Monitorización ambulatoria de la presión arterial en adultos y población pediátrica. Una revisión narrativa / Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review

La hipertensión arterial (HTA) se ha convertido en un factor de riesgo central para el desarrollo de enfermedades cardiovasculares (CV), lo que subraya la importancia de su diagnóstico preciso. Numerosos estudios han establecido una estrecha relación entre los valores elevados de la presión arterial sistólica (PAS) y diastólica (PAD) y un incremento en el riesgo de padecer algún evento cardiovascular (ECV). Tradicionalmente, las mediciones de la presión arterial (PA) realizadas en entornos clínicos han sido el principal método para diagnosticar y evaluar la HTA. No obstante, en los últimos años, se ha reconocido que las mediciones de la PA obtenidas fuera del ambiente clínico, mediante la automedida de la presión arterial (AMPA) y la monitorización ambulatoria de la presión arterial (MAPA), ofrecen una perspectiva más realista de la vida cotidiana de los pacientes y, por lo tanto, brindan resultados más fiables. Dada la evolución de los dispositivos médicos, los criterios diagnósticos y la creciente relevancia de componentes de la MAPA en la predicción de ECV, se requiere una actualización integral que sea práctica para la clínica. Esta revisión tiene como objetivo proporcionar una actualización de la MAPA, enfocándose en su importancia en la evaluación de la HTA. Además, se analizarán los umbrales diagnósticos, los distintos fenotipos según el ciclo circadiano y las recomendaciones en diferentes poblaciones, asimismo, se ofrecerán sugerencias concretas para la implementación efectiva de la MAPA en la práctica clínica, lo que permitirá a los profesionales de la salud tomar decisiones fundamentadas y mejorar la atención de sus pacientes.(AU)

Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients’ daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.(AU)

Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Modelos experimentales murinos en la esclerosis lateral amiotrófica. Puesta al día / Murine experimental models of amyotrophic lateral sclerosis: An update

Introducción: La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa, progresiva y de etiología desconocida caracterizada por la degeneración de motoneuronas superiores e inferiores. Aproximadamente el 90% de los casos de ELA son esporádicos, mientras que el 10% restante se consideran familiares. Independientemente de si son familiares o esporádicas, los pacientes desarrollan una debilidad progresiva, atrofia muscular con espasticidad y contracturas. Por lo general, la esperanza de vida en los pacientes de ELA es de 2 a 5 años. Desarrollo: Los modelos in vivo han ayudado a explicar la etiología y la patogénesis, así como los mecanismos de la ELA. Sin embargo, estos mecanismos no están del todo esclarecidos aún, por lo que los modelos experimentales son fundamentales para continuar con el estudio de los mismos, así como para la búsqueda de posibles dianas terapéuticas. A pesar de que el 90% de los casos son esporádicos, la mayoría de los modelos utilizados hasta la actualidad para estudiar la patogénesis están basados en las mutaciones genéticas asociadas a la enfermedad familiar, lo que provoca que la patogénesis de la ELA esporádica no sea aún conocida. Por tanto, sería fundamental el estudio de la enfermedad en modelos basados en la enfermedad esporádica. Conclusión: En el presente artículo se han revisado los principales modelos experimentales, tanto genéticos como esporádicos, utilizados en el estudio de esta enfermedad, enfocándonos en los que se han desarrollado utilizando el roedor como plataforma experimental.(AU)

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease whose aetiology is unknown. It is characterised by upper and lower motor neuron degeneration. Approximately 90% of cases of ALS are sporadic, whereas the other 10% are familial. Regardless of whether the case is familial or sporadic, patients will develop progressive weakness, muscle atrophy with spasticity, and muscle contractures. Life expectancy of these patients is generally 2–5 years after diagnosis. Development: In vivo models have helped to clarify the aetiology and pathogenesis of ALS, as well as the mechanisms of the disease. However, as these mechanisms are not yet fully understood, experimental models are essential to the continued study of the pathogenesis of ALS, as well as in the search for possible therapeutic targets. Although 90% of cases are sporadic, most of the models used to study ALS pathogenesis are based on genetic mutations associated with the familial form of the disease; the pathogenesis of sporadic ALS remains unknown. Therefore, it would be critical to establish models based on the sporadic form. Conclusion: This article reviews the main genetic and sporadic experimental models used in the study of this disease, focusing on those that have been developed using rodents.(AU)

Consenso AITP español: Una lista de verificación AITP / Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist

Introducción: El curso de Asistencia Inicial al Trauma Pediátricose imparte en España desde 1997, existiendo en la actualidad 9 centrosformadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al errorpor olvido, por lo que las listas de verificación, como herramientasmnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas deverificación para la asistencia al traumatismo pediátrico, ninguna se hadesarrollado en el entorno de nuestro curso. Material y métodos: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con lacomisión científica de politrauma de la Sociedad Española de CirugíaPediátrica. Los ítems para formar la lista de verificación se obtuvierona partir de una revisión bibliográfica y de la consulta a los expertosseleccionados, empleando un método Delphi. Resultados. Se seleccionaron 10 expertos que representan los 9grupos o centros formadores en Asistencia Inicial al Trauma Pediátri-co y se elaboró una lista de verificación con 28 ítems, siguiendo susrecomendaciones de diseño. Conclusiones: Se diseñó una lista de verificación para el manejodel paciente pediátrico politraumatizado, con el consenso de todos losgrupos empleando un método Delphi, requisito fundamental para facilitarla difusión de esta lista. Sería preciso adaptar y validar dicha lista parasu uso en cada centro asistencial.(AU)

Introduction: The course in Primary Care in Pediatric Trauma(ATIP in Spanish) has been taught in Spain since 1997, and there arecurrently 9 accredited training centers. Care of polytraumatized pedi-atric patients often takes place in an environment conducive to errorsresulting from forgetfulness, which is why checklists –mnemonic toolswidely used in industry and medicine– are particularly useful to avoidsuch errors. Although several checklists exist for pediatric trauma care,none have been developed within the setting of our course. Materials and methods: The criteria for being selected as an expertin Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society.The items that make up the checklist were obtained from a review ofthe literature and consultation with selected experts, using the DelphiTechnique. Results: 10 experts representing the 9 groups or training centers inPrimary Care in Pediatric Trauma were selected, and a 28-item checklistwas drawn up in accordance with their design recommendations.Conclusions: With the consensus of all the groups, a checklist forthe treatment of polytraumatized pediatric patients was drawn up usingthe Delphi Technique, an essential requirement for the disseminationof this checklist, which should be adapted and validated for use in eachhealthcare center.(AU)

[Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review]. / Monitorización ambulatoria de la presión arterial en adultos y población pediátrica. Una revisión narrativa.

Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients' daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.

Murine experimental models of amyotrophic lateral sclerosis: an update.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease whose aetiology is unknown. It is characterised by upper and lower motor neuron degeneration. Approximately 90% of cases of ALS are sporadic, whereas the other 10% are familial. Regardless of whether the case is familial o sporadic, patients will develop progressive weakness, muscle atrophy with spasticity, and muscle contractures. Life expectancy of these patients is generally 2 to 5 years after diagnosis. DEVELOPMENT: In vivo models have helped to clarify the aetiology and pathogenesis of ALS, as well as the mechanisms of the disease. However, as these mechanisms are not yet fully understood, experimental models are essential to the continued study of the pathogenesis of ALS, as well as in the search for possible therapeutic targets. Although 90% of cases are sporadic, most of the models used to study ALS pathogenesis are based on genetic mutations associated with the familial form of the disease; the pathogenesis of sporadic ALS remains unknown. Therefore, it would be critical to establish models based on the sporadic form. CONCLUSIONS: This article reviews the main genetic and sporadic experimental models used in the study of this disease, focusing on those that have been developed using rodents.

Harmonization service and global library of models to support country-driven global information on salt-affected soils.

Global distribution of salt-affected soils (SAS) has remained at about 1 billion hectares in the literature over the years despite changes in climate, sea levels, and land use patterns which influence the distribution. Lack of periodic update of input soil data, data gaps, and inconsistency are part of the reasons for constant SAS distribution in the literature. This paper proposes harmonization as a suitable alternative for managing inconsistent data and minimizing data gaps. It developed a new harmonization service for supporting country-driven global SAS information update. The service contains a global library of harmonization models for harmonizing inconsistent soil data. It also contains models for identifying gaps in SAS database and for showing global distribution where harmonization of available data is needed. The service can be used by countries to develop national SAS information and update global SAS distribution. Its data availability index is useful in identifying countries without SAS data in the global database, which is a convenient way to identify countries to mobilize when updating global SAS information. Its application in 27 countries showed that the countries have more SAS data than they currently share with the global databases and that most of their data require SAS harmonization.

Estudio comparativo de la extracción de la pieza de nefrectomía laparoscópica mediante una incisión de tipo Pfannenstiel / Comparative study of intact specimen extraction in laparoscopic nephrectomy by pfannenstiel incision

Objetivos Nuestro objetivo es demostrar que la incisión de Pfannenstiel presenta un perfil más seguro en cuanto a complicaciones postoperatorias frente a otro tipo de incisiones que habitualmente se utilizan para la extracción renal laparoscópica. Material y métodos Estudio retrospectivo y comparativo de 256 pacientes intervenidos de nefrectomía o nefroureterectomía. Dividimos a los pacientes en dos grupos: extracción renal mediante incisión de Pfannenstiel (grupo 1) y extracción renal mediante otro tipo de incisiones (grupo 2). Evaluamos: aparición de eventración y evisceración clínica y subclínica, presencia de infección bacteriana significativa, presencia de dolor, aparición de seroma, hematoma/sangrado, dehiscencia de la herida y parálisis muscular en cada paciente. Resultados Los pacientes del grupo Pfannenstiel presentaron una tasa de complicaciones derivadas de la herida de 11,72% frente a 27,34% en el grupo no-Pfannenstiel, p = 0,002, siendo significativo la menor tasa de dehiscencia (5,5 vs. 12,5%, p = 0,047) y seroma (3,1% vs. 7,8%, p = 0,022). El modelo de regresión logística multivariante mostró que la incisión de Pfannenstiel es un predictor de prevención de complicaciones derivadas de la herida quirúrgica (OR = 0,34, p = 0,005). Conclusiones La elección de una incisión de Pfannenstiel supuso una menor incidencia de dehiscencia y seroma de la herida quirúrgica, permitiendo la extracción de piezas de nefrectomía más voluminosas y con una menor estancia hospitalaria, lo que la convierte en una alternativa válida y segura, con un favorable perfil de complicaciones con respecto a otro tipo de incisiones (AU)

Objectives The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. Materials and methods Retrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. Results Patients in Pfannenstiel group presented a rate of wound complications of 11.72% vs 27.34% with other incisions, p = 0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs 12.5%, p = 0.047) and seroma (3.1% vs 7.8%, p = 0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR = 0.34, p = 0.005). Conclusions The Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select (AU)

Comparative study of intact specimen extraction in laparoscopic nephrectomy by Pfannenstiel incision.

OBJECTIVES: The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. MATERIALS AND METHODS: Retrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. RESULTS: Patients in Pfannenstiel group presented a rate of wound complications of 11.72% vs. 27.34% with other incisions, p=0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs. 12.5%, p=0.047) and seroma (3.1% vs. 7.8%, p=0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR=0.34, p=0.005). CONCLUSIONS: The Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

Promoción de la salud mental durante la pandemia, actuaciones realizadas en el Instituto de Medicina Preventiva de la Defensa / Promotion of mental health during the pandemic, actions carried out at the Defense Preventive Medicine Institute

En la situación de pandemia por COVID-19 la salud pública y la medicina preventiva han pasado a primera línea de actuación. En este marco la salud mental ha resultado muy afectada. Sanitarios y población general han sufrido las consecuencias del aislamiento y la desinformación, entre otros. Desde el Instituto de Medicina Preventiva Capitán médico Ramón y Cajal se han desarrollado varias acciones de promoción de la salud, en las que el abordaje psicológico se ha tenido muy en cuenta. Durante este tiempo, se han seguido las líneas estratégicas de comunicación propuestas por la Organización Mundial de la Salud. Igualmente, con el objetivo de apoyar la labor de los profesionales sanitarios de los ejércitos se han diseñado diversas guías, infografías y otros materiales difundidos a través de la web del instituto. Se ha dedicado una especial atención a la fatiga pandémica para reforzar las medidas de prevención y vencer el cansancio frente a la pandemia, con el fin de cambiar la disminución de la percepción de riesgo. Todas estas acciones tienen como objetivo final mantener las condiciones psicofísicas del personal militar en un estado óptimo para desarrollar las misiones encomendadas.(AU)

In the situation of the COVID-19 pandemic, public health and preventive medicine have come to the forefront of action. In this framework, mental health has been greatly affected, health workers and the general population have suffered the consequences of isolation and misinformation, among others. From the Institute of Preventive Medicine Capitán médico Ramón y Cajal, several health promotion actions have been developed in which the psychological approach has been taken into account. During this time, the strategic lines of communication proposed by the World Health Organization have been followed. Likewise, with the aim of supporting the work of health professionals in the Armed Forces, various guides, infographics and other material have been designed and disseminated through the Institute’s website. Special attention has been devoted to pandemic fatigue to reinforce prevention measures and overcome fatigue in the face of the pandemic, in order to change the decrease in risk perception. All these actions have the final objective of maintaining the psychophysical conditions of military personnel in an optimal state to carry out the entrusted missions.(AU)

Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo / Faecal occult blood test in symptomatic patients in primary care: A retrospective study in a healthcare area of Toledo

Objetivo Revisar el protocolo de solicitud de sangre oculta en heces (SOH) en pacientes sintomáticos como prueba de derivación a colonoscopia, utilizando un punto de corte de 15μg Hb/g heces en 3 muestras consecutivas y comparar su utilidad con las recomendaciones actuales de un punto de corte de 10μg Hb/g heces en una muestra. Material y métodos Estudio observacional retrospectivo centrado en las peticiones de la prueba de SOH en pacientes sintomáticos en Atención Primaria. Las muestras fueron analizadas en el servicio de laboratorio durante el año 2017. En el análisis de datos se incluyeron 715 pacientes con la prueba de SOH positiva y 925 pacientes con resultado negativo. Se realizó un análisis descriptivo de los resultados de SOH, motivo de solicitud y colonoscopia, junto con el estudio de la utilidad diagnóstica de la prueba SOH para los puntos de corte de 10 y 15μg Hb/g heces en la misma población. Resultados La tasa de positividad de la prueba fue del 22,8% y la tasa de detección de cáncer colorrectal fue del 11%. El número de muestras no modifica la precisión diagnóstica. El valor predictivo negativo es superior con el punto de corte de 10μg Hb/g heces. Conclusione La selección correcta de pacientes y del punto de corte óptimo aumentan la tasa de detección de cáncer colorrectal. El cambio de protocolo de 10μg Hb/g heces y la recogida de una muestra para pacientes sintomáticos desde Atención Primaria mejoran la utilidad de la prueba SOH (AU)

Aim To review referral protocol in symptomatic patients from primary care of using 15μgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10μgHb/g faeces threshold and one sample. Material and methods A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15μgHb/g faeces) in the same population. Results FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10μgHb/g faeces threshold. Conclusions Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10μgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose (AU)

Plant-based drinks for vegetarian or vegan toddlers: Nutritional evaluation of commercial products, and review of health benefits and potential concerns.

There is an increasing trend today towards plant-based diets in western society, often resulting in milk restriction. In the case of very young children, the direct substitution of milk by other foods, without proper nutritional advice, may lead to a lack of nutrients and hence to growth and development alterations. This study focuses on the nutritional assessment of various commercially available plant-based drinks, to determine their adequacy as alternatives to ruminant milk, in relation to the nutritional requirements of toddlers (1-3 years old), and to establish whether other sources of nutrient supplementation may be needed, as well as any other possible positive and /or negative health effects associated to their consumption. A sample of 179 commercial plant-based drinks (almond, coconut, hemp, oat, rice, soy, tigernut) were chosen and their nutrient contents were compared to the EFSA nutrient reference values for toddlers. The scientific literature on the presence of bioactive and/or undesirable compounds was reviewed. None of the plant-based drinks studied should be considered as a milk substitute, since they are different food products with a different composition. However, from the results obtained, the best choice for toddlers who do not consume milk would be to consume at least 250 mL/day of fortified soy drink (for its higher amount and quality of protein, polyunsaturated fatty acids and phytosterols), and always in the context of a carefully-balanced diet. Almond, hemp or oat drinks are other alternatives that can be used in combination or for soy-allergic toddlers. The key nutrients that should be fortified in plant-based drinks are: vitamins A and B12, calcium, zinc and iodine, as they represent the most significant nutritional differences with milk; vitamin D would also be desirable. Of these, vitamins A, B12, D and calcium, are easily found in many commercial plant-based drinks on the Spanish market (most frequently in soy drinks), unlike iodine and zinc, which were not added to any. Given the fish restriction in vegetarians/vegans and the fact that plant-based drinks provide high amounts of phytates and tannins, which act as antinutrients, a good strategy for the industry would be to fortify plant-based drinks with iodine and zinc to improve the nutritional value of products aimed to vegetarians/vegans.

[Faecal occult blood test in symptomatic patients in primary care: A retrospective study in a healthcare area of Toledo]. / Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo.

AIM: To review referral protocol in symptomatic patients from primary care of using 15µgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10µgHb/g faeces threshold and one sample. MATERIAL AND METHODS: A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15µgHb/g faeces) in the same population. RESULTS: FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10µgHb/g faeces threshold. CONCLUSIONS: Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10µgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose.

Variant rs4149584 (R92Q) of the TNFRSF1A gene in patients with familial multiple sclerosis.

INTRODUCTION: Genomic studies have identified numerous genetic variants associated with susceptibility to multiple sclerosis (MS); however, each one explains only a small percentage of the risk of developing the disease. These variants are located in genes involved in specific pathways, which supports the hypothesis that the risk of developing MS may be linked to alterations in these pathways, rather than in specific genes. We analyzed the role of the TNFRSF1A gene, which encodes one of the TNF-α receptors involved in a signaling pathway previously linked to autoimmune disease. METHODS: We included 138 individuals from 23 families including at least 2 members with MS, and analyzed the presence of exonic variants of TNFRSF1A through whole-exome sequencing. We also conducted a functional study to analyze the pathogenic mechanism of variant rs4149584 (-g.6442643C > G, NM_001065.4:c.362 G > A, R92Q) by plasmid transfection into human oligodendroglioma (HOG) cells, which behave like oligodendrocyte lineage cells; protein labeling was used to locate the protein within cells. We also analyzed the ability of transfected HOG cells to proliferate and differentiate into oligodendrocytes. RESULTS: Variant rs4149584 was found in 2 patients with MS (3.85%), one patient with another autoimmune disease (7.6%), and in 5 unaffected individuals (7.46%). The 2 patients with MS and variant rs4149584 were homozygous carriers and belonged to the same family, whereas the remaining individuals presented the variant in heterozygosis. The study of HOG cells transfected with the mutation showed that the protein does not reach the cell membrane, but rather accumulates in the cytoplasm, particularly in the endoplasmic reticulum and near the nucleus; this suggests that, in the cells presenting the mutation, TNFRSF1 does not act as a transmembrane protein, which may alter its signaling pathway. The study of cell proliferation and differentiation found that transfected cells continue to be able to differentiate into oligodendrocytes and are probably still capable of producing myelin, although they present a lower rate of proliferation than wild-type cells. CONCLUSIONS: Variant rs4149584 is associated with risk of developing MS. We analyzed its functional role in oligodendrocyte lineage cells and found an association with MS in homozygous carriers. However, the associated molecular alterations do not influence the differentiation into oligodendrocytes; we were therefore unable to confirm whether this variant alone is pathogenic in MS, at least in heterozygosis.

Attempts to use breeding approaches in Aedes aegypti to create lines with distinct and stable relative Wolbachia densities.

Wolbachia is an insect endosymbiont being used for biological control in the mosquito Aedes aegypti because it causes cytoplasmic incompatibility (CI) and limits viral replication of dengue, chikungunya, and Zika viruses. While the genetic mechanism of pathogen blocking (PB) is not fully understood, the strength of both CI and PB are positively correlated with Wolbachia densities in the host. Wolbachia densities are determined by a combination of Wolbachia strain and insect genotype, as well as interactions with the environment. We employed both artificial selection and inbreeding with the goal of creating lines of Ae. aegypti with heritable and distinct Wolbachia densities so that we might better dissect the mechanism underlying PB. We were unable to shift the mean relative Wolbachia density in Ae. aegypti lines by either strategy, with relative densities instead tending to cycle over a narrow range. In lieu of this, we used Wolbachia densities in mosquito legs as predictors of relative densities in the remaining individual's carcass. Because we worked with outbred mosquitoes, our findings indicate either a lack of genetic variation in the mosquito for controlling relative density, natural selection against extreme densities, or a predominance of environmental factors affecting densities. Our study reveals that there are moderating forces acting on relative Wolbachia densities that may help to stabilize density phenotypes post field release. We also show a means to accurately bin vector carcasses into high and low categories for non-DNA omics-based studies of Wolbachia-mediated traits.

Non-pancreatic Pseudocyst Presenting as a Giant Retroperitoneal Mass

Objective: To assess the non-pancreatic retroperitoneal pseudocyst in the differenctial diagnosis of retroperitoneal cystic masses. Methods: To report a case. Results: We present a case of a 50-year-old woman with symptoms of pain and a palpable abdominal mass. In imaging studies a 13-cm retroperitoneal cystic mass with left ureterohydronephrosis was observed. Surgical excision of the mass was performed with pathological diagnosis of non-pancreatic retroperitoneal pseudocyst. Conclusion: Non-pancreatic retroperitoneal pseudocyst is an entity with a very low incidence, benign, usually asymptomatic. It can grow compressing on adjacent structures. The definitive diagnosis is histopathological and the treatment is surgical. It's important to carry out complete exeresis to avoid recurrences (AU)

Objetivo: Considerar el pseudoquiste retroperitonealno pancreático en el diagnóstico diferencial de masas quísticas retroperitoneales.Métodos: Presentación de un caso clínico.Resultados: Se presenta el caso de una mujer de 50años con dolor y masa abdominal palpable. En pruebasde imagen complementarias se objetiva una masa quísticaretroperitoneal de 13 cm que condiciona uréterohidronefrosis izquierda. Se realiza exéresis quirúrgica de la masa condiagnóstico anatomopatológico de pseudoquiste retroperitoneal no pancreático.Conclusión: El pseudoquiste retroperitoneal no pancreático es una entidad con una incidencia muy baja, benigna, habitualmente asintomática y que puede alcanzargran tamaño comprometiendo estructuras vecinas. El diagnóstico definitivo es anatomopatológico y el tratamiento esquirúrgico, siendo importante realizar la exéresis completapara evitar recurrencias (AU)

SARS-CoV-2 transmission dynamics in the urban-rural interface.

OBJECTIVES: As the world responds to the coronavirus outbreak, the role of public health in ensuring equitable health care that considers the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics in rural communities is still a challenge. The same suppression and mitigation measures have been implemented homogeneously, ignoring the differences between urban and rural areas. We propose an epidemiological model and simulate the dynamics of SARS-CoV-2 in urban and rural areas considering the interaction between these regions. STUDY DESIGN: This was a population modeling study. METHODS: A compartmental epidemiological model was formulated to simulate the transmission of SARS-CoV-2 in urban and rural areas. We use the model to investigate the impact of control strategies focused on the urban-rural interface to contain the epidemic size of SARS-CoV-2 in rural areas. RESULTS: Considering five different levels for the exposition rate in urban areas and keeping intrarural and urban-rural exposition rates fixed, the preventive measures reduce the size and delay the peak for the urban infectives. The response of infected individuals and cumulative deaths in rural areas upon changes in the urban dynamics was small but not negligible. On the other hand, preventive measures focused on the urban-rural interface impact the number of infected individuals and deaths in rural areas. CONCLUSIONS: The maintenance of SARS-CoV-2 in rural areas depends on the interaction of individuals at the urban-rural interface. Thus, restrictive measures established by the governments would not be required within rural areas. We highlight the importance of focused preventive measures on the urban-rural interface to reduce the exposure and avoid the transmission of SARS-CoV-2 to rural communities.

Effect of clay and guishe-ash as substrate on Lycopersicon esculentum germination and production.

The effect of biomass ash and clay on tomato plants (Lycopersicon esculentum) in greenhouse conditions from germination to production was studied. Biomass ash is a waste obtained from thermal treatment of guishe (a by-product of natural fiber), and clay is collected from local soils. Several trials were performed to assess the influence of the addition of clay and guishe-ash on seeds germination, seedling growth, and production yield. The decrease in the values of these variables was considered an indicator of toxicity. The obtained results showed that based clay/ash materials positively affect germination (average ∼90% and six materials allow obtaining 90%) and seedlings growth (an increase of ∼20% in height and more than 50% in fresh air corpuscular weight). However, applying these materials on the production stage induces minor positive effects on fruit diameter, locule number, pericarp thickness, and the number of seeds per fruit. Also, adverse effects (first harvest yield, number of fruits, fresh mass of ripe fruits, lycopene content) were observed. To valorize biomass ash, its combination with other materials such as clay could be an alternative to improve tomato production.

The concern to attend the growing demand for food has promoted the use of different kinds of materials as enhancers of plant growth and crop productivity. Among the materials that have been applied in crops are the wastes of biomass thermochemical processes, such as biochar and ashes. This work highlights the importance of evaluating the effect of applying a residue (guishe-ash) to a crop before promoting its use.