ABSTRACT

Introducción: la atención de mujeres con diabetes mellitus gestacional (DMG) demanda un modelo de atención que considere la interacción de factores biológicos, psicológicos y sociales sobre los cuales faltan conocimientos. Objetivos: conocer cuáles son las emociones y el nivel de ansiedad que desencadena el diagnóstico de DMG, y analizar cuáles son las variables psicosociales que influyen en el tratamiento. Materiales y métodos: estudio piloto, descriptivo y analítico de corte transversal, que incluyó 23 mujeres con diagnóstico de DMG que asistieron a un Servicio de Endocrinología y Diabetes de alta complejidad. Se realizó una entrevista semiestructurada que indagó acerca de los factores de riesgo biopsicosociales (edad, nivel educativo, situación laboral, ayuda social y económica). Se empleó la versión Argentina del Inventario de Ansiedad de Beck (Beck anxiety inventory, BAI) modificado para clasificar en grados la detección de los síntomas de ansiedad (mínima, leve, moderada y grave). El protocolo de investigación y el consentimiento informado fueron aprobados por el Comité de Ética e Investigación. Se utilizó el software estadístico InfoStat (UNC). Las variables categóricas se expresaron como número y porcentaje, y para medir el grado de asociación entre las variables nominales se empleó la prueba chi-cuadrado y el coeficiente de contingencia de Cramer. Se consideró diferencia significativa un valor de p<0,05. Resultados: en el 35% de los casos, la edad fue de ≥30 años, el 87% cursaba por primera vez DMG y el 78% no tenía in-formación sobre la patología. Predominó el nivel secundario incompleto. Al recibir el diagnóstico, el 70% refirió emociones de alto grado de intensidad que continuaban. Según el BAI, se detectó que el 30% tenía ansiedad mínima, el 26% leve, el 22% moderada y el 13% grave. Las variables que dificultaron el cumplimiento del tratamiento fueron la socioeconómica (60,86%; χ²=7,89; p=0,01) y la falta de empleo (70%; χ²=7,81; p=0,02). Solicitó apoyo psicológico un bajo número de mujeres que pre-sentaba emociones intensas. El 96% indicó que su red de afrontamiento era la familia. Conclusiones: el afrontamiento del diagnóstico de la DMG provoca emociones y síntomas de ansiedad que se agravan por factores socioeconómicos y que generan dificultades para cumplir con el tratamiento.

Introduction: the care of women with gestational diabetes (GD) demands an attention model that considers the interaction of biological, psychological and social factors, about which knowledge is lacking. Objectives: to know what emotions and level of anxiety trig-ger the diagnosis of GD, and to analyze what psychosocial var-iables influence treatment. Materials and methods: preliminary, descriptive and analytical cross-sectional study in 23 women who were diagnosed with GD and attended a highly complex Endocrinology and Diabetes Service. A semi-structured interview was conducted that inquired about biopsychosocial risk factors (age, educational level, employment status, social and economic assistance). The Argentine version of the modified Beck Anxiety Inventory (BAI) was used to classify the detection of anxiety symptoms into degrees (minimal, mild, moderate and severe). The research protocol and informed consent were approved by the Ethics and Research Committee. InfoStat (UNC) statistical software was used. Categorical variables were expressed as number and percentage and to measure the degree of association between nominal variables, the Chi-square test and Cramer's contingency coefficient were used. A value of p<0.05 was considered significant differences. Results: in 35% the age was ≥30 years, 87% were undergoing GD for the first time and 78% had no information about the pathology. The incomplete secondary level predominated. Upon receiving the diagnosis, 70% reported emotions of a high degree of intensity that continued. According to the BAI, it was detected that 30% had minimal anxiety, 26% mild, 22% moderate, and 13% severe. The variables that made treatment compliance difficult were socioeconomic (60.86%; χ²=7.89; p=0.01) and lack of employment (70%; χ²=7.81; p=0.02). A small number of women who presented intense emotions requested psychological support. 96% indicated that their coping network was the family. Conclusions: coping with the diagnosis of GD generates emotions and anxiety symptoms that are aggravated by socioeconomic factors that these patients have and generate difficulties in complying with treatment.

ABSTRACT

Objective: To determine the epidemiological profile of patients with type 2 diabetes mellitus in a teaching unit. Method: In this observational, cross-sectional, and descriptive study, data from the medical records of consultations conducted between February 2020 and May 2022 at an endocrinology outpatient clinic in a teaching unit in Northeast Brazil were evaluated. A descriptive analysis of the data was performed, with percentage values, medians, and interquartile ranges (IQRs) reported. Result: Data were collected from the medical records of 118 patients, and the medical records of 95 patients were used for statistical analysis after the exclusion of records with insufficient data. Seventy patients (73.6%) were female, with a median age of 57 years (IQR 51.5-65), a median body mass index (BMI) of 28.9 kg/m2 (IQR 25.7-33.1) and a median age at diagnosis of 47.5 years (IQR 38-55). The median glycated hemoglobin (HbA1c) and fasting blood glucose levels during follow-up were 7.6% (IQR 6.6-9.7) and 132.8 mg/dL (IQR 113.5-201.7), respectively, and only 36.8% (n=35) of patients were within their HbA1C therapeutic target range. Approximately 73.6% (n=70) of the patients used statins, but only 18 (18.9%) had LDL-c within their therapeutic target range. Twenty-seven patients (28.4%) had kidney dysfunction, either albuminuria or a glomerular filtration rate (GFR) reduction, and 6 of them (22.2%) did not use any nephroprotective medication. Fewer than half of the patients underwent fundoscopy, and 32.5% of them showed some degree of retinopathy. Neuropathy was present in 33 patients (34.7%), with 3 patients (3.16%) presenting with amputations. Conclusion: Adequate glycemic control was achieved in just under half of the patients, and a relevant proportion of patients experienced microvascular complications. Strategies for the early detection of complications and more aggressive treatment of the disease and its comorbidities are necessary

Objetivo: Traçar o perfil epidemiológico de pacientes com Diabetes Tipo 2 de uma unidade docente-assistencial. Método: Estudo observacional, transversal e descritivo com dados de prontuário de consultas realizadas entre fevereiro de 2020 e maio de 2022 no ambulatório de endocrinologia de uma unidade docente-assistencial no nordeste brasileiro. Procedeu-se à análise descritiva dos dados, sendo informados os valores percentuais, mediana e intervalo interquartil. Resultado: De um total de 118 prontuários, foram analisados 95 pacientes após a exclusão daqueles com dados insuficientes. Destes, 73,6% (n=70) são do sexo feminino, com idade mediana de 57 anos (IIQ 51,5-65), mediana do IMC 28,9kg/m2 (IIQ 25,7-33,1) e idade ao diagnóstico de 47,5 anos (IIQ 38-55). As medianas da última HbA1C e glicemia em jejum foram 7,6% (IIQ 6,6-9,7) e 132,8 mg/dL (IIQ 113,5- 201,7), e apenas 36,8% (n=35) foram classificados como dentro da meta pela HbA1C. Cerca de 73,6% (n=70) dos pacientes utilizavam estatinas, mas somente 18 (18,9%) tinham LDL-c dentro da meta terapêutica. Vinte e sete pacientes (28,4%) apresentavam disfunção renal, seja albuminúria e/ou redução da TFG, e 6 (22,2%) não usavam nenhuma medicação nefroprotetora. Menos da metade dos pacientes realizou fundoscopia, e, destes, 32,5% apresentavam algum grau de retinopatia. Neuropatia está presente em 33 pacientes (34,7%), com 3 pacientes (3,16%) apresentando amputações. Conclusão: O controle glicêmico adequado foi obtido em pouco menos da metade dos pacientes e uma proporção relevante apresenta complicações microvasculares. Estratégias de detecção precoce de complicações e de tratamento mais agressivo da doença e suas comorbidades são necessárias

ABSTRACT

Introdução: A Displasia septo-óptica (DSO) é uma condição clínica relativamente rara, com uma prevalência de 1:10.000 a 20.000 nascidos vivos. O seu diagnóstico é clínico, sendo realizado quando há pelo menos 2 dos componentes da tríade clássica: hipoplasia de nervo óptico (HNO), malformação de linha média e disfunções hipofisárias. Até 70% dos pacientes com DSO podem apresentar deficiências hormonais. Apesar de relativamente rara, tem-se observado um aumento significativo da sua incidência ao longo dos anos, de maneira que cada vez mais estudos estão sendo elaborados para melhor entendimento de sua fisiopatologia. Estima-se uma maior prevalência de obesidade na síndrome, justificada pelos defeitos hipotalâmicos que podem levar a alterações metabólicas como hiperfagia e alterações de sensibilidade da leptina, favorecendo o ganho ponderal. Além disso, as deficiências hormonais hipofisárias, como a deficiência do hormônio de crescimento (GH), também contribuem para agravar o quadro. Objetivos: Avaliar o perfil metabólico, por meio da análise clínica, laboratorial e de bioimpedância elétrica (BIA) dos pacientes com DSO acompanhados no ambulatório de endocrinologia do IPPMG-UFRJ. Metodologia: Estudo transversal descritivo de coorte de pacientes com DSO acompanhados no ambulatório de endocrinologia do IPPMG-UFRJ. Resultados: Foram encontrados 48 indivíduos com DSO (50% do sexo feminino), sendo 28 com seguimento regular. As idades médias de diagnóstico e de encaminhamento ao ambulatório de endocrinologia foram de 3,90 ± 3,85 anos e 3,15 ± 3,30 anos, respectivamente, e a idade média atual daqueles que mantém acompanhamento foi de 7,46 ± 4,83 anos. A idade materna era ≤ 25 anos no momento do parto em 64% (25/39), sendo 44,44% (n=20/45) delas primigestas. Quanto aos critérios diagnósticos da DSO, em 92,6% (N=38/41) foi identificada HNO (78,9% bilateralmente); 95,3% (N=41/43) apresentaram alterações estruturais de linha média em exame de neuroimagem, 85,7% (N=24/28) alterações estruturais de sela túrcica e 73% apresentaram pelo menos uma deficiência hormonal, dos quais 2/3 apresentaram múltiplas disfunções hipofisárias. A disfunção mais frequente foi do hormônio tireotrófico (TSH), seguida pela de GH e hormônio adrenocorticotrófico (ACTH). Foram encontradas as medianas de valores de glicemia, colesterol total, LDL, HDL e triglicerídeos de 77 mg/dL,187 mg/dL, 112,7 mg/dL, 48 mg/dL e 107 mg/dL, respectivamente. Na avaliação da bioimpedância (BIA), foi encontrada uma mediana de 18,7% para massa gorda e uma mediana de 81,3% para massa magra. Na avaliação da distribuição da massa magra entre massa óssea e massa muscular, foi encontrada uma mediana de 4,3% e uma mediana de 28,4%, respectivamente. Dez participantes apresentaram percentual de massa óssea baixo e 9 participantes apresentaram percentual de massa muscular baixo. Onze participantes apresentaram pelo menos 1 destes percentuais abaixo dos valores de referência. Conclusão: Mais de 1/3 dos pacientes apresentava os 3 critérios da tríade clássica de DSO e 2/3 disfunções hipofisárias. Não houve alterações significativas de glicemia, TGO, TGP. A dislipidemia se mostrou presente na maioria dos pacientes, com mais da metade com LDL elevado e quase 2/3 com hipertrigliceridemia. A maioria dos pacientes foi classificada como eutrófica pelo índice de massa corporal (IMC), no entanto » apresentou percentual elevado de massa gorda e quase 80% percentual de massa magra baixo, sendo ¾ com baixo percentual de massa óssea. Recomendase que a BIA não seja substituída pela avaliação do IMC nos pacientes com DSO.(AU)

Background: Septo-optic dysplasia (SOD) is a rare clinical condition, with a prevalence of 1:10,000 to 20,000 live births. Its diagnosis is clinical, being made when there are at least 2 of the components of the classic triad: optic nerve hypoplasia (ONH), midline malformation and pituitary dysfunction. Up to 70% of patients with SOD may experience hormonal deficiencies. Despite being rare, a significant increase in its incidence has been observed over the years, so that more and more studies are being carried out to better understand its pathophysiology. A higher prevalence of obesity in the syndrome is estimated, justified by hypothalamic defects that can lead to metabolic changes such as hyperphagia and changes in leptin sensitivity, favoring weight gain. Furthermore, pituitary hormonal deficiencies, such as growth hormone (GH) deficiency, also contribute to aggravating the condition. Objective: To evaluate the metabolic profile, through clinical, laboratory and bioelectral impedance (BIA) analysis of cohort of patients with SOD followed at the endocrinology outpatient clinic at IPPMG-UFRJ. Methodology: Descriptive study of cohort of patients with SOD followed at the endocrinology outpatient clinic at IPPMG-UFRJ. Results: 48 individuals with SOD were found (50% female), 28 of whom had regular follow-up. The average ages at diagnosis and referral to the endocrinology outpatient clinic were 3.90 ± 3.85 years and 3.15 ± 3.30 years, respectively, and the current average age of those who maintain follow-up was 7.46 ± 4 .83 years. Maternal age was ≤ 25 years at the time of birth in 64% (25/39), with 44.44% (n=20/45) of them being primiparous. Regarding the diagnostic criteria for SOD, ONH was identified in 92.6% (N=38/41), 78.9% bilaterally; 95.3% (N=41/43) had midline structural changes on neuroimaging examination, 85.7% (N=24/28) had structural changes in the sella turcica and 73% had at least one hormonal deficiency, of which 2/3 had multiple pituitary dysfunctions. The most frequent dysfunction was thyrotropic hormone (TSH), followed by GH and adrenocorticotropic hormone (ACTH). A median of blood glucose level, cholesterol, LDL, HDL and triglycerides of 77 mg/dL, 187 mg/dL, 112.7 mg/dL, 48 mg/dL and 107 mg/dL were found, respectively. In the BIA assesment, a median of 18.7% was found for fat mass and a median of 81.3% for lean mass. When evaluating the distribution of lean mass between bone mass and muscle mass, a median of 4.3% and 28.4% were found, respectively. Ten participants had a low bone mass percentage, and 9 participants had a low muscle mass percentage. Eleven participants presented at least one of these percentages below the reference values. Conclusion: More than 1/3 of the patients presented the classic triad criteria of SOD and 2/3 had pituitary dysfunction. There were no significant changes in blood glucose, TGO, TGP. Dyslipidemia was present in most patients, with more than half having elevated LDL and almost 2/3 having hypertriglyceridemia. Most patients were classified as eutrophic based on body mass index (BMI), however » had a high percentage of fat mass and almost 80% a low percentage of lean mass, with ¾ having a low percentage of bone mass. We recommended that BIA not be replaced by BMI assessment in patients with SOD.(AU)

ABSTRACT

Introducción: El síndrome de Marine-Lenhart es una afección benigna, definida por la coexistencia de nódulos tiroideos funcionales benignos en un paciente con enfermedad de Graves. Objetivo: Caracterizar los pacientes con síndrome de Marine-Lenhart en la consulta de endocrinología del área de salud Pedro Díaz Coello en Holguín. Métodos: Se realizó un estudio descriptivo retrospectivo, en el área de salud Pedro Díaz Coello en Holguín, tomando como muestra todos los pacientes con diagnóstico de enfermedad de Graves-Basedow, en el período comprendido de enero del 2019 a diciembre del mismo año. La muestra quedó conformada por 34 pacientes. Para el procesamiento estadístico se utilizó el paquete estadístico SPSS versión 25,0, se determinó el número y el porcentaje de las variables en estudio. Resultados: El grupo de edad que predominó fue el de 19 a 39 años, el sexo masculino fue el que más presencia tuvo y el color de piel blanca. Los nódulos mixtos fueron los que más predominaron, de esta manera también se encontró que en su mayoría fueron negativos, con captación de Iodo131. Cuatro pacientes cumplieron con los criterios diagnósticos empleados en el estudio, en los que predominó el sexo femenino y la presencia de nódulos mixtos. Conclusiones: En el síndrome de Marine-Lenhart se debe pensar en el diagnóstico del estado de salud del paciente y no verla como algo raro o difícil(AU)

Introduction: Marine-Lenhart syndrome is a benign condition, defined by the coexistence of benign functional thyroid nodules in a patient with Graves' disease. Objective: To characterize patients with Marine-Lenhart syndrome in the endocrinology consultation of the Pedro Díaz Coello health area in Holguín. Methods: A retrospective and descriptive study was carried out in the Pedro Díaz Coello health area in Holguín, taking as a sample all patients with a diagnosis of Graves-Basedow disease, in the period from January to December 2019. The sample was made up of 34 patients. For statistical processing, the statistical package SPSS (version 25.0) was used. The number and percentage of the variables under study were determined. Results: The predominant age group was 19 to 39 years old, the male sex was the most present, and the most represented skin color was white. Mixed nodules were the most predominant; thus, it was also found that the majority of them were negative, with iodine uptake131. Four patients met the diagnostic criteria used in the study, among which the female sex and the presence of mixed nodules predominated. Conclusions: In Marine-Lenhart syndrome, one should think about the diagnosis of the patient's health status instead of seeing it as something strange or difficult(AU)

ABSTRACT

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).

ABSTRACT

Introduction: Acromegaly is a rare endocrine disorder, presenting with orofacial mani-festations during its early stages. Timely diagnosis is often not made as these symptoms overlap with other oral diseases. Objective: The objective of this case report is to describe an unusual detection of acromegaly in a dental setting and to provide a checklist for referral upon suspicion of acromegaly. Materials and Methods: This case report describes the orofacial presentation and management of a 44-year-old Chinese man, initially referred for periodontal management. He presented with Localised stage II Grade A periodontitis, class III malocclusion, mandibular prognathism, and large mandibular interproximal gaps. Results: A provisional diagnosis of acromegaly was made, and the patient was referred to the Department of Endocrinology. Conclusion: Dental practitioners can pick up patients with undetected acromegaly with early orofacial changes during routine dental visits according to a simple proposed checklist. (AU)

ABSTRACT

Introducción: Autoconcepto es el conjunto de ideas y actitudes que se tiene acerca de sí mismo, construida en la interacción del individuo con el entorno a lo largo del tiempo, lo que pudiera verse modificado por la situación de enfermedad crónica. Objetivo: describir el nivel de autoconcepto de pacientes pediátricos diabéticos tipo 1 (DM1), atendidos en el servicio de endocrinología del hospital universitario de los Andes para el año 2021. Metodología: estudio de carácter comparativo, transversal, analítico, tipo caso control. La muestra de estudio estuvo conformada por 12 niños con DM1 y 37 sin DM1, características demográficas pareadas y tomados la población general. Se utilizó cuestionario de Pier-Harris. Resultados: población con DM1 fue 57,1% femeninos, 59,2% mayores de 10 años. No se observaron diferencias entre el autoconcepto de ambos grupos. El autoconcepto en las dimensiones: falta de ansiedad (p=0,025), felicidad-satisfacción (p=0,026), autoconcepto global (p=0,042) tuvieron un valor de la media y desviación estándar mayor en el grupo de 10 años o menos. El porcentaje de autoconcepto saludable en los sujetos con DM1 fue del 100% para dimensión felicidadsatisfacción, 97,1% en dimensión física y global, 75% falta de ansiedad, popularidad e intelectual y en la conductual 58,3%. Conclusiones: en el estudio no se observaron diferencias estadísticas en el autoconcepto entre los niños con y sin DM1, lo que pudiera corresponder a un cambio de paradigmas en la atención de las enfermedades crónicas con mayor preocupación en los procesos psicosociales y la resiliencia(AU)

Introduction: self-concept is the set of ideas and attitudes that one has about oneself, built in the interaction of the individual with the environment over time, which could be modified by the situation of chronic disease Objective: To describe the level of self-concept of type 1 diabetic pediatric patients (DM1), treated at the endocrinology service of the Los Andes university hospital for the year 2021. Methodology: comparative, cross-sectional, analytical, case-control study. the study sample consisted of 12 children with DM1 and 37 without DM1, matched demographic characteristics and taken from the general population. Pier-harris Questionnaire was used. results: population with dM1 was 57.1% female, 59.2% older than 10 years. no differences were observed between the self-concept of both groups. the self-concept in the dimensions: lack of anxiety (p=0.025), happiness-satisfaction (p=0.026), global self-concept (p=0.042) had a higher mean value and standard deviation in the group of 10 years or less. the percentage of healthy self-concept in subjects with dM1 was 100% for the happiness-satisfaction dimension, 97.1% in the physical and global dimension, 75% lack of anxiety, popularity and intellectual, and 58.3% in the behavioral dimension. Conclusions: In the study, no statistical differences were observed in selfconcept between children with and without dM1, which could correspond to a paradigm shift in the care of chronic diseases with greater concern in psychosocial processes and resilience(AU)

ABSTRACT

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)

ABSTRACT

La diabetes mellitus es una enfermedad metabólica caracterizada por hiperglucemia, a consecuencia de defectos en la producción, secreción y/o acción de la insulina, produciendo alteraciones en el metabolismo de los hidratos de carbono, lípidos y proteínas; asociado a un proceso inflamatorio crónica en un plazo variable, que provocara lesiones macro y microvasculares. Objetivo: Evaluar los niveles séricos de interleucina-6 (IL-6) en pacientes diabéticos tipo 2 y su correlación con el perfil lipídico. Métodos: Se realizó estudio descriptivo analítico y transversal, comprendido por 60 adultos de ambos sexos entre 30 a 60 años, con diabetes mellitus tipo 2 que acudieron a consulta de Endocrinología del Hospital Militar Universitario Dr. Carlos Arvelo. Se les determino glucemia basal, interleucina-6, perfil lipídico, resultados relacionados con parámetros antropométricos, composición corporal, la edad y tiempo de evolución de la diabetes. Resultados: La edad promedio de 51,60 años ± 6,51, donde el 71,6% correspondieron al sexo femenino y el 28,3% al masculino, tiempo de evolución de la diabetes entre 1 mes y 37 años, con un promedio de 10,97 años. Se presentó correlación positiva baja y estadísticamente significativa entre interleucina 6 y los parámetros de triglicéridos, VLDL y no-HDL Conclusión: Se encontró valores elevados de IL-6 en todos los pacientes diabéticos tipo 2, así como una correlación positiva entre IL-6 y las lipoproteínas ricas en triglicéridos. Esto respalda la idea de que la hipertrigliceridemia puede causar cambios inflamatorios en pacientes diabéticos y esto elevaría el riesgo cardiovascular de estos pacientes(AU)

ABSTRACT

Prólogo. La obra recopiló los hitos históricos, las acciones en gestión y la visión futura de las Unidades Médicas, Administrativas y de Enfermería, en homenaje a los 50 años de función del Hospital de Especialidades Carlos Andrade Marín como ícono de la Seguridad Social del Ecuador, entre el periodo 1970 a diciembre 2020. Cada autor registró el título entrelazado un pensamiento, previo a la cronología de los hechos suscitados en los servicios brindados en beneficio de los pacientes que se atendieron en esta casa de salud. La obra se clasificó en capítulos por Unidades Médicas: Críticas, Clínicas, Quirúrgicas, Administrativas y de Enfermería, se incluyeron tablas, figuras, producción médica, patologías, cambios de técnicas o procedimientos y sustentó su accionar con citas textuales y referen-cias bibliográficas. Además, se narraron mejoras continuas transmitidas de los ilustres y legados maestros, especialistas médicos por varias generaciones, en conjunto con el personal de salud con vocación de servicio, en una reflexión profunda con mensajes vivos de su accionar. En las modalidades de publicación se realizaron aportes de visión nacional e internacional en los ámbitos asistenciales, administrativos, docente, de investigación y producción científica de alto nivel del contexto y naturaleza del emblemático hospital. Finalmente, se agradece a los funcionarios y ex trabajadores que colaboraron durante el proceso de construcción de la obra, así como a ex colaboradores que motivaron aportes de experiencias y la apreciación personal.

Prologue. The work compiled the historical milestones, management actions and future vision of the Medical, Administrative and Nursing Units, in tribute to the 50 years of function of the Carlos Andrade Marin Specialty Hospital as an icon of the Social Security of Ecuador, between 1970 and December 2020. Each author recorded the title intertwined with a thought, prior to the chronology of the events that took place in the services provided for the benefit of patients who were treated in this health center. The work was classified in chapters by Medical Units: Critical, Clinical, Surgical, Administrative and Nursing, and included tables, figures, medical production, pathologies, changes in techniques or procedures, and supported his actions with textual quotations and bibliographical references. In addition, continuous improvements were narrated and transmitted from the illustrious and legacy masters, medical specialists for several generations, together with the health personnel with vocation of service, in a deep reflection with living messages of their actions. In the publication modalities, contributions of national and international vision were made in the care, administrative, teaching, research and scientific production of high level of the context and nature of the emblematic hospital. Finally, we would like to thank the employees and former workers who collaborated during the construction process, as well as former collaborators who contributed with their experiences and personal appreciation.

ABSTRACT

ABSTRACT Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.

ABSTRACT

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.

ABSTRACT

RESUMO Objetivo: Descrever os cuidados com o uso de insulinas disponibilizadas pelo SUS e analisar os fatores associados aos cuidados inadequados. Método: Estudo transversal com 113 pessoas com Diabetes Mellitus de um ambulatório de Goiânia-GO. Foram coletados dados em prontuários sobre conservação, preparo e administração de insulina que foram classificados em adequados e inadequados. Resultados: Do total de participantes,58,4% eram mulheres e a média de idade foi 48 anos. Hipertensão arterial foi relatada por 70,8% e 89,0% apresentaram hemoglobina glicada ≥7%. A totalidade dos usuários de insulina realizavam pelo menos um tipo de cuidado inadequado e 62,8% realizavam quatro ou mais. Os mais frequentes foram:conservarem locais não recomendados (46,7%), não aplicar insulina 30 minutos antes da refeição (87,5%), não avaliar presença de grumos no frasco de insulina NPH (71,9%) e não retirar a insulina da geladeira entre 15 e 30 minutos antes da aplicação (88,7%). Não houve diferença estatisticamente significante com as variáveis de exposição analisadas, porém a maior proporção de quatro ou mais cuidados inadequados ocorreu nas mulheres, nos jovens, naqueles com 11 ou mais anos de estudo, tempo de doença superior a 10 anos e, entre os que aplicam insulina uma ou duas vezes ao dia. Conclusão: Houve alta prevalência de cuidados inadequados e grande variabilidade de práticas, reforçando a importância da implementação da linha de cuidados em Diabetes Mellitus em todos os níveis de atenção à saúde.

RESUMEN Objetivo: describirlos cuidados con el uso de insulinas proporcionados por el Sistema Único de Salud (SUS) y analizar los factores asociados a los cuidados inadecuados. Método: estudio transversal con 113 personas con Diabetes Mellitus de un ambulatorio de Goiânia-GO-Brasil. Fueron recolectados datos en registros médicos sobre conservación, preparación y administración de insulina que fueron clasificados en adecuados e inadecuados. Resultados: del total de participantes, 58,4% era mujeres y el promedio de edad fue 48 años. La hipertensión arterial fue relatada por 70,8%;y 89,0% presentaron hemoglobina glicada ≥7%. La totalidad de los usuarios de insulina realizaban por lo menos un tipo de cuidado inadecuado y 62,8% realizaban cuatro o más. Los más frecuentes fueron: conservar en locales no recomendables (46,7%), no aplicar insulina 30 minutos antes de la comida (87,5%), no evaluar presencia de grumos en el envase de insulina NPH (71,9%) y no sacar la insulina de la heladera entre 15 y 30 minutos antes de la aplicación (88,7%). No hubo diferencia estadísticamente significante con las variables de exposición analizadas, perola mayor proporción de cuatro o más cuidados inadecuados ocurrió entre las mujeres, en los jóvenes, en aquellos con 11 o más años de estudio, tiempo de enfermedad superior a 10 años y, entre los que aplican insulina una o dos veces al día. Conclusión: hubo alta prevalencia de cuidados inadecuados y gran variabilidad de prácticas, reforzando la importancia de la implementación de la línea de cuidados en Diabetes Mellitus en todos los niveles de atención a la salud.

ABSTRACT Objective: To describe management practices of insulin provided by the SUS and analyze the factors associated with insulin management mistakes. Method: Cross-sectional study addressing 113 individuals with Diabetes Mellitus from an outpatient clinic in Goiânia, GO, Brazil. Data concerning insulin storage, preparation, and administration were collected from the patients' medical records and classified as appropriate or inappropriate. Results: 58.4% of participants were women aged 48 years old on average. Hypertension was reported by 70.8%, and glycated hemoglobin was ≥7% in 89.0%. All the patients made at least one insulin management mistake, and 62.8% made four or more mistakes. The most frequent mistakes were: storing insulin in non-recommended places (46.7%), not injecting insulin 30 minutes before meals (87.5%), not checking for the presence of lumps in the NPH insulin vial (71.9%), and not removing the insulin from the refrigerator between 15 and 30 minutes before injection (88.7%). No significant statistical differences were found among the exposure variables, though women, young individuals, those with 11 or more years of schooling, having the disease for more than ten years, and injecting insulin once or twice a day, more frequently made four or more management mistakes. Conclusion: A high prevalence of insulin management mistakes and considerable variability of practices were identified, reinforcing the importance of implementing a DM line of care at all healthcare system levels.

ABSTRACT

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.

ABSTRACT

As grandes filas de espera para atendimento nos consultórios de especialistas são uma realidade no país. As deficiências na coordenação do fluxo de pacientes entre os níveis de atenção contribuem para esse problema. Esse estudo busca avaliar e quantificar a necessidade dos encaminhamentos da atenção primária à saúde para o ambulatório de endocrinologia do serviço de referência. Foram analisados prontuários de pacientes atendidos no serviço de endocrinologia do Hospital Cruz Vermelha Brasileira - Curitiba, entre 2016 e 2018. Trata-se de um estudo descritivo retrospectivo. Os dados evidenciaram uma prevalência de encaminhamentos inadequados, variando de acordo com a comorbidade que motivou a consulta, variando de 90,2% de inadequação no hipotireoidismo e 0% no hipertireoidismo. A taxa de encaminhamentos inadequados foi elevada, indicando a necessidade de melhorar a resolutividade da atenção primária e a organização do fluxo de encaminhamento de pacientes entre os níveis de atenção do Sistema Único de Saúde

The long waiting lines for specialist medical appointments are a reality in the country. Deficiencies in coordinating patient flux between care levels contribute to this problem. This study aims to evaluate and quantify the need for referrals from primary health care to an endocrinology clinic of the reference service. Medical records of patients seen at the endocrinology service of Hospital Cruz Vermelha Brasileira - Curitiba, between 2016 and 2018, were analyzed. This is a retrospective descriptive study. The data showed a prevalence of inadequate referrals, varying according to the comorbidity that motivated the appointment, ranging from 90.2% of inadequacy in hypothyroidism and 0% in hyperthyroidism. In endocrinologic appointments, inadequate referrals' rates were high, indicating a need for larger resolution from primary care services and a better organized referral flux of patients between Unified Health System's levels of care

ABSTRACT

Las enfermedades han sido representadas en el arte desde tiempos remotos. Las obras pictóricas muchas veces nos muestran trastornos que aún no se constituían como una entidad. Observar estos cuadros a la luz de la historia de las enfermedades nos da una perspectiva enriquecedora que nos ayuda a entender mejor dichas patologías. Se comenta un caso clínico endocrinológico pediátrico, la historia probable y su descripción física. Se revisa la historia de cómo se llegó a dilucidar la enfermedad y las claves de su tratamiento.

Diseases have been represented in art since ancient times. Paintings often show us disorders that had not yet been described as a pathological entity. Looking at these pictures in the light of the history of the diseases gives us an enriching perspective that helps us to better understand those pathologies. On this background a pediatric endocrinological clinical case, the most probable history and the features of the physical examination are discussed. The history of how the disease was uncovered and the keys of its treatment are reviewed.

ABSTRACT

Introducción: El estudio del comportamiento de la producción científica es clave para diagnosticar el estado de los centros de investigaciones. Objetivos: Analizar la producción científica de los investigadores del Instituto de Endocrinología indizada en la base de datos SciELO Cuba /2014-2018. Métodos: Estudio cuantitativo, descriptivo y transversal que incluyó todas las publicaciones de los investigadores del Instituto de Endocrinología durante el período 2014-2018 indizadas en SciELO Cuba. Se describió el comportamiento de la producción y colaboración científica mediante indicadores bibliométricos. Resultados: Se confirmó que la producción científica de los investigadores de la institución estuvo presente en 12 revistas especializadas indizadas en la base de datos SciELO Cuba. La autoría múltiple y el artículo original predominaron en la tipología de autoría y en la forma de salida en la muestra de artículos analizados. En la colaboración científica la Doctora Emma Domínguez Alonso fue la autora con mayor grado nodal y la Doctora Daysi Antonia Navarro Despaigne la de mayor grado de intermediación. El Instituto de Endocrinología (INEN) fue la institución que registró mayores niveles de colaboración y mayor grado nodal. La palabra clave con mayor representatividad fue diabetes mellitus. En la productividad por tipología de colaboración predominó la nacional y el año más productivo resultó el 2017(AU)

Introduction: The study of scientific production´s behavior is key for diagnosing the state of research centers. Objectives: Analyze the scientific production of researchers from the Institute of Endocrinology which is indexed in SciELO Cuba /2014-2018 database. Methods: Quantitative, descriptive and cross-sectional non-experimental design study that included all publications of researchers of the Institute of Endocrinology during the period 2014-2018 indexed in SciELO Cuba. The behaviour of scientific production and collaborations was described using bibliometric indicators. Results: It was confirmed that the scientific production of the institution's researchers was present in 12 specialized journals indexed in SciELO Cuba database. Multiple authorship and the original articles predominated in the type of authorship and in the output form in the sample of analyzed articles. In the scientific collaborations, Dr. Emma Dominguez Alonso was the author with the highest nodal degree and Dr. Daysi Antonia Navarro Despaigne had the highest degree of intermediation. The Institute of Endocrinology (INEN, by its acronym in Spanish) was the institution that recorded higher levels of collaborations and higher nodal degree. The most representative keyword was diabetes mellitus. National collaborations predominated in productivity by typology of collaboration, and the most productive year turned out to be 2017(AU)

ABSTRACT

A fines de diciembre de 2019, la OMS fue notificada de un grupo inusual de casos de neumonía en Wuhan, China. La enfermedad, más tarde denominada COVID-19, se propagó rápidamente más allá de las fronteras de China, y los primeros casos en Europa se registraron el 25 de enero de 2020. (1) Investigaciones posteriores identificaron un nuevo beta-coronavirus ahora designado como coronavirus 2 del síndrome respiratorio agudo severo (SARS- CoV-2)(2). Actualmente, no hay opciones de tratamiento antiviral con eficacia comprobada, pero varios ensayos controlados aleatorios están investigando agentes como la hidroxicloroquina, lopinavir-ritonavir, favipiravir y remdesivir. Hasta la fecha, los datos sobre COVID-19 en niños y adolescentes siguen siendo escasos, a pesar de que el número de casos confirmados de COVID-19 ahora supera los 16 millones a nivel mundial.(3) Además, los documentos existentes de China contienen muy pocos datos clínicos sobre niños, y la mayoría carece de detalles sobre Medidas de apoyo requeridas por niños con COVID-19. Del mismo modo, los informes epidemiológicos recientes de Europa y América del Norte contienen poca información clínicamente relevante. (4) Determinar el nivel de apoyo requerido por los niños es esencial para la planificación del servicio pediátrico durante la pandemia de COVID-19 en curso...(AU)