Obesity as a Neuroendocrine Disorder.

Obesity is one of the most prevalent diseases in the world. Based on hundreds of clinical and basic investigations, its etiopathogenesis goes beyond the simple imbalance between energy intake and expenditure. The center of the regulation of appetite and satiety lies in the nuclei of the hypothalamus where peripheral signals derived from adipose tissue (e.g., leptin), the gastrointestinal tract, the pancreas, and other brain structures, arrive. These signals are part of the homeostatic control system (eating to survive). Additionally, a hedonic or reward system (eating for pleasure) is integrated into the regulation of appetite. This reward system consists of a dopaminergic circuit that affects eating-related behaviors influencing food preferences, food desires, gratification when eating, and impulse control to avoid compulsions. These systems are not separate. Indeed, many of the hormones that participate in the homeostatic system also participate in the regulation of the hedonic system. In addition, factors such as genetic and epigenetic changes, certain environmental and sociocultural elements, the microbiota, and neuronal proinflammatory effects of high-energy diets also contribute to the development of obesity. Therefore, obesity can be considered a complex neuroendocrine disease, and all of the aforementioned components should be considered for the management of obesity.

[Breviary of guidelines and goals of critical hospitalized patients in Internal Medicine]. / Breviario de guías y metas del paciente crítico hospitalizado en Medicina Interna.

Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.

Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.