BACKGROUND:Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease and is closely associated with type 2 diabetes mellitus (T2DM) and obesity. However, it continues to have limited clinical visibility outside the field of Hepatology. OBJECTIVE:To evaluate knowledge, liver fibrosis screening practices, and perceived barriers related to MASLD among endocrinologists in Spain. MATERIALS AND METHODS:An exploratory cross-sectional observational study was conducted using an online survey promoted by the MASLD Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and addressed to all society members. A total of 210 anonymized surveys were analyzed, collecting information on: liver fibrosis screening in patients with T2DM and/or obesity, diagnostic tools used, availability of clinical protocols, access to liver elastography, and the main barriers to MASLD management. A descriptive analysis of the results was performed. RESULTS:Approximately half of the endocrinologists reported performing liver fibrosis screening in patients with T2DM or obesity. FIB-4 was the most frequently used screening tool (78.4%), although automated calculation was available in only 60.8% of centers. Lack of time, insufficient training, and limited protocol availability (31.6%) were identified as the main barriers, and direct access to elastography from Endocrinology departments was limited. CONCLUSIONS:This exploratory study shows that MASLD is not yet fully integrated into endocrinology practice in Spain. The lack of systematic screening, together with organisational and educational barriers, limits the early detection of hepatic fibrosis in high-risk populations. Strengthening awareness, training, and protocol development is necessary to integrate liver health into the comprehensive management of patients with metabolic disease.
INTRODUCTION:Hematologic neoplasms (lymphomas, leukemias, and myelomas) represent approximately 10% of all tumors. Antineoplastic treatments, including chemotherapy, targeted therapies, and immunotherapy, generate gastrointestinal toxicity that impacts therapeutic efficacy and nutritional status, establishing a vicious cycle of malnutrition and toxicity. MATERIALS AND METHODS:A narrative review was conducted using a literature search of the electronic databases PubMed, Embase, UpToDate, and Medscape for chemotherapy, targeted therapies, and immunotherapy used in lymphomas, leukemias, and multiple myeloma. The frequencies of gastrointestinal adverse effects (diarrhea, nausea/vomiting, mucositis), as well as those of grade ≥3, were analyzed. RESULTS:The results are presented in tables showing the commonly used drugs along with the probability of experiencing gastrointestinal adverse effects. In acute lymphoblastic leukemia, therapies such as Tisa-Cel and Brexu-Cel, with or without cytotoxic agents, cause gastrointestinal toxicity in almost all patients. In acute myeloid leukemia, most drugs produce nausea and vomiting, while diarrhea and mucositis are less frequent (30%). In chronic lymphocytic leukemia, diarrhea is prominent with targeted therapies (ibrutinib [42%], idelalisib [47%]). In chronic myeloid leukemia, bosutinib causes the highest rate of gastrointestinal intolerance (68%). In non-Hodgkin lymphoma, most combinations induce nausea/vomiting (>90%). Regarding multiple myeloma, gastrointestinal effects are generally low, with the exception of some immunotherapies (selinexor, elranatamab, elotuzumab). DISCUSSION:Diarrhea, nausea, vomiting, and mucositis are common complications, with diverse mechanisms depending on the drug. These toxicities directly impact nutritional status and quality of life, potentially requiring modifications to treatments. CONCLUSIONS:Understanding the frequency and severity of gastrointestinal side effects of drugs used to treat hematological malignancies can facilitate early diagnosis and medical-nutritional management, which can be key to reducing malnutrition and improving clinical outcomes in hematological tumors.
INTRODUCTION:Diabetes mellitus is currently a major health care priority due to its high prevalence, complexity, and associated morbidity and mortality. The organization of care for type 2 diabetes mellitus (T2DM) is essential to deliver high-quality care aimed at optimizing clinical outcomes. However, the effectiveness of different health care delivery models remains under evaluation. MATERIALS AND METHODS:The MEDEA project was a multicenter, quasi-experimental study that assessed three different models of care for T2DM. The comparison groups consisted of an intensive intervention group, a moderate intervention group, and the remainder of the health care system as a control group. The groups differed according to the degree of hospital-based specialist involvement in primary care. Based on electronic health record data, at-risk patients were identified according to predefined criteria: poor metabolic control (HbA1c >8%), inadequate lipid control (LDL > 100 mg/dL), and risk of hypoglycemia in older adults (patients older than 75 years with HbA1c <7% receiving potentially hypoglycemia-inducing treatments). Outcomes were measured as the percentage of patients achieving targets across these three domains. RESULTS:No significant differences were observed in mean HbA1c at baseline and at the end of the study among the three intervention groups. However, the proportion of patients achieving HbA1c <8% increased significantly in the intensive intervention group (17.9%) compared with the moderate intervention and control groups. A total of 3,513 patients were included in the intensive intervention group. In the centers belonging to this group (CS1 and CS2), the target HbA1c <8% was achieved in 56.9% and 68.02% of patients, respectively. Regarding deprescribing, pharmacological withdrawal was achieved in 41.9% and 26.9% of eligible patients in CS1 and CS2, respectively. There was a significant increase in the number of patients treated with more than one oral antidiabetic drug (P < 0.001), with increased use of DPP-4 inhibitors (P = 0.000) and SGLT2 inhibitors (P = 0.002). A reduction in basal-bolus insulin therapy was observed (P = 0.01), alongside an increase in the proportion of patients treated with basal insulin analogs (P = 0.01). CONCLUSIONS:Intensive intervention leads to improved health outcomes in patients with diabetes and is clearly superior to on-demand intervention, which does not demonstrate improvements compared with routine clinical practice. Centralized data more closely reflect the reality of individual centers and enable the identification of at-risk patient groups; however, health records lack specificity and require individualized validation, data cleaning, and clinical contextualization to ensure that analyses accurately represent real-world practice. Mean HbA1c may not be an optimal parameter for assessing intervention impact due to its population distribution. The proportion of patients with HbA1c >8% decreased significantly following coordinated intervention combined with structured external planning and monitoring. Therapeutic inertia also affects deprescribing in older patients; targeted interventions facilitate the withdrawal of potentially hypoglycemia-inducing treatments in vulnerable populations.
Neuroendocrine tumors of the gallbladder are included among neuroendocrine tumors of uncommon location. Because they are non-functioning tumors, they usually do not produce symptoms and are often discovered at advanced stages. Their main differential diagnosis, due to gallbladder wall thickening, is acute cholecystitis. If imaging findings do not improve despite appropriate treatment, this entity should be considered in the differential diagnosis to achieve early treatment. Histopathological examination is the key to diagnosis. Small-cell neuroendocrine tumors with a high Ki-67 index have a poor prognosis and high short-term morbidity and mortality.
BACKGROUND:Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in pediatric patients with type 1 diabetes mellitus (T1DM). The objectives of this study were to analyze the incidence of DKA at the time of T1DM diagnosis and to evaluate changes in its presentation over recent years. We also assessed whether a family history of T1DM or specific HLA haplotypes influenced the incidence of DKA at diagnosis. MATERIALS AND METHODS:We conducted a descriptive, observational, and retrospective study of all patients younger than 14 years diagnosed with T1DM at a tertiary referral center from from 2017 through 2024. Data collected included age at onset, sex, date of diagnosis, and initial laboratory values. Data were, then, grouped into 2 periods of time (2017-2020; 2020-2024) for comparison purposes. RESULTS:A total of 85 patients were included (41 women), with a mean age at diagnosis of 7.9 years. DKA at disease onset was observed in 29 patients (34.1%), including 15 cases (17.6%) classified as severe. Mean C-peptide level was 0.8 ng/mL, mean plasma glucose level was 423 mg/dL, and mean hemoglobin A1c level was 11.1%. Between 2017 and 2020, 37 new diagnoses were established, 37.8% with DKA (13.5% severe) and from 2021 to 2024, 48, 31.2% with DKA (20.8% severe). A total of 12 patients had first-degree relatives with T1DM, and 0 exhibited DKA (P < .05). No significant associations were found between HLA haplotypes and the incidence rate of DKA. CONCLUSIONS:The prevalence of DKA at diagnosis was similar to that reported in other Spanish studies. Having a family history of T1DM seems to be a protective factor against the development of DKA. No significant association was found between HLA haplotypes and DKA prevalence.
Introduction Obesity in women of reproductive age is a significant risk factor for infertility. Current treatment strategies primarily focus on weight reduction through lifestyle modifications, pharmacological interventions, or surgical procedures. However, there is still a lack of consensus on the most effective approach. Moreover, such interventions have limited effectiveness in maintaining WL and optimizing assisted reproduction results following assisted reproductive techniques, which may lead to stigmatization and negative experiences for patients.Although qualitative evidence regarding preconception and gestational stages has increased, literature specifically addressing women who simultaneously present obesity and infertility, as well as the impact of these conditions on their physical and emotional well-being, remains limited. Aim To explore the care trajectory of women with obesity and infertility. Methods We designed a mixed-methods study involving 10 health care professionals, a focus group and a co-creation workshop with 6 and 8 patients respectively, and an online survey was administered and completed by 33 out of a total of 150 women with obesity and reproductive pathology who were invited to participate (response rate 22%). Results While some aspects of preconception care were positively evaluated, the overall patient journey is complex. We identified four areas for improvement: providing personalized information, offering stigma-free emotional support, ensuring efficient time management, and promoting shared decision-making. Conclusions A comprehensive, multidisciplinary approach emerges as a key element to optimize care and enhance the experience of these women.
OBJECTIVES:To describe the clinical and sociodemographic characteristics of people aged 65 years or older with type 2 diabetes mellitus, estimate the prevalence of frailty, and explore its association with metabolic control and pharmacological regimens used. METHODS:We conducted a cross-sectional study with consecutive sampling of patients, active members of an integrated health service network in Argentina as of March 1st, 2022. Frailty was assessed using the Electronic Screening Index of Frailty, considering frail those with ≥ 9 coded clinical conditions. Glycemic control was defined according to individualized HbA1c goals (<7% non-frail, <8% frail), and overtreatment as the use of drugs with a high risk of hypoglycemia (insulin, sulfonylureas, and/or glinides) in patients at goal. RESULTS:A total of 5,937 individuals (mean age, 78 years; 20% older than 85 years) were included. Hypertension and dyslipidemia were the most prevalent comorbidities, and 68% had polypharmacy. Frailty was 8.92% (95%CI, 8.21-9.68), doubling in individuals older than 85 years. Frail patients had more chronic complications and achieved glycemic goals more frequently (57% vs 42%), but at the expense of greater use of risky drugs (37% vs 20%) and overtreatment (23.7% vs 5.9%; aOR, 5.00; 95%CI, 3.88-6.45). CONCLUSIONS:Frailty was associated with a higher risk of overtreatment. It is essential to implement individualized management strategies, deprescribing, and adjusting goals according to functional status. Based on this real-world evidence, we seek to contribute elements for a critical review of current policies and strategies in Latin America.
Solitary fibrous tumor (SFT) is a type of fibroblastic neoplasm with characteristic histological features, typically showing cytoplasmic expression of CD34 and nuclear expression of STAT6, associated with NAB2-STAT6 gene fusion. Thyroid localization is exceptionally rare, with only 51 cases reported worldwide to date. Its behavior in the thyroid is generally benign, although it may exhibit rapid growth, and its treatment is primarily surgical. The NAB2-STAT6 gene fusion, detected by immunohistochemistry, is pathognomonic for SFT. As exemplified in the present case, core needle biopsy (CNB) is more likely to provide sufficient material for microscopic, immunohistochemical, and other diagnostic techniques.
INTRODUCTION:Malnutrition, sarcopenia and sarcopenic obesity have a significant impact on patients with heart failure. Therefore, it is important to perform nutritional assessment in this group of patients. The aim of this study is to determine the prevalence of malnutrition, sarcopenia and sarcopenic obesity in patients with heart failure, assess their quality of life, and eventually reassess their nutritional status. METHODOLOGY:We conducted an observational study of patients with heart failure randomly referred by thecCardiology department and examined from 2021 through 2022 in the Nutrition department and then re-evaluated in 2024. The diagnosis of malnutrition was established using the GLIM criteria; sarcopenia was diagnosed according to EWGSOP2, and sarcopenic obesity according to the ESPEN/EASO criteria. RESULTS:A total of 41 patients were evaluated between 2021 and 2022, of whom 23 were re-evaluated in 2024. A total of 82.6% were men (mean age, 64 yeras [SD, 10.6]). Initially the prevalence of malnutrition was 21.7%; sarcopenia, 8.7%; and sarcopenic obesity, 4.3%. Caloric and protein requirements were not reached in 63.2% and 47.4%, respectively. A total of 26.1% of patients had a low calf circumference (CC) value; 100% had low lower limb strength, 90.9% had low gait speed, and 50% had low stability. All patients (100%) had a good quality of life as assessed by the MLHFQ questionnaire. At reassessment, the prevalence of malnutrition was 21.7%; sarcopenia, 17.4%; and sarcopenic obesity, 8.7%. Caloric and protein requirements were not reached in 60.9% and 78.3%, respectively. Furthermore, 52.2% had low CC value, 100% had low lower limb strength, 91.3% had low speed and 43.5% had low stability. A total of 91.3% had a good quality of life as assessed by the MLHFQ questionnaire. CONCLUSIONS:Approximately 20% of patients with heart failure exhibit malnutrition at initial assessment and during follow-up. A high percentage of patients do not achieve nutritional requirements, presenting deterioration in functional tests and worsening quality of life. It is therefore advisable to establish early and sustained nutritional screening and assessment strategies in these patients, establishing the appropriate nutritional medical treatment.
OBJECTIVES:RECALSEEN analyses the structure, activity and results of the Endocrinology and Nutrition Services and Units (S-U_EyN) of the Spanish National Health System (SNHS). This article presents data collected from the 2024 survey, as well as activity and outcome indicators from the SNHS Minimum Basic Data Set (CMBD) for 2007-2022. MATERIAL AND METHODS:Descriptive cross-sectional study of S-U_EyN in general acute care hospitals of the SNHS. Data obtained through an ad hoc survey referring to data from 2023 and discharges from S-U_EyN recorded in the CMBD (2022) were used. RESULTS:A total of 116 responses were obtained from S-U_EyN of 160 general acute care hospitals in the SNHS (72%). Fifty-six per cent of the S-U_EyN respondents were services or clinical management units. The average number of endocrinologists per S-U_EyN department was 8.4 (5.4), with an estimated rate of 2.9 endocrinologists per 100,000 inhabitants. In 74% of hospitals there is a Clinical Nutrition Unit (dependent on the S-U_EyN in 93% of cases) and 39% of S-U_EyNs have a day hospital. The portfolio of services offered by S-U_EyN is closely related to the complexity of the hospital. There is a significant trend to decline in hospitalisations for endocrine and nutritional diseases. Notable differences were found in resources, activity and outcomes between hospitals and autonomous communities. In relation to quality management and the implementation of good practices, there was still considerable room for improvement. The trend to worsening of short- and long-term complication indicators for diabetes mellitus in the period 2016-2022 should be analysed. CONCLUSIONS:RECALSEEN provides relevant information on S-U_EyN and the evolution of endocrinology and nutrition care in the SNHS.
Objective This study aimed to investigate the association between functional dentition and a prior diagnosis of diabetes mellitus (DM) and/or chronic kidney disease (CKD) in a nationally representative sample of the Brazilian population. Methods We conducted a cross-sectional analysis using data from the 2019 Brazilian National Health Survey (PNS). The PNS is representative of the Brazilian population. The associations between self-reported diagnoses of DM and/or CKD and the absence of functional dentition were assessed using multilevel logistic regression models, adjusted for sociodemographic and behavioral variables, such as age, sex, skin color, income, education, and smoking status. Results Functional dentition was absent in 9.3% of the sample (95%CI, 8.9–9.7). Additionally, 8.8% (95%CI, 8.5–9.0) reported a previous diagnosis of DM, and 1.4% (95%CI, 1.3–1.5) a prior diagnosis of CKD. The proportion of individuals with both CKD and DM was 0.29% (95%CI, 0.27–0.32). In adjusted models, DM was significantly associated with the absence of functional dentition (OR, 1.16; 95%CI, 1.07; 1.23, p<0.001). No significant association was observed for CKD (OR, 1.06; 95%CI, 0.89; 1.26, p=0.48) or for individuals with both DM and CKD (OR, 1.08; 95%CI, 0.74; 1.57, p=0.66). Conclusion Diabetes is associated with a higher risk of functional dentition loss in the Brazilian population. Promoting collaboration between dental and medical professionals is essential to improve the prevention and management of tooth loss, particularly among individuals with diabetes, ultimately contributing to better overall health outcomes.
Gastrinomas are functional neuroendocrine tumors characterized by autonomous gastrin secretion, which leads to acid hypersecretion and chronic diarrhea. They are most widely located in the duodenum or pancreas, while primary hepatic gastrinomas are exceptionally rare. At diagnosis, most cases already present with liver metastases.We present the case of a 19-year-old man with a 2-year history of chronic diarrhea and epigastric discomfort. Imaging revealed the presence of a 12cm hepatic mass without extrahepatic involvement. Functional PET/CT with 68Ga-DOTATOC showed intense uptake confined to the liver. Lab test results included markedly elevated gastrin and chromogranin A levels. Core needle biopsy confirmed a well-differentiated NET G2 positive for gastrin. Treatment with long-acting somatostatin analogs led to rapid symptom improvement, and the patient was ultimately cured following surgical resection of the hepatic tumor. Although rare, primary hepatic gastrinomas should be considered in the differential diagnosis of functional NETs with isolated liver lesions.
