Blanco-Reina E.,University of Malaga |
Ariza-Zafra G.,University Hospital of Albacete |
Leon-Ortiz M.,University Hospital of Albacete |
Bellido-Estevez I.,University of Malaga
European Journal of Clinical Pharmacology | Year: 2015
Purpose: This study aimed to estimate the prevalence of polypharmacy and potential prescribing omissions (PPO) and their related factors in community-dwelling elderly patients and to examine any possible relationship between these two concepts. Methods: A cross-sectional study was carried out including patients 65 years of age or over living on the island of Lanzarote (Spain). Sociodemographic, clinical and functional variables were collected, together with full data on drug therapy. The percentage of patients receiving ≥5 medications (polypharmacy) and the percentage of patients receiving at least one PPO according to Screening Tool to Alert doctors to Right Treatment (START) criteria (underprescription) were the two primary endpoints. Results: A total of 1844 medications were prescribed to the 407 patients included in our study. The overall prevalence of polypharmacy was 45 %. The risk factors associated with polypharmacy were comorbidity (OR 1.98, 95 % CI 1.63-2.44), limitations in activities of daily living (ADL; OR 3.0, 95 % CI 1.51-6.11), and being prescribed a drug in the Anatomical Therapeutic Chemical classification (ATC) C group (OR 7.92, 95 % CI 4.10-16.25) or in the N group (OR 3.80, 95 % CI 2.25-6.55). START criteria identified a total of 303 PPO in 170 (41.8 %) subjects. The risk of PPO increased by 60 % for every additional point in the Charlson Comorbidity Index (OR 1.60, 95 % CI 1.35-1.91). Polypharmacy also independently predicted the odds of at least one PPO according to START criteria (OR 2.19, 95 % CI 1.36-3.55). Conclusion: Our findings show high rates of polypharmacy and PPO, as well as a clear relationship between these two concepts. © 2014 Springer-Verlag Berlin Heidelberg.
PubMed | Hospital Universitario Fundacion Alcorcon, Hospital Universitario Ramon y Cajal, University Hospital of Albacete, University of Lodz and 3 more.
Type: Journal Article | Journal: Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis | Year: 2016
Interference of conventional peritoneal dialysis fluids (cPDFs) with peritoneal membrane cell functions may be attributed to the dialysis fluids low pH, high glucose concentration, and/or the presence of glucose degradation products (GDPs), the last of which leads to higher levels of advanced glycation end-products (AGEs). It has been suggested that the peritoneal membrane might be better preserved by using biocompatible solutions, including cancer antigetn 125 (CA125). This prospective, open-label, multicentre, randomized, controlled, cross-over phase IV study compared the in vivo biocompatibility of a neutral-pH, low-GDP peritoneal dialysis (PD) solution (balance) with a cPDF in automated PD (APD) patients. Our study revealed a significantly increased appearance rate and concentration of CA125 in the peritoneal effluent of APD patients treated with the neutral-pH, low-GDP solution balance versus a conventional PD solution.
Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version
PubMed | Health Area of Malaga Norte, University of Malaga, Health District of Cordoba Sur, University Hospital of Albacete and Health District of Malaga
Type: Journal Article | Journal: PloS one | Year: 2016
Emerging and changing evidence made it necessary to update STOPP-START criteria, and version 2 was published recently. In this study the objectives were to determine the prevalence of potentially inappropriate medication prescribing (PIM) in primary care using STOPP versions 1 (v1) and 2 (v2), as well as 2012 AGS Beers criteria, and analyze the factors associated with inappropriate prescribing according to STOPP/START v2. A cross-sectional study was carried out including community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. This variable was measured using three tools: STOPP v1, 2012 AGS Beers criteria and STOPP v2. Similarly, the percentage of patients receiving at least one potential prescribing omission (PPO) was calculated using START versions 1 and 2. A total of 1,615 prescriptions were reviewed. The median number of medications per patient was 7.1 drugs (3.8). The prevalence of elderly people exposed to polypharmacy (5 medications) was 72.9%, whereas 28.4% of the participants took 10 drugs regularly. PIM were present in 18.7%, 37.3% and 40.4% of participants, according to the STOPP v1, 2012 Beers criteria and STOPP v2, respectively. According to STOPP v2, the number of medications taken (OR: 1.14, 1.06-1.25), the presence of a psychological disorder (OR: 2.22, 1.13-4.37) and insomnia (OR: 3.35, 1.80-6.32) were risk factors for taking a PIM. The prevalence of PPOs was 34.7% and 21.8% according to version 1 and 2, respectively. In conclusion, STOPP-START criteria have been remarkably modified, which is evidenced by the different prevalence rates detected using version 2, as compared to version 1. In fact, the level of agreement between version 1 and the updated version is only moderate. Special attention should be paid on benzodiazepines, which keep being the most frequent PIM.
PubMed | Galdakao Hospital, Directorate General of Public Health, University of Verona, Swiss Tropical and Public Health Institute and 20 more.
Type: Journal Article | Journal: The Journal of allergy and clinical immunology | Year: 2016
Cross-sectional studies have reported a lower prevalence of sensitization in older adults, but few longitudinal studies have examined whether this is an aging or a year-of-birth cohort effect.We sought to assess changes in sensitization and total IgE levels in a cohort of European adults as they aged over a 20-year period.Levels of serum specific IgE to common aeroallergens (house dust mite, cat, and grass) and total IgE levels were measured in 3206 adults from 25 centers in the European Community Respiratory Health Survey on 3 occasions over 20years. Changes in sensitization and total IgE levels were analyzed by using regression analysis corrected for potential differences in laboratory equipment and by using inverse sampling probability weights to account for nonresponse.Over the 20-year follow-up, the prevalence of sensitization to at least 1 of the 3 allergens decreased from 29.4% to 24.8% (-4.6%; 95% CI, -7.0% to -2.1%). The prevalence of sensitization to house dust mite (-4.3%; 95% CI, -6.0% to -2.6%) and cat (-2.1%; 95% CI, -3.6% to -0.7%) decreased more than sensitization to grass (-0.6%; 95% CI, -2.5% to 1.3%). Age-specific prevalence of sensitization to house dust mite and cat did not differ between year-of-birth cohorts, but sensitization to grass was most prevalent in the most recent ones. Overall, total IgE levels decreased significantly (geometric mean ratio, 0.63; 95% CI, 0.58-0.68) at all ages in all year-of-birth cohorts.Aging was associated with lower levels of sensitization, especially to house dust mite and cat, after the age of 20years.
Montero J.C.,University of Salamanca |
Garcia-Alonso S.,University of Salamanca |
Ocana A.,University Hospital of Albacete |
Pandiella A.,University of Salamanca
Oncotarget | Year: 2015
The activation status of a set of pro-oncogenic tyrosine kinases in ovarian cancer patient samples was analyzed to define potential therapeutic targets. Frequent activation of HER family receptor tyrosine kinases, especially HER2, was observed. Studies in ovarian cancer cell lines confirmed the activation of HER2. Moreover, knockdown of HER2 caused a strong inhibition of their proliferation. Analyses of the action of agents that target HER2 indicated that the antibody drug conjugate trastuzumab-emtansine (T-DM1) caused a substantial antitumoral effect in vivo and in vitro, and potentiated the action of drugs used in the therapy of ovarian cancer. T-DM1 provoked cell cycle arrest in mitosis, and caused the appearance of aberrant mitotic spindles in cells treated with the drug. Biochemical experiments confirmed accumulation of the mitotic markers phospho-Histone H3 and phospho-BUBR1 in cells treated with the drug. Prolonged treatment of ovarian cancer cells with T-DM1 provoked the appearance of multinucleated cells which later led to cell death. Together, these data indicate that HER2 represents an important oncogene in ovarian cancer, and suggest that targeting this tyrosine kinase with T-DM1 may be therapeutically effective, especially in ovarian tumors with high content of HER2.
Branchini L.,New England Eye Center |
Branchini L.,Boston University |
Regatieri C.V.,New England Eye Center |
Regatieri C.V.,Federal University of São Paulo |
And 5 more authors.
Ophthalmology | Year: 2012
Purpose: To investigate the reproducibility of choroidal thickness measurements in normal subjects on 3 spectral domain optical coherence tomography (SD-OCT) instruments: Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA), Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany), and Optovue RTVue (Optovue Inc., Fremont, CA). Design: Cross-sectional non-interventional study. Participants: Images were obtained in 28 eyes of 28 healthy undilated volunteers without ocular pathology in a clinical setting. Methods: All subjects were imaged on the fovea using Cirrus HD 1-line raster, Spectralis enhanced depth imaging (EDI), and RTVue retina-cross. Main Outcome Measures: The choroid was measured subfoveally, 750 μm temporal, and 750 μm nasal to the fovea. All measurements were performed by 2 independent observers. Two-way analysis of variance (ANOVA) with Bonferroni's post-test, Pearson correlation, and Bland-Altman analysis were used to compare measurements. Results: The group of 28 subjects consisted of 7 men and 21 women, with an average age of 35.2 years (range, 23-64 years). A 2-way ANOVA with Bonferroni's post-test revealed no significant difference in the average subfoveal choroidal thickness (P > 0.05) among systems for any location: subfoveally, 750 μm temporal, and 750 μm nasal to the fovea. The measurements of choroidal thickness from any pair of 3 instruments (Cirrus vs. Spectralis, Cirrus vs. RTVue, Spectralis vs. RTVue) were also strongly correlated. The Pearson correlation among all 2 system pairs of the 3 systems was greater than 0.9 (P < 0.0001). The 95% limits of agreement among 4 choroidal thickness measurements were +11.21% to -13.57% (bias -1.17) between Cirrus and RTVue, +10.85% to -12.45% (bias -0.80) between Spectralis and RTVue, and +12.81% to -13.33% (bias -0.25) between Cirrus and Spectralis. Conclusions: In our population of young healthy adults with normal vision, there was good reproducibility among choroidal thickness measurements of images acquired with Cirrus, Spectralis, and RTVue. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2012 American Academy of Ophthalmology.
PubMed | Ministry of Health and Social Welfare, Institute of Tropical Medicine, Reference Center for Epidemics Control of Equatorial Guinea and University Hospital of Albacete
Type: | Journal: Malaria journal | Year: 2015
Malaria has traditionally been a leading public health problem in Equatorial Guinea. After completion, in September 2011, of the integrated set of interventions against malaria launched by the Global Fund Malaria Programme in the mainland area, the epidemiological situation of malaria remains unknown. The aim of this study was to investigate the prevalence rate of malaria and associated factors based on the rapid diagnosis test (RDT) in Bata district, in order to provide evidence that will reinforce the National Malaria Control Programme.From June to August 2013, a representative cross sectional survey using a multistage, stratified, cluster-selected sample was carried out in urban zones and rural villages from Bata district. Data on socio-demographic, health status and malaria-related behaviours was collected. Malaria diagnosis was performed by RDT. Bivariate and multivariable statistical methods were employed to assess malaria prevalence and its association with different factors.Prevalence of malaria was higher in rural settings (58.9 %; CI 95 % 55.2-62.5 %) than in the sampled urban communities (33.9 %; CI 95 % 31.1-36.9 %). Presence of anaemia was also high, especially in rural sites (89.6 vs. 82.8 %, p < 0.001). The analyses show that a positive RDT result was significantly associated with age group, the most affected age range being 13 months-14 years old. Other significant covariates were ethnic group (only in urban sites), number of adults living in the house (only in rural villages) previous history of fever, anaemia (only in urban sites) and sleeping under a bed net. Moreover, those who never slept under a bed net were two times more likely to have malaria.The prevalence of malaria was high in Bata district, especially in rural villages. The National Programme to fight malaria in Equatorial Guinea should take into account the differences found between rural and urban communities and age groups to target appropriately those worst affected. The findings of this study will assist in planning and undertaking regional policy and other preventive initiatives.
Lopez O.V.G.,University of Castilla - La Mancha |
Vicente A.M.G.,University of Castilla - La Mancha |
Martinez A.F.H.,University Hospital of Albacete |
Londono G.A.J.,University of Castilla - La Mancha |
And 3 more authors.
Translational Lung Cancer Research | Year: 2015
Objective: To compare the diagnostic performance of different metabolical, morphological and clinical criteria for correct presurgical classification of the solitary pulmonary nodule (SPN). Methods: Fifty-five patients, with SPN were retrospectively analyzed. All patients underwent preoperative 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Maximum diameter in CT, maximum standard uptake value (SUVmax), histopathologic result, age, smoking history and gender were obtained. Different criteria were established to classify a SPN as malignant: (I) visually detectable metabolism, (II) SUVmax >2.5 regardless of SPN diameter, (III) SUVmax threshold depending of SPN diameter, and (IV) ratio SUVmax/diameter greater than 1. For each criterion, statistical diagnostic parameters were obtained. Receiver operating characteristic (ROC) analysis was performed to select the best diagnostic SUVmax and SUVmax/diameter cutoff. Additionally, a predictive model of malignancy of the SPN was derived by multivariate logistic regression. Results: Fifteen SPN (27.3%) were benign and 40 (72.7%) malignant. The mean values ± standard deviation (SD) of SPN diameter and SUVmax were 1.93±0.57 cm and 3.93±2.67 respectively. Sensitivity (Se) and specificity (Sp) of the different diagnostic criteria were (I): 97.5% and 13.1%; (II) 67.5% and 53.3%; (III) 70% and 53.3%; and (IV) 85% and 33.3%, respectively. The SUVmax cut-off value with the best diagnostic performance was 1.95 (Se: 80%; Sp: 53.3%). The predictive model had a Se of 87.5% and Sp of 46.7%. The SUVmax was independent variables to predict malignancy. Conclusions: The assessment by semiquantitative methods did not improve the Se of visual analysis. The limited Sp was independent on the method used. However, the predictive model combining SUVmax and age was the best diagnostic approach. © Translational lung cancer research. All rights reserved.
Ruiz Picazo D.,University Hospital of Albacete
Journal of Pediatric Orthopaedics Part B | Year: 2016
Idiopathic chondrolysis of the hip (ICH) is a rare condition of unknown etiology, and is characterized by rapid, progressive destruction of the articular cartilage in the coxofemoral joint. This condition has an insidious onset, and is observed more commonly in female preadolescents. Patients report intense pain, motion restriction, and often present with an antalgic gait. Medical imaging techniques are required to make a differential diagnosis and biological markers for inflammation and infection should be evaluated. Avascular necrosis, septic arthritis, and juvenile idiopathic arthritis are the primary alternatives that should be precluded before making a diagnosis. Conservative treatment focuses on pain control and preservation of joint mobility. However, surgical treatment may be an option for these patients. We present a rare case of a 10-year-old boy where imaging tests and physical examination were consistent with conventional idiopathic hip chondrolysis. Following hip joint biopsy and culture, we observed the presence of bacteria originating from the mouth, which could have been responsible for the pathogenesis of ICH. This is the first report of ICH in which common bacteria of the mouth were found upon joint biopsy. In addition, with respect to the pathogenesis of hip chondrolysis, this case emphasizes that numerous factors are involved, many of which remain unknown. Level of Evidence: V. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PubMed | University Hospital of Albacete
Type: Journal Article | Journal: Journal of pediatric orthopedics. Part B | Year: 2016
Idiopathic chondrolysis of the hip (ICH) is a rare condition of unknown etiology, and is characterized by rapid, progressive destruction of the articular cartilage in the coxofemoral joint. This condition has an insidious onset, and is observed more commonly in female preadolescents. Patients report intense pain, motion restriction, and often present with an antalgic gait. Medical imaging techniques are required to make a differential diagnosis and biological markers for inflammation and infection should be evaluated. Avascular necrosis, septic arthritis, and juvenile idiopathic arthritis are the primary alternatives that should be precluded before making a diagnosis. Conservative treatment focuses on pain control and preservation of joint mobility. However, surgical treatment may be an option for these patients. We present a rare case of a 10-year-old boy where imaging tests and physical examination were consistent with conventional idiopathic hip chondrolysis. Following hip joint biopsy and culture, we observed the presence of bacteria originating from the mouth, which could have been responsible for the pathogenesis of ICH. This is the first report of ICH in which common bacteria of the mouth were found upon joint biopsy. In addition, with respect to the pathogenesis of hip chondrolysis, this case emphasizes that numerous factors are involved, many of which remain unknown.V.