[Prevalence and predictive factors of parietal cell antibody positivity in autoimmune thyroid disease]. / Prevalencia y factores predictivos de la presencia de anticuerpos anticélula parietal gástrica en la enfermedad tiroidea autoinmune.

BACKGROUND AND OBJECTIVES: Our aim was to evaluate the prevalence of parietal cell antibodies (PCA) in patients with autoimmune thyroid disease (ATD). MATERIAL AND METHODS: We performed a descriptive, cross-sectional study of patients with ATD. The presence of PCA was determined. Elevated antithyroid antibodies (ATAs) were defined as those higher than the 75th percentile of distribution. Multivariate logistic regression models were built to assess the independent contribution of the following variables to PCA positivity: age, sex, hemoglobin, medium corpuscular volume (MCV), dose/Kg of levothyroxine (LT4), disease duration and elevated ATA levels. RESULTS: A total of 148 patients were included (137 females). The mean age was 45.7 (SD 15) years and disease duration was 4.5 (SD 4) years. Forty-three patients (29%) with Graves' disease and 105 (71%) with primary hypothyroidism were included. The 75th percentile of distribution was 420U/ml for anti-peroxidase antibodies and 200U/ml for anti-thyroglobulin antibodies. PCA positivity was found in 30 patients, with an overall prevalence of 20.3%. PCA positivity with titers higher than 1/640 was found in 19 patients (12.8%). The only independent predictive factor of PCA positivity was the presence of elevated levels of ATAs (odds ratio (OR)=3; 95% confidence interval (CI): 1.1-8.6; p=0.04). The only independent predictive factor of PCA positivity at titers >/=1/640 was also the presence of elevated levels of ATAS (OR=7.3; 95% CI: 1.6-32.7; p=0.009). CONCLUSIONS: The prevalence of PCA positivity in patients with ATD was 20%. Elevated levels of ATAs increase the risk of PCA positivity.

Prevalencia y factores predictivos de la presencia de anticuerpos anticelula parietal gastrica en la enfermedad tiroidea autoinmune / Prevalence and predictive factors of parietal cell antibody positivity in autoimmune thyroid disease

Introducción Evaluar la prevalencia de anticuerpos frente a las células parietales gástricas (ACP) en pacientes con enfermedad tiroidea autoinmune (ETI). Material y métodos Estudio descriptivo transversal con inclusión de pacientes con ETI. Se determinó la presencia de ACP. Se definieron como títulos elevados de anticuerpos antitiroideos (ATAS) niveles de anticuerpos antiperoxidasa o antitiroglobulina superiores al percentil 75. Mediante modelo de regresión logística se evaluó la contribución independiente de las siguientes variables a la presencia de ACP positivos: edad, sexo, hemoglobina, volumen corpuscular medio (VCM), dosis/k de levotiroxina (LT4), duración de la ETI y títulos elevados de ATAS. Resultados Se incluyeron 148 pacientes (137 mujeres) con edad de 45,7 (DE 15) años y duración de la enfermedad de 4,5 (DE 4) años. De ellos, 43 (29%) tenían enfermedad de Graves y 105 (71%) hipotiroidismo primario. El percentil 75 fue para anticuerpos anti-peroxidasa 420U/ml y para anticuerpos antitiroglobulina 200U/ml. Los ACP fueron positivos en 30 pacientes, con una prevalencia global del 20,3%. Títulos iguales o superiores a 1/640 aparecieron en 19 pacientes (12,8%). El único factor predictivo independiente de ACP positivos fue la presencia de títulos elevados de ATAS (Odds Ratio [OR]=3; intervalo de confianza [IC] 95%: 1,1–8,6; p=0,04). El único factor predictivo independiente de ACP positivos a títulos iguales o superiores a 1/640 fue también la presencia de títulos elevados de ATAS (OR=7,3; IC 95% 1,6–32,7; p=0,009). Conclusiones La prevalencia de ACP positivos en pacientes con ETI fue del 20%. La presencia de títulos elevados de ATAS incrementa el riesgo de aparición de ACP positivos (AU)

Background and objectives Our aim was to evaluate the prevalence of parietal cell antibodies (PCA) in patients with autoimmune thyroid disease (ATD). Material and Methods We performed a descriptive, cross-sectional study of patients with ATD. The presence of PCA was determined. Elevated antithyroid antibodies (ATAs) were defined as those higher than the 75th percentile of distribution. Multivariate logistic regression models were built to assess the independent contribution of the following variables to PCA positivity: age, sex, hemoglobin, medium corpuscular volume (MCV), dose/Kg of levothyroxine (LT4), disease duration and elevated ATA levels.

Ability of retinopathy to predict cardiovascular disease in patients with type 2 diabetes mellitus.

It is important identify patients with very high cardiovascular risk to intensify their therapy. Our aim was to assess the association between retinopathy and incident cardiovascular events (cardiovascular disease [CVD]) in patients with type 2 diabetes mellitus (DM). Patients were included if they had type 2 DM and a visible fundus. Baseline clinical and biochemical variables, including urinary albumin excretion rate, were collected. Clinical end points were nonfatal or fatal cardiovascular events (unstable angina including revascularization, nonfatal or fatal myocardial infarction, transient ischemic attack, nonfatal or fatal stroke, lower-leg amputation, terminal chronic heart failure, sudden death). Cox multivariate regression models were used to evaluate the risk associated with each variable and the independent contribution of baseline retinopathy. A total of 458 patients were included, with mean follow-up time of 6.7 +/- 2.6 years. Incident CVD rates were 30.7 per 1,000 patient-years in patients with a normal fundus, 56.7 in patients with nonproliferative retinopathy, and 90.7 in patients with proliferative retinopathy (p <0.0001). In multivariate analysis, nonproliferative retinopathy (hazard ratio 1.71, 95% confidence interval 1.1 to 2.66, p = 0.017) and proliferative retinopathy (hazard ratio 2, 95% confidence interval 1.1 to 3.56, p = 0.019) were significantly associated with incident CVD. In conclusion, retinopathy proved to be an independent risk marker for CVD in patients with type 2 DM.

Vías no invasivas para la administración de insulina / Non-invasive routes of insulin administration

Se comentan las indicaciones de la terapia insulínica en la diabetes mellitus tipos 1 y 2. Dada la incomodidad de administración de los derivados de acción rápida por vía subcutánea, se estudian las vías alternativas y se concluye que, en el momento actual, la vía inhalada es la más útil. Además, se lleva a cabo un estudio comparativo de eficacia y seguridad de la insulina inhalada respecto a otras alternativas terapéuticas, y se llega a la conclusión de que la eficacia y la seguridad son similares a las de los otros tipos de insulina, y superiores según el momento evolutivo a las de la mayoría de los antidiabéticos orales. Se indica que, aproximadamente, un 40% de los pacientes con diabetes tipo 2 mal compensados y que no quieren administrarse insulina lo harían si ésta pudiera utilizarse por vía inhalada. Los costes iniciales se podrían ver ampliamente compensados por la prevención de las complicaciones crónicas que la utilización de la insulina inhalada podría evitar (AU)

We discuss the indications for insulin therapy for types 1 and 2 diabetes mellitus. Given the difficulties of the subcutaneous administration of fast-acting derivatives, we analyze alternative routes and conclude that inhalation is the most useful. We also carried out a study comparing the efficiency and safety of inhaled insulin versus other therapeutic alternatives and conclude that this form of insulin is just as efficient and safe as other types of insulin and, depending on the phase of the disease, can be even more so than most oral antidiabetic drugs. Approximately 40% of poorly compensated type 2 diabetics who are unwilling to administer insulin would do so if the route of administration were inhalation. The initial cost would be amply offset by the prevention of chronic complications (AU)