Metabolome biomarkers linking dietary fibre intake with cardiometabolic effects: results from the Danish Diet, Cancer and Health-Next Generations MAX study.

Biomarkers associated with dietary fibre intake, as complements to traditional dietary assessment tools, may improve the understanding of its role in human health. Our aim was to discover metabolite biomarkers related to dietary fibre intake and investigate their association with cardiometabolic risk factors. We used data and samples from the Danish Diet Cancer and Health Next Generation (DCH-NG) MAX-study, a one-year observational study with evaluations at baseline, six and 12 months (n = 624, 55% female, mean age: 43 years, 1353 observations). Direct associations between fibre intake and plasma concentrations of 2,6-dihydroxybenzoic acid (2,6-DHBA) and indolepropionic acid were observed at the three time-points. Both metabolites showed an intraclass-correlation coefficient (ICC) > 0.50 and were associated with the self-reported intake of wholegrain cereals, and of fruits and vegetables, respectively. Other metabolites associated with dietary fibre intake were linolenoyl carnitine, 2-aminophenol, 3,4-DHBA, and proline betaine. Based on the metabolites associated with dietary fibre intake we calculated predicted values of fibre intake using a multivariate, machine-learning algorithm. Metabolomics-based predicted fibre, but not self-reported fibre values, showed negative associations with cardiometabolic risk factors (i.e. high sensitivity C-reactive protein, systolic and diastolic blood pressure, all FDR-adjusted p-values <0.05). Furthermore, different correlations with gut microbiota composition were observed. In conclusion, 2,6-DHBA and indolepropionic acid in plasma may better link dietary fibre intake with its metabolic effects than self-reported values. These metabolites may represent a novel class of biomarkers reflecting both dietary exposure and host and/or gut microbiota characteristics providing a read-out that is differentially related to cardiometabolic risk.

Sleep tight! Adolescent sleep quality across three distinct sleep ecologies.

Background and objectives: Good sleep quality, associated with few arousals, no daytime sleepiness and self-satisfaction with one's sleep, is pivotal for adolescent growth, maturation, cognition and overall health. This article aims to identify what ecological factors impact adolescent sleep quality across three distinct sleep ecologies representing a gradient of dense urbanity to small, rural environments with scarce artificial lighting and no Internet. Methodology: We analyze variation of sleep efficiency, a quantitative measure of sleep quality-defined as the ratio of total time spent asleep to total time dedicated to sleep-in two agricultural indigenous populations and one post-industrial group in Mexico (Campeche = 44, Puebla = 51, Mexico City = 50, respectively). Data collection included actigraphy, sleep diaries, questionnaires, interviews and ethnographic observations. We fit linear models to examine sleep efficiency variation within and between groups. Results: We found that sleep efficiency varied significantly across sites, being highest in Mexico City (88%) and lowest in Campeche (75%). We found that variation in sleep efficiency was significantly associated with nightly exposure to light and social sleep practices. Conclusions and implications: Our findings point toward contextual cost-benefits of sleep disruption in adolescence. We highlight the need to prioritize research on adolescent sleep quality across distinct developmental ecologies and its impact on health to improve adolescent wellbeing through evidence-based health practices.

Apolipoprotein E gene variants shape the association between dietary fibre intake and cognitive decline risk in community-dwelling older adults.

BACKGROUND: healthy dietary patterns have been associated with lower risk for age-related cognitive decline. However, little is known about the specific role of dietary fibre on cognitive decline in older adults. OBJECTIVE: this study aimed to examine the association between dietary fibre and cognitive decline in older adults and to assess the influence of genetic, lifestyle and clinical characteristics in this association. DESIGN AND PARTICIPANTS: the Invecchiare in Chianti, aging in the Chianti area study is a cohort study of community-dwelling older adults from Italy. Cognitive function, dietary and clinical data were collected at baseline and years 3, 6, 9 and 15. Our study comprised 848 participants aged ≥ 65 years (56% female) with 2,038 observations. MAIN OUTCOME AND MEASURES: cognitive decline was defined as a decrease ≥3 units in the Mini-Mental State Examination score during consecutive visits. Hazard ratios for cognitive decline were estimated using time-dependent Cox regression models. RESULTS: energy-adjusted fibre intake was not associated with cognitive decline during the 15-years follow-up (P > 0.05). However, fibre intake showed a significant interaction with Apolipoprotein E (APOE) haplotype for cognitive decline (P = 0.02). In participants with APOE-ɛ4 haplotype, an increase in 5 g/d of fibre intake was significantly associated with a 30% lower risk for cognitive decline. No association was observed in participants with APOE-ɛ2 and APOE-ɛ3 haplotypes. CONCLUSIONS AND RELEVANCE: dietary fibre intake was not associated with cognitive decline amongst older adults for 15 years of follow-up. Nonetheless, older subjects with APOE-ɛ4 haplotype may benefit from higher fibre intakes based on the reduced risk for cognitive decline in this high-risk group.

Sleep deprivation among adolescents in urban and indigenous-rural Mexican communities.

Comparing the nature of adolescent sleep across urban and more isolated, rural settings through an ecological, cross-cultural perspective represents one way to inform sleep nuances and broaden our understanding of human development, wellbeing and evolution. Here we tested the Social Jetlag Hypothesis, according to which contemporary, urban lifestyles and technological advances are associated with sleep insufficiency in adolescents. We documented the adolescent sleep duration (11-16 years old; X̅ = 13.7 ± 1.21; n = 145) in two small agricultural, indigenous and one densely urban context in Mexico to investigate whether adolescents in socio-ecologically distinct locations experience sleep deprivation. Sleep data was assembled with actigraphy, sleep diaries and standardized questionnaires. We employed multilevel models to analyze how distinct biological and socio-cultural factors (i.e., pubertal maturation, chronotype, napping, gender, working/schooling, access to screen-based devices, exposure to light, and social sleep practices) shape adolescent sleep duration. Results suggest that the prevalence of adolescent short sleep quotas is similar in rural, more traditional environments compared to highly urbanized societies, and highlight the influence of social activities on the expression of human sleep. This study challenges current assumptions about natural sleep and how adolescents slept before contemporary technological changes occurred.

Evaluación citogenética en parejas con esterilidad e infertilidad que concurren al Departamento de Genética del Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción en el periodo septiembre 2021- febrero 2022

La prevalencia de la infertilidad no posee datos muy exactos y varía en cada región, pero se estima que aproximadamente entre un 10 a 20% de las parejas experimentan algún problema de fertilidad durante su vida reproductiva. Según la Organización Mundial de la Salud (OMS), entre 48 millones de parejas y 186 millones de personas padecen de trastornos reproductivos en todo el mundo. El objetivo de este estudio fue la evaluación citogenética en parejas con esterilidad e infertilidad que concurrieron al Departamento de Genética del Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción (IICS-UNA) en el periodo septiembre 2021 a febrero 2022. Dicha evaluación citogenética fue realizada en muestras de 19 parejas mediante el análisis microscópico de 30 metafases por paciente. Se identificaron anomalías cromosómicas en algunas parejas estudiadas, se encontraron tres anomalías cromosómicas estructurales y varios polimorfismos o variantes cromosómicas. En el 63% de los individuos estudiados se observó un cariotipo normal, en el 8% alteraciones cromosómicas y en el 29% variantes cromosómicas. De las anomalías cromosómicas encontradas, las deleciones y translocaciones observadas se relacionan con una producción de gametos desequilibrados, dando lugar a abortos espontáneos y a la imposibilidad de concebir; en las parejas con cariotipo normal, se identificaron factores de riesgo como la edad, hábitos tóxicos como el consumo de tabaco, y enfermedades de base.

The prevalence of infertility does not have very exact data and varies in each region, but it is estimated that approximately 10 to 20% of couples experience some fertility problem during their reproductive life. According to the World Health Organization (WHO), between 48 million couples and 186 million people suffer from reproductive disorders worldwide. The objective of this study was the cytogenetic evaluation in couples with sterility and infertility who attended the Genetics Department of the Health Sciences Research Institute of the National University of Asunción (IICS-UNA) from September 2021 to February 2022. The cytogenetic evaluation was carried out in samples from 19 couples, through the microscopic analysis of 30 metaphases per patient. Chromosomal abnormalities were identified in some couples studied, three structural chromosomal abnormalities and several polymorphisms or chromosomal variants were found. A normal karyotype was found in 63% of the couples studied, chromosomal abnormalities in 8%, and chromosomal variants in 29%. Of the chromosomal abnormalities found, the deletions and translocations observed are related to unbalanced gamete production, leading to spontaneous abortions; in couples with a normal karyotype, risk factors such as age, toxic habits such as consumption of tobacco, and underlying diseases were identified.

Effects of Dietary Fibers on Short-Chain Fatty Acids and Gut Microbiota Composition in Healthy Adults: A Systematic Review.

There is an increasing interest in investigating dietary strategies able to modulate the gut microbial ecosystem which, in turn, may play a key role in human health. Dietary fibers (DFs) are widely recognized as molecules with prebiotic effects. The main objective of this systematic review was to: (i) analyze the results available on the impact of DF intervention on short chain fatty acids (SCFAs) production; (ii) evaluate the interplay between the type of DF intervention, the gut microbiota composition and its metabolic activities, and any other health associated outcome evaluated in the host. To this aim, initially, a comprehensive database of literature on human intervention studies assessing the effect of confirmed and candidate prebiotics on the microbial ecosystem was developed. Subsequently, studies performed on DFs and analyzing at least the impact on SCFA levels were extracted from the database. A total of 44 studies from 42 manuscripts were selected for the analysis. Among the different types of fiber, inulin was the DF investigated the most (n = 11). Regarding the results obtained on the ability of fiber to modulate total SCFAs, seven studies reported a significant increase, while no significant changes were reported in five studies, depending on the analytical methodology used. A total of 26 studies did not show significant differences in individual SCFAs, while the others reported significant differences for one or more SCFAs. The effect of DF interventions on the SCFA profile seemed to be strictly dependent on the dose and the type and structure of DFs. Overall, these results underline that, although affecting microbiota composition and derived metabolites, DFs do not produce univocal significant increase in SCFA levels in apparently healthy adults. In this regard, several factors (i.e., related to the study protocols and analytical methods) have been identified that could have affected the results obtained in the studies evaluated. Future studies are needed to better elucidate the relationship between DFs and gut microbiota in terms of SCFA production and impact on health-related markers.

Evaluation of 18 quality indicators from the external quality assurance preanalytical programme of the Spanish Society of Laboratory Medicine (SEQCML).

Objectives: Most errors in laboratory medicine occur in the pre- and post-analytical phases of the total testing process (TTP). In 2014, the Spanish Society of Laboratory Medicine (SEQCML) started the current Preanalytical Phase EQA Programme, with the objective of providing a tool for the improvement of the preanalytical phase. The aim of this study was to review the evolution of quality indicators (QI) and the comparability of established performance specifications (PS) with other EQA programmes. Methods: In the SEQCML programme, participants were asked to register rejections of the main specimens and the causes for rejections. Data collected from 2014 to 2017, and then reviewed biennially (2018-2019), was used to calculate the percentiles; p25, p50, p75, and p90 for every round, and their means were set as PS. These PS were compared with the results of other programmes. Results: The evolution of QI results for 2018-2019 period showed general maintenance or improvement, e.g., a significant decrease in the number of serum samples with a haemolytic index ≥0.5 g/L, except for EDTA and citrate samples handle, maybe for an improvement in detection. The comparison with PS for the QI of the IFCC Working Group "Laboratory Errors and Patient Safety" and the Key Incident Management and Monitoring System (KIMMS) programme of the RCPA showed comparable results, supporting the validity of the established specifications. Conclusions: The PS obtained are a helpful tool for benchmarking and to identify processes of the preanalytical phase whose improvement should be set as a priority.

Evaluation of different phenotypic methods to detect methicillin resistance in Staphylococcus aureus isolates recovered from cystic fibrosis patients.

Methicillin-resistant Staphylococcus aureus (MRSA) detection in cystic fibrosis (CF) is challenging. We compared different phenotypic methods among 157 S. aureus from 136 CF-patients: cefoxitin (FOX) and oxacillin (OXA) broth-microdilution; MicroScan-WalkAway®; FOX and OXA disk-diffusion (DD), and PBP2a-latex agglutination. PCR detection of mecA/mecC was the gold standard. Growth on ChromIDTM-MRSA agar was evaluated and compared with that of 157 blood culture (BC) isolates. ChromIDTM-MRSA was also tested on sputa from 111 CF-patients. 32 isolates (20%) were mecA-positive. Both FOX DD and MicroScan-WalkAway® (FOX/OXA) showed the highest sensitivity and specificity (100% and 100%, 96.9% and 99.2%, 96.9% and 100%). ChromIDTM-MRSA showed an excellent sensitivity for BC and CF-isolates (100% and 96.9%) but a poorer specificity for CF ones (95.5% vs. 73.7%), which was also observed when samples were seeded on this medium. FOX DD and MicroScan-WalkAway® are suitable for MRSA detection among CF-isolates and should be used to confirm ChromIDTM-MRSA positive CF-cultures.

Evaluación de la satisfacción de pacientes en cesación de tabaquismo mediante la utilización de telemedicina en la Cátedra y Servicio de Neumología del Hospital de Clínicas / Evaluation of the patient's satisfaction in smoking cessation through the use of telemedicine in the Chair and Department of Pneumology of the Hospital de Clínicas

El tabaquismo es una importante causa de enfermedad y muerte debido a neoplasias, enfermedades cardiovasculares y pulmonares, provocando además disminución de la productividad y aumento de la pobreza. La telemedicina es una de las innovaciones principales en los servicios de salud, especialmente en el contexto de la pandemia de COVID19 que dificulta la atención presencial. Se ha evidenciado en los pacientes, un grado de satisfacción elevado, un aspecto importante al momento de valorar la calidad de la atención médica prestada y justificar las innovaciones

Smoking is an important cause of illness and death due to neoplasms, cardiovascular and pulmonary diseases, also causing a decrease in productivity and an increase in poverty. Telemedicine is one of the main innovations in health services, especially in the context of the COVID19 pandemic that makes face-to-face care difficult. A high degree of patient satisfaction has been evidenced, an important aspect when assessing the quality of medical care provided and justifying innovations

Ethical guidelines on cardiopulmonary resuscitation in the context of the COVID-19 pandemic in Colombia / [Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia].

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.

La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos. Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar.

Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia / Ethical guidelines on cardiopulmonary resuscitation in the context of the COVID-19 pandemic in Colombia

La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos. Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar.

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.

Frecuencia y perfil del uso de cigarrillos electrónicos en estudiantes de una Universidad Pública / Frequency and profile of the electronic cigarettes use in students of a Public University

Introducción: El consumo de Cigarrillos electrónicos (CE) ha aumentado considerablemente en los últimos años. Estos productos son ahora los más comúnmente utilizados por la juventud en diversos países del mundo y nuestro país no está exento de su utilización. En este contexto se ha realizado el presente estudio; cuyo objetivo fue conocer la frecuencia de uso de cigarrillo electrónico y otras características del consumo de CE en universitarios. Materiales y Métodos: Estudio observacional, descriptivo. Se procesaron datos de 1500 estudiantes de diferentes Unidades Académicas de la UNA que respondieron a la encuesta electrónica. Se determinaron variables demográficas como sexo y edad, particularidades sobre los CE relacionadas a la preferencia por determinado dispositivo, motivaciones para el consumo, simultaneidad de consumo de cigarrillo común, así como la percepción de riesgo con respecto al mismo y las molestias ocasionadas por vapear. La encuesta fue anónima y realizada entre los meses de junio y julio del año 2019 mediante la plataforma libre Google Form. Para el procesamiento de datos se utilizó la planilla Excel. Los estudiantes recibieron vía aplicación de mensajería instantánea un link para responder el cuestionario, el mismo fue distribuido por grupos de docentes y delegados de los cursos de cada unidad académica. Resultados: Respondieron a la encuesta un total de 1500 alumnos, 502 hombres (33,5%) y 998 mujeres (66,5%). El promedio de edad fue de 24 años (DE: ± 3.2), con edades comprendidas entre los 17 y 62 años. Al preguntar sobre el hábito de fumar o vapear los estudiantes respondieron: No fuma ninguno 1222 (81 %), consume cigarrillos electrónicos: 74(5 %), 146 (10%) consumen cigarrillo común y un total de 58(4%) consumen ambos productos. Considerando el total de consumidores de CE y aquellos que utilizan ambos (CE y Cigarrillo común), tenemos una frecuencia de 132 consumidores de CE (9%). Percepción de riesgo con respecto a cigarrillos comunes: Ningún riesgo 32 (24%), pequeño riesgo: 54 (41%), riesgo moderado: 34 (26%), alto riesgo: 9 (7%) e igual riesgo: 3 (2%). Entre las molestias más frecuentes: tos 27 (20%), irritación de garganta 20 (15%), dolor de cabeza 6 (5 %) y malestar general 4 (3%). Conclusión: El uso de CE se aproxima al consumo de cigarrillo común y los universitarios no son conscientes sobre los daños potenciales que confiere el uso de estos dispositivos. Para prevenir y reducir el uso de cigarrillos electrónicos por los jóvenes y los adultos jóvenes debemos poner en práctica estrategias de prevención efectivas.

Introduction: The consumption of Electronic Cigarettes (EC) has increased considerably in recent years. These products are now the most commonly used by youth in various countries of the world and our country is not exempt from their use. In this context, the present study has been carried out; whose objective was to know the frequency of use of electronic cigarettes and other characteristics of CE consumption in university students. Materials and methods: Observational, descriptive study. Data from 1500 students from different UNA Academic Units that responded to the electronic survey were processed. Demographic variables such as sex and age, peculiarities on EC related to the preference for a certain device, motivations for consumption, simultaneity of consumption of common cigarettes, as well as the perception of risk with respect to it and the discomfort caused by vaping were determined. The survey was anonymous and carried out between the months of June and July of the year 2019 through the free platform Google Forms. The Excel spreadsheet was used for data processing. The students received a link via instant messaging application to answer the questionnaire, it was distributed by groups of teachers and delegates of the courses of each academic unit. Results: A total of 1500 students answered the survey, 502 men (33.5%) and 998 women (66.5%). The average age was 24 years (SD: ±16), with ages between 17 and 62 years. When asked about the habit of smoking or vaping, the students answered: 1222 (81%) do not smoke, use electronic cigarettes: 74 (5%), 146 (10%) use a regular cigarette and a total of 58 (4%) use both products. Considering the total of EC consumers and those who use both (EC and Common Cigarette), we have a frequency of 132 EC consumers (9%). Perception of risk with respect to common cigarettes: No risk 32 (24%), small risk: 54 (41%), moderate risk: 34 (26%), high risk: 9 (7%) and equal risk: 3 (2 %). Among the most frequent complaints: cough 27 (20%), throat irritation 20 (15%), headache 6 (5%) and general discomfort 4 (3%). Conclusion: The use of EC is close to the consumption of common cigarettes and the university students are not aware of the potential damage that the use of these devices confers. To prevent and reduce the use of electronic cigarettes by youth and young adults, we must implement effective prevention strategies.

Corrigendum to: Preanalytical issues related to routine and diagnostic glucose tests: Results from a survey in Spain.

[This corrects the article DOI: 10.11613/BM.2020.010704.].

Influence of study model, baseline catalytic concentrations and analytical system on the stability of serum alanine aminotransferase.

Objectives: The stability of the analytes most commonly used in routine clinical practice has been the subject of intensive research, with varying and even conflicting results. Such is the case of alanine aminotransferase (ALT). The purpose of this study was to determine the stability of serum ALT according to different variables. Methods: A multicentric study was conducted in eight laboratories using serum samples with known initial catalytic concentrations of ALT within four different ranges, namely: <50 U/L (<0.83 µkat/L), 50-200 U/L (0.83-3.33 µkat/L), 200-400 U/L (3.33-6.67 µkat/L) and >400 U/L (>6.67 µkat/L). Samples were stored for seven days at two different temperatures using four experimental models and four laboratory analytical platforms. The respective stability equations were calculated by linear regression. A multivariate model was used to assess the influence of different variables. Results: Catalytic concentrations of ALT decreased gradually over time. Temperature (-4%/day at room temperature vs. -1%/day under refrigeration) and the analytical platform had a significant impact, with Architect (Abbott) showing the greatest instability. Initial catalytic concentrations of ALT only had a slight impact on stability, whereas the experimental model had no impact at all. Conclusions: The constant decrease in serum ALT is reduced when refrigerated. Scarcely studied variables were found to have a significant impact on ALT stability. This observation, added to a considerable inter-individual variability, makes larger studies necessary for the definition of stability equations.

Preanalytical issues related to routine and diagnostic glucose tests: Results from a survey in Spain.

INTRODUCTION: Diabetes mellitus (DM) is one of the most prevalent diseases worldwide. The objective of this study was to find out under what preanalytical conditions routine and diagnostic glucose tests are performed across Spanish laboratories; and also what criteria are used for DM diagnosis. MATERIALS AND METHODS: An online survey was performed by the Commission on Quality Assurance in the Extra-Analytical Phase of the Spanish Society of Laboratory Medicine (SEQC-ML). Access to the questionnaire was available on the home page of the SEQC-ML website during the period April-July 2018. Data analysis was conducted with the IBM SPSS© Statistics (version 20.0) program. RESULTS: A total of 96 valid surveys were obtained. Most laboratories were in public ownership, serving hospital and primary care patients, with high and medium workloads, and a predominance of mixed routine-urgent glucose testing. Serum tubes were the most used for routine glucose analysis (92%) and DM diagnosis (54%); followed by lithium-heparin plasma tubes (62%), intended primarily for urgent glucose testing; point-of-care testing devices were used by 37%; and plasma tubes with a glycolysis inhibitor, mainly sodium fluoride, by 19%. Laboratories used the cut-off values and criteria recognized worldwide for DM diagnosis in adults and glucose-impaired tolerance, but diverged in terms of fasting plasma glucose and gestational DM criteria. CONCLUSION: Preanalytical processing of routine and DM diagnostic glucose testing in Spain does not allow a significant, non-quantified influence of glycolysis on the results to be ruled out. Possible adverse consequences include a delay in diagnosis and possible under-treatment.

N-Terminal Pro B-Type Natriuretic Peptide's Usefulness for Paroxysmal Atrial Fibrillation Detection Among Populations Carrying Cardiovascular Risk Factors.

Background: Atrial fibrillation (AF) systematic screening studies have not shown a clear usefulness in stroke prevention, as AF might present as paroxysmal and asymptomatic. This study aims to determine the usefulness of some blood-biomarkers to identify paroxysmal atrial fibrillation in the context of a screening programme. Methods: A total of 100 subjects aged 65-75 years with hypertension and diabetes were randomly selected. AF was assessed by conventional electrocardiogram (ECG) and 4 weeks monitoring with a wearable Holter device (Nuubo™). N-terminal pro B-type natriuretic peptide (NT-proBNP), apolipoprotein CIII (ApoC-III), von Willebrand factor (vWF), ADAMTS13, urokinase plasminogen activator surface receptor (uPAR), and urokinase plasminogen activator (uPA) were determined in serum/plasma samples and the levels were compared depending on AF presence and mode of detection. Results: The AF prevalence in the studied population was found to be 20%. In seven subjects, AF was only detected after 1 month of Holter monitoring (hAF group). NT-proBNP levels were higher in subjects with AF compared with subjects with no AF (p < 0.0001), even when only taking into account the hAF group (p = 0.031). No significant differences were found in the other biomarkers. The NT-proBNP >95 pg/ml cut-off showed high sensitivity and specificity to detect AF (95%, 66.2%) or hAF (85.72%, 66.2%) and was found to be an independent predictor of AF and hAF in a logistic regression analysis. NT-proBNP correlated with AF burden (r = 0.597, p = 0.024). Conclusion: NT-proBNP was elevated in AF cases not identified by ECG; thus, it may be used as a screening biomarker in asymptomatic high-risk populations, with a promising cut-off point of 95 pg/ml that requires further validation.

Tres claves para seleccionar el antibiótico oral adecuado en las infecciones respiratorias / Three keys to the appropriate choice of oral antibiotic treatment in the respiratory tract infections

La exacerbación de la enfermedad pulmonar obstructiva crónica y la neumonía adquirida en la comunidad son las infecciones del tracto respiratorio inferior más frecuentes en la práctica clínica diaria. La selección del antibiótico es un componente crucial en su tratamiento y, en la mayoría de las ocasiones, se realiza de forma empírica. Las sociedades científicas elaboran recomendaciones terapéuticas basadas en la evidencia científica y/o recomendaciones de expertos que son de gran ayuda para los clínicos. Los betalactámicos, las fluoroquinolonas y los macrólidos son los fármacos más utilizados por vía oral. Desde un punto de vista práctico, existen tres claves para la adecuada elección del tratamiento antibiótico oral, que son la efectividad, la seguridad y el impacto ecológico en la microbiota del paciente, incluyendo el desarrollo de resistencias, que van a ser valoradas en profundidad en esta revisión

Exacerbation of chronic obstructive pulmonary disease and community-acquired pneumonia are the most frequent infections of the lower respiratory tract in daily clinical practice. Antibiotic selection is a crucial component in its treatment and, in most cases, it is performed empirically. Scientific societies make therapeutic recommendations based on scientific evidence and / or expert recommendations that are of great help to clinicians. Beta-lactams, fluoroquinolones and macrolides are the most commonly used drugs for oral administration. From a practical point of view, there are three keys to the appropriate choice of oral antibiotic treatment, which are the effectiveness, safety and the ecological impact on the patient's microbiota, including the development of resistance, which will be assessed in depth in this review

Hypermucoviscous Klebsiella pneumoniae: A challenge in community acquired infection.

In 1986, a new syndrome was described in Taiwan secondary to hypervirulent K. pneumoniae (hvKP), and its main feature was the ability to cause severe infection in young and immunocompetent hosts. Their virulence is explained by the efficient acquisition of iron and an increase in capsule production, which confer the characteristic hypermucoviscous phenotype. Most of these cases have been described in Asia and subsequently spread to America and Europe, where their prevalence is much lower. We present four cases of bacteremia and liver abscesses secondary to hypervirulent K. pneumoniae, two of them associated with endophthalmitis. K. pneumoniae isolates recovered from two of the patients belonged to capsular serotype K1 (genes wzx_K1 and magA), while the other two were K2 (gene wzy_K2). Both of the K1 isolates were classified into a ST23, and isolates of serotype K2 belonged to the ST375 and ST881 clones. In Europe, hvKP isolates are less frequently recovered, mostly associated with Asian citizens or travelers, which was not the case in our patients. K1 capsular serotype is a major cause of primary liver abscess and secondary septic embolus, and K2 is associated with secondary liver abscess. Although these hypervirulent variants usually affect immunocompetent patients as in our cases, diabetes mellitus is a major risk factor for the most invasive cases, with concomitant poor prognosis. Identification of hypervirulent K. pneumoniae serotypes K1 and K2 should be considered as part of the microbiological diagnosis of community-acquired liver abscess due to their clinical implications.