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J Med Econ ; 23(2): 193-203, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31613199


Aims: Controlling costs while maximizing healthcare gains is the predominant challenge for healthcare providers, and therefore cost-effectiveness analysis is playing an ever-increasing role in healthcare decision making. The aim of the present analysis was to assess the long-term cost-effectiveness of subcutaneous once-weekly semaglutide (0.5 mg and 1 mg) versus empagliflozin (10 mg and 25 mg) in the Spanish setting for the treatment of patients with type 2 diabetes (T2D) with inadequate glycemic control on oral anti-hyperglycemic medications.Material and methods: The IQVIA CORE Diabetes Model was used to project outcomes over patient lifetimes with once-weekly semaglutide versus empagliflozin, with treatment effects based on a network meta-analysis. The analysis captured treatment costs, costs of diabetes-related complications, and the impact of complications on quality of life, based on published sources. Outcomes were discounted at 3.0% per annum.Results: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted quality-adjusted life expectancy of 0.12 and 0.15 quality-adjusted life years (QALYs), respectively, versus empagliflozin 10 mg and improvements of 0.11 and 0.14 QALYs, respectively, versus empagliflozin 25 mg. Treatment costs were higher with once-weekly semaglutide compared with empagliflozin, but this was partially offset by cost savings due to avoidance of diabetes-related complications. Once-weekly semaglutide 0.5 mg and 1 mg were associated with incremental cost-effectiveness ratios of EUR 2,285 and EUR 161 per QALY gained, respectively, versus empagliflozin 10 mg, and EUR 3,090 and EUR 625 per QALY gained, respectively, versus empagliflozin 25 mg.Conclusions: Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg were projected to be cost-effective versus empagliflozin 10 mg and 25 mg for the treatment of patients with T2D with inadequate glycemic control on oral anti-hyperglycemic medications in the Spanish setting, irrespective of patients' BMI at baseline.

Zootaxa ; 4691(2): zootaxa.4691.2.5, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31719404


Two new species of cecidomyiids were identified on Prosopis caldenia Burkart (Fabaceae) in Argentina: Rhopalomyia caldeniae Cornejo Martínez sp. nov., as the inducer of bivalve leaf galls, and the inquiline Dasineura oportunista Cornejo Martínez sp. nov. These galls are composed of the partial coalescence of two contiguous pinnulae that delimit a single larval chamber, where both species develop. Seven other species were reared from these galls as parasitoids and inquilines.

Dípteros , Fabaceae , Prosopis , Animais , Argentina , Tumores de Planta
Rev Colomb Obstet Ginecol ; 70(3): 181-188, 2019 09.
Artigo em Espanhol | MEDLINE | ID: mdl-31738488


OBJECTIVE: Describe the intraoperative findings, procedures and the safety of laparoscopic surgical management of Deep Infiltration Endometriosis (DIE). METHODS: A descriptive historical cohort study of patients with suspected pre-surgical diagnosis of DIE due to clinical findings, pelvic ultrasound or magnetic resonance imaging and histological confirmation of the disease. The patients were taken to minimally invasive surgery between 2007 and 2016 in a reference health institution located in Pereira, Colombia. Sociodemographic, clinical, intraoperative findings, types of procedure performed, intra and postoperative complications and post-surgical pain levels at 6 weeks were evaluated. A descriptive analysis was performed. RESULTS: One hundred and sixty seven patients were included. The most frequent location of the disease was the recto-vaginal septum (85.7 %). A total of 83 patients (49.7 %) had bowel endometriosis. Of these, 86 % had a shaving and 13.2 % segmental bowel resection. Four patients (2.4 %) had intraoperative complications. One was converted to laparotomy and other five (2.9 %) had post-surgical infection. CONCLUSIONS: Laparoscopic management of DIE is an option to be considered with a 5% of complication frequency. Randomized studies with a control group are required for a better evaluation of safety and efficacy.

Zootaxa ; 4661(3): zootaxa.4661.3.8, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31716702


The Neotropical pimpline Clistopyga diazi species group is revised. Three species, C. albovittata, C. lapacensis and C. speculata are described as new. The species C. diazi Porter and C. lopezrichinii (Blanchard) are redescribed and illustrated. An identification key to all Neotropical species of the group is provided.

Himenópteros , Vespas , Animais
Nutr Cancer ; : 1-7, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31433266


Patients who suffer from cancer are at a higher risk of complications when they experience malnutrition. Evidence shows that oral nutritional supplements favor the healing process. The main objective of this study was to evaluate the efficacy of preoperative oral nutritional intervention in oncological patients undergoing surgery. This study assessed retrospectively 55 cancer patients who previously had undergone abdominal surgery and did not have receive pre-surgical nutritional support (control group), and prospectively 30 oncological patients undergoing gastrointestinal surgery and received pre-surgical high-protein nutritional support (experimental group). All patients had to have a NRS 2002 score ≥ 3. Analytical and clinical parameters were analyzed and the NRS 2002 screening test was performed. Post-operative assessments of surgical wound complications were also carried out to determine the impact of nutrition support. Pre-surgical nutritional interventions reduced the incidence and severity of wound complications as well as the length of hospital stays. Only 26.7% of patients in the experimental group had complications compared to 60% of the control group (P = 0.003). We conclude that pre-surgical nutritional interventions of patients undergoing surgery can improve post-surgical patient outcomes of malnourished patients.

Biomark Res ; 6: 35, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30555700


OPCML hypermethylation is considered a promising cancer biomarker. We examined methylation levels in the first exon of OPCML in two patient cohorts within the esophageal adenocarcinoma and gastric adenocarcinoma cascades and in a range of cell-lines using a custom PyroMark CpG assay. Methylation levels were significantly higher in esophageal tissue with histologically confirmed glandular mucosa as compared to tissue from normal esophagi or gastro-esophageal reflux disease. Higher levels of OPCML methylation were absent in the adjacent normal esophageal tissue of patients with glandular mucosa. Higher levels of methylation were confirmed in cell-lines derived from patients with adenocarcinoma, but also detected in two cell-lines with signs of dysplasia. We validated our assay by showing no differences in methylation levels in DNA extracted from blood of patients within the gastric adenocarcinoma cascade. OPCML hypermethylation is present in a subset of patients with metaplastic changes in their esophagus.

Ann Intensive Care ; 8(1): 109, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30443736


The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.

Int J Clin Pract ; 72(3): e13055, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29341370


AIMS: To evaluate in a real-world setting the effectiveness of exenatide once-weekly (ExQW) in patients with T2D and to determine predictors of glycaemic and weight response to this drug at 6 months. METHODS: Observational, retrospective, multicenter study in adult patients with T2D and BMI ≥30 kg/m2 from 4 tertiary Spanish hospitals who started ExQW therapy at least 6 months before the inclusion and had not achieved adequate glycaemic control on oral therapies or other GLP-1 receptor agonists. Glycaemic response was defined as an A1C reduction ≥1.0% and weight response as a weight loss ≥3% 6 months after ExQW. The best predictive models of glycaemic and weight response were estimated by binary logistic regression. RESULTS: One hundred and forty eight patients were included, mean age 58.0 years, A1C 7.7%, weight 105.9 kg and BMI 38.4 kg/m2 . A1C (-1.1%), weight (-3.9 kg), systolic blood pressure (-4.0 mm Hg), diastolic blood pressure (-2.9 mm Hg), LDL-cholesterol (-14.2 mg/dL) and triglycerides (-31.0 mg/dL) significantly decreased 6 months after ExQW. 41.5% of patients had an A1C reduction ≥1.0% and 53.1% lost ≥3% of baseline weight. Glycaemic and weight reductions were sustained in patients completing 1 and 2 years of follow-up. The best predictive model of glycaemic response only included higher A1C levels (OR 3.9), whereas higher BMI (OR 1.1) and prior DPP-4i therapy (OR 3.1) were associated to weight response in the multivariate analysis. CONCLUSIONS: In a real-world setting, ExQW significantly decreased A1C, weight, blood pressure and lipids at 6 months. Our study identified higher baseline A1C as the sole independent predictor of glycaemic response to ExQW and higher BMI and previous DDP4i treatment as predictive factors of meaningful weight response.

Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adesão à Medicação , Peptídeos/uso terapêutico , Peçonhas/uso terapêutico , Perda de Peso , Adulto , Idoso , Glicemia/análise , Pressão Sanguínea , Peso Corporal , Doenças Cardiovasculares , Esquema de Medicação , Exenatida , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade
Rev. med. Risaralda ; 24(1): 14-22, ene.-jun. 2018. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-902088


Resumen: determinar la asociación entre factores sociodemográficos, exposición a teratógenos y enfermedad materna, con la presencia de malformaciones congénitas en un centro de tercer nivel de la región centro occidental de Colombia durante el año 2013. Métodos: se realizó un estudio analítico tipo casos y controles. Se analizaron variables maternas y del recién nacido, las cuales se presentaron como frecuencias y proporciones y se evaluaron usando las pruebas de Chi2(x2) y exacta de Fisher. Para determinar la asociación entre cada variable se calculó el Odds Ratio (OR) crudo, y Odds Ratio (ORa) ajustado para las variables que presentaron una diferencia estadísticamente significativa, posterior a esto se encontró mediante test de razón de verosimilitud que no habían diferencias importantes entre el modelo completo y el reducido, mostrando entonces valores de un modelo más parsimonioso, con un test de bondad de ajuste Hosmer-Lemeshow 0.19. Resultados: Las variables sociodemográficas edad y ocupación materna, se hallaron como factor de riesgo para desarrollar malformaciones congénitas OR=7.7 (2.4 - 24.5) y OR=2,01 (1,1-3,7) respectivamente. Además en la historia obstétrica se encontró mayor riesgo al tener ganancia de peso mayor al ideal con OR=3.0a (1.3-6.7) y una ganancia de peso menor a lo ideal OR= 2.3a(1.1-4.5) y como factores protectores ser hijo del mismo padre y fácil concepción con OR=0,37C (0,2-0.8) P=0.007 y OR=0,20a (0,1-0,7), Conclusión: la edad mayor de 35 años, trabajar fuera y ganancias de peso mayores o inferiores a lo ideal, fueron los principales factores de riesgo para malformaciones congénitas en este estudio y la fácil concepción se encontró como factor protector para dicha condición del neonato.

Objective: to determine the association between sociodemographic factors, exposure to teratogens and maternal disease, with the presence of congenital malformations in a third-level center in the central western region of Colombia during the year 2013. Methods: An analytical case-control study was conducted And controls. We analyzed maternal and newborn variables, which were presented as frequencies and proportions and were evaluated using Chi2 (x2) and Fisher’s exact tests. To determine the association between each variable we calculated the Odds Ratio (OR) crude, and Odds Ratio (ORa) adjusted for the variables that presented a statistically significant difference, after this it was found by test of likelihood ratio that no differences were found Important between the complete and the reduced model, showing values of a more parsimonious model, with a goodness-of-fit test Hosmer-Lemeshow 0.19. Results: sociodemographic variables age and maternal occupation were found to be a risk for developing congenital malformations OR= 7.7 (2.4-24.5) and OR=2.01 (1.13-3.69), respectively. In the obstetric history, greater risk was found to have greater weight gain than the ideal with OR = 3.0a (1.3-6.7) and a weight gain lower than the ideal OR = 2.3a (1.1-4.9) and as protective factors being Child of the same father and conceive easy OR = 0.37C (0.2-0.8) P = 0.007 and OR = 0.20a (0.1-0.7), Conclusion: Age over 35 years, work outside and A weight gain greater than ideal, or weight gain less than ideal, are major risk factors for congenital malformations found in this study, easy conception is found as a protective factor for congenital malformations.

Rev. med. Risaralda ; 24(1): 29-33, ene.-jun. 2018. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-902090


Introducción: la lactancia materna es una de las estrategias más costo-efectivas para disminuir la morbimortalidad infantil. UNICEF afirma que la lactancia materna exclusiva en la población infantil mundial fue 38%. La Encuesta Nacional de Demografía y Salud reportó que Caldas-Risaralda-Quindío tienen la menor duración de Lactancia materna en Colombia, y la Lactancia materna Exclusiva en Risaralda es de 2.1 meses. Identificar los factores que determinaron la adherencia y el abandono de la lactancia materna en madres de dos comunidades de Dosquebradas, Colombia y el papel del profesional de la salud. Métodos: estudio de corte transversal sobre una muestra de 117 madres a quienes se aplicó una encuesta que indagó por aspectos biopsicosociales que impactan sobre la lactancia materna. Resultados: la duración de la lactancia materna exclusiva tuvo una mediana de 5 meses y la complementaria una mediana de 10 meses La principal causa de adherencia fue “es el alimento ideal” (27,9%) y de abandono fue “poca producción de leche” (58,1%). Los factores que impactaron significativamente la duración la lactancia materna exclusiva fueron la ocupación de la madre, incomodidad al lactar, uso de sucedáneos de la leche y tiempo de lactancia materna complementaria. El rol del profesional de salud no impactó la duración de la lactancia materna. Conclusiones: existe una amplia brecha entre lo recomendado por la Organización Mundial de la Salud y lo practicado por las comunidades.

Introduction: breastfeeding is one of the most cost-effective strategies to decrease infant morbidity and mortality. UNICEF affirms that exclusive breastfeeding is 38 % for infant world population. The Encuesta Nacional de Demografía y Salud reported that Caldas-Risaralda-Quindío have the shortest breastfeeding periods in Colombia, and exclusive breastfeeding periods averaging 2.1 months in Risaralda. Identify the factors that influence adherence and abandonment of breastfeeding, and the role of health care professionals, in mothers of two Colombian communities. Methods: it is a cross-sectional study on a representative sample of 117 mothers who completed a survey of biopsychosocial aspects that have an impact on breastfeeding. Results: a median of 5 months of exclusive breastfeeding and a median of 10 months of total breastfeeding was found. The main adherence reason was “it’s the ideal food” (27,9 %) and the main abandonment reason was “low milk supply” (58,1 %). It became clear that mother’s occupation, breastfeeding discomfort, use of breast-milk substitutes and complementary feeding duration, significantly impacts on exclusive breastfeeding duration. The role of health care professional didn’t impact on the breastfeeding time. Conclusions: there is a huge gap between the World Health Organization recommendations and the practice of the community.

Educ. med. super ; 31(3): 101-109, jul.-set. 2017. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-953090


Introducción: el bajo rendimiento y la consecuente deserción académica son problemas crecientes que pueden afectar la situación socio-económica de un país. Se han postulado los estilos de aprendizaje como factores determinantes del rendimiento académico y es necesario estudiarlos, con el fin de proponer estrategias encaminadas a su resolución. Objetivos: relacionar el estilo de aprendizaje y diferentes variables sociodemográficas con el rendimiento académico en los estudiantes de medicina de una universidad privada del suroccidente colombiano. Métodos: participaron los estudiantes de medicina que cumplían los criterios de inclusión: caso por bajo rendimiento y su respectivo control, a quienes se les analizó variables sociodemográficas, académicas y estilos de aprendizaje; información que se obtuvo de la base de registro académico de la universidad ICESI, mediante un proceso avalado por el comité de ética de dicha universidad. Para el análisis, se usaron técnicas de estadística descriptiva e inferencial por medio del software SPSS 19.0. Resultados: del total de la población (n= 340 estudiantes), 35 cumplieron los criterios de elegibilidad, a quienes se les asignó el respectivo control. No se encontró relación estadísticamente significativa entre el estilo de aprendizaje y el rendimiento académico general, ni con el rendimiento específico de las materias profesionales evaluadas. Tampoco se encontró relación entre el rendimiento académico y las variables sociodemográficas de la población a estudio. Conclusiones: el rendimiento académico en los estudiantes de medicina de nuestra población, puede estar influenciado por otras variables diferentes al estilo de aprendizaje. Sin embargo, se deben tener en cuenta las diversas limitaciones técnicas que este estudio pudo haber tenido(AU)

Introduction: low academic performance and dropout rates are consistently growing problems that can affect the socio-economic situation of a country. The determinants of the problem need to be identified, in order to propose strategies which could be adopted for a further solution. Objectives: Relate learning style and different sociodemographic variables with academic performance in medical students of a private university in southwestern Colombia. Methods: The study includes medical students which met the criteria for inclusion as a case for underperformance and its respective control. Socio-demographic, academic and learning style variables were analyzed with information obtained from the basis of the academic record from Icesi university. Through a process, supported by the ethics committee of the institution. For the analysis, descriptive and inferential statistics techniques were used by SPSS 19.0 software. Results: of the total population (n = 340 students), 35 met the criteria for eligibility and were assigned to their respective control. No statistically significant relationship between learning style and the general performance or the specific performance of professionalizing subjects was found. Nor relationship between academic performance and socio-demographic variables of the study population was found. Conclusions: academic performance in medical students in our population may be influenced by other different learning style variables. However, the technical limitations of the study should had been considered(AU)

Humanos , Masculino , Feminino , Estudantes de Medicina , Desempenho Acadêmico , Aprendizagem , Colômbia
Rev. neurol. (Ed. impr.) ; 64(9): 393-400, 1 mayo, 2017. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-162602


Introducción. El síndrome de Wolf-Hirschhorn (SWH) es un síndrome de genes contiguos que provoca múltiples anomalías congénitas, causado por la pérdida de una porción distal del brazo corto del cromosoma 4 (4p16.3). Se caracteriza por un fenotipo facial peculiar propio, asociado a problemas de crecimiento, retraso psicomotor y epilepsia. Objetivos. Realizar un registro de pacientes con SWH en España, describir sus características, conocer la prevalencia de epilepsia, estimar el grado de retraso psicomotor y realizar una revisión de la bibliografía para comparar estos datos con lo publicado hasta la fecha. Pacientes y métodos. En colaboración con la Asociación Española de Síndrome de Wolf-Hirschhorn se contactó con las familias afectadas y se realizó una recogida de datos mediante formularios corroborados por informes médicos. Resultados. Se describen las características de 51 pacientes. El retraso psicomotor fue considerado grave en el 37% de los casos. El 88% presentaba epilepsia, y la práctica totalidad, problemas de crecimiento. El tamaño medio de la deleción fue de 8,4 Mb y el fenotipo se expone en fotografías. Otra clínica descrita fueron alteraciones sensoriales y patología nefrourológica y cardiológica. Conclusiones. Se describe la segunda cohorte en tamaño de pacientes con SWH publicada hasta la fecha con caracterización genética. Muchas de las características coinciden con lo ya descrito, salvo algunas, como el grado de retraso psicomotor, que parece ser menor en la muestra estudiada (AU)

Introduction: Wolf-Hirschhorn syndrome (WHS) is a contiguous gene syndrome that gives rise to multiple congenital anomalies, caused by the loss of a distal portion of the short arm of chromosome 4 (4p16.3). It is characterised by its own peculiar facial phenotype, associated to growth problems, psychomotor retardation and epilepsy. AIMS. To establish a register of patients with WHS in Spain, describe their characteristics, determine the prevalence of epilepsy, estimate the degree of psychomotor retardation and perform a review of the literature in order to compare these data with those published to date. Patients and Methods: In collaboration with the Spanish Wolf-Hirschhorn Syndrome Association, we contacted the families affected and collected data via forms endorsed by medical reports. Results: The characteristics of 51 patients are described. Psychomotor retardation was considered the most severe in 37% of cases. Of the total sample, 88% presented epilepsy, and nearly all of them showed growth problems. The mean size of the deletion was 8.4 Mb, and the phenotype is displayed in photographs. Other clinical features reported were sensory alterations and nephrourological and cardiological pathologies. Conclusions: This study reports on the second largest cohort of patients with WHS with a genetic characterisation published to date. Many of the characteristics coincide with those described previously, with several exceptions, such as the degree of psychomotor retardation, which appears to be lower in the sample studied here (AU)

Humanos , Masculino , Feminino , Criança , Síndrome de Wolf-Hirschhorn/epidemiologia , Epilepsia/epidemiologia , Deficiência Intelectual/epidemiologia , Transtornos Psicomotores/epidemiologia , Facies , Fenótipo , Registros de Doenças/estatística & dados numéricos , Anormalidades Múltiplas/epidemiologia
Acta Neuropathol ; 133(2): 283-301, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28004277


The activation of the highly conserved unfolded protein response (UPR) is prominent in the pathogenesis of the most prevalent neurodegenerative disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS), which are classically characterized by an accumulation of aggregated or misfolded proteins. This activation is orchestrated by three endoplasmic reticulum (ER) stress sensors: PERK, ATF6 and IRE1. These sensors transduce signals that induce the expression of the UPR gene programme. Here, we first identified an early activator of the UPR and investigated the role of a chronically activated UPR in the pathogenesis of X-linked adrenoleukodystrophy (X-ALD), a neurometabolic disorder that is caused by ABCD1 malfunction; ABCD1 transports very long-chain fatty acids (VLCFA) into peroxisomes. The disease manifests as inflammatory demyelination in the brain or and/or degeneration of corticospinal tracts, thereby resulting in spastic paraplegia, with the accumulation of intracellular VLCFA instead of protein aggregates. Using X-ALD mouse model (Abcd1 - and Abcd1 - /Abcd2 -/- mice) and X-ALD patient's fibroblasts and brain samples, we discovered an early engagement of the UPR. The response was characterized by the activation of the PERK and ATF6 pathways, but not the IRE1 pathway, showing a difference from the models of AD, PD or ALS. Inhibition of PERK leads to the disruption of homeostasis and increased apoptosis during ER stress induced in X-ALD fibroblasts. Redox imbalance appears to be the mechanism that initiates ER stress in X-ALD. Most importantly, we demonstrated that the bile acid tauroursodeoxycholate (TUDCA) abolishes UPR activation, which results in improvement of axonal degeneration and its associated locomotor impairment in Abcd1 - /Abcd2 -/- mice. Altogether, our preclinical data provide evidence for establishing the UPR as a key drug target in the pathogenesis cascade. Our study also highlights the potential role of TUDCA as a treatment for X-ALD and other axonopathies in which similar molecular mediators are implicated.

Adrenoleucodistrofia/fisiopatologia , Axônios/efeitos dos fármacos , Degeneração Neural/fisiopatologia , Ácido Tauroquenodesoxicólico/farmacologia , Resposta a Proteínas não Dobradas/fisiologia , Animais , Axônios/patologia , Humanos , Camundongos , Camundongos Knockout
Med. clín (Ed. impr.) ; 147(supl.esp.1): 8-16, nov. 2016. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-163177


En las últimas décadas se ha producido en el mundo un incremento paralelo en la prevalencia de obesidad y diabetes mellitus tipo 2, dato no sorprendente si tenemos en cuenta que el aumento de grasa visceral es el principal factor de riesgo para el desarrollo de diabetes mellitus tipo 2 en individuos genéticamente predispuestos. La intervención centrada en el control intensivo de la glucemia en la diabetes mellitus tipo 2 con los tratamientos clásicos aumenta el riesgo de ganancia de peso y aparición de hipoglucemias. Por el contrario, la pérdida de peso mediante cambios en el estilo de vida, fármacos y/o cirugía mejora simultáneamente la mayoríade factores de riesgo cardiovascular, incluida la hiperglucemia. La intervención intensiva sobre el estilo de vida induce un beneficio global en el paciente con diabetes mellitus tipo 2, pero la pérdida ponderal a largo plazo es modesta y no ha demostrado reducir la morbimortalidad cardiovascular. La aparición de nuevos grupos terapéuticos para la diabetes mellitus tipo 2 o la obesidad, que consiguen mejorar simultáneamente la HbA1c, el peso y otros factores de riesgo cardiovascular sin producir hipoglucemias, representa un salto cualitativo en el manejo de los pacientes con diabesidad. Un inhibidor del cotransportador sodio-glucosa tipo 2 y un agonista del receptor de GLP1 recientemente han demostrado reducir la mortalidad cardiovascular y total en la diabetes mellitus tipo 2 con enfermedad cardiovascular. Además, la cirugía bariátrica ha mostrado una rápida remisión de la diabetes mellitus tipo 2 en un gran porcentaje de pacientes y reduce la mortalidad específica para diabetes. La aparición de nuevos tratamientos plantea la posibilidad de cambiar la estrategia terapéutica glucocéntrica actual por una estrategia adipocéntrica (AU)

In recent decades, there has been a worldwide parallel increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM), which is not surprising, given that increased visceral fat is the main risk factor for the development of T2DM in genetically predisposed individuals. An intervention focused on intensive blood glucose control in T2DM with classic drugs increases the risk of weight gain and the rate of hypoglycaemia. In contrast, weight loss through lifestyle changes, drugs and/or surgery simultaneously improves most cardiovascular (CV) risk factors, including hyperglycemia. Intensive intervention on lifestyle induces an overall benefit in patients with T2DM, but long-term weight loss is modest and has not been shown to reduce CV morbidity and mortality. The emergence of new therapeutic classes for T2DM and obesity, which simultaneously improve HbA1c, weight and other CV risk factors without inducing hypoglycaemia, represents a major change in the management of patients with diabesity. A sodium-glucose cotransporter-2 inhibitor and a GLP-1 receptor agonist have recently been shown to decrease CV and total mortality in type 2 diabetic patients with CV disease. Furthermore, bariatric surgery rapidly inducesremission or improvement of T2DM in a large percentage of patients and reduces diabetes-relatedmortality. The emergence of new therapies raises the possibility of changing the current glucose-centred therapeutic strategy for a weight-centred approach (AU)

Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Peso Corporal/fisiologia , Receptor do Peptídeo Semelhante ao Glucagon 1/uso terapêutico , Cirurgia Bariátrica , Perda de Peso/fisiologia , Fentermina/uso terapêutico , Bupropiona/uso terapêutico , Naltrexona/uso terapêutico , Estilo de Vida , Obesidade/tratamento farmacológico , Metformina/uso terapêutico
Zootaxa ; 4168(2): 347-352, 2016 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-27701341


New distributional records of the genera Fritziella Marsh, Rhoptrocentrus Marshall and Shawius Marsh are reported. Fritziella plaumanni Marsh, Rhoptrocentrus piceus Marshall and Shawius braziliensis Marsh are newly reported from northern Argentina. Shawius diiorioi Martínez sp. nov. is described and illustrated from central and northern Argentina. The male of Shawius, previously unknown, is described and illustrated for the first time. All species were reared from Fabaceae and Celtidaceae infested by wood boring Coleoptera.

Vespas/anatomia & histologia , Vespas/classificação , Distribuição Animal , Estruturas Animais/anatomia & histologia , Estruturas Animais/crescimento & desenvolvimento , Animais , Argentina , Tamanho Corporal , Fabaceae/parasitologia , Feminino , Masculino , Tamanho do Órgão , Vespas/crescimento & desenvolvimento
Food Chem ; 212: 250-5, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27374530


This study reports the (poly)phenolic fingerprinting and chemometric discrimination of leaves of eight mulberry clones from Morus alba and Morus nigra cultivated in Spain. UHPLC-MS(n) (Ultra High Performance Liquid Chromatography-Mass Spectrometry) high-throughput analysis allowed the tentative identification of a total of 31 compounds. The phenolic profile of mulberry leaf was characterized by the presence of a high number of flavonol derivatives, mainly glycosylated forms of quercetin and kaempferol. Caffeoylquinic acids, simple phenolic acids, and some organic acids were also detected. Seven compounds were identified for the first time in mulberry leaves. The chemometric analysis (cluster analysis and principal component analysis) of the chromatographic data allowed the characterization of the different mulberry clones and served to explain the great intraspecific variability in mulberry secondary metabolism. This screening of the complete phenolic profile of mulberry leaves can assist the increasing interest for purposes related to quality control, germplasm screening, and bioactivity evaluation.

Morus/química , Fenóis/análise , Extratos Vegetais/química , Folhas de Planta/química , Cromatografia Líquida de Alta Pressão/métodos , Flavonóis/análise , Frutas/química , Hidroxibenzoatos/análise , Quempferóis/análise , Espectrometria de Massas/métodos , Quercetina/análise , Espanha
Zookeys ; (589): 143-64, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27408539


The new doryctine genus Sergey gen. n. is described with four new species (Sergey cubaensis Zaldívar-Riverón & Martínez, sp. n., Sergey coahuilensis Zaldívar-Riverón & Martínez, sp. n., Sergey tzeltal Martínez & Zalídivar-Riverón, sp. n., Sergey tzotzil Martínez & Zalídivar-Riverón, sp. n.) from temperate forests of Mexico and Cuba. Similar to many other doryctine taxa, the new genus has a considerably elongated, petiolate basal sternal plate of the first metasomal tergite, although it can be distinguished from these by having the mesoscutum sharply declivous anteriorly with sharp anterolateral edges. The described species have been characterised molecularly based on two mitochondrial (COI, cyt b) and one nuclear (28S) gene markers. Based on the mitochondrial gene genealogies reconstructed, the evidence suggests the existence of incomplete lineage sorting or hybridization in the populations from Chiapas and Oaxaca assigned to Sergey tzeltal sp. n.

Med Clin (Barc) ; 147 Suppl 1: 8-16, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28760227


In recent decades, there has been a worldwide parallel increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM), which is not surprising, given that increased visceral fat is the main risk factor for the development of T2DM in genetically predisposed individuals. An intervention focused on intensive blood glucose control in T2DM with classic drugs increases the risk of weight gain and the rate of hypoglycaemia. In contrast, weight loss through lifestyle changes, drugs and/or surgery simultaneously improves most cardiovascular (CV) risk factors, including hyperglycemia. Intensive intervention on lifestyle induces an overall benefit in patients with T2DM, but long-term weight loss is modest and has not been shown to reduce CV morbidity and mortality. The emergence of new therapeutic classes for T2DM and obesity, which simultaneously improve HbA1c, weight and other CV risk factors without inducing hypoglycaemia, represents a major change in the management of patients with diabesity. A sodium-glucose cotransporter-2 inhibitor and a GLP-1 receptor agonist have recently been shown to decrease CV and total mortality in type 2 diabetic patients with CV disease. Furthermore, bariatric surgery rapidly induces remission or improvement of T2DM in a large percentage of patients and reduces diabetes-related mortality. The emergence of new therapies raises the possibility of changing the current glucose-centred therapeutic strategy for a weight-centred approach.

Adiposidade , Diabetes Mellitus Tipo 2/terapia , Cirurgia Bariátrica , Receptor do Peptídeo Semelhante ao Glucagon 1 , Humanos , Hiperglicemia , Hipoglicemiantes , Estilo de Vida , Obesidade , Perda de Peso
Food Chem ; 190: 566-571, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-26213011


This research has determined qualitatively and quantitatively the fatty acids composition of white (Morus alba) and black (Morus nigra) fruits grown in Spain, in 2013 and 2014. Four clones of each species were studied. Fourteen fatty acids were identified and quantified in mulberry fruits. The most abundant fatty acids were linoleic (C18:2), palmitic (C16:0), oleic (C18:1), and stearic (C18:0) acids in both species. The main fatty acid in all clones was linoleic (C18:2), that ranged from 69.66% (MN2) to 78.02% (MA1) of the total fatty acid content; consequently Spanish mulberry fruits were found to be rich in linoleic acid, which is an essential fatty acid. The fatty acid composition of mulberries highlights the nutritional and health benefits of their consumption.

Ácidos Graxos Essenciais/química , Frutas/química , Morus , Espanha
Rev. neurol. (Ed. impr.) ; 59(9): 392-398, 1 nov., 2014. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-128864


Introducción. En los últimos años parecemos asistir a una creciente demanda asistencial en neuropediatría. Los estudios epidemiológicos son necesarios para dar a conocer dicha demanda y así favorecer una adecuada gestión de los recursos sanitarios. Objetivo. Conocer el peso proporcional de las consultas de neuropediatría en el global de las consultas pediátricas en nuestro hospital, la tasa anual de consulta en neurología infantil por cada 1.000 habitantes menores de 14 años y las características de dicha consulta (datos demográficos, motivos de consulta y otras). Pacientes y métodos. Estudio retrospectivo, descriptivo, sobre la actividad asistencial de consultas pediátricas y neuropediátricas en un hospital público de nivel II en el sur de Madrid, durante el período 2008-2012. Resultados. Desde la apertura de nuestro centro, las consultas de pediatría han experimentado un marcado crecimiento, siendo las de neuropediatría las más demandadas, ya que en el año 2012 atendieron a un total de 2.129 pacientes (718 primeras consultas), con un índice de sucesiva/primera consulta de 1,96. En neuropediatría, se atendieron el 23,49% de todas las consultas pediátricas realizadas en el hospital. La tasa media de primeras consultas en el período de estudio fue de 72,86/1.000 niños. Los principales motivos de consulta fueron los problemas de aprendizaje/trastornos de conducta (24,1%), seguidos de cefalea (21,9%), episodios paroxísticos (14,8%) y retraso del desarrollo psicomotor (9%). Conclusiones. El incremento en la demanda asistencial de la neuropediatría ha resultado claramente superior al de las otras especialidades pediátricas que llevan en funcionamiento el mismo período. En los cinco años de estudio, la tasa de primeras visitas se ha triplicado. Esta sobrecarga asistencial podría condicionar la atención a los pacientes con patología neurológica grave. Serían necesarios estudios similares en diferentes regiones para conocer la realidad de la neuropediatría española (AU)

Introduction. In recent years it seems we are witnessing an increasing demand for neuropaediatric care. Epidemiological studies are needed to make this demand more widely known and thus promote appropriate management of health care resources. Aims. To determine what proportion of all visits to the paediatric department in our hospital are neuropaediatric consultations, the annual consultation rate in child neurology per 1,000 inhabitants under 14 years of age, and the characteristics of that consultation (demographic data, reasons for the visit and others). Patients and methods. We conducted a retrospective, descriptive study on the health care activity of paediatric and neuropaediatric units in a level-II public hospital in the south of Madrid, over the period 2008-2012. Results. Since our centre opened, the number of paediatric consultations has increased sharply, neuropaediatric visits being the most frequently demanded. In the year 2012 a total of 2,129 patients were seen (718 first visits), with a successive/first visit index of 1.96. Of all the paediatric consultations carried out in the hospital, 23.49% took place in neuropaediatrics. The mean rate of first visits in the period under study was 72.86/1,000 children. The main reasons for the consultation were learning disabilities/conduct disorders (24.1%), followed by headaches (21.9%), paroxysmal episodes (14.8%) and delayed psychomotor development (9%). Conclusions. The increase in demand for neuropaediatrics health care was clearly higher than that of other paediatric specialities over the same period of time. In the five years included in the study, the rate of first visits increased threefold. This health care overload could condition the care dispensed to patients with severe neurological pathologies. Further studies of a similar nature in different regions are required to determine the real situation of neuropaediatrics in Spain (AU)

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Doenças do Sistema Nervoso Central/epidemiologia , Administração de Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Transtornos de Aprendizagem/epidemiologia