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Hospital de Órbigo, Spain

Llerena A.,University of Extremadura | Llerena A.,Institute Salud Carlos III | Dorado P.,University of Extremadura | Calzadilla L.R.,Centro Comunitario Of Salud Mental | And 3 more authors.
Pharmacogenomics | Year: 2013

Background & aim: The CYP2D6-1584C>G polymorphism (rs1080985) has been identified as a major factor for CYP2D6 expression and function, with the mutant-1584G promoter type being consistently associated with significantly greater expression than-1584C. It may therefore be associated with ultrarapid metabolism. The objective of the present study was to explore the relationship between the CYP2D6-1584C>G polymorphism and the debrisoquine metabolic ratio in healthy volunteers in order to evaluate its potential impact on the ultrarapid CYP2D6 hydroxylation capacity. Materials & methods: The CYP2D6-1584C>G polymorphism was analyzed in 320 unrelated healthy individuals who were previously phenotyped for debrisoquine hydroxylation. Results: The metabolic ratio (log10 mean ± standard deviation) of individuals with the-1584G allele was lower than that of individuals with the-1584C allele for carriers of one active CYP2D6 gene (-0.13 ± 0.33 and 0.17 ± 0.52, respectively; p < 0.05) or two active CYP2D6 genes (-0.32 ± 0.39 and-0.20 ± 0.44, respectively; p < 0.05). Conclusion: The presence of the-1584G allele in the promoter region of the CYP2D6 gene was related to a high CYP2D6 hydroxylation capacity. Original submitted 3 June 2013; Revision submitted 11 September 201. © 2013 Future Medicine Ltd.

Bureo J.C.,Servicio de Medicina Interna | Arevalo J.C.,Seccion de Medicina Interna | Anton J.,Servicio de Medicina Interna | Adrados G.,Servicio de Medicina Interna | And 18 more authors.
Endocrinologia y Nutricion | Year: 2015

Objective: Despite the high prevalence of chronic kidney disease in the elderly population, few data are available on the frequency of secondary hyperparathyroidism in the Spanish population affected by this problem. We undertook a study on this issue in patients attending the internal medicine departments in our area. Design and methods: An observational, cross-sectional survey performed at internal medicine departments on 415 patients with stage 3 and 4 chronic kidney disease. Clinical history and risk factors were collected using a standardized protocol. Serum creatinine, phosphate, calcium, intact parathormone (PTH) and 25-hydroxy-cholecalciferol (25-OH-vitD) levels were measured in all patients. Results: Among stage 3 patients, 62.9% had PTH levels ≥ 70. pg/mL and 32.7% levels ≥ 110. pg/mL. Median PTH level in stage 4 patients was 120. pg/mL (p < 0.001), and 77.9% of these patients had PTH ≥ 70. pg/mL (p < 0.001) and 54.1% ≥ 110. pg/mL (p = 0.015). Adequate 25-hydroxy-cholecalciferol levels were found in only 7.2% of stage 3 patients and 4.1% of stage 4 patients. Only 7.2% of stage 3 patients had hyperphosphatemia, as compared to 25.4% of stage 4 patients (p < 0.001). Conclusions: Hyperparathyroidism is a common complication of stage 3 and 4 chronic kidney disease which is not associated to detectable changes in serum calcium and phosphate levels. It is therefore advisable to measure PTH levels in all patients with decreased glomerular filtration rate. © 2015 SEEN.

Salinas M.,Hospital Universitario Of San Juan Of Alicante | Salinas M.,University Miguel Hernandez | Lopez-Garrigos M.,Hospital Universitario Of San Juan Of Alicante | Uris J.,University of Alicante | And 73 more authors.
Emergencias | Year: 2014

Objective: To compare laboratory test request patterns for patients treated in Spanish hospital emergency departments. Methods: We studied the number of laboratory tests ordered for patients treated in 76 hospital emergency departments in 2012. We calculated the number of times each test was ordered per 1000 patients and the frequency ratios between certain related tests. The ratios were compared with targets (aspartate aminotransferase [AST]/alanine aminotransferase [ALT], 0.25; urea/creatinine, 0.1). Testing patterns were compared between hospitals grouped by type of administration, geographic location, and size. Results: Variation in demand for the different tests was high between hospitals, especially for the less frequently ordered tests. Only 1 transaminase test was ordered in 12 hospitals (only ALT in 9 hospitals; only AST in 3 hospitals). Both lipase and amylase tests were ordered in half the hospitals. Creatine kinase testing was ordered more often than troponin testing in most hospitals. Most of the hospitals also ordered urea and creatinine tests. A third of the hospitals did not test for either albumin or type B natriuretic peptide levels; a quarter of the hospitals did not order procalcitonin tests. Conclusions: The pattern of laboratory testing, in relation to available tests, varies between emergency departments. Which tests contribute the most to emergency care management should be determined through better communication between emergency department physicians and laboratory staff so that clinical care protocols can be followed. © 2014, Grupo Saned. All rights reserved

Salinas M.,Hospital Universitario Of San Juan | Salinas M.,University Miguel Hernandez | Lopez-Garrigos M.,Hospital Universitario Of San Juan | Uris J.,University of Alicante | And 73 more authors.
Clinical Biochemistry | Year: 2014

Objectives: The study was performed to compare the variability and appropriateness in the request of glycated hemoglobin (HbA1c) in primary care in Spain. Design and methods: 76 Spanish laboratories from diverse regions across Spain filled out the number of HbA1c tests requested by general practitioners (GPs) during the year 2012. Every patient seen at the different primary care centers was included in the study. Each participating laboratory was required to provide organizational data. The number of HbA1c requests per 1000 inhabitants was calculated and compared between regions. To investigate whether HbA1c was appropriately requested to manage and to diagnose Diabetes Mellitus (DM), the number of necessary HbA1c was calculated, according to the disease prevalence in Spain (6.9%) and the guidelines regarding DM management and diagnosis. Results: 17. 679. 195 patients were included in the study. A total of 1. 544. 551 HbA1c tests were ordered. No significant difference in the number of HbA1c requests per 1000 inhabitants was seen according to hospital setting (rural, urban or rural-urban). No significant differences were noticed between 3 Spanish regions, except the Valencian Community that presented higher values. Regarding the request appropriateness, 3. 280. 183 additional tests would have been necessary to manage diabetic patients and to diagnose new patients with the disease. Conclusion: There was a high variability regarding the request of HbA1c; the test was under-requested in all the participating health departments. This emphasizes the need to accomplish interventions to improve an appropriate use. © 2014.

Salinas M.,Hospital Universitario Of San Juan | Salinas M.,University Miguel Hernandez | Lopez-Garrigos M.,Hospital Universitario Of San Juan | Lopez-Garrigos M.,University Miguel Hernandez | And 78 more authors.
Endocrinologia y Nutricion | Year: 2016

Background and objectives: Laboratory tests are crucial for diagnosis and monitoring of thyroid disorders. It is therefore necessary to study the pattern and variability in requests of thyroid function tests.The study objectives were to compare the inter-regional variability in the request of laboratory thyroid tests by general practitioners (GPs) in Spain, and to investigate the potential economic savings if the goals set for some suitability indicators were reached. Methods: Test requests per 1,000 inhabitants and test ratios (free thyroxine (FT4)/thyrotropin (TSH), free triiodothyronine (FT3)/TSH, thyroglobulin antibody (TgAb)/peroxidase antibody (TPOAb)) were compared between the different areas, according to their setting, location, and management. The resulting savings if each department achieved the goals for indicator (0.25 for FT4/TSH, 0.1 for FT3/TSH) were estimated. Results: Seventy-six laboratories covering a population of 17,679,195 inhabitants participated in the study. TSH was requested significantly less in urban-rural areas, and the requests for FT3/1,000 inhabitants, FT3/TSH, and TgAb/TPOAb were higher in departments with private management. The savings generated if specifications for the ratios of related tests were met would be 937,260.5 €. Conclusions: The high variability reported in requests for thyroid function and autoimmunity tests in Spain suggests the need for implementing strategies to improve use of such tests. © 2015 SEEN.

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