Survey-Based Assessment of the Quality of Reporting Guidelines of Carotid Artery Stenosis.

BACKGROUND: No evaluation of the quality of different carotid guidelines using validated scales has been performed to date. The present study aims to analyze 3 carotid stenosis guidelines, apprizing their quality and reporting using validated tools. METHODS: A survey-based assessment of the quality of the European Society for Vascular Surgery (ESVS) 2023, European Stroke Organisation (ESO) 2021, and the Society for Vascular Surgery (SVS) 2021 carotid stenosis guidelines, was performed by 43 vascular surgeons, cardiologists, neurologist or interventional radiologists using 2 validated appraisal tools for quality and reporting guidelines, the AGREE II instrument and the RIGHT statement. RESULTS: Using the AGREE II tool, the ESVS, SVS, and ESO guidelines had overall quality scores of 87.3%, 79.4%, and 82.9%, respectively (P = 0.001) The ESVS and ESO had better scores in the scope and purpose domain, and the SVS in the clarity of presentation domain. In the RIGHT statement, the ESVS, SVS, and ESO guidelines had overall quality scores of 84.0.7%, 74.3%, and 79.0%, respectively (P = 0.001). All 3 guidelines stood out for their methodology for search of evidence and formulating evidence-based recommendations. On the contrary, were negatively evaluated mostly in the cost and resource implications in formulating the recommendations. CONCLUSIONS: The 2023 ESVS carotid stenosis guideline was the best evaluated among the 3 guidelines, with scores over 5% higher than the other 2 guidelines. Efforts should be made by guideline writing committees to take the AGREE II and RIGHT statements into account in the development of future guidelines to produce high-quality recommendations.

Caffeine supplementation improves physical performance without affecting fatigue level: a double-blind crossover study.

This study examined the effect of caffeine supplementation (CAFF) in a Wingate test (WT), and the behaviour of blood lactate concentrations (BLa) and neuromuscular fatigue (NMF), measured as reduced countermovement jump (CMJ) performance, in response to the WT. In a double-blind crossover study, 16 participants attended the laboratory twice, separated by a 72-hour window. In the sessions, participants first ingested 6 mg·kg-1 of either CAFF or placebo (PLAC), and then performed a WT. BLa was measured before (L-pre), and 0.5 min (L-post-0.5) and 3.5 min (L-post-3.5) after conducting the WT. The CMJ test was conducted before (CMJ pre), after (CMJ post), and 3 min after completing (CMJ post-3) the WT. The results indicated that CAFF enhanced peak power (Wpeak: + 3.22%; p = 0.040), time taken to reach Wpeak (T_Wpeak: -18.76%; p = 0.001) and mean power (Wmean: + 2.7%; p = 0.020). A higher BLa was recorded for CAFF at L-post-0.5 (+ 13.29%; p = 0.009) and L-post-3.5 (+ 10.51%; p = 0.044) compared to PLAC. CAFF improved peak power (PP; + 3.44%; p = 0.003) and mean power (MP; + 4.78%; p = 0.006) at CMJ pre, compared to PLAC, whereas PP and MP were significantly diminished at CMJ post and CMJ post-3 compared to pre (p < 0.001 for all comparisons) under both the CAFF and PLAC conditions. PP and MP were increased at post-3 compared to post (p < 0.001 for all comparisons) for both conditions. In conclusion, CAFF increased WT performance and BLa without affecting NMF measured by CMJ. Thus, CAFF may allow athletes to train with higher workloads and enhance the supercompensation effects after an adequate recovery period.

Extensive deep vein thrombosis and pulmonary embolism as a unique clinical manifestation of COVID-19 in a young healthy patient.

BACKGROUND/OBJECTIVE: Deep vein thrombosis and pulmonary embolism have been described as complications in previously diagnosed COVID-19 patients, especially in those admitted in critical ill units, but, to our knowledge, there is no report of venous thromboembolism in an otherwise asymptomatic COVID-19 patient. METHODS: We report the case of a 22-year-old female, healthy patient with pulmonary embolism (Pulmonary Embolism Severity Index Score 22 points, low risk) and extensive proximal deep vein thrombosis as a unique clinical manifestation of the new coronavirus disease. RESULTS: The patient had no risk factors and no familial history of venous thromboembolism. All thrombophilia markers were negative. The patient was treated as first by an independent vascular team, performing vena cava filter placement and open thrombectomy. Her symptoms worsened, and after 3 weeks, she underwent US-enhanced thrombolysis and mechanical thrombectomy. She was isolated for 10 days and did not develop any other clinical manifestation of COVID-19 disease. During follow-up, she remained asymptomatic and complete patency of the venous system was achieved. Full oral anticoagulation was conducted for 6 months. CONCLUSION: COVID-19 appears to be a multi-symptomatic disease, and venous thromboembolism without any other previous described COVID-19 symptom could be considered one of its diverse clinical presentations and RT-PCR for SARS-CoV-2 tests emerge to be mandatory in patients with otherwise unexpected venous thrombosis.

Pseudomonas aeruginosa epidemic high-risk clones and their association with horizontally-acquired ß-lactamases: 2020 update.

Pseudomonas aeruginosa global clones associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) phenotypes, denominated high-risk clones, are a growing threat in hospitals worldwide. Here we provide a 2020 update on nosocomial MDR/XDR high-risk P. aeruginosa clones. According to their prevalence, global spread and association with MDR/XDR profiles and regarding extended-spectrum ß-lactamases (ESBLs) and carbapenemases, the worldwide top 10 P. aeruginosa high-risk clones includes ST235, ST111, ST233, ST244, ST357, ST308, ST175, ST277, ST654 and ST298. ST235 is certainly the most relevant high-risk clone, showing a worldwide dissemination associated with over 60 different ß-lactamase variants, including multiple carbapenemases from classes A and B. Moreover, ST235 shows a highly virulent phenotype associated with a high mortality rate, likely due to the production of the ExoU cytotoxin. ST111 and ST233 are also worldwide disseminated MDR/XDR clones, particularly linked to VIM-2 metallo-ß-lactamase (MBL), whereas ST244 is a very prevalent clone not always associated with MDR/XDR profiles. ST357, ST308 and ST298 are also exoU+ and are therefore potentially associated with higher virulence. In contrast, ST175, prevalent in some European countries, shows a MDR/XDR phenotype frequently caused by specific chromosomal mutations and is associated with lower virulence. Finally, ST277 is highly prevalent in Brazil and is specifically associated with the SPM MBL. A deeper understanding of the underlying factors driving the success of high-risk clones, including the reported increased capacity for acquiring exogenous determinants, increased spontaneous mutation rates or greater ability to develop biofilms, is required to develop global strategies to combat them.

Effects of Cardiorespiratory Exercise on Cognition in Older Women Exposed to Air Pollution.

The aim was to analyze the effects of cardiorespiratory exercise and air pollution on cognition and cardiovascular markers in four groups of older women: the active/clean air group (AC), the active/polluted air group (AP), the sedentary/clean air group (SC), and the sedentary/polluted air group (SP). Active groups performed a training task based on progressive walking. Prior to and after the experiment, the following parameters were assessed: cognition, by Mini Mental State Examination (MMSE); maximum oxygen uptake (VO2max), estimated by the Six-Minute Walk Test (6mWT); heart rate (HR); and oxygen saturation (SpO2). There were significant differences (p < 0.05) between the AC and the SP in all the MMSE dimensions except "Registration", and in all the physiological variables (VO2max, SpO2, HR). Aerobic exercise may be a protective factor against the effects that pollution have on cognition and on the mechanisms of oxygen transport.

Levels of physical activity, health-related quality of life, physical self-concept and body-mass index among Colombian students

Introduction: Physical activity, health-related quality of life, self-concept and body-mass index are indicators of a healthy lifestyle. Objective: To determine the levels of physical activity and sedentary lifestyle, the health-related quality of life, the physical self-concept and the body-mass index in Colombian middle and highschool students. Materials and methods: We included 1,253 students between 10 and 20 years of age (601 men and 652 women) in the study. We used the following instruments for the measurements: A weighing machine, a stadiometer, the International Physical Activity Questionnaire, the 12-Item Short Form Health Survey (SF-12®), and the Physical Self-concept Questionnaire in its Spanish version. Results: The statistical analysis showed higher levels in the body-mass index among female students and higher scores for the physical condition, self-concept and competence among male students, with meaningful statistical differences (p<0,05). Additionally, women had higher scores in moderate and vigorous physical activity, while men had higher scores in walking. Men got higher scores in the dimension of health-related quality of life, except in the social function, which differed significantly from the general health, emotional role, mental health, and vitality dimensions. Conclusions: We found a relation between the body-mass index and the physical condition and competence self-concept, as well as between body-mass index and general health, physical function, mental health and vitality. We also found a relation between a sedentary lifestyle and general health, body pain, and physical role.

Niveles de actividad física, calidad de vida relacionada con la salud, autoconcepto físico eíndice de masa corporal: un estudio en escolares colombianos / Levels of physical activity, health-related quality of life, physical self-concept and body-mass index among Colombian students

Resumen Introducción. La actividad física, la calidad de vida relacionada con la salud, el autoconcepto y el índice de masa corporal son indicadores de un estilo de vida saludable. Objetivo. Determinar el nivel de actividad física y de sedentarismo, la calidad de vida relacionada con la salud, el autoconcepto físico y el índice de masa corporal en escolares colombianos de educación secundaria y media. Materiales y métodos. Participaron en el estudio 1.253 estudiantes entre los 10 y los 20 años (601 hombres y 652 mujeres) (14,62±2,01). Para las mediciones se utilizaron una báscula, un tallímetro, el cuestionario internacional de actividad física, el cuestionario abreviado de salud SF-12® y el cuestionario de autoconcepto físico (CAF) en su versión española. Resultados. Los análisis estadísticos mostraron un mayor índice de masa corporal en las estudiantes, en tanto que en los estudiantes se registraron valores más altos en el autoconcepto de la condición física y la competencia, con diferencias estadísticamente significativas (p<0,05). Además, se encontró que las mujeres registraban mayores puntuaciones en la actividad física moderada y vigorosa, y los hombres, en la caminata. Las puntuaciones fueron mayores en las dimensiones de la calidad de vida relacionada con la salud, excepto en la función social, lo cual difiere significativamente con las de la salud general, el rol emocional, la salud mental y la vitalidad (p<0,05). Conclusiones. Se estableció una relación entre el índice de masa corporal y el autoconcepto de condición física y competencia percibida, y entre el índice de masa corporal y la salud general, la función física, la salud mental y la vitalidad. Asimismo, el sedentarismo se relacionó con la salud en general, el dolor corporal y el rol físico (p<0,05).

Abstract Introduction: Physical activity, health-related quality of life, self-concept and body-mass index are indicators of a healthy lifestyle. Objective: To determine the levels of physical activity and sedentary lifestyle, the health-related quality of life, the physical self-concept and the body-mass index in Colombian middle and high-school students. Materials and methods: We included 1,253 students between 10 and 20 years of age (601 men and 652 women) in the study. We used the following instruments for the measurements: A weighing machine, a stadiometer, the International Physical Activity Questionnaire, the 12-Item Short Form HealthSurvey(SF-12®), and the Physical Self-concept Questionnaire in its Spanish version. Results: The statistical analysis showed higher levels in the body-mass index among female students and higher scores for the physical condition, self-concept and competence among male students, with meaningful statistical differences (p<0,05). Additionally, women had higher scores in moderate and vigorous physical activity, while men had higher scores in walking. Men got higher scores in the dimension of health-related quality of life, except in the social function, which differed significantly from the general health, emotional role, mental health, and vitality dimensions. Conclusions: We found a relation between the body-mass index and the physical condition and competence self-concept, as well as between body-mass index and general health, physical function, mental health and vitality. We also found a relation between a sedentary lifestyle and general health, body pain, and physical role.

Fisiopatología de la obesidad: Perspectiva actual / Pathophysiology of obesity: Current view

RESUMEN La obesidad es una enfermedad crónica de origen multifactorial, asociada a complicaciones de salud potencialmente graves, y con una elevada prevalencia a nivel mundial. Actualmente se considera uno de los principales problemas sociales y de salud que enfrentar en el siglo XXI. El objetivo de este estudio es mostrar el estado actual de la fisiopatología de la obesidad, centrándose en el tejido adiposo. La célula principal del tejido adiposo es el adipocito que convive con otras poblaciones celulares tales como fibroblastos o células inmunes. Debido a factores genéticos y ambientales y su interacción, las personas pueden incrementar los depósitos de tejido adiposo aumentando el tamaño (hipertrofia) o el número de los adipocitos (hiperplasia). La hipertrofia es una respuesta común en todos los estados de obesidad, a menudo asociados con factores patógenos que deterioran la función del tejido adiposo y desarrollan un proceso inflamatorio. Aunque un aumento en la grasa corporal total se asocia con un mayor riesgo para la salud, la cantidad de grasa abdominal, en particular la grasa abdominal visceral, se ha relacionado con un aumento de la comorbilidad y la mortalidad. Es necesario formular mejores propuestas a través de la prevención y tratamientos alternativos a los actuales. Asimismo, realizar importantes esfuerzos institucionales y educativos destinados a promover hábitos alimenticios saludables y programas de ejercicio físico verdaderamente eficaces.

ABSTRACT Obesity is a chronic disease of multifactorial etiology, associated with potentially serious health problems, and with a high worldwide prevalence. Currently it is considered one of the major social and health problems facing the 21st century. The aim of this study is to show the current state of the pathophysiology of obesity, focusing on adipose tissue. The adipocyte is main adipose tissue cell and coexists with other cellular populations such as fibroblasts or immune cells. Because of genetic and environmental factors and their interaction, people may increase adipose tissue deposits by increasing adipocyte size or number (hypertrophy or hyperplasia). Hypertrophy is a common response in obese states, often associated with pathogenic factors that impair adipose tissue function and develop inflammatory processes. Although an increase in total body fat is associated with increased risk to health, the amount of abdominal fat, particularly visceral abdominal fat, has been related with an increase of comorbidity and mortality. It is necessary to formulate better proposals through prevention and alternative treatments to those currently available. Institutional and educational efforts to promote healthy eating habits and effective physical activity programs are equally important.

Hypermutation in Burkholderia cepacia complex is mediated by DNA mismatch repair inactivation and is highly prevalent in cystic fibrosis chronic respiratory infection.

The Burkholderia cepacia complex (Bcc) represents an important group of pathogens involved in long-term lung infection in cystic fibrosis (CF) patients. A positive selection of hypermutators, linked to antimicrobial resistance development, has been previously reported for Pseudomonas aeruginosa in this chronic infection setting. Hypermutability, however, has not yet been systematically evaluated in Bcc species. A total of 125 well characterized Bcc isolates recovered from 48 CF patients, 10 non-CF patients and 15 environmental samples were analyzed. In order to determine the prevalence of mutators their spontaneous mutation rates to rifampicin resistance were determined. In addition, the genetic basis of the mutator phenotypes was investigated by sequencing the mutS and mutL genes, the main components of the mismatch repair system (MRS). The overall prevalence of hypermutators in the collection analyzed was 13.6%, with highest occurrence (40.7%) among the chronically infected CF patients, belonging mainly to B. cenocepacia, B. multivorans, B. cepacia, and B. contaminans -the most frequently recovered Bcc species from CF patients worldwide. Thirteen (76.5%) of the hypermutators were defective in mutS and/or mutL. Finally, searching for a possible association between antimicrobial resistance and hypermutability, the resistance-profiles to 17 antimicrobial agents was evaluated. High antimicrobial resistance rates were documented for all the Bcc species recovered from CF patients, but, except for ciprofloxacin, a significant association with hypermutation was not detected. In conclusion, in the present study we demonstrate for the first time that, MRS-deficient Bcc species mutators are highly prevalent and positively selected in CF chronic lung infections. Hypermutation therefore, might be playing a key role in increasing bacterial adaptability to the CF-airway environment, facilitating the persistence of chronic lung infections.

Unusual diversity of acquired ß-lactamases in multidrug-resistant Pseudomonas aeruginosa isolates in a Mexican hospital.

AIMS: To investigate the presence of extended spectrum and metallo ß-lactamases (MBLs) in Pseudomonas aeruginosa isolates which are resistant to imipenem and ceftazidime that were isolated in a hospital in Mexico. RESULTS: Pulsed-field gel electrophoresis (PFGE) revealed the presence of four clonal types among the 14 isolates. All these genes were found either alone or simultaneously in the P. aeruginosa strains in the following five different arrangements: ; ; ; ; and . Class 1 integrons were detected and contained the cassettes bla(GES-5) and bla(OXA-2), but not that of bla(VIM). bla(VIM) genes occurred only in the chromosome, while bla(GES-5) was located in the chromosome and in the plasmids. CONCLUSIONS: To our knowledge, this is the first description of P. aeruginosa strains simultaneously producing the VIM-2 and VIM-11 variants, and the combination of GES-5 and MBL carbapenemases, which determines a major challenge for the clinical microbiology laboratory and a remarkable epidemiological risk for the nosocomial spread of multidrug-resistant determinants.

Evolution and adaptation in Pseudomonas aeruginosa biofilms driven by mismatch repair system-deficient mutators.

Pseudomonas aeruginosa is an important opportunistic pathogen causing chronic airway infections, especially in cystic fibrosis (CF) patients. The majority of the CF patients acquire P. aeruginosa during early childhood, and most of them develop chronic infections resulting in severe lung disease, which are rarely eradicated despite intensive antibiotic therapy. Current knowledge indicates that three major adaptive strategies, biofilm development, phenotypic diversification, and mutator phenotypes [driven by a defective mismatch repair system (MRS)], play important roles in P. aeruginosa chronic infections, but the relationship between these strategies is still poorly understood. We have used the flow-cell biofilm model system to investigate the impact of the mutS associated mutator phenotype on development, dynamics, diversification and adaptation of P. aeruginosa biofilms. Through competition experiments we demonstrate for the first time that P. aeruginosa MRS-deficient mutators had enhanced adaptability over wild-type strains when grown in structured biofilms but not as planktonic cells. This advantage was associated with enhanced micro-colony development and increased rates of phenotypic diversification, evidenced by biofilm architecture features and by a wider range and proportion of morphotypic colony variants, respectively. Additionally, morphotypic variants generated in mutator biofilms showed increased competitiveness, providing further evidence for mutator-driven adaptive evolution in the biofilm mode of growth. This work helps to understand the basis for the specific high proportion and role of mutators in chronic infections, where P. aeruginosa develops in biofilm communities.

Estudio estadístico del consumo de suplementos nutricionales y dietéticos en gimnasios / Statistical analysis of the consumption of nutritional and dietary supplements in gyms

En la actualidad, el abuso de toda clase de sustancias para mejorar el rendimiento deportivo y la forma física se ha extendido a las personas que acuden a gimnasios regularmente. El objetivo del presente estudio es evaluar el consumo de suplementos nutricionales (SN) y dietéticos en un grupo de 415 usuarios (260 varones y 155 mujeres) de 4 gimnasios de Sevilla (España). Los usuarios realizaron un cuestionario previamente diseñado y con un pilotaje donde se evaluó la validez del contenido. Del total de la muestra, el 56,14 por ciento han consumido en alguna ocasión algún suplemento. Entre estos el 57,6 por ciento, lo hacía buscando mejorar su aspecto físico; el 16,7 por ciento, lo hacía para cuidar su salud, y el 13,2 por ciento, buscaban aumentar su rendimiento deportivo. El perfil del consumidor es el de un hombre joven, que hace tiempo que realiza actividad en gimnasios, que acude al gimnasio varias horas a la semana y que realiza algún tipo de dieta. El porcentaje de SN consumidos en este estudio (56 por ciento) está dentro de los valores aportados por otros estudios. En orden decreciente, Proteínas (28 por ciento), L-Carnitina (18,6 por ciento), Bebida Deportiva (18,3 por ciento), Creatina (17,1 por ciento) y Complejo vitamínico (17,1 por ciento) fueron los cinco SN más consumido por los sujetos de este estudio.

The abuse of all types of substance to improve sport performance and physical fitness has spread to regularly gym users. The aim of this study was to evaluate the intake of nutritional and dietary supplements in a group of 415 individuals (260 males and 155 females) from 4 gyms in Seville (Spain). The users completed a previously designed questionnaire whose content validity had been tested in a pilot study. Out of the total sample, 56.14 percent had consumed a supplement at some time. Among these, the objective was improvement of physical appearance in 57.16 percent, health care in 16.7 percent, and sports performance enhancement in 13.2 percent. The profile of the supplement consumer is a young man who has performed activities in gyms for some time, goes to the gym for several hours a week and is on some type of diet. The percentage of nutritional supplement users (56 percent) is within values reported in other studies. The five supplements most frequently consumed by these individuals were (in decreasing order): proteins (28 percent), L-carnitine (18.6 percent), sport drinks (18.3 percent), creatine (17.1 percent) and vitamin complex (17.1 percent).

[Statistical analysis of the consumption of nutritional and dietary supplements in gyms]. / Estudio estadístico del consumo de suplementos nutricionales y dietéticos en gimnasios.

The abuse of all types of substance to improve sport performance and physical fitness has spread to regularly gym users. The aim of this study was to evaluate the intake of nutritional and dietary supplements in a group of 415 individuals (260 males and 155 females) from 4 gyms in Seville (Spain). The users completed a previously designed questionnaire whose content validity had been tested in a pilot study. Out of the total sample, 56.14% had consumed a supplement at some time. Among these, the objective was improvement of physical appearance in 57.16%, health care in 16.7%, and sports performance enhancement in 13.2%. The profile of the supplement consumer is a young man who has performed activities in gyms for some time, goes to the gym for several hours a week and is on some type of diet. The percentage of nutritional supplement users (56%) is within values reported in other studies. The five supplements most frequently consumed by these individuals were (in decreasing order): proteins (28%), L-carnitine (18.6%), sport drinks (18.3%), creatine (17.1%) and vitamin complex (17.1%).

Impacto del sistema de clasificación aplicando códigos de colores en la urgencia de Ortopedia / Impact of the classification system by applying color codes in orthopedic emergency

La Ortopedia y Traumatología se encuentra entre las primeras especialidades médico-quirúrgicas que generan demandas de atención en los servicios de urgencias; son estos lugares un escenario propicio para la confluencia entre lesionados y los que sufren una enfermedad degenerativa que provoca dolor. ¿Cómo administrar recursos humanos y materiales para satisfacer esas demandas?. Es el objetivo fundamental de este trabajo. Se realizó un estudio descriptivo retrospectivo de la morbilidad de urgencias, generada por la especialidad, de enero a diciembre de 1999, y se atendió para ello a la codificación internacional de enfermedades y a las tablas de códigos de colores confeccionadas en nuestro centro. Toda la información fue recogida en hojas de cargo y procesada en el departamento de estadística de nuestro hospital, según programa SPSS versión 8.0 para Window. Se concluye que la clasificación de los pacientes en el servicio de urgencia según código de colores influyó en la disminución del promedio diario de casos, con el consiguiente descenso del número total de casos atendidos en el período analizado. Además esto ayuda a conocer de forma inmediata las fluctuaciones de la morbilidad. Finalmente se establecen brechas para descender aún más las consultas no urgentes (códigos verdes) que generan una demanda no justificada en estos lugares