Telemedicine screening program for diabetic retinopathy in patients with type 1 diabetes mellitus

PURPOSE

To analyze the results of the telemedicine screening program for diabetic retinopathy (DR) in patients with type 1 diabetes conducted by the Endocrinology and Nutrition Management Unit of Virgen del Rocío University Hospital.

METHODS

This cross-sectional study comprised patients with type 1 diabetes mellitus (DM) in our DR screening program from January 2018 to November 2020. Fundus photographs are performed by trained nurses and reviewed by a trained endocrinologist. Those suggestive of pathology are sent to ophthalmology through a telematic program for review.

RESULTS

Of the 995 fundus photographs evaluated, 646 (65.3%) showed no evidence of DR, 327 (33.1%) presented possible DR, and 16 (1.6%) were not gradable. The diagnosis was confirmed in 254 patients after reviewing by ophthalmology, and the screening program achieved a positive predictive value for DR of 77.7%. Seventy-three were excluded by ophthalmology due to the absence of DR (false positive rate - 22.3%). In 92.5% of the cases classified by the ophthalmologist, the degree of DR was mild or very mild.

CONCLUSION

Our telemedicine screening program for DR in patients with type 1 DM is consistent with the literature. Effective screening for DR is performed, with patients diagnosed in the early stages. Telemedicine programs facilitate efficient communication among healthcare personnel.

Effectiveness and Safety of an Advanced Hybrid Closed-Loop System in Adolescents and Adults with Type 1 Diabetes Previously Treated with Continuous Subcutaneous Insulin Infusion and Flash Glucose Monitoring

This study aimed to evaluate the effectiveness and safety of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system in people with type 1 diabetes (T1D) previously treated with continuous subcutaneous insulin infusion combined with flash glucose monitoring in a real-life setting. A total of 47 subjects (mean age 41 ± 13.6 years, 60% females, diabetes duration 28 ± 11 years) were included and switched to an AHCL system. Baseline and 6-month data were analyzed. Time in range 70-180 mg/dL increased from 65.3% at baseline to 73.8% at 6 months. Time in hyperglycemia >180 mg/dL decreased from 26.6% to 19.3%. Time in hypoglycemia <70 mg/dL decreased from 4.6% to 2.3%. The coefficient of variation also decreased from 36% to 31.6%. No episodes of severe hypoglycemia, diabetes ketoacidosis, or diabetes-related hospital admissions occurred. In conclusion, the MiniMed 780G AHCL system enables the safe achievement of recommended glycemic targets in people with T1D after 6 months of use.

Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center

OBJECTIVE

Thyrotropin (TSH)-secreting pituitary tumors are rare and typically present with hyperthyroidism. Here we report the diagnosis, treatment, and surgical outcomes in a series of patients with TSH-secreting pituitary tumors in a tertiary referral center.

METHODS

Descriptive retrospective study that included all patients with TSH-secreting pituitary tumors who underwent transsphenoidal surgery in the endocrinology and nutrition unit of the Virgen del Rocío University Hospital (Seville, Spain) between 2004 and 2016.

RESULTS

The mean age at diagnosis was 42.8 ± 17 years. The mean time from onset of symptoms to diagnosis was 13 ± 10 months. Four patients displayed symptoms indicating hyperthyroidism (1 suffered from tachycardia); 3 patients showed symptoms because of mass effect (visual impairment and headache) and 3 patients were diagnosed based on incidental findings after routine blood tests (high free thyroxine levels). Eight patients had macroadenomas, and 2 patients had microadenomas. Five patients underwent conventional pituitary surgery, and 5 patients underwent expanded endoscopic transsphenoidal surgery. Six patients achieved cure after surgery. The other patients received radiotherapy and/or treatment with somatostatin analogs. Analysis of somatostatin receptor (SSTR) expression by immunohistochemistry could be performed in 6 tumors.

CONCLUSIONS

Our results confirm the clinical and hormonal heterogeneity caused by TSH-secreting pituitary adenomas. Surgery is considered the first choice of treatment for these tumors. We observed surgical cure rates similar to those reported in recent published series. SSTR2 and SSTR3 are highly expressed in TSH-secreting pituitary adenomas. Our results suggest that somatostatin analog treatment may be also helpful in the treatment of TSH-secreting pituitary adenomas.

MON-467 Expression of Somatostatin Receptors in Aggressive Non-Functioning Pituitary Adenomas

INTRODUCTION Non-functioning pituitary adenomas (NFPAs) are usually benign. However, a substantial proportion of pituitary adenomas show an aggressive behavior with local invasion and increased risk of regrowth or recurrence after surgery. The treatment of choice for these adenomas is transsphenoidal resection but it is not always successful. NFPAs express somastostatin receptors (SSTRs) thus providing a theoretical rationale for the pharmacological treatment with somatostatin analogues. However, a consistent method for evaluating SSTR expression needs to be implemented. AIM The aim of the study was to systematically evaluate the expression of SSTRs in NFPAs by quantitative PCR and by immunohistochemistry with reliable commercial antibodies and analyze their potential association with aggressive features. METHODS. In this retrospective descriptive study, 114 patients that underwent transsphenoidal surgery were evaluated. Clinical variables, histological subtype (including classification of agressive histological subtypes) and need for radiotherapy were collected to analyze potential associations between these variables and SSTR expression. Tumor size and cavernous sinus invasion data were obtained from magnetic resonance images. Cavernous sinus invasion was evaluated using the Knosp classification. Knosp grade 3 and 4 were defined as invasive. The expression of SSTRs (SSTR2. SSTR3 and SSTR5) was evaluated using a score system previously described [Venegas-Moreno et al. J Cell Mol Med. 2018;22(3):1640-1649]. RESULTS Quantitative PCR analysis revealed that SSTR3 was the predominant SSTR subtype detected, followed by SSTR2, SSTR5, and SSTR1. Immunohistochemistry data showed a similar expression pattern. However, The expression of the different SSTRs displayed a notable variability among NFPAs. Thus, 28,9% of NFPAs showed substantial SSTR2 expression, as indicated by high immunohistochemistry scores. Also, 12,3% of NFPAs displayed high SSTR5 expression while 86,8% of NFPAs displayed high SSTR3 levels. No significant associations between SSTR expression and sex, tumor size, invasion and surgical cure. Patients with elevated SSTR2 expression were younger but this association was not observed with SSTR3 and SSTR5. CONCLUSIONS No major association between SSTR expression and aggressive features was observed in NFPAs. A proportion of NFPAs displayed marked expression of SSTR2 and SSTR5 and thus, they might be considered potential candidates for therapy with somatostatin analogues. Sources of Research Support: Spanish Ministry of Health, ISCIII co-funded with Fondos FEDER (PI16/00175) and Novartis Oncology Spain.

The lack of consensus in management of malignant struma ovarii

Struma ovarii is a rare variant of teratoma characterized by the presence of thyroid tissue in more than 50%. Malignant transformation is rare (less than 5%) and the criteria to classify this condition have changed over time. Nowadays it must fulfill the histological categories of differentiated thyroid carcinoma. Its treatment is controversial and there is no unanimous management. We present three cases of women with malignant struma ovarii, diagnosed by the surgical specimen.

Advanced thyroid carcinoma in pregnancy: case report of two pregnancies

Differentiated thyroid carcinoma is one of the most frequently diagnosed cancers during pregnancy, second only to breast cancer. Therefore, it would be of value to determine if there are pregnancy-related physiological effects that impact long-term prognosis for patients with this disease. Hormone effects attributable to β-human chorionic gonadotropin and estrogens seem particularly likely. We present a case of a 40-year-old woman with thyroid follicular carcinoma with accompanying bone metastases. The cancer was discovered immediately after childbirth and the woman became pregnant again when the disease was in an advanced stage. We describe the cancer evolution and present the maternal and fetal results. Pregnancy in women with advanced thyroid carcinoma could affect long-term prognosis. However, more studies are needed to evaluate this hypothesis. In this unique case, there were two pregnancies and the second occurred in an advanced state of the disease. We evaluated how these pregnancies could affect short-term prognosis of the disease.

[Bariatrica paraplegia patient and morbid obesity. New challenge in bariatric surgery]

The loss of mobility due to spinal cord injury is a risk factor for weight gain. Despite the well-documented outcomes of bariatric surgery in outpatients, little information is available about the surgery in paraplegic patients. We present two cases of patients with morbid obesity and spinal cord injury. After several attempts to lose weight conservatively, were assessed by the multidisciplinary team of our hospital and finally intervened by laparoscopic gastric bypass. After surgery have been no post-surgical complications. The patient in case 1, after two years of follow-up, a weight of 84 kg (BMI 25.08 kg/m2). Case 2, after a month of surgery has reduced weight and stopped taking antihypertensive therapy. It 's available to bariatric surgery as an important option to consider if all non-surgical interventions fail is highlighted.

[Gastrocolic fistula as a complication of percutaneous feeding gastrostomy, description of three cases and review of the literature]

INTRODUCTION

Percutaneous gastrostomy, is the procedure of choice to provide enteral access in patients requiring nutritional support in this way in the long run, relegating the surgical gastrostomy.

MATERIAL AND METHODS

We present three patients requiring percutaneous gastrostomy for nutritional support. In two cases was performed endoscopic gastrostomy and another one using interventional radiology.

RESULTS

While performing percutaneous gastrostomy clinical incidents were not detected, but when trying the replacement of gastrostomy tubes, showed the presence of gastrocolic fistula that caused failure or turnover in one case, or abdominal pain and diarrhea in the two other cases.

DISCUSSION

Despite being a safe technique, should be done a proper patient selection in order to minimize the potential complications that may occur, as gastrocolic fistula, recommending in doubtful cases test of image such CT (computerized Tomography).