Circulating levels of plasminogen activator inhibitor-1 are associated with metabolic syndrome rather than with menopause.

The plasminogen activator inhibitor type 1 (PAI-1) is the major determinant of fibrinolytic activity. PAI-1 concentrations are elevated in obesity, type 2 diabetes and metabolic syndrome (MetS). On the other hand, during menopause, fibrinolytic activity decreases and, consequently, PAI-1 concentration increases; however, it is debated whether menopause is an independent determinant factor of PAI-1 levels. The objective of this study was to evaluate the effect of hormonal and metabolic status on the concentration of PAI-1 in pre-and post-menopausal women. A case-control study was conducted in ninety pre-and post-menopausal women aged 45 to 55 years, matched by body mass index (BMI). Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Of all the women, 30% presented MetS. Women with MetS had higher values of PAI-1 (36.0 ± 19.1 vs 19.3 ± 14.8 ng/mL, p < .001); in contrast, no differences were observed when compared by hormonal status (20.7 ± 18.10 vs 20.2 ± 17.0 ng/mL, NS). The results of this study suggest that in women, MetS plays a more important role in the deterioration of the fibrinolytic mechanisms rather than their hormonal status. Therefore, the identification of cardio-metabolic factors is relevant to reduce the presence of thrombosis in post-menopausal women.

Similar to Adiponectin, Serum Levels of Osteocalcin are Associated with Mammographic Breast Density in Postmenopausal Women.

OBJECTIVE: Breast cancer is the most common type of cancer in Canadian women and worldwide. Mammographic density is a well-established breast cancer risk. Recent evidence suggested inverse correlations among adiponectin, osteocalcin, and the risk developing breast cancer. The objective of the study was to evaluate the relationship between breast density and adiponectin and osteocalcin concentrations. METHODS: A cross-sectional study was performed in 239 women, age range 40 to 60. Mammographic density, serum adiponectin, and osteocalcin levels were measured. According to the Wolfe method, participants were divided into those with low-risk and high-risk pattern mammograms. RESULTS: The study population included 107 premenopausal and 132 postmenopausal women. Parameters were no different between women with low-risk and high-risk patterns. In obese postmenopausal women, the high-risk pattern mammogram group had significantly higher values of adiponectin and osteocalcin compared with the low-risk pattern group. Multiple linear regression analyses showed that adiponectin and osteocalcin levels were associated with high-risk pattern mammograms. CONCLUSION: Adiponectin and osteocalcin levels were directly associated with high-risk pattern mammograms in obese postmenopausal women. These results do not support the use of adipokines as biomarkers; nevertheless, the most important factor is to assess the risk through breast density.

[Commentary on the Nobel Prize that has been granted in Medicine-Physiology, Chemistry and Physics to noteable investigators]. / Comentario sobre los Premios Nobel de Medicina-Fisiología, Química y Física otorgados a investigadoras notables.

The Nobel Prize was established by Alfred Nobel in 1901 to award people who have made outstanding achievements in physics, chemistry and medicine. So far, from 852 laureates, 45 have been female. Marie Curie was the first woman to receive the Nobel Prize in 1903 for physics and eight years later also for chemistry It is remarkable that her daughter Irene and her husband also received the Nobel Prize for chemistry in 1935. Other two married couples, Cori and Moser, have also been awarded the Nobel Prize. The present commentary attempts to show the female participation in the progress of scientific activities.

Bariatric Surgery Effect on the Crosstalk of PAI-1 and PCSK9 to Regulate the Metabolic Changes in Patients with Obesity.

BACKGROUND: Adiposity favors several metabolic disorders with an exacerbated chronic pro-inflammatory status and tissue damage, with high levels of plasminogen activator inhibitor type 1 (PAI-1) and proprotein convertase subtilisin/kexin type 9 (PCSK9). OBJECTIVE: To demonstrate the influence of bariatric surgery on the crosstalk between PAI-1 and PCSK9 to regulate metabolic markers. METHODS: Observational and longitudinal study of 190 patients with obesity and obesity-related comorbidities who underwent bariatric surgery. We measured, before and after bariatric surgery, the anthropometric variables and we performed biochemical analysis by standard methods (glucose, insulin, triglycerides [TG], total cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C] and TG/HDL-C ratio, PAI-1 and PCSK9 were measured by ELISA). RESULTS: PAI-1 levels decreased significantly after bariatric surgery, and were positively correlated with lipids, glucose, and TG, with significance on PCSK9 and TG/HDL-C alleviating the insulin resistance (IR) and inducing a state reversal of type 2 diabetes (T2D) with a significant decrease in body weight and BMI (p <0.0001). Multivariate regression analysis predicted a functional model in which PAI-1 acts as a regulator of PCSK9 (p <0.002), TG (p <0.05), and BMI; at the same time, PCSK9 modulates LDL-C HDL-C and PAI-1. CONCLUSIONS: After bariatric surgery, we found a positive association and crosstalk between PAI-1 and PCSK9, which modulates the delicate balance of cholesterol, favoring the decrease of circulating lipids, TG, and PAI-1, which influences the glucose levels with amelioration of IR and T2D, demonstrating the crosstalk between fibrinolysis and lipid metabolism, the two main factors involved in atherosclerosis and cardiovascular disease in human obesity.

Thrombotic risk assessed by PAI-1 in patients with COVID-19: The influence of hyperglycemia and diabetes mellitus.

OBJECTIVE: To assess thrombotic risk with PAI-1 levels in patients with COVID-19, to evaluate PAI-1 differences between hyperglycemic and/or Type 2 Diabetes Mellitus (T2DM) versus non-hyperglycemic patients, and to analyze the association of plasminogen activator inhibitor-1 (PAI-1) with hyperglycemia and T2DM. METHODS: A cross-sectional study carried out in 181 patients hospitalized for COVID-19. Two groups were formed: the patients with hyperglycemia at admission and/or previously diagnosed T2DM group and the non-hyperglycemic group. Fibrinolysis was assessed by measuring PAI-1 levels by ELISA. RESULTS: The mean age was 59.4±16.1 years; 55.8% were male 54.1% of patients presented obesity, 38.1% had pre-existing T2DM and 50.8% had admission hyperglycemia and/or pre-existing T2DM. The patients with admission hyperglycemia and/or preexisting T2DM had higher PAI-1 compared with non-hyperglycemic patients [197.5 (128.8-315.9) vs 158.1 (113.4-201.4) ng/mL; p=0.031]. The glucose levels showed a positive correlation with PAI-1 levels (r=0.284, p=0.041). A multivariate logistic regression analysis showed association of PAI-1 level and hyperglycemia and pre-existing T2DM with severity of COVID-19. CONCLUSION: Patients hospitalized for COVID-19 infection with preexisting T2DM or hyperglycemia detected during their hospitalization presented a greater increase in PAI-1 levels, which suggests that hyperglycemia contributes directly to the hypercoagulable state and probably a worse outcome from the patients.

Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism.

BACKGROUND: Fatigue is a common symptom in hypothyroidism; however, the effect of levothyroxine on fatigue has been little studied. The aim of this study was to evaluate the effect of levothyroxine on fatigue in Latino patients with primary hypothyroidism, as well as the association of TSH and free T4 (FT4) with the severity and persistence of fatigue. METHODS: A prospective study was performed in 92 patients with primary hypothyroidism. Fatigue severity scale (FSS) scores and clinical and biochemical characteristics before and at 6 months of levothyroxine were evaluated. RESULTS: After 6 months of levothyroxine, a reduction in FSS (53 (47-57) vs. 36 (16-38); p = 0.001) and fatigue frequency (45.7% vs. 26.1%; p = 0.008) was evident. Both before and after 6 months of levothyroxine, there was a positive correlation of the FSS score with TSH and a negative correlation with FT4. Persistent fatigue was associated with a pretreatment FSS score (r = 0.75; p = 0.001) and diabetes (r = 0.40; p = 0.001). An FSS > 34 (RR 3.9 (95% CI 1.43-10.73; p = 0.008)), an FSS > 36 (RR 3.23 (95% CI 1.21-8.6; p = 0.019)), and diabetes (RR 5.7 (95% CI 1.25-9.6; p = 0.024)) before treatment were risk factors for persistent fatigue. CONCLUSIONS: Levothyroxine improved fatigue in most patients. Diabetes and an FSS score >34 or >36 before treatment were risk factors for persistent fatigue.

[Vitamin D and its positive effect on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in kidney transplant recipients]. / Vitamina D y su efecto positivo sobre el eje PTH/vitamina D/calcio-FGF23/klotho/fósforo en pacientes con trasplante renal.

Introduction: Background: hypovitaminosis D is frequent in kidney transplant recipient (KTR) patients and is associated with deleterious effects both at the bone and extraosseous levels. Treatment with cholecalciferol is effective for the normalization of 25(OH)D, demonstrating a beneficial effect on the calcium-tropic axis in other populations; however, its effect on the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis in RTR has not been reported. The aim of this study was to evaluate the effect of normalization of serum 25(OH)D concentrations on the PTH/vitamin D/calcium-FGF23/klotho/phosphorus axis in KTR treated with cholecalciferol, as well as the association between the components of this axis. Methods: a prospective study in 23 KTR with hypovitaminosis D, with evolution from 1 to 12 months post-transplantation, an estimated glomerular filtration rate > 60 mL/min/1.73 m2 and a history of primary nephropathy treated with cholecalciferol, in whom the PTH/vitamin D/calcium and FGF23/klotho/phosphorus axis was evaluated during the state of hypovitaminosis D and at normalization of 25(OH)D. Results: at the normalization of 25(OH)D, a reduction in PTH [103 (58.5-123.9) vs 45.6 (30.1-65.1) pg/mL; p = 0.002] and an increase in serum phosphorus [3.1 (2.3-3.5) vs 3.3 (3-3.6) mg/dL; p = 0.01] were evident, with no differences in calcium, klotho and FGF23 concentrations. The time to achieve normalization of 25(OH)D was 12 weeks (RIC, 4-12), with a dose of 5000 IU/day (RIC, 4000-6000). A positive association between klotho and PTH was corroborated (r = 0.54; p = 0.008; linear regression, ß = 0.421; B = 0.004; 95 % CI, 0.003-0.007; p = 0.045). Conclusions: treatment with cholecalciferol is effective for the normalization of 25(OH)D, with a beneficial effect on calcium-phosphotropic metabolism characterized by a reduction in PTH concentration, without significant changes in calcemia or calciuria, as well as an increase in phosphatemia, without modifications in FGF23 or klotho concentrations.

Introducción: Introducción: la hipovitaminosis D es frecuente en los receptores de trasplante renal (RTR) y se asocia con efectos deletéreos tanto a nivel óseo como extraóseo. El tratamiento con colecalciferol es eficaz para la normalización de la 25(OH)D, demostrándose un efecto benéfico sobre el eje calciotrópico; sin embargo, su efecto sobre el eje fosfotrópico no se ha reportado. El objetivo de este estudio fue evaluar el efecto de la normalización de las concentraciones séricas de 25(OH)D sobre el eje PTH/vitamina D/calcio-FGF23/klotho/fósforo en RTR tratados con colecalciferol, así como la asociación entre sus componentes. Métodos: estudio prospectivo en 23 RTR con hipovitaminosis D y antecedente de nefropatía primaria tratados con colecalciferol, en quienes se evaluó el eje PTH/vitamina D/calcio y FGF23/klotho/fósforo durante el estado de hipovitaminosis D y a la normalización de la 25(OH)D. Resultados: a la normalización de la 25(OH)D se evidenció una reducción de la PTH [103 (58,5-123,9) vs. 45,6 (30,1-65,1) pg/mL; p = 0,002] y un aumento del fósforo sérico [3,1 (2,3-3,5) vs. 3,3 (3-3,6) mg/dL; p = 0,01], sin diferencias en las concentraciones de calcio, klotho y FGF23. El tiempo para lograr la normalización de la 25(OH)D fue de 12 semanas (4-12), con una dosis de 5000 UI/día (4000-6000). Se corroboró una asociación positiva entre klotho y PTH (r = 0,54; p = 0,008; regresión lineal, ß = 0,421; IC 95 %: 0,003-0,007; p = 0,045). Conclusiones: el tratamiento con colecalciferol es eficaz para la normalización de la 25(OH)D con un efecto benéfico sobre el metabolismo calcio-fosfotrópico caracterizado por una reducción de la PTH y un incremento de la fosfatemia, sin modificaciones de calcemia, calciuria, FGF23 o klotho.

Women with gestational diabetes develop glucose intolerance with high frequency within one year postpartum.

OBJECTIVE: To investigate the incidence of glucose intolerance postpartum in women with gestational diabetes (GDM) and assess body weight, cholesterol and triglyceride concentrations after delivery. METHODS: This was a study of an initial cohort of 100 women with GDM who were tested at 6 weeks, 6 months, and 1 year postpartum. Postpartum evaluations were glucose tolerance, weight and cholesterol and triglycerides. RESULTS: Impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) was present in 36.5% of 52 participants who were assessed at 6 weeks postpartum and diabetes in 17.3%; the remaining 48 women failed to return for the 3 evaluations. By 6 months, IFG/IGT was demonstrated in 55.8% and diabetes in 32.7% of the women. At 1 year, 46.2% exhibited IFG/IGT and 48% diabetes. Moreover, the weight was higher in those women who presented IFG/IGT (75.5 ± 15.2 kg, mean ± SD) and diabetes (79.0 ± 16.2 kg) compared with those who had normal glucose tolerance (65.3 ± 14.5 kg; p < 0.05). In addition, triglycerides were higher in mothers with glucose intolerance (181.3 ± 85.9 mg/dl in IFG/IGT and 230.9 ± 90.9 mg/dl in diabetes) than in women with normal glycemia (147.8 ± 11.2 mg/dl; p < 0.05). CONCLUSION: We demonstrated an increased incidence of women exhibiting glucose intolerance within 1 year postpartum, mainly in those who remained obese.

[The treatment of hypercholesterolemia is in a crossroad]. / El tratamiento del colesterol alterado en una encrucijada terapéutica.

In order to correct the high level of cholesterol in blood is necessary to improve the life style which includes proper nutrition and physical exercise, but frequently is added some medication. The initial medication that is used is a stantin which decreases total cholesterol and low density cholesterol associated with increment in high density cholesterol in order to prevent cardiovascular involvement. It is frequent the addition of other medicaments, such as niacin or ezetemiba to achieve a greater effect on cholesterol disorders. The effectively of anti-cholesterol elevation should be evaluated by the occurrence of cardiovascular events, instead of the improvement in biochemist markers.

[New trends in gestational diabetes]. / El nuevo enfoque hacia la diabetes gestacional.

It has been considered that gestational diabetes (GD) is onset along a pregnancy and resolves after delivery. It is also believed that GD is a risk factor for the development of diabetes; however it remains controversial the time of pregnancy for looking for and the diagnostic test and protocol to apply. Mother's age and obesity are closely associated with the presence of glucose intolerance; likewise there are an unsatisfactory number of women who return for evaluation after delivery. The purpose of the paper is to discuss this controversial topic and set out a point of view.

Pattern of Adiponectin, Osteocalcin, Irisin, FGF-21, and MCP-1 According to the Body Size Phenotype: Could They Be Markers of Metabolic Health in Mexican-Mestizo Middle-Aged Women?

Variations in levels of some adipokines, myokines, osteokines, hepatokines and inflammatory cytokines contribute to abnormal glucose and lipid metabolism. The aim of this study was to determine the pattern of adiponectin, osteocalcin (OCN), irisin, FGF-21, and MCP-1 according to the body size phenotype of middle-aged women, and their associations with BMI, visceral adipose tissue (VAT), and HOMA-IR. A cross-sectional study in 265 women aged from 40 to 65 years was performed. The biochemical characteristics were evaluated in metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy obese, and metabolically unhealthy obese women. There was an association of OCN with BMI (r = -0.107; p = 0.047); adiponectin with BMI (r = -0.217; p = 0.001), insulin (r = -0.415; p = 0.0001), HOMA-IR (r = -0.429; p = 0.0001), and VAT (r = -0.134; p = 0.025); irisin with BMI (r = 0.604; p = 0.001), insulin (r = 0.446; p = 0.0001), HOMA-IR (r = 0.452; p = 0.0001), and VAT (r = 0.645; p = 0.0001); FGF-21 with insulin (r = -0.337; p= 0.030) and HOMA-IR (r = -0.341; p = 0.03); and MCP-1 with BMI (r = 0.481; p = 0.0001), VAT (r = 0.497; p = 0.001), insulin (r = 0.298; p= 0.001), and HOMA-IR (r = 0.255; p = 0.004). A multivariate analysis showed that an elevation of OCN (OR 1.4 (95%CI 1.06-1.81)) and a reduction of adiponectin (OR 0.9 (0.84-0.96)) were associated factors for a metabolic unhealthy phenotype in normal weight participants. Likewise, higher irisin (OR 1.007 (1.003-1.011)) and MCP-1 (1.044 (1.008-1.083)) were risk factors for a metabolic unhealthy phenotype in woman with obesity. OCN, adiponectin, irisin, FGF-21, and MCP-1 are associated with some metabolic parameters such as BMI, HOMA-IR, and VAT, and could be possible biomarkers of an unhealthy metabolic phenotype in middle-aged women.

COVID-19 in a country with a very high prevalence of diabetes: The impact of admission hyperglycaemia on mortality.

Aims: To evaluate the frequency of diabetes and admission hyperglycaemia in Mexican COVID-19 patients, to describe the clinical and biochemical characteristics of patients with admission hyperglycaemia and to determinate the impact of diabetes and admission hyperglycaemia on COVID-19 severity and mortality. Methods: A multicentric study was performed in 480 hospitalized patients with COVID-19. Clinical and biochemical characteristics were evaluated in patients with admission hyperglycaemia and compared with non-hyperglycaemic patients. The effect of diabetes and admission hyperglycaemia on severity and risk of death were evaluated. Results: Age was 50.7 ± 13.6 years; 68.3% were male. Some 48.5% (n = 233) had admission hyperglycaemia; 29% (n = 139) of these patients had pre-existing diabetes. Patients with admission hyperglycaemia had more requirement of invasive mechanical ventilation (IMV), higher levels of urea, D-dimer and neutrophil-lymphocyte ratio (NLR), as well as lower lymphocyte count. An association between admission hyperglycaemia with IMV and D-dimer with glucose was found. Age ≥50 years (OR 2.09; 95%CI 1.37-3.17), pre-existing diabetes (OR 2.38; 95%CI 1.59-5.04) and admission hyperglycaemia (OR 8.24; 95%CI 4.74-14.32) were risk factors for mortality. Conclusions: Admission hyperglycaemia is presented in 48.5% of COVID-19 patients. Diabetes and admission hyperglycaemia are associated with the severity of disease and mortality. This study shows the devastating conjunction of hyperglycaemia and COVID-19. Clinical trial registration: Clinical characteristics of patients with COVID-19, DI/20/204/04/41 (Hospital General de Mexico) and NR-13-2020 (Hospital Regional de Alta Especialidad Ixtapaluca).

[Frequency of symptoms of the climacteric syndrome]. / Frecuencia de los síntomas del síndrome climatérico.

BACKGROUND: Menopause is the descent in circulating estrogens that manifests clinically for the climacteric symptoms. These symptoms motivate the patient to consult to the physician. OBJECTIVE: To know which are the symptoms that motivate women in the climacteric to begin hormonal therapy. MATERIAL AND METHOD: Atransverse study was settled, 692 patients from the menopause cohort of Endocrine Research Unit, Centro Médico Nacional, IMSS participated. All patients signed the letter of informed consent. Complete clinical evaluation and taking samples of veined blood for the hormonal determinations of LH, FSH and estradiol were carried out. The approach of evaluation of the clinical symptoms was made with the scale of Greene that values six components: psychological, anxiety, depression, somatic, vasomotor and sexual, which quantifies the presence and intensity of the climacteric symptoms. RESULTS: The four main symptoms that accompany the climacteric are: hot flushes, irritability, edginess and sickness. With the registered symptoms, the punctuation of the components in the scale of Greene showed a bigger frequency statistically with difference significant (p < 0.05) for the vasomotor and the depressive component compared with the rest of the components that integrate all the symptoms. CONCLUSIONS: Hot flushes and irritability are the symptoms found in the first time interview, also these are presented in more than half of the patients, therefore these symptoms can be considered as main cause to begin hormonal therapy. In accordance with the scale of Greene that allowed us to evaluate the symptoms in integrated form, the sexual component was a smaller frequency, maybe to that great number of patient does not dare to comment the sexual dysfunctions. However, at the moment has a wide therapeutic arsenal and forms of administration of estrogen therapy that have demonstrated to have a clinical-benefic effect for the control of the climacteric symptoms.

[Bone tissue as an endocrine gland]. / El tejido óseo se incorpora a la constelación hormonal.

Bone tissue was essentially considered as a mechanical structure; however is now well known that is the site of permanent bone remodelation. In addition, bone functions as an endocrine gland producing osteocalcin, which in turn interacts with other tissues, such as fat, pancreas and gastrointestinal tract. As a consequence, osteocalcin intervenes into glucose metabolism, peripheral insulin sensitivity and inflammatory process. In sum, bone may be accepted as an endocrine gland.

[A useful guide for selecting pharmacotherapy in type 2 diabetes]. / Guía para seleccionar el tratamiento farmacológico en diabetes 2.

As the knowledge in medical science development, new molecular mechanism in the diabetes had lead to new drugs and therapeutics, althought the change in life style of the patient is essential for controling the blood levels in diabetic patient glucose. Antidiabetic drugs act through different mechanisms of action, including stimulation of insulin secretion, increasing sensitivity to insulin and the insulin analogues. Other agents are inhibitors of glucose, and finally drugs which imitate intestinal hormones. It is important to emphasize that diabetes is better controlled with more than one single drug, however the corner stone of the treatment is a correct diet and exercise.

[Relationship between sex steroids and bone density in elderly men]. / Relación entre esteroides sexuales y densidad ósea en el hombre senescente.

OBJECTIVE: To determine the relationship between serum estradiol level (ESL) and testosterone serum level (TSL) with bone mineral density (BMD) in elderly men. METHODS: Cross-sectional study including 127 healthy men aged 60 years and over. BMD of the lumbar spine and femoral neck were measured. ESL, TSL and sex hormone binding globulin were estimated by radioimmunoassay. Free testosterone level (FTL) was calculated. RESULTS: The ESL and BMD correlation at the spine was r = 0.288, (p < 0.01) and at the femoral neck was r = 0.224, (p < 0.01). These correlations remained significant after adjustment for BMI and age. By contrast, no correlation was found between TSL and BMD. However FTL were associated with BMD at the spine (r = 0.288, p < 0.01) and at the femoral neck (r = 0.190, p < 0.05). CONCLUSIONS: ESL and FTL are associated with BMD in elderly men. This effect may be partially mediated by the peripheral conversion of testosterone into estradiol.

The colors of adipose tissue and the relationship with irisin.

Excess adipose tissue is considered one of the main causes of metabolic and cardiovascular diseases. Initially, the adipose tissue was considered the main lipid and energy storage of the organism. Subsequently it was discovered that adipose tissue had other functions such as endocrine, controlling different metabolic and immune processes. Currently, different types of adipose tissue are recognized. The white adipocyte represents the main energy reserve, on the contrary the brown adipocyte is responsible for the oxidation of lipids for thermogenesis. The beige adipocyte originates from the white adipocyte, by a process known as "browning", which leads to lipolysis and thermogenesis. The 3 previous types have recently joined the blue adipocyte, which has a role in liver retinoid homeostasis and the pink adipocyte that participates in lactogenesis and is present in the mammary gland of animals; its role is still unknown in humans. The newly identified hormone Irisin is secreted by the skeletal muscle and promotes browning of white to beige adipose tissue, thus favoring thermogenesis. Another interesting aspect of this hormone is that it represents a connection between muscle activity and lipolysis. The above suggests that Irisin may be the key in the prevention and treatment of obesity.

El exceso de tejido adiposo representa una de las principales causas de las enfermedades metabólicas y cardiovasculares. Inicialmente al tejido adiposo se le consideró el almacén de lípidos y energía del organismo. Posteriormente se descubrió que presentaba otras funciones, como la endocrina, controlando diferentes procesos metabólicos e inmunitarios. Por sus características funcionales y estructurales, se reconocen varios tipos de tejido adiposo. El adipocito blanco representa la reserva energética y el adipocito marrón se encarga de la oxidación de los lípidos para la termogénesis. El adipocito beige se origina del adipocito blanco, mediante un proceso que conduce a la lipólisis y la termogénesis. A los anteriores se han sumado el adipocito azul, en el hígado, que interviene en la homeostasis de retinoides, y el adipocito rosa, que participa en la lactogénesis y se ha identificado en la glándula mamaria de animales. La irisina es una hormona secretada principalmente por el músculo esquelético, que promueve el pardeamiento del tejido adiposo blanco a beige, favoreciendo así la termogénesis. Otro aspecto interesante de esta hormona es que representa una conexión entre la actividad muscular y la lipólisis. Por lo anterior, la irisina puede ser una clave en la prevención y el tratamiento de la obesidad.

[Thyroid dysfunction: a topic of constant review for the gynaecologist, for its frequency in women]. / Enfermedad tiroidea: un tema de revisión constante por el ginecólogo, por su frecuencia en las mujeres.

Thyroid dysfunction is more common in women than in men due to the hormone changes which are functional in proper stages such as puberty, pregnancy and menopause. It seems that the interrelationship between the endocrine and immunologic systems may be responsible of the incidence of thyroid dysfunction. The development of precise techniques for the measurement of thyroid hormones as well as the advancement in imagenology studies have contributed to proper diagnosis and therapeutic modalities. Thyroid diseases during pregnancy are now better treated and no harm has been observed in neonates. Fine needle-aspiration biopsy for the diagnosis of thyroid cancer is considered the best diagnostic procedure, but remains in controversy the extension of surgery of the gland. There are still some controversial points regarding TSH universal screening, the adequate treatment of hyperthyroidism and the management of non-cancerous thyroid nodules.

[Efficacy of strontium ranelate for the mineralization of bone in postmenopausal women]. / Eficacia del ranelato de estroncio para la mineralización ósea en mujeres posmenopáusicas.

INTRODUCTION: Osteoporosis is the most common skeletal disorder and is considered a risk of fracture. Most medication used for the treatment of osteoporosis are antiresorptive; however strontium therapy in postmenopausal women has shown a double effect on resorption and bone formation. OBJECTIVE: To evaluate the effect of strontium on bone mineral density (BMD) and circulating biochemical markers of bone turnover in postmenopausal women who had a decreased BMD. MATERIAL AND METHODS: A prospective study was carried out in 23 postmenopausal women who had decreased BMD, who received daily strontium orally by night during 12 months. Evaluation of BMD at lumbar spine and hip as well as biochemical markers in blood for bone turnover before and during therapy. RESULTS: BMD at the spine (0.755 +/- 0.104 to 0.792 +/- 0.094, p < 0.05) and hip (0.833 +/- 0.096 to 0.856 +/- 0.100, p < 0.05) increased significantly after 12 months of treatment. Bone turnover markers showed a decrement of osteocalcin, by contrast the specific alkaline phosphatase increased after 6 months of therapy; however C-terminal telopeptide of type 1 collagen was not modified. CONCLUSIONS: Strontium ranelate increased significantly BMD at the spine and at the hip in postmenopausal women and simultaneously improved bone turnover estimated by circulating bone markers.

Differences between metabolically healthy and unhealthy obesity in PAI-1 level: Fibrinolysis, body size phenotypes and metabolism.

BACKGROUND: Different studies have recognized the existence of subtypes of obesity and normal weight, in which it is reported that not all patients show the same cardiometabolic risk, called "metabolically healthy" and "metabolically unhealthy". In several reviews, differences in the inflammatory profile have been studied, but there is not information on the relationship of body size phenotypes with thrombosis risk. OBJECTIVE: Determine the association between body size phenotypes and fibrinolytic activity by measuring the concentration of plasminogen activator inhibitor-1 (PAI-1). METHODS: A cross-sectional study was conducted in women aged 40 to 65 years. Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Karelis criteria were used to define metabolic status. Four groups were formed: Metabolically healthy normal weight (MHNW), Metabolically unhealthy normal weight (MUNW), Metabolically healthy obese (MHO) and Metabolically unhealthy obese (MUO). RESULTS: 230 women were included in our study with a mean age 52.3 ±â€¯5.9 years. The concentration of PAI-1 showed a significant difference between the groups MHNW, MUNW, MHO, MUO [2.3 (0.08, 13.6), 12.7, (0.08, 33.1), 23.4 (2.6, 28.8) and 22.8 (2.0, 46.7) ng/mL, respectively, p = 0.006]. Multiple regression analysis identified that BMI and HOMA-IR were independent factors influencing PAI-1 levels. CONCLUSION: This study is the first one that recognizes differences in the fibrinolytic activity between body size phenotypes. The groups with the lowest fibrinolytic activity were MUO and MHO, however, MUNW also present alterations of fibrinolysis, thus suggesting a prothrombotic state.