[Evaluation of a motivational intervention of physical activity program in the treatment of obesity and overweight]. / Evaluación de un programa de intervención motivacional de actividad física en el tratamiento de la obesidad y el sobrepeso.

OBJECTIVE: To analyse the outcomes of a motivational physical activity program for the treatment of obesity. METHOD: A randomised, controlled, double blind clinical trial with 2 arms, 12 months of follow-up and a 1:1 allocation ratio. The data was collected between July 2017 and July 2018. The patients, of both genders, had to be referred by their occupational medicine doctors with the diagnosis of overweight or obesity and be aged between 20 and 65 years. An analysis was made of the anthropometric measurements, lipid parameters, as well as on the follow-up of the program. RESULTS: A total of 123 obese or overweight patients participated. Two groups were formed; 61 in intervention group [G1] and 62 in as usual care control group [G2]). As regards the 107 that finished the study (60 in G1 and 47 in G2), the mean age was 45.55±12.83 SD, with 57.2% women and 42.8% men. The number of patients followed-up was much higher in the Physical Activity Program than in the control group, and the number of dropouts (only one) was insignificant. It can be seen how both the weight and the body mass index as the main lipid parameters are reduced in the study group significantly with respect to the control group. The physical activity of the group in the motivated physical activity program is three times higher than in the group without intervention. There was a significant relationship between the increase in activity and weight reduction (P<.001), also between the reduction in weight and the reduction in cholesterol and triglycerides. CONCLUSIONS: In our study, a motivational physical activity program leads to more follow-up and therefore improves the anthropometric and lipid parameters.

Cyclosporine A in juvenile idiopathic arthritis. Results of the PRCSG/PRINTO phase IV post marketing surveillance study.

OBJECTIVE: To investigate the clinical use patterns, clinical effect and safety of cyclosporine A (CSA) in juvenile idiopathic arthritis (JIA) in the setting of routine clinical care. METHODS: An open-ended, phase IV post marketing surveillance study was conducted among members of the Pediatric Rheumatology Collaborative Study Group (PRCSG) and of the Paediatric Rheumatology International Trials Organisation (PRINTO) to identify patients with polyarticular course JIA who had received CSA during the course of their disease. RESULTS: A total of 329 patients, half of whom had systemic JIA, were collected in 21 countries. Data were collected during 1240 routine clinic visits. CSA was started at a mean of 5.8 years after disease onset and was given at a mean dose of 3.4 mg/kg/day. The drug was administered in combination with MTX in 61% and along with prednisone in 65% of the patients who were still receiving CSA. Among patients who were still receiving CSA therapy at the last reported visit, remission was documented in 9% of the patients, whereas in 61% of the patients the disease activity was rated as moderate or severe. The most frequent reason for discontinuation of CSA was insufficient therapeutic effect (61% of the patients); only 10% of the patients stopped CSA because of remission. In 17% of the patients, side effects of therapy was given as the primary reason for discontinuation. CONCLUSION: This survey suggests that CSA may have a less favourable efficacy profile than MTX and etanercept, whereas the frequency of side effects may be similar. The exact place of CSA in the treatment of JIA can only be established via controlled clinical trial.

Massive upper gastrointestinal bleeding. Data on 369 surgically treated patients.

An analysis of 369 patients operated on for massive upper gastrointestinal bleeding is presented. Gastroscopy was performed in all patients. Duodenal ulcer remains the most common cause of such bleeding (45.4 percent of cases). The type of treatment that should be used is the most controversial in patients with bleeding esophageal varices. It is concluded that the procedure that corrects the patient's primary disease is also the most suitable one for treating massive bleeding.

Chemical synthesis of an artificial antigen containing the trisaccharide hapten of Mycobacterium leprae.

The trisaccharide allyl O-(3,4-di-O-methyl-beta-D-glucopyranosyl)-(1----4)-O-(2,3-di-O-methyl-al pha-L- rhamnopyranosyl)-(1----2)-3-O-methyl-alpha-L-rhamnopyranoside was synthesized from partially methylated monosaccharide derivatives. Condensation of 1,4-di-O-acetyl-2,3-di-O-methyl-alpha-L-rhamnopyranose promoted by boron trifluoride etherate with the appropriate alcohol proceeded stereoselectively and with very high yields. Selective deacetylation and glycosylation with 2,4-di-O-acetyl-3,6-di-O-methyl-alpha-D-glucopyranosyl bromide led to a trisaccharide. The acrylamide copolymers of mono-, di-, and tri-saccharide were compared in their ability to specifically bind antibodies from leprosy patients.

[Salivary cortisol as an indicator of physological stress in children and adults; a systematic review]. / Cortisol salival como indicador de estrés fisiológico en niños y adultos; revisión sistemática.

Salivary cortisol is a steroid hormone that is produced in the hypothalamic-pituitary-adrenal axis and secreted into saliva when persons are under stress. High levels of cortisol in saliva can be produced by many different factors, including obesity and certain psychological disorders. The articles selected for inclusion in this review were identified using Google Scholar and Medline, and this search obtained a total of 57 items. The validity of these studies was established according to the degree of evidence presented, by citations and by their applicability to the healthcare context in Spain. Specifically, this review takes into consideration studies of salivary cortisol and stress in children and adults, and those examining the relation between high levels of salivary cortisol and other disorders such as anxiety, attention-deficit/hyperactivity disorder, social phobia or emotional deprivation. These studies show that salivary cortisol is a clear indicator of stress in both children and adults. High levels of this hormone in saliva are associated with the following main consequences: reduced immune function, affecting healing and thus prolonging recovery time; delayed growth in children; increased blood pressure and heart rate in both children and adults.

El cortisol salival es una hormona esteoridea producida en el eje hipotálamo-pitutitario-adrenal que se segrega en la saliva, sobre todo cuando las personas se estresan. Un nivel elevado de cortisol en saliva puede ser producido por muchos factores diferentes, entre los que se encuentran algunas alteraciones, como la obesidad y otras afecciones psicológicas. Los artículos seleccionados para ser incluidos en esta revisión se tomaron de Google Scholar y Medline, y con un total de 57 artículos. La validez de los mismos viene dada por el grado de evidencias demostrado, por las recomendaciones allí recogidas y por la aplicabilidad a nuestro contexto. En esta revisión se han considerado los estudios que investigan el cortisol salival y el estrés en niños y adultos. También se han tenido en cuenta los que relacionan unos niveles altos de cortisol salival con otras alteraciones, como ansiedad, TDAH, fobia social o la carencia afectiva. Los estudios demuestran que el cortisol salival es un claro indicador de estrés, tanto en niños como en adultos. Las principales consecuencias de un alto nivel de esta hormona en la saliva son las siguientes: reducción de la función inmunológica, que afecta a la cicatrización y, como consecuencia, a un mayor tiempo de recuperación. También se relaciona con un déficit en el crecimiento físico de los niños, así como con un aumento de la presión arterial y de la frecuencia cardíaca, tanto en niños como en adultos.

[Assessment of cytotoxicity and biosafety of polyphenolic extracts from olive pits]. / Evaluación de la citotoxicidad y bioseguridad de un extracto de polifenoles de huesos de aceitunas.

UNLABELLED: The olive tree is a source of bioactive compounds, both its fruit and its by-products. Some of its compounds have shown health benefits, being objective of this work the evaluation of biosafety in-vitro and in vivo of extracts of olive stones rich in polyphenols. MATERIAL AND METHODS: He has been evaluated for cytotoxicity by addition of lyophilized extract dissolved in PBS(0-400 mg/l) to a culture of the cell line THP1-XBlue- CD14 and evaluation of cell viability by the reaction of reduction of resazurin by living cells. Biosecurity has been evaluated in zebrafish, incubating eggs fertilized in 0 to 100 mg/l extract for 24 to 72 hours and measuring parameters: a) lethal (dead embryos, coagulated eggs), b) sublethal (spontaneous movements, pigmentation, edemas) and c) teratogenic (malformations, retardation development). RESULTS: Cytotoxicity (toxic effect when less than 75% viability) extract bones of olive in the cell line THP1- XBlue-CD14, is in concentrations higher than 50 mg/l, calculating a LD50 (dose lethality 50) more than 800 mg/l. The biosafety of zebrafish embryos exposed to concentrations of extract from 0-100 mg/l showed total viability at 24, 48 and 72 hours post fertilization (hpf), not observed mortality or appreciated embryos with sublethal effects, teratogenic, or advancement or delay in hatching. It can be concluded that the bones of olive extract is highly biosecured until at least 100 mg/l concentrations.

El olivo constituye una fuente de compuestos bioactivos, tanto en su fruto, como en sus subproductos. Algunos de sus compuestos han mostrado beneficios para la salud, siendo objetivo de este trabajo la evaluación de la bioseguridad in vitro e in vivo de extractos de huesos de aceituna ricos en polifenoles. Material y métodos: Se ha evaluado la citotoxicidad mediante adición de extracto de hueso de olivas disuelto en PBS(0-400 mg/l) a un cultivo de la línea celular THP1- XBlue-CD14 y evaluación de la viabilidad celular mediante la reacción de reducción de la resazurina por las células vivas. La bioseguridad se ha evaluado en pez cebra, incubando huevos fecundados en extracto de 0 a 100 mg/l durante 24 a 72 horas y midiendo los parámetros: a) letales (embriones muertos, huevos coagulados), b) subletales (movimientos espontáneos, pigmentación, edemas) y c) teratogénicos (malformaciones, retraso desarrollo). Resultados: La citotoxicidad (efecto tóxico cuando viabilidad inferior al 75%) del extracto de huesos de oliva en la línea celular THP1-XBlue-CD14, está en concentraciones superiores a 50 mg/l de extracto (viabilidad 77,5%), calculando una LD50 (dosis de letalidad 50%) superior a 800 mg/l. La bioseguridad in vivo con los embriones de pez cebra expuestos a concentraciones de extracto de 0- 100 mg/l mostró total viabilidad a 24, 48 y 72 horas post fecundación (hpf), no observándose mortalidad ni se apreciaron embriones con efectos subletales, teratógenos, ni adelanto o retraso en la eclosión. Se puede concluir que el extracto de huesos de olivas es altamente bioseguro hasta al menos concentraciones de 100 mg/l.

Maternal age as risk factor of prematurity in Spain; Mediterranean area.

BACKGROUND: Maternal age is a preponderant variable in the epidemiological analysis of the premature birth. Studies show that in the extreme ages of the maternal life there is a risk of premature birth that generates a high rate of neonatal morbidity. OBJECTIVES: [corrected] Determine the effect on the extreme ages of women residents in the province of Alicante on the total of the premature births. METHOD: An explanatory, retrospective case-control study was conducted during the period from January 1st, 2008 to December 31st, 2011. The study was based on the revision of the newborn registers from the Neonatal Screening Center of the province of Alicante. All the preterm were included, this means between 22 & 36 complete weeks of pregnancy (5,295 out of 78,391 newborn which represents 6.75% of prematurity), and a random sample of the deliveries with 37 weeks or more of pregnancy (control group). The age of the mother was studied as independent variable and the prematurity as dependent variable. RESULTS: Clearly shows an increased risk of prematurity among teenage mothers compared to the age group nearest to them, which is confirmed by a squared Chi test which gives a significantly different distribution (p < 0,0001) and an OD for very preterm of 2,41 (1,51-3,24) and of preterm of 1,71 (1,32-2,19). This probability is also higher among mothers over 40 years old with an OD of 1,86 (1,39-2,48) and 1,66 (1,44-1,91) for very preterm newborns and preterm newborns respectively. DISCUSSION: The results clearly manifest that teenagers and older pregnant mothers are at higher prematurity and low birth weight risk, therefore imposes the need to trace educational interventions to minimize this problem from the results in this research.

Antecedentes: La edad materna es una variable preponderante en el análisis epidemiológico del nacimiento prematuro. Los estudios muestran que en las edades extremas de la vida materna hay un riesgo de nacimiento prematuro que genera una tasa elevada de morbilidad neonatal. Objetivos: Determinar el efecto de las edades extremas de mujeres residentes en la provincia de Albacete sobre de nacimientos prematuros. Método: Se realizó un estudio explicativo, retrospectivo de casos-control durante el periodo de 1 de enero de 2008 a 31 de diciembre de 2011. El estudio se basó en la revisión de los registros de recién nacidos del Centro de Cribado Neonatal de la provincia de Alicante. Se incluyeron todos los recién nacidos pretérmino, es decir, entre las semanas 22 y 36 de gestación (5.295 de 78.391 recién nacidos, lo que representa un 6,75% de prematuridad), y una muestra aleatoria de los nacimientos con más de 37 semanas de gestación (grupo control). Se estudió la edad materna como variable independiente y la prematuridad como variable dependiente. Resultados: El estudio muestra claramente un mayor riesgo de prematuridad entre las madres adolescentes en comparación con el siguiente grupo más cercano en edad, lo que se confirmó por una distribución significativamente distinta con el test Chi cuadrado (p < 0,0001) con una OD para los grandes prematuros de 2,41 (1,51-3,24) y de 1,71 (1,32-2,19) para los prematuros. Esta probabilidad también fue mayor en madres con edades de más de 40 años con una OD de 1,86 (1,39-2,48) y de 1,66 (1,44- 1,91) para recién nacidos grandes prematuros y prematuros, respectivamente. Discusión: Los resultados muestran claramente que las madres adolescentes y las más mayores tienen mayor riesgo de hijos prematuros o con bajo peso al nacimiento, lo que motiva la necesidad de establecer intervenciones educacionales para disminuir el problema, a partir de los resultados de esta investigación.

[Quantification of fecal excretion of trace elements in newborns as expression of fetal intestinal secretion]. / Cuantificación de la excreción fecal de elementos traza en recién nacidos como expresión de la secreción intestinal fetal.

OBJECTIVE: Trace elements have acquired major importance in the knowledge concerning corporal composition and in the comprehension of their metabolic participation in organic processes. The objective of this study was to know the concentration of trace elements in biological material (serum, meconium and feces) from preterm and fullterm infants during the neonatal period. PATIENTS AND METHODS: Concentrations of Al, Ca, Cr Cu, Fe, Mg, Mn, Mo, P, Pb and Zn were determined simultaneously in stools and serum by induction coupled argon plasma-atomic-emission spectrometry (ICP) of 12 preterm and 38 fullterm infants. Stools were collected for the 1st (meconium), 10th and 20th day and serum on the 10th day. RESULTS: Compared to serum from preterm infants, fullterm infants had an elevated (p < 0.05) value of potentially toxic trace elements (Al and Pb). Compared meconium from fullterm infants, preterm infants had an elevated excretion of Cu (p < 0.001) and Fe (p < 0.01). Compared to stools from the 10 and 20th day from preterm infants, fullterm infants had an elevated excretion of Fe (p < 0.05). Stool excretion of all of the trace elements increases throughout the days during the neonatal period, whereas Mn decreases. CONCLUSIONS: The mineral content of meconium and stools in newborns rarely has been described and ICP is an interesting method of assessment of trace elements in these biological samples during the neonatal period.

[Urinary excretion of mucopolysaccharides in pediatric and adolescent patients]. / Excreción urinaria de mucopolisacáridos en la edad pediátrica y en la adolescencia.

OBJECTIVE: Lysosomal enzyme deficiency results in an accumulation of undegraded material producing structural and functional disorders. Mucopolysaccharidosis is a group of disorders caused by an increase in glycosaminoglycans (GAG) (mucopolysaccharides). Mucopolysaccharidosis, while showing a low incidence, has some clinical manifestations that warrant early diagnosis in order to establish immediate therapeutical action. Although definitive diagnosis is based on quantification of the involved enzymatic activity, it is necessary to have easy to use analytical methods available when there is clinical suspicion of the disease. PATIENTS AND METHODS: This study was made on a population of 632 clinically normal adolescents and children (one month to 18 years of age). In all cases a partial sample of urine to quantify glycosaminoglycans and creatinine expressed as the index GAG/creatinine (mg/mmol) was collected. In a reduced group of 27 people a 24-hour urine sample was collected. Determination of glycosaminoglycan levels was performed with a colorimetric reaction with 1,9-dimethylmethylene blue (DMB). Optimal condition of pH, wavelength and reaction time were established. The values found to be optimal for quantification were defined as pH 4.0, wavelength 528 nm and a reaction time of five minutes. Intra- and inter-assay coefficients of variation were less than 5%. RESULTS: Validity of the partial urine sample was established by obtaining a linear correlation between the 24 hour urine sample and the partial urine sample with a correlation coefficient of r = 0.89 (p < 0.0001). The results obtained have allowed the establishment of normal values ranging from an index GAG/creatinine of 8.70 mg/mmol in the group aged 1 to 2 years to 1.34 mg/mmol in the group 17 to 18 years of age, with a distribution of intermediate ages adjusted to a logarithmic function. There was a clear difference in the values obtained in urine of patients with clinical suspicion of mucopolysaccharidosis. CONCLUSIONS: Modifications in the spectrophotometric method using DMB as a colorant for quantification of glycosaminoglycans are presented. The feasibility, easy application and sensibility of this method, condition required for its widespread use, are confirmed. Normal reference values from a healthy population have been obtained and shown to be age dependent.

[Preliminary analysis in the implementation of a health program in child nutrition]. / Análisis preliminar para la puesta en marcha de un programa de salud de nutrición infantil.

In the view of the importance of nutrition for the eventual physical and psychological development of children, several ways to control the outcome of malnutrition, both due to excess and to defect, have been reported. Before introducing the adequate measures for the prevention and early diagnosis of malnutrition and obesity, the nutritional status of the children aged between 1-7 years was evaluated in the assigned population by means of the Shukla's index. In 681 evaluated children, 42 obese, 23 with malnutrition, 81 overweight and 105 with risk of malnutrition were detected. This prevalence of malnutrition and obesity warrants the implementation of screening measures for the nutritional status in children from the health center. A protocol to this end is outlined in the present article.

Pharmacokinetics of sulbactam and ampicillin intravenously applied in combination to healthy volunteers and patients. Determination of the ratio of the two drugs in serum and in various tissues.

The pharmacokinetics of sulbactam, a new beta-lactamase inhibitor, and ampicillin were investigated in 9 healthy volunteers and 125 patients. The two drugs were administered intravenously in combination (Unacid). Each subject received 1 g sulbactam and 2 g ampicillin. The two drugs showed a similar pharmacokinetic profile in humans. Relevant pharmacokinetic parameters were calculated using a 2-compartment model on the basis of the serum and urine concentrations determined in healthy volunteers. The ratio of sulbactam to ampicillin was found to be nearly constant (approx. 1:2), both in the blood, in several tissues and at various time points. The two compounds apparently penetrated well into the myometrium, renal cortex and medulla, the gall bladder wall, the tonsils and the cutis of the skin. The sulbactam/ampicillin ratios in the bile ranged from 1:3 to 1:13 over 2 h after the infusion. The concentrations of the two compounds measured in the various fluids and tissues of the body reached levels which are effective against beta-lactamase producing bacteria. The similar pharmacokinetics of sulbactam and ampicillin in humans are considered an essential prerequisite for the therapeutic efficacy of such a combination product.

[Mail handling: a possible cause of error in the non-selective screening for congenital hypothyroidism]. / Envío por correo: una posible causa de error en el "screening" no selectivo del hipotiroidismo congénito.

Remittance by mail of blood samples and subsequent time of permanency in mail boxes are not supposed to be best thermic conditions for dried blood samples in paper used for neonatal screening. With the idea of checking if temperatures variations can altered or not the content of TSH and T4, some samples of known concentrations of TSH and T4 has been heated to different temperatures between less than -40 degrees C and 100 degrees C during weekly periods. At such temperatures between less than -40 degrees C and 25 degrees C significant hormones losses are not observed. Nevertheless under higher temperatures the percentages of losses increases. Specifically between 37 degrees C and 60 degrees C an hormonal loss of approximately 36% is observed. T4 had also suffered losses of concentration in relation with temperature. These variations make indispensable the change of the way of managing samples that could had suffered modifications with temperatures, and that have been sent by mail. Therefore, considering that about a 40% loss can exist, limit of 40 mu UI/ml should be modified about 25 mu UI/ml.

[Reference levels for phenylalanine and tyrosine in discs impregnated with blood during analysis by HPLC]. / Niveles de referencia de fenilalanina y tirosina en discos impregnados en sangre mediante HPLC.

Aromatic amino acids tyrosine and phenylalanine have been measured on paper with dried blood samples, using high performance liquid chromatography (HPLC) in reverse phase. The aim of this procedure is to discriminate unclear cases of general screening for aminoacidopathies avoiding unnecessary retest. Plasma normal values of tyrosine and phenylalanine have been obtained in full term babies (0.82 +/- 0.39 mg/dl and 0.53 +/- 0.23 mg/dl) preschool boy (0.78 +/- 0.21 mg/dl and 0.63 +/- 0.20 mg/dl), school boys (0.89 +/- 0.16 and 0.76 +/- 0.22 mg/dl) and normal adults (1.48 +/- 0.19 and 1.41 +/- 0.12 mg/dl). In order to assess if fasting levels can be altered by breast feeding or formula feeding, a sample was obtained after various feeds and postprandially. Results show no differences before or after feeding. A group of malnourished infants showed greater plasma values of tyrosine and phenylalanine (p less than 0.002) conversely a group children suffering for diabetes showed no differences when comparing with matched age controls. In conclusion, measurement of tyrosine and phenylalanine on dried blood in filter paper is accurate enough, to avoid unnecessary recall in unclear cases of screening, and those levels do not alter significantly with normal milk intake.

[Mineral metabolism of calcium, magnesium and phosphorus in the normal newborn infant]. / Metabolismo mineral de calcio, magnesio y fósforo en el recién nacido normal.

The mineral metabolism of calcium, magnesium and phosphorus in 20 newborns and infants was studied. All children were born from term deliveries and none presented clinic, biochemistry signs or radiological evidences of bone mineral metabolism disturbances. In this way, metabolic blance technics were applied. Net absorption of calcium, magnesium and phosphorus were: 54,9 +/- 18,8; 8,7 +/- 4,8 and 64,6 +/- 14,2 mg/kg/day respectively. The retentions of the three elements were: 54,4 +/- 20,6; 7,4 +/- 4,5 and 43,2 +/- 13,6 mg/kg/day. A significative lineal correlation between plasmatic levels of 250Hd and 24,25 (OH)2D with calcium retention was found. The correlation of intestinal calcium apsorption was positive and significative only with 250HD levels. It wasn't found signification between the vitamin D metabolites with the magnesium and phosphorus balance. In other way, it was found a relation between the dietary intake of this two elements with absorption and retention of both of them.

Diminished cytochrome b content and toxic oxygen metabolite production in circulating neutrophils from patients with Crohn's disease.

Phagocytic, chemotactic, and oxidative metabolic capacity of circulating neutrophils was studied in 20 patients with Crohn's disease. In vitro tests of chemotaxis and phagocytosis of isolated neutrophils from patients did not differ from that of healthy controls. However, superoxide anion production by phorbol-myristate-acetate and formylmethionyl-leucyl-phenylalanine-stimulated neutrophils from patients with Crohn's disease was significantly diminished compared with controls. Measurement of cytochrome b559 in total membranes of neutrophils from patients showed that it was significantly lower than in controls. Disease activity did not correlate either with the production of superoxide anion or with the cytochrome b559 content. It is concluded that oxidative metabolism is impaired in neutrophils from patients with Crohn's disease and that this defect could be caused by a reduced content in membrane b-type cytochrome. Although this defective neutrophil function may contribute to granuloma formation, other factors have to be implicated in disease inflammatory activity.