RESUMEN
OBJECTIVE: To describe risk factors associated with microalbuminuria (MA) in subjects with diabetes, investigate the predictive value of MA as a marker of risk for diabetic nephropathy (DN), and define risk factors associated with the development and progression of MA. RESEARCH DESIGN AND METHODS: We conducted a prospective longitudinal study of 23 diabetic subjects with persistent MA and 209 diabetic subjects without MA who attended diabetes clinics at the University of Michigan Medical Center in 1989 and 1990. Both groups were examined at baseline and after 7 years. At baseline, urinary albumin-to-creatinine ratios were studied in random, first morning, and 24-h urine samples. At follow-up, a 12-h overnight urine sample was collected and analyzed for albumin and creatinine. At baseline, MA was defined by at least two separate urine specimens with albumin-to-creatinine ratios between 30 and 299 microg albumin per milligram of creatinine. RESULTS: MA regressed in 56% of subjects with baseline MA without systematic application of corrective measures and developed in 16% of subjects without baseline MA. The predictive value positive of MA as a marker of risk for DN was 43%, and the predictive value negative was 77%. In the combined cohort, the incidence and progression of MA were significantly associated with poor glycemic control and duration of diabetes between 10 and 14 years. CONCLUSIONS: MA may not be as sensitive and specific a predictor of DN as previously suggested. Other markers of risk for DN are needed for optimal clinical management.
Asunto(s)
Albuminuria , Diabetes Mellitus Tipo 1/orina , Diabetes Mellitus Tipo 2/orina , Nefropatías Diabéticas/epidemiología , Adolescente , Adulto , Albuminuria/epidemiología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Biomarcadores/orina , Población Negra , Presión Sanguínea , Niño , Creatinina/orina , Estudios Transversales , Diabetes Mellitus Tipo 1/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Estudios Longitudinales , Michigan , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Fumar , Factores de Tiempo , Población BlancaRESUMEN
One hundred and fifty-two consecutive cases of cholelithiasis were studied. The gallbladder stones were analyzed to determine the constituents, the bile specimens were cultured and correlated with the cultures when wound infection occurred. Mixed gallstones were the commonest type (58.5%), pigment stones (27%) and cholesterol stones (14.5%). Positive bile cultures were found in 41 patients (27%) and Escherichia coli was the commonest organism isolated. The rate of wound infection was 14.5% and the most common organism cultured from the wound was staphylococcus epidermidis.
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Serum cholinesterase catalytic concentrations were estimated in 26 patients diagnosed as having systemic sepsis syndrome (septic shock) in the Intensive Care Unit (12 were admitted with the diagnosis of systemic sepsis syndrome while 14 patients developed the syndrome while in the unit) and in 66 normal, healthy subjects. The assay was performed for 7 consecutive days in the patient group. There was a very significant decrease in the level of cholinesterase in the patient group from the onset of the study as compared to the control group (P < 0.00001). This decrease remained during the course of the seven day study period, indicating hepatic dysfunction early in the diagnosis. When compared to other conventional liver function tests, serum cholinesterase seems to change earlier on in the diagnosis. Prothrombin time showed a pattern of change similar to that of serum cholinesterase. There was a significant relationship between the catalytic concentration of serum cholinesterase and the outcome of the systemic sepsis syndrome, the level being significantly lower in patients who died in comparison to those who lived. It seems that serum cholinesterase is a sensitive indicator of hepatic dysfunction in the systemic sepsis syndrome.
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Bacteriemia/sangre , Colinesterasas/sangre , Choque Séptico/sangre , APACHE , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Tiempo de Protrombina , SíndromeRESUMEN
Early morning urine specimens were obtained from two groups of non-insulin dependent diabetic patients and a group (43 subjects) of normal controls. The diabetic patients were divided into two subgroups according to the degree of diabetic control as judged by their glycosylated haemoglobin (HbA1) levels (well-controlled, 47 subjects; poorly controlled, 51 subjects). The concentration of the low-molecular-weight enzyme (lysozyme) was determined in each urine specimen and related to the concentration of creatinine (lysozyme/creatinine). The mean urinary lysozyme concentration was higher in each of the two diabetic groups as compared with the control group. However, it was not significantly different between the two diabetic groups. These result suggest that there is no association between the degree of glycaemic control and tubular proteinuria.
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Diabetes Mellitus Tipo 2/orina , Nefropatías Diabéticas/orina , Proteinuria/orina , Adulto , Anciano , Glucemia/análisis , Creatinina/sangre , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Muramidasa/orinaRESUMEN
OBJECTIVE: To determine the prevalence of hyperglycemia in semiurban-rural Saudi Arabian communities and to assess some of its important health-care related aspects. RESEARCH DESIGN AND METHODS: A cluster of 12 villages near the city of Abha, the capital of the southern region in Saudi Arabia, with a total population of 2150 (290 families) has been included in this study. The family head was interviewed about diagnosed diabetes among family members. Also, the capillary blood glucose level was measured in subjects greater than or equal to 10 yr (the target population, n = 1419) with a reflectance meter after 2-h fasting after the main midday meal. RESULTS: The 87% of the target population who responded for screening showed a prevalence of 4.6% of diabetes, which was higher among men (5.5%, age adjusted, P less than 0.05) than among women (3.6%). Estimates were based on 57 cases ascertained by positive history of the disease (n = 49) or blood glucose level greater than 11.1 mM (200 mg/dl) without previous diagnosis of diabetes (n = 8). The prevalence of impaired glucose tolerance (blood glucose between 7.8 (140 mg/dl) and 11.0 mM (199 mg/dl) with no history of diabetes) was 3.7%, being higher among women than among men (P less than 0.01). Eighty-eight percent of the previously diagnosed cases were receiving treatment at the time of screening. However, in only 12.2% of those receiving treatment was glucose found to be controlled (level less than 7.8 mM [140 mg/dl]). CONCLUSIONS: Diabetes frequency in this Saudi community is relatively high. There is a pressing need to promote public awareness about the disease and to improve the competency of the health-care team for achieving better control and early detection of the disease.
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Glucemia/análisis , Diabetes Mellitus/epidemiología , Hiperglucemia/epidemiología , Población Rural , Población Suburbana , Adolescente , Adulto , Niño , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/prevención & control , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Arabia Saudita/epidemiología , Caracteres SexualesRESUMEN
The performance of reflectance meters for measuring blood glucose concentrations was evaluated in other studies previously and was found to be satisfactory. In the present study, we have evaluated the reliability of one brand of such meters (Glucometer II), when used by several operators, for blood glucose measurements during an epidemiological survey. We have compared the results obtained by the meter with those obtained by a standard hospital laboratory procedure for the same samples. A high and statistically significant degree of correlation (r = 0.901) was observed between the two groups of measurements. The linear regression equation was Y = 0.9X + 13.4. We conclude that the Glucometer II is an accurate and practical instrument even when used by several operators in epidemiological surveys provided that adequate training is given to those operators prior to using the instrument. This is important since the use of reflectance meters in epidemiological surveys is becoming increasingly widespread especially in the third world countries.
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Glucemia/análisis , Diabetes Mellitus/epidemiología , Tamizaje Masivo/instrumentación , Adulto , Niño , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/prevención & control , Femenino , Humanos , Laboratorios/normas , Masculino , Tamizaje Masivo/métodos , Arabia Saudita/epidemiologíaRESUMEN
The sera from 144 patients (27 males and 117 females) with documented gallstones were assayed for eight different biochemical quantities, in order to study the pattern of specific biochemical changes in the blood of such patients and to establish any aetiologic relationship with gallstones. These quantities included: fasting glucose, alkaline phosphatase, alanine aminotransferase, total protein, albumin, total bilirubin, fasting total cholesterol, and fasting triacylglycerol. The same analysis was performed on sera obtained from 50 (9 males and 41 females) age- and sex-matched healthy controls. The statistical analysis showed that female patients had significantly higher values for fasting plasma glucose; alkaline phosphatase, total protein and albumin; and significantly lower values for bilirubin and total cholesterol than female controls. No overall differences in the levels of alanine aminotransferase and triacylglycerol were observed between the two female groups. Male patients on the other hand showed significantly higher values for fasting glucose and alkaline phosphatase than male controls. All other quantities, however, were not significantly different between the two male groups. When chemical analysis of the gallstones was performed, no consistent relationship was observed between the level of any of the above mentioned quantities and the chemical subtype of the gallstone (for both male and female patients). These data suggest that no specific serum biochemical pattern characterizes gallstone disease, and that there is no relationship between the stone type and the serum level of the studied quantities.
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Bilirrubina/sangre , Glucemia/análisis , Proteínas Sanguíneas/análisis , Colelitiasis/sangre , Colesterol/sangre , Triglicéridos/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Análisis Químico de la Sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Albúmina Sérica/análisisRESUMEN
The level of the acute-phase reactant C-reactive protein was determined in the sera of patients with brucellosis who had arthritic involvement (17 patients) as well as in those who had no arthritis (28 patients). The level was also determined in a group of age-matched controls (31 subjects). Patients with brucellosis had significantly higher levels than controls. Patients without arthritis showed a greater elevation than those with joint involvement. C-reactive protein assay is a helpful adjunct in the diagnosis, and in monitoring the treatment, of patients with brucellosis.
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Artritis Infecciosa/diagnóstico , Brucelosis/diagnóstico , Proteína C-Reactiva/análisis , Adolescente , Adulto , Artritis Infecciosa/sangre , Sedimentación Sanguínea , Brucelosis/sangre , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Microalbuminuria is an important predictor of the development of clinical nephropathy in diabetic patients. In this study we have evaluated the sensitivity and specificity of a rapid semi-quantitative method for the detection of microalbuminuria (Microbumintest tablets) in comparison with radio-immunoassay. When the cut-off point for albumin concentration was set at greater than or equal to 40 mg/l the sensitivity and specificity were 97.2% and 92.2%, respectively. Although the tablets are relatively expensive for screening purposes, we conclude that they represent a reliable and convenient screening method for microalbuminuria in diabetic patients.
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Albuminuria/diagnóstico , Diabetes Mellitus/orina , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
To investigate the abnormalities of cell-mediated immunity in patients with recently diagnosed insulin-dependent diabetes mellitus (IDDM), we studied the responses of the two major T lymphocyte subsets from peripheral blood lymphocytes (PBL) to mitogen stimulation. Samples for PBL were obtained from a group of IDDM patients and from a group of normal controls. CD4+ and CD8+ T cells were isolated and were subsequently stimulated with three specific lymphocyte mitogens, namely Phytohemagglutinin (PHA), Concanavalin A (Con A) and Pokeweek mitogen (PWM). The proliferative response was measured by incorporation of radioactive thymidine in lymphocyte cultures which were stimulated by the three mitogens. The responses of CD8+ T cells from IDDM patients and from controls were not significantly different. However, CD4+ T cells from IDDM patients showed significantly depressed responses to PHA and Con A and to a much lesser extent to PWM. These data provide new information regarding the CD4+ T lymphocyte abnormalities found in patients with IDDM.
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Antígenos CD4/inmunología , Diabetes Mellitus Tipo 1/inmunología , Activación de Linfocitos , Linfocitos T/inmunología , Adulto , Antígenos CD/inmunología , Antígenos de Diferenciación de Linfocitos T/inmunología , Antígenos CD8 , Femenino , Humanos , Lectinas , Masculino , Valores de ReferenciaRESUMEN
The peripheral blood lymphocytes from patients with insulin-dependent diabetes mellitus (IDDM) and healthy controls were analysed for the HLA-DR+, interleukin-2 receptor-positive (IL-2R+) activating antigens, and for CD45R+ and CDw29+ subsets from the purified CD4+ and CD8+ T cells populations. Patients with IDDM had an increased percentage of HLA-DR+ and IL-2R+ cells in both CD4+ and CD8+ T cells. However, the percentage of CD4+ CD45R+ suppressor/inducer T cells were decreased and CD4+ CDw29+ helper/inducer T cells increased in all patients with IDDM, compared with healthy controls. Thus, IDDM patients exhibit a deficiency in the CD4+ CD45R+ suppressor/inducer T cell subsets, which is probably related to the autoimmune phenomenon in this disease. In contrast, the percentage of CD8+ CDw29+ T cell subsets showed no major differences between patients with IDDM and controls. An alteration in the CD4+ CD45R+ and CD4+ CDw29+ T cell subsets appears to be a characteristic feature, and may relate to the impaired cell-mediated immunity in IDDM. These data provide new evidence for T cell dysregulation in IDDM.