Tendencia del programa de intervención en DemoMinga, como estrategia para mejorar las dislipidemias y glucemia en la población Norma Luisa, Minga Guazú / Trend of the DemoMinga intervention program as a strategy to improve dyslipidemia and glycemia in the Norma Luisa population, Minga Guazú

Antecedentes: Las enfermedades no transmisibles siguen siendo un problema creciente en el mundo, sobre todo en los países de mediano y bajo ingresos. Los programas de intervención comunitaria se enfocan en su disminución mediante cambios en estilos de vida más saludables. Objetivos: Analizar la tendencia del programa de intervención en actividad física y nutrición, como estrategia para mejorar las dislipidemias y glucemia en los participantes del proyecto DemoMinga. Materiales y métodos: Estudio con enfoque cuantitativo. Diseño de investigación acción participativa, de carácter longitudinal, prospectivo. La población estuvo constituida por los participantes del Proyecto DemoMinga. Se determinó en cada participante: colesterol total, triglicéridos y glucemia en ayunas. Las muestras fueron procesadas en el Centro de Investigaciones Médicas de la FACISA-UNE. Se determinaron indicadores de tendencia central (mediana) de cada una de las variables. Resultados: Hubo mayor participación del sexo femenino, con predominio de personas con menos de 45 años. Las mediciones químicas arrojaron una tendencia de disminución a partir del quinto año de intervención, con talleres de cocina saludable incluyendo uso de aceite alto oleico, y actividad física. Sin embargo, la prueba no arrojó diferencias significativas de las mediciones entre la línea de base y el corte a los 6 años. Conclusión: El estudio resalta la importancia de los programas de intervención mediante terapias integrales para la promoción y prevención de las enfermedades cardiometabólicas a largo plazo.

Background: Non-communicable diseases remain a growing problem worldwide, especially in middle and low-income countries. Community intervention programs are focused on reducing their prevalence through promoting healthier lifestyle changes. Objectives: To analyze the trend of the physical activity and nutrition intervention program as a strategy to improve dyslipidemia and glycemia among participants of the DemoMinga project. Materials and methods: This study employed a quantitative approach with a participatory action research design, characterized as longitudinal and prospective. The population consisted of participants from the DemoMinga Project. For each participant, total cholesterol, triglycerides, and fasting glycemia were measured. Samples were processed at the Medical Research Center of FACISA-UNE. Indicators of central tendency (median) were determined for each of the variables. Results: There was a higher participation of females, with a predominance of individuals under the age of 45. Chemical measurements showed a decreasing trend starting from the fifth year of intervention, involving healthy cooking workshops that included the use of high oleic oil and physical activity. However, the test did not yield significant differences in measurements between the baseline and the 6-year cutoff. Conclusion: The study highlights the significance of intervention programs using comprehensive therapies for the long-term promotion and prevention of cardiometabolic diseases.

Tendencia del programa de intervención en DemoMinga, como estrategia para mejorar las dislipidemias y glucemia en la población Norma Luisa, Minga Guazú

Antecedentes: Las enfermedades no transmisibles siguen siendo un problema creciente en el mundo, sobre todo en los países de mediano y bajo ingresos. Los programas de intervención comunitaria se enfocan en su disminución mediante cambios en estilos de vida más saludables. Objetivos: Analizar la tendencia del programa de intervención en actividad física y nutrición, como estrategia para mejorar las dislipidemias y glucemia en los participantes del proyecto DemoMinga. Materiales y métodos: Estudio con enfoque cuantitativo. Diseño de investigación acción participativa, de carácter longitudinal, prospectivo. La población estuvo constituida por los participantes del Proyecto DemoMinga. Se determinó en cada participante: colesterol total, triglicéridos y glucemia en ayunas. Las muestras fueron procesadas en el Centro de Investigaciones Médicas de la FACISA-UNE. Se determinaron indicadores de tendencia central (mediana) de cada una de las variables. Resultados: Hubo mayor participación del sexo femenino, con predominio de personas con menos de 45 años. Las mediciones químicas arrojaron una tendencia de disminución a partir del quinto año de intervención, con talleres de cocina saludable incluyendo uso de aceite alto oleico, y actividad física. Sin embargo, la prueba no arrojó diferencias significativas de las mediciones entre la línea de base y el corte a los 6 años. Conclusión: El estudio resalta la importancia de los programas de intervención mediante terapias integrales para la promoción y prevención de las enfermedades cardiometabólicas a largo plazo.

Background: Non-communicable diseases remain a growing problem worldwide, especially in middle and low-income countries. Community intervention programs are focused on reducing their prevalence through promoting healthier lifestyle changes. Objectives: To analyze the trend of the physical activity and nutrition intervention program as a strategy to improve dyslipidemia and glycemia among participants of the DemoMinga project. Materials and methods: This study employed a quantitative approach with a participatory action research design, characterized as longitudinal and prospective. The population consisted of participants from the DemoMinga Project. For each participant, total cholesterol, triglycerides, and fasting glycemia were measured. Samples were processed at the Medical Research Center of FACISA-UNE. Indicators of central tendency (median) were determined for each of the variables. Results: There was a higher participation of females, with a predominance of individuals under the age of 45. Chemical measurements showed a decreasing trend starting from the fifth year of intervention, involving healthy cooking workshops that included the use of high oleic oil and physical activity. However, the test did not yield significant differences in measurements between the baseline and the 6-year cutoff. Conclusion: The study highlights the significance of intervention programs using comprehensive therapies for the long-term promotion and prevention of cardiometabolic diseases.

Screening program for familial hyperchylomicronemia syndrome detection: Experience of a university health system

ABSTRACT Objective: Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive metabolic disorder caused by mutations related to chylomicron metabolism. The objective of this study is to show the development and results of a screening program for FCS in Argentina. Materials and methods: A cross-sectional study was performed. All patients > 18 years with a triglyceride level ≥ 1,000 mg/dL in the period from January 1, 2017 to December 31, 2021 were included. The program was developed in three stages: (1) Review of electronic records and identification of suspected laboratory cases (triglyceride level ≥ 1,000 mg/dL); (2) Identification of suspected clinical cases (all suspected laboratory cases that had no relevant secondary factors) and application of the FCS score to define probable cases (score ≥ 10); (3) Perform genetic tests in probable cases. Results: Globally, 348 suspected laboratory cases (mean age of 49.9 years, 77.3% men) were included. The median triglycerides level was 1,309 mg/dL (interquartile range 1,175-1,607 mg/dL). In total, 231 patients were categorized as suspected clinical cases. After applying the FCS score, 3% of them were classified as "very likely FCS" (probable cases). Four variants of uncertain significance have been identified. No previously reported pathogenic variants were detected. Conclusion: This study shows a screening program for the detection of FCS. Although no patient was diagnosed with FCS, we believe that more programs of these characteristics should be developed in our region, given the importance of early detection of this metabolic disorder.

Hipertrigliceridemia grave en Argentina: prevalencia y características clínicas / Severe Hypertriglyceridemia in Argentina: Prevalence and Clinical Characteristics

RESUMEN Introducción : La hipertrigliceridemia grave (HTGG) es un desorden metabólico con múltiples causas e implicancias tera péuticas. Se desconocen hasta la fecha las características clínicas, la prevalencia y sus posibles causas en nuestra población. Objetivo : estimar la prevalencia, describir las características clínicas y causas subyacentes de la HTGG en un hospital de tercer nivel del municipio de General Pueyrredón. Materia y métodos : Estudio descriptivo y observacional realizado con pacientes ambulatorios e internados de un hospital provincial. Se incluyeron pacientes adultos con triglicéridos (TG) mayores que 885 mg/dL (10 mmol/L) evaluados desde enero de 2018 a diciembre de 2021. Se extrajeron sus historias clínicas y, luego, se los contactó para obtener medidas antro pométricas, variables sociodemográficas, antecedentes personales y familiares, causas secundarias de hipertrigliceridemia y el tratamiento recibido. Resultados : Se analizaron 16 029 muestras; 46 presentaron HTGG, lo que representa una prevalencia total del 0,28% (IC 95% 0,20-0,40%) (IC 95% 0,20-0,40%); se incluyeron 19 participantes en el análisis. La edad media fue de 48,47 años (DE ±16); el 84,2% de ellos eran hombres. La mediana de triglicéridos fue 1821 mg/dL (rango intercuartílico 917-7000 mg/dL); 17 participantes (84,97%) presentaban hipercolesterolemia (colesterol total mayor que 200 mg/dL). Casi el 50% refirió consumo de alcohol, el 55% presentaba obesidad y el 68% diabetes tipo II. Solo 9 participantes se encontraban en tratamiento, 4 con fibratos y 5 con estatinas. Conclusión : se encontró una prevalencia del 0,28%, más alta que la esperada y reportada en series previas. Por otro lado, se destaca la subutilización de medicación para el tratamiento de esta dislipidemia grave.

ABSTRACT Background : Severe hypertriglyceridemia (SHTG) is a metabolic disorder with multiple origins and management implications. Prevalence, clinical characteristics, and its possible causes are unknown in Argentina. Objective : The aim of this study was to estimate the prevalence and describe the clinical characteristics and underlying SHTG causes in a third level hospital in the municipality of General Pueyrredón. Methods : An observational, descriptive study was performed using an electronic database from a provincial Hospital. It included adult patients with triglyceride (TG) levels above 885 mg/dL (10 mmol/L) evaluated from January 2018 to December 2021. Medical records were collected, and patients were then contacted to obtain anthropometric measurements, sociodemographic variables, personal and family history, secondary causes of hypertriglyceridemia, and treatment received. Results : Among 16 029 patients analyzed, 46 presented SHTG, representing a total prevalence of 0.28% (95% CI 0.20-0.40%). Finally, 19 participants with mean age 48.47±16 years and 84.2% men were included in the analysis. Median TG level was 1821 mg/dL (interquartile range 917-7000 mg/dL), and 17 participants (84.97%) had hypercholesterolemia (total cholesterol >200 mg/dL). Almost 50% reported alcohol consumption, 55% were obese and 68% had type II diabetes. Nine participants were under pharmacological treatment, 4 with fibrates and 5 with statins. Conclusion : A prevalence of 0.28% SHTG was found, higher than that reported in other series. Another finding was the underuse of medication for this severe dyslipidemia.

POSTPRANDIAL HYPERTRIGLYCERIDEMIA AS A RISK FACTOR FOR MACROVASCULAR COMPLICATIONS IN TYPE 2 DIABETES MELLITUS

Diabetes mellitus is a common endocrine disorder characterized by chronic hyperglycemia, and disturbances of carbohydrate, fat and protein metabolism. The prevalence of diabetes has been increasing widely in India and worldwide. Diabetes is a cause of significant mortality and morbidity due to macro and micro vascular complications. Dyslipidemia accompanying type 2 Diabetes plays an important role in pathogenesis of atherosclerotic vascular disease. Post prandial hypertriglyceridemia, irrespective of fasting triglyceride levels, has emerged as a significant risk factor for symptomatic and asymptomatic macro vascular disease It is a case control study, conducted for a period of 1 year from November 2020 to October 2021, on patients visiting the Out-patient department of NRI institute of Medical Sciences, Sangivalasa, Visakhapatnam. The cases and controls were subjected to clinical and biochemical evaluation to detect presence of macro vascular complications. The cases were subjected to a high fat meal, and plasma triglycerides were measured two and four hours after a fat challenge. It was observed that post prandial hypertriglyceridemia correlated better than fasting triglycerides in patients with macro vascular complications. Persistent and significant post prandial hypertriglyceridemia was observed in diabetic patients with macro vascular complications; and can be used as a marker for predicting vascular complications in type 2 Diabetes mellitus.

Hyperlipidemia in patients with chronic kidney disease on hemodialysis/conservative management

Background: The prevalence of chronic renal failure has increased, as has the need for renal replacement therapy, as both diabetes and hypertension have become more prevalent. Patients’ mortality rates from cardiac causes have increased despite effective monitoring and care. Dyslipidemia significantly contributes to the risk of arteriosclerotic cardiovascular disease, the main cause of death in people with chronic kidney disease (CKD). Aims and Objectives: The objectives of this study were to measurement of hyperlipidemia in patients with CKD on hemodialysis/conservative management. Materials and Methods: The investigation was conducted on 250 patients with CKD at all stages who were receiving hemodialysis and conservative of both sexes aged 20 years or more and sex-matched healthy control subjects. Lipid profiles of each subject were measured in specimens. Results: In our study, dyslipidemia was identified as having high levels of total cholesterol, triglycerides, and low-density lipoprotein and low levels of high-density lipoprotein. Conclusion: The significance of dyslipidemia as a standalone risk factor for coronary artery disease (CAD) in CKD patients was examined in this study. Hence, based on the evidence presented above, we conclude that close monitoring of the ideal cholesterol levels in CKD patients is necessary to reduce the risk of CAD-related death. In CKD patients, monitoring and treating dyslipidemia can reduce mortality.

Triglyceride-controlling during acute phase of hypertriglyceridemia induced pancreatitis / 中华消化外科杂志

Triglyceride-controlling is an important treatment for hypertriglyceridemia induced pancreatitis in acute phase. At present, there is no unified recommendation of acute pan-creatitis guidelines for triglyceride-controlling at home and abroad, leading to confusion in clinical treatment. Combined with the relevant literatures and current researches, the authors summarize the principles, commonly used methods, status quo, and our recommendations for triglyceride-controlling of acute hypertriglyceridemia induced pancreatitis, aiming to provide theoretical guidance for the standardized treatment of hypertriglyceridemia induced pancreatitis in the acute phase.

Risk factors of new-onset hypertriglyceridemia in kidney transplant recipients: a single-center analysis / 器官移植

Objective To identify the risk factors of new-onset hypertriglyceridemia (HTG) in kidney transplant recipients. Methods Clinical data of 149 kidney transplant recipients were retrospectively analyzed. According to serum triglyceride (TG) level after operation, they were divided into the non-HTG group (TG≤1.7 mmol/L, n=60) and new-onset HTG group (TG>1.7 mmol/L, n=89). Baseline data of all recipients were compared between two groups. The risk factors of HTG in kidney transplant recipients were analyzed by generalized estimating equation (GEE), and validated by multiple regression equations. Results No significant differences were observed in baseline data between two groups (all P>0.05). Multivariate analysis showed that the incidence of HTG in the middle and high tacrolimus (Tac) concentration groups was higher than that in the low Tac concentration group [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.22-7.93, P=0.018 in the middle Tac concentration group; OR 5.11, 95%CI 1.31-19.98, P=0.019 in the high Tac concentration group]. Compared with type-A blood recipients, the risk of new-onset HTG was significantly increased in type-O blood counterparts (OR 2.77, 95%CI 1.14-6.71, P=0.024). The risk of new-onset HTG was decreased along with the increase of preoperative globulin level (OR 0.93, 95%CI 0.87-0.99, P=0.043). At postoperative 3 months, Tac blood concentration in the new-onset HTG group was significantly higher compared with that in the non-HTG group, and significant difference was observed (P<0.05). Multiple regression equations confirmed that the risk of new-onset HTG in type-O blood kidney transplant recipients was higher than that in type-A blood counterparts, and the risk of new-onset HTG in the middle and high Tac concentration groups was higher than that in the low Tac concentration group (all P<0.05). Conclusions Type-O blood kidney transplant recipients are more prone to HTG. It is necessary to strengthen postoperative monitoring and control of blood lipids. The blood concentration of Tac probably affects the new-onset HTG in kidney transplant recipients. Maintaining an appropriate blood concentration of Tac may be beneficial to lowering the risk of HTG.

Pancreatitis aguda por hipertrigliceridemia severa, caracterización en un hospital terciario / Acute pancreatitis due to severe hypertriglyceridemia, characterization in a tertiary hospital

La hipertrigliceridemia severa es una de las principales causas etiológicas de la pancreatitis aguda, donde la literatura internacional la posiciona como la tercera causa. Sus causas gatillantes, comorbilidades, severidad y evolución son importantes de conocer para evitar futuros episodios. En Chile, a nuestro entender, no tenemos literatura sobre esta asociación, por lo que presentamos datos de un hospital terciario, destacando 15 casos de pancreatitis aguda en 5 años de estudio, casi la mitad de ellos con antecedentes previos de hipertrigliceridemia, un porcentaje importante de los casos con cuadros graves y con complicaciones intrahospitalarias y que la diabetes mellitus tipo 2 fue la principal condición asociada a la hipertrigliceridemia severa.

Severe hypertriglyceridaemia is one of the main aetiological causes of acute pancreatitis, with international literature ranking it as the third leading cause. Its triggering causes, comorbidities, severity and evolution are important to know in order to avoid future episodes. In Chile, to our knowledge, we have no literature on this association, so we present data from a tertiary hospital, highlighting 15 cases of acute pancreatitis in 5 years of study, almost half of them with a previous history of hypertriglyceridaemia, a significant percentage of cases with severe symptoms and in-hospital complications, and that type 2 diabetes mellitus was the main condition associated with severe hypertriglyceridaemia.

Familial chylomicronemia syndrome: A comprehensive clinical and genetic approach

Abstract The familial chylomicronemia syndrome (FCS) is characterized by very high levels of circulating triglycerides. FCS is caused by lipoprotein lipase (LPL) deficiency resulting from homozygous or biallelic loss-of-function variants in the LPL or other related genes. Here, we report a case of severe hypertriglyceridemia refractory to conventional therapy in a male patient diagnosed at 33 years of age. LPL activity was below 20%. During the clinical course, the patient developed severe acute pancreatitis in addition to other complications. Two heterozygous variants (c.984G>A and c.1139+6T>C) which had not been previously reported in the major databases were identified in the LPL gene. Treatment with volanesorsen was proposed based on its approved indication as an adjunct to diet in adult patients with confirmed FCS and at high risk for pancreatitis. Volanesorsen was effective and well-tolerated, and the patient did not experience abdominal pain or any other manifestations. The assessment of genetic characterization is essential to guide treatment decisions during follow-up, in addition to the patient's history, their comorbidities and clinical stigmas.

Value of atherogenic index of plasma combined with Bedside Index for Severity in Acute Pancreatitis in the early prediction of severe hypertriglyceridemic acute pancreatitis / 临床肝胆病杂志

Objective To investigate the correlation between atherogenic index of plasma (AIP) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP) and the value of AIP combined with Bedside Index for Severity in Acute Pancreatitis (BISAP) score in the early prediction of severe HTG-AP (sHTG-AP). Methods A retrospective analysis was performed for the clinical data of 170 patients with HTG-AP who were hospitalized in The General Hospital of Central Theater Command from January 2017 to December 2021, and according to related guidelines, they were divided into the sHTG-AP group with 28 patients and non-sHTG-AP group with 142 patients. Peripheral blood samples were collected from all patients within 24 hours after admission, and the two groups were compared in terms of sex, age, laboratory test results, AIP, BISAP score, and modified CT severity index (MCTSI) score. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of continuous data between groups. The Spearman rank correlation test was used to investigate the correlation between each factor and the severity of HTG-AP, and the binary logistic regression analysis were used to investigate the independent risk factors for sHTG-AP. The receiver operating characteristic (ROC) curve was plotted to assess the predictive efficacy of each indicator. Results There were significant differences between the two groups in the medical history of diabetes, lymphocyte count, albumin, Ca 2+ , triglyceride, high-density lipoprotein cholesterol, AIP, BISAP score, MCTSI score, length of hospital stay, and hospital costs (all P < 0.05). The sHTG-AP group had a longer length of hospital stay, higher hospital costs, and a higher AIP value. AIP (odds ratio [ OR ]=1.244, 95% confidence interval [ CI ]: 1.062-1.458, P =0.007), BISAP score ( OR =5.525, 95% CI : 1.646-18.543, P =0.006), and MCTSI score ( OR =2.029, 95% CI : 1.245-3.305, P =0.004) were risk factors for sHTG-AP. AIP, BISAP score, and MCTSI score were positively correlated with the severity of HTG-AP ( r =0.291, 0.631, and 0.649, all P < 0.001), and AIP was positively correlated with BISAP score and MCTSI score ( r =0.190 and 0.215, both P < 0.05). AIP had an optimal cut-off value of 1.095 in predicting sHTG-AP, and AIP, BISAP score, and AIP combined with BISAP score had an area under the ROC curve of 0.759, 0.887, 0.925, respectively, a sensitivity of 0.821, 0.857, and 0.786, respectively, and a specificity of 0.627, 0.817, and 0.937, respectively (all P < 0.001). Conclusion AIP is a risk factor for sHTG-AP and is correlated with disease severity, and AIP combined with BISAP score has a relatively high value in the early prediction of sHTG-AP.

Value of five scoring systems in predicting the severity of hyperlipidemic acute pancreatitis: A comparative analysis / 临床肝胆病杂志

Objective To investigate the value of pancreatitis activity scoring system (PASS) score, Bedside Index for Severity in Acute Pancreatitis (BISAP) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score, harmless acute pancreatitis score (HAPS), and Ranson score in evaluating the severity and prognosis of hypertriglyceridemia acute pancreatitis (HTGAP). Methods A retrospective analysis was performed for the clinical data of 300 patients with HTGAP who were admitted to General Hospital of Ningxia Medical University from January 2016 to January 2022, and according to the disease severity, these patients were divided into mild acute pancreatitis (MAP) group, moderate-severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group. Clinical data and the above scores were compared between the three groups. The chi-square test was used for comparison of categorical data between groups; an analysis of variance was used for continuous data with homogeneity of variance, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups. The receiver operating characteristic (ROC) curve was plotted according to disease severity, and related indicators were compared in terms of the area under the ROC curve (AUC). Results There were significant differences between the three groups in PASS score ( F =219.351, P < 0.01), Ranson score ( χ 2 =83.084, P < 0.01), APACHE-Ⅱ score ( χ 2 =43.388, P < 0.01), and BISAP score ( χ 2 = 50.785, P < 0.01). Compared with the other four scoring systems in evaluating and predicting disease severity, PASS score had the highest sensitivity of 0.945 and the largest AUC of 0.963, followed by Ranson score with a sensitivity of 0.655 and an AUC of 0.819. Conclusion For patients with HTGAP, PASS score can more accurately assess the severity and prognosis of HTGAP patients and thus holds promise for clinical application.

Study on the correlation between triglyceride glucose index and severe hypertriglyceridemic pancreatitis / 中华消化杂志

Objective:To investigate the correlation between triglyceride glucose (TyG) index and severe hypertriglyceridemic pancreatitis (HTGP), and to provide assistance for early evaluation and clinical decision-making of HTGP.Methods:From January 2016 to December 2021, the clinical data of 770 patients diagnosed with HTGP at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively collected. According to severity of pancreatitis, the patients were divided into mild acute pancreatitis (MAP), moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) groups, and the differences in TyG index among the 3 groups was compared. According to the quartile range of the TyG index, the patients were divided into TyG Q1, Q2, Q3 and Q4 groups, and the distribution of severity of pancreatitis in each TyG index quartile group was calculated. Kruskal-Wallis H test was used for statistical analysis. Spearman correlation analysis was used to analyze the correlation between TyG index quartile range and the severity of pancreatitis. Linear trend chi-square test was used to analyze the trend of SAP incidence among groups. Binary logistic regression was used to analyze the relationship between TyG index quartile range and the risk of SAP, and the trend test was also conducted. Results:A total of 770 patients with HTGP were included, among them 330 (42.9%), 268 (34.8%) and 172 (22.3%) were MAP, MSAP and SAP, respectively. The TyG indices of MAP, MSAP and SAP group were 11.8(11.3, 12.4), 12.5(11.9, 13.2) and 12.7(12.1, 13.4), respectively, and the differences among the 3 groups were statistically significant ( H=121.77, P<0.001). The TyG index was 12.21 (11.57, 12.94) in the 770 patients. There were 192, 193, 193 and 192 patients enrolled in TyG Q1(TyG index <11.57)、 Q2(TyG index ranged from 11.57 to <12.21)、 Q3(TyG index ranged from 12.21 to <12.94) and Q4(TyG index≥12.94) group, respectively.The correlation test showed that the difference between TyG quartile range and the severity of pancreatitis was statistically significant ( ρ=0.372, P<0.001). The incidence of SAP in TyG Q1, Q2, Q3 and Q4 group was 10.9%(21/192), 14.5%(28/193), 27.5%(53/193) and 36.5%(70/192), respectively. The trend test of SAP incidence among the TyG gruops was statistically significant ( χ2 =44.33, P<0.001). After adjusting for confounding factors, taking the TyG Q1 group as a reference, the OR values of SAP risk (95% confidence interval) of the TyG Q2, Q3 and Q4 groups were 1.250 (0.619 to 2.524), 2.882 (1.506 to 5.514) and 6.660 (3.456 to 12.836), respectively, and the trend test of SAP risk showed a significant difference ( OR=2.508, 95%confidence interval 1.883 to 3.341, P<0.001). Conclusions:There is a correlation between TyG index and severity of pancreatitis in patients with HTGP. As the TyG index increases, the risk of SAP increases in HTGP patients. TyG index may be an early predictor of severe HTGP.

Lipid metabolism in late pregnancy and its correlation with adverse perinatal outcome among Tibetan pregnant women in high altitudes / 中华围产医学杂志

Objective:To analyze the lipid levels, adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods:Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology, Chaya People's Hospital, Changdu City. The subjects were divided into three groups according to the altitude of their long-term residence, including altitude<3 500 m (Group A, n=161), altitude ≥3 500 m and <4 000 m (Group B, n=203) and altitude≥4 000 m (Group C, n=159). In addition, the subjects were also grouped into high TG group (TG≥3.23 mmol/L, n=80) and control group (TG<3.23 mmol/L, n=443). The baseline information, levels of lipid and perinatal outcome were compared among Group A,B and C, and also between the high TG and control group, respectively, using Mann-whitney U test, Kruskal-Wallis H test, LSD- t, Chi-square test, or Fisher exact test. Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome. Results:The maternal age, gravidity and parity, body mess index, blood pressure on admission and total cholesterol (TC), TG, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A, B and C (all P>0.05). However, the hemoglobin (Hb) level increased with the elevation of altitude as expected, and that in Group C was higher than that in Group A and B [121.0 g/L (108.0-132.0 g/L) vs 115.0 g/L (103.5-128.0 g/L) and 117.0 g/L (101.0-127.0 g/L), H=2.37 and 1.97, both P<0.05]. The proportion of women with hypertriglyceridemia, the high TG group, in late pregnancy was 15.3% (80/523), and no significant difference was found in HDL-C or Hb levels between the high TG and control group [1.7 mmol/L (1.5-2.0 mmol/L) vs 1.8 mmol/L (1.5-2.1 mmol/L), Z=－1.51;123.5 g/L (110.0-131.8 g/L) vs 117.0 g/L (104.0-128.0 g/L), Z=1.69; both P>0.05]. Higher rates of cesarean section [13.8% (11/80) vs 6.6% (29/443), χ2＝4.98], hypertensive disorders of pregnancy (HDP) [16.3% (13/80) vs 7.5% (33/443), χ2＝6.54], preeclampsia (PE) [8.8% (7/80) vs 1.6% (7/443), χ2＝13.37], hyperglycemia during pregnancy [11.3%( 9/80) vs 3.6% (16/443), χ2＝8.69], preterm birth (PB) [7.5% (6/80) vs 2.0% (9/443), χ2＝7.27], microsomia [5.0% (4/80) vs 0.9% (4/443), Fisher exact test] and neonatal asphyxia [8.8%(7/80) vs 2.5% (11/443), χ2＝8.01] were observed in the high TG group than in the control group (all P<0.05). Regarding the pregnant women at different altitude, TG was negatively correlated with Hb ( r=－0.17, P=0.037) only in Group C .Multivariate logistic regression analysis revealed higher risk of HDP ( OR=2.42,95% CI:1.17-5.00), PE ( OR=5.25, 95% CI:1.73-16.00), hyperglycemia during pregnancy ( OR=3.77, 95% CI:1.56-9.09), PB ( OR=4.33, 95% CI:1.42-13.22), microsomia ( OR=4.33, 95% CI:1.42-13.22), neonatal asphyxia ( OR=3.45, 95% CI:1.27-9.35) and fetal demise ( OR=4.94, 95% CI:1.01-24.21) in women with high TG level in late pregnancy (all P<0.05). Conclusions:There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes. However, hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP, PE, hyperglycemia during pregnancy, PB, microsomia, neonatal asphyxia and fetal demise in this group of women.

The clinical characteristics of hypertriglyceridemic pancreatitis and the correlation between triglyceride levels and the severity of severe acute pancreatitis / 中国医师杂志

Objective:To explore the clinical characteristics of hypertriglyceridemic pancreatitis and the correlation between triglyceride (TG) levels and the severity of severe acute pancreatitis (SAP).Methods:A retrospective analysis was conducted on the clinical data of 132 SAP patients admitted to Beijing Friendship Hospital of Capital Medical University from January 2020 to December 2021. They were divided into biliary acute pancreatitis (BAP) group, hypertriglyceridemic pancreatitis (HTGP) group, and alcohol-induced acute pancreatitis (AAP) group based on their etiology. The clinical data and laboratory test results of each group were compared, and the correlation between TG levels and the severity of SAP disease was analyzed.Results:The proportion of male patients, body mass index, length of hospital stay, ICU occupancy rate, C-reactive protein (CRP), TG, and total cholesterol (TC) levels in the HTGP group were significantly higher than those in the BAP and AAP groups. The age of onset, serum calcium (Ca), oxygenation index (PaO 2/FiO 2, P/F), and prothrombin time activity (PTA) in the HTGP group were significantly lower than those in the BAP and AAP groups, and the differences were statistically significant (all P<0.05). There was a negative correlation between TG levels and Ca, P/F, PTA in SAP patients ( r=-0.410, -0.341, -0.365, all P<0.01). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of TG for early prediction of multiple organ dysfunction in SAP patients was 0.868, with a sensitivity of 87% and a specificity of 78%. Conclusions:Patients in the HTGP group have a lower onset age, with more males, obese patients, and critically ill patients. Laboratory indicators such as CRP, TG, and TC levels are higher, while levels of Ca, P/F, and PTA are lower; The serum TG level is correlated with the severity of SAP disease and can be used as one of the early indicators for predicting multiple organ dysfunction in SAP.

Prevalencia de síndrome metabólico en adolescentes escolarizados del Departamento Central en el año 2021

Introducción : El Síndrome Metabólico (SM) es una entidad clínica que se manifiesta por obesidad central, dislipidemia, hiperglicemia y/o hipertensión arterial y se relaciona con el desarrollo de Diabetes Mellitus tipo 2 y enfermedades cardiovasculares. Objetivo : Determinar la prevalencia del SM en adolescentes escolarizados del Departamento Central en el 2021 y evaluar los factores de riesgo relacionados. Materiales y Métodos: Estudio descriptivo con componente analítico. Ingresaron 279 adolescentes de 10 a 16 años de 6 escuelas elegidas aleatoriamente. Se realizó una encuesta sobre estilos de vida, prácticas alimentarias, antecedentes familiares y perinatales. Se realizó medición de peso, talla, circunferencia de cintura (CC), glicemia, perfil lipídico y presión arterial. Para el diagnóstico de SM se utilizó los criterios de Cook. Aprobado por el Comité de Ética del IICS y del Hospital de Clínicas. Para el análisis se utilizaron tablas de frecuencias, mediana y Prueba del Chi cuadrado para razón de prevalencias (RP) con nivel de significancia p p90 36%. La prevalencia de SM fue del 10,7 %. La CC >p90 con RP de 31,4 (7,6-128), y la hipertrigliceridemia con RP de 46,8(14,8-147,7), fueron los componentes preponderantes de SM. El peso elevado al nacer y no realizar actividad física, fueron identificados como factores de riesgo significativo. Conclusiones: La prevalencia de SM fue 10,7%, se relacionó con mayor peso al nacimiento, obesidad y sedentarismo.

Introduction: Metabolic Syndrome (MS) is a clinical entity that is manifested by central obesity, dyslipidemia, hyperglycemia and/or arterial hypertension and is related to the development of Type 2 Diabetes Mellitus and cardiovascular diseases. Objective: To determine the prevalence of MS in adolescents enrolled in school in the Central Department in 2021 and to evaluate their related risk factors. Materials and Methods: This was a descriptive study with an analytical component. 279 adolescents aged 10 to 16 years old from 6 randomly chosen schools were included. A survey on lifestyles, eating practices, family and perinatal history was performed. Weight, height, waist circumference (WC), glycemia, lipid profile, and blood pressure were measured. Cook's criteria were used for the diagnosis of MS. The study was approved by the Ethics Committee of the IICS and the University Hospital. For data analysis, tables of frequencies, median and Chi-square test were used for the prevalence ratio (PR) with a significance level of p p90 in 36%. The prevalence of MS was 10.7%. WC >p90 with a PR of 31.4 (7.6-128), and hypertriglyceridemia with a PR of 46.8 (14.8-147.7), were the predominant components of MS. High birth weight and physical inactivity were identified as significant risk factors. Conclusions: The prevalence of MS was 10.7%, it was related to higher birth weight, obesity and sedentary lifestyle.

An interesting case of hypertriglyceridemia (HTG) induced pancreatitis

Hypertriglyceridemia induced pancreatitis is the third most common cause of acute pancreatitis after gall stones and alcohol. Most of the patients with Hypertriglyceridemia (HTG) has primary or genetic defect in lipoprotein metabolism. Groove pancreatitis is a rare form of Pancreatitis with most patients being male and history of alcohol consumption. Here we report a case of 33 year old female who is a known diabetic, presented with diabetic ketoacidosis. Her serum lipase was 3133 U/l (<40U/l). Here we report a case of familial dyslipidemia with severe hypertriglyceridemia causing pancreatitis involving the Groove presenting with Diabetic Ketoacidosis.

PREGNANCY WITH PINK BLOOD: A CASE REPORT

A 24 year old female P1L1 presented to our hospital on first post operative day of emergency caesarean delivery with complaint of fever with chills and rigors. The per-operative notes showed the presence of thick pinkish maternal blood when compared to cord blood, which turned opaque white while sampling. On examination she had pallor and raised blood pressure. Her lipid levels were very high and ultrasound showed bilateral mild pleural effusion with minimal ascites with increase echogenicity of peripancreatic fat. She was started on injectable antibiotics following which she improved in symptoms. She was also started on fenofibrate and orlistat following which her lipid profile improved and the blood stopped turning opaque white and she was then discharged against medical advice due to financial constraints

Síndrome de quilomicronemia familiar: experiencia pediátrica en Argentina / Familial chylomicronemia syndrome: pediatric experience in Argentina

El síndrome de quilomicronemia familiar (SQF) es unaenfermedad autosómica recesiva rara, con una prevalencia1:200 000 - 1:1 000 000, y se caracteriza por quilomicronemiaen ayunas y niveles muy elevados de triglicéridos (> 880 mg/dl). LPL es el gen más frecuentemente afectado, luego APOC2,GPIHBP1, APOA5 y LMF1; todos ellos comprometen la función de la lipoproteinlipasa endotelial. El SQF suele presentarseen la infancia con dolor abdominal recurrente, xantomaseruptivos, retraso del crecimiento, pancreatitis y, en ocasiones,asintomático. El tratamiento convencional es la restriccióndietética de grasas. Se muestra el resultado clínico de 20 pacientes pediátricoscon SQF reclutados de 4 hospitales en Argentina.

Familial chylomicronemia syndrome (FCS) is a rare autosomalrecessive disease, prevalence 1:200,000 - 1:1,000,000, andis characterized by fasting chylomicrons and very hightriglycerides > 880 mg/dl. LPL is the most frequentlyaffected gene, then APOC2, GPIHBP1, APOA5, LMF1, all ofthem compromising the function of lipoproteinlipase. FCScommonly presents in childhood with recurrent abdominalpain, eruptive xanthomas, failure to thrive, pancreatitis, andsometimes asymptomatic. The conventional treatment isdietetic fat restriction. The clinical outcome of 20 pediatric patients with FCS recruited from 4 hospitals in Argentina is reported.

ERICA: cardiovascular risks associated with oral contraceptive use among Brazilian adolescents

Abstract Objective: To investigate the association between oral contraceptive use and cardiovascular risks, including metabolic syndrome and their components in Brazilian adolescents. Method: This study used data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study with individuals aged 12-17 years. Sociodemographic variables and OC use were assessed by a self-administered questionnaire. International Diabetes Federation criteria were used to define metabolic syndrome. Descriptive statistics were reported as prevalence and their respective confidence interval of 95% of oral contraceptives according to variables. Logistic regression was performed. Crude and adjusted odds ratios were calculated. Results: This subsample was composed of 22,682 female adolescents, of which 12.65% reported using oral contraceptives and their use was associated with hypertension and hypertriglyceridemia. These associations remained statistically significant after adjusting for age, school region, race, and tobacco use with an increase of 2.68 (1.66 - 4.32) and 3.45 (2.56 - 4.65) times, respectively. Conclusion: The present study was the first to examine the association between the use of oral contraceptives and cardiovascular risk factors among the largest number of female Brazilian adolescents. This method was significantly associated with hypertension, hypertriglyceridemia. Teenagers using oral contraceptives should be monitored for side effects, including blood pressure measurements and advised to avoid smoking.