Quality of life and cost-effectiveness analysis of topical tranexamic acid and fibrin glue in femur fracture surgery.

BACKGROUND: We assessed quality of life (QoL) of patients undergoing surgery for proximal femur fracture and performed a cost-effectiveness analysis of haemostatic drugs for reducing postoperative bleeding. METHODS: We analysed data from an open, multicentre, parallel, randomized controlled clinical trial (RCT) that assessed the efficacy and safety of tranexamic acid (TXA group) and fibrin glue (FG group) administered topically prior to surgical closure, compared with usual haemostasis methods (control group). For this study we conducted a cost-effectiveness analysis of these interventions from the Spanish Health System perspective, using a time horizon of 12 months. The cost was reported in $US purchasing power parity (USPPP). We calculated the incremental cost-effectiveness ratio (ICER) per QALY (quality-adjusted life-year). RESULTS: We included 134 consecutive patients from February 2013 to March 2015: 42 patients in the TXA group, 46 in the FG group, and 46 in the control group. Before the fracture, EuroQol visual analogue scale (EQ-VAS) health questionnaire score was 68.6. During the 12 months post-surgery, the intragroup EQ-VAS improved, but without reaching pre-fracture values. There were no differences between groups for EQ-VAS and EuroQol 5 dimensions 5 levels (EQ-5D-5L) health questionnaire score, nor in hospital stay costs or medical complication costs. Nevertheless, the cost of one FG treatment was significantly higher (399.1 $USPPP) than the cost of TXA (12.9 $USPPP) or usual haemostasis (0 $USPPP). When comparing the cost-effectiveness of the interventions, FG was ruled out by simple dominance since it was more costly (13,314.7 $USPPP) than TXA (13,295.2 $USPPP) and less effective (utilities of 0.0532 vs. 0.0734, respectively). TXA compared to usual haemostasis had an ICER of 15,289.6 $USPPP per QALY). CONCLUSIONS: There were no significant differences between the intervention groups in terms of postoperative changes in QoL. However, topical TXA was more cost-effective than FG or usual haemostasis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.

A characterization of the molecular phenotype and inflammatory response of schizophrenia patient-derived microglia-like cells.

Different lines of evidence support a causal role for microglia in the pathogenesis of schizophrenia. However, how schizophrenia patient-derived microglia are affected at the phenotypic and functional level is still largely unknown. We used a recently described model to induce patient-derived microglia-like cells and used this to analyze changes in the molecular phenotype and function of myeloid cells in schizophrenia. We isolated monocytes from twenty recent-onset schizophrenia patients and twenty non-psychiatric controls. We cultured the cells towards an induced microglia-like phenotype (iMG), analyzed the phenotype of the cells by RNA sequencing and mass cytometry, and their response to LPS. Mass cytometry showed a high heterogeneity of iMG in cells derived from patients as well as controls. The prevalence of two iMG clusters was significantly higher in schizophrenia patients (adjusted p-value < 0.001). These subsets are characterized by expression of ApoE, Ccr2, CD18, CD44, and CD95, as well as IRF8, P2Y12, Cx3cr1 and HLA-DR. In addition, we found that patient-derived iMG show an enhanced response to LPS, with increased secretion of TNF-α. Further studies are needed to replicate these findings, to determine whether similar subclusters are present in schizophrenia patients in vivo, and to address how these subclusters are related to the increased response to LPS, as well as other microglial functions.

Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial.

INTRODUCTION: Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA). MATERIALS AND METHODS: We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality. RESULTS: One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events. CONCLUSION: We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA. LEVEL OF EVIDENCE: I.

In vitro, ex vivo and in vivo antihypertensive evaluation of enzymatic hydrolysates of Californian red worm (Eisenia fetida) proteins.

Hypertension is an important risk factor concomitant with cardiovascular disease (CVD) states, which is why we set out to evaluate Californian red worm hydrolysates on antihypertensive activity both in vitro, ex vivo, using rabbit aortic rings and in vivo using hypertensive induced rats. The worms were manually separated, washed with water, purged for 4 h with 4 % sodium bicarbonate, sacrificed with 7 % saline, and finally washed with drinking water. The in vitro antihypertensive capacity was performed by measuring angiotensin-converting enzyme inhibition; for the ex vivo assays, rabbit aorta was used to measure relaxation; for the in vivo assays, rats with induced hypertension were used to perform acute (hypotension) and chronic assays, using captopril as a control in all assays. With respect to angiotensin-converting enzyme (ACE) inhibition, the EC50 value of the worm hydrolysate was found to be 358 ppm; with respect to the analysis in aortic rings, it was found that the mechanisms of action of the hydrolysate are endothelium-dependent, presenting a maximum relaxation of 35 %. With respect to the in vivo assays, the hypotensive test showed that the hydrolysate can reduce blood pressure by up to 32 % in only 2 h, while the chronic analysis showed that the hydrolysate at 150 ppm did not present statistically significant differences with the control (captopril) during the 15 days of analysis. The Red Californian earthworm hydrolysate presents bioactive compounds identified with antihypertensive activities in vitro, ex vivo and in vivo in different isolated and animal models. The study demonstrates the efficacy of the hydrolysate to be used as an alternative in the treatment and prevention of hypertension, and it can be implemented in functional foods or nutraceutical foods. Antihypertensive peptides, particularly those that inhibit angiotensin-converting enzyme (ACE), hold significant importance in medical research, specifically in the context of cardiovascular disease treatment, particularly hypertension. The focus on these peptides and the potential implications of their results in medical research can be summarized through several key points: 1) Mechanisms of Action-Antihypertensive peptides function by inhibiting ACE or renin, crucial enzymes in blood pressure regulation. 2)Alternatives to Synthetic Drugs, 3) Additional Health Benefits, and various other factors.

Optimization and scale up of the enzymatic hydrolysis of Californian red worm protein (Eiseniafoetida).

Although the best-known use of the different species of earthworm is the production of organic fertilizer, they can also be considered a rich source of biologically and pharmacologically-active compounds, for use in the treatment of various diseases. In recent decades, with the development of biochemical technologies, research on the pharmaceutical effects of compounds extracted from different species of earthworms has begun. Enzymatic hydrolysis is the most common and widely used technique for producing bioactive hydrolysates, because it uses moderate operating conditions, with a certain specificity for the substrate. In the present study, the objective was to optimize and scale up the enzymatic hydrolysis of Eisenia foetida protein to obtain peptides with biological activity. The substrate characterization was carried out according to AOAC, a response surface design was performed for the optimization of the enzymatic hydrolysis and then the scaling was performed by means of dimensional analysis. The results show that the major component of the paste is protein, 65% of which is albumin, and the absence of pathogenic microorganisms was also found. Regarding optimization, it was found that the optimal hydrolysis conditions are achieved with pH = 8.5; temperature = 45 °C; amount of substrate = 125 g and volume of enzyme = 1245µL. For the scaling, 4 dimensionless pi-numbers were calculated which describe the process with no statistically significant differences between the model and the prototype; it can be concluded that the enzymatic hydrolysate of Eisenia foetida presents high values of antioxidant activity evaluated by different methodologies.

Thrombectomy with embed aspiration in acute ischaemic stroke.

BACKGROUND: In addition to stent retrievers, direct aspiration has become a reasonable thrombectomy strategy. OBJECTIVES: We carried out the thrombectomy by guiding the aspiration catheter fully over the clot and performing immediate manual aspiration; we call this procedure "embed aspiration". METHODS: In this prospective, non-randomised, single-centre study, we included all patients treated at a high volume-of-care stroke centre between 2017 and 2018 for the TRIANA (Thrombectomy in Andalusia using Aspiration) registry. Thrombectomy was carried out by embed aspiration. Patients were classified according to the success (eTICI 2b67-2c-3) or failure (eTICI 0-1-2a-2b50) of the procedure. Baseline clinical data and outcomes were compared, and multivariate analysis was performed. RESULTS: The embed aspiration technique was used in 370 patients. Treatment was successful in 90.3% of patients. Mean puncture-to-recanalisation time was 25 minutes. The overall rate of good outcomes (mRS 0-2) at 3 months was 64%. CONCLUSIONS: This study supports real-life evidence that standardised embed aspiration may be an alternative to stent retrievers for thrombectomy.

Sustainable use of giant reed to produce industrialized enzymes.

The giant reed (Arundo donax) is a fast-growing plant adapted to different climatic and soil conditions; although its origin is Asian, the species has spread throughout the world. During its development, it consumes three times more water than typical native vegetation and is responsible for changing the landscape of riparian areas; the high biomass productivity and the annual harvest period make this crop an alternative to produce and/or extract industrial bioproducts. The main objective of this research was to evaluate the feasibility of using giant reed in a bioprocess that produces enzymes by a solid-state fermentation experiment, four fungal species were tested (Aspergillus niger GH1, Aspergillus niger PSH, Trichoderma harzianum, and Rhizopus oryzae); enzyme activities were performed using reported methodologies varying only reaction volumes. The A. niger GH1 and PSH strains were the best adapted to the plant material, A. niger GH1 was capable to produce 4 of the 5 evaluated enzymes (cellulase-endoglucanase (174.39 ± 19.62 U/L), xylanase (1313.31 ± 39.25 U/L), invertase (642.22 ± 23.55 U/L), and polyphenol oxidase (6094.01 ± 306.54) while A. niger PSH was able to produce 3 of the 5 evaluated enzymes (cellulase-endoglucanase (147.09 ± 13.88 U/L), xylanase (1307.76 ± 31.40 U/L), and invertase (603.92 ± 3.14 U/L).

Narrow band quantitative and multivariate electroencephalogram analysis of peri-adolescent period.

BACKGROUND: The peri-adolescent period is a crucial developmental moment of transition from childhood to emergent adulthood. The present report analyses the differences in Power Spectrum (PS) of the Electroencephalogram (EEG) between late childhood (24 children between 8 and 13 years old) and young adulthood (24 young adults between 18 and 23 years old). RESULTS: The narrow band analysis of the Electroencephalogram was computed in the frequency range of 0-20 Hz. The analysis of mean and variance suggested that six frequency ranges presented a different rate of maturation at these ages, namely: low delta, delta-theta, low alpha, high alpha, low beta and high beta. For most of these bands the maturation seems to occur later in anterior sites than posterior sites. Correlational analysis showed a lower pattern of correlation between different frequencies in children than in young adults, suggesting a certain asynchrony in the maturation of different rhythms. The topographical analysis revealed similar topographies of the different rhythms in children and young adults. Principal Component Analysis (PCA) demonstrated the same internal structure for the Electroencephalogram of both age groups. Principal Component Analysis allowed to separate four subcomponents in the alpha range. All these subcomponents peaked at a lower frequency in children than in young adults. CONCLUSIONS: The present approaches complement and solve some of the incertitudes when the classical brain broad rhythm analysis is applied. Children have a higher absolute power than young adults for frequency ranges between 0-20 Hz, the correlation of Power Spectrum (PS) with age and the variance age comparison showed that there are six ranges of frequencies that can distinguish the level of EEG maturation in children and adults. The establishment of maturational order of different frequencies and its possible maturational interdependence would require a complete series including all the different ages.

Infection and immunity for human parvovirus B19 in patients with febrile exanthema.

The contribution of parvovirus B19 (B19V) as a causative agent of febrile exanthema (FE) in Cordoba, Argentina, was analysed by detection of viral DNA, and specific IgM and IgG. Serum from 141 patients with FE who were negative for measles and rubella, collected during 2005-2009, plus serum from 31 healthy individuals, were assayed. B19V was the aetiological agent in 14·9% of all FE cases, and in 39·1% in an epidemic year (2007). B19V DNA was detected in 47·6% of IgM-positive FE patients, 30·2% of IgM-negative/IgG-positive FE patients, and 9·7% of healthy controls, indicating B19V long-term infection in ~10% of immunocompetent individuals. Persistent B19V DNA was significantly more frequent in children than adults and in males than females. All patients with acute B19V infection had rash and fever, 85·7% had adenopathy, and only 14·3% had arthropathy. This is the first follow-up study of markers of infection and immunity for B19V infection in Argentina.

Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope.

PURPOSE: To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs. MATERIALS AND METHODS: PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. RESULTS: Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover âˆ¼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment. CONCLUSION: A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

[Parental perceptions of increased child-to-parent violence of Spanish adolescents during covid-19 lockdown.] / Percepciones parentales de incremento de violencia filioparental de los adolescentes españoles durante el confinamiento por COVID-19.

OBJECTIVE: Internationally, there was a warning of the risk of increased domestic violence during lockdown due to the COVID-19 pandemic, including child-to-parent violence. The objective of our study was to assess the prevalence of different violent behaviors from children to parents during pre-lockdown, lockdown and immediately after, between March 14 and June 20, 2020, and to assess differences in behaviors between pre-lockdown and lockdown and between pre-lockdown and post-lockdown. METHODS: The researchers developed a survey with closed questions about different violent behaviors of the children (poor responses, insults and physical aggression). This was distributed with the CAWI methodology during the months of August and September 2020 to a sample of Spanish parents stratified by autonomous communities. 1,500 families with 1,927 adolescents aged 12 to 18 years participated. The frequency of responses obtained between the pre-lockdown and lockdown and between pre-lockdown and post-lockdown was compared through the Mac Nemar test for comparison of related samples. RESULTS: The prevalences of poor responses, insults and aggressions in a pre-lockdown setting were 30.1%, 3.8% and 0.6%, respectively. Poor responses and insults increased significantly between pre-lockdown and lockdown (p<0.001) and between pre-lockdown and post-lockdown (p<0.001) in all autonomous communities, age groups, genders, occupation type of the adolescent and type of household. No statistically significant differences were found in physical aggression for the periods evaluated. Single-parent families, adolescents residing in subsidized housing and those without an occupation or education ("NEET") exhibited more violent behavior in the three periods. CONCLUSIONS: Lockdown led to an increase in nonphysical violent behaviors, which were maintained to the end, warning of the potentially persistent risks of lockdown in this age group, especially in vulnerable families.

OBJETIVO: A nivel internacional se alertó de riesgo de aumento de violencia doméstica, durante el confinamiento debido a la pandemia por COVID-19, incluyendo violencia filioparental. El objetivo de nuestro estudio fue valorar la prevalencia de diferentes conductas violentas de hijos adolescentes a padres en los periodos pre-confinamiento, confinamiento e inmediatamente después del confinamiento producido entre el 14 de marzo y el 20 de junio de 2020, y valorar diferencias en las conductas entre pre y confinamiento, y entre pre y post-confinamiento. METODOS: Los investigadores elaboraron una encuesta con preguntas cerradas acerca de diferentes conductas violentas (malas respuestas, insultos y agresión física) de los hijos. Esta fue distribuida con metodología CAWI durante los meses de agosto y septiembre de 2020 a una muestra de padres españoles estratificada por comunidades autónomas. Participaron 1.500 familias con 1.927 hijos entre 14 y 18 años. Se comparó la frecuencia de respuestas obtenidas entre el momento pre-confinamiento y durante el confinamiento, y entre pre y post confinamiento, a través de la prueba de Mc Nemar para comparación de muestras relacionadas. RESULTADOS: Las prevalencias encontradas de malas respuestas, insultos y agresiones en situación previa al confinamiento fueron del 30,1%, 3,8% y 0,6% respectivamente. Las malas respuestas e insultos aumentaron de forma altamente significativa entre el pre y el confinamiento (p<0,001), y entre el pre y post-confinamiento (p<0,001), en todas las comunidades autónomas, franjas de edad, sexo, tipo de ocupación del adolescente y tipo de vivienda. No se hallaron diferencias estadísticamente significativas en las agresiones físicas en los periodos evaluados. Las familias monoparentales, los adolescentes residentes en viviendas cedidas y aquellos sin ocupación ni estudios ("ninis") presentaban valores porcentualmente más elevados de conductas violentas en los tres periodos. CONCLUSIONES: El confinamiento supuso un incremento de conductas violentas no físicas, que se mantuvieron al cesar el mismo, alertando de los riesgos del confinamiento en esta franja de edad, potencialmente persistente, en especial en familias vulnerables.

[Prevalence of eating disorders in early adolescent students]. / Prevalencia de trastornos alimentariosen estudiantes adolescentes tempranos.

OBJECTIVE: To measure the prevalence of Eating Behavior Disorders (EBD) in Spanish early-adolescent students using standardized methods. METHODS: A two-stage survey of prevalence of ED in a representative sample of 12 to 13 year old students in 2007 in Zaragoza (Spain). Standard evaluation: We used a two-phase cross sectional design, which involved the screening with questionnaires (EAT at a cutoff score of 20) and subsequent semi-structured interviews (SCAN) of screen-positive and screen-negative subjects. We calculated the sociodemographic characteristics, ED prevalence with their 95% confidence intervals (CI) with Confidence Interval Analysis (C.I.A.) disk version 2.0.0 (Altman et al, 2000). The study is financed by F.I.S. PI 05/2533 (Spain Health Department). RESULTS: In 2007 we studied 701 students seventh-grade, ages 12 to 13, girls and boys, in 9 public and private schools in Zaragoza (30 classrooms). In the second phase 164 preteens agreed to proceed with the clinical evaluation (63 at risk, high scorers; 101 selected sample not at risk). ED prevalence was 0.7% EDNOS F 50.9 (CI 95%: 0.3%-1.7%). CONCLUSION: The ICD-10 point prevalence rates of ED population in Spanish preteen students is similar to those reported for other developed countries. The prevalence of subclinical ED is substantially higher than that of full-syndrome.

Effects of chemical silage of red tilapia viscera (Oreochromis spp.) as a source of protein on the productive and hematological parameters in isa-brown laying hens (Gallus gallus domesticus).

This paper evaluates the inclusion of chemical silage from viscera of red tilapia (Oreochromis spp.) in diets of Isa-Brown laying hens (Gallus gallus domesticus), and its influence on productive variables and hematological parameters. A total of 56, 16-week-old laying hens were randomly divided into two groups (one per diet), which in turn were subdivided into 7 replicates of 4 birds each. All test groups were fed for 16 weeks. During this period, the evaluation of the productive variables was carried out, and at the end, random blood samples were taken from 3 birds per diet. The results indicated that the inclusion of chemical silage from red tilapia viscera with a proportion of 17.18% dry matter, does not present statistically significant differences in the productive variables which were evaluated (p > 0.05) with respect to the control. Moreover, the chemical silage did not modify the hematological parameters and blood the chemistry in the hens. This allowed us to conclude that silage can be used as a substitute for conventional protein raw materials such as fishmeal and soybean meal in the preparation of diets for laying hens, without altering their productive performance.

The Effect of Lifestyle Intervention on Pregnancy and Birth Outcomes on Obese Infertile Women: A Systematic Review and Meta-Analysis.

Obesity has been associated with negative effects on natural fertility and poor prognosis when assisted reproductive technologies (ART) are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve the outcomes. There is lack of enough information on how weight-loss would be effective for improving fertility in women who are overweight or obese. We conducted a systematic review to evaluate whether weight-loss achieved by lifestyle program improves natural or assisted reproduction in obese infertile women. We searched CENTRAL, MEDLINE, and EMBASE up to March 2018. Two reviews were selected as randomised trials assessing a lifestyle intervention in women with obesity before receiving treatments for infertility and appraised their risk of bias. We extracted data on pregnancy, birth, and miscarriage rates as the primary outcomes and pooled effect estimates using a random effects model. The primary outcome was the live birth rate. We reported summary measures as the relative risk (RR), 95% confidence interval (CI), and percentage of heterogeneity (I2). We included eight randomised trials with 1175 women. Lifestyle programmes, improved pregnancy rates (RR: 1.43, CI: 95% 1.02 to 2.01; I2=60%; 8 RCTs; N=1098) but had no impact on live births (RR: 1.39, CI: 95% 0.90 to 2.14; I2=64%; 7RCTs; N=1034). Our findings suggest that women participating in lifestyle interventions had an increased risk of miscarriage (RR: 1.50, CI: 95% 1.04 to 2.16; I2=0; 6RCTs; N=543). We rated the quality of evidence for these outcomes as the moderate-to-low. Lifestyle interventions slightly increased the pregnancy rate, while it would be uncertain whether it can improve the live birth. Lifestyle interventions can increase the risk of miscarriage. More research is needed to further explore lifestyle interventions on reproductive outcomes in obese infertile women.

Robust experimental design for optimizing the microbial inhibitor test for penicillin detection in milk.

AIMS: To use experimental design techniques and a multiple logistic regression model to optimize a microbiological inhibition test with dichotomous response for the detection of Penicillin G in milk. METHODS AND RESULTS: A 2(3) x 2(2) robust experimental design with two replications was used. The effects of three control factors (V: culture medium volume, S: spore concentration of Geobacillus stearothermophilus, I: indicator concentration), two noise factors (Dt: diffusion time, Ip: incubation period) and their interactions were studied. The V, S, Dt, Ip factors and V x S, V x Ip, S x Ip interactions showed significant effects. CONCLUSIONS: The use of 100 microl culture medium volume, 2 x 10(5) spores ml(-1), 60 min diffusion time and 3 h incubation period is recommended. In these elaboration conditions, the penicillin detection limit was of 3.9 microg l(-1), similar to the maximum residue limit (MRL). Of the two noise factors studied, the incubation period can be controlled by means of the culture medium volume and spore concentration. SIGNIFICANCE AND IMPACT OF THE STUDY: We were able to optimize bioassays of dichotomous response using an experimental design and logistic regression model for the detection of residues at the level of MRL, aiding in the avoidance of health problems in the consumer.

Adoption Factors Related to Electronic Vaccine Record in the Public Primary Care Network of Buenos Aires City.

The Electronic Health Record used in the public primary care network of Buenos Aires City has a specific module for the vaccines registration. The present study explores the factors of EHR adoption by nurses. We found 5 barriers and one facilitator for adoption. Barriers are related with organize the flow of patients especially during vaccine campaigns, adapt the work stations and integrate the records with the vaccine central program.

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Real-life Patients With Atrial Fibrillation. A Systematic Review and Meta-analysis.

INTRODUCTION AND OBJECTIVES: To assess the effectiveness of direct oral anticoagulants vs vitamin K antagonists in real-life patients with atrial fibrillation. METHODS: A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA statement. The ROBINS-I tool was used to assess risk of bias. RESULTS: A total of 27 different studies publishing data in 30 publications were included. In the studies with a follow-up up to 1 year, apixaban (HR, 0.93; 95%CI, 0.71-1.20) and dabigatran (HR, 0.95; 95%CI, 0.80-1.13) did not significantly reduce the risk of ischemic stroke vs warfarin, whereas rivaroxaban significantly reduced this risk (HR, 0.83; 95%CI, 0.73-0.94). Apixaban (HR, 0.66; 95%CI, 0.55-0.80) and dabigatran (HR, 0.83; 95%CI, 0.70-0.97) significantly reduced the major bleeding risk vs warfarin, but not rivaroxaban (HR, 1.02; 95%CI, 0.95-1.10), although with a high statistical heterogeneity among studies. Apixaban (HR, 0.56; 95%CI, 0.42-0.73), dabigatran (HR, 0.45; 95%CI, 0.39-0.51), and rivaroxaban (HR, 0.66; 95%CI, 0.49-0.88) significantly reduced the risk of intracranial bleeding vs warfarin. Reduced doses of direct oral anticoagulants were associated with a slightly better safety profile, but with a marked reduction in stroke prevention effectiveness. CONCLUSIONS: Data from this meta-analysis suggest that, vs warfarin, the stroke prevention effectiveness and bleeding risk of direct oral anticoagulants may differ in real-life patients with atrial fibrillation.

A randomized, double-blind multicentre clinical trial comparing the efficacy of calcium dobesilate with placebo in the treatment of chronic venous disease.

OBJECTIVE: To assess the efficacy of calcium dobesilate on the quality-of-life (QoL) of patients with chronic venous disease (CVD). DESIGN: Randomised, parallel, double blind, placebo-controlled clinical trial. METHODS: Patients were recruited from vascular surgery clinics and randomised to 500mg capsules of calcium dobesilate twice a day for 3 months or placebo. The primary outcome measure was 'QoL after 3 months' treatment measured by the specific Chronic Insufficiency Venous International Questionnaire (CIVIQ). Secondary outcomes were QoL at 12 months and assessment of the CVD signs and symptoms. The principal analysis was undertaken on the intention-to-treat (ITT) data. RESULTS: Five hundred and nine patients were recruited (246 to calcium dobesilate and 263 to placebo). The analysis of the 'QoL after 3 months' showed no significant differences between groups (p=0.07). For secondary outcomes, oedema and symptoms of CVD, there were no significant differences between groups. In a multi-factorial analysis, the 'QoL at 12 months' was better in the calcium dobesilate group than in placebo group (p=0.02). CONCLUSIONS: Treatment with calcium dobesilate was not found to be superior to placebo on the QoL of CVD patients. The sustained effect of calcium dobesilate observed after treatment should be confirmed in future studies.

[Assessing the use of proton pump inhibitors in an internal medicine department]. / Evaluación del uso de los inhibidores de la bomba de protones en un servicio de medicina interna.

INTRODUCTION: proton pump inhibitors (PPIs) block the H+/K+ ATPase enzyme in gastric wall cells, leading to an inhibition of both baseline and stimulated acid secretion. Appropriate indications include: Gastroesophageal reflux, acute upper gastrointestinal bleeding, erosive gastritis or esophagitis, dyspepsia, NSAID-related gastropathy, and stress ulcer prophylaxis in high risk patients. The aims of this study were to review the current indications of PPIs, and to evaluate their use in Guadalajara s University Hospital. MATERIAL AND METHODS: a transversal, analytic, randomized study was carried out during 2003 in our internal medicine department. A total of 208 medical records for 832 patients receiving PPIs were reviewed (25%). Mean age was 67 years (range: 16-92), 46.2% were females, and most frequent conditions were HBP, COPD, and DM. RESULTS: 34.6% of patients took PPIs before admission, their use being inappropriate in 68.1% of them. Among hospitalized patients 73.03% used PPIs inappropriately, and most of them had no such indication at discharge. CONCLUSIONS: results are in accordance with the literature, with a high frequency of incorrect PPI use; a more accurate use of PPIs is to be recommended to avoid side effects and drug interactions, and to provide a more efficient medical care.