The Beneficial Changes on Inflammatory and Endothelial Biomarkers Induced by Metabolic Surgery Decreases the Carotid Intima-Media Thickness in Men.

Obesity increases cardiovascular risk in men through several mechanisms. Among them, low-grade chronic inflammation and obesity-associated hypogonadism have been described. We aimed to study the effects of metabolic surgery on the carotid-intima media thickness through changes in inflammatory, endothelial biomarkers, and testosterone. We included 60 men; 20 submitted to laparoscopic Roux-en-Y gastric bypass (RYGB), 20 to sleeve gastrectomy (SG), and 20 to lifestyle modification (controls). Several inflammatory and endothelial biomarkers and total testosterone (TT) were measured at baseline and six months after surgery. Free testosterone (FT) was calculated, and carotid intima-media thickness (cIMT) was measured by ultrasonography. Compared to controls, cIMT decreased after surgery concomitantly with CRP, PAI-1, sICAM-1, and IL-18 (p < 0.01) and with an increase in sTWEAK (p = 0.027), with no differences between RYGB and SG. The increase in TT and FT after surgery correlated with the changes in cIMT (p = 0.010 and p = 0.038, respectively), but this association disappeared after multivariate analysis. Linear regression showed that sTWEAK (ß = -0.245, p = 0.039), PAI-1 (ß = 0.346, p = 0.005), and CRP (ß = 0.236, p = 0.049) were associated with the changes in cIMT (R2 = 0.267, F = 6.664, p = 0.001). In conclusion, both RYGB and SG induced improvements in inflammation and endothelial biomarkers that drove a decrease in cIMT compared to men with obesity who submitted to diet and exercise.

The Role of Adiponectin in the Resolution of Male-Obesity-Associated Secondary Hypogonadism after Metabolic Surgery and Its Impact on Cardiovascular Risk.

Male-obesity-associated secondary hypogonadism (MOSH) is a very prevalent entity that may resolve after marked weight loss. Adiponectin (APN) is an adipokine with anti-inflammatory properties that regulates metabolism. Low-circulating APN is associated with obesity, diabetes, and cardiovascular risk, along with circulating testosterone. We aimed to evaluate APN changes in men with MOSH (low circulating free testosterone (FT) with low or normal gonadotropins) and without it after metabolic surgery. We look for their possible association with cardiovascular risk measured by carotid intima-media thickness (cIMT). We included 60 men (20 submitted to lifestyle modification, 20 to sleeve gastrectomy, and 20 to gastric bypass) evaluated at baseline and 6 months after. The increase in APN at follow-up was reduction in patients with persistent MOSH (n = 10) vs. those without MOSH (n = 30) and MOSH resolution (n = 20), and the former did not achieve a decrease in cIMT. The increase in APN correlated positively with FT (r = 0.320, p = 0.013) and inversely with cIMT (r = -0.283, p = 0.028). FT inversely correlated with cIMT (r = -0.269, p = 0.038). In conclusion, men without MOSH or with MOSH resolution showed a high increase in APN after weight loss with beneficial effects on cIMT. Those without MOSH resolution failed to attain these effects.

Sleeve Gastrectomy and Gastric Bypass Decrease the Carotid Intima-Media Thickness in Obese Men: Association with Weight Loss, Cardiovascular Risk Factors, and Circulating Testosterone.

BACKGROUND: Obesity surgery has shown to decrease the carotid intima-media thickness (IMT), but studies that compare different surgical techniques are scarce, especially in men. OBJECTIVE: To evaluate the changes in IMT in men after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and its association with circulating testosterone. SETTING: Academic Hospital. METHODS: We studied 40 men with severe obesity, of whom 20 were submitted to laparoscopic RYGB and 20 to SG. Twenty control men matched for age and degree of obesity were also included. Both patients and controls were evaluated at baseline and 6 months after surgery or conventional treatment with diet and exercise, respectively. RESULTS: The mean carotid IMT decreased after surgery irrespective of the surgical technique whereas no changes were observed in the control men submitted to conventional therapy (Wilks' λ = 0.745, P < 0.001 for the interaction, P < 0.001 for RYGB vs. controls, P = 0.001 for SG vs. controls, P = 0.999 for RYGB vs. SG). The decrease in the carotid IMT correlated with the increase in total testosterone (r = 0.428, P = 0.010) and lost BMI (r = 0.486, P < 0.001). Multivariate linear regression retained only the decrease in BMI (ß = 0.378, P = 0.003) after adjustment (R2 = 0.245, F = 9.229, P = 0.001). CONCLUSION: Both RYGB and SG decrease carotid IMT in men with obesity compared with conventional treatment with diet and exercise.

Efectividad de cuatro prácticas agroecológicas de conservación de suelos, frente a procesos erosivos hídricos en Guasca - Cundinamarca / Effectiveness of four agroecological soil conservation practices against water erosion processes in hillside soils in Guasca-Cundinamarca / Efetividade de quatro práticas agroecológicas de conservação de solos contra processos de erosão em Guasca -Cundinamarca

Resumen Introducción. Una cuarta parte de los suelos agrícolas del mundo padece algún grado de deterioro, especialmente por factores antrópicos, no obstante, reducir el daño es posible cuando se desarrollan prácticas adecuadas de producción. Objetivo. Evaluar la efectividad de prácticas agroecológicas de conservación de suelos de ladera en el municipio de Guasca - Cundinamarca. Materiales y métodos. Se establecieron cuatro tratamientos: barreras vivas, barreras muertas, zanjas de infiltración, terrazas y un testigo, por cada tratamiento se realizaron 4 repeticiones, para un total de 20 unidades experimentales (UE). Se establecieron cultivos asociados de arveja (Pisum sativum), fríjol (Phaseolus vulgaris) y zanahoria (Daucus carota), en surcos en contrapendiente, obteniendo 6 surcos por UE. En cada UE se instaló una zanja recubierta con polietileno, con el objetivo de conducir el volumen de agua escurrido y los sólidos arrastrados al recipiente colector final. Del volumen obtenido, después de una respectiva homogenización con un agitador manual, se obtuvieron muestras de 200 ml para posteriormente secarlas y pesarlas en laboratorio. Resultados. Las pérdidas de suelo y agua por escorrentía presentaron un comportamiento variable, lo que puede ser atribuido a la interacción entre la intensidad y frecuencia de las precipitaciones, textura de suelo, manejo histórico del suelo y la variedad de prácticas de conservación empleadas. Conclusión. Todas las prácticas de conservación de suelos implementadas contribuyeron a reducir la pérdida de sedimentos, siendo las zanjas de infiltración la mejor práctica de conservación, presentando una reducción del 87,8 % de las pérdidas frente al testigo.

Abstract Introduction. A quarter of the world's agricultural soils suffer some degree of deterioration, especially due to anthropic factors. However, regeneration of soils is possible when conservation strategies are developed. Objective. Evaluate the effectiveness of soil conservation agroecological practices in the retention of hillside soils in the municipality of Guasca-Cundinamarca. Materials and methods. Four treatments were established: live barriers, dead barriers, infiltration ditches, terraces and a control. For each treatment, four repetitions were performed, for a total of 20 experimental units (EU). Pea (Pisum sativum), bean (Phaseolus vulgaris) and carrot (Daucus carota) crops were established in furrows in counter-slope, obtaining 6 furrows per EU. In each EU a ditch covered with polyethylene was installed, with the aim of driving the volume of drained water and the solids dragged towards a final collector vessel. From the volume obtained, after a respective homogenization with a manual agitator, samples of 200 ml were obtained for subsequent drying and weighing in the laboratory. Results. The losses of soil and water by runoff presented a variable behavior, which can be attributed to the interaction among factors such as intensity and frequency of rainfall, soil texture, historical soil management and the variety of conservation practices used. Conclusion. All the soil conservation practices implemented contributed to reduce the loss of sediments, infiltration ditches being the best conservation practice, presenting an 87.8 % reduction in losses compared with the control.

Resumo Introdução. Uma quarta parte dos solos agrícolas do mundo padece algum grau de deterioro, especialmente por fatores antrópicos, não obstante, reduzir o dano é possível quando se desenvolvem práticas adequadas de produção. Objetivo. Avaliar a efetividade das práticas agroecológicas de conservação dos solos de ladeira no município de Guasca - Cundinamarca. Materiais e métodos. Estabeleceram-se quatro tratamentos: barreiras vivas, barreiras mortas, trincheiras de infiltração, terraços e um controle, por cada tratamento realizaram-se 4 repetições, para um total de 20 unidades experimentais (UE). Estabeleceram-se culturas associadas de ervilha (Pisum sativum), feijão (Phaseolus vulgaris) e cenoura (Daucus carota), em sulcos em contra pendente, obtendo 6 sulcos por UE. Em cada UE instalou-se uma trincheira recoberta com polietileno, com o objetivo de conduzir o volume de água escorrido e os sólidos arrastrados ao recipiente coletor final. Do volume obtido, despois de uma respetiva homogeneização com um agitador manual, obtiveram-se amostras de 200 ml para posteriormente serem secadas e pesadas no laboratório. Resultados. As perdas do solo e água pelo escorrimento apresentaram um comportamento variável, o que pode ser atribuído à interação entre a intensidade e a frequência das precipitações, textura de solo, manejo histórico do solo e a variedade das práticas de conservação empregadas. Conclusão. Todas as práticas de conservação de solos implementadas contribuíram a reduzir a perda de sedimentos, sendo as trincheiras de infiltração a melhor prática de conservação, apresentando uma redução do 87,8 % das perdas frente ao controle.

Sustentabilidad y variabilidad climática: acciones agroecológicas participativas de adaptación y resiliencia socioecológica en la región alto-andina colombiana / Sustentability and climate variability: participatory agroecologycal actions to adaptation and socio-ecological reesilience in the colombian high- andean region

La variabilidad climática constituye en la actualidad uno de los principales factores de riesgo para la agricultura y la seguridad alimentaria mundial. Los ecosistemas más vulnerables en Colombia son los que se ubican en la zona alto-andina donde miles de familias campesinas se dedican a la agricultura en pequeña escala. Los programas enfocados a adaptar la agricultura a la variabilidad climática no se apoyan suficientemente en el conocimiento local ni motivan a las comunidades para la acción. Esta investigación propuso un análisis de la relación entre sustentabilidad y adaptación a la variabilidad climática, reconociendo de manera participativa los principales factores de riesgo para la sustentabilidad de la agricultura a partir de indicadores y analizando la efectividad de planes de mejora en la capacidad adaptativa de la agricultura alto-andina. Se desarrolló como un estudio de caso con 13 productores familiares vinculados a la Asociación Red Agroecológica Campesina de Subachoque, en 3 fases: a) creación de un marco de análisis sobre los principales factores de riesgo para la agricultura; b) evaluación de la sustentabilidad a partir de indicadores propios y c) implementación de planes para aumentar la capacidad adaptativa de la agricultura. La evaluación realizada en dos momentos diferentes demostró mejora en los 9 indicadores generados, de forma que la implementación de las acciones para mejorar la sustentabilidad influyeron positivamente sobre la capacidad de las fincas para adaptarse a los riesgos de la variabilidad climática. Las estrategias agroecológicas implementadas mejoraron la resiliencia socioecológica de los agroecosistemas manejados por agricultores familiares, aumentando la posibilidad de que respondan mejor ante cualquier escenario de cambio ambiental.

Climate variability constitutes actually one of the main risks to agriculture and food security in the world. The most vulnerable ecosystems in Colombia are located in the high region of the Andeans where thousands of families farming lives from agriculture in small scale. The programs aimed to adapt the agriculture to climate variability do not take into account the local knowledge; neither motivates communities to action. This research proposed an analysis of the relationship between sustainability and agricultural adaptation to climate variability in a participatory way, recognizing the main risk factors to agriculture sustainability using indicators and analyzing the effectiveness of improving plans to the agricultural adaptation capacity in the high-Andeans. It was developed as a study case with 13 farmers linked to the Agro-ecological Farming Net Association of Subachoque. 3 phases were developed: a) the creation of a framework regarding the main the risks factors to the agriculture; b) sustainability appraisal based on own indicators and c) implementation of plans to increase the agricultural adaptation capacity. The appraisal developed in 2 different moments showed improving in the 9 indicators suggesting that the implementation of actions to the sustainability of farming positively influenced on the farms capacity to face the risks of the climate variability. The agro-ecological strategies implemented, improving the socio-ecological resilience of agro-ecosystems managed by family farmers, increasing the possibility that they better responding to any scenario of environmental change.

Monofuncionalidad, multifuncionalidad e hibridación de funciones de las agriculturas en la cuenca del río guaguarco, sur del tolima / Monofuncionality, multifuncionality and hybridization of agriculture' s funtions of the guaguarco river basin in the southern tolima

El rol monofuncional de la agricultura empresarial ha generado serios desequilibrios ambientales y socioculturales que comprometen su productividad futura. Una valoración de la multifuncionalidad de la agricultura en 18 sistemas tradicionales, ganaderos y de monocultivos, evaluados en la cuenca del río Guaguarco a partir de variables biofísicas, sociales, culturales, productivas y financieras, calificaron la agricultura tradicional como la más funcional, seguida de los sistemas ganaderos y de monocultivo. La capacidad de los agricultores para desplegar múltiples funciones en sus sistemas de finca constituye una estrategia para enfrentar las adversidades que ponen en riesgo su continuidad.

The monofunctional role of the business-oriented agriculture has generated serious environmental and socio-cultural imbalances that threaten its future productivity. An appraisal of agriculture's multifunctionality in 18 traditional farming systems, livestock farming and monoculture farming, evaluated at the Guaguarco river basin with biophysical, social, cultural, productive and financial variables, evaluated the traditional farming systems as the most functional followed by the livestock farming and monoculture farming. The farmer's capability to deploy multiple functions to their farming systems, constitute a strategy to face the adversities that put at risk continuity.

Utilización de AINES y uso de IBP profilácticos en pacientes de medicina interna / The Use of NSAIDs Combined with Prophylactic Use of PPIs for Internal Medicine Patients

Introducción: los antiinflamatorios no esteroideos (AINES) son prescritos con frecuencia en la práctica médica y sus eventos adversos gastrointestinales aumentan la morbimortalidad, la cual puede disminuir utilizando profilácticamente inhibidores de la bomba de protones (IBP), misoprostol o anti H2. Objetivo: estimar la prevalencia de consumo de AINES en una población de consulta externa de Medicina Interna y, en ellos, determinar la frecuencia de prescripción profiláctica de IBP en pacientes con riesgo de sangrado gastrointestinal.Métodos: estudio prospectivo de prevalencia analítica con pacientes mayores de 18 años de la consulta externa de Medicina Interna de la Fundación Hospital San Carlos de Bogotá. Los pacientes consumidores de AINES fueron clasificados en tres grupos de riesgo de sangrado gastrointestinal con base en los factores de riesgo tradicionalmente descritos. Resultados: de 140 pacientes incluidos, el 30% tomaban AINES. El 47,6% (n=20) fueron clasificados en el grupo de bajo riesgo, el 28,5% (n=12) en el grupo de riesgo intermedio y el 23,8% (n=10) en el grupo de alto riesgo. El 47% (20 pacientes) de los que consumían AINES tomaban simultáneamente IBP. Con respecto a los grupos de riesgo, consumían IBP el 80% de alto riesgo, el 50% de riesgo intermedio y el 30% de bajo riesgo. Conclusión: en la población estudiada, la prescripción de IBP en pacientes de alto riesgo es superior a la informada en trabajos internacionales (80% versus menos del 50%). Hay formulación de IBP innecesaria en el 30% de los pacientes de bajo riesgo.

Introduction: Adverse gastrointestinal events related to non-steroid anti-inflammatory drugs (NSAIDs) which are frequently prescribed in medical practice increase morbidity and mortality. These can be reduced through prophylactic use of proton pump inhibitors proton pump (PPIs) or misoprostol anti H2. Objective: The objective of this study was to estimate the prevalence of NSAIDs use in a population of internal medicine outpatients and to determine the frequency of prophylactic prescriptions of PPIs for patients at risk of gastrointestinal bleeding. Methods: This was a prospective and analytical study of prevalence among patients over 18 years of age in the Internal Medicine outpatient service at the Hospital San Carlos in Bogota. Patients who consume NSAIDs were classified into three risk groups based on traditionally described risk factors for gastrointestinal bleeding. Results: Thirty percent of the 140 enrolled patients were taking NSAIDs. 47.6 % (n = 20) were classified in the low risk group, 28.5 % (n = 12) in the intermediate-risk group and 23.8 % (n = 10) in the high risk group. 47% (20 patients) of those taking NSAIDs were simultaneously taking PPIs. Eighty percent of the high risk group, 50% of the intermediate-risk group, and 30% of the low risk group were taking PPIs. Conclusion: PPIs were prescribed more frequently for high risk patients in this study population (80%) than has been that reported in international publications (less than 50%). The prescription of PPIs for 30% of the low risk patients is unnecessary.

Biochemical markers of vascular calcification in elderly hemodialysis patients.

The increased vascular calcification, cardiovascular morbidity, and mortality in chronic kidney disease (CKD) patients has been associated with disturbances in mineral-bone metabolism. In order to determine markers of the vascular calcification frequently observed in these patients, blood samples of elderly male and female hemodialysis CKD patients were used to measure serum levels of: osteoprotegerin (OPG), total soluble receptor activator of nuclear factor-κB ligand (sRANKL), and fetuin-A by enzyme immunoassay; tartrate-resistant acid phosphatase (TRACP-5b), and bone-specific alkaline phosphatase (BAP) by immunoenzymometric assay; osteocalcin (OC) by ELISA; iPTH by immunoradiometric assay; 25(OH)D(3) and 1,25(OH)(2)D(3), by I(125) radioimmunoassay; and calcium and phosphorus by photometric assay. Serum OPG, BAP, iPTH, phosphorus, and OC levels were higher and serum 25(OH)D(3), 1,25(OH)(2)D(3), and fetuin-A levels lower in both male and female CKD patients than in their respective controls. Our results indicate that the bone formation and resorption parameters are altered in elderly male and female hemodialysis CKD patients. These changes may lead to vascular calcifications and cardiovascular complications, given that elevated OPG and OC levels and reduced fetuin-A levels are associated with cardiovascular events.

Mineral-bone metabolism markers in young hemodialysis patients.

OBJECTIVE: To study the most frequent markers of mineral-bone metabolism in young hemodialysis (HD) patients in order to detect any metabolism changes that could lead to the atherosclerosis and extravascular calcification frequently observed in chronic kidney disease (CKD) patients and estimate their potential prognostic significance. DESIGN AND METHODS: We measured serum levels of intact-PTH (iPTH), Osteoprotegerin (OPG), total soluble receptor activator of nuclear factor-κB ligand (sRANKL), tartrate-resistant acid phosphatase (TRAP-5b), osteocalcin (Oc), bone-specific alkaline phosphatase (BAP), calcium, phosphorus, 25(OH)D(3) and 1,25 (0H)(2)D(3) in young HD patients and controls RESULTS: In comparison to controls, serum OPG, iPTH, BAP, phosphorus, and osteocalcin levels were higher whereas 25(OH)D(3) and 1,25(OH)(2)D(3) were lower in HD patients. CONCLUSION: In conclusion, our results indicate that bone formation and resorption parameters are already altered in young HD subjects. These changes may lead to vascular calcifications and cardiovascular complications, given that elevated OPG levels predict cardiovascular events in HD patients. Furthermore, low levels of vitamin D metabolites have been associated with the presence of vascular calcification.

Two models of homocysteine behavior in acute myocardial infarction.

OBJECTIVES: To study homocysteine (Hcy) levels during post-infarction follow-up. METHODS AND RESULTS: In this study, serum Hcy levels were measured in 90 healthy individuals and in 127 patients with acute myocardial infarction (MI) on the day of infarction (day 0) and days 2, 5, 7, 9, and 11 post-infarction, comparing Hcy levels in MI patients on day 0 with their follow-up results and with levels in controls. Overall, MI patients had higher Hcy levels on day 0 versus controls. However, the behavior of Hcy levels differed between two groups of MI patients. Thus, patients with similar Hcy levels to controls on day 0 showed significantly higher levels on days 2, 5, 7, 9, and 11 post-infarction than on day 0. In contrast, patients with significant higher Hcy levels than controls on day 0 showed significantly lower levels on days 2, 5, 7, 9, and 11 post-infarction than on day 0. CONCLUSIONS: Different behaviors of Hcy levels in MI patients might correspond to a history or absence of history of asymptomatic myocardial ischemia. Further research is required to test this hypothesis.

Esquizofrenia de inicio en la niñez, revisión de conceptos actuales y dificultades en el diagnóstico / Child schizophrenia: A Review of Current Concepts and Diagnostic Difficulties

La esquizofrenia en niños es una patología cuyodiagnóstico es difícil. La mayoría de los estudioshablan de síntomas en niños escolares yadolescentes y la continuidad en la que se presentaen los adultos. Sin embargo, siguen existiendovacíos diagnósticos en los niños menoresy se busca encontrar mejores marcadores clínicospara detener o retrasar el deterioro propiode esta patología.

Enuresis y encopresis en adolescente de 12 años / Enuresis and Encopresis in a 12-year old Adolescent

Se discute el caso de una niña que presentó enuresis y encopresis de manera crónica y como hallazgo principal, las causas de estrés psicosociales derivadas de estas condiciones, así como depresión mayor. El tratamiento aplicado confirma la comorbilidad entre estas patologías y su superposición.

Dehydroepiandrosterone sulfate and growth axis hormones in patients after surgery.

We selected 38 patients scheduled for cholecystectomy and studied their serum concentrations of dehydroepiandrosterone (DHEA) and growth axis hormones [growth hormone/insulin-like growth factor-1 (GH/IGF-1)]. We aimed to determine whether alterations in these concentrations resulted from surgical stress or, on the contrary, preceded surgery and were themselves a cause of chronic diseases that reduce life expectancy. We measured the serum concentrations of DHEA sulfate (DHEA-S), ACTH, cortisol, human GH (hGH), IGF-1, and IGF-1 binding protein-3 (IGFBP-3) preoperatively and then 2 and 7 days after surgery; we also compared the preoperative findings with those of a healthy control group. The results were analyzed by gender because DHEA and GH/IGF-1 are known to present sexual dimorphism. There were no significant differences between the preoperative and control results for any of the parameters studied. We found a significant reduction in the concentrations of DHEA-S and IGF-1 on days 2 and 7 after surgery versus the preoperative values. We conclude that the decrease in DHEA-S in patients after surgery is a result of surgical trauma and does not precede surgical stress. The decrease in hormone levels observed in patients with chronic disease may therefore be a result, not a cause, of disease, as some have claimed. Further studies with a later endpoint would be of interest to assess any subsequent return of DHEA-S levels to baseline measurements.

Reinducción de la lactancia materna / Reinduction of breast feeding

Algunas experiencias afirman la posibilidad y necesidad de reinducir la lactancia, entendiendo por ello, el proceso fisiológico mediante el cual la lactancia es nuevamente iniciada en mujeres que han destettdo precozmente a sus hijos. En el marco de un programa de hospitalización conjunta del hijo con su madre, se intentó la reinducción en 100 lactantes de 6 meses o menos, hospitalizados por diarrea aguda grave con deshidratación, acidosis o shock. El destete ara total (no tomaban nada de pecho) en 71 y parcial (eran puestos al pecho después de tomar el biberón, lactancia simbólica) en 29. El método de reinducción se basó en la motivación de la madre, grupo familiar y equipo de salud, instalación de un régimen de autodemanda para la lactancia materna, disminución progresiva del biberón de leche de vaca y aporte de un suplemento calórico a la madre. Se logró la reinducción total (alimentación exclusiva al pecho) en 29 lactantes, con un promedio de duración de la lactancia de 55 días (rango 7-150) y parcial (agregado de no más de 2 biberones diarios= en 23, con una duración promedio de 21 días (rango 7-60). La reinducción de la lactancia no se vió favorecida por la administración de cloropromacina. La labor educativa fue pilar fundamental para lograr el cambio de actitud en la madre. Los hechos que impidieron una reinducción exitosa están vinculados a las tensiones psicosociales múltiples a que están sometidas estas madres pertenecientes a los estratos socioeconómicos más bajos de la población (AU)