Do Herbal Supplements and Probiotics Complement Antibiotics and Diet in the Management of SIBO? A Randomized Clinical Trial

Small intestinal bacterial overgrowth (SIBO) arises from dysbiosis in the small intestine, manifesting with abdominal symptoms. This study aims to assess the efficacy of combined antibiotic therapy, herbal supplements, probiotics, and dietary modifications in SIBO management. A total of 179 SIBO-diagnosed patients underwent clinical evaluation and breath testing. Patients were categorized into hydrogen (H2-SIBO) and methane (CH4-SIBO) groups. The control group received standard antibiotic therapy and a low-FODMAP diet, while the intervention group received additional herbal antibiotics, probiotics, and prebiotics. After treatment, both groups exhibited reduced gas levels, particularly in CH4-SIBO. Clinical remission rates were higher in the intervention group, especially in CH4-SIBO cases. Logistic regression analysis showed gas concentrations at diagnosis as significant predictors of treatment success. In conclusion, adjunctive herbal supplements and probiotics did not significantly impact gas levels, but showed potential for clinical improvement, especially in CH4-SIBO.

Medical supervised duodenal-enteral feeding for the treatment of overweight and obesity: MESUDEFT

BACKGROUND

the development of specialised nutritional support techniques allows the maintenance of an adequate supply of nutrients in those patients in whom oral feeding is not possible or is insufficient in relation to their requirements, trying to improve the quality of life, especially in those with chronic diseases.

METHODS

single-center clinical study carried out in a clinical-nutritional center consisting of a medically supervised nasogastric-duodenal tube feeding treatment for overweight, obesity and increased body fat percentage in patients requiring it by means of duodeno-enteral feeding, expecting losses of more than 10 %.

RESULTS

twenty-nine patients completed the protocol (20.4 % male and 79.6 % female) with a mean age of 38 years (SD: 12.4); 87.2 kg (SD: 18.5) mean weight; 37.9 kg (SD: 4.8) mean iFat%; 32.4 (SD: 5.4) iMean body mass index (BMI); 100 cm (SD: 16.0) iMean waist; 113.6 cm (SD: 10.4) iMean hip; 33.8 cm (SD: 3.9) iMean upper arm circumference; 65.5 cm (SD: 7.5) iMean thigh circumference; 9.7 (SD: 4.8) iVisceral fat index; and 22.9 days (SD: 13.9) mean treatment. A mean of 22.9 (SD: 13.9) days of MESUDEFT influences weight loss, fat loss, visceral fat loss and decreased arm, hip and thigh circumferences (p < 0.05) (i: initial).

CONCLUSIONS

MESUDEFT is shown to be an effective alternative as a sole treatment or as an adjunct prior to bariatric surgery for obesity or overweight treatment with a minimum of 10 % loss of BMI and fat mass at completion and 3-6 months follow-up.

Influence of Strict Lockdown on Vitamin D Deficiency in Pregnant Women: A Word of Caution

The main source of vitamin D results from skin sunlight exposure. Vitamin D deficiency (VDD) is linked to several adverse events during pregnancy. While performing a cross-sectional study with 886 pregnant women in Elda (Spain) from September 2019 to July 2020 to determine the association of VDD with gestational diabetes mellitus in relation to body mass index, a strict lockdown (SL) due to the COVID-19 pandemic was declared from 15 March 2020 to 15 May 2020. To determine if VDD prevalence in the local population of pregnant women was influenced by SL, a retrospective cross-sectional study was conducted to estimate the prevalence odds ratio (POR) for the association of VDD and SL. A crude logistic regression model was calculated, and then further adjusted by the biweekly measured vitamin D-specific UVB dose in our geographical area. The POR during SL was 4.0 (95%CI = 2.7-5.7), with a VDD prevalence of 77.8% in the quarantine period. Our results revealed that VDD prevalence in pregnant women was influenced by SL. This valuable information could guide us in future if public officials order the population to stay indoors for any given reason.

Effect of an Immune-Boosting, Antioxidant and Anti-Inflammatory Food Supplement in Hospitalized COVID-19 Patients: A Prospective Randomized Pilot Study

Background: COVID-19 disease is a serious global health problem. Few treatments have been shown to reduce mortality and accelerate time to recovery. The aim of this study was to evaluate the potential effect of a food supplement (probiotics, prebiotics, vitamin D, zinc and selenium) in patients admitted with COVID-19. Methods: A prospective randomized non-blinded clinical trial was conducted in a sample of 162 hospitalized patients diagnosed with COVID-19 recruited over eight months. All patients received standard treatment, but the intervention group (n = 67) was given one food supplement stick daily during their admission. After collecting the study variables, a statistical analysis was performed comparing the intervention and control groups and a multivariate analysis controlling for variables that could act as confounding factors. Results: ROC curve analysis with an area under the curve (AUC) value of 0.840 (p < 0.001; 95%CI: 0.741–0.939) of the food supplement administration vs. recovery indicated good predictive ability. Moreover, the intervention group had a shorter duration of digestive symptoms compared with the control group: 2.6 ± 1.3 vs. 4.3 ± 2.2 days (p = 0.001); patients with non-severe disease on chest X-ray had shorter hospital stays: 8.1 ± 3.9 vs. 11.6 ± 7.4 days (p = 0.007). Conclusions: In this trial, the administration of a food supplement (Gasteel Plus®) was shown to be a protective factor in the group of patients with severe COVID-19 and allowed early recovery from digestive symptoms and a shorter hospital stay in patients with a normal–mild–moderate chest X-ray at admission (ClinicalTrials.gov number, NCT04666116).

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians

PURPOSE

To identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician's opinion of primary care and hospital settings.

METHODS

An observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement.

RESULTS

A total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas.

CONCLUSION

A consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians' opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease.

Vitamin D Deficiency and Gestational Diabetes Mellitus in Relation to Body Mass Index

A relationship between vitamin D deficiency (VDD) and gestational diabetes mellitus (GDM) has been described. Considering that GDM prevalence depends on body mass index (BMI), our main objective was to determine if VDD is associated with GDM, independent of BMI. A cross-sectional study with 886 pregnant women was conducted in Elda (Spain) from September 2019 to June 2020. To assess the association, Poisson regression models with robust variance were used to estimate the prevalence ratio (PR). The observed GDM prevalence was 10.5%, while the VDD prevalence was 55.5%. In the crude model, both VDD and obesity were associated with GDM, but in the adjusted model, only VDD was statistically significant (PR = 1.635, p = 0.038). A secondary event analysis did not detect differences in VDD, but BMI yielded a higher frequency of births by cesarean section and newborns with a >90 percentile weight in the obesity group. In conclusion, VDD is associated with GDM, independent of BMI. Future longitudinal studies could provide information on causality.

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case-Control Study

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case–control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.

Evaluation of Changes in Gut Microbiota in Patients with Crohn's Disease after Anti-Tnfα Treatment: Prospective Multicenter Observational Study

Background: Crohn's disease is believed to result from the interaction between genetic susceptibility, environmental factors and gut microbiota, leading to an aberrant immune response. The objectives of this study are to evaluate the qualitative and quantitative changes in the microbiota of patients with Crohn's disease after six months of anti-tumor-necrosis factor (anti-TNFα) (infliximab or adalimumab) treatment and to determine whether these changes lead to the recovery of normal microbiota when compared to a control group of healthy subjects. In addition, we will evaluate the potential role of the Faecalibacterium prausnitzii/Escherichia coli and Faecalibacterium prausnitzii/Clostridium coccoides ratios as indicators of therapeutic response to anti-TNFα drugs. Methods/Design: This prospective multicenter observational study will comprise a total of 88 subjects: 44 patients with Crohn's disease scheduled to start anti-TNFα treatment as described in the drug specifications to control the disease and 44 healthy individuals who share the same lifestyle and eating habits. The presence of inflammatory activity will be determined by the Harvey-Bradshaw index, analytical parameters in blood, including C-reactive protein, and fecal calprotectin levels at commencement of the study, at three months and at six months, allowing the classification of patients into responders and non-responders. Microbiota composition and the quantitative relationship between Faecalibacterium prausnitzii and Escherichia coli and between Faecalibacterium prausnitzii and Clostridium coccoidesgroup as indicators of dysbiosis will be studied at inclusion and six months after initiation of treatment using ultra sequencing with Illumina technology and comparative bioinformatics analysis for the former relationship, and digital droplet PCR using stool samples for the latter. Upon inclusion, patients will complete a survey of dietary intake for the three days prior to stool collection, which will be repeated six months later in a second collection to minimize dietary bias. Discussion: In this study, massive sequencing, a reliable new tool, will be applied to identify early biomarkers of response to anti-TNF treatment in patients with Crohn's disease to improve clinical management of these patients, reduce morbidity rates and improve efficiency.

Weight loss thresholds to detect early hypernatremia in newborns

OBJECTIVE

The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors.

METHODS

A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium≥145mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping.

RESULTS

There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity=77.6%; specificity=73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level.

CONCLUSIONS

The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.

[Which variables influence compliance with physical activity recommendations in young children?]

INTRODUCTION

There are established European guidelines for physical activity in childhood. The main goal of our study was to determine the factors that may influence compliance with European recommendations for physical activity in young children.

METHODS

We included 136 children (aged 2-8 years) classified by weight status, calculated based on the body mass index z-score using the growth standards of the World Health Organization. We measured physical activity over 5 consecutive days with accelerometers and recorded the food intake.

RESULTS

A greater level of physical activity was associated with a lower weight status category (B=-1.55; 95% CI: -2.02 to -1.08; P<.001), lower age (B=-1.33; 95% CI: -1.72 to -0.93; P<.001) and greater energy expenditure (B=0.02; 95% CI: 0.02 to 0.03; P<.001). The overall physical activity in the sample was light (mean=589 cpm/day). Children with overweight and obesity spent less time engaged in moderate to vigorous physical activity (P=.005) and more time engaged in sedentary activities (P=.005) compared to children with normal weight. All groups spent between 90 and 130minutes a day in sedentary activities, with a mean time spent that amounted to 15.5% of their time (excluding time spent sleeping). The adherence to European recommendations varied in association with sex (P=.010) and weight status (P=.038).

CONCLUSION

Young children spent more than 100minutes a day engaged in sedentary activities. Most of the sample met the European recommendations for daily moderate to vigorous physical activity. However, the degree of adherence depended on sex and weight status.

Influence of Olive Extracts on the Expression of Genes Involved in Lipid Metabolism in Medaka Fish

Aims. To assess the possible effect of polyphenol-rich olive extracts on lipid metabolism in medaka fish by quantifying the expression of lipogenic and lipolytic genes. Materials and methods. Adult medaka fish were maintained in tanks for five days with five extracts at 0.01% in water, causing obesity through a diet rich in carbohydrates, with a control group maintained in water with a normal diet. The extracts contained polyphenols ranging between 7 and 116 mg/g (oleuropein, hydroxytyrosol) with an antioxidant power of 2-13 mmol of 2,4,6-tri(2-pyridyl)-1,3,5-triazine/100 g. After five days, the fish were sacrificed and the hepatic mRNA and its complementary DNA were extracted by reverse transcription. Complementary DNAs were quantified for three lipolytic and three lipogenic genes by real-time PCR. The relative gene expression was calculated from the amplification curves in reference to the control group. Results. The expression of genes involved in lipolysis, including peroxisome proliferator-activated receptor-±, acyl-CoA oxidase 1, and carnitine palmitoyltransferase 1, were clearly decreased in fish subjected to an obesogenic diet, and this situation could not be reversed in fish maintained with polyphenol-rich extracts. In contrast, lipogenic fatty acid synthase, acetyl-CoA carboxylase 1, and sterol regulatory element-binding protein 1 genes increased considerably with the obesogenic diet and reverted to the normal state with the olive extracts. The effect was not dependent on the total polyphenol content, the specific oleuropein or hydroxytyrosol concentration, or the antioxidant power, suggesting a synergistic effect. Conclusion. Olive polyphenols, acting as anti-lipogenic agents, have a positive effect on lipid metabolism, but their mechanism in each gene is different according to the extract, which supports synergistic mechanisms with the different proportions of polyphenols and accompanying phytochemicals in each extract.

Factors associated with moderate neonatal hyperthyrotropinemia

BACKGROUND

Maternal iodine deficiency is related to high neonatal thyroid-stimulating hormone (TSH) values, with the threshold of 5 mIU/L recommended as an indicator of iodine nutrition status. The objective of this study was to analyse possible risk factors for increased TSH that could distort its validity as a marker of iodine status. The clinical relevance of this research question is that if the factors associated with iodine deficiency are known, iodine supplementation can be introduced in risk groups, both during pregnancy and in newborns.

METHODS

A case-control study was carried out in a sample of 46,622 newborns in 2002-2015 in Spain. Of these, 45,326 had a neonatal TSH value ≥5 mIU/L. The main variable was having TSH ≥5 mIU/L and the secondary variables were: sex, gestational age, day of sample extraction and maternal origin. Associated factors were analysed through a logistic regression model, calculating the odds ratio (OR).

RESULTS

The factors associated with this outcome were: male sex (OR = 1.34, 95% CI: 1.20-1.50, p<0.001), originating from an Asian/Oceanic country (OR = 0.80, 95% CI: 0.54-1.20, p = 0.536) or Europe (OR = 0.80, 95% CI: 0.66-0.96, p = 0.285) (including Spain, OR = 1) [p<0.001 for America (OR = 0.54, 95% CI: 0.44-0.68) and p = 0.025 for Africa (OR = 0.78, 95% CI: 0.62-0.97)] and fewer days from birth to sampling (OR = 0.80, 95% CI: 0.77-0.82, p<0.001).

CONCLUSIONS

The risk of high neonatal TSH without congenital hypothyroidism is higher in males, decreases with a greater number of days from birth to extraction, and is dependent on maternal ethnicity but not on gestational age.

Factors Influencing the Success of Peripheral Venous Access in Neonates

PURPOSE

In neonatal units, the use of peripheral venous catheters is a commonly used technique involving risks and local complications. Catheter duration and viability is limited and may involve multiple insertion attempts. Catheterization was considered successful when there were no local complications and the catheter was removed owing to completion of treatment. The aim of the study was to determine the optimal location and instruments to reduce the number of catheter insertion attempts and to increase time without complications.

DESIGN AND METHODS

A cross-sectional descriptive study was undertaken to analyze all the catheters inserted in the neonatal intermediate care unit of Vinalopó University Hospital (Elche, Spain). Between 2013 and 2017 the following variables were collected: sex, age, gestational age, and venipuncture site, as well as catheter type, number of insertion attempts, duration and complications.

RESULTS

A total of 929 catheters were analyzed with a mean duration of 46.5 ± 33.9 h, and were removed upon completion of treatment (success 38.3%). The preferred site was the dorsal hand (48.2%) followed by the cubital fossa (20.1%). In both sites the success of the catheter and its duration was higher than the mean (42.4%; 43.9% and 49.4 ± 35.7; 50.3 ± 33.4 h respectively). The most frequent complications were extravasation (47.0%) and phlebitis (5.9%). Just one attempt was needed for 63.8% of cannulations of the dorsal hand, followed by 38.9% in the forearm. No significant differences were found in fixation type, sex, weight, gestational age or infusion type (continuous/intermittent).

CONCLUSIONS

The success of the technique is low. The preferred insertion sites with fewer complications, longer duration and fewer attempts were the dorsal hand and cubital fossa. With fewer attempts required for cannulation, better results were achieved on the dorsal hand.

La epidemiología como fundamento del diseño curricular de enfermería en salud sexual y reproductiva de los adolescentes y jóvenes

Introducción: La formación enfermera en asignaturas del área materno-infantil tiene como objetivos de aprendizaje, la salud del niño y el adolescente, cuidando de sus necesidades, pero se dejan de lado los aspectos de prevención de la salud sexual y reproductiva en adolescentes y jóvenes. Métodos: Se han revisado los diversos programas de formación enfermera en España, así como los datos epidemiológicos actuales en los que demuestra que estas enfermedades y los abortos y embarazos se han incrementado en adolescentes y jóvenes, situación que ha motivado al equipo investigador a plantear la necesidad de modificar el programa de formación enfermera, atendiendo a las necesidades epidemiológicas que afectan a esta población, capacitando para prevenir en estas edades situaciones que puedan afectar su salud física y emocional con relación a la sexualidad, la salud sexual y la salud reproductiva. Discusión: En nuestros resultados de las necesidades detectadas en la bibliografía y los contenidos de los currículos de las distintas facultades de enfermería no están acordes con las necesidades epidemiológicas constatadas. Se plantean definir y ampliar el concepto de salud de la OMS, a los adolescentes y jóvenes, pues estos tienen vivencias de su salud propias a su entorno, cultura, condiciones políticas, económicas e incluso morales, que hay que tener presente a la hora de ofrecerles formación, prevención, asistencia, acompañamiento emocional y tratamiento. Conclusión: Es necesario investigar los conocimientos que sobre estos aspectos poseen los estudiantes y proponer modificaciones en el currículum acordes a las necesidades detectadas, a la importancia de formar en prevención y en aspectos emocionales de la consulta enfermería del adolescente.

La epidemiología como fundamento del diseño curricular de enfermería en salud sexual y reproductiva de los adolescentes y jóvenes

Introducción: La formación enfermera en asignaturas del área materno-infantil tiene como objetivos de aprendizaje, la salud del niño y el adolescente, cuidando de sus necesidades, pero se dejan de lado los aspectos de prevención de la salud sexual y reproductiva en adolescentes y jóvenes. Métodos: Se han revisado los diversos programas de formación enfermera en España, así como los datos epidemiológicos actuales en los que demuestra que estas enfermedades y los abortos y embarazos se han incrementado en adolescentes y jóvenes, situación que ha motivado al equipo investigador a plantear la necesidad de modificar el programa de formación enfermera, atendiendo a las necesidades epidemiológicas que afectan a esta población, capacitando para prevenir en estas edades situaciones que puedan afectar su salud física y emocional con relación a la sexualidad, la salud sexual y la salud reproductiva. Discusión: En nuestros resultados de las necesidades detectadas en la bibliografía y los contenidos de los currículos de las distintas facultades de enfermería no están acordes con las necesidades epidemiológicas constatadas. Se plantean definir y ampliar el concepto de salud de la OMS, a los adolescentes y jóvenes, pues estos tienen vivencias de su salud propias a su entorno, cultura, condiciones políticas, económicas e incluso morales, que hay que tener presente a la hora de ofrecerles formación, prevención, asistencia, acompañamiento emocional y tratamiento. Conclusión: Es necesario investigar los conocimientos que sobre estos aspectos poseen los estudiantes y proponer modificaciones en el currículum acordes a las necesidades detectadas, a la importancia de formar en prevención y en aspectos emocionales de la consulta enfermería del adolescente.

Estudio longitudinal sobre la adherencia al patrón de dieta mediterránea en estudiantes de ciencias de la salud

Introducción: El periodo universitario suele ser el momento en que los estudiantes asumen por primera vez su propia alimentación y pueden adquirir hábitos que repercutirán en su futura salud. Se analiza la evolución del índice de masa corporal (IMC) y adherencia a la dieta mediterránea en estudiantes de ciencias de la salud estudiando los efectos de la formación recibida en el primer curso y en el segundo curso académico.Material y métodos: Estudio piloto sobre el seguimiento de 124 estudiantes de Ciencias de la Salud de la Universidad Cardenal Herrera - CEU (grados de Enfermería y Fisioterapia), mediante el cuestionario KIDMED en primer curso y durante el segundo curso académico, valorando los cambios en la adherencia a la Dieta Mediterránea y posibles factores asociados (sexo, grado de procedencia, comensalidad, estado de IMC y valoración de la adherencia previa). Resultados: Se encuentra buena correlación entre IMC inicial y final (r2=0,848; p<0,001) y valoración KIDMED inicial y final (r2=0,691; p<0,001). El IMC no muestra diferencias significativas al recibir la formación. Se produce un incremento significativo de la valoración KIDMED, mayor en los alumnos de enfermería (p=0,045). El 50,8 % mejora su adherencia a la dieta, tanto en el análisis bivariante como multivariante de regresión logística binaria, únicamente se observa asociación inversa a la adherencia inicial (OR= 1,68 (1,35-2,08); IC 95%; p<0,001).  Conclusiones: se observó una ligera mejoría en la adherencia a la dieta mediterránea cuando los estudiantes cursaban segundo curso de ciencias de la salud. Por ello, incluir información científica acerca de hábitos dietéticos y estilos de vida saludables a los universitarios contribuye a mejorar sus propios hábitos y poderlos promover entre sus futuros pacientes.

Sexual Quality of Life After Treatment of Stress Urinary Incontinence With Adjustable Tension-free Mesh System in Women Who Were Sexually Active Before Surgery

OBJECTIVE

To assess the sexuality and quality of life of sexually active women with stress or mixed urinary incontinence (SUI or MUI) after surgery with adjustable tension-free suburethral mesh system (transobturator adjustable tape or transvaginal adjustable tape).

MATERIALS AND METHODS

This intervention study with 2 years of follow-up (visits at 3 months, 1 year, and 2 years) involved 60 women with SUI or MUI who underwent surgery using transobturator adjustable tape or transvaginal adjustable tape during 2008-2014 in a Spanish region. The variables of interest measured pre- and postintervention were the global scores on the following questionnaires: (1) the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12; (2) the International Consultation on Incontinence Questionnaire; and (3) the Incontinence Quality of Life Questionnaire. Mixed linear models were constructed to determine the effect of the intervention on the outcome variables.

RESULTS

A significant improvement (P <.001) was seen over time in all the questionnaires, although between the 1- and 2-year visits there was a slight deterioration in all of them.

CONCLUSION

The technique provided an improved quality of life and sexuality, which was maintained at all the postoperative visits compared with baseline.

Construction, internal validation and implementation in a mobile application of a scoring system to predict nonadherence to proton pump inhibitors

BACKGROUND

Other studies have assessed nonadherence to proton pump inhibitors (PPIs), but none has developed a screening test for its detection.

OBJECTIVES

To construct and internally validate a predictive model for nonadherence to PPIs.

METHODS

This prospective observational study with a one-month follow-up was carried out in 2013 in Spain, and included 302 patients with a prescription for PPIs. The primary variable was nonadherence to PPIs (pill count). Secondary variables were gender, age, antidepressants, type of PPI, non-guideline-recommended prescription (NGRP) of PPIs, and total number of drugs. With the secondary variables, a binary logistic regression model to predict nonadherence was constructed and adapted to a points system. The ROC curve, with its area (AUC), was calculated and the optimal cut-off point was established. The points system was internally validated through 1,000 bootstrap samples and implemented in a mobile application (Android).

RESULTS

The points system had three prognostic variables: total number of drugs, NGRP of PPIs, and antidepressants. The AUC was 0.87 (95% CI [0.83-0.91], p < 0.001). The test yielded a sensitivity of 0.80 (95% CI [0.70-0.87]) and a specificity of 0.82 (95% CI [0.76-0.87]). The three parameters were very similar in the bootstrap validation.

CONCLUSIONS

A points system to predict nonadherence to PPIs has been constructed, internally validated and implemented in a mobile application. Provided similar results are obtained in external validation studies, we will have a screening tool to detect nonadherence to PPIs.

A simple equation to estimate body fat percentage in children with overweightness or obesity: a retrospective study

Background

Dual-energy X-ray absorptiometry (DXA) provides separate measurements of fat mass, fat-free mass and bone mass, and is a quick, accurate, and safe technique, yet one that is not readily available in routine clinical practice. Consequently, we aimed to develop statistical formulas to predict fat mass (%) and fat mass index (FMI) with simple parameters (age, sex, weight and height).

Methods

We conducted a retrospective observational cross-sectional study in 416 overweight or obese patients aged 4–18 years that involved assessing adiposity by DXA (fat mass percentage and FMI), body mass index (BMI), sex and age. We randomly divided the sample into two parts (construction and validation). In the construction sample, we developed formulas to predict fat mass and FMI using linear multiple regression models. The formulas were validated in the other sample, calculating the intraclass correlation coefficient via bootstrapping.

Results

The fat mass percentage formula had a coefficient of determination of 0.65. This value was 0.86 for FMI. In the validation, the constructed formulas had an intraclass correlation coefficient of 0.77 for fat mass percentage and 0.92 for FMI.

Conclusions

Our predictive formulas accurately predicted fat mass and FMI with simple parameters (BMI, sex and age) in children with overweight and obesity. The proposed methodology could be applied in other fields. Further studies are needed to externally validate these formulas.

Sample size calculation to externally validate scoring systems based on logistic regression models

BACKGROUND

A sample size containing at least 100 events and 100 non-events has been suggested to validate a predictive model, regardless of the model being validated and that certain factors can influence calibration of the predictive model (discrimination, parameterization and incidence). Scoring systems based on binary logistic regression models are a specific type of predictive model.

OBJECTIVE

The aim of this study was to develop an algorithm to determine the sample size for validating a scoring system based on a binary logistic regression model and to apply it to a case study.

METHODS

The algorithm was based on bootstrap samples in which the area under the ROC curve, the observed event probabilities through smooth curves, and a measure to determine the lack of calibration (estimated calibration index) were calculated. To illustrate its use for interested researchers, the algorithm was applied to a scoring system, based on a binary logistic regression model, to determine mortality in intensive care units.

RESULTS

In the case study provided, the algorithm obtained a sample size with 69 events, which is lower than the value suggested in the literature.

CONCLUSION

An algorithm is provided for finding the appropriate sample size to validate scoring systems based on binary logistic regression models. This could be applied to determine the sample size in other similar cases.

Mortality after out-of-hospital cardiac arrest in a Spanish Region

AIMS

To determine out-of-hospital cardiac arrest mortality in the province of Alicante (Spain) and its associated factors.

METHODS

Cross-sectional observational study of all patients who received cardiopulmonary resuscitation (CPR) by the Emergency Medical Services (EMS) (n = 422) in the province of Alicante in 2013. To determine associated factors, a binary logistic regression model was constructed. Primary outcome: death before arriving at the hospital. Predictive variables: gender, age, artificial respiration, prior functional status, asystole, cardiogenic aetiology, bystander CPR, time from the cardiac arrest to the arrival of the EMS and location of cardiac arrest.

RESULTS

There were 337 deaths (79.9%; 95% CI: 76.0-83.7%). Factors independently associated (p<0.05) with death were: male gender (OR = 2.11; 95% CI: 1.20-3.72; p = 0.010), asystole (OR = 1.99, 95% CI: 1.17-3.39; p = 0.012), cardiac arrest at home (OR = 2.44; 95% CI: 1.42-4.18; p = 0.001) and an increased time between arrest and EMS arrival (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009). Having a worse prior functional status had a tendency towards significance (OR = 0.56, 95% CI: 0.31-1.02, p = 0.059).

CONCLUSIONS

Mortality was high. The associated factors were: male gender, asystole, worse prior functional status, longer time from the cardiac arrest to the arrival of the EMS and having the cardiac arrest at home. The clearly negative impact of experiencing a cardiac arrest at home necessitates modifying training policies in Spain. These policies should be focused on providing information about CPR in schools in order to decrease the mortality of these events.

Multivariate Analysis of Thyrotropin in Preterm Newborns Based on Adequacy of Weight for Gestational Age

BACKGROUND

Different and conflicting data have been published concerning thyrotropin (TSH) levels among small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. The hypothesis of this study was that SGA preterm infants have higher TSH levels than those who are not underweight do.

METHODS

This cross-sectional study analyzed the TSH levels of all preterm newborns with a negative congenital hypothyroidism screening result (TSH <7.5 μIU/mL). Secondary variables were sex, birth weight (SGA, AGA), days of life at blood extraction, maternal origin, gestational age, and being a twin or not. Two multiple linear regression models were constructed comparing TSH levels in SGA and AGA or the z-score for birth weight and the remaining variables.

RESULTS

A sample including 5819 preterm infants was obtained: 53.8% male, 23.3% twins, and 3.3% SGA. TSH concentrations were 2.16 ± 2.0 μIU/mL for the SGA infants and 1.80 ± 1.5 μIU/mL for the AGA infants (p = 0.012), with a negative correlation (p < 0.001) between TSH levels and the z-score for the weight of the newborn. The multivariate analysis comparing TSH levels between SGA and AGA gave the following: SGA (B = 0.46, p < 0.001), Latin American mother (B = -0.16, p = 0.029), days of life at blood extraction (B = -0.26, p < 0.001), and gestational age ≤28 weeks (B = -0.56, p < 0.001). Using the z-score for the weight, the associations were: maternal origin North Africa (B = 0.19, p = 0.042), days of life at blood extraction (B = -0.27, p < 0.001), gestational age ≤28 weeks (B = -0.55, p < 0.001), and z-score for weight (B = -0.12, p < 0.001).

CONCLUSIONS

Our multivariate analysis suggests that TSH concentrations are higher in SGA infants than they are in AGA infants, and this should be taken into account when establishing a reference interval appropriate for this population. The clinical relevance remains unknown, but lines of research are opened that may allow a better understanding of the long-term morbidities in these newborns.

Impact of paid work on the academic performance of nursing students

Background. Little research exists on the impact of paid work on academic performance of students of health sciences. No research exists on this subject for students in Colombia. Objectives. This paper seeks to analyze the impact of paid work on academic performance among nursing students.

DESIGN, SETTINGS AND PARTICIPANTS

cross-sectional research, involving 430 of nursing students from the National University of Colombia (N = 566). Methods. Variables analyzed: sex, age, work activity, attendance, current semester, degree subjects studied and unavailable, lost credits, grades during the second semester of 2013, and delayed semesters. Subgroups analyzed: (i) according to labor activity: do not work, work up to 20 h and work more than 20 h per week; (ii) Grade point average: failing is considered as less than 3.0 and passing 3.0 or above out of 5.0. Percentage of delayed semesters were calculated. Qualitative and quantitative variables were analyzed for groups by work activity. The percentage and probability of students getting a grade point average less than 3.0 and delaying semesters were calculated by multivariate logistic regression. Results. A total of 219 of the students work (50.9%), the main reason is socioeconomic, of which 99 (45.2%) work more than 20 h per week and have an increased risk of failing, which is higher in the first semester. They also get lower grades, lose more credits and take longer to finish the degree. The logistic bivariate regressions of success (grade point average, credits gained, courses gained and not having delayed semesters) reduce with work, above all in those who work more than 20 h per week and increase as the number of semesters completed increases, independent of sex. Conclusion. A high percentage of nursing students work more than 20 h per week. The compatibility of paid work with studies in university nursing students has a negative impact on academic performance, more so when they work more than 20 h per week. This negative impact diminishes as the student completes semesters, irrespective of the sex of the students.

Highest Plasma Phenylalanine Levels in (Very) Premature Infants on Intravenous Feeding; A Need for Concern

OBJECTIVE

To analyse the association in newborns between blood levels of phenylalanine and feeding method and gestational age.

STUDY DESIGN

This observational, cross-sectional study included a sample of 11,829 infants between 2008 and 2013 in a Spanish region. Data were recorded on phenylalanine values, feeding method [breast, formula, mixed (breast plus formula), or partial or fully intravenous feeding], gestational age in weeks (<32, 32-37, ≥37), gender and days since birth at the moment of blood collection. Outcomes were [phenylalanine] and [phenylalanine] ≥95th percentile. Associations were analysed using multivariate models [linear (means difference) and logistic regression (adjusted odds ratios)].

RESULTS

Higher phenylalanine values were associated with lower gestational age (p<0.001) and with intravenous feeding (p<0.001).

CONCLUSION

The degree of prematurity and intravenous feeding influenced the plasma concentration of phenylalanine in the newborn. Caution should be taken in [phenylalanine] for newborns with intravenous feeding, monitoring them carefully. Very preterm infants given the recommended amount of amino acids should also be strictly monitored. These findings should be taken into consideration and call for adapting the amounts to the needs of the infant.

Anti-adipogenic activity of an olive seed extract in mouse fibroblasts

The administration of different polyphenols protects against increased body weight and fat accumulation. The aim of the study was to determine the anti-adipogenic activity of an olive-seed polyphenolic extract, by means of mouse fibroblast cell line 3T3-L1 adipocyte differentiation.

MATERIAL AND METHODS

Cells were incubated and differentiated (6000 cells/cup) in the presence of olive-seed extract at 10 and 50 mg/l biosecure concentrations of polyphenols, and with no extract in the control sample. After 5 to 7 days mature adipocytes are formed. The fat clusters are quantified by means of red-oil staining, 490 nm absorbance, and the expression of the leptin and PPARg genes, and then compared to the values obtained in the cultures before and after adipocyte differentiation.

RESULTS

The control samples, with no extract, presented an accumulation of fat of 100%. By contrast, the addition of 50 mg/l of olive-seed extract polyphenols resulted in a 50% accumulation of fat, similar to that of the non-differentiated cells. A 10 mg/l extract concentration had no effect. Anti-adipogenic activity is thus confirmed, as the expression of the PPARg and leptin genes is reduced in adipocyte differentiation in the presence of extract at 50 mg/l. In conclusion, both the formation of fatty substances characteristic of adipogenesis, and the expression of the adipogenic PPARg and leptin genes are found to be inhibited by the prior addition of olive-seed extract polyphenols at a 50 mg/l concentration.

Effectiveness of telenutrition in a women's weight loss program

Objective. The objective of this study is to evaluate the effectiveness of telenutrition versus traditional nutritional consultations for female obese patients in need of nutritional treatment.

Methods. A comparative clinical study was conducted among 233 obese or overweight women (including 20 who dropped out and 60 who failed) who consulted a nutrition clinic in Barranquilla (Colombia) for nutritional assessment and chose either telenutrition or a traditional consultation that included a weekly follow-up consultation over 16 weeks, food consumption patterns, Body Mass Index (BMI, kg/m²) registeration and waist and hip circumference registeration. Treatment responses and differences between telenutrition and the traditional consultations were made according to BMI, waist, hip and initial-waist/height ratio (iWaist), calculating for the relative risk.

Results. In 68 (29.2%) women who chose traditional attention, 9 (37.5%) dropped out, 24 (40%) failed and 35 (23.5%) were successful, showing 1.4% (1.0 SD) BMI loss, 5.8% (3.4 SD) in waist circumference, 4.5% (2.8 SD) in hip circumference and 0.04% (0.02 SD) in iWaist/height ratio. In 165 (70.8%) women who chose telenutrition, 15 (62.5%) dropped out, 36 (60%) failed and 114 (76.5%) were successful, showing 1.1% (1.0 SD) BMI loss, 5.0% (3.2 SD) in waist circumference, 3.5% (3.1 SD) in hip circumference and 0.03% (0.02 SD) in iWaist/height ratio. A significance level of p < 0.05 is considered.

Conclusion. Telenutrition has a failure or dropout risk factor of about half of the value of traditional consultation, and showed slight, statistically significant differences. This study concludes that telenutrition can support or sometimes replace traditional consultations when developing weight loss programs for obese women.

Adherence to an overweight and obesity treatment: how to motivate a patient?

Objective. To explore anthropometric changes in normal-weight, overweight and obese subjects who did not dropout or fail a weight loss program over the 16 treatment weeks to improve patient motivation and treatment adherence. Methods. A clinical intervention study was conducted among 271 (including 100 dropouts and/or failures) obese and overweight patients who consulted a nutrition clinic in Barranquilla (Colombia) for the purpose of nutritional assessment. They were subject to a personalized weekly follow-up consultation over the course of 16 weeks in which initial and the final Body Mass Index (BMI, kg/m(2)), photographs, food consumption patterns, percentage weight loss, waist and hip circumference were registered and grouped according to BMI, measuring treatment response. Data's nonparametric statistical comparison was made. Results. In 62 patients from the BMI < 25 group, there is weight loss of 2.6% (3.1 SD), 5.5% (3.3 SD) in waist circumference and 3.0% (2.5 SD) in hip circumference. In 67 patients from the 25 ≥ BMI < 30 group, there is weight loss of 3.8% (4.1 SD), 5.7% (4.5 SD) in waist circumference loss and 3.7% (3.0 SD) in hip circumference loss. In 42 patients from the BMI > 30 group, there is weight loss of 4.8% (3.7 SD), 7.0% (3.6 SD) in waist circumference loss and 3.9% (2.4 SD) in hip circumference loss. Monitoring is done every 4 weeks by the Friedman test, with significant differences between the three groups (p < 0.001). Patients do not drop out of treatment because they start to see physical results in waist decrease. When comparing final values of initial waist/hip circumference ratios and waist/height ratios, a clear decrease in the three BMI groups was observed (p < 0.001). Conclusion. After three weeks of continuous treatment patients improved in all overweight and obesity parameter indicators; there were not statistically significant differences in hip circumference (HC) and waist loss (WC) (%) among the three BMI groups (normal-weight, overweight, and obesity). In contrast, there were statistically significant differences in weight loss (%) and waist-to-hip ratios. Based on anthropometric outcomes and patient perception of their body image it can be concluded that the waist circumference loss is the parameter that retains obese patients in the weight loss program.

Distortion of self-image: risk factor for obesity in children and teenagers

Introduction: Self-image is important in the behaviour and lifestyle of children and adolescents. Analysing the self-image they have and the factors that might influence their distortion, can be used to prevent problems of obesity and anorexia. The main objective of present publication was to analyse the risk factors that may contribute to self-image distortion.Material and Methods: A descriptive survey study was conducted among 659 children and adolescents in two social classes (low and medium-high), measuring height and weight, calculating BMI percentile for age and gender. Body image and self-perception were registered.Results: The percentage of overweight-obesity is higher in scholars (41.8% boys, 28.7% girls) than in adolescents (30.1% and 22.2% respectively), with no difference between socioeconomic classes. The multinomial logistic regression analysis gives a risk of believing thinner higher (p=0.000) among boys OR=2.9(95%CI:1.43-3.37), school (p=0.000) OR=2.42(95%CI:1.56-3.76) and much lower (p=0.000) between normally nourished OR=0.08(95%CI:0.05-0.13), with no differences according to socioeconomic status. The risk of believing fatter is lower (p=0.000) between boys OR=0.28(95%CI:0.14-0.57), school(p=0.072) OR=0.54(95%CI:0.27-1.6), and much higher among underweight (p=0.000) OR=9x108 (95% CI:4x108-19x108).Conclusions: Are risk factors of believing thinner: males, being in a group of schoolchildren and overweight-obesity. Conversely, are risk factors of believing fatter: females, teen and above all, be thin.  

Inhibition mechanism of the intracellular transporter Ca2+-pump from sarco-endoplasmic reticulum by the antitumor agent dimethyl-celecoxib

Dimethyl-celecoxib is a celecoxib analog that lacks the capacity as cyclo-oxygenase-2 inhibitor and therefore the life-threatening effects but retains the antineoplastic properties. The action mechanism at the molecular level is unclear. Our in vitro assays using a sarcoplasmic reticulum preparation from rabbit skeletal muscle demonstrate that dimethyl-celecoxib inhibits Ca²⁺-ATPase activity and ATP-dependent Ca²⁺ transport in a concentration-dependent manner. Celecoxib was a more potent inhibitor of Ca²⁺-ATPase activity than dimethyl-celecoxib, as deduced from the half-maximum effect but dimethyl-celecoxib exhibited higher inhibition potency when Ca²⁺ transport was evaluated. Since Ca²⁺ transport was more sensitive to inhibition than Ca²⁺-ATPase activity the drugs under study caused Ca²⁺/P_i uncoupling. Dimethyl-celecoxib provoked greater uncoupling and the effect was dependent on drug concentration but independent of Ca²⁺-pump functioning. Dimethyl-celecoxib prevented Ca²⁺ binding by stabilizing the inactive Ca²⁺-free conformation of the pump. The effect on the kinetics of phosphoenzyme accumulation and the dependence of the phosphoenzyme level on dimethyl-celecoxib concentration were independent of whether or not the Ca²⁺–pump was exposed to the drug in the presence of Ca²⁺ before phosphorylation. This provided evidence of non-preferential interaction with the Ca²⁺-free conformation. Likewise, the decreased phosphoenzyme level in the presence of dimethyl-celecoxib that was partially relieved by increasing Ca²⁺ was consistent with the mentioned effect on Ca²⁺ binding. The kinetics of phosphoenzyme decomposition under turnover conditions was not altered by dimethyl-celecoxib. The dual effect of the drug involves Ca²⁺-pump inhibition and membrane permeabilization activity. The reported data can explain the cytotoxic and anti-proliferative effects that have been attributed to the celecoxib analog. Ligand docking simulation predicts interaction of celecoxib and dimethyl-celecoxib with the intracellular Ca²⁺ transporter at the inhibition site of hydroquinones.

[Metabolic syndrome prevalence in teenagers of Monterrey, Nuevo Leon]

OBJECTIVE

To determine the prevalence of the metabolic syndrome (SM) and its components in teenagers from the metropolitan area of Monterrey Nuevo Leon, Mexico (AMM).

METHOD

A transversal research involving 254 teenage students from 10 to 19 years old. To research investigated their personal characteristics, anthropometrics measures, glucose, triglycerides and cholesterol HDL. The SM definition was adapted from the one suggested by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII).

RESULTS

The SM prevalence was 9.4 % (IC95%: 5.8 to 13.0), there was not a difference between the sexes. The prevalence among each SM component was: 24.4% for high triglycerides, 20.1% for abdominal obesity, 19.0% for cholesterol of lipoproteins of a high density (HDL-c) low, 11.4 % for high glucose and for high blood pressure (9.1% diastolic and 5.9% systolic). The prevalent SM phenotypes were corporal mass (IMC) (OR = 4.93, IC95%: 2.26, 10.73) and the IMC interaction of the teenager with a family history of obesity (OR = 1.37, IC95%: 1.0, 1.87). It was observed that those with a family history of diabetes type 2 only experienced a marginal effect.

CONCLUSION

The SM prevalence in teenagers from AMM is high it was an alarming situation if it continues into adulthood. The existence of obesity in relatives of the first and second grade, altogether with teenager IMC are important prediction factors of SM.