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Molina-Lopez J.F.,Instituto Nacional Of Ciencias Medicas Y Of Nutricion Salvador Zubiran
Surgical Endoscopy and Other Interventional Techniques | Year: 2016

Background: Obesity is the most frequent chronic metabolic disease globally. There is a direct correlation between increasing body mass index (BMI) and elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL), and triglycerides (Tg), and an inverse correlation with high-density lipoprotein cholesterol (HDL); all these lipid derangements are associated with an increased risk of cardiovascular disease. Our aim was to evaluate lipid profiles in morbidly obese patients before and after one-anastomosis gastric bypass (OAGB) performed at a single-center during a 2-year follow-up. Patients and methods: A prospective, observational and descriptive study was carried out, including morbidly obese patients with at least one lipid abnormality, who underwent laparoscopic OAGB. Lipid profiles were evaluated preoperatively and at different intervals during a 2-year follow-up. Results: A total of 150 patients were included (73 % females and 27 % males). Mean age was 45.83 ± 10.65 years, mean BMI was 42.82 kg/m2 ± 6.43, and mean weight was 116.23 kg ± 22.70; 2 years after surgery, the latter two decreased to 24.73 ± 4.43 (p < 0.001) and 67.34 ± 13.35 (p < 0.001), respectively, thus leading to a mean weight loss (WL) of 48.85 kg ± 15.64 and mean %excess WL of 71.87 ± 13.41. Tg, TC and LDL levels significantly decreased: 123.60 ± 56.34 versus 84.79 ± 33.67, 194.33 ± 43.90 versus 173.65 ± 34.84, and 124.47 ± 36.07 versus 97.36 ± 25.05, respectively (p < 0.001); HDL levels significantly increased: 43.61 ± 9.85 versus 61.56 ± 12.63 (p < 0.001). Conclusion: OAGB leads to substantial and durable WL in morbidly obese patients after a 2-year follow-up. Postoperative lipid profiles significantly improved; these changes translate into theoretical relevant cardiovascular risk benefits. © 2016 Springer Science+Business Media New York

Chiquete E.,Hospital Civil de Guadalajara Fray Antonio Alcalde | Chiquete E.,Instituto Nacional Of Ciencias Medicas Y Of Nutricion Salvador Zubiran | Guarena-Serrano C.O.,Hospital Civil de Guadalajara Fray Antonio Alcalde | Banuelos-Becerra L.J.,Hospital Civil de Guadalajara Fray Antonio Alcalde | And 5 more authors.
Revista Mexicana de Neurociencia | Year: 2012

Introduction: Despite the growth of the elderly population in Mexico, little information exists on the risk factors and prognosis of patients older than 80 years suffering acute ischemic stroke (AIS). Objective: To identify differences in the frequency of risk factors for AIS and outcome in patients aged ≥ 80 years and their younger counterparts in a reference hospital from Mexico. Methods: A cross-sectional analysis was performed on 238 adult patients with AIS: 56 (23.5%) aged ≥ 80 years and 182 (76.4%) patients aged < 80 years, as comparators. Data were collected from the clinical records and risk factors and short-term outcome were analyzed. Results: There were no differences in gender proportion between both groups. Diabetes (55%) and hypertension (53%) were the main risk factors, but in patients aged ≥ 80 years diabetes had a significantly lower frequency than that of their younger counterparts (32 vs. 62%, respectively; p <0.001). In contrast, the frequency of atrial fibrillation was significantly higher in octogenarians than in comparators (37 vs. 12%, respectively; p < 0.001). In a Cox proportional hazards model adjusted for relevant covariables, age ≥ 80 years (RR: 3.67, 95% CI: 1.82- 7.37) and the occurrence of septic shock (RR: 6.73,95% CI: 3.19-14.20) were the factors associated with inhospital mortality. Conclusion: Octogenarians hospitalized with AIS have a lower frequency of some vascular risk factors, but a higher risk for in-hospital mortality, when compare with younger individuals.

Bastos M.L.,Federal University of Rio de Janeiro | Hussain H.,Interactive Research and Development | Weyer K.,World Health Organization | Garcia-Garcia L.,Instituto Nacional Of Salud Publica | And 84 more authors.
Clinical Infectious Diseases | Year: 2014

Background: Individualized treatment for multidrug-resistant (MDR) tuberculosis and extensively drugresistant (XDR) tuberculosis depends upon reliable and valid drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line tuberculosis drugs. However, the reliability of these tests is uncertain, due to unresolved methodological issues. We estimated the association of DST results for pyrazinamide, ethambutol, and second-line drugs with treatment outcomes in patients with MDR tuberculosis and XDR tuberculosis.Methods: We conducted an analysis of individual patient data assembled from 31 previously published cohort studies of patients with MDR and XDR tuberculosis.We used data on patients' clinical characteristics including DST results, treatment received, outcomes, and laboratory methods in each center.Results: DST methods and treatment regimens used in different centers varied considerably. Among 8955 analyzed patients, in vitro susceptibility to individual drugs was consistently and significantly associated with higher odds of treatment success (compared with resistance to the drug), if that drug was used in the treatment regimen. Various adjusted and sensitivity analyses suggest that this was not explained by confounding. The adjusted odds of treatment success for ethambutol, pyrazinamide, and the group 4 drugs ranged from 1.7 to 2.3, whereas for secondline injectables and fluoroquinolones, odds ranged from 2.4 to 4.6.Conclusions: DST for ethambutol, pyrazinamide, and second-line tuberculosis drugs appears to provide clinically useful information to guide selection of treatment regimens for MDR and XDR tuberculosis. © The Author 2014.

Ahuja S.D.,Bureau of Tuberculosis | Ashkin D.,A.G. Holley Hospital | Avendano M.,University of Toronto | Banerjee R.,Mayo Medical School | And 66 more authors.
PLoS Medicine | Year: 2012

Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Methods and Findings: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).Conclusions:In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment.Please see later in the article for the Editors' Summary. © 2012 Ahuja et al.

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