Endocrinologia Y Nutricion最新文献

Aims

To assess the prevalence of non-Caucasian patients in hospital admissions for onset of symptomatic diabetes mellitus during the 2003–2010 period, and to analyze the characteristics differentiating them from the Caucasian population at diagnosis and 2 years later.

Material and methods

A retrospective, observational study. Inclusion criteria: patients aged 18–40 years admitted for de novo symptomatic diabetes from January 2003 to October 2010. Prevalence of patients of non-Caucasian origin was analyzed, and clinical, biochemical, immunological, and beta-cell function of both populations were compared at diagnosis and 2 years later.

Results

Nineteen percent of patients admitted to hospital for de novo symptomatic diabetes were non-Caucasian, with a progressive increase in recent years. Non-Caucasian patients had milder decompensation (3.0% had ketoacidosis, as compared to 15.2% in the Caucasian group, p < 0.05), lower presence of autoimmunity (27.2 vs. 73.1%, p < 0.01) and higher stimulated C-peptide levels (0.70 ± 0.56 vs. 0.42 ± 0.39 nmol/L, p < 0.05), mainly because of the subgroup with negative autoimmunity (0.82 vs. 0.25). Two years after diagnosis, less non-Caucasian patients were on intensified treatment (39.1 vs. 93.8%).

Conclusions

Non-Caucasian patients had a lower prevalence of autoimmunity, better beta-cell function at diagnosis, particularly due to the subgroup with negative autoimmunity, and less need for intensive treatment 2 years after diagnosis, features which are more characteristic of type 2 diabetes mellitus.

Objective

This study was intended to establish the percentile distribution of waist circumference in schoolchildren from Bogota, Colombia, participating in the FUPRECOL Study.

Methods

A cross-sectional study conducted in 3,005 children and 2,916 adolescents aged 9–17.9 years. Height, weight, waist circumference, hip circumference, and self-assessed sexual maturity status were recorded. Percentiles (3rd, 10th, 25th, 50th, 75th, 90th, and 97th) and smoothed sex- and age-specific curves were calculated, and the waist circumference values found were compared to international references from other ethnic populations.

Results

Fifty-seven percent of the overall population (n = 5,921) were females (mean age, 12.7 ± 2.3 years). In most age groups, waist circumference was greater in boys as compared to girls. The increase between the 50th and 97th percentiles by age was 15.7 cm in boys aged 9–9.9 years and 16.0 cm in girls aged 11–11.9 years. Comparison of our study results, by age group and sex, to international references showed that our 50th percentile was lower than reported in Peru and the UK except for studies in India, Venezuela (Merida), US, and Spain was higher.

Conclusions

Age- and sex-specific percentiles of waist circumference obtained from children and adolescents from Bogota, Colombia, are reported. They may be used as a reference both for nutritional assessment and for predicting cardiovascular risks at early ages.

Aims

To ascertain the prevalence of metabolic syndrome (MS) in patients with peripheral artery disease (PAD) at the Martorell primary care (PC) center. To analyze the differences in comorbidities and cardiovascular risk factors between patients with PAD with and without MS.

Methods

A cross-sectional, descriptive study on patients diagnosed with PAD according to computerized clinical records of the Martorell PC center. Variables collected included age, sex, high blood pressure (HBP), dyslipidemia (DLP), diabetes (DM), smoking, obesity, cardiovascular disease (CVD), erectile dysfunction (ED), renal failure (RF), and oligoalbuminuria. An analysis comparing patients with and without MS was performed.

Results

There were 131 patients diagnosed with PAD, 104 (79%) of whom were male. Sixty-three (48.1%) also had MS. Patients with both PAD and MS had, as compared to those with PAD only, a higher prevalence of HBP (87.3 vs. 60.3%, p: 0.001), DLP (77.8 vs. 60.3%, p: 0.03), DM (69.8 vs. 30.9%, p: <0.001), obesity (25.4 vs. 10.3%, p: 0.03), CVD (42.9 vs. 19.1%, p: 0.004), ED (81.3 vs. 54.3%, p: 0.02), and RF (40.3 vs. 17.9%, p: 0.006).

Conclusion

Patients with both PAD and MS had a higher prevalence of HBP, DLP, DM, and obesity. They also had more cardiovascular events and were significantly associated with pathological conditions highly relevant for cardiovascular prognosis such as erectile dysfunction and chronic kidney disease.

Diabetes and frailty are two conditions that frequently occur concurrently and are increasingly prevalent in the older patient. We review the concept, epidemiology and consequences of frailty, and the implications of the presence of frailty in the management of diabetes. Frailty is associated with decreased quality of life, a risk of falls, new or increased disability, hospitalization, and increased mortality. All of these factors affect the management of diabetes in older patients. It is important to rule out frailty in all diabetic patients aged >70 years; if frailty is suspected, a comprehensive and multidisciplinary medical and functional assessment of the patient should be conducted to develop an individualized treatment plan. This plan should include nutritional measures, physical activity, and education on self-care and diabetes; drugs should not be used without a clear indication. Antihyperglycemic drugs that may cause excessive weight loss and/or are associated with a high risk of hypoglycemia should be avoided.

Hyponatraemia is the most common electrolyte imbalance in neurosurgical patients. Acute hyponatraemia is particularly common in neurosurgical patients after any type of brain insult, including brain tumours and their treatment, pituitary surgery, subarachnoid haemorrhage or traumatic brain injury. Acute hyponatraemia is an emergency condition, as it leads to cerebral oedema due to passive osmotic movement of water from the hypotonic plasma to the relatively hypertonic brain which ultimately is the cause of the symptoms associated with hyponatraemia. These include decreased level of consciousness, seizures, non-cardiogenic pulmonary oedema or transtentorial brain herniation. Prompt treatment is mandatory to prevent such complications, minimize permanent brain damage and therefore permit rapid recovery after brain insult. The infusion of 3% hypertonic saline is the treatment of choice with different rates of administration based on the severity of symptoms and the rate of drop in plasma sodium concentration.

The pathophysiology of hyponatraemia in neurotrauma is multifactorial; although the syndrome of inappropriate antidiuresis (SIADH) and central adrenal insufficiency are the commonest causes encountered. Fluid restriction has historically been the classical treatment for SIADH, although it is relatively contraindicated in some neurosurgical patients such as those with subarachnoid haemorrhage. Furthermore, many cases admitted have acute onset hyponatraemia, who require hypertonic saline infusion. The recently developed vasopressin receptor 2 antagonist class of drug is a promising and effective tool but more evidence is needed in neurosurgical patients. Central adrenal insufficiency may also cause acute hyponatraemia in neurosurgical patients; this responds clinically and biochemically to hydrocortisone. The rare cerebral salt wasting syndrome is treated with large volume normal saline infusion. In this review, we summarize the current evidence based on the clinical presentation, causes and treatment of different types of hyponatraemia in neurosurgical patients.