Brain-Derived Neurotrophic Factor Levels in Cord Blood from Growth Restricted Fetuses with Doppler Alteration Compared to Adequate for Gestational Age Fetuses

Background and Objectives: Fetal growth restriction (FGR) is a severe obstetric disease characterized by a low fetal size entailing a set of undesired consequences. For instance, previous studies have noticed a worrisome association between FGR with an abnormal neurodevelopment. However, the precise link between FGR and neurodevelopmental alterations are not yet fully understood yet. Brain-derived neurotrophic factor (BDNF) is a critical neurotrophin strongly implicated in neurodevelopmental and other neurological processes. In addition, serum levels of BDNF appears to be an interesting indicator of pathological pregnancies, being correlated with the neonatal brain levels. Therefore, the aim of this study is to analyze the blood levels of BDNF in the cord blood from fetuses with FGR in comparison to those with weight appropriate for gestational age (AGA). Materials and Methods: In this study, 130 subjects were recruited: 91 in group A (AGA fetuses); 39 in group B (16 FGR fetuses with exclusively middle cerebral artery (MCA) pulsatility index (PI) 95th percentile). Serum levels of BDNF were determined through ELISA reactions in these groups. Results: Our results show a significant decrease in cord blood levels of BDNF in FGR and more prominently in those with UA PI >95th percentile in comparison to AGA. FGR fetuses with exclusively decreased MCA PI below the 5th percentile also show reduced levels of BDNF than AGA, although this difference was not statistically significant. Conclusions: Overall, our study reports a potential pathophysiological link between reduced levels of BDNF and neurodevelopmental alterations in fetuses with FGR. However, further studies should be conducted in those FGR subjects with MCA PI < 5th percentile in order to understand the possible implications of BDNF in this group.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEUnión EuropeaComunidad de MadridInstituto de Salud Carlos IIIHalekulani S.LFundación Santiago Dexeus Fontpu

Neurologic outcomes of toxic oil syndrome patients 18 years after the epidemic.

Toxic oil syndrome (TOS) resulted from consumption of rapeseed oil denatured with 2% aniline and affected more than 20,000 persons. Eighteen years after the epidemic, many patients continue to report neurologic symptoms that are difficult to evaluate using conventional techniques. We conducted an epidemiologic study to determine whether an exposure to toxic oil 18 years ago was associated with current adverse neurobehavioral effects. We studied a case group of 80 adults exposed to toxic oil 18 years ago and a referent group of 79 adult age- and sex-frequency-matched unexposed subjects. We interviewed subjects for demographics, health status, exposures to neurotoxicants, and responses to the Kaufman Brief Intelligence Test (K-BIT), Programa Integrado de Exploracion Neuropsicologica (PIEN), and Goldberg depression questionnaires and administered quantitative neurobehavioral and neurophysiologic tests by computer or trained nurses. The groups did not differ with respect to educational background or other critical variables. We examined associations between case and referent groups and the neurobehavioral and neurophysiologic outcomes of interest. Decreased distal strength of the dominant and nondominant hands and increased vibrotactile thresholds of the fingers and toes were significantly associated with exposure to toxic oil. Finger tapping, simple reaction time latency, sequence B latency, symbol digit latency, and auditory digit span were also significantly associated with exposure. Case subjects also had statistically significantly more neuropsychologic symptoms compared with referents. Using quantitative neurologic tests, we found significant adverse central and peripheral neurologic effects in a group of TOS patients 18 years after exposure to toxic oil when compared with a nonexposed referent group. These effects were not documented by standard clinical examination and were found more frequently in women

Medio siglo de cribado neonatal en España: evolución de los aspectos éticos, legales y sociales (AELS). Parte II, marco legal

El cribado neonatal es una actuación sanitaria regulada específicamente en nuestra legislación. El ordenamiento jurídico establece que el cribado sanitario es una actuación de salud pública, enfocada a la prevención de la salud de la sociedad en general y, a la vez, una prestación sanitaria, es decir, un derecho de los individuos, cuyo interés constituye el eje de la regulación. En su diseño e implantación están involucradas las autoridades sanitarias estatales y autonómicas. La eficacia, eficiencia y calidad son los criterios para valorar su idoneidad, y la adopción de medidas que garanticen los derechos de los participantes, la trasparencia y la voluntariedad, son imprescindibles para su aprobación. Estas exigencias generales se refuerzan cuando el cribado se dirige a la población pediátrica y cuando se trata de cribados genéticos, caso en que está prevista la revisión por parte de un comité de ética como requisito previo a su autorización.Neonatal screening is a health action specifically regulated in our legislation. The legal system establishes that health screening is a public health action, focused on the prevention of health of the community in general and, at the same time, a health service, that is, a right of individuals, whose interest is the focus of the regulation. In its design and implementation are involved the State and Regional Health Authorities. The effectiveness, efficiency and quality, are the criteria for assessing its suitability, and the adoption of measures to ensure the rights of participants, transparency and voluntariness, are essential for approval. These general requirements are reinforced when the screening is aimed at the paediatric population and when it comes to genetic screening, in which case a review by an ethics committee is foreseen as a prerequisite for authorization

Medio siglo de cribado neonatal en España. Evolución de los aspectos éticos, legales y sociales (AELS). Parte I, aspectos éticos

El cribado neonatal de enfermedades endocrino-metabólicas tratables se inició en España el 1968, y durante el medio siglo que ha transcurrido desde entonces hemos vivido importantes cambios, políticos, sociales y tecnológicos. Esta serie, dividida en tres partes, analiza la evolución de los aspectos éticos (parte I), legales (parte II) y sociales (parte III) a lo largo de este período. La parte I, aspectos éticos, objeto de este artículo, contempla la aplicación de los principios de la ética biomédica y de la ética de salud pública a los programas de cribado neonatal y los relaciona con los elementos básicos que los caracterizan y que son determinantes para la deliberación ética: el cribado neonatal es un cribado genético; únicamente una pequeña parte de la población sometida al cribado sufre las enfermedades y recibirá los beneficios de la intervención; se aplica a una población asintomática y vulnerable que no puede ejercer su autonomía y requiere protección; la evaluación de los resultados plantea desafíos; es una intervención de salud pública y como la mayoría de intervenciones sanitarias puede producir efectos adversos. La evolución cronológica sitúa una primera etapa, entre 1968 y 2000, que se inicia con la publicación de los principios de Wilson y Jungner, el primer documento que contiene principios éticos aplicables al cribado neonatal e introduce criterios de decisión y de buena práctica en las políticas de salud pública. Una segunda etapa, entre 2000 y2010, marcada por la irrupción de la espectrometría de masas en tándem, que promovió una súbita expansión de los programas y el debate ético consiguiente, con la revisión de los principios de Wilson y Jungner y la aparición de documentos y declaraciones relevantes en EE. UU., Europa y también España, con las primeras publicaciones sobre recomendaciones acerca de los aspectos éticos del cribado neonatal. Y una tercera etapa, entre 2010 y2020, que contempla la incorporación de nuevos criterios a la implementación de los programas y los continuos desafíos tecnológicos con la secuenciación genómica del recién nacido en el horizonte. Será muy importante para el futuro de los programas de cribado neonatal seguir desarrollando paralelamente a los desafíos tecnológicos los aspectos éticos, legales y sociales y que las autoridades sanitarias coloquen las enfermedades, no las tecnologías, en el centro, actuando en el mejor interés del niño, buscando un balance positivo de beneficios/riesgos, contemplando los principios de proporcionalidad, y el respeto por la autonomía y justicia, principios relevantes y ampliamente reconocidos para los cribados genéticos.Newborn screening for treatable diseases began in Spain in 1968. During this half century important changes political, social and technologic have occurred. Present work divided in three parts analyzes the evolution of ethical, legal and social issues (ELSIs), respectively Part I, Part II and Part III. Part I, ethical issues is aimed to the consideration of principles of biomedical and public health ethics applied to newborn screening programs in relationship with its technical characteristics which are very relevant for ethical deliberation: newborn screening is a genetic screening; only a small number of newborns suffers disease included in the program and therefore will receive benefits; screening applies to asymptomatic and vulnerable new-borns that cannot exerts his/her autonomy and therefore must be protected; evaluation of results is challenging; as any public health intervention may have adverse consequences. Chronological evolution states a first period 1968-2000 beginning with the principles of Wilson - Jungner, the first paper containing ethical principles that can be applied to newborn screening, introducing decision criteria and good practices in public health policies. A second period 2000-2010 markedly influenced by the emergency of tandem mass spectrometry that promotes a sudden expansion of programs and the consequent ethic debate, Wilson-Jungner principles are reviewed and appear relevant ethical docu- ments in USA, Europe and also in Spain with the first’s papers on ethical recommendations for screening programs. A third period 2000-2019 examines the incorporation of new criteria in programs implementation and the continuous technological challenges with newborn genome sequencing already in the horizon. It will be very important for the future of the newborn screening programs the development of ethical, legal and social issues in parallel with technological challenges. And that health authorities places diseases and not technologies as central subject, acting in children best interest, looking for a positive balance of benefits/ risks and observing the relevant and well acknowledged principles for genetic screening of proportionality, respect for autonomy and justice

The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature

SARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention

Doñana. Acta vertebrata. vol 12(1)

Contribución a la biometría y biología de la Bermejuela Rutilus arcasii (Steindch., 1866) del embalse de PinillaSistemática de iguanidae, sensu lato y de anolinae en Cuba (Repitilia, sauria)Nueva subespecie de Anolis isolepis (Lacertilia: Iguanidae) para CubaAlimentación del ratonero común (Buteo buteo,L. 1758) en el norte de España.Censo y datos sobre la biología del Halcón de Eleonor (Falco eleonorae Gené, 1839) en las Islas Canarias. Agosto-septiembre 1983Selección de hábitat en un grupo de aves forestales del norte de la Península Ibérica:Importancia de la estructura de la vegetación y competencia interespecíficaThe intersexual differentiation in the foraging behaviour of Oenanthe hispanica L. during the breeding seasonEtograma de Gazella dorcasAlgunos datos sobre el crecimiento y las dimorfometrías sexuales del esqueleto postcraneal de Mus spretus Lataste, 1883 (Rodentia: muridaeDistribución y taxonomía de Molossops temminckii (Chiroptera, Molossidae) en Venezuela.Estudio de una población rural de ratones (Mus musculus L.) II. Análisis comparativo de once estimadores del tamaño poblacional.Distribución de Hyla arborea L. (AMPHIBIA, ANURA, HYLIDAE) en el macizo ibérico septentrionaPresencia y nidificación de gavilán (Accipiter nisus granti Sharpe 1890) en la isla de el Hierro.Autumn food of the ptarmigan (Lagopus mutus Montin, 17776 in the spanish central pyreneesPollo atípico en nido de Hirundo rustica.Primera cita del chorlito social (Vanellus gragarius) en las marismas del GuadalquivirPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group