Hyperinsulinemic hypoglycemia in adolescents: case report and systematic review.

BACKGROUND: Hyperinsulinemic hypoglycemia is the most common cause of severe and persistent hypoglycemia in neonates and children. It is a heterogeneous condition with dysregulated insulin secretion, which persists in the presence of low blood glucose levels. CASE PRESENTATION: We report a case of a 15 year-old male with hyperinsulinemic hypoglycemia, who underwent a subtotal pancreatectomy after inadequate response to medical therapy. Pathological examination was positive for nesidioblastosis (diffuse ß-cell hyperplasia by H-E and immunohistochemical techniques). The patient's blood glucose levels normalized after surgery and he remains asymptomatic after 1 year of follow-up. The systematic review allowed us to identify 41 adolescents from a total of 205 cases reported in 22 manuscripts, from a total of 454 found in the original search done in PubMed and Lilacs. CONCLUSIONS: Although very well reported in children, hyperinsulinemic hypoglycemia can occur in adolescents or young adults, as it happens in our reported case. These patients can be seen, treated and reported by pediatricians or adult teams either way due to the wide age range used to define adolescence. Most of them do not respond to medical treatment, and subtotal distal pancreatectomy has become the elected procedure with excellent long-term response in the vast majority.

Constraints on tree seedling establishment after fires: passing the germination bottlenecks.

Persistence and colonization by tree species in an environment following a fire depends on the effects on seed germination and seedling development. We used seeds of Kielmeyera coriacea and Qualea parviflora as a model to test the effects of high temperatures on germination and initial development of tree seedlings. We exposed the seeds to heat flow (70, 100, 130, 150 or 170 °C) for 2 or 5 min and compared the germination with that of unheated seeds (control). Seedlings were then harvested after 3, 7 or 15 days to evaluate aerial and root mass, root:shoot ratio, presence of cotyledon opening, true leaves, and secondary roots. We found no effect on germination for seeds exposed to temperatures ≥150 °C. However, germination was significantly reduced for seeds exposed to 100 °C for both 2 and 5 min. The mass of 15-day-old K. coriacea seedlings was smaller when seeds were heated at 70 °C for 5 min or at temperatures higher or equal to 100 °C. Qualea parviflora seedlings did not show any difference in mass, but there were marginal differences in the presence of roots and the opening of cotyledons. Kielmeyera coriacea seedlings allocated biomass faster than Q. parviflora. High temperatures affect both quantity and quality of germinable seeds, as well as biomass allocation during initial seedling development. These factors may explain the decrease in seedlings observed after fire, suggesting a bottleneck effect that influences population dynamics and species persistence in systems with frequent fires.

Early safety of tenofovir alafenamide in patients with a history of tubulopathy on tenofovir disoproxil fumarate: a randomized controlled clinical trial.

OBJECTIVES: The aim of the study was to assess the effect of tenofovir alafenamide (TAF) on kidney and bone biomarkers in patients who developed proximal renal tubulopathy (PRT) while receiving tenofovir disoproxil fumarate (TDF). METHODS: Individuals with a history of TDF-associated PRT and currently suppressed HIV infection on a tenofovir-sparing regimen were randomized 1:1 to continue current antiretroviral therapy or initiate emtricitabine (F)/TAF with discontinuation of nucleoside reverse transcriptase inhibitors (NRTIs) as appropriate. Renal and bone biomarkers were analysed at baseline, week 4 and week 12. The primary outcome was the mean difference between study arms in urine retinol-binding protein:creatinine ratio (RBPCR) change from baseline to week 12. Data were analysed using linear regression, with robust standard errors (primary outcome), and repeated measures mixed effects models (secondary outcomes). The trial was registered under European Union Drug Regulating Authorities Clinical Trials Database 2016-003345-29. RESULTS: We randomized 31 individuals [mean age 52.4 (standard deviation 0.3) years; 97% male; 90% white); all completed the study. At 12 weeks, there was no difference in change in RBPCR (ß 19.6; 95% confidence interval -35.3, 74.5; P = 0.47), and no difference in change in estimated glomerular filtration rate (eGFR) (based on creatinine or cystatin C), albuminuria, proteinuria, renal phosphate or urea handling, (fasting) urine osmolality, parathyroid hormone and bone turnover markers in the control versus the F/TAF exposed groups. No cases of PRT were observed. CONCLUSIONS: In people with a history of proximal renal tubulopathy while on TDF, 12-week exposure to TAF did not adversely affect renal tubular function. These data support continued evaluation of the long-term safety of TAF in this group of patients.

Reset Osmostat: Facts and Controversies.

Reset osmostat (RO) consists of a change in the normal plasma osmolality threshold (reduction or increase), which consequently induces chronic dysnatremia (hyponatremia or hypernatremia). Although the early papers on RO state that hyponatremic patients with this condition are usually not symptomatic, the current view is that most patients with hyponatremia are symptomatic and should be treated. RO has been associated with a myriad of clinical conditions and has clear diagnostic criteria which are crucial to arrive at the correct diagnosis and treatment.

Fire-induced damage to Qualea multiflora Mart. seeds depends on fruit protection and the position in the tree crown.

Although the Cerrado vegetation is adapted to fire, anthropogenic fires may impair the reproduction of some species. This study aimed to test the role of fruits of Qualea multiflora and their position in the tree crown in protecting the seeds during fires. Ten trees were selected in an area protected from fire (NB) and ten in a biannually burned area (B). Fruits were counted before the 2008 fire and weekly thereafter for 5 weeks. Fruit dehiscence, damage and position in the tree crown were recorded. Seed germination was assessed for seeds from both areas. In NB, 5.7% of fruits were located higher than 2 m, while in B 49.5% were located at this height. One week after the fire, the proportion of dehiscent fruits was lower in NB (19.5%) than in B (34.5%). Five weeks after the fire, all fruits in NB had dispersed their seeds, whereas in B only 47% of the fruits had. Immediately before the fire, the germination rate of seeds collected in NB was 80% (0-1 m), 97% (1-2 m) and 92% (≥2 m). Fifteen days after the fire, the germination rate of seeds in the B area was 3% (0-1 m), 13% (1-2 m) and 78% (≥2 m). Protection of Q. multiflora seeds from high temperatures is related to the fruit position in the tree crown rather than to fruit protection. Therefore, the results suggest that fire may alter the recruitment of new individuals.

Pancreas Transplantation at a Single Latin-American Center; Overall Results with Type 1 and Type 2 Diabetes Mellitus.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) has become the treatment of choice for type 1 diabetes mellitus (T1DM) patients with chronic renal failure. Type 2 diabetes mellitus (T2DM), was once considered to be a contraindication for pancreas transplantation; however, it has been accepted as a new indication, under strict criteria. Although favorable results have increase the indication for T2DM in developed countries, there have been no reports of long-term results for this indication from Latin American centers. METHODS: From April 2008 to March 2016, patients receiving SPK or pancreas transplant alone (PTA) for T2DM were included and compared with T1DM recipients. Variables were compared between groups with the use of χ2 and t tests; Kaplan-Meier with log rank was used for patient and graft survivals; P < .05 was considered to be significant. RESULTS: A total of 45 SPK and 1 PTA were performed, 35 (76.1%) for T1DM and 11 (24.5%) for T2DM. Mean pre-transplantation C-peptide was significantly higher in the T2DM group (P = .01); HbA1c was higher in the T1DM group (P = .03). No differences were found in weight, body mass index, and pre-transplantation glycemia. Patient survivals for T1DM recipients were 88.2% and 84.8% at 1 and 5 years, respetively, versus 100% and 74.1% for T2DM recipients (P = .87). CONCLUSIONS: Our initial prospective experience in a single Latin American center showed that medium- and long-term outcomes for T1DM and T2DM individuals receiving pancreas transplants are similar, under strict selection criteria.

Impact of rare variants in ARHGAP29 to the etiology of oral clefts: role of loss-of-function vs missense variants.

Non-syndromic cleft lip with or without cleft palate (NSCL/P) is a prevalent, complex congenital malformation. Genome-wide association studies (GWAS) on NSCL/P have consistently identified association for the 1p22 region, in which ARHGAP29 has emerged as the main candidate gene. ARHGAP29 re-sequencing studies in NSCL/P patients have identified rare variants; however, their clinical impact is still unclear. In this study we identified 10 rare variants in ARHGAP29, including five missense, one in-frame deletion, and four loss-of-function (LoF) variants, in a cohort of 188 familial NSCL/P cases. A significant mutational burden was found for LoF (Sequence Kernel Association Test, p = 0.0005) but not for missense variants in ARHGAP29, suggesting that only LoF variants contribute to the etiology of NSCL/P. Penetrance was estimated as 59%, indicating that heterozygous LoF variants in ARHGAP29 confer a moderate risk to NSCL/P. The GWAS hits in IRF6 (rs642961) and 1p22 (rs560426 and rs4147811) do not seem to contribute to the penetrance of the phenotype, based on co-segregation analysis. Our data show that rare variants leading to haploinsufficiency of ARHGAP29 represent an important etiological clefting mechanism, and genetic testing for this gene might be taken into consideration in genetic counseling of familial cases.

The Importance of Evaluating Frailty and Social-behavioral Factors for Managing Drugs and Dialysis Prescription in Elderly Patients.

Ageing is characterized by a progressive loss of complexity, which is an essential condition for making the organism capable of keeping homeostasis. Thus, senile loss of complexity makes old individuals frail: a syndrome characterized by the presence of shrinking (sarcopenia), weakness, poor endurance and energy, slowness, and low physical activity. Moreover, renal ageing progressively leads to a glomerular filtration rate (GFR) reduction, one of the main pharmacokinetic senile changes, which is not detectable by simply evaluating serum urea or creatinine values but measuring or calculating patient's GFR. Finally, current epidemiology has documented that detrimental social-behavioral factors such as low education level, poor financial-resource, depression, and isolation, also influence the onset and progression of chronic diseases, and even overall mortality, particularly in the elderly. Thus, we propose that these 3 variables: frailty phenotype, senile GFR, and detrimental social-behavioral factors, should be considered at time of prescribing drugs or medical procedures in the elderly. Additionally, they should also be considered for following patient's response to prescribed therapies in elderly patients suffering from chronic diseases (diabetes mellitus, chronic kidney disease, etc.), or on organ replacement treatments (dialysis and transplantation).

Larval migration of the ascarid nematode Toxocara canis following infection and re-infection in the gerbil Meriones unguiculatus.

A morphological and immunohistochemical study of larval migration patterns was performed in gerbils that were infected once (primary infected group) or twice (secondary infected group) with 1500 eggs of Toxocara canis. Animals from the primary infected and the re-infected group were killed at different times after infection, and larvae were counted in the intestines, liver, lungs and brain. Fragments of all organs were formalin fixed and paraffin embedded for histology and immunohistochemistry analyses (using polyclonal anti-Toxocara serum raised in rabbits infected with T. canis). In the primary infected group, larvae were more abundant in the intestine at 24 h, in the liver and lungs between 24 and 72 h and in the brain after 96 h; larvae predominated in the brain for up to 60 days after infection. In the re-infected group, an increase in the number of larvae in the liver and a reduction in the number of larvae in the brain was observed up to 60 days after re-infection. Inflammatory reactions were absent or limited. Eosinophils and loose granulomata were observed around the larvae and their antigens in the primary infected group and were more severe. Many eosinophils and typical epithelioid granulomata were observed around larvae in the re-infected group. These results demonstrate that the migration pattern of T. canis larvae in gerbils is similar to that in mice and rats, exhibiting a late neurotropic stage. In the re-infected group, there was histological evidence of an adaptive T-helper 2 (Th-2) response, and larvae were apparently retained within granulomata in the liver, without obvious signs of destruction.

Correlación entre osteocalcina, insulinorresistencia, insulinosensibilidad y metabolismo de la glucosa en adultos mayores con síndrome metabólico / Correlation between Osteocalcin, Insulin Resistance, Insulin Sensitivity and Carbohydrate Metabolism in an Elderly Population with Metabolic Syndrome

Introducción: Recientemente han surgido nuevas evidencias que relacionan el metabolismo óseo con el energético. La osteocalcina es una proteína de la matriz ósea no colágena, sintetizada por los osteoblastos que modula localmente la mineralización ósea, tradicionalmente usada como marcador de formación ósea. Se ha demostrado tanto en modelos "in vitro" como en animales de experimentación que la osteocalcina tiene acción hormonal. Esta proteína tiene la propiedad de regular la insulinosensibilidad, la insulinosecreción y la proliferación de las células beta pancreáticas. Objetivo: Evaluar la existencia de correlación entre los niveles de osteocalcina sérica y marcadores de insulinorresistencia (IR) e insulinosensibilidad en una población de adultos mayores con síndrome metabólico. Material y métodos: En nuestro estudio prospectivo se incluyeron 88 pacientes (68 % mujeres, 32 % hombres, media de edad 73 ± 6 y 74 ± 6 años respectivamente) que concurrieron a los consultorios externos del servicio de Endocrinología y Metabolismo del hospital Dr. César Milstein. Todos cumplían con los criterios diagnósticos de síndrome metabólico del año 2009 de la Federación Internacional de Diabetes (IDF). Se midieron: osteocalcina sérica, hemoglobina glicosilada (HbA1c), HDL y triglicéridos (TG). Se calcularon QUICKI (Quantitative Insulin Sensivity Check Index) y el índice TG/HDL. Resultados: Los niveles de osteocalcina sérica se asociaron positivamente con HDL (r = 0,213, p = 0,05) y QUICKI (r = 0,212, p = 0,05) e inversamente con TG (r = -0,218, p < 0,05), con el índice TG/HDL (r = -0,217, p < 0,05) y con HbA1c (r = -0,253, p < 0,05). Conclusiones: Nuestro estudio mostró que en adultos mayores con sindrome metabólico, los niveles de osteocalcina reducidos se asociaron con un aumento en los índices de insulinorresistencia, una disminución de los de insulinosensibilidad y un peor control metabólico. Rev Argent Endocrinol Metab 52:8-13, 2015 Los autores no poseen conflictos de interés.(AU)

Introduction: In recent years there has been increasing evidence about the relationship between bone and energy metabolism. Osteocalcin is a non-collagenous bone matrix protein synthesized by osteoblasts that locally modulates bone mineralization and is traditionally used as a bone formation marker. Osteocalcin has been shown to have hormonal actions both in in vitro models and in experimental animals. This hormone has the property of regulating insulin secretion and insulin sensitivity as well as beta pancreatic cell proliferation. Aim: To evaluate the existence of correlation between serum osteocalcin levels, insulin resistance and insulin sensitivity markers in an elderly population with metabolic syndrome. Material and methods: Eighty-eight elderly patients were included in our prospective study (68 % women, mean age 73 ± 6 ; 32 % men, mean age 74 ± 6). They attended the outpatient Endocrinology and Metabo¡lism service at Dr. César Milstein Hospital and met the International Diabetes Federation (IDF) criteria of metabolic syndrome. Serum Osteocalcin, Glycated haemoglobin (HbA1c), HDL and Triglycerides (TG) were measured. QUICKI and TG/HDL index were calculated. Results: Serum osteocalcin levels were positively associated with HDL (r = 0.213, p = 0.05) and QUICKI (r = 0.212, p = 0.05), and inversely associated with TG (r = -0.218, p < 0.05), TG/HDL index (r = -0.217, p < 0.05) and HbA1c (r = -0.253, p < 0.05). Conclusions: Our study showed that in elderly patients with metabolic syndrome, reduced osteocalcin levels were associated with increased insulin sensitivity, decreased insulin resistance indexes and impaired metabolic control. Rev Argent Endocrinol Metab 52:8-13, 2015 No financial conflicts of interest exist.(AU)

Correlación entre osteocalcina, insulinorresistencia, insulinosensibilidad y metabolismo de la glucosa en adultos mayores con síndrome metabólico / Correlation between Osteocalcin, Insulin Resistance, Insulin Sensitivity and Carbohydrate Metabolism in an Elderly Population with Metabolic Syndrome

Introducción: Recientemente han surgido nuevas evidencias que relacionan el metabolismo óseo con el energético. La osteocalcina es una proteína de la matriz ósea no colágena, sintetizada por los osteoblastos que modula localmente la mineralización ósea, tradicionalmente usada como marcador de formación ósea. Se ha demostrado tanto en modelos "in vitro" como en animales de experimentación que la osteocalcina tiene acción hormonal. Esta proteína tiene la propiedad de regular la insulinosensibilidad, la insulinosecreción y la proliferación de las células beta pancreáticas. Objetivo: Evaluar la existencia de correlación entre los niveles de osteocalcina sérica y marcadores de insulinorresistencia (IR) e insulinosensibilidad en una población de adultos mayores con síndrome metabólico. Material y métodos: En nuestro estudio prospectivo se incluyeron 88 pacientes (68 % mujeres, 32 % hombres, media de edad 73 ± 6 y 74 ± 6 años respectivamente) que concurrieron a los consultorios externos del servicio de Endocrinología y Metabolismo del hospital Dr. César Milstein. Todos cumplían con los criterios diagnósticos de síndrome metabólico del año 2009 de la Federación Internacional de Diabetes (IDF). Se midieron: osteocalcina sérica, hemoglobina glicosilada (HbA1c), HDL y triglicéridos (TG). Se calcularon QUICKI (Quantitative Insulin Sensivity Check Index) y el índice TG/HDL. Resultados: Los niveles de osteocalcina sérica se asociaron positivamente con HDL (r = 0,213, p = 0,05) y QUICKI (r = 0,212, p = 0,05) e inversamente con TG (r = -0,218, p < 0,05), con el índice TG/HDL (r = -0,217, p < 0,05) y con HbA1c (r = -0,253, p < 0,05). Conclusiones: Nuestro estudio mostró que en adultos mayores con sindrome metabólico, los niveles de osteocalcina reducidos se asociaron con un aumento en los índices de insulinorresistencia, una disminución de los de insulinosensibilidad y un peor control metabólico. Rev Argent Endocrinol Metab 52:8-13, 2015 Los autores no poseen conflictos de interés.

Introduction: In recent years there has been increasing evidence about the relationship between bone and energy metabolism. Osteocalcin is a non-collagenous bone matrix protein synthesized by osteoblasts that locally modulates bone mineralization and is traditionally used as a bone formation marker. Osteocalcin has been shown to have hormonal actions both in in vitro models and in experimental animals. This hormone has the property of regulating insulin secretion and insulin sensitivity as well as beta pancreatic cell proliferation. Aim: To evaluate the existence of correlation between serum osteocalcin levels, insulin resistance and insulin sensitivity markers in an elderly population with metabolic syndrome. Material and methods: Eighty-eight elderly patients were included in our prospective study (68 % women, mean age 73 ± 6 ; 32 % men, mean age 74 ± 6). They attended the outpatient Endocrinology and Metabo­lism service at Dr. César Milstein Hospital and met the International Diabetes Federation (IDF) criteria of metabolic syndrome. Serum Osteocalcin, Glycated haemoglobin (HbA1c), HDL and Triglycerides (TG) were measured. QUICKI and TG/HDL index were calculated. Results: Serum osteocalcin levels were positively associated with HDL (r = 0.213, p = 0.05) and QUICKI (r = 0.212, p = 0.05), and inversely associated with TG (r = -0.218, p < 0.05), TG/HDL index (r = -0.217, p < 0.05) and HbA1c (r = -0.253, p < 0.05). Conclusions: Our study showed that in elderly patients with metabolic syndrome, reduced osteocalcin levels were associated with increased insulin sensitivity, decreased insulin resistance indexes and impaired metabolic control. Rev Argent Endocrinol Metab 52:8-13, 2015 No financial conflicts of interest exist.

Protocol to cryopreserve and isolate nuclei from adipose tissue without dimethyl sulfoxide.

Cryopreservation injuries involve nuclear DNA damage. A protocol for cryopreserving and isolating adipocyte nuclei is proposed. Adipose tissue samples were directly analyzed (NoCRYO-0h), or stored at -196°C for 7 days without 10% dimethyl sulfoxide (DMSO) (CRYO-WO-DMSO) or with DMSO (CRYO-W-DMSO). To determine the effect of DMSO on cryopreservation treatment, adipose tissue samples were stored at 4°C for 24 h with 10% DMSO (NoCRYO-W-DMSO-24h) and without (NoCRYO-WO-DMSO-24h). Samples were processed in isolation buffer, and nuclear integrity was measured by flow cytometry. The coefficient of variation, forward scatter, side scatter, and number of nuclei analyzed were evaluated. Pea (Pisum sativum) was used to measure the amount of DNA. All groups contained similar amounts of DNA to previously reported values and a satisfactory number of nuclei were analyzed. CRYO-W-DMSO presented a higher coefficient of variation (3.19 ± 0.09) compared to NoCRYO-0h (1.85 ± 0.09) and CRYO-WO-DMSO (2.02 ± 0.02). The coefficient of variation was increased in NoCRYO-W-DMSO-24h (3.80 ± 0.01) compared to NoCRYO-WO-DMSO-24h (2.46 ± 0.03). These results relate DMSO presence to DNA damage independently of the cryopreservation process. CRYO-W-DMSO showed increased side scatter (93.46 ± 5.03) compared to NoCRYO-0h (41.13 ± 3.19) and CRYO-WO-DMSO (48.01 ± 2.28), indicating that cryopreservation with DMSO caused chromatin condensation and/or nuclear fragmentation. CRYO-W-DMSO and CRYO-WO-DMSO presented lower forward scatter (186.33 ± 9.33 and 196.89 ± 26.86, respectively) compared to NoCRYO-0h (322.80 ± 3.36), indicating that cryopreservation reduced nuclei size. Thus, a simple method for cryopreservation and isolation of adipocyte nuclei causing less damage to DNA integrity was proposed.

Particularidades del síndrome metabólico en una subpoblación de adultos mayores / Particularities of metabolic syndrome in an elderly subpopulation

Introducción: El síndrome metabólico (SM) se define por un conjunto de alteraciones clínicas que aumentan el riesgo de enfermedad cardiovascular. Diferentes organizaciones internacionales de salud han ajustado progresivamente los criterios que definen al SM, con el consiguiente aumento del diagnóstico del mismo. Sin embargo, ninguno de los parámetros considerados se han adaptado a la edad ni se han tomado en cuenta las modificaciones antropométricas y metabólicas características del envejecimiento. Objetivo: Caracterizar al SM en una población de adultos mayores y evaluar si existen diferencias de género. Materiales y métodos: Se realizó un estudio prospectivo en pacientes que consultaron al Servicio de Endocrinología de la U. A. Dr. César Milstein. El 68,8 % fueron mujeres y la edad de la población fue 73 ± 6 años. Para el diagnóstico de SM se utilizaron los criterios del Joint Interim Statement de 2009. Recabamos información sobre antecedentes, medicación y se realizaron análisis de laboratorio. Se midió índice cintura/talla (ICT). Se calculó media ± desvío estándar (DS) y proporciones. Para establecer comparaciones entre varones y mujeres se utilizó Test de Student y test de Chi2. Resultados: En una muestra de 77 pacientes, 42,9 % cumplió con 3 componentes de SM, 33,8 % con 4 y 23,4 % con 5, con distribución similar en hombres y mujeres. Según el índice de masa corporal (IMC), 32,5 % de la población presentó sobrepeso; 35 % obesidad grado I; 22 % grado II y 9 % grado III. Al evaluar el perímetro de cintura (PC), el 98,7 % superó los puntos de corte. El índice cintura/ talla superó el valor normal en ambos sexos, siendo significativamente superior en las mujeres (p: 0,003). Conclusiones: En la población de adultos mayores que se estudió no se observó diferencia entre ambos sexos en el número de componentes diagnósticos de SM. En cuanto al perímetro de cintura, el valor fue similar en ambos sexos, lo que podría llevar a revisar el valor de corte del mismo en este grupo etario. El ICT estuvo aumentado en toda la población y por ser un subrogante de riesgo cardiovascular, sería otro parámetro a tener en cuenta al momento del diagnóstico de SM. Rev Argent Endocrinol Metab 51:130-135, 2014 Los autores no poseen conflictos de interés.

Introduction: The metabolic syndrome (MS) denotes an association of abnormalities that increase the risk of cardiovascular disease. With the intention of decreasing this risk, international organizations have dropped the normal range for various parameters, with a consequent increase in the diagnosis of MS. Although the changes related to age are well documented, none of these parameters has been age-adapted. Aims: to characterize MS in the elderly population and to establish possible gender differences. Materials and methods: We performed a prospective study in patients who presented at the Department of Endocrinology of the Healthcare Unit Dr. Cesar Milstein. Of the total population, 68.8 % were women and the average age was 73 ± 6 years. For the diagnosis of MS, we used the 2009 Joint Interim Statement diagnostic criteria. Information was collected on previous history and medication, and laboratory analyses were performed. The waist / height ratio was also measured. Mean ± standard deviation (SD) and proportions were calculated. For comparisons between men and women, the Student test and Chi-squared test were used. Results: Of the total population, 42.9 % fulfilled 3 criteria for MS, 33.8 % fulfilled 4 criteria and 23.4 % fulfilled 5, with similar distribution in men and women. According to body mass index (BMI), 32.5 % of the population had overweight, 35 % were grade I obese, 22 % were grade II and 9 % were grade III. As regards waist circumference, 98.7 % of the total population exceeded the established cutoffs. The waist/ height ratio exceeded normal values in both genders, being significantly higher in women (p = 0.003). Conclusions: In the elderly, there are no gender differences in the number of components of MS. As for waist circumference, values were similar in both men and women. This finding could lead to redefine the cutoff value in aged woman. The waist / height ratio, a surrogate marker of cardiovascular disease, was ...

Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient.

Despite decades of research, a full understanding of chronic kidney disease (CKD)-end stage renal disease (ESRD) progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI) on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD) to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34%) patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92) years. Precipitating AKI followed pneumonia (8), acutely decompensated heart failure (7), pyelonephritis (4), post-operative (5), sepsis (3), contrast-induced nephropathy (2), and others (2). Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

Local ethanol injection for the treatment of deltoid parathyroid cell hyperplasia.

Secondary hyperparathyroidism (SHPT) is a serious complication in dialysis patients and is routinely managed with medical therapy. Refractory disease is usually treated either surgically or by local ethanol injection into the parathyroid glands. Total parathyroidectomy with deltoid implant can be successful; however, recurrent, resistant disease is not uncommon. Local ethanol injection was applied to the deltoid autoimplant of a patient with recurrent, resistant SHPT, which had not been resolved with surgical treatment. Serum intact parathyroid hormone (iPTH) levels subsequently decreased from 1,400 to 219 pg/dl and remained stable for the next 6 months. To our knowledge, this procedure has not been previously described in the literature. Local injection of ethanol may represent an interesting alternative to surgery for the treatment of deltoid parathyroid cell hyperplasia in patients in which surgical treatment is not an option.

Prevalence of cardiovascular risk factors among Latin American adolescents: a multilevel analysis.

High blood pressure (HBP) and obesity is a well-established major risk factor for stroke and coronary heart disease. However, the literatures are scarce about these informations in adolescents from low-and-middle income countries. This school-based survey was carried out among students from Maringá (Brazil) and Buenos Aires (Argentina) selected random sampling. We studied 991 Brazilian adolescents (54.5% girls) in the age range of 14-18 years. In Argentina, we studied 933 adolescents (45.9% female) in the age range of 11-17 years. The outcomes of this study are general obesity, abdominal obesity and HBP. The associated factors analysed were gender, age and health behaviours. The prevalence of obesity was 5.8% in Brazil and 2.8% in Argentina, the prevalence of abdominal obesity was 32.7% in Brazil and 11.1% in Argentina, the prevalence of HBP was 14.9% in Brazil and 13.5% in Argentina. The multilevel analysis showed that older adolescents (>14 years old) have a little likelihood of being overweight, whereas male adolescents are more likely to be obese and have HBP. The abdominal obesity in both indicators were not associated with the independent variables. The prevalence of cardiovascular risk factors is high in Latin American adolescents independent of each country, and was associated with male gender.

Renal calcium, phosphorus, magnesium and uric acid handling: comparison between stage III chronic kidney disease patients and healthy oldest old.

INTRODUCTION: It is known that chronic kidney disease (CKD) and senescence bring about a progressive reduction in glomerular filtration rate (GFR) and that in the former this is usually associated with an increase in the fractional excretion of calcium, phosphorus, magnesium, and uric acid. However, it has not yet been explained how these substances are excreted in the healthy oldest old. Thus, in the present study, we examined the renal handling of these substances in very aged people in comparison with CKD patients with similar GFR levels (stage III-CKD). MATERIALS AND METHODS: Twenty volunteers were studied; 10 of them were healthy very old (VO) (≥ 75 years old) individuals and 10 were stage III CKD patients. Exclusion criteria were as follows: presence of altered (abnormally high or low) plasma calcium, phosphorus, magnesium and uric acid, as well as previous diagnoses of diabetes mellitus and obstructive uropathy and use of drugs that could alter plasma levels of the studied substances. All volunteers were on a diet with the same content of these elements (3-day dietary register). We measured calcium, phosphorus, magnesium, uric acid, creatinine in serum plasma and morning urine, as well as serum parathyroid hormone level, in each volunteer. From these data, fractional excretion (FE) of these substances was obtained. A statistical analysis was carried out using the Wilcoxon test. RESULTS: Serum creatinine: 1.8 ± 0.4 mg/dl (CKD) versus 0.8 ± 0.2 mg/dl (VO), p = 0.0002; serum calcium: 9.1 ± 0.3 mg/dl (CKD) versus 8.7 ± 0.4 (VO), p = 0.022; serum magnesium: 2.3 ± 0.2 mg/dl (CKD) versus 2.0 ± 0.1 (VO), p = 0.05; serum phosphorus: 3.9 ± 0.5 mg/dl (CKD) versus 3.0 ± 0.4 mg/dl (VO), p = 0.002; serum uric acid: 6.6 ± 1.5 (CKD) versus 5.2 ± 1.4 mg/dl (VO), p = 0.04; FE of calcium: 2.5 ± 1 % (CKD) versus 0.8 ± 0.3 % (VO), p = 0.04; FE of magnesium: 7.2 ± 4.1 % (CKD) versus 2.9 ± 0.9 % (VO), p = 0.02; FE of phosphorus: 25 ± 9 % (CKD) versus 9.1 ± 5.7(VO), p = 0.001; FE of uric acid: 10 ± 3 % (CKD) versus 8 ± 5 % (VO), p = 0.05. CONCLUSION: Serum levels and FE of calcium, phosphorus, magnesium and uric acid were significantly higher in CKD patients compared to healthy very old people with similar GFR, except for serum magnesium and FE of uric acid, which were similar in both groups.