Obesity associated risk using Edmonton staging in bariatric surgery

Con una prevalencia de obesidad mórbida del 1,2% en población española, los criterios de indicación para Cirugía Bariátrica (CB) no consideran comorbilidades ni estado funcional. Es necesaria una aproximación diagnóstica capaz de predecir mortalidad y sustentar criterios de priorización terapéutica. Objetivo: Aplicar la propuesta Edmonton como sistema de estadiaje clínico para la clasificación de pacientes en lista de espera de CB. Método: Se recogen datos de 81 pacientes (2011 – 2013), tras protocolo prequirúrgico. Se registra peso, talla, IMC, cintura, determinaciones bioquímicas, TA, presencia de enfermedad hepática, renal, osteoarticular, síndrome apnea-hipopnea del sueño (SAHS) y reflujo gastroesofágico. Se aplica a cada persona la propuesta de estadiaje de Edmonton, con 10 variables. Resultados: 67% mujeres. Edad media: 47 años, 18% con edad inferior a 30 años. IMC medio: 47 (37-67), 90% IMC > de 40. El 34% de los pacientes presentan SHAS y el 25% enfermedad por reflujo. Un 9% asocia IMC > 45, disglucosis- diabetes mellitus y SAHS. Aplicando el modelo de Edmonton, nueve pacientes (11%) se sitúan en el rango de mayor riesgo (estadío 3), 70% en rango de riesgo elevado (estadío 2), y 15 pacientes (18%), están incluidos en la condición de bajo riesgo. Ningún paciente se situaba en estadio 0, sin factores de riesgo asociados a obesidad. Conclusiones: El estadiaje de Edmonton nos aporta información sobre la presencia y extensión de co-mobilidades, que apoye la toma de decisiones terapéuticas. La capacidad predictiva de mortalidad de la propuesta de Edmonton podría ser útil para establecer criterios de priorización quirúrgicaWith a prevalence of Morbid Obesity of 1,2% of the Spanish population, the current criteria for Bariatric Surgery do not classify patients taking into consideration co-morbidities or functional status. We need new staging systems useful in predicting mortality and able to support prioritizing treatments. Aim: Applying Edmonton staging system to patients awaiting Bariatric Surgery. Method: Data collected from 81 patients from 2011- 2013 after pre-surgery protocol. Weight, height, waist, BMI, biochemical parameters and blood pressure are registered. Also taken down are hepatic, renal, osteoarticular diseases, sleep-apnea syndrome and/or gastro-oesophageal reflux, if present. Edmonton staging of ten variables is applied to each patient. Results: 81 patients: 67% women, average age 47y, 18% below 30y. Average BMI of 47, 90% of patients have a BMI >40. 34% of patients show sleep-apnea syndrome and 25% gastro-oesophageal reflux. 9% of the patients have a BMI >45, diabetes mellitus and sleep-apnea syndrome. Applying the Edmonton Staging, nine patients (11%) are in the highest risk range (stage 3), 70% are in the high-risk range (stage 2) and 15 patients (18%) are included in the low-risk range. No patient was found to be in stage 0 without obesity risk factors. Conclusions: The Edmonton staging system provides us with information on presence or extent of co-morbidities that guide decision making in individuals. The mortality- predictive ability of Edmonton proposal could help to assist in determining the urgency of Bariatric Surgery and establish better criteria to prioritize these group of patient

Bone microarchitecture and other body composition parameters in patients with overweight or obesity grouped by glucose metabolism disorders

Introducción: la obesidad y la diabetes mellitus tipo 2 (DM-2) disminuyen el entramado trabecular óseo aun cuando puede coexistir aumento del hueso cortical. Otro hallazgo en común es la presarcopenia/sarcopenia secundaria posiblemente a la insulinorresistencia y el estrés oxidativo. Queda por aclarar si estos cambios dependen fundamentalmente de las alteraciones glucídicas precoces (pre DM-2) o tardías (DM-2 establecida), o más bien estarían vinculadas de forma predominante por el exceso de masa grasa en individuos obesos. Objetivos: evaluar y comparar parámetros de composición corporal (compartimentos óseo, muscular y adiposo-visceral) en pacientes con sobrepeso/obesidad agrupados según presenten o no alteraciones glucídicas. Analizar si existen diferencias comparando FRAX vs. FRAX ajustado a trabecular bone score (TBS) en ambos grupos. Métodos: se incluyeron 16 pacientes con sobrepeso/obesidad. A todos se les realizó evaluación clínica-antropométrica, bioimpedanciometría, absorciometría de rayos X de energía dual o densitometría ósea (DXA) y análisis, y se les agrupó según glucemia en tres grupos: a) normal; b) glucemia basal alterada en ayunas (GBA); y c) DM-2. Para el análisis estadístico empleamos pruebas no paramétricas. Resultados: no se encontraron diferencias estadísticamente significativas en los grupos respecto a microarquitectura ósea, masa muscular o grasa visceral. El grupo GBA mostró el mayor promedio de masa muscular y grasa visceral. Tras reclasificar en solo dos grupos, glucemia normal en el grupo 1 y glucemia alterada en el grupo 2 (GBA y DM-2), encontramos diferencias estadísticamente significativas con detrimento de la microarquitectura ósea trabecular en el grupo 2 (p = 0,031) y cifras de fósforo con niveles inferiores en el grupo 1 (p = 0,42). Conclusiones: en nuestro estudio, la microarquitectura ósea está deteriorada en pacientes con glucemia alterada y obesos. Hacen falta estudios con mayor tamaño muestral para establecer en qué momento se instauran estos cambios en la evolución natural de la diabetesIntroduction: obesity and DM-2 decrease trabecular bone mass even though cortical bone increase may coexist. Another common finding is presarcopenia/sarcopenia, possibly due to insulin resistance and oxidative stress. It remains to be clarified whether these changes depend on either early (prediabetes) or late (established DM) glucidic alterations, or rather they would be linked predominantly by excess fat mass in obese patients Objectives: to evaluate and compare body composition parameters (bone, muscle and adipose-visceral tissues) in overweight/obese patients grouped by whether or not they present glucidic metabolism disorders. Analyze if there are differences between FRAX vs FRAX adjusted to trabecular bone score TBS in both groups. Methods: sixteen overweight/obese patients were included. In all of them clinical-anthropometric evaluation, bioimpedance, DXA and analysis were performed. They were grouped by glycemia as: a) normal; b) impaired fasting glycemia (IFG); and c) DM-2. Non-parametric tests were performed. Results: no statistically significant differences were found among groups regarding bone microarchitecture, muscle mass or visceral fat. The IFG group showed the highest average muscle mass and visceral fat. Then, patients were reclassified in only two groups, normal glycemia in group 1 and altered glycemia in group 2 (IFG and DM-2), and statistically significant differences were found at the expense of lower trabecular bone microarchitecture in group 2 (p = 0.031) and phosphorus lower levels in group 1 (p = 0.042). Conclusions: in our study, the bone microarchitecture is impaired in patients with altered glycemia and obesity. Studies with larger sample size are needed to establish when these changes take place in the natural evolution of diabete

With flowers to La Atkins

Photobook, Flowers, Gardens, Vegetables, Plants, World Photobook Day, International Photobook Day, 2021Anna Atkins nos regaló un fotolibro de algas, maravillosamente azules, que son como flores del mundo subacuático. Este año, para celebrar el Día Internacional del Fotolibro 2021, os proponemos hacer un fotolibro colectivo que será como un ramo de flores para Anna. Se trata de hacer fotos a flores, hierbas, plantas, hierbajos, suculentas, cactus... Las fotos nos van a permitir poner en el ramo lo que más nos guste sin preocuparnos de los problemas que nos daría una pieza floral fresca. Podéis sacar la foto a una flor o planta viva, vuestra o de un jardín público o del campo Podéis fotografiar algo de un herbario o una flor prensada que guardabais dentro de un libro Podéis fotografiar una foto de una flor Podéis sacarle una foto a una flor de plástico Podéis fotografiar un dibujo o una pintura (con motivos florales o vegetales, claro) Podéis fotografiar una planta carnívora (en ayunas o haciendo la digestión) Podéis fotografiar flores del mal o del "buenri" Siempre que sea vegetal y/o floral entrará en este libro ramo para Anna. ¡Queremos tanto a Anna! Vamos a mandarle flores como para una boda, como para un fiestón, como para una diva de la ópera que no conoce las alergias y le cabe de todo en el camerino, como para la primavera que está comenzando en el Cono Sur. Organizan: Biblioteca de la Facultad de Bellas Artes de la UCM Photobook Club MadridFac. de Bellas Artesunpu

Dieta mediterránea: ¿Patrón alimentario de referencia en población infantil?

Tesis doctoral inédita leida en la Universidad Autónoma de Madrid. Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 19 de Diciembre de 200

Characterization of High Grade Intraepithelial Cervical Lesion among Adolescents and Young Women

<strong>Introduction:</strong> considering the relationship between human papilomavirus and cervical cancer, the current increase in sexually transmitted diseases constitutes the biggest threaten to adolescents’ health. <strong><br />Objective:</strong> to characterize high-degree intraepithelial cervical lesion in adolescents and young women. <br /><strong>Method: </strong>a descriptive and observational study was conducted. It included 52 patients, all of them younger than 24 years old, who had been diagnosed with high-degree cervical pathology and were treated in the cervix pathology consultation of the "Ramón González Coro" Teaching Gynecologic and Obstetric Hospital from January 2007 to December 2008. Risk factors and diagnosis variables were studied and processed using the SPSS 11.5 system for Windows, through the determination of absolute and relative frequencies. <br /><strong>Results:</strong> 78,8 % of patients had from 20 to 24 years old, 65,3 % of them began having sexual relationships between 15 and 17 years old, 62,2 % had had 3 or more sexual partners and 67,3 % used no contraceptive method. Cyto- histological correlation was of 100 % for intraepithelial cervical lesion II and III. <strong><br />Conclusion:</strong> the results of the present study compromise us to highlight the need of extended sexual education among young people

Hepatotoxicity with cholestatic pattern secondary to enoxaparin treatment

Treatment with low-molecular-weight heparins is very common in clinical practice. Exceptionally, some patients develop hepatitis within a few days of starting treatment, and rapid discontinuation of the drug is decisive to avoid chronification

Hepatotoxicidad colestásica asociada a tratamiento con enoxaparina

El uso de heparina de bajo peso molecular está muy extendido en la práctica clínica. En muy raras ocasiones, algunos pacientes desarrollan hepatitis pocos días después de haber iniciado el tratamiento, y la inmediata suspensión del mismo resulta determinante a la hora de evitar que esta se cronifique

Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers : a multicenter observational study

Altres ajuts: Primary Care Diabetes Europe (PCDE2019/4).Diabetic foot and lower limb complications are an important cause of morbidity and mortality among persons with diabetes mellitus. Very few studies have been carried out in the primary care settings. The main objective was to assess the prognosis of diabetic foot ulcer (DFU) in patients from primary care centers in Catalonia, Spain, during a 12-month follow-up period. We included participants with type 2 diabetes and a new DFU between February 2018 and July 2019. We estimated the incidence of mortality, amputations, recurrence and healing of DFU during the follow-up period. A multivariable analysis was performed to assess the association of these outcomes and risk factors. During the follow-up period, 9.7% of participants died, 12.1% required amputation, 29.2% had a DFU recurrence, and 73.8% healed. Having a caregiver, ischemia or infection were associated with higher mortality risk (hazard ratio [HR]:3.63, 95% confidence interval [CI]:1.05; 12.61, HR: 6.41, 95%CI: 2.25; 18.30, HR: 3.06, 95%CI: 1.05; 8.94, respectively). Diabetic retinopathy was an independent risk factor for amputation events (HR: 3.39, 95%CI: 1.37; 8.39). Increasing age decreased the risk for a DFU recurrence, while having a caregiver increased the risk for this event (HR: 0.97, 95%CI: 0.94; 0.99). The need for a caregiver and infection decreased the probability of DFU healing (HR: 0.57, 95%CI: 0.39; 0.83, HR: 0.64, 95%CI: 0.42; 0.98, respectively). High scores for PEDIS (≥7) or SINBAD (≥3) were associated with an increased risk for DFU recurrence and a lower probability of DFU healing, respectively. We observed high morbidity among subjects with a new DFU in our primary healthcare facilities. Peripheral arterial disease, infection, and microvascular complications increased the risk of poor clinical outcomes among subjects with DFU. The online version contains supplementary material available at 10.1186/s13047-023-00602-6