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2.
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
4.
Eur J Endocrinol ; 181(1): R1-R10, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31048562

RESUMO

Neuroendocrine neoplasms (NENs) are traditionally considered as a single group of rare malignancies that originate from the highly spread neuroendocrine system. The clinical management is complex due to the high heterogeneity of these neoplasms in terms of clinical aggressiveness and response to the therapy. Indeed, a multidisciplinary approach is required to reach a personalization of the therapy, including cancer rehabilitation. In this review, we discuss the possibility to adopt a precision medicine (PM) approach in the management of NENs. To this purpose, we summarize current knowledge and future perspectives about biomarkers and preclinical in vitro and in vivo platforms, potentially useful to inform clinicians about the prognosis and for tailoring therapy in patients with NENs. This approach may represent a breakthrough in the therapy and tertiary prevention of these tumors.


Assuntos
Endocrinologia/tendências , Tumores Neuroendócrinos/terapia , Medicina de Precisão/tendências , Previsões , Humanos , Equipe de Assistência ao Paciente/tendências
5.
Intern Med J ; 49(5): 669-671, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31083806

RESUMO

Over careers spanning 35 years each, we have witnessed great advances in medicine especially in genetics, imaging, immunotherapies and targeted cancer therapies. Our respective specialties of endocrinology and medical oncology have come to overlap significantly necessitating better communication and skills across both specialties. We will highlight common scenarios that straddle endocrinology and medical oncology. The same broad issues apply to other closely related specialties, albeit with different clinical challenges. At present, we see expensive and inefficient cross-referrals to other subspecialists or sometimes no referral at all, leading to significant clinical omissions. Opportunities for dual advanced training, or for more comprehensive single advanced training could more efficiently lead to enhanced patient care and communication.


Assuntos
Certificação , Endocrinologia/educação , Oncologia/educação , Encaminhamento e Consulta , Escolha da Profissão , Certificação/normas , Certificação/tendências , Endocrinologia/normas , Endocrinologia/tendências , Humanos , Oncologia/normas , Oncologia/tendências , Medicina/normas , Medicina/tendências , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/tendências
6.
Drugs ; 79(9): 935-956, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31098899

RESUMO

Endogenous Cushing's syndrome is a chronic disease associated with increased morbidity and mortality if not appropriately treated. Recurrence and/or persistence of hypercortisolemia after surgical treatment, especially for Cushing's disease, are high, and long-term medical treatment is used to decrease cortisol levels and risk of metabolic comorbidities. Medical treatment is also often required while waiting for radiation effects to take place. In some cases, severe or life-threatening hypercortisolism must be urgently and medically treated, via intravenous medications or with combination therapy, before patients can undergo surgery. In the last decade, medical treatment has progressed from a few steroidogenesis inhibitors to three novel drug groups: new inhibitors for steroidogenic enzymes with possibly fewer side effects, pituitary-directed drugs that aim to inhibit the pathophysiological pathways of Cushing's disease, and glucocorticoid receptor antagonists that block cortisol's action. Understanding the pathophysiology of Cushing's syndrome has also led to the identification of potential targets that may decrease adrenocorticotrophic hormone and/or cortisol excess, and/or decrease tumor cell proliferation, and induce senescence or apoptosis. We provide here a review of current and near-future medical options to treat Cushing's syndrome, and discuss updates on clinical trials and the efficacy and safety of novel or in-development drugs, as well as future potential targets.


Assuntos
Hormônio Adrenocorticotrópico/antagonistas & inibidores , Síndrome de Cushing/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Hidrocortisona/biossíntese , Receptores de Glucocorticoides/antagonistas & inibidores , Ensaios Clínicos como Assunto , Síndrome de Cushing/metabolismo , Quimioterapia Combinada , Endocrinologia/métodos , Endocrinologia/tendências , Inibidores Enzimáticos/farmacologia , Humanos , Hipófise/efeitos dos fármacos , Hipófise/metabolismo , Receptores de Glucocorticoides/metabolismo , Resultado do Tratamento
7.
Endocrinol Diabetes Nutr ; 66(5): 291-296, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30971387

RESUMO

INTRODUCTION: In Spain, the system used to select a medical specialty is the MIR (internal resident physician) exam. The MIR selection number may reflect the interest in a given specialty. Our study objective was to confirm the increase in the selection number and to analyze possible factors influencing the decision. MATERIAL AND METHOD: To analyze change over time in the MIR number with which this specialty is chosen and to compare it with other related specialties, as well as the reasons why it is preferred using an anonymous survey to 108 MIRs of endocrinology. RESULTS: The average number of MIR for Endocrinology and Nutrition has gradually increased to 2336 in year 2018, a trend that coincides with an increase in the number of places offered but is more marked as compared to other medical specialties. Respondents weighed different factors when choosing specialty. When asked about the most positive aspects of the specialty, the highest rated was that day to day activity was "less intense". The most commonly mentioned negative aspect was the low number of techniques. When asked if the specialty had met their expectations, respondents gave an average score of 8.7, although the perceived prestige of the specialty scored only 6.7 points. CONCLUSIONS: There is an obvious deterioration of the MIR selection number of our specialty that it is not so marked in other specialties.


Assuntos
Escolha da Profissão , Endocrinologia/tendências , Ciências da Nutrição/tendências , Cardiologia , Estudos Transversais , Endocrinologia/estatística & dados numéricos , Gastroenterologia , Humanos , Medicina Interna , Internato e Residência , Ciências da Nutrição/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Inquéritos e Questionários
9.
Rev. cuba. salud pública ; 45(1)ene.-mar. 2019.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-991132

RESUMO

El objetivo de este artículo es plantear algunas consideraciones que justifican una periodización histórica de la endocrinología en nuestro país, para lo que se tuvieron en cuenta los hitos o hechos con especial significado para esta especialidad médica. Se utilizó el método histórico-lógico, apoyado en la técnica de revisión documental y la entrevista no estructurada en profundidad, la que se aplicó a profesionales vinculados al desarrollo de la endocrinología en nuestro país. Se establecen tres periodos históricos de la endocrinología en Cuba: Periodo de la preendocrinología (1813-1922), donde aparecieron las primeras descripciones de enfermedades endocrinas como el hermafroditismo, galactorrea, ginecomastia, bocio, acromegalia, diabetes mellitus y otras; Periodo de inicio de la endocrinología (1923-1965), caracterizado por la introducción de la insulina en la práctica clínica y el incremento de los aportes a la literatura científica nacional e internacional, la creación de Sociedad Cubana de Endocrinología y su órgano oficial, Acta Endocrinológica Cubana; y, finalmente, Periodo de consolidación y desarrollo de la endocrinología (1966-actualidad), el que se establece con la creación del Instituto de Endocrinología y Enfermedades Metabólicas, pues con su apertura la especialidad comienza su verdadero progreso en las áreas de la investigación, docencia y asistencia. Se concluye, que teniendo en cuenta los hitos o hechos con especial significado para la endocrinología en el territorio nacional, es posible plantear una periodización histórica de esta especialidad médica(AU)


The objective of this article is to present some considerations that justify a historical periodization of Endocrinology in our country taking into account the landmarks and events with special significance for this medical specialty. The historical-logical method was used, supported by the technique of documentary review and in depth's unstructured interview to professionals linked to the development of Endocrinology in our country. Three historical periods of Endocrinology are established in Cuba: Period of Pre-endocrinology (1813-1922), where the first descriptions of endocrine diseases such as hermaphroditism, galactorrhea, gynecomastia, goiter, acromegaly, diabetes mellitus and others appeared; Period of onset of Endocrinology (1923-1965), that was characterized by the introduction of insulin in clinical practice and the increase of contributions to national and international scientific literature, the creation of the Cuban Society of Endocrinology and its official media the Cuban Endocrinological Act; and finally, Endocrinology's consolidation and development period (1966-present), that is established with the creation of the Institute of Endocrinology and Metabolic Diseases. With this last milestone, Endocrinology in Cuba begins its real progress in the areas of research, teaching and care. It is concluded that taking into account the milestones or events with special significance for Endocrinology in our country, it is possible to propose a historical periodization of this medical specialty(AU)


Assuntos
Humanos , Endocrinologia/história , Endocrinologia/tendências , Cuba
10.
Rev. cuba. salud pública ; 45(1)ene.-mar. 2019.
Artigo em Espanhol | CUMED | ID: cum-73443

RESUMO

El objetivo de este artículo es plantear algunas consideraciones que justifican una periodización histórica de la endocrinología en nuestro país, para lo que se tuvieron en cuenta los hitos o hechos con especial significado para esta especialidad médica. Se utilizó el método histórico-lógico, apoyado en la técnica de revisión documental y la entrevista no estructurada en profundidad, la que se aplicó a profesionales vinculados al desarrollo de la endocrinología en nuestro país. Se establecen tres periodos históricos de la endocrinología en Cuba: Periodo de la preendocrinología (1813-1922), donde aparecieron las primeras descripciones de enfermedades endocrinas como el hermafroditismo, galactorrea, ginecomastia, bocio, acromegalia, diabetes mellitus y otras; Periodo de inicio de la endocrinología (1923-1965), caracterizado por la introducción de la insulina en la práctica clínica y el incremento de los aportes a la literatura científica nacional e internacional, la creación de Sociedad Cubana de Endocrinología y su órgano oficial, Acta Endocrinológica Cubana; y, finalmente, Periodo de consolidación y desarrollo de la endocrinología (1966-actualidad), el que se establece con la creación del Instituto de Endocrinología y Enfermedades Metabólicas, pues con su apertura la especialidad comienza su verdadero progreso en las áreas de la investigación, docencia y asistencia. Se concluye, que teniendo en cuenta los hitos o hechos con especial significado para la endocrinología en el territorio nacional, es posible plantear una periodización histórica de esta especialidad médica(AU)


The objective of this article is to present some considerations that justify a historical periodization of Endocrinology in our country taking into account the landmarks and events with special significance for this medical specialty. The historical-logical method was used, supported by the technique of documentary review and in depth's unstructured interview to professionals linked to the development of Endocrinology in our country. Three historical periods of Endocrinology are established in Cuba: Period of Pre-endocrinology (1813-1922), where the first descriptions of endocrine diseases such as hermaphroditism, galactorrhea, gynecomastia, goiter, acromegaly, diabetes mellitus and others appeared; Period of onset of Endocrinology (1923-1965), that was characterized by the introduction of insulin in clinical practice and the increase of contributions to national and international scientific literature, the creation of the Cuban Society of Endocrinology and its official media the Cuban Endocrinological Act; and finally, Endocrinology's consolidation and development period (1966-present), that is established with the creation of the Institute of Endocrinology and Metabolic Diseases. With this last milestone, Endocrinology in Cuba begins its real progress in the areas of research, teaching and care. It is concluded that taking into account the milestones or events with special significance for Endocrinology in our country, it is possible to propose a historical periodization of this medical specialty(AU)


Assuntos
Humanos , Endocrinologia/história , Endocrinologia/tendências , Cuba
11.
Adv Anat Pathol ; 26(3): 198-209, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30730313

RESUMO

Significant advances in genomics and molecular genetics in recent years have reshaped the practice of endocrine pathology. Pan-genomic studies, including the pioneering ones on papillary thyroid carcinoma, phaeochromocytoma/paraganglioma, and adrenal cortical carcinoma from the Cancer Genome Atlas (TCGA) project, provided a comprehensive integrated genomic analysis of endocrine tumors into distinct molecularly defined subtypes. Better understanding of the molecular landscape and more accurate definition of biological behavior has been accordingly achieved. Nevertheless, how any of these advances are translated into routine practice still remains a challenge in the era of precision medicine. The challenge for modern pathology is to keep up the pace with scientific discoveries by integrating novel concepts in tumor classification, molecular genetics, prognostication, and theranostics. As an example, pathology plays a role in the identification of hereditary disease, while it offers the tools for complementing molecular genetics, for example, validation of variants of unknown significance deriving from targeted sequencing or whole exome/genome sequencing approach. Immunohistochemistry has arisen as a cost-effective strategy in the evaluation either of somatic mutations in tumors and/or germline mutations in patients with familial cancer syndromes. Herein, a comprehensive review focusing on novel and emerging biomarkers is presented in order pathologists and other endocrine-related specialists to remain updated and become aware of potential pitfalls and limitations in the field of endocrine pathology.


Assuntos
Biomarcadores Tumorais , Endocrinologia/tendências , Patologia/tendências , Humanos
12.
Diabetes Care ; 42(3): 352-358, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30787058

RESUMO

This address was delivered by Felicia Hill-Briggs, PhD, ABPP, President, Health Care & Education of the American Diabetes Association (ADA) at the ADA's 78th Scientific Sessions in Orlando, FL, on 23 June 2018. Diabetes has become a high-priority condition in the current era of health care transformation due to diabetes and prediabetes prevalence rates, suboptimal diabetes outcomes at the health care system and population levels, and high health care and public health costs attributed to diabetes. Population health is the path forward for the ADA to facilitate diabetes health care and public health improvement nationally. Population health management initiatives underway at the ADA include Diabetes INSIDE for health care systems and a Mental Health Provider Training Program and referral directory. Population health improvement initiatives include the prediabetes Risk Test Campaign, National Diabetes Prevention Program (DPP) dissemination in underserved states and populations, a DPP Express information technology platform, and a social determinants of health scientific review and recommendations. Dr. Hill-Briggs is a professor of medicine; physical medicine and rehabilitation; health, behavior, and society; and acute and chronic care at Johns Hopkins University in Baltimore, MD. She is a core faculty member of the Welch Center for Prevention, Epidemiology & Clinical Research and colead of behavioral, social, and systems science for the Johns Hopkins Institute for Clinical and Translational Research. Dr. Hill-Briggs has been elected to the National Academy of Medicine of The National Academies of Science, Engineering, and Medicine and is the 2018 recipient of the Rachmiel Levine Medal for Leadership from the ADA.


Assuntos
Diabetes Mellitus , Endocrinologia , Administração em Saúde Pública/tendências , Qualidade da Assistência à Saúde/tendências , Sociedades Médicas , Distinções e Prêmios , Pesquisa Biomédica/organização & administração , Pesquisa Biomédica/normas , Pesquisa Biomédica/tendências , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Endocrinologia/métodos , Endocrinologia/organização & administração , Endocrinologia/tendências , Humanos , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/terapia , Saúde Pública/métodos , Saúde Pública/tendências , Administração em Saúde Pública/normas , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Estados Unidos
13.
Artigo em Inglês | MEDLINE | ID: mdl-30621568

RESUMO

BACKGROUND AND OBJECTIVE: Cardiovascular disease is the most important cause of morbidity and mortality worldwide, with a significant economic burden, which is expected to increase in the next years. Alongside the management of cardiac manifestations and major risk factors for atherosclerosis, great attention has been paid to the role of comorbidities in initiating and worsening cardiac conditions. DISCUSSION: The cardiovascular impact of a broad spectrum of endocrine disorders has been evaluated, with particular regard to their effects on cardiac function and cardiovascular prognosis in affected patients. Among the different endocrine conditions considered, the association between subclinical hypothyroidism and cardiovascular events is still uncertain. A number of observational studies have linked subclinical hypothyroidism (in particular severe elevation of TSH levels) with incident cardiovascular disease and poor prognosis, however thyroid replacement therapy is still controversial, especially in the elderly, due to the lack of evidence coming from randomized controlled trials. With regards to testosterone deficiency, even though it has been associated with metabolic abnormalities and poor prognosis in patients affected by cardiovascular diseases, the cardiac safety of replacement therapy has still to be completely clarified. Similarly, growth hormone deficiency showed detrimental effects on cardiovascular events and risk factors which seem to be reverted by replacement therapy, even if unequivocal evidence from randomized clinical trials is still lacking Another relevant chapter in cardiovascular disease management is about the cardiovascular outcomes of diabetes medical treatments. In recent years, a growing interest has been developed around the cardiovascular safety of antidiabetic medications which has led to a great number of publications addressing this issue for the different classes of antidiabetic drugs. Interestingly, the recently approved classes, i.e. incretins and SGLT-2 inhibitors, have additionally demonstrated a protective effect against major cardiovascular events, shedding new light on the management of diabetes in patients affected by cardiovascular disease. CONCLUSION: Important controversies still exist regarding the cardiac implications of the therapies adopted in endocrine diseases. Owing the large prevalence of these conditions, particularly in the cardiovascular population, further research is awaited in order to clarify the potential advantage and the possible cardiac risk related to treatment of the endocrine comorbidities.


Assuntos
Doenças Cardiovasculares/terapia , Doenças do Sistema Endócrino/terapia , Endocrinologia/tendências , Terapias em Estudo/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/efeitos dos fármacos , Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Doenças do Sistema Endócrino/complicações , Doenças do Sistema Endócrino/epidemiologia , Endocrinologia/métodos , Humanos , Hipoglicemiantes/uso terapêutico , Hipotireoidismo/complicações , Hipotireoidismo/epidemiologia , Hipotireoidismo/terapia , Fatores de Risco , Terapias em Estudo/métodos
16.
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