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Cabrera M, Ryan D, Erlewyn-Lajeunesse M, Levin M, Martínez-Cañavate A, Villaizán Pérez C, Angier E, Trujillo J, Cárdenas-Rebollo JM, Reali L. Global assessment of the knowledge and confidence in managing allergic disorders among primary care pediatricians across Europe: An EAACI task force report. Pediatr Allergy Immunol 2024; 35:e14116. [PMID: 38581158 DOI: 10.1111/pai.14116] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self-perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC. METHOD A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5-point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut-off for inclusion and statistical analysis. RESULTS In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut-off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCPs showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier to referral to a specialist was a consideration that the patient's condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral were the need for hospital assessment, and partial response to first-line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between Traditional methods (45.7% and 50.1% respectively) and e-learning 45.5% and 44.9%, respectively. Generalist physicians (GPs) have the poorest access to allergy investigations (32.7%, p = .000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with a special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GPs received the largest amount of allergy teaching as undergraduates. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%). CONCLUSION This study exploring the confidence of PCPs to diagnose, manage, and refer patients with allergies, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure the dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met.
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Affiliation(s)
- M Cabrera
- Hospital Los Madroños, Brunete, Spain
| | - D Ryan
- The University of Edinburgh, Edinburgh, UK
| | | | - M Levin
- University of Cape Town, Cape Town, South Africa
| | | | | | - E Angier
- University of Southampton, Southampton, UK
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O'Keeffe D, Hanley S, McNearney O, Finn B, O'Halloran K, Broderick-Farrell C, Meyer F, Rey R, Trujillo J, Moore M. Clinical examination subtleties in diagnosing an unwitnessed foreign body ingestion. Ir Med J 2023; 116:817. [PMID: 37606517] [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: 08/23/2023]
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Briozzo L, Tomasso G, Trujillo J, Viroga S, Pintos J, Nozar F, Aleman A, Buekens P. COVID-19 mitigation measures increase preterm birth and low birth weight in the public healthcare system in Uruguay. Int J Gynaecol Obstet 2023. [PMID: 37052316 DOI: 10.1002/ijgo.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/05/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To evaluate the impact of the COVID-19 pandemic on preterm birth (PB) and low birth weight (LBW), comparing public and private healthcare systems of the National Integrated Health System in Uruguay, where the mitigation measures for the COVID-19 pandemic generated an immediate socioeconomic and psychological crisis, which caused a sharp widening of existing socioeconomic inequalities. METHODS A national observational study was conducted comparing perinatal outcomes in the first 6 months of 2020 (period of the pandemic without pregnancy infections), which was the beginning of the pandemic, with the same period of the previous year 2019 (pre-pandemic period with no mitigation measures) among pregnant women from the public and private health systems. Data were retrieved from the national database (Informatic Perinatal System) and analyzed by healthcare system category. RESULTS A total of 36 559 deliveries were assessed: 18 563 in the 2019 study period and 17 996 in the 2020 study period. In the public system, there was a significant increase in the risk of LBW (adjusted relative risk [aRR] 1.12, 95% confidence interval [CI] 1.05-1.36) and of the composite outcome (PB or LBW) (aRR 1.15, 95% CI 1.04-1.26). In the private system, by contrast, there was a non-statistically significant decrease of LBW and there were no changes in the incidence of PB and the composite outcome in 2020. CONCLUSION The different evolution of birth outcomes in the public and private systems suggests an unequal impact of mitigation measures on populations of different socioeconomic levels. Given that no COVID-19 infections were identified in pregnant women during the study period, this research offers an opportunity to differentiate the biologic effects of the virus from the psychological and social impacts derived from containment measures. CLINICALTRIALS GOV IDENTIFIER NCT05087160.
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Affiliation(s)
- Leonel Briozzo
- Gynecology Clinic, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Gisselle Tomasso
- Gynecology Clinic, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Janet Trujillo
- Department of Preventive and Social Medicine, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Stephanie Viroga
- Gynecology Clinic, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Javier Pintos
- Department of Preventive and Social Medicine, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Fernanda Nozar
- Gynecology Clinic, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Alicia Aleman
- Department of Preventive and Social Medicine, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Pierre Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Begin P, Brown-Whitehorn T, Garcia-Lloret M, Trujillo J, Petroni D, Ford L, Bois T, Burks A. Reduction in Reaction Severity Following 12 Months of Epicutaneous Immunotherapy with Peanut Patch in Toddlers. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.686] [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: 11/11/2022]
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Robledo-Márquez K, Ramírez V, González-Córdova AF, Ramírez-Rodríguez Y, García-Ortega L, Trujillo J. Research opportunities: Traditional fermented beverages in Mexico. Cultural, microbiological, chemical, and functional aspects. Food Res Int 2021; 147:110482. [PMID: 34399478 DOI: 10.1016/j.foodres.2021.110482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/09/2021] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 12/19/2022]
Abstract
In Mexico, close to 200 fermented products have been described, of which, approximately 20 are beverages. They were obtained through rustic and ancestral fermentation methods by different indigenous Mexican communities; most of them were used in ceremonies, agricultural work, and other occasions. For their elaboration, different substrates obtained from plants are used, where uncontrolled and low-scale spontaneous anaerobic fermentation occurs. In Mexico, some of these products are considered as nutritional sources and functional beverages; the study of those products has revealed the presence of multiple compounds of biological importance. Additionally, elder generations attribute healing properties against diverse illnesses to these beverages. The aim of this review is to highlight the available information on twelve traditional Mexican fermented beverages, their traditional uses, and their fermentation processes along with toxicological, chemical, nutritional, and functional studies as seen from different areas of investigation. In the literature, pulque, cocoa, and pozol were the beverages with the greatest amount of described health properties; sendechó and guarapo were less characterized. Polyphenols, gallic and ferulic acid, anthocyanins and saponins were the most abundant molecules in all beverages. Finally, it is important to continue this research in order to determine the microorganisms that are involved in the fermentation process, as well as the organoleptic and beneficial properties they lend to the traditional Mexican fermented beverages.
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Affiliation(s)
- K Robledo-Márquez
- División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), San Luis Potosí 78216, Mexico
| | - V Ramírez
- Departamento de Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Ciudad de México 14080, Mexico
| | - A F González-Córdova
- Laboratorio de Calidad, Autenticidad y Trazabilidad de los Alimentos y de Química y Biotecnología de Productos Lácteos, Coordinación de Tecnología de Alimentos de Origen Animal (CTAOA), Centro de Investigación en Alimentación y Desarrollo, A.C. (CIAD), La Victoria, Hermosillo, Sonora 83304, Mexico
| | - Y Ramírez-Rodríguez
- División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica (IPICYT), San Luis Potosí 78216, Mexico; Consejo Nacional de Ciencia y Tecnología-Instituto Potosino de Investigación Científica y Tecnológica-Consorcio de Investigación, Innovación y Desarrollo para las Zonas Áridas (CONACYT-CIIDZA-IPICYT), San Luis Potosí 78216, Mexico
| | - L García-Ortega
- Departamento de Ingeniería Genética. Centro de Investigación y Estudios Avanzados de IPN (Cinvestav), Irapuato, Guanajuato 36824, Mexico
| | - J Trujillo
- Consejo Nacional de Ciencia y Tecnología-Instituto Potosino de Investigación Científica y Tecnológica-Consorcio de Investigación, Innovación y Desarrollo para las Zonas Áridas (CONACYT-CIIDZA-IPICYT), San Luis Potosí 78216, Mexico.
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Trujillo J, Vieira MC, Lepsch J, Rebelo F, Poston L, Pasupathy D, Kac G. A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum. J Affect Disord 2018; 232:185-203. [PMID: 29494902 DOI: 10.1016/j.jad.2018.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nutritional requirements need to be met in order to adapt to pre- and postnatal changes. Our aim was to systematically review the evidence of associations between nutritional biomarkers and psychological distress during pregnancy and in the first postnatal year. METHODS MEDLINE, EMBASE, PsycINFO, Scielo, LILACS, clinicaltrials.gov, International Clinical Trials Registry, Cochrane Library, Scopus and Web of Science databases were searched for articles from inception to 4/15/2016. Studies of maternal nutritional biomarkers in blood (fatty acids/micronutrients/amino acids) and associations with psychological distress (depression/anxiety/stress) were included. Two independent reviewers extracted data based on study designs, participants, outcomes, exposures, and association measures. RESULTS Thirty-eight studies were included. A total of 13 studies showed divergent or no associations between serum/plasma/erythrocyte fatty acid concentrations and depression/anxiety during pregnancy and postpartum. Changes in serum cholesterol levels from pregnancy to postpartum showed a significant inverse correlation with depression in one out of three studies. Five out of seven studies found an inverse association between serum vitamin D levels and pre- and postnatal depression. Plasma tryptophan levels were inversely correlated with postnatal depression scores in three out of four studies. We identified that one out of two studies presented no significant association between vitamin B12/folate/ferritin concentrations and depression in postpartum. LIMITATIONS There was higher variability between association measures, time and scales of depression and anxiety assessments. CONCLUSIONS The majority of high-quality studies suggest that lower vitamin D levels may be associated with postpartum depression. However, further evidence is needed for guiding clinical practice on nutritional biomarkers.
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Affiliation(s)
- Janet Trujillo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil
| | - Matias Costa Vieira
- Division of Women's Health, Women's Health Academic Centre, King's College London, Biomedical Research Centre, King's Health Partners, London, UK
| | - Jaqueline Lepsch
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil
| | - Fernanda Rebelo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil; Clinical Research Service, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London, Biomedical Research Centre, King's Health Partners, London, UK
| | - Dharmintra Pasupathy
- Division of Women's Health, Women's Health Academic Centre, King's College London, Biomedical Research Centre, King's Health Partners, London, UK
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Brazil.
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Avila Novoa D, Cárdenas M, Cardona E, Cardona D, Grover F, Ramos C, Trujillo J. ASSOCIATION OF PULSE WAVE VELOCITY AND BODY MASS INDEX IN HEALTHY MEXICAN POPULATION. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.009] [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: 12/01/2022] Open
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Cunha Figueiredo AC, Trujillo J, Freitas-Vilela AA, Franco-Sena AB, Rebelo F, Cunha GM, de Castro MBT, Farnum A, Mokhtar RR, Holick MF, Kac G. Association between plasma concentrations of vitamin D metabolites and depressive symptoms throughout pregnancy in a prospective cohort of Brazilian women. J Psychiatr Res 2017; 95:1-8. [PMID: 28755554 DOI: 10.1016/j.jpsychires.2017.07.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/04/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022]
Abstract
Plasma concentrations of vitamin D metabolites can be inversely associated with depressive symptoms. However, few longitudinal studies have investigated this association, especially during pregnancy. The aim of this study was to investigate the association between concentrations of 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxivitamin D [1,25(OH)2D] with the occurrence of depressive symptoms throughout pregnancy. A prospective cohort of 179 women was followed at 5th-13th, 20th-26th and 30th-36th gestational weeks. At each trimester of pregnancy, the plasma concentrations of 25(OH)D and 1,25(OH)2D were analyzed by liquid chromatography tandem mass spectroscopy. Vitamin D status was categorized according to the Endocrine Society Practice Guidelines and the Institute of Medicine. Depressive symptoms were measured at each trimester using the Edinburgh Postnatal Depressive Scale (cutoff ≥13). Statistical analyses included random intercept logistic regression models for longitudinal analyses. In the first trimester, the prevalence of 25(OH)D <75, <50 and <30 nmol/L were 69.3%, 14.0% and 1.7%, respectively. Prevalence of depressive symptoms were 20.1%, 14.7% and 7.8% for the first, second and third trimesters, respectively. The probability of occurrence of depressive symptoms decreased throughout pregnancy (p-value = 0.005). Women with higher concentrations of 25(OH)D in the first trimester presented a lower odds ratio (OR) for the development of depressive symptoms during pregnancy (OR = 0.98; 95%CI: 0.96 to 0.99, p-value = 0.047) in the adjusted model. In conclusion, there was a higher prevalence of vitamin D inadequacy and depressive symptoms during the first trimester. Higher 25(OH)D concentrations in the first trimester were associated with a decrease of 2% in the odds for presenting depressive symptoms throughout pregnancy.
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Affiliation(s)
- Amanda C Cunha Figueiredo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil
| | - Janet Trujillo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil
| | - Ana Amélia Freitas-Vilela
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil; Special Academic Unit of Health Sciences, Goiás Federal University, GO, Brazil
| | - Ana Beatriz Franco-Sena
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil; Department of Social Nutrition, Emília de Jesus Ferreiro Nutrition School, Fluminense Federal University, Niteroi, Brazil
| | - Fernanda Rebelo
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil; Division of Clinical Trials and Drug Development, National Institute of Cancer, Ministry of Health, RJ, Brazil
| | - Geraldo Marcelo Cunha
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil; Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil
| | - Amanda Farnum
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil
| | | | | | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil; Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, RJ, Brazil.
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Martínez-Ortiz M, Cerezuela P, Marin Zafra G, Balsalobre J, Díaz-Manzano J, Trujillo J. Analysis of the impact of the tumours committee on the multidisciplinary approach to head and neck epidermoid cancer in our institution. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.045] [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: 11/15/2022] Open
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Trujillo J. Criterios diagnósticos y efectividad de intervenciones para el manejo de diabetes gestacional. Rev Cuid 2016. [DOI: 10.15649/cuidarte.v7i2.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
<p>Diabetes mellitus gestacional es definida como intolerancia a los carbohidratos con distintos grados de severidad y detectada por primera vez en el embarazo. Es un problema importante de salud pública por su alta prevalencia que va en aumento y también, por la morbilidad materna y morbimortalidad fetal. Sin embargo, existen todavía controversias en su forma de tamizaje y criterio diagnóstico usados.</p><p class="Default">En esta editorial, se pretende abordar los diferentes tamizajes y criterios diagnósticos, junto con la efectividad en el manejo de mujeres diagnosticadas con diabetes mellitus gestacional.</p><p><strong><em>Cómo citar este artículo:</em></strong><em> Trujillo J.</em> <em>Criterios diagnósticos y efectividad de intervenciones para el manejo de diabetes gestacional</em>.<strong> </strong><em>Rev Cuid. 2016; 7(2): 1251-4.</em><em> </em><a href="http://dx.doi.org/10.15649/cuidarte.v7i2.344"><em>http://dx.doi.org/10.15649/cuidarte.v7i2.344</em></a> <em></em></p>
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Vollmer L, van Dooren M, Trabucchi D, Schneemann J, Steinfeld G, Witha B, Trujillo J, Kühn M. First comparison of LES of an offshore wind turbine wake with dual-Doppler lidar measurements in a German offshore wind farm. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/1742-6596/625/1/012001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Trujillo J, Vigo A, Duncan BB, Falavigna M, Wendland EM, Campos MA, Schmidt MI. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract 2015; 108:288-95. [PMID: 25765668 DOI: 10.1016/j.diabres.2015.02.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/11/2014] [Accepted: 02/06/2015] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate the diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and alternative criteria in terms of resultant prevalence of gestational diabetes mellitus (GDM) and measures of diagnostic impact. METHODS The Brazilian Gestational Diabetes Study (EBDG) is a cohort of pregnant women enrolled consecutively in prenatal care clinics of the Brazilian National Health Service from 1991 to 1995, a time and setting in which those with lesser than diabetes hyperglycemia rarely received drug treatment. Eligibility criteria were age ≥20 years, gestational age 20-28 weeks and no history of diabetes outside pregnancy. After interview and anthropometric measurements, a standardized 2h 75g OGTT was scheduled. Women were followed through early postpartum. RESULTS Prevalence of GDM defined by IADPSG criteria was 18.0% (95% CI 16.9-19.0), ranging from 2.7 to 17.0% with the alternative criteria. Relative risks for large for gestational age (LGA) and preeclampsia were generally small. The diagnostic impact assessed by pre- to post-test gain in the probability of an outcome was also small (3.6% for LGA and 0.5% for preeclampsia). Alternative criteria reached maximum gains of 9.7% and 5.3%, respectively. The fractions of LGA births and preeclampsia attributable to GDM by the IADPSG criteria were small, 6.7% and 3.5%, respectively. CONCLUSIONS The IADPSG criteria identify more women as having GDM but their diagnostic and population impacts with respect to adverse outcomes are small. Alternative definitions, although also presenting small diagnostic and population impacts, showed advantages which may be useful in specific settings.
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Affiliation(s)
- Janet Trujillo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Alvaro Vigo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maicon Falavigna
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Maria I Schmidt
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Trujillo J, Vigo A, Reichelt A, Duncan BB, Schmidt MI. Fasting plasma glucose to avoid a full OGTT in the diagnosis of gestational diabetes. Diabetes Res Clin Pract 2014; 105:322-6. [PMID: 25037441 DOI: 10.1016/j.diabres.2014.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/31/2014] [Accepted: 06/02/2014] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the performance of fasting plasma glucose (FPG) in determining the need for a full oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS A multicenter cohort study of 4926 pregnant women 20 years or older consecutively enrolled in prenatal care clinics of the Brazilian National Health Service from 1991 to 1995. All women underwent a single 2 h 75 g OGTT by weeks 24-28 of pregnancy and were followed to detect adverse pregnancy outcomes. RESULTS A FPG cut-off value of 80 mg/dl indicated that only 38.7% of all women needed to undergo a complete OGTT, while detecting 96.9% of all GDM cases. When the 85 mg/dl cut-off was used, the corresponding percentages were 18.7% and 92.5%, respectively. The fraction of women labeled with GDM who had adverse pregnancy outcomes was nearly identical when using FPG strategies and universal full testing. CONCLUSIONS Using a FPG cut-off to diagnose GDM and to determine the need for post-load OGTT measurements is a valid strategy to diagnose GDM by IADPSG criteria. This approach may improve feasibility of applying IADPSG diagnostic criteria by reducing costs and increasing convenience.
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Affiliation(s)
- J Trujillo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil.
| | - A Vigo
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
| | - A Reichelt
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - B B Duncan
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
| | - M I Schmidt
- Post Graduate Studies Program in Epidemiology, School of Medicine, Rio Grande do Sul Federal University, Rua Ramiro Barcelos 2600, sala 414, 90035-003, Porto Alegre, RS, Brazil
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Falavigna M, Schmidt MI, Trujillo J, Alves LF, Wendland ER, Torloni MR, Colagiuri S, Duncan BB. Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence assessment. Diabetes Res Clin Pract 2012; 98:396-405. [PMID: 23031412 DOI: 10.1016/j.diabres.2012.09.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 09/04/2012] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the effectiveness of gestational diabetes (GDM) treatment compared to usual antenatal care, in the prevention of adverse pregnancy outcomes. Additionally, to assess the quality of the evidence to support GDM treatment according to GRADE guidelines. METHODS Fourteen electronic databases and reference lists of relevant literature were searched for articles published from inception to February, 2012. Controlled clinical trials comparing GDM treatment to usual antenatal care were included. Independent extraction of articles was done by two authors using predefined data fields. RESULTS Seven trials involving 3157 women were included. We found high quality evidence that treatment of GDM reduces macrosomia (RR=0.47; 95% CI, 0.34-0.65; NNT=11.4) and large for gestational age birth (RR=0.57; 95% CI, 0.47-0.71; NNT=12.2); moderate quality evidence that treatment reduces preeclampsia (RR=0.61; 95% CI, 0.46-0.81; NNT=21.0) and hypertensive disorders in pregnancy (RR=0.64; 95% CI, 0.51-0.81; NNT=18.1); and low quality evidence that treatment reduces shoulder dystocia (RR=0.41; 95% CI, 0.22-0.76; NNT=48.8). No statistically significant reduction was seen for caesarean section. No increase in small for gestational age or preterm birth was found. CONCLUSIONS Treatment of GDM is effective in reducing macrosomia (high quality evidence), preeclampsia and shoulder dystocia.
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Affiliation(s)
- Maicon Falavigna
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos n. 2600, Porto Alegre, Brazil.
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Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, Duncan BB, Schmidt MI. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012; 12:23. [PMID: 22462760 PMCID: PMC3352245 DOI: 10.1186/1471-2393-12-23] [Citation(s) in RCA: 351] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes. METHODS We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%. RESULTS Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO. CONCLUSIONS The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.
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Affiliation(s)
| | | | | | - Janet Trujillo
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Bruce B Duncan
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Justice-Allen A, Trujillo J, Goodell G, Wilson D. Detection of multiple Mycoplasma species in bulk tank milk samples using real-time PCR and conventional culture and comparison of test sensitivities. J Dairy Sci 2011; 94:3411-9. [PMID: 21700026 DOI: 10.3168/jds.2010-3940] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 03/18/2011] [Indexed: 11/19/2022]
Abstract
The objective of this study was to further validate a SYBR PCR protocol for Mycoplasma spp. by comparing it with standard microbial culture in the detection of Mycoplasma spp. in bulk tank milk samples. Additionally, we identified Mycoplasma spp. present by analysis of PCR-generated amplicons [dissociation (melt) temperature (T(m)), length, and DNA sequence]. The research presented herein tests the hypothesis that the SYBR PCR protocol is as sensitive as conventional culture for the detection of Mycoplasma spp. in bulk tank milk samples. Mycoplasmas cause several important disease syndromes in cattle, including mastitis in dairy cows. The standard diagnostic method at the herd level has been microbial isolation of mycoplasmas on 1 of several specialized media and speciation through biochemical or immunological techniques; repeated sampling schemes are recommended. The development of a real-time SYBR PCR protocol offers advantages in decrease of time to detection, cost, and complexity. The T(m) of the double-stranded DNA generated from the PCR reaction was used to detect the presence of and tentatively identify the species of mycoplasmas other than Mycoplasma bovis. In the SYBR PCR protocol, the presence of multiple species of mycoplasmas is indicated by an atypical dissociation curve. Gel electrophoresis and sequencing of the amplicons was used to confirm the mycoplasma species present when a non-M. bovis organism was detected (T(m) not equal to M. bovis) and used to identify all the mycoplasma species present for the samples with atypical dissociation curves. Mycoplasma bovis was identified in 83% of SYBR PCR mycoplasma-positive bulk tank samples. Another mycoplasma was identified either alone or in addition to M. bovis in 25% of SYBR PCR mycoplasma-positive bulk tank milk samples. Four species of mycoplasma other than M. bovis (Mycoplasma alkalescens, Mycoplasma arginini, Mycoplasma bovigenitalium, and Mycoplasma gateae) were identified in bulk tank milk samples tested with this method. Five farms had 2 mycoplasma species occurring at different times in their bulk tanks. Two mycoplasma species were identified in the same bulk tank sample in 7 instances on 2 farms. The finding of multiple Mycoplasma spp. coexisting on a farm and even in the same bulk tank milk sample indicates that the clinical significance of multiple mycoplasma species in the pathology of intramammary infections should be investigated further. In comparison with conventional culture, the SYBR PCR protocol was slightly (but not statistically significantly) more sensitive in the detection of mycoplasmas in bulk tank milk.
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Affiliation(s)
- A Justice-Allen
- Department of Animal, Dairy, and Veterinary Science, Utah Veterinary Diagnostic Laboratory, Utah State University, Logan 84321, USA.
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Valencia J, Arroyo J, Trujillo J, Magaña-Sevilla H, Zarco L. Exposure to the Male does not Exert a Luteolytic Effect in Cyclic Goats. Journal of Applied Animal Research 2010. [DOI: 10.1080/09712119.2010.10539507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Justice-Allen A, Trujillo J, Corbett R, Harding R, Goodell G, Wilson D. Survival and replication of Mycoplasma species in recycled bedding sand and association with mastitis on dairy farms in Utah. J Dairy Sci 2010; 93:192-202. [PMID: 20059918 DOI: 10.3168/jds.2009-2474] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 09/26/2009] [Indexed: 12/22/2022]
Abstract
Mycoplasma spp., usually Mycoplasma bovis, are important bovine pathogens that can cause mastitis, metritis, pneumonia, and arthritis. The currently documented routes of transmission of Mycoplasma spp. are through contaminated milking equipment and by direct animal contact. The existence of environmental sources for Mycoplasma spp. and their role in transmission and clinical disease is poorly characterized. Mycoplasma spp. (confirmed as M. bovis in 2 of 4 samples tested using PCR) was found in recycled bedding sand originating from a dairy experiencing an outbreak of clinical mycoplasma mastitis. Mycoplasma spp. were subsequently found in bedding sand from 2 other dairies whose bulk-tank milk was mycoplasma-positive. The association between the occurrence of Mycoplasma spp. in recycled bedding sand and mycoplasma mastitis in cows was further investigated using a pile of recycled sand from dairy 1. Study objectives included the determination of factors associated with the concentration of Mycoplasma spp. in recycled bedding sand and the duration of survival of mycoplasmas in the sand. We also evaluated the efficacy of 2 disinfectants at 2 different concentrations each for the elimination of Mycoplasma spp. from contaminated sand. Mycoplasma spp. survived in the sand pile for 8 mo. The concentration of Mycoplasma spp. within the sand pile was directly related to temperature and precipitation. It was also positively associated with the growth of gram-negative microorganisms, suggesting the possibility of the formation of a biofilm. Ideal temperatures for replication of Mycoplasma spp. occurred between 15 and 20 degrees C. Moisture in the sand and movement of the sand pile also appeared to play a role in replication of mycoplasmas. We found that 0.5% sodium hypochlorite or 2% chlorhexidine were efficacious in eliminating Mycoplasma spp. from contaminated bedding sand. Recycled bedding sand could be an environmental source of Mycoplasma spp., including M. bovis, infections in dairy cows. Future studies should investigate the contribution of this environmental source to the epidemiology of mycoplasma infections in dairy cattle.
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Affiliation(s)
- A Justice-Allen
- Department of Animal, Dairy and Veterinary Sciences, Utah Veterinary Diagnostic Laboratory, Utah State University, Logan 84321, USA.
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León-Barrios M, Gutiérrez-Navarro A, Pérez-Galdona R, Díaz-Siverio J, Trujillo J, Corzo J. Acidic exopolysaccharide fromBradyrhizobium (Chamaecytisus proliferus). ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1365-2672.1992.tb01808.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Trujillo J, Barrios JA, Jimenez B. Effect of peracetic acid, ultraviolet radiation, nanofiltration-chlorine in the disinfection of a non conventional source of water (Tula Valley). Water Sci Technol 2008; 57:621-627. [PMID: 18360005 DOI: 10.2166/wst.2008.181] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Water supply for human consumption requires certain quality that reduces health risks to consumers. In this sense, the process of disinfection plays an important role in the elimination of pathogenic microorganisms. Even though chlorination is the most applied process based on its effectiveness and cost, its application is being questioned considering the formation of disinfection by-products (DBPs). Therefore, alternative disinfectants are being evaluated and some treatment processes have been proposed to remove DBPs precursors (organic matter. This paper reports the results of disinfection of a non conventional source of water (aquifer recharged unintentionally with raw wastewater) with peracetic acid (PAA) and ultraviolet radiation (UV) as well as nanofiltration (NF) followed by chlorination to produce safe drinking water. The results showed that a dose of 2 mg/L PAA was needed to eliminate total and faecal coliforms. For UV light, a dose of 12.40 mWs/cm2 reduced total and faecal coliforms below the detection limit. On the other hand, chlorine demand of water before NF was 1.1-1.3 mg/L with a trihalomethane formation potential (THMFP) of 118.62 microg/L, in contrast with chlorination after NF where the demand was 0.5 mg/L and THMFP of 17.64 microg/L. The recommended scheme is nanofiltration + chlorination.
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Affiliation(s)
- J Trujillo
- Instituto de Ingeniería, UNAM, Ciudad Universitaria, Apartado Postal 70-472, 04510, Coyoacán, México, D.F. México.
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Mimbacas A, Trujillo J, Gascue C, Javiel G, Cardoso H. Prevalence of vitamin D receptor gene polymorphism in a Uruguayan population and its relation to type 1 diabetes mellitus. Genet Mol Res 2007; 6:534-542. [PMID: 17985306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Vitamin D has important immuno-modulatory properties and it influences insulin secretion. It acts through a vitamin D receptor (VDR), for which several gene polymorphisms have been described. The Uruguayan population presents several epidemiological characteristics that make it different from that of other counties, including other Latin-American countries. It went through miscegenation processes, with a tri-hybrid European, Amerindian and African origin, with no contribution from isolated Amerindian communities. Such differences have important consequences for the relationship between frequencies of several genes in the general population and their association with the diabetes mellitus. We examined the prevalence of VDR gene polymorphisms in the general population and their relation to type 1 diabetes in a parent-case design. One hundred unrelated individuals from the general population and 45 parent-patient triads with a child affected with type 1 diabetes were genotyped for FokI, BsmI and TaqI VDR gene polymorphisms by RFLP-PCR. We used a transmission disequilibrium test to assess preferential transmission of parents to affected offspring. The prevalence of the three VDR polymorphisms was: allele F = 48%, B = 35%, T = 64%. The f, b, T alleles and heterozygous genotypes were found at a high frequency in this population. Among 36 informative heterozygous parental genotypes, 30 transmitted the F allele (probability of transmission = 83%). The other two polymorphisms did not show significant transmission. We suggest that FokI polymorphism indicates susceptibility to type 1 diabetes mellitus in the Uruguayan population.
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Affiliation(s)
- A Mimbacas
- Departamento de Citogenética, Unidad Asociada Instituto de Biología, Facultad de Ciencias, Montevideo, Uruguay.
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Abstract
AIM: To study the effects of elenoside, an arylnaph-thalene lignan from Justicia hyssopifolia, on gastro-intestinal motility in vivo and in vitro in rats.
METHODS: Routine in vivo experimental assessments were catharsis index, water percentage of boluses, intestinal transit, and codeine antagonism. The groups included were vehicle control (propylene glycol-ethanol-plant oil-tween 80), elenoside (i.p. 25 and 50 mg/kg), cisapride (i.p. 10 mg/kg), and codeine phosphate (intragastric route, 50 mg/kg). In vitro approaches used isolated rat intestinal tissues (duodenum, jejunum, and ileum). The effects of elenoside at concentrations of 3.2 x 10-4, 6.4 x 10-4 and 1.2 x 10-3 mol/L, and cisapride at 10-6 mol/L were investigated.
RESULTS: Elenoside in vivo produced an increase in the catharsis index and water percentage of boluses and in the percentage of distance traveled by a suspension of activated charcoal. Codeine phosphate antagonized the effect of 25 mg/kg of elenoside. In vitro, elenoside in duodenum, jejunum and ileum produced an initial decrease in the contraction force followed by an increase. Elenoside resulted in decreased intestinal frequency in duodenum, jejunum, and ileum. The in vitro and in vivo effects of elenoside were similar to those produced by cisapride.
CONCLUSION: Elenoside is a lignan with an action similar to that of purgative and prokinetics drugs. Elenoside, could be an alternative to cisapride in treatment of gastrointestinal diseases as well as a preventive therapy for the undesirable gastrointestinal effects produced by opioids used for mild to moderate pain.
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Affiliation(s)
- E Navarro
- Department of Pharmacology, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Apdo. 55, Tenerife, Canary Islands, Spain.
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Hernández JM, García-Sanz R, Golvano E, Bladé J, Fernandez-Calvo J, Trujillo J, Soler JA, Gardella S, Carbonell F, Mateo G, San Miguel JF. Randomized comparison of dexamethasone combined with melphalan versus
melphalan with prednisone in the treatment of elderly patients with multiple myeloma. Br J Haematol 2004; 127:159-64. [PMID: 15461621 DOI: 10.1111/j.1365-2141.2004.05186.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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: 10/26/2022]
Abstract
Melphalan-prednisone (MP) has been the gold standard treatment for more than 30 years in elderly multiple myeloma (MM) patients. In order to assess whether the combination of dexamethasone with melphalan (MD) could improve on the efficacy of MP, we have carried out a randomized trial comparing both treatment approaches. A total of 201 patients >/=70 years old were included in the study. The overall response rate was similar after six cycles (MP: 67.9%versus MD: 64.5%) and after 12 cycles (MP: 49.4%versus MD: 46.1%). However, the proportion of complete responses (CR) was higher in the MD arm, particularly after 12 cycles (MD: 22.4%versus MP: 9.1%; P < 0.05). There was no significant difference in event-free survival (MP: 15.9 months versus MD: 23.3 months). The median overall survival in both arms was almost identical (MP: 29.4 months versus MD: 27.2 months; P = 0.63). No significant differences in haematological toxicity were observed, but non-haematological toxicity was significantly higher in the MD arm. According to these results MP remains as the gold standard for treatment of MM and should be the reference for comparison of new therapeutic approaches involving novel agents.
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Affiliation(s)
- J M Hernández
- Department of Haematology, Hospital General de Segovia, Segovia, Spain.
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24
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Abstract
Elenoside is a cytotoxic arylnapthalene lignan (NSC 644013-W/1) derived from Justicia hyssopifolia (Family: Acanthaceae). The neuropharmacological activity of this lignan, a beta-D-glucoside was studied. The LD50 (24 h) of elenoside in mice is 305 +/- 7 mg/kg by i.p. route. In the present study elenoside was given to rats at doses of 25 and 50 mg/kg, and its effects on locomotor activity (Varimex test), muscular relaxant activity, open-field test and with chlorpromazine, 10 mg/kg was compared. On Varimex test, spontaneous activity was reduced. Elenoside produced a reduction in the permanence time on muscular relaxant activity (traction test). On open-field test, ambulation and rearing were reduced compared with the control group and an increase in boluses of dose-dependent rate was obtained. Thus it can be concluded that elenoside has central sedative effects and possible application in anxiety conditions.
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Affiliation(s)
- E Navarro
- Department of Pharmacology, Faculty of Medicine, University of La Laguna, 38071 La Laguna, Apdo. 55, La Cuesta, Tenerife, Canary Islands, Spain.
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Bebbington A, Carrasco H, Peralbo L, Ramon G, Torres VH, Trujillo J. From protest to productivity: the evolution of indigenous federations in Ecuador. Grassroots Dev 2002; 16:11-21. [PMID: 12344835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Alvarez JI, Londoño DP, Alvarez AL, Trujillo J, Jaramillo MM, Restrepo BI. Granuloma formation and parasite disintegration in porcine cysticercosis: comparison with human neurocysticercosis. J Comp Pathol 2002; 127:186-93. [PMID: 12354530 DOI: 10.1053/jcpa.2002.0579] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Taenia solium cysticerci infect human beings and pigs, causing cysticercosis. In this study the pig was used as a model to characterize the immune response against cysticerci, given the difficulties in analysing the developing immune response in infected human brains. Metacestodes in different stages of viability or degeneration were isolated from the brain, heart and skeletal muscle of naturally infected swine, and the adjacent tissue was examined histologically. The immune response elicited by the cysticerci was classified into four separate stages. In stage I the parasites were surrounded by a thin layer of collagen type I, and by stage II there was a sparse inflammatory infiltrate. In stage III, granuloma formation was evident, and by stage IV the parasite was surrounded by an eosinophil-rich infiltrate and its vesicular membrane had begun to degenerate. The final stage, IV, was detected mainly in the heart but not in the brain. The granulomatous reaction in swine resembled that described previously in human patients, but differed in the abundance of eosinophils, the relative paucity of plasma cells, and the discrete deposition of collagen. These differences were probably due to the fact that in pigs the immune response can be examined earlier than in human patients, in whom sampling is inevitably made at a more chronic stage.
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Affiliation(s)
- J I Alvarez
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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Bladé J, San Miguel JF, Fontanillas M, Esteve J, Maldonado J, Alcalá A, Brunet S, García-Conde J, Besalduch J, Moro MJ, Fernández-Calvo J, Conde E, Font L, Gardella S, Carnero M, Carbonell F, Martí JM, Hernández-Martín J, Ortega F, Besses C, Ribera JM, Trujillo J, Escudero ML, Rozman C, Estapé J, Montserrat E. Increased conventional chemotherapy does not improve survival in multiple myeloma: long-term results of two PETHEMA trials including 914 patients. Hematol J 2002; 2:272-8. [PMID: 11920260 DOI: 10.1038/sj.thj.6200115] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2000] [Accepted: 01/06/2001] [Indexed: 11/09/2022]
Abstract
BACKGROUND Melphalan and prednisone (MP) has been the standard treatment for multiple myeloma (MM) for the last 30 years. Combination chemotherapy at conventional doses has not shown a significant prolongation of survival when compared to MP. There are few data comparing conventional chemotherapy at standard doses with conventional treatment at higher doses. We present the long-term outcome of 914 patients from two randomized trials comparing three different dose intensity regimens. METHODS From 1 January, 1985 to 31 December, 1989, 487 patients were randomized between MP (melphalan 9 mg/m(2) p.o. and prednisone 60 mg/m(2) days 1-4) and alternating VCMP (vincristine 1 mg i.v. on day 1, cyclophosphamide 500 mg/m(2) i.v. on day 1, melphalan 6 mg/m(2) p.o. on days 1-4, and prednisone 60 mg/m(2) on days 1-4) and VBAP (vincristine 1 mg i.v. on day 1, BCNU and doxorubicin 30 mg/m(2) i.v. each on day 1, and prednisone 60 mg/m(2) on days 1-4). From 1 January, 1990 to 31 May, 1994, 427 patients were randomized between VCMP/VBAP at the above detailed doses (VCMP/VBAP 'SD') and the same regimen increasing the doses of cyclophosphamide and doxorubicin from 500 to 1200 mg/m(2) and from 30 to 50 mg/m(2), respectively (VCMP/VBAP 'HD'). RESULTS Increasing dose intensity produced a significantly higher partial response rate (31% vs 45% vs 51% for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P < 0.01). However, a significantly early death rate was observed in the HD arm (7.7, 7.5 and 12.1% for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = 0.05). Median duration of response (20 vs 18 vs 19 months for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = NS) and median survival (25 vs 31 vs 29 months for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = NS) were similar in the three groups. MP produced a higher degree of thrombocytopenia than combination chemotherapy at standard (P = 0.002) or high dose (P = 0.01), this leading to a significantly higher dose reduction in the MP arm (P < 0.001 and P = 0.003 for VCMP/VBAP 'SD' and VCMP/VBAP 'HD', respectively). CONCLUSION In these trials the response rate significantly correlated with the regimen intensity. However, no significant differences in response duration and survival were found. This highlights the limited role of conventional chemotherapy in MM and the need for further trials, aimed at determining the impact of new treatment approaches such as high-dose therapy/autotransplantation.
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Affiliation(s)
- J Bladé
- Spanish Cooperative Group for Hematological Malignancies Treatment (PETHEMA), Spanish Society of Hematology. Institut de Investigacions Biomèdiques August Pi i Sunyer. Hospital Clínico. Barcelona. Spain.
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Alvarez JI, Colegial CH, Castaño CA, Trujillo J, Teale JM, Restrepo BI. The human nervous tissue in proximity to granulomatous lesions induced by Taenia solium metacestodes displays an active response. J Neuroimmunol 2002; 127:139-44. [PMID: 12044985 DOI: 10.1016/s0165-5728(02)00101-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In neurocysticercosis, the nervous tissue surrounding the brain lesion is affected as a consequence of the local immune response induced by a Taenia solium metacestode. In this study, a histological and immunohistochemical analysis of five brain specimens from patients with neurocysticercosis revealed a proinflammatory activity reflected by an apparently altered blood-brain barrier permeability, secretion of pro-inflammatory cytokines, and up-regulation of molecules associated with antigen presentation. There were also anti-inflammatory cytokines, as well as an active wound-healing process reflected by angiogenesis, collagen deposition and glial scar formation. This immune response displayed by the nervous tissue adjacent to chronic neurocysticercosis lesions appeared to be contributing to the local tissue damage, and hence, may be fundamental in the pathology of NCC.
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Affiliation(s)
- J I Alvarez
- Molecular Parasitology Group, Corporación para Investigaciones Biológicas, Cra. 72A No. 78B-141, Medellín, Colombia
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Abstract
A diarylheptanoid, 1,7-di-(3',4'-dihydroxyphenyl)-4-hepten-3-one, hirsutanone, has been isolated from the methanolic extract of the aerial parts of Viscum cruciatum (Viscaceae) and characterized by spectroscopic methods and chemical transformations. This compound showed cytotoxic activity against melanoma (UACC-62), renal (TK-10) and breast (MCF-7) cancer cell lines.
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Affiliation(s)
- C Martín-Cordero
- Laboratorio de Farmacognosia, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain.
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Restrepo BI, Alvarez JI, Castaño JA, Arias LF, Restrepo M, Trujillo J, Colegial CH, Teale JM. Brain granulomas in neurocysticercosis patients are associated with a Th1 and Th2 profile. Infect Immun 2001; 69:4554-60. [PMID: 11401999 PMCID: PMC98532 DOI: 10.1128/iai.69.7.4554-4560.2001] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neurocysticercosis (NCC) is a common central nervous system (CNS) infection caused by Taenia solium metacestodes. Despite the well-documented importance of the granulomatous response in the pathogenesis of this infection, there is limited information about the types of cells and cytokines involved. In fact, there has been limited characterization of human brain granulomas with any infectious agent. In the present study a detailed histological and immunohistochemical analysis of the immune response was performed on eight craniotomy specimens where a granuloma surrounded each T. solium metacestode. The results indicated that in all the specimens there was a dying parasite surrounded by a mature granuloma with associated fibrosis, angiogenesis, and an inflammatory infiltrate. The most abundant cell types were plasma cells, B and T lymphocytes, macrophages, and mast cells. Th1 cytokines were prevalent and included gamma interferon, interleukin-18 (IL-18), and the immunosuppressive, fibrosis-promoting cytokine transforming growth factor beta. The Th2 cytokines IL-4, IL-13, and IL-10 were also present. These observations indicate that a chronic immune response is elicited in the CNS environment with multiple cell types that together secrete inflammatory and anti-inflammatory cytokines. In addition, both collagen type I and type III deposits were evident and could contribute to irreversible nervous tissue damage in NCC patients.
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Affiliation(s)
- B I Restrepo
- Molecular Parasitology Group, Corporación para Investigaciones Biológicas, Medellín, Colombia, Texas, USA
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31
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Abstract
Acute toxicity (24 h) and general behavior in mice of a lignan from Justicia hyssopifolia, a beta-D-glucoside (elenoside), was studied, and the cytotoxic activity was performed. Elenoside (arylnaphthalene lignan) in mice showed a moderate toxicity order (305 mg/kg) and central depressive properties at doses of 25, 50, and 100 mg/kg. It also displayed cytotoxic activity in a range of concentration of 10(-5)-10(-4) M when studied in the human tumor cell line panel of the US National Cancer Institute (NCI). The results indicated that elenoside has central depressant effects, and the cytotoxic activity of elenoside suggests that this compound and its genin derivatives merit further investigation as antitumoral drugs.
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Affiliation(s)
- E Navarro
- Department of Pharmacology, Faculty of Medicine, University of La Laguna, Tenerife, Spain.
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Navarro E, Alonso SJ, Trujillo J, Jorge E, Pérez C. General behavior, toxicity, and cytotoxic activity of elenoside, a lignan from Justicia hyssopifolia. J Nat Prod 2001; 64:134-5. [PMID: 11312930 DOI: 10.1021/np9904861] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Cytotoxicity, acute toxicity, and general pharmacological effects in mice of an arylnaphthalene lignan isolated from Jisticia hyssopifolia were studied. Elenoside was cytotoxic to human cancer cell lines in a range of concentrations from 10(-5) to 10(-4)M. It has an LD(50), ip in mice, of 305 mg/kg and central depressive properties at doses of 25, 50, and 100 mg/kg. Thus, elenoside appears to be a sedative with broad spectrum cytotoxicity.
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Affiliation(s)
- E Navarro
- Department of Pharmacology, University of La Laguna, Tenerife, Spain
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González-Griego M, Pentón E, Delgado G, Pérez-Oliva J, Ramos V, Izquierdo M, García G, Levy N, Cinza Z, Valdivia I, Trujillo J, Delahanty A. [Impact of an anti-hepatitis B virus (HBV) immunization program in patients undergoing dialysis in Havana, Cuba]. Invest Clin 2000; 41:237-44. [PMID: 11155765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The follow-up of HBV markers in selected high infection risk populations, in patients from the hemodialysis and peritoneal dialysis services was used to assess the effectiveness of a special vaccination program. Viral infection markers were studied in prevalence cross sections of the whole population of patients, and also by recording the reports of clinical cases of hepatitis B occurred during that period in those groups of patients. The prevention program consisted of the vaccination of all patients negative to the viral markers and the indication of vaccination for the new cases during the period of the kidney disease, just before the start of the treatment at the hemodialysis unit; besides all the persons susceptible to infection that had already been included in the program, regardless of the stage of the disease. The results show the benefit of the vaccination in these patients, but it is more effective in the period before the treatment with dialysis where there is a lower possibility of being exposed to the virus and the immune system is still competent. Once the program was established, after a follow up o 6 years, there have been no reports of new cases of hepatitis B and the incidence of the disease has been declining.
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Affiliation(s)
- M González-Griego
- División de Farmacéuticos, Centro de Ingeniería Genética y Biotecnología (CIGB), Aptdo, Postal 6162, C. de La Habana CP10600, Cuba.
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Navarro E, Alonso PJ, Alonso SJ, Trujillo J, Pérez C, Toro MV, Ayuso MJ. Cardiovascular activity of a methanolic extract of Digitalis purpurea spp. heywoodii. J Ethnopharmacol 2000; 71:437-442. [PMID: 10940580 DOI: 10.1016/s0378-8741(00)00175-6] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The paper deals with the effects of a glycosidal extract of Digitalis heywoodii, ssp. of Digitalis purpurea L., (Schrophulariaceae) grown in Badajoz (Spain), on isolated cardiac auricle of rabbits, urinary excretion of rats, as well as its emetic effect in pigeons. These effects using vehicle (propylene glycol-ethanol-water, 40:10:50) and digoxin as standards are presented. The extract at concentrations of 20 and 40 microg/ml produced an increase in the contraction force of auricles in a dose-dependent way. At doses of 15 and 30 mg/kg a slight diuretic and natriuretic effect was observed. The active dose range for emesis was 0.5-4 mg/kg and a decrease of the emesis time within 10 min of injection in dose-dependent manner was obtained. The pharmacological activity of the extract is related to gitoxin derivatives (digitalinum verum and strospeside), the most abundant compounds obtained from the leaves of Digitalis purpurea spp. heywoodii.
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Affiliation(s)
- E Navarro
- Departamento de Farmacología, Facultad de Medicina, Universidad de La Laguna, E-38071, Tenerife, La Laguna, Spain
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35
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Cock AM, Cano LE, Vélez D, Aristizábal BH, Trujillo J, Restrepo A. Fibrotic sequelae in pulmonary paracoccidioidomycosis: histopathological aspects in BALB/c mice infected with viable and non-viable paracoccidioides brasiliensis propagules. Rev Inst Med Trop Sao Paulo 2000; 42:59-66. [PMID: 10810319 DOI: 10.1590/s0036-46652000000200001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [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: 11/21/2022] Open
Abstract
Patients with paracoccidioidomycosis often present pulmonary fibrosis and exhibit important respiratory limitations. Based on an already established animal model, the contribution of viable and non-viable P. brasiliensis propagules to the development of fibrosis was investigated. BALB/c male mice, 4-6 weeks old were inoculated intranasally either with 4x10(6) viable conidia (Group I), or 6. 5x10(6) fragmented yeast cells (Group II). Control animals received PBS. Six mice per period were sacrificed at 24, 48, 72h (initial) and 1, 2, 4, 8, 12 and 16 weeks post-challenge (late). Paraffin embedded lungs were sectioned and stained with H&E, trichromic (Masson), reticulin and Grocot&tacute;s. During the initial period PMNs influx was important in both groups and acute inflammation involving 34% to 45% of the lungs was noticed. Later on, mononuclear cells predominated. In group I, the inflammation progressed and granulomas were formed and by the 12th week they fussed and became loose. Thick collagen I fibers were observed in 66.6% and 83.3% of the animals at 8 and 12 weeks, respectively. Collagen III, thick fibers became apparent in some animals at 4 weeks and by 12 weeks, 83% of them exhibited alterations in the organization and thickness of these elements. In group II mice, this pattern was different with stepwise decrease in the number of inflammatory foci and lack of granulomas. Although initially most animals in this group had minor alterations in thin collagen I fibers, they disappeared by the 4th week. Results indicate that tissue response to fragmented yeast cells was transitory while viable conidia evoked a progressive inflammatory reaction leading to granuloma formation and to excess production and/or disarrangement of collagens I and III; the latter led to fibrosis.
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Affiliation(s)
- A M Cock
- Laboratorio de Patología, Clínica de las Vegas, Medellín, Colombia
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36
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Sharma UK, Trujillo J, Song HF, Saitta FP, Laeyendecker OB, Castillo R, Arango-Jaramillo S, Sridharan G, Dettenhofer M, Blakemore K, Yu XF, Schwartz DH. A novel factor produced by placental cells with activity against HIV-1. J Immunol 1998; 161:6406-12. [PMID: 9834132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The factors controlling the dynamics of HIV-1 transmission from mother to infant are not clearly known. Previous studies have suggested the existence of maternal and placental protective mechanisms that inhibit viral replication in utero. Preliminary studies from our laboratory revealed that supernatant from placental stromal cells protected HIV-1-infected PBMC from virus-induced apoptosis and suppressed virus production. We have attempted to characterize the antiviral activity of this placental factor (PF) and delineate the stages of HIV-1 replication affected. This activity was not due to the presence of any known cytokine reported to have anti-HIV effect. Direct exposure to PF had no suppressive effect on the infectivity of cell-free HIV-1, and envelope-mediated membrane fusion appeared to be unaffected. Western blot analysis of HIV-1 from infected PBMC treated with PF revealed that expression of all viral proteins was reduced proportionately, both intracellularly and in released virions. However, exposure of HIV-1-infected cells to PF resulted in production of virions with 10-100-fold-reduced infectivity. PF-treated virions contained two- to threefold reduced ratios of cyclophilin A:Gag protein as compared with untreated virus. Reduced cyclophilin A content resulting in decreased binding of cyclophilin A to Gag could account, in part, for the observed reduction in infectivity. Our results suggest that placental cells produce an antiviral factor that protects the fetus during gestation and may have therapeutic potential.
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Affiliation(s)
- U K Sharma
- Department of Molecular Microbiology and Immunology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Rodríguez L, Balmaseda A, Bravo J, Trujillo J, Martínez L, Ochoa R, Díaz M, Laferté J, Ramos F. [Validation of a ultramicroELISA for detecting antibodies against hepatitis B surface antigen]. Rev Cubana Med Trop 1998; 48:45-9. [PMID: 9768269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The results of a validation study of the ultramicroanalitical assay for the detection of antibodies against the hepatitis B surface antigen (UMELISA anti-HBsAg), which was carried out by comparing the results obtained with the Hepanostika anti-HBsAg, commercial diagnosis kit are presented. For this purpose, sera from the clinical assays of the Cuban recombinant vaccine against hepatitis B were used. With the first sera group (n = 30) it was obtained, 93.1% of sensitivity, 98.5% of specificity and a concordance of 94.3%. The correlation coefficient showed a similar trend of the results (p < 0.01) and no significant differences were found in the average geometrical titre (TPG) between both assays (p > 0.05). With the second group (n = 100), whose assays were carried out at the "Pedro Kouri" Institute of Tropical Medicine (PKI) and at the Immunoassay Center (IAC) simultaneously, it was observed a sensitivity of 96.25% in both centers, a specificity of 75% at the PKI and of 90% at the IAC, and a coincidence of 92% and 95%, respectively. The correlation coefficient presented similar values and there were no significant differences between the TPG obtained by the two methods (p > 0.05). The results attained show in general the validity of the new assay and the feasibility to put it into practice either for following up the infection, or for carrying out clinical assays of vaccine evaluations.
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38
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Tortoriello J, Ortega A, Herrera-Ruíz M, Trujillo J, Reyes-Vázquez C. Galphimine-B modifies electrical activity of ventral tegmental area neurons in rats. Planta Med 1998; 64:309-313. [PMID: 9619110 DOI: 10.1055/s-2006-957440] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Galphimine-B (G-B) is a bioactive compound isolated from the plant Galphimia glauca Cav. (Malpighiaceae) with central nervous system depressant properties previously described. In the present study, extracellular spiking activity records in either somatosensorial cortex or ventral tegmental area (VTA) neurons, were performed in rats after i.p. or local administration of G-B. None of the cortical neurons displayed significant changes induced by any of the applied doses. In VTA cells, two patterns of electrical discharge were recorded, bursting (57%) and nonbursting (43%) types. Systemic administration of G-B induced excitatory effects in neurons with a bursting firing pattern and mixed responses on nonbursting units. When this compound was applied locally by microiontophoresis, most of the bursting and nonbursting spiking neurons showed a firing depression and only a few of the nonbursting neurons showed an increment of discharge frequency. These results are important since VTA is a major dopaminergic center responsible for the innervation of the prefrontal cortex, nucleus accumbens and entorhinal region. These areas are targets for the action of antipsychotic drugs.
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Affiliation(s)
- J Tortoriello
- Centro de Investigación Biomédica del Sur, IMSS, Morelos, México
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Hannaford B, Trujillo J, Sinanan M, Moreyra M, Rosen J, Brown J, Leuschke R, MacFarlane M. Computerized endoscopic surgical grasper. Stud Health Technol Inform 1997; 50:265-71. [PMID: 10180551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
We report a computerized endoscopic surgical grasper with computer control and a force feedback (haptic) user interface. The system uses standard unmodified grasper shafts and tips. The device can control grasping forces either by direct surgeon control, via teleoperation, or under software control. In this paper, we test an automated palpation function in which the grasper measures mechanical properties of the grasped tissue by applying a programmed series of squeezes. Experimental results show the ability to discriminate between the normal tissues of small bowel, lung, spleen, liver, colon, and stomach. We anticipate applications in telesurgery, clinical endoscopic surgery, surgical training, and research.
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Affiliation(s)
- B Hannaford
- Department of Electrical Engineering, University of Washington, Seattle 98195, USA
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40
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Reguillo F, De La Llana R, Castañón J, Alswies M, Trujillo J, Rodríguez G, Ramos W, O'Connor F, Gil-Aguado M. Osteogenesis imperfecta and coronary artery surgery. A case report. J Cardiovasc Surg (Torino) 1996; 37:621-2. [PMID: 9016979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new case of Osteogenesis Imperfecta (OI) suffering ischemic heart disease is reported. The patient was successfully operated on in our Institution and the bibliographic search showed only another case of such an association of diseases successfully treated by surgery. This patient proves that coronary artery surgery procedures are possible when OI complicates the cardiac ischemic syndrome.
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Affiliation(s)
- F Reguillo
- Hospital Universitario San Carlos, Universidad Complutense de Madrid, Spain
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41
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Bladé J, San Miguel JF, Fontanillas M, Alcalá A, Maldonado J, García-Conde J, Conde E, Conzález-Brito G, Moro MJ, Escudero ML, Trujillo J, Pascual A, Rozman C, Estapé J, Montserrat E. Survival of multiple myeloma patients who are potential candidates for early high-dose therapy intensification/ autotransplantation and who were conventionally treated. J Clin Oncol 1996; 14:2167-73. [PMID: 8683251 DOI: 10.1200/jco.1996.14.7.2167] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [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: 02/01/2023] Open
Abstract
PURPOSE To analyze the outcome of patients with multiple myeloma (MM) who were potential candidates for early high-dose therapy (HDT) intensification followed by autotransplantation from a series treated with conventional chemotherapy. PATIENTS AND METHODS From January 1985 through December 1989, 487 patients with symptomatic MM were entered onto a randomized study to compare melphalan and prednisone (MP) versus vincristine, cyclophosphamide, melphalan, and prednisone (VCMP) /vincristine, carmustine (BCNU), doxorubicin, and prednisone (VBAP). The sub-group of 77 patients who could have been candidates for early intensification with HDT followed by stem-cell support (ie, < 65 years of age, stage II or III disease, performance status < 3, and objective or partial response to initial chemotherapy) are the subjects of this report. RESULTS Seventy-seven of 487 patients could have been candidates for early intensification. The median age was 56 years (range, 27 to 64). At diagnosis, 12% had abnormal renal function, 16% hypercalcemia, and 42% serum beta 2-microglobulin level > or = 6 mg/L; 62% had stage III disease at diagnosis. Thirty-six patients were initially treated with MP and 41 with VCMP/VBAP. The median response duration to initial chemotherapy was 22 months, and the actuarial probability of being in continued first response at 5 years was 14%. After a median follow-up time of 58 months, 59 patients have died, one was lost to follow-up evaluation, and 17 are still alive 69 to 119 months after initial chemotherapy. The median survival time from initiation of treatment was 60 months and from the time when autotransplantation would be considered, 52 months. The only independent prognostic parameter for survival was renal function at diagnosis. CONCLUSION The median survival time of patients with MM who are less than 65 years of age and who respond to initial chemotherapy is 5 years. This survival duration is similar to that reported in selected series of patients given early HDT and stresses the importance of ongoing randomized trials to determine the role of HDT in the treatment of younger myeloma patients.
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Affiliation(s)
- J Bladé
- Spanish Cooperative Group for Hematological Malignancies Treatment (PETHEMA), Hospital Clínic, Barcelona, Spain
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Reyes M, Martín C, Alarcón de la Lastra C, Trujillo J, Toro MV, Ayuso MJ. Antiulcerogenicity of the flavonoid fraction from Erica andevalensis Cabezudo-Rivera. Z NATURFORSCH C 1996; 51:563-9. [PMID: 8810096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Investigations were carried out to determine the antiulcerogenicity of the flavonoid fraction (ethyl acetate extract) of Erica andevalensis Cabezudo-Rivera on gastric ulceration induced by different experimental models. Oral treatment with the ethyl acetate extract and the major flavonoid (myricetin 3-O-D-galactoside) were found to be effective to prevent gastric ulceration induced by cold-restraint stress in rats. Statistically significant ulcer index values with respect to the control group were observed. Mucus content was not increased although it was accompanied by an increase in proteins and hexosamines. In pyloric-ligated animals flavonoids showed a significant reduction in the number and severity of the ulcers. Under the same conditions acidity did not decrease with the flavonoid extract and myricetin 3-O-D-galactoside significantly as compared to control. Gastric ulcers induced by oral administration of absolute ethanol were reduced by pretreatment with the flavonoid extract of doses from 125 to 250 mg/kg and the isolated flavonoid of 25 mg/kg p.o. However neither the flavonic extract nor the isolated flavonoid induced changes in the amount and glycoprotein content of gastric mucus.
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Affiliation(s)
- M Reyes
- Laboratorio de Farmacognosia y Farmacodinamia, Facultad de Farmacia, Universidad de Sevilla, España
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Abstract
Previous studies investigating intravenous phenytoin toxicity have been largely anecdotal, and have inferred an association with older patients, cardiovascular disease, and higher doses, concentrations, and infusion rates of phenytoin. This investigation sought to elucidate both the incidence and nature of acute intravenous phenytoin toxicity in emergency department patients, and to identify any demographic, clinical, or dosing associations with toxicity, by analyzing a retrospective case series over 3 years in a municipal teaching hospital. A consecutive series of 164 patients who received intravenous phenytoin loading in the emergency department following acute seizure presentation was identified. Demographic, clinical, and dosing data were collected, and the nature of toxicity was noted. Data were then analyzed statistically for potential associations with toxicity. Eight cases of hypotension and no apnea or arrhythmias were noted in the 164 patients (4.9% incidence). Analysis of demographic, clinical, and dosing data found statistically significant associations between hypotension and both a lower phenytoin dose administered (537 mg in hypotensive patients v 787 mg in normotensive patients, P = .00046) and the presence of abnormal neurological signs at initial presentation (20% incidence when abnormal signs present v 3.5% incidence when absent, P = .026). No other associations were found between toxicity and other variables. This sample size could detect differences ranging from 4% to 11% in complication rate (hypotension) for the various demographic, clinical, and dosing parameters with a statistical power of 80%. It was concluded that the incidence of hypotension from intravenous phenytoin administration in this study population was approximately 5%, and the incidence of apnea and cardiac arrhythmia in this series was 0%. No associations with age, comorbidities, or infusion rates were found, in contrast to other studies. Association of intravenous phenytoin toxicity with lower phenytoin dose is likely related to prompt cessation of the drug once signs of toxicity occur. The possible association of toxicity with abnormal initial neurological signs has not previously been reported and may possibly define a population at risk if validated by prospective research in additional populations.
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Affiliation(s)
- L Binder
- Department of Emergency Medicine, Texas Tech University Health Sciences Center, El Paso, 79905, USA
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44
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Chamorro G, Salazar M, Salazar S, Ceballos G, Trujillo J, Munoz O, Yanez R. Antifertility effects of (+)-S-2-amino-6-iodoacetamidohexanoic acid (2-AIHA) in female rats. Contraception 1996; 53:247-51. [PMID: 8706444 DOI: 10.1016/0010-7824(96)00010-8] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
(+)-S-2-amino-6-iodoacetamidohexanoic acid (AIHA), an irreversible inhibitor of the ornithindecarboxylase and extrahepatic arginase enzymatic activities with antineoplasic properties, was evaluated for antifertility activity in pregnant rats by oral administration at different periods of gestation. Our results showed that doses of 10 and 20 mg/kg of AIHA orally administered produced a contraceptive effect when it was administered from days 2 to 5, and 8 to 12 of gestation, respectively. The gestation time was slightly shortened when AIHA was applied from day 15 until labor. No sign of external malformations in fetuses was observed. On the other hand, AIHA did not affect the total length of oestrous cycle at the same dosage level used to interrupt pregnancy. In ovariectomized immature rats, neither changes in uterine weight, premature vaginal opening, or cornified cells were found. However, AIHA enhanced the estradiol-induced increase in uterine weights when both were concomitantly administered.
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Affiliation(s)
- G Chamorro
- National School of Biological Sciences, Mexico D.F, Mexico
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45
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Lopez-Segura F, Velasco F, Lopez-Miranda J, Castro P, Lopez-Pedrera R, Blanco A, Jimenez-Pereperez J, Torres A, Trujillo J, Ordovas JM, Pérez-Jiménez F. Monounsaturated fatty acid-enriched diet decreases plasma plasminogen activator inhibitor type 1. Arterioscler Thromb Vasc Biol 1996; 16:82-8. [PMID: 8548431 DOI: 10.1161/01.atv.16.1.82] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [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: 01/31/2023]
Abstract
An increase in levels of plasma plasminogen activator inhibitor type 1 (PAI-1) is one of the main hemostatic alterations in patients with coronary heart disease. Despite growing interest in the fibrinolytic system, few studies have been undertaken to determine the effect exerted on it by the different dietary fatty acids. We investigated the effect of a monounsaturated fat (MUFA)-rich diet in comparison with a low-fat diet (National Cholesterol Education Program step 1 diet) (NCEP-1) on factors involved in blood coagulation and fibrinolysis. We also determined the effect of dietary cholesterol on these blood parameters. Twenty-one young, male, healthy volunteers followed two low-fat/high-carbohydrate diets (< 30% fat, < 10% saturated fat, 14% MUFA) for 24 days each, with 115 or 280 mg of cholesterol per 1000 kcal per day, and two oleic acid-enriched diets (38% fat, 24% MUFA) with the same dietary cholesterol as the low-fat/high-carbohydrate diets. Plasma levels of fibrinogen, thrombin-antithrombin complexes, prothrombin fragments 1+2, plasminogen, alpha 2 antiplasmin, and tissue plasminogen activator were not significantly different among the experimental diets used in this study. Consumption of the diet rich in MUFA resulted in a significant decrease in both PAI-1 plasma activity (P < .005) and antigenic PAI-1 (P < .04) compared with the carbohydrate-rich diet (NCEP-1). The addition of dietary cholesterol to each of these diets did not result in any significant additional effect. Changes in insulin levels and PAI-1 activity were positively correlated (r = .425; P < .02). In conclusion, consumption of diets rich in MUFAs decreases PAI-1 plasma activity, which is accompanied by a parallel decrease in plasma insulin levels.
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Affiliation(s)
- F Lopez-Segura
- Unidad de Lípidos y Arteriosclerosis, Hospital Universitario Reina Sofia, Córdoba, Spain
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Pe´rez-Jime´nez F, Lo´pez-Miranda J, Trujillo J, Blanco-Molina A, Blanco J, Lo´pez Segura F, Jansen S, Jime´nez-Perepe´rez J, Ordovas J. Effect of dietary cholesterol in a high-fat diet rich in oleic acid and in a NCEP-I diet on plasma lipids and HDL binding to peripheral granulocytes. Atherosclerosis 1994. [DOI: 10.1016/0021-9150(94)93588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Abstract
An aqueous extract of Lepidium latifolium L. given orally and intraperitoneally considerably enhanced urinary excretion (UV) in rats with respect to control groups. A slight increase in ion excretion was also observed. Other parameters such as specific gravity, nitrite, pH, glucose, ketone bodies, urobilinogen, and blood were also studied. A good correlation for the dosage rat/man for the aqueous extract was achieved.
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Affiliation(s)
- E Navarro
- Departamento de Farmacología, Facultad de Medicina, Universidad de La Laguna, Tenerife, Canary Islands, Spain
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48
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Lee M, Khouri I, Champlin R, Kantarjian H, Talpaz M, Trujillo J, Freireich E, Deisseroth A, Stass S. Detection of minimal residual disease by polymerase chain reaction of bcr/abl transcripts in chronic myelogenous leukaemia following allogeneic bone marrow transplantation. Br J Haematol 1992; 82:708-14. [PMID: 1482658 DOI: 10.1111/j.1365-2141.1992.tb06948.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The prognostic significance of detecting minimal residual disease by polymerase chain reaction (PCR) amplification of bcr/abl mRNA transcripts was investigated in 27 bone marrow samples from 20 patients with Philadelphia chromosome (Ph1) positive chronic myelogenous leukaemia (CML) in complete cytogenetic remission following allogeneic bone marrow transplantation. Sixteen were transplanted in first chronic phase, two were in second chronic phase, one was in accelerated phase and one was in blast crisis. All 20 achieved complete cytogenetic remission post transplant and 15 patients had detectable bcr/abl mRNA by PCR from 2 to 22 months following the procedure. One of these patients had graft failure and one died from graft-versus-host-disease at 7 months. Of the remaining 13 PCR-positive patients, only one (8%) relapsed after 23 months; the other 12 were alive and still in remission after a median follow-up of 16+ months (ranging 5+ to 29+ months). Five patients were PCR negative; all are alive in complete clinical and cytogenetic remission at 10+, 11+, 19+, 25+ and 25+ months post transplant. In this study, detection of subclinical Ph1-positive cells by PCR was not associated with imminent clinical or cytogenetic relapse. Since late recurrence may potentially occur, long-term follow-up is required to definitely determine the prognostic value of the PCR assay.
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Affiliation(s)
- M Lee
- Hemopathology Program, University of Texas M.D. Anderson Cancer Center, Houston 77030
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49
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Erickson P, Gao J, Chang KS, Look T, Whisenant E, Raimondi S, Lasher R, Trujillo J, Rowley J, Drabkin H. Identification of breakpoints in t(8;21) acute myelogenous leukemia and isolation of a fusion transcript, AML1/ETO, with similarity to Drosophila segmentation gene, runt. Blood 1992; 80:1825-31. [PMID: 1391946] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We have developed a restriction map of the chromosome 21 breakpoint region involved in t(8;21)(q22;q22.3) acute myelogenous leukemia (AML) and have isolated a genomic junction clone containing chromosome 8 and 21 material. Using probes from these regions, rearrangements have been identified in each of nine cases of t(8;21) AML examined. In addition, we have isolated cDNA clones from a t(8;21) AML cDNA library that contain fused sequences from chromosome 8 and 21. The chromosome 8 component, referred to as ETO (for eight twenty-one), is encoded over a large genomic region, as suggested by the analysis of corresponding yeast artificial chromosomes (YACs). The DNA sequence of the chromosome 21 portion of the fusion transcript is derived from the normal AML1 gene. A striking similarity (67% identity over 387 bp, with a corresponding 69% amino acid identity) was detected between AML1 and the Drosophila segmentation gene, runt. The critical consequence of the translocation is the juxtaposition of 5' sequences of AML1 to 3' sequences of ETO, oriented telomere to centromere on the der(8) chromosome.
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MESH Headings
- Amino Acid Sequence
- Animals
- Base Sequence
- CCAAT-Enhancer-Binding Proteins
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 8
- Cloning, Molecular
- DNA Probes
- DNA-Binding Proteins/genetics
- Drosophila/genetics
- Genomic Library
- Humans
- Hybrid Cells
- Leukemia, Myeloid, Acute/genetics
- Molecular Sequence Data
- Nuclear Proteins/genetics
- Protein Kinases/genetics
- Rats
- Restriction Mapping
- Sequence Homology, Amino Acid
- Sequence Homology, Nucleic Acid
- Transcription Factors/genetics
- Transcription, Genetic
- Translocation, Genetic
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Affiliation(s)
- P Erickson
- Division of Medical Oncology, University of Colorado Health Sciences and Cancer Center, Denver 80262
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50
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Kornblau SM, Xu HJ, del Giglio A, Hu SX, Zhang W, Calvert L, Beran M, Estey E, Andreeff M, Trujillo J. Clinical implications of decreased retinoblastoma protein expression in acute myelogenous leukemia. Cancer Res 1992; 52:4587-90. [PMID: 1511426] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The retinoblastoma (RB) protein levels in blast-enriched mononuclear fractions from the peripheral blood of 33 newly diagnosed patients with acute myelogenous leukemia were studied. Ten patients who had previously been treated were also analyzed, nine of whom had achieved prior complete remission. Low RB protein expression was found in 13 of 43 (30%) of the acute myelogenous leukemia patients as determined by Western blotting and immunochemical analysis. Of particular interest among the 20 newly diagnosed patients treated with the same therapeutic regimen, the median survival was 39 days for those with low RB protein expression compared to 333 days for those with high levels of RB protein expression in their leukemic cells (P less than or equal to 0.02). This preliminary study suggests that decreases of RB protein expression in peripheral blood of myeloid leukemic cells occur frequently and may be associated with shortened survival of acute myelogenous leukemia patients.
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Affiliation(s)
- S M Kornblau
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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