[Risk of falls and consumption of medicines in an elderly population]

OBJECTIVES

To describe the risk factors and the effect of medication use on the risk of falls in a population of 65 years or older.

MATERIAL AND METHODS

Descriptive study of falls in the elderly population. The risk factors and consequences of the fall were recorded. Hypnotic and sedative risk drugs, opioids, and the simultaneous consumption of six or more drugs were considered. Diuretics were also included. The cumulative incidence for each group and the corresponding relative risks of falls were analysed from the cases registered between June and November 2016.

RESULTS

During the study period, 60 falls were reported, of which 66% were by women and 34% by men. The cumulative incidence of falls was 3 per thousand women (95% CI: 2.22-4.08), and 2 per thousand men (95% CI: 1.44-3.41). The majority (71%) had consumed risk medication. Six or more medications were taken by 40% of the men and 62.5% of the women, and 97.6% was risk medication. The relative risk of falls in people using hypnotics, sedatives and opioids compared to non-users was 8.7 in men and 7.1 in women. In people who took diuretics, the relative risk was 4.6 for both genders. In women on multiple medications the relative risk was 3.7 compared to 1.7 in men.

CONCLUSIONS

Polypharmacy and the use of hypnotic and sedative drugs and opioids and diuretics are an important public health problem, due to being risk factors for falls in this population, with a greater impact for women.

Ovine Toxoplasmosis: A New Look at its Pathogenesis

Conditions causing reproductive failure are a significant concern in the livestock industry, and amongst these, ovine toxoplasmosis is one of the most important. Despite decades of research, there remain gaps in knowledge about this disease, especially regarding the pathogenesis of abortion in sheep. As for other diseases causing ovine abortion, such as chlamydial abortion or border disease, the consequences of infection with Toxoplasma gondii depend largely on the stage of gestation, but the mechanisms involved are not well understood. Immunological modulation occurring during gestation has been proposed as the main mechanism accounting for this clinical variation. However, the extent and effect of such modulation has not yet been identified clearly in sheep and the involvement of other unknown factors has been proposed. Recent experimental studies have defined an unacknowledged clinical presentation of ovine toxoplasmosis, where abortions occur during the acute phase of infection, resulting in as high as 100% fetal loss in susceptible sheep. The pathogenesis of this clinical form differs from that of classically described ovine toxoplasmosis, and its pathological features resemble those of the perinatal syndrome known as cerebral palsy in man. A range of variables, including individual susceptibility, isolate virulence and infective dose, have been proposed as key factors in the development of one or the other of these clinical forms and warrants further investigation in this important disease.

Early postpartum administration of equine chorionic gonadotropin to dairy cows calved during the hot season: Effects on fertility after first artificial insemination

Heat stress reduces fertility of high-producing dairy cows, and early administration of equine chorionic gonadotropin (eCG) may improve it. Here, 401 heat-stressed, high-producing dairy cows on a single commercial farm were given eCG (500 UI, n = 214) or saline (n = 187) on days 11-17 after calving, and the effects on fertility after the first artificial insemination (AI) were assessed. On post-partum day 96.34 ± 9.88, all cows were inseminated after a "double short Cosynch" synchronization protocol. Ovarian activity and uterine status were checked by ultrasound on the day of eCG administration and every 7 days thereafter for a total of 3 weeks; checks were also performed during synchronization, and 7 days after AI. On post-partum day 30, cytobrush uterine cytology was performed to check for subclinical endometritis. Pregnancy status was checked on days 30 and 60 after AI. The eCG and control groups did not differ significantly in terms of average lactations per cow (2.33 ± 1.34), days in milk at first AI (96.33 ± 9.88), average milk yield at AI (41.38 ± 7.74 L), or the particular inseminator or bull used for AI. The eCG and control groups showed increasing ovarian activity with time, with approximately 75% of cows in both groups showing a corpus luteum at the beginning of the synchronization protocol. On post-partum day 30, 17.4% of eCG cows and 22.9% of control cows showed subclinical endometritis. Cows treated with eCG showed a tendency toward lower hyperecogenic intraluminal content (16.8 vs. 21.4%, P = 0.15), but ovarian activity during the synchronization protocol was similar between eCG and control groups, with 91% of animals in both groups showing luteolysis after prostaglandin application and 88% showing ovulation after the last administration of gonadotropin-releasing hormone. Fertility was similar between the two groups at both time points after AI (30 days, 34.9 vs. 31.8%; 60 days, 30.6 vs. 28.5%; P > 0.2). These results suggest that early postpartum eCG administration does not improve fertility of heat-stressed dairy cows as long as 60 days after AI. Other strategies may be more effective at mitigating the ability of post-partum heat stress to reduce fertility of high-producing dairy cows.

Effects of a silver nanomaterial on cellular organelles and time course of oxidative stress in a fish cell line (PLHC-1)

Among the nanomaterials currently in commercial products, those based on silver are the most used, and so there is a high probability that silver nanoparticles (AgNPs) will be released into aquatic environments where they could adversely affect aquatic organisms, including fish. Taking this into account, the aim of the present work was to characterize in depth the mechanisms underlying the toxic action of AgNPs using fish cell lines, determining specifically the contribution of alterations in cellular structures and oxidative stress time course to the cytotoxicity of AgNPs. Since liver plays a key role in detoxification, the hepatoma cell line PLHC-1 was used. Exposure to AgNPs (NM-300K, obtained from the Joint Research Centre Repository) caused alterations at the lysosomal and mitochondrial levels at lower concentrations than those that disrupted plasma membrane (evaluated by means of neutral red, alamarBlue, and 5-carboxyfluorescein diacetate, acetoxymethyl ester assays respectively). AgNO₃, used as a control Ag⁺ ion source, produced similar cytotoxic effects but at lower concentrations than AgNPs. Both silver forms caused oxidative disruption but the initial response was delayed in AgNPs until 6h of exposure. Transmission electron microscopy analysis also evidenced the disruption of mitochondrial structures in cells exposed to cytotoxic concentrations of both forms of silver. At non-cytotoxic concentrations, AgNPs were detected inside the nucleoli and mitochondria, thereby pointing to long-term effects. The present work evidences the mutual interaction between the induction of oxidative stress and the alterations of cellular structures, particularly mitochondria, as cytotoxicity mechanisms not exclusively associated to NPs.

Características de la raza bovina Monchina y de su programa de recuperación

La raza bovina Monchina es una raza autóctona de la Comunidad Autónoma de Cantabria, reconocida como raza en peligro de extinción. La utilización de información molecular mostró una raza dividida en tres ecotipos, con una elevada contribución a la diversidad genética del conjunto de razas bovinas de la Península Ibérica, situándola genéticamente próxima a las razas Tudanca, Lidia, Betizú y Pirenaica. Por otro lado, la información genealógica, todavía con un reducido nivel de completitud, con un valor medio del número equivalente al de generaciones completas de 1,13, mostró una raza con un censo efectivo inferior al considerado por la FAO para poder garantizar la sostenibilidad de la diversidad genética a medio plazo (50 años).

Efecto del uso combinado de la Pronasa E y de un extracto fúngico (Mucor racemosus forma sphaerosporus) en la maduración de embutidos crudos curados / Effect of the combined use of Pronase E and a fungal extract (Mucor racemosus forma sphaerosporus) on the ripening of dry fermented sausages

The effect of the addition of 600 units of Pronase E/kg of sausage mixture and/or a fungal extract ( Mucor racemosus forma sphaerosporus) at two different concentrations (1.75 and 17.5 mg protein/kg sausage mixture) on dry fermented sausages was evaluated. The only addition of protease to sau sages led to an increase in the content of free amino acids and biogenic amines. When the protease and the fungal extract were added together at high concentration (17.5 mg protein/kg sausage mix ture), a decrease in the free amino acid content and a slight increase in the ammonia content were observed, together with a clear increase in the concentration of several volatile compounds, such as 2- and 3-methylbutanal, 2-methylpropanal and 2- and 3-methyl-1-butanol. The addition of the fungal extract only at high concentration (17.5 mg protein/kg sausage mixture) or the combined protease and fungal extract at low concentration (1.75 mg protein/kg sausage mixture), produced slight physi cochemical modifications compared with the corresponding controls. All sausages with Pronase E showed a clear modification of texture, with a marked decrease of hardness, adhesiveness, springi ness, cohesiveness, gumminess, chewiness, cutting force and cutting work. Sensory analysis of the different batches of sausages showed that the combined addition of Pronase E (600 units/kg of sau sage mixture) and the Mucor racemosus forma sphaerosporus extract at high concentration (17.5 mg protein/kg of sausage mixture) improved the odor, taste, texture and, in consequence, the global acceptability in relation to the control batch.

Macrophage Subsets Within Granulomatous Intestinal Lesions in Bovine Paratuberculosis

Animals infected with Mycobacterium avium subspecies paratuberculosis show a variety of granulomatous lesions that range from focal forms, seen in the subclinical stages, to diffuse lesions associated with clinical signs. The aim of this study was to phenotypically characterize the macrophages present in the different lesion types using immunohistochemical methods. Lesions from a total of 23 animals with bovine paratuberculosis, natural and experimental, were examined by immunohistochemistry. Antibodies against inducible nitric oxide synthase (iNOS), tumor necrosis factor α (TNF-α), CD163, interleukin 10 (IL-10), transforming growth factor β (TGF-β), major histocompatibility complex (MHC) class II, natural resistance-associated macrophage protein 1 (Nramp-1), calprotectin, Ki-67, CD68, lysozyme, and ionized calcium-binding adaptor molecule 1 (Iba-1) molecules were employed. Samples were scored semiquantitatively using a complete histological score (H-score), reflecting the staining intensity and the percentage of immunolabeled macrophages. Differences in the H-score were seen depending on the lesion type. In focal lesions, with none or few acid-fast bacilli (AFB), macrophages were polarized toward M1 phenotype, with high H-scores for iNOS and TNF-α. Diffuse multibacillary lesions showed M2 differentiation, with high expression of CD163, IL-10, and TGF-β as well as Nramp-1 and MHC class II antigens. Macrophages in diffuse paucibacillary forms showed high H-scores for iNOS but low ones for TNF-α. Diffuse lesions, either multibacillary or paucibacillary, showed high calprotectin and low Ki-67 expression, suggesting a progressive character, while focal forms, with low H-scores for these antigens, would be consistent with latency. Lysozyme and CD68 expression were related to the amount of AFB. H-score for Iba-1 antibody was similar among all types. The findings of this study provide insights into the polarization status of macrophages and lesion development in bovine paratuberculosis.

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XXVII: factors predictive of a decline to low levels of disease activity

The objective of this study was to examine factors predictive of a decline to low levels of disease activity in a cohort of systemic lupus erythematosus (SLE) patients. Patients with SLE of Hispanic (from Texas or Puerto Rico), African-American or Caucasian ethnicity from a multiethnic cohort were included. A decline to low levels of disease activity was defined as a score ≤5 as per the Systemic Lupus Activity Measure-Revised (SLAM-R) at any annual study visit if preceded by a SLAM-R 8. Using Generalized Estimating Equation (GEE), socioeconomic-demographic, behavioral, function, psychological, laboratory and clinical data [disease manifestations, number of ACR criteria accrued at diagnosis and damage accrual as per the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI)] from the visit preceding that meeting the definition were examined as predictors of decline to low levels of disease activity. Two-hundred and eighty-seven patients (67 Hispanics from Texas, 32 Hispanics form Puerto Rico, 120 African-Americans and 68 Caucasians), accounting for 632 visits were analyzed. In the GEE multivariable analysis, higher degrees of social support (OR = 1.208, 95% CI 1.059-1.379; P = 0.005) were predictive of a decline to low levels of disease activity, while the number of ACR criteria accrued at diagnosis (OR = 0.765, 95% CI 0.631-0.927; P = 0.006) and damage (OR = 0.850, 95% CI 0.743-0.972, P = 0.018) were negatively associated. These data suggest that a decline to low levels of disease activity in lupus patients seems to be multifactorial; this study also underscores the importance of social support for lupus patients.

Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial

OBJECTIVES

To ascertain whether screening for pre-eclampsia (PE) and intrauterine growth restriction (IUGR) by uterine artery (UtA) Doppler in the second trimester of pregnancy and targeted surveillance improve maternal and perinatal outcomes in an unselected population.

METHODS

This was a multicenter randomized open-label controlled trial. At the routine second-trimester anomaly scan, women were assigned randomly to UtA Doppler or non-Doppler groups. Women with abnormal UtA Doppler were offered intensive surveillance at high-risk clinics of the participating centers with visits every 4 weeks that included measurement of maternal blood pressure, dipstick proteinuria, fetal growth and Doppler examination. The primary outcome was a composite score for perinatal complications, defined as the presence of any of the following: PE, IUGR, spontaneous labor < 37 weeks' gestation, placental abruption, stillbirth, gestational hypertension, admission to neonatal intensive care unit and neonatal complications. Secondary outcomes were a composite score for maternal complications (disseminated intravascular coagulation, maternal mortality, postpartum hemorrhage, pulmonary edema, pulmonary embolism, sepsis), and medical interventions (for example, corticosteroid administration and induction of labor) in patients developing placenta-related complications.

RESULTS

In total, 11 667 women were included in the study. Overall, PE occurred in 348 (3.0%) cases, early-onset PE in 48 (0.4%), IUGR in 722 (6.2%), early-onset IUGR in 93 (0.8%) and early-onset PE with IUGR in 32 (0.3%). UtA mean pulsatility index > 90(th) percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UtA Doppler vs non-Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had more medical interventions, such as corticosteroid administration (relative risk (RR), 1.79 (95% CI, 1.4-2.3)) and induction of labor for IUGR (RR, 1.36 (95% CI, 1.07-1.72)). In women developing PE or IUGR, there was a trend towards fewer maternal complications (RR, 0.46 (95% CI, 0.19-1.11)).

CONCLUSIONS

Routine second-trimester UtA Doppler ultrasound in an unselected population identifies approximately 60% of women at risk for placental complications; however, application of this screening test failed to improve short-term maternal and neonatal morbidity and mortality. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

[A comparative study of aggression towards Primary Care and Hospital Health professionals in a Madrid health area (2009-2014)]

INTRODUCTION

The aim of this paper is perform an analysis on the incidents and attacks against medical personnel that occurred in the area covered by the Prevention Service Group, comparing the results in Primary Care (PC) with Hospital Care (HC).

MATERIAL AND METHODS

The information available in the database of the regional Madrid Register of Aggressions Conflict Health Worker between 2009 and 2014 was analysed. This included a total of 8,056 workers, of whom 1,605 were from PC.

RESULTS

A total of 1,262 incidents have been reported, of which 61.2% took place in HC and 38.8% in PC (32.2 notifications/100,000 inhabitants, or 12.88 incidents/100 hospital workers compared to 168.98 notifications/100,000 inhabitants, or 30.53 incidents/100 PC workers). Nurses in CP have a higher incidence of assaults (47.4%), while in HC it is the physicians (53.1%) (P<.001). In PC the aggressor is usually the patient (56.9%), while in HC it is the relative or companion (45.3%) (P<.001). HC aggressions occur more frequently in emergency departments (35.5%) compared with 63.9% in PC, where they occur in the consulting room (P<.001).

CONCLUSIONS

Although it is difficult to make comparisons with previous studies due to methodological differences, a higher incidence of aggression in PC is observed compared with HC. It is necessary to establish improvements in Madrid Register of Aggressions and Conflicts, designed to optimise data quality and use them for preventive purposes.

Loss of lipid material during the dehulling of oilseeds with different structural characteristics

The loss of lipid material by migration to the hull during the dehulling of oilseeds with different structural characteristics was evaluated. The samples selected -three sunflower hybrids and a safflower cultivar- were processed under optimal dehulling operating conditions and with two passes through a dehuller. From the SEM micrographs of the samples it was possible to observe structural differences which affect the mechanical properties of the pericarps and, consequently, the dehulling process. The black-hull sunflower hybrid exhibited residual hull percentages lightly above those recommended by the industry after one pass through the dehuller, therefore, this hybrid should not be further processed to avoid oil losses due to migration to the hull. On the other hand, the safflower cultivar and the high stearic high oleic sunflower hybrid and the traditional striped-hull sunflower require two passes through the dehuller, but this resulted in an oil loss due to migration to the hull of over 0.9 % per gram of grains processed. These results suggest the need to reach 'compromise' decisions based on economic impact studies in the face of the variables that originate simultaneously both positive and negative effects.