Ignasi Castells - Academia.edu (original) (raw)

Papers by Ignasi Castells

Research paper thumbnail of Estudio descriptivo de las características del cáncer diferenciado de tiroides en Cataluña en el periodo 1998-2012. Registro CECaT

Endocrinología y Nutrición, 2015

The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research i... more The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research institute, was recently created in Catalonia (Spain). One of the first initiatives of the group was to perform a descriptive analysis of the characteristics of patients with differentiated thyroid carcinoma (DTC). The cohort included 1,855 patients from 11 hospitals treated over a period of 15 years (1998-2012). In this series, 1.470 (79.2%) patients were women. Mean age was 47.7 (15.7) years old. Age was significantly higher in male than in female patients, 49.3 (15) versus 47.3 (15.8); p=0.02. Papillary thyroid carcinoma accounted for 88.9% of cases. Mean tumor size was 21.5 (16) mm, and was significantly lower in females than in males, 20.1 (14.5) mm and 26.6 (20.3) mm respectively (p<0.001). After a follow-up period of 5.5 (3.7) years, information was available for 1,355 patient, of whom 1065 (78.6%) were free of disease, 239 (17.6%) had no tumor persistence, and 51 (3.8) % had died. The risk of persistent or recurrent disease was significantly associated to older age at diagnosis, male gender, larger tumor size, lymph node metastases at surgery, no signs of thyroiditis in the remaining thyroid tissue, and presence of vascular and/or extraglandular invasion. Patient characteristics analyzed are similar to those reported in other parts of the world.

Research paper thumbnail of Use of communication technologies by people with type 1 diabetes in the social networking era. A chance for improvement

Primary care diabetes, Jan 27, 2015

To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes. Cross-secti... more To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes. Cross-sectional survey assessing views and usage of the Internet, Apps and Web 2.0. Number of participants: 289 (age 42.8±13.5 years; diabetes duration 18.4±12.2 years; 58.7% males; 39% with an upper secondary or higher education level). Web 2.0 usage for health purposes was low with 19.6% and 14% of Web 2.0 members (147; 50.9%) having health-related contacts and posting health comments. Health-related Apps were used by 35.4% of Smartphone owners (161; 55.7%). 75.3% patients would share information online with professionals, preferably through e-mail (78.7%) rather than Facebook (47.7%). 141 (66.5%) of those willing to share information would participate in a professional-moderated Facebook group. Web 2.0 and Apps usage for health purposes is low. The difference between the use of Web 2.0 networks and the willingness to participate in professional-moderated Web 2.0 groups points to the need of a hi...

Research paper thumbnail of Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus

Nefrología : publicación oficial de la Sociedad Española Nefrologia, 2013

Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major ... more Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20....

Research paper thumbnail of Dislipidemia aterogénica en pacientes con diabetes mellitus tipo 1

Medicina Clínica, 2013

To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemi... more To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemia and its relationship with chronic complications in patients with type 1 diabetes mellitus (T1DM). Cross-sectional study including all patients aged 18 and over, diagnosed of T1DM attending the outpatient clinic at Hospital del Mar and Hospital de Granollers, in Barcelona, during 2008. Of the 291 enrolled patients, 17.2 and 7.9% had high density lipoproteins (HDL) cholesterol<40 mg/dL (men) or<50mg/dL (women) and triglycerides>150 mg/dL, respectively. Hypoalphalipoproteinemic patients had a higher prevalence of peripheral neuropathy (28 vs. 7.1%, P<.001), macroalbuminuria (14 vs. 2.5%, P<.001) and higher concentrations of triglycerides (107.5 [55.8] vs. 82.7 [36] mg/dL, P<.0001) compared with those with normal/high HDL cholesterol levels. Hypertriglyceridemia was associated with increasing age (43.6 [11.2] vs. 37.6 [11.8] yr, P<.02), higher prevalence of hypertension (47.8 vs. 22.8%, P<.008), metabolic syndrome (82.6 vs. 22%, P<.001) and microangiopathic complications, lower insulin sensitivity (6.75 [2.1] vs. 8.54 [2.6] mg/Kg(-1)/min(-1), P<.004) compared with the normotriglyceridemic group. One in 5 patients with T1DM has hypoalphalipoproteinemia or hypertriglyceridemia and these conditions are associated with 3 fold-increase microangiopathy. Thus, in these patients glycemic and blood pressure but also lipid profile control must be optimum.

Research paper thumbnail of Renal function and hypertension in non-insulin-dependent diabetes mellitus

American Journal of Hypertension, 1995

Research paper thumbnail of Response to Initial Therapy of Differentiated Thyroid Cancer Predicts the Long-Term Outcome Better than Classical Risk Stratification Systems

International Journal of Endocrinology, 2014

Objective. Although differentiated thyroid cancer (DTC) usually has an indolent course, some case... more Objective. Although differentiated thyroid cancer (DTC) usually has an indolent course, some cases show a poor prognosis; therefore, risk stratification is required. The objective of this study is to compare the predictive ability of classical risk stratification systems proposed by the European Thyroid Association (ETA) and American Thyroid Association (ATA) with the system proposed by Tuttle et al. in 2010, based on the response to initial therapy (RIT). Methods. We retrospectively reviewed 176 cases of DTC with a median follow-up period of 7.0 years. Each patient was stratified using ETA, ATA, and RIT systems. Negative predictive value (NPV) and positive predictive value (PPV) were determined. The area under receiver operating characteristic (ROC) curve was calculated in order to compare the predictive ability. Results. RIT showed a NPV of 97.7%, better than NPV of ETA and ATA systems (93.9% and 94.9%, resp.). ETA and ATA systems showed poor PPV (40.3% and 41%, resp.), while RIT showed a PPV of 70.8%. The area under ROC curve was 0.7535 for ETA, 0.7876 for ATA, and 0.9112 for RIT, showing statistical significant differences ( < 0.05). Conclusions. RIT predicts the long-term outcome of DTC better than ETA/ATA systems, becoming a useful system to adapt management strategies.

Research paper thumbnail of Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit

Endocrinología y Nutrición (English Edition), 2013

Worldwide incidence of thyroid cancer has increased in recent decades. To provide evidence of the... more Worldwide incidence of thyroid cancer has increased in recent decades. To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation. Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed. A total of 1036 patients [P1: 537 (52%), P2: 499 (48%)] were seen and enrolled. Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; FNA number/nodule: 1.68 vs 1.17, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; percent FNAs with inadequate material: 26% vs 5.3%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10mm in size: 9.9% vs 13.7%, p 0.030. Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p=0.002. A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.

Research paper thumbnail of Prevalence of escape and lipodystrophy in patients treated with Pegvisomant. A multicenter study

Endocrine Abstracts, 2013

Research paper thumbnail of Cutoff values of the Inflammatory Bowel Disease Questionnaire to predict a normal health related quality of life

Journal of Crohn's and Colitis, 2010

One of the objectives in the treatment of the inflammatory bowel disease (IBD) is improving the p... more One of the objectives in the treatment of the inflammatory bowel disease (IBD) is improving the patient's quality of life. However, we do not dispose of validated criteria to determine the questionnaire's scoring threshold that has to be reached in order to be able to assert that the patients' quality of life has normalized. Objective: To determine the normality punctuation cutoff in the IBD specific quality of life questionnaire IBDQ-36. Method: Cross-sectional study in a random sample of IBD patients, who have completed the questionnaires IBDQ-36 and EuroQol-5D. The IBDQ-36 normality was calculated according to its equivalence with the EuroQol-5D tariff ≥ 0.90, which corresponds to the 95% CI of the average obtained in a Spanish general population. Results: 218 patients were included. According to the EuroQol-5D tariff, 70 patients were considered to have a normal quality of life and 148 a quality of life poorer than the general population. The IBDQ-36 scoring was significantly higher in the normal quality of life group (222.9 ± 22.8 vs. 171.4 ± 44.8 in the bad quality of life group, p b 0.001). According to the linear regression between IBDQ-36 and EuroQol-5D, the cutoff point is 209, with a sensitivity and specificity to predict normality of 0.74 and 0.71 respectively. Conclusions: Scores of the IBDQ-36 equal or superior to 209 suggest quality of life comparable to that perceived by the general population. This study allowed to set a threshold of normality in the management of the inflammatory bowel diseases.

Research paper thumbnail of Diagnostic efficiency of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH measurements in the diagnosis of adult GH deficiency: importance of an appropriate reference population

European Journal of Endocrinology, 2000

Objective: To analyse the diagnostic role of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/... more Objective: To analyse the diagnostic role of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH (uGH) excretion in adult GH deficiency (GHD). Design: Twenty-seven adults (age range: 18-71 years) with severe GHD, defined by a peak GH response to an insulin tolerance test below 3 mg/l in patients with at least one additional pituitary hypofunction. Reference values were established from a selected age-and body mass index-matched population (154 healthy adults grouped in four age groups). Methods: IGF-I and IGFBP-3 were measured by RIA (Nichols) and results expressed as standard deviation (S.D.) scores from our reference population and assay normative data (S.D. score Nichols). uGH was measured by IRMA. Results: Within the control group, IGF-I, IGFBP-3, IGF-I/IGFBP-3 ratio standardisation regarding our control population and IGF-I with respect to the assay normative data resulted in disappearance of agerelated differences. However, IGFBP-3 S.D. score Nichols resulted in mean values between þ1.4 and þ2.5 S.D. score. Greatest diagnostic efficiency was for IGF-I standardised with respect to our controls (97.2%), followed by S.D. score IGFBP-3 (92.9%). S.D. score IGF/IGFBP-3 ratio and uGH showed poor diagnostic efficiency. Any combination of at least two abnormal parameters raised specificity to 100%. IGF-I standardised with respect to assay reference (S.D. score Nichols) showed similar diagnostic value (95.0%) whereas IGFBP-3 showed low sensitivity (33.3%). Within the GHD patients, those with three or more additional deficiencies had lower S.D. score IGF-I than those with only two or one. Conclusion: We underline the importance of an appropriate reference population for correct interpretation of GH secretion markers. Considering our results, specificity obtained with two simultaneous abnormal parameters when referred to an adequate reference population may add valuable information to alternative GH stimulation tests to confirm adult GHD.

Research paper thumbnail of Inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients

Diabetes Research and Clinical Practice, 2000

Background: to define the prevalence of inducible myocardial ischaemia in asymptomatic Type 2 dia... more Background: to define the prevalence of inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients and its relation to urinary albumin excretion rate (AER). Methods: 98 Type 2 diabetic patients aged 56 9 7 years, and 20 non-diabetic volunteers were recruited. Dypiridamole plus exercise thallium-201 myocardial single photon emission computed tomography (SPECT) was performed in all participants. Exclusion criteria were: age B 30 or \70 years, evidence of cardiovascular disease, anomalous ECG, autonomic neuropathy or serum creatinine level \ 177 mmol/l. Results: 36 out of 98 diabetic patients (37%) showed abnormal thallium SPECT (considered as inducible myocardial ischaemia), versus one out of 20 (5%) in control group (odds ratio 7.3 (95% CI 1.1 -50.5), PB 0.005). Among diabetic patients, prevalence of inducible ischaemia was greater in those with higher urinary AER (AER B30:30 -300:\ 300 mg/24 h: 26: 53: 88%, and greater in the normoalbuminuric group compared to the control group (26 vs. 5%; PB 0.05). An AER \30 mg/24 h was the only independent factor associated with inducible myocardial ischaemia in the multivariate analysis (P= 0.009). Conclusions: raised urinary AER in asymptomatic diabetic patients is a risk factor for present myocardial ischaemia demonstrated by thallium dypiridamole tomography. The prevalence of inducible myocardial ischaemia in asymptomatic diabetic patients without known coronary disease is much higher than in non-diabetic population.

Research paper thumbnail of Escape and lipodystrophy in acromegaly during pegvisomant therapy, a retrospective multicentre Spanish study

Clinical Endocrinology, 2014

Background Pegvisomant is an effective treatment for acromegaly. Objective To investigate escape ... more Background Pegvisomant is an effective treatment for acromegaly. Objective To investigate escape (loss of biochemical control in patients previously controlled) and lipodystrophy in acromegalic patients treated with pegvisomant and to evaluate possible associations with clinical features. Patients and methods Multicentre retrospective study involving 19 Spanish centres. Results Ninety-seven patients were included (59% women, mean age at diagnosis 42 AE 13 years, 80% macroadenomas); mean follow-up on pegvisomant was 5 AE 2Á5 years, and 89 (92%) achieved normal IGF-1. Escape was reported in 30/89 (34%) of responders, after a mean treatment duration of 25 AE 21 months. The mean initial dose of pegvisomant was 11 AE 5 mg/day, and mean dose at escape was 14 AE 7 mg/day. Most patients (26/30, 87%) achieved control with dose increase (57%), additional medical treatment (3%) or both (27%). Mean new dose that controlled IGF-1 after escape was 20 AE 7 mg/day. Treatments associated were somatostatin analogues (SSA in 47%), cabergoline (CAB in 47%) and both (6%). Lipodystrophy was observed in 15 patients (13 females), mild in six, moderate in six, severe in three and persistent in four. Among patients with lipodystrophy, three escaped and three were nonresponders to pegvisomant. Four patients discontinued the drug, and four had dose reductions because of lipodystrophy. It tended to be more frequent in females (P = 0Á06) and in patients treated with triple association SSA+CAB+PEG (P = 0Á018). No relationship between escape and clinical variables was found, except prior CAB (P = 0Á04) and metformin treatment (0Á02) and grade of lipodystrophy (P = 0Á02). Conclusions A significant proportion of patients treated with pegvisomant escaped (34%); however, the majority (87%) was easily controlled with either dose increase, further medical treatment or both. Lipodystrophy developed in 15%, mostly females, and influenced the response to treatment.

Research paper thumbnail of Insulin resistance and hypertension in patients with type 1 diabetes

Journal of Diabetes and its Complications, 2011

To assess blood pressure (BP) control, antihypertensive treatment, and prevalence of resistant hy... more To assess blood pressure (BP) control, antihypertensive treatment, and prevalence of resistant hypertension (RH) in patients with type 1 diabetes stratified by stage of diabetic nephropathy.

Research paper thumbnail of Estudio descriptivo de las características del cáncer diferenciado de tiroides en Cataluña en el periodo 1998-2012. Registro CECaT

Endocrinología y Nutrición, 2015

Recibido el 16 de enero de 2015; aceptado el 9 de marzo de 2015 Disponible en Internet el 13 de m... more Recibido el 16 de enero de 2015; aceptado el 9 de marzo de 2015 Disponible en Internet el 13 de mayo de 2015

Research paper thumbnail of Estudio descriptivo de las características del cáncer diferenciado de tiroides en Cataluña en el periodo 1998-2012. Registro CECaT

Endocrinología y Nutrición, 2015

The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research i... more The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research institute, was recently created in Catalonia (Spain). One of the first initiatives of the group was to perform a descriptive analysis of the characteristics of patients with differentiated thyroid carcinoma (DTC). The cohort included 1,855 patients from 11 hospitals treated over a period of 15 years (1998-2012). In this series, 1.470 (79.2%) patients were women. Mean age was 47.7 (15.7) years old. Age was significantly higher in male than in female patients, 49.3 (15) versus 47.3 (15.8); p=0.02. Papillary thyroid carcinoma accounted for 88.9% of cases. Mean tumor size was 21.5 (16) mm, and was significantly lower in females than in males, 20.1 (14.5) mm and 26.6 (20.3) mm respectively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). After a follow-up period of 5.5 (3.7) years, information was available for 1,355 patient, of whom 1065 (78.6%) were free of disease, 239 (17.6%) had no tumor persistence, and 51 (3.8) % had died. The risk of persistent or recurrent disease was significantly associated to older age at diagnosis, male gender, larger tumor size, lymph node metastases at surgery, no signs of thyroiditis in the remaining thyroid tissue, and presence of vascular and/or extraglandular invasion. Patient characteristics analyzed are similar to those reported in other parts of the world.

Research paper thumbnail of Use of communication technologies by people with type 1 diabetes in the social networking era. A chance for improvement

Primary care diabetes, Jan 27, 2015

To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes. Cross-secti... more To evaluate the health-related use of Web 2.0 tools by patients with type 1 diabetes. Cross-sectional survey assessing views and usage of the Internet, Apps and Web 2.0. Number of participants: 289 (age 42.8±13.5 years; diabetes duration 18.4±12.2 years; 58.7% males; 39% with an upper secondary or higher education level). Web 2.0 usage for health purposes was low with 19.6% and 14% of Web 2.0 members (147; 50.9%) having health-related contacts and posting health comments. Health-related Apps were used by 35.4% of Smartphone owners (161; 55.7%). 75.3% patients would share information online with professionals, preferably through e-mail (78.7%) rather than Facebook (47.7%). 141 (66.5%) of those willing to share information would participate in a professional-moderated Facebook group. Web 2.0 and Apps usage for health purposes is low. The difference between the use of Web 2.0 networks and the willingness to participate in professional-moderated Web 2.0 groups points to the need of a hi...

Research paper thumbnail of Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus

Nefrología : publicación oficial de la Sociedad Española Nefrologia, 2013

Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major ... more Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20....

Research paper thumbnail of Dislipidemia aterogénica en pacientes con diabetes mellitus tipo 1

Medicina Clínica, 2013

To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemi... more To assess the prevalence of lipid abnormalities, with special emphasis on atherogenic dyslipidemia and its relationship with chronic complications in patients with type 1 diabetes mellitus (T1DM). Cross-sectional study including all patients aged 18 and over, diagnosed of T1DM attending the outpatient clinic at Hospital del Mar and Hospital de Granollers, in Barcelona, during 2008. Of the 291 enrolled patients, 17.2 and 7.9% had high density lipoproteins (HDL) cholesterol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40 mg/dL (men) or&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50mg/dL (women) and triglycerides&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;150 mg/dL, respectively. Hypoalphalipoproteinemic patients had a higher prevalence of peripheral neuropathy (28 vs. 7.1%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), macroalbuminuria (14 vs. 2.5%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) and higher concentrations of triglycerides (107.5 [55.8] vs. 82.7 [36] mg/dL, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001) compared with those with normal/high HDL cholesterol levels. Hypertriglyceridemia was associated with increasing age (43.6 [11.2] vs. 37.6 [11.8] yr, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.02), higher prevalence of hypertension (47.8 vs. 22.8%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.008), metabolic syndrome (82.6 vs. 22%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) and microangiopathic complications, lower insulin sensitivity (6.75 [2.1] vs. 8.54 [2.6] mg/Kg(-1)/min(-1), P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.004) compared with the normotriglyceridemic group. One in 5 patients with T1DM has hypoalphalipoproteinemia or hypertriglyceridemia and these conditions are associated with 3 fold-increase microangiopathy. Thus, in these patients glycemic and blood pressure but also lipid profile control must be optimum.

Research paper thumbnail of Renal function and hypertension in non-insulin-dependent diabetes mellitus

American Journal of Hypertension, 1995

Research paper thumbnail of Response to Initial Therapy of Differentiated Thyroid Cancer Predicts the Long-Term Outcome Better than Classical Risk Stratification Systems

International Journal of Endocrinology, 2014

Objective. Although differentiated thyroid cancer (DTC) usually has an indolent course, some case... more Objective. Although differentiated thyroid cancer (DTC) usually has an indolent course, some cases show a poor prognosis; therefore, risk stratification is required. The objective of this study is to compare the predictive ability of classical risk stratification systems proposed by the European Thyroid Association (ETA) and American Thyroid Association (ATA) with the system proposed by Tuttle et al. in 2010, based on the response to initial therapy (RIT). Methods. We retrospectively reviewed 176 cases of DTC with a median follow-up period of 7.0 years. Each patient was stratified using ETA, ATA, and RIT systems. Negative predictive value (NPV) and positive predictive value (PPV) were determined. The area under receiver operating characteristic (ROC) curve was calculated in order to compare the predictive ability. Results. RIT showed a NPV of 97.7%, better than NPV of ETA and ATA systems (93.9% and 94.9%, resp.). ETA and ATA systems showed poor PPV (40.3% and 41%, resp.), while RIT showed a PPV of 70.8%. The area under ROC curve was 0.7535 for ETA, 0.7876 for ATA, and 0.9112 for RIT, showing statistical significant differences ( < 0.05). Conclusions. RIT predicts the long-term outcome of DTC better than ETA/ATA systems, becoming a useful system to adapt management strategies.

Research paper thumbnail of Healthcare impact of introduction of thyroid ultrasound in a thyroid nodule pathology unit

Endocrinología y Nutrición (English Edition), 2013

Worldwide incidence of thyroid cancer has increased in recent decades. To provide evidence of the... more Worldwide incidence of thyroid cancer has increased in recent decades. To provide evidence of the diagnostic and care efficiency of a monographic thyroid nodule clinic integrating clinical examination, ultrasound examination, and cytology with on site evaluation. Patients attending the monographic thyroid nodule clinic from January 2004 to June 2010. Two periods may be distinguished based on availability of ultrasound equipment at the time of the visit: a first period (P1: 01/2004-09/2007) where no ultrasound equipment was available at the clinic and FNA by palpation was performed, and a second period (P2: 10/2007-06/2010) where this equipment was available and ultrasound-guided FNA was performed. A total of 1036 patients [P1: 537 (52%), P2: 499 (48%)] were seen and enrolled. Diagnostic efficiency (P1 vs P2): 143 vs 181 patients were seen annually, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; FNA number/nodule: 1.68 vs 1.17, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; percent FNAs with inadequate material: 26% vs 5.3%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; mean (SD) nodule size: 23.6 (12.4) vs 21.7 (11.7) mm, p 0.040; proportion of nodules examined less than 10mm in size: 9.9% vs 13.7%, p 0.030. Care efficiency: mean time (range) from the first visit to surgery indication: 332 (0-2177) vs 108 (0-596) days, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; proportion of patients referred for surgery due to suspect cytology/other reasons: 1.06 vs 2.21, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001; and operated benign neoplasm/pathology: 0.47 vs 0.93, p=0.002. A monographic thyroid nodule clinic integrating clinical examination, ultrasound, and cytology evaluated on site increases diagnostic and care efficiency in patients with thyroid nodules.

Research paper thumbnail of Prevalence of escape and lipodystrophy in patients treated with Pegvisomant. A multicenter study

Endocrine Abstracts, 2013

Research paper thumbnail of Cutoff values of the Inflammatory Bowel Disease Questionnaire to predict a normal health related quality of life

Journal of Crohn's and Colitis, 2010

One of the objectives in the treatment of the inflammatory bowel disease (IBD) is improving the p... more One of the objectives in the treatment of the inflammatory bowel disease (IBD) is improving the patient's quality of life. However, we do not dispose of validated criteria to determine the questionnaire's scoring threshold that has to be reached in order to be able to assert that the patients' quality of life has normalized. Objective: To determine the normality punctuation cutoff in the IBD specific quality of life questionnaire IBDQ-36. Method: Cross-sectional study in a random sample of IBD patients, who have completed the questionnaires IBDQ-36 and EuroQol-5D. The IBDQ-36 normality was calculated according to its equivalence with the EuroQol-5D tariff ≥ 0.90, which corresponds to the 95% CI of the average obtained in a Spanish general population. Results: 218 patients were included. According to the EuroQol-5D tariff, 70 patients were considered to have a normal quality of life and 148 a quality of life poorer than the general population. The IBDQ-36 scoring was significantly higher in the normal quality of life group (222.9 ± 22.8 vs. 171.4 ± 44.8 in the bad quality of life group, p b 0.001). According to the linear regression between IBDQ-36 and EuroQol-5D, the cutoff point is 209, with a sensitivity and specificity to predict normality of 0.74 and 0.71 respectively. Conclusions: Scores of the IBDQ-36 equal or superior to 209 suggest quality of life comparable to that perceived by the general population. This study allowed to set a threshold of normality in the management of the inflammatory bowel diseases.

Research paper thumbnail of Diagnostic efficiency of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH measurements in the diagnosis of adult GH deficiency: importance of an appropriate reference population

European Journal of Endocrinology, 2000

Objective: To analyse the diagnostic role of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/... more Objective: To analyse the diagnostic role of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH (uGH) excretion in adult GH deficiency (GHD). Design: Twenty-seven adults (age range: 18-71 years) with severe GHD, defined by a peak GH response to an insulin tolerance test below 3 mg/l in patients with at least one additional pituitary hypofunction. Reference values were established from a selected age-and body mass index-matched population (154 healthy adults grouped in four age groups). Methods: IGF-I and IGFBP-3 were measured by RIA (Nichols) and results expressed as standard deviation (S.D.) scores from our reference population and assay normative data (S.D. score Nichols). uGH was measured by IRMA. Results: Within the control group, IGF-I, IGFBP-3, IGF-I/IGFBP-3 ratio standardisation regarding our control population and IGF-I with respect to the assay normative data resulted in disappearance of agerelated differences. However, IGFBP-3 S.D. score Nichols resulted in mean values between þ1.4 and þ2.5 S.D. score. Greatest diagnostic efficiency was for IGF-I standardised with respect to our controls (97.2%), followed by S.D. score IGFBP-3 (92.9%). S.D. score IGF/IGFBP-3 ratio and uGH showed poor diagnostic efficiency. Any combination of at least two abnormal parameters raised specificity to 100%. IGF-I standardised with respect to assay reference (S.D. score Nichols) showed similar diagnostic value (95.0%) whereas IGFBP-3 showed low sensitivity (33.3%). Within the GHD patients, those with three or more additional deficiencies had lower S.D. score IGF-I than those with only two or one. Conclusion: We underline the importance of an appropriate reference population for correct interpretation of GH secretion markers. Considering our results, specificity obtained with two simultaneous abnormal parameters when referred to an adequate reference population may add valuable information to alternative GH stimulation tests to confirm adult GHD.

Research paper thumbnail of Inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients

Diabetes Research and Clinical Practice, 2000

Background: to define the prevalence of inducible myocardial ischaemia in asymptomatic Type 2 dia... more Background: to define the prevalence of inducible myocardial ischaemia in asymptomatic Type 2 diabetic patients and its relation to urinary albumin excretion rate (AER). Methods: 98 Type 2 diabetic patients aged 56 9 7 years, and 20 non-diabetic volunteers were recruited. Dypiridamole plus exercise thallium-201 myocardial single photon emission computed tomography (SPECT) was performed in all participants. Exclusion criteria were: age B 30 or \70 years, evidence of cardiovascular disease, anomalous ECG, autonomic neuropathy or serum creatinine level \ 177 mmol/l. Results: 36 out of 98 diabetic patients (37%) showed abnormal thallium SPECT (considered as inducible myocardial ischaemia), versus one out of 20 (5%) in control group (odds ratio 7.3 (95% CI 1.1 -50.5), PB 0.005). Among diabetic patients, prevalence of inducible ischaemia was greater in those with higher urinary AER (AER B30:30 -300:\ 300 mg/24 h: 26: 53: 88%, and greater in the normoalbuminuric group compared to the control group (26 vs. 5%; PB 0.05). An AER \30 mg/24 h was the only independent factor associated with inducible myocardial ischaemia in the multivariate analysis (P= 0.009). Conclusions: raised urinary AER in asymptomatic diabetic patients is a risk factor for present myocardial ischaemia demonstrated by thallium dypiridamole tomography. The prevalence of inducible myocardial ischaemia in asymptomatic diabetic patients without known coronary disease is much higher than in non-diabetic population.

Research paper thumbnail of Escape and lipodystrophy in acromegaly during pegvisomant therapy, a retrospective multicentre Spanish study

Clinical Endocrinology, 2014

Background Pegvisomant is an effective treatment for acromegaly. Objective To investigate escape ... more Background Pegvisomant is an effective treatment for acromegaly. Objective To investigate escape (loss of biochemical control in patients previously controlled) and lipodystrophy in acromegalic patients treated with pegvisomant and to evaluate possible associations with clinical features. Patients and methods Multicentre retrospective study involving 19 Spanish centres. Results Ninety-seven patients were included (59% women, mean age at diagnosis 42 AE 13 years, 80% macroadenomas); mean follow-up on pegvisomant was 5 AE 2Á5 years, and 89 (92%) achieved normal IGF-1. Escape was reported in 30/89 (34%) of responders, after a mean treatment duration of 25 AE 21 months. The mean initial dose of pegvisomant was 11 AE 5 mg/day, and mean dose at escape was 14 AE 7 mg/day. Most patients (26/30, 87%) achieved control with dose increase (57%), additional medical treatment (3%) or both (27%). Mean new dose that controlled IGF-1 after escape was 20 AE 7 mg/day. Treatments associated were somatostatin analogues (SSA in 47%), cabergoline (CAB in 47%) and both (6%). Lipodystrophy was observed in 15 patients (13 females), mild in six, moderate in six, severe in three and persistent in four. Among patients with lipodystrophy, three escaped and three were nonresponders to pegvisomant. Four patients discontinued the drug, and four had dose reductions because of lipodystrophy. It tended to be more frequent in females (P = 0Á06) and in patients treated with triple association SSA+CAB+PEG (P = 0Á018). No relationship between escape and clinical variables was found, except prior CAB (P = 0Á04) and metformin treatment (0Á02) and grade of lipodystrophy (P = 0Á02). Conclusions A significant proportion of patients treated with pegvisomant escaped (34%); however, the majority (87%) was easily controlled with either dose increase, further medical treatment or both. Lipodystrophy developed in 15%, mostly females, and influenced the response to treatment.

Research paper thumbnail of Insulin resistance and hypertension in patients with type 1 diabetes

Journal of Diabetes and its Complications, 2011

To assess blood pressure (BP) control, antihypertensive treatment, and prevalence of resistant hy... more To assess blood pressure (BP) control, antihypertensive treatment, and prevalence of resistant hypertension (RH) in patients with type 1 diabetes stratified by stage of diabetic nephropathy.

Research paper thumbnail of Estudio descriptivo de las características del cáncer diferenciado de tiroides en Cataluña en el periodo 1998-2012. Registro CECaT

Endocrinología y Nutrición, 2015

Recibido el 16 de enero de 2015; aceptado el 9 de marzo de 2015 Disponible en Internet el 13 de m... more Recibido el 16 de enero de 2015; aceptado el 9 de marzo de 2015 Disponible en Internet el 13 de mayo de 2015