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Aim To evaluate the long-term clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a regional public healthcare system real-world scenario. Methods All adult T1DM patients on CSII for ≥10 years subjected to follow-up in the regional Castilla-La Mancha Public Health Service were included. The primary efficacy outcome was the variation in HbA1c during follow-up. Direct patient data were compiled through the web-based Spanish national registry on CSII therapy. Results A total of 69 T1DM adult patients were treated with insulin pumps for ≥10 years in our region. The mean age was 45.0 ± 10.5 years, with a T1DM duration of 13.9 ± 8.5 years. The mean duration of CSII therapy was 11.4 ± 2.1 years. The main indications for treatment were high glucose variability (39%), problematic hypoglycemia (26%), and HbA1c > 53 mmol/mol (7%) on multiple daily injections (20%). Sensor-augmented pump therapy was used by 31% of the patients. Glycosylated hemoglobin did not change during follow-up (58 ± 11 mmol/mol vs. 58 ± 11 mmol/mol; 7.5 ± 1.0 vs. 7.5 ± 1.0; p = 0.66). However, the percentage of patients with at least one episode of severe hypoglycemia during the last year and unnoticed hypoglycemia decreased from 36% to 7% (p = 0.006) and from 38% to 32% (p Conclusions The reduction of severe hypoglycemia without deterioration of glycemic control can be sustained over long-term CSII therapy.

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.

To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM).Analytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020.In this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041).After 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD.

Aims: To analyze prevalence and clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a public health system real-world sc...

Objective: Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in type 2 diabetes mellitus (T2DM) patients receiving total parenteral nutrition (TPN). The aim of this study was to determine the predictors of hypoglycemia in hospitalized T2DM patients receiving TPN. Methods: Post hoc analysis of the INSUPAR study, which is a prospective, open-label, multicenter clinical trial of adult inpatients with T2DM in a noncritical setting with indication for TPN. Results: The study included 161 patients; 31 patients (19.3%) had hypoglycemic events, but none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to admission, glycemic variability (GV), belonging to the glargine insulin group in the INSUPAR trial, mean daily grams of lipids in TPN, mean insulin per 10 grams of carbohydrates, duration of TPN, and increase in urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of glargine insulin, and TPN duration were risk factors for hypoglycemia. Conclusion: The presence of T2DM with end-organ damage complications, longer TPN duration, belonging to the glargine insulin group, and greater GV are factors associated with the risk of hypoglycemia in diabetic noncritically ill inpatients with parenteral nutrition. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; CV% = coefficient of variation; DM = diabetes mellitus; GI = glargine insulin; GV = glycemic variability; ICU = intensive care unit; RI = regular insulin; T2DM = type 2 diabetes mellitus; TPN = total parenteral nutrition.

To evaluate clinical status and mortality in older adults with long-standing type 1 diabetes mellitus (T1D).Cross-sectional analysis of all patients with T1D for 50 years or more from a cohort followed since 2010 at Castilla-La Mancha Public Health Service (Spain). Primary outcome was HbA1c change during the follow-up (2010-2020 period). Secondary outcomes included evaluation of insulin and continuous glucose monitoring (CGM) use, cardiovascular risk factors (CVRF), diabetes chronic complications and mortality.A total of fifty-five T1D patients were analysed. Mean age was 69.5 ± 8.3 yrs. and T1D duration of 54.7 ± 4.7 yrs. We detected a HbA1c reduction of -0.5% (-6 mmol/mol) [95% CI -0.1, -0.9 (-2, -10); P = 0.016]. CGM was used by 26% of the patients. More patients suffered from hypertension and obesity in 2020 (66% vs. 78%, P = 0.016; and 26% vs. 31%, P = 0.016; respectively). An increase of diabetic polyneuropathy was detected (45% vs. 67%, P = 0.008). Rate of mortality was higher among patients with long-standing T1D (26% vs. 3.5%, P 0.001), due to cardiovascular disease (57%).Older adults with long-standing T1D patients improved glycemic control although a worsening of CVRF and higher mortality rateweredetected.

Resumen Objetivo Evaluar el grado de control metabolico y los tratamientos hipoglucemiantes en una cohorte de pacientes con diabetes mellitus tipo 2 (DM2) tras su valoracion en endocrinologia. Material y metodos Estudio de cohortes prospectivo. Se incluyeron 465 pacientes con DM2 que no realizaban seguimiento en una consulta de endocrinologia. Se recogieron datos de control glucemico y tratamientos recibidos en una visita inicial y tras 26 semanas de seguimiento. Resultados La hemoglobina glucosilada (HbA1c) inicial fue de 8,3 ± 1,8%, mientras que tras 26 semanas de seguimiento fue de 6,6 ± 0,9% (p Conclusiones se produce una mejoria del control metabolico en esta cohorte de pacientes con DM2 tras su valoracion en una consulta de endocrinologia. No obstante, en el 28,7% no se alcanza un HbA1c

Summary Background There is no established insulin regimen in T2DM patients receiving parenteral nutrition. Aims To compare the effectiveness (metabolic control) and safety of two insulin regimens in patients with diabetes receiving TPN. Design Prospective, open-label, multicenter, clinical trial on adult inpatients with type 2 diabetes on a non-critical setting with indication for TPN. Patients were randomized on one of these two regimens: 100% of RI on TPN or 50% of Regular insulin added to TPN bag and 50% subcutaneous GI. Data were analyzed according to intention-to-treat principle. Results 81 patients were on RI and 80 on GI. No differences were observed in neither average total daily dose of insulin, programmed or correction, nor in capillary mean blood glucose during TPN infusion (165.3 ± 35.4 in RI vs 172.5 ± 43.6 mg/dL in GI; p = 0.25). Mean capillary glucose was significantly lower in the GI group within two days after TPN interruption (160.3 ± 45.1 in RI vs 141.7 ± 43.8 mg/dL in GI; p = 0.024). The percentage of capillary glucose above 180 mg/dL was similar in both groups. The rate of capillary glucose ≤70 mg/dL, the number of hypoglycemic episodes per 100 days of TPN, and the percentage of patients with non-severe hypoglycemia were significantly higher on GI group. No severe hypoglycemia was detected. No differences were observed in length of stay, infectious complications, or hospital mortality. Conclusion Effectiveness of both regimens was similar. GI group achieved better metabolic control after TPN interruption but non-severe hypoglycemia rate was higher in the GI group. Clinical trial registry This trial is registered at clinicaltrials.gov as NCT02706119 .

The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings.To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs).Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a posthoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs.We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care.Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs.

Endothelial activation contributes to lung inflammatory disorders by inducing leucocyte recruitment to pulmonary parenchyma. Consequently, vascular-targeted therapies constitute promising strategies for the treatment of inflammatory pathologies. In the present study, we evaluated the effect of 8,9-dehydrohispanolone-15,16-lactol diterpene (DT) on lung endothelium during inflammation. Lung endothelial cells pre-treated with DT and activated with lipopolysaccharide (LPS) or tumour necrosis factor-α (TNF-α) exhibited reduced expression of the pro-inflammatory cytokines Cxcl10, Ccl5 and Cxcl1, whereas the anti-inflammatory molecules IL1r2 and IL-10 were induced. Consistent with this result, DT pre-treatment inhibited nuclear factor κB (NF-κB) nuclear translocation, by interfering with IκBα phosphorylation, and consequently NF-κB transcriptional activity in endothelium activated by LPS or TNF-α. Furthermore, DT, probably through p38 signalling, induced transcriptional activation of genes containing activator protein 1 (AP-1)-binding elements. Inhibition of p38 prevented IL1r2 mRNA expression in endothelium incubated with DT alone or in combination with LPS or TNF-α. Accordingly, conditioned medium (CM) from these cells failed to stimulate leucocytes as measured by a reduction in adhesive ability of the leucocyte cell line J774 to fibronectin (FN). Additionally, DT reduced the expression of the endothelial adhesion molecules E-selectin, vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) after activation. Similarly, expression of VCAM-1 and ICAM-1 molecules on the lung endothelial layer of C57/BL6 mice pre-treated with DT and challenged with LPS were unchanged. Finally, inhibition of vascular adhesion molecule expression by DT decreased the interaction of J774 cells with lung endothelial cells in an inflammatory environment. Our findings establish DT as a novel endothelial inhibitor for the treatment of inflammatory-related diseases triggered by Gram-negative bacteria or by the associated cytokine TNF-α. Sin financiación 3.797 JCR (2016) Q2, 90/290 Biochemistry & Molecular Biology UEM

El linfoma tiroideo primario es una entidad rara que debe sospecharse en mujeres que presenten un crecimiento tiroideo rápido con clínica compresiva asociada. La cirugía tiene una utilidad principalmente diagnóstica y la quimioterapia sistémica, con o sin radioterapia asociada, constituye el tratamiento de elección. Presentamos el caso de una mujer con un linfoma tiroideo primario de células B no-Hodgkin inclasificable, intermedio entre linfoma B difuso de células grandes y linfoma de Burkitt.

Mujer de 61 años remitida a la consulta de Endocrinología para estudio de episodios de mareo sin giro de objetos, así como nerviosismo, palpitaciones y temblor que mejoraban tras la ingesta de hidratos de carbono. Con la sospecha clínica de hipoglucemias y tras la realización de pruebas complementarias, la paciente fue diagnosticada de hiperinsulinismo endógeno. Se descartó la presencia la presencia de hipoglucemias facticias. Se llevó a cabo una ultrasonografía endoscópica gracias a la cual se diagnóstico un insulinoma pancreático no visible en la tomografía computerizada. Finalmente se realizó una enucleación de la lesión tras la que se produjo la resolución del cuadro clínico. La paciente permanece asintomática en el momento actual.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality., This work was supported by Instituto de Salud Carlos III (ISCIII, co-funded by Fondo Europeo de Desarrollo Regional [FEDER], European Union [EU], Una manera de hacer Europa), Ministerio de Ciencia, Innovacion y Universidades, Gobierno de Espana (PI15/01034), and Sociedad Andaluza de Endocrinologia Diabetes y Nutrition (SAEDYN) 2016 research project. Centro de Investigacion Biomedica en Red (CIBERDEM) is an initiative of the Instituto de Salud Carlos III.

Macrophages are highly plastic cells that adopt different functional phenotypes in response to environmental signals. Classically activated macrophages (M1) exhibit a pro-inflammatory role, mediating host defense against microorganisms or tumor cells; whereas alternatively activated macrophages (M2) perform a range of physiological processes, including inflammation, wound repair and tissue remodeling. Interestingly, M2 macrophages have been involved in pathological settings such as tumor progression, parasitic infection and respiratory disorders. Consequently, the search of new agents able to control macrophage polarization is on the basis of new therapeutic strategies. In the present study, we have evaluated the effect of the hispanolone derivative 8,9-dehydrohispanolone-15,16-lactol (DHHL) on M2 macrophage polarization. Our results reveal that DHHL significantly inhibited IL-4- or IL-13-stimulated M2 macrophage activation, as showed by reduced expression of M2 markers. In addition, DHHL suppressed IL-4-induced STAT-6 and JAK-1 tyrosine phosphorylation, suggesting that this compound inhibited M2 polarization by suppressing the JAK-STAT signaling pathway. Finally, DHHL prevented eosinophil recruitment and the presence of F4/80+-CD206+ M2-like macrophages in an in vivo model of M2 polarization via administration of chitin. Collectively, these results confirm DHHL as a novel regulator of macrophage polarization suitable to design future therapies towards M2-macrophages mediated pathologies.

Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005#8211;2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years.Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service.9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes.Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty.

Alternative activation of macrophages plays an important role in a range of physiological and pathological processes. This alternative phenotype, also known as M2 macrophages, is induced by type 2 cytokines such as IL-4. The binding of IL-4 to its receptor leads to activation of two major signaling pathways: STAT-6 and PI3K. However, recent studies have described that p38 MAPK might play a role in IL-4-dependent signaling in some cells, although its role in macrophages is still controversial. In this study, we investigated whether p38 MAPK plays a role in the polarization of macrophages in mice. Our results reveal that IL-4 induces phosphorylation of p38 MAPK in thioglycollate-elicited murine peritoneal macrophages, in addition to STAT-6 and PI3K activation. Furthermore, p38 MAPK inactivation, by gene silencing or pharmacological inhibition, suppressed IL-4-induced typical M2 markers, indicating the involvement of p38 MAPK in the signaling of IL-4 leading to M2-macrophage polarization. Moreover, p38 MAPK inhibition blocked phosphorylation of STAT-6 and Akt, suggesting that p38 MAPK is upstream of these signaling pathways. Finally, we show that in an in vivo model of chitin-induced M2 polarization, p38 MAPK inhibition also diminished activation of M2 markers. Taken together, our data establish a new role for p38 MAPK during IL-4-induced alternative activation of macrophages.

Objective Medullary thyroid cancer is a rare tumor that is more aggressive and has a worse prognosis than differentiated thyroid cancer. The purpose of this study was to report the demographic, clinical, and genetic characteristics of patients seen in the health care system of the community of Castilla-La Mancha over a 16-year period. Patients and methods Data were collected through a review of patients' medical records. Results The medical records of 58 patients (mean age at diagnosis, 51 years; range, 6-82 years; 63.8% women) were reviewed. Prevalence rate was 2.84 cases per 100,000 inhabitants, with a high variability between areas (range, 0-5.4 cases per 100,000 inhabitants). Familial cases accounted for 34.5% of all medullary thyroid cancers, and the most common mutation was C634Y. The condition was most commonly diagnosed following palpation of a cervical lump (70.6%). At diagnosis, 56 of 58 patients underwent ultrasound and 8 of 58 patients were tested for serum calcitonin. Tumor multicentricity was reported in 59 and 50% of patients with multiple endocrine neoplasia syndrome type 2A and 2B, respectively, and in no sporadic cases. Fifty-two percent of patients had an advanced stage (iii or iv) at diagnosis. Median follow-up was 36 months (interquartile range, 14-210); 11 patients were lost to follow-up. Conclusions In Castilla-La Mancha, medullary thyroid cancer is diagnosed by cervical ultrasound, rather than calcitonin assay. There is a high prevalence of both familial and sporadic medullary thyroid cancer, and a significant variability in the type of proto-oncogen rearranged during transfection mutation as compared to the rest of the Spanish population.

Resumen Objetivo El carcinoma medular de tiroides es un tumor de baja prevalencia cuyo pronostico es peor que el del cancer diferenciado de tiroides debido su mayor agresividad. El objetivo de este trabajo es describir las caracteristicas demograficas, clinicas y geneticas de los pacientes atendidos en el area sanitaria de la Comunidad de Castilla-La Mancha durante 16 anos. Pacientes y metodos Los datos se recogieron mediante revision de historias clinicas. Resultados Se revisaron las historias clinicas de 58 pacientes con una edad media al diagnostico de 51 anos (intervalo de 6 a 82 anos) y un 63,8% de mujeres. La prevalencia fue de 2,84 casos por 100.000 habitantes, con una gran variabilidad entre areas (de 0 a 5,4 casos por 100.000 habitantes). Los casos familiares representaron el 34,5% del total, siendo la mutacion mas frecuente la C634Y. El motivo mas frecuente de diagnostico fue la palpacion de un bultoma cervical (70,6%); se solicito ecografia al diagnostico en 56 de 58 casos, y la calcitonina en 8 de 58 casos. La multicentricidad del tumor fue descrita en el 59 y 50% de los casos de sindrome de neoplasia endocrina multiple tipo 2A y 2B, respectivamente, y en ningun caso esporadico. El 52% de los pacientes presentaba un estadio avanzado al diagnostico ( iii o iv ). La mediana de seguimiento fue de 36 meses (rango intercuartilico 14-210), con la perdida de 11 pacientes durante el seguimiento. Conclusiones El diagnostico de carcinoma medular de tiroides en Castilla-La Mancha se basa en la ecografia cervical, pero no en la calcitonina. Existe una alta prevalencia de este carcinoma, tanto familiar como esporadico, y una importante variabilidad en el tipo de mutacion del protooncogen rearranged during transfection comparadas con las del resto de la poblacion espanola.

We perform an update about nutritional measures that have been adopted in patients with acute pancreatitis (AP). The nutritional support is an essential part of treatment in AP. When the AP is mild or moderate, there is no doubt that is not necessary to use an artificial nutritional support, and it is recommended that oral nutritional support should begin as soon as possible. If the AP is severe, the best way to provide nutritional support is through enteral nutritional (EN) because it reduces infection, length of hospitalization and mortality rate. Parenteral nutrition (PN) should be used only when EN is Impossible. However, there is no scientific evidence for recommending the most optimal route necessary to administer this type of nutritional support; we seek to uncover whether this is by gastric or jejunal route and the proper formula to use. There is an international agreement that the nutritional support should begin quickly, within the first 24 and 72 hours of hospitalization. As conclusion, more research needs to be done concerning nutritional support in AP, and many questions are not been answered yet.