Evolution of interconsultal activity to endocrinology and nutrition in hospitalization floor in a third level hospital.

INTRODUCTION: Endocrinology and Nutrition (EyN) is an outpatient and hospital medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. MATERIAL AND METHODS: Longitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. RESULTS: A total of 76093 IC notes (12623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. CONCLUSIONS: The EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC.

All-cause mortality and risk factors in patients with type 1 diabetes in Castilla-La Mancha, Spain. DIACAM1 2010-2020 study.

INTRODUCTION: Despite better treatments and care for patients with type 1 diabetes (T1DM), all-cause and cardiovascular mortality still remains higher compared to the general population. We evaluated mortality and risk factors for mortality in a representative cohort of patients with T1DM. METHODS: DIACAM1 was a cross-sectional, multicenter study on adult patients (≥ 16 years old) and diabetes with at least 5 years since diabetes diagnosis conducted between 2009 and 2010. DIACAM1 2010-2020 study was a follow-up study, extension of DIACAM1, where vital status of patients was evaluated between June 2019 and June 2020. RESULTS: 4.03% [CI95%, 2.53-5.62) of the 1465 patients with T1DM included in the cohort of the DIACAM1 in 2010 had died. Survival was lower than in the sex- and age-matched general population in the same region. 40.7% of deaths were due to cardiovascular disease. HbA1c levels < 7% and triglyceride levels < 150 mg/dL were associated with lower mortality, whereas retinopathy and plasma creatinine were associated with increased mortality. CONCLUSIONS: We confirmed a lower survival in people with T1DM, with cardiovascular disease being the main cause of mortality. High HbA1c, high triglycerides, retinopathy, and high creatinine are factors associated with mortality.

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.

Time-in-range for monitoring glucose control: Is it time for a change?

The HbA1c value has been the gold standard for evaluating glucose control for decades. However, it has limitations such as the lack of information on glycemic variability or the risk of hypoglycemia. The increasing use of continuous glucose monitoring has provided patients and healthcare professionals with a range of useful metrics for the management of diabetes. Among them, Time in Range (TIR) is a simple and intuitive metric that gives information regarding the quality of glucose control. It is defined as the time spent in an individual's target glucose range. TIR is strongly correlated with HbA1c, and it has been linked to the risk of developing microvascular and macrovascular complications. The International Consensus on Time in Range has recently set targets for different diabetes populations. For the majority of people with type 1 or type 2 diabetes, a TIR (70-180 mg/dL or 3.9-10.0 mmol/L) of >70%, a time below range (TBR) <70 mg/dL (<3.9 mmol/L) of <4% and a TBR <54 (<3.0 mmol/L) of <1% are recommended. In this review, we address the latest evidence for the use of TIR as an essential parameter in the management of diabetes.

Interference of Hb D-Los Angeles on the measurement of glycated hemoglobin. A case report / Interferencia en la medida de la hemoglobina glicada en presencia de Hb D-Los Angeles. Presentación de un caso clínico

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Tumor de células de Sertoli-Leydig del ovario; un tumor virilizante poco frecuente. Dos casos clinicopatológicos / Ovarian Sertoli-Leydig cell tumor, a rare virilizing tumour. A report of 2 cases

Los tumores de células de Sertoli-Leydig son neoplasias ováricas infrecuentes; representan apenas el 0,5% de todos los tumores del ovario. Aunque estos tumores secretan andrógenos, produciendo signos de virilización, sin embargo, no todos son funcionalmente activos. El tratamiento y pronóstico dependen de la edad, el estadio y el grado de diferenciación tumoral. Presentamos 2 casos clinicopatológicos de mujeres de 13 y 47 años de edad, ambas con datos de androgenismo, hirsutismo e imagen de lesión sólida en el ovario. Fueron intervenidas quirúrgicamente con diagnóstico anatomopatológico de tumor de células de Sertoli-Leydig moderadamente diferenciado (AU)

Sertoli-Leydig cell tumors are uncommon ovarian neoplasms, accounting for only about 0.5% of all ovarian tumors. Although these tumors secrete androgen-producing signs of virilization, not all are functionally active. Treatment and prognosis depend on age and the stage and degree of tumor differentiation. We present 2 cases in a 13-year-old girl and a 47-year-old woman, both with findings of androgenism, hirsutism and images of solid lesion in the right ovary. Both patients underwent surgery with a histopathological diagnosis of moderately differentiated Sertoli-Leydig cell tumor (AU)

Características clínicas y tratamiento hipoglucemiante en pacientes con diabetes tipo 2 e inadecuado control glucémico de un área de salud de Castilla-La Mancha, España / Features of the disease, and hypoglycemia treatment in patients with type 2 diabetes and inadequate glycemic control in a health area of Castilla-La Mancha, Spain

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Clinical differences between patients with MODY-3, MODY-2 and type 2 diabetes mellitus with I27L polymorphism in the HNF1alpha gene.

OBJECTIVE: The aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1alpha gene. METHODS: The study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1alpha gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed. RESULTS: No differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene had no family history of diabetes (p < 0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene (p < 0.05). CONCLUSIONS: Occasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1alpha gene.

Clinical differences between patients with MODY-3, MODY-2 and type 2 diabetes mellitus with I27L polymorphism in the HNF1alfa gene

Objective: The aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1α gene. Methods: The study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1α gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed. Results: No differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1α gene had no family history of diabetes (p < 0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1α gene (p < 0.05). Conclusions: Occasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1α gene

Objetivos: El objetivo de este estudio es describir y evaluar las características clínicas y metabólicas de pacientes diabéticos MODY 3, MODY 2 y con diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α. Métodos: Se incluyó a 31 pacientes diagnosticados previamente y en seguimiento en consultas externas por diabetes tipo MODY 3, MODY 2 y diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α: 10 pacientes diagnosticados de diabetes MODY 3 (pertenecientes a 5 familias); 15 pacientes con diabetes MODY 2 (pertenecientes a 9 familias) y 6 pacientes diagnosticados de diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α. Se analizan las características clínicas, antropométricas y metabólicas de los pacientes. Resultados: No se objetivaron diferencias en la distribución por sexos y edad o forma de diagnóstico de la diabetes. Todos los pacientes con diabetes MODY 2 y MODY 3 tenían antecedentes familiares de diabetes. El 33,3% de los pacientes con diabetes tipo 2 portadores del polimorfismo I27L en el gen HNF1α no tenían antecedentes familiares de diabetes (p > 0,05). No se encontraron diferencias en el IMC, la prevalencia de hipertensión arterial o la incidencia de complicaciones microvasculares o macrovasculares. En cuanto al tratamiento, el 100% de los pacientes con diabetes MODY 3 necesitaban tratamiento farmacológico. El 100% de los pacientes con diabetes MODY 2 y el 16,7% de los pacientes con diabetes tipo 2 y el polimorfismo I27L en el gen HNF1α no necesitaban tratamiento farmacológico (p > 0,05). Conclusiones: Este artículo realza la dificultad en la correcta clasificación clínica de los pacientes con diabetes MODY 2, MODY 3 y diabéticos tipo 2 con características clínicas atípicas, en este caso portadores del polimorfismo I27L en el gen HNF1α

[Variations in the concentration of the sex hormone binding globulin is a major factor causing a variation in total testosterone values]. / Variaciones en las concentraciones de globulina transportadora de hormonas sexuales como causa importante de alteraciones en las concentraciones de testosterona total.

Measurement of total testosterone concentrations is the initial test for the diagnosis of androgen deficiency or excess in men. However, total testosterone concentrations may be affected by alterations in sex hormone binding globulin (SHBG) concentrations. Most circulating testosterone is bound to SHBG and to albumin and only 0.5-3% of circulating testosterone is unbound or free. The free fraction can be measured by equilibrium dialysis or calculated using published algorithms. The term bioavailable testosterone refers to unbound testosterone plus albumin-bound testosterone; this term reflects the view that, in addition to unbound testosterone, albumin-bound testosterone is readily dissociable and thus bioavailable. Bioavailable testosterone can be measured by precipitation methods or calculated from total testosterone, SHBG, albumin concentrations and their affinity constants. Free testosterone measurements by analog methods are frequently available, but these measurements are affected by alterations in SHBG and are inaccurate. We report the cases of a 42-year-old man with testosterone excess and a 29-year-old man with testosterone deficiency, in whom total testosterone concentrations were affected by SHBG alterations.

Variaciones en las concentraciones de globulina transportadora de hormonas sexuales como causa importante de alteraciones en las concentraciones de testosterona total / Variations in the concentration of sex hormone binding globulin (SHBG) is a major factor causing variations in total testosterone values

La determinación de testosterona total es el primer paso para establecer el diagnóstico de déficit o de exceso de testosterona en varones, pero las concentraciones de testosterona total pueden verse afectadas por un exceso o un déficit de globulina transportadora de hormonas sexuales (SHBG). La mayor parte de la testosterona total circulante se encuentra unida a SHBG y albúmina y sólo el 0,5-3% de la testosterona circulante es testosterona libre. La testosterona libre se puede medir por diálisis en equilibrio o calcularla mediante algoritmos publicados. La testosterona biodisponible hace referencia a la testosterona no unida a proteínas más la testosterona unida a la albúmina; el término biodisponible refleja el hecho de que la testosterona unida a la albúmina es fácilmente disociable. La testosterona biodisponible se puede evaluar por el método de precipitado de SHBG o aproximarnos a su concentración mediante cálculos que utilizan las concentraciones de testosterona total, SHBG, albúmina y sus constantes de afinidad. Debemos tener en cuenta que hay ensayos para determinar testosterona libre que pueden verse afectados por las alteraciones de la SHBG y, por lo tanto, son inadecuados. Presentamos el caso de un varón de 42 años con exceso de testosterona y el de un varón de 29 años con déficit de testosterona, que se debían a la influencia de la testosterona total por la SHBG (AU)

Measurement of total testosterone concentrations is the initial test for the diagnosis of androgen deficiency or excess in men. However, total testosterone concentrations may be affected by alterations in sex hormone binding globulin (SHBG) concentrations. Most circulating testosterone is bound to SHBG and to albumin and only 0.5-3% of circulating testosterone is unbound or free. The free fraction can be measured by equilibrium dialysis or calculated using published algorithms. The term bioavailable testosterone refers to unbound testosterone plus albumin-bound testosterone; this term reflects the view that, in addition to unbound testosterone, albumin-bound testosterone is readily dissociable and thus bioavailable. Bioavailable testosterone can be measured by precipitation methods or calculated from total testosterone, SHBG, albumin concentrations and their affinity constants. Free testosterone measurements by analog methods are frequently available, but these measurements are affected by alterations in SHBG and are inaccurate. We report the cases of a 42-year-old man with testosterone excess and a 29-year-old man with testosterone deficiency, in whom total testosterone concentrations were affected by SHBG alterations (AU)

Cetoacidosis diabética y distrés respiratorio agudo / Diabetic ketoacidosis and acute respiratory distress

El síndrome de distrés respiratorio del adulto (SDRA) es una complicación infrecuente de la cetoacidosis diabética que aumenta notablemente su mortalidad. Su patogenia es probablemente multifactorial. Se han propuesto como mecanismos el descenso brusco de la presión osmótica y las alteraciones hidroelectrolíticas que ocurren durante el tratamiento, en especial la hipofosfatemia. Presentamos el caso de un varón de mediana edad que desarrolló un SDRA durante el tratamiento de un episodio de cetoacidosis (AU)

Acute respiratory distress (ARDS) is a rare complication of diabetic ketoacidosis that markedly increases mortality. The pathogenesis of this entity is probably multifactorial and includes a rapid decrease of osmotic pressure and electrolyte changes occurring during treatment, especially hypophosphatemia. We describe the case of a middle-aged man with acute respiratory distress complicating diabetic ketoacidosis (AU)

Neuralgia del trigémino como manifestación de un macroadenoma hipofisario / Trigeminal neuralgia as a manifestation of pituitary macroadenoma

Los adenomas hipofisarios son tumores con un comportamiento generalmente benigno aunque en alrededor del 9 al 40% de los casos invaden estructuras vecinas. La extensión hacia los senos cavernosos de los adenomas hipofisarios puede producir una compresión de las estructuras que alberga, como los pares craneales oculomotores (III, IV y VI) y la primera y la segunda rama del trigémino. La cefalea es un síntoma frecuente en los pacientes que presentan un adenoma hipofisario y puede estar producida por múltiples causas. La neuralgia del trigémino como consecuencia de la compresión del nervio en su recorrido por el seno cavernoso es una causa rara de cefalea en estos pacientes, y es todavía más infrecuente que éste sea el único síntoma que produzca un adenoma hipofisario. Presentamos el caso de una paciente con un macroprolactinoma que presentó como síntoma una neuralgia del trigémino con una remisión completa del dolor tras el tratamiento del adenoma con cabergolina (AU)

Pituitary adenomas are generally regarded as benign tumors, although they can invade neighboring structures such as the cavernous sinus in 9-40% of cases. Extension of pituitary adenomas towards the cavernous sinus can compress the cranial nerves in the area, such as cranial nerves III, IV and VI, and the first and second branches of the trigeminal nerve. Headache is frequent in patients with pituitary adenoma and can be caused by multiple entities. Trigeminal neuralgia as a result of trigeminal nerve compression is a rare cause of headache in these patients and is even more unusual as an isolated symptom. We present the case of a patient with a macroprolactinoma causing trigeminal neuralgia. Complete remission of pain was produced after the adenoma was treated with cabergoline (AU)

Bocio amiloide secundario a enfermedad de Crohn / Amyloid goiter secondary to Crohn’s disease

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