Consumption of seafood and its estimated heavy metals are associated with lipid profile and oxidative lipid damage on healthy adults from a Spanish Mediterranean area: A cross-sectional study.

The association between the consumption of seafood and its benefits on cardiovascular (CVD) risk can be challenged by its heavy metal (HM) content. This study aimed to explore the association of seafood consumption and its estimated HM contents with the lipid profile and lipid oxidation biomarkers in adults from a Spanish Mediterranean area who do not present risk factors for CVD. In this cross-sectional study, the clinical history, three-day dietary record, lipid profile (LDLc, HDLc, APOB/A, and triglyceride levels), plasma oxidised LDL (oxLDL) and 8-isoprostane levels of 81 adults without risk factors for CVD [43% men, with a mean age of 43.6 years (95%CI: 40.1-47.1)] were assessed. The HM [arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb)] contents of seafood were estimated according to data from analyses of marine species in the same Mediterranean area. Moderate adherence to the Mediterranean diet (score: 4.6 of 9) with a mean seafood consumption of 74.9g/day (95%CI: 59.9-89.9), including 22.7g of shellfish per day (95%CI: 13.5-31.9), was observed. The estimated HM contents were lower than the provisional tolerable weekly intakes (PTWIs): 21.12µg/kg/week As, 0.57µg/kg/week InAs, 0.15µg/kg/week Cd, 1.11µg/kg/week Hg and 0.28µg/kg/week Pb. After adjusting by confounder variables, an increase in shellfish consumption was associated with increases in the levels of LDLc (P=0.013), non-HDLc (P=0.015), APOB/A (P=0.02) and plasma oxLDL (P=0.002). Moreover, an increase in the estimated As and Hg levels in shellfish was associated with an increase in LDLc (P=0.015 and P=0.018, respectively), non-HDLc (P<0.008 and P<0.008, respectively), APOB/A ratio (P=0.008 and P=0.009, respectively), and oxLDL (P≤0.001 and P≤0.001, respectively) levels. In conclusion, in adults without risk factors for CVD, increasing shellfish consumption, even by a moderate amount, could favour a pro-atherogenic lipid profile and a higher level of oxidised LDL. These associations are likely influenced by the estimated exposure to As and Hg from shellfish despite these values are lower than the PTWIs.

Réplica a la carta al director: «Terminología y comunicación entre niveles asistenciales» / Reply to letter to the editor: «Terminology and communication between healthcare levels»

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Communication between primary care and physician specialist: is it improving? / Comunicación entre la atención primaria y el médico especialista: ¿se está produciendo alguna mejora?

Fundamento y objetivo. En los últimos años se ha intentado mejorar en España la comunicación entre la atención primaria y la atención especializada. El objetivo de este estudio fue analizar el impacto de un cambio en el modelo de comunicación entre ambas áreas, comparando el sistema tradicional con un sistema de consultoría. Se analizó la satisfacción de los médicos de atención primaria y el número de derivaciones realizadas. Métodos. En un centro de atención primaria donde trabajan 20 médicos, se pasó un cuestionario al inicio y a los 18 meses de introducir un sistema de consultoría, para conocer su punto de vista sobre la relación con el equipo de endocrinología. Asimismo se contabilizó el número de derivaciones durante ambos períodos. Resultados. Se analizaron 30 cuestionarios: 13 al inicio y 17 tras el establecimiento del sistema de consultoría. El nuevo sistema se prefirió a otras alternativas como medio de comunicación con los endocrinólogos. Tras la introducción del sistema de consultoría, los médicos tenían más confianza y autonomía en la gestión de la diabetes y el hipotiroidismo. Además disminuyó drásticamente el número de derivaciones a la atención especializada, que pasó de 93,8 a 34,6 pacientes por mes tras la introducción del sistema de consultoría. Conclusiones. El sistema de consultoría resultó más eficaz que el sistema tradicional para la resolución de problemas y la respuesta a los médicos. Los médicos aumentaron la confianza y autonomía en la gestión de la diabetes y el hipotiroidismo. Se observó un descenso importante del número de derivaciones (AU)

Background and objective. Efforts have recently been made in Spain to improve the communication model between primary care and specialized care. The aim of our study was to analyze the impact of a change in the communication model between the two areas when comparing a traditional system to a consulting system in terms of satisfaction of general practitioners and the number of patient referrals. Methods. A questionnaire was used to assess the point of view on the relations with the endocrinologist team of 20 general practitioners from one primary care center at baseline and 18 months after the implementation of the new method of communication. In addition, we counted the number of referrals during the two periods. Results. We analyzed 30 questionnaires; 13 before and 17 after the consulting system was established. Consulting system was preferred to other alternatives as a way of communication with endocrinologists. After the consulting system was implemented, general practitioners were more confident in treating hypothyroidism and diabetes. There was a decrease in the number of patient referrals to specialized care from 93.8 to 34.6 per month after implementation of the consultant system. Conclusions. The consultant system was more efficient in resolving problems and responding to general practitioners than the traditional system. General practitioners were more confident in self-management of hypothyroidism and diabetes. A very large decrease in the number of patient referrals was observed after implementation of the consultant system (AU)

Communication between primary care and physician specialist: is it improving?

BACKGROUND AND OBJECTIVE: Efforts have recently been made in Spain to improve the communication model between primary care and specialized care. The aim of our study was to analyze the impact of a change in the communication model between the two areas when comparing a traditional system to a consulting system in terms of satisfaction of general practitioners and the number of patient referrals. METHODS: A questionnaire was used to assess the point of view on the relations with the endocrinologist team of 20 general practitioners from one primary care center at baseline and 18 months after the implementation of the new method of communication. In addition, we counted the number of referrals during the two periods. RESULTS: We analyzed 30 questionnaires; 13 before and 17 after the consulting system was established. Consulting system was preferred to other alternatives as a way of communication with endocrinologists. After the consulting system was implemented, general practitioners were more confident in treating hypothyroidism and diabetes. There was a decrease in the number of patient referrals to specialized care from 93.8 to 34.6 per month after implementation of the consultant system. CONCLUSIONS: The consultant system was more efficient in resolving problems and responding to general practitioners than the traditional system. General practitioners were more confident in self-management of hypothyroidism and diabetes. A very large decrease in the number of patient referrals was observed after implementation of the consultant system.

Oxidative stress in immunocompetent patients with severe community-acquired pneumonia. A pilot study

OBJECTIVE: A comparison was made of the oxidative stress (OS) levels of patients with either viral or bacterial severe community-acquired pneumonia (sCAP) and of patients without infection (healthy volunteers (HV) and patients with acute myocardial infarction (AMI)). DESIGN: A prospective observational study was made. PATIENTS: Critically ill patients with sCAP. VARIABLES: The TBARS level was measured as an index of oxidative injury. SOD, CAT and redox glutathione system (GSH, GSSG, GR, GPx) activities were measured as reflecting antioxidant capacity. Severity of illness was assessed by the APACHE II, SOFA and SIRS scores. RESULTS: Thirty-seven subjects were included: 15 patients with CAP (12 of bacterial origin [BCAP] and 3 due to 2009 A/H1N1 virus [VCAP]), 10 HV and 12 AMI patients. Intensive care CAP mortality was 26.7% (n = 4). Plasmatic TBARS levels were higher in CAP patients than in HV, but similar to those recorded in AMI patients. In contrast, VCAP was associated with lower TBARS levels, and some components of the glutathione redox system were higher in BCAP patients and HV. The OS levels did not differ between survivors and non-survivors. CONCLUSION: Our results suggest the occurrence of higher OS in sCAP patients compared with HV. In contrast, lower TBARS levels were observed in VCAP patients, suggesting an increase of antioxidant activity related to the redox glutathione system. However, further research involving a larger cohort is needed in order to confirm these findings

OBJETIVOS: Comparar el estrés oxidativo (EO) en pacientes con neumonía comunitaria grave (NCG) según su etiología y respecto de voluntarios sanos (VS) y pacientes con infarto agudo de miocardio (IAM). DISEÑO: Estudio prospectivo, observacional. PACIENTES: Pacientes con NCG ingresados en unidades de cuidados intensivos. Variables Los niveles de lipoperoxidación (TBARS) fueron considerados como índice de oxidación, mientras que SOD, CAT y la actividad del sistema redox- glutation (GSH, GSSG, GR, GPx) fueron considerados capacidad antioxidante. La gravedad de los pacientes fue valorada mediante las escalas APACHE II, SOFA y SIRS. RESULTADOS: Treinta y siete sujetos fueron incluidos, 15 pacientes con NCG (12 con etiología bacteriana [NB] y 3 viral 2009 A/H1N1 [NV]), 10 VS y 12 con IAM. La mortalidad global fue del 26,7% (n = 4). Los TBARS plasmáticos fueron superiores en NCG respecto de VS, pero similares al IAM. En contraste, la NV se asoció con menores niveles de TBARS e incremento de componentes del sistema redox-glutation respecto de NB y voluntarios sanos. No se observó asociación entre mortalidad y EO. CONCLUSIÓN: Nuestros resultados evidencian la presencia de EO en pacientes con NCG respecto de los controles. En contraste, la evidencia de un menor nivel de TBARS en la NV respecto de los VS sugiere un incremento de la actividad antioxidante relacionada con el sistema redox-glutation. Sin embargo, son necesarias nuevas investigaciones para confirmar estos hallazgos

Oxidative stress in immunocompetent patients with severe community-acquired pneumonia. A pilot study.

OBJECTIVE: A comparison was made of the oxidative stress (OS) levels of patients with either viral or bacterial severe community-acquired pneumonia (sCAP) and of patients without infection (healthy volunteers (HV) and patients with acute myocardial infarction (AMI)). DESIGN: A prospective observational study was made. PATIENTS: Critically ill patients with sCAP. VARIABLES: The TBARS level was measured as an index of oxidative injury. SOD, CAT and redox glutathione system (GSH, GSSG, GR, GPx) activities were measured as reflecting antioxidant capacity. Severity of illness was assessed by the APACHE II, SOFA and SIRS scores. RESULTS: Thirty-seven subjects were included: 15 patients with CAP (12 of bacterial origin [BCAP] and 3 due to 2009 A/H1N1 virus [VCAP]), 10 HV and 12 AMI patients. Intensive care CAP mortality was 26.7% (n=4). Plasmatic TBARS levels were higher in CAP patients than in HV, but similar to those recorded in AMI patients. In contrast, VCAP was associated with lower TBARS levels, and some components of the glutathione redox system were higher in BCAP patients and HV. The OS levels did not differ between survivors and non-survivors. CONCLUSION: Our results suggest the occurrence of higher OS in sCAP patients compared with HV. In contrast, lower TBARS levels were observed in VCAP patients, suggesting an increase of antioxidant activity related to the redox glutathione system. However, further research involving a larger cohort is needed in order to confirm these findings.

Analysis of human platelet antigen systems in a Moroccan Berber population.

The human platelet alloantigen systems HPA-1, -2, -3, -4, -5 and -6 in a Moroccan Berber population from the Amizmiz region were determined by polymerase chain reaction using sequence-specific primers (PCR-SSP). The gene frequencies obtained from these unrelated Berbers were 0 x 747 and 0 x 252 for HPA-1a and -1b; 0 x 817 and 0 x 182 for HPA-2a and -2b; 0 x 682 and 0 x 317 for HPA-3a and -3b; 1 and 0 x 0 for HPA-4a and -4b; 0 x 8616 and 0 x 1383 for HPA-5a and -5b; 1 and 0 x 0 for HPA-6a and -6b. The Berbers have the highest frequency for the 1b, 2b and 5b alleles of all the populations reported to date and also the lowest frequency for the 3b allele.

Etiopatogenia de la obesidad: actualidad y futuro / Aetiopathogeniy of obesity: current situation and prospects

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Gm and Km alleles in two Spanish Pyrenean populations (Andorra and Pallars Sobirà): a review of Gm variation in the Western Mediterranean basin.

Two Spanish eastern Pyrenean populations, Andorra and Pallars Sobirà, have been tested for G1m(1,2,3,17), G2m(23), G3m(5,6,10,11,13,14,15,16,21,24,28) and Km(1) immunoglobulin allotypes. Km allele and Gm haplotype frequencies in both samples fit well into the Western Mediterranean and, more strictly, Pyrenean ranges with some peculiarities: Andorra showed an elevated frequency (14.7%) of the typical Asian and European Gm21,28;1,2,17;. haplotype, while Pallars Sobirà was characterized by high values (3.7%) of Gm5*;1,17;., a typical sub-Saharan Gm haplotype. Gm diversity assessed through genetic distance and variance analyses revealed a significant geographic partition (4.3%) of Mediterraneans among south, north-east, and north-west groups. It is interesting to note the relatively low genetic variance (2.1%) found between south and north-western Mediterraneans that could reflect ancient population relationships. More locally, genetic boundaries and diversity analyses failed to indicate any geographic pattern and/or genetic differentiation related with the political border in the Pyrenees. The present pattern of variation in this area is probably the result of genetic isolation processes, in addition to some specific demographic phenomena, in the Pyrenean valleys.

GM and KM immunoglobulin allotypes in a Spanish Pyrenean population: Val d'Aran.

Four hundred and thirteen unrelated individuals (202 autochthonous and 211 non-autochthonous) of Val d'Aran (Catalan Pyrenees) have been analysed for the GM and KM immunoglobulin genetic system using the inhibition haemagglutination method. This population was defined by eight GM haplotypes (GM*3 23 5*, GM*3 5*, GM*1,17 21,28, GM*1,2,17 21,28, GM*1,17 5*, GM*1,17 5,6,11,24, GM*1,17 10,11,13,15 and GM*1,17 10,11,13,15,16) inferred from the 17 observed phenotypes. The Val d'Aran population frequencies conform to Hardy-Weinberg expectations. The frequencies of phenotypes and haplotypes show a definite homogeneity between the autochthonous and non-autochthonous people of Val d'Aran and 11 other Pyrenean populations (Mauléon, Macaye, St. Jean Pied de Port, Vallée de L'Ouzom, Gavarnie, Barèges, Luz St. Sauveur, Esparros, Camurac, Capcir and Pays de Sault) that have already been studied for the same allotypes. A factorial correspondence analysis was performed for the 12 autochthonous Pyrenean populations, showing a high frequency of the GM*3 23 5* haplotype in the three Pyrenean regions (Western, Central and Eastern), while the GM*1,17 21,28 haplotype is mainly found in the Central region, GM*3 5* in the Eastern and Western zones, and the GM*1,2,17 21,28 is mainly present in the Central and Eastern populations. The results show a relative regional homogeneity, so there is no evidence of a frequency gradient in the Pyrenean populations for the GM and KM genetic systems. It may, however, be noticed that the Central Pyrenean populations form a group, with one population (Vallée de l'Ouzom) isolated from the rest, probably because of its particular model of inheritance by which the heritage is passed to the first born without sex consideration. It has been possible to point out some differences in the genetic structure of the autochthonous and non-autochthonous Val d'Aran population and to place the autochthonous Aranese group among its Pyrenean neighbours.

Influence of nutrition, thyroid hormones, and rectal temperature on in-hospital mortality of elderly patients with acute illness.

The present study was undertaken to investigate the interrelation of nutrition, core temperature, and thyroid function and their influence on survival of patients aged > or = 70 y admitted to the hospital with acute conditions. Sixty-seven patients entered the study. Nutritional state, thyroid function, rectal temperature, and the APACHE II score were recorded at admission. The patients were followed until death or hospital discharge. Patients with a serum albumin concentration < 35 g/L showed a lower triiodothyronine (T3) concentration, a higher reverse triiodothyronine (rT3) concentration, and a higher death rate. Prior weight loss (> or = 10%) did not influence thyroid status but increased the mortality rate. Eleven patients were hypothermic (< 36.5 degrees C) and had a higher mortality, lower total T3 concentration, and higher rT3 concentration than the normothermic or hyperthermic subjects. Serum albumin, body weight, and total T3 concentration were higher in survivors (n = 51) than in nonsurvivors (n = 16). Ongoing weight loss and hypoalbuminemia at admission are highly prevalent in elderly people with acute disease, and influence their clinical outcome. Mild hypothermia was a good predictor of death. Hypoalbuminemia and hypothermia were associated with low T3 and high rT3 values.

Comparación de dos métodos de valoración de la ingesta de alimentos y nutrientes: recordatorio de 24 horas y custionario de frecuencia semicuantitativo / To compare two dietary methods: a 24-hour recall and a semiquantitative food frecuency questionnaire

Fundamentos: Los métodos de valoración individual de la ingesta dietética incluyen distintos procedimientos con diferentes modos de estimar la ingesta tanto de alimentos como de energía y nutrientes. El objetivo de este estudio ha sido comparar dos métodos de valoración de la ingesta dietética extensamente utilizados en epidemiología nutricional; el recordatorio de 24 horas y el cuestionario de frecuencia de consumo de alimentos semicuantitativo. Métodos: Se entrevistó a una muestar aleatoria de 155 personas del Valle de Arán (Lérida), en la que se obtuvo la información sobre ingesta nutricional mediante ambos cuestionarios. Resultados: Antes del ajuste por la ingesta de energía, el cuestionario de frecuencia sobreestimaba la ingesta de todos los nutrientes excepto del colesterol. Después de dicho ajuste, las estimaciones de los dos métodos fueron muy parecidos. Cuando se comparó el porcentaje de energía procedente de las proteínas, lípidos, hidratos de carbono y la relación de ácidos grasos poliinsaturados/monoinsaturados los resultados también fueron casi iguales. Los coeficientes de correlación entre ambos cuestionarios oscilaban entre 0,81 y 0,23. Los nutrientes que presentaron mayor correlación cruda entre ambos cuestionarios fueron el alcohol, la energía, los hidratos de carbono, el sodio y el yodo (R ò 0,7) mientras que las vitaminas C, B1, B6, B12 y A, niacina, ácido fólico, hierro, fósforo y potasio presentaban la menor correlación (R ó 0,5). Las correlaciones de los nutrientes ajustados por la ingesta energética fueron muy diferentes a las no ajustadas, en especial para los lípidos, ácidos grasos monoinsaturados, hidratos de carbono, fibra, colesterol, cinc y sodio, para los que se obtuvo un menor coeficiente de correlación después del ajuste; y las vitaminas B2, B6, C, D y el potasio, para los que se encontró un coeficiente superior después de ajustar por la ingesta energética. Conclusiones: Si bien los dos métodos de valoración de la ingesta de alimentos y nutrientes tienden a estimar consumos parecidos cuando se expresan ajustados por la ingesta calórica, el cuestionario de frecuencia tiende a subreestimar la ingesta total

Comparación de dos métodos de valoración de la ingesta de alimentos y nutrientes: recordatorio de 24 horas y custionario de frecuencia semicuantitativo / To compare two dietary methods: a 24-hour recall and a semiquantitative food frecuency questionnaire

Fundamentos: Los métodos de valoración individual de la ingesta dietética incluyen distintos procedimientos con diferentes modos de estimar la ingesta tanto de alimentos como de energía y nutrientes. El objetivo de este estudio ha sido comparar dos métodos de valoración de la ingesta dietética extensamente utilizados en epidemiología nutricional; el recordatorio de 24 horas y el cuestionario de frecuencia de consumo de alimentos semicuantitativo. Métodos: Se entrevistó a una muestar aleatoria de 155 personas del Valle de Arán (Lérida), en la que se obtuvo la información sobre ingesta nutricional mediante ambos cuestionarios. Resultados: Antes del ajuste por la ingesta de energía, el cuestionario de frecuencia sobreestimaba la ingesta de todos los nutrientes excepto del colesterol. Después de dicho ajuste, las estimaciones de los dos métodos fueron muy parecidos. Cuando se comparó el porcentaje de energía procedente de las proteínas, lípidos, hidratos de carbono y la relación de ácidos grasos poliinsaturados/monoinsaturados los resultados también fueron casi iguales. Los coeficientes de correlación entre ambos cuestionarios oscilaban entre 0,81 y 0,23. Los nutrientes que presentaron mayor correlación cruda entre ambos cuestionarios fueron el alcohol, la energía, los hidratos de carbono, el sodio y el yodo (R ò 0,7) mientras que las vitaminas C, B1, B6, B12 y A, niacina, ácido fólico, hierro, fósforo y potasio presentaban la menor correlación (R ó 0,5). Las correlaciones de los nutrientes ajustados por la ingesta energética fueron muy diferentes a las no ajustadas, en especial para los lípidos, ácidos grasos monoinsaturados, hidratos de carbono, fibra, colesterol, cinc y sodio, para los que se obtuvo un menor coeficiente de correlación después del ajuste; y las vitaminas B2, B6, C, D y el potasio, para los que se encontró un coeficiente superior después de ajustar por la ingesta energética. Conclusiones: Si bien los dos métodos de valoración de la ingesta de alimentos y nutrientes tienden a estimar consumos parecidos cuando se expresan ajustados por la ingesta calórica, el cuestionario de frecuencia tiende a subreestimar la ingesta total (AU)

[Comparison of 2 methods of evaluation of food and nutrient intake: 24-hour recall and semiquantitative frequency questionnaire]. / Comparación de dos métodos de valoración de la ingesta de alimentos y nutrientes: recordatorio de 24 horas y cuestionario de frecuencia semicuantitativo.

BACKGROUND: Methods of dietary collection at an individual level include various procedures with different estimates of food, energy and nutrients intakes. The aim of this study was to compare two dietary methods widely used in nutritional epidemiology: a 24-hour recall and a semiquantitative food frequency questionnaire. METHODS: One hundred and fifty-five people selected at random from the population of the Valle de Arán (Lérida, Spain) were surveyed. Nutritional intake information was obtained from both methods. RESULTS: The frequency method overestimated all the nutrient intakes only before adjustment by energy intake, except for cholesterol. After adjustment by energy intake estimations from both questionnaires were very similar; the percentages of energy supplied by proteins, fatty acids and carbohydrates were very similar, too; the polyunsaturated/monounsaturated fatty acid ratios, were almost the same. Results show a level of correlation between the questionnaires that ranges from 0.81 to 0.23. Nutrients that showed the highest crude correlation between both questionnaires were alcohol, energy, carbohydrates, sodium and iodine (R > or = 0.7) while vitamins C, B1, B6, B12, and A, niacine, folic acid, iron, phosphorus and potassium showed the lowest (R < or = 0.5). Energy adjusted correlations were quite different to unadjusted ones particularly for lipids, monounsaturated fatty acids, carbohydrates, fiber, cholesterol, zinc and sodium, for which a lower coefficient was calculated after adjustment, and vitamins B2, B6, C, D and potassium, for which a higher coefficient was estimated after energy adjustment. CONCLUSIONS: Both methods make similar assessments when adjusting for caloric intake, but food frequency questionnaire tends to overestimate food consumption.

Positioning of the autochthonous Aran Valley population among Basque and Pyrenean people by means of ABO, Rh (D) and Duffy blood group determinations.

A total of 205 unrelated autochthonous individuals of both sexes from the population of the Aran Valley in the central Pyrenees were tested for ABO, Rh and duffy blood groups. This population is of interest because of its relative geographical and historical isolation and its specific peculiarities, such as its own language. The results show a good correlation between the principal component analysis graphic and the geographic positions of the Basque and Pyrenean populations with which the Aranese population is compared.

Variability of the Rh system in a central Pyrenean population (Aran Valley).

This work describes the results of a survey on the Rhesus system carried out in the autochthonous population of Aran Valley, a small and rather isolated region on the Northern side of the Central Pyrenees. Also, a comparison is made with other geographically and historically related populations in order to discuss the data in terms of the historical origin of this population. The data obtained shows a good agreement between observed and expected values in Hardy-Weinberg equilibrium. The Aranese population also reveals some peculiarities concerning some haplotypes. The comparison with European and non European Mediterranean populations shows a clear genetic distance from Basque populations, and a relative proximity with presumably Celtic ones.

Apparent recurrence of hemolytic uremic syndrome in azathioprine-treated allograft recipients.

The present study describes 3 adult patients with hemolytic uremic syndrome (HUS) leading to chronic renal failure. Following renal transplantation, the 3 patients developed microangiopathic hemolytic anemia associated with acute rejection crises and graft failure. In 2 patients the renal histology of the transplanted kidney was consistent with HUS. It is concluded that, in adult patients, HUS may recur after renal transplantation and contribute to renal graft failure.

Amyloidosis (AA type) associated with nodular nonsuppurative panniculitis.

A 42-year-old man had a 9-year history of idiopathic, nodular nonsuppurative panniculitis that was complicated by generalized AA-type amyloidosis. We believe that this is the first report of this association.