RESUMEN

OBJECTIVE: The aim of the study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and insulin resistance (IR) in Spanish adults and to examine whether this relationship is mediated by abdominal obesity (waist circumference - WC). METHODS: The cross-sectional study included 1162 healthy subjects belonging to the EVIDENT study (mean age 55.0±13.3years; 61.8% women) from six different Spanish provinces. Moderate-to-vigorous physical activity (MVPA) was measured objectively over 7days using Actigraph accelerometers, collecting data in 60-second epochs, and retaining respondents with ≥4 valid days for the analysis. The homeostasis model of assessment (HOMA-IR) was used to determine IR, and its individual components - fasting glucose and insulin - were determined using standard protocols. Linear regression models were fitted according to Baron and Kenny's procedures for mediation analysis. RESULTS: Fasting insulin and HOMA-IR levels were significantly worse in adults who spent fewer minutes in MVPA (first quartile≤30.1 and 22.7min/day in men and women, respectively) after adjusting for age, sex, smoking habits, drinking habits, accelerometer wear time, sedentary time, and Mediterranean diet adherence. However, when WC was added to the ANCOVA models as a covariate, the effects disappeared. Mediation analysis reported that WC acts as a full mediator in the relationship between MVPA and IR (HOMA-IR and fasting insulin). CONCLUSION: These findings show that WC plays a pivotal role in the relationship between MVPA and IR, and therefore highlights that decreasing abdominal obesity might be considered as an intermediate outcome for evaluating interventions aimed at preventing diabetes mellitus.

Asunto(s)

RESUMEN

BACKGROUND: Public health strategies for cardiovascular prevention highlight the importance of physical activity, but do not consider the additional potentially harmful effects of sedentary behavior. This study was conducted between 2010 and 2012 and analyzed between 2013 and 2014. The aim of the study was to analyze the relationship between sedentary behavior and cardiometabolic risk factors in the Spanish adult population and to examine whether this relationship is mediated by moderate-to-vigorous physical activity (MVPA). METHODS: The cross-sectional study included 1122 healthy subjects belonging to the EVIDENT study. Sedentary behavior was objectively measured over 7 days using Actigraph accelerometers. We assessed waist circumference (WC), triglycerides-to-HDL-C ratio (TG/HDL-C), and mean arterial pressure (MAP), and undertook homeostasis model assessment (HOMA-IR). Linear regression models were fitted according to Baron and Kenny procedures for mediation analysis. RESULTS: TG/HDL-C and HOMA-IR were significantly higher in adults who spent more minutes in sedentary activities after adjusting for potential covariates. However when MVPA was added to the ANCOVA models as covariate the effect of sedentary time on HOMA-IR disappeared. In addition, MVPA acted as a full mediator of the relationship between sedentary time and HOMA-IR. In contrast, subjects with lower levels of MVPA presented worse cardiometabolic profiles than those from higher MVPA categories, even after controlling for sedentary time and other potential confounders. CONCLUSIONS: These results suggest that both MVPA and sedentary time should be considered when developing cardiometabolic risk guidelines. TRIAL REGISTRATION: NCT01083082 .

Asunto(s)

RESUMEN

INTRODUCTION: The present study presents the initial results of the use of video-assisted surgery in the curative intent treatment of gastric cancer in a specialised unit of esophago-gastric pathology. METHODS: Since December 2002 we have substituted laparotomy for video-assisted surgery for the surgical treatment of gastric cancer. We report our initial experience in 28 patients. In 20 we performed a total gastrectomy with Roux Y esophago-jejunum reconstruction. In another 8 cases we performed subtotal gastrectomy with Roux Y reconstruction. The anastomoses in total gastrectomy were performed with laparoscopy with the EEA head descending via the endo-esophageal route. The resected piece is extracted via minimum laparotomy. The associated complete lympadenectomy D2 was performed in the tumours of the gastric antrum and D1 plus the lymph node groups 7, 8, 9 and proximal 11 at the second level in the gastric body and fundus. RESULTS: The mean duration of intervention was 222 minutes and the mean blood loss was 185 ml. Mortality was 3.7% and morbidity was 19%. There was a reduction in post-operative analgesia requirements and the mean hospital stay was 11 days. CONCLUSIONS: Gastric resection and related lympadenectomy can be performed using video-assisted surgery in a manner that is as safe as conventional surgery and, further, has considerable advantages. The greater complexity requires that the surgical team is better trained in the use of the laparoscopy technique. In the few studies on the theme, there appears to be no oncological inconveniences associated with the technique.

Asunto(s)

RESUMEN

Extracorporeal membrane oxygenation (ECMO) improves survival in neonatal and pediatric patients with reversible severe respiratory or cardiac failure, in whom intensive treatment fails. Since 1999, a multidisciplinary team is trained to form the first neonatal-pediatric ECMO center in Chile, according to the norms of the Extracorporeal Life Support Organization (ELSO). During 2003 the first three patients were admitted to the program: a male newborn with pulmonary hypertension, a 38 days old female operated for a total anomalous pulmonary venous connection and a 3 months old male with a severe pneumonia caused by respiratory syncytial virus. They remained in ECMO for five, seven and nine days respectively and all survived to the procedure. No neurological complications were observed after one and a half year of follow up. This consolidates the first national neonatal-pediatric ECMO program, associated to ELSO. Up to date, twelve patients have been admitted to the program.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

El monóxido de carbono (CO) es un gas muy venenoso que se une a la hemoglobina desplazando al oxígeno con la formación de carboxihemoglobina (COHb). Esta investigación consistió en una valoración bioquímico-clínico de la intoxicación por CO en una población de 42 motociclistas cobradores en la ciudad de Santo Domingo. Los resultados revelaron que el 31% de la población tenía niveles tóxicos de COHb (mayor de 5%) cuantificada al finalizar la jornada de trabajo. Las manifestaciones clínicas más frecuentes fueron: cefalea (50%), sonnolencia (25%), trastornos visuales (24%) y taquicardia (19%). Estos síntomas aparecieron en el 100%) de los cobradores con niveles tóxicos de COHb y en el 76% de aquellos que tenían valores por debajo del límite de toxicidad lo cual sugiere cierta susceptibilidad al CO. Los cobradores con cinco años o más de labor presentaron las cifras más elevadas de COHb (11-14%)

Asunto(s)

RESUMEN

La incidencia del vólvulo del sigmoides ha aumentado definitivamente. Hay que sospechar esta entidad en pacientes ancianos con distensión abdominal y especialmente en aquellos con enfermedades psiquiátricas o trastornos neurológicos, que están crónicamente encamados. Se recomienda la técnica del uso de la rectosigmoidoscopía y el tubo rectal por cuarenta y ocho horas, concomitantes con hidratación parenteral y sonda nasogástrica. La reducción no operatoria libera la obstrucción colónica y previene la gangrena y debe ser seguida dos semanas después de resección electiva previa preparación mecánica y química. En presencia de gangrena se prefiere la resección primaria o técnica de Hartman. Al lograr una adecuada preparación del colon, un adecuado equilibrio hidroelectrolítico y condición del paciente en el pre y post operatorio, disminuye la mortalidad post operatoria y las complicaciones. Se presenta un caso de paciente masculino con vólvulo del sigmoides; se establecen criterios fisiopatológicos, diagnósticos y de tratamiento

Asunto(s)

RESUMEN

Se reporta un caso de Tumor Carcinoide Gástrico y se efectúa revisión de los aspectos histopatológicos, clínicos, diagnósticos y de tratamiento de esta entidad

Asunto(s)