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Castell MV, Gutiérrez-Misis A, Sánchez-Martínez M, Prieto MA, Moreno B, Nuñez S, Triano R, de Antonio MP, Mateo C, Cano MD, Garrido A, Julian R, Polentinos E, Rodriguez-Barrientos R, Otero Puime A. Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design. BMC Geriatr 2019; 19:25. [PMID: 30691405 PMCID: PMC6348680 DOI: 10.1186/s12877-018-1024-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/28/2018] [Indexed: 01/06/2023] Open
Abstract
Background Physical activity may reverse frailty in the elderly, but we encounter barriers to the implementation of exercise programs in this population. Our main aim is to evaluate the effect of a multicomponent physical activity program, versus regular medical practice, on reverting pre-frailty status among the elderly, 12 months post-intervention. Methods Randomized parallel group multicenter clinical trial located in primary care setting, among non-dependent and pre-frail patients > 70 years old, including 190 patients (95 intervention, 95 control group). Intervention: Multicomponent physical activity program (MEFAP, for its acronym in Spanish) with twelve 1.5 h-weekly sessions comprised of: 1. Informative session; 2. Exercises for improving aerobic resistance, muscle strength, propioception-balance and flexibility; and 3. Handing out of at-home exercise chart (twice/week). Main variable: pre-frailty according to the Fried phenotype. Secondary variables: sociodemographic, clinical and functional variables; exercise program adherence, patient satisfaction with the program and quality of life. We will perform an intention-to-treat analysis by comparing the retrogression from pre-frailty (1 or 2 Fried criteria) to robust status (0 Fried criteria) by the end of the intervention, 6 months and 12 months post-intervention. The accumulated incidence in each group will be calculated, as well as the relative risk (RR) and the number needed to treat (NNT) with their corresponding 95% confidence intervals. Protocol was approved by the Ethics Committee Hospital la Paz. Discussion Within the context of regular clinical practice, our results will provide evidence regarding the effects of exercise interventions on frailty among pre-frail older adults, a key population given their significant potential for functional, physical, and mental health improvement. Trial registration NCT03568084. Registered 26 June 2018. Date of enrollment of the first participant to the trial: July 2nd 2018.
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Affiliation(s)
- M V Castell
- Doctor Castroviejo Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain.,Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, C/ Arzobispo Morcillo, 2-4, 28049, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - A Gutiérrez-Misis
- Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, C/ Arzobispo Morcillo, 2-4, 28049, Madrid, Spain. .,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - M Sánchez-Martínez
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Health Sciences Department, "Santa Teresa de Jesús" Catholic University of Avila, Avila, Spain
| | - M A Prieto
- Valdelasfuentes Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - B Moreno
- Reina Victoria Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - S Nuñez
- Torrelaguna Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - R Triano
- Miraflores Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - M P de Antonio
- Colmenar Viejo Norte Primary Care Health Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - C Mateo
- Fuencarral Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - M D Cano
- Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, C/ Arzobispo Morcillo, 2-4, 28049, Madrid, Spain.,Fuencarral Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - A Garrido
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Barrio del Pilar Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain
| | - R Julian
- Doctor Castroviejo Primary Care Health University Center. Northern Primary Care Health Directorate of the Community of Madrid, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - E Polentinos
- Research Network in Health Services and Chronic Diseases (REDISSEC), Madrid, Spain.,Family and Community Teaching Unit Norte. Primary Care Management. Madrid Health Service, Madrid, Spain
| | - R Rodriguez-Barrientos
- Research Network in Health Services and Chronic Diseases (REDISSEC), Madrid, Spain.,Research support Unit. Primary Care Management. Madrid Health Service, Madrid, Spain
| | - A Otero Puime
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Preventive Medicine and Public Health Department. Family Medicine and Primary Care Unit. School of Medicine, Autonoma University of Madrid, Madrid, Spain
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Sionis A, Suades R, Sans-Roselló J, Sánchez-Martínez M, Crespo J, Padró T, Cubedo J, Ferrero-Gregori A, Vila-Perales M, Duran-Cambra A, Badimon L. Circulating microparticles are associated with clinical severity of persistent ST-segment elevation myocardial infarction complicated with cardiogenic shock. Int J Cardiol 2018; 258:249-256. [PMID: 29544939 DOI: 10.1016/j.ijcard.2017.10.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/12/2017] [Accepted: 10/12/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) is the leading cause of death in patients admitted for acute myocardial infarction (MI). Despite the recent advances in reperfusion and medical treatment mortality remains unacceptably high. Whether cells of the blood compartment in CS-patients are activated and release microparticles (cMPs) that may be both messengers and biomarkers of cell damage is not known. We aimed to investigate the cMP subtypes and parental activated cells of ST-elevation MI (STEMI)-patients complicated by CS and that of non-CS STEMI-patients (non-CS) in order to identify a cMP signature that could aid CS patient's risk stratification. METHODS Clinically-characterized STEMI-patients with and without CS (36/group) were included. Treatment was delivered according to guidelines and included primary percutaneous coronary intervention. cMPs were characterized by triple-labeling flow cytometry using Annexin V and cell surface-specific monoclonal antibodies. RESULTS Increased levels of leukocyte-derived (neutrophil and granulocyte origin) and platelet-derived cMPs were detected in CS compared to non-CS patients. A signature of cMPs derived from platelets, leukocytes, and endothelium discriminated CS-patients (AUC of 0.743±0.059 [95% CI: 0.628-0.859], P<0.0001) and predicted mortality in CS (AUC of 0.869±0.06 [95% CI: 0.750-0.988], P<0.0001). In CS-patients, a higher number of platelet- and monocyte-cMPs and of tissue factor-rich cMPs associated to worse myocardial blush grade and thrombolysis in myocardial infarction flow. CONCLUSIONS cMPs derived from proinflammatory and prothrombotic cells were found to be elevated in CS-patients. In treated as per guidelines CS patients, granulocytes and neutrophils remained activated and actively shed cMPs. These cMPs were biomarkers of adverse prognosis in CS. TRANSLATIONAL ASPECT Increased levels of leukocyte and platelet-derived circulating microparticles (cMPs) are found in cardiogenic shock (CS) patients as compared to non-CS patients. In CS-patients, a higher number of platelet- and monocyte-cMPs and a higher number of tissue factor-rich cMPs were associated to worse myocardial reperfusion. A specific prothrombotic and proinflammatory cMPs signature in cardiogenic shock (CS) patients is a potential discriminator and survival prognostic biomarker for CS, which could aid management and improve clinical outcomes.
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Affiliation(s)
- A Sionis
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CiberCV, Institute of Health Carlos III, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - R Suades
- ICCC, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - J Sans-Roselló
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Sánchez-Martínez
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - J Crespo
- ICCC, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - T Padró
- CiberCV, Institute of Health Carlos III, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; ICCC, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - J Cubedo
- CiberCV, Institute of Health Carlos III, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; ICCC, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - A Ferrero-Gregori
- Epidemiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Vila-Perales
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - A Duran-Cambra
- Acute and Intensive Cardiac Care Unit, Cardiology Department, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - L Badimon
- CiberCV, Institute of Health Carlos III, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; ICCC, Hospital Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Cardiovascular Research Chair, UAB, Barcelona, Spain.
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Sánchez-Martínez M, Castell M, González-Montalvo J, De la Cruz J, Banegas J, Otero Á. Transitions in functional status of community dwelling older adults: Impact of physical performance, depression and cognition. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Hoyos-Alonso MC, Tapias-Merino E, Meseguer Barros CM, Sánchez-Martínez M, Otero A. Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012. Neurologia 2014; 30:416-24. [PMID: 24704249 DOI: 10.1016/j.nrl.2014.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/07/2014] [Accepted: 02/02/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. OBJECTIVE to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. METHODS Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. RESULTS Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs). In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. CONCLUSIONS Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise.
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Affiliation(s)
- M C de Hoyos-Alonso
- Servicio Madrileño de Salud, Centro de Salud Pedro Laín Entralgo, Alcorcón, Madrid, España.
| | - E Tapias-Merino
- Servicio Madrileño de Salud, Centro de Salud Comillas, Área Centro, Madrid, España
| | - C M Meseguer Barros
- Servicio Madrileño de Salud, Subdirección General de Compras de Farmacia y Productos Sanitarios, Consejería de Sanidad, Comunidad de Madrid, España
| | - M Sánchez-Martínez
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, España
| | - A Otero
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, España
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Sánchez-Martínez M, Da Costa Martins R, Quincoces G, Gamazo C, Caicedo C, Irache J, Peñuelas I. Radiolabeling and biodistribution studies of polymeric nanoparticles as adjuvants for ocular vaccination against brucellosis. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.009] [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: 11/15/2022]
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Pérez-Corona M, Sánchez-Martínez M, Valderrama M, Rodríguez M, Cámara C, Madrid Y. Selenium biotransformation by Saccharomyces cerevisiae and Saccharomyces bayanus during white wine manufacture: Laboratory-scale experiments. Food Chem 2011. [DOI: 10.1016/j.foodchem.2010.07.073] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cuevas M, Fernández-García A, Pinilla M, García-Álvarez V, Thomson M, Delgado E, González-Galeano M, Miralles C, Serrano-Bengoechea E, Ojea de Castro R, López-Álvarez M, Lezáun M, Sánchez-García A, Sánchez-Martínez M, Muñoz-Nieto M, Pérez-Álvarez L. Short communication: Biological and genetic characterization of HIV type 1 subtype B and nonsubtype B transmitted viruses: usefulness for vaccine candidate assessment. AIDS Res Hum Retroviruses 2010; 26:1019-25. [PMID: 20707647 DOI: 10.1089/aid.2010.0018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Due to the extraordinary degree of genetic diversity of HIV-1 and the structural complexity of its envelope glycoproteins, designing an effective vaccine is difficult, requiring the development of viral reagents to assess vaccine-elicited neutralizing antibodies. The aim of this study was to improve on our previously developed panel of HIV-1 strains of different genetic forms, focusing on strains from acute and recently acquired infections as the most representative of the transmitted viruses. HIV-1 primary isolates were expanded in peripheral blood mononuclear cells. Viral stocks of 40 ml each were produced. Syncytium-inducing (SI) phenotype, coreceptor use, and TCID(50)/ml were determined. Near full-length HIV-1 genomes were amplified by RT-nested PCR in four overlapping segments. Phylogenetic analyses were performed with neighbor-joining trees and bootscanning. Forty-four HIV-1 strains were included in the panel. Twenty-four (54.1%) strains were from early infections (16 acute and 8 recent); of them, 21 (87%) were sexually transmitted. NSI/R5 phenotype was detected in 37 (84.1%) viruses and SI/R5,X4 in another 7 (15.9%). TCID(50)/ml ranged between 10(4) and 10(6.6). Twelve different genetic forms constituted this panel: subtypes A1, B, C, F1, and G; circulating recombinant forms CRF02_AG, CRF14_BG, and CRF24_BG; and unique recombinant forms CRF02_AG/A3, BF1, CRF12_BF/B, and DF1G. In conclusion, in this study, we report the development of a comprehensive and well-characterized panel of HIV-1 isolates for assessing neutralization in HIV vaccine research. This panel is available for distribution through the Programme EVA Centre for AIDS Reagents, National Institute for Biological Standard and Control (NIBSC).
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Affiliation(s)
- M.T. Cuevas
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - A. Fernández-García
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Pinilla
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - V. García-Álvarez
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Thomson
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - E. Delgado
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. González-Galeano
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - C. Miralles
- Complejo Hospitalario Universitario Xeral Cies de Vigo, Pontevedra, Galicia, Spain
| | | | | | | | - M.J. Lezáun
- Hospital Txagorritxu, Vitoria, Álava, País Vasco, Spain
| | - A.M. Sánchez-García
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Sánchez-Martínez
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Muñoz-Nieto
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - L. Pérez-Álvarez
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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