Assessing Outcomes in Liver Disease Patients: Reliability and Validity of the Spanish Version of the Liver Disease Quality of Life Questionnaire (LDQOL 1.0)

ObjectiveTo assess the reliability and validity of a Spanish version of the LDQOL 1.0 (Liver Disease Quality of Life questionnaire).MethodsObservational, cross-sectional study in Spanish patients awaiting liver transplantation (LT). Feasibility was assessed by analyzing administration times and missing responses. Ceiling and floor effects were calculated and reliability was tested by examining internal consistency (Cronbach's alpha). Convergent validity was tested by examining correlations between LDQOL disease-specific and Short Form health survey with 36 questions (SF-36) dimensions. Known groups' validity was tested by examining the LDQOL's capacity to discriminate between groups defined by etiology and Child–Turcotte–Pugh (CTP) scores.ResultsA total of 200 patients were included for analysis. Mean age (SD) was 52.6 (9.8) years and 73% of the sample were male. The most common indication for LT was liver cancer (34%). Mean (SD) time to complete the questionnaire was 35.8 minutes (21.2 minutes). Missing responses were highest on the dimensions of sexual functioning and symptoms of liver disease. Ceiling effects were over 20% on 7 of the LDQOL's 12 disease-specific scales. Cronbach's alpha coefficients were over 0.70 on all but 2 dimensions. Correlations between SF-36 and LDQOL disease-specific dimensions generally fulfilled the hypotheses, with 35 of the 40 highest and lowest correlations (87.5%) being in the expected direction. The LDQOL discriminated well between patients in CTP class A and C, and as hypothesized, hepatocarcinoma and alcoholic cirrhosis patients scored better on most dimensions than patients with hepatitis C virus or other etiologies.ConclusionsThe Spanish version of the LDQOL 1.0 has shown satisfactory reliability and validity.     

Genotoxic Effects in Swimmers Exposed to Disinfection By-products in Indoor Swimming Pools

Background

Exposure to disinfection by-products (DBPs) in drinking water has been associated with cancer risk. A recent study (Villanueva et al. 2007; Am J Epidemiol 165:148–156) found an increased bladder cancer risk among subjects attending swimming pools relative to those not attending.

Objectives

We evaluated adults who swam in chlorinated pools to determine whether exposure to DBPs in pool water is associated with biomarkers of genotoxicity.

Methods

We collected blood, urine, and exhaled air samples from 49 nonsmoking adult volunteers before and after they swam for 40 min in an indoor chlorinated pool. We estimated associations between the concentrations of four trihalomethanes (THMs) in exhaled breath and changes in micronuclei (MN) and DNA damage (comet assay) in peripheral blood lymphocytes before and 1 hr after swimming; urine mutagenicity (Ames assay) before and 2 hr after swimming; and MN in exfoliated urothelial cells before and 2 weeks after swimming. We also estimated associations and interactions with polymorphisms in genes related to DNA repair or to DBP metabolism.

Results

After swimming, the total concentration of the four THMs in exhaled breath was seven times higher than before swimming. The change in the frequency of micronucleated lymphocytes after swimming increased in association with higher exhaled concentrations of the brominated THMs (p = 0.03 for bromodichloromethane, p = 0.05 for chlorodibromomethane, p = 0.01 for bromoform) but not chloroform. Swimming was not associated with DNA damage detectable by the comet assay. Urine mutagenicity increased significantly after swimming, in association with the higher concentration of exhaled bromoform (p = 0.004). We found no significant associations with changes in micronucleated urothelial cells.

Conclusions

Our findings support potential genotoxic effects of exposure to DBPs from swimming pools. The positive health effects gained by swimming could be increased by reducing the potential health risks of pool water.     

Brain-derived neurotrophic factor serum levels in cocaine-dependent patients during early abstinence

Preclinical studies indicate that brain-derived neurotrophic factor (BDNF) is involved in neuroplastic changes underlying enduring cocaine-seeking following withdrawal. However, little is known about temporal changes in serum BDNF levels or the involvement of BDNF in craving and abstinence in early-abstinent cocaine-dependent patients. Twenty-three cocaine-dependent individuals (aged 33.65±6.85 years) completed a two-week detoxification program at an inpatient facility. Two serum samples were collected for each patient at baseline and at the end of the protocol. Serum samples were also collected for 46 healthy controls (aged 35.52±9.37 years). Demographic, consumption and clinical data were recorded for all patients. Significantly lower serum BDNF levels (p<.0001) were observed for cocaine-dependent patients at baseline compared to healthy controls. Serum BDNF levels increased significantly across 12 days of early abstinence (p=.030). Baseline BDNF levels correlated with craving (p=.034). Post-detoxification BDNF levels correlated with craving (p=.018), loss of control (p<.000), abstinence measures (p=0.031), depression (p=0.036), and anxiety (p=0.036). Post-detoxification BDNF levels also had predictive value for the loss of control measure of craving. Chronic cocaine use is associated with decreased serum BDNF. A progressive increase in serum BDNF levels during early abstinence correlates with cocaine craving and abstinence symptoms and may reflect increasing BDNF levels in different brain regions. These findings suggest that serum BDNF may be a biomarker for cocaine addiction.     

An evaluation of the sexual differences in the accumulation of organochlorine compounds in children at birth and at the age of 4 years

This study of the body burden and serum concentrations of organochlorine compounds (OCs), represents a general population in a cohort from Menorca Island (birth 1997-1998) of children at birth and at 4 years of age; the study has shown that the concentrations of hexachlorobenzene (HCB), 4,4′-DDE, 4,4′-DDT, polychlorobiphenyl (PCB) congeners #153, #138 and #180 and total PCBs in sera collected at 4 years are much higher in breastfed children than in those fed with formula, e.g. HCB 0.48 vs 0.21 ng/ml, β-HCH 0.32 vs 0.24 ng/ml, total DDTs 2.2 vs 0.57 ng/ml and total PCBs 1.4 vs 0.52 ng/ml. Comparison of gender differences in 4 years old children shows higher concentrations of all examined OCs in females than in males with the exception of HCB and PeCB in breastfed children, which are higher in males than in females, e.g. β-HCH 0.34 vs 0.28 ng/ml, total DDTs 2.6 vs 1.7 ng/ml and total PCBs 1.6 vs 1.0 ng/ml for breastfed children and β-HCH 0.23 vs 0.19 ng/ml, total DDTs 0.59 vs 0.48 ng/ml and total PCBs 0.58 vs 0.45 ng/ml for formula fed children. Gender comparison of the body burden between children fed with breastmilk or formula also shows higher concentrations in females than in males, e.g. β-HCH 0.47 vs 0.35 μg, total DDTs 3.0 vs 1.8 μg and total PCBs 1.9 vs 1.2 μg for breastfed children, and β-HCH 0.39 vs 0.17 μg, total DDTs 0.48 vs 0.27 μg and total PCBs 0.66 vs 0.55 μg for formula fed children. The results may suggest a higher capacity in female children for the retention of OCs incorporated through breastfeeding. However, these results should be taken with caution because the differences of the gender averages have low statistically significance when evaluated with the Student test.     

Factores que influyen en la dieta y los hábitos alimentarios de la población inmigrante china en Cataluña

ObjectiveTo characterize the diet and eating habits of adult immigrants of Chinese origin residing in Santa Coloma de Gramenet (Barcelona, Spain), and to identify the factors that influence the changes in diet and eating habits.MethodQualitative study conducted in 2017 through a discussion group with eight adults of Chinese origin (one man and seven women). The information was complemented by five interviews with key informants (three men and two women) and non-participant observation in health promotion workshops aimed at Chinese patients of a health center in Santa Coloma de Gramenet.ResultsChinese adults made three meals a day and tended to snack between meals. Their diet was based on rice, soy and proteins of vegetable origin. Participants rarely consumed milk and milk derivatives but highlighted their consumption of snacks, sugary drinks and pastries, as well as the incorporation of foods, new dishes and cooking techniques from the host country. The Chinese immigrants tried to maintain their diet of origin, however there were various barriers to this, such as the preference of the local diet by the children, work schedules and lack of time.ConclusionsA tendency towards dietary acculturation is observed among the participants. Health promotion activities aimed at Chinese families are needed to improve aspects of their diet and eating habits, aiming to reduce the consumption of snacks and sugary products.     

Improved pharmacokinetic profile of lipophilic anti-cancer drugs using ανβ3-targeted polyurethane-polyurea nanoparticles

Glutathione degradable polyurethane-polyurea nanoparticles (PUUa NP) with a disulfide-rich multiwalled structure and a cyclic RGD peptide as a targeting moiety were synthesized, incorporating a very lipophilic chemotherapeutic drug named Plitidepsin. In vitro studies indicated that encapsulated drug maintained and even improved its cytotoxic activity while in vivo toxicity studies revealed that the maximum tolerated dose (MTD) of Plitidepsin could be increased three-fold after encapsulation. We also found that pharmacokinetic parameters such as maximum concentration (Cmax), area under the curve (AUC) and plasma half-life were significantly improved for Plitidepsin loaded in PUUa NP. Moreover, biodistribution assays in mice showed that RGD-decorated PUUa NP accumulate less in spleen and liver than non-targeted conjugates, suggesting that RGD-decorated nanoparticles avoid sequestration by macrophages from the reticuloendothelial system. Overall, our results indicate that polyurethane-polyurea nanoparticles represent a very valuable nanoplatform for the delivery of lipophilic drugs by improving their toxicological, pharmacokinetic and whole-body biodistribution profiles.     

The Influence of Medical Student Gender and Drug Use on the Detection of Addiction in Patients

Little is known about medical students’ interest in their training on drug addiction, their personal experience of consumption, and whether these aspects influence the detection of addiction in patients. Eighty-eight and one half percent considered that drug dependence issues are important to their professional future. The students report consuming alcohol (69%), cigarettes (19.5%), and illegal drugs (15.8%). Female students consumed fewer illegal drugs than the men (p =.022). Male students consumed more illegal drugs more frequently (p =.005), knew more consumers (p =.023), and those who drink alcohol consumed more illegal drugs than women who drink alcohol (p <.005). Drug and alcohol consumption among medical students may serve to normalize consumption and thus, may prevent the detection of addicts. It is important to educate and raise awareness about drugs and alcohol use, as this may influence detection. The focus should be particularly on the male group.