Prevención del consumo de tabaco en la adolescencia / Tobacco smoking prevention in adolescence

El consumo de tabaco puede llegar a ser un problema durante la adolescencia. La experimentación con el tabaco puede llevar a un consumo de larga duración y dependencia. Los adolescentes fumadores tienen el mismo riesgo a largo plazo que los fumadores adultos de desarrollar cáncer, enfermedades cardiovasculares o enfermedad pulmonar obstructiva crónica. Además, el tabaco supone un riesgo importante para el bebé durante el embarazo y la lactancia. Tras realizar una revisión amplia de la literatura científica, el grupo PrevInfad concluye que no existen pruebas de buena calidad a favor ni en contra para recomendar la intervención individual frente al consumo de tabaco en adolescentes. No obstante, dadas las importantes implicaciones que tiene para la salud el desarrollo precoz de dependencia del tabaco y la mayor dificultad de abandono de este cuando se inicia a edades tempranas, parece mayor el beneficio que el riesgo de realizar consejo o intervención breve, teniendo en cuenta tanto las preferencias y valores de los adolescentes y sus familias como los recursos disponibles

Tobacco consumption may become a problem in adolescence. Experiencing tobacco may drive to a long-lasting consumption and dependence. Adolescents smokers have the same risk in the long term than adult smokers as far as cancer, cardiovascular disease or chronic obstructive pulmonary disease is concerned. Moreover, tobacco implies relevant risks during pregnancy and breastfeeding. After a comprehensive literature review, the group PrevInfad concludes that there is no good quality evidence in favor nor against the recommendation of individual intervention on tobacco consumption in adolescents. Nevertheless, given the relevant implications in health of the early tobacco dependence, and the greater difficulty of its cessation when started at an early age, the benefit of the brief counseling or intervention seems greater than its risk, taking into account the values and preferences of the adolescents and their families as well as the available resources

Cribado de la depresión mayor en la infancia y adolescencia (parte 2) / Screening for depression in chilhood and adolescence (part 2)

El síndrome depresivo que aparece durante la infancia o la adolescencia tiende a seguir un curso crónico, con alta probabilidad de permanecer en la edad adulta. Su sintomatología repercute en la vida diaria del menor y, en el caso de la depresión mayor, supone un riesgo para la aparición de conducta suicida. Dada la variabilidad de sus manifestaciones clínicas y las dificultades en el diagnóstico, se plantea la posible utilidad del uso de cuestionarios de cribado en la población infantil y adolescente, a partir de un análisis del rendimiento de estos y de la eficacia de las medidas terapéuticas actuales. El presente trabajo se ha dividido en dos partes, y al final de este se recopilan las recomendaciones de distintos grupos de trabajo y tras el análisis de la evidencia, las recomendaciones que el grupo PrevInfad ha consensuado para la consulta de los pediatras en Atención Primaria

The depressive syndrome that appears during childhood or adolescence tends to follow a chronic course, with a high probability of remaining in adulthood. Its symptoms affect the daily life of the minor and in case of major depression, it poses a risk for the onset of suicidal behavior. Given the variability of its clinical manifestations and the difficulties in diagnosis, the possible usefulness of the use of screening questionnaires in the child and adolescent population is proposed, based on an analysis of their performance and the efficacy of current therapeutic measures. This article, which has been divided in two parts, ends with several recommendations for the consultation of pediatricians in Primary Care made by PrevInfad Group, after analyzing their evidence

Cribado de la depresión mayor en la infancia y adolescencia (parte 1) / Screening for depression in childhood and adolescence (part 1)

El síndrome depresivo que aparece durante la infancia o la adolescencia tiende a seguir un curso crónico, con alta probabilidad de permanecer en la edad adulta. Su sintomatología repercute en la vida diaria del menor y, en el caso de la depresión mayor, supone un riesgo para la aparición de conducta suicida. Dada la variabilidad de sus manifestaciones clínicas y las dificultades en el diagnóstico, se plantea la posible utilidad del uso de cuestionarios de cribado en la población infantil y adolescente, a partir de un análisis del rendimiento de estos y de la eficacia de las medidas terapéuticas actuales. El presente trabajo se ha dividido en dos partes, y al final de este se recopilan las recomendaciones de distintos grupos de trabajo y tras el análisis de la evidencia, las recomendaciones que el grupo PrevInfad ha consensuado para la consulta de los pediatras en Atención Primaria

The depressive syndrome that appears during childhood or adolescence tends to follow a chronic course, with a high probability of remaining in adulthood. Its symptoms affect the daily life of the minor and in case of major depression, it poses a risk for the onset of suicidal behavior. Given the variability of its clinical manifestations and the difficulties in diagnosis, the possible usefulness of the use of screening questionnaires in the child and adolescent population is proposed, based on an analysis of their performance and the efficacy of current therapeutic measures. This article, which has been divided in two parts, ends with several recommendations made by different work groups and, after analyzing the evidence, the ones that the PrevInfad group has agreed on for the consultation of pediatricians in Primary Care

Prevención de lesiones infantiles por accidente de tráfico / Child injury by traffic accident prevention

La prevención de los accidentes de tráfico es un tema de gran trascendencia social y un asunto de primera magnitud en salud pública. El grupo PrevInfad presenta en este documento la actualización de sus recomendaciones para la prevención de las lesiones por accidente de tráfico en niños y adolescentes, publicando en este caso un documento totalmente nuevo, que puede ser consultado en su versión íntegra en la página web del grupo (previnfad.aepap.org). La metodología incluye el diseño de un marco analítico, la formulación de preguntas estructuradas, la búsqueda y el análisis de la bibliografía. Dentro del apartado de accidentes de tráfico se van a considerar los ocasionados en vehículos a motor con el niño como pasajero o con el adolescente como conductor de ciclomotores u otros vehículos, los sufridos por peatones y las lesiones por caídas de bicicleta o por colisión de estas con vehículos a motor. También se incluye a los niños que se inician en la competición de ciclomotor. Es evidente que gran parte de las acciones preventivas corresponden a otros estamentos, si bien el pediatra tiene el deber de actuar como consejero y como grupo científico

Traffic accident prevention is an issue of social relevance and a very important public health matter. The working group PrevInfad presents in this document the update of its recommendations for traffic injury prevention in children and adolescents. The published document is brand new and can be consulted in full on the group's website (previnfad.aepap.org). The methodology includes the design of an analytic framework, the formulation of structured questions, the search of the evidence and the analysis of the bibliography. Traffic accidents are considered those caused in motor vehicles with the child as a passenger or with the adolescent as a driver of motorcycles or other vehicles, the accidents suffered by pedestrians and the injuries by falls from bicycles or from collision of bicycles with motor vehicles. The document also includes children that initiate into motorcycle competition. Many of the preventive actions concern to other levels, nevertheless the pediatricians must act as advisers and as scientific group

[Childhood and adolescence PAPPS summary 2020]. / RESUMEN PAPPS Infancia y Adolescencia 2020.

Four important topics about children and adolescents in our Primary Care activity are presented in this update document: support for breastfeeding, promotion of physical activity, prevention of child injuries due to traffic accidents, and screening for major depression.

Promoción de la actividad física en la infancia y la adolescencia (parte 2) / Promotion of physical activity in childhood and adolescence (part 2)

La actualización sobre las actividades de promoción de la actividad física en la infancia y adolescencia se aborda en dos partes. En la primera se analizan los beneficios en salud y los posibles riesgos de la actividad física. En la segunda se valora la evidencia sobre la eficacia de las intervenciones dirigidas a la promoción de la actividad física y disminución del sedentarismo en la edad pediátrica. El grupo PrevInfad sugiere hacer intervenciones dirigidas a la promoción de la actividad física o a la disminución del sedentarismo tanto en Atención Primaria como en el entorno escolar o comunitario

The update on actions to promote physical activity in childhood and adolescence is addressed in two parts. In the first part, the benefits in health and the possible risks of physical activity are analysed. In the second part, the evidence about the efficacy of the interventions directed to promote physical activity and decrease sedentary lifestyles in the paediatric age is assessed. The PrevInfad group suggests making interventions aimed at the promotion of physical activity or at reducing sedentary lifestyles, both in primary care and in the school or community environment

Promoción de la actividad física en la infancia y la adolescencia (parte 1) / Promotion of physical activity in childhood and adolescence (part 1)

La actualización sobre las actividades de promoción de la actividad física en la infancia y adolescencia se aborda en dos partes. En la primera se analizan los beneficios en salud y los posibles riesgos de la actividad física. En la segunda se valora la evidencia sobre la eficacia de las intervenciones dirigidas a la promoción de la actividad física y disminución del sedentarismo en la edad pediátrica. El grupo PrevInfad sugiere hacer intervenciones dirigidas a la promoción de la actividad física o a la disminución del sedentarismo tanto en Atención Primaria como en el entorno escolar o comunitario

The update on actions to promote physical activity in childhood and adolescence is addressed in two parts. In the first part, the benefits in health and the possible risks of physical activity are analyzed. In the second part, the evidence about the efficacy of the interventions directed to promote physical activity and decrease sedentary lifestyles in the pediatric age is assessed. The PrevInfad group suggests making interventions aimed at the promotion of physical activity or at reducing sedentary lifestyles, both in Primary Care and in the school or community environment

Apoyo a la lactancia materna en Atención Primaria / Support for breastfeeding in Primary Care

La leche humana se reconoce como el alimento idóneo para todos los niños por sus probados beneficios en la salud de la madre y del niño. La Organización Mundial de la Salud recomienda la lactancia materna exclusiva durante los primeros seis meses de la vida y, al menos hasta los dos años, complementada con otros alimentos. Esta recomendación se extiende a los recién nacidos enfermos y prematuros, salvo raras excepciones. Las pruebas sobre el efecto protector de la lactancia materna en la salud del niño y de la madre son muy robustas en relación con catorce enfermedades, nueve infantiles y cinco maternas. El apoyo a la lactancia materna desde Atención Primaria tiene un efecto favorable y consistente, con un riesgo de efectos adversos mínimo y que precisa una disponibilidad de recursos asumibles. En los centros de salud se sugiere implantar las prácticas recomendadas por la Academia Americana de Pediatría o los siete pasos de la Iniciativa de Humanización de la Asistencia al Nacimiento y Lactancia para prolongar la lactancia materna. Se sugiere formar a los médicos en lactancia materna, implicar a enfermeras consultoras en lactancia y favorecer el apoyo entre pares para prolongar la lactancia materna

Human milk is recognized as the ideal nourishment for all children due to its proven health benefits for mother and child. World Health Organization recommends exclusive breastfeeding during the first six months of life and, at least until two years, complemented with other foods. This recommendation extends to sick and preterm newborns, with rare exceptions. Proofs on the protecting effect of breastfeeding for child and mother health are very robust relating to fourteen diseases: nine child diseases and five mother diseases. Support to breastfeeding in Primary Care has a favourable and consistent effect, with a minimum risk of adverse events and it requires affordable resources. It is suggested to implement in Primary Care Centers the recommended practices of the American Academy of Pediatrics or the 7 steps of Initiative Humanisation of Attendance to Birth and breastfeeding to prolong breastfeeding. It is suggested to train physicians in breastfeeding, involve breastfeeding consultant nurses and promote the peers' support to prolong breastfeeding

GLUCOMANNAN AND GLUCOMANNAN PLUS SPIRULINA-ENRICHED SQUID-SURIMI ADDED TO HIGH SATURATED DIET AFFECT GLYCEMIA, PLASMA AND ADIPOSE LEPTIN AND ADIPONECTIN LEVELS IN GROWING FA/FA RATS.

Type 2 diabetes is a very prevalent chronic disease. Among dietary factors for its prevention and treatment, interest has grown in satiating fibre (konjac glucomannan) and spirulina. Our previous studies suggest that glucomannan itself and/or in conjunction to spirulina displayed hypolipemic and antioxidant effects when incorporated to squid surimi as functional ingredients. The present study aims to determine whether glucomannan- enriched or glucomannan plus spirulina-enriched squid-surimi improve plasma glucose and insulin levels in Zucker fa/fa rats fed a high saturated fat diet. Twenty four growing rats, divided into three groups, were given modified AIN-93M diets for seven weeks: 30% squid-surimi control diet (C), 30% glucomannan-enriched squid-surimi diet (G) and 30% glucomannan plus spirulina-enriched squid-surimi diet (GS). All rats became hyperglycemics and hyperinsulinemics, but G and GS diets induced significantly lower glucose levels (20%; p < 0.05) but did not modify insulinemia with respect to C diet. GS animals showed higher HOMA-D (p < 0.05) than C ones suggesting increased insulin availability. Plasma leptin and adiponectin decreased in G and GS vs. C group (p < 0.05). Adipose adiponectin increased significantly in G and GS vs. C rats (16-20 times, p < 0.01). Leptin in adipose tissue was higher in GS vs. G group (p < 0.05). In conclusion, both glucomannan-diets were able to reduce hyperglycemia and increase adipose tissue adiponectin levels in fa/fa rats, suggesting an anti-hypertrophic and insulin-sensitizing adipokine effect in this tissue. Spirulina inclusion increased insulin availability. Although results are promising, the utility of consuming glucomannan surimis as part of usual diets demands future studies.

La diabetes tipo 2 es una enfermedad crónica de gran prevalencia. Entre otros factores dietéticos para su prevención y tratamiento, la fibra saciante (p. ej. glucomanano de konjac) y la espirulina han experimentado un interés creciente. Estudios previos sugieren que el glucomanano solo o en conjunción con la espirulina, incorporados a surimi de calamar, como ingredientes funcionales, induce efectos hipolipemiantes y antioxidantes. En el presente estudio tratamos de determinar si dichos surimis de calamar mejoran la glucemia y la insulinemia en ratas Zucker fa/fa alimentadas con una dieta hipersaturada. Veinticuatro ratas en crecimiento, divididas en tres grupos, fueron alimentadas durante siete semanas con las siguientes dietas AIN-93M modificadas: dieta control con 30% de surimi de calamar (C), dieta glucomanano con 30% de surimi de calamar enriquecido con 15% glucomanano (G) y dieta glucomanano/espirulina con 30% de surimi de calamar enriquecido con 15% de glucomanano y espirulina 3 g/kg dieta (GS). Todos los grupos presentaron hiperglucemia e hiperinsulinemia, pero las dietas G y GS redujeron significativamente los niveles de glucosa (20%; p < 0,05) con respecto a la dieta C, aunque no lograron modificar la insulinemia. Los animales alimentados con GS tuvieron valores de HOMA-D (p < 0,05) más elevados respecto al grupo C, sugiriendo un aumento de la disponibilidad de insulina. La leptina y la adiponectina plasmáticas disminuyeron en la dieta G y GS respecto a la C (p < 0,05). La adiponectina en tejido adiposo aumentó significativamente en G y GS vs. C (16-20 veces, p < 0,01). La leptina en tejido adiposo fue mayor en GS vs. G (p < 0,05). En resumen, ambas dietas con glucomanano fueron capaces de reducir la hiperglucemia e incrementar la adiponectina en tejido adiposo, sugiriendo para este tejido efectos antihipertróficos y sensibilizantes a la insulina. La inclusión de espirulina incrementó la disponibilidad de insulina. Aunque los resultados son prometedores, la conveniencia del consumo de surimis con glucomanano como parte de una dieta normal requiere futuros estudios.

Glucomannan and glucomannan plusspirulina added to pork significantly block dietary cholesterol effects on lipoproteinemia, arylesterase activity, and CYP7A1 expression in Zucker fa/fa rats

Zucker fa/fa rats easily develop dyslipidemia and obesity. Restructured pork (RP) is a suitable matrix for including functional ingredients. The effects of glucomannan- RP or glucomannan plus spirulina-enriched RP on plasma lipid/lipoprotein levels, cytochrome P450 7A1 (CYP7A1) expression, and arylesterase activity in growing fa/fa rats fed high-energy, high-fat cholesterol-enriched diets were tested. Groups of six rats each received diet containing 15 % control-RP (C), 15 % glucomannan-RP diet (G), 15 % glucomannan + spirulina-RP diet (GS), and same diets enriched with 2.4 % cholesterol and 0.49 % cholic acid (cholesterol-enriched control (HC), cholesterol-enriched glucomannan (HG), and cholesterol-enriched glucomannan + spirulina (HGS) diets) over a 7-week period. C diet induced obesity, severe hyperglycemia, moderate hypercholesterolemia, and hypertriglyceridemia. Those facts were not significantly modified by G or GS diets. G diet increased CYP7A1 expression but decreased the total cholesterol/high density lipoproteins (HDL)-cholesterol ratio (p < 0.05) vs. C diet. GS vs. G diet increased (p < 0.05) CYP7A1 expression. HC vs. C diet reduced food intake, body weight gain, and plasma glucose (p < 0.01) but increased cholesterolemia (p < 0.01), lipidemia (plasma cholesterol plus triglycerides) (p < 0.001), cholesterol/triglyceride ratio in very low density lipoproteins (VLDL), and HDL (p < 0.05), cholesterol transported by VLDL and intermediate density lipoproteins (IDL) + low density lipoproteins (LDL), total cholesterol/HDL-cholesterol ratio and CYP7A1 expression (at least p < 0.05). HG and HGS diets vs. HC noticeably reduced lipidemia (p < 0.001), normalized VLDL and IDL + LDL lipid composition, and increased CYP7A1 expression (p < 0.01) but did not modify the cholesterol/HDL-cholesterol ratio. HGS vs. HG decreased triglyceridemia, the triglyceride-glucose (TyG) index and increased arylesterase/HDL-cholesterol activity (p < 0.05). In conclusion, G- and GS-RP act as functional foods and notably blocked the dietary cholesterol effects. In addition, HGS-RP improved the glucomannan hypolipidemic effects, increased arylesterase/HDL-cholesterol activity, and decreased insulin resistance

Glucomannan and glucomannan plus spirulina-enriched squid-surimi added to high saturated diet affect glycemia, plasma and adipose leptin and adiponectin levels in growing fa/fa rats / Las dietas hipersaturadas que contienen surimi de calamar enriquecido con glucomanano y glucomanano/espirulina afectan a la glucemia y a los niveles plasmáticos y adiposos de leptina y adiponectina en ratas fa/fa en crecimiento

Type 2 diabetes is a very prevalent chronic disease. Among dietary factors for its prevention and treatment, interest has grown in satiating fibre (konjac glucomannan) and spirulina. Our previous studies suggest that glucomannan itself and/or in conjunction to spirulina displayed hypolipemic and antioxidant effects when incorporated to squid surimi as functional ingredients. The present study aims to determine whether glucomannan-enriched or glucomannan plus spirulina-enriched squid-surimi improve plasma glucose and insulin levels in Zucker fa/fa rats fed a high saturated fat diet. Twenty four growing rats, divided into three groups, were given modified AIN-93M diets for seven weeks: 30% squid-surimi control diet (C), 30% glucomannan-enriched squid-surimi diet (G) and 30% glucomannan plus spirulina-enriched squid-surimi diet (GS). All rats became hyperglycemics and hyperinsulinemics, but G and GS diets induced significantly lower glucose levels (20%; p < 0.05) but did not modify insulinemia with respect to C diet. GS animals showed higher HOMA-D (p < 0.05) than C ones suggesting increased insulin availability. Plasma leptin and adiponectin decreased in G and GS vs. C group (p < 0.05). Adipose adiponectin increased significantly in G and GS vs. C rats (16-20 times, p < 0.01). Leptin in adipose tissue was higher in GS vs. G group (p < 0.05). In conclusion, both glucomannan-diets were able to reduce hyperglycemia and increase adipose tissue adiponectin levels in fa/fa rats, suggesting an anti-hypertrophic and insulin-sensitizing adipokine effect in this tissue. Spirulina inclusion increased insulin availability. Although results are promising, the utility of consuming glucomannan surimis as part of usual diets demands future studies (AU)

La diabetes tipo 2 es una enfermedad crónica de gran prevalencia. Entre otros factores dietéticos para su prevención y tratamiento, la fibra saciante (p. ej. glucomanano de konjac) y la espirulina han experimentado un interés creciente. Estudios previos sugieren que el glucomanano solo o en conjunción con la espirulina, incorporados a surimi de calamar, como ingredientes funcionales, induce efectos hipolipemiantes y antioxidantes. En el presente estudio tratamos de determinar si dichos surimis de calamar mejoran la glucemia y la insulinemia en ratas Zucker fa/fa alimentadas con una dieta hipersaturada. Veinticuatro ratas en crecimiento, divididas en tres grupos, fueron alimentadas durante siete semanas con las siguientes dietas AIN-93M modificadas: dieta control con 30% de surimi de calamar (C), dieta glucomanano con 30% de surimi de calamar enriquecido con 15% glucomanano (G) y dieta glucomanano/espirulina con 30% de surimi de calamar enriquecido con 15% de glucomanano y espirulina 3 g/kg dieta (GS). Todos los grupos presentaron hiperglucemia e hiperinsulinemia, pero las dietas G y GS redujeron significativamente los niveles de glucosa (20%; p < 0,05) con respecto a la dieta C, aunque no lograron modificar la insulinemia. Los animales alimentados con GS tuvieron valores de HOMA-D (p < 0,05) más elevados respecto al grupo C, sugiriendo un aumento de la disponibilidad de insulina. La leptina y la adiponectina plasmáticas disminuyeron en la dieta G y GS respecto a la C (p < 0,05). La adiponectina en tejido adiposo aumentó significativamente en G y GS vs. C (16-20 veces, p < 0,01). La leptina en tejido adiposo fue mayor en GS vs. G (p < 0,05). En resumen, ambas dietas con glucomanano fueron capaces de reducir la hiperglucemia e incrementar la adiponectina en tejido adiposo, sugiriendo para este tejido efectos antihipertróficos y sensibilizantes a la insulina. La inclusión de espirulina incrementó la disponibilidad de insulina. Aunque los resultados son prometedores, la conveniencia del consumo de surimis con glucomanano como parte de una dieta normal requiere futuros estudios (AU)

Relationships between serum calcium and magnesium levels and lipoproteins, homocysteine and insulin resistance/sensitivity markers at birth / Relaciones de los niveles séricos de calcio y magnesio con los de homocisteína, lipoproteínas, y marcadores de sensibilidad/ resistencia a la insulina al nacimiento

Background: The relationship between serum minerals and homocysteine, lipoprotein and glucose homeostasis markers at birth has been scarcely reported. This study aims to determine a) the relationship between calcium, magnesium, cardiovascular disease (CVD) markers (e.g. lipids, lipoproteins, homocysteine) and insulin sensitivity/ resistance markers (e.g. glucose, insulin, HOMA) in cord serum; and b) to find out the possible influence of reduced or increased levels of serum calcium and magnesium on those markers. Subjects and Methods: Forty-eight eutocic, normoweight and appropriated-for-gestational age, full-term, singleton without foetal distress newborns from the Mérida Study were studied. Parameter percentiles for serum calcium and magnesium as well as for the Ca/Mg ratio were stated. CVD and insulin sensitivity/resistance markers in neonates within the first quartile for calcium, magnesium and their ratio were compared with those of neonates within the forth quartile for these minerals. Results: Serum calcium negative correlated with HDL-c (p<0.05), arylesterase (AE) (p<0.01), the Apo A1/Apo B (p<0.05) and AE/HDL-c (p<0.05) ratios. Also, negative and significant correlations were found between the Ca/Mg ratio and AE (p<0.01), and AE/HDL-c (p<0.05). Neonates within the highest quartile for Mg displayed significantly higher levels of LDL-c and homocysteine (p<0.05). Newborns within the Ca/Mg ratio first quartile presented higher activities of AE while those of with high Ca/Mg ratio showed low levels of insulin. Conclusions: Calcium and magnesium levels appear related to CVD and insulin sensitivity/resistance markers at birth. Future follow-up studies, mostly in neonates, with high magnesemia and/or high Ca/Mg ratio at birth are recommended (AU)

Introducción La relación entre los niveles de minerales en suero con los de homocisteína, lipoproteínas y marcadores homeostáticos de glucosa al nacimiento es poco conocida. El objetivo del presente estudio fue doble: a) determinar la relación entre calcio, magnesio, marcadores de riesgo de enfermedad cardiovascular (CVD) (p.e. lípidos, lipoproteínas, homocisteína) y marcadores de sensibilidad/resistencia a la insulina (p.e. glucosa, insulina, HOMA) en sangre de cordón; b) encontrar la posible influencia de los niveles elevados o reducidos de calcio y magnesio en suero sobre tales marcadores. Sujetos y Métodos Se testaron 48 recién nacidos a término, de parto eutócico, normopeso, peso adecuado para su edad gestacional, sin distrés fetal del Estudio Mérida. Se obtuvieron percentiles para calcio, magnesio y la relación Ca/Mg y se compararon los niveles de marcadores CVD y sensibilidad/resistencia a la insulina de los neonatos clasificados en el primer cuartil para calcio, magnesio y cociente Ca/Mg con aquellos del cuarto cuartil. Resultados El calcio sérico se correlacionó negativamente con HDL-c (p<0,05), arilesterasa (AE) (p<0,01), cocientes Apo A1/Apo B (p<0,05) y AE/HDL-c (p<0,05). El cociente Ca/Mg correlacionó negativa y significativamente con AE (p<0,01) y AE/HDL-c (p<0,05). Los neonatos del cuarto cuartil para Mg presentaron niveles más elevados de LDL-c y homocisteína (p<0,05). Aquellos del primer cuartil para Ca/Mg presentaron actividades de AE más elevadas, mientras que los del cuarto cuartil para Ca/Mg, menores insulinemias. Conclusiones Calcemia y magnesemia aparecen relacionadas al nacimiento con marcadores CVD y de sensibilidad/ resistencia a la insulina. Se recomiendan estudios de seguimiento, particularmente en aquellos niños con niveles elevados de magnesio y/o cocientes Ca/Mg elevados al nacimiento (AU)

Relationships between serum calcium and magnesium levels and lipoproteins, homocysteine and insulin resistance/sensitivity markers at birth.

BACKGROUND: The relationship between serum minerals and homocysteine, lipoprotein and glucose homeostasis markers at birth has been scarcely reported. This study aims to determine a) the relationship between calcium, magnesium, cardiovascular disease (CVD) markers (e.g. lipids, lipoproteins, homocysteine) and insulin sensitivity/ resistance markers (e.g. glucose, insulin, HOMA) in cord serum; and b) to find out the possible influence of reduced or increased levels of serum calcium and magnesium on those markers. SUBJECTS AND METHODS: Forty-eight eutocic, normoweight and appropriated-for-gestational age, full-term, singleton without foetal distress newborns from the Mérida Study were studied. Parameter percentiles for serum calcium and magnesium as well as for the Ca/Mg ratio were stated. CVD and insulin sensitivity/resistance markers in neonates within the first quartile for calcium, magnesium and their ratio were compared with those of neonates within the forth quartile for these minerals. RESULTS: Serum calcium negative correlated with HDL-c (p<0.05), arylesterase (AE) (p<0.01), the Apo A1/Apo B (p<0.05) and AE/HDL-c (p<0.05) ratios. Also, negative and significant correlations were found between the Ca/Mg ratio and AE (p<0.01), and AE/HDL-c (p<0.05). Neonates within the highest quartile for Mg displayed significantly higher levels of LDL-c and homocysteine (p<0.05). Newborns within the Ca/Mg ratio first quartile presented higher activities of AE while those of with high Ca/Mg ratio showed low levels of insulin. CONCLUSIONS: Calcium and magnesium levels appear related to CVD and insulin sensitivity/resistance markers at birth. Future follow-up studies, mostly in neonates, with high magnesemia and/or high Ca/Mg ratio at birth are recommended.

Introducción La relación entre los niveles de minerales en suero con los de homocisteína, lipoproteínas y marcadores homeostáticos de glucosa al nacimiento es poco conocida. El objetivo del presente estudio fue doble: a) determinar la relación entre calcio, magnesio, marcadores de riesgo de enfermedad cardiovascular (CVD) (p.e. lípidos, lipoproteínas, homocisteína) y marcadores de sensibilidad/resistencia a la insulina (p.e. glucosa, insulina, HOMA) en sangre de cordón; b) encontrar la posible influencia de los niveles elevados o reducidos de calcio y magnesio en suero sobre tales marcadores. Sujetos y Métodos Se testaron 48 recién nacidos a término, de parto eutócico, normopeso, peso adecuado para su edad gestacional, sin distrés fetal del Estudio Mérida. Se obtuvieron percentiles para calcio, magnesio y la relación Ca/Mg y se compararon los niveles de marcadores CVD y sensibilidad/resistencia a la insulina de los neonatos clasificados en el primer cuartil para calcio, magnesio y cociente Ca/Mg con aquellos del cuarto cuartil. Resultados El calcio sérico se correlacionó negativamente con HDL-c (p.

Increased familiarity of intellectual deficits in early-onset schizophrenia spectrum disorders.

OBJECTIVES: Early-onset schizophrenia is considered to be neurobiologically similar to adult-onset forms, although it represents a more severe expression of the disorder. In the present study, we explored putative larger familial vulnerability of intellectual impairments in early-onset schizophrenia spectrum disorders (EOS) when compared to adult-onset (AOS) families. METHODS: A sample of 340 subjects including schizophrenia spectrum disorder patients, their first degree relatives and age-matched healthy controls was assessed on intelligence quotient (IQ). We used linear regression analysis and intraclass correlation coefficients (ICC) to explore familial aggregation of IQ across age at onset groups. RESULTS: The relationship between IQ level of patients and their first-degree relatives showed positive linear association (ß = 0.43, P < 0.01). High significant familial aggregation was found for intelligence quotient in EOS families (ICC = 0.618, P < 0.01), while AOS families responded to lower estimates (ICC = 0.204, P = 0.26; between ICC comparison z = 1.993, P < 0.05). CONCLUSIONS: High aggregation of intellectual performance in the EOS group suggests larger familial vulnerability in early-onset forms of the disease when cognitive functions are considered. Within a continuum of psychopathology in schizophrenia spectrum disorders, specific genetic effects are discussed for distinct onset forms that might be in line with a neurodevelopmental model of the disease.

Usefulness of PCR for monitoring benznidazole response in patients with chronic Chagas' disease: a prospective study in a non-disease-endemic country.

OBJECTIVES: This prospective study focused on the evaluation of antiparasitic therapy in chronic Chagas' disease, monitored by PCR. PATIENTS AND METHODS: One hundred and eighty-one patients, all seropositive for Trypanosoma cruzi infection, underwent specific chemotherapy with benznidazole. Twelve patients were classified as young (2-19 years), 122 patients were classified as adults (20-39 years) and 47 patients were classified as seniors (>or=40 years). In total, 116 (64%) were asymptomatic and 65 (36%) were symptomatic. Patients were monitored for 90, 150 and 420 days after treatment by PCR and serology. RESULTS: Before treatment, 68% had a positive PCR result. PCR positivity was significantly more frequent in patients aged 2-19 years (P = 0.0007) and in short-term immigrants (P = 0.0076). No differences in PCR sensitivity were observed between samples of patients with chronic symptomatic or indeterminate Chagas' disease. All patients presented an early conversion of PCR results 90 days post-treatment. However, at the end of the follow-up period PCR had become positive in four patients (4 out of 58 patients; 6.9%) who had strictly adhered to the treatment and in one who did not complete the treatment. Only one patient showed an alternating PCR during follow-up. CONCLUSIONS: We conclude that PCR is a useful tool for the early detection of parasite susceptibility to benznidazole and for the post-treatment parasitological follow-up of patients with chronic Chagas' disease.

Fasting status and thermally oxidized sunflower oil ingestion affect the intestinal antioxidant enzyme activity and gene expression of male Wistar rats.

The effect of thermally oxidized sunflower oil ingestion on antioxidant levels, enzyme activities and expressions in the small intestine of fed and fasted rats was studied. For three consecutive days, 12 male Wistar rats received 0.5 g of unused sunflower oil/100 g of body weight (controls, C) while another 12 were given 0.5 g of thermally oxidized sunflower oil/100 g of body weight (test group, T). On the night of day 3, 6 rats from each group were fasted (FC and FT, respectively) while the other 6 animals from each group were given free access to food (NFC and NFT, respectively). On day 4, FC and NFC rats received 1 g of unused oil/100 g of body weight, while FT and NFT rats were given 1 g of altered oil/100 g of body weight. Small intestines were extracted after 4 h exposure to the oils. Fasting and oil alteration significantly interacted modifying total, Se-GPx (both, P < 0.001) and non-Se-GPx (P < 0.05) activity, and GPx and Cu,Zn-SOD expressions (both P < 0.001). FT rats showed a significant increase in TBARS (P < 0.05) and catalase activity (P < 0.001) and a decrease in SOD, Se- and non-Se-dependent GPx activities (at least, P < 0.05) with respect to FC and NFT animals. SOD and GPx expressions decreased (p<0.001) but that of TNFalpha increased significantly (P < 0.001) in FT rats with respect to FC and NFT animals. Lengthy fasting and consumption of food containing oxidized fat should both be avoided to prevent intestinal oxidative stress.

Three new cases with a supernumerary ring chromosome 1.

We report on three cases with a cytogenetically identical ring chromosome containing euchromatin from the long arm of chromosome 1 (r[1][::p11.1-->q21.1::]). Two cases were newborn males (Cases 1 and 2) and the third one was prenatally identified as female (Case 3). Mosaicism was present in all three cases in different degrees, i.e. 48%, 25% and 14% of the cells, respectively. Clinical signs and symptoms vary between the three cases. The results of our three cases are compared with those from the literature.

Perfusión continua de urokinasa en hemodiálisis / Continuous perfusion of urokinase in haemodialysis

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Caries incidence in permanent first molars after discontinuation of a school-based chlorhexidine-thymol varnish program.

OBJECTIVES: To determine whether the cessation for 3 years of a 24-month program of chlorhexidine-thymol varnish applications would affect caries incidence in the first permanent molars of a population of schoolchildren of middle and lower-middle socioeconomic level. METHODS: Two groups of 6-7-year-old schoolchildren, randomized by school-class, were followed up in a clinical trial. One group received applications of chlorhexidine-thymol varnish every 3 months and the other group acted as controls. The program ended after 24 months and its effects were evaluated. Three years later, 55.5% of the schoolchildren were re-examined and the caries increments were documented. RESULTS: At the end of the 24-month program, the treated children had significantly fewer decayed and filled surfaces in permanent molars (lower DFS index) versus the controls. At 3 years after the discontinuation of the program, this difference had disappeared; there were no differences in the incidence of decayed, missing and filled surfaces (DMFS) index in permanent molars between the treated children and the controls. CONCLUSION: The cessation for 3 years of a 3-month program of chlorhexidine-thymol varnish applications resulted in a nonsignificant increase in the prevalence of dental caries in the permanent first molar.

Effectiveness of chlorhexidine-thymol varnish for caries reduction in permanent first molars of 6-7-year-old children: 24-month clinical trial.

OBJECTIVES: To determine the effect of chlorhexidine varnish on the prevention of caries in permanent first molars. METHODS: Two groups of 6-7-year-old school children were followed up in a clinical trial, a group of 86 children whose teeth were treated with a chlorhexidine-thymol varnish (Cervitec) and a control group of 95 children. The varnish was reapplied every 3 months and the caries increments were compared at 24 months. RESULTS: The DFS (decayed and filled surfaces in permanent first molars) increment in the control group (mean = 1.85; SD = 2.27) was higher than in the test group (mean = 0.95; SD = 1.38), resulting in a 48.6% caries reduction. This difference was statistically significant (P = 0.032). CONCLUSIONS: Chlorhexidine-thymol varnish is effective in preventing caries in permanent first molars.