[Validation of a questionnaire for the analysis of digital competence in patients with type 1 diabetes mellitus]. / Validación de un cuestionario para analizar la capacidad digital de pacientes con diabetes mellitus tipo 1.

OBJECTIVE: Validation of a questionnaire designed to stratify the level of digital competence in chronic patients. METHOD: Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency. RESULTS: The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77. CONCLUSIONS: The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools.

Aerobic processes for bioleaching manganese and silver using microorganisms indigenous to mine tailings.

Mining wastes containing appreciable concentrations of silver are considered alternative sources for metal extraction, although these wastes are often refractory due to the presence of manganese oxides. The high cost and/or environmental impact of the hydrometallurgical and pyrometallurgical extraction processes make it necessary to search for biotechnological processes for the solubilization of manganese compounds. This paper describes the characterization of chemoorganotrophic microorganisms indigenous to the tailings of a silver mine located in Coahuila, México, regarding their capability to remove manganese and silver present in these residues by lixiviation. The Bacterial and fungal strains isolated were identified by sequencing the rDNA 16S and ITS-1-ITS-2 genomic regions, respectively; the bacterial strains correspond to isolates of Roseospira sp. and Sphingomonas sp., whereas the fungal strains include isolates of Cladosporium sp. A, Cladosporium sp. B and Penicillium chrysogenum. These fungal strains show an effective capacity to lixiviate manganese and silver from solid mine residue when incubated in 9 k medium; it was found that under these conditions, leaching of metals occurs due to a mixed biotic-abiotic process, which yields manganese and silver leaching efficiencies in the ranges of 58-74% and 40-67%, respectively. The fungal strains grown in the LMM medium and the bacterial strains incubated in the PDB medium caused leaching of manganese with a lower efficiency in the range of 0.17-0.24% and 1.42-1.73%, respectively; under these conditions, silver leaching by fungal and bacterial strains appeared to be reduced (< 0.1%).Through in vitro cultures, it was determined that P. chrysogenum and Sphingomonas sp. showed the highest levels of silver resistance.

Prevención secundaria de las fracturas osteoporóticas. ¿Lo hacemos bien? / Secondary prevention of osteoporotic fractures. How well are we doing?

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Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio de Medicina Interna: estudio de cohortes prospectivas / Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: prospective cohort study

Introducción. La desnutrición relacionada con la enfermedad es un reto en nuestros hospitales. Nuestro objetivo fue valorar la factibilidad e importancia de establecer una estrategia de cribado nutricional en nuestro medio. Pacientes y métodos. Estudio de cohortes prospectivo en un servicio de Medicina Interna durante 3 meses. El cribado nutricional se realizó al ingreso y se repitió semanalmente mediante la herramienta Malnutrition Universal Screening Tool. Se analizaron los datos clínicos, la estancia media y los gastos. Resultados. Se incluyeron 330 pacientes (53,9% varones), con una edad media de 77,8 años; la estancia mediana fue de 7 días, y el índice de comorbilidad de Charlson de 5,4. La herramienta Malnutrition Universal Screening Tool detectó al ingreso un 26,9% de pacientes con riesgo de desnutrición. Un 18% de pacientes con buen estado nutricional desarrollaron desnutrición durante la hospitalización. Los pacientes con desnutrición grave inicial presentaron una estancia mediana mayor. Los pacientes cuya situación nutricional empeoró durante el ingreso tuvieron una estancia significativamente mayor (2,5 días) con respecto a los que no empeoró. Además, ocasionaron un sobrecoste de 767 € por ingreso (35% superior), lo que implica un exceso de gastos relacionados con la desnutrición de 646.419,93 € anuales en el servicio estudiado. La adecuada codificación implicó un incremento en el peso medio de 2,11 a 2,81, lo que supondría 82.568,52€, que no se habrían cuantificado previamente. Conclusión. La alta prevalencia y repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en los pacientes ingresados en Medicina Interna hacen recomendable establecer protocolos para su detección precoz y tratamiento (AU)

Background. Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community. Patients and methods. A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses. Results. The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of Euros 767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified. Conclusion. The high prevalence and clinical and financial implications of Disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment (AU)

Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: prospective cohort study. / Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio de Medicina Interna: estudio de cohortes prospectivas.

BACKGROUND: Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community. PATIENTS AND METHODS: A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses. RESULTS: The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of €767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified. CONCLUSION: The high prevalence and clinical and financial implications of Disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment.

Osteoporosis Management in a Real Clinical Setting: Heterogeneity in Intervention Approach and Discrepancy in Treatment Rates when Compared with the NOGG and NOF Guidelines.

Objective: The National Osteoporosis Guideline Group (NOGG) proposes intervention thresholds that vary by age. Instead, the National Osteoporosis Foundation (NOF) proposes a fixed threshold for decision. The aim of the present study was to compare the actual therapeutic decisions taken in a routine clinical practice setting with those recommended by the NOF and NOGG guidelines. Material and methods: A cross-sectional study was conducted in individuals referred to a densitometric unit who were not receiving antiresorptive therapy. The absolute risk of major and hip fracture was calculated using the British formula provided by the FRAX® tool. NOGG and NOF guidelines' therapeutic intervention thresholds were used. Agreement was calculated using Cohen's kappa. Results: A total of 640 individuals were included, of which 95% were women, with a median age of 59.4 (IQR=14) years. 31.7% of subjects who were analyzed received treatment for osteoporosis. The type of treatment that was mainly prescribed (71.9%) consisted of bisphosphonates. When applying the NOGG criteria, treatment was recommended in 22.7% of cases; this percentage increased to 42.2% with the NOF guidelines. According to both guidelines, 20.4% of patients would not have received treatment. The concordance, expressed as the kappa index, was low; 0.25 (CI 95% 0.17-0.34) and 0.49 (CI 95% 0.42-0.55), with the NOGG and NOF, respectively. Conclusions: Important heterogeneity exists in the treatment of osteoporosis in real practice. The choice of guideline has a major impact on the proportion and selection of individuals recommended for treatment and, subsequently, on treatment-related expenditures.

Inflammatory status is different in relationship to insulin resistance in severely obese people and changes after bariatric surgery or diet-induced weight loss.

AIM: To assess if insulin resistance is related to a different inflammatory status (especially lymphocyte subpopulations) in severely obese people and to evaluate changes after weight loss either following a very-low calorie diet (VLCD) or bariatric surgery. RESEARCH METHODS & PROCEDURES: Severely obese patients were consecutively recruited in our Obesity Unit. Blood lymphocyte subpopulations and inflammatory parameters were measured baseline, after a VLCD during 6 weeks and one year after biliopancreatic diversion. Insulin resistance was evaluated by Homeostasis Model Assessment (HOMA) index. RESULTS: After excluding diabetic patients, 58 patients were studied. HOMA index classified 63.8% of them as insulin resistant (IR). Serum baseline levels of inflammatory cytokines were not significantly different between IR and insulinsensitive (IS) patients but, regarding lymphocyte subpopulations, Natural Killer (NK) cells were higher in IR patients [(305.0 (136.7) vs. 235.0 (80.7) cells/µL, p=0.047]. NK cells showed a significant positive correlation with HOMA index (r=0.484, p=0.000) and with the carbohydrate content of the diet (r=0.420, p=0.001). After VLCD, NK cells significantly decreased, but only in IR patients and in those losing more than 10% of their initial weight. After biliopancreatic diversion, total and CD8 T Lymphocytes, B lymphocytes and NK cells also decreased but only in IR individuals. CONCLUSION: NK cells are significantly increased in IR severely obese people in respect to IS, suggesting a slightly different immune status in these patients with a probable dietary relationship. Weight loss could reverse this increase either after VLCD or after bariatric surgery.

[Effects of preoperative weight loss with a very low calorie diet (VLCD) on weight loss after biliopancreatic diversion in patients with severe obesity]. / Efectos de la pérdida de peso mediante una dieta muy baja en calorías (VLCD) sobre la pérdida de peso tras derivación biliopancreática en pacientes con obesidad severa.

BACKGROUND: Weight loss before bariatric surgery, achieved by means of a very low calorie diet (VLCD) has been recently reported to be related to a lower rate of postoperative complications. However, it is controversial if preoperative weight loss after VLCD could improve postoperative weight loss. AIMS: To assess the effectiveness of a preoperative VLCD for 6 weeks in weight loss one year after bariatric surgery. To evaluate the changes obtained in anthropometric measures and biochemical parameters after VLCD. METHODS: Prospective uncontrolled study including severely obese patients undergoing biliopancreatic diversion in our Obesity Unit in 2008-2010. Patients included followed a VLCD providing 840 kcal and 60 g of protein (Optisource®). Descriptive data are presented as mean (standard deviation) and after checking a normal distribution is followed, they were analyzed by Student s T test, ANOVA or Pearson correlation. RESULTS: We evaluated 107 obese patients, 43.5 (10.2) years-old, 72% women, with initial weight 122.4 (18.6) Kg and BMI 46.8 (5.5) kg/m(2). 24.5% of them lost more than 10 % of initial weight and 73.5% more than 5% after following VLCD. Mean percentage of excess weight loss (% PSP) one year after surgery was 59.6 (13.4)%, and although it was higher for those patients losing more weight after VLCD, a significant correlation was not found: those who lost more than 5% showed %PSP 59.5 (13.8) % after twelve months and 68.4 (16.2) % of percentage of excess BMI loss (%PEIMC), vs 57,9 (13,1) % and 68.5 (16.6) % if they didn t lose that amount of weight. Those patients losing more than 10% achieved %PSP 63.3 (13.7) and %PEIMC 70.9 (14.7) vs 58.2 (14.0) y 67.7 (16.7) vs those not losing that amount. Significant correlations between preoperative loss with VLCD and %PSP or %PEIMC at 3,6,9 and 12 months were not found, and only %PSP 1 month after surgery correlated with %PSP after VLCD (r = 0.454, p = 0.003). CONCLUSIONS: Preoperative weight loss with VLCD in severely obese patients did not show to improve either %PSP or %PEIMC one year after bariatric surgery.

Introducción: Se ha comunicado recientemente que la reducción de peso previa a cirugía bariátrica mediante dieta muy baja en calorías (VLCD) durante 2 semanas supone menor tasa de complicaciones postoperatorias. Es debatido, sin embargo, si la pérdida de peso preoperatoria con VLCD puede favorecer pérdida de peso postoperatoria. Objetivos: Valorar la eficacia de una VLCD, seguida durante 6 semanas preoperatorias, en el descenso de peso conseguido al 2013 de la cirugía bariátrica. Evaluar los cambios en parámetros antropométricos y bioquímicos conseguidos con dicha dieta. Metodología: Estudio prospectivo no controlado en los pacientes obesos sometidos a derivación biliopancréatica en la Unidad de Obesidad de referencia en el periodo 2008-2010. Los pacientes recibieron durante 6 semanas previas a la intervención una VLCD que aportaba diariamente 840 kcal y 60 g de proteínas (Optisource®). Los datos descriptivos se presentan como media y desviación estándar (DS), y tras comprobar su distribución normal, fueron analizados mediante prueba t de Student, ANOVA o correlación de Pearson. Resultados: Fueron valorados 107 pacientes obesos, de 43,5 (10,2) 2013s, el 72 % fueron mujeres con peso inicial 122,4 (18,6) Kg e IMC de 46,8 (5,5) kg/m2. Un 24,5% perdieron más de 10 % de su peso inicial y un 73,5% más de 5% tras VLCD. La media de porcentaje pérdida de exceso de peso (% PSP) a los 12 meses de la intervención fue 59,6 (13,4)%, y aunque fue mayor en los pacientes que habían perdido peso con VLCD, no se asoció de forma significativa: aquellos pacientes con pérdida mayor de 5% perdieron a los 12 meses 59,5 (13,8)% de PSP y 68,4 (16,2) % de exceso de IMC (%PEIMC), frente a 57,9 (13,1) % y 68,5 (16,6) % si no conseguían esa pérdida. El grupo de pacientes con pérdida mayor de 10 % consiguió %PSP de 63,3 (13,7) y %PEIMC de 70,9 (14,7) vs 58,2 (14,0) y 67,7 (16,7) si no perdieron >10% del peso inicial. No se encontró correlación entre la pérdida preoperatoria con VLCD y %PSP ni de exceso de IMC (%PEIMC) a 3,6,9 y 12 meses, sólo el %PSP a 1 mes se correlacionó con %PSP con VLCD (r = 0,454, p = 0,003). Conclusiones: La pérdida de peso preoperatoria mediante VLCD en pacientes obesos mórbidos no hademostrado favorecer la pérdida de exceso de peso ni de exceso de IMC al 2013 de la cirugía bariátrica.

Efectos de la pérdida de peso mediante una dieta muy baja en calorías (VLCD) sobre la pérdida de peso tras derivación biliopancreática en pacientes con obesidad severa / Effects of preoperative weight loss with a very low calorie diet (VLCD) on weight loss after biliopancreatic diversion in patients with severe obesity

Introducción: Se ha comunicado recientemente que la reducción de peso previa a cirugía bariátrica mediante dieta muy baja en calorías (VLCD) durante 2 semanas supone menor tasa de complicaciones postoperatorias. Es debatido, sin embargo, si la pérdida de peso preoperatoria con VLCD puede favorecer pérdida de peso postoperatoria. 
Objetivos: Valorar la eficacia de una VLCD, seguida durante 6 semanas preoperatorias, en el descenso de peso conseguido al año de la cirugía bariátrica. Evaluar los cambios en parámetros antropométricos y bioquímicos conseguidos con dicha dieta. Metodología: Estudio prospectivo no controlado en los pacientes obesos sometidos a derivación biliopancréatica en la Unidad de Obesidad de referencia en el periodo 2008-2010. Los pacientes recibieron durante 6 semanas previas a la intervención una VLCD que aportaba diariamente 840 kcal y 60 g de proteínas (Optisource®). Los datos descriptivos se presentan como media y desviación estándar (DS), y tras comprobar su distribución normal, fueron analizados mediante prueba t de Student, ANOVA o correlación de Pearson. Resultados: Fueron valorados 107 pacientes obesos, de 43,5 (10,2) años, el 72 % fueron mujeres con peso inicial 122,4 (18,6) Kg e IMC de 46,8 (5,5) kg/m2. Un 24,5% perdieron más de 10 % de su peso inicial y un 73,5% más de 5% tras VLCD. La media de porcentaje pérdida de exceso de peso (% PSP) a los 12 meses de la intervención fue 59,6 (13,4)%, y aunque fue mayor en los pacientes que habían perdido peso con VLCD, no se asoció de forma significativa: aquellos pacientes con pérdida mayor de 5% perdieron a los 12 meses 59,5 (13,8)% de PSP y 68,4 and 71 (16,2) % de exceso de IMC (%PEIMC), frente a 57,9 (13,1) % y 68,5 (16,6) % si no conseguían esa pérdida. El grupo de pacientes con pérdida mayor de 10 % consiguió %PSP de 63,3 (13,7) y %PEIMC de 70,9 (14,7) vs 58,2 (14,0) y 67,7 (16,7) si no perdieron >10% del peso inicial. No se encontró correlación entre la pérdida preoperatoria con VLCD y %PSP ni de exceso de IMC (%PEIMC) a 3,6,9 y 12 meses, sólo el %PSP a 1 mes se correlacionó con %PSP con VLCD (r = 0,454, p = 0,003). Conclusiones: La pérdida de peso preoperatoria mediante VLCD en pacientes obesos mórbidos no ha demostrado favorecer la pérdida de exceso de peso ni de exceso de IMC al año de la cirugía bariátrica (AU)

Background: Weight loss before bariatric surgery, achieved by means of a very low calorie diet (VLCD) has been recently reported to be related to a lower rate of postoperative complications. However, it is controversial if preoperative weight loss after VLCD could improve postoperative weight loss. Aims: To assess the effectiveness of a preoperative VLCD for 6 weeks in weight loss one year after bariatric surgery. To evaluate the changes obtained in anthropometric measures and biochemical parameters after VLCD. Methods: Prospective uncontrolled study including severely obese patients undergoing biliopancreatic diversión in our Obesity Unit in 2008-2010. Patients included followed a VLCD providing 840 kcal and 60 g of protein (Optisource®). Descriptive data are presented as mean (standard deviation) and after checking a normal distribution is followed, they were analyzed by Student s T test, ANOVA or Pearson correlation. Results: We evaluted 107 obese patients, 43.5 (10.2) years-old, 72% women, with initial weight 122.4 (18.6) Kg and BMI 46.8 (5.5) kg/m2. 24.5% of them lost more than 10 % of initial weight and 73.5% more than 5% after following VLCD. Mean percentage of excess weight loss (% PSP) one year after surgery was 59.6 (13.4)%, and although it was higher for those patients losing more weight after VLCD, a significant correlation was not found: those who lost more than 5% showed %PSP 59.5 (13.8) % after twelve months and 68.4 (16.2) % of percentage of excess BMI loss (%PEIMC), vs 57,9 (13,1) % and 68.5 (16.6) % if they didn’t lose that amount of weight. Those patients losing more than 10% achieved %PSP 63.3 (13.7) and %PEIMC 70.9 (14.7) vs 58.2 (14.0) y 67.7 (16.7) vs those not losing that amount. Significant correlations between preoperative loss with VLCD and %PSP or %PEIMC at 3,6,9 and 12 months were not found, only %PSP 1 month after surgery correlated with %PSP after VLCD (r = 0.454, p = 0.003). Conclusions: Preoperative weight loss with VLCD in severely obese patients did not show to improve either %PSP or %PEIMC one year after bariatric surgery (AU)

One-year effectiveness of two hypocaloric diets with different protein/carbohydrate ratios in weight loss and insulin resistance / Efectividad a un año de dos dietas hipocalóricas con diferente proporción de proteínas y carbohidratos en la pérdida de peso y en la resistencia a la insulina

Background: The maintenance of weight loss may be influenced by the distribution of macronutrients in the diet and insulin sensitivity. Objective: The objective of the study was to evaluate the longterm effect of two hypocaloric diets with different protein/carbohydrate ratios in overweight and obese individuals either with insulin resistance (IR) or without insulin resistance (IS). Design: Prospective, randomized, clinical intervention study. Forty patients were classified as IR/IS after a 75 g oral glucose tolerance test and then randomized to a diet with either 40% carbohydrate/30% protein/30% fat (diet A) or 55% carbohydrate/15% protein/30% fat (diet B). Results: After one year of follow-up there was no difference in weight loss between diets A and B in each group, but the IS group maintained weight loss better than the IR group [-5.7 (3.9) vs. -0.6 (4.1); P = 0.04]. No differences were found in either Homeostasis Model Assessment (HOMA) or other metabolic glucose parameters except lower insulin at 120 minutes with diet A [21.40 (8.30) vs. 71.40 (17.11); P = 0.02]. Conclusions: The hypocaloric diets with different protein/carbohydrate ratios produced similar changes in weight. Insulin resistance may play a negative role in maintaining weight loss (AU)

Introducción: El mantenimiento de la pérdida de peso puede estar influido por la distribución de macronutrientes en la dieta y la sensibilidad a la insulina. Objetivo: El objetivo del estudio fue evaluar el efecto a largo plazo de dos dietas hipocalóricas con diferente distribución de proteínas y carbohidratos (HCO) en individuos con sobrepeso y obesos ya fuese con resistencia a la insulina (IR) o sin resistencia a la insulina (IS). Metodología: Estudio prospectivo, aleatorizado, de intervención clínica. Cuarenta pacientes fueron clasificados como IR / IS después de una prueba de tolerancia oral de 75 g de glucosa y luego asignados al azar a una dieta con 40% de HCO/ 30% proteína /30% grasa (dieta A) o el 55% HCO /15% proteína /30% grasa (dieta B). Resultados: Tras un año de seguimiento, no se observaron diferencias en la pérdida de peso entre las dietas A y B en cada grupo, pero el grupo IS mantuvo la pérdida de peso mejor que el grupo IR [-5,7 (3,9) vs -0,6 (4,1), p = 0,04]. No se encontraron diferencias en ninguno en el Homeostasis Model Assessment (HOMA) u otros parámetros metabólicos de glucosa excepto en una insulina inferior a los 120 minutos con la dieta A [21,40 (8,30) vs 71,40 (17,11), p = 0,02]. Conclusiones: Las dietas hipocalóricas con diferentes proporciones de proteínas y carbohidratos produjeron cambios similares en el peso. La resistencia a la insulina puede jugar un papel negativo en el mantenimiento de la pérdida de peso (AU)

Accuracy of ultrasound elastography in the diagnosis of thyroid cancer in a low-risk population.

OBJECTIVE: Stiffness has been associated to malignancy in prostate and breast, as well as thyroid. Ultrasound elastography objectively measures tissue elasticity, and previous studies have described it as a high sensitivity and specificity technique for the detection of malignant thyroid nodules in high-risk populations. The aim was to assess the accuracy of elastography in a population with low risk of malignancy. DESIGN AND PATIENTS: 128 consecutive patients with nodular goiter were recruited. Elastography and ultrasound-guided fine-needle aspiration were performed. When malignancy was suspected by citology, surgery was recommended. Thyroid nodules were classified by elastography according the criteria described by Ueno, and an alternative classification. Sensitivity, specificity, predictive values, and odds ratio were calculated. RESULTS: Most patients were female, aged 56.1 year, with single nodule (52.0%) or multinodular goiter (45.6%), and a few thyroiditis (2.4%). The majority of nodules were mostly elastic. Fine-needle aspiration found 86% of benign nodules, 9.3% of indeterminate, and 4.7% possibly malignant. After surgery, 3 malignant nodules were confirmed, all of them being papillary carcinomas. All the malignant nodules were mostly elastic, as well as 75% of indeterminate nodules. Low values of sensitivity and specificity were found for elastic nodules being benign and hard nodules malignant. CONCLUSION: In a low-risk population for thyroid cancer, elastography lacks accuracy for the diagnosis of malignant nodules.

Comparison of different body composition mesurements in severely obese patients in the clinical setting / Comparación de las diferentes medidas de la composición corporal en pacientes con obesidad grave en un contexto clínico

Background Aims: Body composition measurements seem to be not reliable enough in obese patients. Our aim was to compare single frequency-bioelectrical impedance (SF-BIA) analysis; foot-to-foot impedance meters (FFI) or upper body fat analysers (UBFA) and DXA (Dual-energy X-ray absorptiometry) in severely obese patients. Patients and methods: Cross-sectional study including 40 severely obese patients. Bioelectrical impedance was performed for SF-BIA (Holtain (H) and OMRON BF 500 (O500)), FFI (Tanita TBF-300 (T)) and UBFA (Omron BF 300 (O300)). DXA scans were performed using a Lunar iDXA. The data were analysed using Pearson's correlation and Bland Altman plots were also drawn to evaluate any agreements. Results: The percentage and total body fat values were 49.2% and 55.2 kg measured with DXA, 44.3%/53.4 kg with O300, 50.6%/58.3 kg with O500, 45.4%/55.4 kg with H and 49.1%/60.3 kg with T. The Holtain BIA showed the worst correlation with DXA for both %BF and FFM. Although the measurements of % body fat, fat mass and fat-free mass were significantly correlated with DXA, each method showed wide limits of agreement, although T was most closely correlated with DXA. Conclusion: Compared to DXA, FFI and UBFA could be useful for assessing body composition in severely obese people, although they appeared to underestimate %BF and FM and their limits of agreement were too wide (AU)

Introducción: La medida de la composición corporal parece no tener suficiente fiabilidad en los pacientes obesos. Nuestro objetivo fue comparar técnicas de impedancia monofrecuencia (SF-BIA), impedanciómetros de arco inferior (FFI) o de arco superior (UBFA) con densitometría (DXA) en pacientes con obesidad severa. Pacientes y métodos: Estudio transversal de 40 pacientes con obesidad severa. Se realizó medida de composición corporal mediante impedancia bioeléctrica realizada con dos instrumentos de medida de impedancia monofrecuencia (Holtain (H) y OMRON BF 500 (O500)), FFI (Tanita TBF-300 (T)) y UBFA (Omron BF 300 (O300)). La densitometría para composición corporal se llevó a cabo en un DXA Lunar iDXA. Se analizaron los datos mediante correlación de Pearson y se empleó el método de Bland Altman para evaluar los acuerdos entre técnicas. Resultados: Los valores absolutos y porcentajes grasa corporal fueron 49,2% y 55,2 kg medidos con DXA, 44,3%/53,4 kg con O300, 50,6%/58,3 kg con O500, 45,4%/55,4 kg con H y 49,1%/60,3 kg con T. El impedanciómetro tipo Holtain mostró la peor correlación con DXA, tanto para Porcentaje de grasa como masa libre de grasa. Aunque las medidas de porcentaje de grasa, masa grasa total y masa libre de grasa se correlacionaron con DXA de forma significativa, los límites de concordancia de cada método fueron demasiado amplios. T fue el método mejor correlacionado con DXA. Conclusión: En comparación con DXA, FFI y UBFA podrían ser útiles para valorar composición corporal en pacientes obesos severos, aunque teniendo en cuenta que parecen infraestimar %BF y FM y que sus límites de concordancia son bastante amplios (AU)

Comparison of different body composition measurements in severely obese patients in the clinical setting.

BACKGROUND AIMS: Body composition measurements seem to be not reliable enough in obese patients. Our aim was to compare single frequency-bioelectrical impedance (SF-BIA) analysis; foot-to-foot impedance meters (FFI) or upper body fat analysers (UBFA) and DXA (Dual-energy X-ray absorptiometry) in severely obese patients. PATIENTS AND METHODS: Cross-sectional study including 40 severely obese patients. Bioelectrical impedance was performed for SF-BIA (Holtain (H) and OMRON BF 500 (O500)), FFI (Tanita TBF-300 (T)) and UBFA (Omron BF 300 (O300)). DXA scans were performed using a Lunar iDXA. The data were analysed using Pearson's correlation and Bland Altman plots were also drawn to evaluate any agreements. RESULTS: The percentage and total body fat values were 49.2% and 55.2 kg measured with DXA, 44.3%/53.4 kg with O300, 50.6%/58.3 kg with O500, 45.4%/55.4 kg with H and 49.1%/60.3 kg with T. The Holtain BIA showed the worst correlation with DXA for both %BF and FFM. Although the measurements of % body fat, fat mass and fat-free mass were significantly correlated with DXA, each method showed wide limits of agreement, although T was most closely correlated with DXA. CONCLUSION: Compared to DXA, FFI and UBFA could be useful for assessing body composition in severely obese people, although they appeared to underestimate %BF and FM and their limits of agreement were too wide.

One-year effectiveness of two hypocaloric diets with different protein/carbohydrate ratios in weight loss and insulin resistance.

BACKGROUND: The maintenance of weight loss may be influenced by the distribution of macronutrients in the diet and insulin sensitivity. OBJECTIVE: The objective of the study was to evaluate the longterm effect of two hypocaloric diets with different protein/carbohydrate ratios in overweight and obese individuals either with insulin resistance (IR) or without insulin resistance (IS). DESIGN: Prospective, randomized, clinical intervention study. Forty patients were classified as IR/IS after a 75 g oral glucose tolerance test and then randomized to a diet with either 40% carbohydrate/30% protein/30% fat (diet A) or 55% carbohydrate/15% protein/30% fat (diet B). RESULTS: After one year of follow-up there was no difference in weight loss between diets A and B in each group, but the IS group maintained weight loss better than the IR group [-5.7 (3.9) vs. -0.6 (4.1); P = 0.04]. No differences were found in either Homeostasis Model Assessment (HOMA) or other metabolic glucose parameters except lower insulin at 120 minutes with diet A [21.40 (8.30) vs. 71.40 (17.11); P = 0.02]. CONCLUSIONS: The hypocaloric diets with different protein/carbohydrate ratios produced similar changes in weight. Insulin resistance may play a negative role in maintaining weight loss.

[Effect of nutritional support on survival in patients with amyotrophic lateral sclerosis]. / Efecto del soporte nutricional sobre la supervivencia en pacientes con esclerosis lateral amiotrófica.

INTRODUCTION: Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. METHODS: A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. RESULTS: There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38). CONCLUSIONS: The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.

[Changes on dietary habits of the late-breakfast in a school population]. / Modificación de los hábitos alimentarios del almuerzo en una población escolar.

BACKGROUND: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children. AIMS: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast. METHODS: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about "the importance of proper nutrition in school" focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency). RESULTS: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed. CONCLUSION: Dietary habits can be modified in a scholar population with an easy nutritional intervention.

Efecto del soporte nutricional sobre la supervivencia en pacientes con esclerosis lateral amiotrófica / Effect of nutritional support on survival in patients with amyotrophic lateral sclerosis

Introducción: La desnutrición influye en la morbimortalidad del paciente con ELA. La unidad de nutrición debe evaluar al paciente precoz y periódicamente ofreciendo las medidas necesarias en la evolución de la enfermedad. Métodos: Estudio retrospectivo de cohortes en el que se analizaron 46 pacientes con diagnóstico de ELA, de los cuáles 21 se encontraban en tratamiento nutricional. Se estudió la edad, forma de inicio de la enfermedad, fecha de entrada en protocolo nutricional, la colocación o no de PEG, y la supervivencia. Se realizó un test de Breslow comparando pacientes que estuvieron en protocolo nutricional respecto de aquellos que no recibieron terapia nutricional, y de aquellos que entraron antes en protocolo respecto de los que entraron después. Resultados: Existió un aumento en la mediana de super vivencia en los pacientes en tratamiento nutricional tanto en ELA bulbar (452 vs 55 días) como en ELA espinal(1.798 vs 357 días; p = 0,002). La mediana de retraso en el inicio de tratamiento nutricional en la ELA espinal fue de 557 días mientras que en la ELA bulbar fue de 230 días: en la ELA espinal los que entraron en protocolo nutricional antes de la mediana tuvieron una supervivencia de 325 días respecto a 181 días (p = 0,09); en la EL Abulbar los que entraron antes de la mediana tuvieron una supervivencia de 435 días respecto a 177 días (p = 0,38).Conclusiones: La entrada de los pacientes con ELA en un protocolo nutricional conlleva un aumento de la supervivencia. Existe una ventaja en la evolución en los pacientes que comienzan antes el tratamiento nutriciona (AU)

Introduction: Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. Methods: A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow c omparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. Results: There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55days) and in spinal ALS (1,798 vs 357 days) (p = 0.002).The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to177 days (p = 0.38).Conclusions: The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment (AU)

Modificación de los hábitos alimentarios del almuerzo en una población escolar / Changes on dietary habits of the late-breakfast in a school population

Introducción: La implantación de hábitos alimentarios saludables en la población infantil en el ámbito escolar y familiar es de gran importancia para la prevención de la obesidad infanto-juvenil. 
Objetivos: Conocer los hábitos de almuerzo de una población escolar, su prevalencia de sobrepeso y obesidad así como instaurar hábitos dietéticos saludables y educar nutricionalmente a ésta para mejorar las costumbres alimentarias a través de un almuerzo saludable. Métodos: Se realizó un estudio prospectivo de intervención en escolares. Se incluyeron niños de 10-13 años. El estudio se llevó a cabo en 3 fases: preintervención (valoración antropométrica y cuestionario de frecuencia de almuerzo y de alimentos consumidos), intervención (charlas formativas al profesorado y los padres sobre «la importancia de una correcta alimentación en el escolar», enfocadas en la trascendencia de una alimentación sana y equilibrada que incluyese un almuerzo saludable diariamente en el escolar y entrega del almuerzo durante dos semanas a los alumnos que incluía lácteos, fruta y bocadillo tradicional), postintervención (cuestionario de frecuencia de almuerzo y de alimentos consumidos). Resultados: La frecuencia de sobrepeso fue del 10,6% y de obesidad del 2,6%. Tras la intervención se produjo un incremento del 9,2% de individuos que almorzaban y una modificación de los alimentos consumidos. Conclusión: La modificación de los hábitos dietéticos del almuerzo de los escolares es posible con campañas sencillas de intervención nutricional (AU)

Background: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children. Aims: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast. Methods: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about «the importance of proper nutrition in school» focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency). Results: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed. Conclusion: Dietary habits can be modified in a scholar population with an easy nutritional intervention (AU)

[Impact of nutritional treatment in the evolution of inflammatory bowel disease]. / Impacto de la nutrición en la evolución de la enfermedad inflamatoria intestinal.

Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary treatment for the disease. Some nutrients could induce a low antigenic stimuli, regulate inflammatory and immunological responses and stimulate intestinal mucosal trophism. Present available evidence supports enteral nutrition in Crohn's disease as a primary treatment if treatment with steroids is not possible (failure or contraindication) (grade of recommendation A) or either combined treatment with drugs in malnourished patients or those with inflammatory bowel stenosis. In those patients with sustained clinical remission, no benefit of either enteral nutrition or supplements in the absence of nutritional deficits has been shown. Elemental or modified formula (glutamine, omega 3 fatty acids) could not be recommended. In ulcerative colitis, nutritional influence over the activity of the disease has not been shown, although there are some promising results regarding enteric coated W3 fatty acids and a possible role for probiotics. In the treatment and prevention of pouchitis, there could be a role for probiotics (VSL#3). Nutritional treatment should be considered an integral component in the Management of patients with inflammatory bowel disease.