Complicated osteoporosis in progeroid syndrome: treatment with teriparatide.

Human progeroid syndromes (PSs) include a group of genetic "premature aging" diseases that affect a variety of organ systems. Bone diseases are common sequelae of patients diagnosed with PSs. Teriparatide therapy is recommended for elderly men with low bone mineral density (BMD; T-score <-2.5) and at least 1 fragility fracture who are unable to tolerate bisphosphonates. We describe a 20-yr-old patient affected by PS and severe osteoporosis complicated with femoral fracture. The patient experienced a significant improvement in lumbar spine BMD after treatment with teriparatide.

Morphological, clinical, and functional efficacy in the short and medium-term after radiofrequency treatment of predominantly solid, large, and clinically relevant thyroid nodules in patients who are not candidates for surgery: The experience after 100 procedures.

INTRODUCTION: Thyroid nodules (TN) are a prevalent pathology that can generate morbidity, in which case the traditional treatment is usually surgery. OBJECTIVE: To analyse the efficacy of radiofrequency ablation (RFA) treatment as a therapeutic alternative in the combined clinical, morphological, and functional control of predominantly solid, benign and clinically relevant TNs in patients not subsidiary to surgery. MATERIALS AND METHODS: A descriptive, retrospective, case series study was carried out to assess the efficacy and safety of the use of RFA. According to medical criteria, the selected patients underwent a clinical, ultrasound, and biochemical assessment prior to the procedure and then after the procedure at 1, 3, 6, and 12 months and then every 6-12 months according to medical criteria. RESULTS: A total of 100 RFA were performed on 83 patients with 85 TNs of ≥2.5 cm with an initial volume (IV) of 21.48 ±â€¯15.89 ml. After a mean of 1.17 RFA sessions per TN, the volume decreased progressively and significantly (p < 0.01 for all times compared to the initial value), with a mean volume reduction rate (VRR) in relation to the IV of 54.43 ±â€¯19.56% at 1-month follow-up; 67.69 ±â€¯17% at 3 months; 70.38 ±â€¯15.46% at 6 months; 70.67 ±â€¯17.27% at 12 months and 70.24 ±â€¯17.7% at the last follow-up. 88% of the patients followed up >6 months achieved the combined objective of a volume reduction rate of more than 50% of the VI, thyroid normal function and absence of clinic; and in all of these, it was maintained until the final follow-up date. Acute complications (mostly mild and all transient) were reported in 9 of the 100 RFA performed. CONCLUSION: Our findings validate in our setting the efficacy and safety of RFA in predominantly large and solid TNs, and add undescribed information to position the technique more favourably as a therapeutic alternative.

[Effect of abdominal obesity on size of myocardial infarction]. / Impacto de la obesidad central en la extensión del área de necrosis miocárdica.

OBJECTIVE: Metabolic syndrome consists of a group of factors that predict the risk of having an acute cardiovascular event. Some of these factors increase the risk of myocardial infarction and are also associated with the severity of cardiovascular events. The objective was to determine the influence of factors associated with metabolic syndrome, and especially abdominal obesity, on the size of coronary events, estimated by the concentration of total creatine phosphokinase (CPK) and CPK-MB isoenzyme (CPK-MB). SUBJECTS AND METHOD: We performed a cross-sectional study of 40 men diagnosed with acute coronary syndrome. We collected clinical data (age, history of diabetes, dyslipidemia and hypertension ) and anthropometric data [body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR)]. CPK and CPK-MB concentrations were measured to determine the maximum concentration reached in order to estimate the size of the myocardial infarction area. RESULTS: The prevalence of metabolic syndrome was 30%. Approximately 84% of the patients were overweight and 42% had abdominal obesity. A positive association was found between myocardial enzymes and anthropometric parameters (BMI, WC, WHR). The variable showing the closest association with the size of myocardial infarction was central obesity [total CPK, r (Pearson) = 0.47; p<0.003] and (CPK-MB, r= 0.4; p<0.01). Metabolic syndrome was not a predictive factor for the size of myocardial necrosis (beta=-0.29; p<0.1). Multiple regression analysis showed that WC predicted maximal total CPK (beta=37.15; 95% CI, 9.16-65.15; p<0.01) and CPK-MB concentrations (beta=5.7; 95% CI, -0.4-11.9; p< 0.06) after an acute coronary event. CONCLUSIONS: The presence of abdominal obesity was associated with greater myocardial necrosis size after an acute coronary event.

[Relationship of body composition measured by DEXA with lifestyle and satisfaction with body image in university students]. / Relación de la composición corporal medida por DEXA con el estilo de vida y la satisfacción con la imagen corporal en estudiantes universitarios.

INTRODUCTION: Introduction: body mass index (BMI) can under-diagnose overweight and obesity as it is a surrogate measure of central adiposity, making it necessary to define more adequate variables for its correct diagnosis. Objective: to compare the categorization of overweight and obesity according to the percentage of fat measured with dual-energy X-ray absorptiometry (DEXA) with the BMI and the Clínica Universidad de Navarra - Body Adiposity Estimator (CUN-BAE) formula, as well as their relationship with adherence to the Mediterranean diet, physical activity and satisfaction with body image. Subjects and methods: cross-sectional study conducted in 64 medical students. We determined weight, height, waist circumference, percentage of fat measured with DEXA, adherence to the Mediterranean diet, level of physical activity and degree of satisfaction with body image. Results: BMI underdiagnoses overweight with respect to the percentage of fat measured by DEXA while CUN-BAE has a good correlation. Percentage of fat is inversely associated with satisfaction with body image more strongly than the BMI. Conclusion: the limitations of BMI to diagnose excess body fat pose the need for new tools to distinguish patients with normal BMI whose percentage of body fat is high. It would be useful to assess whether the use of a questionnaire of satisfaction with body image in people classified as normal weight could distinguish individuals with a higher probability of excess of fat, and thus, employ more accurate study methods in this group.

INTRODUCCIÓN: Introducción: el índice de masa corporal (IMC) es una medida subrogada de la adiposidad corporal, por lo que puede infradiagnosticar sobrepeso y obesidad, lo que hace necesario definir variables más adecuadas para su correcto diagnóstico. Objetivo: comparar la categorización de sobrepeso y obesidad según el porcentaje de grasa medido con absorciometría de rayos X de energía dual (DEXA) con el IMC y la fórmula Clínica Universidad de Navarra - Body Adiposity Estimator (CUN-BAE), así como su relación con la adherencia a la dieta mediterránea, la actividad física y la satisfacción con la imagen corporal. Sujetos y métodos: estudio descriptivo transversal llevado a cabo en una muestra de 64 estudiantes de Medicina. Se determinaron peso, talla, perímetro de cintura, porcentaje de grasa medido con DEXA, adherencia a la dieta mediterránea, nivel de actividad física y satisfacción con la imagen corporal. Resultados: el IMC infradiagnostica sobrepeso respecto al porcentaje de grasa medido por DEXA mientras que la ecuación CUN-BAE presenta una buena correlación. El porcentaje de grasa se asocia inversamente con la satisfacción con la imagen corporal con mayor fuerza que el IMC. Conclusión: se necesitan nuevas herramientas capaces de distinguir los casos con IMC normal cuyo porcentaje de grasa corporal está elevado. Sería útil estudiar si el empleo de un cuestionario de satisfacción con la imagen corporal en personas clasificadas como normopeso podría distinguir a aquellas con una mayor probabilidad de exceso de grasa y así emplear estudios más exhaustivos en este colectivo.

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study.

INTRODUCTION: Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

INTRODUCCIÓN: Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón no está clara. El objetivo es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional. Evaluamos: IMC antes del embarazo, aumento de peso materno total, aumento de peso durante tercer trimestre, semana gestacional de inicio y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (≤ 10) y grande para la edad gestacional (> 90). Resultados: el porcentaje de recién nacidos con peso ≤ 10 fue 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0,06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento la madre dejó de ganar 0,13 ± [(- 0,15)-(- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg versus 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su influir en el peso neonatal.

Familial hypocalciuric hypercalcemia: review of three cases.

Familial hypocalciuric hypercalcemia, also denominated familial benign hypercalcemia, is an uncommon cause of hypercalcemia. It is caused by mutations of the calcium-sensing receptor, which are inherited in an autosomal dominant high-penetrance fashion. Generally, patients are asymptomatic, and heterozygote cases are diagnosed in childhood or adulthood, when diagnostic work-up of an incidentally discovered hypercalcemia ensues. This disorder is characterized by moderate hypercalcemia, with normal parathormone levels and low urine calcium excretion. It is very important to diagnose this condition, as it does not require surgical procedures, unlike primary hyperparathyroidism, which needs parathyroidectomy in 50% of cases. We present 3 cases of familial hypocalciuric hypercalcemia belonging to the same family, and provide an updated review on the topic.

Sellar xanthogranuloma.

We report the case of a 16-year-old girl with a history of idiopathic precocious puberty and normal results on pituitary imaging scan. Ten years later, a new cranial magnetic resonance imaging scan was performed due to worsening of episodes resembling Horton's headache and a lesion suggestive of pituitary bleeding was detected. The headaches diminished with glucocorticoid administration but a severe complication, steroid psychosis, occurred. Surgical treatment and pathological study of the lesion led to the differential diagnosis between craniopharyngyoma and xanthogranuloma of the sella turcica. The clinical progression of the tumor (not visualized 10 years previously), together with preservation of pituitary and visual function both before and after surgery, gross total removal of the tumor (difficult to achieve with craniopharyngioma) and the absence of recurrence provide strong support for the diagnosis of xanthogranuloma of the sella turcica.

Role of fermented beverages in the maintenance of weight loss / Papel de las bebidas fermentadas en el mantenimiento del peso perdido.

Obesity is a very prevalent disease with multiple chronic complications that decrease or disappear after a small (5-10%) but maintained weight loss. Nevertheless, maintaining weight loss after the treatment is very difficult and it involves one of the biggest challenges to control this epidemic. Although the reasons that contribute to regain the lost weight are diverse and related to the biological response to caloric restriction and the lack of adherence to treatment, up to 20% of the patients are able to keep it off. The keys to success, involve the maintenance of healthy habits, exercise and a reasonable daily calorie intake to allow a normal way of life, without sacrificing the social life. At this point, learning to distinguish food and drink options in a society where social life often revolves around the table is very important. We review the keys to keep the weight off after a diet as well as the role of fermented beverages such as beer, in this process. In conclusion, maintenance the weight loss is harder than losing it. The mild-to-moderate consumption of fermented beverages such as beer is not associated with weight increase.

La obesidad es una enfermedad muy prevalente con múltiples complicaciones crónicas que se reducen o desaparecen tras pérdidas pequeñas (5-10%) pero mantenidas de peso. Sin embargo, mantener la pérdida de peso tras el tratamiento es muy difícil, siendo uno de los mayores retos en el control de esta enfermedad. Aunque las razones que contribuyen a recuperar el peso perdido son de diversa índole, relacionadas con la respuesta biológica a la restricción calórica y con la pérdida de adherencia al tratamiento, hasta un 20% de los pacientes son capaces de mantenerlo. Las claves del éxito están relacionadas con el mantenimiento de los hábitos de vida saludable, el ejercicio físico y una ingesta calórica razonable que permita realizar una vida normal, sin pérdida de vida social. En este sentido, aprender a distinguir las opciones de comida y bebida en una sociedad donde la vida social gira en torno a la mesa en muchas ocasiones es muy importante. Revisamos en este artículo las claves para mantener el peso tras una dieta, así como el papel de las bebidas fermentadas, en especial, la cerveza, en este proceso. En conclusión, mantener el peso perdido es más difícil que perderlo. El consumo leve-moderado de bebidas fermentadas como la cerveza no se asocia con incremento del peso.

[Non-alcoholic fatty liver in children and adolescents with excess weight and obesity]. / Hígado graso no alcohólico en pacientes con sobrepeso y obesidad infantojuvenil.

BASIS AND OBJECTIVE: Hepatic steatosis, also known as non-alcoholic fatty liver (NAFL), is the most frequent liver disease in obese children. Due to an increase in infantile obesity, it is experiencing a significant increment in incidence. Our objetives are: Estimate the prevalence of NAFL in children with excess weight and obesity using the glutamate pyruvate transaminase (GPT) value as a biochemical test and an abdominal ultrasound, and correlate the presence of hepatic steatosis with various anthropometric and biochemical parameters. PATIENTS AND METHOD: Cross-sectional prevalence study which includes children with excess weight and obesity between the ages of 5 and 15 years, between the years 2004-2012. The independent variables included were: age, sex, weight, size, body mass index (BMI), waist circumference (WC), waist size index (WSI), insulinemia, Homeostasis model assessment-insulin resistance (HOMA-R), total cholesterol, triglycerides (TG), high density lipoproteins (HDL), low density lipoproteins (LDL), glutamic-oxaloacetic transaminase (GOT), GPT and gamma-glutamyl transpeptidase (GGT). RESULTS: One hundred and twenty-six patients, with an average age of 11.94 (3.12) years were recruited. A percentage of 19.66 of the patients presented elevated GPT pathology. Of the 126 abdominal ultrasounds performed, 38 patients presented hepatic steatosis (30.15%). The levels of insulinemia, HOMA-R and LDL were significantly higher in patients with altered GPT, compared to those with normal GPT values (P=.015, P=.008 and P=.002, respectively). The patients with an objective HGNA in ultrasound, also showed greater levels of insulinemia, WC, WSI, total cholesterol, TG, LDL, GLT, GPT and GGT than the patients with normal ultrasounds, thereby achieving statistical significance in insulinemia, HOMA-R, LDL and GPT values. CONCLUSIONS: NAFL is a relatively frequent disorder in obese children and adolescents. In our study, 2 of 10 children -using GPT- and 3 of every 10 -using abdominal ultrasound- present the same. The biochemical marker which best defines it is an elevation in GPT. A modification in lifestyle which includes weight loss as a principal means of avoiding complications in adult life, is essential and necessary.

[Functional nutrition and optimal nutrition. Near or far?]. / Alimentos funcionales y nutrición óptima. Cerca o lejos?

The concept of functional food, about which scientific agreement is still lacking, springs from the field of Optimum Nutrition, aimed at modifying genetic and physiological aspects of human life and at the prevention and treatment of a growing number of diseases, far beyond merely covering nutritional requirements. From the European Union perspective, functional foods can be natural as well as industrially processed foods. The leading functional foods regarding which the soundest scientific evidence exists are probiotics, live microbial food ingredients represented mainly by fermented dairy products. Prebiotics, such as inulin-type fructans, are the trophic substrate of probiotics and potential intestinal microflora selectors. The combination of prebiotics and probiotics is termed synbiotic. Innumerable substances are known to have functional effects: soluble and insoluble fiber, phytosterols, phytoestrogens, monounsaturated and polyunsaturated fatty acids, phenol derivatives, vitamins and other phytochemicals. Functional foods exert their actions on different systems, especially the gastrointestinal, cardiovascular and immunological ones, acting too as enhancers of development and differentiation and positively modulating nutrient metabolism, gene expression, oxidative stress and the psychic sphere. The establishment of Health Claims must be firmly based upon scientific knowledge and legal regulation. Efficient biomarkers related to biological response must be found. Furthermore, it is essential to analyze possible diet or drug interactions as well as it is indispensable to conduct valid studies on humans. The prime objective must be the diet as a whole. Thus, the future challenge of a functional diet emerges.

[Prevalence of metabolic syndrome in a population of obese children and adolescents]. / Prevalencia de síndrome metabólico en una población de niños y adolescentes con obesidad.

INTRODUCTION: Childhood obesity is a major and increasing health problem for society because it increases the risk of cardiovascular disease, type 2 diabetes mellitus, and hypertension. Thus, when obese children become obese adults, effects on their health and life expectation may be devastating. OBJECTIVES: 1) To assess the prevalence of metabolic syndrome (MS) in a child population with obesity. and 2). To compare anthropometric and biochemical parameters in patients with one or two parameters of MS syndrome to those of patients who meet MS criteria. PATIENTS AND METHODS: A descriptive, cross-sectional study was conducted in children and adolescents with severe obesity (weight>p97) seen at the endocrinology department of Hospital de Getafe. Variables examined included age, sex, height, weight, body mass index (BMI),waist circumference(WC), oral glucose tolerance test (OGTT), insulin, insulin resistance (IR) measured by HOMA, triglycerides (TG), HDL, and systolic and diastolic blood pressure (SBP and DBP). The definition of MS in adolescents was made according to criteria of the International Diabetes Federation (IDF), 2007. RESULTS: A total of 133 patients, 67 males (50.4%) and 66 females (49.6%) with a mean age of 12.17 ± 3.27 years, were enrolled into the study. All patients were obese, with a weight greater than the 97 h percentile for age and sex. Prevalence of several cardiovascular risk factors was as follows: WC ≥ 90th percentile for age and sex, 100%; hypertension, 26.08%; hypertriglyceridemia ≥ 150 mg/dL, 15.94%; HDL <40 mg/dL, 10.86%; fasting blood glucose levels ≥ 100mg/dL, 7.97%. The overall prevalence of metabolic syndrome was 19.6%. A comparison of different anthropometric and biochemical parameters in patients with 1 or 2 MS criteria to those with 3 or more criteria showed that obesity and insulin resistance were significantly greater the greater the number of MS criteria met. CONCLUSIONS: 1.) Prevalence of MS in obese children and adolescents is high, 2). Arterial hypertension and hypertriglyceridemia are the most prevalent metabolic changes in the population studied and 3). Early intervention to control childhood obesity is essential to prevent cardiovascular morbidity and mortality in the future.

[Prevalence of carbohydrate metabolism disturbances in a population of children and adolescents with severe obesity]. / Prevalencia de alteraciones del metabolismo hidrocarbonado en una población infanto-juvenil con obesidad grave.

INTRODUCTION: There is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism. OBJECTIVE: To establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes. MATERIAL AND METHODS: A cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA(1c)), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure. RESULTS: A total of 133 patients were included: 67 boys (50.4%) and 66 girls (49.6%), with a mean age of 12.17±3.27 years. Fourteen patients (10.52%) had prediabetes (10 IFG, 3 IGT, 1 IFG+IGT): 7 girls and 8 boys, with a mean age of 13.2±3.3 years. One patient had DM2 (0.75%). Patients with prediabetes had significantly higher concentrations of fasting glucose (98±10.76 vs 88.53±6.3mg/d; p=0.001), insulinemia (35.38±14.22 vs 22.95±14.30µU/ml; p=0.009) and HOMA index (8.10±3.24 vs 4.89±3.27; p=0.004) than patients without impaired carbohydrate metabolism. These patients also had higher values of HbA(1c), triglycerides, blood pressure and HDL concentrations, although differences were not statistically significant. CONCLUSIONS: The prevalence of prediabetes (IFG/IGT) in children with severe obesity was high (10.52%). These patients should therefore be investigated to establish early diagnosis and appropriate treatment. Obese patients with prediabetes have significantly higher levels of insulin and insulin resistance than individuals without impaired carbohydrate metabolism.