PneumoniaCheck, a novel aerosol collection device, permits capture of airborne Mycobacterium tuberculosis and characterisation of the cough aeromicrobiome in people with tuberculosis.

BACKGROUND: Tuberculosis (TB), a major cause of disease and antimicrobial resistance, is spread via aerosols. Aerosols have diagnostic potential and airborne-microbes other than Mycobacterium tuberculosis complex (MTBC) may influence transmission. We evaluated whether PneumoniaCheck (PMC), a commercial aerosol collection device, captures MTBC and the aeromicrobiome of people with TB. METHODS: PMC was done in sputum culture-positive people (≥ 30 forced coughs each, n = 16) pre-treatment and PMC air reservoir (bag, corresponding to upper airways) and filter (lower airways) washes underwent Xpert MTB/RIF Ultra (Ultra) and 16S rRNA gene sequencing (sequencing also done on sputum). In a subset (n = 6), PMC microbiota (bag, filter) was compared to oral washes and bronchoalveolar lavage fluid (BALF). FINDINGS: 54% (7/13) bags and 46% (6/14) filters were Ultra-positive. Sequencing read counts and microbial diversity did not differ across bags, filters, and sputum. However, microbial composition in bags (Sphingobium-, Corynebacterium-, Novosphingobium-enriched) and filters (Mycobacterium-, Sphingobium-, Corynebacterium-enriched) each differed vs. sputum. Furthermore, sequencing only detected Mycobacterium in bags and filters but not sputum. In the subset, bag and filter microbial diversity did not differ vs. oral washes or BALF but microbial composition differed. Bags vs. BALF were Sphingobium-enriched and Mycobacterium-, Streptococcus-, and Anaerosinus-depleted (Anaerosinus also depleted in filters vs. BALF). Compared to BALF, none of the aerosol-enriched taxa were enriched in oral washes or sputum. INTERPRETATION: PMC captures aerosols with Ultra-detectable MTBC and MTBC is more detectable in aerosols than sputum by sequencing. The aeromicrobiome is distinct from sputum, oral washes and BALF and contains differentially-enriched lower respiratory tract microbes.

Influence of the Number of Players on the Load of Soccer Players During Transition Games.

The aims of this study were to determine the effect of different compositions in transition games (TGs) on the load of soccer players and to evaluate their performance in physical tests. Using a GPS system, 18 players were monitored during: 3vs2, 2vs1 and 1vs1. Distance covered (DC), DC 18-20.9 km·h-1, 21-23.9 km·h-1,>24 km·h-1, peak speed, accelerations (Acc) and decelerations (Dec)>1.0 m·s-2 and>2.5 m·s-2 and rate of perceived exertion (RPE) were recorded. Before and after each TG, countermovement-jump (CMJ), 15- (S15) and 30 m (S30) speed tests were assessed. TG3vs2 showed greater DC and Dec>1.0 m·s-2 than TG2vs1, and DC, DC 18.0-23.9 km·h-1, Acc>1.0 m·s-2 and Dec>2.5 m·s-2 than TG1vs1 (p<0.01). TG2vs1 achieved higher DC, DC 18.0-23.9 km·h-1, and Acc>2.5 m·s-2 (p<0.01) but lower peak speed (p=0.02) and RPE (p=0.02) than TG1vs1. Post-intervention, TG1vs1 showed lower CMJ and higher S15 (p=0.02), while TG3vs2, showed improvements in CMJ (p<0.01). The three tasks showed large variations for DC>24 km·h-1, Acc>1.0 m·s-2, Dec>1.0 m·s-2 and Dec>2.5 m·s-2. The load of TGs is sensitive to their player composition.

A novel aerosol collection method shows the cough aeromicrobiome of people with tuberculosis is phylogenetically distinct from respiratory tract specimens.

Background: Tuberculosis (TB), a major cause of disease and antimicrobial resistance, is spread via aerosols. Aerosols have diagnostic potential and airborne-microbes other than Mycobacterium tuberculosis complex (MTBC) may influence transmission. We evaluated whether PneumoniaCheck (PMC), a commercial aerosol collection device, captures MTBC and the aeromicrobiome of people with TB. Methods: PMC was done in sputum culture-positive people (≥30 forced coughs each, n=16) pre-treatment and PMC air reservoir (bag, corresponding to upper airways) and filter (lower airways) washes underwent Xpert MTB/RIF Ultra (Ultra) and 16S rRNA gene sequencing (sequencing also done on sputum). In a subset (n=6), PMC microbiota (bag, filter) was compared to oral washes and bronchoalveolar lavage fluid (BALF). Findings: 54% (7/13) bags and 46% (6/14) filters were Ultra-positive. Sequencing read counts and microbial diversity did not differ across bags, filters, and sputum. However, microbial composition in bags (Sphingobium-, Corynebacterium-, Novosphingobium-enriched) and filters (Mycobacterium-, Sphingobium-, Corynebacterium-enriched) each differed vs. sputum. Furthermore, sequencing only detected Mycobacterium in bags and filters but not sputum. In the subset, bag and filter microbial diversity did not differ vs. oral washes or BALF but microbial composition differed. Bags vs. BALF were Sphingobium-enriched and Mycobacterium-, Streptococcus-, and Anaerosinus-depleted (Anaerosinus also depleted in filters vs. BALF). Compared to BALF, none of the aerosol-enriched taxa were enriched in oral washes or sputum. Interpretation: PMC captures aerosols with Ultra-detectable MTBC and MTBC is more detectable in aerosols than sputum by sequencing. The aeromicrobiome is distinct from sputum, oral washes and BALF and contains differentially-enriched lower respiratory tract microbes.

Analysis of Differences in Running Demands between Official Matches and Transition Games of Young Professional Soccer Players according to the Playing Position.

The aim of this study was to compare the running demands of transition games (TGs) and official matches, analysing their requirements according to the performance of each position. An observational design was used to examine the activity of 20 soccer players during official matches and TGs. GPS technology was used to monitor the total distance covered (DC), distance at speeds between 14-17.9 km•h-1, 18-21 km•h-1, and above 21 km•h-1, peak speed, accelerations and decelerations above 2.5 m•s-2, and Player Load for both activities. All players were assigned to groups: centre-backs (CBs), fullbacks (FBs), defensive midfielders (DMFs), offensive midfielders (OMFs), wide midfielders (WMFs) and strikers (Ss). TGs showed greater total DC, DC 14-17.9 km•h-1, DC 18-21 km•h-1, DC >21 km•h-1, accelerations and decelerations >2.5 m•s-2, and Player Load (p < 0.01). CBs, FBs and Ss showed more DC, DC 14-17.9 km•h-1, DC 18-21 km•h-1, DC >21 km•h-1, accelerations and decelerations >2.5 m•s-2 and Player Load in TGs (p < 0.01). In the midfielder positions, transition game players showed greater DC 18-21 km•h-1, DC >21 km•h-1, accelerations and decelerations >2.5 m•s-2 than in matches (p < 0.05). DMFs showed higher total DC (p < 0.05) and WMFs greater DC and DC 14-17.9 km•h-1 (p < 0.01) in these drills. During transition games CBs showed greater DC 14-17.9 km•h-1 than FBs, and greater DC than Ss (p < 0.05). FBs performed more decelerations >2.5 m•s-2 than DMFs and OMFs (p < 0.05). TGs produced a homogenized load in soccer players, independent of their position, which exceeded the external load of official matches.

Alleviating Heat Stress in Fattening Pigs: Low-Intensity Showers in Critical Hours Alter Body External Temperature, Feeding Pattern, Carcass Composition, and Meat Quality Characteristics.

Heat stress is a significant environmental problem that has a detrimental impact on animal welfare and production efficiency in swine farms. The current study was conducted to assess the effect of low-intensity showers, provided during critical high-temperature hours daily, on body external temperature, feeding pattern, and carcass and meat quality characteristics in fattening pigs. A total of 400 animals (200 barrows and 200 gilts) were randomly allotted in 40 pens. A shower nozzle was installed over 20 pens (half barrows and half gilts) where pigs received a low-intensity shower for 2 min in 30 min intervals from 12 to 19 h (SHO group). Another group without showers was also considered (CON). Feeder occupancy measurement, thermographic measures, and carcass and meat quality parameters were studied. In the periods with higher environmental temperatures, SHO animals showed an increase in the feeder occupancy rate compared to the CON group. A decrease in temperature was observed after the shower, regardless of the anatomical location (p < 0.005). The treatment with showers led to higher values than in the CON group of 4.72%, 3.87%, 11.8%, and 15.1% for hot carcass weight, lean meat yield, and fat thickness in Longissimus Dorsi (LD) and Gluteus Medius muscles, respectively (p < 0.01). Pork from CON showed a 14.9% higher value of drip loss, and 18.9% higher malondialdehyde concentration than SHO (p < 0.01); meanwhile, intramuscular fat content was 22.8% higher in SHO than in CON (p < 0.01). On the other hand, the CON group exhibited higher L* (2.13%) and lower a* and b* values (15.8% and 8.97%) compared to the SHO group. However, the pH20h of the CON group was significantly lower than that of the SHO group (p < 0.001), indicating a softer pH decrease. Related to fatty acids in subcutaneous outer and inner layers and intramuscular fat, the CON group showed higher ΣSFA and lower ΣMUFA and Δ9-desaturase indexes than SHO (p < 0.05). In conclusion, the amelioration of heat stress through showers at critical times should be considered an interesting tool that improves both carcass and meat quality, as well as animal welfare.

Latent Tuberculosis Infection Is Associated with an Enrichment of Short-Chain Fatty Acid-Producing Bacteria in the Stool of Women Living with HIV.

Latent tuberculosis infection (LTBI) is common in people living with HIV (PLHIV) in high-TB-burden settings. Active TB is associated with specific stool taxa; however, little is known about the stool microbiota and LTBI in PLHIV. We characterised the stool microbiota of PLHIV with [interferon-γ release assay (IGRA)- and tuberculin skin test (TST)-positive] or without (IGRA- and TST-negative) LTBI (n = 25 per group). The 16S rRNA DNA sequences were analysed using QIIME2, Dirichlet-Multinomial Mixtures, DESeq2, and PICRUSt2. No α- or ß-diversity differences occurred by LTBI status; however, LTBI-positive people were Faecalibacterium-, Blautia-, Gemmiger-, and Bacteroides-enriched and Moryella-, Atopobium-, Corynebacterium-, and Streptococcus-depleted. Inferred metagenome data showed that LTBI-negative-enriched pathways included several metabolite degradation pathways. Stool from LTBI-positive people demonstrated differential taxa abundance based on a quantitative response to antigen stimulation. In LTBI-positive people, older people had different ß-diversities than younger people, whereas in LTBI-negative people, no differences occurred across age groups. Amongst female PLHIV, those with LTBI were, vs. those without LTBI, Faecalibacterium-, Blautia-, Gemmiger-, and Bacteriodes-enriched, which are producers of short-chain fatty acids. Taxonomic differences amongst people with LTBI occurred according to quantitative response to antigen stimulation and age. These data enhance our understanding of the microbiome's potential role in LTBI.

Latent tuberculosis infection is associated with an enrichment of short chain fatty acid producing bacteria in the stool of women living with HIV.

Background: Latent tuberculosis infection (LTBI) is common in people living with HIV (PLHIV) in high TB burden settings. Active TB is associated with specific stool taxa; however, little is known about the stool microbiota and LTBI, including in PLHIV. Method: Within a parent study that recruited adult females with HIV from Cape Town, South Africa into predefined age categories (18-25, 35-60 years), we characterised the stool microbiota of those with [interferon-γ release assay (IGRA)- and tuberculin skin test (TST)-positive] or without (IGRA- and TST- negative) LTBI (n=25 per group). 16S rRNA DNA sequences were analysed using QIIME2, Dirichlet Multinomial Mixtures, DESeq2 and PICRUSt2. Results: No α- or ß-diversity differences occurred by LTBI status; however, LTBI-positives were Faecalibacterium-, Blautia-, Gemmiger-, Bacteroides-enriched and Moryella-, Atopobium-, Corynebacterium-, Streptococcus-depleted. Inferred metagenome data showed LTBI-negative-enriched pathways included several involved in methylglyoxal degradation, L-arginine, putrescine, 4-aminobutanoate degradation and L-arginine and ornithine degradation. Stool from LTBI-positives demonstrated differential taxa abundance based on a quantitative response to antigen stimulation (Acidaminococcus-enrichment and Megamonas-, Alistipes-, and Paraprevotella-depletion associated with higher IGRA or TST responses, respectively). In LTBI-positives, older people had different ß-diversities than younger people whereas, in LTBI-negatives, no differences occurred across age groups. Conclusion: Amongst female PLHIV, those with LTBI had, vs. those without LTBI, Faecalibacterium, Blautia, Gemmiger, Bacteriodes-enriched, which are producers of short chain fatty acids. Taxonomic differences amongst people with LTBI occurred according to quantitative response to antigen stimulation and age. These data enhance our understanding of the microbiome's potential role in LTBI.

Bad company? The pericardium microbiome in people investigated for tuberculosis pericarditis in an HIV-prevalent setting.

Background: The microbiome likely plays a role in tuberculosis (TB) pathogenesis. We evaluated the site-of-disease microbiome and predicted metagenome in people with presumptive tuberculous pericarditis, a major cause of mortality, and explored for the first time, the interaction between its association with C-reactive protein (CRP), a potential diagnostic biomarker and the site-of-disease microbiome in extrapulmonary TB. Methods: People with effusions requiring diagnostic pericardiocentesis (n=139) provided background sampling controls and pericardial fluid (PF) for 16S rRNA gene sequencing analysed using QIIME2 and PICRUSt2. Blood was collected to measure CRP. Results: PF from people with definite (dTB, n=91), probable (pTB, n=25), and non- (nTB, n=23) tuberculous pericarditis differed in ß-diversity. dTBs were, vs. nTBs, Mycobacterium-, Lacticigenium-, and Kocuria- enriched. Within dTBs, HIV-positives were Mycobacterium-, Bifidobacterium- , Methylobacterium- , and Leptothrix -enriched vs. HIV-negatives and HIV-positive dTBs on ART were Mycobacterium - and Bifidobacterium -depleted vs. those not on ART. Compared to nTBs, dTBs exhibited short-chain fatty acid (SCFA) and mycobacterial metabolism microbial pathway enrichment. People with additional non-pericardial involvement had differentially PF taxa (e.g., Mycobacterium -enrichment and Streptococcus -depletion associated with pulmonary infiltrates). Mycobacterium reads were in 34% (31/91), 8% (2/25) and 17% (4/23) of dTBs, pTBs, and nTBs, respectively. ß-diversity differed between patients with CRP above vs. below the median value ( Pseudomonas -depleted). There was no correlation between enriched taxa in dTBs and CRP. Conclusions: PF is compositionally distinct based on TB status, HIV (and ART) status and dTBs are enriched in SCFA-associated taxa. The clinical significance of these findings, including mycobacterial reads in nTBs and pTBs, requires evaluation.

Factors associated with compliance with physical activity recommenddations among adolescents in Huesca / Factores asociados con el cumplimiento de las recomendaciones de actividad física entre los adolescentes dehuesca / Factores associados ao cumprimento das recomendações de actividade fisica entre adolescentes de huesca

Schools have been identified as environments of choice for physical activity promotion. This study examines factors associated with compliance with objectively assessed physical activity recommendations for early adolescents taking part in “Sigue la Huella”, a school-based intervention guided by a social ecological framework and Self-Determination Theory (Deci and Ryan, 2002). A total of 200 students (108 boys) aged 12-13 years (M = 12.16; SD = ± 0.51), wore accelerometers during a seven-day period and completed a questionnaire. Participants were considered compliant to the recommendations if their moderate to vigorous physical activity, averaged over seven days, was ≥ 60 minutes a day. As a result 57.4% of boys and 9.9% of girls met recommendations. In a multilevel logistic regression model, compliance was higher among boys and students attending private schools, and lower for obese students. Compliance was also associated with higher perceptions of physical competence, higher perceptions of autonomy in physical education, greater importance attached to physical education and less sedentary time. In conclusion, assessed objectively, gender differences in compliance with physical activity recommendations were greater than expected. Self-Determination Theory emerged as a useful framework to identify motivational factors that can be addressed in school-based physical activity interventions and programs for early adolescents

s centros escolares têm sido identificados como contextos privilegiados para a promoção da actividade física. Este estudo examina osfactores associados ao cumprimento das recomendações da actividade física avaliados objectivamente para os jovens adolescentes que integram o pro-grama “Sigue la Huella”, uma intervenção realizada em contexto escolar e baseada num marco teórico ecológico e na Teoria da Auto-determinação(Deci e Ryan, 2002). Um total de 200 estudantes (108 rapazes) de 12 e 13 anos (M= 12.16; DP= ± 0.51) usaram acelerómetros durante um período desete dias e preencheram um questionário. Os participantes eram considerados como cumpridores das recomendações se a sua actividade física mode-rada-vigorosa média era ≥ 60 e se mantinha durante os sete dias. Os resultados indicam que 57.4% dos rapazes e 9.9% das raparigas cumpriram as re-comendações. Através de um modelo multinível de regressão logística, constatou-se que o cumprimento foi superior entre os rapazes e os estudantes decolégios privados, e menor para os estudantes obesos. O cumprimento das recomendações também se associou a uma maior percepção de competênciafísica, uma maior percepção de autonomia em educação física, maior importância que se atribui à educação física e a um menor tempo sedentário. Emsuma, a partir da avaliação objectiva, as diferenças de género no cumprimento das recomendações de actividade física foram superiores ao esperado. ATeoria da Auto-Determinação configura-se como um marco útil para identificar os factores motivacionais que podem ser abordados nas intervenções eprogramas de actividade física no âmbito escolar para os jovens adolescentes

Los centros escolares han sido identificados como los entornos idoneos para la promoción de la actividad física. Este estudio examina los factores asociados con el cumplimiento de las recomendaciones de actividad física evaluados objetivamente para los jóvenes adolescentes que forman parte de "Sigue la Huella", una intervención basada en el entorno escolar guiada por un marco social ecológico y la teoría de la Autodeterminación (Deciy Ryan, 2002). Un total de 200 estudiantes (108 chicos) de 12 y 13 años (M = 12.16; DE = ± 0.51), llevaron acelerómetros durante un período de siete días y completaron un cuestionario. A los participantes se les consideraba conformes a las recomendaciones si su actividad física moderada-vigorosa, como promedio durante los siete días, era ≥ 60 minutos al día. Como resultado, el 57.4% de los chicos y el 9.9% de las chicas cumplieron las recomendaciones. En un modelo multinivel de regresión logística, el cumplimiento fue mayor entre los chicos y los estudiantes que asisten a colegios privados, y menor para los estudiantes obesos. El cumplimiento también se asoció con una mayor percepción de competencia física, una mayor percepción de la autonomía en la educación física, mayor importancia que se le concede a la educación física y con un menor tiempo sedentario. En conclusión, a partir de la valoración objetiva, las diferencias de género en el cumplimiento de las recomendaciones de actividad física fueron mayores de lo esperado. La teoría de la Autodeterminación surgió como un marco útil para identificar los factores motivacionales que pueden ser abordados en las intervenciones y programas de actividad física en el ámbito escolar para los jóvenes adolescentes

Nuevos fármacos para la diabetes mellitus tipo 2: amigos o enemigos. Reflexiones sobre una nueva guía de «armonización» del tratamiento de la diabetes mellitus tipo 2 / New drugs for type 2 diabetes mellitus: Friends or foes. Reflections on new guidelines to standardize treatment of type 2 diabetes mellitus

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Documento de abordaje integral de la diabetes tipo 2 / Document on a comprehensive approach to type 2 diabetes mellitus

Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2

Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists

Prevención cardiovascular primaria con estatinas en la diabetes mellitus tipo 2: ¿es hora de cambiar de estrategia? / Primary prevention of cardiovascular disease with statin in type 2 diabetes mellitus: Is it time to change our strategy?

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Inercia clínica en pacientes con diabetes mellitus tipo 2 no insulinizados en tratamiento con hipoglucemiantes orales. Estudio INERCIA / INERTIA study: Clinical inertia in non-insulinized patients on oral hypoglycemic treatment. A study in Spanish primary and specialty care settings

Fundamento y objetivo: Investigar la inercia clínica en el uso de los hipoglucemiantes orales (HO) en pacientes con diabetes mellitus tipo 2 (DM2) no insulinizados en España. Pacientes y método: Estudio transversal, retrospectivo (2 años), multicéntrico en toda España. La inercia clínica se definió como: número total de pacientes sin intensificación del tratamiento dividido por el número total de pacientes con valores de hemoglobina glucosilada (HbA1c) inadecuados (_ 7%), multiplicado por 100. Si afectaba a todas las visitas con una HbA1c _ 7% en los 2 años previos se definió como inercia clínica total (ICT), y si solo afectaba a alguna de ellas, como parcial (ICP). El cumplimiento del tratamiento con HO se evaluó con el test de Morisky-Green. Resultados: Se incluyeron 2.971 pacientes, 1.416 bien controlados (HbA1c < 7%) y 1.555 insuficientemente controlados (HbA1c _ 7%). La ICP fue del 52,5% (intervalo de confianza del 95% [IC 95%] 52,4- 52,6%), siendo menor en los pacientes con un control glucémico adecuado (31,4 frente a 71,8%; p < 0,001). La ICT fue del 12,8% (IC 95% 12,2-13,8%). La ICP se asoció a sedentarismo, hipertensión y mayor número de complicaciones microvasculares y macrovasculares. El cumplimiento terapéutico fue del 38,0%, siendo menor en los pacientes con ICP en relación con los que no la presentaban. El sexo femenino (odds ratio [OR] 1,43, IC 95% 1,09-1,86%) y una menor duración de la DM2 (OR 0,98; IC 95% 0,95-0,99%) se asociaron de forma independiente a ICP. Conclusiones: Aproximadamente la mitad de los pacientes con DM2 no insulinizados y en tratamiento con HO presenta ICP. Cuatro de cada 10 pacientes cumplen adecuadamente el tratamiento con HO. El sexo femenino y una menor duración de la DM2 se asocian independientemente a ICP (AU)

Background and objective: To study clinical inertia in the management of oral hypoglycemic agents (OHA)vin non-insulin treated patients with type 2 diabetes mellitus (T2DM) in Spain. Patients and method: Epidemiological, cross-sectional, retrospective (2 years), multicenter study. Clinical inertia was measured as the total number of patients without OHA treatment intensification divided by the total number of patients with inadequate HbA1c values (_ 7%), multiplied by 100. Total clinical inertia (TCI) was the absence of OHA treatment intensification in all visits with a HbA1c _ 7% values in the previous 2 years; partial clinical inertia (PCI) occurred when this absence only occurred in some of these visits. We assessed OHA treatment compliance with the Morisky-Green test. Results: We included 2,971 patients, 1,416 adequately controlled (HbA1c < 7%) and 1,555 inadequately controlled (HbA1c _ 7%). PCI prevalence was 52.5% (95% confidence interval [95% CI] 52.4-52.6%) while TCI prevalence was 12.8% (95% CI 12.2-13.8%). PCI was lower in patients adequately controlled as compared with those inadequately controlled (31.4% vs. 71.8%; P < .001). PCI was associated with sedentary lifestyle, hypertension and higher prevalence of micro and macrovascular complications. Only 38.0% of patients were compliant with the OHA treatment, being this percentage even lower in subjects with ICP. Two variables were independently associated with ICP: female sex (odds ratio [OR] 1.43; 95% CI 1.09-1.86%) and a shorter duration of DM2 (OR 0.98; 95% CI 0.95-0.99). Conclusions: One out of 2 patients with T2DM and treated with OHA without insulin suffer from PCI Only 4 out of 10 patients are compliant with OHA treatment. Female sex and a shorter duration of T2DM are independently associated with PCI (AU)

Prácticas de utilización de plaguicidas en agricultores en el distrito de Huaral-Perú, noviembre 2005 / Pesticide use practices in farmers in the district of Huaral-Peru, November 2005

Objetivo: Describir las prácticas de utilización de plaguicidas en los agricultores del distrito de Huaral. Material y Métodos: Estudio transversal. Se realizó un muestreo por conveniencia de agricultores asistentes a las reuniones del mes de noviembre de las comisiones de regantes Chancay Bajo, La Esperanza, Huando y Chancay Alto (Huaral û Perú). Para la recolección de datos se elaboró y validó una encuesta que se aplicó mediante entrevista. Resultados: Se incluyó 119 agricultores con edad promedio de 50.5 años. El 44.9% de los insecticidas usados eran de uso restringido en el país siendo el más usado Metamidofos. Las prácticas inadecuadas más frecuentes fueron, antes de la fumigación la protección personal incorrecta (54.6%) y la mezcla de diferentes insecticidas durante la preparación (74.4%); durante la fumigación la protección personal incorrecta (51.3%); y después de la fumigación el inadecuado desecho de plaguicida sobrante (53.3%). Se halló relación significativa entre recibir capacitación y uso correcto de protección personal durante la fumigación (p=0.043), además de asociación entre uso de insecticidas restringidos con la práctica de mezcla de insecticidas (p=0.009) y con protección personal incorrecta durante la preparación(p=0.003). Conclusiones: Las prácticas inadecuadas en el uso de plaguicidas son bastante frecuentes en el grupo de agricultores entrevistados. La capacitación es un factor favorable de buenas prácticas mientras que el uso de insecticidas restringidos se constituiría en un marcador de prácticas inadecuadas.

Objective: To describe the pesticide utilization practices among agricultural workers in the district of Huaral. Materials and Methods: This is a transversal study. We carried out a convenient sample among farmers who attended to the meetings of the Irrigation Committee of Chancay Bajo, La Esperanza, Huando and Chancay Alto in November. In order to collect information, we elaborated and validated a questionnaire which was applied in an interview. Results: We included 110 farmers aged 50.5 years old on average. A 44.9% of the pesticides used were restricted in our country, being the most used Metamidofos. The most frequent inadequate practices were: Before the fumigation: defective personal protection (54.6%) and the mixing of different insecticides during the preparation (74.4%); during the fumigation: defective personal protection (51.3%); after the fumigation: inadequate dumping of remaining pesticide (53.3%). We found a significant relation (x2; p=0.043) between receiving training and a correct personal protection use during the fumigation. Also, the connection between restricted pesticides use and the practice of mixing insecticides (p=0.009) and the defective personal protection during the preparation (p=0.003). Conclusions: Inadequate pesticide use practices are quite frequent among the interviewed farmers. Training is a favorable factor for good practices while restricted pesticides use are becoming as a marker of defective practices.

Parámetros de control glucémico: nuevas perspectivas en la evaluación del diabético / Assessment of glycemic control: new insights into the evaluation of the diabetic patient

La diabetes mellitus es una enfermedad cada vez más prevalente a nivel mundial. Se acompaña del desarrollo de complicaciones tanto micro como macroangiopáticas, asociándose a una elevada morbimortalidad. Diversos estudios han demostrado una correlación directa entre la mejora del control metabólico y la disminución del riesgo de complicaciones crónicas, especialmente las microangiopáticas. El control glucémico en el paciente con diabetes tipo 2 (DM2) se centra principalmente en la determinación de 3 parámetros: la hemoglobina glucosilada (HbA1c), la glucemia plasmática en ayunas (GPA) y la glucemia posprandial (GPP). Actualmente, la HbA1c se considera el patrón de referencia para evaluar el control glucémico del paciente diabético, debido a la larga experiencia disponible sobre la reducción del riesgo de complicaciones crónicas. Sin embargo, parece existir una creciente evidencia de que fluctuaciones agudas de glucemia también estarían implicadas en la patogénesis de las complicaciones crónicas. Se ha sugerido que las decisiones sobre el tratamiento no deberían tomarse exclusivamente basándose en los valores de HbA1c, sino teniendo en cuenta también la variabilidad glucémica. En los últimos años han aparecido estudios que abogarían por la utilización de la GPP (bien como dato aislado o como componente de la variabilidad glucémica) para estimar de forma más completa el control glucémico del paciente (AU)

Diabetes mellitus is an increasingly prevalent worldwide disease, complicated by development of micro- and macro-angiopathy and associated with high morbidity and mortality. Several studies have demonstrated a direct correlation between improvement of metabolic control and a reduced risk of chronic complications, especially microangiopathy. Glycemic control in type 2 diabetes (DM2) patients focuses primarily on the assessment of three parameters: glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG). Currently, HbA1c is regarded as the gold standard for assessing glycemic control, due to the large experience regarding the reduction of chronic complication risks. However, there is growing evidence that acute glucose fluctuations could also be involved in the pathogenesis of chronic complications. It has therefore been suggested that treatment decisions should not be based exclusively on HbA1c, but should also take into account glycemic variability. Recently, several studies have advocated the use of PPG (either as an isolated value or as a component of glycemic variability) as a more accurate way of estimating glycemic control in patients with diabetes (AU)

Persistencia del control glucémico en función de los fármacos antidiabéticos orales / Persistence of glycemic control according to type of oral antidabetic drug

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¿La diabetes mellitus es un equivalente de riesgo coronario? Resultados de un metaanálisis de estudios prospectivos / Is diabetes mellitus a coronary heart disease equivalent? Results of a meta-analysis of prospective studies

Introducción y objetivos. El propósito de este artículo es dar a conocer los resultados del trasplante cardiaco desde que se inició esta modalidad terapéutica en España hasta diciembre del 2006. Métodos. Se ha realizado un análisis descriptivo de todos los trasplantes cardiacos realizados desde que se empezó esta actividad en mayo de 1984 hasta el 31 de diciembre de 2006. Resultados. El total de trasplantes realizados es 5.241. La mayoría de novo y en adultos (94%). El porcentaje de trasplantes pediátricos y retrasplantes es bajo (4 y 2%, respectivamente), así como el número de trasplantes combinados con pulmón, riñón, hígado o páncreas (2%). El perfil clínico medio del paciente a quien se realiza un trasplante en España es el de un varón de 52 años, diagnosticado de cardiopatía isquémica no revascularizable con depresión severa de la función ventricular y situación funcional avanzada, al que se le implanta un corazón de 34 años procedente de un donante fallecido por traumatismo craneal y con una tiempo de espera de 125 días. El tiempo medio de supervivencia ha ido incrementándose con los años. Así, mientras en la serie general la probabilidad de supervivencia después de 1, 5, 10 y 15 años es del 75, el 64, el 51 y el 35%, respectivamente, en los últimos 5 años, la probabilidad de supervivencia al primero y el quinto año es del 80 y el 75%, respectivamente. La causa más frecuente de fallecimiento es la infección (21%), seguida del fallo agudo del injerto (18%), enfermedad vascular del injerto más muerte súbita (13%), tumores (10%) y rechazo agudo (8%). Conclusiones. Las supervivencias obtenidas en España con el trasplante cardiaco, sobre todo en los últimos años, lo posicionan como el tratamiento de elección ante cardiopatías terminales en situación funcional avanzada y sin otras opciones médicas o quirúrgicas establecidas (AU)

Introduction and objectives. Several guidelines on the treatment of cardiovascular risk factors base their recommendations on the assertion that diabetes mellitus (DM) is a coronary heart disease (CHD) or cardiovascular disease (CVD) risk equivalent. To date, no systematic review of studies substantiating this assertion has been carried out. Methods. A systematic search of the PubMed database up to February 2006 was performed to identify prospective studies meeting the following criteria: a) follow-up was >5 years; b) groups of subjects with DM and without CHD (i.e., DM+CHD-), without DM and with CHD (DM-CHD+), and without either DM or CHD (DM-CHD-) were all included; and c) data on CHD or CVD mortality was reported. The characteristics of the studies were assessed, and data were combined separately for men and women using a random effects model and taking the DM-CHD- group as a reference. Results. In total, 13 studies met the inclusion criteria. Overall, CHD mortality was non-significantly lower in DM+CHD- men than in DM-CHD+ men, hazard ratio [HR] (95% confidence interval [CI]), 3.06 (2.45-3.83) vs 4.28 (3.24-5.66), respectively (P=.066); as was CVD mortality, HR (95% CI), 2.55 (2.00-3.26) vs 3.61 (2.81-4.62), respectively (P=.051). In women, there was no significant difference between the DM+CHD- and DM-CHD+ groups with regard to either CHD mortality, HR (95% CI), 4.68 (3.40-6.45) vs 3.51 (1.75-7.04), respectively (P=.42), or CVD mortality, HR (95% CI), 4.70 (4.23-5.22) vs 3.39 (1.51-9.02), respectively (P=.59). Conclusions. The findings of this meta-analysis support the view that women in the DM+CHD- group have similar CHD and CVD mortality to those in the DM-CHD+ group, whereas men in the DM+CHD- group demonstrated a non-significant trend towards lower CHD and CVD mortality than those in the DM-CHD+ group (AU)

La carrera profesional en Atención Primaria ¿la solución? / Professional career in Primary Health Care. What is the solution?

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Factores que influyen en las concentraciones plasmáticas de proteína C reactiva en los pacientes con diabetes mellitus tipo 2 / Factors influencing plasma concentrations of C-reactive protein in patients with type 2 diabetes mellitus

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Escasa caracterización clínica de los pacientes con diabetes mellitus incluidos en los principales ensayos clínicos sobre hipertensión arterial / Low reporting of clinical characteristics of patients with diabetes mellitus included in the main clinical trials on hypertension

Fundamento y objetivo: Los pacientes con diabetes mellitus (DM) presentan un elevado pero heterogéneo riesgo cardiovascular. Entre los factores que pueden modificarlo se encuentran la edad, el sexo, la etnia, el tipo y la duración de la enfermedad, el grado de control glucémico, tipo de tratamiento hipoglucemiante y la presencia de nefropatía o de acontecimientos cardiovasculares previos. No se conoce hasta qué punto estas características están descritas en los principales ensayos clínicos sobre tratamiento de la hipertensión que incluyen pacientes con DM. Material y método: Se analizaron los ensayos clínicos aleatorizados y con grupo control, publicados hasta mayo de 2003, sobre el tratamiento de la hipertensión que incluían a pacientes con DM y tenían, dentro de su criterio principal de valoración, cualquiera de los siguientes acontecimientos cardiovasculares: infarto agudo de miocardio, accidente cerebrovascular o mortalidad total. En esos ensayos se valoró la información de los pacientes con DM en relación con las variables referidas en el apartado anterior. Resultados: Se analizó un total de 16 estudios que se clasificaron en 3 grupos: a) ensayos exclusivamente para pacientes con DM (RENAAL, UKPDS 38, UKPDS 39, IDNT); b) ensayos con análisis de subgrupo para pacientes con DM (SHEP, Syst-Eur, MICRO-HOPE, HOT, STOP-2, LIFE), y c) ensayos sin análisis de subgrupo para pacientes con DM (CAPP, NORDIL, INSIGHT, ALLHAT, SANBPSG, CONVINCE). En todos estos estudios se incluyó a un total de 33.984 pacientes con DM, la mayoría de 55 o más años y con un porcentaje de mujeres entre el 33,5 y el 71,9%, aunque en dos estudios no constó este porcentaje (12,5%). No se precisó el origen étnico de los participantes en 10 ensayos (62,5%), el tipo de DM en 7 (43,8%), el tiempo de evolución de la DM en 13 (81,3%), el grado de control glucémico en 10 (62,5%), el tipo de tratamiento en 11 (68,8%), la presencia o ausencia de nefropatía en 11 (68,8%) y no se precisó el porcentaje de acontecimientos cardiovasculares previos en 3 (18,8%). En general, los ensayos que no presentaron un análisis de subgrupos para pacientes con DM presentaron una peor definición de las características clínicas de los pacientes que el resto. Conclusiones: La caracterización clínica de los pacientes con DM incluidos en los principales ensayos clínicos sobre hipertensión es deficiente, lo que limita su validez externa. Esa caracterización debería tenerse en cuenta si se pretende mejorar las recomendaciones terapéuticas de la hipertensión en la DM

Background and objective: Subjects with diabetes mellitus (DM) are at high risk of cardiovascular events. However, their cardiovascular risk varies according to several clinical characteristics like age, sex, ethnicity, type and duration of the DM, quality of glycemic control, type of hypoglycemic treatment, or the presence of nephropathy or previous cardiovascular events. It is not known if these characteristics have been sufficiently reported in clinical trials on hypertension including subjects with DM. Material and method: We analyzed randomized controlled clinical trials about treatment of hypertension published before May 2003 with the following characteristics: a) inclusion of subjects with DM and b) a primary end-point including at least one of the following events: myocardial infarction, cerebrovascular disease or total mortality. In these trials we evaluated the above-mentioned clinical characteristics concerning cardiovascular risk. Results: Sixteen trials were eventually analyzed. These trials were classified into: a) trials designed only for subjects with DM (RENAAL, UKPDS 38, UKPDS 39, IDNT); b) trials with a subgroup analysis for subjects with DM (SHEP, Syst-Eur, MICRO-HOPE, HOT, STOP-2, LIFE), and c) trials without a subgroup analysis for subjects with DM (CAPP, NORDIL, INSIGHT, ALLHAT, SANBPSG, CONVINCE). All these trials included a total of 33984 subjects with DM, most of them >= 55 years old. The percentage of women evaluated ranged from 33.5 to 71.9% although in 2 trials no data were found regarding this percentage (12.5%). There was no information on ethnicity in 10 trials (62.5%), on the type of DM in 7 (43.8%), on the duration of the disease in 13 (81.3%), on the degree of glycemic control in 10 (62.5%), on the type of hypoglycemic treatment in 11 (68.8%), on the presence or absence of nephropathy in 11 (68.8%) and on the presence or absence of previous cardiovascular events in 3 (18.8%). Trials without subgroup analysis for subjects with DM had a lower reporting of the clinical characteristics of the subjects evaluated than the rest of the trials. Conclusions: The reporting of relevant clinical characteristics of cardiovascular risk in subjects with DM in the main clinical trials on hypertension is low, diminishing their external validity. To optimize the therapeutic recommendations in the treatment of hypertension in DM these deficiencies should be overcome