Pharmaceutical targeting of the cannabinoid type 1 receptor impacts the crosstalk between immune cells and islets to reduce insulitis in humans.

AIMS/HYPOTHESIS: Insulitis, a hallmark of inflammation preceding autoimmune type 1 diabetes, leads to the eventual loss of functional beta cells. However, functional beta cells can persist even in the face of continuous insulitis. Despite advances in immunosuppressive treatments, maintaining functional beta cells to prevent insulitis progression and hyperglycaemia remains a challenge. The cannabinoid type 1 receptor (CB1R), present in immune cells and beta cells, regulates inflammation and beta cell function. Here, we pioneer an ex vivo model mirroring human insulitis to investigate the role of CB1R in this process. METHODS: CD4+ T lymphocytes were isolated from peripheral blood mononuclear cells (PBMCs) from male and female individuals at the onset of type 1 diabetes and from non-diabetic individuals, RNA was extracted and mRNA expression was analysed by real-time PCR. Single beta cell expression from donors with type 1 diabetes was obtained from data mining. Patient-derived human islets from male and female cadaveric donors were 3D-cultured in solubilised extracellular matrix gel in co-culture with the same donor PBMCs, and incubated with cytokines (IL-1ß, TNF-α, IFN-γ) for 24-48 h in the presence of vehicle or increasing concentrations of the CB1R blocker JD-5037. Expression of CNR1 (encoding for CB1R) was ablated using CRISPR/Cas9 technology. Viability, intracellular stress and signalling were assayed by live-cell probing and real-time PCR. The islet function measured as glucose-stimulated insulin secretion was determined in a perifusion system. Infiltration of immune cells into the islets was monitored by microscopy. Non-obese diabetic mice aged 7 weeks were treated for 1 week with JD-5037, then euthanised. Profiling of immune cells infiltrated in the islets was performed by flow cytometry. RESULTS: CNR1 expression was upregulated in circulating CD4+ T cells from individuals at type 1 diabetes onset (6.9-fold higher vs healthy individuals) and in sorted islet beta cells from donors with type 1 diabetes (3.6-fold higher vs healthy counterparts). The peripherally restricted CB1R inverse agonist JD-5037 arrested the initiation of insulitis in humans and mice. Mechanistically, CB1R blockade prevented islet NO production and ameliorated the ATF6 arm of the unfolded protein response. Consequently, cyto/chemokine expression decreased in human islets, leading to sustained islet cell viability and function. CONCLUSIONS/INTERPRETATION: These results suggest that CB1R could be an interesting target for type 1 diabetes while highlighting the regulatory mechanisms of insulitis. Moreover, these findings may apply to type 2 diabetes where islet inflammation is also a pathophysiological factor. DATA AVAILABILITY: Transcriptomic analysis of sorted human beta cells are from Gene Expression Omnibus database, accession no. GSE121863, available at https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSM3448161 .

Comparación del estado nutricional de estudiantesuniversitarios wixaritári y mestizos: indicadoresantropométricos y vulnerabilidad social / Comparison of the nutritional status of university students from wixaritáriand mestizos: anthropometric indicators and social vulnerability

Objetivo: Describir y comparar el estado nutricional de estudiantes universitarios wixaritári y mestizos a través de indicadores antropométricos. Métodos: Estudio descriptivo transversal. A cada estudiante se le tomaron las mediciones antropométricas de peso, talla, circunferencia media de brazo, de cadera, cintura, diámetro humeral, pliegue cutáneo bicipital, tricipital, subescapular y suprailíaco, se obtuvieron los índices antropométricos: índice de masa corporal, índice cintura cadera, riesgo cardiovascular por ICC, porcentaje de grasa corporal y complexión. Resultados: Existió una muestra de 388 estudiantes universitarios, de los cuales 46 son alumnos que pertenecen a la etnia wixárika y 342 son mestizos. Se presentó una diferencia estadísticamente significativa (p ≤0,05) en talla, circunferencia de cadera, PCT, PCB, PCSI y PCSE, el IMC y la distribución de grasa. Un porcentaje del 45%(154) de los estudiantes mestizos presento malnutrición y comparado con solo un 17.7%(8) de los estudiantes wixaritári, siendo el sobrepeso el problema con mayor prevalencia en ambos grupos. En cuanto a la complexión, un 76.8%(298) es la media de complexión pequeña, un 21.6% (84) la media de complexión mediana y un 1.8% (6) la media de complexión grande de toda la muestra. En cuanto a la distribución de grasa, un porcentaje más alto de alumnos wixaritári presentan distribución androide. Conclusiones: Es necesaria la creación de políticas públicas institucionales que consideren las necesidades de sus grupos específicos, de manera que se pueda construir un ambiente que fortalezca la dimensión identitaria de sus grupos, garantizando la preservación de sus valores y tradiciones de la cultura, asegurando espacios y alimentos que sean apropiados.(AU)

Objective: Describe and compare the nutritional status ofwixaritari and mestizo university students through anthropometric indicators. Methods: Descriptive cross-sectional study. Anthropometricmeasurements of weight, height, average arm circumference,hip, waist, humeral diameter, bicipital, tricipital, subscapular andsuprailiac skin fold were taken for each student, anthropometricindices were obtained: body mass index, waist index hip, cardiovascular risk due to CHF, body fat percentage and complexion. Results: There was a sample of 388 university students, ofwhich 46 are students belonging to the Wixárika ethnic groupand 342 are mestizos. There was a statistically significant difference (p ≤ 0.05) in size, hip circumference, PCT, PCB, PCSIand PCSE, BMI and fat distribution. A percentage of 45%(154) of the mestizo students presented malnutrition andcompared with only 17.7% (8) of the wixaritári students, being the overweight the most prevalent problem in bothgroups. As for the complexion, 76.8% (298) is the average ofsmall complexion, 21.6% (84) the average of medium complexion and 1.8% (6) the average of large complexion of theentire sample. Regarding fat distribution, a higher percentageof wixaritári students have an android distribution. Conclusions: The creation of institutional public policiesthat consider the needs of their specific groups is necessary,so that an environment that strengthens the identity dimension of their groups can be built, guaranteeing the preservation of their values and traditions of culture, ensuring spacesand food That are appropriate.(AU)

Microglia HMC3 cells are highly susceptible to Rhinovirus infection.

Human rhinovirus (HRV) affects the lower and upper respiratory tract, however, some studies suggest that HRV infection can lead to extrapulmonary complications in critical illness. Moreover, some reports have shown the presence of HRV in patients with Central Nervous System (CNS) disease. During a CNS infection, the microglia cells are the first line of defense against pathogens. In this study, the susceptibility of the human microglial clone 3 cell line (HMC3) to HRV infection was analyzed. Our findings demonstrate for the first time that HRV is capable of completing the entire viral cycle in microglial cells.

Ocular Histopathologic Features of Congenital Zika Syndrome.

Importance: Congenital Zika syndrome (CZS) is known to be associated with severe malformations in newborns. Although microcephaly is the hallmark of this disease, the ocular findings are important given the severe visual impairment that has been observed in these patients. Regardless of the increased number of CZS cases reported, to date, no studies have described the ocular histopathologic findings of this entity. Objectives: To evaluate the presence of Zika virus (ZIKV) antigens and describe the associated ocular histopathologic features of 4 cases of CZS. Design, Setting, and Participants: In this observational case series performed from June 19, 2015, through April 30, 2017, ocular tissue samples from 4 deceased fetuses with a diagnosis of CZS from the National Institute of Health in Colombia were sent to the Florida Lions Ocular Pathology Laboratory for evaluation. Main Outcomes and Measures: The microscopic features of each specimen were described, and immunostaining was performed using a ZIKV NS2B protein antibody. Results: Ocular tissue samples from the 4 deceased fetuses (2 female, 2 male) ranging from 21.5 to 29 weeks' gestation with a diagnosis of CZS were studied. The 4 eyes manifested with pupillary membranes, immature anterior chamber angles, loss of pigment and thinning of the retinal pigment epithelium, choroidal thinning, undifferentiated nuclear layers of the retina, and a perivascular inflammatory infiltrate within the choroid. The optic nerve, present in 2 of the eyes, demonstrated atrophy. Expression of ZIKV antigen was present in the iris in cases 1, 3, and 4; the neural retina and choroid in case 1; and in the optic nerve in case 4. Conclusions and Relevance: Loss of retinal pigment epithelium, the presence of a thin choroid, a perivascular choroidal inflammatory infiltrate, and atrophic changes within the optic nerve were consistently present. These findings may be attributed to ZIKV infection and warrant further study.

Reliability of age estimation from iliac auricular surface in a subactual Chilean sample.

The aim of this study was to test the reliability of Osborne et al. (2004) [8] age estimation based on the iliac auricular surface of the ilium. We selected 172 skeletons with documented sex and age-at-death and established six uniformly distributed age intervals for analysis. ANOVA was employed to assess the association of the documented age with sex and the auricular surface classification. We employed Bonferroni post-hoc tests to find any statistical differences across documented ages within each phase of Osborne's criteria. While the ANOVA showed a significant association between the documented age and the auricular surface classification, post-hoc tests found that phases 2 and 3 were the only consecutive phases with significant differences. We argue that a lack of statistical significance between consecutive phases undermines the reliability of this method for forensic purposes especially in middle adults. It may be possible that the collapse of intermediate phases would increase the accuracy of this method.

Severe Neurologic Disorders in 2 Fetuses with Zika Virus Infection, Colombia.

We report the results of pathologic examinations of 2 fetuses from women in Colombia with Zika virus infection during pregnancy that revealed severe central nervous system defects and potential associated abnormalities of the eye, spleen, and placenta. Amniotic fluid and tissues from multiple fetal organs tested positive for Zika virus.

Alteraciones lipídicas y su relación con los niveles de vitamina D en menores de 18 años con diabetes tipo 1 / Lipid changes and their relationship with vitamin D levels in children under 18 years with type 1 diabetes

Objetivo: Analizar en menores de 18 años con diabetes mellitus tipo 1 (DM1) las alteraciones lipídicas y su relación con los niveles de 25 hidroxi vitamina D3 (25-OH-D). Material y métodos: Estudio transversal y descriptivo. Se incluyen menores de 18 años con DM1 mediante un muestreo no aleatorizado consecutivo. Determinaciones: sexo, edad, estadio puberal, tiempo de evolución de la DM1, peso, talla, índice de masa corporal, perímetro abdominal, hemoglobina glucosilada (HbA1c) 25-OH-D, colesterol total, LDL-colesterol, HDL-colesterol y triglicéridos (TG). Se estratifican los resultados para sexo, edad y estadio puberal. Se analizan los datos con el programa SPSS®. Resultados: Se recogen 90 pacientes: edad media de 11,7 ± 3,6 años, predominio masculino (51,1%) y HbA1c media de 7,5 ± 1,3%. El 26,6% presentan 25-OH-D < 20 ng/ml y el 13,3% 25-OH-D ≤ 15 ng/ml. No se observan diferencias en la 25-OH-D en pacientes con sobrepeso-obesidad respecto al resto. El 1,1% presentan HDL-colesterol < 40 ng/ml, el 34,4% LDL-colesterol ≥ 100 mg/dl y el 2,2% TG ≥ 150 mg/dl. Los pacientes con 25-OH-D < 20 ng/ml presentan valores superiores de TG que el resto (76,80 ± 45,62 vs 57,55 ± 26,08; p = 0,04) en el análisis multivariante para índice de masa corporal, perímetro abdominal y HbA1c. Se observa correlación entre los niveles de 25-OH-D y los TG (–0,230; p = 0,029). Conclusión: En nuestra población los pacientes con insuficiencia de vitamina D muestran valores de TG superiores. Debe realizarse un seguimiento a largo plazo para conocer las repercusiones sobre las complicaciones relacionadas con la diabetes (AU)

Objective: To analyze lipid changes and their relationship with 25-hydroxy vitamin D3 (25-OH-D) levels in patients under 18 years old with type 1 diabetes mellitus (T1DM). Material and methods: A cross-sectional, descriptive study. Patients under 18 years with T1DM were enrolled by consecutive, nonrandomized sampling. Data collected included sex, age, pubertal stage, time since T1DM onset, weight, height, body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), 25-OH-D, total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and triglycerides (TG). Results were stratified by sex, age, and pubertal stage. Data were analyzed using SPSS®. Results: Ninety patients with a mean age of 11.7 ± 3.6 years (51.1% males) and mean HbA1c levels of 7.5 ± 1.3% were enrolled. Of these, 26.6% had 25-OH-D levels < 20 ng/mL and 13.3% 25-OH-D levels ≤ 15 ng/mL. No differences were found in 25-OH-D between patients with overweight or obesity and the rest. HDL-C levels < 40 ng/mL were found in 1.1%, 34.4% had LDL-C levels ≥ 100 mg/dL, and 2.2% had TG levels ≥ 150 mg/dL. Patients with 25-OH-D < 20 ng/mL had higher TG levels than the rest (76.80 ± 45.62 vs 57.55 ± 26.08; P = .04) in the multivariate analysis controlled for BMI, waist circumference, and HbA1c. A correlation was found between 25-OH-D and TG levels (-0.230;P = .029). Conclusions: Patients in our population with vitamin D deficiency had higher TG levels. Long-term follow-up should be performed to understand the potential impact of such levels on diabetes-related complications (AU)

Lipid changes and their relationship with vitamin D levels in children under 18 years with type 1 diabetes.

OBJECTIVE: To analyze lipid changes and their relationship with 25-hydroxy vitamin D3 (25-OH-D) levels in patients under 18 years old with type 1 diabetes mellitus (T1DM). MATERIAL AND METHODS: A cross-sectional, descriptive study. Patients under 18 years with T1DM were enrolled by consecutive, nonrandomized sampling. Data collected included sex, age, pubertal stage, time since T1DM onset, weight, height, body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), 25-OH-D, total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and triglycerides (TG). Results were stratified by sex, age, and pubertal stage. Data were analyzed using SPSS(®). RESULTS: Ninety patients with a mean age of 11.7 ± 3.6 years (51.1% males) and mean HbA1c levels of 7.5 ± 1.3% were enrolled. Of these, 26.6% had 25-OH-D levels<20 ng/mL and 13.3% 25-OH-D levels ≤ 15 ng/mL. No differences were found in 25-OH-D between patients with overweight or obesity and the rest. HDL-C levels<40 ng/mL were found in 1.1%, 34.4% had LDL-C levels ≥ 100 mg/dL, and 2.2% had TG levels ≥ 150 mg/dL. Patients with 25-OH-D<20 ng/mL had higher TG levels than the rest (76.80 ± 45.62 vs 57.55 ± 26.08; P=.04) in the multivariate analysis controlled for BMI, waist circumference, and HbA1c. A correlation was found between 25-OH-D and TG levels (-0.230; P=.029). CONCLUSIONS: Patients in our population with vitamin D deficiency had higher TG levels. Long-term follow-up should be performed to understand the potential impact of such levels on diabetes-related complications.

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

No disponible

Dietary practices in ancient populations from northern Chile during the transition to agriculture (Tarapacá region, 1000 BC-AD 900).

OBJECTIVE: The goal of this research is to understand the relevance of diet diversity during the transition to agriculture, in ancient populations from northern Chile, especially considering the significance of marine resources and crops in a lesser degree. METHODS: A total of 14 human individuals were sampled from the Tarapacá 40 cemetery. Both bone and tooth samples were collected. Samples were studied from bone/dentine collagen for carbon and nitrogen isotopic analysis; and bone/enamel apatite for carbon isotope analysis. Inferential statistical analyses were performed in order to compare Tarapacá 40 stable carbon and nitrogen isotope values with other Formative and Late Intermediate Period groups. A nonparametrical hypothesis Kruskal-Wallis test was used. RESULTS: The results show that the individuals from Tarapacá 40 are intermediate to the values observed for terrestrial and marine fauna as well as C3 and C4 plants. CONCLUSIONS: A gradual transition to crop consumption, especially maize, is suggested. This complemented the earlier hunter-gatherer tradition of marine resources and wild fruit consumption. Contrarily to the predictions made by some archaeologists, the results obtained for northern Chile contrast with the classical perspective of a "Neolithic Revolution" in which transition to agriculture occurred more abruptly and linearly.

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.

Past major depression and smoking cessation outcome: a systematic review and meta-analysis update.

AIMS: To update our prior meta-analysis that showed past major depression (MD+) to be unrelated to smoking cessation outcome. METHODS: Eligible trials included 14 from our original review and 28 identified through an updated systematic review (2000-2009). We coded for assessment of past MD, exclusion for recent MD episode (MDE; ≤6 months versus no exclusion), duration/modality of cognitive behavioral treatment (CBT; face-to-face versus self-help) and other factors. To minimize influence of experimental treatments that may selectively benefit MD+ smokers we analyzed placebo/lowest intensity control arms only. Study-specific ORs for the effect of past MD on short-term (≤3 months) and long-term (≥6 months) abstinence were estimated and combined using random effects. Two-way interaction models of past MD with study methodology and treatment factors were used to evaluate hypothesized moderators of the past MD-abstinence association. RESULTS: MD+ smokers had 17% lower odds of short-term abstinence (n = 35, OR = 0.83, 95% CI = 0.72-0.95, P = 0.009) and 19% lower odds of long-term abstinence (n = 38, OR = 0.81, 95% CI = 0.67-0.97, P = 0.023) than MD- smokers after excluding the sole study of varenicline because of its antidepressant properties. The association between past MD and abstinence was affected by methodological (recent MDE exclusion, type of MD assessment) and treatment (CBT modality) factors. CONCLUSIONS: Past major depression has a modest adverse effect on abstinence during and after smoking cessation treatment. An increased focus on the identification of effective treatments or treatment adaptations that eliminate this disparity in smoking cessation for MD+ smokers is needed.

Análisis del control del paciente diabético en el área de atención primaria Mancha-Centro de Castilla-La Mancha. Barómetro de la diabetes / Analysis of diabetic patient control in the Primary Care Area of La Mancha-Centro, in the Castile-La Mancha region. Diabetes barometer

OBJETIVOS: Evaluar el control del paciente con diabetes mellitus (DM) en atención primaria(AP), analizando el sistema de registro informático del Sevicio de Salud de Castilla-La Mancha(SESCAM). MATERIAL Y MÉTODOS: Muestra de 938 pacientes con diagnóstico de DM sobre 14.733 individuos incluidos en el año 2009 en el registro informático del SESCAM del área Mancha Centro (Turriano), que comprende 25 centros de AP. Se analizaron distintos parámetros clínicos y analíticos: hemoglobina glicosilada (HbA1c), colesterol total (CT), presión arterial (PA) e índice de masa corporal(IMC), así como el número de procesos por paciente/año: análisis de HbA1c y lípidos, controles de PA, monitorizaciones de pie diabético y revisiones oculares. RESULTADOS: La prevalencia de diabetes conocida fue del 6,36% en la población general. El 54%de los pacientes presentaron una HbA1c < 7%, y el 24,1%, > 8%. El 79% asociaban sobrepeso u obesidad. El 38% eran hipertensos. No se realizó control de CT en el 16% de los individuos, obteniendo valores por debajo de 200 mg/dl en el 45%. Se registró menos de una revisión de pie al año, ninguna revisión ocular, ni control de microalbuminuria. CONCLUSIONES: El sistema «Turriano» es eficaz en el registro de pacientes con diabetes. La mayoría de los pacientes de nuestro estudio presentan un buen control metabólico y de los factores de riesgo cardiovascular

AIMS: To determine the clinical control of patients with diabetes in Primary Care in the a Mancha Centro area (Castile-La Mancha region).MATERIAL AND METHODS: The computerised records system of the Regional Health Service in Castile-La Mancha (Turriano) included 14,733 patients in 2009, in which 938 patients with diabetes were identified in the 25 centres belonging to La Mancha Centro area. Several parameters were collected: HbA1c, total cholesterol, blood pressure, and body mass index (BMI). The number of process per patient/year also were also collected, including number of: HbA1c, total cholesterol, blood pressure controls, feet controls, and eyes controls. RESULTS: Diabetes prevalence was 6.36% of the general population. The HbA1c was measured on average once a year. An HbA1c under 7 mg/dL was found in 54% of patients, and greater than 8 mg/dL in 24.1% of them. The large majority (79%) of patients with diabetes were overweight or obese. Hypertension was found in 40% of the patients. Total cholesterol was not controlled in 16% of patients; 45% had a total cholesterol under 200 mg/dL. Less than one check-up of the feet was done, and no eye control nor microalbuminuria were registered. CONCLUSIONS: The Turriano system is effective for recording the diabetic population. Most patients in our study showed good metabolic control as well as of cardiovascular risk factors