Observations on Texas hypoxylons, including two new Hypoxylon species and widespread environmental isolates of the H. croceum complex identified by a polyphasic approach.

Two new species and a new combination of Hypoxylon from Texas were identified and described based on morphological, multigene phylogenetic (ITS [nuc rDNA internal transcribed spacer region ITS1-5.8S-ITS2], 28S [5' 1200 bp of nuc 28S rDNA], RPB2 [partial second largest subunit of the DNA-directed RNA polymerase II], TUB2 [partial ß-tubulin]), and chemotaxonomic data. Hypoxylon olivaceopigmentum is characterized by its pulvinate to glomerate stromata, olivaceous KOH-extractable pigments, equilateral ascospores, and indehiscent perispore. Hypoxylon texense can be distinguished from morphologically similar species by its rust to dark brick KOH-extractable pigments and the high-performance liquid chromatography (HPLC) profile of its stromatal secondary metabolites. Hypoxylon hinnuleum is proposed as the sexual morph of Nodulisporium hinnuleum, featuring dark vinaceous glomerate stromata with dark brick KOH-extractable pigments composed of cohaerin-type azaphilones and smooth equilateral ascospores with indehiscent perispore. Based on these diagnostic characters, H. hinnuleum forms a complex with H. croceum and H. minicroceum. More than 50 ITS sequences with high identity originating from North American and East Asian environmental isolates formed a well-supported clade with the type of N. hinnuleum, demonstrating the widespread distribution of the species complex. In addition, updated descriptions and comprehensive illustrations with detailed information on the diagnostic features of H. fendleri and H. perforatum are provided. The multilocus phylogenetic reconstruction of Hypoxylon supported the status of the new species and broadened the knowledge about intergeneric relationships.

Adenomatosis erosiva del pezón. A propósito de un caso / Erosive adenomatosis of the nipple. A case report

A pesar de su naturaleza benigna, la adenomatosis erosiva del pezón (AEP) continúa suponiendo un reto diagnóstico para patólogos y clínicos. Se trata de un tumor poco frecuente que puede confundirse con facilidad con entidades de carácter maligno como la enfermedad de Paget del pezón o el carcinoma intraductal bien diferenciado, lo que lleva a sobre tratar innecesariamente esta entidad de manera agresiva y mutilante. Presentamos el caso de una paciente de 49 años con una adenomatosis erosiva del pezón seguida en nuestro centro durante los últimos 3 añoS

Despite its benign nature, erosive adenomatosis of the nipple (EAN) continues to pose a diagnostic challenge to pathologists and clinicians. It is a rare tumour that can easily be confused with malignant entities, such as Paget's disease of the nipple or well-differentiated intraductal carcinoma, which leads to unnecessary, aggressive and mutilating overtreatment. We report the case of a 49-year-old patient with erosive adenomatosis of the nipple followed-up at our centre over the last 3 years

[Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society]. / Sueño saludable: evidencias y guias de actuacion. Documento oficial de la Sociedad Española de Sueño.

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed.

Trastornos respiratorios del sueño en Pediatría. Estado de la cuestión / Sleep respiratory disorders in Pediatrics. State of the question

No disponible

Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment.

Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (<3%) asthma. Nineteen subjects had BHR to mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli.

Violencia de los usuarios hacia el personal de enfermería en los servicios de urgencias hospitalarios. Factores de riesgo y consecuencias / Violence against nursing staff in hospital emergency services: risk factors and consequences

Objetivos: Estudiar las manifestaciones hostiles de usuarios hacia los profesionales de enfermería de los servicios de urgencia de los hospitales (SUH) públicos del Servicio Murciano de Salud (SMS) y determinar la frecuencia de exposición a diversas conductas violentas de los usuarios, así como las características sociodemográficas y laborales del trabajador asociadas a una mayor exposición. Analizar la relación de la exposición a conductas hostiles con la presencia de posibles consecuencias psicológicas sobre el trabajador, como variaciones en la satisfacción laboral, el burnout y el bienestar psicológico. Método: Se trata de un estudio descriptivo transversal llevado a cabo en el personal de enfermería de los SUH del SMS en el año 2010. Se entregó un cuestionario autoaplicado y anónimo al 30% de estos profesionales de urgencias, y estratificada por hospitales. Resultados: La manifestación de violencia más frecuente a la que están expuestos estos enfermeros son los enfados por la demora de asistencia o por la falta de información. Hemos encontrado diferencias significativas de puntuación en la escala de violencia no física según las variables tamaño del hospital, profesión y realización de otra actividad, y de violencia física según la antigüedad en el puesto. En estos profesionales, la violencia no física se correlaciona con el grado de burnout, la satisfacción laboral y el bienestar psicológico. Conclusión: Existe un número elevado de agresiones al personal de enfermería en los SUH, que en algunos aspectos es mayor respecto a otros servicios de enfermería hospitalarios. Reducir la frecuencia de las agresiones podría mejorar la salud psicológica delos trabajadores (AU)

Objective: To study hostility directed against nurses and auxiliary nurses by users of hospital emergency departments in the public health system of Murcia, Spain; to determine the frequency of the nursing staff's exposure to various types of user aggression; and to explore the sociodemographic characteristics and position (nurse or auxiliary nurse) of staff exposed to a higher rate of aggression. To analyze the relationship between exposure to hostile behaviors and potential psychological impact, such as changes in a nurse's job satisfaction, burnout, or psychological well-being. Methods: Descriptive cross-sectional survey of public health system hospital emergency department nursing staff in Murcia in 2010. The sample was stratified by hospital and corresponded to 30% of the emergency department nursing staff in the region. Participants responded to an anonymous self-administered questionnaire. Results: The hostile behavior the nurses were exposed to most often was the expression of anger at delayed care or lack of information. The scores for exposure to nonphysical aggression were significantly related to hospital size, staff position, and moonlighting practices; scores for exposure to physical violence were significantly related to staff seniority (years working). Non physical violence was correlated with degree of burnout, job satisfaction, and psychological wellbeing. Conclusions: Expressions of user hostility toward nursing staff are more common in emergency departments than inother hospital areas. Reducing the frequency of hostile encounters would help improve the psychological well-being of these staff members (AU)

Fate of thiabendazole through the treatment of a simulated agro-food industrial effluent by combined MBR/Fenton processes at µg/L scale.

This study has been carried out to assess the performance of a combined system consisting of a membrane bioreactor (MBR) followed by an advanced oxidation process (Fenton/Photo-Fenton) for removing the fungicide thiabendazole (TBZ) in a simulated agro-food industrial wastewater. Previous studies have shown the presence of TBZ in the effluent of an agro-food industry treated by activated sludge in a sequencing batch reactor (SBR), thus reinforcing the need for alternative treatments for removal. In this study, a simulated agro-food industry effluent was enriched with 100 µg L(-1) TBZ and treated by combined MBR/Fenton and MBR/solar photo-Fenton systems. Samples were directly injected into a highly sensitive liquid chromatography-triple quadrupole-linear ion trap-mass spectrometer (LC-QqLiT-MS/MS) analytical system to monitor the degradation of TBZ even at low concentration levels (ng L(-1)). Results showed that the biological treatment applied was not effective in TBZ degradation, which remained almost unaltered; although most dissolved organic matter was biodegraded effectively. Fenton and solar photo-Fenton, were assayed as tertiary treatments. The experiments were run without any pH adjustment by using an iron dosage strategy in the presence of excess hydrogen peroxide. Both treatments resulted in a total degradation of TBZ, obtaining more than 99% removal in both cases. To assure the total elimination of contaminants in the treated waters, transformation products (TPs) of TBZ generated during Fenton degradation experiments were identified and monitored by liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS/MS). Up to four TPs could be identified. Two of them corresponded to mono-hydroxylated derivatives, typically generated under hydroxyl radicals driven processes. The other two corresponded with the hydrolysis of the TBZ molecule to yield benzoimidazole and thiazole-4-carboxamidine. All of them were also degraded during the treatment.

A randomized phase II study to compare oxaliplatin plus 5-fluorouracil and leucovorin (FOLFOX4) versus oxaliplatin plus raltitrexed (TOMOX) as first-line chemotherapy for advanced colorectal cancer

INTRODUCTION: The aim of this study was to compare TOMOX versus FOLFOX4 as first-line treatment of advanced colorectal cancer (CRC). MATERIALS AND METHODS: 191 chemotherapy-naïve patients were randomized to receive TOMOX or FOLFOX4. Patients were evaluated every 3 months and chemotherapy was continued until disease progression or unacceptable toxicity. Overall response rate was the primary endpoint. RESULTS: 183 patients were included in the intent-to-treat analysis (92 TOMOX and 91 FOLFOX4). Overall response rate was 45.6 and 36.3 % (p = 0.003) for TOMOX and FOLFOX4, respectively. No statistically significant differences were observed in overall survival (15.6 and 17.2 months; p = 0.475); progression-free survival (7.7 and 8.7 months; p = 0.292), and response duration (6.4 and 7.6 months; p = 0.372) for TOMOX and FOLFOX4, respectively. Grades 3 and 4 neutropenia (p < 0.0001) and leukopenia (p = 0.028) were more common with the FOLFOX4 regimen, while hepatic disorders and asthenia were higher in TOMOX group (p = ns). There were two treatment-related deaths in the FOLFOX4 arm and one in the TOMOX arm. Quality of life analysis based on the SF-36 revealed differences between the two regimens for physical and mental composite scores after 6 weeks, and for body pain and emotional role functioning after 6 and 12 weeks; all of these favored the FOLFOX4 arm (p ≤ 0.05). CONCLUSIONS: TOMOX and FOLFOX4 seem to have similar efficacy and are well tolerated in the first-line treatment for advanced CRC with different profiles of toxicity. The convenient TOMOX regimen may offer an alternative to fluoropyrimidine-based regimens (AU)

Fracaso renal agudo en un paciente con carcinoma renal tratado con Temsirolimus / No disponible

No disponible

[A firm court resolution against malpractice in the treatment of obesity]. / Una sentencia firme contra la mala práctica en el tratamiento de la obesidad.

Inappropriate dietary treatments against obesity may worsen patients' metabolic and cardiovascular risk, lead to malnutrition, facilitate the appearance in predisposed individuals of eating disorders and ultimately favor the recovery of previously lost weight. Nonetheless, incorrect therapies aimed at reducing weight, sometimes accompanied by promises of miraculous results, are still rather frequent in our country. The public criticism by Drs. Monereo and Vazquez of a concrete method used by several very popular clinics in Madrid, resulted in the director of those centers suing them for libel. In this special article, we summarize the facts, analyze the methods used in those clinics and their likely negative consequences as well as sketch the content of the verdict of one of the trials, already concluded. Its main conclusions are the following: 1) Health education and the defense of public health is a professional duty; 2) The incorrect treatment of obesity can increase the risks associated with it; 3) There is a sufficient spanish and international consensus as well as Guidelines that clearly specifies the requisites of good medical practice with regard to obesity; 4) In spite of that, there are still treatments that constitute deception and fraud of different kinds and that respond more to business motivations rather than professional ones; 5) The fact of being sued as a result of activities that make part of a responsible behavior within an institution and whose purpose is the public benefit has entailed a serious, difficult and painful situation. We consider that the relevance and interest of the verdict warrants its diffusion because it constitutes a reference for professionals and may be decisive in the struggle against bad practices in obesity treatment.

Una sentencia firme contra la mala práctica en el tratamiento de la obesidad / A firm court resolution against malpractice in the treatment of obesity

Los tratamientos dietéticos incorrectos contra la obesidad pueden agravar el riesgo metabólico y cardiovascular de los pacientes, conducir a malnutriciones, facilitar en personas predispuestas el comienzo de trastornos de la conducta alimentaria, y favorecer la recuperación del peso perdido. Sin embargo, la práctica incorrecta de terapias contra el exceso de peso, a veces con promesas de resultados “milagro” sigue siendo bastante frecuente en nuestro país. La denuncia pública de un método concreto aplicado por clínicas de adelgazamiento muy populares en Madrid, realizada por la Dras. Monereo y Vázquez, resultó en una querella que el director de las citadas clínicas interpuso contra las especialistas, por supuestos delitos contra su honor. En este artículo especial se resumen los hechos, se analizan los métodos concretos empleados por el denunciante, sus posibles consecuencias perjudiciales y se resume el contenido dela sentencia de uno de los juicios ya finalizado. Las principales conclusiones de la misma son: 1) que la educación sanitaria y la defensa de la salud pública es un deber profesional; 2) que el conocimiento actual de la obesidad como enfermedad compleja y en cuyo tratamiento un enfoque incorrecto puede agravar aún más el riesgo; 3) que existen suficientes consensos españoles e internacionales que enmarcan con toda precisión los criterios de buena práctica médica en relación con la obesidad; 4) que, sin embargo continúan habiendo tratamientos que constituyen engaño o fraude de distinta índole y que obedecen a negocios más que a actividad profesional, y 5) que la situación inaudita de ser demandadas por actuaciones que sólo responden a la actuación responsable dentro de una institución y buscando el beneficio público y ajustadas a Consensos ha supuesto a nivel personal e institucional una situación grave, difícil y dolorosa. Consideramos de trascendencia e interés la difusión de esta sentencia que constituye una referencia profesional y puede ser decisiva en la lucha contra la mala práctica en el tratamiento de la obesidad

Inappropriate dietary treatments against obesity may worsen patients’ metabolic and cardiovascular risk, lead to malnutrition, facilitate the appearance in predisposed individuals of eating disorders and ultimately favor the recovery of previously lost weight. Nonetheless, incorrect therapies aimed at reducing weight, sometimes accompanied by promises of miraculous results, are still rather frequent in our country. The public criticism by Drs. Monereo and Vazquez of a concrete method used by several very popular clinics in Madrid, resulted in the director of those centers suing them for libel. In this special article, we summarize the facts, analyze the methods used in those clinics and their likely negative consequences as well as sketch the content of the verdict of one of the trials, already concluded. Its main conclusions are the following: 1) Health education and the defense of public health is a professional duty; 2) The incorrect treatment of obesity can increase the risks associated with it; 3) There is a sufficient spanish and international consensus as well as Guidelines that clearly specifies the requisites of good medical practice with regard to obesity; 4) In spite of that, there are still treatments that constitute deception and fraud of different kinds and that respond more to business motivations rather than professional ones; 5) The fact of being sued as a result of activities that make part of a responsible behavior within an institution and whose purpose is the public benefit has entailed a serious, difficult and painful situation. We consider that the relevance and interest of the verdict warrants its diffusion because it constitutes a reference for professionals and may be decisive in the struggle against bad practices in obesity treatment

Variables psicosociales y de personalidad asociadas a la cervicalgia recurrente / Psychosocial and personality variables related to recurrent cervicalgia

El objetivo del presente estudio es evaluar la relación existente entre variables de personalidad y bienestar en pacientes diagnosticados de cervicalgia. Para ello, se seleccionó una muestra de sujetos con diagnóstico y baja laboral por cervicalgia procedentes de dos mutuas de accidentes de trabajo de la ciudad de Murcia. Los resultados indican que la mitad de los sujetos de la muestra tiene una estructura de personalidad desadaptativa, con un claro perfil “neurótico”. Este perfil se caracteriza por inestabilidad emocional, escasos recursos para afrontar las situaciones de estrés y dificultades para adaptarse e implicarse activamente en el trabajo. El 61,9% de los participantes muestra una estructura de personalidad inapropiada para tener éxito laboral. Así mismo, el 49,1% perciben claramente un malestar psicológico que se focaliza en la presencia de síntomas somáticos. La presencia de sintomatología ansioso-depresiva es un indicador de mal pronóstico con relación a la duración de la baja. El perfil de personalidad “neurótica” y la presencia de cuadros depresivos se relacionan con la recurrencia de los cuadros cervicálgicos. Con respecto a la prevención, los resultados sugieren que la evaluación y el tratamiento de aspectos psicopatológicos serían importantes para reducir las bajas laborales, minimizar su duración y evitar las recurrencias

The objective of the present work is to evaluate the relationship between personality variables and wellness among patients diagnosed with cervicalgia. A sample of subjects with cervicalgia and on sick-leave was recruited from two sickness and accident insurance companies at the city of Murcia. About half of the sample showed not to have a well-adapted personality, with a clear “neurotic” profile. This profile was characterised by emotional instability, poor resources to cope with stress and difficulties to be adapted and involved into the work life. 61.9% of participants showed a personality structure non-efficient to achieve work success. In this way, 49.1% reported some psychological discomfort, which was often expressed in soma to form symptoms. Regarding the sick-leave length, the presence of anxious- depressive symptoms was an indicator of worse prognosis. The “neurotic” personality profile and the depressive symptoms were related to the neck pain recurrence. With relation to prevention, our results suggest that taking into account the evaluation and treatment of psychopathological aspects may be of help to minimize the number of sick-leaves, reduce their length and prevent their recurrence

Evaluación del parámetro agudeza visual en pilotos comerciales: tests, máximos y mínimos visuales, uso de lentes de contacto y edad / No disponible

El objetivo de este trabajo es presentar los resultados de varios estudios sobre agudeza visual (AV) realizados en pilotos de líneas aéreas comerciales; comparación de performance de dos tests de agudeza visual lejana (Landolt y Marquez); incidencia de pilotos con AV superior a la normal (AV >1) y con agudeza visual en el límite establecido por la Normativa JAR-FCL (AV=0,7) y revisión de las condiciones visuales asociadas a este valor límite de AV; análisis de la posible influencia de otros factores en la AV tales como el uso de lentes de contacto y la edad. Material y método: utilizamos para el estudio los datos recogidos en la exploración oftalmológica realizada a pilotos de líneas aéreas comerciales en los reconocimientos médicos periódicos para la renovación de las licencias de vuelo. Resultados: Encontarmos diferencias estadísticamente significativas en los valores de AV medidos con uno y otro test. En cuanto a los máximos y mínimos visuales, un 21,62% de pilotos presentaban valores de AV>1 mientras que sólo el 6% tenían AV=0,7, la mayor parte de ellos (81,25%) asociados a defectos de refracción. La edad media de los pilotos con AV>1 fue de 53,39 años. No encontramos diferencias estadísticamente significativas en las AV en sujetos portadores de lentes de contacto y un grupo control ni entre pilotos jóvenes (40 años)

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Seguridad y utilidad de Zaleplon en operaciones aéreas / Efficacy and safety of zaleplon in aviation operations

Fundamento: El insomnio y su tratamiento farmacológico pueden causar incidentes y accidentes aéreos. La normativa aeronáutica internacional sólo autoriza, de modo excepcional y controlado, el consumo de hipnóticos no benzodiacepínicos tipo zolpidem o zopiclona. Sin embargo, zaleplon, un nuevo hipnótico no benzodiacepínico, posee una seguridad farmacológica superior a las de éstos últimos. Objetivo: Evaluar los posibles efectos adversos de zaleplon sobre la función psicomotora de pilotos de aeronave en situación de vuelo simulado en cámara hipobárica durante su entrenamiento fisiológico. Pacientes y método: Participaron 36 pilotos de aeronave, alumnos varones del Ejército del Aire de España, tomaron una única dosis de zaleplon 10 mg o placebo la noche previa a la sesión de entrenamiento fisiológico en cámara hipobárica. El estudio, aleatorizado y doble ciego, valoró la influencia de zaleplon vs placebo sobre la capacidad de atención en condiciones de prehipoxia, hipoxia hipobárica y posthipoxia, utilizando el test de atención Toulouse-Pieron modificado. Resultados: Los valores medios obtenidos en el grupo zaleplon vs el de placebo fueron, respectivamente: 22,11(5,91 y 22,94(9,21 (prehipoxia); 19,17(8,89 y 15,39(7,90 (hipoxia); 29,33(6.27 y 31,44(7,70 (posthipoxia). No existieron diferencias significativas entre ninguno de los va¬lores encontrados en uno y otro grupo. Conclusiones: Tras descartar efectos adversos sobre la capacidad psicomotora en condiciones de hipoxia hipobárica y revisar las evidencias científicas en la literatura biomédica, se concluye que zaleplon puede convertirse en el hipnótico de primera elección en operaciones aéreas

Background: Insomnia and its pharmacological treatment can cause aviation incidents and accidents. International aviation regulations only exceptionally and under controlled conditions authorize the use of non-benzodiazepine hypnotics such as zolpidem or zopiclone. However, zaleplon, a new non-benzodiazepine hypnotic, affords greater pharmacological safety than these latter drugs. Objective: To evaluate the potential adverse events of zaleplon on psychomotor function among aviation pilots under simulated flight conditions in a hypobaric chamber in the course of physiological training. Patients and method: Thirty-six male pilots in training and belonging to the Spanish Air Force were administered a single dose of zaleplon 10 mg or placebo the night before a physiological training session in a hypobaric chamber. The randomized, double-blind study assessed the influence of zaleplon versus placebo on sustained alertness and fatigue resistance under conditions of prehypoxia, hypobaric hypoxia and posthypoxia, based on the modified Toulouse-Pieron alertness test. Results: The mean values obtained in the zaleplon versus the placebo group were respectively: 22.11(5.91 and 22.94(9.21 (prehypoxia); 19.17(8.89 and 15.39(7.90 (hypoxia); 29.33(6.27 and 31.44(7.70 (posthypoxia). There were no significant differences between any of the recorded values in either group. Conclusions: After discarding potential adverse effects on psychomotor capacity under conditions of hypobaric hypoxia and reviewing the sciéntific evidence in the biomedicalliterature, it is concluded that zaleplon may become the first-choice hypnotic in aviation operations

Obesidad como factor de riesgo cardiovascular / Obesity as cardiovascular risk factor

La obesidad es una enfermedad metabólica crónica con riesgo cardiovascular asociado y una morbimortalidad aumentada. Actualmente el sobrepeso y la obesidad se consideran tan importantes como otros factores de riesgo clásico relacionados con la enfermedad coronaria. El tejido adiposo no sólo actúa como almacén de moléculas grasas, sino que sintetiza y libera a la sangre numerosas hormonas relacionadas con el metabolismo de principios inmediatos y la regulación de la ingesta. Asimismo, la obesidad se asocia a numerosos factores de riesgo cardiovasculares como dislipidemia, hipertensión, diabetes, marcadores inflamatorios y estado protrombótico. La pérdida de peso puede evitar la progresión de la placa de aterosclerosis y los eventos coronarios agudos en los sujetos obesos

Obesity is a chronic metabolic disease associated with cardiovascular risk and increased morbidity and mortality. Being overweighted and obese are now considered to be as important as other classic risk factors related to heart disease. Fatty tissue not only acts as stores of fat molecules but synthesizes and releases hormones to the blood which are related to the metabolism of basic food molecules and regulation of food intake. Likewise, obesity is associated with numerous cardiovascular risk factors such as dyslipidemia, hypertension, diabetes, inflammatory markers and prothrombotic state. Weight loss can prevent acute progression of atherosclerotic plaque and coronary events in obese subjects

Course of metabolic syndrome following the biliopancreatic diversion of Larrad.

BACKGROUND: The authors assessed the effect of Larrad's biliopancreatic diversion (BPD) on the main components of the metabolic syndrome. PATIENTS AND METHODS: Plasma concentrations of glucose, insulin, total cholesterol (TC), HDL and LDL cholesterol, triglycerides, LDL/HDL and TC/HDL ratios, and blood pressure and body weight were retrospectively evaluated in 40 patients 3-6, 12, 24 and 60 months after undergoing BPD for morbid obesity with metabolic syndrome. RESULTS: 3-6 months after BPD, glycemia and insulinemia had normalized in 97.5% of the patients and remained stable over the following 5 years. Over this period of 3-6 months to 5 years following BPD, total and LDL cholesterol levels fell by 45.2% and 53.1%, respectively. From 12 months onwards, triglyceride levels decreased appreciably, dropping by 57.4% at 5 years. HDL cholesterol concentrations failed to vary significantly or increased to normal levels in patients showing low initial values. At 5 years, high blood pressure had resolved in 75% of patients and the amount of excess weight lost was 65.5% (+/-14.6). No patient required reversal of the BPD due to severe gastrointestinal or metabolic complications. CONCLUSIONS: Technically adapted to the patient's weight, the Larrad BPD effectively stabilizes the main components of the metabolic syndrome. The BPD has low morbidity rate and should be considered a therapeutic option for patients who do not respond to medical treatment.

[Bariatric surgery: an update]. / Cirugía bariátrica: situación actual.

The indication of bariatric surgery as therapeutic procedure for morbid obese patients requires the application of selection criteria which deal with the degree of obesity, associated complications and previous failure of conventional therapy. Alcohol or drug addiction and concomitant serious disease are contraindications for bariatric surgery. Before operation, a full assessment is needed to identify possible eating behaviour disturbances and associated comorbidity such as cardiovascular disease, sleep apnoea, metabolic and psychiatric alterations which might induce intra and postoperative complications. Surgical techniques can be classified as restrictive, malabsortive and mixed procedures. Gastroplasty and adjustable gastric banding are restrictive techniques, which are indicated in obese patients with body mass index less than 45 kg/m2. Mixed techniques are the most used procedures. They include gastric by-pass which causes a reduction of 60-70% of weight excess, biliopancreatic diversion and duodenal switch which can eliminate a 75% of body weight excess. Following bariatric surgery a dramatic improvement in associated comorbidity can be demonstrated, specially in what refers to diabetes, hypertension, dislipidaemia and apnoea. Postoperative mortality is around 1-2%. Peritonitis and venous thromboembolism are the most serious complications. Postoperative follow-up should be lifelong and requires a progressive nutrition planning and vitamin supplementation.

[Allergy to asparagus]. / Alergia al espárrago.

Asparagus (Asparagus officinalis) is a widely grown vegetable; together with garlic, the onion and the leek, it belongs to the Liliaceae family. Both delayed cell-mediated reactions and IgE-mediated reactions secondary to asparagus have been described. While the former (allergic contact dermatitis) are a fairly common cause of occupational disease, only a few case-reports of IgE-mediated reactions have been published. IgE-mediated reactions can be further grouped into food allergy and reactions due to cutaneous or respiratory exposure, which is often occupational. Anaphylaxis is the most common clinical picture of food allergy, while contact urticaria, rhinitis and asthma, appearing either isolated or associated, are clinical pictures of the latter. Sensitization to different allergens is the likely cause of the different clinical pictures due to asparagus. Their detection and early diagnosis is of prime importance due to the different prognosis and treatment. In the present article we resume our experience over the last 5 years.