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Lavado À, Serra-Colomer J, Serra-Prat M, Burdoy E, Cabré M. Relationship of frailty status with health resource use and healthcare costs in the population aged 65 and over in Catalonia. Eur J Ageing 2023; 20:20. [PMID: 37280371 DOI: 10.1007/s10433-023-00769-8] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome with repercussions on health, disability, and dependency. OBJECTIVES To assess health resource use and costs attributable to frailty in the aged population. METHODS A population-based observational longitudinal study was performed, with follow-up from January 2018 to December 2019. Data were obtained retrospectively from computerized primary care and hospital medical records. The study population included all inhabitants aged ≥ 65 years ascribed to 3 primary care centres in Barcelona (Spain). Frailty status was established according to the Electronic Screening Index of Frailty. Health costs considered were hospitalizations, emergency visits, outpatient visits, day hospital sessions, and primary care visits. Cost analysis was performed from a public health financing perspective. RESULTS For 9315 included subjects (age 75.4 years, 56% women), frailty prevalence was 12.3%. Mean (SD) healthcare cost in the study period was €1420.19 for robust subjects, €2845.51 for pre-frail subjects, €4200.05 for frail subjects, and €5610.73 for very frail subjects. Independently of age and sex, frailty implies an additional healthcare cost of €1171 per person and year, i.e., 2.25-fold greater for frail compared to non-frail. CONCLUSIONS Our findings underline the economic relevance of frailty in the aged population, with healthcare spending increasing as frailty increases.
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Affiliation(s)
- Àngel Lavado
- Information Management Unit, Consorci Sanitari del Maresmes, Mataró, Barcelona, Spain
| | - Júlia Serra-Colomer
- Clinical Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresmes, Hospital de Mataró, Carretera de Cirera S/N, 08304, Mataró, Barcelona, Spain.
- CIBER-Liver and Digestive Diseases (CIBEREHD), ISCIII, Madrid, Spain.
| | - Emili Burdoy
- Primary Care Department, Consorci Sanitari del Maresmes, Mataró, Barcelona, Spain
| | - Mateu Cabré
- Internal Medicine Department, Consorci Sanitari del Maresmes, Mataró, Barcelona, Spain
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Serra-Prat M, Lavado À, Cabré M, Burdoy E, Palomera E, Papiol M, Parera JM. Development and validation of the electronic screening index of frailty. Age Ageing 2022; 51:6637440. [PMID: 35810395 DOI: 10.1093/ageing/afac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND primary care screening for frailty status is recommended in clinical guidelines, but is impeded by doctor and nurse workloads and the lack of valid, easy-to-use and time-saving screening tools. AIM to develop and validate a new electronic tool (the electronic screening index of frailty, e-SIF) using routinely available electronic health data to automatically and massively identify frailty status in the population aged ≥65 years. METHODS the e-SIF was developed in three steps: selection of clinical conditions; establishment of ICD-10 codes, criteria and algorithms for their definition; and electronic tool design and data extraction, transformation and load processes. The validation phase included an observational cohort study with retrospective data collection from computerised primary care medical records. The study population included inhabitants aged ≥65 years corresponding to three primary care centres (n = 9,315). Evaluated was the relationship between baseline e-SIF categories and mortality, institutionalisation, hospitalisation and health resource consumption after 2 years. RESULTS according to the e-SIF, which includes 42 clinical conditions, frailty prevalence increases with age and is slightly greater in women. The 2-year adjusted hazard ratios for pre-frail, frail and very frail subjects, respectively, were as follows: 2.23 (95% CI: 1.74-2.85), 3.34 (2.44-4.56) and 6.49 (4.30-9.78) for mortality; 2.80 (2.39-3.27), 5.53 (4.59-6.65) and 9.14 (7.06-11.8) for hospitalisation; and 1.02 (0.70-1.49), 1.93 (1.21-3.08) and 2.69 (1.34-5.40) for institutionalisation. CONCLUSIONS the e-SIF shows good agreement with mortality, institutionalisation, hospitalisation and health resource consumption, indicating satisfactory validity. More studies in larger populations are needed to corroborate our findings.
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Affiliation(s)
- Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.,CIBER Liver and Digestive Diseases (CIBEREHD), CIBEREHD, ISCIII, Madrid, Spain
| | - Àngel Lavado
- Information Management Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mateu Cabré
- Internal Medicine Department, Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Emili Burdoy
- Primary Care Department, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Elisabet Palomera
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mònica Papiol
- Primary Care Department, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Joan Marc Parera
- Documentation Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain)
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Espinosa-Val MC, Martín-Martínez A, Graupera M, Arias O, Elvira A, Cabré M, Palomera E, Bolívar-Prados M, Clavé P, Ortega O. Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia. Nutrients 2020; 12:nu12030863. [PMID: 32213845 PMCID: PMC7146553 DOI: 10.3390/nu12030863] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022] Open
Abstract
The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.
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Affiliation(s)
- Mᵃ Carmen Espinosa-Val
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mercè Graupera
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Olivia Arias
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Amparo Elvira
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Mateu Cabré
- Internal Medicine, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataro, Spain;
| | - Elisabet Palomera
- ResearchUnit, Fundació Salut del Consorci Sanitari del Maresme, Hospital de Mataró, 08304 Mataro, Spain;
| | - Mireia Bolívar-Prados
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-937-417-700
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
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Méndez-Brich M, Serra-Prat M, Palomera E, Vendrell E, Morón N, Boixeda R, Cabré M, Almirall J. Social Determinants of Community-acquired Pneumonia: Differences by Age Groups. Arch Bronconeumol 2019; 55:447-449. [DOI: 10.1016/j.arbres.2018.12.012] [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] [Received: 07/25/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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Serra-Prat M, Lorenzo I, Palomera E, Yébenes JC, Campins L, Cabré M. Intracellular Water Content in Lean Mass is Associated with Muscle Strength, Functional Capacity, and Frailty in Community-Dwelling Elderly Individuals. A Cross-Sectional Study. Nutrients 2019; 11:nu11030661. [PMID: 30893821 PMCID: PMC6471552 DOI: 10.3390/nu11030661] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
High intracellular water (ICW) content has been associated with better functional performance and a lower frailty risk in elderly people. However, it is not clear if the protective effect of high ICW is due to greater muscle mass or better muscle quality and cell hydration. We aimed to assess the relationship between ICW content in lean mass (LM) and muscle strength, functional performance, frailty, and other clinical characteristics in elderly people. In an observational cross-sectional study of community-dwelling subjects aged ≥75 years, ICW and LM were estimated by bioelectrical impedance, and the ICW/LM ratio (mL/kg) calculated. Muscle strength was measured as hand grip, frailty status was assessed according to Fried criteria, and functional status was assessed by Barthel score. For 324 recruited subjects (mean age 80 years), mean (SD) ICW/LM ratio was 408 (29.3) mL/kg. The ICW/LM ratio was negatively correlated with age (rs = −0.249; p < 0.001). A higher ICW/LM ratio was associated with greater muscle strength, better functional capacity, and a lower frailty risk, even when adjusted by age, sex, nº of co-morbidities, and LM. ICW content in LM (including the muscle) may influence muscle strength, functional capacity and frailty. However, further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, 08304 Mataró (Barcelona), Spain.
| | - Isabel Lorenzo
- Research Unit, Consorci Sanitari del Maresme, 08304 Mataró (Barcelona), Spain.
| | - Elisabet Palomera
- Research Unit, Consorci Sanitari del Maresme, 08304 Mataró (Barcelona), Spain.
| | - Juan Carlos Yébenes
- Intensive Care Unit, Consorci Sanitari del Maresme, 08304 Mataró (Barcelona), Spain.
| | - Lluís Campins
- Pharmacy Department. Consorci Sanitari del Maresme, 08304 Mataró (Barcelona), Spain.
| | - Mateu Cabré
- Geriatric Department, Consorci Sanitari del Maresme, 08304 Mataró (Barcelona), Spain.
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Rejón T, Serra-Prat M, Burdoy E, Cabré M. [Gender differences in the risk factors of falls in the elderly]. Rev Esp Geriatr Gerontol 2019; 54:238-240. [PMID: 30765115 DOI: 10.1016/j.regg.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Tatiana Rejón
- ABS Cirera Molins, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Serra-Prat
- Unidad de Investigación, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
| | - Emili Burdoy
- ABS Mataró Centre, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Cabré
- Servicio de Medicina Interna, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España
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Cabré M, Elias L, Garcia M, Palomera E, Serra-Prat M. Avoidable hospitalizations due to adverse drug reactions in an acute geriatric unit. Analysis of 3,292 patients. Med Clin (Barc) 2017; 150:209-214. [PMID: 28992984 DOI: 10.1016/j.medcli.2017.06.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine prevalence of admissions due to an adverse drug reaction (ADR) and determine whether or not admission was avoidable, and what drugs and risk factors were implicated. DESIGN Cross-sectional observational study. STUDY SAMPLE All patients hospitalized in an acute geriatric unit during the period January 2001 to December 2010 were studied. MEASUREMENT To determine whether admissions were due toADR, we used the World Health Organization-Uppsala Monitoring Centre criteria and the Naranjo scale. Beers criteria were used to detect potentially inappropriate medication. RESULTS A total of 3,292 patients (mean age 84.7 years, 60.1% women) were studied. Of these, 197 (6%) were admissions for ADR and nearly three quarters (76.4%, 152 cases) were considered avoidable admissions. The 5 most frequent drugs associated with admissions for ADR were digoxin, nonsteroidal anti-inflammatory drugs, benzodiazepines, diuretics and antibiotics. Independent risk factors for admissions for ADR were being female (OR 1.84; 95% CI 1.30-2.61), inappropriate medication according to Beers criteria (OR 4.20; 95% CI 2.90-6.03), polypharmacy (>5 drugs) (OR 1.50; 95% CI 1.04-2.13), glomerular filtration rate<30mL/min (OR 3; 95% CI 2.12-4.23) and sedative use (OR 1.40; 95% CI 1-1.91). CONCLUSION ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable. Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use.
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Affiliation(s)
- Mateu Cabré
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, España
| | - Lorena Elias
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, España
| | - Mireia Garcia
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, España
| | - Elisabet Palomera
- Unidad de Investigación, Consorci Sanitari del Maresme, Mataró, Barcelona, España
| | - Mateu Serra-Prat
- Unidad de Investigación, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
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Carrión S, Roca M, Costa A, Arreola V, Ortega O, Palomera E, Serra-Prat M, Cabré M, Clavé P. Nutritional status of older patients with oropharyngeal dysphagia in a chronic versus an acute clinical situation. Clin Nutr 2017; 36:1110-1116. [DOI: 10.1016/j.clnu.2016.07.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
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Campins L, Serra-Prat M, Gózalo I, López D, Palomera E, Agustí C, Cabré M. Randomized controlled trial of an intervention to improve drug appropriateness in community-dwelling polymedicated elderly people. Fam Pract 2017; 34:36-42. [PMID: 27605543 DOI: 10.1093/fampra/cmw073] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems. OBJECTIVES To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people. DESIGN Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up. SETTING Primary care centres. PARTICIPANTS Polymedicated (≥8 drugs) elderly people (≥70 years). STUDY INTERVENTION Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician. CONTROL INTERVENTION Routine clinical practice. MEASUREMENTS Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death. RESULTS About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5% of prescriptions were rated as potentially inappropriate and 21.5% were changed (9.1% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6% of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths. CONCLUSION The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.
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Affiliation(s)
- Lluís Campins
- Pharmacy Department. Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain, .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), ISCIII, Spain and
| | - Inés Gózalo
- Pharmacy Department. Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - David López
- Pharmacy Department. Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Elisabet Palomera
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Clara Agustí
- Pharmacy Department. Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mateu Cabré
- Internal Medicine Department, Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
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Cabré M, Ferreiro C, Arus M, Roca M, Palomera E, Serra-Prat M. Evaluation of CONUT for Clinical Malnutrition Detection and Short-Term Prognostic Assessment in Hospitalized Elderly People. J Nutr Health Aging 2015; 19:729-33. [PMID: 26193855 DOI: 10.1007/s12603-015-0536-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/04/2023]
Abstract
OBJECTIVES To assess agreement between the CONUT and Mini Nutritional Assessment (MNA) instruments in detecting malnutrition in hospitalized elderly patients and to determine their prognostic value compared to that of serum albumin alone in relation to in-hospital and 1-month and 6-month post-discharge mortality rates. DESIGN Prospective observational study. SETTING A Catalan regional hospital. PARTICIPANTS 2155 patients admitted to an acute geriatric unit were assessed using MNA and CONUT and were followed up for 6 months after discharge. MEASUREMENTS On admission, data were collected on age, sex, referral, geriatric syndromes, cognitive status, functional status and nutritional status according to MNA (as the gold standard). Plasma albumin, total cholesterol and lymphocyte levels were recorded to implement CONUT. Mortality was recorded until 6 months after discharge. RESULTS Sample characteristics: 61.3% females, mean age 84.9 years, mean Charlson index 2.2. CONUT sensitivity and specificity for malnutrition were 43% and 71.6%, respectively, with positive and negative predictive values of 88.9% and 19.2%. MNA, CONUT and albumin alone were good predictors of mortality but showed similar sensitivity and specificity results. CONCLUSION CONUT agreement with MNA in nutritional risk assessments for elderly people is poor. Although CONUT is a good predictor of short-and medium-term mortality, it adds little to information provided by albumin alone.
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Affiliation(s)
- M Cabré
- M. Serra-Prat, Consorci Sanitari del Maresme, Research unit, Carretera de cIRERA S/N, Mataró, Barcelona 08304, Spain,
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Carrión S, Cabré M, Monteis R, Roca M, Palomera E, Serra-Prat M, Rofes L, Clavé P. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr 2015; 34:436-42. [DOI: 10.1016/j.clnu.2014.04.014] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 02/19/2014] [Accepted: 04/22/2014] [Indexed: 11/24/2022]
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Serra-Prat M, Papiol M, Monteis R, Palomera E, Cabré M. Relationship between Plasma Ghrelin Levels and Sarcopenia in Elderly Subjects: A Cross-Sectional Study. J Nutr Health Aging 2015; 19:669-72. [PMID: 26054503 DOI: 10.1007/s12603-015-0550-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 01/18/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between plasma ghrelin levels and sarcopenia in elderly people. DESIGN Cross-sectional study. SETTING Health consortium medical centers in the Maresme region, Barcelona (Spain). PARTICIPANTS Two groups of subjects: persons ≥70 years (elderly group) and persons 25-65 years (young adults). MEASUREMENTS Sarcopenia, diagnosed according to the EWGSOP definition, fasting and postprandial plasma ghrelin levels, body composition, hand grip, Barthel score, and frailty using Fried criteria. RESULTS Fifty-five elderly subjects and 33 young adults were recruited. In both age groups, mean ghrelin levels were significantly higher in women than in men. However, mean ghrelin levels were similar in elderly and young men (716 vs. 752 pg mL-1, P = 0.763) as well as in elderly and young women (859 vs. 995 pg mL-1, P = 0.190). In the elderly group, subjects with sarcopenia showed significantly lower ghrelin levels than those without sarcopenia (650 vs. 899 pg mL-1, P = 0.036), but these differences disappeared when stratifying by gender. Elderly subjects without sarcopenia had the same ghrelin levels as young adults (899.3 vs. 899.6 pg mL-1). In young women, ghrelin levels correlated with fat free mass (rs = 0.58, P = 0.007) and muscular mass (rs = 0.54, P = 0.015) but these correlations were not observed in men nor in elderly women. CONCLUSION This cross-sectional study does not allow a definitive conclusion about the relationship between ghrelin levels and sarcopenia. Further large prospective studies are needed to test this hypothesis.
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Affiliation(s)
- M Serra-Prat
- Mateu Serra-Prat, MD, PhD, Research Unit, Hospital de Mataró, Carretera de Cirera s/n, E-08304 Mataró, Barcelona, Spain. Tel.: +34 93 7417730, fax: +34 93 7573321, e-mail:
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Cabré M, Rudi N, Pontes C, Vergara M, Parra I, Gorgas MQ. GRP-121 Multidisciplinary Monitoring of Psychiatric Morbidity of HCV-Infected Patients Treated with Interferon and Ribavirin. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The incidence and prevalence of aspiration pneumonia (AP) are poorly defined. They increase in direct relation with age and underlying diseases. The pathogenesis of AP presumes the contribution of risk factors that alter swallowing function and predispose to the oropharyngeal bacterial colonization. The microbial etiology of AP involves Staphylococcus aureus, Haemophilus influenzae and Streptococcus pneumoniae for community-acquired AP and Gram-negative aerobic bacilli in nosocomial pneumonia. It is worth bearing in mind the relative unimportance of anaerobic bacteria in AP. When we choose the empirical antibiotic treatment, we have to consider some pathogens identified in oropharyngeal flora. Empirical treatment with antianaerobics should only be used in certain patients. According to some known risks factors, the prevention of AP should include measures in order to avoid it.
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Affiliation(s)
- Jordi Almirall
- Servei de Cures Intensives, Hospital de Mataró, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Barcelona, Spain
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Carrión S, Cabré M, Monteis R, Roca M, Palomera E, Clavé P. OP018 ASSOCIATION BETWEEN OROPHARYNGEAL DYSPHAGIA AND MALNUTRITION IN ELDERLY PATIENTS WITH ACUTE DISEASES ADMITTED TO A GENERAL HOSPITAL. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1744-1161(12)70019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clavé P, Rofes L, Carrión S, Ortega O, Cabré M, Serra-Prat M, Arreola V. Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people. Nestle Nutr Inst Workshop Ser 2012; 72:57-66. [PMID: 23052001 DOI: 10.1159/000339986] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Oropharyngeal dysphagia (OD) is a very frequent condition among older people with a prevalence ranging from mild symptoms in 25% of the independently living to severe symptoms in more than 50% living in nursing homes. There are several validated methods of screening, and clinical assessment and videofluoroscopy are the gold standard for the study of the mechanisms of OD in the elderly. Oropharyngeal residue is mainly caused by weak bolus propulsion forces due to tongue sarcopenia. The neural elements of swallow response are also impaired in older persons, with prolonged and delayed laryngeal vestibule closure and slow hyoid movement causing oropharyngeal aspirations. OD causes malnutrition, dehydration, impaired quality of life, lower respiratory tract infections, aspiration pneumonia, and poor prognosis including prolonged hospital stay and enhanced morbidity and mortality in several phenotypes of older patients ranging from independently living older people, hospitalized older patients and nursing home residents. Enhancing bolus viscosity of fluids greatly improves safety of swallow in all these patients. We believe OD should be recognized as a major geriatric syndrome, and we recommend a policy of systematic and universal screening and assessment of OD among older people to prevent its severe complications.
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Affiliation(s)
- Pere Clavé
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
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Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabré M, Serra-Prat M, Clavé P. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil 2010; 22:851-8, e230. [PMID: 20529208 DOI: 10.1111/j.1365-2982.2010.01521.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia is a major complaint among the elderly. Our aim was to assess the pathophysiology of oropharyngeal dysphagia in frail elderly patients (FEP). METHODS A total of 45 FEP (81.5 +/- 1.1 years) with oropharyngeal dysphagia and 12 healthy volunteers (HV, 40 +/- 2.4 years) were studied using videofluoroscopy. Each subject's clinical records, signs of safety and efficacy of swallow, timing of swallow response, hyoid motion and tongue bolus propulsion forces were assessed. KEY RESULTS Healthy volunteers presented a safe and efficacious swallow, faster laryngeal closure (0.157 +/- 0.013 s) upper esophageal sphincter opening (0.200 +/- 0.011 s), and maximal vertical hyoid motion (0.310 +/- 0.048 s), and stronger tongue propulsion forces (22.16 +/- 2.54 mN) than FEP. By contrast, 63.63% of FEP presented oropharyngeal residue, 57.10%, laryngeal penetration and 17.14%, tracheobronchial aspiration. Frail elderly patients with impaired swallow safety showed delayed laryngeal vestibule (LV) closure (0.476 +/- 0.047 s), similar bolus propulsion forces, poor functional capacity and higher 1-year mortality rates (51.7%vs 13.3%, P = 0.021) than FEP with safe swallow. Frail elderly patients with oropharyngeal residue showed impaired tongue propulsion (9.00 +/- 0.10 mN), delayed maximal vertical hyoid motion (0.612 +/- 0.071 s) and higher (56.0%vs 15.8%, P = 0.012) 1-year mortality rates than those with efficient swallow. CONCLUSION & INFERENCES Frail elderly patients with oropharyngeal dysphagia presented poor outcome and high mortality rates. Impaired safety of deglutition and aspirations are mainly caused by delayed LV closure. Impaired efficacy and residue are mainly related to weak tongue bolus propulsion forces and slow hyoid motion. Treatment of dysphagia in FEP should be targeted to improve these critical events.
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Affiliation(s)
- L Rofes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain
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García T, Gómez M, Esparza J, Cabré M, Domingo J. Melatonin increases gene expression of superoxide dismutase and catalase in brain of APP transgenic mice after chronic exposure to aluminum. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.736] [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: 10/19/2022]
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Salazar J, Reverté I, Cabré M, Sánchez-Santed F, Domingo J, Colomina M. Neurotoxicity effects 2 months after exposure to repeated doses of chlorpyrifos in an animal model (TG2576) of Alzheimer's disease. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.752] [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: 10/19/2022]
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Qureshi A, Collazos F, Revollo H, Ramos M, Delgadillo C, Harrak JE, Rubio F, Lizana T, Alonso E, Auquer F, Muñoz D, Cabré M, Blanco P, Simón M, Casas M. The Catalan Healthcare Intercultural Mediation Training Project of “la Caixa” Social and Cultural Outreach Projects. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Known by many different names-culture broker, community interpreter, medical interpreter, and communication facilitator-the intercultural mediator has as a primary task the facilitation of communication and the therapeutic relationship in the presence of linguistic and/or cultural difference. The Immigration Plan of “la Caixa” Social and Cultural Outreach Projects has undertaken an ambitious project to train all of the cultural mediators in Spain, including both those currently working and those newly entering the field, to meet existing needs. In the first phase of the project, the training was developed in Catalunya, in collaboration with the the Catalan Department of Health, executed by the Psychiatry Department of the Vall d'Hebron University Hospital (Autonomous University of Barcelona) and certified by the Health Studies Institute of the Department of Health. Drawing from the four years experience of the NGO SURT and the Department of Psychiatry of the Vall d'Hebron University Hospital, the program provides 200 hours of theoretical and 1200 hours of practical training. 50 currently employed intercultural mediators and 30 novices are being trained. In subsequent phases the training will be adapted to needs of other autonomous regions of Spain. Modules include medical anthropology, Western biomedicine, community health, linguistic interpretation, cultural competence, professional identity, and ethics. Small group supervision provides a supportive environment to facilitate the application of theory to practice. Finally, high quality training materials were developed specifically for the course. Preliminary evaluations of the project are positive despite some unanticipated complications.
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Cabré M, Serra-Prat M, Force L, Palomera E, Pallarés R. Functional status as a risk factor for mortality in very elderly patients with pneumonia. Med Clin (Barc) 2008; 131:167-70. [DOI: 10.1157/13124262] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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García ML, Pascual J, González G, Palomer A, Cabré M, Andreu JA, Mauleón D, Carganico G. A Convenient Synthesis of 1-Ether-2-acylamido-2-deoxy-sn-glycerophospholipids. SYNTHETIC COMMUN 2006. [DOI: 10.1080/00397919308011175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. L. García
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - J. Pascual
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - G. González
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - A. Palomer
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - M. Cabré
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - J. A. Andreu
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - D. Mauleón
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
| | - G. Carganico
- a Laboratorios Menarini S.A. , Alfonso XII, 587, Badalona, Spain
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Abstract
BACKGROUND AND OBJECTIVE To determine whether there are differences between the prognostic factors associated with 30-days mortality in patients 65-84 year-old and patients over 84 years hospitalized for community-acquired pneumonia (CAP). PATIENTS AND METHOD An observational study with retrospective data collection was carried out in a representative sample of all CAP in-patients of 27 general hospitals. Data regarding comorbidities, signs and symptoms on admission, radiological and laboratory examinations, and complications during hospitalization were recorded. RESULTS 1,191 CAP patients were studied, 80.1% in the 65-84 age group and 19.9% in the over 84 age group. Mortality during the first 30 days was 11.9% in the younger group and 20.7% in the older (p < 0.001). In the younger group, the multivariate analysis showed the following independent prognostic factors: general discomfort (odds ratio [OR] = 3.93), respiratory rate > 30/min (OR = 5.02), atrial fibrillation (OR = 3.57), dementia (OR = 9.18), and hospitalization during the previous year (OR = 3.74). In the older group, independent prognostic factors were cancer (OR = 8.4) and renal failure (3.32). Age significantly modified the effect of altered mental state, tachypnea, tachycardia, hyperglycemia, and dementia on mortality. CONCLUSIONS In people over 84 years, except cancer and renal failure, classic CAP prognostic factors used in severity indexes do not distinguish those who will die from those who will not. Therefore, these factors must be interpreted with caution.
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Affiliation(s)
- Mateu Cabré
- Unidad Geriátrica de Agudos, Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona.
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Romeu M, Mulero M, Giralt M, Folch J, Nogués MR, Torres A, Fortuño A, Sureda FX, Cabré M, Paternáin JL, Mallol J. Parameters related to oxygen free radicals in erythrocytes, plasma and epidermis of the hairless rat. Life Sci 2002; 71:1739-49. [PMID: 12151052 DOI: 10.1016/s0024-3205(02)01946-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [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: 10/27/2022]
Abstract
The following parameters related to oxygen free radicals (OFR) were determined in erythrocytes and the epidermis of hairless rats: catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), reduced (GSH) and oxidized (GSSG) glutathione, glutathione S-transferase (GST), superoxide dismutase (SOD) and thiobarbituric acid reactive substances (TBARS). GSH, GSSG and TBARS were also analyzed in plasma. In erythrocytes, the Pearson correlation coefficients (r) were significant (p < 0.001) between glutathione and other parameters as follows: GSH correlated negatively with GSSG (r = -0.665) and TBARS (r = -0.669); GSSG correlated positively with SOD (r = 0.709) and TBARS (r = 0.752). Plasma GSSG correlated negatively with erythrocytic thermostable GST activity (r = -0.608; p=0.001) and with erythrocytic total GST activity (r = -0.677; p < 0.001). In epidermis (p < 0.001 in all cases), GSH content correlated with GSSG (r = 0.682) and with GPx (r = 0.663); GSSG correlated with GPx (r = 0.731) and with GR (r = 0.794). By multiple linear regression analysis some predictor variables (R(2)) were found: in erythrocytes, thermostable GST was predicted by total GST activity and GSSG, GSSG content was predicted by GSH and by the GSH/GSSG ratio and GPx activity was predicted by GST, CAT and SOD activities; in epidermis, GSSG was predicted by GR and SOD activities and GR was predicted by GSSG, TBARS and GPx. It is concluded that the hairless rat is a good model for studying OFR-related parameters simultaneously in blood and skin, and that it may provide valuable information about other animals under oxidative stress.
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Affiliation(s)
- M Romeu
- School of Medicine, University Rovira i Virgili, Sant Llorenç, 21, 43201-REUS, Spain
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Abstract
Relationships between hepatic antioxidant paraoxonase (PON1) activity, lipid peroxidation, and liver injury were investigated in rats with CCl(4)-induced cirrhosis. The study was performed in 60 CCl(4)-treated rats and 60 control animals receiving a standard diet or one supplemented with zinc. Subsets of 10 animals each were killed at weeks 1, 5, and 7 of the study. Results showed that PON1 significantly decreased in rats given CCl(4) alone compared with control animals. This effect was partially reversed in animals receiving zinc. Conversely, lipid peroxides were significantly increased in rats given CCl(4) alone and returned to approximately normal values in animals receiving zinc supplement. PON1 was inversely correlated with lipid peroxidation in all the animals studied. These alterations coincided with changes in serum alanine aminotransferase activity. In vitro incubation of isolated microsomes with CCl(4) or malondialdehyde did not produce any significant changes in PON1, indicating that the decrease in PON1 in CCl(4)-treated animals was not secondary to a direct inhibitory effect of lipid peroxidation products. These data show a time course and quantitative relationship between PON1 activity and lipid peroxidation in rats with CCl(4)-induced cirrhosis and suggest that this enzyme plays a significant role within the antioxidant systems in liver microsomes.
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Affiliation(s)
- N Ferré
- Centre de Recerca Biomèdica, Institut de Recerca en Ciències de la Salut (IRCIS), Hospital Universitari de Sant Joan de Reus, Catalunya, Spain
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Cabré M, Camps J, Ferré N, Paternáin JL, Joven J. The antioxidant and hepatoprotective effects of zinc are related to hepatic cytochrome P450 depression and metallothionein induction in rats with experimental cirrhosis. INT J VITAM NUTR RES 2001; 71:229-36. [PMID: 11582858 DOI: 10.1024/0300-9831.71.4.229] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/19/2022]
Abstract
The aim of the present study was to investigate the time-course of changes in hepatic lipid peroxidation, cytochrome P450 and metallothionein concentrations, and superoxide dismutase and catalase activities in relation to the onset and development of cirrhosis in CCl4-treated rats. Further, the effects of oral zinc administration on these parameters were assessed. Cirrhosis was induced in 120 rats by intraperitoneal injections of CCl4 twice weekly over 9 weeks. Controls were 120 additional animals. Both groups were further subdivided to receive either a standard diet or one supplemented with zinc. Subsets of 10 animals each were euthanized at weeks 1, 2, 3, 5, 7 and 9 from the start of the study. Results indicated that zinc administration delayed the cirrhotic process and the increase in lipid peroxidation. These changes, consistently maintained during the first 5 weeks of the study, were associated with a significant decrease in the hepatic concentration of cytochrome P450 and an increase in the hepatic concentration of metallothioneins. Zinc supplementation did not produce any significant change in superoxide dismutase and catalase activities. These results suggest that cytochrome P450 and metallothioneins may play an important role in the hepato-protective effects of zinc against lipid peroxidation in experimental cirrhosis.
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Affiliation(s)
- M Cabré
- Centre de Recerca Biomèdica, Hospital Universitari de Sant Joan, Unitat de Bioquímica, Facultat de Medicina, Universitat Rovira i Virgili, Reus, Spain
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Ferré N, Camps J, Paul A, Cabré M, Calleja L, Osada J, Joven J. Effects of high-fat, low-cholesterol diets on hepatic lipid peroxidation and antioxidants in apolipoprotein E-deficient mice. Mol Cell Biochem 2001; 218:165-9. [PMID: 11330832 DOI: 10.1023/a:1007296919243] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [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
The present study describes the effects of several high-fat low-cholesterol antiatherogenic diets on the hepatic lipid peroxidation and hepatic antioxidant systems in apolipoprotein E-deficient mice. Eighty mice were distributed into five groups and fed with regular mouse chow or chow supplemented with coconut, palm, olive and sunflower seed oils. After ten weeks, they were sacrificed and the livers were removed so that lipid peroxidation and alpha-tocopherol concentrations, and superoxide dismutase, glutathione peroxidase and glutathione reductase activities could be measured. The size of the atherosclerotic lesions in the aortas was also measured. Results showed that the diets supplemented with olive oil, palm oil or sunflower seed oil significantly decreased the size of the lesion. However, there was an association between those mice that were on diets supplemented with palm or coconut oils and a significant increase in hepatic lipid peroxidation. This association was not found in animals fed with olive or sunflower seed oils, the diets with the highest content of vitamin E. The dietary content of vitamin E was significantly correlated (r = 0.98; p < 0.05) with the hepatic concentration of this compound. Our study suggests that the high content of vitamin E in olive oil or sunflower seed oil may protect from the undesirable hepatotoxic effects of high-fat diets in apo E-deficient mice and that this should be taken into account when these diets are used to prevent atherosclerosis.
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Affiliation(s)
- N Ferré
- Centre de Recerca Biomèdica, Hospital Universitari de Sant Joan, Cantalunya, Spain
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Cabré M, Camps J, Paternáin JL, Ferré N, Joven J. Time-course of changes in hepatic lipid peroxidation and glutathione metabolism in rats with carbon tetrachloride-induced cirrhosis. Clin Exp Pharmacol Physiol 2000; 27:694-9. [PMID: 10972535 DOI: 10.1046/j.1440-1681.2000.03322.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The aims of the present study were to assess: (i) the temporal relationships between hepatic lipid peroxidation, changes in the glutathione detoxification system and the onset/development of cirrhosis in CCl4-treated rats; and (ii) the effects of oral zinc administration on these parameters. 2. Cirrhosis was induced in 120 rats by intraperitoneal injections of CCl4 twice a week over 9 weeks. One hundred and twenty additional animals were used as controls. Both groups were further subdivided to receive either a standard diet or one supplemented with zinc. Subsets of 10 animals each were killed at weeks 1, 2, 3, 5, 7 and 9 from the start of the study. 3. Induction of cirrhosis produced a decrease in the components of the hepatic glutathione anti-oxidant system: glutathione transferase activity decreased from week 1, the concentration of reduced glutathione (GSH) decreased from week 5 and glutathione peroxidase (GPx) activity decreased from week 7. This impairment was chronologically related to an increase in free radical generation. Hepatic lipid peroxidation was significantly correlated with GPx activity (r = -0.47; P < 0.001) in CCl4-treated rats. Zinc administration did not produce any significant improvement of the hepatic glutathione system. 4. In conclusion, cirrhosis induction in rats by CCl4 administration produced a decrease in the hepatic glutathione antioxidant system that was related to an increase in free radical production. Furthermore, zinc supplementation produced a reduction in the degree of hepatic injury and a normalization of lipid peroxidation, but not an improvement of the hepatic GSH anti-oxidant system.
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Affiliation(s)
- M Cabré
- Centre de Recerca Biomèdica, Hospital Universitari de Sant Joan, Reus, Spain
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Ferré N, Girona J, Cabré M, Joven J, LaVille A, Masana L, Paternáin JL, Camps J. Hepatic production of apolar aldehydes in rats with carbon tetrachloride-induced cirrhosis. Mol Cell Biochem 1999; 198:57-60. [PMID: 10497878 DOI: 10.1023/a:1006998028528] [Citation(s) in RCA: 10] [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: 01/22/2023]
Abstract
The aim of this study was to identify apolar aldehydes in liver homogenates from rats with CCl4-induced cirrhosis and, as a corollary, the antioxidant effect of zinc administration. The study was performed in five control rats and in ten cirrhotic rats which were further sub-divided into two groups to receive either a standard diet or one supplemented with zinc. The percentage of hepatic fibrosis, plasma malondialdehyde concentration and alanine aminotransferase activity were measured as well as the following aldehydes: hexanal, octanal, decanal, 2-hexenal, 2-octenal, 2-nonenal, 2,4-heptadienal and 2,4-decadienal. Of the 10 cirrhotic rats, 4 had elevated concentrations of the highly toxic 2,4-dialkenals which coincided with a higher percentage of fibrosis and plasma alanine aminotransferase activity. These aldehydes were not observed in the control group. Zinc administration was associated with a reduction of the hepatic malondialdehyde concentration and an amelioration on the degree of hepatic injury. In conclusion, this study demonstrates the presence of the highly toxic 2,4-dialkenals in hepatic tissue of rats whith CCl4-induced cirrhosis. Results obtained would suggest that these particular aldehydes may be related to the severity of the hepatic injury.
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Affiliation(s)
- N Ferré
- Unitat Clínico-Experimental d'Investigació, Hospital Universitari de Sant Joan-Facultat de Medicina, Universitat Rovira i Virgili, Reus, Catalunya, Spain
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Cabré M, Ferré N, Folch J, Paternain JL, Hernàndez M, del Castillo D, Joven J, Camps J. Inhibition of hepatic cell nuclear DNA fragmentation by zinc in carbon tetrachloride-treated rats. J Hepatol 1999; 31:228-34. [PMID: 10453934 DOI: 10.1016/s0168-8278(99)80218-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS The aims of this study were to ascertain: 1) whether hepatic cell DNA fragmentation is increased in rats with early stages of liver disease induced by carbon tetrachloride; 2) whether the inhibition of DNA cleavage is involved in the hepatoprotective effects of zinc; and 3) if relationships exist between DNA fragmentation and the onset of fibrosis in this experimental model. METHODS Twenty-one treated rats and 23 controls were divided into two groups to receive either a standard diet or one supplemented with zinc. All the animals were sacrificed 1 week later for histological and biochemical assessments, which included a DNA fragmentation index, hepatic zinc and metallothionein concentrations, fibrosis measured by hepatic hydroxyproline concentration and plasma alanine aminotransferase activity. RESULTS Hepatic cell DNA fragmentation was increased in rats with early hepatic fibrosis and the increase was independent of hepatocytolysis, as measured by alanine aminotransferase activity. Oral zinc administration inhibited hepatic cell DNA fragmentation in the treated rats and was proportional to the hepatic concentration of the metal. The mechanism of the zinc-mediated decrease in DNA cleavage was related to an increase in the hepatic metallothionein concentration. Hepatic cell DNA fragmentation was related to hydroxyproline concentration. CONCLUSIONS Our results suggest that apoptosis may be involved in the early transformations occurring in the liver and which can lead to the initiation of cirrhosis. As such, the potential therapeutic use of zinc supplementation would warrant further investigation.
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Affiliation(s)
- M Cabré
- Centre de Recerca Biomèdica, Hospital Universitari de Sant Joan, Reus, Catalunya, Spain
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Folch J, Ortega A, Cabré M, Paternáin JL. Urinary levels of metallothioneins and metals in subjects from a semiindustrialized area in Tarragona Province of Spain. Biol Trace Elem Res 1998; 63:113-21. [PMID: 9823437 DOI: 10.1007/bf02778870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] [Indexed: 10/22/2022]
Abstract
The monitoring of heavy metals is important if adverse effects on health are to be avoided. In humans, metallothionein (MT) has been used as a biomonitor for the assessment of cadmium (Cd). In the present study, subjects drawn from the population of Tarragona Province (NE Spain) were investigated. Urinary MT, zinc (Zn), and copper (Cu) concentrations, corrected for creatine concentrations, were determined in 625 samples from healthy subjects aged between 10 and 65 yr. Mean values of MT and Cu in females were higher than those in males, with levels of 29.5 (23.8) vs. 22.7 (24.9) micrograms MT/creatinine (p < 0.001) and 4.8 (6.1) vs 3.4 (4.9) micrograms Cu/g creatinine (p < 0.001). No differences between males and females were observed with respect to urinary Zn: 78.0 (66.4) vs 73.0 (85.5) micrograms/g creatinine, respectively (p = 0.332). Significantly higher MT, Zn, and Cu values were observed in the females aged 15-19 yr and, in the age group of 50-54 yr, only in the Zn and Cu values, when compared with those in males. Significant positive correlations of MT vs Zn and Cu as well as correlations of Zn vs Cu levels were observed in both genders. The present findings confirm the proposed role of MT as a biomonitor of mineral status.
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Affiliation(s)
- J Folch
- Unitat de Bioquímica, Facultat de medicina, Universitat Rovira i Virgili, Reus, Spain
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Matas C, Joven J, Vilella E, Clivillé X, Cabré M, Prats E, Camps J. Lipoprotein alterations in liver cirrhosis: a possible contribution to changes in plasma oncotic pressure and viscosity. J Hepatol 1997; 27:639-44. [PMID: 9365039 DOI: 10.1016/s0168-8278(97)80080-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS To investigate whether physicochemical alterations in plasma lipoproteins are associated with changes in plasma oncotic pressure and viscosity in liver cirrhosis. METHODS The study included 66 patients with cirrhosis (confirmed by liver biopsy) and 58 healthy volunteers. The constituents measured were: the concentration, density and composition of plasma lipoproteins; plasma oncotic pressure and viscosity; and the concentrations of albumin, total protein, haptoglobin, transferrin, immunoglobulin M and alpha2-macroglobulin. RESULTS Step-wise multiple regression analysis indicated that, in the patients with cirrhosis, plasma oncotic pressure was significantly correlated with plasma albumin+viscosity (r=+0.85; p<0.001) and with plasma total protein+the density of low density lipoprotein (r=+0.74; p<0.001). The inclusion of viscosity and the density of low density lipoprotein in the regression equations significantly improved the observed correlation between albumin and plasma oncotic pressure (r=+0.70; p<0.001). Similarly, plasma viscosity was significantly correlated with the sum of plasma total protein and cholesterol (r=+0.68; p<0.001). The inclusion of cholesterol in the regression equation significantly increased the observed correlation between total protein and plasma viscosity (r=+0.59; p<0.001). CONCLUSIONS These results suggest that lipoprotein alterations associated with liver cirrhosis may play a role in determining plasma oncotic pressure and viscosity, and thus could influence the progression of the disease.
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Affiliation(s)
- C Matas
- Centre de Recerca Biomèdica, Hospital Universitari de Sant Joan, Reus, Spain
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Gassó M, Rubio M, Varela G, Cabré M, Caballería J, Alonso E, Deulofem R, Camps J, Giménez A, Pajares M, Parés A, Mato JM, Rodés J. Effects of S-adenosylmethionine on lipid peroxidation and liver fibrogenesis in carbon tetrachloride-induced cirrhosis. J Hepatol 1996; 25:200-5. [PMID: 8878782 DOI: 10.1016/s0168-8278(96)80074-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIM The aim of this study was to investigate the effects of S-adenosylmethionine on liver peroxidation and liver fibrogenesis in carbon tetrachloride-induced cirrhosis. METHODS Cirrhosis was induced in three groups of six rats by repeated injections of carbon tetrachloride over 9 weeks. One group of animals was treated only with carbon tetrachloride, and the other two received carbon tetrachloride plus S-adenosylmethionine (10 mg/kg intramuscularly daily) from week 3 to week 9, and from week 6 to week 9 of the study, respectively. Two additional groups of six rats, a control group and a group treated only with S-adenosylmethionine, were also studied. Glutathione concentration, thiobarbituric acid-reactive substances, collagen content, prolyl hydroxylase activity, and procollagen type I mRNA expression were determined in liver samples. RESULTS All carbon tetrachloride-treated rats had cirrhosis at the end of the study. Cirrhosis was also present in five of the six carbon tetrachloride-treated rats receiving S-adenosylmethionine for 3 weeks, but in only one of the six rats that received S-adenosylmethionine for 6 weeks. Hepatic glutathione was significantly diminished in carbon tetrachloride-treated rats (2.7 +/- 0.3 mumol/g tissue) and returned to normal in rats receiving S-adenosylmethionine for 3 or 6 weeks (3.7 +/- 0.13 and 3.9 +/- 0.11 mumol/g tissue, respectively). The hepatic thiobarbituric acid-reactive substances were significantly lower in rats treated with carbon tetrachloride and S-adenosylmethionine for 6 weeks (98 +/- 5 nmol/g) than in rats treated with carbon tetrachloride (134 +/- 12 nmol/g) and in those treated with carbon tetrachloride and S-adenosylmethionine for 3 weeks (127 +/- 13 nmol/g). There were no differences in either hepatic collagen and prolyl hydroxylase activity between rats that received only carbon tetrachloride and those treated with S-adenosylmethionine for 3 weeks. In contrast, carbon tetrachloride-treated rats receiving S-adenosylmethionine for 6 weeks had significantly lower collagen and prolyl hydroxylase activity than the other two groups. A much greater increase in procollagen type I mRNA was found in carbon tetrachloride-treated rats than in rats treated with carbon tetrachloride and S-adenosylmethionine for 6 weeks. Furthermore, there was a significant correlation between the hepatic thiobarbituric acid-reactive substances and prolyl hydroxylase activity and hepatic collagen. CONCLUSIONS We conclude that the early administration of S-adenosylmethionine in a model of carbon tetrachloride-induced liver injury restores glutathione levels and reduces lipid peroxidation, resulting in less advanced liver fibrosis.
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Affiliation(s)
- M Gassó
- Liver Unit, Hospital Clínic i Provinvial, University of Barcelona, Spain
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Matas C, Cabré M, La Ville A, Prats E, Joven J, Turner PR, Masana L, Camps J. Limitations of the Friedewald formula for estimating low-density lipoprotein cholesterol in alcoholics with liver disease. Clin Chem 1994; 40:404-6. [PMID: 8131276] [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: 01/29/2023]
Abstract
The accuracy of the Friedewald formula in estimating low-density lipoprotein (LDL) cholesterol was investigated in 47 alcoholic patients with liver disease (21 minimal-change, 26 cirrhotic) by comparing the results with those obtained by sequential preparative ultracentrifugation. In 14% of subjects with minimal-change disease, the error in the estimated LDL cholesterol was 50% +/- 9% (mean +/- SD; range 40-59%) and was related to the degree of attendant hypertriglyceridemia (r = 0.98; P < 0.001). A similar degree of error was observed in patients with cirrhosis, despite the absence of hypertriglyceridemia; an abnormal VLDL cholesterol: triglyceride ratio was the contributory factor in the discrepancy. We conclude that, as is the case in other clinical pathologies in which abnormalities of lipoprotein composition have been described (e.g., diabetes), the Friedewald formula to estimate LDL cholesterol may be inappropriate in chronic alcoholics, particularly those in whom a degree of hepatic dysfunction may be suspected.
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Affiliation(s)
- C Matas
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
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Matas C, Cabré M, La Ville A, Prats E, Joven J, Turner PR, Masana L, Camps J. Limitations of the Friedewald formula for estimating low-density lipoprotein cholesterol in alcoholics with liver disease. Clin Chem 1994. [DOI: 10.1093/clinchem/40.3.404] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
The accuracy of the Friedewald formula in estimating low-density lipoprotein (LDL) cholesterol was investigated in 47 alcoholic patients with liver disease (21 minimal-change, 26 cirrhotic) by comparing the results with those obtained by sequential preparative ultracentrifugation. In 14% of subjects with minimal-change disease, the error in the estimated LDL cholesterol was 50% +/- 9% (mean +/- SD; range 40-59%) and was related to the degree of attendant hypertriglyceridemia (r = 0.98; P < 0.001). A similar degree of error was observed in patients with cirrhosis, despite the absence of hypertriglyceridemia; an abnormal VLDL cholesterol: triglyceride ratio was the contributory factor in the discrepancy. We conclude that, as is the case in other clinical pathologies in which abnormalities of lipoprotein composition have been described (e.g., diabetes), the Friedewald formula to estimate LDL cholesterol may be inappropriate in chronic alcoholics, particularly those in whom a degree of hepatic dysfunction may be suspected.
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Affiliation(s)
- C Matas
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - M Cabré
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - A La Ville
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - E Prats
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - J Joven
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - P R Turner
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - L Masana
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
| | - J Camps
- Centre de Recerca Biomedica, Hospital de Sant Joan, Reus, Spain
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Cabré M. Kate Campbell Hurd-Mead (1867-1941) and the medical women's struggle for history. Collections 1993:1-4, 8. [PMID: 11616845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Palomer A, Cabré M, Mauleón D, Carganico G. Acid-Promoted Phosphonyl Migration inN-Phosphonyl-α-Aminoalcohols. fromN-(2-Hydroxyethyl)Phosphonamides toO-(2-Aminoethyl)Phosphonates. SYNTHETIC COMMUN 1992. [DOI: 10.1080/00397919208019094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Savall R, Cabré M, Grifol M. [Meningovascular syphilis and human immunodeficiency virus infection]. Med Clin (Barc) 1991; 97:236-7. [PMID: 1943286] [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: 12/29/2022]
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Sauca G, Cabré M, Valls F, Diestre G. [Visualization of spirochetes in conventional blood cultures from a patient with Weil's disease]. Enferm Infecc Microbiol Clin 1990; 8:326-7. [PMID: 2090244] [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: 12/30/2022]
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Cabré M, Pérez JL, Príu R, Valls F. [Salmonella enteritidis bacteremia in a district hospital]. Med Clin (Barc) 1987; 89:619-20. [PMID: 3323690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Pérez JL, Savall R, Valls F, Cabré M. [Gonococci as producers of beta-lactamase in Catalonia]. Med Clin (Barc) 1987; 88:389-90. [PMID: 3106728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Pérez JL, Savall R, Valls F, Priu R, Cabré M. Infection with penicillinase producing Neisseria gonorrhoeae in Catalonia. Genitourin Med 1987; 63:60-1. [PMID: 3102350 PMCID: PMC1194011 DOI: 10.1136/sti.63.1.60-a] [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: 01/04/2023]
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Cabré M, Arruga J, Garau J. [Systemic candidiasis in patients without cancer: apropos of 5 cases]. Med Clin (Barc) 1983; 81:576-9. [PMID: 6418988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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