Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses.

OBJECTIVE: Methylprednisolone pulses are used in a variety of disease conditions, both for acute and chronic therapy. Although well tolerated, they increase glucose levels in both non-diabetic and diabetic patients. They may also be considered a significant risk for acute metabolic alterations. The purpose of this report is to determine the metabolic changes in blood glucose levels in non-diabetic patients receiving methylprednisolone pulses and identify the presence of predictive factors for its development. METHODS: Observational, prospective study in 50 non-diabetic patients receiving 1 g intravenous methylprednisolone pulses for three consecutive days as an indication for diverse autoimmune disorders. Demographic, anthropometric, and metabolic variables were analyzed, and glucose, insulin and C-peptide levels after each steroid pulse were identified. Different variables and the magnitude of hyperglycemia were analyzed using Pearson's correlation. RESULTS: 50 patients were included, predominantly women (66%, n = 33). The average age was 41 ± 14 years with a BMI of 26 ± 3 kg/m². Baseline glucose was 83 ± 10 mg/dL. After each steroid pulse, glucose increased to 140 ± 28, 160 ± 38 and 183 ± 44, respectively (p < 0.001). C-peptide and insulin concentrations increased significantly (p < 0.001). The prevalence of fasting hyperglycemia after each pulse was 68%, 94% and 98%, respectively. We found no correlation between the magnitude of hyperglycemia and the studied variables. CONCLUSION: Methylprednisolone pulses produced significant increases in fasting glucose in most patients without diabetes. Further studies are needed to define its role in long-term consequences.

Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses / Distúrbios de glicose em pacientes não diabéticos que recebem tratamento agudo com pulsos de metilprednisolona

OBJECTIVE: Methylprednisolone pulses are used in a variety of disease conditions, both for acute and chronic therapy. Although well tolerated, they increase glucose levels in both non-diabetic and diabetic patients. They may also be considered a significant risk for acute metabolic alterations. The purpose of this report is to determine the metabolic changes in blood glucose levels in non-diabetic patients receiving methylprednisolone pulses and identify the presence of predictive factors for its development. METHODS: Observational, prospective study in 50 non-diabetic patients receiving 1 g intravenous methylprednisolone pulses for three consecutive days as an indication for diverse autoimmune disorders. Demographic, anthropometric, and metabolic variables were analyzed, and glucose, insulin and C-peptide levels after each steroid pulse were identified. Different variables and the magnitude of hyperglycemia were analyzed using Pearson's correlation. RESULTS: 50 patients were included, predominantly women (66 percent, n = 33). The average age was 41 ± 14 years with a BMI of 26 ± 3 kg/m². Baseline glucose was 83 ± 10 mg/dL. After each steroid pulse, glucose increased to 140 ± 28, 160 ± 38 and 183 ± 44, respectively (p < 0.001). C-peptide and insulin concentrations increased significantly (p < 0.001). The prevalence of fasting hyperglycemia after each pulse was 68 percent, 94 percent and 98 percent, respectively. We found no correlation between the magnitude of hyperglycemia and the studied variables. CONCLUSION: Methylprednisolone pulses produced significant increases in fasting glucose in most patients without diabetes. Further studies are needed to define its role in long-term consequences.

OBJETIVO: Pulsos de metilprednisolona são usados em diversas doenças, tanto para tratamento agudo quanto crônico. Embora bem tolerados, eles aumentam os níveis de glicose em ambos os pacientes, não diabéticos e diabéticos. Eles também podem ser considerados um risco significativo para alterações metabólicas agudas. O propósito deste estudo é determinar as alterações metabólicas nos níveis de glicose no sangue de pacientes não diabéticos que recebem pulsos de metilprednisolona e identificar a presença de fatores preditivos para seu desenvolvimento. MÉTODOS: Estudo observacional prospectivo em 50 pacientes não diabéticos que recebem pulsoterapia com 1 g de metilprednisolona intravenosa por três dias consecutivos como tratamento para diversas doenças autoimunes. Variáveis demográficas, antropométricas e metabólicas foram analisadas, e glicose, insulina e níveis de peptídeo C foram identificados após cada pulso de esteroide. Diferentes variáveis e a magnitude da hiperglicemia foram analisadas utilizando a correlação de Pearson. RESULTADOS: 50 pacientes foram incluídos, predominantemente mulheres (66 por cento, n = 33). A idade média foi de 41 ± 14 anos com um IMC de 26 ± 3 kg/m². A glicose de base foi de 83 ± 10 mg/dL. Após cada pulso de esteroide, a glicose aumentou para 140 ± 28, 160 ± 38 e 183 ± 44, respectivamente (p < 0,001). Peptídeo C e concentrações de insulina aumentaram significativamente (p < 0,001). A prevalência de hiperglicemia em jejum após cada pulso foi de 68 por cento, 94 por cento e 98 por cento, respectivamente. Não encontramos nenhuma correlação entre a magnitude da hiperglicemia e as variáveis estudadas. CONCLUSÃO: Os pulsos de metilprednisolona produziram aumentos significativos na glicemia de jejum na maioria dos pacientes sem diabetes. Mais estudos são necessários para definir o seu papel nas consequências em longo prazo.

[Thyroid incidentaloma frequency in a university hospital]. / Prevalencia del incidentaloma tiroideo en un hospital universitario.

BACKGROUND: The prevalence of thyroid incidentaloma is variable and always created the dilemma of how to manage them. The objective was to determine the frequency of thyroid incidentalomas in a University Hospital. METHODS: A descriptive, transversal, prospective study was done; a non-probabilistic sample was used with patients who met the following criteria: >18 years, indiscriminate sex, and an image that included neck: ultrasound, computed tomography and/or magnetic resonance. Patients with known or suspected thyroid nodule or any other thyroid disease and pregnant women were excluded. Descriptive statistics were used. RESULTS: 153 patients who had the criterion; 11 patients had an incidentaloma (7.18%). Females were more frequent with seven cases (63.6%), the mean age was 56.9 years. Morphologically only a single thyroid nodule was detected. The nodules were smaller than 1.5 cm. CONCLUSIONS: The prevalence documented in our study is smaller than other reports, it is proposed monitoring patients with thyroid incidentalomas according to current consensus guidelines.

[NOPHAL Proyect: an integreting vision of hyperglycemia at the hospital]. / Proyecto NOPHAL: una visión integradora de la hiperglucemia en el hospital.

Patients with hyperglycemia are more likely to be hospitalized, and evidence links it with poor outcomes. Recognizing the importance of glycemic control, we develop a multidisciplinary educational program on inpatient glycemic management, with metabolic goals that are reasonable, achievable and safe.

Nondiagnostic thyroid fine needle aspiration cytology: outcome in surgical treatment.

BACKGROUND: Fine-Needle Aspiration (FNA) is the main screening process for distinguishing benign from malignant thyroid nodules. Despite this, by 5-29% of patients, their FNA results are not enough to confirm malign neoplasia, particularly in cases with follicular lesions. The objective of this report is to present the definitive histological results of a group of 41 patients with FNA of Thyroid nodule catalogued as "indeterminate/non diagnostic" sent for surgical treatment. MATERIAL AND METHODS: A retrospective analysis was done on all of the patients who had underwent surgery for thyroid nodule, with a previous diagnosis of "indeterminate/non diagnostic" by FNA. Forty-one patients, three male (7.31%), and 38 female (92.68%), were included in the present study. RESULTS: Fifteen women and one man were positive for malignancies (39.02%). The nodule was bigger than 4 cm in 23 patients in total (56.09%), and of this percentage, 6 were malignant (26.09%). According to age, 24 patients were older than 45 years (58.5%), 8 of whom showed malignant pathology (33.3%). All these variables were non significant. Fifteen of 16 patients had a definitive diagnosis of papillary carcinoma and one follicular carcinoma. CONCLUSIONS: The majority of patients with a diagnosis of "indeterminated/non diagnostic" had benign lesions (60.9%). The usual predictive factors for malignity such as age, sex, size of nodule, did not present a significant support in the differential diagnosis.

[Insulin therapy in patients with severe hypertriglyceridemia]. / Terapia con insulina en pacientes con hipertrigliceridemia severa.

A series of seven patients with severe hypertriglyceridemia (triglyceride levels > 1000 mg/dL) is presented. Four of the patients were diabetics, two of them were in treatment with anti-retroviral drugs, and three of them presented acute pancreatitis. In all patients intravenous infusion of insulin was initiated at a rate of 0.05-2 U/kg/day. Two and a half days after this treatment, the serum triglyceride level remained lower than 400 mg/dL. There were no complications during the treatment. The long treatment included basal insulin, fibrates and avoidance of pharmacotherapy. Insulin therapy for diabetic and non-diabetic patients with severe hypertriglyceridemia is an effective and safe treatment.

[Thyroid cancer in children and adolescents]. / Cáncer de tiroides en niños y adolescentes.

BACKGROUND: Thyroid nodules in children and adolescents may be associated to malignant neoplasms. Although thyroid cancer is a rare event in this age group, delayed diagnosis is associated to metastatic, regional or lung disease, but even in these circumstances appropriate treatment may be followed by good prognosis. We decided to review the clinical course of these patients in our hospital from 1980 to 2001. METHODS: We found fifteen patients younger than 18 years diagnosed with thyroid carcinoma, which had been followed by at least 12 months, with a mean of 95 months and a maximal of 10 years. All patients were treated by surgery and 131 iodine, and followed by scans, ultrasound and thyroglobulin analysis. RESULTS: The patients group were thirteen females and two males. At diagnosis, seven patients (46.7o%) had metastatic regional disease and eight had a thyroid nodule. Total thyroidectomy with a modified neck dissection and 131 iodine was the initial treatment for patients with regional disease and subtotal thyroidectomy and 131 iodine in the follow-up to treat the thyroid bed or metastases was the treatment for patients with localized disease. All patients had a histologic pattern of papillary carcinoma. Nine patients (60%) had local recurrence in a mean follow-up of 37 months, one patient that had been previously treated by total thyroidectomy and all patients that were treated by subtotal thyroidectomy, however, all responded to the complementary treatment. At this moment the mean follow up is 95 months and all the patients have survived. CONCLUSIONS: In our experience thyroid cancer in children and adolescents is a rare event whose delayed diagnosis is associated to regional lymph node or lung metastases. Subtotal thyroidectomy was associated to disease progression to metastases, but complementary treatment was successful and all patients have survived.

Uso de gabapentina en la neuropatía diabética dolorosa / Use of gabapentin on neuropathic diabetic pain

Antecedentes. La polineuropatía diabética es una complicación crónica que deteriora la calidad de vida del paciente con diabetes mellitus de larga evolución. Dado que sólo manteniendo las concentraciones de glucosa dentro de límites normales es factible detener y prevenir el daño neuronal, las medidas terapéuticas son eseciales para minimizar molestias a los enfermos. Objetivo. Dar a conocer nuestra experiencia en el manejo sintomático de la neuropatía diabética con gabapentina. Material y métodos. En un ensayo clínico placebo controlado 15 enfermos con neuropatía diabética (edad promedio de 53 ñ 4 años, con un tiempo de evolución de su diabetes de 13 ñ 3 años) fueron tratados con 300 y 900 mg diarios de gabapentina por vía oral durante tres meses. Resultados. Se obtuvo una mejoría en más de 50 por ciento mediante la escala visual análoga en 13 pacientes (86.6 por ciento), vs sólo 2 (13 por ciento) en el grupo placebo X², p ó 0.0003. El fármaco fue bien tolerado, sin reportarse efectos secundarios importantes. Conclusión. La gabapentina es un medicamento útil e inocuo en el tratamiento sintomático del paciente con neuropatía diabética

Normoglucemia en diabetes mellitus no dependiente de insulina de reciente diagnóstico. Tratamiento no farmacológico vs. tratamiento farmacológico / Normoglucemia in newly diagnosed no insulin dependent diabetes mellitus. Non pharmacologic therapy vs. pharmacologic therapy

Objetivo: Comparar la efectividad en el control metabólico de las medidas no farmacológicas vs. el tratamiento inicial con drogas (glibenclamida y metformina) en pacientes con DMNDI de reciente diagnóstico. Diseño: Ensayo clínico. Marco de referencia: Hospital de tercer nivel de atención en la ciudad de Monterrey, NL. Pacientes: Noventa pacientes con diabetes mellitus no insulinodependiente de reciente diagnóstico (38 hombres y 52 mujeres, con edad promedio de 38 ñ 7 años), sin embarazo, condiciones que requieran insulina o contraindicaciones al uso de los fármacos. Intervenciones: A todos los enfermos se les exhortó a cambiar su estilo de vida, dándoles a conocer los beneficios de modificar su plan de alimentación y realizar ejercicio en forma regular, posteriormente se dividieron en forma aleatoria en tres gupos: I (n = 32), se les indicó continuar con medidas no farmacológicas, IIA (n = 29) y IIB (n = 29), igual al grupo I, pero además se les agregó glibenclamida (10.20 mg/día) y metformina (850-1,750 mg/día), respectivamante. Mediciones y resultados: Se observa que en el grupo I no hay variación en el control glucémico (248 ñ 38 vs. 219 ñ 30 mg/dl, p = NS), tampoco en el perfil de lípidos, peso o concentraciones de insulina; en el grupo de tratamiento con fármacos, el control glucémico fue igual con glibenclamida y metformina: glucosa de 264 ñ 16 a 149 ñ 30 mg/dl; de 270 ñ 31 a 134 ñ 26 y Hgb A1C de 11.2 ñ 2 a 8 ñ 1.3 por ciento y de 11 ñ 2 a 7.9 ñ 1.2 por ciento (p < 0.001 en ambos grupos); sin embargo, sólo en el gupo con metformina fue evidente una disminución significativa de triglicéridos (p < 0.05) y de insulina (p < 0.05). Conclusiones: El tratamiento farmacológico temprano es más eficaz que el tratamiento "convencional" en el paciente con DMNDI de reciente diagnóstico. El efecto hipoglucemiante entre glibenclamida y metformina es similar

Prevalencia de isquemia miocárdica silente en diabetes no insulinodependiente / Prealence of silent myocardial ischemia in non-insulin dependent diabetes

Objetivo. Conocer la prevalencia de la isquemia miocárdica silente en pacientes con diabetes mellitus no inulinodependientes sin datos clínicos de enfermedad cardiovascular. Sitio. Un hospital de especialidades. Paicentes. 60 enfermos con diabetes mellitus no insulinodependientes, con edad de 58 ñ 12 años, sin evidencia clínica de angina u otra enfermedad cardiovascular y con un electrocardiograma en reposo normal; fueron evaluados durante un monitoreo electrocardiográfico ambulatorio con Holter de 24 h en búsqueda de isquemia miocárdica la cual se definió como una deperesión del segmento ST ò de 1mm por ò 1 min. Como grupo control se escogieron a 57 voluntarios sanos de edad y sexo similares. Resultados. En 10 de los 60 diabéticos (17 por ciento) y en 3/57 controles (5 por ciento) se hizo diagnóstico de isquemia miocárdica silente; en dos años de seguimiento, cuatro diabéticos desarrollaron síntomas de angina. Conclusión. La isquemia miocárdica silente es frecuente en el enfermo con diabetes; dado que los síntomas no constituyen una guía adecuada, deben realizarse exámenes paraclínicos que nos ofrezcan más información para detectar esta anormalidad

Glucotoxicidad en la diabetes mellitus no dependiente de insulina / Glucose toxic effect upon non insuline dependent diabetes mellitus

Se ha encontrado defecto específico en el glucorreceptor de pacientes con diabetes mellitus no insulino dependiente (DMNID), aunque existe poca información de los efectos tóxicos de la glucosa sobre la función de la célula beta cuando ésta es estimulada por un agente diferente de la glucos. En el presente informe se analiza la respuesta de insulina en seis pacientes con DMNID crónicamente descompensados a una carga oral de 75 g de glucosa, y posteriormente a 1 mg de glucagon endovenoso, una vez compensados los pacientes, se repitió el mismo protocolo. La concentración de insulina sérica antes de la compensasión fue de 96 96 ñ 32 uU/mL, con una relación glucosa/insulina de 0.343 (p=NS); después de la compensación la concentración de insulina alcanzó 154 ñ 67 uU/mL, (

Glucosa, insulina y perfil de lípidos post carga oral isocalórica "normal" e "hipoprotéica" en pacientes con diabetes mellitus (DM) tipo II / Glucose, insulin, lipds in patients with Diabetes Mellitus to isocalorica diet and low protein

El objetivo de este trabajo fue demostrar los cambios agudos en las determinaciones de glucosa, insulina, triglicéridos, colesterol total, CLDL y CHDL en pacientes con DM tipo II sometidos a una carga oral isocalórica de nutrientes con una distribución normal (DN), así como a una con distribución hipoprotéica (DH). El diseño fue prospectivo, longitudinal y experimental. Procede de un hospital de concentración de tercer nivel. Los pacientes fueron 11 enfermos con DM tipo II sin insuficiencia renal o hepática y con hemoglobina glucosilada menor del 10 por ciento y se les proporcionó durante dos días consecutivos una DN el primer día y una DH el segundo, en ambos se cuantificó en ayunas y dos postprandial: glucosa, insulina y perfil lípidico. Los resultados fueron: un incremento significativo en las determinaciones promedio de glucosa e insulina 1'80-20 lmg porciento P< 0.001, y 31-41 mU/ml P< 0.01, respectivamente con la DH. No existieron modificaciones en las concentraciones de colesterol total o de sus fracciones, ni en ayunas ni postprandial. Concluimos que existió un efecto deletéreo en la relación glucosa/insulina con la DH, desconocemos si a largo plazo en el paciente con DM tipo II promueva más aterogénesis. No se produjeron cambios significativos en el perfil de lípidos, ni en ayunas y tampoco en estado postprandial