Community Emergence of Cefixime-Resistant Escherichia coli Belonging to ST12 with Chromosomal AmpC Hyperproduction.

Escherichia coli isolates that are resistant to cefixime and amoxicillin/clavulanic acid, but apparently susceptible to cefuroxime, with no ESBL identified, were initially detected in Madrid from urine samples in 2019. Throughout 2020 and 2021, all cases of community UTI by E. coli from six health areas in Madrid were studied. A representative sample of 23 cases was selected for further studies. The broth microdilution method and the agar diffusion method were performed to determine the antibiotic susceptibility. WGS was carried out for phylogeny, resistome and virulome analysis. Community consumption of third-generation oral cephalosporins in Madrid (2017-2021) was analyzed. A total of 582 (1.3%) E. coli isolates had the mentioned resistance profile. The mutation at position -32 (T > A) of the AmpC promoter was found in 21 isolates. No plasmid AmpC- or ESBL-encoding genes were detected. A cluster of 20 ST12 isolates was detected by cgMLST. A 6.2% increase in the consumption of third-generation oral cephalosporins, especially cefixime, was observed in Madrid. Chromosomal AmpC-hyperproducing ST12 E. coli isolates could be implicated in the increase in community UTI cases by cefixime-resistant isolates, which correlates with an increasing trend of cefixime consumption.

Risk analysis sampling methods in terrorist networks based on the Banzhaf value.

This article introduces the Banzhaf and the Banzhaf-Owen values as novel measures of risk analysis of a terrorist attack, determining the most dangerous terrorists in a network. This new approach counts with the advantage of integrating at the same time the complete topology (i.e., nodes and edges) of the network and a coalitional structure on the nodes of the network. More precisely, the characteristics of the nodes (e.g., terrorists) of the network and their possible relationships (e.g., types of communication links), as well as coalitional information (e.g., level of hierarchies) independent of the network. First, for these two new measures of risk analysis, we provide and implement approximation algorithms. Second, as illustration, we rank the members of the Zerkani network, responsible for the attacks in Paris (2015) and Brussels (2016). Finally, we give a comparison between the rankings established by the Banzhaf and the Banzhaf-Owen values as measures of risk analysis.

Prevalence of fosA3 Gene in Fosfomycin-Resistant Proteus mirabilis in the Autonomous Community of Madrid (Spain) and Characterization of Two Positive Strains.

Plasmid-mediated resistance to fosfomycin has been seldom described in Proteus mirabilis. We report two strains harboring fosA3 gene. Whole-genome sequencing revealed a plasmid that encoded fosA3 gene flanked by two insertion sequence (IS)26 mobile elements. Both strains also produced the blaCTX-M-65 gene that was located in the same plasmid. The sequence detected was IS1182-blaCTX-M-65-orf1-orf2-IS26-IS26-fosA3-orf1-orf2-orf3-IS26. The importance of this transposon lies in its ability to spread in Enterobacterales, therefore, epidemiological surveillance should be carried out.

Physicochemical and Microbiological Stability of Two Oral Solutions of Methadone Hydrochloride 10 mg/mL.

In this article, we studied physicochemical and microbiological stability and determined the beyond-use date of two oral solutions of methadone in three storage conditions. For this, two oral solutions of methadone (10 mg/mL) were prepared, with and without parabens, as preservatives. They were packed in amber glass vials kept unopened until the day of the test, and in a multi-dose umber glass bottle opened daily. They were stored at 5 ± 3 °C, 25 ± 2 °C and 40 ± 2 °C. pH, clarity, and organoleptic characteristics were obtained. A stability-indicating high-performance liquid chromatography method was used to determine methadone. Microbiological quality was studied and antimicrobial effectiveness testing was also determined following European Pharmacopoeia guidelines. Samples were analyzed at days 0, 7, 14, 21, 28, 42, 56, 70, and 91 in triplicate. After 91 days of storage, pH remained stable at about 6.5-7 in the two solutions, ensuring no risk of methadone precipitation. The organoleptic characteristics remained stable (colorless, odorless, and bitter taste). The absence of particles was confirmed. No differences were found with the use of preservatives. Methadone concentration remained within 95-105% in all samples. No microbial growth was observed. Hence, the two oral methadone solutions were physically and microbiologically stable at 5 ± 3 °C, 25 ± 2 °C, and 40 ± 2 °C for 91 days in closed and opened amber glass bottles.

Prevalence, detection and characterisation of fosfomycin-resistant Escherichia coli strains carrying fosA genes in Community of Madrid, Spain.

OBJECTIVES: The aim of this this study was to describe the presence of different variants of the fosA gene in fosfomycin-resistant Escherichia coli strains in Madrid, Spain. METHODS: fos genes were searched for in 55 E. coli strains collected from seven representative hospitals located in Madrid. A phenotypic screening test was performed following the disk diffusion method with sodium phosphonoformate added as described by Nakamura et al. Additionally, a molecular study based on PCR was used to confirm the screening results. Positive strains for fos genes were further subjected to whole-genome sequencing (WGS). RESULTS: Phenotypic screening was positive in 9/55 strains (16.4%), although genotypic detection was positive in only 3 (fosA3, fosA4 and fosA6). Thus, the prevalence of fos genes in Madrid was 5.5% (3/55). WGS data were not available for the fosA6-positive strain. One isolate with fosA3 (ST69) carried a blaCTX-M-55 gene and seven virulence genes (air, eilA, iha, iss, lpfA, sat and senB). The fosA4-positive isolate (ST4038) carried the virulence genes iss, lpfA, iroN and mchF. Both fos genes were located between two IS26 mobile elements of a plasmid. CONCLUSION: We detected the presence of different variants of plasmid-mediated fosA genes in fosfomycin-resistant E. coli strains in Madrid, Spain. Despite the few reports in Europe, it would be of interest to monitor the spread of these acquired resistance genes.

Sentinel Lymph Node Biopsy in Breast Cancer with 99mTc-Tilmanocept: A Multicenter Study on Real-Life Use of a Novel Tracer.

99mTc-tilmanocept is a novel radiopharmaceutical for sentinel lymph node (SLN) biopsy in breast cancer. Our aim was to describe results with 99mTc-tilmanocept in a heterogeneous group of breast cancer patients scheduled for SLN biopsy. Methods: Radiotracer preparation followed the manufacturer's indications. Local protocols for SLN detection within 9 participant centers were not changed for the entire duration of the study. In total, 344 patients with T1-T4, N0-N2 breast cancer (352 lesions) were included. Superficial (intradermal or periareolar) or deep (peritumoral or intratumoral) injections were performed. The doses were adjusted depending on the scheduled time for surgery. Results: Lymphoscintigraphy was able to depict at least 1 SLN in 339 of 352 breast lesions (96.3%), and the intraoperative SLN detection rate reached 97.2%. On univariable analysis, SLN detection rates did not differ by age, clinical T or N stage, tumor location, histologic subtype, or prior neoadjuvant therapy. Lymphoscintigraphy showed higher SLN detection in patients with a normal weight (body mass index < 25) than in those who were overweight or obese (body mass index ≥ 25), at 99.2% versus 94.6%, respectively (P = 0.031). The proportion of patients with preoperative lymphoscintigraphic detection or excised SLNs was higher with superficial than deep injections. Reinjected cases were significantly lower when superficial injection was chosen first (P < 0.001). Injection site and the tumor markers human epidermal growth factor receptor 2 and estrogen receptor had an impact on preoperative SLN visualization and intraoperative localization. In 80 cases, SLN biopsy resulted in a positive lymph node. During a mean follow-up of 19 mo, no axillary recurrences were observed. Conclusion: Whatever the protocol, 99mTc-tilmanocept showed good results in a heterogeneous breast cancer population, although the best results were achieved when a superficial injection was chosen.

Índices triglicéridos-glucosa como estimadores de insulinorresistencia en personas con riesgo de desarrollar diabetes tipo 2 / Triglyceride-glucose indices as estimators of insulin resistance in people at risk of developing type 2 diabetes

EL HOMA-IR (homeostasis model assessment-insulin-resistance) es un estimador de insulinorresistencia (IR) pero depende de la determinación de insulina. Los índices triglicéridos-glucosa (T-G)-circunferencia de la cintura (CC) (T-G-CC) o triglicéridos-glucosa-índice de masa corporal (TG- IMC) podrían ser sustitutos. Los objetivos de este trabajo consistieron en investigar en personas con riesgo de desarrollar diabetes tipo 2 (DT2): a) los índices T-G, T-G-CC y T-G-IMC como estimadores de HOMA-IR>2,1; b) determinar su poder discriminante. Se realizó un estudio prospectivo en el que se estudiaron 223 individuos ≥45 años con riesgo de desarrollar diabetes tipo 2 (DT2). La relación T-G se calculó como ln [triglicéridos (mg/dL) x glucemia (mg/dL)/2]. La relación T-G-CC y T-G-IMC fue el producto de T-G por CC o IMC. Se utilizó análisis de regresión logística y se calcularon las áreas bajo las curvas ROC (receiver operating characteristic curves) (ABC) para comparar las asociaciones de T-G, T-G-CC y T-G-IMC con HOMA-IR>2,1. Mediante análisis discriminante se evaluó la clasificación de los sujetos entre HOMA-IR>2,1 y HOMA-IR≤2,1. ABC, sensibilidad, especificidad, poder predictivo positivo y negativo para T-G-CC y T-G-IMC fueron mayores que para T-G, con los siguientes valores de corte: T-G=8,75, T-G-CC=821 y T-G-IMC=255. Los odds ratios (OR) para HOMA-IR>2,1, ajustados para confusores, fueron: T-G>8,75, OR: 4,85 (IC 95% 2,73-8,62); T-G-CC>821, OR: 10,41 (IC 95% 5,55-19,53); T-GIMC> 255, OR: 10,41 (IC 95% 5,55-19,53). Con el análisis discriminante T-G>8,75 clasificó correctamente 69,2% individuos con HOMA-IR≤2,1 y 68,3% con HOMA-IR>2,1; T-G-CC y T-G-IMC clasificaron 74,4% y 78,2% respectivamente (p<0,001 en todos los casos). Se concluyó que T-GCC> 821 y T-G-IMC>255 fueron mejores estimadores de HOMA-IR>2,1 que T-G>8,75. Estas son determinaciones simples y accesibles y podrían ser útiles en la práctica clínica y en estudios epidemiológicos.

HOMA-IR ((homeostasis model assessment-insulin-resistance) is a surrogate estimator of insulin resistance (IR) but it depends on insulin determination. Triglyceride-glucose-waist circumference (T-G-WC) or triglyceride-glucose-body mass index (BMI) (T-G-BMI) could be substitutes. The objectives of this work were: to investigate in people at risk of developing type 2 diabetes (T2D): a) T-G, T-G-CC and T-G-BMI as estimators of HOMA-IR>2.1 and b) to determine their discriminating power. A prospective study was conducted studying 223 individuals ≥45 years of age at risk of developing type 2 diabetes (T2D). The T-G ratio was calculated as ln [triglycerides (mg/dL) x glycemia (mg/dL)/2]. The T-G-CC and T-G-BMI ratio was the product of T-G by CC or BMI. Logistic regression analysis was used and the areas under the receiver operating characteristic curves (ROC) curves were calculated to compare the associations of T-G, T-G-CC and T-G-BMI with HOMA-IR>2.1. Using a discriminant analysis, the classification of the subjects between HOMA-IR>2.1 or HOMA-IR≤2.1 was evaluated. AUC, sensitivity, specificity, positive and negative predictive powers for T-G-CC and T-G-BMI were higher than for T-G, with the following cut-off values: TG=8.75, T-G-CC=821 and T-G-BMI=255. Odds ratios (OR) for HOMA-IR>2.1, adjusted for confounders, were: T-G>8.75, OR 4.85 (95% CI 2.73-8.62); T-G-CC>821, OR 10.41 (95% CI 5.55-19.53); T-G-BMI>255, OR 10.41 (95% CI 5.55-19.53). With the discriminant analysis T-G>8.75, 69.2% correctly classified with HOMA-IR≤2.1 and 68.3% with HOMA-IR>2.1; T-G-CC and T-G-BMI correctly classified 74.4% and 78.2% respectively (p <0.001 in all cases). It is concluded that T-G-CC>821 and T-G-BMI>255 were better estimators of HOMA-IR>2.1 than T-G>8.75. T-G-WC and T-G-BMI are simple and reliable determinations and could be useful in clinical practice and epidemiological studies.

O HOMA-IR (homeostasis model assessment-insulin-resistance) e um estimador de resistencia a insulina (RI), mas depende da determinacao da insulina. Triglicerideos-glicose (T-G), circunferencia da cintura (CC) (T-G-CC) ou triglicerideos-glicose-indice de massa corporal (T-G-IMC) poderiam ser substitutos. Os objetivos desse trabalho foram investigar em pessoas com risco de desenvolver diabetes tipo 2 (DT2): a) os indices T-G, T-G-CC e T-G-IMC como estimadores de HOMA-IR> 2,1; b) determinar seu poder discriminante. Um estudo prospectivo foi realizado em 223 pessoas ≥45 anos com risco de desenvolver diabetes tipo 2 (DT2). A razao T-G foi calculada como ln [triglicerideos (mg/dL) x glicemia (mg/dL)/2]. A razao T-G-CC e T-G-IMC foi o produto de T-G por CC ou IMC. A analise de regressao logistica foi utilizada e as areas sob as curvas ROC (receiver operating features) ABC foram calculadas para comparar as associacoes de T-G, T-G-CC e T-G-IMC com HOMA-IR>2.1. Por meio de analise discriminante, avaliou-se a classificacao dos sujeitos entre HOMA-IR>2,1 e HOMA-IR≤2,1. ABC, sensibilidade, especificidade, poder preditivo positivo e negativo para TG-CC e TG-IMC foram maiores que para TG, com os seguintes valores de corte: TG=8,75, TG-CC=821 e TG-IMC=255. Odds Ratios (OR) para HOMA-IR>2,1, ajustados para fatores de confusao, foram: TG>8,75, OR 4,85 (IC95% 2,73-8,62); T-G-CC>821, OR 10,41 (IC 95% 5,55-19,53); T-G-IMC>255, OR 10,41 (IC 95% 5,55-19,53). Com a analise discriminante T-G>8,75, 69,2% foram classificados corretamente com HOMA-IR≤2,1 e 68,3% com HOMA-IR>2,1; T-G-CC e T-G-IMC classificaram 74,4% e 78,2%, respectivamente (p<0,001 em todos os casos). Conclui-se que T-G-CC>821 e TG- IMC>255 foram melhores estimadores de HOMA-IR>2,1 que T-G>8,75. Elas sao determinacoes simples e acessiveis e poderiam ser uteis na pratica clinica e em estudos epidemiologicos.

Valve area and the risk of overestimating aortic stenosis.

OBJECTIVE: To obtain reference values of aortic valve area (AVA) in a large population and to infer the risk of overestimating aortic stenosis (AS) when focusing on flow-corrected indices of severity. METHODS: We prospectively measured indices of AS in all consecutive echocardiograms performed in a large referral cardiac imaging laboratory for 1 year. We specifically analysed the distribution of AVA, indexed AVA and velocity ratio (Vratio) in patients with and without AS, the latter defined as the coexistence of valvular outflow obstruction (Vmax ≥2.5 m/s) and morphological findings of valve degeneration. RESULTS: 16 156 echocardiograms were analysed, 14 669 of which did not show valvular obstruction (peak jet velocity <2.5 m/s). In the latter group, AVA was 2.6±0.7 cm2 in 8190 studies with normal valves and 2.3±0.7 cm2 in 6479 studies with aortic sclerosis (AScl). There was a relatively wide overlap between values of AVA, indexed AVA and velocity ratio between studies of patients with AScl and AS. Values of AVA ≤1.0 cm2 were found in 0.5% of studies with normal valves and 1.8% of studies with AScl. These proportions were 3.1% and 9.3% for AVA ≤1.5 cm2, respectively. Vratio ≤0.25 were found in 0.1% of patients without obstruction. Risk factors for a small AVA in patients without obstruction were AScl, female sex, small body surface area, low ejection fraction and mitral regurgitation. CONCLUSIONS: Normal values of continuity-equation derived AVA are smaller than previously considered. AVA values below cutoffs of moderate or severe AS can be found in patients without the disease. Flow-corrected indices may overestimate AS in patients with low gradients, particularly in the presence of well-identified risk factors.

Caracterización clínica de infecciones de vías urinarias producidas por enterobacterias productoras de betalactamasas de espectro extendido en Duitama (Colombia), durante 2010-2015 / Clinical characterisation of urinary tract infections produced by extended-spectrum beta-lactamase-producing enterobacteria in Duitama (Colombia) from 2010-2015

Objetivo: Caracterizar las infecciones de vías urinarias (IVU) producidas por enterobacterias productoras de betalactamasas de espectro extendido (BLEE) en Duitama (Colombia) durante 2010-2015. Metodología: Se realizó un estudio descriptivo en 2 instituciones prestadoras de salud a partir de los aislamientos de patógenos BLEE asociados a IVU. Se tomaron variables sociodemográficas, comorbilidades, hospitalizaciones por IVU en el último año, agentes aislados, tratamiento empírico y dirigido, y respuesta clínica. Resultados: Se obtuvo un registro de 169 pacientes, con edad promedio de 66,01 ± 19,19; el 55,62% eran mayores de 65 años; el 59,2% eran de género femenino y el 73,6% provenían del área urbana. Las comorbilidades más frecuentes fueron enfermedad pulmonar obstructiva crónica (26%), diabetes (24,9%) y enfermedad renal crónica (16%), con un índice de Charlson de 4,43 ± 2,61. El 61,6% había sido hospitalizado en el último año a causa de IVU. Los agentes aislados más comunes fueron Escherichia coli (94,7%) y Klebsiella spp. (2,4%). Los tratamientos empíricos usados fueron ampicilina/sulbactam (15%), ciprofloxacino (29,6%) y nitrofurantoína (10,7%). Frente al tratamiento dirigido, el 36,7% no recibió ningún escalonamiento, el 32% fue tratado con ertapenem y el 8,9% con piperacilina/tazobactam. La mortalidad fue del 5,9% y la estancia hospitalaria fue en promedio de 7,24 ± 7,43 días. Conclusión: Los datos regionales son similares a los datos mundiales. Frente al tratamiento empírico se debe realizar una revaloración, ya que las guías actuales no recomiendan el uso de ciprofloxacino. También se debe hacer mejor seguimiento a las BLEE, ya que hay fallas en cuanto al tratamiento dirigido en gran porcentaje de las cepas.

Objective: To characterise epidemiologically urinary tract infections (UTI) caused by extended-spectrum betalactamase producing (ESBL)-producing Enterobacteriaceae in Duitama (Colombia) from 2010-2015. Methodology: A descriptive study was conducted on ESBL isolates of pathogens associated with UTI in 2 health institutions. Sociodemographic variables, comorbidities, hospitalisations in the last year for UTI, isolated agents, empirical and directed treatment, and clinical response were recorded. Results: A total of 169 patients were included, with an average age of 66.01 ± 19.19; 55.62% were over 65; 59.2% were female and 73.6% were from an urban area. The most frequent comorbidities were chronic obstructive pulmonary disease in 26%; 24.9% had diabetes and 16% had chronic kidney disease, with a Charlson index of 4.43 ± 2.61. Some 61.6% had been hospitalised in the last year due to UTIs. The most common isolated agents were Escherichia coli in 94.7% and Klebsiella spp. in 2.4%. The empirical treatments used were ampicillin/sulbactam in 15%, ciprofloxacin in 29.6% and nitrofurantoin in 10.7%. Regarding directed treatment, 36.7% do not have des-escalation, 32% of patients were treated with ertapenem and 8.9% were treated with piperacillin/tazobactam. Mortality was 5.9% and the average hospital stay was 7.24 ± 7.43 days. Conclusion: Regional data are similar to global data. Empirical treatment should be revaluated, since current guidelines do not recommend the use of ciprofloxacin. In addition, better tracking of ESLB is needed due to flaws in empirical treatment for a large percentage of the strains.

Relación entre síndrome metabólico e insulino resistencia en adultos con riesgo para diabetes tipo 2 / Relationship between the metabolic syndrome and the insulin resistance in adults with type 2 diabetes risk / Relação entre síndrome metabólica e insulino-resistência em adultos com risco para diabetes tipo 2

La diabetes mellitus tipo 2 (DBT2) es muy frecuente en la población pero no siempre está diagnosticada. Las alteraciones en el metabolismo de la glucosa (Glu) y el síndrome metabólico (SM) se presentan años antes de DMT2. Se realizó un estudio poblacional transversal, aleatorio y estratificado según nivel socioeconómico en 223 sujetos de 45 y más años con riesgo para DMT2. SM se determinó según AHA/NHLBI. El objetivo de este trabajo consistió en: a) Determinar la frecuencia de sujetos con Glu alterada en ayunas y SM; b) Determinar la relación entre diferentes índices de insulino-resistencia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu con SM y sus componentes. Los resultados fueron: la Glu elevada en ayunas (100-125 mg/dL) fue 19,3% (varones 22,1% y mujeres 17,8% (ns)); Glu=126 mg/dL, 2,2%; SM 38,1% (varones 33,8%, mujeres 40,4% (ns)). La IR se asoció con cintura y triglicéridos (p<0,001), C-HDL y presión arterial (p<0,01). Con curvas ROC se hallaron valores de corte de índices de IR para predicción de SM: QUICKI<0,33, HOMA>2,1; Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs SM mostró: sensibilidad 72,6%, especificidad 70,1%, valor predictivo positivo 60,4%, valor predictivo negativo 80,3%. Por análisis de regresión logística se hallaron predictores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p<0,001; historia familiar de diabetes, OR=4,74 (IC 95% 2,23-10,05), p≤0,001; bajo nivel de educación formal OR=2,69 (IC 95% 1,33-5,46), p=0,006. Se concluye que la frecuencia de Glu alterada en ayunas no fue mayor que para población general pero SM fue muy frecuente en las mujeres. HOMA-IR >2,1 y QUICKI<0,33 fueron fuertes predictores de SM asociados a aumentos de cintura y triglicéridos. La historia familiar de diabetes y el bajo nivel de educación formal configuraron un perfil fuertemente predictor de SM.

Relación entre síndrome metabólico e insulino resistencia en adultos con riesgo para diabetes tipo 2 / Relationship between the metabolic syndrome and the insulin resistance in adults with type 2 diabetes risk / RelaþÒo entre síndrome metabólica e insulino-resistÛncia em adultos com risco para diabetes tipo 2

La diabetes mellitus tipo 2 (DBT2) es muy frecuente en la población pero no siempre está diagnosticada. Las alteraciones en el metabolismo de la glucosa (Glu) y el síndrome metabólico (SM) se presentan años antes de DMT2. Se realizó un estudio poblacional transversal, aleatorio y estratificado según nivel socioeconómico en 223 sujetos de 45 y más años con riesgo para DMT2. SM se determinó según AHA/NHLBI. El objetivo de este trabajo consistió en: a) Determinar la frecuencia de sujetos con Glu alterada en ayunas y SM; b) Determinar la relación entre diferentes índices de insulino-resistencia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu con SM y sus componentes. Los resultados fueron: la Glu elevada en ayunas (100-125 mg/dL) fue 19,3% (varones 22,1% y mujeres 17,8% (ns)); Glu≥126 mg/dL, 2,2%; SM 38,1% (varones 33,8%, mujeres 40,4% (ns)). La IR se asoció con cintura y triglicéridos (p2,1; Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs SM mostró: sensibilidad 72,6%, especificidad 70,1%, valor predictivo positivo 60,4%, valor predictivo negativo 80,3%. Por análisis de regresión logística se hallaron predictores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p2,1 y QUICKI<0,33 fueron fuertes predictores de SM asociados a aumentos de cintura y triglicéridos. La historia familiar de diabetes y el bajo nivel de educación formal configuraron un perfil fuertemente predictor de SM.(AU)

Type 2 diabetes mellitus (T2DM) is very common in the population but not always diagnosed. Alterations in the metabolism of glucose (Glu) and the metabolic syndrome (MS) are presented years before T2DM. A cross-population study, randomized and stratified by socioeconomic level in 223 subjects aged 45 and over at risk for T2DM was performed. SM was determined according to AHA / NHLBI. Objectives: a) to determine the frequency of subjects with impaired fasting Glu and SM; b) to determine the relationship between different indices of insulin resistance (IR), QUICKI, HOMA, insulin (Ins) and Ins/Glu with MS and its components. Results: elevated fasting Glu (100-125 mg/dL) was 19.3% (males 22.1%, women 17.8% (ns)), Glu≥126 mg/dL, 2.2%, SM 38.1% (males 33.8%, women 40.4% (ns)). IR was associated with waist and triglycerides (p 2.1, Ins>10 mU/L, Ins/Glu>1.8. HOMA-IR>2.1 vs MS showed: sensitivity 72.6%, specificity 70.1%, positive predictive value 60.4%, negative predictive value 80.3%. For logistic regression analysis found predictors of MS: HOMA> 2.1, OR=8.76 (95% CI 4.37-17.55), p 2.1 and QUICKI <0.33 were strong predictors of SM associated with increases in waist and triglycerides. Family history of diabetes and low levels of formal education shaped a strong predictor of SM profile.(AU)

A diabetes mellitus tipo 2 (DBT2) é muito frequente na populaþÒo mas nem sempre está diagnosticada. As alteraþ§es no metabolismo da glicose (Glu) e da síndrome metabólica (SM) se apresentam anos antes de DMT2. Foi realizado um estudo populacional transversal, aleatório e estratificado conforme o nível socioecon¶mico em 223 sujeitos de 45 e mais anos com risco para DMT2. A SM foi determinada segundo AHA/NHLBI. O objetivo deste trabalho consistiu em: a) determinar a frequÛncia de sujeitos com Glu alterada em jejum e SM; b) Determinar a relaþÒo entre diferentes índices de insulino-resistÛncia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu com SM e seus componentes. Os resultados foram: Glu elevada em jejum (100-125 mg/dL) foi 19,3% (homens 22,1% e mulheres 17,8% (ns)); Glu≥126 mg/dL, 2,2%; SM 38,1% (homens 33,8%, mulheres 40,4% (ns)). A IR foi associada a cintura e triglicerídeos (p2,1, Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs. SM mostrou: sensibilidade 72,6%, especificidade 70,1%, valor preditivo positivo 60,4%, valor preditivo negativo 80,3%. Por análise de regressÒo logística foram achados preditores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p2,1 e QUICKI<0,33 foram fortes preditores de SM associados a aumentos de cintura e triglicerídeos. A história familiar de diabetes e o baixo nível de educaþÒo formal configuraram um perfil fortemente preditor de SM.(AU)

Relación entre síndrome metabólico e insulino resistencia en adultos con riesgo para diabetes tipo 2 / Relationship between the metabolic syndrome and the insulin resistance in adults with type 2 diabetes risk

La diabetes mellitus tipo 2 (DBT2) es muy frecuente en la población pero no siempre está diagnosticada. Las alteraciones en el metabolismo de la glucosa (Glu) y el síndrome metabólico (SM) se presentan años antes de DMT2. Se realizó un estudio poblacional transversal, aleatorio y estratificado según nivel socioeconómico en 223 sujetos de 45 y más años con riesgo para DMT2. SM se determinó según AHA/NHLBI. El objetivo de este trabajo consistió en: a) Determinar la frecuencia de sujetos con Glu alterada en ayunas y SM; b) Determinar la relación entre diferentes índices de insulino-resistencia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu con SM y sus componentes. Los resultados fueron: la Glu elevada en ayunas (100-125 mg/dL) fue 19,3% (varones 22,1% y mujeres 17,8% (ns)); Glu=126 mg/dL, 2,2%; SM 38,1% (varones 33,8%, mujeres 40,4% (ns)). La IR se asoció con cintura y triglicéridos (p<0,001), C-HDL y presión arterial (p<0,01). Con curvas ROC se hallaron valores de corte de índices de IR para predicción de SM: QUICKI<0,33, HOMA>2,1; Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs SM mostró: sensibilidad 72,6%, especificidad 70,1%, valor predictivo positivo 60,4%, valor predictivo negativo 80,3%. Por análisis de regresión logística se hallaron predictores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p<0,001; historia familiar de diabetes, OR=4,74 (IC 95% 2,23-10,05), p≤0,001; bajo nivel de educación formal OR=2,69 (IC 95% 1,33-5,46), p=0,006. Se concluye que la frecuencia de Glu alterada en ayunas no fue mayor que para población general pero SM fue muy frecuente en las mujeres. HOMA-IR >2,1 y QUICKI<0,33 fueron fuertes predictores de SM asociados a aumentos de cintura y triglicéridos. La historia familiar de diabetes y el bajo nivel de educación formal configuraron un perfil fuertemente predictor de SM.(AU)