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Olivares J, Masmiquel L, Del Campo R, Costa A, Cladera A, Amer N, Sureda A, Muñiz M, Borras J, Bargay J. Β2-Microglobulin Correlates With Bia-Muscle Mass Indexes In Newly Diagnosed Patients With Hematological Malignancies. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Pujol A, Gómez LA, Gallegos C, Nicolau J, Sanchís P, González-Freire M, López-González ÁA, Dotres K, Masmiquel L. Thyroid as a target of adjuvant autoimmunity/inflammatory syndrome due to mRNA-based SARS-CoV2 vaccination: from Graves' disease to silent thyroiditis. J Endocrinol Invest 2022; 45:875-882. [PMID: 34792795 PMCID: PMC8598936 DOI: 10.1007/s40618-021-01707-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND As COVID-19 became a pandemic, the urgent need to find an effective treatment vaccine has been a major objective. Vaccines contain adjuvants which are not exempt from adverse effects and can trigger the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). There is very little information about autoimmune endocrine disease and the ASIA after the use of mRNA-based SARS-CoV2 vaccination. CASE SERIES We report three cases and also review the literature showing that the thyroid gland can be involved in the ASIA induced by the mRNA-based SARS-CoV2 vaccination. We present the first case to date of silent thyroiditis described in the context of SARS-CoV2 vaccination with Pfizer/BioNTech. Also, we discuss the first subacute thyroiditis in the context of SARS-CoV2 vaccination with the Moderna's vaccine. Finally, we provide another case to be added to existing evidence on Graves' disease occurring post-vaccination with the Pfizer/BioNTech vaccine. DISCUSSION Adjuvants play an important role in vaccines. Their ability to increase the immunogenicity of the active ingredient is necessary to achieve the desired immune response. Both the Moderna and the Pfizer/BioNTech vaccines use mRNA coding for the SARS-CoV2 S protein enhanced by adjuvants. In addition, the cross-reactivity between SARS-CoV2 and thyroid antigens has been reported. This would explain, at least, some of the autoimmune/inflammatory reactions produced during and after SARS-CoV2 infection and vaccination. CONCLUSION The autoimmune/inflammatory syndrome induced by adjuvants involving the thyroid could be an adverse effect of SARS-CoV2 vaccination and could be underdiagnosed.
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Affiliation(s)
- A. Pujol
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - L.-A. Gómez
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - C. Gallegos
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- Microbiology Department, Son Llàtzer University Hospital, Palma, Baleares Spain
| | - J. Nicolau
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - P. Sanchís
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- Chemistry Department, University of Balearic Islands, Palma, Baleares Spain
| | - M. González-Freire
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - Á. A. López-González
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- ADEMA University School, Palma, Baleares Spain
| | - K. Dotres
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - L. Masmiquel
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
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Nicolau J, Simó R, Conchillo C, Sanchís P, Blanco J, Romerosa JM, Fortuny R, Bonet A, Masmiquel L. Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes. J Endocrinol Invest 2019; 42:881-888. [PMID: 30788770 DOI: 10.1007/s40618-019-01020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM. PURPOSE To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM. METHODS 87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups. RESULTS The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001). CONCLUSIONS Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.
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Affiliation(s)
- J Nicolau
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain.
| | - R Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - C Conchillo
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - P Sanchís
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J Blanco
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - J M Romerosa
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - R Fortuny
- Hormonal Laboratory Department, Hospital Son Llàtzer, Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - A Bonet
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
| | - L Masmiquel
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Palma (IdISPa), Ctra Manacor km 4, 07198, Palma de Mallorca, Baleares, Spain
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Arteaga M, Ayala L, Nicolau J, Lladó B, Sanchis P, Blanco J, Romerosa J, Masmiquel L. Nutritional status and screening of depressive disorder among patients waiting for knee or hip arthroplasty. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leiter LA, Charpentier G, Chaykin L, Garwey WT, Warren ML, Karsbøl JD, Thielke D, Masmiquel L, Lüdemann J. Semaglutid reduzierte das Körpergewicht in den Studien SUSTAIN 1 – 5 unabhängig vom Baseline-BMI. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- LA Leiter
- Departments of Medicine and Nutritional Sciences, Toronto, Canada
| | | | - L Chaykin
- Meridien Research, Bradenton, Bradenton, United States
| | - WT Garwey
- Department of Nutrition Sciences at the University of Alabama, Birmingham, United States
| | - ML Warren
- Endocrinology, Greenville, United States
| | | | | | - L Masmiquel
- Endocrinólogo Palma de Mallorca, Palma de Mallorca, Spain
| | - J Lüdemann
- Schwerpunktpraxis für Diabetes, Gefäß- & Ernährungsmedizin, Falkensee, Germany
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Nicolau J, Simó R, Sanchís P, Ayala L, Fortuny R, Rivera R, Masmiquel L. Prevalence and Clinical Correlators of Undiagnosed Significant Depressive Symptoms Among Individuals with Type 2 Diabetes In A Mediterranean Population. Exp Clin Endocrinol Diabetes 2016; 124:630-636. [DOI: 10.1055/s-0042-109606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J. Nicolau
- Endocrinology and Nutrition Department, Hospital Son LLàtzer (Palma, Spain), University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa)
| | - R. Simó
- Diabetes Research Unit, Endocrinology Division, Hospital Universitari Vall d’Hebron, Universistat Autònoma de Barcelona (Barcelona, Spain)
| | - P. Sanchís
- Endocrinology and Nutrition Department, Hospital Son LLàtzer (Palma, Spain), University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa)
| | - L. Ayala
- Endocrinology and Nutrition Department, Hospital Son LLàtzer (Palma, Spain), University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa)
| | - R. Fortuny
- Hormonal Laboratory Department, Hospital Son Llàtzer (Palma, Spain)
| | - R. Rivera
- Endocrinology and Nutrition Department, Hospital Son LLàtzer (Palma, Spain), University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa)
| | - L. Masmiquel
- Endocrinology and Nutrition Department, Hospital Son LLàtzer (Palma, Spain), University Institute of Health Sciences Research (IUNICS) and Health Research Institute of Palma (IdISPa)
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Masmiquel L, Leiter LA, Vidal J, Bain S, Petrie J, Franek E, Raz I, Comlekci A, Jacob S, van Gaal L, Baeres FMM, Marso SP, Eriksson M. LEADER 5: prevalence and cardiometabolic impact of obesity in cardiovascular high-risk patients with type 2 diabetes mellitus: baseline global data from the LEADER trial. Cardiovasc Diabetol 2016; 15:29. [PMID: 26864124 PMCID: PMC4750199 DOI: 10.1186/s12933-016-0341-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/22/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Epidemiological data on obesity are needed, particularly in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular (CV) risk. We used the baseline data of liraglutide effect and action in diabetes: evaluation of CV outcome results-A long term Evaluation (LEADER) (a clinical trial to assess the CV safety of liraglutide) to investigate: (i) prevalence of overweight and obesity; (ii) relationship of the major cardiometabolic risk factors with anthropometric measures of adiposity [body mass index (BMI) and waist circumference (WC)]; and (iii) cardiometabolic treatment intensity in relation to BMI and WC. METHODS LEADER enrolled two distinct populations of high-risk patients with T2DM in 32 countries: (1) aged ≥50 years with prior CV disease; (2) aged ≥60 years with one or more CV risk factors. Associations of metabolic variables, demographic variables and treatment intensity with anthropometric measurements (BMI and WC) were explored using regression models (ClinicalTrials.gov identifier: NCT01179048). RESULTS Mean BMI was 32.5 ± 6.3 kg/m(2) and only 9.1 % had BMI <25 kg/m(2). The prevalence of healthy WC was also extremely low (6.4 % according to International Joint Interim Statement for the Harmonization of the Metabolic Syndrome criteria). Obesity was associated with being younger, female, previous smoker, Caucasian, American, with shorter diabetes duration, uncontrolled blood pressure (BP), antihypertensive agents, insulin plus oral antihyperglycaemic treatment, higher levels of triglycerides and lower levels of high-density lipoprotein cholesterol. CONCLUSIONS Overweight and obesity are prevalent in high CV risk patients with T2DM. BMI and WC are related to the major cardiometabolic risk factors. Furthermore, treatment intensity, such as insulin, statins or oral antihypertensive drugs, is higher in those who are overweight or obese; while BP and lipid control in these patients are remarkably suboptimal. LEADER confers a unique opportunity to explore the longitudinal effect of weight on CV risk factors and hard endpoints.
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Affiliation(s)
- L Masmiquel
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS-IdISPa), Universitat de les Illes Balears, Palma, Majorca, Spain.
| | - L A Leiter
- Divisions of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - J Vidal
- Endocrinology and Nutrition Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - S Bain
- Institute of Life Science, Swansea University, Swansea, UK.
| | - J Petrie
- Institute of Cardiovascular and Medical Science, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
| | - E Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences and Central Clinical Hospital MSW, Warsaw, Poland.
| | - I Raz
- Diabetes Unit, Internal Medicine Division, Hadassah Hebrew University Hospital, Jerusalem, Israel.
| | - A Comlekci
- Department of Internal Medicine, Division of Endocrinology, Inciralti, Izmir, Turkey.
| | - S Jacob
- Praxis für Prävention und Therapie, Kardio Metabolischen Instituts, Villingen-Schwenningen, Germany.
| | - L van Gaal
- Department of Endocrinology, Diabetology, and Metabolism, Faculty of Medicine, Antwerp University Hospital, Edegem, Antwerp, Belgium.
| | | | - S P Marso
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - M Eriksson
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
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Masmiquel L. [Cardiovascular effects and safety of glucose-lowering drugs: current situation]. Semergen 2014; 40:80-8. [PMID: 24655910 DOI: 10.1016/j.semerg.2012.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/23/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
Abstract
Diabetes mellitus is an independent cardiovascular risk factor. Therefore, in addition to normalising blood glucose, the aim of the treatment for diabetes mellitus should be to prevent cardiovascular complications. However, the evidence available on the cardio-protective role of the different glucose-lowering drugs is scarce and poor, particularly as regards with the risk of major cardiovascular events. In this context, the regulatory agencies have modified the regulations for the approval of glucose-lowering drugs, now requiring to demonstrate the glucose-lowering effect together with a robust assessment of the cardiovascular safety. The aim of this work is to review the cardiovascular effects of the different glucose-lowering drugs, focusing on their impact on the risk of major cardiovascular events.
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Affiliation(s)
- L Masmiquel
- Servicio de Endocrinología, Hospital Son Llàtzer, Palma de Mallorca, España.
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Speranskaya A, Nicolau J, Olivares J, Pascual S, González De Cabo M, Masmiquel L. Mesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Clin Obes 2013; 3:56-8. [PMID: 25586392 DOI: 10.1111/cob.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 12/25/2022]
Abstract
Mesenteric vein thrombosis is a rare complication of bariatric laparoscopic surgery. We report a case of a 47-year-old man with obesity who had mesenteric vein thrombosis 14 days after laparoscopic sleeve gastrectomy. He was treated with heparin anticoagulation with a good therapeutic response. This case and literature review illustrate that mesenteric vein thrombosis has to be included in the differential diagnosis of abdominal pain after a bariatric procedure and listed formally as a complication of bariatric surgery.
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Affiliation(s)
- A Speranskaya
- Endocrinology, Hospital Son Llatzer, Palma de Mallorca, Spain
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Garcia-Ramírez M, Hernández C, Villarroel M, Canals F, Alonso MA, Fortuny R, Masmiquel L, Navarro A, García-Arumí J, Simó R. Interphotoreceptor retinoid-binding protein (IRBP) is downregulated at early stages of diabetic retinopathy. Diabetologia 2009; 52:2633-41. [PMID: 19823802 DOI: 10.1007/s00125-009-1548-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 09/02/2009] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Interphotoreceptor retinoid-binding protein (IRBP) plays a major role in the visual cycle and is essential to the maintenance of photoreceptors. The aim of this study was to determine whether a decrease in IRBP production exists in the early stages of diabetic retinopathy. METHODS Vitreous samples from diabetic patients with proliferative and non-proliferative diabetic retinopathy (PDR, NPDR), and from non-diabetic patients with macular hole (control group) were selected for IRBP quantitative assessment by proteomic analysis (fluorescence-based difference gel electrophoresis) and western blot. Human post mortem eyes (n = 16) from diabetic donors without clinically detectable retinopathy and from non-diabetic donors (n = 16) were used to determine IRBP (also known as RBP3) mRNA levels (RT-PCR) and protein content (western blot and confocal microscopy). Retinal neurodegeneration was assessed by measuring glial fibrillar acidic protein (GFAP) and the apoptotic rate. Y79 human retinoblastoma cells were used to test the effects of glucose, TNF-alpha and IL-1beta on IRBP expression and IRBP levels. RESULTS Intravitreous IRBP concentration was significantly lower in PDR < NPDR < control in proteomic and western blot analysis. IRBP mRNA levels and IRBP protein content were significantly lower in the retinas from diabetic donors than in those from non-diabetic donors. Increased GFAP and a higher degree of apoptosis were observed in diabetic retinas compared with non-diabetic retinas. A dose-dependent downregulation of IRBP mRNA expression and IRBP content was detected with glucose, TNF-alpha and IL-1beta in cultures of Y79 human retinoblastoma cells. CONCLUSIONS/INTERPRETATION Underproduction of IRBP is an early event in the human diabetic retina and is associated with retinal neurodegeneration. The mechanisms leading to this deficit deserve further investigation.
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Affiliation(s)
- M Garcia-Ramírez
- CIBER for Diabetes and Associated Metabolic Diseases (CIBERDEM), Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Rullan M, Cerdà L, Frontera G, Masmiquel L, Llobera J. Authors' response to 'Comments on the use of bemiparin in diabetic foot ulcers'. Diabet Med 2009; 26:313-4. [PMID: 19317831 DOI: 10.1111/j.1464-5491.2009.02670.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rullan M, Cerdà L, Frontera G, Masmiquel L, Llobera J. Treatment of chronic diabetic foot ulcers with bemiparin: a randomized, triple-blind, placebo-controlled, clinical trial. Diabet Med 2008; 25:1090-5. [PMID: 19183313 DOI: 10.1111/j.1464-5491.2008.02527.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To assess the efficacy and safety of bemiparin in the treatment of chronic diabetic foot ulcers. METHODS A triple-blind, parallel, randomized, placebo-controlled trial. Patients aged > 18 years, [corrected] with diabetes for at least 3 years, and with a foot ulcer persisting for > 3 months were selected from 39 Spanish centres. Bemiparin 3500 IU/day for 10 days, followed by 2500 IU/day for up to 3 months plus standard care for ulcers, was compared with placebo plus standard care for ulcers for 3 months. The primary efficacy end-point was ulcer improvement, defined as an objective decrease in ulcer area of >or= 50%, measured by digital photography and ImageJ software, and/or any decrease in Wagner's ulcer grade at 3 months. RESULTS Ulcer improvement rates were 70.3% (26 of 37 patients) in the bemiparin group and 45.5% (15 of 33 patients) in the placebo group [absolute difference 24.8; 95% confidence interval (CI) 2.3, 47.3; P = 0.035] (number needed to treat 4; 95% CI 2, 43). Complete healing rates at 3 months were similar in both groups (35.1% vs. 33.3%; P = 0.874), as were the number of adverse events. CONCLUSIONS Bemiparin is more effective than placebo in the management of diabetic foot ulcers and has few side-effects.
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Affiliation(s)
- M Rullan
- Pollença Primary Care Centre, Ib-Salut, Mallorca, Spain.
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Burguera B, Agusti A, Arner P, Baltasar A, Barbe F, Barcelo A, Breton I, Cabanes T, Casanueva FF, Couce ME, Dieguez C, Fiol M, Fernandez Real JM, Formiguera X, Fruhbeck G, Garcia Romero M, Garcia Sanz M, Ghigo E, Gomis R, Higa K, Ibarra O, Lacy A, Larrad A, Masmiquel L, Moizé V, Moreno B, Moreiro J, Ricart W, Riesco M, Salinas R, Salvador J, Pi-Sunyer FX, Scopinaro N, Sjostrom L, Pagan A, Pereg V, Sánchez Pernaute A, Torres A, Urgeles JR, Vidal-Puig A, Vidal J, Vila M. Critical assessment of the current guidelines for the management and treatment of morbidly obese patients. J Endocrinol Invest 2007; 30:844-52. [PMID: 18075287 DOI: 10.1007/bf03349226] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.
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Affiliation(s)
- B Burguera
- Endocrinology Service, Hospital Universitario Son Dureta, Instituto Universitario Ciéncias de la Salud (IUNICS), Mallorca, Spain.
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Rullán M, Cerdà L, Frontera G, Llobera J, Masmiquel L, Olea JL. [Triple-blind clinical trial with placebo control to evaluate the efficacy of a heparin of low molecular weight (bemiparin) for treating slow-responding ulcers in diabetic foot in primary care]. Aten Primaria 2003; 31:539-44. [PMID: 12765594 PMCID: PMC7681896 DOI: 10.1016/s0212-6567(03)70729-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To establish the degree of efficacy of bemiparin treatment over 3 months in the improvement of slow-responding ulcers in diabetic foot. Also, to evaluate the safety of bemiparin and quality of life and to compare the evolution of retinopathy and nephropathy against placebo. DESIGN Stage III clinical trial to evaluate efficacy and safety in a new indication of a medicine already on the market, parallel in two branches, randomised, triple-blind, and controlled with placebo. SETTING Health care centres in Mallorca, Spain. PARTICIPANTS 42 patients per branch, over 18, with type-1 or 2 DM of over 3 years evolution, and one or more first or second-degree ulcers on the Wagner scale, distal to the knee, that did not heal in three months of health care. Randomised allocation in blocks of four.Interventions. The experimental drug was bemiparin (heparin of low molecular weight), injected subcutaneously at 3500 IU/day for the first 10 days and 2500 IU/day up to 90 days. As control, physiological serum was injected sub-cutaneously in a similar volume for masking. MAIN MEASUREMENTS An "effect"was defined as a reduction of at least 50% in its surface area and/or a favourable evolution in status to a degree between the control at the start of treatment and at three months. Other measurements included proteinuria, retinography and quality of life (SF-36). Analysis of efficacy through principle of intention to treat.
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Affiliation(s)
- M Rullán
- Médico de Atención Primaria. Centro de Salud de Pollença. Mallorca. España.
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15
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Masmiquel L, Segura RM, Mateo C, Calatayud M, Martí R, Mesa J, Simó R. Serum laminin as a marker of diabetic retinopathy development: a 4-year follow-up study. Am J Ophthalmol 2000; 129:347-52. [PMID: 10704551 DOI: 10.1016/s0002-9394(99)00361-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE The usefulness of laminin as a serum marker of diabetic retinopathy is a topic that generates conflicting views. The aim of the present study was to investigate the effect of diabetic retinopathy on serum laminin-P1, the larger pepsin resistant fragment of laminin, and to elucidate whether serum laminin-P1 could be an indicator of the risk for development of diabetic retinopathy. METHODS In a prospective study, 97 consecutive diabetic patients (35 type 1 and 62 type 2) without diabetic retinopathy and a urinary albumin excretion rate lower than 20 microg per minute were enrolled in a 4-year follow-up study. Patients who developed microalbuminuria during the study were excluded in order to avoid the influence of diabetic nephropathy on serum laminin-P1. At the end of follow-up, data from ophthalmologic studies and serum laminin-P1 were evaluated in the 66 normoalbuminuric diabetic patients who completed the study. RESULTS No statistical differences were observed in baseline laminin-P1 serum concentrations between patients who developed diabetic retinopathy (n = 15) and patients who remained without it during follow-up (n = 51). However, serum laminin-P1 levels obtained at the end of the study were significantly higher in patients who developed diabetic retinopathy (1.75 +/- 0.33 U/ml versus 1.47 +/- 0. 27 U/ml; P =.002). Furthermore, statistical difference was observed when initial and final values of serum laminin-P1 were compared in patients who developed diabetic retinopathy (1.56 +/- 0.27 U/ml versus 1.75 +/- 0.33 U/ml; P =.001). Remarkably, an increase in serum laminin-P1 concentration was detected in all but two of the patients who developed diabetic retinopathy. The relative risk of development of diabetic retinopathy in patients who showed an increase in serum laminin-P1 during follow-up was 5.4 (95% confidence interval, 1.32 to 22.13). CONCLUSIONS Serum laminin-P1 is a marker and a risk indicator of diabetic retinopathy but is not an early predictor of its development.
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Affiliation(s)
- L Masmiquel
- Diabetes Research Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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16
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Simó R, Segura RM, García-Pascual L, Masmiquel L, Burgos R, Hernández C, Martí R, Mesa J. [Fibronectin and diabetes mellitus: the factors that influence its plasma concentrations and its usefulness as a marker of late complications]. Med Clin (Barc) 1999; 112:45-50. [PMID: 10065428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The usefulness of plasma fibronectin (FNp) as a marker of late diabetic complications is controversial. The aim of the study was to assess the influence of several variables on FNp in diabetic patients and to determine its usefulness as a marker of late diabetic complications. PATIENTS AND METHODS 79 diabetic patients randomly selected were included in the study. The clinical variables considered were: age, gender, body mass index (BMI), tobacco and alcohol consumption, type, duration and treatment of diabetes, hypertension, and diabetic late complications (macroangiopathy, retinopathy, nephropathy and neuropathy). The laboratory variables analyzed were: blood glucose, glycated hemoglobin, total cholesterol, HDL-cholesterol, LDL-cholesterol, tryglicerides, apolipoprotein AI, apolipoprotein B, microalbuminuria, creatinin and FNp. Statistical study included a multiple regression analysis taking FNp as the dependent variable. RESULTS A direct correlation between FNp and BMI and also with tryglicerides was observed (r = 0.362; p = 0.002, and r = 0.234; p = 0.038, respectively). Higher levels of FNp were found in type 2 diabetic patients in comparison with type 1 (464 [SD, 127] versus 395 [SD, 96] mg/dl; p = 0.014). This difference was due to the higher BMI and tryglicerides concentrations observed in type 2 diabetic patients in comparison with type 1 (28.61 [SD, 4.67] versus 22.56 [SD, 2,.19] kg/m2; p < 0.001, and 4.24 [SD, 2.36] versus 2.52 [SD, 1.40] mmol/l, respectively). Multiple regression analysis showed that only BMI significantly influenced on FNp concentrations (r = 0.330; p = 0.004). No relation among FNp and late diabetic complications and other variables considered in the study was observed. CONCLUSIONS FNp is not a useful marker of diabetic late complications and its concentrations are direct and independently influenced by BMI.
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Affiliation(s)
- R Simó
- Sección de Endocrinología, Hospital General Vall d'Hebron, Barcelona
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17
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Obiols G, Simó R, Burgos R, Tresserras R, Galofré P, Masmiquel L, Hernández C, Mesa J. [Differentiated thyroid carcinoma, 1972-1992. Follow-up, detection of recurrences and prognostic factors]. Med Clin (Barc) 1997; 109:738-43. [PMID: 9470182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is no consensus about the treatment and the follow-up of differentiated thyroid carcinoma (DTC), because in some patients, currently known prognostic factors cannot predict the course of the disease. The aim of this work has been to review the results of the treatment of our patients with DTC and to assess the prognostic factors. PATIENTS AND METHODS We include, retrospectively, 204 patients with DTC (54 males and 150 women) with a men (SD) age of 38 (23) years, attending to a terciary university hospital. The follow-up is 9.2 (6) years (range, 2-22 years). They all underwent near total thyroidectomy, ablative doses of radioactive iodine (131INa) and L-thyroxine to suppress thyroid stimulating hormone (TSH) levels. At least once a year, a clinical examination, a whole-body scan (WBS) with 131INa and serum thyroglobulin (Tg) measurements were performed in hypothyroid state. In the statistics, chi 2 test, univariate analysis, Student's t test, Kaplan-Meier method, Mantel-Cox test and multiple regression analysis were employed. RESULTS The survival rate was 89.05%. Twenty patients died of DTC (9.8%) (papillary 8 [6%], follicular 12[17%]). Surgical complications (recurrent nerve palsy or permanent hypoparathyroidism) were seen in 5% of the patients. The sensitivity of WBS to detect distant metastases or local (neck) involvement was 71% (initial 100%, late 71%). Tg sensitivity was 85% (initial 95%, late 73%). Factors associated to a poor prognosis were age > 40 years (p < 0.0001), follicular carcinoma (p < 0.02) and initial stages III and IV (p < 0.0001). CONCLUSIONS The mortality and complications rates in our patients with differentiated thyroid carcinoma validate our management schedule. Tg measurements are more sensitive than WBS to detect distant or local metastases; however, sensitivity of both techniques was lower in the detection of late metastases. Age below 40 years, papillary carcinoma and initial stages I and II are factors of better prognosis.
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Affiliation(s)
- G Obiols
- Sección de Endocrinología, Hospital General i Universitari Vall d'Hebron, Barcelona
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Masmiquel L, Burgos R, Simó R. [Basal membrane and diabetes mellitus]. Med Clin (Barc) 1997; 109:302-10. [PMID: 9379754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L Masmiquel
- Sección de Endocrinología, Hospital Universitari Vall d'Hebron, Barcelona
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Abstract
The aim was to evaluate Leu-M1 immunoreactivity as a prognostic factor in phaeochromocytoma. Anti-Leu-M1 monoclonal antibodies were used to determine the Leu-M1 immunoreactivity in 17 histologically confirmed phaeochromocytomas from 15 patients, using an avidin-biotin technique. Ten patients had a sporadic phaeochromocytoma, and five had multiple endocrine neoplasia type 2A (MEN 2A). Malignancy was diagnosed in three patients by the presence of metastases. Leu-M1 immunoreactivity was shown in 12 (70.5%) phaeochromocytomas. Three patterns of arrangement were observed: isolated (scattered positive cells) (n = 3); focal (aggregates of positive cells) (n = 5), and diffuse patterns (dispersed positive cells) (n = 4). Two cases of malignant phaeochromocytoma were positive (one focal and one isolated pattern). All cases of MEN 2A showed immunoreactivity, although no characteristic pattern was prevalent. A diffuse pattern was observed in all phaeochromocytomas longer than 7 cm. In conclusion, Leu-M1 expression is frequent in phaeochromocytoma. However, Leu-M1 immunoreactivity seems to be useless in predicting malignant behaviour and to be influenced mainly by tumour size.
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Affiliation(s)
- L Masmiquel
- Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Simó R, Masmiquel L, García-Pascual L, Burgos R, Mateo C, Segura RM, Mesa J. Serum concentrations of laminin-P1 in diabetes mellitus: usefulness as an index of diabetic microangiopathy. Diabetes Res Clin Pract 1996; 32:45-53. [PMID: 8803481 DOI: 10.1016/0168-8227(96)01220-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the influence of several variables on serum laminin-P1 (Lam-P1) and to evaluate its usefulness as a serum marker of diabetic microangiopathy. MATERIAL AND METHODS We determined Lam-P1 by serum radioimmunoassay in 121 controls and 176 diabetic patients, 58 type 1 (insulin dependent) and 118 type (non-insulin dependent), grouped according to retinal status and urinary albumin excretion. The variables evaluated were: age, gender, body mass index, blood pressure, consumption of tobacco and alcohol, type of diabetes, duration of disease, fasting blood glucose, HbA1, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins (A1, B). Imprecision for laminin determination was: 3.6% intrassay; 5.8% interassay. STATISTICS Student's t-test, ANOVA, ANCOVA, and multiple regression analysis. RESULTS In diabetic patients Lam-P1 was higher than in controls (X = 1.63 +/- S.D. 0.36 vs. X = 1.40 +/- S.D. 0.18 U ml-1; P < 0.001) and only correlated with age (P = 0.002). Lam-P1 was higher in diabetics with proliferative retinopathy than in patients with non-proliferative retinopathy and without retinopathy (X = 2.17 +/- S.D. 0.49 U ml-1 vs. X = 1.71 +/- S.D. 0.22 U ml-1 vs. X = 1.47 +/- S.D. 0.26 U ml-1; P < 0.001). Patients with macroalbuminuria presented higher serum Lam-P1 than patients with micro or normoalbuminuria (X = 2.39 +/- S.D. 0.53 U ml-1 vs. X = 1.78 +/- S.D. 0.23 U ml-1 vs. X = 1.51 +/- S.D. 0.29 U ml-1; P < 0.001). These differences remained significative when patients were age-adjusted. CONCLUSIONS Lam-P1 could be useful as an index of diabetic microangiopathy but patient's age should be considered.
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Affiliation(s)
- R Simó
- Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Abstract
Cervical cord compression due to local extension of differentiated thyroid carcinoma (DTC) is an extremely rare condition and, to our knowledge, only one case has been reported in the literature. Among 256 patients with DTC treated at our hospital, we have observed 3 cases of spinal injury due to local extension of DTC. A Brown-Séquard syndrome was detected at physical examination in 2 cases. In both patients, cervical cord compression precipitated a fatal event. In the remaining patient, a radiculopathy C5-C7 was observed. Magnetic resonance imaging was very successful in outlining the mass, clearly differentiating the extrinsic invasion from a metastasis, and allowing the surgical possibilities to be evaluated. Poor cervical uptake of 131I was observed on scans performed in two cases, suggesting a certain degree of cell dedifferentiation. We suggest that cervical spinal injury due to local extension of DTC may be an underreported complication of DTC that seems to condition the patient's outcome. Careful neurological examination is warranted in patients with DTC at stages III-IV and magnetic resonance imaging must be performed when spinal injury is suspected.
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Affiliation(s)
- L Masmiquel
- Department of Endocrinology, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
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Affiliation(s)
- L Masmiquel
- Hospital General Vall d'Hebron, Barcelona, Spain
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Masmiquel L, Simó R. [Plasma fibronectin concentrations in critical patients]. Med Clin (Barc) 1993; 100:439. [PMID: 8464267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Masmiquel L, Borrellas X, Codina S, Piera L. [Chronic renal failure as a risk factor in the etiology of renal cell carcinoma]. Med Clin (Barc) 1992; 98:74. [PMID: 1545627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Masmiquel L, Simó R. [Endocrine pathology associated with human immunodeficiency virus infection]. Med Clin (Barc) 1991; 96:711-5. [PMID: 2072781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L Masmiquel
- Sección de Endocrinología, Hospital General Vall d'Hebron, Barcelona
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