Prevalence and risk factors of gestational diabetes in the health region of Lleida: a retrospective observational cohort study.

BACKGROUND: Diabetes is a very common metabolic condition during pregnancy. The number of cases increases with age and obesity. The prevalence of pre-gestational diabetes and gestational diabetes (GD) differs between different ethnic groups. OBJECTIVE: The aim of the study was to analyse the prevalence of pre-gestational diabetes and GD in the health region of Lleida. We also studied the GD risk factors during pregnancy according to the country of origin of the pregnant woman. METHODS: We performed a retrospective observational cohort study among pregnant women between 2012 and 2018 in the health region of Lleida. A multivariate model was performed with the different variables analysed by calculating the regression coefficient and its 95% confidence interval (CI). RESULTS: In our sample of 17,177 pregnant women, we observed a prevalence of pre-gestational diabetes and GD of 8.2% and 6.5%, respectively. We found a relationship of gestational diabetes with different factors: age, with 6.8% in 30-34 year-old women and 11.3% in women over 35 (OR 1.78 and 3.29, respectively); overweight, with 8.29% (OR 1.89); and obesity, with 12.9% (OR 3.15). Finally, women from Asia and the Middle East and the Maghreb had a higher risk of diabetes, with 12.2% (OR 2.1) and 9.91% (OR 1.3), respectively, and Sub-Saharan women had a lower risk of it 6.07% (OR 0.71). CONCLUSIONS: GD has different risk factors, such as age, overweight, and obesity. Non-related conditions include hypothyroidism, arterial hypertension, and dyslipidaemia. Finally, pregnant women from the Maghreb, and Asia and the Middle East, are at higher risk of developing diabetes during pregnancy; meanwhile, Sub-Saharan origin is protector factor.

Nematodes As Soil Stress Indicators for Polycyclic Aromatic Hydrocarbons: a Review.

Polycyclic aromatic hydrocarbons (PAHs) are an important group of organic pollutants present in all parts of the environment, affecting ecosystems and human health. PAHs, which have a strong affinity for organic carbon, are found in large quantities in soil, which is one of the most important sinks for these contaminants. Their impact on the soil biotic compartments depends on a number of different factors in combination with PAH behaviour and can be assessed using soil monitoring. Soil fauna have already shown excellent properties for biomonitoring of contaminants with most promising indicator frameworks based on nematodes, which are involved in essential processes in this environment. Nematodes respond to PAHs at multiple levels, including molecular, individual and community levels. At the molecular level, this is associated with activation of metabolic pathways for xenobiotics and increased demand for energy and resources. At the individual level, this is reflected in the slowing down of various physiological processes, which has consequences at the individual and community level for sensitive taxa. In this review, the toxicity and the direct and indirect effects of PAHs on soil nematode communities are discussed. It also considers the perspectives and challenges in assessing the toxicity of PAHs and their indication using soil nematodes.

Phylogenetic relationship of Hepatozoon blood parasites found in snakes from Africa, America and Asia.

The blood parasites from the genus Hepatozoon Miller, 1908 (Apicomplexa: Adeleida: Hepatozoidae) represent the most common intracellular protozoan parasites found in snakes. In the present study, we examined 209 individuals of snakes, from different zoogeographical regions (Africa, America, Asia and Europe), for the occurrence of blood parasites using both molecular and microscopic examination methods, and assess phylogenetic relationships of all Hepatozoon parasites from snakes for the first time. In total, 178 blood smears obtained from 209 individuals, representing 40 species, were examined, from which Hepatozoon unicellular parasites were found in 26 samples (14·6% prevalence). Out of 180 samples tested by molecular method polymerase chain reaction (PCR), the presence of parasites was observed in 21 individuals (prevalence 11·6%): 14 snakes from Africa belonging to six genera (Dendroaspis, Dispholidus, Mehelya, Naja, Philothamnus and Python), five snakes from Asia from the genus Morelia and two snakes from America, from two genera (Coluber and Corallus). The intensity of infection varied from one to 1433 infected cells per 10 000 erythrocytes. Results of phylogenetic analyses (Bayesian and Maximum Likelihood) revealed the existence of five haplotypes divided into four main lineages. The present data also indicate neither geographical pattern of studied Hepatozoon sp., nor congruency in the host association.

[The new algorithm for disease management of patients with epilepsy based on genetic research].

We have developed and proposed a new algorithm for treating patients with epilepsy, which takes into account the genetic criteria for the effectiveness of AEDs and provides an opportunity to significantly reduce the time drug-resistance definition, which in turn reduces the time progression epileptohenesis. Therefore, the use of alternative treatments for epilepsy, it is possible before the occurrence of irreversible changes in the patient's central nervous system. Therefore, treatment for this algorithm accelerates the choice of adequate treatment tactics in a particular patient, which promotes safety in society as active and healthy citizens.

[Pharmacogenetic criteria of drug-resistant epilepsy].

Pharmacogenetics, allows to improve our understanding of the mechanisms of action of AEDs and causes drug-resistence epilepsy. We found an association between farmakorezestentnistyu patient with epilepsy and the presence of a CC allele polymorphisms S3534T (rs1045642), S 1236T (rs 1128503) gene ABCB1 that encodes P-glycoprotein (hereafter P - glycoprotein rs1045642, P - glycoprotein rs1128503) and TT allelic polymorphism rs3812718 gene SCN1A, encoding a voltage-dependent sodium channels.

[Change of bone tissue in patients with epilepsy].

By rezultats study found the difference in bone density in patients with epilepsy that a long-term (over 3 years) took anticonvulsants and healthy persons of similar age and sex (P < 0.01). Less than 50% of patients with epilepsy had normal bone density, in 41.2% patients revealed osteopenia, and in 10.1%--had pronounced osteoporosis. Understanding and timely diagnosis of metabolic disorders associated with the AEP technique allows neurologists to conduct timely prevention of osteoporosis in this group of patients, waiting for clinical manifestations of violations of bone density.

[Genetic performance criteria for valproate in patients with epilepsy].

We found a clear correlation between the presence of the CC genotype and genotype combination CC and CT P-glycoproteins rs1045642 and rs1128503 with farmakorezystentnistyu data of patients with valproate (P < 0,01). Also, based on studies demonstrated that the presence of polymorphism TT P-glycoproteins rs1045642 is a positive criterion of forecast performance valproate in a particular patient with epilepsy. We use the definition of P-glycoproteins SNPs rs1045642 and rs1128503 to accelerate the selection of adequate antiepileptic that reduces the selection of adequate treatment tactics in a particular patient. This in turn will prevent the development epileptohenezu that increase the likelihood of full kurabelnosti patient.

Condicionantes del lugar de defunción de pacientes con enfermedad oncológica terminal, adscritos al ESAD, en la provincia de Huesca / No disponible

Objetivos: averiguar qué condicionantes socio-ambientales pueden influir en el hecho de que la muerte de un enfermo oncológico terminal tenga lugar en el domicilio. Método: se realizó un estudio retrospectivo de los pacientes controlados por el equipo de soporte de atención domiciliaria (ESAD) de la provincia de Huesca durante el año 2006, y se seleccionaron aquellos que habían fallecido por causa oncológica en domicilio u hospital, eran mayores de 18 años, tenían un cuidador principal definido y llevaban más de 3 días en el programa del ESAD. Las variables a estudio fueron seleccionadas en base a una revisión de la literatura, lo que permitió la elaboración de una hoja de recogida de datos con las siguientes: «lugar de defunción», «edad», «sexo», «Pfeiffer», «Barthel», «tipo de tumor», «clase social», «residencia», «cuidador principal», «más de un cuidador», «número de visitas por parte del ESAD», «días en programa» y «días de enfermedad desde el momento del diagnóstico». El estudio estadístico se realizó con el paquete estadístico SPSS 14 con análisis de variables categóricas y cuantitativas. Resultados: durante el periodo del estudio se incluyeron 108 pacientes, con una media de edad de 75,75 y mediana de 78 años, 61% eran hombres y 39% mujeres, el 57,4% fallecieron en domicilio y un 42,6% en hospital de agudos. Respecto a la enfermedad de base: el 91,7% presentaban tumores sólidos y 8,3% tumores de origen hematológico. Un 75% residían en zonas urbanas y 25% en rurales. Su estatus social se agrupó en ocho categorías. La mediana de permanencia en programa ESAD fue de 41,5 días, y la mediana de los días de enfermedad fue de 235 días. No encontramos relación entre el lugar de defunción y las variables: Barthel, Pfeiffer, sexo, clase social, cuidador principal, días en programa, número de visitas y días de enfermedad y no podemos asegurar que haya independencia entre las variables lugar de defunción y tipo de tumor. Sí encontramos significación estadística entre el lugar de defunción y el tipo de residencia rural (p-valor = 0,013), y tener más de un cuidador (p-valor = 0,009). La relación con la edad avanzada (p-valor = 0,049, para p-valor < 0,05) no queda demostrada claramente. Conclusiones: la muerte en domicilio, en la población estudiada, se dio con mayor frecuencia cuando la residencia del enfermo estaba en entorno rural y había más de un cuidador (AU)

Objectives: the purpose of this study was to assess the conditions that influence the death of oncological patients in their homes. Method: we carried out a retrospective study of patients recruited in a palliative care program in Huesca province who died in 2006. We selected oncological patients older than 18 years, with a main carer, and more than tree days in the program. After reviewing the literature, we selected several factors that were highly related to place of death. We designed a questionnaire including thirteen of these factors: «place of death», «age», «sex», «Pfeiffer», «Barthel», «type of cancer», «social class», «place of residence», «main carer», «number of home care visits», «number of days as inpatient», and «number of days in program». Statistical analyses for categorical and non-categorical variables were made with the SPSS 14 program.Results: 108 patients were selected: 61% of them were men and 39% women; 57.4% died at home and 42.6% died in an acute hospital; 75% lived in urban areas and 25% in rural areas, with a median of 74.6 days in the palliative care program. Median age was 78 years. The condition was a solid tumour in 91.7% of cases, while the remaining 8.3% had other types of tumour. Social status was grouped into eight categories. Median of days in the program was 41.5, and median disease duration was 235 days. No relations were found between: functional status, mental status, sex, social class, main carer, days in program, intensity of home care, and long disease duration or tumour type. Variables associated with death at home were: living in a rural area (p = 0.013), and extended family support (p =0.009). The relation between death at home and age is questionable (p=0.049). Conclusions: Death at home is more frequent in patients living in rural areas, and having more than one caregiver (AU)

Mesencephalic dopamine neuron number and tyrosine hydroxylase content: Genetic control and candidate genes.

The mesotelencephalic dopamine system shows substantial genetic variation which fundamentally affects normal and pathological behaviors related to motor function, motivation, and learning. Our earlier radioenzyme assay studies demonstrated significantly higher activity of tyrosine hydroxylase (TH), the first and rate limiting enzyme in the biosynthesis of catecholamine neurotransmitters, in the substantia nigra-ventral tegmental area of BALB/cJ mice in comparison with that of C57BL/6ByJ mice. Here, using quantitative immunoblotting and immunocytochemistry, we tested the hypothesis that mesencephalic TH protein content and number of nigral TH-positive neurons show strain-dependent differences in C57BL/6ByJ and BALB/cJ parallel to those observed in the TH activity studies. Immunoblotting experiments detected significantly higher mesencephalic TH protein content in BALB/cJ in comparison to C57BL/6ByJ (P<0.05). Immunocytochemical studies demonstrated that the number of TH-positive cells in substantia nigra was 31.3% higher in BALB/cJ than that in C57BL/6ByJ (P<0.01), while the average dopamine neuron volume was not significantly different. In a search for candidate genes that modulate TH content and the size of mesencephalic dopamine neuron populations we also studied near-isogenic mouse sublines derived from the C57BL/6ByJ and BALB/cJ progenitor strains. A whole-genome scan with 768 single nucleotide polymorphism markers indicated that two sublines, C4A6/N and C4A6/B, were genetically very similar (98.3%). We found significantly higher mesencephalic TH protein content in C4A6/B in comparison to C4A6/N (P=0.01), and a tendency for higher number of dopamine neurons in the substantia nigra in C4A6/B in comparison to C4A6/N, which, however, did not reach statistical significance. To identify the genetic source of the TH content difference we analyzed the single nucleotide polymorphism (SNP) genotype data of the whole-genome scan, and detected two small differential chromosome segments on chr. 13 and chr. 14. Microarray gene expression studies and bioinformatic analysis of the two differential regions implicated two cis-regulated genes (Spock1 and Cxcl14, chr. 13), and two growth factor genes [bone morphogenetic protein 6 (Bmp6) (chr. 13), and fibroblast growth factor 14 (Fgf14) (chr. 14)]. Taken together, the results suggest that (1) nigral dopamine neuron number and TH protein content may be genetically associated but further studies are needed to establish unequivocally this linkage, and (2) Spock1, Cxcl14, Bmp6, and Fgf14 are novel candidates for modulating the expression and maintenance of TH content in mesencephalic dopamine neurons in vivo.

Gamma hydroxybutirate use for sexual assault.

The use of gamma hydroxybutyrate (GHB) as a recreational drug has quickly spread among European young people during the past decade. Although it has been claimed that GHB can be potentially used to facilitate sexual assault, no case reports have been previously described. A case is described in which GHB was used with that criminal purpose and a review of previous literature is undertaken.

The cestode Atractolytocestus huronensis (Caryophyllidea) continues to spread in Europe: new data on the helminth parasite of the common carp.

The caryophyllidean tapeworm Atractolytocestus huronensis Anthony, 1958, originally described from the common carp Cyprinus carpio carpio L. from North America, has recently been introduced into Europe (UK, Hungary). In the present study, the dispersion of the tapeworm in other countries of Central Europe (Slovakia and the Czech Republic) is described, including its first observation in the common carp of the Tisa River, southeastern Slovakia. Because of the transboundary location of the river, there are possible consequences of the rapid distribution of the parasite to other regions throughout the Danube River basin. The parasite has also been found in cultured carp from fishponds in South Bohemia, from where the carp are imported to many European countries. Rapid dissemination of this cestode in Europe indicates its ability to colonise new regions, and represents another example of man-made introduction of potential pathogens of carp and other farmed fish. The morphology of the A. huronensis specimens found is compared with that of specimens from Hungary and North America as well as that of Atractolytocestus sagittatus (Kulakovskaya and Akhmerov, 1965) from the same fish host in eastern Asia.

The future of nursing education. Ten trends to watch.

The millennium has become the metaphor for the extraordinary challenges and opportunities available to the nursing profession and to those academic institutions responsible for preparing the next generation of nurses. Signal change is all around us, defining not only what we teach, but also how we teach our students. Transformations taking place in nursing and nursing education have been driven by major socioeconomic factors, as well as by developments in health care delivery and professional issues unique to nursing. Here are 10 trends to watch, described in terms of their impact on nursing education.

Impact of a helmet law on two wheel motor vehicle crash mortality in a southern European urban area.

BACKGROUND: In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants. OBJECTIVES: To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries. METHODS: Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved. RESULTS: Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period. CONCLUSIONS: This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.

Disabilities resulting from traffic injuries in Barcelona, Spain: 1-year incidence by age, gender and type of user.

The purpose of this study was to examine the 1-year incidence of disabilities resulting from traffic injuries among the population of Barcelona (Spain), as well as its distribution by age, gender and type of motor-vehicle user, taking into account different exposure criteria. This is a population-based cross-sectional study; subjects were all cases (n = 4080) having undergone a medical examination for a traffic injury having occurred in 1993 resulting in a disability among residents in the area of Barcelona. Subjects were considered to have suffered a disability as a result of an injury if they were prevented from carrying out their normal activities for a period of 2 days or more. In 1993, the cumulative incidence rate of disability was 237.9 cases per 100,000 inhabitants, higher for men (287.1) than for women (193.9). The 20-24 year age group showed the highest incidence of disability (607.5). The rate of incidence of disability was 95.5 per 100,000 inhabitants among occupants of two wheeled vehicles, 87.7 among car occupants and 39.9 in pedestrians. When length of exposure to traffic was taken into account, the incidence rate of disability for residents aged > 14 years was 1.09 per 100,000 hours per person per year, similar for both sexes. This study represents a first attempt to use population-based health data to evaluate the incidence of disabilities due to traffic injuries. The results allow the identification of the groups with the greatest risk and who contribute the most to disabilities resulting from injuries, especially young users of two-wheeled motor vehicles.

Variations in [3H]imipramine and 5-HT2A but not [3H]paroxetine binding sites in suicide brains.

Both the [3H]imipramine and [3H]paroxetine binding sites and the 5-HT2A receptor were simultaneously determined in frontal cortex, cingulate cortex, hippocampus and amygdala from 17 control subjects and 17 depressed suicide victims. A significant decrease in the maximum binding (Bmax) of [3H]imipramine was observed in the hippocampus of suicide victims as compared to control subjects (160 +/- 25 vs. 328 +/- 52 fmol/mg protein; P = 0.007) without changes in the apparent affinity constant (Kd). Furthermore, a significant decrease in the number of 5-HT2A binding sites, together with a significantly lower Kd, was also observed in the hippocampus of suicides as compared to control subjects (129 +/- 18 vs. 225 +/- 32 fmol/mg protein; P = 0.02 and 0.91 +/- 0.07 vs. 1.38 +/- 0.08 nM, respectively; P = 0.006). [3H]Paroxetine binding did not display modifications between the two groups in either Bmax or Kd from any of the brain regions studied. When all four brain regions were taken together, a down-regulation was noted between presynaptic [3H]imipramine binding and the postsynaptic 5-HT2A receptor (r = -0.40; P = 0.0013) in the control group. This correlation did not appear in the suicide group. No correlation was observed between [3H]paroxetine binding and the 5-HT2A receptor in either control subjects or suicides. Taken together, these results suggest that the 5-HT uptake site measured with [3H]imipramine and the 5-HT2A receptors are reliable markers of serotonergic dysfunction.

High affinity [3H]imipramine and [3H]paroxetine binding sites in suicide brains.

Specific binding of [3H]imipramine and [3H]paroxetine was simultaneously examined in human brains (frontal cortex, temporal cortex, cingulate cortex, hypothalamus, hippocampus and amygdala) from 11 controls and 11 depressed suicide victims. A single saturable high affinity site was obtained for both radioligands. Age was not related to significant changes in [3H]imipramine and [3H]paroxetine binding parameters, which indicates the stability of the brain serotonergic system with increasing age. A major finding of the present study concerns the existence of a significant decrease in the maximum number (Bmax) of [3H]imipramine binding sites in hippocampus from depressed suicides as compared with the control group, without changes in the binding affinity (Kd). In contrast, when [3H]paroxetine was used as radioligand, no changes in either Bmax or Kd were detected in any of the brain regions studied. These findings suggest that [3H]imipramine may be a better marker than [3H]paroxetine when alterations in the presynaptic serotonergic uptake site are to be detected.

Regional distribution of specific high affinity binding sites for 3H-imipramine and 3H-paroxetine in human brain.

The binding of 3H-paroxetine and 3H-imipramine has been compared in 17 different regions of 12 human control brains. Our findings reveal that the regional distribution is similar for both radioligands and their bindings tend to be parallel in the brain. The highest binding site density was found in basal ganglia (hypothalamus Bmax 780 +/- 102 fmol/mg protein for 3H-imipramine binding and Bmax 515 approximately 83 for 3H-paroxetine binding). The lowest values were found in cortical areas (cingulate cortex 191 +/- 18.5 fmol/mg for 3H-imipramine binding and 88 +/- 7.5 fmol/mg for 3H-paroxetine binding). The Kd values for 3H-paroxetine binding to neuronal membranes were similar in all brain regions (mean +/- s.d. Kd 0.07 +/- 0.007 nM) and also for 3H-imipramine binding (mean +/- s.d. Kd 1.05 +/- 0.12 nM). As these values are the same as in platelet membrane, the results obtained indicate that both binding sites are identical in neuronal and in platelet membranes. These findings suggest that both ligands are good markers of the 5HT transporter. However, the higher affinity of 3H-paroxetine confirms that this compound is a better radioligand for the 5HT uptake site.

Seasonal variability in blood platelet 3H-imipramine binding in healthy controls: age and gender effects.

Binding of 3H-imipramine to blood platelet membranes was determined four times (once each season) in 26 healthy volunteers (11 men and 15 women), over the course of 1 year to determine possible seasonal variations. Blood platelets were obtained in April-May, July-August, October-November, and January-February. Significant seasonal variations in the maximum number of binding sites were found in women but not in men, with circannual peak in summer and a nadir in spring. The pattern of seasonal variations was not the same in men and women. The present results highlight the importance of monitoring for gender and season in binding studies. We found no significant correlation between 3H-imipramine binding parameters and age.

Changes in platelet 3-H-imipramine binding: influences of protein concentration of varying proportions of cytosol or intact platelets and displacing agents used.

Platelet 3-H-imipramine binding exhibits considerable variation, both interindividually and between several groups. The aim of this study was to measure 3-H-imipramine binding, simultaneously in platelet membranes vs. intact platelets vs. cytosol or intracytosolic protein in order to determine their effect on Bmax and Kd values. 3-H-imipramine binding was carried out at different protein concentrations. Our results indicate that the affinity constant is heavily influenced by the presence of cytosol and intact platelets in membrane preparations. Finally, we demonstrate a negative correlation between Bmax and protein concentration. Only perfect analytical conditions will allow platelet 3-H-imipramine binding to be a biological marker for affective disorders.