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Lizcano F.,University of La Sabana | Lizcano F.,Fundacion Cardio Infantil Institute Cardiologia | Guzman G.,University of La Sabana
BioMed Research International | Year: 2014

Sex hormones strongly influence body fat distribution and adipocyte differentiation. Estrogens and testosterone differentially affect adipocyte physiology, but the importance of estrogens in the development of metabolic diseases during menopause is disputed. Estrogens and estrogen receptors regulate various aspects of glucose and lipid metabolism. Disturbances of this metabolic signal lead to the development of metabolic syndrome and a higher cardiovascular risk in women. The absence of estrogens is a clue factor in the onset of cardiovascular disease during the menopausal period, which is characterized by lipid profile variations and predominant abdominal fat accumulation. However, influence of the absence of these hormones and its relationship to higher obesity in women during menopause are not clear. This systematic review discusses of the role of estrogens and estrogen receptors in adipocyte differentiation, and its control by the central nervous systemn and the possible role of estrogen-like compounds and endocrine disruptors chemicals are discussed. Finally, the interaction between the decrease in estrogen secretion and the prevalence of obesity in menopausal women is examined. We will consider if the absence of estrogens have a significant effect of obesity in menopausal women. © 2014 Fernando Lizcano and Guillermo Guzmán. Source

Whitlock R.,Hamilton Health Sciences | Teoh K.,Hamilton Health Sciences | Vincent J.,Hamilton Health Sciences | Devereaux P.J.,Hamilton Health Sciences | And 17 more authors.
American Heart Journal | Year: 2014

Background Steroids may improve outcomes in high-risk patients undergoing cardiac surgery with the use of cardiopulmonary bypass (CBP). There is a need\ for a large randomized controlled trial to clarify the effect of steroids in such patients. Methods We plan to randomize 7,500 patients with elevated European System for Cardiac Operative Risk Evaluation who are undergoing cardiac surgery with the use of CBP to methylprednisolone or placebo. The first coprimary outcome is 30-day all-cause mortality, and the most second coprimary outcome is a composite of death, MI, stroke, renal failure, or respiratory failure within 30 days. Other outcomes include a composite of MI or mortality at 30 days, new onset atrial fibrillation, bleeding and transfusion requirements, length of intensive care unit stay and hospital stay, infection, stroke, wound complications, gastrointestinal complications, delirium, postoperative insulin use and peak blood glucose, and all-cause mortality at 6 months. Results As of October 22, 2013, 7,034 patients have been recruited into SIRS in 82 centers from 18 countries. Patient's mean age is 67.3 years, and 60.4% are male. The average European System for Cardiac Operative Risk Evaluation is 7.0 with 22.1% having an isolated coronary artery bypass graft procedure, and 66.1% having a valve procedure. Conclusions SIRS will lead to a better understanding of the safety and efficacy of prophylactic steroids for cardiac surgery requiring CBP. © 2014 Mosby, Inc. Source

Hendriksz C.J.,Salford Royal NHS Foundation Trust | Hendriksz C.J.,Welcome Clinical Research Facility | Giugliani R.,Federal University of Rio Grande do Sul | Harmatz P.,University of California at San Francisco | And 34 more authors.
Molecular Genetics and Metabolism | Year: 2015

Objective: To report and discuss the multi-domain impact of elosulfase alfa, with focus on tertiary and composite endpoints, in the 24-week, randomized, double-blind, placebo-controlled phase 3 trial in patients with Morquio A syndrome (mucopolysaccharidosis IVA). Methods: Patients with Morquio A syndrome aged ≥. 5. years were randomized 1:1:1 to elosulfase alfa 2.0. mg/kg/week (qw; N. = 58), elosulfase alfa 2.0. mg/kg/every other week (qow; N. = 59), or placebo (N. = 59) for 24. weeks. Primary and secondary efficacy measures were 6-minute walk test (6MWT; primary), 3-minute stair climb test (3-MSCT) and urinary keratan sulfate (KS). Safety was also evaluated. Tertiary efficacy measures included respiratory function measures, activities of daily living (MPS Health Assessment Questionnaire [MPS-HAQ]), anthropometric, echocardiographic and radiographic measures, hearing and corneal clouding assessment. In order to fully characterize treatment impact in this heterogeneous disorder, the effect of elosulfase alfa on composite efficacy measures was evaluated as well. Results: The study was not designed to have sufficient power for any of the tertiary outcomes. For most tertiary endpoints, subjects treated with the weekly dose of elosulfase alfa improved more than those receiving placebo. The largest treatment effects were seen in maximal voluntary ventilation (MVV), MPS-HAQ, height, and growth rate. The qow group appeared similar to placebo. The analysis of a pre-specified composite endpoint (combining changes from baseline in 6MWT, 3MSCT and MVV z-scores equally weighted) showed a modest positive impact of elosulfase alfa qw versus placebo group (P= 0.053). As a pre-specified supportive analysis, the O'Brien Rank Sum composite endpoint (changes from baseline in 6MWT, 3MSC, and MVV), analysis also showed that the qw group performed better than the placebo group (P= 0.011). In post-hoc analyses, combinations of other endpoints were also explored using the O'Brien Rank Sum test and showed statistically significant differences between elosulfase alfa qw and placebo favoring elosulfase alfa qw. Differences between elosulfase alfa qow and placebo were not statistically significant. Positive changes were observed in most tertiary variables, demonstrating the efficacy of weekly treatment with elosulfase alfa. Conclusions: Treatment with weekly elosulfase alfa led to improvements across most efficacy measures, resulting in clinically meaningful benefits in a heterogeneous study population. © 2014. Source

Healy C.,University of Miami | Viles-Gonzalez J.F.,University of Miami | Saenz L.C.,Fundacion Cardio Infantil Institute Cardiologia | Soto M.,Fundacion Cardio Infantil Institute Cardiologia | And 2 more authors.
Cardiac Electrophysiology Clinics | Year: 2015

Chagas disease, a chronic parasitosis caused by the protozoa Trypanosoma cruzi, is an increasing worldwide problem because of the number of cases in endemic areas and the migration of infected individuals to more developed regions. Chagas disease affects the heart through cardiac parasympathetic neuronal depopulation, immune-mediated myocardial injury, parasite persistence in cardiac tissue with secondary antigenic stimulation, and coronary microvascular abnormalities causing myocardial ischemia. A lack of knowledge exists for risk stratification, management, and prevention of ventricular arrhythmias in patients with chagasic cardiomyopathy. Catheter ablation can be effective for the management of recurrent ventricular tachycardia. © 2015 Elsevier Inc. Source

Briceno G.D.,Fundacion Cardio Infantil Institute Cardiologia | Fernandez M.,Fundacion Cardio Infantil Institute Cardiologia | Cespedes J.,Fundacion Cardio Infantil Institute Cardiologia
Biomedica | Year: 2015

Introduction: Cardiovascular disease risk factors begin in childhood. Their presence may predict cardiovascular disease in adulthood. Objective: To determine the prevalence of cardiovascular disease risk factors in a group of nurseś children at a health facility in Bogotá, Colombia. Materials and methods: A cross-sectional, population-based observational study among 3-17 year-old individuals evaluated between June, 2011, and July, 2012. Results: A total number of 118 children were included. The mean age was 7.4 years, with a standard deviation of 3.86; 72.0% of the children had a normal weight. Prevalence of cardiovascular risk factors was distributed as follows: inadequate food habits, 89.0%; sedentary lifestyle, 78.8%; family history of cardiovascular disease, 16.1%; overweight, 15.3%, and obesity, 12.7%. There were no significant differences in risk factors between boys and girls. Among overweight and obese children, sedentary lifestyle was present in 90.9%, and among normal-weight children, in 36.5% (p<0.001). Inadequate food habits were present in 84.8% of the overweight and obese children, and in 42.4% of those with normal weight (p<0.001). Among the study population, 97.5% had at least one risk factor and 42.4% presented 3 or more. The presence of 3 or more cardiovascular disease risk factors was higher in obese children, when compared to overweight (p<0.001) and normal-weight children (p<0.001). Conclusions: The results of this study indicate that there was a substantial burden of cardiovascular disease risk factors in the 3-17 year-old children included, particularly in those who were obese or overweight. Source

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