Latent Autoimmune Diabetes in Adults: a case report.

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune endocrine disorder in which despite the presence of antipancreatic islets antibodies in the moment of diagnostics, the progression to beta-cell secretory insufficiency is slow. It is often confused with others types of diabetes and therefore the management is frequently inadequate. We report a clinical case of a 23-year-old man with diagnosis of type 2 diabetes since 6 months ago, poorly controlled with a sulfonylurea, who initially presented 2 months ago from polyuria, polydipsia, and asthenia and 6 kg weight loss. History of past illness was negative, however, his mother relates exclusive breastfeeding during the first 15 days of life and later (until the 6 months) he was fed with infant formula (S-26). Family history revealed a first-degree relative (father) with diabetes mellitus secondary to steroid administration due to diagnosis of bone marrow hypoplasia. Also presents second-degree family history (uncle and grandfather) of type 2 diabetes mellitus. There were no pathologic findings at the physical examination. Anthropometry and laboratory tests were as follows: body mass index (BMI) = 19.66 kg/m, basal and postprandial glycemia = 108, and 276 mg/dL respectively, glycated haemoglobin = 8.9%, basal and postprandial C-peptide (2 hours) = 1.9, and 3.2 ng/mL, homeostasis model assessment of beta cell function: 87.5%, homeostasis model assessment of insulin resistance: 1.6. LADA presumptive diagnosis was confirmed with presence of autoantibodies anti-tyrosin-phosphatase and GAD65. At the time of diagnosis, individuals with LADA present an onset age <50, BMI <25 kg/m2, low magnitude postprandial and basal hyperglycemia, normal or close to normal C-peptide values, and thus not occur with acute hyperglycemic crises. Insulin therapy preserves pancreatic b-cell function, at the point that eventually prescribed insulin doses need to be reduced.

An elevated level of physical activity is associated with normal lipoprotein(a) levels in individuals from Maracaibo, Venezuela.

Coronary artery disease is the main cause of death worldwide. Lipoprotein(a) [Lp(a)], is an independent risk factor for coronary artery disease in which concentrations are genetically regulated. Contradictory results have been published about physical activity influence on Lp(a) concentration. This research aimed to determine associations between different physical activity levels and Lp(a) concentration. A descriptive and cross-sectional study was made in 1340 randomly selected subjects (males = 598; females = 712) to whom a complete clinical history, the International Physical Activity Questionnaire, and Lp(a) level determination were made. Statistical analysis was carried out to assess qualitative variables relationship by chi2 and differences between means by one-way analysis of variance considering a P value <0.05 as statistically significant. Results are shown as absolute frequencies, percentages, and mean +/- standard deviation according to case. Physical activity levels were ordinal classified as follows: low activity with 24.3% (n = 318), moderate activity with 35.0% (n = 458), and high physical activity with 40.8% (n = 534). Lp(a) concentration in the studied sample was 26.28 +/- 12.64 (IC: 25.59-26.96) mg/dL. Lp(a) concentration according to low, moderate, and high physical activity levels were 29.22 +/- 13.74, 26.27 +/- 12.91, and 24.53 +/- 11.35 mg/dL, respectively, observing statistically significant differences between low and moderate level (P = 0.004) and low and high level (P < 0.001). A strong association (chi2 = 9.771; P = 0.002) was observed among a high physical activity level and a normal concentration of Lp(a) (less than 30 mg/dL). A lifestyle characterized by high physical activity is associated with normal Lp(a) levels.

Origen étnico y enfermedad cardiovascular / Ethnicity and cardiovascular disease

La interacción entre el ambiente y la genética durante la evolución de la especie humana ha predispuesto al padecimiento de muchas enfermedades crónico-degenerativas comunes de nuestra sociedad occidentalizada. El genotipo “Thrifty”, producto de la adaptación del hombre paleolítico y neolítico al medio, se caracteriza por hiperinsulinemia sin inhibición de la gluconeogenesis, que, aunada al estilo de vida condiciona el desarrollo de enfermedades cardiovasculares (ECV). Múltiples hipótesis intentan explicar la elevada morbimortalidad por ECV en los diferentes grupos étnicos. Por ejemplo, las poblaciones afro-americanas presentan isoformas de proteínas desacoplantes relacionados con bajo gasto energético basal y metabolismo oxidativo de los ácidos grasos (AG) disminuido, así como una concentración elevada de Lipoproteína(a) y alta sensibilidad a la sal. La población asiática posee numerosos factores de riesgos cardiovasculares contrarrestados en parte por una dieta rica en PUFA´s ω-3. No obstante, los indio-asiáticos aún teniendo una dieta baja en AG saturados, presentan alta prevalencia de ECV, lo que se ha tratado de explicar por la expresión de un genotipo “Thrifty”. Las poblaciones hispánicas caracterizadas por su origen multirracial presentan alta incidencia de obesidad y diabetes relacionada a leptinorresistencia e insulinorresistencia, con hiperinsulinemia compensadora –de duración variable- que aparentemente precede a la hipertensión arterial esencial. En poblaciones indígenas norteamericanas como los Pima se observa la prevalencia más alta de diabetes a nivel mundial, sugiriéndose una conexión con el gen de la PPP1R3, niveles de TNF-α elevados e IL-6, entre otros.

Oligoastrocitoma anaplásico grado III con componente gemistocítico: reporte de un caso / Oligoastrocitoma with grade III anaplastic gemistocítico component: a case report

Los Oligoastrocitoma mixtos son una minoría (10 por ciento-19 por ciento) de los gliomas supratentoriales. Presentándose generalmente en adultos menores de 40 a¤os con leve predominío del sexo masculino. Su presentación más frecuente son las convulsiones. La presencia de gemistocitos en los gliomas se asocia con un curso clínico desfavorable. Los Oligoastrocitomas anaplásicos grado III con componente gemistoc¡ticos tiene una incidencia del 5 por ciento y una recurrencia de 40 por ciento-100 por ciento y estos pacientes cursan con una sobrevida de dos años, luego de la primera cirugía, aún con tratamiento adicional con radioterapia y/o químioterapia. Presentamos el caso de paciente femenino con 20 años quien debutó con cefalea y amaurosis. Al estudiarse, se diagnóstico tumor occipital derecho mixto, realizándose resección del mismo, la biopsia revelo Oligastrocitoma Anaplásico III (OMS) con importante componente gemistocítico. Egresada por mejoría clínica con tratamiento complementarío de radioterapia.