Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 27)

PurposeThe aims of this study were to report the prevalence of various microvascular complications and to identify the various clinical and biochemical characteristics related to these complications in subjects with newly diagnosed type II diabetes.MethodsOf the 5999 subjects enumerated, 1414 subjects with diabetes (both known and newly diagnosed) were analyzed for the study. Among the diabetic subjects, 248 (17.5%) were newly diagnosed with diabetes and the remaining had history of diabetes. All subjects underwent a detailed standard evaluation to detect diabetic retinopathy (fundus photography), neuropathy (vibration pressure threshold), and nephropathy (microalbuminuria).ResultsThe prevalence of any form of microvascular complication was 30.2% (95% confidence interval [CI] = 24.5–35.9). The prevalence of diabetic retinopathy was 4.8%, and that of diabetic nephropathy and neuropathy was 10.5%. The risk factors for developing any form of microvascular complication were increasing age (odds ratio [OR] = 1.07, 95% CI = 1.04–1.11, P < .0001), increasing systolic blood pressure (OR = 1.03, 95% CI = 1.01–1.06, P = .001), and increasing hemoglobin (OR = 1.39, 95% CI = 1.09–1.79, P = .011). The risk factors for diabetic retinopathy and diabetic nephropathy were increasing systolic blood pressure (OR = 1.06 [P = .001] for retinopathy and OR = 1.04 [P = .012] for nephropathy) and increasing hemoglobin (OR = 2.20 [P = .007] for retinopathy and OR = 1.57 [P = .023] for nephropathy). The risk factor for diabetic neuropathy was increasing age (OR = 1.12, P < .0001).ConclusionsNearly one third of the newly diagnosed type II diabetes subjects had some form of microvascular complication; nephropathy, and neuropathy being commoner than retinopathy.     

Influencia del tratamiento biológico en los factores de riesgo cardiovascular de los pacientes con enfermedad inflamatoria intestinal

IntroductionChronic immune-mediated diseases, including inflammatory bowel disease (IBD), present an increased risk of developing early atherosclerosis and cardiovascular events (CVE) at early age.ObjectiveTo describe the baseline and 1-year cardiovascular profile of patients with IBD according to the biologic treatment received, taking into account the inflammatory activity.Patients and methodsIt is a retrospective, observational study that included 374 patients. Cardiovascular risk factors (CVRF) and CVE were collected at the baseline visit and at one-year follow-up to describe the cardiovascular risk according to the biological treatment received, also assessing clinical and biological remission.ResultsA total of 374 patients were included: 146 (38.73%) were treated with Infliximab, 128 (33.95%) with adalimumab, 61 (16.18%) with ustekinumab and 42 (11.14%) with vedolizumab.The changes in blood glucose levels are [86.31 mg/dL (84.57–88.06) vs. 89.25 mg/dL (87.54–90.96), P=.001] for those treated with antiTNFα and [86.52 mg/dL (83.48–89.55) vs. 89.44 mg/dL (85.77–93.11), P=.11] in the other group.In the group treated with antiTNFα total cholesterol values at baseline visit are [169.40 mg/dL (164.97–173.83) vs. 177.40 mg/dL (172.75–182.05) at one year of treatment, P=<.001], those of HDL [50.22 mg/dL (48.39–52.04) vs. 54.26 mg/dL (52.46–56.07), P=<.001] and those of triglycerides [114.77 mg/dL (106.36–123.18) vs. 121.83 mg/dL (112.11–131.54), P=.054].Regarding weight, an increase was observed, both in those patients treated with antiTNFα [71.39 kg (69.53–73.25) vs. 72.87 kg (71.05–74.70), P<.001], and in the group treated with ustekinumab and vedolizumab [67.59 kg (64.10–71.08) vs. 69.43 kg (65.65–73.04), P=.003].Concerning CVE, no significant differences were observed neither according to the drug used (p = 0.36), nor according to personal history of CVE (P=.23) nor according to inflammatory activity (P=.46).ConclusionsOur results on a real cohort of patients with IBD treated with biologic drugs show a better control of certain cardiovascular parameters such as CRP or HDL, but a worsening of others such as total cholesterol or triglycerides, regardless of the treatment. Therefore, it is possibly the disease control and not the therapeutic target used, the one that affect the cardiovascular risk of these patients.     

Anemia in diabetic patients at an internal medicine ward: Clinical correlates and prognostic significance

BackgroundCharacteristics and prognostic significance of anemia in hospitalized diabetic patients are unknown.MethodsWe studied 3145 unselected patients admitted to two Internal Medicine Departments, 872 (27.7%) of whom were diabetic. Forty diabetic patients died during the first hospitalization period. Out of the remaining 832 patients, 334 (40.2%) were anemic and evaluated for survival. In 87 diabetic patients, the cause of anemia was evident on admission, whereas the other 247 had to be further investigated for etiology of anemia.ResultsCompared to non-anemic diabetic patients, the diabetic anemic patients were older (mean age 71.4 vs. 64.4 years, P < .001) and predominantly females (52.4% vs. 44.4%, P < .02). Of the 247 evaluated patients, 38% were deficient in iron, 12% in vitamin B₁₂ and/or folate, 54% had anemia of chronic disease, 47% suffered from heart failure, 39% had renal dysfunction and 22% were complex nursing care patients and/or had diabetic foot. On median follow-up of 19.2 months, mortality rate was higher in anemic compared to non-anemic diabetic patients (17.3% vs. 4%, P < .001), the main cause of death being infection. Male sex (P = .03), albuminuria (P = .01) and heart failure (P = .06) were associated with shorter survival, male sex being the most significant (OR 2.02, 95% CI 1.04 ? 4.00).ConclusionFrequency of anemia was increased in diabetic patients admitted to the Internal Medicine Departments, compared to the studies performed on ambulatory patient populations. Anemia was multifactorial and associated with higher mortality, predominantly from infections. Males with albuminuria and heart failure were at higher risk of death.     

Evaluation of metabolite changes in visual cortex in diabetic retinopathy by MR-spectroscopy

PurposeTo evaluate metabolite changes in the visual cortex of diabetic patients with nonproliferative or proliferative diabetic retinopathy by Magnetic Resonance Spectroscopy (MRS).Materials and Methods15 normal subjects (group 1), 15 patients with diabetes who did not have diabetic retinopathy (group 2), 15 patients with nonproliferative diabetic retinopathy (NPDR) (group 3), and 15 patients with proliferative diabetic retinopathy (PDR) (group 4) were included in the study. Furthermore, diabetic patients were divided into two groups according to HbA1c levels (Group A: 20 patients, HbA1c < 8%; Group B: 20 patients, HbA1c > 8%). In all cases' left visual cortex, amounts of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were measured by MRS. NAA/Cr, Cho/Cr, and NAA/Cho ratios were calculated. Furthermore, all cases' complete blood count (CBC) and biochemical parameters were evaluated.ResultsThere was no statistically significant difference for NAA/Cr, Cho/Cr, and NAA/Cho ratios between groups 1, 2, 3, and 4 (P > 0.05). However there was a statistically significant difference for NAA/Cr and NAA/Cho ratios between groups A and B (P < 0.05). There was no statistically significant difference for Cho/Cr ratio between groups A and B (P > 0.05).ConclusionAlthough NAA/Cr and NAA/Cho ratios decrease in the visual cortex while diabetic retinopathy progresses, these decreases are not statistically significant. While HbA1c levels increase, the NAA concentration decreases in the visual cortex which indicates neuronal loss. The metabolite changes in the visual cortex are associated with acute events rather than chronic.     

Associations of plasma von Willebrand factor ristocetin cofactor activity and 5-hydroxyindole acetic acid concentrations with blood flow in lower-leg arteries in Japanese type 2 diabetic patients with normal ankle-brachial index

AimsTo evaluate the associations of circulating levels of proinflammatory molecules and endothelial factors with blood flow in lower-leg arteries in diabetic patients with normal ankle-brachial index (ABI > 0.9).MethodsWe enrolled 123 type 2 diabetic patients with normal ABI and 30 age-matched nondiabetic subjects consecutively admitted to our hospital. Flow volume and resistive index, an index of peripheral vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. An automatic device was used to measure ABI and brachial-ankle pulse-wave velocity (baPWV) for evaluation of arterial stiffness. Plasma soluble intercellular adhesion molecule-1 (sICAM-1) and monocyte chemoattractant protein-1 (MCP-1) concentrations, serum high-sensitivity C-reactive protein (hsCRP) levels, plasma von Willebrand factor ristocetin cofactor activity (VWF), and plasma vasoconstrictor serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) concentrations were measured.ResultsDiabetic patients had higher baPWV (P < .0001), resistive index (P < .0001), sICAM-1 (P < .0001), MCP-1 (P = .0224), log hsCRP (P < .0001), VWF (P < .0001), 5-HIAA (P = .0015), and lower blood flow (P < .0001) than nondiabetic subjects. VWF (P = .0019) or 5-HIAA (P = .0011), but not sICAM-1, MCP-1, and log hsCRP, was negatively correlated with blood flow in diabetic patients. A multivariate analysis revealed that the significant independent determinants of blood flow were hypertension, use of renin–angiotensin system inhibitors, VWF and 5-HIAA (r² = 0.198, P < .0001) in diabetic patients.ConclusionsPlasma VWF and 5-HIAA concentrations are associated with blood flow and are involved in the pathogenesis of impaired peripheral circulation due to higher arterial stiffness and greater vascular resistance in lower-leg arteries in diabetic patients with normal ABI.     

Red blood cell distribution width and diabetes-associated complications

AimRed blood cell distribution width (RDW) is a marker of cardiovascular morbidity and mortality. However, there is little data on the relationship between RDW and diabetes-associated complications. The aim was to investigate whether there is any association between RDW, nephropathy, neuropathy and peripheral arterial disease (PAD) in a type 2 diabetic population.MethodsThis study included 196 diabetic patients with proliferative diabetic retinopathy. All subjects were investigated for diabetic nephropathy, diabetic neuropathy and PAD. Participants underwent 24-h blood pressure monitoring and were analysed for markers of the metabolic syndrome, inflammation, and insulin resistance.Results57% of the participants had diabetic nephropathy, 46% had diabetic neuropathy while 26% had PAD. No significant association was found between RDW, diabetic neuropathy and PAD (p = NS). However, RDW was strongly associated with diabetic nephropathy (p = 0.006), even following adjustment for potential confounding variables. Multivariate logistic regression analysis showed RDW (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.15–2.35, p = 0.006), estimated glomerular filtration rate (OR 0.98, 95% CI 0.96–0.99, p < 0.001), night-time diastolic blood pressure (OR 1.07, 95% CI 1.03–1.11, p = 0.001) and erythrocyte sedimentation rate (OR 1.03, 95% CI 1.004–1.05, p = 0.019) to be independently associated with diabetic nephropathy.ConclusionsThis is the first study to report lack of association between RDW, neuropathy and PAD in subjects with type 2 diabetes mellitus. More importantly, RDW was shown to be significantly associated with diabetic nephropathy in a type 2 diabetic population with advanced proliferative retinopathy independent of traditional risk factors, including diabetes duration and glycaemic control.     

Desarrollo de un modelo murino de inflamación y remodelación de vías respiratorias en asma experimental

Background and ObjectiveExperimental animal models are necessary for studying asthma disease mechanisms and for identifying new therapeutic targets. We present a murine model of experimental asthma that allows integrated, quantitative assessment of airway inflammation and remodeling.Material and MethodsBALB/c mice were sensitized to ovalbumin (OVA) and challenged with OVA or vehicle 3 times per week for 12 weeks.ResultsOn bronchoalveolar lavage, the OVA-sensitized mice had significantly higher total leukocyte counts, with a median (Q25–Q75) of 670.0 cells/mL×10³ (376.2, 952.5) in comparison with 40.0 cells/mL×10³ (60.0–85.0) in controls (P=.001), and higher eosinophil and differential lymphocyte counts. In sagittal sections of lungs inflated to a standard pressure, the OVA-sensitized animals showed goblet cell hyperplasia in the respiratory epithelium (periodic acid-Schiff staining, 53.89 [36.26–62.84] cells/mm² vs 0.66 [0.00–1.06] cells/mm², P<.001), dense mononuclear and eosinophilic inflammatory infiltrates (hematoxylin-eosin, 32.87 [27.34–37.13] eosinophils/mm² vs 0.06 [0.00–0.20] eosinophils/mm², P=.002), subepithelial infiltration by mast cells (toluidine blue, 2.88 [2.00–3.28] mast cells/mm² vs 0.28 [0.15–0.35] mast cells/mm², P<.001), increased contractile tissue mass (immunofluorescence analysis for α-smooth-muscle actin, 2.60 [2.28–2.98] vs 1.08 [0.93–1.16], dimensionless, P<.001) and enhanced extracellular matrix deposition (Masson's trichrome, 2.18 [1.85–2.80] vs 0.50 [0.37–0.65], dimensionless, P<.001).ConclusionsOur dataset describes an experimental model of asthma which is driven by prolonged allergen exposure and in which airway inflammation and remodeling develop and are assessed together.     

The relationships between type 2 diabetic retinopathy and VEGF-634G/C and VEGF-460C/T polymorphisms in Han Chinese subjects

ObjectiveTo investigate how VEGF-634G/C and VEGF-460C/T SNPs are related to diabetic retinopathy (DR) in Han Chinese subjects from the Shijiazhuang region of China.MethodsTotally 376 DM cases were divided into non-proliferative diabetic retinopathy (NPDR) group (n = 124), proliferative diabetic retinopathy (PDR) group (n = 108), and diabetes without retinopathy (DWR) group (n = 144). PCR/LDRwas utilised to detect and assess the genotypes and allele distribution frequencies at the VEGF-634G/C and VEGF-460C/T loci in each group.ResultsThe differences between NPDR, PDR and DWR groups were not significant in genotypes and allele distribution frequencies at VEGF-634G/C locus (P > 0.05). But there were significant differences between NPDR and DWR groups in genotypes (P = 0.013) and allele distribution frequencies (P = 0.002) at VEGF-460C/T locus, at which CT + CC genotypes were associated with a reduced risk of developing NPDR. There were no significant differences in genotypes (P = 0.759) or allele distribution frequencies (P = 0.433) at VEGF-460C/T locus between PDR and DWR groups.ConclusionsAmong Chinese Han individuals with type-2 DM, polymorphism − 634G/C of the VEGF gene was not correlated with NPDR or PDR; however, polymorphism-460C/T of the VEGF gene was correlated with NPDR, and C allele was associated with lower NPDR risk than T allele.     

Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations

AimsThe purpose of this study was to identify the presence or absence of geographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers (DFU) and lower extremity amputations (LEA).MethodsDiabetic beneficiaries with foot ulcers (n=682,887) and lower extremity amputations (n=151,752) were enrolled in Medicare Parts A and B during the calendar year 2007. We used ordinary least squares (OLS) regression to explain geographic variation in per capita Medicare spending and one-year mortality rates.ResultsHealth care spending and mortality rates varied considerably across the nation for our two patient cohorts. However, higher spending was not associated with a statistically significant reduction in one-year patient mortality (P= .12 for DFU, P= .20 for LEA). Macrovascular complications for amputees were more common in parts of the country with higher mortality rates (P< .001), but this association was not observed for our foot ulcer cohort (P= .12). In contrast, macrovascular complications were associated with increased per capita spending for beneficiaries with foot ulcers (P= .01). Rates of hospital admission were also associated with higher per capita spending and increased mortality rates for individuals with foot ulcers (P< .001 for health spending and mortality) and lower extremity amputations (P< .001 for health spending, P= .01 for mortality).ConclusionsGeographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers and amputations is associated with regional differences in the utilization of inpatient services and the prevalence of macrovascular complications.     

Serum fibroblast growth factor 21 concentrations in type 2 diabetic retinopathy patients

Aims/purposeFibroblast growth factor 21 (FGF21) is a major metabolic regulator in the body that has been shown to be elevated in a number of metabolic disturbances including type 2 diabetes mellitus (T2DM) and the metabolic syndrome. However, little is known regarding the circulating levels of FGF21 in type 2 diabetic retinopathy (T2DR) and its association with the severity of the condition.MethodsIn a cross-sectional setting, 142 individuals, consisting of (1) T2DM patients without T2DR, (2) T2DM patients with T2DR, and (3) healthy control subjects were recruited for this study. Various clinical and biochemical parameters were assessed and entered for analysis.ResultsSerum FGF21 levels were significantly elevated in T2DM subjects without retinopathy (103.50 [75.75] pg/mL) compared with healthy controls (99.00 [126.75] pg/mL). Circulating FGF21 levels were comparable across different stages of T2DR (233.00 [109.00] for nonproliferative type 2 diabetic retinopathy [NPT2DR] vs. 215.00 [122.00] for proliferative type 2 diabetic retinopathy [PT2DR] groups, P = 361). FGF21, triglycerides, and duration of diabetes mellitus were significantly associated with T2DM in baseline models. However, after adjustment for potential confounders, in the final multivariate model, FGF21 emerged as the only significant factor associated with T2DM (OR = 13.772, 95% CI = 3.062–61.948, P = 001).ConclusionsSerum FGF21 concentrations are markedly elevated in patients with T2RN. The association between FGF21 and T2DR appears to be independent of the effects of potential confounding variables. These findings may suggest FGF21 as a novel surrogate diagnostic biomarker in initial stages of T2DR (particularly with FGF21 values above 135.5 pg/mL).     

Progresión de la enfermedad renal crónica en pacientes con hipertensión resistente sometidos a 2 estrategias terapéuticas: intensificación con diuréticos de asa vs. antagonistas de la aldosterona

IntroductionActualy, there are few data about glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how diferent therapies can modify chronic kidney disease progression (CKD).ObjectiveTo evaluate CKD progression in patients with resistant hypertension undergoing 2 diferent therapies: treatment with spironolactone or furosemide.MethodsWe included 30 patients (21 M, 9 W) with a mean age of 66.3 ± 9.1 years, eGFR 55.8 ± 16.5 ml/min/1.73 m², SBP 162.8 ± 8.2 and DBP 90.2 ± 6.2 mmHg: 15 patients received spironolactone and 15 furosemide and we followed up them a median of 32 months (28-41).ResultsThe mean annual eGFR decrease was -2.8 ± 5.4 ml/min/1.73 m². In spironolactone group was –2.1 ± 4.8 ml/min/1.73 m² and in furosemide group was -3.2 ± 5.6 ml/min/1.73 m², P<0.01. In patients received spironolactone, SBP decreased 23 ± 9 mmHg and in furosemide group decreased 16 ± 3 mmHg, P<.01. DBP decreased 10 ± 8 mmHg and 6 ± 2 mmHg, respectively (P<.01). Treatment with spironolactone reduced albuminuria from a serum albumin/creatine ratio of 210 (121-385) mg/g to 65 (45-120) mg/g at the end of follow-up, P<.01. There were no significant changes in the albumin/creatinine ratio in the furosemide group. The slower drop in kidney function was associated with lower SBP (P=.04), higher GFR (P=.01), lower albuminuria (P=.01), not diabetes mellitus (P=.01) and treatment with spironolactone (P=.02). Treatment with spironolactone (OR 2.13, IC 1.89-2.29) and lower albuminuria (OR 0.98, CI 0.97-0.99) maintain their independent predictive power in a multivariate model.ConclusionTreatment with spironolactone is more effective reducing BP and albuminuria in patients with resistant hypertension compared with furosemide and it is associated with a slower progression of CKD in the long term follow up.     

El paciente tratado de hepatitis C como fuente potencial de derivación de nuevos casos

IntroductionDirect-acting antivirals (DAAs) are an opportunity for hepatitis C virus (HCV) elimination. Strategies are needed to diagnose new patients and to attract those diagnosed without evaluation. Patients with other chronic viral diseases who receive satisfactory treatment promote referral of other patients for evaluation. Our aim was to evaluate whether patients who have been treated with DAAs would recommend follow-up and treatment to other patients as well as the characteristics that influence this decision.Patients and methodsTwo-hundred and 2 HCV-infected patients treated with DAAs were included. Patients were asked about whether they knew other infected people and their willingness to share their experience. A general satisfaction survey and a specific HCV satisfaction survey were carried out. Demographic, socioeconomic and HCV infection variables were recorded.ResultsDespite the fact that 54.4% of the patients reported knowing others infected, 34.2% would not fully agree to share their experience. The analysis of general and specific satisfaction showed that patients who shared their experience mentioned a perception of greater care from the specialist (4.7 ± 0.4 vs. 4.3 ± 0.6, P=.001) and had more information on treatment expectations (4.6 ± 0.5 vs. 4.0 ± 0.7, P=.001) and social support (4.5 ± 0.7 vs. 4.0 ± 0.8, P=.001).ConclusionsThe perception by treated patients of general satisfaction with the healthcare process and information about benefits influences the degree of recommendation to other infected people. Knowledge about treatment and perception of improvement in health of treated patients should be enhanced as it can contribute to increasing referrals to specialized consultation.     

Serum Ferritin Levels Predict All-Cause and Infection-Cause 1-Year Mortality in Diabetic Patients on Maintenance Hemodialysis

BackgroundThe aim of this study was to assess the relationship between the serum ferritin level and the 1-year outcome in diabetic maintenance hemodialysis (MHD) patients.MethodsThe prospective clinical study enrolled 187 diabetic MHD patients from a university hospital in Taiwan. All the patients were divided into 3 groups according to their serum ferritin levels: group I (<200 ng/mL; n = 71), group II (200–700 ng/mL; n = 97), and group III (>700 ng/mL; n = 19). A total of 26 demographic, clinical, and laboratory variables were analyzed as predictors of the 1-year mortality.ResultsThere were no significant differences between these 3 groups except in their erythropoietin usage, hemoglobin, transferrin saturation, and high-sensitive C-reactive protein levels. The 1-year mortality rates were 9.2%, 11.4%, and 46.2% in groups I, II, and III, respectively. Group I and group II patients had a lower 1-year mortality rate than group III patients (log-rank test; χ² = 8.807; P = 0.0112).ConclusionThe study suggested that serum ferritin levels predict both all-cause and infection-cause 1-year mortality in diabetic patients on MHD. In such patients, the serum ferritin levels are associated with both iron stores and the inflammation status.     

Determinants of previous dilated eye examination among type II diabetics in Southwestern Nigeria

PurposeTo assess the prevalence and factors influencing previous dilated eye examination in screening for retinopathy among type II diabetics.MethodologyCross-sectional study of type II diabetic patients receiving treatment at a tertiary hospital in southwestern Nigeria was conducted with information on gender, age, duration of diabetes, current medication and previous dilated eye examination recorded. Eye examination included visual acuity, pen torch examination, applanation tonometry and direct ophthalmoscopy of the dilated eye in a dark room. Visual acuity was presented as classified by WHO while data was analyzed using SPSS version 11 and statistical significance inferred at P < 0.05.ResultsEighty three type II diabetics with mean age 57.5 ± 10.8 years and mean duration of diabetes of 6.6 years were studied. Visual impairment (< 6/18 in the better eye) and blindness (< 3/60 in the better eye) were recorded in 3.6% and 12% of the patients respectively while diabetic retinopathy was present in 21.6%. Only 24 [28.9%] diabetics had previous dilated eye examination; absence of eye symptoms [50.8%] and lack of referral [45.8%] were the main barriers to having previous dilated eye examination. Previous dilated eye examination was significantly influenced by the presence of visual impairment/blindness [P = 0.002], longer duration diabetes mellitus [P = 0.006], current insulin treatment [P = 0.040] and presence of non-diabetic vision threatening eye diseases [P = 0.016].ConclusionDilated eye examination rate is low; inadequate knowledge about diabetic retinopathy as well as low referral rates is contributory. Massive health education on diabetic retinopathy as well as development of sustainable retinopathy screening protocol would be helpful.     

Factores de riesgo predictores de falla a la terapia de inducción de nefritis lúpica en una cohorte de pacientes colombianos

ObjectivesTo determine the predictors of failure to obtain remission after induction therapy for proliferative lupus nephritis in a group of northwestern Colombian patients.Material and methodsA retrospective study was conducted. We included patients with systemic lupus erythematosus according to the American College of Rheumatology criteria who had nephritis confirmed by renal biopsy.ResultsWe followed 84 patients: 88.1% female, and 11.9% male. The mean age at diagnosis of systemic lupus erythematosus was 27.5 ± 11.8 years (9-70). The average time between diagnosis of systemic lupus erythematosus and proliferative nephritis onset was 13.6 months (0-168). Histopathologic type: iv (78.57%), iii (15.47%), iii-iv/v (5.96%). Activity index: 6.7 ± 4.6. Chronicity index: 2 ± 2.7. 24-hour proteinuria (mg): 6,164 (130-18,100). Baseline creatinine: 1.14 mg/dL (0.43-7.4). Induction therapy: Steroids (100%), cyclophosphamide (76.2%) and mycophenolate mofetil (23.8%). At six months, 56% of individuals failed to achieve partial or complete remission. Predictors of failure to induction therapy were, in accordance with the bivariate analysis (OR; 95% CI): creatinine level more than 1.2 mg/dL (10.8; 3.18-36.84; P < .005), nephrotic range proteinuria (11.9; 3.09-45.8; P < .001), and an activity index above 8 (5.04; 1.7-14.3; P < .001). In the multivariate analysis, only baseline creatinine higher than 1.2 mg/dL (10.92; 2.65-45.02; P = .001), and nephrotic range proteinuria (9.81; 1.85-52.04; P = .007) were significant.ConclusionsA significant percentage of Colombian patients fail to achieve remission of proliferative lupus nephritis after six months of treatment.     

Factores predictores de esofagitis eosinofílica en impactación esofágica por bolo alimenticio

BackgroundFood bolus esophageal impaction is often the first symptom in patients diagnosed with eosinophilic esophagitis, representing a change in the epidemiology and management of this urgency.AimTo detect eosinophilic esophagitis predictive factors in patients with esophageal impaction due to food bolus.MethodsPatients seen for foreign body impaction were retrospectively analyzed. Epidemiologic characteristics, endoscopic findings, and impaction history were studied. The statistical analysis was carried out using the Student's t test and the chi square test and a logistic regression model.ResultsOf the 131 patients, 65% were men and the mean age was 56 years. The endoscopic suspicion of eosinophilic esophagitis was the most frequent finding in patients with food bolus impaction (n = 89); those patients that did not have histologic confirmation were excluded (n = 7). The remaining patients (n = 82) were divided into two groups: confirmed eosinophilic esophagitis (Group A) (n = 18) and other endoscopic findings (Group B) (n = 64). Group A presented with a lower mean age (36.47 vs. 64.45, P=.001) and a more frequent past history of impaction (38% vs. 6%, OR = 15.70, 95% CI (3.60-62.50), P=.001) than Group B. Age and impaction history acted as predictors for eosinophilic esophagitis with 82% sensitivity, 80% specificity, and 84% diagnostic accuracy (P<.001).ConclusionsAge and a history of impaction predict the presence of eosinophilic esophagitis in patients with food bolus impaction.     

Importance of glycemic control on the course of glomerular filtration rate in type 2 diabetes with hypertension and microalbuminuria under tight blood pressure control

Background and aimsTo evaluate the role of glycemic control on the evolution of glomerular filtration rate (GFR) in type 2 diabetes (T2DM) with mild-moderate hypertension under tight blood pressure control, and to address the current controversy whether diabetic nephropathy worsens, independently of blood pressure, proportionally to HbA1c at any physiological level or only when HbA1c is above a 7.5–8% threshold.Methods and resultsT2DM (N = 127) during early stage diabetic nephropathy characterized by microalbuminuria were followed during a 2 year multicenter study. Individual GFR profiles were accurately obtained by ⁵¹Cr – EDTA bolus injections and analyzed with linear statistical mixed-effects models. GFR at baseline was significantly negatively correlated with age and plasma creatinine concentration (P ≤ 0.0001), and GFR declined, on average, by 4.0 ml/min 1.73 m²/year (P = 0.001). A significant correlation was found between individual GFR decline rate and average systolic (SBP) and diastolic (DBP) blood pressures (−0.254 (0.736) ml/min 1.73 m²/year per mmHg increase in SBP (DBP), P = 0.041 (0.014)) and % of glycated hemoglobin (HbA1c) (−1.78 ml/min 1.73 m²/year per % increase in HbA1c, P = 0.048). This implies a 44% increase/reduction in GFR decline rate for 1% HbA1c increase/reduction around 7.0% (i.e. 5.79 and 2.24 ml/min 1.73 m²/year at 8% and 6% HbA1c, respectively).ConclusionsThis study demonstrates that, despite tight blood pressure control, an accurate glycemic control till very low patterns of HbA1c (from 10–11% to 5–6%) is needed to delay the progression of GFR decay in Mediterranean T2DM in south Europe with microalbuminuria.     

Dry eye and its correlation to diabetes microvascular complications in people with type 2 diabetes mellitus

AimsThis study was performed to investigate the correlation between dry eye disease and diabetes microvascular complications.MethodsIn this study 243 people with type 2 diabetes were enrolled. Tear osmolarity was measured using tear lab osmolarity system. All of the participants were evaluated for diabetes microvascular complications. The Michigan neuropathy screening instrument was used for detection of peripheral neuropathy, and the albumin/creatinine ratio in a spot urine sample was considered to diagnose diabetic nephropathy.ResultsThe prevalence of dry eye disease was 27.7%. The mean value for tear osmolarity was 301.97 ± 13.52 mOsm/L. We found a significant correlation between dry eye disease and diabetic retinopathy (P = 0.01). However no significant correlation was found between dry eye disease, diabetic neuropathy, and diabetic nephropathy.Dry eye disease was more prevalent in people with proliferative diabetic retinopathy and/or clinically significant macular edema (0.006). In a binary logistic regression analysis model, there was a significant correlation between dry eye disease and retinopathy (OR = 2.29, CI = 1.16–4.52, P = 0.016). In addition, both dry eye and retinopathy had significant correlation with HbA1C.ConclusionsDry eye disease is common in people with type 2 diabetes, especially in those with diabetic retinopathy. In addition, it is more prevalent in people who suffer from advanced stages of diabetic retinopathy.     

Resultados intrahospitalarios tras tratamiento percutáneo frente a quirúrgico en pacientes con estenosis aórtica y enfermedad arterial coronaria concomitante

Introduction and objectivesConcomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD.MethodsUsing discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission.ResultsMatching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P < .001) as was periprocedural stroke (0.9% vs 2.2%; P = .004), acute kidney injury (4.3% vs 16.0%, P < .001), blood transfusion (9.6% vs 21.1%, P < .001), and hospital-acquired pneumonia (0.1% vs 1.7%, P = .001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P < .001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P < .001) and SAVR/CABG (8.3 vs 6.8%, P < .001). Thirty-day cardiovascular readmission did not differ between groups.ConclusionsIn this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.