Sleeve Gastrectomy Reduces Body Weight and Improves Metabolic Profile also in Obesity-Prone Rats.

BACKGROUND: Susceptibility to obesity is associated with a notable inter-individual variation. The aim of the present study was to compare the effectiveness of sleeve gastrectomy (SG) on weight loss and metabolic profile in obesity-prone (OP) rats vs animals that are non-susceptible to obesity (NSO). METHODS: Young male Wistar rats (n = 101) were put in a diet-induced obesity (DIO) programme with ad libitum access to a high-fed diet (HFD) during 12 months. Body weight and food intake were regularly registered. Thereafter, rats were ranked by final body weight to identify the obesity-prone (OP) (n = 13) and non-susceptible to obesity (NSO) (n = 14) animals. OP and NSO rats were submitted to surgical interventions (sham operation, SG and pair-fed to the amount of food eaten by sleeve-gastrectomized rats). Body weight, food intake, energy expenditure, body temperature, fat pads weight, and metabolic profiling were analysed 4 weeks after surgical or dietary interventions. RESULTS: SG in both OP and NSO rats decreased body weight as compared to sham and pair-fed groups (P < 0.05), mainly due to reductions in subcutaneous and perirenal fat mass (P < 0.001). Total weight loss achieved in sleeve-gastrectomized OP and NSO rats was higher than that of pair-fed ones (P < 0.05), showing that the SG effect goes beyond caloric restriction. In this regard, sleeve-gastrectomized rats exhibited significantly (P < 0.05) increased basal rectal temperature together with upregulated brown adipose tissue Ucp-1 protein expression levels. A significant (P < 0.05) improvement in insulin sensitivity was also observed in both OP and NSO animals that underwent SG as compared with pair-fed counterparts. CONCLUSION: Our findings provide the first evidence that obesity-prone rats also benefit from surgery responding effectively to SG, as evidenced by the significant body weight reduction and the metabolic profile improvement.

Impacto sobre el cuidador principal de una intervención realizada a personas mayores dependientes / Impact on the primary carer of an intervention carried out on depenedent elderly people

Objetivos: Evaluar el impacto de un programa de atención domiciliaria de personas mayores dependientes sobre el cuidador principal.DiseñoEstudio de intervención «antes-después».EmplazamientoAtención primaria.ParticipantesCuidadores principales de personas dependientes mayores de 65 años incluidas en un programa de atención domiciliaria (n=156; 7,8% de pérdidas durante el seguimiento).IntervencionesPrograma de atención domiciliaria de personas mayores dependientes.Mediciones principalesSe realizó una medición basal y una evaluación al año de seguimiento. Se evaluaron la salud percibida, la frecuentación, y la satisfacción con la atención recibida, y se administraron los cuestionarios de calidad de vida de Nottingham, de salud psíquica de Golberg, de apoyo social de Duke-UNC y de sobrecarga del cuidador de Zarit).ResultadosNo se observó una modificación significativa de la salud percibida. Mejoraron (p<0,05) las esferas de energía, sueño, emocional y relación social de la calidad de vida. Disminuyó la frecuentación (8,4 vs 7,5; p<0,05) y el porcentaje de hiperfrecuentadores (30,1% vs 6,9%; p<0,01). Se redujo el porcentaje que expresan escaso apoyo social (8,3 vs 2,8%; p<0,05) y sobrecarga del cuidador (56,4 vs 44,4%; p<0,05). El 90,3% consideran que la asistencia mejoró, con mejora significativa de la asistencia recibida global, médica y de enfermería (7,6 vs 8,4; 7,9 vs 8,5 y 7 vs 8,5; p<0,05).ConclusionesLa incorporación a un programa de atención domiciliaria de personas dependientes repercute positivamente sobre su cuidador principal, mejorando su percepción sobre la asistencia recibida, reduciendo su utilización de los servicios sanitarios, disminuyendo el grado de sobrecarga y su percepción de falta de apoyo social(AU)

Objective: To evaluate the impact of joining a home care program on primary caregivers of dependent elderly people.DesignNon-randomised “before-after” intervention study.SettingPrimary Care.ParticipantsPrimary carers of elderly dependent people included in a home care program (n=156; 7.8% loss to follow up).InterventionsInclusion in a home care program for chronically dependent elderly and the assessment of the primary carer in the same year.Variables assessedperceived health, frequency of visits, questionnaires of quality of life (Nottingham questionnaire), psychological health (Goldberg questionnaire), social support (Duke-UNC scale) and overburden of caregivers (Zarit questionnaire) and satisfaction with care received.ResultsThere were no significant changes in perceived health. Improvement in the areas of energy, sleep, emotional and social relationship of the quality of life. Decreased attendance (8.4 vs. 7.5, p<0.05) and the percentage of overusers (30.1 vs 6.9%, P<.01). A reduced percentage of caregivers expressed low social support (8.3 vs 2.8%, P<.05) and caregiver overburden (56.4 vs 44.4%, P<.05). 90.3% of caregivers believed that care had improved at the end of intervention, with a significant improvement of satisfaction of overall medical and nursing care received (7.6 vs 8, 4, 7.9 vs 8.5 and 7 vs 8.5; P<.05).ConclusionsJoining a home care program for dependents has a positive impact on their primary caregiver and improves their perception of care received, reducing their use of health services, reducing the level of overburden and their perceived lack of social support(AU)

[Impact on the primary carer of an intervention carried out on dependent elderly people]. / Impacto sobre el cuidador principal de una intervención realizada a personas mayores dependientes.

OBJECTIVE: To evaluate the impact of joining a home care program on primary caregivers of dependent elderly people. DESIGN: Non-randomised "before-after" intervention study. SETTING: Primary Care. PARTICIPANTS: Primary carers of elderly dependent people included in a home care program (n=156; 7.8% loss to follow up). INTERVENTIONS: Inclusion in a home care program for chronically dependent elderly and the assessment of the primary carer in the same year. VARIABLES ASSESSED: perceived health, frequency of visits, questionnaires of quality of life (Nottingham questionnaire), psychological health (Goldberg questionnaire), social support (Duke-UNC scale) and overburden of caregivers (Zarit questionnaire) and satisfaction with care received. RESULTS: There were no significant changes in perceived health. Improvement in the areas of energy, sleep, emotional and social relationship of the quality of life. Decreased attendance (8.4 vs. 7.5, p<0.05) and the percentage of overusers (30.1 vs 6.9%, P<.01). A reduced percentage of caregivers expressed low social support (8.3 vs 2.8%, P<.05) and caregiver overburden (56.4 vs 44.4%, P<.05). 90.3% of caregivers believed that care had improved at the end of intervention, with a significant improvement of satisfaction of overall medical and nursing care received (7.6 vs 8, 4, 7.9 vs 8.5 and 7 vs 8.5; P<.05). CONCLUSIONS: Joining a home care program for dependents has a positive impact on their primary caregiver and improves their perception of care received, reducing their use of health services, reducing the level of overburden and their perceived lack of social support.

¿Qué cualidades valoran más los Pacientes de su Médico de Familia? / What qualities do patients value more in a Family Doctor?

Objetivo. Conocer qué cualidades del Médico de Familia son más valoradas por los pacientes y en qué medida son cumplidas. Diseño. Estudio descriptivo transversal. Emplazamiento. Atención Primaria. Área de Toledo. Participantes. Mayores de 14 años del Área, seleccionados por muestreo aleatorio sistemático. Mediciones principales. Encuesta telefónica diseñada ad hoc con ítems sobre las características relevantes del médico y el cumplimiento de las mismas, en escala de 0 a 10. Se recogieron también variables sociodemográficas, enfermedades crónicas y utilización de consultas. Resultados. Fueron entrevistados 161 pacientes, con edad media de 42,6 años. El 55,7% mujeres. El 69,7% tenía alguna enfermedad crónica. El 38,6% de ellos había acudido a su médico en el último mes, mientras que el 90,4% lo había hecho en el último año. Las características más valoradas fueron la ‘confiabilidad’ y el ‘trato respetuoso’; las menos valoradas fueron la ‘participación en la toma de decisiones’ y la ‘aceptación de pruebas demandadas por el paciente’. Respecto al grado de cumplimiento de dichas cualidades, destacan el ‘trato respetuoso’ y la ‘confiabilidad’. Conclusiones. La utilización de consulta es muy elevada en nuestro medio. Los pacientes valoran más cualidades de “índole personal” del médico que las de tipo técnico u organizativo. La participación en la toma de decisiones es de las menos valoradas. En general, los médicos del Área de Toledo cumplen en buena medida las expectativas planteadas en lo que a las cualidades personales se refiere (AU)

Objective. To determine what qualities patients value most in a Family Doctor and to what extent their doctors meet these expectations. Design. Cross sectional, descriptive study. Setting. Primary care. Toledo. Participants. Patients over 14 years old, selected by a random sampling method. Main measurements. An ad hoc telephone survey with items on the characteristics of a doctor and compliance to them, measured on a scale of 1 to 10. Socio-demographic variables, chronic diseases and use of doctors’ surgeries were also recorded. Results. A total of 161 patients with a mean age of 42.5 years were interviewed. 55.7% were women. 69,7% had a chronic disease. 38,6% had visited their doctor in the last month, whilst 90.4% had done so in the last year. The most valued characteristics were ‘reliability’ and ‘respectful treatment’; the least valued were “participation in making decisions” and “agreeing to tests requested by the patients”. “Respectful treatment” and “reliability” were the characteristics that most met the patients’ expectations. Conclusions. The use of doctors’ surgeries is very high in our area. The patients valued qualities of a “personal nature” more than technical or organizational qualities. Participation in the decision making process was less valued. In general doctors in the Toledo health area met patients’ expectation as regards personal characteristics (AU)

Influence of waist circumference on the metabolic risk associated with impaired fasting glucose: effect of weight loss after gastric bypass.

BACKGROUND: Impaired fasting glucose (IFG) is a pre-diabetic state defined as a fasting plasma glucose (FPG) between 100 and 125 mg/dl. However, individuals in this group do not exhibit the same atherogenic risk. METHODS: The atherogenic profile of subjects with IFG >110 mg/dl (IFG110, n = 96) or <110 mg/dl (IFG100, n=131) were compared and the potential differential impact of the waist circumference analyzed. In addition, the same clinical variables were measured in 18 morbidly obese patients (8 males, 10 females; BMI 45.3 +/- 1.9 kg/m2) before and after weight loss following Roux-en-Y gastric bypass (RYGBP), in order to analyze the influence of the reduction in waist circumference on the improvement of the metabolic risk factors. RESULTS: Individuals in the IFG110 group showed decreased HDL-cholesterol levels together with an increased total cholesterol to HDL ratio (TC/HDL), accompanied by elevated homocysteine concentrations and white blood cell (WBC) count, and higher waist circumference (P<0.05 for all). Significant correlations between waist circumference and HDL-cholesterol (r=-0.200, P<0.05), TC/HDL (r=0.190, P<0.05), WBC count (r=0.299, P<0.05), and QUICKI (r=-0.375, P<0.0001) were observed. An almost 3-fold increase in the prevalence of T2DM in subjects in the IFG110 group as compared to IFG100 was observed. In the group of patients who underwent RYGBP, the reduction in waist circumference was significantly associated with the improvement in insulin sensitivity as evidenced by the QUICKI index (r=-0.582, P<0.05) and the reduction in TC/HDL (r=0.595, P<0.05). CONCLUSION: Waist circumference is related to metabolic risk factors associated with increased levels of IFG. Our data support that individuals with IFG >110 mg/dl and a high waist circumference should undergo an OGTT to exclude the presence of diabetes.

Tratamiento del teratoma maduro puro de testículo metastatizado. ¿Qué hacer? / The treatment of metastasic testicular pure mature teratoma

OBJETIVO: Dada la escasa frecuencia de teratomas testiculares en relación con el resto de tumores testiculares germinales y las diferentes opciones de tratamiento cuando se encuentran en estadios avanzados, presentamos un caso de teratoma maduro testicular avanzado con adenopatía retroperitoneal al que se realizó tras al orquiectomía una linfadencectomía retroperitoneal con el mismo hallazgo histopatológico que el primario. METODO/RESULTADOS: Realizamos una revisión de la actualidad en el tratamiento en estos estadios con las posibilidades de comenzar con quimioterapia y dejar la linfadenectomía para los residuales o a la inversa, siendo la mayoría de casos tratados de forma mixta. CONCLUSIONES: Sin existir evidencias claras del protocolo a seguir en estos tumores, es aconsejable individualizar el tratamiento en cada paciente según características del tumor, probabilidades de recidiva y seguimento posterior

OBJECTIVE: Given the low frequency of testicular teratoma in relation to the rest of germ cell testicular tumors and the various treatment options for advanced stages, we report one case of advanced testicular mature teratoma with retroperitoneal adenopathy in which orchyectomy was performed after retroperitoneal lymphadenectomy, with the same pathology found in the primary tumor. METHODS: We do an update on the treatment for these stages with the possibility of beginning with chemotherapy leaving lymphadenectomy for residual masses, or the contrary, being most cases treated in a mixed way. CONCLUSIONS: Without clear evidence for guidelines in these tumors, it is recommended to individualize the treatment for each patient, accordingly to tumor characteristics, probability of relapse and follow-up

Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia.

BACKGROUND: Ghrelin is a gastric peptide with potent orexigenic effects. Circulating ghrelin concentrations are increased in obese subjects, but increase after weight loss. However, in patients undergoing Roux-en-Y gastric bypass (RYGBP), a decrease in ghrelin levels has been reported. The effect of comparable weight loss induced by either adjustable gastric banding (AGB), RYGBP or conventional dietary treatment (Conv) on ghrelinemia was studied. METHODS: 24 matched obese male patients in whom similar weight loss had been achieved by either AGB (n=8), RYGBP (n=8) or Conv (n=8) were studied before and 6 months after treatment start. The independence of ghrelin concentrations from body mass index (BMI) and weight loss was further analyzed in a group of patients with total gastrectomy (TtGx, n=6). RESULTS: Comparable weight loss after 6 months exerted significantly different effects on plasma ghrelin concentrations, depending on the procedure applied (AGB: 424.6 +/- 32.8 pg/ml; RYGBP: 131.4 +/- 13.5; Conv: 457.3 +/- 18.7; P<0.001). Without significant differences in body weight and BMI, patients who had undergone the RYGBP exhibited a statistically significant decrease in fasting ghrelin concentrations, while the other two procedures (AGB and Conv) showed a weight loss-induced increase in ghrelin levels. Despite significant differences in BMI between RYGBP and TtGx patients after 6 months (31.9 +/- 2.2 vs 22.0 +/- 0.7 kg/m(2), respectively; P<0.05), both groups showed similar ghrelin concentrations. CONCLUSION: The reduction in circulating ghrelin concentrations in RYGBP patients after 6 months of surgery are not determined by an active weight loss or an improved insulin-sensitivity but rather depend on the surgically-induced bypass of the ghrelin-producing cell population of the fundus.

The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus.

BACKGROUND: Gastric bypass surgery, which involves the production of a reduced stomach pouch,has been shown to markedly suppress circulating ghrelin concentrations. Since bypassing the ghrelin-producing cell population may be relevant to the disruption of fundic-derived factors participating in food intake signaling, the effect of weight loss induced by either adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) was studied. METHODS: 16 matched obese patients [35.0 + 2.4 years; initial body weight 124.8 +/- 5.7 kg; body mass index (BMI) 47.1 +/- 2.2 kg/m(2)] in whom similar weight loss had been achieved by either AGB (n=7), RYGBP (n=6) or BPD (n=3) were studied. Blood was obtained for biochemical and hormonal analyses. Body composition was assessed by air-displacement-plethysmography. RESULTS: Comparable weight loss (AGB: 26.1 +/- 5.1 kg; RYGBP: 32.1 +/- 5.0; BPD: 31.7 +/- 6.1; P=NS) and decrease in percentage body fat (AGB: 10.0 +/- 1.5%; RYGBP: 14.2 +/- 2.8; BPD: 10.3 +/- 1.0; P=NS) induced by bariatric surgery exerted significantly different (P=0.004) effects on plasma ghrelin concentrations, depending on the surgical procedure applied (AGB: 480 +/- 78 pg/ml; RYGBP: 117 +/- 34; BPD: 406 +/- 86). Without significant differences in BMI, body fat, glucose, triglycerides, cholesterol, insulin and leptin levels, patients who had undergone the RYGBP exhibited statistically significant diminished circulating fasting plasma ghrelin concentrations compared with the other two bariatric techniques which conserve direct contact of the fundus with ingested food (P=0.003 vs AGB and P=0.020 vs BPD). CONCLUSION: Fasting circulating ghrelin concentrations in patients undergoing diverse bariatric operations depend on the degree of dysfunctionality of the fundus.

PTEN mutations in eight Spanish families and one Brazilian family with Cowden syndrome.

Cowden syndrome is an autosomal dominant genodermatosis, characterized by the presence of multiple hamartomas in the skin, breast, thyroid, gastrointestinal tract, central nervous system, and an increased risk in developing breast and thyroid carcinomas. Over 80 germline mutations of the tumor suppressor gene PTEN, on chromosome 10q23, have been reported in more than 100 unrelated patients and families; however, questions regarding distribution of the mutations in populations from different geographic areas, and phenotypic expression are still unclear. In this study the results are reported of mutation analysis of PTEN in 13 families from Spain and one family of Brazilian origin with Cowden syndrome. PTEN germline mutations were detected in nine of them (64%). Five mutations were located in exon 5, one in exon 6, two in exon 7, and one in exon 8. Four of the mutations were novel. In another case, an identical change had been previously reported as a somatic mutation in an endometrial carcinoma. In one family, the patient presented a de novo mutation, which was not detected in his parents. In five patients, the detection of the PTEN germline mutation confirmed their condition, even in the absence of sufficient criteria to make the clinical diagnosis of Cowden syndrome.