Sarcopenia, neuropatía periférica y enfermedad arterial periférica en pacientes con diabetes mellitus sometidos a hemodiálisis / Sarcopenia, peripheral neuropathy, and peripheral arterial disease in patients with diabetes mellitus under hemodialysis

Resumen Introducción: La sarcopenia se caracteriza por pérdida de fuerza y masa muscular. Los pacientes con diabetes mellitus que se encuentran bajo tratamiento en hemodiálisis tienen disminución de actividad física y cambios en su ingestión alimentaria, lo que propicia también la presencia de sarcopenia; por otro lado, la neuropatía periférica y enfermedad arterial periférica aparecen comúnmente como complicaciones crónicas de la diabetes mellitus. Material y métodos: Se realizó un estudio transversal, observacional, en pacientes con diabetes mellitus y hemodiálisis. Para la evaluación de la sarcopenia se midió fuerza muscular, rendimiento físico y cantidad de masa muscular. Se midió fuerza muscular con dinamómetro, mientras que el rendimiento físico se evaluó con el tiempo en segundos de marcha con cronómetro, la cantidad de músculo de obtuvo utilizando una báscula con bioimpedancia. Se consideró sarcopenia severa cuando existía baja fuerza y cantidad muscular además de bajo rendimiento físico. La neuropatía periférica se evaluó explorando la sensibilidad a la presión y el tacto con el monofilamento de Semmes-Weinstein y sensibilidad profunda con un diapasón de 128 Hz. El índice tobillo-brazo fue la medición tomada para la clasificación de enfermedad arterial periférica. Resultados: El análisis final se realizó con 33 pacientes. Con un tiempo en hemodiálisis de 3,57 ± 2,56 años. La prevalencia de sarcopenia severa y sarcopenia fue de 90,8% y la de pre-sarcopenia de 9% del total de los pacientes; por otro lado, se encontró al 78,1% los pacientes con pérdida de la sensibilidad profunda, mientras que el porcentaje de los pacientes con pérdida de la sensibilidad a la presión y al tacto fue de 54,5%. Se encontró correlación entre los parámetros de sarcopenia y el tiempo de evolución de la insuficiencia renal y la edad. Conclusión: La sarcopenia se presenta, en sus diferentes etapas, en prácticamente todos los pacientes con diabetes mellitus sometidos a hemodiálisis; existe relación con la edad del paciente y el tiempo de hemodiálisis.

Abstract Introduction: Sarcopenia is characterized by loss of strength and muscle mass. Patients with diabetes mellitus who are under hemodialysis treatment show decreased physical activity and changes in their food intake, which also leads to the presence of sarcopenia. On the other hand, peripheral neuropathy and peripheral arterial disease commonly appear as chronic complications of diabetes mellitus. Methods: A cross-sectional, observational study was carried out in diabetes mellitus patients on hemodialysis. For the assessment of sarcopenia, muscle strength, physical performance and muscle mass percentage were measured. Muscle strength was calculated with a dynamometer, while physical performance was evaluated in seconds by means of a walk test with a stopwatch; muscle mass percentage was obtained using a scale with bioelectrical impedance. Sarcopenia was considered severe when there was low muscle strength and percentage in addition to low physical performance. Peripheral neuropathy was assessed by exploring touch and pressure sensibility with the Semmes-Weinstein monofilament test and deep sensibility with a 128 Hz tuning fork. The ankle-brachial index was the measurement taken for the peripheral arterial disease classification. Results: The final analysis was performed with 33 patients, whose time on hemodialysis was 3.57 ± 2.56 years. The prevalence of severe sarcopenia and sarcopenia was 90.8% and that of pre-sarcopenia was 9% of all patients. On the other hand, 78.1% were found to be patients with loss of deep sensibility, while the percentage of patients with loss of sensibility to pressure and touch was 54.5%. A correlation was found between the sarcopenia parameters and the time of evolution of renal failure and age. Conclusion: Sarcopenia occurs, in its different stages, in practically all diabetes mellitus patients undergoing hemodialysis; there is a relationship with the patient's age and hemodialysis time.

Genotyping of Human Papillomavirus in Cervical Squamous Intraepithelial Lesions in Mexican Women.

Approximately 40 genotypes of the human papillomavirus (HPV) have been identified in cervical mucosa. In particular, HPV-16 and HPV-18 have been associated with cervical neoplasia. Squamous intraepithelial lesions (SILs) are precursors of cervical cancer. This study aimed to identify the HPV by genotype in SILs using a linear array genotyping test in a population in Mexico. We performed a cross-sectional study of 129 female patients with or without SILs, as determined by colposcopy, who completed a risk factor questionnaire. Cervical swab samples were obtained and genotyped using a Linear Array HPV Genotyping assay. Forty-nine (37.98%) samples were positive for HPV, and 24 genotypes were identified among these samples. The most common genotype was HPV-16. Twelve genotypes were found in both high- and low-grade SILs (HPV-6, 16, 31, 39, 51, 52, 53, 58, 59, 61, 67, and 84), of which seven were high-risk SILs (HPV-16, 31, 39, 51, 52, 58, and 59). Among the populations studied, the most frequent genotype was HPV-16, multiple infections were found, and four patients without injury tested positive for HPV.

Association of Irisin Serum Concentration and Muscle Strength in Normal-Weight and Overweight Young Women.

Background: Irisin is a muscle-contraction-induced myokine. In previous studies, it has been related to exercise type, fitness and physical activity; however, evidence is not consistent. Thus, the aim of this study was to research the association between health-related fitness and irisin in young women. Methods: The study was designed as a prospective cross-sectional one. Young, healthy, nonsmoking women were enlisted. The sample comprised 40 overweight (OW) and 40 normal-weight (NW) individuals. The average age was 18.63 ± 0.63 and 18.78 ± 0.73 years, respectively. Components of health-related fitness, metabolic parameters, serum irisin and body composition were analyzed. Results: Statistically significant differences were found in physical tests between NW and OW groups for one-leg standing, hand grip strength, vertical jump, modified push-up, fitness index and maximal oxygen uptake (VO2MAX). There were no differences in concentrations of serum irisin between the groups. We found a positive correlation between irisin and hand grip strength (r = 0.374, p = 0.023). In a multivariate analysis adjusted by body fat, a significant association between irisin and hand grip strength was observed in OW group (ß = 0.380, p = 0.026); as well, a positive association between irisin and one-leg standing test in NW group (ß = 0.311, p = 0.044) was found. Conclusions: According to our findings, hand grip strength could be linked to irisin concentration in overweight young women.

Evaluación de factores de riesgo asociados a enfermedad cardiovascular en jóvenes universitarios de la Localidad Santafé en Bogotá, Colombia / Evaluation of risk factors associated with cardiovascular disease in young university students of Santafe Locality from Bogota, Colombia

Objetivo. Identificar factores de riesgo cardiovascular en población joven de la Localidad Santafé de Bogotá, Colombia. Métodos. Estudio descriptivo, transversal desarrollado en estudiantes de tres universidades de la Localidad Santafé en Bogotá, con edades comprendidas entre los 16 a 29 años, a quienes se les realizaron exámenes clínicos y paraclínicos y se les aplicó una encuesta de factores de riesgo. Resultados. Se estudiaron 747 estudiantes, encontrando que la prevalencia más alta de factores de riesgo estuvo dada por el consumo de alcohol (96.1%), que mostró además relación con el aumento de tensión arterial con la prueba Chi cuadrada. Las prevalencias de sedentarismo (63.8%) y tabaquismo (48.1%) no presentaron diferencias marcadas en comparación con otros estudios, pero el segundo fue el único que se asoció con el aumento de la tensión arterial sistólica (P < 0.001) y diastólica (P = 0.04). La prevalencia de obesidad fue similar a la hallada en investigaciones anteriores hechas en Colombia (2.3%); de igual manera se encontró asociación entre aquella, la presencia de hipertrigliceridemia (P = 0.001) y el incremento en los niveles de glucosa (P = 0.01). Los resultados de este estudio indican que los estudiantes universitarios de la Localidad Santafé en Bogotá, tienen como factores de riesgo preponderantes de enfermedad cardiovascular al consumo de alcohol, el tabaquismo y el sedentarismo.

Objective. To identify cardiovascular risk factors in young people of Santafé Locality of Bogotá, Colombia. Method. This was a descriptive cross-sectional study conducted at three universities in the Santafe Locality of Bogota, aged 16-29 years, who underwent clinical and laboratory examinations and they were asked to answer a risk factor questionnaire. Results. 747 students were evaluated, finding that the highest prevalence of cardiovascular risk factor was alcohol (96.1%), also related to an increased blood pressure with the Chi square test. The prevalence of physical inactivity (63.8%) and smoking (48.1%) showed no marked differences compared with other studies, and the second was the only one that was associated with increased systolic (P < 0.001) and diastolic blood pressure (P = 0.04). The prevalence of obesity was similar to that found in previous research (2.3 %); and it was also associated to the presence of high levels of triglycerides (P = 0.001) and increase in blood glucose (P = 0.01). The results of this study indicate that college students in the Santafe Locality of Bogotá, have as main risk factors of cardiovascular disease, alcohol consumption, smoking and physical inactivity.

A Simple Mathematical Model for Wound Closure Evaluation.

The incidence of ulcers associated to type 2 diabetes mellitus (T2DM) increases every year. We introduce and explore a new mathematical algorithm to evaluate wound-healing in foot ulcers associated to T2DM. Fifteen patients (nine women and six men), mean age of 70 ± 16 years were included. The evolution of their wounds followed-up for a period of 18-45 days. According to the Wagner grading system the ulcers were grade I (5 patients), grade II (9 patients), and grade III (1 patient). Clinically, the type of the ulcers was neuroischemic (12 patients) and neuropathic (3 patients). A new parameter is introduced, the "continuous linear healing rate" Dc that was more accurate with higher values and requires less quantifications than usual formulas to make a wound-healing projection.

Peripheral Pathways in the Food-Intake Control towards the Adipose-Intestinal Missing Link.

In the physiological state a multitude of gut hormones are released into the circulation at the same time depending on the quality and quantity of the diet. These hormones interact with receptors at various points in the "gut-brain axis" to affect short-term and intermediate-term feelings of hunger and satiety. The combined effects of macronutrients on the predominant gut hormone secretion are still poorly understood. Besides, adipokines form an important part of an "adipoinsular axis" dysregulation which may contribute to ß -cell failure and hence to type 2 diabetes mellitus (T2DM). Even more, gestational diabetes mellitus (GDM) and T2DM seem to share a genetic basis. In susceptible individuals, chronic exaggerated stimulation of the proximal gut with fat and carbohydrates may induce overproduction of an unknown factor that causes impairment of incretin production and/or action, leading to insufficient or untimely production of insulin, so that glucose intolerance develops. The bypass of the duodenum and jejunum might avoid a putative hormone overproduction in the proximal foregut in diabetic patients that might counteract the action of insulin, while the early presentation of undigested or incompletely digested food to the ileum may anticipate the production of hormones such as GLP1, further improving insulin action.

Effects of a physical activity program on markers of endothelial dysfunction, oxidative stress, and metabolic status in adolescents with metabolic syndrome.

The metabolic syndrome (MetS) is a precursor of diabetes. Physical activity (PA) improves endothelial dysfunction and may benefit patients with MetS. Aims. To evaluate the effect of a physical activity (PA) program on markers of endothelial dysfunction and oxidative stress in adolescents with (MetS). Methods. We carried out a cohort study of 38 adolescents with and without MetS (18 females and 20 males). All participants completed a 3-month PA program. All variables of the MetS as well as markers of endothelial dysfunction and oxidative stress tests were evaluated. Results. Females with and without MetS showed significant differences for almost all components of the MetS, whereas males were significantly different in half of the components. After the PA program, components of the MetS were not different from baseline values except for HDL-C levels. Some baseline endothelial dysfunction markers were significantly different among adolescents with and without MetS; however, after the PA program, most of these markers significantly improved in subjects with and without MetS. Conclusion. PA improves the markers of endothelial dysfunction in adolescents with MetS although other changes in the components of the MetS were not observed. Perhaps the benefits of PA on all components of MetS would appear after a PA program with a longer duration.