Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study.

Introduction: Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy. Methods: A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed. Results: Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94; p < 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07; p < 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96; p < 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99; p < 0.05). Conclusion: BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.

Prevalence of Sarcopenia and Dynapenia and Related Clinical Outcomes in Patients with Type 1 Diabetes Mellitus.

BACKGROUND: Sarcopenia has recently been recognized as a complication of diabetes. However, there are few results about the prevalence of sarcopenia and dynapenia and the related clinical outcomes in type 1 diabetes mellitus (T1DM). Our objectives were to evaluate the prevalence of sarcopenia and dynapenia and to determine whether there are any associations with disease-related factors in people with T1DM. METHODS: A cross-sectional study was conducted in people with T1DM. We assessed appendicular skeletal mass index (ASMI) using bioimpedance 50 Hz (Nutrilab Akern). Muscle function was assessed through handgrip strength (HGS) using a Jamar dynamometer. Sarcopenia was defined as a low HGS with low ASMI, whereas dynapenia was defined as low HGS with a normal ASMI. We used HGS data from the Spanish population percentile table and a cut-off point at p5 as dynapenia. The association of clinical, metabolic, and lifestyle variables with sarcopenia and dynapenia was studied. RESULTS: This study included 62 T1DM patients (66% females, mean age of 38 ± 14 years, body mass index (BMI) of 24.9 ± 4.7 kg/m2). The prevalence of sarcopenia and dynapenia was 8% and 23%, respectively. In our sample, there were more men in the sarcopenic and dynapenic groups. The sarcopenic group showed a significantly higher mean HbA1c value. Lower diabetes duration, PREDIMED score, BMI, and muscle mass measures (fat-free mass index (FFMI), ASMI, and body cell mass index (BCMI)) were significantly associated with sarcopenia. Decreased diabetes duration, PREDIMED score, phase angle (PhA), and HGS values showed a significant association with dynapenia. CONCLUSIONS: The prevalence of sarcopenia and dynapenia was high in people with T1DM in our study. Specifically, the proportion of dynapenia was quite high. HGS and ASMI are practical tools for the assessment of muscle health status in T1DM, and low values are associated with poor glycemic control, underweight, and low adherence to the Mediterranean diet. Thus, dynapenia may predict accelerated muscle aging in T1DM.

Combination of Soy Isoflavones, 8-Prenylnaringenin and Melatonin Improves Hot Flashes and Health-Related Quality of Life Outcomes in Postmenopausal Women: Flavie Study.

OBJECTIVES: This study aims to investigate the effects of a combination of soy isoflavones, 8-prenylnaringenin (8-PN), and melatonin in postmenopausal women suffering from moderate-to-severe hot flashes (HFs). METHODS: A multicenter, prospective, open-label study enrolled 44 postmenopausal women suffering from moderate-to-severe HFs (≥ 5 daily or ≥ 35 weekly) to receive 54.4 mg standardized soy isoflavones (including 24.5 mg genistein and 16.3 mg daidzein), 100 µg 8-PN, and 1 mg melatonin once daily for 12 weeks. The primary clinical outcomes included changes in health-related quality of life (HRQoL) scores (Menopause-Specific QoL questionnaire [MENQoL] and Cervantes Scale) and HFs following 4 and 12 weeks of treatment. Other analyses included treatment adherence, acceptability, tolerability, and safety. RESULTS: All of the four domains of MENQoL questionnaire significantly improved at 4 weeks (P < 0.05) and 12 weeks (P < 0.001), affecting significantly the vasomotor, psychosocial, and physical spheres (41.2%, 26.3%, and 25.0%; 12 weeks improvements, respectively). Similarly, in the menopause (39.3%) and psychic (51.7%) domains (both P < 0.05 at 12 weeks), the global score of the Cervantes Scale significantly increased at 4 weeks (18.6%) and 12 weeks (35.4%). Accordingly, moderate-to-severe HFs significantly decreased at 4 weeks compared to baseline (41.7% reduction) and further reduced at 12 weeks (76.5%), including the total number of episodes. CONCLUSIONS: Food supplements containing soy isoflavones, 8-PN, and melatonin showed an early and progressive benefit for reducing clinically significant HFs and for improving HRQoL across all domains, favorably affecting postmenopausal women's overall well-being.

Quality of life analysis measured with the Cervantes 16 scale in treated menopausal women with genitourinary syndrome.

Aim: To assess the quality of life of menopausal women with genitourinary syndrome receiving local drugs (prasterone, estriol or promestriene). Methods: Prospective, longitudinal, randomized study in which quality of life was assessed using the 16-item Cervantes scale (EC16) before and after treatment. Results: A total of 45 women were assessed (35.6% received prasterone, 33.3% estriol and 31.1% promestriene). After treatment, statistically significant mean score differences were observed in EC16, mainly with prasterone. Improvement in EC16 score only shows a statistically significant relationship with age and drug use. Conclusion: The EC16 is an affordable and quick-to-apply tool that allows physicians and patients to know patients' self-perceived quality of life. Local treatment has been shown to improve the quality of life of menopausal patients with genitourinary syndrome.

Empleo de la vía subcutánea en un hospital de segundo nivel. Revisión del uso actual y nuevas propuestas / Use of the subcutaneous route in a second level hospital. A review of current use and new proposals

No disponible

Diabetes gestacional y pregestacional: características perinatales y morbilidad neonatal / Gestational and pregestational diabetes: Perinatal characteristics and neonatal morbidity

No disponible

Identificación de necesidades psicosociales de un grupo de escolares españoles con problemas visuales: un estudio con metodología mixta / Psychosocial needs of Spanish schoolchildren with visual impairment: a mixed methods research

Resumen Este estudio presenta un análisis de las necesidades psicosociales de un grupo de escolares españoles que padecen problemas visuales. La investigación utiliza metodología mixta aplicada en una muestra de 26 menores que acuden con sus progenitores a una consulta de oftalmología pediátrica con y sin problemas visuales. Se realizan entrevistas a los niños, adolescentes y/o progenitores sobre las repercusiones de su problema visual en el ámbito educativo, en la realización de actividades de ocio y tiempo libre y en la interacción con sus iguales, además de los sentimientos que les produce su problema visual. A los datos obtenidos se aplican análisis descriptivos, de medias, de varianza y pruebas de independencia entre variables, mediante las pruebas de chi-cuadrado de Pearson (χ²) y de U de Mann-Whitney. Los resultados encontrados indican que el grupo de escolares con problemas visuales graves tienen mayores dificultades que los que no los tienen en el bienestar físico y emocional, en el rendimiento escolar y en la interacción con los otros. Estos resultados sugieren la importancia de programar intervenciones integrales y conjuntas de carácter sanitario y socioeducativo que incidan en la mejora en cada una de las áreas de necesidad.

Abstract This study investigates the psychosocial needs of a group of schoolchildren with visual impairments. Based on a CUAN+CUAL mixed methods, it analyzed 26 children, with and without visual impairment, who attended a pediatric ophthalmology consultation with their parents. Several descriptive, mean and variance tests of independence between variables were performed using Pearson's Chi-square (χ²) and Mann-Whitney U tests. The interviews conducted with the children and/or parents on the impact of their visual impairment on education, leisure activities and peer interaction, as well as the feelings derived from the impairment, underwent discourse analysis. Results show that schoolchildren with severe visual impairments experience greater difficulties regarding physical and emotional well-being, school performance, and peer interaction when compared with those without. These findings suggest the importance of developing comprehensive and joint health and socio-educational interventions to improve these areas.

Effects and Economic Sustainability of Biochar Application on Corn Production in a Mediterranean Climate.

The effects of two types of biochar on corn production in the Mediterranean climate during the growing season were analyzed. The two types of biochar were obtained from pyrolysis of Pinus pinaster. B1 was fully pyrolyzed with 55.90% organic carbon, and B2 was medium pyrolyzed with 23.50% organic carbon. B1 and B2 were supplemented in the soil of 20 plots (1 m2) at a dose of 4 kg/m2. C1 and C2 (10 plots each) served as control plots. The plots were automatically irrigated and fertilizer was not applied. The B1-supplemented plots exhibited a significant 84.58% increase in dry corn production per square meter and a 93.16% increase in corn wet weight (p << 0.001). Corn production was no different between B2-supplemented, C1, and C2 plots (p > 0.01). The weight of cobs from B1-supplemented plots was 62.3%, which was significantly higher than that of cobs from C1 and C2 plots (p < 0.01). The grain weight increased significantly by 23% in B1-supplemented plots (p < 0.01) and there were no differences between B2-supplemented, C1, and C2 plots. At the end of the treatment, the soil of the B1-supplemented plots exhibited increased levels of sulfate, nitrate, magnesium, conductivity, and saturation percentage. Based on these results, the economic sustainability of this application in agriculture was studied at a standard price of €190 per ton of biochar. Amortization of this investment can be achieved in 5.52 years according to this cost. Considering the fertilizer cost savings of 50% and the water cost savings of 25%, the amortization can be achieved in 4.15 years. If the price of biochar could be reduced through the CO2 emission market at €30 per ton of non-emitted CO2, the amortization can be achieved in 2.80 years. Biochar markedly improves corn production in the Mediterranean climate. However, the amortization time must be further reduced, and enhanced production must be guaranteed over the years with long term field trials so that the product is marketable or other high value-added crops must be identified.

Egreso de los pacientes del manicomio general de la Castañeda, (1929-1958) ¿un problema familiar? / Patients’s egress of the manicomio general of la castañeda (1929-1958), a family problem?

Entre 1929 y 1958, los directores del Manicomio General de la Castañeda culparon a las familias de los internos de la sobrepoblación del establecimiento, alegaron que los egresados o no tenían parientes o estos se negaban a recibir a sus deudos. Factores que, a su juicio, impedían reducir la población del nosocomio. En consecuencia, tanto la dirección de la institución como la entidad gubernamental adoptaron una serie de medidas dirigidas a localizar y convencer a los parientes de que asumieran la responsabilidad de la externación de sus enfermos y contribuyeran a su reinserción social. El presente trabajo analiza un conjunto de documentos burocráticos emitidos por la dirección del manicomio y por los responsables de la asistencia pública, relativos al proceso de egreso de los enfermos mentales en su vertiente familiar. Documentos que ponen de manifiesto la complejidad del proceso de externación de los enfermos mentales en un contexto de lucha contra la masificación de esta institución pública y muestran las dificultades, contradicciones y conflictos que se presentaron durante la ejecución de las medidas propuestas por las dependencias implicadas.(AU)

From 1929 to 1958, directors of asylum La Castañeda blaming patients’ families about overcrowded in the hospital. Directors said that patients had not relatives, or they denied receiving them. This prevented the reduction of the population suffered by the institution. According to this situation, the asylum and public assistance adopted several actions to find and to persuade relatives for they to take their responsibility and help to their family member to social reinsertion. The article examines official documents of the asylum’s direction, and public assistance on the egress process of mental illness since family perspective. Those documents expressed the hard process of output on madness in a context of fighting against the overcrowded, and reveal difficulties, contradictions, and conflicts that it presented the execution of actions of mental hospital and Public Assistance. (AU)

Hipertensión pulmonar tromboembólica crónica en España: una década de cambio / Chronic thromboembolic pulmonary hypertension in Spain: a decade of change

Introducción y objetivos El tratamiento de la hipertensión pulmonar tromboembólica crónica (HTPTEC) ha evolucionado en la última década. Sin embargo, apenas se dispone de información sobre el impacto de estos logros en la población general a escala nacional. Este estudio se diseñó para describir las características de los pacientes con HTPTEC en España en la última década. Métodos Se recogieron prospectivamente datos epidemiológicos, clínicos y pronósticos de los pacientes con HTPTEC consecutivos incluidos en el registro español REHAP desde el 1 de enero de 2007 al 31 de diciembre de 2018. Se evaluaron las diferencias entre diferentes periodos de tiempo, estableciendo 2013 como fecha de referencia para el análisis. Se calculó la puntuación de propensión para la intervención mediante un modelo multivariable de regresión logística. Resultados Se incluyó a 1.019 pacientes; se remitió a 659 (64,4%) a un centro nacional de referencia en HTPTEC. Del total, se seleccionó a 350 (34,3%) para cirugía y a 97 (9,6%) para tratamiento percutáneo. Entre los pacientes diagnosticados entre 2007 y 2012 hubo más frecuencia de muerte que entre los diagnosticados de 2013 en adelante (HR=1,83; IC95%, 1,07-3,15; p=0,027). En el grupo de pacientes ajustado por el modelo de puntuación de propensión, las resistencias vasculares pulmonares basales y la distancia recorrida en el test de 6 min de marcha también fueron determinantes del pronóstico (respectivamente, HR=1,24; IC95%, 1,15-1,33; p=0,011, y HR=0,93; IC95%, 0,90-0,97; p=0,001). Las tasas de supervivencia de los pacientes que se sometieron a un procedimiento intervencionista (trombendarterectomía pulmonar o angioplastia con balón de arterias pulmonares) resultaron llamativamente altas. Conclusiones Durante la última década, el diagnóstico y el pronóstico de la HTPTEC han mejorado de manera considerable. La gravedad de la enfermedad al diagnóstico determinó el perfil de riesgo. ... (AU)

Introduction and objectives Chronic thromboembolic pulmonary hypertension (CTEPH) treatment has evolved in the last decade. However, there is scarce information on the long-term impact of this progress in a real-life population at a national level. This study was designed to analyze the characteristics of CTEPH patients in Spain over the last decade. Methods We prospectively collected epidemiological, clinical, and prognostic data from CTEPH patients consecutively included in the Spanish REHAP registry from January 1, 2007, to December 31, 2018. We evaluated differences over time, establishing 2013 as the reference date for analysis. Propensity scores for interventional treatment were calculated using a multivariable logistic regression model. Results A total of 1019 patients were included; 659 (64.4%) were evaluated at a national CTEPH center. Overall, 350 patients (34.3%) were selected for surgery and 97 (9.6%) for percutaneous treatment. Patients diagnosed between 2007 and 2012 died more frequently than those diagnosed from 2013 onward (HR, 1.83; 95%CI, 1.07-3.15; P=.027). Within the subgroup of patients adjusted by propensity score, baseline pulmonary vascular resistance and the 6-minute walk test distance also determined the outcome (HR, 1.24; 95%CI, 1.15-1.33; P=.011; and HR, 0.93; 95%CI, 0.90-0.97; P=.001, respectively). High survival rates were found in patients who underwent an invasive procedure (pulmonary endarterectomy or balloon pulmonary angioplasty). Conclusions CTEPH diagnosis and prognosis have consistently improved in the last decade. Baseline disease severity determines the risk profile. Patients who undergo pulmonary endarterectomy or balloon pulmonary angioplasty have better outcomes. (AU)

Antifungal stewardship in a tertiary care paediatric hospital: the PROAFUNGI study.

BACKGROUND: The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. METHODS: Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July-October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. RESULTS: The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4-13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. CONCLUSIONS: A high rate of AF appropriateness was found for the children's hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children.