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Ara-Martin M.,Hospital Clinico Lozano Blesa | Pinto P.H.,Hospital Universitario La Paz | Pascual-Salcedo D.,Hospital Universitario La Paz
Journal of Dermatological Treatment | Year: 2017

Purpose: This study was conducted to examine the relationship between loss of clinical response to anti-tumor necrosis factor (TNF) therapy and the production of anti-drug antibodies (ADAs) and the potential effects of biologic immunogenicity. Materials and methods: This observational, non-interventional, cross-sectional study included patients with moderate-to-severe plaque psoriasis and secondary failure of adalimumab, etanercept and infliximab who were seen in the clinical practice setting. Clinical data and blood samples were collected after patient enrollment at the time that next doses of anti-TNF therapy were scheduled. ADA and serum drug concentrations were detected at a central reference laboratory using ELISA. Results: Among 137 enrolled patients, ADA were identified in 31/65 (48%), 0/47 and 8/19 (42%) of patients treated with adalimumab, etanercept and infliximab, respectively. The presence of ADA was associated with a slightly worse clinical response in adalimumab-treated patients (Physician Global Assessment score: 3.7 vs. 3.2, ADA-positive vs. ADA-negative patients [p < .05]; correlation between serum ADA titer and body surface area: r = .292 [p = .019]). Concomitant DMARDs were not associated with anti-TNF immunogenicity in any treatment group. Conclusions: Additional evidence is needed from studies of anti-TNF therapy in psoriasis for clinicians to gain a better understanding of the impact of immunogenicity on clinical response. © 2017 Informa UK Limited, trading as Taylor & Francis Group


Marrugo-Florez M.,Grupo de Investigacion Salud de la Mujer | Romero-Perez I.,Grupo de Investigacion Salud de la Mujer | Fernandez-Alonso A.M.,Hospital Torrecardenas | Chedraui P.,University of Guayaquil | And 2 more authors.
Menopause | Year: 2013

The aim of this study was to determine the relationship between self-reported sleep quality, menopausal symptom intensity, and correlates (including ethnicity) among middle-aged women. METHODS: The present cross-sectional study involved 1,078 Colombian women aged 40 to 59 years who completed the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS), and a general questionnaire exploring sociodemographic data. RESULTS: The median [interquartile range] age of the whole sample was 49.0 [9.0] years. Among the participants, 45.4% were postmenopausal, 57.2% had increased body mass index values, 13.9% were black, 20.7% had hypertension, 74.1% had a stable partner, and 3.8% used hormone therapy. The prevalence of poor sleep quality was 57.1% (PSQI global score ≥5). Significant correlations between PSQI global scores and MRS total and subscale scores were found. Multiple linear regression analysis found that higher PSQI scores (poorer quality of sleep) correlated with higher MRS psychological and somatic subscale scores (more severe symptoms), smoking habit, and hypertension. Menopause status and black ethnicity were excluded from the final regression model. CONCLUSIONS: Despite study limitations, poor sleep quality is highly prevalent in this large middle-aged Colombian female sample and is related to menopausal symptom severity, tobacco use, and presence of hypertension. © 2012 by The North American Menopause Society.


Ferrandez A.,Hospital Clinico Lozano Blesa | Piazuelo E.,Aragon Institute of Health science | Castells A.,University of Barcelona
Best Practice and Research: Clinical Gastroenterology | Year: 2012

A large body of evidence from basic science, epidemiologic observations and population-based studies demonstrates that aspirin, as well as other non-steroidal anti-inflammatory drugs, has a chemopreventive effect on several cancer types and, more specifically, in CRC. This protective effect includes prevention of adenoma recurrence and reduction of CRC incidence and mortality. Although the protective effect appears to depend on the dose and the drug, the most important factor is the duration of exposure. However, the lowest effective dose, treatment duration, specific target populations, and effects on survival have not been defined yet. More important, data on the risk-benefit profile for cancer prevention are insufficient and, accordingly, no definitive recommendation can be made at present. In this article, besides reviewing current knowledge of the mechanisms involved in aspirin-based CRC chemoprevention, we will be focused on randomized controlled studies assessing its efficacy in high-, moderate- and average-risk populations. © 2012 Elsevier Ltd. All rights reserved.


Vidal-Casariego A.,Complejo Asistencial Universitario Of Leon | Burgos-Pelaez R.,Hospital Vall dHebron | Martinez-Faedo C.,Hospital Central Of Asturias | Calvo-Gracia F.,Hospital Clinico Lozano Blesa | And 3 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2013

Introduction: Carnitine is an endogenous metabolite and exogenous nutrient with a pivotal role in lipid metabolism. Plasma levels of carnitine are reduced in type 2 Diabetes Mellitus (T2DM). The aim was to evaluate the metabolic effects of the administration of L-carnitine in T2DM. Method: A systematic review was performed. Relevant randomized, controlled-trials trials were searched in Pubmed, Trip Database and Cochrane Library, and selected when they had enough methodological quality assessed with the Jadad scale. Article search strategy included "Carnitineo" OR "L-carnitineo" AND "Diabetes Mellituso" OR "Diabetes mellitus, type 2o" OR "Noninsulindependent-diabetes mellituso". Meta-analysis was performed, and the difference of means calculated with a 95% confidence interval. Heterogeneity was evaluated with the Q statistic. Results: The systematic review included 4 trials with 284 patients. Oral L-carnitine lowered fasting plasma glucose [-14.3 mg/dl (CI95% - 23.2 to -5.4); p=0,002], total cholesterol [-7.8 mg/dL (95%CI -15.5 to -0.1); p=0.09], low density lipoprotein [-8.8 mg/dl (CI95% -12.2 to -8.5), p<0.0001], apolipoprotein-B100 [-7.6 mg/dl (CI95% -13.6 to -1.6); p=0.013] and apolipoprotein-A1 [-6.0 mg/dl (CI95% -10.5 a -1.5); p=0.523]. There was no significant heterogeneity. The changes in triglycerides, lipoprotein (a) or HbA1c were not significant. Conclusion: The administration of L-carnitine in type 2 diabetes mellitus is associated with an improvement in glycaemia and plasma lipids. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.


Reck M.,Hospital Grosshansdorf | Barlesi F.,University Of La Mediterranee Assistance Publique | Crino L.,Hospital Santa Maria della Misericordia | Henschke C.I.,Mount Sinai School of Medicine | And 4 more authors.
Annals of Oncology | Year: 2012

Background: Bevacizumab is a monoclonal antibody against vascular endothelial growth factor. Severe pulmonary haemorrhage (PH) is a rare but serious potential adverse event associated with bevacizumab therapy for advanced non-squamous non-small-cell lung cancer (NSCLC). Methods: A panel of expert oncologists, pulmonologists and radiologists reviewed the available data to identify predictive factors for PH in order to help guide physicians using bevacizumab in patients with NSCLC. Results: Patients with NSCLC are at an increased risk of PH owing to the underlying disease process. Patients with squamous histology and/or a history of grade ≥2 haemoptysis (≥2.5 ml per event) should not receive bevacizumab. No clinical or radiological features (including cavitation and central tumour location) reliably predict severe PH in bevacizumab-treated patients. Major blood vessel infiltration and bronchial vessel infiltration, encasement and abutting may predict PH; however, standardised radiological criteria for defining infiltration have not been established. Eligibility for bevacizumab is not affected by patient age, performance status or anticoagulation or antiplatelet therapy. Conclusions: An individualised risk-benefit assessment should be undertaken in all patients with NSCLC in whom bevacizumab is being considered. Further research is required to elucidate the mechanisms underlying PH and the clinical risk factors. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology.


Cristobal J.A.,Hospital Clinico Lozano Blesa | Remon L.,Hospital Clinico Lozano Blesa | Del Buey M.A.,Hospital Clinico Lozano Blesa | Montes-Mico R.,University of Valencia
Journal of Cataract and Refractive Surgery | Year: 2010

Purpose: To evaluate the implantation of apodized diffractive multifocal intraocular lenses (IOLs) in children with unilateral cataract. Setting: Ophthalmology Service, Hospital Clínico Lozano Blesa, Zaragoza, Spain. Design: Prospective clinical study. Methods: Five children between 4 and 6 years of age with unilateral cataract had cataract extraction and implantation of an apodized diffractive multifocal IOL (AcrySof Restor SN60D3). Phacoaspiration was accompanied by posterior capsulorhexis followed by an anterior vitrectomy. Uncorrected distance (UDVA), corrected distance (CDVA), and corrected near (CNVA) visual acuities; binocular function using the Worth 4-dot test and the TNO stereotest; and subjective symptoms such as glare and halos were evaluated over 21 months of follow-up. Results: At the final follow-up visit, the mean UDVA was 0.45 ± 0.149 logMAR and the mean CDVA was 0.30 ± 0.06 logMAR with 20/32 in 3 eyes, 20/50 in 1 eye, and 20/63 in 1 eye. The mean CNVA was 0.10 ± 0.05 logMAR (about 20/25) with J1 in 2 eyes, J2 in 1 eye, J3 in 1 eye, and J4 in 1 eye. The stereoacuity was 120 seconds of arc (arcsec) in 2 patients, 240 arcsec in 1 patient, 1980 arcsec in 1 patient, and nonexistent in 1 patient. The Worth 4-dot test showed that 4 patients had fusion. None of the 5 patients complained about halos or glare. No IOL decentration was observed in any patient. Conclusion: Implantation of an apodized multifocal IOL seems to be a satisfactory alternative to monofocal pseudophakia in children with unilateral cataract. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.


Chedraui P.,Catholic University of Santiago de Guayaquil | Perez-Lopez F.R.,Hospital Clinico Lozano Blesa
Climacteric | Year: 2013

Interactions between genetic (genome) and environmental factors (epigenome) operate during a person's entire lifespan. The aging process is associated with several cellular and organic functional alterations that, at the end, cause multi-organic cell failure. Epigenetic mechanisms of aging are modifiable by appropriate preventive actions mediated by sirtuins, caloric input, diet components, adipose tissue-related inflammatory reactions, and physical activity. The Mediterranean lifestyle has been for many millennia a daily habit for people in Western civilizations living around the Mediterranean sea who worked intensively and survived with very few seasonal foods. A high adherence to the traditional Mediterranean diet is associated with low mortality (higher longevity) and reduced risk of developing chronic diseases, including cancer, the metabolic syndrome, depression and cardiovascular and neurodegenerative diseases. Reports indicate that some dietary components, such as olive oil, antioxidants, omega-3 and -6 polyunsaturated acids, polyphenols and flavonoids, mediate beneficial anti-aging effects (anti-chronic diseases and increased longevity). Equally, physical activity displays a positive effect, producing caloric consumption and regulation of adipose and pancreatic function. The predictive strength of some food patterns may be a way of developing recommendations for food and health policies. This paper will discuss several ways of improving health during mid-life, focusing on certain groups of functional foods and healthy habits which may reduce or prevent age-related chronic diseases. © 2013 International Menopause Society.


Mostacero Tapia S.,Hospital Of Calahorra | Ferrandez A.,Hospital Clinico Lozano Blesa
Medicine | Year: 2012

The incidence of gastric cancer in Spain as well as globally is progressively declining. However it is the second leading cancer worldwide. The most frequent gastric cancer type is adenocarcinoma that is classified in 2 different types: intestinal and diffuse. Several environmental factors have been identified to play an important role in gastric carcinogenesis, including Helicobacter pylori infection, smoking and different dietetic factors. Gastric cancer is usually asymptomatic and when symptoms appear it usually reflects an advanced disease and a poorer prognosis. Endoscopy with biopsy sampling is considered the standard in gastric cancer diagnosis, and need to be complemented with additional imaging techniques such as endoscopic ultrasound or CT scan for tumor staging. The gold standard for gastric cancer treatment is surgery when the tumor is resectable although it is not known what is the better surgical technique. There are other histological types in gastric cancer that include lymphoma, carcinoid tumors and gastrointestinal stromal tumors (GIST).


Ber Nieto Y.,Hospital Clinico Lozano Blesa
Medicine | Year: 2012

Peptic ulcer (PUD) is a defect in the gastrointestinal mucosa, and is an important cause of morbidity and health care costs. The natural history of PUD ranges from resolution without intervention to the development of complications such as bleeding, obstruction, perforation and penetration. The two principal factors to development PUD are the infection to Helicobacter pylori (HP) and the intake of nonsteroid-antiinflammatory drugs (NSAIDs). The principal treatment is the mucosal healing (treatment with proton pump inhibitors-PPI-) and to eliminate the risk factors (to erradicate HP and the interruption of NSAIDs). In case of complicated PUD, the stabilization of patient is the principal target, later depending of the complication choose to medical, endoscopy and/or surgical treatment. This protocol review the treatment of uncomplicated and complicated PUD.


Ber Nieto Y.,Hospital Clinico Lozano Blesa
Medicine | Year: 2012

Peptic ulcer disease (PUD) is a common problem, it consists in defects in the gastrointestinal mucosa that extend through the muscularis mucosae. Most ulcers occur when the normal mechanisms are disrupted by superimposed processes such as Helicobacter pylori infection and the ingestion of nonsteroidal anti-inflammatory (NSAI) drugs. Since the introduction of proton-pump inhibitors, cyclo-oxygenase-2-selective anti-inflammatory drugs and eradication of Helicobacter pylori infection, the incidence of PUD has decreased. This article reviews the etiology, clinical manifestations, diagnosis and treatment of peptic ulcer.

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