Guía clínica de manejo de la diabetes insípida y del síndrome de secreción inapropiada de hormona antidiurética en el postoperatorio de la cirugía hipofisaria

Changes in water metabolism and regulation of vasopressin (AVP) or antidiuretic hormone (ADH) are common complications of pituitary surgery. The scarcity of studies comparing different treatment and monitoring strategies for these disorders and the lack of prior clinical guidelines makes it difficult to provide recommendations following a methodology based on grades of evidence. This study reviews the pathophysiology of diabetes insipidus and inappropriate ADH secretion after pituitary surgery, and is intended to serve as a guide for their diagnosis, differential diagnosis, treatment, and monitoring.     

Clínica de la demencia con cuerpos de Lewy y evolución frente a la enfermedad de Alzheimer

Lewy body dementia (LBD) is a neurodegenerative disease with well-defined symptoms and established clinical criteria, characterized by the presence of cortical and subcortical dementia, accompanied by some characteristic features such as Parkinsonism, visual hallucinations and fluctuations in alertness and attention, as well as hypersensitivity to neuroleptics. Compared with Alzheimer's disease, LBD seems to have a more rapid clinical course and greater mortality. The differences with Alzheimer's disease may be more apparent in the initial stages of the disease but tend to disappear with disease progression. Because of the greater presence of neuropsychiatric symptoms and the higher degree of dependency in LBD, there is greater caregiver overload and probably greater resource use.     

Biosíntesis de novo de glicerofosfolípidos y longevidad

Background

The glycerophospholipids, synthesised from diacylglycerol (DAG), are one of the main lipid components of cell membranes. The lipid profile is an optimised feature associated with animal longevity. In this context, the hypothesis is presented that the DAG biosynthesis rate, and thus, the glycerophospholipids content, is related to animal longevity.

Incorporación de la ecografía y la punción de tiroides a la actividad de endocrinología en una consulta de alta resolución

IntroductionFine-needle aspiration biopsy (FNAB) is considered the reference diagnostic procedure for thyroid nodules.Materials and methodsRoutine performance of thyroid ultrasound and ultrasound-guided FNAB by endocrinologists allows a more efficient approach in the setting of a high-resolution practice, thus reducing costs and the time elapsed until diagnosis.ResultsWe present our initial results of this procedure 2 years after its introduction, with a total of 286 biopsies performed. After a progressive learning curve over time and according to the endocrinologists’ previous experience, 72.72% samples were considered satisfactory for diagnosis. Greater difficulty was observed in obtaining optimal cytological specimens in smaller nodules. In conclusion, we have successfully incorporated thyroid ultrasound and ultrasound-guided FNAB into routine endocrine practice.ConclusionRoutine performance of thyroid ultrasound in endocrine practice will considerably aid the management of nodular thyroid disease.     

Fisionomía y sociología de los bosques de Nothofagus dombeyi en la región de Nahuel Huapi

Summary In the mountains around Lake Nahuel Huapi three belts of vegetation can be observed: the evergreen forests of Nothofagus dombeyi between surface level of the lake (ca. 770 m a.s.l.) and 1100–1200 m; the deciduous forests of Nothofagus pumilio; and the Andean-antarctic meadows and other communities above the timberline (±1600 m).A physiognomical study of the evergreen beech forests shows three main types of structure, one of which coincides with a quite different floristical composition.Detailed phytosociological work following the method of Braun-Blanquet is proving the floristical relationship between the deciduous forests of Nothofagus pumilio or N. antarctica and the main part of the evergreen patagonical forests of Nothofagus dombeyi, especially when austrocedrus chilensis is present. Besides other units, there has therefore been established a new alliance, Austrocedro-Nothofagion, belonging to the Nothofagetalia pumilionis-dombeyi as an order of the Nothofagetea pumilionis-antarcticae Oberd. 1960.Only a few stands in the extreme West of Argentine territory present the characteristics of the Nothofago-Winterion Oberd., which is an alliance of the Wintero-Nothofagetea Oberd., and corresponds to the forêt valdivienne of phytogeographical literature.Comment has been made on the theoretical bases of systematics, considering that in certain cases the forest communities studied demonstrate what some ecologists think to be a continuum of vegetation.     

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición

IntroductionWaist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115 cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men.ConclusionWC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik     

Guía de práctica clínica para el diagnóstico y tratamiento de la apoplejía hipofisaria

Classic pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland. PA is considered a neuroendocrinological emergency. However, there is no consensus about the best options for PA diagnosis and management.ObjectiveTo develop a clinical practice guideline with a number of recommendations for diagnosis and treatment of patients with PA based on the medical evidence available, in order to help clinicians involved in their care.MethodsThe clinical guideline for diagnosis and treatment of pituitary apoplexy issued in 2006 by the Neuroendocrinology Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and the British Clinical Practice Guideline published in 2011 were taken as the basis. The text has been adapted to the format used in most international medical journals. For this, after updated medical literature, the quality of evidence and the strength of the recommendations were evaluated using the system proposed by the Agency for Health Care Policy and Research (AHCPR).ConclusionsDiagnosis of pituitary apoplexy should be considered in all patients with acute severe headache with or without neuro-ophthalmic signs. Patients with PA must undergo a complete history and physical examination. All patients with suspected pituitary apoplexy should have urgent blood samples drawn to test electrolytes, renal function, liver function, coagulation screen, complete blood count, and basal levels of pituitary and peripheral hormones, and to rule out adrenocorticotropic hormone (ACTH) deficiency. Formal visual field assessment should be performed when the patient is clinically stable. Magnetic resonance imaging (MRI) is the imaging test of choice to confirm diagnosis. Indications for empirical urgent corticosteroid therapy in patients with PA include hemodynamic instability, impaired consciousness, reduced visual acuity, and severe visual field defects. In patients with these severe neuro-ophthalmic signs, surgery should be considered. Surgery should preferably be performed within seven days of the onset of symptoms. Patients with mild and stable signs may be managed conservatively with careful monitoring. Treatment and long-term follow-up of patients with PA should be conducted by a multidisciplinary team consisting, amongst others, of an experienced pituitary neurosurgeon, an ophthalmologist, and an endocrinologist.     

Mujeres mayores de 65 años que realizan ejercicio físico supervisado: diferencias en la capacidad física,la actividad física y la calidad de vida en función de su velocidad de la marcha

IntroductionWalking speed (WS) is an easy, quick and inexpensive measure that could be used to discern between older people with greater and lesser function and thus individualize physical exercise programs.ObjectivesTo analyze the differences in physical capacity, physical activity, and quality of life in people over 65 years of age who attended a physical exercise program according to their WS and age.Methods55 women (mean age: 76.67 ± 6.66 years) were divided into groups based on their WS (low WS: ≤ 1.59 m/s and high WS: > 1.59 m/s) and age (older-younger: ≤ 76 years and older-older: > 76 years). The following parameters were compared: 10 Meters Walk Test (10MWT), Arm Curl Test, Handgrip, Chair Stand Test, 8 Foot Up and Go Test (8FUG), 6 Minute Walk Test (6MWT), and the Minnesota and The Short Form-36 Health Survey (SF-36) questionnaires.ResultsThe level of physical activity was higher than 3000 METs/week in all groups. The high WS group had better results in the Arm Curl Test, 10MWT, 8FUG and 6MWT and in the Physical Role and Vitality dimensions of the SF-36 (P < .05). The older-older group had lower weight, BMI and Handgrip (P < .01).ConclusionsThe best results in physical capacity and quality of life are in those women with higher WS, suggesting that WS could be useful to individualize physical exercise programs.