Omentin-1 Changes following Biliopancreatic Diversion and Relationship with Cardiovascular Risk Factors.

INTRODUCTION: Omentin-1 might play a role in the pathogenesis of insulin resistance and obesity. The aim of the present study was to evaluate the influence of weight loss after biliopancreatic diversion on serum omentin-1 concentrations. Material and Methods A Caucasian population of 24 morbid obese patients was analyzed before and after 12 months of a biliopancreatic diversion surgery. Biochemical and anthropometric evaluation were realized at basal visit and at 12 months. Body weight, fat mass, waist circumferences, blood pressure, fasting blood glucose, fasting insulin, insulin resistance (HOMA-IR), lipid concentrations and omentin-1 were measured. RESULTS: After bariatric surgery and in both gender groups (males vs. females); BMI, weight, fat mass, waist circumference, blood pressure, glucose , total cholesterol, LDL cholesterol, triglycerides, HOMA-IR and fasting insulin decreased in a statistical manner from basal values. Omentin-1 levels increased after bariatric surgery and in both gender the improvement was similar (males vs. females); (delta: -87.1 ± 19.0 ng/dL; p = 0.02 vs. -93.8 ± 28.1 ng/dL; p = 0.03). In the multiple regression analysis adjusted by age and sex; BMI kg/m2 (Beta -0.32: 95% CI -3.98 to -0.12) and insulin UI/L (Beta -0.41: 95% CI -8.38 to -0.16) remained in the model with basal omentin-1 levels as dependent variable. The regression model with post-surgery omentin-1 levels as dependent variable showed as independent variables BMI kg/m2 (Beta -0.13: 95% CI -7.69 to -0.09) and insulin UI/L (Beta -0.24: 95% CI -5.69 to -0.08), too. CONCLUSION: This study showed a significant increase in omentin-1 levels after weight loss secondary biliopancreatic diversion surgery. A weak negative correlation with BMI and basal insulin levels was detected.

Clinical Validation of the Vitro HPV Screening Assay for Its Use in Primary Cervical Cancer Screening.

Many scientific societies have issued guidelines to introduce population-based cervical cancer screening with HPV testing. The Vitro HPV Screening assay is a fully automatic multiplex real-time PCR test targeting the L1 GP5+/GP6+ region of HPV genome. The assay detects 14 high risk (HR) HPV genotypes, identifying individual HPV16 and HPV18 genotypes, and the HPV-positive samples for the other 12 HR HPV types are subsequently genotyped with the HPV Direct Flow Chip test. Following international guidelines, the aim of this study was to validate the clinical accuracy of the Vitro HPV Screening test on ThinPrep-collected samples for its use as primary cervical cancer screening, using as comparator the validated cobas® 4800 HPV test. The non-inferiority analysis showed that the clinical sensitivity and specificity of the Vitro HPV Screening assay for a diagnosis of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were not inferior to those of cobas® 4800 HPV (p = 0.0049 and p < 0.001 respectively). The assay has demonstrated a high intra- and inter-laboratory reproducibility, also among the individual genotypes. The Vitro HPV Screening assay is valid for cervical cancer screening and it provides genotyping information on HPV-positive samples without further sample processing in a fully automated workflow.

Evolution of suppressing TSH therapy at diagnosis and in the long-term follow-up in a cohort of differentiated thyroid cancer.

INTRODUCTION: To evaluate the adequacy of TSH suppression therapy (TSHst) at the first disease assessment and the last follow-up visit. METHODS: Retrospective observational study of those patients under follow-up of DTC in a reference hospital. RESULTS: 216 patients (79.2% women) were evaluated, with a mean age 59.0 ±â€¯13.1 years-old and a mean follow-up of 6.9 ±â€¯4.3 years. 88.4% were papillary carcinomas. At diagnosis, 69.2% had a low risk of recurrence (RR) compared to 13.6% with a high RR. Dynamic risk stratification (DRS) classified patients at first disease assessment and the last visit as excellent response (ER) in 60.0% and 70.7%, respectively. Those patients with ER in the first and last follow-up control maintained TSHst in 30.7% and 16.3% of the cases, respectively (p < 0.001). The factors associated with maintaining TSHst at the last control were younger age, higher RR at diagnosis, DRE at follow-up, presence of multifocality and histological vascular invasion (p < 0.05). In a logistic regression analysis adopting tsTSH at follow-up as the dependent variable, exclusively age (ß = -0.062; p < 0.001), RR at diagnosis (ß = 1.074; p < 0.05) and EDR during follow-up (ß = 1.237; p < 0.05) maintained statistical significance. CONCLUSIONS: Despite the current recommendations, 30.7% of patients with low RR and initial ER are under TSHst. This percentage reduced to 16.3% in those patients with ER after a mean follow-up of 6.9 years. Age, baseline RR, and DRE during follow-up were associated to maintaining tsTSH.

[Hyponatremia among patients with total enteral tube feeding: prevalence and associated clinical factors]. / Prevalencia y factores asociados a la hiponatremia en pacientes con nutrición enteral.

Introduction: Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % -11.0 % at onset and 16.7 % during TEN-. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related.

Introducción: Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal.

[Influence of prior ischemic events on the nutritional status of patients hospitalized for stroke]. / Influencia de la historia de isquemia sobre el estado nutricional en pacientes ingresados por accidente cerebrovascular.

INTRODUCTION: Background and aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization. Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age. Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16). Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events.

INTRODUCCIÓN: Introducción y objetivos: el mal estado nutricional empeora el pronóstico del ictus. El objetivo de este trabajo fue evaluar qué factores se asociaban a una mala situación nutricional en pacientes con ictus en el momento del ingreso. Material y método: estudio transversal de pacientes hospitalizados con ictus que precisaron soporte nutricional enteral, desde enero de 2014 hasta septiembre de 2016. Determinamos el estado nutricional mediante el Mini-Nutritional Assesment y la valoración global subjetiva. Se realizó un análisis de regresión multivariante, incluyendo variables demográficas, situación funcional (escala de Rankin) y variables clínicas y antropométricas, estratificándose por la edad mediana de la muestra. Resultados: se incluyeron 226 pacientes, el 58,3 % varones, con una edad mediana de 77 (66,7-83) años. El 44 % presentaban riesgo de malnutrición y el 24 % desnutrición. Los factores asociados a una mala situación nutricional fueron la edad (odds ratio (OR): 1,03, IC 95 %: 1,01-1,08) y la puntuación en la escala de Rankin (OR: 1,96; IC 95 %: 1,32-2,67). En el análisis estratificado, los factores asociados a una mala situación nutricional fueron, en el subgrupo de los mayores de 77 años, la capacidad funcional previa (OR: 1,88; IC 95 %: 1,26-2,80), y en el subgrupo de los menores de 77 años, la historia de eventos isquémicos previos (OR: 2,86; IC 95 %: 1,01-8,16). Conclusiones: en pacientes hospitalizados por ictus, la mayor edad y la peor situación funcional previa se asociaron a una peor situación nutricional. En los pacientes de mayor edad, el factor principal fue la situación funcional previa, mientras que en los pacientes más jóvenes, fue el antecedente de patología isquémica.

Influence of nutritional status on hospital length of stay in patients with type 2 diabetes. / Influencia del estado nutricional sobre la estancia media hospitalaria en el paciente con diabetes mellitus tipo 2.

INTRODUCTION: In the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment. OBJECTIVES: The aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition. MATERIAL AND METHODS: This was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS). RESULTS: 24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78-25.99) kg/m2 vs. 22.31 (19.79-25.30) kg/m2, P˂.01], a lower total score in the MNA questionnaire [16.5(13.12-19) points vs. 17(14-20) points, P˂.01], and a lower NRS score [83.09(77.72-91.12) points vs. 85.78(79.27-92.83) points, p=0.03]. According to the MNA and the NRS, diabetic patients had an increased risk of malnutrition (<17.5 points) [OR=1.39, IC95%(1.04-1.86), p=0.02]; and NRS (<85 points) [OR=1.65, IC 95% (1.07-2.54) p=0.02], respectively. When adjusted for age these significant results disappeared. Diabetes combined with malnutrition showed that diabetic patients with malnutrition (MNA˂17.5) spent longer in hospital [21(12-36) days vs. 17(9-30) days, P=.01]. CONCLUSIONS: Diabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.

[Metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a familial hypercholesterolemia cohort in a Public Health Program]. / Evaluación del control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de hipercolesterolemia familiar en un programa de salud pública.

INTRODUCTION: Introduction and objective: familial heterozygous hypercholesterolemia (HFH) is the most common monogenic lipid metabolism disorder that associates premature cardiovascular disease. Our aim was to describe the degree of metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a cohort of HFH patients. Subjects and methods: a retrospective cohort study of the index cases and their relatives genetically diagnosed with HFH by the Endocrinology and Nutrition Service in the HCUV from 2009 to 2017. Anthropometric, clinical, laboratory, genetic, and treatment data were analyzed. Results: a total of 138 subjects were studied, with a mean age of 48.8 (17.7) years, 55.8% of them women. A gene mutation was found in 55.8%, and 10.1% had previous ischemic heart disease. At diagnosis mean total cholesterol was 281.1 (68.4) mg/dL, and LDL-C was 204 (65) mg/dL. Among family cases, at diagnosis, a lower mean age was observed [32.89 (19.2) years vs 50.3 (17.6) years, p < 0.001] as well as lower LDL values [181.9 (64.3) mg/dL vs 226.8 (52) mg/dL, p < 0.005] as compared to index cases. A positive correlation was observed between lipid-lowering treatment dose and LDL level reduction (r = 0.254, p < 0.05), although only 30% of patients reached their LDL target. Patients with HFH were highly adherent to Mediterranean diet, with an average score of 9.5 (1.9) in the Predimed test. Conclusions: early HFH detection is necessary to prevent premature cardiovascular events. A diagnosis of cases among family members anticipates the treatment of patients with HFH. Patients with HFH are more sensitive to heart-healthy diets.

INTRODUCCIÓN: Antecedentes y objetivo: la hipercolesterolemia familiar heterocigota (HFH) es el trastorno del metabolismo lipídico monogénico más común que se asocia a patología cardiovascular prematura. Nuestro objetivo fue describir el grado de control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de pacientes con HFH. Material y métodos: estudio de cohortes retrospectivo de casos índices y familiares diagnosticados genéticamente de HFH desde 2009 a 2017. Se analizaron los datos antropométricos, clínicos, analíticos, del estudio genético y del tratamiento. Resultados: se estudiaron 138 sujetos con una edad media de 48,8 (17,7) años, el 55,8% mujeres. Se encontró la mutación positiva en el 55,8%. La media de colesterol total al diagnóstico fue de 281,1 (68,4) mg/dl y la de LDL de 204 (65) mg/dl. El 10,1% presentaban cardiopatía isquémica previa. Entre los casos familiares se observó una menor edad media [32,89 (19,2) años vs. 50,3 (17,6) años, p < 0,001], así como valores de LDL inferiores en el momento del diagnóstico [181,9 (64,3) mg/dl vs. 226,8 (52) mg/dl, p < 0,005] en comparación con los casos índice. Se evidenció una correlación positiva entre dosis de tratamiento hipolipemiante y reducción de los niveles de LDL (r = 0,254, p < 0,05), aunque solo el 30% de los pacientes alcanzaron sus objetivos de LDL. Los pacientes con HFH presentaron una elevada adherencia a la dieta mediterránea, con una puntuación media de 9,5 (1,9) en el test Predimed. Conclusiones: la detección precoz de la HFH es necesaria para prevenir eventos cardiovasculares prematuros. El diagnóstico de casos familiares anticipa el tratamiento de los pacientes con HFH. Los pacientes con HFH están más sensibilizados sobre la adherencia a las dietas cardiosaludables.

Polymorphism rs3123554 in the cannabinoid receptor type 2 (CB2R) gene is associated to metabolic changes after biliopancreatic diversion surgery. / El polimorfismo del gen del receptor cannabinoide subtipo 2 (CB2R) rs3123554 está asociado con los cambios metabólicos tras la derivación biliopancreática.

INTRODUCTION: The role of genetic variants of the CB2R gene in weight loss after a dietary intervention has been investigated in few studies, none of which has been conducted after bariatric surgery. OBJECTIVES: The aim of this study was to assess the effect of the genetic variant (rs3123554) of the CB2R gene on cardiovascular risk factors and weight loss secondary to a biliopancreatic diversion. DESIGN: The study simple consisted of 147 patients with morbid obesity. Biochemical and anthropometric parameters were measured at baseline and at each visit during 3 years (1, 2, and 3 years). RESULTS: Percent excess weight loss, body mass index, weight, waist circumference, fat mass, blood pressure, fasting glucose, LDL cholesterol, total cholesterol, insulin, HOMA-IR, and triglyceride levels improved in both genotype groups. Decreases in fasting insulin levels and HOMA-IR were higher in non-A allele carriers as compared to A allele carriers. CONCLUSIONS: Our data suggest that patients with morbid obesity who undergo bariatric surgery and carry the A allele of variant rs3123554 of the CB2R gene have greater weight. This allele has no influence on weight loss after surgery, but results in a lower decrease in insulin levels and insulin resistance.

Adiponectin gene variant RS rs266729: Relation to lipid profile changes and circulating adiponectin after bariatric surgery.

BACKGROUND: ADIPOQ rs266729 have been associated with body mass index and metabolic parameters. OBJECTIVES: Our aim was to assess the contribution of this genetic variant on lipid profile and serum adiponectin levels after biliopancreatic diversion surgery in morbidly obese patients in a 3-year prospective study. SETTING: Tertiary Hospital. METHODS: A prospective cohort study (sample) of 149 patients with morbid obesity was evaluated. Biochemical and anthropometric parameters were studied at baseline and every year for a 3-year-follow-up period. RESULTS: Percentage of excess weight loss (65.9% versus 66.0%:ns), body mass index, weight, waist circumference, fat mass, blood pressure, fasting glucose, low-density lipoprotein cholesterol, total cholesterol, insulin, homeostasis model assessment of insulin resistance, and triglyceride levels improved in both genotype groups. A decrease in fasting insulin levels, homeostasis model assessment of insulin resistance, total cholesterol, low-density lipoprotein cholesterol, and triglycerides was higher in non-G-allele carriers than G-allele carriers. The increase of adiponectin levels (at 1 yr) found after 1 (delta: 16.2 ± 3.1 ng/mL versus 2.1 ± 1.0 ng/mL; P = .02), 2 (delta: 24.2 ± 3.1 ng/mL versus 3.1 ± 1.1 ng/mL; P = .02), and 3 years (delta: 33.2 ± 3.9 ng/mL versus 4.7 ± 1.8 ng/mL; P = .01) was higher in non-G-allele carriers than G carriers. At all times, adiponectin levels were higher in patients with genotype CC. CONCLUSIONS: Non-G allele of ADIPOQ gene variant (rs266729) is associated with increases in adiponectin levels and better improvement of low-density lipoprotein cholesterol, triglycerides, insulin, and homeostasis model assessment of insulin resistance after biliopancreatic diversion massive weight loss than G-allele carriers.

[Clinical and economic implications of disease-related malnutrition in a surgical service]. / Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio quirúrgico.

INTRODUCTION: disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System. PATIENTS AND METHODS: this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed. RESULTS: MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST < 2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed. CONCLUSION: patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM.

Contributions of trace elements to the sea by small uncontaminated rivers: Effects of a water reservoir and a wastewater treatment plant.

Trace element contributions from small rivers to estuaries is an issue barely addressed in the literature. In this work, freshwater flowing into the Ria of Cedeira (NW Iberian Peninsula) was studied during a hydrological year through the input from three rivers, one considered uncontaminated (the Das-Mestas River), a second affected by urban treated wastewater discharges (the Condomiñas River), and the third containing a water reservoir for urban supply (the Forcadas River). With the objective of assessing the possible influence of human pressure, the annual yields for selected trace elements (Al, Fe, As, Cd, Co, Cr, Cu, Mn, Mo, Ni and Pb) were estimated and compared by normalizing by basin surface. Both dissolved and particulate transported elements were considered. After the data treatment and analysis it can be highlighted that: (i) the Das Mestas River is suitable to be included between the short European pristine baseline of small rivers, at least regarding the transported trace elements; (ii) natural enrichments were identified associated to the lithology of the basin in the Das-Mestas River (i.e. As) and in the Condomiñas River (i.e. Co, Cr and Ni); this fact highlights the importance of considering the local background for a proper assessment; (iii) the impoundment in the Forcadas River is related with a general decrease, even depletion, of the particulate and dissolved transported trace elements, except Mn; (iv) the discharge of sewage to the Condomiñas River is increasing the inputs to the ria of some trace elements in the particulate phase (i.e. Al, Cu and Pb). Both observed human-induced changes can be regarded as typical disturbances of trace element contributions from small rivers to estuaries.

[Relation of variant rs180077 of gen cholesterol ester transfer protein variant, with fat mass, HDL-cholesterol in obese subjects with diabetes mellitus type 2]. / Relación de la variante rs1800777 del gen CETP (proteína transportadora de ésteres de colesterol) con la masa grasa y HDL colesterol, en sujetos obesos con diabetes mellitus tipo 2.

BACKGROUND: There is few evidence of cholesterol ester transfer protein (CETP) in subjects with obesity and diabetes mellitus. OBJECTIVES: We examined the association of the polymorphism (rs1800777) of CETP gene on anthropometric parameters, lipid profile and adipokines in subjects with obesity and diabetes mellitus type 2. MATERIAL AND METHODS: A population of 229 obese subjects with diabetes mellitus type 2 was enrolled. An electrical bioimpedance, blood pressure, dietary intake, exercise and biochemical analyses were recorded. RESULTS: Two hundred and seventeen subjects (94.8%) had genotype GG and 12 GA (5.2%) (genotype AA was not detected). Weight (delta: 14.4 ± 2.1 kg, p = 0.01), body mass index (delta: 2.2 ± 1.1 kg/m2, p = 0.01), fat mass (delta: 11.2 ± 3.1 kg, p = 0.02), waist circumference (delta: 3.9 ± 2.0 cm, p = 0.02), waist to hip ratio (delta: 0.04 ± 0.02 cm; p = 0.01), tryglicerides (delta: 48.6 ± 9.1 mg / dl, p = 0.03) and leptin levels (delta: 58.6 ± 15.9 mg/dl, p = 0.02) were higher in A allele carriers than non A allele carriers. Levels of HDL-cholesterol were lower in A allele carriers than non-carriers (delta: 5.6 ± 1.1 mg/dl, p = 0.03). In regression analysis, HDl cholesterol, weight and fat mass remained in the model with the SNP. CONCLUSION: Our results show an association of this CETP variant at position +82 on HDL cholesterol, levels and adiposity parameters in obese subjects with diabetes mellitus type 2.

Influencia de la historia de isquemia sobre el estado nutricional en pacientes ingresados por accidente cerebrovascular / Influence of prior ischemic events on the nutritional status of patients hospitalized for stroke

Introducción y objetivos: el mal estado nutricional empeora el pronóstico del ictus. El objetivo de este trabajo fue evaluar qué factores se asociaban a una mala situación nutricional en pacientes con ictus en el momento del ingreso. Material y método: estudio transversal de pacientes hospitalizados con ictus que precisaron soporte nutricional enteral, desde enero de 2014 hasta septiembre de 2016. Determinamos el estado nutricional mediante el Mini-Nutritional Assesment y la valoración global subjetiva. Se realizó un análisis de regresión multivariante, incluyendo variables demográficas, situación funcional (escala de Rankin) y variables clínicas y antropométricas, estratificándose por la edad mediana de la muestra. Resultados: se incluyeron 226 pacientes, el 58,3 % varones, con una edad mediana de 77 (66,7-83) años. El 44 % presentaban riesgo de malnutrición y el 24 % desnutrición. Los factores asociados a una mala situación nutricional fueron la edad (odds ratio (OR): 1,03, IC 95 %: 1,01-1,08) y la puntuación en la escala de Rankin (OR: 1,96; IC 95 %: 1,32-2,67). En el análisis estratificado, los factores asociados a una mala situación nutricional fueron, en el subgrupo de los mayores de 77 años, la capacidad funcional previa (OR: 1,88; IC 95 %: 1,26-2,80), y en el subgrupo de los menores de 77 años, la historia de eventos isquémicos previos (OR: 2,86; IC 95 %: 1,01-8,16). Conclusiones: en pacientes hospitalizados por ictus, la mayor edad y la peor situación funcional previa se asociaron a una peor situación nutricional. En los pacientes de mayor edad, el factor principal fue la situación funcional previa, mientras que en los pacientes más jóvenes, fue el antecedente de patología isquémica. (AU)

Background and aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization. Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age. Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16). Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events. (AU)

Evaluación del control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de hipercolesterolemia familiar en un programa de salud pública / Metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a familial hypercholesterolemia cohort in a Public Health Program

ANTECEDENTES Y OBJETIVO: la hipercolesterolemia familiar heterocigota (HFH) es el trastorno del metabolismo lipídico monogénico más común que se asocia a patología cardiovascular prematura. Nuestro objetivo fue describir el grado de control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de pacientes con HFH. MATERIAL Y MÉTODOS: estudio de cohortes retrospectivo de casos índices y familiares diagnosticados genéticamente de HFH desde 2009 a 2017. Se analizaron los datos antropométricos, clínicos, analíticos, del estudio genético y del tratamiento. RESULTADOS: se estudiaron 138 sujetos con una edad media de 48,8 (17,7) años, el 55,8 % mujeres. Se encontró la mutación positiva en el 55,8 %. La media de colesterol total al diagnóstico fue de 281,1 (68,4) mg/dl y la de LDL de 204 (65) mg/dl. El 10,1 % presentaban cardiopatía isquémica previa. Entre los casos familiares se observó una menor edad media [32,89 (19,2) años vs. 50,3 (17,6) años, p < 0,001], así como valores de LDL inferiores en el momento del diagnóstico [181,9 (64,3) mg/dl vs. 226,8 (52) mg/dl, p < 0,005] en comparación con los casos índice. Se evidenció una correlación positiva entre dosis de tratamiento hipolipemiante y reducción de los niveles de LDL (r = 0,254, p < 0,05), aunque solo el 30 % de los pacientes alcanzaron sus objetivos de LDL. Los pacientes con HFH presentaron una elevada adherencia a la dieta mediterránea, con una puntuación media de 9,5 (1,9) en el test Predimed. CONCLUSIONES: la detección precoz de la HFH es necesaria para prevenir eventos cardiovasculares prematuros. El diagnóstico de casos familiares anticipa el tratamiento de los pacientes con HFH. Los pacientes con HFH están más sensibilizados sobre la adherencia a las dietas cardiosaludables

INTRODUCTION AND OBJECTIVE: familial heterozygous hypercholesterolemia (HFH) is the most common monogenic lipid metabolism disorder that associates premature cardiovascular disease. Our aim was to describe the degree of metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a cohort of HFH patients. Subjects and methods: a retrospective cohort study of the index cases and their relatives genetically diagnosed with HFH by the Endocrinology and Nutrition Service in the HCUV from 2009 to 2017. Anthropometric, clinical, laboratory, genetic, and treatment data were analyzed. RESULTS: a total of 138 subjects were studied, with a mean age of 48.8 (17.7) years, 55.8 % of them women. A gene mutation was found in 55.8 %, and 10.1 % had previous ischemic heart disease. At diagnosis mean total cholesterol was 281.1 (68.4) mg/dL, and LDL-C was 204 (65) mg/dL. Among family cases, at diagnosis, a lower mean age was observed [32.89 (19.2) years vs 50.3 (17.6) years, p < 0.001] as well as lower LDL values [181.9 (64.3) mg/dL vs 226.8 (52) mg/dL, p < 0.005] as compared to index cases. A positive correlation was observed between lipid-lowering treatment dose and LDL level reduction (r = 0.254, p < 0.05), although only 30 % of patients reached their LDL target. Patients with HFH were highly adherent to Mediterranean diet, with an average score of 9.5 (1.9) in the Predimed test. CONCLUSIONS: early HFH detection is necessary to prevent premature cardiovascular events. A diagnosis of cases among family members anticipates the treatment of patients with HFH. Patients with HFH are more sensitive to heart-healthy diets

Apoptotic efficacy of etomoxir in human acute myeloid leukemia cells. Cooperation with arsenic trioxide and glycolytic inhibitors, and regulation by oxidative stress and protein kinase activities.

Fatty acid synthesis and oxidation are frequently exacerbated in leukemia cells, and may therefore represent a target for therapeutic intervention. In this work we analyzed the apoptotic and chemo-sensitizing action of the fatty acid oxidation inhibitor etomoxir in human acute myeloid leukemia cells. Etomoxir caused negligible lethality at concentrations up to 100 µM, but efficaciously cooperated to cause apoptosis with the anti-leukemic agent arsenic trioxide (ATO, Trisenox), and with lower efficacy with other anti-tumour drugs (etoposide, cisplatin), in HL60 cells. Etomoxir-ATO cooperation was also observed in NB4 human acute promyelocytic cells, but not in normal (non-tumour) mitogen-stimulated human peripheral blood lymphocytes. Biochemical determinations in HL60 cells indicated that etomoxir (25-200 µM) dose-dependently inhibited mitochondrial respiration while slightly stimulating glycolysis, and only caused marginal alterations in total ATP content and adenine nucleotide pool distribution. In addition, etomoxir caused oxidative stress (increase in intracellular reactive oxygen species accumulation, decrease in reduced glutathione content), as well as pro-apoptotic LKB-1/AMPK pathway activation, all of which may in part explain the chemo-sensitizing capacity of the drug. Etomoxir also cooperated with glycolytic inhibitors (2-deoxy-D-glucose, lonidamine) to induce apoptosis in HL60 cells, but not in NB4 cells. The combined etomoxir plus 2-deoxy-D-glucose treatment did not increase oxidative stress, caused moderate decrease in net ATP content, increased the AMP/ATP ratio with concomitant drop in energy charge, and caused defensive Akt and ERK kinase activation. Apoptosis generation by etomoxir plus 2-deoxy-D-glucose was further increased by co-incubation with ATO, which is apparently explained by the capacity of ATO to attenuate Akt and ERK activation. In summary, co-treatment with etomoxir may represent an interesting strategy to increase the apoptotic efficacy of ATO and (with some limitations) 2-deoxy-D-glucose which, although clinically important anti-tumour agents, exhibit low efficacy in monotherapy.

Curva de aprendizaje de la punción-aspiración con aguja fina en una unidad de tiroides / Learning curve of thyroid fine-needle aspiration citology in a thyroid nodule clinic

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Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio quirúrgico / Clinical and economic implications of disease-related malnutrition in a surgical service

Introducción: la desnutrición relacionada con la enfermedad (DRE) tiene una alta prevalencia e importantes repercusiones clínicas y económicas. Nuestro objetivo es valorar la factibilidad e importancia de establecer una estrategia de cribado nutricional en nuestro medio. Pacientes y métodos: estudio prospectivo realizado en una planta quirúrgica. Se realizó el Malnutrition Universal Screening Tool (MUST) al ingreso y semanalmente, hasta el alta hospitalaria, a todos los pacientes. Cuando fue necesario, se realizó valoración e intervención nutricional así como codificación al alta de los diagnósticos y procedimientos nutricionales. Datos de estancia hospitalaria (EH), costes hospitalarios y parámetros clínicos fueron analizados posteriormente. Resultados: en un 15,6% de pacientes, el MUST detectó riesgo de desnutrición (≥ 2 puntos). Los pacientes con desnutrición al ingreso (DI) presentaron una estancia hospitalaria (EH) cuatro días superior y mayor tasa de mortalidad y de reingresos urgentes (2,4 y 2,0 veces, respectivamente), un año después del alta hospitalaria. La edad y el ingreso urgente fueron los factores asociados a mayor tasa de mortalidad anual. Un 9% de los pacientes con MUST < 2 inicial sufrieron un deterioro del estado nutricional (DEN) durante el ingreso. Estos pacientes, tuvieron mayor EH (siete días) a igualdad de comorbilidad. Considerando los costes relacionados con la EH, en los pacientes que presentaron DI o DEN se observó un sobrecoste del 57% y el 145%, respectivamente. Conclusión: los pacientes con DI presentaron mayor EH y tasa de mortalidad y de reingresos urgentes un año después del alta hospitalaria. Los pacientes con DI o DEN ocasionan un sobrecoste económico. El cribado nutricional es indispensable para el manejo y la detección precoz de la DRE

Introduction: disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System. Patients and methods: this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed. Results: MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST < 2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed. Conclusion: patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM

Relación de la variante rs1800777 del gen CETP (proteína transportadora de ésteres de colesterol) con la masa grasa y HDL colesterol, en sujetos obesos con diabetes mellitus tipo 2 / Relation of variant rs180077 of gen cholesterol ester transfer protein variant, with fat mass, HDL-cholesterol in obese subjects with diabetes mellitus type 2

Antecedentes: existe poca evidencia sobre el papel de los polimorfismos de CETP en sujetos obesos diabéticos. Objetivos: evaluar la asociación del polimorfismo (rs1800777) del gen CETP sobre parámetros antropométricos, perfil lipídico y adipocitoquinas en pacientes obesos con diabetes mellitus. Material y métodos: un total de 229 obesos con diabetes mellitus tipo 2 fueron reclutados. Una impedancia bioeléctrica, la presión arterial, ingesta dietética, ejercicio y bioquímica fueron analizados. Resultados: un total de 217 pacientes (94,8%) presentaron el genotipo GG y 12 pacientes GA (5,2%) (no se detectó el genotipo AA). El peso (delta: 14,4 ± 2,1 kg, p = 0,01), índice de masa corporal (delta: 2,2 ± 1,1 kg/m2, p = 0,01), masa grasa (delta: 11,2 ± 3,1 kg, p = 0,02), circunferencia de la cintura (delta: 3,9 ± 2,0 cm, p = 0,02), índice cintura-cadera (delta: 0,04 ± 0,02 cm; p = 0,01), triglicéridos (delta: 48,6 ± 9,1 mg / dl, p = 0,03) y leptina (delta: 58,6 ± 15,9 mg/dl, p = 0,02) fueron superiores en los pacientes con el alelo A que en los no portadores del alelo A. El HDL-colesterol fue menor en los portadores de alelo A que los no portadores (delta: 5,6 ± 1,1 mg/dl, p = 0,03). Manteniéndose las diferencias en los análisis multivariantes en los niveles de HDL colesterol, masa grasa y peso. Conclusión: nuestros resultados muestran una asociación del polimorfismo en posición +82 del gen CETP sobre los niveles de HDL colesterol, y parámetros de adiposidad en pacientes obesos con diabetes mellitus tipo 2 (AU)

Background: There is few evidence of cholesterol ester transfer protein (CETP) in subjects with obesity and diabetes mellitus. Objectives: We examined the association of the polymorphism (rs1800777) of CETP gene on anthropometric parameters, lipid profile and adipokines in subjects with obesity and diabetes mellitus type 2. Material and methods: A population of 229 obese subjects with diabetes mellitus type 2 was enrolled. An electrical bioimpedance, blood pressure, dietary intake, exercise and biochemical analyses were recorded. Results: Two hundred and seventeen subjects (94.8%) had genotype GG and 12 GA (5.2%) (genotype AA was not detected). Weight (delta: 14.4 ± 2.1 kg, p = 0.01), body mass index (delta: 2.2 ± 1.1 kg/m2, p = 0.01), fat mass (delta: 11.2 ± 3.1 kg, p = 0.02), waist circumference (delta: 3.9 ± 2.0 cm, p = 0.02), waist to hip ratio (delta: 0.04 ± 0.02 cm; p = 0.01), tryglicerides (delta: 48.6 ± 9.1 mg / dl, p = 0.03) and leptin levels (delta: 58.6 ± 15.9 mg/dl, p = 0.02) were higher in A allele carriers than non A allele carriers. Levels of HDL-cholesterol were lower in A allele carriers than non-carriers (delta: 5.6 ± 1.1 mg/dl, p = 0.03). In regression analysis, HDl cholesterol, weight and fat mass remained in the model with the SNP. Conclusion: Our results show an association of this CETP variant at position +82 on HDL cholesterol, levels and adiposity parameters in obese subjects with diabetes mellitus type 2 (AU)

Influencia del estado nutricional sobre la estancia media hospitalaria en el paciente con diabetes mellitus tipo 2 / Influence of nutritional status on hospital length of stay in patients with type 2 diabetes

INTRODUCCIÓN: En el paciente hospitalizado la diabetes mellitus tipo 2 (DM2) puede condicionar una peor situación nutricional debido a su fisiopatología y tratamiento dietético prescrito. OBJETIVOS: Valorar si el paciente con DM2 hospitalizado tiene peor situación nutricional que el no diabético. Determinar la influencia de la DM2 en la estancia media en pacientes con mala situación nutricional. MATERIAL Y MÉTODOS: Estudio transversal desde enero de 2014 hasta octubre de 2016, en 1.017 pacientes en los que se solicitó valoración nutricional al servicio de endocrinología y nutrición. Se recopilaron datos de antropometría, albúmina plasmática, demora en la realización de la interconsulta a nutrición y tiempo de estancia hospitalaria. Se analizó el estado nutricional mediante el cuestionario Mini Nutritional Assesment (MNA) y el índice de riesgo nutricional (IRN). RESULTADOS: Del total de pacientes el 24,4% eran pacientes con DM2 y 75,6% no lo eran. Los pacientes con DM2 presentaban mayor índice de masa corporal (23,18 [20,78-25,99] kg/m2 vs. 22,31 [19,79-25,30] kg/m2, p˂0,01], menor puntuación total del cuestionario MNA (16,5 [13,12-19]) puntos vs. 17 [14-20] puntos, p˂0,01), menor puntuación del índice IRN (83,09[77,72-91,12] puntos vs. 85,78 [79,27-92,83] puntos, p = 0,03). El paciente con DM2 tiene un riesgo aumentado de padecer malnutrición según el cuestionario MNA (<17,5 puntos) (OR=1,39, IC 95% [1,04-1,86], p = 0,02); e IRN [<85 puntos]) (OR=1,65, IC 95%: 1,07-2,54 p = 0,02). Estos resultados significativos desaparecieron al ajustar por edad. Al valorar la desnutrición combinada con la diabetes, los pacientes con DM2 y malnutrición (MNA˂17,5) tienen una estancia media hospitalaria mayor (21 [12-36] días vs. 17 [9-30] días=0,01). CONCLUSIONES: Los pacientes con DM2 tienen peor situación nutricional que los pacientes sin DM2. Los pacientes con diabetes con peor situación nutricional presentan mayor estancia media hospitalaria

INTRODUCTION: In the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment. OBJECTIVES: The aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition. MATERIAL AND METHODS: This was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS). RESULTS: 24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78-25.99) kg/m2 vs. 22.31 (19.79-25.30) kg/m2, P˂.01], a lower total score in the MNA questionnaire [16.5(13.12-19) points vs. 17(14-20) points, P˂.01], and a lower NRS score [83.09(77.72-91.12) points vs. 85.78(79.27-92.83) points, p = 0.03]. According to the MNA and the NRS, diabetic patients had an increased risk of malnutrition (<17.5 points) [OR=1.39, IC95%(1.04-1.86), p = 0.02]; and NRS (<85 points) [OR=1.65, IC 95% (1.07-2.54) p = 0.02], respectively. When adjusted for age these significant results disappeared. Diabetes combined with malnutrition showed that diabetic patients with malnutrition (MNA˂17.5) spent longer in hospital [21(12-36) days vs. 17(9-30) days, P=.01]. CONCLUSIONS: Diabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital