Tranexamic acid plus bemiparin sodium as long-term prophylaxis in a patient with FXII-HAE during pregnancy: a case report

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Desensitization to filgrastim in a 2-year-old girl with a vaginal endodermal sinus tumor

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Usefulness of the basophil activation test to confirm beer allergy

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Dermatitis caused by ingestion of chia seeds

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Asthma exacerbations in a tertiary hospital: clinical features, triggers, and risk factors for hospitalization

Background: The risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients who experience asthma exacerbations. We also assessed potential triggers of exacerbations and possible predictors of hospitalization. Methods: A retrospective, noninterventional cohort study was conducted in adult patients who attended the emergency department of a tertiary hospital with an asthma exacerbation during 2014. Results: The study population comprised 831 patients (888 events). Most episodes occurred in January and May. Respiratory infection was the trigger in 523 events. In 34.21% of cases, the eosinophil count was ≥260/mm3 (≥400/mm3 in 20.7%), which was significantly associated with allergic asthma (P<.0001). The risk factors for hospitalization were older age (OR, 1.58; 95%CI, 1.46-1.71), no previous diagnosis of asthma (OR, 1.40; 95%CI, 1.06-1.86), poorly controlled asthma (OR, 1.78; 95%CI, 1.10-2.88), respiratory infection (OR, 2.65; 95%CI, 1.95-3.62), and severe exacerbation with more treatment requirements. The rate of hospitalization was significantly lower in patients with ≥400 eosinophils/mm3 (P<.001). Conclusion: Older age, absence of a previous asthma diagnosis, uncontrolled disease, and concomitant chronic obstructive pulmonary disease are frequent among patients presenting at the emergency department with asthma exacerbations. Various features were associated with a higher risk of admission. Blood eosinophilia should be considered a marker of asthma, but not a predictor of hospitalization (AU)

Introducción: Los factores de riesgo de las exacerbaciones de asma no se conocen por completo. El objetivo de este estudio fue determinar las características epidemiológicas y clínicas de los pacientes con exacerbaciones de asma, los potenciales factores desencadenantes y los posibles predictores de hospitalización. Métodos: Se llevó a cabo un estudio de cohorte retrospectivo, no intervencionista, en pacientes adultos que acudieron al Servicio de Urgencias de un hospital terciario con una exacerbación de asma durante el año 2014. Resultados: Se incluyeron 831 pacientes (888 eventos). El mayor número de episodios ocurrió en Enero y Mayo. La infección respiratoria se consideró como desencadenante en 523 eventos. 34,21% tenían ≥260 eosinófilos/mm3 (20,7% ≥ 400 eosinófilos/mm3), estando lo cual asociado significativamente con el asma alérgica (p<0,0001). Los factores de riesgo para la hospitalización fueron: edad avanzada [OR: 1,58 (IC 95%: 1,46 a 1,71)]; ausencia de diagnóstico previo de asma [OR: 1,40 (IC 95%: 1,06-1,86)]; mal control del asma [OR: 1,78 (IC 95%: 1,10-2,88)]; infección respiratoria [OR: 2,65 (IC 95%: 1,95-3,62)]; y crisis graves con mayor necesidad de tratamiento. En los asmáticos con ≥ 400 eosinófilos/mm3, la tasa de hospitalización fue menor (p <0,001). Conclusión: La edad avanzada, la ausencia de un diagnóstico de asma previo, el mal control de la enfermedad o el padecer EPOC de forma concomitante son frecuentes entre los pacientes que acuden al Servicio de Urgencias con exacerbaciones de asma. Se detectaron algunas características asociadas con un mayor riesgo de ingreso. La eosinofilia periférica debe ser considerada como un marcador de asma, pero no como un predictor de la hospitalización (AU)

Asthma exacerbations in a tertiary hospital: clinical features, triggers, and risk factors for hospitalization.

BACKGROUND: Risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients with an asthma exacerbation, potential triggers, and possible predictors of hospitalization. METHODS: A retrospective, non-interventional cohort study was conducted in adult patients who attended the Emergency Department of a tertiary hospital with an asthma exacerbation during 2014. RESULTS: 831 patients (888 events) were included. The highest number of episodes occurred in January and May. Respiratory infection was considered the trigger in 523 events. 34.21% had ≥260 eosinophils/mm3 (20.7%≥400 eosinophils/mm3), significantly associated with allergic asthma (p<0.0001). Risk factors for hospitalization were: older age [OR:1.58 (95% CI 1.46-1.71)]; no previous diagnosis of asthma [OR:1.40(95% CI 1.06-1.86)]; poorly controlled asthma[OR:1.78 (95% CI 1.10-2.88)]; respiratory infection [OR:2.65 (95% CI 1.95-3.62)]; and severe crisis with more treatment requirements. Of those asthmatics with ≥400 eosinophils/mm3, the rate of hospitalization was lower (p<0.001). CONCLUSION: Older age, absence of a previous asthma diagnosis, uncontrolled disease or concomitant COPD are frequent among patients presenting to the ED with asthma exacerbations. There were some features associated with higher risk of admission. Blood eosinophilia should be considered as a marker of asthma, but not as a predictor of hospitalization.

Delayed allergic reaction to acenocoumarol with a positive lymphocyte transformation test

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Nutritional risks in the Spanish population: results of the eVe study.

OBJECTIVE: To determine the vitamin status of different groups within the Spanish population. DESIGN: Pooled analysis of cross-sectional population nutritional regional studies and meta-analysis of smaller studies in population subgroups performed in Spain between 1990 and 1999. SUBJECTS: In total, 10 208 participants in eight random population studies aged 25-60 y and participants in 76 studies included in the meta-analysis. INTERVENTIONS: The data from different nutritional studies performed on sample populations representative of eight regions of Spain were integrated into a single database. A meta-analysis was also performed on the results of nutritional studies on the Spanish population involving subjects of other ages and status (all published between 1990 and 1999). RESULTS: The mean intakes observed after the integration of the eight regional studies, and in the meta-analysis study, were similar to those recommended, although a considerable percentage of people had insufficient intakes. CONCLUSIONS: Further studies are required, but the vitamin status of the Spanish population clearly shows room for improvement, especially with respect to vitamins B(2), B(6), A, E, D and folates. Bearing in mind that adequate vitamin intakes are associated with protection from a range of diseases, steps should be taken to correct the imbalances recorded.

Perfil de las competencias profesionales del diplomado en nutrición humana y dietética / Profile of profesional skills and abilities of the graduate in nutrition and dietetics

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Luteína y salud / Lutein and health

La luteína es un pigmento amarillo de la familia de los carotenoides presente en la yema de huevo, verduras y frutas, aunque los suplementos de este compuesto se extraen principalmente de la flor de Cempasuchil o clavelón (Tagetes erecta), alfalfa y algas. La luteína es un carotenoide que no se sintetiza en el cuerpo humano, por lo que debe aportarse con la dieta, aunque todavía no se han establecido ingestas dietéticas de referencia o niveles de protección definidos. Su interés para la salud se basa en su potencial antioxidante, actuando como filtro luminoso en los tejidos sensibles como la retina, cristalino y mácula. Sus propiedades antioxidantes tienen interés en la prevención de las lesiones ateroscleróticas, cataratas, degeneración macular, cáncer de colon y otras propiedades fotoprotectoras y antioxidantes. El análisis del consumo alimentario de la población española entre 25 y 60 años planteado en el estudio eVe nos ha permitido estimar unos aportes de luteína de 2,74 mg/día, cifra que supera los aportes comunicados en Países Bajos, Alemania y EEUU. La distribución de la ingesta de luteína por regiones describe valores más elevados en la zona Nordeste y Norte, en relación a Levante, Sur y Canarias (AU)

Influence of apolipoprotein E polymorphism on plasma vitamin A and vitamin E levels.

BACKGROUND: Plasma concentrations of vitamins A and E are positively correlated with those of concurrent lipids and, on the other hand, lipid levels are influenced by apolipoprotein E polymorphism. Therefore, the effect of this polymorphism on both vitamins was analysed in an adult population. MATERIALS AND METHODS: Subjects were recruited from a working population. Their anthropometric, lifestyle and dietary intake variables and menopausal status were recorded. Their apolipoprotein E phenotype and their plasma vitamins A and E (by high-performance liquid chromatography) and lipid (enzymatically) concentrations were determined after an overnight fast. The associations of the phenotype with vitamins and lipids were studied in men and women separately and controlling for significant covariates. RESULTS: The apolipoprotein E phenotype was associated with the concentrations of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol in women, whereas no associations with lipids were found in men. Vitamin A and vitamin E levels were higher in men than in women, but only the difference in the former persisted after lipid adjustment. Apolipoprotein E2 slightly increased vitamin A levels in women, an effect which was still evident with lipid adjustment. Actually, both the apolipoprotein E phenotype and triglyceride were selected as significant predictors of this vitamin by multiple regression. This phenotype did not affect vitamin E levels in either sex. CONCLUSIONS: Lipids do not mediate the effect of gender on vitamin A levels. Apolipoprotein E polymorphism is an independent determinant of vitamin A levels in women. Pending confirmation by others, we propose that enhancement of this vitamin may contribute to the beneficial impact of the epsilon2 allele on human ageing and health.

Fortified foods. Criteria for vitamin supplementation in Spain.

OBJECTIVE: To review and analyse criteria for vitamin supplementation and fortification in Spain. DESIGN: Systematic review of scientific literature and simulation analysis of food fortification. METHODS: A simulation analysis using a fortified beverage was performed in a random sample of 2855 children aged 2 to 24 years in Spain. RESULTS: High-risk groups for vitamin supplementation and fortification in Spain are highlighted, and target vitamins considered have been: folic acid, vitamin A, vitamin E, vitamin D and vitamin B12 (particularly in the elderly). A beverage fortified with vitamins C, A, B1 and B6 may contribute to improving the intake of all of these vitamins with the exception of vitamin A, since the Recommended Nutrient Intake is already covered with current consumption. CONCLUSIONS: A detailed knowledge of nutritional status helps to ensure the rationale and follow up of nutrient supplementation and fortification.

Apolipoprotein E polymorphism in men and women from a Spanish population: allele frequencies and influence on plasma lipids and apolipoproteins.

UNLABELLED: The apolipoprotein (apo) E phenotype and its influence on plasma lipid and apolipoprotein levels were determined in men and women from a working population of Madrid, Spain. The relative frequencies of alleles epsilon(2), epsilon(3) and epsilon(4) for the study population (n=614) were 0.080, 0.842 and 0.078, respectively. In men, apo E polymorphism was associated with variations in plasma triglyceride and very low-density lipoprotein (VLDL) lipid levels. It was associated with the proportion of apo C-II in VLDL, and explained 5.5% of the variability in the latter parameter. In women apo E polymorphism was associated with the concentrations of plasma cholesterol and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) related variables. The allelic effects were examined taking allele epsilon(3) homozygosity as reference. In men, allele epsilon(2) significantly increased VLDL triglyceride and VLDL cholesterol concentrations, and this was accompanied by an increase of the apo C-II content in these particles. Allele epsilon(4) did not show any significant influence on men's lipoproteins. In women, allele epsilon(2) lowered LDL cholesterol and apo B levels, while allele epsilon(4) increased LDL cholesterol and decreased the concentrations of HDL cholesterol, HDL phospholipid and apo A-I. These effects were essentially maintained after excluding postmenopausal women and oral contraceptive users from the analysis. IN CONCLUSION: (1) the population of Madrid, similar to other Mediterranean populations, exhibits an underexpression of apo E4 compared to the average prevalence in Caucasians, (2) gender interacts with the effects of apo E polymorphism: in women, it influenced LDL and HDL levels, whereas in men it preferentially affected VLDL, and (3) allele epsilon(2) decreased LDL levels in women, while it increased both VLDL lipid levels and apo C-II content in men, but, in contrast to allele epsilon(4), it did not show an impact on HDL in either sex.

Cholesteryl ester transfer activity in lipoprotein lipase deficiency and other primary hypertriglyceridemias.

Cholesteryl ester transfer protein (CETP) activity was measured in d > 1.21 g/ml plasma from hypertriglyceridemic patients and compared with normolipidemic subjects. The assay consisted in measuring the specific transfer of [3H]cholesteryl oleate from a prelabelled, apo E-poor HDL fraction to VLDL after incubation at 37 degrees C in the presence of the d > 1.21 g/ml plasma sample: the lipoproteins were then separated by precipitation with dextran sulfate/Mg2+ solution. Increasing the volume of d > 1.21 g/ml plasma or purified human CETP in the assay produced linear responses in measured activity, whereas, either during incubation at 4 degrees C or in the presence of rat plasma instead of human plasma, the transfer of [3H]cholesteryl oleate to VLDL was not stimulated. Thus, the assay reflects changes in CETP in the sample and appears to be suitable for measuring CETP activity in d > 1.21 g/ml plasma. CETP activity was very similar in the two groups of normolipidemic subjects considered: adolescents (203 +/- 11 nmol esterified cholesterol transferred per 8 h/ml plasma) and adults (215 +/- 5). Patients were grouped into lipoprotein-lipase (LPL)-deficient and non-LPL-deficient according to their enzyme activity in postheparin plasma. CETP activity was highly increased in LPL-deficient, severe hyperchylomicronemic patients (430 +/- 42) and was directly correlated with VLDL levels in the non-LPL-deficient individuals. Marked differences were observed in the lipid composition of HDL and apolipoprotein A-I levels among patients and controls. In the control group, CETP activity was correlated only with HDL-triglyceride and HDL-triglyceride/apo A-I mass ratio, which is compatible with the physiological role of CETP in transferring triglyceride to HDL from other lipoprotein particles. When all hypertriglyceridemic patients were considered together, CETP activity was inversely correlated with apo A-I and HDL-cholesterol, whereas it was directly correlated with HDL-triglyceride/HDL-cholesterol and HDL-triglyceride/apo A-I mass ratios. The results indicate that the enhanced CETP activity associated with hypertriglyceridemia contributes to the compositional change of HDL, which in turn may be responsible for the reduction of HDL levels in this condition.