The Effect of Dietary Patterns on Inflammatory Biomarkers in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Some evidence supports the fact that chronic low-grade inflammation contributes to the physiopathology of type 2 diabetes mellitus (T2DM), and circulating markers of inflammation (e.g., C-reactive protein (CRP), pro- and anti-inflammatory biomarkers (e.g., adiponectin), and endothelial function markers could indicate an ongoing pathology. Following certain dietary patterns (DPs) may result in favorable changes in inflammatory biomarkers. The overarching aim of this systematic review and meta-analysis is to explore the inflammatory effect of healthy DPs on inflammatory biomarkers in adults with T2DM. A systematic search of the literature was conducted using the electronic databases MEDLINE, SCOPUS, and Cochrane Central Register of Controlled Trials. A total of 10 randomized controlled clinical trials (RCTs) were analyzed. In our linear meta-analysis, the random-effects model was applied to estimate standardized mean differences (SMD) to associate the effect of the interventions. Dietary Approaches to Stop Hypertension (DASH), Diabetes UK healthy eating, Mediterranean Diet (MD), Diabetes Prevention Program (DPP), and the American Heart Association's Therapeutic Lifestyle Changes diet were associated with a significant reduction in CRP (SMD: −0.83, 99% CI −1.49, −0.17, p < 0.001; I2 94%), while plasma levels of adiponectin were significantly higher with the intake of MD, DPP, and Diabetes UK healthy eating (SMD: 0.81, 99% CI 0.06,1.56, p < 0.005; I2 96%), both of which indicate less inflammation. Sensitivity analyses were carried out, and potential publication bias was examined. In conclusion, low- moderate-quality evidence from RCTs suggests that, for the DPs evaluated, there are favorable changes in CRP and adiponectin.

Calidad de vida relacionada con la salud en pacientes trasplantados de córnea de un hospital de tercer nivel / Quality of life in adult patients after the cornea transplant in a third level hospita

Introducción: La grave limitación funcional que conlleva la ceguera o debilidad visual concede al trasplante de córnea un alto valor social, económico y humano. La calidad de vida relacionada con la salud se puede considerar como un indicador de calidad asistencial. Objetivo: Determinar la calidad de vida en pacientes adultos después del trasplante de córnea en un hospital de tercer nivel. Método: Con aprobación ética, se realizó un estudio transversal en pacientes trasplantados de córnea de 2012 a 2016. Se analizaron variables sociodemográficas, calidad de vida relacionada con la salud (SF-36) y agudeza visual en el ojo trasplantado (movimiento de manos, recuento de dedos y test de Snellen). Se aplicaron la prueba de ji cuadrado, el test de Kruskal-Wallis y el test de Wilcoxon; se consideró significativa una p < 0.05. Resultados: Se incluyeron 60 pacientes de 17 a 89 años de edad receptores de trasplante de córnea. El motivo de trasplante más frecuente fue por queratocono (n = 36). El 60% (n = 36) tuvieron buena visión después del trasplante y se hallaron diferencias significativas entre la agudeza visual del ojo trasplantado preoperatoria y posoperatoria (p = 0.000). La calidad de vida fue buena en el 86.67% de la muestra. Las dimensiones de la calidad de vida fueron mayores a medida que mejoró la agudeza visual (p < 0.05). Conclusiones: El seguimiento a pacientes trasplantados de córnea es indispensable para evaluar los resultados de la atención médica.

Introduction: The severe functional limitation that blindness or visual weakness entails gives a high social, economic and human value to corneal transplantation. The quality of life related to health can be considered as an indicator of quality of care. Objective: To determine the quality of life in adult patients, after the cornea transplant in a third level hospital. Method: With ethical approval, a cross-sectional survey was carried out in patients transplanted from the cornea from 2012 to 1016. Sociodemographic variables, quality of life related to health (SF-36) and visual acuity (hand movement, counting of fingers and Snellen test). Chi-square test, Kruskal-Wallis test, Wilcoxon test and p < 0.05 were considered significant. Results: We included 60 patients from 17 to 89 years of age, transplanted from the cornea. The most frequent reason for transplant was keratoconus (n = 36). Sixty percent (n = 36) had good vision after transplantation and significant differences were found between visual acuity before and after surgery (p = 0.000). The quality of life was good in 86.67% of the sample. The dimensions of quality of life were greater as visual acuity improved (p < 0.05). Conclusions: The follow-up of patients transplanted from the cornea is essential to evaluate the results of medical care

Relación de la grasa corporal con la alimentación emocional y calidad de la dieta en universitarios de México / Relationship of body fat with emotional eating and quality of diet in university students from Mexico

La obesidad es un problema de salud pública. La comprensión de factores tanto emocionales como dietéticos relacionados a su desarrollo es fundamentales para abordar este problema. El objetivo del presente estudio fue analizar por sexo y edad la relación de la grasa corporal con la alimentación emocional (AE) y la calidad de la dieta (CD) en población universitaria. Se realizó un estudio transversal en el que participaron 367 estudiantes universitarios de medicina (65 % mujeres). El porcentaje de grasa se midió a través de bioimpedancia eléctrica. La alimentación emocional (AE) (emoción, familia, indiferencia, cultura y efecto del alimento) se obtuvo de la escala de AE y la calidad de la dieta (CD)a partir de índice de calidad de la dieta mexicana (ICMX) (suficiente, balanceada, completa, variada e inocua), mediante un cuestionario semicuantitativo de frecuencia de consumo de alimentos. Para identificar qué variables independientes explican el porcentaje de grasa corporal se utilizó la regresión lineal múltiple. Se encontraron diferencias estadísticamente significativas entre sexos, los hombres presentaron valores superiores a las mujeres en edad, peso, altura e IMC (kg/m2), mientras que las mujeres presentaron un mayor porcentaje de grasa corporal respecto a los hombres. La cultura (p=,001) y efecto del alimento (p=,006), factores de la AE, predijeron menor porcentaje de grasa corporal en hombres mayores de 20 años. Resulta necesario implementar programas de salud, que vayan encaminados a un consumo saludable de alimentos mediante actividades recreativas y con el acompañamiento de profesionales de la salud durante la universidad(AU)

Obesity is a public health problem. Understanding both emotional and dietary factors related to its development are essential to address this problem. The objective of this study was to analyze by sex and age the relationship of body fat with emotional eating (EE) and diet quality (DQ) in university population. A cross-sectional study was carried out in which 367 university medical students participated (65% women). Body fat percentage was measured through electrical bioimpedance. Emotional eating (EE) (emotion, family, indifference, culture and effect of food) was obtained from the EE scale and diet quality (DQ) from the Mexican Diet Quality Index (MDQI) (sufficient, balanced, complete, varied and innocuous), using a semi-quantitative food consumption frequency questionnaire. Multiple linear regression was used to identify which independent variables explain body fat percentage. Statistically significant differences were found between sexes, men had higher values than women in age, weight, height, and BMI (kg/m2), while women had a higher body fat percentage compared to men. Culture (p = .001) and effect of food (p = .006), factors of EE, predicted lower body fat percentage in men older than 20 years. It is necessary to implement health programs that are aimed at a healthy consumption of food through recreational activities and with the accompaniment of health professionals during university(AU)

Lesiones por causa externa en el servicio de urgencias de un hospital en un periodo de cinco años.

INTRODUCCIÓN: En el Estado de México no existen investigaciones que proporcionen información para toma de decisiones y administración de recursos relacionados con la atención de las lesiones por causa externa (LCE). OBJETIVO: Describir las LCE en un servicio de urgencias durante un periodo de cinco años. MÉTODO: Se diseñó un estudio retrospectivo con pacientes que ingresaron al servicio de urgencias (2010-2015) por diagnóstico de LCE. Se realizó análisis descriptivo y de clúster. RESULTADOS: En el servicio de urgencias, 16.59 % de las atenciones derivaron de LCE. Se incluyeron 16 567 pacientes de 14 a 99 años (media o promedio = 37.7, DE = 17.28), 69.2 % fue del sexo masculino. Las LCE principalmente ocurrieron en la vía pública (26.3 %) y en el hogar (23.7 %). Las causas más frecuentes fueron agresiones fuera del hogar (32.7 %), en promedio a los 34 años; caídas (25 %) en promedio a los 45 años; accidentes ocasionados por vehículos de motor (9.7 %), en promedio a los 33 años. El análisis por clúster identificó cuatro grupos: agresiones fuera del hogar 32.7 % (5417), contactos traumáticos 26.30 % (4363), accidentes de tránsito 15.9 % (2,640) y caídas 25 % (4147). CONCLUSIÓN: Las LCE relacionadas con vehículos de motor mostraron consecuencias más severas. BACKGROUND: In the State of Mexico there are no investigations that provide information for decision-making and administration of resources related to the care of externally-caused injuries (ECI). OBJECTIVE: To describe ECIs seen in an emergency department over a 5-year period. METHOD: A retrospective study was designed with patients admitted to emergency department (2010-2015) with ECI diagnosis. Descriptive and cluster analyses were performed. RESULTS: At the emergency department, 16.59% of emergency care was related to ECI. A total of 16,567 patients of 14 to 99 years of age (average = 37.7; SD = 17.28) were included; 69.2% were males. ECIs occurred mainly in public places (26.3%) and at home (23.7%). The main causes were aggression outside the home (32.7%), on average at 34 years of age, falls (25%) on average at 45 years, and motor vehicle accidents (9.7%) on average at 33 years. The cluster analysis identified four groups: aggression outside the home 32.7% (5,417), traumatic contacts, 26.30% (4,363), road traffic accidents 15.9% (2,640) and falls 25% (4,147). CONCLUSIONS: Motor vehicle accident-related ECIs showed the most severe consequences.

Norepinefrina/vasopresina versus norepinefrina en pacientes politraumatizados con traumatismo craneoencefálico severo / Norepinephrine/vasopressin versus norepinephrine, in polytraumatized patients with severe traumatic brain injury / Norepinefrina/vasopressina vs norepinefrina em pacientes com traumatismo cranioencefálico grave

Resumen: Introducción: Los pacientes politraumatizados desarrollan una respuesta inflamatoria sistémica y sucesos quimiotácticos similares a los observados en procesos infecciosos; de éstos los que además presentan TCE severo requieren mantenimiento de presión arterial media (TAM) ≥ 90 mmHg, lo que conlleva la necesidad de dosis altas de vasopresores. Objetivo: Evaluar los efectos hemodinámicos de la administración de norepinefrina/vasopresina (grupo experimental) versus norepinefrina (grupo control) en pacientes politraumatizados con traumatismo craneoencefálico severo hemodinámicamente inestables. Material y métodos: Ensayo clínico controlado, no aleatorizado, abierto y de grupos paralelos. Resultados: Se obtuvo una muestra homogénea de 20 pacientes; ambos grupos mantuvieron las medianas de TAM similares [experimental 90 versus control 93 mmHg, p = 0.516]. Los efectos hemodinámicos a favor del grupo experimental fueron: presión arterial sistólica (PAS) [primera hora, p = .041], frecuencia cardiaca (FC) [primera hora p = .029] así como lactato [hora 5, p = .015]. En cuanto al balance hídrico, la mediana del grupo control fue de +1,516 mL versus +553 mL del grupo experimental [p = 0.579]. Conclusión: No existe diferencia significativa en la TAM en la reanimación y neuroprotección de ambos grupos. Hubo mejoría estadísticamente significativa en la TAS y FC en la primera hora a favor del grupo experimental.

Abstract: Introduction: The politraumatized patients develop a systemic inflammatory response and quimiotaxis cascade like the infectious diseases; from this kind of patients, those with severe traumatic brain injury, need to hold medium arterial pressure ≥ 90 mmHg, that triggers high doses of vasopressor. Objective: Evaluate hemodynamic repercussion, of infusion Vasopressin/Norepinephrine (experimental group) vs Norepinephrine (control group) in politraumatized patients with severe traumatic brain injury whom present hemodynamic instability. Material and methods: Controlled, non randomized and open trial, with parallel groups. Results: We got a standardized sample of 20 patients; both groups had the same median of mean arterial pressure (MAP) [experimental group 90 versus control group 93 mmHg, p = 0.516]. There were better hemodynamic effect in experimental group, in systolic arterial pressure (SAP) [first hour, p = .041], heart rate (HR) [first hour p = .029], and lactate [hour 5, p = .015]. The fluid balance's median in control group was +1,516 mL versus +553 mL in experimental group [p = 0.579]. Conclusion: There was no significant difference in MAP of both groups, in reanimation period either neurological protection therapy. There was statistically significant improvement in SAP and HR, in experimental group.

Resumo: Introdução: Os pacientes politraumatizados desenvolvem uma resposta inflamatória sistêmica e eventos quimiotáticos semelhantes aos observados em processos infecciosos; destes, os que además apresentam TCE grave requerem manter a pressão arterial média (PAM) ≥ 90 mmHg, o que leva à necessidade de altas doses de vasopressores. Objetivo: Avaliar os efeitos hemodinâmicos da administração de norepinefrina/vasopressina (grupo experimental) contra norepinefrina (grupo controle), em pacientes politraumatizado com traumatismo cranioencefálico grave, que apresentam instabilidade hemodinâmica. Material e métodos: Ensaio clínico controlado, não randomizado, aberto e com grupos paralelos. Resultados: Obteve-se uma amostra homogênea de 20 pacientes; ambos os grupos mantiveram médias PAM similares [experimental 90 versus controle 93 mmHg, p = 0.516]; Os efeitos hemodinâmicos a favor do grupo experimental foram: pressão arterial sistólica (PAS) [1o hora, p = .041], freqüência cardíaca (FC) [1o hora p = 0.029], bem como lactato [5o, p = 0.015]; Em relação ao balanço hídrico, a mediana do grupo controle foi +1,516 ml vs + 553 ml do grupo experimental [p = 0.579]. Conclusão: Não há diferença significativa na PAM, na ressuscitação e neuroproteção de ambos os grupos. Houve melhora estatisticamente significativa na PAS e FC na primeira hora a favor do grupo experimental.

Vantagens e desvantagens da terapia de exposição virtual para o transtorno de estresse pós-traumático / Advantages and disadvantages of virtual exposure therapy for posttraumatic stress disorder

As técnicas de exposição foram as mais desenvolvidas no estudo do tratamento do Transtorno de Estresse Pós-Traumático nos últimos anos. Porém, exposições ao vivo e através da imaginação apresentam importantes limitações, como a impossibilidade de expor o indivíduo a determinados eventos, dificuldade de acesso emocional às memórias traumáticas e importantes taxas de desistência durante o tratamento. A Terapia de Exposição Virtual tem se mostrado eficaz no tratamento do Transtorno de Estresse Pós-Traumático, mas apresenta desafios para sua operacionalização. Esta revisão se propôs a avaliar as vantagens e desvantagens do uso da Terapia de Exposição Virtual para o Transtorno de Estresse Pós-Traumático. Foram encontradas vantagens em relação à motivação para o tratamento, capacidade de engajamento emocional e controle do terapeuta sobre os estímulos associados ao trauma.Os custos e a necessidade de especialistas em programação são desvantagens importantes. São encontradas também contra indicações médicas e psiquiátricas.Os avanços tecnológicos têm diminuído desvantagens facilitando o uso e a criação de novos cenários virtuais, porém,sem eliminá-las por completo. (AU)

Exposure procedures were the most developed techniques in the study of treatments for Posttraumatic Stress Disorder in recent years. Nonetheless, imaginary and in vivo exposures present important limitations, such as the impossibility of exposing individuals to certain type of events, the difficulty in accessing emotions related to the traumatic memories and elevated dropoutrates during treatment. The Virtual Exposure Therapy has proven to be effective in the Posttraumatic Stress Disorder treatment, however there are challenges to its implementation. This review aims at evaluating the advantages and disadvantages of the use of Virtual Exposure Therapy in the treatment of Posttraumatic Stress Disorder. Results lead to conclusions that Virtual Exposure Therapy has advantagesregarding motivation fortreatment, emotional engagement, and therapist's control over the stimuli associated to the trauma. The costs and the need for programming experts are major disadvantages. There are also medical and psychiatric contraindications. Technological advances facilitate the use and creation of new virtual scenarios, reducing the disadvantages but without eliminating them. (AU)