Diabetic Ketoacidosis Associated with Thyroxine (T4) Toxicosis and Thyrotoxic Cardiomyopathy.

Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T4) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T4) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol's solution) and was discharged a few days later.

Asociación entre Depresión-Ansiedad y el Síndrome de Fibromialgia en 3 centros asistenciales de Lambayeque, Perú, 2011 -2012 / Association between Depression-Anxiety and the Fibromyalgia syndrome in 3 health centers of Lambayeque, Peru, 2011 -2012

Objetivo: determinar la asociación entre depresión y ansiedad con el Síndrome de Fibromialgia en los pacientes atendidos por consulta externa de tres centros asistenciales del distrito de Chiclayo, Perú. Material y métodos: Estudio analítico de tipo casos y controles prospectivo en el que los pacientes provenientes de los consultorios de medicina interna y reumatología de 3 centros asistenciales, fueron evaluados mediante entrevista estructurada para datos clínicos y epidemiológicos y mediante los test de Zung para depresión y ansiedad. Se usó estadística descriptiva, frecuencias absolutas y relativas, se midieron los odds ratio (OR) para depresión y ansiedad y los intervalos de confianza, con un nivel de significancia de 0,05; se calcularon OR ajustados mediante regresión logística. Se utilizó el programa estadístico SPSS v17. Resultados: de 208 pacientes en total, 52 (25%) fueron casos y 156 (75%) controles. Hubo mayor frecuencia de Síndrome de Fibromialgia en las mujeres 48 (92%); la mayoría de pacientes con Fibromialgia tuvieron algún grado de Depresión y Ansiedad: 50 (96,2) y 48 (92,3%) respectivamente; la depresión fue en mayor medida de tipo severa 20 (38,4%) y el nivel de ansiedad más frecuente fue el tipo mínimo-moderada 26 (50%). En el análisis multivariado, se halló asociación entre Síndrome de Fibromialgia y ansiedad (OR=9,7 IC95% 3,1-29,5); mas no con depresión (OR=1,48 IC95% 0,27-8). Conclusión: la frecuencia de ansiedad y depresión en pacientes con síndrome de fibromialgia fue elevada. Sólo se halló asociación entre ésta y ansiedad.

Objective: To determine the association between Depression and Anxiety with Fibromyalgia Syndrome in patients attended by outpatient care centers in three districts of Chiclayo, Perú. Material and methods: analytical prospective case-control in which patients from the offices of Internal Medicine and Rheumatology of the 3 care centers in Chiclayo that got inclusion and exclusion criteria for cases and controls, who were assessed by structured interview to epidemiological data and using the Zung test for Anxiety and Depression. It was a study with descriptive statistics, with absolute and relative frequencies. Odds ratio was measured for depression and anxiety with their respective confidence intervals, with a significance level of 0.05. It was used statistical program Epidat v3.1 and SPSS v17 for Windows. Results: 208 patients were included, 52 (25%) were cases and 156 (75%) controls. There was more frequency of Fibromyalgia Syndrome (FMS) in women 48 (92%); most of patients with FMS were depressed and anxious at some level: 50 (96.2%) y 48 (92.3%) respectively, level of depression was severe 20 (38.4%) in most of patients and most common anxiety level was minimum-moderate 26 (50%). Association between FMS and anxiety was found (OR=9.7 IC95% 3.129.5); however it was not the same with variable depression (OR=1.48 IC95% 0.27-8.0). Conclusion: frequency of anxiety and depression in FMS patients is high, however, only anxiety was found to be significantly associated with fibromyalgia Syndrome.