Contagem de leucócitos e morbimortalidade no infarto do miocárdio / Leukocyte count and morbimortality in myocardial infarction

Objetivo: Avaliar a associação entre maiores níveis da contagem total de leucócitos periféricos e relação neutrófilos/linfócitos obtidos na admissão hospitalar, bem como a morbimortalidade em pacientes diagnosticados com infarto do miocárdio. Métodos: Avaliamos 276 pacientes com infarto agudo do miocárdio, entre janeiro de 2014 e novembro de 2015. Os dados clínicos e laboratoriais foram obtidos e relacionados a: internação, complicações intra-hospitalares, readmissões e mortalidade em 30 dias pós-internação. Resultados: A idade média foi 61 anos e 66,7% eram homens. Pacientes com complicações, comparados ao grupo sem complicações, eram mais velhos (60,85 vs. 62,54; p=0,053), tinham níveis de leucócitos (10,23 vs. 11,78; p=0,001) e neutrófilos (7,17 vs. 8,38; p=0,020) aumentados, doença multiarterial (38,2% vs. 74,5%; p<0.001) e supradesnivelamento de ST (49,3 vs. 65,1; p=0,039). Dois grupos foram constituídos pela mediana (10,56) dos leucócitos e demonstraram-se incidências mais elevadas de choque cardiogênico (p<0,001) e mortes (p=0,031) no grupo com maior leucocitose. Houve associação significativa entre leucócitos >10,56 e valores superiores de CK-MB (p=0,001) e troponina (p=0,039). Conclusão: Houve associação entre aumento dos níveis de leucócitos e maior incidência de complicações intra-hospitalares, incluindo morte, até 1 mês após alta hospitalar em pacientes com infarto agudo do miocárdio. A contagem de leucócitos mostrou relação mais evidente do que a relação neutrófilos/linfócitos e sua fácil acessibilidade colocá-o como ferramenta útil para determinação do prognóstico em pacientes com infarto do miocárdio.(AU)

Objective: To evaluate the association of higher levels of total peripheral leukocytes count and neutrophil/lymphocyte ratio at admission, as well as morbidity and mortality in patients diagnosed with myocardium infarction. Methods: We evaluated 276 patients with Acute Myocardial Infarction through January 2014 to November 2015. Clinical and laboratory data were obtained and related to hospital stay, inhospital complications, 30 day readmissions and mortality. Results: The average age was 61 years, 66.7% were male. Patients with complications, compared to the group with no complications, are older (60.85 vs 62.54, p=0.053), had increased levels of leucocytes (10.23 vs 11.78, p=0.001) and neutrophils (7.17 vs 8.38, p=0.020) count, multivessel disease (38.2% vs 74.5%, p<0.001) and ST elevation (49.3 vs 65.1, p=0.039). Two groups were formed by leucocyte median, and a higher incidence of cardiogenic shock (p<0.001) and deaths (p=0.031) was shown in the group with higher leuco cytosis. There was significant association between leucocytes >10.56 and higher CKMB (p=0.001) and troponin (p=0.039) values. Conclusion: Our study confirms an association between increased levels of leucocytes count and higher incidence of inhospital complications, including death, up to one month after hospital discharge in patients with acute myocardial infarction. Leucocytes count showed a more evident relation than neutrophil/lymphocyte ratio, and its easy accessibility poses it as a very useful tool to determine prognosis in patients with myocardial infarction.(AU)

Microangiopathic complications in type 1 diabetes mellitus: differences in severity when isolated or associated with autoimmune polyendocrinopathies

Context: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease. Objective: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1). Patients: OSAD (n=17)and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 + 8.2 and 13.2 + 5.9 years, respectively) and metabolic control (HbA1c: 6.4 + 1.9 and 6.8 + 1.4 per cent). Main Outcome Measures: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. Results: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 + 2.5 vs. 17.3 + 9.2 mug/min; p<0.05). Nephropathy was detected in 12 per cent of the OSAD (none of them macroproteinuric) and in 39 per cent of the iDM1. The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p<0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29 per cent of the OSAD and in 46 per cent of the iDM1. Conclusions. OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1, the increase in UAE of OSAD was not associated with reductions in GFR.

A case of type II diabetes of early onset presenting with malignant diabetic microangiopathy at diagnosis

In 1987 O'Rahilly described a distinct clinical and genetic syndrome called type II diabetes of early onset (13). Different from Maturity Onset Diabetes of the Young (MODY), that is consistent with autossomal dominant inheritance, this group of patients may have inherited a diabetogenic gene or genes from both parents. Also, in contrast with classical type II diabetes, this syndrome affects mainly younger subjects and has a greater prevalence of severe diabetic microangiopathy. In this paper, we report a 25 year old patient who presented with clinical nephropathy and proliferative retiopathy at the time of diabetes diagnosis. Her mother and a paternal aunt had type II diabetes. Her glicemíc control did not require insulin administration and despite panphotocoagulation and antihypertensive therapy she became blind due to retinal detachment and progressed to chronic renal insufficiency in a few months. To our knowledge this is the first report of an young non-insulin dependent diabetic patient in whom clinical diabetes arose together with severe microangiopathy affecting the kidney and the retina simultaneously. We should call attention to the early diagnosis of this type of diabetes in subjects at risk, in order to institute prompt therapeutic measures able to ameliorate the course of microvascular complications.

Influência da hipertensäo arterial na nefropatia diabetica aspectos fisiopatogênicos, diagnósticos e terapêuticos / Influence of the arterial hypertension on diabetic nephropathy: Aspects physiopathogenesis, diagnosis and treatment

The authors comment the prevalence of hypertension in patient with diabetes the microvascular complications in these patients and the therapeutic advantage of correct drugs treatment of hypertension in diabetics