Clinical features of patients with type 2 diabetes mellitus and hepatitis C infection

The objective of the present cross-sectional study was to assess the prevalence and the clinical and laboratory features of hepatitis C virus (HCV)-positive patients with type 2 diabetes mellitus (DM) attending either an outpatient clinic or hemodialysis units. Serologic-HCV testing was performed in 489 type 2 DM patients (303 outpatients and 186 on dialysis). A structured assessment of clinical, laboratory and DM-related complications was performed and the patients were then compared according to HCV infection status. Mean patient age was 60 years; HCV positivity (HCV+) was observed in 39 of 303 (12.9 percent) outpatients and in 34 of 186 (18.7 percent) dialysis patients. Among HCV+ patients, 32 were men (43.8 percent). HCV+ patients had higher serum levels of aspartate aminotransferase (0.90 ± 0.83 vs 0.35 ± 0.13 µKat/L), alanine aminotransferase (0.88 ± 0.93 vs 0.38 ± 0.19 µKat/L), gamma-glutamyl transferase (1.57 ± 2.52 vs 0.62 ± 0.87 µKat/L; P < 0.001), and serum iron (17.65 ± 6.68 vs 14.96 ± 4.72 µM; P = 0.011), and lower leukocyte and platelet counts (P = 0.010 and P < 0.001, respectively) than HCV-negative (HCV-) patients. HCV+ dialysis patients had higher diastolic blood pressure than HCV- patients (87.5 ± 6.7 vs 81.5 ± 6.0 mmHg; P = 0.005) and a lower prevalence of diabetic retinopathy (75 vs 92.7 percent; P = 0.007). In conclusion, our study showed that HCV is common among subjects with type 2 DM but is not associated with a higher prevalence of chronic diabetic complications.

Coronary artery calcification is associated with insulin resistance index in patients with type 1 diabetes

The objective of the present study was to evaluate the risk factors associated with the presence of coronary artery calcification (CAC) in patients with type 1 diabetes (T1D). A cross-sectional study was conducted on 100 consecutive T1D patients without coronary artery disease, with at least 5 years of diabetes and absence of end-stage renal disease. Mean age was 38 ± 10 years and 57 percent were males. CAC score was measured by multidetector computed tomography (Siemens Sensation 64 Cardiac). The insulin resistance index was measured using the estimated glucose disposal rate (eGDR). The eGDR was lower among CAC-positive patients than among CAC-negative patients, suggesting an increased insulin resistance. In a logistic regression model adjusted for age (at 10-year intervals), eGDR, diabetic nephropathy and gender, CAC was associated with age [OR = 2.73 (95 percentCI = 1.53-4.86), P = 0.001] and with eGDR [OR = 0.08 (95 percentCI = 0.02-0.21), P = 0.004]. In T1D subjects, insulin resistance is one of the most important risk factors for subclinical atherosclerosis.

Effect of metabolic syndrome and of its individual components on renal function of patients with type 2 diabetes mellitus

The objective of this study was to evaluate the effect of metabolic syndrome (MetS) and its individual components on the renal function of patients with type 2 diabetes mellitus (DM). A cross-sectional study was performed in 842 type 2 DM patients. A clinical and laboratory evaluation, including estimated glomerular filtration rate (eGFR) calculated by the modification of diet in renal disease formula, was performed. MetS was defined according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Mean patient age was 57.9 ± 10.1 years and 313 (37.2 percent) patients were males. MetS was detected in 662 (78.6 percent) patients. A progressive reduction in eGFR was observed as the number of individual MetS components increased (one: 98.2 ± 30.8; two: 92.9 ± 28.1; three: 84.0 ± 25.1; four: 83.8 ± 28.5, and five: 79.0 ± 23.0; P < 0.001). MetS increased the risk for low eGFR (<60 mL·min-1·1.73 (m²)-1) 2.82-fold (95 percentCI = 1.55-5.12, P < 0.001). Hypertension (OR = 2.2, 95 percentCI = 1.39-3.49, P = 0.001) and hypertriglyceridemia (OR = 1.62, 95 percentCI = 1.19-2.20, P = 0.002) were the individual components with the strongest associations with low eGFR. In conclusion, there is an association between MetS and the reduction of eGFR in patients with type 2 DM, with hypertension and hypertriglyceridemia being the most important contributors in this sample. Interventional studies should be conducted to determine if treatment of MetS can prevent renal failure in type 2 DM patients.

The impact of an emergency hiring plan on the shortage and distribution of nurses in Kenya: the importance of information systems

Objective:To analyse the effect of Kenya's Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas.Methods We used data from the Kenya Health Workforce Informatics System on the nursing workforce to determine the effect of the Emergency Hiring Plan on nurse shortages and maldistribution. The total number of nurses; the number of nurses per 100 000 population and the opening of previously closed or new heath facilities were recorded. Findings Of the 18 181 nurses employed in Kenya's public sector in 2009; 1836 (10) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7in hospitals; 13in health centres and 15in dispensaries. North Eastern province; which includes some of the most remote areas; benefited most: the number of nurses per 100 000 population increased by 37. The next greatest increase was in Nyanza province; which has the highest prevalence of HIV infection in Kenya. Emergency Hiring Plan nurses enabled the number of functioning public health facilities to increase by 29. By February 2010; 94 of the nurses hired under pre-recruitment absorption agreements had entered the civil service.Conclusion The Emergency Hiring Plan for nurses significantly increased health services in Kenya's rural and underserved areas over the short term. Preliminary indicators of sustainability are promising; as most nurses hired are now civil servants. However; continued monitoring will be necessary over the long term to evaluate future nurse retention. The accurate workforce data provided by the Kenya Health Workforce Informatics System were essential for evaluating the effect of the Emergency Hiring Plan

The prevalence of chronic diabetic complications and metabolic syndrome is not associated with maternal type 2 diabetes

The maternal history of type 2 diabetes mellitus (DM) has been reported more frequently in patients with type 2 DM than paternal history. The aim of the present study was to determine if there was an association between maternal history of DM and the presence of chronic complications or metabolic syndrome (MetS) in patients with type 2 DM. A cross-sectional study was conducted with 1455 patients with type 2 DM. All outpatients with type 2 diabetes attending the endocrine clinics who fulfilled the eligibility criteria were included. Familial history of DM was determined with a questionnaire. Diabetic complications were assessed using standard procedures. The definition of MetS used was that of the World Health Organization and the National Cholesterol Education Program's Adult Treatment Panel III report criteria. Maternal history of DM was present in 469 (32.3 percent), absent in 713 (49.1 percent) and unknown in 273 patients (18.7 percent). Paternal history of DM was positive in 255 (17.6 percent), negative in 927 (63.8 percent) and unknown in 235 patients (16.1 percent). The frequency of microvascular chronic complications in patients with and without a positive maternal history of DM was similar: diabetic nephropathy (51.5 vs 52.5 percent), diabetic retinopathy (46.0 vs 41.7 percent), and diabetic sensory neuropathy (31.0 vs 37.1 percent). The prevalence of macrovascular chronic complications and MetS was also similar. Patients with type 2 DM were more likely to have a maternal than a paternal history of DM, although maternal history of DM was not associated with an increased prevalence of chronic complications or MetS.

Diabetic retinopathy is associated with early autonomic dysfunction assessed by exercise-related heart rate changes

Diabetic retinopathy has been associated with cardiac autonomic dysfunction in both type 1 and type 2 diabetes mellitus (DM) patients. Heart rate (HR) changes during exercise testing indicate early alterations in autonomous tonus. The aim of the present study was to investigate the association of diabetic retinopathy with exercise-related HR changes. A cross-sectional study was performed on 72 type 2 and 40 type 1 DM patients. Autonomic dysfunction was assessed by exercise-related HR changes (Bruce protocol). The maximum HR increase, defined as the difference between the peak exercise rate and the resting rate at baseline, and HR recovery, defined as the reduction in HR from the peak exercise to the HR at 1, 2, and 4 min after the cessation of the exercise, were determined. In type 2 DM patients, lower maximum HR increase (OR = 1.62, 95 percentCI = 1.03-2.54; P = 0.036), lower HR recovery at 2 (OR = 2.04, 95 percentCI = 1.16-3.57; P = 0.012) and 4 min (OR = 2.67, 95 percentCI = 1.37-5.20; P = 0.004) were associated with diabetic retinopathy, adjusted for confounding factors. In type 1 DM, the absence of an increase in HR at intervals of 10 bpm each during exercise added 100 percent to the odds for diabetic retinopathy (OR = 2.01, 95 percentCI = 1.1-3.69; P = 0.02) when adjusted for DM duration, A1c test and diastolic blood pressure. In conclusion, early autonomic dysfunction was associated with diabetic retinopathy. The recognition of HR changes during exercise can be used to identify a high-risk group for diabetic retinopathy.

Vascular complications of black patients with type 2 diabetes mellitus in Southern Brazil

Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95 percentCI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.

The role of K121Q ENPP1 polymorphism in diabetes mellitus and its complications

The aim of the present study was to analyze the frequency of K121Q polymorphism in the ENPP1 gene of Brazilian subjects according to ethnic origin and to determine its possible association with diabetes mellitus (DM) and/or diabetic complications. A cross-sectional study was conducted on 1027 type 2 DM patients and 240 anonymous blood donors (BD). Ethnicity was classified based on self-report of European and African descent. The Q allele frequency was increased in African descendant type 2 DM patients (KK = 25.9 percent, KQ = 48.2 percent, and QQ = 25.9 percent) and BD (KK = 22.0 percent, KQ = 53.8 percent, and QQ = 24.2 percent) compared to European descendant type 2 DM patients (KK = 62.7 percent, KQ = 33.3 percent, and QQ = 4.1 percent) and BD (KK = 61.0 percent, KQ = 35.6 percent, and QQ = 3.4 percent). However, there was no difference in genotype distribution or Q allele frequency between diabetic and non-diabetic subjects (European descendants: DM = 0.21 vs BD = 0.21, P = 0.966, and African descendants: DM = 0.50 vs BD = 0.51, P = 0.899). In addition, there were no differences in clinical, laboratory or insulin resistance indices among the three genotypes. The prevalence of DM complications was also similar. In conclusion, K121Q polymorphism is more common among Afro-Brazilian descendants regardless of glycemic status or insulin sensitivity indices. Likewise, insulin sensitivity and DM chronic complications appear not to be related to the polymorphism in this sample.

Proliferative diabetic retinopathy is associated with microalbuminuria in patients with type 2 diabetes

Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1 percent (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95 percent CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95 percent CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95 percent CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95 percent CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95 percent CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.

Ultrasonographic determination of goiter prevalence in southern Brazilian schoolchildren

The aim of the present study was to estimate the prevalence of goiter in schoolchildren in a formerly iodine-deficient region in southern Brazil by assessing the relationship between body surface area (mý) and thyroid volume (ml) measured by ultrasonography. A population-based sample of 1,094 randomly selected schoolchildren (6 to 14 years; 556 boys and 538 girls) underwent clinical evaluation. A total of 119 (10.9 percent) children were diagnosed with goiter upon clinical examination according to WHO criteria (grade Ia: 65, grade Ib: 24, grade II: 29, grade III: 1). Of these, 85 underwent ultrasonography. In order to ascertain the absence of goiter in the 975 schoolchildren with a negative result upon clinical examination, one of ten children was randomly selected for ultrasonography. Sixty-two children agreed to be submitted to the exam. Thus, 147 schoolchildren were evaluated by ultrasonography (7.5-MHz transducer). Goiter was considered to be present when the thyroid volume:body surface area index was >6.2 ml/mý. The estimated prevalence of goiter if all schoolchildren had been submitted to thyroid volume measurement by ultrasound was 7.2 percent; it was higher in the lower socioeconomic class (8.2 percent) than in the upper (7.8 percent) and middle classes (6.5 percent). In conclusion, the prevalence of goiter in schoolchildren of this region was higher than in other iodine-sufficient areas, especially in lower socioeconomic classes. Goiter in this region may be associated with naturally occurring goitrogens that operate more intensively among less privileged individuals

Ressecçäo cirúrgica de metástases pulmonares: estudo prospectivo em 182 pacientes / Surgical removal o pulmonary metastasis: prospective study in 182 patients

Objetivo. O presente estudo visa avaliar os resultados do tratamento cirúrgico de metástases pulmonares, além de tentar identificar mais precisamente os subgrupos de pacientes que se beneficiariam mais da operaçao. Casuística e Método. O estudo é uma análise prospectiva de pacientes com história de tumores primários, submetidos à ressecçao de nódulos pulmonares com suspeita ou diagnóstico de metástases, para determinar os resultados desta abordagem, e investigar a influência de fatores prognósticos potenciais sobre a probabilidade de sobrevida global ou livre de doença. Foram incluídos neste estudo todos os pacientes (n=182) com neoplasias malignas prévias, e submetidos a toracotomia. Resultados. Os pacientes submetidos à ressecçao pulmonar de nódulos suspeitos de metástases reveleram a ausência de qualquer neoplasia em 34 deles (18,6 por cento), seis deles (3,2 por cento) apresentaram um segundo tumor primário de pulmao. A sobrevida global dos pacientes foi de 28 por cento em 56 meses. A sobrevida livre de doença de 56 meses foi de 9 por cento. A análise multivariada mostrou que a sobrevida global dos pacientes foi influenciada pelo intervalo livre de doença (menor que 1,5 ano, p=0,002), pela ressecçao completa (p=0,039), e pelo número de nódulos maqlignos ressecados (menor que três nódulos, p=0,016). A sobrevida livre de doença foi significativamente afetada pela ressecçao completa das metástases (p=0,0001) e pelo número de nódulo malignos ressecados (menor que três nódulos, p=0,004). Conclusao. A ressecçao cirúrgica de metástases pulmonares beneficia um grupo selecionado de pacientes; estudos complementares sao necessários para se definir o valor da associaçao de outras modalidades terapêuticas na sobrevida destes pacientes.

Risk factors for decreased bone density in premenopausal women

Osteoporosis is a major health problem. Little is known about the risk factors in premenopause. Sixty 40-50 year old patients with regular menses were studied cross-sectionally. None of the patients were on drugs known to interfere with bone mass. Patients answered a dietary inquiry and had their bone mineral density (BMD) measured. The Z scores were used for the comparisons. A blood sample was taken for the determination of FSH, SHBG, estradiol, testosterone, calcium and alkaline phosphatase. Calcium and creatinine were measured in 24-h urine. A Z score less than -1 was observed for the lumbar spine of 14 patients (23.3 percent), and for the femur of 24 patients (40 percent). Patients with a Z score less than -1 for the lumbar spine were older than patients with a Z score ò-1 (45.7 vs 43.8 years) and presented higher values of alkaline phosphatase (71.1 + 18.2 vs 57.1 + 14.3 IU/I). Multiple regression analysis showed that a lower lumbar spine BMD was associated with higher values of alkaline phosphatase, lower calcium ingestion, a smaller body mass index (BMI), less frequent exercising, and older age. The patients with a Z score less than -1 for the femur were shorter than patients with a Z score ò-1 (158.2 vs 161.3 cm). Multiple regression analysis showed that a lower femoral BMD was associated with lower BMI, higher alkaline phosphatase and caffeine intake, and less frequent exercising. A lower than expected BMD was observed in a significant proportion of premenopausal women and was associated with lower calcium intake, relatively lower physical activity and lower BMI. We conclude that the classical risk factors for osteoporosis may be present before ovarian failure, and their effect may be partly independent of estrogen levels.

Braquiterapia endobrônquica de alta taxa de dose no tratamento das recidivas de tumores pulmonares: relato de casos clínicos / High dose rate remote afterloading brachytherapy for treatment of recurrent lung cancer: case reports

A braquiterapia endobrônquica de alta taxa de dose constitui importante arma terapêutica no alívio sintomatológico dos pacientes portadores de neoplasias pulmonares, proporcionando melhora substancial na qualidade de vida. No presente trabalho, säo relatados cinco casos clínicos, tratados nos Departamentos de Cirurgia Torácica e de Radioterapia do Hospital A. C. Camargo, além de se efetuar análise de outros estudos clínicos internacionais. A braquiterapia de alta taxa de dose mostrou ser método prático e eficaz no tratamento das recidivas neoplásicas endobrônquicas, produzindo alívio para sintomas como dispnéia e hemoptise.

Abnormalities in gallbladder dynamics of type 1 (insulin-dependent) diabetic patients with autonomic neuropathy

The aim of this study was to evaluate gallbladder dynamics in insulin-dependent diabetic patients with and without autonomic neuropathy. Gallbladder dynamics was studied by a scintigraphicmethod after a test meal in 26 insulin-dependent diabetic patients and 10 normal individuals. The presence and severity of autonomic neuropathy were defined according to the number of abnormal cardiovascular reflex tests: absent (no abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the begnning of gallbladder emptying was longer (P = 0.01) in diabetic patients with mild (N = 11,12.1 ñ 7.6 min) and severe neuropathy (N = 8,11.0 ñ 10.6 min) than diabetic patients without autonomic neuropathy (N = 7,3.9 ñ 4.4 min) and controls (N = 10,4.8 ñ 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8,5.1 ñ 3.3 percent/min) than diabetic patients with mild (N = 11,2.) ñ 1.0 percent/min) or without autonomic neuropathy (N = 7,1.8 ñ 0.8 por cento/min) and controls (N = 10,2.6 ñ 1 percent/min). Thirty-two percent of the diabetic patients with autonomic neurpathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlation of ejection rate with the presence of these symptoms (biserial point correlation test = 0.67,P<0.01) was also observed. These data suggest that insulin-dependent diabetic patients with autonomic neuropathy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal sumptoms

Análise de fatores associados à recorrência de bócio pós-tiroidectomia / Analysis of the factors associated to recurrence of post-thyroidectomy goiter

Os fatores associados à recidiva de bócio pós-tiroidectomia por doença benigna da tiróoide ainda näo estäo completamente definidos, especialmente o uso profilático de hormônio tiroidiano. Objetivo. Determinar a prevalência, características e fatores associados à recorrência de bócio em pacientes submetidos à tiroidectomia por doença benigna. Métodos. Foram incluídos 66 pacientes, 53 mulheres e 13 homens (idade média = 51 anos, variaçäo = 20-82 anos) submetidos previamente (5,6 + or - 1 anos) à tiroidectomia (lobectomia, n = 50; nodulectomia, n = 5; tiroidectomia subtotal, n = 11). Na ocasiäo do estudo foi realizada ecografia de tiróide e dosagens séricas de T3, T4, TSH e anticorpos antimicrossomal. Definiu-se como recorrência de bócio a presença de volume residual >20mL e/ou novos nódulos >0,5mL à ecografia e näo previamente detectados durante a cirurgia. Resultados. SEte pacientes (10 por cento) apresentaram recorrência de bócio. O tempo de acompanhamento foi mais longo no grupo com recorrência (p < 0,5) e näo foi observada diferença em relaçäo a idade, sexo presença de história familiar de tiropatia e diagnóstico pré-operatório entre os dois grupos. Na análise de regressäo múltipla, apenas o tmepo de acompanhamento pós-tiroidectomia foi significativamente associado à recorrência de bócio (ß = 0,02;//2 = 0,16; p < 0,05), influenciando em 14 por cento a taxa de recorrência. História familiar de tiropatia, uso de hormônio tiroidiano e níveis séricos de T4 e TSE näo influenciaram a recorrência. Conclusäo. A recorrência de bócio pós-tiroidectomia por doença benigna de tiróide ocorre numa minoria de pacientes e estáa relacionada com o maior tempo de acompanhamento após a cirurgia. O uso de hormônio tiroidiano em doses näo supressiva após a cirurgia näo se relaciona à prevençäo de recorrência

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients

1. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate < 30 micrograms/min, 27 females, mean age 53.7 years) and 53 proteinuric (24-h proteinuria > 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Proteinuric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94 per cent vs 23 per cent ), peripheral neuropathy (94 per cent vs 23 per cent ) and arterial hypertension (73 per cent vs 16 per cent ) than normoalbuminuric patients. Age > 50 years, body mass index > 28.6 kg/m2, known duration of diabetes > 10 years, presence of arterial hypertension, and fasting plasma glucose > 160 mg/dl were significantly and independently associated with development of proteinuria

Effect of age and sex on glomerular filtration rate measured by 51Cr-EDTA

The effect of age and sex on glomerular filtration rate (GFR) was measured by the 51 Cr-EDTA radioisotopic method in 76 normal individuals (43 women and 33 men). Age has a significant effect on GFR. Subjects aged 41 to years have GFR values [104,5 ñ 16.5 ml min-1 (1.73 m2)-1, N=43] lower than younger individuals aged 20 to 40 years [116.6 ñ 11.2 ml min-1 (1.73 m2)-1, N=33]. GFR decreases after 40 years of age by approximately 6.0 ml min-1 (1.73 m2)-1 per decade. GFR values in women [105.9 ñ 16.0 ml min-1 (1.73 m2)-1, N=43] were lower when compared to men [114.8 ñ 14.3 ml min-1 (1.73 m2)-1, N=33]. We conclude that the effect of sex and age must be taken into account when establishing reference values for GFR

A short-term low-protein diet reduces glomerular filtration rate in insulin-dependent diabetes mellitus patients

1. The effect of a 7-day low-protein diet on renal function was studied in 17 normotensive, normoalbuninuric, insulin-dependent diabetes (IDDM) patients. Glomerular filtration rate (GRF) and urinary albumin excretion (UAE) were measured after 7 days on an isocaloric low-protein diet (0.5g protein/Kg per day). 2. Compliance was confirmed by 24-h urinary urea levels, GFR was measured after a single injection of 51Cr-EDTA and UAE by radioimmunoassay. 3. GFR was reduced by 13.8% on the low-protein diet (139ñ 27.7 vs 120.4 ñ 25.1 ml min-1 (1.73m2) (P < 0.05). This effect was of the same magnitude as that obtained by others after long-term strict metabolic control. No changes were observed in UAE (5.6 ñ 6.4 vs 5.7 ñ 6.8 microng/min) during the study. The patients were classified as hyperfiltering (N = 9; GFR = 160.3 ñ 16.6 ml min-1(1.73m2)-1 or normofiltering (N = 8; 117.1 ñ 17.6 ml min-1(1.73m2)-1) on the basis of GFR, and no diference in the reduction of GFR was observed in either group. 4. The reduction in GFR is probably caused primarily by the reduction of protein intake since other factors that might influence the GFR such as glucose control and blood pressure did not change during the study

Lack of association between thyroid function and mitral valve prolapse in Graves' disease

To determine whether the association between mitral valve prolapse and Graves' disease is related to thyroid function, three groups of individuals were studied: 16 patients with Graves' disease and hyperthyroidism (hyperthyroid: T4 > 11.5 microng/100 ml), 16 patients with Graves' disease without hyperthyroidism (euthyroid: T4 < 11.5 microng/100 ml), and 40 healthy individuals. The three groups were similar in age, sex distribution, and anthropometrical characteristics. All apatients were evaluated clinically and by M-mode and two-dimensional echocardiopgraphy to determine the presence of mitral valve prolapse. The frequency of mitral valve prolapse was similar in the hyperthyroid (31%) and euthyroid patients (25%), but was higher than in the normal individuals (5%). The frequency of systolic murmur was in the hyperthyroid patients (75%) than the euthyroid patients (19%) or the normal subjects (0%); however, the presence of a murmur was not associated with mitral valve prolapse. Although patients with Graves' disease have a higher frequency of mitral valve prolapse, this is not associated with thyroid function. The presence of a click but not the presence of a systolic murmur may be a clinical indicator of mitral valve prolapse in Graves' disease