Tourniquet application in time-critical aquatic emergencies on a moving rescue water craft (RWC): Can speed and precision coexist?

Lifeguards are the first responders to any type of aquatic incident, including rapid rescue situations such as boating and sporting accidents, animal bites/attacks, and cases involving massive bleeding. In their line of work, rescue boats such as Rescue Water Craft (RWC) are commonly utilized the aim of this study is to evaluate the time and technique of placing a tourniquet on the sled of an RWC navigating at full speed. METHODS: A randomized crossover study design was used with a sample of 44 lifeguards. The inclusion criteria required that participants be certified lifeguards with experience in RWC operations and possess knowledge of responding to massive bleeding. Two CAT tourniquet placement tests were performed. In the 1) Beach-Tourniquet (B-TQ) test: it was performed on land and in the 2) Rescue Water Craft-tourniquet (RWC-TQ) test, sailing at a cruising speed of 20 knots. The evaluation was recorded in a checklist on the steps and timing of the correct application TQ by direct observation by an expert instructor. RESULTS: The tourniquet placement on RWC was an average of 11 s slower than when placed on the beach (BT-TQ 35.7 ± 8.0 vs. 46.1 ± 10.9 s, p > 0.001). In the percentage analysis of the results on correct execution of the skills, higher values are obtained for the B-TQ test than in RWC-TQ in Distance to the wound (into 5-7 cm), band adjustment, checking the radial pulse and reporting the time of tourniquet placement (p > 0.005). CONCLUSION: The placement of a tourniquet on a RWC navigating at 20 knots is feasible, relatively quick, and technically well executed.

Abordaje laparoscópico mediante puerto único versus técnica convencional en el tratamiento quirúrgico del cáncer de endometrio / Single port laparoscopic approach versus conventional technique in the surgical treatment of endometrial cancer

Objetivo: El objetivo de este estudio es comparar el abordaje laparoscópico convencional con el acceso por puerto único en el tratamiento quirúrgico del cáncer de endometrio. Materiales y métodos: Estudio retrospectivo sobre 36 pacientes, 18 operadas con técnica convencional y 18 con acceso por puerto único mediante una única incisión en la piel y 3 en la fascia, para la inserción de un trócar de 10mm y 2 de 5mm. Resultados: Se obtiene menor dolor postoperatorio (22,3% vs. 83,3%, p<0,001) y un mejor resultado estético (10 vs. 8, p=0,001) en el grupo de pacientes intervenidas por puerto único. El tiempo quirúrgico fue mayor en el grupo con técnica convencional (120 vs. 180min; p=0,027). En cuanto a estancia hospitalaria (2,5 vs. 2,5 días, p=0,69), pérdida sanguínea (1,15 vs. 1,25g/dl, p=1), número de ganglios extirpados (16,5 vs. 18; p=0,78) y complicaciones intra (0% vs. 5%, p=0,19) y posquirúrgicas (16,6% vs. 11,1%, p=0,63) no hubo diferencias significativas. Conclusión: El abordaje por puerto único es una técnica factible, segura y efectiva en el tratamiento del cáncer ginecológico, presentando una menor tasa de dolor postoperatorio y un mejor resultado estético.(AU)

Objective: The objective of this study is to compare conventional laparoscopy with transumbilical single-port access for the surgical treatment of endometrial cancer. Materials and methods: A retrospective study was performed with 36 patients, of whom 18 were operated using conventional laparoscopy, and 18 using a transumbilical single-port access (laparoendoscopic single-site surgery, or LESS) by making a single incision in the umbilical skin of 2-3cm, and 3 incisions in the fascia. One 10-mm trocar and two 5-mm trocars were inserted next to each other to access the abdominal cavity. Results: There were no statistical differences between groups in postoperative changes in haemoglobin concentration (1.15 vs. 1.25g/dL, P=1), hospital stay (2.5 vs. 2.5 days, P=.69), intraoperative complication rate (0% vs. 5%, P=.19), postoperative complications (16.6% vs. 11.1%, P=.63), number of pelvic lymph nodes (16.5 vs. 18, P=.78), and number of para-aortic lymph nodes (9 vs. 10, P=.64). Patients in the LESS group experienced less postoperative pain (22.3% vs. 83.3%, P<.001), and had a higher rate of satisfaction with the cosmetic results (10 vs. 8, P=.001). The median operating time was lower in the LESS group (120-180min, P=.027). Conclusion: Laparoendoscopic single-site surgery is a feasible, safety and effective technique for the treatment of endometrial cancer, with less postoperative pain and better cosmetic results.(AU)

Evolución de la competencia en el agua de los socorristas acuáticos / Evolution of the Competence in Water of the Aquatic Lifeguards

En el año 2006 entró en vigor la normativa que actualmente regula la formación de socorristas en la Comunidad Autónoma de Madrid (España). El objetivo de este estudio es conocer la influencia de la aplicación de esta normativa sobre el porcentaje de aspirantes que obtiene el diploma de socorrista acuático y sobre su nivel de competencia en el agua. Para ello, se han analizado las marcas de tiempo acreditadas por 6.105 aspirantes a socorrista (4.288 hombres y 1.817 mujeres) que se formaron entre los años 1993 y 2016. Los resultados demuestran que, desde la entrada en vigor de dicha normativa, se ha incrementado el porcentaje de aspirantes que obtiene el diploma de socorrista acuático, pero se ha disminuido su nivel de competencia en el agua. Se recomienda que las instituciones competentes establezcan objetivos y criterios de evaluación que promuevan la mejora del nivel de competencia en el agua de estos profesionales

In 2006, the normative that currently regulates the training of lifeguards in the Autonomous Community of Madrid (Spain) came into force. The objective of this study is to know the influence of the application of this regulation on the percentage of applicants who obtain the aquatic lifeguard diploma and on their level of competence in the water. For this purpose, the time marks, accredited by 6,105 applicants to lifeguards (4,288 men and 1,817 women) who received this training between 1993 and 2016, have been analysed. The results show that, since the regulation came into force, the percentage of applicants who obtain the lifeguard diploma has increased, but their level of competence in the water has decreased. Therefore, it is recommended that objectives and assessment criteria that are established by the institutions, encourage the improvement of the level of competence in the water of these professionals

Influencia de la longitud del vaso sobre las pruebas de socorrismo acuático profesional / The effect of pool length on the results of professional lifeguard saving tests

En este estudio se ha seleccionado a 2.528 aspirantes a la certificación de socorrista acuático (1.798 hombres y 730 mujeres). Todos ellos han realizado las cuatro pruebas físicas de agua cronometradas que se exigen para trabajar de socorrista en piscinas, instalaciones acuáticas y medio natural en la Comunidad Autónoma de Madrid (España). Del total de los participantes, 1.887 aspirantes realizaron dichas pruebas en vaso de 25 metros y 641 lo hicieron en vaso de 50 metros. El objetivo de este estudio es conocer la influencia de la longitud del vaso en el que se desarrollan estas pruebas físicas, sobre el porcentaje de aprobados y sobre las marcas de tiempo que emplean los participantes para realizarlas. Los resultados de esta investigación demuestran que la longitud del vaso en el que se evalúa a los aspirantes a socorrista, influye significativamente sobre las marcas de tiempo que obtienen y también sobre el número de aprobados

In this study 2.528 aspirants for aquatic lifeguard certification (1.798 men and 730 women) were selected. All the participants of the study have performed the four physical tests of chronometric water required in order to work as a lifeguard for swimming pools, aquatic and open water in the Comunidad Autónoma de Madrid (Spain). Of the whole participants, 1.887 aspirants were tested in a 25-meter pool and 641 were done so in a 50-meter pool. The aim of this study is to know the influence of the length of the pool in which these physical tests are developed, on the pass rate and on the time needed by the sample to carry them out. The results of this research show that the length of the pool in which the aspirants are evaluated, influences on the time marks obtained by them and also on the number of approved ones

Estudio longitudinal de la flexibilidad funcional en mayores físicamente activos / Longitudinal study of functional flexibility in olfer physically active

Un importante componente de la condición física es la flexibilidad, particularmente para las personas mayores que suelen sufrir un deterioro de la misma con los años. Con el objetivo de conocer como la flexibilidad evoluciona a lo largo del tiempo en un grupo de personas mayores físicamente activas, este estudio longitudinal ha evaluado 54 sujetos mayores de 65 años (17 hombres y 37 mujeres), que participaban con regularidad en clases de mantenimiento físico global realizadas dos veces a la semana en sesiones de 60 minutos. Para la medición de la flexibilidad fueron aplicados los tests chair sit and reach y back scratch, en cuatro momentos distintos en un periodo total de 12 meses. Los resultados muestran la evolución positiva de la flexibilidad de las zonas testadas en el grupo de mayores practicantes de actividad física al final de un año. Se concluye que para los participantes previamente activos del estudio la flexibilidad fue mantenida con el tiempo e inclusive mejorada en el periodo total propuesto al conservarse un estilo de vida activo a través de la práctica regular de actividad física de mantenimiento global de la condición física (AU)

Flexibility is an important component of physical fitness, particularly in elderly people whose flexibility tend to deteriorate with the passing of time. The purpose of this longitudinal study was to determine how flexibility of older adults’ change over time. The control group consisted of 54 physically active adults (17 men and 37 women) all of which were 65 years and older. These adults participated in a 60 minute global fitness course, led by a trained instructor, twice a week. During the 12 month study, the subjects’ flexibility was measured at four different times through chair sit and reach and back scratch tests. The results show that the subjects who took part in this yearlong study, experienced positive results in flexibility in the areas tested. The results concluded that the subjects in the study that were previously engaged in regularly physical activity maintained and in some cases, improved flexibility through regular global fitness activity (AU)

Manejo en atención primaria de un primer episodio depresivo. Uso de antidepresivos y derivaciones / Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals

Introducción. La mayor parte de los pacientes que comienzan con un primer episodio depresivo son tratados por médicos de atención primaria. El objetivo de este trabajo ha sido evaluar la utilización de antidepresivos y derivaciones a salud mental y las modificaciones del tratamiento que realiza el psiquiatra. Material y métodos. Analizamos de forma retrospectiva 64 cupos médicos de atención primaria, distribuidos en cinco provincias españolas. Se estudiaron los datos de la historia clínica en cuanto a utilización de antidepresivos, criterios de derivación y respuesta de atención especializada. Periodo de estudio desde junio 2008 a junio 2011. Resultados. Se incluyeron en el estudio 324 pacientes. El fármaco más prescrito fue escitalopram, siendo los ISRS el 73,5% del total. Un 69,7% de pacientes mantienen el tratamiento durante al menos 6 meses, no existiendo en un 40,4% una causa registrada del abandono. La mayoría de los profesionales espera al menos 3 semanas para modificar la medicación (76,9%), siendo la primera opción cambiar de antidepresivo. Se derivó a psiquiatría un 39,2% de los pacientes, aunque en gran parte de dichas derivaciones (43,9%) no hallamos justificación. Escasa derivación a psicología (23,1%). Gran número de pacientes polimedicados a los que se añade antidepresivo, sin tener en cuenta el riesgo de interacciones en un alto porcentaje. Conclusiones. El médico de atención primaria utiliza de manera adecuada los antidepresivos de primera elección, pero descuida los riesgos en pacientes complejos. Debemos insistir más en que la duración del tratamiento sea la adecuada y mejorar los criterios de derivación a salud mental (AU)

Introduction. The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. Material and methods. A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. Results. The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. Conclusions. The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services (AU)

¿Influye la especialización en los estilos de natación sobre la extensibilidad isquiosural? / Does swimming styles specialization influence the hamstring muscle extensibility?

El objetivo de este estudio es comprobar si el estilo de natación en el que están especializados los nadadores, influye sobre la extensibilidad isquiosural de los deportistas que han participado en esta investigación. El test empleado para este trabajo es el test "sit and reach". Se ha medido la extensibilidad isquiosural de todos los nadadores (N=36) de ambos sexos, que entrenan en un centro de tecnificación acuático español. La edad de los participantes del estudio oscila entre los 13 y los 17 años. Esta población de nadadores ha sido dividida en cuatro grupos diferentes, dependiendo del estilo de natación en el que están especializados (crol, espalda, braza y mariposa). Para conocer la influencia del estilo natación sobre los resultados obtenidos en el test "sit and reach", se ha aplicado un test inicial y nueve meses más tarde un test final, lo que ha permitido conocer también la evolución de las mediciones. Como conclusión, la extensibilidad isquiosural y su evolución, no está condicionada por el estilo de natación en el que están especializados los nadadores que han participado en este estudio (AU)

The aim of this research is to verify the swimming style in which swimmers are specialized, have has influences hamstring extensibility athletes who have had participated in this research. The employed test for this work was the "sits and reach" test. It was measured hamstring extensibility of all swimmers (N = 36) of both sexes, who train in Spanish aquatic center modernization. The age of the study participants is between 13 and 17 years. This population of swimmers has been divided into four different groups, depending on the style of swimming in which they are specialized (crawl, backstroke, breaststroke and butterfly). To determine the influence of swimming style on the results obtained in the test "sit and reach", it having had applied an initial test before, and a final test nine months later, which have had permitted also know the measurements evolution. In conclusion, the hamstring muscle extensibility and its evolution have had being not conditioned by swimming style of the swimmers (AU)

[Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals]. / Manejo en atención primaria de un primer episodio depresivo. Uso de antidepresivos y derivaciones.

INTRODUCTION: The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. MATERIAL AND METHODS: A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. RESULTS: The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. CONCLUSIONS: The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services.

Aspectos de salud en educación física en la comunidad de madrid (España) / Health aspects of physical education in the community of madrid (Spain)

Objetivo. Se tratan de analizar aspectos de salud en Educación Física en Centros de la Comunidad de Madrid (España). Material y métodos. El estudio se ha desarrollado en 25 centros, con un total de 686 alumnos. El muestreo ha sido no probabilístico por elección y los datos se han recogido mediante cuestionarios y hojas de observación. Resultados y Discusión. Casi el 50% del alumnado tiene alguna enfermedad crónica. El desarrollo corporal es normal, la adaptación cardiovascular no es mala pero mejorable. La actividad física resulta insuficiente, la valoración de la condición física es inadecuada. Las instalaciones deportivas escolares en los centros públicos son claramente deficientes desde el punto de vista de la salud. Por último, en ninguno de los centros, el profesorado había recogido estos datos antes de la elaboración de esta investigación, salvo adaptaciones curriculares concretas pedidas por el alumnado. Es necesario buscar nuevas metodologías que estén ajustadas a criterios de salud y coordinadas con los servicios de salud (AU)

Objective. The aim of this paper is to analyze the health status of physical education students within the Community of Madrid (Spain). Material and methods. The study was carried out at 25 secondary schools centers with the participation of 686 students in total. A non-probability sampling was selected and data were collected through questionnaires and observation sheets. Results and discussion. The results of this study reveal that almost 50 % of the students claim to have a chronic disease and vision problems are the most predominant. On the other hand, physical development is representative of the average population; cardiovascular adaptation of students is not critical nor alarming but should be better. In addition, school physical activity provides very little help as the assessment of the physical condition is inappropriate and sports facilities in public schools are clearly deficient from the point of view of health. Finally, teachers in all the centres had failed to collect these data before conducting this research, except some specific curricular adaptations requested by the students. Teachers need to seek new work methods that comply with health criteria and that are coordinated with health services (AU)

Outcome of acute renal injury in diabetic mice with experimental endotoxemia: role of hypoxia-inducible factor-1 α.

The role of diabetic nephropathy in the outcome of acute renal injury (AKI) is not well defined. Herein we evaluate the outcome of lipopolysaccharide- (LPS-) induced AKI in streptozotocin-induced diabetes, as well as the potential role of Hypoxia Inducible Factor (HIF-1 α ) in this condition. Although 6 h after LPS injection all mice developed a decrease in renal function, proteinuric diabetic mice showed a better recovery of this parameter throughout the study (72 h). Both HIF-1 α and vascular endothelium growth factor (VEGF) were found to be upregulated in diabetic mice. After LPS injection, all animals showed an upregulation of these factors, although it was higher in the diabetic group. Glycated albumin (GA) was found to upregulate HIF-1 α in HK-2 cells, which resulted in increased production of VEGF. Interestingly, LPS cooperated with GA to induce HIF-1 α upregulation. In conclusion, diabetic mice display a better recovery of AKI after experimental endotoxemia. Moreover, these animals showed an increased expression of both HIF-1 α and VEGF that was reproduced by incubating renal cells with GA. Since VEGF is considered a survival factor for tubular cells, our findings suggest that diabetes displays HIF-1 α upregulation that might function as a "precondition state" offering protection from endotoxic AKI.

Effectiveness of a diagnostic algorithm combining clinical probability, D-dimer testing, and computed tomography in patients with suspected pulmonary embolism in an emergency department.

OBJECTIVE: The aim of our study was to assess the clinical effectiveness of a simplified algorithm using the Wells clinical decision rule, D-dimer testing, and computed tomography (CT) in patients with suspected pulmonary embolism (PE) in an Emergency Department (ED). METHODS: Patients with clinically suspected PE from the Emergency Department were included from May 2007 through December 2008. Clinical probability was assessed using the Wells clinical decision rule and a VIDAS D-dimer assay was used to measure D-dimer concentration. Patients were categorized as "pulmonary embolism unlikely" or "pulmonary embolism likely" using the dichotomized version of the Wells clinical decision rule. Pulmonary embolism was considered excluded in patients with unlikely probability and normal D-dimer test (< 500 ng/ml). All other patients underwent CT, and pulmonary embolism was considered present or excluded based on the results. Anticoagulants were withheld from patients classified as excluded, and all patients were followed up for 3 months. RESULTS: 241 patients were included in the study. The prevalence of PE in the entire population was 23.6%. The combination of unlikely probability using the dichotomized Wells clinical decision rule and a normal D-dimer level occurred in 23.6%, thus making CT unnecessary. During the followup period, no thromboembolic events were recorded and there were no deaths related to venous thromboembolic disease (3-month thromboembolic risk 0% [95% CI, 0%-8%]). CONCLUSIONS: In this study we have confirmed the effectiveness of a diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT in the evaluation and management of patients with clinically suspected pulmonary embolism.

Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis.

BACKGROUND: Procalcitonin is released in response to bacterial infection and it is not released in Inflammatory and viral diseases. OBJECTIVE: To show the diagnostic efficacy and prognostic value of procalcitonin for sepsis. METHODS: A consecutive series of 103 patients with suspected sepsis were admitted to the intensive care unit over a 2-year period. During the first 24 hours of the admission procalcitonin, C-reactive protein, and complement proteins were determined. The diagnostic efficacy was tested with predictive values, likelihood ratios, receiver operating characteristic curves, and multiple logistic regression. The association of procalcitonin with mortality was assessed by the Multivariate Cox proportional hazards model. RESULTS: Procalcitonin had a better positive likelihood ratio than C-reactive protein -2.2 (95% confidence interval: 1.3-3.7) versus 1.1 (95% confidence interval: 0.9-1.2). Sequential Organ Failure Assessment yielded the highest discriminative value, with an area under the curve of 0.82 (95% confidence interval: 0.73-0.92), followed by procalcitonin (0.81; 95% confidence interval: 0.72-0.89). Multivariate regression analysis showed procalcitonin (adjusted odds ratio: 3.8; 95% confidence interval: 1.2-11.8) and Sequential Organ Failure Assessment score (adjusted odds ratio: 5.3; 95% confidence interval: 1.4-19.9) as the only variables independently associated with infection. Multivariate Cox regression analysis revealed that procalcitonin was not independently associated with mortality. CONCLUSIONS: The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins. Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection. C-reactive protein, Sequential Organ Failure Assessment score, age, and gender showed to be helpful to improve the prediction of mortality risk, but not procalcitonin.

[Differences in the synthesis pattern of vasoactive factors in gestational hypertension and preeclampsia]. / Diferencias en el patrón de síntesis de factores vasoactivos en la hipertensión gestacional y en la preeclampsia.

BACKGROUND AND OBJECTIVE: The gestational hypertension -HG- and preeclampsia -P- are hypertensive diseases whose pathogenic mechanism has not been determined yet. The aim of this work is to define some patterns of vasoactive factors release that allow to explain the origin of the differences between both entities. DESIGN: Prospective case-control study. MATERIAL AND METHODS: Two groups of target patients were consecutively selected, GH (n=21) and P patients (n=21). Every patient was matched with a pregnant of similar age and week of pregnancy. Two control groups were obtained, one respect to the GH and another one respect to the P group. A biochemistry, blood cell count, coagulation and quantification of vasoactive factors endothelin, nitrites and GMPc were performed in every woman. Results of GH and P groups were compared with their respective control group with the paired Student's t Test. RESULTS: Both systolic and diastolic arterial pressures were higher in hypertensive pregnants (GH and P) than in their respective controls. Moreover, blood endothelin and GMPc were higher in GH and P. GH pregnants showed decreased norepinephrine and increased epinephrine urinary excretion , as well as an increased plasma nitrites concentration than control group. P patients did not show statistically significant differences in catecholamines urinary excretion nor in plasma nitrites concentration respect their control group. CONCLUSION: There are relevant differences in the synthesis patterns of vasoactive factors between gestational hypertension and preeclampsia. These differences could account for a decreased tissue perfusion in preeclampsia and could also contribute to the genesis of the renal dysfunction of this entity.

Phosphocalcic metabolism after biliopancreatic diversion.

BACKGROUND: Malabsorptive techniques to treat morbid obesity have been followed by alterations in phosphocalcic metabolism. Knowledge of the preoperative situation is important to assess the influence of these techniques on phosphocalcic metabolism and to consider treatments for these alterations. METHODS: 61 consecutive morbidly obese patients (50 women, 11 men, age 19 to 63 years) having had biliopancreatic diversion (BPD) were studied in a prospective manner. Preoperative and postoperative levels of calcium, phosphorus, 25-hydroxyvitamin D, tartrate resistant acid phosphate, plasma parathormone (PTH), tubular absorption of phosphate, and urinary calcium and pyridinolines were analyzed, as well as the potential risk factors for their alterations. Follow-up of all patients was a minimum of 4 years. RESULTS: Before BPD, 42.3% of patients presented an increase in PTH and 54% a decrease in the 25-OH vitamin D, but the values of calcium and plasma phosphorus maintained at normal level. 81.8% of the patients with an increase in the PTH maintained high levels after BPD, while 60% of those with a normal preoperative PTH also presented hyperparathyroidism 4 years after the intervention. A correlation between the levels of plasma PTH and body mass index was not found. CONCLUSION: Morbid obesity is accompanied by a high percentage of hyperparathyroidism. BPD produces malabsorption of vitamin D during the first years, favoring the persistence or appearance of hyperparathyroidism. It is important to recognize and treat the secondary hyperparathyroidism. The postoperative period could necessitate more energetic interventions to get more efficient control of the phosphocalcic metabolism.

Diferencias en el patrón de síntesis de factores vasoactivos en la hipertensión gestacional y en la preeclampsia / Differences in the synthesis pattern of vasoactive factors in gestational hypertension and preeclampsia

Introducción y objetivos: La Hipertensión gestacional -HG-y la preeclampsia -P- son estados hipertensivos del embarazo cuyo mecanismo patogénico no se conoce. Este estudio pretende definir patrones de comportamiento que expliquen el origen de las diferencias entre embarazadas hipertensas y con preeclampsia mediante el análisis de determinados factores vasoactivos. Diseño del estudio: Estudio caso-control basado en casos incidentes. Material y métodos: Se seleccionaron de forma consecutiva dos grupos de pacientes, HG (n = 21) y P (n = 21). Por cada paciente problema se incluyó una gestante normal de similar edad y semana de gestación. Se obtuvieron dos grupos control, uno con respecto al grupo de pacientes HG y otro en relación a las pacientes P. A cada mujer se le realizó estudio de bioquímica, hemograma, coagulación, y cuantificación de los factores vasoactivos endotelina, nitritos y GMPc, así como la excreción urinaria de adrenalina y noradrenalina. Se compararon los resultados de cada grupo de pacientes (HG y P) con su respectivo grupo control. Resultados: La tensión arterial sistólica y diastólica fueron superiores en las pacientes con hipertensión (HG y P) en comparación con sus controles. Igualmente, en las pacientes con HG y en las P se observó un aumento de las concentraciones plasmáticas de endotelina y GMPc. Las pacientes con HG mostraron una eliminación urinaria disminuida de noradrenalina e incrementada de adrenalina, así como una mayor concentración plasmática de nitritos que su grupo control. En las pacientes con P no se observaron diferencias estadísticamente significativas en la eliminación urinaria de catecolaminas ni en la concentración de nitritos en relación con sus controles. Conclusiones: Existen diferencias relevantes en el patrón de síntesis de mediadores vasoactivos en la HG y la P. Estas diferencias condicionarían una perfusión tisular disminuida en la preeclampsia y podrían contribuir a la génesis de las alteraciones renales de este proceso

Background and objetive: The gestational hypertension -HG- and preeclampsia -P- are hypertensive diseases whose pathogenic mechanism has not been determined yet. The aim of this work is to define some patterns of vasoactive factors release that allow to explain the origin of the differences between both entities. Design: Prospective case-control study. Material and methods: Two groups of target patients were consecutively selected, GH (n = 21) and P patients (n = 21). Every patient was matched with a pregnant of similar age and week of pregnancy. Two control groups were obtained, one respect to the GH and another one respect to the P group. A biochemistry, blood cell count, coagulation and quantification of vasoactive factors endothelin, nitrites and GMPc were performed in every woman. Results of GH and P groups were compared with their respective control group with the paired Student’s t Test. Results: Both systolic and diastolic arterial pressures were higher in hypertensive pregnants (GH and P) than in their respective controls. Moreover, blood endothelin and GMPc were higher in GH and P. GH pregnants showed decreased norepinephrine and increased epinephrine urinary excretion, as well as an increased plasma nitrites concentration than control group. P patients did not show statistically significant differences in catecholamines urinary excretion nor in plasma nitrites concentration respect their control group. Conclusion: There are relevant differences in the synthesis patterns of vasoactive factors between gestational hypertension and preeclampsia. These differences could account for a decreased tissue perfusion in preecalmpsia and could also contribute to the genesis of the renal dysfunction of this entity

Proteinuria / Proteinuria

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The parathyroid hormone-related protein system and diabetic nephropathy outcome in streptozotocin-induced diabetes.

The pathophysiology of the diabetic kidney (e.g., hypertrophy, increase urinary albumin excretion (UAE) is still ill-defined. Parathyroid hormone-related protein (PTHrP) is overexpressed in several nephropathies, but its role remains unclear. We evaluated the effect of high glucose on PTHrP and the PTH1 receptor (PTH1R) protein (by Western blot and immunohistochemistry) in the kidney of mice ith streptozotocin-induced diabetes, and in several mouse renal cells in vitro. Diabetic mice showed a significantly increased renal expression of PTHrP and PTH1R proteins with 2-8 weeks from the onset of diabetes. These animals exhibited an intense immunostaining for both proteins in the renal tubules and glomeruli. Using transgenic mice overexpressing PTHrP targeted to the renal proximal tubule, we found a significant increase in the renal hypertrophy index and in UAE in these diabetic mice relative to their control littermates. Moreover, logistic regression analysis showed a significant association between both PTHrP and PTH1R protein levels and UAE in all diabetic mice throughout the study. High-glucose (25 mm) medium was found to increase PTHrP and PTH1R in tubuloepithelial cells, mesangial cells and podocytes in vitro. Moreover, this increase in PTHrP (but not that of PTH1R) was inhibited by the AT1 receptor antagonist losartan. Collectively, these results indicate that the renal PTHrP/PTH1R system is upregulated in streptozotozin-induced diabetes in mice, and appears to adversely affect the outcome of diabetic renal disease. Our findings also suggest that angiotensin II might have a role in the PTHrP upregulation in this condition.

¿Ingieren suficiente calcio nuestras gestantes? / Is calcium intake adequate in pregnant women in Spain?

Objetivo: Cuantificar el consumo de calcio en una población de gestantes españolas. Material y métodos: Se realizó un estudio observacional prospectivo a 115 gestantes. A través de una encuesta dietética recordatoria de 7 días en las semanas 15 y 28 de la gestación, se analizó el consumo diario de calcio, la evolución durante la gestación, así como las diferencias entre gestantes procedentes de un área urbana o rural. Resultados: El consumo medio de calcio en la semana 15 fue de 930,60 ± 300,71 mg/día (rango, 345-1.462), y en la semana 28 de 1.083,03 ± 330,59 mg/día (rango, 274-2.150). Un 76,8% de nuestras gestantes tuvieron un consumo por debajo de la ingesta diaria recomendada para la población española gestante. No hubo diferencias significativas entre el principio y el final de la gestación ni entre embarazadas procedentes de un área urbana o rural. Conclusiones: Un alto porcentaje de nuestra población tuvo un consumo de calcio deficitario

Objective: To quantify calcium intake in a group of pregnant Spanish women. Material and methods: A total of 115 pregnant women were evaluated in a prospective observational study. Dietary information was prospectively collected from pregnant women at 15 and 28 weeks' gestation using 7-day food records. Daily calcium intake throughout pregnancy, as well as differences between rural and urban populations, were analyzed. Results: The mean calcium intake was 930.60 ± 300.71 mg/day (range, 345-1,462) at 15 weeks' gestation and 1,083.03 ± 330.59 mg/day (range, 274-2,150) at 28 weeks' gestation. In 76.8% of the respondents, dietary calcium intake was below the recommended daily intake for pregnant women in Spain. No significant differences were found between early and late pregnancy or between rural and urban populations. Conclusions: Dietary calcium intake is deficient in a high percentage of pregnant women in Spain