Associations Between Hypertension, Angiotensin-Converting Enzyme Inhibitors, and Physical Performance in Very Old Adults: Results from the ilSIRENTE Study.

BACKGROUND: Results regarding the associations between hypertension-related parameters and physical performance in older adults are conflicting. A possible explanation for these divergent results is that investigations may not have adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). OBJECTIVES: To examine the associations between hypertension-related parameters, ACEI use, and a set of physical performance tests in very old adults. DESIGN: Cross-sectional study from the ilSIRENTE database. SETTING: Mountain community of the Sirente geographic area (L'Aquila, Abruzzo, Italy). PARTICIPANTS: All persons born in the Sirente area (13 municipalities) before 1 January 1924 and living in that region at the time of study were identified and invited to participate. The final sample included 364 older adults (mean age: 85.8 ± standard deviation [SD] 4.8). MEASUREMENTS: Physical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at normal and fast pace, 5-time sit-to-stand test (5STS), and muscle power measures. Blood pressure (BP) was measured after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. ACEIs were categorized in centrally (ACEI-c) and peripherally (ACEI-p) acting. Blood inflammatory markers, free insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3 (IGFBP-3) were assayed. RESULTS: Results indicated that 5STS test was significantly and negatively associated with diastolic BP values. However, significance was lost when results were adjusted for ACEI use. Participants on ACEIs were more likely to have greater specific muscle power and higher blood levels of IGFBP-3 than non-ACEI users. When participants were categorized according to ACEI subtypes, those on ACEI-p had higher blood IGF-1 levels compared with ACEI-c users. CONCLUSIONS: The main findings of the present study indicate that ACEI use might influence the association between hypertension-related parameters and neuromuscular parameters in very old adults. Such results may possibly be linked to the effects of ACEI-p on the IGF-1 pathway.

Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait.

PURPOSE: To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales. METHODS: This cross-sectional study involved 22 adults between 18 and 70 years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128 Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences. RESULTS: Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT. CONCLUSIONS: In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.

Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy.

BACKGROUND: Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS: Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS: 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS: In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.

Causas de ataxia aguda en un hospital de tercer nivel de complejidad / Causes of acute ataxia at a tertiary level hospital

La ataxia es una alteración de la coordinación motora voluntaria y del control postural. Es una entidad poco frecuente en la infancia, siendo la principal causa de ataxia aguda descripta en la bibliografía, de origen inmunológico (post infecciosa), seguida de las intoxicaciones. Para el diagnóstico es fundamental una anamnesis detallada, cronología de los síntomas, antecedentes infecciosos o de contacto con sustancias tóxicas y un examen neurológico completo. El objetivo de nuestro estudio fue analizar retrospectivamente la causa de ataxia aguda como signo neurológico predominante en pacientes que consultaron en el Hospital Juan P. Garrahan. Diseño: Se trata de un estudio descriptivo, observacional, retrospectivo y de corte transversal. Población: niños de 1 a 18 años, con o sin patología previa conocida, que consultaron al servicio de emergencias del hospital por ataxia entre enero de 2013 y octubre de 2018. Método: recolección y análisis de historias clínicas comprendidas en esa fecha, con alteración en la marcha como síntoma de consulta. Resultados: de un total de 237 pacientes, la causa más frecuente de ataxia aguda fue la inmunológica (incluyendo en este grupo a las postinfecciosas y a las no asociadas a infección). Conclusión: En nuestro hospital con tercer nivel de atención, la causa más frecuente de ataxia aguda fue la inmunológica. En segundo lugar, las intoxicaciones y, en tercer lugar, las enfermedades neurológicas. (AU)

Ataxia is a disorder of voluntary motor coordination and postural control, which is rare in childhood. The main cause of acute ataxia described in the literature is immune-mediated inflammation (postinfectious), followed by intoxication. A detailed anamnesis, chronology of symptoms, history of infection or contact with toxic substances, and a complete neurological examination are essential in the diagnostic work-up. The aim of our study was to retrospectively analyze the cause of acute ataxia as a predominant neurological sign in patients who consulted at Hospital Juan P. Garrahan. Study design: A descriptive, observational, retrospective, cross-sectional study was conducted. Study population: children aged 1 to 18 years, with or without known previous disease, who presented to the hospital emergency department for ataxia between January 2013 and October 2018. Method: collection and analysis of medical records from that period of patients with gait disturbance as the reason for consultation. Results: out of a total of 237 patients, the most frequent cause of acute ataxia was immune-mediated inflammation (both post-infectious and noninfectious). Conclusion: In our tertiary care hospital, the most frequent cause of acute ataxia was immune-mediated inflammation. The second most frequent cause was intoxication and the third neurological diseases (AU)

COVID-19 pneumonia: Relationship between initial chest X-rays and laboratory findings.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (P<.05 for platelets, P<.01 for lymphocytes, and P<.001 for the remaining parameters), as well as with the time from the onset of symptoms (P<.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings. / Neumonía COVID-19: relación entre la radiografía de tórax inicial y los datos analíticos.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (p<0.05 for platelets, p<0.01 for lymphocytes, and p<0.001 for the remaining parameters), as well as with the time from the onset of symptoms (p<0.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

Evaluación y apoyo nutricional en el paciente pediátrico críticamente enfermo: Revisión de la literatura

RESUMEN Esta revisión se basa en la mejor evidencia actualmente disponible, y en ella se definen las directrices en relación con la evaluación y manejo nutricional en niños críticamente enfermos. Estas directrices incluyen, los criterios para la detección de la malnutrición, tanto por déficit o exceso, así como, se identifican las recomendaciones y consensos de expertos sobre la estimación energética y de macronutrientes, los cuales pueden ser determinantes en prevenir tanto la sobrealimentación como subalimentación. También se señalan las recomendaciones internacionales sobre el momento de inicio del soporte nutricional para que esta sea oportuna, efectiva y segura, eligiendo la vía de alimentación según condición clínica y tipo de patología en función de disminuir el riesgo de morbimortalidad de estos pacientes. A modo general, se sugiere intensificar la investigación científica, con el fin de disponer de mejor evidencia para diseñar protocolos clínicos internacionales y locales para el manejo nutricional del paciente pediátrico críticamente enfermo.

ABSTRACT This review is based on the best evidence currently available and defines the guidelines for the nutritional assessment and management of critically ill children. These guidelines include the criteria for detecting malnutrition, whether due to deficit or excess, as well as the recommendations and consensus of experts on the estimation of energy and macronutrients, which can be decisive in preventing both overfeeding and underfeeding. International recommendations on the time of initiation of nutritional support are also indicated so that it is timely, effective and safe. Choice of feeding route according to clinical condition and pathology type in order to reduce the risk of morbi-mortality of these patients are discussed. In general, an increase in scientific research is suggested, in order to have better evidence to design international and local clinical protocols for the nutritional management of critically ill pediatric patients.

[Feeding behavior, dietary sufficiency and nutritional status in children between 6 and 18 months]. / Comportamiento alimentario, suficiencia dietaria y estado nutricional en niños entre 6 a 18 meses.

INTRODUCTION: Infant feeding has specific qualitative and quantitative characteristics. The influence of parents on food intake is crucial in the development of habits and an adequate nutritional state. OBJECTIVE: To evaluate eating behavior, dietary characteristics, and nutritional status of children between 6 to 18 months. SUBJECTS AND METHOD: Cross-sectional descriptive study in 199 children. Using convenience sampling, demographic and anthropometric data were recorded for nutritional status, and dietary history, through a 24-hour reminder for dietary behavior and food sufficiency. The Student's t-test and one-way ANOVA were applied for continuous variables and the chi-square test for the categori cal ones. RESULTS: 54.8% were women. Regarding nutritional status, 21.1% were overweight and 7.6% obese. 56.8% of the children had meal numbers according to their age. The average energy intake was 652.9 ± 224.2 calories per day. The intake of energy and macronutrients was significantly higher in children not consuming breast milk and aged 12 to 18 months. The energy, lipids, and carbohydrates adequacy in girls was significantly higher than in boys. 83.1% of food consumption was habitual for this age group. CONCLUSION: In eating behavior, we observed that 4 out of 10 children have meal numbers higher than suggested for their ages. Regarding dietary sufficiency, there is a higher intake in children with normal nutritional status, without breastfeeding, and between 12 and 18 months. Despite the high prevalence of obesity, it was lower than that observed at the national level.

Recomendaciones y efectos de la fibra dietaria en niños / Recommendations and effects of dietary fiber for children

Conocida es la influencia de la fibra dietaria sobre los efectos mecánicos a nivel gastrointestinal, la composición y modulación de la microbiota intestinal y su función en la actividad metabólica y nutricional en adultos. En niños y adolescentes estos efectos son menos conocidos, generando interesantes áreas de investigación y desarrollo científico que nos puedan entregar mayor conocimiento de sus repercusiones a nivel fisiológicos y fisiopatológicos. Esta revisión tiene como objetivo entregar información actualizada sobre las diferentes clasificaciones de fibra, sus principales funciones digestivas y metabólicas, así como las recomendaciones de ingesta diaria en pediatría.

Among adults, the influence of dietary fiber on mechanical effects at the gastrointestinal level, the composition and modulation of the intestinal microbiota and function in the metabolic and nutritional activity is known. However, in children and adolescents, these effects are less known, generating interesting areas of research and development that could provide additional knowledge at the physiological and pathophysiological level. The aim of this review was to provide updated information about the different classifications of fiber, the principal digestive and metabolic functions, as well as recommendations for daily intake for pediatric populations.

The Long-Term Impairment in Redox Homeostasis Observed in the Hippocampus of Rats Subjected to Global Perinatal Asphyxia (PA) Implies Changes in Glutathione-Dependent Antioxidant Enzymes and TIGAR-Dependent Shift Towards the Pentose Phosphate Pathways: Effect of Nicotinamide.

We have recently reported that global perinatal asphyxia (PA) induces a regionally sustained increase in oxidized glutathione (GSSG) levels and GSSG/GSH ratio, a decrease in tissue-reducing capacity, a decrease in catalase activity, and an increase in apoptotic caspase-3-dependent cell death in rat neonatal brain up to 14 postnatal days, indicating a long-term impairment in redox homeostasis. In the present study, we evaluated whether the increase in GSSG/GSH ratio observed in hippocampus involves changes in glutathione reductase (GR) and glutathione peroxidase (GPx) activity, the enzymes reducing glutathione disulfide (GSSG) and hydroperoxides, respectively, as well as catalase, the enzyme protecting against peroxidation. The study also evaluated whether there is a shift in the metabolism towards the penthose phosphate pathway (PPP), by measuring TIGAR, the TP53-inducible glycolysis and apoptosis regulator, associated with delayed cell death, further monitoring calpain activity, involved in bax-dependent cell death, and XRCC1, a scaffolding protein interacting with genome sentinel proteins. Global PA was induced by immersing fetus-containing uterine horns removed by a cesarean section from on term rat dams into a water bath at 37 °C for 21 min. Asphyxia-exposed and sibling cesarean-delivered fetuses were manually resuscitated and nurtured by surrogate dams. Animals were euthanized at postnatal (P) days 1 or 14, dissecting samples from hippocampus to be assayed for glutathione, GR, GPx (all by spectrophotometry), catalase (Western blots and ELISA), TIGAR (Western blots), calpain (fluorescence), and XRCC1 (Western blots). One hour after delivery, asphyxia-exposed and control neonates were injected with either 100 µl saline or 0.8 mmol/kg nicotinamide, i.p., shown to protect from the short- and long-term consequences of PA. It was found that global PA produced (i) a sustained increase of GSSG levels and GSSG/GSH ratio at P1 and P14; (ii) a decrease of GR, GPx, and catalase activity at P1 and P14; (iii) a decrease at P1, followed by an increase at P14 of TIGAR levels; (iv) an increase of calpain activity at P14; and (v) an increase of XRCC1 levels, but only at P1. (vi) Nicotinamide prevented the effect of PA on GSSG levels and GSSG/GSH ratio, and on GR, GPx, and catalase activity, also on increased TIGAR levels and calpain activity observed at P14. The present study demonstrates that the long-term impaired redox homeostasis observed in the hippocampus of rats subjected to global PA implies changes in GR, GPx, and catalase, and a shift towards PPP, as indicated by an increase of TIGAR levels at P14.

Author Correction: Unprecedented rains decimate surface microbial communities in the hyperarid core of the Atacama Desert.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Unprecedented rains decimate surface microbial communities in the hyperarid core of the Atacama Desert.

The hyperarid core of the Atacama Desert, the driest and oldest desert on Earth, has experienced a number of highly unusual rain events over the past three years, resulting in the formation of previously unrecorded hypersaline lagoons, which have lasted several months. We have systematically analyzed the evolution of the lagoons to provide quantitative field constraints of large-scale impacts of the rains on the local microbial communities. Here we show that the sudden and massive input of water in regions that have remained hyperarid for millions of years is harmful for most of the surface soil microbial species, which are exquisitely adapted to survive with meager amounts of liquid water, and quickly perish from osmotic shock when water becomes suddenly abundant. We found that only a handful of bacteria, remarkably a newly identified species of Halomonas, remain metabolically active and are still able to reproduce in the lagoons, while no archaea or eukaryotes were identified. Our results show that the already low microbial biodiversity of extreme arid regions greatly diminishes when water is supplied quickly and in great volumes. We conclude placing our findings in the context of the astrobiological exploration of Mars, a hyperarid planet that experienced catastrophic floodings in ancient times.

Influencia de la Actividad Física en la Sintomatología del Síndrome Premenstrual en universitarias / Influence of Physical Activity on Symptoms of the Syndrome Premenstrual in college girls

RESUMEN Objetivo: Determinar la influencia de la actividad física en la sintomatología del síndrome premenstrual en un grupo de mujeres de la Facultad de Medicina de la Universidad de Concepción. Métodos: Estudio observacional, descriptivo, transversal, realizado en 340 mujeres escogidas al azar de edades entre 18 a 27 años, estudiantes de la Facultad de Medicina de la Universidad de Concepción. Se utilizaron instrumentos validados para población chilena, como los criterios para el diagnóstico del trastorno disfórico premenstrual DSM-IV-TR, la Escala Visual Análoga (EVA) para la medición del dolor y el Cuestionario Internacional de Actividad Física (IPAQ) para la intensidad de esta. Los datos se obtuvieron por medio de encuestas autoadministradas y los resultados se analizaron mediante pruebas estadísticas. Resultados: Un 55,9% (n=190) presenta Síndrome premenstrual según los criterios utilizados. Los principales síntomas manifestados fueron: fatiga y falta de energía en un 64,7% (n=220), hipersensibilidad mamaria, cefalea e hinchazón en un 62,9% (n=214) y ansiedad, tensión, agobio y colapso en un 60,9% (n=207). Del total de encuestadas, el mayor porcentaje (42,6%) (n=145) realiza actividad física moderada. Al cruzar las variables de actividad física y la sintomatología del síndrome premenstrual se estableció que no existía relación entre ellas (valor p=0,605). Conclusiones: la actividad física no tiene influencia sobre la disminución de la sintomatología del síndrome premenstrual en la población estudiada.

ABSTRACT Objectives: Determine the influence of physical activity on the symptoms of premenstrual syndrome in females students of the Faculty of Medicine, Universidad de Concepción, Concepción Campus in 2014 Methods: A cross sectional study was applied to 340 randomly selected women aged between 18-27 years old belonging to the Faculty of Medicine of the Universidad de Concepción. Data were obtained through self-administered surveys and the results were analyzed by the respective statistical techniques. Results: Of the sample (n = 340), 55.9% (n = 190) had premenstrual syndrome according to the canon used. The main symptoms manifested were fatigue and lack of energy in 64.7% (n = 220), breast tenderness, headache and swelling in 62.9% (n = 214) and anxiety, stress, overwhelm and collapse into a 60.9% (n = 207). Of the total of the participants, the highest percentage (42.6%) (n = 145) performs moderate physical activity. When the variables of physical activity and premenstrual syndrome were crossed, was established that it did not exist relationship between them (p value = 0.605). Conclusions: With the obtaining and analyzing of the results, it seems that physical activity does not have major influence on the symptoms of premenstrual syndrome in the population studied.

Dislipidemia en niños y adolescentes con historia familiar de enfermedad cardiovascular precoz / Dyslipidemia in children and adolescents with a family history of early cardiovascular disease

INTRODUCTION: In Chile, cardiovascular diseases (CVD) represent the first cause of mortality. The risk of CVD is greater if other factors are associated, among which the family history of CVD acquires special relevance due it represents an independent risk factor of atherogenesis. Aim: To evaluate cardiovascular risk markers: lipid profile, hsCRP and nutritional status in children and adolescents with positive family history of early cardiovascular disease. SUBJECTS AND MATERIALS: Descriptive-transversal study. 138 children and adolescents with a mean age of 13,1 +/- 5,4 years were studied. Anthropometric measurements, blood pressure, lipid profile and hsCRP were evaluated. RESULTS: Dyslipidemia was found in 55,1 percent of the studied population, that was mainly characterized by hypertryglyceridemia and decreased levels of HDL-chol (39,1 percent). In the total of dyslipidemic subjects, 10,5 percent showed 3 altered lipid parameters (total chol, tryglicerides and HDL-chol), 22,4 percent presented 2 parameters that were out the reference range (tryglicerides and HDL-chol) and the 34,2 percent had only one lipid parameter altered (low levels of HDL-chol or hypertriglyceridemia). Dyslipidemia was observed in 69,1 percent, of the overweight and obese population and it was 40,6 percent in the normal weight subjects. hsCRP concentrations were higher in dyslipidemic and overweight and obese individuals. CONCLUSIONS: Dyslipidemia was highly frequent in children and adolescents with positive family history of early CVD and even higher in those overweight and obese subjects. These findings support the screening of dyslipidemia in children and adolescents with positive family history of early CVD.