Prefrontal Cortex Neuromodulation Enhances Frontal Asymmetry and Reduces Caloric Intake in Patients with Morbid Obesity.

OBJECTIVE: The objective of this study was to test the feasibility of a combined intervention involving transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex (dlPFC) and cognitive training (CT). Short-term effects on food consumption, cognition, endocannabinoid (eCB) levels, and electroencephalogram (EEG) markers of future weight loss were explored. METHODS: Eighteen healthy volunteers with morbid obesity were randomized in a double-blind, placebo-controlled, parallel trial. Participants received sham or active tDCS plus CT for four consecutive days. Cognitive performance, daily food intake, and eCB blood samples were collected before and after the intervention; EEG data were gathered before and after daily training. RESULTS: The active tDCS + CT group reversed left-dominant frontal asymmetry and increased frontal coherence (FC) in the γ-band (30-45 Hz) after the intervention. The strength of the latter predicted BMI reduction. Additionally, a large intervention effect on food intake was shown in the active tDCS + CT group at follow-up (-339.6 ± 639 kcal on average), and there was a decrease of plasma eCB concentrations. CONCLUSIONS: dlPFC modulation through tDCS + CT is an effective tool to restore right dominance of the dlPFC and enhance FC in patients with morbid obesity. Moreover, the effect of the strength of FC on BMI suggests that the interhemispheric FC at the dlPFC is functionally relevant for the efficient regulation of food choice.

Risk of underdiagnosis of hypertension in schizophrenia patients.

AIM: Arterial hypertension requires proper screening and management, and its underdiagnosis in patients with schizophrenia (SZ) and/or antipsychotic treatment has been postulated. The objective of the study is to assess whether there are differences in the proportion of screened patients with a blood pressure >140/90 mmHg that are undiagnosed or not confirmed later (risk of underdiagnosis). METHODS: Cross-sectional study of clinical records from SIDIAPQ (Spain) during the 2006-2011 period. Three groups were studied: SZ, no SZ but under antipsychotic treatment, and control groups. Patients with established hypertension, cardiovascular disease, dementia, or diagnosis of SZ or starting with antipsychotic treatment during this period were excluded. RESULTS: The SZ group had a lower risk of underdiagnosis than the control group (OR 0.91; 95% CI: 0.83-0.99; p < 0.05), at the expense of men (OR 0.8; 95% CI: 0.71-0.9; p < 0.001) and patients younger than 50 years of age (OR: 0.84; 95% CI: 0.74-0.93; p < 0.003). In the no SZ but under antipsychotic treatment group there were some differences, but not in the overall results. CONCLUSION: Preventive management of hypertension seemed to be sufficient for SZ and antipsychotic treatment patients. The lower prevalence of hypertension found in these groups may be due to other factors (blood pressure-lowering effect of psychoactive drugs or smoking) but these hypotheses must be evaluated with specific studies.

Screening of cardiovascular risk factors in patients with schizophrenia and patients treated with antipsychotic drugs: are we equally exhaustive as with the general population?

Many studies have previously shown increased cardiovascular risk factors related to schizophrenia independently from the use of antipsychotic drugs. However, a poorer effort in clinical detection and management of cardiovascular risk in patients with severe mental illness could also explain these results. To test this hypothesis, we analyzed the differences in screening and incidence of cardiovascular risk factors between schizophrenia, non-schizophrenic patients on treatment with antipsychotic drugs (NS-TAD) and the general population. Data from adult subjects assessed by high-quality register general practitioners from 2006 to 2011 were extracted from the Catalonian SIDIAP database. The schizophrenia, NS-TAD, and control groups were compared in terms of measurements and incidence of diabetes, dyslipidemia, obesity, hypertension, and smoking. A total of 4911 patients in the schizophrenia group, 4157 in NS-TAD group, and 98644 in the control group were included. Schizophrenia patients were screened for dyslipidemia and diabetes more frequently than the control group, while for obesity or hypertension, they were screened equal to controls. Also, as compared to the control group, the NS-TAD group was more frequently screened for obesity with no differences in dyslipidemia and diabetes and less frequently for hypertension. Smoking was less frequently screened in both study groups. The incidence of all risk factors studied in both study groups was higher than or equal to the control group, except for hypertension, which had lower incidence. The lack of screening of risk factors does not appear decisive in the increased cardiovascular risk of patients diagnosed with schizophrenia seen in primary care. Studies evaluating the possible under diagnosis of the risk factors are required. ABBREVIATIONS: Schizophrenia (SZ); Treatment with antipsychotic drugs (TAD); Cardiovascular risk factor/s (CVRF); Without schizophrenia but on therapy with antipsychotic drugs (NS-TAD); Defined Daily Dose (DDD).

Pharmacokinetics in Morbid Obesity: Influence of Two Bariatric Surgery Techniques on Paracetamol and Caffeine Metabolism.

PURPOSE: The purpose of the study was to study the impact of the two most common bariatric surgery techniques on paracetamol pharmacokinetics (a marker of gastric emptying) and caffeine metabolism (a marker of liver function). MATERIALS AND METHODS: In the present prospective study, we studied 24 morbid obese patients before, at 4 weeks, and 6 months after having undergone sleeve gastrectomy (n = 10) or Roux-en-Y gastric bypass (n = 14). For comparative purposes, 28 healthy controls (14 normal weights and 14 overweights) were also included in the study. RESULTS: Paracetamol pharmacokinetics was altered in the obese participants leading to lower bioavailability. Bariatric surgery resulted in faster absorption and normalized pharmacokinetic parameters, prompting an increase in paracetamol bioavailability. No differences were found between surgical procedures. In the case of caffeine, the ratio paraxanthine/caffeine did not differ between morbid obese and healthy individuals. This ratio remained unmodified after surgery, indicating that the liver function (assessed by cytochrome P450 1A2 activity) was unaffected by obesity or bariatric surgery. CONCLUSIONS: Paracetamol pharmacokinetics and caffeine plasma levels are altered in severely obese patients. The two studied bariatric surgical techniques normalize paracetamol oral bioavailability without impairing the liver function (measured by cytochrome P450 1A2 activity).

Caloric intake capacity as measured by a standard nutrient drink test helps to predict weight loss after bariatric surgery.

BACKGROUND: Instruments that enable to select individuals that will benefit most from bariatric surgery (BS) are necessary to increase its cost-efficiency. Our goal was to assess if intake capacity, measured with a standardized test, predicts response to BS. METHODS: Patients with criteria for BS were randomly allocated to laparoscopic gastric bypass (LRYGB) or sleeve gastrectomy (LSG). We measured caloric intake capacity before and 1 year after surgery using a standardized nutrient drink test. We evaluated if pre-surgery satiation could predict satiation and weight loss (%) 1 year after surgery using multiple regression modeling. Descriptive statistics are given as mean ± SD. RESULTS: Fourteen women (48 ± 9 years old, BMI 41 ± 3 kg/m(2)) were evaluated before and 11 ± 2.6 months after surgery (seven LRYGB, seven LSG). Caloric intake capacity diminished after surgery (-950 ± 85 kcal on average [70 ± 8 % decrease over basal intake capacity]; p=0.002) and similarly in both LRYGB (72 ± 7 % decrease) and LSG groups (68 ± 8 % decrease); p=0.5. There was a significant weight reduction after surgery (-32 ± 10 kg [30 ± 8 % of total basal weight]) with a mean post-surgery BMI of 29 ± 2 kg/m(2). The best predictive model of weight loss (%) after surgery (R (2)=89 %, p=0.0009) included: BMI (p=0.0004), surgery type (p=0.01) and pre-surgery intake capacity (p=0.006). Weight loss was higher in heavier patients and those undergoing LRYGB. Patients with higher intake capacity had a poorer outcome independently of basal BMI and surgery type. CONCLUSIONS: Caloric intake capacity, as measured by a standard nutrient drink test, helps to predict weight loss after bariatric surgery. This test might be useful in algorithms of obesity treatment decision.

I Workshop ibérico sobre la asociación entre diabetes y enfermedades periodontales. Documento de consenso / 1st Iberian Workshop on the relationship between diabetes and periodontal diseases. Consensus Document

Este consenso se ha realizado por expertos de las Fundaciones de las Sociedades Españolas de Diabetes y de Periodoncia. La evidencia revisada presenta datos relevantes que avalan la importancia tanto de la diabetes como de las enfermedades periodontales, así como de la relación bidireccional entre las mismas:- La diabetes tiene una alta prevalencia en las poblaciones de España y Portugal con elevada prevalencia de diabetes no conocida y con cifras en continuo incremento. Además, es muy relevante la importancia, frecuencia y severidad de sus complicaciones.- Las enfermedades periodontales tienen una alta prevalencia, cercana al 90% de la población adulta. La capacidad destructiva de la periodontitis conduce a la pérdida de dientes, lo que provoca importantes alteraciones para el paciente. También la periodontitis se ha asociado a un incremento en el riesgo de enfermedades cardiovasculares, de resultados adversos del embarazo, y de enfermedades pulmonares, entre otras.- Numerosos estudios han señalado que la diabetes es un importante factor de riesgo para sufrir periodontitis, especialmente si el control de la glucemia no es adecuado.- Las enfermedades periodontales han demostrado un efecto negativo sobre el control de la glucemia, tanto en pacientes con diabetes como en sujetos sanos, y se ha demostrado que las complicaciones de la diabetes son más frecuentes en pacientes con periodontitis.- El tratamiento periodontal es capaz de mejorar el control de la glucemia, con un valor de reducción de la hemoglobina glucosilada de 0.4%.Basados en estas evidencias, se proponen distintas implicaciones para los profesionales sanitarios involucrados en el cuidado de estos pacientes

This consensus report has been prepared by a group of experts from the Spanish Foundations of Diabetes and of Periodontology. The reviewed evidence shows relevant data that strongly support the importance of diabetes and periodontal diseases, as well as their bi-directional relationship: - Diabetes has a high prevalence in Spain and Portugal, with a high prevalence of un-diagnosed diabetes, and with continuously increasing rates. In addition, the frequency and severity of their complications is also very important. - Periodontal diseases have high prevalence, close to 90% in adult populations. The destructive capacity of periodontitis leads to tooth loss, which is associated with a profound impact on the patients. Periodontitis have also been related to an increased risk of cardiovascular diseases, adverse pregnancy outcomes, and pulmonary infections, as well as other conditions. - Numerous studies have concluded that diabetes is a significant risk factor for periodontitis, especially in subjects with poor glycemic control. - Periodontal diseases have been shown to have a deleterious effect on glycemic control, both in diabetic patients and healthy subjects, and it has been demonstrated that diabetes complications are more frequent in diabetic patients with periodontitis. - Periodontal treatment has been associated with improvements in glycemic control, with a mean reduction in glycosylated haemoglobin of 0.4%. Based on the above evidence, different challenges are proposed for health professionals involved in diabetic and periodontitis patient care

Psicosis, riesgo cardiovascular y mortalidad asociada: ¿vamos por el buen camino? / Psychosis, cardiovascular risk and associated mortality: Are we on the right track?

Los pacientes con patología psicótica tienen un mayor riesgo de mortalidad precoz. Además de las causas no naturales (accidentes, suicidio), la causa cardiovascular (CV) está de 2 a 4 veces más presente que en población general. Esta revisión no sistemática de MEDLINE pretende esclarecer el papel de todos los condicionantes implicados. La patología psicótica se relaciona con hábitos de vida poco saludables tales como el tabaquismo, la dieta no equilibrada o el sedentarismo. Los fármacos neurolépticos también han sido estudiados como desencadenantes de obesidad y síndrome metabólico. Por tanto, los pacientes psicóticos parecen predispuestos a sufrir muchos de los factores de riesgo CV «clásicos». No es de extrañar que las puntuaciones en las escalas de riesgo cardiovascular (RCV) (Framingham, SCORE) sean superiores a las de la población general. También encontramos publicaciones en las que evidencian mayor dificultad en el manejo de la prevención primaria y secundaria de la enfermedad CV. Además, algunos factores bioquímicos (niveles plasmáticos de cortisol, ACTH, homocisteína, PCR) podrían indicar una vulnerabilidad de la psicosis per se, así como los hallazgos sobre hiperglucemia y resistencia a la insulina en psicóticos no tratados con psicofármacos. Estos factores «no-clásicos» podrían alteran la validez de las escalas de RCV diseñadas para población general. Por otro lado, los fármacos antipsicóticos podrían controlar factores intrínsecos de la psicosis (han demostrado disminuir la mortalidad global), no quedando claro su papel en la mortalidad CV

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic» CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear

[Psychosis, cardiovascular risk and associated mortality: are we on the right track?]. / Psicosis, riesgo cardiovascular y mortalidad asociada: ¿vamos por el buen camino?

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic¼ CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear.

Efectos de la diabetes sobre las enfermedades periodontales / Effects of diabetes on periodontal diseases

Diferentes revisiones publicadas en los últimos años han demostrado claramente la influencia de la diabetes sobre las enfermedades periodontales, señalando que esta interacción tiene importantes implicaciones para los profesionales de la salud, para los pacientes diabéticos y periodontales, y para la población general. Por ello, es oportuno revisar la evidencia científica sobre esta interacción, con el objeto de establecer implicaciones prácticas para todos los estamentos involucrados. La importancia de la diabetes se basa en sus altos niveles de prevalencia, confirmados recientemente en estudios en España y Portugal, incluida la alta presencia de diabetes no diagnosticada. Diferentes factores explican la influencia de la diabetes sobre las enfermedades periodontales, incluyendo los episodios proinflamatorios, los cambios en la microbiota subgingival o la acumulación de productos de glicación avanzados. Estos factores permiten explicar que la diabetes se comporte como un importante factor de riesgo para sufrir periodontitis. Sin embargo, la diabetes parece no interferir con los resultados del tratamiento, excepto en individuos con mal control de la glucemia. Las implicaciones de esta asociación son variadas, desde la posibilidad de realizar cribado de diabetes en la consulta dental, en sujetos con determinadas características periodontales, hasta la necesidad de llevar a cabo protocolos adecuados de atención odontológica y periodontal en pacientes con diabetes

Different studies, published in the last few years, have clearly demonstrated the effects of diabetes on periodontal diseases, pointing out the relevant implications for health professionals, for diabetic periodontal patients, as well as for the general population. It seems of interest to evaluate the scientific evidence supporting this association, with the main aim of identifying practical implications for all involved groups. The importance of diabetes is based, among other things, in the high levels of prevalence, recently confirmed in Spain and Portugal, and the high proportion of undiagnosed diabetes. Different factors may explain the effects of diabetes on periodontal diseases, including proinflammatory events, changes in the subgingival microbiota, or the accumulation of advanced glycation end-products. These factors provide the basis for diabetes being an important risk factor for periodontitis. However, diabetes may not interfere with periodontal therapy, except in subjects with poor blood glucose control. Many implications can be listed: from the possibility of performing diabetes screening in the dental clinics, to the need of clear dental and periodontal care protocols for patients with diabetes

El diabético inmigrante: factores de riesgo cardiovascular y su control. Aportaciones del estudio IDIME / The diabetic immigrant: cardiovascular risk factors and control. Contributions of the IDIME study

Introducción y objetivos. El objetivo del estudio es conocer las características clínicas de la diabetes mellitus y los factores de riesgo cardiovascular asociados en los diabéticos inmigrados a España. Métodos. Estudio multicéntrico, observacional, transversal con una cohorte de 605 diabéticos inmigrados y 307 diabéticos autóctonos, realizado en pacientes diagnosticados de diabetes mellitus atendidos en consultas de atención primaria y especializada en España. El muestreo se realizó a partir de casos sucesivos por orden de llegada a la consulta. Se estudian variables epidemiológicas, clínicas y analíticas relacionadas con la diabetes mellitus, así como la presencia de factores de riesgo clásicos. Resultados. El paciente diabético inmigrado es más joven (50,4 ± 11,5 frente a 62,7 ± 13 años) y con menos años de evolución de la enfermedad (5,8 ± 6,4 frente a 10,5 ± 8,3 años) (p<0,001) que el diabético autóctono. Los diabéticos inmigrados de Hispanoamérica tienen mayor obesidad. No hay diferencias estadísticamente significativas con respecto a la obesidad abdominal o el índice cintura/estatura. El control glucémico era peor que en los autóctonos (glucohemoglobina, el 7,8 ± 2,2 frente al 7,1 ± 1,5%), especialmente entre los indostaníes (8,1 ± 2,5%) (p<0,001), que además utilizan menos insulina (el 12,8 frente al 30,7% de otros inmigrantes) (p<0,001). Sin embargo, la prevalencia de las complicaciones crónicas de la diabetes mellitus es menor entre los inmigrados, especialmente las macrovasculares (el 7,7 frente al 24,4%) (p<0,01). Conclusiones. En nuestro estudio, el perfil de los diabéticos inmigrados a España es el de un diabético joven y sin complicaciones, pero con peor control metabólico. Todo ello nos proporciona una excelente oportunidad preventiva(AU)

Introduction and objectives. The aim of this study was to determine the clinical characteristics of diabetes and associated cardiovascular risk factors in immigrants with diabetes in Spain. Methods. A multicenter, observational, cross-sectional study including a cohort of 605 diabetic immigrants and 307 native diabetics was conducted in patients diagnosed with diabetes and treated in primary and specialized care in Spain. A consecutive sampling method was followed. We studied epidemiological, clinical and laboratory variables related to diabetes and the presence of classical risk factors. Results. The immigrant diabetic patient was younger (50.4 [11.5] vs 62.7 [13] years) and had fewer years of diabetes progression (5.8 [6.4] vs 10.5 [8.3] years) (P<.001) compared with native diabetic patients. Immigrants from South America with diabetes were more obese. No statistically significant differences were found in abdominal obesity or the waist/height ratio. Glycemic control was worse in immigrants than in the native Spaniards group (glycosylated hemoglobin, 7.8 [2.2] vs 7.1 [1.5%]), especially among South Asians (8.1[2.5%]) (P<.001), in whom insulin use was lower (12.8% vs 30.7% in other immigrants) (P<.001). However, the prevalence of chronic complications of diabetes was lower among immigrants, particularly that of macrovascular complications (7.7% vs 24.4%) (P<.01). Conclusions. In our study the profile of immigrant diabetics in Spain is one of a young diabetic without complications, but with worse metabolic control. These findings provide an excellent opportunity to implement preventive measures(AU)

The diabetic immigrant: cardiovascular risk factors and control. Contributions of the IDIME study.

INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the clinical characteristics of diabetes and associated cardiovascular risk factors in immigrants with diabetes in Spain. METHODS: A multicenter, observational, cross-sectional study including a cohort of 605 diabetic immigrants and 307 native diabetics was conducted in patients diagnosed with diabetes and treated in primary and specialized care in Spain. A consecutive sampling method was followed. We studied epidemiological, clinical and laboratory variables related to diabetes and the presence of classical risk factors. RESULTS: The immigrant diabetic patient was younger (50.4 [11.5] vs 62.7 [13] years) and had fewer years of diabetes progression (5.8 [6.4] vs 10.5 [8.3] years) (P<.001) compared with native diabetic patients. Immigrants from South America with diabetes were more obese. No statistically significant differences were found in abdominal obesity or the waist/height ratio. Glycemic control was worse in immigrants than in the native Spaniard group (glycosylated hemoglobin, 7.8 [2.2] vs 7.1 [1.5%]), especially among South Asians (8.1[2.5%]) (P<.001), in whom insulin use was lower (12.8% vs 30.7% in other immigrants) (P<.001). However, the prevalence of chronic complications of diabetes was lower among immigrants, particularly that of macrovascular complications (7.7% vs 24.4%) (P<.01). CONCLUSIONS: In our study the profile of immigrant diabetics in Spain is one of a young diabetic without complications, but with worse metabolic control. These findings provide an excellent opportunity to implement preventive measures.

La cirugía bariátrica como tratamiento de la diabetes tipo 2 / Bariatric surgery for the treatment of type 2 diabetes mellitus

La pérdida de peso puede mejorar el control metabólico de los pacientes con diabetes mellitus tipo 2, aunque la eficacia del tratamiento convencional es limitada. La cirugía bariátrica ha demostrado que, además de producir pérdidas de peso importantes y mantenidas, puede en la mayoría de casos mejorar o resolver la diabetes. Los cambios anatómicos y la modificación en la secreción de las hormonas intestinales pueden explicar la mayor eficacia de las técnicas malabsortivas. En la actualidad la cirugía bariátrica es una alternativa terapéutica en los sujetos diabéticos tipo 2 con obesidad grave de difícil control metabólico con el tratamiento convencional y la investigación se centra en el efecto de las hormonas intestinales, en desarrollar nuevas técnicas y en conocer qué papel puede jugar la cirugía bariátrica en sujetos sin obesidad (AU)

Weight loss can improve metabolic control in patients with type 2 diabetes mellitus but the results of conventional therapy in this respect have been discouraging. Besides achieving significant and sustained weight loss, bariatric surgery can improve or resolve type 2 diabetes mellitus in the majority of patients. Anatomical modifications and changes in the secretion of intestinal hormones can explain the superiority of malabsorptive techniques. Currently, bariatric surgery offers a therapeutic alternative for type 2 diabetes patients with severe obesity and poor metabolic control under conventional therapy. Ongoing research will provide insights regarding the effect of intestinal hormones, new surgery techniques and the possible benefits of bariatric surgery in non-obese patients (AU)

[Bariatric surgery for the treatment of type 2 diabetes mellitus]. / La cirugía bariátrica como tratamiento de la diabetes tipo 2.

Weight loss can improve metabolic control in patients with type 2 diabetes mellitus but the results of conventional therapy in this respect have been discouraging. Besides achieving significant and sustained weight loss, bariatric surgery can improve or resolve type 2 diabetes mellitus in the majority of patients. Anatomical modifications and changes in the secretion of intestinal hormones can explain the superiority of malabsorptive techniques. Currently, bariatric surgery offers a therapeutic alternative for type 2 diabetes patients with severe obesity and poor metabolic control under conventional therapy. Ongoing research will provide insights regarding the effect of intestinal hormones, new surgery techniques and the possible benefits of bariatric surgery in non-obese patients.

Hipertiroidismo en el síndrome de Down / Hyperthyroidism in Down síndrome

La patología tiroidea, sobre todo el hipotiroidismo, es frecuenteen las personas con síndrome de Down (SD). El hipertiroidismotambién se presenta con mayor frecuencia enlos pacientes con SD, si bien hasta ahora sólo se habían publicadocasos aislados o series cortas. Recientemente, hemospublicado la serie más extensa a día de hoy sobre la relaciónentre hipertiroidismo y SD. Se realizó una revisión sistemáticade los 1.856 pacientes atendidos en la Fundació CatalanaSíndrome de Down (FCSD) entre los años 1991 y 2006 y sediagnosticaron 12 casos de hipertiroidismo. La etiología fueen todos ellos la enfermedad de Graves y, tras un tratamientoinicial con fármacos antitiroideos, todos los pacientes requirierontratamiento definitivo con Yodo 131. El diagnósticoprecoz mediante cribado anual bioquímico suele ser ineficazcomparado con los resultados que da con el hipotiroidismo.El hipertiroidismo puede tener efectos sobre el crecimiento yel desarrollo de los niños y adolescentes con SD, que son reversiblescon la instauración del tratamiento (AU)

Thyroid conditions, particularly hypothyroidism, arecommon in people with Down syndrome (DS). Hyperthyroidismis also found at a higher-than-average rate in patientswith DS, although only isolated case reports andshort series had been published up until now. We recentlypublished the longest series so far examining the relationshipbetween hyperthyroidism and DS. A systematicreview of the 1,856 patients seen at Fundació CatalanaSíndrome de Down (FCSD) from 1991 to 2006 was undertaken,and 12 cases of hyperthyroidism were diagnosed.The etiological cause was found to be Graves diseasein all cases. After initial treatment with antithyroid drugs,all patients required definitive treatment with radioactiveiodine I-131. Annual biochemical screening for earlydiagnosis is less effective than it is for hypothyroidism.Hyperthyroidism may influence growth and developmentin children with DS; treatment can reverse its impact (AU)