Epigenetics dysfunction in morbid obesity with or without obstructive sleep apnoea: the EPIMOOSA study.

BACKGROUND: Obstructive sleep apnoea (OSA) and morbid obesity (MO), defined by a body mass index ≥35 kg/m2, are two closely related conditions. Recent studies suggest that circulating microRNA (miRNA) plays a potential role in the physiopathology of both conditions. To date, circulating miRNA expression has been studied separately in both conditions, but never jointly. The primary treatment of OSA is continuous positive airway pressure (CPAP), whereas bariatric surgery (BS) is the treatment of choice for MO. We have thus initiated the Epigenetics modification in Morbid Obesity and Obstructive Sleep Apnoea (EPIMOOSA) study (ClinicalTrials.gov identifier: NCT03995836). METHODS/DESIGN: EPIMOOSA is a prospective non-interventional cohort study aiming to recruit 45 MO patients who are candidates for BS. Three groups will be formed: MO without OSA, MO with OSA without CPAP and MO with OSA and CPAP. All of them will be followed up in 4 visits: baseline, 6 months prior to BS and 3, 6 and 12 months post-BS. At baseline, OSA status will be assessed by home sleep polygraphy (HSP), and CPAP will be adopted according to national guidelines. A specific standardized questionnaire (including medical conditions and AOS-related symptoms) and anthropometrical examination will be performed at each visit. Blood samples will be obtained at each visit for immediate standard biochemistry, haematology and inflammatory cytokines. For bio-banking, serum, plasma, and circulating exosomes will also be obtained. Twenty-four hours of blood pressure and electrocardiogram (ECG) Holter monitoring will be performed at all visits. A new HSP will be performed at the last visit. Finally, the three groups will be sex- and age- matched with participants in the EPIOSA study, an ongoing study aimed at understanding epigenetic changes in non-obese OSA patients. DISCUSSION: EPIMOOSA will evaluate changes in circulating miRNA in MO with or without OSA for the first time. In addition, EPIMOOSA will be able to elucidate the influence of OSA in MO patients and how specific and combined treatments alter miRNA expression.

Disminución de la incidencia de úlceras por presión en sacro y talones en pacientes ingresados en cuidados intensivos / Reduction in the incidence of pressure ulcers in sacrum and heels in patients hospitalized in the intensive care unit

INTRODUCCIÓN: la aparición de úlceras por presión (UPP) es un buen indicador de la calidad asistencial; su control y monitorización es una responsabilidad de los profesionales de Enfermería como actividad básica de seguridad clínica. OBJETIVOS: disminuir las tasas de incidencia de úlceras por presión en la Unidad de Cuidados Intensivos. Determinar la eficacia de los apósitos preventivos de espuma de adhesión atraumática (Mepilex Border Sacrum® y Mepilex Heel®). RESULTADOS: se desarrollaron 11 úlceras por presión, n= 10 en rama de medidas estándar de prevención, y n= 1 en la rama de tratamiento (sacro), 10 UPP en zona sacra y una en talones. La incidencia de úlceras por presión en la muestra fue del 10,47%, 5,07 puntos inferior a la incidencia media en el presente medio, siendo la diferencia estadísticamente significativa. CONCLUSIÓN: parece razonable, a la luz de los resultados, que se establezca un protocolo de apósitos preventivos (Mepilex Border Sacrum® y Mepilex Heel®) en zonas de mayor riesgo de padecer UPP (sacro y talones) en aquellos pacientes con un Braden objetivo de riesgo para padecer dichas UPP igual o inferior a 13-14 y con enfermedades crónicas graves

INTRODUCTION: the presence of pressure ulcers (PUs) is a good indicator of quality of care; nursing professionals are responsible for their control and monitoring as a basic activity within clinical safety. OBJECTIVES: to reduce the incidence rates of pressure ulcers in the Intensive Care Unit. To determine the efficacy of the preventive shaped foam dressings with non-traumatic adhesion (Mepilex Border Sacrum and Mepilex Heel). RESULTS: eleven pressure ulcers were developed, n= 10 in the arm with standard prevention measures, and n= 1 in the treatment arm (sacrum), 10 PUs in the sacral region and one in the heels. There was a 10.47% incidence of pressure ulcers in our sample, 5.07 scores below the mean incidence in the current setting, with a statistically significant difference. CONCLUSION: it seems reasonable, given the results, to establish a protocol for preventive dressings (Mepilex Border Sacrum and Mepilex Heel) in the areas at higher risk of PUs (sacrum and heels), in those patients with a ≤13-14 risk of PUs according to the Braden Scale, and with severe chronic diseases

Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective.

PURPOSE: The aim of the study was to examine national outcomes for congenital diaphragmatic hernia (CDH). METHODS: We analyzed the Kids' Inpatient Database for patients admitted at less than 8 days of age. RESULTS: Overall, 2774 hospitalizations were identified. Most patients were white and had private insurance. Most patients were treated at urban (96%), teaching (75%), and not identified as children's hospital (NIACH) (50%). Birth was the most common admission source at NIACH (91%) and children's unit in general hospital (CUGH) (59%), compared to hospital transfer at children's general hospital (CGH) (81%). Most CDH were repaired through the abdomen (81%), and 25% required extracorporeal membrane oxygenation (ECMO). Most NIACH patients were transferred to another hospital, whereas most at CGH and CUGH were discharged home. Survival to discharge was 66% after excluding hospital transfers. Univariate analysis revealed higher survival for males, birth weight (BW) of 3 kg or more, whites, patients with private insurance, and those in the highest median household income quartile. Survival was 86% after CDH repair but 46% for ECMO. Multivariate analysis identified black race (hazard ratio [HR], 1.536; P = .03) and other race (HR, 1.515; P = .03) as independent predictors of mortality. CONCLUSIONS: Hospital survival for CDH is related to sex, BW, race, and socioeconomic status. Blacks and other non-Hispanic minorities have higher mortality rates.

Usefulness of triglycerides-to-high-density lipoprotein cholesterol ratio for predicting the first coronary event in men.

Overweight and obesity potentiate the development of cardiovascular risk factors but many doubts have arisen recently regarding their role in coronary events. We evaluated the predictive value of a surrogate maker of insulin resistance, the ratio of triglyceride (TG) to high-density lipoprotein (HDL), for the incidence of a first coronary event in men workers according to body mass index (BMI). We designed a case-control study of active subjects collected from a single factory through their annual health examination and medical reports. Case subjects included those with myocardial infarction, unstable angina pectoris, or subclinical myocardial ischemia detected through electrocardiographic abnormalities. The sample was constituted by 208 case and 2,080 control subjects (mean age 49.9 years, 49.6 to 50.2). General characteristics of case and control subjects were well matched. The TG/HDL ratio was significantly higher in case subjects compared to controls. Stratification of the sample revealed an increasing prevalence of case subjects and mean TG/HDL in each category of BMI. Multivariable analysis, adjusted by smoking, demonstrated that TG/HDL increased 50% the risk of a first coronary event (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.26 to 1.71), whereas low-density lipoprotein cholesterol values indicated a more moderate increased risk (OR 1.01, 95% CI 1.005 to 1.012); metabolic syndrome (OR 1.76, 95% CI 0.94 to 3.30) and hypertension (OR 1.50, 95% CI 0.81 to 2.79) did not reach statistical significance. The TG/HDL ratio was associated with a first coronary event in all categories of BMI. In conclusion, the TG/HDL ratio has a high predictive value of a first coronary event regardless of BMI.

Gender differences in obesity related cardiovascular risk factors in Spain.

BACKGROUND: Obesity and overweight are increasing progressively leading to an increase in cardiovascular risk factors and cardiovascular events. METHODS: The MESYAS Registry (Metabolic Syndrome in Active Subjects) recruited active workers from their annual health examinations in Spain through 2003. Body mass index was used to diagnose overweight and obesity. Metabolic syndrome (MS) and risk factors were assessed according to the ATP-III definitions. RESULTS: 19,041 subjects were included (80% males), mean age 42.2 (10.7). The prevalence of overweight was 44.6% (44.0-45.2), obesity 17.3% (17.0-17.5) and MS 12.0% (11.8-12.2). Women had lower prevalence of all cardiovascular risk factors. Multivariate analysis showed independent associations between overweight (OR: 2.4; 95% CI 2.2-2.6) or obesity (OR: 5.3; 95% CI 4.7-5.9) and any other two MS criteria. Overweight and obesity were independently associated with all cardiovascular risk factors, except low high-density lipoproteins in women. Significantly higher association was found in women between obesity and diabetes (OR: 13.6; 95% CI 3.8-48.6), MS (OR: 10.6; 7.6-14.8), hypertriglyceridemia (OR: 8.6; 95% CI 5.6-13.1), and impaired fasting glucose (OR: 3.7; 95% CI 2.7-5.3). CONCLUSIONS: Overweight and obesity are strongly related to classical cardiovascular risk factors, atherogenic dyslipidaemia and MS. Obesity has higher association to insulin-resistance related risk factors in women.

Comparison of serum lipid values in subjects with and without the metabolic syndrome.

Insulin resistance is supposed to be the basis of metabolic syndrome (MS), although it is difficult to measure. The ratio of triglyceride (TG) to high-density lipoprotein (HDL) has been proposed as a surrogate marker of insulin resistance in overweight subjects. The aim of the present study was to assess the accuracy of the TG/HDL ratio for the diagnosis of MS. Data of 18,778 active workers (77.6% men) enrolled in 3 insurance companies in Spain were collected from their annual health examinations. Mean age was 42.2 +/- 10.7 years. MS was assessed according to modified Adult Treatment Panel III criteria. Prevalences of MS were 18.8% in men and 6.1% in women. Mean value of the TG/HDL ratio was 2.50 +/- 2.2 and increased in parallel to the number of MS components present. Subjects with MS had a ratio that was 2 times higher compared with those without (5.10 vs 2.03, p <0.001). Receiver operating characteristic curves were performed to assess the capability of the TG/HDL ratio to contribute to a diagnosis of MS and 80% sensitivity and 78% specificity were obtained for values >2.75 in men and >1.65 in women. In conclusion, the TG/HDL ratio is a feasible and accurate measurement for assessment of MS in healthy subjects. We propose cut-off values of 2.75 for men and 1.65 for women for a diagnosis of MS.

Ingesta de cáscaras de huevo como forma de pica / Egg' s shells intake as a form of pica

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