Ingesta dietética de los estudiantes de secundaria de la ciudad de Badajoz

ObjectivesTo quantify dietary intake of secondary education students in Badajoz, Spain, evaluating food frequency use in teenagers of both sexes.Material and methodsThe study sample consisted of 1197 secondary education students (49.9% male and 50.1% female). After giving informed consent, they completed a self-administered food frequency questionnaire (FFQ) including 51 food items divided into five separate categories. This questionnaire was modified from the one used at the Valencian Community in 2003 and previously validated in a pilot study on 374 students.ResultsMale and females students reported higher intakes of 70.6% and 17.6% of foods analyzed respectively, while intake of 11.8% of food items was similar in both sexes. Sex differences were statistically significant for 35% of foods (of which 72% and 28% were taken more frequently by males and females respectively). Intake of milk and dairy products appeared to be adequate, while intake of fish and seafood was low consumption of meat products was high. Intake of vegetables, fruits, bread, and cereals was below the recommended levels. Intake of pasta, rice, and oils was adequate, and there was not a high consumptio of cookies or industrial pastries. There was an excess intake of sweets, but intake of soft drinks was not high.ConclusionsThese results show intermediate values as compared to other national surveys.     

Aportaciones de los tests de supresión de cortisol al conocimiento de los trastornos psiquiátricos: revisión narrativa de la literatura

Activity of the hypothalamic-pituitary-adrenal axis had been studied for the past half century, when some researchers noted that some patients with Cushing's syndrome and severe mood disorders had high baseline cortisol levels, which resulted in an inhibited response in the 1 mg dexamethasone suppression test. Altered dexamethasone suppression test results were subsequently found in many psychiatric diseases, including anorexia nervosa, obsessive-compulsive disorder, degenerative dementia, bipolar disorders, and schizophrenia. The relationship between high baseline cortisol levels and stress has also been studied. Some researches on the genesis of borderline personality disorder focused on traumatic childhood backgrounds. Other investigations aimed at elucidating the relationship between traumatic backgrounds and some psychiatric disorders noted that patients with post-traumatic stress disorder and borderline personality disorder showed an enhanced cortisol suppression with low cortisol doses (0.5 mg). Recent studies showed that use of an ultra-low dose of cortisol during the dexamethasone suppression test may be helpful for deteting disorders with hyperactivity of the hypothalamic-pituitary-adrenal axis.Recent advances in neuroimaging support the existence of hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with borderline personality disorder, relating a decreased pituitary gland volume to major traumatic backgrounds and suicidal attempts. The purpose of this paper is to make a narrative review of research using dexamethasone suppression test in psychiatric disorders, in order to ascertain its value as a supplemental diagnostic test or as a prognostic marker.     

Rendimiento diagnóstico de los hallazgos ecográficos de los nódulos tiroideos en la detección de lesiones malignas

ObjetiveTo evaluate the diagnostic efficiency of sonographic findings (nodule size, the presence of microcalcifications and echogenicity) compared with the results of fine-needle aspiration biopsy (FNAB) of thyroid nodules.MethodsThe results of cytology and the ultrasound characteristics of 341 thyroid nodules were analyzed.ResultsA total of 25.5% of the FNAB were inadequate, 65.1% were benign and 7.9% were suspicious or malignant. The percentage of inadequate samples was clearly larger in nodules smaller that 15 mm but that of malignant cytologies was also larger in this group of nodules (11.1 versus 2.8%: p=0.04). The percentage of inadequate samples among nodules smaller than 10 mm was 66.7% and no malignancies were detected. A notable finding was the absence of suspicious or malignant FNAB in hyperechogenic and anechogenic nodules. In contrast, the echogenic feature most frequently associated with malignancy was hypoechogenicity, although echogenicity, as a whole, was not significantly associated with malignancy (p=0.313). Most cases with microcalcifications (6 of 10) were malignant compared with four of the 239 nodules (1.7%) without calcifications (p<0.001). Multivariate logistic regression revealed that the only variable maintaining a significant association with malignancy was the presence of microcalcifications.ConclusionsThyroid cytology is an efficient method to evaluate thyroid nodules larger than 10 mm. The presence of nodule microcalcifications is significantly associated with malignancy, while hyperechogenicity and anechogenicity are associated with benign nodules.     

Características diferenciales de la diabetes mellitus tipo 2 en el paciente anciano. Papel de los inhibidores de la dipeptidil peptidasa 4

The prevalence of type 2 diabetes mellitus increases with age, reaching rates around 30% in those over 75 years. The type 2 diabetes mellitus in the elderly has different pathophysiological and clinical characteristics from those of the younger diabetic patient. Some differential aspects in this population are the lower life expectancy and the frequent comorbidity, frailty and associated disability. Avoiding hypoglycemia is a therapeutic priority, given their increased risk of severe hypoglycemia. It is a situation in which the benefits of intensive glycemic control are virtually non-existent, thus prevention of side effects of treatments becomes a priority. Therefore, the goals of glycemic control should be less stringent than in the general population (glycated hemoglobin > 7%), and the drugs of choice should be those with a low risk of side effects (especially hypoglycemia) and well tolerated. Dipeptidyl peptidase 4 inhibitors (iDPP4) are particularly useful in this age group, either as a second drug added to metformin monotherapy, or as first line when metformin is contraindicated or not tolerated. In this article the evidence available on the efficacy and tolerance of different pharmacological options available in population over 70 years is reviewed.     

Análisis de los factores implicados en la evolución de los pacientes mayores de 80 años,ingresados en la unidad de cuidados intensivos: ¿debemos cambiar nuestro proceder?

Background and objectivesThe care of older patients in intensive care units (ICU) is becoming more frequent.To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality.Patients and methodsRetrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression.ResultsSix hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge.An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality.ConclusionsIn older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis.     

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición

IntroductionWaist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115 cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men.ConclusionWC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik     

Efecto de los movimientos explosivos y de impacto aplicados en piscina sobre la composición corporal,la fuerza y la densidad mineral ósea de mujeres mayores de 60 años

BackgroundOsteoporosis is characterised by loss of bone mass and deterioration of bone tissue microarchitecture that leads to fragility related to the risk of fractures. The aim of the study is to analyse the effects of a training program based on explosive movements and impact, assessed in a swimming pool, on body composition, explosive strength and bone mineral density in women over 60 years old.Material and methodsA total of 35 healthy physically active women (60 ± 4.19 years) were divided into a training pool group using multi jumps (JG) and a control group (CG). JG trained for 24 weeks, 3 times a week, an hour and a half per session. Body composition testing, explosive strength, and bone mineral density were assessed before and after the program.ResultsThere were differences in the explosive force (JG vs CG = P < .05 to .001) and the estimated power (JG vs CG = P < .05 to .002) between JG vs CG, with significant increases in JG. There were no significant differences in the percentage of fat and lean mass, bone mineral density lumbar and femoral between groups, although slightly significant increases in bone mineral density lumbar and femoral could be seen in JG after program implementation (JG pre-test vs JG post- test = P < .05).ConclusionsThe training program with impact and explosive movements assessed in a pool induces gains in muscle strength and power with slight adaptations in body mass index in women over 60 years.     

Fisionomía y sociología de los bosques de Nothofagus dombeyi en la región de Nahuel Huapi

Summary In the mountains around Lake Nahuel Huapi three belts of vegetation can be observed: the evergreen forests of Nothofagus dombeyi between surface level of the lake (ca. 770 m a.s.l.) and 1100–1200 m; the deciduous forests of Nothofagus pumilio; and the Andean-antarctic meadows and other communities above the timberline (±1600 m).A physiognomical study of the evergreen beech forests shows three main types of structure, one of which coincides with a quite different floristical composition.Detailed phytosociological work following the method of Braun-Blanquet is proving the floristical relationship between the deciduous forests of Nothofagus pumilio or N. antarctica and the main part of the evergreen patagonical forests of Nothofagus dombeyi, especially when austrocedrus chilensis is present. Besides other units, there has therefore been established a new alliance, Austrocedro-Nothofagion, belonging to the Nothofagetalia pumilionis-dombeyi as an order of the Nothofagetea pumilionis-antarcticae Oberd. 1960.Only a few stands in the extreme West of Argentine territory present the characteristics of the Nothofago-Winterion Oberd., which is an alliance of the Wintero-Nothofagetea Oberd., and corresponds to the forêt valdivienne of phytogeographical literature.Comment has been made on the theoretical bases of systematics, considering that in certain cases the forest communities studied demonstrate what some ecologists think to be a continuum of vegetation.     

Influencia de la enfermedad psiquiátrica previa en la evolución de los pacientes sometidos a cirugía bariátrica

IntroductionPresurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.Patients and methodsRetrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up > 6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).ResultsPatients in group 1 showed a greater tendency for weight gain. They regained a 9,4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p < 0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19,6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 ± 1.6 nutritional deficiencies per patient in group 1 and 2.5 ± 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).ConclusionsThe presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.     

Asociación de los diferentes niveles de hipoxemia en la altura con el perfil lipídico y la glucemia en varones y mujeres a 4.100 m de altitud en los Andes Centrales del Perú

Background and objectivesAt a same altitude, people with greater hypoxemia would have higher hemoglobin (Hb) levels than less hypoxemic patients. It is not known whether higher hypoxemia levels (as measured by higher Hb values) affect basal glucose and lipid profile at an altitude of 4,100 mg (Carhuamayo and Junln).Materials and methodsGlucose, lipid, and hemoglobin levels and body mass index (BMI) were assessed in 158 males and 348 females aged 35 to 75 years. Association of lipid and glucose levels with systolic and diastolic blood pressure (SBP and DBP) was also assessed. Results were analyzed using Student's t test, Chi-square test, analysis of variance, correlations, and linear multivariate analyses adjusted for age, sex, BMI, smoking, and education.ResultsHigher hemoglobin levels were directly associated to higher levels of total cholesterol (P < 0.001), low density lipoprotein cholesterol (P < 0.002), non-high density lipoprotein cholesterol (non-HDL) (P < 0.01), and triglycerides (P < 0.01). No association was found between hemoglobin and glucose (P > 0.05). Levels of total cholesterol, high density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol, and blood glucose were directly associated to DBP.ConclusionsIn people living at high altitude (4100 m), the non-HDL cholesterol fraction and triglycerides are directly associated to hemoglobin value, and increases in them are in turn associated to higher DBP.