Executive Summary from Expert consensus on effectiveness and safety of iDPP-4 in the treatment of patients with diabetes and COVID-19.

BACKGROUND: This consensus aims to clarify the role of Dipeptidyl Peptidase-4 inhibitors (iDPP-4) in managing patients with diabetes during the COVID-19 pandemic. MATERIALS AND METHODS: A PubMed bibliographic search was carried out (December 2019-February 2021). Oxford methodology was used for the evaluation of evidence and possible recommendations were established by consensus. RESULTS: Diabetes appears to be an independent factor in COVID-19 disease (evidence 2b). No increased risk of contagion with iDPP-4 is demonstrated (evidence 2b), and its use has been shown to be safe (evidence 2b). The use of this drug may present a specific benefit in reducing mortality, particularly in in-hospital use (evidence 2a), reducing admission to intensive care units (evidence 2b) and the need for mechanical ventilation (evidence 2b). CONCLUSIONS: The use of iDPP-4 appears to be safe in patients with COVID-19, and quality studies are needed to clarify their possible advantages further.

[Executive Summary from Expert consensus on effectiveness and safety of iDPP-4 in the treatment of patients with diabetes and COVID-19]. / Resumen Ejecutivo del Consenso de expertos sobre la eficacia y seguridad de los iDPP-4 en el tratamiento de pacientes con diabetes y COVID-19.

BACKGROUND: This consensus aims to clarify the role of Dipeptidyl Peptidase-4 inhibitors (iDPP-4) in managing patients with diabetes during the COVID-19 pandemic. MATERIALS AND METHODS: A PubMed bibliographic search was carried out (December 2019-February 2021). Oxford methodology was used for the evaluation of evidence and possible recommendations were established by consensus. RESULTS: Diabetes appears to be an independent factor in COVID-19 disease (evidence 2b). No increased risk of contagion with iDPP-4 is demonstrated (evidence 2b), and its use has been shown to be safe (evidence 2b). The use of this drug may present a specific benefit in reducing mortality, particularly in in-hospital use (evidence 2a), reducing admission to intensive care units (evidence 2b) and the need for mechanical ventilation (evidence 2b). CONCLUSIONS: The use of iDPP-4 appears to be safe in patients with COVID-19, and quality studies are needed to clarify their possible advantages further.

[Risk factors of persistent disease at 5 years from diagnosis in differentiated thyroid cancer: study of 63 patients]. / Factores relacionados con la persistencia de la enfermedad a los 5 años del diagnóstico de cáncer diferenciado de tiroides: estudio de 63 pacientes.

OBJECTIVE: To identify possible risk factors associated with persistent disease 5 years after total or near-total thyroidectomy in patients with differentiated thyroid cancer (DTC). PATIENTS AND METHOD: Retrospective study evaluating data from 63 patients 5 years after they were first diagnosed of DTC. At this time of the study, 46 subjects were considered disease-free (F group) whereas 17 had evidence of persistent disease or had died from DTC (P group). We compared both groups of patients regarding the following variables: a) variables at diagnosis related to the patient (age, gender) and the tumor (histological type, size, extrathyroidal involvement, vascular invasion, multifocality, lymph node and distant metastases), and b) variables recorded during follow-up: percentage of subjects showing serum stimulated thyroglobulin > or = 10 ng/ml few weeks postoperatively (Tg0) and 6 to 12 months later (Tg1). RESULTS: Male gender, extrathyroidal involvement and lymph node metastases were more frequent in P group than in F group (41 vs. 11%, 60 vs. 18% and 50 vs. 5.5%; p < 0.05). During the follow-up the percentage of patients showing Tg > or = 10 ng/ml was higher in P group compared to F group, both at a few weeks postoperatively and 6 to 12 months later (Tg0, 75 vs. 13%; Tg1, 69% vs. 0; p < 0,05). CONCLUSIONS: In our patients, male gender, extrathyroidal involvement, and lymph node metastases at diagnosis were associated with persistent disease 5 years later. Serum stimulated thyroglobulin had a very high predictive value both just after surgery and in the next 6 to 12 months and could help identifying subjects who need a closer follow-up.

Factores relacionados con la persistencia de la enfermedad a los 5 años del diagnóstico de cáncer diferenciado de tiroides: estudio de 63 pacientes / Risk factors for persistent disease at 5 years from diagnosis in differentiated thyroid cancer: study of 63 patients

Objetivo: Identificar en el cáncer diferenciado de tiroides (CDT) factores asociados a la persistencia de enfermedad a los 5 años de la tiroidectomía total o casi total. Pacientes y método: Estudio retrospectivo en 63 pacientes con CDT, de los que se consideró libres de enfermedad a los 5 años a 46 (grupo L) y 17 presentaban enfermedad persistente al quinto año o habían fallecido por CDT (grupo P). Se compararon las siguientes variables entre estos grupos: a) al diagnóstico, relacionadas con el paciente (edad, sexo) y con el tumor (tipo histológico, tamaño, extensión extratiroidea, invasión vascular, multifocalidad, metástasis ganglionares y a distancia), y b) recogidas durante el seguimiento: proporción de pacientes con tiroglobulina (Tg) sérica estimulada ≥ 10 ng/ml tras la cirugía (Tg0) y entre los 6 y los 12 meses (Tg1). Resultados: Al diagnóstico, el sexo masculino, la extensión extratiroidea y las metástasis ganglionares resultaron más frecuentes en el grupo P (el 41 frente al 11%, el 60 frente al 18% y el 50 frente al 5,5% respectivamente; p < 0,05). Durante el seguimiento, el porcentaje de sujetos con Tg ≥ 10 ng/ml fue mayor en el grupo P (Tg0, el 75 frente al 13%; Tg1, el 69% frente a 0; p < 0,05). Conclusiones: En nuestro medio, el sexo masculino, la extensión extratiroidea y las metástasis ganglionares son factores asociados a la enfermedad persistente. El elevado valor predictivo de la Tg estimulada tras la cirugía y a los 6-12 meses ayuda a identificar a los pacientes que precisan de un seguimiento más estrecho (AU)

Objective: To identify possible risk factors associated with persistent disease 5 years after total or near-total thyroidectomy in patients with differentiated thyroid cancer (DTC). Patients and method: Retrospective study evaluating data from 63 patients 5 years after they were first diagnosed of DTC. At this time of the study, 46 subjects were considered disease-free (F group) whereas 17 had evidence of persistent disease or had died from DTC (P group). We compared both groups of patients regarding the following variables: a) variables at diagnosis related to the patient (age, gender) and the tumor (histological type, size, extrathyroidal involvement, vascular invasion, multifocality, lymph node and distant metastases), and b) variables recorded during follow-up: percentage of subjects showing serum stimulated thyroglobulin ≥ 10 ng/ml few weeks postoperatively (Tg0) and 6 to 12 months later (Tg1). Results: Male gender, extrathyroidal involvement and lymph node metastases were more frequent in P group than in F group (41 vs. 11%, 60 vs. 18% and 50 vs. 5.5%; p < 0.05). During the follow-up the percentage of patients showing Tg ≥ 10 ng/ml was higher in P group compared to F group, both at a few weeks postoperatively and 6 to 12 months later (Tg0, 75 vs. 13%; Tg1, 69% vs. 0; p < 0,05). Conclusions: In our patients, male gender, extrathyroidal involvement, and lymph node metastases at diagnosis were associated with persistent disease 5 years later. Serum stimulated thyroglobulin had a very high predictive value both just after surgery and in the next 6 to 12 months and could help identifying subjects who need a closer follow-up (AU)

Evolución del hiperparatiroidismo primario en 56 pacientes. Comparación entre hiperparatiroidismo hipercalcémico y normocalcémico / Progression of primary hyperparathyroidism in 56 patients. Comparison between hypercalcemic and normocalcemic hyperparathyroidism

Introducción: Actualmente, el hiperparatiroidismo primario (HPP) se considera una enfermedad escasamente sintomática y poco progresiva. El HPP normocalcémico (HPPN) es una entidad reconocida e identificada esencialmente por complicaciones asociadas al HPP (osteoporosis y urolitiasis). Pacientes y método: Estudio de 56 pacientes con HPP no operados o con seguimiento mínimo de 1 año previo a la paratiroidectomía. Se subdividió a los pacientes en HPP hipercalcémico (HPPH) (27 pacientes) y HPPN (29 pacientes). Se pretendió analizar las comorbilidades (hipertensión arterial [HTA] y nefrolitiasis) en el grupo total y en cada subgrupo, valorar la evolución anual de calcemia, fosfatemia, paratirina (PTH) y fosfatasa alcalina séricas, calciuria, filtrado glomerular y densidad mineral ósea lumbar durante un período de 1 a 5 años y hallar posibles diferencias entre HPPH y HPPN para estas variables. Resultados: El 55,4% de los pacientes presentaban HTA y se registraron episodios de nefrolitiasis en el 37,5% de los casos. No se apreciaron cambios a lo largo del tiempo en los parámetros bioquímicos y densitométricos ni en el grupo total ni por subgrupos. Excepto en los valores de calcio, fósforo y PTH séricos no se hallaron diferencias entre HPPH y HPPN. Conclusiones: El HPP parece una enfermedad poco progresiva si bien no se incluyó en este estudio a los pacientes remitidos precozmente a cirugía con seguimiento previo escaso que podrían corresponder a casos más agresivos. El HPPN es una entidad asociada a complicaciones similares a las del HPPH por lo que pensamos debería someterse a los mismos criterios de derivación quirúrgica (AU)

Introduction: Primary hyperparathyroidism (PHP) is considered a relatively stable, asymptomatic disease. Normocalcemic PHP (NPHP) is now a recognized entity that is usually diagnosed through its associated complications (such as osteoporosis and nephrolithiasis). Patients and method: We studied 56 patients with PHP who did not undergo surgery or who completed a minimum follow-up of 1 year before parathyroid surgery. The group was subdivided into patients with hypercalcemic PHP (HPHP) (27 patients) and those with NPHP (29 patients). The presence of comorbidities (hypertension, nephrolithiasis) was analyzed in the whole group and in each subset of patients, as was yearly progression of calcemia, phosphatemia, serum parathyroid hormone (PTH) and alkaline phosphatase, urinary calcium, glomerular filtration rate and bone mineral density in the lumbar spine during a follow-up period ranging from 1 to 5 years. Possible differences in these variables between HPHP and NPHP were also studied. Results: A total of 55.4% of the patients were hypertensive and nephrolithiasis events were reported in 37.5%. No changes were observed in biochemical or densitometric variables over time or in the whole group or in the subgroups. Except for serum calcium, phosphate and PTH values, no differences were found between HPHP and NPHP. Conclusions: PHP seems to be a relatively stable disease, although patients referred early to surgery with a short follow-up, who could have had more aggressive kinds of PHP, were not included in this study. The complications of NPHP are similar to those of HPHP and therefore we believe the same recommendations for surgery should be followed in both forms (AU)