Predictive factors of destination at discharge after spinal cord injury.

INTRODUCTION: One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. MATERIAL AND METHODS: We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. RESULTS: During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69). CONCLUSIONS: Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.

Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus.

AIMS: To see the effects of obesity on risk fracture, bone density (BMD), and vitamin D levels in a group of postmenopausal women, and consider how comorbid type 2 diabetes mellitus (T2DM) modifies them. METHODS: 679 postmenopausal women were grouped into obese and non-obese. Obese women were grouped into those with T2DM and those without. 25(OH)-vitamin D, PTH and BMD were measured, and prevalent fragility fractures were gathered. RESULTS: Obese women had higher prevalence of T2DM, than non-obese women. Levels of 25(OH)-vitamin D were lower and those of PTH higher in obese women, BMD values were higher in obese women. Diabetic-obese women had a higher prevalence of non-vertebral fractures than non-diabetic-obese. Multivariate logistic regression model showed association of fragility fractures with age, total hip BMD, BMI and T2DM. Obese women have higher BMD and lower 25(OH)-vitamin D values (and higher PTH) than non-obese, without diabetes. CONCLUSIONS: T2DM confers an increased risk of non-vertebral fractures in postmenopausal obese women.

Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical / Factors associated with functional improvement in patients with cervical spinal cord injuries

Objetivo Determinar los factores que influyen en la mejoría funcional de un lesionado medular cervical traumático durante la hospitalización. Material y métodos Se ha realizado un estudio retrospectivo donde se han incluido los pacientes que han sufrido una lesión medular cervical traumática aguda y que han concluido un programa de rehabilitación en la Unidad de Lesionados Medulares de Canarias entre 2001 y 2018. Para medir la mejoría funcional se ha realizado una valoración del SCIM III al ingreso y al alta. Resultados El 88% de los 141 pacientes de nuestra muestra han sido hombres: pacientes de edad avanzada, con antecedentes de consumo de alcohol, las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. El tiempo desde la lesión hasta el ingreso en la unidad, el tiempo de estancia hospitalaria y el tiempo desde la lesión al alta hospitalaria han tenido una relación significativa con la mejoría funcional. Conclusiones En pacientes con edad avanzada y con antecedentes de consumo de alcohol las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. Por otro lado, el ingreso precoz ha sido fundamental para obtener mejores resultados funcionales y se ha relacionado con estancias hospitalarias más cortas (AU)

Objective To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. Material and methods We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. Results Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. Conclusions Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays (AU)

Influencia de la lactancia materna en el metabolismo mineral óseo después de la menopausia / Influence of breastfeeding on bone mineral metabolism after menopause

Objetivo: Los estilos de vida y la historia ginecológica parecen influir en el metabolismo mineral óseo. Existen datos contradictorios sobre los posibles efectos de la lactancia materna en el posterior desarrollo de una osteoporosis densitométrica o la aparición de fracturas por fragilidad. El objetivo de este estudio fue valorar dichos efectos. Material y métodos: Estudio observacional, transversal, abierto, realizado en 758 mujeres postmenopáusicas que fueron clasificadas en dos grupos, dependiendo de que hubieran lactado a sus hijos o no. Se recogieron datos sobre estilos de vida, historia ginecológica y fracturas por fragilidad. Se les realizó una analítica general, con función renal, hepática, lípidos, iones, así como marcadores bioquímicos de remodelado óseo, hormona paratiroidea (PTH) y vitamina D (25HCC). Se les determinó la densidad mineral ósea (DMO) en la columna lumbar y en la extremidad proximal del fémur mediante absorciometría dual de rayos X (DXA). Así mismo se les realizó una medición mediante ultrasonografía cuantitativa (QUS) en el calcáneo del pie dominante. Los datos crudos, después de ser comparados por grupos, fueron ajustados aplicando el método de pareamiento por puntuación de propensión o propensity score matching, realizándose una comparación más precisa de las variables estudiadas. (AU)

Objetive: Lifestyle and gynecological history appear to influence bone mineral metabolism. There are conflicting data on the possible effects of breastfeeding on the subsequent development of densitometric osteoporosis or the development of fragility fractures. The objective of this study was to assess these effects. Material and methods: Observational, cross-sectional, open study, carried out in 758 postmenopausal women who were classified into two groups, depending on whether they had breastfed their children or not. Data were collected on lifestyles, gynecological history and fragility fractures. They underwent a general analysis, with renal and hepatic function, lipids, ions, as well as biochemical markers of bone remodeling, parathyroid hormone (PTH) and vitamin D (25HCC). Bone mineral density (BMD) was determined in the lumbar spine and in the proximal extremity of the femur by dual Xray absorptiometry (DXA). Likewise, a quantitative ultrasound (QUS) measurement was performed on the calcaneus of the dominant foot. The raw data, after being compared by groups, were adjusted by applying the propensity score matching method, making a more precise comparison of the variables studied. (AU)

Uricemia como factor pronóstico del ictus isquémico agudo / Hyperuricaemia as a prognostic factor for acute ischaemic stroke

Introducción: En el proceso de búsqueda de biomarcadores para el pronóstico del ictus agudo, en los últimos años los estudios realizados en torno al ácido úrico han mostrado resultados contradictorios.MétodosSe recogieron muestras analíticas de 600 pacientes ingresados de manera consecutiva en un hospital de tercer nivel y se analizó la relación entre los niveles de ácido úrico y el pronóstico funcional de los pacientes medido mediante la escala de Rankin modificada (mRS). Se excluyeron los pacientes que habían recibido terapias de reperfusión, ya que podría existir un efecto diferencial en los mismos respecto a los no tratados.ResultadosEl 73% de los pacientes tuvieron una mRS ≤ 2 y los niveles medios de ácido úrico fueron de 5,22 mg/dl. Se encontró una relación no lineal entre el pronóstico funcional al alta y los niveles de ácido úrico sérico en el momento del ingreso al excluir del análisis la medida de la National Institutes of Health Stroke Scale (NIHSS).ConclusionesLos valores séricos de ácido úrico en pacientes afectos de un ictus isquémico agudo se asocian significativamente con el pronóstico funcional en el momento de su alta, pero esta relación es no lineal. Se asocia un peor pronóstico a las concentraciones extremas, muy bajas o muy elevadas, de ácido úrico. Esto podría revelar un doble papel del ácido úrico en su relación con el ictus, como factor de riesgo asociado y/o como posible neuroprotector dado su papel antioxidante. (AU)

Introduction: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results.MethodsWe collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels.ResultsA total of 73% of patients had mRS scores ≤ 2; the mean uric acid level was 5.22 mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis.ConclusionsSerum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect. (AU)

Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

[Factors associated with functional improvement in patients with cervical spinal cord injuries]. / Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical.

OBJECTIVE: To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS: We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS: Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS: Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.

Comparación de los valores densitométricos de la extremidad proximal del fémur en sujetos jóvenes sanos: zurdos vs. diestros / Comparison of the femur proximal extremity’s densitometric values in young and healthy study participants: left-handed vs. right-handed

OBJETIVO: La actividad física es un determinante de la densidad mineral ósea. Las personas zurdas ejercitan más los miembros izquierdos que las diestras, quienes lo hacen con los derechos. El objetivo de este trabajo fue estudiar si los sujetos zurdos tienen valores más elevados de DMO en el miembro inferior izquierdo (fémur proximal) y los diestros en el derecho. MATERIAL Y MÉTODOS: Estudio observacional, transversal realizado en sujetos jóvenes sanos de ambos sexos que no realizaban actividad deportiva, que fueron agrupados en zurdos o diestros según su lateralidad, la cual se estableció aplicando el cuestionario de Edimburgo. A todos ellos se les midió la densidad mineral ósea en la columna lumbar y en la extremidad proximal de ambos fémures por medio de un densitómetro Hologic QDR 4500, Discovery®. RESULTADOS: De los 122 sujetos estudiados, 62 eran diestros y 60 zurdos. No se observaron diferencias estadísticamente significativas entre los casos y controles en la edad, proporción de varones y mujeres, índice de masa corporal y distribución de los estilos de vida: consumo de alcohol, tabaco y actividad física en el tiempo libre. Los zurdos y los diestros mostraron valores similares de densidad mineral ósea en la columna y en todas las localizaciones anatómicas medidas (cuello femoral, total de cadera, trocánter e intertrocánter) de ambos fémures, derecho e izquierdo. Sin embargo, en el fémur izquierdo se obtuvieron valores más bajos de DMO en comparación con el derecho en todas las localizaciones medidas (diferencias que fueron estadísticamente significativas) tanto al considerar a todos los sujetos juntos como al agruparlos según su lateralidad.(AU)

OBJETIVO: Physical activity is a key factor for bone mineral density. Left-handed people exercise more left limbs than right-handed do. The objective of this study was to determine whether left-handed participants have higher values of BMD in the left lower limbs (proximal femur) and right-handed subjects have them higher in the right lower ones. MATERIAL AND METHODS: Cross-sectional observational study performed on young and healthy men and women who do not practice any sport activity, and who were divided into two groups according to their laterality, established by the Edinburgh Handedness Inventory. The bone mineral density in the lumbar spine and the proximal extremity of both femurs was measured in all of the participants using a Hologic QDR 4500 Discovery® densitometer. RESULTS: From the 122 study participants, 62 were right-handed and 60 were left-handed. Statistically significant differences were not perceived among the participants, nor age-related, or in male-female proportion, body mass index or according to the subjects’ lifestyle: alcohol consumption, tobacco use and physical activity practiced during leisure time. Left and right-handed participants showed similar values for bone mineral density in the spine and in all the anatomical regions measured (femoral neck, total hip, trochanter and intertrochanter) in the right and left femurs. However, lower BMD values were obtained in all the measured locations of the left femur, compared to the same measurements in the right femur (these differences being statistically significant) when considered all the participants as a whole or when grouping them according to their laterality. (AU)

Estado cualitativo y cuantitativo óseo generalizado enla osteonecrosis de maxilares. Efecto de los bifosfonatos / Qualitative and quantitative status of general bonein osteonecrosis of the jaws. Effect of bisphosphonates

OBJETIVO: La osteonecrosis de maxilares (ONM) es una enfermedad recientemente descrita cuya etiopatogenia es desconocida, aunque se ha atribuido, entre otras causas, al tratamiento prolongado con bifosfonatos. Sin embargo, mientras que la ONM es una patología localizada, la acción de los bifosfonatos es generalizada, es decir, afecta a todos los huesos. No hay estudios que muestren el estado óseo general de los pacientes con ONM. Con este trabajo hemos querido estudiar en pacientes afectos de ONM dicho estado general mediante medidas cuantitativas y estimaciones cualitativas del hueso por medio de la densidad mineral ósea (DMO) y el trabecular bone score (TBS) y los parámetros ultrasonográficos en el calcáneo (QUS), además de la presencia de otras enfermedades y la toma de fármacos (especialmente los bifosfonatos) en los pacientes con ONM que pudieran participar en su etiopatogenia. MATERIAL Y MÉTODO: Estudio observacional y transversal de casos y controles, realizado en 304 pacientes de ambos sexos, en los que el grupo de casos (grupo I) estaba formado por 24 pacientes que habían sufrido una ONM, mientras que el grupo control (grupo II) estaba formado por 280 pacientes que no presentaban ONM y que recibían bifosfonatos desde un mínimo de 5 años por causas diversas. A todos ellos se les realizó una densitometría ósea (DXA, Hologic 4500 Discovery®) en la columna lumbar y en la extremidad proximal del fémur. Además, se les realizó mediciones del TBS en la columna lumbar, así como de los parámetros ultrasonográficos en el calcáneo (Hologic, Sahara®) en el pie dominante (QUS). RESULTADOS: Los pacientes afectos de ONM tenían una mayor comorbilidad que los controles, con una mayor prevalencia de las siguientes enfermedades: diabetes mellitus, cáncer, artritis reumatoide, hipertiroidismo, cardiopatía, arritmias, insuficiencia cardíaca e hipercolesterolemia. Por ello, el consumo de corticoides, (orales e inhalados), anticoagulantes, hipnóticos, bifosfonatos i.v. (zoledronato), y quimioterapia antineoplásica fue también mayor entre los pacientes afectos de ONM que los pacientes controles. Sin embargo, entre los pacientes con ONM el porcentaje que tomaba bifosfonatos orales fue menor. Los valores densitométricos (DMO medida en la columna lumbar L2-L4, cuello femoral y total de cadera) fueron más elevados en los pacientes con ONM en comparación con los de los controles. El TBS no mostró diferencias estadísticamente significativas entre ambos grupos, y los ultrasonidos presentaron valores más elevados de QUI y SOS en los pacientes con ONM que en los controles. La prevalencia de fracturas por fragilidad fue similar en ambos grupos. CONCLUSIONES: Nuestros pacientes afectos de ONM mostraron una mayor comorbilidad y un mayor consumo de fármacos que los pacientes del grupo control, a excepción de bifosfonatos orales. Por otro lado, tanto la DMO como los parámetros ultrasonográficos mostraron valores más elevados en los pacientes con ONM que los controles. Si consideramos la DXA como una técnica medidora de la cantidad de masa ósea, y el TBS y la ultrasonografía de calcáneo técnicas estimadoras de aspectos cualitativos del hueso, podemos suponer que ni la cantidad ni la calidad óseas en general parecen estar afectadas en la ONM, siendo probablemente otro su mecanismo etiopatogénico. Los bifosfonatos orales no parecen estar entre los fármacos que participen en la etiología de la ONM, aunque sí los bifosfonatos más potentes que se administran por vía intravenosa, si bien no pueden considerarse independientemente de la patología subyacente para la cual se administran

OBJECTIVE: Osteonecrosis of the jaw (ONJ) is a recently reported disease whose origin and development are unknown, although prolonged bisphosphonate treatment has been attributed, among other causes. While ONJ is a localized condition, the action of bisphosphonates is widespread and affects all bones. No studies show the general bone status of patients with ONJ. Our study examines the general condition in patients with ONJ using quantitative measurements and qualitative estimates of bone by means of bone mineral density (BMD) and trabecular bone score (TBS) and ultrasound parameters in the calcaneus (QUS), along with other diseases and the taking of drugs (especially bisphosphonates) in patients with ONJ who may be involved in the pathogenesis. MATERIAL AND METHOD: Observational and cross-sectional study of cases and controls, conducted in 304 patients of both sexes, in which the case group (group I) was formed by 24 patients who had suffered ONJ. The control group (group II) contained 280 patients who did not present ONJ and who received bisphosphonates over at least 5 years for various reasons. All of them underwent bone densitometry (DXA, Hologic 4500 Discovery®) in the lumbar spine and proximal femur. In addition, TBS measurements were made in the lumbar spine, as well as ultrasound parameters in the calcaneus (Hologic, Sahara®) in the dominant foot (QUS). RESULTS: Patients suffering ONJ presented greater comorbidity than controls, with a higher prevalence of diabetes mellitus, cancer, rheumatoid arthritis, hyperthyroidism, heart disease, arrhythmias, heart failure and hypercholesterolemia. Therefore, the consumption of corticosteroids, (oral and inhaled), anticoagulants, hypnotics, bisphosphonates i.v. (zoledronate), and antineoplastic chemotherapy was also higher among patients with ONJ than control patients. However, among the patients with ONJ the percentage taking oral bisphosphonates was lower. Densitometric values (BMD measured in lumbar spine L2-L4, femoral neck and total hip) were higher in patients with ONJ compared to those in controls. The TBS showed no statistically significant differences between the two groups, and the ultrasound showed higher values of QUI and SOS in patients with ONJ than in controls. The prevalence of fragility fractures was similar in both groups. CONCLUSIONS: Patients with ONJ in our study presented greater comorbidity and a higher consumption of drugs than the patients in the control group, except for oral bisphosphonates. On the other hand, both BMD and ultrasound showed higher values in patients with ONJ than in controls. If we consider DXA as a technique for measuring the amount of bone mass, and TBS and calcaneal ultrasound estimating qualitative aspects of bone, we could assume that neither bone quantity nor quality in general seems to be affected in ONJ, and that its etiopathogenic mechanism is probably another. Oral bisphosphonates do not appear to be among the drugs involved in ONJ's origin and development, but the most potent and intravenously administered bisphosphonates are, although they cannot be considered independently of the underlying disease for which they are administered

¿Cuál es el nivel de contaminación del cepillo de dientes almacenado en diferentes entornos sanitarios? / What is the level of toothbrush contamination stored in different sanitary settings?

Introducción: Los cepillos pueden albergar una amplia variedad de microorganismos, incluyendo bacterias hongos y virus, pudiendo así facilitar la translocación de especies en un mismo individuo y la transmisión de especies entre individuos. Métodos: Estudio de la contaminación bacteriana de los cepillos de dientes de cien voluntarios con la cumplimentación de un cuestionario (lugar de almacenamiento, tipo de cepillo, utilización de estuche de almacenamiento y meses de uso). Resultados: Se estudiaron un total de 100 muestras. El 33% guardaba el cepillo fuera del baño, un 20% lo guardaba en el cajón del baño y un 47% sobre el lavabo del baño. El 92% de las muestras estaban contaminadas como mínimo con un grupo de microorganismos Conclusión: El lugar de almacenamiento del cepillo de dientes es fundamental en la reducción de la contaminación. Se debe guardar en un lugar seco, lejos del inodoro y sin estuche

Introduction: Brushes can house a wide variety of microorganisms, including fungal bacteria and viruses, which can facilitate the translocation of species in the same individual and the transmission of species between individuals. Methods: Study of the bacterial contamination of toothbrushes of one hundred volunteers with the completion of a questionnaire (place of storage, type of brush, use of storage case and months of use). Results: A total of 100 samples were studied. 33% kept the brush outside the bathroom, 20% kept it in the bathroom drawer and 47% on the bathroom sink. 92% of the samples were contaminated with at least one group of microorganisms. Conclusion: The storage place of the toothbrush is fundamental in the reduction of contamination. It should be stored in a dry place, away from the toilet and without a box

Cytokine distribution in mothers and breastfed children after omega-3 LCPUFAs supplementation during the last trimester of pregnancy and the lactation period: A randomized, controlled trial.

OBJECTIVE: To determine whether maternal diet supplementation with omega-3 long chain polyunsaturated fatty acids (omega-3 LC-PUFAs) during the last trimester of pregnancy and the breastfeeding period influences the levels of inflammatory cytokines in mother and infants. MATERIAL AND METHOD: This registered, double-blind randomized study included 46 pregnant women, who were randomly allocated to either an experimental group receiving 400mL/day of a fish oil-enriched dairy drink [320mg docosahexaenoic acid (DHA) + 72mg eicoapentaenoic acid] (FO group, n = 24) or to a control group receiving 400mL/day of a non-supplemented dairy drink (CT group, n = 22), from week 28 of pregnancy until the fourth month of lactation. During the study, maternal dietary patterns were monitored by a nutritionist, who encouraged compliance with current recommendations of fatty acids intake. DHA concentrations and cytokine levels (GM-CSF, IL-2, IL-4, IL-6, IL-10, INF-γ and TNF-α) were measured in maternal plasma at the moment of recruitment and in maternal (n = 46) and infant (n = 46) plasma at birth and 2.5 months after birth. RESULTS: Maternal plasmatic IL-4 levels were higher in FO than in CT subjects (p = 0.009). Additionally, a tendency was observed to higher IL-10 and IL-2 in the FO group. Plasmatic IL-6 however, was higher in CT mothers (p = 0.001). TNF-α was higher in CT infants at birth and 2.5 months after birth (p = 0.005). An analysis of possible relationships between DHA and the concentrations of different cytokines revealed negative correlation between maternal plasmatic IL-6 and DHA (higher plasmatic DHA corresponded to lower IL-6). CONCLUSIONS: Maternal dietary omega-3 LC-PUFAs supplementation during critical periods like pregnancy, lactation and early newborn development may influence the levels of certain inflammatory cytokines, reducing pro-inflammatory cytokines and promoting an anti-inflammatory "environment".

Valoración de la capacidad predictiva de la calculadora Garvan del riesgo de fractura a 10 años en una población española / Assessment of the predictive capacity of the Garvan calculator of 10 year risk of fracture in a Spanish population

Introducción: En los últimos años se han desarrollado varias herramientas de cálculo o escalas para valorar el riesgo de fractura por fragilidad a largo plazo. La calculadora Garvan no ha sido validada en la población española. El objetivo de este estudio fue observar su capacidad predictiva en una muestra de la población canaria y, por tanto, de la española. Material y métodos: Se incluyó a 121 pacientes a los que se les realizó un seguimiento de 10 años en nuestras consultas. A todos se les valoró el riesgo de fractura usando la calculadora Garvan y basándonos en los datos obtenidos en la primera visita realizada. Resultados: De los 121 pacientes, 30 sufrieron al menos una fractura osteoporótica a lo largo de los 10 años de seguimiento. El grupo de pacientes fracturados tenían en la escala Garvan un valor medio de riesgo de sufrir cualquier fractura por fragilidad de 27%, frente al 13% de aquellos que no sufrieron fractura (p<0,001). El área bajo la correspondiente curva ROC fue de 0,718 (IC-95% = 0,613 ; 0,824). En base a ella, se estimó que el punto de corte óptimo para considerar un alto riesgo de fractura por fragilidad fue 18,5%. A este valor le correspondió una sensibilidad de 0,67 (IC-95% = 0,47 ; 0,83) y una especificidad de 0,67 (IC-95% = 0,56 ; 0,77). Conclusiones: Nuestros resultados muestran que la escala Garvan predice adecuadamente el riesgo de fractura osteoporótica a 10 años en nuestra población. Un valor inferior a 18,5% permitiría establecer un riesgo de fractura bajo, pudiendo ser utilizada como herramienta de cribado (AU)

Introduction: Several calculation tools or scales have been developed in recent years to assess the risk of fracture due to long-term fragility. The Garvan calculator has not been validated in the Spanish population. This study aims to observe their predictive capacity in a population sample of the Canary Islands and, therefore, of the Spanish population. Material and Methods: We included 121 patients who were followed up for 10 years in our consultations. All were assessed the risk of fracture using the Garvan calculator and based on the data obtained in the first visit. Results: Of the 121 patients, 30 suffered at least one osteoporotic fracture over the 10-year follow-up period. The group of patients with fractures had on the Garvan scale an average risk value to suffer any fracturing fracture of 27%, compared to 13% of those who did not suffer fracture (p<0.001). The área under the corresponding ROC curve was 0.718 (CI-95% = 0.613 ; 0.824). Based on this, the estimated optimal cut-off point to consider a high risk fracture was 18.5%. This value corresponded to a sensitivity of 0.67 (CI-95% = 0.47 ; 0.83) and a specificity of 0.67 (CI-95% = 0.56 ; 0.77). Conclusions: Our results show that the Garvan scale adequately predicts the risk of 10-year osteoporotic fracture in our population. A value lower than 18.5% would allow us to establish a low fracture risk and could be used as a screening tool (AU)

Breastfeeding during the first 6 months of life, adiposity rebound and overweight/obesity at 8 years of age.

BACKGROUND: The question of whether breastfeeding protects the child from obesity is a still debated issue; however, the relationship between early adiposity rebound and higher risk of obesity is well known. This study was aimed at evaluating whether breastfeeding (without formula supplement) during the first 6 months of life delays the time of adiposity rebound and consequently reduces the rates of obesity at the age of 8. METHODS: This retrospective cohort study included 1812 children born in Gran Canaria in 2004, with follow-up until they were 8 years of age. Anthropometrical data had been taken during routine visits to the doctor and were extracted from medical record databases. Only children with breastfeeding for the first 6 months of life (173 children) and children without breastfeeding (192 children) were included. Children with mixed feeding and children whose data were not available were excluded. RESULTS: No body mass index (BMI) differences were found between children with breastfeeding (17.7) or without breastfeeding (17.3) during the first 6 months of life. The percentages of children with normal weight, overweight and obesity were similar in both groups, as well as the age of adiposity rebound breastfeeding 3.61 years; formula 3.64 years). Early adiposity rebound was associated with increased BMI at the age of 8, both in male and female children. CONCLUSIONS: Breastfeeding during the first 6 months of life was not demonstrated to delay the age of the adiposity rebound, in our study.

Uso inadecuado de inhibidores de la bomba de protones y riesgo de fractura por fragilidad. Estudio preliminar / Inappropriate use of proton-pump inhibitors and fragility fracture risk. A preliminary study

Introducción: Los inhibidores de la bomba de protones (IBP) son fármacos ampliamente utilizados, si bien esto conlleva a un sobreuso que no es acorde con las indicaciones aceptadas en España y en el resto de Europa. Por otro lado, algunos autores han establecido una posible implicación de los IBP en el riesgo de fractura. Con este trabajo hemos pretendido efectuar una primera aproximación al conocimiento del consumo de IBP en nuestro medio y analizar para qué indicación son prescritos, a la vez que estudiar su posible asociación con un mayor riesgo de fractura por fragilidad entre sus consumidores. Material y método: Estudio observacional, transversal, abierto, descriptivo, en el que se entrevistó aleatoriamente a un número de pacientes que fueron atendidos en diferentes ámbitos sanitarios: consultas externas hospitalarias, servicios de urgencias, consulta de Atención Primaria y pacientes ingresados en planta hospitalaria. Resultados: De los 411 pacientes entrevistados, el 54% de los pacientes recibían IBP, y cuya edad media era de 63,3 años, frente al 46% que no los tomaban y que eran más jóvenes, con una edad media de 50,9 años. La distribución por sexos fue similar. La principal razón de utilizar el IBP era como “protector gástrico”, en el 39,8% de los pacientes, indicación no existente en la ficha técnica de este grupo de fármacos. Los consumidores de IBP tenían una mayor prevalencia de todas las fracturas por fragilidad. Conclusiones: Más de la mitad de la población encuestada consume IBP, y de ella cerca del 40% sin una indicación médica correcta. Por esto, unido a la mayor prevalencia de fracturas por fragilidad que presentan -que nos hace pensar en un posible mayor riesgo de fractura entre sus usuarios- consideramos la necesidad de un uso más racional de estos fármacos. Estas conclusiones son preliminares pero, a la vista de estos resultados, creemos que puede ser interesante realizar más estudios dirigidos a comprobar de manera más firme la relación entre los IBP y el riesgo de fractura osteoporótica (AU)

Introduction: Proton-pump inhibitors (PPIs) are widely used drugs, though it should be noted that excessive use is not in line with the accepted indications in Spain and throughout Europe. Furthermore, some authors have established a possible PPI link to the risk of fracture. In this paper, we make an initial approach to knowledge into PPI consumption and analyze what indication is prescribed. We also studied the drugs’ possible association with increased risk of fragility fracture in users. Material and method: An observational, transversal, open and descriptive study in which a number of randomly-chosen patients were interviewed. These patients had been treated in outpatient, emergency and primary care centers. Some had also been treated in hospital wards. Results: Of the 411 patients interviewed, 54% received PPIs. The average age was 63.3 years, compared with 46% that did not take them and who were younger presenting a mean age of 50.9 years. Gender distribution was similar. PPIs were mainly used as a “gastric protector”, in 39.8% of the patients, with no indication appearing in the technical specifications for this group of drugs. Consumers of PPIs presented a higher prevalence of all fragility fractures. Conclusions: More than half of the population surveyed consumed PPI. Of this group, about 40% did so without proper medical advice. Therefore, in addition to the higher prevalence of fragility fractures that suggest a possible increased risk of fracture among its users, we consider the need for a more rational use of these drugs. These preliminary findings point to a need for further studies to confirm the relationship between PPIs and the risk of osteoporotic fracture (AU)

Fe de errores de 'Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles' / Erratum of 'New population curves in spanish extremely preterm neonates'

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Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles / New population curves in spanish extremely preterm neonates

INTRODUCCIÓN: La mayoría de los datos antropométricos de referencia utilizados en nuestro país proceden de estudios llevados a cabo fuera del mismo hace muchos años, o bien están basados en datos de un único o pocos centros. Además, el número de recién nacidos extremadamente prematuros (RNEP) incluidos ha sido muy escaso. OBJETIVOS: Desarrollar unas tablas y gráficas de referencia poblacionales en nuestro país para el peso, la longitud y el perímetro craneal (PC), por edad gestacional y sexo, en RNEP de raza blanca procedentes de gestaciones únicas. PACIENTES Y MÉTODOS: Se incluyeron de todos los recién nacidos ≤ 28 semanas de EG, registrados sobre la base de los datos SEN1500 durante 10 años (2002-2011). La EG se estimó basándose en la ecografía fetal precoz o la fecha de la última regla. Los datos se analizaron mediante el paquete estadístico SPSS 20 y se crearon tablas percentiladas de referencia independientes para varones y mujeres, utilizando el método LMS de Cole y Green. RESULTADOS: Se presentan las primeras tablas y gráficas percentiladas con base poblacional en nuestro país de peso, longitud y PC en RNEP, incluyendo recién nacidos al límite de viabilidad. Se objetiva un dimorfismo sexual desde las 23 semanas de gestación. CONCLUSIONES: Estas nuevas referencias, específicas por sexo y de base poblacional, pueden ser útiles para mejorar la evaluación del crecimiento del prematuro extremo en nuestro país, así como para el desarrollo de estudios epidemiológicos, o evaluación de tendencias temporales y de intervenciones clínicas o de salud pública dirigidas a la optimización del crecimiento fetal. Un dimorfismo sexual es evidente desde etapas muy tempranas de la gestación

INTRODUCTION: Most anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability. OBJECTIVES: To develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons. PATIENTS AND METHODS: Anthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method. RESULTS: This study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation. CONCLUSIONS: These new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth

Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening.

Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10(-3)), neck circumference (p < 10(-3)), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10(-3)), and intensity of snoring (p < 10(-3)). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.

[New population curves in spanish extremely preterm neonates]. / Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles.

INTRODUCTION: Most anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability. OBJECTIVES: To develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons. PATIENTS AND METHODS: Anthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method. RESULTS: This study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation. CONCLUSIONS: These new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth.

[Assessment of nutritional interventions and hygiene and health habits in a cohort of primary school students]. / Evaluación de dos intervenciones nutricionales y de hábitos de higiene y salud en una cohorte de alumnos de enseñanza primaria.

OBJECTIVE: To quantify by means of the so-called "Healthy lifestyle pyramid" and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. MATERIALS AND METHOD: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. RESULTS: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. CONCLUSIONS: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood.

Evaluación de dos intervenciones nutricionales y de hábitos de higiene y salud en una cohorte de alumnos de enseñanza primaria / Assessment of nutritional interventions and hygiene and health habits in a cohort of primary school students

Objetivo: Cuantificar tras dos intervenciones educacionales, con la denominada ‘Pirámide de estilo de vida saludable’, los cambios en ingesta, actividades diarias y hábitos de higiene y salud, a corto y largo plazo, en una cohorte de niños sanos. Material y métodos: Es un estudio longitudinal prospectivo con una evaluación basal de hábitos dietéticos y de vida, y dos evaluaciones posteriores tras las dos intervenciones educacionales. Resultados: Participaron 52 niños, con una media de 7,9 años y el 15,4% eran obesos. Hubo una reducción estadísticamente significativa en la ingesta de leche entera, tanto a corto como a largo plazo. Fue significativo a corto plazo la reducción en la ingesta de embutidos y un aumento de frutas. Hubo una reducción significativa en ingesta de dulces, a corto plazo. Hubo significación estadística en lavado de manos, a corto y a largo plazo, al igual que el baño en la playa tras comer. También lo hubo en lograr una postura adecuada y no nadar muy adentro, ambos a largo plazo; y por último a corto plazo, en no utilizar campos de deporte inadecuados. La frecuencia con que practican deportes, a largo plazo, tuvo un incremento significativo y también lo hubo en el número de ejercicios semanales, a corto plazo. Conclusiones: Los niños hicieron tras dos intervenciones educacionales modificaciones significativas de sus hábitos de salud a corto, o largo plazo lo que contribuye a modificar factores de riesgo de enfermedad en la vida adulta (AU)

Objective: To quantify by means of the so-called ‘Healthy lifestyle pyramid’ and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. Materials and method: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. Results: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. Conclusions: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood (AU)