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Contreras M, Mesa A, Pueyo I, Claro M, Milad C, Viñals C, Roca D, Granados M, Giménez M, Conget I. Effectiveness of flash glucose monitoring in patients with type 1 diabetes and recurrent hypoglycemia between early and late stages after flash glucose monitoring initiation. J Diabetes Complications 2023; 37:108560. [PMID: 37480703 DOI: 10.1016/j.jdiacomp.2023.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
AIMS Evaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. METHODS Ambispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimbursed FGM (FreeStyle Libre 2). The primary outcome was the number of SH events (requiring third party assistance) and main secondary outcomes were time below range < 70 (TBR < 70) and < 54 mg/dL (TBR < 54), impaired awareness of hypoglycemia (IAH) and quality of life (QoL). Logistic regression models were constructed to explore variables associated with success of the intervention. RESULTS We included 110 patients (52.7 % women, mean age 47.8 ± 17.0 years). SH events at 1-year follow-up decreased from 0.3 ± 0.6 to 0.03 ± 0.2 (p < 0.001). Significant reductions in patients presenting an SH (26.4 % vs. 2.9 %, p < 0.001) and IAH (47.1 % vs. 25.9 %, p = 0.002) were observed, as well as improvements in QoL. TBR < 70 and TBR < 54 were not significantly reduced. Baseline GMI was inversely associated with a decrease in TBR < 70 [OR 0.37 (0.15-0.93)] and directly with an increase in time in range 70-180 mg/dL [OR 2.10 (1.03-4.28)]. CONCLUSIONS FGM decreased SH and improved hypoglycemia awareness and QoL. Initial tight glycemic control was associated with a decrease in hypoglycemia, while patients with suboptimal control reduced hyperglycemia.
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Affiliation(s)
- Macarena Contreras
- Endocrinology and Nutrition Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Maria Claro
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Montse Granados
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
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Boswell L, Perea V, Amor AJ, Seguí N, Bellart J, Roca D, Giménez M, Conget I, Vinagre I. Impaired hypoglycaemia awareness in early pregnancy increases risk of severe hypoglycaemia in the mid-long term postpartum irrespective of breastfeeding status in women with type 1 diabetes. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:18-26. [PMID: 37268354 DOI: 10.1016/j.endien.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/16/2021] [Accepted: 02/14/2022] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). MATERIALS AND METHODS Retrospective cohort study of women with T1D followed during pregnancy between 2012 and 2019. Data on SH were recorded before and during pregnancy. IAH was evaluated at the first antenatal visit. Data on breastfeeding and the long-term postpartum period were collected by questionnaire and from medical records. RESULTS A total of 89 women with T1D were included with a median follow-up after pregnancy of 19.2 [8.7-30.5] months. Twenty-eight (32%) women had IAH at the first antenatal visit. At discharge, 74 (83%) started breastfeeding during a median of 8 [4.4-15] months. A total of 18 (22%) women experienced ≥1 SH during postpartum. The incidence of SH significantly increased from pregestational to the gestational and post-partum period (0.09, 0.15 and 0.25 episodes/patient-year, respectively). Postpartum SH rates were comparable in breastfeeding and non-breastfeeding women (21.4% vs. 25%, respectively, p>0.05). Clarke test score at the first antenatal visit was associated with postpartum SH (for each 1-point increase: OR 1.53; 95% CI, 1.06-2.21) adjusted for confounders. No other diabetes and pregnancy-related variables were identified as predictors of SH in this period. CONCLUSIONS SH are common in the long-term postpartum period independently of breastfeeding. Assessing IAH in early pregnancy could identify those at an increased risk of SH in the postpartum period.
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Affiliation(s)
- Laura Boswell
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Verónica Perea
- Endocrinology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Seguí
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Bellart
- Obstetrics and Gynecology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daria Roca
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain.
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Brugnara L, Hernandez A, Amor AJ, Roca D, Gimenez M, Segui N, Conget I, Esmatjes E. Changes in physical activity habits in subjects with type 1 diabetes: A comparative study 10 years apart. ENDOCRINOL DIAB NUTR 2023; 70:319-325. [PMID: 37263732 DOI: 10.1016/j.endien.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/21/2022] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Physical activity (PA) is highly recommended in type 1 diabetes (T1D). Few studies have reported the amount of PA performed by individuals with T1D in their daily life, and there is no information about changes over time. MATERIAL AND METHODS Cross-sectional study in patients with T1D from a referral hospital recruited in two different periods: data from the Biobank registers from 2009 and data from patients attending visits at the hospital in 2019, on a consecutive basis. Data included clinical characteristics and the PA assessment through the International Physical Activity Questionnaire-short form (IPAQ-SF). RESULTS In 2019, participants with T1D (n=135) reported a lower sedentary lifestyle and greater levels of high PA compared to subjects with T1D (n=355) from 10 years earlier (6.7% vs. 14.1% sedentariness, p=0.015; and 52.6% vs. 25.4% of high PA, p<0.001, respectively). Similar results were identified when the groups were divided according to sex. Both groups presented similar distribution by sex (women, 54% vs. 55%), age (40 vs. 39 years old), years with diabetes (20 vs. 18 years), BMI (25 vs. 24kg/m2) and glycated haemoglobin (7.5% vs. 7.5%, respectively; p>0.05 for all comparisons). Sex and age groups were not determinant for sedentary lifestyle in the different years studied. Analysing all the 490 participants, there was an inverse correlation of age with sitting hours (p=0.024, r=-0.102), total METs (p<0.001, r=-0.146) and HbA1c (p=0.038, r=-0.097). No correlations were found between PA and HbA1c or BMI. CONCLUSIONS The findings indicate that PA has significantly increased in subjects with T1D over the last 10 years. Future studies are needed to assess whether these healthier habits translate into better outcomes in this high-risk population.
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Affiliation(s)
- Laura Brugnara
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona/Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
| | | | - Antonio J Amor
- Universitat de Barcelona, Barcelona, Spain; Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daria Roca
- Universitat de Barcelona, Barcelona, Spain; Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona/Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain; Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Segui
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Conget
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona/Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain; Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona/Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Brugnara L, Hernandez A, Amor AJ, Roca D, Gimenez M, Segui N, Conget I, Esmatjes E. Changes in physical activity habits in subjects with type 1 diabetes: A comparative study 10 years apart. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.03.013] [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: 10/15/2022]
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Grau-Corral I, Pantoja PE, Grajales Iii FJ, Kostov B, Aragunde V, Puig-Soler M, Roca D, Couto E, Sisó-Almirall A. Assessing Apps for Health Care Workers Using the ISYScore-Pro Scale: Development and Validation Study. JMIR Mhealth Uhealth 2021; 9:e17660. [PMID: 34287216 PMCID: PMC8339980 DOI: 10.2196/17660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 10/22/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background The presence of mobile phone and smart devices has allowed for the use of mobile apps to support patient care. However, there is a paucity in our knowledge regarding recommendations for mobile apps specific to health care professionals. Objective The aim of this study is to establish a validated instrument to assess mobile apps for health care providers and health systems. Our objective is to create and validate a tool that evaluates mobile health apps aimed at health care professionals based on a trust, utility, and interest scale. Methods A five-step methodology framework guided our approach. The first step consisted of building a scale to evaluate apps for health care professionals based on a literature review. This was followed with expert panel validation through a Delphi method of (rated) web-based questionnaires to empirically evaluate the inclusion and weight of the indicators identified through the literature review. Repeated iterations were followed until a consensus greater than 75% was reached. The scale was then tested using a pilot to assess reliability. Interrater agreement of the pilot was measured using a weighted Cohen kappa. Results Using a literature review, a first draft of the scale was developed. This was followed with two Delphi rounds between the local research group and an external panel of experts. After consensus was reached, the resulting ISYScore-Pro 17-item scale was tested. A total of 280 apps were originally identified for potential testing (140 iOS apps and 140 Android apps). These were categorized using International Statistical Classification of Diseases, Tenth Revision. Once duplicates were removed and they were downloaded to confirm their specificity to the target audience (ie, health care professionals), 66 remained. Of these, only 18 met the final criteria for inclusion in validating the ISYScore-Pro scale (interrator reliabilty 92.2%; kappa 0.840, 95% CI 0.834-0.847; P<.001). Conclusions We have developed a reproducible methodology to objectively evaluate mobile health apps targeted to health care professionals and providers, the ISYScore-Pro scale. Future research will be needed to adapt the scale to other languages and across other domains (eg, legal compliance or security).
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Affiliation(s)
- Inmaculada Grau-Corral
- Fundacion iSYS (internet, Salud y Sociedad), Barcelona, Spain.,Hospital Clínic Barcelona, Barcelona, Spain
| | - Percy Efrain Pantoja
- Fundacion iSYS (internet, Salud y Sociedad), Barcelona, Spain.,Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IRB Sant Pau), Barcelona, Spain
| | - Francisco J Grajales Iii
- Fundacion iSYS (internet, Salud y Sociedad), Barcelona, Spain.,University of British Columbia, Vancouver, BC, Canada
| | - Belchin Kostov
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Valentín Aragunde
- Casanova Primary Health-Care Center, Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain
| | - Marta Puig-Soler
- Casanova Primary Health-Care Center, Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain
| | - Daria Roca
- Hospital Clínic Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Antoni Sisó-Almirall
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Les Corts Primary Health-Care Center, Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain
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Viñals C, Mesa A, Roca D, Vidal M, Pueyo I, Conget I, Giménez M. Management of glucose profile throughout strict COVID-19 lockdown by patients with type 1 diabetes prone to hypoglycaemia using sensor-augmented pump. Acta Diabetol 2021; 58:383-388. [PMID: 33125525 PMCID: PMC7596617 DOI: 10.1007/s00592-020-01625-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
AIMS Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with type 1 diabetes (T1D) prone to hypoglycaemia using sensor-augmented pump (SAP). METHODS Patients with T1D prone to hypoglycaemia using SAP (640G Medtronic-Minimed®) for at least 6 months under the funding of a National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st to 14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data and total daily insulin were also analysed. RESULTS Fifty-nine patients were included: 33 women, age 46.17 ± 13.0 years and disease duration of 30.2 ± 12.0 years. TIR 70-180 mg/dL (67.6 ± 11.8 vs. 69.8 ± 12.0%), time > 180 (28.1 ± 13.6 vs. 25.5 ± 13.1%), time > 250 (6.9 ± 6.1 vs. 5.1 ± 4.8) and estimated HbA1c (6.94 ± 0.8 vs. 6.75 ± 0.7%) significantly improved (PL vs. WL, respectively, p < 0.05). Time in hypoglycaemia, coefficient of variation, sensor usage and total daily insulin dose remained unchanged. CONCLUSIONS Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycaemia control by population with DT1 prone to hypoglycaemia using SAP. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time hypoglycaemia.
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Affiliation(s)
- Clara Viñals
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain.
| | - Alex Mesa
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Daria Roca
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Merce Vidal
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit. Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Villarroel 170, 08036, Barcelona, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain
- IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Mesa A, Viñals C, Pueyo I, Roca D, Vidal M, Giménez M, Conget I. The impact of strict COVID-19 lockdown in Spain on glycemic profiles in patients with type 1 Diabetes prone to hypoglycemia using standalone continuous glucose monitoring. Diabetes Res Clin Pract 2020; 167:108354. [PMID: 32739380 PMCID: PMC7392049 DOI: 10.1016/j.diabres.2020.108354] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 11/02/2022]
Abstract
AIMS Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. METHODS Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st-14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data were also analysed. RESULTS 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70-180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. CONCLUSIONS Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Mercè Vidal
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain; IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Madrid, Spain; IDIBAPS, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Grau-Corral I, Jansà M, Gascon P, Lozano-Rubí R, Pantoja PE, Roca D, Aragunde Miguens V, Hidalgo-Mazzei D, Escarrabill J. Mobile Health Projects in a High-Complexity Reference Hospital: Case Study. JMIR Mhealth Uhealth 2020; 8:e16247. [PMID: 32012092 PMCID: PMC7055769 DOI: 10.2196/16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/13/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The widespread adoption of mobile and wearable devices and apps makes it essential to assess their possible impact on the management of health and diseases. Health care providers (HCPs) find themselves faced with a new situation in their setting with the proliferation of mobile health (mHealth) intervention tests. Few studies have addressed the development of mHealth and the methodologies to manage these apps in a tertiary hospital. OBJECTIVE The aim of this study was to evaluate the mHealth projects implemented in the Hospital Clínic of Barcelona to increase awareness of the context in which they are used and to develop policies for the development of good practice in mHealth innovation. METHODS A prospective, descriptive cross-sectional study was conducted in a highly specialized university hospital with 850 beds for adults and a reference population of 520,000 inhabitants. A specific questionnaire was developed based on the Mobile Health 5 Dimensions European (MOHE 5D-EU) theoretical model to find mHealth projects. Apps, telemedicine, and wearable devices were included in the systematic search. For that purpose, a vertical (top-down) email-based snowball process was conducted. Data were collected from February to December 2018 by conducting personal interviews with HCPs using a structured questionnaire. RESULTS During the study period, 45 interviews were conducted; 35 mHealth initiatives were found, with 25 targeted to patients and 10 to health professionals. Most mHealth initiatives (34/35, 97%) were related to the software field (apps and telemedicine initiatives), and one was related to wearable devices. Among the projects, 68% (24/35) were classified as medical devices or developments at the edge (developments susceptible to limitations depending on the intended use). In relation to data protection, 27 initiatives managing personal data (27/35, 77%) considered data protection legislation. Only 9% (3/35) of the initiatives had foreseen the use of interconnectivity standards. Most of the initiatives were funded by grants (14/35, 40%), sponsorships (5/35, 14%), or the hospital itself (5/35, 14%). In terms of clinical management, most projects were developed in the field of research, followed by professional tools, clinical information, and therapeutic education. Only 6 projects were involved with health care; all were led by either the industry or small and medium enterprises. CONCLUSIONS This study helped create the design of a map of the mHealth projects conducted in our hospital that showed the stages of development of the different ongoing projects. This will allow monitoring of mHealth projects and construction of tools to reinforce areas with detected deficiencies. Our theoretical approach using a modified MOHE 5D-EU model was found to be useful for analyzing the characteristics of mHealth projects.
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Affiliation(s)
- Inmaculada Grau-Corral
- Hospital Clinic de Barcelona, Barcelona, Spain.,Fundación Internet Salud y Sociedad, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Grup de Recerca transversal en Atenció Primària, Barcelona, Spain.,Universitat Oberta de Catalunya, PsiNET, Barcelona, Spain
| | - Margarida Jansà
- Hospital Clinic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Pau Gascon
- Hospital Clinic de Barcelona, Barcelona, Spain.,Fundación Internet Salud y Sociedad, Barcelona, Spain
| | - Raimundo Lozano-Rubí
- Hospital Clinic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Daria Roca
- Hospital Clinic de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Valentín Aragunde Miguens
- Consorci d'Atenció Primària Casanova, Consorci d'Atenció Primària de Salut de l'Eixample (CAPSBE), Barcelona, Spain
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Vidal M, Jansà M, Roca D, Yoldi C, Cardona-Hernández R, Giménez M, Conget I. Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center. Endocrinol Diabetes Nutr (Engl Ed) 2019; 67:394-400. [PMID: 31668682 DOI: 10.1016/j.endinu.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/11/2019] [Accepted: 07/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital. PATIENTS AND METHODS Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test <3R or>3R respectively. RESULTS Fifty-six patients (age 18.1±0.3 years, 46% females, HbA1c 8.0±1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33±0.50 vs. 0.09±0.28 P<.05). The percentage of patients with>2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p=0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38±1.06 vs. 0.02±0.15 P=.04). CONCLUSIONS The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D.
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Affiliation(s)
- Mercé Vidal
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España.
| | - Margarida Jansà
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Daria Roca
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Carmen Yoldi
- Unidad de Endocrinología Pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Roque Cardona-Hernández
- Unidad de Endocrinología Pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Marga Giménez
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS, Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, España; CIBERDEM. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
| | - Ignacio Conget
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS, Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, España; CIBERDEM. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
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Quirós C, Viñals C, Giménez M, Roca D, Conget I. Assessment of the effectiveness of long-term insulin pump therapy using a combined goal of HbA 1c decrease and absence of severe hypoglycemia. ACTA ACUST UNITED AC 2019; 66:534-539. [PMID: 31133475 DOI: 10.1016/j.endinu.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/22/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Less than one third of patients with type 1 diabetes mellitus (T1DM) achieve the cut-off value proposed as good metabolic control by most guidelines, HbA1c<7%. However, HbA1c reductions and prevention of severe hypoglycemia (SH) have shown clinically relevant benefits. The study objective therefore was to assess the effectiveness of continuous subcutaneous insulin infusion (CSII) therapy at 5 years of follow-up in a cohort of patients attending a specialized unit using HbA1c reduction and abscence of SH as combined goals. METHODS A retrospective, observational study on 178 patients with T1DM who started CSII treatment at Hospital Clinic of Barcelona between 2003 and 2008. HbA1c levels at baseline and after 5 years of treatment with CSII and presence or absence of SH were recorded. The combined variables calculated included: a) HbA1c reduction by≥0.5 points and absence of SH in the last 2 years; b) HbA1c at 5 years<7.5% and no SH in the last 2 years; c) HbA1c<8.5% and no HG in the last 2 years, and d) HbA1c reduction by≥0.5 points and/or HbA1c<7.5% at 5 years with no SH in the last 2 years of follow-up. RESULTS Twenty-seven of the 178 patients were excluded due to loss to follow-up or CSII discontinuation. A total of 151 patients (aged 37.4±10.5 years, 64% women, diabetes duration of 19.2±10.7 years) were therefore analyzed. The 2 main reasons for starting CSII were suboptimal metabolic control (60.9%) and severe hypoglycemia/hypoglycemia unawareness (28.5%). HbA1c levels in the total cohort and in patients with suboptimal metabolic control were 8.0±1.2 and 8.4±1.1% at CSII start and 7.8±1.2 and 8.0±1.3% at 5 years of treatment (P=.104 and P=.016) respectively. In the overall cohort, 55.5% of patients achieved at 5 years the combined goal of HbA1c<7.5% and/or HbA1c reductions≥0.5% without SH. CONCLUSIONS After 5 years of CSII therapy, more than half of the patients achieved the combined goal of significant HbA1c reduction and absence of SH. The use of combined goals offers the opportunity to assess the effectiveness of T1DM treatment from a clinically more meaningful point of view.
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Affiliation(s)
- Carmen Quirós
- Servicio de Endocrinología y Nutrición, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
| | - Clara Viñals
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España
| | - Marga Giménez
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
| | - Daria Roca
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España
| | - Ignacio Conget
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
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Quirós C, Jansà M, Viñals C, Giménez M, Roca D, Escarrabill J, Garcia F, Pérez S, Conget I. Experiences and real life management of insulin pump therapy in adults with type 1 diabetes. ENDOCRINOL DIAB NUTR 2019; 66:117-123. [PMID: 30076125 DOI: 10.1016/j.endinu.2018.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/28/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is scarce information regarding the performance of a specific, structured education program addressed to patients with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) including both routine use of the therapy and patient experience evaluation. We aimed to assess the routine use of CSII and patient's experience and satisfaction regarding a specific structured patient self-management education and care program. METHODS A retrospective, observational, cross-sectional study collecting CSII routine use downloaded data. Patient experience and satisfaction were evaluated using an anonymous online survey covering different aspects of CSII self-management education and care program. RESULTS 380 T1D subjects were included (aged 45.3±12.17 years, 62.1% women, diabetes duration 27.8±10.3 years, 9.7±4.7 years on CSII, HbA1c 7.7+1.0%; 61.0±7.9mmol/mol). Participants with HbA1c≤7.5% (58mmol/mol, n=178) did more SMBGs per day (4.4±2.1 vs. 3.9±1.9); used more boluses (5.0±1.8 vs. 4.5±2.0); the percentage of insulin given as bolus was higher (50.1±12.8 vs. 44.9±13.2%); the night bolus wizard (BW) high glucose target was lower (125.9±4.4 vs. 130.5±12.8mg/dl) and time on CSII therapy was shorter (8.9±4.6 vs. 10.3±4.6 years. p<0.05 all comparisons). More SMBG/day, shorter duration of CSII treatment, a lower BW low glucose target at night, a lower BW high glucose target at night, total insulin dose per day and total number of carbohydrates per day were related with better HbA1c levels. 60% of 373 patients answered the questionnaire. The response to the different aspects of the educational program was homogeneously highly satisfactory. Seventy-seven percent of patients scored the program as very useful. Ninety-three percent of CSII users would not return to their previous insulin treatment. CONCLUSIONS The analysis of routine clinical use of CSII by T1D patients demonstrates that glucose control may be associated with some pump usage and adherence parameters. The overall user experience and satisfaction with our CSII self-management education and care program was remarkably favorable.
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Affiliation(s)
- Carmen Quirós
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Marga Jansà
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Spain; CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain
| | - Joan Escarrabill
- Chronicity Program, Hospital Clínic i Universitari de Barcelona, Spain
| | - Ferran Garcia
- Project Management and Web Domains, Hospital Clínic i Universitari de Barcelona, Spain
| | - Sofía Pérez
- Digestive and Metabolic Diseases Institute (IMDM), Hospital Clínic i Universitari de Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Dpt, IMDM, Hospital Clínic i Universitari de Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Spain; CIBERDEM (CIBER in Diabetes and Associated Metabolic Disorders), Spain.
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Quirós C, Giménez M, Ríos P, Careaga M, Roca D, Vidal M, Conget I. Long-term outcome of insulin pump therapy: reduction of hypoglycaemia and impact on glycaemic control. Diabet Med 2016; 33:1422-6. [PMID: 26870914 DOI: 10.1111/dme.13094] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/14/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
AIMS To determine the long-term outcome of continuous subcutaneous insulin infusion (CSII) in Type 1 diabetes according to Catalan National Health Service indications. METHODS Retrospective observational study including 178 patients with Type 1 diabetes who started CSII treatment in our centre (2003-2008). All patients were followed in our CSII programme for outpatients for at least 5 years. Data on annual HbA1c levels were collected, and the main indication for starting CSII was analysed. RESULTS Twenty-seven of 178 patients were excluded because of loss to follow-up or withdrawal from CSII, thus 151 patients (aged 37.4 ± 10.5 years, 64% women) were analysed. The main indications for starting CSII were suboptimal metabolic control (60.9%), severe hypoglycaemia/hypoglycaemia unawareness (25.5%) and others (13.6%). HbA1c was 64 ± 13 mmol/mol (8.0 ± 1.2%) at the start of CSII and 62 ± 13 mmol/mol (7.8 ± 1.2%) after 5 years in the total cohort (P = 0.1). The severe hypoglycaemia rates were 0.66 ± 1.61 and 0.17 ± 0.42 episodes/patient/year (P < 0.001). In patients with suboptimal metabolic control, HbA1c decreased from 68 ± 12 mmol/mol (8.4 ± 1.1%) to 64 ± 14 mmol/mol (8.0 ± 1.3%) (P = 0.016), with 37.4% of those in this group having an HbA1c ≤ 58 mmol/mol (7.5%) after 5 years. In patients starting CSII due to severe hypoglycaemia the problem was considered resolved in 93%, and in 64% of those starting CSII because of suboptimal glycaemic control, HbA1c improved significantly. CONCLUSIONS CSII therapy achieves and maintains its efficacy mainly in terms of reducing severe hypoglycaemia. In the whole group of patients, the reduction in HbA1c is transient and disappears after 5 years.
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Affiliation(s)
- C Quirós
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain.
| | - M Giménez
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - P Ríos
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - M Careaga
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - D Roca
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - M Vidal
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain
| | - I Conget
- Diabetes Unit, Endocrinology, Department, Hospital Clínic i Universitari, Barcelona, Spain
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Asins MJ, Raga V, Roca D, Belver A, Carbonell EA. Genetic dissection of tomato rootstock effects on scion traits under moderate salinity. Theor Appl Genet 2015; 128:667-79. [PMID: 25628165 DOI: 10.1007/s00122-015-2462-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/10/2015] [Indexed: 05/22/2023]
Abstract
Rootstock HKT1 genotype affected fruit [Na(+)] and non-commercial fruit yield; QTL analysis of rootstock-mediated scion nutrition is a powerful forward genetic approach to identify wild genes for rootstock breeding. The present study approaches the QTL dissection of rootstock effects on a commercial hybrid variety grafted on a population of RILs derived from Solanum pimpinellifolium, genotyped for 4370 segregating SNPs from the SolCAP tomato panel and grown under moderate salinity. Results are compared to those previously obtained under high salinity. The most likely functional candidate genes controlling the scion [Na(+)] were rootstock HKT1;1 and HKT1;2 as it was previously reported for non-grafted genotypes. The higher fruit [Na(+)] found when rootstock genotype was homozygote for SpHKT1 supports the thesis that scion HKT1 is loading Na(+) into the phloem sap in leaves and unloading it in sink organs. A significant increment of small, mostly seedless, fruits was found associated with SlHKT1 homozygous rootstocks. Just grafting increased the incidence of blossom end rot and delayed fruit maturation but there were rootstock RILs that increased commercial fruit yield under moderate salinity. The heritability and number of QTLs involved were lower and different than those found under high salinity. Four large contributing (>17%) rootstock QTLs, controlling the leaf concentrations of B, K, Mg and Mo were detected whose 2 Mbp physical intervals contained B, K, Mg and Mo transporter-coding genes, respectively. Since a minimum of 3 QTLs (two of them coincident with leaf K and Ca QTLs) were also found governing rootstock-mediated soluble-solids content of the fruit under moderate salinity, grafting desirable crop varieties on stress-tolerant rootstocks tenders an opportunity to increase both salt tolerance and quality.
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Affiliation(s)
- M J Asins
- IVIA, Carretera Moncada-Náquera, km 4.5, Apartado Oficial, 46113, Moncada, Valencia, Spain,
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Serrat C, Roca D, Seres J. Coherent amplification of attosecond light pulses in the water-window spectral region. Opt Express 2015; 23:4867-4872. [PMID: 25836521 DOI: 10.1364/oe.23.004867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present a theoretical study on coherent extreme ultraviolet (XUV) attosecond pulse amplification mediated by nonlinear parametric enhanced forward scattering occurring in the interaction of a strong femtosecond infrared (IR) laser pulse combined with a weak attosecond XUV pulse train with an atom. We predict large amplification of XUV radiation when the IR strong pulse and the XUV weak pulse are optimally phased. We study high-order harmonic processes (HHG) in He, He(+) and Ne(++), and show how although the HHG yield is largely affected by the particular atom used as target, nonlinear parametric XUV amplification is only weakly affected. We conclude that XUV nonlinear parametric attosecond pulse amplification can be most efficiently observed by using atoms with a high ionization potential and that the nonlinear amplification is robust at high photon energies where HHG is not efficient, such as in the water-window spectral region.
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Esmatjes E, Jansà M, Roca D, Pérez-Ferre N, del Valle L, Martínez-Hervás S, Ruiz de Adana M, Linares F, Batanero R, Vázquez F, Gomis R, de Solà-Morales O. The efficiency of telemedicine to optimize metabolic control in patients with type 1 diabetes mellitus: Telemed study. Diabetes Technol Ther 2014; 16:435-41. [PMID: 24528195 DOI: 10.1089/dia.2013.0313] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study evaluated the impact of an Internet-based telematic system on the economic and clinical management of patients with type 1 diabetes mellitus. RESEARCH DESIGN AND METHODS This 6-month prospective, randomized, comparative, open, multicenter study included patients with type 1 diabetes >18 years old treated with multiple insulin doses and with a glycated hemoglobin (HbA1c) level of >8%. We compared an intervention group (IG) (two face-to-face and five telematic appointments) with a control group (CG) (seven face-to-face appointments). The variables studied were (1) patient and healthcare team costs, (2) metabolic control, (3) knowledge of diabetes, (4) quality of life, and (5) self-care treatment adherence. RESULTS Of the 154 patients included, 118 (76.6%) completed the study (IG, 54; CG, 64). The time used by the CG to follow the program was 823±645 min versus 353±222 min in the IG (P<0.0001). Compared with the CG, the IG required less healthcare time from the professionals (288±105 min vs. 232±89 min; P<0.001). HbA1c improved in both groups (IG, 9.2±1.5% [77.0±17.0 mmol/mol] vs. 8.7±1.5% [71.6±17.0 mmol/mol] [P<0.001]; CG, 9.2±0.9% [77.0±10.0 mmol/mol] vs. 8.6±0.9% [70.5±10.0 mmol/mol] [P<0.001], as did knowledge and self-care treatment adherence. CONCLUSIONS The use of interactive telematic appointments in subjects with type 1 diabetes and inadequate metabolic control is an efficient strategy, providing results comparable to those of face-to-face appointments in relation to improvement in glycemic control, knowledge acquisition, and self-care treatment adherence, with a significant reduction in the time used, especially by patients.
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Affiliation(s)
- Enric Esmatjes
- 1 Diabetes Unit, Hospital Clinic, University of Barcelona , Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Barcelona, Spain
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Acevedo J, Fernández J, Prado V, Silva A, Castro M, Pavesi M, Roca D, Jimenez W, Ginès P, Arroyo V. Relative adrenal insufficiency in decompensated cirrhosis: Relationship to short-term risk of severe sepsis, hepatorenal syndrome, and death. Hepatology 2013; 58:1757-65. [PMID: 23728792 DOI: 10.1002/hep.26535] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 12/13/2022]
Abstract
UNLABELLED The prevalence of relative adrenal insufficiency (RAI) in critically ill cirrhosis patients with severe sepsis is over 60% and associated features include poor liver function, renal failure, refractory shock, and high mortality. RAI may also develop in noncritically ill cirrhosis patients but its relationship to the clinical course has not yet been assessed. The current study was performed in 143 noncritically ill cirrhosis patients admitted for acute decompensation. Within 24 hours after hospitalization adrenal function, plasma renin activity, plasma noradrenaline and vasopressin concentration, and serum levels of nitric oxide, interleukin-6 and tumor necrosis factor alpha were determined. RAI was defined as a serum total cortisol increase <9 μg/dL after 250 μg of intravenous corticotropin from basal values <35 μg/dL. Patients were followed for 3 months. RAI was detected in 26% of patients (n = 37). At baseline, patients with RAI presented with lower mean arterial pressure (76 ± 12 versus 83 ± 14 mmHg, P = 0.009) and serum sodium (131 ± 7 versus 135 ± 5 mEq/L, P = 0.007) and higher blood urea nitrogen (32 ± 24 versus 24 ± 15 mg/dl, P = 0.06), plasma renin activity (7.1 ± 9.9 versus 3.4 ± 5.6 ng/mL*h, P = 0.03), and noradrenaline concentration (544 ± 334 versus 402 ± 316 pg/mL, P = 0.02). During follow-up, patients with RAI exhibited a higher probability of infection (41% versus 21%, P = 0.008), severe sepsis (27% versus 9%, P = 0.003), type-1 hepatorenal syndrome (HRS) (16% versus 3%, P = 0.002), and death (22% versus 7%, P = 0.01). CONCLUSION RAI is frequent in noncritically ill patients with acute decompensation of cirrhosis. As compared with those with normal adrenal function, patients with RAI have greater impairment of circulatory and renal function, higher probability of severe sepsis and type-1 HRS, and higher short-term mortality.
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Affiliation(s)
- Juan Acevedo
- Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Barcelona, Spain
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Menacho I, Sequeira E, Muns M, Barba O, Leal L, Clusa T, Fernandez E, Moreno L, Raben D, Lundgren J, Gatell JM, Garcia F, Cayuelas L, Aragunde V, Vergara M, Catalan M, Moreno MA, Hormigo G, Siso A, Herreras Z, Sebastian L, Benito L, Picas A, Hoyo J, Giner MJ, Cararach D, Moles E, Moro ML, Arrabal P, Roca D, Prego S, Ferrer X, Egido A, Ventosa C, Garcia S, Muñoz S, Massana A, Sole J, Curiel M, Heras F, Leon A. Comparison of two HIV testing strategies in primary care centres: indicator-condition-guided testingvs. testing of those with non-indicator conditions. HIV Med 2013; 14 Suppl 3:33-7. [DOI: 10.1111/hiv.12064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 11/28/2022]
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Jansà M, Vidal M, Giménez M, Conget I, Galindo M, Roca D, Colungo C, Esmatjes E, Salamero M. Psychometric analysis of the Spanish and Catalan versions of the Diabetes Self-Care inventory-revised version questionnaire. Patient Prefer Adherence 2013; 7:997-1005. [PMID: 24124352 PMCID: PMC3794847 DOI: 10.2147/ppa.s50271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to validate the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised Version (SCI-R) questionnaire to assess the degree of adherence to self-care among adults with diabetes. METHODS We validated the Spanish and Catalan translation from, and back translation to, English and cultural adaptation of the SCI-R in type 1 diabetes patients on multiple insulin doses or continuous subcutaneous insulin infusion and in type 2 diabetes patients on oral agents and/or insulin. Internal reliability, structural validity, and external validity (correlation with glycated hemoglobin) were evaluated. Responsiveness to change was assessed in patients 1 year after onset of type 1 diabetes and following a structured education program. RESULTS The SCI-R presented good internal reliability Cronbach's α: 0.75, test-retest reliability (r = 0.82) and structural validity (r > 0.40). The external validity was also good; the SCI-R correlated with HbA1c in patients with type 1 diabetes on multiple insulin doses (r = -0.50) or continuous subcutaneous insulin infusion (r = -0.66) and in patients with type 2 diabetes on multiple insulin doses (r = -0.62). However, it was not satisfactory in patients on oral agents (r = -0.20) and/or bedtime insulin (r = -0.35). Responsiveness to change was analyzed in 54 patients (age 27.3±7.4 years, 26% men, HbA1c 6.8% ±1.1%); the SCI-R score was 72.3% ±13.7% and correlated negatively with glycated hemoglobin (r = -0.42) and 3 scales of the Diabetes Quality of Life questionnaire (lower score indicating better perception): Impact (r = -0.37), Social Worry (r = -0.36) and Diabetes Worry (r = -0.38), all at P < 0.05. CONCLUSION The Spanish and Catalan versions of the SCI-R questionnaire show good psychometric properties and both could be considered as useful tools for evaluating self-care behavior in patients with type 1 or type 2 diabetes. However, there are still some subgroups of patients with type 2 diabetes in which the validity of this questionnaire needs further evaluation.
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Affiliation(s)
- Margarida Jansà
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
- Correspondence: Margarida Jansà, Diabetes Unit, Endocrinology and nutrition, Institut Clinic de Malalties Digestives i Metabòliques Hospital Clinic, 170 Villarroel St, 08036 Barcelona, Spain, Tel +34 93 227 9846, Fax +34 93 451 6638, Email
| | - Mercè Vidal
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Mercedes Galindo
- Endocrinology and nutrition Department, Hospital Clinico, Madrid, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | | | - Enric Esmatjes
- Diabetes Unit, Endocrinology and nutrition, Hospital Clinic, Barcelona, Spain
| | - Manel Salamero
- Psychology Department, Hospital Clinic, Barcelona, Spain
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Fernández J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, Pavesi M, Sola E, Moreira L, Silva A, Seva-Pereira T, Corradi F, Mensa J, Ginès P, Arroyo V. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2012; 55:1551-61. [PMID: 22183941 DOI: 10.1002/hep.25532] [Citation(s) in RCA: 392] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 11/25/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Epidemiology, risk factors, and clinical effect of infections by multiresistant bacteria in cirrhosis are poorly known. This work was a prospective evaluation in two series of cirrhotic patients admitted with infection or developing infection during hospitalization. The first series was studied between 2005 and 2007 (507 bacterial infections in 223 patients) and the second between 2010 and 2011 (162 bacterial infections in 110 patients). In the first series, 32% of infections were community acquired (CA), 32% healthcare associated (HCA), and 36% nosocomial. Multiresistant bacteria (92 infections; 18%) were isolated in 4%, 14%, and 35% of these infections, respectively (P < 0.001). Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E; n = 43) was the main multiresistant organism identified, followed by Pseudomonas aeruginosa (n = 17), methicillin-resistant Staphylococcus aureus (n = 14), and Enterococcus faecium (n = 14). The efficacy of currently recommended empirical antibiotic therapy was very low in nosocomial infections (40%), compared to HCA and CA episodes (73% and 83%, respectively; P < 0.0001), particularly in spontaneous bacterial peritonitis, urinary tract infection, and pneumonia (26%, 29%, and 44%, respectively). Septic shock (26% versus 10%; P < 0.0001) and mortality rate (25% versus 12%; P = 0.001) were significantly higher in infections caused by multiresistant strains. Nosocomial origin of infection (hazard ratio [HR], 4.43), long-term norfloxacin prophylaxis (HR, 2.69), recent infection by multiresistant bacteria (HR, 2.45), and recent use of β-lactams (HR, 2.39) were independently associated with the development of multiresistant infections. Results in the second series were similar to those observed in the first series. CONCLUSIONS Multiresistant bacteria, especially ESBL-producing Enterobacteriaceae, are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third-generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis.
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Affiliation(s)
- Javier Fernández
- Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Acevedo J, Fernández J, Castro M, Roca D, Ginès P, Arroyo V. 139 IMPACT OF RELATIVE ADRENAL INSUFFICIENCY ON CIRCULATORY FUNCTION AND MORTALITY IN ADVANCED CIRRHOSIS. J Hepatol 2011. [DOI: 10.1016/s0168-8278(11)60141-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
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Calatayud A, Roca D, Martínez PF. Spatial-temporal variations in rose leaves under water stress conditions studied by chlorophyll fluorescence imaging. Plant Physiol Biochem 2006; 44:564-73. [PMID: 17064922 DOI: 10.1016/j.plaphy.2006.09.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 09/22/2006] [Indexed: 05/12/2023]
Abstract
Spatial-temporal changes were examined by imaging chlorophyll (Chl) a fluorescence in four leaf areas, two central and two external of rose plants (Rosa x hybrida) cv. Grand Gala for 9 days, under progressive water stress. New fluorescence parameters based on the lake model have recently been used to determine Q(A) redox state and excitation energy fluxes in order to gain a better understanding of the mechanisms that occur under drought stress. Chlorophyll fluorescence images showed a spatial variation in the leaves. The lower values for F(o), F(M), phi(2), q(P) and q(L) were found in the internal leaf area while higher values of non-photochemical quenching calculated from Stern-Volmer quenching (NPQ) and phi(NPQ). phi(Po) were more homogeneous throughout leaf. Temporal changes were also observed during the experiment, a 10% decrease in relative water content (RWC) (between day 1 and 2), led to a decrease in photochemical quenching and an increase in non-photochemical processes. Chlorophyll fluorescence parameters were more or less constant till day 8. At the end of the experiment (day 9), energy dissipation by downregulation, electron transport and Q(A) redox state, decreased and phi(NO) increased to compensate the change. Chlorophyll fluorescence parameters based on the lake model q(L), phi(NPQ) and phi(NO) have been found more appropriate for estimating the fraction of open centres, the quantum yield of regulated energy dissipation in photosystem II (PSII) and the quantum yield of non-regulated energy dissipation in PSII, respectively. The F(s)/F(o) ratio is strongly correlated with NPQ and phi(NPQ) up to a RWC of 20%. This coincides with a greater decrease in photochemical quenching and non-photochemical quenching and an increase in phi(NO).
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Affiliation(s)
- A Calatayud
- Department of Horticulture, Instituto Valenciano de Investigaciones Agrarias I.V.I.A., Ctra. Moncada-Naquera km. 4.5, 46113 Moncada, Valencia, Spain.
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Roca D, Martínez P, Martínez S, Belda R, Fornes F. SEASONAL CARBOHYDRATE AND TOTAL NITROGEN DISTRIBUTION IN ROSE PLANTS: DEVELOPMENTAL AND GROWTH IMPLICATIONS. ACTA ACUST UNITED AC 2005. [DOI: 10.17660/actahortic.2005.697.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Martínez P, Roca D, Martínez S, Suay R, Carbonell E, Pérez-Panadés J. NITRATE UPTAKE KINETICS BY A ROSE CROP IN A CLOSED HYDROPONIC SYSTEM. ACTA ACUST UNITED AC 2004. [DOI: 10.17660/actahortic.2004.659.78] [Citation(s) in RCA: 2] [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: 11/17/2022]
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Majó J, Roca D, Escribá I, Gracia I, Doncel A. Histiocitoma fibroso maligno de partes blandas. Rev Esp Cir Ortop Traumatol (Engl Ed) 2004. [DOI: 10.1016/s1888-4415(04)76198-6] [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: 11/30/2022] Open
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Abstract
OBJECTIVE To evaluate the economic and health consequences of the use of a new COX-2 anti-inflammatory drug. DESIGN Cost-effectiveness analysis by modelling three options for prescribing non-steroidal anti-inflammatories (NSAIDs) in patients diagnosed with arthrosis and undergoing long-term NSAID treatment. Option 1: NSAID prescription without gastric protection for low-risk patients, and with gastric protection for patients running a medium or high risk of developing complications (current procedure). Option 2: exclusive prescription of rofecoxib (25 mg/day) for all patients (high and low risk). Option 3: single-therapy rofecoxib (25 mg/day) prescription for patients sensitive to combined treatment (NSAIDs and gastric protection) due to the risk of complications. In each case, resources and expected clinical benefits were accounted for by the calculation of the cost of avoidance of each moderate or high gastro-intestinal side-effect (GISE) (symptomatic ulcer or complication) avoided. The direct economic impact on the centre of passing from option 1 to any of the other two options was calculated. SETTINGS AND PARTICIPANTS The study, conducted in the Barceloneta Primary Care Centre, included in its modelling the 124 patients diagnosed with arthrosis who received NSAIDs continuously during the year 2000. RESULTS Option 2 supposed avoiding 1.5 cases of GISE (0.5 symptomatic ulcers and 0.9 serious complications), to an additional cost of 336 566.78 euros. Each case avoided would cost 24,641.50 euros; and each serious case avoided 38,464.79 euros. Option 3 avoided 0.25 cases of serious complication, at an additional cost of 9,015.18 euros. Avoiding one case would cost 37,262.75 euros. CONCLUSIONS The overall health benefits arising from the universal or partial introduction of a selective COX-2 inhibitor NSAID involve a unit cost of 24,040.48 or 36,060.73 euros, depending on the option. The impact on the Centre s pharmaceutical budget would increase by 1.3% under option 2, and by 0.35% under option 3.
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Affiliation(s)
- J L Segú
- Centro de Atención Primaria Barceloneta, Barcelona, España.
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Solsona J, Caylà JA, Verdú E, Estrada MP, Garcia S, Roca D, Miquel B, Coll P, March F. Molecular and conventional epidemiology of tuberculosis in an inner city district. Int J Tuberc Lung Dis 2001; 5:724-31. [PMID: 11495263] [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: 02/21/2023] Open
Abstract
SETTING Molecular epidemiology has underlined the importance of recent tuberculosis (TB) transmission and has uncovered notable discrepancies compared with conventional epidemiology. OBJECTIVES 1) To determine, by RFLP analysis, the percentage of clustered cases in an inner city district with a high incidence of TB (163/100,000) and the groups at risk of being clustered; and 2) to compare the role of conventional contact tracing (CCT) with that of RFLP. DESIGN RFLP was carried out using the IS6110 and pTBN12 (PGRS) sequences of 165 cultures positive for Mycobacterium tuberculosis in the Ciutat Vella district of Barcelona during 1997-1998. Contact tracing was carried out in 171 of 251 declared cases (68.1%). Associations were assessed by calculating odds ratios (OR) with 95% confidence intervals (CI). Logistic regression was used for multivariate analysis. RESULTS Using RFLP, 76 (46.0%) strains were found to be clustered by IS6110 and PGRS. From CCT, 30 new patients were found among 858 contacts (3.5%) and 57 patients were linked. In terms of RFLP and CCT, the main risk factor was intravenous drug use (IVDU). In 44 cases who lived alone and were not involved in CCT, 50% were in RFLP clusters. The concordance rate between RFLP and CCT was 8/13 (61.5%); the disagreement corresponded to a cluster of five recent immigrants from Africa. Subsequent to RFLP, an epidemiological connection was found in 15/55 cases (27.2%). CONCLUSIONS The percentage of clustered cases is very high. CCT was useful for identifying new cases, but it was insufficient for detecting the pathways of transmission. CCT coverage needs to be improved in marginalized individuals, and the results correlated with those of RFLP.
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Affiliation(s)
- J Solsona
- Centro de Prevención y Control de la Tuberculosis Dr Lluís Sayé, Barcelona, Spain.
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Means TK, Pavlovich RP, Roca D, Vermeulen MW, Fenton MJ. Activation of TNF-alpha transcription utilizes distinct MAP kinase pathways in different macrophage populations. J Leukoc Biol 2000; 67:885-93. [PMID: 10857863 DOI: 10.1002/jlb.67.6.885] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Stimulation of macrophages by lipopolysaccharide (LPS) leads to the rapid activation of MAP kinases (MAPK) and the subsequent induction of cytokine gene expression. We sought to determine whether LPS-inducible cytokine genes were differentially regulated in macrophages derived from different tissues. Our studies revealed that PD98059, an inhibitor of the extracellular-regulated kinase (ERK) pathway, blocked LPS-induced activation of tumor necrosis factor alpha (TNF-alpha) gene expression in a murine cell line derived from alveolar macrophages but not in a nonpulmonary macrophage cell line. These findings were confirmed using primary murine alveolar and peritoneal macrophages. This suggests that the TNF-alpha promoter contains MAPK-dependent and -independent regulatory elements that are used in a cell type-specific manner. We also found that differences in MAPK-regulated signaling were not mediated by NF-KB, LITAF, Egr-1, CREB, or ATF2/ c-Jun. Together, these studies demonstrate that transcriptional activation of the TNF-alpha gene requires the ERK signaling cascade in selected macrophage populations.
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MESH Headings
- Activating Transcription Factor 2
- Animals
- Cell Line
- Cells, Cultured
- Cyclic AMP Response Element-Binding Protein/metabolism
- DNA-Binding Proteins/metabolism
- Early Growth Response Protein 1
- Enzyme Activation
- Enzyme Inhibitors/pharmacology
- Flavonoids/pharmacology
- Immediate-Early Proteins
- Lipopolysaccharides/pharmacology
- MAP Kinase Kinase 1
- MAP Kinase Signaling System
- Macrophages/drug effects
- Macrophages/metabolism
- Macrophages, Alveolar/drug effects
- Macrophages, Alveolar/metabolism
- Macrophages, Peritoneal/drug effects
- Macrophages, Peritoneal/metabolism
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mitogen-Activated Protein Kinase Kinases/metabolism
- Mitogen-Activated Protein Kinases/antagonists & inhibitors
- Mitogen-Activated Protein Kinases/metabolism
- NF-kappa B/metabolism
- Promoter Regions, Genetic
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins c-jun/metabolism
- RNA Caps
- RNA, Messenger/biosynthesis
- Response Elements
- Transcription Factors/metabolism
- Transcription, Genetic/drug effects
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/metabolism
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Affiliation(s)
- T K Means
- Department of Pathology, Boston University School of Medicine, Massachusetts, USA
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Saussine C, Roca D, Bollack C. [Localized hyperthermia of the prostate via the rectum in chronic inoperable urinary retention]. Helv Chir Acta 1992; 59:493-6. [PMID: 1281465] [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: 12/26/2022]
Abstract
Local transrectal hyperthermia of the prostate was used to treat 16 poor surgical risk patients who had an indwelling catheter because of chronic urinary retention caused by benign prostatic hypertrophy. We used the Brucker (Prost-care) model with a rectal applicator, a water cooling system and a microwave generator operating at 915 MHz. Intraprostatic temperatures of 42 degrees to 44 degrees C were measured by a radiometric system. 12 patients received a complete treatment which consists in 6 to 10 sessions of one hour and was controlled at least one month later. 8 of them no longer need a catheter. Uroflowmetry was between 7.5 and 17.6 ml/sec and residual urine appreciate by ultrasounds was less than 60 cm3.
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Affiliation(s)
- C Saussine
- Service de chirurgie urologique, Hôpitaux universitaires de Strasbourg
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Abstract
Conservative surgery is proposed by many authors for small kidney tumors. We reviewed retrospectively the pathology reports of 727 operated patients. In 257, tumor diameter was less than or equal to 5 cm, in 158 it was less than or equal to 4 cm, and in 78 it was less than or equal to 3 cm. The number of multiple tumors were 26 (10.1%), 17 (10.75%), and 10 (12.8%) respectively, which means that there is a 10% potential risk of leaving a tumor in situ in case of conservative surgery. There is no security size limit. These parameters have to be considered before proposing conservative surgery for small kidney tumors as a standard treatment.
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Affiliation(s)
- D Jacqmin
- Department of Urology, CHU Strasbourg, France
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Montpied P, Ginns EI, Martin BM, Roca D, Farb DH, Paul SM. gamma-Aminobutyric acid (GABA) induces a receptor-mediated reduction in GABAA receptor alpha subunit messenger RNAs in embryonic chick neurons in culture. J Biol Chem 1991; 266:6011-4. [PMID: 1848843] [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: 12/29/2022] Open
Abstract
gamma-Aminobutyric acid (GABA), the major inhibitory neurotransmitter in brain, is known to interact with a subclass of receptors that activate a ligand-gated chloride ion channel. Exposure of cultured embryonic chick neurons to physiological concentrations of GABA results in a time-dependent down-regulation of these GABAA receptors. To delineate the cellular mechanism(s) responsible for agonist-induced down-regulation of GABAA receptors we quantified the levels of GABAA receptor alpha subunit messenger RNAs, which encode the subunit(s) containing agonist recognition site(s), and observed a marked reduction in alpha subunit mRNAs following exposure of embryonic chick neurons to GABA. Both the down-regulation of GABAA receptors and the reduction in alpha subunit mRNAs induced by GABA were completely antagonized by the specific GABAA receptor antagonist SR-95531. These data demonstrate the presence of an agonist-induced receptor-mediated mechanism for regulating the expression of receptor subunit-encoding mRNAs that may be involved in the development of tolerance to the pharmacological actions of drugs known to act via GABAA receptors.
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Affiliation(s)
- P Montpied
- Section on Molecular Pharmacology, National Institute of Mental Health, Bethesda, Maryland 20892
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Montpied P, Ginns EI, Martin BM, Roca D, Farb DH, Paul SM. gamma-Aminobutyric acid (GABA) induces a receptor-mediated reduction in GABAA receptor alpha subunit messenger RNAs in embryonic chick neurons in culture. J Biol Chem 1991. [DOI: 10.1016/s0021-9258(18)38073-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pardo EA, Costa Bianchi JE, Barata AD, Quaglio HC, Mayo S, Roca D, Baldi EJ. [Sex chromatin and karyotype in primary amenorrhea]. Obstet Ginecol Lat Am 1973; 31:127-43. [PMID: 4806741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pardo EA, Costa Bianchi JE, Barata AD, Quaglio HC, Mayo S, Roca D, Baldi EJ. [Sex chromatin and karyotype in primary amenorrhea]. Obstet Ginecol Lat Am 1973; 31:1-40. [PMID: 4806736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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