Experiencia piloto con esquema rifapentina-isoniazida semanal por 3 meses para tratamiento de la infección tuberculosa latente en el Programa Nacional de Tuberculosis de Chile / Pilot experience with weekly rifapentine-isoniazid treatment for 3 months for latent tuberculosis infection at the Tuberculosis National Program of Chile

INTRODUCCIÓN: La prevención de la tuberculosis activa en los grupos de riesgo es clave para el control y eliminación de la tuberculosis. El tratamiento de la infección tuberculosa latente (TITL) con rifapentina e isoniazida en dosis semanales por 12 semanas es más corto que con otros esquemas, tiene menor hepatotoxicidad, mejor adherencia y es costo-efectivo. El OBJETIVO del estudio es evaluar la factibilidad de implementar este esquema a nivel programático en Chile. MÉTODOS: Se hizo una intervención piloto en territorios seleccionados entre mayo de 2018 y marzo de 2019. En esos territorios se reemplazó el esquema normado de TITL con isoniazida 6 meses por el esquema rifapentina-isoniazida 12 semanas. Además, se amplió la población objetivo, incluyendo a contactos mayores de 14 años. El tratamiento consistió en la administración conjunta de isoniazida y rifapentina por vía oral con frecuencia semanal, por 12 semanas, de forma supervisada por personal de salud. RESULTADOS: Ingresaron 238 pacientes al piloto, de los cuales 53% fueron mujeres y 54,2% fueron mayores de 14 años. Del total de pacientes, 203 (85,3%) completaron el tratamiento, 22 (9,2%) lo abandonaron, 8 (3,4%) presentaron reacciones adversas y 5 tuvieron otros motivos de egreso. CONCLUSIÓN: Tanto el TITL con rifapentinaisoniazida por 3 meses en dosis semanales supervisadas, como la incorporación de contactos adultos a TITL, son factibles de implementar a nivel programático en Chile.

INTRODUCTION: Prevention of active tuberculosis in risk groups is crucial in tuberculosis control and elimination. Treatment of latent tuberculosis (TITL) with rifapentine and isoniazid in weekly doses for 12 weeks is shorter than other pharmacological treatments, with less liver toxicity, better patient compliance and it is cost-effective. The OBJECTIVE of this study is to evaluate the feasibility to implement this treatment at a programmatic level in Chile. METHODS: A pilot intervention was conducted in selected territories between May 2018 and March 2019. Within these territories, the regulated treatment with isoniazid 6 months was replaced by the 12 weeks treatment with weekly rifapentine-isoniazide. Additionally, the target population was expanded to include contacts over 14 years old, currently not included in the national guidelines. Treatment consisted in oral administration of rifapentine and isoniazide together once a week for 12 weeks, under supervision of trained health workers. RESULTS: From 238 patients entered to the protocol, 53% of them were women and 54.2% were older than 14 years-old. Out of the total number of patients, 203 (85.3%) completed treatment, 22 (9.2%) abandoned, 8 (3.4%) had adverse drug reactions, and 5 ended treatment for different causes. CONCLUSION: Both TITL with rifapentine-isoniazide in 12 supervised weekly doses, and the inclusion of adult contacts in TITL, are feasible to implement at a programmatic level in Chile.

A combination of hydroxytyrosol, omega-3 fatty acids and curcumin improves pain and inflammation among early stage breast cancer patients receiving adjuvant hormonal therapy: results of a pilot study.

PURPOSE: Breast cancer patients receiving hormonal therapies face risks of relapse, increased rates of cardiovascular events, and toxicities of therapy such as aromatase inhibitor (AI)-associated musculoskeletal symptoms (AIMSS). C-reactive protein (CRP), a marker for inflammation, is associated with breast cancer outcomes. We evaluated whether the olive-derived polyphenol hydroxytyrosol combined with omega-3 fatty acids and curcumin would reduce CRP and musculoskeletal symptoms in breast cancer patients receiving adjuvant hormonal therapies. EXPERIMENTAL DESIGN: This prospective, multicenter, open-label, single arm, clinical trial enrolled post-menopausal breast cancer patients (n = 45) with elevated C-reactive protein (CRP) taking predominantly aromatase inhibitors to receive a combination of hydroxytyrosol, omega-3 fatty acids, and curcumin for 1 month. CRP, other inflammation-associated cytokines, and pain scores on the Brief Pain Inventory were measured before therapy, at the end of therapy and 1 month after completion of therapy. RESULTS: CRP levels declined during the therapy [from 8.2 ± 6.4 mg/L at baseline to 5.3 ± 3.2 mg/L (p = 0.014) at 30 days of treatment], and remained decreased during the additional 1 month off therapy. Subjects with the highest baseline CRP levels had the greatest decrease with the therapy. Pain scores also decreased during the therapy. There were no significant adverse events. CONCLUSIONS: The combination of hydroxytyrosol, omega-3 fatty acids, and curcumin reduced inflammation as indicated by a reduction in CRP and reduced pain in patients with aromatase-induced musculoskeletal symptoms. Longer studies comparing this combination to other anti-inflammatories in larger groups of patients with clinical outcome endpoints are warranted.

Growth performance, body composition, and digestive functionality of Senegalese sole (Solea senegalensis Kaup, 1858) juveniles fed diets including microalgae freeze-dried biomass.

Senegalese sole is one of the most promising fish species cultivated in the Southern European countries. This study was aimed at assessing the effects of microalgae biomass added to diets for Senegalese sole juveniles on fish growing and condition status. Three isoproteic (52%) and isolipidic (10%) were formulated containing 15% Tisochrysis lutea (TISO), Nannochloropsis gaditana (NAN), or Scenedesmus almeriensis (SCE) biomass, respectively. An experimental microalgae-free diet (CT) and a commercial diet (COM) were used as controls. Fish were fed at 3% of their body weight for 85 days. Final body weight of fish fed microalgae-supplemented diets did not differ from group fed CT diet. Fish-fed CT, TISO, NAN, and SCE showed higher growth performance and nutrient utilization figures than specimen-fed COM diet. The highest carcass lipid content was found in COM group (141 g kg-1), and no differences were observed in body protein content. Ash was significantly higher in TISO, NAN, and SCE groups compared to fish-fed CT. Muscle EPA and DHA contents were not modified owing to the different dietary treatments. The n3/n6 and EPA/DHA ratios in muscle were similar in all the experimental groups. The quantification of digestive proteolytic activities did not differ among experimental groups, although differences in the protease pattern in digestive extracts by zymography were revealed in those fish fed on COM diet. Both α-amylase activity in the intestinal lumen and leucine aminopeptidase in the intestinal tissue were significantly lower in COM fish. Specimens fed on SCE diet showed a higher leucine aminopeptidase activity associated to the intestinal tissue compared to NAN-fed fish (0.40 and 0.25 U g tissue-1, respectively). The ultrastructural study revealed that the dietary inclusion of algal biomass, especially T. lutea and N. gaditana, had a positive impact on the absorptive capacity of the intestinal mucosa. The highest values for the parameters microvilli length and microvilli absorption surface were observed in fish fed on NAN diet (1.99 µm and 45.93 µm2, respectively). Even though further studies aimed at optimizing commercial formulas for Senegalese sole are required prior to any large-scale practical utilization, the results obtained clearly suggest the potential of microalgae as dietary ingredients for this fish species.

Reflexology and polysomnography: Changes in cerebral wave activity induced by reflexology promote N1 and N2 sleep stages.

BACKGROUND: Several studies have shown the effectiveness of reflexology in different health problems as well as obtaining a high degree of relaxation during its application. A previous study suggested a possible relation between the relaxation obtained during the reflexology session and the sleep. However, the design of the study did not provide evidence for this hypothesis. In this study, we use a polysomnogram to investigate the effects during its application. METHOD: Prospective experimental study conducted in a sleep laboratory. Twelve healthy adults were enrolled. Two groups were created based on whether or not they had knowledge of reflexology. Reflexology was applied for 35 min and their sleep effects were measured by means of polysomnography. A descriptive and bivariate analysis was performed. A bivariate analysis conducted through chi-square test or ANOVA was considered appropriate. RESULTS: After controlling for baseline data, nine of the participants did move toward N1 (p = 0.833) and N2 (p = 0.227) stages, remaining in these states between 4 min and 25.5 min. No significant differences were found between the two groups. CONCLUSIONS: The application of reflexology induces changes in the activity of brain waves in correspondence with the appearance of a high degree of sleepiness and sleep (N1 and N2 NREM sleep). There is a gradual transition and an orderly progression from wakefulness to sleep, which could explain the effects of relaxation and well being obtained with this method, as well as many other benefits.

Food supplementation with rice bran enzymatic extract prevents vascular apoptosis and atherogenesis in ApoE-/- mice.

PURPOSE: Atherosclerosis is associated with reduced mononuclear cell (MNC) telomere length, and senescent cells have been detected in atherosclerotic plaques. Rice bran is a source of γ-oryzanol, phytosterols and tocols with potential lipid-lowering, antioxidant and anti-inflammatory activities. Here, we tested the hypothesis that rice bran enzymatic extract (RBEE) impacts on apoptosis, telomere length and atherogenesis in mice. METHODS: Seven-week-old male ApoE-/- mice were fed high-fat diet (HFD) or isocaloric HFD supplemented with 5 % (w/w) RBEE for 23 weeks. Wild-type mice of the same age were kept under standard diet as controls. RESULTS: RBEE treatment reduced total cholesterol (19.24 ± 1.63 vs 24.49 ± 1.71 mmol/L) and triglycerides (1.13 ± 0.18 vs 1.75 ± 0.22 mmol/L) and augmented HDL-cholesterol (1.86 ± 0.20 vs 1.07 ± 0.20 mmol/L). RBEE attenuated macrophage infiltration by 56.69 ± 4.65 % and plaque development (7737 ± 836 vs 12,040 ± 1001 µm2) in the aortic sinus. In the aorta, RBEE treatment reduced expression of the apoptosis pathway components p16, p53 and bax/bcl-2 ratio. RBEE prevented apoptosis of aortic endothelial cells (2.81 ± 0.71-1.14 ± 0.35 apoptotic nuclei/ring for ApoE-/- HFD and ApoE-/- HFD 5 % RBEE, respectively). In contrast, MNC of RBEE-fed mice exhibited enhanced apoptosis marker expression with increased p53 and bax/bcl-2 protein levels. Compared to WT, ApoE-/- mice on HFD were characterized by significant telomere shortening in aorta (11 ± 2 %) and MNC (73 ± 7 %), which was reduced by supplementation with RBEE (aorta: 40 ± 7 %; MNC: 105 ± 10 %). Expression of telomere repeat-binding factor 2 was increased in RBEE-fed mice. CONCLUSION: Long-term food supplementation with RBEE lowers cholesterol and prevents atherosclerotic plaque development in ApoE-/- mice. Differential regulation of vascular and MNC apoptosis and senescence were identified as potential mechanisms.

Calcium as a nutrient involved in the synthesis and localization of proteins that facilitate iron uptake and efflux in enterocytes / El calcio como nutriente implicado en la síntesis y localización de proteínas que participan en la captación y eflujo del hierro en los enterocitos

Iron deficiency is the most common type of nutritional deficiency in the world, and calcium intake is low in many populations. Developing a supplement that contains both micronutrients would be an excellent method to prevent iron deficiency and increase calcium intake. Human and cellular studies have shown that calcium inhibits iron absorption. Currently, the mechanisms underlying this inhibitory effect have not been elucidated. Because calcium is involved in cell signaling pathways, it may affect the regulation of the expression or localization of proteins involved in iron uptake and efflux in enterocytes. The aim of this review was to describe the processes involved in the absorption of dietary iron and the regulation of the expression and activity of proteins involved in this absorption. Additionally, the potential mechanisms by which calcium affects the expression and localization of these proteins are also discussed.

La deficiencia de hierro es la deficiencia nutricional más común en el mundo y la ingesta de calcio es baja en la mayoría de poblaciones. El desarrollo de un suplemento que contenga ambos micronutrientes sería una excelente estrategia para prevenir la deficiencia de hierro y aumentar la ingesta de calcio. Estudios en humanos y en células han demostrado que el calcio inhibe la absorción del hierro. Actualmente los mecanismos que explican este efecto inhibitorio no están claramente dilucidados. Dado que el calcio está implicado en la señalización celular, podría afectar la regulación de la expresión y localización de proteínas implicadas en la captación y eflujo de hierro en los enterocitos. El objetivo de esta revisión es describir los procesos implicados en la absorción del hierro dietario y la regulación de la expresión y actividad de las proteínas implicadas en esta absorción. Además, se discutirán los posibles mecanismos por los cuales el calcio afecta la expresión y localización de esas proteínas.

Ex-post analysis of landraces sympatric to a commercial variety in the center of origin of the potato failed to detect gene flow.

The possible introduction of genetically modified potato in the Andean region raises concerns about the unintentional introduction of transgenes into the native potato germplasm because it is perceived to convey negative impacts on biodiversity. We investigated this question by an ex-post analysis of existing landraces resulting from natural hybridization between an unknown landrace and the fertile commercial variety 'Yungay'. This variety can be regarded as exotic because it was bred in part from the southern Chilean germplasm of Solanum tuberosum Group Chilotanum. We sampled the landrace germplasm of 1,771 leaf samples comprising more than 400 different landraces from three regions where 'Yungay' and landraces have coexisted for 15-25 years in the Peruvian Andes. Simple sequence repeat (SSR) markers were used to identify putative hybrids based on allele sharing with those of 'Yungay'. The exclusion procedure was iterative, starting with the SSR markers with highest discriminating capacity based on allele frequency of the variety 'Yungay' in our large database of 688 landraces by 24 SSR makers. With only 12 of the 24 SSR markers assayed, all of the samples could be rejected as possible hybrids with 'Yungay' as a parent. This result demonstrates that the unintentional introduction of a transgene, not under farmers' selection, from a widely grown transgenic variety over a long period of time is unlikely to happen at a detectable scale. Our finding reinforces the prominent role of farmers in the selection and maintenance of landraces which, unlike hybrids, have specific characteristics that farmers appreciate.

Microvascular disorders in obese Zucker rats are restored by a rice bran diet.

BACKGROUND AND AIM: Nutritional-based approaches aimed to prevent microvascular dysfunction associated to obesity present potential advantages over pharmacological strategies. Our aim was to test whether a rice bran enzymatic extract (RBEE)-supplemented diet could attenuate microvascular alterations in obese rats. METHODS AND RESULTS: Lean and obese Zucker rats were fed standard diet supplemented or not with 1% and 5% RBEE for 20 weeks. Functional studies were performed in small mesenteric arteries in isometric myograph. Immunoblotting and fluorescence studies were made in arterial homogenates and arterial sections, respectively. RBEE-supplementation restored microvascular function in obese rats through a marked increase in NO and endothelial-derived hyperpolarizing factor contribution by up-regulation of eNOS and calcium-activated potassium channels expression, respectively, in association to a substantial reduction of microvascular inflammation and superoxide anion formation. These data agrees with the beneficial actions of RBEE on dyslipidemia, hyperinsulinemia and hypertension in obesity. CONCLUSION: The multi-factorial properties of RBEE-diet, especially for restoring the function of small resistance arteries shows this dietary-based approach to be a promising candidate for prevention of microvascular alterations in obesity, which are crucial in cardiovascular events in obese subjects.

Interés terapéutico del fruto cardo mariano / Therapeutic interest of milk thistle fruit

La actividad antipatotóxica del fruto de cardo mariano y de la silimarina es conocida desde hace muchos años. Su efecto positivo sobre el hígado está basado en las acciones antioxidante, estabilizadora de membrana, favorecedora de la síntesis proteica, antivirásica, antiinflamatoria, inmunomoduladora y anticolestásica de la silimarina y su principal componente, la silibinina. Su eficacia clínica ha sido demostrada en distintos tipos de alteraciones hepáticas, principalmente en las producidas por alcohol y las causadas po virus. Diversos estudios han establecido el papel quimiopreventivo de la silimarina y de la silibinina en distintas áreas celulares cancerosas, así como su efecto estimulante sobre la secreción láctea, además de su actuación en otros ámbitos (protección ósea, neuroprotección, aterogénesis, etc.). a este conjunto de datos, que apuntan hacia posibles nuevas aplicaciones de los productos obtenidos a partir del cardo mariano, se une su amplio margen terapéutico y su baja toxicidad (AU)

Antihepatotoxic activity of milk thistle fruit and silymarin has been known for many years. The positive effect on the liver is based on the antioxidant, membrane stabilizing, protein synthesis increase, antiviral, anti-inflammatory, immunomodulatory and anticolestatic actions of sylimarin and its major constituten, silybinin. Its clinical efficacy has been shown in several types for liver disorders, namely those produced by alcohol and those caused by virus. Several studies have established the chemopreventive role of sylimarin and silybinin in different cancer cell lines and its stimulating effect on lactation, as well as their beneficial effects in other areas (bone protection, neuroprotection, atherogenesis,e tc.). All these data point to possible new applications of the products derived from milk thistle that, in addition, show a wide therapeutic range and low toxicity (AU)

Potentiality of standardized extract and isolated flavonoids from Zuccagnia punctata for the treatment of respiratory infections by Streptococcus pneumoniae: in vitro and in vivo studies.

ETHNOPHARMACOLOGICAL RELEVANCE: Zuccagnia punctata Cav. (Fabaceae) is a monotypic species distributed in western Argentina and is traditionally used for the treatment of bacterial and fungal infections. The aim of this study was to demonstrated the antibacterial activity of the Zuccagnia punctata standardized extract and the structurally related non-methoxylated flavonoids with similar pattern of substitution and differences in ring C present in this plant species: 7-hydroxyflavanone (HF), 2',4'-dihydroxychalcone (DHC) and 3,7-dihydroxyflavone (DHF), against Streptococcus pneumoniae clinical isolates using in vitro and in vivo models. MATERIALS AND METHODS: MIC values of natural products were determined by agar macrodilution method. In vivo activities were investigated in a Streptococcus pneumoniae infection model in mice. Lung and blood samples were obtained for bacterial cell counts. The serum was used by biochemical analysis (alanine transaminase, aspartate transaminase, urea and creatinine) in order to evaluate the toxicity of natural products. RESULTS: All samples showed antimicrobial activity in vitro with MIC values between 50 and 500µg/ml. Zuccagnia punctata extract (1mg/mice) and HF (1mg/mice) significantly reduced the number of viable Streptococcus pneumoniae in lung (p<0.01) while lower quantities has not effect. Therefore, the present study has shown that intake once or twice a day of 1mg of Zuccagnia punctata extract or HF for seven days did not result in toxicity. CONCLUSIONS: Our results showed that Zuccagnia punctata extract as well as one of its isolated flavonoids, 7-hydroxyflavanone, could be useful for the development of a novel respiratory infections treatment.

Preclinical assessment of the neutralizing capacity of antivenoms produced in six Latin American countries against medically-relevant Bothrops snake venoms.

Species of the genus Bothrops induce the vast majority of snakebite envenomings in Latin America. A preclinical study was performed in the context of a regional network of public laboratories involved in the production, quality control and development of antivenoms in Latin America. The ability of seven polyspecific antivenoms, produced in Argentina, Brazil, Peru, Bolivia, Colombia and Costa Rica, to neutralize lethal, hemorrhagic, coagulant, defibrinogenating and myotoxic activities of the venoms of Bothrops neuwiedi (diporus) (Argentina), Bothrops jararaca (Brazil), B. neuwiedi (mattogrossensis) (Bolivia), Bothrops atrox (Peru and Colombia) and Bothrops asper (Costa Rica) was assessed using standard laboratory tests. Despite differences in the venom mixtures used in the immunization of animals for the production of these antivenoms, a pattern of extensive cross-neutralization was observed between these antivenoms and all the venoms tested, with quantitative differences in the values of effective doses. This study reveals the capacity of these antivenoms to neutralize, in preclinical tests, homologous and heterologous Bothrops venoms in Central and South America, and also highlight quantitative differences in the values of Median Effective Doses (ED50s) between the various antivenoms.

Oleanolic acid induces relaxation and calcium-independent release of endothelium-derived nitric oxide.

BACKGROUND AND PURPOSE: The present study investigated the mechanisms by which oleanolic acid, a component of olive oil, increases release of nitric oxide (NO). EXPERIMENTAL APPROACH: Measurements of isometric tension, NO concentration, or endothelial cell calcium were made in rat isolated mesenteric arteries. Immunoblotting for endothelial NOS (eNOS) and Akt kinase were performed in primary cultures of human umbilical vein endothelial cells (HUVECs). KEY RESULTS: Oleanolic acid (3-30 microM) evoked endothelium-dependent relaxations in noradrenaline-contracted rat superior and small mesenteric arteries. In rat superior mesenteric arteries, oleanolic acid induced simultaneous increases in NO concentration and relaxation, and these responses were inhibited by an inhibitor of NOS, asymmetric dimethyl-L-arginine (300 microM) and by the NO scavenger, oxyhaemoglobin (10 microM). Oleanolic acid-evoked NO increases were not reduced in Ca(2+)-free solution and in the presence of an inhibitor of endoplasmic reticulum calcium-ATPase, thapsigargin (1 microM). Oleanolic acid evoked relaxation without changes in endothelial cell calcium, but decreased smooth muscle calcium in arterial segments. Oleanolic acid failed to increase calcium in HUVECs, but increased time-dependently phosphorylation of Akt kinase at Serine(473) (Akt-Ser(473)) and eNOS at Serine(1177) (eNOS-Ser(1177)), which was attenuated by inhibitors of phosphoinositide-3-kinase. CONCLUSIONS AND IMPLICATIONS: This study provides direct evidence that a component of olive oil, oleanolic acid, activated endothelium-dependent release of NO and decreased smooth muscle cell calcium followed by relaxation. The oleanolic acid-evoked endothelium-derived NO release was independent of endothelial cell calcium and involved phosphoinositide-3-kinase-dependent phosphorylation of Akt-Ser(473) followed by phosphorylation of eNOS-Ser(1177).

[Cognitive effects of combined memory and psychomotor training in elderly adults]. / Efectos cognitivos de un entrenamiento combinado de memoria y psicomotricidad en adultos mayores.

INTRODUCTION: As part of the normal ageing process, cognitive deterioration clearly takes place in memory, attention and the information processing speed (IPS). Among the intervention strategies commonly used, combined programmes like those involving memory and psychomotor skills have the greatest beneficial effects on cognition in the short and long term. AIM: To evaluate the effects of a combined memory and psychomotor training programme entitled 'Independence in Older age' (SIMA) on the cognitive performance of a population sample of healthy elderly adults. SUBJECTS AND METHODS: A cross-sectional study was conducted on 95 elderly adults (49 in the intervention group and 46 in the control group) before and after a 20-session training programme. Both intergroup (intervention group versus control group) and intragroup (each group individually) cognitive performance was analysed. The two groups were paired by age, sex and schooling. RESULTS: The intergroup analysis following the training showed statistically and clinically significant differences in two IPS variables: conflict and interference in the colour-word test, which had a size effect of -1.31 and -1.38, respectively; the performance of the group of trained elderly adults was better than that of the controls. Likewise, in the intragroup analysis significant differences were found in these two variables in the group that received the intervention, with a size effect of -1.27 and -1.15. CONCLUSION: Findings show positive effects of combined SIMA memory and psychomotor training, especially in selective attention and the IPS with a healthy elderly adult population.

El ictus en el siglo XXI. Tratamiento de urgencia / Stroke in the XXI Century. Emergency care

La enfermedad vascular, una verdadera epidemia, es la primera causa de muerte en los países desarrollados, responsable de más de una cuarta parte de las muertes documentadas a nivel mundial y la primera causa de discapacidad grave en el adulto. Las tres cuartas partes de los ictus afectan a pacientes mayores de 65 años, y debido a las previsiones de población en las que España será en el 2050 de las poblaciones más envejecidas del mundo, se prevé un incremento de la incidencia de esta patología en los próximos años. Numerosos estudios describen el escaso conocimiento de la población, sobre los signos y síntomas de presentación del ictus. Se recomienda elaborar campañas informativas orientadas a la población general para aumentar su conocimiento sobre los factores de riesgo, facilitar la identificación de los signos y síntomas de alarma y fomentar entre los pacientes el concepto del ictus como urgencia neurológica. El Código Ictus permite un rápido proceso de identificación, notificación y traslado de los pacientes a los servicios de urgencia hospitalarios. Los avances tecnológicos en el diagnóstico y la aparición de medidas terapéuticas eficaces, trombolíticos, hacen necesaria la organización coordinada y multidisciplinar. La Unidad de Ictus es la aproximación más eficaz y eficiente en el manejo de la fase aguda del ictus isquémico o hemorrágico. Los progresos en la investigación permitirán disponer de nuevas y mejores oportunidades para el tratamiento agudo del ictus (AU)

Cerebrovascular diseases have reached epidemic proportions worldwide. They are the major cause of mortality in developed countries, accounting for over one-quarter of worldwide documented deaths, and the leading cause of severe disability in adults. Given that Spain will become one of the countries most affected by population ageing, an increase in the incidence of these diseases is expected in coming years. Several studies have reported that public levels of awareness of stroke warning signs, symptoms and risk factors are relatively low. Information campaigns aimed at increasing these levels of awareness and considering stroke as a neurological emergency are needed. The stroke code is a system which allows rapid identification, notification, and transfer of stroke patients to the emergency units. Technological advances in stroke diagnosis, and the development of effective therapeutic measures, such as thrombolytics, require a coordinated multidisciplinary approach. Treating patients in Stroke Units is the most effective and efficient approach in acute ischemic or hemorrhagic stroke management. In coming years research advances will provide new and better strategies in acute stroke treatment (AU)

Ochratoxin A in liquorice as affected by processing methods.

A study of the effect of several processing methods on the concentration of ochratoxin A (OTA) in liquorice and derived products was carried out. The effect of the sorting, washing and peeling of fresh liquorice roots was investigated; as well as the production at a laboratory scale of liquorice extract and block liquorice from dry roots. Finally, the thermal stability of OTA was assessed. The OTA content was analysed by high-performance liquid chromatography-fluorescence and confirmed by methyl ester formation. The OTA level in liquorice extract was stable to heat treatment at 150 degrees C for 60 min. The OTA concentration was unaffected by sorting or washing, but it was much reduced by peeling (a 53.1% reduction). A great reduction in the OTA level was found during the production of liquorice extract (78.6%) and block liquorice (91.8%).

Triterpenic compounds from "orujo" olive oil elicit vasorelaxation in aorta from spontaneously hypertensive rats.

There is currently a considerable amount of interest in the benefits of certain dietary elements, and in particular of olive oil, in endothelial function and thus in hypertension. "Orujo" or pomace olive oil is obtained from the residues of the olive by a novel centrifugation process, and it is a good dietary source of triterpenic compounds such as oleanolic and maslinic acid, erythrodiol, and uvaol. Until now, there was no information available regarding the properties of these triterpenoids on the vasculature of hypertensive animals. However, in this in vitro study, we have analyzed the vasorelaxation induced by these triterpenoids in isolated aorta from spontaneously hypertensive rats (SHR). The triterpenoids tested induced concentration-dependent vasorelaxation, mostly involving nitric oxide (NO). Indeed, the responses were attenuated by removal of the endothelium or following pretreatment with the NO synthase inhibitor L-NAME. Furthermore, the differences that were observed in the potency of relaxation, the selectivity, and the dependence on the endothelium were attributed to structural features of the triterpenoids. In conclusion, triterpenic components in pomace olive oil induce vasorelaxation of the aorta from SHR, and this effect generally involves endothelial NO.

L-carnitine and propionyl-L-carnitine improve endothelial dysfunction in spontaneously hypertensive rats: different participation of NO and COX-products.

L-carnitine and propionyl-L-carnitine are supplements to therapy in cardiovascular pathologies. Their effect on endothelial dysfunction in hypertension was studied after treatment with either 200 mg/kg of L-carnitine or propionyl-L-carnitine during 8 weeks of spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY). Endothelial function was assessed in aortic rings by carbachol-induced relaxation (CCh 10(-8) to 10(-4) M) and factors involved were characterized in the presence of the inhibitors: L-NAME, indomethacin, the TXA2/PGH2 Tp receptor antagonist ICI-192,605 and the thromboxane synthetase inhibitor-Tp receptor antagonist, Ro-68,070. The effect on phenylephrine-induced contractions was also observed. To identify the nature of vasoactive COX-derived products, enzyme-immunoassay of incubation media was assessed. Involvement of reactive oxygen species was evaluated by incubating with superoxide dismutase and catalase. Nitric oxide production was evaluated by serum concentration of NO2+NO3.Treatment with both compounds improved endothelial function of rings from SHR without blood pressure change. Propionyl-L-carnitine increased NO participation in WKY and SHR. L-carnitine reduced endothelium-dependent responses to CCh in WKY due to an increase of TXA2 production. In both SHR and WKY, L-carnitine enhanced concentration of PGI2 and increased participation of NO. Results in the presence of SOD plus catalase show that it might be related to antioxidant properties of L-carnitine and propionyl-L-carnitine. Comparison between the effect of both compounds shows that both may reduce reactive oxygen species and increase NO participation in endothelium-dependent relaxations in SHR. However, only L-carnitine was able to increase the release of the vasodilator PGI2 and even enhanced TXA2 production in normotensive rats.

Medicina basada en la evidencia: nutrición en la obesidad / Evidence-based medicine: nutrition in obesity

El tratamiento dietético hipocalórico es la piedra angular del planteamiento terapéutico de la obesidad. En la mayoría de los estudios controlados la distribución de macronutrientes de la dieta no parece marcar la diferencia en términos de pérdida de peso. Así, por ejemplo, las dietas bajas en hidratos de carbono consiguen pérdidas significativas de peso frente a las dietas bajas en grasa, en períodos cortos de tiempo (6 meses), pero no hay diferencias tras un seguimiento a más largo plazo (12 meses). Existe un consenso general acerca de que una reducción energética comprendida entre 500 y 1.000 kcal diarias, respecto a la dieta habitual, consigue pérdidas promedio de 0,5 a 1 kg a la semana durante los primeros 6 meses de tratamiento, lo que representa una reducción entre el 5-10% del peso corporal, una proporción suficiente para atenuar el impacto de las comorbilidades asociadas con la obesidad. Pero los resultados a largo plazo (más de un año) con las dietas bajas en grasas son desalentadores (promedio de 0-3 kg), mientras que la seguridad de las dietas bajas en hidratos de carbono está pendiente de demostrar. En esta revisión se analizan los niveles de evidencia que diferentes tipos de dieta (incluidas las de muy bajo contenido calórico) tienen sobre el peso corporal a medio y largo plazo, poniendo de relieve que, posiblemente, los planteamientos terapéuticos de pérdida de peso deban ser diferentes de aquellos dirigidos al mantenimiento del peso perdido. Por último, cualquiera que sea el planteamiento dietético de la obesidad, no cabe duda de que el refuerzo a través de un programa estructurado de cambios en el estilo de vida y de actividad física constituye una herramienta esencial para asegurar un éxito a largo plazo (AU)

The mainstay of the therapeutic approach to obesity is the low calorie diet. In most controlled studies the distribution of micronutrients in the diet does not seem to influence weight loss. Thus, for example, low carbohydrate diets achieve significant weight loss compared with low-fat diets in short periods (6 months), but there are no differences after longer follow-up (12 months). There is general consensus that a reduction of between 500 and 1,000 kcal daily with respect to the normal diet achieves an average weight loss of 0.5 to 1 kg per week for the first 6 months of treatment, representing a reduction of 5-10% of body weight, a proportion that is sufficient to attenuate the impact of obesity-related comorbidities. However the long-term results (more than 1 year) with low-fat diets are discouraging (0-3 kg), while the safety of low carbohydrate diets remains to be demonstrated. The present review analyzes the levels of evidence for the effect of distinct types of diet (including very low calorie diets) on body weight in the medium and long term, highlighting that possibly the therapeutic approaches to weight loss should differ from the strategies used to maintain weight loss. Lastly, whatever the dietary approach to obesity, there is no doubt that reinforcement through a structured program of lifestyle changes and physical activity is an essential tool to ensure long-term success (AU)