Examining associations between obesity and mental health disorders from childhood to adolescence: A case-control prospective study.

Childhood obesity and mental disorders often co-exist. To date, most of the studies are cross-sectional, involve the assessment of a specific disorder, and rely on self-report questionnaires. This study aimed to provide a comprehensive psychological assessment to examine the concurrent and prospective association between childhood obesity and mental health problems. We compared 34 children with obesity with 37 children with normal weight at baseline, and at a five-year follow-up, to examine the development of mental health disorders from childhood (8-12 years) to adolescence (13-18 years). Both assessments included a clinical interview and self-reported measures of psychosocial and family markers. Findings showed that the obesity group had a higher prevalence of mental disorders, and psychological comorbidity increased in five years. Prospectively, childhood obesity was associated with a psychological diagnosis in adolescence. Moreover, the obesity group displayed higher severity of symptoms at both times. Finally, body esteem contributed to predicting mental health disorders in adolescence regardless of weight status, while eating symptomatology was a specific marker for the obesity group. Therefore, in the management of childhood obesity is suggested to address also psychosocial variables such as weight-related teasing and body esteem, to prevent the onset or development of mental health problems.

Physical Appearance Perfectionism: Psychometric Properties and Factor Structure of an Assessment Instrument in a Representative Sample of Males.

Perfectionism is a multidimensional construct with both positive and negative aspects. Recently, the concept of appearance-oriented perfectionism has been introduced, which is associated with body image dissatisfaction and weight and shape control behaviors. The Physical Appearance Perfectionism Scale (PAPS) is a 12-item two-factor instrument developed to assess this new dimension of perfectionism. The aim of the study is to validate the Spanish version of PAPS among a representative sample of 850 male university students in Spain (M = 20 years old; SD = 2.7). Exploratory and confirmatory factorial structure, internal consistency, convergent and concurrent validity, and associated predictor variables analyses have been carried out. Results showed that the Spanish version of the PAPS maintains the original factor structure with all items and proves to be a reliable instrument. Physical appearance-oriented perfectionism is associated with general perfectionism, higher body dissatisfaction, Eating Disorders and Muscle Dysmorphia symptomatology, and compulsive exercise, particularly in the Worry about Imperfection subscale. These variables also act as predictors of physical appearance perfectionism. The use of the PAPS-S and the analysis of its subscales is recommended in the context of body image-related pathologies such as Eating Disorders and Muscle Dysmorphia.

Establishing the optimal male cut-off point: confirmatory factor analysis of the eating disorder examination-questionnaire (EDE-Q) in a representative sample of Spanish university students.

PURPOSE: Although the EDE-Q is derived from the "gold standard" for the assessment of eating disorders (ED), its factor structure is controversial, particularly in male samples. The aim of the study was to examine the psychometric properties and factor structure of the EDE-Q, as well as to establish a sensitive and specific cut-off point validated by EDE clinical interview. METHODS: A series of Confirmatory Factor Analyses were performed among a representative sample of 796 male university students, of whom 139 were interviewed. Sensitivity and specificity were calculated by receiver-operating characteristic (ROC) analysis to determinate the most appropriate cut-off value. RESULTS: The original factor structure was not confirmed, showing a better fit with a 2-factor solution. For the Spanish male sample, a cut-off ≥ 1.09 for at-risk of ED cases and ≥ 2.41 for clinical cases presents an optimal balance between sensitivity and specificity. CONCLUSIONS: The establishment of specific cut-off points for males may help to reduce the under-diagnosis of ED in this population. LEVEL OF EVIDENCE: III: evidence obtained from well-designed case-control study.

Exploración de las decisiones académicas en estudiantes con alta capacidad / Exploração de decisões acadêmicas em estudantes de alta capacidade / Exploration des décisions académiques chez les étudiants à haute capacité / Exploration of the academic decisions of highly able students

Resumen La elección de carrera en estudiantes con alta capacidad (AC) no está exenta de dificultades. En STEM (Science, Technology, Engineering, Mathematics) las mujeres con AC no eligen dichas áreas en la misma proporción que los hombres. Se buscó entender cómo los factores contextuales influyen en las decisiones académicas. Es un estudio cualitativo donde se realizaron ocho focus group de estudiantes con AC e intereses en STEM. Los resultados muestran a los padres como modelos; sin embargo, el mensaje paterno puede ser amenazante para las mujeres. Los profesores inspiran y entregan orientaciones claras basadas en las habilidades más que desde un desafío real. Las actividades escolares permiten una experiencia directa con la disciplina, pero producen poca vinculación con reales áreas de interés.

Resumo A escolha da carreira de alunos superdotados não está livre de dificuldades. No tocante à STEM (Science, Technology, Engineering, Mathematics), as mulheres superdotadas não escolhem tais áreas na mesma proporção que os homens. Tentou-se entender de que maneira os fatores contextuais influenciam as decisões acadêmicas. Trata-se de um estudo qualitativo no qual foram realizados oito focus groups de alunos superdotados e com interesses em STEM. Os resultados mostram os pais como modelos; no entanto, a mensagem paterna pode ser ameaçadora para as mulheres. Os professores inspiram e transmitem orientações claras baseadas mais em habilidades que em um desafio real. As atividades escolares permitem uma experiência direta com a disciplina, porém produzem pouca ligação com áreas reais de interesse.

Resumé Le choix de la carrière des elèves à haut potentiel n'est pas libre de difficultés. En ce qui concerne STEM (Science, Technology, Engineering, Mathematics) les femmes à haut potentiel ne choisissent pas tels domaines dans la même proportion que les hommes. On a essayé de comprendre de quelle manière les facteurs du contexte influencent les décisions académiques. Il s'agit d'une étude qualitative pour laquelle on été réalisés huit focus groups d'élèves à haut potentiel intéressés à STEM. Les résultats montrent les parents comme modèle, pourtant le message paternel peut être menaçant pour les femmes. Les enseignants inspirent et transmettent des orientations claires basées plus dans des habilités que dans des défis réels. Les activités scolaires permettent une expérience directe avec la discipline, cependant elles produisent peu de liens avec les vrais domaines d'intérêt.

Abstract The choice of career for students with high ability (HA) is not without its difficulties. In STEM (Science, Technology, Engineering, Mathematics), women with HA do not choose such areas in the same proportion as men. We sought to understand how contextual factors influence the academic decisions of HA students. In this qualitative study, eight focus groups with students with HA and interests in STEM were conducted. The results show parents as role models; however, fathers' messages can be threatening for female students. Results also show that teachers inspire and provide clear guidance based on skills, rather than on real challenge, and that school activities allow direct experience of discipline, but produce little linkage to real areas of interest.

Workplace difficulties, health-related quality of life, and perception of stigma from the perspective of patients with Multiple Sclerosis.

INTRODUCTION: In Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health-related quality of life, depression, and stigma and how these factors affect employment status. METHODS: A multicenter, non-interventional, cross-sectional study was conducted in adults with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). Patient-reported questionnaires included: 23-item Multiple Sclerosis Work Difficulties Questionnaire, 29-item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory-Fast Screen. RESULTS: A total of 199 individuals (mean age = 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS) participated in the study. Mean time from diagnosis was 9.6 ± 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0-3.5). Employment rate was 47.2% (n = 94). Mean physical and psychological MSIS-29 impact sub-scores were 40.38 ± 17.1 and 20.24 ± 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate-to-severe depression. Work difficulties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health-related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work-related problems. CONCLUSIONS: Work difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.

Understanding inclusive education in chile: an overview of policy and educational research / Panorama des politiques publiques et des recherches sur léducation inclusive au chili / Para compreender a educação inclusiva chilena: panorama de políticas e pesquisa educativa / Comprender la educación inclusiva chilena: panorama de políticas e investigación educativa

Abstract The development of the concept of inclusive education was based on several sources and surrounded by other notions, such as failure, quality and effectiveness, which influence its interpretation and implementation. This article is a theoretical discussion that seeks to understand, from an educational perspective, how this confluence of ideas was formed. To that end, we establish a historical chronology of international policies, national Chilean policies, and research trends, which are understood as universal concerns, work hypotheses and objects of study, respectively. The discussion reveals the complexity of the concept when we contextualize it and when we clarify its logic in psycho-pedagogical terms and in terms of resource effectiveness, quality and inclusion.

Résumé Le concept d'éducation inclusive a été construit à partir de diverses sources et entouré de notions, telles que l'échec, la qualité et l'efficacité, qui influencent son interprétation et sa mise en œuvre. Cet article vise à comprendre par le biais d'une discussion theorique comment une telle confluence d'idées s'est produite d'un point de vue éducatif. À cette fin, a été réalisée une retrospective chronologique concernant l'histoire des politiques publiques internationales et des politiques nationales chiliennes, aussi bien que les tendances des recherches dans le domaine, vues comme préoccupations universelles, hypothèses de travail et objets d'étude. Cette discussion a dévoilé la complexité du concept son observation contextualisée, mais a aussi rendu plus transparentes les logiques psychopédagogiques, d'efficacité des ressources, de qualité et d'inclusion sur lesquelles il se base.

Resumo O conceito de educação inclusiva foi construído a partir de diversas fontes, cercado de outras noções como fracasso, qualidade e eficácia, que influem em sua interpretação e implementação. Este artigo de discussão teórica tenta compreender a partir de uma perspectiva educativa como foi construída essa confluência de ideias. Para tanto realiza-se uma cronologia de antecedentes de políticas internacionais e nacionais chilenas, bem como de tendências em pesquisas, entendendo-as como preocupações universais, hipóteses de trabalho e objetos de estudo, respectivamente. A discussão nos revela a complexidade do conceito ao observá-lo de maneira contextualizada e torna transparentes as lógicas psicopedagógicas, de eficácia dos recursos e de qualidade e inclusão nas quais se baseia.

Resumen El concepto de educación inclusiva se ha construido desde diversas fuentes rodeado de otras nociones como fracaso, calidad y eficacia que influyen en su interpretación e implementación. Este artículo de discusión teórica busca comprender desde una perspectiva educativa cómo se ha construido esta confluencia de ideas. Para esto se realiza una cronología de antecedentes de políticas internacionales y políticas nacionales chilenas, así como de tendencias en investigaciones, entendiéndolas como preocupaciones universales, hipótesis de trabajo y objetos de estudio, respectivamente. La discusión nos revela la complejidad del concepto al mirarlo de manera contextualizada y transparentar las lógicas psicopedagogistas, de eficacia de los recursos y de calidad e inclusión sobre las que se asienta.

Asprosin, a Fasting-Induced Glucogenic Protein Hormone.

Hepatic glucose release into the circulation is vital for brain function and survival during periods of fasting and is modulated by an array of hormones that precisely regulate plasma glucose levels. We have identified a fasting-induced protein hormone that modulates hepatic glucose release. It is the C-terminal cleavage product of profibrillin, and we name it Asprosin. Asprosin is secreted by white adipose, circulates at nanomolar levels, and is recruited to the liver, where it activates the G protein-cAMP-PKA pathway, resulting in rapid glucose release into the circulation. Humans and mice with insulin resistance show pathologically elevated plasma asprosin, and its loss of function via immunologic or genetic means has a profound glucose- and insulin-lowering effect secondary to reduced hepatic glucose release. Asprosin represents a glucogenic protein hormone, and therapeutically targeting it may be beneficial in type II diabetes and metabolic syndrome.

Fibrillin-1 microfibrils influence adult bone marrow hematopoiesis.

We have recently demonstrated that fibrillin-1 assemblies regulate the fate of skeletal stem cells (aka, mesenchymal stem cells [MSCs]) by modulating TGFß activity within the microenvironment of adult bone marrow niches. Since MSCs can also influence hematopoietic stem cell (HSC) activities, here we investigated adult hematopoiesis in mice with Cre-mediated inactivation of the fibrillin-1 (Fbn1) gene in the mesenchyme of the forming limbs (Fbn1(Prx1-/-) mice). Analyses of 3-month-old Fbn1(Prx1-/-) mice revealed a statistically significant increase of circulating red blood cells, which a differentiation assay correlated with augmented erythropoiesis. This finding, together with evidence of fibrillin-1 deposition in erythroblastic niches, supported the notion that this extracellular matrix protein normally restricts differentiation of erythroid progenitors. Whereas flow cytometry measurements identified a decreased HSC frequency in mutant relative to wild type mice, no appreciable differences were noted with regard to the relative abundance and differentiation potential of myeloid progenitor cells. Together these findings implied that fibrillin-1 normally promotes HSC expansion but does not influence cell lineage commitment. Since local TGFß hyperactivity has been associated with abnormal osteogenesis in Fbn1(Prx1-/-) mice, 1-month-old mutant and wild type animals were systemically treated for 8weeks with either a pan-TGF-ß-neutralizing antibody or an antibody of the same IgG1 isotype. The distinct outcomes of these pharmacological interventions strongly suggest that fibrillin-1 differentially modulates TGFß activity in HSC vs. erythroid niches.

Fibrillin-1 Regulates Skeletal Stem Cell Differentiation by Modulating TGFß Activity Within the Marrow Niche.

A full understanding of the microenvironmental factors that control the activities of skeletal stem cells (also known as mesenchymal stem cells [MSCs]) in the adult bone marrow holds great promise for developing new therapeutic strategies to mitigate age-related diseases of bone and cartilage degeneration. Bone loss is an understudied manifestation of Marfan syndrome, a multisystem disease associated with mutations in the extracellular matrix protein and TGFß modulator fibrillin-1. Here we demonstrate that progressive loss of cancellous bone in mice with limbs deficient for fibrillin-1 (Fbn1(Prx1-/-) mice) is accounted for by premature depletion of MSCs and osteoprogenitor cells combined with constitutively enhanced bone resorption. Longitudinal analyses of Fbn1(Prx1-/-) mice showed incremental bone loss and trabecular microarchitecture degeneration accompanied by a progressive decrease in the number and clonogenic potential of MSCs. Significant paucity of marrow fat cells in the long bones of Fbn1(Prx1-/-) mice, together with reduced adipogenic potential of marrow stromal cell cultures, indicated an additional defect in MSC differentiation. This postulate was corroborated by showing that an Fbn1-silenced osteoprogenitor cell line cultured in the presence of insulin yielded fewer than normal adipocytes and exhibited relatively lower PPARγ levels. Consonant with fibrillin-1 modulation of TGFß bioavailability, cultures of marrow stromal cells from Fbn1(Prx1-/-) limb bones showed improper overactivation of latent TGFß. In line with this finding, systemic TGFß neutralization improved bone mass and trabecular microarchitecture along with normalizing the number of MSCs, osteoprogenitor cells, and marrow adipocytes. Collectively, our findings show that fibrillin-1 regulates MSC activity by modulating TGFß bioavailability within the microenvironment of marrow niches.

[Design and validation of an instrument to assess families at risk for health problems]. / Diseño y validación del instrumento SALUFAM: un instrumento de valoración de la salud familiar con alto valor predictivo clínico para la atención primaria chilena.

BACKGROUND: There is a paucity of screening instruments with a high clinical predictive value to identify families at risk and therefore, develop focused interventions in primary care. AIM: To develop an easy to apply screening instrument with a high clinical predictive value to identify families with a higher health vulnerability. MATERIAL AND METHODS: In the first stage of the study an instrument with a high content validity was designed through a review of existent instruments, qualitative interviews with families and expert opinions following a Delphi approach of three rounds. In the second stage, concurrent validity was tested through a comparative analysis between the pilot instrument and a family clinical interview conducted to 300 families randomly selected from a population registered at a primary care clinic in Santiago. The sampling was blocked based on the presence of diabetes, depression, child asthma, behavioral disorders, presence of an older person or the lack of previous conditions among family members. The third stage, was directed to test the clinical predictive validity of the instrument by comparing the baseline vulnerability obtained by the instrument and the change in clinical status and health related quality of life perceptions of the family members after nine months of follow-up. RESULTS: The final SALUFAM instrument included 13 items and had a high internal consistency (Cronbach's alpha: 0.821), high test re-test reproducibility (Pearson correlation: 0.84) and a high clinical predictive value for clinical deterioration (Odds ratio: 1.826; 95% confidence intervals: 1.101-3.029). CONCLUSIONS: SALUFAM instrument is applicable, replicable, has a high content validity, concurrent validity and clinical predictive value.

Diseño y validación del instrumento SALUFAM: un instrumento de valoración de la salud familiar con alto valor predictivo clínico para la atención primaria chilena / Design and validation of an instrument to assess families at risk for health problems

Background: There is a paucity of screening instruments with a high clinical predictive value to identify families at risk and therefore, develop focused interventions in primary care. Aim: To develop an easy to apply screening instrument with a high clinical predictive value to identify families with a higher health vulnerability. Material and Methods: In the first stage of the study an instrument with a high content validity was designed through a review of existent instruments, qualitative interviews with families and expert opinions following a Delphi approach of three rounds. In the second stage, concurrent validity was tested through a comparative analysis between the pilot instrument and a family clinical interview conducted to 300families randomly selected from a population registered at a primary care clinic in Santiago. The sampling was blocked based on the presence of diabetes, depression, child asthma, behavioral disorders, presence of an older person or the lack of previous conditions among family members. The third stage, was directed to test the clinical predictive validity of the instrument by comparing the baseline vulnerability obtained by the instrument and the change in clinical status and health related quality of life perceptions of the family members after nine months of follow-up. Results: The final SALUFAM instrument included 13 items and had a high internal consistency (Cronbach's alpha: 0.821), high test re-test reproducibility (Pearson correlation: 0.84) and a high clinical predictive value for clinical deterioration (Odds ratio: 1.826; 95% confidence intervals: 1.101-3.029). Conclusions: SALUFAM instrument is applicable, replicable, has a high content validity, concurrent validity and clinical predictive value.

Generation of Fbn1 conditional null mice implicates the extracellular microfibrils in osteoprogenitor recruitment.

Loss-of-function experiments in mice have yielded invaluable mechanistic insights into the pathogenesis of Marfan syndrome (MFS) and implicitly, into the multiple roles fibrillin-1 microfibrils play in the developing and adult organism. Unfortunately, neonatal death from aortic complications of mice lacking fibrillin-1 (Fbn1(-/-) mice) has limited the scope of these studies. Here, we report the creation of a conditional mutant allele (Fbn1(fneo) ) that contains loxP sites bordering exon1 of Fbn1 and an frt-flanked neo expression cassette downstream of it. Fbn1(fneo/+) mice were crossed with FLPeR mice and the resulting Fbn1(Lox/+) progeny were crossed with Fbn1(+/-) ;CMV-Cre mice to generate Fbn1(CMV-/-) mice, which were found to phenocopy the vascular abnormalities of Fbn1(-/-) mice. Furthermore, mating Fbn1(Lox/+) mice with Prx1-Cre or Osx-Cre mice revealed an unappreciated role of fibrillin-1 microfibrils in restricting osteoprogenitor cell recruitment. Fbn1(Lox/+) mice are, therefore, an informative genetic resource to further dissect MFS pathogenesis and the role of extracellular fibrillin-1 assemblies in organ development and homeostasis.

Evaluación de la enseñanza y aprendizaje por parte de estudiantes de un programa de talentos académicos (BETA-PUCV) frente a un curso de neuroanatomía funcional / Evaluation of teaching and learning by gifted students of an enrichment program (BETA-PUCV) of a functional neuroanatomy course

El talento académico se presenta en aproximadamente un 6 por ciento de la población, y se caracteriza por un destacado desempeño intelectual en algún área específica del conocimiento o en áreas generales. Esta investigación explora la aplicación de un método de enseñanza activo-participativo en el área de la neuroanatomía funcional, a estudiantes con talento académico de cursos de Enseñanza media (n=27), que formaban parte de un programa de enriquecimiento curricular (Programa BETA-PUCV). Este método integra las clases interactivas, la realización de pasos prácticos que incluyen disecciones, la confección de modelos tridimensionales y la preparación de técnicas anatómicas, además de un refuerzo virtual a través del Aula Virtual de Anatomía Humana. Los estudiantes formaron parte de cursos impartidos durante el primer y segundo semestre 2008. Al fin del período, los estudiantes evalúan el curso mediante una encuesta que contiene preguntas en escala Likert y una sección cualitativa. Los resultados de la comparación de las evaluaciones realizadas por los estudiantes que participaron en dichos cursos versus estudiantes de otros cursos del área científica del programa BETA, demuestran que a través de las metodologías utilizadas, se han maximizando las posibilidades de aprendizaje de los estudiantes. Esto, se ha reflejado en diferencias significativas de nuestra propuesta versus el resto de los cursos. El talento académico que presenta este tipo de estudiantes sumado a la metodología de trabajo, permiten que cada estudiante avance a su propio ritmo y además descubra a través de la experiencia directa la morfología del sistema nervioso.

Academic talent occurs in approximately 6 percent of the population and can be defined by a superior intellectual performance in specific or general academic fields. This research explores the application of an active and participative teaching model in the field of functional neuroanatomy to high school academically talented students (n=27) that participate in an enrichment program (BETA program). This method integrates interactive lessons, performance of practical steps that include dissections, constructing tridimensional models and the preparation of anatomic techniques. Students were also reinforced through an internet-based virtual classroom called "Aula Virtual de Anatomía Humana". Students were part of the courses implemented during the program's first and second semester of 2008. At the end of the course students do an evaluation using a survey that includes questions using a Likert scale and a qualitative (open) section. The results of the comparative analysis between students that participated in this course versus students from different science courses of the Beta program show that student learning opportunities have been maximized. This is reflected on the significant differences that support our method. Student academic talent plus the teaching methodology allows each student to progress according to their own rhythm and to discover, through direct experience, the morphology of the nervous system.

Fluoro-Julia olefination as a mild, high-yielding route to alpha-fluoro acrylonitriles.

Synthesis of a novel, stable reagent (1,3-benzothiazol-2-ylsulfonyl)fluoroacetonitrile from readily synthesized ethyl alpha-(1,3-benzothiazol-2-ylsulfanyl)-alpha-fluoroacetate is reported. Aldehydes undergo condensations with (1,3-benzothiazol-2-ylsulfonyl)fluoroacetonitrile in the presence of DBU leading to alpha-fluoro acrylonitriles in high yields and with good Z-stereoselectivity. Lowering of reaction temperature increases the Z selectivity.

Síndrome de ovario poliquístico (SOP) y embarazo: Experiencia clínica / Polycystic ovary syndrome and pregnancy: Clinical experience

Background: Polycystic ovary syndrome (PCOS) is an endocrine metabolic dysfunction closely associated with insulin resistance and obesity, which predisposes to pregnancy complications. Aim: To report a prospective clinical experience in PCOS patients who became pregnant after diet, exercise and metformin treatment intervention, and were followed up during the whole pregnancy. Patients and Methods: Seventy pregnant PCOS (PPCOS) women and forty normal pregnant (NP) women of similar age and with singleton pregnancies were included in the study. During gestational ages 10-16 and 22-28 weeks, a 2h, 75 g oral glucose tolerance test (OGTT) was performed with measurement of glucose and insulin in each sample. Results: No differences were found in duration of gestation, weight gain during pregnancy, or systolic and diastolic blood pressure between PPCOS and NP women. There were significant differences in body mass index (BMI) at the initiation and in the third trimester of pregnancy between both groups. The incidence of gestational diabetes was significantly higher (p <0.01) in the PCOS group (35.2 percent) compared to the control group (5.0 percent). The prevalence of small for gestational age (SGA) infants tended to be higher (p =0.09) in the PCOS group. During pregnancy, 2h glucose and insulin were significantly higher in PPCOS than in NP women. Conclusions: PCOS mothers showed a higher prevalence of gestational diabetes and SGA newborns, which cannot be attributed to the weight gain during pregnancy, and seems to be more related to the BMI at the initiation of pregnancy, and to the PCOS condition of the mothe.

[Polycystic ovary syndrome and pregnancy: clinical experience]. / Síndrome de ovario poliquístico (SOP) y embarazo: Experiencia clínica.

BACKGROUND: Polycystic ovary syndrome (PCOS) is an endocrine metabolic dysfunction closely associated with insulin resistance and obesity, which predisposes to pregnancy complications. AIM: To report a prospective clinical experience in PCOS patients who became pregnant after diet, exercise and metformin treatment intervention, and were followed up during the whole pregnancy. PATIENTS AND METHODS: Seventy pregnant PCOS (PPCOS) women and forty normal pregnant (NP) women of similar age and with singleton pregnancies were included in the study. During gestational ages 10-16 and 22-28 weeks, a 2h, 75 g oral glucose tolerance test (OGTT) was performed with measurement of glucose and insulin in each sample. RESULTS: No differences were found in duration of gestation, weight gain during pregnancy, or systolic and diastolic blood pressure between PPCOS and NP women. There were significant differences in body mass index (BMI) at the initiation and in the third trimester of pregnancy between both groups. The incidence of gestational diabetes was significantly higher (p <0.01) in the PCOS group (35.2%) compared to the control group (5.0%). The prevalence of small for gestational age (SGA) infants tended to be higher (p =0.09) in the PCOS group. During pregnancy, 2h glucose and insulin were significantly higher in PPCOS than in NP women. CONCLUSIONS: PCOS mothers showed a higher prevalence of gestational diabetes and SGA newborns, which cannot be attributed to the weight gain during pregnancy, and seems to be more related to the BMI at the initiation of pregnancy, and to the PCOS condition of the mother.

Síndrome de ovario poliquístico, obesidad e hiperinsulinismo: un camino a la diabetes / Polycystic ovary syndrome POS, obesity and hyperinsulinism: a course to diabetes

El síndrome de ovario poliquístico(SOP) es una disfunción endocrinometabólica heterogénea de alta prevalencia, con una probable base genética, que compromete la función reproductiva de la mujer joven y que se encuentra en estrecha asociación a la insulinorresistencia (IR), Dentro de su compleja fisiopatología destacan la hipersecreción de LH e insulina, las cuales agravan una alteración preexistente de la biosíntesis esteroidal. La presencia de IR predispone a estas pacientes a desarrollar complicaciones cardiovasculares y metabólicas, las que suelen ser precoces. Por otro lado, la incidencia de patologías metabólicas asociadas a IR es mayor en los familiares de pacientes SOP que en los de mujeres normales, de ahí que el tratamiento de este síndrome no sólo debe ser sintomático, sino fundamentalmente preventivo. Asimismo, el SOP debería ser considerado un marcador de una patología familiar, un camino a la diabetes y un problema de salud pública

Insulinorresistencia: generalidades e implicancias clínicas / Insulin resistance generalties and clinical approach

La insulinorresistencia, es la base fisiopatológica de múltiples enfermedades de alta prevalencia, entre las que se destacan: la obesidad androide, la intolerancia a la glucosa, la diabetes mellitus, la hipertensión arterial y la dislipidemia. Además, se presenta en otras situaciones patológicas frecuentes, entre otras, diabetes gestacional, ovario poliquístico y en sujetos pequeños para la edad gestacional. Finalmente, está presente en una serie de condiciones fisiológicas y patológicas poco frecuentes o muy excepcionales, ya sea de origen genético, congénitas o adquiridas. Quizás más que por su prevalencia, el principal problema reside en, que esta condición puede permanecer desconocida y el daño metabólico puede ocurrir mucho antes que un exámen fortuito o el cuadro florido de una diabetes 2 nos lleve finalmente a su diagnóstico. El propósito de esta revisión es dar una orientación diagnóstica práctica de este síndrome tanto desde el punto de vista clínico como de las metodologías actualmente en uso