Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort.

INTRODUCTION AND AIMS: Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD). METHODS: A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM. RESULTS: A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes. CONCLUSION: The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.

[«Man-in-the-barrel¼ syndrome: atypical manifestation of giant cell arteritis]. / Sindrome del hombre en el barril: manifestacion atipica de la arteritis de celulas gigantes.

INTRODUCTION: «Man-in-the-barrel¼ syndrome refers to diplegia of the upper extremities in which mobility of the head and lower limbs is preserved. Brachial plexitis that presents as «man-in-the-barrel¼ syndrome is an unusual manifestation of giant cell arteritis. We report a case of C5-C6 plexitis as part of the clinical features of a patient with giant cell arteritis. CASE REPORT: A 70-year-old male with a two-month history of weight loss, headache, facial pain and jaw claudication, associated with a persistent elevation of acute phase reactants and bilateral brachial plexopathy, with no evidence of neck or brain injuries or occult neoplasm and with negative autoimmunity tests. Results of the biopsy study of the temporal artery were compatible with giant cell arteritis, and the positron emission tomography scan revealed extensive vascular involvement of the aorta and its branches. CONCLUSIONS: Although the typical clinical manifestations of giant cell arteritis are headache, jaw claudication, loss of sight, constitutional symptoms and polymyalgia rheumatica, its presence must be suspected in patients over the age of 50 who manifest alterations affecting the peripheral nerve, including brachial diplegia with no other demonstrable cause.

TITLE: Sindrome del hombre en el barril: manifestacion atipica de la arteritis de celulas gigantes.Introduccion. El sindrome del hombre en el barril hace referencia a la diplejia de los miembros superiores con movilidad preservada de la cabeza y los miembros inferiores. La plexitis braquial que se presenta como sindrome del hombre en el barril es una manifestacion inusual de la arteritis de celulas gigantes. Se comunica un caso de plexitis C5-C6 como parte del cuadro clinico de un paciente con arteritis de celulas gigantes. Caso clinico. Varon de 70 años con dos meses de evolucion de perdida de peso, cefalea, dolor facial y claudicacion mandibular, asociados a elevacion persistente de reactantes de fase aguda y plexopatia braquial bilateral, sin evidencia de lesiones cervicales o cerebrales, neoplasia oculta y con pruebas de autoinmunidad negativas; la biopsia de la arteria temporal fue compatible con arteritis de celulas gigantes y la tomografia por emision de positrones demostro una extensa afeccion vascular de la aorta y sus ramas. Conclusiones. Si bien las manifestaciones clinicas tipicas de la arteritis de celulas gigantes son cefalea, claudicacion mandibular, perdida visual, sintomas constitucionales y polimialgia reumatica, se debe sospechar su presencia en pacientes mayores de 50 años que manifiesten alteraciones del nervio periferico, entre ellas, diplejia braquial sin otra causa demostrable.

Ferritina plasmática materna en el tercer trimestre del embarazo y crecimiento fetal / Maternal plasma ferritin during the third trimester of pregnancy and foetal growth

Objetivo: Relacionar las concentraciones de ferritina plasmática materna en el tercer trimestre del embarazo con el crecimiento fetal. Materiales y métodos: Se seleccionaron pacientes con embarazos simples en el tercer trimestre que presentaron partos a término y que fueron atendidas en el Hospital Central «Dr. Urquinaona», Maracaibo, Venezuela. Se evaluaron la edad materna, edad gestacional al momento de la toma de la muestra y del parto, valores de hematocrito, concentraciones plasmáticas de ferritina materna y peso del recién nacido. Resultados: Se seleccionaron 131 pacientes embarazadas en el tercer trimestre a las cuales se les pudo realizar las mediciones de ferritina. La edad promedio de las pacientes fue de 30,6±4,1años. Las concentraciones promedio de ferritina fueron de 31,7±14,7ng/dl y el peso promedio de los recién nacidos fue de 3.194±434g. Al dividir las concentraciones de ferritina materna en cuartiles (concentraciones bajas, medias, altas y muy altas), se observó que las pacientes con concentraciones muy altas y altas de ferritina materna tenían recién nacidos con pesos significativamente más bajos que las pacientes con concentraciones bajas de ferritina (p<0,001). Se observó una correlación moderada, negativa y significativa entre la concentración de ferritina materna y el peso de los recién nacidos (r=-0,481; p<0,001). Conclusión: Existe una relación negativa y significativa de las concentraciones de ferritina plasmática materna en el tercer trimestre del embarazo con el crecimiento fetal

Objective: To relate maternal plasma ferritin concentrations during the third trimester of pregnancy to foetal growth. Materials and method: Patients with single pregnancies in the third trimester who had term deliveries and were cared for at the Hospital Central 'Dr. Urquinaona', Maracaibo, Venezuela were selected. Maternal age, gestational age at moment of sample and delivery, haematocrit values, maternal plasma ferritin concentrations and birth weight were evaluated. Results: We selected 131 patients in the third trimester of pregnancy in whom ferritin measurements could be performed. The mean age of the patients was 30.6±4.1 years. The mean ferritin concentration was 31.7±14.7ng/dl and the mean birth weight of the newborns was 3,194±434g. When the ferritin concentrations of the mothers were divided in quartiles (low, medium, high and very high concentrations), it was apparent that patients with very high and high concentrations of ferritin had newborns with significant lower birth weight than patients with low concentrations of ferritin (P<.001). A moderate, negative and significant correlation between maternal plasma ferritin concentration and newborn birth weight was also observed (r=−.481; P<.001). Conclusion: There is a negative and significant relationship between maternal plasma ferritin concentrations during the third trimester of pregnancy and foetal growth

[Risk factors for coronary heart disease in university students aged 17 to 19]. / Factores de riesgo de enfermedades de arteria coronaria en universitarios de 17 a 19 años de edad.

OBJECTIVE: To study the prevalence of risk factors for coronary heart disease (CHD) in university students between 17 an 19 years of age. METHODS: A sample of 289 first year students, 144 females and 145 males, of the University of Costa Rica were included for anthropometric, biochemical and physical studies. RESULTS: One in six (17% N = 48) had total cholesterol > 200 mg/dL and it was more frequent in females. High LDL-C > 130 mg/dL was found in 26% (N = 74) whereas low HDL-C was present in only 42% (N = 121). Nearly 10% (N = 28) smoked and 38% (N = 111) did not exercise. Obesity was seen in 7% (N = 20) when the Body Mass Index was used as a criterium but only 1.4% (N = 4) by body fat. The distribution of risk factors was: one factor in 36% (N = 105), two factors in 27% (N = 77) and three or more in 13% (N = 37). The most common were sedentarism, dislipedemias and smoking. CONCLUSIONS: CHD risk factors were present in many of our adolescents. Our finding suggests the need to promote healthier lifestyles to minimize the potential of these factors to cause CHD in adulthood.