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Las Palmas de Gran Canaria, Spain

Quesada-Gomez J.M.,Hospital Universitario Reina Sofia | Diaz-Curiel M.,Servicio de Medicina Interna | Sosa-Henriquez M.,Hospital Universitario Insular | Malouf-Sierra J.,Servicio de Medicina Interna | And 5 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.


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.


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.,CIBERSAM
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.


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.,CIBERSAM
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.


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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