Lesiones orales, alteraciones sistémicas y patrón nutricional de adultos mayores en Cartagena, Colombia / Oral lesions, systemic disorders and nutritional pattern of elderlies in Cartagena, Colombia

Introducción: La edad trae consigo cambios en la estructura y función de la cavidad bucal. Factores como el metabolismo y la nutrición pueden asociarse con la aparición de lesiones orales. El objetivo del presente trabajo consistió en describir la prevalencia de lesiones orales, alteraciones sistémicas y patrón nutricional de una muestra de adultos mayores en Cartagena (Colombia). Materiales y métodos: Se realizó un estudio descriptivo transversal en cinco centros geriátricos en Cartagena (Colombia). Se evaluó el estado de salud bucal y sistémico mediante examen intraoral e historia clínica; además, el patrón nutricional mediante un cuestionario de frecuencia de consumo de alimentos (FFQ). El análisis de los datos se realizó mediante estadística descriptiva. Resultados: Se evaluaron 185 adultos mayores a 59 años; 51,9% corresponden al género femenino y 48,1% al género masculino. Según el estado de salud bucal, las lesiones orales observadas con mayor frecuencia fueron el tumor compatible con torus (47,1%) y fisuras en lengua (24,9%). Conforme al estado de salud sistémico las enfermedades mas frecuentes fueron la hipertensión arterial (50,8%) y la diabetes mellitus (38,4%). En cuanto al patrón nutricional, se observó un alto consumo de alimentos farináceos (ricos en hidratos de carbono complejos) (3.408±1.068 gr/semana), frutas (1.956±1.682 gr/semana) y productos lácteos (1.616±514 gr/semana). Conclusión: La muestra de adultos mayores evaluada presenta lesiones orales y enfermedades sistémicas frecuentes en este grupo poblacional. Sin embargo, la condición nutricional puede estar alterada por el bajo consumo de alimentos con alto contenido proteico

Introduction: Age brings with it changes in the structure and function of the oral cavity. Factors such as metabolism and nutrition may be associated with the occurrence of oral lesions. The objective of the present study was to describe the prevalence of oral lesions, systemic alterations and nutritional pattern of a sample of elderly adults in Cartagena (Colombia). Materials and methods: A cross-sectional descriptive study was carried out in five geriatric centers in Cartagena (Colombia). The state of oral and systemic health was evaluated through intraoral examination and clinical history; In addition, the nutritional pattern through a Food Frequency Questionnaire (FFQ). Data analysis was performed using descriptive statistics. Results: 185 adults older than 59 years were evaluated. 51.9% correspond to the female gender and 48.1% to the male gender. According to the state of oral health, the oral lesions most frequently observed were the tumor torus-compatible (47.1%) and tongue fissures (24.9%). According to the state of systemic health, the most frequent diseases were arterial hypertension (50.8%) and diabetes mellitus (38.4%). As for the nutritional pattern, a high consumption of farinaceous foods (rich in complex carbohydrates) (3408±1068 gr/week), fruits (1956±1682 gr/week) and dairy products (1616±514 gr/week). Conclusion: The sample of older adults evaluated presents oral lesions and systemic diseases frequent in this population group. However, the nutritional status may be altered by the low consumption of foods with high protein content

The Suprachiasmatic Nucleus Modulates the Sensitivity of Arcuate Nucleus to Hypoglycemia in the Male Rat.

The suprachiasmatic nucleus (SCN) and arcuate nucleus (ARC) have reciprocal connections; catabolic metabolic information activates the ARC and inhibits SCN neuronal activity. Little is known about the influence of the SCN on the ARC. Here, we investigated whether the SCN modulated the sensitivity of the ARC to catabolic metabolic conditions. ARC neuronal activity, as determined by c-Fos immunoreactivity, was increased after a hypoglycemic stimulus by 2-deoxyglucose (2DG). The highest ARC neuronal activity after 2DG was found at the end of the light period (zeitgeber 11, ZT11) with a lower activity in the beginning of the light period (zeitgeber 2, ZT2), suggesting the involvement of the SCN. The higher activation of ARC neurons after 2DG at ZT11 was associated with higher 2DG induced blood glucose levels as compared with ZT2. Unilateral SCN-lesioned animals, gave a mainly ipsilateral activation of ARC neurons at the lesioned side, suggesting an inhibitory role of the SCN on ARC neurons. The 2DG-induced counterregulatory glucose response correlated with increased ARC neuronal activity and was significantly higher in unilateral SCN-lesioned animals. Finally, the ARC as site where 2DG may, at least partly, induce a counterregulatory response was confirmed by local microdialysis of 2DG. 2DG administration in the ARC produced a higher increase in circulating glucose compared with 2DG administration in surrounding areas such as the ventromedial nucleus of the hypothalamus (VMH). We conclude that the SCN uses neuronal pathways to the ARC to gate sensory metabolic information to the brain, regulating ARC glucose sensitivity and counterregulatory responses to hypoglycemic conditions.

Tratamiento del dolor neuropático central; futuras terapias analgésicas. Revisión sistemática / Treatment of central neuropathic pain; future analgesic therapies. Systematic review

Introducción: el dolor neuropático central (DNC) es aquel causado por una lesión primaria o disfunción del sistema nervioso central que genera una patología incapacitante, difícil de reconocer y tratar. Las causas más frecuentes son accidente cerebrovascular (ACV), esclerosis múltiple y lesión medular traumática. Objetivos: realizar revisión sistemática de las principales causas de dolor neuropático central, presentar evidencia de la efectividad y tolerabilidad de las opciones terapéuticas actuales y analizar las tendencias analgésicas futuras. Material y métodos: se realizó búsqueda de metaanálisis y revisiones sistemáticas en MEDLINE/PubMed, EMBASE, Ovid y Registro Cochrane de Ensayos Controlados (CENTRAL) usando diferentes estrategias de búsqueda. Los artículos relacionados con el DNC se clasificaron según su etiopatogenia en dolor post-ACV (CPSP), dolor por esclerosis múltiple (EM) y dolor post-lesión medular (LME), y fueron evaluados de forma sistémica. Resultados: actualmente se tiene una incompleta compresión de la fisiopatología de este tipo de dolor; existen muy pocos estudios, en comparación con otros tipos de dolor, siendo estos en su mayoría estudios con muestras pequeñas, diseño abierto en humanos o modelos animales. Se precisa la utilización de instrumentos específicos de evaluación del dolor, validadas para cada patología, así como incluir un enfoque multi-modal para tratar este dolor de reconocida naturaleza multifactorial, combinando terapias farmacológicas, físicas, psicológicas e intervenciones cognitivo-conductuales. Conclusiones: se necesitan más estudios para comprender la fisiopatología del dolor neuropático central, mejorar la eficacia de los tratamientos y definir pacientes candidatos a cada uno según características clínicas, síntomas o signos predictivos. Así como investigar las nuevas modalidades terapéuticas, comparándolas con fármacos activos de referencia. En la actualidad no hay suficiente evidencia científica sólida para poder realizar protocolos estandarizados para el tratamiento del DNC (AU)

Background: The central neuropathic pain (DNC) is that caused by a primary lesion or dysfunction of the central nervous system that generates an incapacitating condition, difficult to recognize and treat. The most common causes are stroke (CVA), multiple sclerosis and spinal cord injury. Objectives: To perform a systematic review of the main causes of central neuropathic pain, present evidence of the effectiveness and tolerability of current treatment options and analyze trends analgesic for future. Material and methods: We performed meta-analysis and search for systematic reviews in MEDLINE/PubMed, EMBASE, Ovid and Cochrane Central Register of Controlled Trials (CENTRAL) using different search strategies. The DNC related articles were classified by etiopathogenesis poststroke pain (CPSP), pain of multiple sclerosis (MS) and pain after spinal cord injury (SCI), and were evaluated systemically. Results: Currently we have an incomplete understanding of the pathophysiology of this type of pain, there are few studies, in comparison with other types of pain, and these studies mostly with small samples, open design in human or animal models. It requires the use of specific and validated assessment instruments specific to each condition, and to include a multi-modal approach to treatment, combining drug therapies, physical, psychological and cognitive behavioral interventions. Conclusions: We need more studies to understand the pathophysiology of the central neuropathic pain, improve the effectiveness of treatments and identify eligible patients each according to clinical characteristics, symptoms or signs predictive, and to investigate new therapeutic modalities, comparing drug reference assets. At present there is not enough solid evidence to perform standardized protocols for treatment of DNC (AU)

Manejo del dolor crónico en Atención Primaria, perfil de prescripción de opiáceos mayores: indicación, coste y efectos secundarios / Managing chronic pain in Primary Care, prescription profile for strong opioids: indications, cost and adverse effects

Objetivos: el objetivo principal del estudio es conocer las características de la prescripción de opiáceos mayores en Atención Primaria. Material y métodos: se diseña un estudio retrospectivo mediante una cohorte histórica, valorando a los pacientes que hayan consumido opiáceos mayores en todos los centros de salud de Jaén capital durante 2011, mediante un muestreo sistemático, 215 pacientes, calculando el tamaño de muestra para un nivel de confianza 95 %, precisión 5 %, y pérdidas 5 % (ampliando la muestra este 5 % por sesgo de información); Se auditan las historias clínicas recogiendo: edad, sexo, antecedentes personales, nivel social, frecuentación sanitaria, características de la prescripción de opiáceos (dosis, duración, coste, efectos secundarios) y uso de otros analgésicos/coadyuvantes. Se procesan los datos para ofrecer un estudio descriptivo y una posterior comparación en función del opiáceo prescrito. Resultados: se valoran 215 pacientes (44 % del total de la población), de los que se obtienen 323 prescripciones de opiáceos en el año de estudio (23 % de la muestra con dos prescripciones de opiáceos y 13 % con tres). Los opiáceos más prescritos son fentanilo (60 %) y buprenorfina (22%), por un 3 % de morfina. La buprenorfina es el más usado en monoterapia (70 %), preferentemente en mujeres de edad avanzada y pensionistas, sobre todo para el dolor mixto por parte del médico de familia. El fentanilo se usa principalmente en parches (95 % de las prescripciones de fentanilo) y la hidromorfona se emplea en pacientes de menor edad (< 60 años), prescrito por la Unidad del Dolor y Reumatología (43 % y 20 % del total de prescripciones, respectivamente). La oxicodona se emplea más en pacientes de zonas necesitadas de transformación social (46 % del total de opioides prescritos en ZNTS) y exclusivamente para el dolor neuropático y mixto (52 % y 48 % respectivamente de las prescripciones totales de oxicodona), sobre todo por parte de Reumatología y Unidad del Dolor (25 % y 43 % del total de prescripciones respectivamente). La morfina se emplea en pacientes oncológicos por vía oral (46 % de las prescripciones de morfina), la mitad en formulación retard (45 % de las prescripciones de morfina), siendo estos pacientes quienes presentan una demanda sanitaria superior (91 % del total de pacientes con prescripción de morfina, acuden al servicio de urgencias, y un 46 % precisan ingreso hospitalario). Conclusiones: como medida de mejora, contrastando los resultados obtenidos, se debería fomentar la prescripción de morfina como analgésico de elección tanto en dolor agudo como en dolor crónico severo. Es preciso mejorar los instrumentos de medida específicos para cada tipo de dolor teniendo en cuenta la etiopatogenia de este, así como fomentar una mayor utilización de escalas de valoración, tanto al inicio del tratamiento, como durante el seguimiento de cada paciente para evaluar la evolución del dolor y la efectividad del tratamiento (AU)

Objectives: The main objective of the study was to determine the characteristics of major opioids prescribing in Primary Care. Material and methods: A retrospective study was designed through the use of a historical cohort, assessing patients who have consumed major opiates in all Jaén city health centers during 2011, by systematic sampling, 215 patients, computing the sample size for a confidence level of 95 %, accuracy 5 %, 5 % losses (expanding the 5 % sample by reporting bias). Medical records were audited to collect the following data: Age, sex, medical history, social status, number of appointments and use of hospital resources, characteristics of opioids prescription (dose, duration, cost, adverse reaction) and use of other analgesics/ adjuvants. Data were processed for a descriptive study and a subsequent comparison according to the prescribed opioid. Results: 215 patients were included (44 % of total population) those obtained 323 prescriptions for opiates in the study year (23 % of the sample with two prescriptions of opiates and 13 % with three). Most prescribed opioids were fentanyl (60 %) and buprenorphine (22 %) and the least prescribed is by 3 % morphine. Buprenorphine is the most used in monotherapy (70 %), preferably in older women and pensioners, especially for joint pain by the general practitioner. The fentanyl is mainly used in patches (95 % of prescriptions of fentanyl) and hydromorphone is used in younger patients (< 60 years), prescribed by the Pain and Rheumatology Departments (43 % and 20 % of total prescriptions, respectively). Oxycodone is used in patients from areas with social transformation needs (46 % of prescribed opioids in ZNTS) and exclusively for neuropathic and mixed pain (52 % and 48 % respectively of total prescriptions of oxycodone), especially by the Rheumatology and Pain Unit. Morphine is used orally in cancer patients (46 % of prescriptions for morphine), half in retard formulation (45 % of prescriptions for morphine), and these patients were who have a higher healthcare demands (91 % of totals patients prescribed morphine, go to the emergency department, and 46 % required hospital admission). Conclusions: As improvement measure, after contrasting the results, we should encourage the prescription of morphine as an analgesic of choice in both acute and chronic severe pain. An improvement in the measuring instruments specific to each type of pain considering its pathogenesis is required, as well as fostering a greater use of rating scales, both at the start of treatment and during the follow-up of each patient to assess the evolution of pain and treatment effectiveness (AU)

The suprachiasmatic nucleus changes the daily activity of the arcuate nucleus α-MSH neurons in male rats.

Timing of metabolic processes is crucial for balanced physiology; many studies have shown the deleterious effects of untimely food intake. The basis for this might be an interaction between the arcuate nucleus (ARC) as the main integration site for metabolic information and the suprachiasmatic nucleus (SCN) as the master clock. Here we show in male rats that the SCN influences ARC daily neuronal activity by imposing a daily rhythm on the α-MSH neurons with a peak in neuronal activity at the end of the dark phase. Bilateral SCN lesions showed a complete disappearance of ARC neuronal rhythms and unilateral SCN lesions showed a decreased activation in the ARC at the lesioned side. Moreover light exposure during the dark phase inhibited ARC and α-MSH neuronal activity. The daily inhibition of ARC neuronal activity occurred in light-dark conditions as well as in dark-dark conditions, demonstrating the inhibitory effect to be mediated by increased SCN (subjective) day neuronal activity. Injections into the SCN with the neuronal tracer cholera toxin B showed that α-MSH neurons receive direct projections from the SCN. The present study demonstrates that the SCN activates and possibly also inhibits depending on the moment of the circadian cycle ARC α-MSH neurons via direct neuronal input. The persistence of these activity patterns in fasted animals demonstrates that this SCN-ARC interaction is not necessarily satiety associated but may support physiological functions associated with changes in the sleep-wake cycle.

The NPY intergeniculate leaflet projections to the suprachiasmatic nucleus transmit metabolic conditions.

The intergeniculate leaflet (IGL) is classically known as the area of the Thalamic Lateral Geniculate Complex providing the suprachiasmatic nucleus (SCN) non-photic information. In the present study we investigated whether this information might be related to the metabolic state of the animal. The following groups of male Wistar rats were used for analysis of neuropeptide Y (NPY) and c-Fos in the IGL and SCN. (1) Fed ad libitum. (2) Fasted for 48 h. (3) Fasted for 48 h followed by refeeding for 3 h. (4) Monosodium glutamate-lesioned and 48 h fasted. (5) Electrolytic lesion in the IGL and 48 h fasted. The results were quantified by optical densitometry. Neuronal tracers were injected in two brain areas that receive metabolic information from the periphery, the arcuate nucleus (ARC) and Nucleus of the Tractus Solitarius to investigate whether there is an anatomical relationship with the IGL. Lesion studies showed the IGL, and not the ARC, as origin of most NPY projections to the SCN. Fasting induced important changes in the NPY expression in the IGL, coinciding with similar changes of NPY/glutamate decarboxylase projections of the IGL to the SCN. These changes revealed that the IGL is involved in the transmission of metabolic information to the SCN. In fasted animals IGL lesion resulted in a significant increase of c-Fos in the SCN as compared to intact fasted animals demonstrating the inhibitory influence of the IGL to the SCN in fasting conditions. When the animal after fasting was refed, an increase of c-Fos in the SCN indicated a removal of this inhibitory input. Together these observations show that in addition to increased inhibitory IGL input during fasting, the negative metabolic condition also results in increased excitatory input to the SCN via other pathways. Consequently the present observations show that at least part of the non-photic input to the SCN, arising from the IGL contains information about metabolic conditions.