[COVID-19 and cardiovascular and kidney disease: Where are we? Where are we going?] / COVID-19 y enfermedad cardiovascular y renal: ¿Dónde estamos? ¿Hacia dónde vamos?

The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of cardiovascular and kidney disease in our patients. Primary care constitutes a key level of care for the care of the population with cardiovascular disease. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients.

Importancia de la detección de la disfagia en pacientes geriátricos / Importance of the detection of dysphagia in geriatric patients

Introducción. La disfagia orofaríngea es uno de los síndromes geriátricos menos conocidos, a pesar de su enorme impacto sobre la capacidad funcional, la calidad de vida y la salud de los individuos afectados. Material y método. Estudio descriptivo y prospectivo, por parte del Servicio de Geriatría del hospital de Barbastro (Huesca), desde marzo del 2012 hasta octubre del 2014, con fin de revisiones semestrales y anuales en octubre del 2015. Incluidos todos los paciente a los que se realizó método de exploración clínica de volumen-viscosidad (test MECV-V) por sospecha de disfagia. Resultados. El estudio incluyó a 266 pacientes, con una edad media de 82,35+/-12,3 años, con una puntuación media en el índice de Barthel de 20,5±25,4 y en el índice de Charlson de 1,77±1,6. El motivo de realización del test fue en 105 casos accidente cerebrovascular (40%), en 53 demencia (20%), en 24 parkinsonismos (9%) y por otros motivos diferentes en 80 (31%). Fueron diagnosticados de disfagia 228 casos (86%). Se instauró nutrición enteral en 25 casos (10,9%). Se reflejaron los resultados del test en el informe de alta en el 45% de los mismos con resultado positivo. La supervivencia media obtenida en los pacientes fallecidos desde la realización de test fue de 230,8±256,5 días. Encontramos diferencias en la supervivencia a los 12 meses en pacientes con test positivo, sin una clara relación con la situación funcional ni con la comorbilidad. Conclusiones. La disfagia conlleva una importante mortalidad, debiendo reflejarse adecuadamente el uso de espesantes tras su detección

Introduction. Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. Material and methods. A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. Results. The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. Conclusions. Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported

[Importance of the detection of dysphagia in geriatric patients]. / Importancia de la detección de la disfagia en pacientes geriátricos.

INTRODUCTION: Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. MATERIAL AND METHODS: A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. RESULTS: The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. CONCLUSIONS: Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported.

[Thermoplastic mask in radiotherapy: a source of anxiety for the patient?]. / Le masque de contention en radiothérapie : une source d'anxiété pour le patient ?

PURPOSE: The thermoplastic mask often used to immobilize patients in radiotherapy can cause varying levels of stress and anxiety. This study aimed at evaluating the anxiety related to the use of radiotherapy masks and the coping strategies adopted by patients. PATIENTS AND METHODS: Nineteen patients treated with radiotherapy mask for head and neck cancer, a brain tumour or a lymphoma, were met twice by a psychologist, either after the making of the mask and the first course of radiotherapy, or in the middle and at the end of treatment. Thirty-four semi-structured interviews were treated using a thematic content analysis and 13 patients answered to anxiety (STAI-YB) and coping (WCC) scales. RESULTS: The STAI-YB anxiety scores related to wearing the masks were low during the radiotherapy treatment period, and were confirmed by the remarks of patients recorded during the semi-structured interviews. Most patients had a positive perception of the mask, and considered it as a friend or protection. Twelve out of the 13 patients admitting to anxiety benefited from problem focused coping strategies. CONCLUSIONS: Thermoplastic mask-related anxiety is low and possibly lies in the positive representation patients have about the mask. The explanations provided by health professionals on the radiotherapy mask possibly have a very positive effect on this perception.

Management of malignant insulinoma

AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment (AU)

Management of malignant insulinoma.

AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.

Obesidad y síndrome de apneas-hipopneas del sueño / Obesity and sleep apnea-hypopnea syndrome

El síndrome de apneas-hipopneas del sueño (SAHS) se debe fundamentalmenteal colapso de la vía respiratoria superior durante el sueño. La obesidadviene definida por un exceso de grasa corporal, que conlleva habitualmente unaumento del peso corporal. La elevada mortalidad cardiovascular en pacientescon obesidad se debe a la propia obesidad y a su asociación con otros factoresde riesgo cardiovascular. El SAHS es uno de los factores de riesgo cardiovascularmás prevalentes y de mayor riesgo asociados a la obesidad. El diagnósticode SAHS en pacientes obesos se realiza mediante polisomnografía. Eltratamiento de este síndrome y de la obesidad requiere un abordaje multidisciplinarque abarque el tratamiento con los modernos sistemas de presióncontinua positiva por vía nasal (CPAP) y auto-CPAP durante el sueño, junto conla modificación del estilo de vida para la consecución de una pérdida ponderal(tratamiento dietético, ejercicio físico y modificación de la conducta). En ocasiones,es necesaria la cirugía(AU)

Obstructive sleep apnea syndrome (OSAS) is caused by the collapse of theupper airway during sleep. Obesity is defined by an excess of corporal fat,which is usually accompanied by an excess of body weight. Obese patientsshow an increase in cardiovascular mortality which is caused by obesity itselfand its association to other cardiovascular risk factors. OSAS is one of themost prevalent and important cardiovascular risk factors associated to obesity.The diagnosis of obstructive sleep apnea syndrome in obese patients is madeby polysomnography. OSAS treatment in obesity requires a multidisciplinaryapproach which includes treatment with modern systems of nasal continuouspositive pressure airway (CPAP) therapy and auto-CPAP during sleep, alongwith lifestyle modification with the aim of achieving weight loss (diet, exerciseand behaviour modification). Surgery is sometimes required(AU)

Broncoespasmo postintubación en paciente obesa mórbida tras ocultar infección respiratoria en la información preoperatoria / Bronchospasm after intubation in a morbidly obese woman who did not acknowledge a respiratory infection in the preoperative interview

No disponible

No disponible

Levels of C3 in patients with severe, morbid and extreme obesity: its relationship to insulin resistance and different cardiovascular risk factors.

OBJECTIVE: Increased C3 has been related to body mass index (BMI) and insulin resistance, although there are not sufficient studies in subjects with morbid obesity. The purpose of this study was to evaluate the levels of C3 as a function of the BMI in subjects of both sexes, with severe, morbid and extreme obesity, and their possible relationship to insulin resistance or associated diseases such as diabetes, hypertension and dyslipidemia. SUBJECTS: The study included a total of 316 patients (110 men and 206 women) with severe obesity (17.1%), morbid obesity (54.4%) and extreme obesity (28.4%), with an average BMI of 46.70+/-7.37 kg/m2. MEASUREMENTS: The glucose and insulin levels were determined baseline, and 2 h after a 75 g of oral glucose load. The homeostasis model of assessment for insulin resistance (HOMA-IR) was calculated. A lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein AI and apolipoprotein B100) was obtained and C3 levels determined by nephelometry. RESULTS: When distributing the patients by quartiles of BMI, we found a progressive increase in the levels of C3, and no significant differences in the rest of analytical variables studied were found; the mean values of C3 were 127.78+/-29.7 mg/dl.A significant correlation was found between C3 and the BMI (r=0.263, P<0.001), baseline insulin (r=0.237, P=0.001) and HOMA-IR (r=0.237, P=0.001). High blood pressure was found in 111 patients, type 2 diabetes in 74 patients and dyslipidemia in 139 cases. When distributing the levels of C3 according to the number of associated risk factors (hypertension, diabetes and dyslipidemia), we found significant differences between these patients and those who presented no associated diseases (P<0.01). CONCLUSION: A relationship between C3 and the progressive increase of BMI in subjects with severe, morbid or extreme obesity was established. This increase in C3 was closely related to insulin levels and the values for HOMA-IR. Furthermore, we also found an increase in C3 as more diseases related to insulin resistance, such as diabetes, hypertension and dyslipidemia, were associated with the obesity.

Genes implicados en la hiperlipemia familiar combinada / Genes involved in the familial combined hyperlipidemia

No disponible

[Carbohydrate metabolism derangements in patients with morbid obesity: weight loss impact]. / Estudio del metabolismo hidrocarbonado en pacientes con obesidad mórbida: influencia de la pérdida de peso.

OBJECTIVE: Examination of carbohydrate metabolism derangements in patients with morbid obesity and the influence of weight reduction through nutritional intervention. Assessment of gender influence on carbohydrate metabolism derangements and on response to diet. PATIENTS AND METHOD: 59 patients with morbid obesity were studied with anthropometric assessment and with carbohydrate metabolism assessment through an oral glucose overload and measurement of insulin resistance, before and after a dietary intervention alternating diets of very low caloric content with conventional low-calorie diets. RESULTS: A very significant global weight reduction in both sexes was observed (95% confidence interval [CI], 26.9 to 39.8 kg in males, and 13.5 to 20.3 kg in women). A significant improvement in basal blood glucose was found in both sexes (95% CI: males, 0.44 to 46.5 mg/dl; women, 9.5 to 32.8 mg/dl), and in 120 minute oral glucose tolerance test (OGTT) blood glucose in women (95% CI: 3.5 to 52.9 mg/dl). Both males and women showed significant improvement in basal insulinemia (95% CI: males, 1.6 to 14.2 microU/ml; women, 3.9 to 8.5 microU/ml) and in sex hormone-binding globulins (SHBG) (95% CI: males, -30.1 to -13.3 nmol/l; women, -54 to -19.4 nmol/l). Both males and women showed an improvement of sensitivity to insulin measured with HOMA (HOMAIR) (95% CI: males, 1.46 to 3.59; women, 0.67 to 2.24). CONCLUSION: In patients with morbid obesity carbohydrate metabolism derangements are common. Weight reduction led to a significant reduction of these derangements.

Estudio del metabolismo hidrocarbonato en pacientes con obesidad mórbida: influencia de la pérdida de peso / Carbohydrate metabolism derangements in patients with morbid obesity: weight loss impact

Objetivo. Analizar la presencia de alteraciones del metabolismo hidrocarbonado en pacientes con obesidad mórbida y la influencia de la reducción ponderal mediante intervención dietética sobre las mismas. Valorar la influencia del sexo en la presencia de dichas alteraciones y en la respuesta a la dieta. Pacientes y métodos. A 59 pacientes con obesidad mórbida se les realizó una valoración antropométrica y del metabolismo hidrocarbonado mediante la realización de sobrecarga oral de glucosa y medición de la insulinresistencia antes y después de una intervención dietética, alternando dietas de muy bajo contenido calórico con dietas hipocalóricas convencionales. Resultados. Se apreció una reducción ponderal global muy significativa en ambos sexos (intervalo de confianza [IC] al 95%: 26,9 a 39,8 kg en varones y 13,5 a 20,3 kg en mujeres). Se encuentra una mejoría significativa en ambos sexos de la glucemia basal (IC al 95%: varones, 0,44-46,5 mg/dl; mujeres, 9,5-32,8 mg/dl) y en las mujeres de la glucemia a los 120 min de la sobrecarga oral de glucosa (IC al 95%: 3,5 a 52,9 mg/dl). Tanto los varones como las mujeres presentan mejoría significativa de la insulinemia basal (IC al 95%: varones, 1,6 a 14,2 µU/ml; mujeres, 3,9 a 8,5 µU/ml) y de la globulina transportadora de hormonas sexuales (IC al 95%: varones, -30,1 a -13,3 nmol/l; mujeres, -54 a -19,4 nmol/l). Tanto varones como mujeres mostraron una mejoría de la sensibilidad a la insulina medida por Homeostasis Model Assessment (IC al 95%: varones, 1,46 a 3,59; mujeres, 0,67 a 2,24). Conclusión. En pacientes con obesidad mórbida existe una elevada presencia de alteraciones del metabolismo hidrocarbonado. Con la reducción ponderal obtenida hemos conseguido una Objetivo. Analizar la presencia de alteraciones del metabolismo hidrocarbonado en pacientes con obesidad mórbida y la influencia de la reducción ponderal mediante intervención dietética sobre las mismas. Valorar la influencia del sexo en la presencia de dichas alteraciones y en la respuesta a la dieta. Pacientes y métodos. A 59 pacientes con obesidad mórbida se les realizó una valoración antropométrica y del metabolismo hidrocarbonado mediante la realización de sobrecarga oral de glucosa y medición de la insulinresistencia antes y después de una intervención dietética, alternando dietas de muy bajo contenido calórico con dietas hipocalóricas convencionales. Resultados. Se apreció una reducción ponderal global muy significativa en ambos sexos (intervalo de confianza [IC] al 95%: 26,9 a 39,8 kg en varones y 13,5 a 20,3 kg en mujeres). Se encuentra una mejoría significativa en ambos sexos de la glucemia basal (IC al 95%: varones, 0,44-46,5 mg/dl; mujeres, 9,5-32,8 mg/dl) y en las mujeres de la glucemia a los 120 min de la sobrecarga oral de glucosa (IC al 95%: 3,5 a 52,9 mg/dl). Tanto los varones como las mujeres presentan mejoría significativa de la insulinemia basal (IC al 95%: varones, 1,6 a 14,2 µU/ml; mujeres, 3,9 a 8,5 µU/ml) y de la globulina transportadora de hormonas sexuales (IC al 95%: varones, -30,1 a -13,3 nmol/l; mujeres, -54 a -19,4 nmol/l). Tanto varones como mujeres mostraron una mejoría de la sensibilidad a la insulina medida por Homeostasis Model Assessment (IC al 95%: varones, 1,46 a 3,59; mujeres, 0,67 a 2,24). Conclusión. En pacientes con obesidad mórbida existe una elevada presencia de alteraciones del metabolismo hidrocarbonado. Con la reducción ponderal obtenida hemos conseguido una significativa reducción de estas alteraciones

Objective. Examination of carbohydrate metabolism derangements in patients with morbid obesity and the influence of weight reduction through nutritional intervention. Assessment of gender influence on carbohydrate metabolism derangements and on response to diet. Patients and method. 59 patients with morbid obesity were studied with anthropometric assessment and with carbohydrate metabolism assessment through an oral glucose overload and measurement of insulin resistance, before and after a dietary intervention alternating diets of very low caloric content with conventional low-calorie diets. Results. A very significant global weight reduction in both sexes was observed (95% confidence interval [CI], 26.9 to 39.8 kg in males, and 13.5 to 20.3 kg in women). A significant improvement in basal blood glucose was found in both sexes (95% CI: males, 0.44 to 46.5 mg/dl; women, 9.5 to 32.8 mg/dl), and in 120 minute oral glucose tolerance test (OGTT) blood glucose in women (95% CI: 3.5 to 52.9 mg/dl). Both males and women showed significant improvement in basal insulinemia (95% CI: males, 1.6 to 14.2 µU/ml; women, 3.9 to 8.5 µU/ml) and in sex hormone-binding globulins (SHBG) (95% CI: males, -30.1 to -13.3 nmol/l; women, -54 to -19.4 nmol/l). Both males and women showed an improvement of sensitivity to insulin measured with HOMA (HOMAIR) (95% CI: males, 1.46 to 3.59; women, 0.67 to 2.24). Conclusion. In patients with morbid obesity carbohydrate metabolism derangements are common. Weight reduction led to a significant reduction of these derangements

The relation between obesity, abdominal fat deposit and the angiotensin-converting enzyme gene I/D polymorphism and its association with coronary heart disease.

OBJECTIVE: To analyse the relation between overweight, obesity and fat distribution with I/D polymorphism of the angiotensin-converting enzyme (ACE) gene and its association with coronary heart disease (CHD). DESIGN: Cross-sectional, case-control study. SUBJECTS: A total of 185 cases (141 males) who had suffered at least one episode of CHD and 182 controls (127 males). MEASUREMENTS: Body mass index, waist circumference, blood pressure, plasma total cholesterol, triglycerides, HDL cholesterol and fasting glucose were measured with standard methods, genotyping the I/D polymorphism of ACE gene. RESULTS: Obesity and abdominal fat deposit are associated with CHD in women, but not independently. We have found an association between obesity and abdominal fat deposit with the ACE gene I/D polymorphism in subjects with CHD. Subjects with CHD and DD or ID genotypes have significantly higher prevalence of obesity and abdominal fat deposit and higher values of weight and waist circumference. In addition, the DD and ID genotypes increased crude OR of obesity. The DD and ID genotypes of the ACE gene I/D polymorphism and BMI are independently associated with CHD. CONCLUSION: There is a relation between the type and grade of obesity with the genotypes of the ACE gene I/D polymorphism in subjects with CHD.

Aplicación de niveles asistenciales de rehabilitación psicofuncional en un centro de día para personas dependientes / Application of health care levels of psychofunctional rehabilitation in a day center for dependent persons

El objetivo de este estudio es un ensayo para la aplicación de actividades integradoras mediante un programa psicofuncional en el que están integradas las actividades propias de la rehabilitación física y de la estimulación cognitiva. De esta manera los diferentes profesionales del centro de día se coordinan entre sí mediante un programa de atención personalizado, asumiendo las cargas asistenciales y facilitando a las familias el apoyo y el asesoramiento adecuados.En Geriser Centros de Día se aplica al ingreso de los pacientes un protocolo de valoración psicofuncional que nos definirá los cinco niveles asistenciales en función del deterioro físico y/o cognitivo que presenten.Es importante destacar la puesta en marcha de estos programas que ayudan a mantener la calidad de vida de los pacientes y sus cuidadores y nos invite a profundizar en el diseño de nuestros centros, basados en una orientación terapéutica para nuestros clientes y protésica para sus familiares (AU)

[Malnutrition evaluation in obese patients of both sexes on a very low caloric content diet]. / Evaluación de la malnutrición en pacientes obesos de ambos sexos tratados con dieta de muy bajo contenido calórico.

We have evaluated the effectiveness of a very low caloric content diet (VLCD) during 6 weeks in patients with severe obesity (grades II and III). Twenty-seven men and 61 women were selected for evaluation of anthropometric (weight, body mass index [BMI], waist, hip, C/c, fatty weight and intra-abdominal fatty area) and biochemical (creatinine-height index [CHI], albumin, transferrin, retinol binding protein [RBP], prealbumin, C3, and lymphocytes count) malnutrition parameters, at the beginning and after 6 weeks of treatment with VLCD. In men we found a significant decrease of weight, BMI, waist, hip, fatty weight, and intra-abdominal fatty area. In women the decrease of weight, BMI, hip, and fatty weight was also significant. We found baseline malnutrition in 7.4% of men and in 14.7% of women, and after the treatment in 22.2% of men and in 34.4% of women (p < 0.05). With regard to the biochemical parameters of protein malnutrition, only men showed significant decrease in the CHI and only women showed significant decrease in transferrin, RBP, prealbumin, and C3. In conclusion, we can state that different types of VLCD are effective for weight loss in severe obese subjects. However, within a period of follow-up of 6 weeks we have detected the presence of protein malnutrition, especially in women, being in these patients affected the visceral compartment while in men the muscular compartment is affected.

Transient rise in intact parathyroid hormone concentration after surgery for parathyroid adenoma.

OBJECTIVE: Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur. Study design and setting A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised. RESULTS: This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 +/- 0.6 mg/dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant. CONCLUSION: Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.

Hipocalcemia secundaria a déficit de vitamina D / Hypocalcemia due to vitamin D deficiency

El déficit de vitamina D es una causa poco frecuente de hipocalcemia en nuestro país, dada la ubicuidad de la vitamina D en los alimentos y la síntesis cutánea en presencia de radiación ultravioleta. Ocurre por lo general en personas ancianas sin exposición solar y con déficit en la dieta, y suele ser parcial, sin repercusiones clínicas importantes. Presentamos un caso de hipocalcemia grave por déficit de vitamina D asociado a tratamiento con fenitoína (AU)

Adaptaciones metabólicas en la gestación / Metabolic adaptations in pregnancy

Los factores que influyen en el metabolismo hidrocarbonado de la mujer gestante se originan simultáneamente en el organismo materno, en el feto y en la placenta. En la primera mitad del embarazo, predominan las alteraciones metabólicas debidas al hiperinsulimo sobre la resistencia insulínica. Esto se traduce en una mejor utilización periférica de la glucosa, con aumento de la glucogenolisis e inhibición de la glucogenolisis y neoglucogénesis hepáticas. En la segunda mitad del embarazo, predomina una marcada resistencia a la insulina que provoca un aumento en la glucogenolisis y en la neoglucogénesis, que se traduce en una tendencia a la hiperglucemia postprandial. Podemos considerar que estos cambios están encaminados en la primera fase del embarazo a favorecer el anabolismo materno con depósitos energéticos, mientras que en al segunda mitad de la gestación predomina el catabolismo materno y el anabolismo fetal (AU)

Diagnóstico de las alteraciones del metabolismo hidrocarbonado durante la gestación / The diagnostic of the alterations of the carbohydrate metabolism during the gestation

Definida la diabetes gestacional como toda intolerancia a los hidratos de carbono de intensidad variable, de comienzo o primer reconocimiento durante la gestación, su diagnóstico y tratamiento oportunos evita las frecuentes complicaciones neonatales asociadas a este trastorno. La prevalencia de este proceso oscila entre el 1 al 14 por ciento de los embarazos, dependiendo de la población estudiada y representa el 90 por ciento de todos los embarazos complicados con diabetes , en nuestro país se sitúa entre el 10’7 y el 16 por ciento. Se revisan los diferentes aspectos de la diabetes gestacional tanto para el feto como para la gestante, destacando en el primer aspecto que de tratarse oportunamente la morbilidad perinatal es similar a la de la población normal y en el segundo aspecto el mayor número de cesáreas y el mayor riesgo para la madre de padecer diabetes mellitus de tipo 2. Se revisan los diferentes criterios de diabetes gestacional y se establece el algoritmo diagnóstico y terapéutico del proceso, mediante las pruebas de screening y las pruebas diagnósticas (AU)