Evolution and treatment of vitamin B12 deficiency as a risk factor for (cognitive and functional) neurodegenerative diseases in institutionalized elderly = Evolución y tratamiento de la deficiencia de vitamina B12 como factor de riesgo de enfermedades neurodegenerativas (cognitivas y funcionales) en las personas mayores institucionalizadas.

Prevalence of vitamin B12 deficiency is very common in elderly people and can reach values as high as 40.5% of the population. It can be the result of the interaction among several factors. Vitamin B12 deficiencies have been associated with neurological, cognitive deterioration, haematological abnormalities and cardiovascular diseases that have an important influence on the health of the elderly and their quality of life. It is necessary to approach the problems arisen from the lack of data relative to them. The main objective of this thesis was to analyse the evolution of vitamin B12 status and related parameters, lipid and haematological profiles and their relationship to health risk factors, and to functional and cognitive status over one year and to determine the effect of an oral supplementation of 500 μg of cyanocobalamin for a short period of 28 days. An additional objective was to analyze the possible effects of medicine intakes on vitamin B status. Three studies were performed: a) a one year longitudinal follow-up with four measure points; b) an intervention study providing an oral liquid supplement of 500 μg of cyanocobalamin for a 28 days period; and c) analysis of the possible effect of medication intake on vitamin B status using the ATC classification of medicines. The participants for these studies were recruited from nursing homes for the elderly in the Region of Madrid. Sixty elders (mean age 84 _ 7y, 19 men and 41 women) were recruited for Study I and 64 elders (mean age 82 _ 7y, 24 men and 40 women) for Study II. For Study III, baseline data from the initially recruited participants of the first two studies were used. An informed consent was obtained from all participants or their mentors. The studies were approved by the Ethical Committee of the University of Granada. Blood samples were obtained at each examination date and were analyzed for serum cobalamin, holoTC, serum and RBC folate and total homocysteine according to laboratory standard procedures. The haematological parameters analyzed were haematocrit, haemoglobin and MCV. For the lipid profile TG, total cholesterol, LDL- and HDLcholesterol were analyzed. Anthropometric measures (BMI, skinfolds [triceps and subscapular], waist girth and waist to hip ratio), functional tests (hand grip, arm and leg strength tests, static balance) and MMSE were obtained or administered by trained personal. The vitamin B12 supplement of Study II was administered with breakfast and the medication intake was taken from the residents’ anamnesis. Data were analyzed by parametric and non-parametric statistics depending on the obtained data. Comparisons were done using the appropriate ANOVAs or non-parametric tests. Pearsons’ partial correlations with the variable “time” as control were used to define the association of the analyzed parameters. XIII The results showed that: A) Over one year, in relationship to vitamin B status, serum cobalamin decreased, serum folate and mean corpuscular volumen increased significantly and total homocysteine concentrations were stable. Regarding blood lipid profile, triglycerides increased and HDL-cholesterol decreased significantly. Regarding selected anthropometric measurements, waist circumference increased significantly. No significant changes were observed for the rest of parameters. B) Prevalence of hyperhomocysteinemia was high in the elderly studied, ranging from 60% to 90 % over the year depending on the cut-off used for the classification. LDL-cholesterol values were high, especially among women, and showed a tendency to increase over the year. Results of the balance test showed a deficiency and a tendency to decrease; this indicates that the population studied is at high risk for falls. Lower extremity muscular function was deficient and showed a tendency to decrease. A highly significant relationship was observed between the skinfold of the triceps and blood lipid profile. C) Low cobalamin concentrations correlated significantly with low MMSE scores in the elderly studied. No correlations were observed between vitamin B12 status and functional parameters. D) Regarding vitamin B12 status, holo-transcobalamin seems to be more sensitive for diagnosis; 5-10% of the elderly had a deficiency using serum cobalamin as a criterion, and 45-52% had a deficiency when using serum holotranscobalamin as a criterion. E) 500 μg of cyanocobalamin administered orally during 28 days significantly improved vitamin B12 status and significantly decreased total homocysteine concentrations in institutionalized elderly. No effect of the intervention was observed on functional and cognitive parameters. F) The relative change (%) of improvement of vitamin B12 status was higher when using serum holo-transcobalamin as a criterion than serum cobalamin. G) Antiaenemic drug intake normalized cobalamin, urologic drugs and corticosteroids serum folate, and psychoanaleptics holo-transcobalamin levels. Drugs treating pulmonary obstruction increased total homocysteine concentration significantly. H) The daily mean drug intake was 5.1. Fiftynine percent of the elderly took medication belonging to 5 or more different ATC groups. The most prevalent were psycholeptic (53%), antiacid (53%) and antithrombotic (47%) drugs.

Un método de comprobación de secciones en losas de hormigón armado con familias de armaduras en direcciones arbitrarias. Parte II: Placas y láminas

Este artículo corresponde a la extensión de uno anterior dedicado al estudio del problema de la comprobación y el dimensionamiento de las armaduras de acero en estructuras bidimensionales de hormigón armado tipo laja, cuyos esfuerzos están contenidos en su plano medio. Aquí se consideran las estructuras con cargas normales a su plano medio (placas y láminas), es decir. sometidas a esfuerzos de flexión. El procedimiento de comprobación y dimensionamiento que se propone, permite tratar situaciones importantes como el armado en las esquinas de placa, la combinación de tensiones axiles, rasantes y de flexión que aparecen en los arranques de 10s voladizos en las estructuras de los tableros continuos de puentes, particularmente las zonas sobre apoyos. En estos casos las alternativas actuales son procedimientos heurísticos o fórmulas empíricas como la de Wood. El cálculo, que se lleva a cabo mediante un simple programa de computador, permite obtener en pocos segundos la curva de las tensiones y las deformaciones en cada una de las familias de barras y de las principales en el hormigón en función del factor de amplificación de los esfuerzos. De esta forma se deduce el nivel de seguridad que se alcanza en un punto de la estructura de hormigón armado.

¿Cómo combatir el estrés calórico (II)?

En una primera parte de este artículo, publicado en Entorno Ganadero No. 66, el autor hace referencia a las condiciones ambientales reinantes en un alojamiento de vacuno lechero, las cuales son la mayor importancia para el confort y bienestar de los animales allí alojados, además de explicar que es una condición necesaria (aunque no suficiente) para que éstos puedan expresar todo su potencial productivo. También explicó que cuando las vacas están en unas condiciones de alojamiento óptimas aumenta su resistencia a las enfermedades, es decir, a la primera causa de NO BIENESTAR. Lo anterior debido a que el sistema inmunitario del animal se deprime cuando estas “necesidades ambientales” no están correctamente satisfechas. Ya entrado en materia de este trabajo se refirió fundamentalmente al factor temperatura, cuyos elevados valores van a causar lo que se conoce como “estrés térmico” o “estrés calórico”. Detallando que no obstante, otros factores ambientales como la humedad o la velocidad del aire pueden aliviar o agravar este estrés. Dentro del factor de Temperatura, detalló puntos como: Mecanismos de producción de calor; Mecanismos de eliminación de calor y Temperatura ambiental óptima. En el punto de Evaluación del Estrés Calórico, explicó entre otras cosas, que las vacas lecheras prefieren temperaturas entre 0 y 24ºC, pudiendo mantener su producción incluso a temperaturas de -10ºC. Sin embargo, las vacas empiezan a experimentar estrés por calor a una temperatura de 25ºC, con niveles normales de humedad relativa. En esta segunda entrega, se analizarán puntos como la Consecuencia del Estrés Calórico, los métodos para reducirlo, y se detallará el concepto de refrigeración.