Anthocyanins from Aristotelia chilensis Prevent Olanzapine-Induced Hepatic-Lipid Accumulation but Not Insulin Resistance in Skeletal Muscle Cells.

Type 2 diabetes and obesity are major problems worldwide and dietary polyphenols have shown efficacy to ameliorate signs of these diseases. Anthocyanins from berries display potent antioxidants and protect against weight gain and insulin resistance in different models of diet-induced metabolic syndrome. Olanzapine is known to induce an accelerated form of metabolic syndrome. Due to the aforementioned, we evaluated whether delphinidin-3,5-O-diglucoside (DG) and delphinidin-3-O-sambubioside-5-O-glucoside (DS), two potent antidiabetic anthocyanins isolated from Aristotelia chilensis fruit, could prevent olanzapine-induced steatosis and insulin resistance in liver and skeletal muscle cells, respectively. HepG2 liver cells and L6 skeletal muscle cells were co-incubated with DG 50 µg/mL or DS 50 µg/mL plus olanzapine 50 µg/mL. Lipid accumulation was determined in HepG2 cells while the expression of p-Akt as a key regulator of the insulin-activated signaling pathways, mitochondrial function, and glucose uptake was assessed in L6 cells. DS and DG prevented olanzapine-induced lipid accumulation in liver cells. However, insulin signaling impairment induced by olanzapine in L6 cells was not rescued by DS and DG. Thus, anthocyanins modulate lipid metabolism, which is a relevant factor in hepatic tissue, but do not significantly influence skeletal muscle, where a potent antioxidant effect of olanzapine was found.

Metabolic Syndrome and Antipsychotics: The Role of Mitochondrial Fission/Fusion Imbalance.

Second-generation antipsychotics (SGAs) are known to increase cardiovascular risk through several physiological mechanisms, including insulin resistance, hepatic steatosis, hyperphagia, and accelerated weight gain. There are limited prophylactic interventions to prevent these side effects of SGAs, in part because the molecular mechanisms underlying SGAs toxicity are not yet completely elucidated. In this perspective article, we introduce an innovative approach to study the metabolic side effects of antipsychotics through the alterations of the mitochondrial dynamics, which leads to an imbalance in mitochondrial fusion/fission ratio and to an inefficient mitochondrial phenotype of muscle cells. We believe that this approach may offer a valuable path to explain SGAs-induced alterations in metabolic homeostasis.

Delirium en el hospital, una revisión narrativa / Delirium in the hospital, a narrative review

El delirium es una complicación frecuente entre pacientes hospitalizados, particularmente entre adultos mayores y aquellos con deterioro cognitivo. Se ha asociado a mayor mortalidad, estadías hospitalarias prolongadas, deterioro cognitivo, mayores tasas de institucionalización al alta y mayores costos para los sistemas de salud. Su fisiopatología es escasamente comprendida, planteándose en los últimos años un origen inflamatorio predominante. Ello explicaría su transversalidad y relación con la gravedad de cuadros subyacentes. Clínicamente se caracteriza por su inicio agudo con curso fluctuante, inatención, pensamiento desorganizado y un nivel de conciencia alterado. El enfrentamiento diagnóstico exige la búsqueda sistemática de desencadenantes en forma adicional a las manifestaciones del síndrome. Su tratamiento sintomático está basado en los neurolépticos como primera línea y el lorazepam en caso de que los primeros no puedan utilizarse o exista un escenario de indicación especial. Existe evidencia de que el cuadro puede prevenirse mediante la instauración de estrategias multicomponentes.

Delirium is a common complication in hospitalized patients, particularly the elderly and those with cognitive impairment. It has been associated with higher mortality, prolonged hospitalization, cognitive impairment, higher rates of institutionalization at discharge and higher costs for healthcare systems. Its pathophysiology is poorly understood, and more recently a predominantly inflammatory origin has been proposed, which could explain its pervasiveness and association with underlying conditions. Clinically, it is characterized by acute onset with fluctuating course, inattention, disorganized thinking and altered level of consciousness. Diagnostic approach is based on the systematic search for triggering factors as well as the manifestations of the syndrome. Symptomatic treatment is based neuroleptics as first line treatment, and lorazepam when the former cannot be used or there are special indications. There is evidence that the condition can be prevented by resorting to multi-component strategies.

Dermatitis, un enfoque desde la medicina ocupacional / Dermatitis, an approach from occupational medicine

La dermatitis ocupacional es una de las enfermedades ocupacionales más frecuentes en la práctica clínica. Su prevalencia varía en función de las actividades laborales y tipos de exposición, con cifras citadas en la literatura de hasta un 37 por ciento. Su origen puede ser irritativo o alérgico. Entre sus factores de riesgo se incluyen la atopía y el lavado de manos frecuente o la realización de trabajos húmedos, con evidencia controvertida para factores como el sexo, el consumo de tabaco, entre otros. El diagnóstico se basa en el examen físico, las pruebas etiológicas en parche y la certificación del origen ocupacional mediante criterios estandarizados. Se le ha asociado a disminución de la productividad laboral, ausentismo y cambios de ocupación, así como a disminuciones importantes de la calidad de vida de los pacientes. La prevención se basa fundamentalmente en la educación y la limitación de la exposición. Estas estrategias son compartidas con el tratamiento, al que se agrega el uso de fármacos como los esteroides tópicos y los inhibidores de calcineurina.

Occupational dermatitis is one of the most common occupational diseases in clinical practice. Prevalence varies according to the job activities and types of exposure, with figures of up to 37 percent reported in the literature. Its origin may be irritant or allergic. Atopy and frequent hand washing or exposure to wetness or humidity is described has been described as risk factors, while evidence for gender and tobacco consumption, among others, is controversial. Diagnosis is based on physical examination, etiological patch testing and certification of occupational origin using standardized criteria. The condition has been associated with reduced productivity, absenteeism and occupational changes, as well as significant decreases in the quality of life of patients. Prevention is based primarily on education and restriction of exposure. These strategies are coupled with the treatment, which include the use of drugs such as topical steroids and calcineurin inhibitors.