[Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients]. / Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes.

BACKGROUND AND OBJECTIVE: The high mortality attributable to severe malaria by Plasmodium falciparum is related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternative to exchange transfussion, with the same potential benefits but less undesirable side effects. Literature on this technique is scarce, consisting of isolated reports or short series. The objective of this study is to describe the clinical picture and outcome observed in 6 severely ill malaria patients in whom EA was applied as complimentary therapeutic technique. PATIENTS AND METHOD: An observational prospective descriptive study was carried out of all inpatients with severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiological and parsitological data were analyzed. RESULTS: This series included 2 women and 4 men, with a median age of 43 years. In all cases, the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarial prophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between 10% and 35%. The number of severity criteria was between one and 4, the more frequent being hyperbilirrubinemia. All patients received conventional intravenous treatment. The total length of admission oscillated between 5 and 37 days, while the length of stay in the Intensive Care Unit varied between one and 17 days. All patients survived. CONCLUSIONS: AE is a safe technique, with the same advantages that blood exchange but lacking many of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of 5% is associated with any additional World Health Organization-2000 criteria of clinical severity, should constitute an indication for AE.

Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes / Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients

FUNDAMENTO Y OBJETIVO: La elevada mortalidad de la malaria grave por Plasmodium falciparum serelaciona con el grado de parasitemia. La eritrocitaféresis automatizada (EA) es una alternativasegura a la exanguinotransfusión, con los mismos beneficios potenciales pero menores efectossecundarios. Sin embargo, son escasas las referencias sobre la eficacia e indicaciones de estatécnica. El objetivo de este trabajo ha sido describir las características clínicas y evolución de6 pacientes con malaria grave en los que se empleó esta técnica terapéutica complementaria.PACIENTES Y MÉTODO: Se ha realizado un estudio observacional, descriptivo y retrospectivo de todoslos pacientes con malaria ingresados en un único hospital entre 1996 y 2006. En cadacaso se recogieron los datos clínicos, epidemiológicos y parasitológicos básicos.RESULTADOS: La serie se compone de 2 mujeres y 4 varones, con una media de edad de 43años. En todos los casos la infección fue adquirida en África subsahariana. Ningún pacientehabía efectuado quimioprofilaxis antipalúdica y la especie causal fue Plasmodium falciparum.El grado de parasitemia osciló entre el 10 y el 35%. De los criterios de gravedad, cuyo númeroosciló entre 1 y 4, el más frecuente fue la hiperbilirrubinemia. Todos los pacientes recibierontratamiento convencional. La duración total del ingreso osciló entre 5 y 37 días, y la estanciaen la unidad de vigilancia intensiva, entre 1 y 17 días. Todos los pacientes sobrevivieron.CONCLUSIONES: En resumen, la EA es una técnica segura, con las mismas ventajas que la exanguinotransfusión,pero sin muchos de sus efectos adversos. De acuerdo con los datos de la bibliografíay estas observaciones, podemos señalar que una parasitemia aislada mayor del 10%o una parasitemia superior al 5% asociada a algún criterio de gravedad son indicación para larealización de EA

BACKGROUND AND OBJECTIVE: The high mortality attributable to severe malaria by Plasmodium falciparumis related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternativeto exchange transfussion, with the same potential benefits but less undesirable sideeffects. Literature on this technique is scarce, consisting of isolated reports or short series. Theobjective of this study is to describe the clinical picture and outcome observed in 6 severely illmalaria patients in whom EA was applied as complimentary therapeutic technique.PATIENTS AND METHOD: An observational prospective descriptive study was carried out of all inpatientswith severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiologicaland parsitological data were analyzed.RESULTS: This series included 2 women and 4 men, with a median age of 43 years. In all cases,the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarialprophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between10% and 35%. The number of severity criteria was between one and 4, the more frequentbeing hyperbilirrubinemia. All patients received conventional intravenous treatment. Thetotal length of admission oscillated between 5 and 37 days, while the length of stay in the IntensiveCare Unit varied between one and 17 days. All patients survived.CONCLUSIONS: AE is a safe technique, with the same advantages that blood exchange but lackingmany of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of5% is associated with any additional World Health Organization-2000 criteria of clinical severity,should constitute an indication for AE

Differences in cardiovascular risk factors, insulin resistance, and insulin secretion in individuals with normal glucose tolerance and in subjects with impaired glucose regulation: the Telde Study.

OBJECTIVE: To assess the cardiovascular risk profile, the degree of insulin resistance, and beta-cell secretion in a cohort of subjects with different categories of impaired glucose regulation (IGR): impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT. RESEARCH DESIGN AND METHODS: We studied 902 nondiabetic subjects between 30 and 80 years of age, recruited from a cross-sectional population-based study in Telde, Gran Canaria Island, Spain. Categories of glucose tolerance were defined according to 2003 modified American Diabetes Association criteria. Risk factors for cardiovascular disease, the presence of the metabolic syndrome, and indirect measures of both insulin resistance and beta-cell function were analyzed. RESULTS: A total of 132 (14.6%) participants had isolated IFG, 59 (6.5%) isolated IGT, and 48 (5.3%) combined IFG/IGT. Groups with normal glucose tolerance (NGT) and combined IFG/IGT had, respectively, the most favorable and unfavorable levels of cardiovascular risk factors, metabolic syndrome rates, and measures of insulin resistance. Subjects with IFG and IGT showed an intermediate profile between NGT and IFG/IGT categories. We found no significant differences between IFG and IGT in cardiovascular risk factors, metabolic syndrome prevalence, or insulin resistance. The IFG group exhibited a more impaired insulin secretion than those with IGT or IFG/IGT. CONCLUSIONS: Individuals with IGR, especially those with IFG/IGT, have increased values of cardiovascular risk factors and higher indexes of insulin resistance. Groups with isolated IFG and isolated IGT present similar cardiovascular risk profiles. Subjects with IFG are characterized by more defective beta-cell function than other forms of IGR.

Folate status of adults living in the Canary Islands (Spain).

BACKGROUND AND AIM: Human studies support the hypothesized contribution of folate deficiency to carcinogenesis and vascular risk. We assess the nutritional folate status and its relationship to folate intake, smoking, alcohol consumption, oral contraceptive use, and multivitamin supplements. METHODOLOGY: A representative sample of 601 individuals from 18 to 75 years of age was selected from the participants in the Canary Islands Nutrition Survey. A food frequency questionnaire was administered. Serum and erythrocyte levels of folate were determined using a method of automated ionic capturing. RESULTS: Mean serum and red cell folate were 8.2 ng/mL and 214.3 ng/mL, respectively. Only one individual had serum folate below 3 ng/mL, and 21.7% showed moderate deficits (3-6 ng/mL); 10.7% of the sample had erythrocyte folate levels falling below 140 ng/mL, 61.3% between 140 and 240 ng/mL and the remaining 27.9% above 240 ng/mL. A positive significant association was observed between these two folate measurements, as well as between folate intake and each of these biomarkers (p < 0.001). Tobacco consumption was negatively correlated with folate status (p < 0.001). Alcohol consumption, oral contraceptive, and vitamin supplement use were not associated with serum and red cell folate levels. CONCLUSIONS: Even though nutritional folate status can be considered minimally acceptable, it may reflect the low level of fruit and vegetable consumption within the Canary Islands population.

The effect of methylenetetrahydrofolate reductase C677T common variant on hypertensive risk is not solely explained by increased plasma homocysteine values.

The C677T transition of methylenetetrahydrofolate reductase (MTHFR) gene causes a moderate increase in total plasma homocysteine (tHcy). We studied the effect of MTHFR TT homozygosity and mild hyperhomocysteinemia on arterial hypertension. Normotensive controls (n = 223) and hypertensive subjects (n = 235) were matched for age, gender, and history of cardiovascular disease. Homocysteine levels were measured by a polarization immunoassay method. Methylenetetrahydrofolate reductase we determined by polymerase chain reaction and restriction fragment analysis. Hypertensives showed elevated tHcy compared to normotensive group in men (P = 0.039). Homocysteine values higher than 15 micromol/L were associated with increased hypertensive risk in the male population [odds ratios (OR) = 1.63; 95% confidence interval (CI) = 1.06-2.52; P = 0.027]. In multivariate analysis, TT genotype was associated with an increased risk of hypertension in males (OR = 2.27; 95% CI = 1.12-4.60; P = 0.022) An increased hypertensive risk was observed in those TT males with tHcy levels higher than 15 micromol/L (OR = 2.78; 95% CI = 1.05-7.3; P = 0.032) but not in those non-TT males with tHcy levels higher than 15 micromol/L (P = 0.33). Our findings do not support the possibility that mild hyperhomocysteinemia my solely account for the hypertensive risk associated to the TT genotype.

Evaluación bioquímica del estado nutricional de la población canaria (1998) / Biochemical assessment of nutritional status in the Canary Island population (1998)

La evaluación del estado nutricional de una población debe incorporar una valoración dietética, bioquímica, clínica y antropométrica. Evaluar el estado nutricional de la población canaria mediante indicadores bioquímicos y hematológicos. Se realizó un estudio transversal sobre una submuestra representativa de 6 a 75 años que participó en la Encuesta Nutricional de Canarias, 1997-98 (ENCA). Se determinaron ferritina, vitamina B12 (enzimoinmunoensayo), ácido fólico sérico y eritrocitario (captura iónica automatizada), retinol, tocoferol y carotenos (cromatografía líquida de alta resolución) y minerales (espectrofotometía de absorción atómica). La participación fue del 48,8 por ciento con una distribución similar a la población incluída en la ENCA por edad, sexo y variables socioeconómicas. El 25 por ciento de las mujeres tenían niveles deficitarios de ferritina y la prevalencia de anemia en las mujeres mayores de 18 años fue del 2,9 por ciento. El 13 por ciento de la población tenía niveles de ácido fólico eritrocitario bajos, niveles que aumentan con la edad, y un 3,4 por ciento niveles bajos de vitamina B12, que por el contrario va disminuyendo. Un 15 por ciento de la población presentó déficit de alfa-tocoferol y un 5,2 por ciento de retinol, siendo más frecuentes en los más jóvenes, y el 56,4 por ciento y el 41,1 por ciento tenían niveles bajos de beta-caroteno y de licopeno respectivamente. Entre los minerales y elementos traza destacarón, por su elevada prevalencia de niveles bajos, el manganeso y, en menor medida, el selenio. A pesar de la complejidad de su interpretación, los datos aportan una precisa estimación del estado nutricional en algunas vitaminas y minerales para la población canaria