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Saig I.,Servicio de Endocrinologia y Nutricion | Prez A.,CIBER ISCIII
Revista Clinica Espanola

Glucocorticoid-induced hyperglycemia is a frequent problem. In the general clinical practice, it may generate hospital admissions, their prolongation and repeated emergency visits without obtaining an adequate solution to the problem. Even so, this problem continues to be undervalued in terms of diagnosis, and especially, treatment. The diversity of preparations and dosing schedules of corticosteroids, and above all, the low level of involvement by the professionals who prescribe steroids and the absence of clinical studies and specific recommendations for diagnosis and treatment, contribute to this. In this paper we review the pathophysiology of glucocorticoid-induced hyperglycemia and propose some strategies for their management, based on the clinical situation and the predictable pattern of hyperglycemia according to the type and schedule of glucocorticoids administration. © 2009 ElsevierEspaña, S.L.Todoslosderechosreservados. Source

Modulation of the incretin effect has opened up a new strategy in the treatment of diabetes mellitus type 2 (DM2). To date, this physiological mechanism has been boosted in two ways: firstly, by pharmacological inhibition of the enzyme that physiologically degrades glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP4); secondly, through the development of GLP-1 agonists (GLP-1a) that are resistant to the action of DPP-4. Several clinical trials have shown the clinical superiority of GLPa, which seems to be linked to higher circulating levels of GLP-1. On the other hand, this higher efficacy also seems to be associated with the higher rate of adverse effects associated with aGLP-1 therapy compared with DPP-4 inhibition. These and other differentiating characteristics of the two drug families will determine the choice of drug therapy in the personalized treatment of hyperglycemia in patients with DM2. Copyright © 2014 Elsevier España, S.L.U. All rights reserved. Source

Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements. © 2013 SEEN. Source

Vicente A.,Servicio de Endocrinologia y Nutricion | Lecumberri B.,Hospital Universitario La Paz | Galvez M.T.,Hospital Universitario Reina Sofia Of Cordoba
Endocrinologia y Nutricion

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. Objective: To 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. Methods: The 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). Conclusions: Diagnosis 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. © 2012 SEEN. Source

Santonja F.-J.,University of Valencia | Morales A.,Servicio de Endocrinologia y Nutricion | Villanueva R.-J.,Polytechnic University of Valencia | Cortes J.-C.,Polytechnic University of Valencia
Evaluation and Program Planning

Excess weight is fast becoming a serious health concern in the developed and developing world. The concern of the public health sector has lead to the development of public health campaigns, focusing on two-fold goals: to inform the public as to the health risks inherent in being overweight, and the benefits of a change in nutritional behaviour. Recent studies indicate that the effects of the average public health campaign on the target community is around 5%. In this study we aim to quantify the effect of different public health campaigns on lifestyle behaviour in the target populations in order to bring about weightloss in a significant number of people over the next few years. This study is based on recent works that consider excess weight as a consequence of the transmission of unhealthy lifestyles from one individual to another. Following this point of view, first a mathematical model is presented. Then, policies based on public health campaigns addressed to stop people gaining weight (prevention; this type of policy acts on individuals in order to maintain their weight and to stop an increase in weight) and, policies addressed to overweight individuals to reduce their weight (treatment; these campaigns act on overweight and/or obese individuals in order to reduce their weight) are simulated in order to evaluate their effectiveness. The study concludes that combination of preventive plus treatment campaigns are more effective than considering them separately. © 2011 Elsevier Ltd. Source

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