RESUMEN

INTRODUCTION: The need for parathyroidectomy to treat asymptomatic patients with primary hyperparathyroidism is controversial. The aim of this study was to assess the impact of parathyroidectomy vs. surveillance on skeletal outcomes such as bone mineral density (BMD) and incident fractures. METHODS: This was a retrospective cohort study including 170 patients (112 treated with surgery and 58 subject to active surveillance) between 1991 and 2014. Changes in BMD in lumbar spine, femoral neck, total hip, and radius, and incidence of fractures, were monitored for 2-6 years. RESULTS: Patients treated with surgery had BMD gains at 2years of 4.37%, as compared to 1.59% in non-operated patients (p<0.05) in the lumbar spine, 3.90% vs. 0.19% (p<0.05) in the femoral neck, and 2.70% vs. 0.14% (p<0.05) in total hip. Gain in BMD in the lumbar spine and femoral neck remained significant in operated patients at 4 and 6 years. No improvement was seen in the radius in operated patients. No significant difference was seen in fracture occurrence between operated and non-operated patients. CONCLUSION: Patients with primary hyperparathyroidism treated with surgery experience greater BMD gains than non-operated patients, especially in the lumbar spine and femoral neck. The risk of fracture does not decrease in the group of operated patients.

Asunto(s)

Densidad Ósea , Fracturas Óseas/epidemiología , Fracturas Óseas/fisiopatología , Hiperparatiroidismo Primario/terapia , Paratiroidectomía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Espera Vigilante , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Hiperparatiroidismo Primario/cirugía , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

Introducción: Existe cierta controversia sobre la indicación quirúrgica del hiperparatiroidismo primario, sobre todo en pacientes asintomáticos. El objetivo de este estudio es valorar la evolución de la densidad mineral ósea (DMO) y la aparición de fracturas en pacientes operados vs. pacientes seguidos sin cirugía. Métodos: Se trata de un estudio retrospectivo de cohortes en el que se incluyó a 170 pacientes (112 tratados con cirugía y 58 seguidos sin cirugía) entre los años 1991 y 2014. Se analizó la evolución de la DMO en columna lumbar, cuello femoral, cadera total y radio en 2-6 años de seguimiento, así como la aparición de fracturas. Resultados: Los pacientes tratados con cirugía experimentaron una ganancia de DMO a los 2 años en columna lumbar del 4,37% vs. el 1,59% en no operados (p < 0,05); en cuello femoral del 3,90% vs. el 0,19% (p < 0,05) y en cadera total del 2,70% vs. el 0,14% (p < 0,05). La ganancia de DMO continuó siendo significativa en pacientes operados a los 4 y 6 años, en columna lumbar y cuello femoral. No se observó mejoría en radio distal en los pacientes tratados quirúrgicamente. La aparición de fracturas durante el tiempo de seguimiento no mostró diferencia significativa entre ambos grupos. Conclusiones: Los pacientes con hiperparatiroidismo primario tratados con cirugía experimentan una ganancia de DMO superior a los pacientes no operados, tanto en columna lumbar como en cuello femoral. El riesgo de fractura no desciende en el grupo de pacientes tratados con cirugía

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Introduction: The need for parathyroidectomy to treat asymptomatic patients with primary hyperparathyroidism is controversial. The aim of this study was to assess the impact of parathyroidectomy vs. surveillance on skeletal outcomes such as bone mineral density (BMD) and incident fractures. Methods: This was a retrospective cohort study including 170 patients (112 treated with surgery and 58 subject to active surveillance) between 1991 and 2014. Changes in BMD in lumbar spine, femoral neck, total hip, and radius, and incidence of fractures, were monitored for 2-6 years. Results: Patients treated with surgery had BMD gains at 2years of 4.37%, as compared to 1.59% in non-operated patients (p<0.05) in the lumbar spine, 3.90% vs. 0.19% (p<0.05) in the femoral neck, and 2.70% vs. 0.14% (p<0.05) in total hip. Gain in BMD in the lumbar spine and femoral neck remained significant in operated patients at 4 and 6 years. No improvement was seen in the radius in operated patients. No significant difference was seen in fracture occurrence between operated and non-operated patients. Conclusion: Patients with primary hyperparathyroidism treated with surgery experience greater BMD gains than non-operated patients, especially in the lumbar spine and femoral neck. The risk of fracture does not decrease in the group of operated patients

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Densidad Ósea/fisiología , Fracturas Óseas/etiología , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario/cirugía , Vértebras Lumbares/metabolismo , Cuello Femoral/metabolismo , Osteoporosis/fisiopatología , Hipercalcemia , Estudios Retrospectivos , Estudios de Cohortes

RESUMEN

Background: The receptor of parathyroid hormone and parathyroid hormone-related-protein (PTH/PTHrp) is located in the cell membrane of target tissues - kidney and osteoblasts. It is a G protein-coupled-receptor whose Gsα subunit is encoded by the GNAS gene. Our aim was to study whether the single nucleotide polymorphism (SNP) T393C of the GNAS gene is associated with renal stones, bone mineral density (BMD), or bone remodelling markers in primary hyperparathyroidism (PHPT).Methods: An analysis was made of clinical and biochemical parameters and densitometric values in three areas and their relationship with the T393C SNP of the GNAS gene in 261 patients with primary hyperparathyroidism and in 328 healthy controls. Genotyping was performed using the Custom Taqman(R) SNP Genotyping assay. Results: The genotype frequencies of GNAS T/C 393 were similar in the control and PHPT groups. No association was found between genotypes and clinical expression of PHPT (renal stones and bone fractures). A nonstatistically significant trend was seen to lower BMD in the lumbar spine, femoral neck, and total hip in both PHPT and control C homozygote subjects. Conclusion: Genetic susceptibility to PHPT related to the GNAS T393C polymorphism or a major influence in its development and clinical expression were found. A C allele-related susceptibility to lower BMD in trabecular bone in both PHPT and control subjects is not sufficient to suggest a more severe clinical expression of PHPT. This trend may be considered as a basis for further studies with larger sample sizes and complementary functional evaluation (AU)

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Introducción: El receptor de la hormona paratiroidea y de la proteína relacionada con la hormona paratiroidea (PTH/PTHrp) está situado en la membrana celular de sus tejidos diana: riñón y osteoblastos. Se trata de un receptor unido a proteina G cuya subunidad Gsα está codificada por el gen GNAS. Nuestro objetivo fue estudiar si el polimorfismo de un sólo nucleótido (SNP) T393C del gen GNAS se asociaba con litiasis renal, densidad mineral ósea (DMO) o marcadores de remodelado óseo en el hiperparatiroidismo primario (HPTP). Métodos: Analizamos parámetros clínicos, bioquímicos y densitométricos en 3 zonas y su relación con el SNP T393C del gen GNAS en 261 pacientes con HPTP y en 328 controles sanos. El genotipado se realizó utilizando el ensayo Custom Taqman(R). Resultados: Las frecuencias genotípicas del SNP T/C 393 del GNAS fueron similares en ambos grupos control y HPTP. No encontramos ninguna asociación entre los genotipos y la expresión clínica del HPTP (litiasis renal y fracturas óseas). Encontramos una tendencia no estadísticamente significativa hacia una menor DMO en columna lumbar, cuello femoral y cadera en los sujetos control y HPTP portadores del alelo C. Conclusiones: No encontramos susceptibilidad genética para el desarrollo de PHPT relacionada con el polimorfismo T393C del gen GNAS ni influencia en su expression clínica. Sí hallamos una tendencia hacia niveles menores de DMO en el hueso trabecular relacionada con el alelo C en pacientes con PHPT y en sujetos control sin ser suficiente para sugerir una expresión clínica más grave. Estos resultados pueden ser considerados como un punto de partida para futuros estudios con mayor tamaño muestral y con evaluación funcional complementaria (AU)

Asunto(s)

Humanos , Femenino , Persona de Mediana Edad , Polimorfismo Genético , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/genética , Genotipo , Hipercalcemia/diagnóstico , Pruebas de Química Clínica/métodos , Densitometría/métodos , Densidad Ósea/genética , Nefrolitiasis/diagnóstico

RESUMEN

BACKGROUND: The receptor of parathyroid hormone and parathyroid hormone-related-protein (PTH/PTHrp) is located in the cell membrane of target tissues - kidney and osteoblasts. It is a G protein-coupled-receptor whose Gsα subunit is encoded by the GNAS gene. Our aim was to study whether the single nucleotide polymorphism (SNP) T393C of the GNAS gene is associated with renal stones, bone mineral density (BMD), or bone remodelling markers in primary hyperparathyroidism (PHPT). METHODS: An analysis was made of clinical and biochemical parameters and densitometric values in three areas and their relationship with the T393C SNP of the GNAS gene in 261 patients with primary hyperparathyroidism and in 328 healthy controls. Genotyping was performed using the Custom Taqman® SNP Genotyping assay. RESULTS: The genotype frequencies of GNAS T/C 393 were similar in the control and PHPT groups. No association was found between genotypes and clinical expression of PHPT (renal stones and bone fractures). A nonstatistically significant trend was seen to lower BMD in the lumbar spine, femoral neck, and total hip in both PHPT and control C homozygote subjects. CONCLUSION: Genetic susceptibility to PHPT related to the GNAS T393C polymorphism or a major influence in its development and clinical expression were found. A C allele-related susceptibility to lower BMD in trabecular bone in both PHPT and control subjects is not sufficient to suggest a more severe clinical expression of PHPT. This trend may be considered as a basis for further studies with larger sample sizes and complementary functional evaluation.

Asunto(s)

Cromograninas/genética , Subunidades alfa de la Proteína de Unión al GTP Gs/genética , Hiperparatiroidismo Primario/genética , Polimorfismo de Nucleótido Simple , Anciano , Fosfatasa Alcalina/sangre , Biomarcadores , Densidad Ósea/genética , Remodelación Ósea/genética , Calcio/sangre , Femenino , Frecuencia de los Genes , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/complicaciones , Cálculos Renales/etiología , Masculino , Persona de Mediana Edad , España , Vitamina D/análogos & derivados , Vitamina D/sangre

RESUMEN

El calcitriol ha sido considerado durante años exclusivamente como una hormona reguladora del metabolismo fosfocálcico, pero últimamente se ha demostrado que numerosas células implicadas en la inmunidad innata (epitelios de barrera, monocitos/macrófagos, etc.) son capaces de reconocer determinadas moléculas repetitivas características de diversos gérmenes patógenos mediante receptores de membrana o intranucleares. La activación de estos receptores induce la síntesis de la 1α-hidroxilasa, con lo que dichas células son capaces de sintetizar calcitriol a partir de la 25 hidroxivitamina D circulante. El calcitriol, a través del receptor la vitamina D, modula la expresión de determinados péptidos antimicrobianos, como la catelicidina, la β2-defensina o la hepcidina. Estos péptidos representan un mecanismo versátil de la lucha antibacteriana innata y su producción se ve alterada en la hipovitaminosis D. Se realiza un análisis de la literatura sobre sus mecanismos de secreción, las concentraciones en diversos líquidos orgánicos, y los mecanismos de acción y su relación con la vitamina D (AU)

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Traditionally, calcitriol has been considered a calcium and phosphate regulating hormone, but has recently been shown to play a pivotal role in innate immunity. Many barrier and immune cells have membrane and intracellular receptors that recognize different microbial antigens. Activation of these receptors induces synthesis of 1α-hydroxylase, which acts on 25 hydroxyvitamin D to generate intracellular calcitriol. Calcitriol activates its receptor and enhances the synthesis of important human antibiotics like cathelicidin and β2-defensin while inhibiting hepcidin. These pluripotent peptides have an important role in innate immunity, and their regulation is abnormal in hypovitaminosis D. The literature on their secretion mechanisms, levels in different organic fluids, mechanism of action, and relationship with vitamin D is reviewed here (AU)

Asunto(s)

Humanos , Deficiencia de Vitamina D/fisiopatología , Antibacterianos/efectos adversos , Antibacterianos/farmacocinética , Catelicidinas/farmacocinética , Defensinas/farmacocinética , Hepcidinas/farmacocinética , Calcitriol/farmacocinética

RESUMEN

Traditionally, calcitriol has been considered a calcium and phosphate regulating hormone, but has recently been shown to play a pivotal role in innate immunity. Many barrier and immune cells have membrane and intracellular receptors that recognize different microbial antigens. Activation of these receptors induces synthesis of 1α-hydroxylase, which acts on 25 hydroxyvitamin D to generate intracellular calcitriol. Calcitriol activates its receptor and enhances the synthesis of important human antibiotics like cathelicidin and ß2-defensin while inhibiting hepcidin. These pluripotent peptides have an important role in innate immunity, and their regulation is abnormal in hypovitaminosis D. The literature on their secretion mechanisms, levels in different organic fluids, mechanism of action, and relationship with vitamin D is reviewed here.

Asunto(s)

Calcitriol/farmacología , Catelicidinas/biosíntesis , Vitamina D/farmacología , beta-Defensinas/biosíntesis , Hepcidinas/antagonistas & inhibidores , Humanos , Inmunidad Innata , Receptores de Calcitriol/metabolismo , Vitaminas/farmacología

RESUMEN

BACKGROUND: The CLDN14 gene encodes a protein involved in the regulation of paracellular permeability or ion transport at epithelial tight junctions as in the nephron. The C allele of the rs219780 SNP (single nucleotide polymorphism) of CLDN14 has been associated with renal lithiasis, high levels of parathormone (PTH), and with low bone mineral density (BMD) in healthy women. Our aim is to study the relationship between rs219780 SNP of CLDN14 and renal lithiasis, fractures, and BMD in patients with primary hyperparathyroidism (PHPT). METHODS: We enrolled 298 Caucasian patients with PHPT and 328 healthy volunteers in a cross-sectional study. We analysed anthropometric data, history of fractures or kidney stones, biochemical parameters including markers for bone remodelling, abdominal ultrasound, and BMD and genotyping for the rs219780 SNP of CLDN14. RESULTS: We did not find any difference in the frequency of fractures or renal lithiasis between the genotype groups in PHPT patients. Moreover, we did not find any relationship between the T or C alleles and BMD or biochemical parameters. CONCLUSIONS: rs219780 SNP of CLDN14 does not appear to be a risk factor for the development of PHPT nor does it seem to influence the clinical expression of PHPT.

Asunto(s)

Claudinas/fisiología , Hiperparatiroidismo Primario/genética , Anciano , Alelos , Biomarcadores/sangre , Densidad Ósea , Remodelación Ósea , Calcio/orina , Claudinas/genética , Estudios Transversales , Femenino , Fracturas Espontáneas/epidemiología , Fracturas Espontáneas/genética , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Hipercalcemia/sangre , Hipercalcemia/etiología , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/epidemiología , Masculino , Menopausia , Persona de Mediana Edad , Nefrolitiasis/epidemiología , Nefrolitiasis/genética , Osteoporosis/epidemiología , Osteoporosis/genética , Hormona Paratiroidea/sangre , Factores de Riesgo , España/epidemiología

RESUMEN

AIM: To investigate the plasma levels of betatrophin in patients with cirrhosis. METHODS: Forty patients diagnosed at the clinic with liver cirrhosis according to biological, ultrasonographic, or histological criteria were included. The severity of cirrhosis was classified according to Pugh's modification of Child's classification and MELD score. Insulin resistance (IR) was assessed by the Homeostasis Model Assessment. A total of 20 patients showed a MELD score higher than 14. The control group consisted in 15 sex-and aged-matched subjects. Fasting blood samples were obtained for subsequent analysis. Serum insulin was determined by Liaison automated immune chemiluminiscence assay (DiaSorin S.p.A.) using a sandwich assay. The sensitivity of the assay was 0.2 µU/mL. The intra and interassay variation coefficients were < 4% and < 10%, respectively. The normal values were between 2 and 17 µU/mL. Human active betatrophin was analyzed by specific quantitative sandwich ELISA (Aviscera Bioscience). The sensitivity of the assay was 0.4 ng/mL, and the intra and interassay reproducibility were < 6% and < 10%, respectively. RESULTS: Plasma betatrophin levels were significantly increased in patients with cirrhosis compared with those in healthy subjects (P = 0.0001). Betatrophin levels were also associated with disease severity, being higher in Child-Pugh C patients compared to Child-Pugh B (P < 0.0005) and in patients who displayed a MELD score higher than 14 points compared to patients with lower punctuation (P = 0.01). In addition, we found a positive correlation between plasma betatrophin levels and the severity of cirrhosis according to Child-Pugh classification (r = 0.53; P < 0.01) or MELD score (r = 0.45; P < 0.01). In the overall cohort, a moderate correlation between serum betatrophin and plasmatic bilirrubin (r = 0.39; P < 0.01) has been observed, as well as an inverse correlation between betatrophin and albumin (r = -0.41; P < 0.01) or prothrombin time (r = -0.44; P <0.01). Moreover, insulin resistance was observed in 82.5% of the cirrhotic patients. In this group of patients, betatrophin levels were significantly higher than those in the group of patients without IR (P < 0.05). CONCLUSION: Plasma betatrophin is increased in patients with cirrhosis. This increase is related to the severity of cirrhosis, as well as with the emergence of insulin resistance.

Asunto(s)

Cirrosis Hepática/sangre , Hormonas Peptídicas/sangre , Adulto , Anciano , Proteína 8 Similar a la Angiopoyetina , Proteínas Similares a la Angiopoyetina , Ensayo de Inmunoadsorción Enzimática , Femenino , Homeostasis , Humanos , Resistencia a la Insulina , Cirrosis Hepática/patología , Luminiscencia , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad

RESUMEN

This randomized open-label study compared the incidence of metabolic side effects of aripiprazole, ziprasidone and quetiapine in a population of medication-naïve first-episode psychosis patients. A total of 202 subjects were enrolled. Body weight, body mass index, leptin, fasting lipids and fasting glycaemic parameters were measured at baseline and at 3 months follow-up. A hundred and sixty-six patients completed the follow-up and were included in the analyses. A high proportion of patients experienced a significant weight increase (>7% of their baseline weight): 23% ziprasidone (n=12), 32% with quetiapine (n=16) and 45% with aripiprazole (n=31). Patients treated with aripiprazole gained significantly more weight than the patients in the ziprasidone group (1.2 kg [SD=4.1] versus 4.3 kg [SD=4.8], respectively). The increase in leptin levels was greater in women treated with aripiprazole than in those treated with ziprasidone (p=0.030). Mean prolactin levels significantly increased in patients treated with quetiapine and ziprasidone but not in those treated with aripiprazole. Patients treated with quetiapine and aripiprazole showed a significant increase in total cholesterol and LDL-cholesterol plasma levels. Quetiapine-treated patients resulted in a higher increase in LDL-cholesterol than patients treated with ziprasidone (p=0.021). No other significant differences between groups were found. No significant changes in glycaemic parameters were observed. Our results suggest that ziprasidone has a lower liability for inducing weight gain and lipid abnormalities than aripiprazole or quetiapine.

Asunto(s)

Antipsicóticos/uso terapéutico , Dibenzotiazepinas/uso terapéutico , Piperazinas/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Quinolonas/uso terapéutico , Tiazoles/uso terapéutico , Adulto , Antipsicóticos/efectos adversos , Aripiprazol , Colesterol/sangre , Dibenzotiazepinas/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Piperazinas/efectos adversos , Prolactina/metabolismo , Fumarato de Quetiapina , Quinolonas/efectos adversos , Factores Sexuales , Tiazoles/efectos adversos , Aumento de Peso/efectos de los fármacos

RESUMEN

Data on the long-term metabolic side-effects associated with antipsychotics are scarce. Prospective longitudinal studies in medication-naive patients with a first episode of psychosis are a valuable source of information as they provide an assessment prior to the antipsychotic exposure and minimize the effect of potential confounding factors. The aim of this study was to assess the course of weight gain and the incidence of metabolic abnormalities during the first 3 yr of antipsychotic treatment. Data were collected from a cohort of 170 first-episode psychosis patients. They were randomly assigned to haloperidol (32%); olanzapine (32%) and risperidone (36%). The dose used was flexible. The initial antipsychotic treatment was changed when required, based on clinical response and tolerability. The results showed that the mean weight gain at 3 yr was 12.1 kg (s.d. = 10.7). It appeared to increase rapidly during the first year (85% of the total mean weight gain) and then stabilized gradually over time. Total cholesterol, LDL-cholesterol and triglyceride levels followed a similar trajectory with a significant increase only during the first year. No significant changes were detected in the mean values of glycaemic parameters. Two patients with a family history of diabetes developed diabetes type II. At short-term the factors positively associated with weight gain were lower body mass index, male gender and olanzapine treatment. At long-term, functional status and clinical response were the main predictors. The results of our study indicate that the first year of antipsychotic treatment is a critical period for weight gain and metabolic changes. Identification of weight gain patterns may help to inform studies that aim to prevent or mitigate the metabolic adverse events associated with antipsychotic therapy.

Asunto(s)

Benzodiazepinas/efectos adversos , Haloperidol/efectos adversos , Enfermedades Metabólicas/sangre , Trastornos Psicóticos/tratamiento farmacológico , Risperidona/efectos adversos , Aumento de Peso/efectos de los fármacos , Adolescente , Adulto , Antipsicóticos/efectos adversos , Humanos , Masculino , Enfermedades Metabólicas/inducido químicamente , Persona de Mediana Edad , Olanzapina , Estudios Prospectivos , Trastornos Psicóticos/sangre , Factores de Riesgo , Factores de Tiempo , Adulto Joven

RESUMEN

OBJECTIVE: The main goal of this study was to assess the long-term effect of haloperidol, olanzapine, and risperidone on serum prolactin levels in a naturalistically treated first-episode psychosis population. METHODS: Patients included in this study were drawn from a prospective, randomized, open-label clinical trial. Prolactin levels were measured in 110 patients with medication-naive first-episode psychosis at baseline, 3 months, and 1 year. RESULTS: A repeated-measures analysis of variance revealed a significant difference between treatments (F = 17.28, P < 0.001). At 1-year follow-up, most patients in the haloperidol and olanzapine arms had prolactin values that fell within the reference range. Patients treated with risperidone experienced a significant increase at 3 months resulting in prolactin levels above the reference range in 90% of men and 87% of women. The levels showed a tendency to decrease at 1 year, although still more than 70% of the values remained above the normative range. Sexual adverse drug reactions at 1 year assessed by the Udvalg for Kliniske Undersogelser scale showed that a higher percentage (39.3%) of patients had symptoms in the risperidone group compared to the olanzapine group (24%) or haloperidol group (20%), but the difference did not reach statistical significance (P = 0.281). CONCLUSION: Olanzapine and haloperidol treatments do not significantly affect serum prolactin levels at long term. After 1 year, elevated prolactin levels persist in most patients treated with risperidone.

Asunto(s)

Benzodiazepinas/administración & dosificación , Haloperidol/administración & dosificación , Prolactina/sangre , Trastornos Psicóticos/sangre , Trastornos Psicóticos/tratamiento farmacológico , Risperidona/administración & dosificación , Adulto , Antipsicóticos/administración & dosificación , Biomarcadores/sangre , Femenino , Estudios de Seguimiento , Humanos , Masculino , Olanzapina , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven

RESUMEN

BACKGROUND: Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital's daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain. METHODS: A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence. RESULTS: A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R2 Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R2 Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated. CONCLUSIONS: Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health-economic benefits and stimulates further investigation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN83234896. http://www.controlled-trials.com/isrctn/sample_documentation.asp.

Asunto(s)

Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Adhesión a Directriz , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infusiones Intravenosas , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , España , Resultado del Tratamiento

RESUMEN

This study investigated in vivo the influence of age and vitamin D status on innate immune function in HC. Serum 25OHD was measured in 71 HC. TLR expression on various subpopulations of PBMCs, as well as TLR function by stimulating PBMCs with specific ligands, was assessed by flow cytometry. Circulating cathelicidin levels were determined by ELISA. Serum 25OHD levels decreased with age, and there was a significant inverse correlation between 25OHD levels and age. There was a negative correlation between serum 25OHD levels and MFI expression of TLR7 on B cells, T cells, and monocytes. TLR7 function, addressed by in vitro stimulation with a specific agonist, was significantly correlated with serum 25OHD levels, and this was especially a result of the results in HC older than 60 years. MFI expression of TLR5 on T cells and TLR2 on monocytes was also negatively correlated with serum 25OHD levels. TLR1 (monocytes) and TLR2 (monocytes) expression was positively correlated with age. Furthermore, TLR4 and TLR8 function was negatively correlated with age. Circulating cathelicidin levels decreased with age and were positively correlated with 25OHD levels. Aging is accompanied by changes in expression and function of several TLRs. Serum 25OHD levels decrease with age and are also associated with a change in expression and defective function of certain TLRs, especially those involved in viral response.

Asunto(s)

Inmunidad Innata/inmunología , Monocitos/inmunología , Monocitos/patología , Vitamina D/sangre , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Ensayo de Inmunoadsorción Enzimática , Humanos , Persona de Mediana Edad , Monocitos/metabolismo , Receptores Toll-Like/sangre , Adulto Joven

RESUMEN

UNLABELLED: Water retention is a major clinical problem in patients with liver cirrhosis. The factors that predispose to water retention are poorly understood but may involve genetic factors. Recent research suggests that renal aquaporins may be a pathophysiological factor involved in this condition. Aquaporin-1 (AQP1) is expressed in the proximal tubule and aquaporin-2 (AQP2) in the renal collecting duct cells. The aim of our study was to investigate the distribution of single nucleotide polymorphisms (SNPs) of AQP1: rs1049305 (C/G) and AQP2: rs3741559 (A/G) and rs467323 (C/T) in 100 cirrhotic patients with ascites and to analyze their relationship with dilutional hyponatremia. METHODS: Genomic DNA was extracted from peripheral blood. Genotyping for the presence of different polymorphisms was performed using the Custom Taqman SNP Genotyping Assays. The possible influence of rs1049305 (C/G) in AQP1 gene expression was evaluated by luciferase assays in vitro. RESULTS: The allelic frequencies of the AQP1 gene were the following: CC = 15%; CG = 49%; GG = 36%. Patients with CC genotype had significantly lower plasma sodium concentration than those with CG or GG genotype. Luciferase assays showed that the rs1049305 (C/G) in the AQP1 gene functionally affected the expression level in vitro. In addition, we did not find any relationship between AQP2 SNPs observed and plasma sodium concentration. CONCLUSIONS: Our results suggest that the rs1049305 (C/G, UTR3) AQP1 polymorphism could be involved in the genetic susceptibility to develop water retention in patients with liver cirrhosis.

Asunto(s)

Acuaporina 1/genética , Hiponatremia/genética , Cirrosis Hepática/genética , Cirrosis Hepática/fisiopatología , Adulto , Anciano , Acuaporina 2/genética , Ascitis/genética , Células Cultivadas , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Concentración Osmolar , Polimorfismo de Nucleótido Simple , Agua/metabolismo

RESUMEN

Weight gain is one of the major adverse effects of antipsychotics. Although mechanisms remain unclear, genetic susceptibility has become increasingly attractive as a potential mechanism that could explain a significant part of interindividual variability. Most investigations have explored genes related with the mechanism of action of antipsychotic drugs. An alternative approach to investigate the role that genetic factors play in weight gain secondary to antipsychotic treatment is to study those genetic variants that have been found associated with obesity. The aim of this study was to determine whether the fat mass and obesity-associated gene (FTO) rs9939609 variant, the single nucleotide polymorphism that has shown the strongest association with common obesity in different populations, influences weight gain during the first year of antipsychotic treatment. We investigated also the genetic variants in other 3 strong candidates genes involved in the leptin-signaling pathway including leptin, leptin receptor, and Src homology 2. We carried out a prospective study on 239 patients with first-episode psychosis. Two hundred five patients completed the follow-up at 1 year (85.8%). Before antipsychotic treatment, the homozygous subjects for the risk allele A of the FTOrs9939609 variant had a higher body mass index at baseline (24.2 T 3.8 kg/m²) than the AT/TT group (22.82 T 3.3 kg/m2; F = 5.744; P = 0.018). After 1 year, the magnitude of weight increase was similar in the 3 genotypes defined by the rs9939609 variant. These results suggest that the pharmacological intervention accompanied by changes in energy intake and expenditure could suppress the genetic susceptibility conferred by the FTO genotype. None of the other single nucleotide polymorphisms evaluated were associated with weight gain during the first 12 months of antipsychotic therapy.

Asunto(s)

Antipsicóticos/efectos adversos , Proteínas/genética , Aumento de Peso/efectos de los fármacos , Proteínas Adaptadoras Transductoras de Señales/genética , Adulto , Dioxigenasa FTO Dependiente de Alfa-Cetoglutarato , Antipsicóticos/uso terapéutico , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Leptina/genética , Estudios Longitudinales , Masculino , Polimorfismo de Nucleótido Simple , Estudios Prospectivos , Trastornos Psicóticos/tratamiento farmacológico , Receptores de Leptina/genética , Esquizofrenia/tratamiento farmacológico , Aumento de Peso/genética , Adulto Joven

RESUMEN

Weight gain has become one of the most common and concerning side effects of antipsychotic treatment. The mechanisms whereby antipsychotics induce weight gain are not known. It has been suggested that peptides related to food intake and energy balance could play a role in weight gain secondary to antipsychotic therapy. To better understand the pathophysiology of antipsychotic-induced weight gain, we studied the effects of 3 antipsychotic drugs (haloperidol, olanzapine, and risperidone) on peptides involved in energy balance (insulin, ghrelin, leptin, adiponectin, visfatin, and resistin) in a population of drug-naive patients with first episode of psychosis.A significant increase in weight (10.16 kg [SD, 8.30 kg]; P < 0.001), body mass index (3.56 kg/m [SD, 2.89 kg/m]; P < 0.001), and fasting insulin (3.93 muU/mL [SD, 3.93 muU/mL]; P = 0.028), leptin (6.76 ng/mL [SD, 7.21 ng/mL]; P < 0.001), and ghrelin (15.47 fmol/mL [SD, 47.90 fmol/mL]; P = 0.009) plasma levels were observed. The increments in insulin and leptin concentrations were highly correlated with the increment in weight and body mass index and seem to be a consequence of the higher fat stores. The unexpected increase in ghrelin levels might be related with the causal mechanism of weight gain induced by antipsychotics. Finally, the 3 antipsychotics had similar effects in all parameters evaluated.

Asunto(s)

Antipsicóticos/toxicidad , Metabolismo Energético/efectos de los fármacos , Ghrelina/sangre , Insulina/sangre , Leptina/sangre , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Aumento de Peso/efectos de los fármacos , Adiponectina/sangre , Adolescente , Adulto , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Benzodiazepinas/toxicidad , Composición Corporal/efectos de los fármacos , Índice de Masa Corporal , Relación Dosis-Respuesta a Droga , Femenino , Haloperidol/uso terapéutico , Haloperidol/toxicidad , Humanos , Masculino , Persona de Mediana Edad , Nicotinamida Fosforribosiltransferasa/sangre , Olanzapina , Estudios Prospectivos , Trastornos Psicóticos/sangre , Resistina/sangre , Risperidona/uso terapéutico , Risperidona/toxicidad , Esquizofrenia/sangre

RESUMEN

OBJECTIVE: This study examined the main metabolic side effects induced by antipsychotic treatment in a cohort of first-episode drug-naive subjects. METHOD: A randomized, open-label, prospective clinical trial was conducted. Participants were 145 consecutive subjects included in a first-episode psychosis program (PAFIP) from February 2002 to February 2005, experiencing their first episode of psychosis (DSM-IV codes 295, 297, and 298), and never treated with antipsychotic medication. Patients were assigned to haloperidol, olanzapine, or risperidone treatment during 12 weeks. The main outcome measures were changes at 12 weeks in body weight; body mass index; and 12-hours-fasting morning levels of total cholesterol, tri-glycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, glucose, homeostasis model assessment (HOMA) index, and insulin. RESULTS: At the endpoint, 128 patients were evaluated (88.3%). The mean doses were haloperidol = 4.2 mg/day, olanzapine = 12.7 mg/day, and risperidone = 3.6 mg/day. A significant weight gain was observed with the 3 antipsychotics: haloperidol = 3.8 (SD = 4.9) kg, olanzapine = 7.5 (SD = 5.1) kg, and risperidone = 5.6 (SD = 4.5) kg. Metabolic parameters showed a worsening lipid profile with the 3 treatments (statistically significant increase in total cholesterol and LDL cholesterol levels). Only the olanzapine group showed significant increases in triglyceride levels. After the 12-week study period, there were no significant changes in parameters involving glucose metabolism for any group. CONCLUSIONS: Drug-naive patients experienced an extraordinary weight gain with first- and second-generation antipsychotics after the first 12 weeks of treatment. Significant increases in total cholesterol and LDL cholesterol levels are associated with the 3 treatments. Weight gain and metabolic disturbances induced by antipsychotics may increase the risk of developing cardiovascular disease.

Asunto(s)

Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Diabetes Mellitus Tipo 2/inducido químicamente , Dislipidemias/inducido químicamente , Haloperidol/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Risperidona/uso terapéutico , Adolescente , Adulto , Antropometría , Antipsicóticos/efectos adversos , Benzodiazepinas/efectos adversos , Glucemia/metabolismo , Índice de Masa Corporal , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Dislipidemias/epidemiología , Femenino , Haloperidol/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Olanzapina , Prevalencia , Estudios Prospectivos , Trastornos Psicóticos/diagnóstico , Risperidona/efectos adversos , Índice de Severidad de la Enfermedad , Aumento de Peso/efectos de los fármacos

RESUMEN

BACKGROUND: The precise mechanism that leads to accelerated bone resorption in the early post-transplant period remains unclear. Recent data suggest that osteoprotegerin (OPG) and its ligand receptor activator of nuclear factor-kappaB ligand (RANKL) constitute a novel cytokine system that can influence the function of both bone and immune cells. The aim of our study was to assess OPG and RANKL concentrations in the early post-operative period of liver transplantation. METHODS: Serum OPG and RANKL levels were measured in 30 patients who underwent liver transplantation at 1, 7 and 14 d post-operatively. These values were compared with 22 age- and sex-matched healthy controls. Plasma sodium, creatinine, aspartate-aminotransferase, alanine-amino transferase, gamma-glutamyl transferase, alkaline phosphatase, bilirubin, albumin, prothrombin time, tacrolimus and cyclosporine levels were measured in each patient. RESULTS: We found a significant increase in OPG levels in the early post-operative period compared with the control group: day 1 (10.42 pmol/L, range 3.80-17.50 vs. 3.91 pmol/L, range 1.20-6.60; p = 0.0001), day 7 (6.90 pmol/L, range 3.00-15.30 vs. 3.91 pmol/L, range 1.20-6.60; p = 0.0001) and day 14 (5.76 pmol/L, range 2.60-10.70 vs. 3.91 pmol/L, range 1.20-6.60; p = 0.001). Similarly, serum RANKL levels were significantly higher than in the control group in this period, day 1 (0.123 pmol/L, range 0.010-0.420 vs. 0.054 pmol/L, range 0.010-0.300; p = 0.02), day 7 (0.236 pmol/L, range 0.010-0.720 vs. 0.054 pmol/L, range 0.010-0.300; p = 0.0004) and day 14 (0.137 pmol/L, range 0.010-0.520 vs. 0.054 pmol/L, range 0.010-0.300; p = 0.007). No correlation was found between OPG levels and RANKL, ischemic times, liver function tests, albumin, sodium or creatinine concentrations and tacrolimus or cyclosporine levels. CONCLUSIONS: A significant amount of OPG and RANKL is released in the early post-transplant period of liver transplantation. This might be explained by an activation of the immune system caused by the allograft. Therefore, the RANKL/OPG system may be involved in the pathophysiological evolution of transplantation osteoporosis.

Asunto(s)

Proteínas Portadoras/metabolismo , Glicoproteínas/metabolismo , Trasplante de Hígado , Glicoproteínas de Membrana/metabolismo , Receptores Citoplasmáticos y Nucleares/metabolismo , Receptores del Factor de Necrosis Tumoral/metabolismo , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Osteoprotegerina , Periodo Posoperatorio , Pronóstico , Ligando RANK , Receptor Activador del Factor Nuclear kappa-B

RESUMEN

Escherichia coli heat-labile enterotoxin (LT) exhibits a broad range of immunomodulatory activities, including the induction of lymphocyte-programmed cell death. However, the nature of the lymphoid populations sensitive to LT-induced apoptosis and the mechanisms used by this toxin to promote such activity are still unclear. In this study, we demonstrate that LT induces in mice a rapid increase in the levels of circulating corticosterone, resulting in a dramatic induction of cell death of immature CD4+CD8+, B220+IgM- and IgM+IgD- T and B cell progenitors, respectively. Apoptosis of these cell populations is similar to that reported after experimental treatment with corticosteroids, it is inhibited by mifepristone, a glucocorticoid receptor antagonist, and does not occur in adrenalectomized animals. These results clearly indicate that endogenous glucocorticoids are the mediators of the LT-induced cell death, which involves Bcl-2-dependent apoptotic pathways. The LT-mediated programmed cell death requires systemic exposure and the enzymatic activity of LT, since a mutant devoid of any enzymatic activity have no pro-apoptotic effect at any dose tested.

Asunto(s)

Apoptosis/inmunología , Corticosterona/fisiología , Enterotoxinas/fisiología , Proteínas de Escherichia coli/fisiología , Escherichia coli/patogenicidad , Subgrupos Linfocitarios/metabolismo , Transducción de Señal/inmunología , Sustitución de Aminoácidos , Animales , Toxinas Bacterianas/genética , Diferenciación Celular/inmunología , Corticosterona/biosíntesis , Corticosterona/sangre , Enterotoxinas/genética , Proteínas de Escherichia coli/genética , Subgrupos Linfocitarios/citología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C3H , Ratones Endogámicos C57BL , Ratones Transgénicos , Proteínas Proto-Oncogénicas c-bcl-2/biosíntesis , Proteínas Proto-Oncogénicas c-bcl-2/genética

RESUMEN

Metabolic alterations such as insulin resistance are thought to underlie the endothelial dysfunction and low grade inflammation found in morbid obesity. Twenty-six morbidly obese patients, aged 39.0 +/- 10.0 (mean +/- sd), were evaluated before and 4.2 +/- 0.8 months after bariatric surgery. A marked increment in the insulin sensitivity index (S(I)) and the endothelium-dependent vasodilatory response in a dorsal hand vein was observed after weight loss following bariatric surgery. Circulating levels of E-selectin, P-selectin, plasminogen activator inhibitor-1, and von Willebrand factor, which were higher than those in the control group, decreased significantly after surgery. Plasma vascular cell adhesion molecule-1, angiotensin-converting enzyme, intercellular adhesion molecule-1, thrombomodulin, and plasma and intraplatelet cGMP levels did not change after weight loss. All inflammatory markers were higher in morbidly obese patients. After surgery, C- reactive protein and sialic acid diminished, whereas circulating levels of IL-6, TNF-alpha, and its soluble receptors did not. Positive correlations were found between changes in adiposity and S(I) and changes in C-reactive protein and between changes in sialic acid and changes in endothelial function. In conclusion, a marked improvement in S(I), endothelial function, and low grade inflammation was observed in the weight-losing, morbidly obese patients after bariatric surgery. S(I) and adiposity appear to play roles in obesity-related, low grade inflammation that contribute to the endothelial dysfunction observed in morbid obesity.

Asunto(s)

Peso Corporal , Endotelio/fisiología , Derivación Gástrica , Inflamación/etiología , Resistencia a la Insulina , Obesidad Mórbida/cirugía , Adulto , Femenino , Humanos , Interleucina-6/fisiología , Masculino , Persona de Mediana Edad , Obesidad Mórbida/fisiopatología , Factor de Necrosis Tumoral alfa/fisiología , Molécula 1 de Adhesión Celular Vascular/sangre