Impact of COVID-19 in nutritional and functional status of survivors admitted in intensive care units during the first outbreak. Preliminary results of the NUTRICOVID study.

BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.

Tratamiento dietético de la trimetilaminuria / Dietetic approach to trimethylaminuria

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Importancia de la lactancia materna en la prevalencia de síndrome metabólico y en el grado de obesidad infantil / Importance of breastfeeding in the prevalence of metabolic syndrome and degree of childhood obesity

Objetivos: El objetivo de nuestro estudio es evaluar la relación entre lactancia materna (LM) y prevalencia de obesidad y síndrome metabólico, en un grupo de niños y adolescentes obesos. Material y métodos: Se realizó un estudio retrospectivo en niños y adolescentes con obesidad tratados en el Servicio de Endocrinología y Nutrición del Hospital de Getafe (Madrid). Las variables estudiadas fueron edad, sexo, talla, peso, índice de masa corporal (IMC), circunferencia de cintura (CC), índice cintura-talla (ICT), presión arterial (PA), triglicéridos, lipoproteínas de alta densidad y glucemia basal. Asimismo, se recogió información sobre la alimentación recibida en los primeros meses de vida, considerando LM positiva la recibida durante al menos 3 meses. El programa estadístico utilizado fue SPSS v.15. Resultados: Se reclutó a 126 pacientes obesos (71 niños y 55 niñas), con una media de edad de 11,94 ± 3,12 años; 117 (92,86%) de ellos presentaron obesidad mórbida (IMC > P97 para edad y sexo). Todos los pacientes presentaban CC > P90 para edad y sexo. De los 126 pacientes evaluados, el 36,8% recibió LM durante más de 3 meses, y el 63,2%, sólo lactancia artificial (LA). Frente a los pacientes alimentados con LA, aquellos que recibieron LM presentaban menor IMC (31,53 ± 5,77 frente a 32,08 ± 6,78) y menor CC (95,02 ± 3,4 frente a 95,69 ± 3,2 cm), aunque no se alcanzó la significación estadística. La prevalencia de síndrome metabólico en la población estudiada fue del 19,8%. Dentro de este grupo, el 64% no había recibido LM frente a un 36% alimentado con LA. Conclusiones: Haber recibido LM durante al menos 3 meses conllevó un menor grado de obesidad, menor CC y menos complicaciones relacionadas con el síndrome metabólico durante la infancia y la adolescencia. El 64% de los niños con síndrome metabólico completo habían sido alimentados con LA. Son necesarios más estudios para conocer el impacto de la LM en el desarrollo de obesidad y riesgo cardiometabólico (AU)

Objectives: To evaluate the relationship between breastfeeding and the prevalence of obesity and metabolic syndrome in a group of obese children and adolescents. Material and methods: We performed a retrospective study in obese children and adolescents treated at the Endocrinology and Nutrition Service of the Hospital de Getafe (Madrid). The variables studied were age, sex, height, weight, body mass index (BMI), waist circumference, waist-height ratio, blood pressure, triglycerides, high-density lipoprotein and fasting glucose. Information was also collected on food received in the first months of life. Breastfeeding was defined as feeding with maternal milk for at least 3 months. The SPSS v.15 statistical package was used. Results: A total of 126 patients with obesity were recruited (71 boys and 55 girls) with a mean age of 11.94 ± 3.12 years. Of these, 117 (92.86%) were morbidly obese (BMI > 97th percentile for age and sex). All patients had a waist circumference > 90th percentile for age and sex. Of the 126 patients evaluated, 36.8% were breastfed for more than 3 months and 63.2% were fed with artificial milk only. Compared with patients fed with artificial milk, those who were breast fed had a lower BMI (31.53 ± 5.77 vs 32.08 ± 6.78) and lower waist circumference (95.02 ± 3.4 vs. 95.69 ± 3.2 cm), although this difference was not statistically significant. The prevalence of metabolic syndrome in the study population was 19.8%. Within this group, 64% had not been breast fed compared with 36% who had been fed with artificial milk. (..) (AU)

[Primary trimethylaminuria: the fish odor syndrome]. / Trimetilaminuria: el síndrome de olor a pescado.

Primary trimethylaminuria, or fish odor syndrome, is a congenital metabolic disorder characterized by a failure in the hepatic trimethylamine (TMA) oxidation route to trimethylamine N-oxide (TMANO). TMA is mostly derived from dietary precursors such as choline, carnitine and TMANO. The presence of abnormal amounts of TMA in the urine, sweat, exhaled air and other body secretions confers a very unpleasant body odor resembling that of decaying fish. As a consequence, patients can suffer from serious psychosocial sequelae. We present a case of primary trimethylaminuria with the aim of raising awareness about this condition.

Trimetilaminuria: el síndrome de olor a pescado / Trimethylaminuria: fish odor syndrome

La trimetilaminuria primaria o síndrome de olor a pescado es un error innato del metabolismo, debido al defecto en la oxidación hepática de la trimetilamina (TMA) a trimetilamina N-óxido (TMANO). La TMA procede del metabolismo de precursores dietéticos como colina, carnitina y TMANO. Su excreción en cantidades anormales en la orina, el sudor, el aire espirado y el resto de secreciones corporales despide un fuerte olor que recuerda al pescado podrido. Los pacientes afectos generalmente desarrollan graves problemas psicosociales. Presentamos un caso de trimetilaminuria primaria, con el fin de contribuir al conocimiento de este trastorno (AU)

Primary trimethylaminuria, or fish odor syndrome, is a congenital metabolic disorder characterized by a failure in the hepatic trimethylamine (TMA) oxidation route to trimethylamine N-oxide (TMANO). TMA is mostly derived from dietary precursors such as choline, carnitine and TMANO. The presence of abnormal amounts of TMA in the urine, sweat, exhaled air and other body secretions confers a very unpleasant body odor resembling that of decaying fish. As a consequence, patients can suffer from serious psychosocial sequelae. We present a case of primary trimethylaminuria with the aim of raising awareness about this condition (AU)

Hipercalcemia hipocalciúrica familiar: a propósito de tres casos en una misma familia / Familial hypocalciuric hypercalcemia: review of three cases

La hipercalcemia hipocalciúrica familiar, también denominada hipercalcemia benigna familiar, es una causa poco frecuente de hipercalcemia. Se debe a una mutación del receptor sensible al calcio que se hereda de forma autosómica dominante con alta penetrancia. En general, los pacientes no presentan síntomas y los casos heterocigotos se diagnostican en la infancia o en la edad adulta al estudiar una hipercalcemia detectada de forma incidental. Se caracteriza por hipercalcemia moderada, con paratirina normal o levemente elevada y calciuria baja. Es importante establecer el diagnóstico por su benignidad y porque es una situación que no requiere tratamiento quirúrgico, a diferencia del hiperparatiroidismo que precisa paratiroidectomía en el50% de los casos. Presentamos 3 casos pertenecientes a la misma familia con hipercalcemia hipocalciúrica familiar y a continuación se realiza una revisión actualizada del tema (AU)

Familial hypocalciuric hypercalcemia, also denominated familial benign hypercalcemia, is an uncommon cause of hypercalcemia. It is caused by mutations of the calcium-sensing receptor, which are inherited in an autosomal dominant highpenetrance fashion. Generally, patients are asymptomatic, and heterozygote cases arediagnosed in childhood or adulthood, when diagnostic work-up of an incidentally discovered hypercalcemia ensues. This disorder is characterized by moderate hypercalcemia, with normal parathormone levels and low urine calcium excretion. It is very important to diagnose this condition, as it does not require surgical procedures, unlike primary hyperparathyroidism, which needs parathyroidectomy in 50% of cases. We present 3 cases of familial hypocalciuric hypercalcemia belonging to the same family, and provide an updated review on the topic (AU)

Mielolipoma adrenal gigante: revisión a propósito de un caso / Giant adrenal myelolipoma: case report and literature review

El mielolipoma adrenal es un tumor benigno, poco frecuente, compuesto por tejido adiposo maduro y elementos hematopoyéticos diversos. Su hallazgo suele ser incidental, aunque en ocasiones pueden alcanzar gran tamaño y causar dolor abdominal y otros síntomas clínicos. La ecografía y la tomografía computarizada son herramientas útiles en su diagnóstico. Los tumores pequeños (< 6 cm) y asintomáticos pueden tratarse de forma conservadora con vigilancia periódica y los > 6 cm o con síntomas pueden precisar tratamiento quirúrgico. Presentamos un caso de mielolipoma adrenal gigante y a continuación se realiza una revisión de la literatura (AU)

Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6 cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6 cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma (..) (AU)

Familial hypocalciuric hypercalcemia: review of three cases.

Familial hypocalciuric hypercalcemia, also denominated familial benign hypercalcemia, is an uncommon cause of hypercalcemia. It is caused by mutations of the calcium-sensing receptor, which are inherited in an autosomal dominant high-penetrance fashion. Generally, patients are asymptomatic, and heterozygote cases are diagnosed in childhood or adulthood, when diagnostic work-up of an incidentally discovered hypercalcemia ensues. This disorder is characterized by moderate hypercalcemia, with normal parathormone levels and low urine calcium excretion. It is very important to diagnose this condition, as it does not require surgical procedures, unlike primary hyperparathyroidism, which needs parathyroidectomy in 50% of cases. We present 3 cases of familial hypocalciuric hypercalcemia belonging to the same family, and provide an updated review on the topic.

Giant adrenal myelolipoma: case report and literature review.

Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma and provide a review of the literature.

Un lugar extraño para un lipoma: lipoma supraselar / A strange place for a lipoma: suprasellar lipoma

Los lipomas supraselares son lesiones muy poco frecuentes. Se cree que derivan de una persistencia anormal y mal diferenciada de la meninge primitiva. Su diagnóstico es generalmente incidental, ya que la mayoría son asintomáticos. Sin embargo, a veces dan lugar a síntomas neurológicos, como cefalea, crisis epilépticas o incluso disfunción hipofisaria. La imagen radiológica permite el diagnóstico. El manejo conservador parece ser el tratamiento de elección. La cirugía únicamente estaría recomendada para los pacientes que no responden al tratamiento médico. Presentamos el caso de una mujer de 30 años a quien se estaba estudiando por cefaleas. En una tomografía computarizada que se le realizó, se encontró una imagen indicativa de lipoma supraselar. A propósito de este caso, hemos revisado el origen, el diagnóstico y el tratamiento de estos raros tumores (AU)

Suprasellar lipomas are uncommon lesions. They are thought to be derived from the abnormal and poorly differentiated persistence of primitive meninx. These tumors are usually diagnosed incidentally, since most are asymptomatic. However, these masses sometimes produce neurological symptoms, such as headache, epileptic seizures, and even pineal malfunction. Diagnosis is given by radiological imaging. The treatment of choice appears to be conservative management. Surgery should only be recommended in patients who do not respond to medical management. We present the case of a 30-year-old woman who was being investigated because of headache; a computed tomography scan revealed an image suggestive of suprasellar lipoma. Apropos of this case, we review the origin, diagnosis and treatment of theses rare tumors (AU)

Pubertad precoz verdadera secundaria a masa supraselar: probable histiocitosis X / Central precocious puberty with inflammatory suprasellar mass: probable histiocytosis x

La pubertad precoz central se debe a la activación prematura del generador de pulsos de gonadotropinas del eje hipotálamo-hipofisariogonadal. En la mayoría de los casos se desconoce la etiología, pero siempre se debe descartar afecciones del sistema nervioso central, como tumores, radioterapia craneal, traumatismos craneoencefálicos y procesos inflamatorios como la histiocitosis X. En la histiocitosis X la afección hipotálamo-hipofisaria es muy frecuente, y la manifestación más común es la diabetes insípida. Presentamos el caso de una niña con pubertad precoz central secundaria a masa supraselar inflamatoria, probablemente, histiocitosis X (AU)

Central precocious puberty is due to premature activation of gonadotropin pulse generator in the hypothalamuspituitary- gonadal axis. The etiology isknown in most cases, but tumors, cranial radiotherapy, traumatic brain injury and inflammatory disorders, such as histiocytosis X, are important options to be considered in the differential diagnosis. Hypothalamic-pituitary involvement is common in histiocytosis X, and in these cases diabetes insipidus is the most common endocrine deficiency at presentation. We report the case of a girl with an inflammatory suprasellar mass, probably histiocytosis X, who presented with central precocious puberty (AU)

Tiroides ectópico / Ectopic thyroid tissue

El tiroides ectópico es una alteración congénita infrecuente, consecuencia de la migración defectuosa del tiroides desde el agujero ciego (foramen caecum) hasta su posición final pretraqueal. La localización más frecuente del tejido tiroideo ectópico es lingual y sublingual. En la mayoría de los casos el único tejido tiroideo que queda suele ser ectópico. Puede serasintomático o con clínica variable. Presentamos 2 casos de tiroides ectópicos (sublingual y precricoideo). Los 2 casos asociaban hipofunción tiroidea y síntomas locales. Revisamos la clínica y el manejo diagnóstico y terapéutico (AU)

Ectopic thyroid tissue is a rare abnormality caused by the failure of the thyroid gland to migrate from the foramen cecum to its final pretracheal position. The mostfrequent sites of ectopic thyroid tissue are lingual and sublingual. In most patients, the ectopic tissue is the only source of functioning thyroid. Ectopic thyroid maybe asymptomatic or may produce variable symptoms. We describe 2 cases of ectopic thyroid (sublingual and precricoidal). Both patients had hypothyroidism and localsymptoms. We review the clinical features, diagnosis and treatment of this entity (AU)

Seudoquiste adrenal gigante: a propósito de un caso / Giant adrenal pseudocyst: a case report

Los seudoquistes adrenales son las lesiones quísticas más frecuentes de la glándula suprarrenal, si bien constituyen una entidad rara. Suelen ser asintomáticas, pero pueden producir clínica inespecífica como dolor abdominal o lumbar. Se recomienda tratamiento quirúrgico si son sintomáticos o se sospecha malignidad. Presentamos un caso de un seudoquiste adrenal hemorrágico gigante con un antecedente de traumatismo como posible etiología (AU)

Although rare, adrenal pseudocysts are the most common cystic masses occurring in the adrenal gland. These lesions are usually asymptomatic, although they can produce nonspecific symptoms such as abdominal or lumbar pain. Surgical treatment is warranted only when adrenal pseudocysts are symptomatic or show imaging features suspicious for malignancy. We present a case of a giant hemorrhagic adrenal pseudocyst, possibly related to previous local trauma (AU)

Dificultades diagnósticas en un caso de enfermedad de Addison de origen tuberculoso / Diagnostic difficulties in a case of tuberculous Addison’s disease

La enfermedad de Addison es una entidad clínica poco frecuente. Su diagnóstico es obvio cuando se presenta en forma de crisis adrenal. Generalmente permanece infradiagnosticada durante sus primeros estadios, debido a que la pérdida de la función adrenal suele ser progresiva, lo que produce una aparición gradual e insidiosa de los síntomas, que son en su mayoría inespecíficos. En muchas áreas del mundo, la tuberculosis o las infecciones fúngicas tienen una gran prevalencia y siguen siendo hoy la principal causa de insuficiencia suprarrenal, pero en nuestro medio son relativamente infrecuentes. Presentamos el caso de una paciente con enfermedad de Addison, con una evolución clínica y radiológica típica de la adrenalitis tuberculosa. Revisamos las dificultades en el diagnóstico etiológico de la enfermedad y su tratamiento (AU)

Addison's disease is an uncommon entity. Diagnosis is usually obvious in patients with adrenal crisis. However, in its early stage, Addison's disease is usually underdiagnosed, given that the loss of adrenal function is often progressive, with gradual and insidious onset of symptoms, most of which are nonspecific. In many parts of the world, tuberculosis or fungal infections are highly prevalent and remain the principal cause of adrenal insufficiency. In western countries, however, adrenal insufficiency due to infectious agents is relatively uncommon. We present a case of tuberculous Addison's disease, with typical clinical and radiological development of adrenal tuberculosis. We also review the difficulties posed by the diagnosis and treatment of this disease (AU)