Importancia del laboratorio clínico en los estudios nutricionales en personas mayores que estén o no institucionalizadas / Importance of the clinical laboratory in nutritional studies in elderly persons who are or not institutionalized

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Importancia de las infecciones por Candida en neonatología / Importance of Candida infections in neonatology

Las infecciones por Candida spp. son una de las principales causas de morbimortalidad en neonatos prematuros, especialmente en neonatos pretérmino de muy bajo peso al nacer (peso inferior a 1.500g). Se realiza una revisión de las infecciones por Candida en neonatología, unidades de cuidados intensivos neonatales en neonatos pretérmino de muy bajo peso al nacer, y la conveniencia o no de la utilización de profilaxis, principalmente con fluconazol, y de los factores de riesgo asociados a estos neonatos. La utilización de profilaxis no es una práctica utilizada de forma sistemática en todos los hospitales ni en todas las unidades de intensivos neonatales, dependiendo su implantación de la incidencia de infección por Candida, de la mortalidad asociada y de las características particulares del centro hospitalario. Con base en la evidencia científica, no se sugiere el uso de profilaxis antifúngica de forma rutinaria en todos los neonatos pretérmino (grado 2B). Esta se reserva para los neonatos de peso inferior a 1.000g en centros con alta incidencia de infección fúngica. Y en estos casos se sugiere la utilización de fluconazol frente a otros antifúngicos debido a la mayor y más robusta evidencia

Candida infections are one of the main causes of morbidity and mortality in preterm infants, and especially in preterm infants of very low birth weight (less than 1,500g). A review is presented on Candida infections in neonatology, neonatal intensive care units in preterm infants of very low birth weight and the advantages and disadvantages of the use of prophylaxis, mainly with fluconazole, and the associated risk factors. The use of prophylaxis is not a practice used systematically in all hospitals or in all neonatal intensive care units. Its implementation depends on the incidence of Candida infection, the associated mortality, and the particular characteristics of the hospital. Based on scientific evidence, the use of antifungal prophylaxis is not routinely suggested in all preterm infants (grade 2B). This is reserved for neonates weighing less than 1,000g in centres with a high incidence of fungal infection. Also, in these cases the use of fluconazole against other antifungals is suggested due to the greater and more robust evidence

Enfermedad celíaca y sensibilidad al gluten no celíaca: la necesidad de uso de herramientas diagnósticas alternativas. Provocación controlada y nuevos marcadores / Celiac disease and sensitivity to non-celiac gluten: the need for use of alternative diagnostic tools. Controlled provocation and new markers

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Levels of DKK1 in patients with acute myocardial infarction and response to atorvastatin.

The Wnt-LPR5 signalling pathway plays an important role in skeletal homeostasis, especially in regulating osteoblastic activity. Activation of this pathway is regulated by various inhibitors, including DKK1. The objective of this study was to evaluate DKK1 levels in patients with ischemic heart disease, the response to atorvastatin and the relationship with bone mass. Twenty-one patients with acute myocardial infarction and twenty-three controls with a mean age of 61 ± 9 years with acute coronary syndrome were included. Patients were allocated to low (10-20mg) and high doses (40-80 mg) of atorvastatin according to baseline levels of cholesterol and triglycerides and the index of vascular risk. Patients were studied at hospital admission (baseline) and at 12 months of follow up. DKK1 was determined in all patients at baseline and at 12 months of follow up. Densitometric studies were conducted in the lumbar spine (L2-L4) and the femoral neck and trochanter using an X-ray densitometer. Patients had higher levels of DKK1 than controls, (111 ± 41 nmol/l versus 84 ± 27 nmol/l, p=0.014). Osteoporotic patients had higher levels of DKK1 (137.5 ± 33 nmol/l versus 95.4 ± 36 nmol/l, p=0.021). Analysis of the response to atorvastatin showed reduced DKK1 levels. In conclusion, in patients with acute coronary syndrome, atorvastatin decreases DKK1 levels. This may be a previously unreported mechanism of action of atorvastatin on bone, stimulating the Wnt signalling pathway and increasing bone mass.

Bone mineral density, bone remodeling and osteoprotegerin in patients with acute coronary syndrome.

The objective of this study was to evaluate the relationship between coronary disease and osteoporosis and determine the effect of osteoprotegerin (OPG) on bone remodeling and bone mineral density (BMD) in a group of patients with acute coronary syndrome. Eighty-three patients (52 males and 31 women) with acute coronary syndrome (75 patients with acute myocardial infarction and 8 with unstable angina) with an average age of 61+/-10 years were studied. Levels of osteocalcin, urinarydeoxypyridinoline, OPG and the receptor activator of nuclear factor-kappaB ligand (RANKL) were determined during the hospital stay. Femoral neck, trochanter and lumbar spine densitometry was carried out using a DXA densitometer. Thirty percent of patients presented osteoporosis (39% of females and 26% of males). Osteoporotic patients were older and had a lower weight and height and elevated serum levels of osteocalcin (3.6+/-2.25 2.63 versus +/-1.55, p=0.05). Levels of OPG and RANKL were similar in both groups and showed no relationship with BMD. In conclusion, no relationship was observed between the OPG/RANKL system and BMD in these patients.

Ghrelin and bone mass in postmenopausal hypertensive women.

BACKGROUND: Ghrelin, a recently discovered peptide mainly secreted by the stomach, has an orexigenic effect which stimulates secretion of the growth hormone. It also has vasodilator effects which reduce blood pressure and stimulate in vitro, bone formation. OBJECTIVES: To evaluate the effect of ghrelin on bone mass and bone remodeling markers in postmenopausal hypertensive women. MATERIAL AND METHODS: 25 postmenopausal hypertensive women, light to moderate based on the JNC-VII criteria, were studied. They had a mean age of 58 +/- 8 years, a body mass index of 28 +/- 6 and a hypertension development time of 65 +/- 84 months. Osteocalcin, PTHi, 25-vitamin D, ghrelin in serum and deoxypiridinoline in urine were determined in all patients. A lumbar spine densitometer was made (DXP Lunar, Madison, Wisc., USA). RESULTS: Diminished levels of ghrelin were observed in the osteoporotic group (40 +/- 19 vs. 78 +/- 40, p = 0.027). When the patients were separated according to ghrelin tertiles, a greater bone mass was observed in the upper tertiles, which was associated with a decrease in the urinary deoxypiridinoline. When the total population was analyzed, no relation between the ghrelin and bone mass was found, nor with any of the parameters of calcium metabolism. Only a statistically significant relation between ghrelin and deoxypiridinoline was observed (r = -0.428, p = 0.026). CONCLUSIONS: In postmenopausal hypertensive women, ghrelin may produce a protecting effect over bone mass through an anticatabolic mechanism manifested by a decrease of bone resorption.