Cardiovascular risk biomarkers and metabolically unhealthy status in prepubertal children: Comparison of definitions.

BACKGROUND AND AIMS: The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers. METHODS AND RESULTS: A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR. CONCLUSION: Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.

Inflammation in metabolically healthy and metabolically abnormal adolescents: The HELENA study.

BACKGROUND AND AIMS: Inflammation may influence the cardio-metabolic profile which relates with the risk of chronic diseases. This study aimed to assess the inflammatory status by metabolic health (MH)/body mass index (BMI) category and to assess how inflammatory markers can predict the cardio-metabolic profile in European adolescents, considering BMI. METHODS AND RESULTS: A total of 659 adolescents (295 boys) from a cross-sectional European study were included. Adolescents were classified by metabolic health based on age- and sex-specific cut-off points for glucose, blood pressure, triglycerides, high density cholesterol and BMI. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors (C3, C4) and cell adhesion molecules were assessed. RESULTS: Metabolically abnormal (MA) adolescents had higher values of C3 (p < 0.001) and C4 (p = 0.032) compared to those metabolically healthy (MHy). C3 concentrations significantly increased with the deterioration of the metabolic health and BMI (p < 0.001). Adolescents with higher values of CRP had higher probability of being in the overweight/obese-MH group than those allocated in other categories. Finally, high C3 and C4 concentrations increased the probability of having an unfavorable metabolic/BMI status. CONCLUSIONS: Metabolic/BMI status and inflammatory biomarkers are associated, being the CRP, C3 and C4 the most related inflammatory markers with this condition. C3 and C4 were associated with the cardio-metabolic health consistently.

Valoración de la satisfacción materna con la analgesia epidural para el control del dolor del trabajo de parto / Assessment of maternal satisfaction with epidural analgesia for pain control during labour

Objetivos. Conocer el grado de satisfacción y las características sociodemográficas de las pacientes a las que se les realiza la técnica epidural para el trabajo de parto. Material y métodos. Encuesta SERVQHOS administrada con muestreo consecutivo a 140 pacientes que habían recibido técnica anestésica epidural para el control del dolor de parto desde enero hasta junio de 2014 en el Hospital San Pedro. Resultados. Recogidas 140 encuestas. La satisfacción media global (SERVQHOS): 4,4 con desviación estándar (DE):±0,9 con mejor resultado en preguntas subjetivas: (4,3; DE: 0,8) que objetivas (4; DE: 0,9). El 84,3% se mostraron satisfechas con la analgesia epidural y 100% volverían a solicitarla. No hemos encontrados diferencias significativas en relación con la satisfacción con la epidural ni con la percepción del dolor con variables sociodemográficas (edad, nacionalidad, situación laboral, nivel de estudios o estado civil). El 85% (119) eran mujeres españolas y el 14,3%(20) pertenecían a otras nacionalidades. Una paciente no respondió. Respecto al estado civil: 79,3% (111) estaban casadas, 16,4% (23) eran solteras, 1,4% (2) eran viudas o separadas y no contestaron el 2,9% (4). La edad media fue 33,3 (DE: 4.4). Antes de administrar la analgesia epidural, el 93,2% de las españolas definieron el dolor del parto como grave frente al 95% de las mujeres extranjeras pero sin encontrarse diferencias estadísticamente significativas (p=0,279). Conclusiones. La proporción de pacientes satisfechas con la técnica fue muy elevada, siendo los aspectos subjetivos los mejor valorados (trato y confianza en profesionales) (AU)

Background. To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. Material and Methods. A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. Results. A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD):±0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again. No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status). As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4). Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279). Conclusion. The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more (AU)

[Assessment of maternal satisfaction with epidural analgesia for pain control during labour]. / Valoración de la satisfacción materna con la analgesia epidural para el control del dolor del trabajo de parto.

BACKGROUND: To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. MATERIAL AND METHODS: A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. RESULTS: A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4.4 with standard deviation (SD):±0.9, with the best results being obtained in the subjective ítems: (4.3; SD 0.81) compared to the objective ítems (4; SD: 0.9). The large majority (84.3%) showed satisfaction with the epidural anaesthetic, and 100% would ask for it again. No significant differences were found in epidural satisfaction or pain perception related to socioeconomic variables (age, nationality, employment conditions, education level or marital status). As regards nationality, 119 (85%) were Spanish, and 14.3% (20) of other nationalities, with 1 patient not answering the nationality question. As regards marital status, 79.3% (111) were married, 1.4% (2), single, and 2.9% (4) were widows or separated, and 2.9% (4) did not answer. The mean age was 33.3 years (SD: 4.4). Prior to the administration of the epidural anaesthetic 93.2% of the Spanish citizens group described the pain as severe compared to 95% of the other nationalities group, but this difference had no statistical significance (p=.279). CONCLUSION: The level of satisfaction reported by the patients with this technique was high, with subjective items (good manners and trust) being appreciated more.

Paraoxonase 1 activities and genetic variation in childhood obesity.

Changes in paraoxonase 1 (PON1) activities have been observed in a variety of diseases involving oxidative stress, such as CVD. However, its role in obesity has not been fully established. In the present study, we aimed (1) to genotype sixteen PON1 SNP, (2) to measure serum PON1 activities and (3) to correlate these findings with the incidence of childhood obesity and related traits. We conducted a case-control study of 189 normal-weight and 179 obese prepubertal children, and we measured four different PON1 activities: lactonase; paraoxonase; arylesterase; diazoxonase. Although none of these activities was significantly different between the obese and normal-weight children, lactonase activity was found to be positively correlated with HDL-cholesterol and ApoA1 levels and negatively correlated with myeloperoxidase and fatty acid-binding protein 4 levels. Among the sixteen genotyped PON1 SNP, only the intronic SNP rs854566 exhibited a significant association with obesity (OR 0·61, 95 % CI 0·41, 0·91; P= 0·016). This genetic variant was also associated with increased diazoxonase, lactonase and arylesterase activities and decreased paraoxonase activity. Other genetic variants exhibited different association patterns with serum activities based on their location within the PON1 gene, and SNP that were located within the promoter were strongly associated with lactonase, arylesterase and diazoxonase activities. The functional variant Q192R exhibited the greatest effect on paraoxonase activity (P= 5·88 × 10(-42)). In conclusion, SNP rs854566 was negatively associated with childhood obesity and with increased serum PON1 activities in prepubertal children. We determined that lactonase is a reliable indicator of PON1 activities and should be included in future studies of PON1 function.

A gene variant of 11ß-hydroxysteroid dehydrogenase type 1 is associated with obesity in children.

BACKGROUND: The 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) enzyme catalyses the regeneration of active cortisol from inert cortisone and plays a critical role in tissue-specific corticosteroid reactions; therefore, 11ß-HSD1 is a key molecule associated with the development of obesity. Despite evidence for its role in obesity, no genetic polymorphisms have been significantly associated with the disease per se. OBJECTIVE: The aim of this study was to evaluate whether HSD11B1 gene variants, which have never been studied before, are associated with obesity and its related traits, as well as its relation to biomarkers of inflammation, liver damage and cardiovascular disease in a cohort of Spanish children. DESIGN: We performed a prospective case-control study. SUBJECTS: A total of 534 children were examined and classified as being obese (n=292) or normal weight (n=242). Anthropometric and biochemical measurements related to obesity, including inflammation, liver damage and cardiovascular disease, were determined. Genomic DNA was extracted and 10 HSD11B1 gene single-nucleotide polymorphisms (SNPs) were genotyped. RESULTS: A novel SNP, rs3753519, was strongly associated with obesity and this SNP was the only statistically significant HSD11B1 gene SNP remaining after a Bonferroni correction (odds ratio=1.97 for allelic effect, 95% confidence interval 1.23-3.16; P=0.004 and Bonferroni corrected P=0.046). In addition, this SNP was significantly and positively associated with increased body mass index (BMI), BMI z-score, weight, waist circumference, plasma γ-glutamyl transpeptidase and plasma active plasminogen activator inhibitor 1. The SNP was negatively associated with plasma adiponectin and cortisol after adjusting for sex and age. None of the inflammation biomarkers tested were associated with the risk allele. CONCLUSION: These data, which link an HSD11B1 genotype with both disease prevalence and its related phenotypes, strongly support a role for the rs3753519 polymorphism in the pathogenesis of pediatric-onset obesity.

[Cesarean section in a patient with acute myocardial infarction during pregnancy]. / Cesárea en una paciente con infarto agudo de miocardio durante la gestación.

Maternal heart disease during pregnancy is the main cause of obstetric morbidity and mortality. We report the case of a 40-year-old woman with a history of myocardial infarction and percutaneous transluminal coronary angioplasty. The patient suffered a second heart attack and received pharmacologic treatment. After admission, she was seen to be 29 weeks pregnant. Delivery was by cesarean section under progressive epidural block without complications. We review the medical, obstetric, and anesthetic implications of myocardial infarction during pregnancy. The management of such patients should be multidisciplinary and decisions about delivery should be taken based on obstetric considerations.

Cesárea en una paciente con infarto agudo de miocardio durante la gestación / Cesarean section in a patient with acute myocardial infarction during pregnancy

La enfermedad cardiaca maternal durante el embarazo es la primera causa de morbimortalidad no obstétrica. Presentamos el caso de una mujer de 40 años con antecedente de infarto de miocardio que recibió angioplastia coronaria transluminal percutánea. La paciente sufrió un segundo episodio de infarto y recibió tratamiento farmacológico. Durante el ingreso se descubrió que se encontraba en la semana 29 de gestación. El parto se realizó por cesárea bajo bloqueo epidural progresivo sin complicaciones. Este artículo realiza una revisión del infarto de miocardio durante el embarazo y sus implicaciones médicas, obstétricas y anestésicas, concluyendo que el manejo de dichas pacientes ha de ser multidisciplinar y que la decisión sobre el parto ha de tomarse en base a indicaciones obstétricas

Maternal heart disease during pregnancy is the main cause of obstetric morbidity and mortality. We report the case of a 40-year-old woman with a history of myocardial infarction and percutaneous transluminal coronary angioplasty. The patient suffered a second heart attack and received pharmacologic treatment. After admission, she was seen to be 29 weeks pregnant. Delivery was by cesarean section under progressive epidural block without complications. We review the medical, obstetric, and anesthetic implications of myocardial infarction during pregnancy. The management of such patients should be multidisciplinary and decisions about delivery should be taken based on obstetric considerations

Surface-enhanced Raman spectrometry of triamterene on a silver substrate prepared by the nitric acid etching method.

Surface-enhanced Raman scattering (SERS) spectrometry of the diuretic drug triamterene is discussed. The SERS-active substrate used is a silver foil etched with nitric acid. The influence of solvent and sample doping method on sensivity, intercept and shape of the calibration graphs is discussed.

Surface-enhanced Raman spectrometry for detection in liquid chromatography using a windowless flow cell.

A windowless flow cell has been developed for surface-enhanced Raman (SER) detection in liquid chromatography. Using colloidal silver as an active substrate, SER spectrometry of banned drugs in sport is presented. The experimental factors of primary influence on the analytical performance of the cell have been studied. The results of SER detection with the proposed cell have been compared to UV detection.