The Genetic Variants -717T>C (rs2794521), 1444G>A (rs1130864), and 1846 C > T (rs1205) of CRP Gene, Their Haplotypes, and Their Association with Serum CRP Levels, Acute Coronary Syndrome, and Diabetes in Patients from Western Mexico.

Background: C-reactive protein (CRP) is involved in inflammatory pathways that are associated with the onset and progression of type 2 diabetes mellitus (T2DM) as well as an increased risk of an acute coronary syndrome (ACS). This research aimed to evaluate the potential association of the genetic variants -717T>C, 1444G>A, and 1846 C > T of CRP gene on CRP levels, ACS, and T2DM in participants from Western Mexico. Methods: Six hundred three participants were studied: (1) control group (CG); (2) ACS participants classified as unstable angina (UA), myocardial infarction without ST-segment elevation (NSTEMI), and myocardial infarction with ST-segment elevation (STEMI); (3) T2DM Participants; and (4) ACS plus T2DM participants (ACS+T2DM). Genetic variants were genotyped using allelic discrimination with TaqMan® probes, and high-sensitivity CRP (hs-CRP) was measured by Turbidimetry. Results: TAC haplotype frequency was significantly higher in ACS+T2DM versus CG and versus ACS participants (odds ratio [OR] = 2.774, P = 0.017 and OR = 3.479, P = 0.020, respectively). hs-CRP levels were especially higher for ACS and for ACS+T2DM participants with respect to CG and T2DM (with P < 0.0001). We observed higher hs-CRP levels in NSTEMI and STEMI versus UA in ACS scenario (P = 0.001, P = 0.027, respectively) and for ACS+T2DM scenario (P = 0.0001, P = 0.002, respectively). Conclusion: hs-CRP level fluctuations are related to the presence of T2DM and the presence and severity of ACS. Very high levels (>10 mg/L) are a risk marker of cardiovascular complications. Our results demonstrate a possible relationship between TAC haplotype and an increased risk for T2DM and ACS.

ApoB/ApoA1 ratio and non-HDL-cholesterol/HDL-cholesterol ratio are associated to metabolic syndrome in patients with type 2 diabetes mellitus subjects and to ischemic cardiomyopathy in diabetic women / Los índices ApoB/ApoA1 y no-HDL-colesterol/HDL-colesterol se asocian con el síndrome metabólico en sujetos con diabetes mellitus tipo 2 y con cardiomiopatía en mujeres diabéticas

Background and aim: Presence of metabolic syndrome (MS) in patients with type 2 diabetes mellitus (T2DM) involves an increased risk of cardiovascular disease and death. Markers such as ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios have been used to predict this risk with conflicting results. The study objective was to establish the relationship between the apoB/apoA1 and non-HDL-cholesterol/HDL-cholesterol ratios and MS in T2DM patients from a Madrid (Spain) district. Patients and methods: One hundred patients with T2DM who attended University Hospital Infanta Leonor (Vallecas, Madrid, Spain) between January 2014 and June 2017 were enrolled. A blood sample was taken every 6 months from all patients to measure the different lipid parameters and to calculate ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. A Mann-Whitney's U test to compare means and a Spearman's correlation test for correlations between variables were used, and a multivariate regression analysis was performed to determine the association between MS and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Values of p < 0.05 were considered significant. Results: Associations were found between MS and ApoA1 (R2 = 0.164, p = 0.028), ApoB/ApoA1 (R2 = 0.187, p = 0.001), and non-HDL-cholesterol/HDL-cholesterol (R2= 0.269, p = 0.0001) ratios and, in women with MS, between ApoB/ApoA1 ratio and ischemic cardiomyopathy (IC) (R2 = 0.160, p = 0.032). Associations remained after adjusting for comorbidities and risk factors. Conclusions: In the T2DM patients studied, MS was independently associated to ApoA1 and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Both ratios were better predictors of MS in T2DM subjects that its components alone. The ApoB/ApoA1 ratio could be used as a cardiovascular risk marker in women with MS

Antecedentes: La presencia del síndrome metabólico (MetS) en pacientes con diabetes mellitus tipo 2 (T2DM) conlleva mayor riesgo de enfermedad cardiovascular y muerte. Se han utilizado marcadores para predecir este riesgo, como los índices ApoB/ApoA1 y no-HDL-C/HDL-C, pero con resultados controvertidos. El objetivo ha sido determinar las relaciones entre los índices ApoB/ApoA1 y no-HDL-C/HDL-C y el MetS en pacientes con T2DM de un distrito de Madrid, España. Pacientes y métodos: Se reclutaron 100 pacientes con T2DM del Hospital Universitario Infanta Leonor (distrito de Vallecas, Madrid). A todos, entre enero de 2014 y junio de 2017, se les determinaron cada 6 meses los diferentes parámetros lipídicos, calculándose los índices ApoB/ApoA1 y no-HDL-C/HDL-C. De cada parámetro se realizó una media de 4-5 determinaciones. Se utilizó la U de Mann-Whitney para las comparaciones entre medias, la correlación de Spearman para las relaciones entre variables y un análisis de regresión multivariable para determinar la asociación entre el MetS y los índices ApoB/ApoA1 y no-HDL-C/HDL-C. Una p < 0,05 fue significativa. Resultados: Se han observado asociaciones entre MetS y ApoA1 (R2 = 0,164; p = 0,028), ApoB/ApoA1 (R2 = 0,187; p = 0,001) y no-HDL-C/HDL-C (R2 = 0,269; p = 0,0001); y en mujeres con MetS, entre ApoB/ApoA1 y cardiomiopatía isquémica (IC) (R2 = 0,160; p = 0,032), que permanecen después de ajustar las comorbilidades y los factores de riesgo. Conclusiones: En los pacientes con T2DM estudiados, el MetS se asocia de forma independiente con ApoA1, ApoB/ApoA1 y con no-HDL-C/HDL-C. Ambos índices son mejores predictores de MetS que sus componentes por separado. El índice ApoB/ApoA1 podría usarse como marcador de riesgo cardiovascular en mujeres con MetS

[Nutrition in chronic kidney disease]. / Nutrición en insuficiencia renal crónica.

INTRODUCTION: Chronic kidney disease patients often also present protein-calorie malnutrition, and it is a powerful predictor of morbidity and mortality. In this article, causes and management are shown, highlighting oral and parenteral nutritional supplementation, especially during dialysis process.

INTRODUCCIÓN: Los pacientes con insuficiencia renal crónica presentan frecuentemente malnutrición calórico-proteica, y esta situación es un predictor de morbilidad y mortalidad. En este artículo, se resumen las causas de la desnutrición y las diferentes aproximaciones terapéuticas para revertirla, entre las que se incluyen la suplementación nutricional oral o parenteral, especialmente durante la diálisis.

Nutrición en insuficiencia renal crónica / Nutrition in chronic kidney disease

Los pacientes con insuficiencia renal crónica presentan frecuentemente malnutrición calórico-proteica, y esta situación es un predictor de morbilidad y mortalidad. En este artículo, se resumen las causas de la desnutrición y las diferentes aproximaciones terapéuticas para revertirla, entre las que se incluyen la suplementación nutricional oral o parenteral, especialmente durante la diálisis

Chronic kidney disease patients often also present protein-calorie malnutrition, and it is a powerful predictor of morbidity and mortality. In this article, causes and management are shown, highlighting oral and parenteral nutritional supplementation, especially during dialysis process

Estudio descriptivo de las cetoacidosis atendidas en urgencias de un hospital de la Comunidad de Madrid mediante la herramienta Savana Manager / Diabetic ketoacidosis in a emergency department of a hospital in Madrid (Spain) using the Savana Manager tool

Objetivo: El objetivo del estudio fue describir las características y evolución de los pacientes que acudieron a las urgencias de nuestro hospital y fueron diagnosticados de cetoacidosis diabética (CAD) utilizando la novedosa herramienta de Big Data Savana. Método: Estudio retrospectivo descriptivo de los pacientes atendidos en urgencias del Hospital Universitario Infanta Leonor durante los años 2011 al 2016 con diagnóstico de CAD. La búsqueda se realizó con Savana Manager. Resultados: Se diagnosticaron 95 episodios de CAD en 68 pacientes. Del total de episodios de CAD, 57 fueron en diabéticos tipo 1 (de ellos 4 LADA), 25 en diabéticos tipo 2, 2 en diabéticos postpancreatectomía y 12 fueron debuts diabéticos. Del total, 61 (64,2%) requirieron ingreso hospitalario, de ellos 23 (24,2%) ingresaron en UCI. La media de HbA1c fue de 10,6 ± 2,1%. Tres pacientes requirieron reingreso tras el alta. La mortalidad fue muy baja con el fallecimiento en 1 paciente diagnosticado simultáneamente de cáncer pulmonar. Los desencadenantes de la CAD fueron: 35 casos (36,8%) falta de adherencia al tratamiento, 31 (32,6%) infecciones, 12 (12,6%) debuts, 8 (8,4%) varias causas y 9 (9,5%) no se pudo determinar la causa. Se clasificaron como CAD de gravedad leve un 28%, un 38% como de gravedad moderada y 34% como graves. La duración del ingreso no se relacionó con la severidad de la cetoacidosis. Conclusiones: La CAD es una complicación grave que afecta tanto a diabéticos tipo 1 como a tipo 2 con elevado porcentaje de ingresos hospitalarios y en UCI, aunque con baja mortalidad en nuestro medio. La duración de los ingresos no se relaciona con la severidad del cuadro.

Objective: the study was designed to describe the clinical features and evolution of the diabetic patients attended in our hospital emergency department with diabetic ketoacidosis (DKA) using the novel Big Data tool Savana. Method: Retrospective descriptive study of the patients attended in the emergency room of the Infanta Leonor University Hospital during the years 2011 to 2016 with diagnosis of CAD. The search was made with Savana. Results: 95 episodes of DKA were diagnosed in 68 patients. Of the total episodes of CAD 57 were in type 1 diabetics (of which 4 were LADA), 25 in type 2 diabetics, 2 in diabetics postpancreatectomy and 12 were new onset of diabetes. Of the total, 61 (64.2%) required hospital admission, of which 23 (24.2%) were admitted to the intensive care unit (ICU). The mean HbA1c was 10.6 ± 2.1%. Three patients required readmission after discharge. Mortality was very low with death in 1 patient simultaneously diagnosed of lung cancer. The triggers of CAD were: 35 cases (36,8%) lack of adherence to treatment, 31 (32.6%) infections, 12 (12.6%) new onset, 8 (8,4%) various causes and 9 (9.5%) the cause could not be determined. They were classified as mild DKA 28%, 38% as moderate and 34% as severe. The duration of admission was not related to the severity of ketoacidosis. Conclusions: DKA is a serious complication that affects both, type 1 and type 2 diabetics patients, with a high percentage of hospital and ICU admissions, although with low mortality in our environment. The lenght of the stay in hospital is not related to the severity of the DKA.

ApoB/ApoA1 ratio and non-HDL-cholesterol/HDL-cholesterol ratio are associated to metabolic syndrome in patients with type 2 diabetes mellitus subjects and to ischemic cardiomyopathy in diabetic women.

BACKGROUND AND AIM: Presence of metabolic syndrome (MS) in patients with type 2 diabetes mellitus (T2DM) involves an increased risk of cardiovascular disease and death. Markers such as ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios have been used to predict this risk with conflicting results. The study objective was to establish the relationship between the apoB/apoA1 and non-HDL-cholesterol/HDL-cholesterol ratios and MS in T2DM patients from a Madrid (Spain) district. PATIENTS AND METHODS: One hundred patients with T2DM who attended University Hospital Infanta Leonor (Vallecas, Madrid, Spain) between January 2014 and June 2017 were enrolled. A blood sample was taken every 6 months from all patients to measure the different lipid parameters and to calculate ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. A Mann-Whitney's U test to compare means and a Spearman's correlation test for correlations between variables were used, and a multivariate regression analysis was performed to determine the association between MS and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Values of p<0.05 were considered significant. RESULTS: Associations were found between MS and ApoA1 (R2=0.164, p=0.028), ApoB/ApoA1 (R2=0.187, p=0.001), and non-HDL-cholesterol/HDL-cholesterol (R2= 0.269, p=0.0001) ratios and, in women with MS, between ApoB/ApoA1 ratio and ischemic cardiomyopathy (IC) (R2=0.160, p=0.032). Associations remained after adjusting for comorbidities and risk factors. CONCLUSIONS: In the T2DM patients studied, MS was independently associated to ApoA1 and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Both ratios were better predictors of MS in T2DM subjects that its components alone. The ApoB/ApoA1 ratio could be used as a cardiovascular risk marker in women with MS.

Microvascular complications and risk factors in patients with type 2 diabetes

Realizar un estudio prospectivo en sujetos con diabetes mellitus tipo 2 (DM2) sin complicaciones microvasculares, analizando la asociación entre varios factores de riesgo al inicio y el desarrollo de complicaciones microvasculares durante el seguimiento. Métodos Estudio prospectivo, observacional en 376 sujetos con DM2 incluidos en 2004. El objetivo clínico final fue la excreción urinaria de albúmina (EUA) > 30mg/24h y/o presencia de retinopatía al final del seguimiento en 2007. Basalmente las variables fueron: edad, sexo, duración de la diabetes, glucosa plasmática en ayunas, hemoglobina glucada (HbA1c), presión arterial sistólica y diastólica, peso, talla, índice de masa corporal, circunferencia de la cintura, colesterol total, triglicéridos, colesterol unido a lipoproteína de alta densidad (c-HDL), colesterol unido a lipoproteína de baja densidad (c-LDL), proteína C reactiva de alta sensibilidad (PCR-as), fibrinógeno, EUA, creatinina, tabaquismo, ejercicio, consumo de alcohol, utilización de medicación hipoglucemiante, hipolipemiante e hipotensora, y otros datos relacionados con los antecedentes familiares de diabetes y factores de riesgo. Resultados Al final del seguimiento 95 sujetos (25,2%) desarrollaron una complicación microvascular. En el análisis de regresión logística, los principales factores de riesgo independientes fueron la EUA > 12mg/24h (odds ratio [OR]: 6,12; p=0,000), la PCR-as > 3mg/l (OR: 3,00; p=0,004) y la hipertensión (OR: 2,43; p=0,023). Conclusiones Los niveles de EUA superiores a 12mg/24h, la PCR-as > 3mg/l y la presencia de hipertensión fueron factores de riesgo independientes para el desarrollo de complicaciones microvasculares en los sujetos con DM2 estudiados (AU)

To conduct a prospective study in patients with type 2 diabetes mellitus (T2DM) with no microvascular complications, analyzing the association between various baseline risk factors and development of microvascular complications at follow-up.MethodsA prospective, observational study in 376 patients with T2DM enrolled in 2004. The clinical end-point was urinary albumin excretion (UAE) > 30mg/24h and/or presence of retinopathy at follow-up in 2007. Baseline variables included age, gender, duration of T2DM, fasting plasma glucose, glycated hemoglobin (HbA1c), systolic and diastolic blood pressure, body weight, height, body mass index, waist circumference, total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitive C-reactive protein (hs-CRP), fibrinogen, UAE, creatinine, smoking status, exercise, alcohol consumption, use of hypoglycemic and lipid-lowering drugs, antihypertensive medications, and other data related to family history of diabetes and risk factors.Results Ninety-five subjects (25.2%) developed a microvascular complication at the end of the follow-up period. In logistic regression analyses, the main independent risk factors were UAE >12mg/24h (odds ratio [OR]: 6.12; P=.000), hs-CRP> 3mg/L (OR: 3.00; P=.004), and hypertension (OR: 2.43; P=.023).ConclusionsUAE levels higher than 12mg/24h, hs-CRP >3mg/L, and presence of hypertension were all independent risk factors for development of microvascular complications in patients with T2DM studied (AU)

Microvascular complications and risk factors in patients with type 2 diabetes.

AIM: To conduct a prospective study in patients with type 2 diabetes mellitus (T2DM) with no microvascular complications, analyzing the association between various baseline risk factors and development of microvascular complications at follow-up. METHODS: A prospective, observational study in 376 patients with T2DM enrolled in 2004. The clinical end-point was urinary albumin excretion (UAE) > 30mg/24h and/or presence of retinopathy at follow-up in 2007. Baseline variables included age, gender, duration of T2DM, fasting plasma glucose, glycated hemoglobin (HbA(1c)), systolic and diastolic blood pressure, body weight, height, body mass index, waist circumference, total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitive C-reactive protein (hs-CRP), fibrinogen, UAE, creatinine, smoking status, exercise, alcohol consumption, use of hypoglycemic and lipid-lowering drugs, antihypertensive medications, and other data related to family history of diabetes and risk factors. RESULTS: Ninety-five subjects (25.2%) developed a microvascular complication at the end of the follow-up period. In logistic regression analyses, the main independent risk factors were UAE >12mg/24h (odds ratio [OR]: 6.12; P=.000), hs-CRP> 3mg/L (OR: 3.00; P=.004), and hypertension (OR: 2.43; P=.023). CONCLUSIONS: UAE levels higher than 12mg/24h, hs-CRP >3mg/L, and presence of hypertension were all independent risk factors for development of microvascular complications in patients with T2DM studied.