Quantity is not enough: completeness of suspected adverse drug reaction reports in Spain-differences between regional pharmacovigilance centres and pharmaceutical industry.

PURPOSE: The aim of this study is to compare the completeness of relevant structured fields such as age, sex, drug and reaction start dates, time to onset, outcome and drug indication, in serious spontaneous cases reported in Spain depending on whether they have been collected by regional pharmacovigilance centres or by the marketing authorization holders. METHODS: We analyzed the completeness of key variables for causality assessment related to the patient, the reaction and the suspected drug in all serious cases spontaneously reported and registered in the Spanish Pharmacovilance database, called FEDRA, from 1 January 2011 until 31 December 2018. The completeness scores were calculated according to the type of field and taking into account the VigiGrade tool. Cases were classified according to the reporting pathway, that is whether they were received and transmitted by marketing authorization holder or by regional pharmacovigilance centres. RESULTS: The completeness score of cases collected by regional pharmacovigilance centres was higher in all the studied variables. The main differences were found in drug and reaction start date, and time to onset. CONCLUSIONS: This study shows a high completeness score in cases of suspected adverse reactions reported to the regional pharmacovigilance centres with regard to key elements for causality assessment, signal and duplicate detection. In contrast, marketing authorization holder cases show a low completeness score and a decreasing tendency in all the studied variables over the studied period.

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

OBJECTIVE: To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. METHODS: This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. RESULTS: In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36-3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95-4.85); P = 0.068). CONCLUSION: When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Insulin resistance and glycine metabolism in humans.

Plasma glycine level is low in patients with obesity or diabetes and the improvement of insulin resistance increases plasma glycine concentration. In prospective studies, hypoglycinemia at baseline predicts the risk of developing type 2 diabetes and higher serum glycine level is associated with decreased risk of incident type 2 diabetes. Consistently, plasma glycine concentration is lower in the lean offspring of parents with type 2 diabetes compared to healthy subjects. Among patients with type 2 diabetes, hypoglycinemia occurs before clinical manifestations of the disease, but the pathophysiological mechanisms underlying glycine deficit and its potential clinical repercussions are unclear. Glycine participates in several metabolic pathways, being required for relevant human physiological processes. Humans synthesize glycine from glyoxylate, glucose (via serine), betaine and likely from threonine and during the endogenous synthesis of L-carnitine. Glycine conjugates bile acids and other acyl moieties producing acyl-glycine derivatives. The glycine cleavage system catalyzes glycine degradation to carbon dioxide and ammonium while tetrahydrofolate is converted into 5,10-methylene-tetrahydrofolate. Glycine is utilized to synthesize serine, sarcosine, purines, creatine, heme group, glutathione, and collagen. Glycine is a major quantitative component of collagen. In addition, the role of glycine maintaining collagen structure is critical, as glycine residues are required to stabilize the triple helix of the collagen molecule. This quality of glycine likely contributes to explain the occurrence of medial arterial calcification and the elevated cardiovascular risk associated with diabetes and chronic kidney disease, as emerging evidence links normal collagen content with the initiation and progression of vascular calcification in humans.

Iberian Cured-Ham Consumption Improves Endothelial Function in Healthy Subjects.

OBJECTIVES: Previous studies have shown that dietary components such as oleic acid or polyphenols exert beneficial effects on endothelium. We aimed to assess the impact of regular consumption of Iberian cured-ham (ICH) on endothelial function. DESIGN: An open-label, randomized controlled parallel study. SETTING: Volunteers recruited through advertisements at a hospital in Madrid, Spain. PARTICIPANTS: 102 Caucasian adults (76.8% females) aged 25-55 years, and free from cardiometabolic disease. INTERVENTION: Participants were randomized to an ICH-enriched ad libitum diet or an ad libitum diet without ICH for 6 weeks. Subjects in ICH group were randomly provided with either acorn- or mixed-fed ICH, and followed up for an additional 6-week period under their usual diet. MEASUREMENTS: Clinical parameters, biomarkers of endothelial function and oxidative stress, microvascular vasodilatory response to hyperemia and arterial stiffness were measured before and after the intervention. RESULTS: After 6 weeks, a larger decrease in PAI-1 was observed in subjects consuming ICH compared to the Control group (-6.2±17.7 vs. 0.3±1.4 ng/ml; p=0.020). Similarly, microvascular vasodilatory response to hyperemia showed a significant increase (112.4±391.7 vs. -56.0±327.9%; p=0.007). However, neither oxidative stress, hemodynamic nor clinical parameters differed significantly over the study. Additionally, after stopping ICH consumption, improvements in PAI-1 remained for 6 additional weeks with respect to baseline (p=0.006). CONCLUSION: The present study demonstrates, for the first time, that regular consumption of ICH improves endothelial function in healthy adults. Strategies aimed to preserve or improve the endothelial function may have implications in vascular aging beyond the prevention of the atherothrombotic disease.

Differences in characteristics of mediolateral episiotomy in proffesionals at the same hospital.

OBJECTIVES: The objective of our study was to compare the theoretical concept of the accoucheur in our institution with regard to the characteristics of the mediolateral episiotomy (MLE), with a crowning head and after a delivery. METHODS: We devised two simple pictorial questionnaires (one with a crowning head and the other in rest after a delivery) in order to explore possible differences in clinical practice between the accoucheurs of our institution with respect to the MLE characteristics. RESULTS: With a crowning head, we found more acute angles when the age of accoucheurs was greater than 35 years old and more than 15 years of experience, but no with the perineum at rest. No difference was found between doctors and midwives, nor between males and females. 28.1% of accoucheurs indicated an acuter episiotomy angle with a crowning head. CONCLUSION: This study confirmed that the individual interpretation of MLE differed widely among professionals at the same hospital. These differences which have been shown could predispose women to a greater risk of anal sphincter injuries. For this reason, there is a need to standardize this practice, to make the technique more homogeneous, particularly in the context of future research into the risks and benefits of episiotomy with respect to major perineal trauma.

[Effectiveness of a program for treatment of overweight and nonmorbid obesity in primary healthcare and its influence lifestyle modification]. / Eficacia de un programa para el tratamiento del sobrepeso y la obesidad no mórbida en atención primaria y su influencia en la modificación de estilos de vida.

BACKGROUND: Lifestyle intervention is fundamental for obesity treatment. The aim of this study was to evaluate the effects of a program focused on diet, exercise and psychological support on Lifestyle Modification in overweight and obese patients treated in Primary Health Care setting. METHODS: 60 patients with grade II overweight and non-morbid grade I-II obesity were included in this pilot clinical trial. Ages ranged from 18 to 50 years. They were provided with a program combining nutritional education, physical activity and psychological support. Subjects attended group sessions every 2 weeks. The main outcome measures at baseline and 6 months were body composition parameters (BMI, body fat percentage, waist circumference) and lifestyle intervention using the Questionnaire for the assessment of overweight and obesity related lifestyles at baseline and six months. This questionnaire yields an five dimensions: diet caloric intake (CC), healthy eating (AS), physical activity (EF), searching for psychological well-being eating (BP) and alcohol intake (CA). The higher score indicates better lifestyles for CC, AS, EF and worse for BP y CA. RESULTS: At the end of the intervention the program achieved improvements in Questionnaire related lifestyles subscales: CC (2,60 ± 0,5 vs. 3,49 ± 0,7, p<0,001), EF (2,19 ± 0,9 vs. 3,17 ± 1,0, p<0,001) and AS (3,04 ± 0,4 vs. 3,43 ± 0,4, p<0,05); CA (3,98 ± 0,7 vs. 4,25 ± 0,7, p<0,05) and BP (2,82 ± 1,0 vs. 3,34 ± 0,7, p<0,001) has got worse. CONCLUSION: The Program focused on balanced and moderate energy-restricted diets, increased physical activity and psychological support may improve the anthropometric parameters and the Lifestyle intervention in obese patients treated in a primary healthcare center.

Introducción y Objetivos: la modificación de conductas no saludables es fundamental para tratar la obesidad. El objetivo de este estudio fue evaluar los efectos de un programa basado en dieta, ejercicio y apoyo psicológico en la modificación conductual de pacientes con sobrepeso y obesidad tratados en Atención Primaria. Métodos: 60 pacientes con sobrepeso grado II y obesidad grado I-II fueron incluidos en este ensayo piloto. Edad entre 18-50 2013s. Los pacientes recibieron un programa que combinaba educación nutricional, actividad física y apoyo psicológico. Formato grupal, periodicidad quincenal. Los principales resultados medidos al inicio y 6 meses fueron parámetros antropométricos (índice de masa corporal, porcentaje de masa grasa, perímetro cintura) y de estilos de vida usando el Cuestionario para la valoración de hábitos de vida relacionados con el sobrepeso y la obesidad. Consta de 5 dimensiones: contenido calórico de la dieta (CC), alimentación saludable (AS), ejercicio físico (EF), comer por bienestar psicológico (BP) y consumo de alcohol (CA). La mayor puntuación indica mejores hábitos para CC, AS y EF y peores para BP y CA. Resultados: al final de la intervención mejoraron las escalas CC (2,60± 0,5 vs 3,49± 0,7, p<0,001), EF (2,19± 0,9 vs 3,17± 1,0, p<0,001) y AS (3,04± 0,4 vs 3,43± 0,4, p<0,05) del cuestionario; CA (3,98± 0,7 vs. 4,25± 0,7, p<0,05) y BP (2,82± 1,0 vs. 3,34± 0,7, p<0,001) empeoraron. Conclusión: el programa basado en moderada restricción de la dieta, aumento de actividad física y apoyo psicológico puede mejorar parámetros antropométricos y estilos de vida en pacientes obesos tratados en un centro de Atención Primaria.

Eficacia de un programa para el tratamiento del sobrepeso y la obesidad no mórbida en atención primaria y su influencia en la modificación de estilos de vida / Effectiveness of a program for treatment of overweight and nonmorbid obesity in primary healthcare and its influence lifestyle modification

Introducción y Objetivos: la modificación de conductas no saludables es fundamental para tratar la obesidad. El objetivo de este estudio fue evaluar los efectos de un programa basado en dieta, ejercicio y apoyo psicológico en la modificación conductual de pacientes con sobrepeso y obesidad tratados en Atención Primaria. Métodos: 60 pacientes con sobrepeso grado II y obesidad grado I-II fueron incluidos en este ensayo piloto. Edad entre 18-50 años. Los pacientes recibieron un programa que combinaba educación nutricional, actividad física y apoyo psicológico. Formato grupal, periodicidad quincenal. Los principales resultados medidos al inicio y 6 meses fueron parámetros antropométricos (índice de masa corporal, porcentaje de masa grasa, perímetro cintura) y de estilos de vida usando el Cuestionario para la valoración de hábitos de vida relacionados con el sobrepeso y la obesidad. Consta de 5 dimensiones: contenido calórico de la dieta (CC), alimentación saludable (AS), ejercicio físico (EF), comer por bienestar psicológico (BP) y consumo de alcohol (CA). La mayor puntuación indica mejores hábitos para CC, AS y EF y peores para BP y CA. Resultados: al final de la intervención mejoraron las escalas CC (2,60± 0,5 vs 3,49± 0,7, p<0,001), EF (2,19± 0,9 vs 3,17± 1,0, p<0,001) y AS (3,04± 0,4 vs 3,43± 0,4, p<0,05) del cuestionario; CA (3,98± 0,7 vs. 4,25± 0,7, p<0,05) y BP (2,82± 1,0 vs. 3,34± 0,7, p<0,001) empeoraron. Conclusión: el programa basado en moderada restricción de la dieta, aumento de actividad física y apoyo psicológico puede mejorar parámetros antropométricos y estilos de vida en pacientes obesos tratados en un centro de Atención Primaria (AU)

Background: Lifestyle intervention is fundamental for obesity treatment. The aim of this study was to evaluate the effects of a program focused on diet, exercise and psychological support on Lifestyle Modification in overweight and obese patients treated in Primary Health Care setting. Methods: 60 patients with grade II overweight and non-morbid grade I-II obesity were included in this pilot clinical trial. Ages ranged from18 to 50 years. They were provided with a program combining nutritional education, physical activity and psychological support. Subjects attended group sessions every 2 weeks. The main outcome measures at baseline and 6 months were body composition parameters (BMI, body fat percentage, waist circumference) and lifestyle intervention using the Questionnaire for the assessment of overweight and obesity related lifestyles at baseline and six months. This questionnaire yields an five dimensions: diet caloric intake (CC), healthy eating (AS), physical activity (EF), searching for psychological well-being eating (BP) and alcohol intake (CA). The higher score indicates better lifestyles for CC, AS, EF and worse for BP y CA. Results: At the end of the intervention the program achieved improvements in Questionnaire related lifestyles subscales: CC (2,60± 0,5 vs. 3,49± 0,7, p<0,001), EF (2,19± 0,9 vs. 3,17± 1,0, p<0,001) and AS (3,04± 0,4 vs. 3,43± 0,4, p<0,05); CA (3,98± 0,7 vs. 4,25± 0,7, p<0,05) and BP (2,82± 1,0 vs. 3,34± 0,7, p<0,001) has got worse. Conclusion: The Program focused on balanced and moderate energy-restricted diets, increased physical activity and psychological support may improve the anthropometric parameters and the Lifestyle intervention in obese patients treated in a primary healthcare center (AU)

Impact of two low-calorie meals with and without bread on the sensation of hunger, satiety and amount of food consumed.

BACKGROUND: The aim was to compare the differences in feelings of hunger and satiety in a group of overweight/obese women after eating a test meal with or without bread. PATIENTS AND METHODS: The study included 122 women (BMI≥25<40 kg/m²) who were randomly assigned to consume one of the following test meals: NO BREAD meal (2.40 MJ, 46% carbohydrates, 26% protein, 28% fat; which included rice or pasta) and BREAD meal (2.39 MJ, with equal caloric distribution and the same foods except with bread instead of rice or pasta). A visual analogue scale (VAS) was used, with 5 questions to be answered at different times: 1) just before eating, 2) just after eating and exactly 3) 60 and 4) 90 minutes after eating the test meal. The test was performed at the start and after 16 weeks of following a lifestyle modification program based on a low-calorie diet (with or without bread). RESULTS: 104 women completed the study (48.4±9.0 years) with a baseline BMI of 29.8±3.5 kg/m². At the start of the study there were no significant differences in any of the VAS parameters measured between the groups. After 16 weeks, BREAD group obtained higher scores in question 3 (referring to the sensation of satiety) that were significant at time 3 (7 versus 5; p<0.05) and time 4 (8 versus 4; p<0.01). CONCLUSIONS: The inclusion of bread in a low-calorie meal may result in a greater sensation of satiety after eating. These results contradict the recommendation to exclude bread from a food plan aimed at weight loss.

Impact of two low-calorie meals with and without bread on the sensation of hunger, satiety and amount of food consumed / Repercusión de dos comidas hipocalóricas con y sin pan sobre la sensación de hambre, saciedad y cantidad de comida consumida

Background: The aim was to compare the differences in feelings of hunger and satiety in a group of overweight/obese women after eating a test meal with or without bread. Patients and methods: The study included 122 women (BMI ≥ 25 < 40 kg/m2) who were randomly assigned to consume one of the following test meals: NO BREAD meal (2.40 MJ, 46% carbohydrates, 26% protein, 28% fat; which included rice or pasta) and BREAD meal (2.39 MJ, with equal caloric distribution and the same foods except with bread instead of rice or pasta). A visual analogue scale (VAS) was used, with 5 questions to be answered at different times: 1) just before eating, 2) just after eating and exactly 3) 60 and 4) 90 minutes after eating the test meal. The test was performed at the start and after 16 weeks of following a lifestyle modification program based on a low-calorie diet (with or without bread). Results: 104 women completed the study (48.4 ± 9.0 years) with a baseline BMI of 29.8 ± 3.5 kg/m2. At the start of the study there were no significant differences in any of the VAS parameters measured between the groups. After 16 weeks, BREAD group obtained higher scores in question 3 (referring to the sensation of satiety) that were significant at time 3 (7 versus 5; p < 0.05) and time 4 (8 versus 4; p < 0.01). Conclusions: The inclusion of bread in a low-calorie meal may result in a greater sensation of satiety after eating. These results contradict the recommendation to exclude bread from a food plan aimed at weight loss (AU)

Objetivos: Analizar las diferencias en la sensación de hambre y saciedad en un grupo de mujeres con sobrepeso/obesidad en tratamiento tras el consumo de una comida prueba con o sin pan. Pacientes y métodos: El estudio incluyó a 122 mujeres con IMC ≥ 25 < 40 kg/m2 que fueron randomizadas asignándolas a consumir una de las siguientes comidas prueba: comida NO PAN (2,40 MJ -575 kcal-, 46% hidratos de carbono, 26% proteínas, 28% grasas; que incluía arroz o pasta) y comida PAN (2,39 MJ -571 kcal-, con igual distribución calórica y los mismos alimentos pero con pan en lugar de arroz o pasta). Se empleó una escala analógica visual (Visual Analogue Scale: VAS) de 5 preguntas que debía completarse en diferentes tiempos 1) antes: -1 min; 2) inicio: 0 min; 3) después: 60 min y 4) después: 90 min después de la comida prueba. El test se realizó al inicio del tratamiento y después de 16 semanas de seguir una dieta hipocalórica (con o sin pan), educación nutricional y promoción de actividad física. Resultados: Completaron el estudio 104 mujeres, edad media 48,4 ± 9 años e IMC basal 29,8 ± 3,5 kg/m2. Al inicio del estudio no existieron diferencias significativas en ninguno de los parámetros valorados por la VAS entre grupos. Al repetir el test tras la intervención el grupo comida PAN obtuvo una puntuación mayor en la pregunta 3 (referida a la sensación de saciedad) que fue significativa en los tiempos 3 (7 vs 5 p < 0,05) y 4 (8 vs 4 p < 0,01). Conclusiones: La inclusión del pan en una comida hipocalórica podría favorecer una mayor sensación de saciedad tras la comida. Estos resultados entran en contradicción con la recomendación de excluir el pan en un plan de alimentación orientado a la pérdida de peso (AU)

Parámetros hormonales e inflamatorios en un grupo de mujeres con sobrepeso/obesidad / Hormonal an inflammatory biomarkers in a group of overweight and obese women

Introducción y Objetivos: Recientemente se ha descubierto que la obesidad es una patología caracterizada por un estado crónico de inflamación leve. El objetivo de este estudio fue describir la situación hormonal e inflamatoria de un colectivo de mujeres con sobrepeso/obesidad. Pacientes y métodos: se incluyeron mujeres > 18 años, con IMC ≥ 25 < 40 kg/m2. Se recogieron datos ocio-sanitarios, presión arterial, parámetros antropométricos, de actividad física, estudio bioquímico, hormonal e inflamatorio para determinar la situación hormonal e inflamatoria de un colectivo de mujeres antes del inicio de un tratamiento para el control de peso corporal. Resultados: participaron 104 mujeres con edad media de 48,4 ± 9 años y un IMC de 29,8 ± 3,5 kg/m2. Un 48% de las mujeres estudiadas se encontraba en etapa de menopausia. Un 8,9% presentó hiperinsulinemia. El valor medio obtenido de grhelina fue 38,8 ± 33,6 pg/ml, no se encontró correlación entre sus concentraciones y las variables antropométricas y bioquímicas estudiadas. Los valores medios de PCR, leptina, adiponectina, resistina, IL 6, IL 10 y PAI 1 fueron 3,0 ± 2,7 mg/dl, 36,3 ± 19,5 ng/ml, 8,3 ± 4,5 μg/ml, 24,3 ± 23,2 ng/ml, 51,6 ± 93,6 pg/ml, 10,0 ± 34,2 pg/ml y 22,3 ± 30,6 ng/ml, respectivamente. Estas concentraciones correlacionaron significativamente con diferentes variables antropométricas y bioquímicas, sin embargo, estas correlaciones fueron débiles. Variables como la edad y presencia o no de menopausia o la práctica de actividad física de forma regular no influyeron en los valores medios obtenidos. Las pacientes con obesidad tuvieron valores medios significativamente más elevados que aquellas con sobrepeso, aunque sólo en el caso de la resistina y PAI 1. Conclusión: El grupo de mujeres estudiadas presentó cifras de adipoquinas alteradas en relación a otros estudios realizados en población con situación nutricional normal. Esto pone en evidencia la situación inflamatoria presente en estos pacientes y los valores obtenidos pueden contribuir a establecer unos rangos normalizados de estos marcadores para el colectivo de personas con sobrepeso y obesidad (AU)

Background and objectives: The aim of this study was to describe the hormonal and inflammatory status of a group of overweight/obese women. Patients and methods: The sample studied was a crosssectional cohort of women > 18 years of age, BMI ≥ 25 <40 kg/m2, prior to starting a weight control program. Data collected were: demographic characteristics, blood pressure, anthropometric parameters, physical activity data, and biochemical, hormonal and inflammatory biomarkers. Results: The study involved 104 women with a meanage of 48.4 ± 9 years and a BMI of 29.8 ± 3.5 kg/m2. Some 48% of the women studied were in menopause. Some8.9% had hyper insulinemia. The mean ghrelin value was38.8 ± 33.6 pg/ml; there was no correlation between ghrelinlevels and anthropometric and biochemical variables.CRP, leptin, adiponectin, resistin, IL6, IL10, and PAI1were 3.0 ± 2.7 mg/dl, 36.3 ± 19.5 ng/ml, 8.3 ± 4.5 mg/ml,24.3 ± 23.2 ng/ml, 51.6 ± 93.6 pg/ml, 10.0 ± 34.2 pg/ml and22.3 ± 30.6 ng/ml, respectively. Obese patients had significantly higher mean values of resistin and PAI 1 than those who were overweight. These levels correlated significantly with anthropometric and biochemical variables; however, the correlations were weak. Age, menopause or the regular practice of physical activity had no effect on mean values. Conclusions: The group of women studied had altered inflammatory biomarkers in relation to people of normal weight. The study shows the inflammatory status of overweight/obese individuals, and the values obtained may help to establish standard ranges for these markers (AU)

Evaluation of a lifestyle modification program for treatment of overweight and nonmorbid obesity in primary healthcare and its influence on health-related quality of life.

BACKGROUND: The impact of overweight and nonmorbid obesity on health-related quality of life (HRQL) has not been widely researched. The aim of this study was to evaluate the effects of a lifestyle modification program (LMP) focused on diet, exercise, and psychological support on HRQL in overweight and nonmorbidly obese patients treated in a primary healthcare setting. METHODS: Sixty patients with grade II overweight and nonmorbid grade I-II obesity were included in this open pilot clinical trial; subjects' ages ranged from 18 to 50 years. They were provided with an LMP combining nutrition education, physical activity, and psychological support. Subjects attended group sessions every 2 weeks. The main outcome measures at baseline and 6 months were body composition parameters (body mass index, body fat percentage, and waist circumference) and HRQL using the 1.4 Spanish version of the SF-36 questionnaire. The questionnaire yields an 8-scale profile of physical functioning (PF), role--physical (RP), bodily pain (BP), vitality (VT), social functioning (SF), role--emotional (RE), mental health (MH), and general health (GH) factors. RESULTS: The LMP achieved improvements in SF-36 subscales at the end of the intervention: PF (80.37 ± 18.90 vs 89.40 ± 13.95, P < .001), RP (20.37 ± 9.10 vs 23.14 ± 6.67, P < .05), VT (58.71 ± 21.98 vs 70.91 ± 26.56, P < .01), SF (79.62 ± 27.76 vs 86.57 ± 25.45, P < .03), and GH (61.03 ± 19.13 vs 69.42 ± 18.80, P < .001). CONCLUSION: An LMP focused on balanced and moderate energy-restricted diets, increased physical activity, and psychological support may improve the anthropometric parameters and the quality of life in moderately obese patients treated in a primary healthcare center.

[Knowledge of nutrition labelling in general population. Assessment surveys conducted in La Paz University Hospital in Madrid during the 9th "National Nutrition Day 2010"]. / Análisis de las encuestas sobre etiquetado nutricional realizadas en el Hospital La Paz de Madrid durante la 9ª edición del "Día Nacional de la Nutrición (DNN) 2010".

INTRODUCTION: Nutrition labelling (NL) provides information on the energy and nutrients in a food and it represents a valuable tool to help consumers make informed decisions about their diet and lifestyle. However, little is known about how consumers perceive the nutrition labelling information. OBJECTIVES: Evaluate the knowledge of NL of a population survey and examine aspects such as attention, reading, understanding and utility. MATERIAL AND METHODS: 200 volunteers were interviewed about NL on National Nutrition Day (NND) on May 28, 2010 at the La Paz University Hospital in Madrid. The questionnaire was self-administered and this contained 10 closed multiple choice questions. RESULTS: The surveyed group (66.7% women and 33.3% men) had a mean age of 42.0 ± 15 years and a BMI of 24.1 ± 3.8 kg/m². A percentage of 86.5% had completed secondary and higher education. The concept about NL was knocked by 77.1% of them. This percentage was significantly higher according to the level of their studies (primary 7.1%, secondary 32.1% and higher studies 60.9%; p < 0.0001) and also regarding the age range (42.3% vs. 25% of over that 50, p < 0.05). 73.8% always or almost always readied NL; 67.7% of those who declared that always readied were women and 71% had higher education. 53.8% of people over 50 years were not capable of reading labels due to the small letters. The most interesting information for the consumers was: calories (61%), fats (39%) and cholesterol (25.7%). Nutritional concepts questions had a low percentage of right answers, especially in volunteers with lower level of education and among older age groups. CONCLUSIONS: Results show that consumers have a low level of nutrition information that would enable a better choice to purchase food. Nutrition education is needed should be necessary to NL had a significant impact on the foods election. Therefore, this fact could contribute to the maintenance of health and disease prevention.

Anestesia en consultorio / No disponible

La anestesia en consultorio o office based anesthesia (OBA), es una actividad anestésica que ha tenido un aumento muy importante la última década. Requiere un planteamiento diferente del que se ejerce en los hospitales. Se deben de realizar consideraciones especiales respecto al lugar donde se realiza la práctica, la selección del paciente y la selección de los procedimientos quirúrgicos y anestésicos. La seguridad es el objetivo principal de esta actividad. En este trabajo se presentan las características generales de lo que concierne a la actividad de anestesia en el consultorio (AU)

Office based anesthesia (OBA) has increased substantially over the past decade. It requires a different approach than the traditional hospital one. Special considerations have to be stablished in respect to patient selection, type of surgery and monitoring. Patient safetyis our main priority. In this paper we present the main characteristics of this anesthetic approach (AU)

Análisis de las encuestas sobre etiquetado nutricional realizadas en el Hospital La Paz de Madrid durante la 9ª edición del 'Día Nacional de la Nutrición (DNN) 2010' / Knowledge of nutrition labelling in general population. assessment surveys conducted in la Paz University Hospital in Madrid during the 9th 'National Nutrition day 2010'

Introducción: El etiquetado nutricional es toda la información en relación con el valor energético y los nutrientes que componen al alimento y representa una valiosa herramienta para ayudar a los consumidores a tomar decisiones informadas acerca de su dieta y estilo de vida. Sin embargo, es poco conocido como percibe el consumidor esta información. Objetivos: Conocer el grado de información de la población encuestada sobre el etiquetado nutricional y evaluar aspectos como atención, lectura, comprensión y uso del mismo. Materiales y métodos: 200 voluntarios que asistieron el día 28 de mayo de 2010 (Día Nacional de la Nutrición DNN) al Hospital La Paz y completaron un cuestionario sobre etiquetado nutricional autoadministrado, consistente en 10 preguntas cerradas de opción múltiple. Resultados: El colectivo entrevistado (66,7% mujeres y 33,3% hombres) presentaba una edad media de 42,0 ± 15 años y un IMC de 24,1 ± 3,8 kg/m2. Un 86,5% tenía estudios medios y superiores. Un 77,1% conocía el concepto del etiquetado nutricional. El porcentaje fue significativamente mayor entre aquellos con estudios superiores (primarios 7,1%, medios 32,1% y superiores 60,9%; p < 0,0001) y en las edades comprendidas entre 30-49,9 años (42,3% vs 25% en mayores de 50 años, p < 0,05). Un 73,8% declaró que leía el EN siempre o casi siempre; entre aquellos que declararon que los leían siempre 67,7% fueron mujeres y 71% tenía estudios superiores. Un 53,8% de los mayores de 50 años declaró no poder leer el etiquetado debido al tamaño reducido de las letras. La información que despierta mayor interés sobre los consumidores son las calorías (61%), las grasas (39%) y el colesterol (25,7%). Las preguntas relacionadas con conocimientos nutricionales tuvieron un bajo porcentaje de respuestas correctas, sobre todo en el grupo con menor nivel de estudios y entre las personas mayores. Conclusiones: Los resultados obtenidos muestran que la población presenta un nivel bajo de información nutricional que permita hacer una mejor elección de los productos que se compran. La educación nutricional es necesaria para que el etiquetado nutricional tenga impacto en la elección de los alimentos, ya que permite informar y concienciar a la población sobre como la dieta puede contribuir al mantenimiento de la salud y la prevención de la enfermedad (AU)

Introduction: Nutrition labelling (NL) provides information on the energy and nutrients in a food and it represents a valuable tool to help consumers make informed decisions about their diet and lifestyle. However, little is known about how consumers perceive the nutrition labelling information. Objectives: Evaluate the knowledge of NL of a population survey and examine aspects such as attention, reading, understanding and utility. Material and methods: 200 volunteers were interviewed about NL on National Nutrition Day (NND) on May 28, 2010 at the La Paz University Hospital in Madrid. The questionnaire was self-administered and this contained 10 closed multiple choice questions. Results: The surveyed group (66.7% women and 33.3% men) had a mean age of 42.0 ± 15 years and a BMI of 24.1 ± 3.8 kg/m2. A percentage of 86.5% had completed secondary and higher education. The concept about NL was knocked by 77.1% of them. This percentage was significantly higher according to the level of their studies (primary 7.1%, secondary 32.1% and higher studies 60,9%; p < 0,0001) and also regarding the age range (42.3% vs. 25% of over that 50, p < 0.05). 73.8% always or almost always readied NL; 67.7% of those who declared that always readied were women and 71% had higher education. 53.8% of people over 50 years were not capable of reading labels due to the small letters. The most interesting information for the consumers was: calories (61%), fats (39%) and cholesterol (25.7%). Nutritional concepts questions had a low percentage of right answers, especially in volunteers with lower level of education and among older age groups. Conclusions: Results show that consumers have a low level of nutrition information that would enable a better choice to purchase food. Nutrition education is needed should be necessary to NL had a significant impact on the foods election. Therefore, this fact could contribute to the maintenance of health and disease prevention (AU)

[Hormonal and inflammatory biomarkers in a group of overweight and obese women]. / Parámetros hormonales e inflamatorios en un grupo de mujeres con sobrepeso/obesidad.

BACKGROUND AND OBJECTIVES: The aim of this study was to describe the hormonal and inflammatory status of a group of overweight/obese women. PATIENTS AND METHODS: The sample studied was a crosssectional cohort of women > 18 years of age, BMI ≥ 25 < 40 kg/m², prior to starting a weight control program. Data collected were: demographic characteristics, blood pressure, anthropometric parameters, physical activity data, and biochemical, hormonal and inflammatory biomarkers. RESULTS: The study involved 104 women with a mean age of 48.4 ± 9 years and a BMI of 29.8 ± 3.5 kg/m². Some 48% of the women studied were in menopause. Some 8.9% had hyperinsulinemia. The mean ghrelin value was 38.8 ± 33.6 pg/ml; there was no correlation between ghrelin levels and anthropometric and biochemical variables. CRP, leptin, adiponectin, resistin, IL6, IL10, and PAI1 were 3.0 ± 2.7 mg/dl, 36.3 ± 19.5 ng/ml, 8.3 ± 4.5 mg/ml, 24.3 ± 23.2 ng/ml, 51.6 ± 93.6 pg/ml, 10.0 ± 34.2 pg/ml and 22.3 ± 30.6 ng/ml, respectively. Obese patients had significantly higher mean values of resistin and PAI 1 than those who were overweight. These levels correlated significantly with anthropometric and biochemical variables; however, the correlations were weak. Age, menopause or the regular practice of physical activity had no effect on mean values. CONCLUSIONS: The group of women studied had altered inflammatory biomarkers in relation to people of normal weight. The study shows the inflammatory status of overweight/ obese individuals, and the values obtained may help to establish standard ranges for these markers.

Carcinoma escamoso primario de mama posradiación / Postradiation primary squamous cell carcinoma of the breast

El carcinoma escamoso (CE) primario de mama es una entidad rara dentro de las neoplasias malignas de mama. Su clínica, diagnóstico y tratamiento no difieren del resto de los tumores de mama. El pronóstico es controvertido y la supervivencia a los 5 años es del 50 al 60%. A continuación se presenta el caso de una mujer que sufrió CE primario de mama 11 años después del tratamiento con radioterapia por un carcinoma ductal infiltrante de mama (AU)

Primary squamous cell carcinoma of the breast is a rare entity within malignant neoplasm of the breast. The clinical features, diagnosis and treatment do not differ from those of other breast tumors. Prognosis is controversial and 5-year survival is 50–60%. We report a case of primary squamous cell carcinoma of the breast 11 years after treatment with radiotherapy for an infiltrating ductal breast carcinoma (AU)

Leucemia aguda mieloblástica en gestante de 28 semanas / Acute myeloblastic leukemia in a 28-week pregnant woman

La leucemia aguda es un proceso poco frecuente durante la gestación. Es un problema multidisciplinario que precisa la participación de obstetras, hematólogos, pediatras y la familia, para tomas las decisiones adecuadas tanto para la madre como para el feto. Las pautas de tratamiento con quimioterapia no se modifican durante el embarazo, y las tasas de supervivencia son similares a las de la población general. Pero dependiendo del momento de la gestación es preciso tomar decisiones sobre el bienestar fetal. Presentamos un caso de una gestación de 28 semanas con leucemia aguda mieloblástica de mal pronóstico, con buena evolución materna y fetal tras la administración de quimioterapia durante la gestación (AU)

Acute leukemia is very rare during pregnancy. This process requires a multidisciplinary approach, with the participation of obstetricians, hematologists, pediatricians, and the family in order to make correct decisions for both the mother and the fetus. Treatment guidelines on chemotherapy are not modified during pregnancy and survival rates are similar to those among the general population. However, depending on the stage of pregnancy, decisions must be taken on fetal well-being. We present the case of a 28-weekpregnant woman with acute myeloblastic leukemia and poor prognosis. After chemotherapy administration during pregnancy, good maternal and fetal outcomes were obtained (AU)

Adenosis vaginal no relacionada con dietilestilbestrol / Vaginal adenosis not associated with diethylstilbestrol exposure

Introducción: La adenosis vaginal se caracteriza por la presencia de tejido glandular, o sus secreciones, en la pared vaginal. Caso clínico: Se presentan 2 casos de adenosis vaginal en mujeres con edades comprendidas entre 41 y 76 años, no asociados a dietilestilbestrol (DES) ni otra causa que los justifique. Comentario: Hay 2 grupos de mujeres donde es conocido el desarrollo de adenosis. Uno «congénito», debido a la exposición intraútero al DES que provoca una proliferación del epitelio de los restos mullerianos en la vagina, y otro «adquirido», en el cual se han propuesto como posibles causas: a) un traumatismo e inflamación continuada de la mucosa vaginal (debido al uso de láser de CO2, 5-fluorouracilo, compresas o el uso crónico de pesarios); b) estímulos hormonales, y c) idiopáticas. En todos los casos, tanto los congénitos como los adquiridos, hay un riesgo aumentado de desarrollo de adenocarcinoma vaginal. Por ello, se pretende un diagnóstico precoz mediante la vigilancia y el control de dichas lesiones (AU)

Introduction: Vaginal adenosis is characterized by the presence of glandular tissue or its secretory products in the vaginal wall. Case reports: We report 2 cases of vaginal adenosis not associated with diethylstilbestrol exposure or any other apparent causes in 2 women aged 41 and 76 years old. Discussion: Two groups of women are known to develop vaginal adenosis. In the first «congenital» group, there is proliferation of the remnant Mullerian epithelium in the vagina due to in utero diethylstilbestrol exposure. In the second «acquired» group, the following causes have been proposed: a) trauma and continuous inflammation of the vaginal mucosa (due to the use of CO2 laser, 5-fluoracyl, sanitary products or chronic pessary use); b) sex hormones; and c) idiopathic. In both the congenital and acquired groups, there is an increased risk of developing vaginal adenocarcinoma. Therefore, prompt diagnosis by monitoring lesions is essential (AU)

La depresión en el anciano en una zona rural y su interacción con otros factores / Depression in the elderly living in a rural area and other related factors

Introducción. Se quiere determinar la prevalencia de depresión en población anciana (≥ 65 años) rural, libre de deterioro cognitivo y examinar las características que presentan los ancianos con probable depresión. Pacientes y método. Un total de 265 personas (edad media [DE]: 76,2 [6,7] años; 60,4 % mujeres) residentes en los concejos rurales de Proaza, Quirós y Santo Adriano (Asturias) fueron entrevistados. Se registraron variables sociodemográficas y clínicas y se administraron los siguientes cuestionarios: Mini-Examen Cognoscitivo (MEC), Escala de Depresión Geriátrica de Yesavage (GDS), Cuestionario Oviedo de Sueño (COS), Cuestionario de alcoholismo CAGE, Cuestionario de Salud General de Goldberg (GHQ-28) y el Instrumento de Evaluación de Calidad de Vida de la Organización Mundial de la Salud (WHOQOL-BREF). Resultados. Se excluyeron a 23 personas por puntuar <18 puntos en el MEC. La muestra final incluye 242 sujetos (edad media [DE]: 75,59 [6,2] años; 60,3 % mujeres). Presentaban probable depresión el 23,1 % (30,1 % mujeres frente a 12,5 % hombres; p=0,002), las prevalencias más elevadas de depresión se obtuvieron en aquellos que padecían mayor número de enfermedades físicas (p = 0,012), presentaban comorbilidad psiquiátrica (p = 0,031), puntuaban menos en el MEC (p = 0,019), presentaban mayor prevalencia de problemas de sueño (p ≤ 0,050), puntuaban más en el GHQ-28 (p=0,000) y menos en el WHOQOL-BREF (p=0,000). Conclusiones. La prevalencia de depresión es moderadamente elevada, siendo más frecuente en mujeres, en los que viven solos, carecen de estudios, pertenecen al sector primario, padecen patología física o psíquica, presentan mayor deterioro cognitivo, peor salud general y tienen una peor percepción de su calidad de vida

Introduction. We want to determine the prevalence of depression in a rural population (65 years and over) free from cognitive impairment and to evaluate related factors of late life depression. Patients and method. A total of 265 persons (mean age [SD]: 76.2 [6.7] years; 60.4 % females) residing in the towns of Proaza, Quiros and Santo Adriano (Asturias) were interviewed. The evaluation included sociodemographical and clinical aspects as well as the Mini-Mental State Examination Spanish version (MMSE), the Geriatric Depression Scale (GDS), the Oviedo Sleep Questionnaire (OSQ), the CAGE Questionnaire, the Goldberg General Health Questionnaire (GHQ-28), and the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Results. A total of 23 subjects out of the total sample were excluded from the study due to scoring less than 18 points on the MMSE. The final sample included 242 subjects (mean age [SD]: 75.59 (6.2) years; 60.3 % females). Prevalence of probable depression was 23.1 % [30.1 % females vs 12.5 % males; p = 0.002]. Depression was statistically associated with a higher number of physical diseases (p=0.012), higher psychiatric comorbidity (p=0.031), less cognitive impairment measured by MMSE (p=0.019), higher prevalence of sleep disorders (p ≤ 0.050), higher score in the GHQ-28 (p = 0.000), and worse quality of life evaluated by the WHOQOL-BREF (p=0.000). Conclusions. Depression is moderately prevalent in this population. Depression is more frequent in females, those living alone, without studies, working in agricultural sector, with physical or psychiatric comorbidity, with higher cognitive impairment, and with a worse health status and quality of life perception