Camino Rodríguez-Villar

Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus.

Aimsu2003 To compare the effects of a high‐carbohydrate (CHO) diet and a high‐monounsaturated fatty acid (MUFA) diet on LDL oxidative resistance in free‐living individuals with Type 2 diabetes mellitus.

Lack of interaction of apolipoprotein E phenotype with the lipoprotein response to lovastatin or gemfibrozil in patients with primary hypercholesterolemia

The magnitude of serum lipid changes in response to hypolipidemic drugs varies considerably between individuals. These differences may be due to interactions between genetic and environmental factors that effect drug bioavailability or the capacity of the lipid-regulating enzyme and receptor targets to be affected. The apolipoprotein E (apoE) gene locus has been examined in this regard, but reports are conflicting on the effect of its variability on the response to hypolipidemic drugs. We investigated the effect of apoE polymorphism on the serum lipid response to the hepatic hydroxymethyl glutaryl coenzyme A (HMG CoA) reductase inhibitor lovastatin and the fibric acid derivative gemfibrozil. Lipoprotein changes were assessed after 12 weeks of therapy in 106 patients with primary hypercholesterolemia and combined hyperlipidemia treated with lovastastin and in 63 given gemfibrozil therapy. No significant effect of the apoE phenotypes E3/2, E3/3, or E4/3 on the heterogeneity of lipid responses to either drug was found.

Recommendations for management of Chagas disease in organ and hematopoietic tissue transplantation programs in nonendemic areas

The substantial immigration into Spain from endemic areas of Chagas disease such as Latin America has increased the number of potential donors of organs and tissues. In addition, an increasing number of patients with advanced Chagas heart disease may eventually be eligible to receive a heart transplant, a universally accepted therapeutic strategy for the advanced stages of this disease. Therefore, it is necessary to establish protocols for disease management. This document is intended to establish the guidelines to be followed when a potential donor or a tissue or organ recipient is potentially affected by Chagas disease and summarizes the action criteria against the possibility of Chagas disease transmission through the donation of organs, tissues, or hematopoietic stem cells and aims to help professionals working in this field. A single registry of transplants in Trypanosoma cruzi infected donors and/or recipients will provide and disseminate experience in this area, which has shown a low recorded incidence to date.

Randomized crossover study of gemfibrozil versus lovastatin in familial combined hyperlipidemia: Additive effects of combination treatment on lipid regulation☆

The most appropriate therapy for combined hyperlipidemia remains to be determined. We compared the lipid-regulating effects of gemfibrozil and lovastatin in 30 patients with familial combined hyperlipidemia (FCHL) in a randomized, double-blind, placebo-controlled crossover study including 8-week courses of one drug followed by a washout period and a crossover phase to the alternate drug. After completion of the trial, open-label combination therapy was given for up to 12 months. Lovastatin was more efficacious than gemfibrozil in the reduction of total cholesterol (23% v. 9%, P<.001) and low-density lipoprotein (LDL) cholesterol (28% v. 2%, P<.001), whereas gemfibrozil surpassed lovastatin in the reduction of triglycerides (48% v. 0%, P<.001) and very-low-density lipoprotein (VLDL) cholesterol (50% v. 19%, P = .005) and the increase of high-density lipoprotein (HDL) cholesterol (18% v. 4%, P = .005). Lovastatin caused a greater decline in total apolipoprotein B (apo B) and LDL apo B than gemfibrozil, whereas VLDL apo B decreased only after gemfibrozil therapy. Drug-induced changes in lipoprotein composition indicated that gemfibrozil reduced both the number and size of VLDL particles and lovastatin decreased the number of LDL particles. Combined treatment was safe and had additive effects on lipids, causing significant (P<.001) reductions in total cholesterol (32%), triglycerides (51%), LDL cholesterol (34%), and apo B (26%) and an increase in HDL cholesterol (19%). Target LDL cholesterol levels were achieved only in 11% of patients given gemfibrozil alone and triglycerides decreased to target levels in 22% after lovastatin alone, whereas combined therapy normalized both lipid fractions in 96% of patients. Thus, in FCHL, gemfibrozil has no effect on LDL cholesterol levels but favorably influences the putative atherogenic alterations of lipoprotein composition that are related to hypertriglyceridemia. Conversely, lovastatin markedly decreases LDL cholesterol but has little effect on triglyceride-rich lipoproteins. Combination treatment safely corrects all of the lipid abnormalities in most patients.

Effects of insulin administration in a group of high-risk, non-diabetic, first-degree relatives of Type 1 diabetic patients : an open pilot trial

Aims To elucidate the effect of prophylactic insulin, in a treatment schedule previously demonstrated to achieve β‐cell rest, in a group of high‐risk, non‐diabetic first‐degree relatives of Type 1 diabetic patients.

Effects of insulin administration on β-cell function in subjects at high risk for type I diabetes mellitus☆

The aim of the study was to determine the appropriate dose of subcutaneous insulin to induce beta-cell rest without any hypoglycemic risk, as the first stop in the investigation of its potential effect in preventing or delaying clinical diabetes mellitus onset in high-risk subjects. Four subjects at high risk for type I diabetes mellitus (first-degree relatives, islet cell antibodies (ICA)-positive, and with diminished first-phase insulin secretion) were compared with four healthy individuals. After hospitalization, urinary C-peptide excretion (UCP) and 24-hour serum profiles for glucose were measured before and after administration of NPH insulin 0.1, 0.2, and 0.3 U x kg body weight per day subcutaneously in a single dose on 4 consecutive days. After insulin 0.1 U x kg body weight, a significant inhibition of endogenous insulin secretion was observed in high-risk subjects, but not in control subjects. There was no further inhibition when a higher insulin dose (0.2 and 0.3) was administered. A sustained beta-cell rest was obtained after 3, 6, and 12 months of treatment with 0.1 U x kg body weight per day as outpatient therapy in high-risk subjects. With this dose, no subject developed hypoglycemia (plasma glucose <50 mg/dL), whereas this adverse effect was detected after 0.2 and 0.3 U x kg body weight in both groups. In conclusion, our results indicate that administration of NPH insulin 0.1 U x kg bodyweight per day induces beta-cell rest without the undesirable effect of hypoglycemic episodes. This is a preliminary study to investigate the potential beneficial effect of insulin in preventing or delaying type I diabetes mellitus in subjects at high risk for the disease.

Optimizacion del proceso de donacion de tejidos en un hospital universitario: 10 anos de experiencia

BACKGROUND AND OBJECTIVEnThe demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks standards.nnnMATERIAL AND METHODnAn early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed.nnnRESULTSnA total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P<.00). The study indicated a total increase of 16% (P<.00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P<.00).nnnCONCLUSIONnA pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors rate.

Safety of hepatitis C virus (HCV)-treated donors for kidney transplantation excluding occult HCV infection through kidney biopsies

In 2011, the first Direct Acting Antiviral (DAA) agent was approved for HCV treatment, with high rates of sustained viral response (SVR). Absence of RNA-HCV viral load 12 weeks after end of treatment is considered as permanent viral eradication. However anti-HCV could remain positive despite successful antiviral therapy2.Moreover,HCV can infect extrahepatic tissues, including kidney. The infected extrahepatic tissues might play a role in both HCV persistence and reactivation of infection. This article is protected by copyright. All rights reserved.

The development of a predictive model of graft function in uncontrolled donors after circulatory death: validity of a pulsatile renal preservation machine cut-off value for kidney acceptance

BACKGROUNDnThe criteria for kidney suitability in uncontrolled donors after circulatory death (uDCD) procured after regional normothermic perfusion are based on macroscopic appearance and renal haemodynamic values with final renal resistance (FRR). However, these criteria have not been analysed to predict the future graft function. This study presents a model to predict the outcome in uDCD kidneys and define the predictive FRR value.nnnMETHODSnAll uDCD kidney transplants performed in our hospital from 2004 to 2016 were included. Donors and recipients and pre-transplantation data are described. The endpoint was glomerular filtration rate (GFR) ≥30u2009mL/min at 6u2009months after transplantation.nnnRESULTSnA total of 194 recipients were included. FRR in donors ≥60u2009years old was (meanu2009±u2009SD) 0.27u2009±u20090.11 versus 0.22u2009±u20090.09u2009mmHg/mL/min in donors <60u2009years (Pu2009=u20090.042). Kidney survival was 88.2% versus 84% at 12u2009months and 60.7% versus 30.8% at 120u2009months (Pu2009=u20090.067). For the group of recipients from donors ≥60u2009years, the FRR was 0.37u2009±u20090.08u2009mmHg/mL/min in the GFRu2009<30u2009mL/min group versus 0.18u2009±u20090.06u2009mmHg/mL/min in the GFR ≥30u2009mL/min group (Pu2009<u20090.001). The value FRR ≥0.3u2009mmHg/mL/min predicts 59-79% of GFR <30u2009mL/min [odds ratio = 2.16, 95% confidence interval (CI) 1.80-6.40; Pu2009<u20090.001]. The predictive accuracy of FRR for GFR by ROC curve was 0.968 (95% CI). The best cut-off for FRR was 0.3u2009mmHg/mL/min to predict GFR at 6u2009months with a sensitivity of 67%, specificity of 100%, positive predictive value of 83% and negative predictive value of 92%.nnnCONCLUSIONSnOur results suggest that in uDCD donors the combination of donor age ≥60u2009years together with FRR ≥0.3u2009mmHg/mL/min could predict poor outcome at 6u2009months after transplantation in low immunological risk recipients.

The effect of hyperglycemia on glipizide absorption in NIDDM patients.

suggest, or an experimental artifact for which we compensate by the use of an internal standard. In addition, the data are difficult to interpret, since the authors do not report whether they measured total chiro-inositol (the sum of D and L optical isomers) or the desired D enantiomer. Both occur in urine. Although not acknowledged in the paper (1), the reader should be aware that we have found increased D-chiroinositol in urine from predominantly Caucasian non-insulin-dependent and insulin-dependent diabetes subjects using quantitative GC/MS techniques with an internal standard (3). Our finding is thus exactly the opposite of the authors, who reported decreased urinary levels in non-insulin-dependent diabetes patients (1,2). In our work, elevated urinary excretion of D-chiro-inositol by diabetic subjects was strongly related to urinary glucose, plasma glucose, and glycated hemoglobin levels. Diabetic urine contains greatly increased quantities of many polyols and sugars (4), making trace analyses very difficult without extensive prepurification and the use of an internal standard. Thus, it is possible that the reduced urinary levels of D-chiro-inositol reported by the authors in diabetic subjects from both Japanese (1) and Caucasian (2) populations may have resulted from a GC/MS artifact. It would be important to resolve this question by cross-comparison of results and validation of the authors assays. Future work published in this area should include detailed documentation of the analytical methods used.