Publications by authors named "Mercedes Rigla"

45 Publications

Influence of the BDNF Val66Met polymorphism on weight loss after bariatric surgery: a 24-month follow-up.

Surg Obes Relat Dis 2021 Jan 27;17(1):185-192. Epub 2020 Aug 27.

Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research Network on Mental Health, Instituto de Salud Carlos III, Barcelona, Spain. Electronic address:

Background: Bariatric surgery is currently the most effective long-term treatment for severe obesity. However, interindividual variation in surgery outcome has been observed, and research suggests a moderating effect of several factors including baseline co-morbidities (e.g., type 2 diabetes [T2D] and genetic factors). No data are currently available on the interaction between T2D and variants in brain derived neurotrophic factor (BDNF) and its effect on weight loss after surgery.

Objectives: To examine the role of the BDNF Val66Met polymorphism (rs6265) and the influence of T2D and their interaction on weight loss after bariatric surgery in a cohort of patients with severe obesity.

Setting: University hospital in Spain.

Methods: The present study evaluated a cohort of 158 patients with obesity submitted to bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) followed up for 24 months (loss to follow-up: 0%). During the postoperative period, percentage of excess body mass index loss (%EBMIL), percentage of excess weight loss (%EWL), and total weight loss (%TWL) were evaluated.

Results: Longitudinal analyses showed a suggestive effect of BDNF genotype on the %EWL (P = .056) and indicated that individuals carrying the methionine (Met) allele may experience a better outcome after bariatric surgery than those with the valine/valine (Val/Val) genotype. We found a negative effect of a T2D diagnosis at baseline on %EBMIL (P = .004). Additionally, we found an interaction between BDNF genotype and T2D on %EWL and %EBMIL (P = .027 and P = .0004, respectively), whereby individuals with the Met allele without T2D displayed a greater %EWL and greater %EBMIL at 12 months and 24 months than their counterparts with T2D or patients with the Val/Val genotype with or without T2D.

Conclusion: Our data showed an association between the Met variant and greater weight loss after bariatric surgery in patients without T2D. The presence of T2D seems to counteract this positive effect.
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http://dx.doi.org/10.1016/j.soard.2020.08.012DOI Listing
January 2021

Managing gestational diabetes mellitus using a smartphone application with artificial intelligence (SineDie) during the COVID-19 pandemic: Much more than just telemedicine.

Diabetes Res Clin Pract 2020 Nov 3;169:108396. Epub 2020 Sep 3.

Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell (Barcelona), Spain. Electronic address:

We describe our experience in the remote management of women with gestational diabetes mellitus during the COVID-19 pandemic. We used a mobile phone application with artificial intelligence that automatically classifies and analyses the data (ketonuria, diet transgressions, and blood glucose values), making adjustment recommendations regarding the diet or insulin treatment.
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http://dx.doi.org/10.1016/j.diabres.2020.108396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467870PMC
November 2020

Technology Gap Deepened by Coronavirus Pandemic.

Authors:
Mercedes Rigla

J Diabetes Sci Technol 2020 07 27;14(4):774-775. Epub 2020 May 27.

Endocrinology and Nutrition Department, Parc Tauli University Hospital, Sabadell, Spain.

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http://dx.doi.org/10.1177/1932296820929390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673170PMC
July 2020

Response to the letter to the editor: FKBP5 polymorphism rs1360780 and weight loss after bariatric surgery.

Surg Obes Relat Dis 2020 07 1;16(7):974-975. Epub 2020 Apr 1.

Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals. Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina, Universitat de Barcelona (IBUB), Barcelona, Spain; Centre for Biomedical Research Network on Mental Health, Instituto de Salud Carlos III, Barcelona, Spain.

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http://dx.doi.org/10.1016/j.soard.2020.03.026DOI Listing
July 2020

Role of the FKBP5 polymorphism rs1360780, age, sex, and type of surgery in weight loss after bariatric surgery: a follow-up study.

Surg Obes Relat Dis 2020 Apr 16;16(4):581-589. Epub 2019 Dec 16.

Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research Network on Mental Health, Instituto de Salud Carlos III, Barcelona, Spain. Electronic address:

Background: Emerging evidence suggests that the FK506 binding protein 51 (FKBP5/FKBP51), encoded by the FKBP5 gene, influences weight and metabolic regulation. The T allele of a functional polymorphism in FKBP5 (rs1360780), has been associated with the expression of FKBP51 and weight loss after bariatric surgery.

Objective: To examine the role of the FKBP5 rs1360780 polymorphism in relation to age, sex, and type of surgery in weight loss after bariatric surgery in patients with severe obesity.

Setting: University Hospital in Spain METHODS: A cohort of 151 obese patients submitted to Roux-en-Y gastric bypass (62.3%) and sleeve gastrectomy (37.7%) were followed-up during 24-months (t; loss to follow-up: 0%). During the postoperative period body mass index (BMI) and percentage of excess and total weight loss were evaluated.

Results: The BMI analysis showed an effect of the interaction FKBP5 genotype by sex (P = .0004) and a tendency to the interaction genotype by surgery (P = .048), so that men carrying the T allele had higher BMI at t than those without the T allele, and T-allele carriers that underwent sleeve gastrectomy had higher BMI at t than the noncarriers. Additionally, we found an interaction between FKBP5 and age for the percentage of excess weight loss and BMI (P = .0005 and P = 1.5e-7, respectively), whereby individuals >48 years with the T allele displayed significant differences for the analyzed variables at t compared with the homozygotes for the alternate C allele showing lower weight loss.

Conclusion: FKBP5 rs1360780 genotype has specific effects on weight loss outcomes after bariatric surgery depending on sex, age, and type of surgery, suggesting worse results in older males carrying the T allele who have undergone sleeve gastrectomy.
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http://dx.doi.org/10.1016/j.soard.2019.12.002DOI Listing
April 2020

Salivary Cortisol Determination in ACTH Stimulation Test to Diagnose Adrenal Insufficiency in Patients with Liver Cirrhosis.

Int J Endocrinol 2019 20;2019:7251010. Epub 2019 Jun 20.

Endocrinology Department, Parc Taulí University Hospital, Institut d'Investigacio i Innovació Parc Taulí I3PT, Autonomous University of Barcelona, Sabadell, Spain.

Purpose: The prevalence of adrenal insufficiency (AI) in patients with decompensated liver cirrhosis is unknown. Because these patients have lower levels of cortisol-binding carrier proteins, their total serum cortisol (TSC) correlates poorly with free serum cortisol (FC). Salivary cortisol (SaC) correlates better with FC. We aimed to establish SaC thresholds for AI for the 250 g intravenous ACTH test and to estimate the prevalence of AI in noncritically ill cirrhotic patients.

Methods: We included 39 patients with decompensated cirrhosis, 39 patients with known AI, and 45 healthy volunteers. After subjects fasted ≥8 hours, serum and saliva samples were collected for determinations of TSC and SaC at baseline 0'(T) and at 30-minute intervals after intravenous administration of 250 g ACTH [30'(T), 60'(T), and 90'(T)].

Results: Based on the findings in healthy subjects and patients with known AI, we defined AI in cirrhotic patients as SaC-T< 0.08 g/dL (2.2 nmol/L), SaC-T < 1.43 g/dl (39.5 nmol/L), or ΔSaC<1 g/dl (27.6 nmol/L). We compared AI determination in cirrhotic patients with the ACTH test using these SaC thresholds versus established TSC thresholds (TSC-T< 9 g/dl [248 nmol/L], TSC-T < 18 g/dl [497 nmol/L], or ΔTSC<9 g/dl [248 nmol/L]). SaC correlated well with TSC. The prevalence of AI in cirrhotic patients was higher when determined by TSC (48.7%) than by SaC (30.8%); however, this difference did not reach statistical significance. AI was associated with sex, cirrhosis etiology, and Child-Pugh classification.

Conclusions: Measuring SaC was more accurate than TSC in the ACTH stimulation test. Measuring TSC overestimated the prevalence of AI in noncritically ill cirrhotic patients.
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http://dx.doi.org/10.1155/2019/7251010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609341PMC
June 2019

Simultaneous onset of type 1 diabetes mellitus and silent thyroiditis under durvalumab treatment

Endocrinol Diabetes Metab Case Rep 2019 Jul 15;2019(1). Epub 2019 Jul 15.

Endocrinology and Nutrition Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain

Summary: Durvalumab, a human immunoglobulin G1 kappa monoclonal antibody that blocks the interaction of programmed cell death ligand 1 (PD-L1) with the PD-1 and CD80 (B7.1) molecules, is increasingly used in advanced neoplasias. Durvalumab use is associated with increased immune-related adverse events. We report a case of a 55-year-old man who presented to our emergency room with hyperglycaemia after receiving durvalumab for urothelial high-grade non-muscle-invasive bladder cancer. On presentation, he had polyuria, polyphagia, nausea and vomiting, and laboratory test revealed diabetic ketoacidosis (DKA). Other than durvalumab, no precipitating factors were identified. Pre-durvalumab blood glucose was normal. The patient responded to treatment with intravenous fluids, insulin and electrolyte replacement. Simultaneously, he presented a thyroid hormone pattern that evolved in 10 weeks from subclinical hyperthyroidism (initially attributed to iodinated contrast used in a previous computerised tomography) to overt hyperthyroidism and then to severe primary hypothyroidism (TSH: 34.40 µU/mL, free thyroxine (FT4): <0.23 ng/dL and free tri-iodothyronine (FT3): 0.57 pg/mL). Replacement therapy with levothyroxine was initiated. Finally, he was tested positive for anti-glutamic acid decarboxylase (GAD65), anti-thyroglobulin (Tg) and antithyroid peroxidase (TPO) antibodies (Abs) and diagnosed with type 1 diabetes mellitus (DM) and silent thyroiditis caused by durvalumab. When durvalumab was stopped, he maintained the treatment of multiple daily insulin doses and levothyroxine. Clinicians need to be alerted about the development of endocrinopathies, such as DM, DKA and primary hypothyroidism in the patients receiving durvalumab.

Learning Points: Patients treated with anti-PD-L1 should be screened for the most common immune-related adverse events (irAEs). Glucose levels and thyroid function should be monitored before and during the treatment. Durvalumab is mainly associated with thyroid and endocrine pancreas dysfunction. In the patients with significant autoimmune background, risk–benefit balance of antineoplastic immunotherapy should be accurately assessed.
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http://dx.doi.org/10.1530/EDM-19-0045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115434PMC
July 2019

Kallmann syndrome and ichthyosis: a case of contiguous gene deletion syndrome.

Endocrinol Diabetes Metab Case Rep 2017 Sep 28;2017. Epub 2017 Sep 28.

Endocrinology Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain.

Kallmann syndrome is a genetically heterogeneous form of hypogonadotropic hypogonadism caused by gonadotropin-releasing hormone deficiency and characterized by anosmia or hyposmia due to hypoplasia of the olfactory bulbs; osteoporosis and metabolic syndrome can develop due to longstanding untreated hypogonadism. Kallmann syndrome affects 1 in 10 000 men and 1 in 50 000 women. Defects in 17 genes, including KAL1, have been implicated. Kallmann syndrome can be associated with X-linked ichthyosis, a skin disorder characterized by early onset dark, dry, irregular scales affecting the limb and trunk, caused by a defect of the steroid sulfatase gene (STS). Both KAL1 and STS are located in the Xp22.3 region; therefore, deletions in this region cause a contiguous gene syndrome. We report the case of a 32-year-old man with ichthyosis referred for evaluation of excessive height (2.07 m) and weight (BMI: 29.6 kg/m2), microgenitalia and absence of secondary sex characteristics. We diagnosed Kallmann syndrome with ichthyosis due to a deletion in Xp22.3, a rare phenomenon. Learning points: Kallmann syndrome is a genetically heterogeneous disease characterized by hypogonadotropic hypogonadism with anosmia or hyposmia associated with defects in the production or action of gonadotropin-releasing hormone (GnRH) and hypoplasia of the olfactory bulbs. Several genes have been implicated in Kallmann syndrome, including KAL1, located in the Xp22.3 region, which is responsible for X-linked Kallmann syndrome. KAL1 encodes the protein anosmin-1. X-linked ichthyosis is caused by deficiency of the steroid sulfatase enzyme, encoded by STS, which is also located in the Xp22.3 region. Deletions involving this region can affect both genes and result in contiguous gene syndromes. Phenotype can guide clinicians toward suspicion of a specific genetic mutation. KAL1 mutations are mostly related to microgenitalia, unilateral renal agenesis and synkinesia, although patients need not present all these abnormalities. Longstanding untreated hypogonadism is associated with poor sexual health, osteoporosis and metabolic syndrome with the concomitant risk of developing type 2 diabetes mellitus and obesity. Treatment aims to promote the development of secondary sex characteristics, build and sustain normal bone and muscle mass and restore fertility. Treatment can also help minimize some psychological consequences. Treatments available for patients with congenital GnRH deficiency such as Kallmann syndrome include gonadal steroid hormones, human gonadotropins and GnRH. The choice of therapy depends on the goal or goals.
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http://dx.doi.org/10.1530/EDM-17-0083DOI Listing
September 2017

Decision Support in Diabetes Care: The Challenge of Supporting Patients in Their Daily Living Using a Mobile Glucose Predictor.

J Diabetes Sci Technol 2018 03;12(2):243-250

1 CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.

Background: In type 1 diabetes mellitus (T1DM), patients play an active role in their own care and need to have the knowledge to adapt decisions to their daily living conditions. Artificial intelligence applications can help people with type 1 diabetes in decision making and allow them to react at time scales shorter than the scheduled face-to-face visits. This work presents a decision support system (DSS), based on glucose prediction, to assist patients in a mobile environment.

Methods: The system's impact on therapeutic corrective actions has been evaluated in a randomized crossover pilot study focused on interprandial periods. Twelve people with type 1 diabetes treated with insulin pump participated in two phases: In the experimental phase (EP) patients used the DSS to modify initial corrective decisions in presence of hypoglycemia or hyperglycemia events. In the control phase (CP) patients were asked to follow decisions without knowing the glucose prediction. A telemedicine platform allowed participants to register monitoring data and decisions and allowed endocrinologists to supervise data at the hospital. The study period was defined as a postprediction (PP) time window.

Results: After knowing the glucose prediction, participants modified the initial decision in 20% of the situations. No statistically significant differences were found in the PP Kovatchev's risk index change (-1.23 ± 11.85 in EP vs -0.56 ± 6.06 in CP). Participants had a positive opinion about the DSS with an average score higher than 7 in a usability questionnaire.

Conclusion: The DSS had a relevant impact in the participants' decision making while dealing with T1DM and showed a high confidence of patients in the use of glucose prediction.
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http://dx.doi.org/10.1177/1932296818761457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851238PMC
March 2018

Human Subcutaneous Tissue Response to Glucose Sensors: Macrophages Accumulation Impact on Sensor Accuracy.

Diabetes Technol Ther 2018 04 22;20(4):296-302. Epub 2018 Feb 22.

3 Pathology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain .

Background: Subcutaneous (s.c.) glucose sensors have become a key component in type 1 diabetes management. However, their usability is limited by the impact of foreign body response (FBR) on their duration, reliability, and accuracy. Our study gives the first description of human acute and subacute s.c. response to glucose sensors, showing the changes observed in the sensor surface, the inflammatory cells involved in the FBR and their relationship with sensor performance.

Methods: Twelve obese patients (seven type 2 diabetes) underwent two abdominal biopsies comprising the surrounding area where they had worn two glucose sensors: the first one inserted 7 days before and the second one 24 h before biopsy procedure. Samples were processed and studied to describe tissue changes by two independent pathologists (blind regarding sensor duration). Macrophages quantification was studied by immunohistochemistry methods in the area surrounding the sensor (CD68, CD163). Sensor surface changes were studied by scanning electron microscopy. Seven-day continuous glucose monitoring records were considered inaccurate when mean absolute relative difference was higher than 10%.

Results: Pathologists were able to correctly classify all the biopsies regarding sensor duration. Acute response (24 h) was characterized by the presence of neutrophils while macrophages were the main cell involved in subacute inflammation. The number of macrophages around the insertion hole was higher for less accurate sensors compared with those performing more accurately (32.6 ± 14 vs. 10.6 ± 1 cells/0.01 mm; P < 0.05).

Conclusion: The accumulation of macrophages at the sensor-tissue interface is related with decrease in accuracy of the glucose measure.
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http://dx.doi.org/10.1089/dia.2017.0321DOI Listing
April 2018

SED-SEEP Consensus document on the use of continuous glucose monitoring in Spain.

Endocrinol Diabetes Nutr 2018 Mar 18;65 Suppl 1:24-28. Epub 2017 May 18.

Unidad de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España.

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http://dx.doi.org/10.1016/j.endinu.2017.03.011DOI Listing
March 2018

Mapping the sequence of brain events in response to disgusting food.

Hum Brain Mapp 2018 01 11;39(1):369-380. Epub 2017 Oct 11.

Endocrinology and Nutrition Department, Sabadell University Hospital (UAB), Corporació Sanitària Parc Taulí, Sabadell, 08208, Spain.

Warning signals indicating that a food is potentially dangerous may evoke a response that is not limited to the feeling of disgust. We investigated the sequence of brain events in response to visual representations of disgusting food using a dynamic image analysis. Functional MRI was acquired in 30 healthy subjects while they were watching a movie showing disgusting food scenes interspersed with the scenes of appetizing food. Imaging analysis included the identification of the global brain response and the generation of frame-by-frame activation maps at the temporal resolution of 2 s. Robust activations were identified in brain structures conventionally associated with the experience of disgust, but our analysis also captured a variety of other brain elements showing distinct temporal evolutions. The earliest events included transient changes in the orbitofrontal cortex and visual areas, followed by a more durable engagement of the periaqueductal gray, a pivotal element in the mediation of responses to threat. A subsequent core phase was characterized by the activation of subcortical and cortical structures directly concerned not only with the emotional dimension of disgust (e.g., amygdala-hippocampus, insula), but also with the regulation of food intake (e.g., hypothalamus). In a later phase, neural excitement extended to broad cortical areas, the thalamus and cerebellum, and finally to the default mode network that signaled the progressive termination of the evoked response. The response to disgusting food representations is not limited to the emotional domain of disgust, and may sequentially involve a variety of broadly distributed brain networks. Hum Brain Mapp 39:369-380, 2018. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/hbm.23848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866415PMC
January 2018

Artificial Intelligence Methodologies and Their Application to Diabetes.

J Diabetes Sci Technol 2018 03 25;12(2):303-310. Epub 2017 May 25.

2 Bioengineering and Telemedicine Centre, Universidad Politécnica de Madrid, Spain.

In the past decade diabetes management has been transformed by the addition of continuous glucose monitoring and insulin pump data. More recently, a wide variety of functions and physiologic variables, such as heart rate, hours of sleep, number of steps walked and movement, have been available through wristbands or watches. New data, hydration, geolocation, and barometric pressure, among others, will be incorporated in the future. All these parameters, when analyzed, can be helpful for patients and doctors' decision support. Similar new scenarios have appeared in most medical fields, in such a way that in recent years, there has been an increased interest in the development and application of the methods of artificial intelligence (AI) to decision support and knowledge acquisition. Multidisciplinary research teams integrated by computer engineers and doctors are more and more frequent, mirroring the need of cooperation in this new topic. AI, as a science, can be defined as the ability to make computers do things that would require intelligence if done by humans. Increasingly, diabetes-related journals have been incorporating publications focused on AI tools applied to diabetes. In summary, diabetes management scenarios have suffered a deep transformation that forces diabetologists to incorporate skills from new areas. This recently needed knowledge includes AI tools, which have become part of the diabetes health care. The aim of this article is to explain in an easy and plane way the most used AI methodologies to promote the implication of health care providers-doctors and nurses-in this field.
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http://dx.doi.org/10.1177/1932296817710475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851211PMC
March 2018

A web-based clinical decision support system for gestational diabetes: Automatic diet prescription and detection of insulin needs.

Int J Med Inform 2017 06 6;102:35-49. Epub 2017 Mar 6.

Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Avd. Complutense n°30, 28040, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain. Electronic address:

Background: The growth of diabetes prevalence is causing an increasing demand in health care services which affects the clinicians' workload as medical resources do not grow at the same rate as the diabetic population. Decision support tools can help clinicians with the inspection of monitoring data, providing a preliminary analysis to ease their interpretation and reduce the evaluation time per patient. This paper presents Sinedie, a clinical decision support system designed to manage the treatment of patients with gestational diabetes. Sinedie aims to improve access to specialized healthcare assistance, to prevent patients from unnecessary displacements, to reduce the evaluation time per patient and to avoid gestational diabetes adverse outcomes.

Methods: A web-based telemedicine platform was designed to remotely evaluate patients allowing them to upload their glycaemia data at home directly from their glucose meter, as well as report other monitoring variables like ketonuria and compliance to dietary treatment. Glycaemia values, not tagged by patients, are automatically labelled with their associated meal by a classifier based on the Expectation Maximization clustering algorithm and a C4.5 decision tree learning algorithm. Two finite automata are combined to determine the patient's metabolic condition, which is analysed by a rule-based knowledge base to generate therapy adjustment recommendations. Diet recommendations are automatically prescribed and notified to the patients, whereas recommendations about insulin requirements are notified also to the physicians, who will decide if insulin needs to be prescribed. The system provides clinicians with a view where patients are prioritized according to their metabolic condition. A randomized controlled clinical trial was designed to evaluate the effectiveness and safety of Sinedie interventions versus standard care and its impact in the professionals' workload in terms of the clinician's time required per patient; number of face-to-face visits; frequency and duration of telematics reviews; patients' compliance to self-monitoring; and patients' satisfaction.

Results: Sinedie was clinically evaluated at "Parc Tauli University Hospital" in Spain during 17 months with the participation of 90 patients with gestational diabetes. Sinedie detected all situations that required a therapy adjustment and all the generated recommendations were safe. The time devoted by clinicians to patients' evaluation was reduced by 27.389% and face-to-face visits per patient were reduced by 88.556%. Patients reported to be highly satisfied with the system, considering it useful and trusting in being well controlled. There was no monitoring loss and, in average, patients measured their glycaemia 3.890 times per day and sent their monitoring data every 3.477days.

Conclusions: Sinedie generates safe advice about therapy adjustments, reduces the clinicians' workload and helps physicians to identify which patients need a more urgent or more exhaustive examination and those who present good metabolic control. Additionally, Sinedie saves patients unnecessary displacements which contributes to medical centres' waiting list reduction.
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http://dx.doi.org/10.1016/j.ijmedinf.2017.02.014DOI Listing
June 2017

Takotsubo cardiomyopathy in amiodarone-induced hyperthyroidism.

Endocrinol Diabetes Metab Case Rep 2017 15;2017. Epub 2017 Feb 15.

Endocrinology Department, Parc Taulí Sabadell University Hospital, Sabadell Barcelona, Spain.

Summary: Takotsubo cardiomyopathy (TC) is an atypical, severe but reversible form of acute heart insufficiency. It typically presents with left ventricular failure, transient apical and mid-segments hypokinesis, absence of significant coronary stenosis and new electrographic abnormalities and/or elevation in serum cardiac enzymes. Although TC ('broken heart syndrome') has classically been associated with emotional trauma, evidence suggests that other precipitants might exist, including iatrogenic and thyroid-mediated forms. Thyroid disease is a relatively common comorbidity in TC patients. We report a case of TC in a postmenopausal female with no history of emotional trauma or other potential precipitant factors who was diagnosed with amiodarone-induced hyperthyroidism during her hospital stay. Though some case reports of thyroid-related TC exist, we are not aware of any other reported case of TC precipitated by amiodarone-induced hyperthyroidism.

Learning Points: TC is a relatively new, rare, transient, severe, but reversible cardiovascular condition that is characterized by an acute left ventricular cardiac failure, which can clinically, analytically and electrocardiographically mimic an acute myocardial infarction.Many precipitant factors have been described in TC, being the most classical and emotional trauma. However, thyroid dysfunction is also a significant condition frequently found in patients with TC.A hypercatecholaminergic state leading to cardiomyocyte damage has been established as the main fact of TC physiopathology. Hyperthyroidism induces an upregulation of β-adrenergic receptors.Both hyperthyroidism and hypothyroidism have been related with TC development. Most reported cases of TC involving thyroid dysfunction correspond to hyperthyroidism due to Graves-Basedow disease, but there are also descriptions with severe hypothyroidism, radioiodine treatment or thyroid surgery.Amiodarone is a class III antiarrhythmic agent widely used, and it is a well-known cause of thyroid dysfunction, which can present either with hypothyroidism or hyperthyroidism, as approximately 40 percent of the amiodarone molecule is composed of iodine.In this case, a type II amiodarone-induced hyperthyroidism was the precipitant factor of a TC in a patient with a pre-existing atrial fibrillation. Given the high prevalence of atrial fibrillation and the wide use of amiodarone, the risk of this iatrogenic effect should be taken into account.
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http://dx.doi.org/10.1530/EDM-16-0116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404472PMC
February 2017

Gestational Diabetes Management Using Smart Mobile Telemedicine.

J Diabetes Sci Technol 2018 03 18;12(2):260-264. Epub 2017 Apr 18.

2 Bioengineering and Telemedicine Centre, Universidad Politécnica de Madrid, Madrid, Spain.

Gestational diabetes (GDM) burden has been increasing progressively over the past years. Knowing that intrauterine exposure to maternal diabetes confers high risk for macrosomia as well as for future type 2 diabetes and obesity of the offspring, health care organizations try to provide effective control in spite of the limited resources. Artificial-intelligence-augmented telemedicine has been proposed as a helpful tool to facilitate an efficient widespread medical assistance to GDM. The aim of the study we present was to test the feasibility and acceptance of a mobile decision-support system for GDM, developed in the seventh framework program MobiGuide Project, which includes computer-interpretable clinical practice guidelines, access to data from the electronic health record as well as from glucose, blood pressure, and activity sensors. The results of this pilot study with 20 patients showed that the system is feasible. Compliance of patients with blood glucose monitoring was higher than that observed in a historical group of 247 patients, similar in clinical characteristics, who had been followed up for the 3 years prior to the pilot study. A questionnaire on the use of the telemedicine system showed a high degree of acceptance.
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http://dx.doi.org/10.1177/1932296817704442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851209PMC
March 2018

Assessment of a personalized and distributed patient guidance system.

Int J Med Inform 2017 05 21;101:108-130. Epub 2017 Feb 21.

University of Twente, 7500 AE, Enschede, The Netherlands.

Objectives: The MobiGuide project aimed to establish a ubiquitous, user-friendly, patient-centered mobile decision-support system for patients and for their care providers, based on the continuous application of clinical guidelines and on semantically integrated electronic health records. Patients would be empowered by the system, which would enable them to lead their normal daily lives in their regular environment, while feeling safe, because their health state would be continuously monitored using mobile sensors and self-reporting of symptoms. When conditions occur that require medical attention, patients would be notified as to what they need to do, based on evidence-based guidelines, while their medical team would be informed appropriately, in parallel. We wanted to assess the system's feasibility and potential effects on patients and care providers in two different clinical domains.

Materials And Methods: We describe MobiGuide's architecture, which embodies these objectives. Our novel methodologies include a ubiquitous architecture, encompassing a knowledge elicitation process for parallel coordinated workflows for patients and care providers; the customization of computer-interpretable guidelines (CIGs) by secondary contexts affecting remote management and distributed decision-making; a mechanism for episodic, on demand projection of the relevant portions of CIGs from a centralized, backend decision-support system (DSS), to a local, mobile DSS, which continuously delivers the actual recommendations to the patient; shared decision-making that embodies patient preferences; semantic data integration; and patient and care provider notification services. MobiGuide has been implemented and assessed in a preliminary fashion in two domains: atrial fibrillation (AF), and gestational diabetes Mellitus (GDM). Ten AF patients used the AF MobiGuide system in Italy and 19 GDM patients used the GDM MobiGuide system in Spain. The evaluation of the MobiGuide system focused on patient and care providers' compliance to CIG recommendations and their satisfaction and quality of life.

Results: Our evaluation has demonstrated the system's capability for supporting distributed decision-making and its use by patients and clinicians. The results show that compliance of GDM patients to the most important monitoring targets - blood glucose levels (performance of four measurements a day: 0.87±0.11; measurement according to the recommended frequency of every day or twice a week: 0.99±0.03), ketonuria (0.98±0.03), and blood pressure (0.82±0.24) - was high in most GDM patients, while compliance of AF patients to the most important targets was quite high, considering the required ECG measurements (0.65±0.28) and blood-pressure measurements (0.75±1.33). This outcome was viewed by the clinicians as a major potential benefit of the system, and the patients have demonstrated that they are capable of self-monitoring - something that they had not experienced before. In addition, the system caused the clinicians managing the AF patients to change their diagnosis and subsequent treatment for two of the ten AF patients, and caused the clinicians managing the GDM patients to start insulin therapy earlier in two of the 19 patients, based on system's recommendations. Based on the end-of-study questionnaires, the sense of safety that the system has provided to the patients was its greatest asset. Analysis of the patients' quality of life (QoL) questionnaires for the AF patients was inconclusive, because while most patients reported an improvement in their quality of life in the EuroQoL questionnaire, most AF patients reported a deterioration in the AFEQT questionnaire.

Discussion: Feasibility and some of the potential benefits of an evidence-based distributed patient-guidance system were demonstrated in both clinical domains. The potential application of MobiGuide to other medical domains is supported by its standards-based patient health record with multiple electronic medical record linking capabilities, generic data insertion methods, generic medical knowledge representation and application methods, and the ability to communicate with a wide range of sensors. Future larger scale evaluations can assess the impact of such a system on clinical outcomes.

Conclusion: MobiGuide's feasibility was demonstrated by a working prototype for the AF and GDM domains, which is usable by patients and clinicians, achieving high compliance to self-measurement recommendations, while enhancing the satisfaction of patients and care providers.
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http://dx.doi.org/10.1016/j.ijmedinf.2017.02.010DOI Listing
May 2017

Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea.

Obes Surg 2017 09;27(9):2338-2346

Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, c/ Parc Taulí no 1, 08208, Sabadell, Barcelona, Spain.

Introduction: Morbid obesity and obstructive sleep apnea (OSA) interact at an inflammatory level. Bariatric surgery reduces inflammatory responses associated with obesity. Heme oxygenase-1 (HO-1) is an enzyme with anti-inflammatory properties, which might be increased in morbid obesity or OSA. We studied morbidly obese patients with OSA to determine: (a) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and (b) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation.

Material And Methods: We analyzed the homeostasis model insulin resistance index (HOMA) and plasma concentrations of HO-1, tumor necrosis factor alpha, interleukin-6, interleukin-1-beta, C reactive protein (CRP), and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery and 12 months after surgery.

Results: Before surgery, HO-1 plasma concentrations were similar in three groups of patients with mild, moderate, and severe OSA, and correlated with HOMA (r = 0.27, p = 0.02). Twelve months after surgery, low-grade inflammation and insulin resistance had decreased in all the groups, but HO-1 plasma concentration had decreased only in the severe OSA group (p = 0.02). In this group, the reduction in HO-1 correlated with a reduction in CRP concentrations (r = 0.43, p = 0.04) and with improved HOMA score (r = 0.37, p = 0.03).

Conclusions: Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA, and this decrease is associated with decreases in insulin resistance and in inflammation.
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http://dx.doi.org/10.1007/s11695-017-2635-4DOI Listing
September 2017

Lack of Postprandial Peak in Brain-Derived Neurotrophic Factor in Adults with Prader-Willi Syndrome.

PLoS One 2016;11(9):e0163468. Epub 2016 Sep 29.

Department of Endocrinology and Nutrition, Sabadell University Hospital, Corporació Sanitària Parc Taulí, Sabadell, Spain, Autonomous University of Barcelona, Bellaterra, Spain.

Context: Prader-Willi syndrome (PWS) is characterized by severe hyperphagia. Brain-derived neurotrophic factor (BDNF) and leptin are reciprocally involved in energy homeostasis.

Objectives: To analyze the role of BDNF and leptin in satiety in genetic subtypes of PWS.

Design: Experimental study.

Setting: University hospital.

Subjects: 90 adults: 30 PWS patients; 30 age-sex-BMI-matched obese controls; and 30 age-sex-matched lean controls.

Interventions: Subjects ingested a liquid meal after fasting ≥10 hours.

Main Outcome Measures: Leptin and BDNF levels in plasma extracted before ingestion and 30', 60', and 120' after ingestion. Hunger, measured on a 100-point visual analogue scale before ingestion and 60' and 120' after ingestion.

Results: Fasting BDNF levels were lower in PWS than in controls (p = 0.05). Postprandially, PWS patients showed only a truncated early peak in BDNF, and their BDNF levels at 60' and 120' were lower compared with lean controls (p<0.05). Leptin was higher in PWS patients than in controls at all time points (p<0.001). PWS patients were hungrier than controls before and after eating. The probability of being hungry was associated with baseline BDNF levels: every 50-unit increment in BDNF decreased the odds of being hungry by 22% (OR: 0.78, 95%CI: 0.65-0.94). In uniparental disomy, the odds of being hungry decreased by 66% (OR: 0.34, 90%CI: 0.13-0.9). Postprandial leptin patterns did no differ among genetic subtypes.

Conclusions: Low baseline BDNF levels and lack of postprandial peak may contribute to persistent hunger after meals. Uniparental disomy is the genetic subtype of PWS least affected by these factors.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163468PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042477PMC
September 2016

Hypothyroidism and protein-losing enteropathy: A case report.

Endocrinol Nutr 2016 Feb 17;63(2):95-6. Epub 2015 Dec 17.

Servicio de Endocrinología y Nutrición, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España.

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http://dx.doi.org/10.1016/j.endonu.2015.11.001DOI Listing
February 2016

Anomalous basal ganglia connectivity and obsessive-compulsive behaviour in patients with Prader Willi syndrome.

J Psychiatry Neurosci 2016 06;41(4):261-71

From the MRI Research Unit, CRC Mar, Hospital del Mar, Barcelona, Spain (Pujol, Blanco-Hinojo, Deus, Macià); the Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain (Pujol); the Human Pharmacology and Clinical Neurosciences, Hospital del Mar Medical Research Institute, Barcelona, Spain (Blanco-Hinojo); the Parc Hospitalari Martí i Julià, Salt, Girona, Spain (Esteba-Castillo, Novell-Alsina); the Endocrinology and Nutrition Department. Sabadell University Hospital (UAB), Corporació Sanitària Parc Taulí, Sabadell, Spain (Caixàs, Rigla); the Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia (Harrison); the Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain (Bueno); the Department of Clinical and Health Psychology, Autonomous University of Barcelona, Spain (Deus); and the Rheumatology Department, Hospital del Mar, Barcelona, Spain (Onaindia).

Background: Prader Willi syndrome is a genetic disorder with a behavioural expression characterized by the presence of obsessive-compulsive phenomena ranging from elaborate obsessive eating behaviour to repetitive skin picking. Obsessive-compulsive disorder (OCD) has been recently associated with abnormal functional coupling between the frontal cortex and basal ganglia. We have tested the potential association of functional connectivity anomalies in basal ganglia circuits with obsessive-compulsive behaviour in patients with Prader Willi syndrome.

Methods: We analyzed resting-state functional MRI in adult patients and healthy controls. Whole-brain functional connectivity maps were generated for the dorsal and ventral aspects of the caudate nucleus and putamen. A selected obsessive-compulsive behaviour assessment included typical OCD compulsions, self picking and obsessive eating behaviour.

Results: We included 24 adults with Prader Willi syndrome and 29 controls in our study. Patients with Prader Willi syndrome showed abnormal functional connectivity between the prefrontal cortex and basal ganglia and within subcortical structures that correlated with the presence and severity of obsessive-compulsive behaviours. In addition, abnormally heightened functional connectivity was identified in the primary sensorimotor cortex-putamen loop, which was strongly associated with self picking. Finally, obsessive eating behaviour correlated with abnormal functional connectivity both within the basal ganglia loops and between the striatum and the hypothalamus and the amygdala.

Limitations: Limitations of the study include the difficulty in evaluating the nature of content of obsessions in patients with Prader Willi Syndrome and the risk of excessive head motion artifact on brain imaging.

Conclusion: Patients with Prader Willi syndrome showed broad functional connectivity anomalies combining prefrontal loop alterations characteristic of OCD with 1) enhanced coupling in the primary sensorimotor loop that correlated with the most impulsive aspects of the behaviour and 2) reduced coupling of the ventral striatum with limbic structures for basic internal homeostasis that correlated with the obsession to eat.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915935PMC
http://dx.doi.org/10.1503/jpn.140338DOI Listing
June 2016

Does bariatric surgery reduce cancer risk? A review of the literature.

Endocrinol Nutr 2015 Mar 28;62(3):138-43. Epub 2015 Jan 28.

Servicio de Endocrinología y Nutrición, Hospital Universitari de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain. Electronic address:

Introduction: Bariatric surgery has been shown to provide sustained weight loss and to decrease obesity-related mortality in most patients with morbid obesity, but its effect on cancer risk is less clear. Our aim was to review the published studies on the association between bariatric surgery and cancer risk.

Methods: A literature search for relevant articles published in English, with no limitation on the year of publication, was conducted using PubMed. Studies reporting data on preoperative cancer, case reports, and publications with no abstract available were excluded.

Results: Overall, the published literature suggests that bariatric surgery may decrease risk of cancer, although this effect appears to be limited to women. However, two recent studies contradict these findings and state that risk of cancer has not been actually shown to decrease after surgery, and an increased risk of colorectal cancer has even been seen. Although most studies report lower cancer risk after bariatric surgery, the main limitations include their designs, which do not achieve the highest levels of evidence. Moreover, several mechanisms have been proposed to explain the protective effect of surgery, but the exact mechanisms have not been elucidated yet, which suggests the need for further research.

Conclusions: Bariatric surgery may have a protective effect from overall cancer risk, mainly in women, but additional research is needed. Further research is also required to better examine the relationship between bariatric surgery and risk of colorectal cancer before confirming or dismissing the above reported higher risk, as well as the risk of esophagogastric cancer, which has not been adequately studied to date.
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http://dx.doi.org/10.1016/j.endonu.2014.12.005DOI Listing
March 2015

Toll-like receptor 9 promoter polymorphism as a predictive factor of narrow-band UVB phototherapy response in patients with psoriasis.

Photodermatol Photoimmunol Photomed 2015 Mar 19;31(2):98-103. Epub 2015 Jan 19.

Department of Dermatology, Consorci Sanitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain.

Background: Prediction of response to ultraviolet B (UVB) phototherapy in psoriatic patients mainly relies on clinical criteria, although some genetic predictors have been identified. Toll-like receptors (TLRs) have been involved in psoriasis pathogenesis through activation of the innate immune system. Their polymorphisms may condition not only the clinical profile of psoriasis but also the response to therapy.

Methods: We analyzed the role of functional single-nucleotide polymorphisms (SNPs) of TLR2, 5, 4, and 9 in clinical response to a standard narrow-band UVB (NBUVB) therapy in 39 patients with moderate to severe psoriasis.

Results: We found a significant relationship between TLR9-1486T/C SNP variants and a better response to NBUVB phototherapy. Patients with TC and CC genotype showed a higher improvement of Psoriasis Area and Severity Index (PASI) than patients with TT genotype. Results of multivariate analysis indicate that the differences in PASI improvement at the end of phototherapy attributed to TRL9 SNP genotype were not dependent on the patients' phototype, age, gender, body mass index, basal PASI, or disease evolution.

Conclusions: We describe a functional genetic variant in TLR9 gene that might affect the susceptibility to antipsoriatic treatment. The search of genetic predictive factors may be helpful in therapy selection and optimization of therapeutic regimes in psoriatic patients.
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http://dx.doi.org/10.1111/phpp.12160DOI Listing
March 2015

Naltrexone sustained-release/bupropion sustained-release for the management of obesity: review of the data to date.

Drug Des Devel Ther 2014 18;8:1419-27. Epub 2014 Sep 18.

Endocrinology and Nutrition Department, Parc Tauli Sabadell University Hospital, Autonomous University of Barcelona, Barcelona, Spain.

Obesity is an emerging disease worldwide. Changes in living habits, especially with increased consumption of high-calorie foods and decreased levels of physical activity, lead to an energy imbalance that brings weight gain. Overweight and obesity are major risk factors for several chronic diseases (including cardiovascular diseases, diabetes, and cancer), reduce quality of life, and are associated with higher mortality. For all these reasons, it is of the utmost importance that the trend be reversed and obese people enabled to lose weight. It is known that eating a healthy diet and exercising regularly can help prevent obesity, but data show that in many cases these steps are not enough. This is the reason why, over the last few decades, several antiobesity drugs have been developed. However, the disappointing results demonstrated for the vast majority of them have not discouraged the pharmaceutical industry from continuing to look for an effective drug or combination of drugs. The systematic review presented here focuses on naltrexone sustained-release/bupropion sustained-release combination (Contrave(®)). We conclude from the current published reports that its effectiveness in the treatment of obesity can be estimated as a placebo-subtracted weight loss of around 4.5%. This weight reduction is moderate but similar to other antiobesity drugs. The safety profile of this combination is acceptable, despite additional data regarding cardiovascular disease being needed.
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http://dx.doi.org/10.2147/DDDT.S55587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174046PMC
July 2015

Response to initial therapy of differentiated thyroid cancer predicts the long-term outcome better than classical risk stratification systems.

Int J Endocrinol 2014 8;2014:591285. Epub 2014 Jul 8.

Endocrinology and Nutrition Department, Parc Taulí Sabadell University Hospital, Parc Taulí s/n, Sabadell, 08208 Barcelona, Spain.

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 (P < 0.05). Conclusions. RIT predicts the long-term outcome of DTC better than ETA/ATA systems, becoming a useful system to adapt management strategies.
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http://dx.doi.org/10.1155/2014/591285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121103PMC
August 2014

Patient-oriented Computerized Clinical Guidelines for Mobile Decision Support in Gestational Diabetes.

J Diabetes Sci Technol 2014 Mar 6;8(2):238-246. Epub 2014 Mar 6.

Bioengineering and Telemedicine Centre, Universidad Politécnica de Madrid, Spain CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain.

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients' self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient's access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients' personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients' acceptance of the whole system.
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http://dx.doi.org/10.1177/1932296814526492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455422PMC
March 2014

Topiramate as a Cause of False Positive in the Overnight 1-mg Dexamethasone Suppression Test.

Endocr Pract 2014 Jul;20(7):e116-8

Endocrinology and Nutrition Department, Parc Taulí Sabadell University Hospital. Sabadell, Barcelona, Spain.

Objective: To describe that topiramate may cause a false positive in an overnight 1-mg dexamethasone suppression test (DST) for hypercortisolism screening.

Methods: We present a case in which topiramate induced dexamethasone metabolism, leading to a false positive on the DST.

Results: A 44-year-old female with an incidentally found adenoma in the right adrenal gland underwent a DST for hypercortisolism screening. The patient was taking topiramate prescribed by a psychiatrist for an affective disorder, and insufficient cortisol suppression (11.9 mcg/dL) was observed. Her free cortisol in 24-hour urine was normal, and insufficient suppression was established in a second determination (9.3 mcg/dL). Finally, her psychiatrist switched her treatment from topiramate to bupropion, and the measurements were repeated. When she was not taking topiramate, correct suppression with 1 mg of dexamethasone was obtained (1.7 mcg/dL), and her free cortisol in 24-hour urine was again normal, thereby excluding the presence of hypercortisolism. On reviewing the literature, topiramate was not found to have been previously described as a cause of a false positive on DST, but it was proposed as a cause of hypoadrenalism in a patient taking oral corticosteroid replacement due to its capacity to induce dexamethasone metabolism.

Conclusion: Topiramate treatment may well be a cause of false positives in DSTs, and its presence should be taken into consideration when screening for hypercortisolism.
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http://dx.doi.org/10.4158/EP13485.CRDOI Listing
July 2014

Supporting shared decision making within the MobiGuide project.

AMIA Annu Symp Proc 2013 16;2013:1175-84. Epub 2013 Nov 16.

University of Pavia, Italy.

This paper describes our approach for fostering and facilitating communication among patients and caregivers in the context of shared decision making, i.e., when decisions must be taken not only on the basis of scientific evidence but also of the patient's preferences and context. This happens because clinical practice guidelines cannot provide recommendations for every possible situation, and cannot foresee every change in a patient's context, which might imply the deviation from a previously acknowledged recommendation. Within the EU-funded project MobiGuide (www.mobiguide-project.eu), supporting remote patient management, we propose decision theory as a methodological framework for a tool that, during face to face encounters, is used to tailor pre-defined, generic decision models to the individual patient, by involving the patient himself in the customization of the model parameters. Although this approach is not appropriate for all patients, it leads, in well-chosen cases, to a more informed choice, with potentially better treatment compliance.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900138PMC
May 2014

Artificial pancreas using a personalized rule-based controller achieves overnight normoglycemia in patients with type 1 diabetes.

Diabetes Technol Ther 2014 Mar 23;16(3):172-9. Epub 2013 Oct 23.

1 Endocrinology and Nutrition Department, Parc Taulí Sabadell University Hospital, Autonomous University of Barcelona , Sabadell, Barcelona, Spain .

Objective: This study assessed the efficacy of a closed-loop (CL) system consisting of a predictive rule-based algorithm (pRBA) on achieving nocturnal and postprandial normoglycemia in patients with type 1 diabetes mellitus (T1DM). The algorithm is personalized for each patient's data using two different strategies to control nocturnal and postprandial periods.

Research Design And Methods: We performed a randomized crossover clinical study in which 10 T1DM patients treated with continuous subcutaneous insulin infusion (CSII) spent two nonconsecutive nights in the research facility: one with their usual CSII pattern (open-loop [OL]) and one controlled by the pRBA (CL). The CL period lasted from 10 p.m. to 10 a.m., including overnight control, and control of breakfast. Venous samples for blood glucose (BG) measurement were collected every 20 min.

Results: Time spent in normoglycemia (BG, 3.9-8.0 mmol/L) during the nocturnal period (12 a.m.-8 a.m.), expressed as median (interquartile range), increased from 66.6% (8.3-75%) with OL to 95.8% (73-100%) using the CL algorithm (P<0.05). Median time in hypoglycemia (BG, <3.9 mmol/L) was reduced from 4.2% (0-21%) in the OL night to 0.0% (0.0-0.0%) in the CL night (P<0.05). Nine hypoglycemic events (<3.9 mmol/L) were recorded with OL compared with one using CL. The postprandial glycemic excursion was not lower when the CL system was used in comparison with conventional preprandial bolus: time in target (3.9-10.0 mmol/L) 58.3% (29.1-87.5%) versus 50.0% (50-100%).

Conclusions: A highly precise personalized pRBA obtains nocturnal normoglycemia, without significant hypoglycemia, in T1DM patients. There appears to be no clear benefit of CL over prandial bolus on the postprandial glycemia.
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http://dx.doi.org/10.1089/dia.2013.0229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934437PMC
March 2014

Circulating levels of lipocalin-2 and retinol-binding protein-4 are increased in psoriatic patients and correlated with baseline PASI.

Arch Dermatol Res 2013 Mar 16;305(2):105-12. Epub 2012 Dec 16.

Department of Dermatology, Hospital Universitari Parc Taulí, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí, UAB, Universitat Autònoma de Barcelona, Campus d'excelència Internacional, Bellaterra, Spain.

Psoriasis has been related to metabolic syndrome (MS). Adipocytokines produced by white adipose tissue may be involved in the pathogenesis of psoriasis and its association with MS. Our objectives were to characterize the profile of a number of different inflammatory and atherogenic markers, vitamins, adipokines and cytokines and their potential involvement in MS in patients with moderate-to-severe psoriasis without joint involvement compared to anthropometrically matched controls, and to evaluate correlation with severity of the skin disease and changes after narrow-band UVB (NB-UVB) phototherapy. We designed a prospective cross-sectional study. Baseline waist circumference, body fat composition, lipid, carbohydrate and calcium metabolism profile, inflammation markers, homocysteine and vitamins D, B6, B12 and folic acid, leptin, resistin, omentin, lipocalin-2, adipocyte fatty acid-binding protein, retinol-binding protein-4 (RBP-4), interleukin-6, soluble tumour necrosis factor receptor 1 (sTNFR1) and interleukin-17 of 50 psoriasis patients and 50 gender, age and body mass index-matched controls were recorded, then evaluated after NB-UVB in the patients. The patients had higher baseline serum concentrations of leptin, RBP-4, lipocalin-2 and sTNFR1. Baseline psoriasis area and severity index correlated with serum concentrations of RBP-4 and lipocalin-2 only. Principal components analysis disclosed a component including vitamins B12, B6, folic acid, calcidiol and HDL-cholesterol that was only present in healthy controls and opposed to a cluster of variables which promote MS. This component was absent in the patients. Our results point to lipocalin-2 and RBP-4 as relevant mediators of the trend towards MS in psoriatic patients.
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http://dx.doi.org/10.1007/s00403-012-1306-5DOI Listing
March 2013