Anion-π catalysis on carbon allotropes.

Anion-π catalysis, introduced in 2013, stands for the stabilization of anionic transition states on π-acidic aromatic surfaces. Anion-π catalysis on carbon allotropes is particularly attractive because high polarizability promises access to really strong anion-π interactions. With these expectations, anion-π catalysis on fullerenes has been introduced in 2017, followed by carbon nanotubes in 2019. Consistent with expectations from theory, anion-π catalysis on carbon allotropes generally increases with polarizability. Realized examples reach from enolate addition chemistry to asymmetric Diels-Alder reactions and autocatalytic ether cyclizations. Currently, anion-π catalysis on carbon allotropes gains momentum because the combination with electric-field-assisted catalysis promises transformative impact on organic synthesis.

Electric field-assisted anion-π catalysis on carbon nanotubes in electrochemical microfluidic devices.

The vision to control the charges migrating during reactions with external electric fields is attractive because of the promise of general catalysis, emergent properties, and programmable devices. Here, we explore this idea with anion-π catalysis, that is the stabilization of anionic transition states on aromatic surfaces. Catalyst activation by polarization of the aromatic system is most effective. This polarization is induced by electric fields. The use of electrochemical microfluidic reactors to polarize multiwalled carbon nanotubes as anion-π catalysts emerges as essential. These reactors provide access to high fields at low enough voltage to prevent electron transfer, afford meaningful effective catalyst/substrate ratios, and avoid interference from additional electrolytes. Under these conditions, the rate of pyrene-interfaced epoxide-opening ether cyclizations is linearly voltage-dependent at positive voltages and negligible at negative voltages. While electromicrofluidics have been conceived for redox chemistry, our results indicate that their use for supramolecular organocatalysis has the potential to noncovalently electrify organic synthesis in the broadest sense.

The Origin of Anion-π Autocatalysis.

The autocatalysis of epoxide-opening ether cyclizations on the aromatic surface of anion-π catalysts stands out as a leading example of emergent properties expected from the integration of unorthodox interactions into catalysis. A working hypothesis was proposed early on, but the mechanism of anion-π autocatalysis has never been elucidated. Here, we show that anion-π autocatalysis is almost independent of peripheral crowding in substrate and product. Inaccessible asymmetric anion-π autocatalysis and sometimes erratic reproducibility further support that the origin of anion-π autocatalysis is more complex than originally assumed. The apparent long-distance communication without physical contact calls for the inclusion of water between substrate and product on the catalytic aromatic surface. Efficient anion-π autocatalysis around equimolar amounts but poor activity in dry solvents and with excess water indicate that this inclusion of water requires high precision. Computational models suggest that two water molecules transmit dual substrate activation by the product and serve as proton shuttles along antiparallel but decoupled hydrogen-bonded chains to delocalize and stabilize evolving charge density in the transition state by "anion-π double bonds". This new transition-state model of anion-π autocatalysis provides a plausible mechanism that explains experimental results and brings anion-π catalysis to an unprecedented level of sophistication.

Off-label drug use in neonates and infants in Spain: A five-year observational study.

OBJECTIVES: To provide information about the off-label rate of all drug prescriptions in neonates and infants up to 1 year in Spain. Also, to analyse the off-label prescription of medicines under current practice in this age group according to different evidence sources. STUDY DESIGN: A five-year (2015-2019) exploratory observational study about off-label prescription in neonates and infants (0 to 1 year) at primary health care in Spain. All drug prescriptions in this age group were analysed and classified according to their labelling in off-label or on-label. The drugs prescribed off-label were subsequently reviewed in national formularies and other databases to assess its evidence of use beyond what is recommended in the Summary of Product Characteristics (SmPC). RESULTS: On average 34.50% of total prescriptions were prescribed off-label according to the SmPC. 17.93% of total prescriptions in neonates and infants up to 1 year old were not based on clinical evidence from SmPC, Pediamécum, BNF or DailyMed. In more than 88% of cases, off-label use was related to the posology section of the SmPC, followed by the therapeutic indications and contraindications sections, in 35.20% and 24.10% of cases, respectively. Almost 13% of off-label drugs were over-the-counter. Salbutamol followed by topical tobramycin and colecalciferol were the drugs most prescribed off-label. CONCLUSIONS: Off-label use of drugs remains as an important public health concern, especially for neonates and infants up to 1 year, who receive the greatest proportion of off-label prescriptions. The evidence-based off-label prescription is a widespread practice that has shown a stable trend during the 5-year study period providing also a certain extent of flexibility to paediatricians in some therapeutic decisions.

Prevention strategies to identify LASA errors: building and sustaining a culture of patient safety.

BACKGROUND: Potential look-alike, sound-alike (LASA) errors in outpatient and inpatient prescriptions have been widely described worldwide. However, most strategies of reducing drug name confusion have been only focused on the processes of prescribing and dispensing, often following local rules. MAIN TEXT: An illustrative recent example about this topic is given: the antidepressant Brintellix® (vortioxetine) (Takeda Pharmaceuticals USA, Inc.) and the antiplatelet medication Brilinta® (ticagrelor) (AstraZeneca LP). Revision of the initiatives that are currently applied to prevent potential LASA errors in different countries around the world and debate about the emerging strategies that could be implemented in short and mid-term. At present, a common policy worldwide on the authorization of unique names for innovative medicines does not exist. The implication of authorities in topdown strategies and the importance of developing an international health policy on the authorization of unique names for innovative medicines are highlighted in the following piece of opinion. CONCLUSIONS: Building and sustaining a culture of patient safety should be considered as a global top-down strategy which involved all the elements in the system (regulatory bodies, manufacturers and suppliers). The precedent established by the FDA in prevention strategies to identify and avoid LASA errors has been extremely important and should lead to international discussion. Coordinated international efforts are urgently needed in this area for the sake of patients' safety.

Uso de un sistema de puntuación para la prescripción de fidaxomicina en la infección por Clostridium difícil / A scoring system for prescribing fidaxomicin in Clostridium diffícile infection

Las recurrencias de la infección por Clostridium difficile ocasionan reingresos hospitalarios y costes elevados, además de sufrimiento y frustración para los pacientes que las padecen. Recientemente se ha incorporado fidaxomicina, un nuevo antibiótico con cuya utilización se ha demostrado una reducción significativa de las recurrencias de esta infección. A pesar de esta superioridad, su elevado coste ha ocasionado políticas muy restrictivas en su utilización hasta el punto de que en muchas instituciones solo se emplea para pacientes con múltiples episodios. En espera de herramientas clínicas predictivas, proponemos el desarrollo de sistemas de puntuación que permitan tratar más precozmente a pacientes de alto riesgo (AU)

Recurrences of Clostridium difficile infections lead to hospital readmissions and high costs, in addition to the suffering and frustration for the patients. Fidaxomicin has recently been introduced as a new antibiotic that has been shown to significantly reduce the recurrence of this infection. Despite this superiority, its high cost has led to very restrictive policies in its use, as such that many institutions only use it in patients with multiple recurrences. While waiting for new predictive clinical tools, we propose the development of scoring systems that allow the more high-risk patients to be treated earlier (AU)

High prevalence of Salmonella spp. in wastewater reused for irrigation assessed by molecular methods.

Salmonella spp. is one of the most important causal agents of food-borne illness in developed countries and its presence in irrigation water poses a risk to public health. Its detection in environmental samples is not easy when culture methods are used, and molecular techniques such as PCR or ribosomal rRNA probe hybridization (Fluorescent in situ Hybridization, FISH) are outstanding alternatives. The aim of this work was to determine the environmental risk due to the presence of Salmonella spp. in wastewater by culture, PCR and FISH. A new specific rDNA probe for Salmonella was designed and its efficiency was compared with the rest of methods Serotype and antibiotic resistance of isolated strains were determined. Forty-five wastewater samples (collected from two secondary wastewater treatment plants) were analysed. Salmonella strains were isolated in 24 wastewater samples (53%), two of them after disinfection treatment. Twenty-three Salmonella strains exhibited resistance to one or more antimicrobial agent. Analysis of wastewater samples yielded PCR positive results for Salmonella in 28 out of the 45 wastewater samples (62%). FISH analysis allowed for the detection of Salmonella in 27 (60%) samples. By using molecular methods, Salmonella was detected in four samples after disinfection treatment. These results show the prevalence of Salmonella in reclaimed wastewater even after U.V. disinfection, what is a matter of public health concern, the high rates of resistance to antibiotics and the adequacy of molecular methods for its rapid detection. FISH method, with SA23 probe developed and assayed in this work provides a tool for detecting Salmonella in water within few hours, with a high rate of effectiveness.

A scoring system for prescribing fidaxomicin in Clostridium diffícile infection. / Uso de un sistema de puntuación para la prescripción de fidaxomicina en la infección por Clostridium difficile.

Recurrences of Clostridium difficile infections lead to hospital readmissions and high costs, in addition to the suffering and frustration for the patients. Fidaxomicin has recently been introduced as a new antibiotic that has been shown to significantly reduce the recurrence of this infection. Despite this superiority, its high cost has led to very restrictive policies in its use, as such that many institutions only use it in patients with multiple recurrences. While waiting for new predictive clinical tools, we propose the development of scoring systems that allow the more high-risk patients to be treated earlier.

Fingolimod: efectividad y seguridad en la práctica clínica habitual. Estudio observacional, retrospectivo y multicéntrico en Navarra, Gipuzkoa y La Rioja / Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Navarra, Gipuzkoa and La Rioja

Objetivo. Evaluar la efectividad y seguridad del fingolimod en la práctica clínica en las regiones de Navarra, Gipuzkoa y La Rioja. Pacientes y métodos. Estudio retrospectivo y multicéntrico de pacientes con esclerosis múltiple recurrente tratados con fingolimod, siguiendo la ficha técnica. Se evaluó la tasa anualizada de brotes (TAB), el porcentaje de pacientes libres de brotes, la discapacidad usando la escala expandida del estado de discapacidad (EDSS) y el porcentaje de pacientes sin lesiones captantes de gadolinio. Resultados. Un total de 113 pacientes fueron tratados con fingolimod: el 6%, naïve, y el 58% y 35%, pacientes tratados previamente con inmunomodulador y natalizumab, respectivamente. El fingolimod disminuyó la TAB tras el primer (67%; 1 a 0,3; p < 0,0001) y segundo (89%; 1 a 0,1; p < 0,0001) año de tratamiento, y aumentó así el porcentaje de pacientes libres de brotes durante el tratamiento. La EDSS basal fue 3 y después del tratamiento con fingolimod fue 2,5 en ambos años. El porcentaje de pacientes sin lesiones captantes de gadolinio tras el primer año de tratamiento fue del 77%. Resultados similares se observaron en los pacientes naïve y en los tratados previamente con inmunomodulador. En los pacientes tratados previamente con natalizumab no se observaron cambios tras el tratamiento. Conclusiones. El uso del fingolimod en la práctica clínica mostró una efectividad similar a la eficacia observada en ensayos clínicos. No hubo cambios en la TAB al cambiar desde natalizumab, y sólo un paciente tras suspender el natalizumab presentó ‘rebrote’. El fingolimod se comporta como un fármaco seguro, con escasos efectos adversos y con un bajo porcentaje de abandonos (AU)

Aim. To evaluate the effectiveness and safety of fingolimod in clinical practice in Navarra, Gipuzkoa and La Rioja regions. Patients and methods. We conducted a retrospective multi-centre study with recurrent multiple sclerosis patients treated with fingolimod, following the product data sheet. The following data were evaluated: annualised relapse rate (ARR), percentage of patients free from relapses, disability using the Expanded Disability Status Scale (EDSS) and the percentage of patients without gadolinium-enhancing lesions. Results. A total of 113 patients were treated with fingolimod: 6% were naïve, and 58% and 35% were patients previously treated with an immunomodulator and natalizumab, respectively. Fingolimod lowered the ARR after the first (67%; 1 to 0.3; p < 0.0001) and second (89%; 1 to 0.1; p < 0.0001) years of treatment, and thus the number of patients free from relapses during the treatment increased. The baseline EDSS was 3 and after treatment with fingolimod was 2.5 in both years. The percentage of patients without gadolinium-enhancing lesions after the first year of treatment was 77%. Similar results were observed in naïve patients and in those previously treated with an immunomodulator. In patients previously treated with natalizumab no changes were observed following the treatment. Conclusions. The use of fingolimod in clinical practice showed an effectiveness similar to that observed in clinical trials. There were no changes in the ARR after changing from natalizumab, and only one patient presented a ‘relapse’ after withdrawal of natalizumab. Fingolimod acts like a safe drug, with scarce side effects and a low percentage of drop-outs (AU)

PREVALENCE OF METABOLIC SYNDROME AMONG ADOLESCENTS IN A CITY IN THE MEDITERRANEAN AREA: COMPARISON OF TWO DEFINITIONS.

BACKGROUND AND OBJECTIVE: there are few studies on the prevalence of metabolic syndrome (MetS) in European adolescent populations, and some have reported a higher prevalence in the Mediterranean basin area. Our objective was to examine the prevalence of MetS in adolescents in a Mediterranean city of Spain, comparing two different definitions of MetS and the associated risk factors. METHODS AND RESULTS: a cross-sectional population-based study was conducted among 379 adolescents aged 12-16.9 years, selected using a random sampling method. Anthropometric measurements and fasting blood samples were obtained. The definitions of MetS used were that of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATPIII) and that of the International Diabetes Federation (IDF). Kappa coefficient was used to measure the agreement between definitions and a multivariate logistic regression model to determine the associated risk factors. RESULTS: the prevalence of MetS was 5.7% (95%CI 3.33-8.07) according to the NCEP-ATPIII definition and 3.8% (95%CI 1.85-5.75) according to the IDF definition. No differences between the sexes or by age groups were found. The agreement between the two definitions was very good (kappa 0.815), especially in the obese subsample, but was lower in normal weight adolescents (kappa 0.497). Insulin resistance and obesity were associated with both definitions. CONCLUSIONS: the prevalence of MetS in our adolescent population is higher than the European media. Although the overall agreement between both definitions was very good, the prevalence was higher using the NCEP-ATPIII criteria. Independently of the definition used, obesity and insulin resistance were risk factors for MetS.

Introducción y objetivos: existen escasos estudios acerca de la prevalencia de síndrome metabólico (MetS) en la población general adolescente en Europa. Algunos resultados muestran mayor prevalencia en adolescentes del área mediterránea. Nuestro objetivo fue estudiar la prevalencia de MetS en la población general adolescente de una ciudad del área mediterránea en España, comparando dos definiciones de MetS y los factores de riesgo asociados. Material y métodos: estudio epidemiológico observacional sobre una muestra de base poblacional, elegida de forma aleatoria, representativa de los adolescentes de 12 a 16,9 años escolarizados en la ciudad de Almería. Se recogieron variables antropométricas y analíticas. Se compararon dos definiciones de SM para población adolescente: National Cholesterol Education Program (NECP- ATPIII) e International Diabetes Federation (IDF). Estadística: coeficiente kappa para analizar la concordancia entre definiciones y regresión logística múltiple para el estudio de factores de riesgo asociados. Resultados: la prevalencia de MetS fue 5,7% (95%IC 3,33-8,07) con la definición NECP-ATPIII y 3,8% (95%IC 1,85-5,75) con los criterios IDF. No se encontraron diferencias entre sexos ni entre grupos de edad. La concordancia entre ambas definiciones fue muy buena a nivel global (kappa 0,815) y especialmente en el grupo de obesos, pero empeoró entre adolescentes con normopeso (kappa 0,497). Los factores asociados a ambas definiciones fueron obesidad y resistencia insulínica. Conclusiones: nuestros resultados muestran una prevalencia de MetS en adolescentes mayor a la media europea. Aunque la concordancia entre definiciones fue muy buena a nivel global, la prevalencia fue mayor con la definición NECP-ATPIII. Obesidad y resistencia insulínica fueron los factores de riesgo asociados.

Prevalence of metabolic syndrome among adolescents in a city in the Mediterranean area: comparison of two definitions / Prevalencia de síndrome metabólico en la población general adolescente de una ciudad del área mediterránea: comparación de dos definiciones

Background and objective: there are few studies on the prevalence of metabolic syndrome (MetS) in European adolescent populations, and some have reported a higher prevalence in the Mediterranean basin area. Our objective was to examine the prevalence of MetS in adolescents in a Mediterranean city of Spain, comparing two different definitions of MetS and the associated risk factors. Methods and results: a cross-sectional population-based study was conducted among 379 adolescents aged 12-16.9 years, selected using a random sampling method. Anthropometric measurements and fasting blood samples were obtained. The definitions of MetS used were that of the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII) and that of the International Diabetes Federation (IDF). Kappa coefficient was used to measure the agreement between definitions and a multivariate logistic regression model to determine the associated risk factors. Results: the prevalence of MetS was 5.7% (95%CI 3.33-8.07) according to the NCEP-ATPIII definition and 3.8% (95%CI 1.85-5.75) according to the IDF definition. No differences between the sexes or by age groups were found. The agreement between the two definitions was very good (kappa 0.815), especially in the obese subsample, but was lower in normal weight adolescents (kappa 0.497). Insulin resistance and obesity were associated with both definitions. Conclusions: the prevalence of MetS in our adolescent population is higher than the European media. Although the overall agreement between both definitions was very good, the prevalence was higher using the NCEP-ATPIII criteria. Independently of the definition used, obesity and insulin resistance were risk factors for MetS (AU)

Introducción y objetivos: existen escasos estudios acerca de la prevalencia de síndrome metabólico (MetS) en la población general adolescente en Europa. Algunos resultados muestran mayor prevalencia en adolescentes del área mediterránea. Nuestro objetivo fue estudiar la prevalencia de MetS en la población general adolescente de una ciudad del área mediterránea en España, comparando dos definiciones de MetS y los factores de riesgo asociados. Material y métodos: estudio epidemiológico observacional sobre una muestra de base poblacional, elegida de forma aleatoria, representativa de los adolescentes de 12 a 16,9 años escolarizados en la ciudad de Almería. Se recogieron variables antropométricas y analíticas. Se compararon dos definiciones de SM para población adolescente: National Cholesterol Education Program (NECP-ATPIII) e International Diabetes Federation (IDF). Estadística: coeficiente kappa para analizar la concordancia entre definiciones y regresión logística múltiple para el estudio de factores de riesgo asociados. Resultados: la prevalencia de MetS fue 5,7% (95%IC 3,33-8,07) con la definición NECP-ATPIII y 3,8% (95%IC 1,85-5,75) con los criterios IDF. No se encontraron diferencias entre sexos ni entre grupos de edad. La concordancia entre ambas definiciones fue muy buena a nivel global (kappa 0,815) y especialmente en el grupo de obesos, pero empeoró entre adolescentes con normopeso (kappa 0,497). Los factores asociados a ambas definiciones fueron obesidad y resistencia insulínica. Conclusiones: nuestros resultados muestran una prevalencia de MetS en adolescentes mayor a la media europea. Aunque la concordancia entre definiciones fue muy buena a nivel global, la prevalencia fue mayor con la definición NECP-ATPIII. Obesidad y resistencia insulínica fueron los factores de riesgo asociados (AU)

Opinión de los profesionales sanitarios sobre la adherencia y manejo de tratamientos de larga duración en adolescentes / Opinion of health professionals on adherence and management of long-term treatments in adolescents

Objetivo. Conocer la opinión de los profesionales sanitarios sobre la adherencia y el manejo de tratamientos de larga duración en adolescentes en un hospital de tercer nivel. Método. Estudio observacional, descriptivo y transversal, realizado en el Hospital Universitari Vall d'Hebron de Barcelona, España. Los sujetos de estudio fueron los profesionales sanitarios que atienden a los adolescentes trasplantados de órganos sólidos, seropositivos, con enfermedad oncohematológica, diabetes o fibrosis quística. La recogida de datos se realizó mediante cuestionario autocumplimentado, elaborado específicamente para este estudio. Resultados. Participaron 105 profesionales (70 %). Un 80 % eran enfermeras. El 56 % consideró que el cumplimiento del tratamiento de los adolescentes era bueno. Un 43 % señaló que la adherencia no se abordaba bien. El 79 % de los profesionales no disponían de tiempo planificado para realizar educación sanitaria relacionada con el tratamiento. El 19.5 % de las enfermeras y el 72,2 % de los médicos indicaron disponer de instrumentos de evaluación de la adherencia. El 39 % de los participantes realizó propuestas de mejora. Conclusiones. Casi la mitad de los profesionales opina que la adherencia terapéutica no se aborda adecuadamente. Es importante la evaluación de la adherencia a los tratamientos para identificar causas de bajo cumplimiento e instaurar y evaluar intervenciones adecuadas (AU)

Objective. To assess opinion of health professionals about adherence and management of long-term treatments in adolescents in a tertiary hospital. Method. A cross-sectional study was carried out in the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were health professionals who care adolescents with solid organ transplant, hematologic disease, diabetes, cystic fibrosis or HIV+. Data collection was performed by self-administered questionnaire, developed specifically for this study. Results. A total of 105 professionals (70 %) participated in the study, 80 % were nurses, 56 % of them indicated that treatment compliance was good. 43 % indicated that adherence was not addressed well and 79 % of professionals did not have planned time to conduct health education related to treatment. 19.5 % of nurses and 72.2 % of physicians reported having adherence assessment tools. 39 % of participants made ??suggestions for improvement. Conclusions. Almost half of the professional indicate that the adherence is not adequately addressed. It is important to evaluate adherence to treatment to identify causes of low compliance and establish and evaluate appropriate interventions (AU)

Epidemiología de las estrías gravídicas en España / Epidemiology of striae gravidarum in Spain

Objetivo. Valorar la influencia de diferentes factores en la aparición de estrías antes, durante y después de la gestación. Sujetos y métodos. Estudio epidemiológico observacional sobre la prevalencia e incidencia de estrías gravídicas y no gravídicas en mujeres embarazadas. Se registraron datos de 519 mujeres embarazadas, incluyendo antecedentes tanto ginecoobstétricos como familiares de estrías gravídicas, peso previo al embarazo, talla, índice de masa corporal, tipo de piel, fototipo de Fitzpatrick y uso habitual de cremas o lociones corporales. El análisis multivariante de los factores se utilizó para conocer los componentes asociados de forma independiente con la prevalencia de estrías previas al embarazo, y la incidencia de estas durante la gestación en curso. Resultados. El 85,5% de las mujeres presentaban estrías previas a la gestación asociadas principalmente a embarazos previos (OR = 2,6), a un índice de masa corporal previo al embarazo ≥ 25 (OR = 2,2) y a antecedentes familiares de estrías gravídicas (OR = 1,7). Durante el embarazo en estudio, el 36,8% de las gestantes desarrollaron estrías nuevas, en su mayoría mujeres con sobrepeso u obesidad (OR = 2,2) y menores de 30 años (OR = 1,9). El análisis de los factores permitió asociar un riesgo mayor de estrías al final del embarazo a mujeres con sobrepeso u obesidad previos (OR = 1,8), menores de 30 años (OR = 2,4) y con embarazos previos (OR = 4,3). Conclusiones. La prevención de la aparición de estrías debe realizarse en todos los casos, con especial énfasis en pacientes más jóvenes y con índices de masa corporal altos, debido a su elevado riesgo de desarrollar estrías durante la gestación (AU)

Objective. To assess the influence of different factors on the presence of striae prior to pregnancy as well as the development of new lesions during and after pregnancy. Subjects and methods. An observational epidemiologic study was carried out on the prevalence and incidence of striae gravidarum and stretch marks in pregnant women. Data from 519 pregnant women were registered, including obstetric history, family history of striae gravidarum, weight prior to pregnancy, skin type, Fitzpatrick skin phototype, and current use of body creams and lotions. A multivariate analysis was used to determine the factors associated with the incidence of striae gravidarum during current pregnancy. Results. The prevalence of pre-pregnancy stretch marks was 85.5%, mainly observed in patients with a first pregnancy (OR = 2.6), body mass index ≥ 25 (OR = 2.2), and family history of striae gravidarum (OR = 2.1). The overall incidence of striae gravidarum during pregnancy was 36.8% and most of these patients had a body mass index ≥ 25 (OR = 2.2) and were younger (< 30 years old; OR = 1.9). Risk analysis of all the variables registered indicated a higher risk of striae gravidarum in women who were overweight prior to pregnancy (OR = 1.8), those aged under 30 years (OR = 2.4), and those with previous pregnancies (OR = 4.3). Conclusions. Prevention of striae gravidarum should be recommended in all cases, with special emphasis on younger women and those who are overweight or obese due to their higher risk for the development of these marks during pregnancy (AU)

Factores asociados a insulinemia en población general adolescente / Associated factors to insulin values in a population-based study in adolescents

Objetivo: Analizar los factores asociados con insulinemia en ayunas en población general adolescente. Métodos: Estudio epidemiológico observacional sobre una muestra poblacional de adolescentes (12-16,9 años) seleccionados mediante muestreo probabilístico polietápico. Se realizaron examen físico, antropometría, encuesta nutricional y se determinó insulinemia en ayunas. Estadística: regresión lineal múltiple. Resultados: Se incluyeron 379 adolescentes con edad media 14,08 ± 1,30 años. Se relacionaron con mayores cifras de insulinemia el desarrollo puberal [β 4,55 (95% IC 0,42-8,69)], obesidad abdominal [β 6,11(95% IC 3,938,29)] y el antecedente de bajo peso para la edad gestacional (BPEG) [β 7,45 (95% IC 2,47-12,44)]. El consumo habitual de aceite de oliva en domicilio mostró una relación inversa con las cifras de insulinemia [β -4,14 (95% IC -7,31- -0,98)]. Conclusión: Los factores de riesgo asociados a mayores cifras de insulinemia en ayunas fueron la obesidad abdominal y el antecedente de BPEG. El consumo habitual de aceite de oliva en domicilio fue un factor protector (AU)

Objectives: To identify factors that correlate with insulin values and to examine its independent associations among adolescents. Methods: A cross-sectional population-based study was conducted among adolescents aged 12-16,9 years old. A multi-stage stratified cluster random sampling method was employed. Anthropometric measurements and nutritional survey were performed, and fasting blood samples for insulin were obtained. Statistics: Multiple lineal regression. Results: 379 adolescents were included. Mean age was 14.08 ± 1.30 years. Factors associated with higher fasting insulin levels were puberty [β 4.55 (95% IC 0.42-8.69)], abdominal obesity [β 6.11 (95% IC 3.93-8.29)] and to be born small for gestational age (SGA) [β 7.45 (95% IC 2.47-12.44)]. It was observed a negative association between the regular intake of olive oil at home and insulin values [β -4.14 (95% IC -7.31- -0.98)]. Conclusions: Abdominal obesity and SGA were factors associated with higher fasting insulin values. In contrast, the regular intake of olive oil at home was an independent protective factor (AU)

Schwannoma de mama: a propósito de un caso / Breast schwannoma: Apropos of a case

Los schwannomas o neurilemomas son neoplasias benignas originadas en las células de Schwann de la vaina de los nervios periféricos. Se presentan habitualmente en la cabeza, el cuello, el tronco o en las superficies flexoras de las extremidades, siendo su localización en la mama extremadamente rara. Pueden surgir de forma esporádica, o en el contexto de una neurofibromatosis. Una exhaustiva revisión de la bibliografía ha demostrado un total de 28 casos de schwannomas mamarios documentados en la literatura. En este artículo, presentamos un nuevo caso de schwannoma en la mama de una mujer joven, describiendo los hallazgos mamográficos, ecográficos e histológicos característicos de esta entidad (AU)

Schwannomas or neurilemmomas are benign neoplasms arising in Schwann cells of the peripheral nerve sheath. The most common locations include the head, neck, trunk and flexor surface of the extremities, the breast being a highly unusual location. These tumors may arise sporadically or in the context of neurofibromatosis. An exhaustive review of the literature revealed 28 cases of intramammary schwannomas reported in the English-language literature. We report a new case of Schwannoma of the breast in a young woman and describe its mammographic, ultrasound and histological features (AU)

Prevalencia de diabetes en una población adulta de Madrid (España). Estudio MADRIC (MADrid RIesgo Cardiovascular) / Prevalence of diabetes in an adult population in the region of Madrid (Spain). The Madrid Cardiovascular Risk study

Objetivo Estimar la prevalencia de diabetes mellitus y de glucemia basal alterada en una población adulta de Madrid. Métodos Estudio transversal de base poblacional. Incluyó 1344 adultos (31-70 años de edad), seleccionados aleatoriamente del censo de usuarios de 14 centros de salud de la Comunidad de Madrid. Se realizaron las siguientes determinaciones: cuestionario clínico, exploración física y análisis de sangre basal (glucemia, triglicéridos y colesterol). Se consideraron diabéticos aquellos previamente diagnosticados por su médico, así como los que presentaron una glucemia basal ≥ 126mg/dl en ausencia de un diagnóstico previo de diabetes. Con una glucemia entre 100 y 125mg/dl en ausencia de diabetes se clasificaron como glucemia basal alterada. Resultados Las prevalencias de diabetes y de glucemia basal alterada, ajustadas por edad y sexo, fueron del 6,6% (intervalo de confianza del 95% [IC95%]: 5,9-8,7) y del 14,1% (IC95%: 12,1-15,8), respectivamente. Un 17,2% [IC95%: 10,9-23,5] de los diabéticos detectados no habían sido diagnosticado previamente de esta enfermedad. Los factores asociados de modo independiente con la diabetes fueron la edad, el sexo masculino, la presencia de obesidad abdominal y la hipertensión arterial. Conclusiones En nuestra población de Madrid, la prevalencia de diabetes es similar a la de otras regiones españolas. Es destacable el alto porcentaje de sujetos con una glucemia basal alterada, lo cual, asociado a la obesidad, conlleva un alto riesgo de desarrollar diabetes en el futuro (AU)

Objective To estimate the prevalence of diabetes mellitus and impaired fasting glycemia in an adult population living in Madrid (Spain).Methods In this cross-sectional, population-based survey, we studied 1,344 adults aged 31-70 years, randomly selected from the population living in 14 primary care districts of the Madrid region. All participants underwent a clinical evaluation that included a clinical interview, physical examination and fasting blood analysis (glycemia, cholesterol and triglyceride levels). The participants were considered to be diabetic if they had been previously diagnosed with diabetes by their general physician or had a fasting glycemia ≥ 126mg/dl without a previous diabetes diagnosis. Impaired fasting glycemia was defined as fasting glycemia between 100mg/dl and 125mg/dl in non-diabetic participants. ResultsThe sex- and age-adjusted prevalence figures for diabetes and impaired fasting glucose were 6.6% (95% CI: 5.9-8.7) and 14.1% (95% CI: 12.1-15.8), respectively. A substantial proportion of diabetic patients [17.2% (95% CI: 10.9-23.5)] had not been previously diagnosed. The variables independently associated with diabetes were age, male gender, abdominal obesity and hypertension. Conclusions Our prevalence figure for diabetes is similar to those reported in other Spanish regions. The high frequency of impaired fasting glucose is worrisome, particularly when combined with obesity, as this association confers a high risk for developing diabetes mellitus (AU)

[Prevalence of diabetes in an adult population in the region of Madrid (Spain). The Madrid Cardiovascular Risk study]. / Prevalencia de diabetes en una población adulta de Madrid (España). Estudio MADRIC (MADrid RIesgo Cardiovascular).

OBJECTIVE: To estimate the prevalence of diabetes mellitus and impaired fasting glycemia in an adult population living in Madrid (Spain). METHODS: In this cross-sectional, population-based survey, we studied 1,344 adults aged 31-70 years, randomly selected from the population living in 14 primary care districts of the Madrid region. All participants underwent a clinical evaluation that included a clinical interview, physical examination and fasting blood analysis (glycemia, cholesterol and triglyceride levels). The participants were considered to be diabetic if they had been previously diagnosed with diabetes by their general physician or had a fasting glycemia ≥ 126 mg/dl without a previous diabetes diagnosis. Impaired fasting glycemia was defined as fasting glycemia between 100mg/dl and 125 mg/dl in non-diabetic participants. RESULTS: The sex- and age-adjusted prevalence figures for diabetes and impaired fasting glucose were 6.6% (95% CI: 5.9-8.7) and 14.1% (95% CI: 12.1-15.8), respectively. A substantial proportion of diabetic patients [17.2% (95% CI: 10.9-23.5)] had not been previously diagnosed. The variables independently associated with diabetes were age, male gender, abdominal obesity and hypertension. CONCLUSIONS: Our prevalence figure for diabetes is similar to those reported in other Spanish regions. The high frequency of impaired fasting glucose is worrisome, particularly when combined with obesity, as this association confers a high risk for developing diabetes mellitus.

Seasonal trends in the social composition and inside-trunk distribution of Kalotermes flavicollis (Isoptera: Kalotermitidae) colonizing grapevines.

The polyphagous drywood termite Kalotermes flavicollis (Fabricius) can establish its colonies inside living trees, causing a progressive debilitation that ends with the death of the plant. For this reason, it is considered one of the major pests of Sherry vineyards in Andalusia, SW Spain. To analyze the trends of colonization of this termite, a detailed investigation was performed during 16 mo in seven districts of the Sherry area, cutting randomly selected grapevine trunks into six sections, from which all individuals were collected and counted according to their developmental instar or caste. The results detected variations in the social composition of the groups colonizing grapevines according to the spatial distribution inside the vine trunk and in the numerical trends over the seasons. A pattern of seasonal migrations of the termites inside the trunk was inferred, with upward movements from spring to autumn and downward movements from autumn to winter. During winter, when termites were mainly located in the medium-basal sections of the trunk, a higher proportion of eggs and larvae was detected. Going from spring to summer, when the majority of the termites was located in the medium-upper sections of the trunk, there was an increase of nymphal instars followed, during autumn, by the appearance of alates, mostly located in the upper sections of the grapevine. Pseudergates and reproductives maintained their proportions and locations almost unchanged during the year.

Ovarian juvenile granulosa cell tumors in infants.

Juvenile ovarian granulosa cell tumors (JGCTs) are described infrequently in pediatrics, and their finding in prepubertal patients is exceptional. Most of the tumors are benign, but recurrences up to 4 years of follow-up have been described. We present 2 cases of JGCT in infants: 1 with late recurrence of bilateral ovarian JGCT and 1 in a newborn with Ollier disease. Clinical diagnosis and treatment of JGCT are revised.