Tratamiento nutricional de pacientes con insuficiencia cardíaca en situación de desnutrición

Desnutrició; Suport nutricional; Insuficiència cardíaca; AvaluacióDesnutrición; Soporte nutricional; Insuficiencia cardíaca; EvaluaciónMalnutrition; Nutritional support; Heart failure; EvaluationEl objetivo del presente informe es evaluar la seguridad y la eficacia/efectividad del soporte nutricional (incluyendo la SNO y la NE) en pacientes con IC y desnutrición que no es posible revertir mediante la ingesta única de alimentos de consumo ordinario. Para cumplir con el objetivo planteado, se realizó una revisión sistemática con tal de identificar estudios que hubieran evaluado la seguridad y la eficacia/efectividad del soporte nutricional (SNO y NE) en pacientes con IC y desnutrición.The objective of this report is to evaluate the safety and efficacy/effectiveness of nutritional support (including ONS and EN) in patients with HF and malnutrition that cannot be reversed through the sole intake of ordinary foods. To meet the stated objective, a systematic review was carried out in order to identify studies that had evaluated the safety and efficacy/effectiveness of nutritional support (ONS and EN) in patients with HF and malnutritionL’objectiu d’aquest informe és avaluar la seguretat i l’eficàcia/efectivitat del suport nutricional (incloses la SNO i la NE) en pacients amb IC i desnutrició que no és possible revertir mitjançant la ingesta única d’aliments de consum ordinari. Per complir l’objectiu plantejat, s’ha dut a terme una revisió sistemàtica per tal d’identificar estudis que hagin avaluat la seguretat i l’eficàcia/efectivitat del suport nutricional (SNO i NE) en pacients amb IC i desnutrició

Evaluación de tecnología basada en mSalud para aplicaciones móviles

mSalud; Aplicaciones móviles; Tecnologías sanitarias; EvaluaciónmHealth; Mobile applications; Health technologies; EvaluationmSalut; Aplicacions mòbils; Tecnologies sanitàries; AvaluacióLa actual proliferación del uso de tecnologías de mSalud en el campo de la promoción de la salud y la prevención y/o el control de enfermedades ha hecho necesario el diseño de marcos evaluativos que permitan conocer su aceptabilidad, factibilidad, usabilidad, validez, fiabilidad o sus potenciales efectos sobre variables de salud. La aplicación de estos marcos evaluativos a aplicaciones móviles es indispensable para pilotar su adecuación y viabilidad. El objeto de este desarrollo metodológico es proponer una herramienta para la evaluación de tecnologías sanitarias de mSalud.The current proliferation of the use of mHealth technologies in the field of health promotion and prevention and/ or disease control requires the necessity to design evaluation frameworks to know their acceptability, feasibility, usability, validity, reliability or their potential effects on health variables. The application of evaluation frameworks to assess the quality of mobile solutions is essential to pilot their suitability and viability. The objective of this methodological development is to propose a tool for the evaluation mHealth solutions.L’actual proliferació de l’ús de tecnologies de mSalud en el camp de la promoció de la salut i la prevenció i/o el control de malalties ha fet necessari el disseny de marcs avaluatius que en permetin conèixer l’acceptabilitat, factibilitat, usabilitat, validesa, fiabilitat o els efectes potencials sobre variables de salut. L’aplicació d’aquests marcs avaluatius en aplicacions mòbils és indispensable per pilotar-ne l’adequació i la viabilitat. L’objecte d’aquest desenvolupament metodològic és proposar una eina per a l’avaluació de tecnologies sanitàries de mSalud

Expression of the TGF-beta1 system in human testicular pathologies

In non-obstructive azoospermia, histological patterns of Sertoli cell-only Syndrome (SCO) and hypospermatogenesis (H) are commonly found. In these pathologies, Leydig cell hyperplasia (LCH) is detected in some patients. Since TGF-β1 is involved in cellular proliferation/development, the aim of this work was to analyze the expression of TGF-β1, its receptors TGFBRII, TGFBRI (ALK-1 and ALK-5), and the co-receptor endoglin in human biopsies from patients with idiopathic infertilityFil: Gonzalez, Candela Rocio. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Matzkin, Maria Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Frungieri, Monica Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Terradas, Claudio. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos"Carlos G. Durand"; Argentina. Instituto Médico IPREFER; ArgentinaFil: Ponzio, Roberto . Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Puigdomenech, Elisa. Instituto Médico IPREFER;; ArgentinaFil: Levalle, Oscar. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos"Carlos G. Durand"; ArgentinaFil: Calandra, Ricardo Saul. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina; ArgentinaFil: Gonzalez Calvar, Silvia Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentin

Altered expression of aromatase, estrogen receptors and progesterone receptors in human leydig cell hyperplasia

Testicular function is regulated by pituitary hormones and also by paracrine and autocrine factors. A number of reports have pointed out the importance of estrogens and progesterone in male reproductive tract. Recently, we have reported in testicular biopsies from men with Sertoli Cell Only Syndrome (SCO) or Hypospermatogenesis (H) with Leydig cell hyperplasia (LCH) an increase in the expression of the TGFB1 and its receptors ALK1 and endoglin, which are involved in the proliferation of Leydig cells. The aim of the present work was to analyze the expression of aromatase, estrogen and progesterone receptors (ERs, PR) in pathological testicular biopsies with SCO or H with and without LCH. The ERs and CYP19 proteins were detected in the Leydig cells from all pathological biopsies analyzed. Biopsies with SCO or H with LCH showed an increment in the immunostaining of CYP19 and ERs in the Leydig cells respect to biopsies without LCH. The gene expression of CYP19 was increased in SCO or H biopsies with LCH respect to SCO and H biopsies without LCH. PR was localized in Leydig cells and showed a significant increment in biopsies with LCH respect from biopsies without LCH. The gene expression of both PRA and PRB was increased in biopsies with LCH respect to biopsies without LCH. In concussion, alterations in the gene expression of aromatase, ERs, and PR and the likely interactions of these systems with locally produced factors such as growth factors and cytokines, might lead to Leydig cell proliferation in testicular pathology.Fil: Gonzalez, Candela Rocio. Universidad Maimónides. Area de Investigaciones Biomédicas y Biotecnológicas. Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y de Diagnóstico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Inserra, Pablo Ignacio Felipe. Universidad Maimónides. Area de Investigaciones Biomédicas y Biotecnológicas. Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y de Diagnóstico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Terradas, Claudio. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Ponzio, Roberto Oscar. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Puigdomenech, Elisa. No especifíca;Fil: Levalle, Oscar. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Carlos G. Durand"; ArgentinaFil: Vitullo, Alfredo Daniel. Universidad Maimónides. Area de Investigaciones Biomédicas y Biotecnológicas. Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y de Diagnóstico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Calandra, Ricardo Saul. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Gonzalez de Calvar, Silvia Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentin

Tratamiento nutricional de pacientes pluripatológicos en situación de desnutrición

Pluripatología; Desnutrición; Soporte nutricionalPluripatologia; Desnutrición; Suport nutricionalMultipathology; Malnutrition; Nutritional supportThe objective of this report is to evaluate the safety and efficacy/effectiveness of nutritional support (including ONS and EN) in patients with multiple pathologies (two or more chronic diseases and/or a Charlson Comorbidity Index> 1.5) in a situation of malnutrition in which their nutritional requirements (both caloric and protein) are not met with oral intake in the hospital or outpatient setting. It is also intended to analyse the nutrient profile of the formulas used in the nutritional support of patients with multiple pathologies and malnutrition.L’objectiu d’aquest informe és avaluar la seguretat i l’eficàcia/efectivitat del suport nutricional (incloent-hi la SNO i la NE) en pacients amb pluripatologia (dues o més malalties cròniques i/o un índex de comorbiditat de Charlson >1,5) en situació de desnutrició que no cobreixen els seus requeriments nutricionals (tant calòrics com proteics) amb la ingesta per via oral en l’àmbit hospitalari o ambulatori. També es pretén analitzar el perfil de nutrients de les fórmules emprades en el suport nutricional de pacients amb pluripatologia i desnutrició.El objetivo del presente informe es evaluar la seguridad y la eficacia/ efectividad del soporte nutricional (incluyendo la SNO y la NE) en pacientes con pluripatología (dos o más enfermedades crónicas y/o un índice de comorbilidad de Charlson >1,5) en situación de desnutrición que no cubren sus requerimientos nutricionales (tanto calóricos como proteicos) con la ingesta por vía oral en el ámbito hospitalario o ambulatorio. También se pretende analizar el perfil de nutrientes de las fórmulas empleadas en el soporte nutricional de pacientes con pluripatología y desnutrición

Tratamiento nutricional de pacientes con enfermedad pulmonar obstructiva crónica en situación de desnutrición

Nutrició; Desnutrició; Malaltia pulmonar obstructiva crònica; TractamentNutrición; Desnutrición; Enfermedad pulmonar obstructiva crónica; TratamientoNutrition; Malnutrition; Chronic obstructive pulmonary disease; TreatmentEl objetivo del presente informe es evaluar la seguridad y la eficacia/efectividad del soporte nutricional (incluyendo la SNO y la NE) en pacientes con EPOC en riesgo o desnutrición que no es posible revertir mediante la ingesta única de alimentos de consumo ordinario. También se pretendió definir el perfil de nutrientes de las fórmulas empleadas en el soporte nutricional de pacientes con EPOC en riesgo o desnutrición. Para cumplir con el objetivo planteado, se realizó una revisión sistemática con tal de identificar estudios que hubieran evaluado la seguridad y la eficacia/efectividad del soporte nutricional (SNO y NE) en pacientes con EPOC y desnutrición. Se consideró población de estudio a los pacientes adultos con diagnóstico de EPOC y desnutrición no reversible mediante el consumo habitual de alimentos. La intervención de estudio fue el soporte nutricional (SNO o la NE mediante sonda nasoentérica, gastrostomía o yeyunostomía) realizada en el ámbito hospitalario o ambulatorio. Como comparador, se consideró el tratamiento habitual sin suplemento nutricional (SNO o NE), la nutrición parenteral, el placebo o la no intervención. Las medidas de resultado se relacionaron con la seguridad (acontecimientos adversos y complicaciones del proceso) y la eficacia/efectividad (mortalidad, morbilidad, tasa de ingreso hospitalario, medidas antropométricas, función muscular, función respiratoria, adherencia al tratamiento y calidad de vida relacionada con la salud). Los diseños de estudio considerados fueron revisiones sistemáticas y metaanálisis, estudios comparativos (ensayos clínicos aleatorizados y controlados, estudios cuasi experimentales, estudios de cohortes y estudios de casos y controles). La evaluación de la calidad de los estudios se realizó mediante el análisis del riesgo de sesgo y la aplicabilidadThe purpose of this report is to evaluate the safety and efficacy/effectiveness of nutritional support (including ONS and EN) in patients with COPD already malnourished or at risk of malnutrition that cannot be reversed through the sole intake of ordinary food consumption. The aim was also to define the nutrient profile of the formulas used for the nutritional support of patients with COPD already malnourished or at risk of it. To meet the stated objective, a systematic review was performed to identify studies that had evaluated safety and efficacy/effectiveness of nutritional support (ONS and EN) in patients with COPD and malnutrition. Adult patients with a COPD diagnosis and malnutrition that could not be reversed through regular food consumption were considered as the study population. The study intervention was nutritional support (ONS and EN with nasoenteric tube, gastrostomy, or jejunostomy) performed in a hospital or outpatient setting. The usual treatment without nutritional supplement (ONS or EN), parenteral nutrition, placebo, and no intervention were considered as comparators. Outcome measures were related with safety (adverse events and process complications) and efficacy/effectiveness (mortality, morbidity, hospital admission rate, anthropometric measures, muscle function, respiratory function, adherence to treatment, and health-related quality of life). The study designs considered were systematic reviews and meta-analyses, comparative studies (randomised and controlled clinical trials, quasi-experimental studies, cohort studies, and case-control studies). The assessment of the quality of the studies was performed by analysing the risk of bias and applicability. Of the 241 references identified in the systematic review, 43 were selected for being potentially includible. After reading the complete text and applying the established inclusion and exclusion criteria, 35 studies were excluded.L’objectiu d’aquest informe és avaluar la seguretat i l’eficàcia/efectivitat del suport nutricional (incloses la SNO i la NE) en pacients amb MPOC en risc o desnutrició que no és possible revertir mitjançant la ingesta única d’aliments de consum ordinari. També es va pretendre definir el perfil de nutrients de les fórmules utilitzades en el suport nutricional de pacients amb MPOC en risc o desnutrició. Per aconseguir l’objectiu plantejat, es va dur a terme una revisió sistemàtica per tal d’identificar estudis que haguessin avaluat la seguretat i l’eficàcia/efectivitat del suport nutricional (SNO i NE) en pacients amb MPOC i desnutrició. Es va considerar població d’estudi els pacients adults amb diagnòstic de MPOC i desnutrició no reversible mitjançant el consum habitual d’aliments. La intervenció d’estudi va ser el suport nutricional (SNO o la NE mitjançant sonda nasoentèrica, gastrostomia o jejunostomia) administrat en l’àmbit hospitalari o ambulatori. Com a comparador, es va considerar el tractament habitual sense suplement nutricional (SNO o NE), la nutrició parenteral, el placebo o la no-intervenció. Les mesures de resultat es van relacionar amb la seguretat (esdeveniments adversos i complicacions del procés) i l’eficàcia/ efectivitat (mortalitat, morbiditat, taxa d’ingrés hospitalari, mesures antropomètriques, funció muscular, funció respiratòria, adherència al tractament i qualitat de vida relacionada amb la salut). Els dissenys d’estudi considerats van ser revisions sistemàtiques i metanàlisis, estudis comparatius (assajos clínics aleatoritzats i controlats, estudis quasi experimentals, estudis de cohorts i estudis de casos i controls). L’avaluació de la qualitat dels estudis es va dur a terme mitjançant l’anàlisi del risc de biaix i l’aplicabilitat

Screening Physical Activity in Family Practice : Validity of the Spanish Version of a Brief Physical Activity Questionnaire

The use of brief screening tools to identify inactive patients is essential to improve the efficiency of primary care-based physical activity (PA) programs. However, the current employment of short PA questionnaires within the Spanish primary care pathway is unclear. This study evaluated the validity of the Spanish version of a Brief Physical Activity Assessment Tool (SBPAAT). A validation study was carried out within the EVIDENT project. A convenience sample of patients (n = 1,184; age 58.9±13.7 years; 60.5% female) completed the SBPAAT and the 7-day Physical Activity Recall (7DPAR) and, in addition, wore an accelerometer (ActiGraph GT3X) for seven consecutive days. Validity was evaluated by measuring agreement, Kappa correlation coefficients, sensitivity and specificity in achieving current PA recommendations with the 7DPAR. Pearson correlation coefficients with the number of daily minutes engaged in moderate and vigorous intensity PA according to the accelerometer were also assessed. Comparison with accelerometer counts, daily minutes engaged in sedentary, light, moderate, and vigorous intensity PA, total daily kilocalories, and total PA and leisure time expenditure (METs-hour-week) between the sufficiently and insufficiently active groups identified by SBPAAT were reported. The SBPAAT identified 41.3% sufficiently active (n = 489) and 58.7% insufficiently active (n = 695) patients; it showed moderate validity (k = 0.454, 95% CI: 0.402-0.505) and a specificity and sensitivity of 74.3% and 74.6%, respectively. Validity was fair for identifying daily minutes engaged in moderate (r = 0.215, 95% CI:0.156 to 0.272) and vigorous PA (r = 0.282, 95% CI:0.165 to 0.391). Insufficiently active patients according to the SBPAAT significantly reported fewer counts/minute (-22%), fewer minutes/day of moderate (-11.38) and vigorous PA (-2.69), spent fewer total kilocalories/day (-753), and reported a lower energy cost (METs-hour-week) of physical activities globally (-26.82) and during leisure time (-19.62). The SBPAAT is a valid tool to identify Spanish-speaking patients who are insufficiently active to achieve health benefits

Patterns of sedentary behavior in overweight and moderately obese users of the Catalan primary-health care system

Background and objectives Prolonged sitting time (ST) has negative consequences on health. Changing this behavior is paramount in overweight/obese individuals because they are more sedentary than those with normal weight. The aim of the study was to establish the pattern of sedentary behavior and its relationship to health, socio-demographics, occupation, and education level in Catalan overweight/obese individuals. Methods A descriptive study was performed at 25 healthcare centers in Catalonia (Spain) with 464 overweight/moderately obese patients, aged25 to 65 years. Exclusion criteria were chronic diseases which contraindicated physical activity and language barriers. Face-to-face interviews were conducted to collect data on age, gender, educational level, social class, and marital status. Main outcome was ‘sitting time’ (collected by the Marshall questionnaire); chronic diseases and anthropometric measurements were registered. Results 464 patients, 58.4% women, mean age 51.9 years (SD 10.1), 76.1% married, 60% manual workers, and 48.7% had finished secondary education. Daily sitting time was 6.2 hours on working days (374 minutes/day, SD: 190), and about 6 hours on non-working ones (357 minutes/day, SD: 170). 50% of participants were sedentary 6 hours. The most frequent sedentary activities were: working/academic activities around 2 hours (128 minutes, SD: 183), followed by watching television, computer use, and commuting. Men sat longer than women (64 minutes more on working days and 54 minutes on non-working days), and individuals with office jobs (91 minutes), those with higher levels of education (42 minutes), and younger subjects (25 to 35 years) spent more time sitting. Conclusions In our study performed in overweight/moderately obese patients the mean sitting time was around 6 hours which was mainly spent doing work/academic activities and watching television. Men, office workers, individuals with higher education, and younger subjects had longer sitting time. Our results may help design interventions targeted at these sedentary patients to decrease sitting time.

Promoting healthy teenage behaviour across three European countries through the use of a novel smartphone technology platform, PEGASO fit for future: study protocol of a quasi-experimental, controlled, multi-Centre trial

BackgroundBehaviour change interventions targeting physical activity, diet, sleep and sedentary behaviour of teenagers show promise when delivered through smartphones. However, to date there is no evidence of effectiveness of multicomponent smartphone-based interventions. Utilising a user-centred design approach, we developed a theory-based, multi-dimensional system, PEGASO Fit For Future (PEGASO F4F), which exploits sophisticated game mechanics involving smartphone applications, a smartphone game and activity sensors to motivate teenagers to take an active role in adopting and maintaining a healthy lifestyle. This paper describes the study protocol to assess the feasibility, usability and effectiveness (knowledge/awareness and behavioural change in lifestyle) of the PEGASO system.MethodsWe are conducting a quasi-experimental controlled cluster trial in 4 sites in Spain, Italy, and UK (England, Scotland) over 6 months. We plan to recruit 525, in a 2:1 basis, teenagers aged 13–16 years from secondary schools. The intervention group is provided with the PEGASO system whereas the comparison group continues their usual educational routine. Outcomes include feasibility, acceptance, and usability of the PEGASO system as well as between and within group changes in motivation, self-reported diet, physical activity, sedentary and sleeping behaviour, anthropometric measures and knowledge about a healthy lifestyle.DiscussionPEGASO F4F will provide evidence into the cross-cultural similarities and differences in the feasibility, acceptability and usability of a multi-dimensional smartphone based behaviour change intervention for teenagers. The study will explore facilitating factors, challenges and barriers of engaging teenagers to adapt and maintain a healthy lifestyle when using smartphone technology. Positive results from this ICT based multi component intervention may have significant implications both at clinical level, improving teenagers health and at public health level since it can present an influential tool against the development of chronic disease during adulthood.Trial registrationhttps://clinicaltrials.gov Registration number: NCT02930148, registered 4 October 2016