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1.
Lung Cancer ; 146: 19-22, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32505076

RESUMO

BACKGROUND: Currently there are no reported series determining the Covid-19 infected lung cancer patient´s characteristics and outcome that allow us to clarify strategies to protect our patients. In our study we determine whether exists differences in cumulative incidence and severity of Covid-19 infection between lung cancer patients visiting our Medical Oncology department and the reference population of our center (320,000 people), in the current epicenter of the pandemic in Europe (Madrid, Spain). We also describe clinical and demographic factors associated with poor prognosis and Covid-19 treatment outcomes. PATIENTS AND METHODS: We retrospectively reviewed 1878 medical records of all Covid-19 patients who were admitted at Hospital Universitario Infanta Leonor of Madrid between March 5, 2020 and April 7, 2020, in order to detect cumulative incidence of Covid-19 in lung cancer patients. We also described Covid-19 treatment outcome, mortality and associated risk factors using univariate and multivariate logistic regression analysis. RESULTS: 17/1878 total diagnosis in our center had lung cancer (0.9 %) versus 1878/320,000 of the total reference population (p = 0.09). 9/17 lung cancer patients with Covid-19 diagnosis died (52.3 %) versus 192/1878 Covid-19 patients in our center (p < 0.0001). Dead lung cancer patients were elderly compared to survivors: 72 versus 64.5 years old (p = 0.12). Combined treatment with hydroxychloroquine and azithromycin improves the outcome of Covid-19 in lung cancer patients, detecting only 1/6 deaths between patients under this treatment versus others treatment, with statistical significance in the univariate and multivariate logistic regression (OR 0.04, p = 0.018). CONCLUSIONS: Lung cancer patients have a higher mortality rate than general population. Combined hydroxychloroquine and azithromycin treatment seems like a good treatment option. It is important to try to minimize visits to hospitals (without removing their active treatments) in order to decrease nosocomial transmission.


Assuntos
Infecções por Coronavirus/mortalidade , Infecção Hospitalar/prevenção & controle , Neoplasias Pulmonares/mortalidade , Pandemias , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Azitromicina/uso terapêutico , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Infecção Hospitalar/complicações , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/virologia , Combinação de Medicamentos , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Modelos Logísticos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/virologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Prognóstico , Espanha/epidemiologia
2.
J Deaf Stud Deaf Educ ; 25(1): 105-114, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31628811

RESUMO

This article presents the adaptation of the MacArthur Communicative Development Inventory (CDI; Fenson et al., 1993, Guide and technical manual for the MacArthur Communicative Development Inventories. San Diego, CA: Singular Press; Fenson et al. 1994, Variability in early communicative development. Monographs of the Society for Research in Child Development, 59, 1-173) to Spanish Sign Language (LSE). Data were collected from 55 participants (32 boys and 23 girls; 17 deaf signers, 38 hearing signers) who, evaluated by their caregivers every 4 months, presented a total of 170 records. The parents reported the signs that the children could understand or produce between 8 and 36 months. Results suggested that the CDI adapted to LSE is a valid and reliable instrument. Signing children could understand more signs than they produced at this early developmental stage. There were no significant differences between boys and girls, or between deaf and hearing children. The development of LSE is similar to other sign languages, although with a lower production of signs in the early stages, perhaps due to the bilingualism of most of the children of our study.

3.
BMJ Open ; 9(9): e031341, 2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31542760

RESUMO

OBJECTIVE: To evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK. DESIGN: Population-based cross-sectional study. SETTING: UK primary care. POPULATION: 30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016. MAIN OUTCOME MEASURES: Percentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed-including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status. RESULTS: A total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels: apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC: apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%. CONCLUSION: Between 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted.

4.
Nutr Hosp ; 36(Spec No3): 35-39, 2019 Aug 27.
Artigo em Espanhol | MEDLINE | ID: mdl-31368330

RESUMO

Introduction: In recent years, the advance in gut microbiota knowledge has shown that is key in the development and health status of humans. There are many factors that influence the gut microbiota and its balance, being our lifestyle one of the key factors. There is an association between feeding and practicing physical exercise. People who have an active life have a healthier diet, richer in fiber, vegetables and fruits, while sedentary lifestyle is associated with diets with higher fat content and lower fiber. Our feeding behavior and the practice of physical exercise, determine the microbial diversity, as well as the presence of beneficial bacteria for our health. The influence of these factors is determined by the physiological state of the individual (illness/health, obese/lean, young/old), thus more research is needed to determine how changes occur in the microbiota depending on the individual in order to be able to move towards customized nutrition and exercise recommendations according to the needs of each individual.


Assuntos
Dieta Saudável , Exercício Físico/fisiologia , Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/microbiologia , Estilo de Vida , Fibras na Dieta/microbiologia , Humanos , Comportamento Sedentário
5.
Front Neurosci ; 13: 698, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312118

RESUMO

Extracellular vesicles (EVs), like exosomes, play a critical role in physiological processes, including synaptic transmission and nerve regeneration. However, exosomes in particular can also contribute to the development of neurodegenerative conditions such as Alzheimer's disease (AD), Parkinson's disease, and prion diseases. All of these disorders are characterized by protein aggregation and deposition in specific regions of the brain. Several lines of evidence indicate that protein in exosomes is released from affected neurons and propagated along neuroanatomically connected regions of the brain, thus spreading the neurodegenerative disease. Also, different cell types contribute to the progression of tauopathy, such as microglia. Several groups have reported tau release via exosomes by cultured neurons or cells overexpressing human tau. Although the exact mechanisms underlying the propagation of protein aggregates are not fully understood, recent findings have implicated EVs in this process. The AD brain has two hallmarks, namely the presence of amyloid-ß-containing plaques and neurofibrillary tangles, the latter formed by hyperphosphorylated tau protein. Both amyloid peptide and tau protein are present in specific exosomes. This review summarizes recent advances in our understanding of exosomes in the pathology of AD, with a special focus on tau protein.

6.
BMJ Open ; 9(7): e028750, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300503

RESUMO

OBJECTIVES: Hypotension is of particular relevance for patients with heart failure (HF), since almost all HF drugs cause lowering of blood pressure (BP) and it is associated with a poor prognosis. We aimed to investigate hypotension incidence and risk factors in patients with incident HF in the UK. DESIGN: Retrospective cohort study including nested case-control analyses. SETTING: The Health Improvement Network UK primary care database. PARTICIPANTS: 18 677 adult patients with incident HF during 2000-2005 were followed and cases of hypotension (systolic BP ≤90 mm Hg) were identified. Controls were age-matched, sex-matched and date-matched to cases (1:2). PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated hypotension incidence in the full study population and relevant subgroups (eg, sex and age). Potential risk factors for hypotension overall and for multiple versus single hypotensive episodes were evaluated using conditional logistic regression and unconditional regression models, respectively. RESULTS: During a mean follow-up of 3.31 years, 2565 patients (13.7%) developed hypotension. The incidence of hypotension was 3.17 cases per 100 patient years (95% confidence interval (CI): 3.05-3.30), and was markedly increased in women aged 18-39 years (n=32; 17.72 cases per 100 patient-years; 95% CI: 9.69-29.73). Hypotension risk factors included high healthcare utilisation (proxy measure for HF severity and general comorbidity; eg, ≥10 primary care physician visits versus none, odds ratio (OR): 2.29; 95% CI: 1.34-3.90), previous hypotensive episodes (OR: 2.32; 95% CI: 1.84-2.92), renal failure and use of aldosterone antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Risk factors identified for hypotension generally overlapped with those for multiple versus single hypotensive episodes. CONCLUSIONS: Hypotension occurs frequently in patients with incident HF. Our findings may help identify patients most likely to benefit from close BP monitoring. The increased incidence of hypotension in young women with HF requires investigation.

8.
PLoS One ; 14(1): e0210864, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30668577

RESUMO

For unknown reasons, humans appear to be particular susceptible to developing tau pathology leading to neurodegeneration. Transgenic mice are still undoubtedly the most popular and extensively used animal models for studying Alzheimer's disease and other tauopathies. While these murine models generally overexpress human tau in the mouse brain or specific brain regions, there are differences between endogenous mouse tau and human tau protein. Among them, a main difference between human and mouse tau is the presence of a short motif spanning residues 18 to 28 in the human tau protein that is missing in murine tau, and which could be at least partially responsible for that different susceptibility across species. Here we report novel data using affinity chromatography analysis indicating that the sequence containing human tau residues 18 to 28 acts a binding motif for End Binding proteins and that this interaction could facilitate tau secretion to the extracellular space.


Assuntos
Proteínas tau/química , Proteínas tau/metabolismo , Motivos de Aminoácidos , Sequência de Aminoácidos , Animais , Sítios de Ligação/genética , Células COS , Chlorocebus aethiops , Cromatografia de Afinidade , Humanos , Camundongos , Camundongos Transgênicos , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Ligação Proteica , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Deleção de Sequência , Especificidade da Espécie , Proteínas tau/genética
9.
Thromb Haemost ; 119(1): 66-76, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30597501

RESUMO

BACKGROUND: Many patients on warfarin therapy often present with supratherapeutic international normalized ratio (INR) levels, resulting from the influence of several patient-specific factors, which have been associated with adverse outcomes. OBJECTIVE: This article aims to identify risk factors for over-anticoagulation (INR levels ≥4) in a cohort of patients taking warfarin. METHODS: A cohort of warfarin users aged 18 to 85 years from January 2005 to April 2013 was identified in The Health Improvement Network U.K. primary care database (N = 12,506). A random date was assigned to all patients within their eligible person-time (index date), and a nested case-control analysis was performed with individuals presenting a first episode of INR level ≥4 after the index date used as cases (N = 699) and patients with non-supratherapeutic INR values (≤3) as controls (N = 9,798). Using unconditional logistic regression models, odds ratios with 95% confidence intervals were calculated adjusted for potential confounders. Two sensitivity analyses were performed with alternative definitions of over-anticoagulation (INR levels ≥5 or > 3). RESULTS: Among the factors examined, the strongest predictors of over-anticoagulation were warfarin indication (in particular, valvular atrial fibrillation and valve replacement), renal failure (with the risk increasing steeply with decreasing estimated glomerular filtration rate), cancer, anaemia, respiratory infections treated with antibiotics, chronic obstructive pulmonary disease treated with ß2-agonists, polypharmacy (≥10 medications), low socio-economic status and residency in rural areas. Similar results were obtained when supratherapeutic levels were defined as INR ≥5 or, alternatively, as INR > 3. CONCLUSION: Predictors of supratherapeutic INR levels found in this study might help physicians identify patients where closer INR monitoring is warranted.


Assuntos
Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Varfarina/efeitos adversos , Varfarina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/terapia , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Taxa de Filtração Glomerular , Humanos , Coeficiente Internacional Normatizado , Masculino , Sobremedicalização , Pessoa de Meia-Idade , Neoplasias/terapia , Razão de Chances , Pobreza , Atenção Primária à Saúde/organização & administração , Doença Pulmonar Obstrutiva Crônica/terapia , Análise de Regressão , Insuficiência Renal/terapia , Infecções Respiratórias/terapia , População Rural , Reino Unido , Adulto Jovem
10.
Front Cell Neurosci ; 12: 202, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050413

RESUMO

Tau is a microtubule-associated protein that plays an important role in Alzheimer's disease and related tauopathies. Approximately one-half of all cases of Frontotemporal dementia with parkinsonism-17 (FTDP-17) are caused by mutations in the MAPT gene. The N279K mutation is one of the three mutations more prevalent in FTDP-17 cases. Several studies have demonstrated that N279K Tau mutation alters alternative splicing inducing the presence of exon 10. Tau is mainly found in the cytosol of neuronal cells although it has also been localized within the nucleus. Here we demonstrate by biochemical and immunohistochemistry studies in COS-7 cells, that the proportion of mutant N279K Tau increases compared with wild-type at the cell nucleus although cell viability is not affected. These data will provide us with a better outline of the nuclear role of tau protein offering new clues related with this tauopathie.

11.
Methods Mol Biol ; 1779: 447-461, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29886549

RESUMO

The brain-specific tau protein binds directly through microtubules to regulate dynamically its structure and function. It also plays a critical role in the pathogenesis of a number of neurodegenerative disorders collectively known as tauopathies, the most common of which is Alzheimer's disease (AD). Under pathological conditions, the natively unfolded tau protein self-assembles into filamentous structures of aggregated, hyperphosphorylated tau. In AD brains, tau accumulates in the neuronal perikarya and processes as paired helical filaments (PHF) forming the neurofibrillary tangles (NFT) characteristic of the disease. Prominent tau neurofibrillary pathology is a common feature in all tauopathies and its development is associated with progressive neuronal loss and cognitive decline. A precise understanding of the cellular, biochemical, and structural mechanisms involved in the process of tau protein aggregation and fibril formation is key to design strategies to prevent, slow down, or stop the neurodegenerative pathway leading to neuronal loss in AD and other tauopathies. Herein, we describe some complementary experimental procedures for PHF purification from human postmortem brain, tau expression and purification, as well as in vitro formation of tau filaments from purified recombinant tau.


Assuntos
Doença de Alzheimer/metabolismo , Proteínas tau/química , Proteínas tau/isolamento & purificação , Autopsia , Humanos , Microscopia Eletrônica de Transmissão , Lobo Parietal/metabolismo , Multimerização Proteica , Estrutura Secundária de Proteína
12.
BMC Infect Dis ; 18(1): 196, 2018 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-29699550

RESUMO

BACKGROUND: Benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness of PCV13 vaccination in preventing hospitalisation from pneumonia among middle-aged and older adults. METHODS: Population-based cohort study involving 2,025,730 individuals ≥50 years in Catalonia, Spain, who were prospectively followed from 01/01/2015 to 31/12/2015. Primary outcomes were hospitalisation for pneumococcal or all-cause pneumonia and death from any cause. Cox regression models were used to evaluate the association between PCV13 vaccination and the risk of each outcome, adjusting for age, sex and major comorbidities/underlying risk conditions. RESULTS: Cohort members were observed for a total of 1,990,701 person-years, of which 6912 person-years were PCV13 vaccinated. Overall, crude incidence rates (per 100,000 person-years) were 82.8 (95% confidence interval [CI]: 77.7-88.1) for pneumococcal pneumonia, 637.9 (95% CI: 599.0-678.7) for all-cause pneumonia and 2367.2 (95% CI: 2222.8-2518.7) for all-cause death. After multivariable adjustments we found that the PCV13 vaccination did not alter significantly the risk of pneumococcal pneumonia (multivariable-adjusted hazard ratio [mHR]: 1.17; 95% CI: 0.75-1.83; p = 0.493) and all-cause death (mHR: 1.07; 95% CI: 0.97-1.18; p = 0.190), although it remained significantly associated with an increased risk of all-cause pneumonia (mHR: 1.69; 95% CI: 1.48-1.94; p < 0.001). In stratified analyses focused on middle-aged or elderly persons and immunocompromised or immunocompetent subjects, PCV13 vaccination did not appear effective either. CONCLUSION: Our data does not support clinical benefits of PCV13 vaccination against pneumonia among adults in Catalonia. It must be closely monitored in future studies involving more vaccinated person-time at-observation.


Assuntos
Vacinas Pneumocócicas/imunologia , Pneumonia Pneumocócica/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hospitalização , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/mortalidade , Modelos de Riscos Proporcionais , Espanha/epidemiologia , Streptococcus pneumoniae/imunologia , Análise de Sobrevida , Resultado do Tratamento , Vacinas Conjugadas/imunologia
13.
J Alzheimers Dis ; 64(s1): S529-S534, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29562521

RESUMO

Alzheimer's disease (AD) is characterized by the presence of two aberrant structures: namely senile plaques, composed of amyloid-ß peptide (Aß), and neurofibrillary tangles, composed of tau protein. In this regard, Aß and tau protein have been widely studied in research efforts aiming to find a therapy for AD. Aß and tau pathologies do not always overlap. The precursor of Aß is expressed in peripheral tissues and in the central nervous system (CNS), whereas tau is mainly a neuronal protein. Since AD is a disease of the CNS, it has been proposed that Aß may initiate the disease process, with tau being the executor. In this review, we will focus on future studies of tau pathology, although we will comment on new beginnings for AD, as other molecules other than Aß and tau may be involved in the onset of dementia.


Assuntos
Doença de Alzheimer/metabolismo , Proteínas tau/metabolismo , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/terapia , Animais , Encéfalo/metabolismo , Humanos , Neurônios/metabolismo , Prevalência
14.
Biomol Concepts ; 9(1): 1-11, 2018 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-29509544

RESUMO

The microtubule-associated protein Tau plays a crucial role in stabilizing neuronal microtubules. In Tauopathies, Tau loses its ability to bind microtubules, detach from them and forms intracellular aggregates. Increasing evidence in recent years supports the notion that Tau pathology spreading throughout the brain in AD and other Tauopathies is the consequence of the propagation of specific Tau species along neuroanatomically connected brain regions in a so-called "prion-like" manner. A number of steps are assumed to be involved in this process, including secretion, cellular uptake, transcellular transfer and/or seeding, although the precise mechanisms underlying propagation of Tau pathology are not fully understood yet. This review summarizes recent evidence on the nature of the specific Tau species that are propagated and the different mechanisms of Tau pathology spreading.


Assuntos
Proteínas tau/metabolismo , Animais , Encéfalo/patologia , Células Cultivadas , Humanos , Camundongos , Agregação Patológica de Proteínas , Tauopatias/enzimologia , Tauopatias/patologia
15.
Thromb Haemost ; 118(3): 461-470, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29433149

RESUMO

OBJECTIVE: To investigate the population impact of previously reported interactions between warfarin and other drugs on international normalized ratio (INR) levels. METHODS: Using The Health Improvement Network (THIN), a United Kingdom primary care database, a cohort of warfarin users between 2005 and 2013 (N = 121,962) was followed until the first qualifying prescription for the potential interacting drugs was evaluated. Sixteen sub-cohorts, one for each study drug, and a control sub-cohort of warfarin were ascertained. Short-term changes in INR levels were assessed by comparing INR values measured before and after initiation of the interacting drug with paired Student's t-test. We also evaluated the proportion of patients with INR values outside the therapeutic range (INR: 2-3). RESULTS: Miconazole use was associated with the highest mean increase in INR (+3.35), followed by amiodarone (+1.28), fluconazole (+0.79), metronidazole (+0.75) and nystatin (+0.65). After subtracting the natural INR variation observed in the control sub-cohort, supra-therapeutic levels (INR > 3) were found in 53.2% (miconazole), 45.5% (amiodarone), 23.3% (metronidazole), 23.2% (fluconazole) and 17.6% (nystatin) of patients initiating treatment with these drugs. Carbamazepine use was associated with a mean INR decrease of -0.63 and infra-therapeutic levels (INR < 2) were observed in 46.2% of patients initiating carbamazepine. For all other drugs, the change was small to moderate, in absolute INR units (+0.23 to +0.55) and in the proportion of patients with INR levels out of therapeutic range (<16%). CONCLUSIONS: Clinically potentially important interactions were observed in several study drugs. The majority of them, although confirmed, had little impact after adjusting for standard INR variability in the general population of warfarin users.


Assuntos
Anticoagulantes/administração & dosagem , Interações Medicamentosas , Coeficiente Internacional Normatizado , Varfarina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiodarona/administração & dosagem , Carbamazepina/administração & dosagem , Bases de Dados Factuais , Feminino , Fluconazol/administração & dosagem , Seguimentos , Humanos , Masculino , Miconazol/administração & dosagem , Pessoa de Meia-Idade , Nistatina/administração & dosagem , Atenção Primária à Saúde , Estudos Retrospectivos , Reino Unido , Adulto Jovem
16.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 52(1): 2-8, ene.-feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159269

RESUMO

Introducción. La polifarmacia en las personas mayores es el resultado de la interconexión de múltiples factores y un fenómeno muy común a pesar de los riesgos asociados. No son muchos los estudios de base poblacional realizados en España con el objetivo de medir su magnitud en este grupo de población. Material y métodos. Estudio descriptivo, transversal realizado con datos individualizados de individuos de 65 años o más, de ambos sexos, no institucionalizados, procedentes de las Encuestas Nacionales de Salud de España (ENSE) 2006 (N=7.835) y 2011/12 (N=5.896). Se estimó la prevalencia de polifarmacia (consumo de al menos 4 fármacos en las 2 semanas previas a la encuesta) para las 2 encuestas utilizadas, así como por sexo y grupos de edad, y las prevalencias de uso de los diferentes grupos de fármacos entre los mayores polimedicados. Resultados. La polifarmacia ocurrió en aproximadamente uno de cada 3 mayores en la ENSE 2006 (32,54%), fue significativamente superior en la ENSE 2011/12 (36,37%) (p<0,05) y mayor en ambos casos en mujeres que en hombres y entre los individuos de mayor edad (≥85años) respecto a los más jóvenes. En las 2 encuestas analizadas, los grupos de fármacos más usados fueron los analgésicos (ENSE 2006: 71,93%; ENSE 2011/12: 76,27%; p<0,05) y antihipertensivos (ENSE 2006: 70,26%; ENSE 2011/12: 78,10%; p<0,05). Conclusiones. La magnitud de la polifarmacia en mayores es considerable y una práctica creciente en el tiempo. Se hace necesario conocer esta práctica en mayor profundidad, identificando a aquellos mayores con un riesgo elevado de consumir múltiples fármacos de forma simultánea (AU)


Introduction. Polypharmacy in older people is the result of several inter-connected factors, and is very common despite the associated risks. Not many population-based studies have been conducted in Spain to ascertain the magnitude of polypharmacy in this population. Material and methods. A descriptive, cross-sectional study was conducted with individualised data for non-institutionalised older people (65 or older) of both sexes from the Spanish National Health Surveys (SNHS) 2006 (N=7,835) and 2011/12 (N=5,896). The prevalence of polypharmacy (use of 4 or more drugs within the 2 weeks preceding the survey) was ascertained for the 2 surveys used, as well as by sex and age groups. The prevalence of use of the different drug groups was also estimated in the elderly who used polypharmacy. Results. Polypharmacy occurred in about a third of the older people in the 2006 SNHS (32.54%), and was significantly higher in the 2011/12 SNHS (36.37%) (P<.05). In both surveys, the prevalence of polypharmacy was higher in women than men and among the older individuals (≥85 years) compared to the less old. The type of drugs most commonly used were analgesics (2006 SNHS: 71.93%, 2011/12 SNHS: 76.27%; P<.05), and antihypertensive drugs 2006 SNHS: 70.26%, 2011/12 SNHS: 78.10%; P<.05). Conclusions. The magnitude of polypharmacy is considerable in older people and increasing over time. Further research on this issue is needed to identify those individuals who are at higher risk of using multiple drugs concomitantly (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Polimedicação , Idoso/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Quimioterapia Combinada/tendências , Farmacovigilância , Serviços de Saúde para Idosos/estatística & dados numéricos , Serviços de Saúde para Idosos , Inquéritos Epidemiológicos/estatística & dados numéricos , Sistemas Nacionais de Saúde , Espanha/epidemiologia , Estudos Transversais/métodos , Estudos Transversais/estatística & dados numéricos , Monitoramento de Medicamentos
17.
Rev Esp Geriatr Gerontol ; 52(1): 2-8, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-27756482

RESUMO

INTRODUCTION: Polypharmacy in older people is the result of several inter-connected factors, and is very common despite the associated risks. Not many population-based studies have been conducted in Spain to ascertain the magnitude of polypharmacy in this population. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted with individualised data for non-institutionalised older people (65 or older) of both sexes from the Spanish National Health Surveys (SNHS) 2006 (N=7,835) and 2011/12 (N=5,896). The prevalence of polypharmacy (use of 4 or more drugs within the 2 weeks preceding the survey) was ascertained for the 2 surveys used, as well as by sex and age groups. The prevalence of use of the different drug groups was also estimated in the elderly who used polypharmacy. RESULTS: Polypharmacy occurred in about a third of the older people in the 2006 SNHS (32.54%), and was significantly higher in the 2011/12 SNHS (36.37%) (P<.05). In both surveys, the prevalence of polypharmacy was higher in women than men and among the older individuals (≥85 years) compared to the less old. The type of drugs most commonly used were analgesics (2006 SNHS: 71.93%, 2011/12 SNHS: 76.27%; P<.05), and antihypertensive drugs 2006 SNHS: 70.26%, 2011/12 SNHS: 78.10%; P<.05). CONCLUSIONS: The magnitude of polypharmacy is considerable in older people and increasing over time. Further research on this issue is needed to identify those individuals who are at higher risk of using multiple drugs concomitantly.


Assuntos
Polimedicação , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Espanha
19.
Neurosci Lett ; 634: 63-69, 2016 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-27651066

RESUMO

Tau is a microtubule-associated protein that plays an important role in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease. Several studies have suggested that tau may be secreted to extracellular medium and may be responsible of spreading of neurodegeneration. The overexpression of tau in cultured non-neuronal cells leads to the secretion of this protein. The proline-rich region of tau may serve as a membrane-binding site during the secretion of the full-length tau molecule. Tau fragments lacking this proline-region are either not secreted or are secreted in a distinct manner to the full-length molecule.


Assuntos
Proteínas tau/metabolismo , Animais , Células COS , Morte Celular , Chlorocebus aethiops , Espaço Extracelular/metabolismo , Humanos , Fragmentos de Peptídeos/genética , Fragmentos de Peptídeos/metabolismo , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Proteínas tau/genética
20.
PLoS One ; 11(8): e0160046, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27490468

RESUMO

BACKGROUND: Low-dose aspirin has proven effectiveness in secondary and primary prevention of cardiovascular events, but is also associated with an increased risk of major bleeding events. For primary prevention, this absolute risk must be carefully weighed against the benefits of aspirin; such assessments are currently limited by a lack of data from general populations. METHODS: Systematic searches of Medline and Embase were conducted to identify observational studies published between 1946 and 4 March 2015 that reported the risks of gastrointestinal (GI) bleeding or intracranial hemorrhage (ICH) with long-term, low-dose aspirin (75-325 mg/day). Pooled estimates of the relative risk (RR) for bleeding events with aspirin versus non-use were calculated using random-effects models, based on reported estimates of RR (including odds ratios, hazard ratios, incidence rate ratios and standardized incidence ratios) in 39 articles. FINDINGS: The incidence of GI bleeding with low-dose aspirin was 0.48-3.64 cases per 1000 person-years, and the overall pooled estimate of the RR with low-dose aspirin was 1.4 (95% confidence interval [CI]: 1.2-1.7). For upper and lower GI bleeding, the RRs with low-dose aspirin were 2.3 (2.0-2.6) and 1.8 (1.1-3.0), respectively. Neither aspirin dose nor duration of use had consistent effects on RRs for upper GI bleeding. The estimated RR for ICH with low-dose aspirin was 1.4 (1.2-1.7) overall. Aspirin was associated with increased bleeding risks when combined with non-steroidal anti-inflammatory drugs, clopidogrel and selective serotonin reuptake inhibitors compared with monotherapy. By contrast, concomitant use of proton pump inhibitors decreased upper GI bleeding risks relative to aspirin monotherapy. CONCLUSIONS: The risks of major bleeding with low-dose aspirin in real-world settings are of a similar magnitude to those reported in randomized trials. These data will help inform clinical judgements regarding the use of low-dose aspirin in prevention of cardiovascular events.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragias Intracranianas/etiologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Clopidogrel , Bases de Dados Factuais , Hemorragia Gastrointestinal/epidemiologia , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Estudos Observacionais como Assunto , Razão de Chances , Risco , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico
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