Mortalidad por COVID-19 en México y las enfermedades metabólicas durante el año crítico de la pandemia / COVID-19 mortality in Mexico and metabolic diseases during a critical pandemic year

Conocer la asociación específica de las enfermedades metabólicas en la mortalidad por COVID-19, ocurrida en México durante el año crítico de la pandemia de marzo 2020 a marzo 2021. Método. Se utilizó la base nacional de COVID-19 de la Dirección General de Epidemiología. Se analizaron los casos positivos que presentaron las enfermedades metabólicas: cardiovasculares, hipertensión, diabetes y obesidad. Se realizó un análisis descriptivo para conocer la distribución de los casos fallecidos y no fallecidos. Se empleó la prueba de ji cuadrada para la diferencia de las proporciones. Se utilizaron análisis de regresión logística para conocer la asociación entre las enfermedades metabólicas y la mortalidad por COVID-19 en personas positivas al virus SARS-CoV-2. Los datos fueron ajustados por edad y sexo. Resultados. Se observó la asociación de las enfermedades metabólicas en la mortalidad. La diabetes tuvo mayor porcentaje de letalidad 18,4%. Cuando se conjuntaron las enfermedades cardiovasculares y diabetes el porcentaje de letalidad subió a 31,5%; la conjunción de las enfermedades cardiovasculares, con hipertensión y diabetes fue la de mayor porcentaje de letalidad 38,7%. La obesidad fue la que tuvo menor incidencia. Conclusiones. Las enfermedades metabólicas en México son un problema de salud pública que afectó la mortalidad por covid-19. Es prioritario atender con políticas públicas preventivas y efectivas en favor de un modelo de consumo alimentario sano, acorde con las necesidades nutrimentales de la población(AU)

To know the specific association of metabolic disease on COVID-19 mortality, occurred during the critical year of the pandemic, from march 2020 to march 2021. Method: The Covid-19 national base of the General Directorate of Epidemiology was used. Positive cases of metabolic diseases were analyzed: cardiovascular disease, hypertension, diabetes and obesity. A descriptive analysis was carried out to find out the distribution of deceased and non-deceased cases. The chi-square test was used for the difference in proportions. Logistic regression analysis was used to understand the association between metabolic diseases and COVID 19 mortality in people who tested positive for the SARS-CoV-2 virus. The data were adjusted for age and gender. Results: The association of metabolic diseases on mortality was observed. Diabetes had a higher percentage of lethality 18,4%. When cardiovascular disease and diabetes were combined, the fatality rate rose to 31,5%; the combination of cardiovascular diseases, with hypertension and diabetes was the highest percentage of lethality 38,7%. Obesity had the least incidence. Conclusions: Metabolic diseases in México are a public health problem that affected COVID-19 mortality. It is a priority to deal with preventive and effective public policies in favor of a healthy food consumption model, in line with the nutritional needs of the population(AU)

Self-reported HIV/HAART-associated Lipodystrophy and Modifiable Risk Factors for Cardiovascular Disease

Abstract Background Patient self-report is the most common diagnostic tool in the literature to detect HIV/HAART-associated lipodystrophy. However, data on the association of cardiovascular risk factors with HIV/HAART-associated lipodystrophy assessed by self-report are still missing. Objectives To determine the prevalence of self-reported HIV/HAART-associated lipodystrophy and to identify independent associations between traditional modifiable cardiovascular risk factors and self-reported lipodystrophy. Methods We conducted a retrospective observational study at an outpatient infectious disease clinic in the Central-West of Brazil to identify the association between traditional modifiable cardiovascular risk factors and self-reported lipodystrophy. Sedentary lifestyle, smoking status, family history of cardiovascular disease, hypertension, diabetes, dyslipidemia, increased waist circumference and overweight were the cardiovascular risk factors assessed. Self-reported HIV/HART-associated lipodystrophy was categorized as: mild (noticeable by patients' close inspection), moderate (easily noticeable by patient and physician) or severe (readily noticeable by a casual observer). Prevalence ratio (PR) and 95% confidence interval (CI95%) were calculated. Multivariate Poisson's regression was used to analyze factors associated to HIV/HAART-associated lipodystrophy assessed by self-report considering a significance level of 5%. Results A total of 183 patients were included, with a mean age of 39.3±10.9 years. Most of the sample were male (77.6%), non-white (50.8%) and single (53.0%). The overall prevalence of HIV/HAART-associated lipodystrophy was 52.5% (95% CI 44.96 - 59.88). Severe lipodystrophy was observed in more than half patients (55.2%). No traditional modifiable cardiovascular risk factor was independently associated with lipodystrophy. Female sex (PR 1.49; 95% CI 1.15 - 1.95; p =0.003), time of HIV infection diagnosis of 1-3 years (PR 1.83; 95% CI 1.09 - 3.08; p =0.002) and a positive family history of CVD (PR 1.62; 95% CI 1.11 - 2.36; p <0.001) were independently associated with lipodystrophy. Conclusion HIV/HAART-associated lipodystrophy assessed by patient self-report was not associated with traditional modifiable cardiovascular risk factors. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Association of obesity and anovulatory infertility / Associação entre obesidade e infertilidade anovulatória

ABSTRACT Objective To verify the association of obesity and infertility related to anovulatory issues. Methods This case-control study was carried out with 52 women, aged 20 to 38 years, divided into two groups (infertile − cases − and fertile − control), seen at outpatient clinics, in the period from April to December, 2017. Results We found significant evidence that obesity negatively affects women's fertility (p=0.017). The group of infertile women was 7.5-fold more likely to be obese than fertile women. Conclusion Strategies that encourage weight control are indicated for women with chronic anovulation, due to hight metabolic activity of adipose tissue.

RESUMO Objetivo Verificar em mulheres a associação entre obesidade e infertilidade relacionada a questões anovulatórias. Métodos Estudo de caso-controle com 52 mulheres, de 20 a 38 anos, divididas em dois grupos (mulheres inférteis − casos − e férteis − controles), atendidas em ambulatórios, no período de abril a dezembro de 2017. Resultados Verificou-se evidência significativa de que a obesidade afeta negativamente na fertilidade das mulheres (p=0,017). O grupo de mulheres inférteis teve 7,5 vezes mais chances de serem obesas quando comparadas às mulheres férteis. Conclusão Estratégias que estimulem o controle do peso são indicadas para mulheres com anovulação crônica devido à elevada atividade metabólica do tecido adiposo.

Epilepsias de origen metabólico en el neonato / Epilepsias de origen metabólico en el neonato

Las enfermedades neurometabólicas que manifiestan convulsiones y epilepsia constituyen un amplio grupo de trastornos hereditarios. Se pueden presentar a cualquier edad desde el período neonatal hasta la adolescencia. Las manifestaciones epilépticas pueden ser muy variadas y, en general, se trata de epilepsias refractarias a los fármacos antiepilépticos. La fenomenología epiléptica no contribuye al diagnóstico. Se deben conocer los errores innatos del metabolismo que responden al empleo de cofactores. En descompensaciones agudas es fundamental dar soporte nutricional, hidroelectrolítico y respiratorio. Es muy posible que en pocos años se pueda conocer el perfil metabolómico de estas enfermedades y así profundizar en el diagnóstico no invasivo y ofrecer mayores posibilidades terapéuticas para la epilepsia y especialmente para la enfermedad de base. No debemos olvidar los desórdenes metabólicos transitorios y los desequilibrios hidroelectrolíticos dentro de las causas de las convulsiones, en especial en el período neonatal, que se deben identificar y tratar precozmente para evitar daños mayores.

Neurometabolic diseases that manifest seizures and epilepsy are a large group of inherited disorders. They can present at any age from the neonatal period to adolescence. The epileptic manifestations can be very varied and, in general, they are epilepsies refractory to antiepileptic drugs. Epileptic phenomenology does not contribute to the diagnosis. The inborn errors of metabolism that respond to the use of cofactors should be known. In acute decompensation, it is essential to provide nutritional, hydroelectrolytic and respiratory support. It is possible that in a few years we can detect the metabolomic profile of these diseases, thus knowing better the diagnosis non-invasively and offering greater therapeutic possibilities for their epilepsy and especially for the underlying disease. We must not forget the transitory metabolic disorders and the electrolyte imbalances within the causes of seizures, especially in the neonatal period, and must be identified and treated early to avoid major damages.

Menière's disease and disorders of the carbohydrate metabolism involving the inner ear

Introduction: Menière's disease was described in 1861, but there are still uncertainties regarding its pathophysiology and treatment. Endolymphatic hydrops is recognized as a fundamental pathological characteristic of the disease, as a result of an inadequate absorption of the endolymph. A milder type of endolymphatic hydrops results from an altered chemical composition of the endolymph, due to disorders of the carbohydrate metabolism. Objective: To describe the association of both types of hydrops in patients with Menière disease. Methods: This was a retrospective study of 98 patients with Menière's disease, 62 of whom also presented disorders of the carbohydrate metabolism, and 5 patients with delayed endolymphatic hydrops, 2 of whom also presented disorders of the carbohydrate metabolism. Results: The follow-up of these patients showed that the correction of the metabolic disorders may help in the clinical treatment of Menière's disease and of delayed endolymphatic hydrops, but this does not happen in the more severe types of the diseases. Conclusion: Patients with Menière's disease may present simultaneous disorders of the carbohydratemetabolism, affecting the inner ear. The correction of these disorders helps the clinical treatment but does not preclude the progression of the more severe cases of Menière disease (AU)

Composición corporal y gasto energético en población de niños y adolescentes con mielomeningocele / Body composition and energy expenditure in a population of children and adolescents with myelomeningocele

Introducción: El mielomeningocele es un defecto congénito con cierre incompleto del tubo neural. Presenta alteraciones en la composición corporal y alta prevalencia de obesidad. Es difícil detectar el indicador más apropiado para diagnóstico nutricional por impresición de las medidas antropométricas. Objetivo: Describir en una población de pacientes con mielomeningocele seguidos en el "Hospital Garrahan", la composición corporal, gasto energético en reposo y trastornos metabólicos, comparando los pacientes con mielomeningocele obesos con una población control con obesidad multifactorial. Población y Métodos: Se realizó antropometría, impedanciometría, pliegues cutáneos, perímetro braquial, calorimetría indirecta y determinaciones bioquímicas a todos los pacientes con mielomeningocele entre junio/2013-abril/2014, previa firma del Consentimiento Informado. Resultados: Se evaluaron 131 pacientes de 0,718,6 años, clasificados según Score-Z de Índice de Masa Corporal en 15% bajo peso, 42% normopeso, 12% sobrepeso y 31% obesidad. Se encontró alta correlación (r²0,74) entre %masa grasa por impedanciometría vs calculado con pliegues cutaneos. Los pacientes con % masa grasa elevada vs %masa grasa normal tuvieron mayor score-Z de Indice de Masa Corporal (1,07 vs -0,27 p0,0001) aunque ambos valores se encontraban dentro de parámetros normales. Hubo menor gasto energético en reposo en los pacientes con mielomeningocele obesos comparado con el esperado y con obesos multifactoriales. Conclusiones: Se encontró alto porcentaje de sobrepeso/obesidad en la población con mielomeningocele. Los pliegues cutáneos serían más apropiados para detectar obesidad. Los pacientes con mielomeningocele obesos presentaron gasto energetico en reposo menor al esperado y a los controles. La indicación de energía debe ser personalizada.

Introduction. Myelomeningocele is a congenital defect that occurs when the neural tube fails to close completely. It causes body composition alterations and a high prevalence of obesity. It is difficult to detect the most adequate indicator for a nutritional diagnosis due to the impossibility of recording accurate anthropometric measurements. Objective. To describe body composition, resting energy expenditure and metabolic disorders in a population of patients with myelomeningocele managed at "Hospital Garrahan" by comparing obese patients with myelomeningocele and a control population with multifactorial obesity. Population and methods. An anthropometry, an impedance analysis, skinfold equations, arm circumference equations, indirect calorimetry, and biochemical determinations were done to all patients with myelomeningocele between June 2013 and April 2014, once the informed consent had been signed. Results. 131 patients aged 0.7-18.6 years were assessed; they were classified according to their body mass index Z-score into low weight (15%), normal weight (42%), overweight (12%), and obese (31%). A high correlation (r: 20.74) was observed between the fat mass % measured by impedance analysis versus that estimated using skinfolds. Patients with a high fat mass % had a higher body mass index Z-score than those with a normal fat mass % (1.07 versus -0.27, p: 0.0001) although both values were within normal parameters. A lower resting energy expenditure was observed among obese patients with myelomeningocele than predicted and in comparison with multifactorial obese controls. Conclusions. A high percentage of overweight/obesity was found in the population with myelomeningocele. Skinfold equations would be more adequate to detect obesity. Obese patients with myelomeningocele had a lower resting energy expenditure than predicted and in comparison with controls. Energy indication should be customized.

Estudio venezolano de salud cardio-metabólica (EVESCAM): resultados generales presentados en el XVII congreso venezolano de medicina interna 2017 / Venezuelan study of cardio-metabolic health (EVESCAM): General results presented at the XVII Congress Venezuelan Internal medicine 2017

Ningún estudio ha evaluado la prevalencia nacional de factores de riesgo cardiometabólico en Venezuela. Objetivo: El EVESCAM (Estudio Venezolano de Salud Cardio-Metabólica) fue diseñado para evaluar la prevalencia de los factores de riesgo cardiometabólico en sujetos con ≥ 20 años de las 8 regiones del país. Métodos: Estudio transversal, fueron reclutados un total de 4,454 participantes entre julio de 2014 y febrero de 2017, usando un muestreo multi-etápico estratificado por conglomerados. Fueron evaluados 3,445 (tasa de respuesta 77,3%), con una pérdida de datos de sólo 0,7%, para una muestra final de 3,420 participantes. Los datos fueron recolectados en los hogares y en centros de campo de la comunidad por personal entrenado. Luego de firmar el consentimiento informado, se aplicaron cuestionarios (clínicos, demográficos, actividad física, nutricionales y psicológicos), medidas antropométricas (peso, altura y circunferencia abdominal), grasa corporal por bioimpedancia, fuerza de aprehensión de la mano, presión arterial, electrocardiograma y mediciones bioquímicas (Prueba de tolerancia a la glucosa oral y perfil lipídico(AU)

Complicaciones metabólicas de la cirugía bariátrica / Metabolic complications of bariatric surgery

Se utiliza la base de datos Pub Med, Cochraine, Scopus y Google Escolar para realizar una revisión sistemática del estado del arte de las complicaciones metabólicas derivadas de la cirugía bariátrica. Se realiza una reflexión de la necesidad de evaluar de forma adecuada la preoperación y cumplir con las indicaciones precisas. Debe tenerse en cuanta que se producirán cambios fisiológicos que, si bien intervendrán de manera positiva en la mayor parte de los pacientes, les producirá trastornos en el metabolismo que deben de ser tenidos en cuenta para su prevención y predicción. Se exponen los principios quirúrgicos, objetivos y clasificaciones de este tipo de cirugía. Se exponen las complicaciones con énfasis en los aspectos metabólicos y las contraindicaciones de este tipo de intervención. Se concluye que la cirugía bariátrica es un procedimiento adecuado para el tratamiento de la obesidad y control de algunos aspectos metabólicos, pero es capaz de originar nuevos aspectos, que, de no tenerse en cuenta, podrían hacer fracasar sus resultados(AU)

The databases PubMed, Cochrane, Scopus and Google School were used to perform a systematic review of the state of the art about the metabolic complications resulting from bariatric surgery, reflecting on the need for an adequate preoperative evaluation and compliance with accurate indications taking into account that physiological changes will occur, and that, although they will have a positive impact on most patients, this will produce metabolic disorders that must be taken into account for prevention and prediction. An outlined is presented of the surgical principles, objectives and classifications for this type of surgery. The complications are exposed, with emphasis on the metabolic aspects and contraindications of this type of intervention. The bariatric surgery has been concluded to be a suitable procedure for the treatment of obesity and control of some metabolic aspects, but it is capable of producing other new aspects that, if not taken into account, could lead to the failure of its results(AU)

Metabolic investigation in patients with nephrolithiasis / Investigação metabólica em pacientes com nefrolitíase

ABSTRACT: Objective: To evaluate the prevalence of metabolic disorders associated with nephrolithiasis in a female population. Methods: A retrospective study on 1,737 patients with evidence of recent formation of renal stones, being 54% females. The laboratory investigation consisted of at least two samples of blood and 24-hour urine to assess calcium, uric acid, citrate and creatinine levels, qualitative cystinuria, urinary pH following fasting and 12-hour water restriction, urine culture, serum creatinine and parathyroid hormone. Results: The most frequent alterations were hypercalciuria (40.9%), urinary tract infection (23.2%), hypocitraturia (22.4%), low urinary volume (20.5%) and hyperuricosuria (16%). Conclusion: The most frequent metabolic alterations in females were hypocitraturia, urinary tract infection, low urinary volume and hyperuricosuria.

RESUMO Objetivo: Avaliar a prevalência dos distúrbios metabólicos associados à nefrolitíase em uma população feminina. Métodos: Foi realizado um estudo retrospectivo em 1.737 pacientes com evidência de formação recente de cálculos renais, sendo 54% do sexo feminino. A avaliação laboratorial constou de duas ou mais amostras de sangue e urina de 24 horas com dosagens de cálcio, ácido úrico, citrato e creatinina cistinúria qualitativa, pH urinário em jejum e restrição hídrica de 12 horas, urocultura, creatinina e paratormônio séricos. Resultados: As alterações mais encontradas foram hipercalciúria (40,9%), infecção do trato urinário (23,2%), hipocitratúria (22,4%), baixo volume urinário (20,5%) e hiperuricosúria (16%). Conclusão: As alterações metabólicas mais frequentes na população feminina foram hipocitratúria, infecção do trato urinário, baixo volume urinário e hiperuricosúria.

Antropometria e fatores de risco cardiometabólico agrupados em jovens: revisão sistemática / Anthropometry and clustered cardiometabolic risk factors in young people: a systematic review

RESUMO Objetivo: Revisar sistematicamente a literatura sobre a habilidade de indicadores antropométricos para predizer fatores de risco cardiometabólico (FRC) agrupados em crianças e adolescentes. Fonte de dados: Foram analisados estudos publicados de 1º de junho de 2011 até 31 de maio de 2016 nas bases PubMed, SciELO e LILACS. A pesquisa baseou-se em palavras-chave derivadas dos termos "indicadores antropométricos" AND "fatores de risco cardiometabólico". Foram incluídos estudos observacionais sobre a habilidade de indicadores antropométricos como preditores de FRC agrupados em crianças e adolescentes, nos idiomas português, inglês e espanhol. Não foram incluídos estudos com grupo específico de pacientes com obesidade ou outras doenças. Síntese dos dados: Dos 2.755 registros encontrados, 31 estudos foram selecionados para revisão sistemática. Vinte e oito estudos analisaram a habilidade do índice de massa corporal (IMC) como preditor de FRC agrupados. Dos 25 estudos transversais, apenas em 3 não foi observada associação entre indicadores antropométricos e FRC agrupados. Os resultados dos seis estudos que compararam a habilidade de diferentes medidas antropométricas como preditoras de FRC agrupados foram divergentes, não sendo possível definir um único indicador como melhor preditor de FRC agrupados. Apenas seis estudos eram de coorte, e os achados sugeriram que mudanças na adiposidade na infância predizem alterações nos FRC agrupados na adolescência. Conclusões: O IMC, o perímetro da cintura e a relação cintura-estatura foram preditores de FRC agrupados na infância e na adolescência e apresentaram habilidade similar para predizer esses desfechos. Esses achados sugerem que indicadores antropométricos podem representar uma interessante ferramenta para triagem epidemiológica de FRC agrupados em idades precoces.

ABSTRACT Objective: To conduct a systematic review of the literature on the ability of anthropometric indicators to predict clustered cardiometabolic risk factors (CMRF) in children and adolescents. Data source: Studies published from June 1st, 2011 to May 31st, 2016 in the PubMed, SciELO and LILACS databases were analyzed. The research was based on keywords derived from the terms "anthropometric indicators" AND "cardiometabolic risk factors". Observational studies on the ability of anthropometric indicators as predictors of clustered CMRF in children and adolescents in Portuguese, English and Spanish languages were included. Studies with a specific group of obese patients or with other diseases were not included. Data synthesis: Of the 2,755 articles retrieved, 31 were selected for systematic review. Twenty-eight studies analyzed body mass index (BMI) as a predictor of clustered CMRF. Only 3 of the 25 cross-sectional studies found no association between anthropometric indicators and clustered CMRF. The results of six studies that compared the predictive ability of different anthropometric measures for clustered CMRF were divergent, and it was not possible to define a single indicator as the best predictor of clustered CMRF. Only six articles were cohort studies, and the findings suggested that changes in adiposity during childhood predict alterations in the clustered CMRF in adolescence. Conclusions: BMI, waist circumference and waist-to-height ratio were predictors of clustered CMRF in childhood and adolescence and exhibited a similar predictive ability for these outcomes. These findings suggest anthropometric indicators as an interesting screening tool of clustered CMRF at early ages.

Características polisomnográficas nocturnas y otras variables relacionadas, en pacientes adultos mayores / Nocturnal polysomnbnographic characteristics and other related variables in elderly patients

Se cree que los ancianos necesitan dormir menos. Sin embargo, no es la necesidad de sueño sino la capacidad de dormir lo que disminuye con la edad, en paralelo a la mayor prevalencia de enfermedades cardiovasculares o metabólicas, o de depresión. Poco se ha descripto sobre los hallazgos polisomnográficos de esta población. En el presente estudio analizamos los hallazgos polisomnográficos en pacientes mayores de 65 años. Se realizó un estudio descriptivo a partir del análisis de una base de datos de 551 pacientes mayores de 65 años evaluados entre junio de 2013 y diciembre de 2014. Todos los sujetos se realizaron una polisomnografía (PSG) nocturna de 6 horas de duración. Las variables analizadas fueron: latencia de sueño (LS), eficacia de sueño (ES), latencia de fase REM (Lat R), % de R, índice de apneas hipopneas (IHA) y movimientos periódicos de piernas durante el sueño (PLMS). Se dividió la población en 3 grupos: G1: de 65 a 70 años; G2: 71 a 75; G3: mayor de 75 años. Se analizaron los datos de la serie general y las diferencias intergrupos. El IHA se incrementó con la edad y resultó más severo en los pacientes mayores de 75 años en relación con el grupo de menor edad. El incremento del IAH no se asoció a un incremento del índice de masa corporal ni a mayor somnolencia diurna. (AU)

It is believed that the elderly need less sleep. However, it is not the need for sleep but the ability to sleep that decreases with age, in parallel to the increasing prevalence of cardiovascular or metabolic disease, or depression. Little has been described about the polysomnographic findings of this population, hypothesizing that there are several alterations that prematurely corrected could improve the quality of life as the years go by. We analyzed the polysomnographic findings in patients over 65 years of age. A descriptive study was carried out based on the analyses of a database of 551 patients over 65 years of age evaluated between June 2013 to December 2014. All subjects underwent nocturnal PSG of 6 hours duration. The polysomnographic variables analyzed were: sleep latency (LS), sleep efficiency (ES), latency R phase (Lat R), % R, Apneas Hypoapneas Index (AHI) and Periodic Limb Movements of Sleep (PLMS). The population was divided into 3 groups: G1: from 65 to 70 years G2: 71 to 75, G3 greater than 75. AHI increased with age, being more severe in patients over 75 years of age in relation to the younger age group. The increase in AHI was not associated with an increase in Body Mass Index (BMI) or greater daytime sleepiness. (AU)

Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review / Associação entre padrão alimentar e risco cardiometabólico em crianças e adolescentes: uma revisão sistemática

Abstract Objective: To evaluate the association between dietary patterns and cardiometabolic risk factors in children and adolescents. Data source: This article followed the recommendations of PRISMA, which aims to guide review publications in the health area. The article search strategy included searches in the electronic databases MEDLINE via PubMed, Scopus, and LILACS. There was no date limitation for publications. The descriptors were used in English according to MeSH and in Portuguese according to DeCS. Only articles on dietary patterns extracted by the a posteriori methodology were included. The question to be answered was: how much can an "unhealthy" dietary pattern influence biochemical and inflammatory markers in this population? Data synthesis: The studies showed an association between dietary patterns and cardiometabolic alterations. The patterns were characterized as unhealthy when associated to the consumption of ultraprocessed products, poor in fiber and rich in sodium, fat, and refined carbohydrates. Despite the associations, in several studies, the strength of this association for some risk markers was reduced or lost after adjusting for confounding variables. Conclusion: There was a positive association between "unhealthy" dietary patterns and cardiometabolic alterations in children and adolescents. Some unconfirmed associations may be related to the difficulty of assessing food consumption. Nevertheless, studies involving dietary patterns and their association with risk factors should be performed in children and adolescents, aiming at interventions and early changes in dietary habits considered to be inadequate.

Resumo Objetivo: Avaliar a associação encontrada nos estudos entre padrão alimentar e fatores de risco cardiometabólicos em crianças e adolescentes. Fonte dos dados: Este artigo seguiu as recomendações do Prisma, que objetiva orientar as publicações de revisão na área da saúde. A estratégia de busca dos artigos incluiu pesquisas nas bases eletrônicas Medline via PubMed, Scopus e Lilacs. Não houve data limite de publicação. Os descritores foram usados em inglês de acordo com MeSH e em português segundo os DeCS. Apenas artigos de padrão alimentar extraídos pela metodologia a posteriori foram incluídos. A pergunta a ser respondida foi: quanto um padrão alimentar "não saudável" pode influenciar nos marcadores bioquímicos e inflamatórios dessa população? Síntese dos dados: Os estudos demonstraram haver associação entre os padrões alimentares e alterações cardiometabólicas. Os padrões eram caracterizados como não saudáveis marcados pelo consumo de produtos ultraprocessados, pobres em fibras e ricos em sódio, gordura e carboidratos refinados. Apesar das associações, em vários estudos, a força dessa associação para alguns marcadores de risco era reduzida ou perdida após os ajustes para as variáveis de confusão. Conclusão: Houve associação positiva entre os padrões alimentares "não saudáveis" e as alterações cardiometabólicas em crianças e adolescentes. Algumas associações não confirmadas podem estar relacionadas à própria dificuldade de avaliar o consumo alimentar. Apesar disso, estudos que envolvem padrões alimentares e sua associação com fatores de risco devem ser feitos em crianças e adolescentes com objetivo de intervenções e modificações precoces nos hábitos alimentares tidos como não adequados.

Rabdomiólise como manifestação de uma doença metabólica: relato de caso / Rhabdomyolysis as a manifestation of a metabolic disease: a case report

RESUMO A rabdomiólise é um processo de destruição muscular com manifestações clínicas variáveis. Em pacientes pediátricos, tem como principal etiologia as doenças infecciosas. Apresentamos o caso de uma adolescente previamente saudável, que foi admitida ao nosso pronto-socorro com histórico de 4 dias com mialgia, fraqueza muscular e urina escura. Na avaliação inicial, apresentava-se desidratada. Os exames de sangue revelaram insuficiência renal aguda e aumento de enzimas musculares. A paciente foi transferida para nossa unidade de terapia intensiva pediátrica. Foi realizado tratamento clínico para correção da desidratação e das consequências iônicas e metabólicas da insuficiência renal. Em razão da oligúria, deu-se início à terapia de substituição renal. A investigação etiológica revelou um defeito da betaoxidação. Sabe-se que doenças metabólicas podem provocar rabdomiólise. A destruição muscular deve ser identificada precocemente, para evitar suas potenciais consequências. Em geral, o tratamento da rabdomiólise é conservador, embora em algumas situações seja necessária uma abordagem mais invasiva.

ABSTRACT Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed. Due to oliguria, renal replacement therapy was initiated. An etiological investigation revealed a beta-oxidation defect. Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction should be diagnosed early in order to avoid its potential consequences. Generally, the treatment of rhabdomyolysis is conservative, although in some situations, a more invasive approach is needed.

Forming a stone in pelviureteric junction obstruction: cause or effect?

ABSTRACT Objectives To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. Materials and Methods A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. Results Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. Conclusions Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.

Influence of metabolic risk on adaptation of mean arterial pressure with endurance training and detraining: study of males with mild hypertension

Background: According to uncommon adaptations in blood pressure observed in response to exercise, the standardized exercise prescriptions need to be reconsidered. Therefore, prediction of blood pressure adaptations in response to exercise and detraining is needed

Methods: In this study, 70 sedentary pre-hypertensive men randomized into experimental and control groups. Experimental subjects participated in aerobic training [24 sessions [3/wk] with 60 to 70% of MHR, 40 min/session] which followed by two weeks of detraining. The data were analyzed using Pearson correlation, Kappa test, ANOVA and stepwise regression

Results: After 8 weeks of training and following to detraining some of experimental subjects experienced decline in Mean Atrial Pressure [MAP], some had no changes and some had even experienced its increasing condition [P<0.05]. All metabolic risk factors had significant changes after training and also detrainng, however; Zmets had significant changes just in those subjects with MAP decrease [P<0.05]

The metabolic risk count and also Zmets were higher in both GR [x[2]=52.73, P=0.001] and BR subjects [x[2]=80.1, P=0.001] at baseline. MAP, age, BMI and also plasma HDL and LDL values at baseline were recognized as the significant predictors of Observed changes in MAP after training [R[2]=0.76, P<0.05]

Conclusions: All the Metabolic risk factors are important in predicting the direction of MAP response to training, however; participation in aerobic exercise would not possibly lead to bad responding in those with high metabolic risk factors. However, more research remains to be done because of the lack of similar evidence in this area

Kidney stones: composition, frequency and relation to metabolic diagnosis

Nephrolithiasis is one of the most frequent urologic diseases. The aim of this paper is to study the composition and frequency of 8854 patient kidney stones and in a subset of them their metabolic risk factors to be related to their type of calculi. Physicochemical and crystallographic methods were used to assess kidney stone composition. In a subset of 715 patients, we performed an ambulatory metabolic protocol with diagnostic purposes. From the total sample 79% of stones were made of calcium salts (oxalate and phosphate), followed by uric acid stones in 16.5%, calcium salts and uric acid in 2%, other salts in 1.9% and cystine in 0.6%. Male to female ratio was almost three times higher in calcium salts and other types of stones, reaching a marked male predominance in uric acid stones, M/F 18.8 /1.0. The major risk factors for calcium stones are idiopathic hypercalciuria, followed by unduly acidic urine pH and hyperuricosuria. In uric acid stones unduly acidic urine pH and less commonly hyperuricosuria are the most frequent biochemical diagnosis. Our results show that analysis of kidney stones composition and the corresponding metabolic diagnosis may provide a scientific basis for the best management and prevention of kidney stone formation, as well as it may help us to study the mechanisms of urine stone formation.

La litiasis renal es una de las enfermedades urológicas más frecuentes. El objetivo de este trabajo fue estudiar la composición y frecuencia de 8854 cálculos renales y evaluar en un subgrupo de ellos la relación de los factores de riesgo metabólicos con el tipo de cálculo hallado. Se utilizaron métodos fisicoquímicos y cristalográficos para evaluar la composición de los cálculos renales. En un subgrupo de 715 pacientes, se pudo realizar un protocolo metabólico ambulatorio con fines diagnóstico. De la muestra total, 79.0% de los cálculos fueron de sales de calcio (oxalato y fosfato), seguido por cálculos de ácido úrico en 16.5%, sales de calcio y ácido úrico en 2.0%, otras sales en 1.9% y cistina en 0.6%. La relación hombre/mujer fue casi tres veces mayor en las sales de calcio y otros tipos de cálculos, alcanzando un marcado predominio en varones con cálculos de ácido úrico, M/F 18.8/1.0. Los principales factores de riesgo para los cálculos de calcio fueron la hipercalciuria idiopática, seguida del pH urinario excesivamente ácido y la hiperuricosuria. En los cálculos de ácido úrico el pH urinario excesivamente ácido y con menor frecuencia la hiperuricosuria fueron los diagnósticos más frecuentes. Nuestros resultados muestran que el análisis de la composición de los cálculos renales y el correspondiente diagnóstico metabólico pueden proporcionar una base científica para el mejor manejo y prevención en la formación de cálculos renales, así como que nos puede ayudar a estudiar los mecanismos de formación de los mismos.

Terapêutica hipolipemiante na hipercolesterolemia familiar / Lipid-lowering therapy in familial hypercholesterolemia

A hipercolesterolemia familiar (HF) é doença metabólica muito comum, mas não reconhecida e tratada adequadamente. Sua forma homozigótica, mais rara, leva a aumentos muito importantes do LDL-colesterol e à evolução dramática da aterosclerose e suas complicações em fases muito precoces da vida. Na sua forma mais branda, muito mais comum, a heterozigótica, o aparecimento de manifestações ateroscleróticas costuma ser mais tardio, dependendo da intensidade das alterações do perfil lipídico e dos outros fatores de risco eventualmente presentes. Os recursos terapêuticos para controle da HF vão desde as mudanças do estilo de vida até os medicamentos de uso comum como estatinas potentes em altas doses, na maioria das vezes combinadas à ezetimiba e/ou resina, niacina e fibratos. Novos produtos foram aprovados para uso em outros países, como a lomitapida e o mipomersen, mas apenas para a HF na forma homozigótica. Os inibidores da PCSK9 são importante esperança no controle desses pacientes. As pesquisas com os inibidores da CETP têm sido marcadas por decepções, mas um estudo clínico envolvendo um deles ainda está em andamento. Nosso país não dispõe da LDL-aférese, recurso que se tem mostrado fundamental para a melhora do prognóstico dos portadores das formas graves da HF

Familial hypercholesterolemia (FH) is a common metabolic disease, although not adequately recognized and treated. Its rarer, homozygous form leads to a significant increase in LDL-cholesterol and marked development of atherosclerosis and its complications in very early phases of life. In its milder, much more common, heterozygous form, the appearance of clinical manifestations usually occurs later, depending on the intensity of the changes in lipid profile and the presence of other risk factors. Therapeutic resources for FH control range from changes in lifestyle to medications commonly used as high potency statins in high dosages, in most cases combined with ezetimibe and/or resins, niacin and fibrates. New products have recently been approved for use in other countries such as lomitapide and mipomersen, but only for homozygous FH. PCSK9 inhibitors are an important hope for the control of these patients.Research with CETP inhibitors has failed to demonstrate clinical benefits to date, but a clinical study evaluating one of them is still ongoing. Our country does not have availability of LDL-apheresis, a resource that has proven fundamental for improving the prognosis of patients with more severe forms of FH

Impacto de la profilaxis secundaria en el manejo de pacientes con urolitiasis de alto riesgo de recidiva / Impact of secondary prophylaxis in the management of patients with high recurrence risk of urolithiasis

In a previous study, we showed our experience in a group of 54 patients with a high risk of urolithiasis recurrence, who were subjected to a complete metabolic evaluation. Aim: To report the evolution of these patients after 5 years of follow-up. Patients and Methods: All patients underwent a general management of urolithiasis plus specific treatments for underlying metabolic disorders. Each patient had an annual medical assessment including a clinical examination, urinalysis and imaging studies (non-enhanced computed tomography scan, ultrasonography and plain abdominal Rx rays). In every case, the underlying metabolic disorder, treatment adherence, stones on imaging studies and symptomatology were evaluated. Adherence of general and specific measures were evaluated subjectively. Failure of secondary prevention was defined as the recurrence of clinical or imaging urolithiasis (increase of the number of lithiasis) despite a correct treatment of the metabolic disorders. Results: Twenty nine patients completed the follow-up. Mean age was 45 years old. Nineteen patients (65%) had only one metabolic disorder, three patients (10%) two disorders, one patient (3%) four disorders, and six patients (21%) a normal metabolic study. The median of follow-up was 54 months (45-60). During that period, twenty-three patients (79%) kept the treatment as it was indicated. In this subgroup, 21 had no clinical or imaging recurrence of urolithiasis during follow-up (91%). Total adherence to treatment and follow-up was 42% (23/54) of the initial group of patients. Conclusions: A complete metabolic study allows to identify patients with a high risk of urolithiasis recurrence, enabling a specific treatment of the metabolic disorder. Our experience shows that 75% (21/29) of patients remain free of recurrence at five years of follow-up.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis

ABSTRACT Purpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.