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1.
Gastroenterol Hepatol ; 47(7): 774-792, 2024.
Artículo en Inglés, Español | MEDLINE | ID: mdl-38218430

RESUMEN

It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.


Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Disfunciones Sexuales Fisiológicas , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/terapia , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/terapia , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/terapia , España , Femenino , Masculino , Disfunciones Sexuales Psicológicas/etiología , Disfunciones Sexuales Psicológicas/terapia , Sexualidad , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/terapia , Salud Sexual
2.
Int J Neuropsychopharmacol ; 26(8): 545-556, 2023 08 29.
Artículo en Inglés | MEDLINE | ID: mdl-37350760

RESUMEN

BACKGROUND: Apolipoprotein E (APOE)-4 isoform, reelin, and clusterin share very-low-density liporeceptor and apolipoprotein E receptor 2 receptors and are related to cognition in neuropsychiatric disorders. These proteins are expressed in plasma and brain, but studies involving plasma expression and cognition are scarce. METHODS: We studied the peripheral expression (plasma and peripheral blood mononuclear cells) of these proteins in 24 middle-aged patients with alcohol use disorder (AUD) diagnosed at 4 to 12 weeks of abstinence (t = 0) and 34 controls. Cognition was assessed using the Test of Detection of Cognitive Impairment in Alcoholism. In a follow-up study (t = 1), we measured reelin levels and evaluated cognitive improvement at 6 months of abstinence. RESULTS: APOE4 isoform was present in 37.5% and 58.8% of patients and controls, respectively, reaching similar plasma levels in ε4 carriers regardless of whether they were patients with AUD or controls. Plasma reelin and clusterin were higher in the AUD group, and reelin levels peaked in patients expressing APOE4 (P < .05, η2 = 0.09), who showed reduced very-low-density liporeceptor and apolipoprotein E receptor 2 expression in peripheral blood mononuclear cells. APOE4 had a negative effect on memory/learning mainly in the AUD group (P < .01, η2 = 0.15). Multivariate logistic regression analyses identified plasma reelin as a good indicator of AUD cognitive impairment at t = 0. At t = 1, patients with AUD showed lower reelin levels vs controls along with some cognitive improvement. CONCLUSIONS: Reelin plasma levels are elevated during early abstinence in patients with AUD who express the APOE4 isoform, identifying cognitive deterioration to a great extent, and it may participate as a homeostatic signal for cognitive recovery in the long term.


Asunto(s)
Alcoholismo , Disfunción Cognitiva , Humanos , Persona de Mediana Edad , Alcoholismo/diagnóstico , Apolipoproteína E4/genética , Clusterina/metabolismo , Disfunción Cognitiva/diagnóstico , Estudios de Seguimiento , Leucocitos Mononucleares/metabolismo , Isoformas de Proteínas
3.
Support Care Cancer ; 31(5): 284, 2023 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-37079161

RESUMEN

PURPOSE: The aims of the study were to assess self-reported physical activity (PA) levels, barriers to PA, quality of life and self-efficacy to manage chronic disease of prostate cancer survivor 1 year after radiotherapy treatment. METHODS: A cross-sectional case-control study was performed. Prostate cancer survivor patients treated with radiotherapy were recruited from the Radiation Oncology Service of the "Complejo Hospitalario Universitario" (Granada) and compared with age-matched healthy men. Outcomes included were perception of benefits for physical activity and potential barriers (Exercise Benefits/Barriers Scale), physical activity levels assessed by the International Physical Activity Questionnaire (IPAQ), quality of life (EuroQol five-dimension three-levels) and self-efficacy (Self-Efficacy to Manage Chronic Disease). RESULTS: A total of 120 patients were included in our study. Significant differences were found between groups with worse results for the prostate cancer patient group in the variable perception of the benefit of physical activity, potential barriers, and physical activity. Regarding quality of life and self-efficacy, significant differences were also observed between groups with a greater score in the control group. CONCLUSION: In conclusion, the results of this study reveal that self-reported PA levels, as measured using the IPAQ, were low in prostate cancer survivors after treatment. Results also showed worse perception of benefits for PA and potential barriers by the cancer survivors. Similarly, the quality of life and self-efficacy to manage chronic disease of prostate cancer survivors was lower.


Asunto(s)
Supervivientes de Cáncer , Neoplasias de la Próstata , Oncología por Radiación , Masculino , Humanos , Calidad de Vida , Próstata , Autoeficacia , Estudios Transversales , Estudios de Casos y Controles , Neoplasias de la Próstata/radioterapia , Encuestas y Cuestionarios
4.
Support Care Cancer ; 30(2): 1579-1586, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34541609

RESUMEN

PURPOSE: Patients with lung cancer experience a variety of distressing symptoms which could adversely affect quality of life. The aim of this study was to determine whether psychological distress prior to surgery is associated to health status and symptom burden in lung cancer survivors. METHODS: A longitudinal observational study with 1-year follow-up was carried out. Health status was measured by the WHO Disability Assessment Scale (WHO-DAS 2.0), the Euroqol-5 dimensions (EQ-5D) and the Pittsburgh Sleep Quality Index (PSQI). Symptoms severity included dyspnoea (Multidimensional Profile of Dyspnoea); pain (Brief Pain Inventory); fatigue (Fatigue Severity Scale); and cough (Leicester Cough Questionnaire). RESULTS: One hundred seventy-four lung cancer patients were included. Patients in the group with psychological distress presented a worse self-perceived health status, functionality and sleep quality. The group with psychological distress also presented higher dyspnoea, fatigue and pain. CONCLUSION: Patients with psychological distress prior surgery present with a greater symptom burden and a poorer self-perceived health status, lower functionality and sleep quality, than patients without distress 1 year after the lung resection.


Asunto(s)
Supervivientes de Cáncer , Neoplasias Pulmonares , Distrés Psicológico , Fatiga/epidemiología , Fatiga/etiología , Estado de Salud , Humanos , Pulmón , Neoplasias Pulmonares/cirugía , Calidad de Vida , Calidad del Sueño , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología
5.
Rev Esp Enferm Dig ; 2022 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-35240849

RESUMEN

Given the age of maximum incidence of inflammatory bowel disease, aspects such as fertility and pregnancy are especially relevant in the management of these patients. This review article aims to provide a summarized description of the basic concepts that the gastroenterologist should know when assessing an IBD patient with procreative desires and/or who is pregnant. The review has been carried out selecting the most recent and relevant articles on these topics in order to offer updated information on the latest treatments available.

6.
Dig Dis Sci ; 64(3): 875-879, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30542812

RESUMEN

BACKGROUND: Thiopurines are classically used in Crohn's disease (CD). Treatment fails in a proportion of patients either due to adverse events (AE) or lack of efficacy. Increasing use of anti-TNFα biologic drugs may have had impact on thiopurines usage. AIM: To evaluate the evolving use of azathioprine (AZA) monotherapy in the era of biologics. METHODS: The study retrospectively analyzed clinical records of all CD patients who started treatment with AZA monotherapy at our center since 1990. Dates of starting AZA and treatment failure (TF) were collected. We defined AZA TF if it was withdrawn due to lack of efficacy or AE, or biologics were added. RESULTS: A total of 383 patients were included: 46.5% were males and mean age was 31 (range 17-84) years. Median follow-up was 43 (range 0.2-289) months. Overall, 147 patients (38%) experienced TF. Median cumulative survival time of AZA was 126 (95% CI 105-147) months. Proportion of patients with AZA TF increased along time: 7 patients in 1990-1995 (4.7% of all TF); 8 in 1996-2000 (5.4%); 22 in 2001-2005(15%); 41 in 2006-2010 (28%); 69 in 2011-2014 (47%) (p = 0.04). 7%, 21%, 4%, 45%, and 33.3% of patients moved to biologics in each period, respectively (χ2 = 13.07; p < 0.05). Seventy-four patients (18.4%) stopped AZA due to AE, and 73(19%) due to lack of efficacy. Regarding AZA indication, prevention of postoperative recurrence obtained better results than steroid dependency (p = 0.001); perianal fistulizing CD predicted poorer outcomes (p = 0.002). CONCLUSION: An important proportion of CD patients under AZA monotherapy experienced TF in our experience. Although AZA monotherapy remains useful for CD in the era of biologics, current clinical practice is shifting to anti-TNFα biologic drugs in an increasing proportion of patients.


Asunto(s)
Azatioprina/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Inmunosupresores/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Azatioprina/efectos adversos , Productos Biológicos/uso terapéutico , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/inmunología , Femenino , Fármacos Gastrointestinales/efectos adversos , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , España , Factores de Tiempo , Insuficiencia del Tratamiento , Adulto Joven
8.
Rev Esp Enferm Dig ; 108(2): 79-83, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26838489

RESUMEN

INTRODUCTION: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. MATERIAL AND METHODS: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD) patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH) and its relationship with thiopurine treatment. RESULTS: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%). A total of 4 patients with IBD type Crohn's disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000). Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly) cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3). CONCLUSION: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.


Asunto(s)
Hipertensión Portal/inducido químicamente , Inmunosupresores/efectos adversos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Cirrosis Hepática/inducido químicamente , Mercaptopurina/efectos adversos , Pancitopenia/inducido químicamente , Esplenomegalia/inducido químicamente , Adulto , Anciano , Azatioprina/efectos adversos , Azatioprina/uso terapéutico , Estudios Transversales , Femenino , Humanos , Hipertensión Portal/diagnóstico , Hipertensión Portal/epidemiología , Inmunosupresores/uso terapéutico , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Masculino , Mercaptopurina/uso terapéutico , Persona de Mediana Edad , Pancitopenia/diagnóstico , Pancitopenia/epidemiología , Esplenomegalia/diagnóstico , Esplenomegalia/epidemiología , Resultado del Tratamiento , Hipertensión Portal Idiopática no Cirrótica
9.
J Org Chem ; 80(20): 9915-25, 2015 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-26414427

RESUMEN

A new azobenzene-based photoswitch, 2, has been designed to enable optical control of ionotropic glutamate receptors in neurons via sensitized two-photon excitation with NIR light. In order to develop an efficient and versatile synthetic route for this molecule, a modular strategy is described which relies on the use of a new linear fully protected glutamate derivative stable in basic media. The resulting compound undergoes one-photon trans-cis photoisomerization via two different mechanisms: direct excitation of its azoaromatic unit and irradiation of the pyrene sensitizer, a well-known two-photon sensitive chromophore. Moreover, 2 presents large thermal stability of its cis isomer, in contrast to other two-photon responsive switches relying on the intrinsic nonlinear optical properties of push-pull substituted azobenzenes. As a result, the molecular system developed herein is a very promising candidate for evoking large photoinduced biological responses during the multiphoton operation of neuronal glutamate receptors with NIR light, which require accumulation of the protein-bound cis state of the switch upon repeated illumination.


Asunto(s)
Compuestos Azo/química , Receptores Ionotrópicos de Glutamato/química , Compuestos Azo/síntesis química , Ligandos , Estructura Molecular , Neuronas/química , Procesos Fotoquímicos , Estereoisomerismo
10.
Biochim Biophys Acta ; 1831(4): 803-18, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23318274

RESUMEN

Liver fatty acid binding protein (FABP1) prevents lipotoxicity of free fatty acids and regulates fatty acid trafficking and partition. Our objective is to investigate the transcription factors controlling the human FABP1 gene and their regulation in nonalcoholic fatty liver disease (NAFLD). Adenovirus-mediated expression of multiple transcription factors in HepG2 cells and cultured human hepatocytes demonstrated that FOXA1 and PPARα are among the most effective activators of human FABP1, whereas C/EBPα is a major dominant repressor. Moreover, FOXA1 and PPARα induced re-distribution of FABP1 protein and increased cytoplasmic expression. Reporter assays demonstrated that the major basal activity of the human FABP1 promoter locates between -96 and -229bp, where C/EBPα binds to a composite DR1-C/EBP element. Mutation of this element at -123bp diminished basal reporter activity, abolished repression by C/EBPα and reduced transactivation by HNF4α. Moreover, HNF4α gene silencing by shRNA in HepG2 cells caused a significant down-regulation of FABP1 mRNA expression. FOXA1 activated the FABP1 promoter through binding to a cluster of elements between -229 and -592bp, whereas PPARα operated through a conserved proximal element at -59bp. Finally, FABP1, FOXA1 and PPARα were concomitantly repressed in animal models of NAFLD and in human nonalcoholic fatty livers, whereas C/EBPα was induced or did not change. We conclude that human FABP1 has a complex mechanism of regulation where C/EBPα displaces HNF4α and hampers activation by FOXA1 and PPARα. Alteration of expression of these transcription factors in NAFLD leads to FABP1 gen repression and could exacerbate lipotoxicity and disease progression.


Asunto(s)
Proteína alfa Potenciadora de Unión a CCAAT/metabolismo , Proteínas de Unión a Ácidos Grasos/metabolismo , Hígado Graso/metabolismo , Hígado Graso/terapia , Factor Nuclear 3-alfa del Hepatocito/metabolismo , PPAR alfa/metabolismo , Animales , Proteína alfa Potenciadora de Unión a CCAAT/genética , Células Cultivadas , Proteínas de Unión a Ácidos Grasos/genética , Hígado Graso/genética , Células Hep G2 , Factor Nuclear 3-alfa del Hepatocito/genética , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Enfermedad del Hígado Graso no Alcohólico , PPAR alfa/genética , Unión Proteica
11.
J Am Chem Soc ; 136(24): 8693-701, 2014 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-24857186

RESUMEN

Synthetic photochromic compounds can be designed to control a variety of proteins and their biochemical functions in living cells, but the high spatiotemporal precision and tissue penetration of two-photon stimulation have never been investigated in these molecules. Here we demonstrate two-photon excitation of azobenzene-based protein switches and versatile strategies to enhance their photochemical responses. This enables new applications to control the activation of neurons and astrocytes with cellular and subcellular resolution.


Asunto(s)
Compuestos Azo/química , Proteínas/química , Protones , Compuestos Azo/síntesis química , Células Cultivadas , Células HEK293 , Humanos , Estructura Molecular , Procesos Fotoquímicos
12.
Arch Toxicol ; 88(4): 967-82, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24469900

RESUMEN

It is estimated that only a few marketed drugs are able to directly induce liver steatosis. However, many other drugs may exacerbate or precipitate fatty liver in the presence of other risk factors or in patients prone to non-alcoholic fatty liver disease. On the other hand, current in vitro tests for drug-induced steatosis in preclinical research are scarce and not very sensitive or reproducible. In the present study, we have investigated the effect of well-characterized steatotic drugs on the expression profile of 47 transcription factors (TFs) in human hepatoma HepG2 cells and found that these drugs are able to up- and down-regulate a substantial number of these factors. Multivariate data analysis revealed a common TF signature for steatotic drugs, which consistently and significantly repressed FOXA1, HEX and SREBP1C in cultured cells. This signature was also observed in the livers of rats and in cultured human hepatocytes. Therefore, we selected these three TFs as predictive biomarkers for iatrogenic steatosis. With these biomarkers, a logistic regression analysis yielded a predictive model, which was able to correctly classify 92 % of drugs. The developed algorithm also predicted that ibuprofen, nifedipine and irinotecan are potential steatotic drugs, whereas troglitazone is not. In summary, this is a sensitive, specific and simple RT-PCR test that can be easily implemented in preclinical drug development to predict drug-induced steatosis. Our results also indicate that steatotic drugs affect expression of both common and specific subsets of TF and lipid metabolism genes, thus generating complex transcriptomic responses that cause or contribute to steatosis in hepatocytes.


Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/genética , Perfilación de la Expresión Génica , Hígado/efectos de los fármacos , Enfermedad del Hígado Graso no Alcohólico/inducido químicamente , Enfermedad del Hígado Graso no Alcohólico/genética , Toxicogenética/métodos , Factores de Transcripción/genética , Anciano , Algoritmos , Animales , Modelos Animales de Enfermedad , Regulación de la Expresión Génica/efectos de los fármacos , Marcadores Genéticos , Células Hep G2 , Humanos , Metabolismo de los Lípidos/efectos de los fármacos , Metabolismo de los Lípidos/genética , Hígado/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ratas , Ratas Sprague-Dawley , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Medición de Riesgo , Factores de Transcripción/metabolismo
13.
Adv Drug Alcohol Res ; 3: 11091, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38389819

RESUMEN

Alcohol binge drinking promotes neuroinflammation which could be partially mediated by the passage of ABD-induced peripheral inflammatory molecules to the brain parenchyma through the blood-brain barrier. The BBB is sealed by tight junction proteins, which regulate the access of substances to the brain. Whether ABD alters the BBB or not remains controversial. Here, we measured the expression of BBB proteins in frontal cortex and hippocampus after an ABD procedure that was previously shown to induce neuroinflammation in the FC, and checked neuroinflammation in the hippocampus. Oleoylethanolamide is known to inhibit ABD-induced neuroinflammation in rat FC but the mechanisms of action are not clear: whereas OEA protects against alcohol-induced breakdown of the TJ proteins in the gut barrier reducing peripheral inflammation, its effect in the TJ of the BBB remains unknown. Here, we studied whether OEA (5 mg/kg, before each gavage) prevented alcohol-induced BBB dysfunction by measuring the expression of zona-occludens, occludin, and laminin in FC and hippocampus. ABD animals showed reduced laminin and occludin levels in the FC, indicative of BBB dysfunction, which is concordant with previous findings showing ABD-induced neuroinflammation in this brain region. OEA did not prevent ABD-induced changes in the BBB proteins in the FC, suggesting that the OEA main mechanism of action to inhibit neuroinflammation in this brain region is not related to prevention of TJ proteins alteration in the BBB. In the hippocampus, this ABD protocol did not alter BBB protein levels and no markers of neuroinflammation were found elevated.

14.
Artículo en Inglés | MEDLINE | ID: mdl-36724838

RESUMEN

The lipid-derived messenger oleoylethanolamide (OEA) has been involved in multiple physiological functions including metabolism and the immune response. More recently, OEA has been observed to affect reward-related behavior. Stress is a major risk factor for drug use and a predictor of drug relapse. In the laboratory, social stress has been largely studied using the social defeat (SD) model. Here, we explored the effects of different OEA administration schedules on the increased rewarding properties of cocaine induced by SD. In addition, we evaluated the anti-inflammatory action of OEA pretreatment in TLR4 expression caused by SD in the cerebellum, a novel brain structure that has been involved in the development of cocaine addiction. Adult OF1 mice were assigned to an experimental group according to the stress condition (exploration or SD) and treatment (OEA before SD, OEA before conditioning or subchronic OEA treatment). Mice were administered with OEA i.p (10 mg/kg) 10 min previously to the corresponding event. Three weeks after the last SD encounter, conditioned place preference (CPP) was induced by a subthreshold cocaine dose (1 mg/kg). As expected, socially defeated mice presented greater vulnerability to the cocaine reinforcing effects and expressed CPP. Conversely, this effect was not observed under a non-stressed condition. Most importantly, we observed that OEA pretreatment before SD or before conditioning prevented cocaine CPP in defeated mice. Biochemical analysis showed that OEA administration before SD decreased proinflammatory TLR4 upregulation in the cerebellum caused by social stress. In summary, our results suggest that OEA may have a protective effect on stress-induced increased cocaine sensitivity by exerting an anti-inflammatory action.


Asunto(s)
Cocaína , Ratones , Animales , Cocaína/farmacología , Receptor Toll-Like 4 , Recompensa , Ácidos Oléicos/farmacología
15.
Eur J Phys Rehabil Med ; 59(3): 353-363, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37184415

RESUMEN

INTRODUCTION: The objective of this study was to identify and review the subjective assessment tools validated in patients with fibromyalgia, identifying their most significant structural characteristics, as well as the psychometric characteristics analyzed in each of the identified instruments. EVIDENCE ACQUISITION: This systematic review was registered in PROSPERO with the following reference: CRD42022306878. It analyzed documents published until June 30, 2022, through the Medline, Pedro and Scopus, Dialnet, Cinahl and Latin Index databases. The keywords used were: 1) fibromyalgia; 2) assessment; 3) questionnaire; 4) reliability; 5) validity; 6) scale; and 7) validation study. Combined using the Boolean operators "AND" and "OR." The included articles were analyzed to extract: data on the structural characteristics of the questionnaires (including acronym, year of publication, number of items, sub-categories, time to complete the questionnaire, measurement range, cutoff score and cost) and psychometric characteristics of the selected questionnaires, including data on reliability (Cronbach's alpha and test-retest) and data on the validity of the questionnaires (content, construct and criterion validity). EVIDENCE SYNTHESIS: Twenty-two studies containing 16 questionnaires were analyzed. The quality and risk of bias assessment was performed following the COSMIN checklist. In general, the quality of the subjective assessment studies validated in the population with fibromyalgia was good, with the exception of 5 studies, which did not exceed 5 points out of 10. The first questionnaire analyzed was published in 1991, and the last in 2020; the number of items ranged from 3 to 60. The most measured subcategories are function, overall impact and symptoms; other studies also include sleep and cognition disturbances. Only 6 studies described the time to complete them. The most analyzed psychometric characteristics were reliability (analyzed by 13 questionnaires), validity (analyzed by 7) and error measures (provided by only 3 of them). CONCLUSIONS: There is a wide range of questionnaires specifically designed for patients with fibromyalgia that present good and/or excellent basic psychometric characteristics. The structural characteristics of the identified instruments were very heterogeneous, which makes it possible to select those that best adapt to the clinical/investigator scenario where the tool will be used.


Asunto(s)
Disfunción Cognitiva , Fibromialgia , Humanos , Fibromialgia/diagnóstico , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Psicometría
16.
Crohns Colitis 360 ; 5(1): otac051, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36785555

RESUMEN

Background: Loss of response to anti-tumor necrosis factor drugs in patients with inflammatory bowel disease (IBD) is frequent and, in case of low drug levels, treatment intensification is recommended. In addition, in cases in which clinical response without attainment of remission (clinical, endoscopic, or radiological), intensification could be justified since higher drug levels are associated with better outcomes. For adalimumab (ADA), the standard intensification regimen is 40 mg every week (ew). Availability of ADA 80 mg prefilled pens has enabled every other week (eow) intensification. We assessed the clinical efficacy of intensification with ADA 80 mg eow. Methods: This retrospective study was conducted at a tertiary hospital in Spain. Patients with IBD receiving maintenance ADA 80 mg eow with clinical, biomarker, and drug-level assessments were included. Demographics and clinical, biological, and endoscopic evaluation of the disease before and after ADA intensification, and pharmacokinetic assessments, were collected. Results: Eighty-seven patients (72 Crohn's disease, 15 ulcerative colitis; average age 50 years) were included. Reasons for ADA intensification were: low ADA levels-<5 µg mL-1-(17%), low ADA levels-<5 µg mL-1-without clinical response (63%), clinical response without clinical remission (15%) and active disease on objective evaluation (including colonoscopy, magnetic resonance imaging, capsule endoscopy, and/or intestinal ultrasound; 5%). Following treatment intensification to ADA 80 mg eow, 75 patients (86%) were in clinical remission and 69 (79.3%) were in biologic remission (clinical remission and normalization of biomarkers). After a median follow-up of 19 months (interquartile range 13-25), 63 patients (72%) remained on treatment and in clinical remission. There were no serious infections, hospitalizations, or deaths. Drug costs did not increase with the 80 mg eow regimen versus a standard intensification regimen. Conclusions: ADA intensification to 80 mg eow was safe, effective, and did not increase drug costs versus standard intensification to 40 mg ew in our experience.

17.
J Crohns Colitis ; 17(1): 83-91, 2023 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-35913456

RESUMEN

BACKGROUND AND AIMS: Clinical trials and real-life studies with ustekinumab in Crohn's disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD. METHODS: Elderly patients [>60 years old] from the prospectively maintained ENEIDA registry treated with ustekinumab due to CD were included. Every patient was matched with two controls under 60 years of age, according to anti-tumour necrosis factor use and smoking habit. Values for the Harvey-Bradshaw Index [HBI], endoscopic activity, C-reactive protein [CRP] and faecal calprotectin [FC] were recorded at baseline and at weeks 16, 32 and 54. RESULTS: In total, 648 patients were included, 212 of whom were elderly. Effectiveness was similar between young and elderly patients during the follow-up. Steroid-free remission was similar at week 16 [54.6 vs 51.4%, p = 0.20], 32 [53.0% vs 54.5%, p = 0.26] and 54 [57.8% vs 51.1%, p = 0.21]. Persistence of ustekinumab as maintenance therapy was similar in both age groups [log-rank test; p = 0.91]. There was no difference in the rate of adverse effects [14.2% vs 11.2%, p = 0.350], including severe infections [7.1% vs 7.3%, p = 1.00], except for the occurrence of de novo neoplasms, which was higher in older patients [0.7% vs 4.3%, p = 0.003]. CONCLUSIONS: Ustekinumab is as effective in elderly patients with CD as it is in non-elderly patients. The safety profile also seems to be similar except for a higher rate of de novo neoplasms, probably related to the age of the elderly patients.


Asunto(s)
Enfermedad de Crohn , Ustekinumab , Humanos , Persona de Mediana Edad , Anciano , Ustekinumab/efectos adversos , Enfermedad de Crohn/patología , Inducción de Remisión , Endoscopía , Sistema de Registros , Resultado del Tratamiento , Estudios Retrospectivos
18.
J Clin Med ; 12(14)2023 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-37510928

RESUMEN

(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017-2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients' outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes.

19.
Gastroenterol Hepatol ; 35(9): 634-9, 2012 Nov.
Artículo en Español | MEDLINE | ID: mdl-23036695

RESUMEN

INTRODUCTION: Inflammatory bowel disease (IBD) is an independent risk factor for thromboembolic phenomena (TEP). We evaluated the prevalence and the possible risk factors associated with developing TEP in patients with IBD in our center. MATERIAL AND METHODS: Data were retrospectively collected from January 1995 to December 2011 from 23 patients. A total of 61% were diagnosed with Crohn's disease (CD) and 39% with ulcerative colitis (UC) according to routine criteria. RESULTS: When the Montreal classification was used, 58% of the patients with CD had an inflammatory pattern (B1), 25% a stenosing pattern (B2) and 17% a fistulizing pattern (B3). Half the patients had ileocolic involvement (L3), one-third had colonic involvement (L2) and the remainder had ileal involvement (L1). Among patients with UC according to the Montreal classification, 78% had extensive colitis (E3), 11% had left colonic involvement (E2) and 11% had proctocolitis (E1). During the event, almost half the patients with UC had severe inflammatory activity (S3; 44%), 33% had mild-moderate activity (S1: 22%, S2: 11%) and only 22% were in remission (S0). Overall, at the time of the TEP, 48% of the patients had mild-moderate activity and 22% had severe activity. Likewise, 44% were hospitalized at the time of the event. In UC, an increase in the prevalence of TEP was found in admitted patients (66%). None of the patients had a family history of TEP, two patients (9%) had associated thrombophilia and 26% were active smokers. There were no TEP during pregnancy. Only one patient was taking contraceptive pills when the event occurred. The most frequent forms of TEP were deep vein thrombosis of the legs (55%) followed by pulmonary thromboembolism (25%). CONCLUSIONS: TEP are relatively frequent in patients with IBD, with a strong impact on morbidity and mortality. In our series, risk factors for these events were more extensive involvement (any of the groups) and severe inflammatory activity. No significant association between classical risk factors such as the use of contraceptives, pregnancy, coagulation disorders or smoking and the risk of TEP were found.


Asunto(s)
Colitis Ulcerosa/complicaciones , Enfermedad de Crohn/complicaciones , Tromboembolia/epidemiología , Trombofilia/etiología , Anticoagulantes/uso terapéutico , Colitis Ulcerosa/genética , Enfermedades del Colon/complicaciones , Constricción Patológica , Anticonceptivos Hormonales Orales/efectos adversos , Enfermedad de Crohn/genética , Salud de la Familia , Femenino , Heparina/uso terapéutico , Unidades Hospitalarias , Hospitalización , Humanos , Enfermedades del Íleon/complicaciones , Fístula Intestinal/etiología , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Hematológicas del Embarazo , Embolia Pulmonar/epidemiología , Embolia Pulmonar/etiología , Estudios Retrospectivos , Riesgo , Fumar/efectos adversos , Fumar/epidemiología , España/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Tromboembolia/etiología , Tromboembolia/prevención & control , Trombofilia/genética , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología
20.
Artículo en Inglés | MEDLINE | ID: mdl-36231877

RESUMEN

In Latin American cities, the built environment is facing crucial challenges in the 21st century, not only in terms of the redesign of the physical environment, but also how to remodel public spaces as healthier places for walking and social interaction. The objective of this article is to evaluate the effects of the built environment on walking perceptions in a central neighbourhood in the intermediate city of Valdivia, Chile. The methodology integrates quantitative and qualitative methods to explore which elements of the physical built environment ease and hinder walkability. Depthmap software and Simpson's Diversity Index are used to evaluate connectivity and diversity of land uses at street level. Additionally, the People Following method and 26 walking interviews are conducted using the Natural Go-Along technique to analyse pedestrians' perceptions about their mobility environment. The results show that the factors that promote walkability mainly include streets with high connectivity values, wide pavements, diversity of greening, and facade characteristics of buildings with architectural heritage causing tranquillity, longing, and happiness. On the contrary, factors that inhibit walkability are related to poor-quality and narrow sidewalks, cars parked on sidewalks, dirty streets, and motorized traffic and vehicular noise causing negative emotions in walking perceptions such as tiredness, anger, disgust, discomfort, and insecurity, with negative effects on the well-being of residents that vary according to age and gender. Finally, recommendations are oriented to improve public spaces in central areas in southern Chile, to address moving towards more liveable and inclusive environments and support well-being through urban design in these types of context.


Asunto(s)
Planificación Ambiental , Caminata , Entorno Construido , Chile , Humanos , Características de la Residencia , Caminata/psicología
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