Estudio sobre prevalencia de patologías crónicas en mayores de 50 años y adherencia al tratamiento mediante sistemas de dispensación personalizada / Study on the prevalence of chronic pathologies in the over 50s and adherence to treatment through personalised dispensing systems

JUSTIFICACIÓN: la atención farmacéutica ha sufrido un gran auge estas últimas décadas, debido al aumento de pacientes que padecen enfermedades crónicas, y al hecho de que las farmacias comunitarias son el punto de información sanitario más accesible y cercano para la población.OBJETIVOS: los objetivos del estudio consisten en la evaluación de la prevalencia de patologías crónicas en pacientes mayores de 50 años, así como el análisis de la adherencia al tratamiento mediante el uso de sistemas de dispensación personalizada (SDP) en una farmacia de Beniel, Región de Murcia.MATERIALES Y METODOS: en este trabajo se ha realizado un estudio a cuarenta participantes del municipio de Beniel a los cuales se les ha ofrecido el servicio de dispensación personalizada y el servicio de seguimiento farmacoterapéutico desde la farmacia. Además, se ha evaluado cuáles son las enfermadas crónicas más prevalentes en el municipio.RESULTADOS Y DISCUSIÓN: la enfermedad crónica con mayor prevalencia en Beniel es la hipertensión arterial (100 % de los encuestados), lo que coincide con los datos publicados por el Ministerio de Sanidad en los Informes Anuales de Salud. Por el contrario, la tercera enfermedad crónica más frecuente en el municipio de Beniel es la diabetes, de forma diferente a los datos nacionales que la establecen como la novena enfermedad más frecuente. Se han comparado los valores sociodemográficos en las patologías de depresión y ansiedad crónica, donde se ha visto reflejado una diferencia notable en hombres y mujeres, siendo estas últimas las más afectadas. Destaca el gran número de pacientes en tratamiento con Inhibidores de la bomba de protones (IBP) y antiagregantes plaquetarios.CONCLUSIONES: la población de Beniel no presenta grandes diferencias respecto a las patologías crónicas más frecuentes a nivel nacional. (AU)

Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study / Evaluación de la implantación de tornillos transpediculares en instrumentación espinal con técnica free-hand y navegación asistida con tomografía computarizada intraoperatoria: un estudio analítico-posicional

Spinal instrumentation using transpedicular screws has been used for decades to stabilize the spine. In October 2018, an intraoperative CT system was acquired in the Neurosurgery service of the University Hospital Complex of Vigo, this being the first model of these characteristics in the Spanish Public Health System, so we began a study from January 2015 to December 2019 to assess the precision of the transpedicular screws implanted with this system compared with a control group performed with the classical technique and final fluoroscopic control. Methods: The study was carried out in patients who required transpedicular instrumentation surgery, in total 655 screws were placed, 339 using the free-hand technique (Group A) and 316 assisted with intraoperative CT navigation (Group B) (p>0.05). Demographic characteristics, related to surgery and the screw implantation grades were assessed using the Gertzbein–Robbins classification. Results: 92 patients were evaluated, between 12 and 86 years (average: 57.1 years). 161 thoracic screws (24.6%) and 494 lumbo-sacral screws (75.4%) were implanted. Of the thoracic screws, 33 produced a pedicle rupture. For the lumbo-sacral screws, 71 have had pedicle violation. The overall correct positioning rate for the free-hand group was 72.6% and for the CT group it was 96.5% (p<0.05). Conclusion: The accuracy rate is higher in thoracic-lumbar instrumentation in the navigation group versus free-hand group with fluoroscopic control (AU)

La instrumentación espinal con tornillos transpediculares se ha utilizado durante décadas para estabilizar la columna. En octubre de 2018 se adquirió un sistema de TC intraoperatoria en el Servicio de Neurocirugía del Complejo Hospitalario Universitario de Vigo, siendo este, el primer modelo de estas características en el Sistema Público de Salud español, por lo que iniciamos un estudio desde enero de 2015 a diciembre de 2019 para evaluar la precisión de los tornillos transpediculares implantado con este sistema frente a un grupo control realizado con la técnica clásica y control fluoroscópico final. Métodos: Se realizó un estudio con pacientes que requirieron cirugía de instrumentación transpedicular, en total se colocaron 655 tornillos, 339 con la técnica free-hand (grupo A) y 316 asistidos con navegación por TC intraoperatoria (grupo B) (p>0,05). Se evaluaron las características demográficas relacionadas con la cirugía y los grados de implantación de tornillos según la clasificación de Gertzbein-Robbins. Resultados: Se evaluaron 92 pacientes, entre 12 y 86 años (promedio: 57,1 años). Se implantaron 161 tornillos torácicos (24,6%) y 494 tornillos lumbosacros (75,4%). De los tornillos torácicos, 33 produjeron una rotura pedicular. En el caso de los tornillos lumbosacros, 71 tuvieron violación pedicular. La tasa de correcto posicionamiento en general para el grupo free-hand fue del 72,6% y para el grupo de TC fue del 96,5% (p<0,05). Conclusión: La tasa de precisión es mayor en la instrumentación torácica-lumbar en el grupo de navegación que en el grupo de manos libres con control fluoroscópico (AU)

Molecular dynamics study of nanoconfined TIP4P/2005 water: how confinement and temperature affect diffusion and viscosity.

In the past few decades great effort has been devoted to the study of water confined in hydrophobic geometries at the nanoscale (tubes and slit pores) due to the multiple technological applications of such systems, ranging from drug delivery to water desalination devices. To our knowledge, neither numerical/theoretical nor experimental approaches have so far reached a consensual understanding of structural and transport properties of water under these conditions. In this work, we present molecular dynamics simulations of TIP4P/2005 water under different nanoconfinements (slit pores or nanotubes, with two degrees of hydrophobicity) within a wide temperature range. It has been found that water is more structured near the less hydrophobic walls, independently of the confining geometries. Meanwhile, we observe an enhanced diffusion coefficient of water in both hydrophobic nanotubes. Finally, we propose a confined Stokes-Einstein relation to obtain the viscosity from diffusivity, whose result strongly differs from the Green-Kubo expression that has been used in previous works. While viscosity computed with the Green-Kubo formula (applied for anisotropic and confined systems) strongly differs from that of the bulk, viscosity computed with the confined Stokes-Einstein relation is not so much affected by the confinement, independently of its geometry. We discuss the shortcomings of both approaches, which could explain this discrepancy.

[Intraoperative intracerebral tension pneumocephalus secondary to hydrogen peroxide as a hemostatic agent]. / Neumoencefalo a tension intraoperatorio secundario al uso de peroxido de hidrogeno como agente hemostatico.

TITLE: Neumoencefalo a tension intraoperatorio secundario al uso de peroxido de hidrogeno como agente hemostatico.

Relación entre los niveles de hormonas sexuales en varones por encima de los 50 años y composición corporal, calidad ósea y calidad de vida / Relationships between Sex Hormone Levels in Men over 50 Years of Age and Body Composition, Bone Quality, and Quality of Life

Objetivo: Determinar la relación existente entre los niveles de hormonas sexuales y la composición corporal, la salud ósea y la calidad de vida en hombres por encima de los 50 años. Material y métodos: Estudio transversal en el que se incluyen 230 pacientes. Se determina la composición corporal utilizando parámetros antropométricos directos como el peso, la talla, la circunferencia de la cintura, la circunferencia del brazo dominante, el pliegue cutáneo tricipital, el pliegue en brazo dominante y el pliegue subcapsular. Se calculan parámetros antropométricos indirectos. Se realizan medidas cuantitativas de densidad ósea mediante ecografía del calcáneo, así como marcadores de recambio óseo (N-telopéptidos de excreción urinaria y relación calcio/ creatina). La calidad de vida se evalúa mediante el cuestionario abreviado de calidad de vida SF-36. Los análisis sanguíneos incluyen la determinación de testosterona total, globulina transportadora de hormonas sexuales (SHBG), testosterona libre calculada (TLc), sulfato de dehidroepiandrosterona (S-DHEA), androsteriona, 17-β-estradiol y gonadotropinas. Resultados: La TLc se asocia con un incremento muscular y una disminución del contenido graso, aun ajustándolo por edad (p<0,05). La densidad ósea sólo se relaciona con los niveles de estradiol y su fracción biodisponible (p<0,05). El S-DHEA y la TLc están asociadas a algunas subescalas del SF-36 (p<0,05). Conclusiones: La TLc es la hormona que mejor se relaciona con los cambios corporales asociados a la edad; sin embargo, los niveles de andrógenos no están asociados a la densidad ósea. Un descenso en la TLc y el S-DHEA podría estar relacionado con un descenso en la calidad de vida (AU)

Objetive: To determine whether there was a relationship between sex hormone levels and body composition, bone health, and health-related quality of life in men over 50 years of age. Material and methods: Transversal study carried out in 230 Spanish male outpatients. Body composition was studied using direct anthropometric measures: height, weight, waistline circumference, dominant arm circumference, tricipital skinfold, dominant arm skinfold, subscapular skinfold. Calculated anthropometric parameters were obtained. Quantitative ultrasound measurements of the calcaneus were performed and bone turnover markers were determined (N-telopeptides urinary excretion and calcium/creatinine urinary rate). Quality of life was studied using the short form 36 questionnaire (SF-36). Blood tests included total testosterone, sex hormone binding-globulin, calculated free testosterone (cFT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17-β-estradiol and gonadotrophins. Results: cFT was associated with increased muscle and to decreased in fat content, even after adjusting for age (p<0.05). Bone density was only related to estradiol and its bioavailable fraction (p<0.05). DHEA-S and cFT were related (p<0.05) to some SF-36 subscales. Conclusions: cFT level is most associated with body changes that accompany aging. Androgen levels are not related to bone density. Decline in cFT and DHEA-s levels might be related to decreased quality of life (AU)

[Relationships between sex hormone levels in men over 50 years of age and body composition, bone quality, and quality of life]. / Relación entre los niveles de hormonas sexuales en varones por encima de los 50 años y composición corporal, calidad ósea y calidad de vida.

OBJECTIVE: To determine whether there was a relationship between sex hormone levels and body composition, bone health, and health-related quality of life in men over 50 years of age. MATERIAL AND METHODS: Transversal study carried out in 230 Spanish male outpatients. Body composition was studied using direct anthropometric measures: height, weight, waistline circumference, dominant arm circumference, tricipital skinfold, dominant arm skinfold, subscapular skinfold. Calculated anthropometric parameters were obtained. Quantitative ultrasound measurements of the calcaneus were performed and bone turnover markers were determined (N-telopeptides urinary excretion and calcium/creatinine urinary rate). Quality of life was studied using the short form 36 questionnaire (SF-36). Blood tests included total testosterone, sex hormone binding-globulin, calculated free testosterone (cFT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17-ß-estradiol and gonadotrophins. RESULTS: cFT was associated with increased muscle and to decreased in fat content, even after adjusting for age (p<0.05). Bone density was only related to estradiol and its bioavailable fraction (p<0.05). DHEA-S and cFT were related (p<0.05) to some SF-36 subscales. CONCLUSIONS: cFT level is most associated with body changes that accompany aging. Androgen levels are not related to bone density. Decline in cFT and DHEA-s levels might be related to decreased quality of life.

Maternal BMI and migration status as predictors of childhood obesity in Mexico.

OBJECTIVE: To assess the association of maternal migration to Baja California, body mass index (BMI) status, children's perceived food insecurity, and childhood lifestyle behaviors with overweight (BMI > 85% ile), obesity (BMI > 95% ile) and abdominal obesity (Waist Circumference > 90% ile). METHODS: Convenience sampling methods were used to recruit a cross-sectional sample of 4th, 5th and 6th grade children and their parents at Tijuana and Tecate Public Schools. Children's and parents' weights and heights were measured. Children were considered to have migrant parents if parents were not born in Baja California. RESULTS: One hundred and twenty-two children and their parents were recruited. The mean age of the children was 10.1 ± 1.0 years. Forty nine per cent of children were overweight or obese. Children with obese parents (BMI > 30) had greater odds of being obese, Odds Ratio (OR) 4.9 (95% Confidence Interval (CI), 1.2-19, p = 0.03). Children with migrant parents had greater odds of being obese, OR= 3.7 (95% CI, 1.6-8.3), p = 0.01) and of having abdominal obesity, OR = 3.2 (95% CI, 1.4-7.1, p = 0.01). Children from migrant parents have greater risk of higher consumption of potato chips, OR = 8.0 (95% CI, 2.1-29.1, p = 0.01). Children from non-migrant parents had greater odds of being at risk of hunger. CONCLUSIONS: Parental obesity and migration are associated with increased risk of obesity among Mexican children. Children whose parents were born in Baja California have greater odds of being at risk of hunger. Further studies should evaluate the role of migration on risk for childhood obesity.

Maternal BMI and migration status as predictors of childhood obesity in Mexico / IMC materno y migración como predictor de obesidad infantil de México

Objective: To assess the association of maternal migration to Baja California, body mass index (BMI) status, children's perceived food insecurity, and childhood lifestyle behaviors with overweight (BMI > 85% ile), obesity (BMI > 95% ile) and abdominal obesity (Waist Circumference > 90% ile). Methods: Convenience sampling methods were used to recruit a cross-sectional sample of 4th, 5th and 6th grade children and their parents at Tijuana and Tecate Public Schools. Children's and parents' weights and heights were measured. Children were considered to have migrant parents if parents were not born in Baja California. Results: One hundred and twenty-two children and their parents were recruited. The mean age of the children was 10.1 ± 1.0 years. Forty nine per cent of children were overweight or obese. Children with obese parents (BMI > 30) had greater odds of being obese, Odds Ratio (OR) 4.9 (95% Confidence Interval (CI), 1.2-19, p = 0.03). Children with migrant parents had greater odds of being obese, OR= 3.7 (95% CI, 1.6-8.3), p = 0.01) and of having abdominal obesity, OR = 3.2 (95% CI, 1.4-7.1, p = 0.01). Children from migrant parents have greater risk of higher consumption of potato chips, OR = 8.0 (95% CI, 2.1 -29.1, p = 0.01). Children from non-migrant parents had greater odds of being at risk of hunger. Conclusions: Parental obesity and migration are associated with increased risk of obesity among Mexican children. Children whose parents were born in Baja California have greater odds of being at risk of hunger. Further studies should evaluate the role of migration on risk for childhood obesity (AU)

Objetivo: Determinar la asociación entre la inmigración materna a Baja California, el índice de masa corporal (IMC), la percepción de inseguridad alimentaria de los niños, y los estilos de vida y el sobrepeso, (BMI > 85% ila), la obesidad (BMI > 95% ila) y la obesidad abdominal (Circunferencia de Cintura > 90% ila). Métodos: Se realizó una muestra por conveniencia, en la que se reclutaron niños de 4.o a 6.o grado de primaria y a sus padres, de escuelas públicas de Tijuana y Tecate. Se midió el peso y la estatura de los niños. Los padres que no nacieron en el estado de Baja California se consideraron inmigrantes. Resultados: Fueron reclutados 122 pares de padres y niños. La edad media de los niños fue de 10,1 ± 1,0 años. Cuarenta y nueve por ciento de los niños presentaron sobrepeso u obesidad. Los niños con padres obesos (BMI > 30) presentaron mayor riesgo de obesidad, Razón de Momios (RM) 4,9 (95% Intervalo de confianza (IC) 1,219, p = 0,03). Los niños con padres inmigrantes presentaron mayor riesgo de tener obesidad, RM = 3,7 (95% IC, 1,6-8,3, p = 0,01) y obesidad abdominal, RM = 3,2 (95% IC, 1,4-7,1, p = 0,01). Los niños con padres inmigrantes presentaron mayor riesgo de consumo de patatas fritas, RM = 8,0 (95% CI, 2,1-29,1, p = 0,01). Los niños de padres no inmigrantes presentaron mayor riesgo de hambre. Conclusiones: La obesidad paterna y la inmigración estuvieron asociadas con el aumento de obesidad infantil. Los niños de padres nacidos en Baja California presentaron mayor riesgo de hambre. Se requieren más estudios que valoren el papel de la inmigración sobre el riesgo de obesidad (AU)

Incidence of adult form of autoimmune hepatitis in Valencia (Spain).

BACKGROUND AND STUDY AIMS: There is little information on the incidence of autoimmune hepatitis (AIH) because on many occasions the disease can progress asymptomatically, different diagnostic criteria have been proposed during the last 20 years, and many epidemiological studies are based on retrospective clinical series. The aim of this study was to determine the incidence of AIH in the province of Valencia, Spain, during the year 2003. PATIENTS AND METHODS: The Services of Gastroenterology of eight acute-care reference hospitals in the province of Valencia, Spain, covering 1,774,736 inhabitants over 14 years of age, participated in a prospective study. All newly diagnosed patients with AIH between January 1, 2003 and December 31, 2003 were eligible. The diagnosis was based on criteria of the International Autoimmune Hepatitis Group revised in 1999. RESULTS: There were 19 new cases of AIH, 18 females and 1 male [mean (SD) age of 54.3 (11.2) years, range 23-73]. Incidence peaked in the 45-54 year age group. Eighteen cases were classified as AIH type 1 and one case as AIH type 2. The incidence rate of AIH for the year 2003 in people older than 14 years of age was 1.07 new cases per 100,000 inhabitants, with 1.96 cases per 100,000 inhabitants in females and 0.12 cases per 100,000 inhabitants in males. CONCLUSIONS: The 2003 annual incidence of AIH in Valencia, Spain, was similar to that reported in other European countries. AIH occurred more frequently in women and in the 45-54 year age group, type 1 being the most common.

[A clinical study of adult autoimmune hepatitis in Valencia, Spain]. / Estudio clínico de la hepatitis autoinmune del adulto en Valencia.

OBJECTIVE: the clinical phenotype of autoimmune hepatitis (AIH) varies among geographical areas. The aim of this study is to determine the salient features of AIH in adult patients from the province of Valencia, Spain. MATERIAL AND METHODS: eighty-one patients with AIH attended to in eight acute-care hospitals between 1994 and 2003. New patients diagnosed with AIH during year 2003 were evaluated prospectively. Data from patients currently attending follow-up visits and diagnosed before 2003 were collected retrospectively. RESULTS: a total of 94% of patients were females. Forty-three percent were asymptomatic, 27% had acute hepatitis, and 30% had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases. Type 2 AIH was more frequent in younger patients, and presented with an acute pattern. One third of patients had cirrhosis at onset. Patients with cirrhosis were older than 60 years more frequently. Immunosuppressants were given to 57 patients, with complete or partial remission in 87.7%. There were no significant differences in response to immunosuppression according to presentation pattern or AIH subtype. CONCLUSIONS: AIH in Valencia was predominantly diagnosed in asymptomatic women. Most cases were type 1, and in 25% of patients another autoimmune disease coexisted. At the time of diagnosis one third of patients had cirrhosis, particularly those over 60 years.

Prevalencia de infección tuberculosa en las personas inmigrantes de Lorca (Murcia) / Prevalence of tuberculous infection in immigrants in Lorca (Murcia)

FUNDAMENTO. La tuberculosis (TB) es una de las enfermedades más importantes a escala mundial por el número de enfermos y muertos que causa. El objetivo del estudio fue determinar la prevalencia de infección tuberculosa en la población inmigrante del municipio de Lorca. MÉTODOS. Estudio observacional descriptivo transversal en población inmigrante, con emplazamiento en Atención Primaria. La captación y reclutamiento se realizó en las consultas de Medicina de Familia entre febrero de 2005 y diciembre de 2006. Se realizó intradermorreacción de Mantoux (IDRM), con 0,1 ml (2UT) de PPD RT-23, previa firma del consentimiento informado. Otras variables recogidas fueron: edad, sexo, país de origen, nivel de estudios, situación laboral, número de convivientes y superficie de la vivienda, vacunación y escara (BCG) y tiempo de residencia en Europa. RESULTADOS. Fueron incluidas 106 personas inmigrantes y completaron el estudio el 95,3% (101), con una edad media de 30,5 ± 10,9. El 54,5% eran mujeres y llevaban un promedio de 2,8 años en Europa. La IDRM fue positiva en 28 (27,7% [IC 95%: 18,3-37,5]). Las personas inmigrantes con Mantoux positivo tenían una edad media de 35,7 años (IC 95%: 28,4-39,2). La prevalencia resultó mayor en los hombres, con diferencias significativas en los mayores de 39 años que residían en Europa ≥ 3 años y de nacionalidad ecuatoriana (17,8%). CONCLUSIONES. La prevalencia de infección por TB encontrada en la población inmigrante del municipio de Lorca es alta, superior a la de la población española. Consideramos que está justificada la realización de un examen de salud en su primer contacto con el Sistema Sanitario para descartarla, siendo el nivel sanitario más adecuado la Atención Primaria (AU)

BACKGROUND. Tuberculosis (TB) is one of the most important worldwide diseases due to the number of patients and deaths it causes. This study has aimed to determine the prevalence of tuberculous infection in the immigrant population of the Lorca municipality. METHODS. This is an observational, described, cross-sectional study in the immigrant population at the Primary Health Care level. Patient capture and enrolment was made in the Family Medicine Out-patient Clinics between February 2005 and December 2006. The Mantoux intradermal reaction (MIDR) with 0.1 ml (2UT) of PPD RT-23 was performed after obtaining signed informed consent. Other variables collected were: age, gender, country of origin, study level, work situation, number of persons living in the housing and its surface, vaccinations and scarring (BCG), time of residence in Europe. RESULTS. A total of 106 immigrants were included with 95.3% (101) completed the study. They had a mean age of 30.5 ± 10.9 and 54.5% were women. They had been living for an average of 2.8 years in Europe. MIDR was positive in 28 [27.7% (95% CI; 18.3-37.5)]. The immigrants with positive Mantoux had a mean age of 35.7 years (95% CI 28.4-39.2). Prevalence was greater in the men, with significant differences in those over 39 years of age, in those who had resided in Europe ≥ 3 years, with Ecuadorian nationality (17.8%). CONCLUSIONS. Prevalence of TB infection found in the immigrant population of the Lorca municipality is high, greater than in the Spanish population. We consider that making an examination of their health in their first contact with the Health Care system to rule out TB is justified, the most adequate level for this being Primary Health Care (AU)

[Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors]. / Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo.

OBJECTIVES: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. PATIENTS AND METHODS: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. RESULTS: Age was associated with a significant decrease (p < 0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year), dehydroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p < 0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. CONCLUSIONS: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehydroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age. diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity.

Estudio clínico de la hepatitis autoinmune del adulto en Valencia / No disponible

Introducción: existen factores geográficos que influyen en lascaracterísticas de la hepatitis autoinmune (HAI).Objetivo: conocer las características epidemiológicas, clínicasy respuesta al tratamiento de la hepatitis autoinmune en la provinciade Valencia.Material y métodos: se trata de un estudio realizado en ochohospitales de Valencia, recogiendo de forma prospectiva los casosde hepatitis autoinmune diagnosticados en el año 2003 y deforma retrospectiva los diagnosticados entre 1994 y 2002.Resultados: se incluyeron 81 pacientes con HAI, siendo el94% mujeres. La forma de presentación fue: 43% asintomático,27% hepatitis aguda y 30% enfermedad hepática crónica. La mayoría(90%) fueron del tipo 1, mientras que las de tipo 2 fueronmás jóvenes (p = 0,007) y con predominio de hepatitis aguda (p= 0,04). Existía otra enfermedad autoinmune en uno de cada 4casos. Al momento del diagnóstico una tercera parte de los pacientespresentaba cirrosis. La cirrosis se presentó sobre todo enpacientes de más de 60 años (p < 0,01) y sin diferencias según laformas clínica (p = 0,1). El tratamiento se indicó en 57 casos ycon respuesta –completa o parcial– en el 87,7%. No se encontrarondiferencias significativas en la respuesta terapéutica según laforma de presentación ni los tipos de hepatitis autoinmune.Conclusiones: en nuestra zona la hepatitis autoinmune deladulto se presenta sobre todo en mujeres y de manera asintomática.La mayoría es tipo 1 y en el 25% de los casos coexiste otraenfermedad autoinmune. Al diagnóstico la tercera parte presentacirrosis hepática, sobre todo en los que tienen más de 60 años

Objective: the clinical phenotype of autoimmune hepatitis(AIH) varies among geographical areas. The aim of this study is todetermine the salient features of AIH in adult patients from theprovince of Valencia, Spain.Material and methods: eighty-one patients with AIH attendedto in eight acute-care hospitals between 1994 and 2003. Newpatients diagnosed with AIH during year 2003 were evaluatedprospectively. Data from patients currently attending follow-upvisits and diagnosed before 2003 were collected retrospectively.Results: a total of 94% of patients were females. Forty-threepercent were asymptomatic, 27% had acute hepatitis, and 30%had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases.Type 2 AIH was more frequent in younger patients, and presentedwith an acute pattern. One third of patients had cirrhosisat onset. Patients with cirrhosis were older than 60 years morefrequently. Immunosuppressants were given to 57 patients, withcomplete or partial remission in 87.7%. There were no significantdifferences in response to immunosuppression according to presentationpattern or AIH subtype.Conclusions: AIH in Valencia was predominantly diagnosedin asymptomatic women. Most cases were type 1, and in 25% ofpatients another autoimmune disease coexisted. At the time of diagnosisone third of patients had cirrhosis, particularly those over60 years

Cambios en las hormonas sexuales en varones mayores de 50 años. Prevalencia de niveles bajos de testosterona y factores de riesgo / Changes in sexual hormones in a male population over 50 years of age. Frequency of low testosterone levels and risk factors

Objetivos: Evaluar los cambios en las hormonas sexuales en una población masculina mayor de 50 años, conocer la frecuencia de hipogonadismo bioquímico y qué factores se relacionan con los niveles de testosterona. Pacientes y método: Estudio transversal en 230 varones sanos mayores de 50 años. Se realizaron determinaciones de testosterona total, testosterona libre, testosterona biodisponible, sulfato de de hidroepiandrosterona, estradiol total y biodisponible, LH, FSH y prolactina y se averiguaron los antecedentes clínicos y sociodemográficos. Determinamos la frecuencia de hipogonadismo bioquímico. Analizamos los factores que podían influir en los niveles de testosterona total y libre mediante análisis uni y multivariante y realizamos un análisis de regresión logística para conocer los factores que pueden predecir el hipogonadismo bioquímico en base a la testosterona libre. Resultados: A medida que incrementa la edad de los sujetos evaluados, se observan niveles significativamente más bajos (p<0,05) de los niveles de testosterona total (0,6% anual), testosterona libre (1,3% anual), sulfato de de hidroepiandrosterona (1,8% anual) y estradiol biodisponible (0,69% anual), mientras que se observó un incremento de la SHBG, la LH y la FSH (p>0,05).La prevalencia de niveles bajos de testosterona total fue del 4,8%, alcanzando el 24,8% cuando utilizamos como referencia la testosterona libre. La media de los niveles plasmáticos de testosterona total fue significativamente inferior en los varones con obesidad, diabetes mellitus o dislipemia, mientras que la de los niveles de testosterona libre fue menor en aquellos con estilo de vida sedentario, bajo nivel de estudios, obesos o con diabetes mellitus. En el análisis multivariante, la edad, la diabetes y la obesidad se relacionaron inversamente con los niveles de testosterona total. Con la testosterona libre se relacionan los mismos factores además de la dislipemia. En el análisis de regresión logística multivariante para el hipogonadismo bioquímico, la edad, la obesidad y la diabetes fueron las variables con valor predictivo independiente. Conclusión: A partir de los 50 años se produce un descenso significativo de testosterona total, testosterona libre, sulfato de de hidroepiandrosterona y estradiol biodisponible relacionado con la edad. La prevalencia de hipogonadismo bioquímico es mayor si utilizamos la testosterona libre. Los niveles de testosterona total se relacionan además de con la edad, con la diabetes y la obesidad, añadiéndose la dislipemia para la testosterona libre. La probabilidad presentar niveles bajos de testosterona libre aumenta con la edad y es mayor cuando existen antecedentes de diabetes mellitus y/u obesidad (AU)

Objectives: To investigate the changes in sexual hormones in a selected male population older than 50 years of age. To assess the frequency of biochemical hypogonadism and which factors are related to testosterone levels. Patients and methods: A Cross-sectional study was carried out on 230 Spanish men older than 50 years of age. Blood tests were performed including: total testosterone, SHBG, calculated free testosterone, dehidroepiandrosterone sulfate, androstendione, estradiol, bioavailable estradiol, FSH, LH, and prolactin. Clinical and socio-demographic backgrounds were investigated. The frequency of biochemical hypogonadism was established using total and free testosterone levels as diagnostic criteria. Factors that may influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression model was used to determine which factors can predict biochemical hypogonadism according to free testosterone levels. Results: Age was associated with a significant decrease (p<0.05) in total testosterone (0.6% per year), free testosterone (1.3% per year),dehidroepiandrosterone sulfate (1.8% per year) and bioavailable estradiol (0.69% per year). Moreover, an increase in SHBG, LH, and FSH was observed (p<0.05). According to total testosterone levels, 4.8% of the men were hypogonadal, whereas 24.8% were hypogonadal when free testosterone was considered. In the univariate analysis, obesity, diabetes mellitus and hyperlipemia were related to lower total testosterone levels, while free testosterone levels were lower in men with sedentary life, lower levels of education, obesity or diabetes mellitus. In the multivariate analysis age, diabetes mellitus and obesity were inversely related to total and free testosterone levels. Free testosterone was also inversely related to hyperlipemia. For biochemical hypogonadism, simple logistic regression analysis selected age, sedentary life, obesity and diabetes mellitus. In the multivariate analysis age, obesity and diabetes mellitus had significant independent prognostic value. Conclusions: Starting from 50 years of age, a significant age-related decrease in total testosterone, free testosterone, dehidroepiandrosterone sulfate and bioavailable estradiol is observed. The frequency of biochemical hypogonadism is higher when free testosterone levels are used for diagnosis. Total testosterone levels were related to age, diabetes mellitus and obesity. Free testosterone was related to age, diabetes mellitus, obesity and hyperlipemia. The probability of suffering low free testosterone levels increases with age, diabetes mellitus and/or obesity (AU)

Perception of body size among Mexican teachers and parents.

Obesity in Mexico has reached epidemic proportions; and body image and body satisfaction might be culturally related. Body dissatisfaction has been related to low self-esteem. The aim of this study was to assess the range of perception among Mexican teachers and parents of the ideal body size of adults, boys and girls. Two-hundred and five teachers and eighty parents from Tijuana and Tecate schools participated in the study. Participants were asked to indicate the ideal body size for each group, as well as their own ideal body size. Average perception of ideal body weight for adults 35 to 45 years of age was 4.0 +/- 0.84. Average perception for boys and girls was 4.6. Positive correlations were shown between self-perception of body size and body mass index (0.62, P < 001), waist circumference (0.55, P < 0.001). Self-perception of body size was associated with perception of ideal body size for boys (0.23, P 0.001) and girls (0.22, P < 0.001), but BMI was not associated to perception of ideal body size for boys and girls. These results suggest that teachers and parents should be taught to more accurately assess excess weight status and to initiate action to prevent or correct excessive weight among children and adults.

Perception of body size among Mexican teachers and parents / Percepción del tamaño corporal en profesores y padres mexicanos

Obesity in Mexico has reached epidemic proportions; and body image and body satisfaction might be culturally related. Body dissatisfaction has been related to low self-esteem. The aim of this study was to assess the range of perception among Mexican teachers and parents of the ideal body size of adults, boys and girls. Two-hundred and five teachers and eighty parents from Tijuana and Tecate schools participated in the study. Participants were asked to indicate the ideal body size for each group, as well as their own ideal body size. Average perception of ideal body weight for adults 35 to 45 years of age was 4.0 ± 0.84. Average perception for boys and girls was 4.6. Positive correlations were shown between self-perception of body size and body mass index (0.62, P < 001), waist circumference (0.55, P < 0.001). Self-perception of body size was associated with perception of ideal body size for boys (0.23, P 0.001) and girls (0.22, P < 0.001), but BMI was not associated to perception of ideal body size for boys and girls. These results suggest that teachers and parents should be taught to more accurately assess excess weight status and to initiate action to prevent or correct excessive weight among children and adults

La obesidad en México ha alcanzado proporciones epidérmicas: la imagen corporal y la satisfacción con el cuerpo de uno mismo podrían tener un componente cultural. La insatisfacción con el cuerpo de uno mismo se ha relacionado con auto-estima baja. El propósito de este estudio fue evaluar, entre los profesores y padres mexicanos, el rango de percepción del tamaño corporal ideal de adultos, niños y niñas. Doscientos cinco profesores y ochenta padres de colegios de Tijuana y Tecate participaron en el estudio. Se pidió a los participantes que indicasen el tamaño corporal ideal para cada grupo, así como su propio tamaño corporal ideal. La percepción promedio del peso corporal ideal para adultos de entre 35 y 45 años de edad fue 4,0 ± 0,84. La percepción ideal para niños y niñas fue 4,6. Se observaron correlaciones positivas entre la auto-percepción del tamaño corporal y el índice de masa corporal (0,62, P < 0,001), y la circunferencia de la cintura (0,55, P < 0,001). La auto-percepción del tamaño corporal se asoció con la percepción del tamaño corporal ideal para los niños (0,23, P < 0,001) y las niñas (0,22, P < 0,001), pero el IMC no se asoció con la percepción del tamaño corporal ideal en niños y niñas. Esto sugiere que se debería enseñar a los profesores y padres a evaluar de una forma más precisa el estado de peso e iniciar una acción preventiva o corregir el exceso de peso en niños y adultos

[Evaluation of an immunoassay kit to measure free testosterone]. / Evaluación de una técnica de inmunoanálisis para la determinación de testosterona libre.

INTRODUCTION AND OBJECTIVES: The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement. MATERIAL AND METHOD: One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen's formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed. RESULTS: Mean age was 37 +/- 11 years. Mean serum concentration for total testosterone was 21.43 +/- 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 +/- 0.0118 nmol/L and 0.474 +/- 0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p< 0.05), although correlation coefficient is very low (r = 0.25). CONCLUSIONS: There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable.

Evaluación de una técnica de inmunoanálisis para la determinación de testosterona libre / Evaluation of an immunoassay kit to measure free testosterone

Introducción y objetivos: Los mejores indicadores bioquímicos para el diagnóstico del hipogonadismo son la testosterona libre y la biodisponible. La determinación de ambas fracciones de testosterona es compleja, aunque se han desarrollado técnicas de inmunoanálisis que permiten la determinación de la testosterona libre de manera directa y sencilla. Valoramos la utilidad de una técnica no evaluada de enzimoinmunoanálisis para la determinación de testosterona libre. Material y métodos: En el estudio se incluyeron 133 varones sanos en los que se determinó la testosterona total, la SHBG, la albúmina y la testosterona libre. La testosterona libre fue determinada mediante 2 métodos diferentes: determinación directa mediante enzimoinmunoanálisis (DSL 10-49100 ACTIVE(R) Free Testosterone EIA, Diagnostics System Laboratories) y mediante cálculo matemático utilizando la fórmula desarrollada por Vermeulen, que utiliza la concentración de albúmina, testosterona total y SHBG para calcular la testosterona libre (método recomendado por la 'International Society for the Study of the Aging Male'). Comparamos los valores obtenidos mediante un test de comparación de medias y realizamos un análisis de regresión para observar el grado de correlación existente entre ambos tipos de determinaciones. Resultados: La edad media fue de 37 ± 11 años. Los niveles medios de testosterona total fue de 21,43 ± 6,8 nmol/L y los de testosterona libre de 0,0508 ± 0,0118 nmol/L para el método directo y de 0,474 ± 0,123 nmol/L para el método matemático (p<0,05). En el estudio de regresión lineal se observa que aunque existe una correlación positiva entre ambos métodos (p<0,05) el coeficiente de correlación es bajo (r = 0,25). Conclusiones: Existen diferencias significativas entre los valores de testosterona libre determinados por el método directo de enzimoinmunoanálisis y la testosterona libre calculada. Aunque se observa una cierta correlación, esta es tan baja que hace poco fiable la utilización del enzimoinmunoanálisis para la determinación de la testosterona libre

Introduction and objetives: The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement. Material and method: One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen’s formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed. Results: Mean age was 37 ± 11 years. Mean serum concentration for total testosterone was 21.43 ± 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 ± 0.0118 nmol/L and 0.474±0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p< 0.05), although correlation coefficient is very low (r = 0.25). Conclusions: There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable

Markov chains: computing limit existence and approximations with DNA.

We present two algorithms to perform computations over Markov chains. The first one determines whether the sequence of powers of the transition matrix of a Markov chain converges or not to a limit matrix. If it does converge, the second algorithm enables us to estimate this limit. The combination of these algorithms allows the computation of a limit using DNA computing. In this sense, we have encoded the states and the transition probabilities using strands of DNA for generating paths of the Markov chain.

Incidence and epidemiological factors of hepatocellular carcinoma in Valencia during the year 2000.

AIM: to ascertain the incidence and epidemiological factors of hepatocellular carcinoma in the Province of Valencia, Spain. DESIGN: a prospective study was made of hepatocellular carcinoma during the year 2000 collecting all diagnosed cases from four hospitals during that year. RESULTS: a total of 64 cases of hepatocellular carcinoma with a male predominance (42/22) and a mean age of 73.4 years (range of 42-90) were diagnosed. Incidence rate was 8.2 per 100,000, and cirrhosis was known to pre-exist in most cases, half of which were Child-Pugh A. Anti-VHC positive, alone or alcohol or virus B related was detected in 3 of every 4 cases. In the majority of the cases the tumours were located in the right hepatic lobe and the size at first diagnosis was less than 3 cm in 37.3% of the cases. Alpha-fetoprotein levels only exceeded 200 mg/ml in 37.3% of the patients and bore a good size relation to the tumour (R=0.245, p=0.003. No relation vis-à-vis aetiology with age, sex, tumour location or Child-Pugh stage was found. CONCLUSIONS: the incident rate of hepatocellular carcinoma in Valencia province during 2000 was 8.2 per 100,000 individuals. This lesion appeared more frequently in men between the ages of 60-80. Hepatitis C virus was the main etiologic agent found. Key words: Hepatocellular carcinoma. Incidence. Hepatitis C virus. Epidemiology. Child-Pugh grade. Alpha-fetoprotein.