Impact of different criteria on type 2 diabetes remission rate after bariatric surgery.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) achieve similar type 2 diabetes mellitus (T2DM) remission rates. Since a great variability exists in defining T2DM remission, an expert panel proposed partial and complete remission criteria that include the maintenance of fasting plasma glucose (FPG) and glycosylated hemoglobin (A1c) objectives for at least 1 year. The 2-year T2DM remission rate and time needed to reach it after LSG or LRYGB were compared using different remission criteria. METHODS: This was a prospective cohort study of 55 T2DM subjects operated on with LSG (n = 21) or LRYGB (n = 34). Four models for defining remission were used: Buchwald criteria (FPG <100 mg/dl or A1c <6 %), American Diabetes Association (ADA) complete (FPG <100 mg/dl plus A1c <6 % maintained for at least 1 year), ADA partial (FPG <125 mg/dl with A1c <6.5 % maintained for at least 1 year), and ADA complete without time requirement. RESULTS: Both groups were comparable, except for higher A1c levels in the LSG group. The remission rate ranged from 43.6 % using ADA complete remission to 92.7 % with Buchwald criteria, with no differences between surgical procedures. Differences were found in the time to achieve remission only when ADA complete remission criteria (5.1 ± 2.9 months LRYGB and 9.0 ± 3.8 months LSG, p = 0.014) and ADA without time requirement criteria (4.9 ± 2.7 months LRYGB and 8.4 ± 3.9 months LSG, p = 0.005) were used. CONCLUSIONS: T2DM remission rate varies widely depending on the criteria used for its definition. Remission occurred sooner after LRYGB when the strictest criteria to define remission were used.

Malnutrición extrema en una lactante de origen etíope con síndrome de Down / Extreme malnutrition in an infant of Ethiopian origin with Down’s syndrome

La observación de una lactante de origen etíope con síndrome de Down y malnutrición grave permite reflexionar sobre las condiciones sociales y sanitarias de Etiopía y las causas que han posibilitado que se llegue a esa situación extrema (AU)

Observation of an Ethiopian infant with Down’s syndrome with severe malnutrition, and reflection on the effect that the social and health conditions in Ethiopia had on the causes leading to this extreme situation (AU)

Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en-Y gastric bypass) on lipid profile.

BACKGROUND: Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile, with the results being contradictory. The effect of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on lipid profile was compared. METHODS: A nonrandomized prospective cohort study was conducted on severely obese patients undergoing bariatric surgery. Indication for the type of surgical procedure was based on clinical criteria. Patients on lipid-lowering drugs and those that could not be matched for age, sex, and body mass index were excluded. Finally, 51 patients who underwent LSG and 51 undergoing LRYGB completed this study. RESULTS: During the first year post-surgery, no differences in percentage of excess weight loss and triglyceride reduction were found between groups. After LRYGR, low-density lipoprotein (LDL) cholesterol concentrations fell significantly (125.9 ± 29.3 to 100.3 ± 26.4 mg/dl, p < 0.001), whereas no significant changes were observed in the LSG group (118.6 ± 30.7 to 114.6 ± 33.5 mg/dl, p = 0.220). High-density lipoprotein (HDL) cholesterol increase was significantly greater after LSG (15.4 ± 13.1 mg/dl) compared with LRYGB (9.4 ± 14.0 mg/dl, p = 0.032). Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB. A greater increase in HDL cholesterol was associated with LSG, older age, and baseline HDL cholesterol. CONCLUSIONS: LRYGB produces an overall improvement in lipid profile, with a clear benefit in all lipid fractions. Although LSG does not alter LDL cholesterol levels, its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques.

Results of a national study on anti-mycobacterial drug resistance in El Salvador.

SETTING: The DOTS strategy was introduced in El Salvador in 1997 and had become fully implemented countrywide by 2001. Previously, many deficiencies were identified in the management of patients with tuberculosis (TB). OBJECTIVE: To ascertain the prevalence of Mycobacterium tuberculosis resistant to first-line drugs. DESIGN: A national prospective survey was carried out in 2001 using the standardised World Health Organization/ International Union Against Tuberculosis and Lung Disease model. RESULTS: A total of 711 cultures were analysed (59% of total smear-positive cases); 611 were never treated and 100 were previously treated patients. The study showed resistance rates to isoniazid and rifampicin, either alone or combined (multidrug resistance, MDR), of 1.3%, 1.1% and 0.3%, respectively, in never treated patients, and 12%, 13% and 7%, respectively, in previously treated patients. CONCLUSION: The low rates of MDR-TB in El Salvador are puzzling, as out-patient DOTS was introduced only recently and fixed-dose combination tablets have not been used.

Impact of a model training course for private and public specialist physicians in El Salvador.

BACKGROUND: Private and non-private specialist practitioners are often considered an obstacle to the performance of the National Tuberculosis Control Programme (NTP). OBJECTIVE: To evaluate the impact of an intensive refresher course directed at specialist physicians in El Salvador, a questionnaire was sent to all course participants on their basic knowledge of tuberculosis (TB) control. RESULTS: Of 64 participants, 55 were assessed (86%); 33 were chest physicians and 22 belonged to other related specialities. The evaluation showed a considerable improvement in both groups in their ability to suspect the disease, in their tendency to avoid hospitalising patients and instead refer them to out-patient clinics, and in their adherence to the recommendations of the NTP manual (diagnostic procedures, treatment guidelines, case notification and cohort studies). Improvements were more noticeable, in all the parameters evaluated, among the non-chest physicians. CONCLUSION: The intervention model succeeded in improving the collaboration of private and non-private specialist practitioners with the NTP.

Quantification of the contribution of biological nitrogen fixation to tropical green manure crops and the residual benefit to a subsequent maize crop using 15N-isotope techniques.

In this study the contribution of biological N2 fixation (BNF) to leguminous green manures was quantified in the field at different sites with different 15N methodologies. In the first experiment, conducted on a Terra Roxa soil in Cuba, the BNF contribution to three legumes (Crotalaria juncea, Mucuna aterrima and Canavalia ensiformis) was quantified by applying 15N-labelled ammonium sulphate to the soil. The second experiment was planted in a very low fertility sandy soil near Rio de Janeiro, and the 15N natural abundance technique was applied to quantify BNF in C. juncea, M. niveum and soybean. In both studies the advantages of using several non-N2-fixing reference plants was apparent and despite the much greater accumulation of the C. juncea in the experiment performed on the fertile soil of Cuba, the above ground contributions of BNF at both sites were similar (40-80 kg N x ha(-1)) and greater than for the other legumes. In a further experiment the possible contribution of root-derived N to the soil/plant system of two of the legumes was quantified using a 15N-leaf-labelling technique performed in pots. The results of this study suggested that total below-ground N could constitute as much as 39 to 49% of the total N accumulated by the legume crops.

Pyrazolo[4,3-e]-1,2,4-triazolo[1,5-c]pyrimidine derivatives: potent and selective A(2A) adenosine antagonists.

A series of pyrazolo[4,3-e]-1,2,4-triazolo[1,5-c]pyrimidine derivatives (10a-o,q,r), bearing alkyl and aralkyl chains on positions 7 and 8, were synthesized in the attempt to obtain potent and selective antagonists for the A(2A) adenosine receptor subtype. The compounds were tested in binding and functional assays to evaluate their potency for the A(2A) compared with the A1 adenosine receptor subtype. In binding studies in rat brain membranes, most of the compounds showed affinity for A(2A) receptors in the low nanomolar range with a different degree of A(2A) versus A1 selectivity. Comparison of N(7) (10a-d,h-o)- and N(8) (10e-g)-substituted pyrazolo derivatives indicates that N(7) substitution decreases the A1 affinity with the concomitant increase of A(2A) selectivity. Specifically, the introduction of a 3-phenylpropyl group at pyrazolo nitrogen in position 7 (101) increased significantly the A(2A) selectivity, being 210-fold, while the A(2A) receptor affinity remained high (Ki=2.4 nM). With regards to the affinity for A(2A) receptors, also the compound 10n, bearing in the 7-position a beta-morpholin-4-ylethyl group, deserves attention (Ki=5.6 nM) even though the A2A selectivity (84-fold) was not as high as that of 101. Conversely, the compound 10m (N(7)-4-phenylbutyl derivative) showed a remarkable selectivity (A1/a(2A) ratio = 129) associated with lower A(2A) affinity (Ki = 21 nM). In functional studies, most of the compounds examined reversed 5'-(N-ethylcarbamoyl) adenosine-induced inhibition of rabbit platelet aggregation inhibition which is a biological response mediated by the A2A receptor subtype. The compounds are potent and selective A2A antagonists which can be useful to elucidate the pathophysiological role of this adenosine receptor subtype. These compounds deserve to be further developed to assess their potential for treatment of neurodegenerative disorders such as Parkinson's disease.