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Valerio-Sallent L.,Autonomous University of Barcelona | Roure S.,Autonomous University of Barcelona | Basile L.,Subdireccio General de Vigilancia i Resposta A Emergencies en Salut Publica | Ballesteros L.A.,Servei de Medicina Interna | And 2 more authors.
Revista Clinica Espanola

Background: As an inevitable consequence of Latin American immigration to Europe, Spain and other European countries, it is necessary to confront the approach to cases of Chagas infection/disease for which, epidemiologically, there are more questions than answers. This study has aimed to describe all the Chagas-infected population in the north metropolitan area of Barcelona (406,000 inhabitants). Patients and methods: A prospective and multicentric study was performed in 3 hospitals and 1 International Health Unit. It included all patients with Trypanosoma cruzi positive serology, regardless of the requesting reason.Results The 139 diagnosed cases represent an annual incidence of: a) 0.68/10,000 inhabitants and, b) 73.2/10,000 immigrants coming from endemic zones. Of the patients, 80 (57.6%) had alterations in some complementary tests: cardiologic 62 (44.6%), digestive 38 (27.3%) and 20 (14.4%) both. According to the Brazilian Consensus of Chagas cardiomyopathy, they were classified as: 0=84 (60.4%); a=40 (28.7%); b1=4 (2.9%), b2=10 (7.2%) and c/d=1 (0.7%). Treatment with benznidazole (5 mg/kg/24 h for 60 days) was prescribed in 116 (83.4%) patients, 89 (76.7%) of whom completed it. Secondary effects were recorded in 56 (50.9%), which made it necessary to withdraw it in 21 (19.1%). Conclusions: Fewer cases of Chagas infection/disease than expected have been diagnosed in the North Metropolitan area of Barcelona. The series contains a high number of patients and there may be an elevated number of immigrants from endemic zones who have the asymptomatic chronic stages of the infection and who were unaware of their condition. © 2012 Elsevier España, S.L. Todos los derechos reservados. Source

Martin-Campos J.M.,Biomedical Research Institute Sant Pau | Martin-Campos J.M.,CIBER ISCIII | Roig R.,Biomedical Research Institute Sant Pau | Roig R.,CIBER ISCIII | And 9 more authors.
Clinica Chimica Acta

Background: Familial hypobetalipoproteinemia (FHBL), characterized by extremely low levels of plasma apolipoprotein (apo) B and cholesterol associated with low-density lipoproteins (LDLc), is considered to be an autosomal co-dominant disorder of heterogeneous origin. The main genetic disorder associated with FHBL consists of mutations in the APOB gene, while other less frequent forms are associated with mutations in NPC1L1, PCSK9, a still unidentified gene in 3p21.1-22 and, more recently, in ANGPTL3. Methods: We scanned for ANGPTL3 mutations in 4 unrelated Spanish families with FHBL criteria but negative for mutations in APOB. The entire coding region and intron-exon boundaries of the ANGPTL3 gene were amplified and sequenced. Results: Two probands were positive for the same frameshift mutation, a deletion of 5. bp in codon 121 in ANGPTL3, which produces a truncated protein of 122 residues. This mutation in homozygosis was associated in both families with combined hypolipidemia, characterized by low plasma apoB, low total, LDL and HDL cholesterol and low triglycerides. Conclusion: We confirm the existence of a new phenotype of FHBL, denominated familial combined hypolipidemia, which consist of a biochemical phenotype of low LDLc, low apoB, low TG and, unlike APOB mutations, low HDL cholesterol, due to a loss-of-function mutation in ANGPTL3. © 2011 Elsevier B.V. Source

Amblas Novellas J.,Unitat Integral Geriatria Osona | Panicot J.E.,Unitat Integral Geriatria Osona | Pueyo C.B.,Programa de Prevencio i Atencio a la Cronicitat | Brunet N.M.,Unitat Integral Geriatria Osona | And 3 more authors.
Revista Espanola de Geriatria y Gerontologia

Demographic changes and the economic situation of the recent years have conditioned a turning point in health policies, which have decided to progressively prioritize chronicity care programs. Given that hospital costs were concentrated in attention to patients with chronic diseases, reduction on admissions is now a priority target. Meanwhile, we state that among the obviously community handling paradigmatic aim for those patients and the current care situation, there is a long way to do that should be done gradually. According to the current scientific evidence: Is it sensible to assume that there is a proper level of admissions or is it better for the patients to reduce the number of admissions? Is it possible to operationally and reliably define which hospital admissions are avoidable? Is it harmful to a patient and to the health care system to admit a patient with multiple chronic disease? Maybe are hospital admissions are avoidable and readmissions are indicators of a fragmented health care system?Given that situation, a reasonable approach requires firstly a critical analysis of the various realities of care (microsystems) and a systematic review of the scientific evidence-breaking, and rejecting some topics if necessary. Secondly, we should bring all this knowledge to clinical practice, conciliating «what» and the know-how, individual and population view, sole disease and multimorbidity, and finally clinical approach and health planning. © 2013 SEGG. Source

Cabre M.,Servei de Medicina Interna | Serra-Prat M.,Research Unit | Serra-Prat M.,Institute Salud Carlos III | Force L.,Servei de Medicina Interna | And 4 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences

Background: To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. Methods: Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31, 2010. All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination. Main outcome measure was readmission for pneumonia. Clinical notes were reviewed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia. Results: A total of 2,359 patients (61.9% women, mean age 84.9 y) were recruited and followed for a mean of 24 months. Dysphagia was diagnosed in 47.5% of cases. Overall, 7.9% of individuals were readmitted for pneumonia during follow-up, 24.2% of these had aspiration pneumonia. The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years (95% CI 3.0-4.4) in individuals without dysphagia and 6.7 (5.5-7.8) in those with dysphagia, with an attributable risk of 3.02 readmissions per 100 person-years (1.66-4.38) and a rate ratio of 1.82 (1.41-2.36). Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia, with a hazard ratio of 1.6 (1.15-2.2) for hospitalization for pneumonia, 4.48 (2.01-10.0) for aspiration pneumonia, and 1.44 (1.02-2.03) for nonaspiration pneumonia. Conclusion: Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons. © The Author 2013. Source

Joven J.,Rovira i Virgili University | Micol V.,University Miguel Hernandez | Segura-Carretero A.,University of Granada | Alonso-Villaverde C.,Servei de Medicina Interna | Menendez J.A.,University of Franca
Critical Reviews in Food Science and Nutrition

Plant-derived dietary polyphenols may improve some disease states and promote health. Experimental evidence suggests that this is partially attributable to changes in gene expression. The rational use of bioactive food components may therefore present an opportunity to activate or repress selected gene expression pathways and, consequently, to manage or prevent disease. It remains to be determined whether this use of bioactive food components can be done safely. This article reviews the associated controversies and limitations of polyphenol therapy. There is a paucity of clinical data on the rational use of polyphenols, including a lack of knowledge on effective dosage, actual chemical formulations, bioavailability, distribution in tissues, the effect of genetic variations, differences in gut microflora, the synergistic (or antagonistic) effects observed in extracts, and the possible interaction between polyphenols and lipid domains of cell membranes that may alter the function of relevant receptors. The seminal question of why plants make substances that benefit humans remains unanswered, and there is still much to learn in terms of correlative versus causal effects of human exposure to various nutrients. The available data strongly suggest significant effects at the molecular level that represent interactions with the epigenome. The advent of relatively simple technologies is helping the field of epigenetics progress and facilitating the acquisition of multiple types of data that were previously difficult to obtain. In this review, we summarize the molecular basis of the epigenetic regulation of gene expression and the epigenetic changes associated with the consumption of polyphenols that illustrate how modifications in human nutrition may become relevant to health and disease. © 2014 Copyright Taylor and Francis Group, LLC. Source

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