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Reina-Pérez I, Artacho-Cordón F, Mustieles V, Castellano-Castillo D, Cardona F, Jiménez-Díaz I, López-Medina JA, Alcaide J, Ocaña-Wilhelmi L, Iribarne-Durán LM, Arrebola JP, Olea N, Tinahones FJ, Fernández MF. Cross-sectional associations of persistent organic pollutants measured in adipose tissue and metabolic syndrome in clinically diagnosed middle-aged adults. Environ Res 2023; 222:115350. [PMID: 36709023 DOI: 10.1016/j.envres.2023.115350] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/27/2022] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Although often overlooked in clinical settings, accumulation of persistent organic pollutants (POPs) in visceral adipose tissue (VAT) is thought to be a relevant risk factor for metabolic syndrome (MetS). METHODS One hundred and seventeen patients undergoing non-oncological surgery were randomly recruited and classified as MetS + if presented 3 out of the 5 MetS components: waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP, respectively), serum glucose, insulin, triglycerides (TG) and high-density lipoprotein (HDL) cholesterol levels, according International Diabetes Federation (IDF) criteria. Seventeen organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) were measured in adipose tissue samples. Linear, logistic and weighted quantile sum (WQS) regression models, adjusted for age and sex, were performed. RESULTS One third of the participants were males (36.8%) with a median age of 44 years, showing clinical evidences of MetS (35.0%). Adjusted linear regression models showed that WC correlated positively with all OCP concentrations. Higher fasting serum glucose levels were related to higher HCB and γ-HCH concentrations. The remaining OCPs and PCBs were not associated with this MetS component. HCB was inversely associated with HDL cholesterol levels, while PCB-180 was positively associated. HCB and γ-HCH concentrations were also positively correlated with DBP and SBP levels. PCB-138 was also positively associated with SBP. Adjusted logistic models revealed that exposure to HCB and γ-HCH were associated with increased odds of MetS [ORs (95%CI) 1.53 (1.22-1.92) and 1.39 (1.10-1.76) respectively; p < 0.01]. No associations were observed for the remaining POPs. WQS models showed a positive and significant mixture effect of POPs on the odds of MetS (exp [beta] = 2.34; p < 0.001), with γ-HCH (52.9%), o,p'-DDT (26.9%) and HCB (19.7%) driving the association. CONCLUSIONS Our findings support that POPs accumulated in VAT, specifically HCB and (gamma)-HCH, are associated with both isolated components and clinically diagnosed SMT.
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Affiliation(s)
- Iris Reina-Pérez
- Centro de Investigación Biomédica y Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Granada, E-18016 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), E-18012 Granada, Spain
| | - Francisco Artacho-Cordón
- Centro de Investigación Biomédica y Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Granada, E-18016 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), E-18012 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp), E-28029 Madrid, Spain
| | - Vicente Mustieles
- Centro de Investigación Biomédica y Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Granada, E-18016 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), E-18012 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp), E-28029 Madrid, Spain
| | - Daniel Castellano-Castillo
- Unidad de Gestión Clínica Intercentro de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA)-CIMES-UMA-29010 Málaga, Spain
| | - Fernando Cardona
- Department of Surgical Specialties, Biochemistry and Immunology School of Medicine, University of Malaga, 29010 Málaga, Spain; Unidad de Gestión Clínica de Pediatría, Hospital Universitario Regional de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | | | - Jose A López-Medina
- Unidad de Gestión Clínica de Endocrinología, Hospital Universitario Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), E-29010 Málaga, Spain
| | - Juan Alcaide
- Unidad de Gestión Clínica de Endocrinología, Hospital Universitario Virgen de la Victoria. Instituto de Investigación Biomédica de Málaga (IBIMA), E-29010 Málaga, Spain
| | - Luis Ocaña-Wilhelmi
- Unidad de Cirugía Metabólica, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - Juan P Arrebola
- Instituto de Investigación Biosanitaria (ibs.GRANADA), E-18012 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp), E-28029 Madrid, Spain; Departmento de Medicina Preventiva y Salud Pública, Facultad de Medicina Universidad de Granada, E-18016 Granada, Spain
| | - Nicolás Olea
- Centro de Investigación Biomédica y Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Granada, E-18016 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), E-18012 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp), E-28029 Madrid, Spain
| | - Francisco J Tinahones
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Regional de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición, (CIBERobn), E-28029 Madrid, Spain.
| | - Mariana F Fernández
- Centro de Investigación Biomédica y Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Granada, E-18016 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), E-18012 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp), E-28029 Madrid, Spain.
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Arias-de la Rosa I, Escudero-Contreras A, Ruiz-Ponce M, Cuesta-López L, Román-Rodríguez C, Pérez-Sánchez C, Ruiz-Limón P, Ruiz RG, Leiva-Cepas F, Alcaide J, Segui P, Plasencia C, Martinez-Feito A, Font P, Ábalos MC, Ortega R, Malagón MM, Tinahones FJ, Collantes-Estévez E, López-Pedrera C, Barbarroja N. Pathogenic mechanisms involving the interplay between adipose tissue and autoantibodies in Rheumatoid arthritis. iScience 2022; 25:104893. [PMID: 36046189 PMCID: PMC9421387 DOI: 10.1016/j.isci.2022.104893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/04/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to evaluate the association between adipose tissue (AT) dysfunction, autoimmunity, and disease activity in rheumatoid arthritis (RA). A cross-sectional study including 150 RA patients and 50 healthy donors and longitudinal study with 122 RA patients treated with anti-tumor necrosis factor (TNF)-α, anti-interleukin 6 receptor (IL6R) or anti-CD20 therapies for 6 months were carried out. In vitro experiments with human AT and adipocyte and macrophage cell lines were performed. A collagen-induced arthritis mouse model was developed. The insulin resistance and the altered adipocytokine profile were associated with disease activity, the presence of anti-citrullinated proteins anti-bodies (ACPAs), and worse response to therapy in RA. AT in the context of arthritis is characterized by an inflammatory state alongside the infiltration of macrophages and B/plasmatic cells, where ACPAs can have a direct impact, inducing inflammation and insulin resistance in macrophages and promoting a defective adipocyte differentiation, partially restored by biologicals. IR is related to disease activity, inflammation, and autoimmunity in RA patients IR state and adipocytokines might be associated with a worse response to biologics Visfatin could be used as a potential biomarker of subclinical atherosclerosis ACPAs might directly impact adipose tissue
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Motahari-Rad H, Subiri A, Soler R, Ocaña L, Alcaide J, Rodríguez-Capitan J, Buil V, el Azzouzi H, Ortega-Gomez A, Bernal-Lopez R, Insenser M, Tinahones FJ, Murri M. The Effect of Sex and Obesity on the Gene Expression of Lipid Flippases in Adipose Tissue. J Clin Med 2022; 11:jcm11133878. [PMID: 35807162 PMCID: PMC9267438 DOI: 10.3390/jcm11133878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023] Open
Abstract
Molecular mechanisms behind obesity and sex-related effects in adipose tissue remain elusive. During adipocyte expansion, adipocytes undergo drastic remodelling of lipid membrane compositions. Lipid flippases catalyse phospholipid translocation from exoplasmic to the cytoplasmic leaflet of membranes. The present study aimed to analyse the effect of sex, obesity, and their interactions on the gene expression of two lipid flippases—ATP8A1 and ATP8B1—and their possible microRNA (miR) modulators in visceral adipose tissue (VAT). In total, 12 normal-weight subjects (5 premenopausal women and 7 men) and 13 morbidly obese patients (7 premenopausal women and 6 men) were submitted to surgery, and VAT samples were obtained. Gene expression levels of ATP8A1, ATP8B1, miR-548b-5p, and miR-4643 were measured in VAT. Our results showed a marked influence of obesity on VAT ATP8A1 and ATP8B1, although the effects of obesity were stronger in men for ATP8A1. Both genes positively correlated with obesity and metabolic markers. Furthermore, ATP8B1 was positively associated with miR-548b-5p and negatively associated with miR-4643. Both miRs were also affected by sex. Thus, lipid flippases are altered by obesity in VAT in a sex-specific manner. Our study provides a better understanding of the sex-specific molecular mechanisms underlying obesity, which may contribute to the development of sex-based precision medicine.
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Affiliation(s)
- Hanieh Motahari-Rad
- Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran 14117-13116, Iran;
- Clinical Management Unit (UGC) of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain; (A.S.); (J.A.); (A.O.-G.); (F.J.T.)
| | - Alba Subiri
- Clinical Management Unit (UGC) of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain; (A.S.); (J.A.); (A.O.-G.); (F.J.T.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIlBEROBN), Instituto de Salud Carlos III, 29010 Málaga, Spain;
| | - Rocio Soler
- Clinical Management Unit (UGC) of General and Digestive Surgery, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (R.S.); (L.O.)
| | - Luis Ocaña
- Clinical Management Unit (UGC) of General and Digestive Surgery, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (R.S.); (L.O.)
| | - Juan Alcaide
- Clinical Management Unit (UGC) of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain; (A.S.); (J.A.); (A.O.-G.); (F.J.T.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIlBEROBN), Instituto de Salud Carlos III, 29010 Málaga, Spain;
| | - Jorge Rodríguez-Capitan
- Clinical Management Unit (UGC) of Heart, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 29010 Málaga, Spain;
- Faculty of Medicine, University of Malaga, 29010 Malaga, Spain;
| | - Veronica Buil
- Faculty of Medicine, University of Malaga, 29010 Malaga, Spain;
| | - Hamid el Azzouzi
- Department of Molecular Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Almudena Ortega-Gomez
- Clinical Management Unit (UGC) of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain; (A.S.); (J.A.); (A.O.-G.); (F.J.T.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIlBEROBN), Instituto de Salud Carlos III, 29010 Málaga, Spain;
| | - Rosa Bernal-Lopez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIlBEROBN), Instituto de Salud Carlos III, 29010 Málaga, Spain;
- Clinical Management Unit (UGC) of Internal Medicine, IBIMA, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Maria Insenser
- Diabetes, Obesity and Human Reproduction Research Group, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28034 Madrid, Spain
- Correspondence: (M.I.); (M.M.)
| | - Francisco J. Tinahones
- Clinical Management Unit (UGC) of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain; (A.S.); (J.A.); (A.O.-G.); (F.J.T.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIlBEROBN), Instituto de Salud Carlos III, 29010 Málaga, Spain;
- Faculty of Medicine, University of Malaga, 29010 Malaga, Spain;
| | - Mora Murri
- Clinical Management Unit (UGC) of Endocrinology and Nutrition, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain; (A.S.); (J.A.); (A.O.-G.); (F.J.T.)
- CIBER Fisiopatología de la Obesidad y Nutrición (CIlBEROBN), Instituto de Salud Carlos III, 29010 Málaga, Spain;
- Correspondence: (M.I.); (M.M.)
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Arias de la Rosa I, Escudero-Contreras A, Ruiz-Ponce M, Román-Rodríguez C, Pérez-Sánchez C, Ábalos-Aguilera MDC, Ortega-Castro R, Alcaide J, Murri M, Font P, Calvo-Gutiérrez J, Luque-Tevar M, Patiño-Trives AM, Guzmán-Ruiz R, Malagón MDM, Tinahones FJ, Collantes-Estévez E, López-Pedrera C, Barbarroja N. Molecular Changes in the Adipose Tissue Induced by Rheumatoid Arthritis: Effects of Disease-Modifying Anti-Rheumatic Drugs. Front Immunol 2021; 12:744022. [PMID: 34721412 PMCID: PMC8549628 DOI: 10.3389/fimmu.2021.744022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 02/01/2023] Open
Abstract
Disease severity, progression and response to therapy might be worse in obese rheumatoid arthritis (RA) patients, but paradoxically, obesity also might protect from radiographic joint damage. Thus, the intricate relationship between obesity and RA needs urgent clarification. The aim of this study was to assess the influence of obesity on the onset and development of RA and to determine whether arthritis could modify the adipose tissue biology and whether conventional Disease Modifying Anti-Rheumatic Drugs (cDMARDs) can modulate these alterations. Two strategies were followed: (1) clinical profiling of two cohorts of RA: non-obese and obese patients; and (2) mechanistic studies carried out in both a collagen-induced arthritis (CIA) in an obese mouse model and 3T3-L1 adipocytes treated with cDMARDs (leflunomide, methotrexate, and hydroxychloroquine). In our cohort of RA patients with low-moderate disease activity, the presence of obesity was not related to a higher activity of the disease; actually, disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR) was reduced in the obese RA patients. However, the induction of arthritis promoted transcriptomic changes in the adipose tissue under obesity condition in the obese CIA model. Treatment with hydroxychloroquine reduced weight and insulin resistance, accompanied by beneficial metabolic effects in the adipose tissue. These molecular changes in adipose tissue were also observed after methotrexate administration. In sum, arthritis might affect directly the inflammatory burden and metabolic alterations associated with obesity in adipose tissue. Clinicians should be cautious measuring the activity of the disease in obesity and managing the best therapeutic options for the metabolic comorbidities of these patients, where the combination of hydroxychloroquine and methotrexate should be considered to improve adipose tissue dysfunction in obese RA.
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Affiliation(s)
- Iván Arias de la Rosa
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Alejandro Escudero-Contreras
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Miriam Ruiz-Ponce
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Cristóbal Román-Rodríguez
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Carlos Pérez-Sánchez
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - María Del Carmen Ábalos-Aguilera
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Rafaela Ortega-Castro
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Juan Alcaide
- Biomedical Research Institute (IBIMA), Service of Endocrinology and Nutrition, Malaga Hospital Complex, Virgen de la Victoria, Malaga, Spain.,Centros de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Mora Murri
- Biomedical Research Institute (IBIMA), Service of Endocrinology and Nutrition, Malaga Hospital Complex, Virgen de la Victoria, Malaga, Spain.,Centros de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Font
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Jerusalem Calvo-Gutiérrez
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Maria Luque-Tevar
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Alejandra Maria Patiño-Trives
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Rocío Guzmán-Ruiz
- Department of Cell Biology, Physiology and Immunology, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Maria Del Mar Malagón
- Centros de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.,Department of Cell Biology, Physiology and Immunology, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisco José Tinahones
- Biomedical Research Institute (IBIMA), Service of Endocrinology and Nutrition, Malaga Hospital Complex, Virgen de la Victoria, Malaga, Spain.,Centros de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Collantes-Estévez
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Chary López-Pedrera
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
| | - Nuria Barbarroja
- Rheumatology Service/Deparment of Medicine and Surgical Sciences, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), University of Cordoba, Reina Sofia Hospital, Cordoba, Spain
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Ocaña-Wilhelmi L, Martín-Núñez GM, Ruiz-Limón P, Alcaide J, García-Fuentes E, Gutiérrez-Repiso C, Tinahones FJ, Moreno-Indias I. Gut Microbiota Metabolism of Bile Acids Could Contribute to the Bariatric Surgery Improvements in Extreme Obesity. Metabolites 2021; 11:metabo11110733. [PMID: 34822391 PMCID: PMC8620296 DOI: 10.3390/metabo11110733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023] Open
Abstract
Bariatric surgery is the only procedure to obtain and maintain weight loss in the long term, although the mechanisms driving these benefits are not completely understood. In the last years, gut microbiota has emerged as one of the drivers through its metabolites, especially secondary bile acids. In the current study, we have compared the gut microbiota and the bile acid pool, as well as anthropometric and biochemical parameters, of patient with morbid obesity who underwent bariatric surgery by two different techniques, namely Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Gut microbiota populations differed after the respective procedures, particularly with respect to the Enterobacteriaceae family. Both techniques resulted in changes in the bile acids pool, but RYGB was the procedure which suffered the greatest changes, with a reduction in most of their levels. Blautia and Veillonella were the two genera that more relationships showed with secondary bile acids, indicating a possible role in their formation and inhibition, respectively. Correlations with the anthropometric and biochemical variables showed that secondary bile acids could have a role in the amelioration of the glucose and HDL-cholesterol levels. Thus, we have observed a possible relationship between the interaction of the bile acids pool metabolized by the gut microbiota in the metabolic improvements obtained by bariatric surgery in the frame of morbid obesity, deserving further investigation in greater cohorts to decipher the role of each bile acid in the homeostasis of the host for their possible use in the development of microbiota-based therapeutics, such as new drugs, postbiotics or probiotics.
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Affiliation(s)
- Luis Ocaña-Wilhelmi
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Universidad de Málaga, 29010 Málaga, Spain;
- Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Gracia María Martín-Núñez
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga University, 29010 Málaga, Spain; (G.M.M.-N.); (P.R.-L.); (J.A.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29029 Madrid, Spain
| | - Patricia Ruiz-Limón
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga University, 29010 Málaga, Spain; (G.M.M.-N.); (P.R.-L.); (J.A.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29029 Madrid, Spain
| | - Juan Alcaide
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga University, 29010 Málaga, Spain; (G.M.M.-N.); (P.R.-L.); (J.A.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29029 Madrid, Spain
| | - Eduardo García-Fuentes
- Department of Gastroenterology, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Málaga (IBIMA), Málaga University, 29010 Málaga, Spain;
- CIBER Enfermedades Hepáticas y Digestivas-CIBEREHD, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carolina Gutiérrez-Repiso
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga University, 29010 Málaga, Spain; (G.M.M.-N.); (P.R.-L.); (J.A.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29029 Madrid, Spain
- Correspondence: (C.G.-R.); (F.J.T.); (I.M.-I.)
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga University, 29010 Málaga, Spain; (G.M.M.-N.); (P.R.-L.); (J.A.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29029 Madrid, Spain
- Correspondence: (C.G.-R.); (F.J.T.); (I.M.-I.)
| | - Isabel Moreno-Indias
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga University, 29010 Málaga, Spain; (G.M.M.-N.); (P.R.-L.); (J.A.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29029 Madrid, Spain
- Correspondence: (C.G.-R.); (F.J.T.); (I.M.-I.)
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6
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Aranda E, García-Alfonso P, Benavides M, Sánchez Ruiz A, Guillén-Ponce C, Safont M, Alcaide J, Gómez A, López R, Manzano J, Méndez Ureña M, Sastre J, Rivera F, Grávalos C, García T, Martín-Valadés J, Falcó E, Navalón M, González Flores E, Ma García Tapiador A, Ma López Muñoz A, Barrajón E, Reboredo M, García Teijido P, Viudez A, Cárdenas N, Díaz-Rubio E. First-line mFOLFOX plus cetuximab followed by mFOLFOX plus cetuximab or single-agent cetuximab as maintenance therapy in patients with metastatic colorectal cancer: Phase II randomised MACRO2 TTD study. Eur J Cancer 2018; 101:263-272. [DOI: 10.1016/j.ejca.2018.06.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/21/2018] [Accepted: 06/24/2018] [Indexed: 01/07/2023]
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7
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Godoy-Ortiz A, Plata Y, Alcaide J, Galeote A, Pajares B, Saez E, Alba E, Sánchez-Muñoz A. Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients. Clin Transl Oncol 2017; 20:922-927. [PMID: 29222647 DOI: 10.1007/s12094-017-1808-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.
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Affiliation(s)
- A Godoy-Ortiz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.
| | - Y Plata
- Department of Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Alcaide
- Medical Oncology Service, Hospital Costa del Sol, Málaga, Marbella, Spain
| | - A Galeote
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - B Pajares
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - E Saez
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - E Alba
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - A Sánchez-Muñoz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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8
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Fernandez-Garcia JC, Alcaide J, Santiago-Fernandez C, Roca-Rodriguez MM, Aguera Z, Baños R, Botella C, de la Torre R, Fernandez-Real JM, Fruhbeck G, Gomez-Ambrosi J, Jimenez-Murcia S, Menchon JM, Casanueva FF, Fernandez-Aranda F, Tinahones FJ, Garrido-Sanchez L. Correction: An increase in visceral fat is associated with a decrease in the taste and olfactory capacity. PLoS One 2017; 12:e0173588. [PMID: 28257495 PMCID: PMC5336289 DOI: 10.1371/journal.pone.0173588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Fernandez-Garcia JC, Alcaide J, Santiago-Fernandez C, Roca-Rodriguez MM, Aguera Z, Baños R, Botella C, de la Torre R, Fernandez-Real JM, Fruhbeck G, Gomez-Ambrosi J, Jimenez-Murcia S, Menchon JM, Casanueva FF, Fernandez-Aranda F, Tinahones FJ, Garrido-Sanchez L. An increase in visceral fat is associated with a decrease in the taste and olfactory capacity. PLoS One 2017; 12:e0171204. [PMID: 28158237 PMCID: PMC5291407 DOI: 10.1371/journal.pone.0171204] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 01/18/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction Sensory factors may play an important role in the determination of appetite and food choices. Also, some adipokines may alter or predict the perception and pleasantness of specific odors. We aimed to analyze differences in smell–taste capacity between females with different weights and relate them with fat and fat-free mass, visceral fat, and several adipokines. Materials and methods 179 females with different weights (from low weight to morbid obesity) were studied. We analyzed the relation between fat, fat-free mass, visceral fat (indirectly estimated by bioelectrical impedance analysis with visceral fat rating (VFR)), leptin, adiponectin and visfatin. The smell and taste assessments were performed through the "Sniffin’ Sticks" and "Taste Strips" respectively. Results We found a lower score in the measurement of smell (TDI-score (Threshold, Discrimination and Identification)) in obese subjects. All the olfactory functions measured, such as threshold, discrimination, identification and the TDI-score, correlated negatively with age, body mass index (BMI), leptin, fat mass, fat-free mass and VFR. In a multiple linear regression model, VFR mainly predicted the TDI-score. With regard to the taste function measurements, the normal weight subjects showed a higher score of taste functions. However a tendency to decrease was observed in the groups with greater or lesser BMI. In a multiple linear regression model VFR and age mainly predicted the total taste scores. Discussion We show for the first time that a reverse relationship exists between visceral fat and sensory signals, such as smell and taste, across a population with different body weight conditions.
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Affiliation(s)
- Jose Carlos Fernandez-Garcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Juan Alcaide
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Concepcion Santiago-Fernandez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - M M Roca-Rodriguez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Zaida Aguera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Rosa Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychological, Personality, Evaluation and Treatment of the University of Valencia, Valencia, Spain
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Department of Basic Psychology, Clinic and Psychobiology of the University Jaume I, Castelló, Spain
| | - Rafael de la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra Barcelona, Spain
| | - Jose M Fernandez-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Department of Diabetes, Endocrinology and Nutrition, Institutd'Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
| | - Gema Fruhbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain
| | - Javier Gomez-Ambrosi
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain
| | - Susana Jimenez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jose M Menchon
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Felipe F Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Lourdes Garrido-Sanchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Málaga, Spain
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10
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Santiago-Fernandez C, Garcia-Almeida JM, Gutierrez-Repiso C, Alcaide J, Ocana-Wilhelmi L, Tome M, Rodriguez-Morata A, Tinahones FJ, Tatzber F, Pursch E, Garcia-Fuentes E, Garrido-Sanchez L. Msr1 and Cxcl16 scavenger receptors in adipose tissue are positively associated with BMI and insulin resistance. ACTA ACUST UNITED AC 2016. [DOI: 10.1530/endoabs.41.ep803] [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: 11/08/2022]
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11
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Roca-Rodríguez M, Coín-Aragüez L, Cornejo-Pareja I, Alcaide J, Clu-Fernández C, Muñoz-Garach A, Durán-Martín E, Mora-Navas L, Gómez-Pérez A, Molina-Vega M, Díaz-Perdigones C, Mancha-Doblas I, Tinahones F. Carbohydrate metabolism improvement after Helicobacter pylori eradication. Diabetes & Metabolism 2016; 42:130-4. [DOI: 10.1016/j.diabet.2015.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/08/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
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12
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García-Fuentes E, Santiago-Fernández C, Gutiérrez-Repiso C, Mayas MD, Oliva-Olivera W, Coín-Aragüez L, Alcaide J, Ocaña-Wilhelmi L, Vendrell J, Tinahones FJ, Garrido-Sánchez L. Hypoxia is associated with a lower expression of genes involved in lipogenesis in visceral adipose tissue. J Transl Med 2015; 13:373. [PMID: 26619907 PMCID: PMC4663723 DOI: 10.1186/s12967-015-0732-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/18/2015] [Indexed: 01/17/2023] Open
Abstract
Background A key role for HIF-1α in the promotion and maintenance of dietary obesity has been proposed. We analyzed the association between hypoxia and de novo lipogenesis in human adipose tissue. Methods We studied HIF-1α mRNA and protein expression in fasting status in visceral adipose tissue (VAT) from non-obese and morbidly obese subjects, and in VAT from wild-type and ob/ob C57BL6J mice in both fasting and feeding status. We also analyzed the effect of hypoxia on the VAT mRNA expression of genes involved in lipogenesis. Results HIF-1α was increased in VAT from morbidly obese subjects. In fasting status, C57BL6J ob/ob mice had a higher VAT HIF-1α mRNA expression than C57BL6J wild-type mice. In feeding status, VAT HIF-1α mRNA expression significantly increased in C57BL6J wild-type, but not in C57BL6J ob/ob mice. In humans, HIF-1α mRNA expression correlated positively with body mass index and insulin resistance. VAT HIF-1α mRNA expression correlated negatively with ACC1, PDHB and SIRT3 mRNA expression, and positively with PPAR-γ. VAT explants incubated in hypoxia showed reduced SIRT3 and increased PPAR-γ, SREBP-1c, ACLY, ACC1 and FASN mRNA expression. Conclusions Morbidly obese subjects have a higher level of VAT HIF-1α. Postprandial status is associated with an increase in HIF-1α mRNA expression in C57BL6J wild-type mice. Hypoxia alters the mRNA expression of genes involved in de novo lipogenesis in human VAT.
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Affiliation(s)
- Eduardo García-Fuentes
- Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital, Malaga, Spain. .,CIBEROBN, Institute of Health Carlos III, Malaga, Spain. .,Laboratorio de Investigación, Hospital Civil, Plaza del Hospital Civil s/n, 29009, Málaga, Spain.
| | - Concepción Santiago-Fernández
- Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
| | - Carolina Gutiérrez-Repiso
- Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital, Malaga, Spain.
| | - María D Mayas
- Department of Physiology, University of Jaen, Jaén, Spain.
| | - Wilfredo Oliva-Olivera
- CIBEROBN, Institute of Health Carlos III, Malaga, Spain. .,Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
| | - Leticia Coín-Aragüez
- CIBEROBN, Institute of Health Carlos III, Malaga, Spain. .,Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
| | - Juan Alcaide
- CIBEROBN, Institute of Health Carlos III, Malaga, Spain. .,Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
| | - Luis Ocaña-Wilhelmi
- Department of Surgery, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
| | - Joan Vendrell
- CIBERDEM, Institute of Health Carlos III, Tarragona, Spain. .,Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Pere Virgili Institute, Rovira i Virgili University, Tarragona, Spain.
| | - Francisco J Tinahones
- CIBEROBN, Institute of Health Carlos III, Malaga, Spain. .,Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
| | - Lourdes Garrido-Sánchez
- CIBEROBN, Institute of Health Carlos III, Malaga, Spain. .,Department of Endocrinology and Nutrition, Institute of Biomedical Research of Malaga (IBIMA), Virgen de la Victoria Clinical University Hospital, Malaga, Spain.
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Aranda E, García-Alfonso P, Benavides M, Sanchez-Ruiz A, Guillen-Ponce C, Safont M, Alcaide J, Gomez A, Lopez R, Manzano J, Mendez-Urena M, Lopez C, García-Paredes B, Grávalos C, García-García T, Falco E, Martin-Valades J, Gonzalez-Flores E, Navalon M, Diaz-Rubio E. 2122 Treatment outcomes according to extended RAS mutation testing in a phase II study of first-line mFOLFOX plus cetuximab followed by cetuximab in monotherapy as maintenance therapy or mFOLFOX plus cetuximab in patients with metastatic colorectal cancer: The MACRO-2 trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31044-9] [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: 10/22/2022]
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Garcia-Almeida J, Vegas-Aguilar I, Rioja-Vazquez R, Lopez-Medina J, Cardona-Diaz F, Alcaide J, Tinahones-Madueño F. MON-PP112: Effects on Nutritional and Functional Recovery in Patients with Protein-Energy Malnutrition after Prolonged Hospitalization: Effects of a Specific Protein-Calorie Supplementation Enriched in Calcium Hydroxymethyl Butyrate (HMB). Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30544-6] [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: 10/23/2022]
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Muriel Lopez C, Perez-Ruiz E, Gonzalez I, Ales I, Pascual J, Duran G, Rivas-Ruiz F, Benavides M, Marquez A, Pajares B, Plata Y, Diaz T, Zarcos I, Alcaide J, Gimenez F, Lopez P, Gil S, Muros B, Rueda A, Alba E. 2304 Polychemotherapy on patients with pancreatic carcinoma: Experience of four hospitals in Spain. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31220-5] [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: 10/22/2022]
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16
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Roca-Rodríguez MDM, García-Almeida JM, Ruiz-Nava J, Alcaide J, Lupiañez-Pérez Y, Rico-Pérez JM, Toledo-Serrano MD, Cardona F, Medina-Carmona JA, Tinahones FJ. Long-term effects of varying consumption of ω3 fatty acids in ear, nose and throat cancer patients: assessment 1 year after radiotherapy. Int J Food Sci Nutr 2014; 66:108-13. [PMID: 25265206 DOI: 10.3109/09637486.2014.953453] [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] [Indexed: 11/13/2022]
Abstract
A prospective 1-year follow-up study in ear, nose, and throat (ENT) cancer patients was carried out one year after radiotherapy to assess the effect of varying consumption of ω3 fatty acid according to whether they consumed more or less than the 50th percentile of ω3 fatty acids. Clinical, analytical, inflammatory (CRP and IL-6), and oxidative variables (TAC, GPx, GST, and SOD) were evaluated. The study comprised 31 patients (87.1% men), with a mean age of 61.3 ± 9.1 years. Hematological variables showed significant differences in the patients with a lower consumption of ω3 fatty acids. A lower mortality and longer survival were found in the group with ω3 fatty acid consumption ≥50th percentile but the differences were not significant. No significant difference was reached in toxicity, inflammation, and oxidative stress markers. The group with ω3 fatty acid consumption <50th percentile significantly experienced more hematological and immune changes.
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Affiliation(s)
- María Del Mar Roca-Rodríguez
- Biomedical Research Institute of Malaga (IBIMA), Virgen de la Victoria Hospital, University of Malaga , Málaga , Spain
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Fernández-García JC, Murri M, Coin-Aragüez L, Alcaide J, El Bekay R, Tinahones FJ. GLP-1 and peptide YY secretory response after fat load is impaired by insulin resistance, impaired fasting glucose and type 2 diabetes in morbidly obese subjects. Clin Endocrinol (Oxf) 2014; 80:671-6. [PMID: 23573808 DOI: 10.1111/cen.12221] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 11/22/2012] [Revised: 02/20/2013] [Accepted: 04/06/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Both glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) are gut hormones involved in energy homoeostasis. Obesity, insulin resistance and hyperglycaemia are significant confounders when GLP-1 and PYY secretion is assessed. Thus, we evaluated GLP-1 and PYY response after fat load in morbidly obese patients with different degrees of insulin resistance and glycemic status. DESIGN We studied 40 morbidly obese subjects (mean age, 40·6 ± 1·3 years; mean BMI, 53·1 ± 1·2 kg/m(2) ) divided into groups according to their glycemic status: normal fasting glucose (NFG) group, impaired fasting glucose (IFG) group and type 2 diabetes mellitus (T2D) group. NFG patients were additionally subclassified, according to the homoeostasis model assessment of insulin resistance (HOMAIR ), into a low insulin-resistance (LIR) group (HOMAIR <3·9) or a high insulin-resistance (HIR) group (HOMAIR ≥3·9). MEASUREMENTS Lipid emulsion was administered orally and measurements made at baseline and 180 min postprandially of levels of GLP-1, PYY, insulin, glucose, free fatty acids, triglycerides and leptin. RESULTS At the 180-minute postprandial reading, GLP-1 and PYY had increased in LIR-NFG subjects (41·84%, P = 0·01; 35·7%, P = 0·05; respectively), whereas no changes were observed in HIR-NFG, IFG or T2D subjects. CONCLUSIONS These results suggest that in morbidly obese subjects, both insulin resistance and abnormal glucose metabolism (IFG or T2D) impair the GLP-1 and PYY response to fat load. The implications of this attenuated enteroendocrine response should be elucidated by further studies.
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Affiliation(s)
- José C Fernández-García
- Department of Endocrinology, Virgen de la Victoria University Hospital, Málaga, Spain; Research laboratory, Virgen de la Victoria University Hospital, Málaga, Spain; Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERObn CB06/003), Instituto de Salud Carlos III, Madrid, Spain
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Garrido-Sánchez L, García-Fuentes E, Fernández-García D, Escoté X, Alcaide J, Perez-Martinez P, Vendrell J, Tinahones FJ. Zinc-alpha 2-glycoprotein gene expression in adipose tissue is related with insulin resistance and lipolytic genes in morbidly obese patients. PLoS One 2012; 7:e33264. [PMID: 22442679 PMCID: PMC3307730 DOI: 10.1371/journal.pone.0033264] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/06/2012] [Indexed: 11/24/2022] Open
Abstract
Objective Zinc-α2 glycoprotein (ZAG) stimulates lipid loss by adipocytes and may be involved in the regulation of adipose tissue metabolism. However, to date no studies have been made in the most extreme of obesity. The aims of this study are to analyze ZAG expression levels in adipose tissue from morbidly obese patients, and their relationship with lipogenic and lipolytic genes and with insulin resistance (IR). Methods mRNA expression levels of PPARγ, IRS-1, IRS-2, lipogenic and lipolytic genes and ZAG were quantified in visceral (VAT) and subcutaneous adipose tissue (SAT) of 25 nondiabetic morbidly obese patients, 11 with low IR and 14 with high IR. Plasma ZAG was also analyzed. Results The morbidly obese patients with low IR had a higher VAT ZAG expression as compared with the patients with high IR (p = 0.023). In the patients with low IR, the VAT ZAG expression was greater than that in SAT (p = 0.009). ZAG expression correlated between SAT and VAT (r = 0.709, p<0.001). VAT ZAG expression was mainly predicted by insulin, HOMA-IR, plasma adiponectin and expression of adiponectin and ACSS2. SAT ZAG expression was only predicted by expression of ATGL. Conclusions ZAG could be involved in modulating lipid metabolism in adipose tissue and is associated with insulin resistance. These findings suggest that ZAG may be a useful target in obesity and related disorders, such as diabetes.
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Affiliation(s)
- Lourdes Garrido-Sánchez
- CIBERDEM, Hospital Universitari Joan XXIII, Pere Virgili Institute, Tarragona, Spain
- * E-mail: (LGS); (EGF)
| | - Eduardo García-Fuentes
- Fundación IMABIS, Malaga, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Malaga, Spain
- * E-mail: (LGS); (EGF)
| | - Diego Fernández-García
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Malaga, Spain
- Servicio de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, Malaga, Spain
| | - Xavier Escoté
- CIBERDEM, Hospital Universitari Joan XXIII, Pere Virgili Institute, Tarragona, Spain
| | - Juan Alcaide
- Fundación IMABIS, Malaga, Spain
- Servicio de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, Malaga, Spain
| | - Pablo Perez-Martinez
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Malaga, Spain
- Servicio de Medicina Interna, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Joan Vendrell
- CIBERDEM, Hospital Universitari Joan XXIII, Pere Virgili Institute, Tarragona, Spain
| | - Francisco J. Tinahones
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Malaga, Spain
- Servicio de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, Malaga, Spain
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Garrido-Sánchez L, Vendrell J, Fernández-García D, Ceperuelo-Mallafré V, Chacón MR, Ocaña-Wilhelmi L, Alcaide J, Tinahones FJ, García-Fuentes E. De novo lipogenesis in adipose tissue is associated with course of morbid obesity after bariatric surgery. PLoS One 2012; 7:e31280. [PMID: 22384010 PMCID: PMC3285616 DOI: 10.1371/journal.pone.0031280] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 01/05/2012] [Indexed: 11/18/2022] Open
Abstract
Objective De novo lipogenesis is involved in fatty acid biosynthesis and could be involved in the regulation of the triglyceride storage capacity of adipose tissue. However, the association between lipogenic and lipolytic genes and the evolution of morbidly obese subjects after bariatric surgery remains unknown. In this prospective study we analyze the association between the improvement in the morbidly obese patients as a result of bariatric surgery and the basal expression of lipogenic and lipolytic genes. Methods We study 23 non diabetic morbidly obese patients who were studied before and 7 months after bariatric surgery. Also, we analyze the relative basal mRNA expression levels of lipogenic and lipolytic genes in epiploic visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT). Results When the basal acetyl-CoA carboxylase 1 (ACC1), acetyl-CoA synthetase 2 (ACSS2) and ATP citrate lyase (ACL) expression in SAT was below percentile-50, there was a greater decrease in weight (P = 0.006, P = 0.034, P = 0.026), body mass index (P = 0.008, P = 0.033, P = 0.034) and hip circumference (P = 0.033, P = 0.021, P = 0.083) after bariatric surgery. In VAT, when the basal ACSS2 expression was below percentile-50, there was a greater decrease in hip circumference (P = 0.006). After adjusting for confounding variables in logistic regression models, only the morbidly obese patients with SAT or VAT ACSS2 expression≥P50 before bariatric surgery had a lower percentage hip circumference loss (<P50) after bariatric surgery (SAT: P = 0.039; VAT: P = 0.033). Conclusions A lower basal ACSS2, ACC1 and ACL expression, genes involved in de novo lipogenesis, is associated with a better evolution of anthropometric variables after bariatric surgery. Thus, the previous state of the pathways involved in fatty acid metabolism may have repercussions on the improvement of these patients.
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Affiliation(s)
| | - Joan Vendrell
- CIBERDEM, Hospital Universitari Joan XXIII, IISPV, Tarragona, Spain
| | - Diego Fernández-García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, Málaga, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Málaga, Spain
| | | | | | | | | | - Francisco J. Tinahones
- Servicio de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, Málaga, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Málaga, Spain
- * E-mail: (FJT); (EG-F)
| | - Eduardo García-Fuentes
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Málaga, Spain
- Fundación IMABIS, Málaga, Spain
- * E-mail: (FJT); (EG-F)
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Navarro-Campos C, Martínez-Ferrer MT, Campos JM, Fibla JM, Alcaide J, Bargues L, Marzal C, Garcia-Marí F. The influence of host fruit and temperature on the body size of adult Ceratitis capitata (Diptera: Tephritidae) under laboratory and field conditions. Environ Entomol 2011; 40:931-938. [PMID: 22251694 DOI: 10.1603/en10302] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The adult body size of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann) (Diptera: Tephritidae), varies in natural conditions. Body size is an important fitness indicator in the Mediterranean fruit fly; larger individuals are more competitive at mating and have a greater dispersion capacity and fertility. Both temperature during larval development and host fruit quality have been cited as possible causes for this variation. We studied the influence of host fruit and temperature during larval development on adult body size (wing area) in the laboratory, and determined body size variation in field populations of the Mediterannean fruit fly in eastern Spain. Field flies measured had two origins: 1) flies periodically collected throughout the year in field traps from 32 citrus groves, during the period 2003-2007; and 2) flies evolved from different fruit species collected between June and December in 2003 and 2004. In the lab, wing area of male and female adults varied significantly with temperature during larval development, being larger at the lowest temperature. Adult size also was significantly different depending on the host fruit in which larvae developed. The size of the flies captured at the field, either from traps or from fruits, varied seasonally showing a gradual pattern of change along the year. The largest individuals were obtained during winter and early spring and the smallest during late summer. In field conditions, the size of the adult Mediterannean fruit fly seems apparently more related with air temperature than with host fruit. The implications of this adult size pattern on the biology of C. capitata and on the application of the sterile insect technique are discussed.
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Affiliation(s)
- C Navarro-Campos
- Instituto Agroforestal Mediterráneo (IAM), Universidad Politécnica de Valencia, Valencia, Spain
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21
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Murri M, García-Delgado R, Alcázar-Ramírez J, Fernández-Ramos A, Alcaide J, Cardona F, Tinahones FJ. Effect of CPAP on oxidative stress and circulating progenitor cell levels in sleep patients with apnea-hypopnea syndrome. Respir Care 2011; 56:1830-6. [PMID: 21605479 DOI: 10.4187/respcare.01081] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The sleep apnea-hypopnea syndrome is associated with elevated oxidative stress, which is associated with reduced levels and functional impairment of progenitor cells. OBJECTIVE To evaluate whether one month of CPAP treatment affects circulating-progenitor-cell levels and oxidative stress in patients with sleep apnea-hypopnea syndrome. METHODS We enrolled 13 patients with sleep apnea-hypopnea syndrome who required nasal CPAP. We evaluated white-blood-cell oxidative stress and CD45-, CD34+, KDR+, and CD133+ cell levels via flow-cytometry, before and one month after CPAP treatment. RESULTS Superoxide anion and hydrogen peroxide were reduced, and markers of protection against oxidative stress were increased after CPAP. Progenitor-cell levels increased significantly after CPAP. There was a significant negative correlation between CD45-, CD34+, KDR+, and CD133+ cell levels and the severity of sleep apnea-hypopnea syndrome and superoxide anion. CONCLUSIONS CD45-, CD34+, KDR+, and CD133+ cell levels rose significantly and reached values close to those in the control group after one month of CPAP. This change was accompanied by a significant decrease in oxidative stress, and no change in anthropometric or metabolic variables, including insulin resistance, weight, blood pressure, or lipid levels; consequently, the increase in progenitor-cell levels might be attributable to reduced oxidative stress.
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Affiliation(s)
- Mora Murri
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
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22
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Murri M, Alcázar-Ramírez J, Garrido-Sánchez L, Linde F, Alcaide J, Cardona F, Tinahones FJ. Oxidative stress and metabolic changes after continuous positive airway pressure treatment according to previous metabolic disorders in sleep apnea-hypopnea syndrome patients. Transl Res 2009; 154:111-21. [PMID: 19665687 DOI: 10.1016/j.trsl.2009.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [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: 12/16/2008] [Revised: 06/03/2009] [Accepted: 06/04/2009] [Indexed: 11/18/2022]
Abstract
Sleep apnea-hypopnea syndrome (SAHS) is characterized by recurrent episodes of hypoxia/reoxygenation, which seems to promote oxidative stress. SAHS patients experience increases in hypertension, obesity, and dyslipidemia, and the oxidative state has been related to the genesis of these disorders. The purpose of this study was to examine the changes in oxidative stress markers and metabolic parameters in S AHS patients after 1 month of treatment with continuous positive airway pressure (CPAP), in relation to their previous metabolic disorders. The study included 78 SAHS patients who required CPAP. The patients were classified according to their disorders, including hypertension, obesity, and dyslipidemia. Measurements were made before and after 1 month of treatment with CPAP. The diastolic blood pressure decreased after treatment in all the patients, significantly so in those who were nondyslipidemic, obese, or hypertensive (the systolic pressure also fell in these latter patients). Plasma oxidative stress biomarkers showed a significant antioxidant capacity and increased activity (P<0.05) after treatment, more so in the nondyslipidemic and hypertensive patients. Furthermore, serum lipid peroxidation levels decreased after CPAP (P<0.01). No change was observed in insulin resistance (IR) after CPAP treatment in any of the different disorders. In conclusion, oxidative stress markers improved significantly after CPAP treatment in SAHS patients, especially in the nondyslipidemic and hypertensive patients. Moreover, the blood pressure decreased after CPAP treatment, particularly in the obese, nondyslipidemic, and hypertensive patients. No significant change in IR was found in any of the SAHS patients after CPAP treatment.
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Affiliation(s)
- Mora Murri
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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23
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Pina JM, Domínguez A, Alcaide J, Alvarez J, Camps N, Díez M, Godoy P, Jansá JM, Minquell S, Arias C. [Excess mortality due to tuberculosis and factors associated to death in and annual cohort of patients diagnosed of tuberculosis]. Rev Clin Esp 2007; 206:560-5. [PMID: 17265572 DOI: 10.1016/s0014-2565(06)72897-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To calculate excess mortality in an annual cohort of tuberculosis patients and study the factors associated with death. MATERIAL AND METHOD Cases of tuberculosis reported in Catalonia (May 1996-April 1997). Patients were classified as completed treatment/cured (compliant), non-compliant, failures, transfers out and deaths. Excess mortality was defined as the ratio actual deaths/expected deaths (according to general mortality figures for Catalonia, May 1996-April 1997). Factors associated with death were determined by a comparative study of variables (demographic, substance abuse, comorbidity, tuberculosis-related disease) in deaths after diagnosis and survivors. Time from diagnosis to death was recorded. RESULTS Patients included: 2,085. Patients classified as: completed treatment/cured (compliant), 1,406 (67.43 %); noncompliant, 165 (7, 91%); failures, 5 (0.24%); transfers out, 25 (1.21%); deaths, 133 (6.38%), 28 of which occurred before diagnosis and 105 after diagnosis. Insufficient data in medical record for classification, 351 (16.83%) patients. Excess mortality: 5.98 (95% CI: 4.96-7.0). Factors associated with death: treatment with non-standardized guidelines, 46%; OR: 10.3 (6.2-17.4); HIV infection, 40%; OR: 13.0 (6.6-25.8); age greater than 64 years, 40%; OR: 14.6 (3.0-69.8); alcoholism, 25%; OR: 2.0 (1.1-3.6); neoplasm, 16%; OR: 3.9 (1.8-8.6; renal failure, 8%; OR: 10.1 (3.1-32.3). The shortest time from diagnosis to death was in patients with only one risk factor, except for HIV infection, where the time passed was the longest observed. CONCLUSIONS We found substantial excess mortality in tuberculosis patients. Death was associated with the efficacy of treatment, HIV coinfection, advanced age, alcoholism and the coexistence of neoplasms or renal failure.
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Affiliation(s)
- J M Pina
- Programa de la Tuberculosi de la Regió Sanitária Centre de Catalunya, Barcelona, España.
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Díez M, Bleda MJ, Alcaide J, Castells C, Cardenal JI, Domínguez A, Gayoso P, Guitiérrez G, Huerta C, López MJ, Moreno T, Muñoz F, García-Fulgueiras A, Picó M, Pozo F, Quirós JR, Robles F, Sánchez JM, Vanaclocha H, Vega T. Determinants of health system delay among confirmed tuberculosis cases in Spain. Eur J Public Health 2005; 15:343-9. [PMID: 16014664 DOI: 10.1093/eurpub/cki010] [Citation(s) in RCA: 23] [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: 11/13/2022] Open
Abstract
BACKGROUND Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. METHODS Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. RESULTS A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. CONCLUSION Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.
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Affiliation(s)
- M Díez
- TB Research Unit, National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain.
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Altet-Gômez MN, Alcaide J, Godoy P, Romero MA, Hernández del Rey I. Clinical and epidemiological aspects of smoking and tuberculosis: a study of 13,038 cases. Int J Tuberc Lung Dis 2005; 9:430-6. [PMID: 15830749] [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: 05/02/2023] Open
Abstract
SETTING AND OBJECTIVE Smoking habit and tuberculosis (TB) appear to have common epidemiological and clinical links. The present study was to evaluate risk factors in TB patients with and without a smoking habit. DESIGN A cross-sectional observational study of cases (TB with smoking) and controls (TB without smoking) from the same registry. Data were retrieved from case notes and interviews of patients registered in the Tuberculosis Control Programme in Cataluuña, Spain, between 1 January 1996 and 31 December 2002. Statistical analyses included univariate and stepwise multiple logistic regression analyses. RESULTS There were 13,038 recorded patients. Social factors associated with TB in smokers were male sex (adjusted odds ratio [aOR] 2.2), age <64 years, alcohol use >30 g/day (aOR 7.4) and intravenous drug use (aOR 1.5). Smokers developed more pulmonary disease (aOR 1.5) and more cavitary lesions (aOR 1.9), and were more likely to require hospitalisation (aOR 1.8) which was more protracted. Differences in mortality and delay in diagnosis did not reach statistical significance. CONCLUSIONS Smoking leads to faster and more severe progression of TB. The cost of TB-related hospitalisation for smokers increases by approximately one million euros per year.
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Affiliation(s)
- M N Altet-Gômez
- Unidad de Prevención y Control de la Tuberculosis, Barcelona, Spain.
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26
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Díez M, Bleda MJ, Alcaide J, Caloto T, Castells C, Cardenal JI, Domínguez A, Gayoso P, Gutiérrez G, Huerta C, López MJ, Moreno T, Muñoz F, Navarro C, Picó M, Pozo F, Quirós JR, Robles F, Sánchez JM, Vanaclocha H, Vega T. Determinants of patient delay among tuberculosis cases in Spain. Eur J Public Health 2004; 14:151-5. [PMID: 15230500 DOI: 10.1093/eurpub/14.2.151] [Citation(s) in RCA: 24] [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: 11/13/2022] Open
Abstract
BACKGROUND Patient delay was investigated in a cohort of TB patients identified from May 1996 until April 1997 in 13 Autonomous Regions in Spain. The study covered almost 67% of the total Spanish population. METHODS Data were collected from clinical records. Using unconditional logistic regression with two different cut-off points to define 'patient delay' (the median and 75th percentile), the association between patient delay and different factors was estimated. RESULTS A total of 7,037 cases were included. Median and 75th percentile delays were 22 and 57 days respectively. Factors associated with patient delay greater than the median (p<0.05) were: non-respiratory symptoms of TB and age over 14 years, although the effect of age was not linear. Furthermore, an interaction was observed between intravenous drug user (IDU) and HIV status, in that, whereas patient delay was greater in IDUs than in non-IDUs among cases whose HIV status was either negative or unknown, among HIV-positive patients no such IDU-related differences were in evidence. Factors associated with extreme patient delay (greater than the 75th percentile) were essentially the same, but the above-described interaction disappeared, with IDU status showing no direct effect. In addition, likelihood of extreme patient delay increased in the case of alcoholism and female gender and decreased in the case of chronic renal failure, corticoid treatment, prison inmates and residents of old age homes. CONCLUSION Although there is a universally enjoyed right to health care in Spain, some groups of TB patients could nevertheless be experiencing problems in seeking medical attention.
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Affiliation(s)
- M Díez
- Unidad de Investigación en TB, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
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27
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Godoy P, Domínguez A, Alcaide J, Camps N, Jansà JM, Minguell S, Pina JM, Díez M. Characteristics of tuberculosis patients with positive sputum smear in Catalonia, Spain. Eur J Public Health 2004; 14:71-5. [PMID: 15080395 DOI: 10.1093/eurpub/14.1.71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/13/2022] Open
Abstract
BACKGROUND Patients with positive sputum smears are those with the capacity to spread infection. The objective of this study was to describe the incidence of tuberculosis in Catalonia (an autonomous community in the northeast of Spain which includes Barcelona) and to determine risk factors associated to patients with positive sputum smear test. METHODS New cases of tuberculosis detected by active surveillance between May 1996 and April 1997 were studied. The study was analysed as a coincident cases and controls study. The rate of incidence was calculated per 100,000 persons-year. The association of the dependent variable--case of tuberculosis with positive sputum smear--with the remainder of independent variables was determined by odds ratio (OR) with a 95% confidence interval (CI). RESULTS A total of 2508 cases of tuberculosis were detected. The rate of incidence was 41.4 per 100,000 persons-year. Of these 19.4% (487/2508) were coinfected with HIV and 35.6% (893/2508) presented a positive sputum smear, which implies a rate of 14.7 per 100,000 persons-year. In an adjusted multivariate analysis, cases with positive smears were positively associated with the 15-24 (OR=1.9; 95% CI: 1.4-2.4), 25-34 (OR=2.1; 95% CI: 1.7-2.7) and 35-44 years (OR=1.7; 95% CI: 1.3-2.2) age compared with persons 45 years old and above; with males (OR=1.8; 95% CI: 1.5-2.2) and consumers of alcohol (OR=2.1; 95% CI: 1.7-2.7) and negatively with those under 15 years of age (OR=0.1; 95% CI: 0.1-0.2) and coinfection with HIV (OR=0.5; 95% CI: 0.3-0.7). CONCLUSIONS Measures to control tuberculosis transmission (prompt diagnosis, study of contacts and directly observed treatments) should be reinforced for male adults with excessive consumption of alcohol.
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Affiliation(s)
- P Godoy
- Delegación Territorial de Sanidad y Seguridad Social, Lleida, Spain.
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28
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García de Olalla P, Caylà JA, Milá C, Jansà JM, Badosa I, Ferrer A, Ros M, Gómez i Prat J, Armengou JM, Alonso E, Alcaide J. Tuberculosis screening among immigrants holding a hunger strike in churches. Int J Tuberc Lung Dis 2003; 7:S412-6. [PMID: 14677831] [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: 04/27/2023] Open
Abstract
SETTING In January 2001, approximately 600 immigrants held a sit-down and hunger strike in several churches in Barcelona to force the Spanish government to comply with demands to regulate their immigration status. Following the diagnosis of a case of smear-positive pulmonary tuberculosis (TB) in one of the immigrants, we performed a large contact investigation. OBJECTIVES To describe contact investigation procedures used in this setting and to evaluate contact investigation results. METHODS Demographic variables were collected, and tuberculin skin tests (TST) and chest radiograph examinations were performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and logistic regression was used for multivariate analyses. RESULTS A total of 541 TSTs were performed. Of these, 86% were read and 40.5% yielded a positive reaction with an induration >14 mm. In a multivariate analysis, the risk of presenting a TST induration >14 mm was found to be three times higher among those aged >35 years compared to those <24 years (OR 3.40; 95%CI 1.76-6.59), and for immigrants from Bangladesh (OR 3.14; 95%CI 1.16-6.10) and Pakistan (OR 2.04; 95%CI 1.11-3.73) compared to those from India. A total of 314 chest radiographs examinations were performed and three additional cases of TB were identified, yielding a TB prevalence of 0.7%. CONCLUSIONS By focusing efforts and conducting targeted TB screening in this high-risk population, it was possible to complete the intervention in only 3 days. A high prevalence of TB infection and TB disease was found.
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Abstract
OBJECTIVE To determine the response of tuberculosis patients to tuberculin skin tests. METHOD The results of skin tests used for initial assessment of tuberculosis patients in Catalonia were reviewed (Multicenter Tuberculosis Research Project). Negative skin tests were those with indurations < 5 mm; positive tests were those with indurations measuring > or = 5 mm. Individuals were classed as having or not having risk factors for developing tuberculosis and those without risk factors were classified by age, location and extension of tuberculosis. RESULTS Negative skin tests were seen in 1,566 patients (23%). Negative tests were more common in patients with risk factors, significantly so in those undergoing immunosuppressant therapy (50%) or with HIV infection (61%). Negative tests were less prevalent in patients with no risk factors (13%) and, among them, in children (1%), in patients between 15 and 29 years of age (10%) or in those with non-pulmonary forms (10%). Negative tests were significantly more prevalent among patients 60 to 74 years of age (27%), those over 74 (44%), and those whose disease was pulmonary and extrapulmonary (26%) or disseminated (64%). No significant differences in induration size of positive skin tests were observed for patients with and without risk factors (including HIV infection or non-infection). A normal distribution of induration size was observed in all groups. CONCLUSIONS A negative tuberculin skin test for initial assessment should be interpreted in function of the presence or absence of risk factors, age, location or extension of tuberculosis. When a skin test is positive, the response will be similar whether or not an immunodepressant factor is present.
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Affiliation(s)
- J M Pina
- Programa de la Tuberculosi de la Regió Sanitària Centre de Catalunya. Servei Català de la Salut. Institut Català de la Salut. España
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30
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Diez M, Huerta C, Moreno T, Caloto T, Guerra D, Pozo F, Alcaide J, Castells C, Cardenal JI, Domínguez A, Gayoso P, Gutiérrez G, López MJ, Muñoz F, Navarro C, Picó M, Quirós JR, Robles F, Sánchez JM, Vanaclocha H, Vega T. Tuberculosis in Spain: epidemiological pattern and clinical practice. Int J Tuberc Lung Dis 2002; 6:295-300. [PMID: 11936737] [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: 02/24/2023] Open
Abstract
SETTING Thirteen Autonomous Regions in Spain. OBJECTIVE To study the incidence of all forms of tuberculosis (TB) and investigate clinical practice in TB. DESIGN Cases of all forms of tuberculosis diagnosed in the study setting from May 1986 to April 1997 were identified though active search of different databases. Clinical and epidemiological information on cases was collected from clinical records or by interview with physicians. RESULTS The overall incidence of all forms of tuberculosis was 38.5/100,000 and the incidence of smear-positive disease was 13.83/100,000. Most cases (97.1%) were Spanish nationals, with rates higher in men than in women (52.7/100,000 vs. 24.87/100,000) and in groups aged 25-34 and 75 years and over (61.35/100,000 and 59.35/100,000, respectively). Disseminated forms were frequent (6.6%), and the most common risk factor was human immunodeficiency virus (HIV) infection (17.7% of cases). Hospitalisation was common (71.6%). Microbiological confirmation of diagnosis was sought for 87.7% of the cases (91.8% of pulmonary vs. 75.5% of extra-pulmonary cases), and 65.2% were culture-positive (73.8% of pulmonary vs. 39.7% of extra-pulmonary cases). HIV-infected patients were treated in almost equal proportions with three or four drugs (49.7% and 48.2%, respectively), while HIV-negative cases or those whose HIV status was unknown were usually treated with three drugs. CONCLUSION The epidemiological pattern of TB in Spain is different to other industrialised countries in the age distribution of cases and the proportions of foreigners and cases with HIV infection. Microbiological confirmation of diagnosis is more common in pulmonary than in extra-pulmonary disease, and treatment with four drugs more frequent in HIV-positive cases.
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Affiliation(s)
- M Diez
- Unidad de Investigación en Tuberculosis, Instituto de Salud Carlos III, Madrid, Spain.
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Solsona J, Caylà JA, Nadal J, Bedia M, Mata C, Brau J, Maldonado J, Milà C, Alcaide J, Altet N, Galdós-Tangüis H. Screening for tuberculosis upon admission to shelters and free-meal services. Eur J Epidemiol 2002; 17:123-8. [PMID: 11599684 DOI: 10.1023/a:1017580329538] [Citation(s) in RCA: 27] [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: 11/12/2022]
Abstract
BACKGROUND The homeless are at very high risk of suffering tuberculosis (TB). The aims of this study were to determine the prevalence and risk factors for tuberculosis infection and disease among the homeless in Barcelona and to evaluate the roles of case finding and contact investigation. METHODS Observational prevalence study carried out between 1997 and 1998. PARTICIPANTS 447 homeless patients (394 men and 53 women) were evaluated before admission to shelters and free-meal services. At the same time, 48 co-residents with smear-positive TB patients in 2 long-term shelters were evaluated too. A chest X-ray and Tuberculin Skin Test were performed on all subjects. Sputum smears were processed by the Ziehl-Neelsen and Löwenstein-Jensen procedures in patients with radiographic findings consistent with pulmonary TB. RESULTS Of the 447 homeless examined, 335 (75%) were infected with Mycobacterium tuberculosis. Active pulmonary TB was diagnosed in five persons (1.11%), and 62 (13.8%) had radiographic evidence of inactive pulmonary TB. Tuberculosis infection was associated with age and smoking, but not with sex or alcohol abuse. No significant differences in infection rates were found between the main group and 48 homeless co-residents of smear-positive subjects. Only 16.9% of the homeless with active TB in Barcelona in the same period were diagnosed through active case-finding, the remainder being mainly detected in hospitals (69.8%) and other several centres (13.3%). CONCLUSIONS Homeless individuals have a very high risk of TB infection and disease and contact investigation requires specific methods for them. Programmes of screening and supervised treatment should be ensured in this group.
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Affiliation(s)
- J Solsona
- Centro de Prevenció i Control de la Tuberculosi CAP Drassanes, Barcelona, Spain.
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Julián E, Matas L, Hernández A, Alcaide J, Luquin M. Evaluation of a new serodiagnostic tuberculosis test based on immunoglobulin A detection against Kp-90 antigen. Int J Tuberc Lung Dis 2000; 4:1082-5. [PMID: 11092723] [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: 02/18/2023] Open
Abstract
We evaluated a new serological test for tuberculosis (TB) diagnosis, an enzyme-linked immunosorbent assay which detects the presence of immunoglobulin A (IgA) antibodies in human serum, the Kreatech TB IgA EIA test. The study was performed using 166 serum samples collected in the city of Barcelona, Spain. Fifty-six serum samples were from TB patients and 111 from controls, 40 of which were non-TB pneumonia patients. The test sensitivity was 70.58% in the adult group with pulmonary TB and 50% in the group with extra-pulmonary TB. These sensitivities were similar to those previously reported by others. However, we found that the test had a low specificity of only 68.68%, while specificities of 90% and 95% have been reported. This discrepancy may be attributable to differences in the respective study populations. In our control group we included 40 non-TB pneumonia patients (36% of the entire control group), in whom test specificity dropped to 47.22%. In those studies in which specificities of 90% and above were achieved, very few serum samples from non-TB pneumonia patients were tested (6-12% of the entire control group).
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Affiliation(s)
- E Julián
- Department of Genetics and Microbiology, Sciences Faculty, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
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Alcaide J, Altet MN, Pascual J. [Directly observed treatment of tuberculosis]. Arch Bronconeumol 1998; 34:367-8. [PMID: 9762404 DOI: 10.1016/s0300-2896(15)30410-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Alcaide J, Domínguez A, Albiñana C. [The situation of tuberculosis in Spain]. Med Clin (Barc) 1998; 110:158-9. [PMID: 9580274] [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: 02/07/2023]
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Fourie PB, Becker PJ, Festenstein F, Migliori GB, Alcaide J, Antunes M, Auregan G, Beyers N, Carvalho JM, Cruz JR, Fanning EA, Gie R, Huong ND, Leitch AG. Procedures for developing a simple scoring method based on unsophisticated criteria for screening children for tuberculosis. Int J Tuberc Lung Dis 1998; 2:116-23. [PMID: 9562121] [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: 02/07/2023] Open
Abstract
OBJECTIVE To develop a scoring system for screening children for tuberculosis (TB) and for selecting suspects for further investigation in tuberculosis control programmes. Application of the score model, which would not require sophisticated or expensive technology, would be directed towards resource-poor countries with high prevalences of tuberculosis, where health care workers have to deal with diagnostic problems away from district hospitals or diagnostic facilities. DESIGN Based on contributions from members of an IUATLD task group from 10 countries on the use of diagnostic criteria in childhood tuberculosis, criteria were selected to be used as elements in a score model. Data were collected by standardised questionnaire on 879 subjects aged under 15 years. Of these, 794 were considered probable or confirmed cases of tuberculosis by the diagnosing doctors. From each record, the criteria/procedures used in the diagnosis of probable/confirmed TB and regarded by the doctors as relevant criteria were selected. Bacteriology, histology and chest radiography were used either singly or collectively as the definitive reference (gold standard) against which the more subjective criteria (symptoms, clinical signs, skin test) would be evaluated. The latter criteria cited as relevant were then ranked and further explored for inclusion in the score model. The relative importance of each criterion to every other criterion on the list was expressed as weights, determined by employing a logarithmic least squares method to solve the ratio scale estimation problem which underlies decision-making involving more than one criterion. The resultant values were then assigned to each criterion in the final score model. RESULTS The five clinical criteria thought to be most relevant as predictors of disease in children were history of contact with a case of tuberculosis, positive skin test, persistent cough, low weight for age, and unexplained/prolonged fever. In selecting the optimal cut-off points for the model at which tuberculosis would be suspected, low sensitivity and specificity (below 70%) but reasonably good positive predictive values (60%-77%) were obtained, depending on age group and epidemiological setting. In low tuberculosis prevalence settings, heavy reliance is placed by the model on a history of contact with a household case of tuberculosis and on a positive skin test, both of which have to be true. For high prevalence settings, more or less equal weighting is assigned to all five elements. Case contact and skin tests are less important, with low body weight, prolonged fever and cough being more indicative of tuberculosis. CONCLUSION The model provides for epidemiological differences between target populations and should prove successful as a screening tool to select children for further investigation by radiography and bacteriology.
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Affiliation(s)
- P B Fourie
- MRC National Tuberculosis Research Programme, Pretoria, South Africa
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Martín V, Domínguez A, Alcaide J. [Cost-benefit analysis of the active screening of pulmonary tuberculosis in a recluse population entering prison]. Gac Sanit 1997; 11:221-30. [PMID: 9494287 DOI: 10.1016/s0213-9111(97)71301-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In spanish prisons, tuberculosis is a serious problem of public health and health authorities don't take it seriously. OBJECTIVE To prove the efficiency of pulmonary tuberculosis case-finding on arrival at prison in order to get location resources in this activity. METHODS Cost-benefit analysis of a case-finding program compared with to wait for diagnostic to illness. The sensitivity of test was fixed in 80% and the specificity in 99.99%. The cost was based on market prices. Sensitivity analysis was done in every variables as well as tridimensional analysis in those one of more influence. RESULTS The case-finding was efficient on prevalences of tuberculosis over 5 per mil. Its efficiency was hardly affected by discount social rates or the sensitivity of diagnostic tests. The prevalence of illness, the cost of diagnostic activities as well as the success of treatment and the specificity of diagnostic tests used had as influence on the efficiency model. The tridimensional analysis proved that the case-finding of pulmonary tuberculosis has efficiency on low prevalences (1 per thousand), provided the number of people cured is a 5% higher than the alternative one and the costs of case-finding less than 1,000 pesetas per subject. CONCLUSIONS The case-finding pulmonary tuberculosis on arrival at prisons is of high efficiency. In a cost-opportunity situation (location of available resources, penitentiary and extrapenitentiary) the program is very efficacious taking into account the fact of higher prevalence of pulmonary tuberculosis in this people.
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Affiliation(s)
- V Martín
- Servicio Médico, Centro Penitenciario, León
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Abstract
OBJECTIVE To assess the impact of HIV/AIDS on the incidence of tuberculosis (TB) and to analyse the determinants of TB presenting as the first indicative disease of AIDS. DESIGN Analysis of TB and AIDS surveillance data. SETTING Catalonia, north-east Spain. PATIENTS Two separate sources were used: (i) TB cases reported to the Catalan TB registry diagnosed between January 1982 and December 1993; (ii) AIDS cases reported to the AIDS Catalan registry diagnosed between January 1982 and December 1994. MAIN OUTCOME MEASURES Expected and observed TB cases, and number and characteristics of AIDS cases presenting with TB. RESULTS From 1987 to 1993 the annual TB crude incidence rate increased by 50% to a rate of 49.7 per 100,000, with a least 60% of the increase directly due to AIDS. During that period specific rates among children aged 0-4 years remained high at around 40 per 100,000. A total of 7,010 AIDS cases were diagnosed between 1988 and 1994, of whom 24.3% had TB. Multivariate analysis from those AIDS cases showed that besides male sex, young age, and urban residence, the strongest predictors of TB among AIDS cases were history of imprisonment (odds ratio, 2.16; P < 0.001) and intravenous drug use (odds ratio, 1.65; P < 0.001). CONCLUSIONS The high rates of TB among children and young adults suggest that TB transmission has increased during this period, especially among people at high risk of AIDS. The determinants of individual risk of TB among AIDS patients act together, especially in prisons. The HIV/TB coepidemic is an emerging threat potentially for all and requires expanding targeted measures to prevent and control both disease in our setting.
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Affiliation(s)
- M Vall Mayans
- Department of Health and Social Security, University Hospital Germans Trias i Pujol, Badalona, Spain
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Altet MN, Alcaide J, Plans P, Taberner JL, Saltó E, Folguera LI, Salleras L. Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study. Tuber Lung Dis 1996; 77:537-44. [PMID: 9039447 DOI: 10.1016/s0962-8479(96)90052-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
SETTING Passive smoking-related respiratory disorders in children. OBJECTIVES To assess the effect of passive smoking on the development of active pulmonary tuberculosis (PTB) in children immediately following infection by Mycobacterium tuberculosis within the family. DESIGN An unmatched case-control study in which 93 contacts who became cases (active PTB diagnosed) and 95 contacts who did not became cases (tuberculin-positive children without evidence of active disease) were included. All were household contacts of a new case of pulmonary bacillary tuberculosis. Smoking habits were investigated by a questionnaire. Urinary cotinine was analysed. Odds Ratio (OR) was adjusted for age and socio-economic status using multiple logistic regression analysis. RESULTS Passive smoking was a risk factor for PTB (OR: 5.29; 95% confidence interval (CI): 2.33-12.82; P < 0.00005). The adjusted OR was 5.39 (95% CI: 2.44-11.91; P < 0.00001). The risk increased when contacts were passive smokers both at home and outside the home within the family (OR: 6.35; 95% CI: 3.20, 12.72; P < 0.00001). Contacts 0-4 and 5-9 years old showed a significantly higher risk than those aged > or = 10. There was a dose-response relationship between the risk of developing active PTB immediately following infection and the number of cigarettes smoked daily by the household adults (P < 0.001). Mean (SD) urinary continine detectable concentrations (ng/ml) were different between disease contacts (119.46 [68.61]) and non diseased contacts (91.87 [73.10]). The difference was statistically significant (P < 0.001). CONCLUSIONS Passive exposure to tobacco smoke in children was associated with an increased risk of developing pulmonary tuberculosis immediately following infection. This is an association of great concern requiring health education programmes and antitobacco medical advice.
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Affiliation(s)
- M N Altet
- Centre de Prevenció i Control de la Tuberculosi Dr I.I. Sayé, Barcelona, Spain
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Alcaide J, Domínguez A, Albiñana C, Parrón I. [Current situation of tuberculosis in Spain. A precarious health care perspective with regard to developed countries]. Med Clin (Barc) 1996; 107:239. [PMID: 8755455] [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: 02/02/2023]
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40
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Alcaide J, Altet MN, Plans P, Parrón I, Folguera L, Saltó E, Domínguez A, Pardell H, Salleras L. Cigarette smoking as a risk factor for tuberculosis in young adults: a case-control study. Tuber Lung Dis 1996; 77:112-6. [PMID: 8762844 DOI: 10.1016/s0962-8479(96)90024-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SETTING The association between smoking and pulmonary tuberculosis has not often been studied. OBJECTIVE To assess the influence of cigarette smoking on the development of active pulmonary tuberculosis in young people who were close contacts of new cases of smear-positive pulmonary tuberculosis. DESIGN A case-control study in which 46 'cases' (patients with active pulmonary tuberculosis: isolation of Mycobacterium tuberculosis or clinical and/or radiographic evidence of current pulmonary tuberculosis, with a positive tuberculin skin test) and 46 'controls' (persons with positive tuberculin reaction, negative bacteriological test and without clinical and/or radiological evidence of pulmonary tuberculosis) were included. Smoking habits were investigated by questionnaire. Univariate and multivariate analysis was performed, and odds ratio (OR) was adjusted for age, gender and socio-economic status. RESULTS Statistically significant differences were found in active smokers (occasional and daily smokers) (OR: 3.65; 95% CI, 1.46 and 9.21; P < 0.01), daily smokers (OR: 3.53; 95% CI, 1.34 and 9.26; P < 0.05), and individuals who were both passive and active smokers (OR: 5.10; 95% CI, 1.97 and 13.22; P < 0.01) and passive and daily smokers (OR: 5.59; 95% CI, 2.07 and 15.10; P < 0.001). There was a dose-response relationship between the number of cigarettes smoked daily and the risk of active pulmonary tuberculosis. CONCLUSIONS The data studied show that cigarette smoking is a risk factor for pulmonary tuberculosis in young people, with a dose-response relationship with the number of cigarettes consumed daily.
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Affiliation(s)
- J Alcaide
- Departament de Sanitat l Seguretat Social, Generalitat de Catalunya, Barcelona, Spain
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Altet MN, Alcaide J, Canela J, Serra L, Salleras L. [Retrospective evaluation of the effectiveness of the BCG vaccine campaign in newborns of Barcelona]. Med Clin (Barc) 1992; 99:612-6. [PMID: 1460925] [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: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to know the efficacy of the BCG vaccination campaign of the newborns of Barcelona carried out during the period from 1966-1974. METHODS To achieve this aim an epidemiologic investigation was undertaken by an observational analytical study of paired cases and controls. Two hundred and fifty randomly selected cases were studied between 1978-1988 from between 4-21 years of age during the study period. The cases were paired with 750 controls (1:3) with identical conditions and age, sex and place of residence. Statistical analysis of data was performed by the specific methods for this type of study. RESULTS The estimated gross odds ratio was 0.68; the interval of confidence 95% and 0.51-0.91 (p < 0.025). The efficacy of this vaccination campaign was estimated as weak at 32%, in the age group and investigation time being greater in males and diminished with time. The percentage of new cases of tuberculosis potentially prevented by this campaign was calculated at 13%. CONCLUSIONS The weak efficacy of the BCG vaccination campaign may be attributed not only to the unforeseen effects of this vaccine but also to the deficient operative aspects of the campaign itself.
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Affiliation(s)
- M N Altet
- Centro de Prevención y Control de la Tuberculosis Dr. Lluís Sayé, Barcelona
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Alcaide J, Altet MN, Batalla J, Plans P, Taberner JL, Salleras L, Romero MA. [Comparative study of human cutaneous sensitivity to 2 and 5 international units of the PPD RT 23 tuberculin with Tween 80]. Med Clin (Barc) 1992; 99:525-8. [PMID: 1434985] [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: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to know whether the human reaction to the Mantoux test with 5 UT of PPD RT 23 is similar to that achieved with the same test but with 2 UT of the same substance. METHODS A simultaneous double Mantoux test was used at doses of 2 UT and another of 5 UT of the same trade mark of tuberculin PPD RT 23 with Tween 80 in 2,575 individuals. The subjects were distributed into two different groups of different ages, taking into consideration the possible presence of BCG vaccination. RESULTS The doses of 5 UT produced a greater number of tuberculin positive individuals and a greater diameter of induration of reaction than that of the doses of 2 UT in both groups and with significant statistical differences. One hundred ninety-six (7%) subjects were tuberculin positive with 5 UT and negative with 2 UT. CONCLUSIONS The reactions produced by the Mantoux test with 5 and 5 UT PPD RT were different since the two doses are not bioequivalent.
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Affiliation(s)
- J Alcaide
- Centro de Prevención y Control de la Tuberculosis Dr. Lluis Saye, Barcelona
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