1,721,000 research outputs found
Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype
Full text linkAbstract Background The terms metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) categorize subjects with obesity based on the presence or absence of cardio-metabolic risk factors. Detecting MUO phenotype is crucial due to the high risk of cardio-metabolic complications, requiring tailored and intensive follow-up. However, diagnosing MUO is time-consuming and costly. Thus, we aimed to investigate the role of Mediterranean diet (MD) in determining MHO/MUO phenotypes and whether adherence to MD could serve as an additional screening tool for MUO phenotype. Methods The study population of this cross-sectional observational study consisted of 275 subjects with obesity. We assessed their lifestyle habits (physical activity and smoking habits), anthropometric measurements (weight, height, waist circumference, body mass index), blood pressure, metabolic parameters, inflammatory marker (high sensitivity C reactive protein levels), adherence to MD (by PREvención con DIetaMEDiterránea (PREDIMED) questionnaire), and MHO/MUO phenotypes. Results The study included 275 individuals with obesity (256F/19M; 34.0 ± 10.5 years; BMI 38.3 ± 5.95 kg/m2). Among them, 114 (41.5%) exhibited MHO phenotype, while 161 (58.5%) had MUO phenotype. MHO phenotype exhibited favorable anthropometric and cardio-metabolic profiles, characterized by lower waist circumference (p < 0.001), BMI (p < 0.001), insulin resistance (p < 0.001), blood pressure (p < 0.001), inflammation (p < 0.001), and lipid levels (p < 0.001) compared to MUO phenotype. Notably, we found that MHO phenotype had higher adherence to MD (p < 0.001) and consumed more extra virgin olive oil (EVOO) (p < 0.001), vegetables (p < 0.001), fruits (p < 0.001), legumes (p = 0.001), fish (p < 0.001), wine (p = 0.008), and nuts (p = 0.001), while reporting lower intake of red/processed meats (p < 0.001), butter, cream, margarine (p = 0.008), soda drinks (p = 0.006), and commercial sweets (p = 0.002) compared to MUO phenotype. Adherence to MD (p < 0.001) and EVOO (p = 0.015) intake were identified as influential factors in determining the presence of MUO/MHO phenotypes. Furthermore, a PREDIMED score < 5 proved to be the most sensitive and specific cut-point value for predicting the presence of MUO phenotype (p < 0.001). Conclusion High adherence to MD was associated with MHO phenotype. Moreover, we suggest that a specific cut-off of the PREDIMED score could be an indicator to discriminate patients with MUO/MHO phenotypes and therefore help in identifying patients at higher cardiovascular risk who will require specific dietary intervention
Weight loss, changes in body composition and inflammatory status after a very low-energy ketogenic therapy (VLEKT): does gender matter?
No full textBackground: Considering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT). Methods: Participants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index-BMI -, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention. Results: At baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = - 11.63 ± 1.76 vs - 8.95 ± 1.65 kg, p < 0.001), fat mass (Δ% = - 30.84 ± 12.00 vs -21.36 ± 4.65 kg, p = 0.002), and hs-CRP levels (Δ% = - 41.42 ± 21.35 vs - 22.38 ± 17.30 mg/L, p = 0.003). Of interest, in males phase angle values are statistically improved compared to female (Δ% = 17.11 ± 9.00 vs 7.05 ± 3.30°, p < 0.001). Conclusion: These findings underscore the importance of considering sex-specific responses in personalized obesity treatment strategies, particularly dietary interventions like VLEKTs
Evidencias científicas sobre las estrategias utilizadas para la prevención de reacciones adversas asociadas a la transfusión de concentrados de glóbulos rojos
Full text linkLa transfusión sanguínea es uno de los procedimientos más utilizados en la práctica clínica y su seguridad ha sido ampliamente estudiada, desde sus factores de riesgo, hasta la evaluación de estrategias implementadas para la prevención de posibles complicaciones.
Existen discrepancias en cuanto a la efectividad y seguridad de las estrategias utilizadas para la prevención de reacciones adversas asociadas a la transfusión sanguínea de concentrados de glóbulos rojos (RBC, por sus siglas en inglés); por lo que, el objetivo de esta tesis doctoral es evaluar la calidad de la evidencia que existe en relación con esta intervención.
Se desarrollaron tres trabajos investigativos. El primero fue una revisión sistemática (SR, por sus siglas en inglés) para evaluar la efectividad y seguridad de la transfusión de concentrados de RBC leucorreducidos versus concentrados de RBC no leucorreducidos. El segundo trabajo fue una SR que evaluó la efectividad y seguridad de la transfusión de concentrados de RBC leucorreducidos versus no leucorreducidos en pacientes sometidos a procedimientos de cirugía mayor cardiovascular. El tercer trabajo evaluó críticamente las guías de práctica clínica (CPGs, por sus siglas en inglés) sobre transfusión de concentrados de RBC, mediante el instrumento AGREE II; también se realizó un mapeo de las recomendaciones incluidas en las GPC sobre el umbral de hemoglobina necesario para realizar una transfusión.
El primer trabajo incluyó 13 ensayos clínicos aleatorizados (RCT, por sus siglas en inglés). Se encontró evidencia poco clara respecto a la efectividad de la transfusión de concentrados de RBC leucorreducidos versus RBC no leucorreducidos para evitar daño agudo pulmonar asociado a la transfusión (TRALI, por sus siglas en ingles), muerte, infección y eventos adversos. El análisis secuencial de los ensayos (TSA, por sus siglas en inglés) determinó que el tamaño de la muestra necesario para estos desenlaces no fue suficiente para evitar errores en las estimaciones; por lo que es necesario desarrollar más RCTs para obtener resultados más confiables. La calidad de la evidencia fue baja y muy baja.
En el segundo trabajo de investigación se incluyeron siete RCTs. Se encontró evidencia clara sobre la efectividad de la transfusión de concentrados de RBC leucorreducidos versus RBC no leucorreducidos en pacientes sometidos a procedimientos de cirugía mayor cardiovascular. El TSA determinó que el tamaño de la muestra para estos desenlaces fue suficiente para evitar errores en las estimaciones, por lo que no es necesario desarrollar más RCTs para obtener resultados más confiables. La calidad de la evidencia fue moderada.
En cuanto al trabajo en el que se evaluó la calidad de las CPGs que abordan el tema de transfusión de concentrados de RBC. Solamente 3 de 16 CPGs fueron recomendadas por los evaluadores. Siete CPGs recomendaron una estrategia restrictiva para la transfusión de concentrados de RBC; cuatro CPGs consideraron que una transfusión de concentrado de RBC segura debería ser prescrita de acuerdo con un valor de hemoglobina de 7 g/dL; y 8 CPGs no proporcionaron recomendaciones sobre el umbral de hemoglobina necesario para realizar transfusiones.
Según los resultados de estas investigaciones, no existe evidencia clara para apoyar o rechazar el uso rutinario de la transfusión de concentrado de RBC leucorreducidos en todo paciente que requiere transfusión. Sin embargo, existe suficiente evidencia que apoya la leucorreducción, exclusivamente, en pacientes sometidos a procedimientos de cirugía mayor cardiovascular que requieren una transfusión sanguínea. Finalmente, la calidad de las CPGs evaluadas es heterogénea en aspectos metodológicos, aplicabilidad e independencia editorial. No se pudo determinar homogeneidad en las recomendaciones sobre el umbral de hemoglobina necesario para transfundir concentrado de RBC entre las CPGs, a pesar de que la estrategia restrictiva es de gran beneficio para el paciente en la práctica transfusional.Blood transfusion is a common procedure in clinical practice, and its safety constitutes a relevant research topic that has been widely studied. Several studies have focused on the risk factors associated with blood transfusion and its determinants, while others have addressed the evaluation of strategies for preventing possible complications at different stages of blood transfusion. There is disagreement in terms of the safety and effectivity levels required to give blood transfusion of packed red blood cells (PRBCs). Therefore, the aim of this work aim is to evaluate the quality of scientific evidence about the strategies used to improve the safety of PRBCs’ transfusion in clinical practice.
This work includes three studies. The first study evaluated the safety and effectivity of the transfusion of leukoreduced PRBCs versus non-leukoreduced PRBCs. The second study evaluated the effectivity and safety of the transfusion of leukoreduced PRBCs versus non-leukoreduced PRBCs in cardiovascular surgery patients. The third study involved a critical appraisal of clinical practice guidelines (CPGs) about recommendations of PRBCs transfusion; this critical appraisal was performed with the AGREE II tool. A mapping of evidence of the transfusion threshold needed in the clinical practice was also performed as part of this study.
The first study included 13 eligible randomised clinical trials (RCT). There was not enough evidence regarding the effectivity of leukoreduced PRBC transfusion vs non-leukoreduced PRBC transfusion to avoid transfusion-related acute lung Injury (TRAIL), death and infection from any cause, and adverse events. According to the Trial Sequential Analysis (TSA) that was performed, it was found that the sample size calculated for these outcomes was not enough to avoid errors in the estimates. The quality of evidence for these outcomes was considered low to very low.
The second study included 7 eligible studies. There was clear evidence on the effects of leukoreduced PRBCs transfusion vs non-leukoreduced PRBCs transfusion in cardiovascular surgery patients to avoid death and infection form any cause. The TSA showed that the sample size calculated for these outcomes was enough to avoid errors in the estimates. The quality of evidence for these outcomes was moderate.
In the third work about the quality appraisal of CPGs, reviewers only recommended 3 out of 16 CPGs. Seven CPGs recommended a limited strategy for PRBC transfusion; four CPGs considered that a safe PRBC transfusion should be prescribed according to a haemoglobin threshold of 7 g/dL. Eight CPGs did not provide recommendations on the threshold of haemoglobin needed to perform PRBC transfusion since they mentioned that PRBC transfusion should not be only prescribed according to the threshold of haemoglobin.
According to the results obtained from these three studies, there is not enough evidence to support or reject the regular application of PRBCs’ leukoreduction in all patients who require blood transfusion. However, there is enough evidence to support the regular application of leukoreduction, specifically, in patients who have been through important cardiovascular procedures, and who require PRBCs’ transfusion. Finally, the quality of evidence of the evaluated CPGs was heterogeneous in terms of methodology, applicability and editorial independence. Recommendations about haemoglobin’s threshold for PRBCs’ transfusion were also heterogeneous among guidelines. Further efforts are needed to generate high-quality CPGs in terms of PRBCs’ transfusion in clinical practice
Crisis de opioides en Estados Unidos, un espejo para las Américas
No full textFrom a public health perspective, the United States faces a growing healthemergency that increasingly affects diverse populations, regions, and socialcontexts. This situation highlights the lack of preventive strategies and theabsence of a comprehensive approach to the problem.The numbers are grim: according to the Centers for Disease Control andPrevention (CDC), since 1999 more than 760,000 people have died fromdrug overdoses in the U.S. Opioid overdoses account for the majority ofthese deaths—nearly 75 % in 2020. In 2024, an estimated 68 % of alloverdose deaths involved opioids, and among these, 88 % were due tofentanyl.Addressing this issue requires a global health response encompassingmultiple levels—from preventing inappropriate prescribing and improvingtreatment for dependency, to expanding access to naloxone (an antidote foroverdoses) and harm-reduction programs (e.g., safe needle exchanges,fentanyl testing), as well as strengthening active epidemiologicalsurveillance. The countries of the Americas must act proactively, not only toavert an opioid epidemic but also to prepare and adapt their health systemsfor future health crises. This requires public health policies grounded inscientific evidence and guided by the lessons learned from the devastatingconsequences of weak drug regulation and insufficient attention to addiction—failures that have already caused irreversible harm in affected populations.The experience of the United States offers a clear warning: delayed controlmeasures and fragmented health approaches lead to catastrophic outcomes.The risk in Latin America is not inevitable, but it is imminent—and willdepend on the political, regulatory, and public health decisions made in thecoming years.Desde la salud pública, Estados Unidos enfrenta una emergencia sanitaria que se va agravando con el tiempo y afecta a diversas poblaciones, regiones y contextos sociales. Este problema evidencia la ausencia de estrategias de prevención y de un abordaje integral de estas realidades.
Los datos no son halagadores; según el Centers for Disease Control and Prevention (CDC), desde 1999 más de 760 000 personas han fallecido por sobredosis de drogas en EE.UU. Las sobredosis por opioides representan la mayoría de las muertes, con casi el 75 % de las muertes en 2020. En 2024, se estima que el 68 % de todas las muertes por sobredosis incluyeron opioides y, de éstas, el 88 % se debieron a fentanilo.
El abordaje de este problema es un tema de salud global y su respuesta exige ser amplia, desde la prevención de la prescripción inadecuada y de los tratamientos de las dependencias, hasta el acceso a naloxona (antídoto de sobredosis) y programas de reducción de daños (p. ej., agujas seguras, tests de fentanilo), pasando por la vigilancia epidemiológica activa, entre otras medidas. Los países de las Américas están en la obligación de actuar de forma anticipada, no solo para evitar una epidemia de opioides, sino también para preparar los sistemas de salud y adaptarlos para futuras crisis sanitarias, con políticas de salud basadas en evidencia científica y tomando de ejemplo los graves daños que puede causar la falta de regulación de medicamentos, poca o nula atención a las adicciones, que llegan a causar daños irreparables en la población. Es indispensable tener en cuenta la experiencia de EE. UU., advirtiendo de forma clara que un control tardío, sin un enfoque integral de salud pública, conlleva consecuencias catastróficas. Por tanto, el riesgo en América Latina no es inevitable, pero sí latente y depende de las decisiones políticas, regulatorias y sanitarias que se tomen en los próximos años
Effectiveness and Safety of Preoperative Nutritional Interventions on Surgical Outcomes in Patients Undergoing Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis
No full textBackground: Preoperative nutritional interventions, including low-calorie diets (LCDs) and very low-calorie diets (VLCDs), are commonly implemented in metabolic and bariatric surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative dietary interventions in patients undergoing bariatric surgery, with primary outcomes including perioperative complications, operative time, and length of hospital stay. Methods: A systematic review and meta-analysis were conducted, including studies that compared LCD and VLCD with regular diets in adults undergoing bariatric surgery. The primary outcomes assessed were perioperative complications, operative time, and length of hospital stay. Random- and fixed effects models were used for quantitative synthesis. Risk of bias was evaluated using the Cochrane Risk of Bias tool and ROBINS-I, while the certainty of evidence was assessed using the GRADE approach. Results: Eight trials comprising 1197 patients were included in the meta-analysis. VLCDs were associated with a significant reduction in perioperative complications (OR 0.59; 95% CI: 0.37–0.94; p = 0.03), whereas LCDs showed no significant effect on complications (OR 1.64; 95% CI: 0.71–3.78; p = 0.25). No significant reduction in operative time was observed (MD −2.64 min; 95% CI: −6.01 to 0.73; p = 0.12). Hospital stay was slightly reduced (MD −0.17 days; p = 0.0001), though the clinical significance remains uncertain. The certainty of evidence was low, primarily due to the risk of bias and small sample sizes. Conclusions: VLCDs may lower the risk of perioperative complications, while LCDs do not appear to provide this benefit. However, the evidence is limited by methodological heterogeneity and low certainty. Further high-quality studies are needed to establish optimal preoperative nutritional protocols
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Nuevas variantes, el triunfalismo vacunal y la utopía de la “inmunidad de rebaño”
No full textCon una población mundial que anhela regresar a la “normalidad” anterior a la pandemia Covid-19, el discurso político se ha centrado en encontrar ese porcentaje mágico de población a vacunar necesaria para alcanzar la tan esperada “inmunidad de rebaño” que permitiría a groso modo quitar las restricciones establecidas. Pero esta decisión no tiene base científica sólida debido a que la aparición de nuevas variantes aumenta la capacidad y velocidad de contagio del virus y amenaza la efectividad de las vacunas cambiando las reglas establecidas y los cálculos más optimistas. Por tanto, se va tornando utópica la posibilidad de derrotar al SARSCOV2 en el corto plazo y solamente a través de las vacunas. Es indispensable cambiar el mensaje negacionista y de relajación de un posible fin de la pandemia en pocos días por uno dirigido a mantener las medidas de prevención como la mascarilla, distancia y lavado de manos, vacunación masiva refuerzos, vigilancia epidemiológica, análisis genómico del virus, que son pilares fundamentales para combatir adecuadamente esta guerra sanitaria que no da tregua y sobre la que aún tendremos mucho que hablar
Very low-calorie ketogenic diet (VLCKD): a therapeutic nutritional tool for acne?
No full textBackground: Acne, a chronic inflammatory disease impacting the pilosebaceous unit, is influenced significantly by inflammation and oxidative stress, and is commonly associated with obesity. Similarly, obesity is also associated with increased inflammation and oxidation. The role of diet in acne remains inconclusive, but the very low-calorie ketogenic diet (VLCKD), known for weight loss and generating anti-inflammatory ketone bodies, presents promising potential. Despite this, the effects of VLCKD on acne remain underexplored. This study aimed to investigate the efficacy of a 45-day active phase of VLCKD in reducing the clinical severity of acne in young women with treatment-naïve moderate acne and grade I obesity. Methods: Thirty-one women with treatment-naïve moderate acne, grade I obesity (BMI 30.03-34.65 kg/m2), aged 18-30 years, meeting inclusion/exclusion criteria, and consenting to adhere to VLCKD were recruited. Baseline and post-intervention assessments included anthropometric measurements, body composition, phase angle (PhA), trimethylamine N-oxide (TMAO) levels, and reactive oxygen metabolite derivatives (dROMs) as markers of inflammation, dysbiosis, and oxidative stress, respectively. A comprehensive dermatological examination, incorporating the Global Acne Grading System (GAGS) and the Dermatology Life Quality Index (DLQI), was conducted for all women. Results: VLCKD resulted in general improvements in anthropometric and body composition parameters. Significantly, there were significant reductions in both the GAGS score (Δ%: - 31.46 ± 9.53, p < 0.001) and the DLQI score (Δ%: - 45.44 ± 24.02, p < 0.001) after the intervention. These improvements coincided with significant decreases in TMAO (p < 0.001) and dROMs (p < 0.001) levels and a significant increase in PhA (Δ%: + 8.60 ± 7.40, p < 0.001). Changes in the GAGS score positively correlated with changes in dROMs (p < 0.001) and negatively with PhA (p < 0.001) even after adjusting for Δ% FM. Changes in the DLQI score positively correlated with changes in dROMs (p < 0.001) and negatively with PhA (p < 0.001) even after adjustment for Δ% FM. Conclusion: Given the side effects of drugs used for acne, there is an increasing need for safe, tolerable, and low-cost treatments that can be used for acne disease. The 45-day active phase of VLCKD demonstrated notable improvements in acne severity, and these improvements seemed to be attributable to the known antioxidant and anti-inflammatory effects of VLCKD
Obesity and Obesity-Related Thyroid Dysfunction: Any Potential Role for the Very Low-Calorie Ketogenic Diet (VLCKD)?
Full text linkAbstract
Purpose of Review This review aims to explore in-depth the different aspects of the association between very low-calorie
ketogenic diet (VLCKD), obesity and obesity-related thyroid dysfunction.
Recent Findings The VLCKD, proposed as a non-pharmacological strategy for the management of certain chronic diseases,
is becoming increasingly popular worldwide. Initially used to treat epilepsy, it has been shown to be effective in controlling
body weight gain and addressing various pathophysiological conditions. Research has shown that a low-calorie, high-fat
diet can affect thyroid hormone levels. Weight loss can also influence thyroid hormone levels. Studies have suggested that
long-term use of VLCKD for refractory epilepsy may be related to the development of hypothyroidism, with an effect seen
in various populations. In particular, women with obesity following VLCKD tend to have reduced T3 levels.
Summary We propose further research to unravel the underlying mechanisms linking VLCKD to obesity and obesity-related
thyroid dysfunction
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