Frecuencia de periodontitis en una muestra de diabéticos tipo 2 y no diabéticos de Santiago de Chile / Frequency of periodontitis in a sample of type 2 diabetics and non diabetics

Background: Periodontitis is highly prevalent in the general population and some diseases such as diabetes could favor its development, reaching a prevalence of over 60 percent. Aim: To evaluate the prevalence of periodontitis in a sample of DM2 patients and to compare it with non-diabetic subjects. Patients and Methods: We enrolled patients with DM2 and non-diabetic adult subjects. According to periodontal diagnosis, they were classified as healthy, having mild to moderate periodontitis and having severe periodontitis. Anthropometric assessment was performed and a fasting blood sample was obtained to measure blood glucose and lipid profile. In diabetics, HbA1c, creatinine, microalbuminuria, EKG and fundoscopy were evaluated. Results: We studied 62 patients with DM2, aged 55.2 +/- 9.4 years and with 4.7 +/- 4.6 years of diagnosis of diabetes and 65 non-diabetic subjects, aged 50 +/- 9.6 years. Among diabetics, HbA1c values were 7.85 +/- 2.3 percent. The proportion of periodontitis was significantly higher in DM2 than in non-diabetics (98 and 89 percent, p = 0.02). Mild to moderate and severe periodontitis was observed in 39 and 60 percent of diabetic patients, respectively. Among non-diabetics, 11 percent were healthy, 5 percent had gingivitis, 37 percent mild to moderate periodontitis and 48 percent had severe periodontitis. The frequency of chronic complications of diabetes was low, except for positive microalbuminuria, that was present in 42.6 percent of patients. Conclusions: We found a high prevalence of periodontitis in diabetic and no diabetic patients, but among the former, it was near to 100 percent. Periodontal examination should be considered as part of the evaluation of patients with type 2 diabetes.

Síndrome de Cushing: una revisión a propósito de una casuística nacional / Cushing's syndrome: a review apropos of a national series

Cushing's syndrome occurs rarely; in analyzing 50 cases studied at our institution we discuss the following aspects: syndromatic diagnosis, etiologic differentiation into the 3 categories of the syndrome, and therapeutic strategies for each variety. We postulate that non-endocrinologists should be responseible for the syndromatic diagnosis, easily done by using 2 simple tools: the measurement of basal free urinary cortisol and the performance of and overnight suppression of the adrenal axis with 1 mg of dexamethasone (Nugent's test). In contrast, the etiologic diagnosis and the therapeutic interventions should be strictly restricted to highly specialized institutions having well seasoned endocrinologists, a reliable endocrine laboratory, easy access to computed tomographies of the brain and abdomen as well as to nuclear resonance imaging of the brain. The usefulness of our in-house devised vasopressin challenge following overnight dexamethasone suppression for the etiologic diagnosis is highlighted. Neurosurgical expertise in the transphenoidal approach to the pituitary gland as well surgeons well experience in adrenal surgery sre a must to offer a reasonable chance of success to patients with the syndrome. Forty one (82 percent) of the series were female patients, 78 percent were pituitary-depent and 22 percent pituitary-independent Cushings. Six out of 8 (75 percent) of the adrenal tumors were carcinomas. Only 3 patients (6 percent) qualified as ectopic ACTH syndormes. The easiest variety to diagnose and treat was the adrenal adenoma (2 cases); adrenal carcinomas were always incurable. The ectopic ACTH syndrome was amenable to successful medical treatment with ketoconazole or surgical resolution with complete resection od the offending tumor (1 of 3 cases) or bilateral adrenalectomy (2 of 3 cases) Pituitary-dependent Cushing are quite tricky to diagnose and difficult to treat. Transphenoidal resection of the offending microadenoma was successful in only 43.5 percent (10/23) of cases and we experienced 3 recurrences of the syndrome even after 8 years of successful removal of the pituitary adenoma. The remainder had to be cured by bilateral adrenalectomy. Seven out 39 patients with Cushing's disease (18 percent) ultimately died for a variety of reasons; six out of 6 patients (100 percent) with adrenal carcinoma died of dissemination; 2 out of 2 adrenal adenomas cured and 1 out of the 3 ectopic ACTH syndromes died of dissemination of a malignant thymic carcinoma. We conclude that Cushing's syndrome is a serious, underdiagnosed disorder, which should be suspected and diagnosed by the non specialized physician and then referred to a specialized center for expert etiologic diagnosis and surgical therapy