Food consumption in Tunisian university students and its association with sociodemographic characteristics and lifestyle behaviours.

OBJECTIVE: This study aimed to characterise food consumption among students at the University of Carthage (Tunisia), assessing quality of diet and main dietary patterns, and their association with potential conditioning factors. DESIGN: Cross-sectional study. Participants self-reported food consumption in two 24-h recalls and information about sociodemographic, anthropometric and lifestyle characteristics such as BMI, birthplace, physical activity, eating places or kitchen appliances. Mediterranean Diet Score (MDS) and the Nutrient Rich Foods (NRF) index (NRF9.3) were used to assess diet quality. Exploratory factor analysis was conducted to identify eating patterns. Linear regression models were used to test the association of dietary patterns with the diet quality markers. SETTING: Students at the University of Carthage, Tunisia. PARTICIPANTS: 132 students. RESULTS: Almost 96 % of participants need shifts towards healthier food. Four main food patterns were identified 'Traditional food', 'Transitional food', 'European breakfast' and 'Western food'. 'Traditional food' was the first dietary model, positively associated with MDS and NRF9.3. Women showed higher adherence to 'European breakfast' and higher quality of diet by NRF9.3. Students eating out of home showed higher adherence to 'Western food', those who never kept a regular schedule of meals consumed lower amount of vegetables and tubers, and sedentary or low active students had a higher intake of ready-to-eat products. CONCLUSIONS: Diet quality of the participating Tunisian students is inadequate, but traditional Mediterranean diet remains the main pattern in spite of the advanced transitional nutrition. Some lifestyle risk behaviours affecting quality of diet were identified in this work, which supports the youth's particular vulnerability.

Frailty Assessment in a Stable COPD Cohort: Is There a COPD-Frail Phenotype?

The frailty syndrome increases the morbidity/mortality in older adults, and several studies have shown a higher prevalence of this syndrome in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to identify the characteristics of frail patients with COPD to define a new phenotype called "COPD-frail." We conducted a cross-sectional study in a cohort of patients with stable COPD, classified as either frail, pre-frail, or non-frail. Sociodemographic, clinical, and biochemical variables were compared between the three groups of patients. The study included 127 patients, of which 31 were frail, 64 were pre-frail, and 32 non-frail. All subjects had FEV1/FVC below the lower limit of normal (range Z-score: -1.66 and -5.32). Patients in the frail group showed significantly higher scores in the mMRC (modified Medical Research Council) scale, the CAT (COPD Assessment Test), and the BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index. They also showed differences in symptoms according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), as well as more COPD exacerbations, less physical activity, more anxiety and depression symptoms based on HADS (Hospital Anxiety and Depression Scale), and lower hemoglobin, hematocrit, and 25-hydroxycholecalciferol levels. Variables with independent association with frailty included the mMRC score, the HAD index for depression and age. In summary, differential characteristics of frail patients with COPD encourage the definition of a "COPD-frail" phenotype that-if identified early-would allow performing interventions to prevent a negative impact on the morbidity/mortality of these patients.

Adherence to Mediterranean diet in a Spanish university population.

The aim of this work was to characterize food habits of Spanish University students and to assess the quality of their diet and some possible determinant factors according to Mediterranean food pattern among other indices. Two hundred eighty-four enrolled students during the academic year 2012-2013 participated in this survey. For each individual a questionnaire involving anthropometric measurements, types of housing, smoking habits and levels of physical activity were self-reported. Food consumption was gathered by two nonconsecutive 24 hour recalls including one weekend day. BMI within the normal range was showed by 72.5% of students and 75% of the sample reflected a sedentary lifestyle or low physical activity. The percentage of total energy from each macronutrient was approximately 17% proteins, 40% carbohydrates and 40% lipids. The ratio of polyunsaturated to monounsaturated fat only reached 0.32. Cholesterol consumption in men exceeded the intake in women by 70 mg/day but nutritional objectives were exceeded in both genders. The main source of protein had an animal origin from meat (38.1%), followed by cereals (19.4%) and dairy products (15.6%). The assessment of diet quality conducted by Healthy Eating Index (HEI) and Mediterranean Diet Score (MDS) revealed a low-intermediate score in both (51.2 ± 12.8 and 4.0 ± 1.5, respectively). The main deviations from Mediterranean pattern were a low intake of vegetables and fruit and a high consumption of meat and dairy products. According to HEI classification, 96.1% of subjects scored "poor" or "needs improvement" about the quality of their diet and only 5.3% of students achieved a high adherence to Mediterranean diet. It is necessary to foster changes toward a healthier diet pattern according to cultural context in this population for preventing cardiovascular diseases, type 2 diabetes and insulin resistance.

Performance evaluation of biochemical and ultrasound markers for the screening of chromosomal numerical abnormalities in the first trimester of pregnancy.

BACKGROUND: To estimate the effectiveness of the first-trimester combined screening test in our population, departing from the results of diagnostic sensitivity and false positive rate (FPR), and checking some important parameters in prenatal screening. METHODS: The test was evaluated on 14250 pregnant women. The following variables were studied: the number of invasive techniques and the reasons for using such techniques, newborns with chromosomal abnormalities, total number of births, variation of biochemical markers throughout the gestational weeks, and MoM (multiple of the median) for biochemical and ultrasound markers. RESULTS: An important coverage and a decreased number of invasive techniques were obtained. For our population of pregnant women, the best gestational week to determine free beta-hCG and PAPP-A would be week 11 in which the best discrimination was found between affected and non affected fetuses for the three trisomies researched. We propose the cut-off 1/350, because it is the best one to increase sensitivity without exceeding the 5% FPR. CONCLUSIONS: Combined screening should be offered to pregnant woman, preferentially at week 11. Although different cut-offs for this prenatal test have been recommended by scientific societies, biochemical laboratories should set their own cut-off for getting the best sensitivity and FPR results. There should be a good level of collaboration between the laboratory and each participating ultrasound unit in order to ensure an optimal use of the first-trimester combined screening test.

Recurrent genetic variants and prioritization of variants of uncertain clinical significance associated with hereditary breast and ovarian cancer in families from the Region of Murcia.

Objectives: Hereditary breast and ovarian cancer (HBOC) follows an autosomal dominant inheritance pattern of cancer susceptibility genes. The risk of developing this disease is primarily associated with germline mutations in the BRCA1 and BRCA2 genes. The advent of massive genetic sequencing technologies has expanded the mutational spectrum of this hereditary syndrome, thereby increasing the number of variants of uncertain clinical significance (VUS) detected by genetic testing. Methods: A prevalence study of HBOC was performed within 2,928 families from the Region of Murcia, in southeastern Spain. Genetic testing enabled the identification of recurrent pathogenic variants and founder mutations, which were mainly related to the BRCA1 and BRCA2 genes. VUS testing was performed using a prioritization algorithm designed by our working group. Results: Variants c.68_69del, c.212+1G>A, and c.5123C>A were detected in 30 % of BRCA1 carriers, whereas exon 2 deletion concurrent with c.3264dupT, c.3455T>G and c.9117G>A variants were found in 30 % of BRCA2 carriers. A total of 16 VUS (15 %) were prioritized. Conclusions: The genotype-phenotype correlation observed in our study is consistent with the scientific literature. Furthermore, the founder effect of c.1918C>T (BRCA1) and c.8251_8254del (ATM) was verified in the Murcian population, whereas exon 2 deletion (BRCA2) was proven to be a Spanish founder mutation. Our algorithm enabled us to prioritize potentially pathogenic VUS that required further testing to determine their clinical significance and potential role in HBOC.

Influence of Thermal Annealing Temperatures on Powder Mould Effectiveness to Avoid Deformations in ABS and PLA 3D-Printed Parts.

Fused deposition modelling (FDM)-printed parts can be treated with various post-processes to improve their mechanical properties, dimensional accuracy and surface finish. Samples of polylactic acid (PLA) and acrylonitrile butadiene styrene (ABS) parts are treated with annealing to study a ceramic powder mould's effectiveness in order to avoid dimensional part deformation. The variables chosen are annealing temperatures and the usage of a ceramic powder mould to avoid part deformations. A flexural strength test was carried out to evaluate the mould's influence on the mechanical properties of the part. The effectiveness of the mould has been evaluated mainly attending to the length of the part, because this is the dimension most affected by deformation. A polynomial approximation to a deformation's length and the effectiveness of the mould allows for their prediction. Results obtained show that effectiveness increases with the annealing temperature. Nevertheless, mould effectiveness decreases when parts are fabricated with PLA, because it is a semi-crystalline thermoplastic, and it suffers a lower shrinkage during thermal post-process than amorphous polymers such as ABS. Attending to the flexural strength test, mould has no significant influence on the mechanical properties of the treated parts in both materials studied.

A comparison of pharmacokinetics software for therapeutic drug monitoring of piperacillin in patients with severe infections.

OBJECTIVE: To evaluate the predictive performance of population pharmacokinetic models for piperacillin (PIP) available in the software MwPharm, TDMx and ID-ODs for initial dosing selection and therapeutic drug monitoring (TDM) purposes. METHODS: This is a prospective observational study in adult patients with severe infections receiving PIP treatment. Plasma concentrations were quantified by ultra-high performance liquid chromatography coupled to tandem mass spectrometry. The differences between predicted and observed PIP concentrations were evaluated with Bland-Altman plots; additionally, the relative and absolute bias and precision of the models were determined. RESULTS: A total of 145 PIP plasma concentrations from 42 patients were analysed. For population prediction, MwPharm showed the best predictive performance with a mean relative difference of 34.68% (95% CI -197% to 266%) and a root mean square error (RMSE) of 60.42 µg/mL; meanwhile TDMx and ID-ODs under-predicted PIP concentrations. For individual prediction, the TDMx model was found to be the most precise with a mean relative difference of 7.61% (95% CI -57.63 to 72.86%), and RMSE of 17.86 µg/mL. CONCLUSION: Current software for TDM is a valuable tool, but it may also include different population pharmacokinetic models in patients with severe infections, and should be evaluated before performing a model-based TDM in clinical practice. Considering the heterogeneous characteristics of patients with severe infections, this study demonstrates the need for therapy personalisation for PIP to improve pharmacokinetic/pharmacodynamic target attainment.

Next step in molecular genetics of hereditary breast/ovarian cancer: Multigene panel testing in clinical actionably genes and prioritization algorithms in the study of variants of uncertain significance.

INTRODUCTION: BRCA1 and BRCA2 are the two main genes causing hereditary breast and ovarian cancer (HBOC). However, thanks to the development of Next Generation Sequencing (NGS), other genes linked to this syndrome (CHEK2, BRIP1, ATM and PALB2 among others) can be analysed. MATERIAL AND METHODS: an analysis by multigene panel testing was performed in 138 index cases (ICs) from HBOC Spanish families with a previous non-informative result for BRCA1/2. The BRCA Hereditary Cancer Master™ Plus kit, including 26 actionable and candidate genes related to HBOC was employed. Once classified, an algorithm was employed to prioritized those variants of unknown significance with a higher risk of having a deleterious effect. Moreover, a mRNA splicing assay was performed for the prioritized VUS c.3402+3A > C in ATM, located at intron 23. RESULTS: A total of 82 variants were found: 70 VUS and 12 pathogenic or probably pathogenic variants. The diagnostic yield in actionable genes non-BRCA was 7.97% of the total tested ICs. Overall, 19 VUS were prioritized, which meant 27% of the 70 total VUS. RNA analysis of the variant 3402+3A > C confirmed a deleterious impact on splicing. DISCUSSION: The implementation of a multigene panel in HBOC studied families improved the diagnostic yield, concordant with results obtained in previous publications. Due to the important number of VUS obtained in NGS, the application of a prioritization algorithm is needed in order to select those variants in which it is necessary to conduct further studies.

Effect of a Powder Mould in the Post-Process Thermal Treatment of ABS Parts Manufactured with FDM Technology.

The post-process thermal treatment of thermoplastics improves their mechanical properties, but causes deformations in parts, making them unusable. This work proposes a powder mould to prevent dimensional part deformation and studies the influence of line building direction in part deformations in a post-process thermal treatment of 3D printed polymers. Two sets of ABS (acrylonitrile butadiene styrene) test samples manufactured by fused deposition modelling (FDM) in six different raster directions have been treated and evaluated. One set has been packed with a ceramic powder mould during thermal treatment to evaluate deformations and mould effectiveness. Thermogravimetric tests have been carried out on ABS samples, concluding that the thermal treatment of the samples does not cause degradations in the polymeric material. An analysis of variance (ANOVA) was performed to study internal building geometry and mould influence on part deformation after the thermal treatment. It can be concluded that powder mould considerably reduces dimensional deformations during the thermal treatment process, with length being the most affected dimension for deformation. Attending to the length, mould effectiveness is greater than 80% in comparison to non-usage of moulding, reaching 90% when the building lines are in the same direction as the main part.

[Microbiological diagnosis of bone-joint infections]. / Diagnóstico microbiológico de las infecciones osteoarticulares.

Although infrequent, bone-joint infections are associated with difficult clinical and surgical management and severe complications. Diagnosis of bone-joint infections requires a multidisciplinary analysis of the biochemistry, radiology, nuclear medicine, microbiology, and histopathology results. Diagnosis must be rapid and correct so that appropriate medical and surgical treatment can be administered and serious complications avoided. Microbiology studies are indispensable when determining the causal agents and their antimicrobial susceptibility patterns. Microbiological diagnosis of bone-joint infections is limited by the low sensitivity of Gram staining and difficult interpretation of culture results, particularly when enrichment broth is used (low number of microorganisms present in some infections).

Comparison of Different Parameters to Evaluate Delamination in Edge Trimming of Basalt Fiber Reinforced Plastics (BFRP).

Delamination is one of the main problems that occur when machining fiber-reinforced composite materials. In this work, Types I and II of delamination are studied separately in edge trimming of basalt fiber reinforced plastic (BFRP). For this purpose, one-dimensional and area delamination parameters are defined. One-dimensional parameters (Wa and Wb) allow to know average fibers length while the analysis of area delamination parameters (Sd) allow to evaluate delamination density. To study delamination, different tests are carried out modifying cutting parameters (cutting speed, feed per tooth and depth of cut) and material characteristics (fiber volume fraction and fiber orientation). Laminates with a lower fiber volume fraction do not present delamination. Attending to one-dimensional parameters it can be concluded that Type II delamination is more important than Type I and that a high depth of cut generates higher values of delamination parameters. An analysis of variance (ANOVA) is performed to study area parameters. Although delamination has a random nature, for each depth of cut, more influence variables in area delamination are firstly, feed per tooth and secondly, cutting speed.

[The relevance of anatomical specimens in the teaching of Pathology]. / Papel de las colecciones de piezas anatómicas en la enseñanza de la anatomía patológica.

The relevance of museums of anatomy and pathology lies both in the conservation of anatomical specimens and their excellent reproductions and their use in education and research. The teaching of anatomy dates from ancient times, originating in the Theatrum Anatomicum and anatomical cabinets, located in the anatomy lecture rooms of European medical schools. These were followed by museums of anatomy and pathology in successive centuries. However, after a golden period in the XVIII century, there was a progressive decline which eventually led to a dramatic loss of many museums. Currently, there is a growing interest in the recovery and importance of these collections. We present an historical approach to their development and a review of the current situation in the principal anatomical museums of anatomy in Spain and the rest of Europe.

Accuracy of tumor size measurements performed by magnetic resonance, ultrasound and mammography, and their correlation with pathological size in primary breast cancer. / Precisión de la resonancia magnética, ecografía y mamografía en la medida del tamaño tumoral y su correlación con el tamaño histopatológico en el cáncer de mama primario.

INTRODUCTION: The objective of this study was to determine which image test used to measure the size of pre-operative primary breast cancer (mammography, ultrasound or magnetic resonance imaging [MRI]) correlated best with the size of the tumor in the postoperative surgical specimen. METHODS: A retrospective analysis was conducted of women diagnosed with breast cancer for which primary surgical treatment was indicated and who underwent surgical intervention between January 2014 and December 2016. Sociodemographic, imaging and histological variables were collected. The results are presented by age group, tumor size and histological type. RESULTS: In the 224 women studied, mammography and MRI tumor sizes were compared with pathology study tumor measurements, revealing no significant differences, both overall and based on histologic type or age. However, both significantly underestimated large tumors and significantly overestimated small tumors. Ultrasound significantly underestimated tumor size, especially in large tumors, older patients and in infiltrating ductal carcinoma (IDC) and infiltrating ductal carcinoma with associated ductal carcinoma in situ (IDC+DCIS). MRI correlated best with histological tumor size, although with no statistically significant differences. CONCLUSIONS: MRI is the best predictor of tumor size in breast cancer. Histologic type and tumor size are key parameters when estimating tumor size and should be taken into account when planning surgery. Patient age does not interfere with the interpretation of imaging tests.

Differences in biofilm development and antibiotic susceptibility among clinical Ureaplasma urealyticum and Ureaplasma parvum isolates.

OBJECTIVES: The aim of this work was to study the ability of clinical isolates of Ureaplasma spp. to form biofilms in vitro and to compare the antibiotic susceptibility of sessile cells and their planktonic counterparts. METHODS: A total of nine Ureaplasma spp. isolates recovered from unrelated male patients diagnosed with urethritis or chronic prostatitis and two isolates isolated from the urine of two healthy volunteers were included. Ureaplasma species identification was performed by 16S rDNA gene amplification and sequencing. Conventional antibiotic susceptibility tests were carried out by the broth microdilution method. Biofilm susceptibility assays were performed following the method proposed by Moskowitz using 10C urea broth medium and confirming bacterial growth by colour shift of the medium. The chi(2) test was applied to analyse the statistical differences between the MIC and the minimal biofilm inhibitory concentration. RESULTS: Isolates were identified as Ureaplasma urealyticum serovar 7 (five isolates), U. urealyticum serovar 13 (four isolates) and Ureaplasma parvum serovar 3 (two isolates). Biofilm formation was observed in 9 out of the 11 strains studied (82%); two isolates of U. urealyticum serovar 13 were non-biofilm formers. Global resistance percentages of planktonic cells compared with sessile cells were different for erythromycin (0% versus 44%, P = 0.02), telithromycin (22% versus 77%, P = 0.02), ciprofloxacin (66% versus 100%), levofloxacin (0% versus 33%) and tetracycline (0% versus 33%). All nine biofilm-forming strains were fully susceptible to clarithromycin in both planktonic and biofilm types of growth. CONCLUSIONS: These results indicate that biofilm formation can protect mycoplasma cells from antibiotics and host defences, favouring their persistence in chronically infected or colonized patients while increasing resistance to antimicrobial agents. Therefore, the capacity to form biofilms by Ureaplasma spp. isolates should be considered when antibiotic treatments are required.

Delamination Study in Edge Trimming of Basalt Fiber Reinforced Plastics (BFRP).

Although there are many machining studies of carbon and glass fiber reinforced plastics, delamination and tool wear of basalt fiber reinforced plastics (BFRP) in edge trimming has not yet studied. This paper presents an end milling study of BFRP fabricated by resin transfer molding (RTM), to evaluate delamination types at the top layer of the machined edge with different cutting conditions (cutting speed, feed rate and depth of cut) and fiber volume fraction (40% and 60%). This work quantifies delamination types, using a parameter Sd/L, that evaluates the delamination area (Sd) and the length (L), taking into account tool position in the yarn and movement of yarns during RTM process, which show the random nature of delamination. Delamination was present in all materials with 60% of fiber volume. High values of tool wear did not permit to machine the material due to an excessive delamination. Type II delamination was the most usual delamination type and depth of cut has influence on this type of delamination.

The relationship between socioeconomic status and beverage consumption in children: The Cuenca Study.

INTRODUCTION: beverage consumption constitutes a source of children's daily energy intake. Some authors have suggested that consumption of caloric beverages is higher in children with a low socioeconomic position because families limit their spending on healthy food in order to save money. OBJECTIVE: the aim of this study was to explore the relationship between socioeconomic status and Spanish children's beverage consumption. METHODS: a cross-sectional study was conducted in a sub-sample of 182 children (74 girls) aged 9-11 from the province of Cuenca (Spain). Beverage consumption was assessed using the YANA-C assessment tool, validated for HELENA study. Data for parental socioeconomic status were gathered by using self-reported occupation and education questions answered by parents and classified according to the scale proposed by the Spanish Society of Epidemiology. RESULTS: beverage intake was higher in children belonging to a middle-status family than in those of upper socioeconomic status (p = 0.037). The energy from beverages was similar in most water intake categories, except for water from beverages (p = 0.046). Regarding other beverages categories, middle-status children had higher consumption levels. In contrast, lower status children drank more fruit juices and skimmed milk. All of these do not show statistically significant differences. CONCLUSIONS: our study did not find significant associations between beverages consumption and socioeconomic status in children. In fact, intake for most beverage categories was higher in middle-status children than in both other socioeconomic groups. Future research is needed in order to identify this complex relation between socioeconomic inequality and beverage intake behavior.