Influence of Diet and Gender on Plasma DPP4 Activity and GLP-1 in Patients with Metabolic Syndrome: An Experimental Pilot Study.

BACKGROUND: Glucagon-Like Peptide-1 (GLP-1) is hydrolyzed by Dipeptidyl-Peptidase 4 (DPP4), and several studies suggest that both GLP-1 and DPP4 inhibitors have potentially beneficial effects on cardiovascular risks. The objective of this study was to analyze the differences between plasma GLP-1 and DPP4 activity in male and female patients with metabolic syndrome, and its relationship with physiological and metabolic parameters. The study included 25 apparently healthy Controls (C) and 21 Metabolic Syndrome patients (MS). Anthropometric indices, cardiovascular risk-score, and Mediterranean Diet Adherence (AMeDit) were evaluated. Fasting glucose, glycosylated hemoglobin (HbA1c), and insulin were measured. Insulin, GLP-1, and plasma DPP4 were determined within the first 30-min postprandial period. Body-Mass-Index was significantly higher, and AMeDit was significantly lower, but only in MS women. However, fasting glucose, HbA1c, and postprandial insulin were significantly higher in MS men, but not in MS women. Postprandial GLP-1 levels were lower in C men than in C women. Interestingly, in comparison with controls, we found significant lower levels of plasma DPP4 in MS-women only. Moreover, negative lineal regressions were established between DPP4 activity with waist-to-hip ratio and cardiovascular risk-score, and positive lineal regression with AMeDit. These results indicate gender differences in the behavior of GLP-1 and DPP4 activity in MS, which could be relevant for its treatment with GLP-1 analogues and DPP4 inhibitors.

Análisis de la actividad de un equipo de soporte de cuidados paliativos / Analysis of the activity of a palliative care support team

Objetivo: Conocer el perfil de los pacientes atendidos por un equipo de soporte de cuidados paliativos así como analizar la actividad clínica del mismo. Método: Observacional descriptivo retrospectivo mediante revisión de historias clínicas. Equipo de Soporte de Cuidados Paliativos del Hospital Comarcal San Agustín de Linares (Jaén). Pacientes en seguimiento por dicha unidad fallecidos desde diciembre de 2008 hasta diciembre de 2009.Se recogieron datos sociodemográficos y datos clínicos como diagnóstico, síntomas, tratamiento analgésico, número de visitas y consultas telefónicas. Del mismo modo se valoró el grado de dependencia y se registró el sexo y parentesco del cuidador principal. Resultados: La edad media de los 170 pacientes fue de 71,7 ± 13,5 años. El diagnóstico más frecuente fue cáncer de pulmón o de origen digestivo. El cuidador principal suele ser hijo o cónyuge del paciente y de sexo femenino. El tiempo medio de seguimiento por nuestro servicio fue de 58,7 días. La media de consultas atendidas por paciente fue de 4,7 ± 4,8 y la media de consultas telefónicas 4,0 ± 5,9. Entre los síntomas más prevalentes en la primera consulta destaca el dolor (92,6%), el estrenimiento (57,9%) y la disnea (26,2%). El analgésico más empleado fue el fentanilo. Tres de cada cuatro pacientes fallecieron en su domicilio recibiendo sedación terminal en sus últimas horas el 65% de los mismos. Conclusiones: El perfil de los pacientes atendidos por nuestro equipo de soporte es similara otros estudios realizados destacando el mayor tiempo de seguimiento, mayor número de consultas (presenciales o telefónicas) prestadas así como una mayor tasa de sedación termina (AU)

Objective: To determine the profile of patients who were seen in a Palliative Care Unit and to analyse its clinical activity. Method: Descriptive cross-sectional study of a Palliative Care Unit of the Hospital San Agustin(Linares, Jaen). We reviewed all medical records of palliative patients who had died from December 2008 until December 2009. Data collected were sociodemographic and clinical data, such as diagnosis, symptoms, analgesic treatment, number of visits and telephone consultations. The level of dependency was also assessed and the sex and family relationship of the primary caregiver was recorded. Results: The mean age of patients was 71.7 ± 13.5 years. The most frequent diagnosis was a lung or gastrointestinal cancer. The primary caregiver was usually the daughter or the partner of the patient. The mean follow-up for our service was 58.7 days. The mean number of visits was4.7 ± 4.8 and the mean number of telephone consultations was 4.0 ± 5.9. The most prevalent symptoms were pain (92.6%), constipation (57.9%) and dyspnea (26.2%). The most commonly used analgesic was fentanyl. Three out of four patients died at home, and 65% of them received sedation and analgesia in their last moments of life. Conclusions: The profile of patients who were seen in our Palliative Care Unit is similar to that of other studies. We emphasize the longer follow-up, the highest number of visits and telephone consultations and an increased rate of terminal sedation (AU)

[Coverage and results of a screening program for diabetic retinopathy using mydriatic retinography in primary health care]. / Cribado de retinopatía diabética mediante retinografía midriática en atención primaria.

OBJECTIVE: To identify the coverage of a diabetic retinopathy screening program in primary health care and to assess agreement between ophthalmologists and family physicians (FP) regarding retinography evaluations of diabetic patients. MATERIALS AND METHODS: Cross-sectional observational study,with a review of diabetic patients' mydriatic retinographies (2007-2008) from three urban primary health centers (PHC)(Jaén-Spain). RESULTS: A total of 296 retinographies in 2007 and 380 in 2008 (coverage=26% ± 2,4) were reviewed. Pathological retinographies were identified by 181 FPs (27% ± 1,3) and 59 (9% ± 0,3) ophthalmologists.Total agreement was moderate (kappa=0, 408 ± 0,039).Agreement was better in the latter year (0,45 vs 0,34; p < 0,001 test χ²). FP evaluations showed 97% sensitivity, 80% specificity, 33% positive predictive value, 100% negative predictive value, 4, 88 positive likelihood ratio and 0,04 negative likelihood ratio. We find variability in coverage and agreement between PHC. CONCLUSIONS: Mydriatic retinographies performed and evaluated by FPs are useful to retinopathy screening of diabetic patients. Coverage, predictive values and likelihood ratio were better in the latter year, although the interpretation should be homogenized.

Estudio comparativo de la ingesta alimentaria y el estado nutricional en ancianas con y sin fractura de cadera / Comparative study of dietary intake and nutritional status in elderly women with and without hip fracture

Objetivo. Analizar comparativamente el estado nutricional y la ingesta alimentaria de mujeres mayores ingresadas por fractura de cadera (FC) frente a un grupo control sin fractura y sin alteraciones conocidas de la densidad mineral ósea. Diseño. Observacional descriptivo. Emplazamiento. Hospital Neurotraumatológico de Jaén y 3 Centros de Salud de Jaén capital (CS San Felipe, CS Virgen de la Capilla y CS El Valle). Participantes. Cuarenta y cuatro mujeres con FC, considerada de origen osteoporótico y grupo control compuesto por 42 mujeres del mismo rango de edad, seleccionadas al azar entre las que acuden a consulta médica del Centro de Salud de su área geográfica. Mediciones principales. Se recogieron datos sociodemográficos. Se valoró la ingesta dietética previa a la fractura, así como variables antropométricas en las primeras 72 horas tras su ingreso. Resultados. Las pacientes con FC presentan menor peso (67,2±10,1kg frente a 72,0±10,1kg, p<0,05), IMC (27,6±3,7kg/m2 frente a 31,3±4,6kg/m2, p<0,001), y circunferencias del brazo y de la pierna que las controles. Destaca una ingesta significativamente mayor en cuanto a los macronutrientes y consumo energético en el grupo control e ingesta de calcio y vitamina D inferiores a las adecuadas en ambos grupos, pero más acusada en las pacientes con FC. La regresión logística comprueba que la FC se asocia a un menor IMC, así como a menores consumos de proteínas, carbohidratos y calcio. Conclusiones. Un correcto estado nutricional y una adecuada ingesta de macro y micronutrientes parecen fundamentales para prevenir la aparición de FC de origen osteoporótico(AU)

Aim. To compare the nutritional status and dietary intake of elderly women admitted with hip fracture (HF) versus a control group without fracture and without known abnormalities of bone mineral density. Design: Descriptive and observational study. Location: Hospital Neurotraumatológico in Jaen (Spain) and three urban Primary Health Care centers in Jaen city (San Felipe, Virgen de la Capilla and El Valle). Participants. A total of 44 women with HF, which was considered osteoporotic, and a control group composed of 42 women with a similar age range, selected randomly from the medical outpatients who visit their Primary Health Care centers. Measurements. We record sociodemographic data. Dietary intake before the fracture and anthropometric variables in the first 72hours after admission were assessed. Results. Patients with HF had lower weight (67.2±10.1kg versus 72.0±10.1kg, P<.05), BMI (27.6±3.7kg/m2 versus 31.3±4.6kg/m2, P<.001), as well as lower arm and leg circumferences than the control patients. A significantly higher intake, in terms of macronutrients and energy consumption, was detected in the control group, as well as lower than recommended intake of calcium and vitamin D in both groups, which was more marked in patients with HF. Logistic regression found that the HF was associated with a lower BMI as well as lower intakes of protein, carbohydrates and calcium. Conclusions. Adequate nutritional status and adequate intake of essential macro- and micronutrients seem to prevent osteoporotic HF(AU)

Cribado de retinopatía diabética mediante retinografía midriática en atención primaria / Coverage and results of a screening program for diabetic retinopathy using mydriatic retinography in primary health care

OBJETIVOS: Conocer la cobertura de un programa de cribado de retinopatía diabética en atención primaria y la concordancia entre médicos de familia (MF) y oftalmólogos. MATERIAL Y MÉTODOS: Estudio observacional transversal. Revisión de retinografías midriáticas de pacientes con diabetes mellitus tipo 2 (2007-2008) solicitadas por MF de tres centros de salud urbanos en Jaén,España. RESULTADOS: En total 296 retinografías (2007) y 380 (2008) (cobertura=26 por ciento±2.4).Retinografías patológicas: 181 MF (27 por ciento±1.3) y 59 (9 por ciento±0.3) oftalmólogos. Concordancia global moderada (kappa=0.408±0.039), que mejora del primer al segundo año (0.34 y 0.45; p<0.001, prueba χ2). La interpretación de los MF tiene sensibilidad, 97 por ciento, especificidad, 80 por ciento, VPP, 33 por ciento, VPN, 100 por ciento, cociente de probabilidad positivo, 4.88 y negativo, 0.04. Hay variabilidad en cobertura y concordancia entre centros de salud. CONCLUSIONES: La retinografía midriática realizada e interpretada por MF es útil como cribado de retinopatía en diabéticos. En el segundo año se mejora cobertura, valores predictivos y cocientes de probabilidad, aunque se debe homogeneizar la interpretación.

OBJECTIVE: To identify the coverage of a diabetic retinopathy screening program in primary health care and to assess agreement between ophthalmologists and family physicians (FP) regarding retinography evaluations of diabetic patients. MATERIALS AND METHODS: Cross-sectional observational study,with a review of diabetic patients' mydriatic retinographies (2007-2008) from three urban primary health centers (PHC)(Jaén-Spain). RESULTS: A total of 296 retinographies in 2007 and 380 in 2008 (coverage=26 percent±2,4) were reviewed. Pathological retinographies were identified by 181 FPs (27 percent±1,3) and 59 (9 percent±0,3) ophthalmologists.Total agreement was moderate (kappa=0,408±0,039).Agreement was better in the latter year (0,45 vs 0,34; p<0,001 test χ2). FP evaluations showed 97 percent sensitivity,80 percent specificity,33 percent positive predictive value, 100 percent negative predictive value, 4, 88 positive likelihood ratio and 0,04 negative likelihood ratio. We find variability in coverage and agreement between PHC. CONCLUSIONS: Mydriatic retinographies performed and evaluated by FPs are useful to retinopathy screening of diabetic patients. Coverage, predictive values and likelihood ratio were better in the latter year, although the interpretation should be homogenized.

[Comparative study of dietary intake and nutritional status in elderly women with and without hip fracture]. / Estudio comparativo de la ingesta alimentaria y el estado nutricional en ancianas con y sin fractura de cadera.

AIM: To compare the nutritional status and dietary intake of elderly women admitted with hip fracture (HF) versus a control group without fracture and without known abnormalities of bone mineral density. DESIGN: Descriptive and observational study. LOCATION: Hospital Neurotraumatológico in Jaen (Spain) and three urban Primary Health Care centers in Jaen city (San Felipe, Virgen de la Capilla and El Valle). PARTICIPANTS: A total of 44 women with HF, which was considered osteoporotic, and a control group composed of 42 women with a similar age range, selected randomly from the medical outpatients who visit their Primary Health Care centers. MEASUREMENTS: We record sociodemographic data. Dietary intake before the fracture and anthropometric variables in the first 72hours after admission were assessed. RESULTS: Patients with HF had lower weight (67.2±10.1kg versus 72.0±10.1kg, P<.05), BMI (27.6±3.7kg/m(2) versus 31.3±4.6kg/m(2), P<.001), as well as lower arm and leg circumferences than the control patients. A significantly higher intake, in terms of macronutrients and energy consumption, was detected in the control group, as well as lower than recommended intake of calcium and vitamin D in both groups, which was more marked in patients with HF. Logistic regression found that the HF was associated with a lower BMI as well as lower intakes of protein, carbohydrates and calcium. CONCLUSIONS: Adequate nutritional status and adequate intake of essential macro- and micronutrients seem to prevent osteoporotic HF.