Repercusión de la pérdida ponderal tras cirugía bariátrica en la estructura y función cardiaca / Impact of ponderal loss after bariatric surgery on the cardiac structure and function

Introducción y objetivoEl exceso de peso puede inducir modificaciones en la estructura y función del miocardio. La presencia de hipertrofia ventricular izquierda es un predictor independiente de morbimortalidad cardiovascular.El objetivo principal del estudio ha sido conocer la prevalencia de alteraciones morfofuncionales cardiacas en pacientes con obesidad y su modificación tras la pérdida de peso después de una cirugía bariátrica (CB).Pacientes y métodosEstudio de cohortes prospectivo de 75 pacientes con obesidad y sin cardiopatía conocida a los que se les realizó un bypass gástrico. Se midieron parámetros antropométricos, analíticos y ecocardiográficos antes, a los 6 y 12 meses de la intervención.ResultadosSe incluyeron 75 pacientes (66,6% mujeres, edad media 39,3 [9,7] años e índice de masa corporal [IMC] 47,8 [7,1] kg/m2). A los 6 y 12 meses de la CB se produjo una reducción significativa del peso corporal, una mejora en los parámetros metabólicos, inflamatorios y protrombóticos, así como en los factores de riesgo cardiovascular asociados a la obesidad (hipertensión arterial [HTA], diabetes mellitus tipo 2 [DM2], dislipemia [DLP] y síndrome de apnea-hipopnea del sueño [SAHOS]).Antes de la intervención, el 62,7% de los pacientes presentaba alteración en la geometría del ventrículo izquierdo, siendo el remodelado concéntrico la más frecuente (38,7%). Además, el 50,7% presentaba disfunción diastólica. Al año de la CB, el patrón ventricular fue normal en el 92% de los casos y la función diastólica mejoró significativamente.ConclusionesNuestros resultados corroboran el efecto negativo de la obesidad sobre el miocardio, así como la potencial reversibilidad de estas alteraciones tras una pérdida significativa de peso después de una CB. (AU)

Introduction and objectiveExcess weight can cause structural and functional cardiac disorders. The presence of left ventricular hypertrophy in the obese patient is an independent predictor of cardiovascular morbidity and mortality.The major aim of the present study is to know the prevalence of cardiac morphofunctional disorders in obese patients, before and after weight loss due to bariatric surgery (BS).Patients and methodsProspective cohort study of 75 patients with obesity without known heart disease referred to gastric bypass. Anthropometric, analytical and echocardiographic parameters were measured before and after 6 and 12 months after BS.ResultsThe study included 75 patients (66.6% women, mean age 39.3 [9.7] years and BMI 47.8 [7.1] kg/m2). At 6 and 12 months after BS there was a significant reduction in body weight and an improvement in metabolic, inflammatory and prothrombotic parameters and in cardiovascular risk factors associated with obesity (hypertension, type 2 diabetes, dyslipidemia and obstructive sleep apnea−hypopnea syndrome).Before surgery, cardiac remodeling was present in 62.7%, most frequently in the form of concentric remodeling (38.7%). Diastolic dysfunction occurred in 50.7% of the patients.One year after surgery, the ventricular pattern was normal in 92% of cases and the diastolic function improved significantly.ConclusionsOur results support the negative effect of obesity on cardiac geometry and function and the potential reversibility of these cardiac alterations after marked weight loss due to BS. (AU)

Impact of ponderal loss after bariatric surgery on the cardiac structure and function. / Repercusión de la pérdida ponderal tras cirugía bariátrica en la estructura y función cardiaca.

INTRODUCTION AND OBJECTIVE: Excess weight can cause structural and functional cardiac disorders. The presence of left ventricular hypertrophy in the obese patient is an independent predictor of cardiovascular morbidity and mortality. The major aim of the present study is to know the prevalence of cardiac morphofunctional disorders in obese patients, before and after weight loss due to bariatric surgery (BS). PATIENTS AND METHODS: Prospective cohort study of 75 patients with obesity without known heart disease referred to gastric bypass. Anthropometric, analytical and echocardiographic parameters were measured before and after 6 and 12 months after BS. RESULTS: The study included 75 patients (66.6% women, mean age 39.3 [9.7] years and BMI 47.8 [7.1] kg/m2). At 6 and 12 months after BS there was a significant reduction in body weight and an improvement in metabolic, inflammatory and prothrombotic parameters and in cardiovascular risk factors associated with obesity (hypertension, type 2 diabetes, dyslipidemia and obstructive sleep apnea-hypopnea syndrome). Before surgery, cardiac remodeling was present in 62.7%, most frequently in the form of concentric remodeling (38.7%). Diastolic dysfunction occurred in 50.7% of the patients. One year after surgery, the ventricular pattern was normal in 92% of cases and the diastolic function improved significantly. CONCLUSIONS: Our results support the negative effect of obesity on cardiac geometry and function and the potential reversibility of these cardiac alterations after marked weight loss due to BS.

Penfigoide ampolloso asociado al tratamiento con linagliptina en pacientes con diabetes y enfermedad renal crónica / Bullous pemphigoid associated with linagliptin treatment in diabetic patients with chronic kidney disease

No disponible

Evidencia de asociación entre el gen SLC6A4 y efectos epistáticos con variantes en HTR2A en la etiología del autismo en la población antioqueña / Evidence for association and epistasis between the genetic markers SLC6A4 and HTR2A in autism etiology

Introducción. El espectro autista constituye un grupo de trastornos graves del neurodesarrollo, con un fuerte componente genético. Se ha sugerido un papel importante del sistema serotoninérgico en el desarrollo de este grupo de trastornos, con base en los estudios de respuesta a medicamentos y la hiperserotoninemia, característica común en el autismo. Se han implicado múltiples moléculas en el metabolismo y la neurotransmisión de la serotonina; sin embargo, los resultados de los estudios han tenido poca congruencia entre diferentes poblaciones. Objetivos. Evaluar la relación entre el autismo y el polimorfismo de nucleótido simple (Single Nucleotide Polymorphism, SNP) en los genes SLC6A4, HTR2A e ITGB3, en una muestra de la población antioqueña. Materiales y métodos. Se genotipificaron 42 núcleos familiares con autismo para 10 variantes en los genes SLC6A4, ITGB3 y HTR2A. Se evaluó la asociación utilizando la prueba de desequilibrio en la transmisión. Se exploró el impacto de la interacción entre estos genes y el autismo, utilizando la reducción multidimensional. Resultados. Se encontró asociación de las variantes rs4583306 (OR=2,6, p=0,004) y rs2066713 (OR=2,2 p=0,03), en el gen SLC6A4, y asociación de combinaciones genotípicas entre los genes SLC6A4 y HTR2A y el riesgo de autismo (p=0,0001). Conclusiones. Se encontró asociación significativa con variantes en el gen transportador de serotonina con el autismo, al igual que interacción entre variantes en los genes HTR2A con SLC6A4. Estos resultados concuerdan con los de estudios previos en otras poblaciones y son pruebas a favor del papel del sistema serotoninérgico en la etiología del espectro autista.

Introduction. Autism spectrum disorders are severe neurodevelopmental disorders with a strong genetic component. The potential role of the serotoninergic system in the development of autistic disorder has been based on the observation of hyperserotoninemia in autistic subjects and the results of drug treatment studies. Multiple molecules involved in serotonin metabolism and neurotransmission have been studied; however, replication studies have been inconsistent. This may be partially related to the marked genetic heterogeneity of autism in different populations. Objectives. The relationship between autism and single nucleotide polymorphisms of SLC6A4, HTR2A and ITGB3 genes was evaluated in an urban population of northwestern Colombia. Materials and methods. In Antioquia, Colombia, 42 families with history of autism were screened for 10 SNPs in SLC6A4, HTR2A and ITGB3 genes and evaluated for associations with the transmission disequilibrium test. The interactions among these genes and autism was assessed with multidimensional reduction methods. Results. A significant main effect was seen among the SLC6A4 gene variants rs4583306 (OR=2.6, p=0.004) and rs2066713 (OR=2.2, p=0.03). No main effect of the ITGB3 or HTR2A variants was found, however, in the interaction effects, the SLC6A4 and HTR2A genes demonstrated significant evidence of association with autism (p<0.001). Conclusion. Significant association of markers were discovered within the SLC6A4 gene and the combination of SLC6A4 and HTR2A (S-A) genes to autism. These results were consistent with previous studies conducted in other populations and provide further evidence for the implication of the serotoninergic system in the etiology of autistic disorders.

[Evidence for association and epistasis between the genetic markers SLC6A4 and HTR2A in autism etiology]. / Evidencia de asociación entre el gen SLC6A4 y efectos epistáticos con variantes en HTR2A en la etiología del autismo en la población antioqueña.

INTRODUCTION: Autism spectrum disorders are severe neurodevelopmental disorders with a strong genetic component. The potential role of the serotoninergic system in the development of autistic disorder has been based on the observation of hyperserotoninemia in autistic subjects and the results of drug treatment studies. Multiple molecules involved in serotonin metabolism and neurotransmission have been studied; however, replication studies have been inconsistent. This may be partially related to the marked genetic heterogeneity of autism in different populations. OBJECTIVES: The relationship between autism and single nucleotide polymorphisms of SLC6A4, HTR2A and ITGB3 genes was evaluated in an urban population of northwestern Colombia. MATERIALS AND METHODS: In Antioquia, Colombia, 42 families with history of autism were screened for 10 SNPs in SLC6A4, HTR2A and ITGB3 genes and evaluated for associations with the transmission disequilibrium test. The interactions among these genes and autism was assessed with multidimensional reduction methods. RESULTS: A significant main effect was seen among the SLC6A4 gene variants rs4583306 (OR=2.6, p=0.004) and rs2066713 (OR=2.2, p=0.03). No main effect of the ITGB3 or HTR2A variants was found, however, in the interaction effects, the SLC6A4 and HTR2A genes demonstrated significant evidence of association with autism (p<0.001). CONCLUSION: Significant association of markers were discovered within the SLC6A4 gene and the combination of SLC6A4 and HTR2A (S-A) genes to autism. These results were consistent with previous studies conducted in other populations and provide further evidence for the implication of the serotoninergic system in the etiology of autistic disorders.