Índice de masa triponderal y marcadores de riesgo metabólico en niños y adolescentes con obesidad / Triponderal mass index and markers of metabolic risk in children and adolescents with obesity

Antecedentes y objetivo El índice de masa triponderal (IMT) estimaría mejor que el índice de masa corporal (IMC) el exceso de adiposidad, manteniendo valores estables durante la infancia. Este trabajo pretende determinar la correlación del IMT con marcadores de riesgo metabólico y establecer valores del IMT que se relacionen con un aumento del riesgo metabólico. Material y métodos Estudio multicéntrico, observacional, transversal y prospectivo en menores de 14 años con obesidad. Variables: edad, sexo, estadio puberal, peso, talla, perímetro abdominal, IMC, IMT, glucosa e insulina basales, índice HOMA, presión arterial, perfil lipoproteico, transaminasas y ácido úrico. El IMC y el IMT se expresaron según los valores del estudio longitudinal de Barcelona. Se realizó análisis estadístico con el programa SPSS*. Resultados Se incluyeron 199 pacientes (50,3% varones), con una edad media de 11,08 (2,48) años e IMT de 19,68 (2,36) kg/m3. Se observó correlación del IMT con el perímetro abdominal (r = 0,571; p = 0), la insulina (r = 0,198; p = 0,005), el índice HOMA (r = 0,189; p = 0,008) y el c-HDL (r = −0,188; p = 0,008). El IMT > 20,15 kg/m3 se asoció a insulina ≥ 15 mUI/ml (p = 0,029) y el IMT > 20,36 kg/m3 a c-HDL < 40 mg/dl (p = 0,023). Conclusiones El IMT se correlacionó con el incremento del perímetro abdominal, la insulina y el índice HOMA, y la disminución del c-HDL. El IMT > 20 kg/m3 puede asociarse a elevación de la insulina y a descenso del c-HDL. Por ello, el IMT parece ser un parámetro útil en la valoración de los pacientes pediátricos con obesidad (AU)Background and objective

Triponderal mass index (TMI) would estimate excess adiposity better than body mass index (BMI), maintaining stable values during childhood. This work aims to determine the correlation between TMI and markers of metabolic risk as well as set values of TMI that are related to an increase of metabolic risk. Material and methods Multicenter, observational, cross-sectional and prospective study in children under 14 years of age with obesity. Variables: age, sex, pubertal stage, weight, height, abdominal circumference, BMI, TMI, basal glucose and insulin, HOMA index, blood pressure, lipoprotein profile, transaminases and uric acid. BMI and TMI were expressed according to the values of the Barcelona longitudinal study. Statistical analysis was performed with the SPSS* program. Results One hundred and ninety-nine patients (50.3% male), age 11.08 (2.48) years, TMI 19.68 (2.36) kg/m3. Correlation between TMI and abdominal circumference (r = 0.571; p = 0), insulin (r = 0.198; p = 0.005), HOMA index (r = 0.189; p = 0.008) and HDL-c (r = −0.188; p = 0.008) was observed. IMT > 20.15 kg/m3 was associated with insulin ≥ 15 mIU/ml (p = 0.029) and IMT > 20.36 kg/m3 with HDL-c < 40 mg/dl (p = 0.023). Conclusions TMI was correlated with increase of abdominal circumference, insulin and HOMA index and decrease of HDL-c. IMT > 20 kg/m3 can be associated with increased insulin and decreased HDL-c. Therefore, the IMT seems to be a useful parameter in the assessment of pediatric patients with obesity (AU)

[Triponderal mass index and markers of metabolic risk in children and adolescents with obesity]. / Índice de masa triponderal y marcadores de riesgo metabólico en niños y adolescentes con obesidad.

BACKGROUND AND OBJECTIVE: Triponderal mass index (TMI) would estimate excess adiposity better than body mass index (BMI), maintaining stable values during childhood. This work aims to determine the correlation between TMI and markers of metabolic risk as well as set values of TMI that are related to an increase of metabolic risk. MATERIAL AND METHODS: Multicenter, observational, cross-sectional and prospective study in children under 14 years of age with obesity. VARIABLES: age, sex, pubertal stage, weight, height, abdominal circumference, BMI, TMI, basal glucose and insulin, HOMA index, blood pressure, lipoprotein profile, transaminases and uric acid. BMI and TMI were expressed according to the values of the Barcelona longitudinal study. Statistical analysis was performed with the SPSS* program. RESULTS: One hundred and ninety-nine patients (50.3% male), age 11.08 (2.48) years, TMI 19.68 (2.36)kg/m3. Correlation between TMI and abdominal circumference (r=0.571; p=0), insulin (r=0.198; p=0.005), HOMA index (r=0.189; p=0.008) and HDL-c (r=-0.188; p=0.008) was observed. IMT>20.15kg/m3 was associated with insulin≥15mIU/ml (p=0.029) and IMT>20.36kg/m3 with HDL-c<40mg/dl (p=0.023). CONCLUSIONS: TMI was correlated with increase of abdominal circumference, insulin and HOMA index and decrease of HDL-c. IMT>20kg/m3 can be associated with increased insulin and decreased HDL-c. Therefore, the IMT seems to be a useful parameter in the assessment of pediatric patients with obesity.

A Novel c.968C > T homozygous Mutation in the Polynucleotide Kinase 3' - Phosphatase Gene Related to the Syndrome of Microcephaly, Seizures, and Developmental Delay.

Microcephaly is defined by a head circumference that is at least two standard deviations below the mean for age and sex of the general population in a specific race. Primary microcephaly may occur as an isolated inborn error, which may damage to the central nervous system or as part of the congenital abnormalities associated with genetic syndrome, affecting multiple organ systems. One of the syndromic forms consists of microcephaly, seizures, and developmental delay caused by biallelic mutations in the gene that encode polynucleotide kinase 3' - phosphatase protein (PNKP). In this article, we reported a newborn male who presented with microcephaly, severe developmental delay, and early-onset refractories seizures, caused by a novel homozygous mutation of the PNKP gene.

Relation among Caregivers' Burden, Abuse and Behavioural Disorder in People with Dementia.

Dementia produces a loss of independence to carry out the activities of daily life. The great demand for care that these people need usually falls on the family through informal care. This study aims to analyse the burden showed by the informal caregiver of a person with dementia. In addition, we analyse whether this burden present in informal caregivers could be related to abusive behaviour. We also study the relationship between the stage of the disease, the appearance of behavioural disorders and the level of burden in the caregiver using the Scales of Zarit, CASE and FAST. The data showed that 45.50 per cent of caregivers have light burden or burden. After the research, it was identified that the presence of behavioural disorders in patients with dementia showed a correlation with the increase in both the main caregiver burden and abuse. An increase in the level of burden is followed by an increase in the level of abuse (r = 0.844; p = 0.000). Furthermore, we analysed several conditions that could have a correlation with this burden and abuse. It was found that burden in the caregiver could be linked with the presence of behavioural disorders, like aggression (r = 0.577; p = 0.008) and irritability (r = 0.600; p = 0.005) at the moderate stage of the disease. On the other hand, there is a positive correlation between the probability that people with dementia suffer abuse in the moderate stage of the disease and the presence of aggression (r = 0.732; p = 0.000), lack of inhibition (r = 0.571; p = 0.009) and irritability (r = 0.827; p = 0.000). Taking this data into account, burden and abuse seem to be linked to the presence of behavioural disorders in patients with dementia in the moderate stage.

Génesis sociohistórica de la expresión corporal en Espanã / Social-historical genesis of bodily expression in Spain / Gênese sócio-histórica da expressão corporal na Espanha

Este artículo tiene como objetivo clarificar y ordenar el proceso de institucionalización de la Expresión Corporal en España ante la escasez y fragmentación de investigaciones sobre los aspectos históricos que incidieron en las principales situaciones político-educativas y autores que la han configurado. Para ello, en primer lugar se ha realizado un análisis de documentos científicos y legales para profundizar en nuestro objeto de estudio. En segundo lugar, se han utilizado las entrevistas informales realizadas durante una observación etnográfica no participante y 16 entrevistas semiestructuradas. Como conclusión, la Expresión Corporal en España se encuentra condicionada por la situación histórica y por su sistema educativo. Además, se identifican geográficamente la Expresión Corporal del Noreste y la Expresión Corporal del Centro-Suroeste. A su vez, los autores han sido clasificados en dos generaciones que contribuyeron al proceso de creación, institucionalización y consolidación de la disciplina

Este artigo tem como objetivo esclarecer o processo de institucionalização da Expressão Corporal na Espanha perante a escassez e a fragmentação das investigações sobre aspectos históricos que incidam sobre as principais situações políticas educativas e autores que a configuraram. Para isso, em primeiro lugar realizou-se uma análise de documentos científicos e jurídicos que permitem aprofundar o nosso tema de estudo. Em segundo lugar, recorreu-se às entrevistas informais realizadas durante uma observação etnográfica não participante e 16 entrevistas semiestruturadas. Como conclusão, a Expressão Corporal na Espanha encontra- se condicionada pela situação histórica e pelo seu sistema educativo. Além disso, identificam-se geograficamente a Corporação do Noroeste e a Corporação do Centro-Sudoeste. Por seu turno, os autores foram classificados em duas gerações que contribuíram para o processo de criação, institucionalização e consolidação da disciplina

This article explains and organizes the process of institutionalization of Bodily Expression in Spain considering the absence and fragmentation of research on historical aspects that impacted on the main political and educational situations and the authors that shaped it. To that end, scientific and legal documents were examined in order to elaborate on the object of study. Secondly, the study used informal interviews conducted during non-participant ethnographic observation and 16 semi-structured interviews. It found that Bodily Expression in Spain has been influenced by the country's historical context and educational system. Furthermore, it identified a Bodily Expression of the NorthEast and a Body Expression of the Centre and South-West. its authors were classified into two generations that contributed to the process of creation, institutionalization and consolidation of the discipline

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. / GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE.

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

Self-reported psychological development in cosmetic breast surgery patients.

Cosmetic breast surgery is the only therapeutic alternative for psychological and physical complications associated with micromasty, breast ptosis, and macromasty. We analyzed the effects of 2 variables, time, and type of cosmetic breast surgery, on anxiety symptomatology and quality of life.Following a mixed 3 × 4 design, 3 groups of women with breast augmentation (n = 63), mastopexy (n = 42), and breast reduction (n = 30) were selected and evaluated using the State-Trait Anxiety Inventory and the 12-Item Short-Form Health Survey at 4 different times, the preoperative stage, and at 1, 6, and 12 months postoperative. Pearson's chi square, Welch's U, Games-Howell tests, mixed analysis of variance, and Cohen's d and w for effect size were calculated.Results relating to anxiety (state and trait) showed that the time factor was significant (P < 0.001) with differences between the preoperative stage (higher anxiety levels) and the 3 postoperative stages: at 1 month (P < 0.001), 6 months (P < 0.001), and 12 months (P < 0.001). In quality of life, type of surgery and time factors were found to have interactive effects on vitality (P = 0.044) and role-emotional (P = 0.023) dimensions. Compared to the other 2 groups, women who had undergone mastopexy felt worse (vitality) at 1 month since surgery than in the other stages, and better at 6 months since surgery (role-emotional). In the rest of the dimensions, and focusing on the most relevant effect sizes, the type of surgery made a difference in the physical functioning (P = 0.005) and role-physical (P = 0.020) dimensions, where women who had had breast reduction felt worse than those who had had augmentation. Time also resulted in differences in the physical functioning (P < 0.001), role-physical (P < 0.001), and bodily pain (P < 0.001) dimensions, where women felt worse at 1 month since surgery than during the rest of the stages, as well as in the social functioning dimension (P < 0.001) at 1 month, compared to 6 months postoperative.We conclude that in the long term, women who have cosmetic breast surgery recover their physical and psychological well-being.

Calidad de la cumplimentación del listado de verificación de seguridad quirúrgica en un Hospital Universitario / No disponible

Objetivo. Evaluar la efectividad de una intervención para mejorar la calidad de la cumplimentación del listado de verificación de seguridad quirúrgica (LVSQ). Material y Métodos. Estudio cuasiexperimental sin grupo control realizado en un hospital universitario. Durante febrero 2015, el Servicio de Medicina Preventiva desarrolló la siguiente intervención: a) envío a facultativos del informe sobre la evaluación de la cumplimentación del LVSQ en las cirugías que realizaron durante julio-diciembre 2014, junto con hoja informativa detallando cómo usar el "formulario LVSQ" en la historia clínica electrónica, b) instauración de un Sistema de Vigilancia de cumplimentación del LVSQ con feedback de resultados, c) sesiones formativas a personal de enfermería y cirujanos, y d) inclusión de la cumplimentación del listado en la productividad. Se compararon los porcentajes de cirugías con LVSQ correctamente cumplimentados antes (julio-diciembre 2014) y después (marzo-julio 2015) de la intervención, utilizando la prueba chi-cuadrado. Resultados. El porcentaje de cirugías con LVSQ correctamente cumplimentado en el periodo pre-intervención fue del 68,4%; en la fase post-intervención el mencionado porcentaje alcanzó el 88,9% (p=0,0000). Los ítems con mayores mejoras fueron "recuento de gasas, compresas e instrumental" y "puesta en común de los aspectos clave para la recuperación del paciente". Conclusiones. Nuestra intervención mejoró la calidad de la cumplimentación del LVSQ. Dado que no se alcanzó el 100% de cumplimiento adecuado, consideramos necesario complementar nuestra intervención integrando en el "formulario LVSQ" opción de que salga un aviso automático cuando los ítems no se registren bien (AU)

Objective: Assessing the effectiveness of an intervention to improve the quality of compliance with the surgical safety checklist (SSC). Material and methods. A quasi-experimental study without control group was carried out in a university hospital. In february 2015, the Preventive Medicine Department developed the following intervention: a) each of the surgeons of the hospital were sent a report on the assessment of SSC compliance in the operations carried out in July-December 2014, together with an information sheet which detailed by whom, when and how the SSC needed to be used in the electronic clinical history, b) implementation of a Monitoring System for SSC compliance with feedback of the results, c) teaching of a training session to the nursing staff of the operating room and surgeons, and d) including whether the checklist had been filled as a productivity factor. The percentages of operations with properly filled out SSCs were compared before (July-December 2014) and after (March-July 2015) the intervention using the chi-squared test. Results. The percentage of operations with a properly filled out SSC in the pre-intervention period was 68.4%; in the post-intervention stage, such percentage reached 88.9% (p=0.0000). Items with the greatest improvements were "count of gauzes, compresses and instruments" and "sharing of the key aspects for patient recovery". Conclusions. Our intervention improved the quality of compliance with SSC. Since 100% proper compliance was not reached, we believe that it is necessary to complement our intervention by integrating an option in the SSC through which an automatic warning appears whenever an item has not been filled out correctly

Obesidad y ciclos de vida del adulto / No disponible

La edad adulta es aquella en la que el organismo humanoha alcanzado su pleno desarrollo. Esta etapa se divide en 3fases: adultez temprana, mediana y tardía. La prevalenciade obesidad en la población adulta española se estima enun 15,5%, presentando diferencias significativas entresexos, que aumentan con la edad. Sin embargo, aunquela obesidad es más frecuente en la mujer, su repercusiónsobre la salud es superior en el hombre. La obesidad enel adulto puede estar condicionada por el sobrepeso y/oobesidad durante la infancia y la adolescencia. Además,diversas causas hormonales, otras que dependen de laedad, las asociadas con la ingesta, la disminución de laactividad física y el aumento del sedentarismo, explican elincremento de grasa corporal característico de la menopausia.Entre las personas mayores, es conveniente controlar laalimentación con objeto de evitar el sobrepeso. Aún así, eneste grupo de edad es más preocupante el peso insuficienteo los cambios frecuentes de peso corporal, que el excesode peso. En cada etapa de la vida del adulto la presenciade obesidad va a tener connotaciones y comorbilidadeso patologías asociadas especiales por lo que el enfoqueterapéutico y las recomendaciones dietéticas deben serdiferentes(AU)

Adulthood is the life stage in which the human organismhas reached its full development. This stage can be dividedin three phases: early adulthood, median and late. Theprevalence of obesity in the Spanish adult population isestimated in 15.5%. At the same time, the prevalence ofobesity during adulthood differs between sexes, and differencesincrease with age. Obesity is more frequent amongwomen but the health impact is higher among men. Thisadulthood obesity may be influenced by overweight duringinfancy and adolescence. Besides, hormonal causes, aging,excess energy intake a decrease in physical activity and anincrease of sedentary lifestyles explain the development ofobesity during the menopausal status. Among elderly peopleit is important to control food habits in order to preventobesity. However, in this group of population is even morerelevant to avoid insufficient weight or frequent changes inbody weight. In each stage of adulthood, obesity presentsdifferent characteristics and comorbilities. Therefore, thetherapeutic approach and the dietetic recommendationsmust be slightly different(AU)

Genetics of obesity.

OBJECTIVE: The aim was to review and update advances in genetics of obesity. DESIGN: Analysis and interpretation of recent investigations about regulating the energy balance as well as about gene-nutrient interactions and current nutri-genomic research methods. BACKGROUND AND MAIN STATEMENTS: Obesity results from a long-term positive energy balance. However, its rising prevalence in developed and developing societies must reflect lifestyle changes, since genetic susceptibility remains stable over many generations. Like most complex diseases, obesity derives from a failure of adequate homoeostasis within the physiological system controlling body weight. The identification of genes that are involved in syndromic, monogenic and polygenic obesity has seriously improved our knowledge of body weight regulation. This disorder may arise from a deregulation at the genetic level (e.g. gene transcription or altered protein function) or environmental exposure (e.g. diet, physical activity, etc.). CONCLUSIONS: In practice, obesity involves the interaction between genetic and environmental factors.

Characterization of calcitonin gene-related peptide (CGRP) receptors and their receptor-activity-modifying proteins (RAMPs) in human brain microvascular and astroglial cells in culture.

1. In the present study, we examined the expression of the CGRP receptor-activity-modifying proteins (RAMP1, RAMP2 and RAMP3) and receptor component protein (RCP) in human brain astrocytes (AST), cerebromicrovascular endothelial (EC) and smooth muscle (SMC) cells in culture. Further, we pharmacologically characterized CGRP receptors in these cells by assessing the potency of the CGRP receptor antagonists h-alpha CGRP(8-37) and the new non-peptide compound BIBN4096BS to block the production of cAMP elicited by CGRP(1) and CGRP(2) receptor agonists. 2. AST, EC and SMC all expressed mRNAs for RAMP1, RAMP2 and RCP. In contrast, message for RAMP3 was detected in AST, but not in SMC and in only one out of four preparations of EC. 3. h-alpha CGRP, h-beta CGRP and [Cys (Et)(2,7)]-h-alpha CGRP exerted concentration-dependent production of cAMP in all cultures, with a maximal effect at 25-50 nM (20-60-fold increase from basal levels). In contrast, 50 nM [Cys (Acm)(2,7)]-h-alpha CGRP only induced a weak stimulatory effect on cAMP formation, especially in SMC and AST (1.5- and 5-fold increase above baseline, respectively). 4. h-alpha CGRP(8-37) and BIBN4096BS concentration-dependently inhibited cAMP formation evoked by CGRP receptor agonists. Depending on the agonists used, h-alpha CGRP(8-37) distinguished two different CGRP receptors for which it exhibited low (pIC(50)< or =6.4) and high (pIC(50) approximately 7.3) affinity, respectively. BIBN4096BS was much more potent (>2.5 orders of magnitude) than h-alpha CGRP(8-37). Further, BIBN4096BS was able to discriminate three different CGRP receptor sites for which it exhibited low (pIC(50) approximately 9.3-9.9), intermediate (pIC(50) approximately 10.9), and a very high (pIC(50) approximately 13.7) affinity, respectively. Together, these results suggest the presence of CGRP(1) and/or CGRP(2) receptors in human brain AST, EC and SMC, and of an additional population of CGRP receptors in AST, possibly associated to the combined expression of RAMP3 and RCP in these cells, for which BIBN4096BS exhibits an exquisitely high affinity.