Gravedad de COVID-19 atribuible a obesidad según IMC y CUN-BAE / Severity of COVID-19 attributable to obesity according to BMI and CUN-BAE

Introducción La obesidad es considerada un factor de riesgo en casos graves de la COVID-19, habiendo sido analizada mediante el índice de masa corporal (IMC), estimador que no correlaciona adecuadamente con el porcentaje de grasa corporal (GC). El objetivo de este estudio ha sido analizar la fracción atribuible poblacional a la GC en formas graves de COVID-19 atendiendo al IMC y al CUN-BAE. Material y métodos Estudio multicéntrico observacional de prevalencia. Se recogió información sociodemográfica, antecedentes personales, IMC y CUN-BAE, de casos positivos SARS-CoV-2, de las provincias de León y La Rioja. Mediante modelos de regresión logística se calcularon odds ratio con sus respectivos intervalos de confianza del 95% ajustando por edad y antecedentes personales, así como la fracción atribuible poblacional a la GC. Resultados Participaron 785 pacientes, 123 (15,7%) fueron graves. Se detectaron como factores de riesgo la edad, la obesidad (tanto por IMC como por CUN-BAE) y los antecedentes personales. Un 51,6% de casos graves podrían ser atribuidos a un exceso de IMC y un 61,4% a exceso de GC estimada según CUN-BAE, observándose una mayor infraestimación del riesgo en mujeres. Conclusiones El exceso de GC es un factor de riesgo para formas graves de la COVID-19 junto con la edad avanzada y la presencia de enfermedades cardiovasculares, respiratorias crónicas u oncohematológicas. El IMC infraestima el riesgo, especialmente en mujeres, siendo el CUN-BAE el predictor seleccionado por su mejor estimación del porcentaje de GC (AU)

Introduction Obesity is considered a risk factor in severe cases of COVID-19, which has been analysed using body mass index (BMI), an estimator that does not correlate adequately with body fat (BF) percentage. The aim of this study was to analyse the population attributable fraction to BF in severe forms of COVID-19 based on BMI and CUN-BAE. Material and methods Multicentre observational prevalence study. Sociodemographic information, personal history, BMI and CUN-BAE were collected in SARS-CoV-2 positive cases from the provinces of León and La Rioja. Logistic regression models were used to calculate odds ratios with their respective 95% confidence intervals adjusting for age and personal history, as well as the population attributable fraction to BF. Results Seven hundred eighty-five patients participated, 123 (15.7%) were severe. Age, obesity (both by BMI and CUN-BAE) and personal history were detected as risk factors. 51.6% of severe cases could be attributed to excess BMI and 61.4% to excess BF estimated according to CUN-BAE, with a higher underestimation of risk in women. Conclusions Excess BF is a risk factor for severe forms of COVID-19 together with advanced age and the presence of cardiovascular, chronic respiratory or oncohematological diseases. BMI underestimates the risk especially in women, being CUN-BAE the predictor selected for its better estimation of the percentage of BF (AU)

[Severity of COVID-19 attributable to obesity according to BMI and CUN-BAE]. / Gravedad de COVID-19 atribuible a obesidad según IMC y CUN-BAE.

INTRODUCTION: Obesity is considered a risk factor in severe cases of COVID-19, which has been analysed using body mass index (BMI), an estimator that does not correlate adequately with body fat (BF) percentage. The aim of this study was to analyse the population attributable fraction to BF in severe forms of COVID-19 based on BMI and CUN-BAE. MATERIAL AND METHODS: Multicentre observational prevalence study. Sociodemographic information, personal history, BMI and CUN-BAE were collected in SARS-CoV-2 positive cases from the provinces of León and La Rioja. Logistic regression models were used to calculate odds ratios with their respective 95% confidence intervals adjusting for age and personal history, as well as the population attributable fraction to BF. RESULTS: Seven hundred eighty-five patients participated, 123 (15.7%) were severe. Age, obesity (both by BMI and CUN-BAE) and personal history were detected as risk factors. 51.6% of severe cases could be attributed to excess BMI and 61.4% to excess BF estimated according to CUN-BAE, with a higher underestimation of risk in women. CONCLUSIONS: Excess BF is a risk factor for severe forms of COVID-19 together with advanced age and the presence of cardiovascular, chronic respiratory or oncohematological diseases. BMI underestimates the risk especially in women, being CUN-BAE the predictor selected for its better estimation of the percentage of BF.

The influence of interferon ß-1b on gut microbiota composition in patients with multiple sclerosis.

INTRODUCTION: The association between gut microbiota and animal models of multiple sclerosis has been well established; however, studies in humans are scarce. METHODS: We performed a descriptive, cross-sectional study comparing the relative composition of gut microbiota in 30 patients with multiple sclerosis (15 treated with interferon ß-1b, 15 not receiving this treatment) and 14 healthy controls using next generation sequencing. RESULTS: Patients with multiple sclerosis and controls showed differences in the proportion of Euryarchaeota, Firmicutes, Proteobacteria, Actinobacteria, and Lentisphaerae phyla and in 17 bacterial species. More specifically, we found significant differences in the proportion of Firmicutes, Actinobacteria, and Lentisphaerae and 6 bacteria species between controls and untreated patients; however, these differences disappeared when compared with treated patients. Untreated patients showed a significant reduction in the proportion of Prevotella copri compared to controls, while the bacteria was significantly more abundant in patients treated with interferon ß-1b than in untreated patients, with levels resembling those observed in the healthy control group. CONCLUSION: We observed differences in gut microbiota composition between patients with multiple sclerosis and controls, and between patients treated and not treated with interferon ß-1b. In most cases, no differences were observed between treated patients and healthy controls, particularly for P. copri levels. This suggests that the clinical improvements observed in patients with multiple sclerosis receiving interferon ß-1b may result from the effect of the drug on gut microbiota. Longitudinal and functional studies are necessary to establish a causal relationship.

Composición de la microbiota intestinal en pacientes con esclerosis múltiple. Influencia del tratamiento con interferón B-1b / The influence of interferon B–1b on gut microbiota composition in patients with multiple sclerosis

Introducción. El papel de la microbiota en los modelos animales de esclerosis múltiple está bien establecido; por el contrario, los estudios en humanos son escasos.MétodosEstudio transversal descriptivo que compara la composición relativa de la microbiota intestinal en 30 pacientes con esclerosis múltiple (15 tratados con interferón β-1b, 15 sin tratamiento) y 14 controles sanos utilizando la secuenciación de última generación.ResultadosLos sujetos control y los pacientes con esclerosis múltiple presentaron diferente abundancia de los filos Euryarchaeota, Firmicutes, Proteobacteria, Actinobacteria, y Lentisphaerae y 17 especies bacterianas. Concretamente, la abundancia en Firmicutes, Actinobacteria y Lentisphaerae y 6 especies mostró diferencias al comparar los grupos control y sin tratamiento, desapareciendo esta diferencia cuando se compararon con los pacientes tratados. Se observó reducción estadísticamente significativa en la abundancia de Prevotella copri en pacientes sin tratamiento en comparación con controles, mientras que los tratados con interferón β-1b presentaron un aumento significativo frente a pacientes sin tratamiento, asemejándose al grupo de pacientes sanos control.ConclusiónLa composición de la microbiota intestinal fue diferente entre los pacientes con esclerosis múltiple y los controles, y entre los pacientes sin tratamiento y los tratados con interferón β-1b. En la mayoría de los casos, no se encontraron diferencias entre los pacientes tratados y los controles sanos, siendo especialmente evidente con P. copri. Esto podría indicar que la influencia del interferón β-1b sobre la microbiota intestinal podría subyacer en los beneficios clínicos observados en pacientes con esclerosis múltiple que siguen este tratamiento. Serán necesarios estudios longitudinales y funcionales para poder mostrar causalidad. (AU)

Introduction: The association between gut microbiota and animal models of multiple sclerosis has been well established; however, studies in humans are scarce.MethodsWe performed a descriptive, cross-sectional study comparing the relative composition of gut microbiota in 30 patients with multiple sclerosis (15 treated with interferon β–1b, 15 not receiving this treatment) and 14 healthy controls using next generation sequencing.ResultsPatients with multiple sclerosis and controls showed differences in the proportion of Euryarchaeota, Firmicutes, Proteobacteria, Actinobacteria, and Lentisphaerae phyla and in 17 bacterial species. More specifically, we found significant differences in the proportion of Firmicutes, Actinobacteria, and Lentisphaerae and 6 bacteria species between controls and untreated patients; however, these differences disappeared when compared with treated patients. Untreated patients showed a significant reduction in the proportion of Prevotella copri compared to controls, while the bacteria was significantly more abundant in patients treated with interferon β–1b than in untreated patients, with levels resembling those observed in the healthy control group.ConclusionWe observed differences in gut microbiota composition between patients with multiple sclerosis and controls, and between patients treated and not treated with interferon β–1b. In most cases, no differences were observed between treated patients and healthy controls, particularly for P. copri levels. This suggests that the clinical improvements observed in patients with multiple sclerosis receiving interferon β–1b may result from the effect of the drug on gut microbiota. Longitudinal and functional studies are necessary to establish a causal relationship. (AU)

Impact of dietary lipoic acid supplementation on liver mitochondrial bioenergetics and oxidative status on normally fed Wistar rats.

The aim of this study was to examine the effects of α-lipoic acid (α-LA) on liver mitochondrial bioenergetics and oxidative status for 8 weeks in normal-healthy animals. A pair-fed group was included to differentiate between α-LA direct effects and those changes due to reduced food intake. α-LA decreased body weight gain, liver weight and insulin levels with no differences compared to its pair-fed group. α-LA significantly reduced energy efficiency, the activity of the electron transport chain complexes and induced a lower efficiency of oxidative phosphorylation with reduced ATP production. α-LA supplementation directly decreased plasma triglycerides (TGs), free fatty acids and ketone bodies levels. A significant reduction in hepatic TG content was also observed. A significant up-regulation of Cpt1a, Acadl and Sirt3, all ß-oxidation genes, along with a significant deacetylation of the forkhead transcription factor 3a (FOXO3A) was found in α-LA-treated animals. Thus, α-LA along with a standard chow diet has direct actions on lipid metabolism and liver by modulating mitochondrial function in normal-weight rats. These results should be taken into account when α-LA is administered or recommended to a healthy population.

Limited beneficial effects of piceatannol supplementation on obesity complications in the obese Zucker rat: gut microbiota, metabolic, endocrine, and cardiac aspects

Resveratrol is beneficial in obese and diabetic rodents. However, its low bioavailability raises questions about its therapeutic relevance for treating or preventing obesity complications. In this context, many related natural polyphenols are being tested for their putative antidiabetic and anti-obesity effects. This prompted us to study the influence of piceatannol, a polyhydroxylated stilbene, on the prevention of obesity complications in Zucker obese rats. A 6-week supplementation was followed by the determination of various markers in plasma, liver, adipose tissue and heart, together with a large-scale analysis of gut microbiota composition. When given in doses of 15 or 45 mg/kg body weight/day, piceatannol did not reduce either hyperphagia or fat accumulation. It did not modify the profusion of the most abundant phyla in gut, though slight changes were observed in the abundance of several Lactobacillus, Clostridium, and Bacteroides species belonging to Firmicutes and Bacteroidetes. This was accompanied by a tendency to reduce plasma lipopolysaccharides by 30 %, and by a decrease of circulating non-esterified fatty acids, LDL-cholesterol, and lactate. While piceatannol tended to improve lipid handling, it did not mitigate hyperinsulinemia and cardiac hypertrophy. However, it increased cardiac expression of ephrin-B1, a membrane protein that contributes to maintaining cardiomyocyte architecture. Lastly, ascorbyl radical plasma levels and hydrogen peroxide release by adipose tissue were similar in control and treated groups. Thus, piceatannol did not exhibit strong slimming capacities but did limit several obesity complications (AU)

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Limited beneficial effects of piceatannol supplementation on obesity complications in the obese Zucker rat: gut microbiota, metabolic, endocrine, and cardiac aspects.

Resveratrol is beneficial in obese and diabetic rodents. However, its low bioavailability raises questions about its therapeutic relevance for treating or preventing obesity complications. In this context, many related natural polyphenols are being tested for their putative antidiabetic and anti-obesity effects. This prompted us to study the influence of piceatannol, a polyhydroxylated stilbene, on the prevention of obesity complications in Zucker obese rats. A 6-week supplementation was followed by the determination of various markers in plasma, liver, adipose tissue and heart, together with a large-scale analysis of gut microbiota composition. When given in doses of 15 or 45 mg/kg body weight/day, piceatannol did not reduce either hyperphagia or fat accumulation. It did not modify the profusion of the most abundant phyla in gut, though slight changes were observed in the abundance of several Lactobacillus, Clostridium, and Bacteroides species belonging to Firmicutes and Bacteroidetes. This was accompanied by a tendency to reduce plasma lipopolysaccharides by 30 %, and by a decrease of circulating non-esterified fatty acids, LDL-cholesterol, and lactate. While piceatannol tended to improve lipid handling, it did not mitigate hyperinsulinemia and cardiac hypertrophy. However, it increased cardiac expression of ephrin-B1, a membrane protein that contributes to maintaining cardiomyocyte architecture. Lastly, ascorbyl radical plasma levels and hydrogen peroxide release by adipose tissue were similar in control and treated groups. Thus, piceatannol did not exhibit strong slimming capacities but did limit several obesity complications.

Determinación de la dureza total en agua con EDTA empleando una solución amortiguadora inodora de borato / Total hardness water determination by EDTA using a olorless buffer borate

La determinación de Dureza Total con EDTA en agua usando una solución amortiguadora de amonio pH 10 tiene la desventaja de generar vapores de gas amoníaco que suelen ser molestos o ser potencialmente dañinos para el sistema respiratorio del operario. El objetivo de este estudio fue utilizar una solución amortiguadora inodora de borato pH 10 en sustitución de una solución amortiguadora de amonio a pH 10 para la determinación de la dureza total en agua por la metodología de la norma COVENIN 2408-86 y determinar si existía diferencia estadísticamente significativa entre ambos procedimientos. Se determinó la Dureza Total usando la solución amortiguadora inodora de borato en 13 muestras de agua con diferentes grados de dureza (suave, dura y muy dura); los resultados obtenidos se compararon con los valores del procedimiento de referencia. La solución amortiguadora permitió una visualización rápida y definida del punto final durante la ejecución de la determinación volumétrica, los resultados mostraron que no existe diferencia estadísticamente significativa (p≤0,05) en los valores de dureza al emplear ambas soluciones amortiguadoras. Se concluyó que el empleo de la solución amortiguadora inodora de borato para la cuantificación de dureza total en agua es una alternativa a la solución amortiguadora de amonio.

Total Hardness determination EDTA in water using ammonium buffer solution pH 10 has the disadvantage of generating ammonia gas vapors are usually upset or be potentially harmful to the respiratory system operator. The aim of this study was to use a buffer solution pH 10 borate odorless replacing ammonium buffer solution at pH 10 for the determination of total water hardness in the methodology of COVENIN 2408-86 standard and determine whether there was difference statistically significant between the two procedures. Total Hardness was determined using borate buffer odorless in 13 water samples with different degrees of hardness (soft, hard and very hard); the results obtained were compared with the reference method values. The buffer allowed rapid and sharp display of the end point during the execution of the volumetric determination, the results showed that there was no statistically significant difference (p≤ 0,05) in hardness values by using two buffers. It was concluded that the use of borate buffer odorless for quantification of total hardness water is an alternative to the ammonium buffer.

Gut microbiota: a key player in health and disease. A review focused on obesity

Gut microbiota, its evolutive dynamics and influence on host through its protective, trophic and metabolic actions, has a key role in health and opens unique opportunities for the identification of new markers of the physiopathological state of each individual. Alterations in gut microbiota composition have been associated with plenty disorders. Of interest, the vast number of studies demonstrates the role of microbiota in obesity, a serious public health problem that has reached epidemic proportions in many developed and middle-income countries. The economic and health costs of this condition and its comorbidities such as fatty liver, insulin resistance/diabetes, or cardiovascular events are considerable. Therefore, every strategy designed to reduce obesity would imply important savings. Targeting microbiota, in order to restore/modulate the microbiota composition with antibiotics, probiotics, prebiotics, or even fecal transplants, is considered as a promising strategy for the development of new solutions for the treatment of obesity. However, there is still lot to do in this field in order to identify the exact composition of microbiota in “health” and the specific mechanisms that regulate the host-microbiotal crosstalk. In addition, it is important to note that changes not only in the gut microbiota profile (abundance) but also in its metabolism and functions need to be taken into account in the context of contribution in the physiopathology of obesity and related disorders

Gut microbiota: a key player in health and disease. A review focused on obesity.

Gut microbiota, its evolutive dynamics and influence on host through its protective, trophic and metabolic actions, has a key role in health and opens unique opportunities for the identification of new markers of the physiopathological state of each individual. Alterations in gut microbiota composition have been associated with plenty disorders. Of interest, the vast number of studies demonstrates the role of microbiota in obesity, a serious public health problem that has reached epidemic proportions in many developed and middle-income countries. The economic and health costs of this condition and its comorbidities such as fatty liver, insulin resistance/diabetes, or cardiovascular events are considerable. Therefore, every strategy designed to reduce obesity would imply important savings. Targeting microbiota, in order to restore/modulate the microbiota composition with antibiotics, probiotics, prebiotics, or even fecal transplants, is considered as a promising strategy for the development of new solutions for the treatment of obesity. However, there is still lot to do in this field in order to identify the exact composition of microbiota in "health" and the specific mechanisms that regulate the host-microbiotal crosstalk. In addition, it is important to note that changes not only in the gut microbiota profile (abundance) but also in its metabolism and functions need to be taken into account in the context of contribution in the physiopathology of obesity and related disorders.

Importancia de la ecocardiografía transesofágica intraoperatoria en la decisión quirúrgica en cirugía cardiaca / The importance of intraoperative transesophageal echocardiography in the surgical decision in cardiac surgery

Objetivo. Determinar la importancia de la ecocardiografía transesofágica (ECOTE) intraoperatoria en la decisión quirúrgica en pacientes intervenidos de cirugía cardiaca. Pacientes y método. Estudio prospectivo observacional en pacientes de cirugía cardiaca intervenidos desde enero de 2009 hasta mayo de 2012, a los que se monitorizó con ECOTE por el anestesiólogo responsable. Los datos recogidos fueron: 1) tipo de cirugía; 2) diagnóstico ecocardiográfico preoperatorio (ECO basal); 3) diagnóstico ecocardiográfico antes de entrar en circulación extracorpórea (CEC) (ECOTE pre-CEC); 4) si había diferencias entre la ECO basal y la ECOTE pre-CEC (hallazgo nuevo pre-CEC) y si estas diferencias modificaban la cirugía planeada, y 5) diagnóstico ecocardiográfico después de la desconexión de CEC (hallazgo no esperado pos-CEC) y si estos hallazgos ecocardiográficos pos-CEC hacían reinstaurarla. Para el análisis de datos se utilizó el programa de software SPSS(R). Resultados. El total de pacientes estudiados fue de 1.273; la monitorización con ECOTE mostró «hallazgos nuevos pre-CEC» en 98 pacientes (7,7%) y en 43,8% de estos modificó la cirugía programada; de estos hallazgos, los más frecuentes fueron alteraciones de la válvula mitral que no habían sido diagnosticadas, lo que determinó la sustitución o reparación de la misma que no estaba programada. La incidencia de «hallazgos no esperados pos-CEC» fue del 6,2% (79 pacientes), y de estos, en el 46,8% se requirió reinstaurar la CEC y modificar la cirugía realizada. Las reparaciones valvulares fallidas y las prótesis valvulares disfuncionantes fueron las causas principales que motivaron la reentrada en CEC. En los 42 pacientes restantes, con «hallazgos no esperados pos-CEC», no hubo cambios en la conducta quirúrgica, ya que se consideró que el hallazgo ecocardiográfico no era lo suficientemente significativo como para reinstaurar la CEC y revisar o cambiar el procedimiento quirúrgico. Conclusión. En cirugía cardiaca, la monitorización intraoperatoria con ECOTE por el anestesiólogo aporta información importante antes y después de la CEC que modificó el manejo quirúrgico (AU)

Objective. To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery. Patients and method. Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anesthesiologist in charge. The data collected were: 1) type of surgery; 2) preoperative echocardiographic diagnosis (baseline ECHO); 3) echocardiographic diagnosis before entering cardiopulmonary bypass (CPB) (pre-CPB IOTEE); 4) any differences between the baseline ECHO and the pre-CPB IOTEE (new pre-CPB finding) and whether these differences modified the planned surgery, and 5) echocardiographic diagnosis after disconnection of CPB (unexpected post-CPB finding) and whether these post-CPB echocardiographic findings led to reinstating it. The software program SPSS(R) was used for data analysis. Results. The total number of patients studied was 1,273. Monitoring with IOTEE showed 'new pre-CPB' findings in 98 patients (7.7%), and 43.8% of these led to a change in the scheduled surgery. Of these findings, the most frequent were abnormalities of the mitral valve that had not been diagnosed, and which led to a replacement or repair that had not been scheduled. The incidence of 'unexpected post-CPB findings' was 6.2% (79 patients), and 46.8% of those required reinstating the CPB and modifying the surgery performed. The failed valve repairs and dysfunctional valve prostheses were the main causes that led to re-entry into CPB. In the remaining 42 patients, with 'unexpected post-CPB findings', there were no changes in the surgical procedure as the echocardiographic findings were not considered to be significant enough to re-establish CPB and revise or change the surgical procedure. Conclusion. Intraoperative monitoring with IOTEE by the anesthesiologist during surgery provides important information before and after the CPB that resulted in modifying surgical management (AU)

[The importance of intraoperative transesophageal echocardiography in the surgical decision in cardiac surgery]. / Importancia de la ecocardiografía transesofágica intraoperatoria en la decisión quirúrgica en cirugía cardiaca.

OBJECTIVE: To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery. PATIENTS AND METHOD: Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anesthesiologist in charge. The data collected were: 1) type of surgery; 2) preoperative echocardiographic diagnosis (baseline ECHO); 3) echocardiographic diagnosis before entering cardiopulmonary bypass (CPB) (pre-CPB IOTEE); 4) any differences between the baseline ECHO and the pre-CPB IOTEE (new pre-CPB finding) and whether these differences modified the planned surgery, and 5) echocardiographic diagnosis after disconnection of CPB (unexpected post-CPB finding) and whether these post-CPB echocardiographic findings led to reinstating it. The software program SPSS(®) was used for data analysis. RESULTS: The total number of patients studied was 1,273. Monitoring with IOTEE showed "new pre-CPB" findings in 98 patients (7.7%), and 43.8% of these led to a change in the scheduled surgery. Of these findings, the most frequent were abnormalities of the mitral valve that had not been diagnosed, and which led to a replacement or repair that had not been scheduled. The incidence of "unexpected post-CPB findings" was 6.2% (79 patients), and 46.8% of those required reinstating the CPB and modifying the surgery performed. The failed valve repairs and dysfunctional valve prostheses were the main causes that led to re-entry into CPB. In the remaining 42 patients, with "unexpected post-CPB findings", there were no changes in the surgical procedure as the echocardiographic findings were not considered to be significant enough to re-establish CPB and revise or change the surgical procedure. CONCLUSION: Intraoperative monitoring with IOTEE by the anesthesiologist during surgery provides important information before and after the CPB that resulted in modifying surgical management.

Manejo perioperatorio de la fibrilación auricular / Perioperative management of atrial fibrillation

La fibrilación auricular es una complicación frecuente en el periodo perioperatorio, y cuando aparece se incrementa el riesgo de morbimortalidad perioperatoria debido a ACV, tromboembolismo, fallo cardiaco, IAM, hemorragia debida a anticoagulación y reingresos hospitalarios. En el presente artículo se recogen las recomendaciones para el manejo de la fibrilación auricular perioperatoria basándose en las últimas Guías de Práctica Clínica de la fibrilación auricular publicadas por la Sociedad Europea de Cardiología y la Sociedad Española de Cardiología, prestando atención tanto a su optimización preoperatoria, como al manejo del episodio agudo perioperatorio. En este sentido se incluyen las últimas recomendaciones para control de la frecuencia cardiaca, control del ritmo y anticoagulación (AU)

Atrial fibrillation is a frequent complication in the perioperative period. When it appears there is an increased risk of perioperative morbidity due to stroke, thromboembolism, cardiac arrest, myocardial infarction, anticoagulation haemorrhage, and hospital readmissions. The current article focuses on the recommendations for the management of perioperative atrial fibrillation based on the latest Clinical Practice Guidelines on atrial fibrillation by the European Society of Cardiology and the Spanish Society of Cardiology. This article pays special attention to the preoperative management, as well as to the acute perioperative episode. For this reason, the latest recommendations for the control of cardiac frequency, antiarrhythmic treatment and anticoagulation are included (AU)

[Perioperative management of atrial fibrillation]. / Manejo perioperatorio de la fibrilación auricular.

Atrial fibrillation is a frequent complication in the perioperative period. When it appears there is an increased risk of perioperative morbidity due to stroke, thromboembolism, cardiac arrest, myocardial infarction, anticoagulation haemorrhage, and hospital readmissions. The current article focuses on the recommendations for the management of perioperative atrial fibrillation based on the latest Clinical Practice Guidelines on atrial fibrillation by the European Society of Cardiology and the Spanish Society of Cardiology. This article pays special attention to the preoperative management, as well as to the acute perioperative episode. For this reason, the latest recommendations for the control of cardiac frequency, antiarrhythmic treatment and anticoagulation are included.

Role of mitochondria in HIV infection and associated metabolic disorders: focus on nonalcoholic fatty liver disease and lipodystrophy syndrome.

Highly active antiretroviral therapy (HAART) has considerably improved the prognosis of HIV-infected patients. However, prolonged use of HAART has been related to long-term adverse events that can compromise patient health such as HIV-associated lipodystrophy syndrome (HALS) and nonalcoholic fatty liver disease (NAFLD). There is consistent evidence for a central role of mitochondrial dysfunction in these pathologies. Nucleotide reverse transcriptase inhibitors (NRTIs) have been described to be mainly responsible for mitochondrial dysfunction in adipose tissue and liver although nonnucleoside transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs) have also showed mitochondrial toxicity, which is a major concern for the selection and the long-term adherence to a particular therapy. Several mechanisms explain these deleterious effects of HAART on mitochondria, and evidence points to other mechanisms beyond the "Pol- γ hypothesis." HIV infection has also direct effects on mitochondria. In addition to the negative effects described for HIV itself and/or HAART on mitochondria, HIV-infected patients are more prone to develop a premature aging and, therefore, to present an increased oxidative state that could lead to the development of these metabolic disturbances observed in HIV-infected patients.

Tres complicaciones graves asociadas al catéter de arteria pulmonar en cirugía cardiovascular y torácica / No disponible

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Lipoic acid prevents body weight gain induced by a high fat diet in rats: effects on intestinal sugar transport.

Several studies have suggested that oxidative stress might cause and aggravate the inflammatory state associated with obesity and could be the link between excessive weight gain and its related disorders such as insulin resistance and cardiovascular diseases. Thus, antioxidant treatment has been proposed as a therapy to prevent and manage obesity and associated complications. Therefore, the aim of the present study was to investigate the effects of supplementation of a standard or high fat diet with the antioxidant lipoic acid (LA) during 56 days, on body weight gain, adiposity, feed efficiency and intestinal sugar absorption, in male Wistar rats. LA supplementation induced a lower body weight gain and adipose tissue size in both control or high fat fed rats accompanied by a reduction in food intake. The group fed on a high fat diet and treated with LA (OLIP group) showed a lower body weight gain than its corresponding Pair-Fed (PF) group (P < 0.05), which received the same amount of food than LA-treated animals but with no LA. In fact, LA induced a reduction on feed efficiency and also significantly decreased intestinal alpha-methylglucoside (alpha-MG) absorption both in lean and obese rats. These results suggest that the beneficial effects of dietary supplementation with LA on body weight gain are mediated, at least in part, by the reduction observed in food intake and feed efficiency. Furthemore, the inhibitory action of LA on intestinal sugar transport could explain in part the lower feed efficiency observed in LA-treated animals and therefore, highlighting the beneficial effects of LA on obesity.

El ácido lipoico reduce la ganancia de peso inducida por dieta alta en grasa: efectos sobre el transporte intestinal de azúcares / Lipoic acid prevents body weight gain induced by a high fat diet in rats: Effects on intestinal sugar transport

Several studies have suggested that oxidative stress might cause and aggravate theinflammatory state associated with obesity and could be the link between excessiveweight gain and its related disorders such as insulin resistance and cardiovascular diseases.Thus, antioxidant treatment has been proposed as a therapy to prevent andmanage obesity and associated complications. Therefore, the aim of the present studywas to investigate the effects of supplementation of a standard or high fat diet withthe antioxidant lipoic acid (LA) during 56 days, on body weight gain, adiposity, feedefficiency and intestinal sugar absorption, in male Wistar rats. LA supplementationinduced a lower body weight gain and adipose tissue size in both control or high fatfed rats accompanied by a reduction in food intake. The group fed on a high fat dietand treated with LA (OLIP group) showed a lower body weight gain than its correspondingPair-Fed (PF) group (P<0.05), which received the same amount of foodthan LA-treated animals but with no LA. In fact, LA induced a reduction on feedefficiency and also significantly decreased intestinal α-methylglucoside (α-MG)absorption both in lean and obese rats. These results suggest that the beneficial effectsof dietary supplementation with LA on body weight gain are mediated, at least inpart, by the reduction observed in food intake and feed efficiency. Furthemore, theinhibitory action of LA on intestinal sugar transport could explain in part the lowerfeed efficiency observed in LA-treated animals and therefore, highlighting the beneficialeffects of LA on obesity(AU)

Varios estudios han sugerido que el estresoxidativo podria actuar como desencadenantey agravante del estado inflamatorio asociado ala obesidad y podria ser un potencial nexo deunion entre la excesiva ganancia de peso y lasco-morbilidades asociadas. Asi, se ha propuestoel tratamiento con antioxidantes naturalescomo posible terapia contra el desarrollo deobesidad asi como sus complicaciones asociadas.Por ello, el objeto del presente trabajo fueinvestigar en ratas Wistar macho los efectos dela suplementacion de una dieta estandar o altaen grasa con un antioxidante, el acido lipoico(AL) (0,25g/ 100g de comida) durante 56 diassobre la ganancia de peso corporal, la adiposidad,la eficiencia metabolica y la absorcionintestinal de azucares. La suplementacion de ladieta con AL indujo una menor ganancia depeso corporal y redujo el tamano del tejidoadiposo blanco total, tanto en ratas alimentadascon dieta control como alta en grasa. Ademas,disminuyo la ingesta. La ganancia de pesoen el grupo alimentado con dieta alta en grasay AL fue menor que la de su correspondientegrupo Pair-Fed (P<0,05), el cual recibia lamisma cantidad de comida que los animalestratados con AL pero sin este acido. De hecho,la suplementacion con acido lipoico redujo laeficiencia metabolica y disminuyo significativamentela absorcion intestinal de ƒ¿-metilglucosido(ƒ¿-MG) tanto en ratas control comoobesas. Estos resultados sugieren que los efectosbeneficiosos de la suplementacion de ladieta con AL sobre la ganancia de peso corporalestan mediados, al menos en parte, por lareduccion observada en la ingesta de comida yen la eficiencia metabolica. Ademas, la accioninhibitoria del AL sobre el transporte intestinalde azucares podria explicar, en parte, la menoreficiencia metabolica observada en los animalestratados con AL justificando, por consiguiente,los efectos beneficiosos del AL sobre la obesidad(AU)