Grupos de apoyo de pares para sobrevivientes de intento de suicidio (SOSA): Revisión sistemática

Antecedentes: el intento de suicidio es el principal factor de riesgo de muerte por suicidio. La Organización Mundial de la Salud sugiere grupos de apoyo como intervención para esta población. Objetivo: Este estudio tuvo como objetivo determinar la eficacia de los grupos de apoyo de pares para sobrevivientes de intento de suicidio (SOSA). Método: Revisión sistemática (PROSPERO ID: CRD42022307581). Resultados: En total se identificaron 946 artículos potenciales, se revisaron 81 textos completos y se incluyó un artículo. El artículo informa sobre un estudio piloto abierto con evaluaciones pre y post intervención, sin grupo de control y con alto riesgo de sesgo. Esta es una intervención prometedora, porque los resultados mostraron una disminución de la ideación suicida (d=0,33), y del intento de suicidio (d=0,31). El pequeño número de investigaciones empíricas limita las generalizaciones. Conclusión: El nivel de certeza de la evidencia es bajo (baja certeza), por lo tanto, el grado de recomendación corresponde a evidencia insuficiente (I), para recomendar esta estrategia para las políticas públicas. En este artículo se analizan las razones de estos resultados y los posibles caminos para avanzar en este campo.

Background: Suicide attempt is the main risk factor for death by suicide. The World Health Organization (WHO) suggests support groups as an intervention for this population. Objective: This study aimed to assess the efficacy of peer-support groups for survivors of suicide attempt (SOSA). Method: Systematic review (PROSPERO ID: CRD42022307581). Results: In total, 946 potential articles were identified, 81 full texts were reviewed, and one article was included. The article reported an open-label pilot study with pre- and post-intervention evaluations, without a control group, and with a high risk of bias. This is a promising intervention because the results showed decreased suicidal ideation (d=0.33) and suicide attempt (d=0.31). The small number of empirical investigations limit generalizations. Conclusion: The level of certainty of evidence is low (low certainty); therefore, the grade of recommendation corresponds to insufficient evidence (I) to recommend this strategy for public policies. The reasons for these results and possible paths to advance the field are discussed in this article.

Reduced sedation and increased ethanol consumption in knock-in mice expressing an ethanol insensitive alpha 2 subunit of the glycine receptor.

Previous studies have shown the presence of several subunits of the inhibitory glycine receptor (GlyR) in the reward system, specifically in medium spiny neurons (MSNs) of the nucleus Accumbens (nAc). It was suggested that GlyR α1 subunits regulate nAc excitability and ethanol consumption. However, little is known about the role of the α2 subunit in the adult brain since it is a subunit highly expressed during early brain development. In this study, we used genetically modified mice with a mutation (KR389-390AA) in the intracellular loop of the GlyR α2 subunit which results in a heteromeric α2ß receptor that is insensitive to ethanol. Using this mouse model denoted knock-in α2 (KI α2), our electrophysiological studies showed that neurons in the adult nAc expressed functional KI GlyRs that were rather insensitive to ethanol when compared with WT GlyRs. In behavioral tests, the KI α2 mice did not show any difference in basal motor coordination, locomotor activity, or conditioned place preference compared with WT littermate controls. In terms of ethanol response, KI α2 male mice recovered faster from the administration of ataxic and sedative doses of ethanol. Furthermore, KI α2 mice consumed higher amounts of ethanol in the first days of the drinking in the dark protocol, as compared with WT mice. These results show that the α2 subunit is important for the potentiation of GlyRs in the adult brain and this might result in reduced sedation and increased ethanol consumption.

Changes in neuronal excitability and synaptic transmission in nucleus accumbens in a transgenic Alzheimer's disease mouse model.

Several previous studies showed that hippocampus and cortex are affected in Alzheimer's disease (AD). However, other brain regions have also been found to be affected and could contribute with new critical information to the pathophysiological basis of AD. For example, volumetric studies in humans have shown a significant atrophy of the striatum, particularly in the nucleus Accumbens (nAc). The nAc is a key component of the limbic reward system and it is involved in cognition and emotional behaviors such as pleasure, fear, aggression and motivations, all of which are affected in neurodegenerative diseases such as AD. However, its role in AD has not been extensively studied. Therefore, using an AD mouse model, we investigated if the nAc was affected in 6 months old transgenic 2xTg (APP/PS1) mice. Immunohistochemistry (IHC) analysis in 2xTg mice showed increased intraneuronal Aß accumulation, as well as occasional extracellular amyloid deposits detected through Thioflavin-S staining. Interestingly, the intracellular Aß pathology was associated to an increase in membrane excitability in dissociated medium spiny neurons (MSNs) of the nAc. IHC and western blot analyses showed a decrease in glycine receptors (GlyR) together with a reduction in the pre- and post-synaptic markers SV2 and gephyrin, respectively, which correlated with a decrease in glycinergic miniature synaptic currents in nAc brain slices. Additionally, voltage-clamp recordings in dissociated MSNs showed a decrease in AMPA- and Gly-evoked currents. Overall, these results showed intracellular Aß accumulation together with an increase in excitability and synaptic alterations in this mouse model. These findings provide new information that might help to explain changes in motivation, anhedonia, and learning in the onset of AD pathogenesis.

High ethanol sensitive glycine receptors regulate firing in D1 medium spiny neurons in the nucleus accumbens.

Inhibitory glycine receptors (GlyRs) are widely expressed in spinal cord and brain stem. They are also expressed in the nucleus Accumbens (nAc) where they have been implicated in the release of dopamine from the ventral tegmental area to the nAc in the presence of ethanol. One of the major types of neurons in the nAc are the Dopamine 1 receptor-expressing (D1+) medium spiny neurons (MSNs) that are activated when addictive drugs, like ethanol, are administrated. Thus, D1(+) MSNs are a relevant target for the study of ethanol effects. Here, using electrophysiological recordings, we report that GlyRs in D1(+) MSNs are highly sensitive to ethanol, with potentiation starting at 5 mM (26 ± 5%). Single channel recordings in D1(+) MSNs showed that 10 mM ethanol increased the open probability of the channel (0.22 ± 0.05 versus 0.66 ± 0.16), but did not affect channel conductance (~40 pS). A glycinergic mediated tonic current in D1(+) MSNs was potentiated by 10 and 50 mM ethanol causing a reduction in the excitability of these cells. A 34 ± 7% reduction in action potential firing was observed in these neurons in the presence of 50 mM ethanol. Interestingly, no effects of ethanol were detected in the presence of strychnine or in D1(-) MSNs in the nAc. These results indicate that GlyRs present in D1(+) MSNs are sensitive to low concentrations of ethanol, and that potentiation of this inhibitory current regulates the activation of nAc, acting as a homeostatic signal that would prevent over-activation of the reward system when drugs like ethanol are consumed.

[Spontaneous remission of acromegaly and Cushing's disease in older patients. Report of two cases]. / Remisión espontánea de acromegalia y enfermedad de Cushing en adultos mayores. Casos clínicos.

Pituitary diseases such as acromegaly and Cushing's disease require surgical or medical therapy. In some functioning pituitary tumors, a spontaneous remission of hormonal hypersecretion is observed, mainly associated to apoplexy or pituitary infarction. We report the evolution of two female patients older than 70 years at the time of diagnosis, with multiple comorbidities. In case 1, acromegaly was diagnosed at 74 years of age. Sellar CT scan showed a 10-mm adenoma. During her follow-up, IGF1 levels remained normal. Nine years later, a magnetic resonance (MR) showed a 7-mm adenoma. In case 2, clinical and biochemical diagnosis of Cushing's disease was done being 71 years old. Sellar MR showed a 6-mm adenoma. Three years later, urinary cortisol normalized with no changes in adenoma at MR. Seven years later, she remains without clinical or biochemical signs of hypercortisolism. In both cases, no signs of hemorrhage were observed at MR.

Remisión espontánea de acromegalia y enfermedad de Cushing en adultos mayores: casos clínicos / Spontaneous remission of acromegaly and Cushing's disease in older patients: report of two cases

Pituitary diseases such as acromegaly and Cushing's disease require surgical or medical therapy. In some functioning pituitary tumors, a spontaneous remission of hormonal hypersecretion is observed, mainly associated to apoplexy or pituitary infarction. We report the evolution of two female patients older than 70 years at the time of diagnosis, with multiple comorbidities. In case 1, acromegaly was diagnosed at 74 years of age. Sellar CT scan showed a 10-mm adenoma. During her follow-up, IGF1 levels remained normal. Nine years later, a magnetic resonance (MR) showed a 7-mm adenoma. In case 2, clinical and biochemical diagnosis of Cushing's disease was done being 71 years old. Sellar MR showed a 6-mm adenoma. Three years later, urinary cortisol normalized with no changes in adenoma at MR. Seven years later, she remains without clinical or biochemical signs of hypercortisolism. In both cases, no signs of hemorrhage were observed at MR.

Intervención cognitivo-conductual para trastornos del sueño en adultos mayores / Cognitive-behavioral intervention on senior adults with sleep disorders / Intervenção cognitivo-comportamental para transtornos do sono em idosos

Los trastornos del sueño en el adulto mayor son un problema manifestado con frecuencia, que afecta la calidad de vida y tiene impacto en los costos y el cuidado de salud. La actual forma de manejo de estos problemas se relaciona con prescripciones de fármacos, los cuales tienen efectos secundarios y aumenta su vulnerabilidad. En este contexto, el objetivo de esta investigación es evaluar la efectividad de una intervención cognitivo y conductual, que pretende mejorar el sueño mediante el cambio de los hábitos deficientes, así como el desafío de los pensamientos, las actitudes y las creencias negativas acerca del mismo. El método incluyó intervenciones cognitivo-conductuales grupales, con evaluaciones pre y post intervención. Los resultados indican una media de 9 (Pittsburgh) al inicio del programa y 4.9 al finalizar. Se concluye que la intervención a corto plazo consigue cambios significativos en hábitos e higiene del sueño. Esta investigación orienta a los profesionales de enfermería en la aplicación de estrategias hacia el bienestar del adulto mayor y el desarrollo de la disciplina en el marco del fortalecimiento de cuidados esenciales y fundamentales en procesos vitales.

Sleep disorders among senior adults are a frequent problem which has important impacts on their quality of life, and the costs of healthcare. The current management of these disorders is based on drug prescriptions, which in turn, have secondary effects and also enhance underlying conditions and vulnerabilities. Within this context, the objective of this study was to assess the effectiveness of a cognitive behavioral intervention aimed at improving the quality of sleep of these persons by modifying negative habits, thoughts, and beliefs. The method included group cognitive-behavioral interventions with pre and post assessments. The corresponding results showed a mean of 9 (Pittsburg) at the beginning of the program, and a mean of 4.9 at the end. It was thus concluded that the intervention, in the short term, helped to achieve significant improvements in relation to the sleep hygiene of these persons. This study can orient nursing professionals to establish strategies aimed at the wellbeing of senior adults; all within the vital processes and essential care strengthening framework.

Os transtornos do sono no idoso são um problema manifestado com frequência e que afeta a qualidade de vida e tem impacto nos custos e no cuidado de saúde. A atual forma de manejo destes problemas relaciona-se com prescrições de fármacos, os quais têm efeitos secundários e aumenta sua vulnerabilidade. Neste contexto, o objetivo desta pesquisa é avaliar a efetividade de uma intervenção cognitivo e comportamental, que pretende melhorar o sono mediante a mudança dos hábitos deficientes, assim como o desafio dos pensamentos, as atitudes e as crenças negativas acerca de si próprio. O método incluiu intervenções cognitivo-comportamentais grupais, com avaliações pre e post intervenção. Os resultados indicam uma média de 9 (Pittsburg) ao início do programa e 4.9 para finalizar. Conclui-se que a intervenção a curto prazo consegue câmbios significativos em hábitos e higiene do sono. Esta pesquisa orienta aos profissionais de enfermagem na aplicação de estratégias para o bem-estar do idoso e do desenvolvimento da disciplina no marco do fortalecimento de cuidados essenciais e fundamentais em processos vitais.

Programa de formación de ayudantes de investigación: conocimiento y satisfacción de los estudiantes / Research assistant formation program: students' knowledge and satisfaction / Programa de formação de assistentes de pesquisa: conhecimento e satisfação dos estudantes

Introducción: La inserción de estudiantes de pregrado en actividades de investigación es relevante para fomentar la crítica y aplicación de resultados de investigación. La formación de ayudantes de investigación se plantea como una alternativa válida para que los alumnos se expongan, experimenten y participen activamente en el proceso de investigación. Objetivo: Identificar el nivel de conocimiento y grado de satisfacción de los estudiantes después de participar en un programa de formación de ayudantes de investigación. Método: Estudio de pre y post test en 20 estudiantes de pregrado de Enfermería. Se evaluó el conocimiento alcanzado y la satisfacción de los estudiantes con el programa de formación, el cual considera tres módulos de aprendizaje distribuidos en 180 horas cronológicas. Resultados: El conocimiento de los estudiantes incrementó significativamente con el programa, no se relacionó con el conocimiento que el alumno trae al inicio del mismo, así como tampoco con el semestre que cursa. El grado de satisfacción fue en el 100% de los alumnos muy satisfecho. Discusión: Este artículo reporta un programa de formación de ayudantes de investigación que es posible ser replicado en otras realidades, que incrementa el conocimiento, con un alto grado de satisfacción en los estudiantes. La duración del programa podría considerarse una debilidad. Conclusión: La participación de estudiantes de pregrado en un programa de formación de ayudantes de investigación, puede considerarse una estrategia para involucrar a alumnos en investigación, y que valoren su aporte en la disciplina de enfermería.

Introduction: An early integration of undergraduate students into activities of research can help them develop skills for a critical application of the corresponding findings. The formation of research assistants program is proposed as an experience for students to expose, experiment, and actively participate in diverse researching related activities. Objective: To identify the level of knowledge and degree of satisfaction of students after their participation in a research assistant formation program. Method: This is pre-post-test study involving 20 undergraduate nursing students. Their achieved knowledge and satisfaction in the three-module-180-hours program were assessed. Results: Unrelated to parallel experiences, the students' knowledge increased significantly after the program. All students stated having felt very satisfied. Discussion: This article informs on a program of formation of research assistants which is prone to be extended to other contexts, however its duration could be adjusted. Conclusion: The participation of undergraduate students in a research assistant formation program is a novel strategy to engage students into nursing research.

Introdução: A inserção de estudantes de graduação em atividades de pesquisa é relevante para promover a crítica e aplicação de resultados de pesquisa. A formação de assistentes de pesquisa contempla-se como una alternativa válida para os alunos se exporem, experimentarem e participarem ativamente no processo de pesquisa. Objetivo: Identificar o nível de conhecimento e grau de satisfação dos estudantes depois de participarem em um programa de formação de assistentes de pesquisa. Método: Estudo de pre e post teste de 20 estudantes de graduação de Enfermagem. Avaliou-se o conhecimento atingido e a satisfação dos estudantes com o programa de formação, o qual considera três módulos de aprendizagem distribuídos em 180 horas cronológicas. Resultados: O conhecimento dos estudantes aumentou significativamente com o programa, não se relaciona com o conhecimento que o aluno traz ao início do mesmo, assim como também não, com o semestre que cursa. O grau de satisfação foi do 100% dos alunos: muito satisfeito. Discussão: Este artigo informa um programa de formação de assistentes de pesquisa que é possível ser reproduzido em outras realidades, que aumenta o conhecimento, com um alto grau de satisfação nos estudantes. A duração do programa podia considerar-se uma debilidade. Conclusão: A participação de estudantes de graduação em um programa de formação de assistentes de pesquisa, pode considerar-se uma estratégia para envolver os alunos em pesquisa, e que valorizem seu aporte na disciplina de enfermagem.

[Consensus statement of the Chilean endocrinological society on the role of bariatric surgery in type 2 diabetes]. / Rol de la cirugía bariátrica/metabólica en el manejo de la diabetes mellitus 2. Consenso SOCHED/SCCBM.

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

[False negative spect parathyroid scintigraphy with sestamibi in patients with primary hyperparathyroidism]. / Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario.

BACKGROUND: 99mTc-sestamibi parathyroid SPECT scintigraphy is a useful tool in the pre-operative study of hyperparathyroidism. False negatives (FN) have been reported in 5.7-14% of the examinations. AIM: To characterize 99mTc-sestamibi FN in cases referred for primary hyperparathyroidism (PHP) to a university hospital. MATERIAL AND METHODS: Descriptive retrospective analysis. We included patients with PHP, studied with SPECT scintigraphy, operated at our center between 2008 and 2015. Clinical and surgical data were recorded; biopsies of the FN were blindly reviewed by one pathologist. RESULTS: One hundred twenty one scintigraphies fulfilled the inclusion criteria. Seven (5.8%) were negative and 114 positive. There was no difference in age, sex and PTH levels between FN and true positive scintigraphies. At surgery, one FN case had two hyperplasic glands and two cases had ectopic glands. Pathology reported adenoma in three cases, hyperplasia in three and carcinoma in one. The largest diameter of the lesion was lower in FN (1.3 and 2.1 cm respectively, p = 0.02) and the proportion of adenomas was higher in true positive cases (29% and 75% respectively; p < 0.01). The interval between scintigraphy and parathyroidectomy was greater in FN with a median of 92 days (range 20 days-3.2 years, p < 0.01). The percentage of oxyphilic cells observed was similar in both groups. CONCLUSIONS: FN parathyroid SPECT scintigraphies in PHP are uncommon. They corresponded to lesions under the equipment's resolution limit and resulted in longer time lags between scintigraphy and surgery.

Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario / False negative spect parathyroid scintigraphy with sestamibi in patients with primary hyperparathyroidism

Background: 99mTc-sestamibi parathyroid SPECT scintigraphy is a useful tool in the pre-operative study of hyperparathyroidism. False negatives (FN) have been reported in 5.7-14% of the examinations. Aim: To characterize 99mTc-sestamibi FN in cases referred for primary hyperparathyroidism (PHP) to a university hospital. Material and Methods: Descriptive retrospective analysis. We included patients with PHP, studied with SPECT scintigraphy, operated at our center between 2008 and 2015. Clinical and surgical data were recorded; biopsies of the FN were blindly reviewed by one pathologist. Results: One hundred twenty one scintigraphies fulfilled the inclusion criteria. Seven (5.8%) were negative and 114 positive. There was no difference in age, sex and PTH levels between FN and true positive scintigraphies. At surgery, one FN case had two hyperplasic glands and two cases had ectopic glands. Pathology reported adenoma in three cases, hyperplasia in three and carcinoma in one. The largest diameter of the lesion was lower in FN (1.3 and 2.1 cm respectively, p = 0.02) and the proportion of adenomas was higher in true positive cases (29% and 75% respectively; p < 0.01). The interval between scintigraphy and parathyroidectomy was greater in FN with a median of 92 days (range 20 days-3.2 years, p < 0.01). The percentage of oxyphilic cells observed was similar in both groups. Conclusions: FN parathyroid SPECT scintigraphies in PHP are uncommon. They corresponded to lesions under the equipment's resolution limit and resulted in longer time lags between scintigraphy and surgery.

Evaluación de parámetros clínicos y de laboratorio relacionados con el diagnóstico de insulino resistencia / Evaluation of clinical and laboratory parameters related to the diagnosis of insulin resistance

The evaluation of insulin resistance (IR) in clinical practice is based on the determination of fasting insulin (I0) and insulin level after 2 hours in an oral glucose tolerance test (OGT). However, there are not adequate cutoff points to discriminate IR patients. Objectives: to evaluate the reliability of insulin levels in the diagnosis of IR using the intravenous insulin tolerance test (IVITT) as the gold standard. Patients and Method: The OGT and IVITT of patients who participated as cases or controls in research protocols were analyzed. We excluded those cases with fasting glycemia over126 mg/dl. Results: 128 cases, 111 F, 17 M; Age: 40.3 +/- 14.8 years; BMI: 33 +/- 8 kg/m2; Waist circumference, M: 100.3 +/- 9.4 cm, F: 96 +/- 15 cm. According to IVITT (KITT), 103 (80.5 percent) were IR (KITT < 4.5 percent) and 25 (19.5 percent) were non IR (KITT > 4.5 percent). Fasting (G0) and 120 minutes after glucose challenge glycemia (G120), I0 and I120, HOMA and area under the glycemia and insulin curve, were significantly higher in the IR, as the same as, hypertension and acanthosis nigricans features (p < 0.05). According to G120, 45 cases (35.2 percent) had glucose intolerance, 9 (7 percent) diabetes and 74 (57.8 percent) were normals. In addition to G0, only IVITT was significantly different among the 3 groups (p = 0.025), identifying most insulin resistant subjects. The sensitivity and specificity for a cutoff point of I120 at 60 µIU/mL, were 30 percent and 88 percent, respectively. Conclusion: Baseline and 120 minutes post glucose charge insulin levels and HOMA, do not discriminate insulin resistant subjects, especially when there is fasting or post-stimulus hyperglycemia. Therefore, they are not recommended for individual diagnosis or therapeutic decisions

Factores de riesgo cardiovascular en la población Aymara rural del norte de Chile / Prevalence of cardiovascular risk factors in a rural Aymara population from northern Chile

Background: Some rural non-Caucasian ethnic groups have genetic protective factors for the development of chronic non-communicable diseases. Studies performed in Mapuche and Aymara ethnic groups in Chile, found significantly lower prevalence rates. Aymaras are the second most common ethnic population in Chile. Aim: To determine the prevalence of cardiovascular risk factors in a native Aymara ethnic population. Material and Methods: We studied 276 native Aymara people with a median age of 53 years (63% women), registered in the rural clinics of Camiña and Putre. The frequency of hypertension, Type 2 Diabetes Mellitus (DM2), dyslipidemia, overweight, obesity and smoking were determined. Results: The frequency of overweight and obesity was 38% and 38.4% respectively. The prevalence of hypertension and DM2 were 18.5% and 6.9% respectively. Thirty-five percent had elevated total cholesterol, 21% had high LDL cholesterol, 48% had low HDL cholesterol and 45.7% had high triglyceride levels. Two percent smoked. Conclusions: In this group of Aymara individuals, we found a markedly lower prevalence of hypertension and DM2, despite the high prevalence of obesity and dyslipidemia.

[Prevalence of cardiovascular risk factors in a rural Aymara population from northern Chile]. / Factores de riesgo cardiovascular en la población Aymara rural del norte de Chile.

BACKGROUND: Some rural non-Caucasian ethnic groups have genetic protective factors for the development of chronic non-communicable diseases. Studies performed in Mapuche and Aymara ethnic groups in Chile, found significantly lower prevalence rates. Aymaras are the second most common ethnic population in Chile. AIM: To determine the prevalence of cardiovascular risk factors in a native Aymara ethnic population. MATERIAL AND METHODS: We studied 276 native Aymara people with a median age of 53 years (63% women), registered in the rural clinics of Camiña and Putre. The frequency of hypertension, Type 2 Diabetes Mellitus (DM2), dyslipidemia, overweight, obesity and smoking were determined. RESULTS: The frequency of overweight and obesity was 38% and 38.4% respectively. The prevalence of hypertension and DM2 were 18.5% and 6.9% respectively. Thirty-five percent had elevated total cholesterol, 21% had high LDL cholesterol, 48% had low HDL cholesterol and 45.7% had high triglyceride levels. Two percent smoked. CONCLUSIONS: In this group of Aymara individuals, we found a markedly lower prevalence of hypertension and DM2, despite the high prevalence of obesity and dyslipidemia.

[Bone mineral density disminution post Roux-Y bypass surgery]. / Disminución de masa ósea post-cirugía bariátrica con by-pass en Y de Roux.

INTRODUCTION: Bariatric surgery has important metabolic complications such as bone mass loss. GOAL: To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. METHOD: In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criteria's, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. RESULTS: Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the female's subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. CONCLUSION: Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.

Introducción: La cirugía bariátrica tiene complicaciones metabólicas importantes como la pérdida de masa ósea. Objetivo: Evaluar la densidad mineral ósea (DMO) posterior a by-pass gástrico en Y de Roux (BPYR) en pacientes con indicación de suplemento estándar de calcio y vitamina D. Método: En pacientes con BPYR por obesidad mórbida, 76 mujeres y 22 hombres de diversa edad, con instrucción nutricional, suplemento de calcio y vitamina D, se midió la DMO en columna lumbar y caderas con densitómetro radiológico de doble haz 2 a 3 años post-cirugía. Veinte mujeres fueron seguidas con DMO hasta 54 meses en promedio. Según criterios de Organización Mundial de la Salud (OMS), se comparó con población control joven y de su edad según sexo, evaluando osteopenia y osteoporosis. Resultados: Hubo correlación negativa de DMO con edad; positiva de DMO con índice de masa corporal y con exceso de peso preoperatorio. En mujeres menores de 45 años, se observó disminución de DMO en 26,8%, sin casos de osteoporosis y en 65,7% en las mayores de 45 años (p = 0,0011), correspondiendo a 45,7% de osteopenia y 20% de osteoporosis, predominantemente en columna lumbar. El subgrupo de mujeres con mayor seguimiento, presentó disminución progresiva de DMO, especialmente en cadera izquierda. En hombres se observó 36% de osteopenia y 14% de osteoporosis. Conclusión: Pacientes de ambos sexos y diversa edad, despues de un BPYR, presentaron osteopenia y osteoporosis, a pesar de suplemento precoz de calcio y vitamina D. Consideramos importante medir DMO seriada, individualizando terapias y controlando factores de riesgo.

Effect of exercise on circulating levels of brain-derived neurotrophic factor (BDNF) in overweight and obese subjects.

Exercise increases the expression of brain-derived neurotrophic factor (BDNF) in rodents and in healthy humans. Its relationship with weight loss and improvement in metabolic parameters, in obese human subjects, has not been elucidated. The aim of the study was to evaluate the effect of an aerobic exercise program on circulating levels of BDNF in overweight and obese subjects. We measured anthropometric and metabolic parameters in 15 male and female nondiabetic outpatients (age 38.3±9.5 years, BMI 27-35 kg/m2), before and after 30 sessions of aerobic exercise (3 sessions per week). Plasma (p), serum (s), and platelet (plat) BDNF concentrations were measured at basal condition and after completing 15 and 30 sessions of exercise. Subjects were advised to continue their usual food intake. A significant decrease in weight, BMI, waist circumference, diastolic blood pressure and total cholesterol was observed at the end of the study (p<0.02). Serum and platBDNF showed a significant increase during the training period (p=0.005 and 0.04 respectively). However, pBDNF showed no significant increase. Area under the curve of glucose at baseline, was inversely correlated with sBDNF (r= - 0.53, p=0.04) and platBDNF (r= - 0.6, p=0.01) after session 15. Also, platBDNF was correlated inversely with post load insulin and HOMA2-IR at the end of the training program (r= - 0.53, p=0.03 and r= - 0.52, p=0.04, respectively). In overweight and obese subjects, serum and platBDNF levels increase after 30 sessions of aerobic exercise. This is accompanied with the improvement of anthropometric and metabolic parameters and modest weight loss.