (TRX) are major cellular protein disulphide reductases that are critical for redox regulation. Oxidative stress and inflammation play promoting roles in the genesis and progression of atherosclerosis, but until now scarce data are available considering the influence of TRX activity in familial combined hyperlipidaemia (FCH). Since FCH is associated with high risk of cardiovascular disease, the objective of the present study was to assess oxidative stress status in FCH patients, and evaluate the influence of insulin resistance (IR). MATERIALS AND METHODS A cohort of 35 control subjects and 35 non-related FCH patients were included, all of them nondiabetic, normotensive and nonsmokers. We measured lipid profile, glucose and insulin levels in plasma, and markers of oxidative stress and inflammation such as oxidized glutathione (GSSG), reduced glutathione (GSH) and TRX. RESULTS Familial combined hyperlipidaemia subjects showed significantly higher levels of GSSG, GSSG/GSH ratio and TRX than controls. In addition, FCH individuals with IR showed the worst profile of oxidative stress status compared to controls and FCH patients without IR (P < 0·01). TRX levels correlated with higher insulin resistance. CONCLUSION Familial combined hyperlipidaemia patients showed increased TRX levels. TRX was positively correlated with IR. These data could partially explain the increased risk of cardiovascular events in primary dyslipidemic patients.
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Affiliation(s)
- Sergio Martinez-Hervas
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
| | - Ana Artero
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain
| | - Juncal Martinez-Ibañez
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain
| | | | - Herminia Gonzalez-Navarro
- CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain.,Institute of Health Research-INCLIVA, Valencia, Spain
| | - Antonia Priego
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Jose F Martinez-Valls
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Guillermo T Saez
- Department of Biochemistry and Molecular Biology, University of Valencia-INCLIVA, Valencia, Spain.,Service of Clinical Analysis, Dr. Peset University Hospital, Valencia, Spain
| | - Jose T Real
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
| | - Rafael Carmena
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
| | - Juan F Ascaso
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
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Cortes R, Ivorra C, Martínez-Hervás S, Pedro T, González-Albert V, Artero A, Adam V, García-García AB, Ascaso JF, Real JT, Chaves FJ. Postprandial Changes in Chemokines Related to Early Atherosclerotic Processes in Familial Hypercholesterolemic Subjects: A Preliminary Study. Arch Med Res 2016; 47:33-9. [DOI: 10.1016/j.arcmed.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/13/2016] [Indexed: 12/01/2022]
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Núñez J, Bonanad C, Navarro JP, Bondanza L, Artero A, Ventura S, Núñez E, Miñana G, Sanchis J, Real J. Efecto diferencial de la glucohemoglobina y el tratamiento antidiabético sobre el riesgo de reingreso a 30 días después de un ingreso por insuficiencia cardiaca aguda. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2014.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mendez MM, Folgado J, Tormo C, Artero A, Ascaso M, Martinez-Hervás S, Chaves FJ, Ascaso JF, Real JT. Altered glutathione system is associated with the presence of distal symmetric peripheral polyneuropathy in type 2 diabetic subjects. J Diabetes Complications 2015; 29:923-7. [PMID: 26144280 DOI: 10.1016/j.jdiacomp.2015.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/17/2015] [Accepted: 05/31/2015] [Indexed: 12/21/2022]
Abstract
Distal symmetric peripheral polyneuropathy (DSPN) is a highly prevalent complication of diabetes. However, underlying pathophysiological mechanisms are multiple and not well understood. The aim of our study was to analyze the oxidative stress levels in circulating mononuclear cells by measuring the glutathione system, malondialdehyde and oxidized-LDL, in 60 type 2 diabetic patients from a well-characterized cohort of 196 type 2 diabetic patients. Using a nested case-control design, we studied 30 type 2 diabetic patients with distal symmetric polyneuropathy and 30 diabetic controls without this complication, according to the Neuropathy Disability Score. We have found that diabetic patients with distal symmetric polyneuropathy showed significantly lower values of reduced glutathione (GSH) and reduced glutathione/oxidized glutathione (GSH/GSSG) ratio. These data indicate an increased consumption of glutathione in mononuclear cells from patients with distal symmetric polyneuropathy. No significant differences were found in malondialdehyde or in oxidized-LDL levels comparing both groups. These data show an altered glutathione response in circulating monocytes from diabetic patients with distal symmetric polyneuropathy.
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Affiliation(s)
- Mercedes Molina Mendez
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - José Folgado
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carmen Tormo
- Department of Biochemistry and Molecular Biology, University of Valencia and CIBER de Obesidad, Spain
| | - Ana Artero
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Maria Ascaso
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Sergio Martinez-Hervás
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain; Laboratorio de Estudios Genéticos, Fundación para la Investigación. Instituto de Investigación INCLIVA, Valencia, Spain
| | - F Javier Chaves
- CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain; Laboratorio de Estudios Genéticos, Fundación para la Investigación. Instituto de Investigación INCLIVA, Valencia, Spain
| | - Juan F Ascaso
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain; Laboratorio de Estudios Genéticos, Fundación para la Investigación. Instituto de Investigación INCLIVA, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Jose T Real
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain; CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain; Laboratorio de Estudios Genéticos, Fundación para la Investigación. Instituto de Investigación INCLIVA, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
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Núñez J, Bonanad C, Navarro JP, Bondanza L, Artero A, Ventura S, Núñez E, Miñana G, Sanchis J, Real J. Differential Effect of Glycosylated Hemoglobin Value and Antidiabetic Treatment on the Risk of 30-day Readmission Following a Hospitalization for Acute Heart Failure. ACTA ACUST UNITED AC 2015; 68:852-60. [PMID: 25792287 DOI: 10.1016/j.rec.2014.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/21/2014] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES In patients with heart failure and type 2 diabetes, low glycosylated hemoglobin has been related with higher risk of mortality but information regarding morbidity is scarce. We sought to evaluate the association between glycosylated hemoglobin and 30-day readmission in patients with type 2 diabetes and acute heart failure. METHODS Glycosylated hemoglobin was measured before discharge in 835 consecutive patients with acute heart failure and type 2 diabetes. Cox regression analysis adapted for competing events was used. RESULTS Mean (standard deviation) age was 72.9 (9.6) years and median glycosylated hemoglobin was 7.2% (6.5%-8.0%). Patients treated with insulin or insulin/sulfonylurea/meglitinides were 41.1% and 63.2% of the cohort, respectively. At 30 days post-discharge, 109 (13.1%) patients were readmitted. A multivariate analysis revealed that the effect of glycosylated hemoglobin on the risk of 30-day readmission was differentially affected by the type of treatment (P for interaction<.01). Glycosylated hemoglobin (per 1% decrease) was inversely associated with higher risk in those receiving insulin (hazard ratio = 1.45; 95% confidence interval, 1.13-1.86; P=.003) or insulin/sulfonylurea/meglitinides (hazard ratio = 1.44; 95% confidence interval, 1.16-1.80; P=.001). Conversely, glycosylated hemoglobin (per 1% increase) had no effect in non-insulin dependent diabetes (hazard ratio = 1.01; 95% confidence interval, 0.87-1.17; P=.897) or even a positive effect in patients not receiving insulin/sulfonylurea/meglitinides (hazard ratio = 1.12; 95% confidence interval, 1.03-1.22; P=.011). CONCLUSIONS In acute heart failure, glycosylated hemoglobin showed to be inversely associated to higher risk of 30-day readmission in insulin-dependent or those treated with insulin/sulfonylurea/meglitinides. A marginal effect was found in the rest. Whether this association reflects a treatment-related effect or a surrogate of more advanced disease should be clarified in further studies.
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Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Juan Paulo Navarro
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Lourdes Bondanza
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Ana Artero
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario, INCLIVA, CIBERDEM and Universitat de Valencia, Valencia, Spain
| | - Silvia Ventura
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - José Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario, INCLIVA, CIBERDEM and Universitat de Valencia, Valencia, Spain
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Abstract
Wine is a traditional beverage that has been associated with both healthy and harmful effects. Conceptions like the so-called "French paradox" or the beneficial impact of the Mediterranean diet suggest benefit. Wine has a complex composition, which is affected by whether it is red or white or by other variables, like the variety of grapes or others. Alcohol and phenolic compounds have been attributed a participation in the benefits ascribed to wine. The case of alcohol has been extensively studied, but the key question is whether wine offers additional benefits. Resveratrol, a non-flavonoid compound, and quercetin, a flavonol, have received particular attention. There is much experimental work confirming a beneficial balance for both substances, particularly resveratrol, in various organs and systems. The pharmacological dosages used in many of those experiments have shed doubt, however, on the clinical translation of those findings. Clinical studies are limited by their observational nature as well as for the difficulties to abstract the benefits of wine from other confounders. Notwithstanding the doubts, there is reasonable unanimity in beneficial effects of moderate wine consumption in cardiovascular disease, diabetes, osteoporosis, maybe neurological diseases, and longevity. Observations are less enthusiastic in what refers to cancer. While considering these limitations, clinicians may spread the message that the balance of moderate wine consumption seems beneficial.
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Affiliation(s)
- Ana Artero
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario, Av Blasco Ibáñez 17, 46010 Valencia, Spain.
| | - Arturo Artero
- Department of Internal Medicine, Hospital Univesitario Dr. Peset, Av Gaspar Aguilar 90, 46017 Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Av Blasco Ibáñez 15, 46010 Valencia, Spain.
| | - Juan J Tarín
- Department of Functional Biology and Physical Anthropology, School of Biological Sciences, Burjasot Campus, University of Valencia, Valencia, Spain.
| | - Antonio Cano
- Service of Obstetrics and Gynecology, Clínico University Hospital, Av Blasco Ibáñez 17, 46010 Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Av Blasco Ibáñez 15, 46010 Valencia, Spain.
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Artero A, Martinez-Hervas S, Priego M, Martinez-Ibañez J, Martinez-Valls J, Real J, Ascaso J. Gender differences on oxidative stress markers and complement component C3 plasma values after an oral unsaturated fat load test. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zaragoza R, Camarena J, Sancho S, González R, Artero A, Navarro J, Nogueira J. R2182 Infiuence of doxycycline resistance on outcome in Acine-tobacter baumannii bacteraemia in an intensive care unit. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)72021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zaragoza R, Artero A, Camarena JJ, Sancho S, González R, Nogueira JM. The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit. Clin Microbiol Infect 2003; 9:412-8. [PMID: 12848754 DOI: 10.1046/j.1469-0691.2003.00656.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the occurrence of inadequate antimicrobial therapy among critically ill patients with bacteremia and the factors associated with it, to identify the microorganisms that received inadequate antimicrobial treatment, and to determine the relationship between inadequate treatment and patients outcome. METHODS From June 1995 to January 1999 we collected data on all clinically significant ICU-bacteremias in our teaching hospital. Clinical and microbiological characteristics were recorded and the adequacy of empirical antimicrobial treatment in each case was determined. We defined inappropriate empirical antimicrobial treatment as applying to infection that was not being effectively treated at the time the causative microorganism and its antibiotic susceptibility were known. Multivariate analysis was used to determine the variables associated with inappropriate empirical antimicrobial treatment and to evaluate the influence of this on the related mortality to bacteremia, using the SPSS package (9.0). RESULTS Among 166 intensive care unit patients with bacteremia, 39 (23.5%) received inadequate antimicrobial treatment. In this last group the mean age of patients was 64.1 +/- 13.2 years, and 64% were men. Bacteremia was hospital-acquired in 92% of these cases. Eleven percent developed septic shock and 37.7% severe sepsis, and ultimately fatal underlying disease was present in 28.2% of patients given inadequate empirical antimicrobial treatment. The main sources of bacteremias in this group were: a vascular catheter (15.3%), respiratory (7.6%) or unknown (53.8%). The microorganisms most frequently isolated in the group with inadequate empirical antimicrobial treatment were: coagulase-negative staphylococci (29.5%), Acinetobacter baumannii (27.3%), Enterococcus faecalis, Pseudomonas aeruginosa, Enterobacter cloacae, Proteus mirabilis, Escherichia coli, and Candida species (4.5% each). The frequency of coagulase-negative staphylococci in the cases with inappropriate treatment was higher than in the group with appropriate treatment (OR 2.62; 95% CI: 1.10-6.21; P = 0.015). The global mortality rate was 56% and the related mortality was 30% in the group with inadequate empirical antimicrobial treatment. The only factor associated with inappropriate empirical antibiotic treatment was the absence of abdominal or respiratory focus (P = 0.04; OR = 0.35; 95% CI: 0.12-0.97). Septic shock was related to attributable mortality (P = 0.03; OR = 3.19; 95% CI: 1.08-9.40), but not inappropriate empirical antibiotic treatment (P = 0.24; OR = 1.71; 95% CI: 0.66-4.78). CONCLUSION Almost a quarter of critically ill patients with bloodstream infections were given inadequate empirical antibiotic treatment, but mortality was not higher in the group with inadequate treatment than in the group with adequate treatment. This fact was probably due to microbiological factors and clinical features, such as the type of microorganism most frequently isolated and the source of the bacteremia.
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Affiliation(s)
- R Zaragoza
- Intensive Care Unit, Hospital Universitario Dr Peset, Avda Gaspar Aguilar, 90 46017 Valencia, Spain.
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Affiliation(s)
- A Artero
- Medicina Interna, Hospital Universitario Dr. Peset, Valencia, Spain
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Nogueira JM, Franco J, Camarena JJ, Navarro JC, Olmos A, Blanquer R, Artero A. Molecular approach to identifying route of Mycobacterium tuberculosis transmission in a village. Int J Tuberc Lung Dis 2000; 4:91-2. [PMID: 10654651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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Artero A, Eiros JM, Ochoa C, Inglada L, Guerra L, Armadans L, Vallano A, Vidal JB, Martínez A, Lázaro A, Cerdá T, Ruiz A. [Multicenter study of the variability and adequacy of antimicrobial therapy for community-acquired pneumonia in adults]. Rev Esp Quimioter 1999; 12:352-8. [PMID: 10855015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We performed a study to evaluate the variability and adequacy of prescribing antibiotics in community-acquired pneumonia (CAP) in 10 Spanish hospitals. We studied 452 patients with CAP. Initial empirical administration of antibiotics was prescribed in 90.7% of the cases, 82.5% as monotherapy. Macrolides and third and second generation cephalosporins were the most widely used groups of antibiotics. Penicillin and amoxicillin were only prescribed in 1. 7% of the patients. A significant variability between hospitals was observed. Reference patterns for the use of antibiotics in CAP were devised by a panel of experts. According to the recommendations of this panel, 29% of the total prescriptions were not adequate, with this percentage reaching 65% in outpatients older than 65 years or with comorbidity. This was mainly due to the fact that monotherapy with erythromycin, which was considered inadequate, was the most widely prescribed treatment.
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Affiliation(s)
- A Artero
- Area de Microbiología, Facultad de Medicina, Avda. Ramón y Cajal n(o) 7, 47005 Valladolid
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Lázaro A, Ochoa C, Inglada L, Eiros JM, Martínez A, Vallano A, Armadans L, Bautista Vidal J, Artero A, Ruiz A, Cerdá T, Guerra L. [Practice variation and appropriateness study of antimicrobial therapy for acute pharyngotonsillitis in adults]. Enferm Infecc Microbiol Clin 1999; 17:292-9. [PMID: 10439540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE Infectious pharyngotonsillitis is usually managed with antibiotics by general practitioners and pediatricians both in primary care and the emergency services. In the present work we try to assess the antibiotic variability and appropriateness in the management of acute pharyngotonsillitis among several emergency services in our country related to scientific evidence based in an expert panel criteria. METHOD A transversal trial was carried on in ten emergency services of our country. We included patients older than fourteen years an analyzed the following variables: type of respiratory infection, antibiotic prescription, comorbidity, physician's status and hospital admission. The antibiotics were classified in three levels according to the expert panel criteria: first election, alternative use and inappropriate use. We compared the antibiotic treatments to these three levels. RESULTS 2,869 patients were diagnosed of acute respiratory infection, 356 (12.4%) with pharyngotonsillitis. Commonly the patients were prescribed antibiotics (315; 81%) and the most used were amoxicillin-clavulanate (33%), amoxicillin (16%), penicillin (7%), cefuroxime (6%), erythromicin (4%) and cefixime (3%). Among the 315 prescriptions, 98 (32%) were first election, 147 (50%) alternative use and 50 (17%) inappropriate use. CONCLUSIONS Most of the patients suffering of pharyngotonsillitis were empirically prescribed antibiotics probably many of these cases were non-bacterial pharyngotonsillitis. Alternative and inappropriate use of antibiotics was high.
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Affiliation(s)
- A Lázaro
- Unidad de Investigación, Hospital Virgen de la Concha, Zamora
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Camarena JJ, Artero A, Nogueira JM, Navarro JC, Olmos A, Blanquer R. [Tuberculosis in AIDS patients: the contribution of an analysis of the restriction fragment length polymorphism of Mycobacterium tuberculosis isolates]. Med Clin (Barc) 1998; 111:721-4. [PMID: 9922953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND In this report we study tuberculosis transmission in HIV infected patients using molecular epidemiological methods. PATIENTS AND METHODS We have studied 60 M. tuberculosis isolates from 30 HIV infected cases, and their clinical-epidemiological data. Susceptibility to tuberculostatic agents and electrophoretic patterns using RFLPs (restriction fragment length polymorphisms) method were evaluated. Dice's coefficient was used for the similarity analysis. RESULTS Over 73% studied patients were included in clusters using RFLPs analysis. This data show that nearly 60% of the tuberculosis cases in our area have a recent transmission. Forty per cent of these cases were included in the main cluster. The frequency of tuberculostatic-resistant strains in HIV infected patients was similar to the that of observed in other patients. We did not find correlation between RFLPs clusters and clinical-epidemiological data. CONCLUSIONS Tuberculosis transmission in HIV-positive patients using RFLPs as molecular marker shows that 60% of the cases are caused by recently acquired strains. We did not find multi-drug resistant strains in our isolates. However due to the high transmissibility of these circulating clones, control disease measures in this group of risk population are required.
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Affiliation(s)
- J J Camarena
- Servicio de Microbiología, Hospital Universitario Dr. Peset, Universidad de Valencia.
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Martínez-Triguero ML, Artero A, Vicente R, Molina E. [Lipoprotein(a) levels in patients with human immunodeficiency virus infection]. Med Clin (Barc) 1996; 107:637. [PMID: 9064400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Tornero C, Artero A, Herrejon A, Plaza P, Pons E, Blanquer R. [Pneumatocele, pleural effusion and pneumothorax in nosocomial pneumonia]. Enferm Infecc Microbiol Clin 1996; 14:561-2. [PMID: 9035715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C Tornero
- Servicio de Medicina Interna, Hospital Dr. Peset, Valencia
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Fernández E, León P, Blanquer R, Marín M, Artero A, Pinilla A. [A comparison of lymphocyte populations of the blood and bronchoalveolar lavage in AIDS patients]. Arch Bronconeumol 1996; 32:271-4. [PMID: 8814820 DOI: 10.1016/s0300-2896(15)30751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Changes in cell immunity made manifest by decreases in blood levels of CD4 T cells is the main indicator of progressing HIV infection. The decrease in these lymphocytes, as well as in the CD4/CD8 index and increases in suppressant or cytotoxic CD8 cells can be detected in bronchoalveolar (BAL) lung samples. It is not clear whether the high incidence of respiratory system diseases in HIV patients stems from local or systemic immune changes. The aim of this study was to compare changes in the systemic cell immunity studied in samples of peripheral blood with changes detected in BAL samples from HIV patients with acute respiratory disease. We studied 42 patients in the advanced stages of AIDS (C3 by Centers for Disease Control classification) who were hospitalized for acute respiratory disease and who underwent diagnostic fiberoptic bronchoscopy and BAL. Cell counts and lymphocyte populations were analyzed by flow cytometry in samples of peripheral blood and BAL. The percentage of CD4 lymphocytes and the CD4/CD8 index were lower in BAL, particularly in patients with blood CD4 levels below 12% of the total T cell population, or at a level of 20 CD4 cells/microliters. Changes in cell immunity in patients with advanced HIV infection (C3 classification) and acute respiratory disease are more manifest locally in the lung than peripherally in blood. Lung depletion of CD4 T cells in the lung can be predicted based on blood levels.
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Affiliation(s)
- E Fernández
- Servcio de Neumología, Hospital Dr. Peset Aleixandre, Valencia
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García de Lomas J, Gimeno C, Artero A, Alcácer A, Marín J, García de Lomas E, Ocete MD, Serrat C, Catalán V. [Use of DNA amplification to diagnose cytomegalovirus in HIV seropositive patients]. Med Clin (Barc) 1992; 99:249-52. [PMID: 1328779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is common among HIV seropositive patients, being difficult to diagnose because it requires cell cultures not available in all hospitals. DNA amplification is being applied for diagnosis of infectious diseases with an increase in sensitivity and specificity with respect to previous laboratory methods. METHODS Polymerase chain reaction (PCR) has been used in comparison with culture isolation, early antigen detection to diagnose CMV infection in 22 HIV infected patients, that suffered from symptoms compatible with CMV infection at the present time, and in other 5 patients suffering from Kaposi sarcoma. PCR was done with primer for CMV IE genomic region. The amplified sequences were detected after hybridization with a gamma-P-32 labelled probe, followed by electrophoresis in a 5% polyacrylamide gel and autoradiography. RESULTS The PCR allows to detect CMV genome in cases in which other tests are negatives, in blood as well as in urine, included those patients suffering only from febrile symptoms or with other associated pathogen. CONCLUSIONS PCR is a sensitive method to detect CMV, although it does not establish the responsibility of CMV in HIV infected patients.
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Affiliation(s)
- J García de Lomas
- Departamento de Microbiología, Hospital Clínico Universitario, Valencia
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Rodrigo JM, Serra MA, Aparisi L, Escudero A, Gilabert MS, García F, Gonzalez R, del Olmo JA, Wassel AH, Artero A. Immune response to hepatitis B vaccine in parenteral drug abusers. Vaccine 1992; 10:798-801. [PMID: 1441734 DOI: 10.1016/0264-410x(92)90516-m] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Responsiveness was assessed to a programme of vaccination of hepatitis B vaccine in a cohort of 197 intravenous drug addicts (mean age, 23.7 years) and their antibody response was compared with that of 271 healthy controls (mean age, 24.2 years). All participants were seronegative for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). The vaccination schedule consisted of three intramuscular injections (deltoid area) at months 0, 1 and 2. Although 70% of parenteral drug abusers received the three doses of vaccination, only 43.6% were evaluable for immune response. Fifty-eight per cent of heroin addicts and 80% of controls had evidence of anti-HBs seroconversion at 1 month after vaccination (chi 2 = 15.52, p less than 0.001). Geometric mean antibody titres were also significantly higher in controls (69.1 IU l-1; confidence interval 95%, 56.83 and 84.04) than in parenteral drug abusers (18.2 IU l-1; confidence interval 95%, 12.85 and 25.73) (F = 20.951, p less than 0.0001). The anti-HBs response was not influenced by coexistent anti-HBc, HCV antibody or HIV antibody seropositivity.
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Affiliation(s)
- J M Rodrigo
- Liver Unit, Hospital Clínico Universitario, Valencia, Spain
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Cervera G, Artero A, Redondo A, Guiz J. [Addiction to buprenorphine]. Rev Clin Esp 1989; 184:159. [PMID: 2717796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Serrano Comino M, Artero A, Varela M, Martín C, González Palacios F, Serrano Ríos M. [Experience of granulomatous diseases in a general hospital]. Rev Clin Esp 1988; 182:79-83. [PMID: 3358005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Lluch A, Artero A, Cervantes A, Vicent JM, Codina G, Barrajón G, Rabena MT, Alberola V, García Conde J. [Estrogen and progesterone receptors in cancer of the breast]. Med Clin (Barc) 1987; 89:456-9. [PMID: 3682976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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