Prevalencia de Neuropatía periférica de pequeñas fibras asociada a retinopatía en diabéticos tipo 2: Uso prueba biomédica por imagen termográfica

Introducción: La neuropatía periférica diabética de fibras delgadas (NPD-fd) son diagnosticadas por pruebas biomédicas vasomotoras cuyo fundamento es la alteración de la termorregulación de la piel. Objetivos: Calcular la prevalencia y los factores asociados a NPD-fd usando imagen termográfica (IT). Métodos: Se realizó un estudio observacional, transversal analítico en una unidad especializada en el ámbito de la atención primaria, en el que se avaluó pacientes con diabetes mellitus tipo 2 mediante pruebas neurológicas periféricas como la sensibilidad táctil y vibratoria para el diagnóstico de NPD de fibras gruesas (NPDfg) y la termorregulación pasiva por IT para la NPD-fd . Ésta última se realizó en la planta del pie utilizando una cámara termográfica en la consulta ambulatoria, evaluando 5 mediciones termográficas plantares por sujeto. Luego, la asociación entre diabéticos con y sin NPD-fd fue analizada respecto a género, edad, tiempo de enfermedad diabética, tipo de tratamiento diabético, hipertensión, retinopatía, nefropatía, dieta baja en carbohidratos, actividad física, síntoma dolor y IMC. Resultados: Se estudiaron 304 pacientes con diabetes mellitus tipo 2, una edad promedio de 65.07±11.39 años, en su mayoría de sexo masculino, encontrándose una NPD-fg en 14.8 %, NPD-fd en 27.3 % y ambas NPD en 34.9%. La asociación de la NPD-fd fue únicamente con el factor de la presencia de retinopatía (α=0,02, C= 0.18). Conclusiones: Se encontró una alta prevalencia de NPD-fd usando una imagen termográfica que estuvo asociado a la presencia de retinopatía.

Introduction: Small fibers diabetic peripheral neuropathy (DPN-sf) are diagnosed by biomedical vasomotor tests whose foundation is altered skin thermoregulation. Objectives: To estimate the prevalence and factors associated with DPN-sf using thermographic imaging (TI). Methods: An observational, cross-sectional, analytical study was performed in a specialized unit in the primary care setting, in which patients with type 2 diabetes mellitus were assessed by peripheral neurological tests such as tactile and vibratory sensitivity for the diagnosis of large fibers peripheral neuropathy (DPN-lf) and passive thermoregulation by TI for DPN-sf .The latter was performed on the sole using a thermographic camera in the outpatient clinic, evaluating 5 plantar thermographic measurements per subject. Then, the association between diabetics with and without DPN-sf was analyzed concerning gender, age, time of diabetic disease, type of diabetic treatment, hypertension, retinopathy, nephropathy, low carbohydrate diet, physical activity, pain symptom, and BMI. Results: 304 patients with type 2 diabetes mellitus were studied, mean age of 65.07±11.39 years, mostly male, finding DPN-lf in 14.8 %, DPN-sf in 27.3 %, and both NPD in 34.9%. The association of DPN-sf was only with the factor of the presence of retinopathy (α=0.02, C= 0.18). Conclusions: We found a high prevalence of DPN-sf using thermographic imaging that was associated with the presence of retinopathy.

Type 2 diabetes mellitus in Peru: A literature review including studies at high-altitude settings.

We performed a comprehensive review of recent publications about type 2 diabetes mellitus (T2DM) in Peru, including studies among people living at high altitude above the sea level. An increase in the prevalence of T2DM in Peru has been reported, the reasons are multifactorial and coinciding with the strong economic growth that our country has experienced over the last 20 years along with migration from the Andean regions to the coast and the adoption of a lifestyle that is a known to be a risk factor for obesity and insulin resistance. Scarce information is available in Peru about the prevalence of chronic complications of T2DM such as retinopathy, neuropathy, and nephropathy. There is a need for a health care plan based on early diagnosis of T2DM to reduce social and economic problems, as recommended by the WHO and the United Nations.

Incidence of COVID-19 infection and prevalence of diabetes, obesity and hypertension according to altitude in Peruvian population.

To investigate the cumulative incidence and mortality of COVID-19 and the prevalence of comorbidities such as diabetes, obesity and hypertension in regions with different altitude levels ranging from sea level to high altitude. METHODOLOGY: Analytical study in which we correlated secondary data obtained from reports of the Ministry of Health and National Institute for Statistics and Informatic. The cumulative incidence and mortality of COVID-19 in 25 peruvian regions is reported, together with its relationnship with altitude levels during March-July 2020 using Pearsons correlation. We also aiming to assess the prevalence of diabetes, obesity and hypertension with altitude according to the ENDES 2018 data using Gamma statistics. RESULTS: COVID-19 maintained an inverse correlation with higher rates in the coastal regions and lower rates with increasing altitude in the cumulative incidence (Pearson = -0.8, p < 0.000) and mortality (Pearson = -0.77, p < 0.000), adjusted gender and age. The prevalence of diabetes and obesity showed the same inverse correlation trend with altitude (Gamma p < 0.000) but not hypertension (Gamma p = 0.13) CONCLUSIONS: The data in Peru it is suggested that physiological adaptation in a hypoxic environment at high altitude may protect persons from the severe impact of acute infection caused by SARS-CoV-2. The reduction in cumulative incidence and mortality rates with increasing altitude is the main finding. Possible mechanisms such as a decreased expression of angiotensin-converting enzyme 2 (ACE2) and a lower virulence because of a high altitude environment, may explain this epidemiological features. In addition, the lower prevalence of diabetes, obesity and hypertension may establish a protective epidemiology against these disease.

Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study.

OBJECTIVE: A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study. RESEARCH DESIGN AND METHODS: 662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, highlands and jungle) natural regions across the country, from both sexes, aged 25+ years at baseline, enrolled in 2010-2012, were followed for 3.8 years. New diabetes cases were defined as fasting blood glucose ≥126 mg/dL or on medical diabetes treatment. RESULTS: There were 49 cases of diabetes in 2408 person-years follow-up. The weighted cumulative incidence of diabetes was 7.2% while the weighted incidence rate was estimated at 19.5 (95% CI 13.9 to 28.3) new cases per 1000 person-years. Older age, obesity and technical or higher education were statistically associated with the incidence of diabetes. CONCLUSION: Our results confirm that the incidence of diabetes in Peru is among the highest reported globally. The fast economic growth in the last 20 years, high overweight and obesity rates may have triggered this phenomenon.

Prevalence of diabetes and impaired fasting glucose in Peru: report from PERUDIAB, a national urban population-based longitudinal study.

OBJECTIVES: We aimed to estimate the prevalences of diabetes and impaired fasting glucose (IFG) in a national sample in Peru and assess the relationships with selected sociodemographic variables. METHODS: We estimated prevalence in PERUDIAB study participants, a nationwide, stratified urban and suburban population selected by random cluster sampling. Between 2010 and 2012, questionnaires were completed and blood tests obtained from 1677 adults ≥25 years of age. Known diabetes was defined as participants having been told so by a doctor or nurse and/or receiving insulin or oral antidiabetic agents. Newly diagnosed diabetes was defined as fasting plasma glucose ≥126 mg/dL determined during the study and without a previous diabetes diagnosis. IFG was defined as fasting plasma glucose of 100-125 mg/dL. RESULTS: The estimated national prevalence of diabetes was 7.0% (95% CI 5.3% to 8.7%) and it was 8.4% (95% CI 5.6% to 11.3%) in metropolitan Lima. No gender differences were detected. Known and newly diagnosed diabetes prevalences were estimated as 4.2% and 2.8%, respectively. A logistic regression response surface model showed a complex trend for an increased prevalence of diabetes in middle-aged individuals and in those with no formal education. Diabetes prevalence was higher in coastal (8.2%) than in highlands (4.5%; p=0.03), and jungle (3.5%; p<0.02) regions. The estimated national prevalence of IFG was 22.4%, higher in males than in females (28.3% vs 19.1%; p<0.001), and higher in coastal (26.4%) than in highlands (17.4%; p=0.03), but not jungle regions (14.9%; p=0.07). CONCLUSIONS: This study confirms diabetes as an important public health problem, especially for middle-aged individuals and those with no formal education. 40% of the affected individuals were undiagnosed. The elevated prevalence of IFG shows that nearly a quarter of the adult population of Peru has an increased risk of diabetes.

Frecuencia de síndrome metabólico en adultos mayores del Distrito de San Martin de Porres de Lima, Perú según los criterios de ATP III y de la IDF / Frequency of syndrome in older adults in the District of San Martin de Porres in Lima, Peru according to the criteria of ATP III and IDF

Objetivos: Determinar la frecuencia del Síndrome metabólico en los adultos mayores de la comunidad del distrito de San Martín de Porres de Lima, Perú. Material y métodos: Estudio descriptivo de análisis secundario de base de datos del estudio "Perfil Clínico del Adulto Mayor que habita en la comunidad de San Martín de Porres", el cual se realizó por muestreo probabilístico entre los meses de febrero y mayo de 2013. Resultados: Se incluyeron a 312 adultos mayores. La frecuencia del síndrome metabólico según los criterios ATP III fue 28,2% y según los criterios de la IDF 35,3%, siendo más frecuente en mujeres que en varones. La frecuencia de obesidad según el índice de masa corporal fue 19,2%, y la frecuencia de obesidad abdominal según los criterios del ATP III fue 65,4%, siendo mayor en mujeres, mientras que según los criterios de la IDF fueron 32,1% y 59,3% en hombres y mujeres, respectivamente. Conclusiones: La frecuencia del síndrome metabólico en la población adulta mayor es alta, obteniendose cifras mayores usuando los criterios de la IDF en comparación con ATP III, presentándose con mayor frecuencia en mujeres...

Objectives: To determine the frequency of metabolic syndrome in the elderly living in San Martin de Porres district of Lima. Methods: Descriptive study that used data from the Clinical Profile of the Elderly livig in San MArtin de Porres, a probabilistic sample between February and May 2013 was undertaken. Results: 312 elder patients were included. The frequency of metabolic syndrome following ATP III and IDF was 28.2% and 35.3%, respectively, being more frequent in females than in males. The frequency of obesity based on body mass index and the frequency of abdominal obesity based on ATP III criteria were 19.2% and 65.4%, being more frequent in females, while the values following IDF criteria were 32.1% and 59.3% respectively and were more frequent in males. Conclusions: The frequency of metabolic syndrome in the elderly in this setting is high, particularly among females, with higher values following IDF criteria compared to ATP II criteria...

Diabetes in South and Central America: an update.

The estimated population of the South and Central America (SACA) Region is 467.6 million and 64% is in the age range of 20-79 years but the population pyramid and age distribution are changing. The average prevalence of diabetes in the Region is 8.0% and is expected to reach 9.8% by the year 2035. Prevalence is much lower in rural settings than in urban and the differences attributed to lifestyle changes may be a target for intervention. The indigenous population is a particularly vulnerable group needing special attention. On average, 24% of the adult cases with diabetes are undiagnosed but in some countries this is still as high as 50%. Health expenditure due to diabetes in the Region is around 9% of the global total. Inadequate glycemic control, defined as HbA1c >7%, is a strong predictor of chronic complications which increase resource use in the Region and less than half of the patients enrolled in diabetes care programmes are at target. Fifty percent or more of the adult population is overweight/obese and around one third of the adult population has metabolic syndrome using regional cutoffs for waist circumference. The number of people with IGT is almost equal to those with diabetes presenting an additional challenge for prevention. Children with type 1 diabetes represent only 0.2% of the total population with diabetes but the incidence may be increasing. In many places they have limited access to insulin, and even when available, it is not used appropriately. The available epidemiological data provide the background to act in developing national diabetes programmes which integrate diabetes care with cardiovascular prevention and promote diabetes prevention as well.

Diabetes tipo 2 en niños: reporte de caso / Type 2 diabetes in children: a case report

Se reporta el caso de una niña de 14 años con antecedentes de obesidad, dislipidemia y diabetes que es referida anuestro servicio por polidipsia, poliuria y sobrepeso. La paciente tenía el antecedente familiar de ambos padres con diagnóstico de diabetes tipo 2. El examen físico mostró obesidad central y acantosis nigricans severa en los pliegues cutáneos. Los análisis de laboratorio mostraron hiperglicemia, hiperinsulinemia y péptido C normal. Los autoanticuerpos anti-GAD y anti-ICA fueron negativos. El tratamiento con metformina fue continuado; y la dieta y actividad física fueron reforzadas. Actualmente, los niveles de hemoglobina glicosilada y glicemia en ayunas han mejorado. El incremento en la obesidad infantil ha resultado en un marcado aumento en la incidencia de síndrome metabólico y diabetes tipo 2 en la población infantil.

We report a 14-year-old girl with history of diabetes, obesity and, dyslipidemia. The patient was referred to our service because of polydipsia, polyuria and, overweight. Both parents were patients with type 2 diabetes. Physical examination showed abdominal obesity and severe acanthosis nigricans in skin folds. Laboratory results show edhyperglycemia, hyperinsulinemia, normal C-peptide and, the autoantibodies against islet antigens were negative. Treatment with metformin was continued. Diet and physical activity were reinforced. Currently, hemoglobin A1c and fasting plasma glucose have been improved. The rise in childhood obesity has resulted in a marked increase in the incidence of metabolic syndrome and type 2 diabetes in pediatric population.

A comparison of the prevalence of metabolic syndrome and its components in high and low altitude populations in peru.

BACKGROUND: Prevalence of the metabolic syndrome has been described in populations with ethnic and cultural differences. The aim of this study was to determine the prevalence of the metabolic syndrome on a population from the Andes Mountains of Peru and compare it to a sea-level population. METHODS: A cross-sectional study of subjects aged 30 years old or more from the high-altitude population of San Pedro de Cajas (SPC) (13,450 feet) and the sea-level population of Rimac (331 feet) was done. The metabolic syndrome was identified according to the revised National Cholesterol Education Program definition. The prevalence of metabolic abnormalities was calculated by gender, age, and population. A multivariate analysis was done with metabolic syndrome as the dependant variable. RESULTS: Ninety-nine subjects from SPC and 172 from Rimac were included. The prevalence of metabolic syndrome was higher in SPC (22.2% versus 16.9%; p = 0.28). Prevalence of hypertriglyceridemia was significantly higher in SPC (56.6% versus 29.7%; p < 0.001) and prevalence of high blood pressure was significantly higher in Rimac (30.8% versus 18.2%; p < 0.05). In the multivariate analysis female gender was a risk factor for metabolic syndrome (odds ratio [OR] = 4.2; 95% confidence interval [CI]: 1.76-9.15). CONCLUSIONS: We found an overwhelming predominance of females with the metabolic syndrome in both populations due to high prevalences of abdominal obesity and low highdensity lipoprotein (HDL) Hypertriglyceridemia prevalence was elevated in both men and women of high altitude. Lower prevalence of high blood pressure and of high fasting glucose was found in the high-altitude natives. The prevalence and characteristics of the metabolic syndrome apparently varies among different ethnic groups and this indicates the need for more epidemiologic studies.

Lipid profile, waist circumference, and body mass index in a high altitude population.

Some studies have found different distribution patterns for the lipid profile of high altitude populations, having found the majority of them a more favorable one in these subjects. The objective of this study is to describe the lipid profile of a high altitude population and relate it to the waist circumference, body mass index, gender, and age. A descriptive study was done in an adult population, 30 yr old and above, of the town of San Pedro de Cajas (SPC), Peru, located at 4100 m (13,450 ft) above sea level. One hundred and two representative individuals (38 males and 64 females) were included. HDL cholesterol and triglyceride means were elevated, whereas total cholesterol means were average, and LDL cholesterol means were low. The BMI mean was 25.4 +/- 3.7. We observed a high prevalence of hypercholesterolemia (34.3%) and hypertriglyceridemia (53.9%) in both genders. Higher prevalences of low HDL (45.3%), abnormal waist circumference (64%), and obesity (14.1%) were found in women (p < 0.001). A higher prevalence of low HDL in overweight/obese (74.2%) and abnormal waist circumference (77.4%) subjects was evident (p < 0.001). We found high prevalences of hypercholesterolemia and hypertriglyceridemia for both genders and important prevalences of risk factors for cardiovascular disease and coronary heart disease, such as hypertriglyceridemia, low HDL, abnormal waist circumference, and obesity, in high altitude natives, especially in women.

Geographic variations of the International Diabetes Federation and the National Cholesterol Education Program-Adult Treatment Panel III definitions of the metabolic syndrome in nondiabetic subjects.

OBJECTIVE: We have carried out international comparisons of the metabolic syndrome using the International Diabetes Federation (IDF) and National Cholesterol Education Program-Adult Treatment Panel III (ATP III) definitions. This analysis could help to discern the applicability of these definitions across populations. RESEARCH DESIGN AND METHODS: Nondiabetic subjects aged 35-64 years were eligible for analysis in population-based studies from San Antonio (Mexican Americans and non-Hispanic whites, n = 2,473), Mexico City (n = 1,990), Spain (n = 2,540), and Peru (n = 346). Kappa statistics examined the agreement between metabolic syndrome definitions. RESULTS: Because of the lower cutoff points for elevated waist circumference, the IDF definition of the metabolic syndrome generated greater prevalence estimates than the ATP III definition. Prevalence difference between definitions was more significant in Mexican-origin and Peruvian men than in Europid men from San Antonio and Spain because the IDF definition required ethnic group-specific cutoff points for elevated waist circumference. ATP III and IDF definitions disagreed in the classification of 13-29% of men and 3-7% of women. In men, agreement between these definitions was 0.54 in Peru, 0.43 in Mexico City, 0.62 in San Antonio Mexican Americans, 0.69 in San Antonio non-Hispanic whites, and 0.64 in Spain. In women, agreement between definitions was 0.87, 0.89, 0.86, 0.87, and 0.93, respectively. CONCLUSIONS: The IDF definition of the metabolic syndrome generates greater prevalence estimates than the ATP III definition. Agreement between ATP III and IDF definitions was lower for men than for women in all populations and was relatively poor in men from Mexico City.

HLA genes in Lamas Peruvian-Amazonian Amerindians.

The Lamas Amerindians are the Chancas descents who established before 1532 a.d. (Spanish conquest) at Lamas City, Wayku quarter in a Peruvian-Amazonian province (San Martin). The Lamas HLA profile shows significant differences with other Amerindians HLA profile, i.e.: (a) a higher number of newly found haplotypes compared to other studied Amerindian populations, particularly HLA-A*02-B*48-DRB1*0403-DQB1*0302, A*02-B*48-DRB1*0804-DQB1*0402 and A*02-B*40-DRB1*0407-DQB1*0302; (b) a relative high frequency of HLA-DRB1*0901 (a high frequency southern Asian allele) and HLA-B*48 (a Na-Dene, Siberian and Eskimo allele); both alleles are also found frequently in Quechuas and Aymaras, but not in many other (particularly Meso American) Amerindians and (c) correspondence and neighbor-joining dendrogram analyses show that Lamas (Chancas) may have an origin close to Amazonian Indians that later reached the Andean altiplano.

Prevalence of the metabolic syndrome in the mestizo population of peru.

BACKGROUND: The metabolic syndrome (MS) has been shown to predict mortality due to cardiovascular disease. Currently, no population-based data on the prevalence of the MS is available in Peru. This study was aimed to assess the prevalence of the MS in urban Peruvian Mestizos, in the coastal districts of Lima, the capital of Peru. METHODS: A cross-sectional, epidemiological survey was undertaken, including 612 unrelated subjects aged 30-92 years (68.3% females). Prevalence of the MS was defined by the National Cholesterol Education Program Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) criteria. Insulin resistance was estimated by the homeostasis model assessment (HOMA). RESULTS: Age and sex standardized prevalence of the MS was 14.9% (13.2% in males, 16.5% in females). The MS was significantly more prevalent in females aged 45-59 years old (20.2% vs. 6.7%, p = 0.019). In individuals with the MS, the prevalence of insulin resistance (IR) was 45% in males/42% in females. Abdominal obesity (80% in males/92.8% in females), and low HDL cholesterol (55% males/75.4% females), but neither hypertriglyceridemia (85% in males/81.2% females) nor high fasting glucose (55% in males/36.2 % females) were more common in females. Prevalence of arterial hypertension was similar in both sexes. CONCLUSIONS: In this Mestizo Peruvian population, prevalence of the MS is relatively low as compared to other ethnic groups; the higher prevalence in females is likely due to a higher prevalence of abdominal obesity. Overall, abdominal obesity and hypertriglyceridemia were the predominant combination of metabolic disorders in individuals fulfilling criteria for the diagnosis of the MS.

Diagnóstico de la investigación biomédica en el Perú comunicación preliminar / Diagnostic of the biomedical research in Peru

El presente es un estudio evaluativo de los principales aspectos del desarrollo científico y tecnológico biomédico en el Perú y en el marco del desarrollo global del país, así como latinoamericano y mundial. Se comentan los modelos de salud empleados para llegar a las desigualdades económico-sociales e inequidades existentes. Se analiza la asociación positiva entre el organismo rector de ciencia y tecnología, el sector salud y la Organización Panamericana de la Salud, para promover la realización de proyectos prioritarios en el Perú, con evaluaciones por pares y decisión a nivel nacional. El artículo incide en aspectos de producción científica y bibliográficos, así como de recursos humanos e inversión en ciencia y tecnología; así mismo, plantea un análisis de fortalezas, debilidades y probables escenarios futuros. Se señala la necesidad de reforzar la información y comunicación a niveles de excelencia y la construcción de una nueva cultura en investigación biomédica. Se destaca la importancia de implantar un sistema de acreditación institucional progresivo, recursos humanos con el perfil requerido, producción científica con stándares adecuados y mayor agresividad en la utilización de la cooperación externa.

Diabetes mellitus en el anciano: enfermedad heterogénea, de clasificación dinámica y tratamiento predecible / Diabetes mellitus in elderly: a heterogeneous disease, of dinamic classification and predictable treatment

Para estudiar la presentación clínica y criterios de clasificación de la diabetes mellitus tipo I (DMI) en el anciano diabético (AD), se investigaron 258 pacientes diabéticos con más de 60 años, de los cuales 40 por ciento usaba insulina por haber fracasado el uso de hipoglicemiantes orales (HO). La prevalencia de cardiopatía isquémica fue 36 por ciento, enfermedad vascular periférica 34 por ciento y accidentes cerebro vasculares 30 por ciento; un 47 por ciento presentó retinopatía no-proliferativa, 37 por ciento neuropatía periférica simétrica y 16 por ciento nefropatía con una duración promedio de diabetes de 20 años. El 36 por ciento fueron obesos (IMC>25), 33 por ciento tuvieron hipertensión arterial y 12 por ciento dislipidemia. Péptido-C basal y post glucagon, antígenos HLA-DR y anticuerpos anti islote pancreático (ICA), fueron medidos en 75 AD en tratamiento, de los cuales 24 usaban insulina, 40 HO y 11 sólo dieta. Los AD en insulina, tuvieron un largo período de enfermedad, menos obesidad, niveles basales disminuídos de Péptido-C y baja respuesta de Péptido-C post glucagon (0.94 +/- 0.5 pmol/ml), en comparación con los tratados sólo con dieta (1.8 +/- 0.9 pmol/ml) y en HO (1.8 +/- 0.8 pmol/ml). Los ancianos diabéticos en insulino terapia tuvieron una mayor frecuencia de Ag HLA-DR3 (42 por ciento) y Ag HLA-DR4 (21 por ciento). Los ICA fueron negativos excepto en 2 pacientes. El presente estudio demuestra la alta prevalencia de enfermedad macrovascular y microvascular en los pacientes ancianos con diabetes mellitus y que el parámetro más confiable para caracterizar la insulinodependencia en éste grupo de edad, es la medición del Péptido-C basal y post glucagon. Los marcadores inmunogenéticos Ag HLA-DR e ICA, pueden ser utilizados concomitantemente, para ayudar a clasificar DMI en el anciano é instaurar un tratamiento insulínico racional

Patología tiroidea operada: 12 años de experiencia en el Hospital Cayetano Heredia / Thyroid pathology operated: 12 years of experience at the Hospital Cayetano Heredia

Se presenta las características clínicas, técnica operatoria, estudio histopatológico y evolución de 173 pacientes con patología tiroidea operada en el Hospital Nacional Cayetano Heredia entre 1976 y 1987. 52.6 por ciento presentaron bocio nodular, 63.5 por ciento presentaron nódulos fríos y 21.1 por ciento nódulos calientes. Las técnicas operatorias empleadas fueron: lobectomía total más istmectomía (65.8 por ciento), tiroidectomía subtotal bilateral (19 por ciento), lobectomía total más istmectomía más lobectomía parcial contralateral (8 por ciento) y tiroidectomía total (4 por ciento). La biopsia por congelación se realizó en 95 por ciento de los pacientes. Bocio coloide fue el resultaado histopatológico más frecuente (67.6 por ciento). La patología benigna se encontró en 84.6 por ciento y la maligna en 15.4 por ciento. Las complicaciones fueron: lesión unilateral del nervio recurrente (4 por ciento), hematomas sofocantes (2.3 por ciento) e hipoparatiroidismo transitorio (1.7 por ciento). La mortalidad fué de 0.5 por ciento

Empleo del yodato sódico (Biloptin) en el tratamiento agudo de las complicaciones cardiovasculares severas del hipertiroidismo / Acute treatment of severe cardiovascular complications of thyrotoxic patients by sodium ipodate

Los cambios hemodinámicos del hipertiroidismo son atríbuidos al efecto cronotropo e inotropo cardíaco directo del exceso de T3, así como a cambios en la resistencia periférica. Recientes estudios han demostrado que el yopodato sódico disminuye rápidamente los niveles de T3 en más del 50 por ciento de los valores basales dentro de las 24 horas, al bloquear la conversión de T4 a T3. Este estudio muestra su utilidad en controlar las manifestaciones cardiovasculares severas del hipertiroidismo, en 5 casos de Enfermedad de Graves,evaluados en la Unidad de Cuidados Intensivos mediante cateterismo cardíaco con catéter Swan-Ganz, conectado a un computador Edward de gasto cardíaco y a un medidor de presión Twinbbean-Sanborn. A cada paciente se le administró una dosis de 3 gr. de yopodato p.o más Tapazol 45 mg/d 2 días antes, y se evaluó antes y durante 24 hrs post-yopodato la frecuencia cardíaca ( FC ), presión arterial diferencial ( PAdif ), presiones de aurícula derecha, ventrículo derecho, arteria pulmonar y capilar pulmonar, calculándose índice cardiáco ( IC ), resistencia sistémica total ( RST ) Y trabajo ventricular izquierdo ( TVI ), así como fracción de e yección ventricular izquierda ( FEVI ) mediante un ecocardiógrafo modo M y bidimencional. T3 se midió por radioinmunoensayo ( RIA ). Todos, excepto RST Y FEVI, estuvieron elevados basalmente, y disminuyeron significativamente desde las 3 hrs. después del yopodato, mientras RST se elevó a normal a 6 hrs. FEVI se mantuvo bajo, evidenciando compromiso ventricular izquierdo. Los cambios fueron paralelos a la caída de T3