Estudio del control metabólico en pacientes diabéticos en hemodiálisis crónica: hemoglobina glicosilada, fructosamina y glicemias capilares / Study of metabolic control in diabetic patients on chronic hemodialysis: glycated hemoglobin, fructosamine and capillary glycemia

Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.

Hiponatremia / Hyponatremia

Alterations in plasma osmolality are related to changes in cell volume, which are the pathophysiological substrate of serious diseases. Under normal conditions sodium is the main determinant of plasma osmolality, and its homeostasis depends primarily on water balance. Hyponatremia is common in clinical practice, and is associated with morbidity and mortality by itself or in relation to its treatment. Despite this, sodium disorders are underdiagnosed, undertreated, and often handled improperly. Because multiple conditions with different treatments can be manifested through hyponatremia, the clear understanding of the pathophysiologic condition of each patient is essential for proper management. This review will discuss the pathophysiology, diagnostic approaches and current therapies of hyponatremia (AU)

Necrosis intestinal como presentación de enfermedad de Takayasu / Intestinal necrosis as clinical presentation of Takayasuïs arteritis: report of one case

A 32 years old female was admitted to hospital due to acute abdominal pain, nausea, vomiting and liquid stools. Physical examination was normal except for pain on her left inferior abdominal quadrant without peritoneal irritation signs. An abdominal CAT-scan suggested thrombosis at celiac trunk, although the echo Doppler showed no alterations except for signs of ischemia in the distal branch of the superior mesenteric artery. An exploratory laparotomy was performed disclosing a necrosis of the distal ileum and cecum, diffuse peritonitis and thrombosis of the ileocecoapendiculocolic artery. No vasculitis lesions were found in the arteries of medium size examined. A history of intermittent claudication for the past 3 years as well as acrocyanosis, asymmetry of pulses and blood pressure in the superior extremities was ascertained after the surgery. A MRI angiogram showed multiple stenoses and irregularities at the celiac trunk, hepatic, superior mesenteric and fibular arteries. No abnormalities at the aortic arch and its main branches were documented. A sepsis due to Candida sp complicated her postoperatory period. After recovery, prednisone 1 mg/kg/day was started and the anticoagulation continued. The abdominal pain, intermittent claudication and superior limb acrocyanosis disappeared. This is an unusual case of type IV Takayasu's arteritis with acute abdominal signs as the first manifestation

Neumonía adquirida en la comunidad: comunicación de 8 casos de neumonía grave por legionella pneumophila serogrupo 1 en Chile / Community acquired pneumonia: report of 8 cases of severe pneumonia caused by legionella pneumophila seroproup 1 in Chile

Legionella pneumophila is the second cause of severe community acquired pneumonia. In Chile, however, there are few reports of pneumonia caused by Legionella. We report eight patients (6 men, aged 42 to 72 years old) with community-acquired pneumonia caused by Legionella pneumophila serogroup 1, confirmed by the measurement of urinary antigen. Clinical presentation was characterized by fever or hypothermia (in one case), cough, dyspnea and neurological abnormalities in four patients. Cigarette smoking was the most frequently identified risk factor. All patients had at least one American Thoracic Society severity criteria. Complications observed were acute hypoxemic respiratory failure in seven patients, shock in four, renal failure in four and need for mechanical ventilation in three. No patient died

Insuficiencia renal aguda en hepatitis aguda no fulminante causada por virus A: caso clínico y revisión de la literatura / Acute renal failure in non fulminant hepatitis A: case report and review

La insuficiencia renal aguda es una complicación excepcional de la hepatitis A no fulminante. Esta asociación ha sido comunicada en alrededor de 30 casos en la literatura, la mayoría proveniente de pacientes japoneses. El proceso exacto a través del cual el virus de la hepatitis A (VHA) produce daño renal es incierto, pero se han postulado varios mecanismos patogénicos, como glomerulonefritis por complejos inmunes, toxicidad por hiperbilirrubinemia, síndrome hepatorrenal, nefritis intersticial aguda y necrosis tubular aguda isquémica, siendo este último el más frecuentemente demostrado en los casos en que se ha realizado biopsia renal. Nosotros reportamos el primer caso en Chile de insuficiencia renal aguda no oligúrica, en un paciente hombre de 16 años, cursando una hepatitis no fulminante por el VHA, de muy buena evolución espontánea, sin requerir diálisis, y en el que no se realizó biopsia renal, por coagulación incompatible y rápida mejoría