Physicians' Perception of Oral Nutritional Supplement Acceptance and Tolerability in Malnourished Outpatients: PerceptiONS Study.

Malnutrition is a common condition associated with various pathologies such as infections, neoplasms and digestive system disorders. Patients can be managed using different strategies, which include dietary modifications or oral nutritional supplements (ONS). It is important to promote good ONS adherence in order to attain clinical efficacy and cost-effectiveness. Several factors (amount, type, duration and tolerability) may have an impact on ONS adherence. PerceptiONS is a descriptive, cross-sectional observational study based on an ad hoc electronic survey designed to explore physicians' perception of malnourished outpatients prescribed ONS. The survey considered adherence, acceptance/satisfaction, tolerability and benefits within the context of Spain's healthcare system. The perceptions of 548 physicians regarding the experience of 2516 patients were analyzed. From the physicians' perspective, 57.11% of patients adhered to over 75% of the prescribed ONS. The organoleptic properties of ONS represented the aspect with the most positive impact on adherence, with smell (43.72%) ranking as the top characteristic. In general, patients were satisfied (90.10%) with the ONS, with their related benefits (88.51%) and their organoleptic properties (90.42%), and accepted ONS in their daily diet (88.63%). ONS improved patients' general condition (87.04%), quality of life (QoL) (81.96%) and vitality/energy (81.28%). Physicians would prescribe the same ONS again in 96.4% of the cases.

[Real-life efficacy and safety of PCSK9 inhibitors treatment: Experience in three hospitals in Asturias]. / Efectividad y seguridad del tratamiento con iPCSK9 en vida real: experiencia de tres hospitales asturianos.

BACKGROUND: Inhibitors of proprotein convertase subtilisin/kexin type9 (PCSK9 inhibitors) are a treatment option for those patients with familial hypercholesterolemia or in secondary prevention who do not reach the LDL-C target with other therapeutic measures. The aim of this study is to assess the effectiveness and safety of these drugs. METHODS: Retrospective, multicentric, descriptive study. We collected data from all patients that have started PCSK9 inhibitors treatment in three hospitals in Asturias since the beginning of its use in 2016. We analysed changes in lipid profile with PCSK9 inhibitors and its side effects. RESULTS: We registered 98 patients, 75 of them affected by familial hypercholesterolemia (FH) and 23 unaffected. Two months after the beginning of PCSK9 inhibitors treatment, a 61% reduction rate in LDL-C in patients with FH and 52% in those without this condition was observed. This statistically significant reduction remained stable during follow-up. A significant decrease in total cholesterol was observed, without significant changes in HDL-C and triglycerides. 96% of patients had no complications. CONCLUSIONS: PCSK9 inhibitors are safe drugs that rapidly achieve significant reductions in LDL-C after the beginning of treatment, which are maintained over time. Hence, the use of PCSK9 inhibitors is an alternative for the control of LDL-C in those patients in which the LDL-C target is not reached with other therapeutic measures.

Estrategia de detección de disfunción tiroidea en la gestación: cribado universal o selectivo / Universal vs. selective screening for thyroid dysfunction in pregnancy

Objetivo: Estimar la efectividad del cribado selectivo frente al universal en la detección de disfunción tiroidea (DT) en el embarazo en condiciones de práctica clínica. Material y métodos: Estudio de diseño transversal basado en la identificación de gestantes con factores de riesgo (FR) de DT en una cohorte de 220 mujeres con cribado poblacional positivo. El estudio se desarrolló en el Área Sanitaria de Oviedo entre abril del 2010 y marzo del 2011. Resultados: Se identificaron FR en el 83,6% de las gestantes con DT. Los FR más prevalentes fueron la edad ≥ 30 años (70,5%), la historia de abortos previos (21,8%) y la historia familiar de patología tiroidea (20,9%). Sin tener en cuenta la edad, solo el 51,8% de las gestantes presentaba FR. Conclusiones: El cribado selectivo logra identificar una elevada proporción de gestantes con DT pero a expensas de incluir en el cribado a un gran número de mujeres, por lo que no parece una estrategia efectiva

Objective: To estimate the effectiveness of selective versus universal screening for thyroid dysfunction (TD) during pregnancy. Material and methods: Cross-sectional study applying a selective screening protocol, based on the presence of TD risk factors (RF), in a cohort of pregnant women with a positive universal screening result in the Oviedo Healthcare District. Two hundred and twenty pregnant women with TD were studied between April 2010 and March 2011. Results: Selective screening identified 83.6% of pregnant women with TD. The most prevalent RF were maternal age ≥ 30 years (70.5%), history of miscarriage (21.8%) and family history of thyroid disease (20.9%). Excluding the age factor, only 51.8% of the pregnant women included in the group had risk factors. Conclusions: Selective screening identifies a high proportion of pregnant women with TD but at the expense of screening a large number of women, so it does not appear to be an effective strategy

Insulinoma. Criterios diagnósticos y tratamiento / Insulinoma. Diagnostic criteria and treatment

Los insulinomas son tumores poco frecuentes derivados de las célulasbeta de los islotes pancreáticos. En el 90% de los casos sonesporádicos, únicos y de pequeño tamaño. La secreción autónomade insulina da lugar a hipoglucemias, preferentemente de ayuno, consíntomas neuroglucopénicos. El diagnóstico bioquímico se basa enla demostración de un patrón de hiperinsulinismo endógeno duranteun episodio de hipoglucemia espontánea o inducida por el ayuno. Latomografía computarizada de alta resolución y la ecografía endoscópicaconstituyen los métodos de elección para el diagnóstico prequirúrgico,ya que localizan prácticamente el 100% de los tumores;otras técnicas se reservan para casos seleccionados. La cirugía esel tratamiento de elección, con la que se obtienen altas tasas de curación.Para el control de la hipoglucemia refractaria se utilizan determinadosfármacos, como el diazóxido. Actualmente, se encuentranen fase de desarrollo nuevas estrategias terapéuticas(AU)

Insulinomas are rare islet cell tumors of the pancreas. Ninety percentare sporadic, usually single and small. The autonomous insulinsecretion results in hypoglycaemia, mostly fasting hypoglycaemia,with neuroglucopenic symptoms. Biochemical diagnosis is establishedby demonstrating an endogenous hyperinsulinism pattern duringa spontaneous or fasting-induced episode of hypoglycaemia.High resolution computer tomography and endoscopic ultrasonographyare the preferred imaging techniques for diagnosis beforesurgery, localizing almost 100% of tumors. Other procedures areused only in selected cases. Surgery removal of insulinoma is thetreatment of choice resulting in high overall cure rates. In cases ofrefractory hypoglycaemia medical management using drugs as diazoxidemay be used. Currently, novel therapeutic approaches arebeing developed(AU)