Cirugía metabólica: ¿una nueva alternativa para el tratamiento de la diabetes mellitus tipo 2? / Metabolic surgery: new alternative for diabetes mellitus type 2?

Type 2 Diabetes Mellitus is a global epidemic. Classical studies have demonstrated the benefits of tight glycemic control, showing a decrease in complications and mortality. Current therapy based on changes in lifestyle and medication accomplishes these goals in an insufficient number of patients. Follow up of obese patients undergoing bariatric surgery has shown us a significant reduction in overweight and control comorbidities. In diabetic patients, there is adequate glycemic control, decreased insulin resistance, and decrease in glycosylated hemoglobin.The pathophysiological mechanisms that explain these effects are being studied, and includes benefits associated with significant and sustained weight loss, and mechanisms independent of weight loss that appear early after surgery. The latter would be due to changes in GI anatomy induced by surgery, including activation of the entero insular axis, exclusion of the foregut, and stimulation of the distal ileum with enhanced incretin production. Since the surgery seems to have an effect on diabetes that is primary, specific and independent of weight loss, authors have suggested de idea of extending surgical indication to diabetic patients with BMI <35. Initial surgical experience in this group of patients show encouraging results, however, at this point there is insufficient data to generalize its indication. The results of on going surgical protocols will help to clarify the role of surgery in the treatment of Type 2 Diabetes in patients with BMI <35.

Caracterización de pacientes y de uso de medicamentos en un grupo de adultos mayores asistentes a una actividad promocional de geriatría / Characterization of patients and pharmaceutical preparations use in a group of adults attending majors to a promotional activity of geriatrics

Study objectives: To establish frequency of polypharmacy, proportion of use of drugs without prescriptions, and personal mean monthly expenditure on drugs among elderly people attendingto a promotional activity on geriatrics at the Hospital Clínico de la Universidad de Chile. Methods: Observational study that analyses answers given by 235 elderly people who attended to the promotional activity on geriatrics. Results: The 99.6percent interviewees lived in the Metropolitan Region, 82.6 percent were females, a big number of them had ages between 60 and 69 years. The 63.8 percent were affiliated to the public secure of heath (FONASA). The 41.6 percent of those nonaffiliated to FONASA expended between 10,000 and 50,000 Chilean pesos by month to buy drugs. The 32.3 percent received polypharmacy (5 drugs), and 17.4 percent of interviewees used auto-prescribed drugs. It was observed a greater frequency of auto-indicated drugs among women (34 percent) than men (24.4 percent). The 235 interviewees communicated a total of 857 diseases (3.64 +- 1.89 diseases/patient), being arterial hypertension the most frequent one (19.1 percent). Conclusion: It seems important to develop other type of studies in Chile that permit to establish frequency of polypharmacy amongelderly people, and its outcomes on health quality of life, clinical and economic conditions.

Sarcopenia en la pérdida funcional: rol del ejercicio / Sarcopenia in functional lost: excercise role

Sarcopenia is refers to the gradual decline in muscle mass and quality noted with advancing age, but is not only present in that’s condition. In the last time appear new names proposal how myoestheatosis of the aging in reference at changes in the fat composition of the mass muscle. Factors implicated in the etiology of sarcopenia include decreased physical activity, malnutrition, increase inflammatory activity, oxidative stress and abnormalities in the hormonal and the vitamin axes and others. There is growing evidence linking sarcopenia to the frailty and functional disability, falls, decreased bone density, glucose intolerance contributes significantly to the morbidity, decrease in quality of life, and health care cost in the elderly. Exercise has been shown to increase strength, aerobic capacity, and muscle protein synthesis, in both young and older people, however, exercise does not reverse all age – related changes, but is a strong tool for maintain the autonomy. In special of the strength and resistence together with adequate nutritional state.

Prevensión cardiovascular y actitud de cambio frente a los factores de riesgo: un análisis crítico del estado actual / Cardiovascular prevention and attitude of people towards behavior changes: state of the art

In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.