Eficacia de la fisioterapia para mejorar la calidad de vida y el dolor en el tratamiento del linfedema postmastectomía. Una revisión sistemática / Efficacy of physiotherapy to improve quality of life and pain in the treatment of postmastectomy lymphedema. A systematic review

Objetivo Comparar la evidencia de los diferentes tratamientos para el linfedema y los posibles dolores miofasciales postmastectomía, para conseguir la máxima calidad de vida de los pacientes. Estrategia de búsqueda y selección de estudios Se realizó una búsqueda en las bases de datos PubMed, Phisiotherapy Evidence Database (PEDro) y Web of Science (WOS) durante marzo y abril del año 2022. Se tuvo en cuenta que los pacientes hubiesen sido intervenidos quirúrgicamente por cáncer de mama (CaMama), mayores de 18 años y que los estudios fuesen ensayos clínicos; resultando un total de 10 artículos seleccionados. Se evaluó la calidad metodológica y factor de impacto de cada uno de ellos. Síntesis de resultados Las variables analizadas fueron reducción del linfedema, calidad de vida y abordaje del dolor. El tratamiento a través de drenaje linfático manual (DLM) presentó mejorías en todos los artículos que hacían referencia a la reducción del linfedema, tanto de forma individual como de forma aislada; en cambio, respecto a los dolores miofasciales el tratamiento de liberación miofascial mostró mejoras tanto en la calidad emocional como en la disminución del dolor, siendo más efectivo en esta última variable. Conclusiones Los tratamientos que mejoran la calidad de vida y dolor de los pacientes que han sufrido una intervención quirúrgica debido al CaMama, además de reducir el linfedema son DLM, facilitación neuromuscular propioceptiva (FNP), liberación miofascial y programas de ejercicios y entrenamientos. La limitación principal respecto a los tratamientos, es que no existe ningún programa de intervención específico (AU)

Objective To compare the evidence of the different treatments for lymphedema and possible postmastectomy myofascial pain, to achieve the highest quality of life for patients. Search strategy and selection of studies A search was carried out in the PubMed, Physiotherapy Evidence Database (PEDro) and Web of Science (WOS) databases during March and April 2022. It was taken into account that the patients had undergone surgery surgically for breast cancer, that they were over 18 years of age and that the studies were clinical trials; resulting in a total of 10 selected articles. The methodological quality and impact factor of each of them were evaluated. Summary of results The variables analyzed were reduction of lymphedema, quality of life and pain management. Treatment through manual lymphatic drainage (MLD) presented improvements in all the articles that made reference to the reduction of lymphedema, both individually and in isolation; On the other hand, regarding myofascial pain, myofascial release treatment showed improvements in both emotional quality and pain reduction, being more effective in this last variable. Conclusions The treatments that improve the quality of life and pain of patients who have undergone surgery due to breast cancer, in addition to reducing lymphedema, are manual lymphatic drainage, proprioceptive neuromuscular facilitation, myofascial release, and exercise and training programs. The main limitation regarding treatments is that there is no specific intervention program (AU)

[Professional and psychological impact of second victims among hospital healthcare professionals]. / Impacto laboral y psicológico de las segundas víctimas entre los profesionales sanitarios hospitalarios.

OBJECTIVE: To analyze the occupational and psychological consequences suffered by healthcare workers who are considered second victims (SV). MATERIAL AND METHODS: Observational, descriptive and cross-sectional study among the healthcare workers of a university hospital. The answers collected in a specifically designed questionnaire about psychological consequences at work and the result of a post-traumatic stress scale, "Impact of Event Scale-Revised (IES-R, spanish version)" were evaluated. The variables between the groups were compared using the Chi square test (or Fisher's exact test) when both were qualitative and with the Student's T (or the Mann-Whitney U test for independent data), when one of them was quantitative. The level of statistical significance was P<.05. RESULTS: 75.5% (148/207) of the participants in the study suffered some adverse event (AE) and, of these, 88.5% (131/148) were considered SV. Physicians had a 2.2 times higher risk of feeling SV than nurses (95% CI: 1.88-2.52). The impact on the patient related to the AE explained why the professionals involved in it felt SV (P=.037). 80.6% (N=104) of the SVs presented post-traumatic stress. Women were 2.4 times more likely to suffer from it (OR: 2.4; 95% CI: 1.5-4.0). Intrusive thoughts in the SV were almost three times more frequent when the damage suffered by the patient was permanent or death (OR: 2.5; 95% CI: 0.2-3.6). CONCLUSIONS: Many healthcare workers, especially physicians, considered themselves to be SV, and many of them suffered from post-traumatic stress. The impact on the patient related to the AE was a risk factor for being SV and for suffering psychological consequences.

3D scaffolds of caprolactone/chitosan/polyvinyl alcohol/hydroxyapatite stabilized by physical bonds seeded with swine dental pulp stem cell for bone tissue engineering.

Bone Regeneration represents a clinical need, related to bone defects such as congenital anomalies, trauma with bone loss, and/or some pathologies such as cysts or tumors This is why a polymeric biomaterial that mimics the osteogenic composition and structure represents a high potential to face this problem. The method of obtaining these materials was first to prepare a stabilized hydrogel by means of physical bonds and then to make use of the lyophilization technique to obtain the 3D porous scaffolds with temperature conditions of -58 °C and pressure of 1 Pa for 16 h. The physicochemical and bioactive properties of the scaffolds were studied. FTIR and TGA results confirm the presence of the initial components in the 3d matrix of the scaffold. The scaffolds exhibited a morphology with pore size and interconnectivity that promote good cell viability. Together, the cell viability and proliferation test, Alamar BlueTM and the differentiation test: alizarin staining, showed the ability of physically stabilized scaffolds to proliferate and differentiate swine dental pulp stem cell (DPSCs) followed by mineralization. Therefore, the Cs-PCL-PVA-HA scaffold stabilized by physical bonds has characteristics that suggest great utility for future complementary in vitro tests and in vivo studies on bone defects. Likewise, this biomaterial was enhanced with the addition of HA, providing a scaffold with osteoconductive properties necessary for good regeneration of bone tissue. Graphical abstract.

Actividad física, sedentarismo y preferencias en la práctica deportiva en niños: panorama actual en México / Atividade física, sedentarismo e preferências na prática esportiva infantil: panorama atual no México / Physical activity, sedentary lifestyle and preferences in sports practice in children: current panorama in Mexico

El presente estudio busco conocer la prevalencia de actividad física, sedentarismo y preferencias en la práctica deportiva en niños de México, por sexo y edad. Se seleccionó una muestra no probabilística de 2,621 niños (47.1% niños y 52.5% niñas), con un promedio de edad de 9.86 años. Se utilizaron indicadores para evaluar la actividad física y las conductas sedentarias, así como, preguntas para conocer otros aspectos de las actividades físico deportivas. Los resultados mostraron que el mayor porcentaje de niños se clasifican como físicamente inactivos, encontrando diferencias significativas por sexo en el grupo de 11 a 13 años. Además, se encontró que una proporción importante de niños pasan más de dos horas al día frente a una pantalla. El mayor porcentaje de niños y niñas informaron que han practicado: fútbol soccer, correr y andar en bicicleta, y las actividades que más les gustaría practicar son el ping pong y escalar. (AU)

The present study sought to know the prevalence of physical activity, sedentary lifestyle and preferences in sports practice in children from Mexico, by sex and age. A non-probabilistic sample of 2,621 children (47.1% boys and 52.5% girls) was selected, with an average age of 9.86 years. Indicators were used to evaluate physical activity and sedentary behaviors, as well as questions to learn about other aspects of physical sports activities. The results showed that the highest percentage of children are classified as physically inactive, finding significant differences by sex in the group aged 11 to 13 years. In addition, it was found that a significant proportion of children spend more than two hours a day in front of a screen. The highest percentage of boys and girls reported that they have practiced: soccer, running and cycling, and the activities they would most like to do are ping pong and climbing. (AU)

O presente estudo buscou conhecer a prevalência de atividade física, estilo de vida sedentário e preferências na prática esportiva em crianças mexicanas, por sexo e idade. Foi selecionada uma amostra não probabilística de 2.621 crianças (47,1% meninos e 52,5% meninas), com média de idade de 9,86 anos. Indicadores foram usados para avaliar a atividade física e comportamentos sedentários, bem como questões para aprender sobre outros aspectos das atividades físicas esportivas. Os resultados mostraram que o maior percentual de crianças é classificado como inativo fisicamente, encontrando diferenças significativas por sexo no grupo de 11 a 13 anos. Além disso, constatou-se que uma proporção significativa de crianças passa mais de duas horas por dia em frente a uma tela. O maior percentual de meninos e meninas relatou que já praticou: futebol, corrida e ciclismo, e as atividades que mais gostariam de fazer são pingue-pongue e escaladad. (AU)

Treatment with Hyaluronic Acid and Collagen-Polyvinylpyrrolidone Improves Extracellular Matrix Assembly for Scarring after Tracheal Resection.

Treatment of tracheal stenosis is occasionally performed in combination with wound healing modulators to manipulate new extracellular matrix (ECM) formation and prevent fibrosis. Hyaluronic acid (HA) and collagen-polyvinylpyrrolidone (collagen-PVP) decrease fibrosis in experimental tracheal healing. However, they have not been used clinically as their effect on ECM components, which modify tracheal scarring, has not been described. Objective. To evaluate the effect of the application of HA, collagen-PVP, a mixture of HA and collagen-PVP (HA+collagen-PVP), and mitomycin C on the expression of decorin, matrix metalloproteinase 1 (MMP1), and MMP9, as well as the type of collagen and deposits formed in the scar after resection and end-to-end anastomosis (REEA) of the cervical trachea using an experimental model. Materials and Methods. Thirty dogs underwent REEA of the cervical trachea and were treated with different wound healing modulators: group I (n = 6), control; group II (n = 6), HA; group III (n = 6), collagen-PVP; group IV (n = 6), HA+collagen-PVP; and group V (n = 6), mitomycin C. The dogs were evaluated clinically and endoscopically for 4 weeks. Subsequently, macroscopic and microscopic changes, expression of ECM proteins, and collagen deposition in tracheal scars were analysed. Results. Groups II, III, and IV showed reduced endoscopic, macroscopic, and microscopic inflammation, improved neovascularization, high decorin expression (p < 0.01, analysis of variance (ANOVA)), and moderate expression of MMP1 (p < 0.003, ANOVA) and type I and III collagen (p < 0.05, Kruskal-Wallis). Groups IV and V developed fewer collagen deposits (p < 0.001, ANOVA). Conclusion. Treatment with HA and collagen-PVP improved post-REEA healing by increasing neovascularization, stimulating the expression of decorin, and regulating the expression of MMP1, as well as type I and III collagen and their deposition.

Prevalencia de exceso ponderal entre los escolares de La Mancha-Centro según diferentes criterios / Excess weight in La Mancha-Centro schoolchildren by different criteria

INTRODUCCIÓN: La sobrecarga ponderal infantil constituye un importante problema de salud pública mundial. El índice de masa corporal (IMC) es el indicador más empleado. No existe acuerdo internacional sobre los criterios definitorios que se deben emplear en la infancia, lo que ocasiona gran variabilidad de cifras y dificulta su interpretación. OBJETIVO: Estimar la prevalencia de sobrepeso y obesidad de la población escolar del Área Sanitaria de La Mancha-Centro (Comunidad Autónoma de Castilla-La Mancha) aplicando diferentes criterios definitorios y valorar las diferencias encontradas. MATERIAL Y MÉTODOS: Estudio de corte transversal de una muestra representativa de 954 niños de 6 a 12 años. Se calculó la prevalencia de sobrepeso, obesidad y sobrecarga ponderal global, por sexo e intervalo anual, aplicando los criterios más empleados, nacionales (Estudio Transversal Español de Crecimiento 2010 -ETEC 2010-, Orbegozo 1988, Orbegozo 2004) e internacionales (Organización Mundial de la Salud - OMS-, International Obesity Task Force -IOTF-). RESULTADOS: La prevalencia global de sobrepeso, obesidad y sobrecarga ponderal fue, respectivamente, 25,4%, 21,1%, 46,5% con el criterio de OMS; 26,3%, 11,5%, 37,8% con IOTF; 9,8%, 14,8%, 24,6% con Orbegozo 1988; 10,9%, 15,4%, 26,3% con Orbegozo 2004; y 15,5%, 8,6%, 24,1% con ETEC 2010. Las mujeres presentaron prevalencias más elevadas de sobrepeso y obesidad que los varones, observándose diferencias estadísticamente significativas en la sobrecarga ponderal con todos los criterios empleados. CONCLUSIONES: Los escolares de La Mancha-Centro presentan prevalencias globales muy elevadas de sobrepeso, obesidad y sobrecarga ponderal, ampliamente variables según el criterio utilizado. Estas cifras son superiores a las de la mayoría de los últimos estudios españoles, nacionales o regionales, y de muchos países de nuestro entorno. Las mujeres muestran valores significativamente más altos que los varones. Sería recomendable unificar a nivel internacional qué puntos de corte utilizar en los estudios de exceso ponderal infantil

INTRODUCTION: Childhood excess weight is an important public health worldwide problem nowadays. Body Mass Index (BMI) is the most used indicator to estimate it. There is no international agreement on the defining criteria to be used in children, which implies great data variability and hinders its interpretation. OBJECTIVE: To estimate the prevalence of overweight and obesity in the schoolchildren of "La Mancha-Centro" Health Area (Castilla-La Mancha, Spain) applying different criteria and to assess the differences found. METHODS: Cross-sectional study of a representative sample of 954 from 6 to 12 years old schoolchildren. Overweight, obesity and excess weight prevalence was calculated by sex and age ranges, applying the most used national (Spanish CrossSectional Growth Study 2010 -SCGS 2010-, Orbegozo 1988, Orbegozo 2004) and international (World Health Organization - WHO-, International Obesity Task Force -IOTF-) criteria. RESULTS: Global prevalence of overweight, obesity and excess weight was, respectively, 25,4%, 21,1%, 46,5% with the WHO criteria; 26,3%, 11,5%, 37,8% following IOTF; 9,8%, 14,8%, 24,6% with Orbegozo 1988; 10,9%, 15,4%, 26,3% according to Orbegozo 2004; and 15,5%, 8,6%, 24,1% with SCGS 2010 cut-offs. Overweight and obesity prevalence was higher in girls than in boys, with significant differences in excess weight by all criteria. CONCLUSIONS: Schoolchildren in La Mancha-Centro display high global prevalence of overweight, obesity and excess weight, which varies a lot according to the applied standard and exceeds prevalence of last Spanish, national or regional, and European studies. Girls achieve higher levels than boys significantly. It would be advisable to unify internationally which cut-off points to use in child excess weight studies

Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus.

The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.

[A brief history of marijuana in the western world]. / Breve historia sobre la marihuana en Occidente.

Marijuana is a substance with a long and controversial history. At different times in its history, which goes back over 5,000 years, this plant has been used for different purposes, ranging from recreational and leisure to its use in the treatment of several diseases or to offer relief in processes that entail a certain type of malaise, and including its consideration as a means of relaxation and meditation. Although it was supposed that the roots of marijuana lay in Central America, it is now known that this is but an urban legend with little credibility and that its origins can be found recorded in Chinese medical references dating back to the year 2737 BC. Although this plant was not originally from Central America, it has aroused interest around the world, and above all in Mexico. It is in this country where the use of cannabis has gone from applications in textiles and medicine to its free sale, the bans on its use due to political and social pressures, its tolerance and, recently, its decriminalisation for recreational and medicinal use. Unfortunately there are few references on the history of this plant in Mexico, and thus we have considered it interesting to present some data about the generalities of marijuana, a brief history in the world, the development of decriminalisation in North America, its medicinal uses and its course through Mexico to the present day.

TITLE: Breve historia sobre la marihuana en Occidente.La marihuana es una sustancia con una extensa y controvertida historia. A lo largo del tiempo, esta planta, y desde hace mas de 5.000 años, ha sido utilizada para diferentes fines, que van desde el uso ludico y recreativo, pasando por un medio de relajacion y meditacion, hasta su uso en el tratamiento de varias enfermedades o el alivio de procesos vinculados a cierto tipo de malestares. Aunque se supuso que la marihuana tenia su origen en Mesoamerica, ahora se sabe que es solo una leyenda urbana de poca credibilidad y que sus origenes los podemos registrar en referencias medicas chinas datadas alrededor del año 2737 a. de C. Si bien esta planta no tiene un origen mesoamericano, si ha generado interes en el mundo, y sobre todo en Mexico. Es en este pais donde el uso del cannabis ha ido desde intereses textiles y medicinales hasta el consumo ludico, pasando por su venta libre, la prohibicion por presiones politicas y sociales, su tolerancia y, recientemente, su despenalizacion para uso ludico y medicinal. Desgraciadamente existen pocas referencias de la historia de esta planta en Mexico, por lo que ha sido de nuestro interes presentar algunos datos sobre las generalidades de la marihuana, una breve historia en el mundo, el desarrollo de la despenalizacion en Norteamerica, sus usos medicinales y su paso por Mexico hasta nuestros dias.

Adecuación del cribado de diabetes mellitus en mujeres con antecedente de diabetes gestacional / Suitability of screening for diabetes mellitus in women with a history of gestational diabetes

Objetivo. Evaluar a largo plazo la adecuación del cribado de diabetes mellitus de tipo 2 en mujeres con diagnóstico previo de diabetes gestacional en Atención Primaria. El objetivo secundario fue determinar los factores clínicos que modifican la adecuación del cribado. Material y métodos. Estudio observacional de cohortes. Se seleccionó al total de pacientes con el diagnóstico de diabetes gestacional durante de los años 2000-2009 (n=470) en el Complexo Hospitalario Universitario de Ourense. Se procedió a la revisión de la historia clínica electrónica, valorando la existencia y el año de realización de la última glucemia basal. El tiempo medio de seguimiento fue de 12,9 años. Se consideró cribado adecuado la constancia en la historia clínica de una glucemia basal en los últimos 3 años. Se analizaron las siguientes variables: adecuación del cribado de diabetes mellitus de tipo 2, edad, índice de masa corporal, diabetes gestacional en más de una gestación, medio rural/urbano. Se realizó el análisis descriptivo de los datos. Para la determinación de las diferencias entre subgrupos se utilizó la prueba Chi2 y la prueba t de Student. Se consideró significación estadística p<0,05. Resultados. El control a largo plazo de estas pacientes fue muy irregular. Solo el 67,0% del grupo a estudio realizó cribado de diabetes mellitus de tipo 2. Ni la edad, ni el índice de masa corporal, ni el lugar de residencia, ni el año del diagnóstico modificaron el grado de seguimiento. Las pacientes con más de un episodio de diabetes gestacional presentaron un control glucémico posterior que alcanzó el 94,1%. Conclusión. La adecuación del cribado en nuestra área es muy irregular y altamente mejorable (AU)

Objective. To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. Material and methods. An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 Results. The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. Conclusion. The adequacy of the screening in our area is very irregular and highly improvable (AU)

[Suitability of screening for diabetes mellitus in women with a history of gestational diabetes]. / Adecuación del cribado de diabetes mellitus en mujeres con antecedente de diabetes gestacional.

OBJECTIVE: To assess long-term suitability of screening for type 2 diabetes mellitus in women with a previous diagnosis of gestational diabetes in Primary Care. The secondary objectives were to determine if there were clinical factors that modified the usefulness of the screening. MATERIAL AND METHODS: An observational cohort type study was performed, which included all patients with the diagnosis of gestational diabetes during the years 2000 to 2009 (n=470) in the University Hospital Complex of Ourense. The electronic medical records were reviewed to assess the existence of gestational diabetes and the year of the last fasting blood glucose. The mean follow-up time was 12.9 years. The screening for evidence of a fasting blood glucose in the last 3 years was considered adequate. The following variables were analysed: adequacy of screening for type 2 diabetes mellitus, age, body mass index, gestational diabetes in more than one gestation, and rural/urban environment. A descriptive analysis of the data was performed, using Chi2 and Student's t-test to determine differences between subgroups. Statistical significance was considered as P<.05 RESULTS: The long-term monitoring of these patients was very irregular. Only 67.08% of the study group underwent diabetes mellitus type 2 screening. The level of follow-up was not associated with age, BMI, the place of residence, or the year of diagnosis. In patients with more than one episode of gestational diabetes, subsequent blood glucose control was achieved in 94.1%. CONCLUSION: The adequacy of the screening in our area is very irregular and highly improvable.

[Incidence and clinical risk factors for the development of diabetes mellitus in women with previous gestational diabetes]. / Incidencia y factores clínicos de riesgo de diabetes mellitus en mujeres con diabetes gestacional previa.

BACKGROUND: Gestational diabetes is considered a variant of diabetes mellitus as they share a common pathophysiological basis: insulin resistance in target and insufficient secretion of it by pancreatic p-cell bodies. Pregnancy is a unique physiological situation provides an opportunity to identify future risk of diabetes mellitus. OBJECTIVE: To determine the long-term incidence of diabetes mellitus in women who have previously been diagnosed with gestational diabetes and identifying clinical risk factors for developing the same. METHODS: nested case-control cohort study. 671 patients between 1996 and 2009 were diagnosed with gestational diabetes were selected. The incidence of diabetes mellitus was estimated and 2 subgroups were formed: Group A or cases: women who develop diabetes mellitus after diagnosis of gestational diabetes. Group B or control: random sample of 71 women with a history of gestational diabetes in the follow-up period remained normoglycemic. Both groups were studied up to 18 years postpartum. By studying Kaplan Meier survival of the influence of different gestational variables it was obtained in the later development of diabetes mellitus with time parameter and COX models for categorical variables were applied. Significant variables were studied by multivariate Cox analysis. In all analyzes the Hazard ratio was calculated with confidence intervals at 95%. RESULTS: The incidence of diabetes mellitus was 10.3% in patients with a history of gestational diabetes. They were identified as risk factors in the index pregnancy to later development of diabetes mellitus: greater than 35 and younger than 27 years maternal age, BMI greater than 30 kg/m2, hypertensive disorders of pregnancy, insulin therapy, poor metabolic control and more than a complicated pregnancy with gestational diabetes. CONCLUSIONS: Clinical factors have been identified in the pregnancy complicated by gestational diabetes that determine a higher probability of progression to diabetes mellitus in the medium and long term.

Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real) / Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)

OBJETIVO: Valorar el patrón dietético de la población escolar del Área de Salud La Mancha Centro (Ciudad Real). METODOLOGÍA: Estudio transversal sobre una muestra representativa de los escolares de 6 a 12 años. Se utilizó un cuestionario para explorar los hábitos dietéticos generales y un recordatorio de ingesta de 24 h. RESULTADOS: Se evaluó a 1.142 escolares, 612 niños (53,6%) y 530 niñas (46,4%), con una edad de 9,3±1,7 años. La frecuencia de la ingesta de alimentos, de 4,62±0,6 veces al día, decrecía de forma estadísticamente significativa con la edad de los escolares (p = 0,044) y aumentaba con el nivel educativo de los padres (p = 0,004). La preferencia era un factor influyente en la elección de los alimentos consumidos. El grado de apetito se relacionó de forma directa con el peso y el índice de masa corporal (p< 0,001), la edad (p = 0,02) y el número de ingestas diarias (p = 0,038). Los grupos de alimentos más frecuentemente ingeridos fueron los cereales y derivados (92,8%), la leche y derivados (90,45%) y los menos, las verduras y hortalizas (35,46%). Más del 70% de la muestra consumía como aceite habitual el de oliva. CONCLUSIÓN: El patrón dietético de los escolares mantiene algunas de las características del patrón de dieta mediterránea tradicional, como el hábito de desayuno, el elevado consumo de aceite de oliva o de cereales, pero no otras, destacando el escaso consumo de verduras y frutas, y el elevado de carnes

OBJECTIVE: To assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). METHODOLOGY: A cross-sectional study conducted on a representative sample of schoolchildren aged 6 to 12 years, using a questionnaire to determine their general dietary habits and a record of their 24-hour intake. RESULTS: A total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3±1.7 years of age. The frequency of food intake was 4.62±0.6 times a day, which decreased with the age of the schoolchildren (P=.044), and increased with the educational level of parents (P=.004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI)(P<.001), age (P=.02), and number of daily food intakes by the children (P=.038). The food groups most frequently consumed were cereals and their derivatives (92.8%), milk and dairy products (90.45%), while vegetables were the least consumed (35.46%). Over 70% of the sample usually consumed olive oil. CONCLUSION: The dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat

[Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)]. / Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real).

OBJECTIVE: To assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). METHODOLOGY: A cross-sectional study conducted on a representative sample of schoolchildren aged 6 to 12 years, using a questionnaire to determine their general dietary habits and a record of their 24-hour intake. RESULTS: A total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3 ± 1.7 years of age. The frequency of food intake was 4.62 ± 0.6 times a day, which decreased with the age of the schoolchildren (P=.044), and increased with the educational level of parents (P=.004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI) (P<.001), age (P=.02), and number of daily food intakes by the children (P=.038). The food groups most frequently consumed were cereals and their derivatives (92.8%), milk and dairy products (90.45%), while vegetables were the least consumed (35.46%). Over 70% of the sample usually consumed olive oil. CONCLUSION: The dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat.

Corioamnionitis subclínica: un reto diagnóstico. A propósito de un caso / Case report of subclinical chorioamnionitis: A diagnostic challenge

El diagnóstico de la corioamnionitis subclínica en pacientes con rotura prematura de membranas en gestación pretérmino supone un reto. Cuando se descarta infección intraamniótica mediante amniocentesis, no está claro, dentro del manejo expectante de la paciente, y hasta que se alcanza la edad gestacional subsidiaria de una conducta activa, cuándo se debe repetir la prueba, o si se debe o no se debe repetir. En el caso clínico presentado, se decidió un manejo expectante de la gestación, una vez descartada la infección intraamniótica mediante amniocentesis, pero la alteración en la fórmula leucocitaria junto con el ascenso de reactantes de fase aguda, en ausencia de otro foco infeccioso, sentaron la indicación para realizar de nuevo la prueba. A pesar de llevar a cabo un diagnóstico precoz de corioamnionitis subclínica, ya se había producido afectación fetal por el proceso infeccioso-inflamatorio. Es fundamental obtener un marcador precoz materno sérico de infección intraamniótica

Diagnosis of subclinical chorioamnionitis in patients with premature rupture of membranes in preterm gestation is a challenge. If intraamniotic infection is ruled out by amniocentesis, it is not clear-in the expectant management of the pregnancy and until the fetus has reached a gestational age allowing active management-when the test should be repeated, or whether it should be repeated. In the case reported herein, expectant management of pregnancy was adopted after intra-amniotic infection had been excluded by amniocentesis. However, because of changes in the number of leukocytes and an increase in acute phase reactants in the absence of infection at another site, we decided to repeat the test. Despite early diagnosis of subclinical chorioamnionitis, fetal involvement had already occurred due to the inflammation-infection process. It is therefore essential to obtain an early maternal serum marker of intra-amniotic infection

Concordancia interobservador en la detección de bocio por palpación en población escolar / Interobserver agreement in detecting goitre by palpation in a school population

Objetivo: Estimar la concordancia interobservador en la detección de bocio por exploración física en población escolar. Metodología: Se realizó un estudio transversal para la detección de bocio en una muestra representativa de 1.134 escolares de 6 a 12 años de 20 colegios del área de salud de La Mancha Centro. La exploración fue realizada de forma enmascarada por 2 únicos observadores. Se establecieron 5 grados de tamaño tiroideo (0, I a, I b, II y III ). Se consideró bocio a partir del grado i a. La concordancia se valoró en relación con variables como edad, sexo, índice de masa corporal, talla y día de exploración. Se utilizó el índice kappa como medida de concordancia. Resultados: En los 1.097 escolares con doble exploración, en 96 (8,8%) se detectó bocio por el observador 1 y en 102 (9,3%) por el 2 (p = 0,58). El grado de acuerdo interobservador en la identificación y en la graduación del bocio fue moderado (kappa 0,55; IC del 95%, 0,46-0,64) para la primera y sustancial (kappa ponderado 0,61; IC del 95%, 0,51-0,71) para la segunda. Fue algo mayor en las niñas y en los escolares de mayor edad, peso, talla e índice de masa corporal. La concordancia entre observadores fue relativamente estable a lo largo de la realización del estudio. Conclusiones: La concordancia interobservador en la detección de bocio por palpación en nuestro estudio es moderada, aunque más baja en los niños más pequeños e invariable durante todo el periodo en el que se realizó (AU)

Objective: To estimate the agreement between observers on the detection of goitre by physical exploration in a school population. Methodology: We performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III ). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. Results: In the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=0.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95% CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. Conclusions: The interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study (AU)

Energy-environmental benefits and economic feasibility of anaerobic codigestion of Iberian pig slaughterhouse and tomato industry wastes in Extremadura (Spain).

Anaerobic digestion of Iberian pig slaughterhouse and tomato industry wastes, as well as codigestion operations from such residues, are reported to achieve 54-80% reduction in Chemical Oxygen Demand and 6-19 N m(3)/m(3) substrate methane production. Furthermore, 0.79-0.88 m(3)water/m(3) substrate is seen to be recovered after the above mentioned operations, which might be used as irrigation water, and 0.12-0.21 m(3)agricultural amendment/m(3) substrate with 91-98% moisture content. The present paper also reports on the economic feasibility of both an anaerobic codigestion plant operating with 60% slaughterhouse wastes/40% tomato industry wastes (optimal ratio obtained in previous laboratory-scaled experiments), and an anaerobic digestion plant for Iberian pig slaughterhouse waste. Payback times are reported as 14.86 and 3.73 years, respectively.

[Interobserver agreement in detecting goitre by palpation in a school population]. / Concordancia interobservador en la detección de bocio por palpación en población escolar.

OBJECTIVE: To estimate the agreement between observers on the detection of goitre by physical exploration in a school population. METHODOLOGY: We performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. RESULTS: In the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95%CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. CONCLUSIONS: The interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study.

Postcoalescence evolution of growth stress in polycrystalline films.

The growth stress generated once grains coalesce in Volmer-Weber-type thin films is investigated by time-multiscale simulations comprising complementary modules of (i) finite-element modeling to address the interactions between grains happening at atomic vibration time scales (~0.1 ps), (ii) dynamic scaling to account for the surface stress relaxation via morphology changes at surface diffusion time scales (~µs-ms), and (iii) the mesoscopic rate equation approach to simulate the bulk stress relaxation at deposition time scales (~sec-h). On the basis of addressing the main experimental evidence reported so far on the topic dealt with, the simulation results provide key findings concerning the interplay between anisotropic grain interactions at complementary space scales, deposition conditions (such as flux and mobility), and mechanisms of stress accommodation-relaxation, which underlies the origin, nature and spatial distribution, and the flux dependence of the postcoalescence growth stress.

An Hcp100 gene fragment reveals Histoplasma capsulatum presence in lungs of Tadarida brasiliensis migratory bats.

Histoplasma capsulatum was sampled in lungs from 87 migratory Tadarida brasiliensis bats captured in Mexico (n=66) and Argentina (n=21). The fungus was screened by nested-PCR using a sensitive and specific Hcp100 gene fragment. This molecular marker was detected in 81·6% [95% confidence interval (CI) 73·4-89·7] of all bats, representing 71 amplified bat lung DNA samples. Data showed a T. brasiliensis infection rate of 78·8% (95% CI 68·9-88·7) in bats captured in Mexico and of 90·4% (95% CI 75·2-100) in those captured in Argentina. Similarity with the H. capsulatum sequence of a reference strain (G-217B) was observed in 71 Hcp100 sequences, which supports the fungal findings. Based on the neighbour-joining and maximum parsimony Hcp100 sequence analyses, a high level of similarity was found in most Mexican and all Argentinean bat lung samples. Despite the fact that 81·6% of the infections were molecularly evidenced, only three H. capsulatum isolates were cultured from all samples tested, suggesting a low fungal burden in lung tissues that did not favour fungal isolation. This study also highlighted the importance of using different tools for the understanding of histoplasmosis epidemiology, since it supports the presence of H. capsulatum in T. brasiliensis migratory bats from Mexico and Argentina, thus contributing new evidence to the knowledge of the environmental distribution of this fungus in the Americas.