European University of the Canary Islands
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Valvulitis: un nuevo criterio ecocardiográfico para el diagnóstico de endocarditis infecciosa de bioprótesis de válvula aórtica
No full textIntroduction and objectives: Diffuse homogeneous hypoechoic leaflet thickening, with a wavy leaflet motion documented by transesophageal echocardiography (TEE), has been described in some cases of prosthetic valve endocarditis (PVE) involving aortic bioprosthesis (AoBio-PVE). This echocardiographic finding has been termed valvulitis. We aimed to estimate the prevalence of valvulitis, precisely describe its echocardiographic characteristics, and determine their clinical significance in patients with AoBio-PVE.
Methods: From 2011 to 2022, 388 consecutive patients with infective endocarditis (IE) admitted to a tertiary care hospital were prospectively included in a multipurpose database. For this study, all patients with AoBio-PVE (n = 86) were selected, and their TEE images were thoroughly evaluated by 3 independent cardiologists to identify all cases of valvulitis.
Results: The prevalence of isolated valvulitis was 12.8%, and 20.9% of patients had valvulitis accompanied by other classic echocardiographic findings of IE. A total of 9 out of 11 patients with isolated valvulitis had significant valve stenosis, whereas significant aortic valve regurgitation was documented in only 1 patient. Compared with the other patients with AoBio-PVE, cardiac surgery was less frequently performed in patients with isolated valvulitis (27.3% vs 62.7%, P = .017). In 4 out of 5 patients with valve stenosis who did not undergo surgery but underwent follow-up TEE, valve gradients significantly improved with appropriate antibiotic therapy.
Conclusions: Valvulitis can be the only echocardiographic finding in infected AoBio and needs to be identified by imaging specialists for early diagnosis. However, this entity is a diagnostic challenge and additional imaging techniques might be required to confirm the diagnosis. Larger series are needed.Introducción y objetivos: En pacientes con endocarditis de válvula prótesica sobre bioprótesis aórtica (EVP-AoBio) se ha descrito un engrosamiento difuso homogéneo e hipoecoico de las valvas, por ecocardiografía transesofágica (ETE), con movimiento ondulante de estas. Este hallazgo ha sido denominado valvulitis. Nuestro objetivo es estimar la prevalencia de valvulitis en pacientes con EVP-AoBio, describir con precisión sus características ecocardiográficas y determinar su significado clínico.
Métodos: Desde 2011 hasta 2022, se incluyó en una base de datos multipropósito a 388 pacientes consecutivos con endocarditis de un hospital terciario. Para este estudio, se seleccionó a todos los pacientes con EVP-AoBio (n = 86), cuyas imágenes de ETE 3 cardiólogos revisaron de manera independiente para identificar casos de valvulitis.
Resultados: La prevalencia de valvulitis aislada fue del 12,8%, y el 20,9% de los pacientes presentaron valvulitis acompañada de otros hallazgos ecocardiográficos clásicos de endocarditis. De 11 pacientes con valvulitis aislada, 9 tenían estenosis valvular significativa, mientras que solo 1 caso mostró insuficiencia valvular significativa. Se practicó cirugía cardiaca con menos frecuencia que en otros sujetos con EVP-AoBio (el 27,3 frente al 62,7%; p = 0,017). En 4 de 5 pacientes con estenosis valvular que no fueron operados, se observó una mejora significativa en los gradientes tras un tratamiento antibiótico.
Conclusiones: La valvulitis puede ser el único hallazgo ecocardiográfico en la endocarditis infecciosa sobre bioprótesis de válvula aórtica y es necesario que los especialistas en imagen la reconozcan para un diagnóstico temprano. Sin embargo, supone un reto diagnóstico y pueden ser necesarias técnicas de imagen adicionales. Se necesitan series más amplias.Sin financiación5.9 Q1 JCR 20221.991 Q1 SJR 2023No data IDR 2022UE
Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial
No full textAim: To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders.
Methods: An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis.
Results: Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period.
Conclusion: The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.Instituto de Salud Carlos III through the project “PI18/00767” (Co-funded by European Regional Development Fund/European Social Fund “A way to make Europe”/“Investing in your future”)5.2 Q1 JCR 20220.895 Q1 SJR 2023No data IDR 2023UE
Bioethical knowledge in students and health professionals. A systematic review
No full textIntroduction: Bioethics training is essential for healthcare professionals as it enables them to address ethical dilemmas in their clinical practice. However, there is still a lack of rigorous teaching programs, and assessing bioethical knowledge poses challenges.
Methodology: Systematic review using the PRISMA method.
Results: Analysis of 27 studies reveals a lack of ethical knowledge and skills among healthcare professionals and students. Specific training in bioethics is effective in developing bioethical competencies. Different approaches have been employed, including integrated training in academic curricula and intensive or ongoing programs. The results demonstrate improvements in knowledge, attitudes, and ethical values, although regularly updating these courses is recommended.
Conclusion: Specific training, institutional support, and considering regional and disciplinary differences are necessary to enhance ethics in the practice of healthcare professionals.
Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437146, identifier CRD42023437146.Sin financiación3.9 Q2 JCR 20220.909 Q1 SJR 2023No data IDR 2022UE
Assessing coagulopathy and endothelial dysfunction in pediatric venous malformation: A thromboelastometry and syndecan-1 study
No full textThe occurrence of unpredictable pain crises are the principal determinant of the quality of life for patients with venous malformations (VM). A definite coagulation phenomenon, characterized by an increase in D-dimer levels and the presence of phleboliths within the malformation, has been previously reported. By applying Virchow's triad and evaluating intralesional samples, our objective is to delineate the coagulation profile and the extent of endothelial dysfunction within the malformation.
Methods: With the authorization of the Ethics Committee, a research project was undertaken on intralesional and extralesional blood samples from 30 pediatric patients afflicted with spongiform VM. Thromboelastometry analyses were performed using ROTEM Sigma, and the concentration of syndecan-1 was determined by ELISA.
In the ROTEM analyses, the A5, A10, and maximum clot firmness (MCF) values were below the established reference ranges in the intralesional samples in both the EXTEM and INTEM assays, indicating that intralesional clots had significant instability. Furthermore, during the investigation of the delayed fibrinolysis phase using recombinant tissue plasminogen activator (rtPA) in EXTEM analysis, widespread hyperfibrinolysis was observed intralesional. Additionally, analysis of syndecan-1 showed significant differences between extralesional and intralesional levels (p < .026) and controls (p < .03), suggesting differences in the state of endothelium.
For the first time, we developed a comprehensive understanding of the coagulopathic profile of VM and the role of endothelial dysfunction in its pathogenesis. These findings will enable the implementation of targeted therapies based on the individual coagulation profiles.Sin financiación3.2 Q2 JCR 20220.992 Q1 SJR 2023No data IDR 2022UE
Exploring the Prevalence and Resistance of Campylobacter in Urban Bird Populations
No full textWildlife has been described as a sylvatic reservoir for a multitude of pathogens. The interactions between wild birds, domestic animals, and humans in urban areas are high, so monitoring urban birds is key for the surveillance of zoonosis such as campylobacteriosis. This infection is mainly caused by thermophilic Campylobacter spp., and it is the most reported foodborne zoonosis in the European Union. This study aimed to evaluate the prevalence of thermophilic Campylobacter isolates and their antimicrobial resistance pattern in urban wild birds. Results showed that 16.8% of birds were positive for Campylobacter, with 82.4% of the isolates resistant to at least one antimicrobial. The taxonomic order of individuals, main diet, age, and season of sampling were significant factors associated with Campylobacter spp. carriage. Although the prevalence of Campylobacter was low, the rate of antimicrobial-resistant isolates is worrying, so similar studies should be included in the antimicrobial resistance surveillance programs.Ministry of Ecological Transition (MITECO) of Spain2.4 Q1 JCR 20220.552 Q1 SJR 2023No data IDR 2023UE
Pirfenidone and nintedanib attenuates pulmonary artery endothelial and smooth muscle cells transformations induced by IL-11
No full textIdiopathic pulmonary fibrosis (IPF) associated to pulmonary hypertension (PH) portends a poor prognosis, characterized by lung parenchyma fibrosis and pulmonary artery remodeling. Serum and parenchyma levels of Interleukin 11 (IL-11) are elevated in IPF-PH patients and contributes to pulmonary artery remodeling and PH. However, the effect of current approved therapies against IPF in pulmonary artery remodeling induced by IL-11 is unknown. The aim of this study is to analyze the effects of nintedanib and pirfenidone on pulmonary artery endothelial and smooth muscle cell remodeling induced by IL-11 in vitro. Our results show that nintedanib (NTD) and pirfenidone (PFD) ameliorates endothelial to mesenchymal transition (EnMT), pulmonary artery smooth muscle cell to myofibroblast-like transformation and pulmonary remodeling in precision lung cut slices. This study provided also evidence of the inhibitory effect of PFD and NTD on IL-11-induced endothelial and muscle cells proliferation and senescence. The inhibitory effect of these drugs on monocyte arrest and angiogenesis was also studied. Finally, we observed that IL-11 induced canonical signal transducer and activator of transcription 3 (STAT3) and non-canonical mitogen-activated protein kinase 1/2 (ERK1/2) phosphorylation, but, PFD and NTD only inhibited ERK1/2 phosphorylation. Therefore, this study provided evidence of the inhibitory effect of NTD and PFD on markers of pulmonary artery remodeling induced by IL-11.PID2020-114871RB-I00 (JC)CIBERES (CB06/06/0027)European Regional Development Fund (FEDER) and Instituto de Salud Carlos III (PI20/01363 (JM))5.0 Q1 JCR 20221.055 Q1 SJR 2023No data IDR 2023UE
Targeting IL-11 to reduce fibrocyte circulation and lung accumulation in animal models of pulmonary hypertensionassociated lung fibrosis
No full textBackground and Purpose: IL-11 is a member of the IL-6 family of cytokine initially
considered as haematopoietic and cytoprotective factor. Recent evidence indicates that IL-11 promotes lung fibrosis and pulmonary hypertension in animal models and is elevated in lung tissue of patients with pulmonary fibrosis and pulmonary hypertension. Fibrocytes are bone marrow-derived circulating cells that participate in lung fibrosis and pulmonary hypertension, but the role of IL-11 on fibrocytes is unknown. We investigated the role of IL-11 system on fibrocyte activation in different in vitro and in vivo models of lung fibrosis associated with pulmonary hypertension.
Experimental Approach: Human fibrocytes were isolated from peripheral blood of
six healthy donors. Recombinant human (rh)-IL-11 and soluble rh-IL-11 receptor, α subunit (IL-11Rα) were used to stimulated fibrocytes in vitro to measure:- cell migration in a chemotactic migration chamber, fibrocyte to endothelial cell adhesion in a microscope-flow chamber and fibrocyte to myofibroblast transition. Mouse lung fibrosis and pulmonary hypertension was induced using either IL-11 (s.c.) or bleomycin (intra-tracheal), while in the rat monocrotaline (intra-tracheal) was used. In vivo siRNA-IL-11 was administered to suppress IL-11 in vivo.
Key Results: RhIL-11 and soluble rhIL-11Rα promote fibrocyte migration, endothelial cell adhesion and myofibroblast transition. Subcutaneous (s.c.) IL-11 infusion elevates blood, bronchoalveolar and lung tissue fibrocytes. SiRNA-IL-11 transfection in bleomycin and monocrotaline animal models reduces blood and lung tissue fibrocytes and reduces serum CXCL12 and CXCL12/CXCR4 lung expression.
Conclusion and Implications: Targeting IL-11 reduces fibrocyte circulation and lung accumulation in animal models of pulmonary hypertension-associated lung fibrosis.PID2020-114871RB-I00 (JC)Fondo Europeo de Desarrollo Regional (FEDER) and Instituto de Salud Carlos III (PI20/01363 (JM))Spanish Government CIBERES (CB06/06/0027)Regional Government Prometeo 2017/023/UV (JC)7.3 Q1 JCR 20222.119 Q1 2023No data IDR 2023UE
Industrial-produced lemon nanovesicles ameliorate experimental colitis-associated damages in rats via the activation of anti-inflammatory and antioxidant responses and microbiota modification
No full textPlant-derived nanovesicles (PDNVs) have recently emerged as natural delivery systems of biofunctional compounds toward mammalian cells. Considering their already described composition, anti-inflammatory properties, stability, and low toxicity, PDNVs offer a promising path for developing new preventive strategies for several inflammatory diseases, among which the inflammatory bowel disease (IBD). In this study, we explore the protective effects of industrially produced lemon vesicles (iLNVs) in a rat model of IBD. Characterization of iLNVs reveals the presence of small particles less than 200 nm in size and a profile of bioactive compounds enriched in flavonoids and organic acids with known beneficial properties. In vitro studies on human macrophages confirm the safety and anti-inflammatory effects of iLNVs, as evidenced by the reduced expression of pro-inflammatory cytokines and increased levels of anti-inflammatory markers. As evidenced by in vivo experiments, pre-treatment with iLNVs significantly alleviates symptoms and histological features in 2,4 dinitrobenzensulfuric acid (DNBS)-induced colitis in rats. Molecular pathway analysis reveals modulation of NF-κB and Nrf2, indicating anti-inflammatory and antioxidant effects. Finally, iLNVs affects gut microbiota composition, improving the consistent colitis-related alterations. Overall, we demonstrated the protective role of industrially produced lemon nanovesicles against colitis and emphasized their potential in managing IBD through multifaceted mechanisms.European Union's NextGenerationEU-fondi MUR D.M. (737/2021)EUROSTART, UNIPA, PON "Ricerca e Innovazione" , "Mobilit a dei Ricercatori" of "Attraction and International Mobility" (AIM)6.9 Q1 JCR 20221.493 Q1 SJR 2023No data IDR 2022UE
Efectividad de la neurodinamia en la funcionalidad del miembro superior en pacientes con daño cerebral adquirido
No full textTesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Biomedicina y Ciencias de la SaludNo data 2022UE