Canvis antropomètrics i bioquímics en l'obesitat mòrbida després de la cirurgia bariàtrica: influència de les comorbiditats

[cat] INTRODUCCIÓ: Actualment el bypass gàstric en Y-de-Roux és la tècnica més freqüent portada a terme en l’àmbit internacional en què, en ser de tipus mixta, es produeix una combinació dels elements restrictius i de malabsorció. OBJECTIUS: Hem analitzat un total de 34 pacients amb obesitat mòrbida (presentaven una mitjana d’IMC de 48,8 kg/m2) i observem els canvis que es produeixen a nivell plasmàtic i d’evolució de comorbiditats en períodes curts de temps (1M, 3M, 6M) fins a 1 any. Al mateix temps, hem pogut estudiar si la presència de les comorbiditats (dislipèmia i diabetis mellitus tipus 2) influencia en els efectes de la cirurgia, respecte als que no les presentaven. Això ens permetrà, junt amb els factors predictius, definir el perfil dels nostres candidats a cirurgia bariàtrica i intentar treure els màxims beneficis de la cirurgia aplicada. RESULTATS: En general, els nostres pacients, abans d’operar-se, presenten hipertensió arterial, resistència a la insulina, un perfil aterogènic no elevat (valors d’hipertrigliceridèmia i hipercolesterolèmia de grau lleu) i esteatosi hepàtica. Els nostres pacients perden, en només 1 mes després de la cirurgia, 15 kg, i passat 12 mesos perden un total de 48 kg (un 37 % del pes inicial). Hem vist que els pacients que no presenten comorbiditats pesen més i, alhora, perden més pes, després de la cirurgia; per tant, podríem dir, que són més eficients a nivell metabòlic, tot i que ambdós grups (amb comorbiditats i sense) presenten un descens progressiu d’aquests paràmetres (IMC, pes, excés de pes). Observem una reducció més retardada en el greix visceral que en el greix subcutani, tot i que la reducció del teixit visceral és més marcada al final del període estudiat, però entre la presència o no de comorbiditats no observem canvis a nivell de tipus de teixit adipós. Molt abans de la pèrdua de pes, ja s’observa una millora en l’homeòstasi de la glucosa, i hem pogut comprovar que la cirurgia bariàtrica és molt efectiva en la resolució de la diabetis tipus 2. Respecte al perfil lipídic aterogènic, trobem que al final del període estudiat hi ha una reducció significativa del 40% dels triacilglicèrids, del 20% del colesterol total, i que aquesta és deguda a una reducció del 30% del colesterol de VLDL i del d’LDL. Les importants reduccions en greix en el primer mes van acompanyades de l’elevació dels NEFA plasmàtics i d’un augment dels cossos cetònics, a causa dels canvis en el metabolisme lipídic. A nivell plasmàtic, en els pacients obesos amb comorbiditats s’observa més activitat HL i LPL tant en el moment basal com als 12 mesos postcirurgia. Aquest subgrup amb comorbiditats és el que continua tenint també més triacilglicèrids en plasma. Les proteïnes de fase aguda (PAI-1 i la CRP) disminueixen d’una manera molt espectacular en els nostres pacients al cap dels 12 mesos estudiats. Per tant, trobem una millora a nivell inflamatori, que també influiria en la reducció de la resolució de la resistència a la insulina a llarg termini. Pel que fa a les hormones reguladores de la ingesta, la leptina es correlaciona positivament amb l’IMC, mentre que la grelina i l’adiponectina ho fan negativament amb l’IMC. Podríem considera com a paràmetres predictius positius sobre la pèrdua de pes un alt nombre en el recompte d’hematies o una alta concentració d’insulina o de cortisol basal podrien influir en l’increment de la pèrdua de pes; en canvi la concentració de glucosa, la d’ALT, la de CRP i la presència de comorbiditats tindrien un efecte negatiu en la pèrdua de pes. En conclusió, al cap d’un any de la cirurgia, independentment de les comorbiditats i de les diferències que hem vist a nivell de composició corporal i alteració metabòlica, els nostres pacients recuperen els valors normals en la majoria de les magnituds i paràmetres bioquímics estudiats.[eng] INTRODUCTION The purpose of this study was to evaluate the effect of weight loss induced in morbidly obese subjects by Roux-en-Y gastric bypass bariatric surgery (restrictive mildly malabsortiptive surgery) on the plasma parameters and anthropometric features. METHODS Thirty-four morbidly obese patients were divided by the absence or presence of comorbidities (dyslipidemic and type 2 diabetes). We have studied various plasma parameters and anthropometric features before and after gastric bypass. RESULTS The loss of body weight was already significant at 1 month after surgery and weight loss continued until it reached 37% after 1 year. The bariatric surgery procedure to reduce body weigh had a greatly improve lipid profile and decreased resistance to insulin at 1 year after surgery (during the first month after surgery most of our patients left the treatment for diabetes). The plasma parameters from patients showed a sharp decrease in leptin, CRP and PAI-1. Adiponectin and ghrelin levels show increase trends during weight loss. The group with comorbidities tends to have lower values than the other two groups for anthropometric parameters. Lipid parameters showed significant differences among groups, except for phospholipids and NEFA. For insulin resistance parameters, only glucose was higher in comorbidities group patients, but not insulin or homeostasis model assessment of insulin resistance (HOMA-IR). A high number of erythrocytes, high concentration of insulin or basal cortisol are predictive factors correlates positively with absolute weight loss and glucose concentration, alanine aminostransferase concentration, CRP and comorbidities presence are correlates negatively with absolute weight loss. CONCLUSIONS Our data indicate that the significant weight loss induced by bariatric surgery ameliorates insulin sensibility, atherogenicity of plasma lipoproteins, acute phase protein (CRP, PAI-1) and improves non alcoholic fatty liver disease. All parameters mentioned above improved very significantly by surgery, independent of the occurrence of comorbidities

A new era for Advances in Laboratory Medicine

Journal Citation Reports; PubMed; Impact factorInformes de citas de revistas; PubMed; Factor de impactoInformes de cites de revistes; PubMed; Factor d'impact

Delivery Systems in Ocular Retinopathies: The Promising Future of Intravitreal Hydrogels as Sustained-Release Scaffolds

Delivery systems; Hydrogels; RetinopathiesSistemes de lliurament; Hidrogels; RetinopatiesSistemas de liberación; Hidrogeles; RetinopatíasSlow-release delivery systems are needed to ensure long-term sustained treatments for retinal diseases such as age-related macular degeneration and diabetic retinopathy, which are currently treated with anti-angiogenic agents that require frequent intraocular injections. These can cause serious co-morbidities for the patients and are far from providing the adequate drug/protein release rates and required pharmacokinetics to sustain prolonged efficacy. This review focuses on the use of hydrogels, particularly on temperature-responsive hydrogels as delivery vehicles for the intravitreal injection of retinal therapies, their advantages and disadvantages for intraocular administration, and the current advances in their use to treat retinal diseases.This research was partially funded by ANID FONDECYT Regular (Chile) through project Nº 1210476 (granted to E.D.-L.). D.R. is recipient of a PTA fellowship from the Agencia Estatal de Investigación, Ministerio de Ciencia e Innovación, Spain. S.J.C. receives financial support from the Helmut Ecker Foundation

Pre-analytical and analytical procedures to avoid loss of vitamin C. Comment on: “COVID-19: up to 82% critically ill patients had low vitamin C values”

COVID-19; Vitamin CCOVID-19; Vitamina CCOVID-19; Vitamina

Performance evaluation of a point of care cartridge of the new GEM Premier ChemSTAT analyzer

Acute kidney injury; Creatinine; Point-of-careLesión renal aguda; Creatinina; Punto de atenciónLesió renal aguda; Creatinina; Punt d'atencióBackground and aims GEM Premier ChemSTAT is a new point-of-care system providing rapid creatinine, BUN and tCO2 measurements together with electrolytes, metabolites, hematocrit, pH and pCO2 from a single whole blood specimen in acute care settings such as emergency departments and intensive care units. Accurate measurements of whole blood creatinine can aid in the diagnosis and treatment of renal diseases. Materials and methods Heparinized whole blood samples from different clinical locations were evaluated on the GEM Premier ChemSTAT and results compared to plasma from the same samples on the Beckman AU5800 or whole blood on the GEM Premier 4000. Precision studies were conducted with whole blood and quality control material. Results ChemSTAT correlated well with plasma samples on the AU5800 (regression slopes (S): 0.957–1.159, correlation coefficients (r)≥0.952) and with whole blood specimens on the GEM Premier 4000 (S: 0.9646–1.124, r ≥ 0.974). The repeatability was 0.1%–3.1% and QC precision were within lab and manufacturers’ specifications. Conclusion ChemSTAT demonstrated strong correlation to the comparative methods and excellent precision. Combining with its continuous quality management, ChemSTAT is suitable for acute care settings to provide rapid, reliable results, which could minimize time-to-treatment and improve patient outcome

Recommendations for the measurement of sexual steroids in clinical practice. A position statement of SEQCML/SEEN/SEEP

Immunoassay; Sexual steroids; TestosteroneImmunoassaig; Esteroides sexuals; TestosteronaInmunoensayo; Esteroides sexuales; TestosteronaThe proper clinical approach to a wide range of disorders relies on the availability of accurate, reproducible laboratory results for sexual steroids measured using methods with a high specificity and sensitivity. The chemiluminescent immunoassays currently available have analytical limitations with significant clinical implications. This position statement reviews the current limitations of laboratory techniques for the measurement of estradiol and testosterone and their impact on diverse clinical scenarios. A set of recommendations are provided to incorporate steroid hormone analysis by mass spectrometry in national health systems. International societies have recommended this methodology for a decade

Metabolic fingerprint of acromegaly and its potential usefulness in clinical practice

Acromegaly; Metabolomics; Amino acidsAcromegalia; Metabolómica; AminoácidosAcromegàlia; Metabolòmica; AminoàcidsInsulin-like growth factor-1 (IGF-1) and growth hormone (GH) levels are the main targets for monitoring acromegaly activity, but they are not in close relationship with the clinical course of the disease and the associated comorbidities. The present study was aimed at identifying metabolites that could be used as biomarkers for a better disease phenotyping. For this purpose, metabolic fingerprint using an untargeted metabolomic approach was examined in serum from 30 patients with acromegaly and 30 age-matched controls. Patients with acromegaly presented fewer branched-chain amino acids (BCAAs) compared to the control group (valine: 4.75 ± 0.87 vs. 5.20 ± 1.06 arbitrary units (AUs), p < 0.05; isoleucine: 2.54 ± 0.41 vs. 2.80 ± 0.51 AUs; p < 0.05). BCAAs were also lower in patients with active disease compared to patients with normal levels of IGF-1 with or without medical treatment. GH, but not IGF-1, serum levels were inversely correlated with both valine and isoleucine. These findings indicate that low levels of BCAAs represent the main metabolic fingerprint of acromegaly and that GH, rather than IGF-1, might be the primary mediator. In addition, our results suggest that the assessment of BCAAs could help to identify active disease and to monitor the response to therapeutic strategies.This research was funded by Pfizer Global Investigator Initiated Research. J.P.C. and R.M.L. are funded by Junta de Andalucía (CTS-1406, BIO-0139), Ministerio de Ciencia, Innovación y Universidades (BFU2016-80360-R), and Instituto de Salud Carlos III, co-funded by European Union (ERDF/ESF, “Investing in your future”: PI16/00264, CP15/00156 and CIBERobn). CIBER is an initiative of Instituto de Salud Carlos III

Cortisol Response to Stress in Adults with Attention Deficit Hyperactivity Disorder

Differences in the cortisol response have been reported between children exhibiting the inattentive and hyperactive/impulsive subtypes of attention deficit hyperactivity disorder. However, there is no such information about adults. The aim of the present study was to determine the possible differences between the combined and inattentive subtypes in the cortisol response to stress. Ninety-six adults with attention deficit hyperactivity disorder, 38 inattentive and 58 combined, without any medical or psychiatric comorbidities and 25 healthy controls were included. The Trier Social Stress Test was used to assess physiological stress responses. Clinical data and subjective stress levels, including the Perceived Stress Scale, were also recorded. No significant differences in the cortisol response to the Trier Social Stress Test were found between patients and controls. However, albeit there were no basal differences, lower cortisol levels at 15 (P =.015), 30 (P=. 015), and 45 minutes (P=. 045) were observed in the combined compared with the inattentive subtype after the stress induction; these differences disappeared 60 minutes after the stress. In contrast, the subjective stress responses showed significant differences between attention deficit hyperactivity disorder patients and controls (P <.001), but no differences were seen between attention deficit hyperactivity disorder subtypes. In turn, subjective stress measures, such as the Perceived Stress Scale, positively correlated with the whole cortisol stress response (P <.027). Both the combined and inattentive attention deficit hyperactivity disorder adults exhibited a normal cortisol response to stress when challenged. Nevertheless, the inattentive patients displayed a higher level of cortisol after stress compared with the combined patients. Despite the differences in the cortisol response, adults with attention deficit hyperactivity disorder reported high levels of subjective stress in their every-day lif

Biomarkers and clinical scores to aid the identification of disease severity and intensive care requirement following activation of an in-hospital sepsis code

Few validated biomarker or clinical score combinations exist which can discriminate between cases of infection and other non-infectious conditions following activation of an in-hospital sepsis code, as well as provide an accurate severity assessment of the corresponding host response. This study aimed to identify suitable blood biomarker (MR-proADM, PCT, CRP and lactate) or clinical score (SOFA and APACHE II) combinations to address this unmet clinical need. A prospective, observational study of patients activating the Vall d'Hebron University Hospital sepsis code (ISC) within the emergency department (ED), hospital wards and intensive care unit (ICU). Area under the receiver operating characteristic (AUROC) curves, logistic and Cox regression analysis were used to assess performance. 148 patients fulfilled the Vall d'Hebron ISC criteria, of which 130 (87.8%) were retrospectively found to have a confirmed diagnosis of infection. Both PCT and MR-proADM had a moderate-to-high performance in discriminating between infected and non-infected patients following ISC activation, although the optimal PCT cut-off varied significantly across departments. Similarly, MR-proADM and SOFA performed well in predicting 28- and 90-day mortality within the total infected patient population, as well as within patients presenting with a community-acquired infection or following a medical emergency or prior surgical procedure. Importantly, MR-proADM also showed a high association with the requirement for ICU admission after ED presentation [OR (95% CI) 8.18 (1.75-28.33)] or during treatment on the ward [OR (95% CI) 3.64 (1.43-9.29)], although the predictive performance of all biomarkers and clinical scores diminished between both settings. Results suggest that the individual use of PCT and MR-proADM might help to accurately identify patients with infection and assess the overall severity of the host response, respectively. In addition, the use of MR-proADM could accurately identify patients requiring admission onto the ICU, irrespective of whether patients presented to the ED or were undergoing treatment on the ward. Initial measurement of both biomarkers might therefore facilitate early treatment strategies following activation of an in-hospital sepsis code