Manganese levels in newborns' hair by maternal sociodemographic, dietary and environmental factors.

Exposure to manganese (Mn) has been associated with neurodevelopmental problems in children. Mn exposure begins in utero, and maternal sociodemographic, dietary and environmental factors may affect Mn levels in newborns' hair. This study aimed to characterize in utero Mn exposure using Mn levels in newborns' hair as a biomarker of prenatal exposure, and to analyze its relationship with sociodemographic, dietary and environmental factors in the Spanish INMA-Gipuzkoa cohort. Overall, 638 pregnant women were recruited in the first trimester of pregnancy and a hair sample was obtained from 473 newborns. Sociodemographic, dietary and environmental data were recorded through two questionnaires administered in the first and third trimesters of pregnancy. The median Mn concentration in newborns´ hair was 0.31 µg/g (P5 = 0.02; P95 = 1.23). Mn levels in newborns´ hair were associated with smoking during pregnancy (ß = 0.222; 95% CI = 0.065-0.379) and with maternal PM2.5 exposure (ß = 0.025; 95% CI = 0.004; 0.047), as well as with cereal and pasta intake in the first trimester of pregnancy (ß = 0.002; 95% CI = 0.0004; 0.003). In conclusion, fetal exposure to Mn was associated with smoking and exposure to atmospheric pollution during pregnancy.

The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children.

Maternal smoking during pregnancy increases childhood asthma risk, but health effects in children of nonsmoking mothers passively exposed to tobacco smoke during pregnancy are unclear. We examined the association of maternal passive smoking during pregnancy and wheeze in children aged ≤2 years.Individual data of 27 993 mother-child pairs from 15 European birth cohorts were combined in pooled analyses taking into consideration potential confounders.Children with maternal exposure to passive smoking during pregnancy and no other smoking exposure were more likely to develop wheeze up to the age of 2 years (OR 1.11, 95% CI 1.03-1.20) compared with unexposed children. Risk of wheeze was further increased by children's postnatal passive smoke exposure in addition to their mothers' passive exposure during pregnancy (OR 1.29, 95% CI 1.19-1.40) and highest in children with both sources of passive exposure and mothers who smoked actively during pregnancy (OR 1.73, 95% CI 1.59-1.88). Risk of wheeze associated with tobacco smoke exposure was higher in children with an allergic versus nonallergic family history.Maternal passive smoking exposure during pregnancy is an independent risk factor for wheeze in children up to the age of 2 years. Pregnant females should avoid active and passive exposure to tobacco smoke for the benefit of their children's health.

Pre- and postnatal exposure to tobacco smoke and respiratory outcomes during the first year.

The different role of prenatal and postnatal exposure to tobacco smoke in respiratory outcomes in infants has not yet been clearly established. Our objective is to assess the effects of these exposures on the risk of respiratory outcomes during the first year of life of infants from a Spanish multicenter cohort study. A total of 2506 women were monitored until delivery. About 2039 infants made up the final population. The outcomes were caused by the occurrence of the following: otitis, cough persisting for more than 3 weeks, lower respiratory tract symptoms (wheezing or chestiness), and lower respiratory tract infections (bronchitis, bronchiolitis, or pneumonia). The relationship between prenatal and postnatal exposure and health outcomes was explored using logistic regression analysis. Maternal smoking during pregnancy increased the odds for wheezing (OR: 1.41, 95% CI: 0.99-2.01) and chestiness (OR: 1.46, 95% CI: 1.03-2.01). Postnatal exposure from fathers was associated with otitis (OR: 1.25, 95% CI: 1.01-1.54). Passive exposure at work of non-smoking mothers during pregnancy was related to cough (OR: 1.62, 95% CI: 1.05-2.51). Exposure to tobacco smoke was related to a higher risk of experiencing respiratory outcomes in young infants. Prenatal exposure was that most clearly associated with the respiratory outcomes analyzed.

Intensive care practices in brain death diagnosis and organ donation.

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).

Outbreak of cryptosporidiosis in a child day-care centre in Gipuzkoa, Spain, October to December 2011.

From October to December 2011, an outbreak of 26 cases of cryptosporidiosis occurred in a day-care centre in Gipuzkoa, Spain. The infection spread from person to person and affected 24 children under two years of age (attack rate: 38%) and two caregivers. Cryptosporidium oocysts were observed in 10 of 15 samples. During 2010, only four cases of cryptosporidium were detected in Gipuzkoa, and 27 overall in Spain.

Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury.

CONTEXT: Pressure ulcers are especially difficult to treat in patients with spinal cord injury (SCI) and recurrence rates are high. Prompted by encouraging results obtained using bone marrow stem cells to treat several diseases including chronic wounds, this study examines the use of autologous stem cells from bone marrow to promote the healing of pressure ulcers in patients with SCI. OBJECTIVE: To obtain preliminary data on the use of bone marrow mononuclear cells (BM-MNCs) to treat pressure ulcers in terms of clinical outcome, procedure safety, and treatment time. PARTICIPANTS: Twenty-two patients with SCI (19 men, 3 women; mean age 56.41 years) with single type IV pressure ulcers of more than 4 months duration. INTERVENTIONS: By minimally invasive surgery, the ulcers were debrided and treated with BM-MNCs obtained by Ficoll density gradient separation of autologous bone marrow aspirates drawn from the iliac crest. RESULTS: In 19 patients (86.36%), the pressure ulcers treated with BM-MNCs had fully healed after a mean time of 21 days. The number of MNCs isolated was patient dependent, although similar clinical outcomes were observed in each case. Compared to conventional surgical treatment, mean intra-hospital stay was reduced from 85.16 to 43.06 days. Following treatment, 5 minutes of daily wound care was required per patient compared to 20 minutes for conventional surgery. During a mean follow-up of 19 months, none of the resolved ulcers recurred. CONCLUSIONS: Our data indicate that cell therapy using autologous BM-MNCs could be an option to treat type IV pressure ulcers in patients with SCI, avoiding major surgical intervention.

A swimming pool-related outbreak of pharyngoconjunctival fever in children due to adenovirus type 4, Gipuzkoa, Spain, 2008.

An outbreak of pharyngoconjunctival fever affecting 59 children was detected in a municipality of northern Spain in July 2008. The outbreak was related to insufficient doses of water disinfectant in the municipal swimming pool.

[Minimal changes nephrotic syndrome associated to penicillamine treatment]. / Síndrome nefrótico por cambios mínimos asociado a tratamiento con penicilamina.

We describe three patients with minimal change nephrotic syndrome associated with penicillamine treatment. Two patients had systemic sclerosis and one had rheumatoid arthritis. Cumulative dose of D-penicillamine was similar in all cases, and nephrotic syndrome appeared after 15-33 months of treatment. The drug was stopped and nephrotic syndrome disappeared in 2-4 months, suggesting a possible causal relationship between penicillamine and minimal change disease.

Air Polycyclic Aromatic Hydrocarbons (PAHs) associated with PM2.5 in a North Cantabric coast urban environment.

Health studies and more specifically epidemiological studies require an extended analysis of the physical and chemical characteristics of the environment in which are held. The aim of this study is to evaluate the concentration of six Polycyclic Aromatic Hydrocarbons (PAHs) in PM2.5 fraction of air in a peri-urban environment in the province of Gipuzkoa (Basque Country, Spain) where residential areas are surrounded by industrial activity. The six studied PAH are as follows: Fluoranthene, Benzo(b)fluoranthene, Benzo(k)fluoranthene, (Benzo(a)pyrene, Indene(123-cd)pyrene and Benzo(ghi)perylene. Our six-year study shows a decrease in PAH concentrations between 2006 and 2011, especially since 2008 due to the fall in industrial activity and related traffic. Overall, 801 data were obtained. Total PAH concentration ranged between 0.3 and 8.29ngm(-3) and Benzo(a)pyrene (BaP) from 0.05 to 0.88ngm(-3). The mean value for BaP in PM2.5 was 0.15ngm(-3) and the target value established by European legislation in PM10 was only exceeded in occasional days. Contribution percentages of each PAH in the monitoring sites were very similar, indicating common sources. The results of this study suggest that emission from industry play an important role although we also have to consider the contribution of traffic. PAH seasonal variations are similar as those reported in many previous studies. BaP and PAH concentration values in our region of study were in the range of other Spanish cities.

Sociodemographic, reproductive and dietary predictors of organochlorine compounds levels in pregnant women in Spain.

Organochlorine pesticides and polychlorinated biphenyls (PCBs) are consistently found in human tissues. Serum levels of organochlorine compounds (OC) in pregnant women in particular have raised concern about possible harm to humans in the early phases of physical and behavioural development. The objective of the present study was to evaluate the association between concentration of OCs in serum of two cohorts of pregnant women from Gipuzkoa and Sabadell in Spain and socioeconomic, reproductive and dietary variables. Concentration of polychlorinated biphenyls (PCBs: 28, 52, 101, 118, 138, 153 and 180), hexachlorobenzene (HCB), beta and gamma-hexachlorocyclohexane (ß-HCH and γ-HCH), heptachlor epoxide, dichlorodiphenyl dichloroethylene (p,p'-DDE) and dichlorodiphenyl trichloroethane (p,p'-DDT) were measured in the serum of 1259 pregnant women. Associations between OCs and potential predictor variables were assessed using linear regression models adjusted for potential confounders. The compounds most commonly found in the serum were p,p'-DDE (99% of the samples) and PCB-153 (95% of the samples). Geometric means of serum concentrations (ng g⁻¹ lipid) of organochlorine pesticides were 110.0, 19.1, and 33.5 for p,p'-DDE, ß-HCH, and HCB respectively, while the geometric means of PCBs were 21.8, 38.9 and 26.9 for PCB 138, 153, and 180 respectively. The levels of all OCs increased with age. BMI was positively associated with the concentration of organochlorine pesticides but inversely related to PCB concentrations. The serum levels of OCs fell only after a cumulative period of breastfeeding of over a year. Levels of PCBs were related to fish intake, but in general dietary factors did not improve the explained variability of the concentrations of OCs. Overall, the levels of OCs found in the study are at the lower end of the range reported in Spain and other countries.

The nephrologist's role in metformin-induced lactic acidosis.

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.

Iodine intake in a population of pregnant women: INMA mother and child cohort study, Spain.

BACKGROUND: Monitoring iodine status during pregnancy is essential to prevent iodine-related disorders. The objectives of this study are to estimate iodine intake and excretion, to assess their association and to evaluate the compliance of the recommendations in a multicentre cohort of pregnant women. METHODS: Cross-sectional data on maternal iodine nutritional status, compiled between weeks 8 and 22 of gestation in three Spanish areas (Valencia, Gipuzkoa and Sabadell), were analysed. Information on iodine intake from diet, salt and supplements was estimated through questionnaires. Spot urine samples were analysed for urinary iodine concentration (UIC). Tobit regression analysis was used to assess the association between iodine intake and UIC. RESULTS: 1522 women were included in the study. Median UIC was 134 (IQR 80-218) µg/l in Valencia, 168 (IQR 108-272) µg/l in Gipuzkoa and 94 (IQR 57-151) µg/l in Sabadell. 48.9% of Valencian women consumed iodine supplements, 93.3% in Gipuzkoa and 11.0% in Sabadell. Prevalence of iodised salt consumption was 50.5% in the whole sample. UIC was associated with intake of supplements, iodised salt, dietary iodine and water. UIC levels were lower than expected according to the estimated iodine intake. CONCLUSION: Median UIC reflected iodine deficiency according to WHO reference levels, except in Gipuzkoa where supplements are widely consumed. It is necessary to strengthen iodised salt consumption since it is already far from the objective proposed of coverage of 90% of households. More data would be valuable to assess the correspondence between iodine intake and excretion during pregnancy.