Plasma homocysteine levels and handgrip strength in postmenopausal women.

OBJECTIVE: This study evaluated handgrip strength (HGS), circulating homocysteine levels and related factors in postmenopausal women. METHODS: This study is a sub-analysis of a prospective cohort of 303 postmenopausal women aged 62.7 ± 6.9 years who had HGS measures with a digital dynamometer as the primary outcome, and plasma homocysteine and creatinine levels and glomerular filtration rate (GFR) measures as the secondary outcomes. RESULTS: The average HGS was 22.5 ± 4.0 kg, 29.4% of women had dynapenia (HGS < 20 kg), adiposity was 40.3 ± 5.4% and 9.57% of women had hyperhomocysteinemia (homocysteine >15 µmol/l). There were no differences between tertiles of homocysteine and HGS (p = 0.641). Plasma homocysteine levels were unrelated to HGS (r = -0.06) and correlated with age (r = 0.17), GFR (r = -0.28) and creatinine (r = 0.23). Hyperhomocysteinemia was not associated with HGS (odds ratio [OR] = 0.98 [95% confidence interval (CI): 0.89; 1.08]) or dynapenia (OR = 1.10 [95% CI: 0.45; 2.47]). The risk of presenting low HGS were not significantly associated with homocysteine (OR = -0.08 [95% CI: -0.21; 0.06]) and were associated with age (OR = -0.23 [95% CI: -0.29; -0.17]), adiposity (OR = -6.52 [95% CI: -9.53; -3.50]) and creatinine (OR = 6.22 [95% CI: 2.48; 9.97]). CONCLUSIONS: HGS and dynapenia were unrelated to hyperhomocysteinemia. Age, GFR and creatinine were significantly associated with plasma homocysteine levels.

Evaluation of the relationship between homocysteine levels and bone mineral density in postmenopausal women.

OBJECTIVE: The current study aimed to evaluate the relationship between homocysteine (Hcy) levels and bone mineral density (BMD) in postmenopausal women. METHODS: The present, cross-sectional study included 760 postmenopausal women. The following variables were recorded: age, age at menopause, body mass index (BMI), BMD (measured by dual-energy X-ray absorptiometry [DXA] scanning and expressed as lumbar, femoral neck and total hip T-scores), smoking status, biochemical parameters (Hcy, creatinine, calcium, phosphorus, vitamin D and parathormone levels) and vitamin D supplementation. RESULTS: The mean age of the sample population was 56.4 ± 5.77 years and the mean age at menopause was 49.9 ± 3.62 years. The mean BMI was 25.2 ± 4.49 kg/m2. In the current study, a comparison of the subjects with osteoporosis, osteopenia and normal BMD revealed that the subjects in the low BMD group were significantly older (p < 0.001), had a lower age at menopause (p < 0.001) and had lower BMI (p < 0.001). There was no statistically significant difference among the groups with regard to the plasma levels of Hcy (p = 0.946). The levels of Hcy were positively correlated to the creatinine levels (r = 0.21). The present study did not observe any significant correlations between the Hcy levels and other parameters. CONCLUSIONS: In the present study, 15.3% of the subjects had hyperhomocysteinemia and 62.11% had low BMD. The current results obtained from a group of postmenopausal women suggest that the plasma levels of Hcy are not related to BMD in the lumbar spine (L1-L4), femoral neck and total hip. In the current study, age, age at menopause and low BMI were observed to be associated with low BMD.

Dry eye disease symptoms and quality of life in perimenopausal and postmenopausal women.

OBJECTIVE: This study aimed to evaluate dry eye disease (DED) symptoms and quality of life (QoL) in a group of perimenopausal and postmenopausal women, based on the Ocular Surface Disease Index (OSDI) questionnaire. METHODS: An observational study was performed in a group of 1947 perimenopausal and postmenopausal women, aged between 45 and 79 years. The personal data collected were age, menopause status, age at menopause, and OSDI score. RESULTS: The mean age of the group was 54.18 ± 6.84 years, with a mean age at menopause of 49.45 ± 4.02 years. The average OSDI score was 29.20 ± 19.4. The overall prevalence of DED symptoms was 79%, increasing significantly in postmenopausal women, 76.4% vs. 80.5% (p = 0.029). In our group, 37.7% had severe DED symptoms. Ocular symptoms, vision-related functions, and environmental trigger scores were higher in postmenopausal women, leading to a lower QoL. The severity of OSDI score increases with age (ß coefficient: 0.15 [95% confidence interval: 0.02; -0.28]), while the severity of OSDI score decreases with a later onset age of menopause (ß coefficient: -0.27 [95% confidence interval: -0.55; -0.01]). CONCLUSIONS: DED symptoms are highly prevalent in perimenopausal and postmenopausal women. Postmenopausal women had a higher prevalence of symptoms and higher OSDI scores than perimenopausal women. The severity of DED symptoms and vision-related functions leads to poorer QoL.

Recomendaciones para el manejo de pacientes con enfermedad Inflamatoria Intestinal (EII) y COVID-19 / Recommendations for the management of patients with Inflammatory Bowel Disease (IBS) and COVID-19

The new Coronavirus (SARS-CoV-2) appeared in China in December 2019. Since then and until April 2020 it spread worldwide affecting more than three million people. Its exponential rise is still growing all over the world, taking thousands of lives. SARS-CoV-2 is very contagious, person to person, by droplets which can generate a respiratory infection known as COVID-19. Some patients are at higher risk: Older people, those with cardiovascular disease, diabetes and hypertension are the most prone to an unfavorable outcome. Our Inflammatory Bowel Disease (IBD) patients are a special cluster, with many of them taking immunosuppressive treatment for long periods, which could pose an important risk. Scientifics societies all over the world have joined efforts to generate data, share experiences and make recommendations for good clinical management. This is a review of the available evidence, expert opinion, and proposed ways of working during the pandemic

El nuevo coronavirus (SARS-CoV-2) apareció en China en diciembre de 2019. Desde su inicio hasta abril de 2020 se ha expandido por todo el mundo, afectando a más de tres millones de personas. Su ascenso exponencial sigue creciendo, generando miles de muertes. Su contagiosidad es persona a persona por gotitas, pudiendo llegar a generar un cuadro clínico de infección respiratoria conocido como COVID-19. Algunos pacientes tienen más riesgos de tener un curso desfavorable; adultos mayores, pacientes con enfermedad cardiovascular, hipertensos y diabéticos. Nuestros pacientes con enfermedad inflamatoria intestinal son un grupo de pacientes con características particulares, muchos de ellos reciben tratamiento inmunosupresor por largos períodos, lo que pudiese suponer un riesgo específico. Las sociedades científicas de Europa y Norteamérica han realizado un esfuerzo conjunto para generar datos, compartir experiencias y dictar recomendaciones de buen manejo clínico. Esta es una revisión de la evidencia disponible, opiniones de expertos y formas de trabajo propuestos durante la pandemia.

Factors related to muscle strength in postmenopausal women aged younger than 65 years with normal vitamin D status.

Objective: The study aimed to determine the impact of age, age at menopause, body mass index (BMI), and lumbar and hip bone mineral density (BMD) on muscle strength in young postmenopausal women with normal vitamin D levels. Methods: This was a cross-sectional study performed in 392 postmenopausal women aged <65 years with normal serum 25-hydroxyvitamin D levels (≥30 ng/ml) and no physical disabilities. The following variables were recorded: age, age at menopause, BMI, BMD (measured by dual-energy X-ray absorptiometry [DXA] scanning and expressed as lumbar and hip T-scores), and dominant hand grip strength (measured with a digital dynamometer). Results are reported as mean ± standard deviation or odds ratio (OR) and 95% confidence interval (CI) as appropriate. Results: The mean age of the whole sample was 57.30 ± 3.69 years with a mean age at menopause of 50.46 ± 2.16 years and a mean BMI of 24.93 ± 3.78. Mean DXA results were lumbar T-score of -1.16 ± 1.18 and hip T-score of -0.98 ± 0.93. The mean dominant hand grip force was 24.10 kg. A total of 12.2% (48/392) of women were diagnosed with dynapenia using a cut-off value of <20 kg. A weak but significant inverse correlation was found between grip strength in the dominant hand and age (r = -0.131, p = 0.009). Multivariable logistic regression analysis determined that earlier age at menopause (50 years or younger) was significantly associated with a higher risk of dynapenia (OR 2.741, 95% CI 1.23-6.11, p = 0.014). No other significant association was found with the other variables. Conclusions: A total of 12.2% of the studied young postmenopausal women with normal vitamin D status had dynapenia. There was a weak inverse correlation between grip strength and age, and earlier age at menopause was associated with an increased dynapenia risk.

Fabric phase sorptive extraction: An innovative sample preparation approach applied to the analysis of specific migration from food packaging.

Additives added to food packaging materials can migrate to food in contact with them during storage and shelf life. A novel simple, fast and sensitive analyte extraction method based on fabric phase sorptive extraction (FPSE), followed by analysis using ultra-high performance liquid chromatography and mass spectrometry detection (UPLC-MS) was applied to the analysis of 18 common non-volatile plastic additives. Three FPSE media coated with different sol-gel sorbents characterized with different polarities including sol-gel poly(dimethylsiloxane), sol-gel poly(ethylene glycol) and sol-gel poly(tetrahydrofuran) were studied. All three FPSE media showed very satisfactory results. In general, compounds with low logP values seemed to have higher enrichment factors (EFs), especially with poly(tetrahydrofuran) and poly(ethylene glycol) media. For compounds with high logP values, the use of sol-gel poly(dimethylsiloxane) improved the enrichment capacity. Sample preparation time was optimized at 20 min for sample extraction and 10 min for solvent desorption. Acetonitrile was selected as desorption solvent since recoveries were over 70% for 13 out of 18 selected compounds in all FPSE media. The best extraction recovery values were obtained when compounds were dissolved in aqueous acetic acid solution (3%), where 17 out of 18 compounds showed improvement in their signal intensity after FPSE extraction and 10 obtained enrichment factors above 3 for all the tested FPSE media. When FPSE extracts were concentrated under nitrogen, 11 out of 18 compounds reached EFs values above 100.

[EVIDENCE BASED NURSING: EARLY AND SAFE PROTOCOL FOR ICU PATIENT'S MOBILIZATION]. / Enfermería basada en La evidencia. Protocolo para la movilización temprana y segura del paciente en UCI.

UNLABELLED: Patients admitted to the ICU are at risk of immobility and an early and important physical deconditioning. OBJECTIVE: To develop and to implement an early and safe protocol for ICU patients' mobilization. METHODOLOGY: The Evidence Based Practice Model for Staff Nurses was used. It encompasses Assessment, Problem Identification, Planning, Implementation and Evaluation, Integration and Maintenance in Practice. RESULTS: The research team (Advanced Practice Nurse and expert clinical nurses), along with the medical team and rehabilitation service, identified the need to develop the protocol. For its elaboration, a literature search on the data bases PubMed, CINA-HL and Cochrane Library was performed; a questionnaire was administered and structured observations were conducted. For the implementation training sessions were offered to nurses, posters were placed in the unit and protocol was included in the computer program. Finally, an assessment of the knowledge, perceptions and practices of nurses in the unit and a recording of adverse events related to the mobilization will take place. CONCLUSIONS: The development and implementation of a protocol for early mobilization of ICU patients has facilitated the integration of this care in daily practice. This model of evidence-based practice allows nurses an active part in changing the culture in terms of the integration of research into practice.

BRILMA methylene blue in cadavers. Anatomical dissection / BRILMA azul de metileno en cadáveres. Disección anatómica

No disponible

A new thoracic interfascial plane block as anesthesia for difficult weaning due to ribcage pain in critically ill patients / Nuevo bloqueo del plano interfascial torácico como anestesia para retiradas dificultosas de ventilación mecánica a causa de dolor torácico, en pacientes críticos

No disponible

Compounds from multilayer plastic bags cause reproductive failures in artificial insemination.

High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5 mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags.

Asistencia ventricular definitiva como alternativa al trasplante cardíaco en un paciente ingresado en una unidad de cuidados intensivos: un caso clínico / Ventricular assist device as alternative to heart transplant in a hospitalized patient in an intensive care unit: Clinical case

Objetivo Presentar y analizar un caso clínico con el que se aborde el plan de cuidados de un paciente con asistencia ventricular permanente en una unidad de cuidados intensivos (UCI).Presentación del caso clínico Varón de 65 años de edad que ingresa en la UCI de un hospital universitario de nivel terciario en septiembre de 2011, tras implantarle el dispositivo de asistencia ventricular permanente (Heartmate II®).Discusión e implicaciones para la práctica El análisis del caso se estructura según las categorías que se identifican en la revisión de la literatura médica: prevención de riesgos y complicaciones, manejo del dispositivo y educación para la salud. Conclusión Este trabajo evidencia la importancia de instaurar un plan de cuidados protocolizado para los pacientes portadores de asistencia ventricular permanente en la UCI, lo que evitaría complicaciones en el post-operatorio inmediato, reduciría los costes y el tiempo de hospitalización (AU)

Objective To present and analyze a clinical case that addresses the care plan for a patient with permanent ventricular assist in an intensive care unit (ICU).Clinical case presentation A 65-year-old man admitted to an ICU in a tertiary teaching hospital in September 2011 after receiving an implant of a permanent ventricular assist device (Heartmate II®).Discussion and implications for practice The case analysis has been structured into 3 categories identified in the review of the literature: prevention of risks and complications, management of the device and health education. Conclusion This study shows the importance of establishing a protocolized care plan for the patients who are carriers of permanent ventricular assist in the ICU. This would avoid postoperative complications, reduce costs and hospitalization time (AU)

The challenge of identifying non-intentionally added substances from food packaging materials: a review.

Packaged food can contain non-intentionally added substances (NIAS) as a result of reaction and degradation processes or the presence of impurities in the raw materials used for the packaging production. This manuscript reviews the evidence of NIAS and their possible origin. One of the most challenging and difficult tasks when a sample of packaging materials arrives at the laboratory is knowing the procedure to apply for identifying the unknown compounds. This work proposes an analytical procedure for sample treatment, applicable to polymers as well as to migration samples, and for NIAS identification. The identification protocol comprises the determination of both volatile and non-volatile compounds. A review is presented of the most novel analytical techniques used for identification purposes, particularly high resolution mass spectrometry (HRMS).

[Ventricular assist device as alternative to heart transplant in a hospitalized patient in an intensive care unit: clinical case]. / Asistencia ventricular definitiva como alternativa al trasplante cardíaco en un paciente ingresado en una unidad de cuidados intensivos: un caso clínico.

OBJECTIVE: To present and analyze a clinical case that addresses the care plan for a patient with permanent ventricular assist in an intensive care unit (ICU). CLINICAL CASE PRESENTATION: A 65-year-old man admitted to an ICU in a tertiary teaching hospital in September 2011 after receiving an implant of a permanent ventricular assist device (Heartmate II). DISCUSSION AND IMPLICATIONS FOR PRACTICE: The case analysis has been structured into 3 categories identified in the review of the literature: prevention of risks and complications, management of the device and health education. CONCLUSION: This study shows the importance of establishing a protocolized care plan for the patients who are carriers of permanent ventricular assist in the ICU. This would avoid postoperative complications, reduce costs and hospitalization time.

UPLC-Q-TOF-MS analysis of non-volatile migrants from new active packaging materials.

Ultra-performance liquid chromatography (UPLC) coupled to mass spectrometry (MS) is a useful tool in the analysis of non-volatile compounds, and the use of a quadrupole-time-of-flight (Q-TOF) mass analyzer allows a high sensitivity and accuracy when acquiring full fragment mode, providing a high assurance of correct identification of unknown compounds. In this work, UPLC-Q-TOF-MS technology has been applied to the analysis of non-volatile migrants from new active packaging materials. The materials tested were based on polypropylene (PP), ethylene-vinyl alcohol copolymer (EVOH), and poly(ethylene terephthalate) (PET). The active packaging materials studied were one PP film containing a natural antioxidant, and two PP/EVOH films, two PET/EVOH films and one coextruded PP/EVOH/PP film containing natural antimicrobials. The chemical structure of several compounds was unequivocally identified. The analysis revealed the migration of some of the active substances used in the manufacture of active packaging, such as caffeine (0.07 ± 0.01 µg/g), carvacrol (0.31 ± 0.03 µg/g) and citral (0.20 ± 0.01 µg/g). Unintentionally added substances were also found, such as citral reaction compounds, or citral impurities present in the raw materials.

Atmospheric pressure gas chromatography coupled to quadrupole-time of flight mass spectrometry as a powerful tool for identification of non intentionally added substances in acrylic adhesives used in food packaging materials.

Acrylic adhesives are used to manufacture multilayer laminates that are used in food packaging to form the geometric shape of the package as well as to stick labels on the packages. Once applied on the packaging adhesives can supply potential migrants that could endanger the packaged food. Adhesives are complex matrices where intentionally and non intentionally added substances are present, but the identification of the migrants is required by law. In this study atmospheric pressure gas chromatography coupled to a quadrupole hyphenated to a time of flight mass spectrometer (APGC-MS/Q-TOF) has been explored for identification of unknowns coming from three different acrylic adhesives. The results are compared to those obtained by conventional GC-MS-Q (quadrupole). Sixteen compounds were identified by GC-MS/Q and five of them were confirmed by APGC-MS/Q-TOF as their molecular ions were found. Moreover, additional three new compounds were identified and their structure was elucidated working with the spectra obtained by APGC-MS/Q-TOF. This finding was very relevant as these compounds were biocides suspected to be allergenic and cytotoxic in humans. Migration studies were carried out using Tenax as solid food simulant and the results showed that the three acrylic adhesives tested in this work were safe for being used in food packaging materials since the migration of compounds previously identified was below the limit established in the current legislation.