Dapagliflozin plus exenatide on patients with type 2 diabetes awaiting bariatric surgery in the DEXBASU study.

The glucagon-like peptide-1 receptor agonist family together with the renal sodium/glucose cotransporter-2 inhibitors have garnered interest as potential therapeutic agents for subjects with type 2 diabetes and obesity. In these patients, bariatric surgery is indicated based in a BMI ≥ 35 kg/m2. A 24-week non-blinded, randomized pilot study to assess the efficacy of subcutaneous exenatide 2.0 mg once weekly plus oral dapagliflozin 10 mg once daily (Group A) compared to a control group (Group B) in 56 patients with type 2 diabetes awaiting bariatric surgery was conducted (EudraCTid.: 2017-001,454-33). Both groups received an energy-deficit low-fat diet. The primary endpoint was the proportion of patients running off the criteria for bariatric surgery at the end of the follow-up period (BMI ≤ 35.0 kg/m2 or a BMI ≤ 40.0 kg/m2 plus an HbA1c ≤ 6.0%). Changes in the BMI were also of interest. The proportion of patients who ran off the criteria for bariatric surgery was larger in Group A than in the control group (45.8% vs. 12.0%, p = 0.010). Participants in Group A exhibited an absolute decrease in body weight and BMI of 8.1 kg (95%IC: - 11.0 to - 5.2) and 3.3 kg/m2 (95%IC: - 4.5 to - 2.2), respectively (p < 0.001 for both in comparison with Group B). A higher percentage of participants in Group A reached a BMI < 35 kg/m2 (45.8 vs 12.0%) and lost > 10% of their initial body weight (20.8 vs 0%) compared to Group B. The combination of exenatide plus dapagliflozin appears as a strategic option to reduce the waiting list for bariatric surgery, especially in those patients with type 2 diabetes.

Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet.

Weight loss after bariatric surgery decreases the earlier expansion of the adventitial vasa vasorum (VV), a biomarker of early atheromatous disease. However, no data are available regarding weight loss achieved by very low calorie ketogenic diets (VLCKD) on VV and lipid-based atherogenic indices. A randomized clinical trial was performed to examine changes in adventitial VV density in 20 patients with moderate obesity who underwent a 6-month very low calorie ketogenic diet (VLCKD, 600-800 kcal/day), and 10 participants with hypocaloric diet based on the Mediterranean Diet (MedDiet, estimated reduction of 500 kcal on the usual intake). Contrast-enhanced carotid ultrasound was used to assess the VV. Body composition analysis was also used. The atherogenic index of plasma (log (triglycerides to high-density lipoprotein cholesterol ratio)) and the triglyceride-glucose index were calculated. Serum concentrations of soluble intercellular adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. The impact of weight on quality of life-lite (IWQOL-Lite) questionnaire was administered. Participants of intervention groups displayed a similar VV values. Significant improvements of BMI (-5.3 [-6.9 to -3.6] kg/m2, p < 0.001), total body fat (-7.0 [-10.7 to -3.3] %, p = 0.003), and IWQOL-Lite score (-41.4 [-75.2 to -7.6], p = 0.027) were observed in VLCKD group in comparison with MedDiet group. Although after a 6-months follow-up period VV density (mean, right and left sides) did not change significantly in any group, participants in the VLCKD exhibited a significantly decrease both in their atherogenic index of plasma and serum concentration of sICAM-1. A 6-month intervention with VLCKD do not impact in the density of the adventitial VV in subjects with moderate obesity, but induces significant changes in markers of endothelial dysfunction and CV risk.

Dynamics of Anthropometric Indices in a Large Paired Cohort With 10 Years of Follow-Up: Paving the Way to Sarcopenic Obesity.

Introduction: Paired cohort investigations assessing the evolution of anthropometric indices are scarce. Here we assessed the 10-year evolution of BMI, total body fat, and lean body mass in 50,019 participants aged 18-90 years at the time of first assessment. Material and Methods: A retrospective cohort study using an electronic database that contains anonymized, longitudinal data from Primary Care medical records covering the 2007-2008 and 2017-2018 periods. Total body fat was estimated using the Clínica Universidad de Navarra-Body Adiposity Estimator formula, and the Hume formula was applied to estimate lean body mass. Results: The mean BMI of participants <60 years old in the 2007-2008 period increased significantly, from 27.5 to 28.3 kg/m2 (p < 0.001). However, the BMI of older subjects decreased during the next decade, from 28.9 to 28.3 kg/m2 (p < 0.001). The estimated total body fat showed a continuous progressive increase over all ages. Finally, lean body mass showed a progressive increase until the 40s, with a plateau between 40-45 years old and an uninterrupted decrease until older ages. Also, subjects who increased their BMI by 2 kg/m2 during the 10-year period were mainly women and younger at baseline, with a lower initial BMI and total body fat in comparison with those who experienced a BMI decrease of ≥2.0 kg/m2. Conclusion: The evolutions of BMI and the estimated body compositions reported here confirm that the adverse decrease in lean body mass begins in middle age. The proportion of older subjects is important when evaluating overweight and obesity prevalence in cross-sectional studies.

Esquizofrenia de inicio en la infancia/adolescencia y respuesta a psicofármacos: un binomio complejo / Very early / early Onset Schizophrenia and drug response: a complex binomial

La esquizofrenia de inicio temprano (EOS-menores de 15 años-) y de inicio muy temprano (VEOS-menores de 13 años-) son un cuadro raro (12-33% y 1% de las esquizofrenias respectivamente) que se continúa con la esquizofrenia del adulto, pero que posee un peor pronóstico que ésta al asociar síntomas más variados y una peor respuesta al tratamiento psicofarmacológico (en el 50% de los casos fracasan los fármacos de primera línea, considerándose también en estas edades la clozapina como tratamiento de tercera línea en los casos definidos como refractarios)

Early onset schizophrenia (EOS-under 15 years-) and very early onset schizophrenia (VEOS-under 13 years-) is a rare condition (12-33% and 1% of all cases respectively) which continues with adult schizophrenia, but has a worse prognosis due to associating more varied symptoms and a poorer response to psychopharmacological treatment (first-line drugs fail in 50% of patients, considering at this age, too, clozapine as third line treatment in refractory cases

Un caso de trastorno obsesivo-compulsivo familiar / A case of familiar obsessive-compulsive disorder

El trastorno obsesivo-compulsivo (TOC) se caracteriza por pensamientos recurrentes y persistentes (obsesiones) y comportamientos o actos mentales repetitivos (compulsiones)1. La causa exacta del TOC es aún desconocida1. La evidencia de estudios familiares, individuales y de segregación apoya el papel de un componente genético en la etiología del TOC1. Pero la comorbilidad también es importante en este trastorno2 y, a veces, pasa desapercibido3, por lo que presentamos un caso clínico, en el que se deriva a consulta de salud mental, un paciente con sospecha de trastorno somatomorfo, que resulta presentar un trastorno obsesivo-compulsivo con, además, gran agregación familiar

Obsessive-compulsive disorder (OCD) is characterized by recurrent and persistent thoughts (obsessions), and repetitive behaviors or mental acts (compulsions)1 The exact cause of OCD is still unknown1. Evidence from familial, twin and segregation studies supports the role of a genetic component in the etiology of OCD1. But comorbidity2is also important in this disorder and sometimes it goes unnoticed3. We present a case in which a patient is referred to our mental health service with the suspicion of a somatoform disorder complicated with an obsessive-compulsive disorder, also with high familial aggregation

Análisis comparativo entre los sujetos que acuden y no acuden a una Unidad de Salud Mental de Adultos diagnosticados previamente de códigos Z en la Unidad de Salud Mental de la Infancia y la Adolescencia del área de Santiago de Compostela / Comparative analysis between subjects who come and do not come to an Adult Mental Health Unit previously diagnosed of Z codes in Child and Adolescent Mental Health Unit of area of Santiago de Compostela

INTRODUCCIÓN: Ha aumentado la demanda asistencial en los Servicios de Salud Mental, debiéndose, en gran parte, a lo que se denominan códigos Z (CIE-10) (1). OBJETIVOS: 1. Determinar perfiles de sujetos, previamente diagnosticados de códigos Z en la Unidad de Salud Mental de la Infancia y la Adolescencia (USMIA) que acuden a la Unidad de Salud Mental de Adultos (USMA) y que no, en relación a variables socio-demográficas y clínico-evolutivas. 2. Estudiar los cambios diagnósticos más frecuentes en estos sujetos que acuden a USMA. Material y MÉTODOS: Estudio descriptivo comparativo en el que se seleccionaron al azar 91 pacientes diagnosticados de códigos Z en USMIA de Santiago de Compostela (2000-2012). Se cruzan estadísticos descriptivos de la edad cronológica actual (promedio: 21,38 años) con las variables sexo y asistencia a USMA, utilizando la T-Student; el resto de variables socio-demográficas y clínico-evolutivas se cruzan con las variables anteriores, empleando el Chi-cuadrado (IBM SPSS Statistics 21). CONCLUSIONES: El 12,5% de los niños diagnosticados con códigos Z en USMIA son atendidos posteriormente en USMA; de los cuales, un 12% mantiene el código Z y un 50% son diagnosticados de Trastornos de personalidad y de comportamiento en el adulto y Trastornos neuróticos, secundarios a factores estresantes y somatomorfos

INTRODUCTION: Has the demand for care in Mental Health Units, being due, in large part, to what are called Z codes (ICD-10). OBJECTIVES: 1. To determine profiles of subjects previously diagnosed Z codes in Child and Adolescent Mental Health Unit (CAMHU), who come to the Adults Mental Health Unit (AMHU) and not in relation to variables ocio-demographic and clinical-evolutionary. 2. Study the most common diagnoses changes in these subjects attending in AMHU. MATERIAL AND METHODS: Descriptive comparative study in which randomly selected 91 patients diagnosed with Z codes in CAMHU of Santiago de Compostela (2000-2012). Descriptive statistics of the current cross chronological age (mean: 21.38 years) with the sex and assistance to AMHU, using T-Student; other socio-demographic and clinical variables evolutionary intersect with the above variables using the Chi-squared (IBM SPSS Statistics 21). CONCLUSIONS: 12.5% of children diagnosed with Z codes in CAMHU are then treated at AMHU; of which 12% remains the Z code and 50% are diagnosed with Personality and behavioral disorders in adult and Neurotic, secondary to stressors and somatoform disorders

Evolución clínica de los sujetos diagnosticados de códigos X en la Unidad de Salud Mental de la Infancia y de la Adolescencia de Santiago de Compostela, que posteriormente asisten y no asisten a la Unidad de Salud Mental de Adultos de la misma área sanit / Clinical course of patients diagnosed of X code in Unit Mental Health of Children and Adolescents of Santiago de Compostela, that subsequently attending and not attending the Mental Health Unit of Adults in the same health area

INTRODUCCIÓN: Los códigos X engloban suicidios, tentativas suicidas y parasuicidios (1,2). OBJETIVOS: 1. Describir el oerfil general de códigos X en Unidad de Salud Mental de la Infancia y la Adolescencia (USMIA) durante 2000-2012. 2. Comparar los perfiles de sujetos que asisten y no a Unidad de Salud Mental de Adultos (USMA). 3. escribir el perfil en USMA. Material y MÉTODOS: Estudio observacional descriptivo longitudinal en el que se seleccionaron los códigos X en USMIA de Santiago de Compostela. Para el análisis estadístico de los datos se utilizó el programa IBM SPSS Statistics 21. CONCLUSIONES: 1,12% de diagnósticos realizados en USMIA corresponde a códigos X y, de estos, 19%, todo mujeres, continúa su asistencia en USMA. El perfil general del código X en USMIA es: niña, de 14,10 años, que realiza envenenamiento por fármacos psicotrópicos y no repite la tentativa autolítica. El perfil diferencial en sujetos que asisten y no a USMA viene determinado por: tipo de atención en USMIA, antecedentes familiares psiquiátricos y consumo de otras drogas. Los sujetos que asisten a USMA son diagnosticados principalmente de trastornos depresivos y de personalidad, siendo estos últimos los que repiten la tentativa autolítica en edad adulta. Ninguno se suicida

INTRODUCTION: X codes encompass suicides, suicide attempts and parasuicides (1,2). OBJECTIVES: 1. Describe the general profile of codes X in Mental Health Unit for Children and Adolescents (MHUCA) during 2000-2012. 2. Compare the profiles of subjects attending Mental Health Unit Adult (MHUA) and not. 3. Describe the profile in MHUA. MATERIAL AND METHODS: Longitudinal descriptive observational study in which X codes were selected in MHUCA of Santiago de Compostela. For statistical analysis of data was used IBM SPSS Statistics 21 software. CONCLUSIONS: A 1.12% of diagnoses made in USMIA correspond to X codes and of these, 19%, all of them women, continues its assistance USMA. The general profile of code X in MHUCA is: girl, 14.10 years, who takes psychotropic drugs for poisoning and not repeats the autolytic attempt. The differential profile in subjects who attending and not for MHUA is determined by: MHUCA type of care, psychiatric family history and other drug use. Individuals who attend MHUA are primarily diagnosed of depressive and personality disorders, the latter being which repeat the autolytic attempt at adulthood. None commits suicide

Mesotelioma peritoneal maligno con afectación uterina / Malignant mesothelioma of the peritoneum with uterine involvement

El mesotelioma peritoneal maligno es un tumor de presentación infrecuente, diagnóstico difícil y comportamiento agresivo en la mayoría de los casos. Presentamos el caso de una mujer de 80 años con una formación pélvica que depende de útero con carcinomatosis peritoneal, abundante líquido ascítico e infiltración de recto y vejiga. Se decide realizar un estudio histológico de la masa para después comenzar con quimioterapia paliativa por estado avanzado de la enfermedad. Se indica una minilaparotomía y se realizan múltiples biopsias. La histología y la inmunohistoquímica de la pieza son compatibles con un mesotelioma peritoneal maligno de tipo mixto (epitelial y sarcomatoide). La paciente comienza con evolución desfavorable y se deciden medidas de soporte paliativo. Fallece a los 15 días poscirugía. En mujeres con afectación de órganos genitales es importante hacer el diagnóstico diferencial con los tumores serosos de origen ginecológico puesto que los protocolos de tratamiento quimioterápico son diferentes (AU)

Malignant mesothelioma of the peritoneum is an infrequent tumor that is difficult to diagnose and usually behaves aggressively. We present the case of an 80-year-old woman with a pelvic mass of uterine origin, peritoneal carcinomatosis and abundant ascites. Histologic study of the mass was requested and palliative chemotherapy was started because of the advanced stage of the disease. A minilaparotomy was performed and multiple biopsies were taken. Histologic and immunochemistry studies were compatible with a mixed (epithelial and sarcomatoid) malignant mesothelioma of the peritoneum. Prognosis was poor and palliative care was provided. The patient died 15 days after surgery. In women with involvement of the genital organs, it is important to make a differential diagnosis with serous tumors of gynecologic origin because the chemotherapy protocols differ (AU)

Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly.

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly / Efeitos positivos de um programa de intervenção cognitivo-comportamental para cuidadores familiares de idosos com demência

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

OBJETIVO: Foi analisar os efeitos de um programa de intervenção de Terapia Cognitivo-Comportamental (TCC) administrado a cuidadores familiares de pacientes com demência. MÉTODOS: Foram incluídos 40 cuidadores familiares que participaram do programa durante oito sessões semanais. Foi avaliado o perfil cognitivo, funcional e comportamental dos pacientes, bem como sua qualidade de vida e de seus cuidadores familiares. Foram utilizados instrumentos específicos para a avaliação do nível de estresse do cuidador, estilos de enfrentamento (coping), ansiedade e depressão. RESULTADOS: Ao final do programa, os cuidadores familiares relataram diminuição dos sintomas neuropsiquiátricos nos pacientes e aumento da qualidade de vida deles. Observou-se ainda mudança no estilo de coping dos cuidadores e diminuição significativa do nível de ansiedade. CONCLUSÃO: O Programa de TCC mostrou-se instrumento útil e promissor para a prática clínica, revelando efeitos positivos na qualidade de vida e nos sintomas neuropsiquiátricos da demência, bem como promovendo alívio da ansiedade e do estresse dos cuidadores familiares.

[Single prostatic metastasis of a small cell lung carcinoma]. / Metástasis única en próstata de carcinoma microcítico pulmonar.

BACKGROUND: To make the difference between two uncommon entities, small cell prostate carcinoma and prostatic metastasis of small cell lung cancer. METHODS: We describe a case of single extrapulmonar metastasis in the prostate from small lung carcinoma. RESULTS: We describe a case of single extrapulmonar metastasis in the prostate from small lung carcinoma. CONCLUSIONS: Clinical and radiographic findings and inmunohistochemistry allow differential diagnosis.

DNA is more negatively supercoiled in bacterial plasmids than in minichromosomes isolated from budding yeast.

A series of circular shuttle vectors were constructed that could replicate and transcribe in the cells of both Escherichia coli and Saccharomyces cerevisiae. 2-D agarose gel electrophoresis run without or in the presence of different concentrations of chloroquine (CHL) revealed that bacterial plasmids were more negatively (-) supercoiled than minichromosomes isolated from budding yeast. Attempts to increase (-) supercoiling in S. cerevisiae or to reduce it in E. coli have deleterious biological consequences. These observations indicate that DNA supercoiling can vary in different species but cells are exquisitely sensitive to sudden changes in supercoiling. In E. coli, the observation that cell growth as well as ColE1 plasmid copy number decrease when DNA relaxes suggests that supercoiling could affect cell viability by regulating the initiation of both transcription and replication.

Nefroma mesoblástico congénito / Congenital mesoblastic nephroma

Introducción: El nefroma mesoblástico congénito (NMC) (hamartoma leiomiomatoso o mesenquimal) es una neoplasia renal congénita. Se diagnostica en los seis primeros meses de vida. Su comportamiento clínico es benigno y el tratamiento es quirúrgico. Paciente y métodos: Describimos el caso de un paciente de una semana de edad que presenta una masa renal. En la ecografía es sólida y sustituye al riñón. El TAC muestra una lesión con márgenes mal delimitados y la estructura heterogénea. Macroscópicamente en la pieza quirúrgica se identificaba una masa intrarrenal bien delimitada, sólida, homogénea, blanquecina y con aspecto fasciculado. Microscópicamente se observa una neoformación compuesta por una población monótona de células fusiformes dispuestas en haces entrelazados. La lesión carece de cápsula y en la interfase con el parénquima renal normal hay células tumorales que rodean a los túbulos y a los glomérulos. Conclusiones: La edad en el momento del diagnóstico y la correcta extirpación del riñón son los dos factores pronósticos más relevantes

Introduction: Congenital mesoblastic nephroma (CMN) (leiomomatous or mesenchymal hamartoma) is a benign congenital renal neoplasm. This tumor is usually diagnosed along the first six months of life and surgery is current treatment. Patient and methods: A one week of life patient with a renal mass is reported. Ultrasonographically, the mass appearance was solid and replaces the kidney. Computerized tomography (CT) showed a lesion with irregular margins and heterogeneous structure. Grossly, a well delimited intrarenal mass, white, solid, homogeneus and fasciculated was identified. Microscopically, the tumor was composed by a monotonous population of fusiform cells showing an interlacing fasciculated pattern. The mass lacks capsule and the interphase with normal renal parenchyma showed spindle cells surrounding renal tubuli and glomerula. Conclusions: Best prognostic factors are the adequate extirpation and age at the diagnosis

Terapia ocupacional e atividades socioterapêiticas: contribuindo para a circulaçäo social em saúde mental / Occupational therapy and sociotherapeutics activities: contributing to the social circulation in mental health

O autor caracteriza os conceitos de identidade e cultura, procurando precisá-los na América Latina com todas as suas contradições. Aponta assim as dificuldades dessa constituição em nosso ambiente, comprometendo a formação de nossas crianças.

Climaterio y menopausia: aspectos psicosociales / Climaterio and menopause: aspects psicosociales

Aspectos relacionados con el climaterio y la menopausia, los cambios que ocurren en estas etapas, las alteraciones psíquicas en el climaterio y la presencia de síntomas asociados a la menopausia.