Chronic patients must carry out a rigorous control of diverse factors in their lives. Diet, sport activity, medical analysis or blood glucose levels are some of them. This is a hard task, because some of these controls are performed very often, for instance some diabetics measure their glucose levels several times every day, or patients with chronic renal disease, a progressive loss in renal function, should strictly control their blood pressure and diet. In order to facilitate this task to both the patient and the physician, we have developed a web application for chronic diseases control which we have particularized to diabetes. This system, called glUCModel, improves the communication and interaction between patients and doctors, and eventually the quality of life of the former. Through a web application, patients can upload their personal and medical data, which are stored in a centralized database. In this way, doctors can consult this information and have a better control over patient records. glUCModel also presents three novelties in the disease management: a recommender system, an e-learning course and a module for automatic generation of glucose levels model. The recommender system uses Case Based Reasoning. It provides automatic recommendations to the patient, based on the recorded data and physician preferences, to improve their habits and knowledge about the disease. The e-learning course provides patients a space to consult information about the illness, and also to assess their own knowledge about the disease. Blood glucose levels are modeled by means of evolutionary computation, allowing to predict glucose levels using particular features of each patient. glUCModel was developed as a system where a web layer allows the access of the users from any device connected to the Internet, like desktop computers, tablets or mobile phones.

Cushing's syndrome during pregnancy is a rare and difficult to diagnose disorder. We describe the case of a 30-yr-old woman presenting with symptoms and signs of mild hypercortisolism, in which ACTH-independent Cushing's syndrome was diagnosed. Urinary cortisol excretion was elevated and circadian rhythm of cortisol was absent. ACTH levels were low. In addition, plasma cortisol failed to suppress after a high dexamethasone dose. An abdominal computed tomography scan confirmed a left adrenal mass. While diagnosis work-up was still in progress, the patient became pregnant and wanted to carry her pregnancy to full-term. Hypercortisolism was successfully controlled with metyrapone, which was started at 8 weeks of gestation. At 16 weeks of gestation, a laparoscopic left adrenalectomy was performed. Pathologic examination of the gland showed a benign adrenocortical adenoma. The patient developed secondary adrenal insufficiency and was discharged on 20 mg hydrocortisone daily dose. At 30 weeks of gestation, the patient had a pre-term rupture of membranes and underwent spontaneous vaginal delivery. The newborn was a normal virilized male who weighed 1280 g. No apparent metyrapone-induced teratogenic effects were observed and there was no clinical or biochemical suppression of adrenocortical function. In conclusion, in adrenal Cushing's syndrome during pregnancy, medical treatment with metyrapone as soon as the diagnosis is made, in combination with laparoscopic surgery during the second trimester, are useful in preventing complications secondary to hypercortisolism and safe both for the mother and infant.

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Purpose The purpose of this paper is to study insulin pump therapy and accurate monitoring of glucose levels in diabetic patients, which are current research trends in diabetology. Both problems have a wide margin for improvement and promising applications in the control of parameters and levels involved. Design/methodology/approach The authors have registered data for the levels of glucose in diabetic patients throughout a day with a temporal resolution of 5 minutes, the amount and time of insulin administered and time of ingestion. The estimated quantity of carbohydrates is also monitored. A mathematical model for Type 1 patients was fitted piecewise to these data and the evolution of the parameters was analyzed. Findings They have found that the parameters for the model change abruptly throughout a day for the same patient, but this set of parameters account with precision for the evolution of the glucose levels in the test patients. This fitting technique could be used to personalize treatments for specific patients and predict the glucose-level variations in terms of hours or even shorter periods of time. This way more effective insulin pump therapies could be developed. Originality/value The proposed model could allow for the development of improved schedules on insulin pump therapies.

In a region with a history of borderline iodine deficiency the UICs were below 150 μg/L in a substantial percentage of pregnant women who did not take iodine supplements, regardless of whether or not they took iodized salt. Our results support the use of iodine supplements from the start of the pregnancy, or even before pregnancy in women who live in regions with a history of even small degrees of iodine deficiency. In addition, neonate TSH screening is not the best tool to assess whether the iodine status in populations is ideal.