RESUMO
Familial hypercholesterolemia (FH) is a common but commonly missed diagnosis. Tendon xanthomas are a physical sign strongly suggestive of FH. Physicians must identify tendon xanthomas, apply validated clinical scoring such as the Dutch Lipid Clinic Network criteria and offer cascade screening. This approach will increase recognition of FH.
RESUMO
Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.
Assuntos
Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Corticosteroides/uso terapêutico , Tamponamento Cardíaco/tratamento farmacológico , Criança , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pericardite/diagnóstico , Pericardite/tratamento farmacológico , Pericardite/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To study the association of low serum creatinine, abnormal lipid profile and demographic variables with type 2 diabetic Trinidadian subjects. METHODS: Data were obtained from a cohort of 1122 diabetic and non-diabetic patients from clinics in Trinidad. Variables measured included demographics, HbA1(c), serum creatinine, lipid profile values and diabetic status. RESULTS: The sample consisted of 476 males (61.6% diabetic) and 646 females (50.3% diabetic). Most patients (59.2%) were Indo-Trinidadian, 23.4% were Afro-Trinidadian and 13.5% were of 'mixed' and 'other' categories. The majority (55.1%) of the patients were diabetic and diabetics were older than non-diabetics (p=0.000). Abnormal lipid profile OR=0.728, CI (0.532, 0.994), serum creatinine categories OR=1.520, CI (1.317, 1.754), gender OR=0.690, CI (0.533, 0.892) and age groups OR=1.305, CI (1.185, 1.437) were useful predictors of type 2 diabetes. Ethnicity was not a useful predictor: OR=1.007, CI (0.869, 1.168). Serum creatinine (mean) was found to be lower in diabetics aged 21-50 than in their non-diabetic counterparts. However, above 50 years old, the reverse was true. Serum creatinine means were higher in males than in females (p=0.000). CONCLUSION: Abnormal lipid profile, gender, age and serum creatinine are associated with type 2 diabetes. While age and gender are non-modifiable risk factors, steps should be taken to monitor and control the serum creatinine and lipid profile values of diabetics and non-diabetics.