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Resumen Introduccion La correcta aplicacion del soporte nutricional y el conocimiento sobre Nutricion Clinica de los medicos internos residentes (MIR) de un hospital son fundamentales para garantizar una adecuada atencion nutricional en los pacientes. Material y metodo Se envio una encuesta online a todos los MIR de nuestro centro, cuyas especialidades poseen camas de hospitalizacion. El cuestionario incluia 20 preguntas de eleccion multiple puntuadas del 1 al 10 (1 totalmente en desacuerdo y 10 totalmente de acuerdo), distribuidas en estas materias: valoracion nutricional, dietas, suplementos nutricionales orales, nutricion enteral y percepcion de la Unidad de Nutricion. Resultados Contesto el 69% de MIR de especialidades medicas y 70% de quirurgicas. En el conjunto de la encuesta, la puntuacion de todos los MIR fue de 6,28 siendo mayor en los de especialidades medicas que en los de especialidades quirurgicas (6,86 vs. 5,38; p Discusion Los residentes de especialidades medicas dan mayor importancia a la nutricion de los pacientes hospitalizados que los de especialidades quirurgicas, sin embargo, las medias de puntuacion fueron bajas en todos los casos. Existen oportunidades de mejora en la formacion en Nutricion Clinica de este colectivo, y seria importante incluir en los programas formativos de todos los MIR de especialidades hospitalarias aspectos sobre Nutricion Clinica.

Resumen Introduccion El caso clinico es un articulo cientifico que describe uno o varios pacientes con presentaciones clinicas inusuales. En los ultimos anos, se ha descrito una disminucion en la publicacion de casos clinicos. En este trabajo analizamos la casuistica de publicacion de casos clinicos en revistas de endocrinologia durante los anos 2010, 2015 y 2019. Material y metodos Se realizo una busqueda en Pubmed, y se seleccionaron revistas clinicas de endocrinologia, de lenguaje ingles y/o castellano, analizando variables relevantes. Resultados De 84 revistas analizadas, 51 admitian casos para publicacion, 29 no lo hacian y 4 excepcionalmente. En 2010 se publicaron 11.754 articulos, de los cuales 709 eran casos clinicos (6,9% del total); en 2015, un total de 14.594 articulos, de los cuales 655 eran casos clinicos (5,8% del total); y en 2019 un total de 14.110 articulos, de los que 472 eran casos clinicos (4,6% del total). En las revistas que exigian pago por publicar los casos clinicos representaban el 9% de los articulos, y en las revistas con gratuidad, estos eran el 3% (p Conclusiones Existe un descenso en la publicacion de casos clinicos en las revistas de endocrinologia en los ultimos anos, tanto en cifras absolutas como en el porcentaje respecto a la totalidad de los articulos publicados. Pese a que un caso clinico aislado solo es relevante si es excepcional, la disminucion de publicacion de casos clinicos puede suponer una perdida de informacion cientifica y de conocimiento clinico de determinadas enfermedades.

Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis.La cirrosis hepática es una enfermedad progresiva y crónica del hígado, de etiología diversa, que se asocia frecuentemente con intolerancia a la glucosa y en algunos casos concurre con diabetes tipo 2 (DM2). La DM2 se asocia con resultados adversos en pacientes con cirrosis, incluyendo una mayor tasa de ingresos hospitalarios, una mayor prevalencia de carcinoma hepatocelular y un mayor riesgo de mortalidad. La desnutrición es otra complicación frecuente en la cirrosis, cuya prevalencia aumenta con el grado de disfunción hepática, empeorando el pronóstico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con cirrosis hepática.

Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.La diabetes es una comorbilidad frecuente en pacientes con cáncer, ya que comparten factores de riesgo comunes. En la enfermedad oncológica, la presencia de caquexia tumoral representa un factor de mal pronóstico, que se ve agravado por un estado nutricional deficiente. Clínicamente, la caquexia se manifiesta como una reducción significativa del peso corporal, acompañado de cambios en la composición corporal y alteraciones en el equilibrio del sistema biológico, y causa una disfunción progresiva. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con caquexia tumoral concurrente.

Exhaustive bibliographc research in PubMed/Medline.Búsqueda bibliográfica exhaustiva en PubMed/Medline.

People with diabetes are at high risk of requiring surgical intervention throughout their lives, and of perioperative complications in case of poor metabolic control. Hospitalization represents a stressful event that, together with other factors associated with diagnostic and therapeutic procedures, leads to a deterioration in the nutritional status of the patients. An association between poor nutritional status and adverse outcomes in surgical patients has been observed. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) in the perioperative setting.Las personas con diabetes tienen un riesgo elevado de requerir una intervención quirúrgica a lo largo de su vida y de tener complicaciones perioperatorias en caso de un control metabólico deficiente. La hospitalización representa un evento estresante que, unido a otros factores asociados a procedimientos diagnósticos y terapéuticos, conlleva un deterioro del estado nutricional de los pacientes. Se ha observado una asociación entre un estado nutricional deficiente y resultados adversos en pacientes quirúrgicos. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) en el periodo perioperatorio.

Resumen Introduccion Estudio promovido por la Sociedad Castellano-Manchega de Endocrinologia, Nutricion y Diabetes para conocer las caracteristicas de los pacientes atendidos en las consultas externas de Endocrinologia y Nutricion del Servicio de Salud de Castilla-La Mancha y la casuistica de la patologia atendida en dichas consultas. Material y metodos Estudio transversal retrospectivo de la actividad en 2018 de las consultas externas de Endocrinologia y Nutricion de los hospitales publicos de Castilla-La Mancha. Se analizaron todas las visitas del 10% de los dias laborables. Se recogio edad y sexo del paciente, si la consulta era primera o sucesiva, presencial o no presencial y hasta cinco diagnosticos por visita. Resultados Se analizaron 10.709 visitas con una relacion sucesivas/primeras 3,4. La edad de los pacientes fue 52,1 ± 18,2 anos con un 67,1% de mujeres. Diabetes mellitus tipo 2, hipotiroidismo primario, enfermedad nodular tiroidea y obesidad/sobrepeso fueron las patologias mas frecuentemente registradas como primer diagnostico, superando entre las cuatro la mitad del total de visitas. Diabetes mellitus tipo 1, y cancer de tiroides fueron los diagnosticos en los que la relacion sucesivas/primeras fue mayor. Diabetes mellitus tipo 2, obesidad e hipotiroidismo primario supusieron casi la mitad de las primeras visitas. Conclusiones Se atendieron una amplia variedad de patologias, algunas de las cuales estan entre las mas prevalentes en la poblacion general y otras que son poco prevalentes, pero complejas, y dificilmente manejables por otras especialidades. El conocer y analizar estos datos permitira identificar oportunidades de mejora y poner en marcha acciones en este sentido.

Introduction This study was promoted by Sociedad Castellano Manchega de Endocrinologia, Nutricion y Diabetes to ascertain the characteristics of patients seen at the outpatient clinics of endocrinology and nutrition of the Castilla-La Mancha Health Authority and the case mix of diagnoses. Patients and Methods This was a retrospective, cross-sectional study of the activity of the endocrinology and nutrition outpatient clinics of public hospitals of Castile-La Mancha during 2018. All visits made on 10% of the working days were analyzed. Data collected comprised patient age and sex, whether a first or subsequent had been made, and whether this was face-to-face or not, and up to five diagnoses per visit. Results A total of 10,709 visits with a subsequent/first visit ratio of 3.4 were analyzed. Patient age was 52.1?±?18.2 years, and 67.1% were women. Type 2 diabetes mellitus, primary hypothyroidism, thyroid nodular disease, and obesity/overweight were the most common conditions recorded as first diagnosis, accounting for more than half of the total number of visits. Type 1 diabetes mellitus and thyroid cancer were the diagnoses in which the subsequent/first visit ratio was greater. Type 2 diabetes mellitus, obesity, and primary hypothyroidism accounted for almost half of the first visits. Conclusions A wide variety of conditions were seen, some of which are among the most prevalent in the general population, while others are not so prevalent, but are complex and difficult to manage by other specialties. Improved knowledge and analysis of the data should allow for the identification of opportunities for improvement and for the implementation of specific actions.

Resumen Introduccion La actividad de los servicios de Endocrinologia y Nutricion (EYN) incluye la asistencia en planta de pacientes propios o mediante interconsultas. La actividad asistencial en planta del conjunto de servicios de EYN de un sistema publico de salud no ha sido estudiada en nuestro pais. Material y metodos Estudio retrospectivo de la actividad en planta de hospitalizacion durante 2018 de los Servicios de EYN del Servicio Publico de Salud de Castilla-La Mancha para conocer las caracteristicas de los pacientes atendidos, tanto con caracter de interconsulta como ingresados a cargo de los propios servicios, asi como la casuistica de la patologia de dichos pacientes. Se analizaron todos los pacientes ingresados a cargo de EYN y una muestra del 10% de los atendidos como interconsulta. Resultados Se registraron 261 ingresos a cargo de los servicios de EYN del Servicio Publico de Salud de Castilla-La Mancha. El 82,8% tuvieron caracter urgente y el 53,7% fueron por diabetes mellitus tipo 1. Se atendieron 5955 pacientes en regimen de interconsulta, de los cuales se analizo una muestra de 591. El motivo de interconsulta mas frecuente fue la diabetes mellitus/hiperglucemia (28,8%), requiriendo 6,1 ± 6,7 dias por paciente. Sin embargo, las interconsultas para nutricion artificial requirieron mas dias de asistencia por paciente y supusieron un porcentaje mayor del total de dias de interconsulta (60,4%). Conclusiones La actividad en planta de los servicios de EYN del Servicio Publico de Salud de Castilla-La Mancha se basa en la asistencia de pacientes con patologias cronicas de alta prevalencia hospitalaria como la diabetes mellitus/hiperglucemia y, especialmente, la Nutricion Clinica.

Introduction The activity of an Endocrinology and Nutrition (E&N) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the E&N departments of a public health system has not been studied in Spain. Material and methods This was a retrospective study of hospital ward activity during 2018 of the E&N departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the E&N departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to E&N and a 10% sample of those treated through interconsultation were analysed. Results 261 admissions were recorded for Castilla-La Mancha Public Health Service E&N departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1 ± 6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%). Conclusions The inpatient care activity of the E&N departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.

Resumen Introduccion Las herramientas para analizar la casuistica en consultas externas son escasas e insatisfactorias. El objetivo de este trabajo de la Sociedad Castellano Manchega de Endocrinologia, Nutricion y Diabetes (SCAMEND) fue el desarrollo de una herramienta que permita analizar la casuistica de las consultas externas de Endocrinologia y Nutricion teniendo en cuenta la complejidad de la patologia atendida. Material y metodos Se definio el Indice SCAMEND de Complejidad en Consultas Externas de Endocrinologia y Nutricion (ISCCE-EyN) mediante metodo Delphi con dos rondas entre especialistas en Endocrinologia y Nutricion, comparando la complejidad de cada patologia con la de una revision de hipotiroidismo primario. Resultados Las primeras visitas fueron consideradas mas complejas que las visitas sucesivas. La patologia tiroidea no neoplasica y el sobrepeso/obesidad sin complicaciones fueron consideradas las patologias menos complejas, mientras que las metabolopatias, los sindromes de neoplasias endocrinas multiples y el carcinoma suprarrenal fueron consideradas las mas complejas. El grado de consenso fue elevado en la mayoria de las patologias analizadas. Conclusiones Presentamos una herramienta que permite analizar la casuistica de las consultas externas de Endocrinologia y Nutricion teniendo en cuenta la complejidad inherente a la patologia del paciente atendido. Esta herramienta puede servir para realizar comparaciones entre centros, para asignar mejores recursos dentro de un determinado servicio o para la autoevaluacion.

Introduction The tools for analyzing the case-mix in outpatient care are scarce and unsatisfactory. The objective of this work by the Sociedad Castellano Manchega de Endocrinologia, Nutricion y Diabetes (SCAMEND) was the development of a tool that allows to analyze the the case-mix in outpatient care in Endocrinology and Nutrition considering the complexity of the patient disease. Material and methods The SCAMEND index of complexity in outpatient care in Endocrinology and Nutrition (ISCCE-EyN) was defined using the Delphi method with two rounds between endocrinologists, comparing the complexity of each consult with that of a review visit of primary hypothyroidism. Results The first visits were considered more complex than the successive visits. Non-neoplastic thyroid pathology and uncomplicated overweight/obesity were considered the least complex diseases, while metabolopathies, multiple endocrine neoplasm syndromes and adrenal carcinoma were considered the most complex. The degree of consensus was high in most of the diseases analyzed. Conclusions We present a tool that allows to analyze the case-mix in outpatient care in Endocrinology and Nutrition considering the inherent complexity of the disease of the patient attended. This tool can be used to make comparisons between centres, to better allocate resources within a given service or for self-evaluation.

Type 2 diabetes mellitus is a highly prevalent disease worldwide, generating an increasing clinical and economic burden due to its micro and macrovascular complications. Frequently, people with diabetes are hospitalized for various pathologies. These patients generally have higher risk of complications, prolonged hospitalizations and mortality. An additional factor that worsens the prognosis in these patients is the concurrence of malnutrition, especially in elderly people. All this makes the management of these patients challlenging and requires a specific nutritional approach, whose purpose is to cover the nutritional requirements while always maintaining glycemic control. The purpose of this work is to provide, based on the evidence available in the literature and clinical experience, consensus recommendations by eighteen experts in Endocrinology and Nutrition on the nutritional approach of hospitalized patients with diabetes/hyperglycemia and compare the optimal management based on these recommendations with bedside usual care according to a panel of Spanish doctors surveyed about their daily clinical practice. This first article of the Supplement describes the methodology of the study and the results obtained regarding common issues for all pathologies.

Heart failure (HF) is one of the leading causes of morbidity and mortality among older people, making it a major public health problem. Cardiovascular diseases in general, and HF in particular, are common comorbidities in people with type 2 diabetes (DM2). The concurrence of DM2 and HF is associated with more severe clinical symptoms and signs, and poorer quality of life and prognosis. Furthermore, due to the hypercatabolic state and nutrient absorption disorders, malnutrition is present in many HF cases. This document describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with HF.

Sarcopenia is a multidimensional condition that negatively affects muscle mass, muscle strength, and physical performance. The prevalence of sarcopenia in people with diabetes is much higher than that of the general population, especially in individuals with poor nutritional status. Both sarcopenia and malnutrition are conditions amenable to intervention to improve clinical prognosis. This document describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with sarcopenia.

To the editor,We read with interest in this journal an article by Skralin et al. [1] on a relationship between hospital admissions and mortality in COVID-19. The findings coincide with observations...

Introduction: Several studies have shown that diabetes mellitus (DM) is a risk factor for in hospital mortality due to COVID-19. The aim of our study was to analyze if prior clinical characteristics among DM patients affected the risk of in hospital mortality compared with nondiabetic patients hospitalized with COVID-19. Material and Methods: The study was based on a retrospective, observational design and was conducted at two hospitals located in Albacete (Spain). All patients hospitalized with COVID-19 since the start of the pandemic until 7 July 2020 were included. Results: During the study period, 1468 patients were hospitalized due to COVID-19; 402 of them had DM prior to hospitalization. DM was associated with higher in hospital mortality (28.6% versus 17.5%) in the univariate analysis. But, in a multivariate logistic regression analysis, after adjusting for age, presence of hypertension, smoking, presence of COPD, ACEI, ARB, antiplatelet, or anticoagulant therapy, DM was not a significant risk factor for death. Patients with DM2 receiving insulin treatment had a higher risk of in hospital death than nondiabetic patients (OR 1.78 [1.13-2.81], p=0.0126) after age was considered. The age-associated relative risk was 1.06 (1.05-1.07, p Conclusion: This study confirms that pre-admission need for insulin therapy before hospitalization in patients with DM2 are associated with higher in hospital mortality due to COVID-19 in a large sample of DM inpatients with COVID-19. Disclosure P. J. Pinés-corrales: None. M. Molina: None. L. García-blasco: None. R. Quilez toboso: None. M. Alcaraz: None. L. Vicente gutiérrez: None. G. Paterna mellinas: None. J. Calbo mayo: None. J. Alfaro-martínez: None.

Hypoparathyroidism is considered a rare endocrine disease. Despite being a deficiency of parathyroid hormone, the standard therapy is based on oral calcium and active vitamin D supplementation. This approach provides satisfactory management in most cases but may be inadequate for patients in the most complex spectrum of the disease. Other therapies are being explored, and among them, the use of recombinant human parathyroid hormone (PTH) has proved to decrease the requirements of calcium and active vitamin D to reach adequate therapeutic goals. We aimed to provide information on the effectiveness of the current recombinant parathyroid hormone analogs in the clinical management of difficult to control cases of hypoparathyroidism. We report our experience using teriparatide and PTH (1–84) through five complex cases of hypoparathyroidism of diverse etiologies. We describe each case and report the effectiveness of treatment in clinical practice. Four patients with postsurgical hypoparathyroidism and one patient with autoimmune hypoparathyroidism, all of them with suboptimal control under the standard treatment with calcium and calcitriol supplements or calcium gluconate infusion, are presented. They were all started on teriparatide or PTH (1–84), and all of them showed a diminishment of symptoms and were able to maintain normocalcemia without parenteral calcium despite a reduction of oral treatment. This article highlights the effectiveness and safety of hormonal replacement treatment in difficult to manage hypoparathyroidism and provides evidence which justifies its off-label prescription in the case of teriparatide. We consider that this treatment should be considered in cases in which standard treatment fails to reach adequate therapeutic goals.

Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care.An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit.The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6).Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations.

COVID-19 has a wide range of symptoms reported, which may vary from very mild cases (even asymptomatic) to deadly infections. Identifying high mortality risk individuals infected with the SARS-CoV-2 virus through a prediction instrument that uses simple clinical and analytical parameters at admission can help clinicians to focus on treatment efforts in this group of patients. Data was obtained retrospectively from the electronic medical record of all COVID-19 patients hospitalized in the Albacete University Hospital Complex until July 2020. Patients were split into two: a generating and a validating cohort. Clinical, demographical and laboratory variables were included. A multivariate logistic regression model was used to select variables associated with in-hospital mortality in the generating cohort. A numerical and subsequently a categorical score according to mortality were constructed (A: mortality from 0% to 5%; B: from 5% to 15%; C: from 15% to 30%; D: from 30% to 50%; E: greater than 50%). These scores were validated with the validation cohort. Variables independently related to mortality during hospitalization were age, diabetes mellitus, confusion, SaFiO2, heart rate and lactate dehydrogenase (LDH) at admission. The numerical score defined ranges from 0 to 13 points. Scores included are: age ≥71 years (3 points), diabetes mellitus (1 point), confusion (2 points), onco-hematologic disease (1 point), SaFiO2 ≤ 419 (3 points), heart rate ≥ 100 bpm (1 point) and LDH ≥ 390 IU/L (2 points). The area under the curve (AUC) for the numerical and categorical scores from the generating cohort were 0.8625 and 0.848, respectively. In the validating cohort, AUCs were 0.8505 for the numerical score and 0.8313 for the categorical score. Data analysis found a correlation between clinical admission parameters and in-hospital mortality for COVID-19 patients. This correlation is used to develop a model to assist physicians in the emergency department in the COVID-19 treatment decision-making process.

The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen.Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism.The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed.This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation.

The activity of an Endocrinology and Nutrition (EN) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the EN departments of a public health system has not been studied in Spain.This was a retrospective study of hospital ward activity during 2018 of the EN departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the EN departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to EN and a 10% sample of those treated through interconsultation were analysed.261 admissions were recorded for Castilla-La Mancha Public Health Service EN departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1±6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%).The inpatient care activity of the EN departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.

This study was promoted by Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes to ascertain the characteristics of patients seen at the outpatient clinics of endocrinology and nutrition of the Castilla-La Mancha Health Authority and the case mix of diagnoses.This was a retrospective, cross-sectional study of the activity of the endocrinology and nutrition outpatient clinics of public hospitals of Castile-La Mancha during 2018. All visits made on 10% of the working days were analyzed. Data collected comprised patient age and sex, whether a first or subsequent had been made, and whether this was face-to-face or not, and up to five diagnoses per visit.A total of 10,709 visits with a subsequent/first visit ratio of 3.4 were analyzed. Patient age was 52.1 ± 18.2 years, and 67.1% were women. Type 2 diabetes mellitus, primary hypothyroidism, thyroid nodular disease, and obesity/overweight were the most common conditions recorded as first diagnosis, accounting for more than half of the total number of visits. Type 1 diabetes mellitus and thyroid cancer were the diagnoses in which the subsequent/first visit ratio was greater. Type 2 diabetes mellitus, obesity, and primary hypothyroidism accounted for almost half of the first visits.A wide variety of conditions were seen, some of which are among the most prevalent in the general population, while others are not so prevalent, but are complex and difficult to manage by other specialties. Improved knowledge and analysis of the data should allow for the identification of opportunities for improvement and for the implementation of specific actions.

Aims MODY (maturity onset diabetes of the young) is a group of well-defined diseases clinically characterised by onset before 25 years of age that does not require insulin treatment (at least initially) to prevent the formation of ketone bodies and autosomal dominant inheritance. Despite the importance of accurate classification, it is not always simple to catalogue the diagnosis of a young patient with diabetes, and genetic studies are often improperly used. Methods We describe the clinical features of patients negative for MODY2 and MODY3 and compared them to patients positive for these subtypes. Results All patients with MODY3 had been diagnosed before 25 years of age and required drug therapy for blood glucose control. MODY2 patients were diagnosed at the first laboratory workup either incidentally or as part of gestational diabetes screening. The clinical description of the 19 patients negative for MODY2 and MODY3 showed that only two patients presented a clinical picture consistent with MODY3 and one patient with MODY2. Conclusions Clinical features can be used for early exclusion of a MODY2 or MODY3 diagnosis and may reduce the need for genetic testing.

Resumen Introduccion La cirugia bariatrica mediante la tecnica del cruce duodenal esta considerada como uno de los tratamientos mas efectivos para conseguir la perdida de peso y la disminucion de comorbilidades en pacientes obesos morbidos. Derivada de su practica se pueden producir deficiencias nutricionales que debemos conocer y tratar. Objetivos Valoracion de la perdida de peso y del desarrollo de sindromes carenciales en pacientes obesos morbidos sometidos a cirugia bariatrica mediante la tecnica del cruce duodenal. Material y metodos Se ha estudiado la evolucion de 128 pacientes obesos morbidos sometidos a cirugia bariatrica mediante la tecnica del cruce duodenal en el Hospital General Universitario de Albacete. Se realizaron controles ponderales y de las deficiencias nutricionales mas relevantes surgidas tras la intervencion. Resultados El peso corporal desciende de manera acusada desde un indice de masa corporal (IMC) promedio de 52,9 ± 7,7 kg/m 2 (40,7-78,5) hasta un IMC de 30,8 ± 5,2 kg/m 2 , con un porcentaje de exceso de peso perdido (%EPP) de 81,4 ± 16,4% a los 18 meses tras la intervencion. La perdida de peso se ralentiza en el seguimiento posterior, llegando a su valor mas bajo a los 30 meses postintervencion (%EPP del 82,1 ± 16,8; IMC de 30,2 ± 4,3 kg/m 2 ) y tiende a estabilizarse en los pacientes con seguimiento mas prolongado. Las deficiencias nutricionales mas significativas que requirieron tratamiento sustitutivo se detectaron en algunos micronutrientes como el hierro (42,9%), zinc (38,3%) y vitaminas liposolubles A (55,5%) y D (57,8%), entre otros. Conclusiones El tratamiento de la obesidad morbida mediante cruce duodenal es una tecnica muy efectiva para conseguir una importante perdida de peso de forma mantenida. La elevada presencia de deficits nutricionales durante el seguimiento obliga a realizar revisiones periodicas de forma indefinida.

Introduction Bariatric surgery using the duodenal switch procedure is considered to be one of the most effective treatments for achieving weight loss and decreasing comorbidity in patients with morbid obesity. However, this procedure may be associated with various nutritional deficiencies that should be known and adequately managed. Objectives To assess weight loss and the occurrence of nutritional deficiencies in morbidly obese patients undergoing bariatric surgery using a duodenal switch procedure. Patients and methods One hundred and twenty-eight morbidly obese patients underwent a duodenal switch procedure at Hospital General Universitario in Albacete. Weight changes and the most important nutritional deficiencies occurring after surgery were recorded. Results Median follow-up time was 30 months (interquartile range, 18 months). Body weight markedly decreased, with mean body mass index (BMI) decreasing from a preoperative value of 52.9 ± 7.7 kg/m2 to 30.8 ± 5.2 kg/m2 18 months after surgery. Percent excess weight loss (%EWL) was 81.4 ± 16.4% in this period. Weight loss slowed down subsequently, reaching its lowest value 30 months after surgery (%EWL 82.1% ± 16.8, BMI 30.2 ± 4.3 kg/m2) and tended to stabilize in patients with longer follow-up times. The most significant nutritional deficiencies requiring replacement therapy were found in some micronutrients such as iron (42.9%), zinc (38.3%), vitamin A (55.5%), and vitamin D (57.8%), amongst others. Conclusions Duodenal switch is a very effective surgical procedure for treating morbidly obese patients because it allows them to achieve a significant and sustained weight loss. Close lifetime monitoring is required in these patients because of the high prevalence of nutritional deficiencies during follow-up.

The aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1alpha gene.The study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1alpha gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed.No differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene had no family history of diabetes (p0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene (p0.05).Occasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1alpha gene.

Rhabdomyolysis may be secondary to trauma, excessive muscle activity, hereditary muscle enzyme defects and other medical causes. Primary hyperaldosteronism is characterised by hypertension, hypokalemia, suppressed plasma renin activity, and increased aldosterone excretion. Rhabdomyolysis is not common in primary hyperaldosteronism. We report here a 42-year-old woman presenting with rhabdomyolysis as heralding symptom of primary hyperaldosteronism. We also carried out a search of the literature to identify all cases of rhabdomyolysis as the first-recognized expression of a primary hyperaldosteronism. Sixteen cases met the criteria for inclusion. When rhabdomyolysis occurs in a patient with hypokalemia and metabolic alkalosis, primary hyperaldosteronism has to be suspected: if confirmed, an aldosterone-producing adenoma is the most probable cause.

La distincion entre las distintas formas de sindrome de Cushing dependiente de corticotropina (ACTH), es decir, los adenomas hipofisarios y los tumores ectopicos, puede resultar dificil en determinados casos. Las pruebas diagnosticas que nos orientan en esa situacion son la supresion con dosis altas de dexametasona, la respuesta a metopirona, al estimulo con corticoliberina (CRH) o desmopresina, la determinacion de otras hormonas o marcadores tumorales, las pruebas de imagen y el cateterismo de senos petrosos inferiores, pero todas ellas ofrecen sensibilidades y especificidades suboptimas, por lo que solemos recurrir a la combinacion de varias pruebas. Una vez confirmado el origen ectopico de la secrecion de ACTH, debemos localizar el tumor que la origina. Para ello hay que conocer los tipos tumorales implicados con mayor frecuencia en el sindrome de secrecion ectopica de ACTH/CRH (carcinoides, carcinomas pulmonares de celulas pequenas, tumores neuroendocrinos, carcinomas medulares de tiroides, feocromocitomas y otros) y utilizar las distintas tecnicas de imagen disponibles. La tomografia computarizada (TC) y la resonancia magnetica (RM) son las mas utilizadas y las de mayor rentabilidad diagnostica. Las pruebas de imagen “funcionales”, la gammagrafia con octreotida y la tomografia poremision de positrones, pueden ofrecer resultados positivos cuando la TC y la RM no encuentran la lesion que causa el sindrome. Aun despues de emplear todas estas tecnicas, y otras menos habituales por resultar menos rentables, queda un 15-20% de pacientes con tumores no localizados. Su seguimiento a largo plazo hace que algunos tumores pasen a ser clinicamente evidentes y que el porcentaje de tumores ocultos vaya reduciendose a medida que pasan los anos.

The prescription of parenteral nutrition is a medical procedure that should be properly documented and that requires adequate communication between physicians, pharmacists and nurses. Prescription may be made by orders and paper forms or with software applications, in which case their integration with the rest of the hospital information systems may be difficult. We present our experience with a software for prescribing artificial nutrition integrated with the electronic medical record.In order to develop a software application for artificial nutrition prescription, meetings between the Clinical Nutrition Unit and the Computing Service staff were held, which set the needs of the clinical services and features that should have the application. DESCRIPTION OF THE SOFTWARE: The software allows the prescription of parenteral nutrition component by component or using predesigned templates, generates alerts if extreme value of components or possible physical- chemical incompatibility, imports and stores the results of the labs of patients and records the composition of parenteral nutrition formula in the electronic medical record, among other features.Our experience shows that collaboration between clinical services and hospital Computing permits to develop useful applications for the clinical teams and that can be integrated with other hospital software.Introducción: La prescripción y seguimiento de la nutrición parenteral es un acto médico que debe ser correctamente documentado y que precisa de una adecuada comunicación entre médicos, farmacéuticos y personal de enfermería. Dicha prescripción puede realizarse mediante órdenes y formularios en papel o con aplicaciones informáticas, en cuyo caso surge la dificultad de su integración con el resto de la informática hospitalaria. Presentamos la experiencia de nuestro centro en la integración de un programa informático de prescripción de nutrición hospitalaria con la historia clínica electrónica. Material y métodos: Con objeto de desarrollar una aplicación informática de prescripción de nutrición artificial se llevaron a cabo reuniones entre personal de la Unidad de Nutrición Clínica y el Servicio de Informática donde se establecieron las necesidades de los servicios implicados y las características que debía tener la aplicación. Descripción de la aplicación: El programa informático permite la prescripción de nutrición parenteral componente por componente o mediante plantillas prediseñadas, genera alertas en caso de valores extremos de componentes o posible incompatibilidad físico-química, importa y almacena los resultados de las analíti cas de los pacientes y escribe la composición de la fórmula de nutrición parenteral prescrita en la historia clínica electrónica, entre otras características. Discusión: Nuestra experiencia muestra que la colaboración entre los servicios clínicos y de Informática permite desarrollar aplicaciones hospitalarias adaptadas a la forma de trabajo de los equipos clínicos y que pueden integrarse con el resto de los programas informáticos del hospital.

Presurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.Retrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).Patients in group 1 showed a greater tendency for weight gain. They regained a 9.4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19.6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 +/- 1.6 nutritional deficiencies per patient in group 1 and 2.5 +/- 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).The presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.