Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave.

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

Localized acquired cutis laxa secondary to interstitial granulomatous dermatitis.

We report the case of a 68-year-old woman who had interstitial granulomatous dermatitis associated with seronegative polyarthritis. Two years later, this had evolved to become localized acquired cutis laxa.

Langerhans cell histiocytosis: an update.

The histiocytoses represent a heterogeneous group of disorders that are characterized by the proliferation and accumulation of reactive or neoplastic histiocytes within various tissues. Langerhans cell histiocytosis (LCH) is the commonest of these disorders and it is associated with high morbidity and mortality, especially in children. LCH is a poorly understood disease with features suggestive of a neoplastic, reactive, or immune dysregulation process. The clinical spectrum of LCH is considered to be broad and includes from self-resolving involvement of a single organ to a potentially fatal multisystem disease. The purpose of this review is to undertake an update of LCH with emphasis on the current recommendations regarding the classification, evaluation and treatment of this enigmatic disease.

[Vitamin B complex and homocysteine in chronic renal failure]. / Vitaminas B y homocisteína en la insuficiencia renal crónica.

Metabolic, biochemical, and hormonal changes occur in chronic renal failure usually associated with hyponutrition states. In predialysis patients, knowing the nutritional state about water-soluble vitamins such as thiamine, riboflavin, pyridoxine, cianocobalamine, and folic acid is becoming more and more important since some of the manifestations of chronic renal failure may be due to the deficiency of some of these water-soluble vitamins. The metabolic pathways in which most of these vitamins participate are interrelated and it is difficult to understand how the individual deficits of each vitamin affect renal pathology. This work aims at reviewing not only this issue but also the status of these water-soluble vitamins that different authors have found in groups of predialysis patients. On the other hand, the issue on the high prevalence of hyperhomocysteinemia in chronic renal failure as the main mortality risk factor due to cardiovascular pathologies as well as the implication of these vitamins in the metabolism of homocysteine, and consequently in plasma levels of this metabolite in predialysis patients is reviewed.

Olive oil and mitochondrial oxidative stress.

This review summarizes studies on the role of olive oil intake in the prevention and attenuation of mitochondrial oxidative stress derived from several situations such as ageing, physical exercise, treatment with adriamycin or intake of thermally oxidised oils. After more than fifteen years of studies on these issues, results have demonstrated that under different models of oxidative stress the regular intake of virgin olive oil as dietary fat is able to attenuate or increase free radical production at the mitochondrial level to a lower extent than when n-6 polyunsaturated oils are used. In the same way, virgin olive oil leads to better function of the mitochondrial electron transport chain.

Evaluation of composted sewage sludge as nutritional source for horticultural soils.

Water deficit and soil degradation have become some of the major problems for crop production in semi-arid regions, as it is the South East of Spain. As a matter of fact, considerable productivity loss and risk of erosion have to be taken into account in these areas, especially those with an horticultural use (Davis, 1989). Utilization of sewage sludge in agriculture. Agricultural Progress 64, 72-80]. Horticultural soils are highly vulnerable and prone to erosion, as vegetables are generally fast-growing species under intensive exploitation regimes. High-rate chemical inputs contribute to horticultural soil degradation and have a dramatic effect on soil microbial population and nutrient balance whilst, at the same time, have a counter-effect on price competitiveness of the vegetables to be commercialized. In this paper we monitored variations in physical, chemical and biological properties of a cauliflower plot where four increasing quantities of compost were applied. We carried out a three-stage sampling schedule in order to check the effect of compost applications doses. We conclude that a 2 kg compost/m2 application had a positive effect on physical and biological properties of the soil and provides a supply of nutrients to grow cauliflowers on its surface under intensive exploitation regimes without loss in biomass yield.

Rabbit liver mitochondria coenzyme Q10 and hydroperoxide levels: an experimental model of atherosclerosis.

The development of the atherosclerosis is mediated by the accumulation of oxidized lipids in the arterial wall. There is a relationship between average intake of dietary fat, its quality, and incidence of atherosclerosis. The goal of this work was to study the effect of different dietary fats on the coenzyme Q10 and hydroperoxide content of liver mitochondria in rabbits affected by an induced atherosclerosis. The results show that the induction of experimental atherosclerosis leads to a significant increase in hydroperoxides of rabbit liver membrane mitochondria and to a significant drop in the content of CoQ10. Furthermore, treatment of atherosclerotic rabbits with different diets resulted in an increase of membrane hydroperoxides in the group fed sunflower oil whereas the increase was significantly lower for animals fed virgin olive oil and fish oil stabilized with vitamin E (1 g/kg). CoQ10 levels only recovered partially in all groups; however, values in the sunflower oil were significantly lower as compared to corresponding values of the other groups. The use of either virgin olive oil or vitamin E stabilized fish oil in the dietary treatment of atherosclerosis appears to be a valid alternative for maintaining adequate levels of CoQ10 and hydroperoxides in liver mitochondria.

Coenzyme Q content depends upon oxidative stress and dietary fat unsaturation.

The presence of Coenzyme Q (CoQ) in food, its role in cellular bioenergetics and antioxidant protection and the key role played by dietary fatty acids on membrane structure support the interest for a wide research concerning the relationship between dietary fats, CoQ content and biochemical behaviour. Several models of peroxidative stress 'in vivo' have been extensively investigated in our laboratory, with particular regards to the influence of dietary fat upon mitochondrial CoQ levels. First studies showed that the unsaturation degree of dietary fat leads to different CoQ9 and CoQ10 mitochondrial contents. The highest levels were found using polyunsaturated fat. A significant CoQ9 decrease after adriamycin peroxidative induction was found when dietary fat was polyunsaturated; on the contrary, a light increase was found in the case of monounsaturated fat. Another example of oxidative stress is that produced by food frying. The results obtained were in some cases similar to those of the previous experimental design: in fact monounsaturated dietary fats increased CoQ mitochondrial contents, whereas the polyunsaturated ones decreased CoQ levels. Finally, the combined effect of physical exercise and dietary fats on tissue and plasma CoQ levels has been studied. CoQ levels did not change during aerobic performances when dietary fat was monounsaturated whereas light increases were detected in the case of polyunsaturated fats. On the contrary, in anaerobic conditions, CoQ levels clearly increased with monounsaturated fats and no alterations were found in the case of polyunsaturated ones.

Lipid peroxidation and antioxidants in newborns.

The aim of this investigation was to elucidate a possible correlation between lipid peroxidation, antioxidant concentrations and erythrocyte membrane fluidity in plasma from newborns. Ten healthy newborns were recruited. Venous blood samples were collected at birth, and thereafter at 3 and 72 h postnatal age. The following parameters were assessed: hydroperoxides, Coenzyme Q10 and alpha-tocopherol both in plasma and in erythrocyte membranes, and fluorescence polarization (as a tool for assessing membrane fluidity). Hydroperoxides were shown to be high in erythrocyte membranes at birth and significantly decreased at 3 and 72 h after birth. In the erythrocyte membranes, coenzyme Q10 content showed an opposite behaviour with respect to the plasma compartment. Membrane fluidity appeared unchanged even in the presence of the above mentioned modifications.

Tissue specific interactions of exercise, dietary fatty acids, and vitamin E in lipid peroxidation.

Both physical exercise and ingestion of polyunsaturated fatty acids that play an essential role in free radical-mediated damages cause lipid peroxidation. The intake of specific fatty acids can modulate the membrane susceptibility to lipid peroxidation. Data confirmed that liver, skeletal muscle, and heart have different capabilities to adapt their membrane composition to dietary fatty acids, the heart being the most resistant to changes. Such specificity affects membrane hydroperoxide levels that depend on the type of dietary fats and the rate of fatty acid incorporation into the membrane. Sedentary rats fed a monounsaturated fatty acid-rich diet (virgin olive oil) showed a higher protection of their mitochondrial membranes against peroxidation than sedentary rats fed a polyunsaturated fatty acid-rich diet (sunflower oil). Rats subjected to training showed higher hydroperoxide contents than sedentary animals, and exhaustive effort enhanced the aforementioned results as well as in vitro peroxidation with a free radical inducer. This study suggests that peroxide levels first depend on tissue, then on diet and lastly on exercise, both in liver and muscle but not in heart. Finally, it appears that alpha-tocopherol is a less relevant protective agent against lipid peroxidation than monounsaturated fatty acids.

Vitamin E supplementation increases the stability and the in vivo antioxidant capacity of refined olive oil.

Two experiments were carried out to investigate if the supplementation with vitamin E affects refined olive oil response to oxidation regarding the stability of the oil and the protection in vivo against lipid peroxidation in rats after its intake in comparison with other edible oils. In experiment 1, samples of virgin olive oil, refined olive oil, refined olive oil supplemented by us with 200 mg/kg vitamin E, and sunflower oil were collected before and after a 60 min frying process. After frying, refined olive oil supplemented with vitamin E compared with the non-supplemented refined olive oil had a higher concentration of alpha-tocopherol (240.34+/-6.07 mg/kg vs. 131.94+/-8.14 mg/kg), more resistance against oxidation (19.01+/-1.88% vs. 10.6+/-2.08%) and less polar components (4.2+/-0.06% vs. 5.45+/-0.22%). In experiment 2, 24 male Wistar rats, divided into 4 groups, were fed on diets based on the same unfried oils (8% w/w) as in experiment 1, for 4 weeks. Two days prior to the end of the experiment, the rats were intraperitoneally administered with adriamycin (10 mg/kg/ day) to provoke an oxidative stress. The rats fed on refined olive oil plus vitamin E compared to the rats fed on non-supplemented refined olive oil had lower hydroperoxides concentrations (26.8+/-2.6 nmol/mg vs. 35.6+/-2.49 nmol/mg) higher coenzyme Q levels (128.1+/-11.97 pmol/mg vs. 81.25+/-9.25 pmol/mg) and higher alpha-tocopherol values (1.23+/-0.04 mmol/mg vs. 0.93+/-0.06 mmol/mg) in microsomes of liver. In conclusion, the supplementation of refined olive oil with 200 mg/kg of vitamin E increases the stability of this oil under pro-oxidant conditions, and its intake decreases the oxidative damage generated by adriamycin in rats.

Effect of extra-virgin olive oil and fish-oil supplementation on plasma lipids and susceptibility of low-density lipoprotein to oxidative alteration in free-living spanish male patients with peripheral vascular disease.

The aim of this study was to analyse the in vivo effect of a diet rich in extra-virgin olive oil and a fish-oil supplement on plasma and lipoprotein fatty-acid composition and on LDL susceptibility to oxidative modification in free-living Spanish male patients with peripheral vascular disease. A total of 12 patients were included in the experimental group which received extra virgin olive oil and a fish oil supplement (group OF). On the other hand, 13 patients which had refined olive oil as the main visible fat were considered as Control group. Plasma triglycerides decreased significantly after three months of dietary intervention. The LDL and plasma fatty-acid pattern in the group OF was characterized by a significant increase in n-3 polyunsaturated fatty acids, mainly 20:5 n-3 and 22:6 n-3. The slopes of LDL oxidative susceptibility were similar between baseline and endpoint values in both groups. However, the uptake of oxidized LDL by macrophages was significantly reduced in OF patients in comparison with the Control group. In conclusion, the daily intake of about 40 g/d of extra-virgin olive oil in combination with a daily supplement of 16 g of fish oil for 3 months in patients with peripheral vascular disease leads to a plasma-lipid profile less atherogenic than in patients having refined olive oil as the main visible food fat. The simultaneous consumption of alpha-tocopherol and natural antioxidants provided by extra-virgin olive oil seems to have a protective effect on the LDL susceptibility to oxidative modifications in spite of a higher proportion of n-3 polyunsaturated fatty acids.

Lifestyle changes in free-living patients with peripheral vascular disease (Fontaine stage II) related to plasma and LDL lipid composition: a 15 month follow-up study.

Peripheral vascular disease (PVD) is characterized by arteriosclerosis and lower extremity ischemia which cause intermittent claudication. Patients grouped in the Fontaine stage II have more than 75% organic stenosis in their large coronary arteries and exhibit a number of alterations in blood coagulation and plasma lipids. The aim of this study was to evaluate an intervention program of lifestyle habits including dietary recommendations, moderate exercise and decreased smoking in a population of patients with PVD for a period of 15 months, with respect to plasma-lipid and lipoprotein composition as well as LDL susceptibility to peroxidation. These parameters are well known risk indicators of arteriosclerosis and coronary heart disease. A total 13 subjects diagnosed with PVD (Fontaine stage II) were selected, while a healthy age-matched group (n=20) was used as a reference. This study design was an uncontrolled trial of lifestyle interventions. The group of patients was examined at 0, 3, 6, 9, 12 and 15 months. Patients smoking one or more packets of cigarettes per day at the beginning of the study (54.2%) decreased smoking by as much as 7.7% 15 months later. In addition, physical activity intensified significantly (walking > 1 km: 13.1-77%) and treadmill running increased over the study period while the energy intake decreased by 10%. The percentage of saturated fat in the diet decreased by 10% while the intake of polyunsaturated fat rose, and monounsaturated-fat intake showed a parallel trend to increase; the average intake of cholesterol also fell by 10% and plasma triglycerides and HDL-cholesterol showed a trend to decrease and increase, respectively. No permanent changes in LDL lipid fractions for patients were detected during the follow-up period and no differences between patients and the age-matched reference group were found. The macrophage uptake of plasma-oxidized LDL was significantly higher in patients than in the reference group and no differences due to the intervention period were detected. In conclusion, the education in lifestyle and nutritional habits of patients with PVD led to reduced energy intake parallel with augmented physical activity as well to a fall in plasma triglycerides and a rise in HDL-cholesterol, which are good indicators of a reduced risk of vascular and myocardial complications.

Vitamins B6 and B12 and folate status in an adult Mediterranean population.

OBJECTIVE: To assess the nutritional status for vitamins B(6) and B(12) and folate in an adult Mediterranean population, in order to identify patterns of intake, groups at risk for deficiency, and factors that might influence this risk. DESIGN: A cross-sectional epidemiological survey. SETTING: Andalusia, a western Mediterranean region in southern Spain. SUBJECTS: The study was carried out with a random sample of 3528 subjects (1813 men, 1715 women) who were between 25 and 60 y of age. Blood samples were obtained for biochemical assays in a random subsample of 384 subjects (183 men, 201 women). INTERVENTIONS: Food consumption was assessed by 48-h recall. Vitamin B(6) was measured as alpha erythrocyte aspartate aminotransferase activation coefficient (alphaEAST); vitamin B(12) and folate concentrations were measured in plasma. RESULTS: Energy and vitamin intakes were significantly higher in men than in women. In men, intakes were below two-thirds of the RDA in 10.8, 2.9 and 22.6% for B(6), B(12) and folate, respectively. The corresponding figures in women were 16.7, 5.1 and 23.5% for vitamins B(6), B(12) and folate. Age, place of residence and educational level, alcohol use and smoking were also associated with differences in the intake of these nutrients. Biochemical analyses showed that vitamins B(6), B(12) and folate status was acceptable in 75.7, 89.1 and 57.6% of the population, respectively. Plasma concentration of folate was significantly higher in women. CONCLUSION: Our results provide a precise estimate of the nutritional status for vitamins B(6), B(12) and folate in the adult population of southern Spain. Factors such as age, place of residence, level of education and smoking can increase the risk of inadequate intake of some nutrients. However, these factors did not affect biochemical indexes of nutritional status in the present study. SPONSORSHIP: Dirección General de Salud Pública and the Health Council of the Andalusian Regional Government.

The influence of dietary fat source (sunflower oil or olive oil) on LDL composition and serum lipid levels in miniature swine (Sus scrofa).

A total of 24 miniature swine (Sus scrofa) were fed with two diets of 9% fat content, differing only in the quality of the fat source (sunflower oil and olive oil). Two groups of animals were fed for a 12-week period, and the other two groups were fed for a 50-week period. After the two experimental periods, the influence of the dietary fat on serum lipids and protein and fatty acid composition of isolated LDLs was studied. In the short term, the serum cholesterol level was slightly higher in the olive oil group but, with the time of adaptation to the diet, serum levels of TC, FC and PL increased significantly in the sunflower group. In the long term, LDL and HDL were also significantly higher in the sunflower group when compared to the monounsaturated diet. In the sunflower group, PROT/TC and PROT/LIP ratios decreased significantly with the experimental period, while in the olive oil group they increased, due to the decrease in EC and TG fractions. The LDL particle in the olive group contained fewer saturated fatty acids and more monounsaturated fatty acids, specially oleic acid, than the LDL in the sunflower group. The changes found in chemical and fatty acid compositions of LDL, according to the saturation degree of the predominant fat of the diet, could alter its cellular metabolism.

Alcohol consumption and academic performance in a population of Spanish high school students.

OBJECTIVE: The present study was designed to identify patterns of alcohol consumption among Spanish high school students and describe the relationship between alcohol intake and school performance. METHOD: The sample population consisted of students, aged 14 to 19 years, who were attending high school during the academic year 1994-95 in the city of Granada in southern Spain. We studied 1,602 (861 female) students (alpha error - 0.05, sampling error = 5%), using a self-administered questionnaire that contained items about individual and family demographics, quantity and frequency of alcohol consumption, and school performance. Total alcohol consumption was recorded as grams (g) of alcohol per week and per day for three categories of alcoholic drinks: wine, beer and distilled spirits. RESULTS: The percentage of nondrinkers was 21.05% for male adolescents and 28.56% for female adolescents. The mean amount of alcohol consumed per week was larger in male than in female students (F= 18.36, l/l,594 df, p < .001) and distilled spirits accounted for the largest proportion of alcohol consumed. No significant differences in drinking patterns were found between students at public and private schools. The risk of academic failure increased considerably when more than 150 g of alcohol were consumed per week (OR: 2.91; 95% CI: 1.94-4.43). CONCLUSIONS: Although we cannot draw any conclusions about the causes of the association between academic failure and teenage drinking, our results do show that the risk of failing increases together with alcohol intake. However, it should be noted that academic achievement is also influenced by many factors other than alcohol consumption.

Plasma antioxidants are strongly affected by iron-induced lipid peroxidation in rats subjected to physical exercise and different dietary fats.

Plasma is an important vehicle through which antioxidant molecules are conveyed and in which they may show different behaviors, either acting as a protective factor for oxidative damage to different blood elements or using it as a vehicle through which dietary antioxidant factors would be distributed to the body. The aim of the study was to determine the plasma level of vitamin E, coenzyme Q, uric acid and vitamin A and their relation with the cellular oxidative damage mediated by physical training and the ingestion of different fat (virgin olive and sunflower oils). Male Wistar rats were divided into 8 subgroups based on the dietary fat intake and their physical activity. Results show that both dietary fat and physical training affect susceptibility to iron-induced lipid peroxidation in plasma and the tissues that were studied. The increase of this lipid peroxidation parallels a decrease of the level of all the plasma antioxidants that were studied.