Precisión del diagnóstico de depresión en pacientes con diabetes mellitus tipo 1 / Accuracy of diagnosis of depression in patients with Type 1 diabetes mellitus

Este estudio valora la precisión que tiene el clínico (Médico Especialista en Endocrinología y Nutrición: MEEN) al realizar el diagnóstico de depresión en pacientes con diabetes mellitus tipo 1 (DM1). Participaron 11 MEEN y 153 pacientes con DM1. El diagnóstico de depresión se realizó mediante la entrevista estructurada SCID-1 y la valoración del clínico. De la muestra inicial se seleccionaron aleatoriamente 50 pacientes (imponiendo la condición de que estuviera compuesta por 25 pacientes con depresión y 25 sin depresión). Los resultados muestran que los clínicos realizaron un mayor porcentaje de diagnósticos negativos (paciente sin depresión) que positivos (paciente con depresión). Un porcentaje considerable de pacientes con depresión no fueron diagnosticados (25%). Parece, pues, necesario dotar a los clínicos de protocolos adecuados para evaluar la presencia de este trastorno en DM1, así como continuar la investigación sobre el proceso diagnóstico para la toma de decisiones clínicas (AU)

This study assesses the clinical accuracy of physicians (Specialists in Endocrinology and Nutrition: SEN) to make the diagnosis of depression in patients with Type 1 diabetes mellitus (DM1). This study involved 11 SEN physicians, and 153 patients with DM1. The diagnosis of depression was performed using the SCID-1 structured interview and clinical assessment. From the initial sample, 50 patients were randomly selected (imposing the condition that it was included 25 patients with depression and 25 without depression). The results show that clinicians performed a higher percentage of negative diagnoses (patients without depression) than positive ones (patients with depression). A significant percentage of patients with depression were not diagnosed (25%). It therefore seems necessary to provide adequate clinical protocols to evaluate the presence of this disorder in DM1, as well as continuing research into the diagnostic process for clinical decision making (AU)

[Accuracy of diagnosis of depression in patients with Type 1 diabetes mellitus]. / Precisión del diagnóstico de depresión en pacientes con diabetes mellitus tipo 1.

This study assesses the clinical accuracy of physicians (Specialists in Endocrinology and Nutrition: SEN) to make the diagnosis of depression in patients with Type 1 diabetes mellitus (DM1). This study involved 11 SEN physicians, and 153 patients with DM1. The diagnosis of depression was performed using the SCID-1 structured interview and clinical assessment. From the initial sample, 50 patients were randomly selected (imposing the condition that it was included 25 patients with depression and 25 without depression). The results show that clinicians performed a higher percentage of negative diagnoses (patients without depression) than positive ones (patients with depression). A significant percentage of patients with depression were not diagnosed (25%). It therefore seems necessary to provide adequate clinical protocols to evaluate the presence of this disorder in DM1, as well as continuing research into the diagnostic process for clinical decision making.

Evaluación de los hábitos alimentarios relacionados con la ingesta de yodo, el estado nutricional de yodo y disfunción tiroidea en cuatro poblaciones no seleccionadas (proyecto Tirobus) / Assessment of dietary habits related to iodine intake and iodine concentration and thyroid dysfunction in a non-preselected population in Spain (the Thyrobus Project)

Introducción La mayoría de los últimos estudios realizados en España sobre el estado nutricional de yodo muestran una significativa mejoría. Con motivo de una campaña de información sobre la glándula tiroides, la importancia del yodo y el hipotiroidismo, efectuada en 4 ciudades de España, se realizó un estudio para conocer el consumo de alimentos ricos en yodo, la yoduria y la prevalencia de disfunciones tiroideas. Material y métodos Población no seleccionada que acudió a los centros de información de la campaña realizada en Barcelona, A Coruña, Málaga y Madrid. Se realizó una encuesta sobre el consumo de pescado, leche y sal yodada. Se analizó la yoduria (método Pino) y la tirotropina (TSH) (muestra recogida en papel absorbente Whatman-903®).Resultados Se realizaron 872 encuestas (el 40% en Madrid, el 27% en A Coruña, el 19% en Málaga y el 14% en Barcelona). La edad media de la población encuestada era de 51 años (DE: 16) siendo el 81% mujeres. Afirmaba consumir sal yodada el 60,6%; el 90,8% consumía leche diariamente y el 29,3% consumía pescado 3 veces o más por semana. La mediana de yoduria fue de 143,2μg/l. La prevalencia de TSH elevada (>4mUI/l) fue del 1,3% y de TSH baja (<0,4mUI/l) fue del 1,2%.ConclusionesLa mediana de la yoduria global o por ciudades es indicativa de una nutrición óptima de yodo (según criterios de la Organización Mundial de la Salud). Probablemente, productos como la leche y el pescado, además de la sal yodada, pueden haber influido en estos resultados. La prevalencia de hipertiroidismo e hipotiroidismo no conocido detectada es similar a la descrita en otros estudios (AU)

Introduction Most of the studies on urinary iodine levels in Spain in the last decade have reported a significant improvement. A survey was undertaken together with an information campaign on the thyroid gland, the importance of iodine intake and hypothyroidism in four Spanish cities. The goals of the survey were to obtain information on consumption of iodine-containing foods, to measure urinary iodine levels and to evaluate the prevalence of thyroid dysfunction. Materials and methods A non-preselected population attending the information campaign centers located in Barcelona, La Coruña, Malaga and Madrid was studied. A questionnaire on fish, milk and iodized salt consumption was administered. Urinary iodine levels (Pino's method) and thyrotropin (TSH) concentrations (Whatman 903® dry paper method) were measured. Results A total of 872 questionnaires were completed (Madrid 40%; La Coruña 27%; Malaga 19%; and Barcelona 14%). The mean age was 51 years (SD 16); 81% were women. A total of 60.6% of interviewees reported they consumed iodized salt, 90.8% reported daily milk intake and 29.3% reported fish consumption ≥3 times per week. The mean urinary iodine concentration was 143.2μg/L. The prevalence of high TSH levels (>4mUI/L) was 1.3% and that of low TSH levels (<0.4mUI/mL) was 1.2%.Conclusions According to the World Health Organization criteria, the median urinary iodine concentration, both overall or by city, is indicative of optimal iodine intake. In addition to iodized salt intake, consumption of products such as milk and fish has probably contributed to these positive results. The prevalences of undiagnosed hyperthyroidism and hypothyroidism detected in this study were similar to those found in other studies (AU)

Efectos de la deficiencia de yodo sobre variables intelectuales en una población infantil / Effects of the iodine deficiency on intellectual variables among children

Existen numerosos estudios que relacionan la deficiencia grave de yodo con la disminución de diferentes capacidades mentales superiores. En este trabajo se pretende conocer qué ocurre cuando la deficiencia de yodo no es tan grave como en los citados trabajos, sino que se trata de una falta de yodo leve o incluso moderada, y si los problemas comunes con una deficiencia grave de yodo (incluyendo el retraso mental) siguen apareciendo de una manera más sutil. Además, también interesa conocer si la metodología clásica (comparar zona yododeficiente contra zona no yododeficiente) es la más adecuada, proponiendo combinar esa agrupación por zonas con la yoduria presentada por los individuos de cada zona. Se evalúa cociente intelectual, capacidad manipulativa y verbal, atención, habilidad visomotora y comportamiento disruptivo, estudiadas muy pocas veces o ninguna en este tipo de investigaciones. La muestra la componen 760 escolares de la provincia de Jaén. Los resultados muestran que se encuentra un cociente intelectual más bajo en la zona yododeficiente y en niños con baja yoduria, cosa que no sucede en la zona yodosuficiente. También se ha visto asociado al nivel de yoduria el comportamiento disruptivo. Las otras variables medidas no se han asociado con déficit de yodo

An association between severe iodine deficiency and poor mental development has been found in many studies. We examined the relationship between moderate or mild iodine deficiency and intellectual capacity in order to determine whether problems common to severe iodine deficiency (including mental retardation) also emerge in a more subtle form. We also wished to know whether the classic methodology (comparing iodine-deficient zones with nondeficient zones) is the most adequate, and propose to combine this grouping by zones with urinary iodine presented by individuals in each zone. We measured IQ, manipulative and verbal capacity, attention, visual motor ability and disruptive behaviour, variables that have barely been studied in this kind of investigations. The sample comprised 760 schoolchildren from the province of Jaén (southern Spain). Our results show that children with low levels of iodine intake and with urinary iodine concentration lower than 100 µg/litre had a lower IQ and displayed more disruptive behaviour than children with high levels of the criteria. The other variables were not associated with iodine deficiency

[Effects of the iodine deficiency on intellectual variables among children]. / Efectos de la deficiencia de yodo sobre variables intelectuales en una población infantil.

An association between severe iodine deficiency and poor mental development has been found in many studies. We examined the relationship between moderate or mild iodine deficiency and intellectual capacity in order to determine whether problems common to severe iodine deficiency (including mental retardation) also emerge in a more subtle form. We also wished to know whether the classic methodology (comparing iodine-deficient zones with nondeficient zones) is the most adequate, and propose to combine this grouping by zones with urinary iodine presented by individuals in each zone. We measured IQ, manipulative and verbal capacity, attention, visual motor ability and disruptive behaviour, variables that have barely been studied in this kind of investigations. The sample comprised 760 schoolchildren from the province of Jaén (southern Spain). Our results show that children with low levels of iodine intake and with urinary iodine concentration lower than 100 microg/litre had a lower IQ and displayed more disruptive behaviour than children with high levels of the criteria. The other variables were not associated with iodine deficiency.

Osteoporosis y trasplante de órgano sólido / Osteoporosis and solid organ transplantation

El trasplante de órgano sólido se ha establecido como una opción importante para el tratamiento de muchas enfermedades. La osteoporosis es una complicación común tras un trasplante de órgano sólido y está relacionada con un incremento en la incidencia de fracturas y de la morbilidad en los receptores del trasplante. En esta presentación se pretende revisar los factores implicados en la patogenia de esta importante complicación, así como la evaluación, la prevención y las opciones posibles de tratamiento en la osteoporosis postrasplante (AU)

Solid organ transplantation has become an established treatment option for many diseases. Osteoporosis is a common complication after solid organ transplantation and is associated with an increased incidence of fractures and related morbidity in transplant recipients. The present article reviews the factors contributing to the pathogenesis of this serious complication. The evaluation and prevention of post-transplantation osteoporosis, as well as the available treatment options, are also discussed (AU)

Excess hospitalizations, hospital days, and inpatient costs among people with diabetes in Andalusia, Spain.

OBJECTIVE: The goal of this study was to estimate the excess hospitalizations, hospital days, and inpatient costs attributable to diabetes in Andalusia, Spain (37 hospitals, 7,236,459 inhabitants), during 1999 compared with those without diabetes. RESEARCH DESIGN AND METHODS: This study was an analysis of all hospital discharges. Those with an ICD-9-CM code of 250 as either the main or secondary diagnosis were considered to have been admissions of individuals with diabetes. An estimate of costs was applied to each inpatient admission by assigning a cost weight based on the diagnostic-related group (DRG) related to each admission. RESULTS: A total of 538,580 admissions generated 4,310,654 hospital bed-days and total costs of 940,026,949 euro. People with diabetes accounted for 9.7% of all hospital discharges, 13.8% of total stays, and 14.1% of the total cost. Of the total cost for individuals with diabetes (132,509,217 euro), 58.3% were excess costs, of which 47% was attributable to cardiovascular complications and 43% to admissions for comorbid diseases. Individuals 45-75 years of age accounted for 75% of the excess costs. The rate of admissions during the study year was 145 per 1,000 inhabitants for individuals with diabetes compared with 70 admissions per 1,000 inhabitants for individuals without diabetes. CONCLUSIONS: The costs arising from hospitalization of individuals with diabetes are disproportionate in relation to their prevalence. For those aged >or=45 years, cardiovascular complications were clearly the most important factor determining increased costs from diabetes.

[Iodine deficiency and thyroid function in healthy pregnant women]. / Déficit de yodo y función tiroidea en una población de mujeres embarazadas sanas.

BACKGROUND AND OBJECTIVE: Studies from Spain suggest that the intake of iodine in pregnant women is below nutritional requirements. This study was designed to determine iodine intake and its relation with thyroid volume during pregnancy in women from southeast Spain. PATIENTS AND METHOD: A total of 520 healthy pregnant women were studied during the full three trimesters of their pregnancy. A control group was composed of 373 non-pregnant women. The following variables were measured: TSH, FT3, FT4, thyroglobulin, antiperoxidase antibodies, urinary iodine levels, and thyroid volume. RESULTS: Median urinary iodine levels were below 100 g/l in the controls and the pregnant women during their first trimester. These levels rose progressively and significantly over the second and third trimesters. Thyroid volume increased during the second and third trimesters compared with the first. TSH levels were lower during the first trimester compared to controls, and increased significantly during the third trimester. FT4 levels fell significantly during the third trimester. There was a significant negative correlation between TSH levels and thyroid volume (r = 0.22; p = 0.005). CONCLUSIONS: Iodine intake in pregnant women in Malaga is low. The results suggest a deficit in thyroid function secondary to iodine deficiency, which is worsened as pregnancy advances. The data support the convenience of systematic administration of an iodine supplement in healthy pregnant women.

La irresistible ascensión de la célula adiposa / The irresistible ascent of the adipose cell

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Prevalence of latent autoimmune diabetes of adults (LADA) in Southern Spain.

OBJECTIVE: To study the prevalence of diabetes mellitus and islet autoantibodies in an adult population from Southern Spain. RESEARCH AND METHODS: A cross-sectional study in Southern Spain of 1226 people, age 18-65 years. Clinical data were obtained and a blood sample taken to measure autoantibodies (glutamic acid decarboxylase antibodies (GADAb), tyrosine phosphatase antibodies (IA2Ab), and insulin antibodies (IAA)). An oral glucose tolerance test (OGTT) was also given to 982 of the subjects. RESULTS: The overall prevalence of diabetes mellitus according to the WHO 1979 criteria was 10.9% and according to the ADA 1997 criteria it was 14.7% (8.8% were unaware of their diabetes). The prevalence of impaired fasting glucose (IFG) was 12.4% and of impaired glucose tolerance (IGT) 11.5%. The prevalence of GADAb+ in the general population was 0.9% and in the diabetic population 3.7%. There were no significant differences between groups in the prevalence of IA2Ab or IAA (both were 0.8% in the general population). Of the three autoantibodies studied, only GADAb were significantly different in the diabetic population (P=0.0006). CONCLUSIONS: The prevalence of Type 2 diabetes and LADA are high in the south of Spain.

La obsesión metodológica / Obsession for the method

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