Techno-economic assessment of decentralized polishing schemes for municipal water reclamation and reuse in the industrial sector in costal semiarid regions: The case of Barcelona (Spain).

This study demonstrates the techno-economic reliability of an innovative fit-for-use treatment train to boost municipal reclaimed water reuse fore industrial uses in the Barcelona Metropolitan Area (BMA). The relatively high conductivity (2090 µS/cm) and hardness (454 mg/L) of reclaimed water in the BMA (e.g. Water Reclamation Plant (WRP) of El Baix Llobregat, Barcelona, Spain), together with the restrictive water quality demands in industrial uses, claims for the implementation of advanced reclamation schemes based on desalination technologies such as reverse osmosis (RO). The study assesses the benefits of two potential pre-treatments of the RO stage: (i) ultrafiltration (UF) or (ii) an innovative high-performance nano-structured polymeric adsorbent (CNM); in which a permeability decline of 5% was observed when CNM was used as a pre-treatment, while a stable permeability of RO was found when was fed by the UF effluent. On the other hand, generic cost curves have been calculated for the technologies evaluated and were applied to estimate capital and operational expenditures (CAPEX and OPEX) for the scale-up in three different industrial sites (e.g., chemical, waste management and electro-coating industries). The economic assessment indicates that the use of municipal reclaimed water is economically competitive in front of the use of tap water in the BMA, providing savings between 0.13 and 0.52 €/m3 for the waste management industry and between 0.49 and 0.98 €/m3 for the electrocoating industry. On the other hand, the use of groundwater in one of the industrial sites and its relatively low cost implied that, although it is necessary a RO, the current cost of water is significantly lower.

Integration of membrane distillation as volume reduction technology for in-land desalination brines management: Pre-treatments and scaling limitations.

Management of in-land reverse osmosis (RO) desalination brines generated from surface brackish waters is a current challenge. Among the different near-Zero and Zero Liquid Discharge (ZLD) alternatives, Membrane Distillation (MD), in which the transport of water is thermally driven, appears as an attractive technology if a residual heat source is available. The aim of this study was to identify the limits of Direct Contact MD (DCMD) pre-treatments such as acidification and aeration, or the combination of both to quantify the scaling reduction potential when treating a RO brine from surface brackish water. Experimental data were used to evaluate the effectiveness of DCMD to achieve the highest concentration factors, depending on the chosen pre-treatment. Additionally, an economic analysis of the operational cost, taking as case study a site where the current management of the brine is the discharge to the sea, was also carried out. Results showed that pre-treatments enhanced MD performance by increasing the concentration factor achieved and highest volume reductions (about 3 times) were reached with the combination of acidification and aeration pre-treatments. Both processes reduced the precipitation potential of CaCO3(s) by reducing the total inorganic carbon (>90%); however, CaSO4·2H2O(s) precipitated. Results also indicated that even if a waste heat source is available, brine disposal into the sea is the cheapest option, while ZLD alternatives were not attractive in the current regulatory framework since their cost was higher than the discharge to the sea. Other options related to the Minimal Liquid Discharge may be more economically attractive.

Comparison of perinatal outcomes for all modes of second stage delivery in obstetric theatres: a retrospective observational study.

OBJECTIVE: To compare rates of vaginal delivery and adverse outcomes of instrumental delivery trials in obstetric theatre compared to primary emergency full dilation caesarean section. DESIGN: Retrospective cohort study. SETTING: University teaching hospital. POPULATION: Women with singleton, non-anomalous, pregnancy undergoing instrumental delivery trial in obstetric theatre. METHODS: Data were collected from consecutive cases during 2014 until 2018 using clinical records. Multivariate regression analysis was used comparing outcomes per first delivery method. MAIN OUTCOME MEASURES: Primary outcome was completion of vaginal delivery between all methods of instrumental delivery. Secondary outcome was a composite of immediate perinatal adverse outcomes for instrumental delivery modes and primary full dilation caesarean section. RESULTS: From 971 deliveries analysed: ventouse delivery was significantly less likely to achieve vaginal delivery compared with Keilland's forceps delivery (odds ratio [OR] 0.42, 95% CI 0.22-0.79). Once confounding factors were adjusted for, adverse outcome rates were less frequent in the Keilland's forceps group than with primary full dilation caesarean section (OR 0.37, 95% CI 0.16-0.81); however, the receiver operating characteristic curve produced from this model demonstrated a low predictive value (AUC 0.64). CONCLUSIONS: Attempting instrumental delivery in delivery suite theatre, as an alternative to primary emergency full dilation caesarean section, is both reasonable and safe. In this study, ventouse delivery performed poorly in comparison with other modes of instrumental delivery. Further research in the form of randomised controlled trials to identify the optimal mode of second stage delivery is paramount. TWEETABLE ABSTRACT: Instrumental delivery trials in theatre are safe but use of ventouse was associated with a higher rate of failure.

Coding of COPD Exacerbations and the Implications on Clinical Practice, Audit and Research.

International Classification of Disease 10 (ICD-10) codes record hospital admissions. We aimed to measure the accuracy of COPD exacerbation (ECOPD) codes and examine coding practices for COPD exacerbation.Prospective screening and ICD-10 codes were used to identify potential ECOPD within the DECAF internal validation cohort. Two coding searches were performed. The first search identified patients with an ECOPD discharge code, and a second, broad search was developed to identify all clinically confirmed ECOPD.717 of 1,122 (64%) patients with an ECOPD code had confirmed ECOPD. Common reasons for misclassification in the 405 patients who did not have an ECOPD included: lack of obstructive spirometry to diagnose COPD; and hospital admission due to progressive malignancy, asthma or cardiovascular disease. The broad search identified an additional 297 patients with ECOPD missed by the ECOPD codes. The vast majority of this group had pneumonia complicating ECOPD.ECOPD codes are insufficiently reliable to identify patients with clinically confirmed ECOPD for the purposes of audit or research. Search strategies should include pneumonia codes, specialist review of medical notes and spirometry confirmation of COPD.

Techno-economic evaluation and comparison of PAC-MBR and ozonation-UV revamping for organic micro-pollutants removal from urban reclaimed wastewater.

The presence of sewage-borne Organic Micro-Pollutants (OMP) in Wastewater Treatment Plants (WWTP) effluents represents an increasing concern when water is reclaimed for irrigation or even indirect potable reuse. During eighteen months, an innovative hybrid water reclamation scheme based on a Membrane Biological Reactor (MBR) enhanced with Powder Activated Carbon (PAC) was operated at pilot-scale (70 m3/d) in order to compare it with state-of-the art Wastewater Reclamation System (WWRS) also revamped with a final step of ozonation-UV. Removal of persistent OMP, water quality and treatment costs were evaluated and compared for the different treatment schemes. OMP removal efficiency results for the different schemes concluded that established technologies, such as physico-chemical and filtration systems as well as MBR, do not remove significantly (>15%) the most recalcitrant compounds. The upgrading of these two systems through the addition of ozonation-UV step and PAC dosing allowed improving average recalcitrant OMP removal to 85 ±â€¯2 and 75 ±â€¯5%, respectively. In term of costs, PAC-MBR represents an increase of 37% of costs regarding conventional systems but presents improvements of 50% reduction in space and water quality. On the other hand, ozonation requires up to a 15% increase of foot-print; nevertheless, represents lower costs and lower carbon footprint. Ozonation-UV seems to be the best option for upgrading existing facilities, while PAC-MBR should be considered when space represents a critical limitation and produced water is reused for high water quality purposes.

[Prevalence of human papillomavirus in Spanish women from a population screening program]. / Prevalencia de virus del papiloma humano en mujeres españolas de un programa de cribado poblacionales de riesgo.

OBJECTIVE: The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain). METHODS: Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014. RESULTS: 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population. CONCLUSIONS: Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns.

The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD.

BACKGROUND: One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. METHODS: In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. RESULTS: Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. CONCLUSIONS: The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. TRIAL REGISTRATION NUMBER: UKCRN ID 14214.

Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.

BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported. RESULTS: A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002). CONCLUSIONS: At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.

Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD.

BACKGROUND: Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools. METHODS: The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve. RESULTS: In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality. CONCLUSIONS: DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0-1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3-6) for escalation planning or appropriate early palliation. TRIAL REGISTRATION NUMBER: UKCRN ID 14214.

Aß promotes VDAC1 channel dephosphorylation in neuronal lipid rafts. Relevance to the mechanisms of neurotoxicity in Alzheimer's disease.

Voltage-dependent anion channel (VDAC) is a mitochondrial protein abundantly found in neuronal lipid rafts. In these membrane domains, VDAC is associated with a complex of signaling proteins that trigger neuroprotective responses. Loss of lipid raft integrity may result in disruption of multicomplex association and alteration of signaling responses that may ultimately promote VDAC activation. Some data have demonstrated that VDAC at the neuronal membrane may be involved in the mechanisms of amyloid beta (Aß)-induced neurotoxicity, through yet unknown mechanisms. Aß is generated from amyloid precursor protein (APP), and is released to the extracellular space where it may undergo self-aggregation. Aß aggregate deposition in the form of senile plaques may lead to Alzheimer's disease (AD) neuropathology, although other pathological hallmarks (such as hyper-phosphorylated Tau deposition) also participate in this neurodegenerative process. The present study demonstrates that VDAC1 associates with APP and Aß in lipid rafts of neurons. Interaction of VDAC1 with APP was observed in lipid rafts from the frontal and entorhinal cortex of human brains affected by AD at early stages (I-IV/0-B of Braak and Braak). Furthermore, Aß exposure enhanced the dephosphorylation of VDAC1 that correlated with cell death. Both effects were reverted in the presence of tyrosine phosphatase inhibitors. VDAC1 dephosphorylation was corroborated in lipid rafts of AD brains. These results demonstrate that Aß is involved in alterations of the phosphorylation state of VDAC in neuronal lipid rafts. Modulation of this channel may contribute to the development and progression of AD pathology.

Programas de rehabilitación en centros de mayores: situación actual y propuesta de actuación / Rehabilitation programs in residential homes: current situation and proposed action

Objetivo. El objetivo del estudio es conocer la situación actual de los centros de mayores en nuestra ciudad en cuanto al campo de la rehabilitación se refiere y, en función de los resultados, plantear una propuesta de actuación desde una Unidad de Gestión Clínica (UGC) de Rehabilitación. Material y método. Estudio descriptivo transversal mediante encuesta telefónica a los centros geriátricos de la ciudad de Sevilla con recogida de ítems relacionados con las características del centro, terapias físicas que desarrollan y la adquisición del material ortopédico. Resultados. Contactamos telefónicamente con 23 centros, con capacidad media de 49,3 residentes y una ocupación media del 81,5%. El 35,6% de los residentes era dependiente para las actividades básicas de la vida diaria. El 86% de los centros realizaba programas grupales de rehabilitación, de ellos en solo el 17% se realizaba tratamiento fisioterápico individualizado y en el 13% terapia ocupacional y fisioterapia. El material ortésico era prescrito en la mayoría de los casos por el médico de Atención Primaria. Tras este análisis proponemos un plan de actuación que favorezca la implicación de una UGC de Rehabilitación en el desarrollo de estos programas de forma homogénea en todos los centros, así como la prescripción ortésica. Conclusiones. En la mayoría de los centros de mayores de nuestra ciudad se realizan programas de terapia física grupal sin adecuación al grado de discapacidad del residente, observando heterogeneidad en cuanto al tipo y coordinación del tratamiento que se realiza y de la prescripción ortopédica (AU)

Aim. The aim of the study is to determine the current status of nursing homes in our city as regards rehabilitation and, depending on the results, to make a proposal for action in a Clinical Management Rehabilitation Unit. Material and methods. A descriptive cross-sectional telephone survey of nursing homes in the city of Seville, collecting items related to the characteristics of these homes, physical therapy techniques used and the purchase of orthopaedic equipment. Results. We contacted, by telephone, 23 centres with a mean capacity 49.3 residents and a mean occupancy of 81.5%. Over one third (35.6%) of residents were dependent for basic activities of daily living. Group rehabilitation programs were performed in 86% of the centres, with only 17% of them having individualised physical therapy and 13% with occupational therapy and physiotherapy. The orthopaedic material was acquired by a doctor in most cases. After this analysis an action plan is proposed to promote the involvement of a Management Units of Rehabilitation Clinics in the uniform development of these programs and the acquisition of orthopaedic equipment in all centres. Conclusions. Physical therapy programs in Seville are carried out without any adjustment to the degree of disability of the residents, with variability in the type and coordination of treatment and orthopaedic prescriptions (AU)

Profound bradycardia associated with NIV removal.

A patient with lower-limb onset ALS presented with a one-month history of vasovagal episodes and a one-week history of cough productive of green sputum and lethargy. She was drowsy and in acute on chronic type-two respiratory failure. She responded to non-invasive ventilation, however she suffered recurrent episodes of profound bradycardia on removal of the mask, which gradually resolved over ten days. We have reviewed the literature and offer a potential explanation for these events.

Characterisation of seeds of a C4 phosphoenolpyruvate carboxylase-deficient mutant of Amaranthus edulis.

Seeds from the C(4) plant Amaranthus edulis were studied as part of the characterisation of a mutant (designated LaC(4) 2.16), which contains reduced amounts (5% of wild type) of the photosynthetic leaf form of phosphoenolpyruvate carboxylase (PEPC). On a per seed basis, the amount of PEPC activity was not significantly altered, while the weight and protein content of the mutant seeds were 34% lower than that of the wild type. Western gel blot analysis detected two PEPC polypeptides with molecular masses of 105 kDa (minor) and 100 kDa (major). The determination of in vitro phosphorylation in reconstituted assays revealed the presence of both calcium-dependent and calcium-independent PEPC-kinase activities in protein extracts of wild-type and mutant seeds. However, PEPC proteins were phosphorylated in dry seeds, and PEPC phosphorylation did not occur in vivo during seed imbibition in the presence of (32) P-phosphate. In contrast, (32) P-phosphate was incorporated into a range of proteins in wild-type seeds, but not in mutant seeds. In addition, ATP content was much reduced in germinating mutant seeds and this did not increase following the supply of phosphate. Collectively, these data suggest that the deficiency in C(4) PEPC in mutant A. edulis leaves has no effect on C(3) -type PEPC content and phosphorylation state in seeds, but causes impairment of energy production, thereby accounting for the reduced germination of the mutant.

Hydatid cysts of the lung.

Cystic hydatid disease is a zoonosis caused by infection with the larval cysts of Echinococcus granulosus. Cysts commonly develop in the liver and lungs. Diagnosis in non-endemic regions is often delayed due to a failure to consider hydatidosis. This results from a non-specific presentation and a failure to record an accurate geographical history. The diagnosis requires integrating an appropriate index of suspicion with correct interpretation of imaging and serological tests. In our case, a 44-year-old woman of Yemeni origin presented to a UK hospital with chest pain, pruritus and weight loss. Following detection of pulmonary nodules, a CT-guided biopsy was carried out to exclude malignancy. Iatrogenic cyst rupture precipitated an acute eosinophilic pleurisy. Cystic hydatid disease was subsequently diagnosed following strongly positive hydatid serological tests. This case illustrates the importance of considering diagnoses appropriate to an individual's geographical history particularly in the context of rising immigration and foreign travel.

Perfil lipídico y riesgo cardiovascular en mujeres pre y postmenopáusicas / Lipid profile and cardiovascular risk in pre and postmenopausal women

Objetivo: Describir el perfil lipídico de las mujeres pre y postmenopáusicas y estimar el riesgo cardiovascular (RCV) por el Score de Framingham (SF) y circunferencia de la cintura (CC) en ambas etapas biológicas. (pre y postmenopausicas). Metodología: Muestra por conveniencia de mujeres de 40 a 65 años que concurrieron por primera vez a la consulta nutricional, de enero de 2005 a junio de 2006. Variables: Perfil lipídico (COLT>200, HDL<50, LDL>100 y TG>150), Indice aterogénico (IA)>4,5, Categorías de RCV según Score de Framingham (I, II y III). Se realizó medición directa de Peso, Talla y CC (>80 cm y >88 cm), según técnicas estandarizadas. El análisis estadístico se realizó con el programa Epi 6.04d, con intervalo de confianza (IC) del 95%. Se calculó la significación estadística por Chi2 para las variables correspondientes con valor p<0,05. Resultados: Se incluyeron 216 mujeres, 34,7% premenopáusicas (PM) con edad promedio de 47 ± 4,6 años y 65,3 % postmenopáusicas (PoM) con edad promedio de 57 ± 4,7 años. La edad promedio de menopausia fue de 48 ± 5 años. El 34,6% de PM (IC: 24,5-45,9) presentó IMC = 27,3 y el 70,6% (IC: 59,6-80,1) una CC >80 cm. El 56% de PoM (IC: 47,7-64,0) presentó IMC = 27,3 y 80,8 % (IC: 73,7- 86,7) CC > 80cm. El 100% de la muestra se encontró en Categoría III de RCV según SF. La mayor prevalencia de parámetros lipídicos alterados se observó en el Colesterol total y LDL-C, sin diferencias significativas al comparar ambas etapas biológicas. Conclusiones: Mientras por medición de CC la mayoría de la muestra presenta riesgo aumentado, por determinación del SF, la totalidad presentó bajo riesgo cardiovascular proyectado a 10 años.(AU)

Peso relativo de factores de riesgo para síndrome metabólico en mujeres pre y postmenopáusicas / Relative weight of risk factors for metabolic syndrome in pre and postmenopausal women

Introducción: a partir de la menopausia la disminución estrogénica parece actuar incrementando la presencia de factores de riesgo para el Sindrome Metabólico (SM). Objetivo: Estimar peso relativo de cada factor de riesgo para el Síndrome Metabólico según el Panel de Tratamiento de Adultos III (ATP III) y Federación Internacional de Diabetes (IDF) en mujeres pre y postmenopáusicas que concurren a Consultorios Asociados de Endocrinología en la Ciudad Autónoma de Buenos Aires. Metodología: Diseño transversal. La muestra estuvo integrada por mujeres pre y postmenopáusicas que concurrieron por primera vez a la consulta nutricional. Variables: Factores de Riesgo para SM según ATP III e IDF (obesidad abdominal, hipertensión arterial, hiperglucemia en ayunas, hipertrigliceridemia y HDL bajo). Resultados: Se incluyeron 216 mujeres. Hubo asociación estadística significativa para ambos métodos entre SM y cada uno de los Factores de Riesgo. Al considerar los criterios de la IDF, el odds ratio (OR) de padecer SM resultó de 13 (IC95%: 6,3-26,8) con triglicéridos = 150 mg/dl. Si en cambio se tiene en cuenta una glucemia basal = 100 mg/dl, el OR resultó de 12,7 (IC 95%: 6,3-25,7). Al considerar los criterios del ATP III, la mayor asociación se observó con la circunferencia de la cintura y en segundo lugar también con la glucemia alterada en ayunas. Conclusiones: El mayor peso relativo de los diferentes factores de riesgo para Síndrome Metabólico en la muestra de pre y postmenopáusicas, lo presentaron la hipertrigliceridemia y la hiperglucemia en ayunas para IDF, y la circunferencia de la cintura alterada y la hiperglucemia en ayunas para ATP III.(AU)

Perfil lipídico y riesgo cardiovascular en mujeres pre y postmenopáusicas / Lipid profile and cardiovascular risk in pre and postmenopausal women

Objetivo: Describir el perfil lipídico de las mujeres pre y postmenopáusicas y estimar el riesgo cardiovascular (RCV) por el Score de Framingham (SF) y circunferencia de la cintura (CC) en ambas etapas biológicas. (pre y postmenopausicas). Metodología: Muestra por conveniencia de mujeres de 40 a 65 años que concurrieron por primera vez a la consulta nutricional, de enero de 2005 a junio de 2006. Variables: Perfil lipídico (COLT>200, HDL<50, LDL>100 y TG>150), Índice aterogénico (IA)>4,5, Categorías de RCV según Score de Framingham (I, II y III). Se realizó medición directa de Peso, Talla y CC (>80 cm y >88 cm), según técnicas estandarizadas. El análisis estadístico se realizó con el programa Epi 6.04d, con intervalo de confianza (IC) del 95%. Se calculó la significación estadística por Chi2 para las variables correspondientes con valor p<0,05. Resultados: Se incluyeron 216 mujeres, 34,7% premenopáusicas (PM) con edad promedio de 47 ± 4,6 años y 65,3 % postmenopáusicas (PoM) con edad promedio de 57 ± 4,7 años. La edad promedio de menopausia fue de 48 ± 5 años. El 34,6% de PM (IC: 24,5-45,9) presentó IMC = 27,3 y el 70,6% (IC: 59,6-80,1) una CC >80 cm. El 56% de PoM (IC: 47,7-64,0) presentó IMC = 27,3 y 80,8 % (IC: 73,7- 86,7) CC > 80cm. El 100% de la muestra se encontró en Categoría III de RCV según SF. La mayor prevalencia de parámetros lipídicos alterados se observó en el Colesterol total y LDL-C, sin diferencias significativas al comparar ambas etapas biológicas. Conclusiones: Mientras por medición de CC la mayoría de la muestra presenta riesgo aumentado, por determinación del SF, la totalidad presentó bajo riesgo cardiovascular proyectado a 10 años.

Peso relativo de factores de riesgo para síndrome metabólico en mujeres pre y postmenopáusicas / Relative weight of risk factors for metabolic syndrome in pre and postmenopausal women

Introducción: a partir de la menopausia la disminución estrogénica parece actuar incrementando la presencia de factores de riesgo para el Sindrome Metabólico (SM). Objetivo: Estimar peso relativo de cada factor de riesgo para el Síndrome Metabólico según el Panel de Tratamiento de Adultos III (ATP III) y Federación Internacional de Diabetes (IDF) en mujeres pre y postmenopáusicas que concurren a Consultorios Asociados de Endocrinología en la Ciudad Autónoma de Buenos Aires. Metodología: Diseño transversal. La muestra estuvo integrada por mujeres pre y postmenopáusicas que concurrieron por primera vez a la consulta nutricional. Variables: Factores de Riesgo para SM según ATP III e IDF (obesidad abdominal, hipertensión arterial, hiperglucemia en ayunas, hipertrigliceridemia y HDL bajo). Resultados: Se incluyeron 216 mujeres. Hubo asociación estadística significativa para ambos métodos entre SM y cada uno de los Factores de Riesgo. Al considerar los criterios de la IDF, el odds ratio (OR) de padecer SM resultó de 13 (IC95%: 6,3-26,8) con triglicéridos = 150 mg/dl. Si en cambio se tiene en cuenta una glucemia basal = 100 mg/dl, el OR resultó de 12,7 (IC 95%: 6,3-25,7). Al considerar los criterios del ATP III, la mayor asociación se observó con la circunferencia de la cintura y en segundo lugar también con la glucemia alterada en ayunas. Conclusiones: El mayor peso relativo de los diferentes factores de riesgo para Síndrome Metabólico en la muestra de pre y postmenopáusicas, lo presentaron la hipertrigliceridemia y la hiperglucemia en ayunas para IDF, y la circunferencia de la cintura alterada y la hiperglucemia en ayunas para ATP III.

Correlación entre el descenso del peso corporal y la disminución de la circunferencia de la cintura / Correlation between the reduction of the body weight and the reduction of the waist circumference

Introducción: Actualmente la obesidad abdominal representa un problema alarmante, tanto en clínica como en salud pública. La simple medida de la circunferencia de la cintura (CC) fue una de las variables antropométricas que ha correlacionado mejor con la cantidad de tejido adiposo visceral. Objetivos: Estimar la correlación entre el descenso del peso corporal y la disminución de la CC según el sexo, la edad, el peso corporal y tiempo transcurrido de tratamiento dietoterápico. Métodos: Diseño analítico de correlación, prospectivo y longitudinal. Muestra por conveniencia de 388 adultos que concurrieron a la consulta nutricional para buscar el descenso de peso (89,2% femenino con edad promedio de 46,4 + 13,7 años y 10,8% masculino con edad promedio de 43,4 + 14,2 años). Se realizó medición directa de Peso, Talla y CC según técnicas estandarizadas. Variable dependiente: disminución de la CC (en cm). Independientes: Descenso del peso corporal (en Kg). Edad (> 20 años). Sexo. IMC. Tiempo transcurrido de tratamiento dietoterápico (en días). El análisis estadístico se realizó con programa SPSS 11.5, con intervalo de confianza (IC) del 95%. Se utilizó coeficiente de correlación (Pearson) para las variables correspondientes con valor p<0,05. Resultados: Se obtuvo una fuerte asociación entre el descenso del peso corporal y el descenso de la CC (r: 0.747, p=0.001), no encontrándose que este valor fuera influenciado por la edad, el tiempo transcurrido en tratamiento y sexo, pero sí por el IMC. Conclusión: Es alta la correlación entre el descenso del peso corporal y la disminución de la CC en la muestra estudiada. Resulta indistinto en el monitoreo nutricional, medir primero cintura y luego el peso corporal, o a la inversa(AU)

Background: Nowadays, the abdominal obesity represents an alarming problema, as much in clinic as in public health. The simple measurement of the waist circumference (WC) was one of the anthropometrics variables that it has better correlated with the amount of visceral fat. Objectives: To estimate the correlation between the reduction of the corporal weight and the reduction of the waist circumference according to sex, age, weight and passed time on diet treatment. Methods: Analytical design; longitudinal, correlation, and who concurred to nutritional assessment for weight reduction (women 89.2%, average 46,4 +/- 14,2 uears). Direct measurement of weight, stature and WC were made according to standardized technique. Dependent variable: Reduction of the waist circumference (cm). Independent: Reduction of the weight (kg); Age (> 20 years); Sex; IMC; Passe time on diet treatment (days). The information was statistically analyzed by the SPSS 11.5 program and estimated with safety level of 95%. Coefficient of correlation (Pearson) was used for the corresponding variables with values p<0,05. Results: A strong association between body weight and decrease the decline in CC (r: 0,747, p=0,001), not found that this value was influenced by ag, time spent in treatment and sex, but by the BMI. Conclusion: It is high correlation between the decrease in body weight and decreasing the CC in the sample studied. It is indistintic the nutricional monitoring, measuring waist and then the first body weight, or viceversa(AU)