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Biomedical subjects

F Marín

Publications and source records attributed to F Marín.

At least 19 recordsLinked to original sources
PubMed2006

Characterization of patients with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO).

BACKGROUND: Osteoporotic fractures remain a major public health problem. Currently available osteoporosis therapies significantly reduce the risk of fractures, but up to 50% of patients have an inadequate clinical outcome to therapy. AIM: To describe the clinical and quality of life (QOL) of a study population meeting a proposed definition of inadequate clinical outcome to osteoporosis therapy, recruited for the Observational Study of Severe Osteoporosis (OSSO). DESIGN: Cross-sectional, observational study. METHODS: Post-menopausal women with osteoporosis (n = 2314) were divided into Group 1 (those who had previously experienced a fragility fracture despite osteoporosis drug therapy for at least 12 months) (n = 1309, 57%), or Group 2 (those who had previously discontinued osteoporosis drug therapy due to non-compliance or side-effects) (n = 1005; 43%). Baseline clinical characteristics, quality of life (QOL) and osteoporosis/falls risk factors were analysed. RESULTS: The overall population had low BMD (mean +/- SD T-score at lumbar spine -3.1 +/- 1.1), and risk factors for fracture such as previous fractures (67.8%), family history (15.1%), and prolonged glucocorticoid use (17.5%). QOL was poor: total QUALEFFO and EQ-5D scores were 46.8 +/- 18.7, and 0.50 +/- 0.33, respectively. Patients in Group 1 had higher age and body mass index, fewer hours of exercise, more previous fragility fractures and falls, and poorer QOL scores. DISCUSSION: Our definition of inadequate clinical outcome from osteoporosis drug therapy identifies a severe osteoporosis cohort with poor QOL and increased fracture risk. Using such a definition may lead to earlier recognition of inadequate clinical outcome to osteoporosis therapy, and improved interventions and results.

Absorptiometry, Photon↗
PubMed2006

Expression of Lrrn1 marks the prospective site of the zona limitans thalami in the early embryonic chicken diencephalon.

An unknown chicken gene selected from a published substractive hybridization screen (GenBank Accession No. ; [Christiansen, J.H., Coles, E.G., Robinson, V., Pasini, A., Wilkinson, D.G., 2001. Screening from a subtracted embryonic chick hindbrain cDNA library: identification of genes expressed during hindbrain, midbrain and cranial neural crest development. Mech. Dev. 102, 119-133.]) was deemed of interest because of its dynamic pattern of expression across the forebrain and midbrain regions. A 528bp fragment cloned from early chick embryo cDNA and used for in situ hybridization corresponded to part of the 3' untranslated region of the chicken gene Leucine-rich repeat neuronal protein 1 (Lrrn1). The expression of this gene, mapped in the embryonic chick brain between stages HH10 and HH26, apparently preconfigures the zona limitans thalami site before overt formation of this boundary structure. Apart of colateral expression in the forebrain, midbrain and hindbrain basal plate, the most significant expression of Lrrn1 was found early on across the entire alar plate of midbrain and forebrain (HH10). This unitary domain soon divides at HH14 into a rostral part, across alar secondary prosencephalon and prospective alar prosomere 3 (prethalamus; caudal limit at the prospective zona limitans), and a caudal part in alar prosomere 1 (pretectum) and midbrain. The rostral forebrain domain later downregulates gradually most extratelencephalic signal of Lrrn1, but the rostral shell of zona limitans retains expression longer. Expression in the caudal alar domain also changes by downregulation within its pretectal subdomain. Caudally, the midbrain domain ends at the isthmo-mesencephalic junction throughout the studied period. Embryonic Lrrn1 signal also appears in the somites and in the otic vesicle.

Amino Acid Sequence↗
PubMed2005

Mite allergen exposure, sensitisation and clinical symptoms in Valdivia, Chile.

One hundred consecutive asthmatic paediatric patients were evaluated and skin tested with a battery of skin prick test reagents, including 8 different standardized house dust mite extracts. Asthma severity was graded according to the Global Initiative for Asthma (GINA) document in mild persistent (52 patients), moderate persistent (39) and severe persistent (9). Sixty patients had asthma and allergic rhinitis, 12 asthma and eczema, and 8 asthma, allergic rhinitis and eczema. The patient population was divided into 2 different socioeconomic groups (50 patients per group) based on a standardized, validated questionnaire. A dust sample was collected with an adapted vacuum cleaner from the mattress of each patient and analysed for Der p 1, Der f 1 and Der p 2 allergen content using monoclonal antibodies. Eighty patients were skin test positive to at least one mite species. All positive skin test patients were positive to Dermatophagoides pteronyssinus, 99% to D. farinae, 92% to Euroglyphus maynei, 80% to Lepidoglyphus destructor, 73% to Tyrophagus putrescientae, 72% to Blomia tropicalis; 70% to Acarus siro and 68% to Chortoglyphus arcuatus. All patients with severe persistent asthma had a positive skin test to mites, 85% in the moderate group, and 73% in the mild group (p < 0.01). 95% of patients with asthma and allergic rhinitis had a positive skin test to mites, 92% of patients with asthma and eczema and 100% of patients with asthma, allergic rhinitis and eczema; (p < 0.01). Mean Der p 1, Der f 1 and Der p 2 allergen concentrations were 18.3, 0.6 and 5.6 microg/g of mattress dust, respectively. Mean Der p 1 allergen levels in the middle-low socioeconomic group were significantly higher than in the middle high group (p < 0.01). There is a high rate of allergic sensitisation among pediatric asthmatic patients in Chile. More than one species are implicated, although sensitisation and exposure to D. pteronyssinus predominates. Mite allergic patients are exposed to high mite allergen concentrations, exceeding previously established risk levels for sensitisation and symptoms.

Adolescent↗
PubMed2004

Clinical manifestations and hormonal profile of two women with Cushing's disease and mild deficiency of 21-hydroxylase.

The development of Cushing's disease among patients with deficiency of 21-hydroxylase has not been observed to date. The clinical manifestations and the hormonal profile of this exceptional association are herein described through the study of two cases. The first one was a 39-yr-old woman who had undergone non-curative transsphenoidal surgery for a pituitary-dependent Cushing's syndrome 12 yr before. She showed hypertension, central obesity, severe hirsutism, alopecia and hyperpigmentation. Urinary excretion of cortisol was normal, but ACTH levels were very high and hormonal dynamic studies (cortisol circadian rhythm, insulin-induced hypoglycemia and dexamethasone suppression tests) revealed the qualitative disturbances that characterize Cushing's disease. Serum concentrations of androstenedione, free testosterone and 17-hydroxyprogesterone were clearly increased. Reexamination of the tissue samples from previous surgery confirmed the presence of an ACTH-producing pituitary adenoma. CYP21 gene analysis found the splicing 655G mutation at intron 2 and the V281L mutation at exon 7. The second case was a 21-yr-old woman who was diagnosed with pituitary ACTH-dependent Cushing's syndrome according to unequivocal clinical and laboratory findings. However, hirsutism was particularly severe and both serum androgens and 17-hydroxyprogesterone were elevated. The patient was heterozygote for a large conversion of CYP21 gene. In these cases, the clinical and biochemical expression of Cushing's syndrome was determined by the different severity of 21-hydroxylase deficiency and the subsequent residual ability of adrenal cortex to synthesize cortisol.

Adenoma↗
PubMed2004

Plasma von Willebrand factor, soluble thrombomodulin, and fibrin D-dimer concentrations in acute onset non-rheumatic atrial fibrillation.

OBJECTIVE: To investigate whether new onset acute atrial fibrillation (AF) of < 48 hours' duration creates a prothrombotic state in the absence of anticoagulation and to assess the evolution in research indices after spontaneous or pharmacological cardioversion. METHODS: 24 patients were recruited with first onset acute non-rheumatic AF, in whom sinus rhythm was restored within 48 hours of arrhythmia onset, without anticoagulant treatment. Atrial mechanical function was assessed by transmitral inflow. Soluble thrombomodulin and von Willebrand factor concentrations (both as indices of endothelial damage or dysfunction) and fibrin D-dimer concentrations (as an index of thrombogenesis) were measured. Blood samples were drawn and echocardiographic studies were performed at days 1, 3, 7, and 30 after cardioversion. Research indices were compared with those of 24 healthy participants, 24 patients with chronic AF, and 24 patients with ischaemic heart disease in sinus rhythm. RESULTS: Patients with AF had higher concentrations of soluble thrombomodulin (acute AF 12.1 (4.1) ng/ml; chronic AF 11.8 (4.6) ng/ml), von Willebrand factor (acute AF 137.2 (36.9) ng/ml; chronic AF 133.1 (25.0) ng/ml), and fibrin D-dimer concentrations (acute AF 2.35 (2.68) microg/ml; chronic AF 1.12 (0.65) microg/ml) than did healthy controls (5.9 (2.7) ng/ml, 86.7 (33.2) ng/ml, and 0.39 (0.28) microg/ml, respectively) and patients with ischaemic heart disease (7.4 (3.7) ng/ml, 110.0 (29.0) ng/ml, and 0.99 (0.73) microg/ml, respectively) (all p < 0.05). Day 30 concentrations of fibrin D-dimer were higher in patients with acute AF than in patients with chronic AF (p = 0.038) but sTM and von Willebrand factor concentrations were not different (both not significant). There were no significant changes in research indices or echocardiographic parameters after cardioversion (all p > 0.05). CONCLUSIONS: There was evidence among patients with acute onset AF of endothelial damage or dysfunction and increased thrombogenesis, which persisted up to 30 days after cardioversion.

Acute Disease↗
PubMed2004

[Horner's syndrome following epidural analgesia for labor].

Horner's syndrome is a disorder of the sympathetic nerve supplying the eye. Infrequently, Horner's syndrome can arise as a complication of epidural anesthesia, but its clinical course is favorable. The incidence increases when epidural analgesia is used in obstetrics because of physiological and anatomic changes in obstetric patients that favor spread of the local anesthetic. We report the case of a 31-year-old woman requiring epidural analgesia for labor. She received 10 mL of 0.15% ropivacaine with a bolus dose of 50 microg of fentanyl, followed by epidural catheter infusion of 0.15% and 0.001% fentanyl at a rate of 10 mL/h. Two hours after starting the infusion, the patient's right eye presented a contracted pupil, a drooping eyelid, and enophthalmos, accompanied by flushing on the same side of the face. Horner's syndrome was diagnosed. Signs resolved over the next hour without treatment. The literature contains reports of widely differing incidences of Horner's Syndrome ranging from 1.3% to 75%. The case we report was the only one in our hospital over a period of 4 years during which 12,796 epidural procedures were performed. These data suggest to us that Horner's syndrome often passes undetected because clinical manifestations are not remarkable. Nevertheless, the diagnosis should be kept in mind so that unnecessary treatment is avoided, given that the clinical course is favorable with spontaneous resolution.

Adult↗
PubMed2003

Bone mineral density referral for dual-energy X-ray absorptiometry using quantitative ultrasound as a prescreening tool in postmenopausal women from the general population: a cost-effectiveness analysis.

The aim of our study was to assess, from the perspective of the National Health Services in Spain, the cost-effectiveness of quantitative ultrasound (QUS) as a prescreen referral method for bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) in postmenopausal women of the general population. Using femoral neck DXA and heel QUS. We evaluated 267 consecutive postmenopausal women 65 years and older and attending primary care physician offices for any medical reason. Subjects were classified as osteoporotic or nonosteoporotic (normal or osteopenic) using the WHO definition for DXA. Effectiveness was assessed in terms of the sensitivity and specificity of the referral decisions based on the QUS measurement. Local costs were estimated from health services and actual resource used. Cost-effectiveness was evaluated in terms of the expected cost per true positive osteoporotic case detected. Baseline prevalence of osteoporosis evaluated by DXA was 55.8%. The sensitivity and specificity for the diagnosis of osteoporosis by QUS using the optimal cutoff thresholds for the estimated heel BMD T-score were 97% and 94%, respectively. The average cost per osteoporotic case detected based on DXA measurement alone was 23.85 euros. The average cost per osteoporotic case detected using QUS as a prescreen was 22.00 euros. The incremental cost-effectiveness of DXA versus QUS was 114.00 euros per true positive case detected. Our results suggest that screening for osteoporosis with QUS while applying strict cufoff values in postmenopausal women of the general population is not substantially more cost-effective than DXA alone for the diagnosis of osteoporosis. However, the screening strategy with QUS may be an option in those circumstances where the diagnosis of osteoporosis is deficient because of the difficulty in accessing DXA equipment.

Absorptiometry, Photon↗
PubMed2003

Effect of treatment with the selective oestrogen receptor modulator LY117018-HCl on pituitary sensitivity to GnRH and subsequent ovulation.

The effects of LY117018-HCl (LY; a benzothiophene similar to raloxifene) were examined on various reproductive parameters in female rats. Four-day cyclic rats were treated (10:00 h on dioestrus) with LY (0.01, 0.1, 0.5, 1, 2, 4 or 16 mg kg(-1) p.o.) and assessed for ovulation at oestrus. LY inhibited ovulation at doses as low as 0.5 mg kg(-1), and ovulation did not occur at doses of 4 and 16 mg kg(-1). LY (16 mg kg(-1)) reduced wet uterine mass and LH concentrations at the time of the expected ovulatory surge. Ovulation induced by hCG in pentobarbital-treated rats was not altered by LY treatment, indicating normal ovarian sensitivity to gonadotrophins. LY, however, completely blocked the effects of oestradiol (under either negative or positive feedback modes) on LH secretion in ovariectomized rats. GnRH secretion into hypophyseal portal blood during pro-oestrus was not affected by treatment with LY, whereas the concentrations of serum LH remained reduced. Finally, treatment with LY markedly reduced pituitary sensitivity to GnRH during pro-oestrus, as it completely blocked GnRH-induced LH secretion. These results demonstrate that LY inhibits oestradiol action in the uterus and prevents ovulation in normal cyclic rats. LY-induced inhibition of ovulation is not caused by an alteration of the ovarian response to gonadotrophins or an impairment of GnRH secretion at the hypothalamus, but by a reduction in the sensitivity of gonadotrophs to the stimulatory effects of GnRH during pro-oestrus.

Animals↗
PubMed2001

[Low sensitivity of IGF-I, IGFBP-3 and urinary GH in the diagnosis of growth hormone insufficiency in slowly-growing short-statured boys. Grupo Español de Estudio de la Talla Baja].

BACKGROUND: The usefulness of IGF-I, IGFBP-3, and the urinary GH excretion in the diagnostic evaluation of growth retardation in boys with short stature was studied. SUBJECTS AND METHOD: Serum samples from two GH-stimulation tests and two 24-h urine samples were sent to a Central Laboratory to measure serum and urinary GH, serum IGF-I, IGFBP-3 and GHBP, both in absolute and standardized values (Z-score). Short children were classified as growth hormone deficient (GHD) (n = 25), and idiopathic short statured (ISS) (n = 54), on the basis of the peak stimulated GH concentration of < 7.5 microg/l or > or = 7.5 microg/l respectively. A group of 15 normally growing children and adolescents was also included. RESULTS: Height-velocity standard deviation score (HV)-SDS was lower and body mass index higher in GHD than ISS. Standardized IGF-I differed significantly by ANOVA among the three groups (p = 0.001). Multiple stepwise linear regression analysis with HV-SDS as dependent variable showed IGF-I SDS as the best predictor followed by peak GH clonidine response and uGH excretion. ROC curves showed optimum cut-off level for IGF-I SDS as 2.05 (sensitivity: 32%, specificity: 90%) and 1.14 for IGFBP-3 SDS sensitivity: 28%, specificity: 94%). CONCLUSIONS: Standardized IGF-I and IGFBP-3 measurements were highly efficient only in diagnosis of severe GHD, but they show low sensitivity for the diagnosis of isolated idiopathic GHD as defined according to the low GH response to stimulation tests.

Adolescent↗
PubMed2001

Tissue factor/tissue factor pathway inhibitor system and long-term prognosis after acute myocardial infarction.

UNLABELLED: The tissue factor and tissue factor pathway inhibitor (TFPI) system has been studied in the acute phase of coronary disease but its prognostic importance has been less well assessed. We evaluated its association with recurrent coronary events during long-term follow-up after a myocardial infarction. METHODS: We studied 55 consecutive patients with the following criteria for inclusion: (1) first myocardial infarct; (2) aged < 70 years; (3) non-complicated infarct; (4) low risk effort-test. Blood samples were taken 60-80 days after infarction. Tissue factor, total and free-TFPI were measured. A 4-year follow-up was carried out. Death, unstable angina and new myocardial infarction were considered as poor prognosis. RESULTS: There were no statistical differences in tissue factor/TFPI levels between patients and controls. Total-TFPI showed statistical correlation with total cholesterol (r = 0.59), triglycerides (r = 0.34), LDL-cholesterol (r = 40) and Lipoprotein(a) (r = 0.48). Patients with high levels of cholesterol, LDL-cholesterol and triglycerides showed elevated levels of total-TFPI with no differences in free-TFPI. During follow-up, 8 patients showed poor prognosis. There were no statistical associations between tissue factor/TFPI levels and prognosis. CONCLUSIONS: After acute myocardial infarction, we did not find any differences in the tissue factor/TFPI system between controls and patients. The tissue factor/TFPI system showed little value as a prognostic factor.

Aged↗
PubMed2001

Fungemia due to Scedosporium prolificans: a description of two cases with fatal outcome.

Two cases, probably related, of fungemia due to Scedosporium prolificans are described in two patients with acute leukemia. Both were admitted to the hematological ward in nearby rooms, during building work in the hospital. After a previous bacterial sepsis in the neutropenic phase, which improved with antibiotic treatment, the respiratory status in both patients deteriorated presenting acute dypsnea, with a lung infiltrate in one of them. A few hours later both patients died. Blood cultures were positive for S. prolificans. These two new cases of S. prolificans infection stress the importance of awareness of this emerging pathogen in patients who suffer a hematologic malignancy during the neutropenic phase, especially if building work is taking place in the hospital.

Adult↗
PubMed2001

Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency.

BACKGROUND: Adults with growth hormone (GH) deficiency (GHD) may experience physical and psychological disturbances, which can affect their quality of life (QOL). OBJECTIVES: To develop and validate a disease-specific module from the previously published QOL measure Questions on Life Satisfaction Modules (QLS(M)): the QLS(M)-H that specifically addressed the needs of patients with hypopituitarism. A second aim was for the questionnaire to be applicable across different cultural backgrounds in order to evaluate the efficacy of therapy in large, international clinical trials, thus providing additional clinical endpoints for these studies. DESIGN: A preliminary German language version of the QLS(M)-H was developed from 26 semi-structured interviews of adults with GHD. The questionnaire was then independently translated into five other languages and applied in open, non-controlled, multicentre, longitudinal studies to patient (n=717) and normative populations (n=2700). METHODS: A revised, nine-item version of the questionnaire was developed, based on previously defined criteria, and was evaluated for reliability and validity. Sensitivity to detect changes after GH replacement was also assessed. RESULTS: The 16 items of the preliminary questionnaire were reduced to nine items on the basis of the correlation of items/factors from initial patient interviews. Psychometric analysis revealed the reliability of the nine-item scale. The Cronbach's alpha scores ranged from 0.81 to 0.89 and the test-retest correlations ranged from 0.76 to 0.88, all of which indicate reliability over time. Mean scores increased significantly during GH replacement therapy, with observed changes greater than those seen with the non-specific modules of the QLS(M), indicating the sensitivity of the scale. CONCLUSIONS: The QLS(M)-H questionnaire is concise, easy to complete, and can be effectively applied across different cultural backgrounds. Psychometric evaluation of the questionnaire reveals that it is a valid, reliable and sensitive tool useful for assessing impaired life satisfaction in adult patients with GHD and also for monitoring the efficacy of GH therapy.

Adult↗
PubMed2000

Positional regulation of Krox-20 and mafB/kr expression in the developing hindbrain: potentialities of prospective rhombomeres.

Krox-20 and mafB/kr encode transcription factors involved in the control of hindbrain development and are expressed in rhombomeres (r) 3 and 5 and 5 and 6, respectively. To analyse the regulation of the expression of these genes by positional cues, focusing on the stages just preceding the formation of rhombomeres, we have performed ectopic grafts involving single prospective rhombomeres (pr) or couples of pr on 4-6 somite avian embryos. Transplantation of pr6 in the pr5 position leads to Krox-20 activation and grafting of pr7 in the pr5 position results in mafB/kr activation. Furthermore, pr6 grafted in the pr5 position develops an r5-like cytoarchitecture. These data establish that rostral transplantation can lead to anteriorization within the hindbrain. However, additional experiments indicate that the competence of the transplanted tissue for such anteriorization appears limited and that transformations corresponding to shifts of a single rhombomere are favoured. We also show that caudal transplantation of pr5 into the pr6 position can lead to a down-regulation of Krox-20 expression consistent with posteriorization, suggesting that caudalizing influences are present within the nonsomitic hindbrain after the 4- to 6-somite stage. Finally, combinations of extirpation and grafting experiments suggest that the regulation of mafB/kr expression in the r6-r7 region may involve anteriorizing influences in addition to previously identified posteriorizing signals from the somitic region.

Animals↗