Relationship between Insulin Resistance (HOMA-IR), Trabecular Bone Score (TBS), and Three-Dimensional Dual-Energy X-ray Absorptiometry (3D-DXA) in Non-Diabetic Postmenopausal Women.

BACKGROUND: Insulin may play a key role in bone metabolism, where the anabolic effect predominates. This study aims to analyze the relationship between insulin resistance and bone quality using the trabecular bone score (TBS) and three-dimensional dual-energy X-ray absorptiometry (3D-DXA) in non-diabetic postmenopausal women by determining cortical and trabecular compartments. METHODS: A cross-sectional study was conducted in non-diabetic postmenopausal women with suspected or diagnosed osteoporosis. The inclusion criteria were no menstruation for more than 12 months and low bone mass or osteoporosis as defined by DXA. Glucose was calculated using a Hitachi 917 auto-analyzer. Insulin was determined using an enzyme-linked immunosorbent assay (EIA). Insulin resistance was estimated using a homeostasis model assessment of insulin resistance (HOMA-IR). DXA, 3D-DXA, and TBS were thus collected. Moreover, we examined bone parameters according to quartile of insulin, hemoglobin A1C (HbA1c), and HOMA-IR. RESULTS: In this study, we included 381 postmenopausal women. Women located in quartile 4 (Q4) of HOMA-IR had higher values of volumetric bone mineral density (vBMD) but not TBS. The increase was higher in the trabecular compartment (16.4%) than in the cortical compartment (6.4%). Similar results were obtained for insulin. Analysis of the quartiles by HbA1c showed no differences in densitometry values, however women in Q4 had lower levels of TBS. After adjusting for BMI, statistical significance was maintained for TBS, insulin, HOMA-IR, and HbA1c. CONCLUSIONS: In non-diabetic postmenopausal women there was a direct relationship between insulin resistance and vBMD, whose effect is directly related to greater weight. TBS had an inverse relationship with HbA1c, insulin, and insulin resistance unrelated to weight. This might be explained by the formation of advanced glycosylation products (AGEs) in the bone matrix, which reduces bone deformation capacity and resistance, as well as increases fragility.

IgG4-Related Disease: Results From a Multicenter Spanish Registry.

IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD.

Nuevos conceptos en diabetes mellitus gestacional: evaluación prospectiva de 3.070 mujeres embarazadas / New concept in gestational diabetes mellitus: prospective evaluation of 3.070 pregnancy woman

Evaluación prospectiva de diabetes gestacional en 3.070 mujeres entre las 24 y 26 semanas de embarazo, a partir del año 1992. Se utilizó el criterio recomendado por la Organización Mundial de la Salud desde 1985 y aceptado a partir de 1997 por las Asociaciones Norteamericana y Latinoamericana de Diabetes para el diagnóstico de diabetes mellitus gestacional. Maternidad Concepción Palacios y otros centros de contro prenatal de Caracas. La incidencia de alteraciones del metabolismo de carbohidratos fue de 2,71 por ciento (intolerancia a la glucosa 2 por ciento y diabetes mellitus 0,71 por ciento). El principal factor de riesgo en nuestra población fue la edad mayor de 35 años. Una sola determinación de glicemia a las 2 horas después de ingerir 75 g de glucosa en ayunas, demostró ser un parámetro confiable para el diagnóstico y la orientación terapeútica en todas nuestras pacientes. La baja incidencia de diabetes mellitus gestacional encontrada en nuestra población es menor que la reportada para blancos hispánicos y mexicanos y similar a la de los blancos de origen no hispánico en Estados Unidos y Europa, por lo cual se hace necesario redefinir el alto riesgo atribuido internacionalmente a toda la población latinoamericana. Para realizar la pesquisa recomendamos una sola determinación de glicemia a las 2 horas de ingerir 75 g de glucosa, después de las 24 semanas de embarazo, fundamentalmente en todas las mujeres mayores de 25 años. En presencia de factores de riesgo la pesquisa debe hacerse en edades más tempranas del embarazo y a cualquier edad cronológica

Valor predictivo de la ßHCG en el diagnóstico precoz del embarazo ectópico. Estudio prospectivo / Predictive value of the ß-HCG in the early diagnosis of ectopic pregnancy. Prospective study

Se estudiaron a 100 pacientes operadas con diagnóstico de embarazo ectópico (E.E). Se compararon las evidencias anatomopatológicas (AP) con los niveles de ß-HCG y los resultados fueron los siguientes: en 80 pacientes coincidió el diagnóstico clínico de EE con el AP y los niveles de ß-HCG fueron positivos para embarazos. En 8 pacientes no hubo EE: 5 laparotomías en blanco, 2 casos de torción de quiste de ovario y un caso de piosalpinx bilateral. Las 12 pacientes restantes tenían EE organizado con niveles no detectados de ß-HCG, los cuales podrían catalogarse como abortos tubáricos. Se deja abierta la posibilidad de no operar a este grupo de pacientes, quienes no presentan riesgo de ruptura tubárica, en virtud de no tener actividad trofoblástica. Se concluye que la cuantificación de ß-HCG es un parámetro bioquímico muy importante en el diagnóstico de EE