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We aimed to analyse the impact of COVID-19 during 2020 and 2021 on the prescription of enteral nutritional support and its expenditure in the Community of Madrid, Spain, compared to pre-pandemic data from 2016 in the general population vs. elderly. We analysed official electronic prescriptions of all public hospitals of the Community of Madrid. The population over 75 years of age have the higher prescription of nutritional supplements (p < 0.001 vs. other age groups), with no differences between the 45–64 age group compared to the 65–74 age group (χ2 = 3.259, p = 0.196). The first wave of COVID-19 or the first time there was a real awareness of the virus in Spain is similar in a way to the first peak of prescription of enteral nutrition in March 2020. The second peak of prescription was observed in the over 75 age group in July 2020, being more pronounced in December 2020 and March–April of the following year (F = 7.863, p = 0.041). The last peaks correspond to summer 2021 and autumn of the same year (p = 0.031—year 2021 vs. 2020, p = 0.011—year 2021 vs. 2019), where a relationship between increased prescription of enteral nutrition and COVID-19 cases is observed. High-protein and high-calorie dietary therapies were the most prescribed in patients with or without diabetes. All of this entailed higher cost for the Community of Madrid. In conclusion, COVID-19 significantly affected the prescription of nutritional support, especially in the population over 75 years of age.

Objectives: the aim of the study was to analyze the impact of COVID-19 on enteral nutrition prescription in the Community of Madrid during the first semester of 2020. Material and Methods: this is a descriptive study of enteral nutrition prescription in the first semester of 2020 and its comparison with the first semester of 2019. We included all the prescriptions in public hospitals of the Community of Madrid as recorded in public electronic databases. Results: there was an 8 % increase in the number of enteral nutrition prescriptions in March 2020 when compared with the previous months (p0.001). Then, in April and May 2020 we observed a 9 % decrease in enteral nutrition prescriptions (p0.001). Total costs in enteral nutrition showed a similar pattern, with an increase in March 2020 (p0.001) and a decrease in April and May 2020 (p0.001). When analyzing the data by patient age, those above 75 y.o. showed the highest decrease in enteral nutrition prescriptions (33.1 % higher than for those under 75 y.o.) in April and May 2020 (p0.001). Conclusions: the irruption of COVID-19 had a relevant impact on enteral nutrition prescription, especially among the elderly. Follow-up is needed to assess the long-term consequences of this in nutritional therapy.Objetivos: el objetivo de este estudio es analizar el impacto de la COVID-19 en el primer semestre del año 2020, con respecto a la prescripción de soportes nutricionales enterales, y su gasto en la Comunidad de Madrid. Material y métodos: estudio descriptivo y comparativo del consumo de productos de nutrición enteral prescritos en recetas oficiales electrónicas durante el primer semestre de los años 2019 y 2020 en los hospitales públicos de la Comunidad de Madrid. Resultados: al analizar la prescripción del número de envases totales durante el periodo estudiado, por meses, se observa un incremento del 8 % en la prescripción durante el mes de marzo, comparado con los meses previos (p0,001), seguido de un descenso del 9 % en los meses de abril y mayo (p0,001). El comportamiento de la evolución del gasto sigue el mismo patrón, con un incremento en el mes de marzo (p0.001) y un descenso en los meses de abril y mayo de similar magnitud (ambos, p0,001). Al analizar por grupos de edades, el grupo de edad de más de 75 años fue el grupo con la mayor caída en las prescripciones (33,1 % mayor que entre los menores de 75) en los meses de abril y mayo de 2020 (p0,001). Conclusiones: la COVID-19 afectó de forma importante a la prescripción del soporte nutricional, especialmente en el grupo de mayor edad. El seguimiento de la enfermedad nos permitirá profundizar en el papel de la nutrición a corto y largo plazo.

Background Sexual dimorphism manifests noticeably in obesity-associated gonadal dysfunction. In women, obesity is associated with androgen excess disorders, mostly the polycystic ovary syndrome (PCOS), whereas androgen deficiency is frequently present in obese men in what has been termed as male obesity-associated secondary hypogonadism (MOSH). Obesity-associated gonadal dysfunction, consisting of PCOS in women and MOSH in men, is a frequent finding in patients with severe obesity and it may be ameliorated or even resolve with marked weight loss, especially after bariatric surgery. Objective and rationale We aimed to obtain an estimation of the prevalence of obesity-associated gonadal dysfunction among women and men presenting with severe obesity and to evaluate the response to bariatric surgery in terms of resolution and/or improvement of this condition and changes in circulating sex hormone concentrations. Search methods We searched PubMed and EMBASE for articles published up to June 2016. After deleting duplicates, the abstract of 757 articles were analyzed. We subsequently excluded 712 articles leaving 45 studies for full-text assessment of eligibility. Of these, 16 articles were excluded. Hence, 29 studies were included in the quantitative synthesis and in the different meta-analyses. Quality of the studies was assessed using the Quality index for prevalence studies and the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group available from the National Heart, Lung and Blood Institute. For meta-analyses including more than 10 studies, we used funnel and Doi plots to estimate publication bias. Outcomes In severely obese patients submitted to bariatric surgery, obesity-associated gonadal dysfunction was very prevalent: PCOS was present in 36% (95CI 22-50) of women and MOSH was present in 64% (95CI 50-77) of men. After bariatric surgery, resolution of PCOS was found in 96% (95CI 89-100) of affected women and resolution of MOSH occurred in 87% (95CI 76-95) of affected men. Sex hormone-binding globulin concentrations increased after bariatric surgery in women (22 pmol/l, 95CI 2-47) and in men (22 pmol/l, 95CI 19-26) and serum estradiol concentrations decreased in women (-104 pmol/l, 95CI -171 to -39) and to a lesser extent in men (-22 pmol/l, 95CI -38 to -7). On the contrary, sex-specific changes were observed in serum androgen concentrations: for example, total testosterone concentration increased in men (8.1 nmol/l, 95CI 6-11) but decreased in women (-0.7 nmol/l, 95CI -0.9 to -0.5). The latter was accompanied by resolution of hirsutism in 53% (95CI 29-76), and of menstrual dysfunction in 96% (95CI 88-100), of women showing these symptoms before surgery. Wider implications Obesity-associated gonadal dysfunction is among the most prevalent comorbidities in patients with severe obesity and should be ruled out routinely during their initial diagnostic workup. Considering the excellent response regarding both PCOS and MOSH, bariatric surgery should be offered to severely obese patients presenting with obesity-associated gonadal dysfunction.

espanolAntecedentes: la cirugia bariatrica es una alternativa terapeutica eficaz en la obesidad morbida para conseguir perdidas de peso importantes y mantenidas en el tiempo, la resolucion de la comorbilidad y una disminucion del riesgo cardiovascular. Material y metodos: estudio retrospectivo que incluyo a todos los pacientes intervenidos consecutivamente mediante baypass gastrico laparoscopico en nuestro centro durante 10 anos, en los que se estudiaron la perdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugia y al final del seguimiento. Resultados: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 anos y un IMC de 48,2 ± 6,0 kg/m2. Se siguio al 96,7 % durante 5,7 ± 2,6 anos de media. La resolucion de la comorbilidad al final del seguimiento fue: 53,4 % para la hipertension arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el sindrome de apnea-hipopnea del sueno. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parametros incluidos en su calculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El indice de masa corporal y el porcentaje de sobrepeso perdido a los 2 anos y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. Conclusiones: el bypass gastrico es un metodo eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor numero de pacientes posible y la comunicacion de los resultados a largo plazo para determinar la efectividad real de estos procedimientos. EnglishBackground: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.

intracavitary electrocardiogram (IC-ECG) guidance has been recently proposed for peripherally inserted central catheter (PICC) placement since it may reduce the time of placement and avoid radiological control.to evaluate IC-ECG compared to conventional radiological control. METHOS: prospective study of 532 consecutive patients. Those with arrhythmias or on antiarrhythmic drugs were excluded. In all cases, PICC tip placement was checked by IC-ECG guidance and by a chest X-ray, which was considered as the reference test.PICC placement with IC-ECG guidance was achieved in 96.8% of patients (applicability). PICC correct placement according to IC-ECG guidance was confirmed by chest X-ray in 94% of patients (accuracy). In 13 patients (2.7%) the catheter had to be repositioned after radiological control. The κ concordance index was 0.356 (p0.001). The IC-ECG sensitivity was 0.98, with a PPV of 0.97 and a positive likelihood ratio of 1.5. However, the specificity was only 0.35 with a NPV of 0.41 and a negative likelihood ratio of 0.06.PICC placement by IC-ECG guidance is plausible, safe, presents adequate indexes of validity and reliability, and allows reducing the time of catheter placement. However, radiological verification is still necessary, especially in cases of negative or uncertain ECG.INTRODUCCIÓN: recientemente se ha planteado la posibilidad de comprobar la colocación de los catéteres centrales de inserción periférica (PICC) mediante control electrocardiográfico intracavitario (ECG-IC) ya que permitiría disminuir el tiempo de colocación y evitaría el control radiológico. OBJETIVO: evaluación de dicho método frente al control radiológico habitual. MÉTODOS: estudio prospectivo en el que se incluyeron 532 pacientes de forma consecutiva. Se excluyeron aquellos pacientes con arritmias o en tratamiento con fármacos antiarrítmicos. En todos los casos se comprobó la colocación de la punta del PICC mediante control ECG-IC y mediante la realización de una radiografía de tórax, que fue considerada método de referencia. RESULTADOS: la colocación del PICC gracias al control ECG-IC (aplicabilidad) fue del 96,8%. La correcta colocación del PICC gracias a la interpretación del ECG-IC se confirmó en un 94% de los casos con la radiografía de tórax (precisión). En 13 pacientes (2,7%) se requirió la recolocación del catéter tras el control radiológico. El índice κ de concordancia fue de 0,356 (p0,001). La sensibilidad del método ECG fue de 0,98, con un VPP de 0,97 y un cociente de probabilidad positivo de 1,5. Sin embargo, la especificidad fue solo del 0,35 con un VPN de 0,41 y un cociente de probabilidad negativo de 0,06. CONCLUSIÓN: la comprobación de la colocación de los PICC mediante ECG-IC es plausible, segura, presenta unos índices de validez/fiabilidad adecuados y permitiría disminuir el tiempo de colocación del catéter. Sin embargo, la comprobación radiológica sigue siendo necesaria, especialmente en los casos de ECG negativo o dudoso.

Resumen Introducción: recientemente se ha planteado la posibilidad de comprobar la colocación de los catéteres centrales de inserción periférica (PICC) mediante control electrocardiográfico intracavitario (ECG-IC) ya que permitiría disminuir el tiempo de colocación y evitaría el control radiológico. Objetivo: evaluación de dicho método frente al control radiológico habitual. Métodos: estudio prospectivo en el que se incluyeron 532 pacientes de forma consecutiva. Se excluyeron aquellos pacientes con arritmias o en tratamiento con fármacos antiarrítmicos. En todos los casos se comprobó la colocación de la punta del PICC mediante control ECG-IC y mediante la realización de una radiografía de tórax, que fue considerada método de referencia. Resultados: la colocación del PICC gracias al control ECG-IC (aplicabilidad) fue del 96,8%. La correcta colocación del PICC gracias a la interpretación del ECG-IC se confirmó en un 94% de los casos con la radiografía de tórax (precisión). En 13 pacientes (2,7%) se requirió la recolocación del catéter tras el control radiológico. El índice κ de concordancia fue de 0,356 (p < 0,001). La sensibilidad del método ECG fue de 0,98, con un VPP de 0,97 y un cociente de probabilidad positivo de 1,5. Sin embargo, la especificidad fue solo del 0,35 con un VPN de 0,41 y un cociente de probabilidad negativo de 0,06. Conclusión: la comprobación de la colocación de los PICC mediante ECG-IC es plausible, segura, presenta unos índices de validez/fiabilidad adecuados y permitiría disminuir el tiempo de colocación del catéter. Sin embargo, la comprobación radiológica sigue siendo necesaria, especialmente en los casos de ECG negativo o dudoso.

The use of home parenteral nutrition (HPN) in patients who can not obtain their nutritional requirements by the enteral route is increasing in recent years, allowing normalization lifestyle of patients. Neoplasm and mesenteric ischaemia are some of the diseases that most frequently require HPN in Spain. However, HPN is one of the cornerstones of the treatment of much less frequent illnesses as in the case of encapsulating peritoneal sclerosis. We present the case of a patient with encapsulating peritoneal sclerosis and HPN support for more than 7 years with a peripherally inserted central catheter (PICC) for over 6 years without complications and the autonomy to perform his normal business activity. Given the exceptional nature of the case we refer it to its publication.El uso de la nutrición parenteral domiciliaria (NPD) en pacientes que no pueden alcanzar sus requerimientos nutricionales por la vía enteral está aumentando en los últimos años, permitiendo la normalización del estilo de vida de los pacientes. Entre las patologías que más frecuentemente precisan de la NPD en España destacan la neoplasia y la isquemia mesentérica. Sin embargo, la NPD constituye uno de los pilares básicos del tratamiento de enfermedades mucho menos frecuentes como es el caso de la esclerosis peritoneal encapsulante. A continuación presentamos el caso de un paciente diagnosticado de esclerosis peritoneal encapsulante con soporte NPD de más de 7 años de NPD con un catéter central de inserción periférica (PICC) para la NPD sin complicaciones y pudiendo realizar su actividad laboral habitual. Dado lo excepcional del caso lo remitimos para su publicación.

Fundamento y objetivo Recientemente se ha demostrado una asociacion entre la obesidad y el trastorno psiquiatrico. Sin embargo, en pacientes enviados al hospital por sobrepeso/obesidad, esta asociacion es desconocida en Espana. Pacientes y metodo Se estudio a 333 pacientes consecutivos enviados a nuestras consultas por sobrepeso/obesidad. Se excluyo del estudio a los pacientes con psicopatologia diagnosticada previamente. Se emplearon cuestionarios autoadministrados y validados en poblacion espanola para la identificacion de casos psiquiatricos (cuestionario de Goldberg [GHQ], con punto de corte en 5/6), y de trastorno bulimico de la conducta alimentaria (escala de bulimia y atracones del cuestionario EDI, con punto de corte en 6/7). Resultados En un 47,1% de los casos se identificaron resultados patologicos en el GHQ, y en un 5,8%, en la escala de bulimia del EDI. No hubo diferencias significativas en el analisis de subgrupos cuando se clasifico a los pacientes por el grado de obesidad, aunque si hubo una mayor presencia de casos psiquiatricos en mujeres que en varones (p Conclusion La prevalencia de casos psiquiatricos en los pacientes con sobrepeso/obesidad enviados al hospital es elevada y mayor en las mujeres que en los varones.

the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of parenteral nutrition in these patients regarding prognosis.55 patients with intestinal occlusion and peritoneal carcinomatosis were included. Parenteral nutrition aimed at 20-35 kcal/Kg/day, and 1.0 g/kg/day of amino-acids. Weight, body mass index, type of tumor, type of chemotherapy, and ECOG among others were recorded and analyzed.69.1% of the patients had gastrointestinal tumors, 18.2% gynecologic and 12.7% others. Age was 60 ± 13y, baseline ECOG 1.5 ± 0.5 and body mass index 21.6 ± 4.3. Malnutrition was present in 85%. Survival from the start of parenteral nutrition was not significant when considering baseline ECOG (log rank = 0.593, p = 0.743), previous lines of chemotherapy (log rank = 2.117, p = 0.548), baseline BMI (log rank = 2.686, p = 0.261), or type of tumor (log rank = 2.066, p = 0.356). Survival in patients who received home parenteral nutrition after hospital discharge was higher than those who stayed in-hospital (log rank = 7.090, p = 0.008). Survival in patients who started chemotherapy during or after parenteral nutrition was higher than those who did not so (log rank = 17.316, p0.001). A total of 3.6% of patients presented catheter related infection without affecting survival (log rank = 0.061, p = 0.804).Parenteral nutrition in patients with advanced cancer and intestinal occlusion is safe, and in tho se who respond to chemotherapy, further administration of home parenteral nutrition together with chemotherapy may enhance prolonged survival.Introducción y objetivos: el papel preciso de la nutrición parenteral en el manejo de los pacientes oncológicos con obstrucción intestinal no está bien definido todavía. El objetivo del presente trabajo es evaluar los efectos de la nutrición parenteral en este tipo de pacientes en cuanto al pronóstico. Material y métodos: fueron incluidos 55 pacientes con obstrucción intestinal y carcinomatosis peritoneal. La nutrición parenteral proporcionó 20-35 kcal/Kg/día y 1.0 g/kg/día de aminoácidos. El peso, el IMC, el tipo de tumor, el tipo de quimioterapia recibida y el ECOG, entre otras variables, fueron recogidas y analizadas. Resultados: un 69,1% de los pacientes presentaban tumors gastrointestinales, un 18,2% ginecológicos y otros tumores el 12,7% restante. La edad media fue de 60 ± 13 años, con un ECOG basal de 1,5 ± 0,5 y un IMC de 21,6 ± 4,3. La presencia de malnutrición fue de un 85%. La supervivencia desde el inicio de la nutrición parenteral no fue significativamente distinta entre los pacientes al considerar su ECOG basal (log rank = 0,593, p = 0,743), las líneas previas de quimioterapia recibida (log rank = 2,117, p = 0,548), el IMC basal (log rank = 2,686, p = 0,261), o el tipo de tumor (log rank = 2,066, p = 0,356). La supervivencia en los pacientes en que fue posible el alta hospitalaria con nutrición parenteral fue superior (log rank = 7,090, p = 0,008). La supervivencia en los pacientes en que se inició la quimioterapia durante o tras iniciar la nutrición parenteral fue también superior (log rank = 17,316, p0,001). Un total de 3,6% de los pacientes presentaron infección relacionada con el catéter sin afectar la supervivencia (log rank = 0,061, p = 0,804). Conclusión: la nutrición parenteral en los pacientes oncológicos con obstrucción intestinal y carcinomatosis peritoneal es segura y, en aquellos que responden a qui mioterapia, el uso de la nutrición parenteral domiciliaria, junto con en tratamiento antitumoral activo, aumentan la supervivencia.

Fundamento Establecer la utilidad de los distintos metodos diagnosticos para el insulinoma ennuestro medio, asi como el valor pronostico de la glucemia y/o necesidad de insulinoterapiaposquirurgica. Pacientes y metodo Se trata de un estudio retrospectivo de los casos de insulinoma diagnosticadosen los ultimos 15 anos en nuestro centro. Todos los pacientes fueron sometidos a unaprueba de ayuno y se utilizaron tecnicas diagnosticas de localizacion en los casos positivos. Inmediatamenteantes de la cirugia, durante la reseccion del tumor y en el postoperatorio inmediato,se empleo una infusion intravenosa de suero glucosado al 10% a razon de 2-3 g/kg/diapara evitar la hipoglucemia. La glucemia fue monitorizada desde el postoperatorio inmediatocada 6-8 h. Resultados Se estudiaron 17 casos (incidencia de 2,5 casos/1.000.000/ano), el 59% mujeresy un 41% varones. La sensibilidad (valor predictivo positivo [VPP]) de las tecnicas diagnosticasfue: tomografia computarizada (TC) con contraste, 30% (75%); TC helicoidal, 71,42%(100%), y ecografia intraoperatoria 100% (100%). La resonancia magnetica (RM) solo identificoel tumor en tres de 5 pacientes y la gammagrafia con In-pentetreotido solo identifico el tumoren uno de 5 pacientes. La arteriografia fue necesaria en 7 pacientes, identificando eltumor en solo dos de ellos. El cateterismo venoso selectivo fue diagnostico en el unico pacienteen el que se realizo. Los pacientes que a la larga desarrollaron diabetes mellitus o intoleranciahidrocarbonada presentaron cifras mayores de hiperglucemia posquirurgica, mas dias de hiperglucemiay de insulinoterapia, mientras que aquellos en los que existio recidiva del insulinomano presentaron hiperglucemia posquirurgica. Conclusion El comportamiento de la glucemia en el postoperatorio inmediato tras la resecciondel insulinoma puede ser util para valorar la recidiva tumoral o la aparicion de diabetes mellitusposterior.

Taurine's role in bile acid metabolism and anti-inflammatory activity could exert a protective effect on hepatobiliary complications associated with parenteral nutrition (PN). In this study, the effects of 2 amino acid solutions, with and without taurine, on liver function administered to nonacutely ill postsurgical patients as part of a short-term PN regimen were prospectively compared.Adult patients randomly received (double-blind) Tauramin 10% or a standard PN solution without taurine as the control (1.5 g amino acid/kg body weight [bw]/d; infusion rate of ≤4 mg glucose/kg bw/d) for a period of 5-30 days. γ-Glutamyl transpeptidase (GGT) and other indicators of liver function, glucose metabolism, lipid profile, inflammation markers, and treatment safety data were collected.Thirty-five patients receiving taurine PN and 39 receiving control PN were enrolled (intention-to-treat [ITT] population). Most patients (n = 62) discontinued after day 7 of follow-up (per-protocol [PP] population: n = 24 and n = 27, respectively). ITT patients with high GGT values after 5 days of PN comprised 68.6% and 64.1%, respectively. The mean change in GGT values with respect to the baseline values was 167 ± 192 and 157 ± 185 IU/L, respectively. Low-density lipoprotein (LDL) cholesterol levels after 7 days of PN were significantly decreased in the taurine PN group of PP patients (-2.83 ± 30.9 vs 23.9 ± 27.0 mg/dL for control PN; P.05). None of the adverse events reported (taurine PN: n = 6; control PN: n = 7) were treatment related.PN solutions with and without taurine had similar effects on liver function parameters, except for an LDL reduction in PN with taurine, when administered to nonacutely ill postsurgical patients in the short term (5-7 days).

To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM).The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (€, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed.It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at € 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from € 1,249 and 2.509 million euro depending on T2DM prevalence.Complications of T2DM have a great health and economic impact in ACM.

Background Our aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain). Methods From 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period. Results A significant decrease in serum glucose levels (143 ± 42 mg/dl vs 137 ± 43 mg/dl, p

The authors presented their information in a poster format at the VI GAVeCeLT National Congress "VI Congresso Nazionale GAVeCeLT (Centro Congressi Europa, Università Cattolica del Sacro Cuore)". The authors point out that the use of less invasive systems, such as a PICC catheter (peripherally inserted central catheter), produce excellent results, provided the protocols for care and maintenance are correctly applied.

Our purpose was to establish the efficacy of different diagnostic tests for the diagnosis and localization of insulinoma as well as the prognostic value of postoperative glycemia measurements.Retrospective analysis of all insulinoma patients diagnosed at our hospital over the last fifteen years. Every patient underwent a supervised prolonged fasting and localization imaging tests were performed in positive cases. In the immediate preoperative period, during surgical intervention and immediately after it, an intravenous dextrose solution (10% concentration, 2-3 g/Kg/d infusion rate) was used to avoid hypoglycemia. Glycemia was measured every 6-8 h from the immediate postoperative period until hospital discharge.Seventeen insulinoma cases were identified (incidence 2.5 cases/million/year), 59% women and 41% men. The sensitivity (and positive predictive value) of diagnostic tests was: conventional-contrast CT scan 30% (75%), spiral CT scan 71.42% (100%), arteriography 28.57% (100%) and intraoperative ultrasonography 100% (100%). MRI identified insulinoma in two out of five patients and In-pentetreotide scintigraphy only in one out of five. Patients subsequently developing diabetes mellitus or glucose intolerance had higher levels of postoperative glycemia, which also lasted for more days, and longer need for insulin therapy. However, patients with a recurrence of the tumor did not show rebound hyperglycemia at all.Postoperative glycemia could be a useful prognostic factor in patients who develop diabetes mellitus or glucose intolerance after resection of insulinoma and to predict insulinoma recurrence.

Background: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. Methods: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. Results: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the ‘candy cane' roux limb, with resolution of hypoglycemia in all cases. Conclusions: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.