Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains.

BACKGROUND: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS: To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.

Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente / Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion

Objetivo: El objetivo principal de esta revisión es analizar las diferencias de eficacia entre la administración en perfusión intermitente y la administración en perfusión continua/expandida de piperacilina-tazobactam. Como objetivos secundarios se analizan las diferencias en seguridad, parámetros farmacocinéticos/farmacodinámicos y coste-efectividad entre las 2 formas de administración. Método Se realizaron 2 búsquedas bibliográficas independientes. Se encontraron un total de 38 artículos y finalmente se incluyeron en el estudio 6. Se analizaron los artículos incluidos y se recogieron las variables diseño, tratamiento administrado a cada grupo, número de pacientes total y perteneciente a cada grupo, variables recogidas en cada estudio y resultados. Resultados Se hallaron diferencias significativas en la variable principal en 2 de los 6 estudios incluidos a favor de la perfusión continua/expandida. En el estudio de Lodise et al. se encontraron diferencias (p = 0,04) en mortalidad (31,6% en perfusión intermitente vs 12,2% en perfusión continua/expandida). En el estudio de Lorente et al. se encontraron diferencias (p = 0,001) en curación clínica (56,5% perfusión intermitente vs 89,2% en perfusión continua/expandida). En cuanto a las variables secundarias solo se encontraron diferencias en uno de los estudios en la relación coste-efectividad a favor del grupo de perfusión continua/expandida. Conclusión Los datos analizados indican que la perfusión continua/expandida sería al menos igual de eficaz que la perfusión intermitente, y que podría ser más eficaz en pacientes más graves, o con infecciones por microorganismos más resistentes, como Pseudomonas aeruginosa. Además esta forma de administración es, en teoría, más coste-efectiva (AU)

Objective: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. Method: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. Results: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04)in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion).The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. Conclusion: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory (AU)

[Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion]. / Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente.

OBJECTIVE: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. METHOD: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. RESULTS: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04) in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion). The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. CONCLUSION: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory.

Time to positivity of blood culture association with clinical presentation, prognosis and ESBL-production in Escherichia coli bacteremia.

The time to positivity (TTP) of blood cultures has been associated with increased mortality in bacteremia caused by several microorganisms. The aim of this study is to evaluate the relationship between TTP and prognosis, clinical presentation and extended spectrum B-lactamase (ESBL)-production in patients with Escherichia coli bacteremia. This is a retrospective observational study involving 226 adult patients with E. coli bacteremia. Data collected included underlying diseases, clinical presentation, prognosis factors, TTP, ESBL-production and outcome. Thirty-one (14%) patients had severe sepsis and 29 (13%) septic shock at presentation. Thirty-three (14%) strains were ESBL-producers. Thirty-nine (17%) patients died during admission and 17 (7.5%) within 48 hours. The median TTP was 8.3 hours (range, 0.42­76.5). It was significantly shorter in patients with septic shock (6.23 h, range 1.12­47.29 h vs. 8.51 h, range 0.42­76.50 h; p = 0.018). Rapid growth of E. coli, Pitt index >1.5, non-urinary source and Charlson score >2 were selected as independent risk factors of in-hospital mortality by the multivariate analysis. ESBL-production was not associated with modifications in TTP. Lower TTP is an independent risk factor for septic shock and poor outcome in episodes of E. coli bacteremia. The TTP in E. coli bacteremia is not significantly modified by ESBL-production.

[Utility of procalcitonin, C-reactive protein and leukocyte count in the detection of meningococcal disease during an epidemic cluster]. / Utilidad de la procalcitonina, proteína C reactiva y recuento leucocitario en la detección de enfermedad meningocócica durante un brote epidémico.

OBJECTIVE: To determine the clinical utility of biological markers of the acute phase of bacterial infection (procalcitonin, C-reactive protein and leukocyte count) in invasive meningococcal disease during an epidemic cluster. PATIENTS AND METHODS: Thirty-six patients with feverish syndrome who visited the emergency unit of our hospital within a 6-month period were studied. In all patients, serum procalcitonin and C reactive protein levels and leukocyte count were determined, and blood culture was performed. RESULTS: Invasive meningococcal disease, confirmed by blood culture, was found in seven of the 36 patients studied. The most frequent clinical presentation was a feverish syndrome of less than 24 hours of onset, progressing to sepsis in subsequent hours. Comparison of procalcitonin and C reactive protein concentrations in patients with and without meningococcal disease revealed that procalcitonin and C reactive protein levels greater than 10 ng/ml and 49.95 ng/ml respectively had high sensitivity, specificity and predictive values. Procalcitonin levels < 0.5 ng/ml were useful to easily rule out invasive meningococcal disease. In the case of leukocyte count, no value with clinical significance could be established, although counts were higher in patients with invasive meningococcal disease. CONCLUSIONS: The finding of prolactin levels of < 0.5 ng/ml and/or C-reactive protein levels of < 49.95 ng/ml in children or teenagers with fever of less than 24 hours of onset indicates a low probability of invasive meningococcal disease in epidemic situations.

Utilidad de la procalcitonina, proteína C reactiva y recuento leucocitario en la detección de enfermedad meningocócica durante un brote epidémico / Utility of procalcitonin, c-reactive protein and leukocyte count in the detection of meningococcal disease during an epidemic cluster

Objetivo: Determinar la utilidad clínica de los marcadores biológicos de fase aguda de infección bacteriana (procalcitonina, proteína C reactiva [PCR] y recuento leucocitario) en la enfermedad invasiva meningocócica durante un brote epidémico. Pacientes y métodos: Se estudiaron 36 enfermos con síndrome febril que acudieron al servicio de urgencias de nuestro hospital durante un período de 6 meses. En todos los pacientes se realizaron determinaciones de niveles séricos de procalcitonina, PCR, recuento leucocitario y hemocultivo. Resultados: La enfermedad invasiva meningocócica, confirmada por hemocultivo, apareció en 7 de los 36 enfermos estudiados. La presentación clínica más habitual fue un síndrome febril de menos de 24 h que evolucionó a sepsis en horas posteriores. La comparación de las concentraciones de procalcitonina y PCR en los pacientes con y sin enfermedad meningocócica reveló que para valores de procalcitonina y PCR > 10 y > 49,95 ng/ml, respectivamente, tenían una elevada sensibilidad, especificidad y valores predictivos, aunque valores de procalcitonina inferiores a0,5 ng/ml tenían valor clínico al descartar la enfermedad fácilmente. En el caso del recuento de leucocitos no se pudo determinar un valor adecuado que tuviera significación clínica, aunque los pacientes con infección meningocócica presentaban recuentos más altos. Conclusiones: El hallazgo de niveles de procalcitonina inferiores a0,5 y/o 49,95 ng/ml de PCR en niños y jóvenes con fiebre de menos de 24 h de evolución indica una baja probabilidad de enfermedad invasiva meningocócica en situaciones epidémicas (AU)

Objective: To determine the clinical utility of biological markers of the acute phase of bacterial infection (procalcitonin, C-reactive protein and leukocyte count) in invasive meningococcal disease during an epidemic cluster. Patients and methods: Thirty-six patients with feverish syndrome who visited the emergency unit of our hospital within a 6-month period were studied. In all patients, serum procalcitonin and Creactive protein levels and leukocyte count were determined, and blood culture was performed. Results: Invasive meningococcal disease, confirmed by blood culture, was found in seven of the 36 patients studied. The most frequent clinical presentation was a feverish syndrome of less than 24 hours of onset, progressing to sepsis in subsequent hours. Comparison of procalcitonin and Creactive protein concentrations in patients with and without meningococcal disease revealed that procalcitonin and C reactive protein levels greater than 10 ng/ml and49.95 ng/ml respectively had high sensitivity, specificity and predictive values. Procalcitonin levels < 0.5 ng/ml were useful to easily rule out invasive meningococcal disease. In the case of leukocyte count, no value with clinical significance could be established, although counts were higher in patients with invasive meningococcal disease. Conclusions: The finding of prolactin levels of < 0.5 ng/ml and/orC-reactive protein levels of < 49.95 ng/ml in children or teenagers with fever of less than 24 hours of onset indicates a low probability of invasive meningococcal disease in epidemic situations (AU)

Helicobacter pylori and gastroesophageal reflux disease.

OBJECTIVES: 1. To determine the prevalence of Helicobacter pylori (H. pylori) infection in patients with gastroesophageal reflux disease (GERD), and to compare it with that in a control group. 2. To study the percentage of H. pylori-positive GERD patients according to different grades of esophagitis. MATERIAL AND METHODS: H. pylori prevalence by serological tests was compared among 692 patients with GERD and 200 healthy volunteer controls. Subsequently, the percentage of H. pylori was analyzed in the different grades of esophagitis, according to the Savary-Miller classification. RESULTS: no differences between the GERD group and control group were detected regarding age (50.5+/-14.7 vs 50.7+/-16.4 years, ns) and sex (63 vs 66% of men, ns); on the other hand the prevalence of H. pylori was 40% in the GERD group facing 66% in the control group, p <0.01. There were no differences in H. pylori prevalence according to the different grades of esophagitis, but logistical regression analysis showed that the absence of H. pylori infection was associated with the presence of grade IV esophagitis. CONCLUSIONS: the prevalence of H. pylori infection in GERD patients is lower than that of the general population, and its absence is associated with more severe grades of the disease. These results indicate that H. pylori plays a protective role against GERD.

Clinical features and endoscopic progression of gastroesophageal reflux disease.

OBJECTIVES: 1. To determine the progression of endoscopic affectation in patients with gastroesophageal reflux disease (GERD). 2. To analyze the clinical parameters associated to grade IV of esophagitis, as well as the degree of endoscopic progression. MATERIAL AND METHODS: between 1996 and 2002, 692 patients with GERD have been followed prospectively (66% men and 33% women, with a mean age of 50.7 years). All were submitted to initial upper endoscopy, without treatment, and different clinical parameters associated to grade IV esophagitis were analyzed. During follow up, a new endoscopy was repeated in the event of symptomatic relapse, comparing the new findings with those of the initial exploration. RESULTS: the initial endoscopy did not reveal signs of esophagitis in 49% of the patients. Grade I 11.2%, grade II 22%, grade III 8.1% and grade IV 8.7%. Multivariant analysis showed that advanced age (p <0.01), male sex (p <0.03), smoking (p <0.02) and absence of infection due to Helicobacter pylori (p <0.02) were independent factors associated to grade IV esophagitis. Throughout follow up, patients without esophagitis did not show evidence of esophagitis in successive endoscopies, and a higher grade was found in only 3 of the patients. CONCLUSIONS: the endoscopy did not reveal signs of esophagitis in approximately half of the patients. Advanced age, male sex, smoking and absence of Helicobacter pylori are risk factors associated with severe stages of esophagitis. Patients with reflux without esophagitis did not develop inflammatory disorders during follow-up, while those with esophagitis remained in the stage of the initial diagnosis.

Características clínicas y progresión endoscópica de la enfermedad por reflujo gastroesofágico / No disponible

Objetivos: 1. Conocer el estadio de afectación endoscópica en pacientes con enfermedad por reflujo grastroesofágico (ERGE). 2. Analizar las variables clínicas asociadas a estadio IV de esofagitis, así como el grado de progresión endoscópica. Material y métodos: durante el periodo 1996-2002 se han seguido prospectivamente 692 pacientes con ERGE (66% hombres y 33% mujeres, con una edad media de 50,7 años). A todos ellos se les realizó endoscopia oral inicial, libres de tratamiento, y se analizaron diferentes variables clínicas asociadas a esofagitis grado IV. Durante el seguimiento se repitió nueva endoscopia en caso de recidiva sintomática, comparando los hallazgos con los de la exploración inicial. Resultados: un cuarenta y nueve por ciento de pacientes no mostraron signos de esofagitis en la endoscopia inicial. Grado I 11,2%, grado II 22%, grado III 8,1% y grado IV 8,7%. El análisis multivariante mostró que la edad avanzada (p<0,01), sexo masculino (p<0,03), hábito tabáquico (p<0,02) y ausencia de infección por Helicobacter pylori (p<0,02) fueron factores independientes asociados a esofagitis grado IV. A lo largo del seguimiento ningún paciente sin esofagitis presentó evidencia de la misma en endoscopias sucesivas, y solamente en 3 pacientes con esofagitis se constató un grado superior. Conclusiones: aproximadamente la mitad de pacientes con ERGE no muestra signos de esofagitis en la endoscopia. La edad avanzada, sexo masculino, hábito tabáquico y ausencia de Helicobacter pylori son factores de riesgo asociados a estadio severo de esofagitis. Los pacientes con reflujo sin esofagitis no desarrollan alteraciones inflamatorias a lo largo de su seguimiento, mientras que aquellos con esofagitis tienden a permanecer en el estadio de su diagnóstico inicial (AU)

Características clínicas y progresión endoscópica de la enfermedad por reflujo gastroesofágico / Clinical features and endoscopic progression of gastroesophageal reflux disease

Objetivos: 1. Conocer el estadio de afectación endoscópica en pacientes con enfermedad por reflujo grastroesofágico (ERGE). 2. Analizar las variables clínicas asociadas a estadio IV de esofagitis, así como el grado de progresión endoscópica. Material y métodos: durante el periodo 1996-2002 se han seguido prospectivamente 692 pacientes con ERGE (66 por ciento hombres y 33 por ciento mujeres, con una edad media de 50,7 años). A todos ellos se les realizó endoscopia oral inicial, libres de tratamiento, y se analizaron diferentes variables clínicas asociadas a esofagitis grado IV. Durante el seguimiento se repitió nueva endoscopia en caso de recidiva sintomática, comparando los hallazgos con los de la exploración inicial. Resultados: un cuarenta y nueve por ciento de pacientes no mostraron signos de esofagitis en la endoscopia inicial. Grado I 11,2 por ciento, grado II 22 por ciento, grado III 8,1 por ciento y grado IV 8,7 por ciento. El análisis multivariante mostró que la edad avanzada (p<0,01), sexo masculino (p<0,03), hábito tabáquico (p<0,02) y ausencia de infección por Helicobacter pylori (p<0,02) fueron factores independientes asociados a esofagitis grado IV. A lo largo del seguimiento ningún paciente sin esofagitis presentó evidencia de la misma en endoscopias sucesivas, y solamente en 3 pacientes con esofagitis se constató un grado superior. Conclusiones: aproximadamente la mitad de pacientes con ERGE no muestra signos de esofagitis en la endoscopia. La edad avanzada, sexo masculino, hábito tabáquico y ausencia de Helicobacter pylori son factores de riesgo asociados a estadio severo de esofagitis.Los pacientes con reflujo sin esofagitis no desarrollan alteraciones inflamatorias a lo largo de su seguimiento, mientras que aquellos con esofagitis tienden a permanecer en el estadio de su diagnóstico inicial (AU)

[Spontaneous regression of hepatocellular carcinoma in a cirrhotic patient]. / Regresión espontánea de carcinoma hepatocelular en paciente cirrótico.

Hepatocellular carcinoma mainly affects patients with liver disease and rarely develops in healthy liver. Cirrhosis greatly increases the risk of developing this malignancy and consequently these patients are candidates for close follow-up and surveillance. The most commonly used screening programs are abdominal ultrasonography and serum alpha-fetoprotein determination. Without treatment, the prognosis of hepatocellular carcinoma is poor and mortality continues to be significant even in patients with small tumors detected during follow-up. We present the case of a 71-year-old male patient with alcoholic cirrhosis. The patient was diagnosed during follow-up of a single hepatocellular carcinoma of 4 cm in diameter. Although he refused all treatment, evolution was favorable, serum alpha-fetoprotein levels returned to normal and ultrasonographic images compatible with hepatocellular carcinoma disappeared. Three years after diagnosis, the patient was completely asymptomatic.

Infección por virus C, aumento de ferritina sérica e hiperinsulinemia / Hepatitis C virus infection, increased serum ferritin and hyperinsulinemia

Objetivos: estudios recientes han encontrado una alta prevalencia de diabetes mellitus en pacientes infectados por el virus C (VHC). En este trabajo nos planteamos un doble objetivo: a) sustentar la hipótesis de la hiperinsulinemia como factor de riesgo para diabetes en estos pacientes, estudiando prospectivamente los valores de insulinemia basal en pacientes cirróticos no diabéticos infectados por el virus C, comparándola con la de cirróticos no diabéticos no virus C; y b) investigar en ambos grupos los factores implicados en el aumento de resistencia periférica a la insulina.Material y métodos: se realizó un estudio que incluyó a 32 pacientes cirróticos no diabéticos por VHC (grupo I) y 41 cirróticos no diabéticos de otras etiologías (grupo II). En ambos grupos se compararon las concentraciones de insulinemia basal, así como los factores asociados a resistencia insulínica: edad, índices antropométricos, estadio evolutivo de la cirrosis empleando la clasificación de Child-Pugh, ferritina plasmática y tratamiento con fármacos inductores de resistencia a la insulina.Resultados: la media de los valores de insulinemia basal en el grupo I fue de 21,5 µU/ml (18,6-24,4), frente a 14 µU/ml (1018) en el grupo II (p<0,001), y el porcentaje de hiperinsulinemia del 87,5 por ciento (72,5-95,9) frente al 56,1 por ciento (40,8-70,6), respectivamente (p<0,01). No se encontraron diferencias entre ambos grupos con respecto a las siguientes variables: edad [54,4 (48,360,6) frente a 59,5 años (56,3-62,7) NS], peso [72,9 (69,5-76,3) frente a 74,2 kg (70,8-77,7) NS], talla [163,6 (160,5166-7) frente a 161,3 cm (159,4-163,2) NS], índice de masa corporal [27,6 (26,1-29,1) frente a 28,4 kg/m2 (27,3-29,5) de talla NS] ni estadio de Child-Pugh (A: 31 frente a 27, B: 0 frente a 7, C: 1 frente a 7, NS). En cambio los valores de ferritina sérica en los pacientes del grupo I fueron más elevados que los del grupo II [123,3 (12,4-289,3) frente a 65,5 ng/ml (2,4-306) p<0,05], mientras que en el momento de inclusión en este estudio 3 pacientes del grupo I recibían diuréticos o bloqueantes no selectivos beta adrenérgicos, frente a 14 pacientes del grupo II, p<0,01.El estudio de regresión logística multivariado demostró que los valores de insulinemia (OR=1,21; IC 95 por ciento 1,09-1,34, p<0,001) y ferritina (OR=1,21; IC 95 por ciento 1,02-2,69, p<0,04) fueron variables independientes asociadas a la infección por VHC.Conclusiones: Los pacientes cirróticos no diabéticos debido al VHC tienen unos valores de insulinemia basal más elevados, así como una mayor prevalencia de hiperinsulinemia que la cirrosis debida a otras causas. Esta característica podría explicarse por un aumento de resistencia periférico a la insulina, mediado por el incremento de los depósitos de hierro que igualmente presentan estos pacientes, y puede ser el factor responsable del riesgo aumentado de desarrollar diabetes mellitus (AU)

Pancreatitis aguda inducida por eritromicina / Acute pancreatitis caused by erythromycin

No disponible

[Hyperinsulinemia in cirrhotic patients infected with hepatitis C virus]. / Hiperinsulinemia en pacientes cirróticos infectados por el virus de la hepatitis C.

AIMS: a) To prospectively study the frequency of diabetes mellitus in cirrhotic patients with hepatitis C virus (HCV) infection, comparing it with that in cirrhotic patients without HCV infection and b) to investigate basal insulinemia values in both groups, as well as the possible factors causing insulinemia. MATERIAL AND METHODS: Fifty patients with cirrhosis due to HCV infection (group I) and 50 patients with cirrhosis due to other etiologic agents (group II) were studied. In both groups the percentage of diabetic patients, basal insulinemia values and the factors associated with insulin resistance were compared: age, anthropometric indexes, stage of cirrhosis according to Child-Pugh score, plasmatic ferritin concentrations and treatment with drugs inducing insulin resistance. RESULTS: The percentage of diabetics in group I was 36% (18/50) compared with 18% (9/50) in group II (p < 0.05) and basal insulinemia values were 23.5 +/- 9.7 microU/ml compared with 15.7 +/- 9.9 microU/ml respectively (p < 0.05). No differences between the groups were found in the following variables: age (58.7 +/- 16.2 vs. 60.6 +/- 10.0 years), weight (73.2 +/- 10.7 vs 73.9 +/- 11.2 Kg), height (161.9 +/- 8.8 vs. 161.1 +/- 6.8 cm), body mass index (28.2 +/- 3.1 vs. 28.5 +/- 5.2 Kg/height m2) or Child-Pugh stage (A: 40 vs 34, B: 7 vs. 10, C: 3 vs. 6, NS). In contrast, serum ferritin concentrations were much higher in patients in group I than in those in group II [137.7 (12.4-410.2) vs. 87.6 (2.4-420.0) ng/ml p < 0.05]. At the time of inclusion in this study 10 patients in group I were receiving diuretics or non-selective beta adrenergic blockers compared with 24 patients in group II (p < 0.05). CONCLUSIONS: Diabetes mellitus is more prevalent in patients with cirrhosis due to HVC than in those with cirrhosis due to other etiologic agents. Moreover, basal insulinemia values are higher in these patients, which could be explained by an increase in half insulin resistance associated with an increase in iron deposits.

Hepatitis C virus infection, increased serum ferritin and hyperinsulinemia.

OBJECTIVES: Recent studies have reported a high prevalence of diabetes mellitus in populations infected with Virus C (HCV). The aim of this study is two-fold: a) to support the hypothesis of hyperinsulinemia as a risk factor for developing diabetes in these patients, with a prospective determination of baseline insulinemia in non-diabetic cirrhotic patients infected with HCV, comparing their values with those of a group of non-HCV non-diabetic cirrhotic patients; b) to investigate in both groups the factors associated to increased peripheral resistance to insulin. MATERIAL AND METHODS: Thirty two HCV cirrhotic diabetic patients (group I) and 41 non-diabetic cirrhotic patients of other etiologies (group II) participated in the study. Baseline insulinemia, as well as factors related to insulin resistance such as age, anthropometric indexes, stage of cirrhosis development using the Child-Pugh index, serum ferritin and treatment with insulin resistance inducing drugs were compared in both groups. RESULTS: Average baseline insulinemia in group I was 21.5 mU/ml (18.6-24.4), vs 14 mU/ml (10-18) in group II (p < 0.001), and the percentage of hyperinsulinemia was 87.5% (72.5-95.9) vs 56.1% (40.8-70.6), respectively (p < 0.01). No differences were observed between the two groups when comparing the following variables: age [54.4 (48.3-60.6) vs 59.9 (56.3-62.7) years of age, NS], weight [72.9 (69.5-76.3) vs 74.2 (70.8-77.7) kg, NS], height [163.6 (160.5-166.7) vs 161.3 (159.4-163.2)] cm, NS], body mass index [27.6 (26.1-29.1) vs 28.4 (27.3-29.5) kg/m2 of height, NS]; and Child-Pugh staging score (A: 31 vs 27; B: 0 vs 7; C: 1 vs 7, NS). However, serum ferritin levels in group I patients were higher than those in Group II [123.3 (12.4-289.3) vs 65.5 (2.4-306) ng/ml, p < 0.05]. It must be considered that at the recruitment 3 patients in Group I were taking either diuretics or non-selective beta-adrenergic blockers, compared to 14 patients in Group II, p < 0.01. Finally, the multivariate logistic regression analysis showed that insulinemia values (OR = 1.21; CI 95% 1.09-1.34, p < 0.001) and ferritin levels (OR = 1.21; CI 95% 1.02-2.69, p < 0.04) were independent variables associated to HCV infection. CONCLUSIONS: HCV-positive non-diabetic cirrhotic patients have higher baseline insulinemia levels and increased prevalence of hyperinsulinemia than cirrhosis due to other etiologies. This could be explained by an increase of peripheral insulin resistance, mediated by the increase of iron deposits in these patients, and could be responsible for the increased risk of developing diabetes mellitus.

[Factors associated with an atherogenic lipid profile in premenopausal women without clinical cardiovascular disease]. / Factores asociados a un perfil lipídico aterógeno en mujeres premenopáusicas sin enfermedad cardiovascular clínica.

BACKGROUND: To investigate different factors associated to a non desirable lipid profile in premenopausal women without cardiovascular disease. To determine the independent factors of lipid profile as a whole of the sample, for planning preventive studies. PATIENTS AND METHODS: We study (March 1994 to June 1996) premenopausal women with alcohol consumption less than 14 g/day and normal serum level of glucose. Group I: women with a non desirable lipid profile (total cholesterol [TCH, mg/dl]/high density lipoprotein cholesterol [HDL-C, mg/dl] > or = 5). Group II: with a desirable lipid profile (TCH/HDL-C < 5). The following factors were analyzed: age, body mass index (BMI), waist/hip ratio (W/H), systolic blood pressure (SBP, mmHg), fasting plasma insulin (fpI, microU/ml), cigarette smoke (CS) and presence of parents with history of non insulin dependent diabetes mellitus (NIDDM) or hypertension. STATISTICAL METHODS: Mann-Whitney and Student statistics. Contingency-table analysis (chi 2 statistic). Pearson correlation and multiple linear regression. RESULTS: We analyzed 126 women (age = 30 +/- 8.2; 95% CI, 29-32; TCH = 197 +/- 36; 95% CI, 190-203 mg/dl), with 20 women (group I) and 106 (group II). Women from group I had higher values of W/H (0.83 +/- 0.04 vs 0.78 +/- 0.06; p < 0.001), BMI (29.9 +/- 9 vs 24.6 +/- 4.9; p < 0.03), fpI (12.9 +/- 10.4 vs 7.8 +/- 3.5; p < 0.05), SBP (125.9 vs 117; p < 0.02), as well as higher percentage of smokers (75 vs 40%; p < 0.01) and parents with NIDDM (60 vs 26%; p < 0.01) or hypertension (60 vs 49%; NS). No differences of age were detected (32 +/- 7.3 vs 30 +/- 8.3; NS). BMI (0.32; p < 0.01), W/H (0.50; p < 0.01), SBP (0.27; p < 0.01) and fpI (0.33; p < 0.01) were positively correlated with TCH/HDL-C ratio (n = 126). In multiple regression analysis (n = 126), W/H (regression coefficient = 6.1; 95% CI, 3.1-9.1), fpI (regression coefficient = 0.045; 95% CI, 0.018-0.072) and CS (regression coefficient = 0.5; 95% CI, 0.336-0.667) were the only independent predictors (p < 0.01) of the TCH/HDL-C ratio, controlling a 46% of the variance (R2 = 0.46). CONCLUSIONS: Our data indicates that central obesity, hyperinsulinemia and cigarette smoke are independently associated to a high risk cardiovascular lipid profile in premenopausal women without cardiovascular disease. This study suggests the importance of these factors in the management of early lipid control in these women.