Factores y mecanismos reguladores de la ingesta, apetito y saciedad.

En la alimentación intervienen un conjunto de procesos complejos que permiten al organismo mantener el suministro energético necesario. Todo ello está controlado por mecanismos reguladores de la ingesta y el gasto energético. El comienzo de la ingesta comienza o, bien por deseo o, por necesidad fisiológica y están implicadas diferentes moléculas y rutas. Unas, las orexígenas, generan hambre y otras, las anorexígenas, señalan la finalización de la ingesta. Estas moléculas están reguladas por el hipotálamo y se secretan por la presencia de alimentos en el estómago o por señales del estado metabólico del organismo. Al comer se generan diferentes tipos de señales: estímulos cognitivos, donde entran en juego los sentidos y el placer; las señales preabsortivas, que son aquellas que se generan en el estómago; y las postabsortivas, cuando los nutrientes pasan al torrente sanguíneo, generando señales de saciedad. Además de estas señales, los nutrientes producen saciedad dependiendo de su naturaleza bioquímica, siendo unos más saciantes que otros. El acto de comer no solo comienza por una necesidad fisiológica, sino también participan aquellos factores no fisiológicos que nos producen apetito. La regulación de la ingesta y la saciedad actualmente está siendo muy estudiada debido a que la obesidad, por su estrecha vinculación con las principales causas de morbimortalidad, se ha convertido en un problema de salud pública a nivel mundial. La relación obesidad-resistencia insulínica-diabetes mellitus-hipertensión arterial adquiere cada día mayor importancia, por el papel cada vez más relevante de la obesidad en el desarrollo de cada una de ellas. Por todo ello en este trabajo de fin de grado se han estudiado los mecanismos que regulan este complejo proceso

Identificación de ingredientes vegetales en productos cárnicos para mejorar su perfil nutricional.

La composición de los productos cárnicos puede mejorarse atendiendo a diversos criterios, siendo uno de ellos la incorporación de ingredientes de origen vegetal (legumbres, algas, frutas, verduras y hortalizas) que permiten mejorar la calidad nutricional y generar un impacto en la salud del consumidor. Mediante una revisión sistemática siguiendo el protocolo PRYSMA se han identificado los ingredientes vegetales adicionados a productos cárnicos que hayan generado beneficios en la salud del consumidor. Tras la selección de los artículos se ha extraído la información de los diversos artículos para el desarrollo del trabajo. Con un total de 16 artículos se han evaluado los efectos de las algas (Wakame, Nori y Espagueti de mar), legumbres (harina de guisante y polifenoles de soja) y diversas frutas, verduras y hortalizas en la incorporación de estas productos cárnicos. Se concluye que existe una limitada evidencia de estudios que recogían el objetivo del estudio, pero la incorporación de dichos ingredientes puede generar beneficios en la salud del consumidor así como beneficios económicos a nivel industrial, además del posible uso de estos alimentos como herramienta de prevención o intervención en enfermedades como la obesidad y enfermedades crónicas no transmisibles asociadas.<br /

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio

A genetic analysis of a Spanish population with early onset Parkinson’s disease

[Introduction] Both recessive and dominant genetic forms of Parkinson’s disease have been described. The aim of this study was to assess the contribution of several genes to the pathophysiology of early onset Parkinson’s disease in a cohort from central Spain.[Methods/patients] We analyzed a cohort of 117 unrelated patients with early onset Parkinson’s disease using a pipeline, based on a combination of a next-generation sequencing panel of 17 genes previously related with Parkinson’s disease and other Parkinsonisms and CNV screening.[Results] Twenty-six patients (22.22%) carried likely pathogenic variants in PARK2, LRRK2, PINK1, or GBA. The gene most frequently mutated was PARK2, and p.Asn52Metfs*29 was the most common variation in this gene. Pathogenic variants were not observed in genes SNCA, FBXO7, PARK7, HTRA2, DNAJC6, PLA2G6, and UCHL1. Co-occurrence of pathogenic variants involving two genes was observed in ATP13A2 and PARK2 genes, as well as LRRK2 and GIGYF2 genes.[Conclusions] Our results contribute to the understanding of the genetic architecture associated with early onset Parkinson’s disease, showing both PARK2 and LRRK2 play an important role in Spanish Parkinson’s disease patients. Rare variants in ATP13A2 and GIGYF2 may contribute to PD risk. However, a large proportion of genetic components remains unknown. This study might contribute to genetic diagnosis and counseling for families with early onset Parkinson’s disease.This study was supported by grants from the Spanish Ministry of Economy and Competitiveness [PI14/01823, PI16/01575, PI18/01898] co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña. Pilar Gómez-Garre was supported by the "Miguel Servet" (from ISCIII-FEDER) and “Nicolás Monardes” (from Andalusian Ministry of Health) programs. Silvia Jesús Maestre was supported by the "Juan Rodés" program (from ISCIII-FEDER). Cristina Tejera was supported by VPPI-US from the Universidad de Sevilla

A genetic analysis of a Spanish population with early onset Parkinson's disease.

IntroductionBoth recessive and dominant genetic forms of Parkinson's disease have been described. The aim of this study was to assess the contribution of several genes to the pathophysiology of early onset Parkinson's disease in a cohort from central Spain.Methods/patientsWe analyzed a cohort of 117 unrelated patients with early onset Parkinson's disease using a pipeline, based on a combination of a next-generation sequencing panel of 17 genes previously related with Parkinson's disease and other Parkinsonisms and CNV screening.ResultsTwenty-six patients (22.22%) carried likely pathogenic variants in PARK2, LRRK2, PINK1, or GBA. The gene most frequently mutated was PARK2, and p.Asn52Metfs*29 was the most common variation in this gene. Pathogenic variants were not observed in genes SNCA, FBXO7, PARK7, HTRA2, DNAJC6, PLA2G6, and UCHL1. Co-occurrence of pathogenic variants involving two genes was observed in ATP13A2 and PARK2 genes, as well as LRRK2 and GIGYF2 genes.ConclusionsOur results contribute to the understanding of the genetic architecture associated with early onset Parkinson's disease, showing both PARK2 and LRRK2 play an important role in Spanish Parkinson's disease patients. Rare variants in ATP13A2 and GIGYF2 may contribute to PD risk. However, a large proportion of genetic components remains unknown. This study might contribute to genetic diagnosis and counseling for families with early onset Parkinson's disease

Estudio piloto sobre uma medida específica para as perturbações do sono associadas à doença de Parkinson: SCOPA-sono

Introducción. En la enfermedad de Parkinson (EP) existe una alta prevalencia de trastornos del sueño. Objetivos. Comprobar los atributos métricos básicos de la escala SCOPA-sueño para pacientes con EP; objetivo secundario: analizar el impacto del trastorno del sueño en la calidad de vida relacionada con la salud (CVRS) del paciente y de su cuidador principal. Sujetos y métodos. 68 pacientes con EP y sus cuidadores principales. Se aplicaron: Hoehn y Yahr, SCOPA-motor, impresión clínica de gravedad (CISIPD), escala PDSS, Hospital Anxiety and Depression Scale, SCOPA-psicosocial y EuroQoL. El cuidador cumplimentó un cuestionario PDSS sobre el sueño del paciente y las medidas de la CVRS (SF-36, EuroQoL). Se analizaron la aceptabilidad, las asunciones escalares, la consistencia interna, la validez de constructo y la precisión de la SCOPA-sueño. Resultados. La SCOPA-sueño mostró aceptabilidad satisfactoria y asunciones escalares. La subescala sueño nocturno (SC-Sn) presentó leve efecto techo (22,1%), y la subescala somnolencia diurna (SC-Sd), defectuosa validez convergente del ítem 6; la consistencia interna de ambas resultó satisfactoria (alfa = 0,84 y 0,75, respectivamente). SC-Sn correlacionó significativamente con la PDSS (rS= –0,70) y con el cuestionario PDSS cumplimentado por el cuidador (rS = –0,53), y fueron menores los valores respectivos para la SC-Sd (rS= –0,41 y –0,50). Error estándar de la medida: SC-Sn, 1,45; SC-Sd, 1,76. La CVRS del paciente y la del cuidador mostraron una escasa correlación con las medidas de sueño. Conclusiones. La escala SCOPA-sueño es viable, consistente y útil para evaluar el trastorno del sueño en pacientes con EP. La relación entre la CVRS y la alteración del sueño fue débil. [REV NEUROL 2006; 43: 577-83]Introduction. There is a high prevalence of sleep disorders in Parkinson’s disease (PD). Aims. To assess some basic metric attributes of the SCOPA-Sleep scale, a measure for PD patients; secondary objective: to check the impact caused by the sleep disorder on the health-related quality of life (HRQoL) of patients and their caregivers. Subjects and methods. 68 PD patients and their main caregivers; measures: Hoehn and Yahr staging, SCOPA-Motor, Clinical Impression of Severity Index (CISI-PD), PDSS, Hospital Anxiety and Depression Scale, SCOPA-Psychosocial, and EuroQoL. Carers filled in a PDSS questionnaire about patient sleep and HRQoL measures (SF-36, EuroQoL). SCOPA-Sleep acceptability, scaling assumptions, internal consistency, construct validity and precision were determined. Results. SCOPA-Sleep acceptability and scaling assumptions resulted satisfactory, although the nocturnal sleep subescale (SC-Ns) showed a mild ceiling effect (22.1%) and a defective convergent validity was found for daytime sleepiness (SC-Ds) item 6. Internal consistency also was satisfactory for both scales (alpha = 0.84 and 0.75, respectively). The correlation between SC-Ns and PDSS was high (rS = –0.70), as it was between SC-Ns and PDSS questionnaire by caregiver (rS = –0.53). The corresponding coefficients with the SC-Ds gained lower values (rS = –0.41 y –0.50). Standard error of measurement was 1.45 for the SC-Ns and 1.76 for the SC-Ds. Both, patient and caregiver HRQoL showed a loose association with the sleep measures. Conclusion. SCOPA-Sleep is a feasible, consistent, and useful scale for assessment of sleep disorder in PD patients. A weak association between sleep disorder and HRQoL was found. [REV NEUROL 2006; 43: 577-83]Introdução. A doença de Parkinson (DP) associa-se a uma elevada prevalência de perturbações do sono. Objectivos. Comprovar os atributos métricos básicos da escala SCOPA-sono para doentes com DP; objectivo secundário: analisar o impacto das perturbações do sono na qualidade de vida relacionada com a saúde (QVRS) do doente e do seu principal cuidador. Sujeitos e métodos. Foram estudados 68 doentes com DP e respectivos cuidadores. Aplicaramse as escalas: Hoehn e Yahr, SCOPA-motor, Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD), escala PDSS, Hospital Anxiety and Depression Scale, SCOPA-psicosocial e EuroQoL. O cuidador preencheu um questionário PDSS sobre o sono do doente e as medidas da QVRS (SF-36, EuroQoL). Foram analisadas a aceitabilidade, as assunções escalares a consistência interna, a validade de construção e a precisão da SCOPA-sono. Resultados. A SCOPA-sono revelou aceitabilidade satisfatória e assunções das escalas. A subescala sono nocturno (SC-Sn) apresentou um discreto efeito tecto (22,1%) e a subescala sonolência diurna (SC-Sd) uma validade convergente imperfeita do item 6; a consistência interna de ambas resultou satisfatória (alfa = 0,84 e 0,75, respectivamente). SC-Sn correlacionou-se significativamente com a PDSS (rS = –0,70) e com o questionário PDSS preenchido pelo cuidador (rS = –0,53), e foram menores os valores respectivos para a SC-Sd (rS = –0,41 e –0,50). O erro standard das medidas foi: SC-Sn, 1,45; SC-Sd, 1,76. A QVRS do doente e do cuidador revelou uma ténue correlação com as medidas do sono. Conclusões. A escala SCOPA-sono é viável, consistente e útil para avaliar a perturbação do sono em doentes com DP. Detectou-se uma ténue relação entre a QVRS e a alteração do sono. [REV NEUROL 2006; 43: 577-83

Criação e protocolo de seguimento longitudinal de uma coorte multipropósito de doentes com doença de Parkinson de diagnóstico recente: projecto VIP

La enfermedad de Parkinson (EP) es una enfermedad neurodegenerativa muy heterogénea desde el punto de vista etiológico, clínico y terapéutico, lo que dificulta la interpretación de resultados de estudios transversales. Son necesarios los registros de pacientes y los estudios longitudinales de cohortes bien caracterizadas desde el punto de vista clínico y terapéutico.Parkinson’s disease (PD) is a quite heterogeneous disorder, thus difficulting the interpretation of transversal studies. Patients’ registries and longitudinal studies can be considered as a priority in order to understand many still unknown aspects of the disease.A doença de Parkinson (DP) é uma doença neurodegenerativa muito heterogénea do ponto de vista etiológico, clínico e terapêutico, o que dificulta a interpretação de resultados de estudos transversais. São necessários os registos de doentes e os estudos longitudinais de coortes bem caracterizadas do ponto de vista clínico e terapêutico

Estudio longitudinal de doentes com doença de Parkinson (ELEP): objectivos e metodologia

La enfermedad de Parkinson (EP) es crónica y progresiva. Desde la perspectiva sociosanitaria, representa una fuente de sufrimiento para el paciente y sus cuidadores, así como una importante carga para la sociedad. La información actual sobre la EP es limitada en cuanto al conocimiento del curso evolutivo relacionado con: 1) el desarrollo y la evolución de los aspectos no motores de la enfermedad; 2) el impacto de estas manifestaciones sobre la discapacidad y la calidad de vida relacionada con la salud (CVRS); 3) los determinantes de la discapacidad y de la pérdida de CVRS; 4) los factores relacionados con la velocidad de progresión de la enfermedad; 5) las pautas de aplicación y la repercusión diferencial a largo plazo (sobre complicaciones, discapacidad, CVRS) de las medidas terapéuticas disponibles; y 6) el impacto de la EP sobre los cuidadores. Además, en la información existente se detecta heterogeneidad en la calidad de las propiedades métricas de los instrumentos de medida aplicados y de los sesgos de selección.Parkinson’s disease (PD) is a chronic and progressive disorder. It produces a significant burden not only for patients, but also for their family and caregivers, with a major socio-economic impact on society. Current knowledge on PD is characterized by scarce information about the evolutionary course of: 1) the non-motor PD features; 2) impact of non-motor PD features on disability and health related quality of life (HRQL) impairment; 3) factors related to disability and HRQL determinants; 4) factors that speed or slow the progression of PD; 5) differential long-term effect of available PD therapeutic schedules and their relationships with disability, complications, and HRQL; and 6) impact of the disease on patients’ caregivers. In addition, heterogeneity in the metric quality of the applied measures and selection bias are frequently foundA doença de Parkinson (DP) é crónica e progresiva. De uma perspectiva socio-sanitária, representa uma fonte de sufrimento para o paciente e seus cuidadores, assim como uma carga importante para a sociedade. A informação actual sobre a DP é limitada em quanto ao conhecimento do curso evolutivo relacionado com: 1) o desenvolvimento e a evolução dos aspectos não motores da doença; 2) o impacto destas manifestações sobre a discapacidade e a qualidade de vida relacionada com a saúde (QVRS); 3) os determinantes da discapacidade e da diminuição de QVRS; 4) os factores relacionados com a velocidade de progressão da doença; 5) as pautas de aplicação e a repercursão diferencial a longo prazo (sobre complicações, discapacidade, QVRS) das medidas terapêuticas disponíveis; e 6) o impacto da DP sobre os cuidadores. Além disso, na informação disponível há uma heterogeneidade na qualidade das propriedades métricas dos instrumentos de medida aplicados e dos enviesamentos de selecção

Incidence and clinical manifestations of giant cell arteritis in Spain: results of the ARTESER register

Objective This study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season.Methods We included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged ≥50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season.Results We identified 1675 cases of GCA with a mean age at diagnosis of 76.9±8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people ≥50 years with a peak for patients aged 80–84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients.Conclusions This is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year