El aceite de oliva en nutrición clínica

The different beneficial effects of olive oil have a rational and scientific basis due to advances in the knowledge of lipid metabolism. The evidence that for a similar plasma cholesterol concentration, the rate of cardiovascular deaths is lower in the Mediterranean countries than in other ones, suggests that the beneficial effects of olive oil may not be only related to the known quantitative changes in plasma lipoproteins, but also to other, as yet unknown or little known, anti-atherogenic factors. The peculiarities of olive oil in terms of certain biochemical, biological and nutritional characteristics, open up a field of application in normal clinical practice. The benefits of olive oil in clinical nutrition correlate with its action on lipid metabolism and the cardiovascular system. Even a moderate increase in the ingestion of monounsaturated fats and a reduction in the ingestion of carbohydrates could be more advantageous in those patients with diabetes and hypertriglyceridemia and/or in those where loss of weight is not a priority. Different studies have also demonstrated the benefits of olive oil in different inflammatory and autoimmune diseases, such as rheumatoid arthritis. The chemical composition of extra virgin olive oil contributes to daily requirements of essential fatty acids and active antioxidant nutrients in vitamin E deficiency. This particular and well-balanced situation [oleic acid (18:1 n -9) and minor components in an ideal ratio] undoubtedly has a significant relevance in human clinical nutrition.Los avances en el conocimiento del metabolismo lipídico están permitiendo establecer las bases científicas de los efectos saludables del aceite de oliva. En los países del área Mediterránea, la mortalidad cardiovascular es menor que en otros, aunque la concentración de colesterol en sangre es similar. Es muy probable que la capacidad cardio-protectora del aceite de oliva se relacione con otros factores de riesgo, algunos de los cuales son poco o completamente desconocidos. Las propiedades bioquímicas, biológicas y nutricionales del aceite de oliva son peculiares y permiten su aplicación en la nutrición clínica. Los beneficios del aceite de oliva se correlacionan con su acción sobre el metabolismo lipídico y el sistema cardiovascular. Un aumento moderado en la ingesta de grasa monoinsaturada (aceite de oliva), a expensas de los carbohidratos, es la recomendación en pacientes con diabetes e hipertrigliceridemia. En nutrición clínica, el aceite de oliva también tiene efectos beneficiosos en enfermedades relacionadas con respuestas inflamatorias y autoinmunes, como la artritis reumatoide. La composición química del aceite de oliva virgen extra contribuye a las necesidades diarias de ácidos grasos esenciales y de antioxidantes, especialmente en situaciones patológicas de deficiencia en vitamina E. Sin duda, el aceite de oliva (virgen extra) tiene máxima relevancia, por su contenido de ácido oleico (18:1 n -9) y compuestos minoritarios, en la nutrición clínica

Catalytic activity and accessibility of acidic ion-exchange resins in liquid phase etherification reactions

Abstract Although macroreticular acidic ion-exchange resins have been widely used as catalysts in the industrial world for decades, their catalytic behavior is still far from being completely understood at a molecular level. Several characterization techniques coexist, which provide information about their properties. Only few of these techniques give an actual picture of their working-state features when swollen in anhydrous polar reactive media such as in etherification processes, where they are extensively used. The inverse steric exclusion chromatography technique, based on modeling the micropores structure, or gel-phase, as a set of discrete volume fractions with a characteristic polymer chain density, constitutes an appropriate procedure to assess the morphology of ion-exchangers in the swollen state. Present work proposes an empirical model to correlate the properties of the volume fractions with their catalytic activity in the etherification reaction rates of isobutene by addition of C1 to C4 linear primary alcohols. Sixteen different macroreticular acidic ion-exchange catalysts, both commercial and lab-made, have been used, which differ in acid capacity, sulfonation type, cross-linking degree and swollen-phase volume fractions distribution. Experimental reaction rates have been expressed as a sum of contributions of each individual volume fraction. The contribution of each polymer volume fraction corresponds to the product of the catalyst acidity, the characteristic volume fraction within the gel-phase of the catalyst, and a specific turnover frequency (TOF) of that fraction. Accessibility of the reacting alcohol, expressed in terms of the Ogston coefficient, has been also included in the empirical dependency equation presented in this work

Comparación entre dos tipos de gastrostomías quirúrgicas, abierta y laparoscópica, en nutrición enteral domiciliaria

Objetivo: Exponer las complicaciones de las gastrostomías quirúrgicas utilizadas como vía de soporte nutricional enteral domiciliario (SNED) y detectar si existen diferencias entre las dos técnicas usadas en nuestro medio: Cirugía abierta vs laparoscópica. Material y métodos: Estudio observacional descriptivo de carácter retrospectivo de las gastrostomías quirúrgicas realizadas entre los años 1994 y 2009 seguidas por nuestra unidad. Se han analizado las complicaciones detectadas en consulta durante el seguimiento de pacientes con SNED a través de gastrostomía quirúrgica realizada con técnica laparotómica abierta vs laparoscópica, valorando: fuga del contenido gástrico al exterior, irritación de la pared abdominal, presencia de exudado, presencia de exudado con cultivo positivo que requirió tratamiento antibiótico, quemadura o pérdida de sustancia de la zona periostomía, rotura de balón, úlcera de decúbito por la sonda y formación de granuloma. Resultados: Durante los años 1994-2009 se realizaron 57 gastrostomías quirúrgicas: 47 por técnica laparótomica (abierta) convencional y 10 por vía laparoscópica. La edad media de los pacientes fue de 57,51 ± 17,29 años. La causa más frecuente que motivó la realización de la gastrostomía quirúrgica fue el cáncer de esófago (38,6%) seguido de alteraciones neurológicas (26,3%) y tumores de cabeza y cuello (26,3%). El 97,9% de los pacientes a los que se realizó una gastrostomía quirúrgica abierta presentaron al menos una complicación, es decir que solo el 2,1% estuvieron libres de complicaciones; mientras que el 50% de los que se sometieron a una gastrostomía laparoscópica no tuvo ninguna. Las complicaciones más frecuentes fueron la presencia de fuga del contenido gástrico y la irritación de la pared abdominal que se presentaron en el 89,4% y 83% respectivamente de las gastrostomías laparotómicas frente a la aparición de solo el 30% de ambas complicaciones en las gastrostomías laparoscópicas siendo la diferencia estadísticamente significativa (p Aim: Exposing the complications of surgical gastrostomies used as way of home enteral nutritional support (HEN) and detecting the differences between the two techniques used in our environment: Open Surgery vs Laparoscopic Surgery. Material and methods: Retrospective descriptive observational study of the surgical gastrostomies performed between 1994 and 2009 followed up by our unit. Have been analyzed the complications detected in our practice during the follow-up of patients with HEN performed via open laparotomy vs. laparoscopic tecniques, assessing: leaks of gastric fluid to the exterior, abdominal wall irritation, presence of exudate, presence of exudate with positive culture that required antibiotical treatment, burning or loss of substance of the periostomic zone, breach of balloon, decubitus ulcer caused by the tube and formation of granuloma. Results: Between 1994 and 2009, 57 surgical gastrostomies were performed: 47 using the conventional laparotomic (open) tecnique and 10 laparoscopies. The average age of the patients was 57.51 ± 17.29 years old. The most common cause for the performance of surgical gastrostomy was esophageal cancer (38.6%) followed by neurologic alterations (26.3%) and head and neck tumors (26.3%). 97.9% of the patients who underwent to surgical gastrostomy presented at least one complication, meaning that only 2.1% were free of complications; meanwhile, 50% of the patients were laparoscopic gastrostomy was performed had none of these complications. The most common complications were the presence of leaks of gastric fluid and abdominal wall irritation that appeared on 89.4% and 83% respectively of the laparotomic gastrostomies versus the presence of only 30% of both complications in laparoscopic gastrostomies being the difference statistically significant (p < 0.01). Conclusions: After the introduction of the laparoscopic technique in the performance of surgical gastrostomies has been observed a decrease of the complications occured during the home enteral nutritional support related to surgical gastrostomies

Consensus statement on the diagnosis, management, and treatment of angioedema mediated by Bradykinin. Part. II: treatment, follow-up, and special situations

Background: There are no previous Spanish guidelines or consensus statements on bradykinin-induced angioedema. Aim: To draft a consensus statement on the management and treatment of angioedema mediated by bradykinin in light of currently available scientifi c evidence and the experience of experts. This statement will serve as a guideline to health professionals. Methods: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema, a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientifi c papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor defi ciency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings were held to reach the consensus. Results: Treatment approaches are discussed, and the consensus reached is described. Specifi c situations are addressed, namely, pregnancy, contraception, travelling, blood donation, and organ transplantation. Conclusions: A review of and consensus on treatment of bradykinin-induced angioedema is presentedIntroducción: No existen guías previas españolas sobre el manejo del angioedema mediado por bradicinina. Objetivos: Alcanzar un consenso sobre el manejo y tratamiento del angioedema mediado por bradicinina a la luz de la evidencia científi ca disponible y la experiencia de los expertos, que sirva como guía para los profesionales de la salud. Métodos: SGBA/GEAB, un grupo de trabajo de la SEAIC dirigió el consenso. Se realizó una revisión de los documentos científi cos publicados sobre los diferentes tipos de angioedema mediado por bradicinina [angioedema hereditario o adquirido por defi ciencia de inhibidor de la C1 esterasa, angioedema hereditario relacionado con estrógenos (AEH tipo III, AEH-FXII), angioedema inducido por IECA (inhibidores del enzima convertidor de angiotensina]. Hubo varias reuniones del SGBA/GEAB para alcanzar el consenso. Resultados: Se revisan y discuten los diferentes tratamientos disponibles y se describe el consenso alcanzado. Se abordan situaciones específi cas (embarazo, anticoncepción, viajes, hemodonación, trasplante de órganos). Conclusiones: Se presenta una revisión del tratamiento del angioedema mediado por bradicinina y un consenso sobre su tratamiento en EspañaDr. Teresa Caballero is a researcher with the Hospital La Paz Health Research Institute (IdiPaz) program for promoting research activities (2009

The age again in the eye of the COVID-19 storm: evidence-based decision making

Background: One hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data. Results: Concerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/?L, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve. Conclusion: Age and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results

Angioedema severity and impact on quality of life: Chronic histaminergic angioedema versus chronic spontaneous urticaria

Histamine-mediated angioedema is the most frequent form of angioedema. It is classified as idiopathic histaminergic acquired angioedema (IH-AAE)1 when allergies and other causes have been excluded and a positive treatment response to antihistamines, corticosteroids, or omalizumab has been reported. Idiopathic histaminergic acquired angioedema may occur in isolation, when it is termed chronic histaminergic angioedema (CHA), or it may be associated with wheals in chronic spontaneous urticaria angioedema (CSU-AE). The term CHA is equivalent to IH-AAE and mast cell-mediated angioedema. However, this term reflects the chronic and recurrent course of the disease. Therefore, we propose that the term CHA be internationally discussed in the following guidelines. Chronic spontaneous urticaria is classically characterized by the presence of recurrent episodes of wheals (hives) with or without angioedema for at least 6 weeks.2 Chronic histaminergic angioedema is typically considered a subtype of CSU without wheals. However, a recent study3 found several features that differentiate CHA from CSU, which suggests that CHA is a separate entity. Quality of life (QoL) studies specifically for CHA patients have not been performed, and their QoL has been assessed only in the context of CSU-AE

COVID-19 : Age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study

Background: The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor. Results: In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course. Conclusions: Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease

Epigenetic remodelling licences adult cholangiocytes for organoid formation and liver regeneration.

Following severe or chronic liver injury, adult ductal cells (cholangiocytes) contribute to regeneration by restoring both hepatocytes and cholangiocytes. We recently showed that ductal cells clonally expand as self-renewing liver organoids that retain their differentiation capacity into both hepatocytes and ductal cells. However, the molecular mechanisms by which adult ductal-committed cells acquire cellular plasticity, initiate organoids and regenerate the damaged tissue remain largely unknown. Here, we describe that ductal cells undergo a transient, genome-wide, remodelling of their transcriptome and epigenome during organoid initiation and in vivo following tissue damage. TET1-mediated hydroxymethylation licences differentiated ductal cells to initiate organoids and activate the regenerative programme through the transcriptional regulation of stem-cell genes and regenerative pathways including the YAP-Hippo signalling. Our results argue in favour of the remodelling of genomic methylome/hydroxymethylome landscapes as a general mechanism by which differentiated cells exit a committed state in response to tissue damage.RCUK Cancer Research UK ERC H2020 Wellcome Trus

Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside