Diagnóstico endoscópico de carcinoma pulmonar de célula pequeña y neoplasia folicular de tiroides / Endoscopic Diagnosis of Small Cell Lung Carcinoma and Follicular Thyroid Cancer

No disponible

Prevalencia y factores asociados con la presencia de albuminuria y sus estadios en los pacientes con diabetes mellitus tipo 1 / Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus

Antecedentes y objetivos: A pesar de los beneficios del tratamiento insulínico intensivo, la nefropatía continúa siendo un problema importante en la diabetes mellitus tipo 1 (DM1). Dada la escasez de datos en nuestro medio, hemos realizado un estudio observacional con el objetivo de analizar la prevalencia de albuminuria y sus estadios en una serie pacientes con DM1 y evaluar los factores relacionados. Pacientes y métodos: Estudio transversal que incluyó a todos los pacientes mayores de 18 años con un tiempo de evolución de la DM1 superior a 6 meses, que fueron atendidos de manera consecutiva durante el año 2008 en el Hospital del Mar de Barcelona y el Hospital de Granollers. Resultados: De los 291 pacientes analizados, 46 (20,2 %) presentaban microalbuminuria o proteinuria. Los pacientes albuminúricos presentaron, en comparación con aquellos sin enfermedad renal, mayor edad (42,0 ± 12,3 años vs. 37,1 ± 11,5 años), tiempo de evolución de la diabetes (22,5 ± 11,5 años vs. 14,1 ± 10,1 años), índice de masa corporal (26,3 ± 3,7 kg/m2 vs. 25,2 ± 3,4 kg/m2), hemoglobina glucosilada (8,15 ± 1,5 % vs. 7,59 ± 1,4 %) y de presión arterial sistólica (139,7 ± 21,7 mmHg vs. 122,2 ± 20,3 mmHg). El análisis multivariado mostró una asociación independiente de la presencia de albuminuria con la duración de la diabetes (odds ratio [OR] 1,081; intervalo de confianza [IC] del 95 % 1,038-1,126), la trigliceridemia (OR 1,011; IC del 95 %: 1,002-1,018), el tabaquismo (OR 3,279; IC del 95 %: 1,114-9,654) y la hipertensión arterial (OR 3,495; IC del 95 %: 1,074-11,368). Conclusión: En la presente serie, uno de cada cinco pacientes con DM1 tenía microalbuminuria o proteinuria, y su presencia se relacionó con el tiempo de evolución de la diabetes, la trigliceridemia, el tabaquismo y la hipertensión arterial (AU)

Background and objectives: Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. Patients and methods: Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. Results: 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20.3mmHg). Multivariate analysis showed an independent association of albuminuria with diabetes duration (OR 1.081, 95% CI 1.038-1.126), triglyceride levels (OR 1.011, 95% CI: 1.002-1.018), smoking habit (OR 3.279, CI 95%: 1.114-9.654) and hypertension (OR 3.495, 95% CI: 1.074-11.368). Conclusion: In our series, one out of five patients with type 1 DM had micro- or macroalbuminuria, and its presence is associated with diabetes duration, triglyceride concentration, smoking and hypertension (AU)

Prevalence and related factors with the presence of albuminuria and its stages in patients with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVES: Despite the beneficial effects of intensive insulin therapy, nephropathy continues to be a major concern in type 1 diabetes mellitus (DM). Given the scarce data on this subject in our population, we performed an observational study in order to analyse the prevalence of albuminuria and its stages in a series of patients with type 1 DM and to evaluate the related factors. PATIENTS AND METHODS: Cross-sectional study that included all patients aged 18 and over, diagnosed of type 1 DM for at least 6 months, consecutively attended during 2008 at the Hospital del Mar de Barcelona and Hospital Granollers. RESULTS: 291 patients were analysed and 46 (20.2%) had micro- or macroalbuminuria. Albuminuric patients, compared to those without were older (42.0±12.3 years vs. 37.1±11.5 years), had longer duration of diabetes (22.5±11.5 years vs. 14.1±10.1 years), and higher body mass index (26.3±3.7kg/m2 vs. 25.2±3.4kg/m2), glycosylated haemoglobin (8.15±1.5% vs. 7.59±1.4%) and systolic blood pressure (139.7±21.7 mmHg vs. 122.2±20.3mmHg). Multivariate analysis showed an independent association of albuminuria with diabetes duration (OR 1.081, 95% CI 1.038-1.126), triglyceride levels (OR 1.011, 95% CI: 1.002-1.018), smoking habit (OR 3.279, CI 95%: 1.114-9.654) and hypertension (OR 3.495, 95% CI: 1.074-11.368). CONCLUSION: In our series, one out of five patients with type 1 DM had micro- or macroalbuminuria, and its presence is associated with diabetes duration, triglyceride concentration, smoking and hypertension.

Gestational diabetes in a multiethnic population of Spain: clinical characteristics and perinatal outcomes.

AIMS: To compare clinical characteristics and perinatal outcomes between immigrant and Spanish women with gestational diabetes mellitus (GDM) in a multiethnic population of Barcelona and to identify factors independently associated with the development of large-for-gestational-age (LGA) infants. METHODS: Prospective study of women with GDM from five ethnic groups (Caucasian, South-Central Asian, Latin American, East Asian and Moroccan) at a single institution in Barcelona between 2004 and 2011. Maternal, gestational and newborn characteristics were recorded. RESULTS: The cohort included 456 patients. In univariate analyses, Moroccan women had more frequently a pre-gestational body mass index (BMI)>25 kg/m(2) (76.4%, P=0.012), while East Asian women had lower BMI (23.41 ± 2.79 kg/m(2), P<0.001), less need for insulin therapy (14.3%, P=0.013) and the highest rate of spontaneous labor (69.8%, P=0.014) and eutocic delivery (63.8%, P=0.032). Also, Latin American women had a higher rate of Cesarean section (52.9%, P<0.001) and LGA infants (28.6%, P=0.004), and their newborns had lower umbilical cord pH (7.23 ± 0.06, P=0.005) and Apgar scores (9 [4-10], P<0.01) and a higher incidence of neonatal hypoglycemia (51.4%, P=0.045). Logistic regression analysis identified pre-gestational BMI (OR: 1.18; 95% CI: 1.09-1.27), pregnancy weight gain (OR: 1.19; 95% CI: 1.1-1.28) and insulin use during gestation (OR: 2.29; 95% CI: 1.09-4.82) as predictors of LGA infants. CONCLUSIONS: Significant ethnic differences were found in clinical characteristics and perinatal outcomes of women with GDM. Latin American women had a higher frequency of adverse perinatal outcomes. Pregestational BMI, pregnancy weight gain and insulin use during pregnancy were independent predictors of LGA.

A prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes mellitus.

OBJECTIVE: To analyse first-day-of-life glucose levels in infants of women with gestational diabetes (GDM) and the influence of maternal, gestational and peripartum factors on the development of neonatal hypoglycaemia. STUDY DESIGN: Prospective cohort study including newborns of GDM mothers. Capillary blood glucose (CBG) was measured serially on the first day of life. CBG values were defined as normal (≥ 2.5 mmol/l), mild hypoglycaemia (2.2-2.4 mmol/l), moderate hypoglycaemia (1.6-2.1 mmol/l) and severe hypoglycaemia (<1.6 mmol/l). RESULTS: One hundred and ninety infants were included: 23 (12.1%) presented mild, 20 (10.5%) moderate and only 5 (2.6%) severe hypoglycaemia. Hypoglycaemic infants were more frequently large-for-gestational-age (29.3% vs 11.3%, p=0.003), had lower umbilical cord pH (7.28 vs 7.31, p=0.03) and their mothers had more frequently been hyperglycaemic during labour (18.8% vs 8.5%, p=0.04). In multivariate analysis Pakistani origin (OR: 2.94; 95% CI: 1.14-7.55) and umbilical cord venous pH (OR: 0.04, 95% CI: 0.261-0.99) were significantly and independently associated with hypoglycaemia. CONCLUSIONS: Mild and moderate neonatal hypoglycaemias were common although severe episodes were unusual in infants of women with GDM. Hypoglycaemia is mainly influenced by ethnicity and cord blood pH, although maternal peripartum glycaemic control and large-for-gestational-age condition may also play a role.

Seven-year mortality in heart failure patients with undiagnosed diabetes: an observational study.

BACKGROUND: Patients with type 2 diabetes mellitus and heart failure have adverse clinical outcomes, but the characteristics and prognosis of those with undiagnosed diabetes in this setting has not been established. METHODS: In total, 400 patients admitted consecutively with acute heart failure were grouped in three glycaemic categories: no diabetes, clinical diabetes (previously reported or with hypoglycaemic treatment) and undiagnosed diabetes. The latter was defined by the presence of at least two measurements of fasting plasma glycaemia ≥ 7 mmol/L before or after the acute episode.Group differences were tested by proportional hazards models in all-cause and cardiovascular mortality during a 7-year follow-up. RESULTS: There were 188 (47%) patients without diabetes, 149 (37%) with clinical diabetes and 63 (16%) with undiagnosed diabetes. Patients with undiagnosed diabetes had a lower prevalence of hypertension, dyslipidaemia, peripheral vascular disease and previous myocardial infarction than those with clinical diabetes and similar to that of those without diabetes. The adjusted hazards ratios for 7-year total and cardiovascular mortality compared with the group of subjects without diabetes were 1.69 (95% CI: 1.17-2.46) and 2.45 (95% CI: 1.58-3.81) for those with undiagnosed diabetes, and 1.48 (95% CI: 1.10-1.99) and 2.01 (95% CI: 1.40-2.89) for those with clinical diabetes. CONCLUSIONS: Undiagnosed diabetes is common in patients requiring hospitalization for acute heart failure. Patients with undiagnosed diabetes, despite having a lower cardiovascular risk profile than those with clinical diabetes, show a similar increased mortality.

Las cetoacidosis no siempre son diabéticas / Ketoacidosis is not always diabetic

La cetoacidosis alcohólica se presenta en forma de náuseas, vómitos y dolor abdominal en pacientes con enolismo crónico que, previamente al debut, consumen una cantidad de alcohol superior a la habitual. Bioquímicamente se caracteriza por acidosis metabólica con aumento del hiato amiónico, cetosis con predominio de beta-hidroxibutirato y glicemia normal, baja o moderadamente elevada. El principal diagnóstico diferencial esla cetoacidosis diabética. El tratamiento se basa en el aporte de tiamina e hidratos de carbono. Aunque el uso de insulina es controvertido, algunos pacientes, como en el caso que exponemos a continuación, requieren de su administración para corregir la hiperglicemiasecundaria a la sobrecarga de glucosa (AU)

Alcoholic ketoacidosis presents with nausea, vomiting, and abdominal pain in chronic alcoholics who drink a larger amount of alcohol than usual just before onset. Biochemically this condition is characterized by metabolic acidosis with a high anion gap, ketosis with a high ratio of β-hydroxybutyrate, and a glucose level that is low, normal or only slightly elevated. The main differential diagnosis is diabetic ketoacidosis. Treatment involves thiamine and carbohydrate replacement. Although the use of insulin is controversial, some patients, such as the one whose case we report, require insulin to correct hyperglycemia secondary to glucose overload (AU)

Peripartum metabolic control in gestational diabetes.

OBJECTIVE: We sought to evaluate intrapartum metabolic control in gestational diabetes mellitus (GDM) patients and maternal factors influencing intrapartum glycemic control and neonatal hypoglycemia risk. STUDY DESIGN: A prospective observational study included 129 women with GDM admitted for delivery. Data collected included maternal intrapartum capillary blood glucose (CBG) and ketonemia, use of insulin, and neonatal hypoglycemia. RESULTS: In all, 86% of maternal intrapartum CBG values fell within target range (3.3-7.2 mmol/L) without need for insulin use. There were no cases of maternal hypoglycemia or severe ketosis. Intrapartum CBG >7.2 mmol/L was associated with third-trimester glycated hemoglobin (P = .02) and lack of endocrinologic follow-up (P = .04). Risk of neonatal hypoglycemia was related with pregnancy insulin use compared with dietary control (60.5% vs 29.5%; P = .02). CONCLUSION: Peripartum metabolic control in GDM patients was achieved without insulin in most cases. Intrapartum glycemic control was related with third-trimester glycated hemoglobin and with no endocrinologic follow-up. Neonatal hypoglycemia was associated with insulin use during pregnancy.

Síndrome pierde-sal cerebral en infecciones del sistema nervioso central / Cerebral saltwasting syndrome due to infectious diseases of the central nervous system

No disponible