BackgroundCross-sex hormone therapy (CHT) is known to lead to alterations in the cardiovascular risk factor (CVRF).PurposeTo assess changes in lipid profile and other CVRF in transsexual participants receiving CHT.Material and methodsRetrospective longitudinal study. We evaluated individuals with gender identity disorder following CHT, assisted in the Gender Identity Unit from 2015 to 2017. The primary endpoint was lipid profile change from baseline at 24 months. Secondary endpoints included change in body mass index (BMI), weight, blood pressure (BP) and glycaemic parameters. Statistical analysis was performed with SPSS Statistics 20.0: the Student t-test to compare means for paired quantitative data and Chi-square for qualitative variables.ResultsForty transsexuals, 19 male-to-female (MtF: 47.5%) and 21 female-to-male (FtM: 52.5%). Mean age 23.86±11.25 years, mean duration of CHT 24.7±39.9 months. Mean age and mean duration of CHT was similar in both groups.In the MtF group, weight and BMI increased significantly, from 72.12±19.04 to 75.17±19.96 kg (p=0.01) and from 23.84±5.79 to 25.02±5.85 kg/m2 (p=0.02), respectively, as well as diastolic blood pressure (DBP) (from 71.80±15.59 to 75.6±14.72 mmhg (p=0.03)) and triglycerides (TG) (from 102.90±83.69 to 108.81±88.37 mg/dl (p=0.035)). FtM transsexuals also presented an increase in weight (70.02±11.14 to 72.17±11.17 kg (p=0.02) and BMI (from 24.03±4.04 to 25.32±4.11 kg/m2 (p=0.035)). No significant differences in lipid profile and blood pressure were observed in this group, even though final levels were all within the normal range. No significant differences were observed with regard to gender (MtF vs. FtM).ConclusionMtF transsexuals experienced alterations in weight, serum lipid profile and diastolic BP because of CHT, while FtM only experienced changes in weight and BMI, although final levels were all within the normal range. No significant differences were observed with regard to gender (MtF vs. FtM). We suggest that clinicians should monitor glucose and lipid metabolism and blood pressure regularly, according to established guidelines.No conflict of interest
Background Clopidogrel antiplatelet effects differ according to genotypes ABCB1 and CYP2C19, establishing normal, intermediate and slow metabolizers. The intermediate and slow metabolizers and poor transporters are responsible for the poor response to the antiplatelet drug. Purpose To determine the prevalence of CYP2C19 and ABCB1 genetic polymorphism in the normal Andalusian population (control) and compare it with other populations as a step to implement this determination in clinical practise. Materials and Methods We genotyped 100 controls from the Andalusian DNA bank for CYP2C19 * 2 (rs4244285), CYP2C19 * 3 (rs4986893) and ABCB1 (rs1045642) using TaqMan probes and allelic discrimination technique. Statistical analysis for allelic and genotypic distributions was calculated by chi-squared test or Fisher’s exact test, when necessary, using the Statcalc software packages. Results Genotype frequencies CYP2C19 (*2) in the Andalusian population: *1/*1: 73%, *1/*2: 25%, *2/*2: 2%, and CYP2C19 * 3: none; the same results as in HapMap (NW European ancestry) population. ABCB1: Andalusian population: CC 36%, CT 44%, TT 20%; HapMap population CC 27%, CT 50%, TT 23%. Allelic frequencies: NW European ancestry HapMap CYP2C19 * 2: G is 85% and A is 15%, the same as our Andalusian control results. ABCB1: HapMap C allele frequency is 45% and the T is 55%, and our frequencies are 57% C and 43% T. Having made the genotype study, 59% of the controls were sensitive to clopidogrel and 41% resistant to it. Conclusions Frequencies for CYP2C19 * 2 and * 3 were similar to those reported in other studies. The frequencies for ABCB1 differed slightly It is necessary to perform this type of study in patients with acute coronary syndrome undergoing a percutaneous coronary intervention, to ensure effective treatment as it is documented that clopidogrel is not an effective drug in polymorphisms with allele CYP2C19 * 2 (*1/*2 and *2/*2) and/or ABCB1 TT. No conflict of interest.
BackgroundA prospective study in which the standard parenteral nutrition prescribed by physicians for adult patients was compared with that designed by a resident pharmacist taking advantage of nutritional knowledge acquired during an internship in the area of nutrition with another hospital.PurposeTo weigh the advantages and disadvantages of individualised and standardised parenteral nutrition formulas.Material and methodsWe selected 20 patients hospitalised in surgical wards in our hospital. The standardised parenteral nutrition prescribed by physicians was studied. We evaluated: indication, nutritional status of the patients, the incidence of complications during the process and the suitability of the standardised parenteral nutrition prescribed according to the clinical practice guidelines established by the Working Group on Nutrition – Spanish Hospital Pharmacists Society.ResultsFrom a total of 20 patients, 40% of them had been prescribed standard parenteral nutrition that did not fit with the recommended guidelines.80% of standardised parenteral nutrition did not fit with the caloric and water requirements recommended in clinical practice guidelines.50% of patients had hypertriglyceridemia that was not controlled with the standardised parenteral nutrition.40% of patients needed a correction in the contribution of electrolytes to suit the requirements published in the clinical practice guidelines.ConclusionThere is an excess of standardisation of parenteral nutrition in our hospital.The consequence is a decrease in the quality of treatment.Parenteral nutrition is used in off-label clinical situations.There is a lack of adequate monitoring.Parenteral nutrition can be adapted to the specific requirements of the patients and this is indicated especially in critical patients.The standard parenteral nutrition is useful in patients with standard energy and nutrient requirements.References and/or AcknowledgementsNo conflict of interest.
Background Tocilizumab is a monoclonal antibody for human use, capable of neutralising the biological effect of IL-6 by blocking its specific receptor IL-6R; it has proven effective in the treatment of rheumatoid arthritis (RA). There are a few published cases in off-label amyloidosis and SLE (systemic lupus erythematosus). Purpose To find out whether tocilizumab got good results in two individuals with off-label inflammatory processes refractory to other approved treatment. Materials and methods A Senegalese patient aged 27 was diagnosed with nephrotic syndrome secondary to renal amyloidosis. No possible cause except a history of having had tuberculosis (Mantoux +, negative Lowenstein). Prophylactic treatment was started with rifampicin/isoniazid but given the poor prognosis treatment with tocilizumab 8 mg /kg was initiated monthly and the response assessed. A patient 28 years of age was diagnosed with systemic lupus erythematosus 2 years ago. At the onset of the disease several treatments were used with corticosteroids, mycophenolate and cyclophosphamide. Since the disease was progressing it was decided to introduce rituximab treatment with little response, the patient even had an allergic reaction and the treatment was stopped. The patient suffered clinical and laboratory deterioration with recurrence of systemic symptoms (fever, rash, polyarthritis and increased acute phase reactions). It was decided to initiate treatment with tocilizumab (off label) (8 mg / kg=160 mg) every 2 weeks. Results After the first dose, the amyloidosis patient showed a good response with decreased proteinuria and improved creatinine clearance, but the proteinuria deteriorated again after the second dose. Tocilizumab was stopped. In the SLE patient, after the third dose an insufficient respond was obtained and the dose was increased to 240 mg. At the time of writing the patient had received 7 doses of tocilizumab in combination with corticosteroids and the symptoms of the disease were controlled. Conclusions Tocilizumab was not able to control the effects of amyloidosis but it was able to control those of SLE in another patient.
Background HER2 (ERB2, neu) is a proto-oncogene that encodes a transmembrane protein with tyrosine kinase activity. Trastuzumab (Herceptin), a humanised monoclonal antibody that binds to the HER2 extracellular domain, is used to treat HER2-positive breast cancer. Although it is well tolerated, it has a significant adverse effect: cardiotoxicity. Purpose To evaluate the possible effect of ERB2 gene polymorphism at codon 655 (ATC/isoleucine to GTC/valine) (rs1136201) in cardiac dysfunction related to trastuzumab in women diagnosed with HER2-positive breast cancer. Materials and methods 54 patients with HER2-positive breast cancer treated with trastuzumab in our hospital were evaluated prospectively from January to December 2012. Trastuzumab was administered as a loading dose of 8 mg/kg followed by 6 mg/kg every three weeks. For all patients, cardiac function (left ventricular ejection fraction, LVEF) was checked at baseline and every 3 months by echocardiogram or MUGA (multigated blood-pool imaging) scan. We considered cardiac toxicity if the LVEF dropped 10 percentage points from baseline and below 50%, as stated in the data sheet. For genotyping we used TaqMan probes and an allelic discrimination technique. Statistical analysis was performed with Statcalc software packages and significance was indicated by a p value lower than 0.05. Results The mean age of the patients was 51.11 ± 12.16 years. The distribution of genotypes was 55.56% AA, 40.74% AG and 3.7% GG. Of all patients, 12 developed cardiotoxicity during the treatment with trastuzumab: 4 with genotype AA, 8 with AG and none with GG. Significant correlation was not found between genotypes AA (vs. AA/GG) or GG (vs. AA/AG) and cardiac dysfunction. Instead, statistically significant differences were shown when comparing patients with genotype AG and AA/GG with cardiotoxicity (p = 0.046, OR = 4, 95% CI = 1.026–15.599). Conclusions The results of our study show an association of ERB2 polymorphism Ile655Val with cardiac toxicity associated with trastuzumab. Patients with genotype AG have higher risk of developing cardiac dysfunction related to trastuzumab than those with AA or GG. We need more studies on this polymorphism as well as larger sample sizes to confirm these findings. No conflict of interest.
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