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Munuera I, Gándara-Rodriguez de Campoamor E, Moreno-Montañes J. Study of the ganglion cell complex of the macula by optical coherence tomography in the diagnosis of glaucoma progression. Arch Soc Esp Oftalmol (Engl Ed) 2024; 99:145-151. [PMID: 38216050 DOI: 10.1016/j.oftale.2024.01.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/12/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION The aim of this work is to evaluate the usefulness of the study of the ganglion cell complex of the macula using the OCT technique to estimate the progression of glaucoma according to its severity. MATERIAL AND METHODS This is a retrospective cross-sectional study. It includes 205 eyes of 131 patients with glaucoma or ocular hypertension followed for a mean of 5.7 years. The parameters and rates of three tests have been analyzed using the progression software of each instrument: visual field, optical coherence tomography (OCT) in the ganglion cell complex of the macula and in the nerve fiber layer of the optic nerve. The results of each test, the concordance between them and how they differ according to severity stage have been evaluated. RESULTS Visual field classifies more cases of progression in moderate-advanced glaucoma, while in mild glaucoma its capacity is limited. Optic nerve fiber layer OCT classifies more cases of progression in mild glaucoma than in moderate-advanced glaucoma, as it is artifacted by the floor effect. OCT of the macular ganglion cell complex is the test that classifies more cases of progression and has the highest agreement with visual field, regardless of severity. CONCLUSION In both mild and moderate-advanced glaucoma, OCT of the macula ganglion cell complex may be a better biomarker of progression than OCT of the macula ganglion cell complex.
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Affiliation(s)
- I Munuera
- Departamento de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | | | - J Moreno-Montañes
- Departamento de Oftalmología, Clínica Universitaria de Navarra, Pamplona, Spain
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Suárez-Santisteban MA, Santos-Díaz G, García-Bernalt V, Pérez-Pico AM, Mingorance E, Mayordomo R, Dorado P. Association between CYP4A11 and EPHX2 genetic polymorphisms and chronic kidney disease progression in hypertensive patients. Nefrologia 2024:S2013-2514(24)00037-3. [PMID: 38448299 DOI: 10.1016/j.nefroe.2024.01.020] [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: 04/17/2023] [Accepted: 08/06/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND There are evidence indicating that some metabolites of arachidonic acid produced by cytochromes P450 (CYP) and epoxide hydroxylase (EPHX2), such as hydroxyeicosatetraenoic acids (HETEs), epoxyeicosatrienoic acids (EETs) or dihydroxyeicosatrienoic acids (DHETEs), play an important role in blood pressure regulation and they could contribute to the development of hypertension (HT) and kidney damage. Therefore, the main aim of the study was to evaluate whether the genetic polymorphisms of CYP2C8, CYP2C9, CYP2J2, CYP4F2, CYP4F11 and EPHX2, responsible for the formation of HETEs, EETs and DHETEs, are related to the progression of impaired renal function in a group of patients with hypertension. METHODS 151HT patients from a hospital nephrology service were included in the study. Additionally, a group of 87 normotensive subjects were involved in the study as control group. For HT patients, a general biochemistry analysis, estimated glomerular filtration rate and genotyping for different CYPs and EPHX2 variant alleles was performed. RESULTS CYP4A11 rs3890011, rs9332982 and EPHX2 rs41507953 polymorphisms, according to the dominant model, presented a high risk of impaired kidney function, with odds ratios (OR) of 2.07 (1.00-4.32; P=0.049) 3.02 (1.11-8.23; P=0.030) and 3.59 (1.37-9.41; P=0.009), respectively, and the EPHX2 rs1042032 polymorphism a greater risk according to the recessive model (OR=6.23; 95% CI=1.50-25.95; P=0.007). However, no significant differences in allele frequencies between HT patients and in normotensive subjects for any of the SNP analysed. In addition, the patients with diagnosis of dyslipidemia (n=90) presented higher frequencies of EPHX2 K55R (rs41507953) and *35A>G (rs1042032) variants than patients without dyslipidemia, 4% vs. 14% (P=0.005) and 16 vs. 27% (P=0.02), respectively. CONCLUSIONS In this study has been found higher odds of impaired renal function progression associated with rs3890011 and rs9332982 (CYP4A11) and rs41507953 and rs1042032 (EPHX2) polymorphisms, which may serve as biomarkers for improve clinical interventions aimed at avoiding or delaying, in chronic kidney disease patients, progress to end-stage kidney disease needing dialysis or kidney transplant.
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Affiliation(s)
- Miguel A Suárez-Santisteban
- Biosanitary University Research Institute (INUBE), University of Extremadura, Badajoz, Spain; Service of Nephrology, Virgen del Puerto Hospital, Plasencia, Spain
| | - Gracia Santos-Díaz
- Biosanitary University Research Institute (INUBE), University of Extremadura, Badajoz, Spain
| | | | - Ana M Pérez-Pico
- Department of Nursing, University of Extremadura, Plasencia, Spain
| | | | - Raquel Mayordomo
- Department of Anatomy, Cellular Biology and Zoology, University of Extremadura, Plasencia, Spain
| | - Pedro Dorado
- Biosanitary University Research Institute (INUBE), University of Extremadura, Badajoz, Spain; Department of Medical and Surgical Therapeutics, University of Extremadura, Badajoz, Spain.
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Abad Carratalà G, Garau Perelló C, Amaya Barroso B, Sánchez Llopis A, Ponce Blasco P, Barrios Arnau L, Di Capua Sacoto C, Rodrigo Aliaga M. Clinical and histological predictive factors of reclassification of prostate cancer patients on active surveillance. Actas Urol Esp 2023; 47:303-308. [PMID: 37272322 DOI: 10.1016/j.acuroe.2022.07.003] [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: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 06/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE Active surveillance (AS) has been established as a therapeutic strategy in patients with low-risk prostate cancer. Demographic and anatomopathological factors that increase the probability of reclassifying patients have been identified. MATERIALS AND METHODS Laboratory and histopathological data were collected from 116 patients included on AS since 2014. Univariate analysis was performed with Chi-square, t-student and Kendall's Tau, multivariate analysis according to logistic regression and Kaplan-Meier curves were calculated. RESULTS Of the 116 patients in AS, the median age at diagnosis was 66 years and the median follow-up was 13 months (2-72). Of these, 61 (52.6%) are still on surveillance, while 55 (47.4%) have left the program, mostly due to histological progression (52 patients (45.2%)); radical prostatectomy was performed in 27 (49.1%). Prostate volume (PV)≤60cc and the number of positive cylinders >1 in diagnostic biopsy (P=.05) were associated with higher reclassification rate in univariate analysis (P<.05). Multivariate analysis showed that these two variables significantly correlated with higher reclassification rate (PV 60 cc: OR 4.39, P=.04; >1 positive cylinder at diagnostic biopsy: OR 2.48, P=.03). CONCLUSIONS It has been shown that initial ultrasound volume and the number of positive cylinders in the diagnostic biopsy are independent risk factors for reclassification. Initial PSA, laterality of the affected cylinders and PSA density were not predictive factors of progression in our series.
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Affiliation(s)
- G Abad Carratalà
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain.
| | - C Garau Perelló
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
| | - B Amaya Barroso
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
| | - A Sánchez Llopis
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
| | - P Ponce Blasco
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
| | - L Barrios Arnau
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
| | - C Di Capua Sacoto
- Servicio de Urología, Hospital La Plana (Vila-Real), Castellón, Spain
| | - M Rodrigo Aliaga
- Servicio de Urología, Hospital General Universitario de Castellón, Castellón, Spain
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Barbieri D, Goicoechea M, Verde E, García-Prieto A, Verdalles Ú, Pérez de José A, Delgado A, Sánchez-Niño MD, Ortiz A. Obesity, chronic kidney disease progression and the role of the adipokine C1q/TNF related protein-3. Nefrologia 2023; 43:328-334. [PMID: 36517365 DOI: 10.1016/j.nefroe.2022.02.009] [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: 11/08/2021] [Accepted: 02/07/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION AND AIMS Obesity is a risk factor for incident chronic kidney disease (CKD). C1q/TNF related protein 3 (CTRP3) is an adipokine with multiple effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP3 levels and CKD progression. METHODS Patients with stage 3 and 4 CKD without previous cardiovascular events were enrolled and divided into groups according to body mass index (BMI) and sex. Demographic, clinical, analytical data and CTRP3 levels were collected at baseline. During follow-up, renal events (defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate were registered). RESULTS 81 patients were enrolled. 27 were obese and 54 non-obese. Baseline CTRP3 was similar between both groups (90.1±23.8 vs 84.5±6.2; p=0.28). Of the sum, 54 were men and 27 women, with higher CTRP3 in women (81.4±24.7 vs 106±24.7;p<0.01). During a mean follow-up of 68 months, 15 patients had a renal event. Patients in the higher CTRP3 tertile had less events but without statistical significance (p=0.07). Obese patients in the higher CTRP3 tertile significantly had less renal events (p=0.049). By multiple regression analysis CTRP3 levels could not predict renal events (HR 0.98; CI95% 0.96-1.06). CONCLUSIONS CTRP3 levels are higher in woman than men in patients with CKD, with similar levels between obese and non obese. Higher CTRP3 levels at baseline were associated with better renal outcomes in obese patients.
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Affiliation(s)
- Diego Barbieri
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Marian Goicoechea
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Verde
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana García-Prieto
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Úrsula Verdalles
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Pérez de José
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Delgado
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Alberto Ortiz
- Nephrology Department, ISS-Fundación Jimenez Díaz, Univerisdad Autonoma de Madrid, Madrid, Spain
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Rahmani M, Moghadasi AN, Shahi S, Eskandarieh S, Azizi H, Hasanzadeh A, Ahmadzade A, Dehnavi AZ, Farahani RH, Aminianfar M, Naeini AR. COVID-19 and its implications on the clinico-radiological course of multiple sclerosis: A case-control study. Med Clin (Barc) 2023; 160:187-192. [PMID: 36089420 PMCID: PMC9364744 DOI: 10.1016/j.medcli.2022.06.020] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an immune-mediated disease that has been related to several risk factors such as various viral infections. We carried out this study in order to establish a relationship between COVID-19 infection and MS severity. METHODS In a case-control study, we recruited patients with relapsing-remitting multiple sclerosis (RRMS). Patients were divided into two groups based on positive COVID-19 PCR at the end of the enrollment phase. Each patient was prospectively followed for 12 months. Demographical, clinical, and past medical history were collected during routine clinical practice. Assessments were performed every six months; MRI was performed at enrollment and 12 months later. RESULTS Three hundred and sixty-two patients participated in this study. MS patients with COVID-19 infection had significantly higher increases in the number of MRI lesions (p: 0.019, OR(CI): 6.37(1.54-26.34)) and EDSS scores (p: 0.017), but no difference was found in total annual relapses or relapse rates. COVID-19 infections were positively correlated with EDSS progression (p: 0.02) and the number of new MRI lesions (p: 0.004) and predicted the likelihood of the number of new MRI lesions by an odds of 5.92 (p: 0.018). CONCLUSION COVID-19 may lead to higher disability scores in the RRMS population and is associated with developing new Gd-enhancing lesions in MRI imaging. However, no difference was observed between the groups regarding the number of relapses during follow-up.
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Affiliation(s)
- Mohammad Rahmani
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Shahi
- Tehran Heart Center, Cardiovascular Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Ali Zare Dehnavi
- Department of Neurology, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Department of Infectious Diseases, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammad Aminianfar
- Department of Infectious and Tropical Diseases, Be'sat Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Ranjbar Naeini
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.
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Iglesias S, Munarriz PM, Saceda J, Catalán-Uribarrena G, Miranda P, Vidal JM, Fustero D, Giménez-Pando J, Rius F. Multicentric and collaborative study of Spanish neurosurgical management of pediatric craniopharyngiomas: S-PedCPG.co. Neurocirugia (Astur : Engl Ed) 2023; 34:67-74. [PMID: 36754754 DOI: 10.1016/j.neucie.2022.01.003] [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] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/19/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To present a descriptive analysis of pediatric craniopharyngiomas (PedCPG) treated in various Spanish hospitals, defining factors related to recurrence and performing a critical analysis of the results. METHODS We undertook a multicenter retrospective review of PedCPG treated between 2000 and 2017. Data collected included epidemiological variables, clinical and radiological characteristics, goal of first surgery, rate of recurrence and its approach, adjuvant treatment, complications and permanent morbidity. Associations were studied between progression and number of progressions and independent variables. RESULTS The study involved 69 children from 8 Spanish hospitals. Most of the tumors invaded several intracranial compartments at diagnosis, with the hypothalamus involved in 41.3% of cases. The first treatment strategy was usually gross total resection (GTR) (71%), with some patients treated with radiotherapy or intracystic chemotherapy. The progression rate after first surgery was 53% in a mean follow-up of 88.2 months (range 7-357). In the GTR group 38.8% of tumors recurred, 40% in the group of subtotal resection or biopsy and 93.3% in the cyst fenestration±Ommaya reservoir group. Mortality was 7.2%. Follow-up period, size of the tumor and goal of first surgery were significantly related with progression. CONCLUSIONS Our results in terms of disease control, hormonal or visual impairment and mortality were acceptable, but there are several areas for improvement. Our short-term goals should be to create a national register of PedCPG, reach a consensus about a treatment algorithm, and improve diagnosis of hypothalamic dysfunction to avoid preventable morbidity.
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Affiliation(s)
- Sara Iglesias
- Neurosurgery Department, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Pablo M Munarriz
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Saceda
- Neurosurgery Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Pablo Miranda
- Neurosurgery Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juana M Vidal
- Neurosurgery Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - David Fustero
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Jaumandreu L, Antón A, Pazos M, Rodriguez-Uña I, Rodriguez Agirretxe I, Martinez de la Casa JM, Ayala ME, Parrilla-Vallejo M, Dyrda A, Díez-Álvarez L, Rebolleda G, Muñoz-Negrete FJ. Glaucoma progression. Clinical practice guide. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:40-57. [PMID: 36089479 DOI: 10.1016/j.oftale.2022.08.003] [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] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.
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Affiliation(s)
- L Jaumandreu
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - A Antón
- Institut Català de la Retina (ICR), Barcelona, Spain; Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Pazos
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez-Uña
- Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Oviedo, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez Agirretxe
- Servicio de Oftalmología, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - J M Martinez de la Casa
- Servicio de Oftalmología, Hospital Clinico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense de Madrid, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M E Ayala
- Institut Català de la Retina (ICR), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Parrilla-Vallejo
- Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - A Dyrda
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Díez-Álvarez
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Ars E, Bernis C, Fraga G, Furlano M, Martínez V, Martins J, Ortiz A, Pérez-Gómez MV, Rodríguez-Pérez JC, Sans L, Torra R. Consensus document on autosomal dominant polycystic kindey disease from the Spanish Working Group on Inherited Kindey Diseases. Review 2020. Nefrologia 2022; 42:367-389. [PMID: 36404270 DOI: 10.1016/j.nefroe.2022.11.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 05/02/2021] [Indexed: 06/16/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent cause of genetic renal disease and accounts for 6-10% of patients on kidney replacement therapy (KRT). Very few prospective, randomized trials or clinical studies address the diagnosis and management of this relatively frequent disorder. No clinical guidelines are available to date. This is a revised consensus statement from the previous 2014 version, presenting the recommendations of the Spanish Working Group on Inherited Kidney Diseases, which were agreed to following a literature search and discussions. Levels of evidence mostly are C and D according to the Centre for Evidence-Based Medicine (University of Oxford). The recommendations relate to, among other topics, the use of imaging and genetic diagnosis, management of hypertension, pain, cyst infections and bleeding, extra-renal involvement including polycystic liver disease and cranial aneurysms, management of chronic kidney disease (CKD) and KRT and management of children with ADPKD. Recommendations on specific ADPKD therapies are provided as well as the recommendation to assess rapid progression.
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Affiliation(s)
- Elisabet Ars
- Laboratorio de Biología Molecular, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Carmen Bernis
- Servicio de Nefrología, Hospital de la Princesa, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Gloria Fraga
- Sección de Nefrología Pediátrica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), REDinREN, Barcelona, Spain
| | - Víctor Martínez
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Judith Martins
- Servicio de Nefrología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, Spain
| | - Alberto Ortiz
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - Maria Vanessa Pérez-Gómez
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - José Carlos Rodríguez-Pérez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Laia Sans
- Servicio de Nefrología, REDinREN, Instituto de Investigación Carlos III, Hospital del Mar, Barcelona, Spain
| | - Roser Torra
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), REDinREN, Barcelona, Spain.
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Pisano F, Gontero P, Sylvester R, Joniau S, Serretta V, Larré S, Di Stasi S, van Rhijn B, Witjes A, Grotenhuis A, Colombo R, Briganti A, Babjuk M, Soukup V, Malmstrom PU, Irani J, Malats N, Baniel J, Mano R, Cai T, Cha E, Ardelt P, Varkarakis J, Bartoletti R, Dalbagni G, Shariat SF, Xylinas E, Karnes RJ, Palou J. Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients. Actas Urol Esp 2021; 45:473-478. [PMID: 34147426 DOI: 10.1016/j.acuroe.2020.08.014] [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: 06/30/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. MATERIAL AND METHODS In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. RESULTS The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. CONCLUSIONS The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.
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Affiliation(s)
- F Pisano
- Città della Salute e della Scienza di Torino, University of Studies of Turin; Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.
| | - P Gontero
- Città della Salute e della Scienza di Torino, University of Studies of Turin
| | - R Sylvester
- Formerly Department of Biostatistics, EORTC Headquarters
| | - S Joniau
- Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - V Serretta
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - S Larré
- Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - S Di Stasi
- Policlinico Tor Vergata-University of Rome, Rome, Italy
| | - B van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A Grotenhuis
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R Colombo
- Dipartimento di Urologia, Università Vita-Salute, Ospedale S. Raffaele, Milan, Italy
| | - A Briganti
- Dipartimento di Urologia, Università Vita-Salute, Ospedale S. Raffaele, Milan, Italy
| | - M Babjuk
- Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic
| | - V Soukup
- Department of Urology, Motol Hospital, University of Praha, Praha, Czech Republic
| | - P U Malmstrom
- Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden
| | - J Irani
- Department of Urology, Hospital Bicetre, France
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO)
| | - J Baniel
- Department of Urology, Rabin Medical Centre, Tel Aviv, Israel
| | - R Mano
- Department of Urology, Rabin Medical Centre, Tel Aviv, Israel
| | - T Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - E Cha
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P Ardelt
- University Hospital Basel, Urological University Clinic Basel-Liestal, Basel, Switzerland
| | - J Varkarakis
- Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - R Bartoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Dalbagni
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna, 1190, Austria; Department of Urology, Cochin Hospital, Paris, France
| | - E Xylinas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - R J Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - J Palou
- Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain
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Pisano F, Gontero P, Sylvester R, Joniau S, Serretta V, Larré S, Di Stasi S, van Rhijn B, Witjes A, Grotenhuis A, Colombo R, Briganti A, Babjuk M, Soukup V, Malmstrom P, Irani J, Malats N, Baniel J, Mano R, Cai T, Cha E, Ardelt P, Varkarakis J, Bartoletti R, Dalbagni G, Shariat S, Xylinas E, Karnes R, Palou J. Factores de riesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes con enfermedad T1G3. Actas Urol Esp 2021; 45:473-8. [PMID: 33992448 DOI: 10.1016/j.acuro.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. MATERIAL AND METHODS In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. RESULTS The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. CONCLUSIONS The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.
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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: a syndemic complicated by COVID-19. Med Clin (Barc) 2021; 157:288-293. [PMID: 34049681 PMCID: PMC8101986 DOI: 10.1016/j.medcli.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/15/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/16/2023]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, España
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, España.
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, España
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Barbieri D, Goicoechea M, García-Prieto A, Delgado A, Verde E, Verdalles U, Pérez de José A, Carbayo J, Muñoz de Morales A, Luño J. Obesity related risk for chronic kidney disease progression and cardiovascular disease after propensity score matching. Hipertens Riesgo Vasc 2021; 38:63-71. [PMID: 33759767 DOI: 10.1016/j.hipert.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/24/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Obesity is a major health problem worldwide. It carries a markedly increased risk for multiple diseases such as type 2 diabetes mellitus, hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD). To complicate an already difficult topic a new subtype of obesity has been defined lately, the metabolically healthy obese. Our study aimed to clarify the association between obesity, metabolic syndrome and kidney disease progression. METHODS Observational retrospective single centre study including 212 patients with stage 3-4 CKD with no previous history of rapid kidney disease progression. Patients were divided according to BMI status and presence of metabolic syndrome. Anthropometric, clinical and laboratory data were collected to follow-up. Propensity score matching was performed for age, albuminuria and baseline renal function. During follow-up renal and cardiovascular events were recorded. RESULTS After a mean follow-up of 88.44±36.07 months a total of 18 patients reached the renal outcome in the non-obese group and 21 in the obese group. Differences were not statistically significant (log rank=0.21: p=0.64). Multiple Cox regression analysis showed that obesity was not predictor for worse renal outcomes [HR 1.01, 95% CI 0.45-2.24; p=0.97]. When stratifying the sample according to baseline metabolic syndrome and obesity presence there was no difference in renal survival (log rank=0.852; p=0.35) A total of 48 cardiovascular events were registered: seventeen in the non-obese group and thirty-one in the obese group. Differences in event-free time between both groups were statistically significant (log rank=4.44;p=0.035), especially after four years of follow-up. After stratifying for MS and obesity presence at baseline the event-free time differences where again statistically significant (log rank=16.86;p=0.001), specially for the obese patients with metabolic syndrome. CONCLUSIONS Obesity has little impact on chronic kidney disease progression despite the presence or absence of metabolic syndrome in a cohort matched for age, baseline renal function and albuminuria. Obesity conferred greater cardiovascular risk when combined with metabolic syndrome.
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Guerrero-Ramos F, Rodríguez-Antolín A. [New endovesical chemotherapy and means of administration: EMD, HIVEC, Synergo, Unithermia.]. ARCH ESP UROL 2020; 73:934-944. [PMID: 33269712] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Non-muscle invasive bladder cancer has a high recurrence and progression rate. Endovesical administration of chemotherapy after transurethral resection of bladder tumors aims to minimize the recurrence and progression rates. Over last decades BCG and MMC have been gold standard treatments. Still alarge proportion of patients recur and progress. Altogether with periods of BCG shortage has facilitate the search for alternatives. In the current manuscript we review the current drug sunder study including chemotherapy, immunotherapy and gene therapy. We also updated results on recent findings on means of intravesical administration, including hyperthermia assisted by external devices. The objectives of our products are implementing new efficient and safe alternatives and the development of technologies that increase of currently used drugs. After years without improvements in the field, nowadays we have a myriad of options available. Some of those new devices will remain and reach general urologist for their applicability. Preliminary results are promising and a positive environment surrounds the urologist in charge of bladder cancer.
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Affiliation(s)
- Félix Guerrero-Ramos
- Unidad de UroOncología. Servicio de Urología. Hospital Universitario 12 de Octubre. Madrid. España. Departamento de Urología. Hospital HM Montepríncipe. Puerta del Sur y ROC Clinic. Madrid. España
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Wong K, Dahlmann-Noor A. Myopia and its progression in children in London, UK: a retrospective evaluation. J Optom 2020; 13:146-154. [PMID: 31992534 PMCID: PMC7301194 DOI: 10.1016/j.optom.2019.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 03/07/2019] [Revised: 04/29/2019] [Accepted: 06/26/2019] [Indexed: 05/13/2023]
Abstract
PURPOSE Worldwide, the prevalence of myopia is increasing. Myopia begins at younger ages and progresses faster, leading to more adults with high myopia and risk of sight-threatening complications. No data are available about myopia trends in children in urban areas in the UK. We present a 10-year review of children attending a secondary and tertiary eye care facility in London, focussing on the proportion of glasses prescriptions for myopia and progression rates. METHODS We collated refraction and demographic data from children under the age of 17 years seen at Moorfields Eye Hospital, London, UK, between 2008 and 2017. RESULTS We included 63,854 datasets from 23,593 children (51.2% boys, median age 5.4 years, interquartile range IQR 3.8-7.1). The proportion of myopic prescriptions increased from 24 to 32%. In n = 3355 with initial mild/moderate myopia, median progression rate was -0.16 (-0.5 to 0.04) D/year. In those with progression (n = 2095), the rate was -0.40 (-0.19 to -0.74) D/year, slightly higher in girls than in boys (-0.42 vs -0.38 D/year; p = 0.02). Progression was faster in initial moderate than initial mild myopia (-0.54 vs -0.37 D/year; p < 0.001), and before than after average age of onset of puberty (-0.41 vs -0.35 D/year; p = 0.013). There was no statistically significant difference between children of different ethnic backgrounds. CONCLUSIONS In this cohort, the proportion of glasses prescriptions for myopia and the rate of progression are higher than previously reported for European countries. Living in an urban environment may result in similar progression rates despite different genetic backgrounds.
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Affiliation(s)
- Karen Wong
- Paediatric Service, Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London EC1V 2PD, UK
| | - Annegret Dahlmann-Noor
- Paediatric Service, Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London EC1V 2PD, UK; NIHR Moorfields Biomedical Research Centre, 162 City Road, London EC1V 2PD, UK.
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Krajewski W, Rodríguez-Faba O, Breda A, Pisano F, Poletajew S, Tukiendorf A, Algaba F, Zdrojowy R, Kołodziej A, Palou J. The 1973 WHO and 2004 WHO grading systems are not equal in prediction of survival among stage T1 bladder cancer patients. Actas Urol Esp 2019; 43:467-473. [PMID: 31272800 DOI: 10.1016/j.acuro.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyse prognostic impact of tumour histological grade on survival differences between primary G2 and G3 WHO1973 stage T1 tumours which were graded as HG according to WHO2004 grading system. MATERIALS AND METHODS Data from 481 patients with primary T1HG bladder cancer who were treated between 1986 and 2016 in 2university centres were retrospectively reviewed. Log-rank test and Cox regression analysis was performed to compare the groups. RESULTS 95 (19,8%) tumours were classified as G2 and 386 (80,2%) were G3. Median follow-up was 68 months. The recurrence was observed in 228 (47,5%), and progression in 109 patients (22,7%). Radical cystectomy was performed in 114 pts (23,7%) and there were 64 (13,3%) cancer specific deaths. Recurrence-free rates at 5-years follow-up for G2, G3 and all patients were 68,7%, 51,2% and 56,3% and progression-free rates were 89,3%, 73,2% and 78,1% respectively. For total observation period patients with G3 tumours presented also worse recurrence-free, and progression-free survival levels than patients with G2 tumours. In multivariate analysis, after adjustment for clinical features, the risk of recurrence and progression for G3 tumours was 1,65 and 2,42 fold higher than for G2 tumours. CONCLUSIONS It was shown that G3 T1 tumours are characterized by worse recurrence free and progression free survivals when compared to G2 cancers.
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16
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Krajewski W, Rodríguez-Faba O, Breda A, Pisano F, Poletajew S, Tukiendorf A, Zdrojowy R, Kołodziej A, Palou J. Validation of the CUETO scoring model for predicting recurrence and progression in T1G3 urothelial carcinoma of the bladder. Actas Urol Esp 2019; 43:445-51. [PMID: 31155372 DOI: 10.1016/j.acuro.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Various studies tried to validate Club Urológico Español de Tratamiento Oncológico (CUETO) tables, yet, none of this papers focused on the high and very high risk bladder cancers. The aim of the study was to externally validate the CUETO model for predicting disease recurrence and progression in group of T1G3 tumors treated with BCG immunotherapy. PATIENTS OR MATERIALS AND METHODS Data from 414 patients with primary T1G3 bladder cancer were analysed. To evaluate the model discrimination, Cox proportional hazard regression models were created and concordance indexes were calculated. RESULTS The median follow-up was 68 months. The recurrence was observed in 212 (51.2%) and 64 patients (15.5%) experienced the recurrence more than once during the study follow-up. Progression of the cancer was observed in 106 patients (25.6%). Radical cystectomy was performed in 115 patients (27.8%) and there were 64 (15.5%) cancer specific deaths. For recurrence and progression probability, the concordance index of the CUETO models was 0.633 and 0.697 respectively. CUETO tables underestimated significantly the risk of recurrence and marginally the risk of progression in the first year of observation. For 5 years of observation, the trend for the recurrence was much less clear. On the contrary, there was slight overestimation in the risk of progression. The study is limited by retrospective nature. CONCLUSIONS It was shown that the CUETO risk tables exhibit a fair discrimination for both disease recurrence and progression in T1G3 patients treated with BCG. CUETO scoring model underestimates the risk of tumor recurrence, but predicts well risk of progression.
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Mallya A, Senguttuvan-Karthikeyan V, Sivaraman A, Barret E, Galiano M, Cathala N, Mombet A, Prapotnich D, Sanchez-Salas R, Cathelineau X. Immediate versus delayed prostatectomy and the fate of patients who progress to a higher risk disease on active surveillance. Actas Urol Esp 2019; 43:324-30. [PMID: 30928176 DOI: 10.1016/j.acuro.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Oncological outcomes of radical prostatectomy (RP) in patients progressing on active surveillance (AS) are debated. We compared outcomes of AS eligible patients undergoing RP immediately after diagnosis with those doing so after delay or disease progression on AS. METHODS Between 2000 and 2014, 961 patients were AS eligible as per EAU criteria. RP within 6 months of diagnosis (IRP) or beyond (DRP), RP without AS (DRPa) and AS patients progressing to RP (DRPb) were compared. Baseline PSA, clinical and biopsy characteristics were noted. Oncological outcomes included adverse pathology in RP specimen and biochemical recurrence (BCR). Matched pair analysis was done between DRPb and GS7 patients undergoing immediate RP (GS7IRP). RESULTS IRP, DRP, DRPa and DRPb had 820 (85%), 141 (15%), 118 (12.24%) and 23 (2.7%) patients respectively. IRP, DRPa and DRPb underwent RP at a median of 3, 9 and 19 months after diagnosis respectively. Baseline characteristics were comparable. DRP vs. IRP had earlier median time (31 vs. 43 months; p<.001) and higher rate of progression to BCR (7.6 vs. 3.9%;p=.045). DRPb showed higher BCR (19 vs. 5%;p=.021) with earlier median time to BCR, compared to IRP and DRPa (p=.038). There was no difference in adverse pathology and BCR rates, but time to BCR was significantly lesser in DRPb (49 vs. 6 months;p<.001), compared to GS7IRP. CONCLUSIONS Patients progressing on AS had worst oncological outcomes. RP for GS7 progression and matched pair of GS7 patients had similar outcomes. Worse oncological outcomes in AS progressors cannot be explained by a mere delay in RP.
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Cózar JM, Miñana B, Gómez-Veiga F, Rodríguez-Antolín A. Three-year interim results of overall and progression-free survival in a cohort of patients with prostate cancer (GESCAP group). Actas Urol Esp 2019; 43:4-11. [PMID: 29891440 DOI: 10.1016/j.acuro.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022]
Abstract
AIMS To describe the 3-year progression-free survival (PFS), overall survival (OS) and disease-specific mortality in the prospective prostate cancer GESCAP cohort, as well as the progression to castration resistance in patients on hormone therapy. MATERIAL AND METHODS Prospective, observational, epidemiological, multicentre study. Of the 4087 patients recruited, 3843 were evaluable. The variables analysed were the risk group (localized, locally advanced, lymph involvement, metastatic), age, prostate-specific antigen (PSA) levels, Gleason score and initial treatment. Kaplan Meier survival analysis, the log-rank test and the Cox model were used to evaluate the survival data. RESULTS Three-year PFS was 81.4% and OS was 92.4%. During the 3 years of follow-up, 303 patients died (7.9%), 110 of them (36.3%) due to disease-related causes. The probability of castration resistance for all patients on hormone therapy (n=715) was 14.2%: 5%, 9.9%, 26.1% and 44.4% in localized, locally advanced, lymph involvement and metastatic cancer, respectively (log-rank P<.0001). Patients with metastases had poorer outcomes with respect to PFS, OS, disease-specific mortality and castration resistance. In the multivariate analysis, the Gleason score, PSA and presence of metastases were associated with shorter OS and PFS. CONCLUSIONS Our study showed stratification of risk, with a more unfavourable prognosis for patients with metastases. Patients with locally advanced disease differed with respect to those with localized disease due to their higher risk as regards disease-specific mortality. (Controlled-trials.com ISRCTN19893319).
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Affiliation(s)
- J M Cózar
- Servicio de Urología, Hospital Virgen de las Nieves, Granada, España.
| | - B Miñana
- Servicio de Urología, Hospital Morales Meseguer, Murcia, España
| | - F Gómez-Veiga
- Servicio de Urología, Hospital Universitario de Salamanca-IBSAL-GITUR, Salamanca, España
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Calles-Sastre L, Mucientes-Rasilla J, San-Frutos Llorente LM, Royuela A, Garcia-Espantaleón Navas M, Herrero Gámiz S, Pérez-Medina T. Prognostic significance of metabolic tumor volume and total lesion glycolysis in patients with advanced cervical carcinoma. Rev Esp Med Nucl Imagen Mol 2018; 38:17-21. [PMID: 30366731 DOI: 10.1016/j.remn.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/20/2018] [Revised: 08/07/2018] [Accepted: 08/30/2018] [Indexed: 12/22/2022]
Abstract
AIM 18-Fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET/CT) is considered to be the most accurate image method of detection of node or distant metastases in cervical cancer. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of 18F-FDG PET/CT are volumetric measurements of tumor cells with increased 18F-FDG uptake. The prognostic value of MTV and TLG in patients with advanced cervical cancer (ACC) were evaluated. METHODS 38 patients with ACC from one tertiary university hospital underwent 18F-FDG PET/CT between June 2009 and December 2015. Clinicopathologic factors and various PET parameters were analyzed to evaluate their relationship with recurrence-free survival (RFS) and overall survival (OS). These parameters were: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUV mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor, of the pelvic nodes, of the paraaortic nodes and the metabolic volume of the metastases if any. RESULTS A total of 38 patients with ACC fulfilled the inclusion criteria. All of them underwent a 18F-FDG PET/CT before definitive chemoradiotherapy. In the univariate analyses higher tumor size, pelvic lymph node metastasis and both MTV and TLG showed a significant association with OS and with RFS (MTV HR=1.55, p=0.011 and TLG HR=1.43, p=0.017 for RFS and MTV HR=1.82, p=0.006 and TLG HR=1.67, p=0.007 for OS). CONCLUSION Pretreatment TLG sum and MTV sum seem to be independent prognostic factors for OS and RFS in patients with advanced cervical cancer treated with definitive chemoradiotherapy and they are better than the classic measurement of SUVmax.
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Affiliation(s)
- L Calles-Sastre
- Department of Obstetrics and Gynecology, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain.
| | - J Mucientes-Rasilla
- Department of Nuclear Medicine, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain
| | - L M San-Frutos Llorente
- Department of Obstetrics and Gynecology, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain
| | - A Royuela
- Department of Biostatistical Unit, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain
| | - M Garcia-Espantaleón Navas
- Department of Obstetrics and Gynecology, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain
| | - S Herrero Gámiz
- Department of Obstetrics and Gynecology, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain
| | - T Pérez-Medina
- Department of Obstetrics and Gynecology, Autonoma University of Madrid, Puerta de Hierro University Hospital, Spain
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20
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Pérez Sánchez S, Eichau Madueño S, Rus Hidalgo M, Domínguez Mayoral AM, Vilches-Arenas A, Navarro Mascarell G, Izquierdo G. Usefulness of optic nerve ultrasound to predict clinical progression in multiple sclerosis. Neurologia 2018; 36:209-214. [PMID: 29573900 DOI: 10.1016/j.nrl.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/17/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Progressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time. MATERIAL AND METHODS We conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the 'as low as reasonably achievable' (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0. RESULTS Disease progression was significantly correlated with ultrasound findings (P=.041 for the right eye and P=.037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P=.07 for the right eye and P=.043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables. DISCUSSION Ultrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS).
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Affiliation(s)
- S Pérez Sánchez
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - S Eichau Madueño
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Rus Hidalgo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - A Vilches-Arenas
- Servicio de Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Navarro Mascarell
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Izquierdo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
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Diaz-Llopis M, Pinazo-Durán MD. Superdiluted atropine at 0.01% reduces progression in children and adolescents. A 5 year study of safety and effectiveness. ACTA ACUST UNITED AC 2018; 93:182-185. [PMID: 29398233 DOI: 10.1016/j.oftal.2017.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To confirm the clinical security and effectiveness of the daily application of 0.01% superdiluted atropine eyedrops in the progression of myopia in children. MATERIAL AND METHODS A total of 200 children 9-12 years of age were randomised into a treated group and a control without treatment. Refraction under cycloplegia was performed. RESULTS Myopia progression of the treated group was -0.14±0.35 versus -0.65±0.54 in the control group without treatment. Only 2% of patients were forced to stop treatment due to side effects. CONCLUSION Atropine superdiluted atropine 0.01% eyedrops is effective and well tolerated, and reduced myopia progression by 25%.
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Affiliation(s)
- M Diaz-Llopis
- Unidades de Retina/Mácula y Oftalmología Infantil, Hospital La Fe, Universidad de Valencia, Valencia, España; Unidad de Oftalmo-Biología Celular y Molecular, Departamento de Cirugía. Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España; Centros de especialidades calle Alboraya y Juan Llorens, Hospital General de Valencia, , Valencia, España; Unidad de Investigación Oftalmológica "Santiago Grisolía"/FISABIO, e Instituto Oftalmológico de Valencia (IOVA). Consellería de Sanitat de la Generalitat Valenciana, Valencia, España; Sociedad Española de Miopía, España; Sociedad de Investigación en Retina y Visión (SIREV), España.
| | - M D Pinazo-Durán
- Unidad de Oftalmo-Biología Celular y Molecular, Departamento de Cirugía. Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España; Unidad de Investigación Oftalmológica "Santiago Grisolía"/FISABIO, e Instituto Oftalmológico de Valencia (IOVA). Consellería de Sanitat de la Generalitat Valenciana, Valencia, España; Sociedad de Investigación en Retina y Visión (SIREV), España
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Otero A, Tabernero MD, Muñoz MC, Sousa P, Miranda D, Pascual D, Gonçalves JM, Ruiz L. [Relevance of Simpson's grading system for resections in WHO grade I meningiomas]. Neurocirugia (Astur) 2017; 28:176-182. [PMID: 28242156 DOI: 10.1016/j.neucir.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/15/2016] [Revised: 11/07/2016] [Accepted: 12/18/2016] [Indexed: 11/16/2022]
Abstract
OBJECT The aim of this study is to assess if the recurrence rates and recurrence/progression-free survivals (RFS) are different after Simpson's grades I, II, III and IV resections in World Health Organization (WHO) grade I meningiomas. MATERIAL AND METHODS A retrospective review was conducted on the data of patients who underwent surgical treatment of WHO grade I meningiomas located in convexity, falx/parasagittal, and skull base (anterior/media/posterior) between June 1991 and December 2011. In Simpson's grade IV resections, surgical treatment was supplemented with radiotherapy/radiosurgery on the tumour remains. A comparison was made on the recurrence rates and RFSs between Simpson's grades I, II, III, and IV resections, both overall and in tumour subsets according to their location. RESULTS A total of 208 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson's grades I, II, III, and IV. No significant differences were noted between the different degrees of Simpson in any of the location groups. In convexity meningiomas, the recurrence rates were 7% and 33% in Simpson's grades I and III resections, respectively (P=.131). CONCLUSIONS It has been shown that the rates of tumour control in meningiomas are not related to Simpson grades. In falx/parasagittal and skull base meningiomas, more aggressive attempts of tumour resection must be balanced against the risks of damaging critical neurovascular structures. In convexity meningiomas, a Simpson's grade I resection should be attempted first.
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Affiliation(s)
- Alvaro Otero
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | - María Dolores Tabernero
- Instituto Biosanitario de Salamanca (IBSAL), Unidad de Investigación e IESCSYL, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | - Pablo Sousa
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - David Miranda
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Daniel Pascual
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Jesús María Gonçalves
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Laura Ruiz
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Sarbu N, Oleaga L, Valduvieco I, Pujol T, Berenguer J. Increased signal intensity in FLAIR sequences in the resection cavity can predict progression and progression-free survival in gliomas. Neurocirugia (Astur) 2016; 27:269-276. [PMID: 27233366 DOI: 10.1016/j.neucir.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/21/2015] [Revised: 04/02/2016] [Accepted: 04/07/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if hyperintense fluid in the postsurgical cavity on follow-up fluid-attenuated inversion recovery (FLAIR) sequences can predict progression in gliomas. MATERIAL AND METHODS Observational study of magnetic resonance imaging signal of fluid within the post-surgical cavity in patients with glioma (grade II-IV), with surgery and follow-up between 2007 and 2012. Qualitative comparison between the signal of fluid in the cavity and of the ventricular cerebrospinal fluid (CSF) was performed on FLAIR sequences. Fluid in the cavity was classified as isointense or hyperintense compared to CSF. Double-blind reading was performed. The signal intensity was correlated with tumour progression, assessed using Response Assessment in Neuro-Oncology criteria. RESULTS A total of 107 patients were included, of whom 90 had high-grade gliomas. Inter-rater agreement was excellent, and intra-rater complete (k=0.94 and 1, p<.001). Hyperintense fluid in the resection cavity occurred more commonly (58.9% versus 29.4%, p=.025) and earlier (mean 4.5 versus 9.9 months, p<.001) in high-grade than in low-grade gliomas. Hyperintense fluid was associated with progression in high-grade gliomas, with a sensitivity of 65.7% (95%CI, 54.3-75.6%) and a specificity of 70.6% (95%CI, 46.6-87%), and in low-grade gliomas with a sensitivity of 50% (95%CI, 18.7-81.2%), and a specificity of 81.8% (95%CI, 51.1-96%). The positive predictive value of this sign was 90.6% (95%CI, 79.3-96.3%) for high-grade gliomas, and was higher for grade IV (93.2%, 95%CI, 87.3-99.1%) and lower for grade III (77.8%, 95%CI, 59.6-96%), and low-grade gliomas (60%, 95%CI, 22.9-88.4%). False-positives were identified in 7 patients, due to bleeding or infection. Hyperintense fluid in high-grade gliomas preceded progression in 22 patients (30.1%), with a mean of 4.1 months (SD 2.1, 95% CI, 3.2-5), and associated with poorer progression-free survival (mean 6.8 versus 11.7 months, p=.004). CONCLUSIONS Hyperintense fluid in the resection cavity on follow-up FLAIR sequences occurs more frequently and earlier in high-grade gliomas, and is associated with poorer progression-free survival. Hyperintense fluid is associated with disease progression, and can predict the progression of resected gliomas. False-positives due to bleeding and infection can be observed, and are easily recognizable.
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Affiliation(s)
- Nicolae Sarbu
- Department of Radiology, Hospital Clínic Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Laura Oleaga
- Neuroradiology Section, Department of Radiology, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Izaskun Valduvieco
- Radiation Oncology Department, Institute of Haematology and Oncology, Hospital Clínic Universitari of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Teresa Pujol
- Neuroradiology Section, Department of Radiology, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Joan Berenguer
- Neuroradiology Section, Department of Radiology, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Hartwig A, Charman WN, Radhakrishnan H. Baseline peripheral refractive error and changes in axial refraction during one year in a young adult population. J Optom 2016; 9:32-39. [PMID: 26188389 PMCID: PMC4705314 DOI: 10.1016/j.optom.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/22/2015] [Accepted: 05/27/2015] [Indexed: 05/30/2023]
Abstract
PURPOSE To determine whether the initial characteristics of individual patterns of peripheral refraction relate to subsequent changes in refraction over a one-year period. METHODS 54 myopic and emmetropic subjects (mean age: 24.9±5.1 years; median 24 years) with normal vision were recruited and underwent conventional non-cycloplegic subjective refraction. Peripheral refraction was also measured at 5° intervals over the central 60° of horizontal visual field, together with axial length. After one year, measurements of subjective refraction and axial length were repeated on the 43 subjects who were still available for examination. RESULTS In agreement with earlier studies, higher myopes tended to show greater relative peripheral hyperopia. There was, however, considerable inter-subject variation in the pattern of relative peripheral refractive error (RPRE) at any level of axial refraction. Across the group, mean one-year changes in axial refraction and axial length did not differ significantly from zero. There was no correlation between changes in these parameters for individual subjects and any characteristic of their RPRE. CONCLUSION No evidence was found to support the hypothesis that the pattern of RPRE is predictive of subsequent refractive change in this age group.
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Abstract
Since the introduction of interferon beta 1 b for the treatment of multiple sclerosis, there has been a progressive increase in the number of drugs available for this disease. Currently, 11 drugs have been approved in Spain, and their indications depend on specific clinical characteristics. The present article reviews these indications and also discusses other medications without official approval that have also been used in multiple sclerosis.
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Affiliation(s)
- J Antonio García Merino
- Unidad de Neuroinmunología, Servicio de Neurología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
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Rodríguez-Da Silva A, Miralles C, Ocampo A, Valverde D. [Prevalence study of the genetic markers associated with slow progression of human inmunodefiency virus type 1 in the Galician population (Northwest of Spain)]. Enferm Infecc Microbiol Clin 2017; 35:104-7. [PMID: 26100217 DOI: 10.1016/j.eimc.2015.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/13/2015] [Accepted: 04/08/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The deletion in the CCR5 gene (CCR5Δ32), the HLA-B*27:05, and polymorphisms rs2395029 and rs9264942 have been associated with slower progression of HIV-1. METHODS An analysis was performed on 408 patients on follow-up. The analysis of viral load, CD4+ Tlymphocytes and other clinical variables since the diagnosis of the infection were collected. RESULTS The prevalence of the genetic markers rs9264942, CCR5wt/Δ32, rs2395029, HLA-B*27:05 was 17.9%, 11.5%, 7.6%, and 6.4%, respectively. Of all the patients, 354 were classified as progressors and 46 as long-term non-progressors (LTNPs). Except for the HLA-B*27:05 allele, other genetic markers were associated with slower progression: CCR5wt/Δ32 (P=.011) and SNPs rs2395029 and rs9264942 (P<.0001), as well as their association (P<.0001). CONCLUSION The prevalence of the HLA-B*57:01 allele was higher than described nationally. No association could be found between the HLA-B*27:05 allele and the presence of slower disease progression.
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