The Spanish Scientific Societies before the ESC 2021 guidelines on vascular disease prevention: Generalizing the measurement of albuminuria to identify vascular risk and prevent vascular disease.

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies recognize the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorized based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimize the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing.

Artículo especial por el Día Mundial del Riñón: Las sociedades científicas españolas ante la guía ESC 2021 de prevención de la enfermedad vascular: generalizar la medida de la albuminuria para identificar el riesgo vascular y prevenir la enfermedad vascular / The Spanish Scientific Societies before the ESC 2021 guidelines on vascular disease prevention: Generalising the measurement of albuminuria to identify vascular risk and prevent vascular disease

Las guías de 2021 sobre la prevención de la enfermedad vascular (EV) en la práctica clínica publicadas por la European Society of Cardiology (ESC) y apoyadas por otras 13 sociedades científicas europeas reconocen el papel clave de la detección de la enfermedad renal crónica (ERC) en la prevención de la EV. El riesgo vascular en la ERC se categoriza a partir de las medidas del filtrado glomerular estimado (FGe) y del cociente albúmina:creatinina en orina (ACRo). Así, la ERC moderada se asocia a un riesgo vascular alto y la ERC grave a un riesgo vascular muy alto, debiendo actuar en consecuencia desde el punto de vista terapéutico, sin que sea necesario aplicar otras puntuaciones de riesgo vascular cuando este ya es muy alto debido a la ERC. Es más, la ESC sitúa la medida del FGe y del ACRo en el inicio de la estimación del riesgo vascular y del algoritmo de decisión subsiguiente. A fin de optimizar la implementación de la guía 2021 de la ESC sobre la prevención de la EV en España, consideramos que: 1) El estudio de la orina para determinar la albuminuria mediante el ACRo debería formar parte de la rutina clínica al mismo nivel que el de la glucemia, la colesterolemia y la estimación del FG cuando estas se usan para tomar decisiones sobre el riesgo de EV. 2) Los servicios de salud públicos y privados españoles deberían disponer de los medios y recursos necesarios para implementar de forma óptima las Guías ESC 2021 de prevención de la EV en España, incluyendo la determinación del ACRo.(AU)

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies, recognise the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorised based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimise the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolaemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing. (AU)

How the COVID-19 pandemic has affected the training of Endocrinology and Nutrition Residents. Results of a survey by the Spanish Society of Endocrinology and Nutrition.

INTRODUCTION: COVID-19 disease has become a priority for our healthcare system. The resident physicians training in endocrinology and nutrition (E&N residents) have been integrated into the COVID-19 teams. This study has been designed with the aim of analysing the educational, occupational and health impact on E&N residents. MATERIAL AND METHODS: Cross-sectional observational study via a web survey, aimed at E&N residents who are members of the SEEN, carried out in November 2020. The following data were analysed: demographic variables, number of beds in the training hospital, alteration of rotations, integration in COVID-19 teams, participation in telemedicine, scientific activity and impact on physical and emotional health. RESULTS: 87 responses were obtained (27% of all E&N residents), 67.8% women, 28.1 ±â€¯1.8 years, 60% 4th year E&N residents. 84% participated in COVID-19 teams and 93% in the telemedicine consultations of their service. Most have had their rotations interrupted. 97.7% have participated in scientific meetings or virtual congresses and a third of them have collaborated in scientific work on COVID-19 in relation to endocrinology and nutrition. Overall, 75.8% think the pandemic has affected their mood a lot or quite a lot, and 73.8% think that the pandemic has negatively impacted their training. CONCLUSIONS: The SARS-CoV-2 pandemic has compromised the training, work activity and health of E&N residents. They have been integrated both in COVID-19 teams and in the restructured activity of their departments. However, they have managed to continue their training in virtual format and have participated in scientific work.

[How the COVID-19 pandemic has affected the training of Endocrinology and Nutrition Residents. Results of a survey by the Spanish Society of Endocrinology and Nutrition]. / Cómo ha afectado la pandemia COVID-19 en la formación de los MIR de Endocrinología y Nutrición. Resultados de una encuesta de la Sociedad Española de Endocrinología y Nutrición.

INTRODUCTION: COVID-19 disease has become a priority for our healthcare system. The resident physicians training in endocrinology and nutrition (E&N residents) have been integrated into the COVID-19 teams. This study has been designed with the aim of analysing the educational, occupational and health impact on E&N residents. MATERIAL AND METHODS: Cross-sectional observational study via a web survey, aimed at E&N residents who are members of the SEEN, carried out in November 2020. The following data were analysed: demographic variables, number of beds in the training hospital, alteration of rotations, integration in COVID-19 teams, participation in telemedicine, scientific activity and impact on physical and emotional health. RESULTS: 87 responses were obtained (27% of all E&N residents), 67.8% women, 28.1 ± 1.8 years, 60% 4th year E&N residents. 84% participated in COVID-19 teams and 93% in the telemedicine consultations of their service. Most have had their rotations interrupted. 97.7% have participated in scientific meetings or virtual congresses and a third of them have collaborated in scientific work on COVID-19 in relation to endocrinology and nutrition. Overall, 75.8% think the pandemic has affected their mood a lot or quite a lot, and 73.8% think that the pandemic has negatively impacted their training. CONCLUSIONS: The SARS-CoV-2 pandemic has compromised the training, work activity and health of E&N residents. They have been integrated both in COVID-19 teams and in the restructured activity of their departments. However, they have managed to continue their training in virtual format and have participated in scientific work.

Portfolio of services in Endocrinology and Nutrition. 2020 update. / Cartera de servicios en Endocrinología y Nutrición. Actualización 2020.

Endocrinology and Nutrition is a medical specialty covering the study and treatment of diseases of the endocrine system, metabolism and those derived from the nutritional process, including knowledge of diagnostic techniques and dietary and therapeutic measures. In order to develop these activities and plan the management of resources allocated for this purpose, the so-called Portfolio of Services of the specialty has to be defined. A Portfolio of Services is defined as the set of techniques, technologies or procedures through which care services are provided in a healthcare centre, department or institution. It is an essential tool for organization of a hospital Unit or Department by defining the roles and procedures of its healthcare professionals, and also for structuring the resources required to perform the activity. It also allows for defining how to use these resources and identifying the objectives to be achieved, improving the quality of clinical care. Finally, the definition and preparation of the portfolio of services makes it possible to have an inventory of the offer of healthcare services and to detect new healthcare needs.

¿Qué pueden aportar los agonistas del receptor de GLP1 en el tratamiento de los pacientes con enfermedad hepática grasa no alcohólica? / No disponible

No disponible

What may GLP1 receptor agonists contribute to the treatment of patients with non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease (NAFLD) poses a challenge to health services both in developed and developing countries, with a significant increase in incidence and prevalence that is related to the currently increased prevalence of obesity. Besides an acknowledged higher risk for advanced liver disease (cirrhosis, hepatocellular carcinoma), morbidity and mortality from cardiovascular disease both increase in people with NAFLD. As a matter of fact, NAFLD is a cardiovascular risk factor.

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

La diabetes mellitus tipo 2 (DM2) es un problema de dimensiones globales por su alta y creciente prevalencia en todo el mundo y por los costes personales y económicos asociados a ella. Un tratamiento adecuado ha demostrado reducir la mortalidad y las complicaciones asociadas. Recientemente se han incluido nuevos conceptos en la práctica clínica habitual y en el árbol de decisión de la terapia farmacológica de la DM2. Por ello, la Sociedad Española de Diabetes (SED) encargó al Grupo de Trabajo de Consensos y Guías Clínicas actualizar el documento de 2010 «Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo2». Entre los aspectos novedosos se incluyen nueve características para describir a cada grupo farmacológico: eficacia, riesgo de hipoglucemia, efectos en el peso corporal, efecto demostrado en el riesgo cardiovascular, nefroprotección, limitación de uso en la insuficiencia renal, frecuencia de los efectos secundarios, complejidad y coste. Así mismo, se detallan las opciones de combinación y se desarrollan el inicio y el ajuste de las terapias inyectables disponibles

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

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.

Tratamiento del hígado graso no alcohólico en la diabetes mellitus tipo 2: ¿por qué tratar el hígado graso no alcohólico? / Treatment of non-alcoholic fatty liver disease in type 2 diabetes mellitus: Why treat non-alcoholic fatty liver disease?

El hígado graso no alcohólico (HGNA) es una entidad muy frecuente en el paciente con diabetes mellitus tipo 2 (DM2). La coexistencia de ambas patologías se asocia con mayor y más temprana mortalidad por complicaciones hepáticas y, sobre todo, por enfermedad cardiovascular. En el tratamiento del HGNA y la DM2, además de intentar un estricto control glucolipídico, se debe intervenir sobre los factores de riesgo para la progresión a estadios más avanzados y agresivos. Aún no existe un fármaco aprobado por agencias internacionales para el tratamiento del HGNA, pero hay estudios que han demostrado la utilidad de algunos de ellos, como la pioglitazona, la vitamina E y, recientemente, la liraglutida, entre otros. Esta revisión se centra en las medidas higiénico-dietéticas y los agentes farmacológicos disponibles hasta la fecha, en los cuales se ha puesto de manifiesto un potencial efecto positivo sobre la historia natural de la enfermedad

Non-alcoholic fatty liver disease (NAFLD) is a frequent comorbidity of type 2 diabetes mellitus. This coexistence is associated with higher and earlier mortality due to hepatic complications, especially cardiovascular disease. The treatment of both diseases should not only aim for strict glucose and lipid control but also to diminish the risk factors for its progression to more advanced and aggressive stages. No drug has yet been approved by international agencies for the treatment of NAFLD. Agents with proven usefulness in NAFLD include pioglitazone, vitamin E and, recently, liraglutide, among other drugs. This review focuses on the lifestyle interventions and currently available pharmacological agents that have shown a potentially positive effect on the natural history of NAFLD

Silla turca vacía primaria. Diagnóstico, tratamiento y seguimiento / Primary empty sella syndrome. Diagnosis, treatment and follow-up

La silla turca vacía es una entidad neurorradiológica que se caracteriza por la herniación del espacio subaracnoideo dentro de la silla turca, con la consiguiente compresión de la hipófisis contra el suelo selar. Se denomina silla turca vacía primaria (STVP) cuando no existen antecedentes de procesos patológicos hipofisarios ni tratamientos previos de la hipófisis. Debido al uso generalizado de la tomografía computarizada y la resonancia magnética craneal, el diagnóstico de STVP es cada vez más frecuente. Aunque clásicamente se ha considerado que la función hipofisaria casi siempre es normal, en los últimos estudios publicados se ha demostrado que es una entidad en la que se encuentran con frecuencia alteraciones de la función hipofisaria (hipopituitarismo total o parcial hasta en el 50% de los pacientes, hiperprolactinemia en el 10%), y que en ocasiones es preciso recurrir a tratamientos neuroquirúrgicos ante los síntomas de hipertensión intracraneal. Se describe el caso de una paciente con STVP y se analizan los aspectos relacionados con su epidemiología, clínica, diagnóstico, tratamiento y seguimiento (AU)

Empty sella syndrome refers to a neuroradiological entity characterized by a cerebrospinal fluid-filled sella, with a small pituitary gland compressed to the rim of the fossa. The term primary empty sella syndrome (PESS) is used to refer to the condition when it is unrelated to previous surgical, pharmacological, orradiotherapeutic treatment of the sellar region. Due to the widespread use of computed tomography and magneticresonance imaging techniques, diagnosis of PESS has become increasingly frequent. Although normal pituitary function has traditionally been considered to be preserved in most cases of PESS, the latest studies have reported frequent pituitary abnormalities (partial or total hypopituitarism in up to 50% of patients and hyperprolactinemia in 10%). Moreover, neurosurgical treatment is mandatory in patients with symptoms of intracranial hypertension. We report a case of PESS and describe the epidemiological and clinical features, diagnosis, treatment and follow-up of patients with PESS (AU)