Joaquín Carrasco-Luna

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Beyond established risk factors such as smoking and exposure to pollutants increasing evidence emphasizes the role of oxidative stress (OS) in COPD pathophysiology. OS contributes to chronic inflammation, to the progression of the disease and affects both lung function and exacerbations, which opens a rationale for the use of antioxidant and redox-modulating substances in the treatment of the disease. Although numerous substances with antioxidant capacity have been evaluated in randomized clinical trials (RCTs), their clinical relevance remains uncertain. Therefore, a systematic review was conducted to evaluate the effects of these therapies in COPD. Also, a meta-analysis to evaluate the effects on exacerbations was performed. Nineteen RCTs meet the eligibility criteria and were included in the study. Quantitative analyses were performed using random-effects models. N-acetylcysteine-based interventions were associated with a significant reduction in exacerbation risk (risk ratio 0.80; 95% confidence interval 0.66–0.98), corresponding to a 20% relative reduction. No study reported serious adverse effects. These findings suggest that antioxidant-based strategies may have clinically meaningful benefits in COPD. However, larger, more robust RCTs are required to confirm these results and establish optimal therapeutic strategies.

La apendicitis aguda, es una emergencia quirúrgica en pediatría. Un diagnóstico preciso, apoyado en nuevos biomarcadores podría disminuir las complicaciones asociadas. Objetivo: Valorar la utilidad de biomarcadores en sangre y orina en el diagnóstico de apendicitis aguda en pediatría. Pacientes y Método: Estudio observacional analítico prospectivo de casos y controles, realizado en un centro entre 2019-2022. La población estudiada estuvo compuesta por 160 niños de entre 0 y 15 años, divididos en dos grupos (80 niños con apendicitis aguda y 80 sin apendicitis aguda), que consultaron por dolor abdominal sugestivo de abdomen agudo, evaluados con analítica y ecografía para su diagnóstico. Se evaluaron marcadores en sangre (proteína C reactiva (PCR), índice neutrófilo linfocito (INL), proadrenomedulina (PADM), pentraxina 3 (PTX3), factor de necrosis tumoral alfa (TNF-alfa), interleucina 6 (IL6) y orina (alfa-2-glicoproteina rica en leucina (A2GRL). Se estimaron modelos de regresión logística binaria simple para estudiar su asociación con variables analizadas, estimación de un modelo múltiple con método de entrada paso a paso y consiguiente obtención de OR ajustados y construcción de curvas ROC. Consideramos como significativo un p < 0,05. Resultados: Comparado con controles, el recuento de leucocitos (AUC 0.829), neutrófilos (AUC 0.836) e INL (AUC 0,797) fueron significativamente superiores en el grupo apendicitis (p < 0,001), mientras que la elevación TNF-alfa (AUC 0,959) redujo la predicción de apendicitis, sin diferencias en los otros biomarcadores analizados. Conclusiones: Los valores de leucocitos, neutrófilos, INL y TNF-alfa son los que mejor discriminan apendicitis aguda de otras causas de dolor abdominal.

Obesity is a multifactorial disease whose onset and development are shaped by the individual genetic background. The melanocortin 4 receptor gene (MC4R) is involved in the regulation of food intake and energy expenditure. Some of the single nucleotide polymorphisms (SNPs) of this gene are related to obesity and metabolic risk factors. The present study was undertaken to assess the relationship between three polymorphism SNPs, namely, rs17782313, rs17773430 and rs34114122, and obesity and metabolic risk factors. One hundred seventy-eight children with obesity aged between 7 and 16 years were studied to determine anthropometric variables and biochemical and inflammatory parameters. Our results highlight that metabolic risk factors, especially alterations in carbohydrate metabolism, were related to rs17782313. The presence of the minor C allele in the three variants (C–C–C) was significantly associated with anthropometric measures indicative of obesity, such as the body mass and fat mass indexes, and increased the values of insulinemia to 21.91 µIU/mL with respect to the wild type values. Our study suggests that the C–C–C haplotype of the SNPs rs17782313, rs17773430 and rs34114122 of the MC4R gene potentiates metabolic risk factors at early ages in children with obesity.

Melatonin, the hormone of circadian rhythm regulation, is involved in the modulation of mitochondrial activity through its antioxidant and anti-inflammatory properties. Alteration of circadian rhythms such as sleep is related to obesity and metabolic pathogenesis in adulthood, but studies during childhood are scarce. The present study investigated the association of melatonin with metabolic and inflammatory markers in children with (n = 113) and without obesity (n = 117). Melatonin was measured in saliva four and two hours before bedtime, and after one hour of sleep. Cardiometabolic factors, high sensitivity C-reactive protein, immune markers (monocyte chemoattractant protein-1, plasminogen activator inhibitor-1, tumor necrosis α and interferon-γ), leptin and ghrelin were determined. Sleep duration was recorded by a questionnaire. The melatonin level at 1 h after sleep was found to be increased more than twofold in children with obesity (90.16 (57.16–129.16) pg/mL) compared to controls (29.82 (19.05–61.54) pg/mL, p < 0.001) and was related to fat mass (rho = 0.294, p < 0.001); melatonin levels at 1 h after sleep were inversely correlated with high-density lipoprotein cholesterol. Positive correlation was found with apolipoprotein B, adipokines, high sensitivity C-reactive protein, plasminogen activator inhibitor-1 and tumor necrosis factor-α. Shorter sleep duration and earlier waking times were recorded in children with obesity. In conclusion, melatonin in children with obesity appears to be involved in the global metabolic and inflammatory alteration of this condition.

The aim of this review is to describe adolescent nutritional requirements from a scientific, nutritional, and psychosocial point of view, emphasizing the main risks of malnutrition at this age. Currently, too many teenagers are alone at home and prepare their own meals. The influence of friends replaces parental rules. The habits of adolescents are characterized by a tendency to skip meals, especially breakfast, and, less frequently, the midday meal; to purchase carry-out meals away from home; to consume snacks, especially sweets; to eat at fast food restaurants, almost always with high-calorie content; and to eat fried foods, soft drinks, and sweets. Toxic habits, such as smoking, alcohol, and drugs, interfere with a healthy diet, as well. Physical activity usually decreases during adolescence, particularly in girls. The lack of physical activity is due to a precarious knowledge of the benefits associated with practicing physical activity, low motivation, time constraints, and, in many cases, the lack of adequate facilities. Adolescents interested in a body image in accordance with modern ideals follow restrictive and unbalanced diets without any nutritional basis, which they themselves planned. These behaviors increase the risk of nutritional alterations, such as noncompliance with nutritional requirements, meal pattern irregularities, nutritional problems due to low nutrient intake, and self-esteem issues and frustration. In general, in this age group, there is an increase in protein consumption and salt content, often with a supply of unbalanced nutrients, high-fat diets (35–50% of total calories), and low polyunsaturated/saturated fat ratio. In addition, adolescents consume a low level of complex carbohydrates, fiber, fruits, and vegetables.