Endocrinologia Diabetes Y Nutricion最新文献

Subject-matter

To assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM).

Material and methods

In this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications.

Results

During the pandemic, the gestational week at diagnosis (24.2 ± 7.4 vs 22.9 ± 7.7, p = 0.0016) and first visit to Endocrinology (26.6 ± 7.2 vs 25.3 ± 7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ± 0.48 vs 5.29 ± 0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications.

Conclusions

Care for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.

Purpose

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that begins or is diagnosed during pregnancy. Our study aimed to establish a correlation between proinflammatory and anti-inflammatory response in order to be able to develop treatment strategies and determine early diagnosis biomarkers in the sera of cases diagnosed with GDM. Moreover, we aimed to investigate interleukin (IL), placenta-specific gene 8 protein (PLAC8) and total antioxidant capacity (TAC) in patients with GDM.

Methods

A total of 121 patients were included in the study. These were divided into four patient groups: pregnant and diagnosed with DM (P-GDM, n = 30); pregnant and not diagnosed with DM (P-NGDM, n = 32); non-pregnant diagnosed with DM (NP-DM, n = 29) and non-pregnant and not diagnosed with DM (NPNDM, n = 30). IL-10, IL-17A, IL-21, IL-33, PLAC8 and TAC determinations from patients were evaluated by ELISA (Enzyme-Linked ImmunoSorbent Assay) method.

Results

IL-10 and IL-33 concentrations were found to be significantly higher in P-GDM and NP-DM patient groups compared to P-NGDM and NP-NDM groups (p < 0.001). The PLAC8 level in the P-GDM patient group (20.38 ± 5.37) was determined to be significantly higher than in the P-NGDM patient group (3.41 ± 2.17, p < 0.001). TAC in the P-NGDM and NP-NDM groups (12.42 ± 2.31 vs. 12.96 ± 3.78, p < 0.001) was determined to be significantly higher than in the P-GDM and NP-DM groups (4.8 ± 0.52 vs. 2.21 ± 0.71, p < 0.001).

Discussion

The fact that the importance of PLAC8 level and TAC in the diagnosis and follow-up of GDM in pregnancy is demonstrated for the first time in this study shows that it is unique.

Irritable bowel syndrome (IBS) is a gastrointestinal functional disorder mainly characterised by abdominal pain, bloating and altered bowel habits. Dysbiosis might seem to be involved in the pathogenesis of the disease. Probiotics represent a potential treatment, since these could favour the functional microbiota and improve symptoms. The aim was to review the effectiveness of the use of probiotics in IBS symptomatology, analysing the influence of duration and dose. 18 articles were included. At the individual level, Lactobacillus, Bifidobacterium and Bacillus could be useful in the treatment of symptoms. Bifidobacterium bifidum reported the best results (1 × 10⁹ CFU/day for 4 weeks). The most effective combination was 2 Lactobacillus strains, one of Bifidobacterium and one of Streptococcus (4 × 10⁹ CFU/day for 4 weeks). Future clinical trials should confirm these results and analyse the difference between individual and combined treatments.

Introduction

Patients with incomplete response to initial therapy of thyroid cancer can be managed with ongoing observation or potentially additional therapies.

Our aim was to assess the effect of a second radioactive iodine treatment (RAIT) and its relationship with causes and clinical variables.

Material and methods

Patients undergoing a second RAIT for biochemical or structural incomplete response to initial therapy of DTC were retrospectively included (n = 120). They were categorised based on the American Thyroid Association (ATA) classification of response to initial therapy.

Patients were reclassified in the following 6–18 months after second RAIT based on imaging findings and measurements of thyroglobulin and antithyroglobulin antibody levels.

The associations of a downgrading of response category and progression-free survival (PFS), and the related variables, were evaluated.

Results

Sixty-six patients (55%) had a downgrading on ATA response category after second RAIT. A significant interdependence of causes for second RAIT and outcomes was found (χ² = 29.400, p = 0.001), with patients with neck reoperation showing a higher rate of indeterminate or excellent responses.

A significant association between ATA response to second RAIT and absence of structural progression was found (χ² = 44.914, p < 0.001), with less structural progression in patients with downgrading on ATA response (χ² = 30.914, p < 0.001). There was also significant interdependence to some clinical variables, such as AJCC stage (χ² = 8.460, p = 0.015), ATA risk classification (χ² = 10.694, p = 0.005) and initial N stage (χ² = 8.485, p = 0.004).

Conclusions

In selected cases, a second RAIT could lead to more robust responses with a potential improvement in prognosis in patients with incomplete response to initial DTC treatment.