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).

Niveles séricos de interleucina-6 en pacientes con diabetes tipo 2 y su correlación con el perfil lipídico / Serum levels of interleukin-6 in patients with type 2 diabetes and its correlation with the lipid profile

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)

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)

HCAM la historia de un grande / HCAM the story of a great

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.

Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism

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.

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.

Cuidados com o uso de insulinas disponibilizadas pelo sus: subsídios para o controle em diabetes mellitusManagement of insulin available by sus: support to control diabetes mellitus / Management of insulin available by sus: support to control diabetes mellitus / Cuidado en el uso de insulinas proporcionado porsus: subvenciones para el cuidado de diabetes mellitus

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.

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.

Avaliação da adequabilidade dos encaminhamentos da atenção básica para o serviço de endocrinologia de um hospital escola em Curitiba / Suitability of basic attention forwarding to the endocrinology service of a school hospital in Curitiba

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

Arte, historia y endocrinología / Art, history and endocrinology

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.

Producción científica de los investigadores del Instituto de Endocrinología indizada en SciELO Cuba/2014-2018 / Scientific production of researchers from the Institute of Endocrinology indexed in SciELO Cuba/2014-2018

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)

COVID-19 una perspectiva desde el punto de vista endocrinológico / COVID-19, A perspective from the endocrinological point of view

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)

El programa científico de las reuniones anuales de la Sociedad Cubana de Endocrinología y los congresos cubanos de endocrinología / The Scientific Program of the Annual Meetings of the Cuban Society of Endocrinology and the Cuban Congresses on Endocrinology

RESUMEN Después de la creación en 1953 de la Sociedad Cubana de Endocrinología, la actividad científica más importante en esta primera etapa fue la realización de las reuniones anuales. Como continuación de esas reuniones, a partir de la década de los ochenta del siglo pasado se inició de forma regular la realización de los congresos cubanos de endocrinología. El objetivo de la investigación fue describir el programa científico de las reuniones anuales de la Sociedad Cubana de Endocrinología. Se utilizó el método empírico de revisión documental de las actas de la Sociedad Cubana de Endocrinología en su primera etapa de creación, así como los programas de las reuniones anuales de la sociedad y de los congresos cubanos de endocrinología. Se realizaron tres reuniones anuales la primera el 16 de octubre de 1955 en Matanzas, la segunda el 29 de octubre de 1956 en Pinar del Río y la tercera el 11 de abril de 1959 en el Club de Leones de Marianao en La Habana. Entre los temas más tratados estaban la diabetes mellitus (40,4 por ciento de los trabajos presentados), misceláneas (21,4 por ciento), salud reproductiva (16,6 por ciento) y afecciones del tiroides (9,5 por ciento). Los médicos de mayor participación fueron Julio F. Schutte, Tomas Duran Quevedo, Manuel M. Villaverde, A. Ruiz Leiro y Genaro Suárez. La Sociedad Cubana de Endocrinología en la segunda etapa de trabajo desarrolló nueve congresos. La Sociedad Cubana de Endocrinología desde su fundación promovió la realización de reuniones científicas denominadas reuniones anuales, donde los médicos dedicados a estos temas presentaban lo más novedoso de sus investigaciones. Como continuación de esas reuniones, pero en un escenario social y científico diferente, se inició la realización regular de los congresos cubanos de endocrinología(AU)

ABSTRACT After the creation, in 1953, of the Cuban Society of Endocrinology, the most important scientific activity in this first stage was the holding of annual meetings. As a continuation of these meetings, starting in the 1980s, the Cuban congresses on endocrinology began on a regular basis. The objetive of the investigation was to describe the scientific program of the Annual Meetings of the Cuban Society of Endocrinology. The empirical method of documentary review was used, to search through the minutes of the Cuban Society of Endocrinology in its first stage of creation, as well as the programs of the Annual Meetings of the Society and of the Cuban congresses on endocrinology. Three annual meetings were held: the first one, on October 16, 1955, in Matanzas; the second one, on October 29, 1956, in Pinar del Río; the third one, on April 11, 1959, at Club de Leones in Marianao Municipality, Havana. Among the most addressed topics were diabetes mellitus (40.4 percent of the papers presented), miscellaneous issues (21.4 percent), reproductive health (16.6 percent), and thyroid-related conditions (9.5 percent). The physicians with the highest participation were Julio F. Schutte, Tomas Duran Quevedo, Manuel M. Villaverde, A Ruiz Leiro, and Genaro Suarez. The Cuban Society of Endocrinology, in its second stage of work, developed nine Cuban congresses on endocrinology. Since its creation, the Cuban Society of Endocrinology promoted the holding of scientific meetings called Annual Meetings, in which doctors dedicated to these issues presented the most innovative topics from among their research. As a continuation of these meetings, but in a different social and scientific setting, the regular holding of the Cuban congresses on endocrinology began(AU)

Efectos de la terapia hormonal con drospirenona / 17 ß - estradiol sobre los parámetros del síndrome metabólico en posmenopáusicas / Effects of hormone therapy with drospirenone / 17 ß - estradiol on the parameters of the metabolic syndrome in postmenopausal women

Evaluar los efectos de la terapia hormonal (TH) con Drospírenona (DRSP)/17 ß -estradiol (E2), sobre los parámetros del Síndrome Metabólico (SM) en pacientes postmenopáusicas. Métodos: Investigación comparativa y aplicada, con diseño cuasi experimental, de casos y controles a simple ciego, prospectivo y de campo; realizada en la Consulta de Ginecología. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. Participaron 120 mujeres separadas al azar para recibir la combinación DRSP/E2 (Grupo A) o un placebo (Grupo B). Se evaluaron los componentes del SM antes y posterior a 6 meses de haber recibido la TH. Resultados: Se encontró una alta prevalencia de SM en ambos grupos antes de recibir el tratamiento (53,3% y 48%; grupo A y B respectivamente). Posterior al tratamiento, DRSP/E2 al compararse con un placebo, redujo significativamente tanto la prevalencia del SM como el riesgo de padecerlo (21,7% versus 48,3%, OR [IC95%]= 0,29 [0,13-0,65]; p < 0.001), con reducción significativa (p< 0.001) de la hipertensión arterial, glicemia basal alterada, hipertrigliceridemia y obesidad central; además de una reducción significativa de los síntomas vasomotores, síntomas psicológicos e incontinencia urinaria (p< 0.001). En el grupo B la prevalencia del SM se mantuvo sin cambios, salvo para la glicemia basal alterada y los síntomas vasomotores y psicológicos que mostraron una reducción significativa (p< 0.001). Conclusión: DRSP/E2 (2mg/1 mg) demostró ser eficaz luego de 6 meses de tratamiento tanto para el control de los parámetros que definen al SM; con pocos y leves efectos indeseados(AU)

To assess the effects of hormone therapy (HT) with drospirenone (DRSP)/17 ß -estradiol (E2) on the parameters of the metabolic syndrome (MS) in postmenopausal patients. Methods: We performed a comparative and applied research, with quasiexperimental, case-control, single-blind, prospective and field design. The study was realized in the Gynecology consultation. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. 120 women were included, they were separated to receive either the combination DRSP/E2 (Group A) or placebo (Group B). We assess MS components before and ather 6 months of receiving HT. Results: We found a high prevalence in both groups before receiving treatment (53.3% and 48%, group A and B respectively). A ther treatment, DRSP/E2 when compared to placebo, significantly reduced both the prevalence of MS as the risk of setting it (21.7% versus 48.3%, OR [95%] = 0.29 [0.13-0.65] p <0.001), with a significant reduction (p <0.001) of hypertension, impaired fasting glucose, hypertriglyceridemia, central obesity; and a significant reduction in vasomotor symptoms, psychological symptoms and urinary incontinence (p <0.001). In group B the prevalence of MS was unchanged, except for impaired fasting glycemia and vasomotor and psychological symptoms showed a significant reduction (p <0.001). Conclusion: DRSP/E2 (2mg /1mg), proved to be effective a ther 6 months of treatment both for the control of the parameters that define the SM, with few and mild side effects(AU)

Anatomical investigation of the measurements, shape and arterial irrigation of the adrenal gland in New Zealand rabbits / Investigação anatômica das medidas, forma e irrigação arterial da glândula adrenal em coelhos da raça Nova Zelândia

Rabbits have been used as an experimental model in many studies. These studies are important for not only for veterinary clinicians, but also for researchers in different elds. The aim of this research was to describe gross morphological measurement, shape and arterial supply of the adrenal glands in healthy New Zealand rabbits. Dissections were performed in 30 adult rabbits, 15 males and 15 females, without macroscopic adrenal pathology. Adrenal measurements were made with a digital caliper: length, width, and thickness. The origin of the adrenal arteries was also determined. Both adrenal glands were localized cranially to the respective kidneys. The mean of the right adrenal gland was 0.88 cm length, 0.42 cm width and 0.16 cm thickness; the left gland measured 0.72 cm, 0.46 cm, and 0.17 cm, respectively. The right gland was significantly more elongated than the left (p = 0.0003) and the means of the measurements did not differ between sexes. Most of the right adrenal glands had a piriform shape (73.3%), whereas most of the left gland exhibited a bean-shaped aspect (60.0%). The arterial supply was found to arise from different arteries:  lumbar, aorta, renal, caudal mesenteric, and testicular or ovarian. Comparatively, the descriptions of shape, position and arterial irrigation of the adrenal gland in rabbits are similar to those available in rodents. The data from the pres

Coelhos têm sido utilizados como modelo experimental em muitos estudos. Esses estudos são importantes não apenas para médicos veterinários, mas também para pesquisadores de diferentes campos. O objetivo desta pesquisa foi descrever as medidas morfológicas macroscópicas, forma e suprimento arterial das glândulas adrenais em coelhos saudáveis da raça Nova Zelândia. As dissecções foram realizadas em 30 coelhos adultos, 15 machos e 15 fêmeas, sem sinais macroscópicos de patologia adrenal. As medidas adrenais foram realizadas com paquímetro digital: comprimento, largura e espessura. A origem das artérias adrenais também foi determinada. Ambas as glândulas adrenais foram localizadas cranialmente nos respectivos rins. A média da glândula adrenal direita foi de 0,88 cm de comprimento, 0,42 cm de largura e 0,16 cm de espessura; a glândula esquerda mediu 0,72 cm, 0,46 cm e 0,17 cm, respectivamente. A glândula direita foi significativamente mais alongada que a esquerda (p = 0,0003) e as médias das medidas não diferiram entre os sexos. A maioria das glândulas adrenais direitas tinha uma forma piriforme (73,3%), enquanto a maioria da glândula esquerda exibia um aspecto em “forma de feijão” (60,0%). Verificou-se que o suprimento arterial provém de diferentes artérias: lombar, aorta, renal, mesentérica caudal e testicular ou ovariana. Comparativamente, as descrições de forma, posição e irrigação arterial da glândula adrenal em coelhos são semelhantes às disponíveis em roedores. Os dados da presente investigação ajudarão na interpretação de achados patológicos e / ou experimentais em coelhos da raça Nova Zelândia.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia / Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

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Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

Perfiles de salud en pacientes con enfermedades crónicas en una institución de salud de alta complejidad / Health profiles in patients with chronic diseases in a high-complexity health institution / Perfis de saúde em pacientes com doenças crônicas numa instituição de saúde de alta complexidade

Objetivo: describir los diferentes perfiles, en términos de calidad de vida relacionada con la salud, en pacientes con enfermedades crónicas en una institución de salud de alta complejidad. Metodología: estudio transversal descriptivo. Se evaluó la calidad de vida relacionada con la salud mediante el instrumento EQ-5D en pacientes con enfermedades crónicas que consultaron a medicina interna y sus subespecialidades, en el servicio de consulta externa de una institución de salud de alta complejidad de la ciudad de Medellín durante el año 2017. Resultados: fueron encuestados 158 pacientes. La mediana de la edad fue 58 (46-68) años. El tiempo aproximado de evolución entre la edad de realización del diagnóstico principal y la edad del paciente al momento de la encuesta fue de 8.7 años, un total de 117 pacientes (74.1%) eran de sexo femenino. El estado de salud general de los pacientes de endocrinología y reumatología fue de 80 puntos, siendo los factores que afectaron la calidad de vida los denominados "dolor o malestar" y "ansiedad o depresión". Además, en los pacientes con patologías infecciosas el estado de salud general fue el más bajo, 62.5, donde el factor "dolor o malestar" fue el más común. Conclusiones: se identifica mayor alteración en las variables del EQ-5D de "dolor o malestar" y "ansiedad o depresión" en la población general, así mismo, cuando se trata del sexo femenino y de las áreas de endocrinología y reumatología.

Objective: to describe the different profiles in terms of health-related quality of life found in patients with chronic diseases in a high-complexity health institution. Methodology: cross-sectional descriptive study that evaluated the health-related quality of life through the EQ-5D instrument, in patients with chronic diseases that consulted Internal Medicine and its subspecialties in the outpatient service of a highly-complexity health institution in the city of Medellin, during the year 2017. Results: 158 patients between the ages 46-68 (an average of 58-year-old) were surveyed. A total of 117 patients (74.1%) were female. The time of evolution from the age when the diagnostic was run to the actual age of the patient when surveyed was 8.7 years. The general health status of the patients from Endocrinology and Rheumatology was found to be of 80 points, being the feelings of "pain or discomfort" and "anxiety or depression" the ones that most affected the quality of life. Additionally, in patients with infectious pathologies the general health status was the lowest (62.5); the most common factor was "pain or discomfort). Conclusions: it is evident that there is greater alteration in the variables of the EQ-5D of "pain or discomfort" and "anxiety or depression" in the general population, as well as in the females and the areas of Endocrinology and Rheumatology.

Objetivo: descrever os diferentes perfis, em termos de qualidade de vida relacionada com a saúde, em pacientes com doenças crônicas numa instituição de saúde de alta complexidade. Metodologia: estudo transversal descritivo. Se avaliou a qualidade de vida relacionada com a saúde mediante o instrumento EQ-5D em pacientes com doenças crônicas que consultaram a medicina interna e suas subespecialidades, no serviço de consulta externa de uma instituição de saúde de alta complexidade da cidade de Medellín durante o ano 2017. Resultados: foram entrevistados 158 pacientes. A média de idade foi 58 (46-68) anos. O tempo aproximado de evolução entre a idade de realização do diagnóstico principal e a idade do paciente ao momento da enquete foi de 8.7 anos, um total de 117 pacientes (74.1%) eram de sexo feminino. O estado de saúde geral dos pacientes de endocrinologia e reumatologia foi de 80 pontos, sendo os fatores que afetaram a qualidade de vida os denominados "dores ou mal-estar" e "ansiedade ou depressão". Ademais, nos pacientes com patologias infecciosas o estado de saúde geral foi o mais baixo, 62.5, donde o fator "dor ou mal-estar" foi o mais comum. Conclusões: se identifica maior alteração nas variáveis de EQ-5D de "dor ou mal-estar" e "ansiedade ou depressão" na população geral, assim mesmo, quando se trata do sexo feminino e das áreas de endocrinologia e reumatologia.

Is Follow-up of Adrenal Incidentalomas Always Mandatory?

Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as “adrenal incidentalomas” and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.