Comparación de índices antropométricos para agregación de múltiples factores de riesgo en adultos de Cuenca, Ecuador

Objetivos. El objetivo de este estudio es comparar la capacidad predictiva de diferentes índices antropométricos en la determinación de la agregación de múltiples factores de riesgo (AMFR) en la población adulta de la ciudad de Cuenca, Ecuador. Materiales y métodos. Se realizó un estudio descriptivo transversal con un muestreo aleatorio multietápico en 318 sujetos adultos a quienes se les realizó una evaluación clínica, antropométrica y de laboratorio; siendo la circunferencia abdominal, índice de masa corporal (IMC) e índice cintura altura (ICA) los índices evaluados. La AMFR se definió como la presencia de ≥ dos componentes del síndrome metabólico (excluyendo circunferencia abdominal). Se realizaron curvas COR para determinar el área bajo la curva (ABC) para cada índice. Resultados. De los 318 individuos, un 54,1% (n=172) presentaron AMFR. Según los resultados obtenidos por curvas COR, la mayor capacidad predictiva en mujeres se observó con el IMC y el ICA (ABC: 0,751 y 0,750, respectivamente) mientras que en hombres la circunferencia abdominal y el ICA mostraron una capacidad predictiva similar (ABC=0,762). El análisis multivariante ajustado por sexo y edad mostró que el ICA elevado (OR: 2,53; IC95%: 1,12-5,71; p=0,026) fue el mejor predictor de AMFR, seguido por el IMC (OR: 2,15; IC95%: 1,19-3,88; p=0,010). Conclusiones. La capacidad predictiva de los índices antropométricos está influenciada por el sexo, no obstante, el ICA es el mejor predictor de la AMFR en la población de Cuenca

Biochemical and clinical characterization of metabolic phenotypes: a cross-sectional study from Maracaibo city, Venezuela [version 1; referees: awaiting peer review]

Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”. Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional study with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 5.2% (n=64) corresponded to unhealthy lean subjects, and 17.4% (n=217) to healthy obese subjects. Metabolically unhealthy normal-weight (MUNW) phenotype was found in males in 53.3% in contrast to 51.3% of metabolically unhealthy obese (MUO) phenotype found in females. An association between metabolically unhealthy phenotypes and a higher risk of a coronary event was found, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes exist in Maracaibo city. Related factors may include insulin resistance, basal glucose levels, and triglycerides levels. Lastly, cardiovascular risk exhibited by healthy obese individuals should be classified in categories of major coronary risk related to lean subjects

Association between +45T>G adiponectin polymorphism gene and type 2 diabetes mellitus and metabolic syndrome in a Venezuelan population [version 1; peer review: 2 approved, 1 approved with reservations]

Background: Adiponectin (ADIPOQ) is a hormone primarily synthesized by adipocytes and encoded by the ADIPOQ gene, which exerts anti-inflammatory, antiatheratogenic and insulin sensitizing functions. It has been shown that its plasma concentrations are decreased in individuals with metabolic syndrome (MS) and type 2 diabetes mellitus (DM2), which could be due to variations in the gene coding for this protein. The aim of this study was to detect the +45 T>G polymorphism of the ADIPOQ gene in subjects with DM2 and MS in Maracaibo municipality, Zulia state, Venezuela. Methods: A total of 90 subjects who attended the Center for Metabolic Endocrine Research "Dr. Félix Gómez" were enrolled for this study, 46 of which had MS-DM2 and 44 of which were healthy control individuals. Genomic DNA was extracted from blood samples and PCR-restriction fragment length polymorphism analysis was carried out for the promoter region of the ADIPOQ gene. Likewise, the +45 T> G polymorphism was identified and correlated with MS and DM2 in the studied population. Results: The most frequent allele in both groups was the T allele, and the predominant genotype was homozygous T/T (79%). Genotypes with heterozygous T/G and G/G homozygous polymorphism were more frequent in the control group than in the MS-DM2 group. Regarding the individuals with T/G and G/G genotypes, statistically significant lower mean values ​​were found for fasting glucose, total cholesterol, triacylglycerides, abdominal circumference, and for the medians of systolic and diastolic blood pressure. Odds ratio were calculated for the presence or absence of MS and DM2. Conclusions: The results suggested that the presence of the G allele exerts a protective effect on the carrier individuals, thus avoiding the appearance of the aforementioned metabolic alterations

Cigarette smoking and metabolic syndrome components: a cross-sectional study from Maracaibo City, Venezuela [version 3; referees: 2 approved]

Background: A growing body of evidence suggests that cigarette smoking can cause the onset of metabolic syndrome prior to cardiovascular diseases. Therefore, the objective of this study was to evaluate the relationship between smoking habit and metabolic syndrome components in an adult population from Maracaibo city, Venezuela. Methods: The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multi-stage sampling. In this sub-study, 2212 adults from both genders were selected. On the basis of their medical background, they were classified as smokers, non-smokers and former smokers. Metabolic syndrome was defined according to Harmonizing 2009 criteria, using population-specific abdominal circumference cut-off points. The association between risk factors was evaluated using a logistic regression model. Results: In the studied population, 14.8% were smokers, 15.4% were former smokers. In the multivariate analysis, the presence of metabolic syndrome (smokers: OR, 1.54; 95% CI, 1.11–2.14; p=0.010) and its components were related to cigarette smoking, with the exception of hyperglycemia. High blood pressure was inversely associated with current smoking status (smokers: OR, 0.70 (0.51–0.95); p=0.025). Conclusion: Cigarette smoking represents a related factor with metabolic syndrome, being associated with low high-density lipoprotein-cholesterol, increased abdominal circumference and elevated triacylglyceride levels. Former smokers did not present a greater risk for developing this metabolic disease when compared to non-smokers. The effect of avoiding this habit should be evaluated in future studies in our population

Pubertad precoz central secundario a hamartoma hipotalamico

ResumenPubertad Precoz se define como la presentaci&oacute;n secuencial de cambios puberales (en la configuraci&oacute;n de la mama y vello pubiano) antes de los 8 a&ntilde;os en las ni&ntilde;as; estando influenciado por factores &eacute;tnicos, nutricionales, ambientales, geogr&aacute;ficos. Su etiopatogenia puede estar a nivel central (dependiente de gonadotropina), a nivel perif&eacute;rico (no dependiente de gonadotropinas) o puede ser parcial (variantes del desarrollo puberal). Tiene una incidencia mayor en ni&ntilde;as en relaci&oacute;n 10:1. En el presente caso se sospecha de PPC causada por tumores del SNC, con una sospecha inicial de Hamartoma Hipotal&aacute;mico (HH). Esta tumoraci&oacute;n es derivada del tejido nervioso dependiente del hipot&aacute;lamo, y en ni&ntilde;as constituye el 16% de los casos y en varones aproximadamente el 50%. Para el diagn&oacute;stico la RMN es una opci&oacute;n invalorable, concomitante con la determinaci&oacute;n del pico de LH como respuesta a la estimulaci&oacute;n con LHRH. La importancia del diagn&oacute;stico radica en la necesidad de iniciar un tratamiento, donde para el HH puede ser quir&uacute;rgico y/o con An&aacute;logos de GnRH.SummaryPrecocious puberty is defined as the sequential presentation of (in the configuration of the breast and pubic hair) pubertal changes before age 8 in girls, being influenced by several factors such as ethnic, nutritional, environmental, geographical. Its pathogenesis may be centrally (gonadotropin-dependent), at the peripheral level (not dependent on gonadotropins) or may be partial (variants of pubertal development). The highest incidence is observed in girls with a 10:1 ratio. In the presented &nbsp;case is suspected of PPC caused by CNS tumors the first thing to be discarded is the Hypothalamic Hamartoma, a congenital tumor of the nervous tissue of the hypothalamus; whose incidence in is 16% of cases and in males 50%. The role of MRI imaging for diagnosis is invaluable, concomitant with the determination of the LH surge in response to LHRH stimulation. The importance of the diagnosis lies in the need to initiate treatment; in the HH can be surgical or GnRH analogues; in such a way that part psychosocial and the final size of the patient can not be affected

Pubertad precoz central secundario a hamartoma hipotalamico

ResumenPubertad Precoz se define como la presentaci&oacute;n secuencial de cambios puberales (en la configuraci&oacute;n de la mama y vello pubiano) antes de los 8 a&ntilde;os en las ni&ntilde;as; estando influenciado por factores &eacute;tnicos, nutricionales, ambientales, geogr&aacute;ficos. Su etiopatogenia puede estar a nivel central (dependiente de gonadotropina), a nivel perif&eacute;rico (no dependiente de gonadotropinas) o puede ser parcial (variantes del desarrollo puberal). Tiene una incidencia mayor en ni&ntilde;as en relaci&oacute;n 10:1. En el presente caso se sospecha de PPC causada por tumores del SNC, con una sospecha inicial de Hamartoma Hipotal&aacute;mico (HH). Esta tumoraci&oacute;n es derivada del tejido nervioso dependiente del hipot&aacute;lamo, y en ni&ntilde;as constituye el 16% de los casos y en varones aproximadamente el 50%. Para el diagn&oacute;stico la RMN es una opci&oacute;n invalorable, concomitante con la determinaci&oacute;n del pico de LH como respuesta a la estimulaci&oacute;n con LHRH. La importancia del diagn&oacute;stico radica en la necesidad de iniciar un tratamiento, donde para el HH puede ser quir&uacute;rgico y/o con An&aacute;logos de GnRH.SummaryPrecocious puberty is defined as the sequential presentation of (in the configuration of the breast and pubic hair) pubertal changes before age 8 in girls, being influenced by several factors such as ethnic, nutritional, environmental, geographical. Its pathogenesis may be centrally (gonadotropin-dependent), at the peripheral level (not dependent on gonadotropins) or may be partial (variants of pubertal development). The highest incidence is observed in girls with a 10:1 ratio. In the presented &nbsp;case is suspected of PPC caused by CNS tumors the first thing to be discarded is the Hypothalamic Hamartoma, a congenital tumor of the nervous tissue of the hypothalamus; whose incidence in is 16% of cases and in males 50%. The role of MRI imaging for diagnosis is invaluable, concomitant with the determination of the LH surge in response to LHRH stimulation. The importance of the diagnosis lies in the need to initiate treatment; in the HH can be surgical or GnRH analogues; in such a way that part psychosocial and the final size of the patient can not be affected

Siringomas en área genital tratados exitosamente con láser Erbium: Yac

Los siringomas son crecimientos benignos de las gl&aacute;ndulas sudor&iacute;paras ecrinas, los cuales se presentan con m&aacute;s frecuenta en mujeres de mediana edad. El presente caso es de una paciente de 25 a&ntilde;os que consult&oacute; con cuadro cl&iacute;nico de unos 10 a&ntilde;os de evoluci&oacute;n con lesiones papulares de 1-3 mm de di&aacute;metro, firmes, color piel, ubicadas en el &aacute;rea genital, un &aacute;rea afectada de forma infrecuente por esta condici&oacute;n. Se le realizan 2 biopsias de las lesiones reportando en ambas oportunidades lesiones compatibles con siringomas, por lo cual se realiza tratamiento con L&aacute;ser Erbium:YAG, en sesiones mensuales durante un a&ntilde;o. Las sesiones se realizaron de forma programada con ablaciones aditivas utilizando pulsos (very small pulse) con fluencias que oscilaban entre 250 y 400 mJ. A medida que se progresaba en el tratamiento se trataban las lesiones de forma individual y al final de cada lesi&oacute;n se realizaba un barrido de todas las lesiones, siendo en general bien tolerado. La mejor&iacute;a cl&iacute;nica reportada por la paciente fue del 80 %, sin cambios en la sensibilidad ni cicatrices residuales, sugiri&eacute;ndose como una nueva alternativa para el tratamiento de siringomas en esta localizaci&oacute;n.Syringomas are benign tumors of the eccrine sweat glands, more frequently observed in middle-aged women. The present case concerns a 25 year old patient who referred the following clinical symptoms during a period of ten years: papule lesions 1-3 mm in diameter, firm, skin colored located in genital area, a zone infrequently affected by this condition. Two skin biopsies were performed reporting findings consistent with siringomas. Treatment was initiated with Laser Erbium:YAG in a monthly sessions for a year using ablations with 250 and 400 mJ micropulses power. Each lesion was treated individually and at the end of each session a sweep of all lesions was performed being generally well tolerated by the patient. Clinical improvement reported was 80%, without sensorial alterations or scaring, suggesting this laser type as a new alternative for the treatment of syringoma in this location

Siringomas en área genital tratados exitosamente con láser Erbium: Yac

Los siringomas son crecimientos benignos de las gl&aacute;ndulas sudor&iacute;paras ecrinas, los cuales se presentan con m&aacute;s frecuenta en mujeres de mediana edad. El presente caso es de una paciente de 25 a&ntilde;os que consult&oacute; con cuadro cl&iacute;nico de unos 10 a&ntilde;os de evoluci&oacute;n con lesiones papulares de 1-3 mm de di&aacute;metro, firmes, color piel, ubicadas en el &aacute;rea genital, un &aacute;rea afectada de forma infrecuente por esta condici&oacute;n. Se le realizan 2 biopsias de las lesiones reportando en ambas oportunidades lesiones compatibles con siringomas, por lo cual se realiza tratamiento con L&aacute;ser Erbium:YAG, en sesiones mensuales durante un a&ntilde;o. Las sesiones se realizaron de forma programada con ablaciones aditivas utilizando pulsos (very small pulse) con fluencias que oscilaban entre 250 y 400 mJ. A medida que se progresaba en el tratamiento se trataban las lesiones de forma individual y al final de cada lesi&oacute;n se realizaba un barrido de todas las lesiones, siendo en general bien tolerado. La mejor&iacute;a cl&iacute;nica reportada por la paciente fue del 80 %, sin cambios en la sensibilidad ni cicatrices residuales, sugiri&eacute;ndose como una nueva alternativa para el tratamiento de siringomas en esta localizaci&oacute;n.Syringomas are benign tumors of the eccrine sweat glands, more frequently observed in middle-aged women. The present case concerns a 25 year old patient who referred the following clinical symptoms during a period of ten years: papule lesions 1-3 mm in diameter, firm, skin colored located in genital area, a zone infrequently affected by this condition. Two skin biopsies were performed reporting findings consistent with siringomas. Treatment was initiated with Laser Erbium:YAG in a monthly sessions for a year using ablations with 250 and 400 mJ micropulses power. Each lesion was treated individually and at the end of each session a sweep of all lesions was performed being generally well tolerated by the patient. Clinical improvement reported was 80%, without sensorial alterations or scaring, suggesting this laser type as a new alternative for the treatment of syringoma in this location

Complicaciones obstetricas y perinatales en embarazadas con diabetes gestacional, pre-eclampsia severa o ambas, en el Hospital Enrique C. Sotomayor, Guayaquil - Ecuador

Introducci&oacute;n: Los des&oacute;rdenes hipertensivos asociados al embarazo y la diabetes mellitus gestacional comparten factores de riesgo. Por lo tanto, se ha relacionado recientemente ambas enfermedades. En el presente estudio se pretende establecer la tasa de complicaciones obst&eacute;tricas y perinatales en gestantes con diabetes mellitus y pre eclampsia severa o ambas. Materiales y M&eacute;todos: Estudio observacional, descriptivo, corte transversal de mujeres embarazadas con diagn&oacute;stico de preeclampsia severa, diabetes gestacional o ambos en el Hospital Gineco-Obstetrico Enrique Sotomayor. Para el an&aacute;lisis de la estad&iacute;stica descriptiva, se aplic&oacute; media y desviaci&oacute;n est&aacute;ndar para las variables continuas, y frecuencia y porcentaje para las variables categ&oacute;ricas. La tasa de complicaciones obst&eacute;tricas y neonatales se efectu&oacute; tomando como denominador el n&uacute;mero total de &nbsp;mujeres embarazadas. Para el an&aacute;lisis comparativo de subgrupos se emple&oacute; Chi-cuadrado y ANOVA. Resultados: En el estudio participaron 131 mujeres embarazadas. La media de edad fue 28.43&plusmn;6.96 a&ntilde;os. El 27.5% (n=36) pacientes solo ten&iacute;an preeclampsia, 35.1% (n=46) solo diabetes gestacional y 37.4% (n=49) presentaron ambos. La complicaci&oacute;n m&aacute;s frecuente fue infecci&oacute;n de v&iacute;as urinarias y amenaza de parto pret&eacute;rmino. Adem&aacute;s la ces&aacute;rea estuvo presente en 90%, siendo la indicaci&oacute;n m&aacute;s frecuente la preeclampsia (58%). El diagnostico de peque&ntilde;o para la edad gestacional fue bastante frecuente, aunque similar en los subgrupos Conclusiones: Las complicaciones maternas mas frecuentes fueron infeccion de vias urinarias y amenaza de parto pretermino. En el neonato, pequeno para la edad gestacional fue comun, lo cual refleja el compromiso de la unidad materno fetal en estas enfermedades.&nbsp;Introduction: Hypertensive disorders associated with pregnancy and gestational diabetes mellitus share common risk factors. Therefore, it has recently been linked both diseases. The present study aims to establish the rate of obstetric and perinatal complications in pregnant women with diabetes mellitus and severe pre-eclampsia or both. Materials and Methods: Observational, descriptive, cross-section study of pregnant women with severe preeclampsia, gestational diabetes, or both attended in Obstetric and Gynecology Hospital Enrique Sotomayor. For the analysis of descriptive statistics, mean and standard deviation for continuous variables, and frequencies and percentages for categorical variables was applied. The rate of obstetric and neonatal complications was performed using as the denominator the total number of pregnant women. For comparative subgroup analysis Chi-square and ANOVA was used. Results: The study involved 131 pregnant women. The mean age was 28.43 &plusmn; 6.96 years. 27.5% (n = 36) patients had only reeclampsia, 35.1% (n = 46) alone and 37.4% gestational diabetes (n = 49) had both. The most common complication was urinary tract infection and preterm labor. Furthermore cesarean attended 90%, the most frequent indication preeclampsia (58%). The diagnosis of small for gestational age was quite common, although similar in subgroups Conclusions: The most common maternal complications were urinary tract infection and preterm labor. In the infant, small for gestational age was common, which is a reflection of the compromise of the materno-fetal unit during &nbsp;the progression of such diseases in the expecting mother

Efecto de la administración de una infusión acuosa de Hibiscus Sabdariffa L. sobre el índice de masa corporal, apetito y saciedad en individuos con obesidad grado I.

Introducci&oacute;n: Varios estudios han demostrado el efecto de Hibiscus sabdariffa L. en la reducci&oacute;n de peso en animales de experimentaci&oacute;n. El objetivo de este estudio fue evaluar el efecto de la administraci&oacute;n de una infusi&oacute;n acuosa preparada con los c&aacute;lices de Hibiscus sabdariffa L. sobre el &iacute;ndice de masa corporal (IMC), apetito y la saciedad en individuos con obesidad tipo I. Materiales y M&eacute;todos: 30 adultos con obesidad tipo I fueron asignados al azar para recibir una infusi&oacute;n acuosa preparada a partir de los c&aacute;lices de Hibiscus sabdariffa (n=15) o de placebo (n=15) durante 3 semanas. La evaluaci&oacute;n de los cambios ponderales se realiz&oacute; mediante el IMC y el efecto de administraci&oacute;n del tratamiento o el placebo sobre la sensaci&oacute;n de apetito y saciedad se evalu&oacute; mediante la escala visual anal&oacute;gica (EVA). Las variables cualitativas fueron expresadas como frecuencias absolutas y relativas y las variables cuantitativas como media aritm&eacute;tica &plusmn; DE. Se realiz&oacute; la prueba T de student para la comparaci&oacute;n entre medias. Para comparaciones de las medias aritm&eacute;ticas intra-grupos en relaci&oacute;n al tiempo se utiliz&oacute; el m&eacute;todo de ANOVA de medidas repetidas. Resultados: Se encontr&oacute; reducci&oacute;n estad&iacute;sticamente significativa del IMC en los individuos tratados con la infusi&oacute;n de Hibiscus sabdariffa al compararse con los que recibieron placebo. No se encontraron diferencias significativas en el apetito o saciedad en ninguna de las semanas estudiadas entre el grupo tratado con Hibiscus y el grupo control. Conclusiones: Se demostr&oacute; un efecto a corto plazo en la reducci&oacute;n del IMC al administrar una infusi&oacute;n acuosa de Hibiscus sabdariffa en individuos con obesidad tipo I que no se relacion&oacute; con cambios en el apetito o la saciedad. En este sentido, un posible efecto termog&eacute;nico pudiera explicar la reducci&oacute;n del peso. Introduction: Several studies have demonstrated Hibiscus sabdariffa L administration effects on weight reduction in experimental models. The aim of this study was to evaluate the administration of an aqueous infusion prepared from calyxes Hibiscus sabdariffa L on body mass index, appetite and satiety in type I obese individuals. Materials and Methods: 30 adults with obesity type 1 were randomly assigned to receive an infusion of Hibiscus sabdariffa L or placebo during 3 weeks twice daily. Ponderal evaluation was performed using BMI and the effect of administration of treatment/placebo on appetite and satiety sensation was assessed by visual analog scale (VAS). Qualitative variables were expressed as absolute and relative frequencies and continuous variables as mean &plusmn; SD. Student&acute;s t test was performed for differences between means and intragroup comparisons according time (week 1, 2 and 3) was assessed by repeated measures ANOVA&acute;s test (GLM). Results: The individuals treated with Hibiscus sabdariffa L infusion exhibited a significant BMI reduction when compared with those receiving placebo. No significant differences were found in appetite and satiety between placebo and Hibiscus-treated group in any week studied. Conclusions: We demonstrated a short-term reduction in BMI by Hibiscus sabdariffa aqueous infusion administration in type I obesity individuals not related to appetite or satiety changes. A possible thermogenic effect could explain this weight reduction