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Background: The e-Learning with flipped classroom approach educational program is an alternative to online learning (e-Learning) and face-to-face learning for addressing the challenges related to long-distance skill training. Methods: Consisting of weekly live-time virtual sessions with expert physicians, available resources including updated guidelines, review articles, and blog interactions between colleagues for discussing the clinical cases to improve learning techniques. The availability of all the content (recorded lectures and bibliography) at any time for review is an important aspect for easy learning. This multimodal approach was directed to medical students working in rural communities to get the necessary skills for preventing, diagnosing, treating, and improving the quality of care in non-communicable chronic diseases (NCCD). In addition, this model includes a pre and post-course evaluation, a quality of care test, and a dropout and satisfaction survey. The students who obtain the approving grade at the end of the course get a certificate with medical endorsement.

espanolLa obesidad es una enfermedad cronica cuya prevalencia ha aumentado. Los estudios indican que los medicos especialistas carecen de conocimientos/habilidades para el tratamiento de pacientes con obesidad. Nuestro objetivo fue identificar la inclusion de temas de obesidad en los programas de residencia en especialidades/subespecialidades medicas respaldadas por la Universidad Nacional Autonoma de Mexico (UNAM) y analizar su conformidad con el contexto epidemiologico en Mexico y el mundo. Identificamos 70 programas de especialidad/subespecialidad y analizamos los planes de estudio de 57, luego de excluir aquellos que no involucran contacto con pacientes. Los clasificamos en 3 grupos: 1) aquellos que describieron conocimientos/habilidades especificos sobre obesidad; 2) aquellos que mencionaron la palabra obesidad sin describir conocimientos/habilidades especificos, y 3) aquellos que no incluyeron ninguna mencion de obesidad. Solo 6 programas (10,5%) describieron los conocimientos/habilidades a desarrollar para el tratamiento de la obesidad, 7 (12,3%) mencionaron el termino obesidad y 44 (77,2%) no consideraron la obesidad dentro de sus programas. Los resultados indican que los residentes carecen de una formacion adecuada para el manejo de la obesidad. Proponemos integrar el conocimiento de obesidad en un contexto multidisciplinario en los programas de especialidad/subespecialidad para proporcionar a los especialistas herramientas y habilidades para el tratamiento adecuado de la obesidad. EnglishObesity is a chronic disease with an increasing prevalence worldwide. Despite its importance for public health, studies indicate that medical specialists lack knowledge and skills for the management of patients with obesity. The aim of this study was to identify the inclusion of obesity topics in specialty/subspecialty residency medical programs endorsed by Universidad Nacional Autonoma de Mexico (UNAM), and to assess its conformity within the current epidemiological context in Mexico and worldwide. A total of 70 specialty/subspecialty programs were identified, and the curricula of 57 were analyzed, after excluding those that did not involve contact with patients. These were classified into three groups: (1) those that described specific topics/skills on obesity; (2) those that mentioned the word “obesity” without describing specific knowledge/skills, and (3) those that did not include any mention of obesity. Only six (10.5%) programs described knowledge/skills to be developed for obesity treatment, 7 (12.3%) mentioned the term “obesity”, and 44 (77.2%) did not consider obesity within their curricula. The results indicate that medical residents lack adequate training for obesity management. A proposal is made for need to integrate the current knowledge of obesity into a multidisciplinary context in the specialty/subspecialty programs in order to provide specialists with tools and skills for the appropriate treatment of obesity.

Introduction: Existing evidence indicates that the best treatment model for obesity leading to successful weight loss consists of a so-called comprehensive lifestyle intervention program, but the offer, implementation, and coverage of these kinds of programs for the diagnosis, management, and follow-up of people living with obesity are limited. So, the aim of this study was an evaluation of the feasibility and effectiveness of a comprehensive care program for obesity in a public tertiary hospital in Mexico. Methods: An observational, longitudinal, and retrospective study evaluated a six-month long medium-intensity comprehensive care program (seven visits focused on medical, nutritional, psychological, and psychiatric diagnosis and treatment). A total of 1,017 people living with obesity were recruited for the program. Logistic regression models were used to predict the factors associated with attendance and weight loss. Results: Of the 1,017 participants, 661 completed the program (65% retention rate) and attended 4.9 ± 1.9 visits each, with 40.1% losing ≥5% of their starting weight (X = 4.3 ± 4.4%). From visit 1 to visit 7, the participants that completed the program had weight decreases of Δ = −4.8 kg and body mass index (BMI) −2.3 kg/m2; p < 0.01. Each additional visit increased the likelihood of a 5% weight loss [OR 1.90, 95% CI: 1.51–2.38, p < 0.001] and 10% [OR 2.45, 95% CI: 1.49–4.02, p < 0.001], becoming statistically significant after attending more than four visits. Each additional year of age increased the likelihood of losing ≥5% body weight [OR 1.01, 95% CI: 1.00–1.03, p < 0.05] and increased the likelihood of completing the program [OR 1.02, 95% CI: 1.00–1.03, p < 0.01] after controlling for sex, weight, BMI, and psychiatric and weight loss medications. Discussion/Conclusion: This study demonstrates the feasibility and effectiveness of a six-month comprehensive program for obesity in a public hospital in Mexico.

Objective The Awareness, Care, and Treatment in Obesity Management-International Observation (ACTION-IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico. Methods An online survey was conducted. In Mexico, eligible PwO were ≥18 years of age with BMI ≥30 kg/m2 based on self-reported height and weight. Eligible HCPs had direct patient care. Results The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty-three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight-loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty-five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years. Conclusions This ACTION-IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient-centered approaches.

To investigate if overweight and obesity were associated with a higher degree of biochemical recurrence (BCR) after radical prostatectomy, in Mexican men with prostate cancer (PCa).We included 180 men with PCa, who underwent radical prostatectomy (RP). Body mass index (BMI) was determined and the degree of PCa aggressiveness was established according to the D'Amico classification. Postoperative follow-up of all patients was performed with PSA quantification every/6 weeks after surgery and then at 3-month intervals for 1 year, followed every/6 months for 5 years. Postoperative BCR was defined as two consecutive increases in PSA levels ≥0.4 ng/mL, after RP.Sixty eight percent of the patients presented overweight or obesity. We found that only intermediate/high risk patients presented an increased risk factor for BCR-free survival (HR = 4.39; 95% CI = 1.74-11.24;The overweight and obesity do not represent a risk factor to present BCR after RP for PCa. However, an intermediate/high risk, according to the D'Amico's classification, constitutes a risk factor to present BCR after radical prostatectomy, which is not related to the BMI.

The aim of this study is to compare the differences in body composition in patients with obesity with successful weight loss (SWL) and unsuccessful (USWL) 1 year after Roux-en-Y gastric bypass (RYGB). We included 36 women and 22 men. After stratifying patients according with SWL (defined as ≥ 50% of excess weight loss), fat-free mass (FFM) and fat mass (FM) trajectories were analyzed in each group. The %FM in SWL women (78%) was lower than USWL (36 vs. 44, p

Due to its antimicrobial properties, silver has been used in many areas of medicine and today silver nanoparticles have been incorporated into different biomaterials. The objective of this study was to implement a simple method for the incorporation of silver nanoparticles in polymethyl methacrylate substrates, to determine their mechanical properties, antimicrobial functionality and the solubility of silver incorporated. Using this approach an antimicrobial material can be obtained; the surface of a commercial polymethyl methacrylate (Opti-cryl®) was impregnated with silver nanoparticles (AgNps) using a spray deposition method (0.03% by weight). The antimicrobial activity of the material was evaluated using the Japanese industrial standard (JIS Z 2801) against Escherichia coli and Staphylococcus aureus. Inductively coupled plasma optical spectrometry (ICP-OES) was used to measure the solubility of the incorporated silver nanoparticles. Mechanical tests of flexural strength were performed to observe changes in mechanical properties. The antimicrobial results show that PMMA / AgNps has significant antimicrobial activity, showing better results for Escherichia coli. ICP-OES analysis suggests low solubility in silver nanoparticles. Mechanical tests showed a 1.6% increase in flexural strength for PMMA added with silver nanoparticles. The method presented for incorporating silver nanoparticles into PMMA and producing an acrylic antimicrobial substrate is easy and has the advantage of improving its mechanical properties.

In patients with gastric bypass (GB), high glucose variability (GV) and hypoglycemia have been demonstrated, which could impact the metabolic status and eating behavior. We describe the glucose patterns determined through continuous glucose monitoring (CGM) in two patients with >5 years follow-up after GB and significant weight recovery, who reported hypoglycemic symptoms that interfered with daily activities, and their response to a nutritional and psycho-educative prescription. Case 1: A 40-year-old woman without pre-surgical type 2 diabetes (T2DM) and normal HbA1c, in whom CGM showed high GV and hypoglycemic episodes that did not correlate with the time of hypoglycemic symptoms. Her GV reduced after prescription of a diet with low glycemic index and modification of meal patterns. Case 2: A 48-year-old male with pre-surgical diagnosis of T2DM and current normal HbA1c, reported skipping meals. The CGM showed high GV, 15% of time in hypoglycemia and hyperglycemic spikes. After prescription of a low glycemic index diet, his GV increased and time in hypoglycemia decreased. Through the detailed self-monitoring needed for CGM, we discovered severe anxiety symptoms, consumption of simple carbohydrates and lack of meal structure. He was referred for more intensive psychological counseling. In conclusion, CGM can detect disorders in glucose homeostasis derived both from the mechanisms of bariatric surgery, as well as the patient’s behaviors and mental health, improving decision-making during follow-up. Learning points: High glycemic variability is frequent in patients operated with gastric bypass. Diverse eating patterns, such as prolonged fasting and simple carbohydrate ingestion, and mental health disorders, including anxiety, can promote and be confused with worsened hypoglycemia. CGM requires a detailed record of food ingested that can be accompanied by associated factors (circumstances, eating patterns, emotional symptoms). This allows the detection of particular behaviors and amount of dietary simple carbohydrates to guide recommendations provided within clinical care of these patients. Background Bariatric surgery is the most effective treatment to achieve significant and sustained weight loss in patients with moderate and severe obesity and to attain better control of comorbidities compared with diet and exercise. The gastrointestinal tract is a critical organ for glucose homeostasis, and mixed bariatric procedures such as GB modify different metabolic pathways, as well as hunger and satiety signals (1). Changes in secretion of intestinal peptides, including glucagon-like peptide type 1 (GLP-1) and gastric inhibitory peptide (GIP), are considered among the main mechanisms that promote improvement in glucose and insulin levels (2). Nevertheless, new regulation of glucose metabolism in subjects with GB can also provoke adverse symptoms derived from the altered gastrointestinal function, predisposing to abrupt variability in glucose levels, reportedly higher than those in subjects with type 2 diabetes (T2DM) (3). The term dumping is used to refer to disturbances associated with the adrenergic discharge that occurs with the dilatation of the intestinal loops and to abrupt change in glucose concentrations. Reactive hypoglycemia has been reported in almost two-thirds of these patients, regardless of the diabetes status before surgery (4). These are some of the most common side effects following GB, associated with reduced quality of life and disordered eating behaviors, including responsive carbohydrate consumption and exacerbated insulin secretion. Continuous glucose monitoring (CGM) performed in patients operated with GB has found significant GV, defined as the maximum/minimum index of glucose levels in 24 h, accompanied by significant hyperglycemic spikes, whether in the presence or absence of hypoglycemia (5), and elevation of glucose concentrations above 300 mg/dL after one of these events. Hanaire et al. found values of the mean amplitude of glycemic excursions (MAGEs) among patients operated with GB of 86 ± 58 (mg/dL) and in patients with diabetes of 66 ± 24, respectively (3), compared with values reported for Hispanic population of 21.6 ± 12.6 obtained from a multi-ethnic study (6). Continuous glucose monitoring has also been helpful to confirm the presence of hypoglycemia in patients with and without symptoms of neuroglycopenia after bariatric surgery (5). Two studies have assessed the response of short-term interventions (acarbose and/or reduction in carbohydrate consumption) to reduce hypoglycemic symptoms and GV in patients with GB with favorable results (7, 8). Nevertheless, studies of GV in this population which is rapidly increasing are still limited. This technology is broadly employed in the management of diabetes mellitus, mainly type 1, for its capacity to achieve goals of glycemic control in comparison with multiple measurements of capillary glucose. The capacity to measure detailed glucose patterns has led to the recognition of both GV and hypoglycemia as adverse factors for metabolic and weight control and to impulse their identification and management. These phenomena are not likely to be detected by conventional follow-up, and are imperative to treat, given their potential to influence weight, eating patterns, quality of life and cardiovascular outcomes. We describe patterns of GV (maximum interstitial glucose (IG), time to postprandial peak IG (TP) and MAGE, assessed using Easy GV© software) by CGM in two patients, one female and a male, who we selected for reporting significant hypoglycemic symptoms associated with significant weight recovery (WR) after GB, and the effect of a nutritional and psycho-educative intervention.

While the effect of exercise on white adipose tissue browning and metabolic improvement in rodents is clear, there are few studies in humans with inconclusive results. Thus, the aim of the study was to assess whether an exercise intervention promotes subcutaneous adipose tissue browning in humans, and whether this response is associated with metabolic improvement in three groups of individuals defined by body mass index (BMI) (kg/m2). Sedentary adult subjects with different BMI were enrolled in a 12-week bicycle-training program (3 times per week, intensity 70–80% HRmax). Brown and beige gene expression in subcutaneous adipose tissue (scWAT) biopsies, and serum glucose, insulin, lipid, adipokine, and myokine levels were compared before and after the exercise intervention. Thirty-three non-diabetic subjects (mean age 30.4 ± 4.6 years; 57.57% female; 13 normal weight, 10 overweight and 10 with obesity) completed the exercise intervention. Without any significant change in body composition, exercise improved several metabolic parameters, most notably insulin resistance and particularly in the overweight group. Circulating adiponectin, apelin, and irisin exercise-induced changes predicted 60% of the insulin sensitivity improvement. After exercise UCP1, TBX1, CPT1B scWAT expression significantly increased, along with P2RX5 significant positive staining. These changes are compatible with scWAT browning, however, they were not associated with glucose metabolism improvement. In conclusion, 12-weeks of exercise training produced brown/beige gene expression changes in abdominal scWAT of non-diabetic individuals with different BMI, which did not contribute to the metabolic improvement. However, this result should not be interpreted as a lack of effect of browning on metabolic parameters. These findings suggest that a bigger effect is needed and should not preclude the development of more effective strategies of browning. Furthermore, exercise-induced changes in adiponectin, apelin, and irisin predicted insulin sensitivity improvement, supporting the important role of adipokines and myokines in metabolism homeostasis.

Mitochondrial defects have been related to obesity and prostate cancer. We investigated if Mexican-Mestizo men presenting this type of cancer, exhibited somatic mutations of ATP6 and/or ND3.Body mass index (BMI) was determined; the degree of prostate cancer aggressiveness was demarcated by the Gleason score. DNA from tumor tissue and from blood leukocytes was amplified by the polymerase chain reaction and ATP6 and ND3 were sequenced. We included 77 men: 20 had normal BMI, 38 were overweight and 19 had obesity; ages ranged from 52 to 83. After sequencing ATP6 and ND3, from DNA obtained from leukocytes and tumor tissue, we did not find any somatic mutations. All changes observed, in both genes, were polymorphisms. In ATP6 we identified, in six patients, two non-synonymous nucleotide changes and in ND3 we observed that twelve patients presented non-synonymous polymorphisms. To our knowledge, this constitutes the first report where the complete sequences of the ATP6 and ND3 have been analyzed in Mexican-Mestizo men with prostate cancer and diverse BMI. Our results differ with those reported in Caucasian populations, possibly due to ethnic differences.

Body mass index (BMI) ≥50.0 kg/m2 has been associated with increased surgical complications and mortality. We assessed echocardiographic characteristics and bariatric surgery complications of patients with BMI ≥50.0 kg/m2 vs. those in less severe obesity. A retrospective analysis in patients who underwent gastric bypass was performed. Pre-surgery structural characteristics analyzed included left atrial dimension (LA), left ventricle mass (LVM), LVM indexed for height2.7 (LVMI), and LV hypertrophy (LVH). Functional characteristics included LV diastolic and systolic function. Degree of obesity was correlated with cardiac parameters, comorbidities, and surgical complications. Data on 312 patients (75.3 % women, age 39.3 ± 0.6 years, BMI 50.2 ± 0.5 kg/m2) were analyzed. Cardiac parameters on the basis of BMI (

Metabolic surgery (MS) can be a useful therapeutic strategy in patients with type 2 diabetes (DM2) and obesity. To define the place of MS within DM2 treatment in Mexico. A committee of experts consisting of internists and surgeons representing the leading Mexican associations involved in the field was created. Each one responded to a specific question regarding mechanisms involved in controlling DM2, surgical procedures, and the indications and contraindications for MS. This document was prepared based on the presentation and discussion of such answers. Obesity through insulin resistance, incretins, bile salts, and intestinal microbiota plays a determining role in the appearance of DM2. MS improves glucose homeostasis by reducing weight and intake, increasing incretins, and modifying bile salts and microbiota. MS leads to remission of DM2 and reduces cardiovascular risk factors in well-selected cases. We recommend MS as a therapeutic option in DM2 and grade III obesity regardless of metabolic control and grade II and grade I obesity with poor glycemic control. MS could be considered an option in grade II obesity with good metabolic control in the presence of associated comorbidities. Gastric bypass presents the most favorable risk-benefit profile. Current evidence endorses the inclusion of MS in the algorithm for treatment of DM2 and obesity. The therapeutic approach must be multidisciplinary at experienced centers.

Background:The aim of this study was to investigate if Mexican-Mestizo individuals with obesity, with or without binge eating disorder (BED), exhibited mutations or other type of genetic variants in the sequence ofANKK1.Subjects and methods:Fifty unrelated individuals (21–53 years of age) with obesity, of Mexican-Mestizo ethnic origin were included; 25 of them had BED and 25 presented obesity without BED. The diagnosis of BED was based on criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Besides, we also analyzed 100 individuals with normal body mass index. DNA from blood leukocytes was amplified by the polymerase chain reaction and all exons ofANKK1were sequenced.Results:AfterANKK1sequencing we did not find any mutations; however, we observed various polymorphisms. One polymorphism, rs4938013 in exon 2 showed an association with obesity, whilst rs1800497 (also known as Taq1A) in exon 8, showed an association with BED (P = 0.020). Remarkable, for this study, the number of individuals for both polymorphisms for and additive model was sufficient to derive strong statistical power (80%, with a P < 0.05).Conclusions:To our knowledge, this constitutes the first report where the complete sequences ofANKK1has been analyzed in individuals with obesity, with or without BED. No mutations were found; however, one polymorphism was associated with obesity, with or without BED, and another one was associated with BED.

Background Associations of eating behaviors and psychological profile between mothers and daughters with eating disorders exist, but it is important to dissect the influence of the mother in each specific disorder since all eating disorders must be seen or treated not as one entity. The aim of the present study was to evaluate the association of eating behavior and psychological profile between mothers and daughters with different eating disorders and a control group. Methods The study group included young girls with anorexia nervosa (AN, n = 30), bulimia nervosa (BN, n = 30), binge eating disorder (BED, n = 19), and a control group of women (Non-ED, n = 54) together with their mothers. BMI was calculated for dyads and Eating Disorder Inventory, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale and Three-Factor Eating Questionnaire were applied. The differences between dyads were tested by Student’s t test and Pearson’s correlation was used to study the association between BMI, variables of eating behavior and psychological profile in each dyad. Results The study found significant inverse correlations between the AN dyad; some correlations between the BN dyad, and the highest positive correlations exist in BED dyad, especially in eating behavior. Finally, between the control dyads, low but significant correlations were found in the majority of cases. Conclusions The study concluded that the associations between mothers and daughters with distinct eating disorders varied depending on the specific diagnosis of the daughter, indicating it is necessary to analyze them individually, given that there may be different implications for treatment.

BACKGROUND Obesity constitutes a risk factor for the development of aggressive forms of prostate cancer. It has been proposed, that prostate cancer has a genetic predisposition and that PPARGC1A and ADIPOQ polymorphisms play a role in the development of this condition. OBJECTIVE To analyse the association of two PPARGC1A and ADIPOQ polymorphisms as well as their haplotypes, with the development of aggressive prostate cancer in Mexican-Mestizo men with overweight or obesity. SUBJECTS AND METHODS Two hundred fifty seven men with prostate cancer of Mexican-Mestizo origin were included. Body mass index (BMI) was determined and the degree of prostate cancer aggressiveness by the D'Amico classification. DNA was obtained. Rs7665116 and rs2970870 of PPARGC1A, and rs266729 and rs1501299 of ADIPOQ were studied by real-time PCR allelic discrimination. Pairwise linkage disequilibrium, between single nucleotide polymorphisms was calculated and haplotype analysis was performed. RESULTS A higher-risk (D'Amico classification) was observed in 21.8% of patients. An association of cancer aggressiveness with rs2970870 of PPARGC1A, and rs501299 of ADIPOQ, as well as with one haplotype of ADIPOQ was documented. CONCLUSIONS This is the first study regarding the relationship of PPARGC1A and ADIPOQ polymorphisms, and the aggressiveness of prostate cancer in men with overweight or obesity.

ResumenObjetivoEl propósito de este estudio fue evaluar la eficacia de la aplicación de plasma rico en factores de crecimiento (PRFC), dentro de un defecto periodontal distal, a los segundos molares inferiores después de la extracción de un tercer molar mandibular.Material y métodosSe realizó un ensayo clínico controlado, doble ciego, aleatorizado en 20 pacientes sanos, con defectos óseos bilaterales posterior a la extracción de un tercer molar retenido. Los pacientes fueron dividos en grupo experimental y control. Se realizaron mediciones de nivel clínico de inserción en el área distal del segundo molar previamente a la cirugía, usando una férula de acetato, con el fin de tener la misma referencia de medición posterior al procedimiento. Las mediciones posquirúrgicas fueron realizadas a las semanas 1, 4 y 12. Estas mediciones, así como los tiempos de evaluación, fueron analizados por medio de las pruebas de t de Student, Chi2 y Kruskal-Wallis.ResultadosLas variables demostraron similitud en cuanto a edad, sexo, dificultad y duración de los tiempos quirúrgicos. La medición del nivel clínico de inserción preoperatoria en milímetros fue de 2,68±0,56 vs. 2,63±0,50 (experimental vs. control). Durante la primera semana posterior al procedimiento los resultados fueron: 5,37±1,81 vs. 5,35±1,72; y a los 3 meses la recuperación fue similar en ambos grupos casi a sus niveles basales (2,43±0,89 vs. 2,55±0,92).ConclusionesNo se encontró diferencia significativa con el uso de PRFC en cuanto a ganancia en el nivel clínico de inserción periodontal en el área distal de segundos molares después de la extracción de terceros molares inferiores retenidos.AbstractPurposeThe aim of this study was to evaluate the effectiveness of the application of plasma rich in growth factors (CFRP) in a distal periodontal defect of the lower second molars after extraction of a third molar.Material and methodsA randomised, controlled, and double-blind clinical trial, was conducted on 20 healthy patients with bilateral defects after the extraction of an impacted third molar. The patients were divided into experimental and control groups. Measurements of clinical attachment level were performed in the distal area of the second molar prior to surgery using an acetate splint in order to have the same reference measurement after the procedure. Post-surgical measurements were performed at 1, 4, and 12 weeks. These measurements, as well as evaluation times, were analysed using the Student t-Test, χ2 and Kruskal-Wallis Test.ResultsThe variables showed similarity in age, gender, difficulty, and length of the surgical times. The measurements prior to clinical insertion were 2.68±0.56 vs. 2.63±0.50 (experimental vs. control). During the first week after the procedure, the results were: 5.37±1.81 vs. 5.35±1.72; and at 3 months the recovery almost to baseline was similar in both groups (2.43±0.89 vs. 2.55±0.92).ConclusionsNo significant difference was found with the use of CFRP as regards achieving attachment at clinical level in the distal area of second molars after extraction of third molars.

Background Mitochondrial dysfunction has been associated with the development of cancer and obesity, being prostate cancer more aggressive in obese men. It has been suggested that the mitochondrial transcription factor A (TFAM) plays a central role in these events. Objective The aim of this study was to analyze the possible association of 3 TFAM polymorphisms, as well as their haplotypes, with the development of aggressive prostate cancer in overweight or obese Mexican Mestizo men. Subjects and methods A total of 257 unrelated men with histologically confirmed prostate cancer, of Mexican Mestizo ethnic origin, were included. Body mass index was determined and the degree of prostate cancer aggressiveness was demarcated by the D’Amico classification. DNA was obtained from blood leukocytes. The rs1937, rs1049432, and rs11006132, as well as their haplotypes, were studied by real-time polymerase chain reaction allelic discrimination. Deviations from Hardy-Weinberg equilibrium were tested. Pairwise linkage disequilibrium between single nucleotide polymorphisms was calculated; haplotype analysis was performed. Results A higher risk (D’Amico classification) was documented in 56 patients (21.8%). We did not find a significant association among those polymorphisms analyzed; however, one haplotype was significantly associated with cancer aggressiveness. Conclusions To our knowledge, this constitutes the first study regarding the relationship of 3 TFAM polymorphisms, as well as their haplotypes, and the aggressiveness of prostate cancer in overweight or obese men; the most frequent haplotype was associated with cancer aggressiveness.

Mexico has the second biggest prevalence in the world of obese adults (30%). We conducted a survey to determine knowledge concerning obesity co-morbidities. Three groups were surveyed with a questionnaire divided into three sections: demographic characteristics; knowledge and awareness in relation to obesity being a disease; causes of obesity and the health risks it represents; weight auto-perception and the subject's personal experiences regarding weight. In all groups we found high knowledge regarding that obesity is a disease and the causes of its development, as well as that it greatly increases the risk of presenting type 2 diabetes, high blood pressure and knee osteoarthritis. However, in all groups, there was a gap in knowledge regarding the risk obesity poses for the development of breast and colon cancer. Aggressive health promotion campaigns concerning obesity, which have been implemented recently in Mexico, must emphasize cancer as a potential outcome for obese patients.

OBJECTIVE To assess the additional effect of sudden visceral fat reduction by omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in patients with grade III obesity (G-III O) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB). RESEARCH DESIGN AND METHODS Twenty-two patients were randomized into two groups, LRYGB alone or with omentectomy. Levels of interleukin-6, C-reactive protein, tumor necrosis factor-α, leptin, adiponectin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides, as well as clinical characteristics, were evaluated before surgery and at 1, 3, 6, and 12 months after surgery. Results were compared between groups. RESULTS Baseline characteristics were comparable in both groups. Mean operative time was significantly higher in the group of patients who underwent omentectomy (P < 0.001). Median weight of the omentum was 795 ± 341 g. In one patient, a duodenal perforation occurred at the time of omentectomy. BMI, blood pressure, glucose, total cholesterol, LDL, and triglycerides significantly improved in both groups at 1, 3, 6, and 12 months of follow-up when compared with basal values. However, there were no consistent statistically significant differences among the groups in terms of metabolic syndrome components, acute-phase reactants, and inflammatory mediators. CONCLUSIONS Omentectomy does not have an ancillary short-term significant impact on the components of metabolic syndrome and does not induce important changes in the inflammatory mediators in patients undergoing LRYGB. Operative time is more prolonged when omentectomy is performed.

Common polymorphisms in the fat mass and obesity-associated gene (FTO) have shown strong association with obesity in several populations. In the present study, we explored the association of FTO gene polymorphisms with obesity and other biochemical parameters in the Mexican population. We also assessed FTO gene expression levels in adipose tissue of obese and nonobese individuals. The study comprised 788 unrelated Mexican-Mestizo individuals and 31 subcutaneous fat tissue biopsies from lean and obese women. FTO single-nucleotide polymorphisms (SNPs) rs9939609, rs1421085, and rs17817449 were associated with obesity, particularly with class III obesity, under both additive and dominant models (P = 0.0000004 and 0.000008, respectively). These associations remained significant after adjusting for admixture (P = 0.000003 and 0.00009, respectively). Moreover, risk alleles showed a nominal association with lower insulin levels and homeostasis model assessment of B-cell function (HOMA-B), and with higher homeostasis model assessment of insulin sensitivity (HOMA-S) only in nonobese individuals (P (dom) = 0.031, 0.023, and 0.049, respectively). FTO mRNA levels were significantly higher in subcutaneous fat tissue of class III obese individuals than in lean individuals (P = 0.043). Risk alleles were significantly associated with higher FTO expression in the class III obesity group (P = 0.047). In conclusion, FTO is a major risk factor for obesity (particularly class III) in the Mexican-Mestizo population, and is upregulated in subcutaneous fat tissue of obese individuals.

In the ob/ob mice, keeping adiponectin concentrations in the physiological range (through overexpression of this gene in the adipose tissue) results in expansion of fat mass and protection against metabolic co-morbidities.The aim of the study was to test in humans whether plasma adiponectin levels, similar to those found in lean subjects, are associated with the metabolically healthy obese phenotype.A cross-sectional analysis was performed of a cohort of obese and nonobese subjects aged 18-70 yr. A medical history was taken, and glucose, plasma lipids, and total adiponectin were measured.We studied 189 men and 527 women. The majority were obese (n = 470, 65.6%). The metabolically healthy obese phenotype was found in 38 men and 133 women. This is defined as a body mass index (BMI) above 30 kg/m(2) plus high-density lipoprotein cholesterol of at least 40 mg/dl in the absence of type 2 diabetes and arterial hypertension.Twenty percent of the cases with a BMI above 40 kg/m(2) had adiponectin concentrations above the median value of normal BMI subjects. Adiponectin levels above 12.49 mg/liter in obese women (odds ratio, 3.02; 95% confidence interval, 1.95-4.67; P0.001) and above 8.07 mg/liter in obese men (odds ratio, 2.14; 95% confidence interval, 1.1-4.06; P = 0.01) increased the probability of being metabolically healthy. The association remained significant (beta, 0.673 +/- 0.205, P0.001) in a logistic regression model (r(2) = 0.25, P0.001) after controlling for the confounding effect of age, insulin, and waist circumference.Certain obese individuals have adiponectin levels similar to those found in normal BMI subjects; this is associated with the metabolically healthy obese phenotype.

To investigate the prevalence and characteristics of patients with type 2 diabetes diagnosed before the age of 40 years (early-onset disease) in a nationwide, population-based study.Using a multistage sampling procedure, we enrolled a representative sample of Mexican urban adults aged 20 to 69 years. Weight, height, blood pressure, and plasma levels of glucose, insulin, and other metabolic parameters were measured in all subjects.We identified 993 subjects with type 2 diabetes, including 143 subjects aged 20 to 39 years (14% of those with diabetes). Subjects with early-onset diabetes had a greater prevalence of obesity and higher plasma insulin and lipid levels than did age-matched controls, and a greater prevalence of high-density lipoprotein cholesterol levels35 mg/dL and severe hypertriglyceridemia than did older subjects with diabetes. Those (n = 32) with a normal body mass index (20 to 25 kg/m(2)) tended to have insulin deficiency as the main abnormality, whereas the "metabolic syndrome" characterized the remaining 111 subjects with early-onset diabetes.Most patients with early-onset type 2 diabetes in Mexico are obese or overweight, suggesting that obesity treatment and prevention programs may be effective in reducing the prevalence of this disease.

Chipped tobacco stalks were subjected to steam pretreatment at 205 degreesC for either 5 or 10 min before enzymatic hydrolysis. Glucose (15.4 - 17.1 g/l) and xylose (4.5-5.0 g/l) were the most abundant monosaccharides in the hydrolysates. Mannose, galactose and arabinose were also detected. The hydrolysate produced by pretreatment for 10 min contained higher levels of all sugars than the 5 min-pretreated hydrolysate. The amounts of inhibitory compounds found in the hydrolysates were relatively low and increased with increasing pretreatment time. The hydrolysates were fermented with baker's yeast. Ethanol yield, maximum volumetric productivity and specific productivity were used as criteria of fermentability of the hydrolysates. The fermentation of the hydrolysates was only slightly inhibited compared to reference solutions having a similar composition of fermentable sugars. The ethanol yield in the hydrolysates was 0.38-0.39 g/g of initial fermentable sugars, whereas it was 0.42 g/g in the reference. The biomass yield was twofold lower in the hydrolysates than in the reference. The fermentation inhibition caused by the tobacco stalk hydrolysates was less than that caused by sugarcane bagasse hydrolysates obtained under the same hydrolysis conditions.

The objective of this study was to investigate possible defects in the insulin sensitivity and/or the acute insulin response in a group of Mexican patients displaying early-onset type 2 diabetes and to evaluate the contribution of mutations in three of the genes linked to maturity-onset diabetes of the young. We studied 40 Mexican patients with an age of diagnosis between 20 and 40 yr in which the insulin sensitivity as well as the insulin secretory response were measured using the minimal model approach. A partial screening for possible mutations in 3 of the 5 genes linked to maturity-onset diabetes of the young was carried out by PCR-single strand conformation polymorphism analysis. A low insulin secretory capacity (AIRg = 68.5 +/- 5 muU/mL.min) and a near-normal insulin sensitivity (3.43 +/- 0.2 min/muU.mL x 10(4)) were found in these patients. Among this group we found two individuals carrying missense mutations in exon 4 of the hepatocyte nuclear factor-1alpha (HNF-4alpha) gene (Asp(126)-->His/Tyr and Arg(154)-->Gln, respectively) and one carrying a nonsense mutation in exon 7 of the HNF-1alpha gene (Gln(486)-->stop codon); 7.5% had positive titers for glutamic acid decarboxylase antibodies. Thirty-five percent of cases had insulin resistance; these subjects had the lipid abnormalities seen in the metabolic syndrome. A defect in insulin secretion is the hallmark in Mexican diabetic patients diagnosed between 20 and 40 yr of age. Mutations in either the HNF-1alpha or the HNF-4alpha genes are present among the individuals who develop early-onset diabetes in our population. These particular sequence changes have not been previously reported and therefore represent putative new mutations. Even in the absence of endogenous hyperinsulinemia, insulin resistance is associated with an adverse lipid profile.

The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.

Objective Obesity and osteoporosis are two important public health problems that greatly impact mortality and morbidity. Several similarities between these complex diseases have been identified. The aim of this study was to analyze if different body mass indexes (BMIs) are associated with variations in bone mineral density (BMD) among postmenopausal Mexican-Mestizo women with normal weight, overweight, or different degrees of obesity. Methods We studied 813 postmenopausal Mexican-Mestizo women. A structured questionnaire for risk factors was applied. Height and weight were used to calculate BMI, whereas BMD in the lumbar spine (LS) and total hip (TH) was measured by dual-energy x-ray absorptiometry. We used ANCOVA to examine the relationship between BMI and BMDs of the LS, TH, and femoral neck (FN), adjusting for confounding factors. Results Based on World Health Organization criteria, 15.13% of women had normal BMI, 39.11% were overweight, 25.96% had grade 1 obesity, 11.81% had grade 2 obesity, and 7.99% had grade 3 obesity. The higher the BMI, the higher was the BMD at the LS, TH, and FN. The greatest differences in size variations in BMD at these three sites were observed when comparing women with normal BMI versus women with grade 3 obesity. Conclusions A higher BMI is associated significantly and positively with a higher BMD at the LS, TH, and FN.

Background Since obesity and osteoporosis present a high genetic predisposition and polymorphisms of IL-6, IL6R, LRP5, ESR1 and SP7 may influence the risk of both diseases, the aim of this study was to analyze the possible association of polymorphisms in these genes, as well as their haplotypes, with BMD variations in postmenopausal Mexican-Mestizo women with grade 2 or grade 3 obesity. Methods One hundred eighty unrelated postmenopausal women with grade 2 or grade 3 obesity were included. BMD was measured in total hip and lumbar spine by dual-energy X-ray absorptiometry. DNA was obtained from blood leukocytes. Rs1800795 of IL-6, rs2228145 of IL6R, rs3736228 of LRP5, rs9340799 (XbaI) and rs2234693 (PvuII), of ESR1, rs10876432 and rs2016266, of SP7 (and their haplotypes), were studied by real-time PCR allelic discrimination. Deviations from Hardy–Weinberg equilibrium were tested. Pairwise linkage disequilibrium between single nucleotide polymorphisms was calculated by direct correlation r2, and haplotype analysis was conducted. Results Using WHO criteria, 54.5% had grade 2 obesity, and 45.5% had grade 3 obesity. Regarding DXA results, 11.1% women had osteoporosis, 41.7% had osteopenia, and 47.2% had normal BMD. Genotype and haplotype analysis showed no significant differences with BMD variations at the lumbar spine, total hip or femoral neck. Conclusions We did not find a significant association between the polymorphisms analyzed or their haplotypes and BMD variations in postmenopausal women with obesity. The higher BMD observed in women with obesity could be the result of an adaptive response to the higher loading of the skeleton.

Background Banded Roux-en-Y gastric bypass was designed to avoid or diminish weight regain in the long term. In 2008, we published the initial results of a pilot study design to comparatively evaluate surgical morbidity, mortality, and maximum weight loss in patients undergoing banded and unbanded laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study analyzes the 5-year results. Methods A randomized, controlled trial was carried out in 60 morbidly obese patients who underwent LRYGB. Patients were divided in 2 groups. Half of the patients underwent the banded version of the LRYGB, and half underwent the unbanded version. The 5-year excess weight loss (EWL) and loss of body mass index (BMI) were comparatively analyzed. Results There were 58 females and 2 males with a mean preoperative BMI of 47±4.9 kg/m 2 . A total of 21 patients with banded LRYGB and 22 with unbanded LRYGB completed 5-year follow-up. One patient died 3 years after surgery from metastatic melanoma. EWL at 5 years was 61.6%±19.6% versus 59.8%±15.9% ( P = ns), and loss of BMI was 32.9%±5.2% versus 32.8%±4.3% ( P = ns), respectively, for the banded and unbanded group. Conclusions In this small study, there were no statistical differences in the EWL and the BMI lost at 5 years between the group of patients who underwent banded and unbanded LRYGB.

Numerous efforts for the development of basic and clinical research in obesity are being made by the National Institutes of Health and Federal Reference Hospitals in Mexico. However, greater interaction among researchers and stronger efforts towards the dissemination of the results are needed. The document outlines the general ideas and proposals of the Academic Group for the Study, Prevention and Treatment of Obesity and Metabolic Syndrome of the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals (CCINSHAE). This is the first step in developing common objectives, with the aim of understanding the effect of these entities in public health and to establish guidelines to limit and eventually overcome them. We discuss the appropriateness of analyzing obesity and the metabolic syndrome together, and the current management of these entities at the National Institutes of Health in Mexico. The problems that arise in clinical practice lead to the need to generate a new model of medical care, including a new health worker and a new patient. It is imperative to establish permanent lines of communication and education with health personnel and with patients. The group proposes an integrated approach for research in these areas. Finally, a master plan that links the National Institutes of Health, particularly in the areas of research and programs within the institutions, is required as a first step in seeking answers useful in solving the problem. The second step would be linking the first and second levels of care through concrete actions needed to limit and reduce obesity and metabolic syndrome in the population.

Morbid obesity is a serious health problem associated to a significant reduction in life expectancy.To evaluate the anthropometric and metabolic changes observed in obese patients, 3, 6 and 12 months after laparoscopic Roux-en-Y gastric bypass surgery and the complications associated with the procedure.Retrospective study that included 128 consecutive obese patients submitted for bariatric surgery at the INCMNSZ (2004-2006).Their mean age was 38 +/- 10 years, 83% were women with a BMI of 48 +/- 6 Kg/m2. 65% were hypertensives, 55% had hypertriglyceridemia and 34% diabetes. A year after surgery all patients had at least reduced 20% their body weight and the percentage of excess body weight loss was 73%. The prevalence of hypertension, hypertrigliceridemia and diabetes was reduced to 24%, 17% and 12%, respectively (p0.001). Four patients died (3%), all of them had a leak of the anastomosis and intra-abdominal abscess. One died because pulmonary embolism, another with a myocardial infarction (after surgical reinterventions) and the other two with sepsis.Laparoscopic Roux-en-Y gastric bypass surgery in morbid obese patients favors significant reductions in body weight and associated co morbidities. This surgery is not free of complications and mortality, reason why it must be done only by surgical and interdisciplinary groups with experience in these procedures.

To describe the contributions ofthree Mexican institutions (Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Universidad Nacional Autónoma de México and the Centro de Encuestas Nacionales de Salud of the Instituto Nacional de Salud Pública) in the study, of chronic degenerative disorders.The most relevant group contributions include: the identification of a risk allele for metabolic syndrome and diabetes, specific for the Mexican population (the R230C variant of the ABC-A1 transporter); the design and validation of a population-based definition of metabolic syndrome which is useful to predict the risk of incident diabetes; the description of the molecular epidemiology of familial hypercholesterolemia in Mexico and the identification of several loci associated with familial combined hyperlipidemia. In addition, members of these institutions have participated in the description of the epidemiology of diabetes, metabolic syndrome and lipid abnormalities.The complementary approach of these research groups has facilitated successful collaborations. Our results will be useful for the future development of diagnostic tests and preventive programs.

s / Can J Diabetes 39 (2015) S38eS74 S72 (N1⁄424) were allocation concealed and randomized. The implementation process and context was evaluated by a qualitative study (interviews, field notes) analyzed by thematic analysis. The quantitative outcome measure of the number of weight management visits per full time equivalent RN/NP was blinded and collected over 1 year. Results: Qualitative results have revealed interacting contextual factors influencing the implementation of the intervention. These include the complexity and embedded nature of obesity, multidisciplinary team factors, provider relationship with patients, individual ability and work environment. These factors will enhance understanding of the primary outcome. Qualitative results have identified changes in provider behavior such as a reduction of patient weight bias, improved use of 5As of Obesity Management tools, and efficient obesity assessment. Summary: Tailoring weight interventions to primary care context may be a necessary step in overcoming barriers to implementation and effective change.