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1.
Eur J Endocrinol ; 182(1): G1-G32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855556

RESUMO

Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed - which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.


Assuntos
Índice de Massa Corporal , Hipotireoidismo/diagnóstico , Obesidade/diagnóstico , Comorbidade , Endocrinologia , Humanos , Hipotireoidismo/epidemiologia , Obesidade/epidemiologia , Prevalência , Testes de Função Tireóidea
2.
J Surg Res ; 245: 64-71, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31401249

RESUMO

BACKGROUND: The American Thyroid Association (ATA) issued specific preoperative preparatory guidelines for patients undergoing thyroidectomy for treatment of Graves' disease. Our goal is to determine if compliance with these guidelines is associated with better outcomes. METHODS: A retrospective review of a prospectively maintained database identified 228 patients with Graves' disease who underwent total thyroidectomy between August 2007 and May 2015. Patients treated in compliance with ATA guidelines were compared with those not in full compliance with the current preparatory guidelines. RESULTS: At the time of surgery, 52% of all patients followed ATA guidelines. Patients who were prepped per ATA guidelines had fewer episodes of intraoperative tachycardia (0.3 versus 4.5, P = 0.04) but had no difference in peak systolic blood pressure or in number of episodes of systolic blood pressure > 180 mmHg. ATA prepped and nonprepped patients had similar mean operating room time and length of stay. ATA prepped and nonprepped patients had similar complication rates, including transient hypocalcemia (30.4% versus 25.5%, P = 0.45), prolonged hypoparathyroidism (0.98% versus 4.3%, P = 0.15), hoarse voice (10.8% versus 7.5%, P = 0.42), permanent recurrent laryngeal nerve paralysis (2.9% versus 2.1%, P = 0.71), and hematoma (2.9% versus 0%, P = 0.09). CONCLUSIONS: Our data suggest that compliance with ATA guidelines for thyroidectomy preparation is not essential for a successful surgical outcome. Although preparation per the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, operating room time, or postoperative complications.


Assuntos
Doença de Graves/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Tireoidectomia/normas , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Endocrinologia/normas , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Sociedades Médicas/normas , Tireoidectomia/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
4.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 654-662, dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184793

RESUMO

Las enfermedades endocrinas están experimentando un importante incremento de su prevalencia, debido a causas de diversa índole, entre ellas la epidemia de obesidad y de desnutrición, el envejecimiento de la población, pero también el efecto de los disruptores endocrinos, entre otros. Por otra parte, las nuevas tecnologías, tanto a nivel de analítica molecular y genética, de imagen y de nuevos dispositivos terapéuticos, obligan a que la comunidad profesional endocrina en España tenga que estar en constante formación. La conexión con los pacientes a través de sus asociaciones, cada vez más activas, y con la sociedad civil en general, el compromiso profesional y la demanda de diversos colectivos sociales de una atención moderna y equitativa, y a llevar a cabo investigación que facilite la consecución de avances para los pacientes, obligan al especialista en Endocrinología y Nutrición, y a la Sociedad Española de Endocrinología y Nutrición (SEEN), a posicionarse y dar respuesta a todos estos retos. En el presente documento, la SEEN expone sus propuestas y su estrategia hasta el 2022


Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022


Assuntos
Endocrinologia/organização & administração , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Estratégias , Endocrinologia/tendências , Sistemas Nacionais de Saúde , Medicina/organização & administração , Promoção da Saúde , Espanha
9.
Harefuah ; 158(9): 556-558, 2019 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-31507102

RESUMO

INTRODUCTION: Clinical encounters with transgender people seeking hormonal treatment for gender reaffirmation, provide an opportunity, besides engagement in the endocrine dilemmas, to challenge the binary pattern of thinking and reveal many fascinating and complex matters of transgender medicine: human, philosophical and political. The current review of the subject is presented by an endocrinologist engaged in hormonal treatment of transgender people.


Assuntos
Endocrinologia , Pessoas Transgênero , Transexualismo , Identidade de Gênero , Humanos , Medicina
10.
Urology ; 133: 116-120, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454658

RESUMO

OBJECTIVE: To evaluate reproductive urologist and reproductive endocrinologist practice patterns for postvasectomy surgical sperm retrieval at American private practice fertility clinics. METHODS: Private practice American fertility clinics were contacted by telephone and administered a telephone survey. In states with multiple large cities, several clinics in different cities were surveyed. Our primary endpoint was to determine what specialty of physician (urologist or reproductive endocrinology gynecologist) performed sperm retrieval procedures. Secondarily, we inquired about the location that these procedures were performed (urology vs gynecology clinic), type of anesthesia used, and cash cost for the procedure. RESULTS: Two hundred and twenty-five infertility clinics were contacted (per state range 2-10). 90.2% (203/225) of clinics responded to our queries. Zero clinics had an on-site urologist. An on-staff gynecologist with reproductive endocrinology training performed postvasectomy sperm retrievals in 9.4% (19/203) of clinics. A urologist "partnered" with the infertility clinic performed sperm retrievals at the fertility clinic in 11.8% (24/203) of clinics. 18.7% (38/203) did not offer sperm retrieval on-site, but did have a referral pattern established with a local urologist. Among reproductive endocrinologist performing sperm retrievals, intravenous anesthesia was used in 76.9% (10/13) of clinics. The quoted costs for surgical sperm retrieval performed by a reproductive endocrinologist ranged from $1000 to 10,000. CONCLUSION: Surgical sperm retrieval postvasectomy performed by an on-site reproductive endocrinologist was offered by 9.4% of contacted fertility clinics. The majority (76.9%) of these cases were routinely performed under intravenous anesthesia. Costs for reproductive endocrinologist performed sperm retrievals varied considerably. The reasons for, and safety of reproductive endocrinologists performing these procedures remains to be determined.


Assuntos
Endocrinologia , Ginecologia , Padrões de Prática Médica , Medicina Reprodutiva , Recuperação Espermática/normas , Urologia , Vasectomia , Humanos , Masculino , Prática Privada , Estados Unidos
11.
BMC Med Educ ; 19(1): 290, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362729

RESUMO

BACKGROUND: With the development of medicine, new teaching methods, such as flipped classroom and problem-based learning (PBL), have received much attention in medical education. However, the implementation of flipped classroom combined with PBL in endocrinology education has not been well investigated. Considering that both two teaching methods may complement each other, therefore, the aim of this study was to evaluate students' learning effectiveness acceptability of the pedagogy between traditional lecture-based teaching methods and the combination of flipped classrooms with PBL teaching methods in the endocrinology internship. METHODS: 74 fourth-year medical students at the Bengbu Medical College were enrolled in the endocrinology internship. Hyperthyroidism was chosen for the content of this study. The participants were randomly allocated into either the combination group of flipped classroom with PBL (CG) or the traditional lecture-based classroom group (TG). Both a pre-quiz and a post-quiz were conducted before and after the classes, respectively. All questions in the quizzes were classified into two aspects, basic theoretical knowledge and clinical case analyses based on the Bloom's Taxonomy. The scores were compared and students were required to complete the questionnaire to evaluate their perceptions and experience. RESULTS: The mean post-quiz scores of both the TG and the CG were higher than those of the pre-quiz. Additionally, the post-quiz showed that students in the CG had significantly higher scores in the TG. Further analysis found that after class, only the difference in clinical case analysis between CG and TG was significant. The scores of all items in the questionnaires were higher in the CG than in the TG. More students agreed that the combined teaching method could help to improve their performance, at the same time, it could increase their workload. CONCLUSIONS: The combination of the flipped classroom and PBL teaching approach could be a better option over the traditional lecture-based classroom in the teaching of hyperthyroidism during endocrinology internship, although it can increase students' workload. To be widely accepted and implemented, further optimizations are required.


Assuntos
Endocrinologia/educação , Hipertireoidismo , Internato e Residência , Aprendizagem Baseada em Problemas , Estudantes de Medicina/psicologia , Ensino/organização & administração , China , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
12.
Endocrinology ; 160(10): 2326-2327, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369078
14.
Arch Endocrinol Metab ; 63(3): 187-189, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340239
15.
Endocrinology ; 160(9): 2165-2179, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310273

RESUMO

Viruses have developed different mechanisms to manipulate their hosts, including the process of viral mimicry in which viruses express important host proteins. Until recently, examples of viral mimicry were limited to mimics of growth factors and immunomodulatory proteins. Using a comprehensive bioinformatics approach, we have shown that viruses possess the DNA/RNA with potential to encode 16 different peptides with high sequence similarity to human peptide hormones and metabolically important regulatory proteins. We have characterized one of these families, the viral insulin/IGF-1-like peptides (VILPs), which we identified in four members of the Iridoviridae family. VILPs can bind to human insulin and IGF-1 receptors and stimulate classic postreceptor signaling pathways. Moreover, VILPs can stimulate glucose uptake in vitro and in vivo and stimulate DNA synthesis. DNA sequences of some VILP-carrying viruses have been identified in the human enteric virome. In addition to VILPs, sequences with homology to 15 other peptide hormones or cytokines can be identified in viral DNA/RNA sequences, some with a very high identity to hormones. Recent data by others has identified a peptide that resembles and mimics α-melanocyte-stimulating hormone's anti-inflammatory effects in in vitro and in vivo models. Taken together, these studies reveal novel mechanisms of viral and bacterial pathogenesis in which the microbe can directly target or mimic the host endocrine system. These findings also introduce the concept of a system of microbial hormones that provides new insights into the evolution of peptide hormones, as well as potential new roles of microbial hormones in health and disease.


Assuntos
Interações Hospedeiro-Patógeno/fisiologia , Fator de Crescimento Insulin-Like I/fisiologia , Proteínas Virais/fisiologia , Animais , Endocrinologia , Endotelina-1/fisiologia , Doenças dos Peixes/etiologia , Humanos , Fator de Crescimento Insulin-Like I/química , Proteínas Virais/química
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(6): 346-352, jun.-jul. 2019. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182850

RESUMO

Objetivo: El objetivo de este trabajo es evaluar los cambios en la formación en nutrición clínica y dietética de los residentes de endocrinología y nutrición en los últimos 10 años. Metodología: En el Curso Anual de Actualización en Nutrición Clínica y Dietética que organiza la SEEN se realiza una encuesta de formación a los residentes desde 2006. Se recogen los datos descriptivos de los 10 últimos años. Resultados: Todos los hospitales con docencia acreditada en endocrinología y nutrición disponen de una unidad de nutrición, con dependencia en el 94,5% de los servicios de endocrinología y nutrición. Mientras que en 2006 un 13,3% de residentes necesitaban hacer su rotación en nutrición en otro hospital, en 2018 todos tenían en su hospital recursos suficientes para su formación. Un 62,6% comienzan su formación en nutrición en su tercer año de residencia. La duración de la rotación se ha ido incrementando y está en 6 meses para el 66% de los residentes. Un 41,9% de los residentes considera que su rotación en nutrición debe ser superior a 6 meses. La formación en dietética es la que más consideran que necesitan ampliar. Un 72,5% de los residentes participan en protocolos de estudios o publicaciones, frente a solo un 27,9% en 2009. Existe aún un porcentaje de residentes entre el 10,1 y el 19% que califican como insuficiente su formación global en nutrición. Conclusión: Los residentes consideran que la formación global en nutrición ha mejorado en estos 10 años, aunque aún existen posibilidades de optimización en áreas como dietética


Objective: Our aim is to assess the changes in clinical nutrition and dietetics education of the residents in endocrinology and nutrition for the last 10 years. Methods: During the yearly update course in Clinical Nutrition and Dietetics held by SEEN, a survey about medical training is conducted since 2006. Descriptive data for the last 10 years are reported. Results: Every hospital accredited for medical training in endocrinology and nutrition has a unit of nutrition, depending on endocrinology and nutrition departments in 94.5%. While 13.3% of the residents required a different hospital for training in nutrition in 2006, all of them had enough resources in their own hospital in 2018. The training started in their third year of residency in 62.6%. The rotation has been increasing its length and now it lasts 6 months for 66% of the residents. 41.9% of the residents think it should be longer than 6 months. Education in dietetics should be extended the most. The residents take part in study protocols or publications in 72.5%, against only 27.9% in 2009. There is still a percentage of 10.1% to 19% of the residents grading their training in nutrition as insufficient. Conclusion: The residents consider their global training in nutrition has improved in these last 10 years, although there is still a chance for optimization in areas such as dietetics


Assuntos
Humanos , Internato e Residência , Nutrição em Saúde Pública/educação , Endocrinologia/educação , Dietética/educação
18.
Eur J Endocrinol ; 181(3): P1-P19, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31176307

RESUMO

PARAT, a new European Society of Endocrinology program, aims to identify unmet scientific and educational needs of parathyroid disorders, such as primary hyperparathyroidism (PHPT), including parathyroid cancer (PC), and hypoparathyroidism (HypoPT). The discussions and consensus statements from the first PARAT workshop (September 2018) are reviewed. PHPT has a high prevalence in Western communities, PHPT has a high prevalence in Western communities, yet evidence is sparse concerning the natural history and whether morbidity and long-term outcomes are related to hypercalcemia or plasma PTH concentrations, or both. Cardiovascular mortality and prevalence of low energy fractures are increased, whereas Quality of Life is decreased, although their reversibility by treatment of PHPT has not been convincingly demonstrated. PC is a rare cause of PHPT, with an increasing incidence, and international collaborative studies are required to advance knowledge of the genetic mechanisms, biomarkers for disease activity, and optimal treatments. For example, ~20% of PCs demonstrate high mutational burden, and identifying targetable DNA variations, gene amplifications and gene fusions may facilitate personalized care, such as different forms of immunotherapy or targeted therapy. HypoPT, a designated orphan disease, is associated with a high risk of symptoms and complications. Most cases are secondary to neck surgery. However, there is a need to better understand the relation between disease biomarkers and intellectual function, and to establish the role of PTH in target tissues, as these may facilitate the appropriate use of PTH substitution therapy. Management of parathyroid disorders is challenging, and PARAT has highlighted the need for international transdisciplinary scientific and educational studies in advancing in this field.


Assuntos
Educação/métodos , Endocrinologia/educação , Endocrinologia/métodos , Doenças das Paratireoides/tratamento farmacológico , Sociedades Médicas , Europa (Continente)/epidemiologia , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/tratamento farmacológico , Hiperparatireoidismo Primário/metabolismo , Doenças das Paratireoides/diagnóstico , Doenças das Paratireoides/metabolismo , Hormônio Paratireóideo/uso terapêutico , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/tratamento farmacológico , Neoplasias das Paratireoides/metabolismo
19.
Fertil Steril ; 112(2): 275-282.e1, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31200972

RESUMO

OBJECTIVE: To study the impact of an educational program on the knowledge base of reproductive endocrinology nurses on embryology and genetics topics to determine both improvement in knowledge and confidence in the nurses' ability to counsel patients on such topics. DESIGN: Interventional study. SETTING: Clinics. PATIENT(S): None; subjects were reproductive endocrinology nurses. INTERVENTION(S): Preintervention knowledge self-efficacy test, educational exposure, and 2-week follow-up testing. MAIN OUTCOME MEASURE(S): Knowledge test scores, self-efficacy scores. RESULT(S): Nurses, regardless of educational attainment, demonstrated statistically significant increases in knowledge of both embryology and genetics, which was retained at least 2 weeks after the educational intervention. Furthermore, nurse self-efficacy increased after intervention, and qualitative data support the desire for increased educational opportunities. CONCLUSION(S): Nurses benefit from focused educational efforts, resulting in improved knowledge in embryology and genetics. This improved knowledge base resulted in improved nurse confidence in patient education.


Assuntos
Aconselhamento/educação , Educação em Enfermagem , Embriologia/educação , Testes Genéticos , Conhecimentos, Atitudes e Prática em Saúde , Diagnóstico Pré-Implantação , Adulto , Competência Clínica/normas , Aconselhamento/normas , Educação em Enfermagem/métodos , Educação em Enfermagem/normas , Avaliação Educacional , Endocrinologia/educação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Educação de Enfermagem , Diagnóstico Pré-Implantação/enfermagem , Autoeficácia , Adulto Jovem
20.
Eur J Endocrinol ; 181(2): R73-R105, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31242462

RESUMO

In the currently overwhelming era of polypharmacy, the balance of the dynamic and delicate endocrine system can easily be disturbed by interfering pharmaceutical agents like medications. Drugs can cause endocrine abnormalities via different mechanisms, including direct alteration of hormone production, changes in the regulation of the feedback axis, on hormonal transport, binding and signaling, as well as similar changes to counter-regulatory hormone systems. Furthermore, drugs can interfere with the hormonal assays, leading to erroneous laboratory results that disorientate clinicians from the right diagnosis. The purpose of this review is to cover a contemporary topic, the drug-induced endocrinopathies, which was presented in the monothematic annual Combo Endo Course 2018. This challenging part of endocrinology is constantly expanding particularly during the last decade, with the new oncological therapeutic agents, targeting novel molecular pathways in the process of malignancies. In this new context of drug-induced endocrine disease, clinicians should be aware that drugs can cause endocrine abnormalities via different mechanisms and mimic a variety of clinical scenarios. Therefore, it is extremely important for clinicians not only to promptly recognize drug-induced hormonal and metabolic abnormalities, but also to address the therapeutic issues for timely intervention.


Assuntos
Diabetes Mellitus/metabolismo , Doenças do Sistema Endócrino/induzido quimicamente , Doenças do Sistema Endócrino/patologia , Sistema Endócrino/patologia , Endocrinologia/métodos , Animais , Diabetes Mellitus/diagnóstico , Sistema Endócrino/efeitos dos fármacos , Humanos
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