Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment.

AIM: This guideline (GL) is aimed at providing a clinical practice reference for the management of adult patients with overweight or obesity associated with metabolic complications who are resistant to lifestyle modification. METHODS: Surgeons, endocrinologists, gastroenterologists, psychologists, pharmacologists, a general practitioner, a nutritionist, a nurse and a patients' representative acted as multi-disciplinary panel. This GL has been developed following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A systematic review and network meta-analysis was performed by a methodologic group. For each question, the panel identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for clinical practice recommendations. Consensus on the direction (for or against) and strength (strong or conditional) of recommendations was reached through a majority vote. RESULTS: The present GL provides recommendations about the role of both pharmacological and surgical treatment for the clinical management of the adult patient population with BMI > 27 kg/m2 and < 40 kg/m2 associated with weight-related metabolic comorbidities, resistant to lifestyle changes. The panel: suggests the timely implementation of therapeutic interventions in addition to diet and physical activity; recommends the use of semaglutide 2.4 mg/week and suggests liraglutide 3 mg/day in patients with obesity or overweight also affected by diabetes or pre-diabetes; recommends semaglutide 2.4 mg/week in patients with obesity or overweight also affected by non-alcoholic fatty liver disease; recommends semaglutide 2.4 mg/week as first-line drug in patients with obesity or overweight that require a larger weight loss to reduce comorbidities; suggests the use of orlistat in patients with obesity or overweight also affected by hypertriglyceridemia that assume high-calorie and high-fat diet; suggests the use of naltrexone/bupropion combination in patients with obesity or overweight, with emotional eating; recommends surgical intervention (sleeve gastrectomy, Roux-en-Y gastric bypass, or metabolic gastric bypass/gastric bypass with single anastomosis/gastric mini bypass in patients with BMI ≥ 35 kg/m2 who are suitable for metabolic surgery; and suggests gastric banding as a possible, though less effective, surgical alternative. CONCLUSION: The present GL is directed to all physicians addressing people with obesity-working in hospitals, territorial services or private practice-and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.

Correlation between body mass index and body composition in elite athletes.

AIM: The body mass index (BMI) of an athlete is directly related to his/her weight, however, whether this parameter is actually related to specific anthropometric compartments is still in debate. The aim of this study was to determine the correlation between BMI and fat, muscle and bone percentages. METHODS: To this end, body anthropometric parameters were determined in 3971 athletes according to International Society for Advancement of Kinanthropometry (ISAK) provided equations. Pearson's correlation coefficient was calculated to analyze the relation between BMI and the different anthropometric values. Intraclass correlation coefficient was calculated to validate if BMI is an adequate parameter to measure body composition. RESULTS: The average values found in the different anthropometric parameters, with the exception of bone mass percentage, increased in association with the BMI. However, this positive increase, or decrease in the case of bone mass, is only maintained up to a certain BMI value that differs depending on the parameter analyzed. Athletes that present normal BMI values (18.5-25 kg/m(2) up until 27 kg/m(2)), as well as in several cases where the athletes presented higher values (30-33 kg/m(2)), displayed positive increases for fat percentage, but not for muscle and bone. Pearson's coefficient indicates that BMI has a high correlation with fat content, but not muscle percentage, in athletes. CONCLUSIONS: As seen in the training programs, the data showed that well-trained athletes tend to display optimal muscle contents, being the fat content the only parameter that could influence BMI. However, intraclass correlation coefficient shows that BMI cannot be used as a direct measurement of body fat content in athletes.

[Markers of poor prognosis in convulsive status epilepticus]. / Factores de mal pronóstico en el estado epiléptico convulsivo.

OBJECTIVE: To characterize the variables that might be associated with mortality and the development of neurological deficits in children with convulsive status epilepticus. PATIENTS AND METHODS: Children older than 1 month and younger than 15 years who were admitted to the pediatric intensive care unit of a university hospital between 2001 and 2004 were reviewed. Epidemiologic and clinical factors that might be related to neurological outcome at discharge from the unit were analyzed. RESULTS: Forty-one patients (median age 24 months) were included. A total of 48.3% developed refractory convulsive status epilepticus. Six patients died (mortality 14.6%) during their intensive care unit stay and neurologic worsening was observed in 8.6% of survivors (adverse outcome in 22%). Symptomatic epilepsy was present in all patients who died and in 88.9% of those who recovered with severe neurologic sequelae. Uni- and multivariate analysis showed that adverse outcome was related to symptomatic origin and refractory convulsive status epilepticus (p < 0.05). CONCLUSIONS: Mortality and morbidity is high in childhood convulsive status epilepticus. Refractory convulsive status and symptomatic origin were markers of poor outcome. Children who did not have symptomatic epilepsy had a favorable outcome.

[Sexual activity in cardiac patients. An empirical study]. / Actividad sexual en enfermos/as cardíacos/as. Un estudio empírico.

OBJECTIVES: The objectives of this study are to evaluate the beliefs and views linked to sexuality and sexual behaviour, and the emotional impact of a cardiac lesion. DESIGN: A retrospective cross-sectional study of the lived experience of sexuality after the appearance of the cardiac lesion. SETTING: Hospital and primary care. PATIENTS AND OTHER PARTICIPANTS: A sample of 30 people (12 women and 18 men) with a cardiac complaint, with an average age of 69.89 for women and 60.89 for men. 89% of the men had a stable partner (with an average age of 46.25), and 50% of the women (with an average age of 71.17). MEASUREMENTS AND MAIN RESULTS: Results showed that the appearance of disease was lived as a tough blow and imposed clear limitations on sufferers' lives. Specific sexual problems linked to cardiac complaints appeared, such as difficulties with erection (50%), reduction of libido (61.1%) and of intensity of pleasure (38.9%). Sexual activity was practically non-existent in the women surveyed. CONCLUSIONS: The need to contribute a proper intervention for cardiovascular patients involves recognising the need to develop adequate programmes of sexual counselling. Health-workers must also give information on these kinds of question to cardiac patients.