Consensus document on the management of hyponatraemia of the Acqua Group of the Spanish Society of Endocrinology and Nutrition.

INTRODUCTION: Hyponatremia is the most prevalent electrolyte disorder in the outpatient and inpatient settings. Despite this frequency, hyponatremia, including severe hyponatremia, is frequently underestimated and inadequately treated, thus highlighting the need to produce consensus documents and clinical practice guidelines geared towards improving the diagnostic and therapeutic approach to it in a structured fashion. MATERIAL AND METHODS: Members of the Acqua Group of the Spanish Society of Endocrinology and Nutrition (SEEN) met using a networking methodology over a period of 20 months (between October 2019 and August 2021) with the aim of discussing and developing an updated guideline for the management of hyponatraemia. A literature search of the available scientific evidence for each section presented in this document was performed. RESULTS: A document with 8 sections was produced, which sets out to provide updated guidance on the most clinically relevant questions in the management of hyponatraemia. The management of severe hyponatraemia is based on the i.v. administration of a 3% hypertonic solution. For the management of chronic euvolemic hyponatraemia, algorithms for the initiation of treatment with the two pharmacological therapeutic options currently available in Spain are presented: urea and tolvaptan. CONCLUSIONS: This document sets out to simplify the approach to and the treatment of hyponatraemia, making it easier to learn and thus improve the clinical approach to hyponatremia.

Quo vadis, Endocrinology and nutrition? / ¿Quo vadis, Endocrinología y Nutrición?

INTRODUCTION: In Spain, the system used to select a medical specialty is the MIR (internal resident physician) exam. The MIR selection number may reflect the interest in a given specialty. Our study objective was to confirm the increase in the selection number and to analyze possible factors influencing the decision. MATERIAL AND METHOD: To analyze change over time in the MIR number with which this specialty is chosen and to compare it with other related specialties, as well as the reasons why it is preferred using an anonymous survey to 108 MIRs of endocrinology. RESULTS: The average number of MIR for Endocrinology and Nutrition has gradually increased to 2336 in year 2018, a trend that coincides with an increase in the number of places offered but is more marked as compared to other medical specialties. Respondents weighed different factors when choosing specialty. When asked about the most positive aspects of the specialty, the highest rated was that day to day activity was "less intense". The most commonly mentioned negative aspect was the low number of techniques. When asked if the specialty had met their expectations, respondents gave an average score of 8.7, although the perceived prestige of the specialty scored only 6.7 points. CONCLUSIONS: There is an obvious deterioration of the MIR selection number of our specialty that it is not so marked in other specialties.

Spanish Diabetes Society (SED) recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes: 2018 Update. / Recomendaciones de la Sociedad Española de Diabetes (SED) para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2: Actualización 2018.

Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies.

[Anorexia nervosa as a cause of acute liver failure. Report of a case]. / Anorexia nerviosa como causa de fallo hepático agudo. A propósito de un caso.

Caso clínico: presentamos una paciente de 33 años con anorexia nerviosa de 15 años de evolución con uno de los pocos casos reportados de fallo hepático agudo severo secundario a la desnutrición.Discusión: tras el soporte nutricional protocolizado para evitar el síndrome de realimentación y un adecuado manejo multidisciplinar, la paciente evoluciona favorablemente logrando normalizar los electrolitos, la función hepática y las alteraciones en la coagulación.

[Consumption of nuts and vegetal oil in people with type 1 diabetes mellitus]. / CONSUMO DE FRUTOS SECOS Y ACEITES VEGETALES EN PERSONAS CON DIABETES MELLITUS TIPO 1.

INTRODUCTION: Recent studies have demonstrated the cardiovascular benefits of the Mediterranean Diet, enriched with olive oil and nuts. People with diabetes, who have an increased risk of cardiovascular complications, could benefit greatly from following this type of eating pattern. OBJECTIVE: Analysis of vegetable fats intake from nuts and olive oil in patients with 1 Diabetes Mellitus type (DM1). METHODS: Transverse descriptive study comparing 60 people with type 1 Diabetes Mellitus (DM1) with 60 healthy individuals. We collect the frequency of consumption of vegetable oils and nuts and calculate the contribution of these foods in mono and polyunsaturated fatty acids (oleic acid, linoleic acid and α-linolenic acid). For data collection we designed a food frequency questionnaire specifically. We also collect anthropometric variables, cardiovascular risk factors and diabetes-related variables. RESULTS: Vegetable fat intake from vegetable oils (3.02 ± 1.14 vs 3.07 ± 1.27 portions/day, P = 0.822) and nuts (1.35 ± 2.24 vs 1.60 ± 2.44 portions/week, P = 0.560), was similar in both groups. The DM1 group consumed fewer portions of olive oil daily than the control group (2.55 ± 1.17 vs 3.02 ± 1.34 portions/day, P = 0.046). We detected a significantly lower intake of α-linolenic acid in the control group (1.13 ± 2.06 versus 2.64 ± 4.37 g/day, p = 0.018) while there were not differences in the rest of fatty acids (oleic acid 28.30 ± 18.13 vs 29.53 ± 16.90 g/day, P = 0.703; linoleic 13.70 ± 16.80 vs 15.45 ± 19.90 g/day, P = 0.605). In DM1, it not demonstrated an influence of the intake of vegetable fats and oils from nuts in the anthropometric, metabolic and diabetes-specific variables. CONCLUSIONS: In people with DM1, total intake of vegetable oils and nuts do not differ from the general population. However, the consumption of olive oil and the contribution of α-linolenic fatty acid derived from such fats are slightly lower than the general population. Although intake of vegetable oils and nuts in people with DM1 is not related to metabolic parameters, or progression of complications of diabetes, it is reasonable to increase their intake, given the recognized benefits of this type of food.

Introducción: estudios recientes han demostrado los beneficios cardiovasculares de la dieta mediterránea enriquecida con aceite de oliva y frutos secos. Las personas con diabetes, que tienen un mayor riesgo de complicaciones cardiovasculares, podrían beneficiarse en gran medida de seguir ese tipo de patrón alimentario. Objetivos: análisis de la ingesta de grasas vegetales procedentes de frutos secos y aceites vegetales en pacientes con diabetes mellitus tipo 1 (DM1). Métodos: estudio transversal descriptivo que compara 60 personas con DM1 y 60 sujetos sanos. Se recoge la frecuencia de consumo de aceites vegetales y de frutos secos y se calcula el aporte procedente de estos alimentos en ácidos grasos mono y poliinsaturados (ácido oleico, linoleico y -linolénico). Se utilizó un cuestionario de frecuencia de consumo diseñado de forma específica. Se recogen variables antropométricas, factores de riesgo cardiovascular y variables relacionadas con la diabetes. Resultados: el consumo total de grasa vegetal procedente de aceites vegetales fue similar en los pacientes con DM1 frente a los sujetos control (3,02 ± 1,14 vs. 3,07 ± 1,27 Raciones (R)/día, P = 0,822) y de frutos secos (1,35 ± 2,24 vs. 1,60 ± 2,44 R/semana, P = 0,560). El grupo DM1 consumió menos aceite de oliva que el grupo control (2,55 ± 1,17 vs. 3,02 ± 1,34 R/día, P = 0,046). Se detectó un menor consumo de ácido -linolénico respecto al grupo control (1,13 ± 2,06 vs. 2,64 ± 4,37 g/día, P = 0,018), mientras que no hubo diferencias en el resto de ácidos grasos (oleico 28,30 ± 18,13 vs. 29,53 ± 16,90 g/día, P = 0,703; linoleico 13,70 ± 16,80 vs. 15,45 ± 19,90 g/día, P = 0,605). En los DM1 no se demostró una influencia del consumo de las grasas vegetales procedentes de aceites y frutos secos en los parámetros antropométricos, metabólicos y variables específicas de la diabetes. Conclusiones: en las personas con DM1 el consumo total de aceites vegetales y frutos secos no difiere de la población general. Sin embargo, el consumo de aceite de oliva y el aporte del ácido graso -linolénico es ligeramente inferior al de la población general. Aunque el consumo de aceites vegetales y frutos secos en las personas DM tipo 1 no se relaciona con parámetros metabólicos, o evolución de las complicaciones de la diabetes, es razonable incidir en incrementar su consumo, dados los beneficios reconocidos de este tipo de alimentos.

Decontamination of dental implant surface in peri-implantitis treatment: a literature review.

Etiological treatment of peri-implantitis aims to reduce the bacterial load within the peri-implant pocket and decontaminate the implant surface in order to promote osseointegration. The aim of this literature review was to evaluate the efficacy of different methods of implant surface decontamination. A search was conducted using the PubMed (Medline) database, which identified 36 articles including in vivo and in vitro studies, and reviews of different decontamination systems (chemical, mechanical, laser and photodynamic therapies). There is sufficient consensus that, for the treatment of peri-implant infections, the mechanical removal of biofilm from the implant surface should be supplemented by chemical decontamination with surgical access. However, more long-term research is needed to confirm this and to establish treatment protocols responding to different implant characterics.

[Benefits of a home-based physical exercise program in elderly subjects with type 2 diabetes mellitus]. / Beneficios de un programa ambulatorio de ejercicio físico en sujetos mayores con diabetes mellitus tipo 2.

OBJECTIVE: To analyze the effects of a home-based physical exercise program on quality of life, metabolic control, and anthropometric and biochemical parameters in people over 60 years of age with type 2 diabetes mellitus. METHODS: Eighty-four Spanish patients aged over 60 years were finally randomized to participate in a home-based, combined physical exercise program (aerobic and anaerobic exercises) or to receive conventional treatment for diabetes. At 6 months, effects on quality of life (EuroQoL questionnaire). HbA1c, fasting glucose, hypoglycemic events, weight, BMI, waist circumference, blood pressure, and biochemical parameters were assessed. RESULTS: Mean age of study participants was 66.7 (8.0) years. Patients in the exercise group showed an improved quality of life at six months based on EuroQol: 0.48 (0.38) vs 0.66 (0.35) and analogic scale 67.97 (18.92) vs 76.26 (20.14). An improved glycemic control was also seen: HbA1c 6.35 vs 6.0% and fasting glucose 151.2 (36.7) vs 137.6 (23.5) mg/dL, as well as a weight reduction by 1.7 kg. Hypoglycemic events did not increase. No benefits were seen in the control group. Ten subjects withdrew from the study before 6 months. CONCLUSIONS: A home-based physical exercise program improves quality of life, glycemic control, and weight in type 2 diabetic patients older than 60 years.

Implant treatment in patients with osteoporosis.

Osteoporosis is very common, particularly in post-menopausal women and is characterized by a decrease in bone mass and strength. Osteoporosis also affects the jawbone and it is considered a potential contraindication to placement of dental implants. The present paper reviews the literature regarding the effect of osteoporosis on osseointegration of implants. Experimental models have shown that osteoporosis affects the process of osseointegration, which can be reversed by treatment. However, studies in subjects with osteoporosis have shown no differences in survival of the implants compared to healthy individuals. Therefore, osteoporosis cannot be considered a contraindication for implant placement. Oral bisphosphonates are the most commonly used pharmacological agents in the treatment of osteoporosis. Although there have been cases of osteonecrosis of the jaw in patients treated with bisphosphonates, they are very rare and it is more usually associated with intravenous bisphosphonates in patients with neoplasms or other serious diseases. Nevertheless, patients treated with bisphosphonates must be informed in writing about the possibility of this complication and must give informed consent. Ceasing to use bisphosphonates before implant placement does not seem to be necessary.

[An ambulatory physical exercise program improves in the short term weight and quality of life of obese post-menopausal women]. / Mejora a corto plazo del peso y la calidad de vida de mujeres obesas posmenopáusicas mediante un programa ambulatorio de ejercicio físico.

OBJECTIVES: To evaluate the effects of an ambulatory physical exercise program on the quality of life, anthropometric and biochemical parameters in obese post-menopausal women. METHODS: One hundred and six obese post-menopausal women were randomized to take part in an ambulatory program of physical exercise (aerobic and anaerobic), or to receive conventional information about diet and exercise. After three months, effects on quality of life were evaluated (test Euroqol, Rosenberg and subjective evaluation of health), weight, BMI, waist perimeter and fat mass, and biochemical parameters. RESULTS: Mean age was 59.79 (8.02) years and BMI 37.51 (6.03) kg/m(2). Women included in the exercise group improved their quality of life after three months (EuroQol 0.48 (0.38) vs 0.66 (0.35); Rosenberg: 19.21 (5.05) vs 16.86 (4.94); subjective evaluation of health (%): 60.68 (19.99) vs 71.14 (17.28); p<0.01) and lost weight (90.95 (15.51) vs 88.72 (15.17); p<0.001), BMI (37.5 (5.68) vs 36.59 (5.72); p<0.001) and fat mass (46.28 (4.92)% vs 45.47 (4.88)%; p<0.01). No changes were observed in control group. 31 people withdrew the study before 12 weeks. CONCLUSIONS: An ambulatory physical exercise program improves quality of life and reduces weight and fat mass, in a short period of time, in obese post-menopausal women. The high rate of withdrawal should be considered as an inconvenient in this type of programs.

Efficacy of atorvastatin for achieving cholesterol targets after LDL-cholesterol based dose selection in patients with type 2 diabetes.

We analyzed the feasibility of an intensive lipid-lowering strategy based on a starting dose of atorvastatin according to baseline and target low-density lipoprotein cholesterol (LDL-C) level (<2.6 mmol/L) in 202 statin-naïve patients with type 2 diabetes within 24 weeks. They were assigned to receive a daily dosage of atorvastatin based on their initial LDL-C levels. The primary endpoint was the proportion of patients achieving the LDL-C goal after 24 weeks of treatment. No changes were made in prescribed atorvastatin dosage. At the study end, 66.5% of the 188 patients completing the trial reached the LDL-C target (75%, 67%, 58% and 59% with 10, 20, 40 and 80 mg per day of atorvastatin, respectively) reached LDL-C target. Atorvastatin reduced the levels of total cholesterol, LDL-C, high density lipoprotein cholesterol (HDL-C) and triglycerides by 29%, 35%, 3% and 22%, respectively, and all statin doses were well tolerated. Thus, individualizing the starting dose of atorvastatin according to baseline and target LDL-C levels, allowed a high proportion of type 2 diabetic patients to achieve the target within 24 weeks.

Contribution of positron emission tomography to the diagnosis of a case of acromegaly.

Diagnosis of acromegaly is based on biochemical tests demonstrating increased growth hormone (GH) secretion. More than 95% of patients with acromegaly harbor a GH-secreting pituitary adenoma. The technique of choice in the diagnosis of an adenoma is magnetic resonance imaging (MRI). The use of new techniques such as (111)In-octreotide scintigraphy (OctreoScan) and positron emission tomography (PET) can provide additional information in some cases. We report the case of a woman with acromegaly. The results of several MRI scans and OctreoScan were normal and other diagnostic possibilities were ruled out. The pituitary origin of the increased GH secretion was identified by PET. In acromegaly, the absence of MRI findings and identification of location by means of PET are exceptional.

Effects of diabetes on the osseointegration of dental implants.

The increased prevalence of diabetes mellitus has become a public health problem. Hyperglycaemia entails a rise in the morbidity and mortality of these patients. Although a direct relationship with periodontal disease has already been shown, little is known about the results of dental implants in diabetics. The present paper reviews the bibliography linking the effect of diabetes on the osseointegration of implants and the healing of soft tissue. In experimental models of diabetes, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur during the first year of functional loading, seemingly pointing to the microvascular complications of this condition as a possible causal factor. These complications also compromise the healing of soft tissues. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycaemia, together with other measures, has been shown to improve the percentages of implant survival in these patients.