Efficacy of olmesartan amlodipine in Colombian hypertensive patients (soat study).

BACKGROUND: Emerging evidence has shown a significant deficit in the control of hypertension (blood pressure <140/90 mmHg) among Hispanics or Latinos in about 65%. This study aims to determine the efficacy of the combination in fixed doses of olmesartan and amlodipine (20/5, 40/5, and 40/10 mg) in hypertensive patients treated in daily clinical practice by Colombian doctors. METHODS: This was an observational, retrospective, open-label, multi-center, non-comparative study. The primary outcome was a change in systolic and diastolic blood pressure from the baseline to week 12; the secondary outcome was the proportion of patients achieving a target blood pressure of <140/90 mmHg. Safety and tolerability were also evaluated. For analysis, a student t test was used for paired data, McNemar test, and ANCOVA. RESULTS: A total of 428 patients were enrolled from 16 centers in Colombia. At 12 weeks, patients' systolic blood pressure decreased in response to all three doses: by 27.75 ± 20.73 mmHg in 20/5 mg, 31.13 ± 22.23 mmHg in 40/5 mg, and 46.96 ± 20.15 mmHg in 40/10 mg (all p < 0.001). Furthermore, the diastolic blood pressure decreased by 14.19 ± 12.89 mmHg in 20/5 mg, 16.25 ± 10.87 mmHg in 40/5 mg, and 24.83 ± 10.41 mmHg in 40/10 mg (all p < 0.001). The percentage of patients achieving target blood pressure was 71.31% in 20/5 mg, 70.16% in 40/5 mg, and 63.33% in 40/10 mg. CONCLUSIONS: This study demonstrates the efficacy of the combination in fixed doses of olmesartan and amlodipine in the treatment of Colombian hypertensive patients.

Efectividad del Bypass Gástrico sobre Factores De Riesgo Cardiovascular y Obesidad, experiencia Grupo Colombiano de Obesidad / Effectiveness of Gastric Bypass on Cardiovascular Risk Factors and Obesity, experience Colombian Group of Obesity

Objetivo: Determinar los efectos del bypass gástrico sobre factores de riesgo cardiovascular (hipertensión, dislipidemia, diabetes) en pacientes sometidos a cirugía bariátrica en Colsubsidio IPS, Bogotá, Colombia, y la proporción de pacientes con éxito posterior al procedimiento, definida como una pérdida del 50% del exceso de peso corporal al año. Métodos: Estudio de corte transversal. El tamaño de muestra se calculó con un nivel de significación de 5%, potencia del 80%, asumiendo una proporción de pacientes con comorbilidades del 40% y una proporción esperada al cabo de un año posterior a la cirugía bariátrica del 10%, obteniendo como mínimo 70 pacientes. Se incluyeron 127 pacientes, 106 (83,46%) mujeres; se les realizó bypass gástrico a 114 pacientes (89,76%). Resultados: Se encontró reducción significativa de comorbilidades al cabo de 1 año con el Bypass gástrico, tanto en la proporción de pacientes dislipidémicos, diabéticos e hipertensos, con reducciones del 60,25% (p<0,001), 80,65% (p<0,001) y 78,05% (p=0,01) respectivamente. Se obtuvo pérdida del exceso de peso del 75,77% (p<0,001) y reducción significativa de los niveles de hemoglobina glicosilada de 2,8% (p =0,0016). Conclusión: La cirugía bariátrica representa una estrategia segura para el manejo de la diabetes mellitus en obesos mórbidos con mejoría importante de los factores de riesgo cardiovascular.

Objective: to determine the effects of gastric bypass on cardiovascular risk factors such as hypertension, dyslipidemia and diabetes in patients undergoing bariatric surgery in Colsubsidio Health Care Service Provider, Bogotá, Colombia, and the proportion of patients with post-procedure success, defined as a 50% of excess weight loss in 1 year. Methods: Cross-sectional study. The sample size was calculated with a significance level of 5%, 80% power, assuming a proportion of patients with comorbidities of 40% and an expected rate after 1 year bariatric surgery of 10%, obtaining as at least 70 patients. There were 127 patients enrolled, among them, 106 (83,46%) were women; 114 patients (89,76%) underwent gastric bypass. Results: A significant reduction of comorbidities was found 1 year after gastric bypass in the proportion of patients with dyslipidemia, diabetes and hypertension, with a reducction of 60,25% (p<0, 001), 80,65% (p<0,001) and 78,05% (p=0, 01) respectively. Besides, an excess weight loss of 75,77% (p<0, 001) was founded, as well as a significant reduction of 2,8% (p =0,0016) in glycosylated hemoglobin levels. Conclusions: Bariatric surgery is a safe strategy for the management of diabetes mellitus in morbid obese patients with significant improvement in cardiovascular risk factors.

Puntos de corte de perímetro de cintura para el diagnóstico de obesidad abdominal en población colombiana usando bioimpedanciometría como estándar de referencia / Waist circumference cut-off points for the diagnosis of abdominal obesity in Colombian population by means of bioimpedance as a reference standard

Estudio de correlación de pruebas diagnósticas y determinación de puntos de corte de perímetro de cintura para definir obesidad abdominal en población colombiana, en el que se utilizó como estándar de referencia la bioimpedanciometría, como método de medición de grasa visceral. Se calculó un tamaño mínimo de muestra de 366 pacientes. Al estudio ingresaron en total 501 pacientes. Se definió como grasa visceral aumentada por bioimpedanciometría un porcentaje mayor al 9%; a partir de este dato se determinaron los puntos de corte del perímetro de cintura para hombres y mujeres mediante la construcción de una curva ROC. Se determinó un punto de corte de 89 cm para mujeres, con sensibilidad del 82,35%, especificidad del 78,77% y área bajo la curva 0,89 (IC95% 0,85-0,92). Para los hombres se encontró un punto de corte para perímetro de cintura de 91 cm, con sensibilidad del 82,03%, especificidad del 94,83% y área bajo la curva 0,9586 (IC 95% 0,93-0,98). A partir de este estudio se propone como definición de obesidad abdominal, el punto de corte de perímetro de cintura para hombres y mujeres, mayor o igual a 91 cm y mayor o igual a 89 cm, respectivamente. Esta medida conveniente, le permite al médico clasificar de forma adecuada a los pacientes con obesidad abdominal y síndrome metabólico.

Correlation study between diagnostic tests and cut-off points of waist circumference to define abdominal obesity in Colombian population where the reference standard was bioimpedance as a method of estimating visceral fat. Minimum sample size was calculated at 366 patients. A total of 501 patients were admitted in the study. Visceral fat measurement using bioimpedance was defined as high over the 9% mark; from there the cut-off points of the waist circumference for men and women were estimated with a ROC curve. A cut-off point of 89 cm was estimated for women, with a sensitivity of 82.35% and specificity of 78.77% and area under the curve 0.89 (CI: 95%, 0.85-0.92). For men, the cut-off point for waist circumference was estimated in 91 cm, with a sensitivity of 82.03% and specificity of 94.83% and area under the curve of 0.9586 (CI: 95%, 0.93-0.98). As a result of this study, the definition of abdominal obesity is proposed as the cut-off point of the waist circumference greater than or equal to 91 cm for men and greater than or equal to 89 cm for women. This useful measure allows the physician to conveniently classify patients with abdominal obesity and metabolic syndrome.

Continuous Glucose Monitoring Versus Capillary Point-of-Care Testing for Inpatient Glycemic Control in Type 2 Diabetes Patients Hospitalized in the General Ward and Treated With a Basal Bolus Insulin Regimen.

BACKGROUND: Continuous glucose monitoring (CGM) may improve the management of patients with type 2 diabetes hospitalized in the general ward by facilitating the detection of hyper- and hypoglycemic episodes. However, the lack of data on the accuracy and safety of CGM have limited its application. METHODS: A prospective pilot study was conducted including 38 patients hospitalized in the general ward with a known diagnosis of type 2 diabetes mellitus (DM) and hyperglycemic individuals without a history of DM with a blood sugar of 140-400 mg on admission treated with a basal bolus insulin regimen. Inpatient glycemic control and the incidence of hypoglycemic episodes were compared between detection by CGM of interstitial fluid for up to 6 days and point-of-care (POC) capillary blood glucose monitoring performed pre- and postprandially, before bedtime and at 3 am. RESULTS: No differences in average daily glucose levels were observed between CGM and POC (176.2 ± 33.9 vs 176.6 ± 33.7 mg/dl, P = .828). However, CGM detected a higher number of hypoglycemic episodes than POC (55 vs 12, P < .01). Glucose measurements were clinically valid, with 91.9% of patients falling within the Clarke error grid A and B zones. CONCLUSIONS: Our preliminary results indicate that the use of CGM in type 2 patients hospitalized in the general ward provides accurate estimation of blood sugar levels and is more effective than POC for the detection of hypoglycemic episodes and asymptomatic hypoglycemia.

¿Existe sarcopenia en pacientes menores de 30 años por criterio de bioimpedanciometría? / Is there sarcopenia in patients under 30 years by bioelectrical impedance criteria?

La sarcopenia es una patología detectada principalmente en ancianos, se desconoce la prevalencia en personas jóvenes. Este estudio pretende determinar la prevalencia de sarcopenia en pacientes menores de 30 años mediante bioimpedanciometría y determinar sus factores asociados; en pacientes que acuden a consulta de endocrinología del Centro de Especialistas de Colsubsidio, Bogotá. Metodología: estudio de corte transversal. Se estableció la correlación entre músculo corporal total y otros parámetros antropométricos como peso, talla, grasa corporal total, grasa visceral, sexo y edad. Determinó los factores asociados a sarcopenia mediante análisis multivariado. Resultados: se incluyeron 501 pacientes, 315 mujeres (62.87%) y 186 hombres (37.13%) y se encontró una prevalencia de sarcopenia en pacientes menores de 30 años, clasificada como moderada 60.53% (n=46) y severa 22.37% (n=17) p<0.001; con 31.75% asociado a problemas de sobrepeso u obesidad p<0.001. Además una correlación inversa entre el porcentaje de músculo total y edad, peso, grasa corporal total y grasa visceral tanto para mujeres y hombres respectivamente p<0.01. Los factores independientes asociados a sarcopenia fue el sexo masculino OR = 1.09 x 10(16) (IC 95% 7.37 x 10(11) -1.62 x 10(20)) p<0.001; edad OR=1.15 (IC 95% 1.085-1.22) p<0.001 y grasa corporaltotal OR=1.9(IC 95% 1.59-2.26) p<0.001. Conclusión: la definición de sarcopenia se enfoca en pacientes ancianos y es interesante cómo se aprecia pérdida de la masa muscular desde edades tempranas, asociados a problemas de sobrepeso u obesidad que podría corresponder a "obesidad sarcopénica". Consideramos que se debe realizar una definición de sarcopenia donde se incluya pacientes jóvenes. (Acta Med Colomb 2015; 40: 132-137).

Sarcopenia is a disease detected mainly in the elderly, and its prevalence in young people is unknown. This study aims to determine the prevalence of sarcopenia in patients under 30 years by bioelectrical impedance and determine its associated factors in patients attending endocrinology consultation of Specialists Center Colsubsidio Bogota. Methodology: cross sectional study. The correlation between total body muscle and other anthropometric parameters such as weight, height, total body fat, visceral fat, sex and age was established. Factors associated with sarcopenia were determined by multivariate analysis. Results: 501 patients, 315 women (62.87%) and 186 men (37.13%). Prevalence of sarcopenia found in patients under 30 years was classified as moderate in 60.53% (n = 46) and severe 22.37% (n = 17) p <0.001; 31.75% was associated with overweight or obesity p <0.001. Besides, there was an inverse correlation between the percent of total muscle and age, weight, total body fat and visceral fat for both women and men respectively p <0.01. Independent factors associated with sarcopenia were male gender OR = 1.09x 10(16) (95% CI 7.37 x 10(11) -1,62 x 10(20)) p <0.001; age OR = 1.15 (95% CI 1,085-1.22) p <0.001 and total body fat OR = 1.9 (95% CI 1.59-2,26) p <0.001. Conclusion: the definition of sarcopenia focuses on elderly patients, and it is interesting how loss of muscle mass can be seen from an early age, associated with overweight or obesity that might correspond to "sarcopenic obesity." We believe that a definition of sarcopenia where young patients be included should be made. (Acta Med Colomb 2015; 40: 132-137).

Cáncer de tiroides y síndromes polipósicos intestinales Síndrome de Gardner / Thyroid cancer and intestinal polyposis syndromes Gardner syndrome

Resumen Presentamos el caso de una mujer de 22 años de edad, evaluada debido a que en su historia familiar a su madre se le encontró carcinoma de colon sigmoide. A la paciente se le diagnosticó poliposis colónica, que resolvió tras remoción endoscópica de las lesiones. Se realizó estudio de nódulo tiroideo y se realizó tiroidectomía total encontrándose un carcinoma papilar de tiroides como diagnóstico definitivo. Hicimos una revisión de la literatura. (Acta Med Colomb 2013; 38: 182-185).

Abstract We report the case of a 22-year-old woman evaluated because in her family history his mother had a sigmoid colon carcinoma. The patient was diagnosed with colonic polyposis, which resolved after endoscopic removal of the lesions. We made the study of a thyroid nodule and performed total finding a papillary thyroid carcinoma as definitive diagnosis. (Acta Med Colomb 2013; 38: 182-185).

Determination of the cutoff point for waist circumference that establishes the presence of abdominal obesity in Latin American men and women.

AIMS: The recent definitions of the metabolic syndrome (MS) recognize the need for ethnic and region-specific waist circumference (WC) cut-offs that identify people with abdominal obesity. We tested WC as a diagnostic tool to identify people with visceral adiposity in Hispanics from the Latin America region. METHODS: We used the area of visceral adipose tissue (VAT) ≥ 100 cm² at the level between the 4th and 5th lumbar vertebrae in abdominal CT scans as a marker of visceral adiposity and established the optimal WC threshold for men and women by means of receiver operating characteristic (ROC) curves. RESULTS: 179 men and 278 women from Mexico, El Salvador, Venezuela, Colombia and Paraguay were included. The ROC curves were highly discriminative of excess VAT for men and women (area under the curve 0.9 and 0.8 respectively) and the WC threshold was identified at 94 cm for men and between 90 and 92 cm for women. CONCLUSION: In men the WC cutoff was equal to that proposed for europids and suggested for US adults who may have strong genetic contribution to insulin resistance such as Hispanics. In women the threshold was significantly higher than previously proposed for South and Central Americans.