Acute pancreatitis secondary to severe hypertriglyceridemia induced by antiretroviral therapy (ART).

Hypertriglyceridemia is the third cause of acute pancreatitis after lithiasis and alcohol. When triglycerides are >2000 mg/dL the risk increases to 20%. Acute pancreatitis is an important cause of morbidity in patients infected with human immunodeficiency virus (HIV), especially in those treated with lamivudine, due to hypertriglyceridemia.

Actualización en el tratamiento del hipoparatiroidismo posquirúrgico / Update on management of postoperative hypoparathyroidism

Introducción y objetivo: El hipoparatiroidismo posquirúrgico es una complicación frecuente de la cirugía tiroidea y paratiroidea, con consecuencias significativas sobre la salud y calidad de vida. El objetivo de esta revisión es proporcionar una visión actualizada de su prevención, detección precoz y tratamiento.Síntesis: Tras la tiroidectomía y paratiroidectomía puede aparecer hipoparatiroidismo de forma aguda, especialmente en algunos pacientes de alto riesgo. La determinación de la hormona paratiroidea intacta (PTHi) en el postoperatorio temprano es una herramienta útil en el manejo del paciente. Un nivel de PTHi postoperatoria <10-15 pg/ml, combinado con los niveles de calcemia 24 horas después de la cirugía, ofrece el mejor valor predictivo para hipocalcemia aguda. El hipoparatiroidismo permanente se asocia con morbilidad y deterioro de calidad de vida a largo plazo y debería prevenirse cuando sea posible. El tratamiento convencional incluye calcio oral y metabolitos activos de vitamina D. En caso de hipocalcemia severa o sintomática se precisa calcio intravenoso. El tratamiento debe monitorizarse e incluir educación sanitaria del paciente, para evitar amplias desviaciones de la calcemia. Sin embargo, con la terapia convencional mantener un adecuado control puede representar un desafío. (AU)

Introduction and objective: Surgical hypoparathyroidism is a common complication following thyroid and parathyroid surgery. It has significant consequences for health and quality of life. The objective of this review is to provide an overview of its prevention, early detection, and treatment. Synthesis: Acute hypoparathyroidism can occur after thyroidectomy and parathyroidectomy, especially in high-risk patients. Measurement of early postoperative intact parathyroid hormone (PTHi) can help guide patient management. A postoperative PTHi < 10-15 pg/ml combined with serum calcium assay testing 24 hours after surgery yielded the highest diagnostic accuracy for predicting acute hypocalcemia. Permanent hypoparathyroidism is associated with long-term morbidity and poor quality of life, and should be prevented whenever possible. Conventional treatment consist of oral calcium and active vitamin D analogs. For more severe or symptomatic hypocalcemia it is necessary intravenous calcium. Treatment require monitoring and patient education to avoid wide swings in serum calcium. However, with standard therapy, maintaining an adequate control often presents a therapeutic challenge. Recombinant human parathyroid hormone (rhPTH) replacement can lower the doses of calcium and active vitamin D analogs required, while maintaining serum calcium and phosphate levels within the recommended therapeutic ranges. It may improve bone metabo-lism and quality of life on the long term. Additional data on safety and efficacy are needed. Conclusions: Postoperative hypoparathyroidism is common. It requires early diagnosis, pharmacologic intervention and patient education to achieve optimal control and lower the risk of long-term complications. rhPTH seems to be an effective option for those patients who do not stably mantein their calcium in the target range. (AU)

Inhaled corticosteroids may have a protective effect against coronavirus infection

BACKGROUND: Spain has been severely affected by the COVID-19 epidemic, with 195,944 persons infected and 20,453 deaths at the time of writing. Older people with respiratory or cardiac conditions are most at risk. OBJECTIVE: The aim was to compare respiratory symptoms in nursing home residents and patients with uncontrolled asthma, who are considered vulnerable to COVID-19.METHODS: We studied 134 nursing home residents and 139 patients with uncontrolled asthma, groups vulnerable to COVID-19. Demographic characteristics, clinical manifestations, out-comes, key laboratory results, and radiological images were collected from medical records. COVID-19 infection was detected by polymerase chain reaction (PCR).RESULTS: Thirteen (9.3%) patients with uncontrolled asthma, all receiving inhaled corticoste-roids were infected by COVID-19. Eighty (60%) nursing home residents were infected; only 28, all of whom had received inhaled corticosteroids, had a good prognosis CONCLUSIONS: Early treatment with inhaled corticosteroids may be helpful in COVID-19 infection. Persons with an allergy might have some protective mechanisms against coronavirus

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[Acute diabetic complications attended in a hospital emergency department: a descriptive analysis]. / Estudio descriptivo de las complicaciones agudas diabéticas atendidas en un servicio de urgencias hospitalario.

OBJECTIVES: To analyze the characteristics of acute diabetic complications attended in a hospital emergency department. MATERIAL AND METHODS: Cross-sectional, descriptive, retrospective study of patients with hyper- and hypoglycemic emergencies attended in a tertiary-care university hospital emergency department. RESULTS: We included 237 patients with a mean (SD) age of 61 (26) years. Diabetes had been diagnosed previously in 86.5% (type 2 in 74% and type 1 in 26%). Hyperglycemic emergencies were treated in 72%. The most frequent reasons for decompensation were poor control of type 1 diabetes (41.2%) and infections in type 2 diabetes (51.5%). Twenty-eight percent had low blood sugar levels caused by poor control of disease (50%). Patients with hypoglycemia had shorter mean stays. More admissions were made in type 2 diabetes than in type 1. CONCLUSION: Type 2 diabetes leads to more visits to the emergency department, more admissions, and a longer hospital stay than type 1 diabetes.

OBJETIVO: Conocer las complicaciones agudas diabéticas atendidas en un servicio de urgencias hospitalario (SUH). METODO: Estudio descriptivo transversal retrospectivo, realizado en un SUH de un hospital universitario de tercer nivel asistencial de los pacientes diagnosticados de hiperglucemias e hipoglucemias durante el año 2012. RESULTADOS: Se incluyeron 237 pacientes con una edad media de 61 (± 26) años. El 86,5% presentaba diabetes: el 74% tipo 2 y el 26% tipo 1. Las hiperglucemias supusieron un 72%. Las causas de descompensación más frecuentes fueron el mal control en los diabéticos tipo 1 (41,2%) y las infecciones en los diabéticos tipo 2 (51,5%). Las hipoglucemias supusieron el 28%, producidas principalmente por mal control metabólico (50%). La estancia media fue menor que en las hiperglucemias. Los pacientes diabéticos tipo 2 tuvieron más ingresos que los tipo 1. CONCLUSIONES: Los diabéticos tipo 2 suponen una mayor frecuentación, mayor índice de ingresos y una estancia media mayor que los tipo 1.

Estudio descriptivo de las complicaciones agudas diabéticas atendidas en un servicio de urgencias hospitalario / Acute diabetic complications attended in a hospital emergency department: a descriptive analysis

Objetivo. Conocer las complicaciones agudas diabéticas atendidas en un servicio de urgencias hospitalario (SUH). Metodología. Estudio descriptivo transversal retrospectivo, realizado en un SUH de un hospital universitario de tercer nivel asistencial de los pacientes diagnosticados de hiperglucemias e hipoglucemias durante el año 2012. Resultados. Se incluyeron 237 pacientes con una edad media de 61 (± 26) años. El 86,5% presentaba diabetes: el 74% tipo 2 y el 26% tipo 1. Las hiperglucemias supusieron un 72%. Las causas de descompensación más frecuentes fueron el mal control en los diabéticos tipo 1 (41,2%) y las infecciones en los diabéticos tipo 2 (51,5%). Las hipoglucemias supusieron el 28%, producidas principalmente por mal control metabólico (50%). La estancia media fue menor que en las hiperglucemias. Los pacientes diabéticos tipo 2 tuvieron más ingresos que los tipo 1. Conclusiones. Los diabéticos tipo 2 suponen una mayor frecuentación, mayor índice de ingresos y una estancia media mayor que los tipo 1 (AU)

Objective. To analyze the characteristics of acute diabetic complications attended in a hospital emergency department. Methods. Cross-sectional, descriptive, retrospective study of patients with hyper- and hypoglycemic emergencies attended in a tertiary-care university hospital emergency department. Results. We included 237 patients with a mean (SD) age of 61 (26) years. Diabetes had been diagnosed previously in 86.5% (type 2 in 74% and type 1 in 26%). Hyperglycemic emergencies were treated in 72%. The most frequent reasons for decompensation were poor control of type 1 diabetes (41.2%) and infections in type 2 diabetes (51.5%). Twenty-eight percent had low blood sugar levels caused by poor control of disease (50%). Patients with hypoglycemia had shorter mean stays. More admissions were made in type 2 diabetes than in type 1. Conclusions. Type 2 diabetes leads to more visits to the emergency department, more admissions, and a longer hospital stay than type 1 diabetes (AU)

Hipocalcemia autosómica dominante: una nueva mutación / Autosomal dominant hypocalcaemia: a novel mutation

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