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Prats M.,Rovira i Virgili University | Prats M.,Hospital Universitari Of Tarragona Joan Xxiii | Font R.,Rovira i Virgili University | Garcia C.,Rovira i Virgili University | And 3 more authors.
BMC Nephrology

Background: Some parenteral iron therapies have been found to be associated with hypophosphatemia. The mechanism of the decrease in serum phosphate is unknown. The aim of this study is to examine the effect of IV ferric carboxymaltose(FCM) on phosphate metabolism and FGF23 levels in patients with chronic kidney disease(CKD). Methods. This is a post-hoc analysis of a prospective study carried out in 47 non-dialysis CKD patients with iron-deficiency anaemia who received a single 1000 mg injection of FCM. Markers of mineral metabolism (calcium, phosphate, 1,25-dihydroxyvitamin D, PTH and FGF23[c-terminal]) were measured prior to FCM administration and at week 3 and week 12 after FCM administration. Based on the measured levels of serum phosphate at week 3, patiens were classified as hypophosphatemic or non-hypophosphatemic. Results: Serum phosphate levels decreased significantly three weeks after FCM administration and remained at lower levels at week 12 (4.24 ± 0.84 vs 3.69 ± 1.10 vs 3.83 ± 0.68 mg/dL, respectively, p < 0.0001. Serum calcium, PTH and 1,25-dihydroxyvitamin D did not change over the course of the study. Serum FGF23 decreased significantly from 442(44.9-4079.2) at baseline to 340(68.5-2603.3) at week 3 and 191.6(51.3-2465.9) RU/mL at week 12, p < 0.0001. Twelve patients were non-hypophosphatemic and 35 hypophosphatemic. FGF23 levels decreased in both groups, whereas no changes were documented in any of the other mineral parameters. Conclusions: In non-dialysis CKD patients, FCM induces reduction in serum phosphate levels that persists for three months. FCM causes a significant decrease in FGF23 levels without changes to other bone metabolism parameters. © 2013 Prats et al.; licensee BioMed Central Ltd. Source

Miranda M.,Rovira i Virgili University | Miranda M.,CIBER ISCIII | Escote X.,Rovira i Virgili University | Escote X.,CIBER ISCIII | And 9 more authors.
Journal of Clinical Endocrinology and Metabolism

Context: AQP7 is considered to be the sole adipose glycerol channel, and its regulation is crucial for glycemia control. Objectives: In this work, we aimed to further characterize AQP7 in human adipose tissue in obesity and type 2 diabetes (T2D): 1) to assess AQP7 expression levels in paired abdominal adipose tissue depots (sc and visceral); 2) to relate it with gene expression of genes involved in lipid metabolism; and 3) to confirm that AQP7 is mainly expressed in the adipocytes. Design: We conducted a transversal study of gene expression in paired samples of sc adipose tissue (SAT) and visceral adipose tissue (VAT). Patients: Caucasian lean and obese subjects (n = 62, matched for age and gender) and T2D subjects (n = 11, matched for age, gender, and BMI with their control group) participated in the study. Main Outcome Measure: We measured AQP7 expression levels in paired SAT and VAT. Results: We have proved the presence of AQP7 mRNA and protein in the adipocyte rather than the stromovascular fraction of adipose tissue (P = 0.001) and in mature adipocytes when differentiated in vitro. Increased AQP7 mRNA expression levels in VAT from T2D obese subjects (P < 0.05) were found. AQP7 transcript levels ratio of SAT vs. VAT changed with the presence of obesity and T2D. Interestingly, there were positive associations between AQP7 and both lipogenic and lipolytic genes in a similar manner in both adipose depots. Conclusions: Taken together, these data suggest a subtle regulation between adipose depots of the sole adipose aquaporin, AQP7, which is unbalanced in obesity and T2D. Copyright © 2010 by The Endocrine Society. Source

Bueno H.,Hospital General Universitario Gregorio Maranon | Bardaji A.,Hospital Universitari Of Tarragona Joan Xxiii | Patrignani P.,University of Chieti Pescara | Martin-Merino E.,Centro Espanol Of Investigacion Farmacoepidemiologica | Garcia-Rodriguez L.A.,Centro Espanol Of Investigacion Farmacoepidemiologica
American Journal of Cardiology

The exact mechanism by which nonsteroidal anti-inflammatory drugs (NSAIDs) may increase coronary risk is not completely understood. The aim of this study was to quantify the risk for each type of acute coronary syndrome (ACS) associated using NSAIDs and the role played by dose, duration, and patient characteristics. A prospective case-control study was performed, interviewing 2,954 patients hospitalized for ACS at 32 Spanish hospitals and a similar number of age-matched controls using a structured questionnaire collecting information on the use of NSAIDs, risk factors, and cardiovascular history. Odds ratios (ORs) for any type and each ACS type were calculated adjusted for gender, body mass index, other risk factors, and concomitant medications by conditional logistic regression. The adjusted OR of ACS associated with the current use of NSAIDs was 1.16 (95% confidence interval [CI] 0.95 to 1.42). The risk was increased in patients consuming high doses (OR 1.64, 95% CI 1.06 to 2.53) and those with previous ischemic heart disease (OR 1.84, 95% CI 1.13 to 3.00). The hazard was driven mostly by the increase in the risk for non-ST-segment elevation ACS (OR 1.20, 95% CI 0.99 to 1.47), whereas NSAIDs did not increase the risk for ST-segment elevation myocardial infarction (OR 1.00, 95% CI 0.80 to 1.26). In conclusion, the use of NSAIDs was associated with a small, nonsignificant overall coronary risk that was more apparent for non-ST-segment elevation ACS. This risk was stronger when NSAIDs were used at high doses or in patients with previous ischemic heart disease. © 2010 Elsevier Inc. All rights reserved. Source

Perez-Fernandez N.,University of Navarra | Montes-Jovellar L.,University of Navarra | Cervera-Paz J.,University of Navarra | Domenech-Vadillo E.,Hospital Universitari Of Tarragona Joan Xxiii
Audiology and Neurotology

Tumarkin attacks are a feature of Ménière's disease that generate a significant degree of disability. The surprising nature of these events is the main reason behind their associated morbidity. In this study we set out to evaluate auditory and vestibular function, as well as disability, in a population of patients who suffer Tumarkin attacks. We found that patients who suffer Tumarkin attacks are more disabled and experience severer and more frequent autonomic symptoms and that their hearing level is significantly worse in the asymptomatic ear, especially at low frequencies. Accordingly, we consider that treatment must be carefully planned to be as conservative as possible in terms of hearing and that psychiatric and/or psychological treatment must always be considered as an adjuvant therapy. © 2010 S. Karger AG. Source

Pena M.G.,Hospital Universitari Of Tarragona Joan Xxiii | Massana E.F.,Hospital Universitari Of Tarragona Joan Xxiii | Gutierrez P.H.,Rovira i Virgili University | Condomines J.R.,Autonomous University of Barcelona
Respiratory Care

BACKGROUND: Middle ear effusion (MEE) is rare among adults, but has a higher incidence among ICU patients. The aim of this study was to analyze the effect of nasogastric tube (NGT) on MEE and to assess other predisposing factors. METHODS: Prospective observational study, carrying out an otoscopic examination and tympanometry in 100 mechanically ventilated patients. Immittance testing was carried out within 24 hours of ICU admission and every 72 hours until ICU discharge. In a case of persisting pathologic curve at the moment of discharge from ICU, there was a follow-up examination every 3 days until middle ear function was restored. In addition to descriptive variables, we recorded placement (left or right nostril) and diameter (12, 16, or 18 French) of the NGT. A Cox regression analysis was performed, adjusted for the days since ICU admission. RESULTS: A total of 535 tympanometry studies were carried out, of which 352 were normal and 183 observations presented MEE. We observed that 12 and 16 French NGTs were not significantly associated with abnormal middle ear function, whereas 18 French NGT was significantly associated with MEE (odds ratio 2.54, 95% CI 1.42- 4.55; P = .01). Other variables independently associated with pathological tympanogram curves were Ramsay Sedation Scale score ≥ 4 (odds ratio 2.42, 95% CI 1.65-3.55; P = .01) and orotracheal intubation (odds ratio 5.72, 95% CI 3.40 -9.60; P = .01). No intracranial infection or long-term disabilities were identified. CONCLUSIONS: MEEs and tympanometric alterations are frequent in intubated patients (32% in our study). To prevent these complications, they should receive NGTs with a diameter lower than 18 French, when feasible. © 2013 Daedalus Enterprises. Source

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