Sustainable Biocatalytic Procedure for Obtaining New Branched Acid Esters.

Biocatalytic synthesis of 2-ethylhexyl 2-methylhexanoate is described in this work for the first time. This branched-chain ester is suitable for use at low temperatures in numerous applications. The immobilized lipase Novozym® 435 has demonstrated its ability to catalyze the ester synthesis from 2-ethylhexanol and 2-methylhexanoic acid in a solvent-free medium. The high reaction times that are required result in a loss of alcohol by evaporation, which must be compensated for with an excess of this substrate if high conversions are to be achieved. Therefore, two strategies are established: 70 °C with a 10% excess of alcohol, which requires a longer operating time and provides conversions of 97%, and 80 °C with a 20% excess of alcohol, which allows for the achievement of a 99% conversion in a shorter time. The optimal reaction conditions have been chosen based on reusability of the enzyme, process productivity, green metrics and preliminary economic study. When the synthesis is carried out under the best conditions (70 °C, 10% molar excess of alcohol and six uses of the immobilized enzyme) a productivity of 203.84 kg product × kg biocatalyst-1 is attained. The biocatalytic procedure matches many of the objectives of "green chemistry" and is suitable to be scaled up and used in industrial manufacturing.

NADPH Oxidase 5 and Melatonin: Involvement in Ram Sperm Capacitation.

Reactive oxygen species (ROS) play an essential role in mammalian sperm capacitation. NADPH oxidase 5 (NOX5) has been described as the main source of ROS production in some mammalian spermatozoa, such as human and equine. On the other hand, melatonin can decrease cellular ROS levels and regulates NOX activity in somatic cells. Therefore, the objectives of this work were (1) to identify NOX5 in ram spermatozoa and analyze its possible changes during in vitro capacitation and (2) to investigate the effect of melatonin on NOX5 expression and localization and on superoxide levels in capacitated ram spermatozoa. Protein bands associated with NOX5 were detected by Western blot analysis. Likewise, indirect immunofluorescence (IIF) revealed six different immunotypes for NOX5, which varied throughout in vitro capacitation. Superoxide (O2 ⋅-), evaluated by DHE/Yo-Pro-1, rose after in vitro capacitation and in the presence of the calcium ionophore A23187 but decreased in the presence of the NOX inhibitor GKT136901. GKT also reduced the percentage of capacitated and acrosome-reacted spermatozoa that had increased during incubation in capacitating conditions. The presence of melatonin at micromolar concentrations avoided the increment in O2 ⋅- and the changes in NOX5 immunotypes provoked by capacitation. In conclusion, NOX5 is present in ram spermatozoa and the changes in its distribution, associated with sperm capacitation, can be prevented by melatonin. To this extent, it could imply that melatonin exerts its antioxidant role, at least in part, by modulating NOX5 activity during ram sperm capacitation.

Anomalías congénitas cardíacas en la Comunitat Valenciana 2007-2014, el registro poblacional de anomalías congénitas / Congenital heart defects in the Valencian Community 2007-2014: The Population-Based Registry Of Congenital Anomalies

Introducción: Las anomalías congénitas cardíacas (ACC) son el tipo de anomalías congénitas (AC) mayores de más prevalencia y gravedad. El objetivo fue determinar la frecuencia y distribución de las ACC en la Comunitat Valenciana desde 2007 hasta 2014, describiendo las características comunes de los pacientes y sus madres. Material y Métodos: Se seleccionaron del Registro poblacional de AC de la Comunitat Valenciana los pacientes con ACC nacidos vivos, nacidos muertos e interrupciones voluntarias del embarazo entre 2007-2014 (códigos Q20-Q26 de la Clasificación Internacional de Enfermedades 10.ª Revisión, Asociación Pediátrica Británica). Se calculó la prevalencia por 10.000 nacidos para el total de ACC y sus subtipos, se describió su evolución temporal y distribución geográfica, y se identificaron las malformaciones no cardíacas asociadas. Resultados: Se identificaron 3.671 pacientes con ACC representando el 38,6% de las AC. La prevalencia fue 91,1/10.000 (IC95%:88,1-94,0) destacando especialmente la comunicación interauricular (48,5/10.000 [IC95%:46,4-50,6]) y la comunicación interventricular (36,1/10.000 (IC95%: 34,3-38,0)). La provincia de Castellón obtuvo la prevalencia más alta (137,8/10.000 [IC95%:127,5-148,1]). El sexo de los pacientes fue 47,3% niños y 44,3% niñas. El 90,9% de los pacientes nacieron vivos y el 65,6% fueron diagnosticados al nacimiento. Las malformaciones asociadas a las ACC más frecuentes fueron las musculoesqueléticas y el 19,2% tenían síndromes asociados. La diabetes mellitus, hipotiroidismo e infecciones del tracto urinario fueron las principales patologías maternas. Conclusiones: Las prevalencias de ACC y comunicación interauricular identificadas son superiores a las europeas, mientras que la de la comunicación interventricular es similar. Las malformaciones musculoesqueléticas fueron las AC no cardiacas más relacionadas con las ACC

Introduction: Congenital heart defects (CHDs) are the most prevalent and severe type of major congenital anomalies (CAs). The objective of this study was to determine the frequency and distribution of CHDs in the Valencian Region from 2007 to 2014, describing common characteristics of the patients and their mothers. Material and Methods: We retrieved data on CHDs in live births, stillbirths and cases of termination of pregnancy for fetal anomaly between 2007 and 2014 (codes Q20-Q26 in the 10th Revision of the International Classification of Diseases-British Paediatric Association, ICD10-BPA) from the population-based Registry of congenital anomalies of the Valencian Region. We calculated the prevalence per every 10,000 births of CHDs overall and by subtype, analysed temporal trends and the geographic distribution of cases, and documented the presence of associated noncardiac malformations. Results: We identified 3,671 cases of CHD, corresponding to 38.6% of all CAs. The prevalence was 91.1/10,000 (IC 95%: 88.1-94.0) with a predominance of septal defects, chiefly atrial septal defect (48.5/10,000; IC 95%: 46.4-50.6) and ventricular septal defect (36.1/10,000; IC 95%: 34.3-38.0). We found the highest prevalence in the province of Castellon (137.8/10,000; IC 95%: 127.5-148.1). The sex distribution was 47.3% male and 44.3% female. Of all cases, 90.9% corresponded to live births and 65.6% were diagnosed at birth. The most frequent associated extracardiac malformations were musculoskeletal, and 19.2% of patients had syndromes. The most frequent maternal diseases were diabetes mellitus, hypothyroidism and urinary tract infections. Conclusions: The prevalence of CHD and atrial septal defects was higher compared to European data, while the prevalence of ventricular septal defects was similar. Musculoskeletal malformations were the noncardiac CAs most frequently associated with CHDs

[Congenital heart defects in the Valencian Community 2007-2014: The Population-Based Registry Of Congenital Anomalies]. / Anomalías congénitas cardíacas en la Comunitat Valenciana 2007-2014, el registro poblacional de anomalías congénitas.

INTRODUCTION: Congenital heart defects (CHDs) are the most prevalent and severe type of major congenital anomalies (CAs). The objective of this study was to determine the frequency and distribution of CHDs in the Valencian Region from 2007 to 2014, describing common characteristics of the patients and their mothers. MATERIAL AND METHODS: We retrieved data on CHDs in live births, stillbirths and cases of termination of pregnancy for fetal anomaly between 2007 and 2014 (codes Q20-Q26 in the 10th Revision of the International Classification of Diseases-British Paediatric Association, ICD10-BPA) from the population-based Registry of congenital anomalies of the Valencian Region. We calculated the prevalence per every 10,000 births of CHDs overall and by subtype, analysed temporal trends and the geographic distribution of cases, and documented the presence of associated noncardiac malformations. RESULTS: We identified 3,671 cases of CHD, corresponding to 38.6% of all CAs. The prevalence was 91.1/10,000 (IC 95%: 88.1-94.0) with a predominance of septal defects, chiefly atrial septal defect (48.5/10,000; IC 95%: 46.4-50.6) and ventricular septal defect (36.1/10,000; IC 95%: 34.3-38.0). We found the highest prevalence in the province of Castellon (137.8/10,000; IC 95%: 127.5-148.1). The sex distribution was 47.3% male and 44.3% female. Of all cases, 90.9% corresponded to live births and 65.6% were diagnosed at birth. The most frequent associated extracardiac malformations were musculoskeletal, and 19.2% of patients had syndromes. The most frequent maternal diseases were diabetes mellitus, hypothyroidism and urinary tract infections. CONCLUSIONS: The prevalence of CHD and atrial septal defects was higher compared to European data, while the prevalence of ventricular septal defects was similar. Musculoskeletal malformations were the noncardiac CAs most frequently associated with CHDs.

OpenCASA: A new open-source and scalable tool for sperm quality analysis.

In the field of assisted reproductive techniques (ART), computer-assisted sperm analysis (CASA) systems have proved their utility and potential for assessing sperm quality, improving the prediction of the fertility potential of a seminal dose. Although most laboratories and scientific centers use commercial systems, in the recent years certain free and open-source alternatives have emerged that can reduce the costs that research groups have to face. However, these open-source alternatives cannot analyze sperm kinetic responses to different stimuli, such as chemotaxis, thermotaxis or rheotaxis. In addition, the programs released to date have not usually been designed to encourage the scalability and the continuity of software development. We have developed an open-source CASA software, called OpenCASA, which allows users to study three classical sperm quality parameters: motility, morphometry and membrane integrity (viability) and offers the possibility of analyzing the guided movement response of spermatozoa to different stimuli (useful for chemotaxis, thermotaxis or rheotaxis studies) or different motile cells such as bacteria, using a single software. This software has been released in a Version Control System at Github. This platform will allow researchers not only to download the software but also to be involved in and contribute to further developments. Additionally, a Google group has been created to allow the research community to interact and discuss OpenCASA. For validation of the OpenCASA software, we analysed different simulated sperm populations (for chemotaxis module) and evaluated 36 ejaculates obtained from 12 fertile rams using other sperm analysis systems (for motility, membrane integrity and morphology modules). The results were compared with those obtained by Open-CASA using the Pearson's correlation and Bland-Altman tests, obtaining a high level of correlation in all parameters and a good agreement between the different used methods and the OpenCASA. With this work, we propose an open-source project oriented to the development of a new software application for sperm quality analysis. This proposed software will use a minimally centralized infrastructure to allow the continued development of its modules by the research community.

Melatonin reduces cAMP-stimulated capacitation of ram spermatozoa.

The presence of melatonin receptors on the surface of ram spermatozoa has led to speculation about melatonin having a role in sperm functionality. The aim of this study was to elucidate the mechanism through which melatonin regulates ram sperm capacitation induced by a cocktail containing cAMP-elevating agents. Cocktail samples capacitated in the presence of 1µM melatonin showed lower percentages of capacitated spermatozoa (chlortetracycline staining; P<0.001) together with a decrease in protein tyrosine phosphorylation (P<0.01) and lower levels of reactive oxygen species (ROS) and cAMP (P<0.05) compared with cocktail samples without the hormone. Determination of kinematic parameters, together with principal component and cluster analyses, allowed us to define four sperm subpopulations (SP). After 3h of incubation with cAMP-elevating agents, the percentages of spermatozoa belonging to SP1 (high straightness) and SP4 (less-vigorous spermatozoa with non-linear motility) increased while SP2 and SP3 (rapid spermatozoa starting hyperactivation or already hyperactivated) decreased compared with the control sample. The presence of melatonin at 100 pM and 10nM restored these subpopulations to values closer to those found in the control sample. These results indicate that melatonin at micromolar concentrations modulates ram sperm capacitation induced by cAMP-elevating agents, reducing ROS and cAMP levels, whereas at lower concentrations melatonin modifies motile sperm subpopulations. These findings warrant further studies on the potential use of melatonin for controlling capacitation in artificial insemination procedures.

[Epidemiology of Imperfect Osteogenesis: a Rare Disease in the Valencia Region.] / Epidemiología de la Osteogénesis Imperfecta: una enfermedad rara en la Comnitat Valenciana.

OBJECTIVE: Osteogenesis imperfecta (OI) is a rare connective tissue and bone disease that results in a bone fragility of varying severity. The objective was to determine and describe the OI in the Valencia Region (VR) during the period 2004 to 2014. METHODS: From the Rare Diseases Information System of the VR (SIER-CV) patients from 2004 to 2014 with the codes of the International Classification of Diseases for the OI were identified: 756.51 from the 9th Revision-Clinical Modification and Q78.0 from the 10th Revision. The information was validated by reviewing clinical documentation (mainly electronic health records) and a descriptive analysis of the confirmed cases (diagnosis of OI in the clinical documentation) was performed. RESULTS: 162 patients were identified with a code for OI. 145 of the 161 patients with available clinical documentation were confirmed as cases. The prevalence was 0.29 per 10.000 inhabitants. 93.1% were Spanish, 54.5% were women and they were treated in 25 different hospitals in the VR. The type of OI was known in the 26.4% of the cases and type I was the most common (9.7%). 6.2% of the patients died with an average death age of 60.8 years. 44.8% of patients received treatment with bisphosphonates and 10.4% had affected relatives. CONCLUSIONS: The real situation of the OI in the VR has been established, which will allow a better planning in the health actions to improve the quality of life of the affected ones and their families.

OBJETIVO: La Osteogénesis Imperfecta (OI) es una enfermedad rara del tejido conectivo y óseo que resulta en una fragilidad ósea de diversa severidad. El objetivo fue determinar y describir la situación de la OI en la Comunitat Valenciana (CV) durante el periodo 2004-2014. METODOS: A partir del Sistema de Información de Enfermedades Raras de la CV (SIER-CV) se identificaron los pacientes con los códigos de la Clasificación Internacional de Enfermedades pertenecientes a la OI: el 756.51 de la 9ª y/o el Q78.0 de la 10ª revisión, durante el período 2004-2014. Se validaron los datos mediante la revisión de documentación clínica (historia clínica electrónica principalmente) y de los casos confirmados (diagnóstico de OI presente en la documentación clínica) se elaboró un análisis descriptivo. RESULTADOS: Se identificaron 162 pacientes con código de OI. Se confirmaron 145 casos de los 161 con la documentación clínica accesible. La prevalencia fue de 0,29 por 10.000 habitantes. El 93,1% eran españoles, el 54,5% mujeres y fueron atendidos en 25 hospitales diferentes de la CV. Se identificó el tipo de OI en el 24,8% de los casos, siendo el tipo I el más habitual (9,7%). Fallecieron el 6,2% con una edad media al fallecimiento de 60,8 años. El 44,8% de pacientes recibió tratamiento con bifosfonatos y el 10,4% tenían familiares afectados. CONCLUSIONES: Se ha establecido la situación real de la OI en la CV, lo que permitirá una mejor planificación en las acciones sanitarias para mejorar la calidad de vida de los afectados y sus familiares.

Consumo de medicamentos en el embarazo y riesgo de anomalías congénitas en la Comunitat Valenciana / Drugs use in pregnancy in the Valencia Region and the risk of congenital anomalies

Antecedentes: El consumo de medicamentos durante el embarazo se ha incrementado en las últimas décadas. Objetivo: Identificar el riesgo de anomalías congénitas (AC) asociado a la utilización de medicamentos en atención ambulatoria en embarazadas residentes en la Comunitat Valenciana. Métodos: Estudio de casos-controles, considerando caso a menores de un año nacidos vivos en 2009-2010 diagnosticados de AC y residentes en la Comunitat Valenciana, obtenidos del registro poblacional de AC. Los controles se seleccionaron del Registro de Metabolopatías y la medicación prescrita y dispensada se obtuvo del módulo Gestión Integral de Prestación Farmacéutica. Se calcularon las odds ratio (OR) y los intervalos de confianza al 95% y las OR ajustadas mediante regresión logística. Resultados: Se identificaron 1.913 casos y 3.826 controles. Los grupos de medicamentos más frecuentemente prescritos y dispensados fueron: los que actúan sobre los sistemas musculoesquelético, nervioso, respiratorio, sobre la sangre y órganos hematopoyéticos, y antiinfecciosos. Los medicamentos más habituales fueron: ibuprofeno, dexketoprofeno, paracetamol, amoxicilina, sulfato de hierro y una combinación de ácido fólico. Se identificó un aumento del riesgo de anomalías congénitas significativo para los fármacos de acción sobre el sistema musculoesquelético (OR ajustada de 1,14 [intervalo de confianza al 95% 1,02-1,28]). Se observó una disminución del riesgo significativa en el grupo que actúa sobre la sangre y los órganos hematopoyéticos (OR ajustada de 0,87 [intervalo de confianza al 95% 0,78-0,98]). Conclusiones: Se han identificado asociaciones de medicamentos con AC en mujeres embarazadas residentes en la Comunitat Valenciana, tanto para fármacos que actúan como factores de riesgo de AC como para fármacos que actúan como factores protectores de AC (AU)

Background: Despite the potential risks of drug use during pregnancy, consumption has increased in recent decades. Objective: To identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women residents in the Valencia Region. Methods: A case-control study, considering a case as a less than one year old live birth in 2009-2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. Results: A total of 1,913 cases and 3,826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02-1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78-0.98]). Conclusions: Associations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA (AU)

La validez del Conjunto Mínimo Básico de Datos como fuente de identificación de las anomalías congénitas en la Comunitat Valenciana / The validity of the Spanish Minimum Basic Data Set to identify congenital anomalies in the Valencian Community (Spain)

Objetivo: Evaluar la validez del Conjunto Mínimo Básico de Datos (CMBD) para identificar anomalías congénitas mayores en la Comunitat Valenciana. Métodos: Se realizó un estudio epidemiológico retrospectivo. Del CMBD se seleccionaron las altas en menores de un año nacidos en 2007, residentes en la Comunitat Valenciana con código de anomalía congénita (740-759 CIE9-MC) y una muestra aleatoria de menores de un año sin altas con estos códigos. Tras revisar la documentación clínica, se clasificaron como verdaderos positivos y negativos y falsos positivos y negativos. Se calcularon el valor predictivo positivo y negativo y la sensibilidad. Se analizaron la concordancia de los diagnósticos entre el CMBD y la documentación clínica utilizando la prueba kappa. Resultados: Se identificaron 2305 altas de 1651 pacientes. En los 544 pacientes de la muestra, 4 tenían alguna anomalía congénita mayor. El valor predictivo positivo fue del 56,4% (intervalo de confianza del 95% [IC95%]: 53,9-58,8) y el negativo fue del 99,3% (IC95%: 98,6-100,0). La sensibilidad del CMBD fue del 68,6% (IC95%: 66,1-71,1). Los códigos más frecuentes en los verdaderos positivos fueron: 745.5 (Comunicación interauricular), 745.4 (Comunicación interventricular) y 747.0 (Ductus arterioso persistente), y en los falsos positivos: 747.0, 745.5 y 752.51 (Criptorquidia). El 25,5% de los diagnósticos con anomalía congénita del CMBD no estaban en la historia clínica. Considerando todos los diagnósticos codificados en el CMBD, la concordancia fue de 0,70 (IC95%: 0,68-0,72). Conclusiones: El CMBD es la principal fuente de información para la identificación de casos para el Registro Poblacional de Anomalías Congénitas de la Comunitat Valenciana, pero su principal limitación es el elevado número de casos falsos positivos que detecta (AU)

Objective: To assess the validity of the Spanish Minimum Basic Data Set (MBDS) for identifying major congenital anomalies in the Valencian Community. Methods: A retrospective epidemiological study was carried out. Children under the age of one year, born in 2007 and residing in the Valencian Community with congenital anomalies code 740-759 CIE9-MC, were selected from the MBDS, in addition to a random sample of children under the age of 1 year without these discharge codes. Having reviewed the clinical documentation, the cases were classified as true positives and negatives and false positives and negatives. Positive and negative predictive value and sensitivity were calculated. The kappa test was applied to analyse diagnostic consistency between the MBDS and the clinical documentation. Results: A total of 2305 discharges of 1651 patients were identified. 4 out of the 5434 patients sampled had a major congenital abnormality. The positive predictive value was 56.4% (95% confidence interval [95%CI]: 53.9-58.8) and the negative predictive value was 99.3% (95%CI: 98.6-100.0). MBDS sensitivity was 68.6% (95%CI: 66.1-71.1). The most common codes in the true positives were: 745.5 (atrial septal defect), 745.4 (ventricular septal defect) and 747.0 (patent ductus arteriosus) and in the false positives: 747.0, 745.5 and 752.51 (cryptorchidism). 25.5% of diagnoses with congenital anomaly from the MBDS were not in the clinical documentation. Considering all diagnoses coded in the MBDS, the correlation was 0.70 (95%CI: 0.68-0.72) Conclusions: The MBDS is the main source of information to detect cases in the registry of congenital anomalies of the Valencian Community. Its main limitation is the high number of false positive cases detected (AU)

[The validity of the Spanish Minimum Basic Data Set to identify congenital anomalies in the Valencian Community (Spain)]. / La validez del Conjunto Mínimo Básico de Datos como fuente de identificación de las anomalías congénitas en la Comunitat Valenciana.

OBJECTIVE: To assess the validity of the Spanish Minimum Basic Data Set (MBDS) for identifying major congenital anomalies in the Valencian Community. METHODS: A retrospective epidemiological study was carried out. Children under the age of one year, born in 2007 and residing in the Valencian Community with congenital anomalies code 740-759 CIE9-MC, were selected from the MBDS, in addition to a random sample of children under the age of 1 year without these discharge codes. Having reviewed the clinical documentation, the cases were classified as true positives and negatives and false positives and negatives. Positive and negative predictive value and sensitivity were calculated. The kappa test was applied to analyse diagnostic consistency between the MBDS and the clinical documentation. RESULTS: A total of 2305 discharges of 1651 patients were identified. 4 out of the 5434 patients sampled had a major congenital abnormality. The positive predictive value was 56.4% (95% confidence interval [95%CI]: 53.9-58.8) and the negative predictive value was 99.3% (95%CI: 98.6-100.0). MBDS sensitivity was 68.6% (95%CI: 66.1-71.1). The most common codes in the true positives were: 745.5 (atrial septal defect), 745.4 (ventricular septal defect) and 747.0 (patent ductus arteriosus) and in the false positives: 747.0, 745.5 and 752.51 (cryptorchidism). 25.5% of diagnoses with congenital anomaly from the MBDS were not in the clinical documentation. Considering all diagnoses coded in the MBDS, the correlation was 0.70 (95%CI: 0.68-0.72) CONCLUSIONS: The MBDS is the main source of information to detect cases in the registry of congenital anomalies of the Valencian Community. Its main limitation is the high number of false positive cases detected.

[Drugs use in pregnancy in the Valencia Region and the risk of congenital anomalies]. / Consumo de medicamentos en el embarazo y riesgo de anomalías congénitas en la Comunitat Valenciana.

BACKGROUND: Despite the potential risks of drug use during pregnancy, consumption has increased in recent decades. OBJECTIVE: To identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women residents in the Valencia Region. METHODS: A case-control study, considering a case as a less than one year old live birth in 2009-2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. RESULTS: A total of 1,913 cases and 3,826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02-1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78-0.98]). CONCLUSIONS: Associations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA.

Epidemiología de la Osteogénesis Imperfecta: una enfermedad rara en la Comunitat Valenciana / Epidemiology of Imperfect Osteogenesis: a rare disease in the Valencia Region

Fundamentos: La Osteogénesis Imperfecta (OI) es una enfermedad rara del tejido conectivo y óseo que resulta en una fragilidad ósea de diversa severidad. El objetivo fue determinar y describir la situación de la OI en la Comunitat Valenciana (CV) durante el periodo 2004-2014. Métodos: A partir del Sistema de Información de Enfermedades Raras de la CV (SIER-CV) se identificaron los pacientes con los códigos de la Clasificación Internacional de Enfermedades pertenecientes a la OI: el 756.51 de la 9ª y/o el Q78.0 de la 10ª revisión, durante el período 2004-2014. Se validaron los datos mediante la revisión de documentación clínica (historia clínica electrónica principalmente) y de los casos confirmados (diagnóstico de OI presente en la documentación clínica) se elaboró un análisis descriptivo. Resultados: Se identificaron 162 pacientes con código de OI. Se confirmaron 145 casos de los 161 con la documentación clínica accesible. La prevalencia fue de 0,29 por 10.000 habitantes. El 93,1% eran españoles, el 54,5% mujeres y fueron atendidos en 25 hospitales diferentes de la CV. Se identificó el tipo de OI en el 24,8% de los casos, siendo el tipo I el más habitual (9,7%). Fallecieron el 6,2% con una edad media al fallecimiento de 60,8 años. El 44,8% de pacientes recibió tratamiento con bifosfonatos y el 10,4% tenían familiares afectados. Conclusión: Se ha establecido la situación real de la OI en la CV, lo que permitirá una mejor planificación en las acciones sanitarias para mejorar la calidad de vida de los afectados y sus familiares (AU)

Background: Osteogenesis imperfecta (OI) is a rare connective tissue and bone disease that results in a bone fragility of varying severity. The objective was to determine and describe the OI in the Valencia Region (VR) during the period 2004 to 2014. Methods: From the Rare Diseases Information System of the VR (SIER-CV) patients from 2004 to 2014 with the codes of the International Classification of Diseases for the OI were identified: 756.51 from the 9th Revision-Clinical Modification and Q78.0 from the 10th Revision. The information was validated by reviewing clinical documentation (mainly electronic health records) and a descriptive analysis of the confirmed cases (diagnosis of OI in the clinical documentation) was performed. Results: 162 patients were identified with a code for OI. 145 of the 161 patients with available clinical documentation were confirmed as cases. The prevalence was 0.29 per 10.000 inhabitants. 93.1% were Spanish, 54.5% were women and they were treated in 25 different hospitals in the VR. The type of OI was known in the 26.4% of the cases and type I was the most common (9.7%). 6.2% of the patients died with an average death age of 60.8 years. 44.8% of patients received treatment with bisphosphonates and 10.4% had affected relatives. Conclusion: The real situation of the OI in the VR has been established, which will allow a better planning in the health actions to improve the quality of life of the affected ones and their families (AU)