Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957

Valoración nutricional de trabajadores sanitarios expuestos a turnicidad en Canarias Nutritional evaluation of health shift workers from the Canary Islands

Objetivo: El trabajo a turnos induce hábitos de vida anómalos, lo cual se asocia al aumento de la morbilidad en los trabajadores. En este estudio se valoró el estado nutricional, los hábitos alimentarios y la actividad física de trabajadores hospitalarios sometidos a turnos. Ámbito: La población de estudio estuvo compuesta por 207 trabajadores con turno fijo de mañana y 210 con turno rotatorio (mañana, tarde y noche) seleccionados aleatoriamente entre 2.100 trabajadores. Intervenciones: La ingesta dietética se determinó mediante cuestionario de frecuencia de consumo de alimentos autoadministrado. También se determinaron índice de masa corporal, parámetros lipídicos (colesterol total, colesterol HDL, colesterol LDL y triglicéridos), actividad física, edad y sexo. Resultados: Los trabajadores sometidos a turnicidad mostraron un mayor consumo de ternera, huevos, zumos y pastas. No se encontraron diferencias significativas en cuanto a niveles lipídicos, estado ponderal ni de actividad física entre los trabajos sometidos y no a turnicidad y no. El 62% de los hombres y el 37,2% de las mujeres mostraron sobrecarga ponderal (obesidad y sobrepeso). El 46% de los individuos de la muestra presentaron sedentarismo. Conclusiones: La turnicidad en los trabajadores hospitalarios influye sólo parcialmente en los hábitos alimentarios de dicho colectivo.Objective: Shift workers are known to have increased morbidity associated to wrong habits. In this study we have evaluated the nutritional status, food habits and physical activity in health shift workers. Subjects: 207 permanent morning-shift workers and 210 shift workers (3-shift system) were randomized selected from the 2,100 workers of the North Area of the Canary Island Sanitary Health System. Methods: Dietary intake was assessed by a self-registered food frequency questionnaire. We also assessed Body Mass Index, blood lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides), physical activity, age and sex. Results: Shift workers shown higher intake of red meat, eggs, fruit juices and pasta. No differences were observed in lipid levels, weight status and physical activity in relation to the shift working status. 62% of men and 37.2% of women were overweight or obese. 46% of the subjects were sedentary. Conclusions: Shift work system seems to have little influence on the food habits of health workers

Valoración nutricional de trabajadores sanitarios expuestos a turnicidad en Canarias

Antecedentes y objetivos: La evaluación de la aceptación Objetivo: El trabajo a turnos induce hábitos de vida anómalos, lo cual se asocia al aumento de la morbilidad en los trabajadores. En este estudio se valoró el estado nutricional, los hábitos alimentarios y la actividad física de trabajadores hospitalarios sometidos a turnos. Ámbito: La población de estudio estuvo compuesta por 207 trabajadores con turno fijo de mañana y 210 con turno rotatorio (mañana, tarde y noche) seleccionados aleatoriamente entre 2.100 trabajadores. Intervenciones: La ingesta dietética se determinó mediante cuestionario de frecuencia de consumo de alimentos autoadministrado. También se determinaron índice de masa corporal, parámetros lipídicos (colesterol total, colesterol HDL, colesterol LDL y triglicéridos), actividad física, edad y sexo. Resultados: Los trabajadores sometidos a turnicidad mostraron un mayor consumo de ternera, huevos, zumos y pastas. No se encontraron diferencias significativas en cuanto a niveles lipídicos, estado ponderal ni de actividad física entre los trabajos sometidos y no a turnicidad y no. El 62% de los hombres y el 37,2% de las mujeres mostraron sobrecarga ponderal (obesidad y sobrepeso). El 46% de los individuos de la muestra presentaron sedentarismo. Conclusiones: La turnicidad en los trabajadores hospitalarios influye sólo parcialmente en los hábitos alimentarios de dicho colectivo

Uso inadecuado de inhibidores de la bomba de protones y riesgo de fractura por fragilidad. Estudio preliminar

Introduction: Proton-pump inhibitors (PPIs) are widely used drugs, though it should be noted that excessive use is not in line with the accepted indications in Spain and throughout Europe. Furthermore, some authors have established a possible PPI link to the risk of fracture. In this paper, we make an initial approach to knowledge into PPI consumption and analyze what indication is prescribed. We also studied the drugs’ possible association with increased risk of fragility fracture in users. Material and method: An observational, transversal, open and descriptive study in which a number of randomly-chosen patients were interviewed. These patients had been treated in outpatient, emergency and primary care centers. Some had also been treated in hospital wards. Results: Of the 411 patients interviewed, 54% received PPIs. The average age was 63.3 years, compared with 46% that did not take them and who were younger presenting a mean age of 50.9 years. Gender distribution was similar. PPIs were mainly used as a “gastric protector”, in 39.8% of the patients, with no indication appearing in the technical specifications for this group of drugs. Consumers of PPIs presented a higher prevalence of all fragility fractures. Conclusions: More than half of the population surveyed consumed PPI. Of this group, about 40% did so without proper medical advice. Therefore, in addition to the higher prevalence of fragility fractures that suggest a possible increased risk of fracture among its users, we consider the need for a more rational use of these drugs. These preliminary findings point to a need for further studies to confirm the relationship between PPIs and the risk of osteoporotic fracture.Introducción: Los inhibidores de la bomba de protones (IBP) son fármacos ampliamente utilizados, si bien esto conlleva a un sobreuso que no es acorde con las indicaciones aceptadas en España y en el resto de Europa. Por otro lado, algunos autores han establecido una posible implicación de los IBP en el riesgo de fractura. Con este trabajo hemos pretendido efectuar una primera aproximación al conocimiento del consumo de IBP en nuestro medio y analizar para qué indicación son prescritos, a la vez que estudiar su posible asociación con un mayor riesgo de fractura por fragilidad entre sus consumidores. Material y método: Estudio observacional, transversal, abierto, descriptivo, en el que se entrevistó aleatoriamente a un número de pacientes que fueron atendidos en diferentes ámbitos sanitarios: consultas externas hospitalarias, servicios de urgencias, consulta de Atención Primaria y pacientes ingresados en planta hospitalaria. Resultados: De los 411 pacientes entrevistados, el 54% de los pacientes recibían IBP, y cuya edad media era de 63,3 años, frente al 46% que no los tomaban y que eran más jóvenes, con una edad media de 50,9 años. La distribución por sexos fue similar. La principal razón de utilizar el IBP era como “protector gástrico”, en el 39,8% de los pacientes, indicación no existente en la ficha técnica de este grupo de fármacos. Los consumidores de IBP tenían una mayor prevalencia de todas las fracturas por fragilidad. Conclusiones: Más de la mitad de la población encuestada consume IBP, y de ella cerca del 40% sin una indicación médica correcta. Por esto, unido a la mayor prevalencia de fracturas por fragilidad que presentan –que nos hace pensar en un posible mayor riesgo de fractura entre sus usuarios– consideramos la necesidad de un uso más racional de estos fármacos. Estas conclusiones son preliminares pero, a la vista de estos resultados, creemos que puede ser interesante realizar más estudios dirigidos a comprobar de manera más firme la relación entre los IBP y el riesgo de fractura osteoporótica

Antikinetoplastid Activity of Sesquiterpenes Isolated from the Zoanthid Palythoa aff. clavata

Leishmaniasis and Chagas disease are neglected tropical diseases that cause problems in developing countries. The causative agents, Leishmania spp. and Trypanosoma cruzi, produce a clinical picture that can be fatal for the patient, such as Chagas heart disease, visceral leishmaniasis and megacolon, among others. Current treatments for these diseases are not very effective and highly toxic, since they require very prolonged treatments. The development of innovative, effective and safe drugs to fight infections caused by these parasites remains a challenge. For this reason, in recent years, there has been an increase in the search for new therapies. In this study, the antikinetoplastid activity of 13 sesquiterpene lactones obtained from Palythoa aff. clavata was screened against L. amazonensis, L. donovani and T. cruzi. The results revealed that the sesquiterpene lactones anhydroartemorin (2), cis,trans-costunolide-14-acetate (3) and 4-hydroxyarbusculin A (11) were the most selective against the kinetoplastid species studied. These molecules seem to induce the mechanisms involved in an apoptotic-like death or programmed cell death (PCD) in the kinetoplastids, and since they do not cause necrosis, the inflammatory events associated with this type of cell death will not be triggered

Meroterpenoids from <i>Gongolaria abies-marina</i> against Kinetoplastids: <i>In Vitro</i> Activity and Programmed Cell Death Study

Leishmaniasis and Chagas disease affect millions of people worldwide. The available treatments against these parasitic diseases are limited and display multiple undesired effects. The brown alga belonging to the genus Gongolaria has been previously reported as a source of compounds with different biological activities. In a recent study from our group, Gongolaria abies-marine was proven to present antiamebic activity. Hence, this brown alga could be a promising source of interesting molecules for the development of new antiprotozoal drugs. In this study, four meroterpenoids were isolated and purified from a dichloromethane/ethyl acetate crude extract through a bioguided fractionation process targeting kinetoplastids. Moreover, the in vitro activity and toxicity were evaluated, and the induction of programmed cell death was checked in the most active and less toxic compounds, namely gongolarone B (2), 6Z-1′-methoxyamentadione (3) and 1′-methoxyamentadione (4). These meroterpenoids triggered mitochondrial malfunction, oxidative stress, chromatin condensation and alterations of the tubulin network. Furthermore, a transmission electron microscopy (TEM) image analysis showed that meroterpenoids (2–4) induced the formation of autophagy vacuoles and ER and Golgi complex disorganization. The obtained results demonstrated that the mechanisms of action at the cellular level of these compounds were able to induce autophagy as well as an apoptosis-like process in the treated parasites

In Vitro Activity of Statins against Naegleria fowleri

Naegleria fowleri causes a deadly disease called primary amoebic meningoencephalitis (PAM). Even though PAM is still considered a rare disease, the number of reported cases worldwide has been increasing each year. Among the factors to be considered for this, awareness about this disease, and also global warming, as these amoebae thrive in warm water bodies, seem to be the key factors. Until present, no fully effective drugs have been developed to treat PAM, and the current options are amphotericin B and miltefosine, which present side effects such as liver and kidney toxicity. Statins are able to inhibit the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which is a key enzyme for the synthesis of ergosterol of the cell membrane of these amoebae. Therefore, the in vitro activity of a group of statins was tested in this study against two types of strains of Naegleria fowleri. The obtained results showed that fluvastatin was the most effective statin tested in this study and was able to eliminate these amoebae at concentrations of 0.179 &plusmn; 0.078 to 1.682 &plusmn; 0.775 &micro;M depending on the tested strain of N. fowleri. Therefore, fluvastatin could be a potential novel therapeutic agent against this emerging pathogen

Silver Nanoparticles as a Novel Potential Preventive Agent against Acanthamoeba Keratitis

Free living, cosmopolitan amoebae from Acanthamoeba genus present a serious risk to human health. As facultative human parasites, these amoebae may cause Acanthamoeba keratitis (AK). Acanthamoeba keratitis is a severe, vision-threatening corneal infection with non-specific symptoms. The number of reported AK cases worldwide has been increasing every year. Moreover, 90% of Acanthamoeba keratitis cases are related to contact lens use. Wearing and storage contact lenses not in accordance with the physicians and manufacturers recommendations are the primary key risk factors of this disease. Amoebae can easily adhere to the contact lens surface and transmit to the corneal epithelium. Preventing amoebae adhesion to the contact lens surface could significantly decrease the number of AK infections. Until now, the effective therapy against AK is still under development. Currently proposed therapies are mainly limited to the chlorhexidine digluconate combined with propamidine isethionate or hexamidine applications, which are insufficient and very toxic to the eye. Due to lack of effective treatment, looking for new potential preventive agents is crucial to decrease the number of Acanthamoeba keratitis infections, especially among contact lens users. Nanoparticles have been already included in several novel therapies against bacteria, viruses, fungi, and protist. However, their anti-amoebic potential has not been fully tested yet. The aim of this study was to assess silver nanoparticles (AgNPs) and platinum nanoparticles (PtNPs) anti-amoebic activity and influence on the amoebae adhesion to the surface of four different groups of contact lenses&mdash;classified according to the Food and Drugs Administration (FDA) guidelines. The obtained results show that both tested nanoparticles were effective against Acanthamoeba trophozoites and decreased the amoebae adhesion to the contact lens surface. AgNPs showed better anti-amoebic activity to cytotoxicity dependence and reduced amoebae adhesion in a wider spectrum of the tested contact lenses. Our studies also confirmed that ionization next to hydration of the contact lens material is a crucial parameter influencing the Acanthamoeba adhesion to the contact lens surface. In conclusion, silver nanoparticles might be considered as a novel preventive agent against Acanthamoeba keratitis infection