Serum alkaline phosphatase relates to cardiovascular risk markers in children with high calcium-phosphorus product

Although alkaline phosphatase (ALP) correlates with cardiovascular risk in adults, there are no studies in children. We evaluated the association between serum ALP levels, calcium-phosphorus product (Ca*P) and cardiovascular risk markers in healthy children. Children aged 7.9 ± 1.4 (n = 379) were recruited in this cross-sectional study. The main outcome measures were systolic and diastolic blood pressure (SBP and DBP) and carotid intima-media thickness (cIMT). Additional assessments were body-mass index (BMI), waist circumference, homeostatic model assessment of insulin resistance (HOMA-IR) and fasting lipids, ALP, serum calcium, phosphorus and Ca*P. ALP was directly correlated with BMI (p < 0.0001), waist circumference (p < 0.0001), SBP (p < 0.0001), cIMT (p = 0.005), HOMA-IR (p < 0.0001), and fasting triglycerides (p = 0.0001). Among them, in children with Ca*P values above the median the associations were BMI (r = 0.231; p = 0.001), waist (r = 0.252; p < 0.0001), SBP (r = 0.324; p < 0.0001), cIMT (r = 0.248; p = 0.001) and HOMA-IR (r = 0.291; p < 0.0001)]. ALP independently associated with SBP (β = 0.290, p < 0.001) and cIMT (β = 0.179, p = 0.013) in children with higher Ca*P, after adjusting for confounding variables. Circulating ALP is associated with a more adverse cardiovascular profile in children with higher Ca*P. We suggest that serum ALP and Ca*P levels could contribute to the assessment of risk for cardiovascular disease in children

Endoscopic treatment (endoscopic balloon dilation/self-expandable metal stent) vs surgical resection for the treatment of de novo stenosis in Crohn's disease (ENDOCIR study): an open-label, multicentre, randomized trial.

Background: Stenosis is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length. Methods/design: Exploratory study as "proof-of-concept", multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up. Discussion: The ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC &gt; 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Relació de la proteïna C-reactiva, el quocient neutròfils/limfòcits i l’adiponectina d’alt pes molecular amb paràmetres d’obesitat i de risc cardiometabòlic en nens prepuberals sans. Efecte modulador dels estils de vida

Childhood obesity is one of the most important public health problems and is associated with cardiometabolic risk factors (CMR). Low-grade inflammation plays a prominent role in the development of cardiometabolic alterations associated with obesity, being involved in the atherogenic process. Adipose tissue in the obese patient acts as a source of inflammation and takes on a prominent role in the pathogenesis of cardiometabolic alterations. Several markers of RCM, such as ultrasensitive C-reactive protein (PCRus), neutrophil/lymphocyte ratio (NL) and high molecular weight adiponectin (APM), are part of the inflammatory process related to adipocyte activity. On the other hand, obesity and associated metabolic alterations depend largely on environmental circumstances, such as lifestyle. An improvement in nutrition and physical activity can improve community health and prevent, in the paediatric population, cardiometabolic alterations in the future. For this reason, the aim of this work has been to determine the association between the value of the PCRus, the NL quotient and the APM adiponectin with factors of obesity and CMR, in children of school age in a first baseline visit and after 4 years of follow-up; and determine whether lifestyle modulate these associations. We can conclude that the serum concentration of PCRus, the value of the NL quotient and the serum concentration of APM adiponectin are associated with obesity and RCM parameters in school-aged children and are predictors of these parameters at 4 years of follow-up. In addition, diet and physical activity modulate these associationsL’obesitat en l’edat pediàtrica constitueix un dels problemes més importants de salut pública i s’associa a factors de risc cardiometabòlic (RCM). La inflamació de baix grau juga un paper destacat en el desenvolupament d’alteracions cardiometabòliques associades a l’obesitat, intervenint en el procés aterogènic. El teixit adipós en el pacient obès actua com una font d’inflamació i adopta un paper destacat en la patogènesi d’alteracions cardiometabòliques. Diversos marcadors de RCM, com la proteïna C-reactiva ultrasensible (PCRus), el quocient neutròfils/limfòcits (NL) i l’adiponectina d’alt pes molecular (APM), formen part del procés inflamatori relacionat amb l’activitat adipocítica. D’altra banda l’obesitat i les alteracions metabòliques associades depenen en gran mesura de les circumstàncies ambientals, com els estils de vida. Una millora de l’alimentació i l’activitat física pot millorar la salut comunitària i prevenir, en la població pediàtrica, alteracions cardiometabòliques en un futur. Per aquest motiu, l’objectiu d’aquest treball ha estat determinar l’associació entre el valor de la PCRus, del quocient NL i de l’adiponectina d’APM amb factors d’obesitat i RCM, en nens i nenes d’edat escolar en una primera visita basal i després de 4 anys de seguiment; i determinar si els estils de vida modulen aquestes associacions. Podem concloure que la concentració sèrica de PCRus, el valor del quocient NL i la concentració sèrica d’adiponectina d’APM s’associen amb paràmetres d’obesitat i de RCM en infants d’edat escolar i són predictors d’aquests paràmetres als 4 anys de seguiment. A més l’alimentació i l’activitat física modulen aquestes associacionsPrograma de Doctorat en Biologia Molecular, Biomedicina i Salu

Atenció infermera a la persona en la inserció del catèter venós perifèric

Vídeo explicatiu sobre l'atenció infermera a la persona en la inserció del catèter venós perifèric amb l'objectiu d'aprendre a inserir un catèter venós perifèric en un pacient per tal de realitzar una analítica sanguínia o administrar medicaments necessaris pel correcte tractament de la personaAgraïments: Cullell Rigau Lleal i Gemma Sole Arisa; Col·laboradors: Almerinda Domindo Roura, Vicenç Carreras Frau i Rosa Prat SalaVídeo amb subtítols en castell

Circulating free T3 associates longitudinally with cardio-metabolic risk factors in euthyroid children with higher TSH

IntroductionThyroid hormones play major roles in the regulation of body composition and metabolism, and therefore, the relationship between thyroid hormones and cardio-metabolic risk has been extensively studied in adults. In this study, we aimed to test whether free triiodothyronine (fT3) associates longitudinally with cardio-metabolic risk factors in euthyroid children.MethodsA prospective study cohort of 599 apparently healthy school-age children were assessed at baseline (mean age 8.1 ± 2.1 years), of whom 270 children were also assessed at follow-up (4 years later). Circulating thyroid-stimulating hormone (TSH), free thyroxine (fT4), and fT3 were measured, and cardio-metabolic risk was assessed by means of body mass index (BMI), waist circumference, visceral fat (by ultrasound), blood pressure, circulating lipids, and homeostasis model assessment of insulin resistance (HOMA-IR) index, both at baseline and at follow-up.ResultsAll studied children had normal thyroid function tests. Independent associations between baseline fT3 and both baseline and follow-up BMI, systolic blood pressure, mean arterial blood pressure, triglycerides, and HOMA-IR were found using multivariate regression analysis (adjusting for sex and baseline age and BMI). Analyses of effect sizes showed that for each 1 unit-increase in baseline fT3 (pg/ml), follow-up BMI–standard deviation score (SDS) increased by 0.31 units (z-score) and systolic blood pressure by 6.6 units (mmHg). The observed longitudinal associations were more robust in children belonging to the upper TSH tertile who showed higher TSH levels and were characterized by weighing more and having the highest fT3 levels. In these children, for each 1 unit-increase in baseline fT3 (pg/ml), follow-up BMI-SDS increased by 0.67 units (z-score) and systolic blood pressure by 10.2 units (mmHg).ConclusionsCirculating fT3 associates longitudinally with cardio-metabolic risk factors in euthyroid children with higher TSH. The observed associations of thyroid hormones in these children could conceivably respond to a homeostatic attempt to reduce their cardio-metabolic risk