MEN1-associated primary hyperparathyroidism in the Spanish Registry: clinical characterictics and surgical outcomes

Primary hyperparathyroidism is the most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1) syndrome. Bone and renal complications are common. Surgery is the treatment of choice, but the best timing for surgery is controversial and predictors of persistence and recurrence are not well known. Our study describes the clinical characteristics and the surgical outcomes, after surgery and in the long term, of the patients with MEN1 and primary hyperparathyroidism included in the Spanish Registry of Multiple Endocrine Neoplasia, Pheochromocytomas and Paragangliomas (REGMEN). Eighty-nine patients (49 men and 40 women, 34.2 ± 13 years old) were included. Sixty-four out of the 89 underwent surgery: a total parathyroidectomy was done in 13 patients, a subtotal parathyroidectomy in 34 and a less than subtotal parathyroidectomy in 15. Remission rates were higher after a total or a subtotal parathyroidectomy than after a less than subtotal (3/4 and 20/22 vs 7/12, P < 0.05), without significant differences in permanent hypoparathyroidism (1/5, 9/23 and 0/11, N.S.). After a median follow-up of 111 months, 20 of the 41 operated patients with long-term follow-up had persistent or recurrent hyperparathyroidism. We did not find differences in disease-free survival rates between different techniques, patients with or without permanent hypoparathyroidism and patients with different mutated exons, but a second surgery was more frequent after a less than subtotal parathyroidectom

MEN1-associated primary hyperparathyroidism in the Spanish Registry: Clinical characterictics and surgical outcomes

Primary hyperparathyroidism is the most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1) syndrome. Bone and renal complications are common. Surgery is the treatment of choice, but the best timing for surgery is controversial and predictors of persistence and recurrence are not well known. Our study describes the clinical characteristics and the surgical outcomes, after surgery and in the long term, of the patients with MEN1 and primary hyperparathyroidism included in the Spanish Registry of Multiple Endocrine Neoplasia, Pheochromocytomas and Paragangliomas (REGMEN). Eighty-nine patients (49 men and 40 women, 34.2 ± 13 years old) were included. Sixtyfour out of the 89 underwent surgery: a total parathyroidectomy was done in 13 patients, a subtotal parathyroidectomy in 34 and a less than subtotal parathyroidectomy in 15. Remission rates were higher after a total or a subtotal parathyroidectomy than after a less than subtotal (3/4 and 20/22 vs 7/12, P < 0.05), without significant differences in permanent hypoparathyroidism (1/5, 9/23 and 0/11, N.S.). After a median follow-up of 111 months, 20 of the 41 operated patients with long-term follow-up had persistent or recurrent hyperparathyroidism. We did not find differences in disease-free survival rates between different techniques, patients with or without permanent hypopar athyroidism and patients with different mutated exons, but a second surgery was more freq uent after a less than subtotal parathyroidectomyThe Spanish Registry of Multiple Endocrine Neoplasia, Pheochromocytmas and Paragangliomas is supported by IPSEN Pharmaceutical

Differentiated Thyroid Cancer in Navarra (Spain): Historic Cohort Results (1987–2003)

Introduction. Navarra has the highest incidence of differentiated thyroid cancer in Spain. The aim of this study was to review its management carried out by the Navarra's multidisciplinary Thyroid Disease Unit, from 1987 to 2003. Material and Methods. 325 patients were studied to find the incidence, prevalence, and prognostic factors. Statistical analysis comprised univariate and multivariate Cox proportional hazards regression models for survival and tumor recurrence. Results. The average annual incidence was 3.6 per 100,000 inhabitants, with a final prevalence of 82.4 per 100,000. Regarding survival and recurrence, statistical significance was observed for stage IV, follicular carcinoma, capsular and prethyroid muscles invasion, and T4 group. Only survival was related to tumour size larger than 40 mm. Only recurrence was related to lymph node metastases and radioiodine dose higher than 100 mCi. Conclusions. Attendance of patients in a functional unit setting has allowed us to classify them into three risk groups

Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial

[Objective]: To examine the effects of two Mediterranean eating plans (Med-EatPlans) versus a low-fat eating plan on the need for glucose-lowering medications. [Research design and methods]: From the Prevención con Dieta Mediterránea (PREDIMED) trial, we selected 3,230 participants with type 2 diabetes at baseline. These participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med-EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual randomization, and the clustering effect was taken into account in the statistical analysis. In multivariable time-to-event survival models, we assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management at enrollment and 2) insulin initiation. [Results]: After a median follow-up of 3.2 years, in multivariable analyses adjusting for baseline characteristics and propensity scores, the hazard ratios (HRs) of starting a first glucose-lowering medication were 0.78 (95% CI 0.62–0.98) for Med-EatPlan + EVOO and 0.89 (0.71–1.12) for Med-EatPlan + nuts, compared with the control eating plan. After a median follow-up of 5.1 years, the adjusted HRs of starting insulin treatment were 0.87 (0.68–1.11) for Med-EatPlan + EVOO and 0.89 (0.69–1.14) for Med-EatPlan + nuts compared with the control eating plan. [Conclusions]: Among participants with type 2 diabetes, a Med-EatPlan + EVOO may delay the introduction of new-onset glucose-lowering medications. The Med-EatPlan did not result in a significantly lower need for insulin

RESEARCH Open Access

Short-term role of the dietary total antioxidant capacity in two hypocaloric regimes on obese with metabolic syndrome symptoms: the RESMENA randomized controlled tria

Genetic diagnosis of familial hypercholesterolemia using a DNA-array based platform

The aim of this study was to validate the Lipochip genetic diagnostic platform by assessing effectiveness, sensitivity, specificity and costs for the identification of patients with familial hypercholesterolemia (FH) in Spain. This platform includes the use of a DNA micro array, the detection of large gene rearrangements and the complete resequencing of the low-density lipoprotein receptor gene. DNA samples of patients with clinically diagnosed FH were analyzed for mutations by application of the Lipochip platform. Results obtained were confirmed by DNA sequencing and MLPA analysis by two other, independent laboratories. Of 808 patients tested, Lipochip detected a mutation in 66% of the cases and of these 78% were detected by the micro array. A specificity of 99.5% at a sensitivity of 99.8% was reached. A positive test result could be reported within 22 days after start of analysis. The total average screening costs of $350 per case were significantly lower compared to other existing screening programs. Lipochip provides a reliable, fast and cheap alternative for the genetic testing of patients with clinically diagnosed F

Short-term role of the dietary total antioxidant capacity in two hypocaloric regimes on obese with metabolic syndrome symptoms: the RESMENA randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Dietary strategies seem to be the most prescribed therapy in order to counteract obesity regarding not only calorie restriction, but also bioactive ingredients and the composition of the consumed foods. Dietary total antioxidant capacity (TAC) is gaining importance in order to assess the quality of the diet.</p> <p>Methods</p> <p>Ninety-six obese adults presenting metabolic syndrome (MetS) symptoms completed an 8-week intervention trial to evaluate the effects of a novel dietary program with changes in the nutrient distribution and meal frequency and to compare it with a dietary pattern based on the American Heart Association (AHA) guidelines.</p> <p>Anthropometric and biochemical parameters were assessed at baseline and at the endpoint of the study, in addition to 48-hours food dietary records.</p> <p>Results</p> <p>Both diets equally (<it>p</it> > 0.05) improved MetS manifestations. Dietary TAC was the component which showed the major influence on body weight (<it>p</it> = 0.034), body mass index (<it>p</it> = 0.026), waist circumference (<it>p</it> = 0.083) and fat mass (<it>p</it> = 0.015) reductions. Transaminases (ALT and AST) levels (<it>p</it> = 0.062 and <it>p</it> = 0.004, respectively) were associated with lower TAC values.</p> <p>Conclusion</p> <p>RESMENA diet was as effective as AHA pattern for reducing MetS features. Dietary TAC was the most contributing factor involved in body weight and obesity related markers reduction.</p> <p>Trial registration</p> <p><url>http://www.clinicaltrials.gov; NCT01087086</url></p

Percepción de la pandemia COVID-19 y situación de la formación sanitaria especializada entre los MIR de Navarra

Medical model in Spain is carried out through the specialized training system.&nbsp; The aim of this study is to analyze the opinion of the Medical Interns in Residency (MIR) of the Autonomous Community of Navarra in three areas: consequences derived from COVID-19, training program and future job prospects among last-year residents. Cross-sectional observational study using a voluntary and anonymous online survey, shared interns from Navarra, carried out between April-May 2021. A total of 228 responses were recorded from 553 MIR residents in Navarra. Seventy-eight percent of the residents have carried out some activity related to the COVID, with 97% of them appreciating some degree of deterioration in their training and 96% having suffered a negative emotional impact. 68% would like to continue working at the same center at the end of their training period, with 79% considering the recruitment system to be inadequate. The COVID-19 pandemic has impaired the training of MIRs, altering teaching itineraries, rotations, reducing surgeries and generating a negative emotional impact. Most of the residents have carried out activities related to COVID-19, although most of them consider that it is not necessary to extend their training time. Most residents would like to continue working at the center where they have been trained, although this demand is not matched by the supply available after completing this training period. In addition, recruitment method has little support from the residents.El modelo de especialización médica en España se realiza a través del sistema de formación sanitaria especializada (FSE).&nbsp; El objetivo es analizar la opinión de los Médicos Internos Residentes (MIR) de la Comunidad Foral de Navarra en tres áreas: consecuencias derivadas del COVID-19, aspectos formativos y perspectivas laborales entre los residentes de último año. Estudio observacional transversal tipo encuesta online, voluntaria y anónima, distribuida entre los MIR de Navarra, realizada en abril y mayo de 2021. Se registraron un total de 228 respuestas de los 553 residentes MIR de Navarra. El 78% de los residentes han desarrollado alguna actividad relacionada con el COVID, apreciando un 97% algún grado de deterioro en la formación y un 96% ha sufrido un impacto emocional negativo. El 68% querría continuar trabajando en el mismo centro al acabar el periodo de formación, con un 79% que considera que el sistema de contratación no es el adecuado. La pandemia COVID-19 ha perjudicado la formación de los MIR, alterando los itinerarios docentes, rotaciones, reduciendo quirófanos, generando un impacto negativo emocional. Gran parte de los residentes ha desarrollado actividades relacionadas con el COVID-19 aunque la mayoría consideran que no es necesario ampliar el tiempo de formación. La mayor parte de residentes querrían continuar trabajando en el centro donde se han formado, sin ser equiparable esta demanda con la oferta disponible tras finalizar esta etapa formativa. Además, el método de contratación cuenta con poco respaldo por parte de los residentes