RESUMEN
The objective of the present study was to examine the effect of acute, methionine-induced hyperhomocysteinemia (HHCY) on endothelial function and indices of arterial stiffness in subjects with type 2 diabetes mellitus (T2DM). A total of 30 subjects with T2DM, free of macrovascular disease were examined in a crossover study. L-methionine (M) (0.1 g/kg) and water (W) load were given in random order with an interval of about 1 week in between. Endothelial function was assessed by flow-mediated vasodilation (FMD). Arterial stiffness was assessed by determination of augmentation index (AI). Measurements were performed in the fasting state, 1, 2 and 3 h after the M or the W load. Total plasma homocysteine (HCY) levels did not change after W administration, while M administration resulted in a significant increase in HCY concentrations at 3 h. FMD throughout the experiment expressed as area under the curve (AUC) was significantly lower after the M than after the W load. Consistent with impairment in endothelial function, the AUC of AI was significantly higher after the M than after the W administration. Acute HHCY impairs endothelial function and increases arterial stiffness in patients with T2DM. This effect is probably mediated by a reduction of nitric oxide bioavailability in endothelium.
Asunto(s)
Diabetes Mellitus Tipo 2/fisiopatología , Endotelio Vascular/efectos de los fármacos , Homocisteína/sangre , Hiperhomocisteinemia/inducido químicamente , Metionina/efectos adversos , Vasodilatación/efectos de los fármacos , Anciano , Glucemia/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Arteria Braquial/efectos de los fármacos , Arteria Braquial/fisiopatología , Colesterol/sangre , Diabetes Mellitus Tipo 2/complicaciones , Endotelio Vascular/fisiopatología , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hiperhomocisteinemia/complicaciones , Hiperhomocisteinemia/fisiopatología , Fase Luteínica , Masculino , Metionina/sangre , Persona de Mediana Edad , Triglicéridos/sangre , Agua/administración & dosificaciónAsunto(s)
Grasas de la Dieta/metabolismo , Proteínas en la Dieta/metabolismo , Metabolismo Energético/fisiología , Obesidad/sangre , Hormonas Peptídicas/sangre , Adulto , Composición Corporal/fisiología , Femenino , Ghrelina , Humanos , Persona de Mediana Edad , Valores de Referencia , Estadísticas no ParamétricasRESUMEN
We report the case of a 65-year-old woman with rheumatoid arthritis (RA) under corticosteroid therapy who presented with high fever and dyspnea and who, within 48 h, developed acute respiratory distress syndrome (ARDS) due to Mycobacterium tuberculosis (MTB). Miliary tuberculosis is a rare cause of ARDS; however, because of its ominous outcome, it should be included in the differential diagnosis of immunocompromised patients with rapidly worsening respiratory discomfort. A brief review of miliary tuberculosis as a cause of ARDS is presented.
