Evolution of interconsultal activity to endocrinology and nutrition in hospitalization floor in a third level hospital.

INTRODUCTION: Endocrinology and Nutrition (EyN) is an outpatient and hospital medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. MATERIAL AND METHODS: Longitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. RESULTS: A total of 76093 IC notes (12623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. CONCLUSIONS: The EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC.

A survey on the perception of the specialty of Endocrinology and Nutrition among students preparing for the entrance exam for medical specialty training in Spain.

INTRODUCTION AND AIMS: Previous studies have shown that there is decreasing interest in E&N among medical students. The aim of our study was to evaluate the perception of E&N among a sample of medical students. MATERIAL AND METHODS: We surveyed 2252 students prior to taking the exam that allows access to specialised training in Spain. RESULTS: Overall, 9.9% (222 participants) would probably choose E&N. The most positive aspects in includes of the specialty are its logical pathophysiological basis (54%) and that the work is dynamic and varied (27%), while the least attractive aspects are the few interventional techniques. The parts of the specialty that most attract students are hypothalamic-pituitary disease and diabetes mellitus. CONCLUSIONS: The proportion of candidates who want to study E&N as their first choice is adequate in relation to the number of places available.

Evolution of the choice of places in Endocrinology and Nutrition in the Spanish exam for accessing to the resident physicians training program 2001-2022 measured with the quotation index.

INTRODUCTION: The comparison between specialties or the analysis of evolution over time of a speciality in the Spanish exam for accessing to the resident physicians training programme (RPTP) is difficult due to the changing of the number of places offered. In this paper we describe two parameters (quotation index and quotation order) that objectify the relationship between supply and demand for places in a given medical speciality in a RPTP call and analyse the evolution of the speciality of Endocrinology and Nutrition (E&N). MATERIAL AND METHODS: We analysed the evolution of the supply/demand ratio for the speciality of E&N in the 2001-2022 RPTP calls using the quotation index and quotation order. An increase in the quotation order implies a worsening of the supply/demand ratio. Robust correlation analysis between year and quoatation orden is used. RESULTS: E&N shows a worsening in the RPTP choice, both in relation to all specialties offered and in relation to specialties of medical area (robust correlation coefficient year-quotation order 0.72 (p=0.0002) if all specialties are considered and 0.80 (p<0.0001) if only medical area specialties are considered). CONCLUSIONS: The specialty E&N has shown a negative evolution in the choice of RPTP, objectified through the quotation index and the quotation order, both in relation to all the specialties offered and in relation to all the specialties of the medical area, although it is still among the most sought-after medical specialties in the medical area.

Perception of knowledge about Clinical Hospital Nutrition among resident doctors in a tertiary hospital.

INTRODUCTION: Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care. MATERIALS AND METHOD: An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit. RESULTS: The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p < 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6). DISCUSSION: Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations.

Analysis of the evolution of the publication of case reports in endocrinology journals.

INTRODUCTION: A case report is a scientific article describing one or more patients with unusual clinical presentations. In recent years, the number of case reports in publications has decreased. In this study, we analyze the publication of case reports in journals of Endocrinology during the years 2010, 2015 and 2019. MATERIALS AND METHODS: The Pubmed web was browsed for clinical journals of Endocrinology, those published in English and/or Spanish being selected, and the relevant variables analyzed. RESULTS: Of 84 analyzed journals, 51 accepted cases for publication, 29 did not, and 4 did so only in exceptional cases. In 2010, 11,754 articles were published, of which 709 were clinical cases (6.9% of the total); in 2015, a total of 14,594 articles of which 655 were clinical cases (5.8% of the total); and in 2019 a total of 14,110 articles, of which 472 were clinical cases (4.6% of the total). In journals demanding payment for the publishing of clinical cases, case reports represented 9% of all articles, and in free journals, 3% (P < 0.05). CONCLUSION: There has been a decline in publication of case reports in journals of Endocrinology in recent years, both in absolute and relative terms. Even though the cases described by these reports are, by definition, exceptional, the decline of their publication implies a significant loss of scientific information and clinical knowledge regarding certain pathologies.

Analysis of the evolution of the publication of case reports in endocrinology journals. / Análisis de la evolución en la publicación de casos clínicos en revistas de endocrinología.

INTRODUCTION: A case report is a scientific article describing one or more patients with unusual clinical presentations. In recent years, the number of case reports in publications has decreased. In this study, we analyze the publication of case reports in journals of Endocrinology during the years 2010, 2015 and 2019. MATERIALS AND METHODS: The Pubmed web was browsed for clinical journals of Endocrinology, those published in English and/or Spanish being selected, and the relevant variables analyzed. RESULTS: Of 84 analyzed journals, 51 accepted cases for publication, 29 did not, and 4 did so only in exceptional cases. In 2010, 11,754 articles were published, of which 709 were clinical cases (6.9% of the total); in 2015, a total of 14,594 articles of which 655 were clinical cases (5.8% of the total); and in 2019 a total of 14,110 articles, of which 472 were clinical cases (4.6% of the total). In journals demanding payment for the publishing of clinical cases, case reports represented 9% of all articles, and in free journals, 3% (P<.05). CONCLUSION: There has been a decline in publication of case reports in journals of Endocrinology in recent years, both in absolute and relative terms. Even though the cases described by these reports are, by definition, exceptional, the decline of their publication implies a significant loss of scientific information and clinical knowledge regarding certain pathologies.

Perception of knowledge about Clinical Hospital Nutrition among resident doctors in a tertiary hospital. / Percepción de conocimiento sobre Nutrición Clínica hospitalaria en los médicos residentes de un hospital terciario.

INTRODUCTION: Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care. MATERIALS AND METHOD: An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit. RESULTS: The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p < 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6). DISCUSSION: Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations.

Prevalencia de hipoglucemia grave en una cohorte de pacientes con diabetes tipo 1 / Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes

INTRODUCCIÓN: La hipoglucemia es el principal factor limitante para alcanzar los objetivos de control glucémico en pacientes con diabetes tipo 1. La hipoglucemia grave conlleva riesgo de daño, e incluso de muerte. Tener hipoglucemias repetidas se relaciona con la aparición de hipoglucemias inadvertidas, las cuales incrementan el riesgo de hipoglucemias graves. Algunos metaanálisis recientes estiman una prevalencia del 35% de hipoglucemia grave en pacientes con diabetes tipo 1. OBJETIVO: Conocer la prevalencia de hipoglucemia grave en una cohorte de pacientes con diabetes tipo 1 y evaluar la dependencia entre las variables hipoglucemia grave e inadvertida evaluada mediante el test de Clarke. PACIENTES Y MÉTODOS: Se ha estudiado una cohorte de pacientes con diabetes tipo 1 para analizar la edad, sexo, tiempo de evolución de diabetes, tratamiento (múltiples dosis o infusión subcutánea continua de insulina), autocontrol glucémico, HbA1c, episodios de hipoglucemia grave sin pérdida de conciencia, episodios de hipoglucemia grave con pérdida de conciencia e hipoglucemias inadvertidas. RESULTADOS: El 39,8% de los pacientes presentaron hipoglucemias graves sin pérdida de conciencia (últimos 6 meses) y el 11,4%, con pérdida de conciencia (últimos 12 meses). El 40,9% presentaban hipoglucemias inadvertidas y se descartó la independencia entre estas y las hipoglucemias graves. La presencia de hipoglucemias graves con pérdida de conciencia se asoció a mayor edad y mayor tiempo de evolución; las hipoglucemias inadvertidas, con una mayor edad y una menor HbA1c. CONCLUSIÓN: Se confirma el elevado porcentaje de pacientes con diabetes tipo 1 afectos de hipoglucemia grave e inadvertida

INTRODUCTION: Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES: To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS: The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS: Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS: Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes

Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes. / Prevalencia de hipoglucemia grave en una cohorte de pacientes con diabetes tipo 1.

INTRODUCTION: Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES: To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS: The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS: Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS: Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.

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

Introducción: En España, la elección de la especialidad se realiza vía examen médico interno residente (MIR). El número de elección de plaza MIR puede reflejar el interés por una especialidad. El objetivo del estudio es corroborar el aumento del número de elección y analizar los posibles factores influyentes a la hora de elegirla. Material y método: Analizar la evolución del número de orden con el que se elige nuestra especialidad y compararla con otras especialidades afines, así como las preferencias a la hora de elegirla realizando una encuesta anónima a 108 MIR de Endocrinología. Resultados: El número medio de elección ha ido aumentando progresivamente hasta llegar el último año al número 2336, esta tendencia coincide con un aumento en el número de plazas ofertadas, aunque es más marcada que en otras especialidades médicas relacionadas. En la encuesta se evaluaron diferentes factores influyentes a la hora de elegir especialidad. También se preguntó sobre los aspectos considerados más positivos y negativos de la especialidad. Se consideró como más positivo que sea tranquila y el más negativo, la escasez de técnicas. A la pregunta de si la especialidad había cumplido sus expectativas se dio una puntuación de 8,7 sobre 10, aunque la percepción del prestigio de la especialidad se puntuó solo con 6,7 puntos. Conclusiones: Hay un deterioro evidente del número de elección de nuestra especialidad que no es tan marcado en el resto ramas médicas relacionadas

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

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.

[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.

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

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 (AU)

Case report: We present a 33 years old patient with anorexia nervosa of 15 years of evolution with one of the few reported cases of severe acute liver failure secondary to malnutrition. Discurssion: After the protocolized nutritional support to avoid the refeeding syndrome and a multidisciplinary approach, the patient progresses favorably normalizing electrolytes, liver function and coagulation disorders (AU)