Anisakis physeteris y Pseudoterranova decipiens en el pez Mugil Curema comercializado en Tumaco, Colombia / Anisakis physeteris and Pseudoterranova decipiens in the Mugil curema fish caught in Tumaco, Colombia

RESUMEN Objetivo. Identificar nematodos de la familia Anisakidae en el pez de consumo Mugil curema. Materiales y métodos. Para este estudio, se recolectaron 16 peces Lisa (M. curema) del puerto de Tumaco, una ciudad en la costa colombiana del Pacífico. La identificación morfológica de las larvas se realizó mediante taxonomía clásica y se calculó el porcentaje de infestación de larvas. Para la identificación molecular, se realizó una PCR múltiple con cebadores para las especies Anisakis physeteris, Pseudoterranova decipiens, Anisakis simplex sensu stricto, Contracaecum osculatum, Hysterothylacium aduncum y Anisakis pegreffii. Resultados. La revisión taxonómica permitió la identificación de larvas de tipo II del género Anisakis y larvas del género Pseudoterranova. Las larvas se aislaron principalmente del intestino, donde se encontró que el 94% de los peces estaban parasitados por nematodos anisakidos. La PCR multiplex permitió la identificación de la especie A. physeteris (Larva tipo II) y P. decipiens. Conclusiones. Este estudio es el primer reporte de nematodo Anisakidae en Tumaco, Colombia. Estos resultados proporcionan una justificación convincente para un estudio adicional sobre la familia Anisakidae en Colombia, como un problema de salud pública.

ABSTRACT Objective: Identification nematodes Anisakidae family in Mugil curema fish. Materials and methods: For this study, 16 Lisa fish (Mugil curema) were obtained from the port of Tumaco, a city on the Colombian Pacific coast. Morphological identification of larvae was made by classical taxonomy and the percentage of larval infestation was calculated. For molecular identification, a multiplex PCR was carried out with primers for six species, Anisakis physeteris, Pseudoterranova decipiens, Anisakis simplex sensu stricto, Contracaecum osculatum, Hysterothylacium aduncum and Anisakis pegreffii. Results: The taxonomic revision enabled the identification of type II larvae of the genus Anisakis and larvae of the genus Pseudoterranova. The larvae were isolated mainly from the intestine, where it was found that 94% of the fish were parasitized by anisakid nematodes. The multiplex PCR enabled the identification of the species A. physeteris (Larva type II), and P. decipiens. Conclusions: This study is the first report of nematode Anisakidae on Tumaco, Colombia. These results provide a compelling justification for further study into the Anisakidae family in Colombia, as a public health problem.

Coinfección pulmonar por Aspergillus y citomegalovirus tras tratamiento corticoideo crónico / Coinfection pulmonary by Aspergillus and Citomegalovirus after chronic corticosteroid treatment

Presentamos el caso clínico de una paciente en tratamiento corticoideo crónico que desarrolla infección pulmonar por citomegalovirus y Aspergillus. Tras el ingreso la paciente presenta empeoramiento radiológico y clínico, por lo que ante la posibilidad de infecciones oportunistas dado el tratamiento previo con corticoides a dosis altas de forma prolongada se decide el inicio con antimicrobianos de amplio espectro, con cobertura para hongos, virus y bacterias. Posteriormente, la estabilización de la paciente permitió la realización de pruebas diagnósticas confirmando una coinfección por Aspergillus fumigatus y citomegalovirus, con lo que se pudo realizar un tratamiento dirigido tras el cual la paciente presenta recuperación completa tanto clínica como radiológica, sin complicaciones por toxicidades farmacológicas. Aunque algunos autores dudan sobre el uso de varios antimicrobianos de forma empírica debido a las posibles toxicidades, en situaciones urgentes sin diagnostico con sospecha de patología oportunista puede ser necesaria su cobertura

We present the clinical case of a patient in chronic corticosteroid treatment who develops lung infection with Cytomegalovirus and Aspergillus. After admission, the patient presented with radiological and clinical worsening, with the suspect of opportunistic infections because of previous prolonged treatment with high doses of corticosteroids, we decided to start with broad-spectrum antimicrobials, covering fungi, viruses and bacteria. Subsequently, the stabilization of the patient allowed the performing of diagnostic tests wich confirming a coinfection by Aspergillus fumigatus and Cytomegalovirus, making possible to carry out a directed treatment after which the patient presented complete recovery both clinical and radiological, without complications due to pharmacological toxicities. Although some authors doubt about the use of multiples antimicrobials drugs at the same time empirically due to the possible toxicities, in emergency without diagnosis and suspected opportunistic pathology their coverage may be necessary

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study.

INTRODUCTION: Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient's risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. MATERIALS AND METHODS: Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. RESULTS: Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. CONCLUSION: The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

Hepatotoxicidad inducida por linagliptina y sitagliptina: ¿es un efecto de clase? / Liver injury induced by linagliptine and sitagliptine: It’ a class effect?

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Consecuencias renales de la hipertensión intraabdominal en modelo porcino. Búsqueda de la técnica indirecta de elección de la medida de la presión intraabdominal / Renal Consequences of Intraabdominal Hypertension in a Porcine Model. Search for the Choice Indirect Technique for Intraabdominal Pressure Measurement

Objetivo: Estudiar las consecuencias renales en un modelo porcino de hipertensión intraabdominal y determinar la técnica indirecta de elección para la medida de la presión intraabdominal. Material y métodos: Se utilizaron 30 cerdos divididos en 2 grupos, presión intraabdominal incrementada en 20 mm Hg y en 30 mm Hg. En ambos las presiones se registraron en 8 tiempos hasta3 horas con un insuflador de CO2. Se realizaron 3 medidas de la presión intraabdominal, una directa transperitoneal, empleando un catéter de Jackson-Prat conectado a un traductor depresión, y 2 indirectas, una transvesical mediante un sistema de Foley manómetro y otra transgástrica introduciendo en el estómago un catéter conectado a un monitor de presión con hardware electrónico. Se calculó la presión arterial media, el gasto cardiaco, la producción de orina y la creatinina sérica. Resultados: Hubo una mayor correlación entre la presión intraabdominal transvesical y la transperitoneal (R2 = 0,95). La media de la presión intraabdominal transgástrica fue menor quela transperitoneal en todos los tiempos. La presión arterial media descendió en ambos grupos observando diferencias significativas más precoces a 30 mm Hg (p < 0,020). La producción de orina fue menor a 30 mm Hg (9,63±1,57) vs. (3,26 ml±1,73). La creatinina aumentó en ambos grupos, siendo patológica a 30 mm Hg a partir de 1 h 20 min, existiendo diferencias entre presiones precoces (p < 0,027).Conclusiones: Hubo afectación renal más marcada a presiones de 30 mm Hg. La técnica transvesical mostró una mayor correlación con la técnica directa empleada, por lo que consideramos esta como la de elección (AU)

Objective: To study the effects on the renal system in a porcine model of intraabdominal hypertension, and to determine the indirect technique of choice for determination of the intraabdominal pressure. Material and methods: 30 pigs were used divided in two groups according with increased intraabdominal pressure values (20 mm Hg and 30 mm Hg). In both groups pressures were registered 8 times, summing up to 3 hours, with a CO2 insufflator. Three different measures of the intraabdominal pressure were taken: a direct transperitoneal measure, using a catheter of Jackson-Pratt connected to a pressure transducer, and two indirect measures, a transvesical by means of a Foley to manometer system, and a transgastric by introducing in the stomacha catheter connected to a pressure monitor with electronic hardware. Mean arterial pressure was calculated, along with the cardiac index, production of urine and serum creatinine. Results: There was a greater correlation between the transvesical and the transperitoneal intraabdominal pressures (R2 = 0,95). Average transgastric intraabdominal pressure was inferior to the transperitoneal indicator in all taken measurements. The average arterial pressure descended in both groups, with earlier significant differences observed at 30 mm Hg (p < 0,020).Urine production was lower at 30 mm Hg compared with the 20 mm Hg group (9,63±1,57 versus3.26 ml±1,73). Serum creatinine increased in both groups being pathological at 30 mm Hg after1 h 20 min, with existing differences between early pressures (p < 0,027).Conclusions: This study revealed marked renal affectation with higher severity at 30 mmHg pressures. The transvesical technique showed a greater correlation with the direct measurement technique used, defining this as the method of choice for determination of intraabdominal pressure (AU)

Síndrome compartimental abdominal y síndrome de distrés intestinal agudo / Abdominal compartment syndrome and acute intestinal distress syndrome

La Hipertensión Intraabdominal (HIA) y el Síndrome Compartimental Abdominal (SCA) son entidades frecuentes en los pacientes graves y cursan con una alta mortalidad. En esta revisión se actualizan los aspectos más debatidos sobre la HIA y el SCA: factores desencadenantes, epidemiología, pronóstico, métodos de medición de la presión intraabdominal (PIA), consecuencias fisiopatológicas y medidas terapéuticas, tanto médicas como quirúrgicas. Se plantea que, simultáneamente a los mecanismos de lesión estrictamente físicos, como la compresión directa de vasos y órganos intraabdominales, la transmisión de la PIA a otros compartimentos y el descenso del gasto cardíaco, pueden intervenir también una serie de mediadores inmunoinflamatorios generados en el propio intestino. La hipoperfusión, la isquemia mantenida y el fenómeno isquemia-reperfusión actuarían sobre la microbiota, el epitelio y sistema inmune intestinal desencadenando el Síndrome de Distrés Intestinal Agudo, una respuesta inflamatoria sistémica y una eventual disfunción multiorgánica que pueden aparecer en fases tardías del SCA (AU)

Seriously ill patients frequently present intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) as complications, and the associated mortality is very high. This review offers an update on the most controversial aspects of these entities: factors favoring their appearance, the most common causes, prognosis, and methods of measuring intra-abdominal pressure (IAP), physiopathological consequences in relation to the different organs and systems, and the currently accepted treatment measures (medical and/or surgical). Simultaneously to the strictly physical mechanisms of injury, such as direct compression of intra-abdominal organs and vessels, the transmission of IAP to other compartments, and the drop in cardiac output, a series of immune-inflammatory mediators generated in the intestine itself may also intervene. Hypoperfusion, sustained ischemia and the ischemia-reperfusion phenomenon, would act upon the microbiota, intestinal epithelium and intestinal immune system, triggering a systemic inflammatory response and multiorgan dysfunction that appears in the final stages of ACS (AU)

[Abdominal compartment syndrome and acute intestinal distress syndrome]. / Síndrome compartimental abdominal y síndrome de distrés intestinal agudo.

Seriously ill patients frequently present intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) as complications, and the associated mortality is very high. This review offers an update on the most controversial aspects of these entities: factors favoring their appearance, the most common causes, prognosis, and methods of measuring intra-abdominal pressure (IAP), physiopathological consequences in relation to the different organs and systems, and the currently accepted treatment measures (medical and/or surgical). Simultaneously to the strictly physical mechanisms of injury, such as direct compression of intra-abdominal organs and vessels, the transmission of IAP to other compartments, and the drop in cardiac output, a series of immune-inflammatory mediators generated in the intestine itself may also intervene. Hypoperfusion, sustained ischemia and the ischemia-reperfusion phenomenon, would act upon the microbiota, intestinal epithelium and intestinal immune system, triggering a systemic inflammatory response and multiorgan dysfunction that appears in the final stages of ACS.

Renal consequences of intraabdominal hypertension in a porcine model. Search for the choice indirect technique for intraabdominal pressure measurement.

OBJECTIVE: To study the effects on the renal system in a porcine model of intraabdominal hypertension, and to determine the indirect technique of choice for determination of the intraabdominal pressure. MATERIAL AND METHODS: 30 pigs were used divided in two groups according with increased intraabdominal pressure values (20 mmHg and 30 mmHg). In both groups pressures were registered 8 times, summing up to 3 hours, with a CO2 insufflator. Three different measures of the intraabdominal pressure were taken: a direct transperitoneal measure, using a catheter of Jackson-Pratt connected to a pressure transducer, and two indirect measures, a transvesical by means of a Foley to manometer system, and a transgastric by introducing in the stomach a catheter connected to a pressure monitor with electronic hardware. Mean arterial pressure was calculated, along with the cardiac index, production of urine and serum creatinine. RESULTS: There was a greater correlation between the transvesical and the transperitoneal intraabdominal pressures (R(2)=0,95). Average transgastric intraabdominal pressure was inferior to the transperitoneal indicator in all taken measurements. The average arterial pressure descended in both groups, with earlier significant differences observed at 30 mmHg (p<0,020). Urine production was lower at 30 mmHg compared with the 20 mmHg group (9,63 ± 1,57 versus 3.26 ml ± 1,73). Serum creatinine increased in both groups being pathological at 30 mmHg after 1h 20 min, with existing differences between early pressures (p<0,027). CONCLUSIONS: This study revealed marked renal affectation with higher severity at 30 mmHg pressures. The transvesical technique showed a greater correlation with the direct measurement technique used, defining this as the method of choice for determination of intraabdominal pressure.

Interculturalidad en pediatría: creencias tradicionales en la salud infantil en un área rural / Interculturality in pediatrics: traditional beliefs in the child health in a rural area

Esta investigación tuvo como propósito establecer el sentido de las creencias tradicionales en madres jóvenes y cuidadores y su relación con la salud infantil en un área rural de la Sabana de Bogotá, Colombia. Metodología: estudio cualitativo de caso. Se utilizó la técnica de grupos focales, con una entrevista semiestructurada previo consentimiento informado. Se realizaron siete grupos focales en la consulta externa de pediatría de los municipios de Guasca y Guatavita. Para la selección de participantes se usó un muestreo no probabilístico, intencional por conveniencia, de casos homogéneos. Para el análisis de la información se realizó un análisis cualitativo manual con una codificación abierta. Resultados: se encontró que la creencia tradicional más significativa para la población participante es la de “mal de ojo”, una entidad que produce síntomas físicos en los niños; sin embargo, tiene un origen místico, una prevención y tratamiento en el ámbito de lo religioso, energético y espiritual. Con respecto a este, existe poco conocimiento y confianza por parte del personal de salud. Conclusiones: las creencias son fenómenos dentro de una población que generan actitudes y acciones a gran escala, son base de vital importancia para la crianza de sus hijos y son una tradición. El personal de salud no percibe este fenómeno como algo real, por lo que ignora las creencias y cultura de la población, lo que se convierte en una barrera que afecta la comunicación. Lo anterior demuestra la importancia de la generación de un puente que permita la unión de las creencias y la ciencia.

In vitro adhesion measurements between skin and micropatterned poly(dimethylsiloxane) surfaces.

Micropatterned adhesive surfaces may have potential in reconstructive surgery. The adhesion performance of mice ear skin to micropatterned poly(dimethylsiloxane) (PDMS) was investigated, under in vitro conditions, and compared to flat substrates. No significant difference in separation force F was observed between flat substrates and micropatterned surfaces with pillar arrays. However, the energy necessary for separation of the substrate from the skin was sensitive to the topography. Furthermore, our results show that the force-displacement curves depended on the wetness of the skin: Highest force values were obtained for fresh skin while the forces decreased as the skin dried out. The results are encouraging for further studies on the potential of patterned PDMS in biomedical applications.

[Definition and classification of cerebral palsy: a problem that has already been solved?]. / Definicion y clasificacion de la paralisis cerebral: un problema ya resuelto?

AIM: To carry out a review of the definition and classification of cerebral palsy (CP) from a historical point of view and in the light of current knowledge. DEVELOPMENT: Defining and classifying CP in the medical literature have been difficult to achieve. The different definitions and classifications have represented a limitation when it comes to interpreting the results of epidemiological studies. The definitions do not specify any age limits as regards the moment the brain injury occurred or with respect to the onset of motor disorders or how severe such disorders must be in order to be considered as CP. Within the classifications there are significant inter-observer differences in the interpretation of certain terms, particularly in the topographical and pathophysiological classifications. It has only been in recent years that the first steps have been taken towards achieving greater consistency in the definition and classification of CP. The most recent definition proposed by the Executive Committee for the Definition and Classification of CP, in April 2005, partly satisfies the clinical demands but not those of epidemiological research; nevertheless, the classification of CP proposed here would be useful for both clinical and epidemiological purposes if a number of small modifications mainly concerning the search for causations were introduced. CONCLUSIONS: The definition and classification of CP are a problem that has still not been solved. We recommend drawing up a complementary definition of CP, for epidemiological research purposes, obtained by international agreement.

Definición y clasificación de la parálisis cerebral: ¿un problema ya resuelto? / Definition and classification of cerebral palsy: a problem that has already been solved?

Objetivo. Realizar una revisión de la definición y clasificación de la parálisis cerebral (PC) desde una perspectiva histórica y a la luz de los conocimientos actuales. Desarrollo. La definición y clasificación de la PC en la bibliografía médica han sido problemáticas. La diversidad de definiciones y clasificaciones han constituido una limitación a la hora de interpretar los resultados de estudios epidemiológicos. En cuanto a las definiciones, en ellas no se especifican límites de edad de ocurrencia de la lesión cerebral, ni límites de edad con respecto al momento en que deban presentarse los trastornos motores, como tampoco la gravedad de éstos para ser considerados PC. En las clasificaciones existen variaciones significativas interobservadores en la interpretación de determinados términos, particularmente en las clasificaciones topográficas y fisiopatológicas. Sólo en años recientes se han dado los primeros pasos para el logro de mayor consistencia en la definición y clasificación de la PC. La propuesta de definición más reciente del Comité Ejecutivo para la Definición y Clasificación de PC, de abril de 2005, satisface en parte las exigencias de la clínica, pero no de las investigaciones epidemiológicas; sin embargo, la clasificación de PC propuesta resultaría útil para ambos propósitos, clínicos y epidemiológicos, si se realizaran algunas modificaciones dirigidas fundamentalmente a la búsqueda de etiologías. Conclusiones. La definición y clasificación de la PC constituyen un problema aún no resuelto. Se recomienda la realización de una definición complementaria de PC, con fines investigadores epidemiológicos, obtenida por consenso internacional

Aim. To carry out a review of the definition and classification of cerebral palsy (CP) from a historical point of view and in the light of current knowledge. Development. Defining and classifying CP in the medical literature have been difficult to achieve. The different definitions and classifications have represented a limitation when it comes to interpreting the results of epidemiological studies. The definitions do not specify any age limits as regards the moment the brain injury occurred or with respect to the onset of motor disorders or how severe such disorders must be in order to be considered as CP. Within the classifications there are significant inter-observer differences in the interpretation of certain terms, particularly in the topographical and pathophysiological classifications. It has only been in recent years that the first steps have been taken towards achieving greater consistency in the definition and classification of CP. The most recent definition proposed by the Executive Committee for the Definition and Classification of CP, in April 2005, partly satisfies the clinical demands but not those of epidemiological research; nevertheless, the classification of CP proposed here would be useful for both clinical and epidemiological purposes if a number of small modifications mainly concerning the search for causations were introduced. Conclusions. The definition and classification of CP are a problem that has still not been solved. We recommend drawing up a complementary definition of CP, for epidemiological research purposes, obtained by international agreement

[Hereditary pancreatitis caused by a new mutation in the trypsinogen gene. Report of a family]. / Pancreatitis hereditaria causada por una nueva mutación en el gen del tripsinógeno. Presentación de una familia.

Hereditary pancreatitis is an uncommon autosomal dominant disease secondary to a mutation normally located in the trypsinogen gene, preventing trypsin deactivation. This mutation translates clinically into recurrent attacks of acute pancreatitis and an increased risk of pancreatic cancer. We report a case of acute hereditary pancreatitis due to a trypsinogen mutation that has previously been described in only one family.

Pancreatitis hereditaria causada por una nueva mutación en el gen del tripsinógeno. Presentación de una familia / Hereditary pancreatitis caused by a new mutation in the trypsinogen gene. Report of a family

La pancreatits hereditaria es una rara condición de carácter autosómico dominante secundaria a una mutación normalmente localizada en el gen que codifica el tripsinógeno, lo que da lugar a la síntesis de una tripsina no autoinactivable. Este hecho se traduce clínicamente en pancreatitis agudas de repetición junto a un mayor riesgo de cáncer de páncreas. Presentamos un caso de pancreatitis aguda hereditaria por una mutación del tripsinógeno sólo descrita en una familia con anterioridad (AU)

Hereditary pancreatitis is an uncommon autosomal dominant disease secondary to a mutation normally located in the trypsinogen gene, preventing trypsin deactivation. This mutation translates clinically into recurrent attacks of acute pancreatitis and an increased risk of pancreatic cancer. We report a case of acute hereditary pancreatitis due to a trypsinogen mutation that has previously been described in only one family (AU)

Feature selection in pathology detection using hybrid multidimensional analysis.

Heuristical algorithms can reduce the computational complexity. Such methods require of some stopping criteria (cost function). Some of these cost functions are based on statistics like univariate and multivariate methods of analysis. Dimensional reduction techniques such as principal component analysis (PCA) allow to find a lower dimension transformed space based on data variance, but this procedure does not take into account information about classes separability, the direction of maximum variance does not necessarily correspond to the direction of maximum separability. In this work, we propose a feature selection algorithm with heuristic search that uses multivariate analysis of variance (MANOVA) as the cost function. This technique is put to test by classifying hypernasal from normal voices of CLP (Cleft Lip and/or Palate) patients. The classification performance, computational time and reduction ratio are also considered by the comparison with an alternate feature selection method founded on unfolding the multivariate analysis into univariate and bivariate analysis.

Acoustic speech analysis for hypernasality detection in children.

Here, an analysis of different acoustic features and their influence in automatic identification of hypernasality is shown. Effective feature selection method includes preprocessing of the initial feature space based on statistical independence analysis. Simultaneously, the synthesis of a specialized diagnostic feature is proposed based on analyzing the acoustic emission of the hyper nasal speech. As a result, It is obtained the acoustic features can differentiate with enough precision the pathology. However, the proposed feature does not require training samples and less computational power, as well.

Feature extraction & lips posture detection oriented to the treatment of CLP children.

Adequate recognition of lips posture for speech articulation analysis requires of the measurement of several anthropometric mouth parameters. These are needed to estimate the position and contour of the lips and teeth and tongue positions, as well. Here, a method is proposed for lips contour detection under natural conditions without any extra hardware requirements for image acquisition. The purpose of the suggested process is to obtain the lips contour based on red hue fields detection. Afterward, geometrical features of lips are extracted from their detected contour. Image processing is divided into the following steps: Face and mouth search, lips contour detection and feature estimation from lips geometry. Due to high dimensionality of the initial feature space, it is very important to evaluate the performance of the lips features regarding their ability to discriminate pathological lip postures in the case of children with cleft lip and palate. In this paper, a proposed method for effective selection of the image feature set was developed using multivariate analysis techniques. Finally, the discriminant performance of the selected training sets was evaluated using bayesian estimators. Results of the comparison for different common testing algorithms show that the proposed processing method exposes better performance.

Early MRI findings of central pontine myelinolysis following "rapid" correction of hyponatraemia during diabetic ketoacidosis. A curious pontine lesion (2003:12b).

We describe a diabetic patient with hyponatraemia and ketoacidosis who developed central pontine myelinolysis (CPM) after a very rapid correction of serum sodium. In diabetic ketoacidosis, the marked shifts in osmolarity make these patients more susceptible to the development of CPM. The dramatic early MRI findings (after three weeks) should raise awareness of the risk of permanent damage to the brain associated with hydration therapy in this susceptible group. Magnetic resonance imaging might be a useful investigation at presentation and follow-up of diabetic patients with extreme metabolic derangements.