Pancreatic beta cell function and insulin resistance profiles in first-degree relatives of patients with prediabetes and type 2 diabetes.

AIMS: To evaluate insulin secretion and insulin resistance profiles in individuals with family history of prediabetes and type 2 diabetes. METHODS: This was a cross-sectional study to evaluate clinical and metabolic profiles between individuals with type 2 diabetes, prediabetes and their relatives. There were 911 subjects divided into five groups: (i) normoglycemic (NG), (ii) type 2 diabetes, (iii) prediabetes, (iv) first-degree relatives of patients with type 2 diabetes (famT2D), and (v) first-degree relatives of patients with prediabetes (famPD); anthropometrical, biochemical and nutritional evaluation, as well as insulin resistance and pancreatic beta cell function measurement was performed by oral glucose tolerance to compare between groups. RESULTS: The most prevalent type 2 diabetes risk factors were dyslipidemia (81%), family history of type 2 diabetes (76%), central obesity (73%), male sex (63%), and sedentary lifestyle (60%), and most of them were progressively associated to prediabetes and type 2 diabetes groups. Insulin sensitivity was lower in famT2D groups in comparison to NG group (p < 0.0001). FamPD and famT2D had a 10% lower pancreatic beta cell function (DI) than the NG group (NG group 2.78 ± 1.0, famPD 2.5 ± 0.85, famT2D 2.4 ± 0.75, p˂0.001). CONCLUSIONS: FamPD and famT2D patients had lower pancreatic beta cell function than NG patients, highlighting that defects in insulin secretion and insulin sensitivity appear long time before the development of hyperglycemia in patients genetically predisposed.

Effect of metformin and metformin/linagliptin on gut microbiota in patients with prediabetes.

Lifestyle modifications, metformin, and linagliptin reduce the incidence of type 2 diabetes (T2D) in people with prediabetes. The gut microbiota (GM) may enhance such interventions' efficacy. We determined the effect of linagliptin/metformin (LM) vs metformin (M) on GM composition and its relationship to insulin sensitivity (IS) and pancreatic ß-cell function (Pßf) in patients with prediabetes. A cross-sectional study was conducted at different times: basal, six, and twelve months in 167 Mexican adults with prediabetes. These treatments increased the abundance of GM SCFA-producing bacteria M (Fusicatenibacter and Blautia) and LM (Roseburia, Bifidobacterium, and [Eubacterium] hallii group). We performed a mediation analysis with structural equation models (SEM). In conclusion, M and LM therapies improve insulin sensitivity and Pßf in prediabetics. GM is partially associated with these improvements since the SEM models suggest a weak association between specific bacterial genera and improvements in IS and Pßf.

Doxycycline Prevents Preclinical Atherosclerosis, Pancreatic Islet Loss and Improves Insulin Secretion after Glycemic Stimulation: Preclinical Study in Individuals with a High-Fat Diet.

Doxycycline (Doxy) is an antibiotic, which has exhibited anti-inflammatory activity and glucose metabolism improvement. The present study was proposed to evaluate its effects on glucose metabolism and other associated processes, such as lipemia and adipogenesis, as well as, to evaluate its effects on the liver, pancreas, and aorta in subjects fed with an occidental high-fat diet (HFD). The trial followed three groups of BALB/c mice for 6 months: (1) Standard diet (SD); (2) HFD-placebo (saline solution); and (3) HFD-Doxy (10 mg/kg/day). Intrahepatic fat accumulation (steatohepatosis) and the epididymal fat pad, as well as the hepatic inflammatory infiltrate and ALT serum levels were higher in both groups with the HFD (with/without doxycycline) in comparison with the SD group. The thickness of the aorta (preclinic atherosclerosis) was significantly elevated in the HFD group with respect to the HFD + Doxy and SD group, these two being similar groups to each other. The HFD-Doxy group had pancreatic morphological parameters very similar to those of the SD group; on the contrary, the HFD group reduced the number of pancreatic islets and the number of ß cells per mm2, in addition to losing large islets. The index of ß cell function (∆Insulin0-30/∆Glucose0-30 ratio) was significantly higher in the HFD + Doxy group, compared to the rest of the groups.

[Delta of neutrophil lymphocyte index and mortality in covid-19 disease]. / Delta del índice neutrófilo linfocito y mortalidad en infección COVID-19.

Background: Acute respiratory distress syndrome, due to SARS-CoV-2, is a worldwide health problem. The neutrophil-lymphocyte index allows risk stratification in patients with severe and poor prognostic data, since it reflects the inflammatory state. Objective: To determine whether the Neutrophil-Lymphocyte Index delta predicts mortality in patients with COVID-19. Material and methods: We conducted a longitudinal, comparative study in patients with COVID-19, older than 18 years, admitted to the ICU. We evaluated HAS, DM, obesity, COPD, asthma, PaO2/FiO2, tomographic severity. On admission and on days 3 and 7 we measured Neutrophil-Lymphocyte Index, SOFA and APACHE score. For statistical analysis, we performed ROC and Kaplan-Meyer curves. Results: We included 180 patients with COVID-19, 63 died (35%). Delta INL1(Day1-day3)>4.11 was associated with mortality (AUC:0.633); sensitivity 55.56% and specificity 77.78%, CI95 0.55-0.70, for delta INL2 (Day1-day7)>8.95 (AUC:0.623); sensitivity 44.44% and specificity 84.62%, CI95 0.54-0.69. Difference in survival was observed for Delta1. SOFA scale >6, was associated with more days of mechanical ventilation and lower PaO2/FiO2 (p<0.001). Conclusions: INL delta between the day of ICU admission and the 3rd day of evolution is a predictor of mortality in critically ill patients.

Introducción: El síndrome de dificultad respiratoria aguda, por SARS-CoV-2, es un problema mundial de salud. El índice neutrófilo-linfocito, permite estratificar el riesgo en pacientes con datos de severidad y mal pronóstico, ya que refleja el estado inflamatorio. Objetivo: Determinar si el delta del Índice Neutrófilo-Linfocito predice mortalidad en pacientes con COVID-19. Material y métodos: Se realizó un estudio longitudinal, comparativo en pacientes con COVID-19, mayores de 18 años, ingresados a UCI. Evaluamos HAS, DM, Obesidad, EPOC, asma, PaO2/FiO2, severidad tomográfica., A su ingreso y los días 3 y 7 medimos Índice Neutrófilo-Linfocito, puntaje SOFA y APACHE. En el análisis estadístico, realizamos curvas ROC y Kaplan-Meyer. Resultados: Incluimos 180 pacientes con COVID-19, 63 fallecieron (35%). Se asoció delta INL1(Día1-día3)>4.11 con mortalidad (AUC:0.633); sensibilidad 55.56% y especificidad 77.78%, IC95 0.55-0.70, para delta INL2 (Día1-día7)>8.95 (AUC:0.623); sensibilidad 44.44% y especificidad 84.62%, IC95 0.54-0.69. Se observó diferencia en la sobrevida para delta1. La escala SOFA >6, se asoció a más días de ventilación mecánica y PaO2/FiO2 menor (p<0.001). Conclusiones: El delta de INL entre el día de ingreso a UCI y el 3er día de evolución es predictor de mortalidad en pacientes críticamente enfermos.

Sensitivity and specificity of body mass index and main risk factors for cardiovascular disease in middle-income urban participants in Guanajuato, Mexico.

Introduction: Introduction: several studies have questioned body mass index (BMI) as an accurate diagnostic tool for obesity and therefore a predictor of cardiovascular risk. But BMI is widely used currently. Objective: we analyzed the sensitivity and specificity of BMI and compared cardiovascular risk factors in middle-income urban participants in Guanajuato, Mexico, at different ages. Design: an analytical and cross-sectional study was carried out in 385 apparently healthy subjects, stratified by age ranges (20 to 59 years old). A high global CVD risk was obtained with the Framingham risk score (Framingham Risk Score > 20 %). The odds ratio was used to assess the association between high global CVD risk and the dietetic and anthropometric variables. Sensitivity, specificity, and correlation statistical analyses were carried out between BMI and other anthropometric variables with high cardiovascular risk, and this was integrated to derive recommendations to improve risk factor detection (p < 0.05 and power of 80 %). Results: a high global CVD risk was found in 4 % of the sample. BMI ≥ 30 kg/m2 had a sensitivity of 77 % for the detection of high cardiovascular risk; waist circumference ≥ 90 cm (men) or ≥ 80 cm (women) and body fat percentage ≥ 2 5% (men) or ≥ 35 % (women) had a sensitivity of 100 %. BMI showed a significant association with high global CVD risk (OR = 6.1; 95 % CI, 1.6-22.6, p < 0.01), but was not able to predict high global CVD risk in at least 30 % of the cases. There was not significative difference by age group for waist circumference, body fat percentage, total cholesterol, and low-density lipoprotein. Regarding the comparison of dietary intake of the stratified population by age group, intake of cholesterol, added sugars, fiber, sodium were highest in the 20 years group. Conclusions: a higher intake of cholesterol, simple sugars, and sodium was observed in the 20-year-old age group. The use of BMI with waist circumference and percentage of body fat used together allow a better assessment of cardiovascular risk. We need to integrate this new recommendation to increase early detection of main risk factors for cardiovascular disease.

Introducción: Introducción: diversos estudios han cuestionado el índice de masa corporal (IMC) como herramienta diagnóstica certera de la obesidad y por tanto predictor de riesgo cardiovascular. Pero el IMC es ampliamente utilizado actualmente. Objetivo: se analizó la sensibilidad y especificidad del IMC y se compararon factores de riesgo cardiovascular en participantes de diferentes edades de zonas urbanas de ingresos medios en Guanajuato, México. Diseño: se realizó un estudio analítico y transversal en 385 participantes, aparentemente sanos, estratificados por rangos de edad (20 a 59 años). El riesgo de CVD global alto se obtuvo con la puntuación de riesgo de Framingham (puntuación de riesgo de Framingham > 20 %). Se calculó la odds ratio para evaluar la asociación entre el alto riesgo global de ECV y las variables dietéticas y antropométricas. Se realizó un análisis estadístico de sensibilidad, especificidad y correlación entre el IMC y otras variables antropométricas con el alto riesgo cardiovascular, y se integró para derivar recomendaciones para mejorar la detección de factores de riesgo (p < 0,05 y potencia del 80 %). Resultados: se encontró un alto riesgo global de ECV en el 4 % de la muestra. El IMC ≥ 30 kg/m2 tuvo una sensibilidad del 77 % para la detección del alto riesgo cardiovascular; la circunferencia de la cintura ≥ 90 cm (hombre) o ≥ 80 cm (mujer) y el porcentaje de grasa corporal ≥ 25 % (hombre) o ≥ 35 % (mujer) tuvo una sensibilidad del 100 %. El IMC mostró una asociación significativa con un alto riesgo global de ECV (OR = 6,1; IC 95 % 1,6-22,6; p < 0,01) pero no fue capaz de predecir un alto riesgo global de ECV en al menos el 30 % de los casos. No hubo diferencia significativa por grupo de edad para circunferencia de cintura, porcentaje de grasa corporal, colesterol total y lipoproteínas de baja densidad. Con respecto a la comparación de la ingesta dietética de la población estratificada por grupos de edad, la ingesta de colesterol, azúcares añadidos y sodio fue mayor en el grupo de 20 años. Conclusiones: se observó una mayor ingesta de colesterol, azúcares simples y sodio en el grupo de edad de 20 años. El uso del IMC con la circunferencia de la cintura y el porcentaje de grasa corporal utilizados conjuntamente permiten lograr una mejor evaluación del riesgo cardiovascular. Necesitamos contar con herramientas para aumentar la detección temprana de los principales factores de riesgo de enfermedad cardiovascular.

Effect of linagliptin plus insulin in comparison to insulin alone on metabolic control and prognosis in hospitalized patients with SARS-CoV-2 infection.

To evaluate the effect of the combination of linagliptin and insulin on metabolic control and prognosis in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hyperglycemia. A parallel double-blind randomized clinical trial including hospitalized patients with SARS-CoV-2 infection and hyperglycemia, randomized to receive 5 mg linagliptin + insulin (LI group) or insulin alone (I group) was performed. The main outcomes were the need for assisted mechanical ventilation and glucose levels during hospitalization. Subjects were screened for eligibility at hospital admission if they were not with assisted mechanical ventilation and presented hyperglycemia, and a total of 73 patients with SARS-CoV-2 infection and hyperglycemia were randomized to the LI group (n = 35) or I group (n = 38). The average hospital stay was 12 ± 1 vs 10 ± 1 days for the I and LI groups, respectively (p = 0.343). There were no baseline clinical differences between the study groups, but the percentage of males was higher in the LI group (26 vs 18, p = 0.030). The improvements in fasting and postprandial glucose levels were better in the LI group that the I group (122 ± 7 vs 149 ± 10, p = 0.033; and 137 ± 7 vs 173 ± 12, p = 0.017, respectively), and insulin requirements tended to be lower in the LI group than the I group. Three patients in the LI group and 12 in the I group required assisted mechanical ventilation (HR 0.258, CI 95% 0.092-0.719, p = 0.009); 2 patients in the LI group and 6 in the I group died after a follow-up of 30 days (p = 0.139). No major side effects were observed. The combination of linagliptin and insulin in hospitalized patients with SARS-CoV-2 infection and hyperglycemia reduced the relative risk of assisted mechanical ventilation by 74% and improved better pre and postprandial glucose levels with lower insulin requirements, and no higher risk of hypoglycemia.This study is registered at clinicaltrials.gov, number NCT04542213 on 09/03/2020.

Effect of linagliptin on glucose metabolism and pancreatic beta cell function in patients with persistent prediabetes after metformin and lifestyle.

The goal of the study was to evaluate the effect of adding linagliptin to metformin and lifestyle on glucose levels and pancreatic ß-cell function in patients with persistent impaired glucose tolerance (IGT) after 12 months of metformin and lifestyle. A single center parallel double-blind randomized clinical trial with 6 months of follow-up was performed in patients with persistent IGT after 12 months of treatment with metformin and lifestyle; patients were randomized to continue with metformin 850 mg twice daily (M group, n = 12) or linagliptin/metformin 2.5/850 mg twice daily (LM group, n = 19). Anthropometric measurements were obtained by standard methods and by bioelectrical impedance; glucose was measured by dry chemistry, insulin by chemiluminescence, and pancreatic ß-cell function was calculated with the disposition index using glucose and insulin values during oral glucose tolerance test (OGTT) and adjusting by insulin sensitivity. The main outcomes were glucose levels during OGTT and pancreatic ß-cell function. Patients in the LM group had a reduction in weight (-1.7 ± 0.6, p < 0.05) and body mass index (BMI, -0.67 ± 0.2, p < 0.05). Glucose levels significantly improved in LM group with a greater reduction in the area under the glucose curve during OGTT (AUCGluc0_120min) as compared to the M group (-4425 ± 871 vs -1116 ± 1104 mg/dl/120 min, p < 0.001). Pancreatic ß-cell function measured with the disposition index, improved only in LM group (2.3 ± 0.23 vs 1.7 ± 0.27, p 0.001); these improvements persisted after controlling for OGTT glucose levels. The differences in pancreatic ß-cell function persisted also after pairing groups for basal AUCGluc0_120min. The addition of linagliptin to patients with persistent IGT after 12 months of treatment with metformin and lifestyle, improved glucose levels during OGTT and pancreatic ß-cell function after 6 months of treatment.Trial registration: Clinicaltrials.gov with the ID number NCT04088461.

Trends, structural changes, and assessment of time series models for forecasting hospital discharge due to death at a Mexican tertiary care hospital.

BACKGROUND: Data on hospital discharges can be used as a valuable instrument for hospital planning and management. The quantification of deaths can be considered a measure of the effectiveness of hospital intervention, and a high percentage of hospital discharges due to death can be associated with deficiencies in the quality of hospital care. OBJECTIVE: To determine the overall percentage of hospital discharges due to death in a Mexican tertiary care hospital from its opening, to describe the characteristics of the time series generated from the monthly percentage of hospital discharges due to death and to make and evaluate predictions. METHODS: This was a retrospective study involving the medical records of 81,083 patients who were discharged from a tertiary care hospital from April 2007 to December 2019 (first 153 months of operation). The records of the first 129 months (April 2007 to December 2017) were used for the analysis and construction of the models (training dataset). In addition, the records of the last 24 months (January 2018 to December 2019) were used to evaluate the predictions made (test dataset). Structural change was identified (Chow test), ARIMA models were adjusted, predictions were estimated with and without considering the structural change, and predictions were evaluated using error indices (MAE, RMSE, MAPE, and MASE). RESULTS: The total percentage of discharges due to death was 3.41%. A structural change was observed in the time series (March 2009, p>0.001), and ARIMA(0,0,0)(1,1,2)12 with drift models were adjusted with and without consideration of the structural change. The error metrics favored the model that did not consider the structural change (MAE = 0.63, RMSE = 0.81, MAPE = 25.89%, and MASE = 0.65). CONCLUSION: Our study suggests that the ARIMA models are an adequate tool for future monitoring of the monthly percentage of hospital discharges due to death, allowing us to detect observations that depart from the described trend and identify future structural changes.

Effect of a family and interdisciplinary intervention to prevent T2D: randomized clinical trial.

BACKGROUND: Lifestyle changes can reduce the risk of T2D; however, no study has evaluated the effect of a lifestyle intervention involving patients´ family. The aim of this study was to compare the impact of an interdisciplinary family (FI) Vs individual intervention (II) on glucose metabolism, insulin resistance (IR), pancreatic ß-cell function and cardiovascular risk markers in patients with prediabetes, as well as to measure the impact on their families' metabolic risk. METHODS: Randomized Clinical Trial (RCT) to compare the impact of FI and II on IR and pancreatic ß-cell function in subjects with prediabetes. There were 122 subjects with prediabetes (and 101 family members) randomized to FI or II. Data were collected in 2015-2016 and analyzed in 2017-2018. FI group had the support of their family members, who also received personalized diet and exercise recommendations; patients and their family members attended monthly a lifestyle enhancement program. II group received personalized diet and exercise recommendations. The follow-up was for 12 months. Glucose, IR, pancreatic ß-cell function and secondary outcomes (body composition and lipid profile) were assessed at baseline, 6 and 12 months. RESULTS: FI group improved area under the glucose curve (AUC) (from 18,597 ± 2611 to 17,237 ± 2792, p = 0.004) and the Matsuda index (from 3.5 ± 2.3 to 4.7 ± 3.5, p = 0.05) at 12 months. II group improved Disposition Index (from 1.5 ± 0.4 to 1.9 ± 0.73, p < .0001) at 12 months. The improvements achieved in weight and lipids at 6 months, were lost in II group at 12 moths, whereas in FI persisted. Adherence up to 12 months was not different between the study groups (FI 56% Vs II 60%). CONCLUSIONS: FI intervention was more effective by improving glucose AUC, insulin sensitivity and lipid profile, besides that, metabolic risk in family members of the FI group was maintained, while the risk of II group was increased. TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov on December 15, 2015 (NTC026365646).

Progressive Shifts in the Gut Microbiome Reflect Prediabetes and Diabetes Development in a Treatment-Naive Mexican Cohort.

Type 2 diabetes (T2D) is a global epidemic that affects more than 8% of the world's population and is a leading cause of death in Mexico. Diet and lifestyle are known to contribute to the onset of T2D. However, the role of the gut microbiome in T2D progression remains uncertain. Associations between microbiome composition and diabetes are confounded by medication use, diet, and obesity. Here we present data on a treatment-naive cohort of 405 Mexican individuals across varying stages of T2D severity. Associations between gut bacteria and more than 200 clinical variables revealed a defined set of bacterial genera that were consistent biomarkers of T2D prevalence and risk. Specifically, gradual increases in blood glucose levels, beta cell dysfunction, and the accumulation of measured T2D risk factors were correlated with the relative abundances of four bacterial genera. In a cohort of 25 individuals, T2D treatment-predominantly metformin-reliably returned the microbiome to the normoglycemic community state. Deep clinical characterization allowed us to broadly control for confounding variables, indicating that these microbiome patterns were independent of common T2D comorbidities, like obesity or cardiovascular disease. Our work provides the first solid evidence for a direct link between the gut microbiome and T2D in a critically high-risk population. In particular, we show that increased T2D risk is reflected in gradual changes in the gut microbiome. Whether or not these T2D-associated changes in the gut contribute to the etiology of T2D or its comorbidities remains to be seen.

Comparison between metabolically healthy obesity and metabolically unhealthy obesity by different definitions among Mexican children.

Background There is no consensus on the definition of metabolically healthy obesity (MHO) and the diagnostic criteria in children. Objectives To estimate the prevalence of MHO and compare clinical and biochemical characteristics between MHO and metabolically unhealthy obesity (MUO), and to evaluate the association between MUO and cardiovascular disease (CVD) risk, anthropometrics and family background using different definitions in children. Methods This was a cross-sectional study. Participants included 224 obese children between the years 2007 and 2017. MHO was defined by three different criteria: (i) absence of metabolic syndrome (MHO-MS), (ii) no insulin resistance (IR) by homeostatic model assessment (HOMA) <3.16 cut-off (MHO-IR3.16) and (iii) absence of IR at <95th percentile for Mexican children (MHO-95th). Results The prevalence of MHO-MS, MHO-IR3.16 and MHO-IR95th was 12.9%, 56.3% and 41.5%, respectively. The prevalence of simultaneous MHO-MS plus MHO-IR95th was 5.36%. Children with MHO-MS vs. MUO-MS showed lower height, weight and body mass index (BMI) percentiles; MHO-IR3.16 vs. MUO-IR3.16 showed lower age, acanthosis, Tanner, waist circumference (WC), waist-to-height ratio (WHtR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and glucose; and MHO-IR95th vs. MUO-IR95th showed lower acanthosis, WC, DBP, glucose and high high-density lipoprotein cholesterol (HDL-C). MUO-MS was associated with WC > 90th, type 2 diabetes mellitus (T2DM) in first-degree relatives and obesity in siblings. MUO-IR3.16 was associated with pubertal stages, WC > 90th, WHtR > 0.55 and fasting hyperglycemia. MUO-IR95th was associated with WHtR > 0.55 and HDL < 10th. MHO-MS and MHO-IR3.16 or MHO-IR95th did not have agreement. Conclusions The prevalence of MHO varied depending on the definition, although the real MHO with no MS or IR is very low. Low DBP and high HDL-C in MHO were present in any definition. Association of MUO with anthropometric, biochemical and family background differs across definitions.

Pancreatic ß-cell dysfunction in normoglycemic patients and risk factors.

AIMS: To evaluate pancreatic ß-cell function (ßf) in patients with normoglycemia (NG) and normal glucose tolerance (NGT) and related risk factors. METHODS: An observational and comparative study in 527 patients with NG and NGT that were divided by quartiles of ßf according to the disposition index derived from OGTT. Anthropometrical, clinical, nutritional, and biochemical variables were measured and associated with ßf. RESULTS: Quartiles of ßf were Q1 = DI < 1.93 n = 131, Q2 = DI 1.93-2.45 n = 134, Q3 = DI 2.46-3.1 n = 133, and Q4 = DI > 3.1 n = 129. There was a progressive reduction in pancreatic ß-cell function and it is negatively correlated with age, weight, BMI, total body fat and visceral fat, waist circumference, total cholesterol, LDL, and triglycerides (p < 0.01). Glucose levels during OGTT had a negative correlation with ßf; the product of fasting glucose by 1-h glucose had the best correlation with ßf (r = 0.611, p < 0.001) and was the best predictor of ßdf (AUC 0.816, CI 95% 0.774-0.857), even better than 1-h glucose (r = 0.581, p < 0.001). Energy, fat, and carbohydrate intake were negatively correlated with ßf (p < 0.05). Glucose levels at 1-h OGTT > 110 mg/dl were positively associated with pancreatic ßdf (OR 6.85, CI 95% 3.86-12.4). In the multivariate analysis, glucose levels during OGTT, fasting insulin, and BMI were the main factors associated with ßf. CONCLUSIONS: A subgroup of patients with NG and NGT may have a loss of 40% of their ßf. Factors related to this ßdf were age, adiposity, glucose during OGTT, and the product of fasting and 1-h glucose, as well as food intake.

Clinical and Metabolic Characteristics among Mexican Children with Different Types of Diabetes Mellitus.

BACKGROUND: Current classification of diabetes mellitus (DM) is based on etiology and includes type 1 (T1DM), type 2 (T2DM), gestational, and other. Clinical and pathophysiological characteristics of T1DM and T2DM in the same patient have been designated as type 1.5 DM (T1.5DM). OBJECTIVES: The aim of this study was to classify pediatric patients with DM based on pancreatic autoimmunity and the presence or absence of overweight/obesity, and to compare the clinical, anthropometric, and biochemical characteristics between children in the different classes of DM. METHODS: A sample of 185 patients, recruited (March 2008-April 2015) as part of the Cohort of Mexican Children with DM (CMC-DM); ClinicalTrials.gov, identifier: NCT02722655. The DM classification was made considering pancreatic autoimmunity (via antibodies GAD-65, IAA, and AICA) and the presence or absence of overweight/obesity. Clinical, anthropometric and biochemical variables, grouped by type of DM were compared (Kruskal-Wallis or chi-squared test). RESULTS: The final analysis included 140 children; 18.57% T1ADM, 46.43% T1BDM, 12.14% T1.5DM, and 22.86% T2DM. Fasting C-Peptide (FCP), and hs-CRP levels were higher in T1.5DM and T2DM, and the greatest levels were observed in T1.5DM (p<0.001 and 0.024 respectively). CONCLUSIONS: We clearly identified that the etiologic mechanisms of T1DM and T2DM are not mutually exclusive, and we detailed why FCP levels are not critical for the classification system of DM in children. The findings of this study suggest that T1.5DM should be considered during the classification of pediatric DM and might facilitate more tailored approaches to treatment, clinical care and follow-up.

[Correlation between gait speed and muscular strength with balance for reducing falls among elderly]. / Correlación entre velocidad de marcha y fuerza muscular con equilibrio para reducir caídas en ancianos.

BACKGROUND: Evidence of the benefit on propioceptive neuromuscular facilitation for reducing falls in older people does not exist. OBJECTIVE: The aim of this study is to evaluate the effects of propioceptive facilitation over falls and biomechanical variables, in comparison to standard treatment and control groups. MATERIALS AND METHODS: Series cases comparative for the 24 participants were recruited and randomnly assigned to 3 groups. Group 1, propioceptive neuromuscular facilitation, group 2, standard treatment, and 3 control. Falls and biomechanic variables were measured before and after. Chi(2) was used for falls and multiple regression for biomechanical variables, RESULTS: Participants had similar falls in previous year. Women had higher falls in a relation 7:1 women-men. After intervention, there was no difference between 3 groups. A correlation exista between muscular strength and gait speed with one foot position time r(2) = 0.67, p = 0.02. CONCLUSIONS: Improving 1kilogram-force of muscular strength of pelvic limb and 0.1meter/second in gait speed, balance (unipodal position time) increases balance by 11.3%. After 3 months of intervention group 2 got 7.9kg-force and 0.26m/s of profit, while group 1 had 4.1kg-force and 0.15m/s and control group 2.4kg-force and 0.1m/s.

Safety of the oral methionine load test: effects on the clinical performance and laboratory tests.

INTRODUCTION: Hyperhomocysteinemia is a prothrombotic risk factor. Homocysteine is evaluated during fasting and after an oral methionine load (OML). AIM: To determine the safety of the OML test according to the general performance status and clinical laboratory tests. We studied healthy nonsmoking volunteers and patients with several thrombotic conditions. Before and after receiving an OML, blood samples were obtained to perform several laboratory tests. We also evaluated acute and subacute adverse effects and 30-day associated morbidity and mortality. Of 353 individuals, three were eliminated because they did not tolerate the OML. We studied 175 healthy individuals and 175 patients without age differences. After OML, mild to moderate clinical abnormalities were recorded in 78 subjects (22.1%): nausea (n = 69; 88.5%), dizziness (n = 13; 16.7%) and decreased or increased blood pressure (n = 8; 10.2%). Nausea always disappeared after breakfast in affected individuals. Prevalence of complications was similar in patients and controls. No patient required hospitalization and there was no mortality during the 30-day study period. In conclusion, OML test had no significant undesirable effects on the clinical status or the general laboratory tests of patients and healthy controls. Some mild and moderate symptoms associated with OML tests were observed, and OML test did not negatively affect general laboratory tests. OML test is a safe diagnostic procedure in patients with previous thrombotic events (and with the consequent associated risk factors such as diabetes mellitus or dyslipidemia) and in healthy subjects.

Fibrinogen is associated with silent myocardial ischaemia in type 2 diabetes mellitus.

OBJECTIVE: Because traditional risk factors only partially explain coronary events, it is necessary to search for new ones like fibrinogen which has been related with coronary disease in healthy middle-aged adults. We attempted to determine the impact of fibrinogen on silent myocardial ischaemia (SMI) in diabetic patients. METHODS AND RESULTS: In a cross-sectional study, 134 type 2 diabetes patients with no history of cardiovascular disease were assessed for SMI. A personal history and physical evaluation of each patient was conducted as well as evaluation of cholesterol, glucose, fibrinogen, blood cell counts, glycated haemoglobin, urine albumin quantification, and urinalysis. A modified Bruce test was performed on all study participants to evaluate the presence of SMI. RESULTS: Eleven patients had SMI (8.2%) that was associated with systolic, diastolic and mean blood pressure, hypertension, and fibrinogen. The correlation coefficient was obtained for quintiles of fibrinogen with the percentage of patients with SMI in that quintile (r = 0.97; 95% = 0.66-0.99). Fibrinogen levels were associated with SMI. A receiver-operator curve analysis showed that the cutoff value for fibrinogen to predict SMI was 400 mg/dL (82% sensitivity, 81% specificity). A cutoff value of 306 mg/dL of fibrinogen would rule in the diagnosis of SMI (100% sensitivity, 17% specificity), while fibrinogen cutoff of 682 mg/dL would rule out SMI (100% specificity, 9% sensitivity). CONCLUSIONS: Fibrinogen strongly predicts SMI in diabetic patients and may identify individuals with high cardiovascular risk. Fibrinogen should be evaluated in diabetic patients for a more accurate cardiovascular evaluation.

Nonspecific lymphocytic myocarditis in baboons is associated with Trypanosoma cruzi infection.

Non-specific lymphocytic myocarditis (NLM) is frequently observed in baboons within the endemic range of Trypanosoma cruzi. We sought to determine whether T. cruzi infection is a cause of baboon NLM. We evaluated serial histologic sections of cardiac muscle, blood cultures, immunohistochemistry, serology, polymerase chain reaction, and clinical pathology from 31 baboons with NLM to determine whether T. cruzi infection is associated with NLM. Eleven baboons with no evidence of T. cruzi infection by serology and no NLM were used as controls. Seropositivity for T. cruzi was 45% in baboons with NLM compared with a 2-3% colony prevalence. NLM lesion severity was significantly higher in seropositive than seronegative baboons with NLM. NLM was significantly more common in older baboons. No statistical association between NLM and sex, weight, or clinical pathology was found. These results suggest an association between NLM and T. cruzi infection in the baboon.

Activated protein C resistance and factor V Leiden in Mexico.

A common cause of hereditary thrombophilia is activated protein C resistance (APCR), and most cases result from factor V Leiden mutation. An APCR phenotype without association with factor V Leiden has been described. This transversal, observational, nonrandomized study evaluated these 2 phenomena in healthy indigenous and mestizo Mexican subjects (n = 4345), including 600 Mexican natives. No indigenous subjects had APCR, but 82 mestizo subjects did. After retesting, 50 subjects had a negative test. The remaining 32 subjects had factor V Leiden, giving a 0.85% prevalence of factor V Leiden in the mestizo Mexican population. Only 31% of APCR carriers had factor V Leiden. These results show a very low prevalence of APCR and factor V Leiden in Mexico. Except for factor V Leiden, there are no other mutations in the factor V gene responsible for the APCR phenotype. Acquired APCR is nearly twice as prevalent as the inherited variant.