ABSTRACT
Resumen: OBJETIVO Determinar el alivio de comorbilidades en pacientes a los que se les practicó cirugía bariátrica en el Hospital Regional de Alta Especialidad de la Península de Yucatán. MATERIAL Y MÉTODO Estudio retrospectivo observacional efectuado de 2011 a 2014, en el que se incluyeron pacientes con índice de masa corporal ≥ 40 kg/m2o ≥ 35 kg/m2 con comorbilidades a quienes se les efectuó cirugía bariátrica. Los criterios diagnósticos de síndrome metabólico fueron los de la Federación Internacional de Diabetes válidos para población mexicana. RESULTADOS Se incluyeron 67 pacientes a los que se les hizo cirugía bariátrica (bypass gástrico en Y de Roux por laparoscopia); 79% eran mujeres, el rango de edad fue de 19-55 años con media de 36.5 ± 8.2 años. El promedio de peso antes de la cirugía fue de 119.4±20 kg. El promedio del porcentaje de pérdida de peso posoperatorio fue de 19.8, 27.9 y 34.3% a 3, 6 y 12 meses. La media del peso, índice de masa corporal, presión arterial sistólica y diastólica, colesterol total, LDL, HDL y glucosa disminuyeron significativamente (p< 0.001) un año después de la intervención quirúrgica. Los porcentajes de remisión fueron: síndrome metabólico, diabetes mellitus y col-HDL bajo: 100%, hipertensión arterial: 94.1%, hipertrigliceridemia: 60.9%. CONCLUSIÓN A 12 meses de la intervención quirúrgica, las remisiones de síndrome metabólico, diabetes mellitus y HDL bajo fueron del 100% y mayores a 60% en los otros componentes del síndrome metabólico.
Abstract: OBJECTIVE To determine the relief of comorbidities in patients undergoing bariatric surgery of metabolic syndrome in the Regional Hospital of High Specialty of the Yucatan Peninsula, Mexico. MATERIAL AND METHOD A retrospective observational study was done from 2011 to 2014 in patients with a body mass index (BMI) ≥ 40 kg/m2 or ≥ 35 kg/m2 with comorbidities undergoing bariatric surgery. The diagnostic criteria of the metabolic syndrome were those of the International Diabetes Federation applied to the Mexican population. RESULTS A total of 67 patients undergoing bariatric surgery (laparoscopic Roux-en-Y gastric bypass) were included in the study; 79% were women, the age range was 19-55 years with an average of 36.5 ± 8.2 years. The average weight before surgery was 119.4 ± 20 kg. The average percentage of postoperative weight loss was 19.8%, 27.9% and 34.3% at 3, 6 and 12 months, respectively. The mean weight, BMI, systolic and dyastolic blood pressure, total cholesterol, LDL, HDL and glucose decreased significantly (p < 0.001) one year after surgery. The percentages of remission were: metabolic syndrome, diabetes mellitus and low HDL-cholesterol: 100%, arterial hypertension: 94.1%, hypertriglyceridemia: 60.9%. CONCLUSION At twelve months, the remissions of metabolic syndrome, diabetes mellitus and low HDL were 100%, being greater than 60% in the other components of the metabolic syndrome.
ABSTRACT
Activation of gamma-aminobutyric acid B (GABA(B)) and 5-hydroxytryptamine (5-HT) receptors produces presynaptic inhibition at glutamatergic terminals in the rat neocortex. To evaluate interactions between these metabotropic receptors, field potentials were recorded in layer 2/3 of somatosensory cortex. In addition, the paired pulse (PP) protocol was used to measure changes in the ratio of the second/first extracellular synaptic potentials (S(2)/S(1) ratio) as an index of glutamate release probability in the area. Lowering extracellular [Ca(2+)](o) to 0.5 mM, increased the S(2)/S(1) ratio by 318 +/- 134%. 5-HT (1 microM) increased the S(2)/S(1) ratio by 61 +/- 15%. In presence of the GABA(A) antagonist bicuculline (10 microM), 5-HT increased the S(2)/S(1) ratio by 98 +/- 15%. This effect did not desensitize after two consecutive applications of the amine, and was dose dependent in the concentration range between 0.03-1 microM (EC(50) = 2.36 x 10(-7) mol/L). The increase of S(2)/S(1) ratio induced by 5-HT (1 microM) was blocked reversibly by the 5-HT(1A) antagonist NAN-190 (10-30 microM), but was unaffected by the selective GABA(B) antagonist CGP 52432 (1 microM). The action of 5-HT was mimicked by the 5-HT(1A/7) agonist 8OH-DPAT (10 microM), increasing the S(2)/S(1) ratio by 84 +/- 2%, a response that was unaffected by the 5-HT(2/7) antagonist ritanserin (2 microM). The 5-HT(1B) agonist CP93129 (10 microM) had no effect. The GABA(B) agonist baclofen (1 microM) increased the S(2)/S(1) ratio up to 308 +/- 33%, which is similar to that produced by low [Ca(2+)](o). When the effect of baclofen was maximal, application of 5-HT (1 microM) reversed the S(2)/S(1) ratio back to 78 +/- 27%, a result that was blocked by the 5-HT(2/7) antagonist ritanserin (100 nM). Notably, the interaction between the GABA(B) agonist and 5-HT was order dependent, because enhancement of the S(2)/S(1) ratio elicited by baclofen was not inhibited if 5-HT was applied first. These results suggest a complex interaction between GABA(B), 5-HT(1A), and 5-HT(2) receptors in layer 2/3 of rat somatosensory cortex. Activation of GABA(B) receptors induces PP facilitation (inhibits glutamate release) more efficiently than does activation of 5-HT(1A) receptors. When the effect of GABA(B) receptor activation is maximal, however, the influence of 5-HT changes to the opposite direction, inhibiting PP facilitation (increasing glutamate release) through activation of 5-HT(2) receptors.
