Alfageme I.,University of Seville |
Reyes N.,University of Seville |
Merino M.,Puerta Del Mar Hospital |
Reina A.,University of Seville |
And 3 more authors.
Chronic Respiratory Disease | Year: 2010
COPD is characterized by airflow limitation that is usually progressive. The present study investigated the cause of death and the effect of airflow limitation on all-cause mortality in COPD patients. A prospective cohort of 600 COPD patients were followed for 3 years. Patients in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 (32.7%), GOLD 3 (48.1%), or GOLD 4 (19.1%). Overall, 117 patients died (19.6%). Deaths were due to respiratory failure (29%), cardiovascular disease (25.6%), cancer (17.9%), infection (11%), gastrointestinal disease (9.4%), and other causes (6.7%). According to the Cox regression analysis, the following independent factors were related to mortality: age (years), hazards ratio (HR) 1.046 (confidence interval [CI] 95% 1.021, 1.072); current smoking status, HR 1.535 (CI 95% 1.003, 2.350); cancer, HR 7.172 (CI 95% 4.515, 11.395); cardiovascular disease, HR 2.623 (CI 95% 1.821, 3.778); severe airflow limitation (GOLD 4), HR 2.378 (CI 95% 1.605, 3.525); and highest quartile of acute exacerbations, HR 1.852 (CI 95% 1.236, 2.775). The present study shows that severe airflow limitation, current smoking status, the presence of cardiovascular disease, cancer, and a high frequency of acute exacerbations have an independent negative impact on the prognosis of COPD patients. © 2010 The Author(s).
PubMed | Puerto Real Hospital and Puerta del Mar Hospital
Type: Journal Article | Journal: Journal of diabetes and its complications | Year: 2016
To evaluate relationships between early alterations in blood pressure and the progression of microvascular complications of diabetes in clinically-normotensive patients with type 1 diabetes (T1DM).In a prospective observational study of 85 normotensive T1DM patients without microalbuminuria, blood pressure (BP) was monitored over 24h using the ambulatory blood pressure monitoring (ABPM) system at baseline and 7years later. Development or progression of microalbuminuria, retinopathy and hypertension was evaluated.Initially, 20 patients (24%) were diagnosed with masked hypertension and 31 (37%) with non-dipper pattern as the only pathological findings. At 7years: 1) twenty-seven patients (32%) had progression of retinopathy related to the nocturnal diastolic blood pressure (BPD) (OR:1.122; p=0.034) and final non-dipper pattern (OR:5.857; p=0.005); 2) seven patients (10%) developed microalbuminuria for which nocturnal systolic blood pressure (BPS) was a risk factor (OR:1.129; p=0.007); 3) five of the normotensive patients (9%) progressed to hypertension; historic HbA1c (OR:2.767; p=0.046) and nocturnal BPD (OR:1.243; p=0.046) being the related risk factors. BPD level 65mmHg was associated with an increase in progression of retinopathy and hypertension.In T1DM patients there is an elevated prevalence of BP alterations, detected using ABPM. Alterations in nocturnal BP predispose to development/progression of microvascular complications and overt hypertension.
PubMed | Puerto Real Hospital and Puerta del Mar Hospital
Type: Journal Article | Journal: Journal of human hypertension | Year: 2016
The aim of this study was to evaluate the relationship between early blood pressure (BP) changes (detected using ambulatory BP monitoring; ABPM) with different markers of inflammation and endothelial dysfunction in patients with type 1 diabetes mellitus (T1DM). The study design was observational cross-sectional in 85 T1DM patients, clinically normotensive and with normo-albuminuria. We analyzed the relationships between ABPM-measured BP alterations over 24h with the inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor- and vascular endothelial growth factor (VEGF)) and the markers of endothelial damage (vascular adhesion molecule, intercellular adhesion molecule and plasminogen activator inhibitor-1 (PAI)). Despite being recorded as normotensive, 27 (31.8%) subjects presented with an average of pathological BP. VEGF levels were significantly elevated in the patients with an altered mean diurnal values compared with normotensives (112.33 (72.87-213.53) pgml
PubMed | Puerta del Mar Hospital and Alto Guadalquivir Healthcare Agency
Type: | Journal: Clinical nutrition (Edinburgh, Scotland) | Year: 2016
There is no consensus on the most accurate method to diagnose primary hypolactasia. We aimed to compare the diagnostic accuracy of the new gaxilose test with 2 traditional tests (lactose tolerance test and clinical criteria) for the diagnosis of primary hypolactasia using the C/T-13910 polymorphism as a reference standard.Patients with a clinical suspicion of lactose intolerance were subjected to gaxilose tests, shortened lactose tolerance tests, and symptom questionnaires before and after overload with 50g lactose and after a lactose-free diet. The diagnostic accuracy and degree of agreement and correlation were assessed using a genetic test (C/T-13910 polymorphism) as a reference standard and their respective 95% confidence intervals.Thirty consecutive patients (70% women) participated in the study. The genetic test confirmed the C/T-13910 polymorphism in 11 patients (36.8%). The presence of diarrhoea and the symptom score after lactose overload, along with the tolerance test, were the variables with the highest degree of agreement (>0.60). Area under the ROC curve was >0.82 (p<0.05), with sensitivity and specificity values of >0.80. However, the gaxilose test obtained lower values: , 0.47; area under curve, 0.75 (0.57-0.94); sensitivity, 0.82 (0.55-1); and specificity, 0.68 (0.45-0.92). The multivariate analysis showed an association between the post-overload symptom questionnaire and the results of the genetic test (odds ratio: 1.17; 1.04-1.31; p<0.01).The presence of diarrhoea and the symptom score after overload with 50g lactose showed a higher degree of agreement and diagnostic accuracy for primary hypolactasia than the gaxilose test when the genetic test is used as a reference standard.
Perez-Arana G.,Puerta del Mar Hospital |
Blandino-Rosano M.,Puerta del Mar Hospital |
Prada-Oliveira A.,University of Cádiz |
Aguilar-Diosdado M.,Puerta del Mar Hospital |
Segundo C.,Puerta del Mar Hospital
Endocrinology | Year: 2010
In autoimmune type 1 diabetes mellitus, proinflammatory cytokine-mediated apoptosis of β-cells has been considered to be the first event directly responsible for β-cell mass reduction. In the Bio-Breeding (BB) rat, an in vivo model used in the study of autoimmune diabetes, β-cell apoptosis is observed from 9 wk of age and takes place after an insulitis period that begins at an earlier age. Previous studies by our group have shown an antiproliferative effect of proinflammatory cytokines on cultured β-cells in Wistar rats, an effect that was partially reversed by Exendin-4, an analogue of glucagon-like peptide-1. In the current study, the changes in β-cell apoptosis and proliferation during insulitis stage were also determined in pancreatic tissue sections in normal and thymectomized BB rats, as well as in Wistar rats of 5, 7, 9, and 11 wk of age. Although stable β-cell proliferation in Wistar and thymectomized BB rats was observed along the course of the study, a decrease in β-cell proliferation and β-cell mass from the age of 5 wk, and prior to the commencement of apoptosis, was noted in BB rats. Exendin-4, in combination with anti-interferon-γ antibody, induced a near-total recovery of β-cell proliferation during the initial stages of insulitis. This highlights the importance of early intervention and, as well, the possibilities of new therapeutic approaches in preventing autoimmune diabetes by acting, initially, in the insulitis stage and, subsequently, on β-cell regeneration and on β-cell apoptosis. Copyright © 2010 by The Endocrine Society.
Quintana-Lopez L.,Puerta Del Mar Hospital |
Blandino-Rosano M.,Puerta Del Mar Hospital |
Perez-Arana G.,Puerta Del Mar Hospital |
Cebada-Aleu A.,Puerta Del Mar Hospital |
And 4 more authors.
Mediators of Inflammation | Year: 2013
Nitric oxide (NO) is involved in several biological processes. In type 1 diabetes mellitus (T1DM), proinflammatory cytokines activate an inducible isoform of NOS (iNOS) in β cells, thus increasing NO levels and inducing apoptosis. The aim of the current study is to determine the role of NO (1) in the antiproliferative effect of proinflammatory cytokines IL-1β, IFN-γ, and TNF-α on cultured islet β cells and (2) during the insulitis stage prior to diabetes onset using the Biobreeding (BB) rat strain as T1DM model. Our results indicate that NO donors exert an antiproliferative effect on β cell obtained from cultured pancreatic islets, similar to that induced by proinflammatory cytokines. This cytokine-induced antiproliferative effect can be reversed by L-NMMA, a general NOS inhibitor, and is independent of guanylate cyclase pathway. Assays using NOS isoform specific inhibitors suggest that the NO implicated in the antiproliferative effect of proinflammatory cytokines is produced by inducible NOS, although not in an exclusive way. In BB rats, early treatment with L-NMMA improves the initial stage of insulitis. We conclude that NO is an important mediator of antiproliferative effect induced by proinflammatory cytokines on cultured β cell and is implicated in β-cell proliferation impairment observed early from initial stage of insulitis. © 2013 Laura Quintana-Lopez et al.
Portenoy R.K.,Beth Israel Deaconess Medical Center |
Raffaeli W.,Infermi Hospital |
Torres L.M.,Puerta del Mar Hospital |
Sitte T.,PalliativNetz Osthessen |
And 3 more authors.
Journal of Opioid Management | Year: 2010
Objective: To assess the long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray (FPNS) inpatients with breakthrough cancer pain (BTCP). Design: A multicenter, open-label study. Patients: Patients with chronic cancer pain treated with ≥60 mg/d oral morphine or equivalent experiencing 1-4 episodes per day of BTCP. Intervention: All patients entered into a 16-week treatment phase after undergoing a dose-titration phase with FPNS. Main outcome measures: Safety and tolerability were assessed by adverse events (AEs) and by nasal tolerability assessments. Consistency of effect was monitored through additional rescue medication use and FPNS dose change. Results: Four hundred three patients were included in the safety analyses. Of these, 356 patients entered the treatment phase and 110 patients completed the study. FPNS was self-administered for 42,227 episodes. During the treatment phase, 99 patients (24.6 percent) reported treatment-related AEs; most were mild or moderate and typical of opioids. Serious AEs were reported by 61 patients (15.1 percent), but only five were considered related to study drug. Of the 80 deaths that occurred during this study, one was assessed as possibly related to study drug. Nasal assessments revealed no significant local effects. No additional rescue medication was required after 94 percent of FPNS-treated episodes. More than 90 percent of patients required no increase in their initial dose of FPNS. Conclusions: FPNS use for BTCP was associated with AEs, typical of opioids, with no evidence of nasal toxicity. A large proportion of BTCP episodes were treated with a single dose, and doses remained stable over the 4-month period. © 2010 Journal of Opioid Management, All Rights Reserved.
Mateo-Gavira I.,Puerta del Mar Hospital
Journal of Human Hypertension | Year: 2016
The aim of this study was to evaluate the relationship between early blood pressure (BP) changes (detected using ambulatory BP monitoring; ABPM) with different markers of inflammation and endothelial dysfunction in patients with type 1 diabetes mellitus (T1DM). The study design was observational cross-sectional in 85 T1DM patients, clinically normotensive and with normo-albuminuria. We analyzed the relationships between ABPM-measured BP alterations over 24 h with the inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α and vascular endothelial growth factor (VEGF)) and the markers of endothelial damage (vascular adhesion molecule, intercellular adhesion molecule and plasminogen activator inhibitor-1 (PAI)). Despite being recorded as normotensive, 27 (31.8%) subjects presented with an average of pathological BP. VEGF levels were significantly elevated in the patients with an altered mean diurnal values compared with normotensives (112.33 (72.87–213.53) pg ml-1 vs 71.03 (37.71–107.92) pg ml-1; P=0.007). Further, VEGF levels correlated significantly with the parameters of diurnal BP and of 24 h values. IL-6 concentration was a risk factor in the patients with hypertension (OR=1.406; P=0.027). There were no modifications in the levels of markers of endothelial damage. Summarizing, there is an increase in pro-inflammatory cytokines, but not the endothelial adhesion molecules, in early stages of arterial hypertension in patients with T1DM.Journal of Human Hypertension advance online publication, 18 August 2016; doi:10.1038/jhh.2016.56. © 2016 Macmillan Publishers Limited, part of Springer Nature.
Roca-Rodriguez M.M.,Virgen Of La Victoria Hospital |
Lopez-Tinoco C.,Puerta del Mar Hospital |
Fernandez-Deudero A.,Puerta del Mar Hospital Investigation Unit |
Murri M.,Virgen Of La Victoria Hospital Investigation Unit Imabis |
And 4 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2012
Background: Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for metabolic syndrome and CVD. The aim of the study was to evaluate the relationships between levels of cytokines, components of metabolic syndrome and cardiovascular risk markers in women with previous gestational diabetes. Methods: Women (n=41) with gestational diabetes background (cases) and 21 healthy women (controls) in the postpartum period were enrolled. Demographic and clinical data, lipid and carbohydrate metabolism and uric acid and adipokine levels (TNF-α, IL-6, leptin and adiponectin) were compared and their relationships analysed. Metabolic syndrome prevalence was calculated by WHO and NCEP-ATPIII definitions. Results: There were significant differences between cases and controls: body mass index (kg/m2) 27.4±5.6 vs 23.9±3.6 (p=0.013), waist circumference (cm) 85.2±12.9 vs 77.5±9.0 (p=0.017), metabolic syndrome (WHO definition) 14.6% vs 0% (p=0.012), metabolic syndrome (NCEP-ATPIII definition) 22% vs 0% (p=0.002), low HDL 36.6% vs 9.5% (p=0.024), fasting glucose (mmol/L) 5.4±0.6 vs 4.9±0.2 (p<0.001), glucose 120′ oral glucose tolerance test (mmol/L) 5.8±1.7vs 4.7±0.8 (p=0.007), fasting insulin (μU/mL) 13.4±8.1 vs 8.4±4.3 (p=0.004), HOMA index 3.3±2.3 vs 1.8±1.0 (p=0.002), HbA1c (%) 5.4±0.2 vs 5.2±0.2 (p=0.021), uric acid (mg/dL) 4.1±1 vs 3.5±0.6 (p=0.009), leptin (ng/mL) 32025.5±19917.3 vs 20258.9±16359.9 (p=0.023), respectively. Conclusions: Women with previous gestational diabetes have central adiposity, atherogenic lipid profile, carbohydrate intolerance and adverse adipokine profile, all of which are risk factors for the future development of metabolic disease and CVD. © 2012 John Wiley & Sons, Ltd.
PubMed | Doctor Lobaton Clinic, Pius Hospital Of Valls, Germans Trias i Pujol Hospital, Stallergenes Iberica and 4 more.
Type: Journal Article | Journal: Advances in therapy | Year: 2016
Allergen immunotherapy is a long-term treatment that has been associated with patient adherence issues. The aim of the study was to increase the knowledge on compliance of patients allergic to house dust mites, receiving sublingual immunotherapy (SLIT).A retrospective observational study was performed in 53 Spanish allergy units. We enrolled patients undergoing the SLIT treatment for house dust mites including a scheduled control visit 12months after initiating the therapy. We conducted a comprehensive assessment of compliance using three methods. In the first step, an allergist evaluated the patients according to the results of an interview and the existing medical records. The subjects taking more than 80% of the overall prescription were defined as compliant. The remaining noncompliant patients were divided into groups taking less than 25%, 25-50%, and 50-80% of the prescribed SLIT. In the second stage, we conducted the Morisky-Green test. Finally, the noncompliant patients were asked to fill a self-report assessment form. Data were stratified into age groups. The potential factors affecting compliance were also investigated.Overall, 380 subjects participated in the study. The compliance rate was 79.7%, and the treatment discontinuation rate was 22.5%, while 66.8% of patients were adherent (both compliant and continuing with the treatment). The results showed that children were the most compliant and adolescents the least compliant (86.6% and 60.9%, respectively). The main reason for noncompliance was forgetting some doses in 31.0% of the children, 48.0% of the adolescents, and 53.2% of the adults. Compliance was associated with the following factors: age, number of annual control visits, and reduction in symptomatic medication.Our results showed that two out of three patients with house dust mite-induced allergic rhinitis adhered to the SLIT treatment. Multidisciplinary and integral solutions are needed to improve the compliance, with special attention paid to adolescents.Stallergenes Greer Spain.