Survey on Endocrinology and Nutrition undergraduate teaching in Spain-2021.

OBJECTIVES: Advances in endocrinology and nutrition (E&N) and the importance of its associated disorders require that its teaching within the medical degree meets adequate standards of quality and homogeneity Our objective was to expand the data on E&N undergraduate teaching in Spain. METHODS: We designed an observational, cross-sectional web-based study addressed to the coordinators of E&N teaching at the 42 faculties of medicine that had taught the subject during the 2020-2021 academic year. RESULTS: One in three faculties had a professor who was an E&N specialist, but less than half had a full professor of E&N. There is great variability in teaching programmes, although most of them dedicate 6 ECTS credits to the subject. Over two-thirds of the faculties maintain theoretical lessons with over 50 students per class. Most programmes dedicate between four and six hours to hypothalamic pituitary disorders, thyroid diseases and adrenal gland disorders. However, there is great variability in the time dedicated to diabetes and nutrition. In one-third of the faculties, students are not required to do a rotation in the E&N department. Teachers at the universities widely participate in undergraduate/master's students' final projects and master's degree studies. CONCLUSIONS: The E&N specialty maintains a good position within universities, but there is still great heterogeneity in the teaching structure of the subject.

Tumor sólido pseudopapilar de páncreas: reporte de caso / Pseudopapilar solid tumor of pancreas: case Report

Resumen Introducción: El tumor sólido pseudopapilar del páncreas es una rara entidad que representa menos del 1% de las neoplasias pancreáticas. Suele presentarse en mujeres jóvenes y solo da síntomas de carácter compresivo una vez que alcanza un gran tamaño. Dado su comportamiento biológico incierto el tratamiento es la cirugía. Caso Clínico: Presentamos el caso de una mujer de 23 años con historia de 1 año de evolución de dolor epigástrico y baja de peso. El estudio imagenológico demostró una masa heterogénea sólida-quística dependiente de la cabeza del páncreas de aspecto neoplásico. Se realizó una biopsia incisional laparoscópica cuyo resultado fue de un tumor maligno indiferenciado, por lo que se optó por la resección quirúrgica. Se realizó una pancreatoduodenectomía abierta sin incidentes con un postoperatorio favorable. Los análisis histopatológicos e inmunohistoquímico fueron compatibles con un tumor sólido pseudopapilar de páncreas.

Introduction: The pseudopapillary solid tumor of the pancreas is a rare entity that represents less than 1% of pancreatic neoplasms. It usually occurs in young women and only gives symptoms of a compressive nature once it has reached a large size. Given its uncertain biological behavior, the treatment is surgery. Case Report: We present the case of a 23-year-old woman with a 1-year history of epigastric pain evolution and weight loss. The imaging study demonstrated a solid-cystic heterogeneous mass dependent on the head of the pancreas of neoplasic appearance. A laparoscopic incisional biopsy was performed, the result of which was an undifferentiated malignant tumor, which was why the surgical resection was chosen. An open pancreatoduodenectomy was performed without incident with a favorable post operative. Histopathological and immunohistochemical analyzes were compatible with a solid pseudopapillary tumor of the pancreas.

Up-regulation of FXR isoforms is not required for stimulation of the expression of genes involved in the lack of response of colon cancer to chemotherapy.

Several mechanisms are involved in the poor response of colorectal adenocarcinoma (CRAC) to pharmacological treatment. Since preliminary evidences have suggested that the enhanced expression of farnesoid X receptor (FXR) results in the stimulation of chemoresistance, we investigated whether FXR up-regulation is required for the expression of genes that characterize the multidrug resistance (MDR) phenotype of CRAC. Samples of tumours and adjacent healthy tissues were collected from naive patients. Using Taqman Low-Density Arrays, the abundance of mRNA of 87 genes involved in MDR was determined. Relevant changes were re-evaluated by conventional RT-QPCR. In healthy tissue the major FXR isoforms were FXRα2(+/-) (80%). In tumours this predominance persisted (91%) but was accompanied by a consistent reduction (3-fold) in total FXR mRNA. A lower FXR expression was confirmed by immunostaining, in spite of which there was a significant change in the expression of MDR genes. Pharmacological challenge was simulated "in vitro" using human CRAC cells (LS174T cells). Short-term (72h) treatment with cisplatin slightly increased the almost negligible expression of FXR in wild-type LS174T cells, whereas long-term (months) treatment induced a cisplatin-resistant phenotype (LS174T/R cells), which was accompanied by a 350-fold up-regulation of FXR, mainly FXRα1(+/-). However, the changed expression of MDR genes in LS174T/R cells was not markedly affected by incubation with the FXR antagonist Z-guggulsterone. In conclusion, although the enhanced expression of FXR may be involved in the stimulation of chemoresistance that occurs during pharmacological treatment, FXR up-regulation is not required for the presence of the MDR phenotype characteristic of CRAC.

Hepatitis herpética en paciente hematológico / No disponible

No disponible

Síndrome de Reye en paciente pediátrico / Reye's syndrome in a pediatric patient

No disponible

[Lamivudine for the treatment of patients with chronic hepatitis with negative hepatitis B AgHbe]. / Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus.

INTRODUCTION: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with AgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. AIM: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are AgHB negative. RESULTS: Seven of the 9 patients which were treated in our department for more than 3 months were AgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated with adefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. CONCLUSION: In our series, the majority of the patients (77.7%) were AgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3.5 months). One third of patients treated relapsed after one and a half years of treatment.

Lamivudina en el tratamiento de la hepatopatía crónica por virus hepatitis B AgHbe minus / Lamivudine for the treatment of patients with hepatitis B AGHBE Minus

Introducción: Se estima que la hepatopatía crónica por virus de la hepatitis B afecta a más de 350 millones de personas en todo el mundo. Los pacientes AgHbe minus representan en algunas áreas entre el 50-80% del total. En estos pacientes la remisión espontánea es rara, la respuesta a interferón menor y la probabilidad de evolución a cirrosis y hepatocarcinoma mayor que en la cepa salvaje. Objetivo: Analizar la respuesta al tratamiento con Lamivudina en pacientes con hepatopatía crónica VHB AgHBe negativos. Resultados: De los nueve pacientes tratados en nuestro servicio durante más de 3meses, 7 eran AgHbe negativos. De ellos 6 pacientes respondieron al tratamiento, en un tiempo medio de 3,5 meses (rango 1-6). Se han producido dos recidivas a los 18 y 24 meses que han sido tratadas con Adefovir. Cuatro pacientes persisten con ADN negativo y transaminasas normales tras un tiempo medio de tratamiento de 25 meses.Conclusiones: En nuestra serie, la mayoría de los pacientes (77,7%) eran AgHbe negativos al inicio del tratamiento. La eficacia del tratamiento con Lamivudina en ellos es alta (85,7%) y precoz (media de 3,5 meses). En un tercio de los pacientes tratados se produce recidiva viral, al menos tras 1 año y medio de tratamiento

Introduction: It is estimated that chronic hepatitis B affects to than 350 million people around the world. Patients with eAgHB- minus account, in some areas, for between 50-80% of the total of the population with chronic hepatitis B. Spontaneous clearance is rare within these patients, the response to interferon is low and the probability of developing cirrhosis and hepatocarcinoma is higher than in the wild type. Aim: To analyze the response to lamivudine treatment in patients with chronic hepatitis B which are eAgHB negative. Results: Seven of the 9 patients which were treated in our departmentfor more than 3 months were eAgHB negative. Six of them responded to the treatment in an average time of 3.5 months (range 1-6 months). There were two patients that relapsed at 18 and 24 months and they were treated withadefovir. Four patients remained DNA negative and had normal aminotransferases values after an average treatment time of 25 months. Conclusion: In our series, the majority of the patients (77.7%) were eAgHB negative at the beginning of treatment. The efficacy of the treatment with lamivudine in these cases is high (85.7%) and with an early response (average 3,5 months). One third of patients treated relapsed after one and a half years of treatment

Tuberculosis pulmonar como enfermedad profesional / Pulmonary tuberculosis as an occupational disease

No disponible

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon]. / Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al tratamiento con interferón.

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al trata miento con interferón / The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon

Introducción: Aunque se han realizado múltiples estudios para conocer los factores pre-tratamiento que pueden predecir la respuesta al tratamiento con interferón (IFN), se desconoce si las lesiones histológicas características de la hepatitis crónica C (HCC) sirven para predecir dicha respuesta. Objetivos: Valorar si los parámetros histológicos pueden predecir la respuesta mantenida al tratamiento con IFN en los pacientes con HCC, y estudiar otros parámetros (epidemiológicos y analíticos) ya descritos como factores predictivos de respuesta. Métodos: Se estudiaron de forma retrospectiva 201 pacientes, tratados con IFN durante al menos 3 meses en cuatro hospitales de Castilla y León. La variable dependiente analizada fue la respuesta mantenida al tratamiento. Como factores predictivos de respuesta se estudiaron las siguientes variables histológicas: diagnóstico histológico, índice de Knodell total y por apartados, grado y estadio, y lesiones características de la HCC. Además, se analizaron parámetros epidemiológicos y analíticos. Resultados: El 16 por ciento de los pacientes presentó una respuesta mantenida. Ninguno de los parámetros histológicos sirvió para predecir dicha respuesta. Demostraron ser factores predictivos en el análisis bivariante la edad, el tiempo de evolución de la HCC, la vía de transmisión, la GGT, la ferritina y el genotipo viral. El factor predictivo más importante fue el genotipo viral, y el único asociado independientemente a la respuesta mantenida ("odds ratio" de respuesta al tratamiento de 8,6). Conclusiones: Los parámetros histológicos no predicen la respuesta al tratamiento con IFN. Otros factores, fundamentalmente el genotipo viral, se asocian a un mayor porcentaje de respuestas, aunque ninguno sirve para decidir con exactitud qué pacientes responderán. (AU)

Enterocolitis necrotizante por Aspergillus en paciente imnunodeprimido / Necrotizing enterocolitis for Aspergillus in patient with immunodepression

No disponible

[Waist/hip ratio and vascular risk factors in obese and not obese individuals]. / Indice cintura/cadera y factores de riesgo vascular en sujetos obesos y no obesos.

Three groups of men and three groups of women were studied, each one of the three corresponding to obese individuals, overweight and not overweight according to the ratio of corporal mass > or = 30, 25-29.9 and < 25 respectively. In each group two subgroups were made following the waist/hip ratio (< 1 and > or = 1 for men and < 0.8 and > or = 0.8 for women). In each subgroup arterial pressure, basal glucemia, cholesterol and plasmic triglycerides, lipoproteins and insulinemia after a higher than normal oral intake of glucose were determined, comparing results according to waist/hip ratio. Practically all the parameters studied showed greater levels of risk in subjects of both sexes with high waist/hip ratio, both in obese individuals and not obese individuals. This shows the possibility that high waist/hip ratio in associated with risk factors in individuals who are not obese, and this association is considered as a "metabolic lipopathy" present in the intraabdominal visceral adipocyte. The measurement of waist/hip ratio must be recommended in all patients and in medical examinations.