Three cases of glycogenic hepatopathy mimicking acute and relapsing hepatitis in type I diabetes mellitus

Glycogenic hepatopathy (GH) is an uncommon cause of serum transaminase elevation in type I diabetes mellitus (DM). The clinical signs and symptoms of GH are nonspecific, and include abdominal discomfort, mild hepatomegaly, and transaminase elevation. In this report we describe three cases of patients presenting serum transaminase elevation and hepatomegaly with a history of poorly controlled type I DM. All of the cases showed sudden elevation of transaminase to more than 30 times the upper normal range (like in acute hepatitis) followed by sustained fluctuation (like in relapsing hepatitis). However, the patients did not show any symptom or sign of acute hepatitis. We therefore performed a liver biopsy to confirm the cause of liver enzyme elevation, which revealed GH. Clinicians should be aware of GH so as to prevent diagnostic delay and misdiagnosis, and have sufficient insight into GH; this will be aided by the present report of three cases along with a literature review.     

Osteomyelitis of the Mandible in a Patient with Osteopetrosis. Case Report and Review of the Literature

Osteopetrosis is a rare hereditary bone disorder presenting with variable clinical features and is characterized by an increase in bone density and reduction of marrow spaces that result from a defect in the function of osteoclasts and, consequently, a decrease in bone turnover. This disease is generally divided into three types: severe infantile malignant autosomal recessive, intermediate mild autosomal recessive, and benign autosomal dominant. The prognosis of the first two types is very poor and is characterized by an early onset, usually within the first decade of life, and early death. The benign-type is characterized by a later onset and a longer life span. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. The osteomyelitis is generally caused by tooth extraction or pulpal necrosis. The leading cause of the increased rate of infection is thought to be a lack of adequate bone vasculature. Treatment of osteomyelitis secondary to osteopetrosis is controversial. Treatment regimens include high-dose systemic antibiotics coupled with thorough debridement of necrotic bone and primary closure of soft tissues, if possible. Hyperbaric oxygen has been used for the treatment of chronic osteomyelitis.     

Assessment of Hemodialysis Adequacy by Ionic Dialysance: Comparison to Standard Method of Urea Removal

Background. The hemodialysis adequacy is one of the most important issues influencing the survival of patients on maintenance hemodialysis (HD). Assessment of measuring the delivered dialysis dose using clearance × time/volume (Kt/V) index requires multiple blood sampling. New methods for assessment of dialysis dose based on ionic dialysance (ID) have been suggested. Online conductivity monitoring (using sodium flux as a surrogate for urea) allows the repeated noninvasive measurement of Kt/V on each HD treatment. In this study we have compared this method with the standard method of estimating Kt/V. Methods. We studied 24 established HD patients over a 4 week time period. Patients were dialyzed using Fresenius 4008S dialysis monitors, equipped with modules to measure ID. Data were manually collected and analyzed using the appropriate statistical software. Urea removal (UR) was measured once a week by a two-pool calculation, estimating an eKt/V. Results. The Kt/V measured by ID highly correlated with the one derived from the measurement of the UR (r = 0.8959, p< 0.0001). The ID underestimated UR by the mean of 6%. The ID varied greatly within individual patients with a median of 1.29 ± 0.22. If the eKt/V ≥ 1.2 is considered adequate, 33% of the patients would have been inadequately dialyzed. The mean HD duration to achieve an adequate dialysis was 4 hours and 47 minutes with high interpatient variability. Conclusion. The ID seems to be an easily obtained measure of the delivered dialysis dose, correlating well with standard UR method. Substantial individual variations imply that repeated measures (ideally for all treatments) are necessary to obtain a real answer to the mean treatment dose being delivered to the patients.     

Disease knowledge among type 2 diabetes mellitus patients attending primary care

OBJECTIVE: assess disease knowledge among a patient population. MATERIAL AND METHODS: Cross-sectional study in two health care centers belonging to the National Institute of Social Security (ISSSTE). A general knowledge questionnaire was applied to 141 patients with type 2 diabetes mellitus. Chi-square tests to compare demographic variables with knowledge level were used. Alpha was set at p < 0.05. RESULTS: 29.2% of participants scored correct answers and only 12.3% were fully knowledgeable. The highest percentage (42.4%) of correct knowledge was related to levels of blood glucose. There was no association between appropriate metabolical control among patients and disease knowledge. Being younger, having higher education and less than 10 years with the disease generated higher levels of knowledge. CONCLUSIONS: Knowledge levels among the studied population are low and similar to the results from the literature. Demographic characteristics such as age and education are associated with changes in degree of knowledge. Patient educational programs are a fundamental component of a comprehensive approach to diabetes prevention.     

Functional genomics in single embryo and human oocytes

During three decades human embryo and oocyte analyses have been performed based on morphological or cytogenetical evaluations; molecular techniques, like FISH and PCR, have been gradually incorporated. However, the development of new techniques of individual cell RNA amplification has allowed the analysis of gene expression in oocytes, cumulus-oocyte complex and preimplantation embryos. These techniques will change radically the study of human reproductive biology and assisted reproduction, allowing a powerful and objective analysis of the complex processes and the interactions that may explain the causes of infertility and generate new therapeutics.