Efecto del cambio de gráficas de crecimiento de referencia en la prevalencia de talla baja / Effect of changing reference growth charts on the prevalence of short stature

Introducción: La talla baja es motivo de preocupación familiar y constituye una consulta frecuente en pediatría. Para su diagnóstico las gráficas de crecimiento son una herramienta imprescindible. El objetivo de este estudio es evaluar el impacto del cambio de gráficas de referencia en el diagnóstico de talla baja en nuestra área de salud. Sujetos y métodos: Estudio descriptivo transversal de base poblacional. Los valores de la talla de los niños y niñas de 4, 6, 10 y 13 años se compararon con las tablas de la Fundación Orbegozo 2004 Longitudinal y 2011. Se calcularon las prevalencias de talla baja y el percentil 3 de la muestra del estudio para realizar las comparaciones. Resultados: Se obtuvieron 12.256 registros válidos (89% de la población). La prevalencia de talla baja aumentó en todas las edades con el cambio de las gráficas: diferencia de prevalencias del 3,6% (IC95%: 2,8 a 4,5) a los 4 años; 1,8% (IC95%: 1,3 a 2,3) a los 6 años; 2,8% (IC95%: 2,2 a 3,4) a los 10 años y 1,4% (IC95%: 0,8 a 1,9) a los 13 años. En números absolutos, se pasó de 58 diagnósticos de talla baja con las gráficas 2004 (34 niños y 24 niñas) a 352 con las 2011 (155 niños y 197 niñas). Conclusiones: El cambio de referencia ha multiplicado por 6 el número de diagnósticos de talla baja. La patología hallada en los casos diagnosticados con las gráficas 2011 que no se hubieran diagnosticado con las gráficas anteriores nos permitirá evaluar la idoneidad del cambio realizado

Introduction: Short stature is a family concern, and is a common reason for consultations in paediatrics. Growth charts are an essential diagnostic tool. The objective of this study is to evaluate the impact of changing reference charts in the diagnosis of short stature in a health area. Subjects and methods: A population-based-cross-sectional-descriptive-study was performed in which the height of children of 4, 6, 10 and 13 years-old were compared with the growth charts of the Fundación Orbegozo 2004 Longitudinal and 2011. The prevalence of short stature and the 3 rd percentile of the study sample were calculated. Results: There were 12,256 valid records (89% of the population). The prevalence of short stature increased at all ages with the change in the growth charts, with differences of prevalence of 3.6% (95% CI: 2.8 to 4.5) at 4 years; 1.8% (95% CI: 1.3 to 2.3) at 6 years; 2.8% (95% CI: 2.2 to 3.4) at 10 years, and 1.4% (95% CI: 0.8 to 1.9) at 13 years. In absolute numbers, it went from 58 diagnoses of short stature with the 2004 Longitudinal charts (34 boys and 24 girls) to 352 with the 2011 (155 boys and 197 girls). Conclusions: The change in reference growth charts has increased by 6-fold the number of diagnoses of short stature. The pathological condition found in the cases diagnosed with the 2011 growth charts that had not been diagnosed with the previous charts will allow us to evaluate the suitability of the change

The toxic unit approach as a risk indicator in honey bees surveillance programmes: A case of study in Apis mellifera iberiensis.

The influence of genetic diversity and exposure to xenobiotics on the prevalence of pathogens was studied within the context of a voluntary epidemiological study in Spanish apiaries of Apis mellifera iberiensis, carried out during the spring season of years 2014 and 2015. As such, the evolutionary lineages of the honey bee colonies were identified, a multiresidue analysis of xenobiotics was carried out in beebread and worker bee samples, and the Toxic Unit (TUm) was estimated for each sampled apiary. The relationship between lineages and the most prevalent pathogens (Nosema ceranae, Varroa destructor, trypanosomatids, Black Queen Cell Virus; and Deformed Wing Virus) was analysed with contingency tables, and the possible relationships between TUm and the prevalence of these pathogens were studied by using a factor analysis. The statistical analysis supported the associations between V. destructor and Deformed Wing Virus (DWV), and between N. ceranae and Black Queen Cell Virus (BQCV), but the association between these pathogens and trypanosomatids was not observed. TUm values varied between 5.5 × 10-6 and 3.65 × 10-1. When TUm < 3.35 × 10-4, it was mainly determined by coumaphos, tau-fluvalinate and/or chlorfenvinphos. At higher values, other insecticides also contributed to TUm, although a clear predominance was not seen up to TUm ≥ 1.83 × 10-2, when it was mainly defined by acrinathrin, spinosad and/or imidacloprid. The possible cumulative effect from the joint action of xenobiotics was >10% in the 63% of the cases. The prevalence of pathogens did not appear to be influenced by the distribution of evolutionary lineages and, while the prevalence of V. destructor was not found to be determined by TUm, there was a trend towards an increasing prevalence of N. ceranae when TUm ≥ 23 10-4. This study is an example of using TUm approach beyond the field of the ecotoxicology.

[Effect of changing reference growth charts on the prevalence of short stature]. / Efecto del cambio de gráficas de crecimiento de referencia en la prevalencia de talla baja.

INTRODUCTION: Short stature is a family concern, and is a common reason for consultations in paediatrics. Growth charts are an essential diagnostic tool. The objective of this study is to evaluate the impact of changing reference charts in the diagnosis of short stature in a health area. SUBJECTS AND METHODS: A population-based-cross-sectional-descriptive-study was performed in which the height of children of 4, 6, 10 and 13 years-old were compared with the growth charts of the Fundación Orbegozo 2004 Longitudinal and 2011. The prevalence of short stature and the 3rd percentile of the study sample were calculated. RESULTS: There were 12,256 valid records (89% of the population). The prevalence of short stature increased at all ages with the change in the growth charts, with differences of prevalence of 3.6% (95% CI: 2.8 to 4.5) at 4 years; 1.8% (95% CI: 1.3 to 2.3) at 6 years; 2.8% (95% CI: 2.2 to 3.4) at 10 years, and 1.4% (95% CI: 0.8 to 1.9) at 13 years. In absolute numbers, it went from 58 diagnoses of short stature with the 2004 Longitudinal charts (34 boys and 24 girls) to 352 with the 2011 (155 boys and 197 girls). CONCLUSIONS: The change in reference growth charts has increased by 6-fold the number of diagnoses of short stature. The pathological condition found in the cases diagnosed with the 2011 growth charts that had not been diagnosed with the previous charts will allow us to evaluate the suitability of the change.

Agents with vasodilator properties in acute heart failure: how to design successful trials.

Agents with vasodilator properties (AVDs) are frequently used in the treatment of acute heart failure (AHF). AVDs rapidly reduce preload and afterload, improve left ventricle to aorta and right ventricle to pulmonary artery coupling, and may improve symptoms. Early biomarker changes after AVD administration have suggested potentially beneficial effects on cardiac stretch, vascular tone, and renal function. AVDs that reduce haemodynamic congestion without causing hypoperfusion might be effective in preventing worsening organ dysfunction. Existing AVDs have been associated with different results on outcomes in randomized clinical trials, and observational studies have suggested that AVDs may be associated with a clinical outcome benefit. Lessons have been learned from past AVD trials in AHF regarding preventing hypotension, selecting the optimal endpoint, refining dyspnoea measurements, and achieving early randomization and treatment initiation. These lessons have been applied to the design of ongoing pivotal clinical trials, which aim to ascertain if AVDs improve clinical outcomes. The developing body of evidence suggests that AVDs may be a clinically effective therapy to reduce symptoms, but more importantly to prevent end-organ damage and improve clinical outcomes for specific patients with AHF. The results of ongoing trials will provide more clarity on the role of AVDs in the treatment of AHF.

Critical appraisal of trials for validation of 'risk-guided' cardiovascular disease prevention therapy.

Cardiovascular risk management in the primary prevention population is impeded by the fact that risk scores do not identify properly a low-moderate risk population that could benefit from the use of preventive strategies. Current risk scores are further limited by their complexity and the lack of applicability to special patient populations and the real-life clinical setting, which deters their use. Clinical trials with risk factor interventions have been based on either a treat-to-target or fire-and-forget strategy and have used cardiovascular mortality or major events as their primary endpoint. These endpoints may not be appropriate for assessing cardiovascular benefit in low-moderate risk patients. Cardiovascular risk assessment should guide the strategy for risk factor intervention; however, this needs to be more clearly defined in low-intermediate risk patients.

[Progress in hypertension and diabetes in 2010]. / Novedades en hipertensión arterial y diabetes de 2010.

New developments in hypertension and diabetes mellitus in 2010 have been dominated by the search for a consensus on the aims of blood pressure control and on diagnostic criteria for diabetes mellitus, both of which have featured in the clinical studies and guidelines published throughout the year. These two risk factors continue to provoke debate about the seriousness of their implications for cardiovascular disease, and knowledge about them is increasing. The year 2010 was notable for the publication of new diagnostic criteria for diabetes mellitus by the American Diabetes Association, of revised guidelines on hypertension from the European Society of Hypertension, and of the results of a number of clinical trials and meta-analyses that have deepened our knowledge of the treatment of hypertension and diabetes.

Novedades en hipertensión arterial y diabetes de 2010 / Progress in hypertension and diabetes in 2010

Las novedades en hipertensión arterial (HTA) y diabetes mellitus (DM) del año 2010 han estado marcadas por la búsqueda de consensos sobre los objetivos de control de la presión arterial y los criterios diagnósticos de DM, que se han reflejado tanto en los estudios como en las guías de práctica clínica publicados este año. Ambos factores de riesgo siguen generando debate y conocimiento acerca de su gran implicación en la enfermedad cardiovascular. En 2010 destaca la publicación de los nuevos criterios diagnósticos de DM de la American Diabetes Association y la adaptación de las guías de HTA de la Sociedad Europea de Hipertensión, además de los resultados de varios ensayos clínicos y metaanálisis que profundizaron en el conocimiento del tratamiento de la HTA y la DM (AU)

New developments in hypertension and diabetes mellitus in 2010 have been dominated by the search for a consensus on the aims of blood pressure control and on diagnostic criteria for diabetes mellitus, both of which have featured in the clinical studies and guidelines published throughout the year. These two risk factors continue to provoke debate about the seriousness of their implications for cardiovascular disease, and knowledge about them is increasing. The year 2010 was notable for the publication of new diagnostic criteria for diabetes mellitus by the American Diabetes Association, of revised guidelines on hypertension from the European Society of Hypertension, and of the results of a number of clinical trials and metaanalyses that have deepened our knowledge of the treatment of hypertension and diabetes (AU)

Reactogenicity and immunogenicity of combined Haemophilus influenzae type b-meningococcal serogroup C conjugate vaccine booster dose coadministered with measles, mumps, and rubella vaccine.

A booster dose of Haemophilus influenzae type b-Neisseria meningitidis serogroup C conjugate (Hib-MenC-TT) vaccine simultaneously administered with measles, mumps, and rubella (MMR) vaccine in 13- to 14-month-old Spanish toddlers, primed with 3 doses of a combined Diphteria-Tetanus-Acellular Pertusis DTPa-Hib-containing vaccine and a MenC-CRM197 conjugate vaccine, had a good reactogenicity profile and induced similar Hib and MenC booster responses and MMR seropositivity rates as the vaccines given alone.

Association between physical and echographic fat thickness assessments and a lipodystrophy grading scale in lipodystrophic HIV patients: practical implications.

A simple diagnostic method for detecting in clinical routine HAART-associated lipodystrophy in HIV-infected patients is lacking. We studied the relationships between the scores obtained with a subjective lipodystrophy severity grading scale (LSGS) and standard anthropometric and echographic measurements of the subcutaneous and visceral fat thickness of 74 HIV-infected patients. Patients were divided into four groups according to their LSGS score (0, 1-7, 8-14, 15-21). Significant correlations between the LSGS and the anthropometric and echographic measurements of fat thickness, mainly the limb circumferences (brachial: r= -0.43, p < 0.001; thigh: r= -0.41, p < 0.001), and, especially, the echographically assessed perirenal fat diameters either adjusted (r= 0.46, p < 0.001) or nonadjusted to the body mass index (r= 0.35, p < 0.001) were observed. Significant differences in most of these anthropometric parameters between either the lowest (score 0) and the highest (score 15-21) score groups and the remaining groups were found, but not between the two intermediate groups (scores 1-7 vs. 8-14). This suggests that lipodystrophy should be clinically categorized as absent, mild, or marked, and that even minor changes in physical aspect should be considered as indicative of this disorder. The combination of these subjective and objective parameters could be helpful in the early detection of lipodystrophy in clinical practice.

Perirenal fat diameter measured by echography could be an early predictor of lipodystrophy in HIV type 1-infected patients receiving highly active antiretroviral therapy.

Echographically measured thicknesses of perirenal and subcutaneous fat, as well as serum metabolic and anthropometric parameters, were evaluated in 74 human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy (HAART), 22 of whom were HAART-naive at baseline, who were followed-up for 27 months to detect predictive factors of lipodystrophy. Perirenal fat diameter (PRFD) at baseline differed in HAART-naive and HAART-experienced patients (P<.001), and it was the best predictor of lipodystrophy changes after 12 months of follow-up in the HAART-naive patients (hazard ratio, 7.34; 95% confidence interval, 1.18-45.49; P=.032). In addition, HAART-experienced patients in whom lipodystrophy improved had thinner baseline perirenal fat than those in whom lipodystrophy did not improve (P=.04). A PRFD of >2.6 mm at baseline or >4.9 mm during receipt of HAART suggested lipodystrophy predisposition. PRFD correlated significantly with other metabolic and anthropometric parameters. Echographically measured PRFD is associated with lipodystrophy and could be used as an early predictor of this syndrome in treatment-naive patients starting HAART.

Determination of antioxidant activity of wine byproducts and its correlation with polyphenolic content.

It has been demonstrated that wine and other products derived from the grape have a high antioxidant capability; as a possible consequence of this, they may have potential benefits for health. The byproducts of the winemaking process represent a source of antioxidant compounds that has been relatively unexploited to date, but that is now the subject of increasing industrial interest. This article describes an approach to the study of the antioxidant activity of grape marcs, stalks, and dregs of both white and red varieties. This activity is compared with the measurements of their content of total polyphenols and of individual polyphenolic compounds, identified and quantified by HPLC. From the results we have been able to establish a positive correlation between the antioxidant activity and the total polyphenolic content of samples, but not with specific compounds.

Evaluation of genotoxicity of captan, maneb and zineb in the wing spot test of Drosophila melanogaster: role of nitrosation.

The wing spot test in Drosophila melanogaster is a suitable system for the analysis of genotoxic activity of compounds that need metabolic transformation to render them active. We have analysed the genotoxicity of three fungicides for which it was reported that the metabolic processes taking place in vivo may determine their activity. The compounds analysed are captan, maneb, zineb and ethylenethiourea (ETU) (a metabolic derivative of ethylenebisdithiocarbamates like maneb and zineb). We have also evaluated the ability of ETU to form genotoxic derivatives in vivo analysing this compound in combined treatments with sodium nitrite. Both standard and high bioactivation NORR strains have been used. Captan, usually considered a mutagen in vitro but a non-mutagen in vivo, gave negative results in the wing spot test with both crosses. Positive results were obtained for maneb in the standard cross and for ETU in both the standard and the high bioactivation cross. The genotoxicities of maneb and ETU were higher when treatments were made on media in which nitrosation is favoured. A low absorption of the fungicide and an inefficient availability of the compound in the target may explain negative results obtained with zineb in both crosses. The results obtained in this study with the wing spot test demonstrate once again the suitability of this in vivo assay, in which absorption, distribution and metabolism processes take place, for the evaluation of genotoxicity of compounds to which humans are exposed.

Determination of antioxidant power of red and white wines by a new electrochemical method and its correlation with polyphenolic content.

A new method for measuring the antioxidant power of wine has been developed based on the accelerated electrochemical oxidation of 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS). The calibration (R = 0.9922) and repeatability study (RSD = 7%) have provided good statistical parameters. The method is easy and quick to apply and gives reliable results, requiring only the monitoring of time and absorbance. It has been applied to various red and white wines of different origins. The results have been compared with those obtained by the total antioxidant status (TAS) method. Both methods reveal that the more antioxidant wines are those with higher polyphenolic content. From the HPLC study of the polyphenolic content of the same samples, it is confirmed that there is a positive correlation between the resveratrol content of a wine and its antioxidant power.

Tratamiento hormonal sustitutivo en la prevención de la cardiopatía isquémica en la mujer. Argumentos en contra / Hormone Replacement Therapy in Ischemic Heart Disease Prevention in Women. Arguments Against

El tratamiento hormonal sustitutivo es una de las cuestiones más difíciles a las que se enfrentan las mujeres y sus médicos. Los estudios epidemiológicos demuestran de manera consistente que las mujeres que toman tratamiento hormonal sustitutivo tienen un riesgo de padecer enfermedad coronaria sustancialmente inferior. Los datos observacionales se sustentan en hallazgos que demuestran que el tratamiento hormonal sustitutivo mejora varios factores de riesgo coronario, en especial los cambios en el perfil lipídico. Sin embargo, no se ha demostrado de forma absoluta que las hormonas ayuden a la prevención de la enfermedad cardiovascular. En mujeres sin enfermedad coronaria, el beneficio del tratamiento hormonal sustitutivo no está claro. Lo que sí han demostrado estudios clínicos recientes es que no se debe recomendar este tratamiento a mujeres con enfermedad coronaria establecida con el objetivo de obtener un beneficio cardiovascular (AU)

Infarto agudo de miocardio en el seno de hemoglobinuria paroxística nocturna / Acute Myocardial Infarction with Paroxysmal Nocturnal Hemoglobinuria

Se presenta el caso de un paciente varón de 62 años de edad diabético y fumador que, como otros antecedentes de interés, seguía estudio en otro centro hospitalario por presentar anemia, trombopenia y hematuria de varios meses de evolución. Ingresó en la unidad coronaria en el contexto de un infarto agudo de miocardio transmural extenso que se trató con activador tisular del plasminógeno. A las pocas horas presentó 'orinas hematúricas', disminución de las cifras de hemoglobina y plaquetas, así como insuficiencia renal aguda. Se realizó estudio hematológico que confirmó el diagnóstico de hemoglobinuria paroxística nocturna. El paciente evolucionó de forma desfavorable pese a tratamiento médico intensivo y en su evolución precisó hemodiálisis. Finalmente presentó un taponamiento cardíaco y falleció. Se comenta el papel que tiene la enfermedad hematológica en el infarto agudo de miocardio así como el tratamiento y la evolución del síndrome coronario en el contexto de la enfermedad (AU)