Guía práctica de diagnóstico y tratamiento de la acromegalia

Consensus document[Abstract] Acromegaly and gigantism are due to excess GH secretion, usually by a pituitary adenoma. It is an uncommon disease. Diagnosis is made by showing elevated GH and IGF-I levels in patients with a clinical picture suggesting the condition. Once excess GH is confirmed by biochemical tests, MRI of the hypothalamic–pituitary area should be performed to ascertain the source of excess GH. Transsphenoidal surgery of the pituitary adenoma is the treatment of choice. However, introduction of new drugs has changed the treatment sequence in recent years. Medical treatment with somatostatin analogs may be indicated as primary treatment in patients in whom surgery is not expected to be curative or is contraindicated. The GH receptor antagonist should be used in patients not controlled after surgery who do not adequately respond to somatostatin analogs. Radiotherapy would be indicated in patients not controlled after surgery and medical treatment or with large tumor remnants after surgery.[Resumen] La acromegalia y el gigantismo se deben a la producción excesiva de GH, generalmente por un adenoma hipofisario. Es una enfermedad poco frecuente. El diagnóstico se realiza ante un paciente con un cuadro clínico sugerente con la demostración de concentraciones de GH e IGF-I elevadas. Tras la confirmación bioquímica del exceso de GH debe realizarse una RM del área hipotálamo-hipofisaria a fin de confirmar el origen del exceso de GH. El tratamiento de elección es el quirúrgico del adenoma hipofisario mediante cirugía transesfenoidal, si bien en los últimos años los avances en cuanto a la aparición de nuevos fármacos han modificado la secuencia terapéutica. El tratamiento médico con análogos de somatostatina puede estar indicado como procedimiento primario en pacientes no subsidiarios de curación tras cirugía, o en aquellos casos en que esta esté contraindicada. El antagonista del receptor de GH debe utilizarse en pacientes no controlados tras cirugía que no responden de forma adecuada a análogos de somatostatina. La radioterapia estaría indicada en aquellos casos no controlados tras tratamiento quirúrgico y médico o en aquellos pacientes con grandes restos tumorales tras el tratamiento quirúrgico

Filmed clinical cases improved communication skills of student of Pharmacology in Podiatry degree

Solving clinical case by writing-report lacks of students sympathies and interest in many cases. Make a short film is a novelty that really like to the students and may improve their arguing and planning capacities and their communication skills. Aim: To evaluate the impact of presenting and resolving clinical cases through filming a short-film in the communication skills development and in the learning of medicines in Podiatry undergraduate students. Methods: A two-year study in which students were invited to voluntarily form groups (3 students maximum). Each group has to design and film a short-film (8 min maximum) showing a clinical case in which medicines’ use was needed to treat feet pathology. A camera, a mobile-phone's video editor or whatever they may use was allowed. The job of each group was supervised and helped by a teacher. The students were invited to present their work to the rest of the class. After each short-film projection the students were encouraged to ask questions if they wanted to do it. After all the projections the students voluntarily answered a satisfaction survey. Results: Students of Pharmacology of Podiatry Degree, N=101, 55.6% female, 20±1.3 years old were enrolled. 37 short-films showing a clinical case were made. The average time spent by students in making the film was 12.4±8 h. The percentage of students which were satisfied with this way of presentation of the clinical cases was 75.2%. Conclusion: Filmed clinical cases performed by student of Pharmacology of the Podiatry Degree improved their communication skills.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Convocatoria de Ayudas de la Universidad de Málaga a Proyectos de Innovación Educativa, convocatoria 2013-2015, PIE 13-156 en Área de Ciencias de la Salud

Flipped classroom based on objective structured clinical examinations analysis by undergraduate students of Pharmacology course from the Podiatry Degree improve their learning and assessment communication skills about medicines

Comunicación cartel con defensa oralWe aim to evaluate the impact of the individual and in-group analysis of OSCEs (filmed by other students) looking for correct and incorrect behaviours and contents in their learning of pharmacology. Summary of work and outcomes: A 5-year prospective study in which students of Pharmacology course from the Podiatry Degree analysed filmed OSCEs individually and in a group in a flipped classroom. Each group (max 5 students) analysed along 1 week a filmed OSCE, prepare a summary of correct and incorrect items related to clinical events, medicines uses, and people behaviours. The students presented their analysis results to the rest of the class. After each presentation, the other students of the class were encouraged to ask questions and after that, the students voluntarily answered a satisfaction survey. Result and Discussion: 405 students, 65.2% female, 20±5.3 years old were included. Students spend 13.4±5.4 h on making the filmed-OSCE analysis. The percentage of students satisfied with this way of studying pharmacology was 96.5%. OSCEs analysis by students increased their percentage of success in the final assessment in both OSCEs-related and OSCEs-non-related questions (+18.5% and +10.1%). Conclusion: Filmed Objective Structured Clinical Examinations analysis by undergraduate students on the Pharmacology course of Podiatry Degree improved their knowledge about medicines use and their communication skills during the assessment.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Treatment adherence to pegvisomant (somavert®) in Spain: PEGASO study

This is a pre-copyedited, author-produced version of an article accepted for publication in Endocrine Reviews following peer review. The version of record is avaliable online at Oxford University web page

Treatment adherence to pegvisomant in patients with acromegaly in Spain: PEGASO study

The final publication is avaliable at Springer Link[Abstract] PURPOSE: The burden of chronic daily subcutaneous administration of pegvisomant on adherence has not been previously studied. This study was aimed to determine the adherence to pegvisomant treatment in acromegaly patients in the real-world clinical practice setting in Spain. METHODS: Multicenter, observational, descriptive, cross-sectional study in patients with acromegaly treated with pegvisomant for at least 12 months. Patient adherence was indirectly determined by Batalla and Haynes-Sackett questionnaires and directly by prescription record review. Additionally, treatment satisfaction was assessed by the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and treatment convenience by an ad-hoc Pegvisomant questionnaire. Errors in reconstitution and administration process were determined by direct observation. RESULTS: 108 patients were included in the analysis. Rates of adherence varied from 60.7 to 92.1% and did not correlate with disease control. Older patient age and alternative schedules other than daily pegvisomant dosing were associated with lower adherence. Treatment satisfaction and convenience was high, with a mean (SD) total SATMED-Q score of 74.6 ± 15.4 over 100 and a total ad-hoc Pegvisomant questionnaire score of 71.2 ± 15.2 over 100. 34.3% of patients made mistakes during the reconstitution /administration process. CONCLUSIONS: Patient adherence to pegvisomant was high (60.7-92.1%), but more than a third of the patients in the study made mistakes during the administration process, with a potential impact on disease control. Besides dosing compliance, correct administration of medication should be carefully assessed in these patients

El desarrollo y análisis de ECOEs mejoró las habilidades de comunicación, aprendizaje y evaluación de los estudiantes de Farmacología en el Grado de Podología.

Comunicación a congresoEl desarrollo y análisis de ECOEs mejoró las habilidades de comunicación, aprendizaje y evaluación de los estudiantes de Farmacología en el Grado de Podología. Bellido Estevez I, Blanco Reina E, Bellido Estevez MV, García Arnés JA, Gómez Luque A. Dep. Farmacología. Facultad de Medicina. IBIMA. S. de Anestesia. Hospitales Regional Carlos Haya y Virgen de la Victoria. Universidad de Málaga. Mlaga, España. Antecedentes/Objetivos: La enseñanza inversa facilita el aprendizaje activo. Las evaluaciones clínicas objetivas estructuradas (ECOEs) son herramientas evaluativas, multipropósito, versátiles, usadas para evaluar en el entorno clínico. Nuestro objetivo fue evaluar el impacto del desarrollo y análisis ECOEs en el aprendizaje de la farmacología. Métodos: Estudio prospectivo a lo largo de 5 años en el que los estudiantes de Farmacología del Grado de Podología desarrollaron y analizaron ECOEs usando técnicas de enseñanza inversa. Cada grupo (5 estudiantes máximo) analizó a lo largo de 1 semana una ECOE filmada y desarrollada por otros alumnos, preparó un resumen de los elementos correctos e incorrectos relacionados con eventos clínicos, usos de medicamentos y comportamientos de las personas. Cada grupo presentó sus resultados al resto de la clase, contestaron a las preguntas de sus compañeros y posteriormente a una encuesta de satisfacción. Resultados/Discusión: Fueron incluidos 405 estudiantes, 65,2% mujeres, 20±5,3 años. Los estudiantes dedicaron 13,4±5,4 h a analizar las ECOEs. El porcentaje de estudiantes satisfechos con esta forma de estudiar farmacología fue del 96,5%. Esta actividad incrementó el porcentaje de éxito en la evaluación final en las preguntas relacionadas con las ECOEs un 18,5% y en las no relacionadas un 10,1%. Conclusión: El desarrollo y análisis de ECOEs mejoró los conocimientos sobre el uso de medicamentos, habilidades de comunicación y evaluación de los estudiantes de Farmacología del Grado de Podología.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Effects of GLP-1 receptor agonists on neurological complications of diabetes

Emerging evidence suggests that treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be an interesting treatment strategy to reduce neurological complications such as stroke, cognitive impairment, and peripheral neuropathy. We performed a systematic review to examine the evidence concerning the effects of GLP-1 RAs on neurological complications of diabetes. The databases used were Pubmed, Scopus and Cochrane. We selected clinical trials which analysed the effect of GLP-1 RAs on stroke, cognitive impairment, and peripheral neuropathy. We found a total of 19 studies: 8 studies include stroke or major cardiovascular events, 7 involve cognitive impairment and 4 include peripheral neuropathy. Semaglutide subcutaneous and dulaglutide reduced stroke cases. Liraglutide, albiglutide, oral semaglutide and efpeglenatide, were not shown to reduce the number of strokes but did reduce major cardiovascular events. Exenatide, dulaglutide and liraglutide improved general cognition but no significant effect on diabetic peripheral neuropathy has been reported with GLP-1 RAs. GLP-1 RAs are promising drugs that seem to be useful in the reduction of some neurological complications of diabetes. However, more studies are neededThis work was supported by the Instituto de Salud Carlos III (PI19/01375) co-financed with FEDER programme fund. Funding for open access publishing: Universidad Málaga/CBU

Antidiabetic Drugs in Alzheimer's Disease and Mild Cognitive Impairment: A Systematic Review.

Considering that Alzheimer's disease (AD) and diabetes mellitus share pathophysiological features and AD remains with no cure, antidiabetic drugs like intranasal insulin, glitazones, metformin, and liraglutide are being tested as a potential treatment. The aim of this systematic review was to assess the efficacy of antidiabetic drugs in patients with AD, mild cognitive impairment (MCI), or subjective cognitive complaints (SCCs). Cognition was studied as the primary outcome and modulation of AD biomarkers, and imaging was also assessed as a secondary outcome. We conducted a search in the electronic databases PubMed/MEDLINE, EMBASE, and Scopus seeking clinical trials evaluating the effect on cognition of antidiabetic drugs in patients with AD, MCI, or SCCs. A total of 23 articles were found eligible. Intranasal regular insulin improved verbal memory in most studies, especially in apoE4- patients, but results in other cognitive domains were unclear. Detemir improved cognition after 2 months of treatment, but it did not after 4 months. Pioglitazone improved cognition in diabetic patients with AD or MCI in 3 clinical trials, but it is controversial as 2 other studies did not show effect. Metformin and liraglutide showed promising results, but further research is needed as just 2 clinical trials involved each of these drugs. Almost all drugs tested were shown to modulate AD biomarkers and imaging. Intranasal insulin, pioglitazone, metformin, and liraglutide are promising drugs that could be useful in the treatment of AD. However, many questions remain to be answered in future studies, so no particular antidiabetic drug can currently be recommended to treat AD

Guía práctica de diagnóstico y tratamiento de la acromegalia

Consensus document[Abstract] Acromegaly and gigantism are due to excess GH secretion, usually by a pituitary adenoma. It is an uncommon disease. Diagnosis is made by showing elevated GH and IGF-I levels in patients with a clinical picture suggesting the condition. Once excess GH is confirmed by biochemical tests, MRI of the hypothalamic–pituitary area should be performed to ascertain the source of excess GH. Transsphenoidal surgery of the pituitary adenoma is the treatment of choice. However, introduction of new drugs has changed the treatment sequence in recent years. Medical treatment with somatostatin analogs may be indicated as primary treatment in patients in whom surgery is not expected to be curative or is contraindicated. The GH receptor antagonist should be used in patients not controlled after surgery who do not adequately respond to somatostatin analogs. Radiotherapy would be indicated in patients not controlled after surgery and medical treatment or with large tumor remnants after surgery.[Resumen] La acromegalia y el gigantismo se deben a la producción excesiva de GH, generalmente por un adenoma hipofisario. Es una enfermedad poco frecuente. El diagnóstico se realiza ante un paciente con un cuadro clínico sugerente con la demostración de concentraciones de GH e IGF-I elevadas. Tras la confirmación bioquímica del exceso de GH debe realizarse una RM del área hipotálamo-hipofisaria a fin de confirmar el origen del exceso de GH. El tratamiento de elección es el quirúrgico del adenoma hipofisario mediante cirugía transesfenoidal, si bien en los últimos años los avances en cuanto a la aparición de nuevos fármacos han modificado la secuencia terapéutica. El tratamiento médico con análogos de somatostatina puede estar indicado como procedimiento primario en pacientes no subsidiarios de curación tras cirugía, o en aquellos casos en que esta esté contraindicada. El antagonista del receptor de GH debe utilizarse en pacientes no controlados tras cirugía que no responden de forma adecuada a análogos de somatostatina. La radioterapia estaría indicada en aquellos casos no controlados tras tratamiento quirúrgico y médico o en aquellos pacientes con grandes restos tumorales tras el tratamiento quirúrgico