[Trends in the characteristics of patients treated with nutritional supplements in the Northern Area of Gran Canaria in the period 2016 -2021]. / Tendencias en las características de los pacientes tratados con suplementos nutricionales en el Área Norte de Gran Canaria en el periodo 2016 -2021.

Introduction: Aim: to assess the prescription of oral nutritional supplements (ONS) in the Northern Area of Gran Canaria in the period 2016-2021. Materials and methods: based on electronic prescription data, the first ONS prescription during 2016-2021 was analyzed considering age, gender, nutritional requirements (NR), body mass index (BMI), percentage of weight loss (%WL), albumin and number of prescribed ONS per patient. Results: 10,595 prescriptions were identified corresponding to 6661 patients with the following characteristics: 46.3 % men, mean age 72.84 ± 15.93 years, BMI 20.60 ± 3.98 kg/m2, %WL 11.89 ± 8.32 %; albumin 3.08 ± 0.63 g/dl. The most frequent etiologies of DRE were: neoplasms 42.6 %; degenerative processes of the CNS 28.9 %; stroke 3.9 %; short bowel syndrome 6.9 %, and inflammatory bowel disease (IBD) 5.5 %. The percentages of NR covered by the prescribed ONS were: 100 % in 8.9 % of cases, 50 % in 36.9 %, and 25 % in 54.2 %; 40.4 % of patients received 1 unit of ONS daily, 36.3 % took 2 units of ONS, and 23 % received > 3 units of ONS per day. Greater NR were associated with a greater number of ONS (p < 0.001), but 40.8 % of patients who needed to cover > 50 % of NR received only one unit of ONS. Conclusion: a significant percentage of patients with disease-related malnutrition (DRM) do not receive a number of ONS according to their NR.

Introducción: Objetivo: valorar la prescripción de suplementos nutricionales orales (SNO) en el Área Norte de Gran Canaria en el periodo 2016-2021. Material y métodos: basándonos en datos de receta electrónica, se analizó la primera prescripción de SNO durante 2016-2021 considerando edad, género, requerimientos nutricionales (RN), índice de masa corporal (IMC), porcentaje de pérdida de peso (PPP), albúmina y número de SNO prescritos. Resultados: se identificaron 10.595 prescripciones correspondientes a 6661 pacientes con las siguientes características: 46,3 % varones, edad media 72,84 ± 15,93 años, IMC 20,60 ± 3,98 kg/m2, PPP del 11,89 ± 8,32 %; albúmina 3,08 ± 0,63 g/dl. Las etiologías más frecuentes de la DRE fueron: neoplasias, 42,6 %; procesos degenerativos del SNC, 28,9 %; ictus, 3,9 %; intestino corto, 6,9 % y enfermedad inflamatoria intestinal (EII), 5,5 %. Los porcentajes de RN cubiertos por los SNO prescritos fueron del 100 % en el 8,9 % de los casos, del 50 % en un 36,9 % y del 25 % en el 54,2 %. Un 40,4 % de los pacientes recibió 1 SNO diario, un 36,3 % tomaron 2 SNO y un 23 % recibieron > 3 SNO diarios. Los mayores RN se asociaron con un mayor número de SNO (p < 0,001), pero el 40,8 % de los pacientes que precisaban cubrir > 50 % de RN recibían solo un SNO. Conclusión: un porcentaje importante de pacientes con desnutrición relacionada con la enfermedad (DRE) no recibe SNO de acuerdo a sus RN.

Incidence of hypertension in young transgender people after a 5-year follow-up: association with gender-affirming hormonal therapy.

In order to assess the risk of hypertension development, we performed a retrospective analysis of the clinical records of consecutive transgender patients who began gender-affirming hormonal therapy in our Outpatient Gender Identity Clinic with <30 years of age and had a follow-up >5 years. 149 transgender women treated with estradiol and 153 transgender men treated with testosterone were included; 129 of the transgender women received also androgen blockers (54 spironolactone, 49 cyproterone acetate and 26 LHRH agonists). The annual incidence of hypertension in young transgender men (1.18%) seemed comparable to that of the general population. In young transgender women, it seemed higher (2.14%); we found that the choice of androgen blocker had a remarkable effect, with a highly significant increase in patients treated with cyproterone acetate (4.90%) vs. the rest (0.80%); the adjusted hazard-ratio was 0.227 (p = 0.001). Correlation, logistic regression and mediation analyses were performed for the associations of the available clinical variables with the increase in systolic blood pressure and the onset of hypertension, but besides the use of cyproterone acetate, only the ponderal gain was found significant (Spearman's r: 0.361, p < 0.001); with a 36.7% mediation effect (31.2-42.3%). Cyproterone acetate has additional known risks, such as meningioma; although we cannot conclusively prove that it has a role in the development of hypertension, we conclude that the use of cyproterone acetate for this indication should be reconsidered.

Complete Remission in Metastatic Pheochromocytoma Treated with Extensive Surgery.

Pheochromocytomas are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla. Malignant pheochromocytoma is defined as the presence of metastatic spread in tissues where chromaffin cells are not usually present. This case report describes the case of a relapsed malignant pheochromocytoma, spread to the right liver lobe, superior pole of the right kidney, posterior right hemidiaphragm, right hemidiaphragmatic pillar, inferior vena cava, and regional lymph nodes. After evaluation, an extensive surgery was performed, with resection of all the affected tissues and regional lymphadenectomy. No adjuvant treatment (radiotherapy or chemotherapy) was given. Complete clinical, biochemical, and radiological remission was achieved, with normalisation of metanephrine and normetanephrine. To date, six years after surgery, the patient remains asymptomatic and normotensive without taking any antihypertensive medication. We conclude that the therapeutic approach should be individualized in the case of metastatic pheochromocytoma. Extensive surgery can be considered as a treatment option, even in the case of multiple metastases, as it may be able to achieve complete remission of the disease, avoiding costly and potentially dangerous adjuvant therapies.