Influencia de un programa de actividad física en niños y adolescentes obesos con apnea del sueño; protocolo de estudio.

Recent studies show an alarming increase in the rate of overweight / obesity among the infant - juvenile population. Obesity in childhood is associated with a significant number of complications, such as sleep apnea syndrome, insulin resistance and type 2 diabetes, hypertension, cardiovascular disease and some cancers. It is estimated that the prevalence of sleep apnea in children is 2-3% in the general population, while in obese adolescents, varies between 13% and 66%, according to various studies. It is associated with impairment of neurocognitive function, behavior, cardiovascular system, metabolic disorders and growth. Sleep apnea is a serious public health problem that increases when children and adolescents are overweight or obese. We hypothesize that aerobic endurance exercise can be an effective treatment for obesity and apnea at the same time. The aim of this study was to determine the influence of physical activity in children and adolescents with overweight / obesity in sleep apnea. An observational, descriptive, prospective, longitudinal study will be carried out in children with sleep apnea and obesity. The universe will be made up of 60 children and adolescents aged between 10 and 18 years, attending the endocrinology service for suffering of obesity in the Hospital Clinico San Cecilio of Granada during the period September 2012-September 2013. The smple will consist of children and adolescents that meet these characteristics and to hom their arents/tutors have authorized through the informed consent. Sleep apnea in children wil be measured by polysomnography and sleep quality questionnaire. There will also be a nutritional assessment by a food frequency questionnaire and an anthropometric assessment. Among the expected results are the lower overweight and obesity in children through the physical activity program. To reduce apnea and to improve sleep quality

Efecto del phlebodium decumanum y de la coenzima q10 sobre el rendimiento deportivo en jugadores profesionales de voleibol

INTRODUCTION: Physical training programmes are based on provoking transitory states of fatigue in order to induce super compensation by the biological systems involved in the activity, in order to improve the athlete's medium-long term performance. The administration of nutritional supplements with antioxidant and immunomodulatory properties, such as Phlebodium decumanum and coenzyme Q10, can be a very advantageous means of achieving recovery from the inflammation and tissue damage caused by the stress of prolonged, intense exercise. METHODOLOGY: An experimental, longitudinal, double- blind experiment was conducted, with three randomised groups obtained from a sample of 30 male volleyball players (aged 22-32 years) at the University of Granada, with a high level of training (17 hours a week during the 6 months preceding the study). The effects were then evaluated of a month-long physical training programme, common to all the study groups, associated with the simultaneous administration of the following nutritional supplements: Phlebodium decumanum (4 capsules of 400 mg/capsule, daily), Experimental Group 1; Phlebodium decumanum (same dose andchedule as Group 1) plus coenzyme Q10 (4 capsules of 30 mg/ capsule, daily), Experimental Group 2; a placebo substance, Control Group. The following dependent blood variables were examined to assess the effects of the intervention on the basal immune and endocrine-metabolic profile: cortisol and interleukin-6, both related to the axis of exercise-induced stress; and lactic acid and ammonium, related essentially to the anaerobic metabolism of energy. RESULTS: All the study groups presented favourable adaptive changes with respect to the endocrine-metabolic and immune profile, as reflected by a significant decrease in the post-test concentrations of cortisol, interleukin 6, lactic acid and ammonium, compared to the values recorded before the physical activity with/without nutritional supplement, per protocol. The groups that achieved the most favourable profile were those which had received nutritional supplementation, rather than the placebo, and among the former, those which had received the double- strength supplement with Phlebodium decumanum plus coenzyme Q10. CONCLUSIONS: The intake of Phlebodium decumanum plus coenzyme Q10 for 4 weeks produced protective effects on the endocrine-metabolic and immune profile, which we attribute to the immunomodulatory and antioxidant properties of these substances, which are highly beneficial not only in terms of delaying fatigue and improving athletic performance, but also in reducing the risk of injuries associated with high intensity exercise.

Should screening for Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-men who have sex with men be recommended?

INTRODUCTION Sexually transmitted infections (STI) like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been associated with increased risk of HIV acquisition (1). It has been also described as a high prevalence of asymptomatic CT and NG infections in men who have sex with men (MSM) (2). The aim of this study was to know the prevalence of CT and/or NG infections in asymptomatic HIV-MSM and the related factors. MATERIALS AND METHODS Prospective study of a cohort of asymptomatic HIV-MSM with follow-up in Malaga (southern Spain) during October 2012-May 2014. Patients with an opportunistic event or who received active antibiotic therapy for CT and/or NG in the previous month were excluded. All of them completed a questionnaire about sexual behaviour, barrier methods and recreational drugs use. Demographical, epidemiological, clinical, analytical and therapeutic data were also collected. Pharyngeal and rectal swabs, and urine samples were collected to be tested for CT and NG by nucleic acid amplification test (c4800 CT/NG. Roche Diagnostics, Mannheim, Germany) (3). STATISTICS ANALYSIS SPSS 17.0. RESULTS 255 patients were asked to participate and 248 of them accepted. Median age was 37.7 (30.6-46.3) years, median time since HIV diagnosis was 47.7 (10.5-104.1) months, and median CD4 cells count was 607 (440-824) cell/µL. There were 195 (78.6%) patients on antiretroviral therapy; 81.5% of them had undetectable viral load. 80.5% of the patients had a past history of STI. Infection by CT and/or NG was diagnosed in 24 (9.7%) patients. Overall four urine samples, two pharyngeal, and 15 rectal ones were positive for CT, and five pharyngeal and five rectal swabs were positive for NG. Two patients were co-infected by CT and NG: one with CT in urine and both in rectum, another with CT in urine and rectum and NG in pharynx. One patient presented CT in pharynx and rectum, and two patients NG in pharynx and rectum. Positive CT and/or NG tests were only related with detectable HIV viral load (OR 3.08, 95% CI 1.2-7.4; p=0.01). It was not related with sexual behaviour, nor with alcohol or recreational drugs use. CONCLUSIONS STI screening had a great acceptance in this population. There was a high prevalence of asymptomatic CT and/or NG infections. Rectum sample was the most effective one. Viral suppression could protect from these STI. Screening should be recommended in HIV-MSM.

Cortisol salival como indicador de estrés fisiológico en niños y adultos; revisión sistemática.

Salivary cortisol is a steroid hormone that is produced in the hypothalamic-pituitary-adrenal axis and secreted into saliva when persons are under stress. High levels of cortisol in saliva can be produced by many different factors, including obesity and certain psychological disorders. The articles selected for inclusion in this review were identified using Google Scholar and Medline, and this search obtained a total of 57 items. The validity of these studies was established according to the degree of evidence presented, by citations and by their applicability to the healthcare context in Spain. Specifically, this review takes into consideration studies of salivary cortisol and stress in children and adults, and those examining the relation between high levels of salivary cortisol and other disorders such as anxiety, attention-deficit/hyperactivity disorder, social phobia or emotional deprivation. These studies show that salivary cortisol is a clear indicator of stress in both children and adults. High levels of this hormone in saliva are associated with the following main consequences: reduced immune function, affecting healing and thus prolonging recovery time; delayed growth in children; increased blood pressure and heart rate in both children and adults.

Lipid changes in HIV-patients switching to the coformulated single tablet FTC/RPV/TDF (Eviplera®). Efficacy and safety analysis. GeSida Study 8114.

INTRODUCTION Rilpivirine (RPV) has a better lipid profile than efavirenz (EFV) in naïve patients (1). Switching to RPV may be convenient for many patients, while maintaining a good immunovirological control (2). The aim of this study was to analyze lipid changes in HIV-patients at 24 weeks after switching to Eviplera® (emtricitabine/RPV/tenofovir disoproxil fumarate [FTC/RPV/TDF]). MATERIALS AND METHODS Retrospective, multicentre study of a cohort of asymptomatic HIV-patients who switched from a regimen based on 2 nucleoside reverse transcriptase inhibitors (NRTI)+protease inhibitor (PI)/non nucleoside reverse transcriptase inhibitor (NNRTI) or ritonavir boosted PI monotherapy to Eviplera® during February-December, 2013; all had undetectable HIV viral load for ≥3 months prior to switching. Patients with previous failures on antiretroviral therapy (ART) including TDF and/or FTC/3TC, with genotype tests showing resistance to components of Eviplera®, or who had changed the third drug of the ART during the study period were excluded. Changes in lipid profile and cardiovascular risk (CVR), and efficacy and safety at 24 weeks were analyzed. RESULTS Among 305 patients included in the study, 298 were analyzed (7 cases were excluded due to lack of data). Men 81.2%, mean age 44.5 years, 75.8% of HIV sexually transmitted. 233 (78.2%) patients switched from a regimen based on 2 NRTI+NNRTI (90.5% EFV/FTC/TDF). The most frequent reasons for switching were central nervous system (CNS) adverse events (31.0%), convenience (27.6%) and metabolic disorders (23.2%). At this time, 293 patients have reached 24 weeks: 281 (95.9%) have continued Eviplera®, 6 stopped it (3 adverse events, 2 virologic failures, 1 discontinuation) and 6 have been lost to follow up. Lipid profiles of 283 cases were available at 24 weeks and mean (mg/dL) baseline vs 24 weeks are: total cholesterol (193 vs 169; p=0.0001), HDL-c (49 vs 45; p=0.0001), LDL-c (114 vs 103; p=0.001), tryglycerides (158 vs 115; p=0.0001), total cholesterol to HDL-c ratio (4.2 vs 4.1; p=0.3). CVR decreased (8.7 vs 7.5%; p= 0.0001). CD4 counts were similar to baseline (653 vs 674 cells/µL; p=0.08), and 274 (96.8%) patients maintained viral suppression. CONCLUSIONS At 24 weeks after switching to Eviplera®, lipid profile and CVR improved while maintaining a good immunovirological control. Most subjects switched to Eviplera® from a regimen based on NNRTI, mainly EFV/FTC/TDF. CNS adverse events, convenience and metabolic disorders were the most frequent reasons for switching.

Fosfomycin versus meropenem in bacteraemic urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli (FOREST): study protocol for an investigator-driven randomised controlled trial.

INTRODUCTION Finding therapeutic alternatives to carbapenems in infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is imperative. Although fosfomycin was discovered more than 40 years ago, it was not investigated in accordance with current standards and so is not used in clinical practice except in desperate situations. It is one of the so-called neglected antibiotics of high potential interest for the future. METHODS AND ANALYSIS The main objective of this project is to demonstrate the clinical non-inferiority of intravenous fosfomycin with regard to meropenem for treating bacteraemic urinary tract infections (UTI) caused by ESBL-EC. This is a 'real practice' multicentre, open-label, phase III randomised controlled trial, designed to compare the clinical and microbiological efficacy, and safety of intravenous fosfomycin (4 g/6 h) and meropenem (1 g/8 h) as targeted therapy for this infection; a change to oral therapy is permitted after 5 days in both arms, in accordance with predetermined options. The study design follows the latest recommendations for designing trials investigating new options for multidrug-resistant bacteria. Secondary objectives include the study of fosfomycin concentrations in plasma and the impact of both drugs on intestinal colonisation by multidrug-resistant Gram-negative bacilli. ETHICS AND DISSEMINATION Ethical approval was obtained from the Andalusian Coordinating Institutional Review Board (IRB) for Biomedical Research (Referral Ethics Committee), which obtained approval from the local ethics committees at all participating sites in Spain (22 sites). Data will be presented at international conferences and published in peer-reviewed journals. DISCUSSION This project is proposed as an initial step in the investigation of an orphan antimicrobial of low cost with high potential as a therapeutic alternative in common infections such as UTI in selected patients. These results may have a major impact on the use of antibiotics and the development of new projects with this drug, whether as monotherapy or combination therapy. TRIAL REGISTRATION NUMBER NCT02142751. EudraCT no: 2013-002922-21. Protocol V.1.1 dated 14 March 2014.

Prognosis Relevance of Serum Cytokines in Pancreatic Cancer.

The overall survival of patients with pancreatic ductal adenocarcinoma is extremely low. Although gemcitabine is the standard used chemotherapy for this disease, clinical outcomes do not reflect significant improvements, not even when combined with adjuvant treatments. There is an urgent need for prognosis markers to be found. The aim of this study was to analyze the potential value of serum cytokines to find a profile that can predict the clinical outcome in patients with pancreatic cancer and to establish a practical prognosis index that significantly predicts patients' outcomes. We have conducted an extensive analysis of serum prognosis biomarkers using an antibody array comprising 507 human cytokines. Overall survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox's proportional hazard models were used to analyze prognosis factors. To determine the extent that survival could be predicted based on this index, we used the leave-one-out cross-validation model. The multivariate model showed a better performance and it could represent a novel panel of serum cytokines that correlates to poor prognosis in pancreatic cancer. B7-1/CD80, EG-VEGF/PK1, IL-29, NRG1-beta1/HRG1-beta1, and PD-ECGF expressions portend a poor prognosis for patients with pancreatic cancer and these cytokines could represent novel therapeutic targets for this disease.

Allergens Induce the Release of Lactoferrin by Neutrophils from Asthmatic Patients.

BACKGROUND Despite the evidence that Lactoferrin (Lf) is involved in allergic asthma processes, it is unknown whether neutrophils can be one of the main cellular sources of this key inflammatory mediator directly in response of an IgE mediated stimulus. The present study was undertaken to analyze this question. METHODS Neutrophils from healthy subjects (n = 34) and neutrophils from allergic asthmatic patients (n = 102) were challenged in vitro with specific allergens to which the patients were sensitized, PAF, or agonist mAbs against IgE-receptors, and the levels of Lf were measured in the culture supernatant. The levels of serum IgE together with the severity of symptoms were also analyzed. RESULTS Lf was released into the culture supernatant of neutrophils from allergic asthmatic patients in response to allergens and PAF. This response was highly allergen-specific, and did not happen in neutrophils from healthy donors. Allergen effect was mimicked by Abs against FcεRI and galectin-3 but not by FcεRII. The levels of released Lf correlated well with the levels of serum specific IgE and severity of asthma symptoms. These observations represent a novel view of neutrophils as an important source of Lf in allergic asthma. Importantly, the levels of released Lf by neutrophils could therefore be used to evaluate disease severity in allergic asthmatic patients.

Enfermedad pulmonar obstructiva crónica : proceso asistencial integrado. 3ª ed

Proceso publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

O significado de desmedicalização da assistência ao parto no hospital: análise da concepção de enfermeiras obstétricas

Este estudo teve como objetivo o processo de construção do significado de desmedicalização para enfermeiras obstétricas. Trata-se de pesquisa qualitativa baseada nos princípios da Grounded Theory. Os dados foram obtidos e analisados entre fevereiro e abril de 2006. Foram entrevistadas oito enfermeiras obstétricas atuantes no ensino, pesquisa e/ou assistência ao parto, que adotam a proposta desmedicalizadora como orientação da sua prática. A análise dos dados levou à construção de quatro categorias: refletindo sobre sua prática, caracterizando a prática obstétrica hospitalar como medicalizada, incomodando-se com a assistência medicalizada e identificando os princípios da desmedicalização, cuja integração permitiu identificar o processo construindo o significado de desmedicalização. O respeito à Fisiologia, bem como não usar desnecessariamente práticas intervencionistas como rotina constituíram princípios da desmedicalização. A reflexão sobre sua vida e a caracterização da prática obstétrica hospitalar, como medicalizada, fizeram parte do processo mental das enfermeiras na desconstrução das habilidades adquiridas no modelo biomédico.

A percepção de mulheres quanto à vulnerabilidade feminina para contrair DST/HIV

Pesquisa descritiva com abordagem qualitativa cujo objetivo foi analisar a percepção de mulheres quanto à vulnerabilidade feminina para contrair DST/HIV. Foi realizada em 2006, num campus universitário no Rio de Janeiro. Foram entrevistadas 12 mulheres, de idade superior a 18 anos, de diferentes níveis de escolaridade, raça e religião. Estas eram estudantes, servidoras técnico-administrativas, docentes e outras usuárias. Foram atendidas as exigências do Conselho Nacional de Ética em Pesquisa. Os dados foram analisados segundo os pressupostos da Análise de Conteúdo. Os resultados revelaram duas grandes dimensões: uma que relaciona a percepção pessoal da mulher e seus comportamentos, e outra relacionada à opinião dessas mulheres sobre o comportamento de outras mulheres. Neste artigo discutimos os dados referentes à dimensão coletiva. Concluímos que as mulheres entrevistadas reconhecem os fatores de vulnerabilidade nas outras mulheres e percebem o risco do outro em contrair DST/HIV, porém não se consideram em risco.

Implantació d’una xarxa de banda molt ampla a Rubrera

En el present projecte es tracta de la creació d’una Operadora de Xarxa de Telecomunicacions pel desplegament i explotació d’una xarxa de fibra òptica a la població de Rubrera per tal d’oferir a tots els seus habitants connexió a serveis que necessitaran el suport de banda moltampla. D’aquesta manera s’intenta apropar a tots el Rubrerencs la possibilitat d’accés a aquest tipus de serveis al mateix temps que els habitants de les poblacions més importants del país, integrant-los immediatament a la Societat de la Informació. Així doncs, es dur a terme elpresent projecte que es defineix amb els següents objectius:- És un fet que la Societat de la informació cada dia és més important en la vida diària de les persones. Per això, l’Ajuntament de Rubrera és conscient de que el seu objectiuprincipal és fer arribar la connexió a banda molt ampla a tots els seus habitants, sinó hofan les empreses privades que tenen les autoritzacions corresponents. Com que capoperador s’ha compromès a construir aquest tipus de xarxa a Rubrera a mig termini ,és per això que es proposa establir una xarxa per transportar serveis d’alta capacitat, de tal manera que Rubrera no es quedi desfasada respecte poblacions i territoris de l’entorn.- Proporcionar als Rubrerencs un ventall d‘Operadores de Serveis, d’altre manerainaccessible, on poder escollir. Afavorir i promoure la lliure competència entre lesOperadores a la localitat de Rubrera, que ajudarà a reduir els futurs costos entelecomunicacions.- Constitució d’una empresa de caràcter públic, lligada directament a l’Ajuntament deRubrera, per planificar, dissenyar, desplegar, operar i mantenir la xarxa de caràcter obert a tots els operadors de serveis i en cobertura de tot el territori municipal.- Promoure la inserció del màxim número possible d’operadors de serveis, sobre aquesta xarxa pública oberta, per que se’ls hi garantirà el mateix cost que aquestes han assumit en les poblacions més importants. S’intenta d’aquesta manera oferir a diversesoperadores, la possibilitat de prestar serveis a una població on, en principi no els és rentable el desplegament d’una xarxa pròpia.- Finalment s’intenta des d’aquest projecte oferir un model a seguir per altres poblacions que es trobin en la mateixa situació. La necessitat de banda molt ampla a tot el territori català i espanyol és imminent.

Hotel Pota Blava : procés de creació d'una empresa

Quan ens referim al procés de creació d’una empresa, fem referència al conjunt d’accions necessàries per posar en funcionament un negoci partint únicament d’una sèrie d’idees.Així, amb la nostra feina, hem volgut estudiar amb més detall la situació real en què es troba un jove emprenedor. El fet d’haver triat aquesta opció es deu a què és una de les possibilitats que se’ns presenten en finalitzar la carrera.La raó per la qual ens hem decantat pel sector serveis és, bàsicament, el pes que téactualment en el PIB. Davant de tot el ventall d’activitats econòmiques que ofereixaquest sector, hem triat l’hoteler ja que actualment es troba en creixement i, a més, al’hora de treballar, consideràvem que era un dels més interessants.Un cop decidit el tema que tractaríem, era necessari saber quins aspectes s’havien detenir en compte per portar a terme aquest procés de la forma més realista possible. Pertant, era imprescindible conèixer quins serien els tràmits legals a seguir, quin tipus d’empresa crearíem, el mètode de finançament que millor s’adaptaria al nostre projecte i els costos que caldria afrontar, entre d’altres variables.En el moment en què hem disposat d’aquesta informació, hem aprofundit en altres temes com seria el cas del màrqueting, l’assegurança, l’anàlisi de la competència i la decisió del preu que ens faria obtenir beneficis o, si més no, cobrir les despeses en els primers anys.Ara, una vegada finalitzat el treball, en el cas de voler crear una empresa d’aquestescaracterístiques, ja coneixem totes les pautes a seguir per portar-ho a terme.

¿Por qué Barcelona? : Análisis de la evolución del turismo en la ciudad

“El hotel vela de Ricardo Bofill echa por fin raíces en la nueva bocana” (ElPeriódico; 29 de mayo de 2006); “Bread&Butter deja en BCN 80 millones de euros” (ElPeriódico; 19 de enero de 2007); “Barcelona promociona su oferta de playas en todo elmundo” (El Periódico; 25 de marzo de 2007);… En las portadas y páginas de diarios ygacetas es donde comenzó todo, donde nació y se gestó una idea que posteriormentepasaría a ser nuestro proyecto final.Durante los últimos años la ciudad de Barcelona ha vivido una repentina expansióndel sector turístico y consecuentemente de toda la economía en general de ésta. Nuevoshoteles y complejos turísticos inundan nuestra ciudad, montones de turistas se aglutinanen nuestras calles; y este ritmo parece que nunca llegue a su fin. Delante de estasituación nos planteamos al inicio del proyecto ciertas cuestiones: ¿cuándo podemosconsiderar el inicio de este auge del sector?, ¿cuándo terminará?, ¿qué perfil turístico esel que más puede beneficiar a la ciudad?... Todas estas cuestiones, entre otras, son lasque intentaremos resolver en las próximas páginas.Nuestra primera línea de trabajo parte de varias hipótesis teóricas relacionadas conel turismo de un modo genérico, y mediante un estudio minucioso de la situación actualhemos querido demostrar o desmentir tales tesis para el caso barcelonés. Posteriormentehemos buscado de forma exhaustiva datos oficiales acerca del sector turístico para poderelaborar una evolución de esta variable para los últimos cincuenta años. De este modopretendíamos de nuevo corroborar este crecimiento del sector y dejar de basarnos tansólo en meros argumentos populares.Nuestro proyecto también dedica parte de su contenido al trabajo de campo,centrado en los argumentos y opiniones de oferta y demanda turística de la ciudad. Serealizaron encuestas a turistas para definir así un perfil de visitante de la ciudad, yposteriormente se realizaron entrevistas a personas relacionadas con el mundo delalojamiento para que nos diesen su opinión acerca del fenómeno turístico de la ciudadcondal.El cambio es algo que se hace latente en cada esquina, en cada calle, a cada pasoque damos, por lo que resultará interesante saber qué ha ocurrido para que nuestrosbarrios, nuestros distritos, nuestra ciudad, sea hoy la que es.

IPC alimentario en Barcelona

Comprarse un piso o pagar un alquiler, montar un negocio, pagar la escuela de loshijos, comprar ropa, ir al cine el domingo…vivir, no le cuesta lo mismo a un residentede Pedralbes que a uno de El Raval.Muchos son los factores que condicionan el nivel de vida de una determinada zona y que provocan diferencias de precios entre los servicios que en ellas se ofrecen: sulocalización y su importancia respecto a los centros económicos y de decisión, latradición cultural que posea, el nivel de educación de sus ciudadanos, la atención porparte de la Administración… pero ¿existirán también tales diferencias en productos deconsumo tan básicos como los de alimentación?Mediante este trabajo se quiere dar respuesta a esta pregunta y conocer hasta quépunto la actual coyuntura económica hace aumentar o disminuir las diferenciasexistentes entre varias zonas de Barcelona en lo referente a la variación de precios.