[Design and development of a dietary intervention in children with prediabetes]. / Diseño y desarrollo de una intervención dietética en niños con prediabetes.

INTRODUCTION: Prediabetes is a pathological condition where the blood glucose concentration is higher than normal concentrations, but lower than those considered in the diagnosis of type 2 diabetes mellitus (DM2). Until a few years ago, the prediabetes condition occurred in adults with associated risk factors such as overweight or obesity, sedentary lifestyle, poor eating habits, cardiovascular problems, etc. In recent years it has begun to be detected in children, with the family habits that these children have established becoming increasingly important. MATERIAL AND METHODS: In our study, 29 pre-diabetic children from Pedro Abad, Córdoba, have been evaluated. For this, we have carried out a randomized crossover trial with an intervention group (IG) and a control group (CG), using a dietary intervention with nutritional reinforcement. The main objective of the present study was to determine if the eating habits of pre-diabetic children improved with a dietary intervention based on nutritional education. RESULTS: Through a nutritional evaluation through different tests and visits made to the children, the results corresponding to the first phase of the study, relate an improvement in eating habits and adherence to the Mediterranean Diet by the intervened children. CONCLUSIONS: The eating habits of pre-diabetic children improve with a dietary intervention based on nutritional education, since by providing them with knowledge of the different foods and the contribution of nutrients that they provide us, they can make a better selection of foods.

Analysis of health habits, vices and interpersonal relationships of Spanish adolescents, using SEM statistical model.

The objective of this article is to know the state of health of a sample of adolescents and how it relates to toxic habits and personal relationships. Likewise, it is presented how can influence eating habits, sports practice and interpersonal relationships in their general health status. The research has carried out through a survey of 56 questions to 470 adolescents, between 13 and 18 years old, of both sexes, of different schools in the province of Cordoba, Spain. These results have been subjected to a statistical model widely used in health and social sciences in general, called Structural Equations Model (SEM), through the SPSS program, v. 23 and AMOS. SEM is widely used in the social sciences to estimate regression models (usually multi-equational). The estimated model shows a significant global acceptability based on the usual statistical tests and goodness-of-fit measures. In this regard, these results are: CMIN = 17.554 with 33 degrees of freedom (DF) and a probability level, p = 0.987, which is higher than any reasonable level of significance (α = 0.05, 0.10, even 0.20). Likewise, FMIN = 0.038, CFI = 1.000 and RMSEA = 0.000. The main recommendation of this research aimed at improving good eating and healthy habits, and to avoid toxic habits of adolescents, is to begin the education in the family, in coordination with their school and high school.

Community Acquired Spondylodiscitis caused by Escherichia Coli; Case Report and Literature Review.

Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, with an irregular high intensity area at L2; suggesting a fluid collection extending to adjacent soft tissues. Fluoroscopy-guided core needle bone biopsies were reported positive for Escherichia coli sensitive to ceftriaxone. The patient was treated (received treatment) with a three week course of ceftriaxone following a formal diagnosis of E. coli spondylodiscitis. Follow-up MRI demonstrated complete recovery with the patient able to return (has returned) to normal activity. In this case we highlight the importance of correct and timely diagnosis of spondylodiscitis. Diagnosis of spondylodiscitis is often difficult, delayed or even missed due to the rarity of the disease but can lead to devastating consequences. Therefore a high index of suspicion is needed for prompt diagnosis to ensure improved long-term outcomes.

Recurrent wheezing and asthma after bocavirus bronchiolitis.

BACKGROUND: Human bocavirus (HBoV) was recently discovered and identified as an important cause of respiratory infection in young children. However, the relationship between HBoV-bronchiolitis and the development of recurrent wheezing has not yet been established. OBJECTIVE: We designed this study in order to describe the mid-term outcome, regarding the development of recurrent wheezing and asthma of HBoV-bronchiolitis patients and to compare it with RSV-bronchiolitis infants. METHODS: We studied 80 children (10 with HBoV and 70 with RSV infection), currently aged ≥4 years and previously hospitalised during the seasons 2004-2009 due to acute bronchiolitis. Epidemiological and clinical data were collected through structured clinical interviews at the follow-up visit. Spirometry and skin prick tests to common food and inhaled allergens were performed. RESULTS: All HBoV-patients developed recurrent wheezing and half of them had asthma at age 5-7 years. Almost 30% required hospital admission for recurrent wheezing. Asthma (odds ratio (OR)=1.28) and current asthma (OR=2.18) were significantly more frequent in children with HBoV-bronchiolitis than in RSV-bronchiolitis. FEV1 values were 99.2±4.8 in HBoV-group vs. 103±11 in RSV-group, p: 0.09. No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, and family history of atopy or asthma. CONCLUSIONS: Severe HBoV-bronchiolitis in infancy was strongly associated with asthma at 5-7 years.

Estimating influenza vaccine effectiveness in Spain using sentinel surveillance data.

We aimed to estimate influenza vaccine effectiveness (VE) against laboratory-confirmed influenza during three influenza seasons (2010/11 to 2012/2013) in Spain using surveillance data and to compare the results with data obtained by the cycEVA study, the Spanish component of the Influenza Monitoring Vaccine Effectiveness (I-MOVE) network. We used the test-negative case­control design, with data from the Spanish Influenza Sentinel Surveillance System (SISS) or from the cycEVA study. Cases were laboratory-confirmed influenza patients with the predominant influenza virus of each season, and controls were those testing negative for any influenza virus. We calculated the overall and age-specific adjusted VE. Although the number of patients recorded in the SISS was three times higher than that in the cycEVA study, the quality of information for important variables, i.e. vaccination status and laboratory results, was high in both studies. Overall, the SISS and cycEVA influenza VE estimates were largely similar during the study period. For elderly patients (> 59 years), the SISS estimates were slightly lower than those of cycEVA, and estimates for children (0­14 years) were higher using SISS in two of the three seasons studied. Enhancing the SISS by collecting the date of influenza vaccination and reducing the percentage of patients with incomplete information would optimise the system to provide reliable annual influenza VE estimates to guide influenza vaccination policies.

CCR5 deficiency predisposes to fatal outcome in influenza virus infection.

Influenza epidemics affect all age groups, although children, the elderly and those with underlying medical conditions are the most severely affected. Whereas co-morbidities are present in 50% of fatal cases, 25-50% of deaths are in apparently healthy individuals. This suggests underlying genetic determinants that govern infection severity. Although some viral factors that contribute to influenza disease are known, the role of host genetic factors remains undetermined. Data for small cohorts of influenza-infected patients are contradictory regarding the potential role of chemokine receptor 5 deficiency (CCR5-Δ32 mutation, a 32 bp deletion in the CCR5 gene) in the outcome of influenza virus infection. We tested 171 respiratory samples from influenza patients (2009 pandemic) for CCR5-Δ32 and evaluated its correlation with patient mortality. CCR5-Δ32 patients (17.4%) showed a higher mortality rate than WT individuals (4.7%; P = 0.021), which indicates that CCR5-Δ32 patients are at higher risk than the normal population of a fatal outcome in influenza infection.

Viral respiratory tract infections in the neonatal intensive care unit.

INTRODUCTION: Viral respiratory infections cause major morbidity and mortality in preterm infants. We have performed a prospective study in our neonatal intensive care unit (NICU) to determine the incidence of respiratory infections, their impact and the epidemiology and outcome in high risk neonates. PATIENTS AND METHODS: From September 2011 to May 2013 a prospective study was conducted in all preterm infants <32 weeks gestational age and in all term newborns admitted to NICU for any pathology that was anticipated to have an admission exceeding two weeks. A nasopharyngeal aspirate (NPA) was collected the first day of life and weekly until discharge for virologic study with polymerase chain reaction. When these babies presented respiratory symptoms a new NPA was collected at this moment. A clinical form was filled by the physician. RESULTS: A total of 60 infants were analysed: 30 (50%) had a gestational age <32 weeks and 36 (60%) weighed less than 1500 g. We collected a total of 256 nasopharyngeal aspirate samples, 24 of them being positive (9.3%). These 24 positive samples corresponded to 13 infants in our cohort (21.6% of the patients). Of them, 9 were symptomatic and had 11 episodes of infection (2 patients had two different episodes with negative control between them). The most frequently identified virus was rhinovirus in (19) 79% of cases. The most frequent clinical data was the presence or increase in apneas (75%) and the need for oxygenotherapy. CONCLUSIONS: HRV infections are prevalent in the NICU, and preterm infants have a high risk of infections with clinical relevance.

INTRODUCCIÓN: Las infecciones virales respiratorias son causa de importante morbimortalidad en recién nacidos prematuros. Hemos realizado un estudio prospectivo en nuestra unidad de cuidados intensivos neonatales (UCIN) para determinar la incidencia de infecciones respiratorias, su impacto, epidemiología y pronóstico en neonatos de alto riesgo. PACIENTES Y MÉTODOS: Estudio prospectivo realizado entre septiembre del 2011 y mayo del 2013 entre todos los recién nacidos < 32 semanas de edad gestacional y aquellos niños cuya patología pudiera dar lugar a pensar en un ingreso superior a las 2 semanas. Se recogieron aspirados nasofaríngeos (ANF) el primer día de vida y semanalmente hasta el alta para estudio virológico mediante reacción en cadena de polimerasa. En los casos en los que los niños presentaban síntomas respiratorios, se procedió a recoger un nuevo ANF. El pediatra cumplimentó un cuestionario con los datos clínicos. RESULTADOS: Se estudió a 60 niños; 30 (50%) de ellos con una edad gestacional <32 semanas y 36 (60%) con un peso <1.500 g. Se recogió un total de 256 ANF, 24 de los cuales resultaron positivos (9,3%). Estas 24 muestras positivas correspondieron solo a 13 niños (21,6% de los pacientes). De ellos, 9 resultaron sintomáticos y presentaron 11 episodios de infección (2 pacientes experimentaron 2 episodios diferentes con control negativo entre ellos). El virus más frecuentemente identificado ­ el 79% de las muestras (19) ­ fue el rinovirus (RV). El dato clínico más frecuente fue la presencia o incremento de apneas (75%) y la necesidad de oxigenoterapia. CONCLUSIONES: Las infecciones por RV son frecuentes en la UCIN y los recién nacidos pretérmino tienen un alto riesgo de presentar infecciones de relevancia clínica.

[Viral respiratory tract infections in the Neonatal Intensive Care Unit]. / Infecciones virales de las vías respiratorias en la Unidad de Cuidados Intensivos Neonatales.

INTRODUCTION: Viral respiratory infections cause major morbidity and mortality in preterm infants. We have performed a prospective study in our neonatal intensive care unit (NICU) to determine the incidence of respiratory infections, their impact and the epidemiology and outcome in high risk neonates. PATIENTS AND METHODS: From September 2011 to May 2013 a prospective study was conducted in all preterm infants < 32 weeks gestational age and in all term newborns admitted to NICU for any pathology that are anticipated to have an income exceeding two weeks. A nasopharyngeal aspirate (NPA) was collected the first day of life and weekly until discharge for virologic study with polymerase chain reaction. When these babies presented respiratory symptoms a new NPA was collected in this moment. A clinical form was filled by the physician. RESULTS: A total of 60 infants were analyzed: 30 (50%) had a gestational age < 32 weeks and 36 (60%) weighing less than 1500 grams. We collected a total of 256 nasopharyngeal aspirate samples, 24 of them being positive (9.3%). These 24 positive samples corresponded to 13 infants in our cohort (21.6% of the patients). Of them, 9 were symptomatic and had 11 episodes of infection (2 patients had two different episodes with negative control between them). The most frequently identified virus was rhinovirus in (19) 79% of cases. The most frequent clinical data was the presence or increased of apneas (75%) and the needed of oxygenotherapy. CONCLUSIONS: HRV infections are prevalent in the NICU, and preterm infants have a high risk of infections with clinical relevance.

Hospital admission due to respiratory viral infections in moderate preterm, late preterm and term infants during their first year of life.

BACKGROUND: Respiratory viral infections are a major cause of hospitalisation in infants <1 year and might cause severe symptoms in preterm infants. Our aim was to analyse admissions due to respiratory infections in moderate, late and term infants, and to identify risk factors for hospitalisation in preterm versus term. METHODS: Prospective study in a cohort of moderate and late preterm, and term infants born between October/2011 and December/2012. Admissions due to respiratory infections during the first year of life were analysed and compared among moderate (32-33), late (34-36) and term infants. Sixteen respiratory viruses were detected by RT-PCR. Clinical data were collected. RESULTS: 30 (20.9%) out of 143 preterm infants required admission for respiratory infection, versus 129 (6.9%) of 1858 term infants born in the same period (p<0.0001, OR: 3.6 CI 2.0 to 5.0). Hospitalised children had a higher prevalence of hyaline membrane disease (HMD) at birth (p<0.001, OR: 7.7 CI: 2.121 to 27.954) and needed more mechanical ventilation (p<0.001, OR: 5.7 CI: 1.813 to 18.396). Virus was identified in 25/30 (83%) preterm babies, and in 110/129 (85%) term infants. The most frequent viruses in preterm infants were RSV (76%) rhinovirus (20%). Clinical and epidemiological characteristics among term and preterm infants were similar. CONCLUSIONS: The risk of respiratory admissions during the first year of life is up to 3.6 times higher in moderate and late preterm. Once admitted, clinical features of respiratory episodes requiring hospitalisation are similar among term and preterm infants. Hyaline membrane disease and mechanical ventilation were also risk factors for respiratory admissions.

Densidad asimétrica neuronal inter-hemisférica de la corteza insular en ratones FMR1 knock-out / Interhemispheric neural density asymmetry of insular cortex in FMR1 knock-out mice

El síndrome X frágil en los seres humanos es causado por una mutación en el gen FMR1 y se asocia con grave retraso mental, hiperactividad y ansiedad. Hemos comparado ratones FMR1-KO con ratones Control en la densidad neuronal de la corteza insular, área del cerebro asociada con el procesamiento del dolor y manejo de la ansiedad. Los ratones también fueron sometidos a una prueba de aprendizaje espacial en un entorno de ansiedad. Los resultados muestran asimetría significativa entre la densidad neuronal entre ínsula izquierda y derecha en KO en comparación con ratones de tipo Control. En cuanto al comportamiento, a pesar de los ratones KO no mostraron marcados déficits en la realización de tareas mostraron una velocidad superior a la de sus homólogos de tipo Control. Por otra parte, la asimetría de densidad insular se correlaciona con una mayor velocidad a nivel individual. Estos resultados sugieren que la asimetría de la densidad neuronal insular en FMR1 ratones KO se puede considerar como un correlato anatómico de las anormalidades de comportamiento observados.

Fragile X syndrome in humans is caused by a mutation in the FMR1 gene and it is associated with severe mental retardation, hyperactivity and anxiety. Here we compare FMR1 Knock-Out mice, a model of Fragile-X syndrome, and wild-type mice with respect to the neuronal density of the insular cortex, a brain area associated with pain processing and anxiety management. Mice were also subjected to a spatial learning test in an anxiogenic environment. Results show significant asymmetry between neuronal density between left and right insula in knock out as compared to wild type mice. Behaviorally, although knock-out mice did not show deficits in task completion they explored the maze at a higher velocity than their wild-type counterparts. Furthermore, insular density asymmetry correlated with higher velocity during one of the spatial navigation tasks at the individual mouse level. These results suggest that insular neuronal density asymmetry in FMR1 Knot-Out mice may be considered as an anatomical correlate of the observed behavioral abnormalities.

Y155H amino acid substitution in influenza A(H1N1)pdm09 viruses does not confer a phenotype of reduced susceptibility to neuraminidase inhibitors.

The Y155H amino acid substitution in the neuraminidase gene (NA) has previously been associated with highly reduced inhibition by neuraminidase inhibitors in the seasonal H1N1 influenza A virus which circulated in humans before the 2009 pandemic. During the 2012/13 epidemic season in Spain, two A(H1N1) pdm09 viruses bearing the specific Y155H substitution in the NA were detected and isolated from two patients diagnosed with severe respiratory syndrome and pneumonia requiring admission to the intensive care unit. Contrary to what was observed in the seasonal A(H1N1) viruses, neither of the Y155H A(H1N1) pdm09 viruses described here showed a phenotype of reduced inhibition by NAIs as determined by the neuraminidase enzyme inhibition assay (MUNANA). High-throughput sequencing of the NA of both Y155H viruses showed that they were composed to >99% of H155 variants. We believe that this report can contribute to a better understanding of the biological significance of amino acid substitutions in the neuraminidase protein with regard to susceptibility of influenza viruses to neuraminidase inhibitors. This is of critical importance for optimal management of influenza disease patients.

Masticatory mechanosensitivity, mouth opening and impact of headache in subjects with a history of orthodontics use: a cross-sectional study.

BACKGROUND: The correlation between orthodontics and the development of signs and symptoms of temporomandibular disorders (TMD) is a major concern in the physical rehabilitation field. AIM: The aim of the study was to observe whether subjects with a history of orthodontics use show differences from subjects who have never used orthodontics in: 1) masseter and temporalis muscle mechanosensitivity; 2) maximal vertical mouth opening (VMO); and 3) the impact of headache on their quality of life. DESIGN: Cross-sectional study. SETTING: The study was carried out in the Faculty of Nursing, Physiotherapy and Podiatry of the University of Sevilla, Spain. POPULATION: All participants were pre graduate students from the University of Sevilla, Spain. The final sample comprised 65 subjects (N.=65) with a mean age of 21 ± 2.46 years (18-29) divided into two groups; orthodontics group (N.=31) and non-orthodontics group (N.=34). METHODS: All students followed the same testing protocol. Measurements were taken of the pressure pain threshold (PPT) in two locations of the masseter (M1, M2) and temporalis (T1, T2) muscles, the maximal VMO, and the incidence of headache (Headache Impact Test-6; HIT-6, Spanish version). RESULTS: The measured values of the masticatory muscle PPTs were lower in the non-orthodontics group. Besides, the maximal VMO and HIT-6 scores were better in the orthodontics group. Nevertheless, none of these intergroup differences were statistically significant (ANOVA test): (M1 P=0.790); (M2 P=0.329); (T1 P=0.249); (T2 P=0.440); (HIT-6 P=0.443); (VMO P=0.626). CONCLUSION: A previous history of orthodontics use does not seem to lead to any greater sensitivity of the masticatory muscles, limitations of vertical mouth opening, or greater impact of headache on the subject's quality of life. CLINICAL REHABILITATION IMPACT: There is no evidence enough to support either a positive or negative correlation between orthodontics and signs and symptoms of TMD. Pain is a subjective perception and it is influenced by several factors. It remains uncertain if the use of orthodontics might be one of them.

Gradient induced artifacts in simultaneous EEG-fMRI: Effect of synchronization on spiral and EPI k-space trajectories.

The nature of the gradient induced electroencephalography (EEG) artifact is analyzed and compared for two functional magnetic resonance imaging (fMRI) pulse sequences with different k-space trajectories: echo planar imaging (EPI) and spiral. Furthermore, the performance of the average artifact subtraction algorithm (AAS) to remove the gradient artifact for both sequences is evaluated. The results show that the EEG gradient artifact for spiral sequences is one order of magnitude higher than for EPI sequences due to the chirping spectrum of the spiral sequence and the dB/dt of its crusher gradients. However, in the presence of accurate synchronization, the use of AAS yields the same artifact suppression efficiency for both pulse sequences below 80Hz. The quality of EEG signal after AAS is demonstrated for phantom and human data. EEG spectrogram and visual evoked potential (VEP) are compared outside the scanner and use both EPI and spiral pulse sequences. MR related artifact residues affect the spectra over 40Hz (less than 0.2 µV up to 120Hz) and modify the amplitude of P1, N2 and P300 in the VEP. These modifications in the EEG signal have to be taken into account when interpreting EEG data acquired in simultaneous EEG-fMRI experiments.

Influenza vaccine effectiveness in Spain 2013/14: subtype-specific early estimates using the cycEVA study.

Adjusted early estimates of the 2013/14 influenza vaccine effectiveness (VE) in Spain for all age groups was 35% (95% CI: -9 to 62), 33% (95% CI: -33 to 67) and 28% (95% CI: -33 to 61) against any influenza virus type, A(H1N1)pdm09 and A(H3N2) viruses, respectively. For the population targeted for vaccination, the adjusted VE was 44% (95% CI: -11 to 72), 36% (95% CI: -64 to 75) and 42% (95% CI: -29 to 74), respectively. These preliminary results in Spain suggest a suboptimal protective effect of the vaccine against circulating influenza viruses.

Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis.

We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: -14 to 50). The VE was 40% (95% CI: -12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: -36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).

Dynamic gamma frequency feedback coupling between higher and lower order visual cortices underlies perceptual completion in humans.

To perceive a coherent environment, incomplete or overlapping visual forms must be integrated into meaningful coherent percepts, a process referred to as "Gestalt" formation or perceptual completion. Increasing evidence suggests that this process engages oscillatory neuronal activity in a distributed neuronal assembly. A separate line of evidence suggests that Gestalt formation requires top-down feedback from higher order brain regions to early visual cortex. Here we combine magnetoencephalography (MEG) and effective connectivity analysis in the frequency domain to specifically address the effective coupling between sources of oscillatory brain activity during Gestalt formation. We demonstrate that perceptual completion of two-tone "Mooney" faces induces increased gamma frequency band power (55-71Hz) in human early visual, fusiform and parietal cortices. Within this distributed neuronal assembly fusiform and parietal gamma oscillators are coupled by forward and backward connectivity during Mooney face perception, indicating reciprocal influences of gamma activity between these higher order visual brain regions. Critically, gamma band oscillations in early visual cortex are modulated by top-down feedback connectivity from both fusiform and parietal cortices. Thus, we provide a mechanistic account of Gestalt perception in which gamma oscillations in feature sensitive and spatial attention-relevant brain regions reciprocally drive one another and convey global stimulus aspects to local processing units at low levels of the sensory hierarchy by top-down feedback. Our data therefore support the notion of inverse hierarchical processing within the visual system underlying awareness of coherent percepts.