ABSTRACT
Background: Type 1 diabetes mellitus (DM1) is a disease of increasing incidence among children. The time elapsed between the beginning of symptoms and the diagnosis of the disease is, in most cases, very extended. Aim: To report the clinical picture at onset and laboratory features of children with DM1. Material and methods: Retrospective review of all medical records of patients admitted to the hospital with a DM1 of recent onset. Results: Sixty three males aged 95±47 months and 34 females aged 109±51 months, were studied. Males were significantly younger than females (p <0.05). The lapse between symptoms onset and the diagnosis of the disease was longer in girls than in boys (46±46 and 26±26 days respectively, p <0.02). There was an inverse correlation between plasma glucose and the lapse between symptoms onset and the diagnosis of disease. The most common clinical picture of the disease was the classical symptoms of diabetes (polyuria, polydipsia, weight loss), in 60 percent of cases. Thirty seven percent had developed ketoacidosis at the time of the diagnosis. Ketoacidosis was more common between 1988 and 1995, as compared with the period 1996-2003 (50 percent and 28.8 percent, respectively). The onset of symptoms occurred between April and August (Winter in the Southern Hemisphere) in 38 percent of cases. Conclusions: DM1 is a disease of increasing incidence among children, whose diagnosis is delayed, even though symptoms are evident. The lower incidence of ketoacidosis in our patients between 1996 and 2003 is encouraging.
Subject(s)
Child , Female , Humans , Male , Diabetes Mellitus, Type 1/diagnosis , Age of Onset , Diabetes Mellitus, Type 1/blood , Retrospective StudiesABSTRACT
The disturbances of gut barrier in critically ill patients may influence their outcome and prognosis. Experiments in animals show that fasting and stress collaborate to produce intestinal atrophy and translocation of microorganisms and toxins. This fact is one of the main arguments to promote the use of early enteral feeding in critically ill patients. However, the intestinal barrier behaves differently in humans than in animals. The human enteral cells have a good tolerance to fasting and stress, mucosal atrophy is mild and it is not always associated with changes in intestinal permeability. Moreover, the relationship between intestinal permeability with sepsis and bacterial translocation is controversial. This last phenomenon also happens in normal subjects and may be a mechanism to build immunological memory. One of the most important factors that influence bacterial translocation is the microorganism, that under stress conditions can adhere to the intestinal cell and penetrate the intestinal barrier. Splanchnic ischemia and reperfusion is one of the main pathogenic factors in the failure of intestinal barrier. Finally, the fact that the small bowel is an inflammatory target of extra intestinal injuries, explains several clinical situations. The pathophysiology of the intestinal barrier definitely requires more research.
Subject(s)
Humans , Bacterial Translocation , Critical Illness , Intestinal Mucosa/microbiology , Bacterial Infections/microbiology , Critical Illness/therapy , Immune System/physiology , Intestinal Mucosa/physiology , Permeability , SepsisABSTRACT
En 31 pacientes consecutivos sometidos a nutrición parenteral (NP), se evaluó la eficacia clínica del índice catabólico (IC) descripto Bistrian y la relación entre perdida calórica y protéicas, a fin de evaluar la posibilidad de estimar requerimientos energéticos desde los nitrogenados. Los pacientes recibieron fórmulas de NP con igual cantidad de proteinas (1,8 g/K/día) y con calorias suficientes para promover similar balance calórico en los grupos a estudiar, los que fueron diferenciados según IC (G1=menor de 0; G2=mayor de 5). A pesar de igual aporte de nitrógeno (AN), el balance nitrogenado (BN) fue mayor en G1 que en G2 y G3, y en G2 que en G3 (BN: G1=86,6 ñ 22,9; G2=-10,8 ñ 36,2; G3:-110,0 ñ 56,6 mg/K/día, 1>2>3; p<0,05). No se observó correlación entre gasto energético medido por calorimetría indirecta y perdidas nitrogenadas (R: 0,25; P: NS). Todos los pacientes en G1 estaban en BN (+) y los del G3 en BN (-); 5 de los 14 pacientes de G2 tenían BN (+). Se concluye el IC es una herramienta clínica sencilla y de precisión adecuada. En niveles de IC de 0-5, la precisión es menor al no existir correlación entre gasto calórico y protéico es difícil estimar las perdidas energéticas a partir de este último, siendo mas apropiado medir o estimar por separado las necesidades de energía y nitrógeno en NP.
Subject(s)
Humans , Female , Middle Aged , Protein-Energy Malnutrition , Energy Metabolism , Biomarkers , Parenteral NutritionABSTRACT
Bile acid sequestrant resing are considered agents of choice in the therapy of hypercholesterolemia non responsive to diet treatment. We evaluated the effects of cholestyramine, 12 g per day during 4 weeks, in 11 adult patients with severe hypercholesterolemia. Total cholesterol decreased fom 414 ñ 112 to 302 ñ 140 mg/dl (28%), LDL cholesterol from 330 ñ 122 to 226 ñ 143 (33%) and Apo B lipoprotein from 141 ñ 31 to 115 ñ 34 mg/dl (18%), p < 0.01. HDL cholesterol including fractions HSL2 and HDL3, Apo A1 and Triglyceride levels were not modified. No significant side effects on gastrointestinal function were observed. Thus, we confirm that cholestyramine is an effective therapy for severe hypercholesterolemia