Riesgo de recurrencia y factores de riesgo de invasión del cáncer diferenciado de tiroides / Risk of recurrence and risk factors for invasion of differentiated thyroid cancer

Introducción: El cáncer diferenciado de tiroides (CDT) se encuentra representado por el carcinoma papilar y el carcinoma folicular. Comprende la gran mayoría (>90%) de todos los cánceres de tiroides. Objetivos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Materiales y métodos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Resultados: El 87% fueron del sexo femenino. La edad media fue de 43±14 años. Predominó el riesgo de recurrencia bajo en el 49% de los pacientes, seguido del riesgo intermedio (33%) y riesgo alto (18%). El tamaño tumoral ˃1cm confiere mayor riesgo de ser estratificado como riesgo de recurrencia intermedio/alto (OR 5,7 IC 95% 3,6-9). El sexo masculino representó mayor riesgo de invasión ganglionar (OR 2,8 IC 95% 1,2-6,6); la edad ≥55 años lo fue en la invasión vascular (OR 2,1 IC 95% 1,1-4,1); el tamaño >1cm constituyó un mayor riesgo de manera significativa de invasión capsular (OR 10,5 IC 95% 6,5-17), invasión ganglionar (OR 10,2 IC 95% 3,8-26,9), invasión vascular (OR 30,7 IC 95% 4,2-224) e invasión de tejido peritiroideo (OR 5,2 IC 95% 3,3-8,2). Conclusión: El riesgo de recurrencia inicial más frecuente fue el riesgo bajo. El sexo masculino, la edad ≥55años y el tamaño >1cm constituyen factores de riesgo de invasión a estructuras vecinas.

Introduction: Differentiated thyroid cancer (DTC) is represented by papillary carcinoma and follicular carcinoma. It comprises the vast majority (> 90%) of all thyroid cancers. Objectives: Stratify the risk of initial recurrence of patients with DTC. Relate age, sex, and tumor size to the risk of recurrence, capsular, nodal, vascular, and perithyroid tissue invasion. Materials and methods: Observational, descriptive, retrospective, cross-sectional study with an analytical component. A total of 432 patients with a diagnosis of DTC from Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: 87% were female. The mean age was 43 ± 14 years. Low recurrence risk predominated in 49% of patients, followed by intermediate risk (33%) and high risk (18%). Male sex, age ≥55 years and tumor size ˃1cm confer a higher risk of being stratified as intermediate / high recurrence risk, but only size> 1cm was significantly (OR 5.7 95% CI 3.6-9). Male sex represented a higher risk of lymph node invasion (OR 3.1 95% CI 1.4-2.8) and vascular invasion (OR 2.3 95% CI 1.1-4.8); age ≥55 years was in the vascular invasion (OR 2.6 95% CI 1.4-4.9); size> 1cm constituted a significantly higher risk of capsular invasion (OR 10.7 95% CI 6.7-17.3), nodal invasion (OR 10.5 95% CI 4-27.7), vascular invasion (OR 33 95% CI 4.5-244) and invasion of perithyroid tissue (OR 5.1 95% CI 3.2-8.1). Conclusion: The most frequent initial recurrence risk was low risk. Male sex, age ≥55 years, and size> 1cm are risk factors for invasion of neighboring structures.

Design of 3D Scaffolds for Hard Tissue Engineering: From Apatites to Silicon Mesoporous Materials.

Advanced bioceramics for bone regeneration constitutes one of the pivotal interests in the multidisciplinary and far-sighted scientific trajectory of Prof. Vallet Regí. The different pathologies that affect osseous tissue substitution are considered to be one of the most important challenges from the health, social and economic point of view. 3D scaffolds based on bioceramics that mimic the composition, environment, microstructure and pore architecture of hard tissues is a consolidated response to such concerns. This review describes not only the different types of materials utilized: from apatite-type to silicon mesoporous materials, but also the fabrication techniques employed to design and adequate microstructure, a hierarchical porosity (from nano to macro scale), a cell-friendly surface; the inclusion of different type of biomolecules, drugs or cells within these scaffolds and the influence on their successful performance is thoughtfully reviewed.

Optimization of hyphenated asymmetric flow field-flow fractionation for the analysis of silver nanoparticles in aqueous solutions.

The extensive use of silver nanoparticles (AgNPs) in consumer products, medicine, and industry leads to their release into the environment. Thus, a characterization of the concentration, size, fate, and toxicity of AgNPs under environmental conditions is required. In this study, we present the characterization and optimization of an asymmetric flow field-flow fractionation (AF4) system coupled with UV/Vis spectrophotometer and dynamic light scattering (DLS) detector as a powerful tool for the size separation and multi-parameter characterization of AgNPs in complex matrices. The hyphenated AF4-UV/Vis-DLS system was first characterized using individual injections of the different size fractions. We used electrostatically stabilized AgNPs of 20-, 50-, and 80-nm nominal diameters coated with lipoic acid. We investigated the effect of applied cross-flows, carrier solutions, focus times, and quantity of injected particles on the nature of the AF4 fractograms and on the integrity of the AgNPs. Best size separation of a 1:1 mixture of 20- and 80-nm AgNPs was achieved using cross-flows of 0.5 and 0.7 mL/min with 1 mM NaCl and 0.05% v/v Mucasol as carrier solutions. We also researched the behavior of AgNPs in natural waters using the hyphenated AF4-UV/Vis-DLS system, under determined optimal conditions. Schematic and photograph of the AF4 setup with numbered hardware devices. Dashed lines represent electrical connections; continuous lines represent fluidic connections. For a better overview, not all fluidic connections between pump/6-way valve (2) and the Eclipse AF4 device (3) are shown in the schematic. The fluorescence detector (FL (7)) was not used in the study presented herein.

Antioxidant Capacity Assessment of Plant Extracts for Green Synthesis of Nanoparticles.

In this work, water extracts from different bio-based products of plant origin were studied to evaluate their antioxidant capacity and their potential to form metal nanoparticles from aqueous solutions. Two traditional tests, the Folin-Ciocalteu assay and the DPPH radical scavenging capacity method were compared with a more recent one, SNPAC, based on the formation of silver nanoparticles. The silver nanoparticle antioxidant capacity method (SNPAC) was optimized for its application in the characterization of the extracts selected in this work; kinetic studies and extract concentration were also evaluated. The extracts were obtained from leaves of oak, eucalyptus, green tea, white and common thyme, white cedar, mint, rosemary, bay, lemon, and the seaweed Sargassum muticum. The results demonstrate that any of these three methods can be used as a quick test to identify an extract to be employed for nanoparticle formation. Additionally, we studied the synthesis of Cu, Fe, Pb, Ni, and Ag nanoparticles using eucalyptus extracts demonstrating the efficiency of this plant extract to form metallic nanoparticles from aqueous metal salt solutions. Metal nanoparticles were characterized by transmission electron microscopy and dynamic light scattering techniques.

Synthesis and Structure of a 22 × 12 × 12 Extra-Large Pore Zeolite ITQ-56 Determined by 3D Electron Diffraction.

A multidimensional extra-large pore germanosilicate, denoted ITQ-56, has been synthesized by using modified memantine as an organic structure-directing agent. ITQ-56 crystallizes as plate-like nanocrystals. Its structure was determined by 3D electron diffraction/MicroED. The structure of ITQ-56 contains extra-large 22-ring channels intersecting with straight 12-ring channels. ITQ-56 is the first zeolite with 22-ring pores, which is a result of ordered vacancies of double 4-ring (d4r) units in a fully connected zeolite framework. The framework density is as low as 12.4 T atoms/1000 Å3. The discovery of the ITQ-56 structure not only fills the missing member of extra-large pore zeolite with 22-ring channels but also creates a new approach of making extra-large pore zeolites by introducing ordered vacancies in zeolite frameworks.

Is milk and dairy intake a preventive factor for elderly cognition (dementia and Alzheimer's)? A quality review of cohort surveys.

Milk and dairy (M&D) is a longstanding human food with widespread use. Many studies showed the preventive capacity of M&D in several human health disorders, but its utility in others is under discussion. Aging has been associated to elderly cognitive decline including dementia-Alzheimer syndrome (Dem-AD). The absence of a therapy to impede or postpone Dem-AD determines the need for its prevention, including nutritional factors. To evaluate the preventive capacity of M&D consumption in elderly Dem-AD we performed a systematic review in the main biomedical databases and information resources, but we present this study as a narrative review to discuss better the complexity of this subject. The elderly Dem-AD has a long pre-symptomatic period and the M&D intake has a widespread use. These determinants and the quality flaws of published studies impeach us to answer whether M&D consumption is preventive for Dem-AD. Moreover, two long Japanese cohorts suggest that M&D intake could prevent Dem-AD. Prospective cohorts beginning in midlife (or early life) could answer this question in the future.

Prevalencia de Cáncer de Tiroides en Centros de Referencia del Paraguay / Prevalence of Thyroid Cancer in Reference Centers of Paraguay

Introducción: El Cáncer de tiroides es la neoplasia maligna más frecuente del sistema endócrino. Durante las últimas décadas se ha observado un aumento de su incidencia de forma progresiva en numerosos países y regiones del mundo. Objetivos: Determinar la prevalencia de Cáncer de tiroides y, los tipos histológicos, en 3 hospitales de referencia en Paraguay. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se incluyó a todos los pacientes sometidos a tiroidectomía parcial o total en el Hospital de Clínicas, Instituto de Previsión Social e Instituto Nacional del Cáncer, entre los años 2011 y 2015. Resultados: La prevalencia de cáncer de tiroides fue de 23,7% de 1913 pacientes sometidos a tiroidectomía. El 85,7% fueron del sexo femenino. La edad media fue de 43±14 años. El 85,4 % de los pacientes presentó Carcinoma Papilar; el 9,5% Carcinoma Folicular; el 3,1% Carcinoma Medular; el 1,6% Carcinoma Anaplásico y el 0,4% Carcinoma Papilar + Carcinoma Folicular en el mismo paciente. El sexo femenino fue más frecuente en todos los tipos histológicos y, el Carcinoma Medular resultó igual en ambos sexos. La edad media de los pacientes con Carcinoma Papilar fue de 42±13 años, Carcinoma Medular 49±15 años, del Carcinoma Folicular 50±18 años y Carcinoma Anaplásico 69±11 años. El tamaño promedio del Carcinoma Papilar fue de 19±17 mm, del Carcinoma Folicular 53±24 mm, del Carcinoma Medular 40±22 mm, y el Carcinoma Anaplásico 50±35 mm. Conclusión: Aproximadamente 1 de cada 4 pacientes sometidos a tiroidectomía presentó cáncer de tiroides, siendo más frecuente en el sexo femenino y, el Carcinoma Papilar es el tipo histológico más frecuente.

Introduction: Thyroid cancer is the most frequent malignant neoplasm of the endocrine system. During the last decades, an increase in its incidence has been observed progressively in many countries and regions of the world. Objectives: To determine the prevalence of thyroid cancer and its histological types in thyroidectomies carried out in reference hospitals in Paraguay. Materials and methods: Observational, descriptive, retrospective, cross-sectional study. All patients undergoing partial or total thyroidectomy at the Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: The prevalence of thyroid cancer was 23.7% of 1913 patients undergoing thyroidectomy. 85.7% were female. The mean age was 43 ± 14 years. 85.4% of the patients presented Papillary Carcinoma; 9.5% Follicular Carcinoma; 3.1% Medullary Carcinoma; 1.6% Anaplastic Carcinoma and 0.4% Papillary Carcinoma + Follicular Carcinoma in the same patient. The mean age of the patients with Papillary Carcinoma was 42 ± 13 years, Medullary Carcinoma 49 ± 15 years, Follicular Carcinoma 50 ± 18 years, and Anaplastic Carcinoma 69 ± 11 years. The average size of Papillary Carcinoma was 19 ± 17 mm, Medullary Carcinoma 40 ± 22 mm, Anaplastic Carcinoma 50 ± 35 mm, and Follicular Carcinoma 53 ± 24 mm. Conclusion: About 1 in 4 patients undergoing thyroidectomy has thyroid cancer, it is more frequent in women, and the most frequent histological type is Papillary Carcinoma.

The pharmacist facing the logistics of safely dispensing, storing and preserving drugs in healthcare units.

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have  quickly adapted to respond to a critical situation characterized by the constant  and continuous admission of patients with severe pneumonia who needed  treatment, requiring a transformation of the hospital in order to increase the  number of hospital and critical beds. Moreover, other out-ofhospital spaces have  been transformed into hospitalization units to absorb the large number of  patients that had to be treated and isolated. To guarantee the distribution of  medicines and the quality of the pharmaceutical care, drug distribution systems,  such as unit dose and automated dispensing systems, have undergone  transformations. Standard stocks were assigned for COVID units, and different  dispensing circuits to avoid the risk of cross-contamination between COVID and  non-COVID units were created, as well as disinfection protocols for medication  transport systems and medication return protocols. All this without forgetting  COVID treatment protocol's changes that were affected by the availability of the  drugs. The increase in the number of beds in out-of-hospital spaces, such as  field hospitals, hotels, socio-medical centers and nursing homes, has challenged  Pharmacy Services, since new medication dispensing and conciliation circuits  have been created forcing the increase of pharmacy staff's presence and  modifying work shifts, to afford all the new tasks successfully. Development of  contingency plans for the different Pharmacy Service activities and providing  fluent communication channels are key elements for crisis situations or health  emergencies such as the current pandemic.

Ante la pandemia por SARS-CoV-2, los servicios de farmacia de los hospitales se han adaptado rápidamente para dar respuesta a una situación muy grave  caracterizada por el ingreso constante y continuo de pacientes con neumonía  que necesitaban tratamiento, siendo necesaria una transformación del hospital  para poder aumentar el número de camas de hospitalización y de críticos que se  requerían. Asimismo, otros dispositivos extrahospitalarios se han transformado  en unidades de hospitalización para absorber el elevado número de pacientes  que debían tratarse y aislarse. Para garantizar la distribución de los  medicamentos y la calidad de la atención farmacéutica, los sistemas de  distribución de fármacos, como la unidosis y los sistemas automatizados de  dispensación, han sufrido a su vez transformaciones. Se diseñaron stocks  estándar para las plantas COVID, y circuitos de dispensación diferentes para  evitar el riesgo de contaminación cruzada entre plantas COVID y no-COVID, así  como protocolos de desinfección de los sistemas de transporte de medicación y  protocolos de gestión de las devoluciones de medicación. Todo esto sin olvidar  los cambios en los protocolos de tratamiento de la COVID que se vieron  afectados por la disponibilidad de los fármacos. El incremento del número de  camas en dispositivos extrahospitalarios, como hospitales de campaña, hoteles,  centros sociosanitarios y residencias geriátricas, ha sido un reto para los  servicios de farmacia, ya que se han tenido que crear nuevos circuitos de  dispensación y de conciliación de la  medicación, obligando a reforzar la plantilla  del servicio de farmacia y modificar los turnos de trabajo, estableciendo guardias presenciales para poder llevar a cabo todas las nuevas tareas con éxito. La  elaboración de planes de contingencia de las diferentes actividades del servicio  de farmacia y el establecimiento de canales de comunicación fluidos son  elementos clave para situaciones de crisis o emergencias sanitarias como la  actual.

Role of Vitamin D in Athletes and Their Performance: Current Concepts and New Trends.

We are currently experiencing a vitamin D (VITD) deficiency pandemic across the world. Athletes have the same predisposition to low levels of vitamin D, the majority of its concentrations being below 20 ng/mL in a wide range of sports, especially in the winter months. Vitamin D is important in bone health, but recent research also points out its essential role in extraskeletal functions, including skeletal muscle growth, immune and cardiopulmonary functions and inflammatory modulation, which influence athletic performance. Vitamin D can also interact with extraskeletal tissues to modulate injury recovery and also influence the risk of infection. The data presented in this paper has triggered investigations in relation to the importance of maintaining adequate levels of vitamin D and to the possible positive influence supplementation has on immune and musculoskeletal functions in athletes, benefiting their performance and preventing future injuries. The objective of this review is to describe the latest research conducted on the epidemiology of vitamin D deficiency and its effects on sports performance and musculoskeletal health.

Which Dose Specification Should Be Used for NRG Radiation Therapy Trials: Dose-to-Medium or Dose-to-Water?

PURPOSE: To compare the doses calculated by the Analytical Anisotropic Algorithm (AAA), Acuros dose-to-medium, and Acuros dose-to-water for the patients with lung cancer treated at our institution and show that further investigation and clarification are needed about what dose specifications should be used for NRG clinical trials. METHODS AND MATERIALS: Twenty-one patients with lung cancer who previously received intensity modulated radiation therapy or volumetric modulated arc therapy-based treatments at our institution were analyzed by recalculating their plans for each one with the AAA algorithm (reviewed and approved by our radiation oncologists) and with both reporting modes of the Acuros algorithm. All plans used the same monitor units as the original approved plan and a 2.5-mm grid size. For each patient, D100 of clinical target volume (CTV) and CTV coverage ratios in each plan were compared, and dose distributions and dose-volume histograms calculated by AAA, Acuros dose-to-water (Dw,m), and Acuros dose-to-medium (Dm,m) were compared as well. RESULTS: Differences between CTV D100 calculated by AAA and Acuros Dm,m were larger than the differences between AAA and Acuros XB Dw,m for all patients. When D100 of CTV was evaluated, the largest difference between AAA and Acuros Dm,m was 14.12% and between AAA and Acuros XB Dw,m was 3.68%. The average differences between the CTV D100 calculated by AAA and Acuros Dm,m was 5.39%. Coverage ratio between Acuros Dm,m and AAA ranges from 51.08% to 100% with an average of 91.32%; coverage ratio between Acuros Dw,m and AAA ranges from 87.2% to 100.41% with average of 98.94%; coverage ratio between Acuros Dm,m and Acuros Dw,m ranges from 58.58% to 100% with an average of 92.03%. CONCLUSIONS: The present study shows large and systematic differences in doses calculated by AAA and Acuros Dm,m. Therefore, further investigation and clarification are needed about which dose reporting mode should be used.

El servicio de farmacia frente a la logística de dispensación, almacenamiento y conservación segura de medicamentos en unidades asistenciales / The pharmacy service facing the logistics of safely dispensing, storing and preserving drugs in healthcare units

Ante la pandemia por SARS-CoV-2, los servicios de farmacia de los hospitales se han adaptado rápidamente para dar respuesta a una situación muy grave caracterizada por el ingreso constante y continuo de pacientes con neumonía que necesitaban tratamiento, siendo necesaria una transformación del hospital para poder aumentar el número de camas de hospitalización y de críticos que se requerían. Asimismo, otros dispositivos extrahospitalarios se han transformado en unidades de hospitalización para absorber el elevado número de pacientes que debían tratarse y aislarse. Para garantizar la distribución de los medicamentos y la calidad de la atención farmacéutica, los sistemas de distribución de fármacos, como la unidosis y los sistemas automatizados de dispensación, han sufrido a su vez transformaciones. Se diseñaron stocks estándar para las plantas COVID, y circuitos de dispensación diferentes para evitar el riesgo de contaminación cruzada entre plan-tas COVID y no-COVID, así como protocolos de desinfección de los sistemas de transporte de medicación y protocolos de gestión de las devoluciones de medicación. Todo esto sin olvidar los cambios en los protocolos de tratamiento de la COVID que se vieron afectados por la disponibilidad de los fármacos. El incremento del número de camas en dispositivos extrahospitalarios, como hospitales de campaña, hoteles, centros sociosanitarios y residencias geriátricas, ha sido un reto para los servicios de farmacia, ya que se han tenido que crear nuevos circuitos de dispensación y de conciliación de la medicación, obligando a reforzar la plantilla del servicio de farmacia y modificar los turnos de trabajo, estableciendo guardias presenciales para poder llevar a cabo todas las nuevas tareas con éxito. La elaboración de planes de contingencia de las diferentes actividades del servicio de farmacia y el establecimiento de canales de comunicación fluidos son elementos clave para situaciones de crisis o emergencias sanitarias como la actual

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have quickly adapted to respond to a critical situation characterized by the constant and continuous admission of patients with severe pneumonia who needed treatment, requiring a transformation of the hospital in order to increase the number of hospital and critical beds. Moreover, other out-of-hospital spaces have been transformed into hospitalization units to absorb the large number of patients that had to be treated and isolated. To guarantee the distribution of medicines and the quality of the pharmaceutical care, drug distribution systems, such as unit dose and automated dispensing systems, have undergone transformations. Standard stocks were assigned for COVID units, and different dispensing circuits to avoid the risk of cross-contamination between COVID and non-COVID units were created, as well as disinfection protocols for medication transport systems and medication return protocols. All this without forgetting COVID treatment protocol’s changes that were affected by the availability of the drugs. The increase in the number of beds in out-of-hospital spaces, such as field hospitals, hotels, socio-medical centers and nursing homes, has challenged Pharmacy Services, since new medication dispensing and conciliation circuits have been created forcing the increase of pharmacy staff’s presence and modifying work shifts, to afford all the new tasks successfully. Development of contingency plans for the different Pharmacy Service activities and providing fluent communication channels are key elements for crisis situations or health emergencies such as the current pandemic

Comparison between different methods for measuring body fat after a weight loss program / Comparação entre diferentes métodos para mensuração da gordura corporal após um programa de perda de peso / Comparación entre diferentes métodos para medición de la grasa corporal después de un programa de pérdida de peso

ABSTRACT Introduction Accurate and sensitive measurement of body composition is an important tool in the diagnosis and control of obesity. Objective To compare body fat changes measured by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfolds (SK) in healthy overweight adults in order to evaluate whether all three methods can be used during a weight loss program (WLP). Methods Eighty-four men (n=36) and women (n=48), body mass index 25-29.9 kg/m2, aged between 18-50 years, non-smokers and sedentary, were randomly assigned to strength, endurance, combined strength plus endurance, or physical activity recommendations groups. All subjects followed a hypocaloric diet (25-30% decrease in energy intake in terms of the total daily energy expenditure). The intervention lasted 22 weeks. Results The highest correlation was obtained between DXA and SK when men and women were studied together (r=0.864, p<0.01). In women, significant differences were found between DXA and BIA in fat percentage (underestimation of BIA 2.4%, p<0.05). The underestimation was more determinant for both fat percentage and fat mass in men, 13.2% versus 10.2%, and 6.8 kg versus 4.2 kg between BIA and SK respectively (p<0.05). All the procedures obtained similar results (p>0.05) when changes in body fat caused by intervention were analyzed. However, considering results of the minimal difference compared to DXA, BIA showed the greatest sensitivity to detect changes in fat percentage and fat mass, while SK underestimated the changes, with a significantly lower percentage considered real (p=0.01). Conclusion The SK method seems to underestimate real changes, therefore DXA and BIA can serve as more effective tools to measure the change in fat percentage and fat mass during WLP. Level of evidence II, Diagnosis.

RESUMO Introdução A mensuração precisa e sensível da composição corporal é uma importante ferramenta para o diagnóstico e controle da obesidade. Objetivo Comparar as alterações da gordura corporal mensuradas através da absorciometria com raios-X de dupla energia (DEXA), análise da impedância bioelétrica (BIA) e dobras cutâneas (DC) em adultos saudáveis com sobrepeso, a fim de avaliar se os três métodos podem ser utilizados durante um programa de perda de peso (PPP). Métodos Oitenta e quatro homens (n=36) e mulheres (n=48) com índice de massa corporal entre 25-29,9 kg/m2, idade entre 18-50 anos, não-fumantes e sedentários foram divididos aleatoriamente em grupos de de força, resistência, combinados de força mais resistência ou com recomendações de atividade física. Todos os indivíduos seguiram uma dieta hipocalórica (25-30% de redução na ingestão energética em relação ao gasto energético total diário). A intervenção durou 22 semanas. Resultados A maior correlação foi obtida entre a DEXA e DC quando homens e mulheres foram estudados juntos (r=0,864, p<0,01). Foram encontradas diferenças significativas entre a DEXA e BIA no percentual de gordura (subestimação da BIA em 2,4%, p<0,05) nas mulheres. A subestimação foi mais determinante tanto para o percentual de gordura quanto para a massa gorda nos homens, 13,2% versus 10,2%, e 6,8 kg versus 4,2 kg entre a BIA e DC, respectivamente (p<0,05). Todos os procedimentos obtiveram resultados similares (p>0,05) quando foram analisadas alterações na gordura corporal ocasionadas pela intervenção. No entanto, considerando os resultados da mínima diferença comparados à DEXA, a BIA apresentou maior sensibilidade para detectar mudanças no percentual de gordura e massa gorda, enquanto a DC subestimou as mudanças, com um percentual significativamente mais baixo considerado real (p=0,01). Conclusão O método de DC parece subestimar as mudanças reais, portanto, a DEXA e BIA podem ser ferramentas mais eficazes para mensurar a alteração no percentual de gordura e a massa gorda durante um PPP. Nível de evidência II, Diagnóstico.

RESUMEN Introducción La medición precisa y sensible de la composición corporal es una herramienta importante para el diagnóstico y control de la obesidad. Objetivo Comparar las alteraciones de la grasa corporal medidas a través de la absorciometría con rayos X de doble energía (DXA), análisis de la impedancia bioeléctrica (BIA) y los pliegues cutáneos (PC) en adultos saludables con sobrepeso, con el fin de evaluar si se pueden utilizar los tres métodos durante un programa de pérdida de peso (PPP). Métodos Ochenta y cuatro hombres y mujeres (varones n=36 y mujeres n=48), con índice de masa corporal entre 25-29,9kg/m2, edad entre 18-50 años, no fumadores y sedentarios fueron divididos aleatoriamente en grupos de fuerza, resistencia, combinados de fuerza más resistencia o con recomendaciones de actividad física. Todos los individuos siguieron una dieta hipocalórica (25-30% de reducción en la ingestión energética con relación al gasto energético total diario). La intervención duró 22 semanas. Resultados La mayor correlación fue obtenida entre DXA y PC cuando hombres y mujeres fueron estudiados conjuntamente (r=0,864, p<0,01). Se encontraron diferencias significativas entre DXA y BIA en el porcentual de grasa (subestimación de la BIA en 2,4%, p<0,05) en las mujeres. La subestimación fue más determinante, tanto para el porcentual de grasa como para la masa grasa en los hombres, 13,2% versus 10,2%, y 6,8 kg versus 4,2 kg entre BIA y PC, respectivamente (p<0,05). Todos los procedimientos obtuvieron resultados similares (p>0,05), cuando se analizaron alteraciones en la grasa corporal causadas por la intervención. Sin embargo, considerando los resultados de la mínima diferencia comparados a DXA, la BIA presentó mayor sensibilidad para detectar cambios en el porcentual de grasa y masa grasa, mientras que la PC subestimó los cambios, con un porcentual significativamente más bajo considerado real (p=0,01). Conclusión El método de PC parece subestimar los cambios reales, por lo tanto, la DXA y la BIA pueden ser herramientas más eficaces para medir la alteración en el porcentual de grasa y masa grasa durante un PPP. Nivel de evidencia II, Diagnóstico.

[MASK (Mobile Airways Sentinel Network), a mobile App with ARIA's comprehensive solution in Spanish-speaking countries]. / MASK (Mobile Airways Sentinel Network), una app móvil con la solución integral de ARIA en países de habla hispana.

Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

Aunque existen guías clínicas de alta calidad sobre rinitis alérgica, numerosos pacientes reciben tratamiento deficiente, en parte debido al alto grado de automedicación. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS; en ella, los pacientes indican diariamente cuánto les molestan los síntomas a través de cinco pantallas con una escala visual análoga; recientemente se agregaron dos pantallas más (afectación del sueño). La aplicación también permite descargar los datos del "Diario de alergias" en la computadora del médico en el momento de la consulta a través de un código QR. En este artículo reseñamos el primer año de experiencia en España, México y Argentina, que utilizan la versión española.

[Executive Summary of ARIA 2019: Integrated care pathways for allergic rhinitis in Argentina, Spain and Mexico]. / Resumen ejecutivo de ARIA 2019: Vías integradas de atención para la rinitis alérgica en Argentina, España y México.

The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.

El impacto sanitario y económico de las enfermedades alérgicas está aumentando rápidamente y se necesitan cambios en las estrategias para su manejo. Su influencia reduce al menos en un tercio la capacidad de desempeño laboral y escolar. Los ICP (Vías Integradas de Atención) de las enfermedades de las vías respiratorias son planes de atención estructurados y multidisciplinarios, que promueven las recomendaciones de las guías en protocolos locales y su aplicación a la práctica clínica. En este documento se presenta un resumen ejecutivo para Argentina, México y España. Se desarrollan las guías ARIA de próxima generación para el tratamiento farmacológico de la rinitis alérgica (RA) utilizando las pautas basadas en GRADE para RA, probadas con evidencia de la vida real proporcionada por tecnología móvil basada en escalas visuales analógicas. Se concluye que en el tratamiento de la RA, los antihistamínicos anti-H1 son menos efectivos que los corticoides intranasales (CINS), que en la rinitis gravelos CINS representan la primera línea de tratamiento, y que la combinación intranasal de CINS + anti-H1 es más eficaz que la monoterapia. Sin embargo, según el estudio MASK observacional en vida real, los pacientes tienen pobre adherencia al tratamiento y frecuentemente se automedican de acuerdo con sus necesidades.

Vitamin D: And its role in breast cancer.

Vitamin D is a fat soluble vitamin that plays a role in calcium and phosphorus homeostasis. Recently, extensive research on its extraskeletal actions has linked vitamin D deficiency to an increased risk of infection, diabetes mellitus types 1 and 2, cardiovascular disease, obesity, asthma, inflammatory bowel disease, colon, breast, prostate and ovarian cancer and some neurological diseases. There are various mechanisms by which vitamin D influences the natural history of cancer. These include the role of vitamin D in the induction of apoptosis, stimulation of cell differentiation, anti-inflammatory and antiproliferative effects and inhibition of angiogenesis, invasion and metastasis. The aim of this review is to clarify the true role of vitamin D in the onset of breast cancer and evolution of the disease after treatment. A further aim is to suggest new research directions to identify indications and requirements for vitamin D supplementation in patients with breast cancer.

Body Composition, Dietary, and Gustatory Function Assessment in People With Alzheimer's Disease.

OBJECTIVES: Observe the association of foods habits, body composition, lifestyle habits, and loss of gustatory function with Alzheimer's disease (AD). METHODS: This comparative study enrolled 75 patients with AD (mean age 77.5 years) and 267 healthy volunteers (mean age 73 years). Weight, height, body mass index (BMI), body fat, visceral fat, muscle mass, and waist circumference were measured. Adherence to the Mediterranean diet was measured by the Mediterranean-Diet-Adherence Screener. Gustatory function was investigated using a threshold and triangle test. RESULTS: Cases with AD presented lower BMI and weight and higher sleep hours, being statistically significant the difference between cases and controls ( P = .02; P = .001; P = .001, respectively). Patients with AD showed lower adherence to exercise and Mediterranean diet as shown by the Mediterranean Diet Adherence Screener-score (8.12 ± 2.5 vs 8.65 ± 2.4). The gustatory function was impaired in patients with AD when compared to controls. CONCLUSION: Patients with AD show worst outcomes in terms of anthropometric measurements, lifestyle habits (diet, exercise), and gustatory function than controls.

Genomic Influence in the Prevention of Cardiovascular Diseases with a Sterol-Based Treatment.

Raised serum cholesterol concentration is a well-established risk factor in cardiovascular disease. In addition, genetic load may have an indirect influence on cardiovascular risk. Plant-based sterol-supplemented foods are recommended to help reduce the serum low-density lipoprotein cholesterol level. The objective was to analyse the influence of different polymorphisms in hypercholesterolemia patients following a dietary treatment with plant sterols. A randomised double-blind cross-over controlled clinical trial was carried out in 45 people (25 women). Commercial milk, containing 2.24 g of sterols, was ingested daily during a 3-week period, and then the same amount of skim milk, without sterols, was consumed daily during the 3-week placebo phase. Both phases were separated by a washout period of 2 weeks. At the beginning and end of each phase, blood draws were performed. Genes LIPC C-514T and APOA5 C56G are Ser19Trp carriers and greatly benefit from sterol intake in the diet. LIPC C-514T TT homozygous carriers had lower low-density lipoprotein cholesterol (LDL-c) levels than CC homozygote and CT heterozygote carriers after the ingestion of plant sterols (p = 0.001). These two genes also showed statistically significant changes in total cholesterol levels (p = 0.025; p = 0.005), and no significant changes in high-density lipoprotein (HDL) cholesterol levels (p = 0.032; p = 0.003), respectively. No statistically significant differences were observed for other genes. Further studies are needed to establish which genotype combinations would be the most protective against hypercholesterolemia.

New horizons in anticoagulation: Direct oral anticoagulants and their implications in oral surgery

Background: Thrombotic disorders remain a leading cause of death in the Western World. For decades, vitamin K antagonists used in the prevention of this pathology, such as warfarin or sintrom, were the only oral agents available for long-term anticoagulation, in spite of their disadvantages. Material and Methods: An electronic database search was carried out on MedLine and The Cochrane Library Plus, without restrictions on the type of study nor dates, in English and Spanish. Abstracts were reviewed, and complete articles if necessary, considering all articles that included recommendations on DOACs and oral surgery. Results: In recent years, the so-called "new oral anticoagulants" have been introduced in clinical practice to treat those patients whose medical conditions require long-term anticoagulant treatment, replacing traditional oral anticoagulants. Conclusions: The new oral anticoagulants represent new therapeutic options, with a number of advantages such as poor interaction with food, minor drug interactions, and do not require periodic dose adjustments or routine controls. The purpose of this review is to establish an update on the new oral anticoagulants: Dabigatran, Rivarozaban, Apixaban and Edoxaban (AU)

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Migration and nutritional status of Tarahumara schoolchildren from Chihuahua State (México).

OBJECTIVE: The Tarahumara ethnic group is composed of indigenous people from the Sierra Madre Occidental of Mexico. Conditions of isolation and poverty compel them to migrate to the city in search of better opportunities. This work aims to explore the influence of migration on the growth and nutritional status of Tarahumara schoolchildren. METHODS: One hundred Tarahumara students were analyzed (50 rural with a mean age of 9.78 ± 1.25 years; 50 urban aged 10.0 ± 1.04 years), comparing anthropometric indicators and body composition (T-Student, U-Mann-Whitney Tests). RESULTS: Twenty percent of rural girls and 35% of rural boys showed stunted growth compared to only 9% of the urban girls (no stunted growth among urban boys). Migrants showed greater body size, skinfold thickness, and fat percentage. Weight excess, understood as an increase in the prevalence of overweight and obesity, was detected in 17.8% of urban boys and 13.6% of urban girls compared to 10.0% of boys and 3.3% of girls of the rural series. CONCLUSION: Migration reduces stunting and increases adiposity.