Prevalencia de los factores de riesgo de pie diabético y nivel de conocimiento sobre autocuidados en personas con diabetes. Estudio PIEDIFAC / Prevalence of diabetic foot risk factors and level of knowledge about self-care in people with diabetes. PIEDIFAC study

OBJETIVO: Conocer la prevalencia de los factores de riesgo de pie diabético, el nivel de conocimientos, la capacidad y la realización de autocuidados de las personas con diabetes. Evaluar las intervenciones farmacéuticas.MATERIAL Y MÉTODOS: Diseño: Estudio observacional descriptivo y transversal a realizar en farmacias comunitarias españolas del 15 al 30 de noviembre de 2021. Aprobado por el Comité de Ética de la Investigación (CEICA) de Zaragoza. Inclusión: Usuarios mayores de edad, con tratamiento hipoglucemiante superior a un año, con autonomía y consienten participar. Variable principal: la puntuación del cuestionario adhoc (media±DS) y categorización(N+%), agrupado en los ítems: información sobre la revisión de los pies; adecuación de calzado y calcetines; capacidad física de autoexploración correcta y de detección de alteraciones; Inspección e información por farmacéutico. Recogida de datos: SEFAC e-XPERT. Procedimiento: 1.Diseño de un cuestionario de conocimientos y autocuidados del pie diabético. 2. Ofrecimiento, selección y aleatorización de los usuarios. 3. Cumplimentación de los datos sociodemográficos y la primera parte del cuestionario: conocimiento de autocontroles del pie. 4. Exploración del pie por el farmacéutico. 5. Intervención. (AU)

Funcionamiento familiar, sobrecarga y calidad de vida del cuidador del adulto mayor con dependencia funcional / Family dynamics, overload, and quality of life among caregiver of functionally dependent older adults / Funcionamento familiar, sobrecarga e qualidade de vida no cuidador do idoso com dependência funcional

Resumen Introducción: Ser cuidador de personas con dependencia funcional conlleva el riesgo de presentar deterioro de la calidad de vida, esto puede deberse a que la prolongación del cuidado altera la dinámica familiar y genera sobrecarga en el cuidador. Objetivo: 1) Identificar la relación entre funcionamiento familiar y calidad de vida del cuidador del adulto mayor y 2) Determinar la sobrecarga y calidad de vida del cuidador del adulto mayor. Metodología: Estudio descriptivo y correlacional, muestreo por bola de nieve, la muestra conformada por 86 cuidadores de un centro comunitario. Para las mediciones se utilizó el índice de Barthel, el Test de APGAR Familiar, la prueba de Zarit y la Escala de Calidad de Vida WHOQOL-BREF. Se aplicó la Prueba de Kolmogorov Smirnov y Prueba de Correlación de Spearman. Resultados: El 11.6% de los adultos mayores presentó dependencia total, la percepción de disfuncionalidad familiar grave representó el 3.5%. Los cuidadores con sobrecarga intensa fueron el 32.6%, el 8.1% percibió la calidad de vida deficiente. A mayor funcionamiento familiar mayor calidad de vida del cuidador (p<.05) y a mayor sobrecarga, menor calidad de vida del cuidador (p<.05) en todas las dimensiones. Conclusiones: Se observó que la sobrecarga y funcionalidad familiar están relacionadas con la calidad de vida del cuidador, por lo que se convierten en un escenario disciplinar que plantea la posibilidad de diseñar estrategias de intervención, centradas en la sobrecarga y el funcionamiento de la familia para el mejoramiento de la calidad de vida del cuidador.

Abstract Introduction: The prolonged provision of healthcare to functionally dependent persons can result in the deterioration on the caregiver's quality in terms of family dynamics and overload. Objectives: 1) To identify the relationship between the family dynamics and the quality of life of the caregiver of older adults; and 2) to estimate the quality of life and the overload of the caregiver of older adults. Methodology: This is a descriptive and correlational study with a snowball-derived sample of 86 caregivers in a communitarian center. The corresponding measures were estimated using the Barthel Index, the Family APGAR Test, the Zarit Test, and the WHOQOL-BREF Quality of Life Scale. The Kolmogorov-Smirnov and Spearman Correlation tests were calculated. Results: 11.6% of the older adults being cared showed total dependency. 3.5% of the caregiver's sample perceived having a severe family dysfunction. 32.6% of the sample were found having heavy overloads. 8.1% of the sample perceived having poor quality of life. In all dimensions, the better the family dynamics were, the better the quality of life of the caregivers was (p<.05), and the heavier the overload was, the worse the quality of life of the provider was (p<.05). Conclusions: It was noted that both, overload and family dynamics, are related to the quality of life of the caregivers of older adults; therefore, the design of intervention strategies should be focused on the overload and family dynamics of these professionals in order to improve their quality of life.

Resumo Introdução: Ser cuidador de pessoas com dependência funcional implica o risco de apresentar deterioro da qualidade de vida, isto pode dever-se a que o prolongamento do cuidado altera a dinâmica familiar e gera sobrecarga no cuidador. Objetivo: 1) Identificar a relação entre funcionamento familiar e qualidade de vida do cuidador do idoso e 2) Determinar a sobrecarga e qualidade de vida no cuidador do idoso. Metodologia: Estudo descritivo e correlacional, amostragem por bola de neve, a amostragem conformada por 86 cuidadores de um centro comunitário. Para as medições utilizou-se o índice de Barthel, o Teste de APGAR Familiar, a prova de Zarit e a Escala de Qualidade de Vida WHOQOL-BREF. Aplicou-se a prova de Kolmogorov Smirnov e Prova de Correlação de Spearman. Resultados: O 11.6% dos idosos apresentou dependência total, a percepção de disfuncionalidade familiar grave representou o 3.5%. Os cuidadores com sobrecarga intensa foram o 32.6%, o 8.1% percebeu a qualidade de vida deficiente. Quanto maior funcionamento familiar, maior qualidade de vida do cuidador (p<.05) e quanto maior sobrecarga, menor qualidade de vida do cuidador (p<.05) em todas as dimensões. Conclusões: Observou-se que a sobrecarga e funcionalidade familiar estão relacionadas com a qualidade de vida do cuidador, pelo que se tornam em um cenário disciplinar que envolve a possibilidade de desenhar estratégias de intervenção, centradas na sobrecarga e o funcionamento da família para o melhoramento da qualidade de vida do cuidador.

Potential Immunomodulatory Role of Specific Anticytomegalovirus Intravenous Immunoglobulin in Heart Recipients.

BACKGROUND: Specific anticytomegalovirus (anti-CMV) intravenous immunoglobulin (IVIG) has the potential to influence the immune response, but its complex mode of action has not been well evaluated. METHODS: An immunologic study of 6 CMV-seronegative heart transplant patients receiving anti-CMV prophylaxis with the use of ganciclovir and CMV-IVIG (150 mg/kg within 24 hours after transplantation and 100 mg/kg on days 2, 7, 14, 22, 35, 56, and 77 after transplantation) was performed in a single center. Lymphocyte subsets were evaluated by means of 4-color flow cytometry at the time of inclusion in the waiting list and at 3 months after transplantation. RESULTS: High-risk heart recipients receiving CMV-IVIG showed a clear reduction in the frequency of activated CD4+CD38+DR+ T-helper cells at 3 months after transplantation compared with a group of 27 untreated control subjects who received only anti-CMV prophylaxis with the use of ganciclovir. In this study, an increase of CD19+CD27-IgM+IgD+ naïve B cells was also observed in seronegative recipients after prophylaxis with the use of CMV-IVIG but not in control subjects. None of the CMV-IVIG-treated recipients developed acute cellular rejection during the 1st 6 months after transplantation. CONCLUSIONS: The immune modulation of activated CD4+ lymphocyte and of naïve B-cell subsets after CMV-IVIG use should be further evaluated in future prospective studies with higher numbers of patients.

Evaluation of an immunological score to assess the risk of severe infection in heart recipients.

BACKGROUND: We previously reported how specific humoral and cellular immunological markers that are readily available in clinical practice can be used to identify heart transplant recipients (HTR) at risk of developing severe infections. In this study, we perform an extended analysis to identify immunological profiles that could prove to be superior to individual markers in assessing the risk of infection early after heart transplantation. METHODS: In a prospective follow-up study, we evaluated 100 HTR at 1 week after transplantation. Laboratory tests included determination of immunoglobulin (Ig) levels (IgG, IgA, IgM), complement factors (C3 and C4), and lymphocyte subsets (CD3+, CD4+, CD8+ T cells, B cells, and natural killer [NK] cells). The prevalence of infection during the first 3 months was registered at scheduled visits after transplantation. Severe infections were defined as all infections requiring hospitalization and intravenous antimicrobial therapy. RESULTS: During follow-up, 33 patients (33%) developed severe infections. The individual risk factors of severe infection, according to the Cox regression analysis, were as follows: IgG <600 mg/dL (hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.21-4.78; P = 0.012), C3 <80 mg/dL (HR, 4.65; 95% CI, 2.31-9.38; P < 0.0001), C4 <18 mg/dL (HR 2.30, 95% CI, 1.15-4.59; P = 0.018), NK count <30 cells/µL (HR 4.07, 95% CI, 1.76-9.38; P = 0.001), and CD4 count <350 cells/µL (HR, 3.04; 95% CI, 1.47-6.28; P = 0.0027). An immunological score was created. HRs were used to determine the number of points assigned to each of the 5 previously mentioned individual risk factors. The score was obtained from the sum of these factors. In the multivariate Cox regression analysis, the immunological score was useful for identifying patients at risk of infection and was the only variable that maintained a significant association with the development of infection, after adjustment for the 5 individual factors. CONCLUSION: Patients with an immunological score ≥13 were at the highest risk of severe infections (HR, 9.29; 95% CI, 4.57-18.90; P < 0.0001). This score remained significantly associated with the risk of severe infection after adjustment for clinical risk factors of infection. An immunological score was useful for identifying HTR at risk of developing severe infections. If this score is validated in multicenter studies, it could be easily introduced into clinical practice.

Comparison of drug survival rates for tumor necrosis factor antagonists in rheumatoid arthritis.

BACKGROUND: Persistence of anti-tumor necrosis factor (TNF) therapy in rheumatoid arthritis (RA) is an overall marker of treatment success. OBJECTIVE: To assess the survival of anti-TNF treatment and to define the potential predictors of drug discontinuation in RA, in order to verify the adequacy of current practices. DESIGN: An observational, descriptive, longitudinal, retrospective study. SETTING: The Hospital Clínico Universitario de Valladolid, Valladolid, Spain. PATIENTS: RA patients treated with anti-TNF therapy between January 2011 and January 2012. MEASUREMENTS: Demographic information and therapy assessments were gathered from medical and pharmaceutical records. Data is expressed as means (standard deviations) for quantitative variables and frequency distribution for qualitative variables. Kaplan-Meier survival analysis was used to assess persistence, and Cox multivariate regression models were used to assess potential predictors of treatment discontinuation. RESULTS: In total, 126 treatment series with infliximab (n = 53), etanercept (n = 51) or adalimumab (n = 22) were administered to 91 patients. Infliximab has mostly been used as a first-line treatment, but it was the drug with the shortest time until a change of treatment. Significant predictors of drug survival were: age; the anti-TNF agent; and the previous response to an anti-TNF drug. LIMITATION: The small sample size. CONCLUSION: The overall efficacy of anti-TNF drugs diminishes with time, with infliximab having the shortest time until a change of treatment. The management of biologic therapy in patients with RA should be reconsidered in order to achieve disease control with a reduction in costs.

Kinetics of functionally distinct T-lymphocyte subsets in heart transplant recipients after induction therapy with anti-CD25 monoclonal antibodies.

T cells are involved in the maintenance of immunocompetence and in the development of alloimmune responses in solid organ transplant recipients. The kinetics of functionally distinct T-cell subsets in peripheral blood has received little attention in the field of heart transplantation. We performed a simultaneous analysis of the maturation, activation, and regulatory profiles of T cells using 4-color flow cytometry in a study of 77 heart recipients. Induction therapy included 2 doses of anti-CD25 monoclonal antibodies (daclizumab). Lymphocyte subsets were prospectively evaluated at different times before and up to 1 year after transplantation in 46 heart recipients. A separate cross-sectional study was performed in 33 heart recipients who had received a transplant more than 1 year previously to evaluate abnormalities persisting in the long term. As compared with baseline values, a decrease in regulatory CD4+ T-cell percentages (CD4+CD127lowCD25highFoxP3+) was observed from day 7 to 12 months after transplantation. Interestingly, T cells expressing the beta chain of IL-2 (CD122+) remained stable during the first 3 months. A significant decrease in the activation status of CD4 T cells was documented from day 7 to 1 year after transplantation, while the activation status of CD8+ T cells remained stable during follow-up. Compared with values for healthy controls (n=36), higher CD8+ terminally differentiated effector memory percentages (CD8+CD45RA+CCR7-) were observed from baseline up to more than 1 year after transplantation. Rejection was associated with higher levels of these cells during the first 6 months after transplant. We characterized the abnormalities in distinct functional T-cell subsets at different times before and after heart transplantation. Some of these abnormalities should be further investigated as biomarkers of clinical complications.

Evaluation of lymphoproliferative responses by carboxy fluorescein succinimidyl ester assay in heart recipients with infections.

The analysis of proliferative responses using 5,6-carboxyfluorescein diacetate succinimidyl ester (CFSE) in flow cytometry is widely used to assess lymphocyte function. The aim of this study was to evaluate nonspecific and specific lymphoproliferative responses using CFSE in heart recipients before and after transplantation and their association with the development of infection. We used four-color flow cytometry to measure the response of peripheral CD3+, CD4+, and CD8+ T cells to phytohemagglutinin mitogen (PHA), tetanus toxoid, hepatitis B, and influenza vaccines using a CFSE proliferation assay in 12 heart recipients and 8 healthy control subjects. Recipients were prospectively evaluated. Immunological studies were performed before and at 3 months after transplantation. A 12-month clinical follow-up examination sought to detect the prevalence of severe infectious complications. Heart recipients (infected [n = 7] and uninfected [n = 5]) disclosed significantly lower percentages of proliferative responses than healthy controls against PHA at both study points. Baseline CD3+, CD4+, and CD8+, antitetanus proliferative responses were significantly lower in infected heart recipients than controls. Patients who developed infections displayed significantly lower percentages of CD3+CFSE and CD8+CFSE cells to PHA mitogen at 3 months after transplantation versus those without infections. In conclusion, nonspecific T-cell reactivity to PHA was lower in heart recipients with posttransplantation infections.

Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients.

BACKGROUND: Infection remains a source of mortality in heart recipients. We previously reported that post-transplant immunoglobulin G (IgG) quantification can help identify the risk for infection. We assessed whether other standardized parameters of humoral and cellular immunity could prove useful when identifying patients at risk of infection. METHODS: We prospectively studied 133 heart recipients over a 12-month period. Forty-eight patients had at least one episode of severe infection. An event was defined as an infection requiring intravenous antimicrobial therapy. RESULTS: Cox regression analysis revealed an association between the risk of developing infection and the following: lower IgG2 subclass levels (day 7: relative hazard [RH] 1.71; day 30: RH 1.76), lower IgA levels (day 7: RH 1.61; day 30: RH 1.91), lower complement C3 values (day 7: RH 1.25), lower CD3 absolute counts (day 30: RH 1.10), lower absolute natural killer [NK] cell count (day 7: RH 1.24), and lower IgG concentrations (day 7: RH 1.31; day 30: RH 1.36). Cox regression bivariate analysis revealed that lower day 7 C3 levels, IgG2 concentration, and absolute NK cell count remained significant after adjustment for total IgG levels. CONCLUSIONS: Data suggest that early immune monitoring including C3, IgG2, and NK cell testing in addition to IgG concentrations is useful when attempting to identify the risk of infection in heart transplant recipients.

The AL 333-160 fourth metatarsal from Hadar compared to that of humans, great apes, baboons and proboscis monkeys: non-conclusive evidence for pedal arches or obligate bipedality in Hadar hominins.

Based on comparisons to non-statistically representative samples of humans and two great ape species (i.e. common chimpanzees Pan troglodytes and lowland gorillas Gorilla gorilla), Ward et al. (2011) concluded that a complete hominin fourth metatarsal (4th MT) from Hadar, AL 333-160, belonged to a committed terrestrial biped with fixed transverse and longitudinal pedal arches, which was no longer under selection favoring substantial arboreal behaviors. According to Ward et al., the Hadar 4th MT had (1) a torsion value indicating a transverse arch, (2) sagittal plane angles between the diaphyseal long axis and the planes of the articular surfaces indicating a longitudinal arch, and (3) a narrow mediolateral to dorsoplantar base ratio, an ectocuneiform facet, and tarsal articular surface contours all indicating a rigid foot without an ape-like mid-tarsal break. Comparisons of the Hadar 4th MT characters to those of statistically representative samples of humans, all five great ape species, baboons and proboscis monkeys show that none of the correlations Ward et al. make to localized foot function were supported by this analysis. The Hadar 4th MT characters are common to catarrhines that have a midtarsal break and lack fixed transverse or longitudinal arches. Further comparison of the AL 333-160 4th MT length, and base, midshaft and head circumferences to those of catarrhines with field collected body weights show that this bone is uniquely short with a large base. Its length suggests the AL 333-160 individual was a poor leaper with limited arboreal behaviors and lacked a longitudinal arch, i.e. its 4th MT long axis was usually held perpendicular to gravity. Its large base implies cuboid-4th MT joint mobility. A relatively short 4th MT head circumference indicates AL 333-160 had small proximal phalanges with a restricted range of mobility. Overall, AL 333-160 is most similar to the 4th MT of eastern gorillas, a slow moving quadruped that sacrifices arboreal behaviors for terrestrial ones. This study highlights evolutionary misconceptions underlying the practice of using localized anatomy and/or a single bony element to reconstruct overall locomotor behaviors and of summarizing great ape structure and behavior based on non-statistically representative samples of only a few living great ape species.

Restoration of humoral immunity after intravenous immunoglobulin replacement therapy in heart recipients with post-transplant antibody deficiency and severe infections.

IgG hypogammaglobulinemia is a risk factor for infection in heart recipients. We assessed reconstitution of humoral immunity after non-specific intravenous immunoglobulin (IVIg) replacement therapy administered to treat secondary IgG hypogammaglobulinemia in heart recipients with severe infections. The study population comprised 55 heart recipients who were administered IVIg (IVIg group) and 55 heart recipients with no severe infectious complications (control group). An event was defined as a severe infection requiring intravenous drug therapy during the first year after transplantation. The IVIg protocol comprised non-specific 5% pasteurized IVIg at a dose of 300-400 mg/kg/months. IgG titers were lower in the IVIg group than in controls at seven d (577 vs. 778 mg/dL, p < 0.001) and at one month (553 vs. 684, p = 0.003). After IVIg therapy, IgG concentrations were similar in both groups at three months (681 vs. 737, p = 0.25) and at six months (736 vs. 769, p = 0.46). At three months, the IVIg group had higher levels of antitetanus toxoid and anti-HBs (ELISA, 2.07 ± 2.11 vs. 0.60 ± 1.24 mg/dL [p = 0.003] and 42 ± 40 vs. 11 ± 31 IU/mL [p = 0.005], respectively) than controls. The mean number of infectious complications was significantly lower after IVIG therapy in the IVIG group. IVIg was associated with restoration of humoral immunity in heart recipients with post-transplant IgG hypogammaglobulinemia and severe infections.

The Jinniushan hominin pedal skeleton from the late Middle Pleistocene of China.

Bipedalism has long been recognized as the seminal adaptation of the hominin radiation and thus used to distinguish hominins from great ape fossils. Notwithstanding preconceptions and varied interpretations, the distinctive features of the modern human foot and accompanying striding gait, appear to be recent innovations that are largely absent in the earliest facultative bipeds. These distinctive features are mainly components of fixed longitudinal and transverse pedal arches, and of a uniquely derived hallucal metatarsophalangeal joint. They enhance ankle joint plantar flexor function and accommodate localized peak plantar pressures at the medial ball during terminal stance. To date, the paleontological record has yielded very little of the hominin foot, especially of the Middle Pleistocene hominins. New specimens from this time interval should help provide insights into the timing and pattern of what appears to be a mosaic pattern of evolution of the modern human foot features. Here we describe the fossil hominin foot skeleton recovered from the Jinniushan site, Liaoning Province, People's Republic of China. It affords a singular glimpse of the pedal morphology of a late Middle Pleistocene hominin (c.f. Homo heidlebergensis). Dated to 200ka or older, this foot offers the earliest evidence for increased stability of the medial longitudinal arch, while retaining a number of primitive features apparently characteristic of robust premodern hominins, including lower arches and a less stable hallucal metatarsophalangeal joint (medial ball) than in modern humans. These features reflect different foot capabilities and suggest the bipedal stride of the Jinniushan hominin differed subtlety from that of modern humans.

Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad / Adequacy of the admissions and care provided to the patients with community-acquired pneumonia

Objetivo. El objetivo de este estudio es conocer la adecuación de los ingresos hospitalarios por neumonía adquirida en la comunidad (NAC) aplicando la Regla de Clasificación Pronóstica de Fine Modificada y si la atención del paciente se realiza según los indicadores de calidad que la Infection Diseases Society of America (IDSA) recomienda. Pacientes y métodos. Estudio retrospectivo y transversal que analiza la adecuación de ingresos hospitalarios de todos los pacientes atendidos con NAC en el Hospital Clínico Universitario de Valladolid durante el año 2006. A todos los pacientes se les aplicó la Regla de Clasificación Pronóstica de Fine Modificada para evaluar la adecuación de ingresos hospitalarios analizando la comorbilidad asociada, los parámetros de gravedad y los indicadores de calidad. Resultados. Se detectaron 23 casos (6,07%) de NAC que ingresaron de manera inadecuada de los cuales 5 eran clase I (21,7%), 10 clase II (43,4%) y 8 clase III (34,7%). La EPOC (32,5%) y la hipoxemia (36%) fueron la comorbilidad y el factor de riesgo más implicados a la hora de justificar el ingreso de las NAC de bajo riesgo. Se evidenciaron 25 (32,89%) altas inadecuadas desde Urgencias y con respecto a su PSI se encontró: clase I: 2 (8%); clase II: 10 (40%); clase III: 7 (28%); clase IV: 4 (16%); clase V: 0; Fine desconocido: 2. La comorbilidad más implicada en las altas inadecuadas fue la EPOC (10 [40%]). Se realizaron: hemocultivos en 160 casos (42,2%), radiografía de tórax en 379 (100%), gasometría y/o oximetría de pulso en 379 (100%), y determinación de Ag de Streptococcus pneumoniae y Legionella en orina en 14 (87,5%) de los 16 casos de NAC que precisaron ingreso en UCI. Conclusión. La Regla de Clasificación Pronóstica de Fine Modificada puede ser muy útil a la hora de evaluar la adecuación de ingresos y para decidir la necesidad de ingresos hospitalarios por NAC. Destaca la adecuada atención de los pacientes con NAC según los indicadores de calidad establecidos por la IDSA(AU)

Background. The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. Patients and methods. A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. Results. We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. Conclusion. The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out(AU)

Behavioral and phylogenetic implications of a narrow allometric study of Ardipithecus ramidus.

Narrow allometry is used to compare Ardipithecus ramidus molar and body segment lengths and proportions to those of living primates, with the goal of reconstructing fossil behavior and exploring how lengths and proportions bear on phylogeny. Comparatively short hands and upper limbs suggest Ardipithecus was less adept at forelimb suspension and vertical climbing than are great apes. Its tibial and tarsal lengths, suggest bonobo-like leaping ability. Its short lower limbs, but long toes relative to humans, are not conducive to habitual bipedality. When terrestrial, Ardipithecus would have engaged in palmigrade quadrupedality. Compared to the semi-digitigrade baboon its long fingers and toes suggest a less marked terrestrial commitment and agree with carpal anatomy reflecting full palmigrady. Molar dimensions and surface areas are similar to those of baboons and drills, but greater than in chimpanzees, indicating a diet with less fruit and more roughage than that of chimpanzees. Ardipithecus dimensions reflect a generalized ape, able to move in trees and on the ground, and exploit food sources in woodlands, grasslands and/or flooded terrain. These abilities are well-suited to the mosaic habitats that characterize Africa at 11°N. Parsimonious reconstruction of the common human/African ape ancestor suggests the short upper limbs and metacarpals of Ardipithecus are too derived to belong to an exclusive human ancestor. Because parsimony is a theoretical construct and not an evolutionary reality, derived segment lengths alone do not prove conclusively Ardipithecus is not such an ancestor. Description in Ardipithecus of complex anatomy uniquely shared by humans and African apes, that leaves a record of reversals or parallelisms, would be a first step in showing whether this fossil qualifies as such an ancestor.

[Adequacy of the admissions and care provided to the patients with community-acquired pneumonia]. / Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad.

BACKGROUND: The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. PATIENTS AND METHODS: A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. RESULTS: We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. CONCLUSION: The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out.

Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid / Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid

Objetivos: Descripción de las características antropométricas de una muestra de adolescentes de Valladolid junto al análisis de ingesta dietética del grupo de población. Material y métodos: Estudio de campo observacional descriptivo transversal, de una muestra de 557 adolescentes (14 - 18 años), seleccionada por muestreo probabilística de entre 6 institutos públicos y privados, de distintos barrios de Valladolid. Se realizó un cuestionario de frecuencia de consumo junto a la medición antropométrica. La clasificación de los individuos se realizó mediante el cálculo del Z-score del Índice de Masa Corporal (IMC),los puntos de corte para el IMC de Cole y criterios de la International Diabetes Federation (IDF). El análisis nutricional se realizó mediante un enfoque probabilístico y el índice de adecuación nutricional. Resultados: El exceso de peso es similar en ambos sexos(17%), sin emabargo existe un 15,2% de prevalencia de bajo peso entre las mujeres estudiadas, frente al 4,5% en varones(p<0,005). El 1,3% presentan riesgo de padecer síndrome metabólico. El consumo energético se distribuye: 30-32% lípidos, 45% hidratos de carbono y 16-17% proteínas. La valoración nutricional refleja probable déficit de consumo en yodo, zinc, vitaminas A y E. Conclusiones: La prevalencia de obesos está próxima ala de otras series, pero la prevalencia de sobrepeso es inferior. Es muy importante el porcentaje de mujeres con IMC por debajo de lo normal para su edad y sexo. Existe un exceso de aporte proteico, de grasas saturadas y de colesterol, con un déficit en el consumo de hidratos de carbono, yodo, zinc y vitaminas A y E (AU)

Objectives: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. Materials and methods: Observational study of descriptive cross-field of a sample of 557 adolescents (14 - 18years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole`s cut off points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacyratio. Results: Excess weight is similar in both sexes (17%),but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. Conclusions: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E (AU)

Immunophenotypic abnormalities of CD8+ T-cell subsets in a patient with unusual Good's Syndrome

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