Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Primary esophageal motor disturbances among patients with esophageal symptoms

Background: The esophagus can suffer several motor disturbances of striated or smooth muscle. Aim: To determine the presence of primary motor disturbances of the esophagus among a group of patients with esophageal symptoms. Material and methods: Prospective study of 5,440 patients consulting for heartburn, chest pain or dysphagia, with primary esophageal motor disturbances, studied between 1994 and 2004. All were subjected to an esophageal manometry with eight perfused catheters connected to pressure transducers. Results: Nineteen percent of subjects had a normal esophageal manometry, 60% had unspecific motor disturbances usually associated to gastroesophageal reflux, 13% had a nutcracker esophagus, 5% had diffuse esophageal spasm, 2% had achalasia and 0,3% had an hypertensive sphincter. Conclusions: Primary esophageal motor disturbances are common among patients with esophageal symptoms. A manometry should be performed to these patients

Correlación entre síntomas de reflujo gastroesofágico y resultados de la pHmetría de 24 horas en pacientes con estudio endoscópico normal o levemente alterado

Heartburn and regurgitation are considered highly specific symptoms of gastroesophageal reflux. A considerable number of patients with these symptoms do not have endoscopic signs of esophagitis. Aim: To study the relationship between gastroesophageal reflux symptoms and 24 h esophageal pH mesurement in patients with normal or near normal endoscopic findings. Patients and methods: One hundred eighty six patients with persistent reflux symptoms and absence of severe endoscopic esophagitis were studied. Pathological studies of esophageal biopsies, manometry and 24 h esophageal pH measurements were performed in all. Results: Abnormal acid reflux was found in 131 patients (70%). No differences in the frequency of symptoms, gender or pathologic findings were observed between patients with or without abnormal acid reflux. However, a higher frequency of esophageal erosions and a lower resting pressure of the inferior sphincter of the esophagus was observed in patients with abnormal acid reflux. Conclusions: Thirty percent of patients with heartburn and regurgitation did not have abnormal acid reflux. Therefore, these symptoms are not specific for gastroesophageal reflu

Simultaneous quantification of 49 elements associated to e-waste in human blood by ICP-MS for routine analysis

Health risks concerns related to e-waste contamination are increasing all over the world, and especially in developing countries. We have developed an easy, quick, and robust method for the quantification of 49 elements associated to electronic consumer products and their e-wastes in human blood. An aliquot of blood (130 μL) is simply diluted using an alkaline solution, and the elements are simultaneously quantified at the picogram-per-milliliter level without the need of clean-up steps. The accuracy, precision, linearity and limit of quantification (LOQ) of the method were assessed. Recovery values at concentration levels between 0.010 and 5 ng mL−1 were studied. A range of 89–118% and a range of 87–128% for REE and toxic heavy elements was found respectively. The relative standard deviations (RSD) calculated were lower than 8% for the most elements. The limits of quantification (LOQ) were found to be lower than 0.04 ng mL−1 for toxic heavy elements and 0.06 ng mL−1 for the REE with some few exceptions in both cases. The validity of the proposed methodology was assessed by analyzing a certified human blood reference material with known concentrations of several elements. The proposed method is suitable for routine use in biomonitoring studies

Association of gastroesophageal reflux with posterior laryngitis. Study of 43 patients

Artículo de publicación SciELOBackground: Gastroesophageal reflux (GER) is syndicated as a cause of posterior laryngitis. However the evidence for the association is weak. Aim: To determine if the presence of posterior laryngitis is associated with GER. Material and Methods: Cross sectional study of 43 patients (19 males) with endoscopically confirmed posterior laryngitis derived for the study of GER. All patients underwent a clinical examination, upper gastrointestinal endoscopy, esophageal manometry and 24 hour pH monitoring. Results: Forty eight percent of patients had GER. Among 28 patients with dysphonia, 10 (36%) had heartburn and 11 (39%) had regurgitation. A hypotensive lower esophageal sphincter was associated with dysphagia in 100% of patients, regurgitation in 81%, cough in 100% and hoarseness in 87% of patients. Upper digestive endoscopy revealed the presence of esophagitis in 6 patients (14%) and was normal in the rest. Dysphonia had the best association with GER with a positive predictive value of 64%. Conclusions: Most patients with laryngeal symptoms and posterior laryngitis do not have GER