Modulación antioxidante y antiinflamatoria del ejercicio físico durante el envejecimiento

Aging is characterised by a gradual loss of the functional reserve. This, along with the fostering of sedentary habits and the increase in risk factors, causes a deterioration of antioxidant defences and an increase of the circulatory levels of inflammatory and oxidative markers, boosting a low-rate chronic inflammation, defined as inflamm-aging. This phenomenon is present in the aetiopathology of chronic diseases, as well as in cognitive deterioration cases associated with aging. The objective of this review is to describe the modulation of antioxidant and anti-inflammatory effects of physical exercise of moderate intensity and volume in the elderly. Evidence of its effectiveness as a non-pharmacological resource is presented, which decreases some deleterious effects of aging. This is mainly due to its neuroprotective action, the increase in circulating anti-inflammatory markers, and the improvement of antioxidant defence derived from its practice.     

Ingesta de yodo durante el embarazo: efectos en la función tiroidea materna y neonatal

IntroductionRecent studies in Spain have shown an inadequate iodine intake in a significant proportion of pregnant women. Pregnancy increases thyroid hormone requirements, and adequate iodine intake is therefore needed.Material and methodsOne hundred and forty-seven women in their third trimester (week 37) of pregnancy provided a blood sample and a 24-hour urine sample to test serum and urine iodine levels and completed a food frequency questionnaire to assess iodine intake during pregnancy. Serum TSH levels were measured in the babies born to the 140 mothers in the postpartum group.ResultsOnly 10.9% of pregnant women consumed more than 250 μg iodine daily, and 24.4% of them consumed less than 100 μg daily. Mean free T4 levels were 9.37 pmol/L, and 74 women (54.41%) had levels below the hypothyroxinemia threshold. TSH levels were normal in 135 newborns (96.4%), while 5 (3.6%) had levels higher than 5 μU/mL.     

Valoración de la función tiroidea durante la gestación: intervalos de referencia de tirotropina y tiroxina no unida a proteína durante el primer trimestre

Background and objectivesThe physiological changes that occur during pregnancy affect the physiology of the thyroid gland. Consequently, interpretation of thyroid function markers during pregnancy requires trimester-specific reference intervals. The aims of our study were to: 1) establish first-trimester reference intervals for biochemical markers of thyroid function [thyroid-stimulating hormone (TSH) and free thyroxine (T4)] and 2) to establish the prevalence of autoimmune thyroid disease in pregnant women resident in Cartagena (Murcia, Spain).Patients and methodA total of 441 women between weeks 11 and 13 of pregnancy were included in this study. A blood sample was extracted from all women to measure TSH, free T4 and antithyroid antibodies. Reference intervals for TSH and free T4 were determined in 400 pregnant women without autoimmune thyroid disease or known thyroid disease.ResultsAutoimmune thyroid disease was detected in 23 pregnant women (5.2%) who showed TSH levels higher than those in pregnant women without thyroid autoimmunity. First-trimester reference intervals were as follows: TSH: 0.130–3.710 mUI/L; free T4: 0.89–1.50 ng/dL. These reference intervals differed from the non-pregnant reference intervals used in our laboratory.ConclusionsThe reference intervals established are useful to evaluate thyroid function in women between 11 and 13 weeks of pregnancy. Interpretation of thyroid function requires intervals established in a reference population without autoimmune thyroid disease and with the methodology usually used to analyze these markers.     

Impacto de la pandemia por COVID-19 y el confinamiento estricto de la población en la incidencia de fractura de cadera en España. Una revisión sistemática

Background and objectiveDuring the COVID-19 pandemic, a strict population confinement was decreed in Spain. In a situation of health crisis and health system saturation, knowledge of pathologies whose treatment cannot be delayed is of great importance for the correct management of resources and processes. The objective was to determine the influence of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain.Material and methodSystematic review following the PRISMA guidelines. Search in Pubmed and Chocrane Library on 11/11/2022: hip fracture and COVID-19 and Spain.ResultsSix studies met the inclusion criteria, 50% showed a decrease in the hip fractures incidence during strict population confinement (all in Comunidad de Madrid hospitals), and in the other 50% there were no differences (all in other region hospitals). It was constant that hip fractures, either did not decrease, or decreased much less than the rest of fractures during the period of strict population confinement, increasing their relative number with respect to the total admissions in orthopedic surgery and traumatology.ConclusionsThe behavior of the hip fractures number during the strict population confinement decreed by the COVID-19 pandemic has not been symmetrical in all regions. To design and implement contingency plans in the event of a pandemic situation, these data must be taken into account in order to properly plan material and human resources.     

Guía clínica para el manejo del nódulo tiroideo y cáncer de tiroides durante el embarazo

Special considerations are warranted in management of thyroid nodule and thyroid cancer during pregnancy. The diagnostic and therapeutic approach of thyroid nodules follows the standard practice in non-pregnant women. On the other hand, differentiated thyroid cancer management during pregnancy poses a number of challenges for the mother and fetus. The available data show that pregnancy is not a risk factor for thyroid cancer development or recurrence, although flare-ups cannot be completely ruled out in women with active disease. If surgery is needed, it should be performed during the second term or, preferably, after delivery. A majority of pregnant patients with low-risk disease only need adjustment in levothyroxine therapy. However, women with increased serum thyroglobulin levels before pregnancy or structural disease require regular thyroglobulin measurements and neck ultrasound throughout pregnancy. Pregnancy is an absolute contraindication for radioactive iodine administration.     

Valoración del estado nutricional en Geriatría: declaración de consenso del Grupo de Nutrición de la Sociedad Española de Geriatría y Gerontología

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics.Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner.The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics.     

La medición de la dependencia a partir del tiempo de cuidado y del baremo de valoración de dependencia

AimsTo assign care time to the activities collected in the Dependency Assessment Scale (BVD) and to analyse the relationship between care time and the score received on the BVD.MethodsA cross-sectional observational study of 148 dependent persons was carried out. Socioeconomic and clinical data, the BVD, the 6-dimensional dependency indicator (DEP-6D), as well as data from a diary with the time of care received, were collected. The median time needed to carry out the activities included in the BVD was estimated from the diary. Following the BVD methodology, those who had their mental functions affected were separated. Each person was assigned two scores, one based on BVD and the other based on the time that the caregivers spent to care for them. The correlation between the two was estimated, and a regression was performed to identify the main explanatory factors for the disparity between the two indicators.ResultsBVD and hours of care show a moderate positive correlation. The mental impairment of the dependent person increased the time of care in most activities. The regression analysis suggests that while mental impairment is the main explanatory factor of obtaining a higher assessment with care time than with BVD, being bedridden is the main predictor of having a higher sore with the BVD.ConclusionsThe construct that underlies BVD is moderately related to care time. Future research must contrast the robustness of these results and address whether the normative criteria that underlie the BVD is aligned with the weights that characterise it.     

Programas para combatir la soledad en las personas mayores en el ámbito institucionalizado: una revisión de la literatura científica

Loneliness is a problem that affects a very high percentage of older people, and can lead to physical and/or mental illness. This article aims to present a systematic review of programs to combat loneliness directed towards the institutionalised elderly. Experimental and quasi-experimental articles published between 2000 and 2016 were included in the review. An analysis was carried out on the quality of the methodological evidence of each of the articles. The programs analysed included animal-assisted, contacts with families through videoconferencing, gardening and/or horticulture workshops, reminiscence therapies, humour therapies, and cognitive interventions. The results show that intervention programs are effective to reduce the feeling of loneliness. The methodological limitations of the studies are discussed and future research is recommended.