Diabetic Euglycemic Ketoacidosis Induced by Oral Antidiabetics Type SGLT2i.

Euglycemic diabetic ketoacidosis (euglycemic DKA) is a serious complication of diabetes, which can occur in some patients treated with oral antidiabetics called sodium-glucose co-transporter 2 inhibitors (SGLT2i). This group of drugs works by increasing renal excretion of sodium and glucose, thereby lowering blood glucose levels. Euglycemic DKA is characterized by having blood glucose levels in the normal range, usually below 200 mg/dL (11 mmol/L), which complicates early diagnosis. We present the case of a 67-year-old patient with type 2 diabetes mellitus, treated with metformin and empagliflozin, who was admitted to the Intensive Care Unit in a coma with severe ketoacidotic decompensation.

Seguridad y supervivencia de las terapias biológicas: primer informe del registro paraguayo-uruguayo de acontecimientos adversos con terapias biológicas Biobadaguay / Safety and survival associated with biologic therapies: first report of the biobadaguay on the Paraguayan-Uruguayan registry of adverse events with biologic therapies

OBJETIVOS: Analizar los acontecimientos adversos (AA) y la supervivencia de las terapias biológicas (TB) en el registro paraguayo-uruguayo de AA, Biobadaguay. MÉTODO: Estudio observacional, prospectivo de duración indeterminada. Se han incluido pacientes al inicio de la TB y controles. Se han registrado variables clínicas, biológicas y relacionadas con el tratamiento. RESULTADOS: Se realizaron 826 registros (650 TB y 176 controles). El 70,9% fueron mujeres y el diagnóstico más frecuente fue la artritis reumatoide (AR) (63,2%). La TB más utilizada fue el adalimumab (56,6%) y la causa más frecuente de interrupción, la ineficacia (42,1%). La incidencia de AA en pacientes con TB fue de 143,9 (128,8-160,8) por 1.000 pacientes/año. En el estudio comparativo de AA en función del diagnóstico, se observó que la artritis idiopática juvenil (AIJ) se asoció a más AA globales (RTI = 2,3; IC 95%: 1,6-3,4; p = 4,27×10−6), mientras que la AR se asoció a un mayor número de AA graves (RTI = 2,20; IC 95%: 1,2-4,1; p = 1,17×10−2). Por otro lado, el tratamiento con tocilizumab se asoció a una mayor tasa de AA (RTI = 2,69; IC 95%: 1,90-3,82; p = 3,13×10−8). El diagnóstico de AIJ, el tratamiento con corticoides y el número de TB previas se asociaron a la disminución de la supervivencia de las TB. CONCLUSIÓN: En este primer informe del registro Biobadaguay, la principal causa de interrupción de la TB fue la ineficacia. Con relación al diagnóstico, la AR y la AIJ se asociaron a un mayor riesgo de AA. En este registro, se identificaron variables relacionadas a una menor supervivencia de las TB

OBJECTIVE: Analyze adverse events (AE) and survival associated with biologic therapies (BT) in the Biobadaguay, the Paraguayan Uruguayan registry of adverse events. METHODS: Prospective, observational study of undetermined duration. Patients on BT at initiation and controls were included. Clinical, biological and treatment variables were registered. RESULTS: A total of 826 registers were entered (650 BT and 176 controls); 70.9% were women and rheumatoid arthritis (RA) was the most frequent diagnosis (63.2%). The BT most often used was adalimumab and the main cause of discontinuation was loss of efficacy (42.1%). The incidence of AE of patients on BT was 143.9 (128.8-160.8) per 1000 patients/year. In the comparative study of AE related to diagnosis, juvenile idiopathic arthrosis (JIA) was associated with a higher overall number of AE (RTI = 2.3; 95%CI: 1.6-3.4; P = 4.27 ×10−6), whereas RA was associated with a higher number of serious AE (RTI = 2.2; 95% CI: 1.2-4.1; P =1.17 ×10−2). On the other hand, treatment with tocilizumab was associated with a higher rate of AE (RTI = 2.69; 95% CI: 1.9-3.82; P = 3.13 ×10−8). In JIA, treatment with corticosteroids and number of previous BT was associated with a decrease in BT survival. CONCLUSION: In this first report of the Biobadaguay registry, the main cause of BT discontinuation was loss of efficacy. In terms of the diagnosis involved, RA and JIA were associated with a higher risk of AE. In this registry, variables related to a shorter survival of BT were identified

Safety and Survival Associated with Biologic Therapies: First Report of the Biobadaguay on the Paraguayan-Uruguayan Registry of Adverse Events with Biologic Therapies. / Seguridad y supervivencia de las terapias biológicas: primer informe del registro paraguayo-uruguayo de acontecimientos adversos con terapias biológicas Biobadaguay.

OBJECTIVE: Analyze adverse events (AE) and survival associated with biologic therapies (BT) in the Biobadaguay, the Paraguayan Uruguayan registry of adverse events. METHODS: Prospective, observational study of undetermined duration. Patients on BT at initiation and controls were included. Clinical, biological and treatment variables were registered. RESULTS: A total of 826 registers were entered (650 BT and 176 controls); 70.9% were women and rheumatoid arthritis (RA) was the most frequent diagnosis (63.2%). The BT most often used was adalimumab and the main cause of discontinuation was loss of efficacy (42.1%). The incidence of AE of patients on BT was 143.9 (128.8-160.8) per 1000 patients/year. In the comparative study of AE related to diagnosis, juvenile idiopathic arthrosis (JIA) was associated with a higher overall number of AE (RTI = 2.3; 95%CI: 1.6-3.4; P = 4.27 ×10-6), whereas RA was associated with a higher number of serious AE (RTI = 2.2; 95% CI: 1.2-4.1; P =1.17 ×10-2). On the other hand, treatment with tocilizumab was associated with a higher rate of AE (RTI = 2.69; 95% CI: 1.9-3.82; P = 3.13 ×10-8). In JIA, treatment with corticosteroids and number of previous BT was associated with a decrease in BT survival. CONCLUSION: In this first report of the Biobadaguay registry, the main cause of BT discontinuation was loss of efficacy. In terms of the diagnosis involved, RA and JIA were associated with a higher risk of AE. In this registry, variables related to a shorter survival of BT were identified.

¿Macroamilasemia o hiperamilasemia en un paciente con dolor abdominal? / Macroamylasaemia or hyperamylasaemia in a patient with abdominal pain?

La macroamilasemia debe sospecharse cuando un paciente presenta una concentración catalítica elevada de la α-amilasa plasmática, sin la presencia de datos clínicos que confirmen la existencia de una enfermedad pancreática o parotídea. La macroamilasemia, en la mayoría de los casos, es un complejo formado por la α-amilasa y las inmunoglobulinas plasmáticas que causa una hiperamilasemia con la amilasuria normal o baja. El diagnóstico diferencial con las otras causas de hiperamilasemia es imprescindible para evitar las exploraciones complementarias y los tratamientos invasivos innecesarios. Se presenta el caso de un varón de 53 años con dolor abdominal e hiperamilasemia, diagnosticado inicialmente de pancreatitis aguda. Macroamylasaemia should be suspected when a patient has a high catalytic concentration of plasma α-amylase in the absence of clinical data confirming the existence of a pancreatic or parotid disease (AU)

In most cases, macroamylasaemia is a complex of α-amylase bound to plasma immunoglobulins that cause hyperamylasaemia with low or normal urine amylase. The differential diagnosis with other causes of hyperamylasaemia is essential to avoid unnecessary additional examinations and invasive treatments. The case is presented of a 53 year-old male with abdominal pain and a high plasma amylase, initially diagnosed with acute pancreatitis (AU)

The role of the HIF-1α transcription factor in increased cell division at physiological oxygen tensions.

HIF-1 is a transcription factor that mediates the cellular responses to low oxygen environments, mainly as a result of having an oxygen-labile subunit, HIF-1α. HIF-1α has been carefully studied in the context of severe hypoxic stresses (<1% O2), but it is also known to be present at oxygen tensions commonly found in normal tissues in vivo (∼1-13% O2), albeit at much lower levels. Its role under these physiological conditions is not fully understood. Here, we show that a transcriptionally active HIF-1α was up-regulated at 5% O2, both in normal and cancer cells, but only some of its target genes were elevated as a result. HIF-1α induction was in part dependent on the activation of the ERK1/2 MAPK signalling pathway, which we have previously shown is active at 5% O2. We also found that HIF-1α does not contribute to the protection against DNA damage that can be observed in low oxygen environments, and that there are certain DNA damaging agents, such as doxorubicin and actinomycin D, that prevent HIF-1α induction independently of p53. Moreover, absence of HIF-1α significantly reduced the growth advantage of cells cultured at 5% O2. In view of these data, we conclude that HIF-1α can be induced and activated at physiological oxygen tensions in a MAPK-dependent manner and that, although this does not lead to pro-survival responses to stress, it determines the increased cell proliferation rates that are common under these conditions.

Evaluación de algunos parámetros inmunológicos y epidemiológicos / pacientes con poliposis nasal de localización etmoidal / Evaluation of some immunological and epidemiological parameters in patients with ethmoidal nasal polyposis

La poliposis nasal es una enfermedad crónica inflamatoria de la mucosa rinosinusal que afecta entre 1 por ciento a 5 por ciento de la población general. Si bien se han encontrado varias citocinas implicadas en la patogénesis de la poliposis, el mecanismo fisiopatológico permanece por esclarecer. En este trabajo se determinó la presencia de Interleucina 13 (IL-13) tanto en secreción como en tejido de mucosa sana y polipoide, y se relacionó este hallazgo con la reactividad alérgica de los pacientes y el grado de infiltración por células CD4+ y CD8+ Métodos: Se estudiaron 27 pacientes con poliposis diagnosticada por TAC, de los cuales se obtuvo historia clínica completa, muestra de secreción mucosa y biopsia de tejido polipoide y de mucosa sana. Mediante ELISA se detectó la presencia de IL-13 en las secreciones del tejido nasal sano o afectado por pólipos y por inmunohistoquímica se detectaron células IL-13 + y linfocitos T CD4+ y CD8+, tanto en tejido sano como afectado. Además se realizaron pruebas cutáneas para aeroalergenos. Resultados: En todos los pólipos se encontraron células IL13 +. En todos los casos se detectaron células CD4+ y CD8+, tanto en la mucosa normal como en el tejido polipoide. Sin embargo, el grado de infiltración fue mayor en este último. No se encontró asociación entre el grado de infiltración de células IL13+, CD4+ y CD8+ con la reactividad a las pruebas cutáneas. No hubo diferencia significativa en la concentración de IL-13 en secreción mucosa de pólipo respecto a mucosa sana. No hubo correlación entre los datos demográficos y los antecedentes familiares con el grado de infiltración de células IL13+, CD4+ y CD8+. Conclusiones: Se encontró en las biopsias estudiadas una alta densidad de células positivas para IL-13. En 14/27 casos las concentraciones de IL-13 fueron mayores que las del tejido nasal normal con niveles de hasta 120 pg/ul. No se demostró asociación entre el estado alérgico con la expresión de células IL-13+, ni con el grado de infiltración de linfocitos T CD4+ y CD8.

Nasal Polyposis is a chronic inflammatory disease of the rhinosinusal mucosa that affects 1% to 5% of the general population. Several cytokines have been detected in high concentrations in polyp tissues, but the mechanisms implicated remains to be clarified. In this work the presence of Interleukine 13 (IL-13) was determined as much in secretion as in healthy mucous membrane and polyp tissue, relating this finding with the allergic reactivity of the patients and the infiltration grade for cellsCD4 + and CD8 +. Methods: We studied 27 patients with diagnosed ethmoidal nasal polyposis confirmed by computerized tomography. Secretions and biopsy specimens were taken from both polyp and healthy turbinate tissues. IL-13 ELISA technique was done in secretion samples and an immunohistochemical procedure was realized to detect IL-13+, CD4+ and CD8+ cells in biopsy specimens. Additionally, skin tests for air allergens were done. Results: IL-13+ cells were detected in all nasal polyp samples. CD4+ and CD8+ cells were found in both polyp and healthy turbinate tissues; however, the infiltration degree was higher in the nasal polyp specimens. No association was found between the degree of infiltration of IL-13+, CD4+ and CD8+ cells with the skin test reactivity. Equally concentrations of IL-13 were detected in both polyp and turbinate mucosa secretions. There was no association between the demographic data and the family history with the degree of infiltration of IL-13+, CD4+, CD8+ cells. Conclusion: Our findings confirm the presence of and increase number of IL-13+ cells in all nasal polyp specimens. In 14/27 studied cases they had concentrations of IL-13 higher than those of the nasal normal mucosa with levels of up to 120 pg / ul. There is no association between the allergic state with the IL-13+cell expression, nor with the degree of infiltration of CD4+ and CD8+ T cells.

Aspectos epidemiológicos sobre la poliomielitis y su prevención por medio de las vacunas. Artículos de revisión / Epidemic aspects on the poliomyelitis and their prevention by vaccines. Revision articles

La Poliomielitis es una enfermedad infectocontagiosa viral que puede causar parálisis muscular progresiva e incluso la muerte. Existen dos tipos de vacunas, una oral (OPV a virus atenuados y otra inyectable (IPV) a virus inactivados. En 1987 fue sintetizada la vacuna inactivada de potencia aumentada (eIPV). Estas han permitido reducir considerablemente la tasa de morbilidad. En Paraguay el último caso registrado fue en 1985 y en Sudamérica en 1991. Según la OMS se podría alcanzar la erradicación global en el 2003. El esquema de inmunización universal fue establecido en 1995 y es actualizado cada año. Según la SLIPE, se está llegando al momento de balancear y evaluar la posibilidad de esquemas vacunación secuenciales que tienen ventaja de utilizar lo mejor de ambas vacunas, asegurar la inmunidad y a la vez reducir o eliminar la poliomielitis paralítica asociada a la OPV...