Actividad física,condición física y sobrepeso en niños y adolescentes: evidencia procedente de estudios epidemiológicos

Physical activity and fitness play a significant role in prevention of overweight and obesity in children and adolescentes. Current understanding and evidence from epidemiologic studies provide useful insights to better understand how they relate to each other and how to develop future intervention strategies. This paper summarizes the most relevant information from cross-sectional and longitudinal studies on the relationships between physical activity, physical fitness, and overweight in early life. According to current scientific evidence: (i) High levels of physical activity during childhood and adolescence, particularly vigorous physical activity, are associated to lower total and central adiposity at this age and later in life; (ii) the level of physical fitness, especially aerobic fitness, is inversely related to current and future adiposity levels; (iii) overweight children and adolescents with a high fitness level have a healthier cardiovascular profile than their overweight, low fit peers and a similar profile to their normal weight, low fit peers. This suggests that high fitness levels may counteract the negative consequences attributed to body fat. These findings suggest that increasing physical fitness in overweight children and adolescentes may have many positive effects on health, including lower body fat levels.     

El anciano en la unidad de geriatría de agudos

Although the implementation of acute geriatric units (AGUs) in general hospitals has a grade A of evidency, in Spain, only 12% of them have this resource. The estimation of geriatric especializad beds for the care of acute frail elderly people is of 2.6/1000 inhabitants older than 75 years. AGUs have demonstrated to reduce the functional loss associated with the hospitalization and to increase the percentage of older people that can return home, without increases in mortality nor costs. In this review we present the characteristics of patients who benefit from AGUs, the services offered, the structure and functioning of the unit, the role of the professionals that work in it and the quality indicators that must be acomplished.     

Rol del enterocito en la dislipemia de la resistencia insulínica

The increase in cardiovascular morbidity and mortality associated to insulin resistance (IR) states (obesity, metabolic syndrome, type 2 diabetes) represents a major public health problem. In IR, dyslipidemia typically include hypertriglyceridemia, low high density lipoprotein cholesterol, increased small and dense low density lipoprotein particles, and post-prandial hyperlipidemia, which play a direct or indirect role in the mecanisms of atherosclerosis. Dyslipidemia is mainly due to accumulation of circulating triglyceride-rich lipoproteins from the liver and bowel. The bowel has traditionally been seen as a passive organ, but current evidence confirms that it is an active organ subject to regulation by free fatty acids, insulin, incretins, and inflammation. Two new concepts have emerged: intestinal IR and overproduction of chylomicrons in hyperinsulinemic/IR states. A better understanding of intestinal IR may make the enterocyte a therapeutic target.     

Resultado de la actualización de la vía clínica de la fractura de cadera del anciano en un hospital universitario de Madrid

Background and objectivesOrthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge.Material and methodA retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48 hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year.ResultsMedian age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48 hours (27,7% vs 36,8% p = 0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p < 0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p < 0.001), greater number of discharges in 15 days (78,2% vs 91,5% p < 0.001), lower delirium (54,1% vs 43,5% p = 0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year.ConclusionsUpdating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.     

Uso de sujeciones físicas en relación con el riesgo de caídas en una residencia de ancianos

Backgrounds and objectivesThe use of physical restraints (PR) is common in the care of the elderly. However, their efficacy and safety are not supported by scientific evidence. The aim of this study was to determine the role of PR in preventing falls.Materials and methodsA retrospective cohort study design was used, in which each fall incident (n = 575) was examined in the residents over 65 years of age who resided at the one nursing homes from February 2009 to September 2013. An analysis was made of the association between the use of PR and risk of falls using a multivariate logistic regression, adjusting for the characteristics of residents that were associated with the use of PR according to a bivariate analysis.ResultsRisk factors for falls after accounting for PR use, include: risk of falling (Tinetti test) (OR 4.57; 95% CI 1.76-11.75); ability to walk (OR 6.40; 95% CI 2.78-14.74); hearing impairment (OR 2.12; 95% CI 1.05-4.29); and history of a previous fall (OR 17.81; 95% CI 8.83-35.93). The risk of falls was greater in restrained, ambulatory residents with cognitive impairment (OR 18.95; 95% CI 7.06-50.85). No differences were found in injuries between falls that occurred with and without PR.ConclusionsRestraint use was not significantly associated with fewer falls and injuries. The risk of falls could increase in ambulatory residents with cognitive impairment. The study results suggest the need to consider whether restraints provide adequate protection against the risk of falls.     

Utilidad clínica de la micafungina en el tratamiento de las candidiasis invasoras en el paciente crítico

BackgroundOver the last 30 years a significant increase of Candida spp. invasive disease has been observed in non-neutropenic critical ill patients. Both fluconazole and amphotericin B have been considered first line treatment for invasive (proven and probable) Candida spp. disease, although the mortality rate is still high.ObjectivesTo review the current data on the use of micafungin for the treatment of Candida invasive disease in critical ill patients.MethodsThe pharmacologic, mycological and clinical properties of micafungin are reviewed based on current published data. The use and efficacy of micafungin for the treatment of Candida invasive disease in critical ill patients is discussed.Results and conclusionsTo reduce the rate of mortality more effective antifungals and pre-emptive treatment strategies are currently warranted. Candins achieve better results for the treatment of invasive Candida disease in non-neutropenic critical ill patients. Micafungin has a good safety profile (similar to fluconazole). Micafungin is a first line drug for the treatment of invasive Candida disease and may be used as a pre- emptive approach followed by a de-escalating strategy with azoles.     

Hongos queratinofílicos en suelos de parques de la ciudad de Corrientes,Argentina

BackgroundThe soil is a natural reservoir of keratinophilic fungi, which are a small but important group of filamentous fungi, some of which typically develop on keratinized tissues of living animals. There are numerous species of saprophytic fungi with recognized keratinophilic abilities, and several studies have been undertaken in order to link their presence to possible human disease.AimsTo know the biota of geophilic fungi in general and of keratinophilic fungi particularly in soils from two public parks.MethodsSoil samples from two public parks of Corrientes city, Argentina, were studied during two seasons, using the hook technique and serial dilutions for fungal isolation.ResultsUsing the hook technique, 170 isolates were classified into 17 genera and 21 species, among which it is worth mentioning the presence of Microsporum canis. Shannon index for keratinophilic fungi in autumn was 2.27, and 1.92 in spring. By means of the serial dilutions technique, 278 fungi isolated were identified into 33 genera and 71 species. Shannon index in autumn was 3.9, and 3.5 in spring.ConclusionsThe soils studied have particularly favorable conditions for the survival of pathogens and opportunistic geophilic fungi for humans and animals.     

Prevención de las caídas basada en la evidencia en Europa

ProFaNE (Prevention of Falls Network Europe) is a thematic network funded by the European Commission. This network brings together scientists, clinicians and other health professionals from across Europe to focus on four main topics (taxonomy and co-ordination of trials, clinical assessment and management of falls, assessment of balance function, and psychological aspects of falls). There are 24 members across Europe as well as Network Associates who contribute expertise at workshops and meetings. ProFa- NE, a 4-year project which started in January 2003, aims to improve and standardise healthcare processes by introducing and promoting good practice throughout Europe. ProFaNE has its own website (http://www.profane.eu.org) and undertakes workshops to bring together experts and observers involved in specific topics to exchange knowledge, expertise and resources on interventions to reduce falls. The present article discusses ProFaNE's achievements to date and the work in progress to achieve good clinical practice and research into the prevention of falls across Europe.     

Guía clínica de manejo de la diabetes insípida y del síndrome de secreción inapropiada de hormona antidiurética en el postoperatorio de la cirugía hipofisaria

Changes in water metabolism and regulation of vasopressin (AVP) or antidiuretic hormone (ADH) are common complications of pituitary surgery. The scarcity of studies comparing different treatment and monitoring strategies for these disorders and the lack of prior clinical guidelines makes it difficult to provide recommendations following a methodology based on grades of evidence. This study reviews the pathophysiology of diabetes insipidus and inappropriate ADH secretion after pituitary surgery, and is intended to serve as a guide for their diagnosis, differential diagnosis, treatment, and monitoring.     

Evaluación de la efectividad del tratamiento con glucocorticoides intravenosos en la oftalmopatía de Graves

ObjectiveTo assess the efficacy of intermittent, high-dose treatment with intravenous glucocorticoids (IV GCs) in moderate to severe Graves’ ophthalmopathy (GO).Materials and methodsPatients with GO treated with IV GCs from August 2007 to August 2011 at the Endocrinology Department of Reina Sofía Hospital were enrolled into the study. IV pulse prednisolone (7.5 mg/kg/day) was administered twice weekly every two weeks for 6 weeks, and at half the dose for 6 additional weeks.ResultsEighteen patients (mean age, 43+/-11 years) with moderate to severe GO were analyzed (83.3% females). Four were active smokers, five former smokers, and the rest had never smoked. Hyperthyroidism due to Graves’ disease was found in 66.7% of patients, 41.6% of whom had received radioiodine therapy. Response to treatment was satisfactory in 72.2%, partial in 11.1%, and poor in 16.7%. Mild side effects were reported by 5 patients. Before treatment, 83.3% had diplopia, 33.3% eyelid retraction, 72.2% eye pain, and 44.4% exophthalmos. After treatment, only 33.3% had diplopia (P = .004), 5.6% eyelid retraction (P = .063), 16.7% eye pain (P = .002), and 11.1% exophthalmos (P = .031). Response to treatment was not related to the underlying disease (P = .866), prior radioiodine treatment (P = .447), or smoking status (P = .368).ConclusionsIntravenous glucocorticoid therapy decreased activity in patients with moderate to severe active GO, with major improvement occurring in diplopia, eye pain, and exophthalmos. Side effects were mild and uncommon. Treatment response was independent from the underlying disease, prior radioiodine treatment, or smoking status.