Does curcumin improve liver enzymes levels in nonalcoholic fatty liver disease? A systematic review, meta-analysis, and meta-regression.

The aim of this meta-analysis is to investigate the sources of heterogeneity in randomized clinical trials examining the effects of curcumin supplementation on liver aminotransferases in subjects with nonalcoholic fatty liver disease (NAFLD). We conducted a systematic search of the PubMed, SCOPUS, and Web of Science databases for randomized clinical trials and identified 15 studies (n = 835 subjects). We used random-effects models with DerSimonian-Laird methods to analyze the serum levels of alanine aminotransferase and aspartate aminotransferase enzymes. Our results indicate that curcumin did not affect serum alanine aminotransferase, but it did reduce aspartate aminotransferase levels. Notably, both outcomes showed high heterogeneity (p < 0.01). Subgroup analysis revealed that adding piperine to curcumin did not benefit aminotransferase levels in NAFLD patients. Additionally, we found a negative correlation between the duration of the intervention and the relative (mg/kg/day) curcumin dose with the reduction in liver aminotransferases. In summary, the sources of heterogeneity identified in our study are likely attributed to the duration of the intervention and the relative dose of curcumin. Consequently, longer trials utilizing high doses of curcumin could diminish the positive impact of curcumin in reducing serum levels of aminotransferases in patients with NAFLD.

Physical and Psychosocial Benefits of Sports Participation Among Children and Adolescents with Chronic Diseases: A Systematic Review.

BACKGROUND: This study aims to identify sports interventions for children and adolescents (CaA) with chronic diseases and evaluate their impact on physical, psychological, and social well-being. The findings of this study will contribute to our understanding of the potential benefits of sports interventions for CaA with chronic diseases and inform future interventions to promote their overall health and well-being. METHODS: A systematic review was conducted in eight databases. This systematic review followed PRISMA guidelines and utilized a comprehensive search strategy to identify studies on sport-based interventions for CaA with chronic diseases. The review included randomized controlled trials and observational studies that focused on physical and psychosocial outcomes. RESULTS: We screened 10,123 titles and abstracts, reviewed the full text of 622 records, and included 52 primary studies. A total of 2352 participants were assessed with an average of 45 ± 37 participants per study. Among the included studies involving CaA with chronic diseases with an age range from 3 to 18 years, 30% (n = 15) autism spectrum disorders, 21% (n = 11) cerebral palsy, 19% (n = 10) were attention deficit hyperactivity disorder, and 17% (n = 9) obesity. Other diseases included were cancer (n = 5), asthma (n = 1) and cystic fibrosis (n = 1). Interventions involved various sports and physical activities tailored to each chronic disease. The duration and frequency of interventions varied across studies. Most studies assessed physical outcomes, including motor performance and physical fitness measures. Psychosocial outcomes were also evaluated, focusing on behavioural problems, social competencies, and health-related quality of life. CONCLUSION: Overall, sport-based interventions effectively improved physical and psychosocial outcomes in CaA with chronic diseases. Interventions are generally safe, and participants adhere to the prescribed protocols favorably. Despite that, there is little evidence that interventions are being implemented. Future studies should include interventions tailored to meet the common issues experienced by CaA with chronic conditions, providing a comprehensive understanding of the impact of sports interventions on those affected. REGISTRATION: The methodology for this review was pre-determined and registered in the PROSPERO database (registration number: CRD42023397172).

How useful is a complete urinary tract ultrasound in orchiepididymitis?

Orchiepididymitis (OE) is a frequent cause of pediatric emergency department attendance in boys presenting with acute scrotum. The etiology of most episodes of OE remains unclear and there is no consensus regarding the correlation between OE and underlying genitourinary malformations. Whether imaging evaluation should comprise complete urinary tract ultrasonography (US) or voiding cystography is a subject of debate. The aim of this retrospective, single-center study was to analyze i) the number/type of urinary tract malformations detected by US following a first episode of OE in boys with no previously known malformation and ii) the frequency of associated urinary tract infection (UTI). We reviewed the records of 495 boys <16 years presenting to our pediatric emergency department with acute scrotum between January 2012 and December 2017. Patients with incomplete radiological data were excluded. Of 119 boys with a radiologically-confirmed first episode of OE, 99 had a complete urinary tract US and were included in the study. No genitourinary malformation was detected (0%). Urinary cultures showed UTI in 3/98 (3.1%) patients. Mean age at presentation was 9.7 years (standard deviation, 3.9) with a three-peak incidence of OE at 10-13 years, 4-5 years, and during infancy. Conclusion: Complete urinary tract US does not appear to be useful during a first episode of OE in countries with an antenatal US screening rate similar to Switzerland. The very low UTI rate suggests that a urinalysis is sufficient to investigate a first episode of OE and antibiotics should be reserved for positive urinalysis only.

Accessory Spleen Fracture: Report of a Pediatric Case and Review of the Literature.

Accessory spleen rupture may occur after blunt abdominal trauma or, more rarely, spontaneously. Although only few cases are described in adults, it is even more uncommon in children. We report the case of a 13-year-old boy with traumatic accessory spleen fracture. After a review of the literature, we discuss the diagnostic points that should raise the suspicion for accessory spleen fracture as well as how challenging the diagnosis by computed tomography can be.

Evaluation of Physical Fitness, Body Composition, and Adherence to Mediterranean Diet in Adolescents from Estonia: The AdolesHealth Study.

Unhealthy lifestyles, low levels of physical fitness, and adherence to the Mediterranean diet (MD) are associated with bad quality of life and the development of a wide range of non-communicable diseases (NCDs). The current study aimed to evaluate the level of adherence to the MD in physical fitness performance and body composition parameters in children and adolescents of Estonia. Therefore, 413 adolescents (56% boys) from the city of Tartu completed the Mediterranean Diet Questionnaire (KIDMED) for analyzing the adherence to MD and performed the Alpha Fitness Test for measuring physical fitness and body composition. A 41.67% of low, 44.05% of average, and 14.28% of high adherence to MD was detected, without difference between genders (p = 0.747). In the Alpha Fitness battery, a higher performance was observed in all tests for boys vs. girls (p < 0.05). In relation to body composition, higher height, weight, and waist values were observed in boys (p < 0.05) and a lower body fat percentage (p < 0.01) without differences in body mass index (BMI; p = 0.906). The adherence to the MD is classified as average/low. Gender significantly influences all variables of the Alpha Fitness battery and anthropometrics measures excepting BMI. According the levels of adherence to the MD, no statistically different prevalence was observed for Non-Overweight (N-Oweight), Non-Overfat (N-Ofat), or Non-Overwaist (N-Owaist). Still, a risk factor for Overweight (Oweight) in boys with low adherence was observed in comparison to those with a mid-level of adherence to the MD.

Niveles de actividad física, calidad de vida relacionada con la salud, autoconcepto físico eíndice de masa corporal: un estudio en escolares colombianos / Levels of physical activity, health-related quality of life, physical self-concept and body-mass index among Colombian students

Resumen Introducción. La actividad física, la calidad de vida relacionada con la salud, el autoconcepto y el índice de masa corporal son indicadores de un estilo de vida saludable. Objetivo. Determinar el nivel de actividad física y de sedentarismo, la calidad de vida relacionada con la salud, el autoconcepto físico y el índice de masa corporal en escolares colombianos de educación secundaria y media. Materiales y métodos. Participaron en el estudio 1.253 estudiantes entre los 10 y los 20 años (601 hombres y 652 mujeres) (14,62±2,01). Para las mediciones se utilizaron una báscula, un tallímetro, el cuestionario internacional de actividad física, el cuestionario abreviado de salud SF-12® y el cuestionario de autoconcepto físico (CAF) en su versión española. Resultados. Los análisis estadísticos mostraron un mayor índice de masa corporal en las estudiantes, en tanto que en los estudiantes se registraron valores más altos en el autoconcepto de la condición física y la competencia, con diferencias estadísticamente significativas (p<0,05). Además, se encontró que las mujeres registraban mayores puntuaciones en la actividad física moderada y vigorosa, y los hombres, en la caminata. Las puntuaciones fueron mayores en las dimensiones de la calidad de vida relacionada con la salud, excepto en la función social, lo cual difiere significativamente con las de la salud general, el rol emocional, la salud mental y la vitalidad (p<0,05). Conclusiones. Se estableció una relación entre el índice de masa corporal y el autoconcepto de condición física y competencia percibida, y entre el índice de masa corporal y la salud general, la función física, la salud mental y la vitalidad. Asimismo, el sedentarismo se relacionó con la salud en general, el dolor corporal y el rol físico (p<0,05).

Abstract Introduction: Physical activity, health-related quality of life, self-concept and body-mass index are indicators of a healthy lifestyle. Objective: To determine the levels of physical activity and sedentary lifestyle, the health-related quality of life, the physical self-concept and the body-mass index in Colombian middle and high-school students. Materials and methods: We included 1,253 students between 10 and 20 years of age (601 men and 652 women) in the study. We used the following instruments for the measurements: A weighing machine, a stadiometer, the International Physical Activity Questionnaire, the 12-Item Short Form HealthSurvey(SF-12®), and the Physical Self-concept Questionnaire in its Spanish version. Results: The statistical analysis showed higher levels in the body-mass index among female students and higher scores for the physical condition, self-concept and competence among male students, with meaningful statistical differences (p<0,05). Additionally, women had higher scores in moderate and vigorous physical activity, while men had higher scores in walking. Men got higher scores in the dimension of health-related quality of life, except in the social function, which differed significantly from the general health, emotional role, mental health, and vitality dimensions. Conclusions: We found a relation between the body-mass index and the physical condition and competence self-concept, as well as between body-mass index and general health, physical function, mental health and vitality. We also found a relation between a sedentary lifestyle and general health, body pain, and physical role.

Effects of an Acute Exercise Bout on Serum Hepcidin Levels.

Iron deficiency is a frequent and multifactorial disorder in the career of athletes, particularly in females. Exercise-induced disturbances in iron homeostasis produce deleterious effects on performance and adaptation to training; thus, the identification of strategies that restore or maintain iron homeostasis in athletes is required. Hepcidin is a liver-derived hormone that degrades the ferroportin transport channel, thus reducing the ability of macrophages to recycle damaged iron, and decreasing iron availability. Although it has been suggested that the circulating fraction of hepcidin increases during early post-exercise recovery (~3 h), it remains unknown how an acute exercise bout may modify the circulating expression of hepcidin. Therefore, the current review aims to determine the post-exercise expression of serum hepcidin in response to a single session of exercise. The review was carried out in the Dialnet, Elsevier, Medline, Pubmed, Scielo and SPORTDiscus databases, using hepcidin (and "exercise" or "sport" or "physical activity") as a strategy of search. A total of 19 articles were included in the review after the application of the inclusion/exclusion criteria. This search found that a single session of endurance exercise (intervallic or continuous) at moderate or vigorous intensity (60-90% VO2peak) stimulates an increase in the circulating levels of hepcidin between 0 h and 6 h after the end of the exercise bout, peaking at ~3 h post-exercise. The magnitude of the response of hepcidin to exercise seems to be dependent on the pre-exercise status of iron (ferritin) and inflammation (IL-6). Moreover, oxygen disturbances and the activation of a hypoxia-induced factor during or after exercise may stimulate a reduction of hepcidin expression. Meanwhile, cranberry flavonoids supplementation promotes an anti-oxidant effect that may facilitate the post-exercise expression of hepcidin. Further studies are required to explore the effect of resistance exercise on hepcidin expression.

A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

BACKGROUND: During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. OBJECTIVE: The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. METHODS: The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. RESULTS: A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods. CONCLUSIONS: In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.

Fisiopatología de la obesidad: Perspectiva actual / Pathophysiology of obesity: Current view

RESUMEN La obesidad es una enfermedad crónica de origen multifactorial, asociada a complicaciones de salud potencialmente graves, y con una elevada prevalencia a nivel mundial. Actualmente se considera uno de los principales problemas sociales y de salud que enfrentar en el siglo XXI. El objetivo de este estudio es mostrar el estado actual de la fisiopatología de la obesidad, centrándose en el tejido adiposo. La célula principal del tejido adiposo es el adipocito que convive con otras poblaciones celulares tales como fibroblastos o células inmunes. Debido a factores genéticos y ambientales y su interacción, las personas pueden incrementar los depósitos de tejido adiposo aumentando el tamaño (hipertrofia) o el número de los adipocitos (hiperplasia). La hipertrofia es una respuesta común en todos los estados de obesidad, a menudo asociados con factores patógenos que deterioran la función del tejido adiposo y desarrollan un proceso inflamatorio. Aunque un aumento en la grasa corporal total se asocia con un mayor riesgo para la salud, la cantidad de grasa abdominal, en particular la grasa abdominal visceral, se ha relacionado con un aumento de la comorbilidad y la mortalidad. Es necesario formular mejores propuestas a través de la prevención y tratamientos alternativos a los actuales. Asimismo, realizar importantes esfuerzos institucionales y educativos destinados a promover hábitos alimenticios saludables y programas de ejercicio físico verdaderamente eficaces.

ABSTRACT Obesity is a chronic disease of multifactorial etiology, associated with potentially serious health problems, and with a high worldwide prevalence. Currently it is considered one of the major social and health problems facing the 21st century. The aim of this study is to show the current state of the pathophysiology of obesity, focusing on adipose tissue. The adipocyte is main adipose tissue cell and coexists with other cellular populations such as fibroblasts or immune cells. Because of genetic and environmental factors and their interaction, people may increase adipose tissue deposits by increasing adipocyte size or number (hypertrophy or hyperplasia). Hypertrophy is a common response in obese states, often associated with pathogenic factors that impair adipose tissue function and develop inflammatory processes. Although an increase in total body fat is associated with increased risk to health, the amount of abdominal fat, particularly visceral abdominal fat, has been related with an increase of comorbidity and mortality. It is necessary to formulate better proposals through prevention and alternative treatments to those currently available. Institutional and educational efforts to promote healthy eating habits and effective physical activity programs are equally important.

[Comparative study on the clinical-nutritional status of obese postmenopausal women on a weight loss programme based on prepared dishes]. / Estudio comparativo del estatus clínico-nutricional en mujeres obesas posmenopáusicas incluídas en un programa de pérdida de peso basado en platos preparados.

INTRODUCTION: Few studies have evaluated the efficacy and reliability of weight loss-focussed prepared food dishes in obese post-menopausal women. OBJECTIVE: To compare the efficacy of a weight loss programme based on a balanced hypocaloric diet using prepared dishes* with that of a similar programme based on standard commercially available foods and with a non-intervened control group. A further aim was to evaluate the subjectivity of participants in the preparation of the diet-adjusted dishes based on usually consumed products. SUBJECTS: Obese post-menopausal women aged between 55 and 65 years. DESIGN: Controlled longitudinal interventional study. METHOD: The sample of 75 female volunteers were divided into three groups of 25 women: a control group, who continued to consume their usual non-dietary adjusted meals (CG), an intervened group, treated with a diet adjusted to their individual requirements and based on standard commercially available food (SG), and another intervened group, treated with a similarly adjusted diet but based on prepared dishes (PG). Data were gathered on anthropometric variables, consumption habits and physical activity levels, and clinical-nutritional controls were conducted at the start and every two weeks to the end of the 8-week study in order to evaluate biochemical changes. RESULTS: The weight loss was slightly higher in the prepared-dishes group (PG) than in the standard food diet group (SG), but the difference was not statistically significant, whereas it was considerably higher in both groups than in the non-dietary adjusted control group (CG) and this difference was highly significant (losses of 7.60 kg in PG and 7.01 kg in SG versus 2.10 kg in CG (p < 0.01). However, the PG showed a significantly higher (p < 0.01) loss of fatty mass and abdominal circumference versus the SG women. CONCLUSION: More weight was lost by the two groups treated with a diet based on prepared dishes or usual food items in comparison to untreated controls, but the diet based on prepared dishes obtained more reliable and higher quality outcomes, achieving a positive change at fatty compartment level and in the abdominal circumference.

Estudio estadístico del consumo de suplementos nutricionales y dietéticos en gimnasios / Statistical analysis of the consumption of nutritional and dietary supplements in gyms

En la actualidad, el abuso de toda clase de sustancias para mejorar el rendimiento deportivo y la forma física se ha extendido a las personas que acuden a gimnasios regularmente. El objetivo del presente estudio es evaluar el consumo de suplementos nutricionales (SN) y dietéticos en un grupo de 415 usuarios (260 varones y 155 mujeres) de 4 gimnasios de Sevilla (España). Los usuarios realizaron un cuestionario previamente diseñado y con un pilotaje donde se evaluó la validez del contenido. Del total de la muestra, el 56,14 por ciento han consumido en alguna ocasión algún suplemento. Entre estos el 57,6 por ciento, lo hacía buscando mejorar su aspecto físico; el 16,7 por ciento, lo hacía para cuidar su salud, y el 13,2 por ciento, buscaban aumentar su rendimiento deportivo. El perfil del consumidor es el de un hombre joven, que hace tiempo que realiza actividad en gimnasios, que acude al gimnasio varias horas a la semana y que realiza algún tipo de dieta. El porcentaje de SN consumidos en este estudio (56 por ciento) está dentro de los valores aportados por otros estudios. En orden decreciente, Proteínas (28 por ciento), L-Carnitina (18,6 por ciento), Bebida Deportiva (18,3 por ciento), Creatina (17,1 por ciento) y Complejo vitamínico (17,1 por ciento) fueron los cinco SN más consumido por los sujetos de este estudio.

The abuse of all types of substance to improve sport performance and physical fitness has spread to regularly gym users. The aim of this study was to evaluate the intake of nutritional and dietary supplements in a group of 415 individuals (260 males and 155 females) from 4 gyms in Seville (Spain). The users completed a previously designed questionnaire whose content validity had been tested in a pilot study. Out of the total sample, 56.14 percent had consumed a supplement at some time. Among these, the objective was improvement of physical appearance in 57.16 percent, health care in 16.7 percent, and sports performance enhancement in 13.2 percent. The profile of the supplement consumer is a young man who has performed activities in gyms for some time, goes to the gym for several hours a week and is on some type of diet. The percentage of nutritional supplement users (56 percent) is within values reported in other studies. The five supplements most frequently consumed by these individuals were (in decreasing order): proteins (28 percent), L-carnitine (18.6 percent), sport drinks (18.3 percent), creatine (17.1 percent) and vitamin complex (17.1 percent).

Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism.

BACKGROUND: D-dimer levels remain elevated in many patients after completion of a 6-month anticoagulant drug course for a first episode of venous thromboembolism (VTE), which may limit the clinical usefulness of D-dimer testing for ruling out a possible recurrence. METHODS: We assessed the safety and usefulness of D-dimer testing in patients with suspected pulmonary embolism (PE) who had experienced a previous VTE. We analyzed data from 2 outcome studies that enrolled 1721 consecutive emergency department patients with clinically suspected PE. Information on the existence of a previous episode of VTE was abstracted from the database. All the patients underwent a sequential diagnostic workup, including an enzyme-linked immunosorbent assay D-dimer test and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.1% (415/1719); PE was ruled out by a negative D-dimer test result in 32.7% (462/1411) of the patients without previous VTE but in only 15.9% (49/308) of the patients with previous VTE (P<.001). The 3-month thromboembolic risk was 0% (95% confidence interval, 0.0%-7.9%) in patients with previous VTE and a negative D-dimer test result. The 2-fold lower chance of a negative D-dimer test result in patients with previous VTE was independent of older age, active malignancy, fever, and recent surgery. CONCLUSIONS: In patients with suspected PE and previous VTE, a negative D-dimer test result seems to allow safely ruling out a recurrent event. However, the proportion of negative results is lower in such patients, definitely reducing the clinical usefulness of the D-dimer test in that subgroup.