Antonio Dueñas-Laita

Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended‐spectrum beta‐lactamase (ESBL)‐producing enterobacteria

Aim:  Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended‐spectrum beta‐lactamase (ESBL)‐producing enterobacteria.

Epidemiology of Acute Carbon Monoxide Poisoning in a Spanish Region

Background: In Spain, as in most of the world, the incidence of acute carbon monoxide poisoning is probably underestimated. Methods: During an eighteen-month period we studied, by means of a standardized data collection form, all the cases of acute carbon monoxide poisoning that were diagnosed in 2 university hospitals. Results: During the study, 154 patients were diagnosed with carbon monoxide poisoning. The mean age was 32.2 ± 15.5 years. The two principal exposure sites were the kitchen (43%) and bathroom (23%). The majority of the cases related to malfunction of the water heater (30%) and of the central heating (23%) and 68% occurred in the home. Improper combustion of butane (31%), propane (13%), and natural gas (12%) were most frequent. The most prevalent clinical manifestations were headache (94%), dizziness (56%), nausea (45%), loss of consciousness (38%), and weakness (34%). Five patients died. In 14.4%, symptoms suggested delayed neurological syndrome. The largest number of cases of poisoning occurred during the months of December and January. Conclusions: Compared with previous Spanish series or with the antecedent year, acute carbon monoxide poisoning has a high prevalence in our region. Two factors appear to be essential to the accurate diagnosis of acute carbon monoxide poisoning: 1) the ability of emergency room physicians to recognize the clinical symptoms of carbon monoxide poisoning and 2) access to a carbon monoxide-oximeter.

Hypersensitivity to Generic Drugs with Soybean Oil

The authors report on two women who presented with anaphylaxis a few minutes after ingesting a generic omeprazole capsule. The generic drug that each of the women took contained approved soybean oil as an excipient.

Effect of the TNFα-308 G/A Polymorphism on the Changes Produced by Atorvastatin in Bone Mineral Density in Patients with Acute Coronary Syndrome

Aims: To evaluate the effect of atorvastatin on bone mass and markers of bone remodeling in patients with acute coronary syndrome depending on the tumor necrosis factor-α (TNFα)-308 G/A polymorphism. Methods: Sixty-two patients with acute coronary syndrome (35 males and 27 females), average age 60 ± 10 years, were included. Patients were given low (10–20 mg) and high doses (40–80 mg) atorvastatin according to their baseline levels of cholesterol and triglycerides and their index of vascular risk. Patients were studied during hospital admission (baseline) and at 12 months of follow-up. Cholesterol, triglycerides, total calcium, phosphorus, magnesium, osteocalcin and urinary deoxypyridinoline were determined in all patients at baseline and at 12 months of follow-up. Densitometric studies were conducted in the lumbar spine (L2–L4), femoral neck and trochanter using an X-ray densitometer. The TNFα-308 G/A polymorphism was determined by the polymerase chain reaction.Results:Forty-five patients were homozygous for G/G (72.5%) and 17 were heterozygous for G/A (27.5%). The prevalence of osteoporosis (T score ≤2.5 in the lumbar spine and/or hip) was 33% for the G/G genotype and 35% for the G/A genotype, with no statistically significant differences between groups. There was a statistically significant increase in bone mineral density (BMD) in the lumbar spine (1.107 ± 0.32 vs. 1.129 ± 0.23; p = 0.0001) in patients with the G/G genotype. No changes were observed in patients with the G/A genotype. Conclusion: In patients with acute coronary syndrome, atorvastatin increases lumbar spine BMD solely in patients with the G/G genotype of the TNFα-308 G/A polymorphism.

Levels of DKK1 in patients with acute myocardial infarction and response to atorvastatin

The Wnt-LPR5 signalling pathway plays an important role in skeletal homeostasis, especially in regulating osteoblastic activity. Activation of this pathway is regulated by various inhibitors, including DKK1. The objective of this study was to evaluate DKK1 levels in patients with ischemic heart disease, the response to atorvastatin and the relationship with bone mass. Twenty-one patients with acute myocardial infarction and twenty-three controls with a mean age of 61 ± 9 years with acute coronary syndrome were included. Patients were allocated to low (10-20mg) and high doses (40-80 mg) of atorvastatin according to baseline levels of cholesterol and triglycerides and the index of vascular risk. Patients were studied at hospital admission (baseline) and at 12 months of follow up. DKK1 was determined in all patients at baseline and at 12 months of follow up. Densitometric studies were conducted in the lumbar spine (L2-L4) and the femoral neck and trochanter using an X-ray densitometer. Patients had higher levels of DKK1 than controls, (111 ± 41 nmol/l versus 84 ± 27 nmol/l, p=0.014). Osteoporotic patients had higher levels of DKK1 (137.5 ± 33 nmol/l versus 95.4 ± 36 nmol/l, p=0.021). Analysis of the response to atorvastatin showed reduced DKK1 levels. In conclusion, in patients with acute coronary syndrome, atorvastatin decreases DKK1 levels. This may be a previously unreported mechanism of action of atorvastatin on bone, stimulating the Wnt signalling pathway and increasing bone mass.

Disponibilidad de antídotos en caso de accidentes o atentados con armas químicas

Fundamento Conocer la disponibilidad hospitalariade 6 antidotos utilizables en victimasde accidentes o atentados con armasquimicas. Material y metodo Encuesta telefonica a 6hospitales catalanes y 8 de la Comunidadde Castilla y Leon. Evaluacion de la disponibilidadde antidotos en el hipotetico casode una intoxicacion masiva con 600 afectados. Resultados De los 14 hospitales, unicamentetres disponian de los 6 antidotos encuestados.Solo la atropina y, en hospitalescatalanes, el tiosulfato sodico se encontrabanen cantidad suficiente para tratar al100% de las victimas. Con el resto de losantidotos, el porcentaje de enfermos tratadoshabria sido inferior al 50%. El antidotocon menor disponibilidad era la hidroxocobalamina. Conclusiones En los hospitales encuestadosse han constatado deficiencias antidoticas,tanto de tipo cualitativo como cuantitativo,para atender a los pacientes intoxicados conarmas quimicas.

Celiac Disease and Osteoporosis: A Review

Celiac disease is a highly-prevalent autoimmune disease characterized by chronic intestinal inflammation. Osteoporosis may be a complication of celiac disease in both the classic presentation where digestive symptoms predominate and in subclinical forms where it may be the initial manifestation of the disease. Various etiopathogenic mechanisms have been reported in osteoporosis which may explain its appearance in celiac disease. There are no studies of sufficient quality evaluating the prevalence of osteoporosis in celiac disease in accordance with World Health Organization densitometric criteria. Although an increased risk of osteoporotic fracture has been reported, bone mineral density testing in patients with celiac disease is not cost-effective. A gluten-free diet increases bone mass to nearly-normal levels and specific treatment for patients with a high risk of osteoporotic fracture is required. There are no studies analyzing the efficacy of anabolic and anti-catabolic drugs in patients with celiac disease.

Documento de consenso sobre bloqueadores de los receptores betaadrenérgicos y consumo de cocaína

Cocaine use has risen exponentially in all European countries, particularly Spain and the United Kingdom, with a prevalence of users per capita very similar to that of the United States.1 The fact that cocaine use has become more widespread among Spanish youth is a matter of major concern.2 As a result, the number of users treated in hospital emergency rooms for medical problems resulting from acute intoxication,3 such as chest pain,4 has increased. The extent of the problem in terms of chronic effects, particularly cardiovascular effects,5 remains to be seen; these effects are likely to be associated with coronary disease.6,7 We have read with interest the consensus document on the use of beta-blockers written by a task force of the European Society of Cardiology and published in the Revista Espanola de Cardiologia,8 and would like to point out that no mention was made that these medications are contraindicated when an acute cardiac condition coexists with cocaine intoxication or overdose. In the case of acute coronary syndrome associated with cocaine use, vasospasms worsen in hypertensive patients treated with propranolol.9 Labetalol and esmolol are not effective, and alpha-adrenergic stimulation may actually exacerbate vasospasm and hypertension.10,11 Hence, benzodiazepines, nitroglycerin, and aspirin are recommended as first-line drugs. Alphaadrenergic receptors (phentolamine) and calcium blockers (verapamil) would be used for second-line hypertension therapy. In cases of ST segment elevation, primary percutaneous coronary angioplasty is recommended over fibrinolysis, which has a higher incidence of coronary vasospasm and a greater risk of bleeding in other organs.4 As toxicologists and emergency room physicians, we consider that the attending physician should take this contraindication into consideration not only in patients first seen for an acute coronary syndrome, but also in patients whose clinical condition

Expression of genes related to energy metabolism (osteocalcin, FOXO1, insulin receptor, and SOST) in bone cells of Goto-Kakizaki rats and response to bariatric surgery

OBJECTIVES The aim of this experimental study was to evaluate the expression of 4 genes (osteocalcin, sclerostin (SOST), insulin receptor, and transcription factor forkhead box protein (FOXO1) in the bone cells of Goto-Kakizaki (GK) rats and the expression of these genes in response to bariatric surgery. METHODS We designed an experimental study with 3 arms (Wistar rats, nonoperated GK rats, and GK rats with gastrojejunal bypass). Gene expression (osteocalcin, insulin receptor, FOXO1, SOST) was measured at baseline and after surgery. Plasma levels of glucose, insulin, homeostasis model assessment (HOMA), glucagon-like peptide 1 (GLP-1), and the production of insulin were measured at baseline and at 60 minutes by pancreatic islets. RESULTS GK rats had decreased levels of expression of osteocalcin (50.86 ± 19.21 versus 16.78 ± 22.11, P = .031), insulin receptor (1.45 ± .44 versus .54 ± .35, P = .020), and SOST (.92 ± .05 versus .43 ± .47, P = .048) compared with Wistar rats. Gene expression in GK rats, operated and nonoperated, was similar. In nonoperated GK rats, there was a negative correlation between the SOST gene and plasma insulin (r:-.786, P = .021) and the production of insulin by pancreatic islets at 60 minutes (r:-0.857, P = .014). GLP-1 increased after surgery. CONCLUSION Diabetic GK rats presented a reduced expression of the osteocalcin, insulin receptor, and SOST genes. There was an inverse relationship between SOST and plasma and local insulin. We found no changes in the expression of bone genes that regulate energy metabolism after gastrojejunal bypass.

Clinical significance of cross-reactivity between tobacco and latex.

BACKGROUND Allergen cross-reactivity between tobacco and other species of Solanaceae family (tomato, potato, aubergine and egg plant) have been reported. We have recently studied IgE response to tobacco in asthmatic patients sensitised to Lolium perenne (Perennial rye grass pollen) and have found that 30% of the tobacco responsive patients also have latex sensitisation. OBJECTIVE The aim of our study was to investigate the possibility of cross-reactivity between tobacco and latex in asthmatic patients with IgE response to latex. METHODS A study was performed on tobacco and latex exposure in 15 patients who suffered from asthma and latex sensitisation and who were randomly chosen from our database of latex-sensitive patients. To identify tobacco and latex as possible allergens that might cause clinical specific responses, all these patients were tested with prick-tests, specific IgE to tobacco, latex and related allergens, bronchial challenge, and patch tests with tobacco, latex and nicotine. Immunological response was evaluated with immunoblotting, immunoblotting-inhibition and EAST-inhibition tests. RESULTS Positive prick and bronchial challenge with specific IgE>0.35 kU/L to tobacco was demonstrated in 11 asthmatics who were also sensitised to rye grass. Tobacco IgE level was related with sensitisation to latex (p<0.002), but not to other vegetables belonging to the Solanaceae family. EAST-inhibition and immunoblotting-inhibition showed the existence of cross-reactivity between tobacco and latex. CONCLUSIONS Cross-reactivity exists between latex and tobacco allergens. Smoker patients with IgE response to tobacco may be a risk population for latex sensitisation.