Impaired theory of mind in unaffected first-degree relatives of patients with anorexia nervosa.

OBJECTIVE: Previous studies have shown theory of mind (ToM) is affected in patients with anorexia nervosa (AN). There has also been growing interest in the study of endophenotypes in psychiatric disorders, since they allow better understanding of genetic mechanisms underlying different conditions, making them potential targets for future treatment. The goal of this study was to investigate whether ToM inefficiencies observed in patients with AN, are shared by unaffected first-degree relatives. METHOD: Performance on two ToM tasks (Reading the Mind in the Eyes and Faux Pas Test) were compared in 17 unaffected first-degree relatives of AN patients and in 17 healthy individuals matched for age and level of education. Depression, anxiety, obsessive compulsive, and eating disorder symptoms were also assessed and correlated with ToM and clinical/demographic variables. RESULTS: Significant differences between groups were observed in all ToM tasks, with relatives of AN patients showing poorer performance. ToM assessment did not correlate with any clinical or demographic variable. CONCLUSIONS: The preliminary results of this study suggest unaffected first-degree relatives of AN patients display similar patterns of difficulty in ToM as reported previously for AN patients, supporting the hypothesis that ToM inefficiencies are a familial trait in this condition.

Resultados preliminares de un estudio de evaluación de factores de riesgo cardiovascular en estudiantes de la Universidad de Buenos Aires / Preliminary results of an evaluation study of cardiovascular risk factors in students of Buenos Aires Univesity

Introducción: el síndrome metabólico (SM) aumenta el riesgo de enfermedad cardiovascular. Esta asociación varía según la edad, factores étnicos, económicos y ambientales. El SM no se evaluó en jóvenes de la población argentina. Objetivos: evaluar los componentes del SM en estudiantes de la Universidad de Buenos Aires. Materiales y métodos: se evaluaron 1.550 estudiantes, de 18 a 40 años, en un estudio transversal epidemiológico durante un período de 12 meses. Criterios de exclusión: embarazo, consumo de alcohol o drogas. Se analizaron peso, talla, presión arterial y circunferencia de la cintura (CC). Se midieron los niveles en sangre de glucosa, LDL-C, triglicéridos (TG) y HDL-C. Se calcularon el índice de masa corporal y TG/HDL-C. El SM se definió según los criterios del ATP III. Consideramos alto LDL-C si era >130 mg/dL y TG elevados cuando eran >150 mg/dL. Resultados: la media de edad fue de 25±4,8 años, el 60,2% fue mujer. Prevalencia de factores de riesgo: obesidad 6,6%, sobrepeso 21,9%, glucemia anormal 0,4%, alto LDL-C 12,8%, alto TG 9,2%, bajo HDL-C 9,2%, hipertensión 3,6%, alto TG/HDL 5%, aumento de CC 6,6%, SM 2,5%. Conclusiones: encontramos baja prevalencia de SM en jóvenes estudiantes universitarios

Introduction: metabolic syndrome (MS) increased risk of cardiovascular disease. This association varies by age, race, ethnic, economic and environmental factors. MS in young people has not been evaluated on argentinian population. Objectives: to evaluate the components of the metabolic syndrome in students of the University of Buenos Aires. Materials and methods: a sample of 1.550 students from 18 to 40 years were evaluated on an epidemiological cross-sectional study in a 12 months period. Exclusion criteria: pregnancy, alcohol intake or drugs that affect hepatic parameters. Weight, height, blood pressure and waist circumference (WC) were evaluated. Blood levels of glucose, LDL-C, triglycerides (TG) and HDL-C were measured. Body mass index and TG/HDL-C were calculated. MS was defined according to ATP III criteria. We considered high LDL-C >130 mg/dL and high TG >150mg/dl. Results: mean age was 25±4.8 years, 60.2% were females. Prevalence of risk factors: obesity 6.6%, overweight 21.9%, abnormal glucose 0.4%, high LDL-C 12.8%, high TG 9.2%, low HDL-C 9.2%, hypertension 3.6%, high TG/HDL 5%, increased WC 6.6%, MS 2.5%, Conclusions: we found low prevalence off MS on this young student population

Relación entre actividades de tiempo libre y cognición en adultos mayores: una revisión de estudios argentinos e iberoamericanos / Relationship between leisure activities and cognition in elderly adults: a review of argentine and Iberoamerican studies

El envejecimiento poblacional implica un desafío para la salud pública por las patologías cuyos casos aumentan con la extensión de la vida. Se ha propuesto que ciertas actividades de la vida diaria (AVDs) avanzadas de tiempo libre poseen un efecto bené+co en la cognición de los adultos mayores. El objetivo de este trabajo fue relevar estudios empíricos presentando evidencia respecto a la relación entre dichas actividades y el funcionamiento cognitivo, para países iberoamericanos. Se incluyeron trabajos escritos en español, portugués e inglés, de enero de 2012 a mayo de 2017, involucrando a adultos de 60 y más años de edad no institucionalizados. Se hallaron 15 trabajos. Considerados en su conjunto, existiría evidencia de una relación entre las mencionadas actividades y el rendimiento cognitivo. Los trabajos de diseño prospectivo y los de intervención indicarían que la realización de dichas actividades avanzadas incide bene+ciosamente en el funcionamiento cognitivo.

Population aging implies a challenge to public health for the pathologies whose cases increase with the extension of life. It has been proposed that certain leisure advanced activities of daily living (ATLs) have a bene+cial effect on the cognition of the elderly. The objective of this work was to relieve empirical studies presenting evidence regarding the relationship between these activities and cognitive functioning, for Iberoamerican countries. Works written in Spanish, Portuguese and English were included from January 2012 to May 2017, involving non-institutionalized adults aged 60 and over. Fifteen papers were found. Considered as a whole, there would be evidence of a relationship between these activities and cognitive performance. Prospective design and interventional studies would indicate that such advanced activities has a bene+cial impact on cognitive functioning.

Pharmacotherapy and motor recovery after stroke.

INTRODUCTION: Stroke is one of the most prevalent neurological diseases worldwide, especially among the elderly population. There are various mechanisms that enhance motor recovery after a stroke. In clinical practice, we have the opportunity to enhance plasticity by designing specific rehabilitation programs. Areas covered: There are a variety of drugs commonly administered to people after the acute phase of a stroke. These drugs may modify motor performance. Herein reviewed is the evidence concerning motor enhancement or decline in stroke patients, produced by drugs commonly used in rehabilitation settings. An extensive review of animal and human studies is performed. Expert commentary: Many of the clinical trials carried out were underpowered. Modest evidence supports the claim that there are agents that can affect motor rehabilitation after a stroke. Amphetamine-like agents, serotonin reuptake inhibitors, and levodopa might improve motor outcomes, while antipsychotics, some antiepileptic drugs, and GABAmimetic drugs could impair the recovery process. To draw definite recommendations, more comprehensive knowledge about the efficacy, long-term effects, and safety of these drugs is required. There are also other interesting molecules that open a promising field for basic and clinical research, in the search for new therapeutic options.

Alteraciones lipídicas en adolescentes de peso adecuado / Alterações lipídicas em adolescentes de peso adequado / Lipidic alterations in adolescents of adequate weight

Introducción. Las concentraciones de c-LDL (low-density lipoprotein cholesterol) y de c-HDL (high-density lipoprotein cholesterol) se utilizan generalmente para determinar el riesgo aterogénico. Los diferentes estudios, tanto en adultos como en niños, demuestran el valor pronóstico superior de la apolipoproteina B, colesterol no HDL e índices específicos de las lipoproteínas (triglicéridos/c-HDL, c-LDL/c-HDL, colesterol total/c-HDL). Objetivo. Determinar el perfil lipídico, las lipoproteínas y los perfiles de apolipoproteínas y su asociación con los indicadores antropométricos en la población joven. Materiales y métodos. Fueron evaluados 429 niñas y 514 varones, entre 11 y 14 años. Se determinaron las medidas antropométricas, la presión arterial, el índice de masa corporal (IMC) y la relación entre cintura y talla. Fueron analizados: glucemia, colesterol total, c-LDL, triglicéridos y apolipoproteína B. Se calcularon las relaciones entre triglicéridos y c-HDL y el colesterol no HDL. Resultados. Los varones tuvieron mayor peso, mayor IMC, mayor circunferencia de cintura, mayor presión arterial sistólica y diastólica, en comparación a las niñas. Observamos una correlación positiva entre la circunferencia de cintura y el IMC con el colesterol total y con distintos índices de lipoproteínas en varones; sin embargo, en las niñas únicamente la circunferencia de cintura se asoció con los índices de lipoproteínas. Solo el 70% de los adolescentes tuvieron un perfil lipídico dentro de los parámetros de normalidad, así como el c-LDL y los niveles de colesterol no HDL. El c-HDL se encontró disminuido en un 35% de los varones y en un 45% de las mujeres, anormalidad más frecuentemente hallada. Conclusiones. Demostramos que existe una alta prevalencia de niveles no deseables de lípidos y de lipoproteínas en adolescentes con peso adecuado. Este estudio enfatiza la necesidad de un reconocimiento y de una intervención precoz de la dislipemia en la población pediátrica para prevenir la enfermedad cardiovascular en la etapa adulta.

Lipidic alterations in adolescents of adequate weight Background. Serum concentration of low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) are usually used to determine atherogenic risk. Different studies in adults as well as in children have shown the superior prognostic value of apolipoprotein B, non HDL- cholesterol and specific ratios of lipoprotein variables, such as triglycerides/ HDL-c, LDL-c/ HDL-c and cholesterol/HDL-c. Aims. Determine lipid, lipoprotein and apolipoprotein profiles and its association with anthropometric indicators in a young population. Materials and methods. Four hundred twenty nine girls and 514 boys, between 11 and 14 years old were evaluated. Anthropometric measures, blood pressure, body mass index (BMI) and waist/height ratio were determined. Blood glucose, total cholesterol, LDL-c, triglycerides, apolipoprotein B were analyzed. Triglycerides/HDL-c ratio and non HDL-c were calculated. Results. Males had higher weight, BMI, waist circumference and blood pressure, both systolic and diastolic than girls. We observed positive correlations between waist circumference and BMI with total cholesterol and different lipoprotein ratios in males, however in female only waist circumference was associated with lipoprotein ratios. Only seventy percent of the adolescents presented normal lipid profile as well as LDL and non HDL-c levels. HDL-c was decreased in 35% of males and 45% of females, being the most frequent abnormality found. Conclusions. We showed a high prevalence of undesirable lipid and lipoprotein levels in normal weight adolescents. This study emphasizes the need for early recognition and intervention for hyperlipidemia in pediatric populations to prevent cardiovascular disease in adults.

Alterações lipídicas em adolescentes de peso adequado Introdução. As concentrações séricas de colesterol de lipoproteínas de baixa densidade (LDL-c) e colesterol de lipoproteínas de alta densidade (HDL-c) são geralmente utilizadas para determinar o risco aterogênico. Estudos diferentes tanto em adultos como em crianças mostraram o valor prognóstico superior da apolipoproteína B, colesterol não HDL e relações específicas de variáveis de lipoproteínas, tais como triglicerídeos/HDL-c, LDL-c/HDL-c e colesterol/HDL-c. Objetivos. Determine os perfis lipídicos, lipoproteicos e apolipoproteicos e sua associação com indicadores antropométricos em uma população jovem. Materiais e métodos. Foram avaliados 429 meninas e 514 meninos, entre 11 e 14 anos de idade. Foram determinadas medidas antropométricas, pressão sanguínea, índice de massa corporal (IMC) e relação cintura/altura. Foram analisados: glicemia, colesterol total, LDL-c, triglicerídeos, apolipoproteína B. Foram calculadas taxas de triglicerídeos/HDL-c e colesterol não HDL. Resultados. Os meninos tiveram maior peso, maior IMC, maior circunferência da cintura, maior pressão arterial sistólica e diastólica em comparação com as meninas. Observou-se uma correlação positiva entre a circunferência da cintura e o IMC com colesterol total e lipoproteínas com taxas diferentes em meninos; no entanto, só as meninas a circunferência da cintura foi associado com níveis de lipoproteínas. Apenas 70% dos adolescentes tiveram um perfil lipídico dentro dos parâmetros de normalidade e o LDL-c e os níveis de colesterol não HDL. O HDL-c diminuiu em 35% dos homens e 45% das mulheres, sendo a anormalidade mais freqüente encontrada. Conclusões. Mostramos uma alta prevalência de níveis indesejáveis de lipídios e lipoproteínas em adolescentes com peso normal. Este estudo enfatiza a necessidade de reconhecimento precoce e intervenção para hiperlipidemia em populações pediátricas para prevenir doenças cardiovasculares em adultos.

Tabaquismo pasivo y su efecto en la salud infantil: ¿Qué cambió en 11 años?: Hospital Zubizarreta / Passive smoking and its effect on children's health: What changes in 11 years?: Zubizarreta Hospital

Investigación que sigue los hallazgos de un estudio previo realizado entre junio de 2005 y junio de 2006, sobre el humo ambiental de tabaco y sus efectos en las madres y sus hijos, donde se encuestaron 100 madres de niños que se atendieron en el Hospital Zubizarreta. de la Ciudad de Buenos Aires. La presente investigación tuvo como objetivo determinar cuál es la situación actual de las familias que asisten al mismo hospital, en relación a la exposición al tabaco y si hay algún cambio en la distribución de fumadores en los hogares de los pacientes, o si se expone menos a los niños fumando fuera de las viviendas en las familias de fumadores. Se realizó un estudio epidemiológico descriptivo transversal para el que se confeccionó una encuesta semiestructurada anónima que se les realizó a las madres de niños/as entre 4 meses y 12 años de edad que concurrieron al hospital. La misma fue administrada por médicos del Consultorio Externo de Pediatría y una voluntaria que concurrió por 1 mes para efectuarla. El estudio se llevó a cabo entre julio de 2016 y julio de 2017, y se trabajó sobre las variables socio demográficas incluidas en el Índice de Graffar modificado, como tipo de vivienda, trabajo, escolaridad entre otros. A su vez se incluyen datos de salud, sobre antecedentes obstétricos de la madre y de procesos de enfermedad de los/as hijos/as y del consumo o no de tabaco, entre otras variables

Diagnóstico de esteatosis hepática por métodos clínicos, bioquímicos y por imágenes / Diagnosis of hepatic steatosis using clinical, biochemical and imaging methods

La enfermedad hepática grasa no alcohólica comprende un espectro de afecciones hepáticas que va desde la simple esteatosis a la esteatohepatitis, fibrosis y hasta cirrosis. Su prevalencia aumenta con la edad, la obesidad y está fuertemente asociada con la presencia de síndrome metabólico y aumento de la mortalidad cardiovascular y por enfermedades malignas. Se produce por una acumulación de triglicéridos en los hepatocitos relacionada con insulinorresistencia hepática y muscular. Su presencia se asocia con aumento de transaminasa glutámico-oxaloacética o glutamico-pirúvica, aunque esta última puede no estar elevada en la enfermedad avanzada. Existen 5 índices utilizados para el diagnóstico de esteatosis hepática: SteatoTest, fatty liver index, NAFLD liver fat score, lipid acumulation product y hepatic steatosis index, mientras que para esteatohepatitis contamos con el NASH test, NASH diagnostics, NASH score y HAIR (Hypertention, increased ALT and IR o Insulin resistence). En estadios de fibrosis el índice transaminasa glutamicooxáloacetica-glutamicopiruvica aumenta, así como la ferritina en sangre y el valor del NAFLD fibrosis score, siendo de alta especificidad para el diagnóstico. La ecografía abdominal tiene una gran disponibilidad, pero su sensibilidad diagnóstica es menor cuando existen grados leves de infiltración grasa hepática. La tomografía computada tiene una especificidad del 100% cuando el contenido graso es mayor al 30% pero la radiación emitida no permite un uso frecuente. La resonancia magnética con espectroscopia constituye el método de elección para la detección y cuantificación de contenido de grasa hepática. La biopsia hepática es un método invasivo que permite una clasificación pronóstica adecuada de la enfermedad, pero por sus complicaciones solo debe realizarse en pacientes seleccionados: aquellos con riesgo elevado de esteatohepatitis o riesgo de fibrosis por laboratorio o clínica, o con otras enfermedades hepáticas coexistentes. La identificación temprana de enfermedad hepática grasa no alcohólica permite la implementación de medidas tempranas para disminuir la morbimortalidad asociada a esta condición.

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver diseases ranging from steatosis to steatohepatitis, fibrosis and cirrhosis. Its prevalence increases with age and with obesity, and is strongly associated with the presence of metabolic syndrome and increased cardiovascular and malignant diseases. It is caused by an accumulation of triglycerides in liver hepatocytes and muscles, and related to insulin resistance. Its presence is associated with the increase of alanine aminotransferase (alt), although it may not be elevated in advanced disease. There are 5 indexes used for the diagnosis of hepatic steatosis: SteatoTest, fatty liver index, NAFLD liver fat score, lipid accumulation product and hepatic steatosis index, whereas for esteatohepatitis the NASH test, NASH diagnostics, as well as the non-alcoholic steatohepatitis (NASH) score and HAIR (hypertension, ALT, and insulin resistance). In stages of fibrosis AST-ALT index increases as well as ferritin in blood and the NAFLD fibrosis score, which has a high specificity for diagnosis. Abdominal ultrasound is widely available, but its diagnostic sensitivity is lower when there are mild degrees of hepatic fatty infiltration. Computed tomography has a specificity of 100% when fat content is greater than 30%, but the radiation emitted prevents frequent use. Magnetic resonance spectroscopy is the method of choice for the detection and quantification of liver fat content. Liver biopsy is an invasive method that enables appropriate prognostic classification of the disease, but has some complications, and should only be performed in selected individuals: high risk of steatohepatitis or fibrosis risk of laboratory or clinical or other co-existing liver disease. Early identification of NAFLD allows early measures to be implemented in order to reduce morbidity and mortality associated with this condition.

[Theory of Mind in eating disorders: endophenotype of the disease?]. / Teoría de la mente en los trastornos alimentarios: ¿endofenotipo de la enfermedad?

UNLABELLED: Considering the clinical and empirical evidence of socio-cognitive difficulties in patients with eating disorders, this paper aims to critically review the current state of research on theory of mind in anorexia and bulimia, to evaluate if there is any alteration of it in these pathologies and to determine whether there are indicators that can be considered endophenotype. METHOD: We conducted a literature search of PubMed database, using keywords related to the topic. The papers were analyzed according to inclusion/ exclusion criteria. RESULTS: We identified seven studies of patients with anorexia, one on bulimia and four on both pathologies. Most studies reported that patients with anorexia have alterations in the theory of mind. Studies on bulimia are scarce, and their results contradictory. CONCLUSION: Research on theory of mind in eating disorders at initial level, being the most of works on anorexia. There are indicators of deficits for this pathology on ToM tasks, and they might be considered endophenotypes, although studies that evaluate unaffected first-degree relatives are still lacking.

New centrally acting agents for appetite control: from biological mechanisms to clinical efficacy.

BACKGROUND: Obesity is one of the major problems of health policy in different countries. Pharmacological attempts have been made to help affected people without a definitive solution. Some agents--either with peripheral or central effect--are available in the market. On July 2012, the FDA approved two novel preparations for obese patients: (1) topiramate-phentermine--the first one an anticonvulsant and the second one a sympathomimetic amine--and (2) lorcaserin, a 5-HT2CR agonist. Both preparations emerged as new options for weight management. SCOPE: Based on the complex biology of eating behavior, in this review we discuss the features, mechanisms of action, pharmacokinetics, advantages and possible disadvantages of these new agents. CONCLUSION: With differences in efficacy (higher for the topiramate-phentermine combination), both preparations are active in reducing appetite and body weight, as well as in improving comorbidities. Additional information will be collected from Phase IV surveillance. Focus on cardiovascular, neuropsychiatric (for both introductions) and embrio-fetal safety (especially for topiramate) is expected.

Teoría de la mente en los trastornos alimentarios: ¿endofenotipo de la enfermedad? / [Theory of Mind in eating disorders: endophenotype of the disease?].

UNLABELLED: Considering the clinical and empirical evidence of socio-cognitive difficulties in patients with eating disorders, this paper aims to critically review the current state of research on theory of mind in anorexia and bulimia, to evaluate if there is any alteration of it in these pathologies and to determine whether there are indicators that can be considered endophenotype. METHOD: We conducted a literature search of PubMed database, using keywords related to the topic. The papers were analyzed according to inclusion/ exclusion criteria. RESULTS: We identified seven studies of patients with anorexia, one on bulimia and four on both pathologies. Most studies reported that patients with anorexia have alterations in the theory of mind. Studies on bulimia are scarce, and their results contradictory. CONCLUSION: Research on theory of mind in eating disorders at initial level, being the most of works on anorexia. There are indicators of deficits for this pathology on ToM tasks, and they might be considered endophenotypes, although studies that evaluate unaffected first-degree relatives are still lacking.

Teoría de la mente en los trastornos alimentarios: ¿endofenotipo de la enfermedad? / [Theory of Mind in eating disorders: endophenotype of the disease?].

UNLABELLED: Considering the clinical and empirical evidence of socio-cognitive difficulties in patients with eating disorders, this paper aims to critically review the current state of research on theory of mind in anorexia and bulimia, to evaluate if there is any alteration of it in these pathologies and to determine whether there are indicators that can be considered endophenotype. METHOD: We conducted a literature search of PubMed database, using keywords related to the topic. The papers were analyzed according to inclusion/ exclusion criteria. RESULTS: We identified seven studies of patients with anorexia, one on bulimia and four on both pathologies. Most studies reported that patients with anorexia have alterations in the theory of mind. Studies on bulimia are scarce, and their results contradictory. CONCLUSION: Research on theory of mind in eating disorders at initial level, being the most of works on anorexia. There are indicators of deficits for this pathology on ToM tasks, and they might be considered endophenotypes, although studies that evaluate unaffected first-degree relatives are still lacking.

Pharmacological treatment of obesity in children and adolescents: current status and perspectives.

IMPORTANCE OF THE FIELD: The prevalence of overweight and obesity in children and adolescents is increasing rapidly, while the short- and long-term morbid outcomes make these entities a major public health concern. Initial steps in therapy are based on dietary and lifestyle intervention. In the presence of an insufficient progress, medication or - eventually - surgery may be recommended. Three drugs are currently used: orlistat, metformin, and sibutramine; other candidates are in development. However, trials assessing the efficacy and safety of the current medications are frequently affected by methodological limitations, in particular insufficient power and period of follow-up. AREAS COVERED IN THIS REVIEW: The efficacy and safety of antiobesity drugs currently used for children and adolescents are reviewed. Additional information on upcoming agents is presented. WHAT THE READER WILL GAIN: This is an exhaustive review of current state on controversial issues regarding drugs used in children and adolescent obesity, specifically related with their efficacy and safety. TAKE HOME MESSAGE: The efficacy of these drugs is modest. Our knowledge of their efficacy and safety comes from clinical trials affected by insufficient follow-up (1 year or less); very often, these trials are of limited power. Further data from larger and longer well-designed clinical trials would be advisable.