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Luis de la Fuente

Publications and source records attributed to Luis de la Fuente.

At least 19 recordsLinked to original sources
PubMed2006

Poor validity of self-reported HBV vaccination among young heroin users in Spain supports the policy "don't ask, draw a blood sample, vaccinate and try to schedule another visit".

OBJECTIVES: To assess the validity of self-reported hepatitis B virus vaccination status in young heroin users. STUDY DESIGN: Cross-sectional study among 949 street-recruited young injection heroin users (IHUs) and non-injection heroin users (NIHUs) in Madrid, Barcelona and Seville. Face-to-face interviews and dried blood spot tested for anti-HBc and anti-HBs. The validity of self-reported vaccination status was assessed comparing with the serological status. The percentage of agreement with the kappa (kappa) statistic and the positive predictive value were calculated. RESULTS: The percentage of agreement between self-reported and serologic vaccination status was 51.9% overall, with little difference by city (53.1% in Barcelona, 49.0% in Madrid and 51.5% in Seville) or between IHUs (51.3%) and NIHUs (53.0%). All the kappa scores were lower than 0.1. The positive predictive value of self-reports was less than 25% in all categories analysed, except in the city of Barcelona (37%). Among those who indicated that they had been vaccinated, 31% were actually susceptible. CONCLUSIONS: In areas with a high prevalence of infection and rising coverage of vaccination the policy "don't ask, take a blood sample, give a dose of vaccine and try to schedule another visit" should be recommended in clinical practice.

Adolescent↗
PubMed2006

Do young heroin users in Madrid, Barcelona and Seville have sufficient knowledge of the risk factors for unintentional opioid overdose?

To identify the self-perceived reasons for unintentional opioid overdose of young heroin users in three Spanish cities and their agreement with objective risk factors for overdose. Computer-Assisted Personal Interviews (CAPI) were held with 991 street-recruited current heroin users aged 18-30. The general reasons for overdose and the reasons for the last overdose suffered were explored with open-ended (OEQs) and pre-coded questions (PCQs). Limited knowledge of overdose risk factors was defined as mention of fewer than two objective risk factors for unintentional overdose in the OEQ. Univariate, bivariate, and logistic regression methods were used. 77.8% (Seville), 64.9% (Madrid) and 57.2% (Barcelona) of participants have limited knowledge of overdose risk factors. Residence in Seville and not having attended courses or meetings on overdoses were significantly associated with limited knowledge, after adjusting for other factors. The most frequently identified general reasons in OEQ or PCQ were using heroin in large amounts (66.8%), together with tranquilizers (62.0%), adulterated (60.7%), or purer than usual (57.6%). Most reasons were selected more frequently in PCQ than in OEQ, especially rapid injection of the entire dose and using heroin shortly after using tranquilizers or alcohol, by injection, or after a period of abstinence. The results were similar for overdoses suffered by participants. Most young heroin users do not have sufficient knowledge of overdose risk factors, especially the use of heroin by injection, after a period of abstinence, or together with alcohol or methadone. Specific informational or educational programs adapted to the local context are critically needed.

Adolescent↗
PubMed2006

Injecting and HIV prevalence among young heroin users in three Spanish cities and their association with the delayed implementation of harm reduction programmes.

OBJECTIVES: To evaluate changes in the prevalence of HIV infection among young heroin users in three Spanish cities, and their association with harm reduction programmes (HRPs). METHODS: Two cross sectional studies. The 1995 study included 596 users; half were street recruited and half were recruited at drug treatment centres. The 2001-03 study included 981 street recruited users. Face to face interviews were conducted using a structured questionnaire. Samples for HIV testing (saliva in 1995 and dried blood spot in 2001-03) were collected. RESULTS: The proportion who had ever injected (IDUs) decreased in all three cities. HIV prevalence in IDUs decreased by half in Barcelona (44.1% to 20.8%) and Seville (44.2% to 22.2%), but remained constant in Madrid (36.8% and 34.9%). This difference was attributable to a decrease in HIV prevalence in long term IDUs in Barcelona and Seville, but not in Madrid. The crude odds ratio for HIV prevalence in Madrid compared with Barcelona in long term IDUs was 2.3 (95%CI 1.4 to 3.7), increasing to 3.1 (95%CI 1.5 to 6.2) after adjusting for sociodemographic and risk factors. HIV prevalence in short term IDUs was similar in all cities. In 1992 Barcelona already had 20 heroin users in methadone maintenance programmes (MMPs) per 10 000 population aged 15-49 years; Seville reached this rate in 1994, and Madrid, not until 1998. CONCLUSIONS: The prevalence of HIV infection did not decrease in long term injectors in Madrid. The delayed implementation of HRPs, especially MMPs, may be the most plausible hypothesis. This finding should shed light on decision making in countries in a similar epidemiological and sociological situation.

Adolescent↗
PubMed2005

HTLV infection among young injection and non-injection heroin users in Spain: prevalence and correlates.

BACKGROUND: Although some studies have described the epidemiology of infection with HIV or hepatitis B and C in young users in Spain - one of the European countries with the highest prevalences - there are no studies of the prevalence of HTLV infection and the most important associated factors. OBJECTIVES: To evaluate the prevalence and main determinants of HTLV-1 and HTLV-2 infection in young heroin users (including both injection (IDUs) and non-injection drug users (NIDUs)) recruited outside health care services in three of Spain's principal cities. STUDY DESIGN: Cross-sectional cohort study. All participants (981) were street-recruited by chain referral procedures between April 2001 and December 2003. Face-to-face interviews were conducted using a structured questionnaire and dried blood spot samples were collected for serological testing. RESULTS: No sample was positive for HTLV-1 and 27 samples were positive for HTLV-2; all of these were found only in Spanish IDUs in the cities of Madrid (17, 6.2%) and Barcelona (10, 3.5%). The only two factors significantly associated with HTLV infection in the logistic regression analysis were HIV infection (OR 5.7; 95% CI 2.2-14.8) and having injected in the last 30 days (OR 6.5; 95% CI 1.4-29.8). Having been in prison (OR 2.4; 95% CI 0.9-6.4) and HCV infection (OR 3.8; 95% CI 0.5-30.7), which were strongly and significantly associated in the bivariate analysis, were no longer significant in the logistic analysis. Almost the same variables were selected in the tree analysis, in which subjects could be classified into three groups: high prevalence (28.5%, HIV+ and HBV+ who had injected in the last 30 days), medium prevalence (17.8%) and low (<3%) or zero prevalence (HIV-, HCV- and HBV-). CONCLUSIONS: HTLV-1 was not detected among young Spanish heroin users. HTLV-2 was not found in NIDUs (perhaps due to the low rate of sexual transmission); it was found only in IDUs from Madrid and Barcelona, but not in those from Seville. Its prevalence is very low and the main correlates of infection were HIV infection and injection as the usual route of heroin administration.

Adolescent↗
PubMed2005

Indian hedgehog synchronizes skeletal angiogenesis and perichondrial maturation with cartilage development.

A null mutation in the morphogen Indian hedgehog (IHH) results in an embryonic lethal phenotype characterized by the conspicuous absence of bony tissue in the extremities. We show that this ossification defect is not attributable to a permanent arrest in cartilage differentiation, since Ihh(-/-) chondrocytes undergo hypertrophy and terminal differentiation, express angiogenic markers such as Vegf, and are invaded, albeit aberrantly, by blood vessels. Subsequent steps, including vessel expansion and persistence, are impaired, and the net result is degraded cartilage matrix that is devoid of blood vessels. The absence of blood vessels is not because the Ihh(-/-) skeleton is anti-angiogenic; in fact, in an ex vivo environment, both wild-type and Ihh mutant vessels invade the Ihh(-/-) cartilage, though only wild-type vessels expand to create the marrow cavity. In the ex vivo setting, Ihh(-/-) cells differentiate into osteoblasts and deposit a bony matrix, without benefit of exogenous hedgehog in the new environment. Even more surprising is our finding that the earliest IHH-dependent skeletal defect is obvious by the time the limb mesenchyme segregates into chondrogenic and perichondrogenic condensations. Although Ihh(-/-) cells organize into chondrogenic condensations similar in size and shape to wild-type condensations, perichondrial cells surrounding the mutant condensations are clearly faulty. They fail to aggregate, elongate and flatten into a definitive, endothelial cell-rich perichondrium like their wild-type counterparts. Normally, these cells surrounding the chondrogenic condensation are exposed to IHH, as evidenced by their expression of the hedgehog target genes, patched (Ptch) and Gli1. In the mutant environment, the milieu surrounding the cartilage -- comprising osteoblast precursors and endothelial cells -- as well as the cartilage itself, develop in the absence of this important morphogen. In conclusion, the skeletal phenotype of Ihh(-/-) embryos represents the sum of disturbances in three separate cell populations, the chondrocytes, the osteoblasts and the vasculature, each of which is a direct target of hedgehog signaling.

Alleles↗
PubMed2005

Molecular epidemiology of HTLV-2 infection among intravenous drug users in Spain.

BACKGROUND: HTLV-2 infection is prevalent among intravenous drug users (IDUs), which often are coinfected with HIV-1. Two main subtypes, HTLV-2a and -2b, have been described among European IDUs, with a characteristically geographic distribution: IIa in northern Europe and IIb in the south. Although frequent traveling within Europe might have favoured a wide dissemination of diverse HTLV-2 variants, HTLV-2b was so far the only subtype reported in Spain. OBJECTIVE: To investigate the current molecular epidemiology of HTLV-2 in Spain. STUDY DESIGN: Twenty-six new HTLV-2 strains isolated from IDUs over the last 11 years in different geographic regions were examined. The HTLV LTR region (620bp) was sequenced and phylogenetic analyses were performed. Endonuclease restriction sites were examined to further characterize the HTLV-2 subgroup. RESULTS: All 26 individuals infected with HTLV-2 showed viruses belonging to the HTLV-2 b4 clade and were closely related to the previously reported HTLV-2 Spanish and Italian IDU isolates. CONCLUSIONS: HTLV-2 subtype b4 continues to be the only HTLV-2 subgroup recognized so far in Spain and no introduction of other HTLV-2 variants has occurred over the last 11 years.

Adult↗
PubMed2005

The fickle finger of fate.

In this issue of the JCI, Niedermaier and colleagues demonstrate that a chromosomal inversion in mice results in dysregulation of Sonic hedgehog (Shh), such that Shh is ectopically expressed in a skeletogenic domain typically occupied by Indian hedgehog (Ihh). This molecular reversal eliminates phalangeal joint spaces, and consequently, Short digits (Dsh) heterozygotes (Dsh/+) have brachydactyly (shortened digits). Ihh is normally downregulated in regions that will become the joint space, but in Dsh/+ mice, Shh bypasses this regulatory control and persists; accordingly, cells maintain their chondrogenic fate and the developed digits are shorter than normal. The significance of these data extends far beyond the field of skeletal biology: they hint at the very real possibility that the endogenous Shh regulatory region contains a repressor designed to segregate the activity of Shh from Ihh. The existence of such a repressor provides a window into the distant past, revealing that Shh and Ihh must once have shared responsibilities in establishing tissue boundaries and orchestrating vertebrate tissue morphogenesis.

Animals↗
PubMed2004

[Estimating mortality attributed to illegal drug use in Spain].

BACKGROUND AND OBJECTIVE: The impact of illegal drug consumption on general mortality in Spain is unknown. We aimed to quantify this impact for the period 1994-2000. SUBJECTS AND METHOD: Number of directly drug-related deaths from HIV among injecting drug users as well as others -- both taken from the General Mortality Register (GMR). Next, corrections were made, multiplying the aforementioned figures by the percentage of injecting drug users in the AIDS register in the first case, and by the underestimation index in the second. This index was calculated comparing the GMR with the specific drug-related register in certain areas. RESULTS: In Spain, mortality from illegal drug use fell from 22.7 per 100,000 inhabitants, aged 15-49 years (16.4% of all deaths) in 1996 to 8.9/100,000 in 2000 (7.8% of all deaths), meaning a 58% decrease in general mortality. In 2000, drug-related deaths surpassed AIDS mortality in the group of men aged 15-49 years. CONCLUSIONS: Illegal drug use continues to be an important cause of death among young people in Spain. Overdose is the most likely primary cause of death in drug consumers.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Experimental and clinical regenerative capability of human bone marrow cells after myocardial infarction.

Bone marrow mononuclear cells (BMCs) from 20 patients with extensive reperfused myocardial infarction (MI) were used to assess their myocardial regenerative capability "in vitro" and their effect on postinfarction left ventricular (LV) remodeling. Human BMCs were labeled, seeded on top of cryoinjured mice heart slices, and cultured. BMCs showed tropism for and ability to graft into the damaged mouse cardiac tissue and, after 1 week, acquired a cardiomyocyte phenotype and expressed cardiac proteins, including connexin43. In the clinical trial, autologous BMCs (78+/-41x10(6) per patient) were intracoronarily transplanted 13.5+/-5.5 days after MI. There were no adverse effects on microvascular function or myocardial injury. No major cardiac events occurred up to 11+/-5 months. At 6 months, magnetic resonance showed a decrease in the end-systolic volume, improvement of regional and global LV function, and increased thickness of the infarcted wall, whereas coronary restenosis was only 15%. No changes were found in a nonrandomized contemporary control group. Thus, BMCs are capable of nesting into the damaged myocardium and acquire a cardiac cell phenotype in vitro as well as safely benefiting ventricular remodeling in vivo. Large-scale randomized trials are needed now to assess the clinical efficacy of this treatment.

Aged↗
PubMed2004

[Rate of infection by blood-borne viruses in active heroin users in 3 Spanish cities].

BACKGROUND AND OBJECTIVE: The objective of this paper was to determine the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and human T lymphotropic virus (HTLV) infections in active heroin users in Spain. SUBJECTS AND METHOD: A cross-sectional study was carried out in 440 heroin users in three different urban areas of Spain: Barcelona, Madrid, and Seville. Specimens were analyzed for the presence of anti-HIV, anti-HCV, anti-HBc, and anti-HTLV antibodies. RESULTS: The rate of anti-HIV antibodies was 20% (CI 95%, 16.3-23.7%); anti-HBc: 21.4% (CI 95%, 17.5-25.2%); anti-HCV: 59.1% (CI 95%, 54.5-63.7%); and anti-HTLV (HTLV-II in all cases): 3.4% (CI 95%, 1.7-5.1%). Barcelona and Madrid had similar rates for each virus, yet these were lower in Seville especially with regard to HCV (Barcelona: 59.7% [CI 95%, 53.1-66.3%]; Madrid: 63.8% [CI 95%, 56.7-70.9%]; Seville: 41.8% [CI 95%, 28.8-54.9%]). CONCLUSIONS: HCV is the most prevalent infection among active heroin users in Spain. The rate of infection by blood-borne viruses is higher in Madrid and Barcelona than in Seville (notably for HCV), most likely due to a lower rate of intravenous users in this city.

Adult↗
PubMed2004

[Intracoronary stem cell transplantation in acute myocardial infarction].

INTRODUCTION AND OBJECTIVES: Experimental and clinical studies suggest that necrotic myocardium may have the capacity to regenerate. We have started a clinical study to demonstrate that the intracoronary implantation of stem cells is feasible and safe. The results in our first 5 patients are presented here. PATIENTS AND METHOD: We included patients with anterior acute myocardial infarction and isolated stenosis of the left anterior descending artery that was successfully repaired by primary or facilitated angioplasty. Patients received an intracoronary infusion of bone marrow-derived cells 10-15 days after the infarction. The follow-up protocol included low-dose dobutamine echocardiography, magnetic resonance studies and ECG Holter monitoring. RESULTS: The procedure was carried out with no complications. No patient had a cardiac event during the first 6 months. One patient had a transient ischemic attack without sequelae. No arrhythmias were found. Left ventricular end-diastolic volume remained the same at 6 months (159+/-25 ml, 157+/-16 ml), left ventricular end-systolic volume decreased (77+/-22 ml, 65+/-16 ml), and the ejection fraction increased (53+/-7%, 58+/-8%) although no statistically significant differences were found. In the 3 patients in whom dobutamine echocardiography ruled out viability, we found a significant reduction in both volumes. CONCLUSIONS: Intracoronary bone marrow-derived cell transplantation after an acute myocardial infarction seems to be safe and feasible, and might lead to favorable remodeling.

Aged↗
PubMed2004

Spontaneous coronary dissection during postpartum: etiology and controversies in management.

A 31-year-old female with a history of toxic oil syndrome in childhood, presented with spontaneous left main coronary dissection 4 weeks after an uncomplicated delivery. She had an extensive myocardial infarction, severe left ventricular dysfunction and cardiogenic shock which did not resolve following urgent surgical revascularization. Temporary left ventricular support and heart transplantation were necessary. We analyze the etiology and treatment sequence in what to our knowledge is the first case with these characteristics to be reported.

Adult↗
PubMed2003

Molecular ontogeny of the skeleton.

From a traditional viewpoint, skeletal elements form by two distinct processes: endochondral ossification, during which a cartilage template is replaced by bone, and intramembranous ossification, whereby mesenchymal cells differentiate directly into osteoblasts. There are inherent difficulties with this historical classification scheme, not the least of which is that bones typically described as endochondral actually form bone through an intramembranous process, and that some membranous bones may have a transient chondrogenic phase. These innate contradictions can be circumvented if molecular and cellular, rather than histogenic, criteria are used to describe the process of skeletal tissue formation. Within the past decade, clinical examinations of human skeletal syndromes have led to the identification and subsequent characterization of regulatory molecules that direct chondrogenesis and osteogenesis in every skeletal element of the body. In this review, we survey these molecules and the tissue interactions that may regulate their expression. What emerges is a new paradigm, by which we can explain and understand the process of normal- and abnormal-skeletal development.

Animals↗
PubMed2003

Reasons for selecting an initial route of heroin administration and for subsequent transitions during a severe HIV epidemic.

AIM: To identify the most important reasons for selecting a particular route of heroin administration and for subsequent transitions during a period of epidemic HIV transmission. To study temporal trends in these reasons. DESIGN: Cross-sectional survey. PARTICIPANTS: Nine hundred heroin users in three Spanish cities: 305 in Seville, 297 in Madrid and 298 in Barcelona. MEASUREMENTS: A separate analysis was made of the reasons for five types of behaviour: (a) selecting injection as the initial usual route of heroin administration (URHA); (b) changing the URHA to injection; (c) never having injected drugs; (d) selecting the smoked or sniffed route as the initial URHA; and (e) changing the URHA to a non-injected route. Subjects were invited to evaluate the importance of each reason included in a closed list. Spontaneously self-perceived reasons were also explored in an open-ended question for each of the five types of behaviour studied. FINDINGS: The primary reason selected for each type of behaviour was: (a) pressure of the social environment; (b) belief that injection is a more efficient route than smoking or sniffing heroin; (c) concern about health consequences (especially fears of HIV and overdose), and fear of blood or of sticking a needle into one's veins; (d), pressure of the social environment and (e) concern about health consequences and vein problems. For women, having a sexual partner who injected heroin played a decisive role in initiating or changing to injection. Few people spontaneously mentioned market conditions for purchasing heroin as an important reason for any behaviour, nor did many mention risk of overdose as reasons for (c) or (d). CONCLUSIONS: These findings should be considered when designing interventions aimed at preventing initiation of injecting or facilitating the transition to non-injected routes.

Administration, Inhalation↗
PubMed2003

Unusually strong association between education and mortality in young adults in a community with a high rate of injection-drug users.

BACKGROUND: To examine the association between education and mortality for various causes of death in young adults in a community with a high rate of injection-drug users. METHODS: Linked mortality study based on mortality records for 1996 and 1997 and on 1996 population census data from the Region of Madrid (Spain). The association between educational level and mortality was estimated by the mortality rate ratio. RESULTS: After adjustment for age and other socioeconomic variables the mortality rate in men and women aged 25-44 years with no education was, respectively, 4.7 and 3.7 times higher than in men and women with the highest educational level. The causes of death with the strongest association were chronic liver disease and cirrhosis, AIDS and diseases of the heart in both sexes and suicide in men. For these causes of death the mortality rate ratio between persons with the lowest and highest educational level ranged from 6.8 to 21.8 in men and from 4.1 to 16.9 in women. CONCLUSIONS: These causes of death are the leading specific causes of death in persons aged 25-44 years. Given that probably a substantial part of deaths from diseases of the heart in this age category are drug-related, the common denominator of the excess mortality related poor education seems to be drug injection.

Adult↗
PubMed2002

Coronary stent implantation in patients older than 75 years of age: clinical profile and initial and long-term (3 years) outcome.

OBJECTIVE: The objective of this study was to compare the initial and long-term outcome of elderly and younger patients after coronary stent implantation. METHODS: The evolutions of 76 patients aged >75 years and of 860 patients aged < or =75 years who underwent consecutive stenting (from June 1991 to June 1997) were compared in a cohort study. RESULTS: The elderly patients had lower left ventricular ejection fractions (0.58 +/- 0.14 vs 0.61 +/- 0.13; P =.03) and more frequently had unstable angina (78.9% vs 55.3%; P <.0001), previous heart failure (10.5% vs 4.9%; P =.03), and multivessel disease (68.4% vs 58.3%; P =.08). After the procedure, the elderly patients showed a higher inhospital mortality rate (6.6% vs 2.4%; P =.03) and myocardial infarction rate (5.3% vs 1.7%; P =.04). The long-term follow-up period (mean, 3.2 +/- 1.4 years; median, 3.0 years) showed in the elderly a higher mortality rate (15.4% vs 5.8%; P =.006), a lower rate of repeat revascularization (9.2% vs 19.7%; P =.04), and a similar incidence rate of major adverse cardiac events (27.7% vs 28.2%; P =.93). Multivariate analysis of the elderly group identified female gender (hazard ratio, 2.19; 95% CI, 1.18 to 4.06; P =.012) and presence of multivessel disease (hazard ratio, 2.35; 95% CI, 1.05 to 5.26; P =.037) as independent predictors of further events. CONCLUSION: Patients aged >75 years have a less favorable baseline profile and higher inhospital and 3-year mortality rates. However, the incidence rate of major adverse cardiac events in the long term is acceptable and similar to that of younger patients.

Adult↗