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1.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 443-458, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182864

RESUMO

Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2


Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists


Assuntos
Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Fatores de Risco , Sociedades Médicas/normas , Documentos , Índice Glicêmico , Estilo de Vida , Sociedades Médicas/organização & administração , Estratégias de eSaúde , Exercício/fisiologia
2.
Endocrinol Diabetes Nutr ; 66(7): 443-458, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30827909

RESUMO

OBJECTIVE: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. METHODS: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. CONCLUSIONS: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.

3.
Clin Endocrinol (Oxf) ; 89(4): 414-423, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29947044

RESUMO

OBJECTIVE: HIV infection is associated with an increased risk of cardiovascular disease. Irisin is a miokyne secreted by skeletal muscle, which may influence insulin homeostasis, nonalcoholic fatty liver disease (NAFLD) and atherosclerosis. Our objective was to evaluate the relationships between serum irisin, insulin homeostasis, NAFLD and subclinical atherosclerosis in HIV-infected males. DESIGN: Cross-sectional study in a cohort of HIV-infected patients. PATIENTS: Inclusion criteria: men older than 18 years; antiretroviral therapy (ART) -naïve or on effective ART (<50 HIV-1 RNA copies/mL) without changes in the previous 6 months; no diabetes or hepatitis C. MEASUREMENTS: Irisin was measured by enzymatic immunoassay (Phoenix Pharmaceuticals), insulin sensitivity by homeostasis model assessment of insulin resistance (HOMA-IR), as well as the 2-hour continuous infusion of glucose with model assessment (CIGMA-HOMA). Hepatic steatosis was measured by 1-H magnetic resonance spectroscopy, subclinical atherosclerosis by evaluation of carotid intima-media thickness (C-IMT), measured by Ultrasonography. RESULTS: Eight nine men (age 42.0 ± 8.3 years, duration of HIV infection 7.9 ± 5.6 years, CD4 count 547 ± 279 cells/mL) were included. Circulating irisin was positively related to HOMA-IR and CIGMA-HOMA, hepatic triglyceride content, and to VAT/SAT ratio. Higher irisin concentrations were associated with higher C-IMT, although this association did not persist in multivariate analysis. Lipodystrophy and a higher baseline PAI-1 concentration were independently associated with C-IMT. CONCLUSIONS: In male HIV patients without diabetes, higher irisin concentrations are positively associated with insulin resistance, NAFLD and subclinical atherosclerosis. However, waist-hip-ratio is the main determinant of insulin resistance, and PAI-1 and lipodystrophy were the strongest determinants of IMT in this population.


Assuntos
Aterosclerose/sangue , Fibronectinas/sangue , Infecções por HIV/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Adulto , Espessura Intima-Media Carotídea , Estudos Transversais , Humanos , Resistência à Insulina/fisiologia , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade
4.
Eur J Clin Invest ; 47(8): 591-599, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28664622

RESUMO

BACKGROUND: Pathogenesis of atherosclerosis is complex, and differences between HIV-infected patients and general population cannot be completely explained by the higher prevalence of traditional cardiovascular risk factors. We aimed to analyse the association between inflammation and subclinical atherosclerosis in HIV patients with low Framingham risk score. MATERIALS AND METHODS: Case-control study. SETTING: Outpatient Infectious Diseases clinic in a university hospital. SUBJECTS: HIV-1-infected patients aged > 35 years receiving antiretroviral treatment with viral load < 50 copies/mL and Framingham risk score < 10%. EXCLUSION CRITERIA: inflammatory diseases; dyslipidaemia requiring statins; smoking > 5 cigarettes/day; diabetes; hypertension; vascular diseases. MAIN OUTCOME: subclinical atherosclerosis determined by ultrasonography: common carotid intima-media thickness greater than 0·8 mm or carotid plaque presence. Explanatory variables: ribosomal bacterial DNA (rDNA), sCD14, interleukin-6 (IL-6) and TNF-α. RESULTS: Eighty-four patients were included, 75% male, mean age 42 years and mean CD4+ cells 657 ± 215/mm3 . Median Framingham risk score was 1% at 10 years (percentile 25-75: 0·5-4%). Eighteen patients (21%) had subclinical atherosclerosis; the associated factors were older age (P = 0·001), waist-hip ratio (P = 0·01), time from HIV diagnosis (P = 0·02), rDNA (P = 0·04) and IL-6 (P = 0·01). In multivariate analysis, OR for subclinical atherosclerosis was 7 (95% CI, 1.3-40, P = 0.02) and 9 (95% CI, 1.0-85, P = 0.04) for patients older than 44 years and IL-6 > 6·6 pg/mL, respectively. CONCLUSIONS: Well-controlled HIV patients with low Framingham risk score have a high prevalence of subclinical carotid atherosclerosis, and the main risk factors are age and inflammation. These patients are not receiving primary prophylaxis for cardiovascular events according to current guidelines.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Doenças das Artérias Carótidas/virologia , Infecções por HIV/tratamento farmacológico , Adulto , Fatores Etários , Biomarcadores/metabolismo , Índice de Massa Corporal , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , DNA Ribossômico/metabolismo , Feminino , Humanos , Interleucina-6/metabolismo , Receptores de Lipopolissacarídeos/metabolismo , Masculino , Fatores de Risco , Carga Viral
5.
Endocrinol. nutr. (Ed. impr.) ; 62(8): 380-383, oct. 2015.
Artigo em Espanhol | IBECS | ID: ibc-143403

RESUMO

La disforia de género (DG) en la infancia y adolescencia es una condición compleja, siendo importante la detección precoz y el tratamiento integral, ya que con ello se mejora la calidad de vida, disminuye la comorbilidad mental y la propia DG. En este documento de posicionamiento, el Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN), integrado por especialistas de Endocrinología, Psicología, Psiquiatría, Pediatría y Sociología, establece unas recomendaciones sobre la evaluación y tratamiento de la DG en niños y adolescentes. El manejo interdisciplinar de la DG debe llevarse a cabo en unidades con equipos especializados (UTIG) y considerando que cualquier intervención sanitaria debe seguir los principios del rigor científico, la experiencia acumulada, los principios éticos y deontológicos y la prudencia necesaria ante tratamientos crónicos, agresivos e irreversibles (AU)


Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments (AU)


Assuntos
Adolescente , Criança , Humanos , Transtornos Sexuais e da Identidade de Gênero/diagnóstico , Transtornos Sexuais e da Identidade de Gênero/terapia , Transexualismo/diagnóstico , Transexualismo/terapia , Identidade de Gênero , Pessoas Transgênero
6.
Diabetes Ther ; 6(2): 173-85, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26055216

RESUMO

INTRODUCTION: A limitation with randomized controlled trials is that, while they provide unbiased evidence of the efficacy of interventions, they do so under unreal conditions and in a very limited and highly selected patient population. Our aim was to provide data about the effectiveness of liraglutide treatment in a real-world and clinical practice setting. METHODS: In a retrospective and observational study, data from 753 patients with type 2 diabetes were recorded through an online tool (eDiabetes-Monitor). RESULTS: Mean baseline glycated hemoglobin (HbA1c) was 8.4 ± 1.4% and mean body mass index (BMI) was 38.6 ± 5.4 kg/m(2). After 3-6 months of treatment with liraglutide, we observed a change in HbA1c of -1.1 ± 1.2%, -4.6 ± 5.3 kg in weight and -1.7 ± 2.0 kg/m(2) in BMI (p < 0.001 for all). Compared to baseline, there was a significant reduction in systolic blood pressure (-5.9 mmHg, p < 0.001), diastolic blood pressure (-3.2 mmHg, p < 0.001), LDL cholesterol (-0.189 mmol/l, p < 0.001) and triglycerides (-0.09 mmol/l, p = 0.021). In patients switched from DPP-4 inhibitors, liraglutide induced a decrease of -1.0% in HbA1c (p < 0.001) and a reduction in weight (-4.5 kg, p < 0.001). In patients treated with liraglutide as an add-on therapy to insulin a decrease of -1.08% in HbA1c (p < 0.001) and a weight reduction of -4.15 kg (p < 0.001) were observed. CONCLUSION: Our study confirms the effectiveness of liraglutide in a real-life and clinical practice setting. FUNDING: Spanish Society of Endocrinology and Nutrition.

7.
Endocrinol Nutr ; 62(8): 380-3, 2015 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25935352

RESUMO

Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments.


Assuntos
Disforia de Gênero , Psicologia do Adolescente , Psicologia da Criança , Adolescente , Serviços de Saúde do Adolescente/organização & administração , Criança , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Diagnóstico Precoce , Feminino , Disforia de Gênero/diagnóstico , Disforia de Gênero/psicologia , Disforia de Gênero/terapia , Identidade de Gênero , Hormônios Esteroides Gonadais/administração & dosagem , Hormônios Esteroides Gonadais/efeitos adversos , Serviços de Saúde para Pessoas Transgênero/organização & administração , Humanos , Comunicação Interdisciplinar , Masculino , Equipe de Assistência ao Paciente , Puberdade/efeitos dos fármacos , Procedimentos de Readequação Sexual , Espanha
8.
Endocrinol. nutr. (Ed. impr.) ; 62(1): 4-10, ene. 2015. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-131633

RESUMO

Background and aims The interassay variability found in the measurement of testosterone (T) levels warrants the need for laboratories to validate their methods to establish trustworthy cut-off points for diagnosis of male hypogonadism. The aims of this study were to validate measurement of total T (TT) at our laboratory in order to obtain reference ranges for TT, calculated free T (CFT), calculated bioavailable T (CBT), and salivary T (ST) in healthy young men from the Mediterranean region, and to evaluate the potential clinical value of ST by establishing its correlation with serum T.MethodsAn observational, cross-sectional study with sequential sampling. Inclusion criteria: men aged 18–30 years with body mass index (BMI) < 30. Exclusion criteria: chronic diseases, hepatic insufficiency or use of drugs altering circulating T levels. Main outcome measures TT (chemiluminescent immunoassay UniCell DXI 800 [Access T Beckman Coulter]), CFT and CBT (Vermeulen's formula), and ST (radioimmunoassay for serum TT modified for saliva [Coat-A-Count, Siemens]). Descriptive statistical analyses and correlation by Spearman's rho (SPSS 19.0 Inc., Chicago) were used. Results One hundred and twenty-one subjects aged 24 ± 3.6 years with BMI 24 ± 2.5 kg/m2 were enrolled. Hormone study: TT, 19 ± 5.5 nmol/L (reference range [rr.] 9.7–33.3); CFT, 0.38 nmol/L (rr. 0.22–0.79); CBT, 9.7 nmol/L (rr. 4.9–19.2); and ST, 0.35 nmol/L (rr. 0.19–0.68). Correlation between ST and CFT was 0.46.ConclusionsIn men from the Mediterranean region, values of TT > 9.7 nmol/L, CFT > 0.22 nmol/L, and/or CBT > 4.9 nmol/L make the presence of biochemical hypogonadism unlikely. According to the correlation between serum and ST, the clinical value of ST remains to be established (AU)


Antecedentes y objetivos La variabilidad interensayo existente en la determinación de testosterona (T) justifica la necesidad de que cada laboratorio valide su método y establezca puntos de corte fiables para el diagnóstico del hipogonadismo masculino. Los objetivos del estudio fueron validar la determinación de T total (TT) en nuestro laboratorio para obtener los valores de referencia de TT, T libre calculada (TLC), T biodisponible calculada (TBC) y T salivar (TS) en varones jóvenes sanos del área mediterránea y evaluar la posible utilidad clínica de la TS. Material y métodos Estudio observacional transversal. Muestreo secuencial. Criterios de inclusión: varones, 18–30 años de edad, índice de masa corporal (IMC) < 30. Criterios de exclusión: enfermedades crónicas, insuficiencia hepática o uso de medicamentos que alteran las concentraciones circulantes de T. Metodología: TT (inmunoanálisis de quimioluminiscencia UniCell DXI800 [Acces T Beckman Coulter]), TLC y TBC (fórmula de Vermeulen), TS (radioinmunoensayo para TT sérica modificado para la saliva [Coat-A-Count, Siemens]). Análisis estadísticos: descriptivos y correlación rho de Spearman (SPSS 19,0 Inc.,Chicago).Resultados Se incluyeron 121 individuos de 24 ± 3,6 años e IMC 24 ± 2,5 kg/m2. Estudio hormonal TT, 19 ± 5,5 nmol/L (intervalo de confianza 95% 9,7–33,3); TLC, 0,38 nmol/L ([P2,5–P97,5] 0,22–0,79); TBC, 9,7 nmol/L ([P2,5–P97,5] 4,9–19,2); y TS, 0,35 nmol/L ([P2,5–P97,5] 0,19–0,68). La correlación entre TS y TLC fue 0,46.ConclusionesEn varones de la región mediterránea, concentraciones de TT > 9,7 nmol/L, TLC > 0,22 nmol/L y/o TBC > 4,9 nmol/L hacen improbable la presencia de hipogonadismo bioquímico. De acuerdo a la correlación entre la testosterona sérica y salivar, la utilidad clínica de la ST está aún por establecerse (AU)


Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Testosterona/análise , Saliva/química , Análise Química do Sangue , Gônadas/fisiologia , Hormônios Gonadais/análise , Valores de Referência
9.
Endocrinol Nutr ; 62(1): 4-10, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25444977

RESUMO

BACKGROUND AND AIMS: The interassay variability found in the measurement of testosterone (T) levels warrants the need for laboratories to validate their methods to establish trustworthy cut-off points for diagnosis of male hypogonadism. The aims of this study were to validate measurement of total T (TT) at our laboratory in order to obtain reference ranges for TT, calculated free T (CFT), calculated bioavailable T (CBT), and salivary T (ST) in healthy young men from the Mediterranean region, and to evaluate the potential clinical value of ST by establishing its correlation with serum T. METHODS: An observational, cross-sectional study with sequential sampling. INCLUSION CRITERIA: men aged 18-30 years with body mass index (BMI)<30. EXCLUSION CRITERIA: chronic diseases, hepatic insufficiency or use of drugs altering circulating T levels. Main outcome measures TT (chemiluminescent immunoassay UniCell DXI 800 [Access T Beckman Coulter]), CFT and CBT (Vermeulen's formula), and ST (radioimmunoassay for serum TT modified for saliva [Coat-A-Count, Siemens]). Descriptive statistical analyses and correlation by Spearman's rho (SPSS 19.0 Inc., Chicago) were used. RESULTS: One hundred and twenty-one subjects aged 24±3.6 years with BMI 24±2.5 kg/m(2) were enrolled. Hormone study: TT, 19±5.5 nmol/L (reference range [rr.] 9.7-33.3); CFT, 0.38 nmol/L (rr. 0.22-0.79); CBT, 9.7 nmol/L (rr. 4.9-19.2); and ST, 0.35 nmol/L (rr. 0.19-0.68). Correlation between ST and CFT was 0.46. CONCLUSIONS: In men from the Mediterranean region, values of TT>9.7 nmol/L, CFT>0.22 nmol/L, and/or CBT>4.9 nmol/L make the presence of biochemical hypogonadism unlikely. According to the correlation between serum and ST, the clinical value of ST remains to be established.


Assuntos
Hipogonadismo/diagnóstico , Saliva/química , Testosterona/análise , Adolescente , Adulto , Índice de Massa Corporal , Estudos Transversais , Humanos , Hipogonadismo/sangue , Medições Luminescentes , Masculino , Região do Mediterrâneo , Radioimunoensaio , Valores de Referência , Testosterona/sangue , Adulto Jovem
10.
J Int AIDS Soc ; 17: 18945, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24836607

RESUMO

INTRODUCTION: Vitamin D insufficiency (VDI) has been associated with increased cardiovascular risk in the non-HIV population. This study evaluates the relationship among serum 25-hydroxyvitamin D [25(OH)D] levels, cardiovascular risk factors, adipokines, antiviral therapy (ART) and subclinical atherosclerosis in HIV-infected males. METHODS: A cross-sectional study in ambulatory care was made in non-diabetic patients living with HIV. VDI was defined as 25(OH)D serum levels <75 nmol/L. Fasting lipids, glucose, inflammatory markers (tumour necrosis factor-α, interleukin-6, high-sensitivity C-reactive protein) and endothelial markers (plasminogen activator inhibitor-1, or PAI-I) were measured. The common carotid artery intima-media thickness (C-IMT) was determined. A multivariate logistic regression analysis was made to identify factors associated with the presence of VDI, while multivariate linear regression analysis was used to identify factors associated with common C-IMT. RESULTS: Eighty-nine patients were included (age 42 ± 8 years), 18.9% were in CDC (US Centers for Disease Control and Prevention) stage C and 75 were on ART. VDI was associated with ART exposure, sedentary lifestyle, higher triglycerides levels and PAI-I. In univariate analysis, VDI was associated with greater common C-IMT. The multivariate linear regression model, adjusted by confounding factors, revealed an independent association between common C-IMT and patient age, time of exposure to protease inhibitors (PIs) and impaired fasting glucose (IFG). In contrast, there were no independent associations between common C-IMT and VDI or inflammatory and endothelial markers. CONCLUSIONS: VDI was not independently associated with subclinical atherosclerosis in non-diabetic males living with HIV. Older age, a longer exposure to PIs, and IFG were independent factors associated with common C-IMT in this population.


Assuntos
Aterosclerose/etiologia , Infecções por HIV/complicações , Deficiência de Vitamina D/complicações , Adulto , Doenças Assintomáticas/epidemiologia , Glicemia/análise , Proteína C-Reativa/análise , Espessura Intima-Media Carotídea/estatística & dados numéricos , Estudos Transversais , Humanos , Interleucina-6/sangue , Lipídeos/sangue , Modelos Logísticos , Masculino , Inibidor 1 de Ativador de Plasminogênio/sangue , Fatores de Risco , Fator de Necrose Tumoral alfa/sangue , Vitamina D/análogos & derivados , Vitamina D/sangue
13.
Endocrinol. nutr. (Ed. impr.) ; 60(9): 517e1-517e18, nov. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-117449

RESUMO

Objetivo Proporcionar unas recomendaciones prácticas para la evaluación y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Participantes Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN).Métodos Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron artículos escritos en inglés y castellano con fecha de inclusión hasta el 15 de febrero de 2013. Para las recomendaciones acerca del uso de fármacos, se consideraron tratamientos aprobados por la Agencia Europea de Medicamentos con esa misma fecha. Tras la formulación de las recomendaciones estas se discutieron conjuntamente por el Grupo de trabajo. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y manejo de la hipoglucemia en pacientes con diabetes mellitus (AU)


Objective To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Participants Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Methods Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus (AU)


Assuntos
Humanos , Diabetes Mellitus/tratamento farmacológico , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Padrões de Prática Médica , Prática Clínica Baseada em Evidências/métodos
14.
Endocrinol Nutr ; 60(9): 517.e1-517.e18, 2013 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23916172

RESUMO

OBJECTIVE: To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. METHODS: Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. CONCLUSIONS: The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus.


Assuntos
Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Hipoglicemia/diagnóstico , Hipoglicemia/terapia , Árvores de Decisões , Complicações do Diabetes/etiologia , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Humanos , Hipoglicemia/etiologia
15.
Gastroenterol. hepatol. (Ed. impr.) ; 36(6): 422-436, jun.-jul. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-113733

RESUMO

La pancreatitis crónica (PC) es una enfermedad compleja, con un amplio espectro de manifestaciones clínicas, que abarca desde pacientes asintomáticos a pacientes con síntomas inhabilitantes o con complicaciones serias. El manejo de la PC frecuentemente difiere entre áreas geográficas e incluso entre centros. Ello se debe a la escasez de estudios de calidad y guías de práctica clínica que aborden el diagnóstico y tratamiento de esta enfermedad. El objetivo del Club Español Pancreático fue elaborar recomendaciones basadas en la evidencia para el manejo de la PC. Dos coordinadores eligieron un panel multidisciplinario de 24 expertos en esta enfermedad. Estos expertos se seleccionaron por su experiencia clínica e investigadora en PC. Se elaboró una lista de preguntas, cada una de las cuales se revisó por 2 panelistas. Con ello se produjo un borrador que se discutió en una reunión presencial por todos los participantes. Los niveles de evidencia se basaron en la clasificación del Oxford Centre for Evidence-Based Medicine. En la segunda parte del consenso se dieron recomendaciones para el manejo del dolor, seudoquistes, estenosis biliar y duodenal, fístula pancreática y ascitis, hipertensión portal izquierda, diabetes mellitus, insuficiencia pancreática exocrina y soporte nutricional en PC (AU)


Chronic pancreatitis (CP) is a complex disease with a wide spectrum of clinical manifestations ranging from asymptomatic disease to disabling forms or serious complications. The management of CP frequently differs among geographical areas and even among centers. These differences are due to the scarcity of high-quality studies and clinical practice guidelines that focus on the diagnosis and treatment of this disease. The aim of the Spanish Pancreatic Club was to create evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. These experts were selected on the basis of their clinical and research experience in CP. A list of questions was drawn up and each question was then reviewed by two panelists. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. Levels of evidence were based on the classification of the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus process, recommendations were established for the management of pain, pseudocysts, biliary and duodenal stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP (AU)


Assuntos
Humanos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/terapia , Padrões de Prática Médica , Consenso , Insuficiência Pancreática Exócrina , Fístula Pancreática , Hipertensão Portal
16.
Gastroenterol Hepatol ; 36(6): 422-36, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-23639273

RESUMO

Chronic pancreatitis (CP) is a complex disease with a wide spectrum of clinical manifestations ranging from asymptomatic disease to disabling forms or serious complications. The management of CP frequently differs among geographical areas and even among centers. These differences are due to the scarcity of high-quality studies and clinical practice guidelines that focus on the diagnosis and treatment of this disease. The aim of the Spanish Pancreatic Club was to create evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. These experts were selected on the basis of their clinical and research experience in CP. A list of questions was drawn up and each question was then reviewed by two panelists. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. Levels of evidence were based on the classification of the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus process, recommendations were established for the management of pain, pseudocysts, biliary and duodenal stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP.


Assuntos
Pancreatite Crônica/terapia , Árvores de Decisões , Humanos , Apoio Nutricional
17.
Gastroenterol. hepatol. (Ed. impr.) ; 36(5): 326-339, mayo 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-112380

RESUMO

La pancreatitis crónica (PC) es una enfermedad relativamente infrecuente, compleja y muy heterogénea. La ausencia de un patrón oro aplicable a las fases iniciales de la PC hace que su diagnóstico precoz sea difícil. Algunas de sus complicaciones, en particular el dolor crónico, pueden ser difíciles de manejar. Hay mucha variedad en el diagnóstico y tratamiento de la PC y de sus complicaciones entre los diferentes centros y profesionales. El Club Español Pancreático ha desarrollado un consenso sobre el manejo de la PC. Dos coordinadores eligieron un panel multidisciplinario de 24 expertos en esta enfermedad. Se elaboró una lista de preguntas. Cada pregunta fue revisada por 2 expertos. Con ello se elaboró un borrador compartido con todo el panel de expertos y discutido en una reunión presencial. En la primera parte del consenso se aborda el diagnóstico de la PC y de sus complicaciones (AU)


Chronic pancreatitis (CP) is a relatively uncommon, complex and highly heterogeneous disease. There is no clear pattern applicable to the initial stages of CP, which hampers its early diagnosis. Some of the complications of CP, especially chronic pain, can be difficult to manage. There is wide variation in the diagnosis and treatment of CP and its complications among centers and health professionals. The Spanish Pancreatic Club has developed a consensus document on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. A list of questions was drawn up. Each question was reviewed by two experts. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. The first part of the consensus document focusses on the diagnosis of CP and its complications (AU)


Assuntos
Humanos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/tratamento farmacológico , Insuficiência Pancreática Exócrina/diagnóstico , Insuficiência Pancreática Exócrina/tratamento farmacológico , Padrões de Prática Médica
18.
Gastroenterol Hepatol ; 36(5): 326-39, 2013 May.
Artigo em Espanhol | MEDLINE | ID: mdl-23566414

RESUMO

Chronic pancreatitis (CP) is a relatively uncommon, complex and highly heterogeneous disease. There is no clear pattern applicable to the initial stages of CP, which hampers its early diagnosis. Some of the complications of CP, especially chronic pain, can be difficult to manage. There is wide variation in the diagnosis and treatment of CP and its complications among centers and health professionals. The Spanish Pancreatic Club has developed a consensus document on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. A list of questions was drawn up. Each question was reviewed by two experts. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. The first part of the consensus document focusses on the diagnosis of CP and its complications.


Assuntos
Pancreatite Crônica/diagnóstico , Humanos
20.
Endocrinol Nutr ; 60(7): 358-67, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23416216

RESUMO

INTRODUCTION AND OBJECTIVE: The ability to predict recurrence of pituitary adenoma (PA) after surgery may be helpful to determine follow-up frequency and the need for adjuvant treatment. The purpose of this study was to assess the prognostic capacity of pituitary tumor transforming gene (PTTG), insulin-like growth factor 1 receptor (IGF1R), and Ki-67. MATERIALS AND METHODS: In this retrospective study, the normalized copy number (NCN) of PTIG and IGF1R mRNA was measured using RT-PCR, and the Ki-67 index was measured by immunohistochemistry in 46 PA samples. Clinical data, histological subtype, and radiographic characteristics were collected to assess associations between variables and tumor behavior. Progression of tumor remnants and its association to markers was also studied in 14 patients with no adjuvant treatment after surgery followed up for 46±36 months. RESULTS: Extrasellar tumors had a lower PTTG expression as compared to sellar tumors (0.065 [1st-3rd quartile: 0.000-0.089] NCN vs. 0.135 [0.105-0.159] NCN, p=0.04). IGF1R expression changed depending on histological subtype (p=0.014), and was greater in tumor with remnant growth greater than 20% during follow-up (10.69±3.84 NCN vs. 5.44±3.55 NCN, p=0.014). CONCLUSIONS: Our results suggest that the IGF1R is a more helpful molecular marker than PTTG in PA management. Ki-67 showed no association to tumor behavior. However, the potential of these markers should be established in future studies with standardized methods and on larger samples.


Assuntos
Biomarcadores Tumorais/análise , Antígeno Ki-67/análise , Proteínas de Neoplasias/biossíntese , Neoplasias Hipofisárias/química , Receptor IGF Tipo 1/biossíntese , Securina/biossíntese , Adulto , Idoso , Antígenos de Neoplasias/análise , Antineoplásicos Hormonais/uso terapêutico , Terapia Combinada , Intervalo Livre de Doença , Agonistas de Dopamina/uso terapêutico , Feminino , Seguimentos , Regulação Neoplásica da Expressão Gênica , Humanos , Hipofisectomia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Invasividade Neoplásica , Proteínas de Neoplasias/análise , Proteínas de Neoplasias/genética , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Hipofisárias/classificação , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Prognóstico , RNA Mensageiro/análise , RNA Mensageiro/biossíntese , RNA Neoplásico/análise , RNA Neoplásico/biossíntese , Receptor IGF Tipo 1/análise , Receptor IGF Tipo 1/genética , Estudos Retrospectivos , Securina/análise , Securina/genética , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Resultado do Tratamento
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