Estudio prospectivo de la historia natural de las roturas de manguito en nuestra población envejecida

6 páginas.Trabajo Fin de Máster Universitario en Patología del Hombro (2014/15). Tutor: Dr. Antonio Pablo Rosales Varo. Introducción. Mientras que la reparación quirúrgica de los desgarros del manguito en el adulto joven y activo es una opción terapéutica ampliamente aceptada, sorprende la poca evidencia que existe para poder guiarnos en el tratamiento de estas lesiones en los pacientes ancianos. Justificación. Si queremos justificar el por qué estudiar las lesiones de manguito, encontramos dos razones claras y contundentes: A) Es un problema común, con una prevalencia que aumenta con la edad. B) Es un problema que está consumiendo muchos recursos de la sanidad. Objetivo. El objetivo de este estudio es el conocer lo que en verdad conseguimos en nuestra cirugía y el saber como somos de eficaces en nuestra gestión de la enfermedad del manguito rotador en la población mayor a 60 años y si es o no la rerotura una contraindicación formal en estos pacientes. Identificar los parámetros predictores del tratamiento quirúrgico de las lesiones sintomáticas del manguito en los pacientes mayores de 65 años. Comparar los resultados del tratamiento quirúrgico versus conservador en las lesiones del manguito en esta población. Material y métodos. 100 casos recogidos durante un período de un año. Estudio prospectivo randomizado de pacientes con lesiones sintomáticas del manguito de los rotadores. Tras un estudio clínico y Rx que incluye: valoración de la escala de Costant de ambos hombros, SF-36; dos proyecciones Rx y RNM. Los sujetos serán divididos al azar en dos grupos: uno primero que se le proporcionará una pauta de rehabilitación y un segundo grupo será intervenido quirúrgicamente mediante cirugía abierta

Type 2 diabetes and the surgical treatment

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Localized JNK signaling regulates organ size during development.

A fundamental question of biology is what determines organ size. Despite demonstrations that factors within organs determine their sizes, intrinsic size control mechanisms remain elusive. Here we show that Drosophila wing size is regulated by JNK signaling during development. JNK is active in a stripe along the center of developing wings, and modulating JNK signaling within this stripe changes organ size. This JNK stripe influences proliferation in a non-canonical, Jun-independent manner by inhibiting the Hippo pathway. Localized JNK activity is established by Hedgehog signaling, where Ci elevates dTRAF1 expression. As the dTRAF1 homolog, TRAF4, is amplified in numerous cancers, these findings provide a new mechanism for how the Hedgehog pathway could contribute to tumorigenesis, and, more importantly, provides a new strategy for cancer therapies. Finally, modulation of JNK signaling centers in developing antennae and legs changes their sizes, suggesting a more generalizable role for JNK signaling in developmental organ size control

Does bariatric surgery cure the metabolic syndrome?

Metabolic syndrome (MS) is a risk condition for the development of systemic atherosclerotic disease. Morbid obesity is a state of insulin resistance (IR) associated with visceral fat accumulation, which is involved in the development of MS. In severe obesity, conservative therapies promote an improvement of MS, but weight regain is frequent, whereas bariatric surgery promotes a more significant and sustained weight loss. Bariatric surgery is recommended for patients with unsatisfactory response to clinical treatment and with IMC > 40 kg/m² or > 35 in case of co-morbidities. In those cases, surgical risk must be acceptable and patients submitted to surgery must be informed about complications and postoperative care. Prevention, improvement and reversion of diabetes (DM2) (70 to 90% of cases) are seen in several bariatric surgery modalities. Disabsorptive are more efficient than restrictive procedures in terms of weight reduction and insulin sensitivity improvement, but chronic complications, such as malnutrition, are also more frequent. Vertical gastroplasty with jejunoileal derivation is a mixed surgery in which the restrictive component predominates. In this modality, reversion of DM2 is due to an increase in insulin sensitivity associated with improved beta cell function. Reversion of MS and its manifestations after bariatric surgery are associated with reduction of cardiovascular mortality and, thus, in severe obesity cases, MS can be considered a surgical condition.A síndrome metabólica (SM) é uma condição de risco para o desenvolvimento de doença aterosclerótica sistêmica. A obesidade mórbida é um estado de resistência à insulina associado a excesso de gordura visceral, condições que contribuem para o desenvolvimento da SM. Na obesidade grave, os tratamentos conservadores promovem melhora da SM, mas a recuperação do peso é freqüente, enquanto a cirurgia bariátrica promove perda mais significativa e sustentada de peso. Esta é recomendada a pacientes com resposta insatisfatória ao tratamento clínico e com IMC > 40 kg/m², ou > 35 nos casos de co-morbidades passíveis de reversão com o emagrecimento. Recomenda-se que risco cirúrgico seja aceitável e que os pacientes submetidos à cirurgia tenham conhecimento das complicações e saibam dos cuidados pós-operatórios. Prevenção, melhora e reversão do diabetes (DM2) (entre 70 e 90% dos casos) são observados nas diversas modalidades cirúrgicas bariátricas. Os procedimentos disabsortivos são mais eficazes que os restritivos na redução do peso e na melhora da sensibilidade à insulina, mas as complicações crônicas, em especial a desnutrição, são também mais freqüentes. A gastroplastia vertical com derivação jejuno-ileal é conhecida como mista com predominância do componente restritivo sobre o disabsortivo. Nesta modalidade, reversão do DM2 deve-se a um aumento da sensibilidade à insulina associado a uma melhora da função de célula beta. A reversão da SM e de suas manifestações pós-cirurgia bariátrica associa-se à redução da mortalidade cardiovascular e, assim, nos casos graves de obesidade, a SM pode ser considerada uma condição cirúrgica.40040

Obesity-related glomerulopathy: Current approaches and future perspectives

Obesity-related glomerulopathy (ORG) is a silent comorbidity which is increasing inincidence as the obesity epidemic escalates. ORG is associated with serious healthconsequences including chronic kidney disease, end-stage renal disease (ESRD), andincreased mortality. Although the pathogenic mechanisms involved in the develop-ment of ORG are not fully understood, glomerular hemodynamic changes, renin-angiotensin-aldosterone system (RAAS) overactivation, insulin-resistance, inflamma-tion and ectopic lipid accumulation seem to play a major role. Despite albuminuriabeing commonly used for the non-invasive evaluation of ORG, promising biomarkersof early kidney injury that are emerging, as well as new approaches with proteomicsand metabolomics, might permit an earlier diagnosis of this disease. In addition, theassessment of ectopic kidney fat by renal imaging could be a useful tool to detectand evaluate the progression of ORG. Weight loss interventions appear to be effec-tive in ORG, although large-scale trials are needed. RAAS blockade has a ren-oprotective effect in patients with ORG, but even so, a significant proportion ofpatients with ORG will eventually progress to ESRD despite therapeutic efforts. It isnoteworthy that certain antidiabetic agents such as sodium-glucose cotransporter2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) couldbe useful in the treatment of ORG through different pleiotropic effects. In this article,we review current approaches and future perspectives in the care and treatmentof ORGInstitute of Health“Carlos III”(ISCIII), Grant/Award Numbers: JR 19/00054, CM 17/00169,PI20/01559; Funding for open access charge: Universidad de Málaga / CBU

Níveis séricos da proteína carreadora do retinol 4 em mulheres com diferentes níveis de adiposidade e tolerância à glicose

Objective Retinol-binding protein 4 (RBP4) is an adipokine responsible for vitamin A (retinol) transportation. Studies associated RBP4 increased levels with severity of type 2 diabetes mellitus (T2DM) and insulin resistance (IR). The study aimed to quantify RBP4 serum standards in women with a wide range of body mass index (BMI) and glucose tolerance level. Subjects and methods: Cross-sectional study was performed with 139 women divided into three groups: Group 1 (lean-control, n = 45) and Group 2 (obese, n = 53) with normal glucose tolerance and group 3 (obese with T2DM, n = 41), called G1, G2 and G3. Were assessed clinical, biochemical, anthropometric and body composition parameters. Results According to data analysis, we obtained in G1 higher RBP4 levels (104.8 ± 76.8 ng/mL) when compared to G2 (87.9 ± 38 ng/mL) and G3 (72.2 ± 15.6 ng/mL) levels. Also, were found: in G1 positive correlations of RBP4 with BMI (r = 0.253), glycated hemoglobin (r = 0.378) and fasting insulin (r = 0.336); in G2 with glycated hemoglobin (r = 0.489); in G3 with glycated hemoglobin (r = 0.330), fasting glucose (r = 0.463), HOMA-IR (r = 0.481). Conclusions Although RBP4 have shown lower levels in diabetic and obese, a strong correlation with HOMA-IR index highlights that, in our study, there is growing IR when there is an increasing in RBP4 levels587709714COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informaçãoObjetivo A proteína carreadora do retinol 4 (RBP4) é uma adipocina responsável pelo transporte de vitamina A (retinol). Estudos associam os níveis aumentados de RBP4 com a gravidade do diabetes melito tipo 2 (DM2) e resistência à insulina (RI). O objetivo deste estudo foi investigar como esses níveis se comportam em mulheres com ampla variação do índice de massa corporal (IMC) e tolerância à glicose. Sujeitos e métodos: Estudo transversal realizado com 139 mulheres, divididas em três grupos: Grupo 1 (controles-magras; n = 45) e Grupo 2 (obesas; n = 53), com tolerância normal à glicose; Grupo 3 (obesas DM2; n = 41), denominados G1, G2 e G3. Foram avaliados parâmetros clínicos, bioquímicos, antropométricos e composição corporal. Resultados De acordo com a análise dos dados, obtivemos em G1 maiores níveis de RBP4 (104,8 ± 76,8 ng/mL) em comparação ao G2 (87,9 ± 38 ng/mL) e G3 (72,2 ± 15,6 ng/mL). Também foram encontradas correlações positivas entre RBP4 e IMC (r = 0,253), hemoglobina glicada (r = 0,378) e insulinemia de jejum (r = 0,336); em G2 com hemoglobina glicada (r = 0,489); G3 com hemoglobina glicada (r = 0,330), insulinemia de jejum (r = 0,463) e HOMA-IR (r = 0,481). Conclusões Embora a RBP4 tenha apresentado níveis menores em pacientes diabéticas e obesas, a forte correlação com o índice HOMA-IR deixa claro que, em nosso estudo, há crescente RI quando os níveis dessa proteína também são crescente

Modeling of Photovoltaic Cell Using Free Software Application for Training and Design Circuit in Photovoltaic Solar Energy

There are numerous studies that develop the mathematical modeling of photovoltaic cells and verified by software. The model presented is based on an equivalent circuit implemented in free software. Free software used is Quite Universal Circuit Simulator (QUCS). QUCS uses a generic diode for adjust the current and voltage curve (IVcurve) at photovoltaic cell. Additionally, you can use equations to define the model of photovoltaic cell and represent the characteristic curves on the same page. QUCS is a multiplatform application that runs on Windows and Linux, this software is available in Linux distributions for electronics. Using QUCS to model a PV cell allows subcircuit and a real representation to a attractive presentation for teaching. In section 5 show examples of practices used on formation, further can be used on: courses of photovoltaic, online formation or distance learning, because only need download QUCS application, and is a good complement to a previous works on labo¿ ratory or concepts review for theory. Advantage to used QUCS is that allow several PV cells with a few mouse click, also does not needs buy additional PV cells to used on laboratory because can be modelled the PV cell available on laboratory. Further, is not a problem the availability material on laboratory, because the material of PV system can be expensive, then is best provide a good photovoltaic devices that a devices for all student in a class.Pareja Aparicio, M.; Pelegrí Sebastiá, J.; Sogorb Devesa, TC.; Llario Sanjuan, JV. (2013). Modeling of Photovoltaic Cell Using Free Software Application for Training and Design Circuit in Photovoltaic Solar Energy. En New Developments in Renewable Energy. InTech. 121-139. doi:10.5772/51925S12113

Sagittal abdominal diameter as a surrogate marker of insulin resistance in an admixtured population—brazilian metabolic syndrome study (BRAMS)

Sagittal abdominal diameter (SAD) has been proposed as a surrogate marker of insulin resistance (IR). However, the utilization of SAD requires specific validation for each ethnicity. We aimed to investigate the potential use of SAD, compared with classical anthropometrical parameters, as a surrogate marker of IR and to establish the cutoff values of SAD for screening for IR. Methods A multicenter population survey on metabolic disorders was conducted. A race-admixtured sample of 824 adult women was assessed. The anthropometric parameters included: BMI, waist circumference (WC), waist-to-hip ratio and SAD. IR was determined by a hyperglycemic clamp and the HOMA-IR index. Results After adjustments for age and total body fat mass, SAD (r = 0.23 and r = -0.70) and BMI (r = 0.20 and r = -0.71) were strongly correlated with the IR measured by the HOMA-IR index and the clamp, respectively (p < 0.001). In the ROC analysis, the optimal cutoff for SAD in women was 21.0 cm. The women with an increased SAD presented 3.2 (CI 95%: 2.1-5.0) more likelihood of having IR, assessed by the HOMA-IR index compared with those with normal SAD (p < 0.001); whereas women with elevated BMI and WC were 2.1 (95% CI: 1.4-3.3) and 2.8 (95% CI: 1.7-4.5) more likely to have IR (p < 0.001), respectively. No statistically significant results were found for waist-to-hip ratio. Conclusions SAD can be a suitable surrogate marker of IR. Understanding and applying routine and simplified methods is essential because IR is associated with an increased risk of obesity-related diseases even in the presence of normal weight, slight overweight, as well as in obesity. Further prospective analysis will need to verify SAD as a determinant of clinical outcomes, such as type 2 diabetes and cardiovascular events, in the Brazilian population105CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ563664/2010-

Respiratory function in obese patients submitted to Fobi-Capella operation

BACKGROUND: The objective this study was to measure quantitatively those breathing alterations until 30 days postoperative. METHOD: Breathing evaluations were accomplished before and after bariatric surgery, in morbid obese with IMC greater than 39 kg/m², through arterial gasometry, spirometry function, manovacuometry, to motivate breathing and circumferences. They were breathing physiotherapeutic accomplished, orientations and treatment in the postoperative, with comparative data among evaluations in the 1st, 14th ·e 30th postoperative day. RESULTS: Until the 30th postoperative day, those individuals didn't achieve significant differences in the evaluated parameters, and showed no breathing complications for physiotherapeutic treatment. CONCLUSION: There were no alterations in the analyzed parameters, nor breathing complications in this study with intervention physiotherapy before and after bariatric surgery. Studies should be accomplished, for a longer postoperative period, including specific exercises to achieve different results.INTRODUÇÃO: O objetivo deste trabalho foi mensurar quantitativamente essas alterações respiratórias desses pacientes comparando-os até 30 dias de pós-operatório. MÉTODO: Foram realizadas avaliações respiratórias nos períodos pré e pós-operatório de cirurgia bariátrica em obesos mórbidos com IMC superior a 39kg/m², através de gasometria arterial, prova de função respiratória, manovacuômetria, incentivador da respiração e cirtometrias. Foram realizadas também orientações fisioterápicas respiratórias e tratamento no pós-operatório, com dados comparativos entre as avaliações feitas no préoperatório, no 1º, 14º&middot;e 30º dia pós-operatórios. RESULTADOS: Até o 30º dia de pós-operatório, esses indivíduos não obtiveram diferença significativa nos parâmetros estudados, não havendo, em decorrência do tratamento fisioterápico, complicações respiratórias. CONCLUSÃO: Não houve alterações dos parâmetros analisados, nem complicações respiratórias neste estudo com intervenção fisioterápica pré e pós-operatório de cirurgia bariátrica. Estudos devem ser realizados, para mensuração de um tempo maior de pós-operatório e de exercícios específicos, podendo, assim apresentar resultados diferentes.31432

La pandemia del COVID-19: amenaza biológica versus trabajo y sociedad

ABSTRACT The Covid-19 officially declared a pandemic, since March 11, 2020, spreading in several countries around the world, at the same time affecting hundreds of thousands of people on all continents, causing a large number of deaths, to the date, continues to claim fatalities; However, although there are populations at higher risk (elderly, diabetics, hypertension, among others), at the same time, workers are exposed to a common source of transmission and many jobs that were previously considered relatively safe are now potentially dangerous. Therefore, many workers face threats of exposure to the virus, economic stress and job uncertainty coupled with fears of economic burden to meet the health contingency, get sick and die. A descriptive investigation of a cross-sectional cohort of virtual modality was proposed between the months of September 2020 to January 2021, to know the contextual factors: individual, unit and macro. In the former, economic stress and occupational risk factors that affect the behavior and attitudes of employees towards COVID-19, as well as their health. In the latter, organizational responses to ensure the safety and health of your workforce such as increased PPE and telecommuting. And finally, in the third group, the great variability in the promulgation of policies that affect the lives of almost all workers was evidenced. Finally, the questionnaire can be extrapolated to an institution with a view to a critical analysis in light of the standards of governments, regulators, and NGOs