Obesity and Obesity-Related Thyroid Dysfunction: Any Potential Role for the Very Low-Calorie Ketogenic Diet (VLCKD)?

PURPOSE OF REVIEW: This review aims to explore in-depth the different aspects of the association between very low-calorie ketogenic diet (VLCKD), obesity and obesity-related thyroid dysfunction. RECENT FINDINGS: The VLCKD, proposed as a non-pharmacological strategy for the management of certain chronic diseases, is becoming increasingly popular worldwide. Initially used to treat epilepsy, it has been shown to be effective in controlling body weight gain and addressing various pathophysiological conditions. Research has shown that a low-calorie, high-fat diet can affect thyroid hormone levels. Weight loss can also influence thyroid hormone levels. Studies have suggested that long-term use of VLCKD for refractory epilepsy may be related to the development of hypothyroidism, with an effect seen in various populations. In particular, women with obesity following VLCKD tend to have reduced T3 levels. We propose further research to unravel the underlying mechanisms linking VLCKD to obesity and obesity-related thyroid dysfunction.

[Real-world evidence on pharmacological appropriateness in type 2 diabetes mellitus and cardiovascular disease]. / Evidencia de mundo real sobre adecuación farmacológica en diabetes tipo 2 y enfermedad cardiovascular.

Objective: To estimate the proportion of individuals with established Type 2 Diabetes Mellitus (T2DM) and Cardiovascular Disease (CVD) who are receiving pharmacological anti-diabetic treatment with evidence of cardiovascular benefit at a hospital in Argentina. Materials and Methods: Cross-sectional study conducted at the Italian Hospital of Buenos Aires. A consecutive sample of adult patients affiliated with the institutional prepaid health plan active in March 2020, diagnosed with T2DM and established CVD, was included. Data were collected from the Electronic Health Record. The proportion of pharmacological adequacy (combined use of metformin plus sodium-glucose co-transporter 2 inhibitors and/or glucagon-like peptide 1 receptor agonists) was reported along with its respective 95% confidence interval (CI). Results: A total of 1539 patients were included, with a mean age of 76.2 years; 65.3% were male, and 81.6% were overweight or obese. Hemoglobin A1c levels were recorded in the past year for 74.9% of patients, with an average value of 6.9% (SD 1.2). The most prescribed drugs were metformin (61.3%), insulin (26.7%), and gliptins (11%). Out of the total included patients, 82 exhibited pharmacotherapeutic adequacy for diabetes treatment, with a prevalence of 5.3% (95% CI 4.2-6.5). Conclusions: The prevalence of prescribing anti-diabetic drugs with evidence of cardiovascular benefit was 5.3% (95% CI 4.2-6.5). This real-world evidence highlights the low frequency of prescribing this type of medication at the time of the study in a high cardiovascular risk population.

Objetivo: Estimar la proporción de personas con Diabetes Mellitus tipo 2 (DM2) y Enfermedad Cardiovascular (ECV) establecida que reciben tratamiento farmacológico anti-diabético con evidencia de beneficio cardiovascular en un hospital en Argentina. Materiales y Métodos: Estudio de corte transversal realizado en el Hospital Italiano de Buenos Aires. Se incluyó una muestra consecutiva de pacientes adultos afiliados a prepaga institucional activos a Marzo 2020, con diagnóstico de DM2 y ECV establecida. Los datos se tomaron de la Historia Clínica Electrónica. Se informó la proporción de adecuación farmacológica (uso combinado de metformina más inhibidores del cotransportador de sodio glucosa tipo 2 y/o agonistas del Péptido Similar al Glucagón tipo 1) con su respectivo IC95%. Resultados: Se incluyeron 1539 pacientes, con una media de edad 76,2 años, 65,3% eran de sexo masculino, 81,6% con sobrepeso u obesidad. Un 74,9% de los pacientes tenían registro de hemoglobina glicosilada en el último año, con un valor promedio de 6,9% (DE 1,2). Las drogas más prescritas fueron: metformina (61,3%), insulina (26,7%), y gliptinas (11%). Del total de pacientes incluidos, 82 presentaron adecuación fármaco-terapéutica antidiabética, con una prevalencia de 5,3% (IC95% 4,2-6,5). Conclusiones: La prevalencia de prescripción de drogas antidiabéticas con evidencia de beneficio cardiovascular fue de 5,3% (IC95% 4,2-6,5). Esta información extraída de evidencia del mundo real identifica la baja frecuencia de prescripción de este tipo de fármacos al momento del estudio en una población de alto riesgo cardiovascular.

Valor pronóstico de la hipoglucemia hospitalaria / Prognostic value of hospital hypoglycemia

Resumen Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos interna dos con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl ≥ 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipo glucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

Abstract Background: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. Methods: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and ≥ 40 mg/dl) and critical (glycemia<40mg/dl). Results: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypo glycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. Discussion: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

[Prognostic value of hospital hypoglycemia]. / Valor pronóstico de la hipoglucemia hospitalaria.

BACKGROUND: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. METHODS: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and = 40 mg/dl) and critical (glycemia < 40mg/dl). RESULTS: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypoglycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. DISCUSSION: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos internados con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl = 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipoglucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

Recurrence of Hypoglycemia in Hospitalized Adult Patients in Non-Critical Areas: An Opportunity to Improve Patient Care Using Electronic Health Records.

Electronic Health Records offer an opportunity to improve patient care (in terms of quality and/or safety) by making available patient health information stored in a single Clinical Data Repository. We aimed to estimate the frequency of hypoglycemic recurrences in hospitalized adult patients in non-critical areas. We designed a cross sectional study with hospitalizations between 2017 and 2018, which included patients with at least one hypoglycemia health record (defined as a value <70 mg/dL, either by capillary glycemic monitoring or serum measurement). Recurrence was defined as those who presented a second event, with at least 2 hours of difference. We included 1884 patients, and 573 presented recurrences, yielding a global prevalence of 30.41% (95%CI 28.34-32.54). Due to the high frequency, it is important to identify vulnerable populations, to implement preventive measures to assist clinicians for decision-making tasks, as a clinical decision support system.

Estudio descriptivo de infección por SARS-CoV-2 en adultos con diabetes / Descriptive study of infection by SARS-CoV-2 in adults with diabetes

Resumen El objetivo del trabajo fue estimar la prevalencia de diabetes mellitus (DM) entre los pacientes con COVID-19, explorar factores asociados y describir la evolución clínica de aquellos hospitalizados. Se realizó un estudio de corte transversal que incluyó adultos positivos para COVID-19 entre 12/03/2020 y 15/10/2020, en el Hospital Italiano de Buenos Aires. De un total de 6009 personas con COVID-19, 408 presentaron diagnóstico previo de DM, arrojando una prevalencia de 6% (IC95% 6-7%), con mayor prevalencia asociada a la edad (12% en ≥ 60 años y 3% en < 60 años; p = 0.01). La mortalidad intrahospitalaria fue 6% (IC95% 6-7), siendo 15% en DM y 6% en no diabéticos (p < 0.01). Los factores asociados a la DM fueron variables, cardiovasculares, sexo masculino, hipertensión arterial, tabaquismo, insuficiencia renal crónica, insuficiencia cardíaca, enfermedad coronaria previa; y variables clínicas de fragilidad como edad, demencia e institucionalización previa (todas con p < 0.01). Solo el 23% (96/408) de los DM tuvo una medición de HbA1c en los últimos 3 meses y el 76% en el último año, con un promedio 8.6%, y un 25% en meta (HbA1c ≥ 7%). El manejo fue mayoritariamente intrahospitalario (59%), con un promedio de estadía hospitalaria de 12 días, con las siguientes complicaciones durante la hospitalización: 6% presentó un valor de hipoglucemia (< 70 mg/dl), 42% requirió oxigenoterapia, el 19% pasó a unidad cerrada, 15% requirió ARM (media de 11 días), y 25% (IC95% 20-31%) de mortalidad (promedio de 82 años).

Abstract The main objective was to estimate the prevalence of diabetes mellitus (DM) among patients with COVID-19, to explore associ ated factors; and to describe clinical evolution of hospitalized patients. A cross-sectional study was conducted, which included adults confirmed with COVID-19 between 03/12/2020 and 10/15/2020, at Hospital Italiano de Buenos Aires. From 6009 people with COVID-19, 408 had previous diagnosis of DM, yielding a prevalence of 6% (95%CI 6-7), higher prevalence was associated with age (12% in ≥ 60 years and 3% in < 60 years; p = 0.01). In-hospital mortality was 6% (95%CI 6-7), being 15% in DM and 6% compared in non-diabetics (p < 0.01). As sociated factors with DM were cardiovascular variables such as male sex, hypertension, smoking, chronic renal failure, heart failure, previous coronary disease; and clinical variables proxy of frailty such as: age, dementia and previous institutionalization (all with p < 0.01). Only 23% (96/408) of DM had an HbA1c measurement in the last 3 months and 76% in the last year, with an average 8.6%, and 25% in goal (HbA1c ≤ 7%). Management was mostly in-hospital (59%), with an average hospital stay of 12 days, with the following complications during hospitalization: 6% presented a hypoglycemic value (< 70 mg/dl), 42% required oxygen therapy, 19 % went to intensive care unit, 15% required invasive mechanical ventilation (mean 11 days), and 25% (95%CI 20-31) of in-hospital mortality (mean 82 years).

[Descriptive study of infection by SARS-CoV-2 in adults with diabetes]. / Estudio descriptivo de infección por SARS-CoV-2 en adultos con diabetes.

The main objective was to estimate the prevalence of diabetes mellitus (DM) among patients with COVID-19, to explore associated factors; and to describe clinical evolution of hospitalized patients. A cross-sectional study was conducted, which included adults confirmed with COVID-19 between 03/12/2020 and 10/15/2020, at Hospital Italiano de Buenos Aires. From 6009 people with COVID-19, 408 had previous diagnosis of DM, yielding a prevalence of 6% (95%CI 6-7), higher prevalence was associated with age (12% in = 60 years and 3% in < 60 years; p = 0.01). In-hospital mortality was 6% (95%CI 6-7), being 15% in DM and 6% compared in non-diabetics (p < 0.01). Associated factors with DM were cardiovascular variables such as male sex, hypertension, smoking, chronic renal failure, heart failure, previous coronary disease; and clinical variables proxy of frailty such as: age, dementia and previous institutionalization (all with p < 0.01). Only 23% (96/408) of DM had an HbA1c measurement in the last 3 months and 76% in the last year, with an average 8.6%, and 25% in goal (HbA1c = 7%). Management was mostly in-hospital (59%), with an average hospital stay of 12 days, with the following complications during hospitalization: 6% presented a hypoglycemic value (< 70 mg/dl), 42% required oxygen therapy, 19 % went to intensive care unit, 15% required invasive mechanical ventilation (mean 11 days), and 25% (95%CI 20-31) of in-hospital mortality (mean 82 years).

El objetivo del trabajo fue estimar la prevalencia de diabetes mellitus (DM) entre los pacientes con COVID-19, explorar factores asociados y describir la evolución clínica de aquellos hospitalizados. Se realizó un estudio de corte transversal que incluyó adultos positivos para COVID-19 entre 12/03/2020 y 15/10/2020, en el Hospital Italiano de Buenos Aires. De un total de 6009 personas con COVID-19, 408 presentaron diagnóstico previo de DM, arrojando una prevalencia de 6% (IC95% 6-7%), con mayor prevalencia asociada a la edad (12% en = 60 años y 3% en < 60 años; p = 0.01). La mortalidad intrahospitalaria fue 6% (IC95% 6-7), siendo 15% en DM y 6% en no diabéticos (p < 0.01). Los factores asociados a la DM fueron variables, cardiovasculares, sexo masculino, hipertensión arterial, tabaquismo, insuficiencia renal crónica, insuficiencia cardíaca, enfermedad coronaria previa; y variables clínicas de fragilidad como edad, demencia e institucionalización previa (todas con p < 0.01). Solo el 23% (96/408) de los DM tuvo una medición de HbA1c en los últimos 3 meses y el 76% en el último año, con un promedio 8.6%, y un 25% en meta (HbA1c = 7%). El manejo fue mayoritariamente intrahospitalario (59%), con un promedio de estadía hospitalaria de 12 días, con las siguientes complicaciones durante la hospitalización: 6% presentó un valor de hipoglucemia (< 70 mg/dl), 42% requirió oxigenoterapia, el 19% pasó a unidad cerrada, 15% requirió ARM (media de 11 días), y 25% (IC95% 20-31%) de mortalidad (promedio de 82 años).

In-Hospital Mortality and Glycemic Control in Patients with Hospital Hyperglycemia.

BACKGROUND: Stress-induced hyperglycemia is a phenomenon that occurs typically in patients hospitalized for acute disease and resolves spontaneously after regression of the acute illness. However, it can also occur in diabetes patients, a fact that is sometimes overlooked. It is thus important to make a proper diabetes diagnosis if hospitalized patients with episodes of hyperglycemia with and without diabetes are studied. AIMS: To estimate the extent of the association between stress-induced hyperglycemia and in-hospital mortality in patients with hospital hyperglycemia (HH), and to explore potential differences between patients diagnosed with diabetes (HH-DBT) and those with stress-induced hyperglycemia (SH), but not diagnosed with diabetes. METHODS: A cohort of adults with hospital hyperglycemia admitted to a tertiary, university hospital in Buenos Aires, Argentina, was analyzed retrospectively. RESULTS: In the study, 2,955 patients were included and classified for analysis as 1,579 SH and 1,376 HH-DBT. Significant differences were observed in glycemic goal (35.53% SH versus 25.80% HH-DBT, p < 0.01), insulin use rate (26.66% SH versus 46.58% HH-DBT, p < 0.01), and severe hypoglycemia rate (1.32% SH versus 1.74% HH-DBT, p < 0.01). There were no differences in hypoglycemia rate (8.23% SH versus 10.53% HH-DBT) and hospital mortality. There was no increase in risk of mortality in the SH group adjusted for age, non-scheduled hospitalization, major surgical intervention, critical care, hypoglycemia, oncological disease, cardiovascular comorbidity, and prolonged hospitalization. CONCLUSIONS: In this study, we observed better glycemic control in patients with SH than in those with HH-DBT, and there was no difference in hospital mortality.

[Ileitis as presentation of lymphoma in Wiskott-Aldrich syndrome]. / Ileítis como presentación de linfoma en síndrome de Wiskott-Aldrich.

Wiskott-Aldrich syndrome is a rare X chromosome-linked primary immunodeficiency syndrome associated with an increased incidence of infections, autoimmune disorders and neoplasms. We present the case of a 41-year-old man with a diagnosis of Wiskott-Aldrich syndrome with ileitis as a form of presentation of a lymphoproliferative syndrome. The ileitis, in the context of the patient, represents a clinical challenge given the large number of differential diagnoses (inflammatory bowel disease, infections, neoplasms and lymphoproliferative diseases), so it usually requires anatomopathological diagnosis and particular considerations regarding the subsequent specific treatment.

El síndrome de Wiskott-Aldrich (SWA) es un raro síndrome de inmunodeficiencia primaria ligado al cromosoma X que se asocia con aumento de incidencia de infecciones, trastornos autoinmunes y neoplasias. Se presenta el caso de un varón de 41 años con diagnóstico de síndrome de Wiskott-Aldrich y cuadro de ileítis como forma de presentación de un síndrome linfoproliferativo. La ileítis, en el contexto del paciente, representa un problema clínico dado el gran número de diagnósticos diferenciales (enfermedad inflamatoria intestinal, infecciones, neoplasias y enfermedades linfoproliferativas) por lo que suele requerir diagnóstico anatomopatológico y consideraciones particulares respecto al posterior tratamiento específico.

Ileítis como presentación de linfoma en síndrome de Wiskott-Aldrich / Ileitis as presentation of lymphoma in Wiskott-Aldrich syndrome

El síndrome de Wiskott-Aldrich (SWA) es un raro síndrome de inmunodeficiencia primaria ligado al cromosoma X que se asocia con aumento de incidencia de infecciones, trastornos autoinmunes y neoplasias. Se presenta el caso de un varón de 41 años con diagnóstico de síndrome de Wiskott-Aldrich y cuadro de ileítis como forma de presentación de un síndrome linfoproliferativo. La ileítis, en el contexto del paciente, representa un problema clínico dado el gran número de diagnósticos diferenciales (enfermedad inflamatoria intestinal, infecciones, neoplasias y enfermedades linfoproliferativas) por lo que suele requerir diagnóstico anatomopatológico y consideraciones particulares respecto al posterior tratamiento específico.

Wiskott-Aldrich syndrome is a rare X chromosome-linked primary immunodeficiency syndrome associated with an increased incidence of infections, autoimmune disorders and neoplasms. We present the case of a 41-year-old man with a diagnosis of Wiskott-Aldrich syndrome with ileitis as a form of presentation of a lymphoproliferative syndrome. The ileitis, in the context of the patient, represents a clinical challenge given the large number of differential diagnoses (inflammatory bowel disease, infections, neoplasms and lymphoproliferative diseases), so it usually requires anatomopathological diagnosis and particular considerations regarding the subsequent specific treatment.

Pacientes hospitalizados con hiperglucemia de estrés: incidencia de diabetes y mortalidad al seguimiento / Hospitalized patients with stress hyperglycemia: incidence of diabetes and mortality on follow-up

Introducción: El objetivo fue estimar la incidencia de diabetes y explorar la mortalidad de pacientes hospitalizados durante el seguimiento posterior al alta, clasificados durante la misma según el comportamiento glucémico como hiperglucemia de estrés (HE) o normoglucemia (NG). Material y métodos: Cohorte retrospectiva de adultos no diabéticos con HE (>140mg/dl y HbA1c<6,5%) o NG (todos los valores de glucemia <=140mg/dl). Resultados: Se identificaron 3981 pacientes con NG y 884 con HE. Durante el período de observación (mediana de seguimiento de 1,83 años), hubo un total de 255 casos de diabetes y 831 muertes. La incidencia acumulada de diabetes al año fue de 1,59% (IC95%:1,23-2,06) en NG y 7,39% (IC95% 5,70-9,56) en HE. HE se asoció significativamente con la incidencia de diabetes (HR crudo 1,33; IC95% 1,13-1,73; p 0,025), incluso después del ajuste por edad y sexo (HR ajustado 1,38; IC95% 1,06-1,78; p 0,014). La incidencia de mortalidad al año fue 10,07% (IC95%:9,18-11,05) en NG y 13,24% (IC95%:11,17-15,65) en HE. El sub hazard ratio de desarrollar diabetes considerando la muerte como evento competitivo fue 1,41 (IC95% 1,29-1,53; p<0,001). Conclusiones: La HE es un factor de riesgo para desarrollar diabetes. No hubo diferencias de mortalidad en el seguimiento, pero la muerte parece comportarse como un evento competitivo al desarrollo de diabetes en esta población

Introduction: The study objective was to estimate during post-discharge follow-up the incidence of diabetes and to ascertain mortality in hospitalized patients, classified during follow-up as having stress hyperglycemia (SH) or normoglycemia (NG) based on blood glucose levels. Material and methods: A retrospective cohort of non-diabetic adults with SH (> 140mg/dl and HbA1c <6.5%) or NG (all blood glucose values ≤ 140mg/dl) was used. Results: There were 3981 patients with NG and 884 with SH. During the observation period (median follow-up of 1.83 years), there were 255 cases of diabetes and 831 deaths. The cumulative incidence of diabetes per year was 1.59% (95% CI: 1.23-2.06) in patients with NG and 7.39% (95% CI: 5.70-9.56) in those with SH. SH was significantly associated to diabetes (crude HR 1.33, 95% CI: 1.13-1.73, p .025), even after adjusting for age and sex (adjusted HR 1.38, 95% CI 1.06-1.78, p .014). The mortality rate at one year was 10.07% (95% CI: 9.18-11.05) in NG patients and 13.24% (95% CI: 11.17-15.65) in SH patients. The sub-hazard ratio of developing diabetes considering death as a competitive event was 1.41 (95% CI 1.29-1.53, p <.001). Conclusions: SH is a risk factor for diabetes. There were no differences in mortality during follow-up, but death appears to be a competitive event in development of diabetes in this population

Hospitalized patients with stress hyperglycemia: incidence of diabetes and mortality on follow-up. / Pacientes hospitalizados con hiperglucemia de estrés: incidencia de diabetes y mortalidad al seguimiento.

INTRODUCTION: The study objective was to estimate during post-discharge follow-up the incidence of diabetes and to ascertain mortality in hospitalized patients, classified during follow-up as having stress hyperglycemia (SH) or normoglycemia (NG) based on blood glucose levels. MATERIAL AND METHODS: A retrospective cohort of non-diabetic adults with SH (> 140mg/dl and HbA1c <6.5%) or NG (all blood glucose values ≤ 140mg/dl) was used. RESULTS: There were 3981 patients with NG and 884 with SH. During the observation period (median follow-up of 1.83 years), there were 255 cases of diabetes and 831 deaths. The cumulative incidence of diabetes per year was 1.59% (95% CI: 1.23-2.06) in patients with NG and 7.39% (95% CI: 5.70-9.56) in those with SH. SH was significantly associated to diabetes (crude HR 1.33, 95% CI: 1.13-1.73, p .025), even after adjusting for age and sex (adjusted HR 1.38, 95% CI 1.06-1.78, p .014). The mortality rate at one year was 10.07% (95% CI: 9.18-11.05) in NG patients and 13.24% (95% CI: 11.17-15.65) in SH patients. The sub-hazard ratio of developing diabetes considering death as a competitive event was 1.41 (95% CI 1.29-1.53, p <.001). CONCLUSIONS: SH is a risk factor for diabetes. There were no differences in mortality during follow-up, but death appears to be a competitive event in development of diabetes in this population.

[Granulocytic Sarcoma: Two cases with Lymph Node Presentation]. / Sarcoma Granulocítico : Dos Casos con compromiso Ganglionar.

Two cases of granulocytic sarcoma (GS) with lymph node presentation without marrow involvement are presented because it is a rare presentation of acute myeloid leukemia (AML) that can coexist with or precede it and as initial symptom (case 1) or disease relapse (case 2). The most common differential diagnoses are lymphoma or solid tumor. Biopsy is essential for definitive diagnosis. Imaging studies such as positron emission tomography (PET) are very useful for staging and monitoring. The prognosis and treatment according to the literature is not different from AML. The two cases presented were diagnosed with lymph node biopsy with a bone marrow that did not meet criteria for AML.