Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study.

Introduction: This study aims to assess the extent of rejection and instances of stigmatization linked to obesity within the Spanish population, encompassing a diverse spectrum of weights ranging from normal weight to morbid obesity. Additionally, the study seeks to identify the primary factors influencing these experiences and further examines the impact of bariatric surgery on such dynamics. Materials and methods: Multicenter observational study with involving a total of 1,018 participants who were recruited from various Obesity Units. Negatives attitudes towards people with obesity were assessed through three questionnaires: (i) Antifat Attitudes Scale (AFA), (ii) Stigmatizing Situations Inventory (SSI) and (iii) Weight Bias Internalization Scale (WBIS). Subjects were categorized into four groups based on their BMI and history of prior bariatric surgery. Results: The cumulative score across all questionnaires (AFA, SSI and WBIS) exhibited a progressive increase, from participants with normal weight to those with obesity (p < 0.001 for all). Within the AFA questionnaire, males showed more rejection towards people with obesity than women, also perceiving obesity as a disease linked to a lack of willpower (p = 0.004 and p = 0.030, respectively). The overall SSI score was negatively associated with age (r = -0.080, p = 0.011), with young participants encountering more stigmatizing experiences than their adult counterparts. Neither employment status nor educational demonstrated a significant association with any of the questionnaires. Interestingly, patients who underwent lost weight following bariatric surgery did not exhibit improved outcomes. Conclusion: Individuals with obesity demonstrate a heightened level of aversion towards the disease compared to those with normal weight. Concurrently, the incidence of stigmatizing encounters displays a concerning escalation among younger individuals.

GALIPDIA study: Reaching lipid targets in a population with type 2 diabetes (T2DM) from the Northwest of Spain.

AIM: To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM). METHODS: Multicentre retrospective cross-sectional study, conducted in 380 adults with T2DM and dyslipidaemia in 7 Spanish health areas. INCLUSION CRITERIA: minimum follow-up of one year in Endocrinology Units, at least one visit in 2020 and a lipid profile measurement in the last 3 months. EXCLUSION CRITERIA: familial hypercholesterolaemia, recent hospitalisation, active oncological pathology and dialysis. RESULTS: According to the 2016 and 2019 guidelines the majority of patients were classified as being at very high cardiovascular risk (86.8% vs. 72.1%, respectively). LDL-c compliance was adequate in 62.1% of patients according to the 2016 guidelines and 39.7% according to the 2019 guidelines (p<0.001). Clinical conditions such as history of cardiovascular disease and therapy-related aspects (use of statins, especially high-potency statins, combination therapies and good adherence) were significantly associated with greater achievement of lipid targets. CONCLUSION: There is a discrepancy between dyslipidaemia guideline recommendations and the reality of lipid control in patients with T2DM, despite most of these patients being at very high cardiovascular risk. Strategies to optimise lipid-lowering treatments need to be implemented.

Manejo de la ascitis quilosa y revisión de la literatura / Management of chylous ascites and review of literature

Introducción: La ascitis quilosa es la acumulación de líquido linfático en la cavidad peritoneal. Se trata de una patología poco frecuente cuya causa puede ser traumática oatraumática, siendo la obstrucción por neoplasias abdominales la etiología más frecuente en adultos. No existe evidenciacientífica acerca de una terapia que resulte totalmente eficazen el tratamiento de esta patología. Objetivos: El objetivo fundamental de esta revisión esprofundizar, integrar, resumir y actualizar la información publicada sobre este tema, así como proporcionar informaciónútil y contrastada a otros compañeros para su aplicación en lapráctica clínica. Material y Métodos: Se realiza una revisión de la bibliografía empleando la base de datos PubMed, Medline y Sciencedirect con los descriptores “chylous ascitis” AND “diet”. Los filtros empleados fueron: humanos, últimos 5 años y lenguasespañola e inglesa. Se revisaron los artículos y se seleccionaron 12 trabajos. Resultados: Se describen las diferentes alternativas terapéuticas tanto dietéticas como el tratamiento intervencionista.Discusión: La ascitis quilosa supone un problema médicocomplejo por el potencial deterioro nutricional e inmunológico que genera. Revisada la literatura, existe poca evidenciacientífica sobre el tratamiento de elección en los pacientescon ascitis quilosa, aunque parece existir consenso de que ladieta es el tratamiento más simple y, habitualmente, el primero en implementarse. Debido a esta complejidad, es imprescindible la valoración del paciente por un equipo multidisciplinar y la actitud terapéutica elegida dependerá de lacausa de la ascitis, la situación clínica y la experiencia de losprofesionales sanitarios. Conclusiones: La terapia nutricional de la ascitis quilosase basa en una dieta baja en grasas suplementada con triglicéridos de cadena media y es el tratamiento de elección porsu alto porcentaje de eficacia.(AU)

Introduction: Chylous ascites is the accumulation oflymphatic fluid in the peritoneal cavity. It is a rare pathologyand it can be traumatic or no traumatic. The most commoncause of chylous ascites in adults is obstruction by abdominalneoplasms. There is insufficient evidence about an effectivetreatment. Objectives: The main objective of this review is to deepen, integrate, summarize and update the information published about this topic. Also, we want to provide to other healthprofessionals, a useful and verified information to applicate inclinical practice. Material and Methods: A literature review was made: PubMed, Medline and Science direct search using as descriptors “chylous ascites” AND “diet”. The following filters areused: human, last 5 years and Spanish/English languages.Articles were reviewed and 12 papers were selected. Results: We describe the dietary alternatives and the interventional treatment. Discussion: Chylous ascites is an important medical problem, because of the deterioration of immune system and nutritional parameters. Literature review was made and there isno scientific evidence about the treatment of choice in patients with chylous ascites. Diet is the simplest treatment andthe first to be implemented. A multidisciplinary team is important in the treatment of these patients. To choose the besttherapeutic attitude, we must know the cause, the clinical situation and the experience of health care workers. Conclusions: A lowfat diet supplemented with mediumchain triglycerides is the most efficacy treatment for chylousascites. There is no evidence about an effective treatment forthis pathology and most publications are clinical cases.Prospective, randomized studies are needed to get more evidence on the management of chylous ascites.(AU)

Hipocortisolismo hipofisario por sobrecarga férrica en un paciente conAnemia de Blackfan-Diamond / Pituitary hypocortisolism due to iron overload in a patient with Blackfan-Diamond anemia

Iron overload in the context of a Blackfan-Diamond anemia is a extremely uncommon cause of central adrenal insufficiency. We report apatient with Blackfan-Diamond anemia diagnosis during his childhood.Ten years later, as a consequence of iron overload caused by repeatedtransfusions, he developed central hypocortisolism. Blackfan-Diamondanemia is a hereditary syndrome characterized by erythroid aplasia,predisposition to hematologic and solid organ malignancies and congenital abnormalities.Endocrine complications of Blackfan-Diamond anemia are reported inthe literature and highly variable. Hypocortisolism is considered as anuncommon complication (0.7-4 %). Therefore, in a patient with repeated transfusions, we must considerer in a possible ACTH deficiency inthe context of hemochromatosis due to iron overload. (AU)

Las causas de insuficiencia adrenal de origen central son múltiples,siendo la sobrecarga férrica en el seno de una anemia de Blackfan-Diamond extremadamente infrecuente. Se presenta el caso de un pacientede 15 años diagnosticado de anemia de Blackfan-Diamond en la infancia que desarrolla hipocortisolismo de origen central como consecuencia de la sobrecarga férrica por transfusiones de repetición comotratamiento de soporte de la anemia. La anemia de Blackfan-Diamondes un síndrome hereditario caracterizado por una aplasia eritroide queconlleva un recuento reducido de glóbulos rojos, anomalías congénitasy predisposición a neoplasias hematológicas y de órganos sólidos. Laprevalencia de las complicaciones endocrinas reportadas en la literatura secundarias a esta patología es muy variable siendo el hipocortisolismo muy poco frecuente (0,7-4 %).Por ello, ante un paciente contransfusiones de repetición, debemos tener en cuenta el posible déficitde ACTH en en el contexto de una hemocromatosis por sobrecarga férrica. (AU)

Effectiveness, Safety, and Adherence to Treatment of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Real Practice.

PURPOSE: To evaluate the effectiveness, adverse reactions, and adherence to treatment of hypolipidemic inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9is) in a context of real clinical practice. METHODS: We present an observational, retrospective, descriptive, multicenter study of patients with hypercholesterolemia who began treatment with PCSK9is between January 2017 and December 2019, with a minimum treatment period of 3 months. The main variable we recorded was the frequency of cardiovascular events (cardiovascular death, myocardial infarction, stroke, coronary revascularization, and hospitalization for unstable angina) in patients treated with PCSK9is. We recorded patient demographic characteristics and cardiovascular risk factors at onset of treatment as well as LDL-C levels and their reductions at 3, 6, 12, and 24 months. We calculated adherence to treatment and recorded the adverse reactions during treatment. FINDINGS: A total of 154 patients were studied, 64 (41.6%) of whom were treated with alirocumab and 90 (58.4%) with evolocumab. The initial dose of alirocumab was 75 mg every 14 days in 48 patients (75%) and 150 mg eery 14 days in 16 (25%). All patients who in the evolocumab group received a dose of 140 mg every 14 days. The mean (SD) basal LDL-C level was 159.6 (50.1) mg/dL, the level at 3 months was 87.9 (49.9) mg/dL (mean [SD] decrease, 44.5% [28.2%]), the level at 6 months was 86.7 (49.2) mg/dL (mean [SD] decrease, 46.3% [25.6%]), and the level at 12 months was 80.5 (41.4) (mean [SD] decrease, 48.9% [23.0%]). These values were maintained at 24 months (mean [SD], 80.3 [41.8] mg/dL; mean [SD] decrease, 47.9% [27.8%]). The percentage decrease of LDL-C for both drugs was approximately 50%, which was maintained until 24 months after treatment. Six patients (3.9%) presented with some cardiovascular event: acute myocardial infarction (2 [1.3%]), stroke (1 [0.65%]), coronary revascularization (1 [0.65%]), and hospitalization for unstable angina (2 [1.3%]). We did not see any adverse reactions related to PCSK9i treatment in 76.5% of patients. In the first 6 months, adherence to treatment with PCSK9is, measured as the possession ratio, was a mean (SD) of 99.4% (3.9%). In the rest of the study period (6-24 months), the mean (SD) adherence to treatment was 99.2% (4.7%). IMPLICATIONS: The frequency of cardiovascular events in patients treated with PCSK9is was low and occurred despite adequate adherence to treatment (100% possession ratio) with PCSK9is and concomitant treatment with other hypolipidemics. The effectiveness of PCSK9is is similar to that referred to in other published studies with PCSK9is, and this was maintained in the long term (24 months) with few adverse events, all of which were mild.

Effect of chemoradiation on the size of the thyroid gland.

We aimed to evaluate changes in thyroid gland size during the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation. We performed a retrospective review of records of adult patients treated at our institution with external beam radiation to the chest and/or chemotherapy with taxanes, alkylating agents, and/or a topoisomerase II inhibitor. Neck and chest computed tomography (CT) images were used to calculate thyroid gland volume before and after therapy, using Vitrea® software or the volumetric ellipsoid method. Thirty-seven patients were included. After treatment, there was a significant reduction in thyroid gland volume of 14.0% (P < 0.01) using Vitrea and 17.1% (P < 0.05) using the volumetric ellipsoid method. Exposure to radiation or chemotherapy was not found to be associated with the degree of thyroid gland reduction, nor was the number of days between CT scans or the stage of the malignancy being treated. Finally, the degree of thyroid gland size reduction did not predict mortality. Our results showed that the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation results in a reduction in thyroid gland size. The impact on thyroid gland function remains unknown.

Complicaciones agudas graves por inhibidores del cotransportador sodio-glucosa tipo 2 (sglt2): un problema real y no tan infrecuente / Severe acute complications by sodium-glucose cotransporter-2 (sglt2) inhibitors: A real problem and not so infrecuent

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GLP1 Receptor Agonist and SGLT2 Inhibitor Combination: An Effective Approach in Real-world Clinical Practice.

PURPOSE: The aim of this study was to evaluate the effectiveness and safety of combination therapy with a sodium-glucose cotransporter-2 (SGLT2) inhibitor and a glucagon-like peptide-1 receptor agonist (GLP1RA) in patients with inadequately controlled type 2 diabetes. METHODS: A retrospective search of electronic prescriptions of patients undergoing GLP1RA and SGLT2 inhibitor combination therapy was conducted. Once the patients had been identified, demographic data, blood and urine analyses (glycosylated hemoglobin [HbA1c], glucose, renal function, albuminuria, lipid profile, liver enzymes, and uric acid), physical examination (weight, body mass index, and blood pressure), and adverse effects were obtained from their electronic clinical records according to each of the following 3 periods: before the initiation of the combination, the first visit after initiation, and the last available visit. The influence of the duration of diabetes and the drug combination sequence on the effectiveness of the treatment was also analyzed. Statistical analysis was performed with SPSS version 21.0 (IBM SPSS Statistics, IBM Corporation, Armonk, New York). Quantitative variables are presented as mean and SD and were compared by using the Student t test, one-way ANOVA, or repeated measures ANOVA with Bonferroni correction. Categorical variables are expressed as percentages and were compared by using the χ2 test. RESULTS: A total of 212 patients were included, with women accounting for 52.4%. The mean age (SD) of the population was 61.5 (9.6) years. A significant reduction in HbA1c (-12 mmol/mol [-1.1%]) was observed with combined therapy (P < 0.001). The target of HbA1c <53 mmol/mol (<7%) was achieved in 42% of the participants. Mean weight loss was -3.5 kg, and almost 40% of the patients attained the weight loss goal of ≥5% (P < 0.001 in all analyses). Transaminase levels and renal parameters also improved. These benefits persisted over time and bore no relation to the evolution of diabetes. Simultaneous initiation of a combination of a GLP1RA and SGLT2 inhibitor led to faster weight loss and a greater decrease in HbA1c than when they are used sequentially; however, the long-term benefits in terms of metabolic control were similar. Adverse events were rare, and a tendency for a reduced insulin dose was observed. IMPLICATIONS: The findings of this study reveal the combined benefits of a GLP1RA and SGLT2 inhibitor in real-world clinical practice. In general, the combined treatment was well tolerated, and few adverse events were detected.

Cetoacidosis como complicación de una dieta baja en hidratos de carbono / Ketoacidosis as a complication of a low carbohydrate diet

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