Alicia García

Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents

OBJECTIVE To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. DESIGN Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). SETTING Spain. SUBJECTS In total, 3850 children and youths aged 2-24 years residing in Spain. RESULTS Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. CONCLUSIONS The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer

Abstract.We have used strontium-89 chloride (89Sr) for the palliative treatment of metastatic bone pain. Seventy-six patients (50 males with prostate carcinoma and 26 females with breast cancer) were treated with 148 MBq of 89Sr. Sixteen patients were retreated, receiving two or three doses; the total number of injected doses was consequently 95. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treament. Three levels of response were considered: good – when there was an increase in the Karnofsky status and a decrease in the pain score (equal to or higher than 4) or analgesic score (equal to or higher than 1); partial – when there was an increase in the Karnofsky status and a decrease in the pain score (2 or 3 points) without significant changes in the analgesic score; no response – if no variation or deterioration in these parameters was observed. In prostate cancer patients, the response was good in 64% of cases and partial in 25%, and there was no response in the remaining 11%. In breast cancer patients, the response was good in 62% of cases and partial in 31%, and there was no response in the remaining 8%. Duration of the response ranged from 3 to 12 months (mean 6 months). In the patients who were retreated the effectiveness was as good as after the first dose of 89Sr. A decrease in the initial leucocyte and platelet counts was observed after the 1st month of treatment, with a gradual partial to complete recovery within 6 months. It is concluded that 89Sr is an effective agent in palliative therapy for metastatic bone pain in patients with prostate or breast carcinoma. If required, retreatment can be administered safely and with the same efficacy as is achieved by the first dose.

Bases anatomopatológicas de la disfunción ventricular latente en diabéticos insulinodependientes

Introduccion y objetivos La historia natural dela miocardiopatia diabetica no esta bien definida,debido principalmente a la comun asociacion conenfermedad coronaria e hipertension arterial. Dadoque estas dos entidades son infrecuentes en los pacientesjovenes, estos constituyen un modelo adecuadopara el estudio de la miocardiopatia diabeticaen sus fases incipientes. Pacientes y metodos Se estudiaron 33 pacientesafectados de diabetes mellitus tipo I sin antecedentesde hipertension arterial ni enfermedad coronaria.Su edad media era de 28 ± 8 anos (rango, 18-46anos) y 14 eran varones. Resultados En el ecocardiograma se observo unventriculo izquierdo de tamano normal y sin anomaliasde la motilidad segmentaria, excepto en uncaso. En la ventriculografia isotopica se detectouna fraccion de eyeccion basal del 56,5 ± 6,6% queaumento al 63 ± 7,4% (p Conclusiones La disfuncion ventricular latentees un hallazgo frecuente en los pacientes diabeticosjovenes asintomaticos, y esta no es secundaria aaterosclerosis coronaria ni a enfermedad de pequenovaso. En este grupo de pacientes las anomaliashistologicas son constantes y se manifiestan por fibrosisintersticial, hipertrofia celular, miocitolisis ydepositos lipidicos.

Segmental contour pattern in a case of pulmonary venoocclusive disease

A V/Q mismatch (segmental contour pattern) is described in a patient suffering from dyspnea. Chest roent-genography revealed a mild interstitial pattern and enlarged pulmonary arteries. A lung biopsy demonstrated pulmonary venoocclusive disease.

Kinetics of hypodermically injected technetium-99m and correlation with cutaneous structures: an experimental study in dogs

We investigated the involvement of cutaneous structures in specific linear migration pathways of technetium-99m pertechnetate hypodermically injected at points of low electrical resistance in the metacarpus of male beagles. Skin-deep incisions were made in the front or back legs on either the same side as the 99mTc injection or on the opposite side. Incisions in the back legs did not affect the migration pattern. Incisions in the front legs before the injection of 99mTc prevented tracer migration. After the injection of 99mTc, incisions in the front contralateral leg caused sudden cessation of the migration, while incisions in the ipsilateral leg caused immediate disappearance of the pathway previously observed. Radioactivity was not detected in flaps obtained from the skin overlying the migration pathway or from the corresponding area of the contralateral leg. In conclusion, the specific linear migration pathways of 99mTc hypodermically injected at points of low electrical resistance cannot be explained by any known biological function. Although the migration of 99mTc does not seem to be strongly linked to any cutaneous structure, the skin overlying the radioactive pathway and the corresponding area of the contralateral leg must be intact if tracer migration is to take place.

Abnormal scintigraphic evolution in AA hepatic amyloidosis

A patient with AA amyloidosis secondary to ankylosing spondylitis showed intense liver uptake of Tc-99m MDP on bone imaging. The biopsy showed hepatic amyloid deposition. A repeat bone scan with Tc-99m MDP 1 year later was negative, although the clinical signs and liver function tests of the patient had not changed. A mechanism might exist, other than the affinity of amyloid to calcium, which would explain the extraosseous uptake of pyrophosphates and diphosphonates in organs and soft tissues affected by systemic amyloidosis.

Complete Atrioventricular Block Secondary to Pulmonary Embolism

We describe a 73-year-old woman with a history of breast cancer and metastatic disease diagnosed in January 2002 (stable when we saw her) who was admitted for sudden dyspnea and presyncope. Complete atrioventricular block was documented, and a temporary pacemaker was implanted. Eight hours after admission she recovered sinus rhythm with left bundle branch block as seen in previous recordings. Computed tomography showed bilateral pulmonary thromboembolism. An electrophysiological study showed normal atrioventricular conduction. We suggest that in this patient, who had previous left bundle branch block, pulmonary thromboembolism may have induced transient right bundle branch block, which in turn caused atrioventricular block.

Bloqueo auriculoventricular completo secundario a tromboembolia pulmonar

Paciente de 73 anos, con antecedentes de neoplasia de mama y enfermedad metastasica diagnosticada en enero de 2002, estable actualmente. Ingresa por disnea subita y sensacion presincopal; se documenta la existencia de un bloqueo auriculoventricular completo, que requiere la implantacion de marcapasos temporal. A las 8 h recupera el ritmo sinusal con bloqueo de rama izquierda ya conocido. Una tomografia computarizada demuestra la existencia de una tromboembolia pulmonar bilateral. Un estudio electrofisiologico muestra conduccion auriculoventricular normal. Sugerimos que en presencia de bloqueo de rama izquierda, una tromboembolia pulmonar, que pudo cursar con bloqueo de rama derecha transitorio, provoco este bloqueo completo paroxistico.

Enterogastric reflux detection with technetium-99m IDA.

A Tc-99m IDA scan was performed in a patient with severe alkaline esophagitis subsequent to a Bilroth I gastroenterostomy. The scan showed enterogastric reflux simultaneously with gastroesophageal reflux of bile. The study was recorded in a computer and the reflux quantitated.

False-positive early indium-111 leukocyte scan.

An ln-111 leukocyte scan was performed in a cirrhotic patient with ascitic fluid infection to rule out an abdominal abscess. Scintigraphy showed localized uptake in the area between the liver and right lung 30 minutes after reinjection of the labeled cells. The 24-hour study was negative. No purulent collection was demonstrated in any location.