Low prolactin levels are associated with visceral adipocyte hypertrophy and insulin resistance in humans.

PURPOSE: Low prolactin (PRL) serum levels are associated with glucose intolerance and type 2 diabetes in adults, and with metabolic syndrome and obesity in children. In obese rodents, PRL treatment promotes insulin sensitivity by maintaining adipose tissue fitness, and lack of PRL signaling exacerbates obesity-derived metabolic alterations. Since adipose tissue dysfunction is a key factor triggering metabolic alterations, we evaluated whether PRL serum levels are associated with adipocyte hypertrophy (a marker of adipose tissue dysfunction), insulin resistance, and metabolic syndrome in lean, overweight, and obese adult men and women. METHODS: Samples of serum and adipose tissue from 40 subjects were obtained to evaluate insulin resistance index (homeostasis model assessment of insulin resistance (HOMA-IR)), signs of metabolic syndrome (glucose levels, high-density lipoproteins, triglycerides, blood pressure, and waist circumference), as well as adipocyte size and gene expression in fat. RESULTS: Lower PRL serum levels are associated with adipocyte hypertrophy, in visceral but not in subcutaneous fat, and with a higher HOMA-IR. Furthermore, low systemic PRL levels together with high waist circumference predict an elevated HOMA-IR whereas low serum PRL values in combination with high blood glucose predicts visceral adipocyte hypertrophy. In agreement, visceral fat from insulin resistant subjects shows reduced expression of prolactin receptor. However, there is no association between PRL levels and obesity or signs of metabolic syndrome. CONCLUSIONS: Our results support that low levels of PRL are markers of visceral fat dysfunction and insulin resistance, and suggest the potential therapeutic value of medications elevating PRL levels to help maintain metabolic homeostasis.

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols.

BACKGROUND: Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). METHODS: The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. DISCUSSION: The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection. TRIALS REGISTRATION: NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).

Requerimientos técnicos de los espirómetros en la estrategia para garantizar el acceso a una espirometría de calidad / Technical Requirements of Spirometers in the Strategy for Guaranteeing the Access to Quality Spirometry

El acceso a una espirometría de calidad es un objetivo imprescindible para poder minimizar el infradiagnósticode las enfermedades respiratorias, especialmente en las más frecuentes, como la EPOC y el asma.Este objetivo es alcanzable a corto plazo pero requiere la integración simultánea de estrategias diversas:formación de los profesionales que deben realizar la espirometría, definición de estándares para la transmisiónde la información, programa de control de calidad requerimientos técnicos en las adquisicionesde aparatos y la correcta interpretación de los resultados.El presente trabajo muestra la utilización de estándares para el intercambio electrónico de informaciónclínica. Para normalizar el tratamiento de los datos relacionados con la espirometría y permitir elintercambio de información se ha utilizado el estándar CDA R2 (Clinical Document Architecture, Release2) de HL7 (Health Level Seven) versión 3. HL7 es un producto de HL7 International, una organizaciónno lucrativa que se dedica a la producción de estándares en el ámbito de la salud para facilitar lainteroperabilidad.La definición de este estándar, además, es imprescindible para asegurar la adopción del mismo porparte de los fabricantes de espirómetros. Mediante este proceso se ponen las bases para facilitar el accesoa la espirometría desde todos los ámbitos asistenciales y, a su vez, es un elemento técnico fundamentalpara dise˜nar los programas de control de calidad de las exploraciones (AU)

Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosisof respiratory diseases, especially in those that are most frequent, such as COPD and asthma. Thisobjective can be reached in the short term, but it requires the simultaneous integration of differentstrategies: training of the health-care professionals who perform spirometry, definition of standards forthe transmission of the information, technical requirements for acquiring apparatuses and the correctinterpretation of the results.This present study shows the use of standards for the electronic exchange of clinical information.In order to normalize the treatment of the data related with spirometry and to enable the exchangeof information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7(Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization thatdeals in the production of standards in the health-care setting in order to facilitate interoperability.Furthermore, defining these standards is essential for ensuring that they are adopted by spirometermanufacturers. Be means of this process, the base is set for facilitating access to spirometry at the healthcarelevel, while at the same time it is a fundamental technical element for designing quality controlprograms of the explorations (AU)

Technical requirements of spirometers in the strategy for guaranteeing the access to quality spirometry.

Access to quality spirometry is an essential objective in order to be able to minimize the underdiagnosis of respiratory diseases, especially in those that are most frequent, such as COPD and asthma. This objective can be reached in the short term, but it requires the simultaneous integration of different strategies: training of the health-care professionals who perform spirometry, definition of standards for the transmission of the information, technical requirements for acquiring apparatuses and the correct interpretation of the results. This present study shows the use of standards for the electronic exchange of clinical information. In order to normalize the treatment of the data related with spirometry and to enable the exchange of information, we have used the standard CDA R2 (Clinical Document Architecture, Release 2) of HL7 (Health Level Seven), version 3. HL7 is a product by HL7 International, a non-profit organization that deals in the production of standards in the health-care setting in order to facilitate interoperability. Furthermore, defining these standards is essential for ensuring that they are adopted by spirometer manufacturers. Be means of this process, the base is set for facilitating access to spirometry at the health-care level, while at the same time it is a fundamental technical element for designing quality control programs of the explorations.

[Evaluation of autonomic cardiovascular functioning in patients with syncope]. / Valoracion de la funcion autonomica cardiovascular en pacientes con sincope.

INTRODUCTION: According to the current literature on the subject, patients with syncope suffer a dysfunction of the autonomic nervous system (ANS). Yet few studies offer a clear explanation of this dysfunction. Moreover, the evaluation of cardiovascular reflexes is a simple, useful method of studying the functional status of the ANS. This work was designed to evaluate the existence of dysautonomia in syncope patients by means of the autonomic cardiovascular stimulation tests; it has been the most comprehensive of those published to date. SUBJECTS AND METHODS: We studied 170 healthy volunteers and 188 patients with syncopes in the previous months, paired by age and sex. Cardiovascular stimulation tests were conducted, in accordance with Ewing and Clark's methodology, together with the cold test. A rating scale was included to evaluate the symptoms related to ANS involvement. RESULTS: Syncope patients display lower reactivity in tests involving cardiovascular stimulation of the ANS, regardless of whether they are taken individually or as a whole (67% in patients and 39% in controls) (p = 0.0001), except in the cold test. They also show an increase in the clinical symptoms of an autonomic origin (2.82 +/- 0.17) with respect to control subjects (0.78 +/- 0.09) (p = 0.0001). CONCLUSIONS: Our syncope patients have a dysautonomia that appears as a sympathetic and parasympathetic hypofunction. These findings confirm the value of autonomic cardiovascular stimulation tests in the study of these patients. Moreover, the search for other symptoms of autonomic involvement can be a great aid in evaluating this pathology.

Valoración de la función autonómica cardiovascular en pacientes con síncope / Evaluation of autonomic cardiovascular functioning in patients with syncope

Introducción. La bibliografía actual considera que en lospacientes con síncope existe una disfunción del sistema nerviosoautónomo (SNA). Sin embargo, existen pocos estudios que objetivendicha disfunción. Por otra parte, la valoración de los reflejoscardiovasculares constituye un método de estudio sencillo y útil delestado funcional del SNA. Este trabajo se diseñó para valorar laexistencia de disautonomía en pacientes con síncope mediante lostests de estimulación autonómica cardiovascular; ha sido el másnumeroso de los publicados hasta ahora. Sujetos y métodos. Estudiamosa 170 voluntarios sanos y 188 pacientes con síncopes en los meses previos, pareados por edad y sexo. Se realizaron los testsde estimulación cardiovascular, según la metodología de Ewing yClark, y el test del frío. Se incluyó una escala de valoración de lossíntomas relacionados con la afectación del SNA. Resultados. Lospacientes con síncope presentan una menor reactividad en los testsde estimulación cardiovascular del SNA, tomados de forma aisladao en su conjunto (67% en los pacientes y 39% en los controles)(p = 0,0001), si exceptuamos el test del frío. También refieren unaumento de la sintomatología de origen autonómico (2,82 ± 0,17)con respecto a los controles (0,78 ± 0,09) (p = 0,0001). Conclusión.Nuestros pacientes con síncope presentan una disautonomíaque se muestra como una hipofunción simpática y parasimpática.Estos resultados confirman la utilidad de los tests de estimulaciónautonómica cardiovascular en el estudio de dichos pacientes. Porsu parte, la búsqueda de otros síntomas de afectación autonómicapuede ser de gran ayuda para la valoración de esta patología

Introduction. According to the current literature on the subject, patients with syncope suffer a dysfunction of theautonomic nervous system (ANS). Yet few studies offer a clear explanation of this dysfunction. Moreover, the evaluation ofcardiovascular reflexes is a simple, useful method of studying the functional status of the ANS. This work was designed toevaluate the existence of dysautonomia in syncope patients by means of the autonomic cardiovascular stimulation tests; it hasbeen the most comprehensive of those published to date. Subjects and methods. We studied 170 healthy volunteers and 188patients with syncopes in the previous months, paired by age and sex. Cardiovascular stimulation tests were conducted, inaccordance with Ewing and Clark’s methodology, together with the cold test. A rating scale was included to evaluate thesymptoms related to ANS involvement. Results. Syncope patients display lower reactivity in tests involving cardiovascularstimulation of the ANS, regardless of whether they are taken individually or as a whole (67% in patients and 39% in controls)(p = 0.0001), except in the cold test. They also show an increase in the clinical symptoms of an autonomic origin (2.82 ± 0.17)with respect to control subjects (0.78 ± 0.09) (p = 0.0001). Conclusions. Our syncope patients have a dysautonomia thatappears as a sympathetic and parasympathetic hypofunction. These findings confirm the value of autonomic cardiovascularstimulation tests in the study of these patients. Moreover, the search for other symptoms of autonomic involvement can be agreat aid in evaluating this pathology

Aspectos medico legales en los servicios de urgencia / Medical legal aspects in emergency services

Los autores hacen una interesante revisión sobre el tema de la atención de urgencias y establecen que en las actividades de rescate existen tres tipos de responsabilidades que deben tener los médicos: éticas, morales y legales. Se definen la responsabilidad moral, la responsabilidad ética y la responsabilidad legal, y de acuerdo con la OMS se define también el término urgencia. Se hace una revisión de los delitos en que puede incurrir un médico y se establece que éstos pueden ser por omisión, acción y por comisión por omisión. De igual forma, se definen las reponsabilidades civiles, penales y administrativas. Por último, se describe un estudio realizado por la Comisión de Arbitraje Médico del Estado de México durante 18 meses de actividades.

Un método analítico del estudio rinomanométrico / An analytical method of the rhinometric study

En el presente trabajo se presenta un método para en el análisis de las curvas rinomanométricas, basándose en los conceptos de Cottle, pero mediante un registro que permite transformar en cifras los diferentes tipos de curva. Se estudiaron prospectivamente 623 enfermos que fueron sometidos a estudio clínico y rinomanométrico. Los autores consideran que es necesario simplificar y estandarizar el análisis de las curvas rinomanométricas, lo cual consideran alcanzar mediante el método propuesto, con ello la función nasal se puede valorar en forma objetiva y completa el diagnóstico clínico, además de favorecer el entendimiento de las alteraciones respiratorias

Aspergillosis del seno maxilar sin enfermedades predisponentes: presentación de un caso / Aspergillosis of the maxillary sinus without predisposing diseases: report of a case

Se presenta el caso de un paciente joven y sano, que desarrolló una Aspergillosis del seno maxilar izquierdo, la cual fue corroborada histológicamente. Se Logró la curación mediante 10 días. La Aspergillosis del aparato respiratorio y en especial de las regiones naso-sinusales han sido reportadas cada vez con más frecuencia en las dos últimas décadas, pero se presentan generalmente en sujetos de más de 60 años con enfermedades sistémicas. Los casos reportados en sujetos jóvenes y aparentemente sanos han sido ocasionales. Se considera que la Aspergillosis debe tenerse como posibilidad diagnóstica, cuando ante una sinusitis, no obtenemos ninguna respuesta a los tratamientos convencionales