Metabolic Surgery and Class 1 Obesity (< 35 kg/m2): a Prospective Study with Short-, Mid-, and Long-term Results Among Latinos.

INTRODUCTION: Metabolic surgery for managing class 1 obesity and type 2 diabetes mellitus has recently gained popularity. The Latino population presents high rates of these diseases. Reports on surgical outcomes in this population are scarce. METHODS: Prospective study with Mexican patients diagnosed with diabetes and class 1 obesity submitted to Roux-en-Y gastric bypass. The objective was to determine short-, mid-, and long-term outcomes (weight loss, metabolic, morbidity, and diabetes remission). Sub-analysis was included, based on preoperative usage of one (group A) or more (group B) oral hypoglycemic agents ± insulin. RESULTS: Fifty-one patients with a mean body mass index of 33.1 ± 1.9 kg/m2, and glycated hemoglobin 7.2 ± 1.7% were included. Significant improvements were observed in almost every parameter. At 24, 36, and 60 months, complete diabetes remission was achieved in 73.8%, 52.2%, and 50% of patients with glycated hemoglobin levels of 5.7% ± 0.8%, 5.8% ± 0.5%, and 6.1% ± 0.8%, respectively. At 24, 36, and 60 months, patients in group A (N=28) showed 90.9%, 69.2%, and 75% remission, respectively, versus patients in group B (N=23), who had remission rates of 50%, 30%, and 25% during the same period. Diabetes relapse was higher in patients using ≥ 2 oral hypoglycemic agents ± insulin before surgery. CONCLUSION: Gastric bypass is a safe and effective metabolic surgery that results in excellent mid- and long-term results among Mexicans. Patients using one drug preoperatively showed improved results and remission rates, which underscores the importance of intervening in the early stages of the disease. TRIAL REGISTRATION: Clinical Trials identifier: NCT04595396 ( www.ClinicalTrials.gov ).

Type 2 Diabetes Mellitus Remission Models Following Laparoscopic Gastric Bypass: a 4-Model Analysis in a Latino Population.

BACKGROUND: Bariatric surgery is indicated for major weight loss and for the control of associated comorbidities, particularly type 2 diabetes. Remission prediction scores have been proposed for this end, such as: DiaRem, Ad-DiaRem, ABCD, and DiaBetter. Nevertheless, they have not been evaluated all together in a specific population. METHODS: Retrospective study with Mexican patients submitted to gastric bypass with at least 12 months follow-up. All patients had BMI > 30 kg/m2 and type 2 diabetes. The primary objective was to evaluate the remission prediction performance of scores. A baseline analysis (anthropometric, biochemical, and metabolic) and remission rates were obtained. Remission scores and cut-off values were assigned based on original descriptions. A ROC analysis was performed for sensibility and specificity. RESULTS: A total of 95 patients were included. Mean age 44 years, 85.6% female with mean BMI of 44.1 kg/m2, and mean HbA1C of 7.2%. At 12 months, complete remission was obtained in 76.8%. ROC curves were plotted showing that DiaRem had 75.3% sensitivity and 68.2% specificity (AUC 0.723 p = 0.001), Ad-DiaRem had 84.9% and 50% (AUC 0.702 p = 0.002), ABCD had 57.5% and 77.3% (AUC 0.0.690 p = 0.002), and DiaBetter had 72.6% and 77.3% (AUC 0.748 p < 0.001). CONCLUSION: In Mexican patients with obesity and type 2 Diabetes, submitted to gastric bypass, remission prediction could be assessed with any current model showing satisfactory sensibility and specificity. Among such models, DiaBetter obtained the best statistical performance in our population. Type 2 diabetes remission rate at 1 year is similar to any other race or ethnicity.

Evidencia de caso: intoxicación por benzodiazepinas / Case evidence: benzodiazepine poisoning

Las benzodiazepinas, tranquilizantes menores potentes, se recomiendan actualmente para el tratamiento de la ansiedad y en el área quirúrgica como inducción terapéutica del sueño fisiológico en el paciente que va a ser intervenido, a través de un mecanismo de acción facilitan la actividad inhibidora del neurotransmisor ácido gamma-amino butírico o GABA en el sistema nervioso central. A pesar que poseen un margen de seguridad y son drogas poco tóxicas, puede ocurrir que a través de los metabolitos demetilados de las benzodiazepinas, con una vida media mayor (la del diazepan alrededor de 33 horas, con una vida media inicial de 1,0) en dosis sucesivas su acumulación sea capaz de producir reacciones adversas, así como fenómenos de farmacodependencia. Su principal vía de excreción es la orina (70 a 90) y el resto en las heces a través de la bilis. La toxicidad se manifiesta con trastornos nerviosos, gastrointestinales, hematológicos y alérgicos que ceden con la supresión del medicamento. Presentamos a continuación un caso de intoxicación por benzodiazepina de una niña de 5 años de edad que ingresa con manifestaciones neurológicas importantes. Se discutirá el caso clínico, su sintomatología, tratamiento, así como una exhaustiva investigación en la bibliografía mundial.

Benzodiazepines, powerful minor tranquilizers, are currently recommended for anxiety treatment and in surgery as a therapeutic induction to physiological sleep in a patient who is going to OR. Through a mechanism of action facilitates the inhibitory activity of the gammaaminobutyric acid (GABA) neurotransmitter of the central nervous system. Although they have a safety margin and are not very toxic drugs it could happen that through their de-methylated metabolites with a longer half-life (diazepam half-life is about 33 hours, an a starting half-life of 1,0) in consecutive doses their accumulation could cause adverse reactions as well as dependence. Their main excretion way is urine (70 a 90 ) and the rest in feces or through the bile. Their toxicity shows nervous, gastrointestinal, hematologic, and allergic disorders that subside stopping medicine. Now we present a case of benzodiazepine poisoning of a 5 years old girl that was admitted with serious neurological signs. The symptoms and , treatment of the case will be discussed, as well as a thorough research in worldwide bibliography.

Consideraciones sobre la artritis reumatoidea juvenil: con comentarios sobre el tratamiento médico y quirúrgico en una muestra de 15 pacientes / Considerations on the juvenile rheumatoid arthritis: with commentary on the medical and surgical treatment in a sample of 15 patiennts

Este trabajo analiza una muestra de 15 pacientes para evaluar el tratamiento tanto médico como quirúrgico de la Artritis Reumatoide Juvenil. Se hizo una revisión de la literatura sobre las posturas actuales en el tratamiento médico de esta enfermedad progresiva, haciendo hincapié en el importante papel que juega la cirugía preventiva como método de elección para detener o retrasar la destrucción articular. Se hace un esquema de los pasos quirúrgicos de las principales técnicas utilizadas. Al analizar los pacientes se observa que estos necesitan muchas veces múltiples intervenciones quirúrgicas en un tiempo o sucesivas en distintas articulaciones. Por supuesto que la cirugía debe ir siempre acompañada de un largo periodo de rahabilitación y mantener continuamente la medicación terapéutica