Effectiveness and Tolerability of the Intensification of Canagliflozin Dose from 100 mg to 300 mg Daily in Patients with Type 2 Diabetes in Real Life: The INTENSIFY Study.

Aim: This study aimed to evaluate the effectiveness and tolerability of intensifying the dose of canagliflozin from 100 mg/day (CANA100) to 300 mg/day (CANA300) in patients with type 2 diabetes (T2DM) and suboptimal metabolic control in a real-world setting. Methods: A multicenter observational study was conducted on adult patients with T2DM who initiated treatment with CANA100 and subsequently required intensification to CANA300. The primary outcome measures were changes in HbA1c and weight at 6 months after the switch and at the end of the follow-up period. Results: A total of 317 patients met the inclusion criteria (59.6% male, mean age 62.2 years, baseline HbA1c 7.55%, weight 88.6 kg, median duration of treatment with CANA100 9.9 months). Switching to CANA300 resulted in a significant reduction in HbA1c (6 months: -0.33%; last visit: -0.47%, both p < 0.0001) and weight (6 months: -1.8 kg; last visit: -2.9 kg, both p < 0.0001) over a median follow-up period of 20.8 months. The proportion of patients that achieved HbA1c < 7% increased from 26.7% with CANA100 to 51.6% with CANA300 (p < 0.0001). Among individuals with poor baseline glycemic control (HbA1c > 8%, mean 9.0%), HbA1c was significantly reduced by -1.24% (p < 0.0001). Furthermore, significant improvements were observed in fasting plasma glucose (FPG), blood pressure (BP), liver enzymes, and albuminuria. No unexpected adverse events were reported. Conclusions: Intensifying the treatment to CANA300 in a real-world setting resulted in further significant and clinically relevant reductions in FPG, HbA1c, weight, and BP in patients with T2DM. The switch was particularly effective in patients with higher baseline HbA1c levels.

Physico-chemical and biological characterization of a new bovine bone mineral matrix available for human usage.

BACKGROUND: Anorganic bovine bone has been deeply studied for bone regeneration in the oral cavity. Different manufacturing processes can modify the final composition of the biomaterial and the responses that induce. AIM: To evaluate the physico-chemical characteristics of a bovine bone mineral matrix and the clinical, radiographical, histological, and mRNA results after using it for maxillary sinus floor augmentation in humans. MATERIALS AND METHODS: First, the physical-chemical characteristics of the biomaterial were evaluated by X-ray powder diffraction, X-ray fluorescence, and electron microscopy. A frequently used biomaterial with the same animal origin was used as comparator. Then, a clinical study was designed for evaluating clinical, radiographical, histological, and mRNA outcomes. Patients in need of two-stage maxillary sinus floor augmentation were included in the study. Six months after the grafting procedure, a bone biopsy was collected for evaluation. RESULTS: In terms of physico-chemical characteristics, no differences were found between both biomaterials. Clinically, 10 patients were included in the study. After 6 months, clinical and radiographical data showed adequate outcomes for allowing implant placement. Histological, immunohistochemical and mRNA analyses showed that the biomaterial in use provides biological support to induce responses similar to those of other commonly used biomaterials. CONCLUSION: Bovine bone mineral matrix (Creos™ Xenogain) used as a single material for maxillary sinus floor augmentation shows adequate biological, clinical, and radiological outcomes. In fact, the results from this study are similar to those reported in the literature for another bovine bone-derived biomaterial with whom it shares composition and micro- and nanoscale characteristics.

Effectiveness of an App for tobacco cessation in pregnant smokers (TOBBGEST): study protocol.

BACKGROUND: Tobacco consumption during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant smokers and their foetus. Even though pregnant smokers are conscious about the negative effects of tobacco consumption, they also had barriers for smoking cessation and most of them continue smoking, being a major public health problem. The aim of this study is to determine the effectiveness of an application (App) for mobile devices, designed with a gamification strategy, in order to help pregnant smokers to quit smoking during pregnancy and in the long term. METHODS: This study is a multicentre randomized community intervention trial. It will recruit pregnant smokers (200 participants/group), aged more than 18 years, with sporadically or daily smoking habit in the last 30 days and who follow-up their pregnancy in the Sexual and Reproductive Health Care Services of the Camp de Tarragona and Central Catalonia Primary Care Departments. All the participants will have the usual clinical practice intervention for smoking cessation, whereas the intervention group will also have access to the App. The outcome measure will be prolonged abstinence at 12 months after the intervention, as confirmed by expired-carbon monoxide and urinary cotinine tests. Results will be analysed based on intention to treat. Prolonged abstinence rates will be compared, and the determining factors will be evaluated using multivariate statistical analysis. DISCUSSION: The results of this study will offer evidence about the effectiveness of an intervention using a mobile App in smoking cessation for pregnant smokers, to decrease comorbidity associated with long-term smoking. If this technology is proven effective, it could be readily incorporated into primary care intervention for all pregnant smokers. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT05222958 . Trial registered 3 February 2022.

Memoria de trabajo y planificación como predictores de las competencias matemáticas tempranas

Introducción: La relación entre funciones ejecutivas y habilidades matemáticas ha sido ampliamente estudiada. Sin embargo, no existe consenso respecto de la contribución específica de la memoria de trabajo y la planificación en el desarrollo de competencias matemáticas tempranas. El objetivo de este estudio fue determinar la capacidad predictiva de estos dos dominios ejecutivos sobre las competencias matemáticas de preescolares. Método: Se implementó un diseño no experimental ex post facto, con una muestra de 104 niños/as chilenos/as. La evaluación de sus funciones ejecutivas se realizó con la tarea "inversión de números" de la Batería IV Woodcock-Muñoz para evaluar la memoria de trabajo verbal, la subprueba "Torpo, el topo torpe" del Test de Evaluación Neuropsicológica Infantil (TENI) para evaluar la memoria de trabajo visoespacial y el Test de Laberintos de Porteus para evaluar la planificación. Con el fin de evaluar las habilidades matemáticas se utilizó el Test de Evaluación Matemática Temprana Utrecht (TEMT-U), versión chilena. Se realizaron análisis descriptivos, correlaciones y modelos de regresión múltiple. Resultados: La memoria de trabajo verbal seguida por la memoria de trabajo visoespacial y la planificación fueron los mejores predictores de las competencias matemáticas de los/as niños/as. Conclusiones: Estos resultados sugieren que estas funciones ejecutivas desempeñan un papel clave en el aprendizaje de las matemáticas y aportan información específica a las/os educadoras/es para que puedan planificar sus estrategias de enseñanza en función de las demandas cognitivas que requiere cada habilidad matemática, lo que puede ser una vía potencial para promover mejores logros de aprendizaje en esta importante disciplina.

Introduction: The relationship between executive functions and mathematical skills has been extensively studied. However, there is no consensus regarding the specific contribution of working memory and planning in the development of early mathematical skills. The aim of this study was to determine the predictive capacity of these two executive domains on preschoolers' mathematical skills. Method: A non-experimental ex post facto design was implemented with a sample of 104 Chilean children. The evaluation of their executive functions was performed with the "number inversion" task of the Woodcock-Muñoz IV Battery to assess verbal working memory, the "Clumsy Mole the Clumsy Mole" subtest of the TENI Child Neuropsychological Evaluation Test to assess visuospatial working memory, and the Porteus Maze Test to assess planning. To assess mathematical skills, the Test de Evaluación Matemática Temprana Utretch TEMT-U, Chilean version, was used. Descriptive analyses, correlations and multiple regression models were performed. Results: Verbal working memory followed by visuospatial working memory and planning were the best predictors of children's mathematical skills. Conclusions: These results suggest that these executive functions play a key role in mathematics learning and provide specific information to educators so that they can plan their teaching strategies according to the cognitive demands required by each mathematical skill, which may be a potential way to promote better learning achievements in this important discipline.

Prevalencia de niños preescolares con alteraciones cognitivas en la provincia de Cienfuegos / Prevalence of pre-school children with cognitive alterations in Cienfuegos province

Introducción: Existen pocos estudios sobre alteraciones cognitivas en niños realizados en las provincias centrales cubanas. Objetivo: Determinar la prevalencia de niños preescolares con alteraciones cognitivas. Métodos: De un universo de 25 600 niños de la provincia de Cienfuegos entre 0-6 años, se seleccionaron 825 niños preescolares entre 4 y 6 años de varias instituciones educativas y médicas. Todos se evaluaron con la prueba neuropsicológica Luria Inicial. Se usó la norma cubana de la prueba para obtener la prevalencia: percentiles 30 - 35, niños con trastornos del neurodesarrollo, y percentiles 40 - 45, niños con alteraciones cognitivas asociadas a factores psicosociales. Resultados: El 3,9 por ciento de los niños presentaron alteración cognitiva asociada a factores psicosociales, mientras que 1,4 por ciento presentaron alteraciones asociada a trastornos del neurodesarrollo. Las principales alteraciones se resumieron en cuatro tareas: cálculos sencillos, psicomotricidad, lenguaje y memoria de trabajo. En las instituciones educativas, 1 de 10 niños presentaron trastorno del neurodesarrollo, mientras que 3 de 10 niños presentaron alteraciones explicadas por causas educativas. En las instituciones médicas, el 58,0 por ciento de los niños presentó alteraciones explicadas también por causas educativas. Conclusiones: En la provincia de Cienfuegos la prevalencia de niños preescolares con alteraciones cognitivas es moderadamente alta. En especial, las alteraciones se encuentran en las funciones ejecutivas, lingüísticas y en las habilidades relacionadas con el procesamiento numérico. En las instituciones médicas, el niño con alteraciones en las funciones ejecutivas y lingüísticas es frecuente, mientras que en las instituciones educativas prevalecen las alteraciones en las funciones ejecutivas y en el procesamiento numérico(AU)

Introduction: There are few studies on cognitive alterations in children that have been carried out in the Cuban provinces of the central region. Objective: To determine the prevalence of pre-school children with cognitive alterations. Methods: From a group sample of 25 600 children from 0 to 6 years old of Cienfuegos province, there were selected 825 pre-school children in the ages from 4 to 6 years from different educational and health institutions. All the children were evaluated with the Luria Incial neuropsychological test. It was used the Cuban standard of the test to obtain the prevalence data: percentiles 30 - 35, children with neurodevelopmental disorders, and percentiles 40 - 45, children with cognitive alterations related to psychosocial factors. Results: The 3.9 percent of the children presented cognitive alterations related to psychosocial factors, while the 1.4 percent presented alterations related to neurodevelopmental disorders. The main alterations were comprised in 4 tasks: simple calculations, psychomotricity, language and working memory. In the educational institutions, 1 of 10 children presented a neurodevelopmental disorder, while 3 of 10 children presented alterations due to educative causes. In the health institutions, 58,0 percent of the children presented alterations due to educative causes. Conclusions: In Cienfuegos province, the prevalence of pre-school children with cognitive alterations is moderately high. The alterations are specially found in the executive and linguistic functions and in the abilities related with the numbers processing. In the health institutions, it is common to have children with alterations in the executive and linguistic functions, while in the educative institutions prevail the alterations in the executive functions and the numbers processing(AU)

Estimulación de las funciones ejecutivas y su influencia en el rendimiento académico en escolares de primero básico / Stimulation of the executive functions and their influence on academic performance of students of first grade of elementary school

Resumen El estudio de la estimulación de las funciones ejecutivas (FE) en la infancia ha generado un creciente interés investigativo en la última década, especialmente por su relación con el desempeño académico y éxito escolar. De acuerdo a esto, el presente estudio tiene por objetivo estudiar el efecto de un programa de estimulación de las FE sobre el desempeño ejecutivo y el rendimiento académico de una muestra de 43 estudiantes de primero básico de la comuna de Valparaíso (Chile), de edades entre 6 y 7 años. Para ello, se implementó un diseño factorial mixto. La intervención duró 12 semanas y se llevó a cabo en el aula, dirigida por un educador diferencial y con el apoyo de la profesora del curso. Los resultados evidencian la existencia de un efecto significativo del programa implementado en la mejora del desempeño ejecutivo de los participantes, particularmente del grupo experimental. Tales efectos no fueron replicados en el rendimiento académico, lo que podría encontrar una posible explicación en los factores contextuales relacionados con las condiciones de precariedad de la institución educativa. Se observó además un efecto diferenciado del programa sobre el componente de control inhibitorio. Los hallazgos generales ponen de manifiesto la relevancia de la estimulación de las FE en la infancia temprana y los beneficios que esto puede reportar en contextos educativos. Además, sugiere el potencial aporte de la incorporación de este tipo de intervenciones en las prácticas docentes cotidianas.

Exploring bacterial community composition in Mediterranean deep-sea sediments and their role in heavy metal accumulation.

The role of microbial processes in bioaccumulation of major and trace elements has been broadly demonstrated. However, microbial communities from marine sediments have been poorly investigated to this regard. In marine environments, particularly under high anthropogenic pressure, heavy metal accumulation increases constantly, which may lead to significant environmental issues. A better knowledge of bacterial diversity and its capability to bioaccumulate metals is essential to face environmental quality assessment. The oligotrophic westernmost Mediterranean, which is highly sensitive to environmental changes and subjected to increasing anthropogenic pressure, was selected for this study. A sediment core spanning the last two millennia was sampled at two intervals, with ages corresponding to 140 (S1) and 1400 (S2) yr BP. High-throughput sequencing showed an abundance of Bacillus, Micrococcus, unclassified members of Planococcaceae, Anaerolineaceae, Planctomycetaceae, Microlunatus, and Microbacterium in both intervals, with slight differences in their abundance, along with newly detected ones in S2, i.e., Propionibacterium, Fictibacillus, Thalassobacillus, and Bacteroides. Canonical correspondence analysis (CCA) and co-occurrence patterns confirmed strong correlations among the taxa and the environmental parameters, suggesting either shared and preferred environmental conditions, or the performance of functions similar to or complementary to each other. These results were further confirmed using culture-dependent methods. The diversity of the culturable bacterial community revealed a predominance of Bacillus, and Micrococcus or Kocuria. The interaction of these bacterial communities with selected heavy metals (Cu, Cr, Zn and Pb) was also investigated, and their capacity of bioaccumulating metals within the cells and/or in the extracellular polymeric substances (EPS) is demonstrated. Interestingly, biomineralization of Pb resulted in the precipitation of Pb phosphates (pyromorphite). Our study supports that remnants of marine bacterial communities can survive in deep-sea sediments over thousands of years. This is extremely important in terms of bioremediation, in particular when considering possible environmentally friendly strategies to bioremediate inorganic contaminants.

Decodificación fonológica y fluidez lectora: un estudio longitudinal / Phonological decoding and fluency reader: a longitudinal study

El desarrollo de la lectura depende de dos mecanismos lingüísticos: la decodificación fonológica y la compresión de texto. Sin embargo, el efecto de ambos mecanismos puede variar según dos características: tipo de idioma (transparente vs. opaco) y experiencia lectora. Desde esta posición, se realizó un estudio longitudinal para determinar el efecto de la habilidad fonológica y léxica en la lectura durante 3 años de experiencia lectora en el idioma español. En el análisis se controló el efecto de la Memoria Verbal y la Inteligencia. Participaron 156 niños de 1er grado de dos escuelas primarias de Cienfuegos, Cuba. Al principio del 1er grado, se aplicaron cuatro pruebas: Vocabulario, Rimas de Sílabas, Memoria Verbal e Inteligencia. Al final del 1er grado, los niños se re-evaluaron con una prueba de fluidez lectora. Esa misma población se re-evaluó al final de 2do y 3er grado con otra prueba: Fluidez de Lectura, Segmentación Fonológica, Síntesis Fonemática Auditiva, Síntesis Fonemática Visual y Vocabulario de Peabody. Según los resultados, un año de experiencia de lectura en el idioma español es suficiente para obtener un desarrollo semántico significativo en los niños. Tres años de experiencia de lectura en el idioma español no es suficiente para indicar una automatización del mecanismo de decodificación fonológica.

The development of reading depends on two linguistic mechanisms: phonological decoding and reading compression. However, the effect of both mechanisms can vary according to the characteristics of the language (transparent vs. opaque) and reading experience (2 or 4 years of educational instruction). From this position, a longitudinal study was conducted to determine the effect of phonological and lexical ability on reading during 3 years of reading experience in the Spanish language. In the analysis, the effect of Verbal Memory and Intelligence was controlled (Raven Test). 156 children of first grade participated from two primary schools of Cienfuegos, Cuba. At the beginning of the 1st grade, four tests were applied: Vocabulary, Syllable Rhymes, Verbal Memory and Intelligence. At the end of the 1st grade, children were re-evaluated with a Reading Fluency Test. That same population was re-evaluated at the end of 2nd and 3rd grade for Reading Fluency, Phonological Segmentation, Phonetic Auditory Synthesis, Phonetic Visual Synthesis, and Peabody Vocabulary. According to the results, one year of reading experience in the Spanish language is sufficient to obtain a significant semantic development in the children. Three years of reading experience in the Spanish language is not enough to indicate an automation of the phonological decoding mechanism.

The Effectiveness of Different Doses of Iron Supplementation and the Prenatal Determinants of Maternal Iron Status in Pregnant Spanish Women: ECLIPSES Study.

Iron deficiency (ID), anemia, iron deficiency anemia (IDA) and excess iron (hemoconcentration) harm maternal-fetal health. We evaluated the effectiveness of different doses of iron supplementation adjusted for the initial levels of hemoglobin (Hb) on maternal iron status and described some associated prenatal determinants. The ECLIPSES study included 791 women, randomized into two groups: Stratum 1 (Hb = 110-130g/L, received 40 or 80mg iron daily) and Stratum 2 (Hb > 130g/L, received 20 or 40mg iron daily). Clinical, biochemical, and genetic information was collected during pregnancy, as were lifestyle and sociodemographic characteristics. In Stratum 1, using 80 mg/d instead of 40 mg/d protected against ID on week 36. Only women with ID on week 12 benefited from the protection against anemia and IDA by increasing Hb levels. In Stratum 2, using 20 mg/d instead of 40 mg/d reduced the risk of hemoconcentration in women with initial serum ferritin (SF) ≥ 15 µg/L, while 40 mg/d improved SF levels on week 36 in women with ID in early pregnancy. Mutations in the HFE gene increased the risk of hemoconcentration. Iron supplementation should be adjusted to early pregnancy levels of Hb and iron stores. Mutations of the HFE gene should be evaluated in women with high Hb levels in early pregnancy.

Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos / Design and validation of the scale to assess the fragility of chronic patients

Objetivo: Crear una escala y herramienta que nos permita medir la fragilidad del paciente crónico. Diseño: Estudio observacional sobre crónicos del área. Emplazamiento: Se ha realizado entre enero de 2011 a diciembre 2015, una población de 2.108 individuos. Los datos se recogieron de la historia clínica y aplicación expresa para el registro de los pacientes frágiles, sobre hoja estructurada de recogida de datos. Participantes: Sujetos frágiles del área Sanitaria Norte de Málaga. Intervención: Diseño y validación de una escala. Mediciones principales: Variable principal de resultado: escala de fragilidad Antequera (EPADI) constituida por seis criterios/factores valorables: edad, Pfeiffer, Barthell, Charlson, sociofamiliar y pluripatológico. Las variables de resultados en accesibilidad se utilizaron como variables de predicción. Las variables cuantitativas se describen mediante la media y desviación estándar. Las variables cualitativas las presentamos en frecuencias junto con sus porcentajes. Para obtener un modelo de predicción de la utilización de recursos la muestra se dividió en dos sub-muestras de igual tamaño. Resultados: A partir de las variables de interés por expertos, se identificaron predictores univariantes en la utilización de recursos en la muestra M_EPADI1, para construir un modelo de regresión logística multivariante que permita predecir la utilización de recursos. Para la validación de la escala se utilizó la muestra M_EPADI2. Conclusiones: Se ha podido comprobar que los criterios utilizados en nuestra escala son adecuados para definir la fragilidad, por lo tanto la escala EPADI valora perfectamente el grado de fragilidad de los usuarios crónicos en base a los recursos consumidos

Objective: To create a scale and tool that allows us to measure the fragility of the chronic patient. Design: Observational study on the area's chronicles. Location: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. Participants: Fragile subjects of the North Sanitary Area of Malaga. Intervention: Design and validation of a scale. Main measurements: Study variables. Main outcome variable: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. Results: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. Conclusions: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. Conclusions: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed

Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real-world setting: The XENSOR Study.

AIMS: To evaluate in a real-world setting the effectiveness of two drugs, orlistat and liraglutide, in patients with overweight or obesity and insufficient weight loss (WL) after a lifestyle modification programme. METHODS: Retrospective, observational cohort study comparing clinical outcomes of orlistat 120 mg three times a day and liraglutide (up to 3 mg daily) in adult patients with BMI ≥30 kg/m2 or ≥27 kg/m2 with at least a weight-related comorbidity who had failed to lose at least 5% of their weight after 6 months of lifestyle modification. The co-primary end-points, assessed at 3-6 months and at the end of the follow-up, were weight change from baseline, proportion of patients who lost at least 5% of their baseline weight and adjusted differences in WL between both drugs. RESULTS: Five hundred patients, 400 in the group of orlistat (age 47.0, weight 107.8 kg) and 100 in the group of liraglutide (age 51.9 years, weight 105.1 kg), were included. Treatment with both drugs significantly reduced weight, fasting plasma glucose, systolic BP, low-density lipoprotein-cholesterol and alanine transaminase over a median follow-up period of 7 months. WL with liraglutide (-7.7 kg) was significantly greater than that observed with orlistat (-3.3 kg), and more individuals lost at least 5% of their baseline weight with liraglutide (64.7%) than with orlistat (27.4%). Rates of prediabetes significantly decreased with liraglutide in comparison to orlistat. CONCLUSIONS: In this real-world study, liraglutide showed a greater effectiveness in WL compared with orlistat and improved several obesity-associated metabolic and cardiovascular risk factors.

Mortalidad inmediata y a los 30 días en las intoxicaciones digitálicas atendidas en servicios de urgencias de Cataluña / Immediate and 30 days mortality in digoxin poisoning cases attended in the Hospital Emergency Services of Catalonia, Spain

Introducción: La intoxicación digitálica es un motivo frecuente de consulta en los servicios de urgencias hospitalarios (SUH). El objetivo de este estudio es conocer la mortalidad asociada a dicha intoxicación. Método: Estudio descriptivo y observacional de las intoxicaciones digitálicas atendidas en los SUH de 4 hospitales de Cataluña durante los años 2013-15. Se recogieron datos relativos a la intoxicación, la mortalidad inmediata y a los 30 días. Se analizó la existencia de posibles factores asociados a la mortalidad. Resultados: Se registraron 171 intoxicaciones digitálicas. Siete eran agudas (4,1%) y 164 (95,9%) crónicas. La mortalidad inmediata fue del 6,4% y a los 30 días fue del 13,4%. El análisis binario no identificó ningún factor relacionado con la mortalidad inmediata. En cuanto a la mortalidad a 30 días, los pacientes que fallecieron tenían con mayor frecuencia una intoxicación aguda (13% vs 2,7%; p= 0,05), había más intoxicaciones con intencionalidad suicida (8,7% vs 0,7%; p= 0,048), más afectación renal (21,7% vs 9,5%; p= 0,037), menos sintomatología neurológica (4,3% vs 17,8%; p= 0,005), mayor digoxinemia (4,7 mg/dl vs 3,7 mg/dl; p= 0,027) y menor puntuación en el índice de Barthel (IB) (49,1 (33,4) vs 70,3 (28,5); p= 0,006). El análisis de regresión logística identificó la digoxinemia como un factor independiente de mortalidad inmediata y la puntuación en el IB en la mortalidad a 30 días. Conclusiones: La digoxinemia se relaciona con la mortalidad inmediata y el IB se relaciona con la mortalidad a 30 días

Background and objective: Digoxin poisoning is a frequent reason for seeking emergency care. This study aimed to assess mortality related to digoxin poisoning. Methods: Descriptive observational study of digoxin poisonings attended in the emergency departments of 4 hospitals in Catalonia from 2013 through 2015. We gathered data relevant to the poisonings and recorded immediate and 30-day mortality. Factors possibly related to mortality were explored. Results: A total of 171 digoxin poisonings were attended. Seven (4.1%) were acute and 164 (95.9%) were chronic. The immediate and 30-day mortality rates were 6.4% and 13.4%, respectively. Bivariate analysis did not identify factors related to immediate mortality. However, the variables more often associated with 30-day mortality in this analysis were acute poisoning (after which 13% died vs 2.7% of those with chronic poisoning, P=.05), suicide attempts (8.7% of whom died vs 0.7%, P=.048), more compromised renal function (21.7% vs 9.5%, P=.037), fewer neurologic symptoms (4.3% vs 17.8% with more symptoms, P=.005), higher mean digoxin concentrations (4.7 mg/dL in those who died vs 3.7 mg/dL, P=.027), and a lower Barthel index (mean [SD] 49.1 [33.4] in those who died vs 70.3 [28.5]; P=.006). Logistic regression analysis identified serum digoxin concentration to be independently associated with immediate mortality. A lower Barthel index was associated with 30-day mortality. Conclusions: Immediate mortality is related to a high digoxin concentration in serum, and 30-day mortality to a low Barthel index

Immediate and 30 days mortality in digoxin poisoning cases attended in the Hospital Emergency Services of Catalonia, Spain. / Mortalidad inmediata y a los 30 días en las intoxicaciones digitálicas atendidas en servicios de urgencias de Cataluña.

OBJECTIVES: Digoxin poisoning is a frequent reason for seeking emergency care. This study aimed to assess mortality related to digoxin poisoning. MATERIAL AND METHODS: Descriptive observational study of digoxin poisonings attended in the emergency departments of 4 hospitals in Catalonia from 2013 through 2015. We gathered data relevant to the poisonings and recorded immediate and 30-day mortality. Factors possibly related to mortality were explored. RESULTS: A total of 171 digoxin poisonings were attended. Seven (4.1%) were acute and 164 (95.9%) were chronic. The immediate and 30-day mortality rates were 6.4% and 13.4%, respectively. Bivariate analysis did not identify factors related to immediate mortality. However, the variables more often associated with 30-day mortality in this analysis were acute poisoning (after which 13% died vs 2.7% of those with chronic poisoning, P=.05), suicide attempts (8.7% of whom died vs 0.7%, P=.048), more compromised renal function (21.7% vs 9.5%, P=.037), fewer neurologic symptoms (4.3% vs 17.8% with more symptoms, P=.005), higher mean digoxin concentrations (4.7 mg/dL in those who died vs 3.7 mg/dL, P=.027), and a lower Barthel index (mean [SD] 49.1 [33.4] in those who died vs 70.3 [28.5]; P=.006). Logistic regression analysis identified serum digoxin concentration to be independently associated with immediate mortality. A lower Barthel index was associated with 30-day mortality. CONCLUSION: Immediate mortality is related to a high digoxin concentration in serum, and 30-day mortality to a low Barthel index.

OBJETIVO: La intoxicación digitálica es un motivo frecuente de consulta en los servicios de urgencias hospitalarios (SUH). El objetivo de este estudio es conocer la mortalidad asociada a dicha intoxicación. METODO: Estudio descriptivo y observacional de las intoxicaciones digitálicas atendidas en los SUH de 4 hospitales de Cataluña durante los años 2013-15. Se recogieron datos relativos a la intoxicación, la mortalidad inmediata y a los 30 días. Se analizó la existencia de posibles factores asociados a la mortalidad. RESULTADOS: Se registraron 171 intoxicaciones digitálicas. Siete eran agudas (4,1%) y 164 (95,9%) crónicas. La mortalidad inmediata fue del 6,4% y a los 30 días fue del 13,4%. El análisis binario no identificó ningún factor relacionado con la mortalidad inmediata. En cuanto a la mortalidad a 30 días, los pacientes que fallecieron tenían con mayor frecuencia una intoxicación aguda (13% vs 2,7%; p = 0,05), había más intoxicaciones con intencionalidad suicida (8,7% vs 0,7%; p = 0,048), más afectación renal (21,7% vs 9,5%; p = 0,037), menos sintomatología neurológica (4,3% vs 17,8%; p = 0,005), mayor digoxinemia (4,7 mg/dl vs 3,7 mg/dl; p = 0,027) y menor puntuación en el índice de Barthel (IB) (49,1 (33,4) vs 70,3 (28,5); p = 0,006). El análisis de regresión logística identificó la digoxinemia como un factor independiente de mortalidad inmediata y la puntuación en el IB en la mortalidad a 30 días. CONCLUSIONES: La digoxinemia se relaciona con la mortalidad inmediata y el IB se relaciona con la mortalidad a 30 días.

[Design and validation of the scale to assess the fragility of chronic patients]. / Diseño y validación de la escala para valorar la fragilidad de los pacientes crónicos.

OBJECTIVE: To create a scale and tool that allows us to measure the fragility of the chronic patient. DESIGN: Observational study on the area's chronicles. LOCATION: Between January 2011 and December 2015, a population of 2108 individuals. Data were collected from the medical history and expressed application for the registration of fragile patients, on structured data collection sheet. PARTICIPANTS: Fragile subjects of the North Sanitary Area of Malaga. INTERVENTION: Design and validation of a scale. MAIN MEASUREMENTS: Study variables. MAIN OUTCOME VARIABLE: Antequera Fragility Scale (EPADI) consisting of five criteria / factors: age, Pfeiffer, Barthell, Charlson, sociofamiliar and pluripatological. Accessibility outcome variables were used as prediction variables. Quantitative variables are described by mean and standard deviation. The qualitative variables are presented in frequencies along with their percentages. To obtain a predictive model of resource utilization the sample was divided into two subsamples of equal size. RESULTS: From the variables of interest by experts, univariate predictors were identified in the use of resources in the sample M_EPADI1, to construct a model of multivariate logistic regression that allows to predict the resource utilization. For the validation of the scale, the sample M_EPADI2 was used. CONCLUSIONS: It was verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly values the degree of fragility of chronic users based on the resources consumed. CONCLUSIONS: It has been verified that the criteria used in our scale are adequate to define the fragility, therefore the EPADI scale perfectly evaluates the degree of fragility of chronic users based on the resources consumed.

High-resolution data from Laser Ablation-ICP-MS and by ICP-OES analyses at the Cretaceous/Paleogene boundary section at Agost (SE Spain).

A high-resolution analysis of the distribution of major and trace elements across the Cretaceous/Paleogene boundary (KPgB) in the distal section of Agost (SE Spain) was performed. The KPgB sediments were drilled to recover a 22 cm-long core; the lower 5 cm corresponding to the uppermost Maastrichtian and the upper 17 cm to the lowermost Danian. The unconsolidated sediments were resin-embedded under O2-free conditions, cut and polished. Laser Ablation-Inductivity Coupled Plasma-Mass Spectrometry (LA-ICP-MS) analyses were conducted at 10 µm increments and a laser-beam of 80 µm. Discrete samples were taken immediately prior to the resin-embedding and analyzed by Inductivity Coupled Plasma-Optical Emission Spectroscopy (ICP-OES). Results obtained by both analytical methods (LA-ICP-MS and ICP-OES) are presented. (Further interpretations and discussion are included in Sosa-Montes de Oca et al., 2018 [6]).

Competencias parentales que favorecen el desarrollo de funciones ejecutivas en escolares / Parental competences that favor the development of executive functions in schoolchildren / Competências parentais que favorecem o desenvolvimento das funções executivas em estudantes

Resumen (analítico): Dada la relevancia del desarrollo y estimulación temprana de las Funciones Ejecutivas (FE) en escolares, nuestro objetivo en esta investigación fue determinar si existe relación estadísticamente significativa entre las Competencias Parentales (CP) de 31 padres y madres de escolares de segundo básico de Chile, y las FE y Rendimiento Académico (RA) de estos. Los instrumentos utilizados fueron la Escala de Parentalidad Positiva e2p y el Test de Evaluación Neuropsicológica Infantil Teni. Los resultados evidenciaron que los padres y madres que tienen más desarrolladas las CP protectoras, reflexivas y formativas, tienen hijos o hijas con mayor desarrollo de las FE. Respecto a la relación entre las CP y el RA, la encontramos solo en matemáticas. Concluimos que existen CP que se relacionan con el desarrollo de FE y con el RA de los escolares, especialmente en matemáticas.

Abstract (analytical): Given the relevance of development and the early stimulation of Executive Functions (EF) among school children, the objective of this study was to determine if there is a statistically significant relationship between the Parenting Competencies (PC) of 31 parents of second-grade schoolchildren in Chile and their EF and Academic Performance (AP). The instruments used included the Positive Parenting Scale (E2P) and the Neuropsychological Assessment Test (Teni). The results showed that the parents who had developed their protective, reflective and formative PC had children with greater EF development. Regarding the correlation between PCs and AP, it was found that this only occurred in the subject area of mathematics. As a conclusion, the research identified that there are PCs that are related to the development of EF and to the AP of schoolchildren, especially in mathematics.

Resumo (analítico): Dada a importância do desenvolvimento e estimulação precoce das funções executivas (FE) na escola, o objetivo deste estudo foi determinar se existe relação estatisticamente significativa entre as competências parentais (CP) de 31 pais de escolas primarias do Chile e suas FE e desempenho acadêmico (RA). Os instrumentos utilizados foram a escada de parentalidade positiva e2p e o teste de Avaliação Neuropsicológica Infantil Teni. Os resultados mostraram que os pais mais desenvolvidos nas CP protetora, reflexiva e formativa, tinham filhos/as com maior desenvolvimento das FE. Quanto à relação entre CP e RA, ele foi encontrado apenas em matemática. Conclui-se que existem CP que relacionam-se com o desenvolvimento das FE e RA de escolares, especialmente em matemática.

Barium bioaccumulation by bacterial biofilms and implications for Ba cycling and use of Ba proxies.

Ba proxies have been broadly used to reconstruct past oceanic export production. However, the precise mechanisms underlying barite precipitation in undersaturated seawater are not known. The link between bacterial production and particulate Ba in the ocean suggests that bacteria may play a role. Here we show that under experimental conditions marine bacterial biofilms, particularly extracellular polymeric substances (EPS), are capable of bioaccumulating Ba, providing adequate conditions for barite precipitation. An amorphous P-rich phase is formed at the initial stages of Ba bioaccumulation, which evolves into barite crystals. This supports that in high productivity regions where large amounts of organic matter are subjected to bacterial degradation, the abundant EPS would serve to bind the necessary Ba and form nucleation sites leading to barite precipitation. This also provides new insights into barite precipitation and opens an exciting field to explore the role of EPS in mineral precipitation in the ocean.

Holocene geochemical footprint from Semi-arid alpine wetlands in southern Spain.

Here we provide the geochemical dataset that our research group has collected after 10 years of investigation in the Sierra Nevada National Park in southern Spain. These data come from Holocene sedimentary records from four alpine sites (ranging from ∼2500 to ∼3000 masl): two peatlands and two shallow lakes. Different kinds of organic and inorganic analyses have been conducted. The organic matter in the bulk sediment was characterised using elemental measurements and isotope-ratio mass spectrometry (EA-IRMS). Leaf waxes in the sediment were investigated by means of chromatography with flame-ionization detection and mass spectrometry (GC-FID, GC-MS). Major, minor and trace elements of the sediments were analysed with atomic absorption (AAS), inductively coupled plasma mass spectrometry (ICP-MS), as well as X-ray scanning fluorescence. These data can be reused by environmental researchers and soil and land managers of the Sierra Nevada National Park and similar regions to identify the effect of natural climate change, overprinted by human impact, as well as to project new management policies in similar protected areas.

Earliest evidence of pollution by heavy metals in archaeological sites.

Homo species were exposed to a new biogeochemical environment when they began to occupy caves. Here we report the first evidence of palaeopollution through geochemical analyses of heavy metals in four renowned archaeological caves of the Iberian Peninsula spanning the last million years of human evolution. Heavy metal contents reached high values due to natural (guano deposition) and anthropogenic factors (e.g. combustion) in restricted cave environments. The earliest anthropogenic pollution evidence is related to Neanderthal hearths from Gorham's Cave (Gibraltar), being one of the first milestones in the so-called "Anthropocene". According to its heavy metal concentration, these sediments meet the present-day standards of "contaminated soil". Together with the former, the Gibraltar Vanguard Cave, shows Zn and Cu pollution ubiquitous across highly anthropic levels pointing to these elements as potential proxies for human activities. Pb concentrations in Magdalenian and Bronze age levels at El Pirulejo site can be similarly interpreted. Despite these high pollution levels, the contaminated soils might not have posed a major threat to Homo populations. Altogether, the data presented here indicate a long-term exposure of Homo to these elements, via fires, fumes and their ashes, which could have played certain role in environmental-pollution tolerance, a hitherto neglected influence.

Sexual dimorphism in the incisive canal in humans: a literature review / Dimorfismo sexual del canal incisivo en cráneos humanos: revisión de la literatura

Aim: To describe the morphometric characteristics of the maxillary incisor canal (IC) in human beings by gender. Material and method. Descriptive study. A systematic search for articles related to anatomical and topographical variations of the IC by sex and published in the last ten years was performed in the Medline database. Selected publications presented the following criteria: Number of samples and average values, in millimeters (mm), for length, diameter and distance from the IC to the maxillary central incisors (ICM). In addition, author and year of publication were considered. Data were presented using descriptive statistics. Results. Three studies were selected. In men, IC average dimensions were higher in diameter (2,79+/-0,94 mm v/s 2,43+/-0,85 mm), length (11,96+/-2,73 mm v/s 10,39+/-2,47 mm) and distance from the apex and middle third of the root of the MCI than in women. Conclusion. IC morphometric values were higher in men. It is important to keep in mind IC dimensions vary according to gender when planning surgeries and rehabilitations in this area of the oral cavity.

Objetivo. Describir las características morfométricas del canal incisivo del maxilar (CI) según el género en humanos. Material y método. Estudio descriptivo. Se realizó una búsqueda sistemática en la base de datos de MEDLINE, sobre artículos relacionados con las variaciones anatómicas y topográficas del CI entre géneros. Se registró autor, año de publicación, cantidad de muestras y valores promedios en milímetros de la longitud, diámetro y distancia del CI con respecto a los incisivos centrales del maxilar (ICM). Resultados. Se analizaron 3 Artículos. Las dimensiones promedio del CI fueron mayores en los hombres que en las mujeres tanto en el diámetro (2.79+/-0.94 mm v/s 2.43+/-0.85 mm ), longitud (11.96+/-2.73 mm v/s 10.39+/-2.47 mm) y distancia con el ápice y punto medio de la raíz de los ICM. Conclusión. Las características morfométricas del CI fueron mayores en hombres. Se debe tener en cuenta que las dimensiones del CI varían dependiendo del sexo para la planificación de cirugías y rehabilitación en este sector de la cavidad oral.