Restless legs syndrome in patients with high serum ferritin and normal iron levels

Trabajo presentado como póster en el 18.º Congreso de la European Sleep Research Society, celebrado en Innsbruck (Austria) en 2006Objetivo. Documentar la asociación entre síndrome de piernas inquietas (SPI) y concentraciones de ferritina elevadas en cinco pacientes. Pacientes y métodos. Estudiamos a cinco varones con una edad media de 59 años (rango: 36-73 años). Todos los pacientes fueron remitidos por SPI (dos de ellos donantes de sangre), en dos casos asociado a síndrome de apnea obstructiva del sueño. Se efectuaron registros videopolisomnográficos y se realizó una analítica para determinar los niveles de ferritina y hierro en plasma. Resultados. Los cinco pacientes presentaban criterios clínicos de SPI: parestesias en las pantorrillas asociadas a una necesidad imperiosa de mover las piernas, inquietud motora, agravamiento de los síntomas por la tarde y por la noche, mejoría con el movimiento, dificultad de conciliación del sueño y despertares nocturnos frecuentes. La exploración neurológica, el electroencefalograma, el electromiograma y la resonancia magnética cerebral fueron normales. Los registros videopolisomnográficos mostraron sueño nocturno fragmentado, reducción del tiempo total de sueño, escasa eficiencia, índice de apnea-hipopnea > 10/h en dos casos, y en los cinco casos, índice de movimientos periódicos de las piernas por hora de sueño > 5/h. En todos los casos los niveles de hierro sérico estaban dentro de los límites normales y la concentración de ferritina era elevada. Conclusiones. La asociación entre SPI con movimientos periódicos de las piernas durante el sueño, hierro sérico normal y ferritina elevada no se ha descrito previamente. El hallazgo de la disminución de concentración de ferritina en uno de los pacientes –meses más tarde del tratamiento con fármacos dopaminérgicos– apoya la implicación de un mecanismo dopaminérgico en la fisiopatología del SPIAim. To document the association between restless legs syndrome (RLS) and high ferritin levels in five patients. Patients and methods. The five patients were male, mean age: 59 years (range: 36-73 years). The patients were referred for RLS (two of them blood donors), in two cases associated with obstructive sleep apnea. Patients underwent a video-PSG recording. Serum iron and serum ferritin were determined. Results. All patients fulfilled the clinical criteria for RLS: leg paresthesias associated with an urge to move, motor restlessness, worsening of symptoms during the evening and night, and partial relief with activity, difficulty falling asleep, and presence of nocturnal awakenings due to RLS. Neurological examination, EEGs, EMGs and MRIs were normal. Video-PSGs recordings showed a disturbed and fragmented sleep with a reduction in total sleep time, low sleep efficiency, respiratory abnormalities with an apnea-hipopnea index > 10/h in two cases, and in all of them a periodic leg movements index > 5/h. The serum iron levels were within the normal range in all cases, whereas those in serum ferritin levels were high. Conclusions. To our knowledge the association of normal serum iron with high serum ferritin levels in patients diagnosed clinically and polygraphically as having RLS with periodic leg movements has not been described before. The notion of an involvement of a dopaminergic mechanism in the pathophysiology of RLS is supported by the decrease in the values of serum ferritin concentration observed in one patient during follow-up while being treated with dopaminergic agent

Prácticas habituales de las matronas en el parto en los hospitales públicos de Barcelona

Objetivo: Conocer cuáles son las actividades y prácticas realizadas por las matronas, según el nivel de complejidad hospitalario nivel I (hospital comarcal), nivel II (hospital de referencia) y nivel III (de alta tecnología). Diseño: Estudio descriptivo transversal. Personas y método: Matronas de hospitales públicos de la provincia de Barcelona que trabajaban en sala de partos. Como instrumento de recogida de datos se diseñó un cuestionario distribuido a todos los hospitales entre di-ciembre de 2004 y febrero de 2005. Las principales va-riables del estudio fueron sociodemográficas, actividades realizadas por las matronas y percepción del propio rol. Resultados: Se estudiaron 135 matronas procedentes de 18 hospitales. La media de edad fue de 44,6 años (DE= 8,45), y la media de experiencia profesional de 19,9 años (DE= 10,24). Los partos eutócicos son atendidos por las matronas en un 43,6% (58) y en los hospitales de nivel I con un 81,1% (30). El hecho de efectuar el diagnóstico de parto y el control de dilatación ejercido por la matrona fue distinto según el nivel de hospital (p <0,001). Respecto a las actividades protocolizadas (control de la dilatación, realización de ventanas de monitorización cardiotocográfica), no se reflejaron diferencias entre los distintos niveles de atención hospitalaria. En cuanto a las actividades y la educación sanitaria en el puerperio, destaca la poca presencia de las matronas en las salas maternoinfantiles. Las matronas definieron su rol como profesionales que ejer-cen por igual tareas autónomas como delegadas (63,4% (83), no existiendo variabilidad entre tipos de hospitales. Conclusión: Las actividades realizadas por las matronas en el diagnóstico, atención al parto eutócico y control puerperal difieren entre los distintos niveles de atención hospitalaria, siendo menores cuanto mayor es el nivel del hospital

Sleep quality and sleep deprivation: relationship with academic performance in university students during examination period

The beginning of the university brings together maturational, psychosocial and academic changes that make university students more prone to suffer from insufficient or poor quality sleep, which can negatively influence their academic performance. The period of taking exams is a key part of the academic year. However, there are few studies that analyze sleep during this period of time. Our aim is to study the association of sleep quality and sleep deprivation with academic performance during the examination period. A descriptive, cross-sectional and correlational study was carried out with the participation of 640 subjects in the first three years of five faculties belonging to the Universidad Autónoma de Madrid. The instrument used consisted of a questionnaire that included sociodemographic and academic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and information about the academic performance. During the examination period, a positive association was found between sleep quality and academic performance. University students slept less than desired, both on weekdays and weekends, and the sleep debt during the week was associated with a worse students’ perception of their academic performance. In total, 61.3% of the students believed that their performance would improve by getting more sleep. In addition, low drowsiness and napping were also found. In conclusion, during periods of greater academic demand, an insufficient sleep and poor quality is commonly observed, affecting negatively to their academic performance. Actually, about 2/3 of our subjects believed that their performance would improve by getting more slee

Clinical and polysomnographic predictors of the Natural History of poor sleep in the general population

Study Objectives: Approximately 8-10% of the general population suffers from chronic insomnia, whereas another 20-30% of the population has insomnia symptoms at any given time (i.e., poor sleep). However, few longitudinal studies have examined risk factors of the natural history of poor sleep, and none have examined the role of polysomnographic (PSG) variables. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1,741 individuals of the adult Penn State Cohort, 1,395 were followed up after 7.5 yr. Measurements: Full medical evaluation and 1-night PSG at baseline and telephone interview at follow-up. Results: The rate of incident poor sleep was 18.4%. Physical (e.g., obesity, sleep apnea, and ulcer) and mental (e.g., depression) health conditions and behavioral factors (e.g., smoking and alcohol consumption) increased the odds of incident poor sleep as compared to normal sleep. The rates of persistent, remitted, and poor sleepers who developed chronic insomnia were 39%, 44%, and 17%, respectively. Risk factors for persistent poor sleep were physical health conditions combined with psychologic distress. Shorter objective sleep duration and a family history of sleep problems were risk factors for poor sleep evolving into chronic insomnia. Conclusions: Poor sleep appears to be primarily a symptom of physical and mental health conditions, whereas the persistence of poor sleep is associated with psychologic distress. Importantly, sleep apnea appears to be associated with incident poor sleep but not with chronic insomnia. Finally, this study suggests that objective short sleep duration in poor sleepers is a biologic marker of genetic predisposition to chronic insomniaThis research was funded in part by the National Institutes of Health grants RO1 51931, RO1 40916 (to Dr. Bixler), and RO1 64415 (to Dr. Vgontzas)

G-band Spectral Synthesis in Solar Magnetic Concentrations

Narrow band imaging in the G-band is commonly used to trace the small magnetic field concentrations of the Sun, although the mechanism that makes them bright has remained unclear. We carry out LTE syntheses of the G-band in an assorted set of semi-empirical model magnetic concentrations. The syntheses include all CH lines as well as the main atomic lines within the band-pass. The model atmospheres produce bright G-band spectra having many properties in common with the observed G-band bright points. In particular, the contrast referred to the quiet Sun is about twice the contrast in continuum wavelengths. The agreement with observations does not depend on the specificities of the model atmosphere, rather it holds from single fluxtubes to MIcro-Structured Magnetic Atmospheres. However, the agreement requires that the real G-band bright points are not spatially resolved, even in the best observations. Since the predicted G-band intensities exceed by far the observed values, we foresee a notable increase of contrast of the G-band images upon improvement of the angular resolution. According to the LTE modeling, the G-band spectrum emerges from the deep photosphere that produces the continuum. Our syntheses also predict solar magnetic concentrations showing up in continuum images but not in the G-band . Finally, we have examined the importance of the CH photo-dissociation in setting the amount of G-band absorption. It turns out to play a minor role.Comment: To appear in ApJ, 554 n2 Jun 20, 33 pages and 9 figure

Possible role of highly activated mucosal NK cells against viral respiratory infections in children undergoing haematopoietic stem cell transplantation

Infection is the leading cause of non-relapse-related mortality after allogeneic haematopoietic stem cell transplantation (HSCT). Altered functions of immune cells in nasal secretions may influence post HSCT susceptibility to viral respiratory infections. In this prospective study, we determined T and NK cell numbers together with NK activation status in nasopharyngeal aspirates (NPA) in HSCT recipients and healthy controls using multiparametric flow cytometry. We also determined by polymerase chain reaction (PCR) the presence of 16 respiratory viruses. Samples were collected pre-HSCT, at day 0, +10, +20 and +30 after HSCT. Peripheral blood (PB) was also analyzed to determine T and NK cell numbers. A total of 27 pediatric HSCT recipients were enrolled and 16 of them had at least one viral detection (60%). Rhinovirus was the most frequent pathogen (84% of positive NPAs). NPAs of patients contained fewer T and NK cells compared to healthy controls (p = 0.0132 and p = 0.120, respectively). Viral PCR + patients showed higher NK cell number in their NPAs. The activating receptors repertoire expressed by NK cells was also higher in NPA samples, especially NKp44 and NKp46. Our study supports NK cells relevance for the immune defense against respiratory viruses in HSCT recipients.This work was supported in part by the National Health Service of Spain, Instituto de Salud Carlos III (ISCIII), FONDOS FEDER grant (FIS) PI18/01301, CRIS Foundation to Beat Cancer, Patients’ Support Associations Fundación Mari Paz Jiménez Casado and La Sonrisa de Álex and a Small Grant Award from the European Society for Paediatric Infectious Diseases.S

Amb quina freqüència la població immigrant indocumentada fa ús dels serveis sanitaris a Catalunya i quines malalties tenen?

Persones immigrants indocumentades; Cobertura sanitària universal; Sistema sanitari públicPersonas inmigrantes indocumentadas; Cobertura sanitaria universal; Sistema sanitario públicoUndocumented immigrants; Universal health coverage; Public health systemAntecedents. A Espanya, l’any 2012, es va aprovar el RDL 16/2012 que excloïa les persones immigrants indocumentades del sistema sanitari públic. Catalunya no va aplicar aquesta legislació i va continuar garantint l’assistència sanitària a tota la població. L’objectiu d’aquest estudi és analitzar l’ús dels serveis sanitaris i l’estat de salut de les persones immigrants indocumentades a Catalunya, comparar-les amb les residents legals classificades d’acord amb el seu nivell socioeconòmic (SEP). Mètodes. Es va dur a terme un estudi transversal amb dades administratives individuals. L’estudi va incloure la població resident a Catalunya l’any 2017, de 65 anys o menys, i amb una renda màxima de 18.000€ anuals, classificada en tres grups: SEP baix, SEP molt baix i immigrants indocumentats. Es van analitzar els indicadors referents a l’ús dels serveis sanitaris (atenció primària, urgències, salut mental, hospitalitzacions), prescripció de medicaments, i malalties cròniques i infeccioses. Resultats. Es va incloure un total de 4.071.088 persones residents a Catalunya, un 2,8% (113,450) de les quals eren immigrants indocumentades. D’entre totes les persones immigrants indocumentades, un 61,0% de dones i un 46,0% d’homes havia estat atès a centres d’atenció primària: aquests percentatges d’atenció van ser menors ens els qui tenien un SEP molt baix (84,8% en dones i 72,1% en homes). Les taxes d’hospitalització entre els homes amb SEP molt baix eren tres vegades més altes que en immigrants indocumentats (111,6 versus 35,7). La taxa de tuberculosi més alta es va trobar en homes immigrants indocumentats (4,35%). Conclusions. Les persones immigrants indocumentades van utilitzar menys els serveis sanitaris que les de SEP baix i molt baix, però les seves taxes de diagnòstic d’algunes malalties infeccioses eren més altes. Aquests resultats constitueixen un argument addicional que dona suport al manteniment de la cobertura sanitària universal per a tota la ciutadania

Anti-CXCR4 Antibody Combined With Activated and Expanded Natural Killer Cells for Sarcoma Immunotherapy

Sarcoma is one of the most severe forms of pediatric cancer and current therapies -chemotherapy and surgery- fail to eradicate the disease in half of patients. Preclinical studies combining new therapeutic approaches can be useful to design better therapies. On one hand, it is known that CXCR4 expression is implicated in rhabdomyosarcoma progression, so we analyzed relapses and chemotherapy-resistant rhabdomyosarcoma tumors from pediatric patients and found that they had particularly high levels of CXCR4 expression. Moreover, in assays in vitro, anti-CXCR4 blocking antibody (MDX1338) efficiently reduced migration and invasion of alveolar rhabdomyosarcoma RH30 cells. On the other hand, activated and expanded natural killer (NKAE) cell therapy showed high cytotoxicity against sarcoma cells in vitro and completely inhibited RH30 tumor implantation in vivo. Only the combination of MDX1338 and NKAE treatments completely suppressed metastasis in mice. In this study, we propose a novel therapeutic approach based on anti-CXCR4 blocking antibody in combination with NKAE cell therapy to prevent rhabdomyosarcoma tumor implantation and lung metastasis. These results provide the first evidence for the efficacy of this combined immunotherapy for preventing sarcoma disease dissemination.This work was supported in part by the National Health Service of Spain, Instituto de Salud Carlos III (ISCIII), FONDOS FEDER grant (FIS) PI15/00973; Asociacion Espanola Contra el Cancer to AP-M; CRIS Foundation to Beat Cancer grant to JV, LF, and AE; and Patients' Support Associations Fundacion Mari Paz Jimenez Casado and La Sonrisa de Alex to MV and the research project

Blood donations and transfusions during the COVID-19 pandemic in Spain: Impact according to autonomous communities and hospitals

Worldwide, the COVID-19 pandemic has caused a decline in blood donations, between 30% and 70% in some of the most affected countries. In Spain, during the initial eight weeks after the State of Emergency was decreed on 14 March 2020, in the weekly reports of the Health Ministry, an average decrease of 20% was observed between 11 and week 25 compared with the 2018 donation. We aimed to investigate the impact of the COVID-19 pandemic on blood donations and blood distribution in four autonomous communities, and to explore the evolution of the consumption of blood components (BCs) in ten hospitals of six autonomous communities. We performed a prospective study of grouped cohorts on the donation and distribution of blood in four regional transfusion centers in four autonomous communities in Spain, and a retrospective study of the consumption of blood components in ten hospitals in six autonomous communities. Regarding donations, there was no significant decrease in donations, with differences between autonomous communities, which started between 1 and 15 March 2020 (−11%). The increase in donations in phase II (from 26 May 2020) stands out. Regarding consumption, there was a significant reduction in the consumption of packed red blood cells (RBCs) (24.5%), plasma (45.3%), and platelets (25.3%) in the central period (16 March–10 May). The reduction in the consumption of RBCs was significant in the period from 1–15 March. Conclusions: The COVID-19 pandemic has affected the donation and consumption of BCs

Las alteraciones metabólicas asociadas a la obesidad están ya presentes en los primeros años de vida: estudio colaborativo español

Los objetivos de este estudio son, realizar una descrip-ción de las características demográficas, antropométricas y de las alteraciones metabólicas de niños atendidos por obe-sidad resaltando las características aquellos casos de obesidad de inicio temprano (< 10 años) y los de inicio precoz (< 5 años), y evaluar la capacidad diagnóstica de la definición de síndrome metabólico (SM) según diferentes criterios. Métodos: Es un estudio retrospectivo, caso-control, trans-versal, multicéntrico. Han participado un total de 10 Uni-dades de Endocrinología Pediátrica de diferentes hospitales españoles con un grupo de 469 niños con obesidad de inicio temprano y otro grupo de 30 niños con obesidad de inicio precoz. El grupo control estuvo constituido por 224 niños sanos menores de 10 años. Se realizó una valoración antro-pométrica y determinación analítica de parámetros del me-tabolismo de los hidratos de carbono y lipidograma. Resultados: La presencia de alteraciones metabólicas asociadas a la obesidad en la etapa infanto-juvenil en Espa-ña es notable, de forma aislada, o englobada bajo la defini-ción de SM. La prevalencia de éste aumenta sustancialmen-te cuando se considera la resistencia periférica a la acción de la insulina como criterio diagnóstico. Se demuestra cómo en niños menores de 10 años, dichas alteraciones están presen-tes en un porcentaje reseñable, y se encuentran las primeras alteraciones metabólicas ya en niños obesos < 5 años. Conclusión: En los niños españoles existen alteracio-nes metabólicas asociadas a la obesidad en la etapa in-fanto-juvenil de forma aislada o englobada bajo la de-finición de SM, y ya están presentes a edades precoces. The objectives of this study are to provide a description of the demographic, anthropometric characteristics and metabolic abnormalities in children with early-onset (< 10 years) and of very-early-onset obesity (< 5 years). We also evaluate the diagnostic ability using the definition of meta-bolic syndrome (MS) according to different criteria. Methods: It is a retrospective, case-control, cross-sec-tional, multicenter study. A total of 10 Pediatric Endo-crinology Units in different Spanish hospitals were in-volved. A group of 469 children with early-onset obesity and another group of 30 children with very early-onset obesity were studied. The control group consisted of 224 healthy children younger than 10 years. Anthropometric and analytical determination of carbohydrates metabo-lism parameters and the lipid profile were performed. Results: The presence of metabolic alterations associa-ted with obesity in children and adolescents in Spain is remarkable, either on their own, or encompassed within the definition of MS. This prevalence increases substan-tially when considering the peripheral resistance to in-sulin action as a diagnostic criterion. It also shows how children who could not be diagnosed with MS according to the definition provided by the International Diabetes Federation (IDF) due to age below 10 years, these altera-tions are already present in a remarkable percentage. In fact, metabolic abnormalities are already present in the very-early-onset obese children (<5 years). Conclusion: In Spanish children there are metabolic alterations associated with obesity in the infant-juvenile stages alone or encompassed within the definition of MS, and are already present at earlier ages