Robust and versatile pectin-based drug delivery systems.

Pectin-based resistant, interactive and versatile hydrogel vehicles for oral administration have been prepared. These systems are thought to be versatile enough to allow the inclusion of substances (such as the surfactants tested: Pluronic, Tween, Na Lauryl sulphate) that may contribute to tailor the drug release patterns. Tolbutamide, that shows a discrete and pH-dependent solubility in water, has been employed as a model drug to test the capability of these matrices to overcome such drug-imposed restraints. The incorporation of different surfactants produced pectin-based hydrogels of difficult manipulation. In order to improve this drawback, two different strategies have been developed: blending with agarose or freeze-drying. The presence of agarose yields robust systems that can be handled and tested as prepared, in the fresh state. Freeze-drying not only allows to shape pure pectin and blend systems, but also generates a porous structure whose microstructure, determined by the different components included, influences on the drug release behavior. Tolbutamide release kinetics from freshly prepared matrices can be fitted to the Higuchi model while the freeze-dried ones adjust to the Korsmeyer-Peppas model; hence the hydrogel chains rearrangement processes rule the release during the rehydration process.

Agarose drug delivery systems upgraded by surfactants inclusion: critical role of the pore architecture.

Anionic or non-ionic surfactants have been introduced in agarose-based hydrogels aiming to tailor the release of drugs with different solubility. The release of a hydrophilic model drug, Theophylline, shows the predictable release enhancement that varies depending on the surfactant. However, when the hydrophobic Tolbutamide is considered, an unexpected retarded release is observed. This effect can be explained not only considering the interactions established between the drug loaded micelles and agarose but also to the alteration of the freeze-dried hydrogels microstructure. It has been observed that the modification of the porosity percentage as well as the pore size distribution during the lyophilization plays a critical role in the different phenomena that take place as soon as desiccated hydrogel is rehydrated. The possibility of tailoring the pore architecture as a function of the surfactant nature and percentage can be applied from drug control release to the widespread and growing applications of materials based on hydrogel matrices.

Actualidad en ejercicio y diabetes tipo 2 (II) / Current exercise and type 2 diabetes (II)

La Diabetes Mellitus Tipo 2 (DMT2) es una enfermedad muy frecuente a nivel mundial y representa una causa importante de morbilidady mortalidad. Su incidencia y prevalencia han aumentado globalmente en las últimas décadas y si no se toman medidas urgentes la magnitud del problema crecerá con consecuencias para el paciente, el sistema de salud y los factores socioeconómicos de las regiones. Está demostrado que los cambios en el estilo de vida – ejercicio regular, peso saludable y conducta alimentaria– pueden prevenir el desarrollo de DMT2 principalmente en pacientes de alto riesgo, siempre y cuando, la actividad física se diseñe y se realice de forma similar a los estudios de cohorte exitosos. De manera similar, la adecuada prescripción del ejercicio aeróbico y de fuerza en el diabético es un pilar fundamental en su manejo, tratamiento, control y pronóstico y tiene múltiples beneficios, no sólo en el control glicémico, sino también en parámetros cardiovasculares, metabólicos, antropométricos, psicosociales, etc. Por todo lo mencionado, esta revisión abarca en general, la visión global de la diabetes, el papel del ejercicio en la prevención de la DMT2, el rol del ejercicio en el tratamiento de la DMT2, la prescripción especial del ejercicio, los mecanismos para la mejoría del control glicémico y relata algunas recomendaciones basadas en la evidencia para la prevención y el tratamiento de la DMT2 con el ejercicio aeróbico y el de fuerza (AU)

Type 2 Diabetes Mellitus (T2DM) is a very common disease worldwide and represents an important cause of morbidity and mortality. Its incidence and prevalence have increased overall in recent decades and if urgent action is not taken the problem will grow with consequences for the patient’s, health system and socioeconomic factors of the regions. It is shown that changes in lifestyle - regular exercise, healthy weight and eating - can prevent the development of T2DM mainly in high-risk patients, provided that physical activity should be designed and carried out in a similar way to cohort studies successful. Similarly, the appropriate prescription of aerobic exercise and strength training in the diabetic is a cornerstone in their management, treatment, prognosis and control and has many benefits, not only in glycemic control but also in cardiovascular parameters, metabolic, anthropometric, psychosocial, etc. For all these reasons, this review covers in general, the global vision of diabetes, the role of exercise in the prevention of T2DM, the role of exercise in the treatment of T2DM, especially prescription of exercise, the mechanisms for improved glycemic control and relates some evidence based recommendations for the prevention and treatment of diabetes with aerobic exercise and strength training (AU)

Actualidad en el ejercicio y diabetes tipo 2 (I) / Current exercise and type 2 diabetes (I)

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Condiciones higiénico-sanitarias como factores de riesgo para las parasitosis intestinales en una comunidad rural venezolana / Sanitary conditions as risk factors for intestinal parasites in a rural community in venezuelan

Las parasitosis intestinales, enfermedades tropicales desasistidas, contribuyen con el ciclo de la pobreza en poblaciones rurales, con acceso limitado a la atención médica, malas condiciones higiénicas, con consumo de agua y alimentos contaminados. El propósito de este estudio de prevalencia, muestra no aleatoria de 69 niños, fue evaluar los factores de riesgo higiénico-sanitarios mediante inspección, las normas de disposición de residuos sólidos y manipulación de alimentos en la Unidad Educativa de Panaquire-Miranda, ejecutar encuesta sobre las condiciones de vida, examinar muestras de heces mediante el método Formol-Tritón-Éter y asociar las condiciones higiénico-sanitarias de la vivienda con la presencia de parasitosis. La disposición de residuos y manipulación de alimentos fue insatisfactoria según los parámetros validados por los inspectores de salud a nivel nacional. Diecinueve por ciento de los encuestados sin acceso al agua peridomiciliaria, 17% viven en ranchos y 10% disponen sus excretas a cielo abierto. Casi 60% de las muestras fueron positivas para mono o poliparasitosis. Las infecciones por helmintos con alta prevalencia (73,5%), mmás frecuente la Trichuris trichiura (34,4%). Se encontró una asociación causal entre la defecación a campo abierto y la infección por Áscaris lumbricoides (Odds Ratio OR=8; IC 95%:1,27–50; p=0,03) y Trichuris trichiura (OR=14; IC 95%:1,51–133,4; p=0,01). Los hallazgos refuerzan la necesidad de políticas de salud para mejorar las condiciones higiénico-sanitarias en las comunidades rurales y proteger la salud pública.

Intestinal parasites, neglected tropical diseases, contribute to the cycle of poverty in rural populations with limited access to medical care and unhygienic conditions, coupled with the consumption of contaminated food and water. Prevalence study which involved 69 children, to evaluate through inspection, standards for solid waste disposal and food handling in the Panaquire-Miranda school unit, sanitation and hygiene life conditions obtained by the participant survey, examine fecal samples of participants using the method formaldehyde-Triton-ether and associate sanitary conditions of housing with the presence of parasites. Waste, water and food management handling were unsatisfactory according to official parameters validated by health inspectors. Nineteen percent of participants do not have access to water, 17% live on poor housing and 10% have their excreta in the open field. Nearly 60% of stool samples were positive for mono or poliparasitosis. Helminthes infections were highly prevalent (73.5%) and Trichuris trichiura (34.4%) most frequent. The results showed a positive correlation between open field defecation and infection with Ascaris lumbricoides (Odds Ratio OR=8; 95%CI=1.27-50, p=0.03) and Trichuris trichiura(OR=14 95%CI=1.51-133.4, p=0.01). These findings reinforce the need for political action to improve sanitary conditions in rural communities and protect public health.

Estabilidad rotatoria de las reconstrucciones del ligamento cruzado anterior con uno y dos haces: estudio comparativo / Comparisson between single and double bundle anterior cruciate ligament reconstruction in terms of rotational stability

Introducción: hay controversia en los resultados de la estabilidad rotatoria después de la reconstrucción del ligamento cruzado anterior (LCA) con uno o dos haces. El objetivo de este estudio fue comparar la estabilidad de la rodilla, principalmente la rotatoria, después de la reconstrucción del LCA con doble haz o con único haz. Materiales y métodos: 31 pacientes con lesión del LCA a quienes se les realizó reconstrucción con único haz (grupo UH) y 22 pacientes a quienes se les reconstruyó el LCA con 2 haces (grupo DH), entre junio del 2005 y marzo del 2008, se evaluaron con pruebas clínicas de estabilidad antes y 12 meses después de la cirugía. Además, todos los pacientes participaron en un programa de rehabilitación y permanecieron en el seguimiento posoperatorio por lo menos durante 12 meses. Resultados: a los 12 meses de la cirugía no se encontró diferencia en las pruebas de Lachman (p = 0,892) y pivot-shift (p = 0,741) al comparar los grupos. En el grupo UH, solo se encontró un paciente con la prueba de Lachman anormal y la prueba de pivot-shift + y otro con una prueba de Lachman con desplazamiento mayor de 10 mm y una prueba de pivot-shift ++. La mayoría de los pacientes (29) tenían la prueba de Lachman y la de pivot-shift negativas. En el grupo DH se encontró, en 20 pacientes, la prueba de Lachman y pivot-shift negativas. Sólo un paciente tenía pivot-shift + y otro una prueba de Lachman con desplazamiento mayor de 10 mm y una prueba de pivot-shift ++. Discusión: No hubo diferencia en la estabilidad rotatoria después de la reconstrucción del LCA con único haz o con doble haz.

[Prevention of maternal RhD isoimmunization with anti-D gamma isoimmunization]. / Prevención de la isoinmunización materna al RhD, con gamma-globulina anti-D.

OBJECTIVE: To report our experience in preventing RhD maternal isoimmunization by using anti-D gamma globulin among Rh-negative women. MATERIAL AND METHODS: Between 1982 and 1995, immunologic and hematologic data were collected from all Rh-negative women seen at Mexico's National Perinatology Institute. Women at risk of Rh isoimmunization were given a prophylactic dose of 150 micrograms of anti-D gamma globulin. RESULTS: A total of 4,857 Rh-negative women were seen during the study period (4.85% of the total population of women seen at the Institute), 629 (13.0%) of whom developed RhD isoimmunization; 542 (86.2%) of these women were already isoimmunized when first seen at our Institute. Twenty-two women (3.5%) developed isoimmunization even after receiving a proper dose of anti-D gamma globulin. Prophylaxis was given to 2,605 women (53.6%); 2,039 received a single dose, and 475 two doses. Prophylaxis failed in 22 cases; four were women with multiple pregnancy and 18 developed obstetric pathologic conditions. CONCLUSIONS: The use of anti-D gamma globulin resulted in a reduction of maternal Rh isoimmunization to less than one case per 1,000 women. Failures to prevent isoimmunization were associated to additional obstetric conditions and to lack of adherence to prevention guidelines.

Test de conocimientos sobre el climaterio: proceso de construcción y validación / Test of knowledge about the menopause: process of construction and validation

Objetivo. Construir y validar un test de conocimientos sobre el climaterio. Emplazamiento. El ámbito de aplicación de este instrumento es la Comunidad Autónoma de Andalucía. Método. 1. Construcción del universo teórico mediante técnica Delphi. 2. Ponderación de cada una de las dimensiones del universo teórico. 3. Formulación y selección de los elementos conceptuales a introducir en el cuestionario y formulación de sus correspondientes ítems. 4. Selección de ítems y análisis de la consistencia interna, homogeneidad, estabilidad y equivalencia tras pilotaje. Participantes. El pilotaje del cuestionario se ha realizado en 150 mujeres andaluzas, seleccionadas a través de un muestreo por cuotas de edad, hábitat y nivel de instrucción. Mediciones y resultados. Obtención de un cuestionario de 56 ítems de verdadero y falso (V/F) agrupados en 4 dimensiones: aspectos biológicos (14 ítems), aspectos psicosociales (14), riesgos de salud asociados al climaterio (6), cuidados y actividades preventivas y de mejora de la salud en el climaterio (22). Su validez y fiabilidad vienen determinadas por los siguientes resultados: nivel de consistencia interna y homogeneidad global: alfa de Cronbach, 0,86; estabilidad o ausencia de diferencias significativas respecto al momento en que se realiza la encuesta (t de Student, 1,09; p = 0,28), coeficiente de correlación intraclase (CCI), 0,753; equivalencia o ausencia de influencia de los encuestadores (t de Student, 1,09; p = 0,28), CCI = 0,761. Conclusiones. A tenor de los resultados, podemos concluir que se ha obtenido un instrumento estable teniendo en cuenta la independencia de la variable tiempo y la variable encuestador, un buen nivel de consistencia interna y una buena representatividad de los elementos conceptuales que conforman el universo teórico (AU)

Valoración de conocimientos sobre el climaterio en mujeres andaluzas / Evaluation of knowledge of the menopause among andalusian women

Objetivos. Valorar el nivel de conocimientos sobre el climaterio que poseen las mujeres andaluzas de 30-60 años, y determinar su posible relación con variables sociodemográficas, de utilización de servicios sanitarios y con su situación respecto al climaterio. Diseño. Estudio transversal. Participantes. Se ha seleccionado una muestra de 770 mujeres andaluzas de 30-60 años, para un error muestral de ñ 5 por ciento y un nivel de confianza del 95 por ciento, elegidas mediante un muestreo multietápico: aleatorio proporcional por provincia y tamaño de hábitat, y un muestreo por cuotas de edad y nivel de instrucción. Mediciones. La variable principal de estudio es el nivel de conocimiento de la mujer sobre el climaterio, valorado a través de un test validado de 56 preguntas dicotómicas. En el análisis descriptivo se ha obtenido la media, desviación estándar e intervalos de confianza del 95 por ciento (IC del 95 por ciento); y en el análisis relacional se ha aplicado test de homogeneidad de medias, análisis de variancia y regresión. Resultados. En un escala de 0-56 puntos, la media obtenida en la muestra es de 18,17 con una desviación estándar de 14,37, (IC del 95 por ciento, 17,15-19,17). Un 57,9 por ciento de la muestra encuestada obtiene valores de bajo o muy bajo nivel de conocimientos. En el análisis relacional, y según los datos del análisis de variancia, encontramos que el nivel de conocimientos está relacionado para una p < 0,001 con edad (F = 64,21), nivel de instrucción (F = 131,19), tipo de menopausia (F = 8,94) y haber recibido información sobre el climaterio (F = 7,57). De estas 4 variables es el nivel de instrucción el que en mayor medida explica la variabilidad del nivel de conocimiento (r = 0,52; p < 0,001). Sin embargo, la experiencia de la menopausia, o la utilización de los servicios sanitarios en relación a ésta no parece influir en el conocimiento sobre la etapa climatérica y sus cuidados. Conclusiones. El escaso conocimiento sobre el climaterio que posee la población de estudio pone de manifiesto la necesidad de educación para la salud sobre esta etapa de la vida. Del análisis relacional podemos concluir que el perfil de la mujer estudiada con mayor nivel de conocimientos parece ser el relacionado con un nivel de instrucción medio/alto, edad (30-40 años), que ha tenido una menopausia quirúrgica y recibido información sobre el climaterio (AU)

[Test on knowledge about climacteric: development and validation process]. / Test de conocimientos sobre el climaterio: proceso de construcción y validación.

OBJECTIVE: To construct and validate a test of knowledge about the menopause. SETTING: The context for use of this test is the Autonomous Community of Andalusia. METHOD: 1. Construction of the theoretical universe through the Delphi Technique. 2. Weighting of each of the dimensions of the theoretical universe. 3. Formulation and selection of the conceptual elements to introduce into the questionnaire and formulation of the corresponding items. 4. Selection of items and analysis of their internal consistency, homogeneity, stability and equivalence after a pilot study. PARTICIPANTS: The questionnaire's pilot study was run with 150 Andalusian women, chosen through sampling by quotas of age, habitat and educational background. MEASUREMENTS AND RESULTS: A questionnaire with 56 true and false (T/F) items grouped in four dimensions was obtained: biological aspects (14 items), psychological and social aspects (14), health risks linked to the menopause (6), care and preventive and health-improvement activities at the menopause (22). Its validity and reliability were determined by the following results: internal consistency and overall homogeneity (Cronbach's alpha = 0.86); stability or absence of significant differences at the moment the questionnaire is run (Student's t = 1.09; p = 0.28); intra-class correlation coefficient (ICC) = 0.753; equivalence or absence of bias of the questioners (Student's t = 1.09; p = 0.28), ICC = 0.761. CONCLUSIONS: The results lead us to conclude that the instrument is stable, allowing for the independence of the time and questioner variables, with high internal consistency and representing well the conceptual elements that shape the theoretical universe.

[Evaluation of knowledge about climacteric in Andalusian women]. / Valoración de conocimientos sobre el climaterio en mujeres andaluzas.

OBJECTIVES: To evaluate the level of knowledge about the menopause of Andalusian women between 30 and 60 years old; and to determine their knowledge's relationship with social and demographic variables, health service use and their position as regards the climacteric. DESIGN: Cross-sectional study. PARTICIPANTS: A sample of 770 Andalusian women between 30 and 60 was chosen, for a sample error of +/- 5% and 95% confidence interval, chosen through multi-stage sampling: at random with proportionality for province and size of habitat, and sampling by age quotas and educational background. MEASUREMENTS: The principal study variable was women's level of knowledge about the menopause, evaluated through a validated test of 56 dichotomous questions. In the descriptive analysis, the mean, standard deviation and 95% CIs were obtained; in the analysis of relationships, the test of homogeneity of means, and variance and regression analysis were used. RESULTS: On a scale of 0-56, the mean on the sample was 18.17 with a standard deviation of 14.37 (95% CI: 17.15-19.17). 57.9% of the sample polled had values of low or very low level of knowledge. In the analysis of relationships, and according to the variance analysis data, we found that the level of understanding is related (p < 0.001) to age (F = 64.21), educational background (F = 131.19), type of menopause (F = 8.94), and having received information on the menopause (F = 7.57). Of these four variables it is educational background which most explains the variability in knowledge (r = 0.52, p < 0.001). However, experience of the menopause or use of the health services for the menopause do not seem to affect knowledge about the climacteric period and its treatment. CONCLUSIONS: The lack of knowledge of the menopause shown by the population studied demonstrates the need for Health Education on this stage of life. The relationships analysis leads us to conclude that the profile of women studied who knew most was someone with middle/high educational background, aged 30-40, who had had a surgical menopause, and had received information about the menopause.

Mortality according to age and burned body surface in the Virgen del Rocio University Hospital.

The application of updated clinical protocols for the treatment of burned patients is showing very good results. The mortality curves according to age and the percentage of burned body surface could be of great use for the comparison of clinical results between different burns units. The probability of survival in 1000 consecutive patients admitted to the Burns Unit of the Virgen del Rocio University Hospital between July, 1993 and August, 1997, is compared, by graphic analysis, with the mortality curves of other centers, obtaining similar results. We conclude that the results of medical attendance in our unit are in line with those considered as a reference.

[Maternity education in primary care. Efficacy, utility and satisfaction of pregnant women]. / Educación maternal en atención primaria. Eficacia, utilidad y satisfacción de las embarazadas.

OBJECTIVE: To evaluate the Maternity Education (ME) programme: improvement of previous knowledge, changes in hygiene and dietary habits, attitudes to giving birth, satisfaction with the development of the sessions and perceived use. DESIGN: Pre-test/post-test. SETTING: Urban Health Centre. PARTICIPANTS: 222 pregnant women who attended ME. 211 answered the first questionnaire, 145 also the second, and 113 all three. MEASUREMENTS AND MAIN RESULTS: Self-administered questionnaires on social and demographic profile, hygiene and diet habits and knowledge of pregnancy, birth and caring for the new-born. Satisfaction and perceived use survey. Mean overall knowledge went up by 4.97 points (CI 95%: 4.5-5.44). Age (p < 0.0001), greater educational level (p < 0.001) and not being primiparas (p < 0.001) were linked to better initial knowledge. 46.7% of smokers stopped smoking between the start of pregnancy and the start of ME. By the end 23.6% of the women smoked, with an average of 4.53 cigarettes per day. Consumption of milk products per day went up from 2.78 to 3.07 (p = 0.002). Those taking physical exercise went up from 22.4% to 57.6% (p = 0.0001). 99.5% considered the sessions very pleasant; 89%, easily understandable; and 100% took part freely in the discussions. 86.7% had little or no fear of giving birth. 92.8% found the breathing exercises useful; and 69.8% the relaxation exercises. 98.2% thought that all pregnant women should experience ME. CONCLUSIONS: Group ME is effective for improving knowledge and health habits. Pregnant women thought it useful for confronting the birth and were very satisfied with the methods used.

[Health education on menopause: consensus on its contents]. / Educación para la salud sobre el climaterio: un consenso sobre sus contenidos.

OBJECTIVE: To define the standard knowledge women should have about the menopause in order to confront this stage successfully. DESIGN: Use of the Delphi technique to reach consensus with experts at a national level. PARTICIPANTS: 43 professionals were chosen from the biological, psychological and social health fields, who had professional experience in women's problems at this stage of their lives, and/or authors of books, articles, doctoral theses and other documents on the menopause. MEASUREMENTS AND MAIN RESULTS: Through three mailings, we obtained the views of 37 (86.04%) of the experts about the knowledge a woman should have of the menopause and the importance attached to each facet of this knowledge. Combining both criteria enabled us to classify the 266 Conceptual Elements (CE) that were expressed into three categories according to their relevance to women's knowledge. CONCLUSION: The Conceptual Framework on the Menopause is made up of a total of 173 CE, structured in 4 dimensions: biological aspects (23.12%), psychological and social aspects (24.8%), health risks (10.98%), and care, prevention and health promotion activities concerning the menopause (41.4%). This last dimension contained the highest percentage of specially relevant material (47.88% Level I CE).