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

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

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

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

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

Diabetes tipo 2 en paciente anciano

Diabetes mellitus (DM) is the fifth more frequent disease in the elder, after degenerative osteoarthritis, arterial hypertension, cataracts and cardiovascular diseases. The number of elders with DM is growing because of the increase of life expectation and higher prevalence of DM in this population. Let's sense beforehand a habitual case in our clinical practice, an 82-year-old woman with long term DM dates with important comorbidity associated that presents cardiac decompensation secondary to urine infection and diabetic decompensation. We detail the management we followed in this case.La diabetes mellitus (DM) es la quinta enfermedad más frecuente en el anciano, tras la artrosis, la hipertensión arterial, las cataratas y las enfermedades cardiovasculares. El número de ancianos con DM está creciendo por el aumento de la expectativa de vida y la mayor prevalencia de DM en esta población. Presentamos un caso habitual en nuestra práctica clínica, una mujer de 82 años diabética de larga data con importante comorbilidad asociada, que presenta un cuadro de descompensación cardíaca secundaria a una infección de orina y descompensación glucémica; y detallamos el manejo de la misma