Las Palmas de Gran Canaria, Spain
Las Palmas de Gran Canaria, Spain

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Quesada-Gomez J.M.,Hospital Universitario Reina Sofia | Diaz-Curiel M.,Servicio de Medicina Interna | Sosa-Henriquez M.,Hospital Universitario Insular | Malouf-Sierra J.,Hospital Of La Santa Creu I Sant Pau | And 6 more authors.
Journal of Steroid Biochemistry and Molecular Biology | Year: 2013

An observational cross-sectional study was conducted to assess calcium intake and vitamin D status by measurement of 25-hydroxyvitamin D (25(OH)D), in postmenopausal osteoporotic women (PMOW) treated and untreated for osteoporosis. To assess the influence of sunlight exposure on vitamin D status, the study group was categorized on the basis of sunlight exposure (above or below 2500 sunlight h/year). A group of 336 PMOW older than 65 years was identified (190 [56.5%] treated and 146 [43.5%] untreated for osteoporosis). The demographic and clinical data of the PMO women included history of prior fractures, pharmacological treatments and dietary calcium intake. BMD was measured by DEXA and 25(OH)D was determined by an HPLC method. Results: vitamin D serum levels were lower in the untreated group as compared with the treated group (58 ± 27 vs. 67 ± 27 nmol/l; p = 0.006). Prevalence of vitamin D deficiency (cut-off point set at <50 nmol/l) was higher in the non-treated group (43.8% vs. 29.5%; p = 0.009). Nearly all PMOW, whether treated or not for osteoporosis had a total calcium intake of less than 1200 mg. Sunlight exposure did not influence the vitamin D status. Conclusions: vitamin D deficiency and an insufficient calcium intake are highly prevalent in both treated and untreated Spanish PMOW older than 65 years. This can be related to low therapeutic adherence and/or insufficient prescription. Therefore physician's and patient's knowledge regarding the optimization of vitamin D status and calcium intake should be improved and implemented. © 2012 Elsevier Ltd. All rights reserved.


Lopez-Bastida J.,University of Castilla - La Mancha | Boronat M.,Hospital Universitario Insular | Moreno J.O.,REDISSEC | Moreno J.O.,University of Castilla - La Mancha | Schurer W.,LSE Health
Globalization and Health | Year: 2013

Background: Diabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain.Methods: We performed systematic searches from secondary sources, including scientific literature and government data and reports.Results: Diabetes Type II prevalence is estimated at 7.8%, and an additional 6% of the population is estimated to be undiagnosed. Four Spanish diabetes cost studies were analyzed to create a projection of direct costs in the NHS and productivity losses, estimating €5.1 billion for direct costs along with €1.5 billion for diabetes-related complications (2009) and labour productivity losses represented €2.8 billion. Glycemic control (glycolysated hemoglobin) is considered acceptable in 59% of adult Type II cases, in addition to 85% with HDL cholesterol ≥40mg/dl and 65% with blood pressure <140/90 mmHg, pointing to good intermediate outcomes. However, annual figures indicate that over half of the Type II diabetics are obese (BMI >30), 15% have diabetic retinopathy, 16% with microalbuminuria, and 15% with cardiovascular disease.Conclusions: The direct health care costs (8% of the total National Health System expenditure) and the loss of labour productivity are high. The importance of a multi-sectoral approach in prevention and improvements in management of diabetes are discussed, along with policy considerations to help modify the disease course. © 2013 Lopez-Bastida et al.; licensee BioMed Central Ltd.


Isasi A.G.,Hospital Universitario Insular | Echeburua E.,University of the Basque Country | Liminana J.M.,Complejo Hospitalario Universitario Insular Materno Infantil | Gonzalez-Pinto A.,Hospital Santiago Apostol
Journal of Affective Disorders | Year: 2010

Background: The aim of this research was to evaluate the short-term and long-term efficacy of a combined treatment (pharmacological + psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder. Method: 40 patients were randomly assigned to one of the following: Experimental group under combined treatment, and Control group under pharmacological treatment. We used an analysis of variance (ANOVA), including one or two factors, with repeated measures at different evaluation times: baseline, post-treatment, 6-month follow-up and 12-month follow-up. Results: We found significant between-group differences at all evaluation times after the treatment. The experimental group showed less hospitalizations than the control group in the 12-month evaluation (p = 0.007) as well as lower rates of depression and anxiety in the 6-month valuation (p = 0.015; p = 0.027) and the 12-month evaluation (p = 0.001; p < 0.001). Significant differences in relation to mania and inadaptation emerged in the post-treatment evaluation (p = 0.004; p < 0.001) and were sustained throughout the study (p = 0.002, p < 0.001; p < 0.001, p < 0.001). Analysis of within-group differences in the Experimental group showed reduction of mania (p < 0.001), depression (p = 0.001), anxiety (p = 0.003) and inadaptation (p < 0.001) throughout the study; while in the Control group, it showed increased numbers of hospitalizations (p = 0.016), as well as higher rates of mania (p = 0.030), anxiety (p < 0.001) and inadaptation (p = 0.003). Conclusions: Our results suggest that a combined treatment is effective in patients with refractory bipolar disorder. Suggestions for future research are commented on. © 2009 Elsevier B.V. All rights reserved.


Lorenzo V.,Hospital Universitario Of Canarias | Boronat M.,Hospital Universitario Insular | Saavedra P.,University of Las Palmas de Gran Canaria | Rufino M.,Hospital Universitario Of Canarias | And 3 more authors.
Nephrology Dialysis Transplantation | Year: 2010

Background. An exceptionally high incidence of diabetes-related end-stage renal disease (DM-ESRD) has been reported in the Canary Islands. This phenomenon was attributed to an increased prevalence of diabetes in this community. We compared the incidence of DM-ESRD in the Canary Islands with the rest of Spain among the estimated number of individuals at risk (people with diabetes in the population).Methods. The population-at-risk was calculated using census population figures and estimates of self-reported diabetes prevalence from the Spanish National Health Survey in the years 2003 and 2006. The incidence of DM-ESRD for the same years was obtained through Spanish regional registries. The independent effect of age, community of residence and calendar year was estimated with a Poisson regression model. Age-standardized acceptance rate ratios were calculated for each community.Results. Overall DM-ESRD incidence in the Canary Islands population-at-risk was 1209.9 per million population (pmp) in 2003 and 1477.3 pmp in 2006. Rates for the remaining Spanish regions ranged from 177.3-984.9 pmp. The incidence was higher in the Canary Islands across all age groups, but was most striking for patients ≥75 years. Diabetes prevalence in the general population was greater in the two youngest age strata and diminished from 75 years on in the Canary Islands, in comparison with other areas of Spain. Using a cluster of three communities with the lowest incidence as a reference, the relative risk of DM-ESRD in the Canary Islands population-at-risk was 3.88 [95% confidence interval (CI): 3.07-4.89]. Age-standardized acceptance ratios (95% CI) in the Canary Islands were 2.21 (1.85-2.61) in 2003 and 2.73 (2.34-3.17) in 2006.Conclusions. Individuals with diabetes in the Canary Islands present a disproportionately high incidence of ESRD. Diabetic Canary inhabitants are exposed to the disease for a longer time and therefore, may be more vulnerable to the development of chronic diabetes complications, including ESRD. © The Author 2010.


Gonzalez Isasi A.,Hospital Universitario Insular | Echeburua E.,University of the Basque Country | Liminana J.M.,Complejo Hospitalario Universitario Insular Materno Infantil | Gonzalez-Pinto A.,Santiago Apostol Hospital
European Psychiatry | Year: 2014

Objective: The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological. +. psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder. Method: Forty patients were randomly assigned to either an Experimental group-under combined treatment-or a Control group-under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points. Results: Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P= 0.015). The Experimental group showed lower depression and anxiety in the 6-month (P= 0.006; P= 0.019), 12-month (P = 0.001; P < 0.001) and 5-year (P < 0.001, P < 0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P = 0.009; P < 0.001) and were sustained throughout the study (6-month: P= 0.006, P < 0.001; 12-month: P < 0.001, P < 0.001; 5-year: P= 0.004, P < 0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning. Conclusions: A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented. © 2012.


Boronat M.,Hospital Universitario Insular | Boronat M.,University of Las Palmas de Gran Canaria | Saavedra P.,University of Las Palmas de Gran Canaria | Perez-Martin N.,Hospital Universitario Insular | And 4 more authors.
Cardiovascular Diabetology | Year: 2012

Background: Recent data suggest that concentrations of lipoprotein(a) [Lp(a)] may be inversely associated with the risk of diabetes. This study analyzed the relationships between Lp(a) and both diabetes and insulin resistance in an adult cohort from the island of Gran Canaria, Spain.Methods: Lp(a), homeostasis model assessment for insulin resistance (HOMA-IR) and conventional risk factors for diabetes were assessed in a sample of 1,030 adult individuals participating in a cross-sectional population-based epidemiological survey in the city of Telde. Diabetes was defined according to the WHO 1999 criteria, or as a previous diagnosis of diabetes. To identify patients at risk for diabetes, an Lp(a) cutoff level of 46 mg/dl was selected previously using classification and regression tree analysis. A multivariate logistic regression model with L2-regularization was used to assess the independent effect of Lp(a) on diabetes and its interactions with variables traditionally linked to the disease. Additionally, to investigate the effect of Lp(a) on insulin resistance, a parametric model was developed to describe the relationship between age and HOMA-IR values in subjects with levels of Lp(a) ≤46 or >46 mg/dl.Results: Along with variables known to be associated with diabetes, including age, mean blood pressure, serum triglycerides, and an interaction term between age and low HDL cholesterol, the logistic model identified a significant inverse association for diabetes and the interaction term between age and Lp(a) levels >46 mg/dl. According to the proposed parametric model, HOMA-IR was significantly lower in subjects of all ages who had Lp(a) levels >46 mg/dl.Conclusions: These results suggest that the age-related increase in the probability of having diabetes is significantly lower in subjects with Lp(a) levels >46 mg/dl. This could be explained in part by a lower insulin resistance in this subset of the population. © 2012 Boronat et al.; licensee BioMed Central Ltd.


Boronat M.,Hospital Universitario Insular | Boronat M.,University of Las Palmas de Gran Canaria | Saavedra P.,University of Las Palmas de Gran Canaria | Lopez-Rios L.,Hospital Universitario Insular | And 5 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - To characterize the cardiovascular risk profile of subjects categorized differently by A1C- and oral glucose tolerance test (OGTT)-based diagnostic criteria for diabetes according to the recommendations of the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS - An OGTT, A1C, and several cardiovascular risk factors were assessed in 964 individuals without known diabetes participating in a cross-sectional epidemiological survey in Gran Canaria, Spain. RESULTS - Taking the OGTT as the gold standard, the sensitivity and specificity of an A1C value ≥6.5% were 38.7 and 99.6%, respectively. Subjects who fulfilled A1C-based criterion presented greater measures of BMI and waist circumference, lower values for HDL cholesterol, and higher values for fasting plasma glucose, homeostasis model assessment of insulin resistance, and fibrinogen than subjects with diabetic OGTT but A1C <6.5%. CONCLUSIONS - Newly diagnosed diabetic individuals who fulfill A1C-based diagnostic criterion for the disease display a more unfavorable cardiovascular risk profile than individuals who only meet the glucose-based criteria. © 2010 by the American Diabetes Association.


Boronat M.,Hospital Universitario Insular | Marrero D.,Hospital Universitario Insular | Lopez-Plasencia Y.,Hospital Universitario Insular | Barber M.,Complejo Hospitalario Universitario Insular | And 2 more authors.
Gynecological Endocrinology | Year: 2011

Background. Ketoconazole is the most widely used medical treatment for Cushing's syndrome, but, because of its potential to cause birth defects, it is not recommended during pregnancy. Specifically, due to its antiandrogenic effects, ketoconazole entails theoretical risks of interfering with the development of external genitalia in male fetuses. Case. A pregnancy was diagnosed at 13 weeks of gestation in a 26-year-old woman with Cushing's disease under treatment with ketoconazole. The drug was withdrawn and the patient underwent transsphenoidal surgery at 16 weeks of pregnancy. She did not develop postsurgical adrenal insufficiency and was treated with metyrapone during the second and third trimesters of gestation. Partum was induced at 34 weeks of pregnancy. The patient delivered a healthy male infant with normal external genitalia. Conclusion. Treatment with ketoconazole during the critical period of organogenesis did not cause congenital birth defects to the male fetus of a woman with Cushing's disease. This report should be taken into account for future cases of unplanned pregnancies in women with Cushing's syndrome treated with ketoconazole, as well in those cases in which other therapeutic options are not feasible. © 2011 Informa UK, Ltd.


Borrego L.,Hospital Universitario Insular
Actas Dermo-Sifiliograficas | Year: 2010

Etanercept is a biological drug, inhibitor of the Tumor Necrosis Factor indicated for the treatment of severe or moderate psoriasis resistant to other therapies. Because its use is becoming increasingly extended, we should know its possible teratogenic effects. The data provided by the literature and studies prior to the marketing of the product are very limited. Thus, it is necessary to study the presence of possible risks more through experiments in animal models and to conduct prolonged prospective studies in humans. With the current knowledge, it seems that suspension of the treatment from one month prior to becoming pregnant would provide an adequate safety margin, and that most of the patients who have become pregnant and have suspended etanercept as soon as they knew they were pregnant have not had any complications. However, the data needed to recommend etanercept for the control of psoriasis of a pregnant woman are very limited and controversial. Since the effects of a possible transfer of etanercept to maternal milk in a still-immature immune system are not known, in accordance with the risk/benefit principle, the use of etanercept should not be recommended in breast-feeding women. © 2010 Elsevier España, y AEDV.


Guerra Ramos F.J.,Hospital Universitario Insular
Archivos de Bronconeumologia | Year: 2011

Echocardiography is the non-invasive method of choice for the study of patients with suspected pulmonary hypertension. This technique allows systolic pulmonary artery pressure to be estimated and can also provide additional information on the cause and effects of the disease. To estimate systolic pulmonary pressure, equivalent to right ventricular systolic pressure, maximal flow velocity of tricuspid regurgitation and right atrial pressure - estimated on the basis of the degree of inferior vena cava dilation - can be employed. Other parameters that should be evaluated are those related to right cavity size and right ventricular function.Unlike the left ventricle, the anatomy and geometry of the right ventricle is complex, hampering calculation of its systolic function. Consequently, over the years, various indirect methods have been developed to estimate right systolic function, the most commonly used being tricuspid annular plane systolic excursion (TAPSE) and the Tei index. New echocardiographic methods such as study of myocardial deformation (strain) and three-dimensional echocardiography may soon provide data suggesting poor clinical course in the short and medium term. Consequently, accurate determination and characterization of these data are essential. © 2011 Sociedad Española de Neumología y Cirugía Torácica.

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