Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity.

BACKGROUND: Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS: Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS: We obtained 599 responses. The respondents mean age was 44.4 ±â€¯11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS: The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.

Medical treatment of type 2 diabetes mellitus: Recommendations of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine.

Type 2 diabetes is a big health concern due to its high prevalence and morbi-mortality. Medical treatment has a growing complexity which is focus on patients' clinical situations. This article contains a consensus statement about recommendations on medical treatment of type-2 diabetes from the Working Group of Diabetes, Obesity and Nutrition of Spanish Society of Internal Medicine. The aim of this consensus is to facilitate therapeutic decision-making to improve the diabetes patients care. The document prioritizes treatments with cardiovascular, especially heart failure, and real benefits.

Medical treatment of type 2 diabetes mellitus: Recommendations of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine. / Tratamiento médico de la diabetes mellitus tipo 2: recomendaciones del Grupo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna.

Type 2 diabetes mellitus is a major health problem with high prevalence, morbidity and mortality, and its medical treatment is growing in complexity due to patients' diverse clinical conditions. This article presents a consensus document by the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine, with recommendations for the medical treatment of type 2 diabetes mellitus. The main objective of this article is to facilitate the therapeutic decision-making process to improve the care of patients with diabetes. The document prioritises treatments with cardiovascular benefits, especially those that benefit patients with heart and renal failure.

Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity. / La obesidad es una enfermedad crónica. Posicionamiento del grupo de trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna (SEMI) por un abordaje centrado en la persona con obesidad.

INTRODUCTION: Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS: Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS: We obtained 599 responses. The respondents mean age was 44.4±11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS: The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.

Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones.

The evolution (from 1990 to 1996) of fluoroquinolone consumption and resistance and the current patterns of fluoroquinolone usage were examined in a 250-bed community hospital in Spain. Fluoroquinolone consumption increased from 1392 g in 1990 to 3203 g in 1996 (p < 0.05). A significant increase in ciprofloxacin resistance was observed in Escherichia coli isolated from urine samples (from 3 to 20%, p < 0.00001), but not in those E. coli isolated from blood or other sample cultures. In 69 randomly selected clinical charts, fluoroquinolone was used as prophylaxis, empirical therapy, and specific directed therapy in 20%, 65%, and 15%, respectively. Evaluation of quinolone indication was: first choice agents (29%), alternative agents (49%), experimental agents (4.3%) and, agents with no role (1.4%). Our study shows that the increase in the use of fluoroquinolones is associated with the emergence of ciprofloxacin-resistant E. coli from urinary tract sources. Based on their indications, current quinolone usage can be greatly reduced.

Synthesis of lactoferrin and transport of transferrin in the lactating mammary gland of sheep.

Two iron-binding proteins, lactoferrin and transferrin, are present in ruminant milk. Lactoferrin commonly has been assumed to be a product of mammary synthesis, but the origin of milk transferrin has not been elucidated. The objective of this experiment was to study the synthesis and distribution of these two proteins in the mammary gland of sheep. Explants from lactating mammary gland of sheep have been cultured in the presence of [3H]leucine to determine rates of synthesis of lactoferrin and transferrin. After incubation, [3H]lactoferrin was found, but labeled transferrin was not. The capacity of the mammary gland to synthesize lactoferrin decreased markedly in the first 24 h of lactation. Immunohistochemical techniques were utilized to identify the locations of lactoferrin and transferrin in the mammary gland. Transferrin was found in the colostrum contained in the alveolar lumen, in the cytoplasm of the secretory cells, and in the connective tissue between the mammary acini. High concentration of transferrin was found in the basal membrane of the secretory alveolar cells, mainly in those near capillary vessels. Lactoferrin was found in the colostrum and in the cytoplasm of secretory cells with a more homogeneous distribution than transferrin. The connective tissue stained negative for lactoferrin. These results suggest that, although lactoferrin is synthesized by mammary gland of the sheep, transferrin comes from blood serum, probably by a receptor-mediated mechanism of transcytosis.

Insulin in bovine colostrum and milk: evolution throughout lactation and binding to caseins.

The changes in insulin concentration in bovine milk in the first period of lactation and its association with other milk proteins were studied. Highest concentration was found in the first milking (327 ng/ml). This concentration fell within the first 24 h postpartum to about 50% of its initial value. By d 3, the level was about 25%, and, on d 7, a stable concentration was reached at approximately 46 ng/ml (about 14% of its initial value). This concentration is about 100 times higher than that in serum, which suggests a specific mechanism of transfer from blood to milk. Colostral whey obtained by ultrafiltration or ultracentrifugation contains much less insulin than colostrum. When colostrum or milk was incubated with [125I]insulin and whey and casein fractions were separated by precipitation, it was observed that most insulin remained with the casein. However, when colostrum was incubated with [125I]insulin and subjected to gel filtration, most of the radioactivity corresponded to free insulin, indicating that insulin is associated with the precipitated casein but not with the casein micelles in solution.

Synthesis and evolution of concentration of beta-lactoglobulin and alpha-lactalbumin from cow and sheep colostrum and milk throughout early lactation.

Synthesis of beta-lactoglobulin and alpha-lactalbumin by explants of ovine mammary gland and evolution of concentration of these proteins in cow and sheep colostrum and milk throughout early lactation have been studied. The evolution of both proteins was similar in cow and sheep species. The highest concentration was found in the first milking (19 and 2 mg/ml for beta-lactoglobulin and alpha-lactalbumin, respectively). Then, levels of beta-lactoglobulin decreased sharply and those of alpha-lactalbumin slowly during the first days of lactation, reaching stable values during the second week postpartum (4 and 1.5 mg/ml). The concentration ratio beta-lactoglobulin/alpha-lactalbumin was four times greater in colostrum than in mature milk. On the other hand, synthesis of these proteins represented about 25-30% of the synthesized total soluble proteins. The synthesis ratio beta-lactoglobulin/alpha-lactalbumin in explants obtained at 12 and 30 hours postpartum was found to be 3.5 and 1.7. These results indicate that the synthesis and secretion of beta-lactoglobulin are comparatively greater than those of alpha-lactalbumin during colostral period, suggesting that beta-lactoglobulin could have some specific function during this period.