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1.
Int J Mol Sci ; 25(2)2024 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-38256058

RESUMEN

Lipids are a large group of natural compounds, together with proteins and carbohydrates, and are essential for various processes in the body. After death, the organism's tissues undergo a series of reactions that generate changes in some molecules, including lipids. This means that determining the lipid change profile can be beneficial in estimating the postmortem interval (PMI). These changes can also help determine burial sites and advance the localization of graves. The aim was to explore and analyze the decomposition process of corpses, focusing on the transformation of lipids, especially triglycerides (TGs) and fatty acids (FAs), and the possible application of these compounds as markers to estimate PMI and detect burial sites. A systematic review of 24 scientific articles from the last 23 years (2000-2023) was conducted. The results show that membrane glycerophospholipids (such as phosphatidylcholine and phosphatidylglycerol, among others) are the most studied, and the most promising results are obtained, with decreasing patterns as PMI varies. Fatty acids (FAs) are also identified as potential biomarkers owing to the variations in their postmortem concentration. An increase in saturated fatty acids (SFAs), such as stearic acid and palmitic acid, and a decrease in unsaturated fatty acids (UFAs), such as oleic acid and linoleic acid, were observed. The importance of intrinsic and extrinsic factors in decomposition is also observed. Finally, as for the burial sites, the presence of fatty acids and some sterols in burial areas of animal and human remains can be verified. In conclusion, glycerophospholipids and fatty acids are good markers for estimating PMI. It has been observed that there are still no equations for estimating the PMI that can be applied to forensic practice, as intrinsic and extrinsic factors are seen to play a vital role in the decomposition process. As for determining burial sites, the importance of soil and textile samples has been demonstrated, showing a direct relationship between saturated fatty acids, hydroxy fatty acids, and some sterols with decomposing remains.


Asunto(s)
Lipidómica , Fitosteroles , Animales , Humanos , Ácidos Grasos , Cadáver , Esteroles , Glicerofosfolípidos
2.
Molecules ; 24(13)2019 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-31261852

RESUMEN

A method based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of bisoprolol and atenolol in human bone. After the addition of lobivolol as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were centrifuged, and the supernatants were subjected to solid phase extraction. Elution was achieved by using 3 mL of 2% ammonium hydroxide in 80:20 dichloromethane:isopropanol solution. Eluted samples were evaporated and derivatized. Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.1-0.3 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries were 60% for bisoprolol and 106% for atenolol, the matrix effect was 69% for bisoprolol and 70% for atenolol and process efficiency was 41% for bisoprolol and 80% for atenolol. The intra- and inter-assay accuracy values were always better than 12%. The validated method was then applied to bone samples from two real forensic cases in which toxicological analysis in blood were positive for atenolol in the first case (0.65 µg/mL) and bisoprolol in the second case (0.06 µg/mL). Atenolol was found in bone samples from the corresponding case at the approximate concentration of 148 ng/mg and bisoprolol was found at 8 ng/mg.


Asunto(s)
Atenolol/análisis , Bisoprolol/análisis , Huesos/química , Toxicología Forense , Cromatografía de Gases y Espectrometría de Masas , Humanos , Reproducibilidad de los Resultados , Extracción en Fase Sólida
3.
Adicciones ; 31(2): 95-105, 2019 04 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30059576

RESUMEN

Greater attention is focusing on the motivations of subjects recruited for research protocols, especially in vulnerable populations. Although addiction is a highly stigmatized condition, very little research has focused on the factors influencing the decision to participate of patients with an addiction. Our aim is to gather further evidence in relation to the motivations of people with Substance Use Disorders (SUD), comparing their reasoning and willingness to participate in a hypothetical research study of 53 subjects with DSM-5 diagnoses of SUD and 50 controls. Responses on the MacArthur Competence Assessment Tool for Clinical Research were documented and correlated with several variables. There were no significant differences in willingness to participate in research and reasons for doing so between SUD and controls. Among SUD subjects, 59% mentioned altruism, 53.8% expected therapeutic benefits, and 43.6% desired to help others; none mentioned money. Of those patients with SUD who refused to participate in research, 69.2% cited aversion and 46.2% mentioned risk. Willingness to participate was correlated with higher computer literacy and better cognitive performance. In the multivariate analysis, aversion was a significant predictor of willingness to participate in research. When research is not related to their diagnosis, the motivations of SUD and controls are similar and flowed logically from the study. However, elements associated with therapeutic misconceptions were also evident. Therefore, negative views about the motivations of SUD subjects' participation in research are unfounded. Consequently, to improve study recruitment, assessments may be targeted to specific vulnerabilities rather than to diagnoses.


Cada vez se presta más atención a las motivaciones de las personas reclutadas para ensayos clínicos, especialmente si pertenecen a colectivos vulnerables. Aunque la participación en investigación de las personas con trastorno por uso de sustancias (TUS) suscita estereotipos negativos, muy pocos estudios se han centrado en los factores que influyen en la misma. Nuestro objetivo es analizar sus motivaciones comparando las razones y la disposición a participar en un ensayo hipotético de 53 pacientes con diagnósticos DSM-5 de TUS y 50 controles. Las respuestas que dieron a la entrevista MacArthur Competence Assessment Tool for Clinical Research se correlacionaron con diversas variables. No encontramos diferencias significativas entre ambas poblaciones en términos de motivaciones y disposición a participar. El 59% de la población TUS mencionó altruismo, un 53,8% esperaba beneficio terapéutico, y el 43,6% deseaba ayudar a otros. De los pacientes con TUS que rechazaron participar, el 69,2% alegó miedo y el 46,2% incomodidad por los riesgos. La disposición a participar se relacionó con un mayor nivel cognitivo y de alfabetización informática. En el análisis multivariante, la aversión a la investigación permaneció como factor predictivo significativo de la disposición a participar. Cuando la investigación no está relacionada con su diagnóstico, las motivaciones de la población TUS son similares a las de los controles y se deducen lógicamente del estudio, aunque también se evidenciaron elementos de "error terapéutico". Por consiguiente, las visiones negativas sobre las motivaciones de los TUS como participantes en investigación son infundadas. Para mejorar el reclutamiento, las valoraciones deben dirigirse a vulnerabilidades especificas en lugar de al diagnóstico.


Asunto(s)
Investigación Biomédica , Competencia Mental , Motivación , Participación del Paciente/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Estudios de Casos y Controles , Toma de Decisiones , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Participación del Paciente/estadística & datos numéricos
4.
Adicciones ; 29(3): 213-214, 2017 Jun 28.
Artículo en Inglés, Español | MEDLINE | ID: mdl-28492963

RESUMEN

Letter to the editor.


Resumen: el consentimiento informado constituye un elemento clave para una investigación ética. La población adicta puede tener deteriorada su capacidad para consentir por varios motivos. Las drogodependencias representan un campo idóneo para un análisis bioético porque implican conflictos de valores a diversos niveles. Constituyen un problema complejo en el que interaccionan intereses económicos, políticos, sociales, y sanitarios. Analizamos las implicaciones de estas cuestiones para la práctica clínica y la investigación con personas con trastornos adictivos y damos unas directrices sobre cuándo, cómo y por qué llevar a cabo valoraciones de la capacidad para participar en investigación.


Asunto(s)
Investigación Biomédica , Toma de Decisiones , Competencia Mental , Sujetos de Investigación , Trastornos Relacionados con Sustancias/psicología , Humanos
5.
BMC Med Ethics ; 17: 3, 2016 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-26759171

RESUMEN

BACKGROUND: Informed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research. METHODS: 53 subjects with DSM-5 diagnoses of a Substance Use Disorder (SUD) and 50 non psychiatric comparison subjects (NPCs) participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out at a community-based Outpatient Treatment Center and at an urban-located Health Centre in Spain. A binary judgment of capacity/incapacity was made guided by the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) and a clinical interview. Demographics and clinical characteristics were assessed by cases notes and the Mini-Mental State Examination, the Global Assessment Functional Scale and the Clinical Global Impression Scale. RESULTS: NPCs performed the best on the MacCAT-CR, and patients with SUD had the worst performance, particularly on the Understanding and Appreciation subscales. 32.7% SUD people lacked research-related decisional capacity. There were no statistically significant differences between the groups in terms of capacity to consent to research. CONCLUSIONS: The findings of our study provide evidence that a large proportion of individuals with SUD had decisional capacity for consent to research. It is therefore inappropriate to draw conclusions about capacity to make research decisions on the basis of a SUD diagnosis. In the absence of advanced cognitive impairment, acute withdrawal or intoxication, we should assume that addicted persons possess decision-making capacity. Thus, the view that people with SUD would ipso facto lose decision-making power for research consent is flawed and stigmatizing.


Asunto(s)
Investigación Biomédica/ética , Toma de Decisiones , Consentimiento Informado/psicología , Competencia Mental , Sujetos de Investigación/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Consentimiento Informado/ética , Masculino , Persona de Mediana Edad , Adulto Joven
6.
Psychiatr Q ; 87(1): 89-105, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25952945

RESUMEN

Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains yet uncertain. The aim of this study is to evaluate the association between capacity to consent research and different psychiatric disorders and to characterize predictors of impairments in research decision-making capacity across diagnostic groups in a cross-sectional study. 139 consecutively referred outpatients with DSM-IV TR diagnoses of psychotic, mood and anxiety disorders were interviewed and a binary judgment of incapacity was made guided by the MacArthur competence assessment tool for consent research (MacCAT-CR). Demographics and clinical information were assessed by cases notes. Patients with anxiety disorders performed the best on the MacCAT-CR, and patients with psychotic disorders had the worst performance, however, there was considerable heterogeneity within each group. Cognitive impairment and global functioning were strongly correlated with MacCAT-CR subscales scores. 30.6% participants lacked research-related decisional capacity. Low Understanding score OR 0.07 (IC 95% 0.01-0.32) and Low Reasoning score OR 0.30 (IC 95% 0.11-0.82) were the factors most closely associated with lack of capacity. No absolute statements about decisional capacity can be driven merely due to the diagnosis. We found several risk factors which may be considered to decide which populations may require more thorough capacity assessments. The issues under consideration in the present study are by no means unique to people with psychiatric conditions. Ignoring this caveat, risks further inappropriate stigmatization of those with serious mental illness.


Asunto(s)
Trastornos de Ansiedad/psicología , Consentimiento Informado/psicología , Competencia Mental/psicología , Trastornos del Humor/psicología , Pacientes Ambulatorios/psicología , Pacientes Ambulatorios/estadística & datos numéricos , Trastornos Psicóticos/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia
7.
Int J Legal Med ; 129(4): 807-13, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25432861

RESUMEN

The diagnosis of drowning can be extremely difficult, especially when the typical morphological signs of drowning are not present, or when the body is in an advanced stage of putrefaction. The main aim of this work is to demonstrate the applicability of laser-induced breakdown spectroscopy (LIBS) to the diagnosis of seawater drowning. Ten teeth samples were selected from eight medico-legal autopsies. A Nd:YAG laser operating at its fundamental wavelength (1,064 nm) was used to generate microplasmas at the sample surface. Strontium (Sr) concentration in tooth samples has been found to be a key factor for the diagnosis of seawater drowning. Spectral differences between the dentin and the enamel were observed. Greater Sr abundance was located in the dentin, with relative standard deviations in the range of 30 to 35%. In addition, chemical images were generated to study the spatial distribution of Sr along the piece. In all cases, Sr content was higher when the cause of the individual death was drowning. A blind experiment was performed to exclude the possibility that the increase of Sr is due to passive diffusion in the blood. The detection of Sr as well as the determination of its distribution by LIBS in dentin seems to be a promising complementary tool for the diagnosis of death by seawater drowning.


Asunto(s)
Dentina/química , Ahogamiento/diagnóstico , Estroncio/análisis , Anciano , Odontología Forense , Humanos , Láseres de Estado Sólido , Masculino , Persona de Mediana Edad , Agua de Mar , Análisis Espectral
8.
Am J Forensic Med Pathol ; 33(3): 211-4, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21063198

RESUMEN

Because of the adverse effects that diagenesis exert on ancient skeletal remains, DNA from these samples is often compromised to the point where genetic typing can be challenging. Nevertheless, robust and reliable methods are currently available to allow successful genotyping of ancient specimens. Here we report nuclear DNA-based methods and typing strategies used to analyze 2 human skeletons from a medieval burial. Reliable DNA nuclear profiles were obtained from teeth, whereas mitochondrial DNA analyses in bones were inconclusive. A complete nuclear mini short tandem repeat profile was obtained from a well-preserved premolar, but only a partial one from the femur. Increasing the sensitivity of the polymerase chain reaction system allowed a full profile from the latter, but the presence of artifacts reinforced the idea that the interpretation of this kind of analysis must be performed with caution. The results presented here also indicate that DNA from dental pieces can be better preserved than from bones, even in the case of well-preserved long bones with thick cortical tissue such as the femurs, and have a better chance of successful genetic typing, probably because of the high degree of protection conferred to the DNA by the enamel.


Asunto(s)
Diente Premolar/química , Dermatoglifia del ADN/métodos , ADN Mitocondrial/genética , Repeticiones de Microsatélite , Degradación Necrótica del ADN , Electroforesis Capilar , Femenino , Fémur/química , Historia Medieval , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Secuencia de ADN
9.
Toxics ; 10(6)2022 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-35736927

RESUMEN

Suicide affects all sociodemographic levels, age groups, and populations worldwide. The factors that can increase the risk of suicidal tendencies are widely studied. The aim of this study was to analyze the types and combinations of toxics found in fatal suicide victims with different suicide mechanisms. A total of 355 autopsies were retrospectively studied, and 26 toxics were determined and related to mechanisms of suicide. Hanging (55%), drug overdose (22.7%), and jumping from a height (17.8%) were most represented suicide mechanisms with positive toxicology. Hanging was the most represented in men (50.3%; p = 0.019), while jumping from a height was more represented in women (29.7%, p = 0.028). Drugs of abuse were the most frequent toxics found in men (55.5%; p < 0.001), while medicines were the most frequent type found in women (70.3%, p < 0.001). Alcohol, nordiazepam, cocaine, and venlafaxine were the most consumed toxics. Benzodiazepines and venlafaxine were found in suicides involving drug overdose, hanging, and jumping from a height. In conclusion, most suicides were associated with drug abuse in men. Hanging was more represented in men and jumping from a height in women. Alcohol was present in combination with other toxics and medicines. The toxicological analysis is fundamental to understanding consumption patterns and establishing strategies and protocols for detecting and preventing suicide.

10.
Anal Biochem ; 418(1): 30-6, 2011 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-21787742

RESUMEN

The aim of this study was to develop a method for the determination of ethyl-glucuronide (EtG) and ethyl-sulfate (EtS), two direct ethanol metabolites, in early placental and fetal human tissues, as potential biomarkers of transplacental ethanol transfer from the mother to the fetus. Placental and fetal tissue samples were obtained from women undergoing voluntary termination of pregnancy at 12 weeks of gestation. Samples were deproteinized and directly injected into a liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) system. Limits of detection of 13.0 and 23.0 pmol/g and lower limits of quantification of 22.0 and 40.0 pmol/g were reached for EtG and EtS, respectively. Inter- and intraday imprecision and accuracy were always lower than 15%. The method was applied to 70 samples (35 placentas and 35 fetal tissues). Of 35 samples, 4 samples collected from 4 women tested positive for EtG and EtS, always showing higher concentrations for EtG. The placenta/fetal tissue ratio for EtG was 2.9 ± 0.9, whereas EtS showed a ratio of 1.7 ± 0.7. Preliminary results suggest that these metabolites are present in both tissues. Further studies should now corroborate the hypothesis, not yet confirmed, that transplacental transfer of ethanol takes place not only for the parent compound but also for EtG and EtS.


Asunto(s)
Feto/química , Glucuronatos/análisis , Placenta/química , Ésteres del Ácido Sulfúrico/análisis , Biomarcadores/análisis , Cromatografía Liquida , Femenino , Humanos , Intercambio Materno-Fetal , Embarazo , Detección de Abuso de Sustancias/métodos , Espectrometría de Masas en Tándem
11.
Med Law ; 30(1): 55-63, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21528797

RESUMEN

The aim of this paper is to study the role of a professional dental organization in the resolution of malpractice claims in Murcia (southeast of Spain). We analysed all the claims presented to the College of Dentists during the last sixteen years (n = 84). Professional behaviour was demonstrated as adequate in 29 cases and as malpractice in 55 (32 cases were considered technically correct but with information failures and in 23 cases technical errors were observed). The written informed consent was absent in 40 cases, although information was supplied verbally in 30 cases of the 40. The distribution of the dental interventions performed in the claim cases was: surgery, 20 cases (23.80%), prosthetic, 36 cases (42.85%) and endodontic, 28 cases (33.33%). Only in 22 cases (26.19%) was a final agreement reached between the parties. The Dental College could improve these results, acting as a real arbitral court and minimizing the problems for professionals and the claimers.


Asunto(s)
Odontólogos/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Sociedades Odontológicas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Gestión de Riesgos , España
12.
Front Med (Lausanne) ; 8: 786798, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35071269

RESUMEN

Background: In forensic autopsies, examining the wounds is one of the most critical aspects to clarify the causal relationship between the cause of death and the wounds observed on the corpse. However, on many occasions, it is difficult to differentiate antemortem injuries from post-mortem injuries, mainly when they occur very close to the moment of death. At present, various studies try to find biomarkers and clarify the molecular mechanisms involved in a wound due to the high variability of conditions in which they occur, thus being one of the most challenging problems in forensic pathology. This review aimed to study the omics data to determine the main lines of investigation emerging in the diagnosis of vital injuries, time of appearance, estimation of the age and vitality of the wound, and its possible contributions to the forensic field. Methods: A systematic review of the human wound concerning forensic science was carried out by following PRISMA guidelines. Results: This study sheds light on the role of omics research during the process of wounding, identifying different cytokines and other inflammatory mediators, as well as cells involved in the specific stage of the wound healing process, show great use in estimating the age of a wound. On the other hand, the expression levels of skin enzymes, proteins, metal ions, and other biomarkers play an essential role in differentiating vital and post-mortem wounds. More recent studies have begun to analyze and quantify mRNA from different genes that encode proteins that participate in the inflammation phase of a wound and miRNAs related to various cellular processes. Conclusions: This study sheds light on the role of research in the molecular characterization of vital wounds, heralding a promising future for molecular characterization of wounds in the field of forensic pathology, opening up an important new area of research. Systematic Review Registration: URL: https://www.crd.york.ac.uk/prospero/#myprospero, Identifier: CRD42021286623.

13.
J Anal Toxicol ; 44(9): 985-992, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-32453428

RESUMEN

A procedure based on gas chromatography-mass spectrometry was developed for the analysis of benzodiazepines (nordiazepam, oxazepam, lormetazepam, lorazepam, clonazepam, bromazepam and alprazolam) in postmortem human ribs. Powdered bone samples, including marrow remains inside, with the internal standard diazepam-d5 were subjected to enzymatic hydrolysis with 100 µL of ß-glucoronidase and were incubated in sodium hydroxide for 1 h in a 70°C oven. Samples underwent liquid phase extraction and ethyl acetate was used as eluent. Chromatography was performed on a fused silica capillary column and the selected-ion-monitoring mode was used for analytes determination. The method was validated in the range 0.1-0.5 ng/mg (depending on the benzodiazepine) to 100 ng/mg with average values of recovery, matrix effect and process efficiency ranged from 83.2 to 94.3%, from 97.3 to 102.1% and from 80.5 to 91.2%, respectively. The intra- and inter-day accuracy was <15%. The procedure was tested in rib specimens obtained during routine autopsies from 20 cases where these benzodiazepines were found in blood. Benzodiazepines were detected in the combined bone and marrow samples in 60% of cases. Lorazepam was detected in bone in the range of 0.3-0.7 ng/mg, nordiazepam at 1.3-4.2 ng/mg and oxazepam at 1.1-1.2 ng/mg. To our knowledge, this protocol for the simultaneous analysis of these benzodiazepines is the first performed and validated using human ribs.


Asunto(s)
Benzodiazepinas/análisis , Toxicología Forense/métodos , Cromatografía de Gases y Espectrometría de Masas , Alprazolam , Autopsia , Cromatografía Liquida , Clonazepam , Diazepam , Humanos , Extracción Líquido-Líquido , Lorazepam/análogos & derivados , Nordazepam , Oxazepam , Espectrometría de Masas en Tándem
14.
Leg Med (Tokyo) ; 48: 101817, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33264697

RESUMEN

The paper presents the procedure followed to fully solve a forensic case which occurred in Southeastern Spain through the collaboration of specialists from different scientific areas belonging to two different government institutions, a public University and the Guardia Civil. Entomological evidence was required to estimate the PMI in order to settle the perimortem circumstances. Piophila megastigmata (Diptera: Piophilidae) is reported for the first time from a forensic case in Spain, enhancing the interest of its presence in corpses to estimate the PMI. The procedure followed for each scientific specialist is detailed and the possibilities and requirements of each discipline are discussed in detail. Taking into account that institutional interdisciplinary collaboration is not a rule in solving cases of forensic investigation in Spain, the relevance and need of such interdisciplinary collaboration in solving cases of forensic investigation is emphasized.


Asunto(s)
Autopsia/métodos , Dípteros , Entomología Forense/métodos , Medicina Legal/métodos , Comunicación Interdisciplinaria , Cambios Post Mortem , Animales , Cadáver , Dermatoglifia , Larva , España , Factores de Tiempo
15.
Arch Med Sci ; 17(3): 682-693, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34025838

RESUMEN

INTRODUCTION: The Child-Pugh and model for end-stage liver disease (MELD) scores are widely used to predict the outcomes of liver transplant (LT). Both have similar prognostic values in most cases, although their benefits might differ in some specific conditions. The aim of our study was to analyze the influence of pre-transplant ascites and encephalopathy in post-transplant liver rejection development and survival in alcohol cirrhosis (AC) patients undergoing LT to determine the usefulness of the Child-Pugh score for the assessment of prognosis in such patients. MATERIAL AND METHODS: Two hundred and eighty-one AC patients, classified according to viral infections and pre-transplant complications, were analyzed. Acute (AR) and chronic (CR) liver rejections and Child-Pugh, MELD and albumin-bilirubin (ALBI) scores were studied in all cases. RESULTS: Similar AC rejection percentages were observed in ascites or encephalopathy groups (18.5% and 16.5%, p = 0.735), although a higher but not statistically significant AC rate was observed in patients with grade III ascites (p = 0.777) and with grade II encephalopathy (p = 0.089). Chronic rejection was only developed by 9.1% of AC patients, regardless of the presence of ascites (6.2%) or encephalopathy (5.5%). The presence of ascites and encephalopathy complications did not seem to influence post-transplant survival. Neither the Child-Pugh nor the ALBI score can be considered the best for predicting patient survival in the short or long term. CONCLUSIONS: Ascites and encephalopathy do not seem to influence AC or CR in patient survival, regardless of the presence of viral infections, so in our study neither the Child-Pugh nor ALBI score seems to be the best score to predict the outcomes of these patients.

16.
Arch Med Sci ; 17(3): 764-774, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34025847

RESUMEN

INTRODUCTION: The molecular mechanisms underlying alcoholic liver fibrosis and cirrhosis are not completely understood. Hepatic fibrosis involves the interplay of diverse cells and factors, including hepatic stellate cells (HSCs), Kupffer, NK cells, and T-lymphocyte subsets. Killer-cell immunoglobulin-like receptors (KIR) are membrane receptors involved in mediation between NK and activated HSCs, regulating NK cell function through their interaction with HLA-I molecules. The aim of this study was to analyse the genetic association between KIR genes and the susceptibility to or protection from alcoholic cirrhosis (AC) in a cohort of male AC patients undergoing liver transplantation (LT) with and without concomitant viral infections. MATERIAL AND METHODS: KIR genotyping was performed in nuclear DNA extracted from 281 AC patients and compared with 319 male controls. RESULTS: Significant differences between total AC patients and healthy controls were only found in the case of KIR2DL2 and KIR2DS5. KIR2DL2 was significantly underrepresented in non-viral AC patients (52.6% vs. 63.3%; p = 0.015), while patients heterozygous for KIR2DL2 were also underrepresented in the non-viral AC group compared with controls (p = 0.034). KIR2DS5 was overrepresented in this group compared with healthy controls (p = 0.002). All these observations were only evident in AC patients older than 54 years old. CONCLUSIONS: Our data suggest a contrary effect of KIR2DL2 and KIR2DS5 in AC patients older than 54 years, in whom the presence of KIR2DL2 appears to be protective against AC, whereas the presence of KIR2DS5 seems to promote the fibrotic process, particularly in patients with no associated viral infection.

17.
Cuad Bioet ; 31(103): 309-317, 2020.
Artículo en Español | MEDLINE | ID: mdl-33375798

RESUMEN

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never happens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy.


Asunto(s)
Divorcio/ética , Negociación , Adolescente , Factores de Edad , Bioética/educación , Niño , Custodia del Niño/ética , Derechos Civiles , Toma de Decisiones Clínicas , Divorcio/legislación & jurisprudencia , Educación Médica , Padre , Femenino , Humanos , Consentimiento Informado , Masculino , Madres , Pediatras/educación , Rol del Médico , Relaciones Profesional-Familia , Psicología del Adolescente , Psicología Infantil , Consentimiento por Terceros/ética , Consentimiento por Terceros/legislación & jurisprudencia , Revelación de la Verdad/ética
18.
Leg Med (Tokyo) ; 46: 101717, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32442861

RESUMEN

In this study quetiapine and pregabalin were analyzed in human bones. A method previously developed for the determination of antidepressants in human bone was tested for the analysis of these two substances. Bones were pulverized and subjected to the extraction protocol, and after undergoing solid-phase extraction, samples were analyzed using gas chromatography-mass spectrometry. The assay was validated in the range 0.3-500 ng/mg, mean analytical recovery was 76.9% for quetiapine and 90.9% for pregabalin, matrix effect was 83% for quetiapine and 91% for pregabalin and process efficiency was 63.8% for quetiapine and 82.7% for pregabalin. The intra- and inter-day precision was below 3% in all cases and the intra- and inter-assay accuracy values were in almost all cases better than 12%. The validated method was then applied to bone samples from forensic cases. Drugs were detected in bone in 2 of the 3 blood positive cases. The approximate concentrations in bone were 40 ng/mg for pregabalin and 7 ng/mg for quetiapine. To our knowledge, this is the first time these substances were detected in bones. With this study the number of substances with a validated protocol to be used in human bones in case of necessity is expanded.


Asunto(s)
Antidepresivos/análisis , Huesos/metabolismo , Toxicología Forense/métodos , Pregabalina/análisis , Fumarato de Quetiapina/análisis , Antidepresivos/aislamiento & purificación , Cromatografía de Gases y Espectrometría de Masas , Humanos , Pregabalina/aislamiento & purificación , Fumarato de Quetiapina/aislamiento & purificación
20.
J Proteomics ; 192: 54-63, 2019 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-30145274

RESUMEN

Proteomic techniques in bones forensic samples are increasingly, being applied. The main aim of forensic sciences is the estimation of postmortem interval. Most current techniques are useful for the first post-mortem stages. However, in the case of osseous remains, these techniques may be difficult to use due to the high level of decomposition of the sample. Our objective was to attempt to know whether there is a protein profile in human bone remains that would enable a late postmortem. interval ranging from 5 to 20 years postmortem to be estimated. A total of 40 femur bones from 40 different cadavers (data range 5-20 years) were use. Of the 275 total proteins, we excluded the circulating ones (n = 227), leaving a total of 48 proteins (29 structural and 19 functional) were found. A multiple correspondence analysis was applied on the 48 proteins. Finally selecting 32 proteins that allowed us to discriminate between the. two groups of postmortem interval. Analysis of the protein profile present in bone permits an approximation of the date of death within the studied interval, and could be used to complement other tests for estimating the postmortem interval.


Asunto(s)
Fémur/química , Medicina Legal , Cambios Post Mortem , Proteínas/análisis , Adulto , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteómica
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