Familial isolated pituitary adenoma caused by a Aip gene mutation not described before in a family context.

The cause of familial isolated pituitary adenomas (FIPA) remains unknown in a high percentage of cases, but the AIP gene plays an important role in the etiology. The aim of the study is to describe a family with FIPA syndrome and the results of genomic studies. A 16-year-old man had a giant prolactinoma resistant tomedical treatment with delayed growth and pubertal development. His mother had been previously diagnosed with a nonfunctioning pituitary macroadenoma. Transsphenoidal endoscopic resection was performed and a genetic study revealed a heterozygous mutation in exon 6: 974G>A (p.Arg325Gln). Because the AIP gene is a tumor suppressor gene, we searched for loss of heterozygosity within the AIP gene by amplifying exon 6 from tumor tissue of the patient. In the electropherogram, only the A allele was amplified (hemizygous state), indicating loss of the normal allele. We report a Spanish family with FIPA in whom a mutation in the AIP gene previously unreported in a familiar context was identified.

Hypovitaminosis D and incidence of obesity: a prospective study.

The aim of this study was to assess the relationship between obesity and vitamin D status cross-sectionally, the relationship between obesity and the incidence of hypovitaminosis D prospectively and inversely the relationship between vitamin D status and incidence of obesity in a population-based cohort study in Spain. At baseline (1996-1998), 1226 subjects were evaluated and follow-up assessments were performed in 2002-2004 and 2005-2007, participants undergoing an interview and clinical examination with an oral glucose tolerance test. At the second visit, 25-hydroxyvitamin D and intact parathyroid hormone concentrations were also measured. Prevalence of obesity at the three visits was 28.1, 36.2 and 39.5%, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D ≤ 20 ng/ml (≤ 50 nmol/l)) was 34.7%. Neither obesity at baseline (OR=0.98, 95% CI: 0.69-1.40, P=0.93) nor the development of obesity between baseline and the second evaluation (OR=0.80, 95% CI: 0.48-1.33, P=0.39) were significantly associated with vitamin D status. In subjects who were non-obese (BMI <30 kg/m²) at the second evaluation, 25-hydroxyvitamin D values ≤ 17 ng/ml (≤ 42.5 nmol/l) were significantly associated with an increased risk of developing obesity in the next 4 years (OR=2.35, 95% CI: 1.03-5.4, P=0.040 after diverse adjustments). We conclude that vitamin D deficiency is associated with an increased risk of developing obesity.

Diarrea crónica refractaria y mal absorción secundaria a hipogammaglobulinemia común variable, infestación crónica por giardialambila y gastrectomía total por adenocarcinoma gástrico: un manejo nutricional complejo / Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management

El adenocarcinoma gástrico es una de las causas más frecuentes de mortalidad en el mundo, siendo la cirugía el único tratamiento potencialmente curativo, aunque los efectos adversos digestivos y nutricionales son frecuentes y abundantes. La hipogammaglobulinemia variable comunes causa de frecuentes manifestaciones digestivas, derivándose las más importantes en diarrea crónica causada porgiardiasis, hiperplasia nodular linfoide o atrofia vellosa, siendo frecuente la mal absorción y la desnutrición. Los déficits nutricionales secundarios a la mal absorción (postgastrectomía y asociada a la atrofia vellosa y la giardiasis por hipogammaglobulinemia variable común) son asi mismo frecuentes. Presentamos el caso de un paciente gastrectomizado por adenocarcinoma gástrico y con hipogammaglobulinemia variable común e infestación crónica por giardiasis que presenta una importante diarrea crónica refractaria a tratamiento y mal absorción (AU)

Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastro intestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis andc ommon variable immunodeficiency ) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption (AU)

Vitamin D deficiency in Spain: a population-based cohort study.

BACKGROUND: Vitamin D deficiency is common worldwide. No homogenous reference values have yet been established and no studies of values have been conducted in Spain involving a large number of participants. OBJECTIVE: To study the population concentrations of vitamin D in a representative sample of the Spanish population. SUBJECTS/METHODS: The study involved two cohorts from Spain, the Asturias study and the Pizarra study, which are two prospective, population-based studies involving 2260 participants. In 1262 subjects (age: 20-83 years) we studied 25-hydroxyvitamin D, intact parathyroid hormone (iPTH), calcium, phosphorus and creatinine. RESULTS: The median population values of 25-hydroxyvitamin D and iPTH were 22.46 ng/ml and 42.29 pg/ml, respectively. The values of 25-hydroxyvitamin D were significantly higher in summer and correlated with age (ß = -0.05 ± 0.01, P < 0.0001), creatinine (ß = 6.42 ± 1.17, P < 0.0001) and iPTH (-0.07 ± 0.01, P < 0.0001), but not with calcium, phosphorus or sex. The increase in iPTH with age was seen whatever the values of 25-hydroxyvitamin D, and was greater in the older persons. The concentration of iPTH rose continuously with effect from 25-hydroxyvitamin D values below ≈30 ng/ml. Values above ≈35 ng/ml were associated with a significantly lower concentration of iPTH. CONCLUSIONS: One-third (33.9%) of the Spanish population may be at risk for Vitamin D deficiency. The 25-hydroxyvitamin D values above 30 ng/ml can safely discard 'hyper PTH'. The increase in iPTH concentration is greater in older persons for similar values of 25-hydroxyvitamin D.

[Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management]. / Diarrea crónica refractaria y malabsorción secundaria a hipogammaglobulinemia común variable, infestación crónica por giardia lamblia y gastrectomía total por adenocarcinoma gástrico: un manejo nutricional complejo.

Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Estudio longitudinal del impacto del tratamiento con infusores de insulina en variables psicológicas, la calidad de vida y el control glucémico de pacientes con diabetes mellitus tipo 1 / Longitudinal study of the impact of the treatment with insulin infusion in psychological, quality of life, and glycemic control of patient with type 1 diabetes mellitus

Introducción: Desde el estudio DCCT, han sido muchas las investigacionesque han intentado evaluar las distintas propuestas de terapia intensiva. Pocosestudios a largo plazo incluyen variables psicosociales. Objetivos: Evaluarvariables psicológicas y metabólicas en pacientes con diabetes tipo 1 tras 2años de tratamiento con infusión subcutánea continua de insulina (ISCI). Materialesy métodos: Veintidós pacientes con diabetes tipo 1 en tratamientocon múltiples dosis de insulina recibieron tratamiento con ISCI. Se realizó unaevaluación a los 6, 12 y 24 meses, utilizando diversos instrumentos como elBDI, el DQOL, la MHLC, el STAI y el cuestionario de miedo a las hipoglucemias.Se admitió un control glucémico adecuado con una HbA1c <7,5%. Elanálisis estadístico se realizó mediante pruebas no paramétricas y el coeficientede correlación de Pearson. Resultados: Los pacientes partían de una puntuaciónmedia en depresión de 9,55 ± 9,12 (media ± DT). En calidad devida, los datos iniciales fueron 92,95 ± 16,15, mientras que el nivel de HbA1cfue de 8,45 ± 1,59%. Al cabo de los 2 años de tratamiento, se aprecian mejorassignificativas en las puntuaciones obtenidas en depresión (p= 0,018),calidad de vida (p= 0,005) y control glucémico (p= 0,003). La ansiedad rasgoy el locus de control externo correlacionaron significativamente, encontrándoseuna fuerte relación entre el miedo a las hipoglucemias y las variablespsicológicas estudiadas. Los pacientes con mal control glucémico basal mejoraronal cabo de los 2 años de tratamiento. Conclusiones: Después de 2años con ISCI, los pacientes con diabetes tipo 1 mejoran significativamente sucalidad de vida, su control glucémico y su sintomatología depresiva(AU)

Introduction: Since the DCCT study, many studies have tried to assess differentintensive therapies. However, few long-term studies have included psychosocialvariables. Objectives: To evaluate psychological and metabolic variablesin patients with type 1 diabetes after 2 years of therapy with continuoussubcutaneous insulin infusion (CSII). Materials and methods: Twenty-twotype 1 diabetic patients treated with multiple daily injections were treated withCSII. An evaluation at 6, 12 and 24 months was performed, using several instrumentsas BDI, DQOL, MHLC and a questionnaire to evaluate fear of hypoglycaemia.Acceptable metabolic control was admitted with HbA1c <7.5%.Statistical analysis was realized using non parametric tests and Pearson’s correlationcoefficient. Results: Initially, patients had a mean score for depressionof 9.55 ± 9.12 (mean ± SD). In quality of life, initial values were 92.95 ±16.15, while the level of HbA1c was 8.45 ± 1.59%. After 2 years of treatmentwe found significant improvement in depression (p= 0.018) and quality of life(p= 0.005) scores and glycemic control (p= 0.003). Trait anxiety and externallocus of control showed a significant correlation, with a strong correlation betweenfear of hypoglycemia and the analyzed psychosocial variables. Patientswith bad basal glycemic control improved after 2 years of treatment. Conclusions:After two years with CSII, type 1 diabetic patients improve significantlytheir quality of life, glycemic control and depressive symptoms(AU)

Personalidad y adherencia al tratamiento con infusor subcutáneo de insulina y monitorización continua de glucosa en pacientes con diabetes mellitus tipo 1 / Personality and adherence to the treatment with continuous subcutaneous insulin infusion and continuous glucose subcutaneous monitoring system in patients with type 1 diabetes mellitus

Antecedentes: Aunque en la literatura se ha subrayado la importancia de la adherencia al tratamiento para el correcto control metabólico, parte de los pacientes con diabetes continúa manteniendo una baja adherencia terapéutica. La personalidad parece ser una variable relevante. Objetivos: Estudiar la adherencia de pacientes adultos con diabetes tipo 1 al tratamiento con sistema integrado de infusión subcutánea continua de insulina (ISCI) y monitorización continua de glucosa intersticial a tiempo real (MCG-TR). Materiales y métodos: Veinte pacientes con diabetes tipo 1 de larga evolución recibieron tratamiento intensivo de insulina mediante un sistema integrado de infusor subcutáneo de insulina (ISCI) y monitorización continua de glucosa a tiempo real (MCG-TR) durante 6 meses. Se utilizaron el inventario de personalidad de Millon (MCMI-II) y una escala de satisfacción. Resultados: Los pacientes con diabetes mellitus tipo 1 que abandonaron el tratamiento tuvieron mayores puntuaciones en las escalas de histrionismo, narcisismo, agresividad y abuso de drogas, así como peor control metabólico y mayor insatisfacción con el tratamiento. Conclusiones: El perfi l de los pacientes que abandonaron el tratamiento fue de insatisfacción con el tratamiento (sistema integrado ISCI más MCG-TR) que no mejora el control metabólico, estilo de personalidad caracterizado por histrionismo, narcisismo y agresividad, e historia reciente o recurrente de abuso de drogas, con difi cultad para reprimir los impulsos o mantenerlos dentro de los límites sociales convencionales (AU)

Background: Although it has been reported the importance of adherence toprescribed treatment to maintain an adequate metabolic control, a proportionof patients with diabetes have a low adherence to treatment. Personality seems to be an important variable. Objectives: To study the adherence of adult patients with type 1 diabetes to treatment with integrated system of continuous insulin infusion (CSII) and real time continuous glucose subcutaneous monitoring system (RT-CGMS). Materials and methods: Twenty patients with longduration type 1 diabetes received intensive treatment with CSII and RT-CGMS during 6 months. Millon personality inventory (MCMI-II) and a satisfaction scale were employed. Results: Patients with type 1 diabetes who abandoned the treatment, had higher scores on the dimensions of histrionism, narcissism, aggressivenessand drug abuse, as well as worse glycemic control, and weremore dissatisfied with the treatment. Conclusions: Profile of patients whodecide to leave the treatment was of patients dissatisfied with treatment (CSII and RT-CGMS) which does not improve metabolic control, personality style characterized by histrionism, narcissism and aggressiveness, and recent or recurrent history of abuse of drugs, with difficulty to repress impulses or to maintain them inside the conventional social limits(AU)

[Influence of temperature on food intake in hospitalized patients]. / Influencia de la temperatura en la ingesta de pacientes hospitalizados.

BACKGROUND AND OBJECTIVES: Prevalence of hyponutrition in hospitalized patients is very high and it has been shown to be an important prognostic factor. Most of admitted patients depend on hospital food to cover their nutritional demands being important to assess the factors influencing their intake, which may be modified in order to improve it and prevent the consequences of inadequate feeding. In previous works, it has been shown that one of the worst scored characteristics of dishes was the temperature. The aim of this study was to assess the influence of temperature on patient's satisfaction and amount eaten depending on whether the food was served in isothermal trolleys keeping proper food temperature or not. MATERIAL AND METHODS: We carried out satisfaction surveys to hospitalized patients having regular diets, served with or without isothermal trolleys. The following data were gathered: age, gender, weight, number of visits, mobility, autonomy, amount of orally taken medication, intake of out-of-hospital foods, qualification of food temperature, presentation and smokiness, amount of food eaten, and reasons for not eating all the content of the tray. RESULTS: Of the 363 surveys, 134 (37.96%) were done to patients with isothermal trays and 229 (62.04%) to patients without them. Sixty percent of the patients referred having eaten less than the normal amount within the last week, the most frequent reason being decreased appetite. During lunch and dinner, 69.3% and 67.7%, respectively, ate half or less of the tray content, the main reasons being as follows: lack of appetite (42% at lunch time and 40% at dinner), do not like the food (24.3 and 26.2%) or taste (15.3 and 16.8%). Other less common reasons were the odor, the amount of food, having nausea or vomiting, fatigue, and lack of autonomy. There were no significant differences in the amount eaten by gender, weight, number of visits, amount of medication, and level of physical activity. The food temperature was classified as adequate by 62% of the patients, the presentation by 95%, and smokiness by 85%. When comparing the patients served with or without isothermal trays, there were no differences with regards to baseline characteristics analyzed that might have had an influence on amount eaten. Ninety percent of the patients with isothermal trolley rated the food temperature as good, as compared with 57.2% of the patients with conventional trolley, the difference being statistically significant (P = 0.000). Besides, there were differences in the amount of food eaten between patients with and without isothermal trolley, so that 41% and 27.7% ate all the tray content, respectively, difference being statistically significant (P = 0.007). There were no differences in smokiness or presentation rating. CONCLUSIONS: Most of the patients (60%) had decreased appetite during hospital admission. The percentage of hospitalized patients rating the food temperature as being good is higher among patients served with isothermal trolleys. The amount of food eaten by the patients served with isothermal trolleys is significantly higher that in those without them.

Influencia de la temperatura en la ingesta de pacientes hospitalizados / Influence od temperatura on food intake in hospitalizad patients

Antecedentes y objetivos: La prevalencia de desnutrición en los pacientes hospitalizados es muy elevada y se ha demostrado que constituye un factor pronóstico importante. La mayoría de los pacientes ingresados dependen de la comida hospitalaria para cubrir sus requerimientos nutricionales siendo importante el análisis de los factores que influyen en la ingesta y que se puedan modificar, para conseguir mejorarla y así evitar las consecuencias derivadas de una nutrición inadecuada. En anteriores trabajos se ha demostrado que una de las características de la comida peor valoradas por los pacientes es la temperatura. El objetivo de este trabajo fue evaluar la influencia de la temperatura en la satisfacción y cantidad ingerida en función de que se sirviese o no en carros isotérmicos que mantienen una temperatura adecuada de la comida. Material y métodos: Se realizaron encuestas de satisfacción a pacientes del hospital con y sin carros isotérmicos con dietas basales. Se recogieron los siguientes datos: edad, sexo, peso, número de visitas, movilidad, autonomía, cantidad de medicación por vía oral, ingestión de alimentos traídos de fuera del hospital, calificación de la temperatura, presentación y humedad, cantidad de comida ingerida y motivos por los que no se ingirió todo el contenido del carro isotérmico. Resultados: De las 363 encuestas, 134 de ellas (37,96%) se realizaron en pacientes con bandeja térmica y 229 (62,04%) en pacientes sin ella. El 60% de los pacientes referían haber comido menos de lo normal en la última semana siendo la causa más frecuente la disminución de apetito. En el almuerzo y cena comieron la mitad o menos del contenido de la bandeja el 69,3% y 67,7% respectivamente, siendo las causas más frecuentes las siguientes: la falta de apetito (42% en almuerzo y 40% en cena), no gustarles la comida (24,3 y 26,2%) y el sabor (15,3 y 16,8%). Otras causas menos frecuentes fueron el olor, la cantidad de comida, presentar náuseas o vómitos, cansancio y falta de autonomía. No hubo diferencias significativas en la cantidad de ingesta en función del sexo, peso, número de visitas, cantidad de medicación y grado de actividad. La temperatura de la comida fue clasificada como buena por el 62% de los pacientes, la presentación por el 95% y la humedad por el 85%. Al comparar a los pacientes con y sin carro isotérmico, no hubo diferencias en las características basales analizadas que pudiesen influir en la cantidad ingerida. Calificaron la temperatura como buena un 90% de los pacientes con carro isotérmico y un 57,2% sistema tradicional, siendo esta diferencia estadísticamente significativa (P = 0,000). Además hubo diferencias en la cantidad de comida ingerida entre los pacientes con y sin carro isotérmico, de modo que se lo comieron todo un 41% frente al 27,7% respectivamente siendo esta diferencia estadísticamente significativa (P = 0,007). No hubo diferencias en la calificación de humedad y presentación. Conclusiones: La mayoría de los pacientes (60%) presentan disminución de apetito durante el ingreso. La proporción de ingresados que califican la temperatura como buena es mayor en los pacientes con el sistema de carros isotérmicos. La cantidad ingerida por los pacientes con carros isotérmicos es significativamente mayor que en los pacientes sin ellos (AU)

Background and objectives: Prevalence of hyponutrition in hospitalized patients is very high and it has been shown to be an important prognostic factor. Most of admitted patients depend on hospital food to cover their nutritional demands being important to assess the factors influencing their intake, which may be modified in order to improve it and prevent the consequences of inadequate feeding. In previous works, it has been shown that one of the worst scored characteristics of dishes was the temperature. The aim of this study was to assess the influence of temperature on patient's satisfaction and amount eaten depending on whether the food was served in isothermal trolleys keeping proper food temperature or not. Material and methods: We carried out satisfaction surveys to hospitalized patients having regular diets, served with or without isothermal trolleys. The following data were gathered: age, gender, weight, number of visits, mobility, autonomy, amount of orally taken medication, intake of out-of-hospital foods, qualification of food temperature, presentation and smokiness, amount of food eaten, and reasons for not eating all the content of the tray. Results: Of the 363 surveys, 134 (37.96%) were done to patients with isothermal trays and 229 (62.04%) to patients without them. Sixty percent of the patients referred having eaten less than the normal amount within the last week, the most frequent reason being decreased appetite. During lunch and dinner, 69.3% and 67.7%, respectively, ate half or less of the tray content, the main reasons being as follows: lack of appetite (42% at lunch time and 40% at dinner), do not like the food (24.3 and 26.2%) or taste (15.3 and 16.8%). Other less common reasons were the odor, the amount of food, having nausea or vomiting, fatigue, and lack of autonomy. There were no significant differences in the amount eaten by gender, weight, number of visits, amount of medication, and level of physical activity. The food temperature was classified as adequate by 62% of the patients, the presentation by 95%, and smokiness by 85%. When comparing the patients served with or without isothermal trays, there were no differences with regards to baseline characteristics analyzed that might have had an influence on amount eaten. Ninety percent of the patients with isothermal trolley rated the food temperature as good, as compared with 57.2% of the patients with conventional trolley, the difference being statistically significant (P = 0.000). Besides, there were differences in the amount of food eaten between patients with and without isothermal trolley, so that 41% and 27.7% ate all the tray content, respectively, difference being statistically significant (P = 0.007). There were no differences in smokiness or presentation rating. Conclusions: Most of the patients (60%) had decreased appetite during hospital admission. The percentage of hospitalized patients rating the food temperature as being good is higher among patients served with isothermal trolleys. The amount of food eaten by the patients served with isothermal trolleys is significantly higher that in those without them (AU)

[Probiotics and prebiotics in clinical practice]. / Probióticos y prebióticos en la práctica clínica.

This article revises the concepts of prebiotics, probiotics and symbiotics, and their use in different situations of daily clinical practice. With a high level of evidence, it is concluded that the use of certain strains of probiotics significantly reduces the risk for antibiotic-induced diarrhea. Although further studies are needed, the use of probiotics, prebiotics, and symbiotics in people suffering from inflammatory bowel disease (particularly ulcerative colitis, and pouchitis) might improve the rates of remission induction/maintenance. The administration of probiotics and symbiotics to patients with liver transplant, severe acute pancreatitis, and intensive and surgical care patients, emerges as a promising therapeutic option that seems to reduce the number of infections; however, it is currently no possible to establish evidence-based recommendations, with a need for a higher number of better designed works. About safety of probiotics and symbiotics, the benefits/risks ratio clearly favors the former since the risk for infection is low, even in immunosuppressed patients. There are, however, selected groups of patients in which caution is advised.

Probióticos y prebióticos en la práctica clínica / Probiotics and prebiotics in clinical practice

En este artículo se revisa el concepto de prebióticos, probióticos y simbióticos y su empleo en diferentes situaciones de la práctica clínica diaria. Con un grado de evidencia alto se concluye que el empleo de determinadas cepas de probióticos reduce significativamente, el riesgo de diarrea por antibióticos. Aunque son necesarios más estudios, el uso de prebióticos, probióticos y simbióticos en personas afectas de enfermedad inflamatoria intestinal (especialmente en la colitis ulcerosa y en la pouchitis) podría mejorar las tasas de inducción y/o mantenimiento de la remisión. La administración de probióticos y simbióticos en pacientes con trasplante hepático, pancreatitis aguda grave, y en pacientes de cuidados intensivos y quirúrgicos, emerge como una opción terapéutica prometedora que parece reducir el número de infecciones; no obstante, en la actualidad no es posible establecer recomendaciones basadas en la evidencia requiriendo mayor número de trabajos y mejor diseñados. Respecto a la seguridad de los probióticos y simbióticos, la balanza de beneficios frente a los riesgos está claramente inclinada hacia los primeros ya que el riesgo de infección es bajo, incluso en pacientes inmunodeprimidos. No obstante, existen grupos seleccionados de pacientes en los cuales todavía se recomienda emplear con precaución

This article revises the concepts of prebiotics, probiotics and symbiotics, and their use in different situations of daily clinical practice. With a high level of evidence, it is concluded that the use of certain strains of probiotics significantly reduces the risk for antibiotic-induced diarrhea. Although further studies are needed, the use of probiotics, prebiotics, and symbiotics in people suffering from inflammatory bowel disease (particularly ulcerative colitis, and pouchitis) might improve the rates of remission induction/maintenance. The administration of probiotics and symbiotics to patients with liver transplant, severe acute pancreatitis, and intensive and surgical care patients, emerges as a promising therapeutic option that seems to reduce the number of infections; however, it is currently no possible to establish evidencebased recommendations, with a need for a higher number of better designed works. About safety of probiotics and symbiotics, the benefits/risks ratio clearly favors the former since the risk for infection is low, even in immunosuppressed patients. There are, however, selected groups of patients in which caution is advised