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INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politecnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.1 ± 3.4 kg/m2, mean duration of diabetes 25.5 ± 6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91.3%, 91.3% and 89.5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2% and 93.6% at one year, 88.2% and 93.7% at 3 years, and 85.3% and 93.7% at 5 years, respectively (P = 1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2%, 69.1% and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5% and 80.6% at one year, 64.7% and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P = .0109). Post-transplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13 years' experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.

Resumen Introduccion El trasplante simultaneo de pancreas-rinon (SPK, por simultaneous pancreas kidney) es una opcion terapeutica valida en pacientes afectos de diabetes mellitus tipo 1 con enfermedad renal cronica terminal que son candidatos a trasplante renal. Se presentan los resultados desde el inicio del programa de trasplante SPK en la Comunidad Valenciana. Metodos Estudio descriptivo, retrospectivo y unicentrico de los trasplantes de pancreas realizados en el Hospital Universitari i Politecnic La Fe, desde septiembre de 2002 a diciembre de 2015. Se recogieron variables clinicas de los donantes y receptores, variables peri-operatorias y supervivencia del paciente y del injerto pancreatico. Resultados Ochenta y un pacientes con diabetes mellitus tipo 1 (48 hombres y 33 mujeres, de 37,4 ± 5,7 anos, IMC de 24,1 ± 3,4 kg/m2, con una duracion de su diabetes de 25,5 ± 6,5 anos) recibieron un trasplante SPK. La supervivencia global del paciente a uno, 3 y 5 anos fue del 91,3, el 91,3 y el 89,5%, respectivamente. Sin embargo, la supervivencia del paciente en los periodos 2002-2008 y 2009-2015 fue del 88,2 y el 93,6% al ano, del 88,2 y el 93,7% a los 3 anos, y del 85,3 y el 93,7% a los 5 anos, respectivamente (p = 1). La supervivencia global del injerto pancreatico a uno, 3 y 5 anos fue del 75,2, el 69,1 y el 63,2%, respectivamente. Por otra parte, la supervivencia del injerto pancreatico en los periodos 2002-2008 y 2009-2015 fue del 67,5 y el 80,6% al ano, del 64,7 y el 71,8% a los 3 anos, y del 58,8 y el 65,3% a los 5 anos, respectivamente (p = 0,0109). Las complicaciones postrasplante fueron: rechazo del injerto en un 8,6%, trombosis venosa del injerto en un 7,4% y pancreatitis del injerto en un 4,9%. Conclusiones En 13 anos de experiencia en trasplante SPK, la supervivencia del paciente y del injerto pancreatico y la tasa de complicaciones tras el trasplante de pancreas son similares a las de otras series de mayor tamano. La experiencia del equipo medico-quirurgico mejora la supervivencia del injerto pancreatico, sin influir en la supervivencia del paciente.

The diagnosis of obesity comprises subjects with totally different phenotypes and metabolic profiles. Systemic inflammation and oxidative stress derived from the white adipose tissue are suggested as the link between this disease and the development of insulin resistance and metabolic comorbidities. The presence of unicellular eukaryotic parasites colonizing the human gut ecosystem is a common circumstance, and yet their influence on the inflammatory and redox status of the obese host has not been assessed. Herein, a set of inflammatory and redox biomarkers were assessed together with a parasitological analysis of 97 severely obese subjects. Information was also collected on insulin resistance and on the antioxidant composition of the diet. The global prevalence of intestinal unicellular parasites was 49.5%, with Blastocystis sp. the most prevalent protozoan found (42.3%). Colonized subjects displayed a higher total antioxidant capacity and a trend towards higher extracellular superoxide dismutase activity, regardless of their insulin resistance status, along with lower reduced glutathione/oxidized glutathione (GSH/GSSG) ratios in plasma in the insulin-resistant subgroup. No changes in malondialdehyde levels, or in inflammatory cytokines in plasma, were found in regard to the colonization status. In conclusion, enteric eukaryotic unicellular parasites may play an important role in modulating the antioxidant defenses of an obese host, thus could have beneficial effects with respect to the development of systemic metabolic disorders.

Resumen Objetivo Proporcionar unas recomendaciones practicas para la evaluacion y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Participantes Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Espanola de Endocrinologia y Nutricion (SEEN). Metodos Las recomendaciones se formularon segun el sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizo una busqueda sistematica en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron articulos escritos en ingles y castellano con fecha de inclusion hasta el 28 de febrero de 2020. En este resumen ejecutivo incluimos la evidencia reciente incorporada desde 2013. Conclusiones El documento establece unas recomendaciones practicas basadas en la evidencia acerca de la evaluacion y manejo de la hipoglucemia en pacientes con diabetes mellitus.

Resumen Objetivo Valorar objetivamente la afectacion hepatica y pancreatica en el sindrome metabolico mediante biomarcadores de resonancia magnetica (RM). Material y metodos Serie retrospectiva inicial de 407 pacientes con diagnostico de sindrome metabolico, estudiados con RM en un unico centro durante 2 anos. Se excluyeron 154 pacientes por falta de datos clinico-analiticos, alteraciones pancreaticas o inadecuada calidad de la RM. Para la medicion de la grasa hepatica y pancreatica se utilizaron las imagenes con desplazamiento quimico (en fase y fase opuesta), con medidas por regiones de interes de la fraccion grasa (%) en el pancreas (FGP) e higado (FGH). La asociacion entre las variables clinico-analiticas seleccionadas y la fraccion grasa se evaluo mediante modelos de regresion beta. Resultados Se incluyeron finalmente 253 pacientes. La FGH fue del 4,9% y la FGP del 7,9%. La FGH no presento ninguna asociacion estadistica con las variables clinico-analiticas. Sin embargo, la FGP se asocio positivamente con la edad (odds ratio [OR] = 1,025, p Conclusiones La esteatosis pancreatica puede considerarse un marcador del sindrome metabolico y la diabetes. La RM cuantitativa permite el diagnostico y la gradacion de pacientes con pancreas graso mediante tecnicas sencillas de desplazamiento quimico.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of unknown etiology that affects upper and lower motor neurons resulting in progressive atrophy of skeletal muscles. There are two forms of ALS: spinal motor neuron injury and bulbar paresis. Dysphagia is a highly prevalent severe and invalidating symptom in ALS: almost 80% of ALS patients with bulbar paresis will develop dysphagia. Also, dysphagia is one of the most common and serious complications, with respiratory insufficiency, in patients with ALS as it exposes them to malnutrition, dehydration and aspiration pneumonia. These conditions are reported to be associated with a minor survival in patients with ALS. Screening for dysphagia must be performed in all ALS patients at diagnosis and during the follow-up to approach dysphagia as soon as possible. This chapter includes the latest developments in the assessment and approach of dysphagia in ALS patients.

A definition of pancreatic fistula specifically addressing pancreas transplantation (PT) is lacking. This study sought to characterize pancreatic fistula in this setting and to define its clinical relevance on the postoperative course and long-term graft survival (GS).Consecutive simultaneous pancreas and kidney transplantations were analysed. The global postoperative course was assessed through the comprehensive complication index (CCI). PF was defined according to the original International Study Group for Pancreatic Surgery (ISGPS) definition. Predictors of poor postoperative course and GS were explored.Seventy-eight patients were analysed. Surgical morbidity was 48.7%, with severe complications occurring in 39.7%. Ninety-day mortality was 2.6%. PF occurred in 56.6% of patients, although its average clinical burden was low and did not correlate with either early or long-term outcomes. Peri-graft fluid collections, postoperative day (POD) 1 drain fluid amylase (DFA) ≥ 2200 U/L, and POD 5 DFA/serum amylase ratio ≥7.0 independently correlated with poor postoperative course. Perigraft fluid collections were associated with reduced GS.Conventionally defined pancreatic fistula is frequent following PT, although its clinical impact is negligible. To define clinically relevant PF, novel cut-offs for DFA might be pondered in a future series, while perigraft fluid collections should be strongly considered.

Background: Challenges of patient care in diabetes were exacerbated by COVID, undermining the ability of patients to engage in-person with health care professionals (HCPs). To combat this, there has been accelerated adoption of telemedicine to support patient and provider connectivity. Methods: We collated survey information regarding telemedicine from 21 European clinical institutions. Health care professionals joined virtual meetings focusing on the OneTouch Reveal (OTR) ecosystem and its utility for conducting telemedicine. Selected HCPs provided clinical case studies to explain how the OTR ecosystem supported patient care. Results: Remote consultations increased by nearly 50% in 21 European clinics during the pandemic (Belgium [24%], Iberia [65%], Germany [34%], Italy [54%]). In all, 52% of people with diabetes using OTR app to connect remotely with HCPs had type 1 diabetes and 48% had type 2 diabetes. Remote connection methods included telephone (60%), email (19%), video chat (10%), text only (3%), or a mix of these methods (8%). Health care professionals usually reviewed patient data during consultations (45%) rather than before consultations (25%). Fifty-five percent of HCPs indicated digital ecosystems like OTR ecosystem would become their standard of care for diabetes management. In-depth conversations with HCPs provided a deeper understanding of how a digital ecosystem integrated into clinical practice and population management. In addition, five patient case studies using OTR ecosystem were provided by a selection of our HCPs. Conclusion: Diabetes management solutions, such as OTR ecosystem, supported telemedicine during the pandemic and will continue to play a valuable role in patient care beyond the pandemic.

Resumen Antecedentes El objetivo de este consenso es esclarecer el papel de los iDPP-4 en el manejo de los pacientes con diabetes durante la pandemia por COVID-19. Material y metodos Se llevo a cabo una busqueda bibliografica en PubMed (diciembre 2019-febrero de 2021). Se empleo la metodologia Oxford y se establecieron de forma consensuada posibles recomendaciones. Resultados La diabetes parece ser un factor independiente en la enfermedad de COVID-19 (evidencia 2b). No se demuestra mayor riesgo de contagio con iDPP-4 (evidencia 2b), y su uso ha demostrado ser seguro (evidencia 2b). Los iDPP-4 pueden presentar un cierto beneficio en la reduccion de la mortalidad, particularmente su uso intrahospitalario (evidencia 2a), reduciendo la admision a unidades de cuidados intensivos (evidencia 2b) y la necesidad de ventilacion mecanica (evidencia 2b). Conclusiones Los iDPP-4 parecen ser farmacos seguros en pacientes con COVID-19, y se necesitan estudios de calidad que aclaren sus posibles ventajas.

Resumen La prevalencia de la obesidad se ha incrementado mundialmente en las ultimas decadas. La obesidad se asocia a multiples comorbilidades, como la diabetes tipo 2, que generan un gran impacto en la salud y en la economia. La perdida de peso en este colectivo favorece el control glucemico, por lo que es uno objetivo a lograr. Los cambios en el estilo de vida son poco efectivos por si solos, y en los ultimos anos se han desarrollado otras opciones terapeuticas como la cirugia bariatrica/metabolica, asi como farmacos para la diabetes tipo 2 y farmacos para reducir peso en la obesidad. El objetivo de la revision es la comparacion de los resultados en reduccion de peso y control glucemico de los distintos tipos de farmacos con los resultados de la cirugia bariatrica/metabolica en diabetes tipo 2.

Bariatric surgery has demonstrated to be effective in remission of type 2 diabetes in obese patients, but it is unclear in non-obese patients. The aim of this study is to investigate if metabolic surgery is effective in diabetes resolution in patients with BMI

[EN] Background: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. Objective: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. Methods: We first studied the users' needs and gathered users' graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. Results: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11%), 5 overweight people (7%), and no obesity cases. The mean BMI was 21.4 kg/m(2) (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. Conclusions: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives., Moreover, the authors acknowledge the funding support for this study provided by the CrowdHealth Project (Collective Wisdom Driving Public Health Policies, 727560).

Introducción: Los pacientes sometidos a Trasplante de Células Madre Hematopoyéticas o trasplante de médula padecen varias complicaciones nutricionales. El objetivo del estudio fue realizar una descripción prospectiva en estos pacientes.Material y métodos: Se reclutaron 14 pacientes con una edad media de 48,0±9,8 años. Resultados: El 28,6% padecía sobrepeso, el 14,3% obesidad y el 57,1% tenía un peso normal, con una evoluciónentre -0,3±0,3 kg/m2 (normopeso) hasta -3,1±0,2 kg/m2 (obesidad). Se observó una pérdida de peso variable, de hasta 7,3±0,7% en pacientes con mayor Índice de Masa Corporal (IMC). La composición corporal también empeoró al alta, con una evolución de la circunferencia braquial de -1,7±0,4 cm en trasplantes alogénicos y -2±4,5 cm en trasplantes autólogos. Un 42,9% de hombres y 28,6% de mujeres eran dados de alta con un Índice de Masa Libre de Grasa (IMLG) por debajo de las recomendaciones, incrementándose desde el ingreso en hombres (desde un 14,3%). Se observa una pérdida de fuerza muscular, en trasplantes alogénicos de -5,0±1,5 kg en el caso de hombres, y -3,0±0,5 kg en mujeres; en autólogos, de -5 kg y -4 kg respectivamente. Sobre síntomas, al inicio existía una alta prevalencia de vómitos (71,4%), náuseas (42,9%) o saciedad temprana (57,1%); durante la hospitalización, destaca la saciedad temprana (92,9%), náuseas (71,4%), vómitos (71,4%), disgeusia (57,1%), diarrea (50%) y anorexia (50%). Conclusiones: Los pacientes admitidos para trasplante de médula ósea están aparentemente bien nutridos, y existe un deterioro durante la hospitalización; parece adecuado implementar estrategias dietéticas durante la hospitalización para optimizar la ingesta y prevenir la malnutrición.

Background Obesity is a chronic disease whose pathogenesis has been related to changes in the intestinal microbiota. Yet, the role of protozoa and other unicellular eukaryotic parasites in this microenvironment is still largely unknown. Their presence within the gut ecosystem in obese subjects warrants further study, as well as their influence on the host metabolism and comorbidities. Methods Herein, a single center, cross-sectional study of 104 obese individuals was performed to assess the presence of six intestinal unicellular parasites in stool using a commercially available kit, and to evaluate its relationship with the presence of abdominal symptoms, metabolic comorbidities, variations in body composition and nutritional deficiencies. Results The overall parasitic colonization rate was 51%, with Blastocystis sp., identified as the most frequent (44.2%), followed by Dientamoeba fragilis (11.5%) and Giardia intestinalis (8.7%), and significantly related to the consumption of ecological fruits and vegetables. Contrary to what previous studies pointed out, colonization with parasites species was significantly associated with fewer abdominal symptoms and depositions per day. The presence of parasites did not correlate with any nutritional deficiencies nor differences in body composition, while it did with significant lower HOMA-IR levels and a lower trend towards metabolic syndrome. Conclusion Obese subjects frequently harbor unicellular enteric parasites, apparently without clinical nor nutritional harm. This evidence suggests that carrying these microorganisms, from an endocrinological perspective, has a beneficial effect, especially on insulin resistance and possibly on the development of related comorbidities.

This chapter is a descriptive use case of the Interactive Process Mining paradigm in one of the most significant problems of healthcare in relation to the management of chronic conditions, Type 2 Diabetes Mellitus. The chapter firstly performs a comprehensive description of the disease, its origins, evolution and standard of care, to thereafter adapt the concepts of Interactive Process Mining to trigger big quantities of heterogeneous observational data into actionable information for patient’s evaluations. The use case is focused in the analysis of Glycated Hemoglobin, a major indicator of blood glucose levels and a key factor in the management of the disease. The chapter is a preliminary approach to the application of Interactive Process Mining in healthcare

Objective To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. Participants Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). Methods The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 28 February 2020 were reviewed. This executive summary takes account of the evidence incorporated since 2013. Conclusions The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

Neuroendocrine tumors (NETs) frequently overexpress somatostatin receptors (SSTR) on their cell surface. The first-line pharmacological treatment for inoperable metastatic functioning well-differentiated NETs are somatostatin analogs. On second line, Lu-DOTA-TATE (177Lu-DOTA0 Tyr 3 octreotate) has shown stabilization of the disease and an increase in progression free survival, as well as effectiveness in controlling symptoms and increasing quality of life. The management of functional NETs before and during LU-DOTA-TATE treatment is specially challenging, as several complications such as severe carcinoid and catecholamine crisis have been described. The aim of this review is to establish practical guidance for the management and prevention of the most common hormonal crises during radionuclide treatment with Lu-DOTA-TATE: carcinoid syndrome (CS) and catecholamine hypersecretion, as well as to provide a brief commentary on other infrequent metabolic complications. To establish a practical approach, a systematic review was performed. This systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and conducted using MEDLINE (accessed from PubMed), Google Scholar and ClinicalTrials.gov. Literature searches found 449 citations, and finally nine were considered for this systematic review.

FreeStyle Libre2 system is a sensor-based flash monitoring (FM) system, which assesses interstitial fluid glucose. The study aimed to estimate the cost associated with the use of FM compared to self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (T2DM) population from the Spanish National Health System perspective. The cost for glucose monitoring in T2DM patients treated with ≥2 insulin doses a day was modelled. The cost estimation considered the annual resource consumption for glucose monitoring (strips, lancets and FM sensors) and clinical management of hypoglycemia episodes. Severe hypoglycemia episodes (SHE) and non-severe hypoglycemia episodes (NSHE) published event rates (2.5 and 17.0 episodes/patient/year) were considered. Event reductions associated to FM system use were applied (48.8% [SHE]; 27.7% [NSHE]), derived from REPLACE trial findings. Based on published evidence, hospital attendance was required in 20.5% of SHEs (further hospitalization in 16.0%). Daily strip and lancet-consumption in T2DM patients was fixed at 4.81 for SMBG users, and 0.2 for FM system users according the REPLACE findings. FM sensor annual consumption per patient was 26. Unitary costs (€,2019 excluding VAT) derived from national databases and literature were: €0.28/strip; €0.09/lancet; €3.09/daily FM sensor; €3,774/hospitalized SHE; €1,779/hospital-attended non-admitted SHE; €385/community attended SHE and €15/NSHE. Yearly cost was €2,779 and €2,295 per patient using SMBG or FM system, respectively. For a cohort of 1,000 T2DM patients using ≥2 insulin doses a day; 1,221 SHEs (48 hospitalizations for SHE) and 4,715 NSHEs, yearly could be avoided with FM use. The use of the FM system in 1,000 patients could generate annual cost-savings up to €483,031 compared to SMBG (-17.4% of cost reduction). In conclusion, FM system is a potential cost-saving strategy in T2DM patients treated with ≥2 insulin doses a day, in Spain. Disclosure F. Gomez-Peralta: Advisory Panel; Self; Abbott, Menarini Group, Novartis AG, Sanofi. Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novartis AG, Novo Nordisk A/S, Sanofi. I. Oyagüez: None. S. Artola: None. F. Carrasco: None. J. Carretero Gomez: None. F. Garcia-Soidan: None. R. Gomez-Huelgas: None. J. Merino Torres: None. A. Pérez: None. Funding Abbott Diabetes Care

IntroductionCompare cost of the interstitial liquid glucose flash monitoring (FM) system (FreeStyle Libre 2) versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes mellitus (T1DM) in Spain.Research design and methodsA model was developed to estimate, with the perspective of the Spanish health system, the annual costs associated with glucose monitoring and hypoglycemic events management in T1DM population, with multiple insulin daily doses (MDI). According to published evidence, rate of severe hypoglycemia (SHE) of 4.90 episodes per patient-year was applied. Reduction of SHE (58.6%) was modeled associated with FM use. Published rates of hospital care (20.2%) and subsequent admission (16%) were assumed for SHE. The daily consumption of strips and lancets was 9 in patients with SMBG (before and after 4 daily intakes and at bedtime) and 0.5 for FM users (according to IMPACT trial findings). Annual consumption of 26 FM sensors was considered (1 every 14 days). Unit costs (in € of 2019, excluding VAT) were obtained from literature and national databases. Sensitivity analyses (SA) were carried out to evaluate the model robustness.ResultsThe total annual cost/patient was €4437 for SMBG and €2526 for FM. The use of FM would be associated with an annual savings in the costs of monitoring and managing hypoglycemic events of €1911 per patient-year. In a hypothetical cohort of 1000 patients with T1DM MDI, FM could avoid in 1 year 4900 SHE, 93 hospitalizations for SHE. In addition, the use of FM would generate total savings of up to €1 910 000 per year. In the SA with alternative hypoglycemia events rates and use of strips and lancets, and including non-SHE episodes, savings from €370 000 to €1 760 000 were observed with FM.ConclusionsThe use of the FM system to monitor glucose in adults with T1DM treated with MDI, would reduce hypoglycemic events and would result in cost savings for the health system.

Background. Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. Methods. Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. Results. 48 males and 33 females, mean age 37.4±5.7 years, mean BMI 24.0±3.4 kg/m2, and mean duration of diabetes 25.5±6.5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5th year after SPK (p=0.03), as well as improvement of the Valsalva ratio at the 3rd (p<0.001) and 5th (p=0.001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. Conclusions. Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test.

OBJECTIVE To objectively evaluate hepatic and pancreatic involvement in metabolic syndrome through magnetic resonance imaging (MRI) biomarkers. MATERIAL AND METHODS From an initial retrospective sample of 407 patients diagnosed with metabolic syndrome studied by MRI in a single center during a 2-year period, 154 were excluded because of a lack of clinical and/or laboratory data, pancreatic abnormalities, or inadequate quality of MRI studies. To measure hepatic and pancreatic fat, we used chemical shift imaging (in-phase and out-of-phase), measuring the fat fraction (%) in regions of interest in the pancreas and liver. Associations between the fat fraction and selected clinical and laboratory variables were assessed with beta regression models. RESULTS In the end, 253 patients were included. The hepatic fat fraction was 4.9% and the pancreatic fat fraction was 7.9%. We found no significant associations between the hepatic fat fraction and any of the clinical or laboratory variables. However, the pancreatic fat fraction was positively associated with age (OR=1.025, p

Los tumores neuroendocrinos son neoplasias infrecuentes y de abordaje complejo. Actualmente se necesitan más ensayos clínicos aleatorizados para establecer el manejo óptimo de los pacientes afectados por metástasis hepáticas no resecables. Aportamos un caso de TNE metastásico en el que se indicó trasplante hepático por sintomatología derivada del síndrome carcinoide no controlable con el tratamiento médico habitual.

BACKGROUND Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. OBJECTIVE This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. METHODS We first studied the users’ needs and gathered users’ graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. RESULTS We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11%), 5 overweight people (7%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. CONCLUSIONS The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives.

Nowadays, scientific studies are emerging on the possible etiological role of intestinal parasites in functional digestive disorders. Our study was carried out with healthy individuals (control group, n = 82) and symptomatic patients with lactose or fructose malabsorption, including positive (malabsorbers, n = 213) and negative (absorbers, n = 56) breath test, being analyzed for the presence of intestinal parasites. A high parasitic prevalence was observed in malabsorbers (41.8%), exclusively due to single-cell eukaryotes but not helminths. Giardia intestinalis was the predominant parasite in cases of abnormal absorption (26.5%), significantly associated with fructose malabsorption and doubling the probability of developing this pathology. Within controls, Blastocystis sp. (13.4%) was almost the only parasite, being the second among patients (12.6%), and Cryptosporidium parvum, the last species of clinical relevance, was detected exclusively in two malabsorbers (0.9%). The consumption of ecological food and professions with direct contact with humans arose as risk factors of parasitism. A diagnosis of carbohydrate malabsorption in adulthood is the starting point, making the search for the primary cause necessary. Accurate parasitological diagnosis should be considered another tool in the clinical routine for patients with recurrent symptoms, since their condition may be reversible with adequate therapeutic intervention.