Early blood pressure alterations are associated with pro-inflammatory markers in type 1 diabetes mellitus.

The aim of this study was to evaluate the relationship between early blood pressure (BP) changes (detected using ambulatory BP monitoring; ABPM) with different markers of inflammation and endothelial dysfunction in patients with type 1 diabetes mellitus (T1DM). The study design was observational cross-sectional in 85 T1DM patients, clinically normotensive and with normo-albuminuria. We analyzed the relationships between ABPM-measured BP alterations over 24 h with the inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α and vascular endothelial growth factor (VEGF)) and the markers of endothelial damage (vascular adhesion molecule, intercellular adhesion molecule and plasminogen activator inhibitor-1 (PAI)). Despite being recorded as normotensive, 27 (31.8%) subjects presented with an average of pathological BP. VEGF levels were significantly elevated in the patients with an altered mean diurnal values compared with normotensives (112.33 (72.87-213.53) pg ml-1 vs 71.03 (37.71-107.92) pg ml-1; P=0.007). Further, VEGF levels correlated significantly with the parameters of diurnal BP and of 24 h values. IL-6 concentration was a risk factor in the patients with hypertension (OR=1.406; P=0.027). There were no modifications in the levels of markers of endothelial damage. Summarizing, there is an increase in pro-inflammatory cytokines, but not the endothelial adhesion molecules, in early stages of arterial hypertension in patients with T1DM.

[Effectiveness of lifestyle intervention program in persons with obesity treated in a day hospital]. / Efectividad de un programa de intervención sobre los estilos de vida en personas con obesidad atendidos en régimen de Hospital de día.

INTRODUCTION: Obesity is a chronic disease that affects approximately 25% of the Spanish population, causing high morbidity and associated healthcare costs. OBJECTIVE: To evaluate the effectiveness of an intervention program on lifestyles in obese patients treated in a day hospital scheme. METHODS: A prospective non- controlled intervention study was conducted on obese patients treated in the Endocrinology and Nutrition day hospital, Puerto Real University Hospital, and included in program of lifestyle modification to achieve a weight loss of ≥ 5% minimum. RESULTS: We studied 262 patients with a mean age of 44.6±16.0 years (71% women) with an initial weight, body mass index and waist circumference of 110.4±21.1kg, 41.6±6.6Kg/m(2) and 120.5±13.2cm, respectively. Patients who continued in the study lost an average of 4.8±4.8kg (n=165) and 7.0±6.2kg (n=48) at three and six months, respectively, with 51.5% (n=135) patients reaching the weight loss goal of ≥ 5%. There were no statistically differences in weight loss between any clinical or follow-up variables analysed. 43.5% of patients voluntarily left the study without reaching the weight loss goal. CONCLUSION: The intervention on lifestyles in obese patients treated in a day hospital achieves moderate weight loss in the medium term, with half of patients achieving a weight loss ≥5%.

[Economic costs associated to type 1 diabetes]. / Costes económicos asociados a la diabetes tipo 1.

OBJECTIVE: The objective of our study was to determinate the health resource utilization and economic cost associated to diabetes in a patient group with type 1 diabetes. PATIENTS AND METHODS: We designed a cross-sectional study that involved 71 type 1 diabetes patients (59.4% women) with 29.2 +/- 12.2 years old mean age and 10.5 +/- 7.9 years of diabetes evolution attended in Endocrinology Service of Puerta del Mar Hospital in Cádiz. Direct and indirect cost associated to diabetes during a year period were determinated by information obtained from patient medical history and hospital, emergency, primary care and medical inspection of social insurance databases. RESULTS: Type 1 diabetes patients presented a total cost associated to diabetes of 3.311 euros/patient/year (95% IC: 2.202-4.420 euros/patient/year). Direct cost (2.104 euros/patient/year; 95% IC: 1.825-2.383 euros/patient/year) was higher than indirect cost (1.250 euros/patient/year; 95% IC: 291-2.225 euros/patient/year). Multiple regression analysis showed an independent association between total cost associated to diabetes (dependent variable) and variables number of hospitalizations related to diabetes (p = 0.006), pensioner situation (p = 0.02) and micro and macrovascular complications (p = 0.001). CONCLUSIONS: We conclude that economic cost associated to type 1 diabetes is important and presents a notable and independent increase with hospitalizations related to diabetes, pensioner situation and micro and macrovascular complications.

[Pituitary apoplexy: retrospective study of 9 patients with hypophyseal adenoma]. / Apoplejía pituitaria: análisis retrospectivo en 9 pacientes con adenomas hipofisarios.

Pituitary apoplexy is an acute hemorrhage or ischemia infarction of the pituitary gland, almost invariably occurring in the presence of an pituitary adenoma. Although intratumoral bleeding occur in about 9.5 to 25% of pituitary adenomas, various series suggest that clinical apoplexy may be diagnosed in about 2% to 10% of the adenomas. In a retrospective study from 1988 to 1998 of 110 patients with hypophyseal adenomas, there were 9 cases with pituitary apoplexy, yielding an incidence of 8.2%. Their mean age was 52.4 +/- 12.8 años years, with a male to female ratio of 7:2. Symptoms observed were headache (89%), sudden visual deterioration (78%), vomiting (78%) and oculomotor nerves paresis (33%). The diagnosis of pituitary apoplexy was established by computerized tomographic scans, and hypophyseal macroadenoma with intratumoral bleeding was observed in every patient. Five patients underwent transphenoidal surgery. Improvement of visual deficit was observed in 3/4 (75%) and ocular paresis in 3/3 (100%) of affected patients. Four patients were treated conservatively with steroids. Two patients who had visual deficit recovered it completely without surgery. Two hypophyseal adenomas were resolved spontaneously after bleeding, one stayed unchanged and another presented recurrence of bleeding at six years of follow-up. Steroid and thyroid hormone replacement therapy was required in 62.5% of patients.