Miopatías RYR1 en la infancia: correlación fenotipo-genotipo e incidencia / RYR1 myopathies in childhood: phenotype-genotype correlation and incidence

Introducción: Las miopatías relacionadas con el receptor de rianodina de tipo 1 (RYR1-RM) constituyen la categoría más frecuente de miopatías congénitas. La introducción de técnicas genéticas ha cambiado el paradigma diagnóstico y sugiere la prioridad de estudios moleculares sobre biopsias. Este estudio busca explorar las características clinicoepidemiológicas de pacientes con variantes del gen RYR1 en un hospital pediátrico de tercer nivel con el objetivo de ampliar la comprensión de la correlación genotipo-fenotipo en las RYR1-RM. Pacientes y métodos: Estudio observacional, descriptivo y transversal, de pacientes menores de 14 años con síntomas miopáticos y variantes potencialmente patógenas del gen RYR1 entre enero de 2013 y diciembre de 2023, considerando variables como sexo, edad, desarrollo motor, variantes genéticas, patrón de herencia y otras manifestaciones. Todas las variables fueron tabuladas frente a la variante genética. Resultados: De los nueve pacientes incluidos, la incidencia estimada fue de aproximadamente 1/10.000 nacidos vivos. La mediana en el momento del diagnóstico fue de 6 años, con una variabilidad fenotípica significativa. Se observaron síntomas comunes, como debilidad y retraso del desarrollo motor. Las variantes genéticas afectaron al gen RYR1 de manera diversa, y hubo cinco variantes previamente no descritas. La biopsia muscular se realizó en cinco pacientes, en dos de ellos de tipo miopatía central core; en uno, multiminicore; en uno, desproporción congénita de fibras; y en otro, de patrón inespecífico. Conclusiones: Las RYR1-MR de nuestra serie ofrecieron variabilidad fenotípica y de afectación, con una incidencia en nuestra área de en torno a 1/10.000 recién nacidos. La mayoría de los casos fueron varones, de variantes missense dominantes. Aportamos cinco variantes genéticas no descritas con anterioridad.(AU)

Introduction: Ryanodine receptor type 1-related myopathies (RYR1-RM) represent the most prevalent category of congenital myopathies. The introduction of genetic techniques has shifted the diagnostic paradigm, suggesting the prioritization of molecular studies over biopsies. This study aims to explore the clinical and epidemiological characteristics of patients with RYR1 gene variants in a tertiary pediatric hospital, intending to enhance the understanding of the genotype-phenotype correlation in RYR1-RM. Patients and methods: An observational, descriptive, and cross-sectional study was conducted on patients under 14 years old with myopathic symptoms and potentially pathogenic RYR1 gene variants from January 2013 to December 2023. Variables such as gender, age, motor development, genetic variants, inheritance pattern, and other manifestations were considered. All variables were tabulated against the genetic variant. Results: Of the nine included patients, the estimated incidence was approximately 1 in 10,000 live births. The median age at diagnosis was six years, with significant phenotypic variability. Common symptoms such as weakness and delayed motor development were observed. Genetic variants affected the RYR1 gene diversely, including five previously undescribed variants. Muscle biopsy was performed in five patients, revealing central core myopathy in two, multiminicore in one, congenital fiber-type disproportion in one, and a nonspecific pattern in another.(AU)

Early hospital discharge through prediction of post-thyroidectomy hypoparathyroidism.

INTRODUCTION: Hypoparathyroidism is the most common postsurgical complication of total thyroidectomy. Furthermore, it is the main cause of prolonged hospitalisation after this procedure. OBJECTIVE: To predict the probability of post-thyroidectomy hypocalcaemia according to the levels of intact parathyroid hormone (iPTH), as well as to determine the needs for treatment with exogenous calcium according to the levels of serum calcium (Ca). MATERIALS AND METHODS: Retrospective study was carried out on patients who underwent total thyroidectomy between January 2017 and January 2020 at Los Arcos del Mar Menor University Hospital (HULAMM). iPTH and Ca levels ​​were measured at 4, 24 and 48 h after the surgery. Follow-up was 6 months. RESULTS: Ninety-four patients were operated on. Temporary and permanent postoperative hypoparathyroidism percentages were, respectively, 51.06% and 6.38%. iPTH level 24 h after the procedure was the most reliable predictor of post-thyroidectomy temporary hypoparathyroidism (Area Under the ROC Curve (AUC) = 0.933, p < .001). iPTH levels ​​≥29 pg/mL predicted normal parathyroid metabolism. CONCLUSIONS: The combined values of iPTH and Ca levels 24 h after thyroidectomy seems to be a reliable, safe and efficient method to control the post-thyroidectomy hypoparathyroidism. Our protocol could reduce the hospital stay of patients at low risk of hypocalcaemia, allowing them to be discharged from the hospital on the first postoperative morning and identifying patients at high risk of hypocalcaemia early.

Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

Efeitos da suplementação do cálcio sobre marcadores da pré-eclâmpsia: ensaio clínico randomizado / Efectos de los suplementos de calcio en marcadores de preeclampsia: ensayo clínico aleatorizado / Effects of calcium supplementation on markers of preeclampsia: randomized clinical trial

Resumo Objetivo Analisar os efeitos da suplementação de cálcio nos marcadores da pré-eclâmpsia ao longo do tempo, comparando o uso de cálcio em alta e baixa dosagem em mulheres grávidas com hipertensão. Métodos Trata-se de ensaio clínico randomizado com três grupos paralelos, placebo controlado, realizado no ambulatório de referência para o pré-natal de alto risco na Região Sul do Brasil, com análise de intenção de tratar e seguimento após quatro e oito semanas. A intervenção consistiu na ingestão de cálcio 500mg/dia, cálcio 1500mg/dia e placebo. Os dados foram analisados segundo um modelo generalizado de estimação de equações mistas adotando α 0,05. Resultados O efeito do cálcio em baixa e alta dosagem na evolução ao longo do tempo foi mantido entre os grupos, mesmo após o ajuste para os fatores de confusão. Houve diferença significativa nos parâmetros analisados na interação tempo e grupo (p <0,000) e diminuição nas médias de 12,3mmHg na PAS, 9,2 mmHg na PAD, 3,2 mg/dl creatinina e 7,2 mg/dl proteinúria para o grupo cálcio 500mg/dia. Os resultados foram semelhantes para o grupo com suplementação máxima. Conclusão O cálcio melhorou o prognóstico vascular em mulheres grávidas com hipertensão ao reduzir os níveis pressóricos e os marcadores da pré-eclâmpsia.

Resumen Objetivo Analizar los efectos de los suplementos de calcio en los marcadores de preeclampsia a lo largo del tiempo, comparando el uso de calcio en dosis altas y bajas en mujeres embarazadas con hipertensión. Métodos Se trata de un ensayo clínico aleatorizado con tres grupos paralelos, placebo controlado realizado en consultorios externos de referencia en el control prenatal de alto riesgo en la Región Sur de Brasil, con análisis de intención de tratar y seguimiento luego de cuatro y ocho semanas. La intervención consistió en la ingesta de calcio 500 mg/día, calcio 1500 mg/día y placebo. Los datos se analizaron de acuerdo con un modelo generalizado de estimación de ecuaciones mixtas adoptando α 0,05. Resultados El efecto del calcio en dosis bajas y altas en la evolución a lo largo del tiempo se mantuvo entre los grupos, inclusive después de los ajustes por los factores de confusión. Hubo diferencia significativa en los parámetros analizados en la interacción tiempo y grupo (p <0,000) y reducción de los promedios de 12,3 mmHg en la PAS, 9,2 mmHg en la PAD, 3,2 mg/dl creatinina y 7,2 mg/dl proteinuria en el grupo calcio 500 mg/día. Los resultados fueron parecidos en el grupo con suplemento en dosis máxima. Conclusión El calcio mejoró el pronóstico vascular en mujeres embarazadas con hipertensión al reducir los niveles de presión y los marcadores de preeclampsia. Registro Brasileiro de Ensaios Clínicos: RBR-9ngb95

Abstract Objective To analyze the effects of calcium supplementation on markers of preeclampsia over time by comparing the use of high- and low-dose calcium in hypertensive pregnant women. Methods This is a randomized clinical trial, placebo controlled, with three parallel groups carried out at the reference outpatient clinic for high-risk prenatal care in the South Region of Brazil, with intention-to-treat analysis and follow-up after four and eight weeks. The intervention consisted of ingesting calcium 500mg/day, calcium 1500mg/day and placebo. Data were analyzed according to a generalized mixed equation estimation model adopting α 0.05. Results The effect of low- and high-dose calcium on evolution over time was maintained between groups, even after adjustment for confounding factors. There was a significant difference in the parameters analyzed in the time and group interaction (p <0.000) and a decrease in the means of 12.3 mmHg in SBP, 9.2 mmHg in DBP, 3.2 mg/dl creatinine and 7.2 mg/dl proteinuria for the 500mg calcium/day group. The results were similar for the maximal supplementation group. Conclusion Calcium improved vascular prognosis in hypertensive pregnant women by reducing blood pressure levels and markers of preeclampsia. Brazilian Registry of Clinical Trials: RBR-9ngb95

Prevention of osteoporosis in population older than 50 from Colombia: An intervention model from a nutrieconomics perspective

Introduction: Osteoporosis is a chronic disease characterized by a decrease in the density of bone mass, making bone more porous, less resistant and of lower quality than normal bone. This leads to the deterioration of its microstructure, making the bone more fragile and therefore increasing the risk of fracture. It has been found that high concentrations of Lactobacillus and Bifidobacterium promote the absorption of minerals such as calcium, magnesium, and phosphorus and thus increase mineral density. Due to the great social and economic impacts of osteoporosis, it is necessary to develop interventions that can be easily adopted at the population level, improving the quality of life of individuals without significantly affecting the health system. Objective: Assessing the impact of increased dairy consumption on the Colombian population diagnosed with osteoporosis between 2015 and 2020 through the simulation of the potential impact fraction (PIF). Methods: Using data from the Integrated Social Protection Information System (SISPRO) and National Nutritional Situation Survey (ENSIN), the incidence, the frequency of milk consumption, the potential impact fraction (PIF), and disability-adjusted life years (DALYs) were estimated. Results: A total of 63,640 cases of osteoporosis were identified. The highest incidence was observed in 2019. Seventeen food groups were identified in the ENSIN, and the most frequent products consumed by respondents over 50 years of age were milk, cheese, and yogurt. The PIF was then analysed, with a calcium intake of 600 mg/ day, and a significant difference in the decrease in the number of cases was observed. In 2019, a higher estimated DALY loss of 9.9 was observed. In women, years of life lost due to fractures were the highest in the 65-69 age group. In men, they were highest in the 75-79 age group. Discussion: We observed that the departments with the highest consumption of dairy products were the capital of the country and regions where dairy products factories are located. It was not possible to establish an association between socioeconomic strata and low dairy intake. Nevertheless, some authors have proposed that westernization of diets and low income reduce access to fresh fruits and milk derivates. Conclusion: Years lost due to disability increased in the population over 60 years of age. In the PIF analysis, a decrease in cases was observed when the population increased consumption of dairy products.

Introducción: La osteoporosis es una enfermedad crónica caracterizada por una disminución de la densidad de la masa ósea que hace que el hueso sea más poroso, menos resistente y de menor calidad que el hueso normal. Esto conduce al deterioro de su microestructura, por lo que el hueso se hace más frágil y, por lo tanto, aumenta el riesgo de fractura. Se ha encontrado que las altas concentraciones de Lactobacillus y Bifidobacterium promueven la absorción de minerales como calcio, magnesio y fósforo y, por lo tanto, aumentan la densidad mineral. Debido a los grandes impactos sociales y económicos de la osteoporosis, es necesario desarrollar intervenciones que puedan ser fácilmente adoptadas a nivel poblacional con el fin de mejorar la calidad de vida de los individuos sin afectar significativamente el sistema de salud. Objetivo: Evaluar el impacto del aumento del consumo de lácteos en la población colombiana con diagnóstico de osteoporosis entre 2015 y 2020 mediante la simulación de la fracción de impacto potencial (PIF). Materiales y métodos: Estudio ecológico realizado en adultos mayores de 50 años con diagnóstico de osteoporosis. A partir de los registros del Sistema Integrado de Información de Protección Social (SISPRO) y la Encuesta Nacional de Situación Nutricional (ENSIN), se estimó la incidencia, la frecuencia de consumo de leche, el PIF y los años de vida ajustados por discapacidad (AVAD). Resultados: Se identificaron un total de 63 640 casos de osteoporosis en SISPRO, la mayor incidencia se observó en 2019. Se establecieron 17 grupos de alimentos en la ENSIN, los productos más frecuentes consumidos en población mayor de 50 años fueron leche, queso y yogur. En el cálculo del PIF se encuentra que con una ingesta de calcio de 600 mg/día se reduciría significativamente el número de casos. En 2019 se observó una mayor pérdida estimada de AVAD de 9,9. En las mujeres, los años de vida perdidos debido a fracturas fueron más altos en el grupo de edad de 65 a 69 años. En los hombres, fue más alta en el grupo de edad de 75-79 años. Discusión: Observamos que los departamentos con mayor consumo de productos lácteos fueron la capital y las regiones donde se encuentran las fábricas de productos lácteos. No fue posible establecer una asociación entre los estratos socioeconómicos y la baja ingesta de lácteos. Sin embargo, algunos autores han propuesto que la occidentalización de las dietas y los bajos ingresos reducen el acceso a frutas frescas y derivados de la leche. Conclusión: Los años perdidos por discapacidad aumentaron en la población mayor de 60 años. En el análisis PIF, se observó una disminución en los casos (reducción de 2329 casos/ año) cuando la población aumentó el consumo de productos lácteos.

Recurrent Quantification Analysis Based Study of Wide-Field Calcium Imaging Data in Relation to Brain's Wake/Sleep Condition

Wide-Field Calcium Images (WFCI) directly reflect neuronal excitation, but their poor frame rate could be a drawback for time series analysis. This work was aimed at exploring the diagnostic capability retained by a time series obtained from calcium imaging data. To that purpose, we analyzed publicly available data from 2.88 hour continuous recordings of calcium images obtained from seven mice at different wake/sleep stages. Data were obtained from the Physionet portal and were submitted to Recurrence Quantification Analysis (RQA). The association between retrosplenial and parietal areas was also assessed. Nonlinear RQA analysis allowed to identify the right retrosplenial and parietal areas as particularly sensitive to changes in sleep walking condition. Specifically, our results suggested that the RQA feature lmean decreases in non-REM sleep_1 stage as compared to waking stage. Sleep (both sleep_1 stage and REM) apparently elicits an increase in the association between retrosplenial and parietal areas. Overall, these results suggest that RQA and association analysis are appropriate to assess modifications associated to changes in brain condition, in spite of the low sampling rate of WFCI signals.

Las Imágenes de Calcio de Campo Ancho (Wide-Field Calcium Images, WFCI) reflejan directamente la excitación neuronal, pero su escasa resolución temporal pudiera resultar un impedimento para el análisis de series temporales. El presente trabajo tuvo por finalidad explorar la capacidad diagnostica que retiene una serie temporal extraída de imágenes de calcio. Para ello, se estudió una base de datos disponible en la red que contiene registros de 2.88 horas de duración de imágenes de calcio correspondientes a 7 ratones transgénicos a diferentes estadios de sueño/vigilia. Los datos fueron descargados del portal Physionet y sometidos a Análisis de Cuantificación Recurrente (Recurrent Quantification Analysis, RQA). La asociación entre las áreas retrosplenial y parietal derechas fue también evaluada. El análisis no lineal mediante RQA permitió identificar las áreas retrosplenial y parietal derechas como zonas particularmente sensibles a cambios en el estado de sueño/vigilia. Específicamente, nuestros resultados sugieren que el índice l mean se redujo en el estadio 1 de sueño no REM en comparación con el estado de vigilia. El estado de sueño, tanto REM como no-REM aparentemente induce un reforzamiento en la apreciación entre las áreas retrosplenial y parietal derechas. En su conjunto, estos resultados apuntan que el análisis de RQA y de asociación entre áreas son pertinentes para sensar las modificaciones asociadas a cambios en el estado del cerebro, a pesar de la baja resolución temporal de las señales WFCI.

Calcium carbide-ripened plantain induced alterations in plasma electrolytes concentration and kidney function in rats / Alterações induzidas por plátano maturado com carbureto de cálcio na concentração plasmática de eletrólitos e na função renal em ratos

Abstract Introduction: Artificial fruit ripening agents such as ethanol, ethylene, ethephon, and calcium carbide (CaC2) is usually employed in stimulating the fruit ripening process. Currently, there is a paucity of information regarding the effects of various artificial fruits ripening methods on the health status of consumers. In this study, the physiological effects and possible health hazards associated with the consumption of plantain ripened by CaC2 and other non-chemical methods on the kidneys were investigated. Methods: Artificially ripened plantain was mixed with rat feed and fed to Wistar albino rats for four weeks, and the levels of plasma electrolytes (Na+, HCO3−, K+, and Cl−), urea, creatinine, as well as histological changes in the kidneys were determined. Results: Results indicated that rats fed with carbide-ripened plantain had a significantly high level of plasma bicarbonate (HCO3−) compared to control rats., but there was no difference in the level of plasma sodium (Na+). However, the levels of plasma potassium (K+) and chloride (Cl−) were significantly low in rats fed with CaC2-ripened plantain as compared to the control rats. Furthermore, the levels of urea and creatinine were significantly high in rats fed with CaC2-ripened plantain compared to the control animals. Histological analyses showed glomeruli atrophy and tubular necrosis in kidneys of rats fed with CaC2-ripened plantain, thereby further indicating toxicity to the kidneys. Conclusions: Histological evidence and alterations in the level of the plasma electrolytes, urea, and creatinine suggest that consumption of fruits ripened with calcium carbide may be harmful to the kidneys.

Resumo Introdução: Agentes de maturação artificial como etanol, etileno, etefon e carbureto de cálcio (CaC2) são comumente empregados para estimular o amadurecimento de frutas. Atualmente, há uma escassez de informações a respeito dos efeitos de diversos métodos artificiais de maturação de frutas no estado de saúde dos consumidores. Neste estudo, investigaram-se os efeitos fisiológicos e possíveis riscos à saúde associados ao consumo de plátano maturado por CaC2 e outros métodos não químicos nos rins. Métodos: O plátano artificialmente amadurecido foi misturado com ração de rato e fornecido a ratos albinos Wistar por quatro semanas, e determinaram-se os níveis de eletrólitos plasmáticos (Na+, HCO3−, K+, e Cl−), ureia, creatinina, bem como alterações histológicas nos rins. Resultados: Ratos alimentados com plátano amadurecido com carbureto apresentaram um nível significativamente maior de bicarbonato plasmático (HCO3−) em comparação com ratos controle, mas não houve diferença no nível plasmático de sódio (Na+). Entretanto, os níveis plasmáticos de potássio (K+) e cloreto (Cl−) foram significativamente baixos em ratos alimentados com plátano maturado com CaC2 comparados com ratos controle. Além disso, os níveis de ureia e creatinina foram significativamente mais elevados em ratos alimentados com plátano amadurecido com CaC2, em comparação com os animais controle. Análises histológicas mostraram atrofia glomerular e necrose tubular em rins de ratos alimentados com plátano amadurecido com CaC2, indicando assim ainda mais toxicidade aos rins. Conclusões: Evidências histológicas e alterações nos eletrólitos plasmáticos, ureia e creatinina sugerem que o consumo de frutas amadurecidas com carbureto de cálcio pode ser prejudicial aos rins.

Características de los pacientes hospitalizados con hipercalcemia en la provincia de Málaga: estudio longitudinal, retrospectivo y multicéntrico / Characteristics of hospitalized patients with hypercalcemia in the province of Malaga: A longitudinal, retrospective, multicenter study

Antecedentes y objetivo Existen escasos estudios que analicen la hipercalcemia en pacientes hospitalizados. Nuestros objetivos fueron: describir las características clínicas de los pacientes hospitalizados con hipercalcemia, estimar su prevalencia en el medio hospitalario, analizar la tasa de corrección de la hipercalcemia, e identificar variables pronósticas. Materiales y métodos Estudio observacional, longitudinal, retrospectivo y bicéntrico. Se incluyeron pacientes adultos ingresados en dos hospitales de Málaga (2014-2018) con diagnóstico de hipercalcemia. El seguimiento mínimo fue de 2años o hasta el fallecimiento. Resultados Se incluyeron 205 pacientes con hipercalcemia (incidencia: 0,13%). La edad media (DE) fue de 68,2 (13,1) años, con predominio de varones (55,1%). La calcemia mediana (RIC) al ingreso fue de 13,1 (11,8-14,6) mg/dL. Las etiologías más frecuentes fueron: neoplasias (75,1%), hiperparatiroidismo primario y fármacos (ambas, 8,8%). La mediana (RIC) de seguimiento fue de 5,1 (1,7-60,3) semanas. Los tratamientos más usados fueron: fluidoterapia (86,8%), diuréticos de asa (70,9%), bifosfonatos (60,7%) y glucocorticoides (46,2%). La tasa de corrección de la hipercalcemia fue del 65,2%, con una mediana (RIC) de 6 (3-10) días La tasa de mortalidad fue del 81,5%. La mediana (IC95%) de supervivencia fue de 5,1 (3-7,3) semanas. Los factores asociados a una mayor mortalidad fueron: edad avanzada, etiología neoplásica, calcemia al ingreso y no corrección de la hipercalcemia. Conclusiones La hipercalcemia en pacientes hospitalizados se debe principalmente a procesos neoplásicos y se asocia a una elevada mortalidad. Observamos una baja tasa de seguimiento de las recomendaciones para el manejo de la hipercalcemia (AU)

Background and objective There are limited studies analyzing hypercalcemia in hospitalized patients. Our objectives were to describe the clinical characteristics of hospitalized patients with hypercalcemia, estimate its prevalence in the hospital setting, analyze the rate of correction of hypercalcemia, and identify prognostic variables. Materials and methods Observational, longitudinal, retrospective, and bicentric study. Adult patients admitted to two hospitals in Málaga (2014-2018) with a diagnosis of hypercalcemia were included. The minimum follow-up was 2years or until death. Results A total of 205 patients with hypercalcemia were included (incidence: 0.13%). The mean age (SD) was 68.2 (13.1) years, with a predominance of males (55.1%). The median (IQR) serum calcium at admission was 13.1 (11.8-14.6) mg/dL. The most common etiologies were neoplasms (75.1%), primary hyperparathyroidism, and medications (both 8.8%). The median (IQR) follow-up period was 5.1 (1.7-60.3) weeks. The most commonly used treatments were fluid therapy (86.8%), loop diuretics (70.9%), bisphosphonates (60.7%), and glucocorticoids (46.2%). The rate of correction of hypercalcemia was 65.2%, with a median (IQR) of 6 (3-10) days. The mortality rate was 81.5%. The median (95%CI) survival was 5.1 (3-7.3) weeks. Factors associated with higher mortality were advanced age, neoplastic etiology, serum calcium at admission, and failure to correct hypercalcemia. Conclusions Hypercalcemia in hospitalized patients is mainly due to neoplastic processes and is associated with high mortality. We observed a low rate of adherence to recommendations for the management of hypercalcemia (AU)

Niveles plasmáticos de Vitamina D en adultos mayores de Lima Metropolitana, Perú

Objetivo. Determinar los niveles plasmáticos de vitamina D y su relación con la ocupación, procedencia y los valores de calcio, leucocitos, hemoglobina y plaquetas en adultos mayores de Lima Metropolitana. Método. Estudio observacional descriptivo de corte transversal, participaron 100 adultos mayores de uno u otro sexo de Lima Metropolitana, ellos fueron reclutados durante las estaciones de invierno-primavera del 2022, los niveles de vitamina D se categorizó como suficiente, insuficiente y deficiente, las concentraciones séricas de vitamina D se midieron por radioinmunoensayo. La relación de variables se realizó con el coeficiente de correlación de Spearman y regresión logística. Resultados. La edad media fue 69.6 años, el 71%, fueron del sexo femenino, la concentración media de vitamina D fue 36.56 ng/ml, el 13% tuvieron niveles de deficiente, y el 32% de insuficiente y el 53% suficientes. Según sexo, el 77,7% de los que tuvieron niveles de deficiente/insuficiente fueron mujeres. En el análisis bivariado no hubo correlación entre los valores de vitamina D con calcio, hemoglobina leucocitos y plaquetas, los que procedieron de distritos de menor temperatura tuvieron 2,25 veces más riesgo de tener niveles insuficientes/deficiente de vitamina D. Conclusiones. El 45% de los adultos mayores tuvieron niveles deficientes/insuficiente de vitamina D, siendo más frecuente en las mujeres y de los procedentes de distritos de menor promedio de temperatura.

Objective. To determine the plasmatic levels of vitamin D and its relationship with the occupation, origin and the values of calcium, leukocytes, hemoglobin and platelets in older adults of Metropolitan Lima. Methods Observational descriptive cross-sectional study, 100 older adults of either sex from Metropolitan Lima participated, they were recruited during the winter-spring seasons of 2022, vitamin D levels were categorised as sufficient, insufficient, and deficient, serum vitamin D concentrations were measured by radioimmunoassay. The relationship of variables was established with the Spearman correlation coefficient and logistic regression. Results. The mean age was 69.6 years, 71% were women, the mean vitamin D concentration was 36.56 ng/ml, 13% had deficient levels, 32% were insufficient and 53% sufficient. By sex, 77.7% of those with deficient/insufficient levels were women. In the bivariate analysis, there was no correlation between vitamin D values with calcium, hemoglobin, leukocytes and platelets; those who came from districts with lower temperatures had a 2.25 times greater risk of having insufficient/deficient levels of vitamin D. Conclusions. 45% of older adults had deficient/insufficient levels of vitamin D, more frequent in women and those coming from districts with lower average temperatures.

Characteristics of hospitalized patients with hypercalcemia in the province of Malaga: a longitudinal, retrospective, multicenter study.

BACKGROUND AND OBJECTIVE: There are limited studies analyzing hypercalcemia in hospitalized patients. Our objectives were to describe the clinical characteristics of hospitalized patients with hypercalcemia, estimate its prevalence in the hospital setting, analyze the rate of correction of hypercalcemia, and identify prognostic variables. MATERIALS AND METHODS: Observational, longitudinal, retrospective, and bicentric study. Adult patients admitted to two hospitals in Málaga (2014-2018) with a diagnosis of hypercalcemia were included. The minimum follow-up was 2 years or until death. RESULTS: A total of 205 patients with hypercalcemia were included (incidence: 0.13%). The mean age (SD) was 68.2 (13.1) years, with a predominance of males (55.1%). The median (IQR) serum calcium at admission was 13.1 (11.8-14.6) mg/dl. The most common etiologies were neoplasms (75.1%), primary hyperparathyroidism, and medications (both 8.8%). The median (IQR) follow-up period was 5.1 (1.7-60.3) weeks. The most commonly used treatments were fluid therapy (86.8%), loop diuretics (70.9%), bisphosphonates (60.7%), and glucocorticoids (46.2%). The rate of correction of hypercalcemia was 65.2%, with a median (IQR) of 6 (3-10) days. The mortality rate was 81.5%. The median (95% CI) survival was 5.1 (3-7.3) weeks. Factors associated with higher mortality were advanced age, neoplastic etiology, serum calcium at admission, and failure to correct hypercalcemia. CONCLUSIONS: Hypercalcemia in hospitalized patients is mainly due to neoplastic processes and is associated with high mortality. We observed a low rate of adherence to recommendations for the management of hypercalcemia.

Hipercalcemia asociada a hiperparatiroidismo primario: enfoque y manejo a partir de un caso clínico

Introducción: el calcio es el electrolito más abundante del cuerpo humano y la hipercalcemia es el trastorno común causado normalmente por el hiperparatiroidismo primario o malignidad, su manejo depende de la presentación y causa subyacente. Además, una proporción de casos se presentan como una emergencia, lo que conlleva a una mortalidad significativa. Objetivo: mostrar un caso inusual de presentación clínica de hipercalcemia asociada a hiperparatiroidismo primario y, asimismo, dar una breve revisión acerca del enfoque y el manejo de esta patología. Presentación del caso: paciente femenina de 32 años, antecedente de adenoma paratiroideo no resecado y pancreatitis, asiste por tres días de dolor abdominal de tipo cólico y de moderada intensidad, acompañado de episodios eméticos de contenido alimentario, paraclínicos iniciales con hipercalcemia severa, electrocardiograma con bloqueo auriculoventricular grado I, gases arteriales con alcalosis respiratoria aguda e hiperlactatemia. También se le practicó un TAC de abdomen donde este apareció con tumores pardos. Se ingresó a la UCI para la administración de líquidos endovenosos, diuréticos de asa y cinacalcet, pero no presentó mejoría, por lo que se indicó terapia de hemodiálisis. Discusión y conclusión: la hipercalcemia es un hallazgo frecuente. El hiperparatiroidismo primario y la neoplasia maligna son las dos causas más frecuentes de aumento de los niveles de calcio sérico y, en conjunto, representan alrededor del 90 % de todos los casos, donde los valores en suero varían entre el calcio total (8,5 y 10,5 mg/dl) y el iónico (1,16-1,31). La concentración sérica de Ca 2+ está estrechamente relacionada por las acciones de la hormona paratiroidea y el calcitriol, donde el hiperparatiroidismo primario ocurre como resultado de adenomas, hiperplasias y carcinoma. Las manifestaciones clínicas y la severidad van a estar correlacionadas con el tiempo de duración de la enfermedad, los niveles de calcio y de PTH. Dentro del tratamiento, este será guiado por su causa, sin embargo, es posible clasificarlo en tratamiento urgente y no urgente. Además, el enfoque de la hipercalcemia aguda severa es un reto diagnóstico dadas las múltiples causas que pueden llevar a este trastorno hidroelectrolítico y la rápida instauración de tratamiento que se requiere cuando es detectada.

Background: Calcium is the most abundant electrolyte in the human body, hypercalcemia is a common disorder usually caused by primary hyperparathyroidism or malignancy. A proportion of cases presenting as an emergency, leading to significant mortality. The management of hypercalcemia depends on the presentation and underlying cause. Purpose: to present an unusual case of clinical presentation of hypercalcemia associated with primary hyperparathyroidism, as well as to give a brief review about the approach and management of this pathology. Case presentation: A 32-year-old female patient, with a history of unresected parathyroid adenoma and pancreatitis, attended for 3 days of abdominal pain, moderate intensity, accompanied by emetic episodes of food content, initial paraclinical findings showed severe hypercalcemia, electrocardiogram with block grade I atrioventricular, arterial gases with acute respiratory alkalosis and hyperlactatemia. CT of the abdomen with brown tumors. She was admitted to the ICU for administration of intravenous fluids, loop diuretics, and cinacalcet without showing any improvement, so hemodialysis therapy was indicated. Discussion and conclusion: hypercalcemia is a frequent finding. Primary hyperparathyroidism and malignancy are the two most common causes of elevated serum calcium levels, together accounting for about 90 % of all cases. Serum values vary between total calcium 8.5 and 10.5 mg/dl and ionic 1.16- 1.31. Serum Ca 2+ concentration is closely related by the actions of parathyroid hormone and calcitriol. Primary hyperparathyroidism occurs as a result of adenomas, hyperplasias, or carcinoma. The clinical manifestations and severity will be correlated with the duration of the disease, calcium and PTH levels. Within the treatment, this will be guided by its cause, however, it is possible to classify it into urgent and non-urgent treatment. The approach to severe acute hypercalcemia is a diagnostic challenge given the multiple causes that can lead to this hydroelectrolyte disorder and the rapid establishment of treatment that is required when it is detected.

Efeito de diferentes irrigantes finais na resistência união de um cimento de silicato de cálcio: estudo in vitro / Effect of different final irrigants on the bond strength of a calcium silicate cement : in vitro study

Objetivo: Este estudo teve como objetivo avaliar a resistência de união do cimento Biodentine® à dentina radicular após a utilização de diferentes irrigantes finais. Método: Vinte dentes humanos extraídos tiveram seu terço médio radicular cortado em fatias que foram submersas em hipoclorito de sódio 2,5% e posteriormente divididas aleatoriamente em 4 grupos experimentais (n=15) conforme o irrigante final utilizado (1) água destilada (controle), (2) QMixTM, (3) ácido cítrico 10%, (4) EDTA 17%. Após a imersão na substância teste as amostras foram preenchidas com o cimento Biodentine e imersas em solução salina tamponada com fosfato (PBS) por um período de 7 dias. O teste de push out foi realizado e os valores de resistência de união em Mpa foram obtidos. Os dados foram analisados pelos testes de Kruskal Wallis e Studend- Newman-Keuls. Resultados: Os piores valores de união foram obtidos após a utilização do EDTA enquanto a água destilada, o QMix e o ácido cítrico apresentaram resultados estatisticamente semelhantes entre si. Conclusão: A remoção da smear layer não resultou em melhora nos resultados de união do cimento Biodentine.(AU)

Objective: This study aimed to evaluate the bond strength of Biodentine® cement to root dentin after the use of different final irrigants. Method: Twenty extracted human teeth had their middle root third cut into slices that were submerged in 2.5% sodium hypochlorite and then randomly divided into 4 experimental groups (n=15) according to the final irrigant used (1) distilled water (control), (2) QMixTM, (3) 10% citric acid, (4) 17% EDTA. After immersion in the test substance the samples were filled with Biodentine cement and immersed in phosphate buffered saline (PBS) for a period of 7 days. The push out test was performed and the bond strength values in MPa were obtained. The data were analyzed by Kruskal Wallis and Studend- Newman-Keuls tests. Results: The worst bond values were obtained after using EDTA while distilled water, QMix and citric acid showed statistically similar results to each other. Conclusion: Removal of the smear layer did not result in improved bonding results of Biodentine cement.(AU)

3D Printing characteristics and mechanical properties of a bio scaffold obtained from a Micro-CT Scan, using the fused deposition modeling technique

The objective is to determine which biopolymer has the best 3D printing characteristics and mechanical properties for the manufacture of a bioscaffold, using the fused deposition printing technique, with models generated from an STL file obtained from a Micro-CT scan taken from a bovine iliac crest bone structure. Through an experimental exploratory study, three study groups of the analyzed biopolymers were carried out with thirteen printed structures of each one. The first is made of 100% PLA. The second, 90B, we added 1g of diatom extract, and the third, 88C, differs from the previous one in that it also contains 1g of calcium phosphate. The 39 printed structures underwent a visual inspection test, which required the fabrication of a gold standard scaffold in resin, with greater detail and similarity to the scanned bone structure. Finally, the structures were subjected to a compressive force (N) to obtain the modulus of elasticity (MPa) and compressive strength (MPa) of each one of them. A statistically significant difference (p=0.001) was obtained in the printing properties of the biomaterial 88C, compared to 90B and pure PLA and the 88C presented the best 3D printing characteristics. In addition, it also presented the best mechanical properties compared to the other groups of materials. Although the difference between these was not statistically significant (p=0.388), in the structures of the 88C biomaterial, values of compressive strength (8,84692 MPa) and modulus of elasticity (43,23615 MPa) were similar to those of cancellous bone in the jaws could be observed. Because of this result, the 88C biomaterial has the potential to be used in the manufacture of bioscaffolds in tissue engineering.

El objetivo es determinar cuál biopolímero presenta las mejores características de impresión 3D y propiedades mecánicas para la fabricación de un bioandamiaje, utilizando la técnica de impresión por deposición fundida, con modelos generados a partir de un archivo en formato STL que se obtuvo de un Micro-CT Scan de una estructura osea de cresta iliaca bovina. Mediante un estudio exploratorio, se realizaron 3 grupos de estudio con trece estructuras impresas de cada uno. El primero, se compone 100% de PLA. El segundo, 90B, se le agrega 1g de extracto de diatomea, y el tercero, 88C, se diferencia del anterior ya que contiene además, 1g de fosfato de calcio. A las 39 estructuras impresas se les realizó una prueba de inspección visual, por lo que se requirió la confección de un patrón de oro en resina, con mayor detalle y similitud a la estructura ósea escaneada. Finalmente, las estructuras fueron sometidas a una fuerza compresiva (N) para la obtención del módulo de elasticidad (MPa) y de la resistencia compresiva (MPa) de cada una de ellas. Se obtuvo una diferencia estadísticamente significativa (p=0,001) en las propiedades de impresión del biomaterial 88C, con respecto al 90B y al PLA puro, presentando las mejores características de impresión 3D. Además, obtuvo las mejores propiedades mecánicas en comparación con los otros grupos de materiales. Aunque la diferencia entre estos no fue estadísticamente significativa (p=0,388), en las estructuras del biomaterial 88C, se pudieron observar valores de resistencia compresiva (8,84692 MPa) y módulo de elasticidad (43,23615 MPa) que son semejantes a los del hueso esponjoso de los maxilares. A razón de este resultado, el biomaterial 88C cuenta con el potencial para ser utilizado en la fabricación de bioandamiajes en la ingeniería tisular.

Evaluación de la densidad mineral ósea en adultos de 40 años y más, Honduras 2022

El objetivo de esta investigación fue evaluar la densidad de masa ósea (DMO), la situación nutricional, la ingesta de nutrientes y el nivel de actividad física, por medio de un estudio descriptivo, transversal, en una universidad internacional ubicada en Honduras cuyo universo es 376 empleados, con edad de 40 años y más. La muestra de 50 empleados fue estimada usando la fórmula para poblaciones finitas con una probabilidad de 90% y un error de 10%. Se tomaron medidas antropométricas con equipo SECA; densidad mineral ósea con equipo de ultrasonido en radio Sunlight MiniOmni™. Se aplicó un recordatorio de alimentos consumidos en las últimas 24 horas y el cuestionario Internacional de Actividad Física (IPAQ). Los datos se analizaron en EPI INFO v 7.2.5. El promedio de edad fue 48,9 años con 58% de mujeres participantes. El 90% tuvo sobrepeso y obesidad. Se identificaron 14 casos de DMO no normal, de éstos, uno fue osteoporosis (mujer, de 50 años y más); 93% de los casos tuvieron sobrepeso y obesidad, 43% se identificaron en personas de 40 a 49 años y 71% fueron mujeres. La actividad física fue 48% baja. El promedio de calorías consumidas/día/persona fue de 2.517; con 21% de adecuación de vitamina D, 87% de calcio, 275% de fósforo, 166,69 mg de cafeína. Se concluye que se requiere el control del sobrepeso y obesidad, así como el diagnóstico temprano de los cambios en la densidad mineral ósea, particularmente en las mujeres.

The objective of this research was to evaluate bone mass density(BMD), nutritional status, nutrient intake, and physical activity level, through a cross-sectional descriptive study, in an international university located in Honduras with a universe of 376 employees, aged 40 and over. The sample of 50 was estimated with the formula for finite population with a 90% probability and an error of 10%. Anthropometric measurements were taken with SECA equipment; bone mineral density with Sunlight MiniOmni™ radio ultrasound equipment. A 24-hour dietary recall method and the International Physical Activity Questionnaire (IPAQ) were applied. The data was analyzed in EPI INFO v 7.2.5. The average age of the people in the sample was 48,9 years with 58% of women. 90% were overweight and obese. 14 cases of non-normal BMD were identified, of these, one was osteoporosis (woman, 50 years of age and over); 93% of the cases were overweight and obese, 43% were identified in people between 40 and 49 years of age, and 71% were women. Physical activity was 48% low. The average number of calories consumed/day/person was 2.517; 21% adequacy of vitamin D, 87% of calcium, 275% of phosphorus, 166.69 mg of caffeine. It is concluded that control of overweight and obese is required, and the early diagnosis of changes in bone mass density, particularly in women.

Vitamina D y su efecto positivo sobre el eje PTH/vitamina D/calcio-FGF23/klotho/fósforo en pacientes con trasplante renal / Vitamin D and its positive effect on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in kidney transplant recipients

Introducción: la hipovitaminosis D es frecuente en los receptores de trasplante renal (RTR) y se asocia con efectos deletéreos tanto a nivel óseo como extraóseo. El tratamiento con colecalciferol es eficaz para la normalización de la 25(OH)D, demostrándose un efecto benéfico sobre el eje calciotrópico; sin embargo, su efecto sobre el eje fosfotrópico no se ha reportado. El objetivo de este estudio fue evaluar el efecto de la normalización de las concentraciones séricas de 25(OH)D sobre el eje PTH/vitamina D/calcio-FGF23/klotho/fósforo en RTR tratados con colecalciferol, así como la asociación entre sus componentes. Métodos: estudio prospectivo en 23 RTR con hipovitaminosis D y antecedente de nefropatía primaria tratados con colecalciferol, en quienes se evaluó el eje PTH/vitamina D/calcio y FGF23/klotho/fósforo durante el estado de hipovitaminosis D y a la normalización de la 25(OH)D. Resultados: a la normalización de la 25(OH)D se evidenció una reducción de la PTH [103 (58,5-123,9) vs. 45,6 (30,1-65,1) pg/mL; p = 0,002] y un aumento del fósforo sérico [3,1 (2,3-3,5) vs. 3,3 (3-3,6) mg/dL; p = 0,01], sin diferencias en las concentraciones de calcio, klotho y FGF23. El tiempo para lograr la normalización de la 25(OH)D fue de 12 semanas (4-12), con una dosis de 5000 UI/día (4000-6000). Se corroboró una asociación positiva entre klotho y PTH (r = 0,54; p = 0,008; regresión lineal, β = 0,421; IC 95 %: 0,003-0,007; p = 0,045). (AU)

Background: hypovitaminosis D is frequent in kidney transplant recipient (KTR) patients and is associated with deleterious effects both at the bone and extraosseous levels. Treatment with cholecalciferol is effective for the normalization of 25(OH)D, demonstrating a beneficial effect on the calcium-tropic axis in other populations; however, its effect on the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis in RTR has not been reported. The aim of this study was to evaluate the effect of normalization of serum 25(OH)D concentrations on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in KTR treated with cholecalciferol, as well as the association between the components of this axis. Methods: a prospective study in 23 KTR with hypovitaminosis D, with evolution from 1 to 12 months post-transplantation, an estimated glomerular filtration rate > 60 mL/min/1.73 m2 and a history of primary nephropathy treated with cholecalciferol, in whom the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis was evaluated during the state of hypovitaminosis D and at normalization of 25(OH)D. Results: at the normalization of 25(OH)D, a reduction in PTH [103 (58.5-123.9) vs 45.6 (30.1-65.1) pg/mL; p = 0.002] and an increase in serum phosphorus [3.1 (2.3-3.5) vs 3.3 (3-3.6) mg/dL; p = 0.01] were evident, with no differences in calcium, klotho and FGF23 concentrations. The time to achieve normalization of 25(OH)D was 12 weeks (RIC, 4-12), with a dose of 5000 IU/day (RIC, 4000-6000). A positive association between klotho and PTH was corroborated (r = 0.54; p = 0.008; linear regression, β = 0.421; B = 0.004; 95 % CI, 0.003-0.007; p = 0.045). (AU)

Ingesta de calcio y densidad mineral ósea en adolescentes chilenos con desarrollo puberal completo

Introducción: La cantidad diaria recomendada (RDA) de calcio en adolescentes es de 1.300 mg/día. La última Encuesta Nacional de Consumo Alimentario de Chile, mostró que la mediana de ingesta total de calcio fue menos de la mitad de la RDA. Una ingesta insuficiente de calcio puede impactar negativamente la mineralización ósea. Objetivo: Determinar el efecto de la ingesta de calcio y estado nutricional sobre la densidad mineral ósea (DMO) de adolescentes con desarrollo puberal completo. Métodos: Estudio de corte transversal. Participaron n= 79 adolescentes de ambos sexos de entre 17 y 18 años elegidos al azar, aparentemente sanos, estadio Tanner 5 e IMC-1 DE). Según estado nutricional, no hubo diferencias significativas en la ingesta de nutrientes, pero sí en la DMO. En media, la DMO estandarizada (puntaje Z) fue normal para ambos sexos (>-1 DE); los adolescentes con obesidad presentaron una DMO estandarizada significativamente mayor que los adolescentes de peso normal (1,05±0,85 vs 0.33±0,86; P= 0,04). La ingesta de calcio no se relacionó con la masa ósea total ni con la DMO estandarizada. Conclusión: En adolescentes con desarrollo puberal completo no hubo relación entre la ingesta de calcio y los niveles de mineralización ósea. Sí hubo relación entre mineralización ósea y estado nutricional, siendo mayor la DMO en los individuos con obesidad.

Background: In adolescents, the recommended daily intake (RDI) of calcium is 1,300 mg. In Chile, the latest National Survey of Food Consumption showed that the median total calcium intake was less than half of the RDI. An adequate intake of calcium in adolescence negatively affects BMD. Aim: To determine the association of calcium intake and nutritional status with bone mineral density (BMD) in male and female adolescents with completed pubertal development (Tanner 5). Methods: Cross-sectional study in a random sample of 79 male and female adolescents, ages 17-18. Participants were healthy, Tanner stage 5, and BMI −1 SD. BMD was higher in obese participants compared to normal-weight adolescents (1.05±0.85 vs 0.33±0.86; P= 0.04), although no differences in nutrients and food intake. Calcium intake was unrelated to total bone mass and unstandardized BMD. Conclusions: In our sample of adolescents with complete pubertal development, there was no relationship between calcium intake and bone mineralization levels. There was a significant relationship between bone mineralization and nutritional status, with BMD being higher in adolescents with obesity.

S100 proteins and their implication in the thalamus: an integrative review / Las proteínas S100 y su implicación en el tálamo: una revisión integradora

SUMMARY: S100 proteins belong group of calcium-binding proteins and are present in physiological intracellular and extracellular regulatory activities, such as cell differentiation, and act in inflammatory and neoplastic pathological processes. Recently, its expressions in the nervous system have been extensively studied, seeking to elucidate its action at the level of the thalamus: A structure of the central nervous system that is part of important circuits, such as somatosensory, behavioral, memory and cognitive, as well as being responsible for the transmission and regulation of information to the cerebral cortex. This article is an integrative review of scientific literature, which analyzed 12 studies present in Pubmed. The analysis showed that the relationship of S100 proteins and the thalamus has been described in neoplastic processes, mental disorders, hypoxia, trauma, stress, infection, Parkinson's disease and epilepsy. In summary, it is possible to conclude that this protein family is relevant as a marker in processes of thalamic injury, requiring further studies to better understand its clinical, preclinical meanings and its prognostic value.

Las proteínas S100 pertenecen al grupo de proteínas fijadoras de calcio y están presentes en actividades reguladoras fisiológicas intracelulares y extracelulares, como la diferenciación celular, y actúan en procesos patológicos inflamatorios y neoplásicos. Recientemente, sus expresiones en el sistema nervioso han sido ampliamente estudiadas, buscando dilucidar su acción a nivel del tálamo: una estructura del sistema nervioso central que forma parte de importantes circuitos, como el somatosensorial, conductual, de memoria y cognitivo, así como además de ser responsable de la transmisión y regulación de la información a la corteza cerebral. Este artículo es una revisión integradora de la literatura científica, que analizó 12 estudios presentes en Pubmed. El análisis mostró que la relación de las proteínas S100 y el tálamo ha sido descrita en procesos neoplásicos, trastornos mentales, hipoxia, trauma, estrés, infección, enfermedad de Parkinson y epilepsia. En resumen, es posible concluir que esta familia de proteínas es relevante como marcador en procesos de lesión talámica, requiriendo más estudios para comprender mejor su significado clínico, preclínico y su valor pronóstico.

[Vitamin D and its positive effect on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in kidney transplant recipients]. / Vitamina D y su efecto positivo sobre el eje PTH/vitamina D/calcio-FGF23/klotho/fósforo en pacientes con trasplante renal.

Introduction: Background: hypovitaminosis D is frequent in kidney transplant recipient (KTR) patients and is associated with deleterious effects both at the bone and extraosseous levels. Treatment with cholecalciferol is effective for the normalization of 25(OH)D, demonstrating a beneficial effect on the calcium-tropic axis in other populations; however, its effect on the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis in RTR has not been reported. The aim of this study was to evaluate the effect of normalization of serum 25(OH)D concentrations on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in KTR treated with cholecalciferol, as well as the association between the components of this axis. Methods: a prospective study in 23 KTR with hypovitaminosis D, with evolution from 1 to 12 months post-transplantation, an estimated glomerular filtration rate > 60 mL/min/1.73 m2 and a history of primary nephropathy treated with cholecalciferol, in whom the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis was evaluated during the state of hypovitaminosis D and at normalization of 25(OH)D. Results: at the normalization of 25(OH)D, a reduction in PTH [103 (58.5-123.9) vs 45.6 (30.1-65.1) pg/mL; p = 0.002] and an increase in serum phosphorus [3.1 (2.3-3.5) vs 3.3 (3-3.6) mg/dL; p = 0.01] were evident, with no differences in calcium, klotho and FGF23 concentrations. The time to achieve normalization of 25(OH)D was 12 weeks (RIC, 4-12), with a dose of 5000 IU/day (RIC, 4000-6000). A positive association between klotho and PTH was corroborated (r = 0.54; p = 0.008; linear regression, ß = 0.421; B = 0.004; 95 % CI, 0.003-0.007; p = 0.045). Conclusions: treatment with cholecalciferol is effective for the normalization of 25(OH)D, with a beneficial effect on calcium-phosphotropic metabolism characterized by a reduction in PTH concentration, without significant changes in calcemia or calciuria, as well as an increase in phosphatemia, without modifications in FGF23 or klotho concentrations.

Introducción: Introducción: la hipovitaminosis D es frecuente en los receptores de trasplante renal (RTR) y se asocia con efectos deletéreos tanto a nivel óseo como extraóseo. El tratamiento con colecalciferol es eficaz para la normalización de la 25(OH)D, demostrándose un efecto benéfico sobre el eje calciotrópico; sin embargo, su efecto sobre el eje fosfotrópico no se ha reportado. El objetivo de este estudio fue evaluar el efecto de la normalización de las concentraciones séricas de 25(OH)D sobre el eje PTH/vitamina D/calcio-FGF23/klotho/fósforo en RTR tratados con colecalciferol, así como la asociación entre sus componentes. Métodos: estudio prospectivo en 23 RTR con hipovitaminosis D y antecedente de nefropatía primaria tratados con colecalciferol, en quienes se evaluó el eje PTH/vitamina D/calcio y FGF23/klotho/fósforo durante el estado de hipovitaminosis D y a la normalización de la 25(OH)D. Resultados: a la normalización de la 25(OH)D se evidenció una reducción de la PTH [103 (58,5-123,9) vs. 45,6 (30,1-65,1) pg/mL; p = 0,002] y un aumento del fósforo sérico [3,1 (2,3-3,5) vs. 3,3 (3-3,6) mg/dL; p = 0,01], sin diferencias en las concentraciones de calcio, klotho y FGF23. El tiempo para lograr la normalización de la 25(OH)D fue de 12 semanas (4-12), con una dosis de 5000 UI/día (4000-6000). Se corroboró una asociación positiva entre klotho y PTH (r = 0,54; p = 0,008; regresión lineal, ß = 0,421; IC 95 %: 0,003-0,007; p = 0,045). Conclusiones: el tratamiento con colecalciferol es eficaz para la normalización de la 25(OH)D con un efecto benéfico sobre el metabolismo calcio-fosfotrópico caracterizado por una reducción de la PTH y un incremento de la fosfatemia, sin modificaciones de calcemia, calciuria, FGF23 o klotho.

Coronary artery calcium score as a gatekeeper for further testing in patients with low pretest probability of obstructive coronary artery disease: A cost-effectiveness analysis.

INTRODUCTION AND OBJECTIVES: Current guidelines recommend not routinely testing patients with chest pain and low pretest probability (PTP <15%) of obstructive coronary artery disease (CAD), but envisage the use of risk modifiers, such as coronary artery calcium score (CACS), to refine patient selection for testing. We aimed to assess the cost-effectiveness (CE) of three different testing strategies in this population: (A) defer testing; (B) perform CACS, withholding further testing if CACS=0, and proceeding to coronary CT angiography (CCTA) if CACS>0; (C) CCTA in all. METHODS: We developed a CE model using data from a two-center cross-sectional study of 1385 patients with non-acute chest pain and PTP <15% undergoing CACS followed by CCTA. Key input data included the prevalence of obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.1%). RESULTS: Not testing would correctly classify 89.7% of cases and at a cost of €121433 per 1000 patients. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases and cost €247116/1000 patients. Employing first-line CCTA would correctly classify all patients, at a cost of €271007/1000 diagnosed patients. The added cost for an additional correct diagnosis was €1366 for CACS±CCTA vs. no testing, and €2172 for CCTA vs. CACS±CCTA. CONCLUSIONS: CACS as a gatekeeper for further testing is cost-effective between a threshold of €1366 and €2172 per additional correct diagnosis. CCTA yields the most correct diagnoses and is cost-effective above a threshold of €2172.

Consumo de calcio en mujeres jóvenes y factores de riesgo que favorecen la osteoporosis en la postmenopausia / Calcium consumption in young women and risk factors that favor osteoporosis in postmenopause

Fundamentos: La osteoporosis es una enfermedad crónica ósea considerada un problema de salud pública, cuya prevalencia es mayor en mujeres que en hombres. Debido a ello el objetivo fue evaluar el consumo de calcio diario en 138 mujeres jóvenes de la localidad de Makallé, Chaco, teniendo en cuenta sus requerimientos y señalar los factores de riesgo. Métodos: Estudio descriptivo de corte transversal, una vez obtenido el consentimiento de los encuestados, se aplicó una encuesta online estructurada con preguntas cerradas y abiertas dividida en dos secciones, para determinar elnivel de conocimiento de calcio y su frecuencia de consumo. Se analizó la distribución de frecuencias y se realizaron análisis de varianza para ver las diferencias entre grupos. Resultados: Se obtuvieron 136 respuestas, que evidenciaron que el 60% de las mujeres conoce la importancia del consumo de calcio y el momento fundamental de su consumo; el 82% conoce los alimentos fuentes del mineral y sus factores inhibidores como el alcohol el 42% y las bebidas cola el 39%. Por otra parte, demostraron desconocer cómo prevenir pérdidas del mineral un 40% siendo solo el 28% de respuestas correctas. El 50% conocía la enfermedad de osteoporosis y el 49% cómo prevenirla. Conclusiones: Se pudo determinar en las encuestadas que muchas mujeres no cubren el requerimiento diario promedio de calcio a través de la alimentación, teniendo en cuenta los factores que inhiben su absorción lo cual predispone a mayor riesgo de osteoporosis a edad avanzada. Esto señala la necesidad de establecer un programa de prevención sobre la osteoporosis. (AU)

Background: Osteoporosis is a chronic bone disease considered a public health problem and being more prevalent in women than in men. Therefore, the importance of studying young women in the age range in which they are closeto the maximum bone peak since it is a preventable disease. Due to this problem, the main objective is to evaluate the daily calcium consumption in 138 young women from the town of Makallé, Chaco, taking into account their requirements and pointing out the risk factors. Methods: Descriptive cross-sectional study, once the consent of the respondents was obtained, a structured online survey with closed and open questions was applied, divided into two sections, to determine the level of knowledge of calcium and its frequency of consumption. The results are presented in tables and graphs of frequency distribution and being significant when the value of p was less than 0.05. Results: 136 responses were obtained, which showed that 60% of the women know the importance of calciumconsumption and the fundamental moment of its consumption; 82% know the food sources of the mineral and its inhibitory factors such as alcohol 42% and cola drinks 39%. In addition, they demonstrated not knowing how to prevent mineral losses by 40%, with only 28% being correct. 50% know about osteoporosis disease and 49% know how to prevent it. Conclusions: It was determined that the surveyed women do not meet their average daily calcium requirementthrough food, taking into account the factors that inhibit its absorption, which predisposes them to a higher risk of osteoporosis in advanced age. This point to the need to establish a prevention program on osteoporosis since it iscurrently considered a public health problem. (AU)