Importance of the identification of the CYP3A4*2 polymorphism for the prescription of pharmacological treatment

The CYP3A4*2 polymorphism is rare in the population studied. Given the low frequency of CYP3A4*2 polymorphisms found in homozygous or heterozygous condition, it is advisable to consider the genotype of the patient before prescribing drugs metabolized by this gene.Variability in response to drugs is a problem in clinical practice. The rate of patients who respond adequately to pharmacological therapy is generally around 60. The CYP450 multienzyme complex is a microsomal system located in the endoplasmic reticulum. The enzymes participate in phase I metabolism of xenobiotics. CYP3A4 is the isoenzyme mostly expressed in liver. Its gene is polymorphic, of which CYP3A4*1A is the wild allele and CYP3A4*2 is a polymorphism which consists of the S222P substitution in the amino acid sequence, affecting the activity of the enzyme. Methods: In this study, we determine the frequency of CYP3A4*2 polymorphism in Mexican individuals. 62 apparently healthy individuals, from Toluca de Lerdo, Mexico. The sample was 3 mL of peripheral blood. The DNA was extracted and PCR-RFLPs were performed. Results:58 individuals possess the wild allele in homozygosity CYP3A4*1A/CYP3A4*1A (94%) and 4 individuals were heterozygous CYP3A4*1A/CYP3A4*2 (6%). The homozygous polymorphic CYP3A4*2/CYP3A4*2 was not found in any individual.COMECY

The adiponectin/leptin ratio is a useful tool to evaluate de metabolic status in an Obstetrical Intensive Care Unit

Introduction. Critically ill patients, including obstetrical patients, face undernutrition but a reliable and cost effective study to assess their nutritional state is still missing. Our main objective was to analyze serum leptin and adiponectin concentrations in puerperal women attended in an Obstetrical Intensive Care Unit (OICU) in order to evaluate their potential role as nutritional metabolic parameter. Methods. This was a descriptive, clinical, longitudinal and comparative study. We evaluated the anthropometric variables, clinical laboratories, daily calories and adiponectin and leptin serum levels of 16 puerperal women attended at the OICU of the Materno Perinatal Hospital “Mónica Pretelini” (HMPMP). Results. For all women there was a negative correlation with Spearman test between leptin the day of discharge from the obstetrical intensive care unit and the days of stay –0.632 (p = 0.011). Considering an adiponectin/leptin ratio, the media in the first day was of 0.3 (0.07–13.6) and in the day of discharge it was of 2.4 (0.1–24.6) in overweight women. The same values for obese women were of 0.3 (0.2–0.4) and 0.5 (0.3–1.2). Conclusion. After an average of six days of hospitalization, leptin showed a decrement in women attended at the OICU. As expected, adiponectin increased in both groups. The adiponectin/leptin ratio could be a useful metabolic parameter

Thyroid function is associated with insulin resistance markers in healthy adolescents with risk factors to develop diabetes

Introduction: The prevalence of obesity and Type 2 diabetes mellitus (T2DM) among children and adolescents is rising. Thyroid function has been associated with insulin resistance. There is scarce information about how thyroid function could be related with cardiovascular risk or glucose homeostasis in adolescent. Aim: To analyze how thyroid function is associated with insulin resistance and another cardiovascular risk factors in healthy adolescents with risk factors to develop diabetes. Methods: A prospective cross-sectional analysis was carried out on euthyroid, adolescents. considered at high risk to develop Type 2 diabetes. Fasting blood samples were obtained. Thyroid function test and another cardiometabolic parameters were assessed. A 75 grams oral glucose tolerance test was performed to calculate insulin resistance. Results: One hundred adolescents were evaluated. The mean age was 15.9 ± 0.8 years, There is a negative correlation between Fasting insulin, post glucose load insulin and HOMA IR. There were no correlation with Matsuda index. We could not found any correlation with TSH values. Conclusions: We found a correlation between fasting insulin, HOMA IR and serum thyroid hormones, we did not find any relation with serum TSH. In euthyroid adolescents with risk factors to develop diabetes

PrimerCongreso Internacional de Enfermedades Crónico Degenerativas y de Rezago

Verificar como influyen los factores socioeconómicos culturales en el control metabólico del paciente con diabetes mellitus de manera parcial o determinante.La diabetes es una enfermedad crónica con un impacto importante en la vida del sujeto siendo la enfermedad que concentra mayor volumen de recursos económicos del sector salud

Association of Irisin Serum Concentration and Muscle Strength in Normal-Weight and Overweight Young Women

Background: Irisin is a muscle-contraction-induced myokine. In previous studies, it has been related to exercise type, fitness and physical activity; however, evidence is not consistent. Thus, the aim of this study was to research the association between health-related fitness and irisin in young women. Methods: The study was designed as a prospective cross-sectional one. Young, healthy, nonsmoking women were enlisted. The sample comprised 40 overweight (OW) and 40 normal-weight (NW) individuals. The average age was 18.63 ± 0.63 and 18.78 ± 0.73 years, respectively. Components of health-related fitness, metabolic parameters, serum irisin and body composition were analyzed. Results: Statistically significant differences were found in physical tests between NW and OW groups for one-leg standing, hand grip strength, vertical jump, modified push-up, fitness index and maximal oxygen uptake (VO2MAX). There were no differences in concentrations of serum irisin between the groups. We found a positive correlation between irisin and hand grip strength (r = 0.374, p = 0.023). In a multivariate analysis adjusted by body fat, a significant association between irisin and hand grip strength was observed in OW group (β = 0.380, p = 0.026); as well, a positive association between irisin and one-leg standing test in NW group (β = 0.311, p = 0.044) was found. Conclusions: According to our findings, hand grip strength could be linked to irisin concentration in overweight young women

SARCOPENIA, NEUROPATÍA PERIFÉRICA Y ENFERMEDAD ARTERIAL PERIFÉRICA EN PACIENTES CON DIABETES MELLITUS SOMETIDOS A HEMODIÁLISIS

La sarcopenia se caracteriza por pérdida de fuerza y masa muscular. Los pacientes con diabetes mellitus que se encuentran bajo tratamiento en hemodiálisis tienen disminución de actividad física y cambios en su ingestión alimentaria, lo que propicia también la presencia de sarcopenia; por otro lado, la neuropatía periférica y enfermedad arterial periférica aparecen comúnmente como complicaciones crónicas de la diabetes mellitus

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Dietary patterns associated with body mass index (BMI) and lifestyle in Mexican adolescents

Abstract Background The objetive in this study is to determine the relationship between dietary patterns, BMI, type 2 diabetes mellitus family history (T2DMFH) and some lifestyle variables such as smoking and skipping breakfast in a Mexican adolescent population. Methods Cross-sectional, observational, analytical study.Subjetcts: 14-16 years old male and female adolescents (n 373). A previously validated food frequency questionnaire (FFQ) was used and dietary patterns were derived using principal component analysis (PCA). Scores for dietary patterns were categorized by tertiles. Results Three major dietary patterns that explained 47 % of variance were found: westernized, high in protein/fat and prudent pattern. Subjects at the highest tertile of prudent pattern had lower BMI. And was also associated with less T2DMFH and less smoking habit when compared with the lowest tertile. We found a positive correlation between BMI and high scores for westernized and high in protein/fat pattern Conclusions Dietary patterns of adolescents are a public health concern because there is a direct association between inadequate diet at this early age and obesit

Factores de riesgo y de estilo de vida asociados a enfermedad renal crónica

"El estilo de vida tiene una influencia determinante en el avance de la enfermedad renal crónica (ERC), la cual inicia con algún daño renal que puede permanecer y progresar por la acción de factores de riesgo, además de que pueden agregarse lesiones rena

Sarcopenia, neuropatía periférica y enfermedad arterial periférica en pacientes con diabetes mellitus sometidos a hemodiálisis

Introduction: Sarcopenia is characterized by loss of strength and muscle mass. Patients with diabetes mellitus who are under hemodialysis treatment show decreased physical activity and changes in their food intake, which also leads to the presence of sarcopenia. On the other hand, peripheral neuropathy and peripheral arterial disease commonly appear as chronic complications of diabetes mellitus. Methods: A cross-sectional, observational study was carried out in diabetes mellitus patients on hemodialysis. For the assessment of sarcopenia, muscle strength, physical performance and muscle mass percentage were measured. Muscle strength was calculated with a dynamometer, while physical performance was evaluated in seconds by means of a walk test with a stopwatch; muscle mass percentage was obtained using a scale with bioelectrical impedance. Sarcopenia was considered severe when there was low muscle strength and percentage in addition to low physical performance. Peripheral neuropathy was assessed by exploring touch and pressure sensibility with the Semmes-Weinstein monofilament test and deep sensibility with a 128 Hz tuning fork. The ankle-brachial index was the measurement taken for the peripheral arterial disease classification. Results: The final analysis was performed with 33 patients, whose time on hemodialysis was 3.57 ± 2.56 years. The prevalence of severe sarcopenia and sarcopenia was 90.8% and that of pre-sarcopenia was 9% of all patients. On the other hand, 78.1% were found to be patients with loss of deep sensibility, while the percentage of patients with loss of sensibility to pressure and touch was 54.5%. A correlation was found between the sarcopenia parameters and the time of evolution of renal failure and age. Conclusion: Sarcopenia occurs, in its different stages, in practically all diabetes mellitus patients undergoing hemodialysis; there is a relationship with the patient's age and hemodialysis time.Introducción: La sarcopenia se caracteriza por pérdida de fuerza y masa muscular. Los pacientes con diabetes mellitus que se encuentran bajo tratamiento en hemodiálisis tienen disminución de actividad física y cambios en su ingestión alimentaria, lo que propicia también la presencia de sarcopenia; por otro lado, la neuropatía periférica y enfermedad arterial periférica aparecen comúnmente como complicaciones crónicas de la diabetes mellitus. Material y métodos: Se realizó un estudio transversal, observacional, en pacientes con diabetes mellitus y hemodiálisis. Para la evaluación de la sarcopenia se midió fuerza muscular, rendimiento físico y cantidad de masa muscular. Se midió fuerza muscular con dinamómetro, mientras que el rendimiento físico se evaluó con el tiempo en segundos de marcha con cronómetro, la cantidad de músculo de obtuvo utilizando una báscula con bioimpedancia. Se consideró sarcopenia severa cuando existía baja fuerza y cantidad muscular además de bajo rendimiento físico. La neuropatía periférica se evaluó explorando la sensibilidad a la presión y el tacto con el monofilamento de Semmes-Weinstein y sensibilidad profunda con un diapasón de 128 Hz. El índice tobillo-brazo fue la medición tomada para la clasificación de enfermedad arterial periférica. Resultados: El análisis final se realizó con 33 pacientes. Con un tiempo en hemodiálisis de 3,57 ± 2,56 años. La prevalencia de sarcopenia severa y sarcopenia fue de 90,8% y la de pre-sarcopenia de 9% del total de los pacientes; por otro lado, se encontró al 78,1% los pacientes con pérdida de la sensibilidad profunda, mientras que el porcentaje de los pacientes con pérdida de la sensibilidad a la presión y al tacto fue de 54,5%. Se encontró correlación entre los parámetros de sarcopenia y el tiempo de evolución de la insuficiencia renal y la edad. Conclusión: La sarcopenia se presenta, en sus diferentes etapas, en prácticamente todos los pacientes con diabetes mellitus sometidos a hemodiálisis; existe relación con la edad del paciente y el tiempo de hemodiálisis