Prevalencia de Síndrome metabólico en niños y adolescentes según diferentes criterios diagnósticos y su correlación con niveles de leptina y adiponectina / Prevalence of Metabolic Syndrome in Children and Adolescents by Different Diagnostic Criteria and their Correlation with Levels Leptin and Adiponectin

Los objetivos del trabajo fueron detectar sujetos con obesidad, sobrepeso y con afecciones que componen el Síndrome Metabólico (SM) en una población infantojuvenil. Determinar la frecuencia de SM según distintos criterios y comparar entre ellos, los valores de leptina y adiponectina. Se evaluó a 700 sujetos entre 6 y 19 años mediante encuestas, medidas antropométricas y registros de presión arterial. En aquellos con 1 o más componentes del SM (n: 138-20 %) se efectuaron dosajes de glucosa, insulina, perfil lipídico, leptina y adiponectina. El SM se definió de acuerdo a Cook, a De Ferranti y a Weiss. El análisis estadístico comprendió el estudio descriptivo de medias e intervalos del 95 % de confianza (IC) y el de asociación mediante test t y chi cuadrado con un nivel de significación del 5 %. De acuerdo al índice de masa corporal, el 14 % de la muestra presentó obesidad y el 22 %, sobrepeso. Según la circunferencia de cintura, el 15 % tuvo obesidad y 6 % sobrepeso. Hubo asociación significativa entre individuos obesos o con sobrepeso con la hipertensión arterial y en menor grado con otros parámetros como el índice HOMA, c-HDL y triglicéridos. La frecuencia de SM fue según Cook del 15 %, De Ferranti de 18 % y Weiss de 14 %. La mayor proporción que se obtuvo con los criterios de De Ferranti, se debe probablemente a que los percentiles y los valores de corte son más estrictos. La media de leptina fue significativamente mayor y la media de adiponectina fue significativamente menor en los pacientes con diagnóstico de SM de acuerdo las tres clasificaciones que se utilizaron (p < 0,01). Es necesario establecer criterios uniformes para diagnosticar al SM en la infancia y adolescencia ya que no existe acuerdo respecto a su definición, pues el desarrollo y crecimiento a estas edades, dificultan el establecimiento de valores de referencia precisos. Los autores declaran no poseer conflictos de interés.

The study aims were to detect subjects with obesity, overweight and components of Metabolic Syndrome (MS) in a child and adolescent populations. Also to determine the frequency of MS according to different criteria and compare them with Leptin and Adiponectin levels. 700 subjects between 6 and 19 years through standardized surveys, anthropometric and blood pressure measurements were studied. In those with 1 or more components of MS (n: 138-20 %), blood glucose, insulin, lipid profile, leptin and adiponectin were analyzed. MS were defined according criteria of Cook, or De Ferranti or Weiss. A descriptive statistical analysis showing the mean and 95 % confidence intervals (CI) were made. The association analysis was performed by t and chi-square tests with a significance level of 5 %. In the population studied by body mass index there were a 14 % of obesity and 22 % of overweight and through a waist circumference 15 % of obesity and 6 % of overweight. There was a strong association between overweight/obesity with hypertension and in a lesser degree, with other risk factors as HOMA index, HDL-cholesterol and triglycerides. The prevalence of MS according Cook was 15 %, according to De Ferranti 18 % and Weiss was 14 %. We speculate that the major percentage was obtained with the De Ferranti criteria, because the percentiles and cut-offs are more demanding. The mean value of leptin was significantly higher and the mean value of adiponectin was significantly lower in patients with MS according to the three criteria used (p < 0.01). It is necessary to establish a uniform standards and criteria to characterize MS in childhood and adolescence because there is no agreement on its definition, due to changes during growth and development that prevent the establishment of precise cut-off values. The authors do not have conflicts of interest.

Does combined multichannel intraluminal esophageal impedance and manometry predict postoperative dysphagia after laparoscopic Nissen fundoplication?

Laparoscopic Nissen fundoplication (LNF) is an effective treatment for gastroesophageal reflux disease; however, some patients develop dysphagia postoperatively. Manometry is used to evaluate disorders of peristalsis, but has not been proven useful to identify which patients may be at risk for postoperative dysphagia. Multichannel intraluminal impedance (MII) evaluates the effective clearance of a swallowed bolus through the esophagus. We hypothesized that MII combined with manometry may detect those patients most at risk of developing dysphagia after LNF. Between March 2003 and January 2007, 74 patients who agreed to participate in this study were prospectively enrolled. All patients completed a preoperative symptom questionnaire, MII/manometry, and 24-h pH monitoring. All patients underwent LNF. Symptom questionnaires were administered postoperatively at a median of 18 months (range: 6-46 months), and we defined dysphagia (both preoperatively and postoperatively) as occurring more than once a month with a severity >or=4 (0-10 Symptom Severity Index). Thirty-two patients (43%) reported preoperative dysphagia, but there was no significant difference in pH monitoring, lower esophageal sphincter pressure/relaxation, peristalsis, liquid or viscous bolus transit (MII), or bolus transit time (MII) between patients with and without preoperative dysphagia. In those patients reporting preoperative dysphagia, the severity of dysphagia improved significantly from 6.8 +/- 2 to 2.6 +/- 3.4 (P < 0.001) after LNF. Thirteen (17%) patients reported dysphagia postoperatively, 10 of whom (75%) reported some degree of preoperative dysphagia. The presence of postoperative dysphagia was significantly more common in patients with preoperative dysphagia (P= 0.01). Patients with postoperative dysphagia had similar lower esophageal sphincter pressure and relaxation, peristalsis, and esophageal clearance to those without dysphagia. Neither MII nor manometry predicts dysphagia in patients with gastroesophageal reflux disease or its occurrence after LNF. The presence of dysphagia preoperatively is the only predictor of dysphagia after LNF.

Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder.

UNLABELLED: A strong link exists between gastroesophageal reflux disease (GERD) and airway diseases. Surgical therapy has been recommended as it is more effective than medical therapy in the short-term, but there is little data on the effectiveness of surgery long-term. We analyzed the long-term response of GERD-related airway disease after laparoscopic anti-reflux surgery (LARS). METHODS: In 2004, we contacted 128 patients with airway symptoms and GERD who underwent laparoscopic antireflux surgery (LARS) between 12/1993 and 12/ 2002. At median follow-up of 53 months (19-110 mo) we studied the effects on symptoms, esophageal acid exposure, and medication use and we analyzed the data to determine predictors of successful resolution of airway symptoms. RESULTS: Cough, hoarseness, wheezing, sore throat, and dyspnea improved in 65-75% of patients. Heartburn improved in 91% (105/116) of patients and regurgitation in 92% (90/98). The response rate for airway symptoms was the same in patients with and without heartburn. Almost every patient took proton pump inhibitors (PPIs) preoperatively (99%, 127/128) and 61% (n = 78) were taking double or triple dose. Postoperatively, 33% (n = 45) of patients were using daily antiacid therapy but no one was on double dose. The only factor that predicted a successful surgical outcome was the presence of abnormal reflux in the pharynx as determined by 24-hour pharyngeal pH monitoring. One hundred eleven (87%) patients rated their results as excellent (n = 78, 57%) or good (n = 33, 24%). CONCLUSION: LARS provides an effective and durable barrier to reflux, and in so doing improves GERD-related airway symptoms in approximately 70% of patients and improves typical GERD symptoms in approximately 90% of patients. Pharyngeal pH monitoring identifies those patients more likely to benefit from LARS, but better diagnostic tools are needed to improve the response of airway symptoms to that of typical esophageal symptoms.

Medium- and long-term outcome of laparoscopic redo fundoplication.

BACKGROUND: For a small subset of patients, laparoscopic fundoplication fails, typically resulting in recurrent reflux or severe dysphagia. Although redo fundoplications can be performed laparoscopically, few studies have examined their long-term efficacy. METHODS: Using a prospectively maintained database, the authors identified and contacted 41 patients who had undergone redo laparoscopic fundoplications at the University of Washington between 1996 and 2001. The median follow-up period was 50 months (range, 20-95 months). Current symptoms were compared with those acquired and entered into the authors' database preoperatively. Patients also were asked to return for esophageal manometry and pH testing. RESULTS: All redo fundoplications were performed laparoscopically. There were no conversions. The most common indication for redo fundoplication was recurrent reflux. The most common anatomic abnormality was a herniated wrap. Heartburn improved in 61%, regurgitation in 69%, and dysphagia in 74% of the patients. Complete resolution of these symptoms was achieved, respectively, in 45%, 41% and 38% of these same patients. Overall, 68% of the patients rated the success of the procedure as either "excellent" or "good," and 78% said they were happy they chose to have it. For those who underwent reoperation for gastroesophageal reflux disease, distal esophageal acid exposure according to 24-h pH monitoring decreased after redo fundoplication from 15.7% +/- 18.1% to 3.4% +/- 3.6% (p = 0.041). CONCLUSION: Although not as successful as primary fundoplication, a majority of patients can expect durable improvement in their symptoms with a laparoscopic redo fundoplication.

Multichannel intraluminal impedance for the assessment of post-fundoplication dysphagia.

Dysphagia often occurs after fundoplication, although its pathophysiology is not clear. We sought to better understand postfundoplication dysphagia by measuring esophageal clearance with multichannel intraluminal impedance (MII) along with more traditional work-up (manometry, upper gastrointestinal imaging [UGI], endoscopy). We evaluated 80 consecutive patients after laparoscopic fundoplication between April 2002 and November 2004. Patients were evaluated clinically and underwent simultaneous manometry and MII, 24-hour pH monitoring, endoscopy, and UGI. For analysis, patients were divided into the following groups based on the presence of dysphagia and fundoplication anatomy (by UGI/endoscopy): (1) Dysphagia and normal anatomy; (2) Dysphagia and abnormal anatomy; (3) No dysphagia and abnormal anatomy; and (4) No dysphagia and normal anatomy. Patients with dysphagia (Groups 1 & 2) had similar peristalsis (manometry), but were more likely to have impaired clearance by MII (32 pts, 62%) than those without dysphagia (9 pts, 32%, P = 0.01). Patients with abnormal anatomy (Groups 2 & 3) were also more likely to have impaired esophageal clearance (66%vs. 38%, P = 0.01). Finally, of patients that had normal fundoplication anatomy, those with dysphagia were much more likely to have impaired clearance (12 pts, 52%) than those with dysphagia (4 pts, 21%, P = 0.03). MII after fundoplication provides objective evidence of esophageal clearance, and is commonly abnormal in patients with abnormal fundoplication anatomy and/or dysphagia. Esophageal clearance is impaired in the majority of patients with postoperative dysphagia, even with normal fundoplication anatomy and normal peristalsis. MII may detect disorders in esophageal motility not detected by manometry.

Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: evaluation with multichannel intraluminal impedance.

BACKGROUND: Morbid obesity is associated with gastroesophageal reflux disease (GERD), and both have an independent association with motility disorders. Impaired esophageal function is thought to play a role in the development of dysphagia after fundoplication and bariatric procedures (especially restrictive procedures). The authors aimed to define both the physiology and the underlying pathophysiology of swallowing using a novel technique, multichannel intraluminal impedance (MII), which can accurately determine the clearance of a swallowed bolus through the esophagus, in combination with traditional manometry, which can measure peristalsis. METHODS: Simultaneous MII, manometry, and pH monitoring were performed for 10 asymptomatic subjects, 22 consecutive nonobese patients with GERD (GERD), and 22 consecutive morbidly obese patients with GERD (MO-GERD) who were under evaluation for antireflux and bariatric surgery at the University of Washington. In this study, MII was defined as abnormal if less than 80% of swallowed liquid boluses cleared the esophagus completely. RESULTS: All GERD and MO-GERD patients had abnormal pH monitoring. The manometric findings were similar for the GERD and MO-GERD patients. All the asymptomatic subjects had normal manometry and impedance test results. Abnormal manometry would have predicted that approximately 23% of GERD and MO-GERD patients had defective emptying. However, when measured with impedance, esophageal clearance was found to be defective in two times as many GERD and nearly three times as many MO-GERD patients. CONCLUSIONS: In patients with GERD, impedance often detects impairments in esophageal motility not identified by manometry. Morbidly obese patients with GERD have a higher incidence of impaired esophageal motility than nonobese patients with GERD. This may have implications for bariatric procedures, especially those that are restrictive.

Estabilidad de zidovudina en una suspensión extemporanea oral / Stability of zidovudine as an extemporaneous oral suspension

El servicio de Farmacia tiene la esponsabilidad de satisfacer los requerimientos de los pacientes que por su edad o patología no pueden ingerir medicamentos con formas farmacéuticas sólidas. El objetivo de este trabajo fue realizar una suspensión extemporánea oral de Zidovudina. La farmacia Oncológica entre medicamentos a pacientes HIV ambulatorios cada 15 días, para garantir el cumplimiento terpéutico; por tal motivo, se tomó como período arbitrario 30 días, para el estudio de la suspensión, se partió de cápsulas originales de Zidovudina y se midió la estabilidad de la suspensión oral de 10 mg/ml, a treinta días y a 4º C, 25º C y 37º C de temperatura, por técnica cromatográfica con HPLC. zidovudina suspensión oral 10 mg/ml, resultó estable a 4º C, 25º C y 37º C de temperatura, durante 30 días.

Purification and characterization of the invertase from Pycnoporus sanguineus.

A constitutive invertase (EC 3.2.1.26) was isolated and purified by the first time from Pycnoporus sanguineus. The enzyme is a glycoprotein. Its relative molecular mass is about 84,000 and its structure is dimeric, with two identical subunits (about 41,000). The enzyme is able to attack sucrose, raffinose, stachyose, inulin and levan, being sucrose the preferred substrate (Km 4.89 +/- 0.13 mM). Fructose was a classical competitive inhibitor, but glucose was not an inhibitor of the enzyme. Lectins with specificity toward glucose are inhibitors of the enzyme. Glucose was present in invertase acid hydrolysates. Unlike higher plant invertases, bovine serum albumin is not an effector of the Pycnoporus sanguineus enzyme, and the inhibition by fructose is not suppressed by this protein. The properties of the Pycnoporus sanguineus enzyme are discussed with reference to higher plant invertases.