Calidad de vida en pacientes con enfermedad de Pompe: estudio observacional / Quality of Life in Patients with Pompe Disease: Cross-Sectional Study

Introducción: La enfermedad de Pompe es una enfermedad genética multisistémica y rápidamente progresiva, que causa compromiso muscular (esquelético, cardíaco y liso), severa hipotonía y dificultad en la deglución. Debido a la naturaleza de la enfermedad, la calidad de vida de las personas que la padecen puede verse más afectada con respecto a la población general. Método: Se llevó a cabo un estudio descriptivo de corte transversal. Se diseñó un instrumento tipo encuesta con preguntas de caracterización sociodemográfica y referentes a la enfermedad. Para medir la calidad de vida se aplicó el Medical Outcomes Study 36-Item Short Form (SF-36) Questionnaire. Se hizo una comparación entre grupos, con nivel de significancia de 0,05. Resultados: Se obtuvieron encuestas de 27 pacientes de seis países. La edad media fue de 40,52 años, el 59 % fueron mujeres, el 51 % casados, el 63 % activos laboralmente, con edad media de diagnóstico de 30,3 años (SD = 15,557). La dimensión con menor media fue el rol físico (10,2; IC 95 % = 1,5-21,9), mientras que la de mayor media fue la salud mental (65,5; IC 95 % = 56,9-74,0). El 29,7 % (IC 95 % = 11,2-48,0) de los encuestados consideró sentirse en peores condiciones de salud que el año anterior. Discusión: Se evidencia una baja calidad de vida en pacientes con EP, en comparación con la población general, si se tienen en cuenta otros estudios que utilizan el mismo cuestionario. Conclusiones: Se evidencia una baja calidad de vida en los pacientes con enfermedad de Pompe participantes; las dimensiones asociadas con parámetros físicos fueron las de menores puntuaciones.

Introduction: Pompe disease is a rapidly progressive, multisystemic genetic disease that causes muscle involvement (skeletal, cardiac and smooth), severe hypotonia and difficulty in swallowing. Due to the nature of the disease, the quality of life may be more affected compared to the general population. Method: A descriptive cross-sectional study was carried out. A survey-type instrument was designed with questions of sociodemographic characterization and those referring to the disease. To measure Quality of Life, the Medical Outcomes Study 36-Item Short Form (SF-36) questionnaire was applied. A comparison was made between groups with a significance level of 0,05. Results: 27 surveys of patients from six countries were obtained. The mean age 40.52 years, women 59 %, married 51 %, 63 % active in employment, with a mean age of diagnosis of 30.3 years (SD = 15,557). The dimension with the lowest mean was the Physical Role (10.2; 95 % CI = 1.5 - 21.9), while the one with the highest mean was the Mental Health dimension (65.5; 95 % CI = 56.9 - 74.0). 29.7 % (95 % CI = 11.2 - 48.0) of those surveyed considered they felt in worse health conditions than the previous year. Discussion: Low quality of life is evidenced in patients with PD in comparison to the general population described in other studies using the same questionnaire. Conclusions: A low quality of life is evidenced in the study individuals where the dimensions related to the physical area were lower.

Tratamiento de la enfermedad de Pompe / Treatment of Pompe Disease

Introducción: La enfermedad de Pompe es un trastorno de origen genético causado por la deficiencia de la enzima alfa-glucosidasa ácida, que se caracteriza por el acumulo anormal de glucógeno en los músculos y otros tejidos, generando una debilidad muscular progresiva, la cual debe ser diagnosticada y tratada de forma oportuna, ya que de esto dependerá el pronóstico, la sobrevida y la funcionalidad de los pacientes con esta condición. Contenidos: El abordaje multidisciplinario incluye tanto una adecuada valoración y soporte nutricional como el inicio del tratamiento modificador de enfermedad a través de la terapia de reemplazo enzimático, que a su vez dependerá de la forma de presentación, la variante genética, el perfil inicial del paciente, las condiciones especiales que puedan existir y las metas propias para cada paciente. Para garantizar un manejo adecuado, se deben realizar estudios de seguimiento con parámetros objetivos, evaluar posibles eventos secundarios e instaurar su manejo en caso de presentarlos. Conclusiones: El pronóstico de esta enfermedad dependerá del inicio oportuno del tratamiento, la implementación de pautas nutricionales adecuadas y el establecimiento del seguimiento de los parámetros clínicos y paraclínicos para cada uno de los pacientes.

Introduction: Pompe disease is a disorder of genetic origin caused by the deficiency of the acid alpha-glucosidase enzyme, which is characterized by the abnormal accumulation of glycogen in the muscles and other tissues, generating progressive muscle weakness, which must be diagnosed and treated in a timely manner, since the prognosis, survival, and functionality of patients with this condition will depend on this. Contents: The multidisciplinary approach includes both an adequate evaluation and nutritional support as well as the initiation of disease-modifying treatment through enzyme replacement therapy, which in turn will depend on the form of presentation, the genetic variant, the initial profile of the patient, the special conditions that may exist and the specific goals for each patient. To guarantee adequate management, follow-up studies must be carried out with objective parameters, evaluate possible secondary events and establish their management in case of presenting them. Conclusions: The prognosis of this disease will depend on the timely initiation of treatment, the implementation of adequate nutritional guidelines and the establishment of monitoring of clinical and paraclinical parameters for each of the patients.

Enfermedad de Pompe: historia, epidemiología, fisiopatología y manifestaciones clínicas / Pompe's disease: History, epidemiology, pathophysiology and clinical manifestations

Introducción: La enfermedad de Pompe o glucogenosis tipo II pertenece al grupo de las miopatías metabólicas y es producida por la deficiencia parcial o total de la enzima alfa glucosidasa ácida. La ausencia/ déficit de esta enzima genera un almacenamiento de glucógeno en el interior de los lisosomas en diversos tejidos, incluidos el músculo esquelético, el miocardio y las células del músculo liso. Se trata de una enfermedad multisistémica que puede tener un inicio temprano o tardío de los síntomas. Contenidos: En este artículo se describirán los aspectos históricos de la enfermedad, su fisiopatología y sus manifestaciones clínicas, con el énfasis puesto en su inicio temprano o tardío. Conclusiones: Es necesario reconocer la enfermedad de Pompe debido a que esta patología es susceptible de tratamiento.

Introduction: Pompe's disease or glucogenosis type II belongs to the group of metabolic myopathies and is caused by a partial or total deficiency of the acid alpha glucosidase enzyme. The lack/deficiency of this enzyme generates glycogen storage inside the lysosomes in various tissues including skeletal muscle, myocardium and smooth muscle cells. It is a multisystemic disease that can have an early onset or a late onset. Contents: In this article, the historical aspects, the pathophysiology and the clinical manifestations of the disease, will be described. Conclusions: It is necessary to recognize Pompe disease because this pathology is treatable.

Efecto de los residuos fibrosos de avena ( Avena sativa ) y caraotas ( Phaseolus vulgaris ) sobre la actividad in vitro de las disacaridasas intestinales en ratas / Effect of the Fibrous Residues of Avena (Avena sativa) and Black Beans (Phaseolus vulgaris) on the in vitro Activity of Intestinal Disacaridases in Rats

Resumen Antecedentes: las disacaridasas intestinales pueden ser inhibidas o estimuladas parcialmente en presencia de fibra. Objetivo: evaluar el efecto de los residuos fibrosos de avena (Avena sativa) y caraotas (Phaseolus vulgaris) sobre la actividad in vitro de las disacaridasas intestinales. Materiales y métodos: 15 ratas Sprague Dawley se dividieron en tres grupos: un grupo control, un grupo alimentado con harina de caraota y un grupo alimentado con harina de avena, durante 21 días. Se obtuvo un homogeneizado de la mucosa intestinal que fue utilizado para la determinación de la actividad de las disacaridasas por un método enzimático, en presencia de sustrato natural y con la adición de residuos fibrosos de harina de avena y caraotas en concentración de 2,5 % (P/V). Resultados: la mayor actividad enzimática se registró en la región intestinal media para cada enzima (p<0,05). El orden de actividad enzimática en mg glucosa/mg proteína/min fue maltasa (0,149) sacarasa (0,096) y lactasa (0,014) (p<0,05). La maltasa fue inhibida en mayor medida por el residuo de caraota; la sacarasa, por el residuo de avena; y la lactasa, por ambos. Conclusiones: la adición de fibra purificada de avena y caraota produjo una disminución significativa de la actividad in vitro de las disacaridasas intestinales, especialmente en presencia del residuo de caraota.

Abstract Background: Intestinal disaccharidases can be partially inhibited or stimulated in the presence of fiber. Objective: To evaluate the effect of fibrous residues of oats (Avena sativa) and black beans (Phaseolus vulgaris) on the "in vitro" activity of the intestinal disaccharidases. Materials and Methods: 15 Sprague Dawley rats, were divided into three groups: control, fed with bean flour, and fed with oatmeal flour for 21 days. Homogenate was obtained by scraping the mucosa. The determination of enzymatic activity of the disaccharidases was measured by the enzymatic method, in the presence of its natural substrate and with addition of the fibrous residues obtained from the oatmeal and black beans, in concentration of 2.5 % (W/V). Results: The highest enzymatic activity was recorded in the middle intestinal region for each enzyme (p <0.05). The order of enzymatic activity in mg glucose / mg protein / min was maltase (0.149) sucrase (0.096) and lactase (0.014) (p<0.05). Maltase was inhibited to a greater extent by bean residue; sucrase by oat residue and lactase by both. Conclusion: The addition of purified fiber of oats and bean produced a significant decrease in the in vitro activity of the intestinal disaccharidases, especially in the presence of the bean residue.

Consenso argentino sobre enfermedad de Pompe de inicio tardío / Argentine consensus on late-onset Pompe's disease

La enfermedad de Pompe (EP) es un desorden metabólico autosómico recesivo infrecuente, producido por la ausencia o deficiencia de la enzima lisosomal alfa-glucosidasa ácida en los tejidos de los individuos afectados. Se considera enfermedad de Pompe de inicio tardío (EPIT) en aquellos individuos de más de un año de edad al comienzo de los síntomas. El objetivo del presente consenso es el de actualizar las pautas y recomendaciones para un correcto tratamiento de los pacientes con EPIT, tomando como referencia los lineamientos del Consenso Argentino para el diagnóstico, seguimiento y tratamiento de la enfermedad de Pompe publicado en el año 2013. Se organizó un consenso que reunió profesionales con experiencia en la EP en las áreas de clínica médica, diagnóstico de laboratorio, neuropatología, neumonología, nutrición, neurología, enfermedades metabólicas, enfermedades neuromusculares y rehabilitación. Se realizó una actualización de la bibliografía sobre EPIT, con especial atención en las publicaciones relevantes de los últimos cuatro años. Los términos finales del documento fueron consensuados por todo el grupo de trabajo. Cada participante proporcionó su declaración de conflicto de intereses. El resultado es una actualización del último Consenso Argentino para la EP, con particular enfoque en su forma de comienzo tardío. Tratándose de una afección infrecuente, en la que los datos disponibles son limitados, las presentes recomendaciones deben ser consideradas como opinión de expertos.

Pompe's disease (PD) is an infrequent metabolic autosomic recessive disorder produced by the lack or deficiency of the acid alpha-glucosidase lysosomal enzyme in tissues of involved individuals. Delayed-onset PD is considered whenever symptoms onset start after one year of age. We present an update of the recommendations for the management of delayed-onset PD, taking as reference the guidelines from the Argentine Consensus for diagnosis, treatment and follow-up of PD published in 2013. The present consensus gathered several experts in PD in the areas of internal medicine, laboratory diagnosis, neuropathology, pulmonology, nutrition, neurology, metabolic and neuromuscular disorders as well as rehabilitation to perform an update of the literature of delayed-onset PD, with special attention on relevant information published within the last 4 years. The entire working group approved the final version of the consensus. Each participant provided a declaration of conflict of interest. As a result, it is an update of the previous Argentine PD Consensus with focus on the delayed-onset presentation of the disease. Being such infrequent disorder, available data were rather limited and thus, the recommendations represent expert opinions.

Antidiabetic potential of methanol extracts from leaves of Piper umbellatum L.and Persea americana Mill

Objective:To determine inhibitory activity of methanolic leaf extract of Piper umbellatum and Persea americana (P.americana) (traditionally used in Cameroon against diabetes) on α-glucosidase,β-glucosidase,maltase-gluconmylase,aldose reductase and aldehyde reductase activities,enzymes involved in starch digestion or diabetic complications.Methods:The methanol extracts from Piper umbellatum and P.americana were prepared by maceration.To assess relative efficacy of these extracts,the determination of concentrations that were needed to inhibit 50％ of enzyme activity was done,whereas,gas chromatography-mass spectrum was used to identify components from extracts that may be responsible for the activities.Resullts The tested extracts strongly inhibited α-glucosidase,maltase-glucoamylase,aldose reductase and aldehyde reductase activities with IC50 ranging from (1.07 ± 0.03) to 01.77 + 1.17) μg/mL.Among the tested extracts,P.americana was the most active against sensitive enzymes (IC50 of 1.07 ± 0.03 to 15.63 ± 1.23).But,none of the extracts showed interesting inhibitory effect against β-glucosidase as their percentage inhibitions were less than 16％.From gas chromatographymass spectrum analysis,10 and 8 compounds were identified in Piper umbellatum and P.americana extracts respectively,using NIST library 2014.Conclusions:Results of this study provide the scientific credential for a prospective usage of these plants to treat diabetes.

Antidiabetic potential of methanol extracts from leaves of Piper umbellatum L. and Persea americana Mill

Objective: To determine inhibitory activity of methanolic leaf extract of Piper umbellatum and Persea americana (P. americana) (traditionally used in Cameroon against diabetes) on α-glucosidase, β-glucosidase, maltase-glucoamylase, aldose reductase and aldehyde reductase activities, enzymes involved in starch digestion or diabetic complications. Methods: The methanol extracts from Piper umbellatum and P. americana were prepared by maceration. To assess relative efficacy of these extracts, the determination of concentrations that were needed to inhibit 50% of enzyme activity was done, whereas, gas chromatography-mass spectrum was used to identify components from extracts that may be responsible for the activities. Results: The tested extracts strongly inhibited α-glucosidase, maltase-glucoamylase, aldose reductase and aldehyde reductase activities with IC

Enfermedad de Pompe: reporte de caso / Disease Pompe: report of case

Objetivo. Se describe el caso de un paciente masculino de siete meses de edad, evaluado por cardiología a los quince días de vida por antecedente de muerte súbita cardíaca de hermana a los cuatro meses, no se sospechó nada pese a consanguinidad de padres y diagnóstico temprano del paciente de cardiomiopatía. Evoluciona con un cuadro clínico de infecciones respiratorias a repetición desde los tres meses (bronquiolitis recurrente), falla de medro y cuadro de neumonía reciente y fallece a los ocho días de la consulta con la genetista. Métodos. El abordaje inicial fue la realización de un ecocardiograma a los quince días de nacido por antecedente de muerte súbita de hermana a los cuatro meses por cardiomegalia y consanguinidad de los padres. Continúa con deterioro clínico a través de los meses por lo que se remite a genética, se toman pruebas enzimáticas en gota de sangre seca, el paciente fallece antes de recibir el diagnóstico de Enfermedad de Pompe. Resultados. Se enfocó al paciente con un posible diagnóstico de Enfermedad de Pompe solicitándose enzima lisosomal alfa-glucosidasa (GAA) en muestra de gota de sangre seca y reporte final de la secuenciación genética.

Objective. It is a case of a seven months male patient, evaluated by cardiology fifteen days after he was born secondary, to sudden cardiac death of his sister of four months, nothing suspicious despite consanguinity of parents and early diagnosis of the patient with Cardiomyopathy. Evolved with the following clinical conditions recurrent respiratory infections from three months (recurrent bronchiolitis), widespread malnutrition and recent pneumonia. Died eight days after the consultation with the geneticist. Methods. The initial approach was to perform echocardiogram at fifteen days old, because of history of the sudden death of his sister of four months, cardiomegaly and parental consanguinity. Clinical deterioration continues through months so he is referred to genetic, enzymatic tests, taken in dried blood, the patient dies before receiving the diagnosis of Pompe disease. Results. The patient was focused with a possible diagnosis ofPompe Disease so lysosomal enzyme α-glucosidase (GAA) sample was requested in dried blood and genetic sequencing final report to define diagnosis.

Inhibitory effects of an extract of fruits of Physalis peruviana on some intestinal carbohydrases / Evaluación in vitro del efecto de un extracto de frutos de Physalis peruviana sobre algunas carbohidrasas intestinales

Physalis peruviana is an Andean specie whose fruits are eaten as food and also has been reported in Colombian folk medicine for diabetes mellitus treatment. In addition, previous pharmacological studies on diabetic Wistar rats, an extract of P. peruviana fruits has been showed antidiabetic activity. In order to deepen in P. peruviana action mode as antidiabetic, in this investigation were determinate the Inhibitory Concentrations 50 (IC50) of P. peruviana fruits crude extract on alpha glucosidase from S. cerevisiae and from intestinal rat powder, on maltase and alpha amylase enzymes. The kinetic behavior of the extract on each enzyme was also investigated, and the enzyme constant (Km) and maximum rate (Vmax) were determined. Extract of fruits of P. peruviana showed different IC50 for alpha glucosidase from S. cerevisiae and intestinal rat powder, suggesting greater affinity for the enzyme of mammalian source (4114.7 and 3552.7 µg/mL, respectively). For maltase, the IC50 was close to that obtained for alpha glucosidase (4191.0 µg/mL) while for alpha amylase, the extract exhibited the highest inhibition (IC50: 619.9 g/mL). Regarding kinetic behavior, the extract showed competitive inhibition on alpha-glucosidase and maltase, and on the non-competitive type of alpha amylase. These suggest that inhibition of intestinal carbohydrases is one of the modes of action for the antidiabetic activity of fruits of P. peruviana.

Physalis peruviana es una especie andina, cuyos frutos además de ser usados como alimento, son empleados en la medicina tradicional para el tratamiento de la diabetes mellitus. Además, estudios farmacológicos previos en ratas Wistar han demostrado actividad antidiabética de extractos de frutos de P. peruviana. Con el fin de profundizar en el modo de acción de la actividad antidiabética de los frutos de P. peruviana, en la presente investigación se determinó la concentración inhibitoria 50 (CI50) del extracto crudo de frutos de P. peruviana, sobre las enzimas alfa glucosidasa obtenida de S. cerevisiae y de polvo intestinal de rata, maltasa y alfa amilasa. El comportamiento cinético del extracto sobre cada una de las enzimas también fue investigado y la constante enzimática (Km) y la velocidad máxima (Vmax) fueron determinadas. El extracto de frutos de P. peruviana, mostró diferentes valores de CI50 para alfa glucosidasa obtenida de S. cerevisiae y para la obtenida de polvo intestinal de rata, sugiriendo una mayor afinidad por la enzima de origen mamífero (4114,7 and 3552,7 µg/mL, respectivamente). Para maltasa la CI50 fue cercana a la obtenida para alfa glucosidasa (4191,0 µg/mL), mientras para alfa amilasa, el extracto presentó la mayor inhibición (CI50: 619,9 g/mL). Respecto al comportamiento cinético, el extracto mostró inhibición de tipo competitiva sobre alfa glucosidasa y maltasa y no competitiva sobre alfa amilasa. Los resultados sugieren que la inhibición de carbohidrasas intestinales es uno de los modos de acción de los frutos de P. peruviana como agente antidiabético.

Influence of starch and casein administered postruminally on small intestinal sodium-glucose cotransport activity and expression

Twenty-four Holstein steer calves (88 ± 3kg) with abomasal catheters were randomly assigned within blocks to one of four treatments. The treatments consisted of four abomasal infusions: water (control), 4 g/kg BW.d-1 of partially hydrolyzed starch (SH), 0.6 g/kg BW.d-1 of casein, and a mix of SH + casein. The small intestine was collected and five equidistan, 1m sites were identified (duodenum, jejunum 1, jejunum 2 jejunum 3 and ileum). Maltase specific activity in mucosal homogenate and brush border membrane vesicles, SGLT1 protein abundance, and sodium-dependent glucose uptake in brush border membrane vesicles did not differ between the calves receiving different abomasal infusion treatments. However, maltase specific activity in homogenates and brush border membrane vesicles increased four-fold from the duodenum to the first jejunal site before declining steadily towards the ileum (p=0.0145 p=0.0020, respectively). The SGLT1 abundance differed by intestinal sampling site (p=0.0162). These data indicated that cattle might not have the ability to alter the capacity for glucose uptake when challenged with different substrates and that the regulation of SGLT1 expression could differ between bovine and other species.

The effect of insulin on gastrointestinal growth and development in IUGR neonatal piglets / 肠外与肠内营养

0.05)。But the DNA,RNA content and lactase activities and maltase activity in the small intestine mucosa in I-fed piglets were significantly greater than those of P-fed piglets. Conclusions:These results show that insulin influences the enzymatic activity and the proliferation of intestinal epithelial cells of IUGR newborn piglets.

Glycogen Storage Disease Type II: A Case Report

Glycogen Storage Disease Type II is caused by the deficiency of acid maltase resulting in lysosomal accumulation of glycogen. There are two major clinical syndromes, a severe generalized and invariable fatal disease of infancy, and a myopathy starting in juvenile or adult life. The clinical and laboratory findings of a patient with Glycogen Storage Disease Type II are presented. The patient, a 17-year-old male, experienced slowly progressive weakness of muscle of the pelvis shoulder girdles and trunk. Muscle biopsy showed vacuolar myopathy and electromyograph showed features of myopathy with fibrillation potentials, positive sharp waves, myotonic discharges, without clinical myotonia at rest, and polyphasic potentials on volition. Clinical features, histopathologic and electrophysiologic findings of this disease and differential diagnosis were reviewed.