Home- vs clinic-based daylight photodynamic therapy with 5-aminolevulinic acid nanoemulsion (BF-200 ALA) for actinic keratosis: A randomized, single-blind, prospective study.

BACKGROUND: Daylight photodynamic therapy (DL-PDT) has become one of the most effective treatments for the resolution of actinic keratosis (AK) of Olsen grade 1 and 2. Generally, PDT it is carried out in a clinic setting, which involves the patient's and their caregivers commuting to the hospital as well as a significant use of resources to carry it out within the clinic setting. OBJECTIVES: To determine the efficacy and safety of a home-based treatment of AK with DL-PDT with the BF-200 ALA gel compared to a clinic-based setting. METHODS: The study was performed as a randomized, single-center, non-inferiority clinical trial with two parallel groups. 9 patients received one clinic-based DL-PDT (group 1) and 11 patients received one session of home-based DL-PDT (group 2). The primary endpoints were the mean AK clearance per patient and the total AK lesion clearance rate 12 weeks after treatment. The secondary endpoints were the number of remaining AKs and new AKs appearing in the treatment field 12 weeks after one PDT session. The pain during and 24 h after PDT as well as the local skin reactions were also assessed. RESULTS: The overall reduction of AK lesions per patient was similar in both groups with one PDT session. An overall AK clearance per patient of 10 ± 4.33 for group 1 versus 9.73 ± 2.9 for group 2 without statistically significant differences (p = 0.868). Regarding the clearance rate, although it was slightly higher in group 2 (71.58 ± 22.51 vs 82.1 ± 11.13), the analysis did not show statistically significant differences. The mild pain recorded during the treatment course and the mild local skin reactions were similar in both groups. Patient satisfaction was high for both groups without statistically significant differences. CONCLUSION: Self-performed home-based DL-PDT with BF-200 ALA gel is as effective as the one performed in a clinic-based setting, with a comparable safety profile, high levels of patient satisfaction and with advantages for the patients and their caregivers that can enhance patient´s adherence to the treatment.

Primary hyperparathyroidism in pregnancy: a two-case report and literature review.

Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

Encefalopatía metabólica secundaria a intoxicación por vitamina D / Metabolic encephalopathy secondary to vitamin d intoxication

La asociación entre la deficiencia de vitamina D y un mayor riesgo de diversas enfermedades, entre ellas cardiovasculares y autoinmunes, ha aumentado en los últimos años el uso de suplementos para la normalización de los valores plasmáticos de esta vitamina. Desde entonces se ha descrito un mayor número de casos de intoxicación iatrogénica por vitamina D. Presentamos una enferma de 81 años con encefalopatía metabólica e insuficiencia renal secundarias a una intoxicación por vitamina D. Los suplementos orales con calcio y vitamina D se le prescribieron después de sufrir una fractura vertebral osteoporótica. La enferma mejoró clínica y analíticamente tras hidratación y diuréticos. Es importante destacar la hipercalcemia como causa de encefalopatía metabólica y considerar la intoxicación por vitamina D como etiología poco frecuente pero posible de hipercalcemia e insuficiencia renal reversibles (AU)

The association between vitamin D deficiency and increased risk of, among others, cardiovascular and autoimmune diseases has lead in the last years to an enhanced interest in the usage of supplements to achieve the normalization of plasmatic values at 25(OH) D. Apparently this search for normalization is resulting in an higher incidence on vitamin D intoxication. We present the case of an 81 years old woman with metabolic encephalopathy and renal failure secondary to iatrogenic vitamin D intoxication. Calcium and vitamin D oral supplements were prescribed after an osteoporotic vertebral fracture. The patient improved clinically as well as analytically after receiving treatment with diuretics and hydration. We emphasize the importance of discarding hypercalcemia as a cause of metabolic encephalopathy; moreover we highly recommend keeping vitamin D intoxication in mind as an uncommon although always possible etiology of reversible hypercalcemia and renal failure (AU)

Situación de la endocrinología y la nutrición clínica hospitalarias en España / Current situation of hospital-based endocrinology and clinical nutrition in Spain

En 2006, la Comisión de Asistencia de la Sociedad Española de Endocrinología y Nutrición realizó una encuesta para conocer la situación actual de la endocrinología y nutrición clínica en los sistemas públicos de salud de España. En esta ocasión, la encuesta ha sido más amplia que en ocasiones anteriores y, además de datos sobre el número y distribución de los especialistas en las diferentes Comunidades autónomas, se han recogido datos concretos de actividad asistencial. La participación media de los hospitales públicos con especialistas en endocrinología y nutrición ha sido del 50% (AU)

In 2006, the Healthcare Commission of Spanish Society of Endocrinology and Nutrition did a survey in order to know the actual situation of endocrinology and clinical nutrition healthcare in Public Sanitary Systems in Spain. The survey has been more extensive than the last and it has taken up number and geographical distribution of specialists in Spain in addition to data about clinical assistance. The mean of public hospitals with endocrinologist participation has been 50% (AU)

Current situation of hospital-based endocrinology and clinical nutrition in Spain.

In 2006, the Healthcare Commission of Spanish Society of Endocrinology and Nutrition did a survey in order to know the actual situation of endocrinology and clinical nutrition healthcare in Public Sanitary Systems in Spain. The survey has been more extensive than the last and it has taken up number and geographical distribution of specialists in Spain in addition to data about clinical assistance. The mean of public hospitals with endocrinologist participation has been 50%.

[Influence of nutritional status on the organism's response to infectious disease]. / Influencia del estado de nutrición en la respuesta del organismo a las enfermedades infecciosas.

The nutritional status of a patient determines to a great extent his/her susceptibility and capacity in responding to infections. Protein and caloric malnutrition as well as many selective mineral and vitamin deficiencies deteriorate the immune and inflammatory metabolic response, increasing the frequency of infections and worsening their evolution and prognosis. Furthermore, recurrent infections can deteriorate nutritional status, with both problems forming a vicious circle that needs to be recognized for adequate treatment. This problem is not as foreign to us as we might think, given that many hospitalized patients as well as those with chronic diseases suffer from serious nutritional deficiencies. If we also take into account the proposition that the nutritional status of a patient can affect his/her response to treatment with antibiotics and vaccines, we realize then that not enough attention has been paid to this important public health risk factor to date.

[The evolution of commercial enteral formulas in Spain in 1988-1991]. / Evolución de las fórmulas enterales comercializadas en España en el período 1988-1991.

Enteral nutrition is an artificial form of nutrition which is expanding an there are thus a great many commercial preparations on the market which are rapidly being developed. This study is a presentation of the quantitative and qualitative changes in these preparations from 1988-1991, classified depending upon their main nutrient: proteins. In global terms, there has been an increase of 18 formulae, distributed among different types, but with the most spectacular increase in special diets. Discussion of the trends observed, which respond to further knowledge on the absorption or tolerance of nutrients and nutritional needs in different pathologies.