Prevalence in vulnerable population of liver fibrosis identified by transient elastography.

BACKGROUND: Transient elastography (TE) is a useful tool for the assessment of hepatic fibrosis as an alternative to liver biopsy, but it has not been validated as a screening procedure in apparently healthy people. AIM: To determine the prevalence of advanced liver fibrosis diagnosed by TE in a socioeconomically challenged rural population. MATERIAL AND METHODS: We enrolled 299 participants aged over 18 years old from a vulnerable population in Mexico who responded to an open invitation. All participants had their history recorded and underwent a general clinical examination and a liver stiffness measurement, performed by a single operator according to international standards. RESULTS: Overall, 7.35% participants were found to be at high risk for cirrhosis. Three variables correlated with a risk for a TE measure ≥ 9 kPa and significant fibrosis: history of alcohol intake [7.95 vs. 92.04%, odds ratio (OR) 4.47, 95% confidence interval (CI) 1.45-13.78, P = 0.0167], body mass index (BMI) ≥ 30 kg/m2 (30.87 vs. 69.12%, OR 4.25, 95%CI 1.04-6.10, P = 0.049), and history of diabetes mellitus (14.87 vs. 85.12%, OR 2.76, 95%CI 1.002-7.63, P = 0.0419). In the multivariate analyses BMI ≥ 30 kg/m2 was the only significant risk factor for advanced liver fibrosis or cirrhosis (OR 2.54, 95%CI 1.02-6.3, P = 0.0460). CONCLUSION: TE could be useful as a screening process to identify advanced liver fibrosis in the general and apparently healthy population.

Neutrophil gelatinase-associated lipocalin: a novel biomarker in acute kidney injury.

Acute kidney injury (AKI) is a frequent complication in critically ill patients and is associated with high morbidity and mortality; therefore, its prophylaxis, diagnosis and intervention positively impact patient evolution. Neutrophil gelatinase-associated lipocalin (NGAL) or lipocalin, a protein synthesized by renal tubular cells, has the property to transport lipophilic molecules such as vitamins, hormones and antigenic agents. It is a novel biomarker of AKI of several etiologies and is increased in both serum and urine 48 h before the increase of creatinine. It has a strong correlation with early diagnosis of AKI. NGAL is of the most investigated and promising biomarkers for early diagnosis of AKI in different clinical scenarios, most notably in sepsis, cardiorenal syndrome, cardiac surgery, kidney transplant, contrast nephropathy and hemolytic uremic syndrome. Lipocalin guides the early institution of therapeutic interventions to improve prognosis in AKI of several etiologies.

[The importance of updating criteria of altered fasting glucose levels in Mexico]. / Importancia de la actualización en México del criterio de glucosa en ayuno alterada.

OBJECTIVE: To evaluate the impact of applying the 2003-ADA-proposed lower normality value of fasting glucose (FG) on impaired fasting glucose (IFG), prevalence and the agreement between diagnostic categories from ADA-2003 FG values and WHO two hours oral glucose tolerance test (OGTT) current criteria in a Mexican population with suspected diabetes. METHODS: A retrospective cross sectional study was undertaken. We analyzed fasting and 2 hours post load glucose values of 2062 patients and compared diagnostic categories on the basis of different criteria. RESULTS: Considering fasting values, prevalence of IFG changed from 17.7 % to 41.3 % when applying ADA-1997 or ADA-2003 criteria, respectively. Furthermore, based on their OGTT values (WHO-1999), 63 % the 852 IFG patients identified by ADA-2003 criteria were reclassified as having diabetes (26.1 %) or IGT (36.9 %). A heavy kappa test showed a moderate diagonal agreement of 0.43260 (CI 95 % = 0.43214-0.43305) between diagnostic categories from ADA-2003 with FG and OGTT values and WHO current criteria. CONCLUSIONS: The lower ADA-2003 criteria for IFG identifies a higher ratio of patients with IGT or DM.

Inclusion of educational messages in laboratory reports aids to complete the diagnostic workup of hyperglycemia.

OBJECTIVE: To evaluate whether educational messages regarding oral glucose tolerance test (OGTT) indications in laboratory reports increase the number of OGTTs appropriately requested. RESEARCH DESIGN AND METHODS: The following message was printed on the lab reports of individuals with a fasting plasma glucose (FPG) concentration between 5.5 and 6.9 mmol/l: "A FPG between 5.5 and 6.9 mmol/l is considered abnormal by the American Diabetes Association (impaired fasting glucose). An OGTT is recommended if the patient does not have a diagnosis of diabetes and suffers from conditions associated with an increased risk for having type 2 diabetes (i.e., overweight, high blood pressure, abnormal plasma lipids or family history of diabetes)." The number of educational messages printed was 81,099. RESULTS: The intervention resulted in a significant increase in the number of OGTTs requested, from 78 +/- 19 to 268 +/- 48 tests per month. It also resulted in a greater proportion of case subjects that had an abnormal OGTT result. CONCLUSIONS: Educational messages in laboratory reports aid in the diagnostic workup of hyperglycemia.

Probable intoxicación por cumarínicos al ingerir un antiinflamatorio / A probable case of warfarin overdose during anti-inflammatory therapy

La ingestión de cumarínicos conduce a hipoprotrombinrmia y diátesis hemorrágica. Se presenta el caso de una paciente quien, después de ingerir una sobredosis de antiinflamatorio (Wobenzym-R), desarrolló hipoprotrombinemia grave, hematuria, sangrado de tubo digestivo y púrpura. La administración de plasma fresco y suplementos de vitamina K resolvió el cuadro en 24 horas. En conejos, se logró demostrar que el fármaco en cuestión era capaz de producir alargamiento del tiempo de protrombina, y en estudios cromatográfico pudo demostrarse un componente compatible con cumarina, por lo que se concluyó que el medicamento estaba posiblemente contaminado por este fármaco. Este informe debe alertar a la comunidad médica sobre la capacidad de este antiinflamatorio de producir hipoprotrombinemia grave