Variables that enhance the development of resilience in young gay people affected by the COVID-19 pandemic

AIMS

Sexual and gender minorities are more likely to suffer from depression and anxiety caused by COVID-19. However, they also have specific variables that have been little studied but which may protect them from this adverse situation. The aim of this study was to find out whether there were differences in socio-demographic and psychosocial variables in two groups of Spanish gay young people (high and low resilience), and predictors of risk and protective factors were examined.

METHODS

Nine hundred and seventy-nine young homosexuals (389; 39.73% self-reported as women) aged between 18 and 26 years old who experienced mandatory confinement due to COVID-19, completed an anonymous online questionnaire. Hope, perceived self-efficacy, reappraisal index, coping humour, anxiety, depression were assessed along with socio-demographic information. Data were collected between 15 and 26 April 2020.

RESULTS

Socio-demographic variables that were predictive of highly resilient behaviour included being between 24 and 26 years old, living with LGBTI+ peers and living in big cities, protective psychosocial variables included reframing in reappraising the confinement situation, humour as coping, social support from significant others and self-efficacy.

CONCLUSION

This is one of the first studies on this subject of compulsory COVID-19 confinement on young homosexuals in Spain. Mental health professionals and organizations should also include work on psychosocial protective factors, not just risk factors, to enhance resilient outcomes in this group.

Prevalence Rates of Arterial Hypertension According to the Threshold Criteria of 140/90 or 130/80 mmHg and Associated Cardiometabolic and Renal Factors: SIMETAP-HTN Study

Background and objectives: Arterial hypertension (HTN) is the leading preventable cause of atherosclerotic cardiovascular diseases (ASCVD) and death from all causes. This study aimed to determine the prevalence rates of HTN diagnosed according to the threshold diagnostic criteria 130/80 mmHg and 140/90 mmHg, to compare blood pressure (BP) control, and to evaluate their associations with cardiovascular diseases and cardiometabolic and renal risk factors. Materials and Methods: This was a cross-sectional observational study conducted in primary care with a population-based random sample: 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HTN were calculated. BP control was compared in HTN patients with and without ASCVD or chronic kidney disease (CKD). Their associations with cardiovascular diseases and cardiometabolic and renal factors were assessed using bivariate and multivariate analysis. Results: Adjusted prevalence rates of HTN diagnosed according to 140/90 and 130/90 criteria were 30.9% (32.9% male; 29.7% female) and 54.9% (63.2% male; 49.3% female), respectively. BP < 130/80 mmHg was achieved in 60.5% of HTN patients without ASCVD or CKD according to 140/90 criterion, and 65.5% according to 130/80 criterion. This BP-control was achieved in 70% of HTN patients with ASCVD and 71% with CKD, according to both criteria. Coronary heart disease (CHD), heart failure, atrial fibrillation, stroke, diabetes, prediabetes, low glomerular filtration rate (eGFR), hyperuricemia, hypercholesterolemia, obesity, overweight, and increased waist-to-height ratio were independently associated with HTN according to both criteria. Conclusions: Almost a third of the adult population has HTN according to the 140/90 criterion, and more than half according to the 130/90 criterion, with a higher prevalence in men. The main clinical conditions associated with HTN were heart failure, diabetes, CHD, low eGFR, and obesity.

Heart Failure Prevalence Rates and Its Association with Other Cardiovascular Diseases and Chronic Kidney Disease: SIMETAP-HF Study

INTRODUCTION AND OBJECTIVES

Heart failure (HF) is a major health problem that causes high mortality and hospitalization rates. This study aims to determine the HF prevalence rates in populations aged both ≥18 years and ≥50 years and to assess its association with cardiovascular diseases and chronic kidney disease.

METHODS

A cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of HF were calculated. The associations of renal and cardiometabolic factors with HF were assessed in both populations using univariate, bivariate and multivariate analysis.

RESULTS

The HF crude prevalence rates were 2.8% (95%CI: 2.4-3.2) in adults (≥18 years), and 4.6% (95%CI: 4.0-5.3) in the population aged ≥ 50 years, without significant differences between males and females in both populations. The age- and sex-adjusted prevalence rates were 2.1% (male: 1.9%; female: 2.3%) in the overall adult population, and 4.5% (male: 4.2%; female: 4.8%) in the population aged ≥ 50 years, reaching 10.0% in the population aged ≥ 70 years. Atrial fibrillation, hypertension, low estimated glomerular filtration rate (eGFR), coronary heart disease (CHD), stroke, sedentary lifestyle, and diabetes were independently associated with HF in both populations. A total of 95.7% (95%CI: 92.7-98.6) of the population with HF had an elevated cardiovascular risk.

CONCLUSIONS

This study reports that HF prevalence increases from 4.5% in the population over 50 years to 10% in the population over 70 years. The main clinical conditions that are HF-related are sedentary lifestyle, atrial fibrillation, hypertension, diabetes, low eGFR, stroke, and CHD.

Successful restoration of corneal surface integrity with a tissue-engineered allogeneic implant in severe keratitis patients

OBJECTIVES

Corneal diseases are among the main causes of blindness, with approximately 4.6 and 23 million patients worldwide suffering from bilateral and unilateral corneal blindness, respectively. The standard treatment for severe corneal diseases is corneal transplantation. However, relevant disadvantages, particularly in high-risk conditions, have focused the attention on the search for alternatives.

METHODS

We report interim findings of a phase I-II clinical study evaluating the safety and preliminary efficacy of a tissue-engineered corneal substitute composed of a nanostructured fibrin-agarose biocompatible scaffold combined with allogeneic corneal epithelial and stromal cells (NANOULCOR). 5 subjects (5 eyes) suffering from trophic corneal ulcers refractory to conventional treatments, who combined stromal degradation or fibrosis and limbal stem cell deficiency, were included and treated with this allogeneic anterior corneal substitute.

RESULTS

The implant completely covered the corneal surface, and ocular surface inflammation decreased following surgery. Only four adverse reactions were registered, and none of them were severe. No detachment, ulcer relapse nor surgical re-interventions were registered after 2 years of follow-up. No signs of graft rejection, local infection or corneal neovascularization were observed either. Efficacy was measured as a significant postoperative improvement in terms of the eye complication grading scales. Anterior segment optical coherence tomography images revealed a more homogeneous and stable ocular surface, with complete scaffold degradation occurring within 3-12 weeks after surgery.

CONCLUSIONS

Our findings suggest that the surgical application of this allogeneic anterior human corneal substitute is feasible and safe, showing partial efficacy in the restoration of the corneal surface.

Elevated pulse pressure and cardiovascular risk associated in Spanish population attended in primary care: IBERICAN study

Introduction

Elevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD.

Objective

To evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD).

Materials and methods

Observational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out.

Results

The mean of PP was 52.35 mmHg, and was significantly higher (p < 0.001) in patients with HTN (56.58 vs. 48.45 mmHg) The prevalence of ePP adjusted for age and sex was 23.54% (25.40% men vs. 21.75% women; p < 0.0001). The ePP prevalence rates increased linearly with age (R2 = 0.979) and were significantly more frequent in population aged ≥65 than in population aged <65 (45.47% vs. 20.98%; p < 0.001). HTN, left ventricular hypertrophy, low estimated glomerular filtration rate, alcohol consumption, abdominal obesity, and CVD were independently associated with ePP. 66.27% of patients with ePP had a high or very high CVR, as compared with 36.57% of patients without ePP (OR: 3.41 [95% CI 3.08-3.77]).

Conclusions

The ePP was present in a quarter of our sample, and it was increased with the age. Also, the ePP was more frequent in men, patients with HTN, other TOD (as left ventricular hypertrophy or low estimated glomerular filtration rate) and CVD; because of this, the ePP was associated a higher cardiovascular risk. In our opinion, the ePP is an importer risk marker and its early identification lets to improve better diagnostic and therapeutic management.

Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials

BACKGROUND

The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs.

RESULTS

Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants' mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91-0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87-1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes.

CONCLUSIONS

The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.

Prevalence rates of overweight and obesity and their associations with cardiometabolic and renal factors. SIMETAP-OB study

INTRODUCTION

Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations.

METHODS

Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis.

RESULTS

The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity.

CONCLUSIONS

The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.

Prevalence of prediabetes and association with cardiometabolic and renal factors. SIMETAP-PRED study

INTRODUCTION

Prediabetes is a major public health problem. The aims of the SIMETAP-PRED study were to determine the prevalence rates of prediabetes according to two diagnostic criteria, and to compare the association of cardiometabolic and renal risk factors between populations with and without prediabetes.

METHODS

Cross-sectional observational study conducted in Primary Care. Based random sample: 6,588 study subjects (response rate: 66%). Two diagnostic criteria for prediabetes were used: 1) prediabetes according to the Spanish Diabetes Society (PRED-SDS): Fasting plasma glucose (FPG) 110-125mg/dL or HbA1c 6.0% -6.4%; 2) prediabetes according to the American Diabetes Association (PRED-ADA): FPG 100-125mg/dL or HbA1c 5.7%-6.4%. The crude and sex- and age-adjusted prevalence rates, and cardiometabolic and renal variables associated with prediabetes were assessed.

RESULTS

The crude prevalence rates of PRED-SDS and PRED-ADA were 7.9% (95% CI 7.3-8.6%), and 22.0% (95% CI 21.0-23.0%) respectively, their age-adjusted prevalence rates were 6.6% and 19.1 respectively. The high or very high cardiovascular risk of the PRED-SDS or PRED-ADA populations were 68.6% (95%CI 64.5-72.6%) and 61.7% (95%CI 59.1-64.1%) respectively. Hypertension, hypertriglyceridemia, overweight, obesity, and increased waist-to-height ratio were independently associated with PRED-SDS. In addition to these factors, low glomerular filtration rate and hypercholesterolemia were also independently associated with PRED-ADA.

CONCLUSIONS

The prevalence of PRED-ADA triples that of PRED-SDS. Two thirds of the population with prediabetes had a high cardiovascular risk. Several cardiometabolic and renal risk factors were associated with prediabetes. Compared to the SDS criteria, the ADA criteria make the diagnosis of prediabetes easier.

Mediterranean diet and diabetes risk in a cohort study of individuals with prediabetes: propensity score analyses

AIMS

Randomized controlled trials have demonstrated the efficacy of several dietary patterns plus physical activity to reduce diabetes onset in people with prediabetes. However, there is no evidence on the effect from the Mediterranean diet on the progression from prediabetes to diabetes. We aimed to evaluate the effect from high adherence to Mediterranean diet on the risk of diabetes in individuals with prediabetes.

METHODS

Prospective cohort study in Spanish Primary Care setting. A total of 1184 participants with prediabetes based on levels of fasting plasma glucose and/or glycated hemoglobin were followed up for a mean of 4.2 years. A total of 210 participants developed diabetes type 2 during the follow up. Hazard ratios of diabetes onset were estimated by Cox proportional regression models associated to high versus low/medium adherence to Mediterranean diet. Different propensity score methods were used to control for potential confounders.

RESULTS

Incidence rate of diabetes in participants with high versus low/medium adherence to Mediterranean diet was 2.9 versus 4.8 per 100 persons-years. The hazard ratios adjusted for propensity score and by inverse probability weighting (IPW) had identical magnitude: 0.63 (95% confidence interval, 0.43-0.93). The hazard ratio in the adjusted model using propensity score matching 1:2 was 0.56 (95% confidence interval, 0.37-0.84).

CONCLUSIONS

These propensity score analyses suggest that high adherence to Mediterranean diet reduces diabetes risk in people with prediabetes.

Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España

Introducción

En España, los sistemas sanitarios están transferidos a las Comunidades Autónomas (CC.AA.), constituyendo 19 sistemas sanitarios con gestión y recursos diferenciados. Durante la primera onda epidémica de la COVID-19 se objetivaron diferencias en los sistemas de declaración y en las tasas de letalidad (TL) entre las CC.AA. El objetivo de este estudio fue analizar las TL por CC.AA. durante la segunda onda epidémica (del 20 de julio al 25 de diciembre de 2020) y su relación con la prevalencia de la infección.

Material y métodos

Se realizó un estudio observacional descriptivo con la información disponible sobre el número de fallecidos por COVID-19 registrados en el Ministerio de Sanidad, Consejerías de Salud y los Departamentos de Salud Pública de las CC.AA. y según el exceso de mortalidad informado por el Sistema de Monitorización de Mortalidad Diaria (MoMo). La prevalencia de la infección se estimó a partir de las diferencias entre la segunda y cuarta ronda del estudio ENE-COVID y sus intervalos de confianza del 95%. Se calcularon las TL (fallecidos por cada mil infectados) globales, por sexo, grupos de edad (< 65 y ≥ 65 años) y CC.AA. Se calculó la razón estandarizada de letalidad por edad (REL) de las CC.AA. utilizando las TL de España para cada grupo de etario. Estas estimaciones se realizaron con las defunciones declaradas oficialmente (TLo) y el exceso de defunciones estimadas por MoMo (TLMo). Se estimaron las correlaciones entre las prevalencias de infección y las TLo y TLMo, ponderando por población.

Resultados

Para el conjunto de España, la TLo durante la segunda onda epidémica fue del 7,6%, oscilando entre 3,8% de Baleares y 16,4% de Asturias, y la TLMo fue de 10,1%, oscilando entre el 4,8% de Madrid y el 21,7% en Asturias. Se observaron diferencias significativas entre la TLo y la TLMo en Canarias, Castilla la Mancha, Extremadura, Comunidad Valenciana, Andalucía y las Ciudades Autónomas de Ceuta y Melilla. La TLo fue significativamente mayor en hombres (8,2%) que en mujeres (7,1%). Las TLo y TLMo fueron significativamente mayores en el grupo de edad ≥ 65 años (55,4 y 72,2%, respectivamente) que en el grupo < 65 años (0,5 y 1,4%, respectivamente). País Vasco, Aragón, Andalucía y Castilla la Mancha presentaron una REL significativamente superiores a uno. Las correlaciones entre la prevalencia de infección y las TLo fueron inversas.

Conclusiones

La letalidad por COVID-19 durante la segunda onda epidémica en España mejoró respecto a la primera. Los datos disponibles sugieren que la letalidad de la segunda onda en las CC.AA. estaría influida por la elevada letalidad observada en la primera onda en personas con comorbilidades, así como por las limitaciones de los sistemas de detección y notificación de SARS-CoV-2. Las tasas de letalidad fueron mayores en hombres y personas mayores, y variaban significativamente entre CC.AA. Es necesario profundizar en el análisis de las causas de estas diferencias.

Spanish Validation of the “Life Snapshot Inventory”

Introduction:

The Life Snapshot Inventory (LSI) is a self-report instrument to measure the meaningful vital, personal, and social directions. It was created in the Functional Analytic Psychotherapy as a continuous evaluation of vital changes in areas of life (family, work, love, spirituality, sexuality, health, etc.).

Objective:

The aim was to validate its psychometric characteristics for the first time.

Method:

This study involved 530 participants (average age 33 years), in a Spanish sample. The questionnaire has been compared with the Rosenberg Self-Esteem Scale (RSES) to obtain convergent validity.

Results:

The results showed a high internal consistency (α = .93) and a correlation of .61, both statistically significant. The factorial analysis showed only one factor (43.56% of variance). In addition, it was sensitive to changes due to interventions, and made it possible to differentiate those people with vital problems.

Conclusion:

This questionnaire could be a helpful measure for healthcare and clinical contexts.

Gender Differences in Psychological Impact of the Confinement During the COVID-19 Outbreak in Spain: A Longitudinal Study

The rapid spread of the coronavirus disease 2019 (COVID-19) has led the authorities to establish compulsory confinement for most of the Spanish population from March to May 2020. Severe isolation combined with the uncertainty and fear associated with the public health crisis can have a psychological impact on the general population. The aim of the current study was to compare possible gender differences in mental health and psychological measures throughout the confinement. One hundred and sixty-four Spanish participants (75% female; M_age = 39.8; SD = 13.5) completed the surveys at the beginning, middle, and end of the forced confinement. The psychological variables were associated with depressive, anxiety, stress, and intrusive/avoidance symptoms, as well as a total score for overall mental health, and a positive/negative affect measure. The results showed that although females had significantly higher scores than males in almost all measures at the beginning of the confinement, the gender differences were quickly vanishing away over time. In fact, intra-group analysis showed that while the female group significantly improved their results on most psychological measures, the male group improved on only one single measure. In summary, the results showed that although the female group started the confinement with higher levels of negative emotions (particularly symptoms of stress and avoidance) than the male group, these differences were significantly reduced in the first few weeks due to the overall improvement in the results of the female group.

Progressive Multimedia Exposure for Specific Phobias: A Clinical Case of Claustrophobia and Acrophobia

We present a multimedia exposure intervention for specific phobias using images and videos in a specific case of claustrophobia and acrophobia. The patient was a 47-year-old woman named “Jane” (anonymized name) who was diagnosed with fear of heights (acrophobia) and fear of confined spaces and enclosed areas (claustrophobia). The procedure was a single-case A-B design with several concurrent baselines, pre-post measurements, and two follow-ups (6 and 12 months). For the assessment, there were several questionnaires on anxiety and phobias and the continuous evaluation of anxiety and heart rate during treatment assays for each session. The treatment consisted of eight sessions of progressive multimedia exposure: images, videos, and in vivo settings. The results showed a decrease in the score for pre-post questionnaires ( Z = −4.196, p < .0010) and also a total decrease in anxiety in the different baselines (PND 100%). The benefits were maintained during 1 year of follow-up. After the treatment, “Jane” could be confronted with situations she previously feared, such as being on floors of different levels (up to ninth floor), in closed places, in crowded elevators, and traveling on buses and trains for long distances.

Portuguese validation of the Adult Separation Anxiety-Questionnaire (ASA-27)

Adult separation anxiety disorder (ASAD) is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. Despite the high rates of this diagnosis among Portuguese adults, there is a lack of measures to assess it. In this study, we assessed the psychometric properties of a Portuguese adaptation of the Adult Separation Anxiety questionnaire (ASA-27) on a sample of 267 adults (72.7% women) aged 18–80 years (M = 40.5, SD = 13.1). Factor structure, internal consistency, and convergence validity were examined. This study confirmed the single-factor structure of the Portuguese version of ASA-27. Consistency was high for the total sample (ω = .92) and by gender (ω = .93 and 92, men and women groups, respectively). The scale was positively related to the Portuguese version of State-Trait Anxiety Inventory (STAI) (r = .57, p< .001, for both State and trait anxiety scales) and Composite Codependency Scale total score (r = .29, p< .001). In addition, the ASA-27 total score showed incremental validity in the explanation of anxiety measured by STAI. In conclusion, results show that the Portuguese version of the ASA-27 is a reliable and valid measure of ASAD.

Heat rectification with a minimal model of two harmonic oscillators

We study heat rectification in a minimalistic model composed of two unequal atoms subjected to linear forces and in contact with effective Langevin baths induced by Doppler lasers. Analytic expressions of the heat currents in the steady state are spelled out. Asymmetric heat transport is found in this linear system if both the bath temperatures and the temperature-dependent bath-system couplings are exchanged. The model can be realized with two ions in either common or individual traps. This physical setting allows for a natural temperature dependence of the coupling to the baths. We also explore the parameter space of the model to optimize asymmetric heat current and find conditions for maximal rectification. High rectification corresponds to a good match of the power spectra of the ions for forward temperature bias and mismatch for reverse bias, which may be understood by the behavior of dissipative normal modes.

Related cardiometabolic factors and prevalence of low HDL-cholesterol levels and atherogenic dyslipidemia. SIMETAP-AD study

AIM

To determine the crude and sex- and age-adjusted prevalence rates of atherogenic dyslipidemia (AD) and low HDL-cholesterol levels (low-HDLc), and to assess their associations with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases.

METHODS

Population-based cross-sectional study conducted in Primary Care, with randomly selected adult subjects. The AD was considered if the patients had hypertriglyceridemia (triglycerides≥150mg/dL) and low-HDLc (<40mg/dL [men];<50mg/dL [women]). Crude and sex- and age-adjusted prevalence rates were determined, and univariate and multivariate analysis were performed to assess related cardiometabolic factors.

RESULTS

Study population with 6,588 adults (55.9% women) with mean age 55.1 (±17.5) years. The mean HDLc levels were 49.2 (±12.6) mg/dL in men and 59.2 (±14.7) mg/dL in women. The crude prevalence rates of low-HDLc and AD were 30.8% (95%CI: 29.7-31.9), and 14.3% (95%CI: 13.5-15.2), respectively. The adjusted prevalence rates of low-HDLc were 28.0% in men and 31.0% in women, and AD were 16.4% in men and 10.6% in women. Seventy-three percent of the population with AD had high or very high cardiovascular risk. The independent factors associated with low HDLc or with AD were diabetes, smoking, abdominal obesity, and obesity. The major factors associated with low HDLc and AD were hypertriglyceridemia and diabetes, respectively.

CONCLUSIONS

Almost a third of the adult population had low HDL-C and half of them met AD criteria. Cardiometabolic factors were associated with low HDL-C and AD, highlighting hypertriglyceridemia with low HDLc, and DM with AD.

Mesenchymal stromal cells in human immunodeficiency virus-infected patients with discordant immune response: Early results of a phase I/II clinical trial

Between 15% and 30% of HIV‐infected subjects fail to increase their CD4⁺ T‐cell counts despite continuous viral suppression (immunological nonresponders [INRs]). These subjects have a higher morbidity and mortality rate, but there are no effective treatments to reverse this situation so far. This study used data from an interrupted phase I/II clinical trial to evaluate safety and immune recovery after INRs were given four infusions, at baseline and at weeks 4, 8, and 20, with human allogeneic mesenchymal stromal cells from adipose tissue (Ad‐MSCs). Based on the study design, the first 5 out of 15 INRs recruited received unblinded Ad‐MSC infusions. They had a median CD4⁺ nadir count of 16/μL (range, 2‐180) and CD4⁺ count of 253 cells per microliter (171‐412) at baseline after 109 (54‐237) months on antiretroviral treatment and 69 (52‐91) months of continuous undetectable plasma HIV‐RNA. After a year of follow‐up, an independent committee recommended the suspension of the study because no increase of CD4⁺ T‐cell counts or CD4⁺/CD8⁺ ratios was observed. There were also no significant changes in the phenotype of different immunological lymphocyte subsets, percentages of natural killer cells, regulatory T cells, and dendritic cells, the inflammatory parameters analyzed, and cellular associated HIV‐DNA in peripheral blood mononuclear cells. Furthermore, three subjects suffered venous thrombosis events directly related to the Ad‐MSC infusions in the arms where the infusions were performed. Although the current study is based on a small sample of participants, the findings suggest that allogeneic Ad‐MSC infusions are not effective to improve immune recovery in INR patients or to reduce immune activation or inflammation. ClinicalTrials.gov identifier: NCT0229004. EudraCT number: 2014‐000307‐26.

[Analysis of fatality rates case of SARS-CoV-2 infection in the Autonomous Communities of Spain]

INTRODUCTION

The SARS-CoV-2 pandemic has posed a real challenge to health systems. In Spain, the heterogeneous distribution of the virus infection and the different health strategies have conditioned the morbidity and fatality rate. The aim of this study was to analyse the lethality of the infection by sex and age range in the Autonomous Communities (AC) of Spain.

MATERIAL AND METHODS

To perform the analysis, data were extracted from the Ministry of Health, Regional and Public Health Departments of the different AC. The infected population was estimated from the results of the ENE-COVID19 and the population registered on 1 January 2020 (INE) for the validity of the IgG antibody test with 80% sensitivity and 100% specificity. The case fatality rate (TL) (deaths/1000 estimated infected) by sex and age (<20years, 20-64 and ≥65years) was calculated for each AC. The standardized case fatality ratio (REL) was calculated by the exact method (EPIDAT).

RESULTS

The estimated prevalence of SARS-CoV-2 infection in Spain was 6% (range, 1.4% [Ceuta] -14.1% [Community of Madrid]). The TL in Spain was 9,6/1000, ranged per AC from 1/1000 in Melilla to 26.6/1000 in La Rioja, with no correlation between case fatality and prevalence of infection. The TL was higher in men (10.2/1000, ratio 1.17 with respect to women), except in Cataluña (ratio 0.92), and especially high in those over 64years of age in La Rioja (143.5/1000), Asturias (69.2/1000) and Basque Country (46.6/1000). Overall excess REL was found to be over 30% in La Rioja (2.91; 95%CI: 2.36-3.57), Asturias (1.51; 95%CI: 1.27-1.80), Basque Country (1.42; 95%CI: 1.31-1.54) and Extremadura (1.37; 95%CI: 1.20-1.57) and in those over 64 years in Madrid and the Canary Islands.

CONCLUSIONS

SARs-CoV-2 virus infection has been very unevenly distributed in the different ACs, with notably differences in TL between ACs, particularly high in La Rioja, Asturias and the Basque Country. Is important to study the excess in TL the population over 64years of age in the ACs of Madrid and the Canary Islands.

Multimedia intervention for specific phobias: A clinical and experimental study

BACKGROUND

Exposure is the treatment of choice for specific phobias. We present an experimental and clinical study on the efficacy of the progressive multimedia exposure procedure for specific phobias.

METHOD

The sample size consisted of 36 individuals, 7 men and 29 women (mean age: 29 years old), with different types of specific phobias. A combined between-groups (3x4) with repeated measures design was used, including several follow-ups up to 3 years. Participants were assigned to different groups: Experimental (10), Waiting List (12), and Control (14). As an evaluation method, a Behavioural Avoidance Test (BAT) with subjective anxiety and heart rate was used for images and videos, plus general and specific anxiety questionnaires for each phobia. The intervention was carried out in four phases of multimedia exposure: photographs, videos, simulated stimuli, and real stimulation.

RESULTS

Anxiety and avoidance were significantly reduced in the experimental group, with a very large effect size (between d = 1.37 and 5.37). There were no significant changes in either the Control Group or the Waiting List Group.

CONCLUSIONS

The treatment had a clinically significant impact on the daily life of the participants. This multimedia procedure was shown to be effective and to use few resources, thus allowing it to always be adapted to the individual characteristics of the participants.

Hyaluronic acid biomaterial for human tissue-engineered skin substitutes: Preclinical comparative in vivo study of wound healing

BACKGROUND

There is not an ideal biomaterial for tissue-engineered skin substitutes (TESSs), and most of the studies or existing therapies use xenogeneic origin natural biomaterials or biosynthetic scaffolds.

OBJECTIVE

To analyse clinical, histological integration and homeostasis parameters of a human TESS manufactured with fibrin-hyaluronic acid biomaterial (HA-Skin), grafted in immunodeficient mice for 8 weeks, and compared with the gold standard treatment (Autograft), a human TESS manufactured with fibrin-agarose biomaterial (AG-Skin) and secondary wound healing dressings.

METHODS

Human TESSs and autografts were implanted into BALB/c mice after surgical excision. Secondary wound healing approach was achieved with biosynthetic collagen wound dressing (Biobrane^® ) and fibrin-hyaluronic acid or fibrin-agarose biomaterial without cells (Total N = 44). Clinical integration and homeostasis parameters were evaluated every two weeks for two months. Histological and immunohistochemical analyses were performed four and eight weeks after grafting.

RESULTS

HA-Skin, AG-Skin and Autograft groups showed a proper clinical integration and epithelization eight weeks later. Scar evaluation revealed better results for Autograft and HA-Skin. Homeostasis analysis indicated similar values of transepidermal water loss and elasticity between HA-Skin (6.42 ± 0.75 g/h/m² , 0.42 ± 0.08 AU), Autograft (6.91 ± 1.28 g/h/m² , 0.40 ± 0.08 AU) and healthy mouse skin (6.40 ± 0.43 g/h/m² , 0.35 ± 0.03 AU). Histological results showed that human TESSs and autografts presented better skin structuration and higher expression of cytokeratins.

CONCLUSIONS

This study suggests that human TESS based on fibrin-hyaluronic acid biomaterial could be suitable for clinical application in the treatment of several dermatological pathologies (wound healing).

Spatial configurations and temperature profiles in nonequilibrium steady state of two-species trapped ion systems

We study Coulomb crystals containing two ion species simultaneously confined in radio frequency traps and coupled to different thermal reservoirs located in two separate regions. We use a three-dimensional model to simulate the trapped bicrystal and show in a numerically rigorous manner the effects of the mass dependence of the trapping frequencies on the underlying nonequilibrium dynamics and the temperature profiles. By solving the classical Langevin equations of motion, we obtain the spatial probability densities of the two ion species and the kinetic temperature profiles across the axial direction of the trap in the nonequilibrium steady state. We analyze trapping conditions leading to bicrystals that exhibit ion conformations ranging from a linear chain of alternating ion species to two- and three-dimensional configurations. The results evidence the spatial segregation of the two ion species due to the mass dependence of the trapping frequencies and the increase of ion delocalization for heavier ion species and/or weaker trapping confinements. We also show the correlation between the increase of the temperature gradient in the bulk and this enhancement of ion delocalization through the trap.

Creating a Computerized Instrument for the Assessment of Blood-Injury-Injection Phobia

A new computerized instrument (the Multimedia Behavioral Avoidance Test, or MBAT) for blood-injury-injection phobia (BII) assessment is presented. Analogous stimuli such as images and videos can also elicit anxiety responses; thus, they can be used for the assessment of phobia. The MBAT was applied to participants via computer, and subjective anxiety responses and time latency were recorded. The MBAT was composed of 30 original images and 30 videos related to blood, injury and injections. The MBAT was compared with other pencil-and-paper questionnaires for BII phobia, and heart rate was also measured with a pulsioximeter. The participants included 160 students and professionals (34.5% males, 65.6% females; mean 28.6 years old). The results showed a high reliability for internal consistency in images and videos (α = .98 both), with a single factor that groups all the items. In addition, the MBAT had high concurrent validity (r = .78 to .85) with the different anxiety scales compared. The MBAT diagnosed 12 participants with possible BII phobia. It is a useful instrument in the assessment of this kind of phobia because it is easier and quicker than pencil-and-paper questionnaires, it uses more objective measurements, and it is useful in planning subsequent exposure with images and videos.

Delocalization and heat transport in multidimensional trapped ion systems

We study the connection between heat transport properties of systems coupled to different thermal baths in two separate regions and their underlying nonequilibrium dynamics. We consider classical systems of interacting particles that may exhibit a certain degree of delocalization and whose effective dimensionality can be modified through the controlled variation of a global trapping potential. We focus on Coulomb crystals of trapped ions, which offer a versatile playground to shed light on the role that spatial constraints play on heat transport. We use a three-dimensional model to simulate the trapped ion system and show in a numerically rigorous manner to what extent heat transport properties could be feasibly tuned across the structural phase transitions among the linear, planar zigzag, and helical configurations. By solving the classical Langevin equations of motion, we analyze the steady state spatial distributions of the particles, the temperature profiles, and total heat flux through the various structural phase transitions that the system may experience. The results evidence a clear correlation between the degree of delocalization of the internal ions and the emergence of a nonzero gradient in the temperature profiles. The signatures of the phase transitions in the total heat flux as well as the optimal spatial configuration for heat transport are shown.

Prevalence of diabetes mellitus in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-DM study

INTRODUCTION

The aims of this study were to determine the age- and sex-adjusted prevalence rates of DM, type-1 DM (T1DM), and type-2 DM (T2DM), and to compare the relationship with cardiovascular risk factors, cardiovascular diseases, chronic kidney disease, and metabolic diseases between populations with and without DM.

METHODS

SIMETAP-DM is a cross-sectional observational study conducted in a Primary Care setting with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, T1DM and T2DM were based on clinical and biochemical criteria and/or the checking of these diagnoses in the medical records. The crude and age- and sex-adjusted (standardised for Spanish population) prevalence rates were calculated.

RESULTS

The crude prevalence rates of T1DM, T2DM, and DM were 0.87% (95% confidence interval [95% CI]: 0.67-1.13), 14.7% (95% CI: 13.9-15.6), and 15.6% (95% CI: 14.7-16.5), respectively. The age- and sex-adjusted prevalence rates of T1DM, T2DM, and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women), and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population≥70 years was double (30.3% [95% CI: 28.0-32.7]) that of the population between 40 and 69 years (15.3% [95% CI: 14.1-16.5]). Hypertension, peripheral arterial disease, increased waist-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM.

CONCLUSIONS

In a Spanish primary care setting, the age-adjusted prevalences of T1DM, T2DM and DM in the adult population were 1.0, 11.5, and 12.5%, respectively. One-third (33%) of the population over 70 years had DM.

Correction to: Similarities and differences in tissue distribution of DLK1 and DLK2 during E16.5 mouse embryogenesis

In the original publication of the article, some symbols in Figure 3 were not correctly aligned with the image.

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study

INTRODUCTION

Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED.

METHODS

Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population.

RESULTS

The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years.

CONCLUSIONS

SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Consensus document of the Spanish Society of Arteriosclerosis (SEA) for the prevention and treatment of cardiovascular disease in type 2 diabetes mellitus

A consensus document of the Diabetes working group of the Spanish Society of Arteriosclerosis (SEA) is presented, based on the latest studies and conceptual changes that have appeared. It presents the cardiovascular risk in type 2 diabetes mellitus (T2DM) and the action guidelines for the prevention and treatment of cardiovascular disease (CVD) associated with T2DM. The importance of lipid control, based on the objective of LDL-C and non-HDL-C when there is hypertriglyceridemia, and the blood pressure control in the prevention and treatment of CVD is evaluated. The new hypoglycemic drugs and their effects on CVD are reviewed, as well as the treatment and control guidelines of hyperglycemia. Likewise, the use of antiplatelet agents is considered. Emphasis is placed on the importance of global and simultaneous action on all risk factors to achieve a significant reduction in cardiovascular events. This supplement is sponsored by Laboratorios Esteve, S.A.

Epithelial In vitro Differentiation of Mesenchymal Stem Cells

Mesenchymal stem cells or mesenchymal stromal cells (MSCs) are non-hematopoietic stromal cells that reside in many human organs and have been isolated from a variety of adult or fetal tissues such as adipose tissue, bone marrow and umbilical cord Wharton's jelly, among others. Because they are a heterogeneous population, International Society for Cellular Therapy has established 3 minimum criteria to characterize MSCs in vitro: i) adherence to plastic, ii) differentiation potential (osteogenic, chondrogenic and adipogenic lineages) and iii) expression of specific surface antigens (CD73+, CD90+, CD105+, CD34-, CD45-, CD11b-, CD14-, CD19-, CD79a-, HLA-DR-). Because of these characteristics, MSCs are useful for different applications and studies, most of them related with regenerative biomedicine. Epithelial in vitro differentiation of MSCs, for clinical use, is one of the main objectives in this field, due to, on the one hand, the difficulties to establish epithelial cell cultures and, on the other hand, the immunomodulatory capacity of MSCs that could increase the success of transplantation. According to this and the information compiled from bibliography, production of epithelial cells differentiated in vitro from MSCs is a complex procedure and a lot of techniques and culture media are necessary to explore. The objective of this review is to show the different methods of epithelial in vitro differentiation and remark the need to further study for being capable of establishing specific cell lines of epithelial cells differentiated from autogenic or allogenic MSCs.

Population and methodology of the SIMETAP study: Prevalence of cardiovascular risk factors, cardiovascular diseases, and related metabolic diseases

The prevention of cardiovascular disease is based on the detection and control of cardiovascular risk factors (CVRF). In Spain there are important geographical differences both in the prevalence and in the level of control of the CVRF. In the last decade there has been an improvement in the control of hypertension and dyslipidaemia, but a worsening of cardio-metabolic risk factors related to obesity and diabetes. The SIMETAP study is a cross-sectional descriptive, observational study being conducted in 64 Primary Care Centres located at the Community of Madrid. The main objective is to determine the prevalence rates of CVRF, cardiovascular diseases, and metabolic diseases related to cardiovascular risk. A report is presented on the baseline characteristics of the population, the study methodology, and the definitions of the parameters and diseases under study. A total of 6,631 study subjects were selected using a population-based random sample. The anthropometric variables, lifestyles, blood pressure, biochemical parameters, and pharmacological treatments were determined. The highest crude prevalences were detected in smoking, physical inactivity, obesity, prediabetes, diabetes, hypertension, dyslipidaemias, and metabolic syndrome. A detailed analysis needs to be performed on the prevalence rates, stratified by age groups, and prevalence rates adjusted for age and sex to assess the true epidemiological dimension of these CVRF and diseases.

A study protocol for a multicentre randomised clinical trial evaluating the safety and feasibility of a bioengineered human allogeneic nanostructured anterior cornea in patients with advanced corneal trophic ulcers refractory to conventional treatment

INTRODUCTION

There is a need to find alternatives to the use of human donor corneas in transplants because of the limited availability of donor organs, the incidence of graft complications, as well as the inability to successfully perform corneal transplant in patients presenting limbal deficiency, neo-vascularized or thin corneas, etc. We have designed a clinical trial to test a nanostructured fibrin-agarose corneal substitute combining allogeneic cells that mimics the anterior human native cornea in terms of optical, mechanical and biological behaviour.

METHODS AND ANALYSIS

This is a phase I-II, randomised, controlled, open-label clinical trial, currently ongoing in ten Spanish hospitals, to evaluate the safety and feasibility, as well as clinical efficacy evidence, of this bioengineered human corneal substitute in adults with severe trophic corneal ulcers refractory to conventional treatment, or with sequelae of previous ulcers. In the initial phase of the trial (n=5), patients were sequentially recruited, with a safety period of 45 days, receiving the bioengineered corneal graft. In the second phase of the trial (currently ongoing), subjects are block randomised (2:1) to receive either the corneal graft (n=10), or amniotic membrane (n=5), as the control treatment. Adverse events, implant status, infection signs and induced neovascularization are evaluated as determinants of safety and feasibility of the bioengineered graft (main outcomes). Study endpoints are measured along a follow-up period of 24 months, including 27 post-implant assessment visits according to a decreasing frequency. Intention to treat, and per protocol, and safety analysis will be performed.

ETHICS AND DISSEMINATION

The trial protocol received written approval by the corresponding Ethics Committee and the Spanish Regulatory Authority and is currently recruiting subjects. On completion of the trial, manuscripts with the results of phases I and II of the study will be published in a peer-reviewed journal.

TRIAL REGISTRATION

CT.gov identifier: NCT01765244 (Jan2013). EudraCT number: 2010-024290-40 (Dec2012).

Adipose tissue-derived mesenchymal stromal cells as part of therapy for chronic graft-versus-host disease: A phase I/II study

BACKGROUND AIMS

Despite the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT), the procedure is still associated with high toxicity in patients with refractory graft-versus-host disease (GvHD). Mesenchymal stromal cells (MSCs) are a new mode of therapy in the context of allo-HSCT. The objective of this study was to evaluate the safety and feasibility of the use of adipose tissue-derived MSCs (AT-MSCs) in patients with chronic GvHD.

METHODS

Fourteen patients with moderate (n = 7) or severe (n = 7) chronic GvHD received 1 × 10⁶/kg (group A, n = 9) or 3 × 10⁶/kg (group B, n = 5) AT-MSCs with cyclosporine and prednisone as first-line therapy.

RESULTS

Ten of the 14 patients were able to continue under the protocol: 80% were in complete remission, and 100% were off of steroids at week 56. The remaining 4 patients either worsened from chronic GvHD (n = 3) or abandoned the study (n = 1). At the end of the study, 11 of 14 patients are alive (overall survival 71.4%, median survival of 45.3 weeks). No suspected unexpected serious adverse reactions occurred during the trial. Neither relapse of underlying disease nor mortality due to infection was observed in this cohort. Biological studies showed increased CD19, CD4 and tumor necrosis factor-α with a temporary decrease in natural killer cells.

DISCUSSION

AT-MSCs, in combination with immunosuppressive therapy, may be considered feasible and safe and likely would have an impact on the course of chronic GvHD. More studies are warranted to understand the potential benefits of AT-MSCs in these patients.

Contribución al conocimiento de los tricópteros (Insecta: Trichoptera) de Andalucía

A partir de una exhaustiva revisión bibliográfica y de nuevos datos aportados en este estudio se establece que el número de especies de tricópteros registradas en Andalucía asciende a 136, incluidas en 53 géneros y 17 familias. Este número equivale aproximadamente al 38% de las especies presentes en la península ibérica. Catagapetus mclachlani y Oxyethira falcata constituyen nuevas citas para Andalucía, así como el género Beraea. Se confirma asimismo la presencia de Stenophylax permistus. Además se menciona una nueva especie de Hydropsyche, otra de Helicopsyche y una probable nueva especie del género Agapetus. Las familias mejor representadas son Hydroptilidade (18%), Limnephilidae (17%), Leptoceridae (13%) e Hydropsychidae (13%). Con esta actualización se han registrado 86 nuevas citas provinciales, mejorando sensiblemente los inventarios de las provincias de Granada, Jaén, Málaga y Sevilla. Los tricópteros de las provincias de Almería y especialmente los de Huelva, permanecen sin embargo muy poco estudiados. El estudio biogeográfico llevado a cabo entre las ocho unidades geográficas propuestas muestra tres grandes dominios diferenciados: Sierra Morena, el Sistema Bético y la depresión del Guadalquivir. Contrariamente a lo que se podría pensar, la tricopterofauna de las sierras Béticas húmedas (Serranía de Ronda y Campo de Gibraltar) parece mostrar una mayor similitud con la de Sierra Morena. La fauna de tricópteros andaluza está formada mayoritariamente por componentes de origen europeo (más del 50%) y endemismos (42%), de los que un 60% son exclusivos de Andalucía. Estos datos muestran que, dentro de la península ibérica, esta región destaca como una zona importante de refugio y centro de especiación para los tricópteros.

A new species of genus Schizopelex McLachlan (Trichoptera, Sericostomatidae), from the southern Iberian Peninsula

The West Palearctic genus Schizopelex McLachlan 1876 is represented by eleven recognized species. The center of its distribution area is in Turkey, where seven species have been reported (Malicky 2004; Sipahiler 2005, 2012; Oláh 2010; Sipahiler & Pauls 2012). These 7 species are S. anatolica Schmid 1964, S. rhamnes Malicky 1976, S. sinopica Sipahiler 2012, S. yenicensis Sipahiler & Pauls 2012, S. boluensis Sipahiler 2012 (in Sipahiler & Pauls 2012), S. cachetica Martynov 1913a, S. pontica Martynov 1913b. Schizopelex cachetica and S. pontica have also been reported from the Caucasus and the Transcaucasia, respectively (Martynov 1913a, 1913b; Ivanov 2011). In addition, two species (S. huettingeri Malicky 1974 and S. persica Schmid 1964) are known from the Balkans and Iran, respectively. The two remaining species are distributed in the southwestern West Palearctic region (southwestern Europe): Schizopelex furcifera McLachlan 1880 has been reported from the northeastern Iberian Peninsula and the Pyrenees (González et al. 1992; Martínez-Menéndez & González 2010); Schizopelex festiva (Rambur 1842) is distributed throughout most of the Iberian Peninsula and the Maghreb (González et al. 1992; González & Martínez 2011). In this paper is described and illustrated for the first time a new species of Schizopelex from the southern Iberian Peninsula.

Kinetic modelling of passive transport and active efflux of a fluoroquinolone across Caco-2 cells using a compartmental approach in NONMEM

The purpose was to develop a general mathematical model for estimating passive permeability and efflux transport parameters from in vitro cell culture experiments. The procedure is applicable for linear and non-linear transport of drug with time, <10 or >10% of drug transport, negligible or relevant back flow, and would allow the adequate correction in the case of relevant mass balance problems. A compartmental kinetic approach was used and the transport barriers were described quantitatively in terms of apical and basolateral clearances. The method can be applied when sink conditions are not achieved and it allows the evaluation of the location of the transporter and its binding site. In this work it was possible to demonstrate, from a functional point of view, the higher efflux capacity of the TC7 clone and to identify the apical membrane as the main resistance for the xenobiotic transport. This methodology can be extremely useful as a complementary tool for molecular biology approaches in order to establish meaningful hypotheses about transport mechanisms.

Clinical and polygraphic evolution of sleep-related breathing disorders in adolescents

It has been suggested that sleep-related breathing disorders (SRBD) involve a continuum that develops over the course of life. If modifiable factors could be identified, the progression of SRBD could perhaps be addressed early in life. Although some studies have looked at the evolution of SRBD in pre-pubertal children, very few studies obtained data in adolescents. Anthropometric, clinical and polygraphic variables were collected during a 4-yr follow-up study among 148 normal adolescents after initial cross-sectional analysis. From a total of 267 adolescents studied at baseline (mean+/-sd age 14.3+/-2.1 yrs), 148 (55.4%) were followed up for 4 yrs. During follow-up, there were no significant changes in snoring and polygraphic parameters. However, a tendency toward weight gain with centrally distributed fat was observed. Habitual snorers had a significantly higher body mass index and more centrally distributed fat than nonsnorers. Males had a higher snoring prevalence and a higher number of respiratory events than females. Snoring at baseline, male sex and poor academic performance were significant predictors of snoring at follow-up. Snoring tends to persist during adolescence and male sex acts as a risk factor. A relationship between snoring and academic performance was observed. These findings may have implications for long-term management of sleep-related breathing disorders.

Laboratory evaluation of entomopathogenic fungi Beauveria bassiana and Metarhizium anisopliae against puparia and adults of Ceratitis capitata (Diptera: Tephritidae)

Laboratory experiments were done to measure the pathogenicity of 10 autochthonous isolates of Beauveria bassiana (Balsamo) Vuill. and of five Metarhizium anisopliae (Metsch.) Sorok. toward puparia and adults of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann) (Diptera: Tephritidae). Although all isolates applied via inoculation of the fungal suspensions on the ventral surface of the abdomen were pathogenic to adults, with mortality rates ranging from 30 to 100% and average survival times (ASTs) from 6.5 to 8.6 d, when C. capitata puparia were immersed in the conidial suspensions, only B. bassiana Bb-1333 and EABb 01/103-Su and M. anisopliae EAMa 01/58-Su isolates caused >50% mortality of puparia. In a second series of bioassays conducted on five selected isolates, adults were sprayed with four 10-fold concentrations ranging from 1.0 x 10(5) to 1.0 x 10(8) colony-forming units (cfu)/ml. The median lethal concentrations (LC50) of the four most virulent isolates ranged from 4.9 x 10(5) to 2.0 x 10(6) cfu/ml with estimated time to kill 50% of the insects ranging from 4.6 to 5.3 d. The effect of a sublethal dose (ca. LD50) of either B. bassiana EABb 01/103-Su or M. anisopliae EAMa 01/58-Su isolate was studied by reciprocal crossing. Treatment with B. bassiana reduced fecundity and fertility at 6, 8, and 10 d after treatment, with fecundity and fertility reductions ranging from 20.0 to 71.2% and from 33.6 to 60.0%, respectively. These reductions occurred in pairing combinations of treated females with either treated or nontreated males. M. anisopliae was more effective in reducing fecundity and fertility at 6 d after treatment, with the reduction varying from 58.4 to 72.1% and from 28.6 to 45.9%, respectively. In addition, the first oviposition was significantly delayed for 1 d in females treated by either fungal species. The above-mentioned five selected isolates were assayed against C. capitata puparia treated as late third instars in sterilized soil at 25'C under three moisture conditions (-0.1, -0.01, and -0.0055 MPa). At -0.01 MPa, all isolates were low pathogenic to C. capitata puparia, whereas significant differences in the puparia mortality occurred between isolates at -0.1 and -0.0055 MPa. The highest pupal mortalities ranged from 52.5 to 70.0%, as a function of soil moisture and were caused by EAMa 01/58-Su and Bb-1333 isolates.

[Study of unmatched cases and controls: hyperhomocysteinaemia and chronic ischaemic cardiopathy]

OBJECTIVE

To evaluate the extent of the association between hyperhomocysteinaemia and chronic ischaemic heart disease.

DESIGN

Unmatched, case-control (1:3) study.

SETTING

Pintores Health Centre, Area 10, Primary Care, Madrid, Spain.

PARTICIPANTS

Patients of the health centre over 35 with chronic ischaemic heart disease or without it.

METHOD

Consecutive, non-randomized sample. Analysis of cases and controls with chi2 test and odds ratio (OR). The quantitative variables were analysed with the Student's t test.

RESULTS

The 76.32% (87/114) of cases had 2 or more cardiovascular risk factors versus 33.56% (99/265) in the control group (P<.0001). Average homocysteinaemia was 10.07 micromol/L (SD, 3.64) in the control group; and 12.74 (SD, 4.59) in the cases group. The difference between the averages (2.67 micromol/L; 95% CI, 1.82-3.52) was significant (P<.001). The difference (16.07%; 95% CI, 6.91-25.23) in hyperhomocysteinaemia (> or =15 micromol/L) between cases (28.95%, 33/114) and controls (12.88%, 38/295) was significant (P=.0001), with an association between hyperhomocysteinaemia and chronic ischaemic heart disease (OR=2.76; 95% CI, 1.62-4.68). This association increased (OR=3.26; 95% CI, 2.07-5.13) when hyperhomocysteinaemia was taken as > or =12 micromol/L, with a significant difference of 27% (95% CI, 16.59-37.41) (P<.0001) between cases (51.75%, 59/114) and controls (24.75%, 73/295).

CONCLUSIONS

The risk factor of hyperhomocysteinaemia > or =15 micromol/L was significantly associated (OR=2.76) with chronic ischaemic heart disease. This association was greater (OR=3.26) when hyperhomocysteinaemia was taken as > or =12 micromol/L.

Pharmacokinetics, bioavailability and absorption of flumequine in the rat

The study demonstrates that the oral extent of bioavailability of flumequine in the rat, relative to the intravenous injection, is complete (0.94 +/- 0.04) and not significantly different from that found by the intraduodenal route (0.95 +/- 0.04). The rate of oral bioavailability, however, is slow (ka = 1.20 +/- 0.07 h-1; Tmax = 2.0 h), but enough to maintain plasma levels above the minimal inhibitory concentration of the most common pathogens for an extended period of time (about 10 h). The reason for the oral absorption slowness could be a slow gastric emptying, an adsorption to the gastric mucosae, a precipitation in the gastric medium or any other feature concerning the stomach as the intraduodenal administration is very quick (kid = 38.1 +/- 4.7 h-1; Tmax = 0.05 h). A possible precipitation of flumequine cannot be discarded as the solubility of flumequine is very low in the pH range of 3 to 6 (mean pH values for rat stomach and rat intestine, respectively; T.T. Kararli, Biopharm. Drug Dispos. 16 (1995) 351-380). Flumequine was shown to be not substantially excreted in bile (2-3% of the dose). Surprisingly, plasma levels and AUC values found for animals with interrupted bile flow always surpass those found for animals with enterohepatic circulation. This could be due to experimental model features, which might bias plasmatic flumequine concentrations if the homeostatic equilibrium of the animal is not completely restored due to the volume reduction induced by biliary extraction.