Nuevas perspectivas en el tratamiento farmacológico de la enfermedad de Cushing

Hypercortisolism induced by Cushing disease causes high morbidity and mortality.The treatment of choice is pituitary surgery, but it often fails to achieve cure, and other treatment modalities (radiotherapy, bilateral adrenalectomy) may therefore be required. If these treatments are not effective or while waiting for their results, hypercortisolism should be controlled with drugs.The classical drug treatments are those that act by inhibiting cortisol secretion by the adrenal gland (ketoconazole, metyrapone, mitotane, etomidate).The preliminary results of a new drug (LCI699) which is a potent enzyme inhibitor of cortisol secretion have been reported.A clinical trial of the safety and efficacy of mifepristone, a glucocorticoid receptor antagonist, has just been published.The drugs deserving more attention today are those with a direct action on the tumor by inhibiting ACTH secretion: somatostatin analogues (pasireotide), dopamine agonists (cabergoline), PPAR-γ, and retinoic acid.A special review is made of the available clinical trials with pasireotide and cabergoline.     

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice.ObjectiveOur aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value.MethodsWe carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient.ResultsFour hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r = ?0.597; P < .0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased.ConclusionsFrail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.     

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición

IntroductionWaist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115 cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men.ConclusionWC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik     

Papel de los biomarcadores en el diagnóstico precoz de la enfermedad de Alzheimer

Alheimer's disease is the most frequent cause of cognitive decline and behavioral abnormalities in adults. Diagnosis is currently made in the advanced phases. An an early diagnosis in the prodromal phase (or earlier if possible) is required for the prevention of this disease, its early management and the development of potential therapies that could alter its natural course. The syndromic concept of mild cognitive impairment (the presence of detectable and quantifiable deterioration in one of the cognitive domains but without affecting -or without substantially affecting- autonomic performance of instrumental function) and its variants has aided understanding of the predementia stages of Alheimer's disease, even though its etiology may involve multiple factors. The use of biomarkers such as determination of the proteins involved in the disease in cerebrospinal fluid (Aβ42-amyloid, total and phosphorylated tau) and measurement of the hippocampus and entorhinal cortex with magnetic resonance imaging and positron emission tomography (both glucose and amyloid measurements), alone or combined, could allow early and etiologic diagnosis. Patients with Alzheimer's disease show reduced Aβ42-amyloid levels and increased total and phosphorylated tau levels in cerebrospinal fluid.     

Relación entre el perfil oxidativo y el índice de diversidad de la dieta en adultos mayores de una zona urbano-marginal de Costa Rica

Background and objectiveThe older we get, the greater the production of reactive oxygen species and therefore the greater the oxidative stress, which is related to the deterioration of the health of older adults. This study analyzed the relationship between the oxidative profile and the dietary diversity index in an urban-marginal population of older adults in Costa Rica.MethodsEighty-eight older adults were studied and various markers of oxidative stress, serum glucose levels, lipid profile, and some micronutrients were determined. In addition, the body mass index (BMI) was calculated and the dietary diversity index (DDI) was determined.ResultsLipid peroxidation and DNA oxidation, a mean plasma antioxidant capacity percentage of 39.54 ± 10.67%, which decreased with age, were evidenced. 67% of the participants had alterations in glycemia, 73% had one or more alterations in blood lipid levels, 55% had insufficient vitamin D levels, and 68.6% were overweight. The average IDD was 4.91 points, indicating that the diet was not very diverse. No relationship was found between IDD and nutritional status, between nutritional status and oxidative stress, nor between biochemical variables and oxidative stress.ConclusionThe adults studied presented high oxidative stress, a high percentage of overweight, and a low IDD. A higher IDD was associated with a lower blood concentration of MDA and a higher % PAC.     

Esporotricosis: prevalencia,perfil clínico y epidemiológico en un centro de referencia en Colombia

BackgroundSporotrichosis is a subacute and chronic infection caused by Sporothrix schenckii, which affects humans and other mammals. Clinical and epidemiological information in Colombia is scarce.ObjectiveTo describe clinical and socio-demographic findings and diagnostic tests in patients with sporotrichosis from 1996 to 2005 in a national reference center in Colombia, and to determine the institutional prevalence from 2002 to 2005.Material and methodsThis was a prevalence study, including patients with clinical diagnosis of sporotrichosis and at least one of the following criteria: positive culture with S. schenckii, pathologic diagnosis suggestive of sporotrichosis, or response to treatment with potassium iodide.ResultsSixty cases were included, 67% were male, and 25% of them were farmers. The most affected anatomical areas were the forearms and hands (32.5% and 22.8% respectively). Most cases came from the Cundinamarca and Boyacá areas. The cases presented as fixed cutaneous sporotrichosis and lymphangitic sporotrichosis. Differential diagnoses with: leishmaniasis and chromoblastomycosis were performed in most of the cases. All patients were treated with potassium iodide. The prevalence for our center from 2002 to 2005 was 8 cases per 100,000 patients.ConclusionsThe characteristics of our patients are similar to those described in other populations, with some differences. The culture continues to be the gold standard for diagnosis purposes. Potassium iodide is the treatment of choice in our center.     

Valores de referencia de la circunferencia de la cintura e índice de la cintura/cadera en escolares y adolescentes de Mérida,Venezuela: comparación con referencias internacionales

ObjectiveTo collect regional reference values of waist circumference (WC), and waist/hip ratio (WHR) in children and adolescents from Merida, Venezuela, and to compare them to international references.Subjects and methodsA total of 919 students aged 9-17 years from public and private educational establishments were assessed. Weight, height, WC, and WHR were measured. Outliers (± 3 SD Z-Score) were excluded from the data collected. Percentile distribution of the tested variables was done by age and sex.ResultsFifty-one percent of subjects were female, and 52.7% were from public institutions. WC (p = 0.001) and WHR (p = 0.0001) were statistically higher in boys. With advancing age, WC increased in both sexes, while WHR showed the opposite behavior (p = 0.0001 for both). The 90th percentile (pc) for WC ranged from 69.7 and 83.6 cm in girls and from 69.2 and 86.7 cm in boys. The 90th pc values of WHR ranged from 0.79 and 0.91 in girls and from 0.86 and 0.93 in boys. Overall, our WC and WHR values were lower than North American values and similar to those of some Latin American references.ConclusionPercentile reference charts for WC and WHR specific for age and sex, obtained from a representative sample of children and adolescents from Mérida, Venezuela, are provided. They may be used regionally, both for individual assessment and to implement prevention policies.