Iodine status and thyroid function among Spanish schoolchildren aged 6-7 years: the Tirokid study.

I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6-7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 µg/l, and 17·9 % of children showed UI<100 µg/l. The median UI was higher in males (180·8 v. 153·6 µg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.

Switching to lopinavir/ritonavir with or without abacavir/lamivudine in lipoatrophic patients treated with zidovudine/abacavir/lamivudine.

BACKGROUND: Discontinuation of thymidine nucleoside reverse transcriptase inhibitors (tNRTIs) is the only proven strategy for improving lipoatrophy. It is unclear whether switching to NRTI-sparing or to non-thymidine NRTI-containing therapy has differential effects on body fat recovery. METHODS: This was a 96 week, open-label, randomized study in suppressed patients with moderate/severe lipoatrophy and no prior virological failure while receiving a protease inhibitor and who had their triple NRTI regimen (zidovudine/lamivudine/abacavir) switched to lopinavir/ritonavir plus abacavir/lamivudine for a 1 month run-in period and then randomized to lopinavir/ritonavir plus abacavir/lamivudine versus lopinavir/ritonavir monotherapy. The KRETA trial is registered with ClinicalTrials.gov (number NCT00865007). RESULTS: Of 95 patients included, 88 were randomized to lopinavir/ritonavir plus abacavir/lamivudine (n = 44) or lopinavir/ritonavir monotherapy (n = 44). Median (IQR) baseline limb fat was 2.5 (1.6-3.7) kg in the lopinavir/ritonavir plus abacavir/lamivudine group and 2.5 (2.0-5.4) kg in the lopinavir/ritonavir monotherapy group. Six patients in the triple therapy group and 13 in the monotherapy group had discontinued study drugs by week 96. Although there were limb fat gains in each group at weeks 48/96 (+324/+358 g in lopinavir/ritonavir plus abacavir/lamivudine, P = 0.09/0.07, versus +215/+416 g in the lopinavir/ritonavir monotherapy group, P = 0.28/0.16), differences between groups were not significant [difference +109 g (95% CI -442, +660)/-57 g (95% CI -740, +625)]. CONCLUSIONS: In lipoatrophic patients treated with zidovudine/lamivudine/abacavir, switching to lopinavir/ritonavir monotherapy had no additional benefit in limb fat recovery relative to switching to lopinavir/ritonavir with abacavir/lamivudine. These data suggest that non-thymidine nucleosides such as abacavir/lamivudine are not an obstacle to limb fat recovery.

Prevalence of HLA-B*5701 in HIV-infected patients in Spain (results of the EPI Study).

BACKGROUND: A hypersensitivity reaction (HSR) is associated with abacavir (ABC), a nucleoside reverse transcriptase inhibitor. Genetic association of ABC HSR with the presence of HLA-B*5701 has been demonstrated in PREDICT-1 study, showing a prevalence of 5.6% in HIV-infected population. However the prevalence of this allele in HIV-infected patients in Spain has not been established yet. METHOD: This is a cross-sectional epidemiological study that included 1,198 patients in 74 centers that serve the HIV-infected population of Spain. HLA-B*5701 was checked both in the hospital lab and one central lab, showing an overall prevalence of this allele of 6%. RESULTS: HLA-B*5701 was most prevalent in Caucasian population (6.5%). Concordance between the local and central lab was very high for positive and negative results (95.7% and 99.3%, respectively). CONCLUSION: These aspects define this test as a useful tool for the management of HIV-infected patients.

Introducción, definición y medida del exceso de peso en adolescentes / No disponible

No disponible

Comorbilidades del exceso ponderal en el adolescente / No disponible

No disponible

Prevalence of obesity in 4-18-year-old population in the Basque Country, Spain.

The objective of the study was to estimate the prevalence of overweight and obesity in children and adolescents in the Basque Country, Spain. It consisted of an analysis of baseline data of the Nutrition Survey, a cross-sectional study, carried out in 2004-2005. The study population comprised child and adolescent living in the Basque Country. The analysis was carried out in a representative random sample of 1178 people aged 4-18 years. Anthropometric examinations were undertaken by trained observers using standardized methods and included measurements of weight and height. Subjects were classified into different body mass index categories, according to the International Obesity Task Force guidelines. A 5.4% of the population studied was obese; 6% of males and 4.7% of females, the highest in the 11-14 age group in boys (7.2%) and in the 4-6 age group in girls (12.5%). Overweight (22.9%) was slightly higher in girls. The highest prevalence of excess weight (overweight+obesity) was observed in girls aged 4-6 years (38.4%), decreasing with age. Subjects in the 15-18 age group rated 16.6%. Boys evidenced a higher excess weight rate in the 11-14 (32.9%) and 7-10 (32%) age groups; the lowest rate was found in the 4-6 age group. Prevalence of obesity was higher in the less privileged socio-economic strata (6.9% vs. 5.2%), for both boys and girls. However, this trend was observed only in girls for overweight (25.9% vs. 21.8%). This study shows a high prevalence of obesity and overweight in the studied population and similar to other European countries and regions.

Guía de Práctica Clínica para el Manejo del Sobrepeso y la Obesidad en Personas Adultas / Clinical Practice Guideline for the Management of Overweight and Obesity in Adults

La obesidad es una enfermedad crónica multifactorial de gran trascendencia sociosanitaria y económica y constituye un problema de salud pública. Causa o empeora un gran número de problemas relacionados con la salud: diabetes, enfermedad coronaria, hipertensión y determinados tumores. Se asocia con mayor riesgo de mortalidad cardiovascular, mayor prevalencia de alteraciones psicopatológicas, incremento del coste sanitario y disminución de la esperanza de vida. Actualmente en España, la prevalencia de exceso de peso afecta aproximadamente al 50% de la población. La Sociedad Española de Endocrinología y Nutrición (SEEN) ha elaborado una Guía de Práctica Clínica sobre el diagnóstico, la evaluación y el tratamiento del sobrepeso y de la obesidad en adultos estructurada en dos partes: 1) Definición y clasificación, epidemiología, etiopatogenia, complicaciones, beneficios de la reducción ponderal y evaluación del enfermo con sobrepeso u obesidad; 2) identificación de enfermos con riesgo de obesidad subsidiarios de tratamiento, objetivos de tratamiento y estrategias terapéuticas disponibles para conseguirlos, indicándose además, el grado de recomendación basado en la evidencia científica sobre cada uno de estos aspectos. Aun siendo la obesidad una enfermedad que debiera implicar no sólo a personal sanitario, sino también a autoridades políticas, agentes sociales, educadores e industria alimentaria entre otros, la SEEN ha querido desarrollar esta guía dados los evidentes aspectos endocrinológicos y metabólicos de este trastorno. Esta guía establece recomendaciones basadas en la evidencia científica para ayudar a tomar decisiones sobre el diagnóstico, la evaluación y el tratamiento del exceso ponderal en adultos y posibilitar una atención más homogénea y de calidad (AU)

Obesity is a chronic, multifactor disease with sizeable socio sanitary and economic consequences and is an issue in public health, mostly in developing countries. It causes or exacerbates a large number of health problems: diabetes, coronary heart disease, hypertension, and the incidence of certain cancers. It has been linked to a greater risk of cardiovascular mortality, a higher prevalence of psychopathology disorders and social maladjustment with a higher health care cost and shorter life-expectancy. In Spain, nowadays, the prevalence of overweight and obesity is nearly 50% of population. SEEN has developed a Clinical Practice Guide on diagnosis, evaluation and treatment of overweight and obesity in adult people with two sections: 1) Definition and classification of adult obesity, its epidemiology, etiopathogeny, complications, benefits of weight reduction and clinical evaluation of patients with overweight or obesity, and 2) Identification of patients with obesity risk subsidiary to weight reduction treatment, therapy goals and therapeutical strategies available to achieve them indicating as well the degree of recommendation based upon scientific evidence on each aspect. Although obesity is a disease which is supposed to involve not only medical but also political authorities, social agents, educators and food industry among others, SEEN decided to develop this Guide taking into account the evident endocrinological and metabolical aspects of this disorder. The Guide contains scientific evidencebased recommendations intended to help doctors making decisions on diagnose, evaluations and treatment of adult overweight so that a more homogeneous attendance with settled quality can be achieved (AU)

Herramientas de laboratorio para individualizar el tratamiento: resistencias y niveles de fármacos / Laboratory tools for personalising treatment: resistance and drug levels

A pesar del éxito del tratamiento antirretroviral (TARV) todavía nos enfrentamos a varios problemas relacionados con el mismo, entre los cuales destacan la toxicidad y el fracaso virológico. En relación a este último, aunque las causas del mismo pueden ser muy diversas, la aparición de resistencias va a estar estrechamente correlacionada. La utilización de los tests de resistencias para individualizar el tratamiento ha demostrado ser un instrumento útil para alcanzar el objetivo de la indetectabilidad. Por otro lado, la monitorización de niveles plasmáticos de fármacos, aunque todavía con datos escasos, nos está demostrando que, en situaciones determinadas, va a estar estrechamente ligada con el éxito del tratamiento. Por último, la correlación de las dos técnicas, resistencias y niveles plasmáticos en una sola variable, como es el cociente inhibitorio, parece que en un futuro cercano se convertirá en predictora del éxito del tratamiento de rescate en los pacientes en fracaso (AU)

Despite the success of antiretroviral treatment, we still face various problems related to it, particularly toxicity and virological failure. Although the reasons for the latter may be very diverse, the appearance of resistance correlates very closely. The use of the resistance test to personalise treatment has shown that it is a useful instrument for reaching the objective of being undetectable. In addition, the monitoring of drug plasma levels, though still with scant data, shows us that in determined situations it is going to be intimately linked to the success of the treatment. Finally, the correlation of the two techniques, resistance test and plasma levels, in one sole variable such as the inhibitory quotient may well become in the near future predictive of the success of rescue treatment of patients in failure (AU)

Polyunsaturated fatty acid deficiency during dietary treatment of very long-chain acyl-CoA dehydrogenase deficiency. Rescue with soybean oil.

Nutritional management of very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency is based on the avoidance of fasting and substitution of medium-chain triglycerides for long- and very long-chain triglycerides. We report two cases of this disease, which developed omega-6 essential fatty acid deficiency after three and five months from the beginning of nutritional therapy (SHS product: Monogen). This alteration could be especially dangerous in these patients owing to their possible susceptibility to the development of pigmentary retinopathy. The incorporation of linoleic acid as 3-4% of total caloric intake supported as soybean oil ameliorates this deficiency. We wish to remark on this early complication in the nutritional management of VLCAD deficiency and the possibility of rescue by the incorporation of soybean oil into the diet.

Molecular evidence of homosexual transmission of HIV type 2 in Spain.

Eight HIV-2-infected Caucasian men living in the same geographical area in Gipuzkoa (northern Spain) have been identified in the last 5 years. HIV-2 infection in this area is uncommon, and no other cases of HIV-2 infection have been found after extensive testing for HIV-1/2 antibodies. Epidemiological data suggested a possible link among the identified subjects, with homosexual contact being the most likely way of transmission. A genetic analysis of four of the subjects, from whom specimens were available, was conducted. Phylogenetic and signature pattern studies of the reverse transcriptase (RT) and env genes supported a single source of infection. Interindividual nucleotide variability ranged from 2.4 to 4.8% in the RT region and from 5.2 to 6.1% in the env gene, whereas the mean divergence between patient and control strains was 9.8 and 18.3%, respectively. The nucleotide and amino acid signature patterns were closely related in viruses from the four examined individuals. This is the first report of a cluster of HIV-2 infections with genetic sequence data support. The singularity of this cluster should alert clinicians on the possibility of HIV-2 outside endemic areas.

[Administration of granulocyte colony-stimulating factor in patients infected with human immunodeficiency virus and prolonged neutropenia]. / Administración de factor estimulante de colonias de granulocitos en pacientes con infección por el virus de la inmunodeficiencia humana y neutropenia prolongada.

BACKGROUND: Persistent neutropenia is frequent in HIV infected patients with severe immunodeficiency. G-CSF induces proliferation and differentiation of granulocyte precursors. Our objective has been to assess the response to G-CSF therapy on patients with advanced HIV disease and prolonged neutropenia. METHODS: A retrospective analysis of databases containing demographic information, analytic controls and hospitalizations related to neutropenia for patients attending our Infectious Diseases Unit from December 1, 1992 to January 30, 98. The episodes with absolute neutrophil counts lower than 1,000 x 10(6)/l at least during 7 days which descend below 500 x 10(6)/l at any moment were included. RESULTS: 36 episodes were included. 9 episodes started on treatment with G-CSF. The median duration was 9 (3-76) weeks. Hospitalization with fever related to neutropenia was significantly less frequent in episodes which received G-CSF (22.2%) than episodes without (66.7%). CONCLUSION: In this study, a significantly lower risk of hospitalization due to fever and neutropenia was associated with administration of G-CSF in patients with absolute neutrophil counts lower than 500 x 10(6)/l.

[Recommendation of GESIDA (AIDS Study Group)/National Plan on AIDS with respect to the anti-retroviral treatment in adult patients infected with the human immunodeficiency virus in the year 2000 (I)]. / Recomendaciones de GESIDA/Plan Nacional sobre el Sida respecto al tratamiento antirretrovírico en pacientes adultos infectados por el virus de la inmunodeficiencia humana en el año 2000 (I).

OBJECTIVE: To update the recommendations for antiretroviral therapy in adult HIV-infected persons according to the new scientific advances and the existence of new antiretroviral drugs in the last two years. METHODS: The antiretroviral therapy recommendations have been condensed by a panel of experts from the Spanish AIDS Study Group (Grupo de Estudio de sida-GESIDA) of the Spanish Infectious Diseases and Clinical Microbiology Society (SEIMC) and from the Clinical Advisory Panel of the Secretariat of the Spanish National Plan on AIDS (SPNS) of the Ministry of Health. Three levels of evidence have been established depending if the data came from randomised and controlled studies, from cohort or case-control studies or from descriptive studies and expert opinions. For that purpose we have reviewed the advances in HIV pathophysiology and results of efficacy (clinical, virologic and immunologic) and security (toxicity) from clinical trials involving antiretroviral therapy lasting at least 12 months, from cohort studies and pharmacokinetic and security data of antiretroviral drugs, presented in international conferences or published in biomedical journals in the last two years. In each situation we have established either to recommend or to consider or not recommend antiretroviral therapy. RESULTS: Nowadays, antiretroviral therapy consisting of at least three drugs constitutes the election therapy for chronic HIV infection, since it delays clinical progression, increases significantly the survival and diminishes hospital admissions and associated costs. The decision to start antiretroviral therapy must be based upon three elements: presence or absence of symptoms, plasma viral load and CD4+ cells counts. Thus, in asymptomatic cases with a high CD4+ cells count (> 500/microL) and low viral load (< 10,000 copies/ml by branched DNA [bDNA] or < 20,000 copies/ml by reverse-transcription polymerase chain reaction [RT-PCR] or nucleic acid sequence based amplification [NASBA]) we recommend to delay antiretroviral therapy. In symptomatic patients we recommend to start it, and in asymptomatic patients, we could recommend or consider antiretroviral therapy initiation depending on the risk of progression, established by the viral load and the CD4+ cells count. In any case, if therapy is started, the objective must be to reach an undetectable viral load (< 50 copies/ml). The adherence to antiretroviral therapy plays a key role for its initial moment and for the duration of the antiviral response, antiretroviral therapy can achieve a restoration of cellular immunity in the advanced patients. There are few therapeutic options in failing patients due to cross-resistance. Resistance studies can be useful in this setting. The toxicity is a new and limiting factor of antiretroviral therapy which requires to look for new therapeutic options. Antiretroviral therapy criteria for acute infection, pregnancy, post-exposure prophylaxis and when to use resistance testing are discussed. CONCLUSIONS: In this moment, there is a more conservative attitude towards starting antiretroviral therapy than in previous recommendations in which a virus eradication was considered. On the other hand, the high number of disposable drugs, the more sensitive monitorization methods (plasma viral load) and the possibility of performing resistance studies make therapeutic strategies more dynamic and individualised for each patient and situation. In any case, it is mandatory to ensure a perfect adherence to antiretroviral therapy from the patients.