Obesity associated risk using Edmonton staging in bariatric surgery

Con una prevalencia de obesidad mórbida del 1,2% en población española, los criterios de indicación para Cirugía Bariátrica (CB) no consideran comorbilidades ni estado funcional. Es necesaria una aproximación diagnóstica capaz de predecir mortalidad y sustentar criterios de priorización terapéutica. Objetivo: Aplicar la propuesta Edmonton como sistema de estadiaje clínico para la clasificación de pacientes en lista de espera de CB. Método: Se recogen datos de 81 pacientes (2011 – 2013), tras protocolo prequirúrgico. Se registra peso, talla, IMC, cintura, determinaciones bioquímicas, TA, presencia de enfermedad hepática, renal, osteoarticular, síndrome apnea-hipopnea del sueño (SAHS) y reflujo gastroesofágico. Se aplica a cada persona la propuesta de estadiaje de Edmonton, con 10 variables. Resultados: 67% mujeres. Edad media: 47 años, 18% con edad inferior a 30 años. IMC medio: 47 (37-67), 90% IMC > de 40. El 34% de los pacientes presentan SHAS y el 25% enfermedad por reflujo. Un 9% asocia IMC > 45, disglucosis- diabetes mellitus y SAHS. Aplicando el modelo de Edmonton, nueve pacientes (11%) se sitúan en el rango de mayor riesgo (estadío 3), 70% en rango de riesgo elevado (estadío 2), y 15 pacientes (18%), están incluidos en la condición de bajo riesgo. Ningún paciente se situaba en estadio 0, sin factores de riesgo asociados a obesidad. Conclusiones: El estadiaje de Edmonton nos aporta información sobre la presencia y extensión de co-mobilidades, que apoye la toma de decisiones terapéuticas. La capacidad predictiva de mortalidad de la propuesta de Edmonton podría ser útil para establecer criterios de priorización quirúrgicaWith a prevalence of Morbid Obesity of 1,2% of the Spanish population, the current criteria for Bariatric Surgery do not classify patients taking into consideration co-morbidities or functional status. We need new staging systems useful in predicting mortality and able to support prioritizing treatments. Aim: Applying Edmonton staging system to patients awaiting Bariatric Surgery. Method: Data collected from 81 patients from 2011- 2013 after pre-surgery protocol. Weight, height, waist, BMI, biochemical parameters and blood pressure are registered. Also taken down are hepatic, renal, osteoarticular diseases, sleep-apnea syndrome and/or gastro-oesophageal reflux, if present. Edmonton staging of ten variables is applied to each patient. Results: 81 patients: 67% women, average age 47y, 18% below 30y. Average BMI of 47, 90% of patients have a BMI >40. 34% of patients show sleep-apnea syndrome and 25% gastro-oesophageal reflux. 9% of the patients have a BMI >45, diabetes mellitus and sleep-apnea syndrome. Applying the Edmonton Staging, nine patients (11%) are in the highest risk range (stage 3), 70% are in the high-risk range (stage 2) and 15 patients (18%) are included in the low-risk range. No patient was found to be in stage 0 without obesity risk factors. Conclusions: The Edmonton staging system provides us with information on presence or extent of co-morbidities that guide decision making in individuals. The mortality- predictive ability of Edmonton proposal could help to assist in determining the urgency of Bariatric Surgery and establish better criteria to prioritize these group of patient

Comparable Renal Function at 6 Months with Tacrolimus Combined with Fixed-Dose Sirolimus or MMF: Results of a Randomized Multicenter Trial in Renal Transplantation

In a multicenter trial, renal transplant recipients were randomized to tacrolimus with fixed-dose sirolimus (Tac/SRL, N = 318) or tacrolimus with MMF (Tac/MMF, N = 316). Targeted tacrolimus trough levels were lower in the Tac/SRL group after day 14. The primary endpoint was renal function at 6 months using creatinine clearance (Cockcroft-Gault) and was comparable at 66.4 mL/min (SE 1.4) with Tac/SRL and at 65.2mL/min (SE 1.3) with Tac/MMF (completers). Biopsy-confirmed acute rejection was 15.1% (Tac/SRL) and 12.3% (Tac/MMF). In both groups, graft survival was 93% and patient survival was 99.0%. Premature withdrawal due to an adverse event was twice as high in the Tac/SRL group, 15.1% versus 6.3%. Hypercholesterolemia incidence was higher with Tac/SRL (P < .05) while CMV, leukopenia, and diarrhea incidences were higher with Tac/MMF (P < .05). The incidence of any antidiabetic treatment for >30 consecutive days in previously nondiabetic patients was 17.8%, Tac/SRL, and 24.8%, Tac/MMF. Evaluation at 6 months showed comparable renal function using tacrolimus/sirolimus and tacrolimus/MMF regimens

Dysglycemia and a History of Reproductive Risk Factors

OBJECTIVE—The purpose of this study was to identify reproductive risk factors associated with dysglycemia (diabetes, impaired glucose tolerance, and impaired fasting glucose) in a contemporary multiethnic population

Current Experience in Testing Mitochondrial Nutrients in Disorders Featuring Oxidative Stress and Mitochondrial Dysfunction: Rational Design of Chemoprevention Trials

An extensive number of pathologies are associated with mitochondrial dysfunction (MDF) and oxidative stress (OS). Thus, mitochondrial cofactors termed mitochondrial nutrients (MN), such as alpha-lipoic acid (ALA), Coenzyme Q10 (CoQ10), and L-carnitine (CARN) (or its derivatives) have been tested in a number of clinical trials, and this review is focused on the use of MN-based clinical trials. The papers reporting on MN-based clinical trials were retrieved in MedLine up to July 2014, and evaluated for the following endpoints: (a) treated diseases; (b) dosages, number of enrolled patients and duration of treatment; (c) trial success for each MN or MN combinations as reported by authors. The reports satisfying the above endpoints included total numbers of trials and frequencies of randomized, controlled studies, i.e., 81 trials testing ALA, 107 reports testing CoQ10, and 74 reports testing CARN, while only 7 reports were retrieved testing double MN associations, while no report was found testing a triple MN combination. A total of 28 reports tested MN associations with classical antioxidants, such as antioxidant nutrients or drugs. Combinations of MN showed better outcomes than individual MN, suggesting forthcoming clinical studies. The criteria in study design and monitoring MN-based clinical trials are discussed

Downregulation of miR-31 in Diabetic Nephropathy and its Relationship with Inflammation

Background/Aims: There is a lack of reliable biological markers for the early diagnosis of diabetic nephropathy (DN) during type 2 diabetes. In this pilot study we aim to assess whether miR-31 levels are modulated by the presence of DN and whether the expression of this miRNA is related to leukocyte-endothelial interactions and inflammation. Methods: Thirty-one T2D patients were enrolled in this pilot study; 18 with no diabetic complications and 13 with diabetic nephropathy. 24 non-diabetic subjects and 13 T2D patients with retinopathy (absent of other complications) were included to test the specificity of miR-31. Following anthropometric and biochemical evaluation, serum miR-31 levels were assessed by Real Time-PCR. Leukocyte-endothelial interactions were evaluated by a parallel flow chamber in vitro model. Serum TNFα, IL-6 and ICAM-1 levels were determined by XMAP-technology in a flow cytometry-based Luminex 200 instrument. Results: Serum miR-31 levels were similar between control and T2D subjects. However, T2D patients with DN displayed reduced levels of miR-31 with respect to patients without complications. This decrease in miR-31 was more pronounced in patients with macroalbuminuria than in those with microalbuminuria and was specific for DN, since patients with retinopathy displayed unaltered miR-31 levels. The presence of DN involved a lower leukocyte rolling velocity and an increased rolling flux and adhesion. miR-31 levels were positively correlated with leukocyte rolling velocity and negatively associated to leukocyte adhesion, TNFα, IL-6 and ICAM-1 levels. Conclusion: Serum miR-31 may be a biomarker for DN in T2D patients. The regulation of this miRNA seems to be related to the recruitment of leukocytes to vascular walls induced by pro-inflammatory and adhesion molecules