Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

[Effectiveness and complications of bariatric surgery in the treatment of morbid obesity]. / Eficacia y complicaciones de la cirugia bariátrica en el tratamiento de la obesidad mórbida.

INTRODUCTION AND OBJECTIVES: Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional, digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery. MATERIAL AND METHODS: Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano's procedure, and 25 by laparoscopic gastric bypass). Anthropometrics (height, weight, body mass index), cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid) and nutritional parameters (serum albumin, complete blood count, and phosphorus and calcium) were assessed before the bariatric procedure and one and two years after surgical treatment. Quality of life was evaluated through the B.A.R.O.S. system. RESULTS: Seventy patients with morbid obesity have been analyzed (56 women and 14 men) with a mean age of 36.5 +/- 11 years. Mean pre-surgical weight was 129.7 +/- 25.6 kg and BMI 48.8 +/- 8.8 kg/m2. Two years after the surgical procedure BMI was 31.0 +/- 6.6 kg/m2, the ponderal reduction 47.7 kg and the percentage of weight loss 36.5%. Hundred percent of dislipidemic patients, 90% of diabetic patients, and 72% of hypertensive patients normalized their corresponding profiles after surgery. The most common nutritional complications were anemia and iron deficiency, which occurred in 54.4% and 36.6% of the cases, respectively. Other observed nutritional deficits were: mild hypoalbuminemia in 20.3% of the patients, hypothrombinemia in 14.9%, folic acid decrease in 17.8%, vitamin B12 deficiency in 12.5%, hypocalcaemia in 23.8%, and secondary hyperparathyroidism in 45.4% of the cases. All nutritional complications were more frequent in patients submitted to biliopancreatic bypass, with the exception for vitamin B12 deficiency that occurred more frequently in patients with gastric bypass. The most frequently observed digestive complication was diarrhea/steatorrhea in 39.1% of the cases. Sixty-four point two percent of the patients considered the surgery outcome as excellent or very good. CONCLUSION: In patients with morbid obesity, bariatric surgery is a technique by which a great improvement in anthropometrical parameters, cardiovascular risk factors, and quality of life of patients is achieved, but it associates an important percentage of nutritional complications that we should take into account in order to prevent them.

Eficacia y complicaciones de la cirugía bariátrica en el tratamiento de la obesidad mórbida / Effectiveness and complications of bariatric surgery in the treatment of morbid obesity

Introducción y objetivos: La cirugía bariátrica constituye una alternativa terapéutica eficaz en pacientes con obesidad mórbida refractaria al tratamiento médico. Sin embargo, estas técnicas quirúrgicas aumentan el riesgo de provocar una malnutrición proteico energética o el déficit selectivo de algunos micronutrientes. El objetivo de este trabajo ha sido analizar las modificaciones antropométricas, nutricionales, digestivas, factores de riesgo cardiovascular y calidad de vida en pacientes con obesidad mórbida sometidos a cirugía bariátrica. Material y métodos: Estudio descriptivo retrospectivo donde se ha evaluado a un grupo de pacientes con obesidad mórbida que fueron intervenidos de cirugía bariátrica (45 mediante bypass biliopancreático según técnica de Scopinaro y 25 mediante bypass gástrico laparoscópico). Se les realizó una valoración antropométrica (talla, peso,índice de masa corporal), factores de riesgo cardiovascular (tensión arterial, perfil lipídico, glucémico y uricemia) y parámetros nutricionales (albuminemia, estudio hematológico y fosfocálcico) antes dela técnica bariátrica y al año y dos años después del tratamiento quirúrgico. La calidad de vida se evaluó mediante el sistema B.A.R.O.S Resultados: Se ha analizado a 70 pacientes con obesidad mórbida (56 mujeres y 14 varones) con una edad media de 36,5 ± 11 años. El peso medio prequirúrgico fue de 129,7 ± 25,6 Kg y el IMC de48,8 ± 8,8 Kg/m2. A los dos años tras la técnica quirúrgica el IMC fue de 31,0 ± 6,6 Kg/m2, la reducción ponderal de 47,7 Kg y el porcentaje de pérdida de peso del 36,5%. El 100% de los pacientes dislipémicos, el 90% de los diabéticos y el 72% de los hipertensos normalizaron sus perfiles correspondientes tras la cirugía. La complicación nutricional más común fue la anemia y la ferropenia que ocurrieron en el 54,4% y 36,6% de los casos respectivamente. Otros déficit nutricionales observados fueron: hipoalbuminemia leve en el 20,3% de los pacientes, hipoprotrombinemia en el 14,9%, descenso de ácido fólico en el 17,8%, déficit de vitamina B12 en el 12,5%, hipocalcemia en el 23,8% e hiperparatiroidismo secundario en el 45,4% de los casos. Todas las complicaciones nutricionales fueron más frecuentes en pacientes sometidos a bypass biliopancreático excepto en el caso del déficit de B12 que ocurrió con más frecuencia en pacientes con bypass gástrico. La complicación digestiva mas frecuentemente observada fue la diarrea/esteatorrea en el 39,1% de los casos. El 64,2% de los enfermos consideraron el resultado dela cirugía como excelente o muy bueno. Conclusión: En pacientes con obesidad mórbida, la cirugía bariátrica es una técnica con la que se consigue una gran mejoría en los parámetros antropométricos, en los factores de riesgo cardiovascular y en la calidad de vida de los pacientes, pero que conlleva asociadas un porcentaje importante de complicaciones nutricionales que deberemos tener en cuenta para poderlas prevenir (AU)

Introduction and objectives: Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional, digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery. Material and methods: Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano’s procedure, and 25 by laparoscopic gastric bypass). Anthropometrics (height, weight, body mass index), cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid) and nutritional parameters (serum albumin,complete blood count, and phosphorus and calcium)were assessed before the bariatric procedure and one and two years after surgical treatment.Quality of life was evaluated through theB.A.R.O.S. system. Results: Seventy patients with morbid obesity have been analyzed (56 women and 14 men) with a mean age of 36.5 ± 11 years. Mean pre-surgical weight was 129.7 ± 25.6 kg and BMI 48.8 ± 8.8kg/m2. Two years after the surgical procedureBMI was 31.0 ± 6.6 kg/m2, the ponderal reduction47.7 kg and the percentage of weight loss 36.5%.Hundred percent of dislipidemic patients, 90% of diabetic patients, and 72% of hypertensive patients normalized their corresponding profiles after surgery. The most common nutritional complications were anemia and iron deficiency, which occurred in 54.4% and 36.6% of the cases, respectively.Other observed nutritional deficits were:mild hypoalbuminemia in 20.3% of the patients, hypothrombinemia in 14.9%, folic acid decrease in 17.8%, vitamin B12 deficiency in12.5%, hypocalcaemia in 23.8%, and secondary hyperparathyroidism in 45.4% of the cases. All nutritional complications were more frequent inpatients submitted to biliopancreatic bypass, with the exception for vitamin B12 deficiency that occurred more frequently in patients with gastric bypass.The most frequently observed digestive complication was diarrhea/steatorrhea in 39.1%of the cases. Sixty-four point two percent of the patients considered the surgery outcome as excellentor very good.Conclusion: In patients with morbid obesity,bariatric surgery is a technique by which a great improvement in anthropometrical parameters,cardiovascular risk factors, and quality of life of patients is achieved, but it associates an important percentage of nutritional complications that we should take into account in order to prevent them (AU)

Insulina glargina en nutrición enteral / Glargine insulin in enteral nutrition

Se presenta el caso de un varón de 37 años con diabetes mellitus tipo 1 de 20 años de evolución que padece una grave gastroparesia diabética. Para el tratamiento de ésta, requirió la colocación de una sonda de yeyunostomía por la que recibía nutrición enteral continua en bomba de perfusión y su diabetes estaba bien controlada con una dosis diaria de insulina glargina (AU)

We report the case of a 37-year-old man with type 1 diabetes mellitus of 20 years' duration who presented with severe gastroparesis. Gastroparesis required jejunostomy with enteral nutrition administered with continuous perfusion pump and diabetes was well regulated with a daily dose of insulin glargine (AU)

Intestinal anisakiasis mimicking intestinal obstruction.

We report one case of acute abdomen after the ingestion of raw or undercooked fish containing nematode larvae of the genus Anisakis. Early diagnosis is very important as it could prevent unnecessary surgical procedures since the symptoms of intestinal anisakiasis may mimic other illnesses such as appendicitis, ileitis or peritonitis. We suggest that anisakiasis should be considered in the differential diagnosis of patients with acute abdomen.