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2.
Aten. prim. (Barc., Ed. impr.) ; 52(1): 29-37, ene. 2020. graf, tab
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3526

RESUMO

Objetivos: Evaluar la prevalencia, severidad y factores de riesgo asociados a la retinopatía diabética (RD) en Cantabria. Diseño: Estudio transversal de base poblacional. Emplazamiento: Centro de salud de Cantabria. Participantes: Muestra aleatoria de 442 pacientes con diabetes mellitus tipo 2. Mediciones principales: Retinografía no midriática, clasificándolas según la International Clinical Diabetic Retinopathy Disease Severity Scale. Los factores de riesgo estudiados: edad, sexo, edad diagnóstico, años de evolución de la diabetes, grado de control glucémico (HbA1c), tratamiento de la diabetes, control de la tensión arterial, control lipídico, obesidad, tabaquismo, hematocrito bajo, embarazo, déficit de vitamina D, nefropatía y eventos cardiovasculares. Resultados: Prevalencia de RD del 8,56% (IC: 5,81-11,32). RD no proliferativa leve: 5,07% (IC: 2,89-7,25); RD no proliferativa moderada: 1,38% (IC: 0,17-2,60); RD no proliferativa severa: 0,27% (IC: 0,006-1,28); RD proliferativa: 1,84% (IC: 0,46-3,22); edema macular diabético: 2,30% (IC: 0,77-3,83). Edad media: 70 años, edad de diagnóstico 58,97 años; índice de masa corporal 29,86; hipertensos 78,40%; dislipidemia 67,30% y HbA1c mediana 6,76%. El déficit de 25 (OH) D fue del 77%. En el análisis multivariante los factores independientes fueron tratamiento de la diabetes mellitus tipo 2, índice de masa corporal, años de evolución y control de la diabetes. Conclusiones: La prevalencia de RD ha disminuido hasta el 8,56%; esta disminución se asocia a la mejora en el control de los factores de riesgo modificables. Los factores de riesgo asociados de forma independiente fueron: tratamiento, índice de masa corporal, años de evolución y control de la diabetes. Las variables control hipertensión arterial, eventos cardiovasculares y nefropatía también mostraron capacidad predictiva para la RD


Objetive: To assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria. Design: Cross-sectional population based study. Location: Health center of Cantabria. Particiants: A random sample of 442 patients with type 2 diabetes. Main measurements: Non-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events. Results: The prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors. Conclusions: The prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR

5.
Aten Primaria ; 2019 May 17.
Artigo em Espanhol | MEDLINE | ID: mdl-31109720

RESUMO

OBJETIVE: To assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria. DESIGN: ross-sectional population based study. LOCATION: Health center of Cantabria. PARTICIANTS: A random sample of 442 patients with type 2 diabetes. MAIN MEASUREMENTS: Non-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events. RESULTS: The prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors. CONCLUSIONS: The prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR.

10.
Prog. obstet. ginecol. (Ed. impr.) ; 59(5): 342-349, sept.-oct. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-163929

RESUMO

Objetivo: la Sociedad Española de Obstetricia y Ginecología establece como uno de sus objetivos el conocer la tasa de mortalidad materna en España durante el periodo 2010-2012 y sus principales causas. Sujetos y Método: con este fin, la Sociedad Española de Obstetricia y Ginecología constituye un grupo de trabajo que elabora una encuesta que se remite a los 191 jefes de servicio de hospitales públicos y privados españoles. El análisis de los datos se llevó a cabo de forma confidencial, al igual que los nombres de los centros de los que procedían. Se llevó a cabo un procedimiento confidencial de los datos y su procedencia. Se cruzaron. Se analizan las causas obstétricas directas e indirectas de los datos con los publicados por el Instituto Nacional de Estadística. Resultados: respondieron 45 hospitales (23,56%). La encuesta representa el 18,9% de los recién nacidos en España en ese periodo. La tasa de mortalidad materna fue de 6,00/100.000 nacidos. Se consideró una subestimación del 48% de los datos registrados por el Instituto Nacional de Estadística. Las causas obstétricas directas representaron el 37,5%, siendo la hemorragia postparto la más importante. La causa obstétrica indirecta representó el 56,25%. El porcentaje de autopsias fue de 31%. Conclusiones: la tasa de mortalidad materna fue de 6/100.000 nacidos. El porcentaje de subestimación en las cifras oficiales se cifra en 48%. La causa obstétrica directa representó el 37,5%, siendo la hemorragia postparto las más frecuente. Se proponen medidas para mejorar esta información en nuestro país (AU)


Objectives: One of the aims of the Spanish Society of Obstetrics and Gynaecology is to determine the rate of maternal mortality and its main causes for the period 2010-2012. Subjects and methods: To do this, the Spanish Society of Obstetrics and Gynaecology formed a working group to draft a survey sent to 191 heads of obstetrics and gynaecology services in public and private hospitals. Analysis of the data and their origin was confidential. The data were crossed with those published by the Spanish National Statistics Institute. Direct and indirect obstetric causes were analysed. Results: Forty-five hospitals responded (23.56%). The survey represented 18.9% of newborns in Spain in that period. The maternal mortality ratio was 6/100.000 births. An underestimation of 48% was observed in relation to the data from the Spanish National Statistics Institute. Direct obstetric causes accounted for 37.5% of deaths, the most important being postpartum haemorrhage. Indirect obstetric causes accounted for 56.25%. The percentage of autopsies was 31%. Conclusions: The maternal mortality ratio was 6/100.000 births. The percentage of underestimation regarding official figures was 48%. Direct obstetric causes accounted for 37.5% of deaths, the most important cause being postpartum haemorrhage. Measures to improve this information in Spain are proposed (AU)


Assuntos
Humanos , Feminino , Mortalidade Materna/tendências , Sociedades Médicas/estatística & dados numéricos , Sociedades Médicas/normas , Pré-Eclâmpsia/epidemiologia , Eclampsia/epidemiologia , Sociedades Médicas/organização & administração , Intervalos de Confiança , Cuidado Pré-Natal/estatística & dados numéricos , Diagnóstico Pré-Natal/estatística & dados numéricos
11.
BMC Pulm Med ; 16(1): 99, 2016 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-27392908

RESUMO

BACKGROUND: Vitamin D and vitamin D dependent antimicrobial peptides such as Cathelicidin (LL-37) and ß-defensin 2 have an important role in innate and adaptative immunity, but their role in pleural effusions has not been studied before. METHODS: Serum and pleural fluid samples from 152 patients with pleural effusion were collected, corresponding to 45 transudates and 107 exudates, 51 infectious effusions (14 complicated and 37 non-complicated), 44 congestive heart failure effusions and 38 malignant effusions. The levels of 25 OH-vitamin D, 1,25-(OH)2-vitamin D, Vitamin D Binding Protein (VDBP), LL-37 and ß-defensin 2, both in serum and pleural fluid were evaluated in this prospective study. Differences between groups were analysed using unpaired t tests or Mann-Whitney tests. Correlations between data sets were examined using Pearson correlation coefficient or Spearman rank correlation coefficient. Diagnostic accuracy was estimated using ROC curve analysis. RESULTS: Low serum 25 OH vitamin D levels were found in all groups. Infectious effusions (IE) had higher serum and pleural fluid LL-37 levels compared to congestive heart failure or malignant effusions. Among IE, complicated had higher serum and pleural fluid LL-37 levels, and lower serum ß-defensin-2 levels. Positive correlations were found between serum 25 OH-vitamin D levels and serum or pleural 1,25-(OH)2-vitamin D levels, and between 1,25-(OH)2-vitamin D and LL-37 serum. Diagnostic accuracy of the different molecules was moderate at best. CONCLUSIONS: Hypovitaminosis D is highly prevalent in pleural effusions. LL-37 is produced intrapleurally in IE. This production is higher in complicated IE. No evidence of pleural production of ß-defensin 2 was found in any of the groups. Diagnostic accuracy of the different molecules is at the best moderate for discriminating different types of effusions.


Assuntos
Peptídeos Catiônicos Antimicrobianos/química , Proteínas de Ligação a DNA/química , Exsudatos e Transudatos/química , Derrame Pleural Maligno/química , Fatores de Transcrição/química , Vitamina D/química , beta-Defensinas/química , Peptídeos Catiônicos Antimicrobianos/sangue , Biomarcadores/sangue , Biomarcadores/química , Proteínas de Ligação a DNA/sangue , Insuficiência Cardíaca/complicações , Humanos , Estado Nutricional , Derrame Pleural Maligno/sangue , Derrame Pleural Maligno/microbiologia , Estudos Prospectivos , Curva ROC , Espanha , Fatores de Transcrição/sangue , Vitamina D/sangue , beta-Defensinas/sangue
13.
Int Immunol ; 28(2): 55-64, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26270267

RESUMO

Several studies have analyzed the potential of T regulatory cells (Treg cells) as biomarkers of acute rejection (AR). The aim of the present multicenter study was to correlate the percentage of peripheral Treg cells in liver graft recipients drawn at baseline up to 12 months after transplantation with the presence of AR. The percentage of central memory (cm) Treg cells (CD4(+)CD25(high)CD45RO(+)CD62L(+)) was monitored at pre-transplant and at 1 and 2 weeks, and 1, 2, 3 and 6 months and 1 year post-transplantation. The same validation standard operating procedures were used in all participating centers. Fifteen patients developed AR (23.4%). Hepatitis C virus recurrence was observed in 16 recipients, who displayed low peripheral blood cmTreg levels compared with patients who did not. A steady increase of cmTregs was observed during the first month after transplantation with statistically significant differences between AR and non-AR patients. The high frequency of memory Treg cells allowed us to monitor rejection episodes during the first month post-transplantation. On the basis of these data, we developed a prediction model for assessing risk of AR that can provide clinicians with useful information for managing patients individually and customizing immunosuppressive therapies.


Assuntos
Biomarcadores/metabolismo , Rejeição de Enxerto/diagnóstico , Memória Imunológica , Transplante de Fígado , Linfócitos T Reguladores/metabolismo , Doença Aguda , Adulto , Idoso , Antígenos CD/metabolismo , Progressão da Doença , Feminino , Seguimentos , Rejeição de Enxerto/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Linfócitos T Reguladores/imunologia , Adulto Jovem
14.
Biomed Res Int ; 2015: 812027, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26448946

RESUMO

Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1) expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (P < 0.0001) when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/metabolismo , Colágeno Tipo XI/metabolismo , Recidiva Local de Neoplasia/epidemiologia , Papiloma Intraductal/epidemiologia , Papiloma Intraductal/metabolismo , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Estudos Longitudinais , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/metabolismo , Papiloma Intraductal/diagnóstico , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade
16.
Transplantation ; 98(11): 1213-8, 2014 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-25083613

RESUMO

BACKGROUND: Prognostic biomarkers of acute rejection (AR) in solid organ transplantation have been addressed in multiple small retrospective studies, and there is a critical need for multicenter studies. Because of their tolerogenic properties, regulatory T cells (Tregs) play an important role in transplant outcome. METHODS: In the present multicenter study, we have retrospectively examined different Treg subpopulations in an independent cohort of kidney transplant patients within first year after kidney transplantation. All participating centers used identical flow cytometry standard operating procedures. RESULTS: Seventy-five renal transplant patients were included, and six of them experienced an AR episode. The activated Treg (aTreg) subpopulation (CD4CD25CD62LCD45RO) was increased in the AR group before transplantation, and an aTreg percentage higher than 1.46% before kidney transplantation conferred an increased risk of AR. The univariate logistic regression model achieved an area under the curve of 81.6%. By including recipient age and thymoglobulin induction as variables in a multivariate logistic regression model, the prediction of AR improved to 92.4%. CONCLUSION: The evaluation of CD4CD25CD62LCD45RO aTreg cells may be useful as pretransplantation predictive biomarker of AR in kidney transplant patients. Definitive confirmation of our results awaits tests in validation groups.


Assuntos
Linfócitos T CD4-Positivos/citologia , Rejeição de Enxerto/imunologia , Transplante de Rim , Insuficiência Renal/imunologia , Linfócitos T Reguladores/citologia , Adolescente , Adulto , Idoso , Biomarcadores/metabolismo , Feminino , Citometria de Fluxo , Rejeição de Enxerto/diagnóstico , Humanos , Imunossupressores/uso terapêutico , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Selectina L/metabolismo , Antígenos Comuns de Leucócito/metabolismo , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/cirurgia , Estudos Retrospectivos , Linfócitos T Reguladores/imunologia , Resultado do Tratamento , Adulto Jovem
17.
Clin Exp Rheumatol ; 32(4): 484-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24983912

RESUMO

OBJECTIVES: To investigate the functional consequences of IL10 (-592C/A and -1082A/G) gene polymorphisms and their association with susceptibility to, and disease phenotype, in patients with polymyalgia rheumatica (PMR). METHODS: A total number of 168 with PMR and 124 age-matched controls were genotyped using allele-specific primers and restriction fragment length polymorphism analysis. The levels of circulating IL10 and the production of IL10 by PBMCs after in vitro stimulation were studied by Cytometric Bead Array. RESULTS: No significant differences were observed in genotype or allele frequency distribution between patients and controls. The clinical characteristics and prognosis of these patients were also unrelated to the presence of these polymorphisms. No significant differences between PMR patients with low ESR (<40 mm/hr) and classic PMR (>40 mm/hr) were found. Furthermore, we did not observe any influence of circulating IL10 with the intensity of the acute phase response. In both, PMR patients and age-matched controls, no differences in circulating IL10 levels or IL10 production were observed depending on the genotypes of the IL10 gene. CONCLUSIONS: These results do not support the impact of IL10 variants in susceptibility or clinical phenotype of PMR patients. In this aged population no functional association was found between IL10 gene variants and IL10 production.


Assuntos
Interleucina-10/genética , Leucócitos Mononucleares/imunologia , Polimorfismo Genético , Polimialgia Reumática/genética , Polimialgia Reumática/imunologia , Regiões Promotoras Genéticas , Idoso , Idoso de 80 Anos ou mais , Sedimentação Sanguínea , Estudos de Casos e Controles , Células Cultivadas , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Interleucina-10/sangue , Masculino , Pessoa de Meia-Idade , Fenótipo , Polimialgia Reumática/sangue , Polimialgia Reumática/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco
18.
Autoimmun Rev ; 13(8): 788-94, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24667078

RESUMO

OBJECTIVE: To evaluate the effect of antiplatelet/anticoagulant therapy on the occurrence of severe ischemic complications in GCA patients at diagnosis and while on treatment with corticosteroids (CS), and the risk of bleeding in these patients. METHODS: A comprehensive search of PubMed and the Cochrane Central Register of Controlled Trials databases was completed and supplemented by hand searching of the references of all selected articles published from 1992 through December 2012. The cumulative meta-analysis included 6 retrospective studies that provided a total of 914 GCA patients. The effect of established antiplatelet/anticoagulant therapy on the occurrence of severe ischemic complications in patients with GCA at diagnosis and on the development of new severe ischemic complications in patients with GCA after diagnosis and while on treatment with CS were evaluated; as well as the risk of bleeding in patients with GCA on concomitant treatment with CS and antiplatelet/anticoagulant therapy. RESULTS: Antiplatelet/anticoagulant therapy before the diagnosis of GCA was not associated with a protection to develop severe ischemic complications (OR: 0.661; 95% CI [0.287-1.520]; p=0.33). However, such a therapy may prevent from severe ischemic complications after the diagnosis of GCA (OR: 0.318; [0.101-0.996]; p=0.049) without increasing the risk of bleeding in patients with GCA on concomitant treatment with CS (OR: 0.658; [0.089-4.856]; p=0.682). CONCLUSIONS: Antiplatelet/anticoagulant therapy prior to the diagnosis of GCA was not associated with reduction in severe ischemic complications. However, antiplatelet/anticoagulant therapy demonstrated a marginal benefit when used together with CS therapy in patients with established GCA without associated bleeding risk.


Assuntos
Anticoagulantes/uso terapêutico , Arterite de Células Gigantes/complicações , Hemorragia/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Corticosteroides/uso terapêutico , Anticoagulantes/efeitos adversos , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/epidemiologia , Hemorragia/induzido quimicamente , Hemorragia/complicações , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos
19.
Clin Rev Allergy Immunol ; 47(1): 56-64, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24395029

RESUMO

Polymorphisms of cytokine genes have been investigated as susceptibility markers of giant cell arteritis (GCA). Here, we have reviewed the evidence to date and especially addressed the functional consequences of IL10 (-592C/A and -1082A/G) gene polymorphisms and their association with susceptibility to and disease phenotype in GCA. A total number of 71 patients with GCA and 124 age-matched controls were genotyped using allele-specific primers and restriction fragment length polymorphism analysis. As previous studies in GCA showed inconsistent results, a meta-analysis of the existing studies was also conducted by using both fixed and random-effects models. The levels of circulating IL10 and the production of IL10 by peripheral blood mononuclear cells after in vitro stimulation were studied by Cytometric Bead Array. Data showed no significant differences in genotype or allele frequency distribution between patients and controls. The clinical characteristics and prognosis of these patients were also unrelated to the presence of these polymorphisms. However, the meta-analysis found a significant association of IL10 -592C/A polymorphism with susceptibility to GCA (odds ratio 2.205 (95% confidence interval 1.074-4.524); p = 0.031). In both patients and age-matched controls, no differences in circulating IL10 levels or IL10 production were observed depending on the genotypes of the IL10 gene. In conclusion, although our cohort results do not support the impact of IL10 variants in susceptibility or clinical phenotype of GCA patients, the meta-analysis revealed a significant association of -592C/A polymorphism with susceptibility to GCA. In this population, no functional association was found between IL10 gene variants and IL10 production.


Assuntos
Predisposição Genética para Doença , Arterite de Células Gigantes/genética , Interleucina-10/genética , Leucócitos Mononucleares/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência do Gene , Estudos de Associação Genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Regiões Promotoras Genéticas/genética
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