Prevalencia y resultados perinatales adversos en adolescentes con diabetes mellitus gestacional según tres criterios diagnósticos internacionales / Prevalence and adverse perinatal outcomes in adolescent women with gestational diabetes mellitus according to three criteria international diagnostics

Resumen: OBJETIVO: comparar la prevalencia y resultados perinatales adversos de la diabetes mellitus gestacional en mujeres embarazadas adolescentes utilizando tres criterios diagnósticos internacionales diferentes. MATERIAL Y MÉTODOS: estudio comparativo y observacional de cohorte retrospectiva efectuado en adolescentes a quienes se tomó una curva de tolerancia oral a la glucosa de 75g-2 h, entre las 24 y 28 semanas de gestación. Se analizaron la prevalencia y los resultados perinatales adversos, con criterios del Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups y National Institute for Health and Care Excellence. RESULTADOS: se estudiaron 493 adolescentes en quienes se obtuvo una prevalencia de diabetes mellitus gestacional de: 0.2, 6.3 y 1.8%, con los criterios del Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups y National Institute for Health and Care Excellence, respectivamente. La prevalencia de diabetes mellitus gestacional fue significativamente mayor con los criterios de la International Association of Diabetes and Pregnancy Study Groups, sin diferencias significativas en los resultados perinatales adversos al utilizar cualquiera de los tres criterios. CONCLUSIÓN: la prevalencia de diabetes mellitus gestacional según los criterios de la International Association of Diabetes and Pregnancy Study Groups es 3 veces mayor que con los criterios del National Institute for Health and Care Excellence y 30 veces mayor con los criterios de la Fifth International Workshop-Conference on Gestational Diabetes Mellitus. No hubo riesgo incrementado de resultados perinatales adversos en adolescentes con diabetes mellitus gestacional; sin embargo, podrían tener mayor riesgo de padecer diabetes mellitus tipo 2 a largo plazo.

Abstract: OBJECTIVE: To compare the prevalence and perinatal outcomes of gestational diabetes mellitus in adolescent women using three international diagnostics criteria. METHODS: An observational retrospective cohort study, 493 adolescents were included, an oral glucose tolerance test 75g-2 h was performed, between 24 and 28 weeks of gestation, the prevalence and adverse perinatal outcomes was analyzed, with criteria of Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups and National Institute for Health and Care Excellence. RESULTS: The prevalence of gestational diabetes mellitus was: 0.2%, 6.3% and 1.8%, with the criteria of Fifth International Workshop-Conference on Gestational Diabetes Mellitus, International Association of Diabetes and Pregnancy Study Groups and National Institute for Health and Care Excellence, respectively. The prevalence of gestational diabetes mellitus was significantly higher with criteria of the International Association of Diabetes and Pregnancy Study Groups; there were no significant differences among adverse perinatal outcomes when using any of the three criteria. CONCLUSION: Prevalence of gestational diabetes mellitus using the criteria of the International Association of Diabetes and Pregnancy Study Groups is 3 times higher than National Institute for Health and Care Excellence criteria and 30 times higher than the Fifth International Workshop-Conference on Gestational Diabetes Mellitus criteria. There was no increased risk of adverse perinatal outcomes in adolescents with gestational diabetes mellitus; however, adolescents may be at increased risk of developing type 2 diabetes mellitus long term.

Valores de referencia de HOMA-IR y QUICKI durante el embarazo en mujeres mexicanas / HOMA-IR and QUICKI reference values during pregnancy in Mexican women

Resumen: OBJETIVO: determinar los valores de referencia del Homeostatic Model Assessment Insulin Resistance (HOMA-IR) y Quantitative Insulin Sensitivity Check Index (QUICKI) para establecer el diagnóstico de resistencia a la insulina en mujeres mexicanas no embarazadas y embarazadas, por trimestre de gestación. MATERIALES Y MÉTODOS: estudio transversal al que se incluyeron mujeres embarazadas y no embarazadas sin alteraciones concomitantes, mayores de18 años de edad, índice de masa corporal pregestacional entre 18.5-24.9 kg/m2. A todas las participantes se les realizó la curva de tolerancia a la glucosa oral de 75 g-2h. Se excluyeron las mujeres con diabetes gestacional o cualquier alteración pregestacional, índice de masa corporal pregestacional menor de 18.5 o más o menos mayor de 25 kg/m2 y embarazo múltiple. Se calcularon los percentiles 5 y 95 como valores de referencia para definir resistencia a la insulina por HOMA-IR y QUICKI en mujeres sin embarazo y en cada trimestre del embarazo. Resultados: se incluyeron 400 mujeres, agrupadas de la siguiente forma: Grupo de mujeres sin embarazo (SE): n=42, grupo trimestre (T) 1: n=82, grupo T2: n=159 y grupo T3: n=117. Los valores de referencia de HOMA-IR para el percentil 5 y 95 fueron: 0.33-2.6, 0.35-1.6, 0.40-2.9 y 0.38-2.6 y para QUICKI: 0.33-0.46, 0.35-0.46, 0.32-0.45 y 0.33-0.45, para los grupos SE, T1, T2 y T3, respectivamente. Conclusión: el valor de referencia de HOMA-IR para establecer el diagnóstico de resistencia a la insulina en mujeres mexicanas no embarazadas (SE) es ≥ 2.6 y en pacientes embarazadas por trimestre: T1 ≥1.6, T2 ≥2.9 y T3 ≥2.6; respecto de QUICKI, los valores de referencia son SE <0.33, T1 <0.35, T2 <0.32 y T3 <0.33, respectivamente.

Abstract: OBJECTIVE: To determine the reference values of Homeostasis Model Assessment Insulin Resistance, (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) to define insulin resistance (IR) in women without pregnancy (WP) and each trimester of pregnancy among Mexican women. METHODS: Cross-sectional study, women without pregnancy and pregnant women age >18 years, without pathologies, pre-pregnancy body mass index (BMI) between 18.5-24.9 kg/m2 were included. All participants underwent CTOG 75gr-2h to rule out diabetes. We excluded women with gestational diabetes or any pre-pregnancy pathology, pre-pregnancy BMI <18.5 or ≥25 kg/m2 and multiple pregnancy. Percentiles 5 and 95 were calculated as reference values to define RI by HOMA-IR and QUICKI in women without pregnancy and each trimester of pregnancy. RESULTS: A total of 400 women were included, which were grouped as follows: Group of women without pregnancy (SE): n = 42, quarter Group (T) 1: n = 82, T2 Group: n = 159 and T3 group: n = 117. The reference values of HOMA-IR for the 5th and 95th percentile were: 0.33-2.6, 0.35-1.6, 0.40-2.9 and 0.38-2.6 and QUICKI: (0.33 to 0.46, 0.35 to 0.46, 0.32 to 0.45 and 0.33- 0.45, for groups SE, T1, T2 and T3, respectively. CONCLUSION: The reference value of HOMA-IR to define RI in Mexican women should be ≥2.6 and the T1 ≥1.6, T2 pregnancy: ≥2.9 and T3 ≥2.6 and QUICKI in women <0.33, T1 <0.35, T2 <0.32 and T3 <0.33.

Prevalencia de autoinmunidad tiroidea en mujeres subfértiles / Prevalence of thyroid autoimmunity in subfertile women

Resumen OBJETIVO: estimar la prevalencia de enfermedad tiroidea autoinmunitaria en pacientes subfértiles y saber si existe asociación entre enfermedad tiroidea autoinmunitaria aislada en mujeres eutiroideas y los resultados en técnicas de reproducción asistida. MATERIALES Y MÉTODOS: estudio observacional, transversal, ambispectivo, que evaluó mujeres de 18 a 43 años de edad atendidas en el servicio de Reproducción Humana del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes que tuvieran una determinación del perfil tiroideo con anticuerpos antitiroideos en la primera consulta de infertilidad. RESULTADOS: la prevalencia de enfermedad tiroidea autoinmunitaria en mujeres infértiles fue de 19%. El 48% tuvieron seropositividad para anticuerpos antitiroideos, 32% para anticuerpos antitiroglobulina más anticuerpos antiperoxidasa y 20% restante solo para anticuerpos antitiroglobulina. En el grupo de pacientes con enfermedad tiroidea autoinmunitaria se observó una prevalencia de hipotiroidismo clínico de 8% y subclínico de 48%. La media de TSH para las mujeres con enfermedad tiroidea autoinmunitaria fue de 4.6 μUI/L. Las mujeres con enfermedad tiroidea autoinmunitaria aislada eutiroideas representaron 8.3% de la población y tuvieron una alta tasa de abortos espontáneos previos (45.5%) y de fracaso en técnicas de reproducción asistida (70%). CONCLUSIÓN: la determinación de la autoinmunidad tiroidea debe ralizarse de manera rutinaria en la población de mujeres.

Abstract OBJECTIVE: To estimate the prevalence of autoimmune thyroid disease in subfertile patients who come to the Human Reproduction service of the National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico city. MATERIAL AND METHODS: A retrospective, cross-sectional, observational, ambispective study evaluating 18- to 43-year-old women from the INPer "Isidro Espinosa de los Reyes" human reproduction service with a thyroid profile determination with anti-thyroid antibodies in The first consultation of infertility. RESULTS: The prevalence of TEE in the population of infertile women is 19%. 48% have seropositivity for Ac-TPO, 32% for Ac-tiroglobulina plus Ac-TPO and the remaining 20% only for Ac-tiroglobulina. A prevalence of clinical hypothyroidism of 8% and subclinical of 48% was observed in the group of patients with ATE. The mean TSH for women with ATE was 4.6 μUI/L. Women with isolated euthyroid ETA represent 8.3% of the population and have a high rate of previous spontaneous abortions (45.5%) as well as failure in assisted reproduction techniques (70%). CONCLUSION: Determination of thyroid autoimmunity should be routinely performed in the female population.

Los hombres también se fracturan: la osteoporosis en el varón / Men also have fractures: osteoporosis in the male

La osteoporosis (OP) es una enfermedad muy prevalente, cuya consecuencia final, las fracturas, supone un importante deterioro en la calidad de vida de las personas que las sufren. Conocemos ampliamente que afecta mayoritariamente a la mujer, aunque no por eso debemos olvidar que la osteoporosis también afecta a los hombres. En el varón se retrasa la aparición de fractura de cadera unos 10 años con respecto a la mujer, pero su mortalidad es mayor. A los 60 años el 25% de los hombres sufrirá una fractura osteoporótica y a los 90 el 16,6% sufrirá una fractura de cadera. La mayoría de los casos de OP diagnosticados en el varón son de causa secundaria (40-60%), los más frecuentes son debidos a hipogonadismo y a excesiva ingesta de alcohol de forma crónica, pero también a la ingesta de glucocorticoides, la baja ingesta de calcio o la escasa actividad física. En este artículo resumimos las causas más frecuentes de OP en el varón, la forma de evaluar a estos pacientes, las pruebas diagnósticas necesarias para su estudio y los diferentes tratamientos que podemos utilizar realizando para todo ello un enfoque desde Atención Primaria

Osteoporosis (OP) is a very prevalent disease whose final consequence, fractures, supposes a significant deterioration in the quality of life of those suffering it. We know well that it mostly affects women, although we should not forget that osteoporosis also affects men. The appearance of hip fractures in the male occurs about 10 years later than in the woman, but its mortality is greater. At 60 years, 25% of men will have an osteoporotic fracture and at 90 years, 16.6% will suffer a hip fracture. Most of the cases of OP diagnosed in the male have a secondary cause (40%-60%). The most frequent ones are due to hypogonadism and excess chronic alcohol intake, but also due to glucocorticoids, low calcium intake and limited physical activity. In this article, we summarize the most frequent causes of OP in the male, the way of evaluating these patients, the diagnostic tests needed for their study and the different treatments we can use, all of this being done from the approach of Primary Health Care

Insulin sensitizing drugs increase the endogenous dopaminergic tone in obese insulin-resistant women with polycystic ovary syndrome.

To investigate whether the long-term administration of metformin or pioglitazone to women with polycystic ovary syndrome (PCOS) could induce changes in their hypothalamic dopaminergic (DA) tone and to analyze whether these changes correlated with modifications in insulin resistance, we originally studied 57 obese hyperinsulinemic, non-diabetic, insulin resistant women with PCOS, but only 34 completed the study. They were randomly divided into two groups: group one (n=17) received pioglitazone (30 mg/day) and group 2 (n=17) received metformin (850 mg, three times a day) over 24 weeks. All women were identically studied before (basal) and 6 months after (T6) drug administration, including clinical evaluations, a 2 h oral glucose tolerance test (75 g) (OGTT) for glucose and insulin measurements, followed a week later by a 2 h intravenous metoclopramide test (10 mg bolus) for prolactin (PRL) determinations. The areas under the insulin (AUC-insulin) and PRL (AUC-PRL) curves were calculated, along with the index of insulin resistance (HOMA-IR) and the indexes of insulin sensitivity (QUICKI and fasting glucose-insulin ratio). At baseline, women in both groups were of similar age, body weight, body mass index (BMI) and Ferriman-Gallwey hirsutism score (F-G score). At completion of the study, body weight and BMI remained unchanged but the F-G score significantly decreased. Fasting serum insulin concentrations and the AUC-insulin significantly decreased by the end of the trial in a similar fashion in both groups, while the AUC-PRL significantly increased at the end of the trial in both groups. At no time were significant correlations between AUC-PRL and AUC-insulin or the indexes HOMA-IR, QUICKI or fasting glucose-insulin ratio observed. The present results suggests that either pioglitazone or metformin administration was associated with a clear improvement in the endogenous hypothalamic DA tone, simultaneously with an amelioration of the insulin resistance status in these obese women with PCOS.

Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome.

Severe insulin resistance is a key abnormality in obese women with polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate whether pioglitazone decreases insulin resistance (IR) and hyperandrogenism to the same extent as metformin in obese women with PCOS who have not received any previous treatment. Fifty-two women with PCOS were randomly allocated to receive either pioglitazone (30 mg/d, n = 25) or metformin (850 mg three times daily, n = 27) and were assessed before and after 6 months. Body weight, body mass index, and waist to hip ratio increased significantly (P

Thyroid peroxidase antibodies in Mexican-born healthy pregnant women, in women with type 2 or gestational diabetes mellitus, and in their offspring.

OBJECTIVE: To search for differences in the frequency of thyroid peroxidase antibodies (TPO-Ab) among 150 pregnant Mexican women who were healthy, had type 2 diabetes mellitus (DM), or had gestational diabetes mellitus (GDM). METHODS: Fifty healthy women, 50 women with type 2 DM, and 50 women with GDM were studied at delivery. In addition, 142 of their offspring were included in the study. TPO-Ab were determined by enzyme immunoassay, and total triiodothyronine, free thyroxine, and thyroid-stimulating hormone (thyrotropin) were measured by radioimmunoanalysis. RESULTS: TPO-Ab were < or = 70 U/mL (negative) in 50% of the healthy women and in 60% and 60% of women with type 2 DM and GDM, respectively (no significant difference). TPO-Ab were 71 to 250 U/mL (slightly positive) in 40% of healthy women and in 30% and 34% of women with type 2 DM and GDM, respectively (no significant difference). TPO-Ab were > or =251 U/mL (strongly positive) in 10% of healthy women and in 10% and 6% of women with type 2 DM and GDM, respectively. One healthy woman had subclinical hypothyroidism, and the rest were euthyroid. The newborn offspring of these Mexican women were euthyroid and had similar frequencies of TPO-Ab (all had TPO-Ab <250 U/mL). CONCLUSION: (1) The frequency of TPO-Ab > or =251 U/mL was similar in pregnant Mexican women with GDM in comparison with those who were healthy or had type 2 DM. (2) The similar high frequencies of slightly positive TPO-Ab in the three groups of pregnant women can partially be explained by the existence of an ethnic factor, the very strong family history of DM in a substantial percentage of them, and the use of a more sensitive and specific assay for detection of TPO-Ab.

Stereoselective anticonvulsant activity of the enantiomers of (+/-)-2-hydroxy-2-phenylbutyramide.

The enantiomers of the anticonvulsant DL-2-hydroxy-2-phenylbutyramide (1) were prepared by resolving the (-)-quinine and (+)-1-phenylethylamine salts of the acids. The optically active acids were then esterified and reacted with ammonia to give (+)-1 and (-)-1. Optical purity of the amides was greater than 99.9% enantiomeric excess by chiral HPLC. Examination of the infrared spectra of the enantiomers and the racemate of 1 in chloroform solution showed identical spectra, but the spectrum of the racemate in a KBr disc was somewhat different from those of the pure enantiomers. Pharmacologically, 1 and its enantiomers have a similar significant anticonvulsant activity at peak drug effect against pentylenetetrazol seizures, but a variation in time between the enantiomers was found with the anticonvulsant activity. In the rotarod ataxia test (-)-1-possessed the lowest neurotoxicity.