Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Tiroiditis subaguda asociada a COVID-19: revisión narrativa / Subacute thyroiditis associated with COVID-19: A narrative review

La infección por SARS-CoV-2 podría gatillar la ocurrencia de numerosas patologías, algunas de ellas de tipo endocrinológico. Se presenta una revisión narrativa sobre la asociación entre COVID-19 y tiroiditis subaguda, en la que se describen aspectos epidemiológicos, fisiopatológicos, manifestaciones clínicas y de laboratorio, tratamiento y pronóstico. La prevalencia de alguna disfunción tiroidea en pacientes COVID-19 fluctúa entre 13 y 64%, específicamente en relación con tiroiditis subaguda se describe un cambio en la prevalencia de 0,5% a 10% entre los años 2019 y 2020. La tiroiditis subaguda se produce por la unión del virus SARS-CoV-2 con la enzima convertidora de angiotensina 2 (ACE-2) ampliamente expresada en la glándula tiroides, generando manifestaciones clínicas tipo tirotoxicosis, aunque la presentación de la tiroiditis subaguda asociada a COVID-19 puede ser atípica. Los elementos centrales del tratamiento son similares a los empleados ante cualquier tiroiditis subaguda. Se concluye la necesidad de considerar esta entidad en el diagnóstico diferencial de pacientes actual o previamente infectados por SARS-CoV-2 que presenten síndrome febril, elevación de parámetros inflamatorios o taquicardia persistente, sin etiología precisada.

SARS-CoV-2 infection can trigger the occurrence of numerous pathologies, some of them endocrinological. The present narrative review works on the association between COVID-19 and subacute thyroiditis, which describes epidemiological and pathophysiological aspects, clinical and laboratory manifestations, treatment, and prognosis. The prevalence of thyroid dysfunction in COVID-19 patients fluctuates between 13 and 64%, explicitly concerning subacute thyroiditis; it has been described as a change in prevalence from 0.5% to 10% between 2019 and 2020. The binding of the SARS-CoV-2 virus with the angiotensin-converting enzyme 2 receptor (ACE-2) widely expressed in the thyroid gland causes subacute thyroiditis, generating thyrotoxicosis-like clinical manifestations. However, the presentation of subacute thyroiditis associated with COVID-19 may be atypical. The central elements of the treatment are similar to those used in any subacute thyroiditis. We conclude that this entity must be considered in differential diagnoses of patients currently or previously infected with SARS-CoV-2 that present a febrile syndrome, elevated inflammatory parameters, or persistent tachycardia without a specified aetiology.

Variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey

Fundamento: la infertilidad femenina es un término utilizado para referirse a una mujer que no ha podido quedar embarazada después de haberlo intentado por lo menos en un año al mantener relaciones sexuales desprotegidas. Objetivo: caracterizar algunas variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en el Hospital Docente Ginecobstétrico Provincial Ana Betancourt Mora de Camagüey durante el año 2021. El universo estuvo constituido por 304 pacientes con diagnóstico de infertilidad. Las variables estudiadas incluyeron: grupo etáreo, tipo de infertilidad, municipio de origen, tasa de incidencia, nivel educacional, hábitos tóxicos, factores de riesgo y antecedentes personales. Los datos se expresaron en números y porcientos. Resultados: el 30,9 % correspondió al grupo etáreo de 30 a 34 años, procedentes en su mayoría del municipio Camagüey (43,5 %), mientras Céspedes alcanzó la mayor tasa de incidencia (13,8 %) por cada 1000 mujeres con rango de edad que pudieran ser admitidas en el programa. Un porciento elevado tenía estudios universitarios (45,4 %) y preuniversitarios (24,3 %), predominó el consumo de café (24,0 %) y tabaco (14,5 %) como hábitos tóxicos; así como enfermedades de trasmisión sexual (24,7 %) y el uso de anticonceptivo (21,1 %). La obesidad (13,5 %) resultó ser el principal antecedente personal. Conclusiones: la infertilidad femenina está determinada por varios factores, incluidos los epidemiológicos, como los hábitos tóxicos, el estado nutricional, los antecedentes personales, entre otros, en su mayoría modificables, que pueden ser tratados desde la Atención Primaria de Salud.

Background: female infertility is a term used to refer to a woman who has not been able to get pregnant after trying for at least a year by having unprotected sexual intercourse. Objective: to characterize some socio-epidemiological variables of female infertility in Camagüey province. Methods: a descriptive, cross-sectional study was carried out at the Ana Betancourt Mora Camagüey Provincial Gynecobstetric Teaching Hospital during the year 2021. The universe consisted of 304 patients diagnosed with infertility. The variables studied included: age group, type of infertility, municipality of origin, incidence rate, educational level, toxic habits, risk factors, and personal history. Data were expressed in numbers and percentages. Results: 30.9 % corresponded to the age group of 30 to 34 years, coming mostly from the Camagüey municipality (43.5 %), while Cespedes reached the highest incidence rate (13.8 %) per 1000 women with age range that could be admitted to the program. A high percentage had university studies (45.4 %) and pre-university studies (24.3 %), the consumption of coffee (24.0 %) and tobacco (14.5 %) predominated as toxic habits; as well as sexually transmitted diseases (24.7 %) and the use of contraception (21.1 %). Obesity (13.5 %) turned out to be the main personal history. Conclusions: female infertility is determined by several factors, including epidemiological ones, such as toxic habits, nutritional status, personal history, among others, mostly modifiable, which can be treated from Primary Health

Pituitary Apoplexy in Pregnancy: What do We Know? / Apoplexia hipofisária na gravidez: o que sabemos?

Abstract Pituitary apoplexy refers to a rare clinical syndrome consisting of signs and symptoms that occur due to rapid expansion of the contents of the sella turcica. It can occur spontaneously or associated with pituitary tumors. It can have a broad clinical spectrum, but usually presents with severe headache, visual impairment and hypopituitarism. Sudden onset of symptoms associated to imagiologic confirmation makes the diagnosis. Surgical treatment is advised when there is important compression of the optic tract. We present a case report and a review of the literature on pituitary apoplexy in pregnancy. The cases were reviewed to obtain information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. Our review found 36 cases of pituitary apoplexy in pregnancy. Most of the cases occurred in the second trimester of pregnancy and headache was the most frequent symptom at presentation. Surgical therapy was required in more than half of the patients. In what respect maternal and fetal outcomes, there were 3 cases of preterm delivery and one case of maternal death. Our clinical case and literature review reinforces the importance of an early diagnosis to avoid potential adverse consequences.

The effect of COVID-19 process on patients with endocrinological disease in a pandemic hospital: What happened to the others?

ABSTRACT Objective: To evaluate the effects of the pandemic process on those with an endocrinological disease that will require close follow-up from the last visit before the pandemic. Materials and methods: Patients of 3,903 with thyroid, calcium-bone metabolism, adrenal gland, pituitary diseases, and neuroendocrine tumor (NET) were retrospectively scanned. The remaining 855 (656 females and 199 males) patients with active disease or who still needed multidisciplinary approaches were included. The number of patients who continued the disease-related medical procedures and could complete these procedures on time in the pandemic period was determined, and medical deprivation rate (MDR) was calculated. Results: The prepandemic period of our patients with thyroid disease (n = 594), calcium-bone metabolism disorder (n = 130), adrenal disease (n = 85), pituitary disease, and NET (n = 46) had MDRs of 85%, 56%, 81%, and 89%, respectively. For each subgroup of patients, the lowest MDR (67%) was in medullary thyroid carcinoma, the highest MDR (89%) was in differentiated thyroid carcinoma; the lowest MDR (6%) was in osteoporosis, the highest MDR (100%) was in the active Paget's disease; the lowest MDR (0%) was in primary adrenocortical insufficiency, the highest MDR (100%) was in hyperfunctional adrenal adenomas; the lowest MDR (81%) was in pituitary nonfunctional adenomas, and the highest MDR (100%) was in Cushing's disease, active prolactinoma, TSHoma, and NET, respectively. Conclusion: This study showed that not only those who had COVID-19 but also those who had medical deprivation due to their current endocrinological disease were not to be underestimated during the pandemic period.

The triglyceride-glucose index as an indicator of insulin resistance and cardiometabolic risk in Brazilian adolescents

ABSTRACT Objective: To set cutoff points for the triglyceride and glucose index (TyG) as a marker of insulin resistance (IR) for the pediatric population. Subjects and methods: This was a cross-sectional study with schoolchildren population-based data using data of 377 schoolchildren age 10 to 17 years of both sexes. We studied metabolic variables associated with IR indicators, such as fasting insulin and blood glucose, to calculate the homeostatic model assessment (HOMA-IR), and we studied triglycerides (TG) to determine the TyG index. We obtained TyG cutoff values for IR using the receiver operation characteristic (ROC), with definitions of sensitivity (Sen), specificity (Spe), and area under the ROC curve (AUC), with the HOMA-IR as reference. Results: The cutoff points of the TyG index for IR in adolescents are 7.94 for both sexes, 7.91 for boys, and 7.94 for girls, indicating moderate discriminatory power. When we also considered anthropometric variables of excess weight [TyG-BMI (body mass index)] and visceral fat [TyG-WC (waist circumference)], these indexes reached AUC values higher than 0.72, enhancing their potential use for a good diagnosis. Conclusion: TyG has proven to be a useful instrument for identifying IR in adolescent health screening, with high discrimination capacity when added to anthropometric variables, making it a feasible and inexpensive option.

Particularidades del entrenamiento físico y el control de los factores de riesgo en la población trans y de género diverso / Particularities of physical training and control of risk factors in the transgender and gender-diverse population

Resumen La población trans y de género diverso (TGD) tiene una gran relevancia en relación con la práctica de ejercicio y deporte. Se destacan desafíos específicos, como la inactividad física motivada por razones internas y externas, incluida la discriminación en entornos deportivos. Existen aspectos psicológicos y efectos de la terapia hormonal que generan implicaciones para la dificultar participación en competiciones deportivas. También se menciona la disparidad en los factores de riesgo cardiovascular y se plantea la necesidad de políticas deportivas inclusivas basadas en evidencia científica. El artículo enfatiza la importancia de abordar los aspectos sociales, psicológicos y médicos para promover la salud física y mental de la población TGD, especialmente en el ámbito deportivo profesional.

Abstract The transgender and gender-diverse (TGD) population holds significant relevance concerning exercise and sports practices. Specific challenges are highlighted, such as physical inactivity driven by internal and external reasons, including discrimination in sports environments. Psychological aspects and hormonal therapy effects create implications for hindering participation in sports competitions. Disparities in cardiovascular risk factors are also mentioned, emphasizing the need for inclusive sports policies based on scientific evidence. The article underscores the importance of addressing social, psychological, and medical aspects to promote the physical and mental health of the TGD population, particularly in the professional sports area.

Riesgo de enfermedad cardiovascular en la población transgénero / Cardiovascular disease risk in the transgender population

Resumen Este artículo resume la literatura existente hasta este momento sobre el impacto de la terapia hormonal para la asignación de género utilizada en la población transgénero, y de los factores de riesgo tradicionales y emergentes, en los desenlaces cardiovasculares o los marcadores subrogados de enfermedad cardiovascular. Actualmente se reconoce la evidencia creciente de que las personas transgénero o con género diverso son víctimas de disparidades en una gran variedad de factores de riesgo cardiovascular comparadas con sus pares cisgénero. Se ha reportado disparidad en morbilidad y mortalidad como resultado de una alta prevalencia en estilos de vida no saludables. Sin embargo, recientemente se ha incorporado la interpretación de que no solo la disparidad en factores de riesgo cardiovascular es lo que incrementa el riesgo en la salud cardiovascular de la población transgénero. Existe la hipótesis de que el exceso en morbilidad y mortalidad cardiovascular está relacionado con estresores psicosociales a lo largo de la vida de este grupo en múltiples niveles, incluyendo violencia estructurada (p. ej., discriminación, falta de acceso a los servicios de salud, falta de vivienda digna, etc.). La falta de información y de investigación en este grupo son limitantes importantes que requieren un abordaje multifacético para mejorar aspectos como la promoción de la salud y el mejor cuidado cardiovascular.

Abstract This review summarizes the impact of gender affirming hormone therapy used in the transgendered population and the classic and emerging risk factors on cardiovascular outcomes and surrogate markers of cardiovascular health. There is a growing body of evidence that people who are transgender and gender diverse are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Previously, disparities have been reported in cardiovascular morbidity and mortality across this group as a result of a higher prevalence of non-healthy life style. However, recent research suggests that there are additional factors playing a role in this differences: there is the hypothesis that the excess of cardiovascular morbility and mortality has been driven by psychosocial stressors across the lifespan at multiple levels, as structural violence (e.g., discrimination, lack of affordable housing, lack of access to health care, etc.). Lack of information and research in this population is an important limitation; therefore, a multifaceted approach that integrates best practice into research, health promotion and cardiovascular care for this understudied and growing population is clearly needed.

The application of clinical path teaching method and case-based learning in the standardized residency training in the department of endocrinology / 中华医学教育探索杂志

Objective:To explore the application effect of clinical path teaching method (CPTM) and case-based learning (CBL) in the standardized residency training in the department of endocrinology.Methods:A total of 120 residents who participated in the standardized residency training in the Department of Endocrinology in The First Affiliated Hospital of University of Science and Technology of China from June 2020 to June 2021 were selected as subjects. They were randomly divided into the control group (30 cases) who received traditional teaching mode, CPTM group (30 cases), CBL group (30 cases) and the experimental group (30 cases) who received CPTM + CBL combination teaching mode. The graduation examination results, usual performances and the teaching satisfaction among the four groups were compared.Results:The students in experimental group had higher score in learning methods, task completion, clinical thinking ability and operational assessment than the rest three groups. In addition, the students in experimental group were more enthusiastic to learn than the control group and CPTM group, and the difference was statistically significant ( P<0.05). The students in experimental group had better performance in graduation examination (55.97±5.58) than the control group (51.97±4.54), CPTM group (53.48±3.37) and CBL group (51.36±3.72).The teaching satisfaction of the students in experimental group was higher than that of the rest three groups. Furthermore, the teaching experience of teachers in experimental group was better. Conclusion:CPTM combined with CBL teaching method can improve the thinking skills and learning initiative, which is beneficial to cultivate the clinical ability of residents in the standardized residency training of endocrinology.

Malignant hypercalcemia at a national referral center. A retrospective analysis

Malignant hypercalcemia is the most frequent endocrinological emergency in cancer. The factors related to its occurrence have not been evaluated, nor are there any related studies in Colombia. Objective: to determine the factors associated with the onset of malignant hypercalcemia (MH) in patients hospitalized at Instituto Nacional de Cancerología (2014-2019). Design: a retrospective analytical case-control study Population: 230 cases of adults with cancer and calcium corrected for albumin equal to or greater than 10.5 mg/dL and 223 controls of cancer patients with normal corrected calcium (8.5 to 10.4 mg/ dL) were included. Squamous cell carcinoma was used as the pairing variable. Analysis: univariate and bivariate analyses between the variables and the occurrence of MH were conducted to determine association, and raw ORs were calculated. Depending on their statis tical significance (p<0.05), they were included in the logistic regression for multivariate analysis and to rule out bias. Results: the median calcium for cases: 12.98 mg/dL (11.64-14.42) vs. 9.4 mg/dL (9.02-9.74) (p < 0.0001). The two groups were similar in age and sex. There was more metastasis in the cases (60.0% vs. 39.91%) (p< 0.0001). Altogether, 54.34% of the cases developed neurological symp toms. The median hospital stay was 16 days (IQR 9-27) vs. 9 days (IQR 6-17) for the controls (p< 0.0001), and inpatient deaths occurred in 48.70% vs. 16.59% (p < 0.0001). The following showed an association with MH: normal albumin, OR 0.41 (95% CI 0.29-0.55); a Karnofsky Index greater than or equal to 70, OR 0.98 (95% CI 0.97-0.99); and metastasis, OR 1.87 (95% CI 1.23-2.84). (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2555).

La hipercalcemia maligna es la urgencia endocrinológica en cáncer más frecuente, los factores relacionados a su presentación no han sido evaluados, ni hay estudios relacionados en Colombia. Objetivo: determinar los factores asociados a la presentación de hipercalcemia maligna (HM), en pacientes hospitalizados en el Instituto Nacional de Cancerología (2014-2019). Diseño: estudio analítico retrospectivo de casos y controles. Población: se incluyeron 230 casos de adultos con cáncer y calcio corregido por albúmina mayor e igual a 10.5 mg/dL y 223 controles de pacientes oncológicos con calcio corregido normal (8.5 a 10.4 mg/dL), se usó el carcinoma escamocelular como variable pareadora. Análisis: para establecer asociación se realizó el análisis univariado y bivariado entre las variables y la presentación de HM, se calcularon OR crudos, según significancia estadística (p<0.05) fueron incluidas en regresión logística para el análisis multivariado y excluir sesgos. Resultados: mediana de calcio en los casos: 12.98 mg/dL (11.64-14.42) vs. 9.4 mg/dL (9.02-9.74) (p < 0.0001). Los dos grupos presentaron edad y sexo similares. Hubo mayor proporción de metástasis en los casos (60.0% vs. 39.91%) (p < 0.0001). El 54.34% de los casos desarrolló síntomas neuro lógicos. La mediana de estancia hospitalaria fue de 16 días (RIC 9-27) vs. nueve días (RIC 6-17) para los controles (p < 0.0001) y la muerte intrahospitalaria se presentó en el 48.70% vs. 16.59% (p < 0.0001). Demostraron asociación con HM: albúmina normal OR 0.41 (IC 95% 0.29-0.55), índice de Karnofsky mayor o igual 70 OR 0.98 (IC95% 0.97-0.99) y presencia de metástasis OR 1.87 (IC 95% 1.23-2.84). (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2555).

Impacto de la pandemia por COVID-19 en la consulta ambulatoria endocrinológica y teleconsulta en un hospital Peruano

Introducción: La pandemia por COVID-19 afectó la continuidad de las consultas médicas presenciales, así se implementaron estrategias, como las teleconsultas, para cerrar brechas de atención. El objetivo del estudio fue describir el impacto de la pandemia en la consulta endocrinológica en el Hospital Nacional Alberto Sabogal Sologuren (Callao, Perú). Materiales y métodos: Se realizó un estudio descriptivo de análisis de datos secundarios obtenidos del Sistema de Salud Inteligente del Seguro Social de Perú. Se analizó datos de las consultas ambulatorias entre mayo 2019 y noviembre 2021. Resultados: Debido a la pandemia, la proporción de consultas presenciales disminuyó de 100% (periodo prepandemia) a 29,4% (durante la pandemia), mientras que las teleconsultas predominaron tras su implementación. Mas del 68% de pacientes fueron mujeres, en las consultas presenciales la mediana de edad antes y durante la pandemia fue 59 y 56 años, respectivamente, mientras que en teleconsultas fue 58 años. La diabetes mellitus fue el principal motivo de consulta (entre 32,6% a 34,4% del total de consultas), seguido del hipotiroidismo y la enfermedad nodular tiroidea. Durante la pandemia, la proporción de consultas por hipotiroidismo fue mayor en teleconsultas vs consulta presencial (25,3% vs 18%). Conclusiones: Durante la pandemia, las teleconsultas predominaron sobre la consulta presencial. No hubo diferencias relevantes en la mediana de edad o sexo predominantes entre los pacientes antes o durante la pandemia. La diabetes mellitus fue el principal motivo de consulta en general y durante la pandemia las consultas por hipotiroidismo fueron mayor en teleconsulta.

ABSTRACS Background: The COVID-19 pandemic affected the continuity of face-to-face medical consultations, so strategies, such as teleconsultations, were implemented to close the gaps in care. The objective of this study was to describe the impact of the pandemic in the traditional endocrinology consultation at Hospital Nacional Alberto Sabogal Sologuren (Callao, Peru). Materials and methods: We carried out a descriptive study of analysis of secondary data, that was obtained from the Sistema de Salud Inteligente of the Social Security of Peru. Data from outpatient consultations between May 2019 and November 2021 were analyzed. Results: Due to the pandemic, the proportion of face-to-face consultations decreased from 100% (pre-pandemic period) to 29,4% (during the pandemic), while teleconsultations predominated after its implementation. More than 68% of patients were women, in face-to-face consultations the median age before and during the pandemic was 59 and 56 years, respectively, while in teleconsultations it was 58 years. Diabetes mellitus was the main reason for consultation (between 32,6% and 34,4% of all consultations), followed by hypothyroidism and nodular thyroid disease. During the pandemic, the proportion of consultations for hypothyroidism was higher in teleconsultations vs. face-to-face consultations (25,3% vs. 18%). Conclusions: During the pandemic, teleconsultations predominated over face-to-face consultation. There were no relevant differences in median age or predominant gender among patients before or during the pandemic. Diabetes mellitus was the main reason for consultation in general and during the pandemic consultations for hypothyroidism were higher in teleconsultation.

A systematic review of hormone levels, biomarkers of cellular injury and oxidative stress in multi-stressor military field training exercises

ABSTRACT The fundamental objective of military field training exercises (FTX) is to prepare military personnel for real-life operations through simulated scenarios. These training sessions often require extreme physical efforts with prolonged, high-intensity exercises that can be combined with food restrictions and partial, or total, sleep deprivation. Such conditions can compromise an individual's physical performance and cause tissue damage, thus affecting their health. This study aimed to perform a systematic review of the literature to identify studies that measured the changes in hormone levels and biomarkers of cellular injury and oxidative stress resulting from FTX with high levels of energy expenditure combined with food and sleep restrictions. PubMed and the Scopus database were searched for articles that combined physical effort/food restriction/sleep deprivation with military training. The initial database search identified 158 articles that were reduced to 18 after confirmation. Significant reductions were reported in thyroid hormones, T3, T4, and anabolic hormones such as testosterone, insulin and androstenedione. An exception for GH was found, which increased throughout FTX. Less distinct responses to FTX were observed with cortisol, TSH and LH. The presence of biomarkers for cellular damage (myoglobin, TNF, and CRP) and increased immune response activities were also described. The scarcity of information on oxidative stress, analyses of cellular injury and biomarkers of inflammatory responses warrants the future study of these topics, which could be helpful in facilitating the safe and effective physical preparations of the members of the armed forces.

Prevalencia de retinopatía diabética en una zona rural de Argentina / Prevalence of diabetic retinopathy in a rural area of Argentina

Resumen La retinopatía diabética es uno de los grandes problemas que enfrenta la salud pública en el siglo XXI. La prevalencia mundial se encuentra en constante aumento; sin embargo, poco se conoce sobre la frecuencia de esta enfermedad en la Argentina. Los programas de tele-oftalmología han ayudado a combatir y a comprender mejor esta enfermedad, principalmente en áreas rurales. El objetivo del siguiente tra bajo fue estimar la prevalencia de la retinopatía diabética en la provincia de La Pampa. Se realizó un estudio observacional de corte transversal, evaluando las características de la población asistida por un programa de tele-oftalmología en la zona rural de la provincia. Se evaluaron imágenes de retina obtenidas con un retinógrafo no midriático, la presión intraocular y características generales de la población. Se estimó una prevalencia del 21.5% y un 14.1% de estas personas tenían una amenaza visual grave. Además, se observó que el 5.0% tenían glaucoma, 63.4% hipertensión arterial y 42.6% dislipemia. Estos resultados son similares a los presentados en otros países del mundo. Son datos fundamentales para comprender detalles de la situación epidemiológica en esta región y poder armar estrategias sanitarias para enfrentar a esta enfermedad.

Abstract Diabetic retinopathy is one of the major problems public health is facing in the 21st century. The worldwide prevalence is increasing; however, little is known about the frequency of this disease in Argentina. Tele-ophthalmology programs have helped to face and to better understand this disease, mainly in rural areas. The aim of this study was to estimate the prevalence of diabetic retinopathy in the province of La Pampa. A cross-sectional observational study was carried out, evaluating the characteristics of the population assisted by a tele-ophthalmology program in a rural area of the province. The images, taken with a non-mydriatic retinal camera, the intraocular pressure and general characteristics of the population were evaluated. A disease prevalence of 21.5% was estimated and 14.1% of them had a vision-threatening diabetic retinopathy. In addition, it was observed that 5.0% had glaucoma, 63.4% hypertension and 42.6% dyslipidemia. These findings are similar to those reported in other countries around the world. These data are fundamental to understand the details of the epidemiological situation in this region and to be able to develop health strategies to deal with this disease.

Application of formative assessment combined with Ladder type teaching in the teaching of standardized training of nephrology and endocrinology / 中华医学教育探索杂志

Objective:To explore the application effect of formative assessment combined with Ladder type teaching on the teaching of standardized training of nephropathy and endocrinology.Methods:A total of 39 residents who rotated in the Department of Nephrology and Endocrinology, Sichuan Science City Hospital from March 2019 to March 2020 were included in the control group and were taught routinely, and another 42 residents who rotated from April 2020 to April 2021 were classified as a research group and were given formative assessment and Ladder type teaching. The out-department assessment results between the two groups were compared, and the mini-clinical exercise evaluation (Mini-CEX), normal performance assessment and 360-degree evaluation results of the research group when entering and exiting the department were compared. The students' satisfaction with teaching between the two groups was also compared. SPSS 24.0 was used for t test, chi-square test and rank sum test. Results:The scores of theory, skill manipulation and case analysis in the research group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The Mini-CEX score, usual performance assessment score and 360-degree evaluation score in the research group when exiting the department were all higher than those when entering the department, with statistically significant difference ( P<0.05). There were significant differences in the grades distribution of teaching satisfaction degrees between the two groups ( P<0.05), and the total satisfaction rate of the research group was higher than that of the control group. Conclusion:The use of formative assessment combined with Ladder type teaching in the standardized training of nephropathy and endocrinology can significantly improve the scores of the residents and their clinical comprehensive literacy, and increase the satisfaction of teaching, with great value of popularization and application.

Construction and clinical effects of endocrinology nursing subspecialty group / 中国实用护理杂志

Objective:To construct endocrinology nursing subspecialty model and explore its clinical effect.Methods:In December 2018, the organization structure of endocrinology nursing subspecialty was constructed in the Drum Tower Hospital Affiliated of Nanjing University Medical School and applied in clinic. In this model, the data of 2018 were taken as the data before application and the data of 2020 were taken as the data after application. The comprehensive ability of nurses, nurse satisfaction, related nursing workload and scientific research ability of nurses were compared before and after the application of the model.Results:After the application of subspecialty nursing mode, nurses′ comprehensive ability score was (92.00 ± 2.36) points. Compared with (84.25 ± 3.24) points before implementation, the difference was statistically significant ( t=-9.46, P<0.01); nurses′ satisfaction evaluations including specialty development (7.92 ± 1.41), self-quality improvement (8.00 ± 1.69), work pressure (6.42 ± 2.67), salary and welfare (3.96 ± 0.85), compared with (5.79 ± 2.31), (6.17 ± 2.82), (8.33 ± 1.50), (2.88 ± 1.59) before implementation, the difference was statistically significant ( t values were -3.86--2.73, all P<0.05). The annual workload of related nursing increased and the scientific research ability of nurses was improved. Conclusions:The application of endocrinology nursing subspecialty mode is beneficial to improve nurses′ comprehensive ability of clinical work, improve the level of specialized nursing, improve the quality of nursing service and promote the improvement of economic benefits, which is worthy of clinical promotion.

Application of mixed BOPPPS combined with case analysis teaching in nursing practice teaching in the department of endocrinology / 中华医学教育探索杂志

Objective:To explore the application of mixed BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, summary) combined with case analysis teaching in nursing practice teaching in the department of endocrinology.Methods:Forty-five nurses of Batch 2017 who practiced in the Department of Endocrinology were selected as the control group, using traditional teaching; 45 practical nursing students of Batch 2018 were selected as the research group, using mixed BOPPPS combined with case analysis teaching. After the teaching, the teaching effect was evaluated by the theoretical and practical skill operation assessments, and the satisfaction with the teaching was investigated through the questionnaire. SPSS 22.0 was used for t test and chi-square test. Results:The scores of basic theory [(28.31±2.07) vs. (24.66±2.15)] and professional theory [(67.01±3.05) vs. (55.62±3.20)] in the theoretical assessment of practical nurses in the research group were higher than those in the control group, with significant differences ( P<0.05); the scores of each sub-item of the practical skills operation assessment were better than those in the control group, with significant differences ( P<0.05); in terms of teaching satisfaction, the research group was better than the control group in such 10 aspects as whether to improve the level of theoretical and practical skills operation, whether to improve the awareness of humanistic care and whether to improve the nurse-patient communication ability, etc., with significant differences ( P<0.05). Conclusion:The BOPPPS combined with case analysis teaching significantly improves the theoretical and practical skills and comprehensive literacy of the endocrinology practical nursing students, and the teaching satisfaction is significantly better than that of the traditional teaching, which is of promotion value.

Apuntes para la historia de la Endocrinología en Camagüey / Notes for the history of Endocrinology in Camagüey

Introducción: En la década del 60 del pasado siglo, se inicia la atención especializada de Endocrinología en la provincia de Camagüey, Cuba. No existen evidencias documentales sobre esta temática en el territorio, por lo que puede afirmarse que es este un tema pendiente y necesario para la formación integral de los futuros especialistas. Objetivo: Describir la historia de la Endocrinología en la provincia de Camagüey, a partir de la labor de sus principales exponentes y los momentos más importantes de su desarrollo. Método: Investigación histórica basada en la investigación documental. Se utilizó el submétodo cronológico para establecer el orden de los hechos que se describen. Se hicieron entrevistas a personalidades que laboraron en la especialidad y se revisaron algunos artículos históricos publicados, así como documentos de la Biblioteca Provincial "Julio Antonio Mella." Resultados: Se pudo comprobar que antes de 1967 no existía atención endocrinológica especializada en la provincia y los pacientes con este tipo de afecciones eran atendidos fundamentalmente por especialistas en Medicina Interna. A inicios de 1967 llega a la provincia el primer especialista en Endocrinología, el Dr. Sergio Amaro Méndez. Este último, establece un servicio en esta especialidad y se inicia a partir de este momento un desarrollo acelerado en los aspectos docente, asistencial y científico. Conclusiones: La historia de la Endocrinología en Camagüey se inicia en 1967 y tiene su mayor esplendor durante el período de 1979-1990 con el inicio de las determinaciones hormonales por radioinmunoanálisis en la provincia y el inicio de la docencia médica de posgrado. El Grupo Provincial de Endocrinología se ha consolidado hasta alcanzar el prestigio nacional(AU)

Introduction: In the 1960s, specialized endocrinology care began in the province of Camagüey, Cuba. There is no documentary evidence on this topic in the territory, so it can be stated that this is a pending and necessary issue for the comprehensive training of future specialists. Objective: Describe the history of Endocrinology in the province and the most important moments of its development. Method: Historical research based on documentary research. The chronological sub-method was used to establish the order of the events that are described. Interviews were conducted to important people who worked in the specialty and some published historical articles were reviewed, as well as documents from ´´Julio Antonio Mella´´ Provincial Library. Results: It was found that before 1967 there was no specialized endocrinological care in the province and patients with these types of conditions were cared primarily by specialists in Internal Medicine. At the beginning of 1967, the first specialist in Endocrinology, Dr. Sergio Amaro Méndez, arrived to the province. He established a service in this specialty and from this moment on, an accelerated development in the teaching, healthcare and scientific aspects begins. Conclusions: The history of Endocrinology in Camagüey province begins in 1967 and has its greatest splendor during the period 1979-1990 with the beginning of hormonal determinations by radioimmunoassay in the province and the beginning of postgraduate medical teaching. The Provincial Group of Endocrinology has established itself as a group of national prestige(AU)

Choosing Wisely for Thyroid Conditions: Recommendations of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Objective: Choosing Wisely (CW) is an initiative that aims to advance the dialogue between physicians and patients about low-value health interventions. Given that thyroid conditions are frequent in clinical practice, we aimed to develop an evidence-based list of thyroid CW recommendations. Materials and methods: The Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) named a Task Force to conduct the initiative. The Task Force work was based on an electronic Delphi approach. The 10 recommendations that received the highest scores by the Task Force were submitted for voting by all SBEM associates. The 5 recommendations that received the highest scores by SBEM associates are presented herein. Results: The Task Force was composed of 14 thyroidologists from 10 tertiary-care, teaching-based Brazilian institutions. The brainstorming/ideation phase resulted in 69 recommendations. After the removal of duplicates and recommendations that did not adhere to the initiative's scope, 35 remained. Then the Task Force voted to attribute a grade (0 [lowest agreement] to 10 [highest agreement]) for each recommendation. The 10 recommendations that received the highest scores by the Task Force were submitted to all SBEM associates. A total of 683 associates voted electronically, attributing a grade (0 to 10) for each recommendation. The 5 recommendations that received the highest scores by the SBEM associates compose our final list. Conclusion: A set of recommendations to avoid unnecessary medical tests, treatments, or procedures for thyroid conditions are offered with a transparent methodology. This initiative aims to foster productive interactions between physicians and patients, stimulating shared decision-making.

Morphometry, topography and arterial supply of the thyroid gland in brazilian shorthair cat

Thyroid gland diseases are the most common endocrinopathies in feline practice. Diagnosis and surgical treatment must base on solid anatomical knowledge about the gland size, localization, and blood supply. However, some textbooks provide a general anatomical description of the thyroid gland of domestic carnivores. Thus, specific details of the feline gland are missing. The present study aimed to investigate the dimensions, topography, and arterial supply of the thyroid gland in Brazilian shorthair cats and, therefore, provide additional data to diagnose and treat feline thyroid diseases. Thirty Brazilian shorthair cats formalin-fixed cadavers (15 male and 15 female) were injected with red-stained latex solution by a canula in the thoracic aorta. The necropsy unit of the Rural Federal University of Rio de Janeiro donated the specimens. The study included only adult animals with no history of thyroid disease. After the fixation period, the cadavers were dissected to investigate the measurements (length, width at cranial and caudal poles, and thickness), topography, and in situ arterial supply of the thyroid lobes. The mean measurements of the length, cranial pole width, caudal pole width, and thickness in the right lobe were 19.39 ± 3.10 mm, 5.36 ± 1.40 mm, 3.67 ± 0.93 mm, and 1.30 ± 0.29 mm, respectively; and 20.29 ± 3.35 mm, 4.85 ± 1.58 mm, 3.88 ± 0.91 mm, 1.64 ± 0.65 mm in the left lobe, respectively. There were no statistical differences (P > 0.05) in the comparison of the measures between sexes or antimers (sides). Pearson's linear correlation detected a positive, moderate (r = 0.55), and significant (P < 0.05) correlation between the right and left lobe lengths. In 70% of the cats, both left and right lobes had the cranial poles located at the same level. Typically, the lobes extended between the first to the eighth tracheal ring. However, the cranial pole of some lobes located as cranially as the cricoid cartilage level, and the caudal pole as caudally as the 12th tracheal ring. Fifty-six percent of the cats had a ventrally located isthmus. In all the sampling, one single thyroid artery emerged as a branch of the common carotid artery and provided branches directly to the thyroid lobe, isthmus and the adjacent muscles and esophagus. Besides establishing average dimensions of normal thyroid lobes in Brazilian shorthair cats, this study detected no significant difference between the average measurements of right and left lobes. Also, a positive linear correlation between the length and width of the right and left lobes became evident. Therefore, the practitioner must consider suspicious any length asymmetry between right and left thyroid lobes until further endocrine test proves otherwise. Most of the cats had the right and left thyroid lobe positioned at the same transversal level; however, positional asymmetries are not uncommon. Unlike dogs, Brazilian shorthair cats have only a single artery to supply each lobe: the thyroid artery. In a feline thyroidectomy, the surgeon must avoid blindly ligating the thyroid artery since this vessel also provided numerous branches to adjacent muscles and esophagus. In a bilateral thyroidectomy, the ventral region between lobes should be thoroughly inspected for the common presence of an isthmus. Sometimes, the surgeon may need to extend the incision caudally beyond the 12th tracheal ring level to visualize the gland tissue entirely.(AU)

El cumpleaños de la endocrinología: una revisión histórica / The birthday of endocrinology: a historical review

En esta revisión histórica se establece que nuestra especialidad tiene una fecha fundacional precisa, ­el 1 de junio de 1889­ y que su padre fundador fue el excéntrico fisiólogo mauriciano Charles-Édouard Brown-Séquard, en quien se encuentran ancestros irlandeses, indios y franceses. El paradigma sustitutivo, pilar fundacional de la especialidad, fue enunciado esa noche por Brown-Séquard: los déficits de las secreciones internas de las glándulas desprovistas de conducto pueden remediarse administrando extractos de las glándulas homólogas de animales. Brown-Séquard es un reconocido padre de la neurología y el síndrome producido por la hemisección de la médula espinal lleva su nombre. Su aporte más genial, sin embargo, es la fundación de nuestra especialidad. Relatamos cómo un neurofisiólogo llegó a fundar nuestra especialidad, siguiendo una idea que nace de su demostración que las suprarrenales son esenciales para la vida (1856). Luego ­en Inglaterra-, adhirió erróneamente a un mito victoriano absurdo: los varones que se abstenían voluntariamente de eyacular reabsorbían principios testiculares desconocidos aún, que les proporcionaban grandes beneficios de salud. Finalmente, su experiencia personal con la andropausia lo lleva a inyectarse extractos acuosos de testículos de cuy y de perro, reportando una milagrosa mejoría frente a la comunidad científica francesa, que rechazó sus conclusiones y lo acusó de ser un "profesor senil". Dos años más tarde, en 1891 Murray en Inglaterra curó a una mujer mixedematosa con extractos acuosos de tiroides de oveja, validando así la órgano-terapia. Treinta años más tarde ­en 1921­, Banting y Best en Toronto, aislaron la insulina y se inició la era insulínica en la diabetes. En 1923 este trabajo fue premiado con el Premio Nobel de Medicina. Si bien es cierto que los extractos testiculares de Brown-Séquard parecen no haber tenido testosterona, la maravillosa intuición de Brown-Séquard le permitió la enunciación del paradigma fundacional de la especialidad.

In this historical review, the precise birthdate of our specialty is remembered (June 1, 1889) and the figure of its founding father, the eccentric Mauritian physiologist, Dr. Charles-Édouard Brown-Séquard ­who had Irish, Indian, and French ancestors­, is highlighted. The substitutive paradigm, the foundational pillar of our specialty, was enunciated that night by Brown-Séquard: deficits in internal secretions from the ductless glands may be remediated by administering extracts from homologous animal glands. Brown-Séquard is one of the acknowledged fathers in the field of Neurology, and the syndrome produced by the hemisection of the spinalcord bears his name. However, his most genial achievement is the foundation of Endocrinology. We disclose how a neurophysiologist became the founding father of our specialty. Firstly, he demonstrated that the adrenal glands are essential to sustain life (1856). Later on, while working in London, he mistakenly accepted an absurd Victorian myth: disciplinary men who voluntarily refrained from ejaculation in any form resorbed testicular principles ­unknown by then­, endowing them with great health benefits. As he aged, he had a personal encounter with andropause and decided to inject himself with testicular aqueous extracts from animals. On June 1, 1889, Brown-Séquard reported his miraculous health improvements to the French Biology Society. The audience rejected his conclusions and accused him of being a "senile Professor". However, just two years after this episode, G. Murray in England reported the cure of a myxedematous woman with injections of aqueous extracts from sheep thyroids. Thirty years later, in1921, Banting and Best in Toronto isolated insulin and started the insulin era in diabetes therapy. In 1923 their work was awarded the Nobel Prize in Medicine. Even though the testicular aqueous extracts used by Brown-Séquard were probably devoid of testosterone, his marvelous imagination allowed him to enunciate the foundational paradigm of our specialty.