Hair follicle characteristics as early marker of Type 2 Diabetes.

Type 2 Diabetes mellitus (DM2) includes a continuum of metabolic disorders characterized by hyperglycemia that causes several chronic long-term complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The hair follicle could reveal signs of early vascular impairment, yet its relationship to early metabolic injuries has been largely ignored. We propose that in earlier stages of the continuum of DM2-related metabolic disorders, a group of susceptible patients who do not yet meet the diagnostic criteria to be considered as persons with DM2 may present chronic vascular impairment and end organ damage, including hair follicle damage, which can be evaluated to identify an early risk marker. This hypothesis is based in the association found between insulin resistance and alopecia in non-diabetic persons, and the hair loss on the lower limbs as a manifestation of long-term peripheral arterial disease among subjects with DM2. In order to test this hypothesis, studies are required to evaluate if hair follicle characteristics are related to and can predict hyperglycemic complications, and if they do so, which feature of the hair follicle, such as hair growth, best characterizes such DM2-related conditions. If this hypothesis were proven to be true, significant advances towards a personalized approach for early prevention strategies and management of DM2 would be made. By focusing on the hair follicles, early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques. In so doing, this approach could provide early identification of DM2-susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage.

Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department.

BACKGROUND: Presepsin (PSEP) is released during infectious diseases and can be detected in the blood. PSEP has shown promising results as sepsis marker. We examined the diagnostic and prognostic validity of PSEP in patients suspicious of sepsis on admission in the emergency department (ED). METHODS: One hundred twenty three patients with signs of SIRS and/or sepsis and 123 healthy individuals were enrolled. PSEP was determined on admission, after 8, 24 and 72 h. RESULTS: Mean PSEP concentrations of the control group and the patient group were 130 and 1945 pg/ml. PSEP differed between SIRS, sepsis, severe sepsis and septic shock and showed strong association with 30-day mortality ranging from 10.3% in the 1st to 32.1% in the 4th quartile. The ROC curve analyses revealed an AUC value of 0.743. Combined assessment of PSEP and MEDS score increased the AUC up to 0.878 demonstrating the close relationship with outcome. Based on the PSEP values in the different severity degrees, decision thresholds for risk stratification were established. The course of PSEP during the first 72 h was associated with effectiveness of treatment and outcome. CONCLUSIONS: PSEP allowed outcome prediction already on admission to a similar degree as the clinical scores MEDS and APACHE II. Combination of PSEP with MEDS score improved the discriminatory power for outcome prediction.

Supradesnivel del segmento ST en derivación aVR en el síndrome coronario agudo con elevación persistente del segmento ST. revisión de la literatura a propósito de un caso / ST segment elevation in aVR derivation in acute coronary syndrome with persistent elevation of ST segment. literature review following a case

Durante los últimos años, se ha observado la asociación del supradesnivel de ST en la derivación aVR con el compromiso de la arteria descendente anterior (DA), tronco coronario izquierdo (TCI) y coronaria derecha (CD), en el contexto de un infarto de miocardio agudo con segmento ST elevado (IMA-STE). Por medio del electrocardiograma se puede predecir con una probabilidad del 80% el compromiso de TCI frente a DA, cuando la relación aVR sobre V1 es mayor a la unidad. Asimismo, la presencia de un supradesnivel en aVR se asocia a mayor mortalidad a los 30 dias en IMA-STE de cara anterior e inferior. Por lo expuesto previamente, se recalca la importancia del análisis de la elevación del ST en aVR en un IMA-STE de cara anterior puesto que predice compromiso de gran territorio vascular y empeora el pronóstico del paciente.

During last years an association between elevation of the ST segment in the aVR derivation with the affection of the anterior descending coronary artery (ADCA), left coronary artery trunk (LCT) and right coronary artery (RCA) in the context of acute myocardial infarction with elevated ST segment (AMI-ESS) has been observed. The electrocardiogram may predict with 80% accuracy the affection of the LCT versus ADCA when the relation of aVR over V1 in higher than 1. Moreover, an elevation of the ST segment in aVR is associated with higher 30- day mortality in patients with AMI-ESS of the anterior and inferior side. Therefore, we emphasize the importance of analyzing the elevation of the ST segment in aVR in patients with AMI-ESS of the anterior side as it predicts extensive vascular affection and worsens prognosis.

Transtornos cardiovasculares en pacientes con cólera / Cardiovascular disorders in cholera patients

Se realizó un estudio analítico en pacientes con cólera, con deshidratación moderada y severa en el Hospital Nacional Edgardo Rebagliati M. (Diciembre 92-Marzo 93), buscando relacionar los niveles de potasio sérico y las alteraciones cardiovasculares. De 54 pacientes que cumplieron los criterios de inclusión se encontró deshidratación moderada en el 56 por ciento y severa en el 44 por ciento; de éstos, 6 tuvieron shok hipovolémico. Los signos clínicos más relevantes fueron: Hipotensión arterial (PA sistól nes séricas de potasio en la mayoría (55 por ciento) estuvieron en límites normales y sólo en 15 por ciento se halló hipokalemia no encontrándose relación significativa con la severidad de la deshidratación y los trastornos cardiacos. Taquicardia sinusal fue el hallasgo electrocardiográfico mas frecuente, además de aplanamiento e inversión de la onda T, presencia de onda U, arritmia supraventricular; siendo la fibrilación auricular con respuesta ventricular elevada la de mayor presentación. Podemos concluir que los niveles séricos de potasio no se correlacionan directamente con las alteraciones cardiovasculares y electrocardiográficas.