Biomedical subjects

I Galán

Publications and source records attributed to I Galán.

14 recordsLinked to original sources

PubMed2006

Fatigue in multiple sclerosis persists over time: a longitudinal study.

BACKGROUND AND OBJECTIVE: Fatigue is one of the most frequent symptoms in multiple sclerosis (MS) but there is a lack of knowledge about its behaviour over time. The aim of our study was to investigate changes in fatigue in a large cohort of MS patients and to determine the relationship between changes in disability and depression with changes in fatigue severity. METHODS: We studied fatigue in 227 MS consecutive patients and again after one year. During the clinical interview, we recorded the patient's degree of disability using the Expanded Disability Status Scale and relapses; fatigue was measured by means of the Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale (FSS) and depression was measured by the Beck Depression Inventory (BDI). RESULTS: After a mean follow-up of 18 months, 86.8% of patients who were fatigued at study onset remained in a fatigued status, whereas 25% of those without fatigue at onset had become fatigued at the end of follow-up. We observed that only variations on BDI scores positively correlate with variations on fatigue scales, mainly with MFIS (r = 0.49, p < 0.0001). An increase of BDI score was the factor that best predicted the increase of fatigue over time. No differences in the increase of fatigue were found between patients with and without progression of disability during the follow-up period, or between patients with or without relapses. CONCLUSIONS: Fatigue in MS persists over time. Changes in mood status but not in disability are related to changes in fatigue in MS patients.

Adult↗

PubMed2006

Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project.

OBJECTIVE: To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities METHODS: The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed. RESULTS: Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0-1), except in the case of ozone where there was a more delayed relation (lag 2-3). For combined estimates an increase of 10 microg/m3 in the PM10 levels in lag 0-1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2-3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m3 in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models CONCLUSIONS: A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.

Aged↗

PubMed2005

Homeostatic role of IL-7 in HIV-1 infected children on HAART: association with immunological and virological parameters.

AIM: To investigate the role of IL-7 in HIV-infected children on highly active antiretroviral therapy (HAART) and its association with laboratory parameters related to disease progression. PATIENTS AND METHODS: A cross-sectional study in 31 vertically HIV-infected children (median age 8.4 y) treated with HAART, and a longitudinal study in four of those same children was carried out. In both studies, viral load, CD4+ T-cell counts, thymic production of T cells by TCR rearrangement excision circles (TRECs), IL-7 plasma levels and viral phenotype were determined. RESULTS: IL-7 levels were higher in HIV-infected children than in age-matched, uninfected controls. In addition, HIV children with CD4+ T cells between 200 and 500 T cells/mm3 had higher IL-7 levels and lower TREC values than HIV-infected children with CD4+ T cells >500 T cells/mm3. IL-7 levels were higher in children with syncytium-inducing (SI) phenotype than in those with non-syncytium-inducing (NSI) variants. During the follow-up of four HIV children, the decrease in viral load after HAART was always associated with a recovery of CD4+ T cells and TRECs, which was followed by a decrease in IL-7 returning to the levels present prior to the drop in CD4+ T cells. The four HIV-infected children had SI/X4 isolates in PBMC before HAART, and the viral phenotype switched to NSI/R5 after HAART. CONCLUSION: Our data suggest that IL-7 plays a key role in the maintenance of T-cell homeostasis in HIV-infected children on HAART, both through peripheral expansion and through a thymus-dependent mechanism.

Adolescent↗

PubMed2005

Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS?

BACKGROUND: As a symptom of multiple sclerosis (MS), fatigue is difficult to manage because of its unknown etiology, the lack of efficacy of the drugs tested to date and the absence of consensus about which would be the ideal measure to assess fatigue. OBJECTIVE: Our aim was to assess the frequency of fatigue in a sample of MS patients and healthy controls (HC) using two fatigue scales, the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS) with physical, cognitive and psychosocial subscales. We also studied the relationship fatigue has with depression, disability and interferon beta. METHODS: Three hundred and fifty-four individuals (231 MS patients and 123 HC) were included in this cross-sectional study. Fatigue was assessed using the FSS and MFIS. Depression was measured by the Beck Depression Inventory (BDI), and disability by the Expanded Disability Status Scale (EDSS). A status of fatigue was considered when the FSS > or =5, of non-fatigue when the FSS < or =4, and scores between 4.1 and 4.9 were considered doubtful fatigue cases. RESULTS: Fifty-five percent of MS patients and 13% of HC were fatigued. The global MFIS score positively correlated with the FSS in MS and HC (r =0.68 for MS and r =0.59 for HC, p <0.0001). Nonetheless, the MFIS physical subscale showed the strongest correlation score with the FSS (r =0.75, p <0.0001). In addition, a prediction analysis showed the physical MFIS subscale to be the only independent predictor of FSS score (p <0.0001), suggesting other aspects of fatigue, as cognition and psychosocial functions, may be explored by the FSS to a lesser extent. Depression also correlated with fatigue (r =0.48 for the FSS and r =0.7 for the MFIS, p <0.0001) and, although EDSS correlated with fatigue as well, the scores decreased after correcting for depression. Interferon beta showed no relationship with fatigue. CONCLUSIONS: Fatigue is a frequent symptom found in MS patients and clearly related with depression. Each fatigue scale correlates with one another, indicating that they are measuring similar constructs. Nevertheless, spheres of fatigue as cognition and psychosocial functions are probably better measured by the MFIS, although this hypothesis will need to be confirmed with appropriate psychometrical testing.

Adult↗

PubMed2004

Population at risk for eating disorders in a Spanish region.

OBJECTIVE: To estimate the prevalence of adolescent population at risk for eating disorders (EDs), to examine gender differences and their association with non-psychotic mental disorders. METHODS: Cross-sectional study using an anonymous, self-reported questionnaire in the classroom and measurement of weight and height in a representative sample of 4334 teenagers of both sexes. A definition of population at risk for EDs has been established, that differentiates those with dieting criteria and those with binge-purge eating behaviour criteria. This definition includes a combination of weight, behaviour, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, and Eating Disorder Inventory (EDI) results. The General Health Questionnaire-28 (GHQ-28) was used to assess non-psychotic mental disorders. RESULTS: The prevalence of population at risk for EDs was 2.2% (95% CI: 1.6-2.8) for men and 15.3% (95% CI: 13.8-16.9) for women. The prevalence rate of combining both ED risk and mental disorder was 0.8% (95% CI: 0.4-1.2) for men and 9.9% (95% CI: 8.6-11.2) for women. Non-psychotic mental disorders were more prevalent in the population at risk for EDs than in the rest of the population. CONCLUSIONS: A considerable proportion of adolescent females have eating problems and non-psychotic mental disorders. Their male counterparts also suffer from these disorders, however, a different pattern is followed.

Adolescent↗

PubMed2004

Non-linear short-term effects of airborne pollen levels with allergenic capacity on asthma emergency room admissions in Madrid, Spain.

BACKGROUND: Several time-series studies have shown positive associations between pollen levels and asthma morbidity. However, few studies have included air pollution as a potential confounder when examining this relationship, and they have only done so on a linear basis. OBJECTIVE: To investigate the potential non-linear short-term effects of the types of pollen with allergenic capacity across the whole range of exposure on the daily number of asthma-related hospital emergencies in Madrid for the period 1995-1998. METHODS: Data were collected on the daily number of asthma emergency room admissions and daily average levels of major types of pollen with allergenic capacity: Olea, Plantago, Poaceae and Urticaceae. We used Poisson regression with generalized additive models, controlling for trend and seasonality, meteorological variables, acute respiratory infections and air pollutants. To study the non-linear effect of pollen levels on asthma emergency room admissions, pollens were categorized into five groups defined on the basis of their respective distributions. RESULTS: The strongest associations were registered in respect of a lag of 1 day for Urticaceae, a lag of 2 days for Plantago, and a day lag of 3 days for Poaceae. Adjustment for the different types of pollen failed to result in major changes. Non-linearities were evident for pollen levels. The greatest increase in risk vs. the reference category (minimum value - 50th percentile) was observed for the categories between the 95th and 99th percentiles, with increases of 32.0% for Plantago, 32.2% for Poaceae and 24.6% for Urticaceae, and between the 99th percentile and the maximum value, with increases of 31.3%, 78.7% and 49.8%, respectively. Olea was not related with asthma emergency room admissions. CONCLUSIONS: Pollens with allergenic capacity in Madrid are positively associated with asthma-related hospital emergencies. These associations remain stable when simultaneous adjustment is made for the four types of pollen and for air pollutants and meteorological variables. In terms of non-linear effects, Poaceae register the strongest association with asthma emergency room admissions.

Adolescent↗

PubMed2004

HIV-infected children with moderate/severe immune-suppression: changes in the immune system after highly active antiretroviral therapy.

The objective of this study was to monitor the changes in the immune system of HIV-infected children with moderate or severe immunodeficiency after highly active antiretroviral therapy (HAART), comprising a follow-up study in 14 HIV-infected children on HAART at two time points separated approximately by 11.8 +/- 0.4 (9.9; 15.4) months. HIV-infected children had significantly lower TREC levels than the control group, but 1 year after HAART the levels increased significantly (P < 0.05). In contrast, viral load (VL) did not change significantly. A positive correlation between T cell receptor excision circle (TREC) levels and both CD4(+) T cell absolute counts (r = 0.558; P = 0.05) and percentages (r = 0.625; P = 0.030) was found. During follow-up on HAART, the percentages and absolute counts of naive CD4(+) and CD8(+) T cell subsets were increased significantly (P < 0.05). CD4(+) CD45RA(hi+) CD62L(+), CD4(+) CD45RA(+) and CD4(+) CD38(+) percentages, and the CD8(+) CD45RA(hi+) CD62L(+) counts reached similar values to the control group. Also, CD8(+) CD45RO(+) CD38(+) and CD8(+) CD45RO(+) percentages, and CD8(+) CD45RO(+) CD38(+) absolute counts (P < 0.05) decreased with respect to the baseline. Lymphoproliferative responses to pokeweed mitogen (PWM) before HAART were lower in HIV-infected children than the control group, but they recovered to normal levels after a year on HAART. Tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma production by PHA-activated peripheral blood mononuclear cells (PBMC) was lower before HAART (P < 0.001), but reached similar levels to the control group 1 year after HAART. In HIV-infected children IgG, IgG(1) and IgG(3) plasma levels decreased significantly after HAART. The immune system reconstitution induced by HAART in HIV-infected children seems to be the consequence of decreased immune system activation and naive T cell reconstitution, mainly of thymic origin.

Adolescent↗

PubMed2003

Short term effects of airborne pollen concentrations on asthma epidemic.

BACKGROUND: Few studies have used time series to investigate the relationship between asthma attacks and aeroallergen levels on a daily basis. METHODS: This study, based on time series analysis adjusting for meteorological factors and air pollution variables, assessed the short term effects of different types of allergenic pollen on asthma hospital emergencies in the metropolitan area of Madrid (Spain) for the period 1995-8. RESULTS: Statistically significant associations were found for Poaceae pollen (lag of 3 days) and Plantago pollen (lag of 2 days), representing an increase in the range between the 99th and 95th percentiles of 17.1% (95% confidence interval (CI) 3.2 to 32.8) and 15.9% (95% CI 6.5 to 26.2) for Poaceae and Plantago, respectively. A positive association was also observed for Urticaceae (lag of 1 day) with an 8.4% increase (95% CI 2.8 to 14.4). CONCLUSIONS: There is an association between pollen levels and asthma related emergencies, independent of the effect of air pollutants. The marked relationship observed for Poaceae and Plantago pollens suggests their implication in the epidemic distribution of asthma during the period coinciding with their abrupt release into the environment.

Adolescent↗

PubMed2003

Short-term effects of air pollution on daily asthma emergency room admissions.

Many time-series studies have shown positive associations between air pollutants and asthma morbidity. However, few studies have included pollen as a potential confounder when examining this relationship. This study analysed the short-term association between air pollutants (sulphur dioxide (SO2), particles measured with a median aerodynamic diameter of <10 microm (PM10), nitrogen dioxide (NO2) and ozone (O3)) and asthma emergency room admissions in Madrid, Spain, in 1995-1998, adjusting for four types of pollen with allergenic potential (Olea europaea, Plantago sp., Poaceae and Urticaceae). Data were analysed using autoregressive Poisson regression and generalised additive models (GAM). The strongest associations were observed at 1 day lag for O3, and 3 days lag for the remaining pollutants. Using Poisson regression, a single-pollutant model showed that a 10-microg x m(-3) rise in pollutant level led to relative risks of: 1.039 for PM10; 1.029 for SO2; 1.033 for NO2; and 1.045 for O3. Adjustment for the different types of pollen led to no substantial variation in these associations. In the multipollutant models for cold-season pollutants (including PM10, SO2 and the four types of pollen) and photochemical pollutants (including NO2, O3 and the four types of pollen) the associations for PM10, NO2 and O3 held, but no relationship with SO2 was evident. GAM analysis yielded the same results, both in terms of lags and of quantification of the effect for all pollutants. In conclusion, the usual air pollution levels in Madrid were associated with an increase in asthma emergency room admissions, and this association remained controlling for the presence of ambient pollen.

Acute Disease↗

PubMed2002

[Descriptive study of first visits in a multiple sclerosis specialised unit].

BACKGROUND: The need for optimal care has led to implementation of multiple sclerosis care units, specialised in diagnosis and follow-up of multiple sclerosis patients. Since information on multiple sclerosis prognosis is crucial, accurate diagnosis is one of their major roles. METHOD: Prospective analysis of first visits during a year (origin and diagnosis) at the Unidad de Neuroinmunología Clínica of Hospital Vall d'Hebron. RESULTS: A total of 437 first visits were analysed; a moderate agreement (kappa = 0.468) between referral diagnoses and diagnosis at follow-up was obtained; agreement was very good (kappa = 0.844) between diagnosis at first visit and diagnosis at follow-up. In the subgroup of 200 patients with a demyelinating disease on follow-up after one year, 37.6% of referrals came from other non-specialised centers and 40.6% from our own center. CONCLUSION: Specialised care units enhance diagnostic precision; direct influence zone and non-specialised centers referrals are their more important sources of patients.

Adolescent↗

PubMed1996

[Interobserver variability in the evaluation of functional systems and Kurzke expanded disability status scale in a multiple sclerosis patient].

Changes in the progression of disability is still the main variable measured in clinical trials involving patients with multiple sclerosis (EM). The amplified scale of the state of disability (EEDA) of Kurtzke continues to be the most widely used scale. One of the most important limitations of the EEDA is interobserver variability. The object of our study was to find the interobserver variability between members of our EM unit in patients with EEDA between 0 and 3.5 when applying functional systems (SF) and EEDA. Seven patients with recurrent remittent EM (EEDA 0-3.5), participating in a multicentric trial with natural beta-interferon, were assessed monthly for 12 months by two of four neurologists. The SF were assessed and the EEDA applied separately and without knowing the former. 80 paired examinations were made. Complete concordance of SF was only seen when a variation of 2 points was allowed, while it was very high for a variation of 0 and 1 points. Complete concordance for EEDA was seen in 36.6% of the cases and only in 11% was there discordance of 1 or 1.5 points. The average variability of EDSS was 0.39. There was greater variability when the two scores were at different levels of incapacity.

Disability Evaluation↗

PubMedDate not supplied

[Validation of self-reported weight and height in an adolescent population].

INTRODUCTION: The aim of this study was to examine the relationship between self-reported population in order to evaluate the validity of self-reported measures for the purpose of estimating the prevalence of low (less-than-or-equal 15th percentile) and high (greater-than-or-equal 85th percentile) body mass index (BMI) in the study population. SUBJECTS AND METHOD: Information on self-reported and objective weight and height was obtained from a representative sample of 3,244 adolescents, aged 15-18 years, in secondary education schools in the Autonomous Community of Madrid. We calculated the mean relative error; the correlation between subjective and objective parameters, sensitivity, specificity and predictive value positive of low and high BMIs. RESULTS: The mean relative errors were as follows: weight: +0.07% for males versus and 0.79% for females; height, +0.51% for males versus +0.98% for females; BMI: 0.88% for males versus 2.63% for females. The correlation between self-reported and objective BMI was 0.87 for males and 0.90 for females. The prevalence of high BMI was underestimated by 34.1% and 34.4% of females white that of low BMI was overestimated by 10.7% of males and 14.8% of females. CONCLUSION: Analysis of BMI as a continuous variable, based on self-reported weight and height measurement data, entails a small margin of error. However, its use as a categorical variable involves a considerable underestimate of the prevalence of high BMI, and an smaller overestimate of the prevalence of low BMI.

Adolescent↗

PubMedDate not supplied

Different antiganglioside antibody pattern between relapsing-remitting and progressive multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is an autoimmune disorder, but an unique antigen has not been found. Antiganglioside antibodies (AGA) have been reported in MS, nevertheless, a clinical significance of AGA in MS has not been established. The aims of this study were to study AGA in sera of MS patients and to investigate relationships between AGA and clinical course of MS. MATERIAL AND METHODS: 42 patients with MS who fulfilled the criteria of clinically definite disease (59% RRMS, 21% SPMS, 20% PPMS), 89 patients with systemic lupus erythematosus and 36 healthy controls were studied. A modification of previously described ELISA techniques was used to estimate serum IgG and IgM anti-GM1, asialoGM1 and anti-GD1a antibodies. RESULTS: 47.6% of the patients showed AGA reactivity. Anti-GM1 was found in 38% of MS patients, anti-asialoGM1 in 23.8% and anti-GD1a in 33.3%. IgG was the isotype more commonly found. A correlation between presence of AGA and progressive disease and between anti-GD1a and PPMS was found. CONCLUSIONS: The presence of AGA in MS patients is elevated. In contrast with the results of others authors, a strong correlation between AGA and progressive disease is showed in our study.

Adult↗

PubMedDate not supplied

[Air pollutants and their monitoring].

Some basic concepts regarding air pollution are set out. Although, from a health care standpoint, our interest revolves around the impact which pollution has on human health, it being important to ascertain the main pollutants, the sources of emissions, the physiochemical properties thereof, the sampling and analysis methods which are used at the air pollution control stations, the limits set by the laws currently in impact and the World Health Organization recommendations with regard to the levels of immission. This study reviews these concepts with regard to the pollutants which have been analyzed in the Spanish Multicenter Study of Air Pollution and Mortality (EMECAM): particles, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). For this purpose, the most recent publications on this subject have been used, including part of what is going to be the line around which all of the measures aimed at combating air pollution are going to be revolving in the very near future, that is, the new set of European Union Directives (some currently in the proposal stage) and the latest recommendations (not as yet published) of the World Health Organization. Lastly, a wide range of aspects are set out which involve Public Health in the field of air pollution, despite the monitoring and control thereof falling to the environmental affairs authorities in terms of government organization.

Air Pollutants↗