Gestational Diabetes Mellitus (GDM): Relationship Between Higher Cutoff Values for 100 g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement During Pregnancy.

Objectives To study if there is any relationship about higher cutoff values for 100 g oral glucose tolerance test and the need for insulin in women diagnosed with gestational diabetes. Materials and Methods This is a retrospective population-based study of 201 women diagnosed with Gestational Diabetes Mellitus (GDM) between January 2012 and June 2014 in the area of Oviedo, Asturias, Spain. According to diagnostic criteria recommended by GEDE, NDDG, gestational diabetes is diagnosed if two or more plasma glucose levels meet or exceed the following threshold: fasting glucose of 105 mg/dl, 1-h 190 mg/dl, 2-h 165 mg/dl, or 3-h 145 mg/dl. We aim to know if there is any relationship between higher cutoffs and insulin requirement. Results 36 out of 201 patients (17.91%) needed insulin to achieve the targets of blood glucose control. There were no differences in mean maternal age and birthweights. Fasting blood glucose levels were significantly higher in women with further need for insulin than those who only needed diet and exercise (p < 0.001). Also, blood glucose levels 2 h after the oral glucose intake were statistically different between the two groups (p 0.032). AUC for fasting glucose value was the highest according to ROC curve. Conclusions Fasting cutoff vales for 100 g oral glucose tolerance test are consistently higher in women diagnosed with Gestational Diabetes that further needed insulin to achieve adequate blood glucose control. The positive predictive value of fasting glucose value 105 mg/dl on OGTT was 81.1%, whereas for the cut-off 95 mg/dl it was 54.0%.

[Gastrocolic fistula as infrequent cause of chronic diarrhea in a patient with percutaneous radiological gastrostomy]. / Fístula gastrocólica como causa infrecuente de diarrea persistente en un paciente portador de gastrostomía radiológica percutánea.

Introduction: Introduction: gastrocolic fistula is an infrequent but severe complication of percutaneous gastrostomy. Clinical suspicion in the presence of chronic diarrhea of unknown etiology manifesting after percutaneous radiological gastrostomy (PRG) tube replacement is key to early detection and treatment. Case report: we report the case of a patient with PRG that began with chronic diarrhea after tube replacement and developed severe malnutrition. Initial treatment was not effective, studies were extended with the finding of this complication in a CT image. The use of this tube was discontinued with resolution of diarrhea and a favorable nutritional outcome. Discussion: this case report shows the importance of considering gastrocolic fistula in the differential diagnosis of persistent diarrhea in a patient with a gastrostomy tube.

Introducción: Introducción: la fístula gastrocólica supone una complicación infrecuente pero potencialmente grave de las sondas de gastrostomía. La sospecha clínica ante una diarrea de origen incierto que comienza tras el recambio de la sonda es clave para la detección y el tratamiento precoces. Caso clínico: se presenta el caso de un paciente portador de gastrostomía radiológica percutánea (PRG) que comienza con diarrea persistente tras el primer recambio de la sonda y desnutrición grave secundaria. Tras el fracaso de las medidas terapéuticas iniciales se amplían los estudios, con hallazgo de esta complicación en la imagen de TC. Se suspende el uso de esta sonda con resolución de la diarrea y evolución nutricional favorable. Discusión: este caso pone de manifiesto la importancia de incluir la fístula gastrocólica en el diagnóstico diferencial de la diarrea persistente en un paciente portador de sonda de gastrostomía.

[Gender differences in the mortality of people with type 2 diabetes: Asturias Study 2018]. / Diferencias de género en la mortalidad de personas con diabetes tipo 2: Estudio Asturias 2018.

OBJECTIVE: To investigate the influence of gender on mortality according to the presence or absence of type 2 diabetes mellitus (DM2) and other cardiovascular risk factors in the Asturias Study cohort. METHOD: The Asturias Study (started in 1998) is an observational, prospective cohort study of a representative sample of a population of Asturias aged 30-75 years. The population was divided into groups according to the presence or absence of DM2 and according to gender to assess control of cardiovascular risk factors. In addition, aware of the vital status of the cohort 18 years after the beginning of the study, we analyzed differences in causes of mortality according to the previous categories. RESULTS: In 1998, 1034 people started the study, 561 women (54.25%) and 473 men (45.75%). Of these, 131 (12.66%) had diabetes (75 men and 56 women). The women with T2D presented a hazard ratio (HR) for total mortality of 1.64 (95% confidence interval [95%CI]: .97-2.77), which was 1.63 (95%CI: 1.07-2.50) for the men and, for cardiovascular mortality, 3.06 (95%CI: 1.44-6.47) for the females, versus 1.49 (95%CI: 0.64-3.46) for the males. The mortality rate for people with T2D of both sexes was higher than for people without T2D. CONCLUSIONS: Women with T2D have a risk more than three times higher than women without diabetes of dying from cardiovascular causes. We should implement treatment strategies in women with this condition.

Epidemiology of type 1 diabetes in Asturias: 2002-2011. / Epidemiología de la diabetes tipo 1 en Asturias: 2002-2011.

INTRODUCTION: Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in childhood. An increased incidence of T1DM has recently been noted in children under 15 years of age, and especially in the younger group. The purpose of this study was to know the incidence of T1DM in Asturias and its characteristics. MATERIAL AND METHODS: Children and young adults under 40 years of age living in Asturias and diagnosed with T1DM in public and private centers from January 1, 2002 to December 31, 2011, were included in the study. Information collected included age, sex, date of diagnosis, initial symptoms, and biochemical parameters of the disease. RESULTS: A total of 436 patients were diagnosed, of whom 59.63% were males; 169 were younger than 15 years, 56.8% of them males. The age-adjusted overall incidence rate (IR) in Asturias of people diagnosed with diabetes before 40 years of age during this period was 9.45/100.000 population/year (95% CI: 8.58-10.38), 11.07 in males (95% CI: 9.77-12.50) and 7.77 in females (95% CI: 6,66-9,00). In subjects under 30 years of age, IR rate was 10.82 (95% CI: 9.67-12.07), 11.91 in males (95% CI: 10.23-13.78) and 7.61 in females (95% CI: 6,25-9.17). The IR in subjects younger than 15 years of age was 15.60 (95% CI: 13.33-18.13), 17.24/100,000 population/year (95% CI: 13.97-21.06) in males and 13, 86 (95% CI: 10.86-17.42) in females. Estimated IR adjusted by age group in children under 15 years of age was 9.58 (95% CI: 6.64-13.39) in those aged 0-4 years, 18.25 in those aged 5-9 years (95% CI: 14.06-23.31), and 18.78 (95% CI: 14.67-23.69) between 10 and 14 years of age. IR remained stable in virtually all age groups and in both sexes, except in girls under 4 years of age, who showed a significant upward trend. There were significant differences in incidence between the central area of Asturias, predominantly urban, and the peripheral areas, mainly devoted to farming and livestock breeding. Thus, while IR in Mieres was 8/100,000/year, in Jarrio reached 25.6/100,000/year. CONCLUSION: In Asturias, incidence of T1DM in children and young adults is similar to that of the surrounding communities, but lower than the average in Spain. It has remained stable in recent years, except in the younger girls (in whom it has increased), and shows a great geographical variability between the center of the region and the periphery.

Epigenetic modulators of thyroid cancer.

There are some well known factors involved in the etiology of thyroid cancer, including iodine deficiency, radiation exposure at early ages, or some genetic changes. However, epigenetic modulators that may contribute to development of these tumors and be helpful to for both their diagnosis and treatment have recently been discovered. The currently known changes in DNA methylation, histone modifications, and non-coding RNAs in each type of thyroid carcinoma are reviewed here.

Altered intragenic DNA methylation of HOOK2 gene in adipose tissue from individuals with obesity and type 2 diabetes.

AIMS/HYPOTHESIS: Failure in glucose response to insulin is a common pathology associated with obesity. In this study, we analyzed the genome wide DNA methylation profile of visceral adipose tissue (VAT) samples in a population of individuals with obesity and assessed whether differential methylation profiles are associated with the presence of type 2 diabetes (T2D). METHODS: More than 485,000 CpG genome sites from VAT samples from women with obesity undergoing gastric bypass (n = 18), and classified as suffering from type 2 diabetes (T2D) or not (no type 2 diabetes, NT2D), were analyzed using DNA methylation arrays. RESULTS: We found significant differential methylation between T2D and NT2D samples in 24 CpGs that map with sixteen genes, one of which, HOOK2, demonstrated a significant correlation between differentially hypermethylated regions on the gene body and the presence of type 2 diabetes. This was validated by pyrosequencing in a population of 91 samples from both males and females with obesity. Furthermore, when these results were analyzed by gender, female T2D samples were found hypermethylated at the cg04657146-region and the cg 11738485-region of HOOK2 gene, whilst, interestingly, male samples were found hypomethylated in this latter region. CONCLUSION: The differential methylation profile of the HOOK2 gene in individuals with T2D and obesity might be related to the attendant T2D, but further studies are required to identify the potential role of HOOK2 gene in T2D disease. The finding of gender differences in T2D methylation of HOOK2 also warrants further investigation.

[Chylous asctites post abdominal laparotomy; revision and report of a case]. / Ascitis quilosa postlaparoscopia abdominal; revisión y descripción de un caso.

We describe the case of a 23 year old man who had undergone laparoscopic surgery in order to remove a residual mass secondary to a testicular embryonal carcinoma. 15 days after he attended the emergency department complaining about abdominal bloating and copious drainage via the two laparoscopic surgery incisions. Biochemical analysis was consistent with chylous ascites. Although this is uncommon, it is well known that there is more likely to develop chylous ascites after oncologic surgery if retroperitoneal lymph nodes dissection is performed1. We decide to start with conservative treatment (dietary modifications) but, as it is not enough, then we decide stop any oral intake and treat him with parenteral nutrition, achieving then total resolution of the ascites.

Describimos el caso de un varón de 23 años operado mediante laparoscopia de una masa residual secundaria a un carcinoma embrionario testicular. 15 días después acude al servicio de Urgencias por distensión abdominal y drenaje de líquido lechoso por las dos incisiones de la cirugía laparoscópica. Tras el análisis bioquímico del líquido que reflejaba un aumento de triglicéridos se llegó al diagnóstico de ascitis quilosa. Aunque es infrecuente, se describe que existe mayor probabilidad de ascitis quilosa después de cirugías oncológicas si se lleva a cabo la disección de ganglios linfáticos retroperitoneales1. Se decide tratamiento conservador inicialmente con modificaciones dietéticas y posteriormente con nutrición parenteral, con resolución total de la ascitis.

Iodine nutrition in pregnant women from Oviedo area. Is iodine supplementation necessary?

BACKGROUND AND OBJECTIVE: In Asturias, where iodine deficiency was eradicated in school children by the year 2000, iodine deficiency persisted in pregnant women, who were recommended to use of iodine supplementation. The aim of this study was to determine the iodine nutrition of pregnant women in our area and whether or not iodine supplements are needed. MATERIAL AND METHODS: Throughout May and June 2013 we studied the iodine nutrition and thyroid function during the first trimester of pregnancy in 173 women in the health area of Oviedo. RESULTS: The median urinary iodine was 197 µg/L. Iodinated supplements were used by 47% of women, which had a yoduria median higher than those not taking iodinated supplements (247 vs. 138 µg/L; p<.001), and also a higher TSH (2.30 vs 1.94 mU/L) although not significantly different. Yoduria was also higher in women who took more than 2 servings of dairy products (median: 230 µg/L) than those who took less (median: 191 µg/L). Within the group of women who were not taking iodine supplements, those regularly using iodized salt in the kitchen (47%) had a median urinary iodine concentration of 190µg/L indicating iodine sufficiency. CONCLUSIONS: Iodinated supplements seem unnecessary nowadays in pregnant women of Oviedo who regularly take iodized salt and our recommendation in these cases should be to continue the use of iodized salt in the recommended amounts during pregnancy and consume at least two daily servings of milk or dairy products.