Relationship between platelet indices and lipidemias: a cross-sectional study at Karachi

To compare platelet indices among patients with low and high levels of cholesterolemia and triglyceridemia. This cross-sectional study was conducted from January 2011to May 2012 at the departments of pathology, PNS Rahat and Baqai medical and dental university, Karachi. A total of 867 subjects presenting for estimation of fasting triglycerides and total cholesterol were selected after excluding patients receiving anti-platelet or lipid medication, pregnancy, acute in factious disorders. They were interviewed, examined and sampled for measurement of total cholesterol, triglycerides and platelet indices including total platelet count, mean platelet volume [MPV], platelet distribution width [PDW] and platecrit [PCT]. The results of platelet count and mean platelet volume were found to be significantly different among subjects with normal cholesterolemia [<5.2mmol/L], borderline raised cholesterol group [5.2-6.3 mmol/L] and hypercholesterolemia [>6.3 mmol/L]; however, post-hoc comparison did not show any significant difference between all groups. Using age as a variable and segregating total cholesterol results into 7 groups, starting from very low cholesterol values [<4.0 mmol/L] to highest [>6.5 mmol/L], in a univariate general linear model, higher mean platelet volume were observed at the extremes of cholesterolemia groups [p=0.039]. A similar trend was observed for platelet count after adjusting for age, where low levels of platelet levels were associated with hypocholesterolemia and hypercholesterolemia [p=0.021]. Higher MPV and low total platelet counts were associated with the observed extremes of cholesterol range. No significant differences were observed for platelet indices across various groups formulated based upon fasting triglycerides

Pancreatitis aguda secundaria a hipertrigliceridemia: revisión a propósito de un caso / Hypertriglyceridemia-induced pancreatitis: review of a case report

La pancreatitis aguda es un proceso inflamatorio reversible. La hipertrigliceridemia como etiología de la pancreatitis aguda es alrededor de un 2 por ciento, diagnosticándose cuando los niveles de triglicéridos alcanzan valores por sobre los 1000 mg/dl. El objetivo terapéutico es disminuir los niveles de triglicéridos y prevenir el desarrollo de complicaciones. Esto se logra estimulando la actividad de la lipoproteinlipasa que aumenta la degradación de los quilomicrones disminuyendo así los valores plasmáticos de triglicéridos a niveles menores a 500 mg/dl Se puede plantear desde un manejo conservador hasta otro tipos de terapias como insulina, heparina, prostaféresis, entre otros. En el presente articulo se discute un caso de pancreatitis aguda por hipertrigliceridemia, atendido en el Hospital Regional de Talca, manejado con tratamiento conservador con adecuada respuesta clínica y significativa disminución de los niveles de triglicéridos a partir de las 48h. de iniciada la terapia, sin necesidad de medidas terapéuticas complementarias.

Dislipidemia relacionada à fibrose cística / Cystic fibrosis-related dyslipidemia

Esse artigo tem por objetivo rever o conhecimento atual sobre a fisiopatologia, o diagnóstico e a abordagem da dislipidemia relacionada à fibrose cística (DFC). A pesquisa bibliográfica utilizou os bancos de dados Medline e Literatura Latino-Americana e do Caribe em Ciências da Saúde (1987-2007), selecionando os artigos mais relevantes sobre o tema. A DFC é caracterizada por hipertrigliceridemia e/ou hipocolesterolemia e deficiência de ácidos graxos essenciais. Seus principais fatores de risco são: insuficiência pancreática, dieta rica em carboidratos, hepatopatias, estado inflamatório e corticoterapia. Não existem recomendações específicas sobre a triagem, que habitualmente é realizada a partir do diagnóstico e, em intervalos regulares, com maior freqüência, nos indivíduos pertencentes aos grupos de risco. O tratamento inclui: dieta balanceada, reposição de micronutrientes, vitaminas e fibras, além de exercício físico regular de acordo com a tolerância individual. Na grande maioria dos casos, a hipertrigliceridemia da DFC não atinge valores que indiquem o uso de hipolipemiantes. Conclui-se que existem poucos trabalhos na literatura sobre a freqüência, etiologia e manejo da DFC. A recomendações preventivas e terapêuticas para a hipertrigliceridemia são extrapoladas de diretrizes para indivíduos sem fibrose cística. Mais pesquisas são necessárias para investigar a associação da deficiência de ácidos graxos essenciais com a fisiopatologia da fibrose cística. Como a hipertrigliceridemia é um importante fator de risco para doença arterial coronariana, estudos prospectivos irão contribuir para o melhor entendimento da história natural dessa complicação bem como definir maneiras de preveni-la e tratá-la.

This article aims to review the physiopathology, diagnosis and treatment of cystic fibrosis-related dyslipidemia (CFD). Bibliographic searches of the Medline and Latin American and Caribbean Health Sciences Literature databases were made (year range, 1987-2007), and the most representative papers on the theme were selected. The characteristic symptoms of CFD are hypertriglyceridemia-with or without hypocholesterolemia-and essential fatty acid deficiency. The principal CFD risk factors are pancreatic insufficiency, high-carbohydrate diet, liver diseases, inflammatory state and corticosteroid therapy. There are no specific recommendations regarding screening, which is typically performed based on the diagnosis, and at regular intervals, and more frequently in individuals belonging to high-risk groups. Treatment includes a balanced diet, micronutrient supplementation, and regular physical exercise according to individual tolerance. In the great majority of the cases, CFD-related hypertriglyceridemia does not reach values for which the use of hypolipidemic drugs is indicated. We conclude that there are few articles in the literature regarding the frequency, etiology and management of CFD. Preventive and therapeutic recommendations for hypertriglyceridemia are extrapolated from studies in individuals without cystic fibrosis. Further research is necessary to investigate the association of essential fatty acid deficiency and the physiopathology of cystic fibrosis . Since hypertriglyceridemia is an important risk factor for coronary artery disease, prospective studies will contribute for a better understanding of the natural history of this condition and define how to prevent and treat it.

Clinical study of lipid profile in diabetic patients

To know the incidence of hypertriglyceridaemia, its age and sex distribution and prevalence in NIDDM and IDDM and also to know the relationship between the glycaemic control and degree of hypertriglyceridaemia and incidence of complications of hypertriglyceridaemia in diabetes mellitus. one hundred and twenty patients of well-established diabetes mellitus were included in the study. All patients underwent the following investigations: 1. Base line investigations like blood CP with ESR, Blood urea, urine RE, ECG and x-ray chest. 2. Planned investigations: These included fasting and 2 hours post pr and ial blood glucose estimation, serum electrolytes, serum creatinine, serum amylase, uric acid, LFT's, TFT's, ETT and abdominal ultrasound to look for liver texture and for any evidence of fatty change; morphology, texture of kidney and pancreas and other abdominal viscera. 3. Total lipid profile which included: Total fasting lipids, Total fasting triglycerides, Total fasting cholesterol, HDL cholesterol and LDL cholesterol. The commonest finding was hypertriglyceridaemia both in insulin- and non-insulin dependent diabetic patients. It was more so in non-insulin dependent diabetes mellitus [70%] as compared to insulin-dependent diabetics [30%]. Hypertiglyceridaemia is the most common lipid abnormality in diabetes mellitus, which is more common in NIDDM than IDDM. Early diagnosis, good glycaemic control and dietary modification are usually enough for prevention and treating hypertriglyceridaemia in diabetes mellitus

Pancreatite hiperlipêmica: aspectos clínico-evolutivos / Hyperlipemic pancreatitis: clinical and evolutive aspects

A pancreatite aguda é uma das complicações associadas à hipertrigliceridemia acentuada, quer primária ou secundária. A freqüência de hipertrigliceridemia em pacientes com pancreatite aguda varia de 4 a 53 por cento. Acredita-se que a elevação dos níveis séricos de triglicérides induza à liberação de ácidos graxos livres e conseqüente lesão na célula acinar pancreática. Durante um período de três anos, nove pacientes com pancreatite aguda por hipertrigliceridemia foram admitidos no Hospital Universitário da Universidade Federal de Juiz de Fora e no Hospital Monte Sinai (Juiz de Fora, MG). Todos apresentavam quadro clínico sugestivo de pancreatite aguda, principalmente dor em andar superior do abdome, náuseas, vômitos e íleo, embora em apenas três casos tenha sido observada hipermilasemia. Todos tinham níveis séricos de triglicérides acima de 1000 mg/dl (11,3 mmol/L). A evolução após instituição do tratamento clínico foi bem sucedida em oito pacientes, sendo que dois necessitaram de nutrição parenteral. O único óbito constatado foi secundário a um quadro de choque e insuficiência respiratória grave, refratária ao tratamento clínico. O tratamento de manutenção, como o controle ou exclusão dos fatores predisponentes, quando exqüível, aliado à redução dos níveis séricos de triglicérides com drogas hipolipeminantes, foi eficaz em prevenir a recorrência dos episódios de pancreatite aguda, durante os 23 meses de seguimento.

Tizolidinadionas: una nueva familia de Hipoglicemiantes Orales / Thizolidinediones: a new family of oral hypoglycemic agents

A partir de un estudio de la literatura más actualizada se presenta una revisión bibliográfica de una nueva serie de compuestos conocidos como tiazolidinadionas. Se consultaron las bases de datos Medline (1989-8/96), Excerpta Médica (1990-7/96), Predicast (1992-6/96), Medical Research Division (1991) y Life Science (1993-95). Se resumen los resultados obtenidos en los estudios preclínicos y clínicos de los derivados de esta familia conocidos hasta el momento

Undiagnosed hypercholesterolemia: a serious health challenge: the Mexico City Diabetes Study

In this report we present the results of a population based survey designed to characterize the prevalence of hypercholesterolemia (HCL: total cholesterol > or = 240 mg/dl) in a low income urban area of Mexico City (The Mexico City Diabetes Study). In an area of 15,532 inhabitants, 3505 (22.57 per cent) were found to be study eligible (all 35 -64 year-old men and nonpregnant women residing in the area permanently). A home interview was obtained in 2813 (80.26 per cent) subjects. A physical exam and oral glucose tolerance test was performed on 2282 (81.2 per cent of the individuals that gave the interview and 65.1 per cent of all study eligibles, 941 men and 1341 women). The crude prevalence of HCL for men in this group was 12.3 per cent and for women 12.5 per cent. Severe HCL (total cholesterol > or = 260 mg/dl) was found in 6.6 per cent of men and 6.5 per cent of women. In the older age group (55 - 64 years) prevalence in women reached 21.1 per cent. Of the individuals with HCL this abnormality was previously diagnosed in only 15.9 per cent of men and in 7.8 per cent of women. Despite having been diagnosed, the abnormality remained untreated in all cases. HCL was associated with higher mena systolic blood pressure (in women), higher mean diastolic blood pressure (in men) and higher mean fasting and 2 h post-glucose load glycemia as weel as post-challenge insulinemia in both sexes. Mean TG was found high in both groups (with and without HCL), but in subjects with HCL the values were significantly higher. We conclude that HCL is very common in this population. The majority of the cases remained undiagnosed and of the small fraction of subjects that have been diagnosed, virtually none is under medical care. It is necessary to design and implement a national program to reduce the impact of this serious health problem

Metabolismo de lípidos y lipoproteínas en la diabetes mellitus / Metabolism of lipids and lipoproteins in diabetes mellitus

En este trabajo se describen algunas características y propiedades de los lipidos y lipoproteínas, cuyos niveles se modifican con mayor frecuencia en el paciente diabético. Se incluye la prevalencia de dislipidemia donde los factores de riesgo para enfermedad vascular son la hipercolesterolemia e hipertrigliceridemia y se destaca la utilidad de la determinación de lípidos y lipoproteínas en el diagnóstico de la enfermedad y en la evaluación de tratamientos terapéuticos. Se sabe que actualmente se estudian nuevas terapias para el tratamiento de dislipidemias y que existen varias sustancia probadas experimentalmente que pueden tenera aplicación clínica en humanos, por lo que se proporciona información al respecto

Efecto de la edad y duración de la diabetes sobre los hallazgos electrocardiográficos / Effect of age and diabetic duration upon electrocardiographic findings

El objetivo del presente estudio fue conocer la asociación entre la edad y la duración de la diabetes con las alteraciones encontradas en el electrocardiograma. Se realizó una investigación prospectiva en 49 pacientes diabéticos no dependientes de insulina, hiperglucémicos, obesos, con hipercolesterolemia y sin antecedente de compliaciones tardías o cardiopatía. Se les practicó un electrocardiograma de reposo para agruparse posteriormente de acuerdo a la edad y duración de la diabetes. De los pacientes menores de 60 años, 25.0 por ciento presentaron alteración electrocardiográfica en comparación con 46.1 por ciento del grupo de ancianos (X²=1.86, p=NS). No se encontró diferencia estadísticamente significativa entre las alteraciones electrocardigráficas de 35.7 por ciento de los menores de 10 años de evolución en comparación con 23.8 por ciento del otro grupo. Se concluye que ni la edad, ni la duración de la diabetes inciden en la frecuencia de los hallazgos electrocardiográficos anormales en pacientes diabéticos de alto riesgo no hipertensos o cardiópatas

Tratamento de hipertensos essenciais, hipercolesterolêmicos com ou sem hipertrigliceridemia, com dose baixa de bezafibrato (200 mg/dia) / Treatment of essential hypertension, hypercholesterolemia with or without hypertriglyceridemia, with low dose of bezafibrate (200 mg/day)

Vinte hipertensos esenciais, cinco portadores de dislipidemia tipo IIa e 15, IIb, foram tratados com 200 mg/dia de bezafibrato. Um grupo semelhante, controle, näo medicado, näo apresentou diferenças significativas da lipidemia. Seis pacientes eram do sexo masculino (60 anos ñ 4) e 14 do feminino (57 anos ñ 2). A clesterolemia e a trigliceridemia foram valiadas antes do início da terapéutica (dia zero) e nos dias 28§ e 56§. A colesterolemia média inicial (n = 20) foi de 334 mg/dl ñ 10 E.P.§.), diminuindo significativamente para 274 ñ 7 e 279 ñ 11 (P < 0,01). A trigliceridemia média inicial (n = 15) foi de 544 mg/dl ñ 85, decrescendo significativamente (P < 0,01) para 234 ñ 36 e 245 ñ 36. A reduçäo porcentual média do colesterol foi de 16% ñ 4 e 14% ñ 5; a dos triglicérides, na dislipidemia IIb (n = 15), foi de 46% ñ 8, em ambos os dias 28§ e 56§. Näo foram constatados efeitos colaterais da droga. Concluíu-se que o bezafibrato (200 mg/dia) foi útil na melhora das dislipidemias de hipertensos essenciais, apesar dos pacientes näo terem modificado os hábitos alimentares e a atividade física, em curto prazo