Papers by MArgarita Esteban Salán
Medicina Clinica, Mar 1, 2011
To analyse clinical and serological variables (lipid profile, inflammatory biomarkers) as potenti... more To analyse clinical and serological variables (lipid profile, inflammatory biomarkers) as potential risk factors for the development of short-term cardiovascular events and mortality in patients suffering from intermittent claudication. We included all patients with a first-time diagnosis of vascular intermittent claudication in our center during 2005-2006. We analysed clinical data, serological parameters (creatinine, total cholesterol, LDL-cholesterol, HDL-cholesterol, ApolipoproteinA1, ApolipoproteinB100, lipoprotein(a), homocysteine, C-reactive protein, erythrocyte sedimentation rate [ESR], fibrinogen), cardiovascular events and mortality during 1-3 year follow-up. We included 162 patients: 143 (88.3%) men, mean (SD) age 66 (10.4) (41-86) years, 76 (46.9%) active smokers, 96 (59.3%) hypertensive, 56 (34.6%) diabetic, 129 (79.6%) hypercholesterolemic. We registered 16 (9.9%) coronary/cerebrovascular events, 18 (11.1%) lower limb vascular events and 9 (5.9%) late deaths during follow-up (mean [SD] 18.2 [8] months). Hypertension was the only predictor of coronary or cerebrovascular events (p=0.013); heart disease and HDL-cholesterol<45 mg/dL were independent risk factors for lower limb vascular events (p=0.021 and 0.049), and ESR>20 mm/h was associated with all-cause death (p=0.008). Reduced HDL-cholesterol and elevated ESR have emerged as independent risk factors for short-term lower limb vascular events and death.
El aneurisma de la aorta abdominal (AAA) es una dilatacion patologica de la aorta a nivel infrarr... more El aneurisma de la aorta abdominal (AAA) es una dilatacion patologica de la aorta a nivel infrarrenal (diametro ? 30 mm). Las fases de desarrollo y crecimiento son asintomaticas, pero si el diametro alcanza 50 mm puede romperse de forma espontanea. Esta rotura va asociada a una alta mortalidad (80%) aunque haya intervencion quirurgica para su reparacion. La incidencia en paises occidentales es alta por encima de los 65 anos y es la causa de muerte de 1-2% de la poblacion. La etiologia es compleja y multifactorial compartiendo con la enfermedad aterotrombotica algunos factores de riesgo. No se conocen completamente los mecanismos biologicos involucrados en el inicio y progresion de la enfermedad. El AAA se caracteriza por destruccion del colageno y elastina de la capa media de la aorta por una activacion de enzimas proteoliticas y aumento de estres oxidativo y apoptosis de las celulas musculares lisas. Esto origina una respuesta compensatoria inmunoinflamatoria y fibrotica de la adve...
Endocrinología, Diabetes y Nutrición, 2021
Prolactin measurement is very common in standard clinical practice. It is indicated not only in t... more Prolactin measurement is very common in standard clinical practice. It is indicated not only in the study of pituitary adenomas, but also when there are problems with fertility, decreased libido, or menstrual disorders, among other problems. Inadequate interpretation of prolactin levels without contextualizing the laboratory results with the clinical, pharmacological, and gynecological/urological history of patients leads to erroneous diagnoses and, thus, to poorly based studies and treatments. Macroprolactinemia, defined as hyperprolactinemia due to excess macroprolactin (an isoform of a greater molecular weight than prolactin but with less biological activity), is one of the main causes of such erroneous diagnoses, resulting in poor patient management when not recognized. There is no unanimous agreement as to when macroprolactin screening is required in patients with hyperprolactinemia. At some institutions, macroprolactin testing by polyethylene glycol (PEG) precipitation is routinely performed in all patients with hyperprolactinemia, while others use a clinically based approach. There is also no consensus on how to express the results of prolactin/macroprolactin levels after PEG, which in some cases may lead to an erroneous interpretation of the results. The objectives of this study were: 1. To establish the strategy for macroprolactin screening by serum precipitation with PEG in patients with hyperprolactinemia: universal screening versus a strategy guided by the alert generated by the clinician based on the absence or presence of clinical symptoms or by the laboratory when hyperprolactinemia is detected. 2. To create a consensus document that standardizes the reporting of prolactin results after precipitation with PEG to minimize errors in the interpretation of the results, in line with international standards.
Clinical Chemistry, 2000
Background: LDL-cholesterol (LDL-C) concentrations are the primary basis for treatment guidelines... more Background: LDL-cholesterol (LDL-C) concentrations are the primary basis for treatment guidelines established for hyperlipidemic patients. LDL-C concentrations are commonly monitored by means of the Friedewald formula, which provides a relative estimation of LDL-C concentration when the triglyceride concentration is <2000 mg/L and there are no abnormal lipids. The Friedewald formula has several limitations and may not meet the current total error requirement of <12% in LDL-C measurements. Methods: We evaluated the analytical and clinical performance of two direct methods (Roche and Wako) by analyzing 313 fresh serum samples obtained from dyslipidemic patients in a lipid clinic and comparing them with modified β-quantification. Results: Both homogeneous assays displayed excellent precision (CV <2%). The Roche method showed a mean total error of 7.72%, and the Wako method showed a mean total error of 4.46% over a wide range of LDL-C concentrations. The Roche method correlated...
Revista del Laboratorio Clínico, 2019
Dislipidemias; Dislipidemias primarias; Estrategia para el diagnóstico de las dislipidemias Resum... more Dislipidemias; Dislipidemias primarias; Estrategia para el diagnóstico de las dislipidemias Resumen Las dislipidemias son alteraciones del metabolismo lipídico que cursan con concentraciones de lípidos alteradas, tanto por exceso como por defecto. Estas alteraciones están fuertemente asociadas con el proceso aterosclerótico, y se ha demostrado que el control de dichas alteraciones consigue disminuir la incidencia de episodios de origen isquémico. Diagnosticar las dislipidemias desde un punto de vista etiológico es muy importante, ya que el riesgo cardiovascular al que predispone cada una de ellas es diferente, dependiendo del tipo de lipoproteína que esté alterada y de su concentración. Por ello es de gran utilidad disponer de algoritmos diagnósticos sencillos que incluyan magnitudes del metabolismo lipídico disponibles en la mayoría de los laboratorios clínicos, con el fin de realizar el diagnóstico inicial del tipo de dislipidemia, en caso de poseer las herramientas diagnósticas adecuadas identificarla y, en caso contrario, disponer de la información apropiada para recomendar la ampliación del estudio en otro centro que disponga de los recursos necesarios para establecer el diagnóstico.
Annals of Laboratory Medicine, 2018
Background: Lipemia, a significant source of analytical errors in clinical laboratory settings, s... more Background: Lipemia, a significant source of analytical errors in clinical laboratory settings, should be removed prior to measuring biochemical parameters. We investigated whether lipemia in serum/plasma samples can be removed using a method that is easier and more practicable than ultracentrifugation, the current reference method. Methods: Seven hospital laboratories in Spain participated in this study. We first compared the effectiveness of ultracentrifugation (108,200 ×g) and high-speed centrifugation (10,000 ×g for 15 minutes) in removing lipemia. Second, we compared high-speed centrifugation with two liquid-liquid extraction methods-LipoClear (StatSpin, Norwood, USA), and 1,1,2-trichlorotrifluoroethane (Merck, Darmstadt, Germany). We assessed 14 biochemical parameters: serum/plasma concentrations of sodium ion, potassium ion, chloride ion, glucose, total protein, albumin, creatinine, urea, alkaline phosphatase, gammaglutamyl transferase, alanine aminotransferase, aspartate-aminotransferase, calcium, and bilirubin. We analyzed whether the differences between lipemia removal methods exceeded the limit for clinically significant interference (LCSI). Results: When ultracentrifugation and high-speed centrifugation were compared, no parameter had a difference that exceeded the LCSI. When high-speed centrifugation was compared with the two liquid-liquid extraction methods, we found differences exceeding the LCSI in protein, calcium, and aspartate aminotransferase in the comparison with 1,1,2-trichlorotrifluoroethane, and in protein, albumin, and calcium in the comparison with LipoClear. Differences in other parameters did not exceed the LCSI. Conclusions: High-speed centrifugation (10,000 ×g for 15 minutes) can be used instead of ultracentrifugation to remove lipemia in serum/plasma samples. LipoClear and 1,1,2-trichlorotrifluoroethane are unsuitable as they interfere with the measurement of certain parameters.
Revista del Laboratorio Clínico, 2018
Program (NCEP) and by the Spanish Society of Laboratory Medicine (SEQC ML). Determination of HDL ... more Program (NCEP) and by the Spanish Society of Laboratory Medicine (SEQC ML). Determination of HDL cholesterol using automatic homogenous methods is considered acceptable for normal clinical practice, and the Friedewald Formula is considered to be usable to estimate LDL cholesterol concentration when triglyceride concentrations are below 200 mg/dL (2.3 mmol/L). If this should not be the case, the use of non-HDL cholesterol is recommended. Routine quantification of apolipoproteins A1 and B, and lipoprotein (a) can be measured using immunonephelometric or immunoturbidimetric methods, with calibrators that are traceable to reference materials.
Angiología, 2015
Las concentraciones plasmáticas de PCR mantienen una asociación con el diámetro aneurismático a l... more Las concentraciones plasmáticas de PCR mantienen una asociación con el diámetro aneurismático a lo largo del seguimiento y se relacionan con la progresión de los AAA.
Revista del Laboratorio Clínico, 2012
Conclusiones: Estos resultados sugieren que existen discrepancias en la valoración de las magnitu... more Conclusiones: Estos resultados sugieren que existen discrepancias en la valoración de las magnitudes obtenidas con los métodos homogéneos, probablemente generada por una elevada inexactitud en algunos de ellos y que es conveniente que los laboratorios conozcan las caracteristicas de imprecisión y sesgo del metodo directo que utilizan con respecto al de referencia.
Medicina Clínica, 2011
To analyse clinical and serological variables (lipid profile, inflammatory biomarkers) as potenti... more To analyse clinical and serological variables (lipid profile, inflammatory biomarkers) as potential risk factors for the development of short-term cardiovascular events and mortality in patients suffering from intermittent claudication. We included all patients with a first-time diagnosis of vascular intermittent claudication in our center during 2005-2006. We analysed clinical data, serological parameters (creatinine, total cholesterol, LDL-cholesterol, HDL-cholesterol, ApolipoproteinA1, ApolipoproteinB100, lipoprotein(a), homocysteine, C-reactive protein, erythrocyte sedimentation rate [ESR], fibrinogen), cardiovascular events and mortality during 1-3 year follow-up. We included 162 patients: 143 (88.3%) men, mean (SD) age 66 (10.4) (41-86) years, 76 (46.9%) active smokers, 96 (59.3%) hypertensive, 56 (34.6%) diabetic, 129 (79.6%) hypercholesterolemic. We registered 16 (9.9%) coronary/cerebrovascular events, 18 (11.1%) lower limb vascular events and 9 (5.9%) late deaths during follow-up (mean [SD] 18.2 [8] months). Hypertension was the only predictor of coronary or cerebrovascular events (p=0.013); heart disease and HDL-cholesterol&amp;amp;amp;amp;amp;amp;amp;amp;lt;45 mg/dL were independent risk factors for lower limb vascular events (p=0.021 and 0.049), and ESR&amp;amp;amp;amp;amp;amp;amp;amp;gt;20 mm/h was associated with all-cause death (p=0.008). Reduced HDL-cholesterol and elevated ESR have emerged as independent risk factors for short-term lower limb vascular events and death.
Revista Española de Cardiología (English Edition), 2018
Revista Española de Cardiología, 2018
Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis
Analytical reports from the clinical laboratory are essential to guide clinicians about what lipi... more Analytical reports from the clinical laboratory are essential to guide clinicians about what lipid profile values should be considered altered and, therefore, require intervention. Unfortunately, there is a great heterogeneity in the lipid values reported as "normal, desirable, recommended or referenced" by clinical laboratories. This can difficult clinical decisions and be a barrier to achieve the therapeutic goals for cardiovascular prevention. A recent international recommendation has added a new heterogeneity factor for the interpretation of lipid profile, such as the possibility of measuring it without previous fasting. All this justifies the need to develop a document that adapts the existing knowledge to the clinical practice of our health system. In this regard, professionals from different scientific societies involved in the measurement and use of lipid profile data have developed this document to establish recommendations that facilitate their homogenization.
Revista del Laboratorio Clínico, 2012
ABSTRACT Objective To analyse the predictive value of several approaches to cardiovascular risk p... more ABSTRACT Objective To analyse the predictive value of several approaches to cardiovascular risk prevention: measuring apolipoprotein B concentrations (apoB), estimation of fractionated LDL cholesterol (cLDLf) and non-HDL cholesterol (HDLc), to predict increases in LDL cholesterol.
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Papers by MArgarita Esteban Salán