High-Risk Obesity Phenotypes: Target for Multimorbidity Prevention at the ROFEMI Study.

Background: Describe the profile of patients with obesity in internal medicine to determine the role of adiposity and related inflammation on the metabolic risk profile and, identify various "high-risk obesity" phenotypes by means of a cluster analysis. This study aimed to identify different profiles of patients with high-risk obesity based on a cluster analysis. Methods: Cross-sectional, multicenter project that included outpatients attended to in internal medicine. A total of 536 patients were studied. The mean age was 62 years, 51% were women. Patients were recruited from internal medicine departments over two weeks in November and December 2021 and classified into four risk groups according to body mass index (BMI) and waist circumference (WC). High-risk obesity was defined as BMI > 35 Kg/m2 or BMI 30−34.9 Kg/m2 and a high WC (>102 cm for men and >88 cm for women). Hierarchical and partitioning clustering approaches were performed to identify profiles. Results: A total of 462 (86%) subjects were classified into the high-risk obesity group. After excluding 19 patients missing critical data, two profiles emerged: cluster 1 (n = 396) and cluster 2 (n = 47). Compared to cluster 1, cluster 2 had a worse profile, characterized by older age (77 ± 16 vs. 61 ± 21 years, p < 0.01), a Charlson Comorbidity Index > 3 (53% vs. 5%, p < 0.001), depression (36% vs. 19%, p = 0.008), severe disability (64% vs. 3%, p < 0.001), and a sarcopenia score ≥ 4 (79% vs. 16%, p < 0.01). In addition, cluster 2 had greater inflammation than cluster 1 (hsCRP: 5.8 ± 4.1 vs. 2.1 ± 4.5 mg/dL, p = 0.008). Conclusions: Two profiles of subjects with high-risk obesity were identified. Based on that, older subjects with obesity require measures that target sarcopenia, disability, psychological health, and significant comorbidities to prevent further health deterioration. Longitudinal studies should be performed to identify potential risk factors of subjects who progress from cluster 1 to cluster 2.

Linfoma no Hodgkin T como complicación infrecuente de la micosis fungoide tumoral / T-cell non-Hodgkin lymphoma as a rare mycosis fungoide complication

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Síndrome de Ortner y disfagia por aurícula izquierda gigante en el paciente anciano / Dysphagia and Ortner syndrome due to a giant left atrium in the elderly

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Pancreatitis aguda severa y precoz por liraglutide / Liraglutide-induced severe early acute pancreatitis

Los agonistas GLP-1 presentan como efectos secundarios más frecuentes las náuseas y vómitos que son de carácter leves y moderados, siendo transitorios y dosis dependiente sin necesidad de suspender el fármaco en la mayoría de casos. Estos efectos ocurren más frecuentemente con exenatide y raramente con liraglutide, sin conocer un caso clínico de tal severidad y sobre todo precocidad. Se describe una mujer de 55 años caucasiana con diabetes mellitus tipo 2 de larga evolución asociadas que presentó cuadro de dolor abdominal, náuseas, vómitos incoercibles e hiperlipasemia de aparición súbita tras la primera dosis de titulación de liraglutide, completando solo 2 dosis en 48 horas, consultando en urgencias donde se apreció fracaso renal agudo y descompensación hiperosmolar que requirió su ingreso en unidad de cuidados intensivos. Al emplear la escala de probabilidad de reacción a fármaco de Naranjo obtenemos dicha reacción como probable, sin encontrar otras alternativas justificables clinicamente.

The most frequent side effects seen with GLP-1 agonists are mild and moderate nausea and vomiting, which are typically transient and dose-dependent, in most cases not requiring discontinuation of the drug. These effects occur most frequently with exenatide, and rarely with liraglutide; no clinical cases with such a severity -and especially with such an early occurrence- had been previously reported. The case herein described is that of a 55-year-old Caucasian female with a long-standing Type 2 diabetes mellitus, who presented with sudden abdominal pain, nausea, relentless vomiting an increased lipase serum levels after the first dosage of liraglutide, after completing only 2 dosages in 48 hours. The patient was seen at the emergency room, where she was diagnosed acute renal failure and hyperosmolar decompensation that required admission at the intensive care unit. According to Naranjo’s odds scale, the reaction was considered to be likely related to the drug; no other alternatives were considered to be clinically justified.

Pancreatitis aguda asociada a angioedema hereditario / Acute pancreatitis associated with hereditary angioedema

El angioedema hereditario (AH) es un proceso infrecuente, de carácter recurrente, potencialmente mortal, originado por el déficit o disfunción de factor C1 inhibidor. El dolor abdominal secundario a edema intestinal es relativamente frecuente en pacientes con AH pero tras una revisión de la literatura solo se han informado seis casos de pancreatitis aguda asociado a angioedema hereditario (AU)

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C1 inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity (AU)

[Acute pancreatitis associated with hereditary angioedema]. / Pancreatitis aguda asociada a angioedema hereditario.

Hereditary angioedema (HAE) is an infrequent, recurrent, and potentially lethal disorder caused by a deficiency of C(1) inhibitor or its activity. Abdominal pain secondary to bowel edema is common in these patients. However, a thorough literature search yielded only six previously reported cases of pancreatitis associated with this entity.

Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto / Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma

El linfoma colorrectal es una entidad extremadamente infrecuente, representando menos del 0,5% del total de las neoplasias colorrectales primarias. La localización colorrectal supone el 15–20% del total de los linfomas gastrointestinales, tras el estómago y el intestino delgado. Debido a la inespecificidad de los síntomas, la enfermedad suele estar avanzada en el momento del diagnóstico. Primordial interés tienen los criterios de Dawson para diferenciar la afectación colorrectal primaria de la afectación del tracto gastrointestinal secundaria a un linfoma sistémico, dadas sus diferentes connotaciones pronósticas y terapéuticas. Presentamos el caso de un linfoma no hodgkiniano tipo B de localización rectal, de difícil diagnóstico, tratado con esquema poliquimioterapéutico con ciclofosfamida, adriamicina, vincristina, prednisona y rituximab, cuya evolución fue desfavorable (AU)

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15–20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor (AU)

[Primary diffuse large B-cell lymphoma of the rectum simulating a rectal adenocarcinoma]. / Linfoma de tipo B difuso de células grandes primario rectal que simula un adenocarcinoma de recto.

Colorectal lymphoma is an extremely infrequent entity, representing less than 0.5% of all primary colorectal neoplasms. Colorectal localization accounts for 15-20% of all gastrointestinal lymphomas, after the stomach and small intestine. Because the symptoms are non-specific, this disease is usually diagnosed in the advanced stages. Dawson's criteria are highly useful in the differential diagnosis between primary colorectal involvement and gastrointestinal tract involvement secondary to systemic lymphoma, which is important due to the distinct prognosis and treatment of these entities. We report the case of a B-cell non-Hodgkin's lymphoma that was difficult to diagnose and was treated with R-CHOP polychemotherapy. Outcome was poor.

Neumonía en el anciano: un viejo desafío, nuevas perspectivas / Pneumonia in the elderly: old challenge, new perspectives

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Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality.

OBJECTIVES: To evaluate and identify factors determining survival in elderly patients with advanced dementia. METHODS: A prospective, follow-up, observational analysis in a cohort of 67 community-based patients aged 65 years or older with dementia defined by DSM-IV and stage 7A or above on the FAST scale. Data were recorded on socio-demographic variables, FAST, Katz index, language, swallowing ability, diet, nutritional status (from anthropometric and laboratory data), associated diseases and medical complications during the previous 12 months. Survival was analyzed by the Kaplan-Meier method. Prognostic factors for survival were identified by the Cox proportional hazards regression model. RESULTS: The median follow-up was 832 days. The mean age was 82.2+/-6.7 years and 92.5% were women. A comorbid condition was present in 71.6%, most frequently hypertension (22.4%). A clinical event had occurred in 52 (77.6%) patients during the previous year (pneumonia, urinary infection, stroke, pressure sore, dehydration, sepsis or others). A total of 25 (37.3%) patients died. The mean survival was 676 days (95% confidence interval, 600-752 days). Cox proportional hazards model showed that independent prognostic factors for mortality were having pneumonia within the previous year (RR:3.7; p=0.001), a permanent nasogastric tube (RR:3.5; p=0.003) and serum albumin values below 3.5 g/dL (RR:2.9; p=0.028). CONCLUSIONS: In patients with advanced dementia, hypoalbuminemia and pneumonia are strongly and positively associated with mortality. Artificial nutrition via a nasogastric tube reduces survival in these patients.