Patrones de consumo de alimentos en España

Spain has been considered as a reference of the Mediterranean Diet, known for its contribution to a higher life quality. This diet is reknown for its consumption of olive oil, fresh foods, red wine, more fish than meat and the absence of processed foods. Our goal is to know the consumption pattern of the Spanish population and the different Spanish regions, comparing them and measuring their adherence to the Mediterranean Diet. Therefore, apart from the descriptive analysis of the food intakes of every Spanish region by food group, a cluster analysis in two stages is performed, using both the hierarchical Ward’s method and the k-means to clasify the Spanish regions by their food consumption. Additionaly, the adherence of the Spanish diet to the Mediterranean Diet is studied. The “Mediterranean Diet consumption pattern” is compared to the Spanish regions. It is hard to conclude that the current counsumption patterns in Spain are within the standards of the Mediterranean Diet.España se ha considerado una de las regiones de referencia de la Dieta Mediterránea, conocida por su contribución a la mejora en la calidad de vida. Esta dieta se caracteriza por el consumo de aceite de oliva, productos frescos, vino tinto, más pescado que carne y pocos alimentos procesados. Nuestro objetivo es conocer las pautas de consumo de la población española general y sus distintas regiones, analizando cómo pueden agruparse y su grado de adherencia a la Dieta Mediterránea. A este respecto, además de un análisis descriptivo del consumo de cada región española y de cada grupo de alimentos, se realiza un análisis de conglomerados en dos etapas usando el método jerárquico de Ward y el método de K-medias para clasificar las regiones españolas en base al consumo alimentario. Adicionalmente, se analizará la adherencia de la dieta española a la Dieta Mediterránea. La variable, “patrón de consumo de la Dieta Mediterránea” se compara con las distintas regiones españolas. Es difícil, en virtud de los resultados situar las pautas de consumo actuales en España dentro de los estándares de la Dieta Mediterránea

Measurement uncertainty of β-lactam antibiotics results: estimation and clinical impact on therapeutic drug monitoring

Background: Despite that measurement uncertainty data should facilitate an appropriate interpretation of measured values, there are actually few reported by clinical laboratories. We aimed to estimate the measurement uncertainty of some β-lactam antibiotics (β-LA), and to evaluate the impact of reporting the measurement uncertainty on clinicians' decisions while guiding antibiotic therapy. Methods: Measurement uncertainty of β-LA (aztreonam [ATM], cefepime [FEP], ceftazidime [CAZ], and piperacillin [PIP]) values, obtained by an UHPLC-MS/MS based-method, was estimated using the top-down approach called the single laboratory validation approach (EUROLAB guidelines). Main uncertainty sources considered were related to calibrators' assigned values, the intermediate precision, and the bias. As part of an institutional program, patients with osteoarticular infections are treated with β-LA in continuous infusion and monitored to assure values at least 4 times over the minimal inhibitory concentration (4×MIC). We retrospectively evaluated the impact of two scenarios of laboratory reports on clinicians' expected decisions while monitoring the treatment: reports containing only the β-LA values, or including the β-LA coverage intervals (β-LA values and their expanded measurement uncertainties). Results The relative expanded uncertainties for ATM, FEP, CAZ and PIP were lower than 26.7%, 26.4%, 28.8%, and 25.5%, respectively. Reporting the measurement uncertainty, we identified that clinicians may modify their decision especially in cases where 4×MIC values were within the β-LA coverage intervals. Conclusions: This study provides a simple method to estimate the measurement uncertainty of β-LA values that can be easily applied in clinical laboratories. Further studies should confirm the potential impact of reporting measurement uncertainty on clinicians' decision-making while guiding antibiotic therapy

The Q-junction and the inflammatory response are critical pathological and therapeutic factors in CoQ deficiency

Defects in Coenzyme Q (CoQ) metabolism have been associated with primary mitochondrial disorders, neurodegenerative diseases and metabolic conditions. The consequences of CoQ deficiency have not been fully addressed, and effective treatment remains challenging. Here, we use mice with primary CoQ deficiency (Coq9R239X), and we demonstrate that CoQ deficiency profoundly alters the Q-junction, leading to extensive changes in the mitochondrial proteome and metabolism in the kidneys and, to a lesser extent, in the brain. CoQ deficiency also induces reactive gliosis, which mediates a neuroinflammatory response, both of which lead to an encephalopathic phenotype. Importantly, treatment with either vanillic acid (VA) or β-resorcylic acid (β-RA), two analogs of the natural precursor for CoQ biosynthesis, partially restores CoQ metabolism, particularly in the kidneys, and induces profound normalization of the mitochondrial proteome and metabolism, ultimately leading to reductions in gliosis, neuroinflammation and spongiosis and, consequently, reversing the phenotype. Together, these results provide key mechanistic insights into defects in CoQ metabolism and identify potential disease biomarkers. Furthermore, our findings clearly indicate that the use of analogs of the CoQ biosynthetic precursor is a promising alternative therapy for primary CoQ deficiency and has potential for use in the treatment of more common neurodegenerative and metabolic diseases that are associated with secondary CoQ deficiency.MCIN/AEI, SpainEuropean Commission RTI2018093503-B-100Muscular Dystrophy Association MDA-602322Junta de Andalucia P20_00134 PEER-00832020EPIC-XS - Horizon 2020 programme of the European Union 823839"Plan Propio de Investigacion" from the University of Granada Junta de Andaluci

The impact of surgical practice on oncological outcomes in robot-assisted radical hysterectomy for early-stage cervical cancer, Spanish National Registry

Minimal invasive surgery (MIS) has been associated with lower disease-free survival than open surgery among women who underwent radical hysterectomy for early-stage cervical cancer. However, the mechanisms by which MIS increases mortality in cervical cancer remain uncertain. We aimed to determine if surgical practice among centers using robotic surgery has an impact on oncological outcomes. We evaluated 215 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) who underwent robot-assisted radical hysterectomy in five Spanish tertiary centers between 2009 and 2018. A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed for the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes in all surgical approaches. Abstract: This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of 10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13-1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02-1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04-1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer

Psicopatología en el cine paraguayo: una primera aproximación

Introducción: el cine puede ser una herramienta útil para la educación médica. En la Psiquiatría, específicamente, el cine permite explorar las representaciones de diferentes trastornos mentales, cómo es vivir con una enfermedad mental, el estigma, la ética médica, la relación psiquiatra/paciente, entre otros. El objetivo de este estudio fue determinar la presencia de algún tipo de psicopatología en películas producidas en Paraguay, con el fin de que las mismas puedan ser utilizadas como herramientas didácticas en la enseñanza de la Psicopatología. Metodología: el diseño de esta investigación fue de tipo cualitativo exploratorio. Se seleccionaron, por conveniencia, 10 películas paraguayas, producidas entre los años 2010 y 2019. Las películas se eligieron tomando en cuenta su disponibilidad de visualización en las plataformas Netflix, Amazon Prime Video, HBO GO, Apple TV+, YouTube, y en formato DVD. Resultados: se analizaron en busca de Psicopatología las siguientes películas Universo Servilleta (2010), Cuchillo de Palo (2010), 7 cajas (2012), La Enamorada (2012), Latas Vacías (2014), La Chiperita (2015), Los Buscadores (2017), Leal (2018), Las Herederas (2018), y El Supremo Manuscrito (2019). En las películas seleccionadas se encontraron personajes con signos y síntomas que pueden resultar útiles para enseñar algunos de los principales síndromes psiquiátricos: trastornos depresivos, ansiedad, intentos de suicidio, rasgos obsesivo-compulsivos, trastornos de la personalidad, ideas delirantes, alteraciones del control de los impulsos y adicciones. Conclusión: el cine paraguayo, cada vez más rico y diverso, además de ser una fuente de inspiración y entretenimiento, puede ayudar en la enseñanza de la Medicina en general, y de la Psiquiatría en particular

The Q-junction and the inflammatory response are critical pathological and therapeutic factors in CoQ deficiency

Defects in Coenzyme Q (CoQ) metabolism have been associated with primary mitochondrial disorders, neurodegenerative diseases and metabolic conditions. The consequences of CoQ deficiency have not been fully addressed, and effective treatment remains challenging. Here, we use mice with primary CoQ deficiency (Coq9R239X), and we demonstrate that CoQ deficiency profoundly alters the Q-junction, leading to extensive changes in the mitochondrial proteome and metabolism in the kidneys and, to a lesser extent, in the brain. CoQ deficiency also induces reactive gliosis, which mediates a neuroinflammatory response, both of which lead to an encephalopathic phenotype. Importantly, treatment with either vanillic acid (VA) or β-resorcylic acid (β-RA), two analogs of the natural precursor for CoQ biosynthesis, partially restores CoQ metabolism, particularly in the kidneys, and induces profound normalization of the mitochondrial proteome and metabolism, ultimately leading to reductions in gliosis, neuroinflammation and spongiosis and, consequently, reversing the phenotype. Together, these results provide key mechanistic insights into defects in CoQ metabolism and identify potential disease biomarkers. Furthermore, our findings clearly indicate that the use of analogs of the CoQ biosynthetic precursor is a promising alternative therapy for primary CoQ deficiency and has potential for use in the treatment of more common neurodegenerative and metabolic diseases that are associated with secondary CoQ deficiency

Descripción de las características psicológicas relacionadas con la salud mental en la situación de emergencia de salud pública originada por el Covid-19

La pandemia por el coronavirus ha afectado sustancialmente a toda la población, impactando negativamente múltiples aspectos de la vida humana, en lo físico, psicológico, económico, social y cultural. La investigación realizada ha buscado describir las características psicológicas relacionadas con la salud mental en la situación de emergencia de salud pública actual. A partir, de un estudio descriptivo que contó con la participación de 174 personas que presentan algún vínculo con la Universidad Cooperativa de Colombia. Para la recolección de la información se diseñó un cuestionario que permitió identificar las características sociodemográficas y clínicas de la muestra de estudio, el evento de interés: riesgo para presentar una alteración en salud mental, se estimó a partir del instrumento de tamizaje, Cuestionario de Síntomas Self-Reporting Questionnaire. Se concluyó que las condiciones sociodemográficas y económicas de la población analizada, así como, las medidas de aislamiento y cuarentena para prevenir la propagación de la pandemia, podrían constituir factores de riesgo o protectores para la aparición de trastornos mentales.The coronavirus pandemic has substantially affected the lives of the entire world population, affecting multiple aspects of human life, physically, psychologically, economically, socially and culturally. The research carried out has sought to describe the psychological characteristics related to mental health in the current public health emergency situation. Starting from a descriptive study that included the participation of 174 people who have some connection with the Universidad Cooperativa de Colombia. To collect the information, a questionnaire was designed to identify the sociodemographic and clinical characteristics of the study sample. The event of interest: risk to present an alteration in mental health, was estimated from the screening instrument, Symptom Questionnaire. Self-Reporting Questionnaire. It was concluded that the sociodemographic and economic conditions of the analyzed population, as well as the isolation and quarantine measures to prevent the spread of the pandemic, could constitute risk or protective factors for the appearance of mental disorder.1. Resumen. -- 2. Abstract -- 3. Introducción. -- 4. Planteamiento y formulación del problema. -- 5. Justificación. -- 6. Objetivos de la investigación. -- 7. Marco referencial. -- 8. Marco teórico. -- 9. La salud mental, evolución del concepto.-- 10. Principales síndromes de salud mental -- 11. Ansiedad -- 12. Depresión -- 13. El estrés postraumático -- 14. Factores que influyen en la salud mental -- 15. Factores genéticos. -- 16. Factores psicosociales. -- 17. La salud menta l y la naturaleza biopsicosocial del ser humano. -- 18. Marco legal. -- 19. Diseño metodológico. -- 20. Proceso investigativo. -- 21. Población y muestra. -- 22. Técnicas en instrumentos de recolección de la información y sistematización. -- 23. Consideraciones éticas. -- 24. Resultados. -- 25. Discusión. -- 26. Conclusiones. -- 27. Bibliografía. -- 28. Anexos. -- 29. Cronograma. -- 30. Cuestionario de caracterización sociodemográfica y clínica. -- 31. Cuestionario de síntomas self-reporting questionnaire (Srq)

Assessment of the quality of multiple-choice exams through the Item Response Theory: implementation in the subject of “Psychological Assessment”

[EN] Multiple Choice testing (MCT) is one of the most popular approaches to the assessment of knowledge acquisition. Preparing a MCT is complex; however, its metric quality (in terms of difficulty, discrimination capacity, or distractors effectiveness) is not usually assessed. “Item Response Theory" (IRT) is a statistical approach that may assist when evaluating the quality of a MCT. IRT lets to estimate indices that may be used later as a way to improve the quality of the assessment. The aim of this work was to present the results of a teaching innovation project in which the IRT was employed to analyze the MCT used during the last 3 courses in the subject «Psychological Evaluation» (Degree in Speech Therapy). Results suggested that a significant proportion of the questions analyzed presented certain limitations, such as the excessive prevalence of easy items (between 45%-67.5%) or ineffective distractors (between 17.5%-26.6%). Yet, these issues did not impact the discrimination capacity of the MCT. These results serve as a basis for proposing initiatives to improve evaluations through MCT, which ultimately will result in a fairer and more balanced evaluation of the students of the subject.[ES] Los Exámenes de Alternativa Múltiple (EAM) son la forma más popular de evaluar la adquisición de conocimiento. Elaborar un EAM entraña cierta complejidad; sin embargo, rara vez se analiza en qué grado los EAM cumplen los criterios de calidad exigibles a estas pruebas (p.e., en términos de dificultad, capacidad de discriminación o eficacia de los distractores). La «Teoría de Respuesta al Ítem (TRI)» es una aproximación estadística que puede ayudar a la hora de evaluar la calidad de un EAM a través de la obtención de índices objetivos que, en una fase posterior, se pueden usar para mejorar la evaluación. El objetivo de este trabajo es presentar los resultados de un Proyecto de Innovación Docente en el que se analizó, mediante TRI, los EAM usados durante los últimos tres cursos en la asignatura «Evaluación Psicológica» (Grado en Logopedia). Los resultados sugieren que una proporción importante de preguntas analizadas presentaban limitaciones relacionadas con la excesiva presencia de ítems fáciles (entre el 45%-67.5%) o distractores ineficaces (entre el 17.5%-26.6%), si bien esto no afectó sobre su capacidad de discriminación. Estos resultados sirven de base para proponer iniciativas que permitan mejorar las evaluaciones a través de EAM.Castro-Calvo, J.; Pons-Cañaveras, D.; Beltrán-Martínez, P.; Atienza-González, F.; Bellver-Pérez, A.; De La Barrera-Marzal, U.; Díaz-Martínez, A.... (2022). Análisis de la calidad de exámenes de alternativa múltiple a través de la teoría de respuesta al item: aplicación en la asignatura de “Evaluación Psicològica”. Editorial Universitat Politècnica de València. 379-391. https://doi.org/10.4995/INRED2022.2022.1590537939

Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.Funding: This work was partially supported by RETICS Programs, RD08/0075 (RIER), RD12/0009/0013 and RD16/0012 from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Correlation between in vitro cytotoxicity and in vivo lethal activity in mice of epsilon toxin mutants from Clostridium perfringens

Epsilon toxin (Etx) from Clostridium perfringens is a pore-forming protein with a lethal effect on livestock, producing severe enterotoxemia characterized by general edema and neurological alterations. Site-specific mutations of the toxin are valuable tools to study the cellular and molecular mechanism of the toxin activity. In particular, mutants with paired cysteine substitutions that affect the membrane insertion domain behaved as dominant-negative inhibitors of toxin activity in MDCK cells. We produced similar mutants, together with a well-known non-toxic mutant (Etx-H106P), as green fluorescent protein (GFP) fusion proteins to perform in vivo studies in an acutely intoxicated mouse model. The mutant (GFP-Etx-I51C/A114C) had a lethal effect with generalized edema, and accumulated in the brain parenchyma due to its ability to cross the blood-brain barrier (BBB). In the renal system, this mutant had a cytotoxic effect on distal tubule epithelial cells. The other mutants studied (GFP-Etx-V56C/F118C and GFP-Etx-H106P) did not have a lethal effect or cross the BBB, and failed to induce a cytotoxic effect on renal epithelial cells. These data suggest a direct correlation between the lethal effect of the toxin, with its cytotoxic effect on the kidney distal tubule cells, and the ability to cross the BBB