Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women. The Flamenco project.

BACKGROUND AND AIMS: The Mediterranean diet (MD) has been associated with reduced morbidity from cardiovascular diseases in the general population. The aim of this study was to assess whether different degrees of adherence to the MD were associated with the cardiometabolic risk in peri and menopausal women. METHODS AND RESULTS: This cross-sectional study included 198 peri and menopausal women participating in the Flamenco project. Validated questionnaires were used to assess menopause health-related quality of life and degree of adherence to the MD (low, medium and high). The following cardiometabolic risk factors were assessed: fat mass percentage, waist circumference, blood pressure and resting heart rate, plasma markers (total cholesterol, high and low-density lipoprotein cholesterol [HDL-C and LDL-C, respectively], total cholesterol/HDL ratio, triglycerides, C-reactive protein and fasting glucose), Physical activity levels and smoking status. The degree of adherence to the MD among the study sample was 27%, 40% and 30% for low, medium and high adherence, respectively. After controlling for potential confounders, women with a high adherence to the MD showed lower plasma total cholesterol (p = 0.025), resting heart rate (p = 0.005), LDL-C (p = 0.019), triglycerides (p = 0.046) and C-reactive protein (p = 0.009) compared to those with a low adherence. Likewise women with high adherence to the MD showed lower total cholesterol/HDL-C ratio (p = 0.020) compared to those with a medium adherence. The high MD adherence group also showed lower clustered cardiometabolic risk (p = 0.004). Moreover, when analysing specific MD components, whole grain cereals, pulses (both p < 0.05) and red wine (p < 0.01) consumption were inversely associated with the clustered cardiometabolic risk. CONCLUSION: The present findings suggest that a high but not medium adherence to the MD is associated with a cardioprotective effect in peri and menopausal women. As a low percentage of the sample showed a high adherence to the MD, future research aimed at increasing the adherence to this dietary pattern for a better cardiometabolic status during peri and menopause is warranted.

[Venous thromboembolism prevention in pregnancy and the postpartum period in Primary and Specialized Care]. / Prevención del tromboembolismo venoso durante el embarazo y el puerperio en Atención Primaria y Especializada.

After noting that there are a number of risk factors for venous thromboembolism disease during pregnancy, it emphasizes primary prevention and treatment of this serious condition during pregnancy and the postpartum period are essential to reduce maternal morbidity and mortality. Low molecular-weight heparins are under the anticoagulant of choice in pregnancy. Your prescription may make both the primary care physician, as the hematologist and obstetrician. As for prescribing terms, an application protocol in both primary and specialized, multidisciplinary care, based on the existing literature on the subject is presented, which indicated that the hypercoagulable disorders associated with some of the risk factors, forced to do thromboprophylaxis with low molecular-weight heparins throughout pregnancy and the postpartum period presented.

[Low back pain during pregnancy. Multidisciplinary approach]. / Lumbalgia durante el embarazo. Abordaje multidisciplinar.

After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women.

Endocrinopatías durante el puerperio. Manejo / Endocrinopathies during the postpartum period. Management

Se describen las distintas endocrinopatías que pueden aparecer durante el puerperio. La más importante y frecuente es la diabetes, gestacional y pregestacional, pero también se mencionan otras menos frecuentes, pero muy importantes, como son el hipopituitarismo (síndrome de Sheehan e hipofisitis linfocitaria) y las alteraciones tiroideas, preexistentes (hipertiroidismo e hipotiroidismo) o de aparición durante el posparto (tiroiditis posparto y enfermedad de Graves). Tras describir las características de las mismas, se hace hincapié en el adecuado manejo de estas afecciones endocrinas, algunas de ellas de aparición exclusiva durante el puerperio (AU)

The various endocrinopathies that may occur during the postpartum period are described. The most important and common is gestational and pre-gestational diabetes, but other less common, and also very important ones, are mentioned such as hypopituitarism (Sheehan’s syndrome and lymphocytic hypophysitis) and thyroid disorders, pre-existing (hyperthyroidism and hypothyroidism), or postpartum onset (postpartum thyroiditis and Graves’ disease). After describing their characteristics, the emphasis is placed on the proper management of these endocrine diseases, some of them which exclusively appear during the postpartum period (AU)

[Endocrinopathies during the postpartum period. Management]. / Endocrinopatías durante el puerperio. Manejo.

The various endocrinopathies that may occur during the postpartum period are described. The most important and common is gestational and pre-gestational diabetes, but other less common, and also very important ones, are mentioned such as hypopituitarism (Sheehan's syndrome and lymphocytic hypophysitis) and thyroid disorders, pre-existing (hyperthyroidism and hypothyroidism), or postpartum onset (postpartum thyroiditis and Graves' disease). After describing their characteristics, the emphasis is placed on the proper management of these endocrine diseases, some of them which exclusively appear during the postpartum period.

[First results of the orchiopexy via scrotal approach]. / Primeros resultados de la orquidopexia vía escrotal.

PURPOSE: We present our first results with the technique described by Bianchi and Squire in 1989 for the surgical treatment of undescended testis by scrotal incision as an alternative to the traditional inguinal approach. MATERIALS AND METHODS: Prospective study of patients operated with the diagnosis of cryptorchidism with scrotal orchidopexy from October 2008 through July 2009. INCLUSION CRITERIA: patients with inguinal palpable testis, scrotal orchidopexy, testicular position was assessed at 6 months and/or one year after surgery. All procedures were performed by the same surgeon. Retractile testes were excluded. We studied the preoperative localization of the testis, the average surgical time, presence or absence of the processus vaginalis, conversions to the traditional inguinal orchiopexy, complications and location of six months and one year after surgery. RESULTS: A total of 50 orchidopexy were performed in 39 patients during this period. Aged between 1 and 12 years (mean 5 years, median 4 years). Were located in the intraoperative exam under anesthesia, fifteen testes in the inguinal canal and 35 in the external inguinal ring. Operative times ranged from 15 to 60 minutes (mean 34 minutes). The processus vaginalis was patent in 25 procedures (50%) and were ligated via the scrotal incision. Two patients required conversion to a traditional inguinal approach. All testes were satisfactorily positioned in the scrotum and there were no cases de testicular atrophy or ascent, hernia o hydrocele formation with followup that ranged from 6 months to 1 year. CONCLUSIONS: The technique of orchiopexy with scrotal approach is a safe, well tolerated and reliable method.

Primeros resultados de la orquidopexia vía escrotal / First results of the orchiopexy via scrotal approach

Objetivo. Evaluar nuestros resultados con la técnica de orquidopexia mediante incisión escrotal, descrita por Bianchi y Squire en 1989para el tratamiento quirúrgico del testículo no descendido, como alternativa a la técnica estandarizada de doble incisión mediante abordaje inguinal. Material y métodos. Estudio prospectivo de pacientes intervenidos con el diagnóstico de criptorquidia mediante orquidopexia escrotal, desde octubre de 2008 hasta julio del 2009. Criterios de inclusión: pacientes con testículo palpable en región inguinal, orquidopexia víaescrotal realizada por el mismo cirujano y control de la posición testicular a los 6 meses y/o al año de la cirugía. Se excluyeron los testículos retráctiles. Se analiza: localización preoperatoria del testículo, duración de lacirugía, presencia o ausencia del conducto peritoneo-vaginal, reconversiones a la técnica inguinal, complicaciones y localización a los seis meses y al año de la cirugía. Resultados. Durante este periodo se han realizado un total de 50orquidopexias en 39 pacientes, de edades comprendidas entre 1-12 años (..) (AU)

Purpose. We present our first results with the technique described by Bianchi and Squire in 1989 for the surgical treatment of undescended testis by scrotal incision as an alternative to the traditional inguinal approach. Materials and methods. Prospective study of patients operated with the diagnosis of cryptorchidism with scrotal orchidopexy from October 2008 through July 2009.Inclusion criteria: patients with inguinal palpable testis, scrotalorchidopexy, testicular position was assessed at 6 months and / or one year after surgery. All procedures were performed by the same surgeon. Retractile testes were excluded. We studied the preoperative localization of the testis, the average surgical time, presence or absence of the (..) (AU)

[Urodynamic evaluation of experimental bladder augmentation with seromuscular colocystoplasty]. / Evaluación urodinámica de ampliación vesical experimental mediante colocistoplastia.

INTRODUCTION: The use of de-epithelialized intestinal segment can avoid the complications associated of use to bowel segments for bladder augmentation. OBJECTIVE: We designed an experimental model New Zealand rabbit with previously reduced bladder capacity, and afterward we performed augmentation cystoplasty with urodynamics comparative effectiveness demucosalized and conventional colocystoplasty techniques. MATERIAL AND METHODS: In thirty-six male New Zealand rabbits fifty percent reduction cystoplasty was carried out. A month later the animals had bladder augmentation. They were randomly divided in two groups: 18 rabbits (group 1) underwent conventional colocystoplasty. In 18 rabbits (group 2) autoaugmentation procedure and demucosalized colocystoplasty was performed. All animals were sacrificed at 8 weeks of bladder augmentation. Urodynamics studies were practiced at beginning of each operation in all of them. RESULTS: Nine rabbits died and twenty-seven were evaluated: 14 rabbits group-1 and thirteen of group-2. The average increase in bladder capacity was 63% in group-1 under conventional colocystoplasty and 17% in group-2 demucosalized colocystoplasty. Average compliance improved to 141% in group-1 and 38% in group-2. CONCLUSIONS: In this study with "small bladder" New Zealand rabbit, the seromuscular colocystoplasty has poor urodynamics result in improving capacity and compliance bladder but conventional colocystoplasty has result effective.

Apendicitis aguda. Utilidad de una vía clínica basada en la evidencia / Acute appendicitis. Usefulness of an evidenced-based clinical pathway

Objetivos. Determinar los efectos de la implantación de una vía clínica basada en la evidencia científica en pacientes pediátricos con apendicitis aguda, en un hospital de referencia de área. Material y métodos. Se estudian 229 pacientes de edades comprendidas entre 3 y 14 años, con diagnóstico anatomopatológico de apendicitis aguda, divididos en dos grupos. Un grupo prospectivo, experimental, al que se le aplicó la vía clínica (n=114), (Junio 1999-Enero 2001), frente a un grupo de control histórico, retrospectivo, formado por pacientes que recibieron tratamiento en el período inmediatamente anterior a la introducción de la vía (n=115), (Diciembre 1997-Mayo 1999). Se comparan la edad, el sexo, tipo de apendicitis, complicaciones, días de estancia hospitalaria y número de dosis de antibióticos administradas. Resultados. Los dos grupos se consideraron comparables puesto que no se demostraron diferencias significativas para las variables de edad (p=0,61), sexo (p=0,73) y tipo de apendicitis (p=0,91). La estancia media fue inferior en el grupo de la vía (4,34 versus 5,33 días) (p=0,000049) y se emplearon menos dosis de antibióticos en estos pacientes (media: 11,17 frente a 16,13 dosis) (p=0,000000). Se presentaron 22 complicaciones, 6 en el grupo de la vía y 16 en el retrospectivo (p=0,09).Conclusiones. La reducción de la estancia hospitalaria y del número de dosis de antibióticos administradas demuestran la utilidad y rentabilidad de la vía clínica. La menor incidencia de complicaciones confirma su seguridad (AU)

Estudio comparativo de funcion renal diferencial mediante DMSA y MAG-3 en uropatías congénitas unilaterales / Comparative study of differential renal function by DMSA and MAG-3 in congenital unilateral uropathies

En las hidronefrosis congénitas obstructivas, el valor de la Función renal diferencial (FRD) es esencial para establecer un pronóstico o determinar la necesidad de tratamiento quirúrgico. El método más fiable para medir este parámetro es el estudio isotópico con DMSA. El MAG-3 se emplea fundamentalmente para estudiar la eliminación renal aunque en los minutos 1-3 también mide la FRD. Objetivo: Comparar los valores de la FRD obtenidos mediante DMSA y MAG-3 en uropatías congénitas unilaterales. Material y metodos: Se revisan 138 estudios isotópicos de niños entre 0 y 9 años, en los últimos 3 años: 67 casos de uropatía obstructiva unilateral (estenosis pieloureteral y megauréter), y 71 con uropatía no obstructiva unilateral (reflujo vesicoureteral, hipoplasia renal y duplicidad). En todos ellos se realizaron tests pareados con DMSA y MAG3 protocolizado. Ambas series se dividieron en 4 grupos: 1) FRD 50 por ciento. Se calculó, el coeficiente de correlación entre las medidas de la FRD obtenidas por DMSA y MAG-3, y comparación de medias para muestras apareadas empleando el test de Student. Resultados: Se observa una fuerte correlación lineal de la FRD obtenida con ambos métodos, en la serie obstructiva es de 0,96 (P < 0,01) y en la serie no-obstructiva de 0,92 (P < 0,01).Conclusiones: La FRD medidas con DMSA y MAG-3 tienen una alta correlación en la uropatías congénitas unilaterales, por lo tanto en las obstructivas; la FRD y el patrón de eliminación pueden estudiarse de forma fiable y segura con MAG-3 protocolizado, siendo innecesario el estudio complementario con DMSA, evitando radiación adicional al paciente (AU)

Grado de satisfacción y mejoría radiologica en pacientes con deformidad torácica tras cirugía correctora / The grade of satisfaction and radiological improvement in patients with chest deformity after reconstructive surgery

Se han descrito muchos métodos para la corrección quirúrgica de las deformidades de la pared torácica anterior, siendo el más empleado el de Ravitch modificado. Revisamos las historias clínicas de 15 pacientes con deformidad torácica corregida quirúrgicamente entre 1991 y 1999, comparando las fotografías, imágenes de TAC e índices de Haller pre y postoperatorios. La técnica de Ravitch modificada se empleó en 14 casos y la de Nuss en uno. Se hizo una encuesta postoperatoria para conocer el grado de satisfacción de los pacientes con el tratamiento quirúrgico realizado. De nuestros 15 pacientes, 14 eran varones. La edad media en el momento de la cirugía fue de 11 años (rango: 4-17 años). Nueve pacientes (60 por ciento) presentaban pectus excavatum y seis (40 por ciento) pectus carinatum. Las fotografías y tomografías computadorizadas postoperatorias mostraron un contorno torácico anterior sin depresión ni protrusión en todos los casos. La media de los índices de Haller pre y postoperatorios pasó de 4,75 (rango: 2,8-7,7) a 3,12 (rango: 2,4-3,7). El grado de satisfacción con el resultado quirúrgico fue alto en el 80 por ciento de los pacientes. Esta serie, aunque limitada, demuestra el alto grado de satisfacción de los pacientes tratados quirúrgicamente de su deformidad torácica. (AU)

[Acute appendicitis. Usefulness of a evidence-based critical pathway]. / Apendicitis aguda. Utilidad de una vía clínica basada en la evidencia.

OBJECTIVE: To determine the effects of an evidence-based clinical pathway for acute appendicitis in paediatric patients at a tertiary hospital. METHODS: We studied 229 patients with an age range from 3 to 14 years, with a pathological diagnosis of acute appendicitis divided in two groups. A prospective, experimental clinical pathway group of children (n = 114), (June 1999-January 2001) was compared with a historical control prepathway group of patients treated by conventional means in the previous years, (n = 115), (December 1997-May 1999). Age, gender, type of appendicitis (uncomplicated/complicated), length of hospitalisation, number of antibiotics doses supplied and rates of complications, were compared between pathway and and control patients. RESULTS: There were no differences in age (p = 0.61), gender (p = 0.73), either the number of complicated/uncomplicated appendicitis (p = 0.91) between the two groups. The average duration of hospitalisation was significantly shortened in pathway group (4.34 versus 5.33 days) (p = 0.000049) and the number of antibiotics doses were reduced from 16.13 to 11.17 doses (p = 0.000000). The number of major complications was lower in the pathway group than in the control group (6 and 16 respectively) but there was no significative difference (p = 0.09). CONCLUSIONS: Clinical pathway is an efficient and safe tool for acute appendicitis because decrease the length of hospitalisation and the number of antibiotics doses supplied, while maintaining quality of care.

[Comparative study of differential renal function by DMSA and MAG-3 in congenital unilateral uropathies]. / Estudio comparativo de funcion renal diferencial mediante DMSA y MAG-3 en uropatías congénitas unilaterales.

UNLABELLED: In congenital obstructed hydronephrosis, the assessment of the differential renal function (DRF) is essential to provide a prognosis or to determine surgical treatment. The most reliable method to measure the differential renal function is the isotopic study with DMSA. The MAG-3 is employed to evaluation renal elimination, although in the minutes 1-3 it also measures the differential renal function. OBJECTIVE: We compared the estimation of differential renal function by 99Tc-dimercapto-succinic acid (DMSA) and 99Tc-mercaptoacetyltriglycyne (MAG-3) methods in congenital unilateral uropathies. MATERIALS AND METHODS: We reviewed the results of 138 isotopic studies of children (age range: 0-9 years) with congenital unilateral uropathies: 67 cases were obstructed and 71 non-obstructed. In all of them were carried out match tests pairs with DMSA and MAG-3. Both series were divided into 4 groups: 1) DRF < 40%, 2) DRF 40-45%, 3) DRF 46-50% and 4) DRF > 50%. The measurement differential renal function correlation by DMSA and MAG-3 were analysed. RESULTS: The coefficient of correlation was 0.96 (P < 0.01) in obstructed unilateral uropathy and 0.92 (P < 0.01) in non-obstructed serie. CONCLUSIONS: The differential renal function measured with DMSA and MAG-3 has a close correlation in congenital unilateral uropathies. Therefore in obstructed types, differential renal function and half-time elimination can be reliable and sure studied with MAG-3, being unnecessary DMSA test, avoiding additional radiation to the children.

[Satisfaction levels and radiological improvement in patients with chest deformity after reconstructive surgery]. / Grado de satisfacción y mejoría radiológica en pacientes con deformidad torácica tras cirugía correctora.

Many methods for surgical correction of anterior chest deformities has been described; the modified Ravitch's technique is the most performed. We reviewed the clinical reports of 15 patients who had corrected chest deformity from 1991 to 1999. We compared the photographies, CT images and Haller's pre and postsurgery indexes. The modified Ravitch's technique was performed in 14 cases and the Nuss's technique in one. A postoperative questionnaire was done to know the grade of satisfaction that the patients reported after surgery. Of 15 patients, 14 were male. The mean age at the moment of surgery was 11 year old (range: 4-17). Nine patients (60%) had pectus excavatum and six (40%) pectus carinatum. In all cases, the postsurgery photographies and CT images showed neither chest depression nor protrussion. The mean of Haller's pre and postsurgery indexes changed from 4.75 (range: 2.8-7.7) to 3.12 (range: 2.4-3.7). The grade of satisfaction after surgery was high in the 80% of the patients. In our limited experience, the most of the patients with anterior chest deformities are satisfied with the results of the surgical management.

Utilidad de la laparoscopia en la infancia / Utility of laparoscopy in childhood

La laparoscopia es un método efectivo y poco invasivo que nos permite acceder a la cavidad abdominal y retroperitoneal, proporcionándonos una visión directa del contenido de los mismos, permitiéndonos además realizar procedimientos quirúrgicos asociados. Recientes avances en la técnica e instrumentación han permitido que se incremente su uso en la edad pediátrica. La laparoscopia en la infancia ha recorrido un largo camino desde sus inicios en 1970 promovido por Steve Gans, esta técnica se limitó a la exploración y procedimientos biópsicos en la cavidad abdominal. En las últimas décadas y acorde con el desarrollo videotecnológico los cirujanos pediátricos de todo el mundo han incorporado esta técnica en su armamentario. El espectro de indicaciones en la infancia es amplio toda vez que prácticamente la totalidad de procedimientos quirúrgicos convencionales se pueden realizar laparoscópicamente, sin límite de edad o peso. La cirugía laparoscópica como método de cirugía mínimamente invasiva tiene ventajas conocidas como la mejor visión del campo operatorio magnificado, el menor tiempo de recuperación, corta estancia, cicatriz mínima y mayor confort atribuibles al menor trauma quirúrgico. El objeto de esta exposición es enfocar los procedimientos más comunes de laparoscopia en la práctica pediátrica y sus reales beneficios, no olvidemos que los niños se recuperan rápidamente de la mayoría de los procedimientos quirúrgicos por vía convencional (AU)

Fluorescent whole-cell hybridization with 16S rRNA-targeted oligonucleotide probes to identify Brucella spp. by flow cytometry.

A whole-cell hybridization assay with fluorescent oligonucleotide probes derived from the 16S rRNA sequence of Brucella abortus in combination with flow cytometry has been developed. With the three fluorescent probes selected, a positive signal was observed with all the representative strains of the species and biovars of Brucella and with a total of nine different Brucella clinical isolates. Using the B9 probe in the hybridization assay, it was possible to discriminate between Brucella suis biovars 2, 3, 4, and 5 and almost all the other Brucella spp. On the basis of differences in fluorescence intensities, no discrimination was established between Brucella spp. and other phylogenetically related microorganisms. No positive fluorescence signals were detected with any of the bacteria showing serological cross-reactions with Brucella spp. and with a total of 17 clinical isolates not belonging to the genus Brucella. These results suggest that the 16S rRNA whole-cell hybridization technique could be a valuable diagnostic tool for the detection and identification of Brucella spp.

Dolor abdominal en la edad escolar: avances / Abdominal pain in the school aged children. Advances

En esta presentación discutimos la utilidad de nuevos métodos y avances tecnológicos en el diagnóstico diferencial, evaluación y tratamiento del dolor abdominal en la edad escolar. La causa más común de cirugía por dolor abdominal agudo es la apendicitis aguda, cuyo diagnóstico precoz depende de la facilidad de acceso a una atención especializada y su diagnóstico continúa siendo eminentemente clínico. La laparoscopia es útil en determinados casos de apendicitis aguda y donde demuestra mayor ventaja como medio diagnóstico y terapéutico es en el llamado "dolor abdominal recidivante" que se presenta en el 10-15 por ciento de niños en edad escolar, aumentando el 10 por ciento de etiología orgánica demostrable por otros medios. El mejor conocimiento de la patogenia del Helicobacter pylori y el empleo de la endoscopia digestiva en el diagnóstico histológico de la gastritis crónica, permitirán definir con mayor claridad si existe relación con el dolor abdominal crónico (AU)

[Maternal and fetal morbidity in a group of women with gestational diabetes]. / Morbilidad materna y fetal en un grupo de mujeres con diabetes gestacional.

Normal pregnant women in the second and third trimester were screened to detect gestational diabetes. Using the protocol proposed by the World Health Organization, we identified 33 women whose two hr glucose levels was > 200 mg/dl. Only sixteen women had less than 34 weeks of pregnancy when were seen for the first time at the diabetes clinic, the other seventeen women had more than 34 weeks when they presented to the diabetes clinic. The first group, was called the treated group and the second group was the non-treated group. The main clinical characteristics of these patients, treated vs non-treated, were (X +/- SD): age (years) 33.2 +/- 5.2 (20-40) vs 30.2 +/- 6.5 (20-39), p < 0.05; weeks of pregnancy at diagnosis: 27.9 +/- 4.1 (19-33) vs 36.1 +/- 2.3 (34-40), p < 0.05; weight (Kg): 79.9 +/- 13.1 (61.8-108) vs 87.4 +/- 16.8 (60.8-118), p = NS; length of pregnancy (weeks) 38 +/- 1.3 (36-40) vs 38.4 +/- 1.4 (35-40), p = NS; newborns weight (g): 3,654 +/- 650 (2,475-5,100) vs 3,221 +/- 529 (2,650-4,650), p = NS. There was an intrauterine death of a macrosomic fetus in the non-treated group. There were three macrosomic newborns in the treated group and one in the non-treated group, p = NS. Also, there was a premature newborn of 1,975 g, whose pregnancy was interrupted for acute fetal distress. Delivery by cesarean section occurred in 29 women (87.8%), and it was mainly related to the diabetes diagnosis. The prevalence of macrosomia in the treated group supports the idea that treatment has to be established at least at 24 weeks of pregnancy, to reduce this rate. It is concluded that gestational diabetes is associated to an increase in maternal and fetal morbidity, requiring strict supervision to detect and treat fetal distress and a tight glucose control to decrease the macrosomia rate.