[Early-onset type 2 diabetes mellitus. The experience from a third level medical institution]. / Diabetes tipo 2 de inicio temprano. Experiencia en una institución de tercer nivel de atención médica.

OBJECTIVE: Describe the clinical, metabolic and psychosocial characteristics observed among patients with early onset type 2 diabetes (T2DM). METHODS: We included 80 consecutive patients with early onset T2DM. All had a medical record, completed a battery of questionnaires and had blood and urine tests. RESULTS: Mean age was 49 +/- 12 years, 57.5% were women, 76.2% had a family history of diabetes and 68.8% a personal history of obesity. Diabetes was diagnosed at the mean age of 32 +/- 6 years with a mean duration of 17 +/- 11 years. Most patients (66.2%) were on poor glycemic control (Alc > 9.0%) and 30% were depressed. Insulin was commonly needed (80% of the patients) and started on average 9 years after diagnosis Significant diabetes related complications were common (71.3% of patients). A longer diabetes duration was the variable most significantly associated with developing complications (p < 0.00001). CONCLUSIONS: Patients with early onset T2DM constitute 27.8% of the total number of diabetic patients attending our clinic; they are characterized by a stronger family history of diabetes, a personal history of obesity and co-morbidities associated with metabolic syndrome. Longer disease course and poor glycemic control contribute to a high prevalence of diabetes related complications and high rates of mortality.

Antibody response to nitrogenase-positive and-negative Klebsiella pneumoniae strains in juvenile-onset ankylosing spondylitis patients and their first degree relatives: lack of differential recognition of the bacterial nitrogenase

En la búsqueda de las consecuencias patogénicas del mimetismo molecular entre la nitrigenasa de Klebsiella pneumoniae y el antígeno HLA-B27, se determinó la presencia de anticuerpos contra extractos completos de cepas de K. pneumoniae nitrogenasa positiva y negativa en el suero de individuos pertenecientes a 16 familias con casos de espondilitis anquilosante juvenil. Se hizo una selección inicial de cepas de K. pneumoniae productoras e nitrogenasa a partir de 31 aislamientos clínicos. Se buscó la mejor cepa productora de nitrogenasa así como una no productora y mediante inmunoelectrotransferencia se hizo un análisis del suero de 82 sujetos, de los cuales 55 fueron HLA-B27 positivos y de éstos, 26 mostraron alguna manifestación clínica. Aunque los patrones electroforéticos fueron diferentes con ambas cepas, no hubo reconocimiento distintivo o diferencial de las proteínas de 30 a 40 kDa donde se ubica el sub-componente de la nitrogenasa que tiene la secuencia QTDRED que se comparte con la molécula HLA-B27. Por otra parte, se encontró un fuerte reconocimiento de una proteína de 60 kDa (p60Kp) en el 75 por ciento de los sujetos HLA.B27 positivos, independientemente de su estado clínico. Actualmente se están realizando estudios para determinar la naturaleza de dicha molécula y su papel en la patogenia de la espondilitis anquilosante