Evaluación del metabolismo hidrocarbonado y riesgo de diabetes en sujetos hospitalizados por cardiopatía isquémica

Este trabajo forma parte de un proyecto de evaluación clínica global de los pacientes hospitalizados en una planta de Cardiología del Hospital Regional de Málaga, y consta de dos partes: 1ª parte. Estudio transversal que describe la situación clínica (factores de riesgo cardiovascular, antecedentes de enfermedad cardiovascular y diabetes), psicológica (síntomas de depresión y ansiedad evaluados a través del cuestionario HADS) y de calidad de vida relacionada con la salud (evaluada a través del cuestionario SF-36), de una amplia muestra de sujetos ingresados en una planta de Cardiología. Cada vez adquieren mayor importancia la optimización del estado de salud y la precepción de salud de las personas en los sistemas asistenciales y en los protocolos de atención a pacientes con enfermedades crónicas, entre los que se incluyen a los pacientes con patología cardiaca. Por lo tanto, es de interés conocer la situación psicológica y de calidad de vida de estos pacientes. Los resultados más relevantes de esta parte del trabajo son: - Los síntomas de depresión y ansiedad son frecuentes en los pacientes hospitalizados en una planta de Cardiología, pero no se asociaron a la presencia de diabetes conocida. - El tratamiento con insulina en los pacientes con diabetes mellitus tipo 2 se asoció a síntomas de depresión. - La calidad de vida relacionada con la salud de los pacientes hospitalizados en una planta de Cardiología, tanto en la esfera física como en la esfera mental, estaba reducida, y estuvo asociada a la presencia de síntomas de depresión. - En los pacientes con diabetes mellitus tipo 2, la presencia de complicaciones macrovasculares y los síntomas de depresión se asoció a peor calidad de vida en la esfera física. 2ª parte. Estudio observacional prospectivo que estudia la situación del metabolismo hidrocarbonado en los sujetos hospitalizados por cardiopatía isquémica. Tiene como objetivos principales profundizar en el conocimiento de las relaciones existentes entre las alteraciones del metabolismo hidrocarbonado y la enfermedad coronaria durante el ingreso por sospecha de cardiopatía isquémica con especial interés en el estrés tanto metabólico como del que está derivado de alteraciones psicológicas; e identificar los métodos diagnósticos que permitan detectar de forma precoz y adecuada los nuevos casos de diabetes en este grupo de pacientes. Los resultados más relevantes de esta parte del trabajo son: - La proporción de sujetos con diabetes e intolerancia a la glucosa en los pacientes hospitalizados por sospecha de cardiopatía isquémica fue hasta tres veces superior a la de los en sujetos de la población general de su misma edad, sexo e índice de masa corporal. - Los sujetos hospitalizados por sospecha de cardiopatía isquémica que presentaron hiperglucemia de estrés no tuvieron un porcentaje significativamente superior de diagnósticos de diabetes en la re-evaluación ambulatoria a los tres meses del alta que los sujetos con un metabolismo hidrocarbonado normal durante el ingreso. - La HbA1c determinada al ingreso fue el mejor predictor de diabetes tras el alta en los pacientes hospitalizados por cardiopatía isquémica. Los valores de la HbA1c que predijeron con mayor sensibilidad y especificidad el diagnóstico de diabetes son aquellos superiores a 5,9%. - El punto de corte de HbA1c de 6,5% recomendado por la guías científicas tuvo una baja sensibilidad para diagnosticar diabetes en pacientes con cardiopatía isquémica. - La diabetes conocida y la diabetes desconocida podrían aumentar hasta tres veces la probabilidad de presentar lesiones significativas en dos o más vasos coronarios, mientras que la intolerancia a la glucosa y la glucemia basal alterada no se asociaron a un incremento de presentar lesiones coronarias severas en nuestro estudio. Por tanto, dada la elevada prevalencia de diabetes no conocida en los pacientes con cardiopatía isquémica y las consecuencias que ella conlleva, es importante realizar un diagnóstico precoz de diabetes en esta población, para lo cual recomendaríamos, como método de cribado, la determinación de la HbA1c a todos los pacientes hospitalizados por cardiopatía isquémica sin diabetes conocida; y que valores de HbA1c superiores a 5,9% se considerasen límite para realizar otras pruebas que confirmasen el diagnóstico de diabetes

Clinical Interest of LMO2 Testing for the Diagnosis of Aggressive Large B-Cell Lymphomas

MYC rearrangements usually confer aggressive biological behavior to large B-cell lymphomas. In this study, we aimed to evaluate the relevance of LMO2 detection to the clinical approach to these tumors. First, the ability of LMO2 loss of expression to recognize the presence of MYC rearrangements was evaluated. A series of 365 samples obtained from 351 patients, including 28 Burkitt lymphoma, 230 diffuse large B-cell lymphoma, 30 high-grade B-cell lymphoma with MYC and BCL2/BCL6 rearrangements, eight high-grade B-cell lymphoma-NOS, 43 transformed diffuse large B-cell lymphoma, and 26 high-grade follicular lymphomas was analyzed. Among the CD10-positive tumors prospectively analyzed in whole tissue sections, LMO2 negative expression obtained values of 88% sensitivity, 94% specificity, and 93% accuracy, proving the utility of LMO2 to screen MYC rearrangements. In addition, survival analyses were performed in a series of 155 patients. As per univariate analyses, the prognosis relevance of LMO2 was as useful as that of the diagnostic categories, MYC rearrangements, and MYC immunohistochemistry. Multivariate models revealed that both LMO2 (hazard ratio 0.51 p = 0.02) and IPI (hazard ratio 1.67 p < 0.005) were independent variables predicting overall survival. Finally, MYC and LMO2 mRNA expression were analyzed in a small group of cases. Taken together, these findings show the interest of LMO2 testing in large B-cell lymphomas

Telemedicine, Psychology and Diabetes: Evaluation of results and cost analysis

The Psychosocial Aspects of Diabetes (PSAD) Study Group is an official Study Group of the European Association for the Study of Diabetes (EASD).AIMS: Evidences of benefits of telemedicine in T1DM patients on continuous subcutaneous insulin infusion (CSII) treatment are limited. Aims: 1) to analyse the differences in clinical and psychological variables between subjects with T1DM on CSII treatment who were included in a Telecare (TC) program, and subjects with T1DM on CSII treatment who received Conventional care (CC); 2) Perform a cost analysis of the use of telemedicine in DM1 patients treated with CSII (TC versus CC). METHODS and PARTICIPANTS: Cross-over randomized clinical trial with duration of 18 months. 51 patients signed informed consent. Participants were randomly assigned to receive TC program or CC during 6 months, and after a 3 months wash-out period, patients changed to CC or to TC respectively. TC program included monthly visits using an Internet platform. CC comprised face-to-face visits every three months. Sociodemographic, clinical and psychological data was measured at the beginning and at the end of TC and CC. The direct and indirect costs were also measured. T Student was performed to assess differences between first and last visits in both groups (TC / CC). RESULTS: Patients with telemedicine at the end of treatment, have fewer hyperglycemia / week, less distress and greater adherence. Considering both direct and indirect costs, the cost per treatment (TC / CC) is similar. CONCLUSIONS: Telemedicine has significant implications for clinical and psychological variables and has the same cost (total) than the conventional treatment. Therefore, it can be a useful alternative for treatment of DM1 patients with CSII. However, studies with a larger sample size are needed.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Serum vascular endothelial growth factor b and metabolic syndrome incidence in the population based cohort [email protected] study

Background/Objectives Although vascular endothelial growth factor b (VEGFb) might have an impact on the development of obesity, diabetes and related disorders, the possible relationship between VEGFb serum levels and the incidence of these metabolic complications in humans is still unknown. The aim of our study was to evaluate the association between VEGFb serum levels and the new-onset of metabolic syndrome (MS) and its components in the Spanish adult population after 7.5 years of follow-up. Subjects/Methods A total of 908 subjects from the [email protected] cohort study without MS at cross-sectional stage according to International Diabetes Federation (IDF) or Adult Treatment Panel III (ATP-III) criteria were included. Additionally, five sub-populations were grouped according to the absence of each MS component at baseline. Socio-demographic, anthropometric and clinical data were recorded. The Short Form of International Physical Activity Questionnaire (SF-IPAQ) was used to estimate physical activity. A fasting blood extraction and an oral glucose tolerance test were performed. Serum determinations of glucose, lipids, hsCRP and insulin were made. VEGFb levels were determined and categorized according to the 75th percentile of the variable. New cases of MS and its components were defined according to ATPIII and IDF criteria. Results A total of 181 or 146 people developed MS defined by IDF or ATP-III criteria respectively. Serum triglyceride levels, hs-CRP and systolic blood pressure at the baseline study were significantly different according to the VEGFb categories. Adjusted logistic regression analysis showed that the likelihood of developing MS and abdominal obesity was statistically reduced in subjects included in the higher VEGFb category. Conclusion Low serum levels of VEGFb may be considered as early indicators of incident MS and abdominal obesity in the Spanish adult population free of MS, independently of other important predictor variables.This investigation has been supported by CIBERDEM (Ministerio de Economia, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e IgualdadISCIII, Instituto de Salud Carlos III (research grants PI20/01322, PI18/01165, PI17/02136, PI14/00710) and cofunding by the European Regional Development Fund (ERDF) "A way to build Europe". LifeScan Espana (Madrid, Spain) kindly donated the glucometers and test strips for capillary glucose measurements. Cristina MaldonadoAraque is a researcher in the `Rio Hortega' program (CM19/00186) financed by the Instituto de Salud Carlos III. Natalia Colomo is a member of the regional "Accion B para clinicos investigadores" research program of the Consejeria de Salud of the Junta de Andalucia, Spain (B-0002-17). Gemma Rojo-Martinez belongs to the Nicolas Monardes research program of the Consejeria de Salud (C-0060-2012; Junta de Andalucia, Spain)

Ambient air pollution and thyroid function in Spanish adults. A nationwide population-based study ([email protected] study)

Background Recent reports have suggested that air pollution may impact thyroid function, although the evidence is still scarce and inconclusive. In this study we evaluated the association of exposure to air pollutants to thyroid function parameters in a nationwide sample representative of the adult population of Spain. Methods The [email protected] study is a national, cross-sectional, population-based survey which was conducted in 2008-2010 using a random cluster sampling of the Spanish population. The present analyses included 3859 individuals, without a previous thyroid disease diagnosis, and with negative thyroid peroxidase antibodies (TPO Abs) and thyroid-stimulating hormone (TSH) levels of 0.1-20 mIU/L. Participants were assigned air pollution concentrations for particulate matter <2.5 mu m (PM2.5) and Nitrogen Dioxide (NO2), corresponding to the health examination year, obtained by means of modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). TSH, free thyroxine (FT4), free triiodothyronine (FT3) and TPO Abs concentrations were analyzed using an electrochemiluminescence immunoassay (Modular Analytics E170 Roche). Results In multivariate linear regression models, there was a highly significant negative correlation between PM2.5 concentrations and both FT4 (p<0.001), and FT3 levels (p<0.001). In multivariate logistic regression, there was a significant association between PM2.5 concentrations and the odds of presenting high TSH [OR 1.24 (1.01-1.52) p=0.043], lower FT4 [OR 1.25 (1.02-1.54) p=0.032] and low FT3 levels [1.48 (1.19-1.84) p=<0.001] per each IQR increase in PM2.5 (4.86 mu g/m(3)). There was no association between NO2 concentrations and thyroid hormone levels. No significant heterogeneity was seen in the results between groups of men, pre-menopausal and post-menopausal women. Conclusions Exposures to PM2.5 in the general population were associated with mild alterations in thyroid function.CIBERDEM (Ministerio de Economia, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III (PI17/02136, PI20/01322), Consejeria de Salud y familias (PI-0144-2018), European Regional Development Fund (ERDF) "A way to build Europe". GRM belongs to the regional Nicolas Monardes research program of the Consejeria de Salud (RC-0006-2016; Junta de Andalucia, Spain). CMA is recipient of a "Rio Hortega" research contract (CM19/00186, Instituto de Salud Carlos III). VKDG is recipient of a "Rio Hortega" research contract (CM21/00214, Instituto de Salud Carlos III)

From tumor-suppressor to oncogene: finding the oncogenic genetic determinants of the mitotic kinase Polo-Llike Kinase 1

Trabajo presentado en el II Congreso Anual de la Red Conexión Cáncer, celebrado en Benidorm (España) del 23 al 25 de enero de 2023