Asunto(s)
Acetilcisteína/uso terapéutico , Depuradores de Radicales Libres/uso terapéutico , Encefalopatía Hepática/tratamiento farmacológico , Fallo Hepático Agudo/tratamiento farmacológico , Dengue Grave/tratamiento farmacológico , Administración Intravenosa , Femenino , Encefalopatía Hepática/etiología , Humanos , Fallo Hepático Agudo/etiología , Persona de Mediana Edad , Dengue Grave/complicaciones , Resultado del TratamientoRESUMEN
AIMS: The prevalence of islet cell, thyroid, adrenal and celiac disease related autoantibodies in patients with Type 1 diabetes mellitus (Type 1 DM) from Sri Lanka is described. DESIGN AND METHODS: Autoantibodies to glutamic acid decarboxylase 65 (GAD65Ab), protein tyrosine phosphatase IA-2 (IA-2Ab), insulin (IAAb), thyroglobulin (TgAb), thyroid peroxidase (TPOAb), TSH receptor (TRAb), 21-hydroxylase (21-OHAb) and tissue transglutaminase (tTGAb) were measured in 122 Type 1 DM patients who had low C-peptide activity or were >20 yr old at the time of diagnosis and in 100 non-diabetic blood donors. RESULTS: GAD65Ab and/or IA-2Ab were present in 74/122 (60.7%) Type 1 DM subjects with a significantly higher prevalence compared to non-diabetic controls (no. 100) (GAD65Ab-59 vs 4%; IA-2Ab-14 vs 0%; respectively) (p<0.001). The median (inter-quartile range) Type 1 DM duration in antibody positive subjects was 3.3 (0.99-6.9) vs 4.9 (1.7-7.5) yr in antibody negative subjects (p=0.23). IA-2Ab prevalence decreased with disease duration > or =5 yr (19 vs 4%) (p<0.001). There was no difference in the prevalence of TgAb (25 vs 33%)(p=0.21) and TPOAb (22 vs 18%) (p=0.48) in Type 1 DM and non-diabetic subjects. Also, there was no difference in TgAb and TPOAb prevalence in antibody positive Type 1 DM (34.7%) compared to antibody negative Type 1 DM (24.4%) subjects (p=0.24). tTGAb (3/119) and TRAb (1/119) were found in low prevalence and 21-OHAb were not detected. CONCLUSIONS: Diabetes associated autoantibodies were detected in the majority of Type 1 DM subjects, suggesting a major role for autoimmunity in the pathogenesis of Type 1 DM in Sri Lankans. The prevalence of TgAb and TPOAb in Type 1 DM subjects and non-diabetic controls was relatively high and similar in both groups.
Asunto(s)
Glándulas Suprarrenales/inmunología , Autoanticuerpos/análisis , Enfermedad Celíaca/inmunología , Diabetes Mellitus Tipo 1/inmunología , Islotes Pancreáticos/inmunología , Glándula Tiroides/inmunología , Adolescente , Adulto , Edad de Inicio , Enfermedad Celíaca/epidemiología , Niño , Diabetes Mellitus Tipo 1/epidemiología , Femenino , Glutamato Descarboxilasa/inmunología , Humanos , Inmunoglobulinas Estimulantes de la Tiroides , Anticuerpos Insulínicos/análisis , Yoduro Peroxidasa/inmunología , Isoenzimas/inmunología , Masculino , Prevalencia , Proteína Tirosina Fosfatasa no Receptora Tipo 1 , Proteínas Tirosina Fosfatasas/inmunología , Sri Lanka/epidemiología , Esteroide 21-Hidroxilasa/inmunología , Transglutaminasas/inmunologíaRESUMEN
The aim was to study the quality of care at a diabetic clinic of a large hospital in Sri Lanka; a sample of 200 patients was randomly selected. A questionnaire was designed to assess patient knowledge of diabetic management and service provision. Clinic attendance records were also used. Measures of outcome were taken to be (i) the patient's level of understanding of their condition, (ii) the availability of diagnostic tests, (iii) the provision of regular screening and (iv) the length of consultation time. The average attendance at each four-hour clinic was 174 patients. With three doctors available, average consultation time was four minutes per patient. Procedures undertaken included measuring blood glucose levels, testing for proteinuria and screening for hyperlipidaemia, hypertension and eye disease. The average score for knowledge regarding management and complications, obtained from analysis of the questionnaire, was 5.3 out of a maximum of 9.0 points. The study showed that the quality of care of diabetic patients did not meet the standards that should be expected. Two of the principal problems were lack of good organisation and poor planning of resource utilisation. An increase in funding would, of course, assist in implementing the improvements suggested.
Asunto(s)
Instituciones de Atención Ambulatoria/normas , Diabetes Mellitus/terapia , Tamizaje Masivo/estadística & datos numéricos , Auditoría Médica , Calidad de la Atención de Salud , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/organización & administración , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ocupaciones , Distribución por Sexo , Sri Lanka , Encuestas y CuestionariosAsunto(s)
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Hospitales/estadística & datos numéricos , Hospitales/tendencias , Guías de Práctica Clínica como Asunto/normas , Humanos , Incidencia , Vigilancia de la Población , Prevalencia , Sociedades Médicas , Sri Lanka/epidemiología , Estados Unidos , Organización Mundial de la SaludRESUMEN
The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in a rural Sri Lankan community adopting the World Health Organization (WHO) criteria were 2.5% and 8% respectively. The low socioeconomic status, adequate physical exercise and the low prevalence of obesity appear to have not only contributed to the low prevalence of diabetes but also has prevented progression from IGT to overt diabetes.
Asunto(s)
Diabetes Mellitus/epidemiología , Intolerancia a la Glucosa/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus/sangre , Diabetes Mellitus/etiología , Femenino , Intolerancia a la Glucosa/sangre , Intolerancia a la Glucosa/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Salud Rural , Sri Lanka/epidemiologíaRESUMEN
We report a case of central retinal artery occlusion associated with migraine. Although this association is rare, the importance of early diagnosis, and the long-term management of this form of complicated migraine are briefly discussed.
Asunto(s)
Trastornos Migrañosos/complicaciones , Oclusión de la Arteria Retiniana/etiología , Adulto , Humanos , Masculino , Oclusión de la Arteria Retiniana/diagnósticoRESUMEN
A giant mycotic aneurysm of the thoracic aorta, which is a rare presentation of infective endocarditis, is reported.