Impact of hyponatremia in patients hospitalized in Internal Medicine units: Hyponatremia in Internal Medicine units.

The aim of this study was to analyze the impact and the clinical and evolutionary characteristics of hypotonic hyponatremia in patients hospitalized in Internal Medicine units. Prospective multicenter observational study of patients with hypotonic hyponatremia (<135 mmol/L) in 5 hospitals in southern Spain. Patients were included according to point prevalence studies carried out every 2 weeks between March 2015 and October 2017, by assessing demographic, clinical, analytical, and management data; each patient was subsequently followed up for 12 months, during which time mortality and readmissions were assessed. A total of 501 patients were included (51.9% women, mean age = 71.3 ±â€…14.24 years), resulting in an overall prevalence of hyponatremia of 8.3%. The mean comorbidities rate was 4.50 ±â€…2.41, the most frequent diagnoses being heart failure (115) (23%), respiratory infections (65) (13%), and oncological pathologies (42) (6.4%). Of the total number of hyponatremia cases, 180 (35.9%) were hypervolemic, 164 (32.7%) hypovolemic, and 157 (31.3%) were euvolemic. A total of 87.4% did not receive additional diagnostic tests to establish the origin of the condition and 30% did not receive any treatment. Hospital mortality was 15.6% and the mean length of stay was 14.7 days. Euvolemic and admission hyponatremia versus hyponatremia developed during admission were significantly associated with lower mortality rates (P = .037). Mortality at 1 year and readmissions were high (31% and 53% of patients, respectively). Hyponatremia was common in Internal Medicine areas, with hypervolemic hyponatremia being the most frequent type. The mortality rate was high during admission and at follow-up; yet there is a margin for improvement in the clinical management of this condition.

Lifestyle, Type of Work, and Temporary Disability: An Incidence Study of the Working Population.

The objective of the study was to identify lifestyles associated with loss of health among workers. A retrospective longitudinal incidence study was carried out over a three-year period (2015, 2016, and 2017) among the working population. A total of 240 workers were analysed using information from occupational health assessments. The outcome variable was loss of health due to common illness or workplace injury, quantified by the number of days each episode lasted. Predictor variables were age, gender, type of work, tobacco use, alcohol consumption, physical activity (IPAQ), and adherence to the Mediterranean diet (AMD). An adjusted multiple linear regression was performed, determining the goodness of fit of the final model using the coefficient of determination adjusted r2. During the study, 104 men (58.8%) and 25 women (39.7%) suffered an episode of illness or workplace injury (p < 0.05). The overall incidence was 17.9% people/year 95% CI [15, 21.3]. 4.6% of the workers were sedentary or engaged in light physical activity, and 59.2% maintained an adequate AMD. Workers who engaged in high levels of physical activity had an average of 36.3 days of temporary disability compared to 64.4 days for workers with low-moderate levels of physical activity (p < 0.01).

Relationships between work, lifestyles, and obesity: cross-sectional study based on the 2017 Spanish National Health Survey.

AIMS: Overweight and obesity are affected by factors such as dietary transgressions and lack of exercise, as well as less obvious factors such as shift work and sedentary working. (i) To explore the associations between overweight and obesity (O/O) with working conditions such as type of job position, and work shifts; (ii) to know the associations between O/O with lifestyles (physical activity, eating habits, and tobacco and alcohol consumption). METHODS AND RESULTS: A cross-sectional, population-based design was used based on the Spanish National Health Survey. The final sample consisted of 9097 workers aged between 18 and 65. The influence of the explanatory variables on the outcome variable (body mass index) was examined using logistic regression. The prevalence of O/O increased by 4% for every additional year of age (P < 0.001) and was 3.1 times more frequent among men (P < 0.001). It also was 20% higher in night work or rotating shifts (P < 0.01), and 14.9% lower in sedentary job positions (P < 0.05). Low consumption of the following foods was significantly associated with a reduction in O/O: meat (16.2%), fish (75.4%), cured meats (35.1%), dairy products (33.3%), and snacks (47.1%). CONCLUSION: Age, men, engaging in moderate or low levels of physical activity, being an ex-smoker, working during the night or rotating shifts, holding a non-sedentary job position, having a low to moderate consumption of pasta, potatoes, and rice, a moderate consumption of bread and cereals, as well as dairy products, vegetables, sugary foods, and fast food, have been significantly associated with a higher prevalence of O/O. No relationships were identified between the consumption of alcohol, fruit, eggs, pulses, and sugary soft drinks.

Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate.

The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA (sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (p < 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (p > 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain.

Moderate Beer Consumption Modifies Tumoral Growth Parameters and Pyrrolidone Carboxypeptidase Type-I and Type-II Specific Activities in the Hypothalamus-Pituitary-Mammary Gland Axis in an Animal Model of Breast Cancer.

AIMS: To determine the effect of moderate alcoholic and nonalcoholic beer consumption on tumoral growth parameters, the histopathology, pyrrolidone carboxypeptidase type I (Pcp I), and type II (Pcp II) specific activities in the hypothalamus-pituitary-mammary gland axis, and the circulating levels of estradiol (E2) and progesterone (P4) in rats with N-methyl-N-nitrosourea (NMU) induced mammary tumors. MATERIAL AND METHODS: Food and drink intake, weight gain and tumor growth parameters were collected. The malignant phenotype of the tumor was performed using the Scarff-Bloom-Richardson grading method. Pcp specific activities were fluorometrically analyzed using pyroglutamyl-ß-naphthylamide as substrate. Circulating steroid hormones were determined. RESULTS: Differences were found in tumoral parameters, depending on the drink. Animals that were given alcohol-containing beer (A/C) beer to drink showed the lowest values of hypothalamic Pcp I, in association with the lowest levels of circulating E2. The significant decrease in Pcp I activity in all NMU-treated groups suggest a clear role of the Pcp I in the tumoral process, and A/C beer interferes with it. DISCUSSION: Moderate consumption of alcoholic beer would have beneficial effects against mammary tumors through the modification of the endocrine status mediated by GnRH due to changes on Pcp I and II activities at different levels.

Putative Involvement of Endocrine Disruptors in the Alzheimer's Disease Via the Insulin-Regulated Aminopeptidase/GLUT4 Pathway.

It has been well established that there is a connection between type II diabetes (DMTII) and Alzheimer's disease (AD). In fact, the increase in AD incidence may be an emerging complication of DMTII. Both pathologies are related to estradiol (E2) exposure; on the one hand, estrogen receptors (ER) are emerging as important modulators of glucose homeostasis through ß-pancreatic cell function; on the other hand, brain bioenergetic and cognitive deficits have been related to the down regulation of brain ERs, contributing to women ageing and AD susceptibility, both related to the reduction in estradiol levels and the deficits in brain metabolism. Here we discuss that environmental contaminants with estrogenic capacity such as bisphenol A (BPA) could develop pharmacological effects similar to those of E2, which could affect ß-pancreatic cell function by increasing the biosynthesis of glucose-induced insulin after extranuclear ER binding. BPA-induced hyperinsulinemia would promote the translocation of glucose transporter 4 (GLUT4), which is located next to insulin-regulated aminopeptidase (IRAP) in intracellular vesicles. In insulin-responsive tissues, IRAP and GLUT 4 are routed together to the cell surface after insulin stimulation. IRAP is also the angiotensin IV (AngIV) receptor, and AngIV associates the brain renin-angiotensin system (bRAS) with AD, since AngIV is related to learning, memory, emotional responses, and processing of sensory information not only through its inhibitory effect on IRAP but also through the stimulation of glucose uptake by increasing the presence of IRAP/GLUT4 at the cell surface. Thus, the IRAP/GLUT4 pathway is an emerging target for pharmacological intervention against AD.

Correlation between biomarkers of pain in saliva and PAINAD scale in elderly people with cognitive impairment and inability to communicate: descriptive study protocol.

INTRODUCTION: Pain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate. METHODS AND ANALYSIS: This is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357-2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.