Prevalencia de la enfermedad tiroidea autoinmune en pacientes con diabetes mellitus tipo 1 / Prevalence of autoimmune thyroid disease in patients with type 1 diabetes

Objetivo: Evaluar la prevalencia de enfermedad tiroidea autoinmune (ETA) enpacientes con diabetes tipo 1 (DM1) y su relación con variables clínicas y analíticas.Material y métodos: Estudio observacional descriptivo en pacientescon DM1 en el que se analiza la prevalencia de ETA y los factores relacionados.Resultados: Se estudiaron 507 pacientes con DM1 (50,4% mujeres)de 33,5 ± 11,8 años de edad y 16,1 ± 9,5 años de evolución de la DM1, ycon un nivel medio de HbA1c del 7,8 ± 1,4%. El 17,8% de los pacientes presentabaETA (9,9% hipotiroidismo primario, 7,1% hipotiroidismo subclínico y0,8% enfermedad de Graves). Los pacientes DM1 y ETA eran, con mayor frecuencia,mujeres (24,6 frente a 10,8%; p <0,001) y fumadores (15,6 frentea 2,2%; p= 0,039) y presentaban niveles séricos de colesterol LDL (c-LDL)más elevados (110,1 ± 31,4 frente a 102,9 ± 28,8 mg/dL; p <0,043).Conclusión: Observamos una elevada prevalencia de ETA en pacientes conDM1, asociándose a sexo femenino, tabaquismo activo y niveles elevados dec-LDL. Recomendamos el cribado sistemático de ETA en pacientes con DM1,que permita un precoz diagnóstico y tratamiento(AU)

Objective: To evaluate the prevalence of autoimmune thyroid disease in type1 diabetes patients and their association to clinical and analytical parameters.Methodology: A retrospective observational study of type 1 diabetes patientswas designed to analyze the prevalence of autoimmune thyroid disease andrelated factors. Results: The study included 507 patients with type 1 diabetes(50.4% women), aged 33.5 ± 11.8 years with an average duration of diabetesof 16.1 ± 9.5 years. The average level of HbA1c was 7.8 ± 1.4%.Theprevalence of autoimmune thyroid function disorder was 17.8% (9.9% primaryhypothyroidism, 7.1% subclinical hypothyroidism, and 0.8% Graves disease).There was a positive association between thyroid disease and femalegender (24.6% versus 10.8% in men, p <0.001), smoking (15.6% versus2.2%, p= 0.039) and serum LDL levels (110.1 ± 31.4 mg/dL versus 102.9± 28.8 mg/dL; p <0.043). Conclusion: Prevalence of autoimmune thyroiddisease in type 1 diabetes patients is high and it is associated with femalegender, smoking and increased LDL levels. We suggest a systematic screeningfor autoimmune thyroid disease in type 1 diabetes to establish an early diagnoseand treatment(AU)

Evaluación de la enfermedad vascular periférica en pacientes con diabetes tipo 2 mediante medición del índice tobillo-brazo / Peripheral vascular disease evaluation in patients with type 2 diabetes by measurement of ankle-brachial index

Objetivo: Describir los resultados de la medición del índice tobillobrazo (ITB) en pacientes con diabetes tipo 2 (DM2) evaluados en una unidad de atención especializada. Pacientes y métodos: Estudio descriptivo realizado en pacientes con DM2 en los que se valoró el ITB mediante ecografía Doppler bidireccional durante los años 2005 y 2006. Se analizan los resultados obtenidos y su relación con diversas variables demográficas, clínicas y analíticas. Se consideró patológico un ITB igual o inferior a 0,9. Resultados: Se analizan 79 exploraciones en pacientes de 64,4 ± 9,7 años de edad y 13,9 ± 8,1 años de evolución de la diabetes (54,4% mujeres). El ITB resultó normal en el 67,1% y patológico en el 32,9%. El 25% de los pacientes con ITB patológico presentaban pulsos periféricos normales, y el 34,6% no refería síntomas. Los pacientes con ITB patológico eran de mayor edad (68 ± 8,6 años frente a 62,7 ± 9,9 años; p= 0,016), más frecuentemente varones (47% frente a 20,9%; p= 0,013) y fumadores (45% frente a 24%; p= 0,044), presentaban niveles más bajos de colesterol LDL (100,8 ± 32,6 mg/dL frente a 118,7 ± 35,7 mg/dL; p= 0,039) y tomaban más frecuentemente ácido acetilsalicílico (47,2% frente a 21,4%; p= 0,016). Conclusiones: El cribado de la enfermedad vascular periférica mediante medición del ITB debe generalizarse a todas las personas con DM2, ya que permite identificar la presencia de enfermedad vascular periférica silente (sin síntomas ni hallazgos exploratorios patológicos)

Objectives: To report the results of ankle-brachial index (ABI) measurement in patients with type 2 diabetes evaluated in a Diabetes Care Unit. Patients and methods: A descriptive study was performed between 2005 and 2006 in patients with type 2 diabetes by measuring the ABI with bidirectional echo-Doppler. The results and their relationship to demographic, clinical and analytical variables were analyzed. An ABI of 0.9 or less was considered to be indicative of disease. Results: The results of 79 examinations carried out in patients (54.4% women) aged 64.4 ± 9.7 years with a duration of diabetes of 13.9 ± 8.1 years were analyzed. The ABI was normal in 67.1% of the patients and indicative of disease in 32.9%. Twentyfive of the patients in the latter group had normal peripheral pulses and 34.6% reported no symptoms. Patients with an ABI indicative of disease were older (68 ± 8.6 versus 62.7 ± 9.9 years old; p= 0.016), more often were men (47% versus 20.9%; p= 0.013) and smokers (45% versus 24%; p= 0.044), presented lower LDL-cholesterol levels (100.8 ± 32.6 versus 118.7 ± 35.7 mg/dl; p= 0.039) and more frequently were taking aspirin (47.2% versus 21.4%; p= 0.016) than patients with normal ABI. Conclusions: Peripheral vascular disease screening by measurement of ABI should be recommended in all type 2 diabetes patients because it enables the identification of asymptomatic peripheral vascular disease in the absence of disease symptoms or examination findings

First Report of a 16SrIV Group Phytoplasma Associated with Declining Coyol Palms in Honduras.

Lethal yellowing (LY) of coconut palm (Cocos nucifera L.) caused by a subgroup 16SrIV-A phytoplasma has been present along the northern coast and adjacent Bay Islands of Honduras since 1996. In the southern municipalities of San Esteban and Guanaco, approximately 150 km from the Atlantic coast, substantial numbers of coyol palm (Acrocomia aculeata (Jacq.) Lodd. ex Mart.) and several coconut palms growing nearby were either dead or in an advanced stage of decline during 2005. Declining palms of both species exhibited loss of fruit, withered inflorescences, and dried, discolored (grayish brown) leaves. Most or all leaves on declining palms had collapsed and hung downward around the stem. Samples (3 to 5 g) of tissue were excised from stems of 20 coyol and 2 coconut palms. DNA was extracted from each sample using a previously described protocol (2) and assayed for phytoplasma DNA using polymerase chain reaction (PCR) employing phytoplasma universal rRNA primer pair P1 (1) and P7 (4). A product of expected size (approximately 1.8 kb) was amplified from 12 of 20 diseased coyol palms, 2 of 2 diseased coconut palms and from DNA of a Florida-grown Chinese fan palm (Livistona chinensis (Jacq.) R. Br. ex Mart.) with LY symptoms included as a known positive control. Amplified P1/P7 products used in a nested PCR assay with 16SrIV-specific primer pair LY16Sf (2) and LY16Sr (5'-GCTTACGCA-GTTAGGCTGTC-3') yielded a product of approximately 1.39 kb. Neither primary nor nested PCRs generated a product from DNA of healthy coconut palm. Poor quality of tissues within stems of declining palms may have contributed to lack of amplification of any product from eight coyol samples. A reevaluation of DNA samples using PCR employing nonribosomal primer pair LYF1/LYR1, which specifically detects subgroup 16SrIV-A phytoplasmas (3), failed to amplify an expected 1-kb product from any palm sample other than the LY positive control. Digestion of nested amplification products (1.39 kb) with AluI endonuclease and electrophoresis of digests through 8% polyacrylamide gels revealed the same three-fragment restriction pattern for all phytoplasmas detected in coyol and coconut palms. The pattern differed from the five-fragment profile of LY phytoplasma rDNA included for comparative purposes. These results indicate that coyol palm is a new phytoplasma host and that decline symptoms on coyol and adjacent coconuts were not a consequence of natural dispersion of subgroup 16SrIV-A phytoplasmas from the northern coast. The 16S rDNA sequences amplified from coyol palm decline (CPD) (GenBank Accession No. DQ321818) and coconut decline (CLDO) (GenBank Accession No. DQ321819) phytoplasmas were coidentical and most similar (99.87%) to that of Yucatan coconut lethal decline (LDY), a known subgroup 16SrIV-B strain. This relationship was further supported by phylogenetic analysis of rDNA sequences. On the basis of these findings, we have tentatively concluded that strains CPD and CLDO represent new members of the coconut lethal yellows subgroup 16SrIV-B. References: (1) S. Deng and C. Hiruki, J. Microbiol. Methods 14:53, 1991 (2) N. A. Harrison et al. Plant Dis. 86:676, 2002 (3) N. A. Harrison et al. Plant Pathol. 43:998, 1994. (4) C. D. Smart et al. Appl. Environ. Microbiol. 62:2988, 1996.