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González-Lorenzo Ó, Franco Pelaez JA, Kallmeyer A, Nieto L, Esteban L, Pello A, Aceña Á, Aldamiz G, Tuñón J. Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery. Front Cardiovasc Med 2024; 11:1305162. [PMID: 38464841 PMCID: PMC10921089 DOI: 10.3389/fcvm.2024.1305162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG). Materials and methods This is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery. Results One-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27-2.69], age (HR = 1.35, 95% CI 1.09-1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80-0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001). Conclusions Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.
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Affiliation(s)
| | | | - Andrea Kallmeyer
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Nieto
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Esteban
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Faculty of Medicine, Autónoma University, Madrid, Spain
| | - Gonzalo Aldamiz
- Department of Cardiac Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Faculty of Medicine, Autónoma University, Madrid, Spain
- Laboratory Department of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- CIBERCV, ISCIII, Madrid, Spain
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Corchete Prats E, González-Parra E, Vega A, Macías N, Delgado M, Fernández M, Sánchez RJ, Álvarez L, Miranda RJ, Vian J, López V, Mérida E, Pereira M, Sapiencia D, Andrés N, Muñoz P, Gil Y, Sánchez M, Cases C, Gil B, García A, Sainz V, Alexandru S, Pampa S, López M, Flor JCDL, Estrada PN, Berlanga JR, Zamora R, Sánchez R, Rodríguez-Osorio L, Fraile C, Caravaca-Fontán F, Moratilla C, Cabré C, Furaz K, Nieto L, Villaverde MT, Tapia CG, Cedeño S, Castellano S, Valdés E, Ferreira M, Martínez P, Sanz M, Sánchez M, Ríos F, Palomo S, Serrano ML, Blanco A, Espinel L, Tornero F, Herrero JA. Epidemiology of Fabry disease in patients in hemodialysis in the Madrid community. Nefrologia 2023; 43:435-441. [PMID: 36564230 DOI: 10.1016/j.nefroe.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/03/2022] [Indexed: 06/17/2023] Open
Abstract
This study screened for Fabry disease (FD) in patients in hemodialysis (HD) in the region of Madrid (CAM) with a cross-sectional design to evaluate HD-prevalent patients, followed by a three-year period prospective design to analyze HD-incident patients. INCLUSION CRITERIA patients older than 18 years on HD in the CAM, excluding patients diagnosed with any other hereditary disease with renal involvement different from FD, that sign the Informed Consent (IC). EXCLUSION CRITERIA underaged patients or not agreeing or not being capable of signing the IC. RESULTS 3470 patients were included, 63% males and with an average age of 67.9±9.7 years. 2357 were HD-prevalent patients and 1113 HD-incident patients. For HD-prevalent patients, average time in HD was 45.2 months (SD 51.3), in HD-incident patients proteinuria was present in 28.4%. There were no statistical differences in plasmatic alpha-galactosidase A (α-GAL-A) activity or Lyso-GL-3 values when comparing HD-prevalent and HD-incident populations and neither between males and females. A genetic study was performed in 87 patients (2.5% of patients): 60 male patients with decreased enzymatic activity and 27 female patients either with a decreased GLA activity, increased Lyso-Gl3 levels or both. The genetic variants identified were: p.Asp313Tyr (4 patients), p.Arg220Gln (3 patients) and M290I (1 patient). None of the identified variants is pathogenic. CONCLUSIONS 76% of HD Centers of the CAM participated in the study. This is the first publication to describe the prevalence of FD in the HD-population of a region of Spain as well as its average α-GAL-A-activity and plasmatic Lyso-Gl3 levels. It is also the first study that combines a cross-sectional design with a prospective follow-up design. This study has not identified any FD patient.
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Affiliation(s)
| | | | - Almudena Vega
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Nicolás Macías
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María Delgado
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Milagros Fernández
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | - Laura Álvarez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Ramón Jesús Miranda
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Javier Vian
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Virginia López
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Evangelina Mérida
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Mónica Pereira
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - David Sapiencia
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Natalia Andrés
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Patricia Muñoz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Yohana Gil
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María Sánchez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Clara Cases
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Beatriz Gil
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Alicia García
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Valeria Sainz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Simona Alexandru
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Saúl Pampa
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María López
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | | | - José Ramón Berlanga
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Rocío Zamora
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Rosa Sánchez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | - Carmen Fraile
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | - Cristina Moratilla
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Carmen Cabré
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Karina Furaz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Luis Nieto
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | | | - Santiago Cedeño
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Sandra Castellano
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Evaristo Valdés
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Marta Ferreira
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Pilar Martínez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Marta Sanz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Mercedes Sánchez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Francisco Ríos
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Sofía Palomo
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María Luisa Serrano
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Ana Blanco
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Laura Espinel
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Fernando Tornero
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
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Jimenez MDA, Méndez A, Furaz K, Botella A, Yetman D, Cazar R, Cabana ML, Handel M, Luz sanchez M, Delgado M, Vasquez MM, Martinez MI, Pereira M, González-Parra E, Sánchez MSP, Garayzabal IS, Rodriguez-Osorio L, Portoles J, Hernán D, Miranda B, Arenas MD, Miranda B, Hernán D, Dapena F, Mendez A, Acuña M, Gaitán D, Guerrero E, Furaz K, de la flor JC, Cordón A, Benavides N, González A, Botella A, Naranjo J, Zalamea F, Manso P, Cabana ML, Beato L, Burgos M, Yetman D, Fernández J, Sobrado J, Carneiro D, Caramés C, Handel M, Terleira M, Sánchez ML, Cerón MD, Herruzo J, Barbeito J, Vasquez MM, SanJuan M, Nieto L, Sainz V, Cazar R, Hernández J, Carrillo JG, Martinez MI, Rossignoli A, Hernández RS, Zamora R, Rodriguez-Osorio L, Ledesma C, Pérez AG, Rubio RE, Garayzábal IS, Iglesias A, Pizarro-Sanchez MS, Piña L, Saíco SEP, Tapia MP, Alexandru S, Picasso ML, Gonzalez-Parra E, Pereira M, Feijoo MCF. Impact of the COVID pandemic on vascular access creation for hemodialysis in 16 Spanish hemodialysis centers. Clin Kidney J 2022; 15:1340-1347. [PMID: 35756749 PMCID: PMC9217639 DOI: 10.1093/ckj/sfac094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.
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Affiliation(s)
| | - Angel Méndez
- Department of nephrology. Los llanos II center, Getafe, Madrid, Spain
| | - Karina Furaz
- Department of nephrology. Los llanos I center, Móstoles, Madrid, Spain
| | - Ana Botella
- Department of nephrology. Los Lauros center, Majadahonda, Madrid, Spain
| | - Delfina Yetman
- Department of nephrology. Os carballos I center; Vigo, Madrid, Spain
| | - Ramiro Cazar
- Department of nephrology. Santa Engracia center, Madrid, Spain
| | - Mara Lisbet Cabana
- Department of nephrology. Os Carballos II center; Porriño, Madrid, Spain
| | - Marc Handel
- Department of nephrology. El Castañar (Béjar) y las Encinas (Ciudad Rodrigo) centers Salamanca, Spain
| | - María Luz sanchez
- Department of nephrology. El Castañar (Béjar) y las Encinas (Ciudad Rodrigo) centers Salamanca, Spain
| | - Margarita Delgado
- Department of nephrology. Los Pinos center, Medina del campo, Valladolid, Spain
| | | | | | - Monica Pereira
- Department of nephrology. Hospital Fundación Jimenez Diaz, Madrid, Spain
| | | | | | | | | | - José Portoles
- Department of nephrology. Hospital Universitario Puerta de Hierro, Madrid, Spain
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Alcázar-Arroyo R, Portolés J, López-Sánchez P, Zalamea F, Furaz K, Méndez Á, Nieto L, Sánchez-Hernández R, Pizarro S, García A, Pereira M, Gallego-Valcárcel E, Llópez-Carratala R, Gadea-Gironés I, Martín R, Miranda B. Rapid decline of anti-SARS-CoV-2 antibodies in patients on haemodialysis: the COVID-FRIAT study. Clin Kidney J 2021; 14:1835-1844. [PMID: 34211708 PMCID: PMC7989535 DOI: 10.1093/ckj/sfab048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) patients on haemodialysis (HD) have high mortality. We investigated the value of reverse transcription polymerase chain reaction (RT-PCR) and the dynamic changes of antibodies (enzyme-linked immunosorbent assay immunoglobulin M (IgM) + IgA and/or IgG) in a large HD cohort. METHODS We conducted a prospective observational study in 10 Madrid HD centres. Infection rate, anti-SARS-CoV-2 antibody dynamics and the incidence of asymptomatic SARS-CoV-2 infection (defined by positive RT-PCR, IgM + IgA and/or IgG) were assessed. RESULTS From 1 March to 15 April 2020, 136 of 808 (16.8%) HD patients were diagnosed with symptomatic COVID-19 by RT-PCR of nasopharyngeal swabs and 42/136 (31%) died. In the second fortnight of April, RT-PCR and anti-SARS-CoV-2 antibodies were assessed in 763 of the surviving patients. At this point, 69/91 (75.8%) symptomatic COVID-19 patients had anti-SARS-CoV-2 antibodies. Four weeks later, 15.4% (10/65) of initially antibody-positive patients had become negative. Among patients without prior symptomatic COVID-19, 9/672 (1.3%) were RT-PCR positive and 101/672 patients (15.0%) were antibody positive. Four weeks later, 62/86 (72.1%) of initially antibody-positive patients had become negative. Considering only IgG titres, serology remained positive after 4 weeks in 90% (54/60) of patients with symptomatic COVID-19 and in 52.5% (21/40) of asymptomatic patients. The probability of an adequate serologic response (defined as the development of anti-SARS-CoV-2 antibodies that persisted at 4 weeks) was higher in patients who had symptomatic COVID-19 than in asymptomatic SARS-CoV-2 infection {odds ratio [OR) 4.04 [95% confidence interval (CI) 2.04-7.99]} corrected for age, Charlson comorbidity index score and time on HD. Living in a nursing home [OR 5.9 (95% CI 2.3-15.1)] was the main risk factor for SARS-CoV-2 infection. CONCLUSIONS The anti-SARS-CoV-2 antibody immune response in HD patients depends on clinical presentation. The antibody titres decay earlier than previously reported for the general population. This inadequate immune response raises questions about the efficacy of future vaccines.
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Affiliation(s)
- Roberto Alcázar-Arroyo
- Department of Nephrology, University Hospital Infanta Leonor, Madrid, Spain
- Department of Medicine, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - José Portolés
- Department of Nephrology, University Hospital Puerta de Hierro, Madrid, Spain
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
| | - Paula López-Sánchez
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
| | - Felipe Zalamea
- Department of Nephrology, Dialysis Center–Los Lauros, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Karina Furaz
- Department of Nephrology, Dialysis Center–Los Llanos, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Ángel Méndez
- Department of Nephrology, Dialysis Center–Los Llanos II, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Luis Nieto
- Department of Nephrology, Dialysis Center–Santa Engracia, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | | | - Soledad Pizarro
- Department of Nephrology, University Hospital Rey Juan Carlos, Madrid, Spain
| | - Alicia García
- Department of Nephrology, University Hospital Infanta Elena, Madrid, Spain
| | - Mónica Pereira
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Gallego-Valcárcel
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
- Department of Nephrology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Rosario Llópez-Carratala
- Department of Nephrology, University Hospital Puerta de Hierro, Madrid, Spain
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
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Venegas A, Nieto L, Pello AM, Lorenzo O, Pelaez JAF, Villelabeitia K, Fernandez JT. INFLAMMATORY AND MINERAL METABOLISM BIOMARKERS EVOLUTION AMONG PATIENTS WITH ACUTE CORONARY SYNDROME AFTER A CARDIAC REHABILITATION PROGRAM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salas De Armas IA, Akkanti B, Doshi PB, Patel M, Kumar S, Akay MH, Hussain R, Dinh K, Baloch MY, Ahmed MS, Banjac I, Jumean MF, McGinness K, Janowiak LM, Mittal Agrawal K, Nathan S, Zaki J, Nieto L, Klein K, Taub E, Tint H, Patel JA, Nascimbene A, Kar B, Gregoric ID. Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support. Perfusion 2021; 37:477-483. [PMID: 33926332 DOI: 10.1177/02676591211012840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. STUDY DESIGN Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. RESULTS Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0-76.0), median injury severity score was 34.0 (IQR, 27.0-43.0), and the median duration of ECMO support was 11 days (IQR, 7.5-20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). CONCLUSIONS Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.
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Affiliation(s)
- Ismael A Salas De Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Bindu Akkanti
- Division of Pulmonary, Critical Care and Sleep Medicine, UTHealth, Houston, TX, USA
| | - Pratik B Doshi
- Division of Pulmonary, Critical Care and Sleep Medicine, UTHealth, Houston, TX, USA.,Department of Emergency Medicine, UTHealth, Houston, TX, USA
| | - Manish Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M Hakan Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Rahat Hussain
- Division of Pulmonary, Critical Care and Sleep Medicine, UTHealth, Houston, TX, USA
| | - Kha Dinh
- Division of Pulmonary, Critical Care and Sleep Medicine, UTHealth, Houston, TX, USA
| | | | - Mahmoud Samy Ahmed
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Igor Banjac
- Department of Emergency Medicine, UTHealth, Houston, TX, USA
| | - Marwan F Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kelly McGinness
- Cardiovascular Perfusion Program, UTHealth, Houston, TX, USA
| | - Lisa M Janowiak
- Department of Emergency Medicine, UTHealth, Houston, TX, USA
| | | | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - John Zaki
- Department of Anesthesia, UTHealth, Houston, TX, USA
| | - Luis Nieto
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kimberly Klein
- Department of Pathology and Laboratory Medicine, UTHealth, Houston, TX, USA
| | - Ethan Taub
- Division of Acute Care Surgery, Trauma & Critical Care, UTHealth, Houston, TX, USA
| | - Hlaing Tint
- Department of Pathology and Laboratory Medicine, UTHealth, Houston, TX, USA
| | - Jayeshkumar A Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Corral-Gudino L, Bahamonde A, Arnaiz-Revillas F, Gómez-Barquero J, Abadía-Otero J, García-Ibarbia C, Mora V, Cerezo-Hernández A, Hernández JL, López-Muñíz G, Hernández-Blanco F, Cifrián JM, Olmos JM, Carrascosa M, Nieto L, Fariñas MC, Riancho JA. Methylprednisolone in adults hospitalized with COVID-19 pneumonia : An open-label randomized trial (GLUCOCOVID). Wien Klin Wochenschr 2021; 133:303-311. [PMID: 33534047 PMCID: PMC7854876 DOI: 10.1007/s00508-020-01805-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine whether a 6-day course of methylprednisolone (MP) improves outcome in patients with severe SARS-CoV‑2 (Corona Virus Disease 2019 [COVID-19]). METHODS The study was a multicentric open-label trial of COVID-19 patients who were aged ≥ 18 years, receiving oxygen without mechanical ventilation, and with evidence of systemic inflammatory response who were assigned to standard of care (SOC) or SOC plus intravenous MP (40 mg bid for 3 days followed by 20 mg bid for 3 days). The primary outcome was a composite of death, admission to the intensive care unit, or requirement for noninvasive ventilation. Both intention-to-treat (ITT) and per protocol (PP) analyses were performed. RESULTS A total of 91 patients were screened, and 64 were randomized (mean age70 ± 12 years). In the ITT analysis, 14 of 29 patients (48%) in the SOC group and 14 of 35 (40%) in the MP group suffered the composite endpoint (40% versus 20% in patients under 72 years and 67% versus 48% in those over 72 years; p = 0.25). In the PP analysis, patients on MP had a significantly lower risk of experiencing the composite endpoint (age-adjusted risk ratio 0.42; 95% confidence interval, CI 0.20-0.89; p = 0.043). CONCLUSION The planned sample size was not achieved, and our results should therefore be interpreted with caution. The use of MP had no significant effect on the primary endpoint in ITT analysis; however, the PP analysis showed a beneficial effect due to MP, which consistent with other published trials support the use of glucocorticoids in severe cases of COVID-19.
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Affiliation(s)
- Luis Corral-Gudino
- Hospital Rio Hortega, Servicio de Medicina Interna, Universidad de Valladolid, Valladolid, Spain
| | | | - Francisco Arnaiz-Revillas
- IDIVAL, Hospital U M Valdecilla, Servicio de Enfermedades Infecciosas, Universidad de Cantabria, Santander, Spain
| | - Julia Gómez-Barquero
- Hospital Rio Hortega, Servicio de Medicina Interna, Consulta de Enfermedades Infecciosas, Universidad de Valladolid, Valladolid, Spain
| | - Jesica Abadía-Otero
- Hospital Rio Hortega, Servicio de Medicina Interna, Consulta de Enfermedades Infecciosas, Universidad de Valladolid, Valladolid, Spain
| | - Carmen García-Ibarbia
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
| | - Víctor Mora
- IDIVAL, Hospital U M Valdecilla, Servicio de Neumología, Universidad de Cantabria, Santander, Spain
| | | | - José L. Hernández
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
| | | | | | - Jose M. Cifrián
- IDIVAL, Hospital U M Valdecilla, Servicio de Neumología, Universidad de Cantabria, Santander, Spain
| | - Jose M. Olmos
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
| | | | - Luis Nieto
- Servicio de Medicina Interna, Hospital Sierrallana, Torrelavega, Spain
| | - María Carmen Fariñas
- IDIVAL, Hospital U M Valdecilla, Servicio de Enfermedades Infecciosas, Universidad de Cantabria, Santander, Spain
| | - José A. Riancho
- IDIVAL, Hospital U M Valdecilla, Servicio de Medicina Interna, Universidad de Cantabria, Santander, Spain
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Carugno J, Nieto L, Alonso L. Hysteroscopic Management of Retained Products of Conception. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Riveiro-Barciela M, Bes M, Rodríguez-Frías F, Tabernero D, Ruiz A, Casillas R, Vidal-González J, Homs M, Nieto L, Sauleda S, Esteban R, Buti M. Serum hepatitis B core-related antigen is more accurate than hepatitis B surface antigen to identify inactive carriers, regardless of hepatitis B virus genotype. Clin Microbiol Infect 2017; 23:860-867. [PMID: 28288829 DOI: 10.1016/j.cmi.2017.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/24/2017] [Accepted: 03/05/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether hepatitis B surface antigen (HBsAg) and hepatitis B core-related antigen (HBcrAg) levels are useful to identify inactive carriers among HBeAg-negative patients infected by different hepatitis B virus (HBV) genotypes. METHODS In all, 202 consecutive HBeAg-negative patients with chronic hepatitis B, 135 inactive carriers and 67 with HBV activity, were prospectively followed for 1 year. RESULTS In HBeAg-negative patients, HBsAg levels differed across the different genotypes (p <0.001). The highest levels were observed in genotypes F or H (4.2 ± 0.6 logIU/mL), followed by genotype E (3.4 ± 1.1 logIU/mL), genotype A (3.4 ± 0.8 logIU/mL), and the lowest in genotype D (2.7 ± 1.1 logIU/mL). Variations in HBsAg levels were similar in inactive carriers and patients with HBV activity. HBsAg <3 logIU/mL showed good performance for identifying genotype D inactive carriers: 76% of genotype D inactive carriers met this cut-off versus ≤31% for genotypes A, E, F or H. However, in patients with genotype A, HBsAg levels ≤3.7 logIU/mL better classified inactive carriers. The combination of a single measurement of HBcrAg ≤3 logU/mL plus HBV DNA ≤2000 IU/mL yielded a positive predictive value and diagnostic accuracy >85% in all HBV genotypes, except genotype H or F, with values of 62.5% and 72.7%, respectively, for the two parameters. CONCLUSIONS HBsAg levels varied across genotypes in HBeAg-negative patients. HBsAg levels <3 logIU/mL were only useful for identifying genotype D inactive carriers. A single HBcrAg measurement ≤3 logU/mL plus HBV DNA ≤2000 IU/mL was highly accurate for identifying inactive carriers, regardless of their HBV genotype.
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Affiliation(s)
- M Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - M Bes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut, Barcelona, Spain
| | - F Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit) Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Tabernero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit) Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Ruiz
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit) Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Casillas
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - J Vidal-González
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Homs
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit) Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Nieto
- Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit) Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Sauleda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut, Barcelona, Spain
| | - R Esteban
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - M Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Dorokhin D, van IJzendoorn LJ, de Jong AM, Nieto L, Brunsveld L, Orsel JG, Prins MWJ. Molecular interference in antibody-antigen interaction studied with magnetic force immunoassay. N Biotechnol 2015; 32:450-7. [PMID: 25676839 DOI: 10.1016/j.nbt.2015.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
Abstract
Molecular interferences are an important challenge in biotechnologies based on antibody-antigen interactions, such as sandwich immunoassays. We report how a sandwich immunoassay with magnetic particles as label can be used to probe interference by surfactants. Surfactants are often used to improve the performance of immunoassays, however the surfactants can affect the involved proteins and the mechanism of action of surfactant molecules on the antibody-antigen system is mostly unknown. As an example, we investigated molecular interference by a nonionic surfactant (Pluronic F-127) in a cardiac troponin (cTn) sandwich immunoassay with two monoclonal antibodies. The influence of the surfactant below the critical micelle concentration (0.00-0.04%) on dissociation properties was quantified in a magnetic tweezers setup, where a force is applied to the molecules via magnetic particle labels. The force-dependent dissociation curves revealed the existence of two distinct cTn-dependent bond types, namely a weak bond attributable to non-specific binding of cTn, and a strong bond attributable to the specific binding of cTn. The dissociation rate constant of the strong bonds increased with the surfactant concentration by about a factor of two. Circular dichroism spectroscopy data showed that the nonionic surfactant influences the conformation of cTn while not noticeably affecting the two monoclonal antibodies. This suggests that the surfactant-induced increase of the dissociation rate of the specific sandwich-type cTn binding may be related to a conformational change of the antigen molecule. The described methodology is an effective tool to study the influence of surfactants and other interferences on assays based on protein interactions.
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Affiliation(s)
- D Dorokhin
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - L J van IJzendoorn
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - A M de Jong
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - L Nieto
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - L Brunsveld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J G Orsel
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
| | - M W J Prins
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Salva S, Duran N, Rodriguez V, Nieto L, Serra J, Rello J. Clostridium difficile in the ICU: study of the incidence, recurrence, clinical characteristics and complications in a university hospital. Med Intensiva 2013; 38:140-5. [PMID: 23769945 DOI: 10.1016/j.medin.2013.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/17/2013] [Accepted: 03/27/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Although several studies have established the association between antibiotics and Clostridium difficile infection (CDI), there is a lack of epidemiological studies on the incidence of CDI in European Intensive Care Units outside the context of infection outbreaks. The present study describes the incidence, patient characteristics, complications, and recurrence rates of CDI in a Spanish ICU. DESIGN A retrospective study was carried out. SETTING A clinical-surgical ICU with 34 beds, a tertiary referral hospital with 1400 beds. PATIENTS All patients over 18 years of age admitted to the ICU from January 2010 to December 2011 with diarrhea for more than 48 h. INTERVENTIONS None. STUDY VARIABLES Underlying diseases, risk factors, fever, leukocyte count, complications, recurrence of infection. RESULTS A total of 1936 adult patients were admitted. Seven patients acquired CDI (0.36%), representing an infection rate of 3.1 per 10,000 bed-days and a cumulative incidence rate of 3.6 in two years. The mean age was 61 years. Six patients showed some degree of immunosuppression. The mean APACHE II score at ICU admission was 17 (IQR 13-24). Severe sepsis was reported in 5 cases of CDI, three of which presented shock and multiorgan dysfunction. Four patients presented recurrence of CDI during hospitalization. ICU admission was prolonged for a mean of 24 days (SD 17.8) after diagnosis. CONCLUSIONS Less than 1% of the patients admitted to a clinical-surgical ICU in a large teaching institution in Spain developed CDI. However, a high risk of recurrence/complications was associated with prolonged ICU stay.
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Affiliation(s)
- S Salva
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - N Duran
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Rodriguez
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Nieto
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Serra
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Rello
- Critical Care Department, Vall d'Hebron University Hospital, CIBERES & CRIPS, Universitat Autónoma de Barcelona, Barcelona, Spain.
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Albalate M, de la Piedra C, Ortiz A, Hernández Pérez J, Rubert M, Pérez Garcia R, Zazo P, Nieto L, de Sequera P, Egido J. Risk in dosing regimens for 25-OH vitamin D supplementation in chronic haemodialysis patients. Nephron Clin Pract 2012; 121:c112-9. [PMID: 23221739 DOI: 10.1159/000345148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/06/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION 25-OH vitamin D (25-OHvitD) insufficiency or deficiency should be treated in haemodialysis (HD) patients, although the 25-OHvitD target, drug or dosing regimens are unclear. AIMS To describe factors associated with 25-OHvitD levels in HD patients and to assess the effect of three dosing regimens to supplement 25-OHvitD (calcifediol) on serum calcium (Ca), phosphate (P), parathyroid hormone (PTH), 25-OHvitD and 1,25-OHvitD. METHODS Two hundred and seventeen patients from three HD units were studied. Demographic and biochemical data were collected at baseline. Two different 25-OHvitD assays were used. One hundred and sixty-seven patients were treated with various calcifediol dosing regimens. The same biochemical determinations were repeated after 3 months of treatment. RESULTS At baseline, 12.9% of patients had 25-OHvitD <10 ng/ml. In multivariate linear regression, the season (lower in winter) and the assay method were determinants of 25-OHvitD concentration. Following calcifediol supplementation, 25-OHvitD, calcium and phosphate increased, while PTH diminished with statistical significance. After treatment, there were positive correlations between 25-OHvitD and Ca (r = 0.28, p < 0.0001) or 1,25-OHvitD (r = 0.75, p < 0.0001) that were not observed in the baseline dataset. High concentrations of post-treatment 25-OHvitD were associated with higher 1,25-OHvitD levels. Calcemia increased more in those treated with concomitant active vitamin D or those having suppressed baseline PTH, while PTH decreased more in those having above-target PTH levels. CONCLUSIONS Standardisation of methods to determine 25-OHvitD blood levels is needed. In HD patients, calcifediol increased 25-OHvitD, calcemia and phosphatemia and lowered PTH. Caution should be exercised with the higher calcifediol dosing regimens, especially in patients with suppressed PTH or on vitamin D receptor activators.
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Affiliation(s)
- M Albalate
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Autonoma University IIS-Fundación Jiménez Díaz, Madrid, Spain.
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Fallone F, Britton S, Nieto L, Salles B, Muller C. ATR controls cellular adaptation to hypoxia through positive regulation of hypoxia-inducible factor 1 (HIF-1) expression. Oncogene 2012; 32:4387-96. [PMID: 23085754 DOI: 10.1038/onc.2012.462] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 07/20/2012] [Accepted: 08/24/2012] [Indexed: 01/29/2023]
Abstract
Tumor cells adaptation to severe oxygen deprivation (hypoxia) plays a major role in tumor progression. The transcription factor HIF-1 (hypoxia-inducible factor 1), whose α-subunit is stabilized under hypoxic conditions is a key component of this process. Recent studies showed that two members of the phosphoinositide 3-kinase-related kinases (PIKKs) family, ATM (ataxia telangiectasia mutated) and DNA-PK (DNA-dependent protein kinase), regulate the hypoxic-dependent accumulation of HIF-1. These proteins initiate cellular stress responses when DNA damage occurs. In addition, it has been demonstrated that extreme hypoxia induces a replicative stress resulting in regions of single-stranded DNA at stalled replication forks and the activation of ATR (ataxia telangiectasia and Rad3 related protein), another member of the PIKKs family. Here, we show that even less severe hypoxia (0.1% O2) also induces activation of ATR through replicative stress. Importantly, in using either transiently silenced ATR cells, cells expressing an inactive form of ATR or cells exposed to an ATR inhibitor (CGK733), we demonstrate that hypoxic ATR activation positively regulates the key transcription factor HIF-1 independently of the checkpoint kinase Chk1. We show that ATR kinase activity regulates HIF-1α at the translational level and we find that the elements necessary for the regulation of HIF-1α translation are located within the coding region of HIF-1α mRNA. Finally, by using three independent cellular models, we clearly show that the loss of ATR expression and/or kinase activity results in the decrease of HIF-1 DNA binding under hypoxia and consequently affects protein expression levels of two HIF-1 target genes, GLUT-1 and CAIX. Taken together, our data show a new function for ATR in cellular adaptation to hypoxia through regulation of HIF-1α translation. Our work offers new prospect for cancer therapy using ATR inhibitors with the potential to decrease cellular adaptation in hypoxic tumors.
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Affiliation(s)
- F Fallone
- 1] CNRS, IPBS (Institut de Pharmacologie et de Biologie Structurale), Toulouse, France [2] Université de Toulouse, UPS, IPBS, Toulouse, France
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Arruda-Neto JDT, Nieto L, Righi H, Cotta MA, Carrer H, Rodrigues TE, Genofre GC. Fragmentation of extracellular DNA by long-term exposure to radiation from uranium in aquatic environments. ACTA ACUST UNITED AC 2012; 14:2108-13. [DOI: 10.1039/c2em30196b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Iglesias M, Vázquez I, Barreiro de Acosta M, Figueiras A, Nieto L, Piñeiro M, Gómez R, Lorenzo A, Domínguez Muñoz JE. Health related quality of life in patients with Cohn's disease in remission. Rev esp enferm dig 2010; 102:624-30. [DOI: 10.4321/s1130-01082010001100002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Iglesias M, Barreiro de Acosta M, Vázquez I, Figueiras A, Nieto L, Lorenzo A, Domínguez-Muñoz JE. Impacto psicológico de la enfermedad de Crohn en pacientes en remisión: riesgo de ansiedad y depresión. Rev esp enferm dig 2009. [DOI: 10.4321/s1130-01082009000400003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Iglesias M, Barreiro de Acosta M, Vázquez I, Figueiras A, Nieto L, Lorenzo A, Domínguez-Muñoz JE. Psychological impact of Crohn's disease on patients in remission: anxiety and depression risks. Rev Esp Enferm Dig 2009; 101:249-257. [PMID: 19492900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND the role of anxiety and depression in CD patients in remission has been poorly investigated. OBJECTIVE the aim of the study was to evaluate the frequency of anxiety and depression symptoms in CD patients in remission, and potential factors influencing the development of these symptoms. METHODS CD patients older than 18 years in remission for at least 6 months before study entry were included. CD remission was defined as a Crohn s Disease Activity Index (CDAI) < 150 points together with C-reactive protein < 5 mg/L. A demographic questionnaire was filled in, and all patients were clinically classified. The therapy maintaining remission was also recorded. A Hospital Anxiety and Depression scale (HAD) was administered to all patients. Results are shown as OR and 95% CI, and analyzed by logistic regression. RESULTS 92 consecutive patients were included (48 male, mean age 37 years, range from 18 to 71 years). One patient failed to correctly fill in the questionnaire. Anxiety and depression symptoms were present in 36 (39%) and 22 (24%) patients, respectively. Infliximab therapy was the only factor associated with anxiety (OR = 3.11; 95% CI: 1.03-9.43; p < 0.05). In contrast, the presence of depressive symptoms is less frequent in patients under infliximab therapy (OR = 0.16; 95% CI: 0.02-0.97; p < 0.05). CONCLUSIONS despite clinical remission, an important number of CD patients present with anxiety or depressive symptoms. Infliximab therapy in CD patients is associated to more anxiety but fewer depressive symptoms. CD patients in remission would probably benefit from psychological support.
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Affiliation(s)
- M Iglesias
- Fienad Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain
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Abstract
BACKGROUND Mechanisms underlying cough and bronchoconstriction in patients with cough-variant asthma (CVA) are not well established. Differences in location or degree of activation of eosinophils and allergic cytokines have been suggested as the likely causes. To address this issue, we have carried out a comparative study of airway inflammatory markers between patients with CVA and classic asthma (CA). The relationship between these markers with airway hyperresponsiveness (AHR) and cough sensitivity has also been studied. METHODS Twenty-seven non-smokers and steroid-naive patients with CVA (12) and CA (15) were examined. Capsaicin challenge, histamine bronchoprovocation test, nitric oxide levels in exhaled air and sputum induction were performed in all of them. Differential cell sputum recount and supernatant concentrations of eosinophil granule-derived cationic proteins (ECP), interleukin (IL)5, IL8 and tumour necrosis factor (TNF)-alpha were also measured. RESULTS There were no significant differences in either the inflammatory pattern of soluble markers or differential cell counts between CA and CVA. Histamine PC20 was correlated with IL-5 in CVA, whereas it was associated with sputum eosinophilia in CA. Cough sensitivity (log C5) and histamine PC20 were inversely related in CA. CONCLUSIONS Although the pattern of inflammatory sputum markers in patients with asthma and cough-variant asthma is similar, its relation with bronchial hyperreactivity and cough sensitivity is different in each group.
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Affiliation(s)
- A De Diego
- Service of Pneumology, University Hospital La Fe, Valencia, Spain
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Abstract
OBJECTIVES To assess the utility of capsaicin test in the differential diagnosis of non-productive causes of chronic cough and to examine the effects of treatment on this reflex. PARTICIPANTS 86 healthy volunteers and 101 patients with chronic cough: asthma (n: 54) gastroesophageal reflux (n: 35) and post-nasal drip syndrome (n: 12). DESIGN Prospective intervention trial. Spirometry, bronchoprovocation test with histamine (PC20), and cough challenge with ascending concentrations of capsaicin (0.49-500 microM) were initially performed in all subjects. Patients were treated for 3 months according to the origin of the cough. Concentrations that elicited two (C2) and five or more coughs (C5) were determined before and after treatment. RESULTS In healthy subjects, cough sensitivity to capsaicin was not influenced by gender or smoking status; however, women with chronic cough were more sensitive to cough challenge than men. C2 and C5 were significantly lower in patients with asthma or gastroesophageal reflux than in post-nasal drip syndrome. No significant correlation was observed between the capsaicin cough threshold and PC20. Cough sensitivity did not improve significantly in most patients with asthma or gastroesophageal reflux despite adequate medical treatment during 3 months. Discriminative value of capsaicin test to differentiate healthy subjects from patients with asthma or reflux was poor. CONCLUSIONS Cough sensitivity to inhaled capsaicin is a safe and reproducible tool in the study of chronic cough. However, its usefulness for the management and differential diagnosis is limited.
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Affiliation(s)
- L Nieto
- Service of Pneumology and Service of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
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Caramelo C, Goicoechea M, Albalate M, Nieto L, Melero R, Berlanga JR, López MD, González Pacheco F, Marrón B, Alvarez Arroyo MV, Castilla MA, Yagüe S, Deudero JJ, Ortiz A. [Structural changes and vascular calcifications in uremia]. Nefrologia 2002; 21:538-47. [PMID: 11881423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- C Caramelo
- Fundación Jiménez Díaz, Universidad Autónoma, Fundación Renal Iñigo Alvarez de Toledo, Madrid.
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Palacios-Boix A, Bolaños F, Luviano C, Nieto L, Maisterrena J, Alarcón-Segovia D. [Thyroid acropachy. Report of a clinical case documented using gammagraphy]. Rev Invest Clin 1986; 38:185-8. [PMID: 3755542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Juárez F, Orozco H, Guevara L, Uribe M, Hernández J, Tielve M, Nieto L, Santillán P, Aranceta M, Mercado MA. [Intrahepatic shunting in portal hypertension]. Rev Invest Clin 1985; 37:189-97. [PMID: 4081365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Uribe M, Dibildox M, Malpica S, Guillermo E, Villallobos A, Nieto L, Vargas F, Garcia Ramos G. Beneficial effect of vegetable protein diet supplemented with psyllium plantago in patients with hepatic encephalopathy and diabetes mellitus. Gastroenterology 1985; 88:901-7. [PMID: 2982694 DOI: 10.1016/s0016-5085(85)80006-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A controlled crossover study was performed in 8 diabetic patients with chronic portal-systemic encephalopathy. After a basal period the patients were treated during periods A and B. During period A, a meat protein diet (0.8 g/kg body wt, approximately 1800 kcal/day) was consumed and neomycin plus laxatives were given. During period B patients received vegetable protein (0.8 g/kg body wt, 1800 kcal/day). This diet was supplemented with psyllium fiber to reach 35 g of fiber per day. Four patients were randomly assigned to receive the treatments in the order A-B and the other 4 patients in the order B-A. At the end of the first experimental period, fasting glucose levels were 204 +/- 86 mg% in the meat protein diet group and 127 +/- 8 mg% in the vegetable protein diet group (p less than 0.014). The patients were receiving 2.5 +/- 0.2 g/day and 2.1 +/- 0.5 g/day of tolbutamide at the end of the meat protein diet and vegetable protein diet, respectively. In all cases, fasting glucose levels decreased at the end of the vegetable diet period regardless of the previous treatment. An improvement of greater than or equal to 25 mg% of fasting glucose levels was observed in 7 of the 8 patients after the vegetable protein diet and in no case after the meat protein diet (p less than 0.0078). The parameters of encephalopathy were comparable at the end of both the meat protein diet and the vegetable protein diet. A significant increase in the number of bowel movements was noticed after the vegetable diet plus fiber (p less than 0.01). We propose the use of vegetable diet plus fiber to facilitate the treatment of patients with both diabetes and hepatic encephalopathy.
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Moreno J, Uribe M, Peña F, Elizondo J, Gallo S, Hernández J, Quiroz F, Nieto L. [Prospective evaluation of diagnostic procedures in patients suspected of malignant hepatomegaly (author's transl)]. Rev Invest Clin 1981; 33:343-8. [PMID: 6276956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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25
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Uribe M, Sifuentes J, Orozco H, Nieto L, Maldonado H, González Y, Murphy C, Luviano C. [Evaluation of the Leveen shunt patency by intraperitoneal injection of technetium 99 m (author's transl)]. Rev Invest Clin 1981; 33:9-12. [PMID: 7268237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Uribe M, Nieto L, Wolpert E, Kershenobich D, González Y, Murillo H. Acute alcoholic hepatitis: clinical, biochemical and liver scintiscanning correlation in assessing prognosis. Rev Invest Clin 1979; 31:139-44. [PMID: 472544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Martínez-Campos A, Nieto L, Tovar E, Maisterrena J, García-Reyes JA, Valverde C. Growth hormone response to oral TRH as a diagnostic aid in acromegaly. Rev Invest Clin 1978; 30:127-30. [PMID: 97744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Medina M, Parra A, Scaglia HE, Nieto L, Pérez-Palacios G. Suprahypophyseal dysfunction in a patient with asexual ateleiosis. Eur J Endocrinol 1978; 87:449-55. [PMID: 204142 DOI: 10.1530/acta.0.0870449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The neuroendocrine function of a 19 years old female dwarf with primary amenorrhoea and lack of sexual development (asexual ateleiosis) was studied. Undetectable fasting plasma levels of growth hormone (GH) and a lack of response to three different provocative stimuli was observed. Oestrogen administratin did not modify the GH response. Thyroid and adrenal function were within normal limits. Undetectable plasma levels of immunoreactive oestradiol and lack of oestrogenic activity in vaginal smears indicated absence of ovarian function. Low levels of circulating gonadotrophins with a significant rise after synthetic LH-RH administration was demonstrated, while clomiphene citrate failed to induce ovulation. Following 6 months of continuous GH administration a significant increase in the growth rate was evident, whereas no pubertal development was observed. These data are interpreted as demonstrating the suprahypophyseal origin of the sexual infantilism in a patient with inappropriate GH secretion. It is suggested that a combined deficiency of LH-RH and GH-RH may account for the aetiology of this disorder.
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Farca A, Nieto L, Wolpert E. [Reduced postprandial serum gastrin in liver cirrhosis. A preliminary report (author's transl)]. Rev Invest Clin 1978; 30:59-63. [PMID: 635324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Orozco H, Guevara L, Hernández-Ortiz J, Elizondo J, Nieto L, Campuzano M. [Surgical treatment of portal hipertension by means of selective vascular derivations (author's transl)]. Rev Invest Clin 1977; 29:143-50. [PMID: 897389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Campuzano M, Orozco H, Guevara L, Nieto L. [Percutaneous splenoportogammagraphy in the study of patients with portal hypertension]. Rev Gastroenterol Mex 1977; 42:18-22. [PMID: 568303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Percutaneous esplenoportogammagraphy in 28 patients with portal hypertension, was carried out; in three patients studies were done before and after a derivative operation; in nine only after operation for portal hypertension and thirteen patients were not surgically treated. Hepatic maximal opacification was obtained in 4.35 seconds. In the operated patients the tecnesium reached right cardiac chambers in 2.91 seconds. In three of the thirteen patients with the test, there were intrahepatic circulatory pattern changes, average spleen-liver was 6 seconds and spleen-heart, 7 seconds, that is, esplenoportal perfussion was poor. In all the operated patients the decreased circulation time spleen-heart and the typical image showed anastomosis permeability.
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Beltrán M, Nieto L, Cuevas L, Ruiz E, Valverde C. [Direct radioimmunoassay of serum thyroxine (author's transl)]. Rev Invest Clin 1974; 26:125-31. [PMID: 4840175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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