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BACKGROUND: Sex differences in atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolaemia have been reported but are not fully established. We aimed to assess sex differences in the risk of ASCVD and life-time burden of ASCVD in patients with heterozygous familial hypercholesterolaemia. METHODS: SAFEHEART is a nationwide, multicentre, long-term prospective cohort study conducted in 25 tertiary care hospitals and one regional hospital in Spain. Participants in the SAFEHEART study aged 18 years or older with genetically confirmed familial hypercholesterolaemia were included in our analysis. Data were obtained between Jan 26, 2004, and Nov 30, 2022. ASCVD and age at onset were documented at enrolment and at follow-up. Our aim was to investigate the differences by sex in the risk and burden of ASCVD in patients with heterozygous familial hypercholesterolaemia, over the study follow-up and over the life course. The SAFEHEART study is registered with ClinicalTrials.gov, NCT02693548. FINDINGS: Of the 5262 participants in SAFEHEART at the time of analysis, 3506 (1898 [54·1%] female and 1608 [45·9%] male participants) met the inclusion criteria and were included in the current study. Mean age was 46·1 years (SD 15·5) and median follow-up was 10·3 years (IQR 6·4-13·0). Mean on-treatment LDL-cholesterol at follow-up was 3·1 mmol/L (SD 1·4) in females and 3·0 mmol/L (1·5) in males. LDL-cholesterol reductions over time were similar in both sexes (1·39 mmol/L [95% CI 1·30-1·47] absolute reduction in females vs 1·39 mmol/L [1·29-1·48] in males; p=0·98). At enrolment, 130 (6·8%) females and 304 (18·9%) males (p<0·0001) had cardiovascular disease. During follow-up, 134 (7·1%) females and 222 (13·8%) males (p<0·0001) had incident cardiovascular events. Median age at first ASCVD event (mostly due to coronary artery disease) was 61·6 years (IQR 50·0-71·4) in females and 50·6 years (42·0-58·6) in males (p<0·0001). The adjusted hazard ratio for ASCVD in males compared with females during follow-up was 1·90 (95% CI 1·49-2·42) and for cardiovascular death was 1·74 (1·11-2·73). Major adverse cardiovascular disease event (MACE)-free survival from birth was lower in males than females (hazard ratio 3·52 [95% CI 2·98-4·16]; p<0·0001). Median MACE-free survival time was 90·1 years (95% CI 86·5-not estimable) in females and 71·0 years (69·2-74·6) in males. The age at which 25% of female participants have had a MACE event was 74·9 years, this figure was 55·5 years in male participants. INTERPRETATION: Our findings suggest that the burden and risk of ASCVD are markedly lower in females than males with familial hypercholesterolaemia. The impact of sex needs to be considered to improve risk stratification and personalised management in patients with heterozygous familial hypercholesterolaemia. FUNDING: Fundación Hipercolesterolemia Familiar, the Instituto de Salud Carlos III, and Next Generation EU funds from the Recovery and Resilience Mechanism Program. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.
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Aterosclerose , Hiperlipoproteinemia Tipo II , Humanos , Masculino , Feminino , Hiperlipoproteinemia Tipo II/epidemiologia , Espanha/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Aterosclerose/epidemiologia , Idoso , Fatores Sexuais , Heterozigoto , Fatores de Risco , Doenças Cardiovasculares/epidemiologia , SeguimentosRESUMO
Arcobacter butzleri is a foodborne pathogen that mainly causes enteritis in humans, but the number of cases of bacteraemia has increased in recent years. However, there is still limited knowledge on the pathogenic mechanisms of this bacterium. To investigate how A. butzleri causes disease, single knockout mutants were constructed in the cadF, ABU_RS00335, ciaB, and flaAB genes, which might be involved in adhesion and invasion properties. These mutants and the isogenic wild-type (WT) were then tested for their ability to adhere and invade human Caco-2 and HT29-MTX cells. The adhesion and invasion of A. butzleri RM4018 strain was also visualized by a Leica CTR 6500 confocal microscope. The adhesion and invasion abilities of mutants lacking the invasion antigen CiaB or a functional flagellum were lower than those of the WTs. However, the extent of the decrease varied depending on the strain and/or cell line. Mutants lacking the fibronectin (FN)-binding protein CadF consistently exhibited reduced abilities, while the inactivation of the other studied FN-binding protein, ABU_RS00335, led to a reduction in only one of the two strains tested. Therefore, the ciaB and flaAB genes appear to be important for A. butzleri adhesion and invasion properties, while cadF appears to be indispensable.
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Adesinas Bacterianas , Arcobacter , Aderência Bacteriana , Flagelos , Aderência Bacteriana/genética , Humanos , Arcobacter/genética , Células CACO-2 , Adesinas Bacterianas/genética , Adesinas Bacterianas/metabolismo , Flagelos/genética , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Técnicas de Inativação de Genes , Células HT29 , Fibronectinas/metabolismo , Fibronectinas/genética , Fatores de Virulência/genética , Fatores de Virulência/metabolismo , Genes Bacterianos/genética , Células Epiteliais/microbiologia , Virulência/genéticaRESUMO
The impact of global warming on Argentine viticulture may result in a geographical shift, with wine-growing regions potentially moving towards the southwest, known as one of the windiest regions in the world. Deficit irrigation is a widely used strategy to control the shoot growth and improve fruit quality attributes, such as berry skin polyphenols. The present study aimed to assess the effects of different wind intensities and irrigation levels, as well as their interactions, on field-grown Vitis vinifera L. cvs. Malbec and Cabernet Sauvignon. The experiment was conducted during two growing seasons with two wind treatments (sheltered and exposed) and two irrigation treatments (well-watered and moderate deficit irrigation) in a multifactorial design. Vegetative growth, stomatal conductance, shoot biomass partition, fruit yield components and berry skin phenolics were evaluated. Our study found that, generally, wind exposure reduced vegetative growth, and deficit irrigation increased the proportion of smaller berries within the bunches. Meanwhile, deficit irrigation and wind exposure additively increased the concentration of berry skin phenolics. Combined stressful conditions enhance biomass partition across the shoot to fruits in Malbec, increasing the weight of bunches and the number of berries. Our findings offer practical implications for vineyard managers in windy regions, providing actionable insights to optimize grapevine cultivation and enhance wine quality.
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In Latin America, obesity rates are among the highest in the world. Currently, people with obesity (PWO) receive suboptimal care due to several challenges and barriers. The international ACTION-IO study aimed to identify perceptions, attitudes and behaviours of PWO and healthcare providers (HCP), and to assess potential barriers to effective obesity care. The aim of this subanalysis of the Chilean cohort was to compare their characteristics, perceptions, attitudes and behaviours according to the percentage of weight loss (lower weight loss [LWL; ≤10%] or higher weight loss [HWL; >10%] of basal weight). The ACTION-IO survey was completed by 1000 Chilean PWO and 200 HCPs. Mean age of PWO was 38 years (range 18-75); 62% were female. The majority had class I obesity. HWL subgroup represented 17.2% of all Chilean subset. Specific characteristics of patients with HWL were identified (higher educational level, lower proportion of class III obesity, preference for consulting obesity specialists, considering conversations with HCP as very helpful). HWL patients reported higher rates of favourable outcomes following HCP advice and a higher probability of attending scheduled follow-up visits. Certain demographic and behavioural variables (educational level, consultation to obesity specialists, adherence to HCP advice, follow-up scheduled visits and becoming aware of the obesity state) may identify PWO with a higher probability of a greater weight loss.
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BACKGROUND AND AIMS: Premature atherosclerotic cardiovascular disease (CVD) is a clinic characteristic of familial hypercholesterolemia (FH). Coronary calcium score (CCS) is a highly used imaging modality to evidence atherosclerotic plaque burden. microRNAs (miRNAs) are non-coding RNAs that epigenetically regulate gene expression. Here, we investigated whether CCS associates with a specific miRNA-signature in FH-patients. METHODS: Patients with genetic diagnosis of FH (N = 86) from the nationwide SAFEHEART-cohort were investigated by computed tomography angiography imaging and classified depending on the presence of coronary calcification in FH-CCS (+) and FH-CCS (-) groups by the Agatston score. Differential miRNA profiling was performed in two stages: first by Affymetrix microarray technology (high-throughput differential profiling-studies) and second by RT-PCR using TaqMan-technology (analytical RT-qPCR study) in plasma of the two patient groups. RESULTS: miR-193a-5p, miR-30e-5p and miR-6821-5p levels were significantly higher in FH-CCS (+) compared to FH-CCS (-). miR-6821-5p was the best miRNA to discriminate FH-patients CCS(+), according to receiver operating characteristic (ROC) analysis (AUC: 0.70 ± 0.06, p = 0.006). High miR-6821-5p levels were associated with older age (p = 0.03) and high LDL-burden (p = 0.014) using a ROC-derived cut-off value. However, miR-6821-5p did not correlate with age in either the CCS- or CCS + group. Genes involved in calcification processes were identified by in silico analysis. The relation of cell-calcification and expression levels of miR-6821-5p, BMP2 and SPP1 was validated experimentally in human vascular smooth muscle cell cultures. CONCLUSIONS: Up-regulated levels of miR-6821-5p are found in the plasma of asymptomatic FH-patients with coronary calcified atherosclerotic plaques, as well as in isolated human vascular smooth muscle cells expressing the pro-calcification genes BMP2 and SPP1. These findings highlight the impact of epigenetic regulation on the development of subclinical atherosclerosis.
Assuntos
Doença da Artéria Coronariana , Hiperlipoproteinemia Tipo II , MicroRNAs , Calcificação Vascular , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/genética , Hiperlipoproteinemia Tipo II/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/sangue , Calcificação Vascular/genética , Calcificação Vascular/diagnóstico por imagem , MicroRNAs/sangue , MicroRNAs/genética , Adulto , Doenças Assintomáticas , Angiografia por Tomografia Computadorizada , MicroRNA Circulante/sangue , MicroRNA Circulante/genética , Angiografia Coronária , Células Cultivadas , Placa Aterosclerótica/sangue , Biomarcadores/sangue , Perfilação da Expressão Gênica , Idoso , Miócitos de Músculo Liso/metabolismo , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Curva ROCRESUMO
AIM: We aimed to describe clinical and genetic characteristics, lipid-lowering treatment and atherosclerotic cardiovascular disease (ASCVD) outcomes over a long-term follow-up in homozygous familial hypercholesterolemia (HoFH). METHODS: SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) is a long-term study in molecularly diagnosed FH. Data analyzed in HoFH were prospectively obtained from 2004 until 2022. ASCVD events, lipid profile and lipid-lowering treatment were determined. RESULTS: Thirty-nine HoFH patients were analyzed. The mean age was 42 ± 20 years and nineteen (49%) were women. Median follow-up was 11 years (IQR 6,18). Median age at genetic diagnosis was 24 years (IQR 8,42). At enrolment, 33% had ASCVD and 18% had aortic valve disease. Patients with new ASCVD events and aortic valve disease at follow-up were six (15%), and one (3%), respectively. Median untreated LDL-C levels were 555 mg/dL (IQ 413,800), and median LDL-C levels at last follow-up was 122 mg/dL (IQR 91,172). Most patients (92%) were on high intensity statins and ezetimibe, 28% with PCSK9i, 26% with lomitapide, and 23% with lipoprotein-apheresis. Fourteen patients (36%) attained an LDL-C level below 100 mg/dL, and 10% attained an LDL-C below 70 mg/dL in secondary prevention. Patients with null/null variants were youngers, had higher untreated LDL-C and had the first ASCVD event earlier. Free-event survival is longer in patients with defective variant compared with those patients with at least one null variant (p=0.02). CONCLUSIONS: HoFH is a severe life threating disease with a high genetic and phenotypic variability. The improvement in lipid-lowering treatment and LDL-C levels have contributed to reduce ASCVD events.
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Anticolesterolemiantes , LDL-Colesterol , Homozigoto , Hiperlipoproteinemia Tipo II , Humanos , Hiperlipoproteinemia Tipo II/genética , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/complicações , Feminino , Masculino , Adulto , Seguimentos , Pessoa de Meia-Idade , LDL-Colesterol/sangue , Resultado do Tratamento , Anticolesterolemiantes/uso terapêutico , Estudos Prospectivos , Adulto Jovem , Espanha/epidemiologia , Fatores de Tempo , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Biomarcadores/sangue , Fenótipo , Pró-Proteína Convertase 9/genética , Pró-Proteína Convertase 9/metabolismo , Ezetimiba/uso terapêuticoRESUMO
Objectives: Individuals with familial hypercholesterolemia (FH) are at an increased risk for coronary artery disease (CAD). While prior research has shown variability in coronary artery calcification (CAC) among those with FH, studies with small sample sizes and single-center recruitment have been limited in their ability to characterize CAC and plaque burden in subgroups based on age and sex. Understanding the spectrum of atherosclerosis may result in personalized risk assessment and tailored allocation of costly add-on, non-statin lipid-lowering therapies. We aimed to characterize the presence and burden of CAC and coronary plaque on computed tomography angiography (CTA) across age- and sex-stratified subgroups of individuals with FH who were without CAD at baseline. Methods: We pooled 1,011 patients from six cohorts across Brazil, France, the Netherlands, Spain, and Australia. Our main measures of subclinical atherosclerosis included CAC ranges (i.e., 0, 1-100, 101-400, >400) and CTA-derived plaque burden (i.e., no plaque, non-obstructive CAD, obstructive CAD). Results: Ninety-five percent of individuals with FH (mean age: 48 years; 54% female; treated LDL-C: 154 mg/dL) had a molecular diagnosis and 899 (89%) were on statin therapy. Overall, 423 (42%) had CAC=0, 329 (33%) had CAC 1-100, 160 (16%) had CAC 101-400, and 99 (10%) had CAC >400. Compared to males, female patients were more likely to have CAC=0 (48% [n = 262] vs 35% [n = 161]) and no plaque on CTA (39% [n = 215] vs 26% [n = 120]). Among patients with CAC=0, 85 (20%) had non-obstructive CAD. Females also had a lower prevalence of obstructive CAD in CAC 1-100 (8% [n = 15] vs 18% [n = 26]), CAC 101-400 (32% [n = 22] vs 40% [n = 36]), and CAC >400 (52% [n = 16] vs 65% [n = 44]). Female patients aged 50-59 years were less likely to have obstructive CAD in CAC >400 (55% [n = 6] vs 70% [n = 19]). Conclusion: In this large, multi-national study, we found substantial age- and sex-based heterogeneity in CAC and plaque burden in a cohort of predominantly statin-treated individuals with FH, with evidence for a less pronounced increase in atherosclerosis among female patients. Future studies should examine the predictors of resilience to and long-term implications of the differential burden of subclinical coronary atherosclerosis in this higher risk population.
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Background: Familial hypercholesterolemia (FH) is commonly associated with mutations in-LDL receptor (LDLR), apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9). Aim: To identify genetic variants associated with FH in a population of children and adolescents with hypercholesterolemia or a family history of-demonstrated early CVD. Material and Methods: Clinical and biochemical parameters were evaluated, and nine genes related to FH were sequenced namely LDLR, APOB, PCSK9, LDLRAP1, LIPA, APOE, ABCG5, ABCG8 and STAP1, in 55 children and adolescents aged 1 to 18 years old, from non-consanguineous families. Results: Mutations associated with FH were found in 17 children and adolescents, corresponding to p.Asp47Asn, duplication of exons 13-15 and p.Ser326Cys of the LDLR gene; p.Glu204* and Ile268Met of the APOE gene. Thirteen patients were heterozygous, two homozygous, two compound heterozygous, and one double heterozygous. Conclusions: Children and adolescents carrying mutations associated with FH were found by selective screening, which constitutes the first stage in the identification of genetic variants in our country.
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Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Pró-Proteína Convertase 9/genética , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/genética , Hiperlipoproteinemia Tipo II/epidemiologia , Chile , MutaçãoRESUMO
Resumen La infección es una complicación infrecuente de los aneurismas de la aorta abdominal. Campylobacter fetus tiene un especial tropismo por el endotelio vascular y ha sido reportado como causa de infección de aneurismas aórticos. Este tipo de infección es de alta mortalidad por lo que el reconocimiento temprano con el inicio precoz de terapia antibacteriana efectiva es clave. Además del tratamiento médico, puede requerirse cirugía, la que tiene una alta letalidad en pacientes inestables y con comorbilidades. Comunicamos el caso clínico de un adulto mayor con un aneurisma de aorta abdominal infectado por C. fetus. Dado su compromiso del estado general y antecedentes cardiovasculares se decidió tratamiento médico con imipenem, con una buena respuesta clínica y microbiológica, sin recurrencia de los síntomas. También se presenta una revisión de los casos publicados.
Abstract Infection is a rare complication of abdominal aortic aneurysms. Campylobacter fetus has special tropism for vascular endothelium. It has been reported as a cause of infected abdominal aortic aneurysms. The mortality of these patients is high, so an early recognition with a start of antibiotic therapy is crucial. In addition to medical treatment surgery may be required, which has high mortality in patients with many diseases and unstable. We report the case of an old man with infected abdominal aortic aneurysm with C. fetus, whom was decided to be treated with imipenem, due to his cardiovascular history and his general condition at admission. The patient showed a good clinical response without recurrence of symptoms. We also carry out a review of the reported cases.
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Humanos , Masculino , Idoso , Aneurisma Infectado/diagnóstico por imagem , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/tratamento farmacológico , Aneurisma da Aorta Abdominal , Campylobacter fetus , Antibacterianos/uso terapêuticoRESUMO
Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.
Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.
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Humanos , Feminino , Adulto , Idoso , Pneumonia/epidemiologia , Pneumonia/diagnóstico por imagem , Pneumonia Pneumocócica , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Infecções Comunitárias Adquiridas/epidemiologia , Streptococcus pneumoniae , Estudos Retrospectivos , HospitalizaçãoRESUMO
ABSTRACT Background: Most of the Chilean population has overweight or obesity. The ACTION-IO survey identified the perceptions, attitudes, and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). Aim: To report the results of the survey in Chile. Material and Methods: An online survey was conducted in 11 countries. In Chile, eligible PwO were adults with a body mass index ≥ 30 kg/m2. Eligible HCPs were physicians involved in direct patient care. Results: The survey was completed by 1,000 PwO and 200 HCPs in Chile. Seventy four percent of PwO and 95% of HCPs agreed that obesity was a chronic disease. Most PwO (79%) assumed responsibility for their own weight loss, while 47% of HCPs considered weight loss to be the sole responsibility of their patients. Both 82% of PwO and 97% of HCPs believed that lack of exercise was a key barrier to weight loss. Sixty six percent of PwO and 58% HCPs noted that the cost of weight management medications, programs, and services was another barrier. Compared with HCPs, more PwO felt that genetic factors prevented weight loss (26 and 44% respectively). Few HCPs (19%) thought that their patients were motivated to lose weight, while 55% of PwO reported being motivated. Most (70%) PwO had discussed their weight problem with their HCP in the past 5 years, and of those that had not, 89% want their HCP to start a discussion about weight. Conclusions: Chilean data reveal misconceptions among PwO and HCPs about obesity and highlights the need to improve education about its biologic background and clinical management.
Antecedentes: La población chilena tiene una alta prevalencia de sobrepeso u obesidad. La encuesta ACTION-IO, realizada en personas con obesidad (PcO) y profesionales de la salud (PdS), identificó las percepciones, actitudes y barreras para lograr un efectivo manejo de la obesidad. Objetivos: Informar los resultados de la encuesta en Chile. Material y Métodos: Se realizó una encuesta on-line en 11 países. En Chile, las PcO elegibles fueron adultos con un índice de masa corporal ≥ 30 kg/m2 y los PdS eran médicos que realizaban atención directa de pacientes. Resultados: En Chile, la encuesta fue completada por 1000 PcO y 200 PdS. Un 74% de las PcO y 95% de los PdS consideraron que la obesidad es una enfermedad crónica. La mayoría de las PcO (79%) asumieron su total responsabilidad en la pérdida de peso, mientras que el 47% de los PdS consideraron que la pérdida de peso era responsabilidad exclusiva de los pacientes. Un 82% de las PcO y 97% de los PdS estimaron que la falta de ejercicio era una importante barrera para la pérdida de peso. Además, las PcO (66%) y los PdS (58%) refirieron que el costo de los programas, medicamentos y otros servicios constituyen barreras para el control del peso. Un 44% de las PcO y un 26% de los PdS consideraron que factores genéticos dificultaban la baja de peso. Solo el 19% de los PdS pensaban que sus pacientes estaban motivados para perder peso, mientras que el 55% de las PcO afirmaron estar motivados. La mayoría de las PcO (70%), había discutido el problema del peso con algún PdS en los últimos cinco años. De aquellas que no lo habían hecho, el 89% deseaba entablar una conversación sobre el peso con algún PdS. Conclusiones: Los datos chilenos revelan percepciones y creencias discordantes entre PcO y PdS sobre la obesidad, destacando así la necesidad de mejorar la educación sobre su base biológica y manejo clínico.
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Humanos , Adulto , Redução de Peso , Obesidade/terapia , Obesidade/epidemiologia , Chile/epidemiologia , Inquéritos e Questionários , Pessoal de SaúdeRESUMO
La depresión y la obesidad son patologías altamente prevalentes y corresponden a los principales problemas de salud pública. Estas patologías tienen un gran impacto en la morbilidad y mortalidad de los pacientes y afectan la salud y el bienestar de quienes las padecen, así como también afectan en el aspecto socioeconómico consecuencia del deterioro funcional y el gasto de recursos en salud ocasionados. Resultados de estudios epidemiológicos, ensayos clínicos y meta-análisis apoyan la asociación entre los estados depresivos y la obesidad, ya que ambos ocurren conjuntamente en todas las razas de poblaciones evaluadas. El objetivo es abordar la evidencia con respecto a 4 aspectos: (1) obesidad y respuesta a los antidepresivos, (2) trastornos depresivos y su impacto sobre la progresión de la obesidad, (3) tratamiento de la obesidad y el impacto sobre los resultados entre pacientes con trastornos depresivos, (4) el tratamiento de los trastornos depresivos y su impacto sobre los resultados de la obesidad. La evidencia existente apoya la asociación entre obesidad y los resultados adversos para la salud en individuos con trastornos depresivos. Además, destaca el concepto que el tratamiento de una de las dos enfermedades (obesidad o trastornos depresivos) es relevante para mejorar el curso de la otra patología. Puede ser beneficioso explorar dirigidamente la presencia de un trastorno depresivo en sujetos con sobrepeso u obesidad, así como el aumento de peso en personas con depresión. Conocer el efecto de los fármacos antidepresivos sobre el peso corporal es también relevante para facilitar la adherencia al tratamiento en el largo plazo.
Depression and obesity are highly prevalent illness and a mayor public health concern. These diseases have a great impact on morbidity and mortality of patients and affect the health and well-being of those who suffer them, as well as being affected in the socioeconomic aspect as a result of the functional deterioration and the spending of resources. Results of epidemiological studies, clinical trials and meta-analysis support the association between mood disorders and obesity, since both occur together in all the populations evaluated. The objective is to address the evidence regarding four aspects: (1) obesity and response to antidepressants, (2) depressive disorders and their effect on the progression of obesity, (3) treatment of obesity and the effect on outcomes among patients with depressive disorders, (4) the treatment of depressive disorders and their effect on obesity outcomes. Existing evidence supports the association between obesity and adverse health outcomes in individuals with depressive disorders. In addition, it highlights the concept that the treatment of one of the two diseases (obesity or depressive disorders) is relevant to improve the course of the other disease. It may be beneficial to explore the presence of a depressive disorders in overweight or obese subjects, as well as weight gain in subjects with depression. Knowing the effect of antidepressant drugs on body weight is relevant to facilitate adherence to long-term treatment.
Assuntos
Humanos , Transtorno Depressivo/psicologia , Transtorno Depressivo/epidemiologia , Obesidade/psicologia , Obesidade/epidemiologia , Peso Corporal , Índice de Massa Corporal , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/tratamento farmacológico , Sobrepeso , Antidepressivos/uso terapêutico , Obesidade/fisiopatologia , Obesidade/terapiaRESUMO
Introducción: El objetivo de este estudio es analizar nuestros resultados clinico-radiologicos con el uso de copas de tantalio trabecular para la reconstruccion de acetabulos complejos, tanto en cirugias primarias como en revisiones, y compararlos con series similares de otros autores. Materiales y Métodos: Se llevo a cabo una revision retrospectiva de una serie de 42 cirugias (29 revisiones y 13 artroplastias primarias) en 40 pacientes, entre marzo de 2010 y marzo de 2016. La serie incluyo a 20 mujeres y 20 hombres, con una edad promedio de 60 anos (rango 27-93). El seguimiento promedio fue de 37 meses (rango 12-84). Todos los pacientes fueron tratados con el mismo tipo de metal trabecular. Resultados: Al promedio de seguimiento mencionado la supervivencia del componente acetabular fue del 97,6%. Un paciente fue tratado con artroplastia de reseccion debido a una infeccion persistente. La tasa de complicaciones totales fue del 12% y el promedio del Harris Hip Score posoperatorio fue de 81,54 (rango 63,25-92,75). Conclusiones: Aunque se necesita un seguimiento mas prolongado, el uso de copas de metal trabecular logra resultados prometedores para el tratamiento de acetabulos complejos. Nivel de Evidencia: IV
Introduction: The purpose of this paper is to review of our clinical and radiological results with the use of trabecular metal cups for complex acetabular reconstruction, both in primary and revision total hip arthroplasties, and to compare our results with those in similar series from other authors. Methods: A series of 42 surgeries (29 hip revisions and 13 primary total hip arthroplasties) in 40 patients, between March 2010 and March 2016 was retrospectively reviewed. The series included 20 women and 20 men, with a mean age of 60 years (range 27-93). The mean follow-up was 37 months (range 12-84). All patients were treated with the same type of trabecular metal. Results: At the average follow-up, the survival of the acetabular component was 97.6%. One patient required resection arthroplasty due to persistent infection. Overall complication rate was 12% and the average postoperative Harris Hip Score was 81.54 (range 63.25-92.75). Conclusions: Despite further follow-up is needed, trabecular metal cup use for complex acetabular reconstruction shows promising results. Level of Evidence: IV
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Tantálio , Artroplastia de Quadril/métodos , Procedimentos de Cirurgia Plástica/métodos , Articulação do Quadril/cirurgia , Acetábulo/cirurgia , Seguimentos , Resultado do TratamentoRESUMO
En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad escasamente atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA), se organizó un grupo de expertos que se ha denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para generar un documento con análisis de su prevalencia y ofrecer recomendaciones prácticas. Se utilizó la metodología Delphi modificada, con revisión comprensiva de la literatura con énfasis en aquellas publicaciones con implicaciones para LA. Subsecuentemente, se desarrollaron preguntas claves para ser discutidas. En LA no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. Múltiples causas se han reconocidos, como alta ingesta de alimentos de mayor densidad calórica, contenido de colesterol, grasas trans, sedentarismo y cambios epigenéticos. La DA bien puede ser tratada con los cambios terapéuticos del estilo de vida (CTEV) con incremento en la actividad física, ejercicio regular y dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA.
In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document for analyzing its prevalence and to offer practical recommendations. Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. In LA there is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2%, more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increased in physical activities, regular exercise and a diet with a low proportion of carbohydrates y rich in poliunsatured fatty acid, such as omega-3 fatty acid as primary intervention. If needed, this strategie must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3.fatty acid. Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are its cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated. It is important and neccesary to design a global study of risk factors in LA to know the true prevalence of AD.
RESUMO
En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad no muy atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA). Métodos: organizamos un grupo de expertos denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para así generar un documento con análisis de su prevalencia y recomendaciones terapéuticas prácticas. Se utilizó la metodología Delphi modificada, con una revisión integral de la literatura y énfasis en las publicaciones con implicaciones para LA. Subsecuentemente, desarrollamos preguntas claves para ser discutidas. Resultados: En Latinoamérica (LA) no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. La DA bien puede ser tratada con los cambios del estilo de vida (CTEV) como ncremento en laactividad física, dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Conclusiones: Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA(AU)
In the current clinical guidelines, atherogenic Med Interna (Caracas) 2017; 33 (3): 121 - 139 Dislipidemia Aterogénica en Latino América: Prevalencia, causas y tratamiento Carlos I. Ponte-N, Jesús E. Isea-Pérez, Alberto J. Lorenzatti, Patricio López-Jaramillo, Fernando Stuardo Wyss-Q, Xavier Pintó, Fernando Lanas, Josefina Medina, Livia T. Machado-H, Mónica Acevedo, Paola Varleta Alfonso Bryce, Carlos Carrera, Carlos Ernesto Peñaherrera, José Ramón Gómez-M, Alfredo Lozada, Alonso Merchan-V, Daniel Piskorz, Enrique Morales, María Paniagua, Félix Medina-Palomino, Raúl Alejandro Villar-M, Leonardo Cobos, Enrique Gómez-Álvares, Rodrigo Alonso, Juan Colan, Julio Chirinos, Jofre Lara, Vladimir Ullauri, Ildefonso Arocha Documento de la posición de expertos de la Academia Latino Americana para el estudio de los Lípidos (ALALIP) y avalado por la Sociedad Interamericana de Cardiología (SIAC), Sociedad Sur Americana de Cardiología (SSC), el Colegio Panamericano de Endotelio (CPAE) y la Sociedad Internacional de Aterosclerosis (IAS). Publicado en conjunto con las Revistas de la Sociedad Venezolana de Medicina Interna y de la Sociedad Venezolana de ndocrinología y Metabolismo. dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document to analize it´s prevalence and to offer practical recommendations. Methodology: Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. Results: In LA There is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2% more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increase in physical activities, regular exercise and a diet with a low proportion of carbohydrates and rich in poliunsatured fatty acid, such as omega-3 fatty acids as primary intervention. If needed, this strategy must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3. fatty acid. conclusions: Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are the cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated It is important and necesary to design a global study of risk factors in LA to know the true prevalence of AD(AU)
Assuntos
Humanos , Masculino , Feminino , Dieta Aterogênica/efeitos adversos , Aterosclerose/etiologia , Dislipidemias/complicações , Doenças Cardiovasculares , Epidemiologia , Medicina InternaRESUMO
Statins are the preferred treatment for hypercholesterolemia and several studies have demonstrated their long-term safety and efficacy in reducing cardiovascular morbidity and mortality. However, in some cases of severe hypercholesterolemia such as homozygous and heterozygous familial hypercholesterolemia or statin intolerant patients, statins can be less efficient. In recent years, new lipid-lowering agents with novel mechanisms of action have been developed to reduce LDL-cholesterol in patients with severe hypercholesterolemia, associated or not to conventional lipid-lowering therapy. These therapies include microsomal transfer protein inhibitor (Lomitapide), antisense oligonucleotide to Apo B100 (Mipomersen) and monoclonal antibodies against Proprotein convertase subtilisin/kexin type 9 (PCSK9). Different studies have shown the great effectiveness of these new therapies. Short-term studies confirmed their adequate security profile, especially in patients with homozygous familiar hypercholesterolemia or severe hypercholesterolemia. Some of these agents have been also tested in statin-intolerant patients. However, long-term studies are needed to evaluate their safety, effectiveness and impact on cardiovascular risk reduction.