Child non-ischemic priapism, a conservative approach: case report and updated review.

Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.

Aspirin therapy is still underutilized among patients with type 2 diabetes / A terapia com aspirina ainda é subutilizada em pacientes com diabetes tipo 2

The daily use of aspirin in patients with type 2 diabetes mellitus (DM2) reduces significantly cardiovascular events (CVE). In the absence of contraindications, American Diabetes Association (ADA) recommends the use of aspirin to all DM2 patients older than 40 years of age. To evaluate aspirin use among 636 out patients with DM2 who participate in a regional multicenter study in Southern Brazil, a standard questionnaire was used. Patients also underwent a physical examination and laboratorial tests. All patients were older than 40 years (mean 58 ± 11 years old; 42 percent male) and by ADA guidelines most of them should be using aspirin. However, only 177 (27.5 percent) were on this medication. The use of aspirin was higher when any CVE were present. However, the percentage of users was still below the expected, not even reaching 50 percent. In conclusion, even though the use of aspirin is greater in patients with CVE, and its benefits are well documented, it is still underutilized. Strategies to enhance the use of aspirin should be developed to reduce the morbidity and mortality from cardiovascular diseases in patients with DM2.

O uso diário de aspirina em pacientes com diabetes mellitus do tipo 2 (DM2) reduz significantemente os eventos cardiovasculares (ECV). Na ausência de contraindicações, a ADA (American Diabetes Association) recomenda o uso de aspirina para todos os pacientes com DM2 maiores de 40 anos de idade. Para avaliar o uso de aspirina em 636 pacientes ambulatoriais com DM2 que participaram de um estudo multicêntrico na região Sul do Brasil, utilizamos um questionário padrão. Os pacientes foram também examinados e submetidos a testes laboratoriais. Todos eram maiores de 40 anos (média 58 ± 11 anos; 42 por cento homens) e a maioria deles deveria estar usando aspirina, de acordo com as orientações da ADA. Entretanto, somente 177 (27,5 por cento) estavam com esta medicação. O uso de aspirina era maior em presença de qualquer ECV. Contudo, a porcentagem dos que a usavam estava ainda abaixo do esperado, não atingindo 50 por cento. Em conclusão, mesmo sendo o uso da aspirina maior em pacientes com ECV, e seus benefícios bem documentados, ela ainda é subutilizada. Assim, estratégias para aumentar o uso de aspirina devem ser desenvolvidas para reduzir a morbi-mortalidade decorrente da doença cardiovascular em pacientes com DM2.

Aspirin therapy is still underutilized among patients with type 2 diabetes.

The daily use of aspirin in patients with type 2 diabetes mellitus (DM2) reduces significantly cardiovascular events (CVE). In the absence of contraindications, American Diabetes Association (ADA) recommends the use of aspirin to all DM2 patients older than 40 years of age. To evaluate aspirin use among 636 out patients with DM2 who participate in a regional multicenter study in Southern Brazil, a standard questionnaire was used. Patients also underwent a physical examination and laboratorial tests. All patients were older than 40 years (mean 58 +/- 11 years old; 42% male) and by ADA guidelines most of them should be using aspirin. However, only 177 (27.5%) were on this medication. The use of aspirin was higher when any CVE were present. However, the percentage of users was still below the expected, not even reaching 50%. In conclusion, even though the use of aspirin is greater in patients with CVE, and its benefits are well documented, it is still underutilized. Strategies to enhance the use of aspirin should be developed to reduce the morbidity and mortality from cardiovascular diseases in patients with DM2.

The fatty acid-binding protein-2 A54T polymorphism is associated with renal disease in patients with type 2 diabetes.

The intestinal fatty-acid binding protein-2 (FABP2) gene codes a protein responsible for the absorption of long-chain fatty acids. To test whether FABP2 is a candidate gene for renal disease in patients with type 2 diabetes, a functional A54T polymorphism was genotyped in 1,042 Brazilians with type 2 diabetes. Patients were classified as having normoalbuminuria (urinary albumin excretion [UAE] <20 microg/min; n = 529), microalbuminuria (UAE 20-199 microg/min; n = 217), or proteinuria (UAE >199 microg/min; n = 160). Patients with end-stage renal disease (ESRD) (n = 136) were also included. The prevalence of the TT genotype was higher in patients with renal involvement compared with those with normoalbuminuria (odds ratio [95% CI] 2.4 [1.1-5.4]) following adjustment for type 2 diabetes duration, BMI, hypertension, A1C, and cholesterol levels. The risk was similar considering different stages of renal involvement. In a second independent patient sample (483 type 2 diabetic Caucasians residing in Massachusetts), a significant association was also observed between the TT genotype and proteinuria or ESRD (2.7 [1.0-7.3]; P = 0.048). This study thus provides evidence that FABP2 confers susceptibility to renal disease in type 2 diabetic patients.