Laboratory and In situ Selenium Bioaccumulation Assessment in the Benthic Macroinvertebrates Hyalella azteca and Chironomus dilutus.

Selenium (Se) bioaccumulation and toxicity in aquatic vertebrates have been thoroughly investigated. Limited information is available on Se bioaccumulation at the base of aquatic food webs. In this study, we evaluated Se bioaccumulation in two benthic macroinvertebrates (BMI), Hyalella azteca and Chironomus dilutus raised in the laboratory and caged in-situ to a Canadian boreal lake e (i.e., McClean Lake) that receives continuous low-level inputs of Se (< 1 µg/L) from a uranium mill. Additional Se bioaccumulation assays were conducted in the laboratory with these BMI to (i) confirm field results, (ii) compare Se bioaccumulation in lab-read and native H. azteca populations and (iii) identify the major Se exposure pathway (surface water, top 1 cm and top 2-3 cm sediment layers) leading to Se bioaccumulation in H. azteca. Field and laboratory studies indicated overall comparable Se bioaccumulation and trophic transfer factors (TTFs) in co-exposed H. azteca (whole-body Se 0.9-3.1 µg/g d.w; TTFs 0.6-6.3) and C. dilutus (whole-body Se at 0.7-3.2 µg Se/g d.w.; TTFs 0.7-3.4). Native and lab-reared H. azteca populations exposed to sediment and periphyton from McClean Lake exhibited similar Se uptake and bioaccumulation (NLR, p = 0.003; 4.1 ± 0.8 µg Se/g d.w), demonstrating that lab-reared organisms are good surrogates to assess on-site Se bioaccumulation potential. The greater Se concentrations in H. azteca exposed to the top 1-3 cm sediment layer relative to waterborne exposure, corroborates the importance of the sediment-detrital pathway leading to greater Se bioaccumulation potential to higher trophic levels via BMI.

Effects of diluted effluent on aquatic macroinvertebrate communities at the McClean Lake uranium operation in northern Saskatchewan.

Diluted treated effluent from the McClean Lake uranium mill in northern Saskatchewan is released into Vulture Lake, which flows into the east basin of McClean Lake; this input could potentially cause a variety of disturbances to the aquatic systems. This study aimed to determine the potential effects of diluted effluent exposure (metals and major ions) on benthic macroinvertebrates in Vulture Lake and McClean Lake. Two monitoring locations located in Vulture Lake and eight in McClean Lake were used for collection water, sediment, and benthic macroinvertebrates. Complementary surface water bioassays were performed with larvae of the midge Chironomus dilutus using lake water from selected sites. Results indicated that total macroinvertebrate abundance and Margalef index (MI) did not follow the diluted effluent pattern. In addition, while the MI from artificial substrate samplers showed higher values in Vulture Lake and lower values at McClean Lake sites 4 and 5 (closer to effluent diffuser), the values recorded for sediment grab samples registered lower indices in Vulture Lake and higher values for sites 4 and 5. The final model from a Generalized Additive Modelling (GAM) approach suggested that electrical conductivity (EC), selenium (Se), and chloride (Cl) in water, and total organic carbon (TOC) and cadmium (Cd) in sediment are key variables that collectively may have influenced macroinvertebrate community composition at the study sites. Finally, across all test endpoints in the bioassays, exposure to lake water from Vulture Lake and McClean Lake had no statistically significant effects on C. dilutus.

The influence of sampling method and season on modeling of selenium into coldwater fish and implications on tissue-based water quality benchmarks.

Selenium (Se) contamination of aquatic ecosystems has led to the local extirpation of some Se-sensitive fish species. Although Se exposure occurs primarily via diet, considerable uncertainty lies in modeling Se transfer and bioaccumulation from sediment, detritus, and/or periphyton through benthic macroinvertebrates (BMI) to fish. Here we estimated Se concentrations in four coldwater fish species (northern pike, white sucker, lake whitefish, and ninespine stickleback) inhabiting boreal lakes downstream from a uranium mill in northern Canada. In addition, we evaluated the potential effects of BMI and periphyton sampling methods (artificial substrates vs. grab samples), seasons (summer vs. winter), and models (USEPA vs. Assessment of the Dispersion and Effects of Parameter Transport) on the estimated Se concentrations in fish tissue. Results were compared with site-specific benchmarks and observed Se concentrations in resident fish. In summer 2019, periphyton and BMI were sampled at 10 sampling stations (two in Vulture Lake and eight in McClean Lake) using artificial substrates (n = 4) and sediment grab samples (n = 3). In winter 2021, samples were collected in McClean Lake (n = 3) through ice holes using a sediment grab sampler. Estimated Se concentrations in fish tissue depended on the surface sediment or periphyton Se concentrations used in the models. At Vulture Lake, Se concentrations in northern pike muscle estimated using the grab sample data (17.3 ± 11.5 µg/g DW), but not the artificial substrates (34.5 ± 1.2 µg/g DW), were comparable with the observed mean concentration (19.0 ± 1.4 µg/g DW) in this species. At McClean Lake, Se body burdens in forage fish estimated using data from both sampling methods were comparable with measured data. Significantly lower mean whole-body Se concentrations were estimated for all fish species in winter (1.0 ± 0.3 µg/g DW) relative to summer (4.8 ± 1.6 µg/g DW). Further investigation is necessary to understand how potential seasonal shifts in dietary Se exposure relate to fish reproduction and early life stages. Integr Environ Assess Manag 2023;00:1-15. © 2023 SETAC.

Alkanes in Minisci-Type Reaction under Photocatalytic Conditions with Hydrogen Evolution.

We report herein a protocol for the selective activation of C(sp3)-H bonds based on the interplay of two readily available organic catalysts and their successful implementation in cross-coupling azaarenes with alkanes. This Minisci-like reaction is promoted by visible light at room temperature and is free from chemical oxidants, metals, and chlorinated solvents. A wide range of substrates are compatible, including some bioactive molecules. Mechanistic studies support a dual catalytic cycle with H2 evolution.

[Indicators of diabetes mellitus after liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin]. / Indicadores de diabetes mellitus posterior a liraglutida, sitagliptina/metformina, linagliptina y sitagliptina.

Background: The control of diabetes mellitus is multifactorial, the different therapeutic options make it necessary to compare the effectiveness with previous therapeutic schemes. Objective: Analize the indicators of control of diabetes mellitus after incorporating liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin. Methods: Observational, analytical, longitudinal study. Glucose, glycosylated hemoglobin, and blood pressure were compared after the inclusion of new cues in patients with diabetes mellitus; in addition to the control indicators reported in the unit in october, november, and december 2000, with those of 2021 in the same months. A descriptive analysis was performed, T for related samples and McNemar, a value of < .05 was considered significant, a confidence level of 95%, with the IBM-SPSS 24 software. Results: 352 files were analyzed, 59% women, aged 26 to 88 years, and the percentage of control decreased after the change of scheme (38.4% vs 35.8%) without a statistical difference (p .503). There was no statistical difference between the levels of glucose, glycated hemoglobin, weight, and blood pressure before and six months after the change. In the unit, the regimen glycemic control indicator improved in October, November, and December 2020 compared to the same months in 2021, it increased (from 17.2, 18.7, and 16.3, to 41.6, 47.2, and 46.5%). Blood pressure control went from 64.5, 66.7, and 67 to 82.4, 85.1, and 83.1%. Conclusions: The control indicators in the unit improved, however, the patients who used the new keys did not show any difference.

Introducción: el control de la diabetes mellitus es multifactorial, las diferentes opciones terapéuticas hacen necesario comparar la efectividad con esquemas terapéuticos previos. Objetivo: analizar los indicadores de control de diabetes mellitus posterior a incorporar liraglutida, sitagliptina/metformina, linagliptina y sitagliptina. Métodos: estudio observacional, analítico, longitudinal. Se compararon glucosa, hemoglobina glucosilada y presión arterial posterior a la inclusión de nuevas claves en pacientes con diabetes mellitus; además de los indicadores de control reportados en la unidad en los meses octubre, noviembre y diciembre 2020, con los del 2021 en los mismos meses. Se realizó un análisis descriptivo, T para muestras relacionadas y McNemar, se consideró un valor de p ≤ 0.05 como significativo, un nivel de confianza de 95%, con el programa informático IBM-SPSS 24. Resultados: se analizaron 352 expedientes, el 59% correspondía a mujeres, con edades de 26 a 88 años, el porcentaje de control disminuyó después del cambio de esquema (38.4% frente a 35.8%) sin diferencia estadística (p = 0.503). No hubo diferencia estadística entre los niveles de glucosa, hemoglobina glucosilada, peso y presión arterial previos y seis meses después del cambio de esquema. En la unidad, el indicador de control de glucemia en los meses de octubre, noviembre y diciembre 2020 comparados con los mismos meses en el 2021 incrementaron (17.2, 18.7 y 16.3, a 41.6, 47.2 y 46.5%). El control de presión arterial pasó del 64.5, 66.7 y 67 a 82.4, 85.1 y 83.1%. Conclusiones: los indicadores de control en la unidad mejoraron, sin embargo los pacientes que utilizaron las nuevas claves no mostraron diferencia.

Sampling method and season influence selenium dynamics at the base of a boreal lake food chain.

Few studies have investigated the potential influence of sampling method and season on Se bioaccumulation at the base of the aquatic food chain. In particular, the effects of low water temperature associated with prolonged ice-cover periods on Se uptake by periphyton and further transfer to benthic macroinvertebrates (BMI) have been overlooked. Such information is crucial to help improve Se modelling and risk assessment at sites receiving continuous Se inputs. To date, this seems to be the first study to address these research questions. Here, we examined potential differences related to sampling methods (artificial substrates vs. grab samples) and seasons (summer vs. winter) on Se dynamics in the benthic food chain of a boreal lake (McClean Lake) receiving continuous low-level Se input from a Saskatchewan uranium milling operation. During summer 2019, water, sediment grab samples and artificial substrates were sampled from 8 sites with varying mill-treated effluent exposure. In winter 2021, water and sediment grab samples were sampled at 4 locations in McClean Lake. Water, sediment, and biological samples were subsequently analyzed for total Se concentrations. Enrichment functions (EF) in periphyton and trophic transfer factors (TTF) in BMI were calculated for both sampling methods and seasons. Periphyton collected with artificial substrates (Hester-Dendy samplers and glass plates) exhibited significantly higher mean Se concentrations (2.4 ± 1.5 µg/g d.w) than periphyton collected from the surface of sediment grab samples (1.1 ± 1.3 µg/g d.w). Selenium concentrations in periphyton sampled in winter (3.5 ± 1.0 µg/g d.w) were significantly greater than summer (1.1 ± 1.3 µg/g d.w). Nevertheless, Se bioaccumulation in BMI was similar between seasons, possibly suggesting that invertebrates are not actively feeding in winter. Further investigations are necessary to verify if peak Se bioaccumulation in BMI takes place in spring, coinciding with the reproductive and developmental windows of some fish species.

Application of autonomous sensor technology to estimate selenium exposure and a site-specific selenium threshold in a Canadian boreal lake.

There is an increasing trend in the use of real-time sensor technology to remotely monitor aquatic ecosystems. Commercially available probes, however, are currently not able to measure aqueous selenium (Se) concentrations. Because of the well-described bioaccumulation potential and associated toxicity of Se in oviparous vertebrates, it is crucial to monitor Se concentrations at sites receiving continuous effluent Se input. This study aimed to estimate Se concentrations in a boreal lake (McClean Lake) downstream from a Saskatchewan uranium mill using real-time electrical conductivity (EC) data measured by autonomous sensors. Additionally, this study aimed to derive a site-specific total aqueous Se (TSe) threshold based on Se concentrations in periphyton and benthic macroinvertebrates sampled from the same lake. To characterize effluent distribution within the lake, eight Smart Water (Libelium) sensor units were programmed to report EC and temperature for five and seven consecutive weeks in 2018 and 2019, respectively. In parallel, periphyton and benthic macroinvertebrates were sampled with Hester-Dendy's artificial substrate samplers (n = 4) at the same sites and subsequently analyzed for Se concentrations. Electrical conductivity was measured with a handheld field meter for sensor data validation and adjusted to the median lake water temperature (13 °C) registered for the deployment periods. Results demonstrated good accuracy of sensor readings relative to handheld field meter readings and the successful use of real-time EC in estimating TSe exposure (r = 0.87; r2 = 0.84). Linear regression equations derived for Se in detritivores versus Se in periphyton and Se in periphyton versus sensor-estimated TSe were used to estimate a site-specific TSe threshold of 0.7 µg/L (±0.2). Moreover, mean Se concentrations in periphyton (16.7 ± 4.4 µg/g dry weight [d.w.]) and benthic detritivores (6.0 ± 0.4 µg/g d.w.) from one of the exposure sites helped identify an area with potential for high Se bioaccumulation and toxicity in aquatic organisms in McClean Lake. Integr Environ Assess Manag 2023;19:395-411. © 2022 SETAC.

Selenium Distribution and Trophic Transfer in the Periphyton-Benthic Macroinvertebrate Food Chain in Boreal Lakes Downstream from a Milling Operation.

Selenium (Se) is an essential micronutrient with a narrow essentiality-toxicity range known to bioaccumulate in aquatic food webs. Selenium uptake and trophic transfer at the base of aquatic food chains represent a great source of uncertainty for Se risk assessment. The goal of the present study was to investigate Se distribution in water and sediment and its subsequent transfer into the periphyton-benthic macroinvertebrate (BMI) food chain in boreal lakes downstream from a Saskatchewan uranium mill. In particular, the present study aimed to assess potential differences in Se bioaccumulation patterns by BMI taxa to contribute to the current knowledge gap. During summer 2018 and 2019, water, sediment, periphyton, and BMI were sampled at two sites in Vulture Lake, seven sites in McClean Lake east basin, and one reference site in McClean Lake west basin. Periphyton and BMI taxa were sampled with artificial substrates (Hester-Dendy) deployed for 5 weeks in 2018 and 7 weeks in 2019; BMI were sorted into the lowest practical achievable taxonomic level and analyzed for total Se concentrations. At the diluted effluent exposure sites, Se concentrations in BMI ranged from 1.3 to 18.0 µg/g dry weight and from 0.3 to 49.3 µg/g dry weight in 2018 and 2019, respectively, whereas concentrations ranged from 0.01 to 3.5 µg/g dry weight at the reference site. Selenium concentrations in periphyton and some BMI taxa sampled near the effluent diffuser (Se < 1 µg/L) reached levels comparable to higher effluent exposure sites (Se > 2 µg/L). Despite differences in Se bioaccumulation among BMI taxa, an approximately one-to-one trophic transfer ratio was observed for benthic primary consumers and benthic predatory taxa. Environ Toxicol Chem 2022;41:2181-2192. © 2022 SETAC.

Delineating Effluent Exposure and Cumulative Ecotoxicological Risk of Metals Downstream of a Saskatchewan Uranium Mill Using Autonomous Sensors.

There is increasing interest in using autonomous sensor technology to monitor aquatic ecosystems in real time and in employing such monitoring data to perform better ecological risk assessments. At seven locations in McClean Lake in northern Saskatchewan (Canada) that received diluted uranium milling effluent, we deployed sensor units to track effluent distribution and help predict potential biological effects on aquatic invertebrates. Water was also collected from each location on multiple occasions to measure major ions, dissolved metals, and routine water quality, and sediment was sampled to analyze total metals. The ecotoxicological risk to aquatic invertebrates was estimated using hazard quotients (HQs). The cumulative risk was estimated by summing the individual HQs, and the major ions risk was based on total osmolarity. The results indicated temporal and spatial variations in effluent exposure based on sensor electrical conductivity (EC) measurements in the McClean Lake East Basin. Individual HQs for water ranged from "moderate" (0.40-0.69) to "very high" (greater than 1) for silver, cadmium, arsenic, selenium, mercury, iron, and thallium. At all sites, major ions risk was less than 1. Individual HQs for sediment were "moderate" (0.40-0.69), "high" (0.7-0.99), and "very high" (greater than 1) for vanadium and cadmium. The cumulative risk in water and sediment for all metals combined was greater than 1 at some sites in Vulture Lake (which discharged into McClean Lake) and in McClean Lake itself. A more detailed estimation of the risks for aqueous selenium and arsenic (the only two metals that had good correlation with sensor EC data) indicated that their 90th percentile HQ values were less than 1 in McClean Lake, suggesting that these contaminants of concern do not represent a significant direct risk to aquatic invertebrate communities. Environ Toxicol Chem 2022;41:1765-1777. © 2022 SETAC.

EMA Review of Daunorubicin and Cytarabine Encapsulated in Liposomes (Vyxeos, CPX-351) for the Treatment of Adults with Newly Diagnosed, Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes.

On June 28, 2018, the Committee for Medicinal Products for Human Use adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Vyxeos, intended for the treatment of acute myeloid leukemia (AML). Vyxeos was designated as an orphan medicinal product on January 11, 2012. The applicant for this medicinal product was Jazz Pharmaceuticals Ireland Limited. Vyxeos is a liposomal formulation of a fixed combination of daunorubicin and cytarabine, antineoplastic agents that inhibit topoisomerase II activity and also cause DNA damage. The strength of Vyxeos is 5 units/mL, where 1 unit equals 1.0 mg cytarabine plus 0.44 mg daunorubicin. The marketing authorization holder Jazz Pharmaceuticals had found that this was an optimal ratio for the efficacy of the product. Study CLTR0310-301, a phase III, multicenter, randomized, trial of Vyxeos (daunorubicin-cytarabine) liposome injection versus standard 3+7 daunorubicin and cytarabine in patients aged 60-75 years with untreated high-risk (secondary) AML, showed a statistically significant difference between the two groups in overall survival (OS) with a median OS of 9.56 months in the daunorubicin-cytarabine arm compared with 5.95 months for standard chemotherapy (hazard ratio, 0.69; 95% confidence interval, 0.52-0.90; one-sided p = .003). The most common side effects were hypersensitivity including rash, febrile neutropenia, edema, diarrhea/colitis, mucositis, fatigue, musculoskeletal pain, abdominal pain, decreased appetite, cough, headache, chills, arrhythmia, pyrexia, sleep disorders, and hypotension. IMPLICATIONS FOR PRACTICE: Vyxeos has demonstrated a clinically significant improvement in overall survival compared with the standard of care 7+3 in the proposed population of patients with newly diagnosed acute myeloid leukemia (AML) with myelodysplasia-related changes and therapy-related AML. This is remarkable given the very poor prognosis of these patients and their unmet medical need. Secondary endpoints support the primary outcome, in particular an increased rate of hematopoietic stem cell transplantation, which is potentially the only curative treatment in AML.

Human Metapneumovirus: Etiological Agent of Severe Acute Respiratory Infections in Hospitalized and Deceased Patients with a Negative Diagnosis of Influenza.

Human metapneumovirus (HMPV) is one of the four major viral pathogens associated with acute respiratory tract infections (ARI) and creates a substantial burden of disease, particularly in young children (<5 years) and older individuals (≥65 years). The objective of this study was to determine the epidemiological behavior of HMPV in Mexico. This retrospective study was conducted over a nine-year period and used 7283 influenza-negative respiratory samples from hospitalized and deceased patients who presented Severe Acute Respiratory Infection (SARI). The samples were processed with the help of qualitative multiplex RT-PCR for simultaneous detection of 14 respiratory viruses (xTAG® RVP FAST v2). 40.8% of the samples were positive for respiratory viruses, mainly rhinovirus/enterovirus (47.6%), respiratory syncytial virus (15.9%), HMPV (11.1%) and parainfluenza virus (8.9%). Other respiratory viruses and co-infections accounted for 16.5%. HMPV infects all age groups, but the most affected group was infants between 29 days and 9 years of age (65.6%) and adults who are 40 years and older (25.7%). HMPV circulates every year from November to April, and the highest circulation was observed in late winter. The results of this study aim to raise awareness among clinicians about the high epidemiological impact of HMPV in young children and older individuals in order to reduce the economic burden in terms of health care costs.

Individual Trade-Offs Between Possible Benefits and Risks of Cancer Treatments: Results from a Stated Preference Study with Patients with Multiple Myeloma.

BACKGROUND: The objectives of this study were to elicit the preferences of patients with multiple myeloma regarding the possible benefits and risks of cancer treatments and to illustrate how such data may be used to estimate patients' acceptance of new treatments. PATIENTS AND METHODS: Patients with multiple myeloma from the cancer charity Myeloma UK were invited to participate in an online survey based on multicriteria decision analysis and swing weighting to elicit individual stated preferences for the following attributes: (a) 1-year progression-free survival (PFS, ranging from 50% to 90%), (b) mild or moderate toxicity for 2 months or longer (ranging from 85% to 45%), and (c) severe or life-threatening toxicity (ranging from 80% to 20%). RESULTS: A total of 560 participants completed the survey. The average weight given to PFS was 0.54, followed by 0.32 for severe or life-threatening toxicity and 0.14 for mild or moderate chronic toxicity. Participants who ranked severe or life-threatening toxicity above mild or moderate chronic toxicity (56%) were more frequently younger, working, and looking after dependent family members and had more frequently experienced severe or life-threatening side effects. The amount of weight given to PFS did not depend on any of the collected covariates. The feasibility of using the collected preference data to estimate the patients' acceptance of specific multiple myeloma treatments was demonstrated in a subsequent decision analysis example. CONCLUSION: Stated preference studies provide a systematic approach to gain knowledge about the distribution of preferences in the population and about what this implies for patients' acceptance of specific treatments. IMPLICATIONS FOR PRACTICE: This study demonstrated how quantitative preference statements from a large group of participants can be collected through an online survey and how such information may be used to explore the acceptability of specific treatments based on the attributes studied. Results from such studies have the potential to become an important new tool for gathering patient views and studying heterogeneity in preferences in a systematic way, along with other methods, such as focus groups and expert opinions.

Análisis del uso de la terminología anatómica entre los estudiantes de la asignatura anatomía de la Licenciatura en Medicina, de la Facultad de Medicina de la Universidad Nacional Autónoma de México / Analysis of the use of the anatomical terminology between students of anatomy courses at the Faculty of Medicine of the Universidad Nacional Autónoma de México

La Anatomía puede ser considerada el primer campo científico específico dentro del área de la medicina, es una ciencia concreta, utilizada para describir las estructuras del cuerpo humano, para lo cual ha desarrollado un lenguaje descriptivo específico, preciso, universal, inequívoco, denominado "Terminologia Anatomica" (TA). El Departamento de Anatomía de la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM), privilegia el uso de la TAI considerando que los alumnos deben conocerla y utilizarla desde el primer año de la licenciatura en medicina, sin embargo, existe cierta resistencia por parte de alumnos y profesores, los cuales recurren en más de una ocasión al uso de epónimos. El propósito de esta investigación fue el de conocer las condiciones de uso que la TA presenta entre los estudiantes del primer año de la licenciatura en medicina en la Facultad de Medicina UNAM, participaron 182 estudiantes de la asignatura Anatomía durante el ciclo escolar 2011-2012. El análisis de los resultados pone en evidencia que el 60,2 % de los alumnos utilizan preferentemente los términos propuestos por la TAI durante el desarrollo de las clases de Anatomía, mientras que fuera de clase solamente el 52,1 % la utilizan. Es posible que estas pautas en el uso de la TA afecten el aprendizaje del lenguaje médico científico que los alumnos utilizarán durante toda su vida profesional.

Anatomy can be considered the first specific scientific field within the area of the medicine, is a concrete science, used to describe the structures of the human body, which has developed a specific, unequivocal, precise, universal and descriptive language, called "Anatomical Terminology" (TA). The Department of Anatomy, from the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), favors the use of TA considering students should know and use it from the first year of a degree in medicine. However, there is some resistance on the part of students and teachers, who on more than one occasion, relied on the use of eponyms. The purpose of this research was to determine the knowledge of use of the TA among first year medical students at the Faculty of Medicine UNAM, in which 182 students of the anatomy course, participated during the 2011-2012 school year. The analysis of the results shows that 60.2 % of students prefer to use the terms proposed by the TAI during the anatomy class, while out of class only 52.1 % were using it. It is possible that these guidelines on the use of TA affect learning scientific medical language that students will use throughout their professional life.

La obesidad en México. Programas en marcha / Obesity in Mexico. Ongoing programs

La obesidad es un problema de salud pública a nivel mundial. Según datos arrojados en el año 2014 por la OCDE, México ocupa junto con Estados Unidos de América el primer lugar en obesidad. En el año 2000, la Encuesta Nacional de Salud encontró una prevalencia combinada de sobrepeso y obesidad del 61.8 % y para el año 2012 la prevalencia fue del 71.3 %. Son diversos los factores que influyen en el desarrollo de la obesidad, en México destacan: la inseguridad alimentaria, la falta de actividad física y el consumo de bebidas azucaradas. Ante este panorama, se implementó en el año 2013, la Estrategia Nacional para la Prevención y el Control del Sobrepeso, la Obesidad y la Diabetes que se acompaña de una reforma legal y en la que intervienen el sector público, la iniciativa privada y la sociedad civil. Por su parte, en el estado de Veracruz, la Universidad Veracruzana desde hace más de 25 años aplica un examen de salud integral a los alumnos de nuevo ingreso a la universidad. Entre los resultados más importantes se encuentra el aumento del sobrepeso y la obesidad. A partir de estos resultados se han implementado diversas acciones encaminadas no sólo a reducir la prevalencia de la obesidad, sino también a promover la salud integral del estudiante universitario. Sin embargo, aún falta mucho por hacer, una tarea fundamental será la medición del impacto de los programas regionales y nacionales para combatir el sobrepeso y la obesidad, mediano y largo plazo (AU)

Obesity is a worldwide public health issue. According to the OECD in 2014, Mexico and United States had the first place on obesity. In 2000, the Mexican Health and Nutrition Survey found a mixed prevalence of overweight and obesity representing 61.8 % and in 2012 the prevalence was of 71.3 %. There are many factors that interfere on obesity development, in Mexico: food insecurity, lack of physical activity and sweetened beverages consumption. With that as a reference in 2013 the National strategy of prevention and control of overweight, obesity and diabetes was established, it involves a legal reform, which is intervene by a public sector, private initiative and civil society, In another hand Veracruz state, Universidad Veracruzana have been applying an integral health survey for 25 years to the new comers students of university. The most important outcomes have been the increase of obesity and overweight. From these results there have been established several actions not just to reduce the prevalence of obesity but to promote integral health to the university student. However there’s a long way to go a fundamental task would be the measurement of the impact of regional and national programs to confront overweight and obesity, short and long term (AU)

Prácticas de alimentación con leche materna en recién nacidos menores de 1.500 g o de menos de 32 semanas / Feeding practices with human milk in newborns less than 1.500 g or less than 32 weeks

INTRODUCCIÓN: Actualmente no existe una política unificada de cómo promocionar la lactancia materna en la unidad neonatal ni sobre la práctica de nutrición enteral con leche materna (LM) en los prematuros. Nuestro objetivo fue describir las medidas de apoyo a la lactancia y la utilización de LM en grandes prematuros de los hospitales públicos españoles. MÉTODO: Se distribuyó un cuestionario sobre prácticas de alimentación enteral. Se analizaron los datos de las unidades que atendían a menores de 32 semanas o 1.500g. Se realizó un análisis univariante comparando las unidades de nivel II y III. RESULTADOS: La tasa de respuesta fue del 91%. Un total de 93 unidades atienden a menores de 32 semanas o de 1.500 g (17 de nivel II y 76 de nivel III). El 49% registra la tasa de lactancia al alta. En el 75% (70/93) existe una guía de manejo de LM (nivel III 81 vs. nivel II 47%; p = 0,002). El 25% dispone de leche donada. El 46% inicia alimentación trófica en las primeras 6 h. En el 89% el volumen máximo de LM administrado es ≥180 ml/kg/día (nivel III 93 vs. nivel II70%; p = 0,017). Se fortifica en el 96% de las unidades y el 92% la inicia a partir de un volumen determinado de leche. Para modificar la cantidad de fortificante, el 59% utiliza la curva de peso y el 36% criterios analíticos. El 9% emplea fortificante proteico puro. CONCLUSIONES: Existe una gran variabilidad en las medidas de apoyo a la lactancia y en las prácticas de alimentación enteral de los grandes prematuros en las unidades españolas

INTRODUCTION: There is currently no unified policy on either breastfeeding support or enteral nutrition practices, as regards human milk (HM) in pre-term newborns. The aim of this study was to describe breastfeeding support measures, as well as the use of HM in very preterm infants in Spanish public hospitals. METHOD: A questionnaire on enteral feeding practices was distributed. Data were analysed from units caring for newborns less than 32 weeks or 1,500g. A univariate analysis was performed comparing level II and III care units. RESULTS: There was a 91% response rate. A total of 93 units cared for infants less than 32 weeks or 1,500g (17 level II and 76 level III), and 49% of the units recorded the breastfeeding rate on discharge. Around 75% (70/93) had a guideline on managing HM (level III 81 vs. level II 47%,P=.002), and 25% had access to donor human milk. Just under half (46%) started trophic feeding in the first 6h. Target enteral feeding volume in stable preterm infants was ≥ 180 ml/kg/day in 89% of the units (level III 93% vs. level II 70%, P =.017). HM fortifier was used in 96% of the units. In 92%, it was added when the required enteral volume was tolerated. In 59% of the units, adjustments in the quantity of fortifier were made according to weight, and in 36%, it depended on analytical criteria. Some units (9%) used pure protein fortifier. CONCLUSIONS: There is a marked variability in breastfeeding support measures and in feeding practices of preterm infants in Spanish neonatal units

The European Medicines Agency Review of Decitabine (Dacogen) for the Treatment of Adult Patients With Acute Myeloid Leukemia: Summary of the Scientific Assessment of the Committee for Medicinal Products for Human Use.

UNLABELLED: : On September 20, 2012, a marketing authorization valid throughout the European Union (EU) was issued for decitabine for the treatment of adult patients aged 65 years and older with newly diagnosed de novo or secondary acute myeloid leukemia (AML) who are not candidates for standard induction chemotherapy. Decitabine is a pyrimidine analog incorporated into DNA, where it irreversibly inhibits DNA methyltransferases through covalent adduct formation with the enzyme. The use of decitabine was studied in an open-label, randomized, multicenter phase III study (DACO-016) in patients with newly diagnosed de novo or secondary AML. Decitabine (n = 242) was compared with patient's choice with physician's advice (n = 243) of low-dose cytarabine or supportive care alone. The primary endpoint of the study was overall survival. The median overall survival in the intent-to-treat (ITT) population was 7.7 months among patients treated with decitabine compared with 5.0 months for those in the control arm (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.69-1.04; p = .1079). Mature survival data after an additional year of follow-up were consistent with these results, with a median overall survival of 7.7 months in patients treated with decitabine and 5.0 months in the control arm (HR, 0.82; 95% CI, 0.68-0.99; p = .0373). Secondary endpoints, including response rates, progression-free survival, and event-free survival, were increased in favor of decitabine when compared with control treatment. The most common adverse drug reactions reported during treatment with decitabine are pyrexia, anemia, thrombocytopenia, febrile neutropenia, neutropenia, nausea, and diarrhea. This paper summarizes the scientific review of the application leading to approval of decitabine in the EU. The detailed scientific assessment report and product information (including the summary of product characteristics) for this product are available on the EMA website (http://www.ema.europa.eu). IMPLICATIONS FOR PRACTICE: Acute myeloid leukemia (AML) remains an area of significant unmet need, especially in older patients. Older patients and those with comorbidities are often considered ineligible for standard induction therapy, and outcome for these patients is poor. Decitabine has favorable effects in terms of overall survival, which were considered clinically meaningful in the context of a manageable toxicity profile and after consideration of the lack of therapeutic alternatives for these patients. Decitabine is widely used in the treatment of AML in patients aged >60 years, as per current guidelines, including the European LeukemiaNet and the U.S. National Cancer Comprehensive Network.

Cuerpo extraño apendicular / Appendicular foreign body

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