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Torres-Borrego J, Sánchez-Solís M. Dissecting Airborne Allergens. J Clin Med 2023; 12:5856. [PMID: 37762797 PMCID: PMC10532401 DOI: 10.3390/jcm12185856] [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: 07/16/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Asthma is a heterogeneous and very complex group of diseases, and includes different clinical phenotypes depending on symptoms, progression, exacerbation patterns, or responses to treatment, among other characteristics. The allergic phenotype is the most frequent, especially in pediatric asthma. It is characterized by sensitization (the production of specific IgEs) to allergens and frequent comorbidity with rhinitis as well as atopic dermatitis. Given the complexity of allergic asthma, knowledge of it must be approached from different points of view: clinical, histological, physiological, epidemiological, biochemical, and immunological, among others. Since partial approaches do not allow for the understanding of this complexity, it is necessary to have multidimensional knowledge that helps in performing the optimal management of each case, avoiding a "blind men and elephant parable" approach. Allergens are antigens that trigger the production of specific IgE antibodies in susceptible individuals, who present symptoms that will depend on the type and intensity of the allergenic load as well as the tissue where the interaction occurs. Airborne allergens cause their effects in the respiratory tract and eyes, and can be indoor or outdoor, perennial, or seasonal. Although allergens such as mites, pollens, or animal dander are generally considered single particles, it is important to note that they contain different molecules which could trigger distinct specific IgE molecules in different patients. General practitioners, pediatricians, and other physicians typically diagnose and treat asthma based on clinical and pulmonary function data in their daily practice. This nonsystematic and nonexhaustive revision aims to update other topics, especially those focused on airborne allergens, helping the diagnostic and therapeutic processes of allergic asthma and rhinitis.
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Affiliation(s)
- Javier Torres-Borrego
- Pediatric Allergy and Pulmonology Unit, Reina Sofia Children’s University Hospital, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Cordoba, Av. Menendez Pidal sn, 14004 Cordoba, Spain
| | - Manuel Sánchez-Solís
- Pediatric Respiratory and Cystic Fibrosis Unit, Virgen de la Arrixaca University Children’s Hospital, Biomedical Research Institute of Murcia (IMIB), University of Murcia, Avda Teniente Flomesta, 5, 30003 Murcia, Spain;
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2
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Núñez-Sánchez MÁ, Jiménez-Méndez A, Suárez-Cortés M, Martínez-Sánchez MA, Sánchez-Solís M, Blanco-Carnero JE, Ruiz-Alcaraz AJ, Ramos-Molina B. Inherited Epigenetic Hallmarks of Childhood Obesity Derived from Prenatal Exposure to Obesogens. Int J Environ Res Public Health 2023; 20:ijerph20064711. [PMID: 36981620 PMCID: PMC10048338 DOI: 10.3390/ijerph20064711] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 06/01/2023]
Abstract
Childhood obesity has reached epidemic levels in developed countries and is becoming a major cause for concern in the developing world. The causes of childhood obesity are complex and multifactorial, involving the interaction between individual genetics and environmental and developmental factors. Among the environmental factors, there is a growing interest in understanding the possible relationship between the so-called environmental obesogens and the development of obesity in children. Exposure to these obesogens such as phthalates, bisphenol A, or parabens, has been identified as a promoter of obesity through different mechanisms such as the alteration of adipocyte development from mesenchymal progenitors, the interference with hormone receptors, and induced inflammation. However, less attention has been paid to the inheritance of epigenetic modifications due to maternal exposure to these compounds during pregnancy. Thus, the aim of this review is to summarize the current knowledge of epigenetic modifications due to maternal exposure to those obesogens during pregnancy as well as their potential implication on long-term obesity development in the offspring and transgenerational inheritance of epiphenotypes.
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Affiliation(s)
- María Á Núñez-Sánchez
- Obesity and Metabolism Research Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Almudena Jiménez-Méndez
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 Murcia, Spain
| | - María Suárez-Cortés
- Department of Nursing, Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain
| | - María A Martínez-Sánchez
- Obesity and Metabolism Research Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Manuel Sánchez-Solís
- Group of Pediatric Research, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
- Respiratory and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, 30120 Murcia, Spain
| | - José E Blanco-Carnero
- Department of Obstetrics and Gynecology, 'Virgen de la Arrixaca' University Clinical Hospital, 30120 Murcia, Spain
- Gynecology, Reproduction and Maternal-Fetal Medicine Research Group, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Antonio J Ruiz-Alcaraz
- Department of Biochemistry, Molecular Biology B and Immunology, School of Medicine, University of Murcia, Regional Campus of International Excellence "Campus Mare Nostrum", 30100 Murcia, Spain
| | - Bruno Ramos-Molina
- Obesity and Metabolism Research Laboratory, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
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3
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Ramos-Navarro C, Maderuelo-Rodríguez E, Concheiro-Guisán A, Pérez-Tarazona S, Rueda-Esteban S, Sánchez-Torres A, Sánchez-Solís M, Sanz-López E, Sánchez-Luna M. Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network. Eur J Pediatr 2022; 181:789-799. [PMID: 34596741 DOI: 10.1007/s00431-021-04248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/12/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 preterm patients diagnosed with BPD. Of the total sample, 90.6% (n = 1591) were less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8-28.5) and median birth weight 885 g (740-1,070 g). A total of 52.5% (n = 922) were classified as mild (type 1), 25.3% (n = 444) were moderate (type 2), and 22.2% (n = 389) were severe BPD (type 3). In patients born at under 30 weeks' gestation, most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV. Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30. What is Known: • BPD is a highly complex multifactorial disease associated with preterm birth. What is New: • The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors. • Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.
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Affiliation(s)
- Cristina Ramos-Navarro
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain.
| | - Elena Maderuelo-Rodríguez
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
| | - Ana Concheiro-Guisán
- Neonatologist at Neonatology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
| | | | - Santiago Rueda-Esteban
- Pediatric Pulmonologist at Pulmonology Department, San Carlos University Hospital, Madrid, Spain
| | - Ana Sánchez-Torres
- Neonatologist at Neonatology Department, La Paz University Hospital, Madrid, Spain
| | - Manuel Sánchez-Solís
- Pediatric Pulmonologist at Pulmonology Department, Virgen Arrixaca University Hospital Murcia, Murcia, Spain
| | - Ester Sanz-López
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O'Donnell 48 street, 28009, Madrid, Spain
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4
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Azurmendi-Funes ML, Martínez-Villanueva M, Delgado-Marín JL, Ramis R, Sánchez-Sauco MF, López-Hernández FA, Sánchez-Solís M, Monteagudo-Piqueras O, Noguera-Velasco JA, Claudio L, Ortega-García JA. An Integrative Screening Tool of Alcohol Exposure During Early Pregnancy: Combining of the CDT Biomarker with Green Page Questionnaire. Alcohol Alcohol 2020; 54:599-608. [PMID: 31612211 DOI: 10.1093/alcalc/agz073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman by applying questionnaires. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy. METHODS A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data. RESULTS About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women's body mass index and European white race. CONCLUSION Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.
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Affiliation(s)
- María Luisa Azurmendi-Funes
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Miriam Martínez-Villanueva
- Clinical Laboratory, University Clinical Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Juan Luís Delgado-Marín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Virgen de la Arrixaca University Hospital, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Rebecca Ramis
- Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute and Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Avda. Monforte de Lemos 5, 28029 Madrid, Spain
| | - Miguel Felipe Sánchez-Sauco
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Fernando Antonio López-Hernández
- Departamento de Métodos Cuantitativos e Informáticos, Universidad Politécnica de Cartagena, C/ Real, 3; 30201 Cartagena, Murcia, Spain
| | - Manuel Sánchez-Solís
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | | | - José Antonio Noguera-Velasco
- Clinical Laboratory, University Clinical Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Luz Claudio
- Department of Environmental Medicine and Public Health, Mount Sinai School of Medicine, One Gustave L. Levy Place, #1057, New York, NY, 10029-6574, USA
| | - Juan Antonio Ortega-García
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5) Institute of Biomedical Research, IMIB-Arrixaca, Virgen de la Arrixaca University Hospital, University of Murcia, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
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5
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Sánchez-Campillo M, Ruiz-Palacios M, Ruiz-Alcaraz AJ, Prieto-Sánchez MT, Blanco-Carnero JE, Zornoza M, Ruiz-Pastor MJ, Demmelmair H, Sánchez-Solís M, Koletzko B, Larqué E. Child Head Circumference and Placental MFSD2a Expression Are Associated to the Level of MFSD2a in Maternal Blood During Pregnancy. Front Endocrinol (Lausanne) 2020; 11:38. [PMID: 32117064 PMCID: PMC7012934 DOI: 10.3389/fendo.2020.00038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a world-wide health challenge, which prevalence is expected to increase in parallel to the epidemic of obesity. Children born from GDM mothers have lower levels of docosahexaenoic acid (DHA) in cord blood, which might influence their neurodevelopment. Recently, the membrane transporter Major Family Super Domain 2a (MFSD2a) was associated with the selective transportation of DHA as lysophospholipids. The expression of the DHA membrane transporter MFSD2a is lower in GDM placentas, which could affect materno-fetal DHA transport. Humans with homozygous inactivating mutations in the MFSD2a gene present severe microcephaly and intellectual impairments. Herein, we intended to identify early blood biomarkers that may be of use during pregnancy to monitor the offspring development and the adequate nutritional interventions, such as nutritional supplementation, that may be selected to improve it. We evaluated MFSD2a expression in maternal blood at the third trimester of pregnancy, and its potential relationship with the expression of placental MFSD2a at delivery and child outcomes. Three groups of pregnant women were recruited: 25 controls, 23 GDM with dietary treatment, and 20 GDM with insulin treatment. Maternal and neonatal anthropometric and biochemical parameters were evaluated. MFSD2a was analyzed in placenta, blood and serum. MFSD2a protein expression in maternal blood was significantly lower in GDM groups and correlated with placental MFSD2a and Z-score neonatal head circumference during the first 6 months of life. The cord/maternal serum ratio of DHA, a solid indicator of materno-fetal DHA transport, was reduced in GDM groups and correlated with MFSD2a in maternal blood at the third trimester and in placenta at delivery. This indicates that altered MFSD2a levels in maternal blood during pregnancy might influence placental nutrient transport and fetal neurodevelopment. Furthermore, MFSD2a levels in maternal blood on the third trimester were inversely correlated to DHA in maternal serum lyso-PL. Thus, the level of MFSD2a in maternal blood could be used as a potential biomarker for the early detection of disturbances of MFSD2a expression during pregnancy and the subsequent consequences for the neurodevelopment of the child, as well as it may help to choose the optimal treatment approach for the affected subjects.
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Affiliation(s)
- María Sánchez-Campillo
- Department of Physiology, Faculty of Biology, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
| | - María Ruiz-Palacios
- Department of Physiology, Faculty of Biology, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
| | - Antonio J. Ruiz-Alcaraz
- Department of Biochemistry, Molecular Biology B and Immunology, Faculty of Medicine, Regional Campus of International Excellence Campus Mare Nostrum and Biomedical Research Institute of Murcia (IMIB), University of Murcia, Murcia, Spain
| | | | | | - Matilde Zornoza
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - María José Ruiz-Pastor
- Department of Physiology, Faculty of Biology, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
| | - Hans Demmelmair
- Ludwig-Maximilians-University Munich, Dr. von Hauner Children's Hospital, München, Germany
| | | | - Berthold Koletzko
- Ludwig-Maximilians-University Munich, Dr. von Hauner Children's Hospital, München, Germany
| | - Elvira Larqué
- Department of Physiology, Faculty of Biology, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
- *Correspondence: Elvira Larqué
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6
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Cárceles-Álvarez A, Ortega-García JA, López-Hernández FA, Fuster-Soler JL, Ramis R, Kloosterman N, Castillo L, Sánchez-Solís M, Claudio L, Ferris-Tortajada J. Secondhand smoke: A new and modifiable prognostic factor in childhood acute lymphoblastic leukemias. Environ Res 2019; 178:108689. [PMID: 31479979 DOI: 10.1016/j.envres.2019.108689] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The 5-year overall survival (OS) in childhood acute lymphoblastic leukemia (ALL) has reached 90% in high-income countries, levels that can no be longer overcome with strategies based on intensification of treatment. Other approaches in the search for new and modifiable prognostic factors are necessary to continue to improve these rates. The importance of environmental factors in the etiopathogenesis of childhood ALL has been regaining interest but its role in the prognosis and survival of this disease is not well explored. We aim to investigate the association between secondhand smoke (SHS) and survival in children diagnosed with ALL. METHODS We analyzed survival rates in 146 patients under the age of 15 years diagnosed with ALL between January 1998 and May 2016 in the Region of Murcia, Spain. Evaluation of parental SHS and other known prognostic factors (sex, age, white blood cell count at diagnosis, cytogenetics, NCI/Rome Criteria, early response to therapy, and relapse) were assessed for impact on OS, event-free survival (EFS), cumulative incidence of relapse (CIR), and treatment-related mortality (CITRM) using Kaplan-Meier analysis, Cox regression, and Fine-Gray model. RESULTS The mean follow-up time was 105.3 months (±66.5). Prenatal exposure to SHS due to parental smoking was highly prevalent. Of the mothers, 44.4% and 55.5% of the fathers smoked at some point during pregnancy. After the child's diagnosis of ALL 39.7% of mothers and 45.9% of fathers reported smoking. The Cox proportional hazards model showed that maternal smoking during pregnancy and after diagnosis (HR = 4.396, 95% CI: 1.173-16.474, p = 0.028); and relapse (HR = 7.919; 95% CI: 2.683-21.868; p < 0.001) are independent prognostic factors in determining survival. The Fine-Gray model showed that maternal smoking during pregnancy and after diagnosis (HR = 14.525, 95% CI: 4.228-49.90, p < 0.001) is an independent prognostic factor in CITRM. CONCLUSIONS Persistent SHS worsens OS and TRM in children with ALL. This negative impact contributes to a different prognosis and may possibly provide an exceptional insight into new therapeutic approaches, including environmental aspects such as prevention and smoking cessation to improve survival outcomes.
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Affiliation(s)
- Alberto Cárceles-Álvarez
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Environmental Health Speciality Unit, Department of Pediatrics, Laboratory of Environment and Human Health (A5), Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - Juan A Ortega-García
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Environmental Health Speciality Unit, Department of Pediatrics, Laboratory of Environment and Human Health (A5), Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain.
| | - Fernando A López-Hernández
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Department of Quantitative Methods and Computing, Technical University of Cartagena, Spain
| | - José L Fuster-Soler
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Onco-Hematology Section, Department of Pediatrics, Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | - Rebeca Ramis
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain; Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Spain
| | - Nicole Kloosterman
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Environmental Health Speciality Unit, Department of Pediatrics, Laboratory of Environment and Human Health (A5), Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - Luis Castillo
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Onco-Hematology Department, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Manuel Sánchez-Solís
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Pediatric Neumology Section, Department of Pediatrics, Institute of Biomedical Research (IMIB-Arrixaca), Clinical University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | - Luz Claudio
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Department of Environmental Medicine and Public Health, Division of International Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josep Ferris-Tortajada
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Spain; Environmental Health Committee, Spanish Pediatric Association, Madrid, Spain
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7
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Sánchez-Solís M, García-Marcos L. Bronchopulmonary Dysplasia: The Importance Of Physical Exercise. Arch Bronconeumol 2019; 55:609-610. [PMID: 30846204 DOI: 10.1016/j.arbres.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Manuel Sánchez-Solís
- Unidad de Neumología, Hospital Infantil Virgen de la Arrixaca, El Palmar, Murcia, España; Red de Asma, Reacciones Adversas y Alérgicas (ARADyAL), España; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, España
| | - Luis García-Marcos
- Unidad de Alergia, Hospital Infantil Virgen de la Arrixaca, El Palmar, Murcia, España; Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, Murcia, España.
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Abstract
Asthmatic adults with lower lung function have been described as having had this worse condition early in life. Lung function is reduced in children with persistent asthma and continues low throughout adult life. The challenge is to know if impaired lung function is a risk factor of asthma, as a consequence of special congenital characteristics of the airways, or whether asthmatic patients suffer a loss in lung function as early as 9 years of age as a consequence of very precocious remodeling of the airways. The loss is so early in life that it is probably a congenital characteristic, however there is not a cut-off point with clinical interest to predict risk of asthma later in life. There are contradictory results regarding whether asthmatic children lose lung function as a consequence of the airway remodeling by the illness itself. This aspect seemed to be shown for children at risk-the offspring of asthmatic mothers. The early BHR seems to be very frequent even in healthy infants, but is probably not a risk factor for asthma years later; except in the offspring of asthmatic mothers in which it has been shown. There are still many uncertainties in this field; so, more research is needed in order to better understand the pathophysiology of asthma, the early risk factors and to design new therapeutic targets and early interventions to change the natural history of the disease.
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Affiliation(s)
- Manuel Sánchez-Solís
- Department of Pediatric, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Biomedical Research Institute of Murcia (IMIB), Palmar, Spain.,Department of Surgery, Pediatric, Obstetric and Gynaecology, University of Murcia, Murcia, Spain
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9
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Conesa-Segura E, Reyes-Dominguez SB, Ríos-Díaz J, Ruiz-Pacheco MÁ, Palazón-Carpe C, Sánchez-Solís M. Prolonged slow expiration technique improves recovery from acute bronchiolitis in infants: FIBARRIX randomized controlled trial. Clin Rehabil 2018; 33:504-515. [PMID: 30442030 DOI: 10.1177/0269215518809815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To examine the effect of prolonged slow expiration respiratory physiotherapy treatment on the acute bronchiolitis severity scale and O2 saturation at short-time and at medical discharge in infants and the hospital stay. DESIGN: Randomized controlled trial. SETTING: Infants' unit of university hospital. PARTICIPANTS: Infants with acute bronchiolitis ( N = 80). INTERVENTION: Infants were randomized into respiratory treatment (RT) with prolonged slow expiration or treatment as usual (control) for one-week period. MAIN OUTCOME MEASURES: The primary outcomes were Acute Bronchiolitis Severity Scale score and O2 saturation, recorded shortly after each intervention during the stay and at medical discharge, and the hospital stay. RESULTS: The RT had a significantly lower Acute Bronchiolitis Severity Scale 10-minute after the first intervention (mean difference -1.7 points, 95% confidence interval (CI) -3.0 to -0.38), 2 hours after (-2.0 points, 95% CI -3.2 to -0.86) and the last day before medical discharge (-1.3 points, 95% CI -2.1 to 0.51). No changes were detected in O2 saturation. The survival analysis of time at medical discharge showed decrease in the average number of days to achieve an Acute Bronchiolitis Severity Scale of less than 2 points (RT: 2.6 days, 95% CI 2.1-3.1; Control: 4.4 days, 95% CI 3.6-5.1). CONCLUSION: A prolonged slow expiration physiotherapy reduces Acute Bronchiolitis Severity Scale scores and does not change O2 saturation. Infants in RT group stay less days in hospital than infants in control group and no adverse events were detected.
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Affiliation(s)
- Enrique Conesa-Segura
- 1 Programa de Doctorado en Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | | | - José Ríos-Díaz
- 3 Centro Universitario de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain.,4 Fundación San Juan de Dios, Madrid, Spain
| | | | | | - Manuel Sánchez-Solís
- 6 Paediatric Neumology, Virgen Arrixaca University Children's Hospital, Murcia, Spain
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Ortega-García JA, Sánchez-Solís M, Ferrís-Tortajada J. Contaminación atmosférica y salud de los niños. An Pediatr (Barc) 2018; 89:77-79. [DOI: 10.1016/j.anpedi.2018.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022] Open
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Sanchez-Luna M, Burgos-Pol R, Oyagüez I, Figueras-Aloy J, Sánchez-Solís M, Martinón-Torres F, Carbonell-Estrany X. Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain. BMC Infect Dis 2017; 17:687. [PMID: 29041909 PMCID: PMC5645982 DOI: 10.1186/s12879-017-2803-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/07/2017] [Accepted: 10/06/2017] [Indexed: 12/22/2022] Open
Abstract
Background This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age –wGA-) in Spain. Methods A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes. Results Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model. Conclusions The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in Spain. Electronic supplementary material The online version of this article (10.1186/s12879-017-2803-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Sanchez-Luna
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Burgos-Pol
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain
| | - J Figueras-Aloy
- Hospital Clinic, Catedratic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | | | - F Martinón-Torres
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - X Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
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Villalona S, Glover-López G, Ortega-García JA, Moya-Quiles R, Mondejar-López P, Martínez-Romero MC, Rigabert-Montiel M, Pastor-Vivero MD, Sánchez-Solís M. R248G cystic fibrosis transmembrane conductance regulator mutation in three siblings presenting with recurrent acute pancreatitis and reproductive issues: a case series. J Med Case Rep 2017; 11:42. [PMID: 28196530 PMCID: PMC5310058 DOI: 10.1186/s13256-016-1181-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/29/2015] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Mutational combinations of the cystic fibrosis transmembrane conductance regulator, CFTR, gene have different phenotypic manifestations at the molecular level with varying clinical consequences for individuals possessing such mutations. Reporting cystic fibrosis transmembrane conductance regulator mutations is important in understanding the genotype-phenotype correlations and associated clinical presentations in patients with cystic fibrosis. Understanding the effects of mutations is critical in developing appropriate treatments for individuals affected with cystic fibrosis, non-classic cystic fibrosis, or cystic fibrosis transmembrane conductance regulator-related disorders. This is the first report of related individuals possessing the R248G missense cystic fibrosis transmembrane conductance regulator mutation and we present their associated clinical histories. Case presentation All three patients are of Spanish descent. Deoxyribonucleic acid analysis revealed that all three siblings possessed a novel c.742A>G mutation, resulting in a p.Arg248Gly (R248G) amino acid change in exon 6 in trans with the known N1303K mutant allele. Case 1 patient is a 39-year-old infertile man presenting with congenital unilateral absence of the vas deferens and recurrent episodes of epigastric pain. Case 2 patient is a 32-year-old woman presenting with periods of infertility, two previous spontaneous abortions, recurrent epigastric pain, and recurrent pancreatitis. Case 3 patient is a 29-year-old woman presenting with recurrent pancreatitis and epigastric pain. Conclusions We report the genotype-phenotype correlations and clinical manifestations of a novel R248G cystic fibrosis transmembrane conductance regulator mutation: congenital unilateral absence of the vas deferens in males, reduced female fertility, and recurrent acute pancreatitis. In addition, we discuss the possible functional consequences of the mutations at the molecular level. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-1181-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seiichi Villalona
- Pediatric Environmental Health Specialty Unit, University Hospital Virgen of Arrixaca, Murcia, Spain
| | | | | | - Rosa Moya-Quiles
- Center of Clinical Genetics, University Hospital Virgen of Arrixaca, Murcia, Spain
| | - Pedro Mondejar-López
- Cystic Fibrosis Unit, Pediatric Neumology, University Hospital Virgen of Arrixaca, Murcia, Spain
| | | | | | - María D Pastor-Vivero
- Cystic Fibrosis Unit, Pediatric Neumology, University Hospital Virgen of Arrixaca, Murcia, Spain
| | - Manuel Sánchez-Solís
- Cystic Fibrosis Unit, Pediatric Neumology, University Hospital Virgen of Arrixaca, Murcia, Spain
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Garcia-Marcos L, Sánchez-Solís M. The fatum of preterm lungs: Every week counts. Allergol Immunopathol (Madr) 2016; 44:487-488. [PMID: 27836069 DOI: 10.1016/j.aller.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
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Ortega-García JA, Perales JE, Cárceles-Álvarez A, Sánchez-Sauco MF, Villalona S, Mondejar-López P, Pastor-Vivero MD, Mira Escolano P, James-Vega DC, Sánchez-Solís M. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients. Adicciones 2016; 28:99-107. [PMID: 26990263 DOI: 10.20882/adicciones.778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.
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Plaza A, Ibáñez M, Sánchez-Solís M, Bosque-García M, Cabero M, Corzo J, García-Hernández G, de la Hoz B, Korta-Murua J, Sánchez-Salguero C, Torres-Borrego J, Tortajada-Girbés M, Valverde-Molina J, Zapatero L, Nieto A. Consensus-based approach for severe paediatric asthma in routine clinical practice. Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.08.011] [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: 11/17/2022] Open
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Plaza AM, Ibáñez MDP, Sánchez-Solís M, Bosque-García M, Cabero MJ, Corzo JL, García-Hernández G, de la Hoz B, Korta-Murua J, Sánchez-Salguero C, Torres-Borrego J, Tortajada-Girbés M, Valverde-Molina J, Zapatero L, Nieto A. [Consensus-based approach for severe paediatric asthma in routine clinical practice]. An Pediatr (Barc) 2015; 84:122.e1-122.e11. [PMID: 26515042 DOI: 10.1016/j.anpedi.2015.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines. MATERIAL AND METHODS An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results. RESULTS Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids. CONCLUSIONS This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.
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Affiliation(s)
- A M Plaza
- Alergología Infantil, Hospital Sant Joan de Deu, Barcelona, España
| | - M D P Ibáñez
- Alergología Infantil, Hospital Niño Jesús, Madrid, España
| | - M Sánchez-Solís
- Neumología Infantil, Hospital Virgen de la Arrixaca, Murcia, España
| | - M Bosque-García
- Unidad de Alergia, Neumología e Inmunología Pediátrica, Hospital de Sabadell, Corporación Universitaria Parc Taulí, Barcelona, España
| | - M J Cabero
- Neumología Infantil, Hospital Marqués de Valdecilla, , Santander, España
| | - J L Corzo
- Sección de Alergia Infantil, HMI, Málaga, España
| | - G García-Hernández
- Neumología y Alergia Pediátricas, Hospital Universitario 12 de Octubre, Madrid, España
| | - B de la Hoz
- Alergología Infantil, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Korta-Murua
- Neumología Infantil, Hospital Universitario Donostia, San Sebastián, España
| | | | - J Torres-Borrego
- Unidad de Alergia y Neumología Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España
| | - M Tortajada-Girbés
- Neumología y Alergología Infantil, Hospital Universitario Dr. Peset, Valencia, España
| | - J Valverde-Molina
- Neumología Infantil, Hospital Universitario Los Arcos del Mar Menor, San Javier (Murcia), España
| | - L Zapatero
- Alergología Infantil, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - A Nieto
- Neumología y Alergología Infantil, Hospital La Fe, Valencia, España.
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Zornoza-Moreno M, Fuentes-Hernández S, Carrión V, Alcántara-López MV, Madrid JA, López-Soler C, Sánchez-Solís M, Larqué E. Is low docosahexaenoic acid associated with disturbed rhythms and neurodevelopment in offsprings of diabetic mothers? Eur J Clin Nutr 2014; 68:931-7. [DOI: 10.1038/ejcn.2014.104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/20/2014] [Accepted: 04/18/2014] [Indexed: 02/08/2023]
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Bernal MJ, Periago MJ, Martínez R, Ortuño I, Sánchez-Solís M, Ros G, Romero F, Abellán P. Effects of infant cereals with different carbohydrate profiles on colonic function--randomised and double-blind clinical trial in infants aged between 6 and 12 months--pilot study. Eur J Pediatr 2013; 172:1535-42. [PMID: 23812516 DOI: 10.1007/s00431-013-2079-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/16/2013] [Indexed: 11/30/2022]
Abstract
Infant cereals are often the elected foodstuff for beginning complementary feeding and provide carbohydrates which are different to those found in maternal milk. The objective of this preliminary study was to ascertain the colonic effects of two infant cereals, with different carbohydrate profiles, in a randomised and double-blind trial in healthy infants. Nineteen term infants between 6.3 and 9.8 months of age were enrolled, after written informed consent was obtained from parents. Ten subjects were allocated to take infant cereal A and nine, infant cereal B. An intervention period was 2 months, with five visits every 15 days, to take anthropometric measurements and faeces samples for the analysis of microbiota, short-chain fatty acids concentration (SCFA), pH value and secretory immunoglobulin A (sIgA). An adequate growth and stool frequency was registered in both intervention groups. Faecal counts of Bifidobacterium, Lactobacillus, Enterobacteriaceae, Enterococcus, Clostridium and Bacteroides did not show any statistical differences. However, a significantly (P < 0.05) higher butyric acid and sIgA, and lower faecal pH were observed in infants who had ingested infant cereal A, with a higher ratio complex/simple carbohydrates. In conclusion, small changes in the carbohydrate profile of infant cereals could lead to significant differences in parameters related to fermentative activity of intestinal microbiota.
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Affiliation(s)
- María José Bernal
- Global Technology Center For Infant Nutrition, Hero Group, Avda. Murcia 1, 30820, Alcantarilla, Murcia, Spain,
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Muro M, Mondejar-López P, Moya-Quiles MR, Salgado G, Pastor-Vivero MD, Lopez-Hernandez R, Boix F, Campillo JA, Minguela A, Garcia-Alonso A, Sánchez-Solís M, Álvarez-López MR. HLA-DRB1 and HLA-DQB1 genes on susceptibility to and protection from allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Microbiol Immunol 2013; 57:193-7. [PMID: 23278646 DOI: 10.1111/1348-0421.12020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 01/17/2023]
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity pulmonary disease that affects both patients with cystic fibrosis (CF) and those with asthma. HLA-DRB1 alleles have previously been associated with ABPA-CF susceptibility; however, HLA-DQB1 allele associations have not been clearly established. The aim of the present study was to investigate HLA class II associations in patients with ABPA-CF and determine their roles in susceptibility or protection. Patients with ABPA-CF, patients with CF without ABPA, patients with asthma without ABPA (AST), and healthy controls were included in this study. DNA was extracted by automatic extractor. HLA-DRB1 and -DQB1 genotyping was performed by the Luminex PCR-SSOP method (One Lambda, Canoga Park, CA, USA). Allele specific PCR-SSP was also performed by high-resolution analysis (One Lambda). Statistical analysis was performed with SSPS and Arlequin software. Both HLA-DRB1*5:01 and -DRB1*11:04 alleles occurred with greater frequency in patients with ABPA-CF than in those with AST and CF and control subjects, corroborating previously published data. On the other hand, analysis of haplotypes revealed that almost all patients with ABPA-CF lacking DRB1*15:01 or DRB1*11:04 carry either DRB1*04, DRB1*11:01, or DRB1*07:01 alleles. In the HLA-DQB1 region, the HLA-DQB1*06:02 allele occurred more frequently in patients with ABPA-CF than in those with AST and CF and healthy controls, whereas HLA-DQB1*02:01 occurred less frequently in patients with ABPA-CF. These data confirm that there is a correlation between HLA-DRB1*15:01, -DRB1*11:04, DRB1*11:01, -DRB1*04 and -DRB1*07:01 alleles and ABPA-CF susceptibility and suggest that HLA-DQB1*02:01 is an ABPA-CF resistance allele.
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Affiliation(s)
- Manuel Muro
- Immunology Service, University Hospital Virgen Arrixaca, Madrid-Cartagena Rd, 30120, El Palmar, Murcia, Spain.
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Menasalvas-Ruiz AI, Salvador-García C, Moreno-Docón A, Alfayate-Miguélez S, Pérez Cánovas C, Sánchez-Solís M. Enterovirus reverse transcriptase polymerase chain reaction assay in cerebrospinal fluid: an essential tool in meningitis management in childhood. Enferm Infecc Microbiol Clin 2012; 31:71-5. [PMID: 23238160 DOI: 10.1016/j.eimc.2012.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/10/2012] [Accepted: 07/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Enteroviruses (EV) are the main aetiological agents of aseptic meningitis in children and a common cause of febrile illnesses in young infants in summer. A rapid diagnosis is essential to rule out other conditions. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay performed in cerebrospinal fluid (CSF) has proved to be a very fast and useful tool. METHODS We collected demographic, clinical and laboratory data of children (aged 11-years or younger) with EV RT-PCR (Cepheid(®) Xpert EV) positive in CSF from December 2007 to July 2010, to describe EV meningitis in children and to determine the role of this assay. RESULTS We included 92 children (mean age 2.5 years), 32% of whom were neonates. There was no pleocytosis in the CSF of 18.5% (36% in newborn) of the patients, and 23 (25%) were discharged to home from the Emergency Room after the positive results. Length of hospital stay was 2 days (>2 years) versus 4.5 days in newborns (P<0.0001). Antibiotic treatment was prescribed in 38% (75% <3 months), but in 40% of these, it was stopped after the positive results. Mean EV RT-PCR information time was 7h (4-18h). All children had a good clinical outcome. CONCLUSIONS EV RT-PCR assay in CSF has played an essential role in the management of children with EV meningitis, allowing earlier discharges and decreasing avoidable inappropriate antibiotic treatments. This test should be considered as part of the initial study of children with aseptic meningitis, especially during epidemic seasons.
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Affiliation(s)
- Ana Isabel Menasalvas-Ruiz
- Unidad de Enfermedades Infecciosas-Servicio de Pediatría, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
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Ortega-García JA, López-Fernández MT, Llano R, Pastor-Vivero MD, Mondéjar-López P, Sánchez-Sauco MF, Sánchez-Solís M. Smoking prevention and cessation programme in cystic fibrosis: integrating an environmental health approach. J Cyst Fibros 2011; 11:34-9. [PMID: 22000068 DOI: 10.1016/j.jcf.2011.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Received: 05/05/2011] [Revised: 07/13/2011] [Accepted: 09/15/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND There have been several studies assessing the epidemiology and effects of tobacco smoke in the cystic fibrosis (CF) population, but few address the efforts of smoking cessation interventions. Our objective is to present one tobacco prevention and cessation programme targeting patients with CF in the Mediterranean region of Murcia (Spain). METHODS All registered patients in the Regional CF unit (n=105) in 2008 were included in a cross-sectional and prospective uncontrolled study of tobacco use and exposure in CF patients using a baseline and 1-year follow-up. Target population includes both patients and other family members living at home. The study included an initial telephone questionnaire, measurement of lung function, urinary cotinine levels, and several telephone counselling calls and/or personalised smoking cessation services. RESULTS Of the 97 contacted patients, 59.8% (n=58) were exposed to environmental tobacco smoke (ETS), 12.4% (n=12) had smoked at one time, and 14.3% (n=8) of patients over the age of 15 actively smoked. The mean age was 31.13 (range: 19-45). Of the non-smokers (n=89), 56.2% reported ETS and 26.9% live with at least one smoker at home. 49.2% had urinary cotinine levels >10 ng/ml. The correlation found between patients' cotinine levels and their reported tobacco exposure was (0.77, p<0.0001). Active smoking by mothers during pregnancy was associated with significantly lower lung function in young CF patients (-0.385, p=0.04). At the 1-year follow-up, 13 individuals made attempts to stop smoking, 6 of which are now ex-smokers (12.5% of all smokers). CONCLUSIONS Smoking during pregnancy adversely affects lung function in individuals with CF. Tobacco prevention and cessation programmes are an effective and vital component for CF disease management. The trained professionals in prevention and smoking cessation services could provide patients with adequate follow-up, integrating an environmental health approach into CF patients' healthcare.
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Pastor-Vivero M, Martínez-Carrasco E, Mondéjar-López P, López-Fernández M, Ortega-García J, Sánchez-Solís M. Tobacco smoke exposure and effectiveness of a smoking cessation program in cystic fibrosis patients and their relatives. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60451-1] [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: 11/27/2022]
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Ortega-García JA, Rodriguez K, Calatayud M, Martin M, Vélez D, Devesa V, Sánchez-Alarcon MC, Torres Cantero AM, Galindo-Cascales C, Gil-Vázquez JM, Sánchez-Sauco MF, Sánchez-Solís M, Alfonso-Marsilla B, Romero-Braquehais F. Estimated intake levels of methylmercury in children, childbearing age and pregnant women in a Mediterranean region, Murcia, Spain. Eur J Pediatr 2009; 168:1075-80. [PMID: 19096874 DOI: 10.1007/s00431-008-0890-z] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 11/24/2008] [Indexed: 11/25/2022]
Abstract
Methylmercury (MeHg) is a bioaccumulable toxin in the trophic chain and a powerful neurotoxin during fetal and child development. Consumption of contaminated fish and shellfish is a principal environmental source of MeHg exposure. This study was designed to assess the Hg and estimated MeHg intake in vulnerable groups of the Murcia region, a Mediterranean part of Spain, compared with international regulations. A validated food frequency questionnaire was used to assess seafood consumptions in 320 children younger than 10 years, 301 women of childbearing age, and 537 pregnant women. Hg concentrations were measured in the most consumed fish products by cold vapor generation-atomic fluorescence spectrometry. The weekly intake of MeHg (microg/kg bw/week) was 2.60 (95% CI = 2.10-3.10) in children 1-5 years, 2.65 (95% CI = 2.26-3.03) in children 6-10 years, 0.98 (95% CI = 0.89-1.07) in women of childbearing age, and 0.88 (95% CI = 0.81-0.95) in pregnant women. The main exposure to MeHg, especially in young children, is related to intake of bluefin tuna and swordfish. Fifty-four percent of children aged 1-10 years, 10% of pregnant women, and 15% of women of childbearing age exceed the Joint Expert Committee on Food Additives provisional tolerable weekly intake of MeHg. In the Murcia region, where fish is a central component of the diet, the focus should be on educating vulnerable populations to reorient fish consumption in order to lower the amount of Hg incorporated with the diet as well as to reduce Hg emissions into the environment.
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Affiliation(s)
- Juan Antonio Ortega-García
- Pediatric Environmental Health Specialty Unit (PEHSU-Murcia), Hospital University Virgen de la Arrixaca, El Palmar, Murcia CP 30120, Spain.
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Sánchez-Bahíllo M, García-Marcos L, Pérez-Fernández V, Martínez-Torres AE, Sánchez-Solís M. [Trends in asthma mortality in Spain from 1960 to 2005]. Arch Bronconeumol 2009; 45:123-8. [PMID: 19286113 DOI: 10.1016/j.arbres.2008.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/27/2008] [Accepted: 05/29/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE No data have been published on trends in asthma mortality in Spain between 1960 and 2005. The aim of this study was to trace these trends for both the general population and the 5- to 34-year age group in Spain. MATERIAL AND METHODS The data on asthma mortality for the general population and by age and sex were obtained from the Spanish National Institute of Statistics and used to calculate the asthma mortality rates per 100 000 inhabitants. RESULTS The overall asthma mortality rate per 100 000 inhabitants was 9.36 in 1960 and 2.22 in 2005, showing a reduction from 12.26 to 0.96 in males and from 6.58 to 3.44 in females. In the 5- to 34-year age group, the mortality rate for both sexes ranged from 0.4 to 0.1, showing great variability over time. CONCLUSIONS Asthma mortality decreased in the period analyzed, but less in women than in men. The trend and rates in Spain are similar to those of most countries for which data are available.
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Affiliation(s)
- María Sánchez-Bahíllo
- Fundación para la Formación e Investigación Sanitarias de la Región de Murcia (FFIS), Murcia, España.
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Valverde-Molina J, Sánchez-Solís M, Pastor-Vivero MD, García-Marcos L. Asociación entre colonización-infección crónica por Pseudomonas aeruginosa e hiperreactividad bronquial en pacientes con fibrosis quística. Arch Bronconeumol 2008. [DOI: 10.1157/13119536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Valverde-Molina J, Sánchez-Solís M, Pastor-Vivero MD, García-Marcos L. [Association between chronic colonization or infection with Pseudomonas aeruginosa and bronchial hyperreactivity in patients with cystic fibrosis]. Arch Bronconeumol 2008; 44:180-184. [PMID: 18423178] [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: 05/26/2023]
Abstract
OBJECTIVE In patients with cystic fibrosis, bronchial hyperreactivity is a common finding that has not been conclusively associated with atopy. The objective of the present study was to determine the relationship between chronic colonization or infection with Pseudomonas aeruginosa and bronchial hyperreactivity in a group of patients with cystic fibrosis. PATIENTS AND METHODS A nonspecific histamine bronchial provocation test was administered to a group of 32 cystic fibrosis patients with a mean (SD) age of 11.25 (3.7) years. The presence of atopy and of chronic colonization or infection with P aeruginosa was also studied. RESULTS Nine of the 32 patients (28.1%) studied showed bronchial hyperreactivity. The clinical status of these 9 patients was significantly worse and all were colonized or infected with P aeruginosa. Atopy was present in 17 of the 32 patients (53.1%) in the study group, but in only 3 of the 9 patients (33.3%) with bronchial hyperreactivity. Bronchial hyperreactivity was significantly associated with colonization or infection with P aeruginosa (P< .001), but not with atopy (P=.12). In the patients without atopy, colonization was significantly associated with bronchial hyperreactivity (P=.017). In the group with normal lung function (forced expiratory volume in 1 second >/=80%) this association was also significant (P=.044), while the association between bronchial hyperreactivity and atopy was not (P=.11). CONCLUSIONS The results of the present study suggest that in patients with cystic fibrosis, bronchial hyperreactivity may be associated with colonization or infection with P aeruginosa, and that this may be a more important risk factor for bronchial hyperreactivity than atopy.
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Affiliation(s)
- José Valverde-Molina
- Unidad de Neumología Pediátrica, Hospital Los Arcos, Santiago de la Ribera, Murcia, España.
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Valverde-Molina J, Sánchez-Solís M, Pastor-Vivero MD, García-Marcos L. Association Between Chronic Colonization or Infection With Pseudomonas aeruginosa and Bronchial Hyperreactivity in Patients With Cystic Fibrosis. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1579-2129(09)60013-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guillén-Navarro E, Carbonell P, Glover G, Sánchez-Solís M, Fernández-Barreiro A. Novel HMBS founder mutation and significant intronic polymorphism in Spanish patients with acute intermittent porphyria. Ann Hum Genet 2005; 68:509-14. [PMID: 15469427 DOI: 10.1046/j.1529-8817.2003.00114.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute intermittent porphyria (AIP) is an autosomal dominant disorder of heme biosynthesis, caused by a partial deficiency of hydroxymethylbilane synthase (HMBS). Knowledge of the nature of the HMBS mutations causing AIP in Spanish families is very limited. Here we report a novel 669_698del of the HMBS gene in twenty-two individuals from five independent Spanish AIP families, settled in Murcia (southeastern region of Spain). All mutation carriers shared a common disease associated haplotype indicating an ancestral founder effect. Identification of the 669_698del founder mutation allowed rapid and simple molecular diagnosis of AIP in families from this region in Spain. In addition, 771 + 58C>T in intron 12 on the non-669_698del allele was identified in six AIP patients, which promoted homozygous AIP misdiagnosis.
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Affiliation(s)
- E Guillén-Navarro
- Unidad de Genética Médica del Servicio de Pediatría, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
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Abstract
Weapon injuries other than gunshot wounds or low-velocity stab wounds to the head are extremely rare. We report the case of a 6-year-old girl who sustained a penetrating craniocerebral injury after being accidentally shot with an underwater fishing harpoon. This mechanism of injury seems to share characteristics of both high- and low-velocity projectiles. We discuss the management of this unusual injury in a child, remarking that foreign body removal in these cases must be carried out following the original direction of the projectile trajectory. We review the current literature on craniocerebral injuries caused by similar objects, especially those occurring in children.
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Affiliation(s)
- F López
- Section of Pediatric Neurosurgery, Virgen de la Arrixaca University Hospital, E-30120 Murcia, Spain
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