125 research outputs found
Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies
This independent research and
manuscript writing and editing activities were
funded by unconditional grant from Angelini
Pharma Espan˜a SLU. Angelini Pharma Espan˜a
SLU also funded the journal’s rapid service fee.The authors thank Isabel San Andre´s (Incimed,
Madrid, Spain) for performing the literature
searchThis
article is based on previously conducted studies
and does not contain any new studies with
human participants or animals performed by
any of the authors.Introduction To assess the risk of occurrence and potential determinants of metabolic disorders in adult patients treated with second-generation antipsychotics (SGAs) under real-world practice conditions. Methods MEDLINE, EMBASE, and PsycInfo were searched in July 2019 from database inception. We included population-based, longitudinal, comparative studies that report the results of the outcomes of interest for adult participants, including diabetes, ketoacidosis, hyperosmolar hyperglycemic state, weight gain/obesity, dyslipidemia, hypertension, and metabolic syndrome. Two reviewers independently extracted data on the study design, study quality, and study outcomes. Results We included 40 studies. Most studies showed that clozapine and olanzapine were associated with an increased likelihood of developing diabetes, while the results for risperidone and quetiapine were mixed. Although less well studied, ziprasidone and aripiprazole appeared to not be associated with the occurrence of diabetes. Information on antipsychotic-induced weight gain/obesity is extremely scarce. Regarding dyslipidemia, aripiprazole was not associated with an increased likelihood of developing dyslipidemia, clozapine was associated with an increased likelihood of developing dyslipidemia, and risperidone, olanzapine, quetiapine, and ziprasidone showed mixed results. Two studies suggested an association between ziprasidone and the occurrence of hypertension. Several studies found that the occurrence of a metabolic disorder acted as a risk factor for the development of other metabolic disorders. We did not find information on brexpiprazole, cariprazine, or lurasidone, and data on any long-acting SGA were lacking. Conclusion Although there are relevant differences among SGAs concerning the risk of metabolic disorders, it appears that none of the SGAs included in our review are fully devoid of these disturbances.Angelini Pharma Espana SL
Do Bilateral Pleural Effusions Always Have the Same Cause?
A 67-year-old man with a history of seropositive rheumatoid arthritis (RA) was admitted to the Internal Medicine ward for bilateral pleural effusion. Two years before this episode, coinciding with an exacerbation of the RA, he was incidentally diagnosed with asymptomatic left pleural effusion compatible with rheumatoid exudate, which was resolved with a tube thoracostomy. Three weeks before admission, the patient developed asthenia, orthopnoea and progressive dyspnoea. A chest x-ray revealed bilateral pleural effusion occupying the lower third of the left hemithorax and a smaller portion of the right hemithorax along with marked elevation of N-terminal fragment of pro-brain natriuretic peptide levels. The patient was admitted with a diagnosis of left-sided heart failure. Transthoracic echocardiography and cardiac catheterization confirmed the existence of ischaemic cardiomyopathy. After 2 days of diuretic treatment, the right pleural effusion resolved, but the left effusion persisted. A needle thoracentesis was performed, draining 800 ml of milky fluid compatible with rheumatoid pseudochylothorax
Clinical and epidemiologic characteristics of hospitalized oncological patients with hypercalcemia: a longitudinal, multicenter study
Background There are few studies that have analyzed the characteristics of hypercalcemia in hospitalized oncological patients. Our objectives were to describe the clinical characteristics of hospitalized patients with paraneoplastic hypercalcemia and to identify prognostic variables for mortality. Methods This was an observational, longitudinal, retrospective, and bicentric study. It included adult patients admitted to two hospitals in Málaga, Spain (2014–2018). The minimum follow-up period was 2 years or until death. Results A total of 154 patients were included; the majority (71.4%) were admitted to the internal medicine department. The median follow-up was 3.5 weeks (interquartile range [IQR] 1.1–11.5). The mean (standard deviation) age was 67.6 (12.3) years, with a predominance of males (58.4%). The median (IQR) serum calcium at admission was 13.2 (11.8–14.6) mg/dl. The most common neoplasms were pulmonary (27.3%), hematologic (23.4%), urological (13%), and breast (12.3%). Furthermore, 56.5% of cases had a known history of neoplasia at the time of diagnosis. The parathyroid hormone (PTH) level was determined in 24%; of these, 10.8% had elevated levels. In all, 95.5% of patients died during follow-up. The median survival was 3.4 weeks (95% confidence interval 2.6–4.3). Factors associated with higher mortality were age, serum calcium at admission, previous history of neoplasia, etiology other than multiple myeloma, and noncorrection of hypercalcemia. Conclusions In hospitalized patients, paraneoplastic hypercalcemia was associated with high short-term mortality. Several factors associated with a worse prognosis were identified in these patients.Funding for open access charge: Universidad de Málaga / CBU
Reacción leucemoide por cáncer de cabeza y cuello. A propósito de un caso
The leukemoid reaction is defined as a count of mature leukocytes greater than 50 x 109 cells/L. It is described a rare case of leukemoid reaction presented as paraneoplastic manifestation associated with epidermoid head and neck cancer, and which has been diagnosed after excluding other causes, and which implies a worse prognosis of the disease. The production mechanism is unknown although the current theories point to the production of stimulatory cytokines in the bone marrow.La reacción leucemoide se define como un recuento de leucocitos maduros superior a 50 x 109 células/L. Describimos un caso poco frecuente de reacción leucemoide como manifestación paraneoplásica asociada a cáncer epidermoide de cabeza y cuello, diagnosticada al excluir otras causas y que conlleva un peor pronóstico de la enfermedad. El mecanismo de producción es desconocido, aunque las teorías actuales apuntan a la producción de citocinas estimulantes de la médula ósea
Pericarditis purulenta por Staphylococcus aureus sin foco en paciente con neoplasia pancreática
We present the case of a patient with a short-term fever and dyspnea, diagnosed with purulent pericarditis with bacteremia associated with Staphylococcus aureus, and no primary infectious focus found. As a casual finding, a pancreatic neoplasm was detected. After undergoing surgery, he developed hemodynamic instability and poor evolution despite intensive measures and died during the postoperative period.Presentamos el caso de un varón con cuadro febril y disnea de corta duración, diagnosticado de pericarditis purulenta con bacteriemia asociada por Staphylococcus aureus, en el que no se encontró foco primario infeccioso. Como hallazgo casual, se le diagnosticó de neoplasia pancreática. Tras someterse a intervención quirúrgica, comenzó con inestabilidad hemodinámica y mala evolución a pesar de las medidas intensivas, y falleció durante el posoperatorio
Relationship between quadriceps femoris echotexture biomarkers and muscle strength and physical function in older adults with heart failure with preserved ejection fraction
Background: Muscle wasting is pronounced in patients with heart failure with preserved ejection fraction
(HFpEF). The quadriceps femoris echotexture biomarkers assessed by ultrasound (US) have not been studied in
these patients.
Objective: To describe echotexture biomarkers assessed by the US and to assess their relationship with sex, age,
body mass index (BMI), self-reported outcomes, muscle strength and physical function in older adults with
HFpEF.
Methods: A cross-sectional study was conducted. Patients 70 years and older with HFpEF were included. The sex,
age, BMI, and self-reported outcomes were collected. The US assessed muscle and subcutaneous fat tissue
contrast, correlation, energy, homogeneity, and entropy at rest and maximal voluntary isometrical contraction
(MVIC). The six-minute walk test (6MWT), the short physical performance battery (SPPB), the timed up and go
test (TUG), the usual pace gait speed test (UGS), and the fast pace gait speed test (FGS) were used to assess
physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant
Pearson correlations and subsequent multivariate linear regression analyses were conducted.
Results: Seventy-two older adults with HFpEF [81.06 years, 29.13 BMI, and 55.60% females] were recruited. In
women, relaxed and MVIC muscle energy and entropy explained 35.40% of the TUG variance; relaxed muscle
entropy and MVIC muscle energy shared 24.00% of the UGS variance; relaxed and MVIC muscle entropy, MVIC
muscle contrast and MVIC muscle energy explained 32.60% of the FGS variance, adjusted all the models by age
and BMI.Funding for open access charge: Universidad de málaga /CBU
Conferencia de consenso: tratamiento de la diabetes tipo 2 en el paciente anciano
El tratamiento de la diabetes tipo 2 en el anciano representa un importante reto tanto desde el punto de vista clínico como del de la salud pública. El envejecimiento poblacional está condicionando un marcado incremento de la pandemia de diabetes en las personas de edad avanzada. Sin embargo, existen pocas evidencias científicas que apoyen el tratamiento más adecuado de la diabetes en los ancianos. Dada la gran heterogeneidad de la población anciana, que incluye a sujetos con muy diferente capacidad funcional y cognitiva, diversa comorbilidad y con muy diferente expectativa de vida, resulta crucial realizar una valoración global del anciano desde una perspectiva biopsicosocial y abordar integralmente los factores de riesgo vascular, planteando unos objetivos personalizados de control glucémico. En ancianos frágiles o con corta expectativa de vida puede ser razonable mantener un objetivo de HbA1c de 7,6-8,5%. La estrategia terapéutica en el anciano con diabetes tipo 2 debe individualizarse y consensuarse con el paciente y sus cuidadores, en función del objetivo planteado. Mejorar la calidad de vida, preservar la seguridad del paciente y evitar los efectos adversos del tratamiento antidiabético deben ser objetivos básicos. Dada la mayor predisposición de los ancianos a las hipoglucemias y sus graves consecuencias en esta población, deberían priorizarse las terapias antidiabéticas que minimicen el riesgo de episodios hipoglucémicos
Inverse relation between FASN expression in human adipose tissue and the insulin resistance level
<p>Abstract</p> <p>Background</p> <p>Adipose tissue is a key regulator of energy balance playing an active role in lipid storage and may be a dynamic buffer to control fatty acid flux. Just like PPARγ, fatty acid synthesis enzymes such as FASN have been implicated in almost all aspects of human metabolic alterations such as obesity, insulin resistance or dyslipemia. The aim of this work is to investigate how FASN and PPARγ expression in human adipose tissue is related to carbohydrate metabolism dysfunction and obesity.</p> <p>Methods</p> <p>The study included eighty-seven patients which were classified according to their BMI and to their glycaemia levels in order to study FASN and PPARγ gene expression levels, anthropometric and biochemical variables.</p> <p>Results</p> <p>The main result of this work is the close relation between FASN expression level and the factors that lead to hyperglycemic state (increased values of glucose levels, HOMA-IR, HbA1c, BMI and triglycerides). The correlation of the enzyme with these parameters is inversely proportional. On the other hand, PPARγ is not related to carbohydrate metabolism.</p> <p>Conclusions</p> <p>We can demonstrate that FASN expression is a good candidate to study the pathophysiology of type II diabetes and obesity in humans.</p
Correction to : Cost Analysis of FreeStyle Libre ® 2 System in Type 2 Diabetes Mellitus Population
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