Search

ImportanceTo our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non–ST-segment elevation acute myocardial infarction (NSTEMI).ObjectiveTo compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022.InterventionsPatients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy.Main Outcomes and MeasuresThe primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization.ResultsThe study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, −7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, −63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78).Conclusions and RelevanceIn this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI.Trial RegistrationClinicalTrials.gov Identifier: NCT03208153

Resumen La obesidad supone uno de los grandes retos en salud en la actualidad. Las importantes repercusiones que implica obligan a un manejo integral. El presente documento tiene como objetivo establecer recomendaciones practicas y basadas en la evidencia para el diagnostico y el manejo de la obesidad en Espana, desde la perspectiva del endocrinologo clinico. Se ha realizado un documento de posicionamiento que puede consultarse en www.seen.es , que ha sido consensuado por el Grupo de Obesidad de la Sociedad Espanola de Endocrinologia y Nutricion (GOSEEN), junto con el Area de Nutricion (NutriSEEN) y el Grupo de trabajo de Endocrinologia, Nutricion y Ejercicio Fisico (GENEFSEEN).

Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.

Resumen La Terapia Ocupacional es una disciplina emergente dentro de los equipos educativos multidisciplinarios, por lo que, resulta relevante indagar sobre su rol dentro del contexto educativo chileno. Este artículo presenta una investigación cualitativa cuyo objetivo es analizar desde una perspectiva crítica, cómo influye el diagnóstico clínico en las prácticas de terapeutas ocupacionales que trabajan en contextos educativos, considerando como ejes principales para la investigación, el marco normativo inclusivo vigente en Chile, el discurso de terapeutas ocupacionales a cerca de sus prácticas y las relaciones que se establecen con el diagnóstico clínico en este contexto. La muestra corresponde a diez terapeutas ocupacionales que se desempeñan en establecimientos educativos del sur de Chile, a quienes se les aplicaron entrevistas semi-estructuradas. Los resultados permiten visualizar que las políticas educativas influyen significativamente en las prácticas de terapeutas ocupacionales, aún cuando la normativa no especifica el rol disciplinar. Además, el diagnóstico circula fuertemente en el discurso de terapeutas ocupacionales, funcionando como un dispositivo de poder al interior de las prácticas profesionales, especialmente con el fin de validar el rol profesional dentro del contexto educativo. Se discute el uso del diagnóstico en relación a la identidad profesional y los efectos que tiene sobre los sujetos de intervención. El artículo concluye con la propuesta de adoptar una visión crítica del propio quehacer de la disciplina, basándose en la acción transformadora que ésta busca generar a través de la práctica. Resumo A Terapia Ocupacional é uma profissão emergente nas equipes educacionais multidisciplinares, portanto, é relevante indagar sobre seu papel, no âmbito educacional, em contexto chileno. Este artigo apresenta uma pesquisa qualitativa cujo objetivo foi analisar, a partir de uma perspectiva crítica, como o diagnóstico clínico influencia nas práticas de terapeutas ocupacionais que atuam em contextos educacionais, considerando como eixos principais para a pesquisa, o marco normativo de inclusão vigente no Chile, o discurso dos profissionais sobre suas práticas e as relações estabelecidas com o diagnóstico clínico. A amostra foi composta de dez terapeutas ocupacionais que atuam em estabelecimentos de ensino no sul do Chile, aos quais foram aplicadas entrevistas semiestruturadas. Os resultados demonstraram que as políticas educacionais influenciam significativamente as práticas dos terapeutas ocupacionais, mesmo quando os regulamentos não especificam seu papel disciplinar. Além disso, o diagnóstico circula fortemente no discurso dos terapeutas ocupacionais, atuando como um dispositivo de poder nas práticas profissionais, com o objetivo de validar o papel profissional no contexto educacional. Discute-se sobre o uso do diagnóstico em relação à identidade profissional e seus efeitos nos sujeitos da intervenção. O artigo conclui com a proposta de adotar uma visão crítica do próprio papel do terapeuta ocupacional, a partir da ação transformadora que esta profissional busca gerar através da prática. Abstract Occupational Therapy is an emerging discipline within multidisciplinary educational teams, therefore, it’s relevant to inquire about its role in the Chilean educational context. This article presents research whose aim was to analyze, from a critical perspective, how clinical diagnosis influences the practices of occupational therapists that work in the school system, considering as the main axes for research, the normative framework that governs the educational system in Chile, the discourse of occupational therapists on their practices and the relationships established with the diagnosis in this context. The sample was ten occupational therapists who work in schools from the south of Chile, to whom semi-structured interviews were applied. The results allow us to visualize that educational policies significantly influence the practices of occupational therapists, even when the regulations do not specify the disciplinary role. In addition, clinical diagnosis emerges strongly in the discourse of occupational therapists, functioning as a device of power within professional practices, especially to validate the professional role within the educational context. The use of diagnosis concerning the professional identity and the effects it has on the people they work with is discussed. This article concludes with the proposal of adopting a critical vision of the discipline’s task, based on the transformative action that it seeks to generate through practice.

Introducción: La hipersensibilidad, alteración del aspecto dental y fracturas son problemas comunes en la hipomineralización incisivo molar que generan problemas funcionales y socioemocionales. Objetivo: evaluar el efecto de la HIM en la calidad de vida relacionada con la salud bucal de niños y adolescentes. Materiales y métodos: Se realizó una búsqueda bibliográfica sistemática en bases de datos electrónicas (Pubmed, Epistemonikos, Dentistry & Oral Sciences Source y Biblioteca Virtual en Salud). Se identificaron estudios observacionales en inglés o español realizados entre 2016-2022 que evaluaron la calidad de vida de niños y adolescentes con hipomineralización incisivo molar. Resultados: De 96 estudios identificados, trece fueron incluidos en la síntesis. El criterio diagnóstico para hipomineralización incisivo molar más frecuente fue European Academy of Paediatric Dentistry index y nueve estudios informaron la gravedad de la enfermedad. La escala para medir calidad de vida más usada fue Child Perception Questionnaire (CPQ). Según la percepción de los niños las dimensiones más afectadas fueron “Síntomas Orales” y “Bienestar Emocional”, según los padres fueron “Síntomas Orales” y “Limitación Funcional”. Las niñas con hipomineralización incisivo molar tuvieron peor calidad de vida relacionada con la salud bucal. Conclusiones: El efecto negativo de la hipomineralización incisivo molar en la calidad de vida relacionada con la salud bucal infantil parece variar entre la percepción de los padres y de los niños.

[Abstract] Introduction/purpose: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. Materials/methods: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. Results: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. Conclusion: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.

Resumen Introduccion y objetivos Aunque las guias de practica clinica recomiendan una estrategia invasiva para el infarto agudo de miocardio sin elevacion del segmento ST (IAMSEST), en la practica clinica esta estrategia se infrautiliza en ancianos fragiles. Ademas estos enfermos habitualmente quedan excluidos de los ensayos clinicos, por lo que la evidencia es escasa. Nuestra hipotesis es que una estrategia invasiva para el anciano con fragilidad y IAMSEST mejorara el pronostico. Metodos Se trata de un estudio prospectivo, multicentrico y aleatorizado que compara una estrategia invasiva frente a una conservadora en ancianos fragiles con IAMSEST. Los criterios de inclusion son: IAMSEST, edad ≥ 70 anos y fragilidad definida por al menos 4 criterios de la escala Clinical Frailty Scale. Se aleatorizara a los participantes a una estrategia invasiva (coronariografia y revascularizacion si se considera anatomicamente indicada) o conservadora (tratamiento medico y coronariografia solo en caso de inestabilidad clinica persistente). El objetivo principal sera el numero de dias vivo fuera del hospital durante el primer ano. El objetivo coprincipal sera el tiempo hasta la presentacion de muerte cardiovascular, reinfarto agudo de miocardio o revascularizacion tras el alta. El tamano de la muestra estimado es de 178 pacientes (89 por grupo), asumiendo un incremento del 20% en la proporcion de dias vivo fuera del hospital con la estrategia invasiva. Resultados Los resultados del estudio aportaran informacion novedosa para el tratamiento del anciano fragil con IAMSEST. Conclusiones Nuestra hipotesis es que una estrategia invasiva mejorara el pronostico de los pacientes ancianos fragiles con IAMSEST. Si esta hipotesis se confirmara, la situacion de fragilidad no deberia disuadir al cardiologo de indicar un tratamiento invasivo. Ensayo registrado en ClinicalTrials.gov (Identificador: NCT03208153 ).

Esta investigacion, realizada en el marco de la maestria en Psicoterapia Psicoanalitica del IUPA, busca aportar al conocimiento de la psicoterapia en instituciones de salud con adolescentes que han realizado un intento de autoeliminacion. Se centra en la percepcion de pacientes acerca de su proceso psicoterapeutico e indaga especificamente en factores que favorecieron la adherencia al tratamiento. Sigue una metodologia cualitativa basada en 16 entrevistas semiestructuradas a adolescentes que finalizaron sustratamientos en instituciones de salud.Aqui se presentan algunos de los principales resultados a los que arribe a partir de una interpretacion de los discursos desde un marco teorico psicoanalitico. Analizo el papel de la institucion de salud en la adherencia a la psicoterapia. Concluyo que lapresencia de los adultos referentes comprometidos con el proceso fue fundamental para que las pacientes lograran una buena adherencia y que los factores intersubjetivos de la psicoterapia asociados al compromiso, interes y disposicion afectiva en el vinculo con el terapeuta aparecen como aspectos destacados por las adolescentes.

Data from previous heart failure (HF) trials suggest that patients with mild symptoms (NYHA II) actually have a poor clinical outcome. However, these studies did not assess clinical stability and rarely included patients in NYHA I. We sought to determine the incidence of short-term clinical progression in supposedly stable HF patients in NYHA I. In addition, we aimed to investigate the predictive value of widely available electrocardiographic and echocardiographic parameters for short-term disease progression. This is a retrospective study including 153 consecutive patients with HF with reduced and mid-range ejection fraction (HFrEF: LVEF40%; HFmrEF: LVEF 40-49%) in NYHA I with no history of decompensation within the previous 6 months. All patients underwent comprehensive baseline echocardiographic and electrocardiographic assessment. The primary endpoint was the composite of cardiovascular death, hospitalization and need for intensification of HF treatment within a 12 month follow-up period. The cumulative incidence of HF progression was 17.8%, with a median time to event of 193 days. Death and hospitalization due to HF accounted for three-quarters of the events. QRS duration ≥120ms and mitral regurgitation grade1 showed to be significant predictors of HF progression (HR: 8.92, p0.001; and HR: 4.10, p0.001, respectively). Patients without these risk factors had a low incidence of clinical events (3.8%). In conclusion, almost one in five supposedly stable HF patients in NYHA I experience clinical progression in short-term follow-up. Simple electrocardiographic and echocardiographic predictors may be useful for risk stratification and could help to improve individual HF patient management and outcomes.

[Abstract] Obesity is one of the great challenges in healthcare nowadays with important implications for health so requiring comprehensive management. This document aims to establish practical and evidence-based recommendations for the diagnosis and management of in Spain, from the perspective of the clinical endocrinologist. A position statement has been made that can be consulted at www.seen.es, and that has been agreed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), together with the Nutrition Area (NutriSEEN) and the Working Group of Endocrinology, Nutrition and Physical Exercise (GENEFSEEN). [Resumen] La obesidad supone uno de los grandes retos en salud en la actualidad. Las importantes repercusiones que implica obligan a un manejo integral. El presente documento tiene como objetivo establecer recomendaciones prácticas y basadas en la evidencia para el diagnóstico y el manejo de la obesidad en España, desde la perspectiva del endocrinólogo clínico. Se ha realizado un documento de posicionamiento que puede consultarse en www.seen.es, que ha sido consensuado por el Grupo de Obesidad de la Sociedad Española de Endocrinología y Nutrición (GOSEEN), junto con el Área de Nutrición (NutriSEEN) y el Grupo de trabajo de Endocrinología, Nutrición y Ejercicio Físico (GENEFSEEN).

The benefits attributed to emotional intelligence (EI) in a school environment can be observed in areas such as interpersonal relationships, psychological well-being, academic performance, and avoidance of disruptive behaviors. The objective of this study was to analyze a sample of 3451 adolescents from a secondary school to test whether EI is a protector against cybervictimization and the repercussions of cybervictimization, and whether EI has an influence on academic performance. The instruments used in the study included a questionnaire of risk factors for cybervictimization&mdash, the Trait Meta Mood Scale 24 (Spanish version)&mdash, and the global marks or academic performance of the students. The relationships between the variables were analyzed and a structural equation model was developed. The correlations revealed that there was a positive relationship between EI and student academic performance, but there was also a negative relationship regarding cybervictimization. In other words, students with lower EI were more likely to suffer from cybervictimization and could experience negative repercussions on school success. Through EI training and addressing disruptive behaviors by focusing on school climate, classroom management, and discipline, we can create emotional regulation guidelines among students to eradicate disruptive behaviors.

The objective of this study was to analyse the relationship between emotional intelligence and social skills, and how these two variables influence bullying. In this study, 912 Spanish high school students, 471 boys and 441 girls aged 14&ndash, 16 years, participated, who were administered the Spanish version of the Trait Meta Mood Scale 24, the &ldquo, Bateria de socializaci&oacute, n BAS-3&rdquo, and the Peer Harassment Questionnaire. To analyse the results, a structural equation model was made. The results reflected a positive relationship between emotional intelligence and social skills (B = 0.44, p &lt, 0.001), and a negative relationship with respect to bullying (B = &minus, 0.56, p &lt, 0.001). In turn, social skills reflected a negative relationship with respect to bullying (B = &minus, 0.38, p &lt, 0.001). These results reflect the need to implement educational programs focused on the development of emotional intelligence in the classroom, as a means to try to stop bullying behaviours in the classroom.

The traditional structure of families is undergoing profound changes, causing the so-called &ldquo, crisis of family care.&rdquo, This study describes the experiences and emotions of the family member who hires migrant caregivers for the older people. This is a qualitative study using a phenomenological design with nine women participants between 53 and 72 years of age. The data collection was carried out through two in-depth interviews and a focus group. There were three major topics: (1) the women in this study recognized that they were not able to take care of the family member directly, due to their responsibilities as female workers and mothers. The fact that migrant caregivers were chosen was conjunctural, where economic reasons were more important. (2) The family members supported the caregivers by teaching them about care and also resolving conflicts produced by culture shock. (3) Trusting the caregiver was a gradual process, the family members felt a complex set of emotions (insecurity, gratitude for the help, moral obligation). In conclusion, they wanted a caregiver who would provide the elder dependent with the love and compassion that they, as daughters, would provide if they had time to do so. The family became the caregiver&rsquo, s managers and assumed the responsibility of training and helping them.

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the &ldquo, time-within-remission range&rdquo, as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 &plusmn, 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, &ldquo, and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 &plusmn, 9.2 years old, body mass index (BMI) 46.3 &plusmn, 6.9 kg/m2) underwent primary bariatric procedures. &ldquo, Time-within-remission range&rdquo, were 83.3% (33.3&ndash, 91.6) after gastric bypass, 68.7% (7.1&ndash, 87.5) after sleeve gastrectomy and 90% (83.3&ndash, 92.8) after malabsorptive techniques (p &lt, 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the &ldquo, The association of bariatric techniques with &ldquo, using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34&ndash, 5.84), p &lt, 0.001 for malabsorptive techniques and OR 0.55 (0.40&ndash, 0.75), p &lt, 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The &ldquo, unveils a superiority of gastric bypass compared to sleeve gastrectomy.

The incidence of oropharyngeal dysphagia in Parkinson’s disease (PD) is very high. It is necessary to search for effective therapies that could prevent pneumonia. Previous results should be interpreted cautiously as there is a lack of evidence to support the use of compensatory or rehabilitative approaches to dysphagia. We reviewed the scientific literature to describe the treatments of dysphagia in PD. A systematic review was performed in PubMed, Scopus, Elsevier, and Medline according to PRISMA standards in 2018. The articles that did not mention dysphagia secondary to PD or used surgical treatment were excluded. Eleven articles met the criteria with information from 402 patients. The review relates to different protocols, such as training in expiratory muscle strength, postural techniques, oral motor exercises, video-assisted swallowing therapy, surface electrical stimulation, thermal stimulation, touch, compensatory interventions, training regime for swallowing, neuromuscular electrical stimulation, Lee Silverman voice treatment, swallow maneuver, airway protection, and postural compensation maneuvers. This review identifies the rationing interventions in each trial, if they are efficient and equitable. Several rehabilitative therapies have been successful. An improvement was seen in the degenerative function (coordination, speed, and volume), quality of life, and social relationships of people with PD. Further investigations concerning the clinical applicability of these therapies based on well-designed randomized controlled studies are needed. Larger patient populations need to be recruited to evaluate the effectiveness, long-term effects, and new treatment techniques.

El sarcoma de células claras renal es el segundo tumor renal maligno más frecuente en la edad pediátrica, después del tumor de Wilms. Es una neoplasia de difícil diagnóstico, con presentación clínica inespecífica como masa abdominal palpable, dolor abdominal e hipertensión y hematuria. Las características de imagen de esta lesión son inespecíficas, por lo que su diagnóstico se realiza mediante el estudio anatomopatológico del tumor. Su importancia gira en torno a la dificultad diagnóstica, ya que este tumor presenta gran variabilidad histológica y pocos marcadores inmunohistoquímicos adecuados. El tratamiento incluye quimioterapia neoadyuvante y post quirúrgica, con un pronóstico que mejora si el diagnóstico de la enfermedad es temprano.

Introduction and objectives Although clinical guidelines recommend invasive management in non–ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI . Methods This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the first year. The coprimary endpoint will be the time until the first cardiac event (cardiac death, reinfarction or postdischarge revascularization). We estimate a sample size of 178 patients (89 per arm), considering an increase of 20% in the proportion of days alive out of hospital with the invasive management. Results The results of this study will add important knowledge to inform the management of frail elderly patients hospitalized with NSTEMI. Conclusions We hypothesize that the invasive strategy will improve outcomes in frail elderly patients with NSTEMI. If this is confirmed, frailty status should not dissuade physicians from implementing an invasive management strategy. Clinical trial registration: URL: http://www.clinicaltrials.gov.Identifier : NCT03208153 .

Objectives As the role of polymorphisms in death receptors (DRs) such as Tumor Necrosis Factor–related Apoptosis-inducing Ligand Receptor 1 (TRAIL-R1) and Tumor Necrosis Factor Receptor 1A (TNF-R1A) on the response to anti-TNF therapy remains unknown, we evaluated the association between TRAILR1 and TNFR1A gene polymorphisms (rs20575/C626G and rs767455/G36A) and the pharmacogenetics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with TNFα blockers. Methods One hundred and forty-five patients (90 RA and 55 PsA) treated with anti-TNFα therapy (RA: 75 infliximab, 8 etanercept, 7 adalimumab. PsA: 27 infliximab, 19 etanercept, 9 adalimumab) were genotyped for TRAILR1 and TNFR1A polymorphisms by allelic discrimination. The response to anti-TNFα was assessed by EULAR criteria. Results In RA, the TRAILR1 CC genotype was associated with a better response after 3 and 6 months of anti-TNFα treatment (CC: 91.7% vs. CG/GG: 62.2%; P = 0.019, and CC: 82.6% vs. CG/GG: 56.1%; P = 0.019, respectively). Similar results were observed in only infliximab-treated RA patients. With respect to the TNFR1A polymorphism, there was an association between the AA genotype and a poorer response at 3 months in RA patients (AA: 39.3% vs. AG/GG: 19.0%; P = 0.04). In PsA, TRAILR1 CC genotype was only associated with EULAR response to infliximab at 6 months (CC: 71.4% vs CG/GG: 50%P = 0.048). In contrast to RA, the TNFR1 polymorphism in PsA was associated with a better response at 3 months (AA 88% vs AG/GG 58.9%; P = 0.04). Conclusions This study provides the first evidence that a polymorphism in TRAILR1 influences the response to anti-TNFα therapy in RA and also suggests that TNFR1A polymorphism may have opposing effects on the response to anti-TNFα in RA and PsA.

Resume Objectifs Puisque le role des polymorphismes des recepteurs de mort (TNFR) tels que le recepteur tumor necrosis factor-related apoptosis-inducing ligand receptor 1 (TRAILR1) et le recepteur tumor necrosis factor receptor 1A (TNFR1A) joues dans la reponse au traitement anti-TNF reste inconnu, nous avons evalue l’association entre les polymorphismes des genes TRAILR1 et TNFR1A (rs20575/C626G et rs767455/G36A) et la pharmacogenetique des patients atteints de polyarthrite rhumatoide (PR) et de rhumatisme psoriasique (RP) traites par anti-TNFα. Methodes Cent quarante-cinq patients (90 PR et 55 RP) traites par anti-TNFα (PR : 75 infliximab, huit etanercept, sept adalimumab ; RP : 27 infliximab, 19 etanercept, neuf adalimumab) ont ete genotypes pour les polymorphismes de TRAILR1 et de TNFR1A par discrimination allelique. La reponse aux anti-TNFα etait evaluee selon les criteres de l’European League Against Rheumatism (EULAR). Resultats Dans la PR, le genotype CC de TRAILR1 etait associe a une meilleure reponse apres trois a six mois de traitement par anti-TNFα (CC : 91,7 % versus CG/GG : 62,2 % ; p = 0,019, et CC : 82,6 % versus CG/GG : 56,1 % ; p = 0,019, respectivement). Des resultats similaires ont ete observes uniquement chez les patients traites par infliximab. En ce qui concerne le polymorphisme de TNFR1A, une association entre le genotype AA et une plus mauvaise reponse a trois mois a ete observee chez les patients atteints de PR (AA : 39,3 % versus AG/GG : 19,0 % ; p = 0,04). Dans le RP, le genotype CC de TRAILR1 etait associe uniquement a une reponse EULAR a l’infliximab apres six mois (CC : 71,4 % versus CG/GG : 50 % p = 0,048). Compare a la PR, le polymorphisme de TNFR1 dans le RP etait associe a une meilleure reponse a trois mois (AA 88 % versus AG/GG 58,9 % ; p = 0,04). Conclusions Cette etude apporte les premieres preuves qu’un polymorphisme de TRAILR1 influe sur la reponse au traitement par anti-TNFα chez les patients atteints de PR et suggere aussi que le polymorphisme TNFR1A peut avoir des effets opposes sur la reponse aux anti-TNFα chez les patients atteints de PR ou de RP.

Obesity impairs quality of life, but the perception of the impairment could be different from one country to another. The purpose was to compare weight-related quality of life (QOL) between cohorts from Spain and North America.A cross-sectional case-control study was performed between two populations. Four hundred Spanish and 400 North American obese subjects suitable for bariatric surgery closely matched for race, gender, age, and body mass index (BMI) were included. Two non-obese control groups matched for gender, age, and BMI from each population were also evaluated (n = 400 in each group). The participants completed the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, a measure of weight-related QOL.Spanish morbidly obese patients showed poorer QOL than their North American counterparts in physical function, sexual life, work, and total score. By contrast, Spanish non-obese control subjects reported better QOL in all domains than their North American counterparts. Women, both in Spain and North America, reported reduced QOL compared to men on the domain of self-esteem. In addition, North American women reported reduced QOL on the sexual life domain compared to men. BMI correlated negatively with all domains of QOL except for self-esteem in both national groups.Spanish obese subjects suitable for bariatric surgery report poorer weight-related quality of life than their North American counterparts, and obese women, regardless of nationality, perceive a reduced quality of life compared to men.

Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). Data from 3843 patients were available (44.8 +/- 10.5 years, a 3:1 female-to-male ratio, 46.9 +/- 8.2 kg/m(2)). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand.

Lab on a chip devices are an alternative for accessible, cost-effective and early detection medical tests. MEMS technologies provide possibilities for reduction of reagent volume, sample size and fast in-situ diagnosis. This review summarizes the main working principles and applications of Lab on a Chip devices and their potential for strengthening research at higher education facilities and improving the health systems in Latin America and the Caribbean. Keywords— Microelectromechanical systems, microfluidics, Lab on a chip Digital Object Identifier (DOI): http://dx.doi.org/10.18687/LACCEI2015.1.1.200 ISBN: 13 978-0-9822896-8-6 ISSN: 2414-6668

The final publication is avaliable at Springer Link [Abstract] Background. Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding the underlying maternal and perinatal risks are scarce. The objective of this nationwide study is to evaluate maternal and perinatal outcomes after BS. Methods. We performed a retrospective observational study of 168 pregnancies in 112 women who underwent BS in 10 tertiary hospitals in Spain over a 15-year period. Maternal and perinatal outcomes, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders (PAHD), pre-term birth cesarean deliveries, small and large for gestational age births (SGA, LGA), still births, and neonatal deaths, were evaluated. Results were further compared according to the type of BS performed: restrictive techniques (vertical-banded gastroplasty, sleeve gastrectomy, and gastric banding), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD). Results. GDM occurred in five (3 %) pregnancies and there were no cases of PAHD. Women whose pregnancies occurred before 1 year after BS had a higher pre-gestational body mass index (BMI) than those who got pregnant 1 year after BS (34.6 ± 7.7 vs 30.4 ± 5.3 kg/m2, p = 0.007). In pregnancies occurring during the first year after BS, a higher rate of stillbirths was observed compared to pregnancies occurring after this period of time (35.5 vs 16.8 %, p = 0.03). Women who underwent BPD delivered a higher rate of SGA babies than women with RYGB or restrictive procedures (34.8, 12.7, and 8.3 %, respectively). Conclusions. Pregnancy should be scheduled at least 1 year after BS. Malabsorptive procedures are associated to a higher rate of SGA births.

Introduction: intragastric balloons provide early satiety and thereby induce short-term weight loss. The aim of this study was to evaluate safety and short and medium-term effectiveness of gastric balloons associated to hypocaloric diet in obesity. Material and methods: from May 2004 to June 2011 91 obese patients, body mass index [BMI] 45.2 ± 7.2 kg/m 2 were prospectively followed after endoscopic implantation of a gastric balloon associated to restricted diet. Successful therapy was defined as percent loss of total weight (%LTW) ≥ 5 % at six months after balloon placement and 6 and 12 months after their withdrawal. All analyses followed intention-to treat principles considering significant p-values < 0.05. Results: we placed 73 fluid-filled balloons (80.2 %) and 18 air-filled ones (19.8 %). Compared to baseline values, at 6-month 73.7 % subjects succeeded, showing significant reductions in weight (13.3 ± 8.8 kg), BMI (5 ± 3.4 kg/m 2 ) (p < 0.0001), with % LTW 11 ± 7 %. Six and twelve months after retrieval 45.1 % and 28.6 % patients reached % LTW ≥ 5 %. Short-term and medium-term effectiveness was negatively associated to obesity in first-grade relatives (p = 0.003 and p = 0.04). Higher weight loss 6 months after balloon placement independently predicted medium-term effectiveness (p = 0.0001). Mortality was absent but there were two spontaneous deflations of air-filled balloons and severe withdrawal difficulties in 8 patients, leading to surgery in one case. Retrieval complications associated to air-filled balloons (p = 0.0005). Conclusions: in obesity, effectiveness of gastric balloons associated to hypocaloric diet decreases over time. Complications occurred mainly in the retrieval endoscopic procedure and related to air-filled balloons.

The TRAILR1/TRAIL system is implicated in the induction of the extrinsic apoptotic pathway and constitutes an emerging target in cancer therapeutics. The objective of this study is to assess lymphoma risk associated with certain polymorphisms in TRAILR1 and TRAIL1 genes. DNA was extracted from 381 subjects (190 lymphoma cases and 191 matched controls) and genotyped for polymorphisms rs20576, rs2230229 and rs20575 in TRAILR1 and rs12488654 in TRAIL gene. In contrast to TRAILR1 polymorphisms, the genotype distribution of rs12488654 in TRAIL gene was different between cases and controls, A allele carriers (CA/AA) being much more common in the cases with different lymphoma types (follicular, 45 %; diffuse large B cell, 45.2 % and Hodgkin lymphomas, 40 %) than in controls (15.7 %) (odds ratio (OR), 3.5; CI, 2.1–5.9; p

Cytokines such as IL1 are central mediators of joint inflammation in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and polymorphism in IL1 has been associated with disease susceptibility and severity.

Besides the therapeutic effect of infliximab by the blocking of soluble tumour necrosis factor (TNF), current evidence indicates that membrane-bound TNF is also a target of infliximab and therefore...

Background: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. Methods: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. Results: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the ‘candy cane' roux limb, with resolution of hypoglycemia in all cases. Conclusions: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.