Sensibilidad al gluten no celiaca: etiología, diagnóstico diferencial y presentación clínica / Non-celiac gluten sensitivity: Clinical presentation, etiology and differential diagnosis

La sensibilidad al gluten no celiaca (SGNC) es la última enfermedad incorporada al grupo de trastornos relacionados con el gluten. Esta revisión aborda la evidencia sobre su etiología, diagnóstico diferencial y sintomatología. Aunque la SGNC se define por una reacción al gluten, se han descrito otros posibles mecanismos etiopatogénicos, como una respuesta inadecuada a otros componentes del trigo o a los FODMAP, extendiéndose últimamente el término sensibilidad al trigo no celiaca. Existen resultados contradictorios sobre la validez del protocolo diagnóstico de los expertos de Salerno. La evidencia sobre biomarcadores diagnóstico para la SGNC escasea, aunque algunos estudios señalan los siguientes: anticuerpos antigliadina, zonulina, prueba ALCAT, micro-ARN, incARN y ciertas citoquinas. En la SGNC, el dolor abdominal y la fatiga son los síntomas más comunes. Además, es frecuente la alteración del estado nutricional. En conclusión, se necesita más investigación sobre la SGNC para mejorar nuestro conocimiento de su etiopatogenia y clínica.(AU)

Non-celiac gluten sensitivity (NCGS) is the latest pathology incorporated into the group of gluten-related disorders. This review addresses the evidence on its etiology, differential diagnosis and symptomatology. Although NCGS is defined by a reaction to gluten, other possible etiopathogenic mechanisms have been described, such as an inadequate response to other components of wheat or to FODMAPs, with the term non-celiac sensitivity to wheat recently being extended. There are contradictory results on the validity of the diagnostic protocol of the Salerno experts. Evidence on diagnostic biomarkers for NCGS is scarce, although some studies indicate the following: antigliadin antibodies, zonulin, ALCAT test, micro-RNA, incRNA and certain cytokines. In NCGS, abdominal pain and fatigue are the most common symptoms. In addition, altered nutritional status is common. In conclusion, more research on NCGS is needed to improve understanding of its etiopathogenesis and clinical features.(AU)

Non-celiac gluten sensitivity: Clinical presentation, etiology and differential diagnosis. / Sensibilidad al gluten no celiaca: etiología, diagnóstico diferencial y presentación clínica.

Non-celiac gluten sensitivity (NCGS) is the latest pathology incorporated into the group of gluten-related disorders. This review addresses the evidence on its etiology, differential diagnosis and symptomatology. Although NCGS is defined by a reaction to gluten, other possible etiopathogenic mechanisms have been described, such as an inadequate response to other components of wheat or to FODMAPs, with the term non-celiac sensitivity to wheat recently being extended. There are contradictory results on the validity of the diagnostic protocol of the Salerno experts. Evidence on diagnostic biomarkers for NCGS is scarce, although some studies indicate the following: antigliadin antibodies, zonulin, ALCAT test, micro-RNA, incRNA and certain cytokines. In NCGS, abdominal pain and fatigue are the most common symptoms. In addition, altered nutritional status is common. In conclusion, more research on NCGS is needed to improve understanding of its etiopathogenesis and clinical features.

Frequency of potentially inappropriate prescriptions in older people at discharge according to Beers and STOPP criteria.

BACKGROUND: Potentially inappropriate prescriptions (PIP) are frequent, generate negative outcomes, and are to a great extent avoidable. Although there is general agreement about the definition of PIP, how to measure them is a matter of debate. OBJECTIVE: Our aim was to measure the frequency of PIP in older people at hospital discharge using two sets of criteria--Beers (2012 update) and STOPP. SETTING: A university hospital in southern Spain. METHOD: This cross sectional study involved a random sample of patients 65 years or more discharged from the University Hospital San Cecilio (Granada, Spain), from July 1, 2011 to June 30, 2012. Age, gender, length of hospital stay, type of hospital service, drugs prescribed and pathologies were obtained from discharge reports. MAIN OUTCOME MEASURE: The main outcome measures were: (1) the prevalence of PIP according to each set of criteria (Beers and STOPP) and its 95 % confidence interval, globally and stratified for different categories of the study variables; (2) the degree of agreement between the two criteria using Kappa statistics; and (3) the drugs most commonly involved in PIP according to both criteria. RESULTS: There were 624 patients (median age 78) included in our study. According to Beers criteria, 22.9 % (19.6-26.2 %) of the patients had at least one PIP. This figure was 38.4 % (34.6-42.2 %) for STOPP criteria. Just 13.6 % of the patients had prescriptions simultaneously inappropriate for both criteria. Higher PIP frequency was observed in patients discharged from internal medicine. PIP increased with the Charlson Index and with the number of drugs prescribed, but not with gender, age or length of hospital stay. CONCLUSION: A very high frequency of PIP at discharge was observed. By intervening in five drug groups, about 80 % of PIP might be avoided according to either of the two criteria.

Incidência dos hábitos de atividade física nos níveis plasmáticos de proteínas de estresse térmico numa amostra de população saudável / Incidence of physical activity habits in plasma levels of heat shock proteins in a healthy population sample

INTRODUÇÃO E OBJETIVO: A relação entre as proteínas de choque térmico (Hsp) e hábitos de atividade física não foram estudadas em profundidade, o que levanta a questão sobre o papel destas proteínas desempenham na saúde das pessoas. Com base nessa incerteza, este estudo visa determinar se os níveis plasmáticos dessas proteínas são modificados de acordo com os hábitos de atividade física. MÉTODOS: Amostras de sangue foram coletadas para estudar a concentração de Hsp, através do teste de ELISA e aplicação do Questionário Internacional de Atividade Física (IPAQ) para determinar hábitos de atividade física. A análise estatística comparou a média de Hsp (variáveis ​​categóricas), utilizando-se ANOVA, a correlação (Spearman) foi estudada para variáveis ​​contínuas e um modelo de regressão linear múltipla foi desenvolvido para determinar o efeito de cada uma das variáveis ​​independentes sobre as concentrações de Hsp. RESULTADOS: Para esta amostra, não foram encontradas diferenças estatisticamente significativas nas concentrações de Hsp entre sedentários e ativos, no entanto, observou-se como sujeitos tornam-se mais ativos se reduzem as concentrações Hsp. Não foi demonstrada correlação entre gasto de energia e os níveis de Hsp. Na população masculina foram encontradas diferenças significativas entre os níveis de Hsp e hábitos de atividade física (medido em três categorias). CONCLUSÃO: Mais pesquisas são propostas, pois o estudo sugere que a prática de atividade física regular atua como um fator protetor para a saúde, reduzindo a presença dessas proteínas no sangue.

INTRODUCTION AND OBJECTIVE: The relationship between heat shock proteins (Hsp) and physical activity habits has not been studied in depth, which raises the question about the role these proteins play in health. Based on this uncertainty, this study aims to determine whether plasma levels of these proteins are modified according to the physical activity habits. METHOD: Twenty-four blood samples were taken to study the Hsp concentration, by ELISA test, and the International Physical Activity Questionnaire (IPAQ) was applied to determine physical activity habits. In the statistical analysis, were compared the Hsp average (categorical variables), using ANOVA, the correlation (Spearman) was studied for the continuous variable, also a multiple linear regression was developed in order to establish the effect of each one of the independent variables on the Hsp concentrations. RESULTS: For the studied sample, not statistically differences were found in the concentrations of Hsp, between active and sedentary subjects; however it was noticed that as individuals become more active, the levels of Hsp are reduced. The correlation between energy expense and concentration of Hsp was not found. In the male population, significant differences between the concentration of Hsp and physical activity habits were found (measured in three categories). CONCLUSION: We propose to keep investigating, because in fact the study suggests that the regular practice of physical activity acts as protective factor, reducing the levels of these kinds of proteins in the blood.

Prevalence of hepatitis A virus in bivalve molluscs sold in Granada (Spain) fish markets.

Viruses are the leading cause of foodborne illness associated with the consumption of raw or slightly cooked contaminated shellfish. The aim of this study was to evaluate the prevalence of hepatitis A virus in molluscs. Standard and real-time reverse transcription-polymerase chain reaction procedures were used to monitor bivalve molluscs from the Granada fish markets (southern Spain) for this human enteric virus. Between February 2009 and October 2010, we collected a total of 329 samples of different types of bivalve molluscs (mussels, smooth clams, striped venus, and grooved clams). The results showed the presence of hepatitis A virus in 8.5% of the 329 samples analyzed. We can therefore confirm that conventional fecal indicators are unreliable for demonstrating the presence or absence of viruses. The presence of hepatitis A virus in molluscs destined for human consumption is a potential health risk in southern Spain.

The association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles involved in traffic crashes in Spain.

BACKGROUND: This study was designed to separate the association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles (TWMV) involved in crashes into its two theoretical components: severity of the crash and occupant resilience. METHODS: We analyzed the retrospective cohort comprising all 48 016 pairs of drivers and passengers aged 14 years or more in TWMV involved in crashes with victims in Spain from 1993 to 2007 recorded in the Spanish traffic crash registry. The outcome (death or survival), age, sex and helmet use was known for both occupants. Adjusted relative risks (RR) for the association of age, sex and helmet with the risk of death were calculated with Poisson regression models. RESULTS: Each 1-year increase in age was related with a 3% increase in the risk of death related with lower resilience. The severity-dependent RR of death was 1.84 for male sex and 0.86 for non-helmet use, and the resilience-dependent RR was 0.72 and 2.53, respectively. CONCLUSIONS: The direction and magnitude of the association between age, sex and helmet use and the risk of death of an occupant of a TWMV involved in a crash changed depending on which component of risk was considered: crash severity or occupant resilience. Specifically, female sex and non-helmet use seemed to be associated with crashes of lower severity, but together with increased age they were also related with lower resilience to the energy released in the crash, and therefore with a higher risk of death after adjustment for crash severity. This should be taken into account when assessing the association of individual factors with the risk of death after a crash.

Association of age, sex and seat belt use with the risk of early death in drivers of passenger cars involved in traffic crashes.

BACKGROUND: This study was designed to break down the association of age, sex and seat belt use with risk of death for drivers of automobiles involved in a crash into two theoretical components: intrinsic severity of the crash and occupant resilience. METHODS: We studied all 84,338 pairs of drivers and front-seat passengers aged > or = 18 years in passenger cars involved in traffic crashes with victims recorded in the Spanish traffic crash registry between 2000 and 2004. Relative risks (RR) for the association of age, male sex and non-seat belt use with risk of death were calculated with Poisson conditional and unconditional multiple regression models. RESULTS: For drivers, the risk of death associated with severity of the crash was slightly higher in men (RR = 1.18), and decreased with age (RR = 0.993 per year). However, resilience-dependent risk of death increased with age (RR = 1.028 per year), and especially among unbelted occupants (RR = 4.02). CONCLUSIONS: We conclude that in drivers involved in traffic crashes the association of age, sex and seat belt use with risk of death depends on the component of risk considered: severity of the crash or the occupant's resilience to energy.

Bactericidal activity of phosphoric acid, citric acid, and EDTA solutions against Enterococcus faecalis.

OBJECTIVES: The objectives of this study were to evaluate the minimal bactericidal concentration (MBC) for Enterococcus faecalis of phosphoric acid, citric acid, and ethylenediaminetetraacetic acid (EDTA) solutions, and to determine the contact time required for 2.5% and 5% phosphoric acid, 10% and 25% citric acid, and 17% EDTA to exert bactericidal activity. STUDY DESIGN: Bactericidal activity was tested by means of the dilution neutralization method in accordance with BS-EN-1040:2005 norm, using contact times of 0.5 to 60 minutes. RESULTS: The MBCs of citric and phosphoric acid were 20% and 2.5%, respectively. EDTA solution lacks bactericidal activity, even after 60 minutes of contact. The 2.5% and 5% phosphoric acid solutions required 5- and 3-minute contact times, and the 10% and 25% citric acid solutions required 10- and 3-minute contact times, respectively. CONCLUSIONS: Phosphoric acid revealed bactericidal activity against E. faecalis and required less time than citric acid to exert its activity.

[Effect of environmental factors on the risk of death for drivers of two-wheeled motorized vehicles involved in road crashes]. / Efecto de las circunstancias ambientales sobre el riesgo de defunción de los conductores de vehículos de dos ruedas de motor implicados en accidentes de tráfico.

OBJECTIVES: To assess the effect of environmental factors on the risk of death for drivers of two-wheeled motorized vehicles (TWMV) after a crash. METHODS: We studied a case series comprising all 309,626 drivers of TWMV involved in road crashes with victims compiled by the Spanish Department of Transportation from 1993 to 2002. The dependent variable was death of the driver. Environmental factors included temporal variables (year, month, day and hour of the crash) and spatial variables (area where the accident took place and light conditions, among others). Confounding variables related to the driver (age, sex, helmet use), the vehicle, and the type of crash were also recorded. Poisson regression models were constructed to obtain crude and adjusted relative risks for each environmental condition. RESULTS: In the adjusted analysis, no association was found between most time-related factors and the risk of death, with the exception of an increased risk in the early hours of the morning. The risk of death was much greater for crashes on open roads (especially highways and motorways) than in urban areas, where the risk of death increased as the size of the town decreased. CONCLUSIONS: After adjustment for several confounders, the only environmental factors related to the risk of death in TWMV drivers after a crash were the area when the crash occurred, and (more weakly) the time of day when it occurred.

Efecto de las circunstancias ambientales sobre el riesgo de defunción de los conductores de vehículos de dos ruedas de motor implicados en accidentes de tráfico / Effect of environmental factors on the risk of death for drivers of two-wheeled motorized vehicles involved in road crashes

Objetivos: Valorar el efecto de las circunstancias ambientales sobre el riesgo de muerte de los conductores de vehículos de dos ruedas de motor (VDRM) tras un accidente de tráfico. Métodos: Se ha estudiado la serie de casos formada por los 309.626 conductores de VDRM implicados en accidentes de tráfico con víctimas en España, entre 1993 y 2002, recogidos por la Dirección General de Tráfico. La variable dependiente ha sido la defunción del conductor. Como variables ambientales se han considerado factores temporales (año, mes, día y hora) y espaciales (zona del accidente, iluminación, entre otros). También se han recogido potenciales factores de confusión dependientes del conductor (edad, sexo, uso de casco), del vehículo y el tipo de accidente. Se han obtenido, mediante modelos de regresión de Poisson, riesgos relativos crudos y ajustados para cada categoría ambiental. Resultados: Para la mayoría de las variables temporales, no hay asociación con el riesgo de defunción en el análisis ajustado, a excepción de un mayor riesgo para la conducción de madrugada. El riesgo aumenta fuertemente en carretera (especialmente autopistas y autovías) con respecto a las zonas urbanas, para las que hay una clara relación dosis-respuesta entre un menor tamaño del municipio y una mayor letalidad. Conclusiones: Tras ajustar por los factores de riesgo dependientes del conductor, el efecto de los factores ambientales sobre el riesgo de muerte del conductor de un VDRM tras el accidente se circunscribe a la zona donde se produce el accidente y, en menor medida, a la hora en que ocurre

Objectives: To assess the effect of environmental factors on the risk of death for drivers of two-wheeled motorized vehicles (TWMV) after a crash. Methods: We studied a case series comprising all 309,626 drivers of TWMV involved in road crashes with victims compiled by the Spanish Department of Transportation from 1993 to 2002. The dependent variable was death of the driver. Environmental factors included temporal variables (year, month, day and hour of the crash) and spatial variables (area where the accident took place and light conditions, among others). Confounding variables related to the driver (age, sex, helmet use), the vehicle, and the type of crash were also recorded. Poisson regression models were constructed to obtain crude and adjusted relative risks for each environmental condition. Results: In the adjusted analysis, no association was found between most time-related factors and the risk of death, with the exception of an increased risk in the early hours of the morning. The risk of death was much greater for crashes on open roads (especially highways and motorways) than in urban areas, where the risk of death increased as the size of the town decreased. Conclusions: After adjustment for several confounders, the only environmental factors related to the risk of death in TWMV drivers after a crash were the area when the crash occurred, and (more weakly) the time of day when it occurred