A healthy lifestyle is associated with lower arterial stiffness in a metabolically healthy elderly population with overweight or obesity.

BACKGROUND AND AIMS: Arterial stiffness is linked with the development of cardiovascular and noncardiovascular diseases. In clinical practice, measurement of carotid-femoral pulse wave velocity (cf-PWV) has become a widely used study for the assessment of cardiovascular risk in elderly population. Our aim was to evaluate whether maintaining a healthy life, based on Mediterranean Diet (MedDiet) and regular practice of physical activity, are associated with arterial stiffness in an elderly, metabolically healthy with overweight or obesity (MHOe) population. INDIVIDUALS AND METHODS: A transversal, analytical-descriptive study in MHOe population (aged ≥65 years) with a BMI at least 27 kg/ m 2 who had one or less of the following cardiometabolic disorders: fasting plasma glucose at least 100 mg/dl, blood pressure at least 135/85 mmHg (or the use of blood pressure-lowering agents), low high-density lipoprotein (HDL) cholesterol (≤ 40 mg/dl for men, ≤50 mg/dl for women) or triglycerides at least 150 mg/dl (or the use of lipid-lowering therapies) was conducted. Blood pressure, height, weight, BMI, waist to hip ratio (WHR), practice of physical activity, MedDiet adherence and food intake along with cf-PWV were analysed. RESULTS: One hundred and fifty-eight MHOe individuals (age: 72.2 ±â€Š5.0 years, BMI: 31.6 ±â€Š3.8 kg/m 2 ) were recruited. One hundred and nine of them were younger than 75 years of age (young-old, age: 69.3 ±â€Š2.8 years and BMI: 32.0 ±â€Š3.9 kg/m 2 ) and 49 of them aged 75 years or older (old-old, age: 78.1 ±â€Š2.9 years and BMI: 30.7 ±â€Š3.6 kg/m 2 ). All population showed a strong adherence to the Med Diet due major consumption of homemade meal, olive oil and lean meats. In addition, they presented an important practice of all intensities of physical activity. Young-old individuals had a cf-PWV of 9.7 ±â€Š2.2 m/s and old-old individuals had a cf-PWV of 11.1 ±â€Š4.4 m/s. In all populations, a negative correlation between cf-PWV and BMI ( r  = -0.17, P  = 0.04) and a positive correlation with WHR in men ( r  = 0.18, P  = 0.03) was found. WHR shows a significantly positive correlation with the cf-PWV values in old-old women participants ( r  = 0.41, P  = 0.008). On the other side, only vigorous physical activity showed a negative correlation with cf-PWV in all population and in young-old individuals ( r  = -0.20; P  = 0.02 and r  = -0.22; P  = 0.03, respectively). CONCLUSION: Healthy lifestyle habits based on MedDiet adherence and regular practice of physical activity are associated with lower arterial stiffness in a metabolically healthy population with overweight or obesity older than 65 years compared with data from other elderly populations previously reported in the literature.

Metabolically healthy obesity: Inflammatory biomarkers and adipokines in elderly population.

BACKGROUND AND AIMS: Obesity is linked to elevated levels of inflammatory serum markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFa). Adiponectin and resistin are adipokines related to obesity. It has been described that adipose tissue presents a high production and secretion of these diverse pro-inflammatory molecules, which may have local effects on the physiology of fat cells as well as systemic effects on other organs. Our aim was to evaluate the impact that lifestyle modifications, by following a Mediterranean Diet (MedDiet) program and physical activity (PA) training, would have on inflammatory biomarkers and adipokine profile in a Metabolically Healthy Obese (MHO) elderly population from Malaga (Andalusia, Spain). SUBJETCS AND METHODS: Subjects aged ≥65 years (65 to 87 years old) with obesity (BMI ≥30 kg/m2) were included in this study if they met ≤1 of the following criteria: systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥ 85 mmHg; triglycerides ≥150 mg/dL; HDL-C <40mg/dL in men and <50mg/dL women; and fasting blood glucose ≥100mg/dL. Selected subjects underwent a personalized intensive lifestyle modification. Anthropometric measurements, PA, MedDiet adherence, analytical parameters, and inflammatory biomarkers were analyzed after 12 months of intervention. RESULTS: 166 MHO elderly subjects, 40 (24.1%) male and 126 (75.9%) female (p < 0.0001), aged 71.7±5.2 years old (65 to 87 years old) were included in the study. After 12 months of intervention, only the waist circumference was significantly reduced in all the population (-2.5 cm, p<0.0001), although weight and BMI were maintained. MedDiet adherence increased significantly (p<0.001), but all intensity levels of PA decreased significantly (p<0.001). Concerning inflammatory biomarkers, only TNFa serum increased their levels after the intervention (p<0.001). Regarding the adipokine profile, adiponectin concentrations experienced a significant increment (p<0.001); besides, resistin concentrations decreased significantly (p<0.001). In this sense, only TNFa, adiponectin, and resistin correlated with PA. Adiponectin also correlates with insulin, triglycerides and HDL-c in baseline conditions and after 12 months of intervention; CRP, IL-6, TNFa, adiponectin, and resistin concentrations correlated with anthropometric parameters and some intensities of PA. In addition, adiponectin levels correlates with insulin, triglycerides and HDL-c. In baseline conditions, resistin levels correlated positively with TNFa (p = 0.01) and CRP (p<0.0001) levels. TNFa and IL-6 correlated positively with CRP (p = 0.03 and p<0.0001, respectively). After 12 months of intervention, only IL-6 correlated positively with CRP (p = 0.006). In addition, adipokines levels correlated positively during the process of lifestyle modification. However, during this process, only IL-6 correlated positively with itself (p<0.0001) and with CRP (p = 0.03). CONCLUSION: Healthy aging is a multifactorial biological process in which lifestyle is essential. The presence of obesity in elderly metabolically healthy population is not a problem necessarily. Elderly MHO population who eat a MedDiet and practice regularly PA are capable to modulate their production of inflammatory cytokines (CRP, IL-6, TNFa) and adipokines profile (adiponectin, resistin), preventing other metabolic disorders.

Adipokines Profile and Inflammation Biomarkers in Prepubertal Population with Obesity and Healthy Metabolic State.

(1) Background and aims: Obesity and high body max index (BMI) have been linked to elevated levels of inflammation serum markers such as C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), adiponectin, and resistin. It has been described that adipose tissue presents a high production and secretion of these diverse pro-inflammatory molecules, which may have local effects on the physiology of the fat cell and also systemic effects on other organs. Our aim was to evaluate the impact that lifestyle modifications, following a Mediterranean Diet (MedDiet) program and physical activity (PA) training, would have on inflammatory biomarkers in a metabolically healthy prepubertal population with obesity (MHOPp) from Malaga (Andalusia, Spain). (2) Methods: 144 MHOPp subjects (aged 5-9 years) were included in this study as they met ≤1 of the following criteria: waist circumference and blood pressure ≥ 90 percentile, triglycerides > 90 mg/dL, high-density lipoprotein cholesterol (HDL-c) < 40 mg/dL, or impaired fasting glucose (≥100 md/dL). Selected subjects followed a personalized intensive lifestyle modification. Anthropometric measurements, inflammation biomarkers, and adipokine profile were analyzed after 12 and 24 months of intervention. (3) Results: 144 MHOPp participants (75 boys-52% and 69 girls-48%; p = 0.62), who were 7.8 ± 1.4 years old and had a BMI 24.6 ± 3.3 kg/m2, were included in the study. After 24 months of MedDiet and daily PA, a significant decrease in body weight (-0.5 ± 0.2 SD units; p < 0.0001) and BMI (-0.7 ± 0.2 SD units; p < 0.0001) was observed in the total population with respect to baseline. Serum inflammatory biomarkers (IL-6, TNF-alpha, and CRP) after 24 months of intervention were significantly reduced. Adipokine profile (adiponectin and resistin) did not improve with the intervention, as adiponectin levels significantly decreased and resistin levels increased in all the population. Inflammatory biomarkers and adipokine profile had a significant correlation with anthropometric parameters, body composition, and physical activity. (4) Conclusions: After 24 months of lifestyle modification, our MHOPp reduced their Z-score of BMI, leading to an improvement of inflammatory biomarkers but inducing deterioration in the adipokine profile, which does not improve with MedDiet and physical activity intervention. An adequate education within the family about healthier habits is necessary to prevent and reduce an excessive increase in obesity in childhood.

Lifestyle Modification Program on a Metabolically Healthy Elderly Population with Overweight/Obesity, Young-Old vs. Old-Old. CONSEQUENCES of COVID-19 Lockdown in This Program.

The SARS-CoV-2 pandemic led to lockdowns, which affected the elderly, a high-risk group. Lockdown may lead to weight gain due to increased food intake and reduced physical activity (PA). Our study aimed to analyze the impact of a 12-month lifestyle intervention on a metabolically healthy overweight/obese elderly (MHOe) population and how the lockdown by COVID-19 affected this program. Methods: MHOe participants (65-87 years) were recruited to participate in a lifestyle modification intervention based on the Mediterranean diet (MedDiet) and regular PA. Participants were classified into two groups: young-old (<75 years) or old-old (≥75 years). Anthropometric and clinical characteristics, energy intake, and energy expenditure were analyzed at baseline and after 12 months of intervention. Results: The final sample included 158 MHOe participants of both sexes (age: 72.21 ± 5.04 years, BMI: 31.56 ± 3.82 kg/m2): 109 young-old (age: 69.26 ± 2.83 years, BMI: 32.0 ± 3.85 kg/m2) and 49 old-old (age: 78.06 ± 2.88 years, BMI: 30.67 ± 3.64 kg/m2). After 12 months of intervention and despite lockdown, the young-old group increased MedDiet adherence (+1 point), but both groups drastically decreased daily PA, especially old-old participants. Fat mass significantly declined in the total population and the young-old. Depression significantly increased (26.9% vs. 21.0%, p < 0.0001), especially in the old-old (36.7% vs. 22.0%, p < 0.0001). No significant changes were found in the glycemic or lipid profile. Conclusions: This study indicates that ongoing MedDiet intake and regular PA can be considered preventative treatment for metabolic diseases in MHOe subjects. However, mental health worsened during the study and should be addressed in elderly individuals.

Recursos sanitarios empleados por pacientes paliativos fallecidos en domicilio / Health resources used by palliative care patients who died at home

INTRODUCCIÓN: Existe un número creciente de pacientes paliativos que prefieren fallecer en casa con apoyo sanitario. Además, los servicios de salud disponen de diversos recursos asistenciales para dar respuesta a las necesidades de salud que presenta esta población. OBJETIVO: Conocer los recursos asistenciales empleados por personas susceptibles de cuidados paliativos (CP) previos a su fallecimiento, tanto de atención primaria (AP) como de urgencias, así como su relación con el seguimiento por la unidad de CP. MATERIAL Y MÉTODOS: Se realizó un estudio observacional retrospectivo sobre la población fallecida durante el año 2015 en el domicilio de Málaga capital, que pertenece a la zona básica de salud de Málaga (Distrito Sanitario Málaga-Guadalhorce). Se recogieron datos sobre las asistencias realizadas durante los seis meses previos al fallecimiento. Las variables principales fueron: visitas por unidad de CP, consultas y visitas de profesionales de AP, visitas de urgencias y emergencias extrahospitalarias, admisiones en urgencias hospitalarias, patologías susceptibles de CP, edad y sexo del paciente. El análisis de datos fue descriptivo con resúmenes numéricos y tablas de frecuencia, e inferencial mediante test de Chi Cuadrado y U de Mann-Whitney. RESULTADOS: Novecientas cincuenta personas fallecieron en su domicilio, de las cuales 417 (43,89 %) fueron incluidas en el estudio por haber sido identificadas como susceptibles de CP siendo 212 atendidas exclusivamente por AP y 205 por AP, así como por unidades de CP. La mediana de tiempo de seguimiento por la unidad de CP fue de 47 días. Algunos datos relevantes a destacar en la media de asistencias que reciben estos pacientes son: llamadas telefónicas por la unidad de CP (6,83), visitas por la unidad de CP (4,71), visitas por Enfermera de familia (4,26), consultas al MdF (3,32), equipo médico del Servicio de Urgencias de Atención Primaria (2,08), hospitalizaciones (1,46), entre otros. En general, en aquellos pacientes seguidos por la unidad de CP hay un aumento del 21,6 % en consultas y visitas por profesionales de AP (agregados), y un aumento del 31,4 % en visitas por las unidades móviles de urgencias (agregadas). Desglosando por tipo de recurso, destaca el aumento en el número de visitas a domicilio de enfermeras de AP y urgencias domiciliarias. CONCLUSIONES: Las personas susceptibles de CP hacen uso frecuente de AP para su asistencia sanitaria, complementándose con los servicios de urgencias a domicilio y admisiones a hospital. En los pacientes con mayor complejidad, que son derivados para el seguimiento por unidades de CP, se constata un incremento de asistencias por profesionales de AP y por los servicios de urgencias, especialmente de sus enfermeras

INTRODUCTION: There is an increasing number of palliative care patients who prefer to die at home with healthcare support. Also, health services offer a great number of care resources to attend to the healthcare needs of this population. OBJECTIVE: To explore the care resources used by patients susceptible to palliative care (PC) before dying, both from primary and emergency care services, as well as their relation to follow-up by PC units. MATERIAL AND METHODS: A retrospective observational study was carried out in a population deceased at home in Málaga city during 2015, adscribed to the Primary Health Care area of Málaga (Málaga-Guadalhorce Health Care District). Data were collected during the last 6 months before death. The most important variables were: visits by the PC unit, consultations and visits by primary care professionals, prehospital emergencies, admissions to the hospital's emergency department, pathologies susceptible to PC, patient age and sex. The data analysis was descriptive with numerical summaries and frequency tables, and inferential using the Chi-squared test and Mann-Whitney U-test. RESULTS: A total of 950 people died at home, of which 417 (43.89 %) were included because of having been susceptible to palliative care. Of these, 212 were attended to exclusively by Primary Care and 205 by both Primary Care and PC units. The median time of follow-up by a PC unit was 47 days. The mean number of visits received by these patients include: 6.83 telephone calls from the PC unit; 4.71 visits by PC unit staff; 4.26 visits by a family nurse; 3.32 visits by the family physician; 2.08 by the primary care emergency service medical team; and 1.46 hospitalizations, among others. Generally, patients followed by a PC unit had a 21.6 % increase in consultations and visits by primary care professionals (aggregated) and a 31.4 % increase in visits by mobile emergency care services (aggregated). This growth is particularly remarkable for primary care and home emergency nurses. CONCLUSIONS: People susceptible to palliative care frequently use Primary Care for their health care, complementing it with home emergency services and hospital admissions. Patients with added complexity referred to PC units are associated with an increased assistance rate by primary care professionals and emergency services, especially nurses

Metabolically Healthy Obesity: Presence of Arterial Stiffness in the Prepubescent Population.

AIM: Arteriosclerotic cardiovascular disease, one of the world's leading causes of death, first manifests itself at an early age. The identification of children who may have increased cardiovascular risk in the future could be an important prevention strategy. Our aim was to assess the clinical, analytical, and dietary variables associated with arterial stiffness (AS), measured by carotid-femoral pulse wave velocity (cfPWV) in a prepubescent population with metabolically healthy obesity (MHO). SUBJECTS AND METHODS: A cross-sectional study in prepubescent subjects with obesity who had ≤1 metabolic syndrome criteria (abdominal perimeter and blood pressure ≥90th percentile, triglycerides >150 mg/dL, HDL-cholesterol <40 mg/dL, fasting plasma glucose ≥100 mg/dL) was conducted. Adherence to Mediterranean Diet, blood pressure, BMI, waist/height ratio (WHtR), glycemic status, lipid profile, and cfPWV were analyzed. 75 MHO children (boys: 43; girls: 32; p = 0.20) (age = 10.05 ± 1.29 years; BMI = 25.29 ± 3.5 kg/m2) were included. RESULTS: We found a positive correlation between cfPWV and weight (r = 0.51; p < 0.0001), BMI (r = 0.44; p < 0.0001), WHtR (r = 0.26; p = 0.02), fasting insulin levels (r = 0.28; p = 0.02), and insulin resistance (Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index) (r = 0.25; p = 0.04). Multiple linear regression analysis identified BMI and HOMA-IR as independent parameters associated with cfPWV. CONCLUSIONS: Prepubescent children with obesity who were shown to be metabolically healthy presented with arterial stiffness, which is closely related to BMI and the state of insulin resistance.

Utility of Liver Function Tests and Fatty Liver Index to Categorize Metabolic Phenotypes in a Mediterranean Population.

The aim of this study was to analyze the utility of liver function tests (LFT) and fatty liver index (FLI), a surrogate marker of non-alcoholic fatty liver disease, in the categorization of metabolic phenotypes in a Mediterranean population. A cross-sectional study was performed on a random representative sample of 2233 adults assigned to a health center in Málaga, Spain. The metabolic phenotypes were determined based on body mass index (BMI) categorization and the presence or absence of two or more cardiometabolic abnormalities (high blood pressure, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, pre-diabetes) or type 2 diabetes. No difference was observed between metabolically healthy and metabolically abnormal phenotypes on LFT. The mean FLI of the population was 41.1 ± 28.6. FLI was significantly higher (p < 0.001) in the metabolically abnormal phenotypes in all BMI categories. The proportion of individuals with pathological FLI (≥60) was significantly higher in the metabolically abnormal overweight and obese phenotypes (p < 0.001). On a multivariate model adjusted for sex, age, and waist circumference, a significant correlation was found between pathological FLI and metabolically abnormal phenotypes in the overweight and obese BMI categories. Area under the curve (AUC) of FLI as a biomarker was 0.76, 0.74, and 0.72 for the metabolically abnormal normal-weight, overweight, and obese groups, respectively. Liver biochemistry is poorly correlated with metabolic phenotypes. Conversely, a good correlation between FLI, as a marker of non-alcoholic fatty liver disease (NAFLD), and metabolically abnormal phenotypes in all BMI ranges was found. Our study suggests that FLI may be a useful marker for characterizing metabolically abnormal phenotypes in individuals who are overweight or obese.

Colangitis por infección fúngica del tracto hepatobiliar: descripción de un caso / Fungal cholangitis of the hepatobiliary tract: a case report

No disponible

Fungal cholangitis of the hepatobiliary tract: a case report.

We report the case of a 52-year-old male diagnosed with primary sclerosing colangitis, mainly of the extrahepatic bile duct, with a long evolution. After liver transplantation, the explanted liver showed necrosis of the bile duct wall, with fungal structures inside the bile duct that was compatible with Candida. The patient was treated with mesalazine and ursodeoxycholic acid and does not have a stent in the bile duct.

Pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4: descripción de un caso y revisión de la literatura / An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review

Presentamos el caso de un varón de 67 años con una úlcera gástrica de 9 años de evolución, con clínica de hematemesis y melenas, que a nivel histológico mostró lesiones de fibrosis y acúmulos de células plasmáticas con positividad para inmunoglobulina G4, sin evidencia de malignidad. Esta lesión alcanzaba al páncreas, donde se observaron lesiones histológicas superponibles a las gástricas. El diagnóstico final fue el de pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4 (AU)

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease (AU)

An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review.

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease.

Synthesis of ß-galactosylamides as ligands of the peanut lectin. Insights into the recognition process.

The synthesis of mono and divalent ß-galactosylamides linked to a hydroxylated chain having a C2 symmetry axis derived from l-tartaric anhydride is reported. Reference compounds devoid of hydroxyl groups in the linker were also prepared from ß-galactosylamine and succinic anhydride. After functionalization with an alkynyl residue, the resulting building blocks were grafted onto different azide-equipped scaffolds through the copper catalyzed azide-alkyne cycloaddition. Thus, a family of structurally related mono and divalent ß-N-galactopyranosylamides was obtained and fully characterized. The binding affinities of the ligands towards the model lectin PNA were measured by the enzyme-linked lectin assay (ELLA). The IC50 values were significantly higher than that of galactose but the presence of hydroxyl groups in the aglycone chain improved lectin recognition. Docking and molecular dynamics experiments were in accordance with the hypothesis that a hydroxyl group properly disposed in the linker could mimic the Glc O3 in the recognition process. On the other hand, divalent presentation of the ligands led to lectin affinity enhancements.

Differences in the Neuroprotective Effect of Orally Administered Virgin Olive Oil (Olea europaea) Polyphenols Tyrosol and Hydroxytyrosol in Rats.

The neuroprotective effect of virgin olive oil (VOO) polyphenols has been related to their antioxidant effect. The main objective was to analyze how tyrosol and hydroxytyrosol contribute to the antioxidant and neuroprotective effects of VOO in a model of hypoxia-reoxygenation in rat brain slices. Rats were treated per os (po) (10 or 20 mg/kg/day) with hydroxytyrosol ethyl ether (HTEE), tyrosol ethyl ether (TEE), or 3,4-di-o-methylidene-hydroxytyrosol ethyl ether (MHTEE), used as a negative control for antioxidant effects. Lipid peroxidation was inhibited with HTEE, TEE, and MHTEE (from 5.0 ± 1.5 to 2.6 ± 1.5, 4.5 ± 1.5, and 4.8 ± 1.5 nmol/mg protein, respectively). However, all three compounds had similar neuroprotective effects: from 2.8 ± 0.07 to 1.8 ± 0.02 arbitrary units for HTEE, 1.4 ± 0.09 arbitrary units for TEE, and 1.3 ± 0.2 arbitrary units for MHTEE. All three compounds inhibited 3-nitrotyrosine production (from 3.7 ± 0.3 to 1.2 ± 0.03 nmol/0.1 g tissue for HTEE, 1.0 ± 0.2 nmol/0.1 g tissue for TEE, and 1.3 ± 0.1 nmol/0.1 g tissue for MHTEE), prostaglandin E2 production (from 55.7 ± 2.2 to 46.4 ± 1.9 pg/0.1 g tissue for HTEE, 24.7 ± 1.3 pg/0.1 g tissue for TEE, and 27.6 ± 2.6 pg/0.1 g tissue for MHTEE), whereas only HTEE inhibited IL1ß production (from 35.7 ± 1.5 to 21.6 ± 0.8 pg/0.1 g tissue). Pearson correlation coefficients related neuroprotective effect with an antioxidant effect for HTEE (R = 0.72, p < 0.001), and inhibition of nitrosative stress (R = 0.78, 0.67, and 0.66 for HTEE, TEE, and MHTEE, respectively, p < 0.001) and inflammatory mediators (R = 0.72, 0.79, and 0.64 for HTEE, TEE, and MHTEE, respectively, p < 0.001) with all three compounds.

Trauma abdominal abierto por arma de fuego con lesión en intestino delgado, aislada y asociada a otros órganos: la relación respecto a la morbilidad y mortalidad / Open abdominal trauma by firearm with injury in small intestine, isolated and associated to other organs: the relation with to morbidity and mortality

Objetivo: Demostrar si existen diferencias en la morbi-mortalidad entre los pacientes con trauma abdominal abierto por arma de fuego con lesión de intestino delgado sola y los que tengan lesiones asociadas a otros órganos abdominales. Metodología: Estudio de cohorte. Se seleccionó pacientes con traumatismo abdominal abierto por arma de fuego, dividiéndolos en Grupo 1: lesión de intestino delgado aislada y Grupo 2: lesión en intestino delgado y lesión de otro órgano intra-abdominal agregada. Las variables estudiadas fueron edad, género, tipo de lesión, órgano intra-abdominal lesionado, complicaciones y mortalidad. Resultados: Se incluyeron 62 pacientes (M: 60, F: 2) con lesión en intestino delgado, edad promedio de 26.9 años. Grupo 1: 24 pacientes, Grupo 2: 38 pacientes. La lesión agregada más común fue en intestino grueso. La comparación de las complicaciones entre los grupos tuvo diferencias significativas (p<0.05), 33.3 por ciento vs. 68.4 por ciento para el grupo 1 y el grupo 2, respectivamente. La mortalidad fue de 0 por ciento para el grupo 1 y de 18.4 por ciento para el grupo 2, con un p<0.05. Conclusiones: Traumas abdominales abiertos por arma de fuego con lesión a intestino delgado más lesión asociada a órgano intra-abdominal incrementan la morbilidad y mortalidad.

Objective: To assess whether there are differences in morbidity and mortality between patients with penetrating abdominal trauma by gunshot affecting only the small bowel and those with penetrating abdominal trauma affecting aside from the small bowel other abdominal organs. Methodology: Cohort. We selected patients with open abdominal trauma by gunshot, dividing them into Group 1: isolated small bowel injury and Group 2: small bowel injury associated to injuries in another intra-abdominal organ. The variables studied were age, gender, type of injury, intra-abdominal organ injury, complications and mortality. Results: Sixty-two patients were studied (60 men and 2 women), with small bowel injury, average age of 26.9 years. Group 1 with 24 patients, Group 2 with 38 patients, the most common associated injury was in the large intestine. Comparison of complications between the two groups yielded significant differences (p<0.05), 33.3 per cent vs. 68.4 per cent for group 1 and 2, respectively. Mortality was 0 per cent for group 1 and of 18.4 per cent for group 2, with a statistically significant difference, p<0.05. Conclusions: Penetrating abdominal wounds by gunshot, with injury to the small bowel plus another associated injury to an intra-abdominal organ increase morbidity and mortality.

Estructura y adecuación del Inventario de Depresión de Beck en pacientes con fibromialgia / Structure and adequacy of the Beck Depression Inventory in patients with fi bromyalgia

El inventario de Depresión de Beck (BDI) es un instrumento ampliamente utilizado para la medida de la depresión en dolor crónico. Sin embargo, no existen estudios que analicen la estructura y adecuación del uso del BDI en estos pacientes. En este trabajo se han realizado análisis factoriales exploratorios y confirmatorios de los resultados del BDI en una muestra de 300 pacientes de fibromialgia. La estructura factorial exploratoria del BDI plantea tres factores que incluyen los síntomas cognitivos, afectivos y somáticos. Los análisis de ecuaciones estructurales realizados para confirmar el ajuste de os datos de esta muestra a los modelos recogidos en la literatura para el dolor crónico no han resultado significativos. Estos resultados parecen señalar que existen diferencias entre las manifestaciones depresivas de este tipo de pacientes y los de dolor crónico. Además, la peculiar estructura del BDI en esta muestra de pacientes parece indicar un solapamiento entre algunos síntomas depresivos y los síntomas de fibromialgia, que podría conducir a una sobreestimación de la ocurrencia de depresión, cuando ésta se mide con el BDI, sesgo que debería ser valorado y modificado (AU)

The Beck Depression inventory is a widely used instrument for the measurement of depression in chronic pain. However, there are no studies that analyze the structure and adequacy of the use of the BDI in these patients. In this work, we have carried out exploratory and confirmatory factor analysis of the results of the BDI in a sample of 300 patients with fibromyalgia. The factor structure of the exploratory BDI yields three factors that include cognitive, emotional and somatic symptoms. The structural equation analyses carried out to confirm the fit of the data in this sample with the models of chronic pain presented in the literature were not significant. These results indicate that there are differences between the depressive manifestations of this type of patients and those with chronic pain. In addition, the peculiar structure of the BDI in this sample of patients seems to indicate an overlap between some depressive symptoms and the symptoms of fibromyalgia, which could lead to an overestimation of the occurrence of depression when measured with the BDI, a bias that should be assessed and modified (AU)

[Structure and adequacy of the Beck Depression Inventory in patients with fibromyalgia]. / Estructura y adecuación del Inventario de Depresión de Beck en pacientes con fi bromialgia.

The Beck Depression inventory is a widely used instrument for the measurement of depression in chronic pain. However, there are no studies that analyze the structure and adequacy of the use of the BDI in these patients. In this work, we have carried out exploratory and confirmatory factor analysis of the results of the BDI in a sample of 300 patients with fibromyalgia. The factor structure of the exploratory BDI yields three factors that include cognitive, emotional and somatic symptoms. The structural equation analyses carried out to confirm the fit of the data in this sample with the models of chronic pain presented in the literature were not significant. These results indicate that there are differences between the depressive manifestations of this type of patients and those with chronic pain. In addition, the peculiar structure of the BDI in this sample of patients seems to indicate an overlap between some depressive symptoms and the symptoms of fibromyalgia, which could lead to an overestimation of the occurrence of depression when measured with the BDI, a bias that should be assessed and modified.