ABSTRACT
AIMS: Assessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time-consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point-of-care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN. METHODS: Nerve amplitude (AMPPOCD ) and conduction velocity (CVPOCD ) were measured in a cross-sectional study including 198 asymptomatic patients with type 1 diabetes. CAN was diagnosed by the Ewing score and power spectral heart rate [low-frequency (LF) and high-frequency (HF) activity]. Diagnostic accuracy was determined by ROC curves. RESULTS: CVPOCD and AMPPOCD showed positive correlations with LF and HF, and a negative correlation with age. Overall, AMPPOCD had an 81.7% accuracy in identifying CAN [AUC = 0.817 (95% CI 0.692-0.942)] with an AMPPOCD ≤6 µV showing 90% sensitivity and 73% specificity. In a stepwise binary logistic regression analysis, the model (R2 : 0.297; P < 0.001) retained the duration of type 1 diabetes [ß: 1.131 (95% CI: 1.051-1.216); P = 0.001) and A1c [ß: 2.131 (95% CI: 1.060-4.283); P = 0.034) as significant predictors of CAN. The combination of AMPPOCD ≤6 µV + a type 1 diabetes duration of ≥8 years maximized the sensitivity, showing a diagnostic performance of 87% [AUC = 0.867 (95% CI 0.769-0.965)] with 90%, 76%, and 99%, sensitivity, specificity, and NPV, respectively. Adding A1c ≥ 7% to this model maintained accuracy [AUC = 0.867 (95% CI: 0.788-0.963) and NPV (99%), while increasing specificity to 84%. CONCLUSIONS: The combination of AMPPOCD with A1c and the duration of type 1 diabetes mellitus showed a good performance for the detection of asymptomatic CAN, making POCD an easy and rapid test for its routine screening in the clinical setting.
Subject(s)
Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Diabetic Neuropathies , Humans , Cross-Sectional Studies , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diagnosis , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/etiology , Heart Rate , Neural Conduction/physiology , Point-of-Care SystemsABSTRACT
BACKGROUND: We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation. METHODS: A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations. RESULTS: After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation. CONCLUSIONS: The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.
Subject(s)
Diabetes Mellitus, Type 1 , Hyperglycemia , Insulin Resistance , Metabolic Syndrome , Adult , Cross-Sectional Studies , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Humans , Hyperglycemia/complications , Hyperglycemia/diagnosis , Hyperglycemia/epidemiology , Inflammation/complications , Metabolic Syndrome/complications , Metabolic Syndrome/diagnosis , Metabolic Syndrome/epidemiology , Prevalence , Risk FactorsABSTRACT
Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.
Subject(s)
Abdomen, Acute/diagnosis , Anisakiasis/diagnosis , Abdomen, Acute/etiology , Aged , Diagnosis, Differential , Emergencies , Emergency Service, Hospital , Female , HumansABSTRACT
La anisakiasis es una zoonosis cada vez más prevalente especialmente en países europeos, causada por la ingesta del nemátodo del género Anisakis en su tercer estadio larvario tras el consumo de pescado crudo o poco cocido. Puede producir una afectación gastrointestinal y también una reacción de hipersensibilidad a las proteínas del parasito. Presentamos un caso de anisakiasis gástrica acompañada de hipersensibilidad (forma gastroalérgica) tras la ingesta de pescado crudo.
Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.
Subject(s)
Aged , Female , Humans , Anisakiasis/diagnosis , Abdomen, Acute/diagnosis , Diagnosis, Differential , Emergencies , Emergency Service, Hospital , Abdomen, Acute/etiologyABSTRACT
Objetivo: Determinar la validez de la prueba de adenosina deaminasa (ADA) y el recuento diferencial de leucocitos para el diagnóstico de tuberculosis pleural. Diseño: Estudio retrospectivo de precisión diagnóstica. Institución: Hospital Regional de Huacho, Ministerio de Salud, Huacho, Perú. Material: Historias clínicas de pacientes con prueba de ADA en líquido pleural. Intervenciones: Estudio de historias clínicas de pacientes a quienes se les realizó la prueba de ADA en líquido pleural, desde enero 2005 hasta diciembre 2007. El valor de la prueba de ADA y el recuento diferencial de leucocitos fueron analizados mediante la curva ROC. La sensibilidad (Se), especificidad (Sp), valores predictivos (VPP y VPN) y los cocientes de verosimilitud (CVP y CVN) fueron hallados para cada variable. Principales medidas de resultados: Punto de corte para la prueba de ADA para el diagnóstico de tuberculosis pleural. Resultados: La tuberculosis fue culpable de la mayoría de los derrames pleurales; 47,5 fue el punto de corte hallado para la prueba de ADA, con Se y Sp de 73 por ciento y 90 por ciento, respectivamente (IC 95 por ciento: 0,74 - 0,95; p<0,001). La curva ROC para el recuento diferencial de leucocitos dio un punto de corte de 0,725; con Se y Sp de 60,9 y 64,7, respectivamente (IC 95 por ciento: 0,47 - 0,79; p=0,129). Conclusiones: El mejor punto de corte discriminatorio para el diagnóstico de tuberculosis pleural fue 47,5 UI/L. Esta prueba sirve más para confirmar el diagnóstico que para descartar la enfermedad. Además, un mayor porcentaje de linfocitos en el recuento diferencial de leucocitos (>72 por ciento) incrementaría la sospecha de tuberculosis pleural.
Objective: To determine the validity of both adenosine diaminase (ADA) test and differential cell count for pleural tuberculosis diagnosis. Design: Retrospective study for diagnosis precision. Setting: Huacho Hospital, Ministerio de Salud, Huacho, Peru. Material: Medical records of patients with ADA test in pleural fluid. Interventions: Medical records study of patients with ADA test in pleural effusion performed from January 2005 through December 2007. ADA test values and differential cell counts were analyzed by ROC curve. Sensitivity (Se), specificity (Sp), predictive values (VPP and VPN) and likehood ratios (LRP and LRN) were found for each variable. Main outcome measures: ADA test cut-off point for pleural tuberculosis diagnosis. Results: Tuberculosis was responsible for most cases of pleural effusion; 47,5 UI/L was the cut-off point by ROC curve, with Se and Sp 73 per cent and 90 per cent, respectively (IC 95 per cent: 0,74 - 0,95; p<0,001). The ROC curve for differential cell count cut-off point was 0,725, with Se and Sp 60,9 and 64,7, respectively (IC 95 per cent: 0,47 - 0,79; p=0,129). Conclusions: The best cut-off point for pleural tuberculosis diagnosis was 47,5 UI/L. This test worked better to confirm the disease rather than ruling it out. Thus, a larger percentage of lymphocytes in the differential cell count (>72 per cent) will increase the suspicious of pleural tuberculosis.
Subject(s)
Humans , Adenosine Deaminase , Leukocyte Count , Tuberculosis, Pleural , Retrospective StudiesABSTRACT
La miasis es la infección de humanos y otros vertebrados, por larvas o pupas de moscas. La miasis bucal es unacondición rara no reportada en el Perú. Se presenta un caso de miasis en cavidad oral por Cochliomyia hominivorax en un varón de 62 años procedente de Huacho (Lima, Perú) con postración por enfermedad de Parkinson.
Myasis is an infection of humans and other vertebrates by fly larvaes. It is a rare condition which has not been described in Peru. We presented a case report of an oral myasis by Cochliomyia hominivorax in a 62 year-old patient from Huacho (Lima, Peru) with prostration for Parkinson disease.
