Recomendaciones de “no hacer” en la consulta de Atención Primaria / Recommendations for “not to do” in primary care practice

Introducción: en los últimos años se ha observado un exceso de prácticas clínicas innecesarias en Pediatría que carecen de suficiente evidencia científica y generan costos significativos, además de resultar molestas para el paciente y no aportar beneficios adicionales. Por ello, diversas sociedades e instituciones científicas han propuesto recomendaciones para evitar estas intervenciones ineficaces y científicamente injustificadas. Material y métodos: el proyecto fue coordinado por el grupo de trabajo PrevInfad de la Asociación Española de Pediatría de Atención Primaria (AEPap). Se desarrolló en dos fases a través del intercambio de correos electrónicos. En la primera, se solicitó a los coordinadores que divulgaran el proyecto y recopilaran propuestas de intervenciones innecesarias. En la segunda, se realizó la selección de las recomendaciones mediante el método Delphi y dos rondas de votación. Resultados: en la primera fase se obtuvieron 40 propuestas de recomendaciones de “no hacer”. En la primera ronda de la segunda fase se aceptaron 7 propuestas. Cinco recomendaciones fueron rechazadas y 28 fueron consideradas dudosas y pasaron a una segunda valoración. En la segunda ronda se aceptó una recomendación adicional. En total, se aprobaron 8 recomendaciones de “no hacer”. Conclusiones: la AEPap elaboró una lista de recomendaciones de “no hacer” en Pediatría en colaboración con sus grupos de trabajo y asociaciones federadas utilizando la metodología Delphi para el consenso entre expertos. Estas recomendaciones buscan mejorar la calidad asistencial y promover la utilización adecuada de recursos en la Atención Primaria pediátrica (AU)

Introduction: in recent years, there has been an excess of unnecessary clinical practices in pediatrics that lack sufficient scientific evidence and generate significant costs, in addition to being bothersome and not providing additional benefits. For this reason, various scientific societies and institutions have proposed recommendations to avoid these ineffective and scientifically unjustified interventions.Material and methods: the project was coordinated by the PrevInfad working group of the Spanish Association of Primary Care Pediatrics (AEPap). It was developed in two phases through the exchange of e-mails. In the first phase, the coordinators were asked to disseminate the project and to collect proposals for unnecessary interventions. In the second phase, the recommendations were selected using the Delphi method and two rounds of voting.Results: in the first phase, 40 proposals for 'do not do' recommendations were obtained. In the first round of the second phase, seven proposals were accepted. Five recommendations were rejected and 28 were considered doubtful and passed to a second assessment. One additional recommendation was accepted in the second round. In total, 8 'do not do' recommendations were approved.Conclusions: the AEPap developed a list of 'do not do' recommendations in pediatrics in collaboration with its working groups and federated associations using the Delphi methodology for consensus among experts. These recommendations aim to improve the quality of care and promote the appropriate use of resources in pediatric primary care. (AU)

Modified NEOMOD score as a neonatal mortality prediction tool in a medium-income country: A validation diagnostic test study.

Background and Aims: Multiple organ dysfunction (MOD) is a potentially reversible physiological disorder that involves two or more systems. Modified NEOMOD (Neonatal Multiple Organ Dysfunction score) scale could be a useful instrument to measure MOD and predict mortality. Our aim was to validate modified NEOMOD in patients from a neonatal intensive care unit (NICU) of a middle-income country. Methods: Diagnostic test study. Preterm newborns admitted NICU were included. Daily values were collected from birthday to Day 14. MOD was defined as at least one point in two or more systems. The lowest score is 0 and the maximum is 16. The outcome variable was mortality. Secondary outcomes were bronchopulmonary dysplasia, retinopathy of prematurity (ROP), late-onset neonatal sepsis (LONS), intraventricular hemorrhage (IVH) and length of hospital stay. Area under the curve (AUC) and Hosmer-Lemeshow test were calculated to evaluate scale discrimination and calibration. Logistic regression was used to estimate the association between daily modified NEOMOD score and death. Results: We included 273 patients who met the inclusion criteria. MOD incidence was 74.4%. The median gestational age in patients with MOD was 30 (interquartile range [IQR]: 27-33) and in patients without MOD it was 32 (IQR: 31-33) (p < 0.001). There were 40 deaths (14.6%), 38 (18.7%) from the MOD group and 2 (2.9%) from non-MOD group. On accumulated Day 7, AUC was 0.89 (95% confidence interval [CI]: 0.83-0.95). Modified NEOMOD had good calibration (X 2 = 2.94, p = 0.982). DBP (12.8% vs. 2.9%, p = 0.001), ROP (3.9% vs. 0%, p = 0.090), IVH (33% vs. 12.9%, p < 0.001), and LONS (36.5% vs. 8.6%, p < 0.001) frequency was higher in the MOD group than non-MOD group. Length of hospital stay also was higher in MOD group (median 21 days [IQR 7-44] vs. median 5 days [IQR 4-9], p = 0.004). Conclusion: Modified NEOMOD scale presents good discrimination and calibration for death in preterm children. This scale could help in clinical decision-making in real-time.

Recomendaciones de no hacer en distintos ámbitos de la atención pediátrica / Do not do recommendations in different paediatric care settings

Introducción: Muchas son las iniciativas encaminadas a eliminar intervenciones clínicas de poco valor en la asistencia sanitaria. Desde el Comité de Calidad Asistencial y Seguridad del Paciente de la Asociación Española de Pediatría, se ha propuesto la elaboración de recomendaciones de «no hacer» (RNH) con el objetivo de señalar una serie de prácticas evitables en la atención del paciente pediátrico en atención primaria, urgencias, hospitalización y domicilio. Material y métodos: Este trabajo se desarrolló en 2fases: una primera en la que se propusieron posibles RNH y una segunda en la que se consensuaron las recomendaciones finales mediante el método Delphi. Tanto las propuestas como las evaluaciones partieron de miembros de los grupos y sociedades pediátricas a los que se les realizó la propuesta, coordinados por miembros del Comité de Calidad Asistencial y Seguridad del Paciente. Resultados: Fueron propuestas un total de 164 RNH por la Sociedad Española de Neonatología, la Asociación Española de Pediatría de Atención Primaria, la Sociedad Española de Urgencias de Pediatría, la Sociedad Española de Pediatría Interna Hospitalaria y el Comité de Medicamentos de la Asociación Española de Pediatría con el Grupo Español de Farmacia Pediátrica de la Sociedad Española de Farmacia Hospitalaria. Se logró reducir el conjunto inicial a 42 RNH y en sucesivas fases se llegó a la selección final de 25 RNH, 5 RNH por cada grupo o sociedad. Conclusiones: Este proyecto ha permitido seleccionar y consensuar una serie de recomendaciones para evitar prácticas inseguras, ineficientes o de escaso valor en distintos ámbitos de la atención pediátrica, lo que podría resultar útil para mejorar la seguridad y la calidad de nuestra actividad asistencial. (AU)

Introduction: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics has proposed the development of «do not do» recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. Material and methods: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. Results: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the Spanish Association of Pediatrics and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. Conclusions: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice. (AU)

Do not do recommendations in different paediatric care settings.

INTRODUCTION: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics (AEP) has proposed the development of "DO NOT DO" recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. MATERIAL AND METHODS: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. RESULTS: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the AEP and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. CONCLUSIONS: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice.

[Summary PAPPS Childhood and Adolescence 2022]. / Resumen PAPPS Infancia y Adolescencia 2022.

Two important topics about children and adolescents in our primary care activity are presented in this update document: tobacco smoking prevention in adolescence and prophylaxis with vitamin K to prevent the hemorrhagic disease of the newborn.

Platos olvidados o de consumo ocasional en la gastronomía española: Asturias / Forgotten dishes or occasional consumption in Spanish gastronomy: Asturias

El mar Cantábrico con sus pescados y mariscos, y los valles profundos de la cordillera Cantábrica que proporcionan pastos para la cría de ganado en libertad suministran los ingredientes a la cocina asturiana tradicional, con importante presencia también de verduras, hortalizas y legumbres como las fabes, sin olvidar la gran variedad de quesos artesanales. (AU)

The Cantabrian Sea with its fish and shellfish, and the deep valleys of the Cantabrian mountains that provide pasture for free-range cattle raising, supply the ingredients for traditional Asturian cuisine, with an important presence of vegetables and legumes such as fabes, without forgetting the great variety of artisanal cheeses. (AU)

A selective and stable Fe/TiO2 catalyst for selective hydrogenation of butadiene in alkene-rich stream.

The replacement of precious metals by more abundant and therefore much less expensive metals remains a very important challenge in catalysis. A Fe/TiO2 catalyst prepared by deposition-precipitation with urea showed very high selectivity to alkenes (>99%), even at high conversion (>90%), in selective hydrogenation of butadiene in an excess of propene. Its activity is very stable at 175 °C whereas the catalyst deactivates at 50 °C, although it is also initially very active. The presence of metallic iron seems to be necessary to ensure these excellent performances.

Uso profiláctico de la vitamina K para prevenir la enfermedad hemorrágica del recién nacido / Prophylactic use of vitamin K to prevent hemorrhagic disease of the newborn

El déficit de vitamina K al nacimiento supone un factor de riesgo para desarrollar la enfermedad hemorrágica del recién nacido (EHRN). Este estado pro hemorrágico puede producir sangrados graves principalmente a nivel cutáneo, gastrointestinal y cerebral. Hay buena evidencia de que la administración de vitamina K en el recién nacido (RN) es segura y eficaz, los daños potenciales son leves, por lo que está claro el beneficio neto a favor de la administración. El grupo PrevInfad recomienda administrar a todos los recién nacidos 1 mg de vitamina K de forma profiláctica por vía intramuscular para prevenir la EHRN. En el documento, se hacen consideraciones especiales para prematuros y para niños cuyos padres rechazan la profilaxis intramuscular. Asimismo, se presenta una propuesta operativa e información para padres (AU)

Vitamin K deficiency at birth is a risk factor for Haemorrhagic disease of the newborn. This bleeding prone situation can produce severe hemorrhages mainly in the skin, gastrointestinal tract and brain.There is strong evidence that the administration of vitamin K to the newborn is safe and effective, potential side effects are mild, so there is a clear benefit of its administration.PrevInfad workgroup recommends the prophylactic administration of 1 mg intramuscular Vitamin K to prevent the Haemorrhagic disease of the newborn.Some special considerations for preterm newborns and for children whose parents reject intramuscular prophylaxis are explained in the document. Moreover, an operative proposal and information for parents are presented. (AU)

Evaluation of atopy schools for parents

Introduction Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and prognosis. A study was conducted regarding parent satisfaction following educational sessions in an Atopy School organized by a multidisciplinary team. Material and methods E-mail surveys with variables scored by means of a Likert scale were administered among the parents participating in the workshops organized by the Atopy School. The educational program comprised four sessions with a duration of 4 hours. Results Ninety-five percent of the parents were satisfied after participating in the workshops, and were of the opinion that the therapeutic education received was useful for improving control of the illness of their children. Likewise, 85% were satisfied or very satisfied with the help received in the sessions for control of the disease during flare-ups, and 90% considered the data and advice received in the sessions to be of use in improving quality of life of both the children and the family as a whole. Conclusions The Atopy School afforded caregiver empowerment, and the parents were satisfied and felt more secure in dealing with the disease of their children—thereby improving the prognosis and quality of life (AU)

Evaluation of atopy schools for parents.

INTRODUCTION: Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and prognosis. A study was conducted regarding parent satisfaction following educational sessions in an Atopy School organized by a multidisciplinary team. MATERIAL AND METHODS: E-mail surveys with variables scored by means of a Likert scale were administered among the parents participating in the workshops organized by the Atopy School. The educational program comprised four sessions with a duration of 4 hours. RESULTS: Ninety-five percent of the parents were satisfied after participating in the workshops, and were of the opinion that the therapeutic education received was useful for improving control of the illness of their children. Likewise, 85% were satisfied or very satisfied with the help received in the sessions for control of the disease during flare-ups, and 90% considered the data and advice received in the sessions to be of use in improving quality of life of both the children and the family as a whole. CONCLUSIONS: The Atopy School afforded caregiver empowerment, and the parents were satisfied and felt more secure in dealing with the disease of their children-thereby improving the prognosis and quality of life.

Análisis de menús sin gluten de comedores escolares en granada capital y área metropolitana: ¿son equilibrados? / Analysis of the gluten-free menus served in school canteens: are they balanced?

Introducción y objetivos: analizar el perfil alimentario y el valor nutricional de los menús adaptados para celiacos ofertados en los comedores de los centros escolares de Granada capital y área metropolitana. Material y métodos: estudio descriptivo en el que se han analizado los menús adaptados para niños celiacos de 41 centros escolares, cinco con cocina propia y 36 abastecidos por catering. La participación de los centros fue voluntaria, una vez fueron informados de las características y objetivos del estudio. Se recogió información a través de las fichas técnicas de los platos elaborados con la cantidad de cada alimento, además de las marcas de los productos sin gluten utilizados. Se analizaron menús de cuatro semanas en cuanto a distribución de raciones, energía, macro y micronutrientes para el grupo de 10 a 12 años, obteniendo valores medios y desviación estándar de 31 parámetros. Se utilizaron el programa Odimet y la base de datos CeliacBase. Se usó el programa estadístico IBM SPSS 22.0. Resultados: la pasta sin gluten fue la base del primer plato en el 31,7% de los menús analizados. En el segundo plato, la carne fue el constituyente principal. En todos los menús se ofertaba, al menos, una ración diaria de verdura. El 80% de los menús no alcanzaron la ingesta energética recomendada, aunque la distribución de macronutrientes fue adecuada. La cantidad media de fibra y de hidratos de carbono totales fue superior a lo recomendado. La cantidad de calcio y vitamina D no alcanzó la ingesta recomendada. Destaca un elevado consumo de sodio, que duplica la cantidad recomendada para la comida del mediodía. Conclusiones: los menús escolares adaptados para niños celiacos se ajustan a las recomendaciones, aunque deberían limitar la ingesta semanal de carne y presentan exceso de azúcares totales y sal

Introduction and objectives: the alimentary profile and the nutritional value of the menus adapted for coeliacs in the dining halls of the schools of Granada capital and Metropolitan Area. Material and methods: descriptive study in which we analyzed the menus adapted for children from 41 schools, 5 with their own kitchen and 36 supplied by catering. The information is recognized through the technical sheets of the dishes made with the quantity of each food, in addition to the brands of the gluten-free products. The four-week menus will be analyzed in terms of the distribution of rations, energy, macro and micronutrients for the age group of 10 to 12 years, obtaining average values and standard deviation of 31 parameters. The Odimet program and the CeliacBase database are used. The data will be analyzed using the IBM SPSS 22.0 statistical program. Results: gluten-free pasta was the basis of the first course in 31.7% of the menus analyzed. In the second dish, the meat was the main constituent. In all the menus, at least one daily vegetable ration was offered. 80% of the menus did not reach the recommended energy intake, although the distribution of macronutrients was adequate. The average amount of fiber and total carbohydrates was higher than recommended. The amount of calcium and vitamin has not been recommended. It emphasizes a high consumption of sodium, which doubles the amount recommended for the midday meal. Conclusions: school menus adapted for children conform to the recommendations, although they should be limited to intake

[Analysis of the gluten-free menus served in school canteens: are they balanced?] / Análisis de menús sin gluten de comedores escolares en granada capital y área metropolitana: ¿son equilibrados?

INTRODUCTION: Introduction and objectives: the alimentary profile and the nutritional value of the menus adapted for coeliacs in the dining halls of the schools of Granada capital and Metropolitan Area. Material and methods: descriptive study in which we analyzed the menus adapted for children from 41 schools, 5 with their own kitchen and 36 supplied by catering. The information is recognized through the technical sheets of the dishes made with the quantity of each food, in addition to the brands of the gluten-free products. The four-week menus will be analyzed in terms of the distribution of rations, energy, macro and micronutrients for the age group of 10 to 12 years, obtaining average values and standard deviation of 31 parameters. The Odimet program and the CeliacBase database are used. The data will be analyzed using the IBM SPSS 22.0 statistical program. Results: gluten-free pasta was the basis of the first course in 31.7% of the menus analyzed. In the second dish, the meat was the main constituent. In all the menus, at least one daily vegetable ration was offered. 80% of the menus did not reach the recommended energy intake, although the distribution of macronutrients was adequate. The average amount of fiber and total carbohydrates was higher than recommended. The amount of calcium and vitamin has not been recommended. It emphasizes a high consumption of sodium, which doubles the amount recommended for the midday meal. Conclusions: school menus adapted for children conform to the recommendations, although they should be limited to intake.

INTRODUCCIÓN: Introducción y objetivos: analizar el perfil alimentario y el valor nutricional de los menús adaptados para celiacos ofertados en los comedores de los centros escolares de Granada capital y área metropolitana. Material y métodos: estudio descriptivo en el que se han analizado los menús adaptados para niños celiacos de 41 centros escolares, cinco con cocina propia y 36 abastecidos por catering. La participación de los centros fue voluntaria, una vez fueron informados de las características y objetivos del estudio. Se recogió información a través de las fichas técnicas de los platos elaborados con la cantidad de cada alimento, además de las marcas de los productos sin gluten utilizados. Se analizaron menús de cuatro semanas en cuanto a distribución de raciones, energía, macro y micronutrientes para el grupo de 10 a 12 años, obteniendo valores medios y desviación estándar de 31 parámetros. Se utilizaron el programa Odimet y la base de datos CeliacBase. Se usó el programa estadístico IBM SPSS 22.0. Resultados: la pasta sin gluten fue la base del primer plato en el 31,7% de los menús analizados. En el segundo plato, la carne fue el constituyente principal. En todos los menús se ofertaba, al menos, una ración diaria de verdura. El 80% de los menús no alcanzaron la ingesta energética recomendada, aunque la distribución de macronutrientes fue adecuada. La cantidad media de fibra y de hidratos de carbono totales fue superior a lo recomendado. La cantidad de calcio y vitamina D no alcanzó la ingesta recomendada. Destaca un elevado consumo de sodio, que duplica la cantidad recomendada para la comida del mediodía. Conclusiones: los menús escolares adaptados para niños celiacos se ajustan a las recomendaciones, aunque deberían limitar la ingesta semanal de carne y presentan exceso de azúcares totales y sal.

Reversión de sobrepeso y obesidad en población infantil de Vilafranca del Penedès: Programa ACTIVA'T (2012) / Reversion of overweight and obesity in Vilafranca del Penedès child population: ACTIVA'T Program (2012)

Objetivo: Describir los resultados sobre el estado nutricional de niños/as de 8 a 14 años con sobrepeso u obesidad y poco activos/as, antes y después de una intervención nutricional con promoción de la actividad física (Programa ACTIVA'T). Método: Estudio antes-después en población infantil (8-14 años) de Vilafranca del Penedès (Barcelona) con sobrepeso u obesidad y poco activos, aleatorizados en grupo control (n = 51, 47,1% niñas, intervención nutricional y actividad física ≤3h/sem) y en grupo ACTIVA'T (n = 45, 37,8% niñas, intervención nutricional y actividad física ≥5h/sem). Se determinaron el índice de masa corporal, el índice cintura/altura y la calidad de la dieta mediante el test KIDMED al inicio y al final del estudio. Durante la intervención, cada participante estuvo acompañado/a por un familiar (padre o madre) que realizó las mismas actividades que los/las niños/as. Resultados: Las recomendaciones dietéticas han cambiado positivamente los hábitos del grupo ACTIVA'T y del grupo control. La reversión en la prevalencia de sobrepeso y obesidad ha sido del 93,8% y el 58,6%, respectivamente, en el grupo ACTIVA'T, frente al 25,0% y el 35,8% en el grupo control. La obesidad abdominal se redujo del 42,2% al 17,8% en el grupo ACTIVA'T y del 47,1% al 27,5% en el grupo control. Conclusiones: El programa de educación nutricional y promoción de la actividad física ACTIVA'T mejora la calidad de la dieta y revierte la prevalencia de sobrepeso y obesidad en la población infantil poco activa

Objective: To assess a 6-month nutritional and physical activity intervention program on the nutritional status of overweight or obese and not very active 8-14 years old children by means of a controlled pre-post design (ACTIVA'T program). Method: Pre-post study in 8-14 years old overweight or obese and low active children from Vilafranca del Penedès (Barcelona, Spain) randomized in control group (n = 51, 47.1% girls, nutritional intervention and ≤3h/wk physical activity) and ACTIVA'T group (n = 45, 37.8% girls, nutritional and physical activity ≥5h/wk intervention). Body mass index, waist/height index, and diet quality by means of KIDMED test at the beginning and at the end of the program were assessed. During the intervention, each participant was accompanied by a relative (father or mother) who performed the same activities as the children. Results: Dietary recommendations have positively changed the habits of both ACTIVA'T and control group. The reversion in the prevalence of overweight and obesity was 93.8% and 58.6%, respectively, in the ACTIVA'T group, compared to 25.0% and 35.8% in the control group. Abdominal obesity was decreased from 42.2% to 17.8% in the ACTIVA'T group and from 47.1% to 27.5% in the control group. Conclusions: The program ACTIVA'T (nutritional education and physical activity promotion) improves the quality of diet and reverses the prevalence of overweight and obesity in the underactive child population

[Reversion of overweight and obesity in Vilafranca del Penedès child population: ACTIVA'T Program (2012)]. / Reversión de sobrepeso y obesidad en población infantil de Vilafranca del Penedès: Programa ACTIVA'T (2012).

OBJECTIVE: To assess a 6-month nutritional and physical activity intervention program on the nutritional status of overweight or obese and not very active 8-14 years old children by means of a controlled pre-post design (ACTIVA'T program). METHOD: Pre-post study in 8-14 years old overweight or obese and low active children from Vilafranca del Penedès (Barcelona, Spain) randomized in control group (n = 51, 47.1% girls, nutritional intervention and ≤3h/wk physical activity) and ACTIVA'T group (n = 45, 37.8% girls, nutritional and physical activity ≥5h/wk intervention). Body mass index, waist/height index, and diet quality by means of KIDMED test at the beginning and at the end of the program were assessed. During the intervention, each participant was accompanied by a relative (father or mother) who performed the same activities as the children. RESULTS: Dietary recommendations have positively changed the habits of both ACTIVA'T and control group. The reversion in the prevalence of overweight and obesity was 93.8% and 58.6%, respectively, in the ACTIVA'T group, compared to 25.0% and 35.8% in the control group. Abdominal obesity was decreased from 42.2% to 17.8% in the ACTIVA'T group and from 47.1% to 27.5% in the control group. CONCLUSIONS: The program ACTIVA'T (nutritional education and physical activity promotion) improves the quality of diet and reverses the prevalence of overweight and obesity in the underactive child population.

Exploring the diversity, infectivity and metabolomic landscape of Rickettsial infections for developing novel therapeutic intervention strategies.

Rickettsioses are zoonotic infections caused by obligate intracellular bacteria of the genera Rickettsia that affect human health; sometimes humans being considered as accidental hosts. At a molecular level, the rickettsiae infection triggers molecular signaling leading to the secretion of proinflammatory cytokines. These cytokines direct the immune response to the host cell damage and pathogen removal. In this review, we present metabolic aspects of the host cell in the presence of rickettsiae and how this presence triggers an inflammatory response to cope with the pathogen. We also reviewed the secretion of cytokines that modulates host cell response at immune and metabolic levels.

Dolor postoperatorio, analgesia y presencia de factores de riesgo para dolor crónico en pacientes hospitalizados de un hospital público de Santiago de Chile / Postoperative pain, analgesia and presence of risk factors for chronic postoperative pain in hospitalized patients of a public hospital of Santiago de Chile

INTRODUCCIÓN: el dolor postoperatorio es un importante problema de salud pública, con una elevada incidencia según publicaciones internacionales. el dolor crónico postoperatorio (DCPO) se desarrolla posterior a una cirugía y persiste por más de dos meses, excluyendo otras causas y problemas preexistentes. se han descrito factores de riesgo demográficos, psicosociales y médicos para el desarrollo de dolor crónico postoperatorio (DCPO), siendo el más importante el dolor postoperatorio agudo elevado. actualmente, en Chile se carece de datos locales sobre dolor postoperatorio agudo y crónico. OBJETIVO: evaluar la intensidad del dolor agudo en pacientes post-operados y las medidas analgésicas utilizadas, esto en el contexto de la identificación de los factores de riesgo para el desarrollo de DCPO en pacientes hospitalizados en el servicio de cirugía de un hospital de alta complejidad. MATERRIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de corte transversal retrospectivo. La muestra incluyó a 100 pacientes post-operados seleccionados en forma aleatoria del área de cirugía del Hospital del Salvador entre los meses de septiembre y octubre de 2017. Se realizó una revisión de protocolos operatorios, evoluciones e indicaciones médicas y se registraron edad, sexo, dolor postoperatorio según la escala numérica del dolor (EN) y factores de riesgo de DCPO (cirugía con riesgo de daño nervioso, revisional, abierta, malla, complicaciones postoperatorias, dolor postoperatorio sobre 5, según EN), además del tiempo operatorio. Se realizó un registro electrónico en planilla de excel (Microsoft® Excel® 2011) pre-codificada y diseñada para este fin, resguardando la identidad de los participantes. Los datos obtenidos se expresaron como promedios (con desviación estándar) y medianas. RESULTADOS: se encontró una incidencia de 44% de dolor postoperatorio, con intensidad promedio de 4,4 ± 1,64 puntos entre los pacientes que presentaron dolor en algún grado. el 93% de los pacientes con dolor presentó dolor moderado a severo. en el 98% del total de pacientes se indicó terapia analgésica; de éstos, el 47,95% solo tuvo indicación de antiinflamatorios no esteroidales (AINEs), 39,79% AINEs y paracetamol, 7,14% solo paracetamol y 5,10% otras combinaciones. el 95% de los pacientes presentó uno o más factores de riesgo para DCPO, y el 11%, cuatro o más. DISCUSIÓN: el conocimiento de la incidencia e intensidad local de dolor postoperatorio es un primer paso para optimizar su manejo. la identificación de la población en riesgo de desarrollar DCPO podría permitir implementar a futuro medidas preventivas, que mejoren la calidad de vida de los pacientes postoperados

INTRODUCTION: postoperative pain is an important public health issue, with a high incidence reported in international literature. chronic postoperative pain (CPOP) is developed posterior to a surgical intervention and persists over two months, excluding other causes and preexisting problems. several risk factors for CPOP have been mentioned, including demographic, psicosocial and medical ones; the most relevant being high acute postoperative pain. nowadays, Chile lacks local data of acute and chronic postoperative pain. OBJECTIVES: assess the intensity of acute postoperative pain and the analgesia used, in the context of the identification of risk factors for CPOP in a surgery department of a high complexity hospital. MATERIALS AND METHODS: an observational descriptive tranversal restrospective study was used. the sample was constituted by 100 postsurgical patients selected randomly from the surgical department of the Hospital del Salvador between september and october 2017. a revision of surgical protocols and medical charts was made; age, sex, postsurgical pain according to numeric pain scale (NPS) and risk factors for CPOP (surgery with risk of nervous damage, second look, open, use of mesh, postsurgical complications, postsurgical pain above 5 according to NPS) were registered, besides surgical time. the record was made on an precoded excel sheet (Microsoft® Excel® 2011), designed for this purpose. the identity of the patients was kept anonymous. the data obtained was expressed as mean (with standard deviation) and median. RESULTS: an incidence of 44% of postsurgical pain was found, with mean intensity of 4.4 ± 1.64points between patients that presented any degree of pain.93% from the patients with pain presented moderate to severe pain. 98% from the total of patients had analgesia, from them 47.95% only had non-steroidal antiinflamatory drugs (NSAIDs), 39.79% NSAIDs and acetaminophen, 7.14% only acetaminophen and 5.10% other combinations. 95% of patients had one or more risk factors for CPOP, and 11% four or more of them. DISCUSSION: the knowledge of the incidence and intensity of postsurgical pain is the first step in order to optimize its manage. the identification of the population at risk to develop CPOP could allow the implementation of preventive measures that may improve the quality of life of postsurgical patients.

The first description of a hormone-sensitive lipase from a basidiomycete: Structural insights and biochemical characterization revealed Bjerkandera adusta BaEstB as a novel esterase.

The heterologous expression and characterization of a Hormone-Sensitive Lipases (HSL) esterase (BaEstB) from the Basidiomycete fungus Bjerkandera adusta is reported for the first time. According to structural analysis, amino acid similarities and conservation of particular motifs, it was established that this enzyme belongs to the (HSL) family. The cDNA sequence consisted of 969 nucleotides, while the gene comprised 1133, including three introns of 57, 50, and 57 nucleotides. Through three-dimensional modeling and phylogenetic analysis, we conclude that BaEstB is an ortholog of the previously described RmEstB-HSL from the phylogenetically distant fungus Rhizomucor miehei. The purified BaEstB was characterized in terms of its specificity for the hydrolysis of different acyl substrates confirming its low lipolytic activity and a noticeable esterase activity. The biochemical characterization of BaEstB, the DLS analysis and the kinetic parameters determination revealed this enzyme as a true esterase, preferentially found in a dimeric state, displaying activity under alkaline conditions and relative low temperature (pH = 10, 20°C). Our data suggest that BaEstB is more active on substrates with short acyl chains and bulky aromatic moieties. Phylogenetic data allow us to suggest that a number of fungal hypothetical proteins could belong to the HSL family.

Identification of a novel carbohydrate esterase from Bjerkandera adusta: structural and function predictions through bioinformatics analysis and molecular modeling.

A new gene from Bjerkandera adusta strain UAMH 8258 encoding a carbohydrate esterase (designated as BacesI) was isolated and expressed in Pichia pastoris. The gene had an open reading frame of 1410 bp encoding a polypeptide of 470 amino acid residues, the first 18 serving as a secretion signal peptide. Homology and phylogenetic analyses showed that BaCesI belongs to carbohydrate esterases family 4. Three-dimensional modeling of the protein and normal mode analysis revealed a breathing mode of the active site that could be relevant for esterase activity. Furthermore, the overall negative electrostatic potential of this enzyme suggests that it degrades neutral substrates and will not act on negative substrates such as peptidoglycan or p-nitrophenol derivatives. The enzyme shows a specific activity of 1.118 U mg(-1) protein on 2-naphthyl acetate. No activity was detected on p-nitrophenol derivatives as proposed from the electrostatic potential data. The deacetylation activity of the recombinant BaCesI was confirmed by measuring the release of acetic acid from several substrates, including oat xylan, shrimp shell chitin, N-acetylglucosamine, and natural substrates such as sugar cane bagasse and grass. This makes the protein very interesting for the biofuels production industry from lignocellulosic materials and for the production of chitosan from chitin.