Infarto agudo de miocardio en cuatro hospitales de atención secundariaen Cuba en la era COVID-19

Introducción: Las características clínico-epidemiológicas en el diagnóstico, evolu-ción y tratamiento de los pacientes con infarto agudo de miocardio en la era COVID-19 dependen de varios factores.Objetivo: Precisar el comportamiento de algunas variables clínico-epidemiológicas en la atención y tratamiento de los pacientes con infarto agudo de miocardio en el curso de la COVID-19.Método: Se realizó un estudio observacional en cuatro hospitales de atención secundaria en Cuba. Se utilizaron las siguientes variables: número de ingresos por infartos, mortalidad hospitalaria, tiempo de demora mayor de 4 horas desde el inicio de los síntomas y la llegada a la primera asistencia médica y el porcentaje de trombólisis. Se definieron dos grupos, los ingresados entre el 1 de marzo al 30de septiembre de 2019 (Grupo I) y los ingresados en igual período pero del 2020(Grupo II). Las comparaciones entre ambos grupos se realizaron utilizando el test de Chi cuadrado.Resultados: Existió una disminución de 53 ingresos por infarto agudo de miocardio en Las Tunas (112vs. 159, p<0.05), con un incremento del número de ingresosen el Hospital Enrique Cabrera en los pacientes del grupo II (98vs. 68, p<0.05). Se incrementó el número de fallecidos y la mortalidad hospitalaria en el grupo II en todos los centros con relación al grupo I. En la mayoría de los centros se incrementó la demora desde el inicio de los síntomas y la llegada al lugar de la primera asistencia médica. El porciento de trombólisis fue superior al 50porciento en la mayoría delos centros en el grupo II.Conclusiones: Las características de la COVID-19 pueden modificar aspectos clínicos y epidemiológicos en la atención y tratamiento de los pacientes con infarto agudo de miocardio.[AU]

Health-related quality of life in individuals with metabolic syndrome: a cross-sectional study / Calidad de vida relacionada con la salud en individuos con síndrome metabólico: un estudio descriptivo

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected

INTRODUCCIÓN Y OBJETIVOS: El síndrome metabólico (SM) es la combinación de diversos factores de riesgo cardiovascular que pueden derivar en un mayor impacto en la morbimortalidad prematura. Sin embargo, el impacto del SM en la calidad de vida relacionada con la salud (CVRS) es desconocido. El objetivo de este estudio es evaluar la CVRS en la población adulta española de 55 años o más con SM. MÉTODOS: Se realizó un análisis transversal con los datos del ensayo PREDIMED-Plus. Seis mil cuatrocientos treinta varones y mujeres entre 55-75 años con sobrepeso/obesidad y SM. El instrumento de medida de la CVRS fue el cuestionario SF-36. Cada escala del SF-36 fue descrita y estratificada por sexo. RESULTADOS: Los participantes mostraron valores más altos en las escalas función social (media: 85,9; IC 95%: 85,4-86,4) y rol emocional (media: 86,8; IC 95%: 86,0-87,5). En los varones, la peor puntuación fue en la dimensión salud general (media: 65,6; IC 95%: 65,0-66,2) y en las mujeres el dolor corporal (media: 54,3; IC 95%: 53,4-55,2). Además, los varones obtuvieron puntuaciones más altas en todas las escalas. En la escala función física en varones se encontró una disminución significativa de la CVRS en los participantes entre 70 y 75 años en comparación con los más jóvenes. Las peores puntuaciones se obtuvieron en las dimensiones físicas agregadas. CONCLUSIONES: El SM afecta de manera negativa a la CVRS en las dimensiones agregadas físicas, haciendo especial hincapié en la esfera dolor corporal en mujeres y salud general en varones. Sin embargo, las esferas psicológicas se encuentran menos afectadas por el SM

Tendencias de la investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19 / Research tendencies about mental disorder symptoms during the COVID-19 pandemic / Tendências da investigação sobre sintomas de transtornos mentais durante a pandemia por COVID-19

Objetivo: Realizar una revisión sistemática de la tendencia de investigación sobre síntomas de trastornos mentales durante la pandemia por COVID-19. Métodos: Se recuperaron artículos publicados entre el 31 de diciembre 2019 y el 3 de mayo 2020, en Pubmed, SCOPUS, EBSCO, PsycINFO, Science Direct, Redalyc y Web of Science, seleccionando, conforme a la metodología PRISMA, un total de 16 artículos, al descartarse duplicados o estudios no empíricos. Resultados: La mayoría se realizaron en China, el tamaño de la muestra osciló entre 20 y 7236 participantes, en su mayoría adolescentes y adultos, entre 12 a 80 años, con muestreo no probabilístico por conveniencia. La tendencia de los síntomas y trastornos más estudiados fueron ansiedad (28%), depresión (23%), estrés (15.3%), trastorno del sueño-vigilia (9.6%) y trastorno por estrés postraumático (5.7%), asociados con el consumo de sustancias psicoactivas, bajo rendimiento académico, pérdida de trabajo, calidad del sueño, bajo autocuidado y baja percepción del estado de salud durante la pandemia. Conclusiones: Los síntomas y trastornos de ansiedad, depresión y estrés son los más frecuentes. Algunas limitaciones son la ausencia de medición previa a la pandemia o cuarentena y el uso de muestreo no aleatorio, para hacer generalización de resultados. Es necesario formular investigaciones de intervención para mitigar el impacto psicológico. Los sistemas de salud deben ofrecer programas de prevención y de promoción de la salud, que consideren factores psicosociales dirigidos a la población general, pacientes y personal sanitario, para disminuir la prevalencia de estas dificultades, en particular, para Iberoamérica, en donde es escasa la producción científica al respecto.

Objective: To carry out a systematic review of the research trend on mental disorders symptoms during the COVID -19 pandemic. Methods: Articles published between December 31, 2019 and May 3, 2020 were retrieved in Pubmed, SCOPUS, EBSCO, PsycINFO, Science Direct, Redalyc, and Web of Science, selected according to the PRISMA methodology, a total of 16 articles by ruling out duplicates or non-empirical studies. Results: Most were carried out in China, the sample size ranged between 20 and 7236 participants, mostly adolescents and adults, between 12 and 80 years old, with non-probability sampling for convenience. The most studied symptoms and disorders were anxiety (28%), depression (23%), stress (15.3%), sleep-wake disorder (9.6%) and post-traumatic stress disorder (5.7%), associated with psychoactive substance use, low academic performance, job loss, sleep quality, low self-care, and low perception of health status during the pandemic. Conclusions: The symptoms and disorders of anxiety, depression, and stress are the most frequent. Some limitations are the absence of pre-pandemic or quarantine measurement and the use of non-random sampling to generalize the results. Intervention research needs to be formulated to mitigate the psychological impact. Health systems must offer prevention and health promotion programs that consider psychosocial factors aimed at the general population, patients, and health personnel, to decrease the prevalence of these difficulties, particularly for Latin America where about scientific production is scarce.

Objetivo: Realizar uma revisão sistemática da tendência de investigação sobre sintomas de transtornos mentais durante a pandemia por COVID-19. Métodos: Se recuperaram artigos publicados entre 31 de dezembro 2019 e 3 de maio 2020, em Pubmed, SCOPUS, EBSCO, PsycINFO, Science Direct, Redalyc e Web of Science, selecionando, conforme à metodologia PRISMA, um total de 16 artigos, ao descartar-se duplicados ou estudos não empíricos. Resultados: A maioria se realizaram na China, o tamanho da amostra oscilou entre 20 e 7236 participantes, na sua maioria adolescentes e adultos, entre 12 a 80 anos, com amostragem não probabilístico por conveniência. A tendência dos sintomas e transtornos mais estudados foram ansiedade (28%), depressão (23%), estresse (15.3%), transtorno do sono-vigília (9.6%) e transtorno por estresse pós-traumático (5.7%), associados com o consumo de substâncias psicoativas, sob rendimento acadêmico, perda de trabalho, qualidade do sono, baixo autocuidado e baixa percepção do estado de saúde durante a pandemia. Conclusões: Os sintomas e transtornos de ansiedade, depressão e estresse são os mais frequentes. Algumas limitações são a ausência de medição prévia à pandemia ou quarentena e o uso de amostragem não aleatório, para fazer generalização de resultados. É necessário formular investigações de intervenção para mitigar o impacto psicológico. Os sistemas de saúde devem oferecer programas de prevenção e de promoção da saúde, que considerem fatores psicossociais dirigidos à população geral, pacientes e pessoal sanitário, para diminuir a prevalência destas dificuldades, em particular, para Ibero América, onde é escassa a produção científica ao respeito.

Regulatory roles of miR-155 and let-7b on the expression of inflammation-related genes in THP-1 cells: effects of fatty acids

The main aim of this investigation was to study the regulatory roles of let-7b and miR-155-3p on the expression of inflammation-associated genes in monocytes, macrophages, and lipopolysaccharide (LPS)-activated macrophages (AcM). A second goal was to analyze the potential modulatory roles of different fatty acids, including oleic, palmitic, eicosapentaenoic (EPA), and docosahexaenoic (DHA), on the expression of these miRNAs in the three cell types. This hypothesis was tested in human acute monocytic leukemia cells (THP-1), which were differentiated into macrophages with 2-O-tetradecanoylphorbol-13-acetate (TPA) and further activated with LPS for 24 h. Monocytes, macrophages, and AcM were transfected with a negative control, or mimics for miR-155-3p and miR-let-7b-5p. The expression of both miRNAs and some proinflammatory genes was analyzed by qRT-PCR. Interestingly, let-7b mimic reduced the expression of IL6 and TNF in monocytes, and SERPINE1 expression in LPS-activated macrophages. However, IL6, TNF, and SERPINE1 were upregulated in macrophages by let-7b mimic. IL6 expression was higher in the three types of cells after transfecting with miR-155-3p mimic. Similarly, expression of SERPINE1 was increased by miR-155-3p mimic in monocytes and macrophages. However, TLR4 was downregulated by miR-155-3p in monocytes and macrophages. Regarding the effects of the different fatty acids, oleic acid increased the expression of let-7b in macrophages and AcM and also increased the expression of miR-155 in monocytes when compared with DHA but not when compared with non-treated cells. Overall, these results suggest anti- and proinflammatory roles of let-7b and miR-155-3p in THP-1 cells, respectively, although these outcomes are strongly dependent on the cell type. Noteworthy, oleic acid might exert beneficial anti-inflammatory effects in immune cells (i.e., non-activated and LPS-activated macrophages) by upregulating the expression of let-7b

Influencia de la obesidad y la ganancia de peso sobre la calidad de vida según el SF-36 en individuos de la cohorte dinámica Seguimiento Universidad de Navarra / The influence of obesity and weight gain on quality of life according to the SF-36 for individuals of the dynamic follow-up cohort of the University of Navarra

Antecedentes: La calidad de vida relacionada con la salud es un elemento importante en la valoración integral del sobrepeso y la obesidad. Objetivo: Evaluar el impacto de la obesidad y la ganancia de peso sobre la calidad de vida relacionada con la salud en la cohorte dinámica Seguimiento Universidad de Navarra. Materiales y métodos: Los análisis incluyeron a 10.033 participantes de la cohorte dinámica prospectiva del Proyecto Seguimiento Universidad de Navarra, con una tasa de respuesta de aproximadamente el 90%. La calidad de vida fue medida con la versión abreviada de la Encuesta de Salud (SF-36) (0: peor calidad de vida, 100: mejor calidad de vida). El análisis estadístico se realizó con modelos lineales generalizados (media de cada dominio del SF-36 e IC al 95%). Una diferencia de 3 puntos fue considerada como clínicamente relevante. Resultados: El análisis del SF-36 mostró que la función física, la salud general y la variable física sumario fueron inferiores en las personas con sobrepeso y obesidad al inicio del estudio que en los individuos con normopeso. La población a estudio con sobrepeso u obesidad sin cambios tras 2años de seguimiento presentó peores puntuaciones en los dominios del SF-36 correspondientes a la función física, dolor corporal, variable física sumario y salud general que los individuos que mantuvieron la categoría del normopeso según el IMC (kg/m2). Conclusiones: La obesidad parece asociarse a un impacto negativo sobre la calidad de vida relacionada con la salud, que afecta más significativamente al área física que a la psicosocial

Background: The health-related quality of life is an important element for the comprehensive assessment of overweight and obesity. Objective: To assess the impact of obesity and weight gain on the health-related quality of life of the dynamic cohort of the Follow-up Program of the University of Navarra. Material and methods: The analysis included 10,033 participants of the prospective dynamic cohort of the Follow-up Project of the University of Navarra, with a response rate of approximately 90%. The quality of life was measured with the Short Form 36 Health Survey (SF-36) (0, worst quality of life; 100, best quality of life). The statistical analysis was performed with generalized lineal models (mean of each SF-36 domain and 95% CI). A difference of 3 points was considered clinically relevant. Results: The SF-36 analysis showed that physical function, general health and the physical component summary were inferior in individuals with excess weight and obesity at the start of the study, compared with individuals with normal weight. The study population with unchanged excess weight or obesity after 2 years of follow-up presented lower scores on the SF-36 domains corresponding to physical function, body pain, physical component summary and general health than individuals who maintained the normal weight category according to BMI (kg/m2). Conclusions: Obesity appears to be associated with a negative impact on health-related quality of life, affecting the physical area more significantly than the psychosocial

El proceso de llegar a ser excelente en el deporte: el caso de Pau Gasol / O processo de tornar-se excelente no esporte: o caso de Pau Gasol / The process of becoming to be excellent in sport: the case of Pau Gasol

La presente investigación se centra en conocer el proceso de llegar a ser excelente en el deporte a través de un estudio de caso único. Con el método biográfico se han analizado tres grandes dimensiones (deportiva, social y personal) que incluyen 5, 4 y 8 categorías respectivamente. Así, se seleccionaron las fuentes biográficas de Pau Gasol porque eran las que mejor se adaptaban a la propuesta del estudio y al sistema categorial establecido en función de otras investigaciones y del marco conceptual. Además, se han tenido en cuenta los criterios de transferibilidad y credibilidad para dotar de calidad la investigación. Los resultados indican que, para conseguir la excelencia en el deporte, es muy importante la motivación intrínseca y de logro para esforzarse y sacrificarse tanto en el entrenamiento formal como en la práctica por cuenta propia, planteando desafíos y superando las dificultades, aprendiendo de los errores. A nivel social destaca la importancia de la familia como apoyo emocional, como facilitadores y modelos de la práctica deportiva, transmitiendo el valor del esfuerzo. Respecto al entrenador existe un perfil con roles diferenciados entre las etapas formativas y la élite (AU)

The existing research focuses on understanding the process of transitioning towards excellence in sport through a single case study. Through the implementation of the biographical methodology, three major dimensions have been analyzed (sporting, social, and personal), of which include 5, 4 and 8 categories respectively. Thus, biographical sources were selected from subject Pau Gasol because they were the best suited to the proposal of the study and the categorical system established based on other research and the conceptual framework. In addition, it would have taken into account the criteria of transferability and credibility to provide quality research. The results indicate that, in order to achieve excellence in sport, it is vital that the athlete is driven by intrinsic motivation, a self-dedication that permits for sacrifices to be made in order to co-train and self-train, and ultimately a resilience to overcome and learn from mistakes. The social factor stresses the importance of the family as the emotional support, as facilitators and models of the practice of sports, transmitting the value of effort. With regard to the coach, there is a profile with different roles between the formative stages and the elite (AU)

A presente pesquisa enfoca a compreensão do processo de obtenção de ser excelente no desporto através de um único estudo de caso. Com o método biográfico foram analisadas três grandes dimensões (sporting, sociais e pessoais) que incluem 5, 4 e 8 categorias respectivamente. Assim, fontes biográficas foram selecionados de Pau Gasol porque eles eram os mais adequados para a proposta do estudo e o sistema categorial estabelecido com base de outras atividades de investigação e o quadro conceptual. Além disso, teria tomado em consideração os critérios de transferibilidade e credibilidade para fornecer a investigação de qualidade. Os resultados indicam que a fim de alcançar a excelência no desporto, é muito importante para a motivação intrínseca e realização a lutar e sacrificados em ambos o treinamento formal como na prática por sua própria conta, colocam desafios e superar as dificuldades de aprendizagem com os erros. Em nível social sublinha a importância da família como suporte emocional como facilitadores e os modelos de prática de esportes, transmitindo o valor de esforço. No que diz respeito ao treinador existe um perfil com diferentes papéis entre a fases formativas e elite (AU)

Aspectos metodológicos de los procesos asistenciales integrados (PAI) / Methodological aspects of integrated care pathways

Un proceso asistencial integrado (PAI) es una herramienta cuyo propósito es aumentar la efectividad de las actuaciones clínicas a través de una mayor coordinación y garantía de continuidad asistencial. Los PAI sitúan al paciente como el eje central de la organización asistencial. Se definen como el conjunto de actividades que realizan los proveedores de la atención sanitaria con la finalidad de incrementar el nivel de salud y el grado de satisfacción de la población que recibe los servicios. La elaboración de un PAI precisa analizar el flujo de actividades, la interrelación entre profesionales y dispositivos asistenciales y las expectativas del paciente. En este artículo se presenta y se discute la metodología para la elaboración de un PAI, así como los factores de éxito para su definición y su efectiva implantación. Se explica también, a modo de ejemplo, el reciente PAI para hipoglucemias en personas con diabetes mellitus tipo 2 elaborado por un equipo multidisciplinar y avalado por varias sociedades científicas (AU)

An Integrated Healthcare Pathway (PAI) is a tool which has as its aim to increase the effectiveness of clinical performance through greater coordination and to ensure continuity of care. PAI places the patient as the central focus of the organisation of health services. It is defined as the set of activities carried out by the health care providers in order to increase the level of health and satisfaction of the population receiving services. The development of a PAI requires the analysis of the flow of activities, the inter-relationships between professionals and care teams, and patient expectations. The methodology for the development of a PAI is presented and discussed in this article, as well as the success factors for its definition and its effective implementation. It also explains, as an example, the recent PAI for Hypoglycaemia in patients with Type 2 Diabetes Mellitus developed by a multidisciplinary team and supported by several scientific societies (AU)

Adherence to Mediterranean diet is associated with methylation changes in inflammation-related genes in peripheral blood cells

Epigenetic processes, including DNA methylation, might be modulated by environmental factors such as the diet, which in turn have been associated with the onset of several diseases such as obesity or cardiovascular events. Meanwhile, Mediterranean diet (MedDiet) has demonstrated favourable effects on cardiovascular risk, blood pressure, inflammation and other complications related to excessive adiposity. Some of these effects could be mediated by epigenetic modifications. Therefore, the objective of this study was to investigate whether the adherence to MedDiet is associated with changes in the methylation status from peripheral blood cells. A subset of 36 individuals was selected within the Prevención con Dieta Mediterránea (PREDIMED)-Navarra study, a randomised, controlled, parallel trial with three groups of intervention in high cardiovascular risk volunteers, two with a MedDiet and one low-fat control group. Changes in methylation between baseline and 5 years were studied. DNA methylation arrays were analysed by several robust statistical tests and functional classifications. Eight genes related to inflammation and immunocompetence (EEF2, COL18A1, IL4I1, LEPR, PLAGL1, IFRD1, MAPKAPK2, PPARGC1B) were finally selected as changes in their methylation levels correlated with adherence to MedDiet and because they presented sensitivity related to a high variability in methylation changes. Additionally, EEF2 methylation levels positively correlated with concentrations of TNF-alfa and CRP. This report is apparently the first showing that adherence to MedDiet is associated with the methylation of the reported genes related to inflammation with a potential regulatory impact

Influencia de la agresividad sobre el rendimiento de equipos de fútbol en España / The influence of aggressiveness on the performance of football teams in Spain

La agresividad es un concepto complejo de definir, y que engloba aquellas acciones encaminadas a dañar al rival. Pueden estar justificadas como un instrumento para conseguir el objetivo del equipo o ser una manifestación de violencia explícita. El objeto de esta investigación es comprobar si esa creencia sobre el juego agresivo tiene soporte empírico, al analizar su influencia en la variación en el marcador en los partidos disputados en la 1ª división de la liga española de fútbol durante las temporadas 2007/2008 y 2008/2009. Para ello, se distingue entre agresión instrumental y hostil como diferentes niveles de agresividad. Además, se mide el rendimiento de los equipos en relación al cambio en el marcador, una variable reflejada directamente sobre los goles, y no sobre otras variables de juego que pueden o no traducirse en cambios en el marcador. Los resultados muestran, globalmente, que la agresividad tiene efectos negativos sobre el rendimiento (AU)

Aggressiveness is a complex concept to define and one which includes actions intended to harm a rival. Such actions can be justified as a means to achieving the goals of the team, or simply a manifestation of explicit violence. The aim of this research was to test whether the belief that aggressive play reaps benefits has empirical support byanalyzing its influence on the variation in the scoring of all matches in the 1st division of the Spanish football league, for the 2007/2008 and 2008/2009 seasons. In order to do so, we distinguished between instrumental and hostile aggression as different levels of aggressiveness. Furthermore, we measured the performance of teams through changes in the scoreboard, that is to say, when a goal is scored. Results derived from the estimation of five different models showed, overall, that aggressiveness has a negative impact on team performance (AU)

Utilidad del cuestionario «Edmonton Obesity Staging System» para el desarrollo de la nutrición médica de precisión / Usefulness of the «Edmonton Obesity Staging System» to develop precise medical nutrition

No disponible

Tratamiento de fracturas de tercio distal de clavícula (tipo ii-b de Neer) con sistema de triple botón / Treatment of distal-third clavicular fractures (Neer type ii-b) with a triple button device

Objetivo. El objetivo de este estudio es describir los resultados de un dispositivo de triple botón para el tratamiento de las fracturas desplazadas de tercio distal de clavícula (tipo ii-b de Neer). Material y método. Estudio retrospectivo de una serie de pacientes entre noviembre de 2011 y diciembre de 2014. Catorce pacientes se ajustaron inicialmente a los criterios de inclusión, 2 de los cuales fueron excluidos, dejando 12 pacientes (83,3% varones; edad media 32,2 años) para el análisis final. El seguimiento medio fue de 26±11,24 meses (rango, 12-48). El seguimiento postoperatorio se realizó a las 2 semanas (en los 2 primeros meses) y después mensualmente, hasta que se consiguió la curación clínica y radiológica. El resultado funcional se evaluó mediante el test de Constant y la puntuación DASH en el último seguimiento. Resultados. La puntuación media del test de Constant fue de 95,5±5,2 puntos (rango, 85-100) y la del test DASH, de 3,3±4,4 puntos (rango: 0-12,5). El tiempo medio para la curación clínica fue de 10,3±3,1 semanas (rango, 8-16) y para la consolidación radiológica, de 13,6±2,6 semanas (rango, 12-20). No hubo complicaciones mayores. Hubo 5 complicaciones menores sin repercusión clínica: 2 calcificaciones coracoclaviculares, una cicatriz hipertrófica, un paciente con molestias sobre el dispositivo y una infección de la herida. Todos los pacientes retomaron su actividad previa. Conclusión. El dispositivo de triple botón consigue excelentes resultados en el tratamiento de las fracturas de tercio distal de clavícula sin necesidad de retirar el material (AU)

Objective. The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). Material and method. A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. Results. The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. Conclusion. Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware (AU)

Cambios alimentarios y de estilo de vida como estrategia en la prevención del síndrome metabólico y la diabetes mellitus tipo 2: hitos y perspectivas / Alimentary and lifestyle changes as a strategy in the prevention of metabolic syndrome and diabetes mellitus type 2: milestones and perspectives

El elevado aporte calórico de la alimentación actual y el sedentarismo, son los principales causantes del notable incremento de la obesidad en nuestra sociedad. A su vez, esto conlleva un aumento de las patologías asociadas a ella, como pueden ser el síndrome metabólico y la diabetes tipo 2. En el presente trabajo, han sido revisados los estudios y programas más recientes y significativos en cuanto a su tamaño muestral y a su diversidad geográfica, poniendo de manifiesto que los cambios en la alimentación y en los estilos de vida, son un instrumento efectivo para combatir o retrasar la aparición de estas enfermedades. En este sentido, la prevención también es clave para evitar las graves consecuencias, relacionadas con la diabetes y el síndrome metabólico, que pueden afectar a la calidad de vida de la población (AU)

A high caloric intake in today’s nutrition and a sedentary lifestyle are the main causes of the notable increase in obesity in our society. In turn, this results in an increase in associated pathologies, such as metabolic syndrome and diabetes type 2. In the present work we review most recent studies and programs, which are significant due to their sample size and geographical diversity. It clearly shows that changes in alimentation and lifestyles are an effective instrument for combatting or delaying the onset of these diseases. In this sense, prevention is also key to avoiding serious consequences related to diabetes and metabolic syndrome, which can affect the life of the population (AU)

Circulating irisin and glucose metabolism in overweight/obese women: effects of alpha-lipoic acid and eicosapentaenoic acid

Irisin is a myokine/adipokine with potential role in obesity and diabetes. The objectives of the present study were to analyse the relationship between irisin and glucose metabolism at baseline and during an oral glucose tolerance test (OGTT) and to determine the effects of eicosapentaenoic acid (EPA) and/or alpha-lipoic acid treatment on irisin production in cultured human adipocytes and in vivo in healthy overweight/obese women following a weight loss program. Seventy-three overweight/obese women followed a 30 % energy-restricted diet supplemented without (control) or with EPA (1.3 g/day), alpha-lipoic acid (0.3 g/day) or both EPA + alpha-lipoic acid (1.3 + 0.3 g/day) during 10 weeks. An OGTT was performed at baseline. Moreover, human adipocytes were treated with EPA (100–200 μM) or alpha-lipoic acid (100–250 μM) during 24 h. At baseline plasma, irisin circulating levels were positively associated with glucose levels; however, serum irisin concentrations were not affected by the increment in blood glucose or insulin during the OGTT. Treatment with alpha-lipoic acid (250 μM) upregulated Fndc5 messenger RNA (mRNA) and irisin secretion in cultured adipocytes. In overweight/obese women, irisin circulating levels decreased significantly after weight loss in all groups, while no additional differences were induced by EPA or alpha-lipoic acid supplementation. Moreover, plasma irisin levels were positively associated with higher glucose concentrations at beginning and at endpoint of the study. The data from the OGTT suggest that glucose is not a direct contributing factor of irisin release. The higher irisin levels observed in overweight/obese conditions could be a protective response of organism to early glucose impairments

Impact of intermittent hypoxia and exercise on blood pressure and metabolic features from obese subjects suffering sleep apnea-hypopnea syndrome

Strategies designed to reduce adiposity and cardiovascular-accompanying manifestations have been based on nutritional interventions conjointly with physical activity programs. The aim of this 13-week study was to investigate the putative benefits associated to hypoxia plus exercise on weight loss and relevant metabolic and cardiorespiratory variables, when prescribed to obese subjects with sleep apnea syndrome following dietary advice. The participants were randomly distributed in the following three groups: control, normoxia, and hypoxia. All the subjects received dietary advice while, additionally, normoxia group was trained under normal oxygen concentration and Hypoxia group under hypoxic conditions. There was a statistically significant decrease in fat-free mass (Kg) and water (%) on the control compared to normoxia group (p < 0.05 and p < 0.01, respectively). Body weight, body mass index, and waist circumference decreased in all the groups after the study. Moreover, leukocyte count was increased after the intervention in hypoxia compared to control group (p < 0.05). There were no statistically significant variations within groups in other variables, although changes in appetite were found after the 13-week period. In addition, associations between the variations in the leukocyte count and fat mass have been found. The hypoxia group showed some specific benefits concerning appetite and cardiometabolic-related measurements as exertion time and diastolic blood pressure, with a therapeutical potential

Parity implications for anthropometrical variables, lifestyle behaviors and dietary habits in pregnant women / Influencia de la paridad sobre variables antropométricas, estilos de vida y hábitos alimentarios en mujeres embarazadas

Background: Maintaining an adequate health status and appropriate lifestyles during pregnancy is of great importance to prevent adverse outcomes for both mother and baby. The present study aimed to assess the nutritional status, socio-demographic features, lifestyle behaviors and dietary habits of pregnant women in Spain, and to identify the influence of parity on these profiles. Methods: This cross-sectional study included pregnant women from regions all over Spain. The information was collected through a 40 item questionnaire, previously validated, by community health professionals. Results: The 5,087 pregnant women analyzed had an average age of 31.9 years with an adequate nutritional status. The distribution of the sample was 56% nulliparous and 44% multiparous. The nulliparous reported a better self-perceived health status and nutritional balance, and a lower incidence of gestational diabetes mellitus. However, the multiparous showed healthier lifestyle habits (lower rates of smoking and alcohol consumption) and more physically active patterns. Regarding diet, nulliparous pregnant women consumed more dairy products, fresh fruit and nuts, and less bread, rice/pasta/potatoes, meat, sausage and buns/pastries than multiparous pregnant women. Conclusions: Differences between analyzed patterns were observed in anthropometrical variables, lifestyle behaviors and dietary habits, which may require different nutritional messages to nulliparous as compared to multiparous from a public health point of view (AU)

Fundamento: Durante el embarazo, el mantenimiento de un adecuado estado de salud y estilos de vida, es de gran importancia para prevenir resultados adversos tanto para la madre como para el bebé. El presente estudio tuvo como objetivos evaluar el estado nutricional, características sociodemográficas, estilos de vida y hábitos alimentarios de mujeres embarazadas en España, e identificar la influencia de la paridad sobre estos perfiles. Material y método: Este estudio transversal incluyó mujeres embarazadas de todas las comunidades autónomas de España. La información se recogió a través de un cuestionario de 40 preguntas, previamente validado, por profesionales de la salud comunitarios. Resultados: Las 5.087 mujeres embarazadas presentaron una edad media de 31,9 años y un adecuado estado nutricional. De la muestra un 56% fueron nulíparas y un 44% multíparas. Las mujeres nulíparas declararon mejor autopercepción de su estado de salud y estado nutricional, y menor incidencia de diabetes mellitus gestacional. Sin embargo, las mujeres multíparas mostraron estilos de vida más saludables (tasas de consumo de tabaco y alcohol más bajas) y un patrón de actividad física más activo. En cuanto a la dieta, las nulíparas consumieron más lácteos, fruta fresca y frutos secos, y menos pan, arroz/pasta/patatas, carne, embutidos y bollos/pasteles que las multíparas. Conclusiones: Se observaron diferencias entre los grupos analizados en cuanto a variables antropométricas, estilos de vida y hábitos alimentarios, que pueden requerir distintos mensajes nutricionales para mujeres nulíparas y multíparas, desde un punto de vista de Salud Pública (AU)

Prevalencia de ansiedad y depresión en pacientes con EPOC, calculada mediante diagnóstico psiquiátrico / Prevalence of anxiety and depression in COPD patients, diagnosed with psychiatric confirmation

INTRODUCCIÓN: la asociación de la EPOC a ansiedad o a depresión constituye una dimensión importante de la enfermedad, pero sin embargo, a menudo, estas comorbilidades no son diagnosticadas. Los estudios disponibles sobre prevalencia de ansiedad y depresión, con frecuencia, disponen de tamaños de muestra pequeños y carecen de un diagnóstico de certeza mediante entrevista psiquiátrica estructurada. OBJETIVO: el objetivo principal del estudio es calcular la frecuencia de asociación entre ansiedad o depresión y EPOC y determinar el grado de infradiagnóstico en nuestra muestra. Del mismo modo, se analizarán qué factores clínicos, funcionales y sociodemográficos distinguen a los pacientes EPOC con ansiedad o depresión del resto de la muestra, para identificar posibles factores de riesgo para estas comorbilidades, a tener en cuenta tanto en la práctica clínica como en sucesivos estudios. Pacientes y método: se han estudiado 204 pacientes ambulatorios con EPOC estable, a los que se realizó un cribado de síntomas de ansiedad o depresión, mediante el cuestionario autoadministrable «Hospital Anxiety and Depression Scale» (HADS) y una confirmación posterior, mediante diagnóstico psiquiátrico. El diagnóstico final de ansiedad o depresión se ajustó a los criterios de la clasificación ICD 10. RESULTADOS: se confirmó la presencia de comorbilidad psiquiátrica (ansiedad o depresión) en un 36% de los pacientes. Al inicio del estudio, sólo un 8% de los incluidos había sido diagnosticado de ansiedad o depresión. Se constató un alto grado de acuerdo entre el HADS positivo y el diagnóstico psiquiátrico. La prevalencia de ansiedad o depresión asociadas a la EPOC se sitúa entre el 32-45%, con una confianza del 95%. CONCLUSIONES: el uso del cuestionario autoadministrado HADS en la práctica clínica habitual puede corregir el alto infradiagnóstico de la ansiedad y la depresión en los pacientes EPOC

INTRODUCTION: the association between COPD and anxiety or depression is an important dimension of the disease but frequently those comorbidities are undiagnosed. The available studies about anxiety and depression prevalence usually achieve small numbers of patients y lack of a certain diagnosis based on a structured psychiatric schedule. OBJECTIVE: the primary objective of the study is to estimate the frequency of the association between anxiety or depression and COPD and to determinate the underdiagnosis level in our sample. The clinical, functional and social and demographics factors that characterize the COPD patients with anxiety or depression to identify possible risk factors for these comorbidities that should be considered both in clinical practice and future studies. PATIENTS AND METHOD: 204 out-patients with stable COPD were screened for anxiety and depression with the self-administered «Hospital Anxiety and Depression Scale» (HADS) and if positive, a psychiatric interview was made to confirm the diagnosis. The anxiety or depression final diagnosis was made according the ICD 10 criteria. RESULTS: the presence of psychiatric comorbidity (anxiety or depression) was confirmed in a 36% of the patients. At de beginning of the study only an 8% of the patients included were already diagnosed with anxiety or depression. The prevalence of anxiety or depression associated with COPD lies between 32-45% with a 95% confidence. CONCLUSIONS: using the self-administered HADS in the clinical practice may correct the high underdiagnosis of anxiety and depression in COPD patients

La geometría de la quilla condiciona el comportamiento de la bandeja tibial frente a fuerzas de torsión en prótesis totales de rodilla / The geometry of the keel determines the behaviour of the tibial tray against torsional forces in total knee replacement

El diseño de la quilla de una bandeja tibial es fundamental para la transmisión de la mayor parte de las cargas a las estructuras óseas periféricas, las cuales tienen mejores propiedades mecánicas reduciendo, de este modo, el riesgo de aflojamiento. El objetivo de este estudio es comparar el comportamiento de diferentes diseños de bandeja tibial ante cargas de torsión. Se modelizaron 4 componentes tibiales diferentes. La reconstrucción 3 D se llevó a cabo con el programa MIMICS. Los sólidos se generaron en SolidWorks. Se realizó el estudio por elementos finitos mediante Unigraphics. Se simuló una torsión de 6 Nm aplicada sobre los laterales de cada bandeja tibial. La bandeja tibial GENUTECH® con apoyo en el hueso trabecular periférico mostró un menor desplazamiento y menores tensiones transmitidos bajo fuerzas de torsión. Los resultados indican que la bandeja tibial con apoyo más periférico tienen un mejor comportamiento mecánico mejor frente a los otros diseños estudiados (AU)

The keel design of the tibial tray is essential for the transmission of the majority of the forces to the peripheral bone structures, which have better mechanical proprieties, thus reducing the risk of loosening. The aim of the present study was to compare the behaviour of different tibial tray designs submitted to torsional forces. Four different tibial components were modelled. The 3-D reconstruction was made using the Mimics software. The solid elements were generated by SolidWorks. The finite elements study was done by Unigraphics. A torsional force of 6 Nm. applied to the lateral aspects of each tibial tray was simulated. The GENUTECH® tibial tray, with peripheral trabecular bone support, showed a lower displacement and less transmitted tensions under torsional forces. The results suggest that a tibial tray with more peripheral support behaves mechanically better than the other studied designs (AU)

Epigenetic patterns of two gene promoters (TNF-alpha and PON) in stroke considering obesity condition and dietary intake

Some causal bases of stroke remain unclear, but the nutritional effects on the epigenetic regulation of different genes may be involved. The aim was to assess the impact of epigenetic processes of human tumor necrosis factor (TNF-alfa) and paraoxonase (PON) promoters in the susceptibility to stroke when considering body composition and dietary intake. Twenty-four patients (12 non-stroke/12 stroke) were matched by sex (12 male/12 female), age (mean 70 ± 12 years old), and BMI (12 normal-weight/12 obese; mean 28.1 ± 6.7 kg/m2). Blood cell DNA was isolated and DNA methylation levels of TNF-alfa (-186 to +349 bp) and PON (-231 to +250 bp) promoters were analyzed by the Sequenom EpiTYPER approach. Histone modifications (H3K9ac and H3K4me3) were analyzed also by chromatin immunoprecipitation in a region of TNF-α (-297 to -185). Total TNF-α promoter methylation was lower in stroke patients (p < 0.001) and showed no interaction with body composition (p = 0.807). TNF-α and PON total methylation levels correlated each other (r = 0.44; p = 0.031), especially in stroke patients (r = 0.72; p = 0.008). The +309 CpG methylation site from TNF-α promoter was related to body weight (p = 0.027) and the region containing three CpGs (from −170 to -162 bp) to the percentage of lipid intake and dietary indexes (p < 0.05) in non-stroke patients. The methylation of PON +15 and +241 CpGs was related to body weight (p = 0.021), waist circumference (p = 0.020), and energy intake (p = 0.018), whereas +214 was associated to the quality of the diet (p < 0.05) in non-stroke patients. When comparing stroke vs non-stroke patients regarding the histone modifications analyzed at TNF-α promoter, no changes were found, although a significant association was identified between circulating TNF-alfa level and H3K9ac with H3K4me3. TNF-alfa and PON promoter methylation levels could be involved in the susceptibility to stroke and obesity outcome, respectively. The dietary intake and body composition may influence this epigenetic regulation in non-stroke patients

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La alimentación del adolescente: necesidad imperiosa de actuar de forma inmediata / Adolescent nutrition: an urgent need to act immediately

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