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PubMed | University of Barcelona, Institute dAssistencia Sanitaria, Hospital Santa Caterina, Hospital Universitari Of Bellvitge and University of Girona
Type: Journal Article | Journal: Medicina clinica | Year: 2014

Anosognosia is a disorder that affects the clinical presentation of Alzheimers disease (AD), increasing in frequency with the evolution of AD. The objective was to determine the prevalence of anosognosia and analyze the associated factors and predictors.Multicenter transversal and observational study of 345 AD patients. Anosognosia was assessed by Anosognosia Questionnaire-Dementia and the evolutionary stage with the Global Deterioration Scale (GDS). Tests used were Mini-Mental State Examination, Disability Assessment for Dementia and Neuropsychiatric Inventory to assess cognition, functional status and neuropsychiatric symptoms, respectively. We adjusted linear regression models to determine the associated variables and binary logistic regression (RLog) to identify predictors of anosognosia.The overall prevalence of anosognosia was 46.7% (95% confidence interval [95% CI] 41.3 to 52.1). The prevalence in stages was 28.4% (GDS 4), 64.6% (GDS 5) and 91.4% (GDS 6). The RLog identified as predictors older age (odds ratio [OR] 1.04; 95% CI 1.01-1.09), lower functional capacity (OR 0.96; 95% CI 0.93-0.98), lower cognitive level (OR 0.9; 95% CI 0.88-0.99), and greater apathy (OR 1.1; 95% CI 1.03-1.18), disinhibition (OR 1.2; 95% CI 1.09-1.50), irritability (OR 1.1; 95% CI 1.09-1.50) and motor disorders (OR 1.2; 95% CI 1.09-1.50).Anosognosia increases with further deterioration. In patients with a mild impairment, predictor variables were apathy, disinhibition and motor disorders.


Garcia Figueiras R.,Complexo Hospitalario Universitario Of Santiago Of Compostela | Padhani A.R.,Mount Vernon Hospital | Vilanova J.C.,Clinica Girona | Vilanova J.C.,Hospital Santa Caterina | And 2 more authors.
Radiologia | Year: 2010

Most advances in conventional diagnostic imaging techniques have focused on improving the spatial resolution and speed of acquisition of images or on new contrast agents. However, tumors are extremely complex biological models with a series of characteristics like hypoxia, metabolism, cellularity, angiogenesis, and functionality of the lymph nodes that are very important in oncology but can not bead equately studied with these diagnostic imaging methods. In this article, we discuss the possible contributions of different functional imaging techniques based on computed tomography, magnetic resonance imaging, or positronemissiontomographytoobta in information about different biological processes and characteristics that are very important for diagnosing, staging, planning treatment, evaluating the response to treatment, and monitoring the evolution of cancer patients, as well as for the development of new drugs. © 2009 SERAM. Published by Elsevier España, S.L. All rights reserved.


Lopez-Siles M.,University of Girona | Martinez-Medina M.,University of Girona | Busquets D.,Hospital Dr Josep Trueta | Sabat-Mir M.,Hospital Santa Caterina | And 4 more authors.
International Journal of Medical Microbiology | Year: 2014

Background: Crohn's disease (CD) and ulcerative colitis (UC) diagnosis requires comprehensive examination of the patient. Faecalibacterium prausnitzii and Escherichia coli have been reported as representatives of Inflammatory Bowel Disease (IBD) dysbiosis. The aim was to determine whether or not quantification of these species can be used as a complementary tool either for diagnostic or prognostic purposes. Methods: Mucosa-associated F. prausnitzii and E. coli abundance was determined in 28 controls (H), 45 CD, 28 UC patients and 10 irritable bowel syndrome (IBS) subjects by quantitative polymerase chain reaction (qPCR) and the F. prausnitzii E. coli index (F-E index) was calculated. Species abundances were normalized to total bacteria and human cells. Data was analyzed taking into account patients' phenotype and most relevant clinical characteristics. Results: IBD patients had lower F. prausnitzii abundance than H and IBS (P. <. 0.001). CD patients showed higher E. coli counts than H and UC patients (P. <. 0.001). The F-E index discriminated between H, CD and UC patients, and even between disease phenotypes that are usually difficult to distinguish as ileal-CD (I-CD) from ileocolonic-CD and colonic-CD from extensive colitis. E. coli increased in active CD patients, and remission in I-CD patients was compromised by high abundance of this species. Treatment with anti-tumor necrosis factor (TNF) α diminished E. coli abundance in I-CD whereas none of the treatments counterbalanced F. prausnitzii depletion. Conclusion: F. prausnitzii and E. coli are useful indicators to assist in IBD phenotype classification. The abundance of these species could also be used as a supporting prognostic tool in I-CD patients. Our data indicates that current medication does not restore the levels of these two species to those found in a healthy gut. © 2014 Elsevier GmbH.


PubMed | University of Aberdeen, Hospital Santa Caterina, Hospital Universitari Dr Josep Trueta and University of Girona
Type: Journal Article | Journal: Applied and environmental microbiology | Year: 2015

Faecalibacterium prausnitzii depletion in intestinal diseases has been extensively reported, but little is known about intraspecies variability. This work aims to determine if subjects with gastrointestinal disease host mucosa-associated F. prausnitzii populations different from those hosted by healthy individuals. A new species-specific PCR-denaturing gradient gel electrophoresis (PCR-DGGE) method targeting the 16S rRNA gene was developed to fingerprint F. prausnitzii populations in biopsy specimens from 31 healthy control (H) subjects and 36 Crohns disease (CD), 23 ulcerative colitis (UC), 6 irritable bowel syndrome (IBS), and 22 colorectal cancer (CRC) patients. The richness of F. prausnitzii subtypes was lower in inflammatory bowel disease (IBD) patients than in H subjects. The most prevalent operational taxonomic units (OTUs) consisted of four phylotypes (OTUs with a 99% 16S rRNA gene sequence similarity [OTU99]), which were shared by all groups of patients. Their distribution and the presence of some disease-specific F. prausnitzii phylotypes allowed us to differentiate the populations in IBD and CRC patients from that in H subjects. At the level of a minimum similarity of 97% (OTU97), two phylogroups accounted for 98% of the sequences. Phylogroup I was found in 87% of H subjects but in under 50% of IBD patients (P = 0.003). In contrast, phylogroup II was detected in >75% of IBD patients and in only 52% of H subjects (P = 0.005). This study reveals that even though the main members of the F. prausnitzii population are present in both H subjects and individuals with gut diseases, richness is reduced in the latter and an altered phylotype distribution exists between diseases. This approach may serve as a basis for addressing the suitability of F. prausnitzii phylotypes to be quantified as a putative biomarker of disease and depicting the importance of the loss of these subtypes in disease pathogenesis.


Turro-Garriga O.,Institute dAssistencia Sanitaria Girona | Garre-Olmo J.,Institute dAssistencia Sanitaria Girona | Garre-Olmo J.,University of Girona | Vilalta-Franch J.,Institute dAssistencia Sanitaria Girona | And 7 more authors.
International Journal of Geriatric Psychiatry | Year: 2013

Objectives Anosognosia is the lack of deficit awareness, and it is a common symptom in patients with Alzheimer's disease (AD). The objective of this study was to assess the relationship between anosognosia and caregiver burden. Methods This was a cross-sectional, analytical study of patients who were diagnosed with AD and their caregivers. Anosognosia was evaluated using the Experimenter Rating Scale, and caregiver burden was evaluated using the Burden Interview (BI). Using the BI's comprehensive scoring and each of its five factors as dependent variables, we adjusted six linear regression models to determine the effect of anosognosia on caregiver burden. Results The sample consisted of 124 patients and 124 caregivers. The mean patient age was 78.9 years (SD = 6.9); the mean caregiver age was 59.7 years (SD = 13.6), and 66.6% of the caregivers were women. The prevalence of anosognosia was 24.2% (95% confidence interval = 16.7-33.3). The degree of caregiver burden was associated with the degree of anosognosia (r2 = 0.426; standardised beta [βs] = 0.346; p < 0.001), which explained 14.7% of the variance. For the BI factors, the Experimenter Rating Scale was associated with physical and social burden (r 2 = 0.452; βs = 0.378; p < 0.001), relationship of dependence (r2 = 0.301; βs = 0.203; p = 0.010) and emotional stress (r2 = 0.212; βs = 0.227; p = 0.014). Conclusions The presence of anosognosia in patients with AD is an independent factor that increases caregiver burden by increasing physical wear, social isolation, dependence and tension related to patient care. © 2012 John Wiley & Sons, Ltd.


Busquets D.,Hospital Dr Josep Trueta | Mas-de-Xaxars T.,University of Girona | Lopez-Siles M.,University of Girona | Martinez-Medina M.,University of Girona | And 6 more authors.
Journal of Crohn's & colitis | Year: 2015

METHODS: The microbiota composition, and the Faecalibacterium prausnitzii / Escherichia coli quantitative relationship as dysbiosis indicator, were studied at baseline [T0], one month [T1], and 3 months [T3] after starting treatment using a polymerase chain reaction-denaturing gradient gel electrophoresis [PCR-DGGE] of 16S rRNA gene fragments and quantitative PCR, respectively, in rectal mucosal biopsies from 15 CD patients and four healthy subjects.RESULTS: T0 and T3 fingerprints were different in all patients; whereas T1 and T3 presented similar patterns. Recovered phylogroups were Firmicutes [79.1%], Bacteroides [12.5%], and Actinobacteria [6.25%]. The prevalence of E. coli decreased during treatment. Relative E. coli loads in CD samples were significantly reduced at every analysed step [T1 and T3] [p < 0.005] whereas no significant changes were observed in relative F. prausnitzii counts.BACKGROUND: The composition of the intestinal microbiota is altered in Crohn's disease [CD] patients. The objective of this study was to evaluate the qualitative and quantitative changes in the microbiota of CD patients in 3 months of treatment with adalimumab [ADA], and determine whether or not these changes are produced towards the recovery of the normal, healthy-like microbiota.CONCLUSION: Treatment with ADA induces short-term changes in the microbiota composition which seem to parallel the partial recovery of the gut bacterial ecology, with recovery parameters tending to eubiosis recovery. The quantitative determination of dysbiosis-representative bacteria, such as E. coli, may provide a fast and reliable indicator of the healing state of the intestinal mucosa. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.


Coduras A.,Fundacion Gaspar Casal | Rabasa I.,Fundacion Gaspar Casal | Frank A.,Hospital Universitario La Paz | Bermejo-Pareja F.,University Hospital 12 Of Octubre | And 5 more authors.
Journal of Alzheimer's Disease | Year: 2010

In this study, we analyzed the economic impact of one-year healthcare and non-healthcare resources utilization by patients with dementia of Alzheimer's disease (AD) under usual medical practice in Spain. A one-year, prospective, naturalistic, multicenter cohort study was designed to recruit patients with mild, moderate to severe, and severe AD according to Clinical Dementia Rating scale: the ECO study. Healthcare resources (medical visits, drugs and concomitant treatments, complementary and diagnostic tests, institutionalization and use of home-nursing facilities) and non-healthcare resources (inventory materials, consumables, professional and non-professional caregivers' time for care and supervision) were recorded and valued at 2006 prices. A total of 560 patients with possible/probable AD by DSM-IV-NINCDS-ADRDA criteria were included in the study: 68% women, 77 ± 6 years old, 29% treatment naïve. Monthly average cost per patient was EURO1,425.73, and increased 10.08% at the end of the study (baseline monthly cost; EURO1,316.22). Non-healthcare costs EURO1059.00, 74.30% of total cost) decreased EURO4.30/month (0.40%) at the end of the year, while healthcare costs, which presented a total average of EURO366.66, grew by EURO136.94 in the period (54.06%), mainly due to cost of drugs, nursing home utilization, and institutionalization. The 87.26% of the overall cost (EURO1,244.22) was not financed by National Health Service (NHS), and the majority of this cost corresponded to caregiver-associated cost. The caregiver's total burden represented 70.86% of the overall cost-of-illness. In conclusion, monthly overall mean cost of dementia of AD type was high in Spain (EURO1,412.73). Almost 88% of the cost-of-illness is funded by the patient's own family, adding a financial burden to the suffering of these families. © 2010 - IOS Press and the authors. All rights reserved.


Turro-Garriga O.,Hospital Santa Caterina | Lopez-Pousa S.,Hospital Santa Caterina | Vilalta-Franch J.,Hospital Santa Caterina | Garre-Olmo J.,Hospital Santa Caterina | Garre-Olmo J.,University of Girona
Revista de Neurologia | Year: 2012

Aims. To compare the prevalence of anosognosia in patients with Alzheimer's disease (AD) using two different evaluation methodologies, to analyse the discrepancy between them and to determine the variables associated with this discrepancy. Patients and methods. The methodology involved a cross-sectional, observational study conducted in patients with AD. The Anosognosia Questionnaire-Dementia (AQ-D) and the Experimenter Rating Scale (ERS) were administered. Clinical and sociodemographic information was recorded about both the patient and his/her caregiver by means of standardised instruments. Prevalence was determined with each instrument and the degree of agreement between them was then established. A variable called 'agreement/non-agreement' was created and a logistic regression model was adjusted to determine the variables associated to the discrepancy. Results. The prevalence of anosognosia in the mild cases was 13.6% (95% confidence interval, 95% CI = 5.5-21.7) and 17.3% (95% CI = 8.4-26.1), and 44.2% (95% CI = 28.2-60.2) and 55.8% (95% CI = 38.8-71.8) in the moderate cases, according to the ERS and the AQ-D, respectively. The degree of agreement between the two measurements yielded a kappa-value of 0.7. The regression model with the discrepancy between the ERS and the AQ-D as the dependent variable was associated to a lower functional capacity (odds ratio = 0.080; 95% CI = 0.855-0.997; p = 0.042). Conclusions. The data from the study showed an increase in the prevalence of anosognosia linked to the severity and a higher disagreement in its evaluation with two different methods as the degree of the patient's functional disability increased. © 2012 Revista de Neurología.


There is still no reliable biomarker for the diagnosis of pancreatic adenocarcinoma. Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker only recommended for pancreatic adenocarcinoma follow-up. One of the clinical problems lies in distinguishing between this cancer and other benign pancreatic diseases such as chronic pancreatitis. In this study we will assess the value of panels of serum molecules related to pancreatic cancer physiopathology to determine whether alone or in combination could help to discriminate between these two pathologies.CA 19-9, carcinoembryonic antigen (CEA), C-reactive protein, albumin, insulin growth factor-1 (IGF-1) and IGF binding protein-3 were measured using routine clinical analyzers in a cohort of 47 pancreatic adenocarcinoma, 20 chronic pancreatitis and 15 healthy controls.The combination of CA 19-9, IGF-1 and albumin resulted in a combined area under the curve (AUC) of 0.959 with 93.6% sensitivity and 95% specificity, much higher than CA 19-9 alone. An algorithm was defined to classify the patients as chronic pancreatitis or pancreatic cancer with the above specificity and sensitivity. In an independent validation group of 20 pancreatic adenocarcinoma and 13 chronic pancreatitis patients, the combination of the four molecules classified correctly all pancreatic adenocarcinoma and 12 out of 13 chronic pancreatitis patients.Although this panel of markers should be validated in larger cohorts, the high sensitivity and specificity values and the convenience to measure these parameters in clinical laboratories shows great promise for improving pancreatic adenocarcinoma diagnosis.


Conde-Sala J.L.,Hospital Santa Caterina | Garre-Olmo J.,Hospital Santa Caterina | Turro-Garriga O.,Hospital Santa Caterina | Vilalta-Franch J.,Hospital Santa Caterina | Lopez-Pousa S.,Hospital Santa Caterina
Dementia and Geriatric Cognitive Disorders | Year: 2010

Background/Aims: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. Method: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. Results: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. Conclusions: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers. Copyright © 2010 S. Karger AG, Basel.

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