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1.
Respirology ; 26(4): 352-359, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33167075

RESUMEN

BACKGROUND AND OBJECTIVE: The relationship between IPF development and environmental factors has not been completely elucidated. Analysing geographic regions of idiopathic pulmonary fibrosis (IPF) cases could help identify those areas with higher aggregation and investigate potential triggers. We hypothesize that cross-analysing location of IPF cases and areas of consistently high air pollution concentration could lead to recognition of environmental risk factors for IPF development. METHODS: This retrospective study analysed epidemiological and clinical data from 503 patients registered in the Observatory IPF.cat from January 2017 to June 2019. Incident and prevalent IPF cases from the Catalan region of Spain were graphed based on their postal address. We generated maps of the most relevant air pollutant PM2.5 from the last 10 years using data from the CALIOPE air quality forecast system and observational data. RESULTS: In 2018, the prevalence of IPF differed across provinces; from 8.1 cases per 100 000 habitants in Barcelona to 2.0 cases per 100 000 in Girona. The ratio of IPF was higher in some areas. Mapping PM2.5 levels illustrated that certain areas with more industry, traffic and shipping maintained markedly higher PM2.5 concentrations. Most of these locations correlated with higher aggregation of IPF cases. Compared with other risk factors, PM2.5 exposure was the most frequent. CONCLUSION: In this retrospective study, prevalence of IPF is higher in areas of elevated PM2.5 concentration. Prospective studies with targeted pollution mapping need to be done in specific geographies to compile a broader profile of environmental factors involved in the development of pulmonary fibrosis.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Fibrosis Pulmonar Idiopática , Contaminantes Atmosféricos/análisis , Contaminación del Aire/efectos adversos , Humanos , Fibrosis Pulmonar Idiopática/epidemiología , Fibrosis Pulmonar Idiopática/etiología , Estudios Prospectivos , Estudios Retrospectivos
2.
Ann Biomed Eng ; 48(1): 271-281, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31441008

RESUMEN

Drug-eluting stents are now routinely used in the treatment of acute coronary syndromes caused by coronary artery disease. Whilst the sustained release of anti-proliferative drugs from these devices has greatly reduced the need for repeat revascularisation procedures, this approach is not suitable for all patients and appears to delay regrowth of the endothelium, necessitating the use of prolonged dual anti-platelet therapy. Although the development of more advanced stent platforms and drug coatings has produced modest improvements in performance, these devices have not fully addressed the limitations experienced with their first-generation counterparts. In the present study, we developed a novel stent coating that provides controlled sirolimus release from a bioactive polymer (accelerate™ AT) that has previously been shown to support endothelial cell growth in vitro. A bespoke electrospray deposition process provided control over the coating thickness, surface roughness, drug load, and release kinetics. The resultant optimised coating combines rapid release of an anti-proliferative agent from a bioactive polymer coating that promotes re-endothelialisation, thereby offering potential protection against in-stent restenosis and thrombosis. This novel, dual-action coating therefore has significant therapeutic potential, with the enhanced control of drug load and release kinetics offered by electrospray deposition also opening up opportunities for more personalised treatment approaches. Further development and evaluation of these technologies in vitro and in vivo is therefore warranted.


Asunto(s)
Stents Liberadores de Fármacos , Polímeros/administración & dosificación , Sirolimus/administración & dosificación , Animales , Supervivencia Celular , Células Cultivadas , Sistemas de Liberación de Medicamentos , Liberación de Fármacos , Células Endoteliales/efectos de los fármacos , Polímeros/química , Sirolimus/química , Porcinos , Tecnología Farmacéutica
4.
Rev. Asoc. Esp. Espec. Med. Trab ; 27(4): 220-231, dic. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-178860

RESUMEN

Se exploraron factores sociodemográficos, laborales y ambientales asociados a la cefalea en 686 trabajadores del sector informal de la economía en el centro de Medellín, Colombia a través de un estudio descriptivo transversal con intención analítica, fuentes primarias de información, y aplicación de encuesta asistida que incluyó el auto reporte de cefalea. La prevalencia de cefalea fue del 47,8%, se asoció a mayor prevalencia de cefalea la condición biológica, el sentir calor o frío exagerado en el puesto de trabajo y considerar que la contaminación del aire afectaba su labor como trabajadores informales. Ser mujer es una condición que explica mayor prevalencia de cefalea. Las condiciones sociodemográficas, laborales y ambientales, pueden aportar a una mayor vulnerabilidad laboral de esta población trabajadora, la cual puede afectar su estado de salud, siendo la cefalea una de las dolencias que deben ser atendidas para mejorar sus condiciones de vida y de trabajo


Sociodemographic, occupational and environmental factors associated with headache were explored in 686 workers of the informal sector of the economy in the center of Medellin, Colombia, through a transversal descriptive study with analytical intention, primary sources of information, and application of assisted survey that included the headache self-report. The prevalence of headache was 47,8%. The biological condition was associated with a higher prevalence of headache, as well as the feeling of exaggerated heat or cold in the workplace and considering that air pollution affected their work as informal workers. Being a woman is a condition that explains the higher prevalence of headache. The socio-demographic, occupational and environmental conditions can contribute to a greater labor vulnerability of this working population, which can affect their health status, being the headache one of the ailments that must be addressed to improve their living and working conditions


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Clase Social , Condiciones de Trabajo , Cefalea/epidemiología , 16054 , Colombia/epidemiología , Estudios Transversales , Cefalea/economía , Análisis Multivariante , Indicadores de Morbimortalidad
5.
Enferm. univ ; 15(1): 1-5, ene.-mar- 2018. tab
Artículo en Español | LILACS, BDENF - Enfermería | ID: biblio-946879

RESUMEN

La revista en su evolución y con la constante mejora en la calidad del proceso editorial ha logrado consolidarse y adquirir reconocimiento, de tal forma que en la actualidad está incluida en ocho bases de datos, entre estas, las tres principales de América Latina: La Biblioteca Virtual en Salud Regional, Scielo y Redalyc, en las dos últimas es la única revista de enfermería de México. En 2016 obtiene otro reconocimiento importante, al ser incluida en el Sistema de Clasificación de Revistas Mexicanas de Ciencia y Tecnología del Consejo Nacional de Ciencia y Tecnología de nuestro país. Estos datos están íntimamente relacionados con la visibilidad y difusión alcanzada, por ejemplo, durante 2017 el número de visitas al sitio de la revista, sólo en la base de datos Scielo, fue de 481 mil, lo que equivale a 1317 visitas por día.


Asunto(s)
Investigación en Enfermería , Editorial
6.
Gastric Cancer ; 21(1): 96-105, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28393278

RESUMEN

BACKGROUND: Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry. METHODS: Patients with AGC treated with polychemotherapy without trastuzumab at 28 hospitals in Spain between 2008 and 2016 were included. The effect of anthracycline-based triplets against doublets was evaluated by propensity score matching (PSM) and Cox proportional hazards (PH) regression. RESULT: A total of 1002 patients were included (doublets, n = 653; anthracycline-based triplets, n = 349). The multivariable Cox PH regression failed to detect significantly increased OS in favor of triplets with anthracyclines: HR 0.90 (95% CI, 0.78-1.05), p = 0.20035. After PSM, the sample contained 325 pairs with similar baseline characteristics. This method was also unable to reveal an increase in OS: 10.5 (95% CI, 9.7-12.3) vs. 9.9 (95% CI, 9.2-11.4) months, HR 0.91 (CI 95%, 0.76-1.083), and (log-rank test, p = 0.226). Response rates (42.1 vs. 33.1%, p = 0.12) and PFS (HR 0.95, CI 95%, 0.80-1.13, log-rank test, p = 0.873) were not significantly higher with epirubicin-based regimens. The triplets were associated with greater grade 3-4 hematological toxicity, and increased hospitalization due to toxicity by 68%. The addition of epirubicin is viable, but 23.7% discontinued treatment because of adverse effects or patient decision. CONCLUSION: Anthracyclines added to platinum-fluoropyrimidine doublets did not improve the response rate or survival outcomes in patients with AGC but entailed greater toxicity.


Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Adulto , Anciano , Antraciclinas/administración & dosificación , Antraciclinas/efectos adversos , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Pirimidinas/administración & dosificación , Pirimidinas/efectos adversos , Sistema de Registros
7.
Sci Rep ; 7(1): 5566, 2017 07 17.
Artículo en Inglés | MEDLINE | ID: mdl-28717213

RESUMEN

The stabilization of δ-phase of poly(vinylidene fluoride) PVDF in a 14 µm-thickness ferroelectric membrane is achieved by a simple route based on the use of a dimethylformamide (DMF)/acetone solvent, in which the application of external electric field is not required. X-ray diffraction and calorimetric experiments on heating reveal that, at 154 °C, the original mixture between ferroelectric δ-phase and paraelectric α-phase transits to a system with only this latter phase in the crystalline fraction. A gradual and slight increment of amorphous fraction up to the melting at 161 °C is also observed. The existence of δ-phase is corroborated by the occurrence of a broad maximum around 154 °C in dielectric permittivity measurements, as well as the hysteresis loops observed at room temperature. These results suggest a wide thermal window for a stable δ-phase, between room temperature and 154 °C, a subsequent transition into α-phase and the corresponding melting at 161 °C. The broad dielectric maximum observed around 154 °C in dielectric and calorimetric measurements, can be associated with a diffuse ferroelectric-paraelectric transition.

9.
Rev Esp Quimioter ; 30(2): 127-130, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28181429

RESUMEN

OBJECTIVE: Fluconazole is an alternative for candidemic patients who are not critically ill. Fluconazole is mainly fungistatic and does not completely inhibit visual Candida albicans growth. We studied the usefulness of fluconazole-containing Sabouraud dextrose agar plates for detecting susceptibility to fluconazole in C. albicans. METHODS: Adjusted inocula of 19 isolates were transferred directly onto fluconazole-containing Sabouraud dextrose plates (concentrations ranging from 0.125 mg/L to 128 mg/L). The fluconazole MIC in fresh isolates and after growth on the fluconazole-containing plate at 128 mg/L was recorded following the EUCAST EDef 7.2 guidelines. Then isolates were classified according to their degree of trailing production, based on microdilution procedure. RESULTS: All isolates were able to grow on all fluconazole-containing plates, even those isolates susceptible to fluconazole. In fact, we selected isolates with different degrees of trailing based on microdilution procedures. 50% of isolates classified as heavy trailers, 35.71% as moderate trailers, and 14.28% as slight trailers. CONCLUSIONS: The use of fluconazole-containing Sabouraud dextrose agar plates was not a reliable method to detect fluconazole susceptibility in C. albicans isolates; growth of the isolates was a trailing effect rather than true resistance.


Asunto(s)
Antifúngicos/farmacología , Candida albicans/efectos de los fármacos , Medios de Cultivo , Fluconazol/farmacología , Pruebas de Sensibilidad Microbiana/métodos , Agar , Candidiasis/microbiología , Glucosa , Reproducibilidad de los Resultados
10.
BJOG ; 124(3): 495-502, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27506510

RESUMEN

OBJECTIVE: To evaluate whether colposcopic measurement of the lesion size at diagnosis and/or human papillomavirus (HPV) genotyping can predict the absence of dysplasia in a large loop excision of the transformation zone (LLETZ) specimen in women treated for squamous intraepithelial lesions/cervical intraepithelial neoplasia (SIL/CIN). DESIGN: Prospective observational study. SETTING: Tertiary university hospital. POPULATION: A cohort of 116 women who underwent LLETZ because of biopsy-proven low-grade SIL/CIN that had persisted for 2 years, or because of a high-grade SIL/CIN diagnosed in the referral visit and squamocolumnar junction completely visible (types 1 or 2, according to the International Federation of Cervical Pathology and Colposcopy, IFCPC). METHODS: After LLETZ the women were classified by histology into the study group (absence of SIL/CIN in the surgical specimen, 28/116, 24.1%) and the control group (SIL/CIN in the LLETZ specimen, 88/116, 75.9%). MAIN OUTCOME MEASURES: The size of the lesion determined in the diagnostic colposcopy and the HPV genotype were evaluated in all women. RESULTS: The lesion size was significantly smaller in the study group (25.7 ± 37.8 versus 84.5 ± 81.7 mm2 ; P < 0.001). A lesion size of ≤12 mm2 and HPV types other than 16 or 18 were associated with an absence of SIL/CIN in the LLETZ specimen (P < 0.001 and P = 0.016, respectively). On multivariate analysis only a lesion size of ≤12 mm2 predicted the absence of SIL/CIN (odds ratio, OR 10.6; 95% confidence interval, 95% CI 3.6-30.6; P < 0.001). A lesion size of ≤12 mm2 had a specificity of 90.9% (95% CI 83.0-95.3%) and a negative predictive value of 86.0% (95% CI 77.5-91.6%) to predict the absence of SIL/CIN in the surgical specimen. CONCLUSIONS: Small lesion size in diagnostic colposcopy could predict the absence of SIL/CIN in the LLETZ specimen. Colposcopy measurement of lesion size prior to LLETZ may avoid unnecessary treatment. TWEETABLE ABSTRACT: Small lesion size in colposcopic evaluation might predict the absence of SIL/CIN in an LLETZ specimen.


Asunto(s)
Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopía/métodos , Pruebas de ADN del Papillomavirus Humano/métodos , Lesiones Intraepiteliales Escamosas de Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/patología , Neoplasia Intraepitelial Cervical/cirugía , Cuello del Útero/patología , Cuello del Útero/cirugía , Femenino , Estudios de Seguimiento , Genotipo , Humanos , Persona de Mediana Edad , Papillomaviridae/genética , Infecciones por Papillomavirus/diagnóstico , Estudios Prospectivos , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/patología
11.
Data Brief ; 9: 876-882, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27872884

RESUMEN

In this article, the full description of a heart failure with reduced ejection fraction (HF_REF) cohort of 192 patients is provided. Tables with the baseline demographic, prior history, ECG parameters, echocardiographic parameters, laboratory values and pharmacological treatment of these patients are included. Also, the quartile values of the analyzed circulating biomarkers: high sensitivity Troponin T (hs-TnT), galectin-3 (Gal-3), C-terminal propeptide of type I procollagen (CICP), soluble AXL (sAXL) and Brain Natriuretic Peptide (BNP) are given. The main demographic and clinical features of the patients' subgroups that have hs-TnT, Gal-3, CICP or BNP above the third quartile are described. Tables with Pearson correlation analysis of the HF_REF patients' biomarker levels are included. And Pearson correlation analysis of the HF_REF patients' hs-TnT, Gal-3, CICP levels with patients' biochemical parameters, blood count and inflammation parameters are also described. These data are related to the research articles (AXL receptor tyrosine kinase is increased in patients with heart failure (M. Batlle, P. Recarte-Pelz, E. Roig, M.A. Castel, M. Cardona, M. Farrero, et al., 2014) [1] and Use of serum levels of high sensitivity troponin T, galectin-3 and C-terminal propeptide of type I procollagen at long term follow-up in Heart Failure patients with reduced ejection fraction: comparison with soluble AXL and BNP (M. Batlle, B. Campos, M. Farrero, M. Cardona, B. González, M.A. Castel, et al., 2016) [2].

12.
Int J Cardiol ; 225: 113-119, 2016 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-27718443

RESUMEN

BACKGROUND: Prognostic biomarkers are needed to improve the management of the heart failure (HF) epidemic, being the brain natriuretic peptides the most valuable. Here we evaluate 3 biomarkers, high sensitivity troponin T (hs-TnT), galectin-3 (Gal-3) and C-terminal propeptide of type I procollagen (CICP), compare them with a recently described new candidate (sAXL), and analyze their relationship with BNP. METHODS: HF patients with reduced ejection fraction (n=192) were included in this prospective observational study, with measurements of candidate biomarkers, functional, clinical and echocardiographic variables. A Cox regression model was used to determine predictors for clinical events, i.e. all-cause mortality and heart transplantation. RESULTS: Hs-TnT circulating values were correlated to clinical characteristics indicative of more advanced HF. When analyzing the event-free survival at a mean follow-up of 3.6years, patients in the higher quartile of either BNP, hs-TnT, CICP and sAXL had increased risk of suffering a clinical event, but not Gal-3. Combination of high sAXL and BNP values had greater predictive value (HR 6.8) than high BNP alone (HR 4.9). In a multivariate Cox regression analysis, BNP, sAXL and NYHA class were independent risk factors for clinical events. CONCLUSIONS: In this HF cohort, hs-TnT is a good HF marker and has a very significant prognostic value. The prognostic value of CICP and sAXL was of less significance. However, hs-TnT did not add predictive value to BNP, while sAXL did. This suggests that elevated troponin has a common origin with BNP, while sAXL could represent an independent pathological mechanism.


Asunto(s)
Galectina 3/sangre , Insuficiencia Cardíaca/sangre , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Proteínas Proto-Oncogénicas/sangre , Proteínas Tirosina Quinasas Receptoras/sangre , Troponina T/sangre , Biomarcadores/sangre , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Estudios Prospectivos , Volumen Sistólico/fisiología
13.
Mater Sci Eng C Mater Biol Appl ; 61: 893-905, 2016 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-26838921

RESUMEN

Despite the significant advances in the meniscus tissue engineering field, it is difficult to recreate the complex structure and organization of the collagenous matrix of the meniscus. In this work, we developed a meniscus prototype to be used as substitute or scaffold for the regeneration of the meniscal matrix, recreating the differential morphology of the meniscus by electrospinning. Synthetic biocompatible polymers were combined with the extracellular matrix component, collagen and used to replicate the meniscus. We studied the correlation between mechanical and structural properties of the polymer blend as a function of collagen concentration. Fibers were collected on a surface of a rapidly rotating precast mold, to accurately replicate each sectional morphology of the meniscus; different electro-tissues were produced. Detailed XRD analyses exhibited structural changes developed by electrospinning. We achieved to integrate all these electro-tissues to form a complete synthetic meniscus. Vascularization tests were performed to assess the potential use of our novel polymeric blend for promising meniscus regeneration.


Asunto(s)
Materiales Biocompatibles/química , Polímeros/química , Animales , Colágeno/química , Fuerza Compresiva , Módulo de Elasticidad , Femenino , Riñón/patología , Ácido Láctico/química , Meniscos Tibiales/fisiología , Microscopía Electrónica de Rastreo , Poliésteres , Ratas , Ratas Wistar , Regeneración , Ingeniería de Tejidos , Difracción de Rayos X
14.
Rev. colomb. gastroenterol ; 30(4): 474-478, oct.-dic. 2015. ilus, tab
Artículo en Español | LILACS | ID: lil-772422

RESUMEN

La intususcepción intestinal es una patología infrecuente en el adulto causante de 1%-5% de obstrucciones intestinales, se asocia con frecuencia a patologías de origen neoplásico o alteraciones estructurales del tracto gastrointestinal, sin embargo hasta en el 10% de los casos es idiopática. En la mayoría de los casos el diagnóstico se realiza después de la intervención quirúrgica, pero con el desarrollo de técnicas de imagen, en la actualidad, se puede llegar a la presunción diagnóstica previa intervención. Se presenta un caso clínico en el cual el diagnóstico se realiza de manera preoperatoria por medio de tomografía computarizada y la revisión de literatura correspondiente.


Intestinal intussusception is an uncommon condition in adults which causes 1% to 5% of intestinal obstructions. Although it is frequently associated with neoplastic pathologies or structural abnormalities of the gastrointestinal tract, up to 10% of cases are idiopathic. In most cases the diagnosis is made after surgery, but with the development of imaging techniques, a diagnosis is possible prior to intervention. This article presents a case in which the diagnosis was made preoperatively by CT scan and presents a review of the relevant literature.


Asunto(s)
Humanos , Femenino , Adulto , Adulto , Obstrucción Intestinal , Intususcepción
15.
Enferm. univ ; 12(4): 171-172, oct.-dic. 2015. ilus
Artículo en Español | LILACS-Express | LILACS, BDENF - Enfermería | ID: lil-785652

RESUMEN

Las malas prácticas o prácticas inadecuadas se presentan en paralelo con el desarrollo de la investigación, de tal forma que en los Requisitos de uniformidad para manuscritos enviados a revistas biomédicas (Normas Vancouver) , publicados por primera vez en 1978, se incluyen definiciones que aluden a estas conductas inadecuadas, en su última edición realizada en 2013 donde se adopta la denominación de Recomendaciones para la realización de informes, edición y publicación de trabajos académicos en revistas médicas se mantienen en su inciso IIID las definiciones y señalamientos sobre ese tipo de prácticas 1; su prevención o erradicación ha dado origen a organismos específicos que tienen como tarea central establecer directrices sobre buenas prácticas para publicaciones , es el caso, a nivel internacional, del Comité de ética para publicaciones (COPE por sus siglas en inglés) fundado en 1997; que ha establecido directrices para buenas prácticas en cada fase de la investigación, relativas a la actuación de los participantes, ya sea autores, revisores o editores, para identificar conflictos de interés; también definen algunas conductas inapropiadas, y se brinda orientación para investigarlas y adoptar sanciones según la gravedad del caso particular.

16.
Bioresour Technol ; 198: 488-96, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26432053

RESUMEN

The enzymatic hydrolysis of cellulosic biomass is a key step in the biochemical production of fuels and chemicals. Economically feasible large-scale implementation of the process requires operation at high solids loadings, i.e., biomass concentrations >15% (w/w). At increasing solids loadings, however, biomass forms a high viscosity slurry that becomes increasingly challenging to mix and severely mass transfer limited, which limits further addition of solids. To overcome these limitations, we developed a fed-batch process controlled by the yield stress and its changes during liquefaction of the reaction mixture. The process control relies on an in-line, non-invasive magnetic resonance imaging (MRI) rheometer to monitor real-time evolution of yield stress during liquefaction. Additionally, we demonstrate that timing of enzyme addition relative to biomass addition influences process efficiency, and the upper limit of solids loading is ultimately limited by end-product inhibition as soluble glucose and cellobiose accumulate in the liquid phase.


Asunto(s)
Biotecnología/métodos , Celulosa/metabolismo , Técnicas de Cultivo Celular por Lotes , Biocombustibles , Biomasa , Biotecnología/instrumentación , Celobiosa/química , Celobiosa/metabolismo , Celulosa/química , Enzimas/química , Enzimas/metabolismo , Glucosa/química , Glucosa/metabolismo , Hidrólisis , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/métodos , Reología/instrumentación , Reología/métodos
17.
Transpl Infect Dis ; 16(6): 951-7, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25318640

RESUMEN

BACKGROUND: Invasive aspergillosis (IA) has been considered an infrequent complication after renal transplantation. We aimed to evaluate the differences in clinical and epidemiologic characteristics of IA between renal and other types of transplantation. METHODS: We reviewed all cases of solid organ transplant (SOT) recipients from Hospital Clinic at Barcelona, who had proven and probable IA, according to the EORTC/MSG criteria, between June 2003 and December 2010. RESULTS: A total of 1762 transplants were performed. From this cohort, 27 cases of IA were diagnosed (1.5%): in 56% (15/27) liver, 33% (9/27) kidney, and 11% (3/27) combined transplant. The median onset time from renal and non-renal transplants to IA was 217 and 10 days, respectively (P < 0.001). There were 6 cases (22%) of late IA (>6 months), all in kidney recipients (P < 0.001). Renal transplant patients with IA more frequently had chronic lung disease (44% vs. 6%) and chronic heart failure (33% vs. 6%); they also had none of the classical risk factors for IA defined for liver transplantation (0% vs. 33%, P = 0.001), and therefore they did not receive antifungal prophylaxis (0% vs. 72%, P = 0.001). In 14/24 patients, serum galactomannan antigen was positive, and this related to higher mortality. CONCLUSIONS: While classical risk factors described for IA in liver recipients are still valid, IA appears later in renal patients and is commonly associated with co-morbid conditions.


Asunto(s)
Aspergilosis/diagnóstico , Trasplante de Riñón/efectos adversos , Aspergilosis/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
18.
Genet Couns ; 25(2): 129-41, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25059011

RESUMEN

BACKGROUND AND OBJECTIVE: Multidisciplinary management of Duchenne Muscular Dystrophy (DMD) has achieved outstanding results in developed nations. We aimed to describe the status of diagnosis and management of DMD in a developing country through the experience of non-profit organizations. METHODS: A Multistate, multiple-source, population-based survey was performed from medical records of 432 patients. Data were retrospectively collected, reviewed and curated by health specialists; including clinical features, age at first symptoms, age at diagnosis, disease progression and management, family history, education, age and cause of death. RESULTS: There is a delay in noticing first symptoms and it did not diminish over the past 20 years. Less than 30% of patients obtained definite diagnosis and most of them are in physiotherapy programs but not under steroid treatment. In our study, family history does not anticipate recognition of symptoms compared to sporadic cases (p = 0.05). Approximately 93.33% of our patients attended to education programs. Mean age at death was 18.94 +/- 6.73 years and the most frequent cause was pneumonia. CONCLUSION: Delayed diagnosis of DMD in Mexico is mainly caused by the late detection of first symptoms. There is no difference in early detection of symptoms between familiar and sporadic cases. Lifespan of patients in our cohort is reduced compared to developed countries. The late diagnosis and low percentage of definite cases may affect patient management and genetic counseling and could also preclude participation of patients into novel clinical trials.


Asunto(s)
Diagnóstico Tardío/estadística & datos numéricos , Manejo de la Enfermedad , Asesoramiento Genético/estadística & datos numéricos , Distrofia Muscular de Duchenne/diagnóstico , Adolescente , Adulto , Niño , Preescolar , Países en Desarrollo , Femenino , Humanos , Lactante , Masculino , México/epidemiología , Distrofia Muscular de Duchenne/epidemiología , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/terapia , Estudios Retrospectivos , Adulto Joven
19.
Transpl Infect Dis ; 16(4): 631-3, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24903646

RESUMEN

Toxoplasma gondii is an opportunistic pathogen that causes neurologic and extraneurologic manifestations in immunosuppressed patients. Encephalitis and intracranial mass lesions are easily recognized as typical manifestations of toxoplasmosis. However, meningitis caused by T. gondii is a rare condition with very few cases described in the literature. We present the case of a heart transplant recipient who developed toxoplasmic encephalitis associated with meningitis. After an extensive review of the medical literature, we found only 1 case of meningitis in solid organ transplant recipients and <25 cases in immunosuppressed patients, such as patients infected with human immunodeficiency virus or those with Hodgkin's disease. In this report, we consider toxoplasmosis in the differential diagnosis of meningitis in immunocompromised individuals.


Asunto(s)
Encefalitis/parasitología , Trasplante de Corazón/efectos adversos , Meningitis/parasitología , Toxoplasmosis Cerebral/etiología , Antiprotozoarios/administración & dosificación , Antiprotozoarios/uso terapéutico , Clindamicina/administración & dosificación , Clindamicina/uso terapéutico , Quimioterapia Combinada , Humanos , Masculino , Meningitis/complicaciones , Persona de Mediana Edad , Inhibidores de la Síntesis de la Proteína/administración & dosificación , Inhibidores de la Síntesis de la Proteína/uso terapéutico , Pirimetamina/administración & dosificación , Pirimetamina/uso terapéutico , Toxoplasmosis Cerebral/parasitología
20.
Int J Cardiol ; 173(3): 402-9, 2014 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-24681018

RESUMEN

BACKGROUND: AXL is a membrane receptor tyrosine kinase highly expressed in the heart and has a conspicuous role in cardiovascular physiology. The role of AXL in heart failure (HF) has not been previously addressed. METHODS AND RESULTS: AXL protein was enhanced 6-fold in myocardial biopsies of end-stage HF patients undergoing heart transplantation compared to controls from heart donors (P<0.0001). Next, we performed a transversal study of patients with chronic HF (n=192) and a group of controls with no HF (n=67). sAXL and BNP circulating levels were quantified and clinical and demographic data were collected. sAXL levels in serum were higher in HF (86.3 ± 2.0 ng/mL) than in controls (67.8 ± 2.0 ng/mL; P<0.0001). Also, sAXL correlated with several parameters associated with worse prognosis in HF. Linear regression analysis indicated that serum creatinine, systolic blood pressure and atrial fibrillation, but not BNP levels, were predictive of sAXL levels. Cox regression analysis indicated that high sAXL values at enrollment time were related to the major HF events (all-cause mortality, heart transplantation and HF hospitalizations) at one year follow-up (P<0.001), adding predictive value to high BNP levels. CONCLUSIONS: Myocardial expression and serum concentration of AXL is elevated in HF patients compared to controls. Furthermore, peripheral sAXL correlates with parameters associated with the progression of HF and with HF events at short term follow-up. All together these results suggest that sAXL could belong to a new molecular pathway involved in myocardial damage in HF, independent from BNP.


Asunto(s)
Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/diagnóstico , Miocardio/enzimología , Proteínas Proto-Oncogénicas/sangre , Proteínas Tirosina Quinasas Receptoras/sangre , Anciano , Biomarcadores/sangre , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad
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