Dislipemias

Para prevenir las enfermedades cardiovasculares en la vida adulta, es necesario identificar y tratar lo antes posible la hipercolesterolemia en los niños y en los adolescentes. Se debe realizar estudio a la población infantil de riesgo después de los 2 años, si existe historia familiar positiva o presencia de factores de riesgo cardiovascular en el niño. Las causas secundarias de hipercolesterolemias deben ser descartadas. El objetivo primordial del tratamiento dietético de las hipercolesterolemias será lograr que los niveles de C-LDL disminuyan, consiguiendo un descenso de un 10 a un 15%, aunque existen grandes variaciones individuales. Las estatinas deben ser incluidas entre los potenciales fármacos de primera línea por la experiencia adquirida en los últimos años, y por su capacidad de disminuir los niveles de C-LDL en torno a 18-45%, y sin afectación del crecimiento ni del desarrollo puberal. La edad de inicio del tratamiento con estatinas debe ser a partir de los 10 años, preferentemente a partir del Tanner II en los varones y después de la menarquia en las niñas. Otras opciones farmacológicas son el ezetimibe o las resinas de intercambio iónicoTo prevent cardiovascular diseases in adulthood, it is necessary to identify and treat as soon as possible hypercholesterolemia in children and adolescents. The study should be performed to child population at risk after two years, if there is a positive family history or presence of cardiovascular risk factors. Secondary causes of hypercholesterolemia should be discarded. The primary objective of the dietary treatment of hypercholesterolemia is to decrease LDL-C levels, achieving a decrease of 10 to 15%, although there are large individual variations. Statins should be included among potential first-line drugs, as per experience gained in recent years, and its ability to lower LDL-C levels around 18-45%, without affecting the growth and pubertal development. Treatment with statins should be started at 10 years of age and over, preferably starting with Tanner II in males and after menarche in girls. Other pharmacological options include ezetimibe or ion exchange resin

Pubertad precoz y retraso puberal

La edad en que la pubertad se inicia es muy variable y, en condiciones normales, está infl uenciada, además de por el sexo, por factores genéticos y ambientales. Su presentación precoz o tardía puede ser una simple variación extrema de la normalidad o el refl ejo de alguna de las múltiples patologías que pueden infl uir o condicionar el momento de su aparición. En cualquier caso, aun en ausencia de patología, el desarrollo de los caracteres sexuales secundarios a una edad “inadecuada” es motivo de preocupación para los padres y los pacientes y puede tener repercusiones negativas en la vida adulta. El pediatra de Atención Primaria es el profesional que se enfrenta inicialmente a este tipo de situaciones y debe ser capaz de realizar un enfoque diagnóstico adecuado, diferenciar aquellas variantes normales del desarrollo de las que no lo son, orientar a los padres y al paciente y, en aquellos casos que considere necesario, derivar al paciente a un servicio de Endocrinología PediátricaThe age in which puberty initiates varies greatly and, under normal conditions, is also infl uenced by gender, genetic and environmental factors. Its early or late presentation may be a simple extreme variation of normality or the refl ex of any of the multiple conditions that may affect or condition the moment of its appearance. In any case, even in the absence of disease, the development of sexual characters secondary to an “inadequate” age is a reason for concern for the parents and the patients and may have negative repercussions in the adult age. In primary care in pediatrics, it is the professional who initially faces this type of situation and should be capable of performing an adequate diagnostic approach, of differentiating those normal variants from development which are not, of orienting the parents and patient, and in those cases were considered necessary, of referring the patient to a Pediatric Endocrinology servic

Pubertad normal y sus variantes

La pubertad es el periodo de transición entre la infancia y la edad adulta, donde tienen lugar importantes cambios físicos, funcionales, psicológicos y relacionales. La cronología de la pubertad es extremadamente variable en función del componente genético y ambiental. Se producen cambios en los ejes hipotálamo-hipófi so-gonadal y de la hormona de crecimiento, así como en los factores de crecimiento semejantes a la insulina, la leptina y los andrógenos. También, se producen cambios en la composición corporal y en la mineralización ósea. Se describen las variantes normales de pubertad, y se revisan los aspectos etiológicos y clínicos, los criterios diagnósticos y el tratamiento a realizarPuberty is the transition period between childhood and adult age. There are important physical, functional, psychological and related changes during puberty. The chronology of puberty is extremely variable based on the genetic and environmental component. Changes occur in the hypothalamic-pituitary-gonadal axes and growth hormone, as well as in the growth factors similar to insulin, leptin and androgens. Changes also occur in the body composition and bone mineralization. The normal variants of puberty are described and the etiological and clinical aspects, diagnostic criteria and treatment to be performed are reviewe

Pubertad precoz y retraso puberal

La edad en que la pubertad se inicia es muy variable y, en condiciones normales, está infl uenciada, además de por el sexo, por factores genéticos y ambientales. Su presentación precoz o tardía puede ser una simple variación extrema de la normalidad o el refl ejo de alguna de las múltiples patologías que pueden infl uir o condicionar el momento de su aparición. En cualquier caso, aun en ausencia de patología, el desarrollo de los caracteres sexuales secundarios a una edad “inadecuada” es motivo de preocupación para los padres y los pacientes y puede tener repercusiones negativas en la vida adulta. El pediatra de Atención Primaria es el profesional que se enfrenta inicialmente a este tipo de situaciones y debe ser capaz de realizar un enfoque diagnóstico adecuado, diferenciar aquellas variantes normales del desarrollo de las que no lo son, orientar a los padres y al paciente y, en aquellos casos que considere necesario, derivar al paciente a un servicio de Endocrinología PediátricaThe age in which puberty initiates varies greatly and, under normal conditions, is also infl uenced by gender, genetic and environmental factors. Its early or late presentation may be a simple extreme variation of normality or the refl ex of any of the multiple conditions that may affect or condition the moment of its appearance. In any case, even in the absence of disease, the development of sexual characters secondary to an “inadequate” age is a reason for concern for the parents and the patients and may have negative repercussions in the adult age. In primary care in pediatrics, it is the professional who initially faces this type of situation and should be capable of performing an adequate diagnostic approach, of differentiating those normal variants from development which are not, of orienting the parents and patient, and in those cases were considered necessary, of referring the patient to a Pediatric Endocrinology servic

Síndrome metabólico en la infancia y en la adolescencia

El síndrome metabólico es el conjunto de factores de riesgo relacionados con la obesidad, dislipemia, hipertensión arterial, resistencia a la insulina, y los estados infl amatorios, protrombóticos y aterogénicos, todos ellos predictores de enfermedad cardiovascular. La mayoría de los estudios demuestran que la prevalencia del síndrome metabólico es dependiente de las defi niciones utilizadas. Los mecanismos fi siopatológicos en niños han sido poco investigados, siendo uno de los principales la resistencia a la insulina. La determinación de la glucemia y la insulina en ayunas son necesarios para identifi car las alteraciones de la homeostasis de la glucemia y refl ejan, fundamentalmente, la secreción de insulina y la sensibilidad hepática y periférica. El tratamiento comprende, en primer lugar, la realización de una dieta adecuada que tiene como objetivo mejorar la sensibilidad a la insulina y prevenir o corregir las alteraciones metabólicas y cardiovasculares asociadas. Asimismo, se debe acompañar de la realización de ejercicio físico regular y un adecuado soporte psicológico. Para el tratamiento farmacológico de la obesidad grave, disponemos de algunos fármacos, siendo aún su indicación limitada en la adolescencia. En las alteraciones de la tolerancia a la glucemia, la modifi cación de los estilos de vida mejoran tanto la glucemia como los factores de riesgo cardiovascular. A menudo, hay que recurrir al tratamiento farmacológico, ya que los cambios en el estilo de vida son, a veces, complicados en los adolescentes. Por último, las estrategias para la prevención de la obesidad y el síndrome metabólico deben iniciarse en Atención Primaria, con programas dirigidos al ambiente familiar del niño con riesgo de obesidad y con programas desarrollados en el medio escolarThe metabolic syndrome is a combination of risk factors related with obesity, dyslipidemia, high blood pressure, insulin resistance, and infl ammatory, prothrombotic and atherogenic states, all of these predictors of cardiovascular disease. Most of the studies show that the prevalence of the metabolic syndrome is dependent on the defi nitions used. The pathophysiological mechanisms in children have not been demonstrated much, one of the principal ones being insulin resistance. Measurement of fasting glucose and insulin are necessary to identify the alterations of glucose homeostasis and fundamentally refl ect insulin secretion and hepatic and peripheral sensitivity. Treatment includes, in the fi rst place, adequate diet whose objective is to improve sensitivity to insulin and prevent or correct associated metabolic and cardiovascular disorders. In addition, it should be accompanied by regular physical exercise and adequate psychological support. Some drugs are available for their pharmacological treatment of severe obesity, their indications still being limited in adolescence. In glucose tolerability alterations, modifi cations of style of life improves spoke glucose and cardiovascular risk factors. It is often necessary to resort to drug treatment, since changes in style of life are sometimes complicated in adolescence. Finally, the strategies for the prevention of obesity on metabolic syndrome should be initiated in Primary Care, with programs aimed at the family environment of the child with risk of obesity and with programs developed in the school settin

Obesidad en la infancia y en la adolescencia

La obesidad se considera en la actualidad un problema de salud pública mundial debido al constante aumento de su prevalencia asociado a los cambios en los estilos de vida de la población, que incluyen la inactividad física y el incremento en el ingreso de calorías. Además, existe una baja percepción del problema por parte de las familias, sobre todo de aquellas que tienen más riesgo. La prevalencia actual en nuestro país se estima en un 14%. Determinados sujetos pueden tener una mayor predisposición genética a aumentar de peso, y los genes pueden no expresarse totalmente hasta la etapa adulta. En este artículo, se abordarán: la etiopatogenia y su clasifi cación, la elevada comorbilidad asociada, así como el abordaje diagnóstico y terapéutico. La base fundamental del tratamiento es la instauración de un programa multidisciplinar a largo plazo que asocie educación nutricional, aumento de la actividad física, restricción dietética y modifi caciones de la conducta de la población. Se debe iniciar la prevención en edades precoces; ya que, los hábitos de salud se establecen en la infancia y, posteriormente, será muy difícil modifi carlos. El pediatra tiene un gran protagonismo detectando los factores y poblaciones de riesgo, ejerciendo una acción educadora a nivel de las familias, sus hijos, la escuela y los ámbitos sociales y políticos.Obesity is now considered a global public health problem due to the constant increase in its prevalence associated with changes in the population’s lifestyles, including the reduction in physical inactivity and an increase in caloric intake. There is also a low awareness of the problem in families, especially those at higher risk. The current prevalence in Spain is estimated at 14%. Certain individuals may have a greater genetic predisposition to gain weight, and genes may not be fully expressed until adulthood. This article addresses: pathogenesis and its classifi cation, high comorbidity associated with obesity and its diagnostic and therapeutic approach. The basis of the treatment is to establish a multidisciplinary program that combines a long-term nutritional education, an increase in physical activity, a dietary restriction and certain behavioral modifi cations in the population. Prevention should be initiated at earlier ages, since health habits are established during childhood and are very complicated to change afterwards. Pediatricians play a major role in detecting factors and segments of the population at risk, ensuring the education in families, their children and in schools and other social and political environments

Proyecto de prevención del bullying y de mejora de la convivencia escolar

Trabajo de fin de grado. Grado en Trabajo Social. Curso académico 2014-2015Se trata de un proyecto de prevención del acoso escolar con una doble finalidad: Por un lado, la de concienciar y sensibilizar a la comunidad educativa (familias, alumnado, profesores y personal no docente) sobre el acoso escolar, así como formarles y capacitarles para prevenir su incidencia. Dicha prevención se va a realizar desde la perspectiva ecológica, disminuyendo las condiciones de riesgo e incrementando los factores de protección, mediante el fomento de las competencias y fortalezas de los alumnos/as y generando un clima satisfactorio para los participantes del contexto escolar. Por otro lado, hacer visible la necesidad de que el profesional en Trabajo Social tenga un papel activo en la escuela a nivel grupal y comunitario y, por tanto, también en la prevención e intervención del acoso escolar

Fertilization of maize with compost from cattle manure supplemented with additional mineral nutrients

[EN] An alternative approach for cattle manure management on intensive livestock farms is the composting process. An industrial-scale composting plant has been set up in northwest Spain for producing compost from cattle manure. Manure composting involved an increase in pH, electrical conductivity (EC), cation exchange capacity (CEC) and NO3--N concentration, and a decrease in temperature, moisture content, organic matter (OM) content, NH4+-N concentration and C/N ratio. Cu, Zn and Ni concentrations increased due to the reduction of pile weight during the composting process. The resulting compost was applied to a field to study the viability of applying this compost combined with a nitrogen mineral fertilizer as a replacement for the mineral fertilization conventionally used for maize (Zea mays L.). The thermophilic phase of the composting process was very prolonged in the time, which may have slowed down the decomposition of the organic matter and reduced the nitrification process, leading to an over-short maturation phase. The humification and respirometric indexes, however, determined immediately after compost application to the soil, showed it to be stable. Compost application did not decrease the grain yield. A year later, soil pH, OM content and CEC were higher with the compost treatment. Total P, K, Ca and Na concentrations in compost-amended plots were higher than in mineral-fertilized ones, and no significant differences between treatments were found in soil concentrations of NH4+-N, NO3--N, available P, Mg and B. Compost caused no heavy metal pollution into the soil. Therefore, this compost would be a good substitute for the mineral fertilizers generally used for basal dressing in maize growingS

Assessing of the most appropriate biotechnological strategy on the recovery of antioxidants from beet wastes by applying the life cycle assessment (LCA) methodology

The valorization of agro-industrial waste streams and residues for the production of antioxidant compounds is a good strategy for circular economy approaches. However, to demonstrate its suitability and operational feasibility, it is necessary to develop environmental assessments to ensure the effectiveness of the production strategy. In this sense, a large-scale simulation has been developed, obtaining ten different scenarios in which both leaves and steam residues are used as process inputs, and five different extraction techniques are applied, both conventional: Soxhlet and maceration, and emerging technologies: ultrasonic assisted extraction (UAE), supercritical fluid extraction (SFE) and pressurized liquid extraction, (PLE). Environmental results have shown that SFE and PLE technologies have the lowest environmental burdens, while UAE has the worst profile due to high energy demand. Electricity could be considered as the main hotspot with the highest impact, followed by steam requirements and the use of extraction solvent. To improve the environmental profile, sensitivity analyses were performed, considering the use of renewable resources for the production of the energy requirements and the selection of the extraction solvent. Although significant improvements were obtained when electricity and steam production is based on hydropower and waste incineration, the environmental profile did not improve when considering ethanol: water mixture or hexane for extraction. Future research should focus on reducing energy requirements and optimizing the solvent dosage for the extraction processThis research has been supported by the project Enhancing diversity in Mediterranean cereal farming systems (CerealMed) project funded by PRIMA Programme and FEDER/Ministry of Science and Innovation-Spanish National Research Agency (PCI2020-111978) and by a project granted by Xunta de Galicia (project ref. ED431 F 2016/001). The authors belong to the Galician Competitive Research Group (GRC ED431C 2017/29) and to the Cross-disciplinary Research in Environmental Technologies (CRETUS Research Center, ED431E 2018/01)S

Low cost autonomous lock-in amplifier for resistance/capacitance sensor measurements

This paper presents the design and experimental characterization of a portable high-precision single-phase lock-in instrument with phase adjustment. The core consists of an analog lock-in amplifier IC prototype, integrated in 0.18 µm CMOS technology with 1.8 V supply, which features programmable gain and operating frequency, resulting in a versatile on-chip solution with power consumption below 834 µW. It incorporates automatic phase alignment of the input and reference signals, performed through both a fixed-90° and a 4-bit digitally programmable phase shifter, specifically designed using commercially available components to operate at 1 kHz frequency. The system is driven by an Arduino YUN board, thus overall conforming a low-cost autonomous signal recovery instrument to determine, in real time, the electrical equivalent of resistive and capacitive sensors with a sensitivity of 16.3 µV/O @ erS < 3 % and 37 kV/F @ erS < 5 %, respectively