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COVID-19 has a wide spectrum of clinical severity and there is evidence that SARS-Cov2 affects several organs and systems. Among the organs affected since the beginning of the pandemic, the relationship between SARS-CoV-2 infection and thyroid involvement has been demonstrated. Novel and highly effective mRNA and DNA-based vaccines have been rapidly developed to decrease SARS-CoV-2 morbidity and mortality. Early after mass vaccinations, cases of thyroid dysfunction mainly including episodes of subacute thyroiditis, began to be reported like adverse effects. The objective of this study is to determine the impact of the pandemic, both due to SARS-CoV2 infections and vaccinations, on the incidence of Graves´ disease.Cross-sectional, observational study comparing incidence of Graves´ disease in adult population (over 18 years) before (2017-2019) and after (2020-2021) Covid-19 pandemic. Only patients with new cases of Graves' disease, no relapsed diseases, were included. SARS-CoV-2 diagnosis was based on nucleic acid amplification tests on nasopharyngeal swabs or measurement of class M and class G antibodies to SARS-CoV-2 by highly specific assays. Data on incidence and vaccination related to SARS-CoV-2 infection were obtained from the public records from Castilla y León autonomous regional government.180 subjects were diagnosed and treated for Graves' disease (GD) during the study period. We observed a notable increase in expected GD cases in 2021 compared to 2017-19. The number of GD cases was higher in the second (Q2) quarter. Among 2021 GD cases, 42/66 patients (63.6%) had been vaccinated in the 90 days prior to symptom onset, but none of them in the first quarter of the year. 97.7% were women with a mean age of 48.9 (SD 15.6) years. On average they were diagnosed 19.9 (SD 17.6) days after receiving the vaccine.7/42 (16.67%) had another previously diagnosed autoimmune disease and 11/42 (26.19%) were smokers.Our results show a notable increase in the incidence of GD during the year 2021, specially in women with a history of smoking. Hyper activation of the immune system induced by SARS-Cov2 and by the recently released SARS-COV-2 vaccines has been highlighted in recent months. To assess whether this observed increase in the incidence of GD is sustained in the coming years or has simply been a precipitous trigger for individuals who were already predisposed to develop the disease, future studies will be needed. This article is protected by copyright. All rights reserved.

Resumen Obesidad y diabetes son dos entidades muy relacionadas. Las modificaciones en los habitos de vida y el tratamiento farmacologico no consiguen una remision exitosa de la diabetes. Una opcion terapeutica para estos pacientes es la cirugia bariatrica (CB). En funcion del tipo de tecnica empleada (restrictiva o malabsortiva), las tasas de remision parcial y completa varian, siendo mas efectivas las malabsortivas, tanto en reduccion de peso como en remision de diabetes (RD). Existen diferentes escalas (DiaRem, Ad-DiaRem o 5y-Ad-DiaRem) que predicen la probabilidad de RD tras CB, sobre todo tras bypass gastrico (BG). Algunos estudios muestran tasas de RD mas elevadas, en cirugias con mayor componente malabsortivo. Nuestro objetivo fue estudiar los beneficios de la CB al ano y cinco anos, en cuanto a peso y perfil glucemico en pacientes con obesidad y diabetes mellitus tipo 2 (DM2), evaluar el porcentaje de RD segun criterios de la American Diabetes Association (ADA), determinar la capacidad predictiva de RD de distintos scores y examinar que variables predicen RD al ano y a cinco anos de la derivacion biliopancreatica (DBP). La DBP presenta mayor porcentaje de sobrepeso perdido (PSP) y una mayor reduccion tanto en glucemia como en HbA1c. La remision completa de la diabetes oscila en un 80% aproximadamente a uno y cinco anos de la CB. En general los scores que determinan probabilidad de RD tienen poco poder discriminativo en cirugias malabsortivas. La HbA1c precirugia predice RD a uno y cinco anos tras DBP. Se debe individualizar el tipo de cirugia realizada, en funcion de la gravedad de la DM2 y las caracteristicas especificas de cada paciente.

Obesity and diabetes are two closely related disorders. Lifestyle changes and drug treatment do not achieve successful diabetes remission. A treatment option for these patients is bariatric surgery (BS). The partial and complete remission rates vary, depending on the type of technique used (restrictive or malabsorptive), with malabsorptive surgery being more effective in terms of both weight reduction and diabetes remission (DR). Different scales (DiaRem, Ad-DiaRem or 5y-Ad-DiaRem) predict the probability of DR after BS, particularly after gastric bypass surgery. Some studies report higher DR rates in surgery with a greater malabsorptive component. Our aim was to study the benefits of BS at one year and 5 years in terms of the weight and blood glucose profile in patients with obesity and type 2 diabetes mellitus; assess percentage DR according to ADA criteria; determine the DR predictive capacity of different scores; and examine which variables predict DR at one and five years after biliopancreatic diversion (BPD). Percentage overweight reduction and the decrease in both blood glucose and HbA1c were greater with BPD. Complete diabetes remission was approximately 80% at one and 5 years after BS. In general, the scores that determine the probability of DR show poor discriminative capacity in malabsorptive surgery. Presurgery HbA1c predicts DR at one and 5 years after BPD. The type of surgery performed should be individualized, based on the severity of diabetes and the specific characteristics of each patient.

Resumen A partir de la tercera decada de la vida, y por causas multifactoriales, se pierde masa y fuerza muscular de forma progresiva, afectando a la funcionalidad del aparato locomotor. A esta perdida combinada de masa y fuerza muscular que aparece con el envejecimiento se le denomina sarcopenia, la cual se asocia a una mayor morbimortalidad en el sujeto anciano, por lo que el tratamiento precoz es fundamental, siendo el ejercicio fisico la estrategia terapeutica que mejores resultados ha demostrado. En esta revision bibliografica realizada para analizar el efecto individual del ejercicio fisico, excluyendo el papel que podria representar en el tratamiento de la sarcopenia otras propuestas desde el enfoque nutricional, se incluyen 12 articulos. En aquellos estudios que incluian ejercicios de fuerza de alta intensidad de forma aislada, exclusivamente o combinado con ejercicio aerobico, se observa mejoria de la masa muscular, fuerza muscular y tiempos en pruebas funcionales. Existe asimismo un incremento significativo de masa libre de grasa en individuos que realizaban ejercicio con mayor frecuencia (mas de 2 sesiones a la semana). La evidencia actual demuestra que los entrenamientos basados en fuerza-resistencia y la combinacion en programas multimodales con ejercicio aerobico muestran efectos significativamente beneficiosos sobre parametros antropometricos y de funcionalidad muscular, debiendo por tanto adecuarse los programas de ejercicios pautados, incluyendo ejercicios de fuerza adaptados a las caracteristicas de cada individuo, y sustituir a la practica habitual de prescribir en exclusiva ejercicios de tipo aerobico (caminar).

Disease-related malnutrition (DRM) is underdiagnosed and underreported despite its well-known association with a worse prognosis. The emergence of Big Data and the application of artificial intelligence in Medicine have revolutionized the way knowledge is generated. The aim of this study is to assess whether a Big Data tool could help us detect the amount of DRM in our hospital.This was a descriptive, retrospective study using the Savana Manager® tool, which allows for automatically analyzing and extracting the relevant clinical information contained in the free text of the electronic medical record. A search was performed using the term "malnutrition", comparing the characteristics of patients with DRM to the population of hospitalized patients between January 2012 and December 2017.Among the 180,279 hospitalization records with a discharge report in that period, only 4,446 episodes (2.47%) included the diagnosis of malnutrition. The mean age of patients with DRM was 75 years (SD 16), as compared to 59 years (SD 25) for the overall population. There were no sex differences (51% male). In-hospital death occurred in 7.08% of patients with DRM and 2.98% in the overall group. Mean stay was longer in patients with DRM (8 vs. 5 days, P.0001) and there were no significant differences in the 72-hour readmission rate. The most common diagnoses associated with DRM were heart failure (35%), respiratory infection (23%), urinary infection (20%), and chronic kidney disease (15%).Underdiagnosis of DRM remains a problem. Savana Manager® helps us to better understand the profile of these patients.

Resumen Introduccion La desnutricion relacionada con la enfermedad (DRE) esta infradiagnosticada e infrarreportada, a pesar de su asociacion con un peor pronostico. La irrupcion del big data y la inteligencia artificial aplicada en medicina ha revolucionado la forma de generar conocimiento. El presente estudio tiene como objetivo valorar si una herramienta de big data podria ayudarnos a detectar y conocer la DRE en nuestro hospital. Metodologia Estudio retrospectivo descriptivo, utilizando la herramienta Savana Manager®, que permite analizar y extraer de forma automatica la informacion clinica relevante contenida en el texto libre de la historia clinica electronica. Se realiza una busqueda con el termino «desnutricion», comparando las caracteristicas de los pacientes con DRE frente a la poblacion de pacientes hospitalizados en el periodo comprendido entre enero de 2012 y diciembre de 2017. Resultados De 180.279 registros de hospitalizacion con informe de alta en dicho periodo, solo 4.446 episodios (2,47%) incluian el diagnostico de desnutricion. La edad media de los pacientes con DRE fue 75 anos (DE 16) frente a 59 (DE 25) anos de la poblacion global. No hubo diferencias en genero (51% varones). El fallecimiento intrahospitalario se produjo en el 7,08% de los pacientes con DRE frente al 2,98% en el grupo general. La estancia mediana fue superior en los pacientes con DRE (8 vs. 5 dias, p Conclusion El infradiagnostico de la DRE sigue siendo un problema. Savana Manager® ayuda a conocer mejor el perfil de estos pacientes.

Background Secondary hyperparathyroidism (SHPT) is a matter of concern after biliopancreatic diversion (BPD). The aim of this study was to investigate the relationship between SHPT, 25(OH)D, and calcium after BPD. Design A retrospective analysis in obese patients after BPD performed between 1998 and 2016. Methods Patients with at least 1 year of follow-up were included. SHPT was considered when PTH > 65 pg/mL in the absence of an elevated corrected calcium. 25(OH)D (ng/mL) status was defined as: deficiency Results In total, 321 patients were included (76.6% women), with mean age 43.0 (10.5) years. Median follow-up was 6.0 (IQR 3.0-9.0) years. Mean body mass index was 49.8 (7.0) kg/m2. SHPT increased to a maximum of 81.9% in the ninth year of follow-up (95% CI: 1.5-9.1). Two years after surgery, 33.9% of patients with 25(OH)D sufficiency had SHPT (p = 0.001). Corrected calcium levels were lower in patients with PTH > 65 pg/mL when compared with PTH 65 pg/mL and 25(OH)D sufficiency had lower corrected calcium levels when compared with subjects with PTH and 25(OH)D in normal range. Two years: 9.0 vs 9.2 mg/dL (p Conclusions Once 25(OH)D is sufficient, the increase in PTH persists associated with a decrease in serum corrected calcium. It is important to ensure a sufficient calcium intake in these patients in order to avoid SHPT and osteomalacia in the future.

Tolvaptan introduction has constituted the main therapeutic novelty in the management of hyponatremia in recent years.To describe the experience with this drug at Complejo Asistencial Universitario de León, Spain.Retrospective, observational study of tolvaptan outpatient use in a tertiary care hospital from March 2014 to August 2017.A total of 9 patients were treated with tolvaptan in the outpatient setting. Eunatremia was reached in 24 h by 23.1%. After tolvaptan administration, a reduction in days of hospitalization was recorded (361 vs. 70; p = 0.007), especially in those days of hospitalization that were attributable to hyponatremia (306 vs. 49; p = 0.009).Long-term use of tolvaptan appears to be safe and is associated with a decrease in days of hospitalization.La introducción de tolvaptan ha supuesto la principal novedad en el tratamiento de la hiponatremia en los últimos años.Describir la experiencia con tolvaptan en el Complejo Asistencial Universitario de León, España.Estudio observacional retrospectivo de utilización ambulatoria de tolvaptan en un hospital de tercer nivel, de marzo de 2014 a agosto de 2017.Fueron tratados con tolvaptan de forma ambulatoria nueve pacientes, 23.1 % alcanzó eunatremia en 24 horas. Posterior a la administración de tolvaptan se registró reducción en días de hospitalización (361 versus 70, p = 0.007), especialmente por hiponatremia (306 versus 49, p = 0.009).El uso a largo plazo de tolvaptan parece ser seguro y se relaciona con descenso en los días de hospitalización.

Objective Obesity is a challenge for bioelectrical impedance analysis (BIA) estimations of skeletal muscle and fat mass (FM), and none of the equations used for appendicular lean mass (ALM) have been developed for people with obesity. By using different equations and proposing a new equation, this study aimed to assess the estimation of FM and ALM using BIA compared with dual-energy x-ray absorptiometry (DXA) as a reference method in a cohort of people with severe obesity. Methods This cross-sectional study compared a multifrequency BIA (TANITA MC-780A) versus DXA for body composition assessment in adult patients with severe obesity (body mass index [BMI] of >35 kg/m2). Comparisons between measured (DXA) and predicted (BIA) data for FM and ALM were performed using the original proprietary equations of the device and the equations proposed by Kyle, Sergi, and Yamada. Bland-Altman plots were drawn to evaluate the agreement between DXA and BIA, calculating bias and limits of agreement (LOA). Reliability was analyzed using intraclass correlation coefficient (ICC). Stepwise multiple regression analysis was used to derive a new equation to predict ALM in patients with obesity and was validated in a subsample of our cohort. Results In this study, 115 patients (72.4% women) with severe obesity (mean BMI of 46.1 [5.2] kg/m2) were included (mean age 43.5 [8.6] y). FMDXA was 61.4 (10.1) kg, FMBIA was 57.9 (10.3) kg, and ICC was 0.925 (P Conclusion BIA using multifrequency BIA in people with obesity is reliable enough for the estimation of FM, with good correlation and low bias to DXA. Regarding the estimation of ALM, BIA showed a good correlation with DXA, although it overestimated ALM, especially when proprietary equations were used. The use of equations developed using the same device improved the prediction, and our new equation showed a low bias for ALM.

During pregnancy, thyroid peroxidase (TPO) antibodies may increase the risk of developing subclinical hypothyroidism (SCH). Both conditions appear to be associated to maternal-fetal complications. The objectives of this study were to analyze if a relationship exists between TSH and TPO levels during pregnancy and the potential effects on gestational and perinatal complications, and to assess whether detectable, but not positive, TPO levels have an impact on development of gestational SCH.A prospective study was conducted at the Leon Health Area (CAULE), where universal screening for gestational thyroid dysfunction is performed between weeks 7-13 of pregnancy. Data on TSH and TPO levels and gestational and perinatal complications were collected for all 2016 deliveries. Positive TPO antibodies were defined as values≥35IU/mL. In a previous study, a TSH level3.72mU/L was established as the cut-off value for gestational SCH.Records corresponding to 1,980 deliveries at CAULE, 21 abortions, and 18 deliveries outside the hospital were analyzed. Of the 1,670 pregnant women screened (84.34%), 142 (8.50%) had positive TPO antibodies and their presence was associated to diagnosis of SCH (P0.01) and to significantly higher mean TSH levels (3.51mU/L vs. 2.46mU/L, P=0.03). There were no significant differences in gestational or neonatal complications. In the group with undetectable TPO antibodies (10lU/mL), the mean TSH levels was slightly lower than in the group with TPO values ranging from 10-35 IU/mL, but the difference was not significant (P=0.89).Presence of positive TPO antibodies is associated to higher TSH levels and higher risk of gestational SCH, but does not increase the rate of maternal-fetal complications.

Resumen Introduccion Los anticuerpos antiperoxidasa tiroidea (ATPO) en la gestacion pueden influir en el desarrollo de hipotiroidismo subclinico gestacional (HSG). Ambas entidades parecen asociarse a complicaciones maternas y fetales. Los objetivos de este estudio son analizar si existe relacion entre los valores de TSH y ATPO durante el embarazo, los posibles efectos sobre complicaciones gestacionales y perinatales, y valorar si los ATPO detectables, pero no positivos, influyen en el desarrollo de HSG. Metodologia Estudio prospectivo realizado en el area sanitaria del Complejo Asistencial Universitario de Leon (CAULE), donde se realiza cribado universal para disfuncion tiroidea gestacional entre la semana 7-13 de gestacion. Se recogieron datos de TSH, ATPO, obstetricos y neonatales de los partos de 2016. Se considera ATPO positivo si ≥ 35 UI/ml. En estudio previo se establecio valor TSH > 3,72 mU/L como corte para HSG. Resultados Se analizaron registros correspondientes a 1.980 partos en CAULE, 21 abortos y 18 partos fuera del centro. Se realizo cribado a 1.670 gestantes (84,34%): 142(8,50%) tuvieron ATPO positivos. La deteccion de ATPO positivo se asocio con el diagnostico de HSG (p Conclusion La presencia de ATPO positivo se asocia con valores de TSH mas elevados y con mayor riesgo de HSG, pero no incrementa la tasa de complicaciones materno-fetales.

espanolIntroduccion: La introduccion de tolvaptan ha supuesto la principal novedad en el tratamiento de la hiponatremia en los ultimos anos. Objetivo: Describir la experiencia con tolvaptan en el Complejo Asistencial Universitario de Leon, Espana. Metodo: Estudio observacional retrospectivo de utilizacion ambulatoria de tolvaptan en un hospital de tercer nivel, de marzo de 2014 a agosto de 2017. Resultados: Fueron tratados con tolvaptan de forma ambulatoria nueve pacientes, 23.1 % alcan- zo eunatremia en 24 horas. Posterior a la administracion de tolvaptan se registro reduccion en dias de hospitalizacion (361 versus 70, p = 0.007), especialmente por hiponatremia (306 versus 49, p = 0.009). Conclusiones: El uso a largo plazo de tolvaptan parece ser seguro y se relaciona con descenso en los dias de hospitalizacion. EnglishIntroduction: Tolvaptan introduction has constituted the main therapeutic novelty in the management of hyponatremia in recent years. Objective: To describe the experience with this drug at Complejo Asistencial Universitario de Leon, Spain. Method: Retrospective, observational study of tolvaptan outpatient use in a tertiary care hospital from March 2014 to August 2017. Results: A total of 9 patients were treated with tolvaptan in the outpatient setting. Eunatremia was reached in 24 h by 23.1%. After tolvaptan administration, a reduction in days of hospitalization was recorded (361 vs. 70; p = 0.007), especially in those days of hospitalization that were attributable to hyponatremia (306 vs. 49; p = 0.009). Conclusions: Long-term use of tolvaptan appears to be safe and is associated with a decrease in days of hospitalization.

From the third decade of life and due to multiple causes, muscle mass and strength are gradually lost, which affects the function of the musculoskeletal system. This combined loss of muscle mass and strength with aging is called sarcopenia, and is associated with greater morbidity and mortality in the elderly. Early treatment is therefore essential, and physical exercise is the therapeutic approach that has given the best results. This literature review intended to analyze the effect of physical exercise, excluding the role that other treatments proposed, including the nutritional approach, could play in the treatment of sarcopenia, refers to 12 articles. In studies including high intensity strength exercises in isolation, either alone or combined with aerobic exercise, improvements were seen in muscle mass, muscle strength, and functional test times. There is also a significant increase in fat-free mass in individuals who exercised more frequently (more than two sessions per week). Current evidence shows that strength-resistance training and its combination in multimodal programs with aerobic exercise show significantly beneficial effects on anthropometric and muscle function parameters. Programs of prescribed exercises including strength exercises adequate to the characteristics should therefore be adapted to the characteristics of each individual and replace the usual practice of prescribing aerobic exercises (walking) only.

Cancer patients are at high risk of malnutrition due to several symptoms such as lack of appetite. The aim of this study was to determine the prevalence of different appetite disorders in cancer patients and their influence on dietary intake, nutritional status, and quality of life. We conducted a cross-sectional study of cancer patients at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall, and patients were questioned about the presence of changes in appetite (none, anorexia, early satiety, or both). Quality of life was measured using EORTC-QLQ-C30. Multivariate analysis was performed using linear regression. 128 patients were evaluated. 61.7% experienced changes in appetite: 31% anorexia, 13.3% early satiety, and 17.2% both. Appetite disorders were more common in women and with the presence of cachexia. The combination of anorexia and satiety resulted in a lower weight and BMI. However, there were no significant effects on energy or macronutrient intake among different appetite alterations. Patients with a combination of anorexia and early satiety had worse overall health perception, role function, and fatigue. Appetite disorders are highly prevalent among cancer patients at risk of malnutrition. They have a significant impact on nutritional status and quality of life, especially when anorexia and early satiety are combined.

Background Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). Methods A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. Results In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p = 0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p = 0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. Conclusions Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery.