Atherogenic lipids and vascular complications in a selected diabetic population with normal urinary albumin/creatinine ratios.

OBJECTIVE: To test the hypothesis that at different urinary albumin/creatinine ratios within the normal ranges, diabetics have low but similar prevalence of metabolic and micro vascular disease. METHODS: The study sample consisted of normotensive diabetics not taking any medications known to effect blood pressure and lipids. The data were collected from the Diabetes Register. The diabetics were subgrouped according to the urinary albumin/creatinine ratios. MA is defined as present if the albumin/creatinine ratio (ACR) is more than 2 mg/mmol. RESULTS: MA was present in 16% of the 152 diabetics. Total cholesterol, systolic BP, and triglycerides were significantly high in diabetics with ACR≥1<2 compared with <1. The prevalence rates for retinopathy and neuropathy in the MA group were also significantly high. However, a large number of diabetics without MA had had established complications (37% retinopathy, 40% neuropathy, and 16% peripheral vascular disease). Because these results were based on single early morning urine samples, we looked at their MA in the past year. After exclusion of regressed and progressed groups, the complications rate remained the same. CONCLUSION: The high prevalence of metabolic and vascular complications seen even in absence of MA indicates an early intervention and those diabetics should not wait unitl CVD risk scores raise to receive preventive treatment.

Chyle and gout causing acute monoarthritis: some unusual findings.

A 67-year-old man presented with acute monoarthritis of the right knee. Aspiration was carried out under aseptic precautions. This yielded a milky appearing fluid. Polarized microscopic examination confirmed uric acid crystals. The patient had a history of trauma to the joint. Acute monoarthritis of the knee can occur due to gout. Chylous effusions in the knee are rare. This combination of findings in the same joint has not been described in the literature. We emphasise the importance of history of trauma in acute monoarthritis. We discuss the unusual features of this case.

A case of breathlessness, confusion and diarrhoea.

A 61-year-old woman presented to the emergency department with acute-onset breathlessness, fever, sore throat and confusion. Her initial investigations revealed hyponatremia and middle lobe consolidation. In view of the atypical symptoms and signs, erythromycin was commenced. Urinary legionella antigen was requested and that tested positive. She was one of the first few patients whose findings alerted us to a possible outbreak of legionnaire' disease. We drew the following conclusions from our experience with this and other cases that we saw during the legionnaires' outbreak: an atypical presentation is common, as seen in this lady with confusion. If two cases of atypical pneumonias test positive for legionella within a period of a week, we suggest that public health authorities should be notified to identify the source and contain it. There is a need for continuous and high vigilance for legionnaires' disease.