Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria / Identify the risk foot in patients with diabetes. A space for improvement in primary care

Objetivos: Identificar los factores condicionantes del pie de riesgo (PR) comparando 2 métodos de evaluación (cualitativo y cuantitativo) para neuropatía, arteriopatía y deformidades del pie. Concordancia entre alteraciones detectadas y registradas en el historial clínico (HC). Material y métodos: Estudio observacional. Ámbito: 2 centros de atención primaria del Instituto Catalán Salud. Población: Quinientos treinta y dos pacientes con diabetes, ambos sexos >18 años con registros del PR y consentimiento informado. Mediciones: Neuropatía: valoración síntomas (NSS) y signos discapacidad (NDS). Arteriopatía: índice tobillo brazo (ITB), cuestionario Edimburgo, pulsos pedios. Deformidades pie: pedigrafía. Valores de referencia cuantitativos: Neuropatía definida: NDS>6 puntos o 3-5 y NSS>5 puntos. ITB: valor normalidad (0,90-1,30). Resultados: Mujeres: 46,42%; edad media: 67,29 años (DE: 7,69). Ciento cincuenta y tres pacientes sin complicaciones neurovasculares. Cualitativo: Sin diferenciar manifestaciones clínicas: 252 pacientes presentaron neuropatía; 99 pacientes presentaron ITB alterado; 28 pacientes presentaron complicaciones y 101 pacientes cuestionario Edimburgo alterado. Cuantitativo: Diferenciando manifestaciones clínicas: del grupo neuropatía, 110 pacientes solo presentaron síntomas; 46 pacientes presentaron neuropatía definida y 96 pacientes puntuación NDS y NSS, sin criterios neuropatía definida. ITB alterado: 52, solo ITB>1,30; 47, solo ITB<0,90; 12, asociaron neuropatía e ITB>1,30 y 16 con ITB<0,90. Cuestionario Edimburgo: 47 pacientes presentaron clínica atípica y 54, típica. Concordancia entre alteraciones neurovasculares cuantitativas y registradas r=0,32 para neuropatía y r=0,21 en arteriopatía. El punto de presión sobre el 5.° metatarso se asoció a neuropatía cuantitativa: OR: 2,32 (1,188-4,546); p=0,01.Conclusión: La evaluación, identificando manifestaciones clínicas, mejora la identificación del PR aunque necesitamos más investigación (AU)

Goals: Identify conditioning factors of the foot risk (FR) by comparing two evaluation methods (qualitative and quantitative) for neuropathy, arteriopathy, foot deformities. Concordance between detected the alterations and registered in clinical history (CH). Material and methods: It is an observational study. Ambit: in two primary care centers of the Catalan Health Institute. Population: Five hundred thirty-two patients with diabetes, both >18 years with FR records and informed consent. Measurements: Neuropathy: symptom assessment (NSS) and signs of disability (NDS). Arteriopathy: Index ABI. Edinburgh Questionnaire, fart pulses. Foot deformities: Pedigraphy. Quantitative reference: Values Defined neuropathy: NDS>6 points or 3-5 and NSS>5 points. ITB: Normal value (.90-1.30). Results: Women, 46.42%. Middle ages, 67.29 years (SD 7.69). One hundred fifty-three patients did not present neurovascular alterations. Qualitative: Without differentiating clinical manifestations: 252, patients presented neuropathy; 99, altered ITB; 28, two complications and 101, Edinburgh Quiz: altered. Quantitative: Differentiating clinical manifestations: among the neuropathy group; 110, patients only presented symptoms; 46, definite neuropathy. In 96, NDS and NSS scores without defined neuropathy criteria. Altered ABI: 52, only ABI>1.30; 47, ABI<.90; 12, associated neuropathy and ABI>1.30 and 16, with ABI<.90. Edinburgh questionnaire: 47, presented atypical symptoms and 26, typical. Agreement, between quantitative and recorded neurovascular alterations r=.32 for neuropathy and r=.21 in arteriopathy. The pressure point on the 5th metatarsal, was associated with quantitative neuropathy: OR: 2.32 (1.188–4.546), P=.01. Conclusion: The evaluation, identifying clinical manifestations, improves the identification of FR, although we need more research (AU)

[Identify the risk foot in patients with diabetes. A space for improvement in primary care]. / Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria.

GOALS: Identify conditioning factors of the foot risk (FR) by comparing two evaluation methods (qualitative and quantitative) for neuropathy, arteriopathy, foot deformities. Concordance between detected the alterations and registered in clinical history (CH). MATERIAL AND METHODS: It is an observational study. Ambit: in two primary care centers of the Catalan Health Institute. POPULATION: Five hundred thirty-two patients with diabetes, both >18 years with FR records and informed consent. MEASUREMENTS: Neuropathy: symptom assessment (NSS) and signs of disability (NDS). Arteriopathy: Index ABI. Edinburgh Questionnaire, fart pulses. Foot deformities: Pedigraphy. Quantitative reference: Values Defined neuropathy: NDS>6 points or 3-5 and NSS>5 points. ITB: Normal value (.90-1.30). RESULTS: Women, 46.42%. Middle ages, 67.29 years (SD 7.69). One hundred fifty-three patients did not present neurovascular alterations. QUALITATIVE: Without differentiating clinical manifestations: 252, patients presented neuropathy; 99, altered ITB; 28, two complications and 101, Edinburgh Quiz: altered. QUANTITATIVE: Differentiating clinical manifestations: among the neuropathy group; 110, patients only presented symptoms; 46, definite neuropathy. In 96, NDS and NSS scores without defined neuropathy criteria. ALTERED ABI: 52, only ABI>1.30; 47, ABI<.90; 12, associated neuropathy and ABI>1.30 and 16, with ABI<.90. Edinburgh questionnaire: 47, presented atypical symptoms and 26, typical. Agreement, between quantitative and recorded neurovascular alterations r=.32 for neuropathy and r=.21 in arteriopathy. The pressure point on the 5th metatarsal, was associated with quantitative neuropathy: OR: 2.32 (1.188-4.546), P=.01. CONCLUSION: The evaluation, identifying clinical manifestations, improves the identification of FR, although we need more research.

Energy density as a probe of band representations in photonic crystals.

Topological quantum chemistry (TQC) has recently emerged as an instrumental tool to characterize the topological nature of both fermionic and bosonic band structures. TQC is based on the study of band representations and the localization of maximally localized Wannier functions. In this article, we study various two-dimensional photonic crystal structures analyzing their topological character through a combined study of TQC, their Wilson-loop (WL) spectra and the electromagnetic energy density. Our study demonstrates that the analysis of the spatial localization of the energy density complements the study of the topological properties in terms of the spectrum of the WL operator and TQC.

[Pharmacological treatment of obesity for Primary Care physicians]. / Tratamiento farmacológico de la obesidad para médicos de Atención Primaria.

Obesity is a disease of high prevalence in Primary Care clinics. It is associated with major comorbidities (dyslipidaemia, diabetes, hypertension) that increase morbidity and mortality, health expenditure, and reduces the quality of life of patients. Changes in lifestyle are still the pillars of the treatment of excess weight. Pharmacological treatment should be considered when there are difficulties in achieving weight loss goals. In this article, a review is presented on the currently authorised drugs for the treatment of obesity and overweight with major comorbidities.

[Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management]. / Percepción del entorno de práctica enfermera de Atención Primaria de la Comunidad Valenciana, en departamentos con gestión pública y privada.

BACKGROUND: Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). METHOD: Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. RESULTS: Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. CONCLUSIONS: The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained.

Outcome of drug-induced sleep endoscopy-directed surgery for persistent obstructive sleep apnea after adenotonsillar surgery.

PURPOSE: Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment. METHODS: Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12 ±â€¯3 months. RESULTS: All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1 ±â€¯4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895 ±â€¯1.11 vs 6.143 ±â€¯4.88; p < 0.05) and, in 85% (n = 17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12 ±â€¯3 months (15%; n = 3) compared to before surgery (75%; n = 15) (p < 0.005). CONCLUSION: DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

OBJECTIVE: To perform an external validation of FRAX algorithm thresholds for reporting level of risk of fracture in Spanish women (low < 5%; intermediate ≥ 5% and < 7.5%; high ≥ 7.5%) taken from a prospective cohort "FRIDEX". METHODS: A retrospective study of 1090 women aged ≥ 40 and ≤ 90 years old obtained from the general population (FROCAT cohort). FRAX was calculated with data registered in 2002. All fractures were validated in 2012. Sensitivity analysis was performed. RESULTS: When analyzing the cohort (884) excluding current or past anti osteoporotic medication (AOM), using our nominated thresholds, among the 621 (70.2%) women at low risk of fracture, 5.2% [CI95%: 3.4-7.6] sustained a fragility fracture; among the 99 at intermediate risk, 12.1% [6.4-20.2]; and among the 164 defined as high risk, 15.9% [10.6-24.2]. Sensitivity analysis against model risk stratification FRIDEX of FRAX Spain shows no significant difference. By including 206 women with AOM, the sensitivity analysis shows no difference in the group of intermediate and high risk and minimal differences in the low risk group. CONCLUSIONS: Our findings support and validate the use of FRIDEX thresholds of FRAX when discussing the risk of fracture and the initiation of therapy with patients.

Apoptotic and autophagic cell death induced by glucolaxogenin in cervical cancer cells.

The antiproliferative and cytotoxic activity of glucolaxogenin and its ability to induce apoptosis and autophagy in cervical cancer cells are reported. We ascertained that glucolaxogenin exerts an inhibitory effect on the proliferation of HeLa, CaSki and ViBo cells in a dose-dependent manner. Analysis of DNA distribution in the cell-cycle phase of tumor cells treated with glucolaxogenin suggests that the anti-proliferative activity of this steroid is not always dependent on the cell cycle. Cytotoxic activity was evaluated by detection of the lactate dehydrogenase enzyme in supernatants from tumor cell cultures treated with the steroid. Glucolaxogenin exhibited null cytotoxic activity. With respect to the apoptotic activity, the generation of apoptotic bodies, the presence of active caspase-3 and annexin-V, as well as the DNA fragmentation observed in all tumor lines after treatment with glucolaxogenin suggests that this compound does indeed induce cell death by apoptosis. Also, a significantly increased presence of the LC3-II, LC3 and Lamp-1 proteins was evidenced with the ultrastructural existence of autophagic vacuoles in cells treated with this steroidal glycoside, indicating that glucolaxogenin also induces autophagic cell death. It is important to note that this compound showed no cytotoxic effect and did not affect the proliferative capacity of mononuclear cells obtained from normal human peripheral blood activated by phytohaemagglutinin. Thus, glucolaxogenin is a compound with anti-proliferative properties that induces programmed cell death in cancer cell lines, though it is selective with respect to normal lymphocytic cells. These findings indicate that this glycoside could have a selective action on tumor cells and, therefore, be worthy of consideration as a therapeutic candidate with anti-tumor potential.

Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Surface enhanced Raman scattering study of the antioxidant alkaloid boldine using prismatic silver nanoparticles.

Prismatic silver nanoparticles (PNps) were used in the surface enhanced Raman scattering (SERS) study of the antioxidant alkaloid boldine (5,6,6a,7-tetrahydro-1,10-dimethoxy-6-methyl-4H-dibenzo[de,g]quinoline-2,9-diol). Prismatic and quasi-spherical (QsNps) silver nanoparticles were synthesized and characterized by UV-Vis spectra, topographic profile (AFM) and zeta potential measurements. Raman and infrared (IR) spectra of the boldine were registered. Theoretical model calculations of the boldine onto the Ag surface predict a nearly coplanar orientation of the benzo[de]quinoline moiety and non-bonded interactions (electrostatic).

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Concurrent diseases and conditions in dogs with splenic vein thrombosis.

BACKGROUND: Splenic venous thrombosis (SVT) is usually considered an incidental finding on abdominal ultrasound examination but can indicate the presence of underlying disease. Concurrent disease processes and conditions in dogs with SVT have not been identified previously. OBJECTIVES: To identify concurrent diseases and conditions in dogs with SVT. ANIMALS: Eighty dogs with SVT. METHODS: Retrospective review. Medical records from 1994 through 2008 were searched for dogs with SVT identified by ultrasound examination. These records were then reviewed for signalment, medical history, clinicopathologic testing, diagnostic imaging, and clinical diagnosis. RESULTS: The most common concurrent conditions were neoplasia (54%), exogenous corticosteroid administration (43%), systemic inflammatory response syndrome (26%), disseminated intravascular coagulation (20%), pancreatitis (18%), and immune-mediated disease (16%). The most common neoplastic disease was lymphoma, and the most common immune-mediated disease was immune-mediated hemolytic anemia. Protein-losing nephropathy and naturally occurring hyperadrenocorticism were identified in <10% of the dogs. Concurrent splenic infarcts were identified in 33% of dogs, and concurrent portal vein thrombi were found in 18% of dogs. CONCLUSIONS: SVT is a sonographic finding of clinical importance, and dogs with SVT can have 1 or more coexisting diseases.

Predictive factors and the effect of phenoxybenzamine on outcome in dogs undergoing adrenalectomy for pheochromocytoma.

BACKGROUND: Some studies in dogs undergoing adrenalectomy for pheochromocytoma suggest that anesthetic complications and perioperative mortality are common. In humans, surgical outcome has improved with the use of phenoxybenzamine (PBZ) before adrenalectomy. HYPOTHESIS: Dogs treated with PBZ before adrenalectomy have increased survival compared with untreated dogs. ANIMALS: Forty-eight dogs that underwent adrenalectomy for pheochromocytoma. METHODS: A retrospective medical record review for dogs that underwent adrenalectomy for pheochromocytoma at a veterinary medical teaching hospital over the period from January 1986 through December 2005. RESULTS: Twenty-three of 48 dogs were pretreated with PBZ (median dosage: 0.6 mg/kg PO q12h) for a median duration of 20 days before adrenalectomy. Duration of anesthesia and surgery, percentage of dogs with pheochromocytoma involving the right versus left adrenal gland, size of tumor, and presence of vascular invasion were similar for PBZ-treated and untreated dogs. Thirty-three (69%) of 48 dogs survived adrenalectomy in the perioperative period. PBZ-treated dogs had a significantly (P = .014) decreased mortality rate compared with untreated dogs (13 versus 48%, respectively). Additional significant prognostic factors for improved survival included younger age (P = .028), lack of intraoperative arrhythmias (P = .0075), and decreased surgical time (P = .0089). CONCLUSIONS AND CLINICAL IMPORTANCE: Results from this retrospective study support treatment with PBZ before surgical removal of pheochromocytoma in dogs.

Cytotoxic effect of curcumin on Giardia lamblia trophozoites.

Giardia lamblia is one of the most important worldwide causes of intestinal infections produced by protozoa. Thus, the search for new alternative therapeutic approaches for this parasitic disease is very important. Common drugs used to control and eradicate this infection, frequently exhibit side effects that force patients to abandon treatment. The present work evaluates the anti-protozoan activity of curcumin, the main constituent of turmeric. Axenic G. lamblia (Portland 1 strain) cultures were exposed to different concentrations of curcumin. Its effects were evaluated on parasite growth, adhesion capacity and parasite morphology. We also evaluated the capacity of curcumin to induce an apoptosis-like effect. All curcumin concentrations inhibited trophozoite growth and adhesion in more than 50% in dose and time dependent manner. Morphological changes were described as protrusions formed under the cytoplasmic membrane, deformation due to swelling and cell agglutination. Curcumin induced apoptosis-like nuclear staining in dose and time dependent manner. In conclusion, curcumin exhibited a cytotoxic effect in G. lamblia inhibiting the parasite growth and adherent capacity, induced morphological alterations, provoked apoptosis-like changes. Future in vitro and in vivo experiments are endowed to elucidate the effect of curcumin in an experimental model of G. lamblia infection, analyze the involvement of ion channels in the swelling effect of curcumin during an apparent osmotic deregulation in G. lamblia trophozoites. This will lead to the proposal of the action mechanism of curcumin as well as the description of mechanism involved during the activation process for the apoptotic-like effect.

Check-ups in obese and diabetic patients: preventive medicine.

Obesity is a chronic disease associated with important additional diseases, such as DM 2, that both reduce life quality and increase morbimortality from any cause. In the Western world, obesity is directly responsible for most deaths due to associated chronic disease. Therefore, substantial effort should be directed towards adequate primary prevention campaigns and policies, as well as towards an intensive and long-term multidisciplinary treatment of obesity, in an attempt to combat this threat to the health of a large part of our population.